The problem I have with fb is that I am friends with supervisors and peers at work, and therefore can't rant about work.
Which is all this amounts to. I work in LTC where management posted the following notice to nurses. "Do not call the doctor for orders to transfer residents to the hospital.without calling the Don or Adon We can and should treat them in house."
So here are my problems with this: I am in the building and you Don/Adon are not. So you don't know what I am finding on my assessment that prompted my call to the doctor. Also though absolutely we can treat residents in house, is it best for the pt? One nurse 20 patients, no RT no Md in house VS one nurse and 8 patients, RT, Md and onsite xray and lab results and a pharmacy. Which setting would be best for the patient with acute health problems? Plus who will be liable if the patient treated in house has a bad outcome? I am betting it would be me the nurse who did not call the doctor. I don't say, "Hey I want to send this pt to the ER". I just present assessment data, code status and ask the doctor what he would like me to do. Lots of times it will be order these labs/xrays , start this med, etc. I feel like management in there concern for census is not serving patients, nurses or doctors well.
Plus it just kind of says we don't trust your nursing judgement.
Rhi007...I am in management. I was not born into the position. I held and was successful at every position in long term care. I can most likely run circles around you on a subacute floor.That said, I trust most of the nurses who work for me. If they think the resident needs to go and they've tried everything they can in the facility, the patient goes to the hospital. End of story. If they are clueless as to how to treat CHF then I encourage them to use the tools I've given them or they feel free to call me at home for advice. i do know what's going on with my 160 residents since I make it my business to know.The OPs dilemma has absolutely nothing to do with Facebook.
And managers like you make the world go 'round. I adore managers like you. Unfortunately, some nurses have managers that are the antithesis of you. I work in an unusual situation now, but my last "typical" nursing job included a manager that absolutely could not have functioned on the unit, even if someone put a gun to her head. That was one of our main complaints about her. If absolutely forced to, she would come out and take a patient, but leave most of the necessary stuff undone. She second guessed everything we did, but she couldn't do it herself. Such a hypocrite.
This is why I have paranoid security settings on FB. Nobody can see any of my posts unless I specify EXACTLY which friends I want to see them. Nothing is public, either.
People can still see what you are doing on their sidebar. For instance, if a mutual friend posts a reply to your post, it will show up in the sidebar of others who know you both. If that person just hovers their cursor over the notification, they can see the entire conversation.
I would avoid venting about work on facebook regardless of who your FB friends are, we got by just fine for many decades without venting our work frustrations on facebook, I think we can continue without any problem.
I do know of a Nursing home that made similar rule, but it was because the staff kept sending patients to the hospital who had made it clear they did not want to be sent to the hospital.
Isn't it pretty rare to actually call 911? I've done it once in my three years in LTC. I've paged the doctor plenty of times and had him tell me to send the pt to the ER. But, then, I'm not really the one sending him out, am I? The doctor is the one making that call. All I did was give him the assessment data. That's why I get confused when people say "the nurses ship residents out too often" in LTC. The nurses *don't* decide to ship anyone out. We just follow doctors orders to do so....
Specializes in Gerontology, Med surg, Home Health.
We don't always wait for the doctor to call back.If the nurse thinks it's true emergency, she/he calls 911, gets the resident out and then notifies the MD. We DO decide to ship them out. Sometimes the docs are slow to call back and if we waited, someone could die.
The problem I have with fb is that I am friends with supervisors and peers at work, and therefore can't rant about work.
Which is all this amounts to. I work in LTC where management posted the following notice to nurses. "Do not call the doctor for orders to transfer residents to the hospital.without calling the Don or Adon We can and should treat them in house."
So here are my problems with this: I am in the building and you Don/Adon are not. So you don't know what I am finding on my assessment that prompted my call to the doctor. Also though absolutely we can treat residents in house, is it best for the pt? One nurse 20 patients, no RT no Md in house VS one nurse and 8 patients, RT, Md and onsite xray and lab results and a pharmacy. Which setting would be best for the patient with acute health problems? Plus who will be liable if the patient treated in house has a bad outcome? I am betting it would be me the nurse who did not call the doctor. I don't say, "Hey I want to send this pt to the ER". I just present assessment data, code status and ask the doctor what he would like me to do. Lots of times it will be order these labs/xrays , start this med, etc. I feel like management in there concern for census is not serving patients, nurses or doctors well.
Plus it just kind of says we don't trust your nursing judgement.
Easy one.
If an MD orders a transfer to a hospital, you immediately page the DON/ADN and say, "Dr. Feelgood has ordered patient X transferred to the hospital. I am letting you know per your policy."
Done. If they give you grief, you can refer them to the ordering MD.
I once had a Rapid Response Nurse light me up after a very attentive and physically present MD had tried to treat a patients' sagging BP and other issues on the med surg floor before ordering a transfer to ICU. The Rapid Nurse said, "Why didn't I know about this?? The patient could have adrenal insufficiency or something and we could have treated her here. Why did you not call me??"
I explained that the physician was here on the floor assessing and treating the patient (not simply taking pages or phone calls) and was ordering fluids, labs, EKG, etc and made the decision to transfer the patient. "What were you going to do?" I asked her, "Countermand the MD's orders?"
The rapid nurse walked away in a huff and lit up the charge RN with the same nonsense.
I talked to my unit's assistant manager and that little situation got cleared right up and did not re-occur.
Isn't it pretty rare to actually call 911? I've done it once in my three years in LTC. I've paged the doctor plenty of times and had him tell me to send the pt to the ER. But, then, I'm not really the one sending him out, am I? The doctor is the one making that call. All I did was give him the assessment data. That's why I get confused when people say "the nurses ship residents out too often" in LTC. The nurses *don't* decide to ship anyone out. We just follow doctors orders to do so....
I can't speak to the OP's example and the reason behind their policy, but the similar policy I'm familiar with came about because the Nurses also didn't think they were the one's sending the patient out, even the Docs were expecting the Nurses to make the final call.
When we started a new palliative care program in my facility, one of the first things they zero'd in on was how often patients were coming to the ER from Nursing homes to die, even though they had agreements with the Nursing homes that they would not be sent out. The nurses explained that when they called the Docs with their assessments of the patients, the Docs were saying that they should go to the ER, yet the Docs were genuinely perplexed that the Nurses were actually sending these patients out if they had stated their wishes not to have that happen. The Docs explain that their only role is to advise based on the assessment info, the Nurses were then responsible for deciding if this was actually appropriate, and not send them if it's not, while the Nurses felt like they would get in trouble for not following an order, to which one Doc responded "Oh God, please don't tell me you just follow my orders, they're not really "orders".
Out of the whole process of us looking into this, one quote from a Doc stood out; "A Nurse's obligation isn't to me, it's to the patient".
monkeybug
716 Posts
And managers like you make the world go 'round. I adore managers like you. Unfortunately, some nurses have managers that are the antithesis of you. I work in an unusual situation now, but my last "typical" nursing job included a manager that absolutely could not have functioned on the unit, even if someone put a gun to her head. That was one of our main complaints about her. If absolutely forced to, she would come out and take a patient, but leave most of the necessary stuff undone. She second guessed everything we did, but she couldn't do it herself. Such a hypocrite.