what do you think of this policy?

Neveranurseagain, RN · Dec 5, 2009

Ask her to put the policy in writing. Then do what is best for the pt, not the DON.

kiszi, RN · Dec 5, 2009

When I worked LTC I sent a patient to the hospital on more than one occasion before the doctor had even called back. Always remember to trust your gut and do what is best for your patient. If you feel there is time to call the DON then do it. If not, tough. Just one more ridiculous hoop to jump through in LTC, imo.

Plagueis · Dec 5, 2009

What is the reasoning behind these type of policies? Is it that the facility gets charged each time a resident is sent out, so in order to save money, the DON is the final decider (in trying to reduce the number of residents send out)? What if the DON says to not send someone out, but the MD says to do so, will the nurse get fired if she listens to the MD? I don't understand this kind of policy. If the DON is concerned about too many residents being sent out, then she should either be in the building to be a personal witness to resident incidents, or have a supervisor on duty in the building who can also assess the resident.

wooh, BSN, RN · Dec 5, 2009

At my job, we're supposed to ask the house supervisor before we call a doc at night all because sometimes the doctors get mad at being woken up. I feel the same way about that as I do about the OP. NOT GONNA HAPPEN. If *I* feel the MD needs to be called, I absolutely *WILL* call the MD.

How's it going to look in court, "Well I knew the patient was krumping, but another nurse didn't agree so I let the patient die instead of calling the MD."

PinkaRN · Dec 5, 2009

I always called he doc when a patient was going bad when I worked in LTC. I think that's not a good policy at all. :nono:

tencat · Dec 5, 2009

Call the DON and tell her you're calling the MD. End of story. If you can't get hold of the DON, call the MD anyway and document that you tried to call DON. That way you are doing what they want you to do, and you're covering your behind as well. It sounds like either a power issue on the DON's part, or a cost saving measure at the expense of your residents. Not a good policy at all. But it shouldn't take more than 2 or 3 minutes to attempt to follow it and then call the MD. Of course, in an emergency situation where the resident has to be transported out NOW, then forget both the MD and the DON and call 911.

debRN0417 · Dec 7, 2009

There is some great advice here from other posters and here is my two-cents:

YOU are the nurse- YOU are the one assessing the patient- YOU are the one responsible. If in YOUR assessment and nursing judgement you feel the patient/resident needs to go out, then YOU should do this and then call the DON and let her know. Many times there is pressure to try to keep census up and keep residents inhouse- I know this to be true because I lived it, HOWEVER NEVER sacrifice what you know is right and the care of the residents entrusted in your care...ultimately regardless of what the DON says, it all comes down to YOU being responsible. There are times, though that you may not be completely sure and need someone talk to about what you are seeing, and there is nothing wrong with that. I isually assess, decide, send and then let everyone know that I sent and why. You may get yelled at for not calling first, but no one has ever lost a license or been sued because they did not call the DON before sending a paitent out! There have been residents who died because the nurse did not send them out and who do you think was held accountable? It was not the DON.

Ms.RN · Dec 7, 2009

thank you everybody for a good advice. what i dont understand is if patient is having respiratory issues or any other issues why does don who is a nurse have to make a decision on what treatment needs to be done instead of md? can she make such a medical decisions? when we had our meeting our don told us that if our census keeps going down then she have to start sending staff home and she doesnt want to send people home because she said its not safe to have low number of staff. is it safe to not to send patient to the hospital when they needs to be sent to the hospital? she definitely is not thinking about safety of patients but she is thinking about making profit. then she proceeded to say she doesnt want to lay people off because we all need money, i just rolled my eyes. :bugeyes:

Nascar nurse, ASN, RN · Dec 7, 2009

thank you everybody for a good advice. what i dont understand is if patient is having respiratory issues or any other issues why does don who is a nurse have to make a decision on what treatment needs to be done instead of md? can she make such a medical decisions? when we had our meeting our don told us that if our census keeps going down then she have to start sending staff home and she doesnt want to send people home because she said its not safe to have low number of staff. is it safe to not to send patient to the hospital when they needs to be sent to the hospital? she definitely is not thinking about safety of patients but she is thinking about making profit. then she proceeded to say she doesnt want to lay people off because we all need money, i just rolled my eyes.

well there are often 2 sides to every story. i have seen nurses send residents out for the most ridiculous things too. maybe this is happening in your facility. resident care and safety are always the first priority, but a don does have to consider $$. it is a sad reality, but a reality nonetheless! no reason to treat a uti in the hospital when they could be treated in the ltc, keep the census and keep from laying off staff. i would guess these are the types of situations she is probably trying to avoid.

just to remind anyone ready to flame me..go back and read my other post on this thread. it is unfortunate that some nurses lack solid decision making skills (don't deny it, we all work with at least one).

Plagueis · Dec 7, 2009

thank you everybody for a good advice. what i dont understand is if patient is having respiratory issues or any other issues why does don who is a nurse have to make a decision on what treatment needs to be done instead of md? can she make such a medical decisions? when we had our meeting our don told us that if our census keeps going down then she have to start sending staff home and she doesnt want to send people home because she said its not safe to have low number of staff. is it safe to not to send patient to the hospital when they needs to be sent to the hospital? she definitely is not thinking about safety of patients but she is thinking about making profit. then she proceeded to say she doesnt want to lay people off because we all need money, i just rolled my eyes.

i was told by a couple of fellow nurses that their dons claim that if anything goes wrong from not sending a resident to the hospital, then the don will be held responsible, so the nurses who go along with not sending a resident out will not get blamed/sued. yeah, right. however, i know that some dons have concerns about some nurses sending residents out, who end up coming back to the nursing home within a few hours, with nothing seriously wrong with them.

i have to admit that i am a newer lpn who is still learning, and constantly asks questions. my friends who are nurses have told me to follow that phrase, "when in doubt, send them out." is that not a guideline to follow anymore? on my shift, there is no supervisor or charge nurse in the building, so us nurses cannot ask them for help in having another visual opinion of an incident. we have an on-call nurse, but of course, she advises from afar.

Nascar nurse, ASN, RN · Dec 8, 2009

I was told by a couple of fellow nurses that their DONs claim that if anything goes wrong from not sending a resident to the hospital, then the DON will be held responsible, so the nurses who go along with not sending a resident out will not get blamed/sued. Yeah, right. However, I know that some DONs have concerns about some nurses sending residents out, who end up coming back to the nursing home within a few hours, with nothing seriously wrong with them.
I have to admit that I am a newer LPN who is still learning, and constantly asks questions. My friends who are nurses have told me to follow that phrase, "When in doubt, send them out." Is that not a guideline to follow anymore? On my shift, there is no supervisor or charge nurse in the building, so us nurses cannot ask them for help in having another visual opinion of an incident. We have an on-call nurse, but of course, she advises from afar.

When in doubt, go back to the basics... the ABC's. Air must go in, air must go out.. blood must go round and round (but stay inside the body). When this fails, you have an emergency and must act quickly. Most other things can wait at least a little bit for a second opinion.

southernbeegirl, BSN, RN · Dec 8, 2009

i doubt there is a DON in any country that would tell a nurse to not send a patient out in a true emergency. i doubt there is a DON who would even mind if you called her after the fact in an emergency. the problem is that what some nurses consider an emergency in LTC is actually something that can be treated in the facility without having to send the patient out. Thats good for the patient and the facility at the same time.

as the RN supervisor, i know a huge part of my job is to decide what interventions a patient needs.

example:

pt. spiking a fever, coughing and wheezing after eating. part of my job is to decide BEFORE i call the doctor what this patient needs. would a CXR, lab work, antibiotics and nebs be sufficient in my facility or does the patient's condition warrant acute observation? i have to decide this before calling the doc so i can tell the doc what i want to do. there are very few docs that would tell you to send someone to the ER when you feel they can be treated in your facility. if you are able to treat inhouse, then the pt can easily be sent out if his condition continues to decline and he needs more acute care.

the problem is that some nurses don't think along these lines. their first reaction is to send the patient out.

thats why she wants to be called. not to second guess everything but to decide if it's something that can be treated inhouse without sending the pt out.

its a fine line between doing what's right for the patient and doing what's right for the facility. it's her job to know how to walk that line.