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Discussion

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.

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    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.

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    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!!!

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    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.

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