My DON came to my house today

Specialties Geriatric

Published

I'm an RN who works at a small-town nursing home, owned by a large, multi-state company; I work nights--1745 to 0615 (or until the day is done--you know how it is). So here's the situation: geriatric pt with increasing edema. We attempt to contact the doctor but get his PA instead. The PA orders an increase in Lasix to 40mg po qDay x 3 days and a BMP with f/u with the doctor. The blood work gets drawn and sent to the lab the next morning and the first dose of Lasix 40mg is given. The BMP reveals a critical low potassium (2.9); results are faxed to the Dr. with a request for further instructions, which don't come that day. During the noc shift, I put the next dose of lasix on hold pending further instructions from the doctor and I fax him again and pass this on to the on-coming shift via verbal report. My DON comes in later, can't figure out why I would have held the lasix when it was a brand-new order, goes into a tizzy fit and COMES TO MY HOUSE!!! She pounds on my door, waking me up from a sound sleep, to demand to understand why I thought I could put a one-dose hold on that Lasix. She tells me that it was an inappropriate action on my part and orders the day shift LPN to give the Lasix anyway, apologizing to the doctor for my actions.

Here's my question: was I really out of line in holding one dose of lasix while waiting for further instructions on a critical low potassium? Did I overstep my legal authority as an RN? I did not d/c the order, only put it on hold pending further instructions. Is what I did so far from logical thought that it warranted her coming to my home and waking me up?

Specializes in CVICU.

What a lunatic. I would be looking for a new job.

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Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.

I am wondering what the nurse practice act of the state that you practice in says about the duty to protect the patient versus coddle the doctor and follow a dangerous bs policy of not reporting potentially life threatening abnormal labs. I also wonder if the DON knows about HER duty to protect patients as she is the one who has ultimate 24 hour accountability of everything that goes on in the facility. Further, I wonder about the medical practice acts that the doctors have to follow and what they say about being involved in the enforcement of a policy that is dangerous to the patients.

Does your facility, or better yet the corporation that owns it, have a confidential means to report unethical, unsafe and unacceptable behavior? If it does, use it. Report that DON. Her behavior was clearly unacceptable. While you're at it, consider a report to the BON. Nurses get reported for far less than that.

Document everything that happened, from start to finish, for your own records. Names, dates, times, incidents. This is a good way to CYA if a complaint is made against you. You did the right thing, btw. You are a conscientious and astute nurse.

Get out of that facility before something bad happens. This situation has red stickers all over it.

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Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.

Look for a good Nurse Attorney too in case they try to hang you.

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Specializes in Postpartum, Med Surg, Home Health.

OP I am so sorry that happened to you! What a crazy DON! Who in their right mind would drive to an employees HOME and bang on their door and demand answers? Maybe that DON has watched too many tv shows.

You should report her to corporate. And you should be looking for a new job! That place sounds toxic. I worked at a snf and it was bad, but yours sounds worse. The difference is our DON was a big pt advocate atleast, very intelligent and would get us in trouble if we were NOT contacting the MD, not vice versa! Good luck and please do not waste your time there any further

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Specializes in ER, TRAUMA, MED-SURG.
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.

This! Sounds like your DON is a nut!!

I'd be looking for something else super-stat!

Anne, RNC

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Specializes in psych and geriatric.

There are limited employment options in my little community. I could apply to the hospital, but then I'd be working directly under doctors that I don't respect or trust. My parents live in this community and Dad is stage 4 lung CA so I'm pretty much stuck, unless I want to leave nursing. Believe it or not, the DON is more respectful of me than she is of the day nurses. The DON has only been a nurse for maybe 6 years and she routinely ridicules the knowledge of one LPN who has been an LPN for 51 years. We are, as a group, rather fed up with it and are near our "can't take it any more" explosion.

Thank you for the validation of my clinical decision and for some very useful advise and emotional support.

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Specializes in psych and geriatric.

By the way, the doc did finally respond with orders to continue the lasix 40mg but to also add KCl 10 mEq BID and recheck potassium level in a week.

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Specializes in psych and geriatric.

That and at this hospital, good care is not guaranteed. They almost cost me my leg (crush injury that started to necrose in the muscle. Wouldn't take my concerns of tunneling seriously--and I was a very new nurse and trusted the more experienced professionals--until there was a 5-inch long tunnel running along my bone. Referral to a larger hospital resulted in 2 surgeries to debride, a month with a wound vac and 6 weeks with a PICC for IV abx and a massive bill which have left me somewhat doubtful of the quality of care provided here.) Unfortunately, mine is not an isolated case. I had a friend go to the ER here a month after spinal surgery. She was oozing a clear, sticky, odorless fluid, enough to fill a sanitary pad twice a day. C/o headache, nausea and blurred vision. Surgical site was somewhat swollen but not red or hot. The ER here sent her home on antibiotics. My sis saw her the next day, thought she looked awful and thought it was wrong that she couldn't maintain her balance and insisted on driving her to the hospital that had performed the surgery. Take a wild guess at what they found?

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Oh hell naw. I would report her 100% super inappropriate.

Also that's not rocket science obviously you would hold the diuretic if the potassium is that low. Maybe you should give that DON a in service on muscle contractility and THEN find a new job. Oh hell naw I'm mad for you.

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Specializes in HH, Peds, Rehab, Clinical.

Well, a restraining order would mean that OP can't come to work....

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.

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this needs to posted in the DON forum, see what they say. I second what Canigraduate had to say.

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Well, a restraining order would mean that OP can't come to work....

Or it would mean that the DON would have to stay on the other side of the building from her at all times.

I don't know if this is still true, or true in your state, OP, but I remember restraining orders where you could choose the distance.

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