Nurse Lynwood here. Forgive me if this question has been asked before, I am new to the forums.
I work 11-7 at a LTC facility. I get a call from my unit manager today saying it is urgent that I come up to the nursing home (LTC facility) where I work and write an order for Friday night (the last day I worked). That was a really chaotic night. To make a very long story short...I had to call 911 because a resident was a full code, (usually A&Ox3) and became unresponsive on me. And was hypotensive BP 80/40. I immediately called 911 to have him transported to the ER. The situation was critical and I didn't feel there was time to call the doc, and wait an hour for the on call doc to give me the order to "send to ER for eval and tx" (it was 3am). So I get a call today (Monday morning, I was off all weekend) and my unit manager says "you must come up here immediately and write the order for sending Mr. X to the ER for Friday night". Huh? I never got any such order or talked to any doc. I straight 911'd him out because the situation was so critical. In my years of experience, I have never had to write an order to "Send to ER for eval" unless I got that order straight from the doc before sending the patient out. As I understand it, if you "911 em out" you don't need an order from the doc to send them. Correct?
I think she just wants me up there because "the administrators" are in the building and they are short staffed & she is using this phoney excuse to get me up there so she can put me to work (they are short staffed today) and once I clock in (to write a 30 second order), they'd hold me there for a 16 hour shift and call it "abandonment" if I left. Yeah, that's they way they roll. I'm getting ready to quit this place because they've done nothing but abuse me with situations like this over the past 10 months.
So, my question is, YOU DO NOT NEED AN ORDER FROM THE MD TO SEND SOMEONE OUT TO THE ER if you used 911 to send them out in an emergency, CORRECT?
Thanks in advance for your time and response. I have already asked another nurse who works with me and they were unsure?
DNR doesn't mean do not treat. The DNR deserves the same shot to survive, sans the CPR.
Right but it would just change the order of events.. if a resident is who is a full-code is showing signs of a stroke.. I wouldn't wait for the MD to call back, just call 911 first. If the resident is a DNR and showing signs of a stroke I would call the MD first then 911 right away.
I am an ICU nurse, and I wouldn't transfer a pt to a stroke center if they're having a life-threatening stroke without a doctor's order- I wouldn't be able to. That doesn't mean I don't understand the seriousness of the situation. Obviously, sending a pt from LTC to the ER is a different situation. It just doesn't make sense to me that you can do something that requires a doctor's order and get the order after the fact- but I guess LTC is just a whole different ballgame.
Also, any pt showing signs of a stroke need the same medical attention, in the same timeframe, regardless of code status.
Where I work you have to get an order for each time a resident goes out.
If it's not a dire emergancy then I will call the on-call and press the issue. Press how this isn't their norm, and so on.
If it is a dire emergancy then I call 911 first and get that patient out NOW. Then once the paramedics have walked off the unit that's when I call the on-call doctor. In the nurses notes I write why I called 911 first before the doctor. Then when I get the call back I just explain about how I sent the patient out to the hospital (and why I did) and that I just need him to ok the order for me to send the patient out. 99% of the doctors will say yes right away.
I can only speak for my facility. We have standing orders that we can send a resident out and write "nursing judgement" on the order. Our wonderful medical director will always sign it, but we do have to have an order. As far as going in to sign the order, I would say pick your battles, and to me, this doesn't seem like one.
Right but it would just change the order of events.. if a resident is who is a full-code is showing signs of a stroke.. I wouldn't wait for the MD to call back, just call 911 first. If the resident is a DNR and showing signs of a stroke I would call the MD first then 911 right away.
But that slight delay has now compromised the DNR's chances of recovery.
I work in LTc. Yes there needs to be on order written in the residents chart to send to ER for eval & tx.. does this mean I wait till I get that order from the Dr to send the resident out? Absolutely not. Its nursing judgement in an emergency situation and no Dr is going to argue that you shouldn't send them out if it is a true emergency. So we send then get the "order" later when the Dr is notified. usually when resident is on way to ER.
Specializes in Gerontology, Med surg, Home Health.
I've had docs refuse to give orders to send people out, especially psychotic people having a breakdown. There is a regulation, at least in this state, that you don't need an MD order if " a person with the necessary knowledge to deem it an emergency is present". (I paraphrase) if I think the person needs to go, I'll send them. I once had a doc refuse to give an order for an old woman who was in respiratory distress to go to the hospital because " she smokes and she is a bit demented." While I waited for the ambulance that I had already called, I lectured him on his attitude and had changed his mind by the time she was on the stretcher.
if you afraid of working just show up in shorts and sandals with a cut off tee
I had a colleague who came in to pick up her check, ended up being guilted into staying due to short staffing then went to Wally World and bought a set of scrubs and shoes so she could be decent at work!!
I had a colleague who came in to pick up her check, ended up being guilted into staying due to short staffing then went to Wally World and bought a set of scrubs and shoes so she could be decent at work!!
I never let them guilt me into working on my day off. I use to when I was new but .. no more. I don't go into work to pick up my check if I'm off on that day. I wait until the next day I'm working.
I have not started on the floor yet but in orin. the policy states that in an emergency we are to call 911, get as much paper work in order. Then call the on call dr and let him/her know what happened and then get the order for the 911 call. In our facility there are a handful of doctors in care of the pts. I am sure they have outside doctors but we staff 6 doctors.
SuesquatchRN, BSN, RN
10,263 Posts
DNR doesn't mean do not treat. The DNR deserves the same shot to survive, sans the CPR.