Sharing unorthodox treatments - Where to draw the line?

[radtechgirl]

Dear Fellow Nurses,

All during school we are taught to "think outside of the box". We are taught to use alternative approaches such as meditation or imagery for pain management. It is also engrained in us to respect, embrace, and enable our patient's religious, family, health, and ceremonial practices as much as possible. My question to you then is what is the liability involved in sharing and/or supporting these practices, and where do we draw the line?

As an example, I used to work with a physician who prescribed her patient's douche with anti-septic mouthwash to prevent and treat UTI's. Many patient's swore by this method, and I feel that it may have had some validity, but I would never share an idea like this with my patient's for fear of liability or retribution. Another example is the patient that wants my professional opinion on the mega doses of vitamin D-3 & K-2 that they are taking. I mean obviously I pull out the old R.D.A's. to cover my hide, and also refer them to their practitioner, but sometimes I would like to say more, but find I do not, because I do not want to offend my patient, upset my fellow staff, or risk liability or safety issues.

Readers, I ask that you please share some unorthodox treatments that you may have come across in your nursing career, and tell me how you chose to handle that situation, and what was your outcome?

Your input is greatly appreciated.

[Libby1987]

You have all kinds of liability in recommending any treatment/supplement outside of nursing practice, which just about everything. Everything you've mentioned except imagery to supplement pain mgmt requires a dr's order before you can discuss with your patient anything outside of general definitions.

[classicdame, MSN, EdD]

just don't make recommendations. That way you are safe.

[caliotter3]

When discussions go in that direction, I always refer my clients to their physician.

[radtechgirl]

Thank you all for your prompt and thoughtful replies. I figured it would be a liability issue, so that's exactly why I don't say more. I am glad to hear that this is the best approach. I think more so what I am seeking is input on the best way to support a practitioner's (your boss's) unorthodox treatment recommendations without creating a personal liability for myself? Also, another example is the practitioner that feels okay with dosing pediatric patient's with a hefty combination dose of Prozac and Adderall. How can I endorse my practitioner's choices if I myself do not feel they are safe, but still wish to keep my job?

[nurseprnRN, BSN, RN]

I disagree. There are plenty of times when a nursing-based intervention may be appropriate. It is perfectly within your scope of practice to discuss, for example, OTC meds in the context of, "What do you know about these, and do you use them, and how do they work for you?" Vinegar (mild acetic acid) has been used as an antiseptic for donkey's years and is cheaper and often more culturally acceptable than the Massengill product that's pretty much the same thing. You can always say, "I have had patients tell me they got good results with xyz," if you have and you know of your own education and experience that xyz wouldn't be harmful, and add, "and you might want to discuss this with Dr. X when you see her." You wouldn't (I hope) hesitate to recommend an OTC steroid cream for poison ivy or bug bites, or an OTC antifungal for a fungal otitis externa or under-the-pannus or -breasts, even if they're all marketed for jock itch or athlete's foot. You can recommend the evidence-based practice supported OTCs for acne, hair loss, skin care, sleep, teething pain, hemorrhoids and episiotomy pain, smoking cessation, RICE for simple sprains, and all sorts of health-related stuff.

As to megavitamin regimens, you have access to studies that tell you about the risks of, say, too much Vit A, the futility of chromium supplements in prostatic hypertrophy or B6 in cardiovascular disease, and many others. If you don't, you can find them and discuss them with patients. You're an educated professional.

You should take it as a compliment that your patients want to ask you. They know you know. How often do patients really ask their physicians these sorts of questions, and how often do they get thoughtful answers? Mmmm.

I have also seen home care nurses use honey-- and not overpriced "Medihoney," either-- for chronic wounds, as a nursing intervention without physician prescription (we don't take orders... lose that word).

As to non-substance interventions, it is within your scope of practice, if you have training and experience, to help a patient with visualization, relaxation, meditation, and other such things. You can recommend consultation with an acupuncturist or a physical therapist (yes, you can; they will see someone for a consult without insurance preapproval in most cases, and if it's to be on a self-pay basis, insurance doesn't enter into it at all).

[radtechgirl]

Thank you for sharing your view of things. One of our local practitioners off loads diabetic foot injuries by rubber cementing foam directly to the skin. He says he's done it for years with positive results. Also another example is good ol' Colace for dissolving earwax, or clove oil for those patient's in pain, but who cannot afford dental care. I also like to recommend MSM lotion to patient's for neuropathy. Anyhow my point is that some of these I am comfortable with, and some not, and I just don't know where to draw the line? Is it enough to utilize an evidence based support site, or would it still all be on me if called into question? Also do you find the practitioners are displeased with you facilitating these questions and directing such to them?

[nurseprnRN, BSN, RN]

Not at all, if you ask them coming from a place of "I want to learn about this" and not from an argumentative position. Then when you've been a nurse for twenty years and say, "Gee, that seems like a lot of medication for a kid, did he not do well on less?" you'll get a better sense of what's happening.

[caliotter3]

If I did not agree with my practitioner's decisions, and there were many of these instances, I think I would just look for another position. It would depend on just how stressed out I became over the dichotomy of viewpoints, and how difficult it would be to find my next job.

[Libby1987]

Educating patients regarding meds is different than recommending meds/supplements without dr's orders or discouraging against dr's orders. Legally I wouldn't take that chance and my employer would fire me.

Same with wound care, I would lose my job if I implemented wound care such honey treatment without dr's orders or whatever today's PC terminology. I often make wound care recommendations to dr's who appreciate and authorize my recommendations but I don't implement without authorization.

[radtechgirl]

Dear Libby1987,

I like your approach. It's simple enough, but I had never thought of obtaining the practitioner's approval for unorthodox procedures I would like to offer my patient. That makes for good teamwork, and it may also open up a two way communication so that I could discuss with said practitioner things that they suggest to their patient's for which I feel at odds.

[lovinglife2015]

How can I endorse my practitioner's choices if I myself do not feel they are safe, but still wish to keep my job?

Find a job in Alternative Medicine or Naturopathy. I prefer and use natural treatments myself, but you have to be very careful how you speak to patients and what you recommend. Best to avoid liability.