treating a visitor of your pt? reprimanded for not doing it....

  1. am i right or wrong here? just fyi, i work in a subacute rehab attached to ltc.

    during report, had a nurse manager come in, tell me pt "had fainting spell" and to go see her. i get up, go in the pt's room, ready to do VS and assess, etc. four family members in the room with pt, one of whom is lying in bed next to pt. i say "what happened?", pt sitting up, a/o, no c/o. i go to take a BP on her, and another family member says "no, it's not her, it's my sister". sister laying in bed, says she has a "heart problem" and is vague with her symptoms. i say "sorry, i am not allowed to take your VS, but i will call an ambulance for you". rest of the family says, "no thanks, she's been complaining for the last hour, but we don't know why the nurses can't just give her a BP pill and check her VS every so often." offer again to call ambulance, declined offer. so i go to nurse manager who's supervising building for the weekend, who goes to talk to family, and then writes me up for not taking the woman's vs. :stone

    am i completely wrong here?
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  2. 79 Comments

  3. by   TweetiePieRN
    At my hospital, we are not to take the VS of anyone other than our own patients. I don't know all the legalities associated with it, but it's against the policy.

    I wish I could give you more insight...but I think you did the right thing! You offered to call 911 for them.
  4. by   UM Review RN
    Quote from TweetiePieRN
    At my hospital, we are not to take the VS of anyone other than our own patients. I don't know all the legalities associated with it, but it's against the policy.

    I wish I could give you more insight...but I think you did the right thing! You offered to call 911 for them.
    Obviously, you would've been (way, way, way) beyond the bounds of your licensure to actually give the person a pill. You did the right thing, and you are not legally or morally responsible for the patient's sister, IMHO.

    I hope you stated clearly on the writeup that this was NOT a patient of the facility and that it would've been inappropriate for you to treat her.
  5. by   Bipley
    Quote from rehab nurse
    ... "sorry, i am not allowed to take your VS, but i will call an ambulance for you". ...
    Do you have a written policy to that effect? If so, use it and fight the write up.
  6. by   UM Review RN
    Quote from Bipley
    Do you have a written policy to that effect? If so, use it and fight the write up.
    Stellar idea, Bipley. I agree, fight that write-up.

    Wouldn't the fact that you are employed by the facility kinda imply that you are only employed to care for the actual residents of that facility?

    I'm thinking for a visitor, you'd only be covered as far as the Good Samaritan Laws allow, and you did the right thing by encouraging the person to go to the hospital via ambulance since she might've been having cardiac symptoms.

    Further, I think taking vital signs might have been interpreted as you implying that you would be responsible for her care--but I'm not sure about that. I think what you did made much more sense, because what good are vital signs if you can't treat?

    So maybe one of our legal-eagles can answer this, but I'd be very very doubtful that the write-up holds any water at all.
  7. by   rehab nurse
    our facilities p&p's are terribly out of date. and no, there is none that deals with this scenario. all i kept thinking is reading in a legal column once that even if you give advice, you are engaging in a nurse-pt relationship, and thus responsible for their care. how could i treat the woman even if i did an assessment and vs? i have no info on her, no attending physician, no physician orders for meds, etc. she is not a pt on my floor, so on whose orders am i to even assess her? i am not a medic responding to a call, i am not a doc/np who can prescribe, and i certainly do not work in an er. i thought that even if i worked in a hosp and had the same situation, i should have them go to er. and of course, since i am a lpn, the rn supervisor loved telling me how incompetent i am after she went and did the lady's vitals.

    my mind just keeps pouring over the possible outcomes. what if the rn went and took the bp, and got 200/100? what are you gonna do? pop her out a catapres? give me a break!

    thanks everyone for your insight and replies...

    i will fight this tomorrow
  8. by   LoriAlabamaRN
    I would have done the same thing you did... in my facility we can't check the vital signs of family members.
  9. by   Katillac
    As other folks have said, if you take VS you have entered into a nurse/patient relationship. The reason that facilities have policies against this is that if you took the BP and it WAS through the roof, you would then be negligent (and the facility also vulnerable to litigation) if you didn't intervene appropriately. In such a case, Good Samaritan laws wouldn't cover you in most states because this wasn't an emergency and because the family was seeking your care as an employee.

    Also (separate issue) in her case, without her having been admitted and without her having signed consents, you would have been practicing outside your scope. For all of the reasons you state, you couldn't treat this woman, and VS are treatment. She was flat wrong to have written you up, and she put her license and the facility at significant risk by taking them herself.
    Heck, you could write HER up!
  10. by   talaxandra
    Just another vote saying you did the right thing
    And if we did start treating relatives, where would it end?
  11. by   Jessy_RN
    I agree that you should fight it. Good luck
  12. by   student4ever
    Definetly fight it. I work in an ER, so it's a bit different scenario. We've had patients' family members go bad before - pass out, etc. etc. In that case, we start treating them, and if they decide they don't want us to treat them at any point in time, we have them sign an AMA (against medical advice) form, and legality is taken care of. Now if a family member asks to have their BP taken, or their O2 sat, we will do that. If it's bad, we will advise being seen, but it is their choice to be seen or not, just as if they had come in to triage, sat down, had vital signs taken, and then walked out. It's their choice to come and be seen, or to go home, even if they would be better off being seen by the doctor. But in your case, with an LTC facility, I can see how it is legally outside of your scope of care. You are there to treat YOUR patients/residents. Their family members are not your responsibility. Definetly, you were written up wrongly, IMO.
  13. by   judyblueeyes
    I think the NM was completely wrong. We send all visitors to a 'treatment room' to be evaluated properly.
  14. by   CoffeeRTC
    Why didn't the NM go and take her BP?

    YOu did the right thing!

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