Surrendering RN Scope!
- 2I have serious concern about how willing RNs are in the hospital to shrink their scope of practice and be relegated more and more to merely following MD orders. Case in point: our hospital recently created a policy that Ensure drinks required MD order. We're talking food! If that's not firmly still in the RN scope, then what is?? I understand the need for MDs to define parameters for intake, calories, etc. But deciding whether to use a particular drink to accomplish those parameters should be an RN-level decision.
What gets me is that so many coworkers were relieved that they didn't have to make the decision of whther or not to give a patient Ensure if they asked for it. They would much rather follow orders than to think critically about their patient's needs. They had no idea that this is actually a BAD step for nursing, not a good one.
There are many more examples. What do we need to do in hospitals to RECLAIM RN scope of practice?
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- 12Jul 12 by emtb2rnQuote from jegalinkYou need to have a list of orders that can be input under "nurse judgement". This requires putting a proposal into your nursing practice council & physician council. After they approve the list, it goes to informatics for coding, then education does their piece & away you go.If so, RNs should be able to give that order within the RN scope - without MD approval. This is not how its being implemented in my example. Again, there are many more examples out there.
You will need a champion for this. The best is the CNO. We did this years ago and add items as needed. Docs love it because they don't have to get a phone call at 0dark30 to order say a special mattress or an ensure.
- 4Jul 12 by RNperdiemI agree with the others. I think it is a billing and reimbursement issue. Hospitals are big these days on getting anything they can billed for and reimbursed. Doctors' orders provides a clear place to put in the Ensure order and I think the computerized software a lot of us use are geared toward looking to the orders for services/stuff to bill.
- 2Jul 13 by amoLuciaIn LTC, Ensure needs an MD order. And I do believe it's a cost thing.
Why not use house shakes? Regular and sugar free. We can just give them out. Kitchen can make them up for minimal cost.
Re your question of maximizing or minimizing our scope of practice - Would it result in better or worse compensation for our efforts.
I doubt we'd be better compensated. And you certainly wouldn't want to upset any apple carts that would cause some penny-pinching head honcho to cut cost corners by rationalizing us to be less paid.
And I see a fine line being crossed. Using Ensure as your example, why would I be giving it? Have I medically diagnosed some condition that requires supplementation so it could be reimbursed. Yes, any shopper can go to the local grocery and buy Ensure. But who is paying for it? I believe it come out of their private pockets.
For 6 - 8oz bottles regular Ensure, the usual cost is $7.99 at my local ShopRite. For 4 - 14oz bottles Ensure High Protein is usually $9.49.
(They WERE having a sale this week so there was another sale price.) I have no idea what it would cost the institution for bulk cost, but I know the facilities wouldn't be giving it away for free so there'd have to some way to bill it with a medical diagnosis.
You ask a good question though. Medical diagnosing we cannot do and reimbursement has to be considered. And with expanded practice, we should be better compensated for the increased responsibility but that's not likely to happen any time soon. And finally, we do have NPs and APRNs so where does that line differentiate?
- 1Jul 13 by TheCommuter Asst. AdminWhat do we need to do in hospitals to RECLAIM RN scope of practice?