anne919

I am reading the threads. I learned so much insights from the replies. Thank you so much. Now it makes me wonder on what field of nursing that I really want to be in. This had been a reality check for me that ltc is not going to work for me.

Ltc wouldn't send out their resident to ER as much as possible. But when the md wouldn't give appropriate orders and we see the pt deteriorating that is the only time we send them out.

Thanks for your help. Really apreciate it.

Maybe it is just really hard to explain the scenarios. He only order to monitor the patient in most of the cases not just this one. To make the story short to fully describe this is that most of the old nurses in the facility are the ones who orders their lab without the md order. I know that is malpractice. I dont medically diagnose my patient. Nurses do have nursing diagnosis based on signs and symptoms. Maybe the thread had become so inconsistent with the time frame im so sorry. First off, the patient had audible wheeze. Auscultated the pt learned that the resident has inspiratory and expiratory wheezing. Use of acessory muscle but denies everything. States that wheezing is nothing. Patient daughter asked for re-assessment from md because the resident is to be discharged for the next day. I called the md. Described how the resident was. His order was just keep on monitoring the patient. He hanged up on the phone cause he is with another patient. Gave the md some time to call back for clarification. Told him again that the resident exhibits inspiratory and expiratory wheezing and the daughter thinks its best to send out the resident. Then now the md ordered cxr abt

Initially he did not order abt neither cxr. His only order was monitor the pt. He would not o rder anthing besides monitor.

He ordered that cxr and abt after I told him that I really think and the other nurse-happens to be the resident's daughter- thinks the resident should be sent out to the hospital. We have a low census and that doctor is running out of residents in the facility because the resident asks for another md to tend to them since he does not even visit them. He gives new medication to the resident without seeing them, no labs to confer it to. The residents asked for discharged because of his actions. Sorry if I did not fully describe the circumstances here for I am so tired from work thinking and trying to keep the residents alive and satisfied with their care since they do not like how the md works for them.

This is the first time I had seen a doctor who does not order labs or xray or other exams. All he ever order is continue to monitor the patient.

As described by the resident's daughter, the resident does not complain or say anything. The resident tend to keep everything on her own. Last month I saw the resident grimacing appearing as if in agony of pain. I assessed the resident but the resident denies anything. Maybe if the resident was not wheezing audibly we would not treated her and she would have been discharge.

That is what I dont really get. I need to study more in depth about hospice for it is confusing for me.

As much as I want to call 911, my hands are tied with sending the resident out cause we do have a policy that the md should give an order first before sending the patient out. hence the md ordered cxr. I know it is unethical and unlawful. As a novice nurse i carried out the md's order. hoping the resident will be fine. Until now I am monitoring the resident. Maybe the md will actually visit the resident when he goes to the facility for which he do not do.

Yes for the flu. What I documented was runny nose, febrile and muscle aches.

I also did not hang up on him I said to him that I needed to go off the phone for I have many other patients to tend to. And ill keep on monitoring the pt like the md asked me to. We do have a protocol but the protocol isnt much very clear.

Thanks for all your help. I might have had not fully described somethings but the patient denies difficulty of breathing but you can see that the resident is using accessory muscles. So I took that as labored breathing and you can audibly hear her wheezing i theb listened to her lung sound and she has inspiratory and expiratory wheezing. It isnt much of a lie. I was not the only one who assessed this resident nor the diabetic resident. I always ask for another nurse to also assess the resident. I dont document things outside the scope of nsg. I only document matter of fact so that my license will be covered.I know that you only document what you see what touch what you yourdelf had witnessed.

As for the diabetic hospice resident, the pt is fine, eating well and fighting for her life. But the md simply stated 'she is hospice what do you want me to do? She is dying'

The pt with atelectasis is not responsing with the neb treatment and she was supposed to be discharged on the next day but she started wheezing. To describe this fully: His inital order was just robitussin. I lied to him that the pt is having difficulty of breathing even though the resident says that everything if fine cause my gut feeling is telling me that it isnt just a regular wheezing since the resident has inspiratory and expiratory wheezing.and so he ordered a stat chest xray and antibiotic. Then the xray revealed that the pt has atelectasis. Case rested with that one cause the doctor does not seem to care to treat if the pt is being discharged or hospice or no code. And yes, I basically describe every pt sibjective and objective symptoms with nsg observations. I dont medically diagnose.

That md is just really difficult to deal with. More residents are now having s/sx of flu that they now have confusions because of dob. Yet he doesn't want to order anything. My pt desat yesterday and guess what he said send the pt out if I really think the pt needs it coz he wont give me an order for oxygen! I told him that i initiated an oxygen at 2 liters per minute to have my pt's spo2 to go up and help her with wheezzing and labored breathing. She had became cold and clammy. And after few minutes my other co-worker walked to me telling me that the md ordered her to check with my pt and assess how is the pt doing in room air and with o2. The supervisor came back from break and guess what she had told me the pt is cold and clammy because of the room temp. I dont know what did that supervisor is thinking the room temp is normal room temp, not hot or cold. One of my co-workers left the room because he cannot confine his laugh of the supervisor's comment. It is a realization that I need to move to another workplace.

What I do is just log the objective assessments into the dr's log book. If the pt's lab shows impending dhn and pt refuses oral hydration and the urine's color is abnormal and going to anuria that is when I call the md. He even said before that the pt is hospice what else does he need to do. I know that hospice and dnr are no code but it does not mean do not treat them! Now he told my supervisor that he wont answer any of my page any longer. So when there is a real code it would be my problem. I dont know if I am bashing his ego as md or he's got other factor.

I dont document diagnosis but rather the s/sx only. All I can say is that I am no doctor and I am not really good with assessment but when im really in doubt with pt circulation I will take abrupt actions rather than have a code in the floor.

I work in a nsg skilled facility and rehab at the same time. Our medical director always orders continue to monitor when I report something to him. One time I reported an extremely high blood glucose level of our hospice pt.he just told me what should he do since she's hospice! As much as I want to talk back on him that we should still treat the resident even if they are hospice I only suggested to increase her insulin. And as soon as I got the order I hung up on him. Yesterday, I learned from my co-workers that he was infuriated that I logged a pt condition and stating the pt med that might have had a side effect. I also wrote down that a couple of pt was having early s/sx of flu. Oh yeah, one of our resident also has an incredibly audible wheezing inspiratory and expiratory but he doesnt want the resident be on a hospital so he ordered a stat cxr. The patient has an atelectasis. He ordered an antibiotic med. My gut feeling is telling me to send that resident into the hospital but I cannot make him give me an approval to send her out. How can I speak with my DON about this matter?

Makes a lot of sense now. Thanks.

Thanks a whole bunch because hipaa is always hard to understand for me since I work in a nsg home. We have very limited information about pt hx and advanced directives or legal docs in our pt charts. I even encountered an enraged pt and family members because I did not disclose anything even when in fact the caller has been authorized for the pt health info. The caller's name was not on the emergency or responsible party list so I directed the caller to our nsg director.

Are you violating hipaa when you tell the patient's family that you are not allowed to tell any health info about your patient to their loved ones, but their loved ones is currently okay?

Every job is tough but if ur heart tells u that helping and caring for somebody is ur calling then continue studying nursing. Things are tough but when ur patient shows a relief from pain, a smile, and a thank you it is much more rewarding than your pay check!

I do have the best cna that I can always get. I know they always complain of me not helping them out. But what can I do. My patients are all demanding. One call after another. And yes, you need to set limits for them but they are really near on their end of life crisis. I barely get the time to sit. As a matter of fact since I started working, I can count into my fingers and toes how many time I ate my dinner or use the washroom. All they can see from me is just passing on the medications. But the patient view me as more than that. If you will actually take the time to talk to your patient, youll find out that they dont have dementia or any short term or long term memory loss. Youll be surprise.so better treat them right coz battery is just around the corner. Please dont give me that killer look if I promised you that ill do the vitals and ended up asking you to do it. I am always doing my quick assessment that is the reason why I am always stuck in that pt room. Havent you noticed that our call lights is not being used much? Havent you noticed that those hollering around isnt yelling? Being a charged nurse is just f*in tiring! If only we can trade half of the day and ull know what I am talking about. You see me as a dumb nurse and u dont think I got the license. I am not dumb if I ask the other nurses on how to go about a certain situation or how to do a procedure. It just shows that I dont want anybody to get worst. You'll see good nurses and lazy nurses who thinks they are way better than anybody. Those doctors are just nuts if you can actually see it. Ull page them and you'll surely be waiting for 3-4 hrs before they call you. And when you do the SBAR talk, you'll get a reply. Ok ok good.continue to monitor the patient. And when you go back to work ull notice having an order at 3am! 6Hrs after you talked to them!

Thanks. It felt so good to vent out and knowing that somebody else had been in my shoes. It means that I am not alone and if you guys walked pass by this, I know I can do it as well. I worked my ass hard to gain this nursing degree. Didnt enjoyed life for a year of studying for nclex. Had to fight for having a license and work. Swallowing the low salary that I can get. All I can say is ill be doing my job as best as I can! And I swear from now on, I wouldn't meddle with somebody else's patient. They can watch over their own patient call lights and falls! If they put their pt beside my med cart ill stop and drive that patient to them! I've had it with them. It is just not right with what they are doing. They are unprofessionals.