Nursing home NPs

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Specializes in Pain, critical care, administration, med.

I have a question for NPs in the nursing homes. Have you been asked to write orders for giving a resident a certain amount of fluids every shift? Let me start of by saying that this is because the staff do not regularly offer fluids to residents. I refused to write such a order as I feel this is a internal issue they need to address.

They also want CXRs on every resident that coughs. I am all about assessment and ordering appropriately. When they don't like what I do they go to my collaborating MD to get a order.

I don't like it. A lot of safety concerns and look to us to deflect their problems. It's very sad for the residents.

Thoughts?

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Specializes in Vascular Neurology and Neurocritical Care.

I hope your collaborating physician backs you up. That sounds pure unadulterated chicanery going on there.

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Specializes in Nephrology, Cardiology, ER, ICU.

I'm a nephrology APN and I know at least in IL, I am not even allowed to write for fluid restriction as the rationale is that the NH is the pts home and they can't restrict what they drink....

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Specializes in Vascular Neurology and Neurocritical Care.

I was thinking the same thing. Four a short while in my nursing career i was nurse manager at a nursing home but not for long enough to develop an expertise. If this were a nursing home that does IV fluids and antibiotics etc I could understand that kind of fluid restriction but PO fluids i can't see how this should be done

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Specializes in Vascular Neurology and Neurocritical Care.

And tbh it seems they simply don't want to round on the patients....

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I work in a BLS psych hospital, not a nursing home, but as far as fluid restriction it doesn't happen unless we have documentation of hyponatriemia. I have ordered for a patient to get extra fluids, but again with some documentation and a time limit to recheck the labs.

If it is a chronic issue, it wold seem that this would be something that the dietitian needs to address to have extra fluids on the meal trays.

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Specializes in kids.
I have a question for NPs in the nursing homes. Have you been asked to write orders for giving a resident a certain amount of fluids every shift? Let me start of by saying that this is because the staff do not regularly offer fluids to residents. I refused to write such a order as I feel this is a internal issue they need to address.

They also want CXRs on every resident that coughs. I am all about assessment and ordering appropriately. When they don't like what I do they go to my collaborating MD to get a order.

I don't like it. A lot of safety concerns and look to us to deflect their problems. It's very sad for the residents.

Thoughts?

I think the OP is asking about ensuring the residents get ENOUGH fluid, and i agree that is an internal issue that should be handled by the DON or DNS.

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Specializes in Nephrology, Cardiology, ER, ICU.

Agree that OP is asking about pts getting ENOUGH fluids - I was just pointing out that at least in IL where I practice, we can't order any kind of fluid amt or limit intake either.

I should have been more clear - sorry.

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Specializes in Gerontology, Med surg, Home Health.

I've had discussions with NPs asking them NOT to specify an amount of fluid for a resident. They often flat out refuse to drink what we think is enough. And, I've worked in plenty of buildings where we maintain fluid restrictions IF the resident is alert and oriented and goes along with the plan.

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