Is this out of scope of practice?

[Maddyd]

I work in an outpatient facility w/ dept of mental health. Our clinical director feels that clinicians who work in our agency can authorize state beds for clients being admitted to their hospital. I disagree. I feel as the clinical director this is her role and not mine. I am a R N with an Outpt agency and feel I should not be authorizing input beds for ER. IS THIS OUT OF SCOPE OF PRACTICE?

[Davey Do]

Please forgive me, Maddy, but I'm experiencing some difficulty assimilating this situation:

Maddyd said:

Our clinical director feels that clinicians who work in our agency can authorize state beds for clients being admitted to their hospital.

"Authorize state beds"? Specifically, what does that mean?

In a nutshell, in Illinois, a potential psychiatric patient must be assessed and recommended by an treatment team consisting of a psychiatrist, nursing administrator, and therapist. Typically, the patient is recieving treatment in a community hospital and requires long term treatment that a community hospital cannot provide when this assessment and recommendation for admission to a state facility takes place. The state facilty must review the case and accept the patient if criteria is met.

Maddyd said:

I should not be authorizing input beds for ER.

In Illinois, a patient recommended for inpatient treatment must be assessed by an ERP and Therapist. Then, the patient must be accepted by an admitting psychiatrist.

Maddyd said:

IS THIS OUT OF SCOPE OF PRACTICE?

There should be documented process to follow, as in written policy and procedures guidelines. These policies and procedures are reviewed and accepted by surveying and benefitting agencies. These surveying and benefitting agencies have to adhere to state and federal laws. They make sure the agency providing services, such as the one you're referring to, are adhering to those laws.

I hope my post sheds some light on your situation. Good luck to you, Mandy!

Dave

[salvadordolly]

In some states, an RN can start the emergency detention (hold) process. But ultimately to be admitted, a psychiatrist has to agree with your assessment. I've never heard of RN's being able to "direct admit" to a psych hospital or ER.

[classicdame, MSN, EdD]

Scope of practice would be defined in your Nurse Practice Act, which may be available online. At the very least, you could consult with someone at the BON

[nurseprnRN, BSN, RN]

"Scope of practice" has a very specific definition as defined by your state BoN. It sounds to me as if yours is a job description (and maybe a state DMH regulation) issue.

As classicdame says, you can check out your scope of practice online, or get the ANA Scope and Standards of Practice at Amazon. For the job description or state reg issue, you must have access to those at your place of employment or contact the state agency with oversight.

[Meriwhen, ASN, BSN, MSN, RN]

salvadordolly said:

In some states, an RN can start the emergency detention (hold) process. But ultimately to be admitted, a psychiatrist has to agree with your assessment. I've never heard of RN's being able to "direct admit" to a psych hospital or ER.

Agreed. RNs can evaluate patients and make recommendations for admission/transfer to psych or other types of units, but it's the MD/primary care provider who has to order it.