are you required to call DON first before calling MD?

[Ms.RN]

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?

[debRN0417]

I think I posted this before, but again, you may get yelled at for not calling the DON first, but no one has ever lost a license over it! Also there have been residents who died because they were not sent out- and who do you think was held accountable? It was not the DON, and not the MD....because as a nurse it is YOUR responsibiity to assess and intervene. You may say, "well I called the DON or MD and told them...." and their(DON, MD) response would be, "He/she (You the nurse) did not communicate accurate information to me regarding the residents condition..."