Sending resident to ER without a providers order.

[Davyd0322, ASN, BSN, MSN, CNA, LPN, RN]

So I had a nursing home patient that fell, the fall was unwitnessed. The patient was face down, and complaining of head and shoulder pain. The patient had obvious hit her head and stated she smacked it on the floor when she fell. This patient is also on several blood thinners. I was unable to reach a provider, and I sent the patient to the ER. Long story short the DON popped an attitude and stated we had to have a provider order to send the pt out. I thought this would fall under a nursing judgement. I work in Tennessee so I'm not even sure what the actually law is on this since I couldn't find any specifics. But I have worked in longterm care 15 years and this has never been an Issue till today. Could anyone tell me the laws or scope of practice regarding this?

[FolksBtrippin, BSN, RN]

A doc will have to write an order eventually but you should not delay emergency treatment waiting for an order. Was the DON suggesting you did the wrong thing? Because of course you didn't. 
 

[lifelearningrn, BSN, RN]

It was an emergency, I've never heard of needing a doctor's order to send to the ER. 

[nursej22, MSN, RN]

I seriously doubt any facility licensed by a state is going to have a written policy that says a patient/client/resident cannot be sent to ER for an emergency. That would be huge liability. And I seriously doubt any competent provider is going to say  head injury, blood thinners on board, naw, she doesn't need medical eval. 

Now if someone has a specific do not transport directive, that would be different and then its likely family or a guardian would have to approve. 

[DallasRN]

If this is the full story, and I have no reason to believe it isn't, it makes one wonder where they find some of these DON's/Nurse Leaders.  Given the facts presented, it seems to be a no-brainer that emergency assessment/treatment would be necessary.

As a rapidly aging nurse, I find it frightening to think some of these *leaders* might be responsible for my health and safety in the not-to-distant future.

I say it all the time...no wonder nurses enter and leave the profession as if they're going through revolving doors.  "Do no harm".  "Advocate".  "Assess".  But too often when a nurse uses best judgment and does those simple things, his/her hands are slapped.

[DallasRN]

lifelearningrn said:

It was an emergency, I've never heard of needing a doctor's order to send to the ER. 

Also, if the OP's nursing judgment can't be trusted, why was he hired in the first place?  I suspect many homeless people would willingly occupy space on a unit for a warm place to stay and something to eat - which is what seems to be the case in the scenario presented.  (I hope this comment wreaks of sarcasm).

[Erin Lee, BSN, RN]

I wouldn't worry about the laws or scope of practice, because you did nothing wrong. If the DON suggests otherwise she is wrong. You prioritized your patient's safety; that is all that matters.  Remember these DONs are not necessarily concerned about our licenses, but more about their numbers. 

[abbnurse]

DallasRN said:

If this is the full story, and I have no reason to believe it isn't, it makes one wonder where they find some of these DON's/Nurse Leaders.  Given the facts presented, it seems to be a no-brainer that emergency assessment/treatment would be necessary.

 

Exactly.  I worked LTC for years, and never had to request permission to send a patient to the ER in an emergency situation.   You used your good nursing judgement.  Hope your patient was OK!     

[Been there,done that, ASN, RN]

"Could anyone tell me the laws " No we can't.. we are nurses not lawyers. DON  sounds  like an idiot. You did the right thing  The resident required a full work up STAT. 

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