Out of Scope of Practice?

echoRNC711, BSN · Oct 11, 2012

CapeCodMermaid said:
I don't where all y'all work, but where I've worked 99% of the time it's the NURSE who brings up hospice. We are the ones who know the resident and the family. It is NOT outside the scope of anyone's practice to advocate for the resident.

Absolutely!

Sparrowhawk · Oct 11, 2012

If you have enough time on your hands to worry about another nurse's job you have too much time on your hands. Sure go to the DON. Throw the day nurse under the bus, that's what we do.

On a less harsh note..... What everyone else said is completely correct. Also, never run to the boss about another nurse without talking to said nurse first....

ktwlpn, LPN · Oct 11, 2012

ladytopaz said:
Yesterday several family members came in to see their loved one stating that they had heard through other family members that they were now being seen by Hospice. To make a long story short, the day nurse had spoken with a family member and stated that the resident's organs were shutting down and that their only option was to talk to Hospice. Number one, isn't that considered diagnosing? And number two, isn't it also considered under the same, practicing beyone scope of practice, that you never mention Hospice to a family? A doctor makes that decision and the Hospice agency then does an eval, depending upon that they request a meeting with the family! I'm sorry, but this is way out of scope of practice for a nurse, especially an LPN. (sorry for that comment) Should I go to the DON with this? I'm afraid that if the family really wanted to pursue this, the LTC facility could be in big hot water!!

It is certainly within my "scope of practice" as an LPN to open up that dialogue.It is within my scope of practice to lay out every option available to any of the resident's in my care.I would not imply in any way what I think is appropriate.I always make it clear that is up to the family and they must consider their loved ones wishes Perhaps the physician had told the day nurse that the resident was failing.It's pretty easy to come to that conclusion when you are with these folks day after day and see the wt. loss and withdrawal.The families are aware of it too and are often waiting for someone to bring up the topic.

It is up to the resident and the family-NOT the doctor.In my facility we must obtain a physician's order for a consult with hospice and then we must write an order for hospice care if the res. meets the criteria and the family chooses that path. I have called the doc a few times for a request for a hospice consult which they believed was not appropriate but if it's what the s.o. and res. desire then we get the order.

How exactly is anyone "going to be in hot water?" If the s.o. did not agree with the nurse's assessment of the situation and called the doc themselves I could see the doc throwing the nurse under the bus (they always do that were I work).That's why I am very careful in my communications with families and visitors and have a witness whenever possible. I think you should talk directly to that nurse and then maybe your supervisor and social services.You need to know your protocol so you can be an effective advocate for your residents without worrying about "getting into hot water" You need to educate yourself. I often bring up end of life issues to families,sometimes I start that dialogue upon admission (especially on people with full code status and tons of co-morbidities)

Anna Flaxis, BSN, RN · Oct 11, 2012

Everyone else has already done a wonderful job of addressing your question. What concerns me beyond that is this when you said:

ladytopaz said:
To make a long story short, the day nurse had spoken with a family member and stated that the resident's organs were shutting down and that their only option was to talk to Hospice.

How do you know this is what the day nurse said to the family? Were you there? Were the family members who told you this there? Is this what the day nurse told you she said?

Unless you were there and heard with your own ears, you have no idea what was actually said, nor the tone in which the message was delivered. Be very wary of second (or third) hand information! The conversation could have been completely different from what you were led to believe.

I would hope that if you really had concerns, you would speak with the day nurse first and get her side of things before you go knocking on the DON's door.

I work in an outpatient, primarily patient education capacity. I am very careful about what I say and how I say it and I do frequent perception checks to make sure the patient is understanding me. Yet still, it sometimes amazes me what perceptions people walk away with. Sometimes things come back to me where the patient said to another nurse that I said X, when I remember very clearly that I said Y. In reality, the patient *heard* X when I said Y.

I've seen this in the inpatient environment as well, especially when you're hearing it second hand from the family members who weren't even there.

Any time a patient or family member reports something concerning regarding another staff member, of course you want to take them seriously and listen to what they have to say. But often, their perception (or misperception, as can sometimes be the case) is only part of the story. Best to get the other side of the story and keep in mind that the truth often lies somewhere in the middle. Don't be so quick to throw the other nurse under the bus.

Imagine if the shoe were on the other foot, and a patient said something involving you, and nobody bothered to get your side of the story before deciding you were guilty!

PMFB-RN, RN · Oct 11, 2012

If it happend the way you say it does the only thing she said she shouldn't have is the

"That their only option was to talk to Hospice"

Of course they have other options. There is no requirement they talk to Hospice. Other than that what she was just doing what nurses do. My advice is not to worry about injecting your opinion about her comments. I would certainly not go to the DON.

Of course she wasn't diagnosing. It's silly to even call it that. Never mention Hospice to a family!!! In my experience it is usually nurses who talk to the family about Hospice, organ donation, palliative care and lots of other issues. I assume, given your post, you are a brand new nurse. With experience you will realize that.

Talk about nurses eating their young....

KelRN215, BSN, RN · Oct 12, 2012

BrandonLPN said:
One question. Doesn't the actual consult to a hospice provider have to be an official order from the physician?

Everywhere I've worked, the consult to the hospice comes from the Case Manager. The hospice requires physician orders but very few physicians (other than oncologists in my experience) even know how to consult hospice.

To the OP, no it's not outside of the nurse's scope of practice. I have raised the question of hospice countless times with families. It's also not inappropriate to explain to a family that grandma's organs are shutting down. That's not diagnosing, that's sharing information.

DSkelton711 · Oct 12, 2012

Perfectly acceptable for the nurse to open dialogue about Hospice. Where I work we obtain a physician's order for hospice once we've discussed with the family their options and they give the okay. Our in-house physician is really good at recognizing need for hospice, but she also accepts our recommendations as well.