Need help with boss and ethical dilema...

Nurses General Nursing

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I work for a company which I will not name here, but I need your advice.

I am a nurse and I work for a DME company.

I had a patient refuse their oxygen. The patient is a smoker, in his home, doesn't feel short of breath, yet overnight pulse ox shows less than 88% for over 20 minutes. I educated him on his low o2, and what effects this could have on him should he not follow MD orders. The patient still refused. I had him sign a refusal letter and was later told by my boss that we need to first talk to the doctor to see if the doctor wants us to keep it in their home until we get another overnight pulse ox. The patient told me even if it's low again "I DON"T WANT IT" I was told that "my job is to make the pt compliant" as "this is what the doctor is expecting us to do". I told them ABSOLUTELY NOT...that my job was to be a caring nurse, patient advocate and that I would inform the patient of their rights, inform them of possible outcomes should they not follow doctors orders, but that they have the right to refuse treatment.

The sales rep at the company will set up oxygen in a heartbeat, because he gets paid for every o2 set up...but I have this one patient who refused it 4 weeks ago, they said the patient is to set up an appt with the doctor before we pull the o2...and guess what...this company is billing medicare for a service the patient refused...they are telling me we can wait on the doctor to tell us what to do...I thought the patient has the right to refuse regardless of what the doctor wants. Am I correct, or am I missing something? Is this a form of medicare fraud?

I love the patients I go and visit and the stress is very low normally, so I don't want to quit...

Help!

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I think you will get an ulcer if you don't find an employer that doesn't go so far against your better sensibilities about advocating for the patient.

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I have thought about leaving, but it's the first nursing job that I've had that I actually like, minus the the times I run onto patients refusing o2 and having to deal with my boss on this issue. My boss is a nice man, but this company is only interested in getting o2 numbers which does bother me.

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Specializes in Med/Surg, Acute Rehab.

Hi Regnurse!

I am certainly no fan of insurance companies nor false billing, but could it be that your company is just charging for the service until the doctor gives an order to discontinue home O2? I have no idea of how this works, but if the pts aren't using the O2, then they couldn't bill for new tanks, but just for the rental time. Does your company actually need an order to d/c the O2? By the way, what is a DME company???

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DME stands for "durable medical equipment".

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Hi Regnurse!

I am certainly no fan of insurance companies nor false billing, but could it be that your company is just charging for the service until the doctor gives an order to discontinue home O2? I have no idea of how this works, but if the pts aren't using the O2, then they couldn't bill for new tanks, but just for the rental time. Does your company actually need an order to d/c the O2? By the way, what is a DME company???

I think it would be like a hospital pharmacist charging for a pill when the nurse wrote "refused" because they were waiting for an order for the med to be dc'd.

The o2 just sits in the patients home for weeks. They refuse to use it and want it picked up, we haven't picked it up and still charging for it "because we haven't heard from the doctor"

This isn't right is it?

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No, it is not ethically right, but maybe technically it is. The onus is on someone to get the doctor to d/c the order to the DME company. Until the doctor does this, the company is following orders. I can see their standpoint.

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Specializes in Trauma Surgical ICU.

I worked at at DME while in nursing school and yes even with non-compliance the Dr must still DC the O2 and send the order to the DME before they can pick it up without fear of being held liable if something should happen to the pt.

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Specializes in Med/Surg, Acute Rehab.
DME stands for "durable medical equipment".

THANKS!

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Specializes in Med/Surg, Acute Rehab.
no, it is not ethically right, but maybe technically it is. the onus is on someone to get the doctor to d/c the order to the dme company. until the doctor does this, the company is following orders. i can see their standpoint.

this what i was thinking . it's not really the same as pharmacy charging for pill not taken by a pt. if it was the first time you had the pt. and you opened the packet and the pt refused it, well then it has to be wasted or thrown away with documentation. the next time the pt was due the med, the nurse should ask if said pt is going to take the pill. if pt says no, then you wouldn't pull the med. then you notify md.

the advocate for this home care pt with the o2 would serve the patient best by doing all they could to contact this doctor. just my opinion. :twocents:

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

It's cheating.

Just legally, unfortunately.

DC the oxygen.

J

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Why is it so hard to get the d/c order?!!?? Whether or not the doctor 'likes' it, the pt is refusing the O2, and it should not have been left in the home. Get the order.

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