hospitalists clashing and nurses stuck in the middle

[gagirl1124]

I am a nurse in a small hospital with two hospitalists that rotate weekly. One is an MD, the other a DO. They clash all the time and the nurses get stuck in the middle. My current issue is with PCA pumps. One doctor writes orders for patients not to leave the floor while connected to PCA pumps. The other doctor says it's illegal to keep them on the floor and says we can't keep them from going downstairs "to smoke or to the vending machines." The problem is the area that this hospital is in has drug problems. Many patients that come in to our facility are known drug abusers. The nurses on the floor feel there is a liability issue here with letting them wander when they are connected to PCA pumps. If they are feeling good enough to wander, do they really need the PCA pump? Does anyone know of any legal websites I can use to resolve this issue?

[OB_RN]

You are responsible for your pt when you are assigned, no matter where they are. If they are down smoking, inject something interesting in thier IV, it interacts with thier PCA med, or potentiates it, and they die, whose fault do you think it is?

In my hospital, you may not go to smoke because our campus is smoke free. That does help with this issue. Before the ban, we used to allow postpartum pts to go in a w/c, accompanied by family, when the nurse deemed her condition safe to do so. If they had an IV, nope. So now we simply do not allow anyone to leave the floor. End of report.

[VICEDRN, BSN, RN]

Student here...

All of the hospitals I know of in this area don't let patients leave the floor with the PCA pump that includes to go to scanners or the OR. Anywhere. In those areas, the patients have to get their pain meds from the practitioners there.

[Dolce, RN]

I wouldn't let a patient wander with a PCA pump. Way too big of a risk in my opinion. If they are feeling well enough to go outside and smoke they are feeling well enough to come off the PCA.

[gagirl1124]

"If they are down smoking, inject something interesting in thier IV, it interacts with thier PCA med, or potentiates it, and they die, whose fault do you think it is?"

This is exactly the reason that we are trying to fight the issue. Our licenses are at risk when a patient goes off the floor without us. We have too mant addicts in our community and it's a bigger issue than this doctor wants to believe. I really want to find the legal documentation to back me up on this. I want to show it to the doctor here so that policy can be made.

[nursejohio, ASN, RN]

In my hospital, you may not go to smoke because our campus is smoke free. That does help with this issue. Before the ban, we used to allow postpartum pts to go in a w/c, accompanied by family, when the nurse deemed her condition safe to do so. If they had an IV, nope. So now we simply do not allow anyone to leave the floor. End of report.

How do you manage that? Our hospital went smoke free in July, but our patients still leave the floor. We educate them on the policy, but we aren't allowed to restrain them or anything. TPTB are discussing making a policy that if they want to leave the floor they have to sign out AMA and have their IV dc'd, but that hasn't come to fruition yet...

[indigo girl]

"If they are down smoking, inject something interesting in thier IV, it interacts with thier PCA med, or potentiates it, and they die, whose fault do you think it is?"

This is exactly the reason that we are trying to fight the issue. Our licenses are at risk when a patient goes off the floor without us. We have too mant addicts in our community and it's a bigger issue than this doctor wants to believe. I really want to find the legal documentation to back me up on this. I want to show it to the doctor here so that policy can be made.

Call your Risk Managers, and ask them about it.

[gagirl1124]

Just an update, I went to the DON and ADON and told them how the nurses felt. I told them we really wanted a policy to be made to protect us. They both agreed that would be something worth doing and will work on it. Thanks for the info and advice.

[Virgo_RN, BSN, RN]

We have a waiver that is basically a release of liability that he patient must sign if they want to go out to smoke. There must also be a doctor's order in the chart. Patients are not allowed to leave the floor with hospital equipment, such as PCAs, so if they want to go out to smoke, they need to be stable enough to not need IVF, IV meds, or PCA.

[diane227, LPN, RN]

You need to get administrative back up on this with a clear policy. We do not allow patients to go off the floor with a PCA. If they want to go off the floor we disconnect the PCA first. Your manager needs to set the standard and just tell these two how it is going to be. Let them know that they will no longer have a choice. The chief of staff needs to sit down and have a little come to Jesus meeting with them.

[XB9S, BSN, MSN, EdD, RN, APN]

We have policies in place that say patients are not allowed to leave the ward whilst attached to any IV medications, if they insist on doing so they are not complying with medical instructions and the IV is discontinued until they are prepared to comply.

If they are pain free enough to leave the ward area then PCA is taken down and they will be converted to alternative analgesia, if they are in pain enough to need a PCA they do not leave the ward.

[smcabee]

You cannot force someone to stay on the unit, you cannot force someone to remove their pca, you cannot force someone to have their iv removed. The best thing in this case is to have a policy in place. You then instruct the patient on the policy with another nurse or manager present and document, document and document some more. If they choose not to comply that is their issue and they would not have a leg to stand on if it went to court.