Question About Vaccines

[CommunityRNBSN, BSN, RN]

I work in a very chaotic outpatient clinic (an FQHC) in which I generally have little faith that things are done in an ethical or correct way.  I know that sounds harsh, but I want to set the context properly. Just in case anyone is going to suggest "read your policies and procedures," they are essentially non-existent.  Nor can I really ask my nurse manager (or rather, I did ask her and she blew me off) which is why I'm turning to you.

My clinic owns several buildings on the same city block.  One of them is used exclusively for Covid vaccines.  As you can imagine, this used to be a very busy building but now pretty much sits empty.  They have a nurse assigned there all day (thanks, federal grant money), and whoever is assigned will only give like four or five shots in the entire day.  They also-- this is the important part-- have a provider assigned.  Usually, we spend the day taking care of administrative work, phone calls, etc., since there are so few patients. 

Today I arrived to find two patients waiting and no provider in sight.  I asked the front desk staff and they said "Well, when Dr. X is assigned, she never comes over." I called another nurse who said, "Yeah, I don't bother trying to track her down; when she's assigned to the vax clinic, she never comes over. I just give the shots anyway."

I made a stink, they called her, she came over, and I gave the shots.  Was that the correct thing to do?  The reason I'm hesitating is because if you go to CVS, you can get a Covid shot without a doctor present.  On the other hand, we don't have any standing orders or anything.  (Also, the clinic is billing for a provider visit, which is not really my problem.)

The doctor was next door (a five minute walk).  If a patient had gotten anaphylaxis after a shot, I obviously know how to use an Epipen and provide first-aid services.

Do I have a stick up my ***?  I'm just so aware that if a patient suddenly died, my administrators would tell the news that a rogue nurse was handing out shots without a doctor ordering them.

[Wuzzie]

You must follow your facility policy regardless of how other places function. That is the only safeguard for you if something happens. If your policy requires a provider then you need to have a provider. That's what they are paid for. If they don't like it have them change the policy. 

[Okami_CCRN, BSN, RN]

I agree completely with Wuzzie, you have to follow your policy and procedure; and you did the right thing by requesting that the assigned doctor (who is being paid) to be present for the vaccination.

 The reason why retail pharmacies can give the vaccine without a provider present is because the pharmacist has an emergency kit that they can use (and is within their scope of practice) while someone calls EMS. 

Also, what a lot of COVID vaccination sites do is utilize a local EMS company to stand by in the post vaccination waiting area to assist with any emergencies that may arise. 

 

[JBMmom, MSN, NP]

You did the right thing. It's not your fault if someone else doesn't want to do their job. If there had been an emergency it would have fallen directly on you, you did what was right. 

[CommunityRNBSN, BSN, RN]

Thanks everyone. Actually as I was typing it, I thought "Now that I see this written out, I think I was in the right." I'm glad to have your opinions in agreement. 

[UrbanHealthRN, BSN, RN]

4 hours ago, CommunityRNBSN said:

I'm just so aware that if a patient suddenly died, my administrators would tell the news that a rogue nurse was handing out shots without a doctor ordering them.

I work in a health center, too, and we usually have standing orders for vaccines so that nurses can give them without needing a specific doctor's order in the moment. I'm wondering if that's the case for the Covid vaccines you give, or if they need a doctor's order each time? I guess I'm just curious as to why your health center requires a doctor to be physically present while you give Covid vaccines. Regardless of the reason, if that's the policy then yes absolutely ask for that doctor to come over!

[CommunityRNBSN, BSN, RN]

4 hours ago, UrbanHealthRN said:

I work in a health center, too, and we usually have standing orders for vaccines so that nurses can give them without needing a specific doctor's order in the moment. I'm wondering if that's the case for the Covid vaccines you give, or if they need a doctor's order each time? I guess I'm just curious as to why your health center requires a doctor to be physically present while you give Covid vaccines. Regardless of the reason, if that's the policy then yes absolutely ask for that doctor to come over!

That would make sense, wouldn’t it, to have standing orders??  The answer is “because they want to bill Medicare for doctor’s visits.”  If we had something, ANYTHING, on paper saying that we could administer them, I’d be all for it. That’s what we do with flu shots. But they’ve run this Covid clinic with the doctors ordering every shot individually for a year now! 

[klone, MSN, RN]

Holy ***. That's crazy. There should be a standing order.

[UrbanHealthRN, BSN, RN]

Whoah....this sounds like it's bordering on fraud. If this is what your health center wants, though, then I'm right there with you- I'd make sure that doctor is on site for every patient visit or else I'd refuse to give the vaccines. God forbid the billing practices were ever called into question, and you couldn't verify that you had a doctor around. 

[RuralMOSchoolRN, ADN, RN]

Yeah, that sounds unethical--people shouldn't need a doctor's visit to get their vaccine.  I work at a local health department and we have a standing order to give each vaccine we offer by our medical director.  He's mostly retired now so we  (nurses) are the only ones at the office.  We also have standing orders and protocols for allergic reactions and practice this yearly (we have an anaphylaxis kit with epi, Benadryl, etc and a form with orders for escalating steps while the receptionist calls 911).  

For where you are and how things are run there, you did the right thing by requesting the physician be there.  It would be fraud if people were being charged and she never saw them.  

[NotFlo]

On 4/13/2022 at 10:41 AM, CommunityRNBSN said:

 

I work in an outpatient clinic. It's in our policy that a clinician is supposed to be onsite when vaccines are being given. It's pretty silly but if we have, for instance, a flu shot fair they come and sit in the back somewhere and do their inbox or whatever.

On 4/13/2022 at 2:56 PM, UrbanHealthRN said:

I work in a health center, too, and we usually have standing orders for vaccines so that nurses can give them without needing a specific doctor's order in the moment. I'm wondering if that's the case for the Covid vaccines you give, or if they need a doctor's order each time? I guess I'm just curious as to why your health center requires a doctor to be physically present while you give Covid vaccines. Regardless of the reason, if that's the policy then yes absolutely ask for that doctor to come over!

My clinic does have standing orders, they just have a policy that a clinician is supposed to be "on site". They usually don't do anything at all related to vaccines and people certainly are not billed for any kind of doctor's visit. 

[CommunityRNBSN, BSN, RN]

Thank you everyone, your replies have verified what I was already thinking.

I now work at the clinic as a per diem, and recently I'm primarily doing a non-Covid related, behavioral health project.  I think next time my boss asks me to do Covid shots, I'm going to tell her that it's way too sketchy for me to participate in.