janikc

They have the first CON written, so just a hold. I have tried for a while to find laws concerning this but to no avail.

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

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!

I was offered a job with a relocation bonus. It was on a psychiatric unit at a community hospital. This was in August. My agreement stated I had to stay for 2 years or I had to repay it. It is now December and they are closing my unit. They can't keep the census up enough to make it profitable to have open. So they have advised that all of our nurses and cnas can apply within the company and work in a different area. However, there aren't any more psych units within the company and I don't want to go back to med surg. My question is, if I decline to transfer within the company to another position, can they make me repay my relocation bonus? I would have never moved for it if it wasn't psych. I would think since they are technically eliminating my position, even if they say I can apply within the company, it should get me off the hook so I can apply somewhere else and stay in psych instead of having to work med-surg until my 2 years is up just to fufill my contract. I called HR and she danced around my question. She said, "we value all of the #### unit employees and would like for them to stay within the company". So I left it at that until I can learn more about this. Thanks ahead for any advice!