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D.O.N. concerned more with census than NH residents care

burrt-lpn burrt-lpn (New) New

:madface: At the facility where i work the D.O.N. is denying nurses to send residents out to the hospital who need to go in order to keep the census up. Residents who are full codes have stayed in the facility while being in acute distress. Being a NH with very limited supplies there is very little we can do. She would rather the person died there it seems. I know when the lawsuits come she will be in the clear because she will say she was not aware of the serious nature of the situation. she has gotten unit managers to lie to family members telling them their loved one will sit in the ER for 8 hours without being seen and that it is better for them to stay in the facility. This particular resident was in resp distress! Everybody knows resp distress patients are priority in the ER, but the family believed them. This D.O.N even bosses around the nurse practicioner! I don't get it. This DON MSN claims to be a christian, and cares so much about people yet her bonus at the end of the quarter is more important than a human life!

unknown99, BSN, RN

Specializes in Inpatient Acute Rehab.

If I were you,

I would get out of there. Not sending a patient to the ER for emergency treatment when needed is considered negligence. If this happens, you can bet eventually a family will sue, and do you think the DON will bavk you up?? NO. She will cover herself; you will be fired; and named in a negligence lawsuit.

I am sure you worked much too hard for your license to lose it like that!!

Thunderwolf, MSN, RN

Specializes in Med-Surg, Geriatric, Behavioral Health. Has 32 years experience.

did i hear you say...you or someone else...made an anonymous complaint to the state bon or another governing body?....ooops, did i say that?

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RosesrReder, ASN, BSN, MSN, RN

Has 18 years experience.

[color=olive]:) welcome to the site, enjoy your stay and best wishes to you! :balloons:

:madface: At the facility where i work the D.O.N. is denying nurses to send residents out to the hospital who need to go in order to keep the census up. Residents who are full codes have stayed in the facility while being in acute distress. Being a NH with very limited supplies there is very little we can do. She would rather the person died there it seems. I know when the lawsuits come she will be in the clear because she will say she was not aware of the serious nature of the situation. she has gotten unit managers to lie to family members telling them their loved one will sit in the ER for 8 hours without being seen and that it is better for them to stay in the facility. This particular resident was in resp distress! Everybody knows resp distress patients are priority in the ER, but the family believed them. This D.O.N even bosses around the nurse practicioner! I don't get it. This DON MSN claims to be a christian, and cares so much about people yet her bonus at the end of the quarter is more important than a human life!

First off Welcome to Allnurses. Secondly, you are working off your license. So call the MD and notify them of any abnormal assessments and if the MD wants the resident sent to ER then they should go. I have worked LTC for a long time as an LPN, RN, and a nurse manager. You need to cover your own butt and protect your residents. Chart carefully your assessment and you conversations with the MD and family. Try to not take short cuts with this because you are busy.Sometimes families will chose to not allow an ER transfer and that is fine as long as the MD is on board and the nurse keeps all updated on condition and changes. This way you will be protected when DPH arrives for a complaint of improper nursing care. Good luck.

SmilingBluEyes

Has 20 years experience.

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txspadequeenRN, BSN, RN

Specializes in ICU, PICC Nurse, Nursing Supervisor. Has 20 years experience.

Welcome to all nurses!!!! Now you need to run, not walk away from this job. When you are standing in court or defending yourself in front of the BON this DON will be no where to be found. DON or not if they need to go ....THEN THEY GO!!!! I would find another job if I were you. What does she think if they stay her census stays up until they all die ,then what. Then state comes busting through the door investigating these numerous deaths and look who's name is on the charting. You will never back your license by saying "Well the DON didnt want to send them out". It is a sad situation when money and census comes between doing the right thing.

CoffeeRTC, BSN, RN

Has 25 years experience.

Maybe someone can move this out of the intro forum?

This is total BS. Every year around the holidays they post a note about contacting the DON or ADM before sending a pt to the hospital. Um, no. Heck no. I am the nurse practicing on my license, not the ADM. I will assess the pts and call the doc for further orders. A lot of times a doc will try to just send the pt out even if it is something treatable in the NH. In those situations I will ask for treatment at the nursing home and they will most often agree, but if needed they are sent out. (A lot of nurses won't question a docs order and will just send them out for minor things....that is where the notes come from)

Now the main reason I end up sending pts out is that over the weekends or holidays, labs don't come for pick ups, pharmacy is delayed or it is almost impossible to get an X ray done. If we would have better services at our nursing home, I would definatley make sure my pts stay in their home for treatments, but heck we all know the reality of the situation.

You are the nurse, you are praticing on your license and under the doctors orders. Not the DONs or ADM.

Thunderwolf, MSN, RN

Specializes in Med-Surg, Geriatric, Behavioral Health. Has 32 years experience.

Good suggestion. Thread is moved to the Long Term Care Nursing forum for additional viewing, feedback, and support. Good job, folks...who have responded thus far.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Can you spell "G" tag??? When in doubt ship 'em out...the DNS needs to get a grip! Where I work when the census goes down we take highly inappropriate (read psychotic) patients we are not equipped to deal with....

i once had a don who gave me an order and i reluctantly carried it out.

dph (dept of public health) ended up being involved; i told them i was carrying out an order from my don. the don outright denied ever giving me that order. inevitably she was charged, i was not. from that incident, i learned to trust my gut instincts and fiercely protect my license. sadly i've learned that there are many unscrupulous people in upper mgmt. and the bottom line is the $$, not the patients.

leslie

I am a DON in a LTC. Your DON is the kind of person that gives the rest of us a bad name. She probably wasn't a very good nurse either. You have two choices. You can leave and hope the residents don't die of neglect or you can stay. If you stay make sure that you document everything, and to be on the safe side make copies for yourself. Don't let people know that you are, just put them aside in case you need them later. You would be surprised at the records that come up missing. Always CYA.

Always rely on your own judgement. You really do not need an order to send a resident into the hospital. If something like this would ultimately go to court, it would all come down to the nurse taking direct care of the resident at the time. Your nursing judgement is what would be on trial. I have sent residents to the ER without an order. Sometimes the doctor is mad at me, but I would rather it be him/her than a family with a lawyer.

btw: when I said you could leave and hope the residents don't die of neglect, I wasn't really trying to put pressure on you to stay. It just sounds like they need a good resident advocate/nurse.

I have a similar problem where I work. We have to notify the DON and the Administrator before we send someone out. Plus they want us to use the facility van to transport instead of an ambulance whenever possible. At one point I had to have the DON do her assessment of the resident before I was allowed to send them to ER. It's disgusting. Now when someone needs to go to the ER I just make the calls and send them. If anyone gives me any flak I just say either we'll lose this resident temporarily or permanently (if they die), and if they have a three day hospital stay the facility will get the Med-A money (I think it's around $10,000 a month). That always shuts them up! I think the anonymous call to State was a wonderful idea. It sounds like your DON needs a huge wakeup call!!!

If a patient needs to go to the hospital and you work as a nurse in LTC, it is your responsibility to call 911 and get the patient transferred if there is a need to do so.

Also, I would not continue to work in such a setting.

Finally, make sure that you protect yourself by having nursing malpractice insurance (with a disciplinary defense---Board of Nursing provision) if you work anywhere in long term care.

It is my personal belief that you are more likely to be reported to your Board of Nursing or sued if you work in LTC. :balloons:

This is concerning. I do not dictate when my nurses send residents out, unless I feel they need to go and my nurses are dragging their feet. I get called after the resident is taken care of (night, weekend etc) as it should be. We do involve the family if the doc does not want to admit. You know if the resident is treated early enough, they come back and will stay on your census longer. I'm wondering if they usually do not come back for some reason, or the hospital refers them elsewhere. In this case, the DON may want to work on public relations to help your facility become the preferred provider so that the hosptital will refer and send them back. If they are medicaid, the bed is usually held and paid for at least at the default rate, and if they are private, the facility bills the family for the bedhold rate. This is really too bad. Not all DONs are like this...Do you have a risk manager on staff?

This topic has recently caused me to resign from a job at one facility and go work at a sister facility. My DON refused to send a patient out ( nursing home) who had had diarrhea for 4 days. We called the DOC, got an order, she calls him back and tells him all she needs is to drink water, which she promised she would do personally.She hung up the phone and goes home. The DOC resinded the order, the patient died in her sleep that night. I reported to administration, the office nurses re-wrote the proof on the chart, labled ME a RAT, and stopped talking to me. Then,,,,, Two LPN's mentally harassed and abused one of my patients for their own entertainment by taunting and inciting her into a rage directed at me. I reported it in writing, The Don "heard a rumor" that I don't like her and focused her attention on that instead of the abuse. She terminates me for insubordination and breaching patient and facility confidentiality. She NEVER adresses the patient abuse reported by me in any way. I wanted to sue her for wrongful termination, But I am thinking of reporting her to the RN board. Can any one tell me what evidence I should include in my report, and what your thoughts are about my plan of action? THANKS, this has me in a career crises.

HappyJaxRN

Specializes in Transplant, homecare, hospice. Has 9 years experience.

:madface: At the facility where i work the D.O.N. is denying nurses to send residents out to the hospital who need to go in order to keep the census up. Residents who are full codes have stayed in the facility while being in acute distress. Being a NH with very limited supplies there is very little we can do. She would rather the person died there it seems. I know when the lawsuits come she will be in the clear because she will say she was not aware of the serious nature of the situation. she has gotten unit managers to lie to family members telling them their loved one will sit in the ER for 8 hours without being seen and that it is better for them to stay in the facility. This particular resident was in resp distress! Everybody knows resp distress patients are priority in the ER, but the family believed them. This D.O.N even bosses around the nurse practicioner! I don't get it. This DON MSN claims to be a christian, and cares so much about people yet her bonus at the end of the quarter is more important than a human life!

:eek: RUN! Get out...if not, then CYA with documentation. OMGosh, bad situation.

I am soooo glad I work with a good group of people, right from the administrator on down! Our DON would NEVER do something like this. If I were you I would, as others have posted, RUN as fast as I could!!

Any nurse who sees another nurse act in an incompetent manner has a duty to do something with that knowledge. If a DON fails to act upon a report of patient abuse, she is not following an appropriate standard of

nursing practice and you certainly could report her to the Board of Nursing in your state. Additionally, you should report the suspected patient abuse to the appropriate state agency so that follow-up will be done.

In many states, if a health care facility or agency terminates a nurse they must report that nurse to the state Board of Nursing and then the Board of Nursing will contact the nurse, in this case you.

Therefore, if the facility has already reported you to the Board of Nursing, you will have to respond to the Board of Nursing. If you have been reported to the Board of Nursing you will want to find a nurse/attorney who has experience in representing nurses before the Board of Nursing to represent you and help you to respond to the Board of Nursing in such a way that all your rights will be protected.

You can find a nurse attorney by contacting The American Association of Nurse Attorneys (TAANA). Their web site is: www.taana.org

This topic has recently caused me to resign from a job at one facility and go work at a sister facility. My DON refused to send a patient out ( nursing home) who had had diarrhea for 4 days. We called the DOC, got an order, she calls him back and tells him all she needs is to drink water, which she promised she would do personally.She hung up the phone and goes home. The DOC resinded the order, the patient died in her sleep that night. I reported to administration, the office nurses re-wrote the proof on the chart, labled ME a RAT, and stopped talking to me. Then,,,,, Two LPN's mentally harassed and abused one of my patients for their own entertainment by taunting and inciting her into a rage directed at me. I reported it in writing, The Don "heard a rumor" that I don't like her and focused her attention on that instead of the abuse. She terminates me for insubordination and breaching patient and facility confidentiality. She NEVER adresses the patient abuse reported by me in any way. I wanted to sue her for wrongful termination, But I am thinking of reporting her to the RN board. Can any one tell me what evidence I should include in my report, and what your thoughts are about my plan of action? THANKS, this has me in a career crises.

There should be posted somewhere in the facility a phone number to report abuse (you are a mandated reporter). If your DON won't report it, you have the obligation to. This can be done annonymously. Also there should be a number for the Ombudsman for your facility. They will also investigate. A report/complaint to the BON sounds in order too.

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