"Don't Send Anyone Out!"

Specialties Geriatric

Published

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?

Specializes in ICU, PICC Nurse, Nursing Supervisor.

I was working at the very upscale alzheimers center across the street from you for many years.. I was the weekend supervisor and when the nurses called to tell me they were sending out a patient.. I went to help with the paper work not prevent them from sending the patient out. I dont work with these patients everyday and dont see all the changes that occur. I trust the nurses I work with and and feel confident in their judgment. Not only that that is what we are there for to provide care to these residents ; if we feel that they need more acute care/assessment how ethical is it for us to deny that. Now having said that ... your residents should have a bed hold policy and still be required to pay the daily fee. If they stay in the hospital more than three days then they can return medicare. However , this is what I would do. You are required to notify families (POA) with a change in condition as well as the MD. Now most of the time (depending on how you word what you tell the family) they will want the resident sent to the hospital . The doc will 99% of the time go with what the family wants and after this your weekend supervisor cant say anything.. Its now a family request. I did run into this before I became the supervisor and my response became " Family wants the patient sent out". You can talk to your ADON or DON but I bet this crap came from your upper management. I totally understand your situation and have been there myself. Unfortunatly these places we work at are all about money and forget the real reason they are there... patient care. I have always stood my ground and I have even told them ..I could care less about your financing ..my patient comes first. Now they didnt like that but I also didnt like their response to me sending out my patient to the hospital. Good luck and let me know if I can help you anymore.

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

Update: over the weekend I sent one of my elderly patients out to the hospital. He had prostate surgery three days earlier and had returned to our facility with mental status changes, low blood pressure readings, and grossly bloody urine. As time passed, this continent resident could no longer urinate. I sent him to the hospital without consulting my weekend supervisor. Once my weekend supervisor found out about this resident being sent out, he stated, "Couldn't you have catheterized the guy?" I told my supervisor that the resident is extremely confused with low blood pressure and tachycardia, and that his urine is bloody. The supervisor stated, "Well, the paramedics want to file a complaint against you for being mean."

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Specializes in Gerontology, Med surg, Home Health.

Hmmmm...why is it that lately any nurse who is doing her job, assessing her patients, and acting in the patient's best interest in a timely manner is being called 'mean'. I was called 'hard to approach' the other day at a meeting....I asked them what was meant by that and was told, 'you know...you want us to do everything right"....what is the matter with this business!?!?!

PS....sounds to me like you did the right thing by sending this man out.

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Lordy Lord. Boggles the mind what's going on in health care.

BTW- as soon as I read the orginal post I was thinking "I bet this is in Texas."

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Specializes in LTC,Hospice/palliative care,acute care.
eterized the guy?" I told my supervisor that the resident is extremely confused with low blood pressure and tachycardia, and that his urine is bloody. The supervisor stated, "Well, the paramedics want to file a complaint against you for being mean."
Mean? Mean towards who? You must have called 911 during their dinner break....And who are they going to file this complaint with? Your employer? The BON? What crap...How many times have paramedics shown up at the LTC and b*tched about picking up the resident? How old is she/he? Well-is she/he a dnr? Why are you sending she/he out? Often times spoken right in front of the resident..... Cut me a break-looking at his vitals he at least needed his tank topped off and maybe a cysto..I wonder what his hgb was...I bet he was dehydrated,too.........Let us know what happened.....
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Specializes in ICU, PICC Nurse, Nursing Supervisor.

You know what ... I bet the supervisor is just saying all this junk to intimidate you. You didnt seek his "approval " prior to calling EMS and I bet he is ticked he didnt get the last say in the matter. The patient should have been sent out , no question about it. I would have told my supervisor to ..get to filing. And mean against who, the patient or them ???? I have come across the meanest/most arrogent paramedics from med-star. I think its a load of you know what..

Update: over the weekend I sent one of my elderly patients out to the hospital. He had prostate surgery three days earlier and had returned to our facility with mental status changes, low blood pressure readings, and grossly bloody urine. As time passed, this continent resident could no longer urinate. I sent him to the hospital without consulting my weekend supervisor. Once my weekend supervisor found out about this resident being sent out, he stated, "Couldn't you have catheterized the guy?" I told my supervisor that the resident is extremely confused with low blood pressure and tachycardia, and that his urine is bloody. The supervisor stated, "Well, the paramedics want to file a complaint against you for being mean."
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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I have come across the meanest/most arrogent paramedics from med-star.
Yep. The paramedic who wants to file a complaint against me for "being mean" is from Med-Star.

Mean? Mean towards who? You must have called 911 during their dinner break....And who are they going to file this complaint with?
I called the ambulance service at 10 o'clock in the morning, well after breakfast.

BTW, the hospital said that this resident most likely had a TIA.

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Specializes in LTC,Hospice/palliative care,acute care.

I called the ambulance service at 10 o'clock in the morning, well after breakfast.

BTW, the hospital said that this resident most likely had a TIA.

So you interrupted their morning coffee break-you ARE mean!:lol2:

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Specializes in CRNA, Finally retired.
The book is The House Of God. I remember reading it in the eighties.Quite funny.

Well it certainly started out funny but in the end was really sad because the young intern realized that he was somekind of a corporate lackey in the medical-industrial complex who participated in torturing the fragile elderly like we do every day in the hospital. Why are 90 year olds dying in the hospital? I can't think of a more miserable place to die. We see nursing home residents getting admitted far too often to the hospital where there's obviously no long-term plan because there's nothing we can do to make the patient better. Obviously there a some NH residents who can benefit from an admission (usually they are able to cooperate with thieir medical care). We nurses should be educating the resident's family from the getgo about the REAL needs of the patient so that, in a fit of guilt, they aren't demanding aggressive care when TLC is called for. Thanks.

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The Facility's budget/income is NOT your concern! Your concern is your patient's well being and his/her wishes (family's too). Your concern is doing within your scope what you should do and abiding by the (ridiculous) supervisor's monetary guidelines is ludicrous. Aren't some people NUTS?:lol2:

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Specializes in LTC,Hospice/palliative care,acute care.
Why are 90 year olds dying in the hospital? I can't think of a more miserable place to die. We see nursing home residents getting admitted far too often to the hospital where there's obviously no long-term plan because there's nothing we can do to make the patient better. Obviously there a some NH residents who can benefit from an admission (usually they are able to cooperate with thieir medical care). We nurses should be educating the resident's family from the getgo about the REAL needs of the patient so that, in a fit of guilt, they aren't demanding aggressive care when TLC is called for. Thanks.
You can educate 'til the cows come home and you'll still see 90 to 104 yr old LTC residents dying in hospital. The ignorance and selfishness of many families is unbelievable. THey just won't let go.However I have learned through the years that it is their right to make the decisions they are comfortable with and I try not to take any of it personally because I don't want to burn out.

Also I have often sent residents to the hospital and they've come back with feeding tubes because the house doc told the family "Your mom will starve without it" In Pa. advance directives seem to be useless.............

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this sounds like it comes from the rn and the ultimate decision to call the md is yours . if md does not call back in timely [your call] manner than send out to er...better to err on the side of safety

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