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. 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.
Specializes in Tele/ICU/MedSurg/Peds/SubAcute/LTC/Alz.
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.
It is so true what everyone is saying. I took a break from LTC and work in Med/Surg/Peds now. I came upon a situation in which a Dr. wouldn't give me an order for one of my Pediatric patients. Guess it is an ongoing problem at this hospital. So you know I wrote a note about it, to cover my butt! :angryfire
Specializes in Gerontology, Med surg, Home Health.
You have to call if something is significantly wrong. It's your license, your judgment and might just be the patient's life. So what if the doc gets mad? That's his problem. Your problem will come if you DON'T call and the patient suffers from it.
I learned to call whenever there is a change of condition. Even if all you get is the answering service and all they can do is to take a message, get the name of the person you gave the message to and document it. And make sure that you tell the person that you would like a call back from the MD as soon as they contact him. You have to watch out for yourself as well as your patient. These people at your facility that are telling you not to call and to wait until Monday will change their song when an event leads to a lawsuit and people are being questioned about their actions/lack of action and the policies in place. Luck in the past does not insure luck in the future.
Just my opinion but isn't this what they went to school for. I don't feel bad at all if I call a doc in the middle of the night for a legitimate reason. Every job has it's moments. We wipe butt and they get woke up.
Not sure why you would need to call an MD to put in a coude, just yesterday a nurse came to get me and said she could not get the new foley into a male. I asked if she was using a coude and she said no. I got her one and it went right in. I have found over the years that most males have the need for a coude.
Calling the doc on off hours? YES, for anything out of the normal for the resident. It is our responsibilty to care for the residents around the clock and their job to answer their pages. Years ago when i worked noc shift, I had to call the MD and after 30 minutes of waiting, I called the answering service a second time to report i hadn't heard from him. The answering service called back in 15 minutes and stated she had sent the police to his house. The MD responded within 10 minutes then and was not even rude. I ended up having to draw labs on a resident and start an IV, so my choice was correct in protecting the resident.
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.
thank goodness....you were thinking exactly what i was!! heck, i don't want the doc to "come".....i just want orders. he's going to come once a week as usual...if he thinks the pt needs seen sooner, they go to the er. really, you learn to use your judgement and know your docs. the medical director where i work would not be pleased if you called to ask if you could use a coude' cath. just do it....the pt has a cath order...he didn't write for what size or type...just that he wants the cath in. same with falls with no injury...if i call him at 4 am to tell him that mr. smith was found on his floor mat resting comfortable with nai, then doc will be less then pleased. i find that we have a lot of autonomy in ltc....but our doc encourages it in nurses he trusts. and when i do call for something important, after he gives orders he'll say "is there anything else you need me to order"? he respects our judgement.
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. 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.
OMG, we have docs on call 24/7. We do not hesitate to call if need be. We would probably get blasted if we didn't CALL. This sounds like a very dangerous place to work!
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.
st4wb3rr33sh0rtc4k3
253 Posts
It is so true what everyone is saying. I took a break from LTC and work in Med/Surg/Peds now. I came upon a situation in which a Dr. wouldn't give me an order for one of my Pediatric patients. Guess it is an ongoing problem at this hospital. So you know I wrote a note about it, to cover my butt! :angryfire