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Discussion

Differences

I'm sure this has or is being discussed somewhere, if it is just point me in that direction.

What do nurses do when they have different opinions about treatment of patients? or conflicts with ER physicians about whether or not the patient should have been admitted? Should you keep your mouth shut? what if a patients get worse?

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If you feel the doctor's plan of treatment is wrong and harmful, you go up the chain of command.

The best thing to do is identify why you are uncomfortable with the plan of treatment or discharge. Calmly and quietly state your opinion and reason for it, and allow the md to make his decision, or the charge nurse. I have disagreed with people and been right, and disagreed and been wrong. When I have been in a position where I felt that the pt was in danger or rights/wishes were being violated., I went to my supervisor.

  • Author

Thanks, I just thought of another scenario, What if a patients family does not feel the patient was treated fairly, meaning not being admitted through the ER until the third visit. What advise do you give them? There was reason to admit on the second and third visits IMO.

I would refer them to the charge nurse. This is a situation that could become tricky and you must protect yourself.

We are PTs. advocates.You could calmly state what you think.And as far as different opinions with techniques or something,Sometimes it is written in the policy manual of that facility.It used to be my Bible at times.

If a MD, other RN, Specialist is in the act of a process/procedure or order that I KNOW will HARM/KILL a patient I will stop them - I will use the least restrictive means. But, will take whatever steps are necessary.

Questioned practice.

Deliberate explanation.

Call reinforcements.

Stop the process/remove myself from it as a last resort if theirs is an INSISTENCE in the fact that "they" will continue at all costs!

I can still have to defend my practice.

Stand up for your PATIENT and YOURSELF,

BOTH are WORTH IT!

Practice SAFE!

;)

Thanks, I just thought of another scenario, What if a patients family does not feel the patient was treated fairly, meaning not being admitted through the ER until the third visit. What advise do you give them? There was reason to admit on the second and third visits IMO.

Refer them to the Charge Nurse, Unit Manager, or Hospital Supervisor. NEVER tell the family that "they should have been admitted when they were here earlier."- even if they should have been, saying things like this is just asking for trouble. I'd keep my mouth shut & refer them to management. If you are questioning a doctor's orders for medications, etc, privately ask them for the reasoning behind their order & tell them your concerns- just NEVER do this in front of patients or family members!

  • Experts

Technically, only a physician who is on staff and has admitting privileges can admit patients. ER doctors without admitting privileges who admit patients are a serious administrative problem. It may be a violation of your state law. It is probably a violation of the medical staff bylaws as well. You need to bring it to the attention of your manager who will, hopefully, make sure it gets passed up the chain of command. This is something that needs to be communicated to the President of the medical staff and the CEO of the hospital. It is potentially a liability problem if something goes wrong with a patient and there is no doctor of record.

If you want to take the bull by the horns and jump the chain of command there are a couple of people you could notify of what is going on. The hospital should have a person in the position of a Medical Director. This person would not be a doctor, but an administrator who is the communication link between the CEO and the doctor who is the President of the Medical Staff.

Another thing you can do is to find out where the office of Medical Staff Services is. These are the people who assist and support the physicians who ARE officially on the medical staff of your hospital and tell them what has been going on. These Medical Staff Services people assist the doctors who are on the medical staff with administrative issues so they have a very good knowledge of the problems that are going on with the medical staff. Put a bug in their ear. They'll make sure it gets to the doctor who is the President of the medical staff. He's not going to be happy to hear that physicians without admitting privileges are admitting patients. It puts not only the nurses, but also the hospital in legal jeopardy.

I would also talk about this with every physician who would listen to me. One of them will get this information to their chiefs of staff. Make sure you let them know what a very precarious situation this practice puts you nurses in, especially if a patient goes bad and you don't know who to call for orders. In actuality, the person you would ultimately call would be the President of the Medical Staff (Chief of Staff), but I would go through your manager, nursing office or the supervisor on duty to do that.

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