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.
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.
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.
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."
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...
Specializes in Mental Health, Gerontology, Palliative.
What a load of bull
If your nursing judgement is telling you the patient needs more help than you can provide, you are well within your parameters to tell anyone to call 111.
Think about it, if a family member collapse in front of you and would you hesitate to tell someone to call 111 while you performed CPR.
Who ever told you that sounds like a the clinical manager who told my CNAs they would only be allowed to use two pairs of gloves in one 8 hr shift
As a long term care LPN, I have called 911 at the request of another nurse. Sometimes it was for an LPN, sometimes an RN. I have also requested another nurse to call 911 while I'm with a patient who needs emergent help. As far as I'm concerned, I don't care who calls, if it is an emergent situation the call needs to be made. I'd rather make the call and tell them to disregard if we stabilize the patient. I don't want to be the nurse who doesn't call when the patient did need emergent help.
This is almost definitely a $ issue. I worked at a LTC facility that wanted us to call the DON to get approval to send a patient out. They definitely wanted their beds full. Trouble is, you are the patient advocate, you have the education to make the decision and like another poster stated you are held to the prudent nursing judgment standards of care that all of us licensed nurses are - including an LPN. So if it was a situation that could not be handled at our facility and could result in imminent death, out they went and everyone was notified after. You have a duty to tell those providers that your urgent care is not able to provide appropriate care and your management can take a flying leap in my opinion. Ridiculous.
Oh btw, there are ads and commercials out there trying to educate the public as what situations call for the ER vs Urgent Care, because they want to cut down on unnecessary ER visits and make sure patients get appropriate care. Can’t imagine your doctors want to be bothered for common sense decisions either. Your employers are on another planet.
No BON is going to strip you of your license for having someone call 911 for a pt presenting with significant symptoms. You could, however, be held accountable for the poor soul with scary symptoms/vitals that has a bad outcome waiting to be assessed by a physician because YOU said to have them wait. Am calling BS and advising that you might wanna rethink working for people who don't get this.
LovingLife123
1,592 Posts
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.