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.
We have a standing order signed by a medical director who is not in the building. My clinic has a covering NP or PA for the day. We can call her with any questions and she will arrive to do an assessment if a patient states he/she has any symptoms (usually d/t anxiety).
As far as citing policies... in my experience, supervisors will dance around your questions and give you very vague answers. I once had someone say "this policy doesn't apply to your unit". Huh??? I'm not sure if this is just an outpatient behavior?
2BS Nurse, BSN
703 Posts
We have a standing order signed by a medical director who is not in the building. My clinic has a covering NP or PA for the day. We can call her with any questions and she will arrive to do an assessment if a patient states he/she has any symptoms (usually d/t anxiety).
As far as citing policies... in my experience, supervisors will dance around your questions and give you very vague answers. I once had someone say "this policy doesn't apply to your unit". Huh??? I'm not sure if this is just an outpatient behavior?