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Is it outside the scope of practice for an RN to tell another RN to call 911?

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Guest688994 Guest688994 (Member)

Title says most of it, but here is some more detail:

I work in the urgent care department of an outpatient facility. We make up the rapid response team of the building, but sometimes clinics will call our department and tell us they're sending a patient rather than paging an overhead RRT.

Here's the question:

Is it appropriate and within scope of practice for us to tell another healthcare provider (such as LPN, physical therapy, occupational therapy, clinic RN, etc) to call 911?

I have done so before for patients I've seen as being in their best interest to skip the urgent care experience and go directly to an ER (for example, chest pain with SOB, BGLs >600, syncopal patients, etc). We were just told it's outside of our scope of practice to do so and all such calls should be referred to one of our physicians to decide if 911 should be called or if they should be brought to our department.

I checked my state's scope of practice and it mentions helping outside of course or place of work, such as accident scenes, but nothing about this kind of situation specifically.

Also, clinics can and are encouraged to call 911 in addition to RRTs. So there isn't a rule about clinics not calling 911.

For what it's worth, all of the nurses in our department are ACLS certified and start IVs, do EKGs, give meds, etc. as well. We transfer people to local ERs daily.

I just want to be the first to call BS.

Told by whom, and with what possible justification?

Complete and utter crapola.

PT has a cardiac arrest at your facility, and as you initiate ACLS protocols, you call 911. You don't wait for Dr Finnegan to get out of exam room 3 to have a look, do you?

There is no scope of practice for using a phone.

Now, management might have a case that it is best practice to have a doc see all stable PTs. What do your clinic docs want? I would be surprised that they would want to waste the time seeing PT's beyond the abilities of the clinic- it slows things down and increases their work load with no PT benefit.

1 hour ago, GoScubaRN said:

We were just told it's outside of our scope of practice to do so and all such calls should be referred to one of our physicians to decide if 911 should be called or if they should be brought to our department.

That is absolute malarkey.

As I'm sure you know, even lay people who find themselves in the area of an emergency are taught in formal classes to instruct bystander to "call 911 and bring the AED" (or similar).

This is *not* a scope of practice issue. It is a matter of your employer's policies for dealing with emergencies. If you are not an ED and your policy doesn't make allowance for calling 911 in an emergency without first taking some other convoluted steps to be directed by someone else to do it, I wouldn't work there.

But I probably wouldn't want to work where they claim it is outside of an RN's scope to call 911 to begin with.

Is their contention that 911 services are being summoned inappropriately? Kind of sounds like it.

Edited by JKL33

OyWithThePoodles, RN

Specializes in Med-surg, school nursing.. Has 10 years experience.

Maybe suggest a "standing order". Talk with the physicians and tell them the situation. Ask them if there are any pt's they would rather you have sent straight to the ED and if so, which ones. If they still want all pts to come to them, even though they are clearly in distress and the end result with be the ED anyway, well... to me all I see is $$$.

It very well could be that they got a complaint from a pt who was sent to the ED by a nurse over the phone, got to the ED, and the ED told them it could've been handled at the urgent care facility, so they are wanting the UC to eat the cost for an unnecessary ED visit.

56 minutes ago, hherrn said:

I just want to be the first to call BS.

Told by whom, and with what possible justification?

...

Now, management might have a case that it is best practice to have a doc see all stable PTs. What do your clinic docs want? I would be surprised that they would want to waste the time seeing PT's beyond the abilities of the clinic- it slows things down and increases their work load with no PT benefit.

Our nurse manager told us this. It sounds bogus to me but I would argue if the clinic is sending them to us to be seen for something like SOB, chest pain, low BGL, altered mental status, etc., then we can use our nursing judgment to avoid a delay in care and get them to an ER rather than play around in urgent care.

Oh and for the most part the providers trust our judgment. So I don't believe the providers are saying that they want all calls from clinics to decide if 911 should be called or not.

On 11/25/2019 at 11:08 AM, JKL33 said:

As I'm sure you know, even lay people who find themselves in the area of an emergency are taught in formal classes to instruct bystander to "call 911 and bring the AED" (or similar).

This is *not* a scope of practice issue. It is a matter of your employer's policies for dealing with emergencies. If you are not an ED and your policy doesn't make allowance for calling 911 in an emergency without first taking some other convoluted steps to be directed by someone else to do it, I wouldn't work there.

But I probably wouldn't want to work where they claim it is outside of an RN's scope to call 911 to begin with.

Is their contention that 911 services are being summoned inappropriately? Kind of sounds like it.

I agree, that's actually the first thing I brought up, is isn't part of ACLS protocol directing someone to call a code or call 911?

We are definitely not an ER, which is why I think it's more appropriate to refer patients out. And they are saying that urgent care nurses can't tell a nurse in podiatry or endocrinology to call 911, instead we have to transfer them to one of our docs who will make the decision.

I think there is a concern among management that we are "outsourcing" our sick patients to 911. But let me reiterate, we are an urgent care. Not an ER.

So what they are saying is, let a provider make the decision. Then they come to us with a critically high blood sugar, or BP, or something like that. Then they get to sit around in our department while we call an interfacility transfer. And they end up in the ER anyway but first they had to hang out with us for 1+ (more like 2+ usually) hours. It doesn't make sense to me.

nlkimmel, MSN, PhD, RN

Specializes in MSN-FNP-BC.

Hi, Thanks for a great question.

If I am understanding this question correctly, I would say, regardless who is standing beside you in a code situation, if you are the one doing compressions, you can and must certainly tell whomever is there to call 911.

Regards,

Nancy

kp2016

Has 20 years experience.

My guess would be some overzealous person in management wants to ensure that you "capture very possible patient". I have actually heard that exact phrase used before at an outpatient facility I worked out. Due to our lack of critical care support we had strict criteria as to our patient population. New manager wanted to personally review every single patient prior to them being referred elsewhere to ensure we didn't miss out on any possible patients. Too bad about the delay in care that caused.

Let's face it if I called your urgent care clinic from home and asked "if I should bring in family member X" for chest pain with SOB, altered neurological state or severe hypo/ hyperglycemia you would never say sure we are here 24/7. You would say call 911 immediately, X needs an ER.

I hope you get this resolved before this ridiculous delay in ER care causes a poor outcome.

Jedrnurse, BSN, RN

Specializes in school nurse. Has 28 years experience.

In a pinch, anyone can call 911 (hopefully not gratuitously, and I would think a unit secretary would yell for a nurse or a doctor before doing so). But it is not a "scope of practice" thing. The rationale they gave you is crapola.

On 11/25/2019 at 12:46 PM, kp2016 said:

My guess would be some overzealous person in management wants to ensure that you "capture very possible patient". I have actually heard that exact phrase used before at an outpatient facility I worked out. Due to our lack of critical care support we had strict criteria as to our patient population. New manager wanted to personally review every single patient prior to them being referred elsewhere to ensure we didn't miss out on any possible patients. Too bad about the delay in care that caused.

Let's face it if I called your urgent care clinic from home and asked "if I should bring in family member X" for chest pain with SOB, altered neurological state or severe hypo/ hyperglycemia you would never say sure we are here 24/7. You would say call 911 immediately, X needs an ER.

I hope you get this resolved before this ridiculous delay in ER care causes a poor outcome. 

I think this is exactly it to be honest. And if the patient who gets sent from a clinic has an adverse outcome, the first thing they will say is why didn't they call 911.

Home health nurses call 911.

Nursing home nurses call 911.

School nurses call 911

I am an ER nurse- if I have somebody I can't get out of a car, I call 911.

Your manager is FOS.

ivyleaf

Specializes in Ambulatory Case Management, Clinic, Psychiatry. Has 13 years experience.

Crappity crap crapola

Anyone can call 911.

There’s another reason they don’t want 911 called, but it’s not a scope of practice. Anyone can call 911. In simple BLS training, you are expected to tell someone to call 911.

If it’s a company policy that’s one thing, but apparently somebody is trying to scare you by telling you it’s a scope of practice thing. They are trying to scare you by thinking that calling 911 would affect you license. That’s so opposite of what we are taught.

I’d leave this company. Either somebody is a complete moron that runs things or they are using scare tactics. Neither of which I would want to be apart of.

On 11/25/2019 at 9:52 PM, LovingLife123 said:

There’s another reason they don’t want 911 called, but it’s not a scope of practice. Anyone can call 911. In simple BLS training, you are expected to tell someone to call 911.

If it’s a company policy that’s one thing, but apparently somebody is trying to scare you by telling you it’s a scope of practice thing. They are trying to scare you by thinking that calling 911 would affect you license. That’s so opposite of what we are taught.

I’d leave this company. Either somebody is a complete moron that runs things or they are using scare tactics. Neither of which I would want to be apart of.

If having a moron in admin was criteria for leaving a job, there would truly be a nursing shortage.

I'd be willing to bet that if your employer has this as a policy they have other equally absurd or dangerous policies in place. Consider carefully whether you want to continue to be in situations where doing the right thing is against company policy.

Closed Account 12345

Has 13 years experience.

Urgent Care isn't bound by EMTALA; not all patients need to be seen by a provider. Time is tissue, so even a "quick" 30 minute visit through UC could have serious negative consequences for MI and CVA patients because it delays appropriate treatment. Lay people can call 911 for concerns, so how could doing so possibly be out of the scope of practice for a reasonably prudent RN whose judgment indicates a need for emergency care and facilitates that on the patient's behalf? On the contrary, I think failure to refer some patients directly to the ER could land you in hot water. You didn't have to pass NCLEX to be able to call 911.

Any decent UC facility should have triage guidelines indicating which chief complaints are routed directly to the ER without passing go. Your medical director should have created triage guidelines. Triage guidelines can be distributed to clinics in your building so they know which referrals are appropriate and which you are unable to accept. As part of a RRT, you can still make yourself available until an ambulance arrives (if indicated).

Chest pain x 1 month that is reproducible on palpation, worse with certain muscle movements, and normal VS? Sure. Route to UC.

Acute chest pain with shortness of breath? To ER.

For lack of better sounding wisdom: this is dumb.

One other thing - Remember, company policies can require RNs to practice at a higher standard than their Board sets, but company policies can't LOWER the standard of practice for RNs. They can't say "It's ok. You don't need to respond as a reasonably prudent nurse would. Get Dr. Smith instead."

Edited by FacultyRN

As an LPN, I know I work under the guidance and supervision of a doctor or an RN. If an RN TELLS me to call 911, I'm calling. She or he can hash it out with their supervisor later if it was a mistake. In an emergency you do what needs doing. Gosh, if I'm ever in a bad way, I hope the care team knows what to do and. wastes no time in doing it. When the emergency has arrived, it's too late to be asking those kind of questions.

My 8 year old son knows how to call 911. I would hope than in an emergency he would feel comfortable either 1) calling 911 or 2) telling a friend to go call 911. I’m pretty sure he’s allowed to do so, with no medical credentials at all...