Out of Scope of Practice?

Specialties Geriatric

Updated:   Published

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 beyond 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!!

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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?

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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.

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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.

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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.

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BrandonLPN said:
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

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Specializes in Gerontology, Med surg, Home Health.

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.

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CapeCodMermaid said:
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!

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Specializes in Trauma Surgical ICU.

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.

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Specializes in LTC, Hospice, Case Management.
artsmom said:
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.

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\ said:
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.

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One question. Doesn't the actual consult to a hospice provider have to be an official order from the physician?

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