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 psych and geriatric.
Why are you dealing with this situation if you work nights? Did I read this wrong?

The day shift faxed the results to the doctor. I came to work and was slammed from before I even clocked it--hospice wanting me to help figure something out for a resident I'd not even met yet, a fall, dealing with short-staffed CNAs and grumpy kitchen staff. It wasn't until around 0200 that I was able to draw breath enough to realize that I'd not listened to report yet, at which point I learned about the critical lab. I put the AM dose of lasix on hold pending further instruction from the doc and faxed him the bloodwork, the information about the recently increased lasix and that the AM dose was being held until he responded. Passed it all on to the AM shift and went home to recoup for the next night.

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
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...

Our facility medical director always had an on-call for after hrs emergencies. The on-call typically took the route: send them out.

You know the old nursing adage, "when in doubt, send them out" to an acute care medical hospital.

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True; how do I delete/edit the post and how do I post a photo without linking it to my facebook?

Not sure never had to do it myself. Maybe search the forum or use the report button

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Specializes in psych and geriatric.

"And the administrator's response to the DON coming to our house? Does the admininistrator have enough clinical background to appreciate why you held the lasix and the communication issues with doctors after hours?"

The DON and the administrator have been close personal friends for years. I'm not sure what will happen now, whether the situation will resolve or whether I'll have a major target on my back. I'll watch and see. If it starts feeling personal, I'll probably have to look at moving from my town in order to get another job. We shall see.

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Specializes in LTC.
"And the administrator's response to the DON coming to our house? Does the admininistrator have enough clinical background to appreciate why you held the lasix and the communication issues with doctors after hours?"

The DON and the administrator have been close personal friends for years. I'm not sure what will happen now, whether the situation will resolve or whether I'll have a major target on my back. I'll watch and see. If it starts feeling personal, I'll probably have to look at moving from my town in order to get another job. We shall see.

I would go ahead and start looking for another job. Best to be prepared "just in case".

I worked at a small facility in a very small town with the MD being the ER doc at the tiny little rural hospital. I'm pretty sure I know precisely the type of environment that you are in and it's not good. In fact, it's likely downright dangerous.

I understand the needs of your family, but some small rural facilities tend to run on the "buddy system". (Nepotisim, anyone?) If you're not "in" you will have a target on your back. Mind your practice, chart to CYA, and make plans to exit with your license intact.

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Specializes in psych and geriatric.

So, a year has passed since this incident. Six months ago, my husband and I moved to another town and I am working in a different facility. This facility is non-profit, owned by a church denomination and has been wonderful. There were several more issues between th DON and myself and I finally got to the point where I couldn't take it anymore. I came close to giving up nursing. This new job has allowed me to rediscover my love of nursing and has cemented my enjoyment of long term care. The staff to patient ratios is smaller, there are providers who are much more responsive/responsible, and my supervisor and DON have a LOT more common sense and common courtesy. My overall stress level has reduced so much I've been able to stop some medications and I no longer face going to work with a feeling of dread with my stomach in a tight knot all shift. There are hectic days, but none of my worst days have been as bad as a normal day at the previous facility. I NEVER want to work in a for-profit organization again. Ever.

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Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
So, a year has passed since this incident. Six months ago, my husband and I moved to another town and I am working in a different facility. This facility is non-profit, owned by a church denomination and has been wonderful. There were several more issues between th DON and myself and I finally got to the point where I couldn't take it anymore. I came close to giving up nursing. This new job has allowed me to rediscover my love of nursing and has cemented my enjoyment of long term care. The staff to patient ratios is smaller, there are providers who are much more responsive/responsible, and my supervisor and DON have a LOT more common sense and common courtesy. My overall stress level has reduced so much I've been able to stop some medications and I no longer face going to work with a feeling of dread with my stomach in a tight knot all shift. There are hectic days, but none of my worst days have been as bad as a normal day at the previous facility. I NEVER want to work in a for-profit organization again. Ever.

So glad that this worked out for you :)

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Thanks for the update, mtjoanna. Big Fish In A Small Pond/Small Town Mentality Nepotism Blacklist Blues here, too. Relocation isn't an option for me, but as I've reached a point eerily similar to yours in your previous position, I'll take a much longer commute for a little more sanity and less chance of finding myself afflicted with 'tire tracks'.

Soooo glad to read things are happier in your world!:yes:

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