ER RNs, who does the petition?

[gonzo1, ASN, RN]

Just wondering if I am being picky or not. Do your triage nurses do the petitions on the suicidal ideations that come in, or does the assigned nurse do it. Had the nurse bring me the petition out to triage this morning and tell me that I had to do it because I am the one she said she was suicidal to. I always thought it was the job of the assigned nurse to go in and assess the pt, find out reason for being there and then do the petition. I myself have never taken the petition out to the triage nurse and told her to do it. I have always done it myself after assessing the pt. Thanks for being there.:monkeydance:

[Katnip, RN]

In our ED either the patient was voluntary-and most who presented to triage admitting suicidal ideation were, or the docs wrote up the petition if the police had not done it when they brought a patient in.

[gonzo1, ASN, RN]

I should add to my question that even our voluntarys are always petitioned so they can't change their minds. Still don't know who is responsible for doing the petition though. Help Help

[traumaRUs, MSN, APRN]

In our level one trauma center, we had the luxury of 24/7 master's-prepared mental health clinicians who did the petition and the doctor did the certificate. Our hospital had no inpt psych beds, so the EMTALA and transportation arrangements were also done by the mental health clinicians. It was very nice. The nurses had nothing to do with it.

[angel337, MSN, RN]

anyone that heard the patient verbalize or exhibit unsafe behavior can do the petition. the primary nurse should always do an assessment. maybe that is the policy of your ER to have the person that triaged the patient do the petition. i don't think that the triage nurse should do it because they won't be caring for the patient, but every place is different. check with your manager or charge nurses to make sure you are following correct protocol.

[gonzo1, ASN, RN]

Sadly, our charge nurses don't know what the protocal is and right now, we don't have a manager. That is why I put it forth to my allnurse family.

[Altra, BSN, RN]

I should add to my question that even our voluntarys are always petitioned so they can't change their minds. Still don't know who is responsible for doing the petition though. Help Help

Our involuntary commitments are probably split into thirds - 1/3 by police, 1/3 by psych nurses or social workers at our facility, and 1/3 by family/friends who have observed behavior. If one of our pts. expresses suicidal ideation/intention they are evaluated by a psych nurse once "medically cleared" by our ER docs. In that eval they may contract for safety & be discharged home with a plan for follow-up, may be admitted at our hospital or transferred to another psych facility.

I have to say that the above statement raises some concerns for me -- do you mean that if a patient says they are willing to commit themselves voluntarily, they are still involuntarily committed? This would seem to definitely be a violation of their rights in my mind ... I'm probably not understanding you correctly.

[gonzo1, ASN, RN]

At our facility if a patient comes in and states they are suicidal we always do a petition and mark emergency involuntary admission so that they can't change their minds and leave and then go and hurt themselves. I don't know the reason why this is done this way as I have only worked this ER for about 1.5 years. Just know that this is the way they do it. I have questioned them several times as to why and no one can give me a good answer. It must be okay because no has ever come back and made waves. After they are petitioned and go to the floor or another facility they stay there until examined by the psyche doctor. Then I don't know what happens after that. I assume they are treated and released. We have many frequent returns who we do this on on a regular basis.

[nuangel1, BSN, RN]

regardless of how the pt comes to our er ie ambulatory ,brought in by police or emts .if pt is voicing suicidal ideation and or homicidal ideation our policy requires medical clearance 1st (labs and urien tox) our dr see's the pt .once all lab work is back dr med clears pt and either our mental health clinician or 1 0f our 2 contracted health companies clinician comes in to eval pt.pt can be contracted for safety and be d/c with f/u or voluntary commitment to our psych floor or another institution.if evaluator feels pt needs to be involuntarily committed the he/she files the petition .

[Altra, BSN, RN]

At our facility if a patient comes in and states they are suicidal we always do a petition and mark emergency involuntary admission so that they can't change their minds and leave and then go and hurt themselves. I don't know the reason why this is done this way as I have only worked this ER for about 1.5 years. Just know that this is the way they do it. I have questioned them several times as to why and no one can give me a good answer. It must be okay because no has ever come back and made waves.

OK ... applicable laws on this vary considerably from state to state.

In my state, an involuntary psychiatric commitment means you can no longer ever purchase (be licensed to own) a handgun, and limits your employability in certain fields. I believe, although I'm not 100% sure of this, that it also precludes you from enlisting in the military. It is a permanently life-changing event. I'm not saying that it's necessarily a bad thing for people whose psychiatric state is such that they require involuntary commitment for treatment because they will not voluntarily admit themselves.

But again, just so I understand ... your facility takes this step of involuntary commitment for individuals who present themselves to the ER and voluntarily verbalize suicidal/homicidal ideation or intention? Has anyone in risk management really thought that through?

[donastaci]

You must have written policy somewhere in your ER. Find out where they are and look it up. The name of the game is CYA and "I didn't know" is never an acceptable defense.

[augigi, CNS]

I don't know the reason why this is done this way as I have only worked this ER for about 1.5 years. Just know that this is the way they do it. I have questioned them several times as to why and no one can give me a good answer. It must be okay because no has ever come back and made waves.

If I were you, I'd make it my business to find out the hospital's written policy on this if I was putting my signature on the page. Saying "it must be okay..." is not a legal defense. Cover yourself. You can bet if someone does "make waves", the hospital administrators will be the first to say "Nurse So and So did not follow hospital policy".