Nikilea

I have also been contemplating the many replies to my dilema. Maybe I wasn't too clear. The patient in question had been at our facility approximately 2 days; had not been treated as of yet, by of our out-pt. Psychiatrist when she went into the hospital. I know of no policy at my agency regarding notification. I have made several attempts to notify this Doc about the patients he is familiar with and usually end up getting no response, or a casual response if I am at the office where he sees our clients. As for "suggestions"vs orders. The "suggestions" I received from the Hospital were on legal prescription pads. I am having a hard time understanding how any nurse could feel that it is better to go back to the old drug regimen pre-hospitalization for a stabilized patient while awaiting a reply from the out-pt. doc? I have the support of my superiors on this situation, as it has not been an issue with any of our other Docs. I do understand how this may be a protocol in certain systems, but our system is pretty scattered with no Docs doing in-patient rounds at any of the facilities we use. I think the lesson here for our agency is to develop a protocol that ensures the highest quality patient care!

I would greatly appreciate any feedback/advice as to how to a handle a situation that occured today . I am currently working as a Nurse case manager for an agency that provides residential services for CMI patients. The Psychiatrist that oversees my clients is also employed by the company I work for. Yesterday at a routine appointment with a new admit he, in my mind, professionally berated me in the presence of the staff at the appointment, as well as the client.Staff reported to me today that he was quite verbal about the patient being inappropriately medicated. Some background... This patient transferred to our facility from another area, and 2 days later ran away from the Group Home. They were found darting in and out of traffic and very psychotic by the local police. Our agency through their Access folks obtained an immediate in-pt. stay for med stabilization. Upon discharge from the hospital, there were some medication increases. Nothing unexpected or greatly increased. Our Dr. proceeded to tell both the patient and the staff that I, and he used my name, had improperly medicated this patient. That the discharge orders from the in-pt. Doc were merely suggestions and HE is the patient's "attending physician". I have never had an incident like this occur in 14 years of nursing. I have always treated discharge orders as discharge "orders". I did not contact this Dr. as he was not familiar with this patient and had not seen them for initial intake. I am more than a little confused, and dismayed that he would make comments to the the patient and staff that were inappropriate and in reality not true. Would appreciate any comments/suggestions on what I might have done differently or better next time? ps I have only worked with this Doc a short time and have been told by colleagues that he is a little short tempered and "difficult" at times. Hellllpppp

I am currently the"Nursing Supervisor" of a large facility that serves children and Adults with Developmental Disabilities/Behavoral difficulties. We serve well over 150 clients in residential settings, as well as a main campus that includes 4 secure units . I am the only full time RN. I have one full time LPN and one 10 hour a week RN that basically does paperwork for 5 of the Group Homes. I am really a Nurse Director without the pay or the Control. My boss is a "Clinical Director" who is a behavoral psychologist. I could write chapters about the frustrations that myself and the Nurses who work "for me" live with 24/7! But I do have a specific issue that I am hoping someone can enlighten me on from their experience or expertise. I get telephone calls 24/7 from any and all the units and residential staff. The LPN that works most closely with me gets a few calls as well. I also was given an Alpha Numeric Pager. I have had a pager for the entire 5 and 1/2 years of working for this Facility. I do not get on-call pay, and am not considered "on the clock" at any time while not at work. I am concerned about both the liability issues, as well as where does my responsibility to this agency stop, and to my own well-being begin. I find this type of nursing very challenging and rewarding, I must add, however, I have been seriously looking to leave the current situation. It is not my greatest desire to walk away from the clients I serve, or almost 6 years of sweat and tears. Please, can anyone offer any suggestions, or views on my current situation? PS: My position is salaried, and I have worked my way up from 14/hr to almost 21/hr over these years. ------------------