It's just a ******* straight cath!!!

Nurses General Nursing

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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.

thanks for letting me vent. Carry on...

"Idk this isn't the place for me and im looking for other jobs and going back to school." And all the while, the resident has not received treatment.

I understand why you're interpreting this that way but I care a lot about my residents. she did recieve tx the minute I got back after my time off. i checked her and sent her out to the ER. Can't blame me for being frustrated at this job. Nothing is all about me, but one should like their job and not just say, "im gonna put up with this because it's all about my residents"

It's all about my residents/patients when I'm At work.

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.

That's why I initially wanted to cath her but they d/c'd the UA and the cath, and by the time I came back for my scheduled day to work she was not in good shape. But she's on IV ABT now and doing better

Updates, patient is doing well. :) she had large Amt of e. Coli in urine and has UTI but no kidney infection or sepsis!

Also- Regional director is fumed that they dc'd everything and I said, in all due respect I've heard a lot about AL being cited for doing invasive procedures so maybe from now on we should just make arrangements to take her to urgent care or just send to ER. She said that's not the protocol and that if it's emergent that I need to do certain things under certain circumstances. So I said, "I understand, but in order to do this the right way can you please sign off on these things as I am very cautious of doing them in AL but if you sign off that you approved the skilled care in these situation I will gladly do it. She said that's fine. I'm holding her to that.

Thank you all for the input!

Specializes in kids.
Updates, patient is doing well. :) she had large Amt of e. Coli in urine and has UTI but no kidney infection or sepsis!

Also- Regional director is fumed that they dc'd everything and I said, in all due respect I've heard a lot about AL being cited for doing invasive procedures so maybe from now on we should just make arrangements to take her to urgent care or just send to ER. She said that's not the protocol and that if it's emergent that I need to do certain things under certain circumstances. So I said, "I understand, but in order to do this the right way can you please sign off on these things as I am very cautious of doing them in AL but if you sign off that you approved the skilled care in these situation I will gladly do it. She said that's fine. I'm holding her to that.

Thank you all for the input!

Glad the pt is doing well, but I would still be leery of working outside the scope of AL license. Get the regs or call your BON, they will be able to help.

Specializes in Psych, Addictions, SOL (Student of Life).

Many nursing homes and AL's don't want to send residents out to ER especially if it's within 90 days of last time out as medi care won't pay for the readmission and the sending facility eats the costs so they try to treat them in- house. In our facility we have a standing protocol for obtaining a straight cath as many of our patients simply can't supply a clean catch sample. We've gotten pretty good at swooping in and getting the sample quickly and without undue drama or trauma.

Hppy

Specializes in ER, Trauma, Med-Surg/Tele, LTC.

It's pretty incredulous how nothing was done for this patient in the 3 days OP was off work. OP was still the one who ended up sending this patient out. 3 days with no urine collected, no antibiotics, no interventions whatsoever for a patient that was exhibiting altered mental status for some time already at this point. It's pretty sad how apathetic some people can be even when lives are concerned.

OP, based on this post and several of your other posts, even though you're new and inexperienced, I think you're already a GREAT nurse. Your actions stem from patient advocacy instead of just blindly following rules. I'm sorry this particular place is burning you out already.

Specializes in ICU.

It was an eye opener. I have a better understanding of why so many Assisted Living residents present with septic shock.

It was an eye opener. I have a better understanding of why so many Assisted Living residents present with septic shock.

My guess is the UTI issues as well as infected wounds. I'm really on top of dressings.. I'm always working closely with wound care nurses and keeping them updated and if a wound is not healing properly I call them right away to get the resident on the service

Our local ALF's take their patients to out patient services, she could have been seen as an out patient for a cath UA without getting to the point of needing ER and IV abx. There's definitely something wrong with your employer's protocols and/or training. I wouldn't consider that $5000/mo care.

I haven't read all of the posts yet, but having worked in an ALF in the past I know that a lot of what the facilities nursing staff is allowed to do is based on the specific licensure of the facility. I worked for a very large facility but we did not have the licensure to do anything 'skilled'-not even a bandaid with neosporin-had to have a home health order-seriously...it's frustrating, but the facility may not be able to straight catch in the ALF section of the facility.

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