Guest688994

I think this is exactly it to be honest. And if the patient who gets sent from a clinic has an adverse outcome, the first thing they will say is why didn't they call 911.

I agree, that's actually the first thing I brought up, is isn't part of ACLS protocol directing someone to call a code or call 911? We are definitely not an ER, which is why I think it's more appropriate to refer patients out. And they are saying that urgent care nurses can't tell a nurse in podiatry or endocrinology to call 911, instead we have to transfer them to one of our docs who will make the decision. I think there is a concern among management that we are "outsourcing" our sick patients to 911. But let me reiterate, we are an urgent care. Not an ER. So what they are saying is, let a provider make the decision. Then they come to us with a critically high blood sugar, or BP, or something like that. Then they get to sit around in our department while we call an interfacility transfer. And they end up in the ER anyway but first they had to hang out with us for 1+ (more like 2+ usually) hours. It doesn't make sense to me.

Our nurse manager told us this. It sounds bogus to me but I would argue if the clinic is sending them to us to be seen for something like SOB, chest pain, low BGL, altered mental status, etc., then we can use our nursing judgment to avoid a delay in care and get them to an ER rather than play around in urgent care. Oh and for the most part the providers trust our judgment. So I don't believe the providers are saying that they want all calls from clinics to decide if 911 should be called or not.

Title says most of it, but here is some more detail: I work in the urgent care department of an outpatient facility. We make up the rapid response team of the building, but sometimes clinics will call our department and tell us they're sending a patient rather than paging an overhead RRT. Here's the question: Is it appropriate and within scope of practice for us to tell another healthcare provider (such as LPN, physical therapy, occupational therapy, clinic RN, etc) to call 911? I have done so before for patients I've seen as being in their best interest to skip the urgent care experience and go directly to an ER (for example, chest pain with SOB, BGLs >600, syncopal patients, etc). We were just told it's outside of our scope of practice to do so and all such calls should be referred to one of our physicians to decide if 911 should be called or if they should be brought to our department. I checked my state's scope of practice and it mentions helping outside of course or place of work, such as accident scenes, but nothing about this kind of situation specifically. Also, clinics can and are encouraged to call 911 in addition to RRTs. So there isn't a rule about clinics not calling 911. For what it's worth, all of the nurses in our department are ACLS certified and start IVs, do EKGs, give meds, etc. as well. We transfer people to local ERs daily.

Hi! New to AN, long time lurker, first time poster. I recently had a patient who had an elective joint replacement. The patient used a Victoza pen at home which was unavailable to us the first night after her surgery, then her family brought it in. I spent some time getting the order straightened out (she said she took 18 mg), then brought it in with her evening meds. She said, I don't know how to do it, my husband always does it for me. Husband had left for the night at this point. Errrmkay. After some Googling with the charge nurse, we figured out how to attach the needles, dial up the right dose, and give it. You know... on the fly nurse's station training. We printed instructions, highlighted the relevant parts, and I went in to the patient and said, if you don't know, then let's learn! She got nervous and said oh no, I can't. After a few minutes of back and forth I said... well okay, today I'll show you then tomorrow night you can do it yourself. We went through it, she got the Victoza, verbalized understanding, no problem. Next night: I'm back, husband is there. As soon as I came in (hi! I'm GoScubaRN and I'll be your nurse again tonight) he was upset about the Victoza. Among other things he said: -I've been giving her shot for two years -She's not going to learn here, she'll learn at home -Don't force the issue SO! After I explained my rationale to him (which was, she had to get her Victoza, you weren't here, the patient didn't know how to do it, I didn't know how to do it, the charge nurse didn't know how to do it, and it would be beneficial for her to learn how to use it anyway, since it is her medication) he insisted on giving her the shot. It's not as though my feelings hurt, but I definitely felt railroaded. The patient, meanwhile, is in the background going, she (me) was only trying to help. Etc etc. So I'm wondering. The husband made me feel like a jerk, despite my explanations. I was trying to foster some independence here. I mean really, those pens are pretty easy to operate and it wasn't like it was sliding scale insulin or something like that - after doing it once I think I had a good grasp on it. He was just so forceful about it. My question to AN - was I right to drop it, or should I have been more pushy? I'm having conflicting thoughts about it.