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?

[yashalag]

I can't believe any doctor would allow it. We also have a nonsmoking policy at my hospital. We do not disconnect people and let them go outside to smoke across the street. It's a safety issue. Why would you allow that anymore than allowing them to hit the bar down the road and having a few drinks?

I believe you most certainly can force somebody to have their PCA disconnected if they leave the facility. It's a controlled substance. Why would you think it can't be disconnected? Medications get discontinued all the time. You can't force a doctor to continue a prescription, nor can you force a nurse to continue the administration of a drug that has been discontinued.

On a side note, I worked in Utilization Review for an insurance company for a while. If we read the notes and saw the patient was well enough to go off the premises and smoke cigarettes, we would deny the stay.

[suanna]

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......

I agree you cannot force someone against thier will to stay on the floor but if policy says no IV narcotics off the floor or unsupervised by a nurse then that is MY PCA pump and I'll disconect it if I need to in order to protect my licence and whoever the wanderer may want to share the meds with. If they insist on leaving the floor they are in actuality refusing PCA meds since PCAs can't leave the floor with them. I could be wrong but that is how I see it- A written policy would be a great idea.