No Nurse Supervisor

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Working as a per-diem nurse in the field in a home health agency where the nurse supervisor is on sick leave. It's a strain if one of my patients is sick and their doctor is not accessible--if he does not answer requests for orders or clarifications. There is no back-up right now, all I can do is document and inform the patient and family.

I haven't been in this situation before. Is this common? Other agencies I worked in had more than one supervisor and they covered for each other. How long is it reasonable to wait?

Right now the path is a fax to the doctor which is not answered and no one to back me up. I'm wondering how to protect myself, and whether this job is going to be possible.

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As long as I have prepared the order sheet, sent the original to the office, and put the suspense copy in the field chart, I have done my job. At one point, I was bypassing the office and sending everything directly to the doctor's office, sending a copy to the office. Nobody ever called me on the carpet for doing that and I believed at the time it was because they couldn't even figure out I was doing that. Most of the time I work on night shift so I can't follow up if I wanted to.

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right now there is no one at the office to follow-up. one of the doctors is not willing to answer questions on the phone and won't answer faxes. I like the patients, and I like the job, but I feel out on a limb.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
As long as I have prepared the order sheet, sent the original to the office, and put the suspense copy in the field chart, I have done my job. At one point, I was bypassing the office and sending everything directly to the doctor's office, sending a copy to the office. Nobody ever called me on the carpet for doing that and I believed at the time it was because they couldn't even figure out I was doing that. Most of the time I work on night shift so I can't follow up if I wanted to.

I would be surprised to learn if they ever picked up on it. If and when they did, though, you can bet they wouldn't have thanked you for efficiently making sure the patient received optimum care. The problem I'm having is that because of sloppy work and tremendous turnover in the Case Management people, they lose, ignore, misinterpret, what-have-you until the whole documentation issue is a snarled mess and who gets the blame? :rolleyes: sighhh. . .it wouldn't be so bad if the new ones didn't blame me for the deficiencies of the old ones by stabbing their finger at the chart and demanding did you do this? That? That must be documented, you know. Where's the order for this? I don't know, sir. I'm not responsible for the typists transcription errors on the 485, ma'am. I can't alter a signed order, sir. Ahh, well. It's a tough economy. Thank you for reminding me that you have so many people who would love to have my job. I've pretty much given up on the idea of them actually noticing how many times I've saved their butts, but a girl can still dream.:nurse:

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I noticed that initiative is more likely to bring about criticism than acknowledgement. I am certain that the general lack of concern meant that no one gave it a thought, otherwise, I would have been criticized and probably told to stop the practice.

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Right now the path is a fax to the doctor which is not answered and no one to back me up. I'm wondering how to protect myself, and whether this job is going to be possible.

I keep a copy of the fax I send to the physician along with the confirmation of the fax saying that it went through, to what #, and the time and date.

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I would be surprised to learn if they ever picked up on it. If and when they did, though, you can bet they wouldn't have thanked you for efficiently making sure the patient received optimum care. The problem I'm having is that because of sloppy work and tremendous turnover in the Case Management people, they lose, ignore, misinterpret, what-have-you until the whole documentation issue is a snarled mess and who gets the blame? :rolleyes: sighhh. . .it wouldn't be so bad if the new ones didn't blame me for the deficiencies of the old ones by stabbing their finger at the chart and demanding did you do this? That? That must be documented, you know. Where's the order for this? I don't know, sir. I'm not responsible for the typists transcription errors on the 485, ma'am. I can't alter a signed order, sir. Ahh, well. It's a tough economy. Thank you for reminding me that you have so many people who would love to have my job. I've pretty much given up on the idea of them actually noticing how many times I've saved their butts, but a girl can still dream.:nurse:

I refuse to sign any 485's or orders on which the typists have made errors. I write in red the correction and send it back along with the source document, so they can see what originally was given to them (and typed incorrectly).

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thanks for all the responses. one thing I'm trying to figure out is-- how weird is this situation? I don't have any support right now in trying to make sure all the nursing bases are covered, or support in covering my own base.

but it seems like there are a lot of agencies that are not well-organized. I'm shocked, shocked to find out that money trumps patient care.

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I think you are correct in surmising that you may very well find the lack of follow up in just about any agency you go to. In all my years of home health nursing, I have only ever found that one individual nursing supervisor who ever lifted one finger to insure that copies of signed orders made it back to the home in between sending updated 485s.

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thanks for all the responses. one thing I'm trying to figure out is-- how weird is this situation? I don't have any support right now in trying to make sure all the nursing bases are covered, or support in covering my own base.

but it seems like there are a lot of agencies that are not well-organized. I'm shocked, shocked to find out that money trumps patient care.

Unfortunately, in my city at any rate, there are very few nursing jobs available. When we do get a job we have to put up with the deficiencies of the organization, no matter how "weird" or else find a different line of work. Sad, isn't it? But the upside of home health nursing is that you can stay on top of your patient's condition and treatment a lot more than you can in the hospital setting. It is a big disappointment to see how nursing plays out in the real world after the training we receive in our programs, that emphasize the IDEAL ways in which to practice.

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