Does This Constitute a Nurse-Patient Relationship?

RNsRWe, ASN, RN · Mar 26, 2012

Taking this as an opinion (rather than deciding on the interpretation of your contract), it seems to me that the very job of nurse is as a patient advocate. And the patient is the one getting blood drawn, NOT the police agency.

The patient is the one who needs your advocacy and support, IMO.

rn/writer, RN · Mar 26, 2012

Interesting question. When I trained as a SANE (sexual assault nurse examiner), this same kind of scenario came up in regard to possible perpetrators who were brought in to have evidence collected for a suspect kit. After a lot of discussion between law enforcement and SANE higher-ups in the state, it was decided that when a suspect refused an exam, we SANE nurses would proceed only after a warrant had been obtained. The warrant made it lawful for us to act in spite of the patient's refusal and protected us from charges of battery, after the fact.

In such a situation, the nurse is obligated to use the same diligence, caution, and excellence of technique that she would with a more "sympathetic" patient. But her role as an advocate would be limited to, a) making sure that the necessary warrant was obtained, b) preventing officers from harassing the person or exploiting their vulnerability during the exam, and c) making it clear that threats or other improper remarks were not welcome and would be reported to the nurse's supervisor (who would then contact the officer's superior).

Because both of these forensic-related scenarios (obtaining evidence for DUI or running a kit for possible assault charges) require the nurses involved to avoid rendering any kind of judgment along the way, neutrality toward the subject is the correct way to express advocacy if there is no impropriety on the part of law enforcement. In the event that an officer behaves incorrectly, that advocacy then extends to making the charge nurse aware so that the subject is protected AND so that neither the evidence nor the collection process itself is compromised.

Music in My Heart · Mar 26, 2012

Taking this as an opinion (rather than deciding on the interpretation of your contract), it seems to me that the very job of nurse is as a patient advocate. And the patient is the one getting blood drawn, NOT the police agency.
The patient is the one who needs your advocacy and support, IMO.

Yes, that cuts to the heart of my question. I guess I'm not clear in my own mind that, in fact, the suspect having their blood drawn actually is a patient under these circumstances.

In trying to apply the nursing theory that seemed to make the sense to me (that the nurse's role is to do for the patient what they would do for themselves if they could...), I don't see that I'm performing a nursing function with the suspect. Rather, I'm simply performing a technical service for the state at the lawful request of its representatives. (If it's found to be an unlawful request, the evidence will be inadmissible.)

To both the suspect and the state, I owe a professional duty to perform the task with due skill and care, to observe and maintain the evidence chain of custody, and to provide truthful and accurate testimony of my actions.

This differs from the situation in which the suspect or prisoner is brought in for treatment or medical clearance. In that case, the person does become a patient and has the right to accept or refuse any treatment or care that we offer... that is, they maintain their autonomy as it pertains to my actions.

Music in My Heart · Mar 26, 2012

interesting question. when i trained as a sane (sexual assault nurse examiner), this same kind of scenario came up in regard to possible perpetrators who were brought in to have evidence collected for a suspect kit. after a lot of discussion between law enforcement and sane higher-ups in the state, it was decided that when a suspect refused an exam, we sane nurses would proceed only after a warrant had been obtained. the warrant made it lawful for us to act in spite of the patient's refusal and protected us from charges of battery after the fact. in our case, we do not need a warrant. california law provides for the collection of evidence, with or without consent, with an officer's request and statement that the person is a dui suspect. it is left to the court to determine whether the request was reasonable. the law specifically provides immunity from civil and criminal liability for our actions in such a case.
in such a situation, the nurse is obligated to use the same diligence, caution, and excellence of technique that she (or "he", in my case) would with a more "sympathetic" patient. but her role as an advocate would be limited to, a) making sure that the necessary warrant was obtained, b) preventing officers from harassing the person or exploiting their vulnerability during the exam, and c) making it clear that threats or other improper remarks were not welcome and would be reported to the nurse's supervisor. well stated. one other advocate's role is ensuring proper chain of custody. i did have a case in which the officer did not place the sample in the sealed evidence bag as is customary. in retrospect, i should have insisted (though the guy was clearly intoxicated).
i did have another case where i felt that the suspect was being unfairly targeted by the cops. he was very cooperative with me and i did make notes on the evidence sheet that i detected no odor of alcohol, no slurring of speech, no altered equilibrium, nor bloodshot eyes.
because both of these forensic-related scenarios (obtaining evidence for dui or running a kit for possible assault charges) require the nurses involved to avoid rendering any kind of judgment along the way, neutrality toward the subject is the correct way to express advocacy if there is no impropriety on the part of law enforcement. in the event that an officer behaves incorrectly, that advocacy then extends to making the charge nurse aware so that the subject is protected and so that neither the evidence nor the collection process itself is compromised. you've here addressed my reply to paragraph 2. i'm fortunate that nearly all of the cops that i deal with are professional in their actions and genuinely seem to want to avoid the dramatics.

.....

NoviceRN10 · Mar 27, 2012

I totally thought you were asking for the purpose of actually having a personal relationship with one of these patients after you had drawn their blood. I don't understand why you would think these people are not your patients if you are providing professional services to them?