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I'm so stressed, I want to give up nursing...

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by payang0722 payang0722 (New Member) New Member

payang0722 specializes in Geriatric.

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Hello everyone,

It's my 3rd week on the floor as a new nurse in a snf and I feel like giving up. I made a stupid (excuse me for the word) thing yesterday. Here's what happen, and please give me some advice or feedbacks...

4 days ago, I noticed a lady with +2 pitting edema on her LLE. Informed MD of my assessment & MD ordered Venous Doppler Study to rule out DVT. Okay, so Diagnostics called & appt. done. Yesterday, it was during the shift of report when the technician came and asks to do clarification on the order. He said that Medicaire won't cover it if the order says "to rule out DVT", but instead it should be "to rule out leg edema". The off-going nurse says, ok I'll make the T.O. sheet and just call the MD later, assuming that the MD will agree with that. It was my biggest mistake, I signed that T.O. & a copy was given to the technician. Hours later, I called the MD to update about another pt, and also to get that order from him to ok " to rule out leg edema", yet MD said no. He said follow original order of "to rule out DVT"...That's when my head starts to crush. What am I suppose to do now?The technician already left with that assumed copy of the T.O. saying "to rule out leg edema" with my signature. I called my co-nurse who is so wonderful and helped me figure out a solution. This is what we did: I made the new T.O. and put it on Physician's order saying this: "Follow original order for venous doppler study to rule out DVT. Disregard other T.O." Then I faxed that to the Diagnostics.

Now, It's all in my head. I didn't sleep wondering, worrying that I will be in great trouble later. They might throw to me a question saying, why did I make a T.O. assuming that the MD will ok it. I don't want pointing fingers, but I would have not done that if the off-going nurse didn't assume that in the first place.

I need your feedbacks please. Thank you.

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Jenni811 has 3 years experience as a RN and specializes in Intermediate care.

1,032 Posts; 12,691 Profile Views

Im new too, so i feel the frustration you are going through. Its been almost a year for me now but i still find myself in situations.

As long as no harm was done to the patient, you are fine. People chart errors all the time and we are able to fix them through facilities policies.

I once took a set of vitals, of which i got a blood pressure of 191/102, very high!!!! I documented every task i did in the wrong patient's chart (EMR).

This COULD have led to something very serious because the wrong patient could have been treated for a high bp.

However; i caught it, documented my error and corrected it.

No harm done!

things like this happen. you sound like you handled it correctly and no harm was done to the patient.

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Sherriblu has 30 years experience.

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You learned a big lesson so dont beat yourself up:):) but never ever assume what a MD will do. Dont ever write your own order. Always follow policy and not what anyone tells you. Dont give up, this is part of the process of learning nursing. IT is stressful but as you learn more and become more confident you will feel more comfortble.

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Double-Helix has 6 years experience as a BSN, RN and specializes in PICU, Sedation/Radiology, PACU.

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A doppler study to "rule out leg edema"? Haven't you already confirmed leg edema by looking at and feeling the leg?

Anyway... it seems like you did the right follow up when you were misled (unintentionally) by the other nurse. It's a lesson learned, I think. Just say you made out the other T.O in order to be prepared in case the physician decided to change the order when you asked and diagnostics took the wrong one.

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payang0722 specializes in Geriatric.

60 Posts; 3,467 Profile Views

Thanks everyone...i'm feeling better after reading your comments

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41 Posts; 1,823 Profile Views

I'm just wondering why anyone would order a Doppler study to rule out edema? I thought that was always an objective assessment. Please correct me if I'm wrong. I am a fairly new nurse.

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12 Articles; 115 Posts; 32,158 Profile Views

Just a thought,

The diagnostic request to rule out leg edema seems a little odd to me, but...regardless...what I think I might have done (and this of course depends on your relationship with the doctor) would be to have told him that the technician said that Medicare wouldn't cover it if the order read to rule out DVT, so can we write the order to rule out leg edema? If the MD understood that, then he probably wouldn't have an issue with the order saying the rule out leg edema. Either which way, the Dopper study is going to show the same result, I would think.

It seems like more a paperwork technicality.

I tell the Dr. when I call him things all the time like "The pharmacy says it has to be this, etc." I think it would be the same with a diagnostic study. Sometimes it just all boils down to the wording with all of the paperwork hoops that we have to jump through.

The MD can still get the results he wants from the Doppler no matter what the wording of the order in a case like this. Just be right up front with him about situations like that. From a diagnostic stand point it sounds dumb to say "To rule out leg edema" which is probably why he didn't want to change it, but from the payment system's standpoint, if they accept "To rule out leg edema" by all means, the order could say that. Just explain the situation to him.

Then, if he still wants to leave it "To rule out DVT" at least he has all of the facts in front of him : i.e. Medicare will not cover the Doppler if the order says "To rule out DVT"

I hope I didn't make that really confusing, but just some food for thought for the next time something like that comes around. :)

When you asked his ok on changing the order, did you tell him why you wanted it changed? :)

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Miss Kitty00 specializes in Med_Surg, Renal, intermediate care.

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I'm just wondering why anyone would order a Doppler study to rule out edema? I thought that was always an objective assessment. Please correct me if I'm wrong. I am a fairly new nurse.

At my facility. a doppler study is to rule out DVT. I never heard of one to rule out edema.

To the original poster, you did fine, no harm was done to the patient.

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MassED has 15 years experience as a BSN, RN and specializes in ER.

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Hello everyone,

It's my 3rd week on the floor as a new nurse in a snf and I feel like giving up. I made a stupid (excuse me for the word) thing yesterday. Here's what happen, and please give me some advice or feedbacks...

4 days ago, I noticed a lady with +2 pitting edema on her LLE. Informed MD of my assessment & MD ordered Venous Doppler Study to rule out DVT. Okay, so Diagnostics called & appt. done. Yesterday, it was during the shift of report when the technician came and asks to do clarification on the order. He said that Medicaire won't cover it if the order says "to rule out DVT", but instead it should be "to rule out leg edema". The off-going nurse says, ok I'll make the T.O. sheet and just call the MD later, assuming that the MD will agree with that. It was my biggest mistake, I signed that T.O. & a copy was given to the technician. Hours later, I called the MD to update about another pt, and also to get that order from him to ok " to rule out leg edema", yet MD said no. He said follow original order of "to rule out DVT"...That's when my head starts to crush. What am I suppose to do now?The technician already left with that assumed copy of the T.O. saying "to rule out leg edema" with my signature. I called my co-nurse who is so wonderful and helped me figure out a solution. This is what we did: I made the new T.O. and put it on Physician's order saying this: "Follow original order for venous doppler study to rule out DVT. Disregard other T.O." Then I faxed that to the Diagnostics.

Now, It's all in my head. I didn't sleep wondering, worrying that I will be in great trouble later. They might throw to me a question saying, why did I make a T.O. assuming that the MD will ok it. I don't want pointing fingers, but I would have not done that if the off-going nurse didn't assume that in the first place.

I need your feedbacks please. Thank you.

why didn't you tell that doc that you were instructed by the u/s tech that insurance won't pay for r/o DVT??? Not a big deal....

You could call that doc and clarify that was what was going on....

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316 Posts; 5,646 Profile Views

Are you sure the technician said "To RULE OUT leg edema?" I'm betting what he said, or what he meant to say, was that the order should say the doppler is being done due to leg edema.

I know for our company they want the symptom the exam is being done for, not the "rule out". So, for a chest x-ray, we can say cough or wheeze or increased temp or shortness of breath or chest congestion but not "to rule out pnumonia". We wouldn't say "to rule out cough" if cough is the symptom that was noted, the doctor would just write, "portable chest x-ray cough, increased congestion" end of story.

I can't believe the MD would be so inflexible as to not allow you to add the symptom of leg edema to the order.

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Jenni811 has 3 years experience as a RN and specializes in Intermediate care.

1,032 Posts; 12,691 Profile Views

I'm just wondering why anyone would order a Doppler study to rule out edema? I thought that was always an objective assessment. Please correct me if I'm wrong. I am a fairly new nurse.

i was thinking the same thing too. But that is insurance for ya! Never understand their reasoning behind stuff...

i think it has to deal with a DVT could mean the hospital is held reliable (don't move the patient, no SCDs, no anticoagulant ordered etc.) so they dont want to have to pay for a DVT that may be the hospitals fault so you order something you know the patient has that can't be caused by something the hospital did.

I dont know if that makes sense, but it does in my mind haha.

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Forever Sunshine has 7 years experience as a ASN, RN and specializes in LTC.

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Are you sure the technician said "To RULE OUT leg edema?" I'm betting what he said, or what he meant to say, was that the order should say the doppler is being done due to leg edema.

I know for our company they want the symptom the exam is being done for, not the "rule out". So, for a chest x-ray, we can say cough or wheeze or increased temp or shortness of breath or chest congestion but not "to rule out pnumonia". We wouldn't say "to rule out cough" if cough is the symptom that was noted, the doctor would just write, "portable chest x-ray cough, increased congestion" end of story.

I can't believe the MD would be so inflexible as to not allow you to add the symptom of leg edema to the order.

I think thats what was happening too. We are encouraged to put a symptom in the diagnosis or description in the order.

I would just write a new Tx order.. "Venous doppler on 5/25/11 to RLE to rule out DVT secondary to leg edema."

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