dont know what to do....

crissrn27, RN · Jan 28, 2008

You did do the right thing by calling the ambulance, even if the s/s had resolved by the time they got there. What if they hadn't? Who exactly did it hurt by having them come, then not needing them after all? If, on the other hand, the pt had been having an MI, etc, and you didn't call, that would have been a big deal!

As far as your crooked DON, what kind of things has she done? Was it just a mistake with the incident report, or did she know that you didn't work that day?

As far as her wanting to assess a resident before being sent out, RN's are taught more assessment skills in school. But during a true emergency, or if she is hard to contact, I would just send them out. Better to have a ticked off DON than a dead resident! And that is what I would tell her if she wanted to give you a hard time about sending someone out without her approval!

It sounds like you are a great nurse, and have great assessment skills! Don't worry about this incident, you did what you had to do!

TheCommuter, BSN, RN · Jan 28, 2008

the reason my DON wants to be called before we send ANYONE out is "she is an RN and has better assessment skills **even over the phone**"

No. The true reason your DON wants to be called before residents are sent out to the hospital is "the bottom line." Most LTCFs have contracts with certain ambulance services, and the facility must pay several hundred dollars for each transport to the hospital. Your DON might be misguidedly attempting to save the facility money by keeping the census up and the ambulance bills low by not sending any residents out.

After all, it's not her license in jeopardy if and when the patient dies.

sleepyndopey · Jan 29, 2008

I have never heard of a nurse losing her license because she/he sent someone out who didn't need to be sent out. Now not sending someone out who needs to be...that can get you in trouble. I always say, When in doubt, send 'em out!

sharlynn · Jan 30, 2008

No. The true reason your DON wants to be called before residents are sent out to the hospital is "the bottom line." ...... Your DON might be misguidedly attempting to save the facility money by keeping the census up .....
After all, it's not her license in jeopardy if and when the patient dies.

Most facilities I have worked at had a "bed hold" policy where the family agreed to pay a portion of the regular rate to keep the bed available until after discharge. Few family members were wise enough to take their chances when the census was down. It's not like all ten beds would be filled in a week. But it also means their family members personal belongings including furniture didn't have to be removed.

Daytonite, BSN, RN · Jan 30, 2008

first of all, you are new at being an lvn. you're going to make mistakes. we all made lots of mistakes when we were brand new graduates for probably a year or two when we got out of school. you learn from these mistakes and move on.

secondly, your don is not crooked. nothing you said in your post indicated to me that she was crooked in any way. she delegated tasks to you which is within her scope of authority. when i was a nurse manager in the acute hospital someone had to follow up on every incident report. our director of nursing delegated that task to the nurse managers. there were times when i delegated that task to my assistant managers if i felt it was appropriate or i was busy with other more pressing issues. it is nothing more than an investigation of the facts of an incident.

thirdly, residents change their minds all the time. and their vital signs change. it goes with the territory of being a nurse. so, if you blame a patient for making you look like a dummy you better decide now if this is the profession you want to be in because it's going to happen again and again, i guarantee it. a patient has the right to change their mind. it doesn't make us dummies. we just shrug our shoulders and go with the flow.

now you know that you should have gone into the meeting and interrupted the don. next time you will do that. when i worked in ltc, our don or administrator wanted to know about any transfer outs. the primary reason was because our facility got stuck with the bill for the ambulance service if there is no stipulation in the contract that the family was going to pay for ambulance service. how would you nurses know about that for every patient? there might be special information from the family that the don knows about that you nurses don't. the family may have been in the don's office ranting about the patient's bill or something else and you don't know what those conversations were either. in addition, the don has the right to know what major thing is going on with every patient in the facility. getting transferred out is a major thing and the don needs to know about it asap. she is ultimately responsible for the welfare of those patients.

just because you are an lvn doesn't mean that your assessment skills need to be lesser than an rns. where did that attitude come from? there is nothing in this world that says you can't practice and improve your skill at this. you can get a copy of health assessment made incredibly visual or you can access the free incredible weblinks of information on this thread on the nursing student forums:

https://allnurses.com/forums/f205/health-assessment-resources-techniques-forms-145091.html - health assessment resources, techniques, and forms (in nursing student assistance forum) and start practicing assessment every chance you get. you have one of the greatest places in the world, ltc, to practice and no end of patients to practice on. you won't learn this stuff in a day, a week, a month or even a year. it takes time. but you constantly pursue it. make it your personal pet project. concentrate on one body part at a time. eventually, you should be able to get just as good as an rn at it if you want to be. don't short sell yourself or i will personally look you up and come over and give you whatfor. my mother was an lvn who worked in icu and ccu. she was damn good at it too. i get so angry at you lvns who think you are lesser than rns it makes me want to slap you.

whoamiRN · Feb 1, 2008

You did everything you thought was best for that resident at the time of the incident. This is how we ALL learn in the nursing field. good for you for taking the initiative. Just be careful increasing the 02 on a COPD'er. Some can tolerate, some can't. Looks like this one could. :)