Another vent. I promise I'll stop when I get a new job. Swear I'm not one of those people who hates and runs from every job lol but this current one is taking every once of energy I have.
i get a call on my day off about an order the doc sent. "UA and CS, straight cath if necessary"
the day nurse was livid because it was for an AL patient. Still, our director said we can cath in AL as needed. I do this in our subacute unit all the time.
The reason for the order- this patient has been confused and combative most likely due to suspected UTI (she has dementia but is usually very sweet, foul smelling concentrated urine.. All the s/s) I couldn't get the urine cause It took me and 3 CNAs to toilet her for nothing, just to get her back into the chair and then into the bed as she went in her diaper.
she has hep c and is digging nails into people and trying to hit us. Just not a good situation.
so I called md and she said what about a straight cath? I said yes and some Ativan. She said fax me a reminder and I will fax the orders in the morning.
next morning day nurse flipped saying that I have no right to dx someone with a UTI and get order for a cath for an AL patient as its a liability to cath her and as an invasive procedure we could make a mistake and it's a liability.
im thinking, dude it's a urinary catch not a chest tube?
But it anyway I said go ahead get the order d/c for the catch and we'll try to get the urine. Been 3 days and still have not gotten it but I'm gonna let them call the shots cause I'm done with the arguing. Being made to feel dumb, and im done with the gossip too. As she ran and told the other nurses about everything.. I'm thinking, grow up?
Idk this isn't the place for me and im looking for other jobs and going back to school.
Specializes in Clinical Documentation Specialist, LTC.
Good on you for advocating for your resident! A temp. of 101 would've had me sending her to the ER as well. I would rather deal with the PTB than find myself sitting in court answering as to why the resident was left untreated when she clearly showed s/s of a UTI, then rapidly declined and died from septic shock. Not on my watch.
I'm curious...What was her blood pressure before you sent her out?
If you were working in LTC, the symptoms you saw and actions you took are exactly what we would've done where I work. Those symptoms and straight cath make total sense.
If you're not allowed to straight cath because you can't in AL, maybe that's why the morning nurse freaked out. She should've told you what they normally do for a suspected UTI. I don't understand why they didn't do anything for the resident while you were gone.
I didn't think you were making it all about you. It sounds like your coworkers aren't working with you as a team and it's got to be hard to be a nurse without teamwork. I think you have every right to complain. We all complain about our jobs! I would be especially upset with that kind of environment. For me coworkers can make or break a job.
Good luck if you are searching for jobs, there has to be something better out there.
Good on you for advocating for your resident! A temp. of 101 would've had me sending her to the ER as well. I would rather deal with the PTB than find myself sitting in court answering as to why the resident was left untreated when she clearly showed s/s of a UTI, then rapidly declined and died from septic shock. Not on my watch.
I'm curious...What was her blood pressure before you sent her out?
It was normal but I still didn't wanna take any chances.. She shouldn't have had to suffer like this but at least I know she'll get the care she needs now even if I do get reprimanded
Specializes in Clinical Documentation Specialist, LTC.
It was normal but I still didn't wanna take any chances.. She shouldn't have had to suffer like this but at least I know she'll get the care she needs now even if I do get reprimanded
Specializes in Mental Health, Gerontology, Palliative.
So a straight cath is the same as an in out catheter?
Personally if thats the case, I think its a brilliant idea. We have one very demented patient with a long term IDC who in the first 8 weeks they were in the facility pulled the @@@@@ thing out at least five times.
Yeah I sent her to ER cause no one else was doing anything.. It is confusing and especially being a new nurse.. When everyone I work with and for, is saying all different things.
In my area they send residents from AL out to the ER all the time to get evaluated for "altered mental status" or "fever" when the patient does not have a PCP who is doing home visits or has a NP who does home visits.
It really depends a lot on the residents insurance and provider. Some health care providers who are part of medicare advantage plans are sending out their NP to see the patient in their home - home can be an AL facility.
But if this is not the case, and the patient needs to be evaluated, they are being send to the ER - which is a long wait, not cost effective in most cases, and a lot of aggravation for most.
As far as referring to home health for a straight cath, unless the patient was already on home health services, a referral for new change in mental status would be inappropriate..
1) A straight cath is not a billable skilled service. Teaching a patient to self cath would be but not just a single time to collect a lab sample.
and more importantly 2) Referring to home health for a recent and significant change in mental status is completely inappropriate, I wouldn't accept the patient and would advise you to seek medical attention (MD or ER) and then the MD/ER will make a referral to HH if appropriate and medically necessary to follow up, but not to perform initial diagnosis and treatment.
If the patient was already receiving home health services, I assume that would have been the first call made 5 days ago.
LTCNS, LPN
623 Posts
Good on you for advocating for your resident! A temp. of 101 would've had me sending her to the ER as well. I would rather deal with the PTB than find myself sitting in court answering as to why the resident was left untreated when she clearly showed s/s of a UTI, then rapidly declined and died from septic shock. Not on my watch.
I'm curious...What was her blood pressure before you sent her out?