Community Mental Health Clinic Nurse

Published

Specializes in Community Mental Health.

Quick questions for all the psych nurses (LPN/LVN, RN, BSN or anyone else who wants to chime in :) )

I'm currently a LPN/LVN at a local community mental health clinic in Texas. Until about 2 weeks ago I would see patients in between doctors visits. The MD's does this because his schedule is 3+ months out due to his large case load. If it is someone who isn't stable then the MD's will just reschedule the person with them in 2-4 weeks. Both MD's wish the patients to see a nurse in between because anything can happen in 3 months. During the visit with me it is a focused assessment based on the current needs at that moment in time. Most patients might not be sleeping as well as they were, or feel like a medication isn't working was well as it was, and others simply just need refills until the next MD visit. If issues arise or refills are needed I would staff with the MD who would decide if anything needed to be changed based on what the patient informed me or MD's known history with the patient. That would then get relayed back to the client. If client had become unstable or needed a more in-depth assessment of the situation at hand the MD would come into my office and visit with the patient face to face. Either way I would take a verbal order for the new medications/refills and call them into the local pharmacy to fill. The MD would then sign off on the verbal order after my charting and documentation was done. Recently I've been told that it is out of my scope to do this and have had my job duties changed to just seeing patients who receive injections. Now the same assessment is done with said injection clients, however, the supervisor higher up said that these would be ok because they were stable patients due to injections. Which in of itself I could argue that they aren't which is why they are on injectionables to begin with but that is a side argument.

My question is in the above setting is this a unsafe and out of scope practice for a LPN/LVN? The assessment is focused. The data obtained is relayed to a MD who then interprets the data to determine interventions needed. Orders obtained verbally and relayed to patient then called into pharmacy. If client is unstable or further assessment is needed care is then taken over by MD directly.

I'm just confused why this is being done. I have searched high and low for something to point me into a unsafe or out of scope area. I don't want to work out of my scope by any means but I if I don't understand how it is out of my scope, if it is, then how can I possibly avoid this down the road? I've as the supervisor in question and I just keep getting told that it is out of my scope, that the patients are unstable etc. Which is not the case for our clinic. The RN on site even agrees that the patient disease processes are predictable in nature and she doesn't understand it either.

Thank you in advance!

I would check with your state board of nursing as it may differ among states.

As an inpatient psych nurse, I have to add that injections don't mean someone is unstable more than someone getting a med PO. Sometimes, patients prefer the injection because it lasts longer without having to remember daily pills.

Were you doing anything that could be construed as "education"? As far as I recall (and I've been a RN for 2.5 years), only RNs can educate patients. It is above the scope of a LPN/LVN to educate patients. Of course, that term could be used loosely and it may be different in your state.

Again, to be safe, I would check with your board of nursing and make sure there's a clear job description.

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