are you required to call DON first before calling MD?

morte, LPN, LVN · Sep 17, 2008

in my ltc that im working now don told all the nurses that when there is a change of condition of patient and possibly sending patient out to the hospital, nurses have to call don first before calling the md. then she decides whether or not we can send patient out to the hospital. even nurses call the md first and tells nurse to send patient to the hospital, we still have to call don and get permission from her. is your place of work like that too?

and what was the name of the medical school she/he graduated from????

NursKris82 · Sep 17, 2008

I'm a new nurse and sometimes call the DON or on- call manager on the weekends if I'm not sure if I need to call a doc.. The managers do like to be kept in the loop and be called, but if I know I need to call a doc., I call a doc and I send the resident out if they are ordered to be sent out. Then, I'll call the DON and let her know what happened. It's your liscense and often, time is of the essence. I would call if it is possible, otherwise I'd do what I had to to keep my patient safe and my liscense active!!

suanna · Sep 17, 2008

I don't work LTC but I would LOVE to see our current nursing administrator tell a doc that she will be deciding whether or not they can send their patients to a higher acuity level of care; Mostly because I love trauma patients and I'm sure the administrator would qualify for a trauma code very shortly there after!!! I don't know about your "policy" rules but it would be a cold day in **** before I, as a nurse, would countermand a physicians order to transfer a LTC patient to acute care. I 'm thinking that is a fast-tract option to earily retirement via the BON, not to mention every malpractice attorney's sweetest dream! Speeking of retirement- I think I would start looking for different career opportunities(in nursing) before that DON gets in more hot water than she can imagine and takes her nursing staff into the stew with her. Good Luck!

kcochrane · Sep 17, 2008

We have night supervisors, so they decide when to call the doctor.

Dolce, RN · Sep 17, 2008

I bet that she has had her butt chewed by docs who have been complaining that the nurses at your LTC are calling too frequently. Now she is basically trying to screen all calls to the MD. I wouldn't be able to stay long at a place like that. I want to call the MD MYSELF because I think the person taking care of the patient needs to call--not some uppity-up in a suit.

WickedRedRN, BSN, RN · Sep 17, 2008

Hold up a minute.....

To play Devil's advocate here....if a resident is NOT sent to the hospital for higher level acute care and this results in a negative outcome, what happens if the family makes a complaint? Who will be the license held responsible for not taking care of the patient?

I only bring this up because I have seen this type of behavior in my LTC days. DON's or administrators pressured nurses to convince MD's that instead of transferring to the hospital, we could provide the care at the facility. The bottom line is census was low and the management team was being pressed to not lose beds.

Your license is your responsibility. Please do not think for one minute that if an investigation is initiated that management would own up and take responsibility. You have to be the advocate for the resident, even if that means standing up against the DON.

I would be looking for a new place of employment if it were me.

Nascar nurse, ASN, RN · Sep 17, 2008

I am part of nursing management, but don't consider myself a upity in a suit, and I can see both sides of this issue.

First, if a resident is acutely ill and clearly in distress - I am calling Dr. and then 911 (if coding I'm calling 911 first tho then Dr.) and then I will let DON know what happened and my actions.

But I also see why many DON's want to be notified first. Within the last month I read facility documentation stating essentially "resident with severe abd. pain. 911 called and resident transported" That's all there was documented and that's all the nurse assessed. Want to guess the diagnosis in ER.... constipation. Little MOM, one big poop, send resident back and all is well! If the nurse had a little help with assessment skills while resident was still in facility the resident would have avoided all the drama and there would have been a huge cost savings, something many many nurses want to ignore, but if we're all going to keep our doors open, sometimes this has got to be a consideration in cases such as this.

Again, I am not saying or supporting letting an ACUTELY ill resident hang out until you can get ahold of the DON.

onyx77 · Sep 17, 2008

When did DONs get the power to refuse to carry out a Dr's order? If we have a Dr's order it should be followed through when concerned with admitting a resident to the ER or hospital. We do not have to call our DON before calling the DR. I think my DON would be pretty upset if I called her prior to every call I made to the Dr. As an RN I should know when it is apropriate to call or not, and if there is any question (as I am still a pretty new nurse) I will not hesitate to ask. Sounds like your DON is on a power trip or something!

Long Term Care Columnist / Guide · Sep 17, 2008

I am part of nursing management, but don't consider myself a upity in a suit, and I can see both sides of this issue.
First, if a resident is acutely ill and clearly in distress - I am calling Dr. and then 911 (if coding I'm calling 911 first tho then Dr.) and then I will let DON know what happened and my actions.
But I also see why many DON's want to be notified first. Within the last month I read facility documentation stating essentially "resident with severe abd. pain. 911 called and resident transported" That's all there was documented and that's all the nurse assessed. Want to guess the diagnosis in ER.... constipation. Little MOM, one big poop, send resident back and all is well! If the nurse had a little help with assessment skills while resident was still in facility the resident would have avoided all the drama and there would have been a huge cost savings, something many many nurses want to ignore, but if we're all going to keep our doors open, sometimes this has got to be a consideration in cases such as this.
Again, I am not saying or supporting letting an ACUTELY ill resident hang out until you can get ahold of the DON.

I'm a DON in a high-acuity assisted living, and yes, I appreciate a call from staff when a resident becomes acutely ill and needs a higher level of care, even if it's just a trip to ER. But when the resident's BP is crashing and they're turning blue, I don't want them to call me---they need to call 911 and THEN worry about notifying me and/or the PCP.

BTW, I'm one of the 'suits' too, and I HATE the term 'uppity'---just for the record.:)

achot chavi · Sep 17, 2008

Get this policy in writing and be grateful you have such a hands-on DON who then takes responsibility (and the heat) for difficult situations. With all due respect- you don't know how upset families can be with every hospitalization and many feel that we are too quick to send out the patient. It's not a policy I would embrace myself- not being so centralistic but each DON has the right to decide her own thing and if this is what she decided- its up to the staff to go along. I wouldn't gripe about this.

If she refuses to allow you to send a patient out who you think you can't handle then put that in writing as well. I'm sure this too will work out!!

calliesue · Sep 17, 2008

If I think my patient needs acute care I am calling the Dr.

My responsibility is to the patient first and my nursing license second. :no: :no:

I do not ever want to be sitting in a court and find my self being asked , "Well what would a prudent nurse have done in this situation ?" So I will make the call about calling the dr unless my nursing supervisor wants to assume care of my patient. Which I would be documenting the heck out of. As in, care of patient transfered to nursing supervisor.