Need Your Advice ASAP

[DallasRN]

Hello, All. I started to post this in Ambulatory Care/Clinic forum but seems there is very little traffic there and I need advice quickly - and especially from experienced/seasoned nurses. And if any RN, JD's want to chime in - please do!

I work part time (15-18 hours/week) in a clinic (of sorts) with one other RN. No physician, no physician oversight, no policies. Clients schedule appointments and we stay busy. It's a 501-c for seniors. Essentially, all we do is ear cleaning (warm water flush), toenail trims/files, and low cost lab work. We do not require physician order to draw labs. We also do the usual b/p checks, FSBS's. Now for my concern: Aside from continuously making my thoughts known on needing a physician medical advisor to at least be available for questions/review policies we might write, I have issues with blood draws especially. I consider it to be an invasive procedure. When we get results back from lab, the clerk mails them to the client and nurse doesn't always see them. I'm of the very strong opinion these results need to come to the nurse for review and if labs are abnormal, the nurse needs to contact the client and review/recommend client discuss with their PCP, make referral to a free clinic, etc. Obviously, nurse can't dx. However, if liver enzymes are elevated, I might discuss potential causes (alcohol intake), determine if client using acetaminophen excessively, etc., and again, recommend f/u with PCP. This contact/discussion needs to be documented in client chart. After 38 years of nursing, I can make fairly decent judgement calls.

Again, aside from the fact I constantly worry about my license, I also feel like I have an obligation to the clients. Please, please, please send your advice ASAP. I have a meeting Tuesday and as you might guess, I've met huge resistance. Then, too, maybe I'm wrong. Tell me that, too. Thanks!!

[azzgirlRN]

WOW!. I would be very cautious, I do think that some sort of physician oversight would be necessary when it comes to invasive procedures of any kind.

[Lorie Brown RN, MN, JD]

Trust your gut. I always say it is better to get another job because you cannot get another license. If your facility does not have policies and procedures, that is the place to start. If they don't have them, start a committee. That is your best defense if you were following them.