legal nursing orders in the USA

PeakRN · Dec 17, 2018

This will vary from state to state in the USA.

In my state we have medical holds which are placed by an acute cognitive change that prevents the patient from making their own decisions (this can be drugs, alcohol, stroke, medical condition related delirium, and so on). These don't have formal time limits but if there are going to exist for an extended period of time (typically longer than a few days) we will seek out how to determine the best decision maker (be it family, the hospital, the state, and so on), often this involves going to the courts.

If a patient already has a legally appointed decision maker who isn't otherwise disqualified (for example is being motivated by secondary gain) then they would have decision making from the beginning. If for some reason we don't think that the decision maker is appropriate we can appeal to the courts.

If medically cleared psych patients can be placed on a 72 hour emergency psych hold. If they are still in an ED, CSU, or medical hospital 72 hour holds can be renewed while seeking further evaluation. If they are in a psychiatric hospital then they need to seek legal certification (same idea but a court needs to adjudicate that the patient is not competent to make their own decisions), we can seek these out in a medical hospital but it is very rare.

Medical holds can be placed by a licensed independent practitioner, essentially a nurse practitioner or physician. Emergency psychiatric holds can be placed by trained registered nurses, certain social workers, police officers, nurse practitioners, physicians, licensed practical counselors, and licensed masters or doctorate prepared psychologists. Medical or psychiatric holds can also be presumed by EMS and registered nurses, who must then either immediately transport to an appropriate receiving facility or contact a person who can then evaluate and could place the appropriate hold.

lesipsem · Dec 17, 2018

@peakRN

Thank you so much for the explanation, that makes it easier to understand!