May need legal guidance

[mdrkan]

I am an RN and work in a large call center along with a couple of other RNs. Our role is in an administrative capacity r/t adverse event reporting-HIPAA privacy compliance-operating procedures. We were not hired to provide any type of nursing care to any member of the staff which is >250.

The problem is we are being called upon to respond to anyone in the facility that is having a potential health issue. I mean anything from can you check my head, I think I have lice -to - There's a guy/girl by the break room having chest pain, or so and so fell or fainted- can you go help.

Just to clarify-we are being asked by fellow employees and management to perform nursing duties.

We are concerned because we just don't know what potential liability this could place us in. If we don't respond or if we do respond we feel that we could potentially be in a litigious situation. How can we find out what exactly we can/can't do legally and keep our licenses intact?

My feeling is that if I were to witness a situation in which anyone anywhere needed my help I would be there and do all that i am trained to do. For lack of better words, I feel wierd inside when I consider the idea of saying to someone, "no I can't help". Then I think to myself well if they are not conscious I will help, but then I think how do you know where to really draw a line because maybe they were conscious when the messenger left them and then went in to a cardiac arrest and I didn't respond. Gosh I hope I am making sense. The crazy thing is that the staff will literally run for a nurse before calling 911 which is the corporate policy. Additionally we nurses have been advised by our HR Manager that we are not to respond period. Unfortunately the call floor management do not respect this rule. This week alone we had fire rescue transport 3 employees to the local ED.

Thanks in advance for any responses.

Sincerely,

Karen

[SFCardiacRN]

As a nurse, friends/family/co-workers are going to constantly be asking for advice. It comes with the territory. As long as you're not giving medical advice and referring them to their primary PRN, you should be OK. Just don't let it interfere with your duties or ask them to see you on break or after work. The "good Samaritan" law should protect you in emergencies.

[Nurse Ratched, RN]

Additionally we nurses have been advised by our HR Manager that we are not to respond period.

Unfortunately the call floor management do not respect this rule.

This problem needs to be resolved ASAP.

If that facility wants to operate and staff an occupational health center, fine. But you're being dragged into things that are outside your specified duties. Responding to an emeregency situation is one thing - you initiate 911 if no one else has had the good sense to, and perform the BLS we're all trained to. Otherwise, HR needs to reinforce that your team is NOT the company medical squad.

The first thing I quoted from your post means that if something goes wrong in the course of you providing care outside of your scope (other than emergency response as taught in any basic Red Cross or AHA course) the company will not back you up. HR needs to reinforce their directive with the floor managers, and your team must be gentle, but firm, in reiterating that you are not permitted under the scope of your practice and job, to provide medical care (except as previously noted.)

Good luck - this is a bit of corporate culture that's going to be difficult to shake.

[rnfullofbs]

karen

1. what does your job description read? i would follow it

2. do you have a risk manager you can talk to about this? that's their job--to identify risks and offer solutions

3. what does your policy say about where ill employees are to go for treatment? er? employee health? if so refer them there. same for visitors? is there a policy and if not, rally a group of folks to write one.

4. i believe under hipaa managers should not be disclosing confidential information to you about other employees. you don't have a treating relationship with them. can you quote hipaa?

5. next time someone comes with an emergency i would call 911. if your manager gets angry tell them you did the best you could under the circumstances and you didn't have time to consult with them. if you see your relationship with her goes sour because they feel you went over their head, i would evaluate whether you even want to work there anymore.

6. it sounds like yours is a close knit group? maybe others feel they can approach you with these issues because you are very friendly? i would set boundaries on the work relationship. intially it will take a lot of energy to establish those boundaries. however, i think you will expend less energy setting those boundaries than the energy you are wasting now by chasing your tail and having little to show for it.

i will share an incident i was involved in. i worked in employee health. it was the hospital's policy that employees had to go to their personal docs for treatment of illness and non-work related inujuries. employees would constantly come to my office and ask to be treated and tested for this or for that. i felt like a heel having to be the bad guy and send them away. i was consistent and treated everyone the same, no waivering on my position. an employee came to me one day with a sore throat. i told her she had to go to her doctor. explained why she was better off doing so. she was mad filed a complaint and complained to her colleagues. i used to walk down the hall of the hospital and feel like i was the most hated person there. anyway management backed me. when she went to her doctor she found out she had a tumor in her carotid artery. she had emergency surgery. from that point on, i was well respected and she apologized. my job from that point on was a piece of cake and i was able to get on with the job i was hired to perform. it would have been unfair of me to offer her substandard care. there was no way i could have determined she had a tumor in her carotid artery. i didn't have the right equipment or training to know what to tests to run. i also didn't have the authority as an rn to order the test needed to make a diagnosis and was not authorized to even make a diagnoses. in other words it would have been a disservice to offer her a "half ass" job-she deserved more. i may have felt better about myself not having to say no no no all the time but that would have been selfish and unprofessional.

in your down time, i would calmly think about each of these problems and use the nursing process adpie to solve them-i bet that by doing that in a systematic manner before these issue arise, you will have found a solution.

good luck

[mdrkan]

SFCardiacRN, Nurse Ratched, and rnfullofbs-

Thank you all so much for responding, everything that all of you shared I found to be of great value.

Sincerely,

Karen

Florida RN