I did not want to further comment on this issue but I felt that I can provide more insight and update. On Monday we discussed how we can improve patient care regarding this type of scenario with the nurse manager, NPs and nurses. If a pt is presenting for skin conditions (including tick bite, poison ivy/sumac etc) whoever is rooming the pt will provide a gown for them to put on.Ask pts whether they want to have their skin checked for other tick bites, so they don't just ask that in the middle of the exam and catch us off guard. Here is the deal, if NP is ready to see the pt at that point, she will just go in and do the whole exam, including skin check. But if NP is with another pt or running late, nurses will do the check and report any findings. No, nurses are not required remove and identify any ticks. All of our nurses have been living in this area for sometime and knowledgable about the ticks.Problem solved!
Somebody made a comment that I should learn how to order not request. Here is a little education on that -risking sounding "snooty" here, I know.
Orders go on pt's EMR with particular diagnose attached to them and you choose from pre-populated options. Then you sign the orders for nurses to complete in the office such as throat swabs, labs, ear irrigations etc. Tick check is not one of those orders. Therefore it was a verbal request because I don't bark orders to nurses, I request them to complete a task.
As a NP I am well aware that I don't make rules or policies as I go. I work for a big health care organization. On the other hand we can bring issues forward to discuss with management to provide better and safer pt care. Thank you again for your comments.