How do you convince administration and or doctors?

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    How do you convince administration and doctors that certain pts need higher levels of care than what a small facility can provide? The past couple of weeks we have had several peds patients that really needed a pediatrician. (We only have family practice docs and some specialists that consult on patients). One peds pt is still in our facility and he/she is a very sick child. But the family doc think the patient can be managed at our facility. And administration gets mad if we suggest transfer of some patients. One of my personal favorites is when a dialysis pt is admitted who is going to require dialysis the next day. We don't have dialysis at our facility. So after we go through all the paperwork of an admission (that takes over an hour if you do it correctly) the person will have to be transferred the next for dialysis. Or we get a fairly young person (40's-60's) who is having chest pain with no prior cardiac history...of course tuck them in at our place until cardiology comes through later in the day and decides to have them transferred for a cath. This stuff just aggravates me. Do all that paperwork and shazam! the patient is transferred...

    We complain to our DON but she just turns a deaf ear....and the administrator just gets mad when we suggest a pt needs transfered to another facility. One time one of the family practice docs wanted to admit a 3 week old infant for something...I believe rapid resps and a cough. Our DON (who hasn't done bedside nursing since Florence was around with her lamp) said she would go down and determine if the infant was suitable for admission at our facility. Why not send one of the nurses who work WITH pts everyday and knows the strengths and limitations of the nursing staff go down and evaluate the infant? Because she knew we would say the kid needed transferred. And guess what? After 2 days the child was transferred to a larger hospital with a pediatrician.

    Anyone else run into this problem at their rural facility? How does your administration and doctors deal with it? What determines if a pt stays or is transferred? (Of course some pts are obvious, even for our docs!). How does the nursing staff try to persuade a physician into transferring a patient? And convince administration the transfer was necessary? Any ideas?
    gcupid likes this.
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  3. 8 Comments so far...

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    Deespoo,
    Used to work rural as you already may remember. Those are such tough situation.
    I worked my way through appropriate chain of command when the doctor would not ship out patients that required care above the capabilities of the facility. Sounds like you've taken it as high as you can, if Drs(chief of staff) nor administrators are responding to your concerns.
    We did have a few situations where the nurses refused the assignment, however they would just call nurses at home until they found one that would do it .
    How do the families deal with the situation,
    How do you answer their questions?
    Puts you in such a ethical delima?
    Wish I had a great answer for you, but I do not.
    Keep going, never let them stop us from being a PT ADVOCATE
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    ps. iI would have never won any popularity contest with administration!!!!!!!!!
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    Originally posted by cwazycwissyRN
    ps. iI would have never won any popularity contest with administration!!!!!!!!!

    Me neither! I am probably administration's worst nightmare after an attorney!! I do not back down from an argument very easily....just ask my husband. He says I am without a doubt the most stubbornest (is that even a word? ), thickheaded person he has ever met in his life...He says I am more stubborn than my own mother which is either a compliment or an insult depending on my mood at the time...

    Sometimes us nurses will drop subtle hints about getting a second opinion or being transferred to a larger facility. Sometimes they get the hint, sometimes they don't. If I really truly believe a pt needs transferred I will just ask the doctor point blank.

    There are some patients who I think are just way too sick/complicated for what my knowledge base is. 80 y/o with CHF, no problem. I can deal with that. 40 y/o with an uncomplicated case of pneumonia? I can do that too. Cellulitis, DVT's, colon resections, hysterectomies, gallbladders, and appys, bring them on!! A 12 y/o with a SpO2 in the 70's without O2? Ship her and PDQ!! 45 y/o male with chest pain with no prior cardiac history? I want him on the next ambulance out of town!! If that guy would need an immediate cath, we are an hour away from the nearest hospital with a cath lab!! 14 y/o kid who is bigger than I am with a new onset of grand mal seizures? Outta there!! (The last one actually happened to us. The kid ended up having viral encephalitis!!)...oh the joys of working in a rural hospital....
  7. 0
    How do you convince administration and/or docs?

    Data, data, data. Collect the relevant data, organize it, analyze it, present your case. Choose the data carefully. Use it to show that the current practices are causing problems of some kind, bad outcomes, etc. You might also want to collect some articles, case studies, etc. that show that the hospital is taking on some unnecessary legal risk by keeping patients who shouldn't be there.

    It's all about "making a case" -- collecting information, evidence, etc. and presenting it well. Take the professional approach. If you simply complain, it may appear that you are simply trying to get out of doing the work of caring for these patients.

    Good luck,
    llg
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    Be honest and unafraid to give your opinion to the admitting doc. The nice thing (sometimes) about our small facilities is that we know our coworkers, doctors and nurses alike, quite well. It doesn't always make you popular to make a suggestion to transfer, but it is necessary sometimes. Here are some things I've said or heard others say:

    We don't want to keep a person that young and unstable here, do we?

    If that were my husband, I would insist that he be transfered to a place where he could be cathed (cardiac) right away.

    I wouldn't want to be the nurse with him on the ambulance transfer much less in charge of him overnoc. Let's get a helicoptor in the air!

    I think I would insist that a pediatric specialist be the one to do that to my little one (liver biopsy on 18 month old).

    We do not have the staff available to monitor that baby (RSV) for respitory fatigue moment-by-moment. She needs an appropriate ICU and ventilator set-up for that eventuality.
  9. 0
    Originally posted by ceecel.dee
    Be honest and unafraid to give your opinion to the admitting doc. The nice thing (sometimes) about our small facilities is that we know our coworkers, doctors and nurses alike, quite well. It doesn't always make you popular to make a suggestion to transfer, but it is necessary sometimes. Here are some things I've said or heard others say:

    We don't want to keep a person that young and unstable here, do we?

    If that were my husband, I would insist that he be transfered to a place where he could be cathed (cardiac) right away.

    I wouldn't want to be the nurse with him on the ambulance transfer much less in charge of him overnoc. Let's get a helicoptor in the air!

    I think I would insist that a pediatric specialist be the one to do that to my little one (liver biopsy on 18 month old).

    We do not have the staff available to monitor that baby (RSV) for respitory fatigue moment-by-moment. She needs an appropriate ICU and ventilator set-up for that eventuality.

    Hey, thanks. I will have to try a few of those lines someday. I think our family docs get a lot of static from our administrator about keeping patients at our facility. I have no problem with that as long as the pt has something that we can safely deal with. I know that you can't always anticipate emergencies, but some pts just come in with it tatooed on their heads "Code blue waiting to happen!"
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    My last full time job( am happily doing agency for now) was at rural place, and this came up quite frequently with one doc. He thinks he can fix everything....last fight nurses had with him cincerned pedi burn patient who really should have not been admitted, should have been shipped from er to burn center. When weekend came along said doc was not on call. Took nurses about 5 min to convince oncall doc to ship....

    Another time one of my fav docs had a patient go into 3rd degree block. That doc wanted to wait a few days until one of cardio guys showed up for his weekly visits. So( very sweetly) I asked him how well he did transvenous pacers, as those externals were so durned uncomfortable...HAd cardios phone # in hand as i said it. Had that patient in helio within the hour...Being sneaky works with some
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    Cactus wren-

    I really enjoy the way you think!! I will have to try your approach to getting certain patients on to bigger facilities. Thanks...


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