New to CM--question about scope


Hi, I'm new to CM nursing, and this may be a stupid question, but I'm hoping some of you can help clear this up for me. I work as a w/c Nurse Case Manager, and my Claims Adjuster (who sees herself as my supervisor) wants me to give out wrist splints when any office workers c/o anything that could remotely be suspicious of carpal tunnel (as an alternative to physician treatment). I'm not comfortable with this. Yes, I know these can be bought without a prescription, but I would assume if I'm providing them, I'm going to be responsible for f/u and any complications from these people wearing them incorrectly. And it's not like I'm working in a clinic with standing orders or anything. I'm just concerned about the ramifications of this. Am I over-reacting here? Thanks in advance for your help.


2 Posts

I've worked in CM for five years now in the managed care setting. While I don't do w/c specifically other nurses in the office do and I can tell you they would not recommend doing this. I would think it would fall under prescribing a treatment which is not within your scope of practice. I would also consider that if the symptoms worsened after they started using a splint you told them to use then you could be held liable.


45 Posts

Specializes in ER, Occupational.

Those were my exact concerns. Thanks for confirming that I'm not being unreasonable. My background is in ER and Occupational Nursing, and I've always had a Dr. that can give me orders or had standing orders signed off by a Dr. When I explained this to my "supervisor," she just gave me a blank look and then started telling me the people that held my job previously did it (as if that's going to make me any more likely do something I believe is wrong). She's not a nurse, and I'm not sure she'll ever truly understand why I object to doing this...wish me luck!!! And thanks again for backing me up!!!


60 Posts

Good luck. You are right about this. If the employee has carpal tunnel they need a doctor, and if they don't it's a waste of a splint. If the company considers a splint protective equipment for the job they have to write it into policy.

How about the employees take a half hour break when their wrist hurts? That would do more good.