zygee

I'd be interested in the actual acuity of these patients. The one that was "on a diuretic", was this a high dose constant bumex drip? In any case the dosage wasn't high enough nor the patient critical enough to mention need for pressors that would actually make the patient ICU status. Peeing the bed simply isn't a reason to say "I can't fluff and tuck another patient immediately prior to shift change". Not that shift change admissions are convenient, but for the patient means much more comfort and care than can be afforded in an ER gurney. Complaining of being "tripled" with step down patients is honestly offensive and just lazy practice. Yes 6+ step down patients is too much, but not being able to handle three is just pansy sauce.

Also, there is a doctor who has some office staff member that thinks they can be given patient information and that they can give orders for that doctor. They will not tell you who they are or what (if any) credentials they have. They will not take call back information or give the phone to the doctor so nurses can discuss information with the doctor. When I said I will only speak with or take orders directly from the doctor they said "I do this every day with other nurses, what's the problem?" Basically I just want to do things right and to not do anything that might risk my license or my patient's health, safety, and well-being within my scope of knowledge and skill set if that makes sense. Not having a place to turn to regarding what I can do for patients without losing my license or having other issues seems ridiculous to me.

The specific issues I've listed came up in a staff huddle lead by the director of my floor during a JCAHO visit to our hospital. JCAHO had found a blood sugar value in the computer for a patient that did not have orders for blood sugar checks in the computer. The story went something like "the tech overheard the doctors talking about how the patient was diabetic and the patient complained they felt they had low blood sugar and so they checked the sugar". Another story the director gave as reported by JCAHO reps (apparently) was that a patient had somehow been transferred to a bed without admission orders and that patient had vitals taken and an admission documented etc. JCAHO said that's a no no.

Similar to BBP42'S comment the wide variation in what nurses consider to be inside or outside our scope of practice varies and I don't like that. For example, In initial orientation to my unit I was told that we cannot take "continue all home medication" orders which I understand to a point, but many nurses take the order. More recently there's apparently been an issue where nurses and aids are not allowed to perform blood sugar checks, ekg's, etc. not even vital sign checks without a doctors order in the computer. This seems ridiculous to me, especially when ACLS is expected required on my floor. I would think between my RN license and ACLS certification I would be able to do an EKG if I feel the need.

Is there a list of what skills, activities, etc. are within the RN scope of practice? Particularly within Florida? I've tried looking through the FBON resource page which includes the Florida Nurse Practice act. I found a "Help/FAQ" section which had the following question/answer: Q:What can I do to determine if a nursing task which includes procedures/treatments is within my scope of practice? A: Nurses have the option of filing a Petition for Declaratory Statement”.In many instances nursing duties and responsibilities are not specifically addressed in the Florida Nurse Practice Act (Chapter 464, FS), or the Rules of the Florida Board of Nursing (Title 64B9, Florida Administrative Codes) Declaratory statements are an agency's opinion as to the applicability of a statutory provision, or of any rule or order of the agency, as it applies to the petitioner's particular set of circumstances (s. 120.565, F.S.). This page is a listing of declaratory statements. Requests to file a Petition for Declaratory Statement” can be located by selecting the link below: Declaratory Statements | Florida Department of Health That makes it sound to me like there may not be any place that says what we can or can't do; but I'm hoping that's wrong and I'm just missing something obvious. Florida Board of Nursing >> Nursing FAQs - Licensing, Renewals & Information Florida Board of Nursing >> Links and Resources - Licensing, Renewals & Information