Do you have to call your nurse manager before you call the doctor?

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We are told on all shifts that we must call "the nurse manager on call" before we call a doctor for any reason. Is that just at my nursing home or do other nursing homes have that policy too? All of us nurses absolutely hate that rule. So what happens if I think that the resident needs to go to the emergency room stat but the "nurse manager" says "No" So who gets sued if the patient dies? Me or the "nurse manager" who said No don't send the resident to the ER?

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If I wanna call the doctor just to say "hello", I will. Jk, but I call the doctor per my own nursing judgement, since they are my patients when I'm working. I actually had a former DON who wanted every little question brought to her attention. Problem was, she wasn't very good with the answers!

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Specializes in Gerontology, Med surg, Home Health.

I've worked at places like that too. It's ridiculous. You are there with the patient. Why call someone else who isn't there to do an assessment? I encourage my nurses to call the supervisor in the building for another set of eyes but that's it.

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We don't have this policy but we are supposed to call the DON after an incident.

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Specializes in LTC, assisted living, med-surg, psych.

I worked for a place like that once. Guess who I didn't call when my resident's blood sugar was 28 and the Glucagon didn't bring him around? (I did leave her a note.....)

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Specializes in Gerontology, Med surg, Home Health.

We have a very busy post acute unit with very sick people. If my nurses had to call me before they called the doctor or after they called the doctor, I'd get even less sleep than I do now! I hired them because they have good assessment skills and know what to do for a resident who is going to crash...no need to second guess them.

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Specializes in Geriatrics, Dialysis.

Is this a new nurse manager that is trying to find her way in the unit? If so, it's a little understandable as she/he wants to have a good idea of what's going on and would want any change requiring an MD call reported. On the other hand, if this is an established nurse manager then it sounds like there is a micromanaging issue. If she/he really wants repeated phone calls for every little thing at all hours of the day or night, then that's their problem when sleep and free time are frequently interrupted.

As for an emergent situation, well if a resident needs to go the ER now I am not wasting my time or compromising the residents safety by calling a nurse manager before an ambulance but I would call after the fact and report that I sent somebody out.

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I think it is a micromanaging issue. I work different shifts and we have all awakened her by calling her at night. Lately, she seems annoyed when we call her and wake her up lol. I think she wants to keeps the residents at the nursing home as much as possible and thinks she can talk us out of asking a doctor to send the resident to the ER. Sorry, but when a doctor who is half asleep asks me if I think the resident should go to the ER for an evaluation and I think the resident does need to go, I will tell the doctor yes.

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Specializes in LTC.

I totally get keeping the pt. in the facility rather then shipping them out. Shipping someone out is very hard on the patient. Instead of making nurses call her before calling an MD and/or 911 maybe she needs to start providing more education to staff.

There are too many situations a nurse needs to act quickly in for the safety of a patient. This NM is really going to be kicking herself the day she gets the call "Mary FullCode is in cardiac arrest. Can I call the MD?"

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Sounds like someone is micromanaging the facility. Either there has been an issue before, this manager is new to their role, or they have control issues. Use common sense. If it's an emergency call the MD first. Everything else you can appease them and call them first. Preferable in the middle of the night :cheeky:

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That is ridiculous. FYI it would be you to be sued not her or the md

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Hmm. My workplace isn't like that- but my job is specifically charge nurse and I do expect the LPNs to come to me before calling the doctor. Not that I don't trust them- they're fantastic!- but we work on a relatively small unit and I usually know what's going on with all my residents throughout the day. I also am the only nurse that liases with the docs and does rounds, etc. I still would never be upset if someone went to a doc without telling me if it was warranted. I guess it just depends on your job descriptions and the structure of your facility.

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