Did I do the right thing???

[luvmy2angels]

I am an LPN that works for a HH agency owned by our local hospital. We have probably 60 nurses and only 5 of us are LPNs. We are used for re-visits only since we can't do admits and discharges. I saw a post open heart patient the other day, had a CABG X 4. She was extremely SOB and could not even hold a conversation with me, was coughing after about every other word. Respers were 28, recounted again to make sure and got 30, very shallow and rapid. Her lungs were clear but slightly diminished throughout. She has a history of lung disease so i did take that into account. I quickly reviewed the notes of the RNs that saw her previously and both had noted the same s/s as i did but had not contacted the Dr. I totally did not feel comfortable leaving this patient. I made the decision to call the Dr and they wanted her to come in for a CXR and then see the Dr. The patient was very grateful and thanked me repeatedly for calling the Dr, I just worry sometimes that the case managers will get upset...as if i'm "stepping on thier toes", so to speak. I mean the other nurses didn't think it was necessary to call the Dr so did they know something i didn't???? I just keep telling myself that i couldn't leave the pt seeing her in such distress, i would never forgive myself if somethig was wrong and i didn't do anything. Better to be safe than sorry, right????

[annaedRN, RN]

No - you did the right thing. If the patient is not stable the doc should be notified - whether its you or the case manager. Thats why we are there - to assess the patient, and if a change or deteriorated status is noted - its your responsibilty to report it - the patients depend on it! theyre some RNs that I work with that seem to be too lazy or nonchalant to be bothered to make the appropriate calls...if they get upset at you for doing what they should be doing...it's on them. You need to protect our license!!!

[mamamerlee, LPN]

You did the right thing - most agencies would want you to call the case manager or supe, as well as the MD. I always told the LPNs I worked with to contact MD or 911 first if necessary, then me or clin supe. I trusted their judgement.

[nursel56]

She was on daily visits? Are your case managers swamped? It does seem odd that they charted the same s/s you did, ie already deteriorating status, and didn't do anything. I would have called the doctor, too. There are times when I'm not able to get hold of someone on the phone right away and phone tag takes up too much time. Your lady was your first priority. It helps a whole lot when your manager trusts your judgement. I work with a great Case Manager right now.

[KateRN1]

I am a case manager with a home health agency and work with a fabulous LPN. I would never question any time that she calls a doc or sends a pt to the hospital. My toes have nothing to do with it. She is the person seeing the patient at that time and she is responsible for the care that she provides. It never dawned on me that she should report to me about a patient's condition to ask for permission to send a patient to the hospital. How odd. After the fact, absolutely, but not to make sure it's okay.

[caliotter3]

Do not base your decisions on what other nurses may or may not have done. I have found that about 90% of the time other nurses are less than eager to do anything that involves extra effort. You took the time to do what should probably have been done at a previous visit. Do not be concerned about others criticizing you because you did your job.

[luvmy2angels]

Thanks everyone for your support. I found out today that the pt was admittd to the hospital after her visit to the dr office, do not know the diagnosis but i am so glad that i made the decision to call the dr!! Thanks again ladies!!:redbeathe

[caliotter3]

Good for you! Now you know how it feels to know that you did the right thing.

[ellakate]

Good job, Nurse! Don't worry about the patients that thank you.

I agree with KateRN1. While HH is about keeping patients at home, it is also about getting them help when they need it. Our patients count on our assessment skills.