CNSnurse

Most hospitals in my area (Los Angeles, CA) do not use the PPD anymore due to false negatives. My current employer does the quantiferon gold (Q gold for short) blood test. its more accurate, but I have heard its much more expensive.

Hi everyone, I recently had a situation that made me feel a little uneasy and I am wondering what other nurses think about patient leaving AMA safely. Patient was signing out AMA due to lack of insurance and was going to the local county hospital immediately from our hospital (worrys about bills they cant pay). The issue I had was that this patient was almost 6'5" 450lbs and ambulated (barely) with a front wheel walker. I searched all over our unit for a bariatric wheelchair to push them to the valet where their ride was waiting. I could NOT locate one fast enough, and the patient was already unsteadily walking down the halls with the walker. When I called for assistance from my charge nurse and other staff, they ALL told me its hospital policy that "we don't help patients who sign out AMA". WHAT?! I just imagined this patient falling down, hitting their head, getting a subdural hematoma and dying. Even management told me that since they signed the AMA form, it releases us from all liability. I feel like it is still nursing responsibility to make sure they patient leaves the facility safely, even if they are leaving AMA. If they person is independent and ambulatory, sure..... they can walk out, but what do you do if they can barely walk? any ideas or opinions would be greatly appreciated :)

I will definitely follow up and see if i can report it. thank you!

Hi everyone, I am a floor nurse at a hospital and where I work we take inpatient hospice patients. I recently had a situation where I was really unsure if we were stepping into a gray ethical area. The patient's family had decided that hospice was the best choice for their family member. Earlier in the day, the neurologist had requested a referral to our inpatient hospice program. When the primary doctor came in later that day, he immediately canceled the referral for our inpatient hospice program and convinced the family that "X" hospice company through "Y" nursing home was the best choice. The family was in a crisis time, sitting in the room crying, and tending to their loved one, so of course the family does not protest and agrees with the physician's plan of care. The physician admits to me and the family that he is the medical director at "X" hospice company and his wife is an administrator at "Y" nursing home that he just convinced the family to use. This immediately sent off alarms in my head, especially after how he went on a long rant about how horrible our inpatient hospice program is (all the times I have worked with our program is has been amazing, the staff are always responsive, and really tend to the patient/family). Now my worry is that this is somehow illegal? He basically pushed his own hospice company on the family and to use the nursing facility his wife is an administrator at! Wouldn't he would be getting money from the hospice portion AND his wife's income from using the facility? Later in the evening, the family requested to use their own choice of hospice and felt really weird about it since the doctor was raving about how he was the medical director and his wife was the administrator at the nursing home he wanted to use. They felt like he had financial motives, not the patient's best interests are heart. Any thoughts?

Thank you for your responses! I will definitely learn from this experience and use my nursing judgement when to call :)

Hi everyone, I am wondering if anyone else has received similar orders....One cardiologist I work with in particular ALWAYS writes "Do NOT call unless > 20 beats Vtach." Does anyone else ever get orders like this? My patient happened to have 8 beats Vtach (asymptomatic) and I called the MD and I got yelled at! I originally called because I did not see the original "do not call" order (writing is practically illegible) and was expecting to get a telephone order for "do not call" at that time. While I apologized for not seeing the original order, I got ripped a new one when he came to see the patient a few hours later. In front of other physicians and nurses..... in the middle of the nursing station...... Anyways, How do you feel about these kinds of orders and not being able to document physician notification? thank you!