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janikc

janikc

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  1. Hello, My employer is an inpatient psychiatric unit and most of our patients come in under involuntary status. The acuity on our unit is fairly low so the "culture" here is to have them sign to voluntary status almost as soon as they come in the door. The state, however, has been pressuring the facility to initiate treatment faster on our uninsured patients. We don't have a provider on site 24/7. So the facility came up with the idea of the RNs doing a nursing assessment (which we do anyway) and reporting the findings to the on call provider and get a telephone order to sign the patient to voluntary status. Is this something that sounds ok to you guys? Is this being done anywhere else? I'm my experience a patient has to be evaluated face to face by a provider to determine decision making capacity before they are allowed to sign voluntary. We (the RNs I work with and myself) have contacted the BON here in TN and they told us they cannot comment on the legality or if this is within our scope of practice or not. But the facility is forcing us to do this after hours when a provider is not there and we all know we will be held accountable if something backfires. Thanks, Cristy
  2. Hey guys, For those who work in a psychiatric inpatient unit, have you ever heard of patients coming in on a CON and then the nurses assessing the patient and calling the provider for a telephone order to sign the patient to voluntary status? Without them being seen by a psychiatrist or NP? I have emailed the BON and they said they cannot comment on the legality of this and that it is acceptable for an RN to assess a patient and call a doctor for orders (well duh). They don't seem to understand that a CON is a legal document and I don't think it is within an RNs scope of practice to sign them over voluntary without psych eval. Sure, we are getting a telephone order to do so. But it's based off of an RN's assessment. Oh and this is just on uninsured patients. You know, the ones facilities get state funding for. Does this sound normal to anyone? If it does or if anyone else has heard of this please let me know, we are at a loss for what to do. Management is pushing it and the BON isn't backing us up. Thanks!
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