What is the nurses role when a patient is being discharged too early?

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I'm really struggling on this topic. I have not been able to find any information on this particular situation. I have went through all my textbooks and tried searching the internet...

Basically I am working on a case study that involves a patient that just received discharge orders. He is weak and tired and unable to walk. He has lost at least 15 pounds while staying in the hospital (he had to be intubated). He is about to get discharged and is still in pain and unable to transfer or drive himself home.

What is the nurses role as the patient advocate? Who would you talk to? What would you say?

Obviously he is not ready to go home. Would I talk with the charge nurse? The doctor directly? Or should I speak with the patient?

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Specializes in cardiac-telemetry, hospice, ICU.

Some info is missing, is he from home, have family, etc? I f he is truly on his own then- you could go to social worker and see if they assess him for rehab/ snf placement. If so, go to Dr and ask for discharge to said facility. If you strike out, you go up the chain of command, charge nurse, manager, DON. You are right, if your assessment is that he will be unsafe on his own, you must advocate. I am not surprised that your textbooks do not address this, they don't deal with real world.

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Specializes in Pediatrics, Emergency, Trauma.
Some info is missing is he from home, have family, etc? I f he is truly on his own then- you could go to social worker and see if they assess him for rehab/ snf placement. If so, go to Dr and ask for discharge to said facility. If you strike out, you go up the chain of command, charge nurse, manager, DON. You are right, if your assessment is that he will be unsafe on his own, you must advocate. I am not surprised that your textbooks do not address this, they don't deal with real world.[/quote']

I agree. :yes:

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Specializes in Pedi.
Some info is missing, is he from home, have family, etc? I f he is truly on his own then- you could go to social worker and see if they assess him for rehab/ snf placement. If so, go to Dr and ask for discharge to said facility. If you strike out, you go up the chain of command, charge nurse, manager, DON. You are right, if your assessment is that he will be unsafe on his own, you must advocate. I am not surprised that your textbooks do not address this, they don't deal with real world.

Who you go to also depends on how your facility is structured. Social work had nothing to do with these kind of decisions in my hospital and they are not involved in them with any of the hospitals I deal with now as a home health case manager. Social work only got involved in discharge if there were, well, social issues like housing and the family needed to be placed in a shelter or some other sort of temporary housing. Rehab referrals were handled by case management. IMO, the role of the nurse in this situation is to refuse to discharge the patient if he's unsafe for discharge. I have refused to discharge patients before for that very reason and I blocked a hospital discharge last weekend for one of my patients who I knew wasn't ready/that they were trying to just push out the door.

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Specializes in Acute Care, Rehab, Palliative.

It depends on your resources. Where I work there are Discharge Planners that weigh in plus OT.PT and Social Work all can have a say or an opinion.

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so in your scenario does he live alone? Does he have assistance at home? Is he being d/c home or to SNF/LTC?

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My humble newbie opinion is that yes, some info is missing. IF the patient is being discharged to a situation where they have no assistance, then I would absolutely go up the chain of command to oppose the discharge. We are our patient's advocate. That is the be all, end all statement of a nurse...patient advocate.

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At the most basic, though, no matter what information is missing, the RN's first duty is always to be a patient advocate and to protect the patient, according to every state nurse practice act and the ANA Scope and Standards of Nursing Practice, which is binding on all RNs. It's a slim volume and if you haven't read it, you can get it from Amazon or the ANA website, and every RN should have a passing familiarity in it because we ARE held to that standard.

If your assessment leads you to believe that it would not be safe to discharge him to the situation he would be going to, it is your duty to move heaven and earth to keep him until he is safe, prepare him to be safe, get him to a different situation where he would be safe... you get the picture. The nurse is the last protection a patient has from dangerous practices, whether they are the wrong medication or discharge to an unsafe situation.

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Specializes in Emergency, Telemetry, Transplant.

I was thinking more of going to case management than a social worker. Case management should have been involved already in D/C planning, so, hopefully they will be able to step right in and provide for (possibly) transportation home, a home health nurse, etc. If your pt can't even get out of the hospital (physically) and transport himself home, then you would have to do more that just pack in a wheelchair and push him out the door. Also, does he have orders for something to help him with the pain (medication, therapy, etc.)? While it is unlikely he will not be 100% pain free on discharge, as the discharging nurse you have to be sure he has something in place to deal with the pain.

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