[cannulator]

I was wondering if the triage nursing world could shed some light...
I have recently started taking call at our large university cancer center outpt unit. This is not call where you actually go in to the hospital to see pts, but where you take a pager home and take after-hours/weekend calls and troubleshoot problems pts are having. About half the calls can be managed by the nurse, about a quarter of the pts clearly need to be sent to the ER, and the other quarter I call the Dr oncall for further advice and referral.
I have been doing this for 6 months or so, and have several questions regarding liability as a nurse at home giving medical advice. First of all,most of the calls are not from the pt, but from family members calling for the pt. Why is this not a HIPAA violation? As a matter of fact, since I do not even have access to any medical information about the pt from home, I cannot even verify the identity of the pt being called about(such as DOB). On the same thread, I most often do not personally know the pt, and have no access to any medical information about the pt, including meds, allergies, comorbities, etc. I am very knowledgable about chemo and side effects, but often, it is a shot in the dark when they are having problems and you cannot eyeball them in person. They are often relunctant to go to the ER because of the very long wait time (8-10 hours) and since they are often neutropenic, I walk a fine line sending them there as well.
We have no algorithms for our oncall staff, nor do we record any of the calls. It's sort of flying by the seat of your pants. When I have recently talked to managemnet about tightening up some of these loopholes, I ended up feeling like I was making a litigious mountain out of a molehill. I would like to know if I am. I would be happy to back down. Thanks is advance for any replys.

[eltrip]

No, you're not making a mountain out of a molehill. Asking for guidelines, or even better, standing orders for the more common situations you encounter would be in the best interest of the patient. Isn't that the purpose for the existence of the practice, to help patients?

Additionally, having guidelines protects both you and the docs. With you doing weekend call "flying by the seat of your pants," you are risking your license. It is conceivable that you could be accused of practicing outside of your scope of practice. Without written protocols, the physicians are risking potential malpractice lawsuits (unless they claimed the on-call nurse was acting on his/her own authority). In any event, it's not a position you want to encounter.

Yes, ask for protocols and/or algorithms. Protect the patient and your license.

regards,
eltrip

[bigsyis]

What eltrip said. You are truly out there flying by the seat of your pants!