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Advice about sending patients out to ED for a new grad?


Hello everybody,

I am a new grad RN in a sub-acute rehab/LTC facility. I have been here for a month and am on my own, off orientation. When it comes to being cautious and sending patients to the ER r/t a patient condition change, I live by the saying "when in doubt, send them out". As much as I am on my toes and always on the lookout for anything that could go wrong so I could prevent it, I am worried that something wont be so obvious to me (especially because I am brand new and my assessment skills are not great and I have 20 patients). I am constantly running around throughout my shift. I am worried that a patient will end up being sent to the ER by the next nurse because I missed something and that I will be to blame because I delayed treatment. It would be very hard to live with myself if I thought I could have caused a patient to decline due to being swamped or just too new to identify an abnormal finding. How often does this happen, and how do I prevent this? This is a huge source of anxiety to me about my new job. I have seen this happen once to a nurse at my facility where the patient was hypotensive and the nurse did not send the patient out because the patient was stable other than the blood pressure, only to discover that the next shift nurse sent the patient out only one hour later r/t even worsening hypotension and the patient became symptomatic whereas he was asymptomatic before. I really appreciate all of the advice and wisdom on this forum. Thank you in advance.


Specializes in Geriatrics, Hospice, Palliative Care. Has 7 years experience.

I'm an LPN but I'll take a stab at this. Start with your assessment; then call the MD, who will make the decision whether or not to transfer. I really like the interact act program INTERACT - Interventions to Reduce Acute Care Transfers - very helpful, especially for newer nurses! The "when in doubt, send out" attitude is going away since there are financial penalties. If you want to be successful in your SNF, you will want to develop the skills that let you give the MD enough accurate information to make the decision. Also, there's plenty of evidence that elders do really poorly in hospitals, so that is another reason to treat their condition at the SNF if it is possible.

WittySarcasm, BSN

Specializes in rehab. Has 10 years experience.

One thing that's really important. Listen to your CNAs if they tell you the patient's not right believe them. They see the patient so much more than you can ever hope to. No matter how attentive you are they will catch it before you. And they learn so much from us.

Secondly, not everyone is going to be sick so use the nursing judgement. If you have a stable person just do a normal assessment. However if you see someone that just seems off keep an eye on them. It lessens your stress and continued assessments.

Also if you have any other nurses in the facility ask them if they can double check your findings, even if the patient seems fine and have that gut feeling go with it.