In Need of advice...

Published Feb 16, 2012

1 Post

Specializes in LTC.

Hi everyone,

I am in need of some advice.

I work at a LTC and yesterday I found one of my resident on the floor who had a large hematoma above his right eye laying on his right side after myself and an aide moved him out of the corner he was laying in I noticed that his right leg was shortened and rotated externally and he complained of right hip pain. After assessing him, myself along with our ADON and 2 aides placed him onto a draw sheet and lifted him off of the floor and back into his bed. His neuro checks were WNL, I call his doc and get orders to send him out to the ER for Eval and TX due to the hip complaints and hematoma. After transport leaves with him I d/c'd the neuro checks as he was no longer in the facility.

He returned at 2pm in the afternoon after having a CT of the Brain and CXR at the hospital which were all normal. I was going through his discharge paperwork and did not find anything about hip or pelvic xrays being done. I call the ER and was told by the nurse who cared for him there that they did not do any xrays of his hips/pelvis. I pass this onto my supervisor as I ma not comfortable making and decisions about his mobility/ transfering till I have definative proof that there is not a fracture. Mind you he continues to complain of hip pain. Apparently my Supervisor called the hodpital and was told that they did do pelvic xrays

I get back to work this morning and get called in to the DON's office with a write up waiting for me because I did not continue to do Neuro checks after his return. I explained that his CT was normal and then started to explain about the hip/pelvic issues. Apparently my supervisor called his doc and recieved orders to continue neuro checks this info was never communicated to me or documented in his nurses notes till sometime after 5 pm as that was the last time I charted on him as my shift was over at 6p and then there was a late entry by my sup after that.

I am confused, do you guys continue to do Neuro Checks after a normal CT. I was always told not to unless there is a history of a bleeding disorder or coumadin/plavix use or there is an order to continue (had I known about the order of course I would have continued) We do not have a policy on this at my current job and If I have done something wrong I would gladly accept responsibilty for it. I'm just confused and feel like I am being targeted by this supervisor as we both interviewed for the same position that she recieved over me. I'm not saying that I am perfect but I am a good nurse and a lot of the times she will try to make decisions about my residents that I question, whenever I question them I usually am correct.

Ugh, I just don't know what to do!