Who do you work for the patient or the facility?

[hppygr8ful, ASN, RN, EMT-I]

So last night I did something that could get me fired. Oh well I was looking for a job when I found this one .

To give a bit of background, I work swing (3-11) shift in a small SNF (45 beds) We are usually occupied at 85 to 90%. There has been recent push by our Corporate Office to get to 100% occupancy and to accept more residents with higher medical and psychiatric acuity. Understand we are not a locked facility and are 100% restraint free.

So I came on duty yesterday and told we were getting an admit from a hospital that regularly dumps fragile patients on SNFs. As I read the packet I became concerned as the patient was 3 days post op and just out of ICU for respiratory depression. On continuous bi-pap. Were going to wean off the machine and do PT/OT for the surgery.

So the hospital calls to give me report at 10:30 pm. Really Not even fully weaned of bi-pap satting in the high 80's when machine is off. I asked if patient would be coming with own Bi-pap as we do not have that equipment and would not be able to get it until the next day. Nurse said "well you can just leave it off and see how patient does. I said I would have to speak to my manager and the admitting physician so hung up and paged both. Admin called first an of course said take the patient. The physician called next and said "What happens if the patient codes after arrival? He further stated that he did not feel comfortable accepting the patient without proper equipment and said tell them to send patient in am to give us time to be properly set up. I called hospital and relayed info then texted my manger also tried to call her with same info but she did not pick up or return my call.

I am on my way to work today and am sure management will want to talk to me about this. From the first day I became a nurse I have always been a strong patient advocate. In reality I feel a work for the patients and not for the facility where I hang my hat. So if this is the end of this employment I will walk out with my head held high.

Anyway just had to vent this out!

Thanks for listening

Hppy

[Magsulfate, BSN, RN]

I'd like to say I'd have done the same thing. CYA. It would have been all on YOU if he got there and became worse, which he would have without the bipap!

[Vana21, ADN, BSN, RN]

If the patient had come without the proper equipment and took a turn for the worse, I think we all know your admin wouldn't have had your back. You did the right thing

[VANurse2010]

Tell them that their medical director refused to accept to patient without the BIPAP machine and to take it up with him. In this case you are "just the nurse" and you do not "accept" or "reject" an admission/transfer. That's what the medical director is for.

[Karou]

Holy cow, that's a ridiculous situation. This patient should never have been accepted at your facility. If the patient had arrived you surely would have had to send them back!! The hospital can't wean the patient off the bipap, and your facility can't get a bipap that night. I know even on my medsurg floor, we can't keep patients who are on continuous bipap, they must be sent to the unit.

I am very glad the physician agreed and refused to accept the patient.

Good job for you for advocating for that patient. I would have done the same. If your manager and administrators keep accepting more acute patients to get 100% capacity, I'd be looking for a new job also. That's begging for bad outcomes.

[KatieMI, BSN, MSN, RN]

Honestly, I think you did good for BOTH parties. Would you management love dealing with a royal mess of a code on the floor and with everything that follows instead?

[sallyrnrrt, ADN, RN]

Proud did the right thing.... I have been DON in LTC, If you had to send the patient back , the hospital would have had hard time being reimbursed...... Never no matter what, take a patient/ resident, that you can not meet their needs.....you are MY KIND OF NURSE

[Libby1987]

I don't see the conflict, between patient and employer, it would be best for either to delay admission until you have the necessary equipment.

My employer is amazing that way, we don't have to choose, counting my blessings once again.

[LeChien, BSN, RN]

Honestly, I think you did good for BOTH parties. Would you management love dealing with a royal mess of a code on the floor and with everything that follows instead?

Management wouldn't be dealing with the code though, OP would.

Good on you OP!!

[CoffeeRTC, BSN, RN]

BTDT. Don't you just love the super late admits? I see nothing wrong with what you did. If the doc refused to accept the patient what else could you do? I'm guessing the ADM might have wanted you to doctor shop?

Crazy situation.

[Been there,done that, ASN, RN]

The physician did not accept the patient, end of story.

[Nurse SMS, MSN, RN]

I can't imagine even questioning this. There was no decision to be made here. Patient was not equipped for discharge.