MD order to NOT allow resident to go to the hospital

[Enthused RN, BSN, RN]

I work at a nursing home and I'm still pretty new there.

When I started my shift today, one of the doctors was there. When she saw me walk in, she talked to me about a patient I supposedly "sent out" last night to the hospital. The thing is, she advised us and the resident that while she will not give an order for him to go to the hospital, he can call for ambulance himself. So he did just that the other night. The paramedics show up and I'm a little bewildered but I roll with the punches and give them the obligatory paperwork for continuity of care purposes. Then today, she actually writes AN ORDER to not allow the patient to go to the hospital. She said I'm supposed to call her and hand the phone over to the paramedics next time so she can make them go away. I made the paramedic company aware the other night that there was no physician order on file for him to go and they are aware he is financially responsible, and they still took him. What the heck did she expect me to do? Body block the paramedics from taking the resident??? Does this sound crazy to anyone else? Can't the resident leave the facility of their own free will provided they are AxO? Isn't it entrapment otherwise? I'm starting to see why my co-workers think the place is insane.

[morte, LPN, LVN]

entrapment isn't the word, kidnap/unlawful restraint? however, if this patient has no need to go, and it is coming out of the inst. budget, what is going to happen? perhaps it would be best to transfer the patient?

I work at a nursing home and I'm still pretty new there.

When I started my shift today, one of the doctors was there. When she saw me walk in, she talked to me about a patient I supposedly "sent out" last night to the hospital. The thing is, she advised us and the resident that while she will not give an order for him to go to the hospital, he can call for ambulance himself. So he did just that the other night. The paramedics show up and I'm a little bewildered but I roll with the punches and give them the obligatory paperwork for continuity of care purposes. Then today, she actually writes AN ORDER to not allow the patient to go to the hospital. She said I'm supposed to call her and hand the phone over to the paramedics next time so she can make them go away. I made the paramedic company aware the other night that there was no physician order on file for him to go and they are aware he is financially responsible, and they still took him. What the heck did she expect me to do? Body block the paramedics from taking the resident??? Does this sound crazy to anyone else? Can't the resident leave the facility of their own free will provided they are AxO? Isn't it entrapment otherwise? I'm starting to see why my co-workers think the place is insane.

[CrossCountryRN2008]

Legally he has the right to go. The NP can refuse to order it but medics cannot if they feel he needs ED workup for whatever complaints

[Enthused RN, BSN, RN]

i'm ok with her refusing to give an order for the transfer, but making an order for him to NOT go. how the heck do i comply with that? it puts me in an awkward position.

[Enthused RN, BSN, RN]

Legally he has the right to go. The NP can refuse to order it but medics cannot if they feel he needs ED workup for whatever complaints

I knew I was right! Of course he has the right to go.

Thank you both for your responses. I just feel so weird about this situation.

[heron, ASN, RN]

i'm ok with her refusing to give an order for the transfer, but making an order for him to NOT go. how the heck do i comply with that? it puts me in an awkward position.

You don't, any more than you would comply with a dangerous med order. If they don't know about it already, you might alert nsg admin. and facility admin. to this.

I'm reminded of an incident that happened to me quite a few years ago. I was giving pronestyl - a bp drug - and found the pts. bp to be below 100 systolic. He also had an elevated creatinine and bun. Pronestyl levels had already been drawn, but results were not available. Doc said to give it anyway. Supervisor said to give it anyway. I said you'll have to give it yourself. Neither of them would do so. Couple of days later, we found out the guy's pronestyl-toxic due to kidney dysfunction.

Sad to say, docs will take great liberties with other peoples' licenses. Not to mention that, in your specific situation, you could go to jail for assault and battery.

[morte, LPN, LVN]

that does leave us with the problem of what to do, in the long term, with a patient who does this. Is he/she truly A+O? are the attention seeking, or psych? etc. can you refuse to take him/her back, r/t "not able to provide care patient wants/requires?"

[CrossCountryRN2008]

Just curious but what is her reason for the order to not let him go?

[morte, LPN, LVN]

and, conversely, why does the patient want to go?

Just curious but what is her reason for the order to not let him go?

[Enthused RN, BSN, RN]

The resident is definitely a frequent flier. The complaints change from day to day but usually it's due to pain (yet declines pain medication from us). I'm not sure why the doctor wants to prevent him from going when the facility is not financially responsible.

[Alex Egan, LPN, EMT-B]

Give the phone to the paramedics so she can make them go away... That I would like to see. My system and I think most systems do not allow on scene physicians to direct care, not to mention by phone. She either has to be or talk to a medical command physician who could order me as the EMT. It's the equivalent to her thinking she is going to walk into a random hospital and get full privileges.

[lmccrn62, MSN, RN]

Always do the right thing for your patient. As a licensed professional you are responsible and don't let the physician intimidate you. At the LTC I work as a NP the administrator and DON determine who can be sent to the hospital or not . The nurses feel intimidated and do as they are told. If a incident ends up in court they are not standing behind you. They haven't pulled that on me nor will they!