Out of Scope of Practice????

  1. 1 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 nurse had spoken with a family member and stated that the resident's organs were shutting down and that their only option was to talk to Hospice. Number one, isn't that considered diagnosing? And number two, isn't it also considered under the same, practicing beyone scope of practice, that you never mention Hospice to a family? A doctor makes that decision and the Hospice agency then does an eval, depending upon that they request a meeting with the family! I'm sorry, but this is way out of scope of practice for a nurse, especially an LPN. (sorry for that comment) Should I go to the DON with this? I'm afraid that if the family really wanted to pursue this, the LTC facility could be in big hot water!!
    Last edit by ladytopaz on Oct 10, '12 : Reason: Preview
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  3. Visit  ladytopaz profile page

    About ladytopaz

    From 'Somewhere between O-hi & O'; 58 Years Old; Joined Jan '03; Posts: 62; Likes: 3.

    30 Comments so far...

  4. Visit  Anne36 profile page
    0
    Have you said anything to the LPN who made those comments to the family? Wasnt it the family who came in and brought up the subject of hospice?
  5. Visit  artsmom profile page
    6
    I don't think I fully understand the problem. The day nurse told the family hospice was needed because their family member's organs were shutting down, right? While possible phrased inappropriately, discussing needing hospice with a family is common for a nurse. If the family is interested then we call the doc and get the ball rolling. I think the only problem with all of this is poor choice of wording on the nurses part.
    fromtheseaRN, KelRN215, nrsang97, and 3 others like this.
  6. Visit  BrandonLPN profile page
    5
    So we can't describe the disease process, ever, to the family 'cause that's "diagnosing"?? And I think a nurse can at least *broach* the subject of hospice.... but the doctor has to be the one to give "the talk" where the decision is made.
    KelRN215, nrsang97, echoRNC711, and 2 others like this.
  7. Visit  BrandonLPN profile page
    9
    For example:

    I could say "your mother's kidneys have shut down and she's not a candidate for dialysis or transplant. Have you considered hospice?"

    Sally the daughter replies: "I've
    been thinking about it. I have some questions though...."

    Me: "Okay, I'll get you in touch with mom's physician."

    See? At no point did I over step my SOP.
    AheleneLPN, opossum, nrsang97, and 6 others like this.
  8. Visit  artsmom profile page
    5
    Quote from BrandonLPN
    For example: I could say "your mother's kidneys have shut down and she's not a candidate for dialysis or transplant. Have you considered hospice?" Sally the daughter replies: "I've been thinking about it. I have some questions though...." Me: "Okay, I'll get you in touch with mom's physician." See? At no point did I over step my SOP.
    Completely agree
    AheleneLPN, nrsang97, DawnJ, and 2 others like this.
  9. Visit  CapeCodMermaid profile page
    21
    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.
    SuesquatchRN, Altra, not.done.yet, and 18 others like this.
  10. Visit  artsmom profile page
    6
    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.
    Same here. The doctor is usually last to know the patient requires hospice!
    NutmeggeRN, nrsang97, wooh, and 3 others like this.
  11. Visit  Sun0408 profile page
    2
    I don't see the problem... The nurse did not DX nor did she overstep her SOP. Many facilities allow nurses LPN/RN to get consults for hospice care. Nursing consults are allowed in my hospital.
    nrsang97 and wooh like this.
  12. Visit  Nascar nurse profile page
    3
    Quote from artsmom
    Same here. The doctor is usually last to know the patient requires hospice!
    No kidding - geesh, if we waited on the Dr to decide on hospice a resident would NEVER get on hospice.

    My conversation: We see Mom is declining based on recent weight loss, labs, whatever. Did Mom ever speak to you about her advance directives and what she believes to be a quality of life? I can call the Dr. and request (fill in tests or a g-tube or whatever) but I think you should give some thought as to what outcome you can realistically expect and how much you are willing to put her thru.

    From there I discuss the option of hospice and offer to call someone from hospice to come speak to them.
    SuesquatchRN, nrsang97, and wooh like this.
  13. Visit  FLmed profile page
    1
    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.
    You took the words right out of my mouth. I also agree with what Brandon said.
    Sun0408 likes this.
  14. Visit  BrandonLPN profile page
    0
    One question. Doesn't the actual consult to a hospice provider have to be an official order from the physician?
  15. Visit  artsmom profile page
    0
    Yes it needs to be an order, but a T.O. is okay.


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