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Comment by maxxxxx | Hacker News Reader

I bet it's because they system is very hierarchical. Once a doctor says something the nurse can't really override it.

The hospitalist is acting as the “gatekeeper” to admission here, so they decide if the hospital will take the patient or not. That doesn’t stop the NP from shipping the patient straight to the hospital’s ER. By federal law, emergency rooms must see every patient who comes in their doors.

The NP absolutely could have sent the patient to the ER. The vast majority of patients admitted to a hospital come in through the ER.

From what I know about hospitals the NP is supposed to defer to the doctors.

I think there’s big variation state-by-state in terms of NP independence.

I think the problem is she brought it to her organization's doctor that often does the ER admitting in situations like this and that doctor overruled her.

The NP could still have done it, but it would have been against two different doctors and the organization who employs her practices. The sad thing is that this probably happens often, this is just the first time someone sued over the death.

Or the first time it got taken to court instead of settled by everyone involved.

The NP did the right thing in a sense though - she went up the chain of command. The person up the chain, however, did the wrong thing.

edit to add: possibly the NP went up the chain of command precisely because the doctors there wanted veto power on hospital admissions. they didn't want pesky underlings getting in the way of whatever motivated their decisions.

Yeah, from what I have seen an NP overruling a doctor is a big No, No.

Once a doctor says something the nurse can't really override it.

Once two doctors say something.

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