Ok so I recently joined as a dialysis nurse with a small hospital who manages all their treatments instead of contracting to a dialysis company. With that said, the nurses pretty much control alot of what goes on and gets along well with staff because they too are members of the hospital. I've been a dialysis nurse for six years in both acutes and non acutes and my question is this.
there was an order to dialyze a brand new patient for first time treatment in the morning. the order said "hemodialysis in the morning". So that morning the lab results were not available so I waited for it to come up because it said pending. When I got the results I called the dr...had to page him twice....and he stated that he hasn't laid eyes on the patient yet so to wait until he sees the patient to dialyze. He stated he would come after noon time. So i go down to the unit and help a bit where I can in the unit. Then I go upstairs around 1 pm and the dr is there so i start restringing the machine to start dialysis. Next day my manager is mad that I messed up productivity. She said I should have started this brand new patient in ICU on dialsyis since the order said hemodialysis in am. She said the doctors there back the nurses up and they understand productivity is big there since it is a small hospital. My thing is...in all my years I have never started a brand new patient without dr writing orders. I know dialysis is dialysis and doesnt change much but I think that makes me feel unsafe plus its out of my scope of practice. my boss said dialysis is dialysis and we know what we are doing. i think if it happens again to me i still wont do it. What do you guys think. Am I making a big deal? I'm in the process of getting a new job but I have to tough this one out till the other job follows through for good.
I too am with a small hospital, one thing about small hospitals vs. the bigger companies is that there are not always real clear practices put in place. We also have an issue with Dr's writting clear and timely orders. I feel you were in the right on this one. By chance you did set up and start dialysis and went with a safe dialyzer and safe bath, well, what happens if it is totally different than what the dr wanted? Would they still back you? I am not a nurse but have been in the game for 15 years, Drs always try to tell me to change the dialyzer to this or that or change other parts of the treatment and I have to tell them they need to tell the nurse so it can be a verbal order. Long and short, you need orders to run a pt. Plain and simple. You are not wrong at all. Good luck.
I think you are correct in your actions as well
Who wrote the order for dialysis in AM? In my experience, only a nephrologist can order dialysis and there are many ER doctors who will write this.
How can you have an order for dialysis that does not say what bath, dialyzer, etc??
You did the right thing.
|Powered by Social Strata|