"Don't Send Anyone Out!"

Specialties Geriatric

Published

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I'm a newer LVN and employed as a weekend-double shift nurse at an upscale nursing home. My weekend RN supervisor has a happy-go-lucky, coolly unconcerned personality. He unrelentlessly picks on some nurses but tends to leave me alone.

He has made it crystal clear that we are to refrain from sending any resident to the hospital unless they are extremely ill. His reasoning is monetary: if a resident spends one week in the hospital being evaluated and treated, then the nursing home will lose one week's worth of money from that resident. Private-room residents pay $6,900 monthly and semi-private residents pay $4,600 monthly. This seems fishy and unethical to me. I usually will send a sick resident out because I want no person to die or worsen under my care. Any thoughts or comments on this issue?

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Horse Hockey! If the resident has outta wack labs or any other medical problem that warrents calling the MD, and thus going out.....out they go! Who's license are you more worried about? :uhoh3:

Suebird :p

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Specializes in Peds, ER, Geriatrics, Rehab.

"Ditto" with Suebird..We have a similiar rule...but nursing judgement is nursing judgement. If your assessment indicates a problem that cannot be fixed in your facility, then they need to be sent out.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Keep on doing what you're doing. If a patient needs a higher level of care, then send them on out.

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OMG! A senior spends that kind of money and the facility could care less about their health. What country are you in???????

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
OMG! A senior spends that kind of money and the facility could care less about their health. What country are you in???????
I am in the 'Republic of Texas'.
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Specializes in ICU.
I am in the 'Republic of Texas'.

So, I'm curious... as an LVN, you have the final call on whether to send them to the hospital, not the RN supervisor?

(Basic question from a student. :))

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Actually, Meloney, it is what the LPN/LVN OR RN observes in the resident and or labs that warrents a call to the MD. If the MD says to send out, I do so.

Often I suggest person needs observation.....

Suebird :p

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
So, I'm curious... as an LVN, you have the final call on whether to send them to the hospital, not the RN supervisor?

(Basic question from a student. :))

If the patient is under my care, I have the final call on whether to send them out to the hospital. Actually, I need an order from the doctor before sending someone out. This particular RN supervisor simply wants to be informed when we intend to send residents to the hospital with the hopes of persuading the nurses to change their minds and not send the resident out. I hope that made sense.

It is the doctor that calls the final shots.

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I'm a newer LVN and employed as a weekend-double shift nurse at an upscale nursing home. My weekend RN supervisor has a happy-go-lucky, coolly unconcerned personality. He unrelentlessly picks on some nurses but tends to leave me alone.

He has made it crystal clear that we are to refrain from sending any resident to the hospital unless they are extremely ill. His reasoning is monetary: if a resident spends one week in the hospital being evaluated and treated, then the nursing home will lose one week's worth of money from that resident. Private-room residents pay $6,900 monthly and semi-private residents pay $4,600 monthly. This seems fishy and unethical to me. I usually will send a sick resident out because I want no person to die or worsen under my care. Any thoughts or comments on this issue?

If I were you, I would make sure and save any and all written letters, directives, communications, etc, from this supervisor and other supervisors, to use as evidence in case something happens to one of your residents. This includes any cell phone and/or home answering machine messages.

Remember my letter on practicing "defensive employment"? An ounce of prevention is worth a pound of cure. And a picture, or piece of paper, is worth a thousand words. JMHO, and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Personnally, I always saved any and all communications from administratration and management. If not, it is you word against theirs. ALWAYS start a "paper trail" about management, abusive, neglectful physicians, and lets not forget, the co-workers who sleep in duty, and/or, do not do their work.

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Specializes in Gerontology, Med surg, Home Health.

We are still responsible for our own actions. I don't think saying "the supervisor wouldn't 'let' me send them out" would be a good defense in court. We assess the residents and if they have to go..they go. And I don't wait around for the doctor to call back. If I think they have to go, I call rescue and then let the doctor know that I WILL be sending the patient out. I'd rather deal with a doctor whose nose is a bit out of joint then wait for a call back and have the resident decline further.

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Specializes in ER, OPEN HEART RECOVERY.
Keep on doing what you're doing. If a patient needs a higher level of care, then send them on out.

Do you think that sending a gomer to an emergency department equals a higher level of care?

Remember the XIII Law: The delivery of medical care is to do as little as possible.

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