Scope of practice concern

Nurses General Nursing

Published

Specializes in Med/Surg; Psych; Tele.

Hi! I am a little confused about something and wonder if anyone can shed some light on this situation...I just recently accepted a position where I will be working in a community mental health center (obviously not for the $ :o ) and was told that I would be expected to issue patient diagnoses (and no, not nursing diagnoses). I discussed the issue of diagnosing being of out the scope of nursing practice with my future boss (who is a licensed counselor). She said that the medical director does sign off on all charts and that the medical director may change my diagnosis, but that I would still be expected to make the initial diagnosis. She said that she did not see a problem with the RN making the psych diagnosis as long as everyone else on the team was on the general same page as far as a treatment plan was concerned. The example she gave was that I, as the RN, might diagnose a patient as having Schizoaffective d/o and the MD might change it to Major Depressive d/o with psychotic features - the treatment plan, however, might be much the same for both diagnoses. My future boss (director of this facility) also said that the previous RN in this position (who had 15 years of psych experience) did not see a problem with this aspect of the position. So, I'm just a little confused having always learned that diagnosing patients is out of the scope of practice for nurses. However, I know that things run a little differently at the community level (but I'm just not exactly sure how). My concern is that I do not want to put my license in jeopardy for praticing out of the scope of nursing. I've referenced my state's nurse practice act but have not come up with any clear answers. Please help!

Thanx in advance,

Cher

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Specializes in Multiple.

Hi - if you were not trained to diagnose, and your gut feeling is that it is out of your scope of practice - like I feel you do or you would not have posted this...then don't do it - if you are not trained, then you will lose your hard earned licence if something goes wrong - or if it doesn't!

Just because someone else does something doesn't automatically make it right...

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Specializes in Assisted Living Nurse Manager.

You should call the board of nursing in your state, to get clarification about this issue. I am sure they would know if this is within your scope of practice. I personally would find out before starting the job. I am an LPN student and have always been told or had it pounded into me that a nurse does not do the diagnosing :nono: . Anyways, good luck and I hope you find the answers to your questions.

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I searched the board of nursing and our scope for this one I was curious. I think you need to get futhur explanation on this though. Are you the first person that the pateints sees? and you are admitting them to the psych unit for suspected? until a doctor can assess them? orrrr are you making the actual diagnosis after other people have seen and admitted them. I can understand the suspected diagnosis until the doc can see but anything other than that seems to not be correct. and I would look into it. From what it sounds like is she is trying to talk you into doing it by explaining everyone else does it and the person before you did it, and something is just fishy ... personally I wouldn't take the job. Plus you don't seem excited about it anyway. :)

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Definitely read your state's/area's nurse practice law and the hospital policy(ies) on this.

Sounds fishy to me.

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You will find the answer to your question in a nursing legal handbook. Nurses are not allowed to make medical diagnoses. It is practicing outside of the nurses scope and is not legal. It doesn't make a difference if others on the healthcare team think it's ok for you to do. They are wrong. It is the MD's job.

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You will find the answer to your question in a nursing legal handbook. Nurses are not allowed to make medical diagnoses. It is practicing outside of the nurses scope and is not legal. It doesn't make a difference if others on the healthcare team think it's ok for you to do. They are wrong. It is the MD's job.

I agree. As for the previous nurse in the position, I've seen plenty of experienced, veteran nurses over the years who were so sure of their own skills (and their own importance! :uhoh3: ) that they were quite comfortable practicing outside their legal scope of practice. Always scares the bejeesus out of me ... I've been in similar situations in the past, where I started a new job and found myself expected to do something that was outside of my legal scope of practice; and when I said that I couldn't do (whatever it was), got told that "all the other nurses have done it ..." I've always put my foot down and stood my ground.

You need to look out for your own license -- no one else at the MHC is going to do that for you!

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Specializes in Med-Surg, Geriatric, Behavioral Health.

In my days of old in being an outpt psych nurse in a CMHC, I can say I can relate to what you are asking. What the CMHC may be asking is NOT that you would be making a dx, but a "diagnostic impression" as evidenced by:____________________. This may seem like spiltting hairs, but there is a difference. It is NOT in the scope of practice for nurses to diagnose, but we do communicate as professionals about our impressions that a disorder or abnormality MAY exist. In CMHCs, providing diagnostic impressions are usually performed by staff in intake, seeing new folks coming into the door...just prior to seeing the doc. When an intake worker collects ALL the data (the CMHC often spells it out what to collect/assess), what is often part of the intake assessment is the diagnostic impression by that intake worker...often reported in all five Axes of the DSM criteria. When the patient does see the doc for the ist doc appointment, the doc has documentaion to refer to. Now, the doc may agree or very much so disagree with the diagnostic impression. However, the doc makes the dx, not intake. Intake may only give "impressions" of a diagnosis. The exception to this rule is if the member of intake, who makes the report, has a terminal license and is allowed by that state to diagnose...such as a licensed psychologist and in some states... Licensed Counselors in counseling or MISWs in social work or NPs/CNSs in nursing...but, it depends on that state. So check with your BON regarding your licensure and licensure laws. I hope this helps.

Wolfie

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Specializes in Med/Surg; Psych; Tele.

This is exactly why I love this website...there is usually always someone who has been in your situation or something very similar. Like the rest of the ladies who responded, I too thought something just wasn't right. But, after reading your reply, Wolfie, I remembered that my future boss did say that I could write "diagnostic impression" if that would be more comfortable for me (sorry - forgot to include that in the original message:imbar ). I guess what worried me was her saying, "You will be expected to diagnose" - kept ringing in my mind so much that I dismissed the possibility that a "diagnostic impression" could be different *enough* to keep me within my professional scope. Wolfie...thank you so much for helping me to clarify this issue! So, I guess I have no reason to worry if I always just make sure I write "diagnostic impression", right?

Cher

In my days of old in being an outpt psych nurse in a CMHC, I can say I can relate to what you are asking. What the CMHC may be asking is NOT that you would be making a dx, but a "diagnostic impression" as evidenced by:____________________. This may seem like spiltting hairs, but there is a difference. It is NOT in the scope of practice for nurses to diagnose, but we do communicate as professionals about our impressions that a disorder or abnormality MAY exist. In CMHCs, providing diagnostic impressions are usually performed by staff in intake, seeing new folks coming into the door...just prior to seeing the doc. When an intake worker collects ALL the data (the CMHC often spells it out what to collect/assess), what is often part of the intake assessment is the diagnostic impression by that intake worker...often reported in all five Axes of the DSM criteria. When the patient does see the doc for the ist doc appointment, the doc has documentaion to refer to. Now, the doc may agree or very much so disagree with the diagnostic impression. However, the doc makes the dx, not intake. Intake may only give "impressions" of a diagnosis. The exception to this rule is if the member of intake, who makes the report, has a terminal license and is allowed by that state to diagnose...such as a licensed psychologist and in some states... Licensed Counselors in counseling or MISWs in social work or NPs/CNSs in nursing...but, it depends on that state. So check with your BON regarding your licensure and licensure laws. I hope this helps.

Wolfie

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