He's a nurse, let's get him to do the IMs

[NurseDaddy2006]

I'm working for an organization that provides residential and clinical services to the mentally ill. I'm the RN on a clinical resource team. We provide educational interventions and support for consumers and program staff when incidents occur, and intervene before they occur in order to keep our consumers safe. I work along side two social workers and a psychologist. Our team leader is one of the social workers. We are overseen by a psychiatrist.

The organization's mental health clinics apparently do not have any nurses on staff, and the psychiatrists there are giving the IMs. The psychiatrist who over sees the CRT is now thinking it's appropriate to get me to do the IMs instead.

When I started I was told that my role here was for consulting, advising, educating, and that I could not even do a finger stick to measure blood glucose. No treatment on any of the 1600 mental health consumers. That's the job of the treatment teams they see, as I was told.

Now they want me to drive to all our sites so I can inject people who are patients at the clinics since they don't have a nurse? A few things come to mind:

• They're not my patients.
  
• I'm not supposed to be doing anything invasive, so I was told.
  
• The patients are being followed psychiatrically at the clinics, of which I'm not an employee.
  
• I'm an unknown to the consumer, as they are to me.
  
• I need to know who's going to monitor for side effects, not send people back out into the community and say see ya in two weeks for another risperdal consta.
  
• Who's got the medical info I need to know before I put a needle in someone?
  
• My gut tells me I won't be practicing safely if I do it.
  

Any thoughts? Thanks.

ND

[Music in My Heart]

If your employer's protocol does not permit you to do anything invasive then you need go no further: You simply cannot give injections while there in that capacity.

[CrunchRN, ADN, RN]

I would think you would need written orders by an MD for each client you would be giving the injection to just like any other time. It would be the MD's responsibility to make sure they were appropriate. I would also talk directly to my supervisor and clarify whether or not you should be doing anything invasive or not.

Seems the scheduling would be very difficult to coordinate......

[Music in My Heart]

Even with an order, unless his employer OK's it, he could be in trouble with them.

[CrunchRN, ADN, RN]

Kind of confusing though about who "thinks" they are his employer if he is being told by the teams he should do this and someone says nothing invasive. I would clarify that as I said in my previous post. Then if whoever is the ultimate supervisor says to do it I would want a written order on each and every clients chart........

[NurseDaddy2006]

Hi,

Thanks to those that replied. An update on the situation:

I called a nurse consultant that used to work with us here, and she agreed that what was being proposed (stepping outside my oversight position and injecting people) was unrealistic, inefficient use of my time, and probably not in the best interest of our consumers.

Thankfully I have a team leader that is willing to listen, and she took note of my concerns and spoke to the senior VP (the psychiatrist who thought the clinic's doctors should have to be the ones injecting their patients). During our weekly supervision meeting with the VP she said "thank you for bringing up your nursing concerns that you had {team leader} share with me. I hadn't thought of that. I'll meet with the other VPs and let you know when we figure out what we'll do".

That's where its at, for now. We'll see what more comes of it.

ND

[CrunchRN, ADN, RN]

Let us know!

[NurseDaddy2006]

So I came in this chilly monday morning to find an email from the senior VP to the clinic director, with a CC to me and my team leader saying "we've verified that our nurses are covered with malpractice insurance so I'd like Eric to go to the Bronx, review the chart, and give the Risperdal IM injection."

Not once did she ever address me personally in this and ask me if I would. So my position which has always stipulated that I can not provide treatment, not even a finger stick, has now become one where I can give an IM?

I guess I'm not given much choice in the matter.

I've voiced my concerns and opinion but nobody hears me.

[Tippy-ta-ta]

I would call the nursing board and ask them their opinion. just because they have malpractice insurance on their nurses does not mean that they have it on YOUR license. Their malpractice insurance covers them as the whole, not you as the individual. If something were to happen and the Clinic got sued, the malpractice insurance covers them for employing you, but it does not cover you as an individual if you were to be sued on an individual level.

I would very seriously consider calling your state nursing board and ask them what their opinion would be.

The clinic where I work is very similar in the same way. ( You sure you don't work where I do??)

We have 2 Psych APN's one is certified to see both adults and kids over 12. The other is only certified to see Adults 18 and over. The APN who is only suppose to see Adults had a 17 yo kid on her schedule. I asked her when she started seeing kids cause she had been there 6 yrs and had never seen a kid before. She said she did not think she was certified to see kids. So she went to HR dept to ask them about it and she was told by HR to "see the patient and we will figure it out later, if he's here you have to see him." Needless to say the kid left before seeing her because he was with his therapist and forgot about his appt. I told her to call the nursing board to make sure because you don't want to put your license at risk for them if they won't back you and ask you to do something you are not authorized to do or something beyond your scope of practice. Practice CYA effectively.

Good Luck to ya.

[NurseDaddy2006]

So tomorrow makes 2 weeks since I gave the IM. Nobody has said anything about it to me since. Then this morning, the clinic director sends me a reminder email saying the patient is due for her IM tomorrow.

Nobody ever told me this would be an ongoing thing. While I was at the clinic two weeks ago the doctor there asked me to inservice him on how to prepare the Risperdal Consta injection, so while I was making it ready, I went through it. He said he'd give the next one. So I responded back to the email saying the doctor had said he'd do it, but if need be I'd do it.

They got back to me saying they'd prefer if I came up there and went over it again with the doctor and see that everything goes well with the IM, and if so he'll do it until they come up with another solution.

Long and short of it, is I don't want to be the solution. Because that is not my role, she is not my patient, and my license is something I need to protect. I am here in a consultative position, and asking me to inject someone after they've told me I can't even check someone's blood glucose with a fingerstick just doesn't sit well.

[chevyv, BSN, RN]

How bizarre to have to go over the im with the doc. I have insurance to cover me that I purchased online. I just felft my employer would cover their own butts before mine. Also, some employers will throw anyone else under the bus besides themselves. Maybe think about checking out some insurance of your own. It's actually pretty cheap and gives me a bit of calm.

Perhaps you should point out the directions in the box of the risp consta :) It really is pretty straight forward. Hopefully, they at least keep it in the fridge. Although it's not a big deal, I wonder why they are okay with you doing this but not a finger stick? Seems like you have the ever changing roll. Yep, sounds like nursing to me.

[CrunchRN, ADN, RN]

I just do not get the problem

You are a nurse and it is within your scope to give injections.

There is a written order to give the injection by an MD.

The dose is within normal guidelines for that type of medication.

Your supervisors are saying they want you to do this despite the fact that your main tasks are not normally procedure oriented.

I get that it may not be in your original job description, but they always throw all that stuff under "and other duties......"

Hope it all worked out ok in the end.