Can Managers Override Policy and Drs Orders?!?

Because cauti are high, our manager said that now we can't get orders from the provider. It has to go through him and he has to approve a foley. Does a manager trump Drs orders and policies?!?!? He said we have to straight cath patients q4-6 and there's no harm doing this daily. 

39 minutes ago, klone said:

Um, is the manager an MD? If not, then no. LOL

That’s what I thought! he’s not an MD, not a PA or even an NP. The nerves LOL. 

22 minutes ago, JKL33 said:

I suspect the OP has simplified (or perhaps their manager did in conveying the message to staff) but what they wrote here for us to comment on is that they were told they can't get orders from the provider and that [if their patient is having an issue...for which a foley might be considered] they are to go to him. If that is true, that is a no. As a general concept.

Yes, it's not really clear what's going on

2 minutes ago, JKL33 said:

And let's not overlook the elephant in the room, which is that any UTIs associated with multiple straight caths by (often inexperienced) extremely harried staff members is not something that is being measured and it doesn't have an acronym-turned-word for people to crow about. It's good that we have been able to decrease inappropriate use of indwelling catheters and infections associated with them, but for now we have replaced that with an intervention/outcomes we aren't vigorously measuring. If that straight cath patient develops a UTI, at least it won't be a CAUTI!! Whew! ?

You could also decrease CAUTI rate by telling nurses that they must report to the nurse manager if they think their patient needs a urine culture. ?

No disagreement here. Straight caths aren't the only answer to cauti reduction

On 9/10/2022 at 7:28 AM, mtmkjr said:

It may not be a matter of overriding MD orders or policy but being involved to reduce the number of Foleys. He says it has to go "through"  him not "to"  him. If the provider agrees that a straight cath would be appropriate then the patient is saved a Foley. If they do not agree then the patient gets a Foley per order.

If on the other hand he is changing orders from Foley to straight cath, then big no. 

No the providers don’t have a say according to him, he gets the final say so. We had 2 patients where we had orders to place a foley because for 2 days the patients have been retaining urine. According to policy if we straight cath 3 times and the patient is retaining we can place a foley (with providers order for urinary retention) now we can’t. We have to go to him NOT the providers for a foley. Then the charge nurse has to get it from the managers office. The 2 patients that had orders he said no and we needed to continue straight catheterizing. The providers are VERY upset at this and I’m hoping they take this upwards.

They have now gone to the extremes of removing ALL foleys from the units. 

On 9/10/2022 at 11:09 AM, mtmkjr said:

The nurse is ultimately following the provider order not the managers - the provider would have to agree that straight cath is OK, and may choose a Foley in spite of manager suggesting otherwise.  The nurse is still the patient advocate and following appropriate orders, and would reflect standard practice under scrutiny. 

Actually it’s not the providers order to straight cath, the providers are saying patients need the foley. The manager is saying no. This is why the providers are also upset. 

5 hours ago, toomuchbaloney said:

Does your manager want to put his directive in writing? He should.  Will he object to you documenting that he was the professional who provided that guidance? 

It's really up to you as to whether you will follow the doctor's orders or the manager's orders. But if you choose to follow the manager's orders you need to document the specific actions that you took and document why you chose to do something different from what the provider ordered.  That won't necessarily save you should there be repercussions but it will at least make the patient record clear as to who was dictating the care. 

Now that he has removed the foleys from the unit, it has to go through him since they will be kept in his office only.  Nothing is in an email or writing, everything is verbal. 

46 minutes ago, Aloe_sky said:

Now that he has removed the foleys from the unit, it has to go through him since they will be kept in his office only.  Nothing is in an email or writing, everything is verbal. 

Okay well then he is out of bounds. Hopefully no one in upper management supports this. 

Specializes in Critical Care.
Tweety said:

If the manager is saying straight cath without an order then no that's not legal.  

If the manager is saying, "let's talk about this before you call the doctor to get an order for a foley" that's totally appropriate.

I am confused that you say he says to straight cath q4-6h and it's it's okay to do this daily.  That doesn't make sense.

18 hours ago, Delia37 said:

I feel like there is more to this, since CAUTI protocols are so common everywhere. Wish the OP would come back to provide more details/clarification. My facility implemented the need for the bedside nurse to notify the charge nurses when there is a need for a Foley; since being in the frontline, is common for nurses to often request for Foley placements. Initially we hated it, however, I have to admit...it has tremendously decreased the amount of Foleys placed in, since some nurses were requesting Foleys just for incontinence. 

We were never able to place foleys for incontinence. We have to have an order for specific criterias….for patients that are hospice, retention (if the nurse has to straight cath 3 times in a row according to policy), for wounds that are in the peri-area and stage 3 and 4 pressure ulcers. No longer in the ICU can we use a foley for strict I&Os, even if Nephrology or ICU providers order it. Also if I go to the provider and say I’ve straight cathed 3 times, they will put in an order for a foley. The manager says we can’t despite policy and despite the providers order. 

1 hour ago, Aloe_sky said:

We were never able to place foleys for incontinence. We have to have an order for specific criterias….for patients that are hospice, retention (if the nurse has to straight cath 3 times in a row according to policy), for wounds that are in the peri-area and stage 3 and 4 pressure ulcers. No longer in the ICU can we use a foley for strict I&Os, even if Nephrology or ICU providers order it. Also if I go to the provider and say I’ve straight cathed 3 times, they will put in an order for a foley. The manager says we can’t despite policy and despite the providers order. 

So when the manager says you can't, what happens next?

1 hour ago, mtmkjr said:

So when the manager says you can't, what happens next?

Since he just started this a few days ago, we have been straight cathing. However 1 nephrologist is very upset and insisted on my patient having a foley and a cardiologist insisted on another patient having a foley. 

the cardiologist had his nurses place it in the cath lab. The nephrologist spoke to my manager directly.

on nights the physician assistants honestly don’t have leadership skills and I honestly think they don’t care much about any of this. So they will place the order for a foley because it’s policy but whether or not we do it, they don’t care.

our bladder machine is old and takes a long time to process, especially working with a majority obese population, it increases the processing time since we have to push deeper and try to get a reading. I got report from a nurse that didn’t have time to do it at all.

In the ICU we now are budgeted, nurses can’t work overtime to help in order to “prevent burn out” but those that are scheduled are required to take on extra patients instead of our usual 1 or 2 patients as if that doesn’t contribute to burn out!  

Nurses are saying they don’t care anymore and I completely understand, it’s sad. I’m tired of venting, it is what it is.

Specializes in Psych/Med Surg/Ortho/Tele/Peds.

That mgr sounds as foolish as my old facility "All restraints (chem/mechanical) go through me." ?

12 hours ago, feelix said:

Inappropriate an uneccessary foleys can lead to cauti, sepsis and death. Regulatory agencies are watching hospitals and nursing homes like hawks where prolonged foley use is concerned.

Hospitals in turn are doing so too to avoid consequences. Maybe your manager has been asked to monitor foley use.

It seems to be communication failure above all.

Yes but can’t urinary retention also be a cause of UTIs? Can’t that also be a risk of bladder damage and kidney disease?  Can’t straight cathing if not using proper technique also risk contamination and introduce bacteria into the bladder? 
we now have patients that some nurses don’t have time to bladder scan, sometimes we can’t even find a bladder scanner and nurses are refusing to go on the hunt for them, we also now have run out of straight caths and nurses are also refusing to look for them on other units. It just seems like this is going to be worse. 

+ Join the Discussion