I recently had a situation at work and need some feedback--

I am an RN charge nurse on the night shift in a LTC facility. I have a staff of one other nurse and 5 STNA's. Recently, one of my aides, an older lady, came to me and stated she had chest pain  and a headache. I took her VS and he BP was 156/100, P 117. I told her immediately that she need to be seen at the hospital. She told me she had already ahd a heart attack and she did not want to go. I attempted ( and so did everyone else) to convince her to leave work and go to the ER. She would not, until I checked her BP again and it was 177/100. Let me backtrack and tell you that with the original BP, I did give her an aspirin. Anyway, I was able to convince her to go to the ER, but only after she had worked half of her shift and if her husband took her.She would not allow me to call and ambulance.

So, after she left and went to the ER, I received a phone call form the doctor at the ER, He told me of her conditon (She's ok), and then proceeded to berate and belittle what I had done to treat this woman. After numerous attempts to tell him that I was only able to do what I did because she refused everything else, he told me that I "should have made her" go to the ER and that I should have called the ambulance, whether she wanted me to or not.

How can I "make" someone do something they refuse to do? She is a reasonably intelligent. alert and oriented person who knows the consequences of her decisions. Is there not such a thing as patient rights? My other concern is that if I had called the ambulance, who paid for it if she refused to go? This a concern because I don't know what the company insurance pays (I don't have it) and I don't want this person who makes barely more than minimum wage to be hit with a huge bill.

 I feel I did the right thing with the situation I was in, but did I?  Any thoughts would be appreciated! Thank you!

Thank you. What I didn't post in the original was that I called my DON and she told me to have her sit down and rest to see if she felt better. She also told me that if she felt better, I didn't need to send her home. I also didn't post that I had to threaten this lady with sending her home to get her to agree to go. I know for fact there is no policy in place for something like this. I don't even think we have a policy and procedure manual at our disposal for other day to day things, now that I think of it. I have never had a sitution like this and did not know what to do. The person that I called for guidance basically blew me off. I handled it the best way I knew how, with the resources and guidance I had.

I guess what I need to know is was the doctor justified in calling in and reprimanding me, like I was in his employ? My DON and administrator did not have any issues with the way I handled it, because my coworker was admitted to the hospital for 4 days. They did tell me that if I had sent her home and there was no issue, I would have been written up. I don't know what they could have written me up for , exactly, but that is what I was told.

You are right, of course. I did give ASA without an order or policy to back me. The doctor did not question that- in fact, he told me that was the ony thing I did right. He was concerned as to why I did not "make" this person go to the ER. I am sure I could have handled the whole thing differently, if I had the proper support.

Please know that I am not a new nurse, nor am I inexperienced, per se. I have been a nurse for 5 years. I have been in this position for 3 years and it seems that every time I try to make a decision, I am rebuffed by upper management. I am not allowed to "supervise". I am only the charge nurse because the DON cannot be there 24/7. She told me that if she could be there all the time, she would be. I have never really been able to handle situations of any kind without being questioned later or having any decision I make scrutinized relentlessly.

" I agree that this physician," cannot force medical treatment upon anyone". I do remember inservices relating to,

  " Patient's Rights Advocacy"; medical personnel cannot administer care unless the patient:

    1) shows significant,cognitive decline and is unable to make clear choices with regards to his medical stability.

        ( prolonged seizure,loss of consciousness, severe hypoglycemia,CVA / SDH, respiratory distress, Alzheimer's

           or Dementia.)

    2) Implies verbal consent," yes", or physical consent," nods,reaching for throat,ie.choking episode.

    3) Classified," 302"; Presents extreme danger / harm  to himself / herself  and others within their presence,

         ( guns,knives,explosives,hostage situation or bomb threat,etc.) ***If none of the above is present, NO MEANS NO".

I would definitely follow up with your DON and administrator to get a policy in place to cover you in the future.  The situation just may present itself again with this very same employee, and you do not want to be caught in the same maelstrom.  If it were me, I would send a person home if they refuse to leave work for the ER.  Let them take responsibility for their own actions by leaving the workplace.