Is this considered neglect?

[lawp01]

Hello,

I’m a RN of 13 years, just starting graduate school for NP. Yesterday I was called into work to discuss a situation which occurred over the weekend. It involved a transfer of a resident and the therapy department not doing any therapy for three days, which resulted in non payment by Medicare for those days. In my nursing judgement the resident was not safe to transfer via pivot by therapy from bed to chair, as orders were for strict hip precautions. Therapy then did nothing with her after I instructed them she was to only be a lift transfer. My supervisors are now telling me I caused neglect, and I may lose my job, by not allowing her therapy, the only thing I wasn’t allowing was her to be transferred via pivot. I never stated not to do therapy and I’m confused how a pivot transfer is called therapy? I want to add that they have ran out other nurses who were advancing their degree. I did contact a lawyer who stated that if what I did was not contraindicated by my facility policy then it was not neglect. Thank you.

[mmc51264, BSN, MSN, RN]

I am an orthopedic nurse. Hip sx pts are not to be transferred via lift. I am not sure what your "strict hip precautions" are. If there is a no forward flex >90 degrees, def no lift. Most hip pts are safe to stand pivot to BSC or chair.

Nurses should be trained to transfer pts once PT has initially assessed them. On my unit, PT drives most cases: they determine whether they are safe to transfer and make the d/c recs, as well as equipment needed. Surgeons and NP/PA defer entirely to PT recs.

I am not sure if your situation is neglect, but losing Medicare funding is a big deal.

[JKL33]

I wouldn't have become involved in this other than to make sure everyone was aware that hip precautions were in effect. I'm sure the PTs are well aware of the expectations for hip precautions. Why would you think that a patient had to be a lift transfer for hip precautions?

Forget about the graduate school thing, worrying about whether they care about that is not a defense.

(IANAL): You may not have caused neglect in the common/lay sense, but you had a major role in something that amounts to your facility having neglected its duties to a patient by not providing the appropriate services it was specifically authorized to provide and bill for. I would argue that the PTs had this same role/responsibility in it as you did, tho.

2 hours ago, lawp01 said:

I did contact a lawyer who stated that if what I did was not contraindicated by my facility policy then it was not neglect.

Well, that just isn't the whole of it.

What is your employer proposing to do about this?

[Orion81RN]

An initial assessment is done by PT. I would think if a nurse told them what you did, then they would either 1) disregard what you said and continue with whatever plan they would come up with, or 2) speak with the doctor to advise further. That's how it was in my rehab facility anyway. PT worked very closely with the doctors. They assessed and then gave us the orders. Not the other way around. So if they didn't provide any therapy, then it should be on them (PT) at least as much if not more than on you. I mean, how does a physical therapist get away with, "Well, the nurse said..." When it is their job and area of expertise...I don't know. Keep us posted. I hope your work provides you with education and no further disciplinary action. Bc that's what it was. Lack of education/understanding on your part. The rest is on PT IMO.