Being pulled to medical

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I have been working psych for a little over 2 years. My supervisor has been allowing the house supervisor of this facility to pull from our psych teams to staff the medical side for which we are neither trained or oriented to. I have brought the concern up the chain of command to be told to do it, on SNU units and now critical care and that we are to act as "techs" and not RN's. I feel this is preposterous. It is my inclination should there be an emergent issue that I will be expected legally to act within my scope of practice. I live in IL and I am wondering if anyone can tell me about safe harbor, if it exists in IL and am I covered or is it up to facility policy. I do not want to injure someone or my career for that matter. Speedy response please.

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Specializes in Psych (25 years), Medical (15 years).

Welcome to AN.com Sissybee!

To my Understanding, in the State of Illinois, as RN's, we cannot be expected to perform any Skilled Duties for which we have not received Training and Orientation. Any acceptance of performing a Skilled Duty is, Ultimately, Our Responsibility.

In other words, if we're Comfortable with Skilled Invasive Procedures, such as Urinary Catheter Insertion, IM injections, IV's and the Like, we can perform these Tasks on the Psych Unit as well on the Medical Unit. However, if Monitoring a Patient, or Performing Duties that are outside of our Usual Scope of Practise, we may inform Supervising Entities of our Limitations.

This is a Slippy Slope Area. Once we Clock In to work, we are accepting the Assignment as Deemed by the Supervising Entities. If we Refuse the Assignment, our Refusal could be taken as Insubordination by Administrative Officials who are not Understanding of our Assets and Limitations.

Bottom LIne is, when I worked as a Supervisor for a Home Health Agency, no Nurse could be assigned to perform any Task for which they were not Trained and Oriented.

There was some sort of Legalities involved, but it's been so long ago, I fear I have forgotten the Specifics.

Hopefully, more In-Tune Members will Chime In and be able to give you More Information.

Good Luck to you, Sissybee!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Illinois has no safe harbor law. They have a staffing plan requirement that requires to hospital to post and have available staffing pattern at minimal levels.

FLoating a RN to do patient care and vitals is within your scope of safe practice outside your unit. Even under safe harbor you would not be able to use it. They aren't asking you to be a nurse they are asking you to do patient care. Something you are qualified to do just about anywhere.

It stinks but they are within their rules and regs...unless you have a union with a contract that states otherwise.

http://www.ihatoday.org/uploadDocs/1/nursestafflaws.pdf

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Specializes in Psych.

If we get pulled to the medical side ( Ive been pulled one time to Transitional Care, where I functioned as an CNA for the shift) we can do physical assessments, pass PO medications, hang IV's and any other skill that we use on our unit. So I wouldnt start an IV but I can maintain it ( well I could start it, but its not fair for the patient to be a practice arm). Usually we have staff pulled to us and they mostly pass the medications, some are trained to do our physical assessments and 1:1.

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Specializes in Behavioral Health.

I want to focus my career on Psych, but to keep up my nursing skills I work at a Long-term care facility through the week. This way I can practice on the senile. Most times they don't remember the pain I put them through by the time the next shift or a family member arrives. It helps me feel prepared if I'm ever forced to do what my superviser refers to as "real nurse" work.

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Specializes in Psych (25 years), Medical (15 years).
This way I can practice on the senile.

Mr. Rockstar-RN, if I didn't know you as a Capable, Competent, Caring, Comedic Caregiver, I would have taken this Statement with Some Reservations about your Morals, Ethics, Standards, Practices, and Ability to Provide Quality Care to the Patients you Serve.

Perhaps the Comedic Portion of your Positive Qualities could be better Utilized in the BreakRoom Side of AN.com?

You can get to there by Clicking on Breakroom on the Right Upper Quadrant of the Page.

Hope to see you in there.

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Specializes in Psych ICU, addictions.
FLoating a RN to do patient care and vitals is within your scope of safe practice outside your unit. Even under safe harbor you would not be able to use it. They aren't asking you to be a nurse they are asking you to do patient care. Something you are qualified to do just about anywhere.

I have to agree with Esme. To act as a tech is well within the nurse's scope of practice even for psych nurses. Vitals, bathing patients, changing linens, and assisting them with ADLs...that is stuff we all learned in Nursing 101. Should passing meds be involved, psych nurses are able to do that as well.

Depending on state law and facility policy, there may be a few things that techs do that you as a psych nurse may not feel competent doing--for example, the tech may be allowed to draw blood for labwork. In this case, you should let the medical supervisor that you are not qualified for this particular task. But to act as a tech...in general, psych nurses are more than qualified to do so.

However, I would make it clear to the medical supervisor that being a tech is all you should be doing, and that there needs to be a medical RN assigned to be responsible for the patient's nursing care. If they won't assign a medical RN but instead expect YOU to assume primary responsibility for the medical patient, then you should refuse the assignment.

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"Another thing to consider is that if there were a patient injury or death of a patient you were caring for as a patient-care tech or nursing assistant, and the allegations against you were that you were negligent in some way in the care of the patient, the standard of care that would be applied to you would be that of an RN and not of a patient-care tech or nursing assistant."

Quote from Nancy Brent, nurse and attorney from Illinois, at nurse.com on 1/12/11. Emphasis mine.

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Specializes in LTC, assisted living, med-surg, psych.
I want to focus my career on Psych, but to keep up my nursing skills I work at a Long-term care facility through the week. This way I can practice on the senile. Most times they don't remember the pain I put them through by the time the next shift or a family member arrives. It helps me feel prepared if I'm ever forced to do what my superviser refers to as "real nurse" work.

'Practice on the senile'??!

I do hope you're joking.

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Specializes in Behavioral Health.

Of course I'm joking. I feel the whole situation is ridiculous. One wouldn't want a Proctologist to repair a brain aneurysm. A psych nurse going into an ICU as a "tech" is no different. Why are nurses expected to cross disciplines without at least proper training in that area? If I go to an ICU and something goes south, even IF I'm acting as a tech, it's not only a failure to the Pt, but could be my home and a good deal of suffering for my children.

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