Ridiculous, overbearing restrictions on volunteers

ParkerBC,MSN,RN, PhD, RN · Dec 17, 2010

I can understand your frustrations. Let’s talk about the secretary that helped with the feeding. While it seems harmless, things can go wrong. Besides, it would give the nurse an opportunity to assess the patient’s ability to eat (are dentures loose, sores in the mouth, loss of muscle control on one side, ect…). An example would be an RN asking a Tech to pass medications to a patient. Regardless of whether or not the medications are the correct ones and being administered to the correct patient, the task is out of the Tech’s scope of practice. In that case, both should be terminated.

I am sorry to hear about the staff treating volunteers like crap. Do you suppose that perhaps the staff has had numerous of negative experiences with volunteers? Maybe the staff has been burned by volunteers in the past. While you may be different, the staff doesn’t know that. Keep being kind to everyone and offering help.

I think you pose good ideas as far as the hospital saving costs, but their hands are tied too. The majority of hospital protocols, policies and procedures mirror federal, state, and local laws and regulations of healthcare providers and facilities providing care. So, if you are not asked to do something you think is simple and harmless, don’t take it personally. I am sure the staff is simply following the regulations.

Good luck to you and I am happy to hear you are volunteering your time. Thank-you.

Axmann, RN, BSN, NREMT-B · Dec 17, 2010

An example would be an RN asking a Tech to pass medications to a patient. Regardless of whether or not the medications are the correct ones and being administered to the correct patient, the task is out of the Tech's scope of practice. In that case, both should be terminated.

I disagree. Also, you didn't specify what kind of tech. There are hundreds of different types. The point is, just because a task is out of someone's "scope of practice" doesn't always mean that they shouldn't be allowed to do it. If it's something that requires additional knowledge aside from common sense to perform correctly (like surgical procedures), then of course you wouldn't want someone untrained doing such a thing. However, if all you mean by "pass medications" is simply taking the pills from the nurse and handing them to the patient as instructed, why shouldn't someone be allowed to do such a task when all it requires is common sense?

llg, PhD, RN · Dec 17, 2010

... because there could be an unforeseen problem or issue at the time of administration. If the med is given by someone unqualified to assess the patient, make judgments about the appropriateness of the medication, and respond appropriately to any unforeseen circumstances surrounding the administration ... a disaster could happen. The patient would be harmed and everyone involved in allowing an "unapproved" person to give the med would be both legally and morally held accountable for failure to follow the appropriate saftey precautions.

Those restrictions exist to make sure that "nothing slips through the cracks" or gets overlooked by assuring that properly educated people perform tasks that involve sophisticated judgment or risk. If you want to be granted the responsibility for other people's safety and well-being, then get the education you need to be entrusted with that higher level of service.

What looks like "common sense" often requires much more knowledge, skill, and/or judgment to be safe than you apparently imagine.

sandi1743 · Dec 17, 2010

I disagree. Also, you didn't specify what kind of tech. There are hundreds of different types. The point is, just because a task is out of someone's "scope of practice" doesn't always mean that they shouldn't be allowed to do it. If it's something that requires additional knowledge aside from common sense to perform correctly (like surgical procedures), then of course you wouldn't want someone untrained doing such a thing. However, if all you mean by "pass medications" is simply taking the pills from the nurse and handing them to the patient as instructed, why shouldn't someone be allowed to do such a task when all it requires is common sense?

unfort - in a case like this - ParkerBeanCurd is correct. For the most part, medications that an RN is to dispense has to be dispensed by them or a very short list of approved people - kind of like a chain of custody. it may seem silly to you but to some people that could be brought up in a lawsuit if something else happens tot hat pt while in the hospital. The higher ups at hospitals are always checking their backs b/c people sue over some crazy things sometimes.

klhmc729 · Dec 17, 2010

"The point is, just because a task is out of someone's "scope of practice" doesn't always mean that they shouldn't be allowed to do it."

No, that's exactly what it means. Let's consider the med pass example: There is a physician's order for 10mg of BlahBlahBlah. The reason that a nurse has to carry out those orders is because they have had phamacology training. They know that BlahBlahBlah should only be given in 1mg doses, so the order should have actually said 1.0mg! The nurse just kept the patient from possibly a lethal-sized dose of the medication because there is a series of checks and balances.

I know it is really hard when you want to get all the experience that you can out of volunteering, and you want to help out the overworked nurses on the floor - those are great traits and will make you a terrific nurse in the future. But understand that the protocols have been studied and are based on evidence that shows what keeps patients the safest.

Saysfaa · Dec 17, 2010

Axemann,

Restricting what someone can do is the definition of "scope of practice", at least in the medical field. I'm not sure if the term has other meanings in other settings. I agree that all the rules slow things down but I think the medical field needs a higher degree of policies and procedures because it can take such a small mistake to make a disaster for someone.

I think it is just a tad unfair to equate being paid with not wanting to be there and with not wanting to help people.

I agree volunteers should be given respect. I'm less sure about the "just as much as ...paid staff" part. From my viewpoint, there is a certain amount of respect one gives simply because it is polite; additional respect is earned individually and is irrespective of one's role. It gets a little messier than that because equal amounts of respect look different given to a volunteer than to a doctor.

Music in My Heart · Dec 17, 2010

The point is, just because a task is out of someone's "scope of practice" doesn't always mean that they shouldn't be allowed to do it.

That's precisely what it means, otherwise the scope of practice is meaningless.

Perhaps 99.9% of the time, everything goes just as predicted. In those exceptional cases, however, it is the license (and the training that enabled it) that provides the experience, knowledge, and skill to recognize those cases, respond appropriately to them, and the accountability.

Using your example of feeding a patient... Did the secretary have the experience to assess the patient's swallowing ability? Did the secretary have the experience to know that aspiration is a risk? Did the secretary have the knowledge of how to respond in such an event? Was the secretary taking full responsibility for the patient?

And most importantly, how would anybody know?

The rules are not arbitrary; they exist both to safeguard patients and staff and to manage the hospital's liability risk as best as possible.

Axmann, RN, BSN, NREMT-B · Dec 18, 2010

Before I reply, I just want it to be known that while I may not agree with the rules, I always respect and follow them. That said, I do believe that there are many aspects of healthcare and society in general that could use reform, and I simply want to express (and receive input on) my ideas in an appropriate venue (which I believe this is).

both legally and morally held accountable

Morality is subjective, though.

One could easily make a case for allowing volunteers to have a wider scope of practice, and could also probably go a step further and make the case that not only is it beneficial to patient care to allow volunteers extended authority, but that there is a moral obligation to allow volunteers to perform a wider set of duties.

If you're interested in how I would go about making that case, feel free to request that I do.

circumstances surrounding the administration

Now hold on a second there. I never said we were talking about injections. That requires knowledge.

Handing patients pills, however, is not an action that requires any sort of specialized knowledge in order to be carried out effectively. Cutting out unnecessary "prerequisites" for the most inane tasks in health care could save a lot of time, money, and stress. Plus, I also think that the more time volunteers spend with patients, the happier patients are because they know they're there on their own time and have a true desire to help them.

We cannot completely deny the existence of those in healthcare who perform their duties solely for monetary gain. That would just be silly.

What looks like "common sense" often requires much more knowledge, skill, and/or judgment to be safe than you apparently imagine.

I have no doubt that most hospital volunteers possess this "common sense" if they had enough sense to get a volunteer job in the first place. Volunteers require background checks, interviews, and numerous other "vetting" processes. If they successfully make it through this vetting, by HR people no less (who tend to be paranoid and thorough, in my experience), then I don't see why their ability to perform routine tasks should come into question.

physician's order for 10mg of BlahBlahBlah. The reason that a nurse has to carry out those orders is because they have had phamacology training. They know that BlahBlahBlah should only be given in 1mg doses, so the order should have actually said 1.0mg!

I think we're talking about two different things. I'm not saying that volunteers should be able to do the job that nurses do. I'm not saying they should be able to take the order directly from the physician, get into the Pyxis, and then administer the medication to a patient without any clue what they're giving is.

I'm simply talking about nurses instructing volunteers exactly what to do, and then allowing a volunteer to do it, to save a nurse time. "Take these pills to the patient in 18, please. Also, make sure he drinks some orange juice with them" saves the nurse loads of time, and it is not the same thing as "Sure, Doctor. I'll administer this morphine drip right away."

A simple set of instructions shouldn't require so much oversight that it takes the nurse's time away and slows down the administration of care to other patients. And when it does, it negatively effects the state of the hospital and all its inhabitants overall. Unnecessary bureaucratic bloat amounts to general unwarranted paranoia, which itself could most likely lead to mistakes, wouldn't you agree?

I think it is just a tad unfair to equate being paid with not wanting to be there and with not wanting to help people.

Where did I do that? I believe no such thing, and I made no such connection between the two. Just because I believe that working without compensation indicates a high degree of passion, I did not mean to insinuate (nor do I believe) that getting paid in a healthcare position reflects a lack of passion. I'm sure that everyone here knows, however, that there are very few people who are willing to work for free. Volunteers can be treated like garbage sometimes, and I think working to help people and getting nothing in return is selfless and something to be admired. Again, this does not mean that I believe getting paid in a healthcare job isn't something worth being admired. I'm just saying that volunteers shouldn't be treated like bottom-rung garbage.

I'm less sure about the "just as much as ...paid staff" part.

Respect and authority are not the same. Are you saying that volunteers should not be respect as much as paid janitors?

Respect is defined as: "willingness to show consideration or appreciation."

Are you saying that because someone doesn't receive monetary compensation for their efforts, they should be shown less consideration and less appreciation? That sounds exactly like what you're saying to me.

Perhaps 99.9% of the time everything goes just as predicted.[/quote']
Hand sanitizer only gets rid of 99.9% of bacteria, but it's still an extremely important resource in healthcare, right?

chicagoing, ADN, RN · Dec 18, 2010

Now, while I understand that hospitals have a pecking order, and that usually, at least as I'd like to believe, that pecking order is usually more about protecting patients than protecting the hospital from a lawsuit, but I'm starting to think that things have become very over-bureaucratic and that this immensely slows things down on the floor.
I have heard stories of people getting fired for such small, menial things. I heard that a nurse and a secretary were both fired simply because the nurse asked the secretary for help, and she helped the nurse in in feeding a patient when the nurse asked her to.
Also, when it comes to staff interacting with volunteers, I have noticed many people treat them with unnecessary disrespect. I don't see anything "low" or "bottom rung" about people who would sacrifice their own time without any compensation to come in and give the unit an extra hand. On the contrary, people who give their time for free tend to have much more positive interactions when dealing with patients because they want to be there, they are not required to be there.
I truly believe that if hospitals gave volunteers the ability to perform a greater variety of services in the hospital setting, not only do I fully believe hospital costs would be greatly reduced, I also think that the number of lawsuits that hospitals face would see a general decrease. You would most likely see an increase in overall patient happiness/wellness. Many times I have seen patients become very close with volunteers and greatly enjoy their company.
A passion for helping others that goes beyond money and compensation, especially knowing all of the stress and anger people take out on them, is something (unfortunately) rare in health care. I consider it a blessing and I believe volunteers should, at the very least, be given just as much respect as a nurse, doctor, or any other paid staff member.

Hm...if my loved one were to die as a direct result of a nurse passing on "menial" duties, then I'd sue that hospital so fast they won't know what hit them.

It's better to be safe than sorry.

Axmann, RN, BSN, NREMT-B · Dec 18, 2010

I'd sue that hospital so fast they won't know what hit them.

You've essentially summed up my entire point I was trying to make. Do you really think that nurses are more likely to hand pills to a patient correctly than any other person with general common sense? I'm sorry, but I cannot bring myself to believe that such tasks require 2-hour courses (or 4-year programs, for that matter) to be performed correctly 99.9% of the time. I believe you'd see the exact same percentage (or less) of error if volunteers were allowed to perform duties which could take stress off of nurses (and decrease the likelihood that, in their stress, they make a mistake due to their mental status).

"I'd sue them in a heartbeat" is the kind of attitude which puts great doctors out of work, and puts patients on the street due to a lack of common-sense and bureaucratic reasonability.

anon695 · Dec 18, 2010

You obviously aren't a nurse or even a first-year nursing student, because you have no clue what nurses do or the implications of the professional duties they are responsible for. Your suggestions are beyond ridiculous, we have rules and regulations for a reason.