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Nsg home administrator vs the nurse.


Specializes in LTC.

Ok..here is the deal. I have a cancer patient. She is not currently on chemo..but it will resume after she is discharged from us and moves to her daughters. According to the administrator and DON this is the only way they could accept her on our rehab unit was if the chemo was held til after discharge. It works out anyhow because her white count is too low to get it. Its a matter of money and I know this. She is medicare A...so the facility has to cover all her expense til Medicare reimburses them. Well...she is allergic to phenergan. SHe had an order for Kytril 1 mg po q 12 hrs prn for n/v. Well..lately shes been c/o nausea alot. Poor po intake everything seems to nauseate her....to me its the typical cancer pts complaint and completely valid to me. Well...the pill was changed to a 3.1mg/24 hr patch....which the pharmacist told me is on back order and is about 400.00. I got the order changed and clarified because the DON and the admin. asked me to...then when I did it....the admin. says to me "oh no no no...she cant have that patch. its too expensive and we are not going to pay for that. D/c It. "...I refused. I told him that I did what was asked of me and that cost is not my concern. Thats what medicare and her insurance is for. I explained her allergy to phenergan and that they could get the patch changed to IM or to zofran...both of which are pricey as well. I told him that it would be negligent on my part to get this whole thing d/cd strictly based on cost and that if that were my mom and I found out that the ADMINISTRATOR..who is not a doc or a nurse...and has NO medical knowledge other than business aspects I would have a lawsuit in a hot minute for negligence. Well that ended it right there. The next day the DON tells me that they are going to change it to the IM because its cheaper 33.00 per vial. Well thats all fine and dandy as long as this pt gets what ever she needs to be relieved...but I am not writing any orders for that. My thing is this....where does an administrator get off making decisions about who can get what meds? What gives them the right to do that? This isnt the first time this has come up. Another instance of greed was when a pt was sent to the er.....the hospital called and said that one of us needed to come pick them up...an ambulance wasnt medically necessary....none of us are covered on insurance to drive the work van....and we cannot use personal vehicles due to insurance purposes to transport residents. The administrator can drive the van..but refused to and made one of the aides go get that pt. He didnt want to pay for transport from an ambulance to bring her back. The 2nd time this happened....i told the hospital they would either have to get that persons RP to bring them back or get an ambulance.... and bill the family or whoever. I wouldnt allow anyone on my shift to use their car to pick this pt up. Boy did he get mad about that one!

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

You are describing the realities of for profit healthcare delivery. Non medical people making medical decisions and choices regarding what will and won't be paid for, provided, or allowed for patients is the standard today. Decisions in this environment are not based upon what is best for the patient but, rather, upon what is more profitable. You are correct in refusing to bend rules and laws in order to insure improved profits for your facility. If the administrator wants someone to incur the liability of transporting a patient he should put himself on the short list of volunteers. He has the "right" to make these decisions about meds and ambulances because there is no law that says he can't...we have (as a country) allowed the "free market" to control this and now we have a system which provides increasingly less service for increasingly more money. Until we have meaningful legislative reform we will continue to see this pattern and people will become more and more accustomed to nonmedical panels of people making important healthcare decisions for patients and families based upon profitability rather than risk/benefit for patient.

pagandeva2000, LPN

Specializes in Community Health, Med-Surg, Home Health.

Of course, we see some really insane things that occur in health care because of the almighty dollar. Transporting patients improperly is one of them because the driver of the vehicle can be liable if something happens, and of course, the vehicle is not equipped to deal with a possible emergency nor is the driver trained to intercede if there is one. One of the main arguements that medical personnel such as nurses and doctors have is that they are now interacting with administrators that are not licensed providers themselves...they may not have a full understanding of what risks are involved for the licensed providers due to their intervention.

But, another reality is that the administrator is usually in charge of the budget. In this economy, where it is a worldwide economic shortage, one does have to look at alternative methods of achieving the same thing for less. We do it at home, the hospitals have to as well. If money is wasted, it can lead to the reduction of beds, furlough of hours (such as reduction of hours to work), lay offs, closing of the entire facility. I don't know of too many situations where staff nurses are ultimately responsible for what particular drugs are available in the hospital. An example of this may be that instead of using namebrand Tylenol, acetomenophen is prescribed instead. There is some budget person that will assist the pharmacy by saying that one type of drug that is cheaper can achieve the same result...so, in essence, the administrator may, in fact, have a role in this somehow, but we don't see how decisions are always made on our level.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

Solution to the transport problem. Have the hospital put her in a cab and then meet the cab at the door with a wheelchair.


Specializes in LTC.

Good input !we just got two living room floors redone coated six grand and the new time punch clock coated thirty grand both are nice but we didn't need them yet somehow meds fall short it is what it is but I do feel better and I'm still glad I chose not to get it dc'd I just want this pt to be in some kind of comfort while in my care even if it means I have to endure a verbal lashing for it from the powers that be