Need advice! Jeopardizing my license? Violation of hospital policy. - page 2
Hey folks, I'm a relatively new nurse (RN for almost a year) and I'm currently working in the psychiatric field. I recently became concerned because I've been asked to do something that explicitly... Read More
Dec 2, '11Quote from talricoThough young in the nursing field, you are wise, good job.Aha! We are of the same mind. I am looking to expand my skill set beyond psych. Unfortunately, you have to work a full year at my hospital (which is sort of the biggest game in town and my state) before switching units but I already have my license in NY (not my home state) and recently acquired one in SC (also not my home state) which is a compact state. I have submitted several new applications as of today, so hopefully something will blow back.
Dec 2, '11I could maybe believe that the law would allow a psychiatric APN to conduct the face-to-face, but certainly no one below the APN level...
Dec 2, '11Quote from CreamsodaThough reasonable, the policy actually states that a patient without a face to face assessment within an hour must be released from restraints. The trouble is really that we have no residents on call within the facility that we are allowed to call. Of course if this problem does arise, I will be calling absolutely everyone from the NM to the MD to the Nurse Supervisor of the hospital.What I would do is chart very explicitly why the MD is not able to come, that they are aware the patient is restrained but unable to come see the patient and that the order is to continue to restrain the patient. It is not your responsibility for the MD to do his Job. (but I can see why he would not come in for that, I mean really?) If he can't thats his prerogative. Its really out of your control. Just make sure the orders get signed when they do come in and write them as verbals. Also ensure the paper, EMR what have you is signed by the doc personally when he does come in. It would bbe far worse for the patient to hurt him self over a policy that is contradictory.
Dec 2, '11Nothing makes a malpractice attorney salivate more than evidence that hospital staff violated their own policy and procedure. If this happens, the institution might as well just write a check.
Policies and procedures exist as much to protect staff as patients. There is no excuse for having one on the books if it can't be met. If it is not feasible in your unit to have a patient examined by a physician within an hour of applying behavioral restraints, then the policy needs to be changed.
I'm not a psych nurse, so I don't claim to know what is reasonable. Perhaps the policy could be altered to allow an exam by an APN. Perhaps to permit hourly phone contact with a physician.
As a former nurse manager, with 24/7 accountability for the care in my unit, I would not have lasted a day knowing that there were policies on my books that could not be met by staff. It's time for a serious meeting with nursing leadership, medical leadership and risk management to hash out a policy that can and will be followed, especially given the potential for litigation in your practice setting.
In the meantime, either turf the issue to your supervisor or follow the darn policy as written, or I have a feeling you'll be left to defend yourself in the event of legal action by a patient or family member. Hospital leaders who are so ignorant as to brush off "unworkable" policies are probably not going to back you up in the event of litigation.Last edit by Jolie on Dec 2, '11
Dec 2, '11Quote from CreamsodaI don't think the OP can accurately chart what you have suggested. She stated that pages to the outside physicians are not always returned, so it is not accurate to state that the physician is aware of the restraints. She also doesn't know that the physician is "not able to come." Perhaps he simply chooses not to. It's not the nurse's job to explain in the chart why a physician is not present.What I would do is chart very explicitly why the MD is not able to come, that they are aware the patient is restrained but unable to come see the patient and that the order is to continue to restrain the patient. It is not your responsibility for the MD to do his Job. (but I can see why he would not come in for that, I mean really?) If he can't thats his prerogative. Its really out of your control. Just make sure the orders get signed when they do come in and write them as verbals. Also ensure the paper, EMR what have you is signed by the doc personally when he does come in. It would bbe far worse for the patient to hurt him self over a policy that is contradictory.
In any situation, regardless of specialty, any time a physician does not respond as needed to a nurse's request, the only viable option is for the nurse to go up the chain of command and thoroughly document doing so.
"Behavioral restraints applied due to patient attempting to punch and kick staff. Dr. So and So's answering service notified and immediate call back requested." After one hour, patient continues to to hit and kick at staff members. Second phone call to Dr. So and So remains unanswered. Nursing supervisor, Ms. Jones, called to unit for consultation. Restraints left in place per her instruction." or "Restraints removed per her instruction and patient left in the company of 1:1 attendant."
THEN GET THE SUPERVISOR TO SIGN THE NOTE WITH YOU!
Dec 2, '11I agree with Jolie. This is not safe. The pt needs to have appropriate medications to help with the agitation, and if not or if it is not enough, security needs to be called, but keeping a pt in behavioral restraints past that hour mark without a physician evaluating the pt is outside of the nursing scope of practice. If the facility is caring for that sort of pt population, then a physician needs to be available for these situations. They are opening themselves up for a world of legal problems; if somebody does actually complain, the facility will be found to have been blatantly in the wrong. Good luck, I hope for everyone's sake they can come up with a workable policy or a way to make the present policy work.
Dec 2, '11I don't know but at my work (psych hospital), certain RNs can do face-to-face for S&R. They have to be certified/qualified of some sort (most of the time it's the nurse managers or house supervisors). Physicians are always notified but from what I have seen, NO PHYSICIANS had ever come to do a face-to-face for S&R. Most of the time, we take patients out of S&R after half an hour or an hour anyway.
Dec 3, '11At many facilities I am familiar with the policy is that LIP's or "specially trained" RN's can complete the face-to-face. However, if the policy states that it has to be a MD, then it has to be a MD.