I work in a nursing home rehab center in Florida. Administration has a policy, that nurses are to call the DON before we call the doctor or 911, if we feel a patient needs to be sent to the ER for any reason.
The DON instructs the nurse on how to treat the patient if possible, (like giving them Lasix IV if they're severely congested w/CHF or a COPDer), and the nurse has to write the order. It's a cost/revenue saving measure. The facility loses money for every day that person is in the hospital. A few days ago, close to change of shift, I overheard that the Nurse manager had given a resident IV push Lasix, because she had suddenly developed CHF; was extremely congested. She was fine the day before and her admit dx. was s/p suicide attempt, she also had COPD and HTN. She was at our facility for wound recovery and rehab. This elderly resident had voided > 2000 ml urine. Afterwards, according to the nurses notes, the resident was stable, alert and oriented.... A few hours later on the evening shift, she became unresponsive and with total lt. sided weakness. The evening nurse, called the DON first, and was then instructed to let the MD know and call 911. She had suffered a stroke. Is this the new trend among LTC facilities; for nurses to treat and take a chance?
unless your don happens to be an np you have a problem. wow, it amazes me how some nurses want to push the boundries as far as their scope of practice. it also amazes me the docs willing to go behind them and sign for these things!?!?! i appriciate as nurses we have a vast amount of knowledge in the disease processes and pharmacology, but i don't remember any classes in nursing school on how to be a physician(but maybe i was out sick for that lecture?). it kind of bothers me when you see nurses whos goal in life is to overstep the boundries of their scope... they tend to be so focused on doing everyone elses job most of them turn out to be pretty atrocious nurses. just my . if that was me i would be looking for another job. if this was taken to the bon not only would the don be liable but so would the rn who is pushing the drugs.
SweetLemon
213 Posts
unless your don happens to be an np you have a problem. wow, it amazes me how some nurses want to push the boundries as far as their scope of practice. it also amazes me the docs willing to go behind them and sign for these things!?!?! i appriciate as nurses we have a vast amount of knowledge in the disease processes and pharmacology, but i don't remember any classes in nursing school on how to be a physician(but maybe i was out sick for that lecture?). it kind of bothers me when you see nurses whos goal in life is to overstep the boundries of their scope... they tend to be so focused on doing everyone elses job most of them turn out to be pretty atrocious nurses. just my
. if that was me i would be looking for another job. if this was taken to the bon not only would the don be liable but so would the rn who is pushing the drugs.