Hospice Doctors

Listen to your "gut"..  Not only are you putting your nursing license at risk, but potentially putting the patient at risk.  I'm not in hospice, however, I have been considering it... so now, I wonder as well, is this "normal" in nursing for the Hospice industry?  If so, I'm not only concerned for the patients who deserve the best care, but would not work in hospice if this is the norm.

This definitely is not the norm.  Never heard of such a practice.  I worked many years as a hospice nurse.  We had an in house physician and a APRN.  

Bro. You are determining treatments and writing your own orders, plus a non-licensed person is signing the orders. No bueno for me if this is the expectations put on you. 

A good argument could be made that you are practicing medicine without a license. *** fast! That's what I would do. 

Barriss Offee said:

Bro. You are determining treatments and writing your own orders, plus a non-licensed person is signing the orders. No bueno for me if this is the expectations put on you. 

A good argument could be made that you are practicing medicine without a license. *** fast! That's what I would do. 

Yeah. Wonder if I should report this place and who I would report to. They are a little sketchy. 

Barbara Dilieto said:

This definitely is not the norm.  Never heard of such a practice.  I worked many years as a hospice nurse.  We had an in house physician and a APRN.  

 

Yes we technically have a nurse practitioner and an MD but we are not allowed to call either one, since they are too busy. I called our NP once for orders and I was chastised by my manager. 

Auscali said:

Listen to your "gut"..  Not only are you putting your nursing license at risk, but potentially putting the patient at risk.  I'm not in hospice, however, I have been considering it... so now, I wonder as well, is this "normal" in nursing for the Hospice industry?  If so, I'm not only concerned for the patients who deserve the best care, but would not work in hospice if this is the norm.

I'm not sure it's the norm to THIS level but yes I think it's more or less common. I wouod feel more comfortable if our standard orders included more than just admit to hospice and morphine and Ativan. More patients need a more complex pain/medication plan than just that and all my boss keeps saying is to Google orders and dosages and write them 

Yea, NO that is not acceptable.   Nurses do not have the authority to write orders.. period.  I would love to know which company this is so I can avoid it at all costs during my job search!!  

How do you have IDT collaborations? 

You are right to be concerned.  I would be leaving that hospice company.  CMS is almost always interested in hearing about companies not meeting the requirements.  

Juniper369 said:

Yes we technically have a nurse practitioner and an MD but we are not allowed to call either one, since they are too busy. I called our NP once for orders and I was chastised by my manager. 

I'm not sure it's the norm to THIS level but yes I think it's more or less common. I wouod feel more comfortable if our standard orders included more than just admit to hospice and morphine and Ativan. More patients need a more complex pain/medication plan than just that and all my boss keeps saying is to Google orders and dosages and write them 

Bro. Think about it. 

If you are working in a place where your providers and even your own nursing manager have made it so calling the provider is not allowed, AND you have to determine your own treatment plans and medication orders by using Google, in what world would this ever be considered "the norm"? I don't care if this is a trauma ICU or home health or even an outpatient primary care clinic, NO WAY I would do any of this as a nurse. *** what setting it is in. All of what you are describing is so out of the scope of a nurse. 

Who cares about the culture or standard practice of your employer or the setting you practice in? You need to stand up for yourself and say no when being tasked to do things that are not within your scope

 Period. 

Would you even do something like fill out a prescription for antibiotics for a kid with strep throat and determine the med and dose yourself before having the unlicensed SPOUSE of the doctor (same doctor you are NOT allowed to talk to!) sign the prescription to give to the patient? 

Speaking of the spouse, you have ZERO knowledge whether or the not the doctor is actually reviewing your orders you put in when the unlicensed spouse signs those orders. It is very likely the unlicensed spouse is using someone else's CS and DEA registration and prescribing credentials to sign those orders. That alone is so *** illegal like *** bro. damn DEA could come down on everyone involved and start passing out jail time and strikes against licenses like *** candy, yo!

Hell no, bruh!!

Did you not learn anything in nursing school about scope of practice?

And why would you be willing to work somewhere that the nursing manager and the doctors explicity prevent you from calling the doctor and explicitly demand you practice GROSSLY outside of your scope and training? 

Googling meds and treatment plans? Are you *** serious? Bro I would WALKED day 1 on that job and immediately reported the facility, nursing manager, and the doctors to the medical and nursing boards. IMMEDIATELY. NO WAY am I going to be complicit in those practices or be complicit in allowing those practices to continue. 

Lastly, if you care about anything at all, what about caring about your patient? Are the practices you are being tasked to do which are grossly outside of your training/education, are these the best, safest, most optimal treatments for that patient? Is this how you participate in minimizing risk of harm exposure for your patients? damn bro at least do what's right FOR YOUR PATIENTS for *** sake.

Juniper369 said:

Yeah. Wonder if I should report this place and who I would report to. They are a little sketchy. 

A little sketchy? "LITTLE"? 

I don't think that word means what you think it means. 

Barriss Offee said:

Bro. Think about it. 

If you are working in a place where your providers and even your own nursing manager have made it so calling the provider is not allowed, AND you have to determine your own treatment plans and medication orders by using Google, in what world would this ever be considered "the norm"? I don't care if this is a trauma ICU or home health or even an outpatient primary care clinic, NO WAY I would do any of this as a nurse. *** what setting it is in. All of what you are describing is so out of the scope of a nurse. 

Who cares about the culture or standard practice of your employer or the setting you practice in? You need to stand up for yourself and say no when being tasked to do things that are not within your scope

 Period. 

Would you even do something like fill out a prescription for antibiotics for a kid with strep throat and determine the med and dose yourself before having the unlicensed SPOUSE of the doctor (same doctor you are NOT allowed to talk to!) sign the prescription to give to the patient? 

Speaking of the spouse, you have ZERO knowledge whether or the not the doctor is actually reviewing your orders you put in when the unlicensed spouse signs those orders. It is very likely the unlicensed spouse is using someone else's CS and DEA registration and prescribing credentials to sign those orders. That alone is so *** illegal like *** bro. damn DEA could come down on everyone involved and start passing out jail time and strikes against licenses like *** candy, yo!

Hell no, bruh!!

Did you not learn anything in nursing school about scope of practice?

And why would you be willing to work somewhere that the nursing manager and the doctors explicity prevent you from calling the doctor and explicitly demand you practice GROSSLY outside of your scope and training? 

Googling meds and treatment plans? Are you *** serious? Bro I would WALKED day 1 on that job and immediately reported the facility, nursing manager, and the doctors to the medical and nursing boards. IMMEDIATELY. NO WAY am I going to be complicit in those practices or be complicit in allowing those practices to continue. 

Lastly, if you care about anything at all, what about caring about your patient? Are the practices you are being tasked to do which are grossly outside of your training/education, are these the best, safest, most optimal treatments for that patient? Is this how you participate in minimizing risk of harm exposure for your patients? damn bro at least do what's right FOR YOUR PATIENTS for *** sake.

Yes you are absolutely right. I put in my notice. 

Juniper369 said:

Yes you are absolutely right. I put in my notice. 

It's up to you about the notice.

Personally, if I had to choose between walking away now with an email stating my resignation is effective immediately versus doing a whole 2 week notice, I would absolutely minimize my risk of malpractice, patient harm, etc by just emailing my resignation as effective immediately and not showing up for the next 2 weeks (provided I am not working at this very moment and my next scheduled shift is coming up so as to avoid abandonement). If that employer ever gives me *** about it or tries to mess with  my reputation to future employers for not doing a whole 2 week notice, I would absolutely crush their *** in court. That would be such obvious retaliation against me for my refusal to continue to work in conditions that are grossly illegal and unsafe not just to myself but the patients. 

To me at least, it sounds like this employer and the nursing manager and the doctors don't fecking deserve the courtesy of a 2 week notice and nor would I be willing to risk myself in that environment for another 2 weeks.

Hell, there have been nurses who quit on the spot (before clocking in and accepting an assignment of course) because they knew the work ahead was riddled with unsafe practices and no resources which would more than likely result in patient harm and expose that nurse to malpractice. 

All I can say is if it was me, I would *** now. Now in the literal sense. I would absolutely not go anywhere near that place or those people for the rest of my career let alone during a 2 week notice. 

If I had to continue these grossly inappropriate, unsafe, illegal practices for the next two weeks as part of my "notice" in order to save face with the company, I would do as Elon Musk said: "I hope this is clear. ***."

What would I do? I'd leave before I lost my license, that's what I'd do.  There are things wrong here on so many levels.