Published Sep 24
NurseyNurseNursey
20 Posts
Let me preface by saying I have extremely high anxiety (which is why I have never worked bedside), but I have somehow managed to spiral into a pit of anxiety even at my "soft life" job. I've gotten myself super worked up about potentially losing my license over this.
I am a Texas RN. I just started a new job in the realm of Quality Assurance. My main role is to ensure that certain charting/assessments is in place to meet specific accreditation standards.
The job is overall super simple. I am completing assessments in the patient charts that is basically to denote that are no red flags in terms of treatment, and that it is still appropriate for the patient to continue to receive the medication(s) safety wise and that there are no obvious barriers to treatment adherence.
The language in the standard assessment template explicitly states that I am not making treatment recommendations and continued treatment is at the discretion of the MD. It also explicitly states that is it a medical record review. I am not speaking to any patients. The assessment consists of these disclaimers and stating that I have reviewed the medication profile, diagnosis, adverse events, treatment adherence, comorbidities, and I do not see that there are any barriers to treatment/adherence. In the assessment I do denote specific adverse events, missed doses, etc., chronologically when I come across them in the chart. Sometimes there are not resolutions to these events in the chart, so in those cases it will just say something like "09/23/24-Nausea, 09/24/24-Diarrhea." I am only entering these assessments in the chart if there are not any obvious barriers to treatment. If there are any major issues then I escalate it to the appropriate provider or delay the assessment if there is a note that states follow-up will occur at a certain date.
My concern is that even with the explicit disclaimers someone could look at this at think that I am making treatment decisions and therefore working outside my scope. This position and these assessments exist outside the normal workflow and are specifically to meet accreditation standards. Am I doing something illegal and outside my scope here? I'm freaking out over this and starting to regret taking this job...
Okami_CCRN, BSN, RN
939 Posts
It sounds like you are working for an insurance company, typically nurses are utilized in the review process and prior authorization department. In these areas nurses are either reviewing treatment plans for members for quality tracking or auto-approving prior authorizations based on guidelines provided by the insurance. If there is ever a situation, where it is not clear the flow should be to escalate to the medical provider for review and determination. As a nurse you are not the one denying service, that would be outside your scope of practice. You can always review the Texas Nurse Practice Act for further clarification.
Okami_CCRN said: It sounds like you are working for an insurance company, typically nurses are utilized in the review process and prior authorization department. In these areas nurses are either reviewing treatment plans for members for quality tracking or auto-approving prior authorizations based on guidelines provided by the insurance. If there is ever a situation, where it is not clear the flow should be to escalate to the medical provider for review and determination. As a nurse you are not the one denying service, that would be outside your scope of practice. You can always review the Texas Nurse Practice Act for further clarification.
This is helpful info!
I work in a similar area to what you describe. I am actually completing these assessments for patients currently in ongoing treatment, based on available records/notes in their charts. The goal is to determine if continued treatment is appropriate at that timepoint given how the patient is doing and goals of care. So I denote that I have reviewed side effects, comorbidities, diagnosis, adherence to treatment, possible barriers to treatment, safety issues, and if there are no red flags then I submit the assessment to the patient chart. If there are major issues I escalate to a provider for their review.
I do explicitly state that I am not making treatment recommendations, and continued treatment is at the provider's discretion, but I'm worried that it still looks like I am making treatment recommendations? This would be outside my scope as an RN to make treatment recommendations I believe.
RNNPICU, BSN, RN
1,300 Posts
The role was created for an RN. I do not see how you are making treatment recommendations. You are not prescribing anything, As an RN you can make recommendations to a provider based on assessments, the provider ultimately makes the decision. RNs always are making recommendations, it is part of our assessment process. You chart what you see, hear, observe. etc/ You are not operating outside of your practice.
RNNPICU said: The role was created for an RN. I do not see how you are making treatment recommendations. You are not prescribing anything, As an RN you can make recommendations to a provider based on assessments, the provider ultimately makes the decision. RNs always are making recommendations, it is part of our assessment process. You chart what you see, hear, observe. etc/ You are not operating outside of your practice.
Thank you! I think I'm definitely overthinking this. Also, my role and my assessments exist outside the normal workflow so in theory no one should be using my assessments to make any changes to treatment or anything else. The assessments are specifically because a certain accreditation body requires that we document them at certain timepoints.
FolksBtrippin, BSN, RN
2,262 Posts
It's not outside your scope to make treatment recommendations. That's what RNs do, in all kinds of settings. We don't prescribe medicine, but we do ask for orders that we think are appropriate.
Jory, MSN, APRN, CNM
1,486 Posts
Nope...all you are doing is documenting. Employment records will show you work in quality and not bedside and never examined the patient. Yes, you are over-thinking it ❤️