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Disillusioned/Legal Concerns

Posted

Has 9 years experience.

I have come to find that most mental health facilities are primarily concerned with maximizing profits. Medicine is a business, I get that. My frustration with the psychiatric side of it revolves around the shady practices that coincide with admission and skirting responsible standards of care.

This seems to be a running theme in my state, however, I am especially concerned with my current facility. Other places I worked required a nurse to nurse and provider sign offs for admissions. We also didn't admit people who refused voluntary treatment. If they weren't petition-worthy (involuntary legal process) then they were free to go. IOW, lack of psychosis, delusions, obvious DTO/DTS concerns. You are basically telling someone that refuses consent to treatment that they are going to be admitted without any signatures approving the process. You need a petition for that.

Well, my current facility has been instructed to dismiss a nurse to nurse or even provider signature, provided a counselor (e.g., SW) says "its okay". The social worker's okay is the pressure from administration to bring in patients and fear of losing their job. Meanwhile, the nurses are being exposed to problems that they aren't equipped to deal with. We have no medical supplies, no medical services, nothing. So intake brings patients to the unit and dumps them with a myriad of issues we can't handle.

The real crux of the issue is that they have been admitting people who aren't voluntary. Active psychosis, delusions, ect... No signatures on paperwork to give consent. Those are involuntary patients and that requires a legal process.

I will leave with questions. What is required for acceptance from another hospital? I know a provider is needed for acceptance because I've had to do many nurse to nurses at other hospitals. Is a nurse to nurse required legally? If a medical facility sends out a referral for inpatient voluntary treatment and the intake coordinator (non-medical) social worker or even non-licensed worker reviews the packet, are they not obligated to have a medical staff review it? It's labs and medical data!

I am so frustrated with this job. :-/

Psychcns

Specializes in Psychiatric Nursing. Has 30 years experience.

Is there an admission policy? A provider needs to accept the admission and write the orders.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

TCASII:

There are Benefitting, Surveying, Accreditation, and Bulldog Agencies which put Responsibilities upon Facilities to meet Certain Standards.

They can be notified in the Event Provision of Care is Substandard.

Problem Situations need to be Resolved First Internally. Facilities should have Internal Regulation Devices, which are Required to provide Hotline Numbers to Employees, as a First Line Offense in a Complaint Process. These Complaint Hotlines should also be Confidential.

Good Luck to you, TASCII!

wingding

Has 4 years experience.

Still use alot of the advise, wisdom & warnings of my teachers ---- "Every nurse must decide what they are ok with & we try to teach good ethics --- so ask yourself, Is it ethical? Is it Legal? Is it worth your License? -- you may come to a time you will have to stand & speak up for what is right --- or maybe walk away. You can always get another job - but once your license is revoked, you will never be a nurse again."

I sure hope you hotline this --- sounds like you are working in a time bomb!

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

Use the Chain of Command also.

Objectively Document the Situation and Respectfully Submit the Documentation to your Superior, Requesting a Reply. If the Situation is not being Rectified in a Reasonable Amount of Time, Summit the Documentation to the Next Administrator, and so on.

Then, when Chain of Command is Exhausted, use the Hotline and/or Outside Resources.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

One Important Aspect of any Complaint Process is the Focus upon Patient Safety and Welfare.

We always need to Act as the Patient's Advocate and make our Complaint Process be an Endeavor to Improve Patient Care.

Whispera, MSN, RN

Specializes in psych, addictions, hospice, education.

Off topic: Davey, I love reading the content of what you write but the capitalization leads my brain to brake for impact along the way. I'd appreciate it bunches if you wouldn't capitalize so much!

TCASII, ADN

Has 9 years experience.

It sounds like I just need to get out. We've all had talks with the DON and they're losing people left and right. The CEO is only concerned with numbers/bodies. The fact that people have left and told them time and time again about their concerns shows that they don't care. Even the counselor are worried because the CEO is forcing them to accept patients without nursing oversight. It's a real train wreck of a job. Most psych facilities in this state are, but this one has crossed the line IMO. :-(

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

Off topic: Davey, I love reading the content of what you write but the capitalization leads my brain to brake for impact along the way.!

You're absolutely right, Whispera. I was going to save my A.A. Milne mode for off-topic entertainment purposes only.

Thanks for reminding me!

Again, good luck in your endeavors, TCASII!