My DON came to my house today

[mtjoanna]

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?

[f1j1nurse]

Wow your DON makes mine look like a saint! Sorry you had to go thru that but yes your DON was out of line by coming to your place!! And just so you know I'd have held the lasix as well and I'm shaking my head at the ridiculous idea/rule that your facility has of faxing even critical lab values!! The whole place sounds crazy!

[DeeAngel]

Get out. I'm not being overly dramatic, that place is a lawsuit waiting to happen and I can promise you that you will be the first one thrown under the bus. If you do not have personal malpractice insurance, get it today, it only costs around $100.00 from NSO and is the smartest investment you will ever make. You are working in an unsafe environment.

[vlk70lpn2RN]

I also would have held the Lasix. I also would have called the MD, like it or not. I would rather deal with a pissed off MD than a dead patient. I work ICU now for the past 5 years, formerly LTC for 3.5 years. Potassium level of 2.9 in an elderly patient with multiple medical issues could lead to heart dysrhythmias and even death.

As far as the DON coming to your house beating on your door, she is lucky you didn't meet her at the door with a loaded gun. I do not have any kind of sense of humor when awoken after a 12+ hour shift during the middle of "my night's" sleep.

[nrseduk8ter]

2.9 k level is considered a critical value where I work

[dec2007]

You could also report the facility and the individual docs to the state and to CMS for neglect.

Yes!!! Do it!!!

[bloatedputti, MSN, RN]

Sounds like you used good judgement, but neither you nor the next nurse followed it through. Push push push when lab values or any other assessment is abnormal.

The DON is out of line. No question. This may have ruined your relationship. Only you can know. I'd start looking for a "Plan B"

[GenSurgRNFA, BSN]

That DON has no right to come to your house, that is incredibly unprofessional. I would report that to a higher up administrator and see what they have to say. If you get no response there I would consider leaving.

[anewsns]

That is absolutely nuts!!!!!!! A critical lab is an emergency . You definitely did the right thing not to give the lasix ... If you can't get an order from the doc or use an ambulance for an EMERGENCY I would say that's reportable to the state somehow. The only other thing I would have done besides holding the lasix was to give tomato soup or whatever you have handy with potassium in it.. (But then again, you wouldn't want to give too much fluid either of course )And then run like hell from that place !!! That's infuriating

also, I think you can always call an ambulance on nursing judgment right? Even if it's discouraged by the facility ?

[anewsns]

Also, I feel like if the docs don't want to be called at night for a critical lab then they aren't respectable either. (In response to your post about the hospital docs ).. I mean isn't there like a docs office you can work at? I don't mean to grill you too much but this whole situation just makes me mad for you.

[Jensmom7, BSN, RN]

Also, I feel like if the docs don't want to be called at night for a critical lab then they aren't respectable either. (In response to your post about the hospital docs ).. I mean isn't there like a docs office you can work at? I don't mean to grill you too much but this whole situation just makes me mad for you.

My response to people who would get worried about "bothering" a grumpy doc in the middle of the night for something that he really did need to be informed of: "He doesn't want to be bothered, he should have gone into banking."

[Here.I.Stand, BSN, RN]

she routinely ridicules the knowledge of one LPN who has been an LPN for 51 years

Yet who is the one who thinks nothing of administering Lasix to someone with a K+ of 2.9? Not the LPN of half a century, I'd venture to guess.

[Tenebrae, BSN, RN]

That's insane.

You did the right thing. Ensure you document everything. Your DON sounds like a lunatic and I wouldnt trust her not to turn around and say "I never said that"

As for coming to your house. I would have stated "I will discuss this with you when I am next at work do not come to my house like this ever again" and put in a written complaint to the higher ups.