Changing MD wound care order

[Tampa121]

I work for a small HC company. The MD ordered 1/2 in nu gauze packing to the wound. I called MD to inform him we did not have nu gauze and could I substitute a sterile 2x2. The MA at his office called my administrator and said, "doesn't your nurse know how to cut a 2x2 sterile gauze?" He never told her we did not have the nu gauze. I showed him that cutting a 2x2 frays and that can cause problems in her wound. He wrote me up, because we lost the patient. I have always been taught if we need to change the order we have to call MD. Was I wrong? More to come, this agency is a mess, absent DON and I am ADON with NO job desciption which I have requested numerous times. Administator wants me to train nurses in OASIS! I have always had formal training courses and have 2 manuals that I use all the time. He pays me 20.00hr for 4 hrs a day and has assigned numerous tasks for me, supervising staff, all OASIS visits, performing chart reviews, wants me to set up a training schedule for all staff, put together a medical record with all necessary papers, supervise HHA q 2 wks, LPN's monthly and on and on-all in 4 hrs. Oh and I have to correct their documentation, make a list of supplies nurses need. Please help! I am applying at other companies.BTW- the absent DON called and said I should have used Iodoform packing!! The patient was young and alert. DON has been out for 3 months and is coming back PT 3 mornings a week for 1-2 hrs.

Thank you in advance for your comments!

[Moneytree100]

If I was you I would bail as quickly as possible. It sounds like the administrator is putting your license in jeopardy by having you do everything and anything without a clearly defined job description.Not to mention taking orders from a medical assistant in an MD's office?I would find another job soon and report both the medical assistant that is giving doctor's orders and the administrator for taking the orders to the state board of health.

[RNMom2010]

I agree, get OUT! The things you have listed that you are supposed to complete in 4 hours a day are going to take a full work week to complete accurately. You are being paid a terribly low amount to have all those job responsibilities. However, all of those things you do will look great on your resume for the next, hopefully more realistic home health agency!! Good Luck!!

[Tampa121]

Thank you, I agree with you. I asked him again today for a job description and he finally admitted he didn't have one. so he said he will put a clause into the job desc. i have which is contract hi tech rn. i wrote a formal letter requesting to work 9-1p. his response-i'll have to think about it. everyone there works for other companies including his wife! I can work for another agency with those hrs but not 10-2or even 2:30 which btw he refused to pay me the lousy 1/2 i worked extra for the past 2 weeks! It is a mess there and thank god i document all conversations and have malpractice. I do think it looks good on my resume, so with that until i get something better i'll do what i can in the 4 hrs.