Am I putting my license in jeporady?

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Hello Nurse Beth,

I am an Employee Health RN. We do new hire health assessment appointments that include a bp screening. I recently had a new hire whose Bp was 179/103 hr 83, recheck was 173/109 hr 83. They have a history of HTN, and forgot to take their medication that day, asymptomatic. I educated them about HTN, recommended they take their bp meds as prescribed, speak with their Dr about their bp values and gave them a bp educational handout. Is this enough of a nursing intervention?

In an inpatient acute setting, with a bp that high, a nurse would be doing more interventions (medications, immediate follow up monitoring, notifying a provider, etc). I worry about putting my nursing license in jeopardy by not being able to do more of an intervention since we are in a small clinic setting, separate from the hospital. One could argue I did not do enough of an intervention for a person with borderline hypertensive crisis ( American heart association classifies hypertensive crisis as bp higher than 180/120). When I brought my concerns to my boss, he said it's just a bp screening like the dentist would do, if they were higher than 180/120 and/or symptomatic we would advocate for them to go to the Emergency department. I feel uncomfortable taking a bp and not being able to do any interventions that will bring the bp down. Is this a reasonable concern, should I have done more, should I request a change in bp screenings at my work?

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Specializes in Tele, ICU, Staff Development.

Dear Employee Health RN,

Understandably, you have concerns about the level of intervention you can provide as an Employee Health RN during BP screenings. While your primary responsibility is to conduct screenings and provide education, you must be comfortable with the scope of your practice and the protocols in place.

It's reasonable to request clarification on the expectations and protocols for managing high blood pressure readings or other abnormal vital signs in your setting. Ask for clear guidelines on what steps should be taken when a new hire presents with significantly elevated blood pressure, particularly if they have a history of hypertension.

If no policies or protocols are in place, you and the organization are not entirely protected. Risk management should be consulted for their input.

You could propose implementing a policy. This may include involving a healthcare provider for immediate follow-up or referring the individual to their primary care physician for further evaluation.

Ultimately, it's crucial to align your practice with your professional standards and ensure that you provide the best care possible within your role and the context of your work environment.

Best wishes,

Nurse Beth

 

 

 

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