Hi, I'm an LPN with a private practice in BC. (~ 120 clients)
The CLPNBC states one must practice within one's scope. I.E. You CAN do foot care if you've been trained.
Provincial legislation, law, states an LPN can ONLY provide care to a client under the direction of a physician or RN who also provides care to that client.
I have spoken to CLPNBC practice consultants about this. They said a prescription or note from a physician constitutes direction. Without direction the CLPNBC will not back an LPN if something goes wrong (error and omission aka malpractice) insurance.
No direction (prescription or note) = no malpractice insurance
, no support.
This insurance is provided by the CLPNBC, our annual dues pay for it.
That said, malpractice in foot care is, I am told, pretty much unheard of IF you are doing what you were trained to do.
Early on I pushed one practice consultant as to how exactly this note or script constituted actual "direction". I was told that I could speak to the physician and we could then agree as to when to meet to discuss a particular patient's foot care needs, really. (Hmmm, ok, I see why you're a consultant instead of a practicing nurse, however my question remains....) I didn't even know where to begin in explaining exactly why that idea is pretty much ridiculous. Suffice to say I have not tried to sell that idea to any MDs, but do feel free to try!
Note DVA is similar, they ask LPNs who the "prescriber" is, the acceptable answer is RN or MD.
Most foot care LPNs I know, mostly ignore the direction requirement. As for the DVA requirement, most adhere to that.
I, however, possessing questionable wisdom, observe provincial legislation.
I fax a nice short request for a script to the client's MD and request same be faxed back.
I call it physician roulette.
It takes somewhere between 20 minutes and never. It is the bane of my existence. It drives me crazy.
Most physicians, 80%, fax me a note or script "please provide foot care for Mr. Smith" within a few days, excellent, perfect, helpful, they have my gratitude, really.
Some ignore me. One crossed town, charged into the the care home and gave the staff nurses there a hard time because of my request(s) that he was clearly ignoring, I made it clear I am not on staff there. "Mr Jones no longer requires foot care" Thus punished, I suppose, for my audacity. Gee doc, who's going to pay the price for that display of assertiveness, Mrs. foot nurse or Mr. Jones? Of course the same MD politely fired me a script within 30 minutes upon the next request I made a week later for a client living at home. Come to think of it I DID learn something from all that. Another MD who used to send me scripts post haste now ignores me, perhaps I serve too many of his patients and take too much of his time? One MD ignored my request, I faxed a detailed letter explaining why I need a script "I am a trained foot care nurse, however provincial legislation states..." no reply, I had the client request a script from that MD next time they saw him, the MD's response was "I don't know what that nurse wants." Ok, I get it, they are busy, but really, you'd think they'd want their patients to receive care. All they need to do is scribble a note and get someone else to fax it off, is that really too much to ask? Well, sometimes, apparently, it is. If I was charitable I'd say it's due to the stress and strain MDs are under, but then again....
Oh boy, there I go, venting again, well, truth is most MDs are pretty good about this nonsense.
I think this situation would be better if all MDs were aware of the requirement for direction that LPNs live with, but I don't think they are. Frustratingly the "direction" I receive is seldom direction at all, it's more like permission, it meets the letter of the law but serves little actual purpose beyond that. In a perfect world the requirement would be for LPNs to make their client's physician aware that they are providing foot care for that patient. Accountability is a good thing.
The delay caused by waiting for a script from an MD has cost me clients. New clients seldom call me when they need foot care three weeks in the future, they call when they need foot care three weeks ago. Some tire of waiting for me, which really means they tire of waiting for their MD to fax me a script, and call another nurse. If that happens to be an LPN who ignores the law, well, so be it.
That said, I really like the work, my clients enjoy my service and often recommend me to others, growing a practice is a slow slog, but the more it grows the faster it grows, it takes at least a year to get it rolling.
good luck, never mind the weltschmerz!
PS hint de jour, get an all in one fax answering machine.