what do you think of this policy?

Published

our don told floor nurses today that when there are change of condition of resident and there are possibility of sending patient out to the hospital she said " our policy is to call me first because if you call doctor first then you have to act on it" what do you think about this?

Up Vote Up Vote ×

Do you trust your DON? I think that would be my first concern. How is her ability to assess and how are her decisions? As a LPN I have to work call a RN first at night who then calls the doctor. Of course I'm not liable, the RN is. How would liability work for you in this case. I believe if it is policy to call the DON first, you may be ok.

Look forward to hearing others on this.

Up Vote Up Vote ×

Why? Do doctors not give good enough orders or something?

Is she available 24/7?

I understand an LPN asking an RN charge nurse who is in the building and able to assess the patient first before the doctor is called, but this seems different.

Up Vote Up Vote ×
Specializes in Gerontology, Med surg, Home Health.
Do you trust your DON? I think that would be my first concern. How is her ability to assess and how are her decisions? As a LPN I have to work call a RN first at night who then calls the doctor. Of course I'm not liable, the RN is. How would liability work for you in this case. I believe if it is policy to call the DON first, you may be ok.

Look forward to hearing others on this.

You ARE liable for your own actions. If you know something is wrong and you ask someone else's opinion, you are still responsible for what YOU did.

I think having nurses call the DON before they call the doc with a change of status is wrong, antiquated, and asking for trouble with the family, the doctors, and the DPH.

Up Vote Up Vote ×

If you are comfortable with this then carry on. But I can imagine what will happen the first time someone has a major difference of professional opinion with the DON. If your judgement tells you to call the doc, don't you think you should not waste time, but instead call the doc? What are you going to do if the DON overrides your decision to call the doc? Worry and fret over your liability? I see trouble ahead.

Up Vote Up Vote ×

You know, I remember someone else asking this same question...let me see if I can find it. Sounds like a way to save money at the expense of the resident and/or RN.

Up Vote Up Vote ×

Here's the post.

https://allnurses.com/geriatric-nurses-ltc/you-required-call-334093.html

Personally I would be ok with calling the DON first...if there was time and with the understanding that I would call the MD if I felt different about the decision.

Up Vote Up Vote ×

no problem...but if i don't agree i will call the doc myself. my license not hers

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

In a court of law, your DON's preferences won't matter a whit.

You will be held to the standard of practice of a reasonably prudent nurse in a similar situation.

Would a reasonably prudent nurse delay contact with the physician in order to get an OK from a supervisor who is not on site? I don't think so.

Up Vote Up Vote ×
Specializes in Cardiology, Oncology, Medsurge.

Collaborate and make the call first prior to calling the physician; sounds reasonable to me.

Up Vote Up Vote ×
Specializes in Gerontology, Med surg, Home Health.

That's bad advice. If you don't call the MD in 'a timely manner', you risk getting a citation for delay of treatment and the resident can be at risk for a bad outcome. There is NO reason for anyone to have to call the DON before calling the MD. It's patently absurd. If the DON doesn't trust the judgment of the nurses working for her, she has big problems and so do you.

Up Vote Up Vote ×
Specializes in LTC, Hospice, Case Management.

As stated in previous posts, it would all depend on what was going on. I would gladly go along with this policy if not an urgent issue just to keep everyone happy. BUT.. urgent/potentially life threatening situation is different and I would throw the policy out the window. I can sleep at night if the DON is ticked... I can't sleep if I let someone die because I was busy playing phone tag (and like someone else said, the DON's policy won't stand up in a court of law either).

Heck I'm even bypassing the Dr and calling 911 FIRST if they are a full code and suddently stop breathing. Never once in 20 years has anyone ever "yelled" at me (boss or Dr.) for bypassing them in this situation & my judgement would hold up in court. Use your judgement wisely. No ones gonna have your back better than you.

Up Vote Up Vote ×
+ Join the Discussion