Anonymous says ...

There is a situation at work that I feel extremely uneasy about. I need direction, maybe I'm making something that isn't a big deal into a big deal. I work on a unit that the patients are there to rehab, either get stronger and go home or are placed in long term care if they can't be cared for at home. There is a nurse on the unit that calls the doctors has all their medications discontinued and has them order roxinal Q1hour and made COMFORT CARE ONLY. These are people that are not terminal. There are two currently that are comfort care only, she got insulins dc'd which seems extremely wrong. I can't believe the doctors are giving these orders. I have been working on another unit and a patient there has refused her calcium for a month, one of the nurses requested an order to dc the calcium and the doctor said NO, continue to attempt and encourage patient to take the calcium. This person gets a doc to dc insulin?? The thing is one of the residents that just passed came in with hip repair and she was made comfort care, roxinal, dc all other orders. In the past when I have had comfort care only the patient is terminal, knocking on the pearly gates, having difficult time swallowing. We have people over her and they don't do anything about this. I mentioned that it seemed strange the other day and someone replied "oh ya, nurse kavorkiain" so other nurses see this and are not doing anything about it. She got upset with me last night because I didn't give any roxinal, the patient didn't need it, I could barely get her to wake up and she wants me to give the roxinal?

What are your thoughts, I couldn't sleep thinking of this, it's just eating at me.

I am a hospice nurse. We do call doctors and talk to them about TERMINALLY ill pt's.  If a pt is in rehab, chances are they do not even meet the criteria for hospice. Also if a visit is made to evaluate a pt in rehab or anywhere in a facility of any kind, the nurse should be documenting in the progress notes or somewhere that she was there, what she found on examination, who she talked to such as PCP, PCN, CNA whatever. The nurse also needs to write if she talked with a family member and if so, who, and if that person has POA for pt's health. Also write if pt was talked to and what they said. The pt. could be complete coherent and not know that this is being done to them if the nurse is not directly talking to them.  If this nurse is with another organization other than the facility, she should also be wearing an ID badge with her picture and what organization she is with.  I would talk with the supervisor, the social worker and the nurse writing the orders.  Then possibly the board.  Is it possible that this nurse is the doctor's office nurse and is reviewing charts for him and then calling her findings for orders from him or is it multiple doctors?