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Nurses need to speak up when it's too early to discharge a patient safely

Nurses are highly-trained health care providers who owe a duty to their patients to exercise independent judgment and advocacy

Many patients and family members have told us at Painter Law Firm that they felt suddenly rushed out of the hospital. Sometimes patients still had the same exact problems that brought them to the hospital in the first place. Other times, they couldn’t walk out on their own or needed special assistance at home that hadn’t been lined up yet.

Doctors ultimately make the decision to discharge patients, but it’s impossible to overstate or give too much emphasis of the important role that nurses have in the discharge process.

Discharge Planning

From the very moment a patient is admitted to the hospital, the standard of care requires the nursing staff to start thinking about and planning for what happens when the patient leaves. This is called discharge planning and should be documented in the patient’s medical record. Other health care professionals, such as case managers and social workers, often participate in the process, but overall discharge planning is a nursing function.

It starts with a head-to-toe nursing assessment of the patient to establish a baseline of the patient’s medical problems and clinical status. Throughout the admission, nurses then reassess the patient and document what things have changed.

Using this clinical information, nurses plan ahead for what the patient may need to be safely discharged to home or a facility with a lower of level of care—a rehabilitation center or skilled nursing facility, for example. The goal for a successful discharge is that the patient’s clinical status won’t deteriorate, and the patient won’t have to be readmitted for the same condition or a complication.

For many patients, this may require lining up medical supplies and equipment, home health nursing, or other types of assistance for the patient’s home. If the nursing staff is doing its job, there shouldn’t be a surprise or mad rush to get things done when a doctor makes the discharge order.

Unfortunately, that happens more than you’d think. I’m thinking now about a wrongful death medical malpractice case where a patient needed supplemental oxygen after a surgery that required a hospital admission. It was close to a major holiday and, all of a sudden, the physicians and nurses wanted the patient pushed out the door (I suspect that Medicare or insurance coverage was about to run out for the hospitalization).

The medical records have a discharge planning document that included arranging supplemental oxygen and the related necessary equipment for the patient’s home. Yet, the nurses didn’t follow through, and it never showed up. A major holiday was right around the corner, and the family couldn’t get the hospital nursing staff to respond to their requests for help. Plus, vendors were closed.

Sadly, the patient died, essentially from suffocation. This all could have been avoided with proper discharge planning. The hospital’s nursing staff really let this patient down.

Speaking up when a patient’s not ready for discharge

It’s up to nurses to advocate for necessary care to keep their patients safe. Patient advocacy is one of the hallmark responsibilities of good nursing care. If the nurse has a professional opinion that it’s not safe to discharge a patient, the nurse is obligated to speak up and advocate for the patient. When they don’t do so, “we were just followed doctors’ orders” isn’t a valid excuse.

It starts with the nurse informing the doctor of concerns. That’s usually all it takes—in my experience as a former hospital administrator, most physicians listen to nurses. But if the doctor is dismissive and won’t listen, nurses may need to take further steps, going up the chain of command to the charge nurse (supervisor) and other physicians in the hospital’s departmental or facility leadership.

I’ve handled numerous cases where patients went to the emergency room or were hospitalized and were told that they were being discharged despite no improvements or even getting worse. In each case, it seemed like the nurses were on auto-pilot and certainly weren’t exercising critical thinking and their own independent judgment in caring for their patients.

What you can do

If you face a situation where there’s a big rush by the doctors and nurses to discharge a patient, and you have concerns, be assertive and speak up.

Ask to see the discharge plan. Ask for a meeting with the nurse and case manager. Make sure that things are lined up to achieve a smooth, safe discharge from the hospital. If not, ask why, and request that the nurse advocate for the patient.

If you or someone you care for has been seriously injured because of an unsafe, premature discharge from the hospital, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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