do staffs have a right not to send pt to hospital?

Long Term Care Columnist / Guide · Nov 7, 2005

A patient who is A&O and who wants to go to the hospital has every right to be sent there if she wishes. Even if there's no obvious reason, your facility would be in BIG trouble if it turned out that she had a problem that was missed because the staff refused to send her out. It's like pain: the problem is whatever the patient SAYS it is, whenever he or she says it's occurring.

Something else about this post bothers me as well.......namely, the judgmental tone of "she just wants more drugs". How does the OP 'know' this, and who says that's what it is---other staff? It may very well be true; there is such a thing as hypochondria, not to mention attention-seeking, addiction, and other psychiatric and physical issues that cause people to seek health services. But even if it is true, this pt. still deserves to be evaluated and treated.......staff can't NOT send her out just because they think she's faking it. End of story.:stone

nicunana · Nov 7, 2005

Yikes!

Why not bite her head off while you're at it, ms moderator? It sounds to me like wantobeRN asked her question because she truly wanted to learn something, not because she wanted to be raked over the coals. Did it occur to you that the patient insisted " I have to go to the hospital because I want more drugs and you won't give them to me!" ? We weren't there, so please don't be so quick to judge OP. I give her credit for asking for guidance from more experienced nurses about what to do the next time. I guess you taught HER not to bother us important people here at this forum with her stupid questions!

NurseyBaby'05, BSN, RN · Nov 7, 2005

I think the point Marla was trying to make was for the OP to cover her a** and send the patient. The hospital will assess her and decide if there's anything more they can do for her than where she's at. If it's nothing, they'll send the patient home. If it is something, the OP's back is covered. You know what they say when you assume. It make's an a** of u & me.

veronica butterfly, ADN, RN · Nov 7, 2005

Something else about this post bothers me as well.......namely, the judgmental tone of "she just wants more drugs". How does the OP 'know' this, and who says that's what it is---other staff? It may very well be true; there is such a thing as hypochondria, not to mention attention-seeking, addiction, and other psychiatric and physical issues that cause people to seek health services. But even if it is true, this pt. still deserves to be evaluated and treated.......staff can't NOT send her out just because they think she's faking it. End of story.:stone

That statement made by OP about her just wanting more drugs hit me the wrong way too, sounded kind of judgemental. What kind of drugs, we are assuming pain meds.... I don't think this reply to OP was harsh, just a question back, and a fair one at that.

miphillli · Nov 7, 2005

I have to agree with the moderator on this one,OP sounds alittle judgemental,maybe the pt wants to "get away".

ktwlpn, LPN · Nov 7, 2005

The OP is apparently not a nurse-and we all know the level of training the cna undergoes.A good nurse will try to educate the staff and in my experince the first thing an immature inexperienced aide must learn is that every resident has rights -the right to refuse or demand care...Also-isn't it up to the physician to give the order for transfer? It is NOT the nurse's responsibility....

CoffeeRTC, BSN, RN · Nov 8, 2005

You need to send them. Period end of question. If they were at home they would take themselves. What does the doc say? Where is the family on this one? Now as far as using an ambulance....I'm not sure it it would be covered if it wasn't a medical necessity.

Noryn · Nov 8, 2005

Very interesting question. I have went thought this before. If the person is alert and oriented then you cannot stop them from making decisions affecting their care plain and simple. That being said they DO NOT have the power to prescribe medical treatment.

Some have touched on this but it entirely depends on your facilities policies. 99 perrcent of the facilities will require a doctor's order to send her out. Your job will be to communicate the symptoms and complaints to the doctor and DOCUMENT your butt off. If the doctor does not give you an order, I think it would be out of your scope of practice to override the doctor. If the doctor said no then I would notify the supervisor or DON and put this in my documentation.

Your question is really vague so we may be missing some important things. Here is the thing, in long term facilities or rehab facilities if you really feel as if someone should go out I dont see a doctor saying, "no." They are usually respectful of your opinion. Since this is obviously a problem at your facility you need clarification by your DON or supervisor and perhaps allow the social worker to intervene.

The main point is to follow policy and chain of command. If she is alert and oriented she can call her own ambulance (if she is physically able) and there is nothing that can be done to stop her. If I went through everything and the doctor said no you cant send her out then I would personally tell her she has that right and I would document this. That is just what I would do, this may get you in trouble with the facility. You would also tell her what repercussions that would have as that would probably be considered leaving against medical advice in which she may lose her bed, etc.

Again these questions are really vague. She obviously does have a problem. Whether it is legitimate pain or drug seeking behavior there needs to be an intervention by the medical staff and facility. It the decision would fall on me she is going out!

Crystle_clear · Nov 8, 2005

I work in a psych facility that attracts TONS of drug seekers, and they know the system well enought to realize that once they get admitted for being "suicidal" our hospital foots the bill for their "backpain" visit to the ER to get the morphine and demerol our docs would not perscribe. When these people start b****ing, I simply remind them that they are a voluntary patient and that they can check themselves out at any time and walk their little drug seeking hiney across the street to the ER by themselves, and pay for it by themselves too. I absolutly detest abuse of the system!

txspadequeenRN, BSN, RN · Nov 8, 2005

If she has no power of attorney and she is indeed her own power of attorney then you have to send her. You probably have to send her non emergency transport unless. As for the drug seeking issue the RX's have to come back to the facility and admin is followed by the nurses. You should call the doc when the patient gets back and he can D/C the new meds if he wishes.

My patient is alert and oriented X3 and is her own responsible person. She insisted on sending her to the hospital despite the fact that there is nothing medically wrong with her and no reason to send her to the hospital. She just wanted to get more drugs at the hospital. So do staffs have a right not to send her to the hospital or are we putting ourself in liability for keeping her and not sending her out?

KrisV27 · Nov 8, 2005

Give her the phone and tell her to call away....

For the nurse to have this arranged, don't you need a dr. order? If he says, no, chart it, and that's all of your responsibility. right?