My DON came to my house today

bluegeegoo2, LPN · Oct 13, 2015

First, yes, I would have held the Lasix but I can't help but wonder why a crit lab was FAXED instead of being called on for orders? And why this lab went through a couple of shifts and no one followed up?

If my DON came to my house like that, I would 1.) Put in a time adjustment form. You can chew on me all you want, but you'll do it on YOUR time, not mine. And 2.) Look for another job. The practice there seems hinky to me.

mtjoanna · Oct 13, 2015

Our doctors have made it clear that they are not to be called unless it is an after-hours emergency--and critical labs don't count to them. It drives me nuts sometimes... We have to call them ahead of time for permission to send residents to the ER, even for serious bleeding and heart attack/stroke s/sx. We also have to get specific orders for use of an ambulance, even if it is after hours and we don't have anyone who can drive the facility van. I got my butt chewed by my DON for calling the doc "needlessly" when a (new) resident had a firm, distended abdomen with pain radiating from stomach to under her rib cage with no bowel sounds. Per my DON, I'd let the resident "manipulate" me into sending her to the ER. Good idea on the time sheet; I think I'll do that when I get to work tonight.

Nurse Leigh · Oct 13, 2015

I have no LTC experience but this whole thing seems ridiculous. My advice is to start putting out feelers for a new employer and I would consider calling for necessary orders regardless of MD preferences. Do you think if something bad goes down because they didn't intervene they'll accept their fate for their refusal to have you call as appropriate - OR - throw you under the bus?

And let them gripe if there is an emergency that requires a call to 911 before a call for permission.

Sorry you're dealing with inept people. Wish the families of residents understood what goes on behind the scenes and who creates the some of the problems instead of just blaming the nurses and aides caring for their loved ones.

canigraduate · Oct 13, 2015

I'd tell that DON if you catch her on your property again you'll press charges for trespassing and get a restraining order.

Going to your home and harassing you is NOT OK.

Anybody who comes pounding and yelling at my door will be escorted off the premises by someone in uniform.

You also need to write her up and report her for her conduct. What she did is so far beyond acceptable that she needs to be slapped back into reality before she does something even more criminal.

canigraduate · Oct 13, 2015

As far as holding the lasix, I guess you could have just given it and put your patient into an arrhythmia. *sarcasm*

Actually, that's not such a bad idea. Then they'd have to go to the hospital where there is no dumbass DON trying to kill them.

Jensmom7, BSN, RN · Oct 13, 2015

As far as holding the lasix, I guess you could have just given it and put your patient into an arrhythmia. *sarcasm*
Actually, that's not such a bad idea. Then they'd have to go to the hospital where there is no dumbass DON trying to kill them.

Yes, but apparently they would still have to get permission from the doc to send the patient out, and the DON would still rant about her being "manipulated" by the patient.

Yikes.

mtjoanna · Oct 13, 2015

You are only missing my DON. I chart just about everything, including when the docs are contacted and when they say yay or nay to the pt being seen. I've also been known to contact family/guardians and get their permission rather than the DON's, which means I'm not her favorite nurse sometimes.

mtjoanna · Oct 13, 2015

Part of the issue is that in our small community, our doctors are the hospital doctors who are on-call for the ER. It has gotten somewhat better since a couple of new PAs have shown up. We (the nurses as a group) have been known to wait for the clinic to close and the PAs to be on duty before calling in over a concern. Unfortunately, sometimes the docs still take call.

Karou · Oct 13, 2015

What is your facilities policy on critical labs? We have a specific strict policy that we must call within 30 minutes to notify the physician and he/she must respond an hour after notification. It has to be documented. And it gets audited.

I don't think 2.9 is critical though, but very low. I would have held the Lasix as well. However, I would have woken that cranky doctor up to tell him of the K level and inform him why I was holding Lasix, and ask for K replacement along with the Lasix prior to administering. If he wanted to pitch a fit I would report he behavior to the administrator. You are the patients advocate, not the doctors.

I would be horrified if my supervisor came to my house for an issue like this. First of all, errors and mistakes happen. A phone call would be fine. Coming to your home is inappropriate and weird. It shows how little she cares about her staff when she supports this whole "wake the doctor only if the patient is basically coding" unofficial policy, yet wakes up your sleep at your home for a held Lasix.

CapeCodMermaid, RN · Oct 13, 2015

Just when you think you've heard it all you come to Allnurses and hear more.

She went to your house?!?!?!.Holy crow....what a lunatic.

It seems the problems are the doctors who don't call back. If I were you and this happens again, call the MEDICAL DIRECTOR. They have to answer. It's part of their job.

Karou · Oct 13, 2015

Our doctors have made it clear that they are not to be called unless it is an after-hours emergency--and critical labs don't count to them. It drives me nuts sometimes... We have to call them ahead of time for permission to send residents to the ER, even for serious bleeding and heart attack/stroke s/sx. We also have to get specific orders for use of an ambulance, even if it is after hours and we don't have anyone who can drive the facility van. I got my butt chewed by my DON for calling the doc "needlessly" when a (new) resident had a firm, distended abdomen with pain radiating from stomach to under her rib cage with no bowel sounds. Per my DON, I'd let the resident "manipulate" me into sending her to the ER. Good idea on the time sheet; I think I'll do that when I get to work tonight.

Your DON is an idiot. Does she like sentinel events? Would she rather coddle a doctor than care for a resident? Good grief. I would not want my family member at a facility where nurses and staff are afraid to call the doctor for fear of getting chewed out, and their supervisors are only supporting this culture.

You don't have x-ray vision. While some patients can be manipulative (like those who complain of CP specifically on the day of discharge, every single time...) I don't see how atone can fake absent bowel sounds!!! You had totally objective findings that warranted a KUB at the absolute very least, possibly a trip to the ED with an impaction. Does she know bowels can rupture and perforate???

We had to call for permission from the supervisor and physician to send to the ED when I worked in LTC also. Don't think I ever had anyone say no. If I had, depending on what was going on, I might have called 911 anyway. To hell with what they say, if I believe it's an emergency then it's my responsibility to get the care they need.