Am I wrong? Is this legal?

[bossfrog]

I have been a psych nurse for 6 years and did some traveling for a while. At my current job in Indiana (which is a permanent job, not travel), they have a practice that I'm not comfortable with and I can't seem to find anything definitive to confirm what I believe to be true even though I'm fairly certain I'm right. What they do here is on night shift, when a referral comes through, they expect the nurses to make the decision whether or not to admit a patient. If the criteria is clear (such as psychosis or suicide attempts) then they want us to get consents and give the referring agency the go-ahead to send the patient without calling the doc. None of the 5 psychiatric facilities prior to this one ever did this. Even when the criteria was clear, they ALWAYS called the doc for the decision to admit. Now the understanding here is that if it's a clear case, the doc will sign off on the admit orders. But the question I have is what if a patient gets admitted that the doc says he wouldn't have accepted? You can guess who would get the blame.

I have refused to do this, with the support of some peers and the scorn of others. RNs do NOT have admitting privileges to my knowledge and there can be no such thing as a standing order to admit non-specified patients. One of the unit secretaries actually wrote me up for refusing to make a unilateral decision on a patient! Am I way off base here? Is this common practice and this is simply the first time I've run across it? Most importantly, is it even legal? Should I report the write-up to the Nursing Board? Hell, should I report the hospital itself and start looking for a different place to work?

[elkpark]

As for being a "mom and pop" hospital, no. They're the largest privately owned, free-standing psych hospital in Indiana. So there is no ERP to write admitting orders here. It must be the psychiatrist.

I feel like this crap needs to be reported somewhere but I don't even know where, or even if I should. I don't want to hurt my staff that I work with.

I'm not trying to be argumentative, but, regardless of the size of the hospital, if you're telling me the wife of the attending psychiatrist is the owner of the hospital, that sounds like a "mom 'n pop" operation to me. I've never heard of such a thing.

I would not be willing to work under the conditions you describe. One of these days, something awful is going to happen there that will involve the lack of a proper, legitimate admissions process, and the higher-ups are going to go looking for someone other than themselves to blame. I would not be hanging around waiting for that to happen.

Best wishes!

[Crush]

[she's NOT a nurse, BTW. She's a CNA.]

She told me that administration was getting tired of some of us nurses refusing to bring in patients over night(without calling doc), so they approved for her to make the decision.

I told the secretary she has no legal right to make that decision. She said it was a change in their policy. I told her the law trumps policy.

Holy sheeminies. That is insane! Does the physician know his wife is doing this? I would think she is not only putting the facility at risk but also her husband's medical license as well as staff, etc. One day, something bad might happen and I sure would not want to be there for it. Good for you for sticking to the right way.

[cleback]

Yeah, that's one of the reasons I no longer work inpatient psych. Calling the admitting for admission orders at night. For some reason, we had a medical group covering who decidedly did not want to do anything psych related. This resulted in a lot of poor behavior... hanging up the phone, ordering 1:1 sitters for every suicidal patient, etc. And if you called the psychiatrist, they tear you a new one...

Anywho, a death occurred on said psych unit. People (nurses, ancillary staff) were fires or quit... I had quit.

Anyway, I don't have any success stories but will just encourage you to CYA. Management will not side with nursing staff if something goes wrong, much less any regulatory agencies. If the physicians wife is willing to risk that, then there's not a whole lot you can do.

[RainMom]

Risk management may be interested in hearing there are pts being admitted by nurses & CNAs...

[Orion81RN]

Thanks Davey. But what are those appropriate outside agencies? And the write-up really just pissed me off more than anything. My DON said if I'm not comfortable bringing in a pt without talking to doc, that's fine. But the administrative people are the ones insisting we do this. They say the doctor's wife (she owns the hospital) complains when the doctor doesn't get enough sleep. So administration doesn't want him called. Either way, I'm sticking to my guns.

Oh dear lord, I'd get out of there ASAP. I'd work at McDonald's until finding a new job, that's how intolerable that would be to me.

[Nurse SMS, MSN, RN]

I agree, unfortunately. There are VERY few situations in which I would quit without notice and accept times will be tight until I find another job. This would absolutely fall in that category for me.

I am rooting for you and praying you get out before the poo hits the fan. It is coming, that much is certain.

[TriciaJ, RN]

Thanks Davey. But what are those appropriate outside agencies? And the write-up really just pissed me off more than anything. My DON said if I'm not comfortable bringing in a pt without talking to doc, that's fine. But the administrative people are the ones insisting we do this. They say the doctor's wife (she owns the hospital) complains when the doctor doesn't get enough sleep. So administration doesn't want him called. Either way, I'm sticking to my guns.

You're supposed to violate the Nurse Practice Act and practice medicine without a license so the doctor (who is most likely compensated for his call time) can get enough sleep? This is why nepotism is such a poor way to run anything.

Yes, complain to the BON, your state medical association, the hospital risk manager, if there is one. Drop a dime to JCAHO. This is the stupidest thing I ever heard of. Keep us posted.

[MelEpiRN]

This sounds like a concern for DHH. (Looks like they're called ISDH in your state). IN.gov

[Guest219794]

Thanks Davey. But what are those appropriate outside agencies? And the write-up really just pissed me off more than anything. My DON said if I'm not comfortable bringing in a pt without talking to doc, that's fine. But the administrative people are the ones insisting we do this. They say the doctor's wife (she owns the hospital) complains when the doctor doesn't get enough sleep. So administration doesn't want him called. Either way, I'm sticking to my guns.

I don't know if this nonsense is legal or not. An ER nurse can put in orders, including medication based on a nursing assessment and protocol. This includes, meds, fluids, EKG, CT, etc.......

So, maybe the same holds for admitting.

Should you report a bad and dangerous practice? Sure. But....

This is a bad place to work.

Reporting it will not make it a good place to work.

You have conflict with the core staff.

Reporting it will not resolve this conflict.

But, maybe other parts of the job make it worth keeping. Only you can make that call. It is just unrealistic to expect that anything you do, especially if you are in the minority, will improve this ridiculous place. The doctor's wife owns the hospital and wants him to get a good night's sleep?????? Good grief.

[Have Nurse, ADN, RN]

Secretaries do not dictate nursing practice. Call your board of Nursing and let them know what's going on. Stick to your guns. You have a license to protect. (Not sure why this reply posted here. It was in reply to the Psyche RN in Indiana.) Or maybe my system is acting up....LOL

(Looks like it fell into place.)

[Nascar nurse, ASN, RN]

I'm in Indiana, although not in psych. I've been in both hospice and LTC a long time & I know both places have Rules of Participation required by the state and federal government. Maybe a google search will help you find psych related ROPs? As for the poster in ER that is able to put in orders and such based on assessment - it's pretty safe to "assume" that these are the legal protocols outlined by your facility (ie: physician and legal authority approved). Maybe there is a way to make official protocols on this psych unit?

[GeminiNurse29]

Run like the wind!

I worked psych and whenever we got an admission at 3-4am and others were hesitant about waking the doc up, I'd remind them that the doc is making more than all of us combined to pick up his/her phone and give admissions orders. 9/10 we just suggested the orders and they mumbled their agreement on it, we got it down, and the orders would be signed the next day. But nowhere on earth would we ever accept admission unless a doc had authorized it.