Doctor vs Nurse - page 7

by anne919

13,683 Views | 89 Comments

I work in a nsg skilled facility and rehab at the same time. Our medical director always orders continue to monitor when I report something to him. One time I reported an extremely high blood glucose level of our hospice pt.he... Read More


  1. 1
    Am I the only one who thinks this is completely made up? All of it?
    CapeCodMermaid likes this.
  2. 4
    Quote from Orange Tree
    Am I the only one who thinks this is completely made up? All of it?
    I hope it is but I doubt it. I am beginning to wonder if English is the OP's second language and that's contributing to the misinformation.
    BrnEyedGirl, tewdles, Nascar nurse, and 1 other like this.
  3. 0
    Is it regular charting to put down the side effects? Nurses cannot make diagnosis...did you write flu in the chart? So you were making a prediction...that's not nursing. You should have learned this in school. You need to brush up on your charting.

    As far as the doc just work with him and stop taking everything so personally. If you call have prepared what you want and then proceed from there. Relax, they're not the enemy.
  4. 0
    You lied...

    I am not a nurse, but only a student.

    Wrong tread.
    Last edit by violetgirl on Dec 30, '12
  5. 0
    Quote from SionainnRN

    Why in the world would you call 911 for wheezes??? As another ED RN that is an extreme reaction. Your patient has wheezes and poss pneumonia on an CXR, and guess what? The MD started abx and breathing treatments and O2. What in the world do you think we could do that isn't being done? The only reason to call 911 in this case is if the pt couldn't maintain their O2 sats and was going into resp distress. Otherwise give the abx some time to start working, geez.
    And this is in NO WAY unethical or unlawful. It seems to me you have your panties in a bunch about the doctor and are trying to find anything you can to make them look bad.
    I don't see where she said breathing treatments were ordered. You can't ignore audible wheezing. Lets be really honest here folks. The ltc folks call 911 for absolutely everything including a fever with no other symptoms. Expiratory wheezing bears addressing in my opinion as a nurse.
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    Vicedrn....I am one of those "ltc folks". At any facility I've run, we did NOT call 911 for "absolutely everything". In fact, we try absolutely everything we can to keep our patient in the facility....labs, xrays, ultra sounds, IV therapy,nebs...what we don't do is shoot a confused elder full of Haldol like you ER folks do.
    LTCNS, BrandonLPN, and tyvin like this.
  7. 0
    Quote from CapeCodMermaid
    Vicedrn....I am one of those "ltc folks". At any facility I've run, we did NOT call 911 for "absolutely everything". In fact, we try absolutely everything we can to keep our patient in the facility....labs, xrays, ultra sounds, IV therapy,nebs...what we don't do is shoot a confused elder full of Haldol like you ER folks do.
    The facilities in my area absolutely do not do IV therapy or new neb treatments. I can tell you this as a fact. I recall one night hearing in report that our facility disciplined a nurse for discharging a patient to LTC with an iv access. The LTC called 911 to take the patient back to the hospital and have it removed. I am NOT MAKING IT THIS UP!!!!

    They absolutely won't do nebs on a new onset wheezing. Every patient has to have his or her own neb machine and they expect it at their facility before we discharge patient.

    We aren't permitted to give Haldol to pts with acute confusion anymore. I miss the days greatly. I think the reaction to the use of haldol in confused elderly is overblown and mostly cultural. We just can't associate little old grandma with a schizophrenic! oh no! that would be so not right. Haldol is not, in my opinion, the end of the world under certain circumstances. In fact, sometimes I think its the only humane thing to do.
  8. 1
    I've worked both sides (ltc and er) and I think not of you have fundamental misunderstandings about what the other does. In ltc you are often working with patients who are relatively stable but need some more help with adl's. The nurses in this environment are carrying between 15 and 30 patients depending on the facility. With these patients you are expected to medicate, do wound care, ensure that feeding and toileting take place etc. If a patient begins to go south there is frankly little time to sit and monitor them to see if their condition changes. You go with your gut and call the md. As an er nurse now I have much respect for what they do because I've been there and know how hard and stressful that work can be. My shift, start the finish, was basically a medication pass... God help me if anything came up.

    From an er nurses standpoint pts come from ltc's in all sorts of conditions. From basically nothing wrong but being sent out because the family insists that grandma with dementia who they haven't bothered visiting in a year is acting more confused needs an er eval to patients who are satting in the low 80s gasping. We don't just give them "haldol" and send them back. All of the patients have to be worked up, and unfortunately the history that we get from the nursing homes leaves a little bit to be desired.

    Both of you need a reality check... Walking a mile in the others shoes might be helpful
    Altra likes this.
  9. 0
    Quote from VICEDRN

    The facilities in my area absolutely do not do IV therapy or new neb treatments. I can tell you this as a fact. I recall one night hearing in report that our facility disciplined a nurse for discharging a patient to LTC with an iv access. The LTC called 911 to take the patient back to the hospital and have it removed. I am NOT MAKING IT THIS UP!!!!
    Would you dc a patient home with iv access? It's a HUGE risk for infection. I pulled ivs out of patients we received from the ER but they should not have been left in the first place as ltc's do not typically give iv drips. Your coworker screwed up.

    They absolutely won't do nebs on a new onset wheezing. Every patient has to have his or her own neb machine and they expect it at their facility before we discharge patient.
    This isn't a hospital that you're dealing with, it's not like they have a supply of nebulizers that can just be pulled from, if the pt needs nebs it would be prudent to have the equipment on hand, wouldn't you say?

    We aren't permitted to give Haldol to pts with acute confusion anymore. I miss the days greatly. I think the reaction to the use of haldol in confused elderly is overblown and mostly cultural. We just can't associate little old grandma with a schizophrenic! oh no! that would be so not right. Haldol is not, in my opinion, the end of the world under certain circumstances. In fact, sometimes I think its the only humane thing to do.
    Haldol is overly sedating and can exacerbate existing confusion. You do realize that haldol has a black box warning r/t administration in elderly dementia patients, right? As it turns out there is a higher mortality rate in those who receive it. The problem with elderly psychotics is that it is near impossible sometimes to differentiate organic deterioration vs psychotic symptoms.
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    In OP, she works at a skilled nursing and rehab....in my area, when there is a "rehab" component, they do IV infusions-including TPN, nebs, etc, especially if it is designated as a LTAC (long term acute care). More and more of LTC is becoming sub acute....the "rehab" part now is truly "rehab"! And you still have 25 patients. When I worked in rehab, you didn't send them out for new onset wheezing...you can take an x-ray, there's a pharmacy on site, respiratory therapy, etc. I may be making an assumption, but what I gather from the poster, this facility has the capabilities of handling this, but from her novice experience, she wanted to send out the pt, also for concern for her license, despite misleading the doc and charting incorrectly.... We have to remember depending on where we work geographically, there are many aspects of nursing care that may be changing, especially in LTC, and even facilities still vary.
    Altra and VICEDRN like this.


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