specific rules and regulations in ltc/snf

[leslie :-D]

I am in a heap of trouble. Anyway, does anyone know where a nurse can find some resources re: specific rules/regs that pertain to nurses and md orders.

I applied a heating pad to a resident and was written up for not obtaining an md order. I absolutely had no idea that nurses needed an order for this; I always thought it to be a supportive and therapeutic intervention. Where can I find info as to what nurses are allowed to do utilizing their nsg. judgement vs. what warrants an md order????????????? I am totally stunned. When I worked in acute care, you did not need orders for this. I live in Massachusetts, if that makes a difference. Thanks so much in advance.

[Rnltc]

WOW...then people wounder why no one wants to work LTC. I know that I have days I ask myself WHY? Did you get to see this blister? Was truly a burn blister or pressure? HAve you asked to see your employee file? You have a right to inspect your file. This way you know what they are putting in your file. What did the physician have to say? Yes we need order for EVERYTHING in LTC. Some days I am even afraid to wipe a running nose without an order.

Do not give up on this.....You need to talk with an attorney....you might have been wrongly discharge......DId the facility receive a citation from the state?

[leslie :-D]

WOW...then people wounder why no one wants to work LTC. I know that I have days I ask myself WHY? Did you get to see this blister? Was truly a burn blister or pressure? HAve you asked to see your employee file? You have a right to inspect your file. This way you know what they are putting in your file. What did the physician have to say? Yes we need order for EVERYTHING in LTC. Some days I am even afraid to wipe a running nose without an order.

Do not give up on this.....You need to talk with an attorney....you might have been wrongly discharge......DId the facility receive a citation from the state?

i have an attorney....a nurse attorney. the facility received some very serious deficiencies because of this. the don and nurse mgr. were also charged by the bon. i've received my personnel file and there were some things missing but i'll leave that to my lawyer to handle. there's really no way of determining if the blister was from burn or pressure. i absolutely have to say NOT burn since there wasn't any heat being emitted after i heated it!!! unless of course, someone reheated it on 11-7 and put it on me since i'm the one who documented applying this heat. the administrator and don have been playing very dirty but it certainly appears there has been retaliatory behaviors because of some whistle blowing i've done. i also did find out that there is no specific rule/reg re: heat application and dph usually bows to the facility's p&p manual. my lawyer seems to think that the charge from the bon will be dismissed against me. after working there 7 yrs. i've come to the very sad conclusion that no one is really your friend.

[renerian, BSN, RN]

Did you try your department of health website?

renerian

[leslie :-D]

Did you try your department of health website?

renerian

in terms of what?

[Town & Country]

unless of course, someone reheated it on 11-7 and put it on me since i'm the one who documented applying this heat.

Bingo! :angryfire

[snikodym]

You might go back to your state's nurse practice act. It will help to a point. What are you policies on such a procedure. Maybe it is something you need to change

I am in a heap of trouble. Anyway, does anyone know where a nurse can find some resources re: specific rules/regs that pertain to nurses and md orders.

I applied a heating pad to a resident and was written up for not obtaining an md order. I absolutely had no idea that nurses needed an order for this; I always thought it to be a supportive and therapeutic intervention. Where can I find info as to what nurses are allowed to do utilizing their nsg. judgement vs. what warrants an md order????????????? I am totally stunned. When I worked in acute care, you did not need orders for this. I live in Massachusetts, if that makes a difference. Thanks so much in advance.

[leslie :-D]

i've contacted my bon as well as the dept. of public health. there is nothing in the nurse practice act that addresses this specific policy. and up until this incident, there was absolutely nothing in our p&p manual regarding application of heat. i did receive a letter from the nurse practice coordinator from dph stating there are no specific guidelines re: this and they usually reference the facility's p&p. that's why my lawyer thinks the charge will be dismissed.

[snikodym]

Sounds like you took all the right steps. I think the next proactive step would be to write a P&P and present it for acceptance. In fact I am going to double check my policies as I don't think we have one either. Thanks

i've contacted my bon as well as the dept. of public health. there is nothing in the nurse practice act that addresses this specific policy. and up until this incident, there was absolutely nothing in our p&p manual regarding application of heat. i did receive a letter from the nurse practice coordinator from dph stating there are no specific guidelines re: this and they usually reference the facility's p&p. that's why my lawyer thinks the charge will be dismissed.