Are these orders valid?

A colleague works as an RN in Home Health. They have a pt with complicated wound care and the ordering MD is 100 + miles away. She suggested to her supervisor that she attend an MD visit with the pt so she could be instructed on the wound care. The supervisor stated this would be a good idea so the RN went with the pt on his next MD visit and got new orders for wound care. On her return the supervisor stated that she was not going to be " paying for one of your shopping trips out of town" My colleague is not concerned about being paid for her time but rather if she was operating out of her scope of practice and wether the MD orders are valid since technically she wasn't wotking as she is not being paid. Please let me know your opinion.

I am not sure I understand your question. How or in what manner would the RN be working outside the scope of practice. When a physician writes new orders it is not necessary that an RN be on duty at the time nor being paid. Many orders are written by physicians while Nurses who will ultimately carry them out are off duty perhaps at home sleeping. Am I missing something here?

First of all, the supervisor should have defined the limits of being paid BEFORE this occurred. First she says it's a good idea, then it is a "little shopping trip?" That is pretty unprofessional of the supervisor.

As far as practicing, did she practice? Did SHE do the wound instruction? If so, she deserves to be paid, and as far as I am concerned her supervisor approved it!

As far as practicing outside the scope? No, I don't see a problem with that. Workers comp and auto case managers attend exams all the time, but they do no other hands on usually.

Taking an order while not on duty? no, not if the md signed it. We often give our reliable pt's a blank 487 with name and #'s filled out, so that the doc can just write the order right there at the visit and sign it. Keeps us from mailing and chasing docs down. And there is no nurse present then.

I have more of a problem with the supervisor. Frankly, as great of an idea as hers is, and believe me, we have all had patient's whom we think it would be great to accompany on visits and act as an advocate of for no other reason, in the present, this is not something Medicare or insurances reimburse for, so HH companies will not be paying for it. It would be fantastic if this could be the case, this would be true case management at it's best. But, I don't see it happening. Your friend needs to learn what her own limits are, or soon she will burn herself out. It is, at the present time, not her role as a HH case manager to attend md visits, so I don't think what she did was legally wrong, she could be in trouble with her employer. BUT, she shouldn't in this instance, because her ding-a-ling supervisor should have informed her of her boundaries, right up front.

Well said hoolahan.. I see nothing wrong with this scenerio except the supervisor is an idiot.

I like the idea of sending the 487 with the patient's. (thanks)

The nursing license is in effect at all times, not just when the nurse is being paid. What the nurse's duty was may change depending on whether he/she is "on the clock," but the nursing license is still valid.