D.O.N. concerned more with census than NH residents care

Specialties Geriatric

Published

:madface: At the facility where i work the D.O.N. is denying nurses to send residents out to the hospital who need to go in order to keep the census up. Residents who are full codes have stayed in the facility while being in acute distress. Being a NH with very limited supplies there is very little we can do. She would rather the person died there it seems. I know when the lawsuits come she will be in the clear because she will say she was not aware of the serious nature of the situation. she has gotten unit managers to lie to family members telling them their loved one will sit in the ER for 8 hours without being seen and that it is better for them to stay in the facility. This particular resident was in resp distress! Everybody knows resp distress patients are priority in the ER, but the family believed them. This D.O.N even bosses around the nurse practicioner! I don't get it. This DON MSN claims to be a christian, and cares so much about people yet her bonus at the end of the quarter is more important than a human life!

I have a similar problem where I work. We have to notify the DON and the Administrator before we send someone out. Plus they want us to use the facility van to transport instead of an ambulance whenever possible. At one point I had to have the DON do her assessment of the resident before I was allowed to send them to ER. It's disgusting. Now when someone needs to go to the ER I just make the calls and send them. If anyone gives me any flak I just say either we'll lose this resident temporarily or permanently (if they die), and if they have a three day hospital stay the facility will get the Med-A money (I think it's around $10,000 a month). That always shuts them up! I think the anonymous call to State was a wonderful idea. It sounds like your DON needs a huge wakeup call!!!

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If a patient needs to go to the hospital and you work as a nurse in LTC, it is your responsibility to call 911 and get the patient transferred if there is a need to do so.

Also, I would not continue to work in such a setting.

Finally, make sure that you protect yourself by having nursing (with a disciplinary defense---Board of Nursing provision) if you work anywhere in long term care.

It is my personal belief that you are more likely to be reported to your Board of Nursing or sued if you work in LTC. :balloons:

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This is concerning. I do not dictate when my nurses send residents out, unless I feel they need to go and my nurses are dragging their feet. I get called after the resident is taken care of (night, weekend etc) as it should be. We do involve the family if the doc does not want to admit. You know if the resident is treated early enough, they come back and will stay on your census longer. I'm wondering if they usually do not come back for some reason, or the hospital refers them elsewhere. In this case, the DON may want to work on public relations to help your facility become the preferred provider so that the hosptital will refer and send them back. If they are medicaid, the bed is usually held and paid for at least at the default rate, and if they are private, the facility bills the family for the bedhold rate. This is really too bad. Not all DONs are like this...Do you have a risk manager on staff?

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This topic has recently caused me to resign from a job at one facility and go work at a sister facility. My DON refused to send a patient out ( nursing home) who had had diarrhea for 4 days. We called the DOC, got an order, she calls him back and tells him all she needs is to drink water, which she promised she would do personally.She hung up the phone and goes home. The DOC resinded the order, the patient died in her sleep that night. I reported to administration, the office nurses re-wrote the proof on the chart, labled ME a RAT, and stopped talking to me. Then,,,,, Two LPN's mentally harassed and abused one of my patients for their own entertainment by taunting and inciting her into a rage directed at me. I reported it in writing, The Don "heard a rumor" that I don't like her and focused her attention on that instead of the abuse. She terminates me for insubordination and breaching patient and facility confidentiality. She NEVER adresses the patient abuse reported by me in any way. I wanted to sue her for wrongful termination, But I am thinking of reporting her to the RN board. Can any one tell me what evidence I should include in my report, and what your thoughts are about my plan of action? THANKS, this has me in a career crises.

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Specializes in Transplant, homecare, hospice.
:madface: At the facility where i work the D.O.N. is denying nurses to send residents out to the hospital who need to go in order to keep the census up. Residents who are full codes have stayed in the facility while being in acute distress. Being a NH with very limited supplies there is very little we can do. She would rather the person died there it seems. I know when the lawsuits come she will be in the clear because she will say she was not aware of the serious nature of the situation. she has gotten unit managers to lie to family members telling them their loved one will sit in the ER for 8 hours without being seen and that it is better for them to stay in the facility. This particular resident was in resp distress! Everybody knows resp distress patients are priority in the ER, but the family believed them. This D.O.N even bosses around the nurse practicioner! I don't get it. This DON MSN claims to be a christian, and cares so much about people yet her bonus at the end of the quarter is more important than a human life!

:eek: RUN! Get out...if not, then CYA with documentation. OMGosh, bad situation.

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I am soooo glad I work with a good group of people, right from the administrator on down! Our DON would NEVER do something like this. If I were you I would, as others have posted, RUN as fast as I could!!

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Any nurse who sees another nurse act in an incompetent manner has a duty to do something with that knowledge. If a DON fails to act upon a report of patient abuse, she is not following an appropriate standard of

nursing practice and you certainly could report her to the Board of Nursing in your state. Additionally, you should report the suspected patient abuse to the appropriate state agency so that follow-up will be done.

In many states, if a health care facility or agency terminates a nurse they must report that nurse to the state Board of Nursing and then the Board of Nursing will contact the nurse, in this case you.

Therefore, if the facility has already reported you to the Board of Nursing, you will have to respond to the Board of Nursing. If you have been reported to the Board of Nursing you will want to find a nurse/attorney who has experience in representing nurses before the Board of Nursing to represent you and help you to respond to the Board of Nursing in such a way that all your rights will be protected.

You can find a nurse attorney by contacting The American Association of Nurse Attorneys (TAANA). Their web site is: www.taana.org

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This topic has recently caused me to resign from a job at one facility and go work at a sister facility. My DON refused to send a patient out ( nursing home) who had had diarrhea for 4 days. We called the DOC, got an order, she calls him back and tells him all she needs is to drink water, which she promised she would do personally.She hung up the phone and goes home. The DOC resinded the order, the patient died in her sleep that night. I reported to administration, the office nurses re-wrote the proof on the chart, labled ME a RAT, and stopped talking to me. Then,,,,, Two LPN's mentally harassed and abused one of my patients for their own entertainment by taunting and inciting her into a rage directed at me. I reported it in writing, The Don "heard a rumor" that I don't like her and focused her attention on that instead of the abuse. She terminates me for insubordination and breaching patient and facility confidentiality. She NEVER adresses the patient abuse reported by me in any way. I wanted to sue her for wrongful termination, But I am thinking of reporting her to the RN board. Can any one tell me what evidence I should include in my report, and what your thoughts are about my plan of action? THANKS, this has me in a career crises.

There should be posted somewhere in the facility a phone number to report abuse (you are a mandated reporter). If your DON won't report it, you have the obligation to. This can be done annonymously. Also there should be a number for the Ombudsman for your facility. They will also investigate. A report/complaint to the BON sounds in order too.

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We were told that before by our D.O.N. and E.D. Some of the other nurses were afraid to send out residents.. I still send resident's to the hospital if I feel they need to be sent. I am the patient advocate.. I am there to care for my residents the very best I know how.. and If I feel they need to be sent to the hospital, out they go.. If I have a critical resident.. and they are full code, they are outa there.. ASAP..

If they want to fire me for it let them go ahead.. The only comment they make to me.. is If you sent so and so out, then we know they needed to go or you wouldn't have sent them.. Amen to that.. CYA.. and take care of your residents to the best of your ability.

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Well, thank you all for the replies to my posting. I am still working at the sister facility, my administrator has promised to amend my separation notice due to the wording on it. I am giving her till the end of this month to correct it, then I am going to an attorney to: file complaints with the R.N. Board, the DHH in my state, and personally sue her and the facility for wrongful termination. I am also reporting the L.P.N.s to the L.P.N. board for verbal and psychological abuse of a patient.

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Can you spell "G" tag??? When in doubt ship 'em out...the DNS needs to get a grip! Where I work when the census goes down we take highly inappropriate (read psychotic) patients we are not equipped to deal with....

yup we do too.. isn't it sad ?

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I just caught this thread. Sounds so very familiar. I suppose LTC for the most part is the same all over the U.S. For profit.. for gain. Most DON's are rarely seen outside their offices, Administrators are NOT nurses (although they love to pretend they are!), Managers that won't manage except to say "no" to any request, Dietary that won't cook what these older folks are used to eating (how many 70 year olds have ever eaten biscotti?)

Please... it's all about the census, the numbers, when management is concerned. Otherwise, they wouldn't get their hefty monthly/quarterly bonuses, would they?

If only .. if only State legislators would wake up. Bill Frist, where are you when we need you?

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