At what point do you send to the hospital?

ClearBlueOctoberSky · Jul 29, 2013

I'm not sure of the structure of your facility, however, at mine, I would have been responsible for notifying the doctor and obtaining any orders. If I felt that the patient needed to be sent out, it would have been up to me to call the doc, notify him and family of change of condition, and explore/advocate options.

The LPN's here charge their own floors, with the RN there as a back up. If I have any doubt, I get the floor RN, or more often than not, I call my DON or NM to come and help.

jamd11 · Jul 29, 2013

Thanks for the info!

At the facility I am at (its probably different in canada mind you) the RN makes the final call (I'm a RPN which I think is equal to a LPN) to send to the hospital or contact the MD. I did phone the on-call acting doc and was basically told it was the RNs decision. I presented her with my assessments and what I thought was best for the patient and asked her to at least phone the MD for clarification but that didn't happen.

ClearBlueOctoberSky · Jul 29, 2013

In that case, I might follow up with my DON. I wouldn't do it in an accusatory tone. I would just want clarification and to know the rationale of why was the patient treated the way they were. You would also be able to express your feelings of not being heard or taken seriously by the RN.

I can tell you, if that was my family member, upset would be a mild word for what I would be feeling.

DedHedRN · Jul 30, 2013

This whole situation stinks. Are you a RN because this is unacceptable. You have to follow the standards of nursing, remember from nursing school? ADPIE? This sounds like gross neglect to me.

Even as a new nurse, you must advocate for your pts. You MUST call the dr for changes. If someone tells you not to, and you listen to them, you are exercising bad judgement. You are practicing under YOUR own license and you must protect it. What if this was your family member, would you be happy with your actions?

IrishErin · Jul 30, 2013

Thanks for the info!
At the facility I am at (its probably different in canada mind you) the RN makes the final call (I'm a RPN which I think is equal to a LPN) to send to the hospital or contact the MD. I did phone the on-call acting doc and was basically told it was the RNs decision. I presented her with my assessments and what I thought was best for the patient and asked her to at least phone the MD for clarification but that didn't happen.

I had been in a similar situation at an LTC home in Canada as well, I called the family and asked for their wishes. Mind you, the pt was not a dnr. The RN had been unconcerned but I couldn't ignore the symptoms. Turns put the pt had indeed suffered from an ischemic stroke. I did receive a "talking to" for going over the RN's head but ultimately I did the right thing. I didn't stay long there and am happy in my current place of employment.

jamd11 · Jul 30, 2013

This whole situation stinks. Are you a RN because this is unacceptable. You have to follow the standards of nursing, remember from nursing school? ADPIE? This sounds like gross neglect to me.
Even as a new nurse, you must advocate for your pts. You MUST call the dr for changes. If someone tells you not to, and you listen to them, you are exercising bad judgement. You are practicing under YOUR own license and you must protect it. What if this was your family member, would you be happy with your actions?

Hi Isis. I'm not an RN and yes I remember my schooling. Had you read my entire post you'd see that I stated at the facility I work at in Canada the charge nurse who is ALWAYS the RN makes the final decision. I did what was required of me I told the RN my thoughts and I was completely undermined to the point I called the director of care who told me it is what it is and the RN makes the final call based off my information and assessments. I fulfilled my duties and documented everything including my opinion that the resident should have been transferred to the hospital or at least have the MD notified. I realize that policies are different in the states I was just looking for some general advice and not a lecture about how I was neglectful. I thank you for your opinion and I was not happy about the decisions made, hence why I was asking for advice. Unfortunately, I did all I could do and to answer your question I would be livid if it happened to my family member. I've only been at the facility for not even a month and I have to say I disagree with their policies and procedures and will be looking for employment elsewhere. I will also make sure to ask what their policy is in situations like this. Lesson learned.

jamd11 · Jul 30, 2013

I had been in a similar situation at an LTC home in Canada as well, I called the family and asked for their wishes. Mind you, the pt was not a dnr. The RN had been unconcerned but I couldn't ignore the symptoms. Turns put the pt had indeed suffered from an ischemic stroke. I did receive a "talking to" for going over the RN's head but ultimately I did the right thing. I didn't stay long there and am happy in my current place of employment.

Thanks for sharing. I wish now I went over the RN. But I can't turn back time . As I just posted above lesson learned ! I really dislike this policy, a previous Rpn was fired recently for going over the RN and sending a resident to the hospital. I was weary of this happening to me too. Thanks again for sharing !

chrisrn24 · Jul 30, 2013

This whole situation stinks. Are you a RN because this is unacceptable. You have to follow the standards of nursing, remember from nursing school? ADPIE? This sounds like gross neglect to me.
Even as a new nurse, you must advocate for your pts. You MUST call the dr for changes. If someone tells you not to, and you listen to them, you are exercising bad judgement. You are practicing under YOUR own license and you must protect it. What if this was your family member, would you be happy with your actions?

Yep.

If the patient were to die and family sues its not the other nurse's license on the line, it's yours. I would've sent them out. If nothing was wrong they will come right back.

jamd11 · Jul 30, 2013

Yep.
If the patient were to die and family sues its not the other nurse's license on the line, it's yours. I would've sent them out. If nothing was wrong they will come right back.

Not according to the policy at this institution it's states clearly that the RN is responsible for the final decision. I don't agree with it at all but it is what it is I called the doc to let her know and she told me exactly this " it's out of your hands the RN must make the decision to send". It's also in our employee handbook.

DedHedRN · Jul 30, 2013

Some institutions have policys that can cause you to lose your license. I know. I have ran into them even in California. And I have also chose to ignore company policy when it is going to put my license in jeapory and faced having to explain myself before. But since I always advocate for my pt even when its against the grain, the law is on my side, and the board of registered nursing would be on my side as well if it ever came down to it. Law and company policy are occasionally at odds as well, and I choose to follow the law.

There....are....Four.....lights!

jamd11 · Jul 30, 2013

Thanks for the advice!