Need advice! Jeopardizing my license? Violation of hospital policy.

  1. 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 goes against hospital policy.

    Hospital policy states that an RN has the authority to initiate behavioral restraints if the patient is at risk of harming his/herself or others.

    The policy further states that a physician must assess the patient "face to face" within one hour of the restraints being applied and write an order.

    Here's where the problem comes in: our particular unit, despite being part of a large hospital system, contracts outside doctors who are not completely available all the time. They must be paged at night and frequently do not respond to pages. In many cases, even if a page is returned, the doctor would probably be unlikely to arrive to the unit within an hour.

    My nurse manager has instructed me that the physicians will not be coming in to conduct the face to face assessment and that a rotating schedule of nurse managers will come to conduct the assessment. I am not sure if this is outside of the scope of practice (or against the law) but it certainly is a direct violation of hospital policy. I'm worried about punitive action being taken against me if I bring this issue up with her again.

    I contacted the state board of nursing and they said to try to address the issue through my hospital standards group, but I'm concerned for what I should do in the meantime.

    Does anyone have any thoughts or advice on this topic??
  2. Visit talrico profile page

    About talrico

    Joined: Aug '10; Posts: 20; Likes: 8


  3. by   NicuGal
    They do need to take it to the standards committee at your hospital. If this is what they want and it is within the state boundaries, then they need to add it to the policy/procedure so that all involved are covered.

    Does everyone on the unit feel this is a bad idea...seems like it to me. You all need to band together and see what can be done. If no one comes in, is there a supervisor you can call or a house officer?
  4. by   talrico
    Part of the problem is that my boss, the Nurse Manager, has explained this is our unit's policy (even acknowledging that it contradicts broader hospital policy) and it was put forth by the director (the person above her). I'm not sure to what extent their licenses are actually on the line here though and I am afraid to rely on them to back me if I followed these instructs and something happened. It also isn't documented explicitly anywhere (though I got her to reiterate it in an e-mail response to me, so I have that at least).

    I suppose I'll talk to the other night shift nurses and see if they are concerned too.
  5. by   jahra
    Hopefully you have malpractice insurance yourself. Call your insurance,
    they have a legal department and describe the situation to them,
    ask them to advise you how to protect yourself while the
    administrators sort this out. Tell them you are concerned about
    patient safety under these circumstances and your role as this is sorted out.

    Its a catch 22---

    If you restrain and no one (MD ) shows up in an hour you could be held
    liable for assault..

    If you do not restrain and the patient hurts or kills himself, you are liable
    for not protecting him.

    So there is the question, what do they advise you to do ????...
  6. by   talrico
    I do NOT have my own malpractice insurance, but I've just applied for it through NSO (thanks for the recommendation). I should be approved by tomorrow, which is when I go back to work again, so I'll call them tomorrow and ask for their advice. I'm WAY too young and new to this to take these unnecessary risks.
  7. by   jahra
    Quote from talrico
    I do NOT have my own malpractice insurance, but I've just applied for it through NSO (thanks for the recommendation). I should be approved by tomorrow, which is when I go back to work again, so I'll call them tomorrow and ask for their advice. I'm WAY too young and new to this to take these unnecessary risks.
    They should not be putting you in this situation.Good for you, NSO is a good group.
    You are wise to seek counsel on this as if something happens you or your nursing colleagues will stand alone and management will not back you up...
  8. by   talrico
    I am inclined to agree. What worries me is how little it seems to concern them. They seem content to dismiss the issue simply because it hasn't actually been a problem up to this point. But again, I think it's probably because it does not pose a direct risk to their licenses, but ours.

    Maybe it's neurotic, but I feel compelled to be a little more proactive.
  9. by   jahra
    Quote from talrico

    I feel compelled to be a little more proactive.
    Sensible, and good insight. You also need to consider having your parachute ready to be
    able to bail out to another job if the management team continues to stall on this issue.
    It will be a matter of time before a patient needs restraint and the sooner they
    have a crystal clear policy the safer for the patient and the nurses..
  10. by   talrico
    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.
  11. by   jahra
    Sent you a pm, have some suggestions for you..
  12. by   talrico
    Do you have to have a special membership for a PM? Because I don't think I've gotten anything. But I just might not know how to access them.

    EDIT: figured it out.
    Last edit by talrico on Dec 1, '11
  13. by   sapphire18
    This is not legal- at least not in the 2 states that I've worked in. Our restraint forms specifically say that an MD needs to face-to-face assess the pt within 1 hour of being put in restraints, and every 4 hours after that (for behavioral restraints, not med-surg restraints).
  14. by   Creamsoda
    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.