Out of Scope of Practice???? - page 2

Yesterday several family members came in to see their loved one stating that they had heard through other family members that they were now being seen by Hospice. To make a long story short, the day... Read More

  1. by   BrandonLPN
    Quote from artsmom
    Yes it needs to be an order, but a T.O. is okay.
    So a nurse (even a RN) can't just deciede to call the hospice company for a consult for a resident. It has to be physician ordered, right?
  2. by   artsmom
    Yes, technically.
  3. by   Nascar nurse
    Quote from artsmom
    Yes, technically.
    Just to talk to a hospice representative does NOT require a MD order. (The point of this conversation is a Q & A about what hospice care is all about, the services to be provided, financial information, etc) To have the hospice actually begin services requires an MD order.
  4. by   artsmom
    We require an order for the initial eval.
  5. by   BrandonLPN
    Yeah, I think we do too. You need an order to consult a hospice service, just like you need an order to consult a specialist.
  6. by   Nascar nurse
    Quote from artsmom
    We require an order for the initial eval.
    Yes, an eval requires an order. During an eval there will be resident specific concerns discussed, ie: what meds they are on, what end of life diagnosis will be used, contract agreements signed, the nurse will do a hands on clinical assessment of the resident.

    During a talk with a hospice representative (that does not require an order) - this is simply a discussion by a hospice representative related to the services they provide. This is no different than any person that wanders into your facility and requests a tour and a little information. Nothing more than a fact gathering session and not an agreement to any services. My local hospice services are always more than happy to come out and give their talk. There is no commitment for services to be provided. The family has the option of agree to an eval or decline the use of hospice care. If they want an eval then I call and get the order. Hospice will not go any further in the process until there is a MD order on the chart. This allows the family or resident to be fully informed of their options before an agreement is made.
  7. by   JulieL
    Thanks for the great discussion, you three! I learned a lot by your conversation.
  8. by   lillymom
    I agree with Nascar nurse. A Hospice nurse came and spoke to our class last month and she said that anyone can call and get an appt. with hospice. She said that they could make a guess if someone would be eligible but they would need an MD order to actually evaluate them and give a definite response. Mostly they just talk about what hospice means and what they can do for the patient and the family.

    She also said that the hospice nurse can send an order to the MD to sign so a nurse is not needed at all for a consult. The nurses where I work send for a consult (not evaluation) all the time. I think more people in general, and especially nurses, need to be educated about this because it is a great resource, not only the patient, but the family as well.

    As far as what the nurse said there are some doctors that will not tell the family the truth about the patient's true condition. We had this situation in our simulation lab and our role as nurse was to explain to the family what the MD failed to explain. Basically that the patient was dying and what was likely to happen during this process.
  9. by   CT Pixie
    I'm an LPN and have brought up Hospice to several family members. In my facility its normally the nurses (more often than not the floor/unit nurse who is an LPN) who brings Hospice into the conversations. It is not overstepping my SOP to give information to the family. I am not diagnosising anything.
  10. by   tokebi
    I echo what many people already said here: if we nurses don't bring up hospice or palliative care options, who will? Many people don't know about it or have misconceptions, or MDs either don't even consider it or reluctant about it.

    I've had a personal experience with this issue. An extended family member was dying of cancer. She did not know about hospice care or all the pain control and comfort measures available to her until I brought it up. None of her physicians or even nurses throughout her long treatment process discussed it with her. We had to contact an agency ourselves, and then we had to request her doctor to send in the order. Only then, she found some relief from the agonizing pain. She died the next day. I berated myself for not butting in sooner. I thought I was doing her a favor by keeping my nursey mouth shut, because she was a fiercely-independent and stubborn person. Had I known how much pain she was in and the total lack of end-of-life care plan...

    Back on topic, explaining the disease (dying) process, or guiding the patient and family through different treatment options, it is not only within our scope of practice, it is our duty as an advocate. Especially since it ultimately requires an MD order for eval, I wouldn't ever think of suggesting hospice as out of our SOP, but as a collaboration with (or nudging) the medical team for the patient's best interest.
  11. by   echoRNC711
    I focus my care on the pt not what any other nurse said or did. If we keep our focus on how to best serve the pt it keeps our practice cleaner.
    If the pt is ready for hospice and the family is receptive it sounds to me like she did a good job.
    Sometimes in nursing we can be so concerned with either rules or paperwork we miss the obvious...The patient!
    The role here with both the pt and family is to be supportive.
    I am not sure how telling the truth can be wrong.
    I watched pt suffer for months on end when open heart surgery went bad. The family was on a roller coaster. Every Dr. showing up is focusing on their specialty. To the renal guys "Yes,lets get CVVH going " The family hears this and think this equals hope. All the nurses can see this pt is notgoing home. Its more how long death can be postponed. Death is still a "failure" to doctors.
    Ask yourself. If you were the pt or family what would you rather...To remain in the dark. To endure suffering . To allow others about you do procedure after procedure that ultimately won't change the outcome ...or .....have someone step forward and speak the truth. Advocating for pt includes their right to die "well " with dignity . I have seen pt suffer intolerably because no one spoke up.
    Last edit by echoRNC711 on Oct 11, '12 : Reason: typo
  12. by   echoRNC711
    Quote from CapeCodMermaid
    I don't where all y'all work, but where I've worked 99% of the time it's the NURSE who brings up hospice. We are the ones who know the resident and the family. It is NOT outside the scope of anyone's practice to advocate for the resident.

  13. by   Sparrowhawk
    If you have enough time on your hands to worry about another nurse's job you have too much time on your hands. Sure go to the DON. Throw the day nurse under the bus, that's what we do.

    On a less harsh note..... What everyone else said is completely correct. Also, never run to the boss about another nurse without talking to said nurse first....

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