NO autonomy!

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I'm used to having the autonomy of using my own judgement in certain things, but at this LTCF, it seems like you have none.

The other nite, it was time to change this old gents foley. I could not get the new cath to pass, so I asked the other nurse who hadn't left yet to try - she couldn't get it either - by this time I figured that we had poked enough, and was ready to try a coude, which we had in the facility. Oh, no, can't do that, so the other nurse kept poking and poking - by this time I told her that we'd just leave it out for the night, and call the doc in the AM. She finally got it to pass. But I'm sure that after all that poking, if he didn't need a coude before, he'll need one now.:o At the hospital, I'd have gotten a coude, and at some point would have notified the doc of the difficulty passing the regular one.

The DON told me the next morning that we should never call docs at nite - after all, "this is a nursing home, and the rules are different". Fine, I understand that, but if I think a patient is having a problem - I'm calling, I don't care what time it is.

A couple of weeks ago I came in on a Saturday nite to find out another fella had suddenly had blood in his cath all day - not just a little either. He was A/O and didn't think he'd pulled on it. When I asked if they'd called the doc I was told they'd do it on Monday.

I just don't get it!! Does this sound right to you guys? I've seen them do this on multiple occasions.

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If something is going on with a patient, I tend to call. Blood in urine? NOT normal. So, time to call the doctor. Besides, whose license are you working under?

Suebird :p

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Personally, I dont care what time it is, if I have a resident that has a problem,I call the doc,24/7. Of course,you try to use your best judgement in these types of situations. A lab thats a little off? No, I wouldnt call. Temp of 102, not responding to inteventions after an hour or so? No doubt. I worked as a weekend nurse for three years,and

I never hesitated to call the docs. If the MD on call chose not to treat, or to notify the primary on Monday, that is what I would document. Always cover yourself, and if the DON or other nurses dont like it, so be it.

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Specializes in many.

please pardon the ignorance... coude = Texas?

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please pardon the ignorance... coude = Texas?

it's a urinary catheter with a special tip made to get past any obstructions in a male such as an enlarged prostate.

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If something is going on with a patient, I tend to call. Blood in urine? NOT normal. So, time to call the doctor. Besides, whose license are you working under?

Suebird :p

Thank you Sue bird!! I feel so redeemed!:kiss

I'm not one to call with piddling things - I just take care of what I can and use my own judgement. That's why I could see NO reason to call to ask permission to insert a coude cath late at night. I'd have notified the doc in the AM. What's he gonna say? NO? Just keep jamming the regular cath in?

I guess some of these folk don't have much experience dealing directly with doctors - I do, I've done it for years. They're driving me crazy!!:bugeyes:

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I agree with calling the doc. I work on a dementia unit, weekend shift. Call whenever something is wrong with one of my folks!

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Specializes in Tele/ICU/MedSurg/Peds/SubAcute/LTC/Alz.

If something is wrong with the patient I call! Since I am a new nurse and been there for a few months - I am still learning. I ask Nurse Managers what to do first - and let them give me the heads up, especially in the evening or on the weekends. Although, I have learned that any change - mental, physical, vital signs - that aren't right call. Hey, sometimes something is wrong and something is not all about your judgement.

If it is at night or on the weekend. I do not call for a dressing order. Falls with no injuries and skin tears with no injuries I leave a message and have morning follow up with it.

Coming on Monday morning leaves you with all the report from the weekend and follow up with doctors so it is a busy day.

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Well to the wonderful world of ltc, dammed if you do dammed if you dont hemturia could ve many things bph, uti,renal lithaisis, prostate ca who knows? Thanks for educated on the coude catheter thats interesting hmm? I say cover your rearend its your license and not expect your fellow nurse to cover it you are the master of your destiny because nurses are not automonous if they were then we would be a powerful force of change in nursing.

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Specializes in nursing home care.

Always call the doc? It's your license at the end of the day and your responsibility. If the doc won't come, document it.

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I call. Sounds to me like those docs want the money for "caring" for the residents without the responsibility.

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Always call the doc? It's your license at the end of the day and your responsibility. If the doc won't come, document it.
Not only would a doc not come to the facility, he would ROAR at a nurse who would dare request he come. Docs usually come on some sort of scheduled visits, Ive never seen one come to the facility for any emergency or requested visit, they would give an order to send the patient out to the ER. As for calling for hematuria, yes definatly, I have seen a patient exanguinate(sp?) through the foley. I also have seen patients die because of delay in calling doc till a Monday.They may be old, they may be a burden to someone, but they DO deserve the same care we would give to our own elderly reletive.
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