Ridiculous, overbearing restrictions on volunteers

[Axmann, RN, BSN, NREMT-B]

Now, while I understand that hospitals have a pecking order, and that usually, at least as I'd like to believe, that pecking order is usually more about protecting patients than protecting the hospital from a lawsuit, but I'm starting to think that things have become very over-bureaucratic and that this immensely slows things down on the floor.

I have heard stories of people getting fired for such small, menial things. I heard that a nurse and a secretary were both fired simply because the nurse asked the secretary for help, and she helped the nurse in in feeding a patient when the nurse asked her to.

Also, when it comes to staff interacting with volunteers, I have noticed many people treat them with unnecessary disrespect. I don't see anything "low" or "bottom rung" about people who would sacrifice their own time without any compensation to come in and give the unit an extra hand. On the contrary, people who give their time for free tend to have much more positive interactions when dealing with patients because they want to be there, they are not required to be there.

I truly believe that if hospitals gave volunteers the ability to perform a greater variety of services in the hospital setting, not only do I fully believe hospital costs would be greatly reduced, I also think that the number of lawsuits that hospitals face would see a general decrease. You would most likely see an increase in overall patient happiness/wellness. Many times I have seen patients become very close with volunteers and greatly enjoy their company.

A passion for helping others that goes beyond money and compensation, especially knowing all of the stress and anger people take out on them, is something (unfortunately) rare in health care. I consider it a blessing and I believe volunteers should, at the very least, be given just as much respect as a nurse, doctor, or any other paid staff member.

[CuriousMe]

You've essentially summed up my entire point I was trying to make. Do you really think that nurses are more likely to hand pills to a patient correctly than any other person with general common sense? I'm sorry, but I cannot bring myself to believe that such tasks require 2-hour courses (or 4-year programs, for that matter) to be performed correctly 99.9% of the time. I believe you'd see the exact same percentage (or less) of error if volunteers were allowed to perform duties which could take stress off of nurses (and decrease the likelihood that, in their stress, they make a mistake due to their mental status).

"I'd sue them in a heartbeat" is the kind of attitude which puts great doctors out of work, and puts patients on the street due to a lack of common-sense and bureaucratic reasonability.

Hmmm...I'm not sure that you understand what nurses are required to know before they're allowed to give meds.

Before I give any drug, I'm required to know, the name of the drug, how it works ( ie what receptors it's targeting, and what the effect on the body will be), why the patient is receiving it (I may also need to document if it relieved those symptoms), any possible drug interactions that drug may have, any anticipated side effects as well as the safe dosage range.

That is just the information I need about the drug, I then need information about the patient, like do they have allergies? What is their current status? To find that out, I need to do an assessment on my patient to ensure that nothing has changed and they A) still need the medicine, and B) it's safe to give them the medicine (ie is their heart rate to slow to give them one of their blood pressure meds because--since I understand how it works---I know it also slows down the heart rate?).

This is all before I do the 5 (7, or 9 depending who taught you) Rights of medication administration.

I need to know all this information, because not knowing it could endanger the patient.

So, as you can see, it really isn't about just passing out pills.

[JenniferSews]

I'm simply talking about nurses instructing volunteers exactly what to do, and then allowing a volunteer to do it, to save a nurse time. "Take these pills to the patient in 18, please. Also, make sure he drinks some orange juice with them" saves the nurse loads of time, and it is not the same thing as "Sure, Doctor. I'll administer this morphine drip right away."

A simple set of instructions shouldn't require so much oversight that it takes the nurse's time away and slows down the administration of care to other patients. And when it does, it negatively effects the state of the hospital and all its inhabitants overall. Unnecessary bureaucratic bloat amounts to general unwarranted paranoia, which itself could most likely lead to mistakes, wouldn't you agree?

I agree with so many other posters, but I'm just going to respond to this one thing right now.

"Take these pills to patient 18" Means that the nurse is assuming legal responsibility that 1- the patient got the pills. 2- the pills were given at the moment that they should have been. 3- that the patient managed to swallow the pills without issue (are most volunteers CPR certified? Do you know what to do if a patient chokes? What would you do if the heimlich didn't work?) 4- the nurses is signing off that they have assessed that patient.

The literal meaning is that yes, they gave the patient their morphine and the patient swallowed it themselves. If the patient says they didn't actually get their morphine, the nurse can answer honestly that they saw the patient swallow it themselves. If they can't, there are some real problems with that system. What if the volunteer isn't honest? What if they did steal the morphine and that patient was really in pain and unmedicated? Who is losing here, the patient who had to wait a bit longer for pain meds from the nurse or nurse who managed to save a few minutes time by delegating to a person who wasn't trained, tested, monitored and accountable for those medications?

What if an untrained volunteer decides to give those medications after they take a break, or help someone else? They have no knowledge to know how critical that medication is or what the effects will be of delaying treatment. Who is responsible? The nurse.

What if a patient looks like they have swallowed a medication, but hasn't? This happens a lot in patients with swallowing difficulties or even in patients who would rather "save" some medications so they may secretly take a larger dose later. Without training, it's easy to miss. That patient may later choke while unattended or overdose. Who is legally responsible? The nurse.

What if the volunteer gives a blood pressure medication and doesn't know they should assess the patients blood pressure or heart rate first? Sometimes you can give bp meds without knowing their bp and hr. Sometimes you can't. Sometimes it depends on the persons present condition and sometimes it depends on the medication. This is just one example of MANY medications that can't simply be given without some knowledge. So if the volunteer gives these meds and something bad happens, who is responsible? The nurse.

On the surface it might seem like the legality of the issue is more important, but what all those silly rules boil down to is patient safety. Patients go to the hospital to get better. They have a right trust the people taking care of them. A volunteer must pass perhaps a minimal background check, a simple interview, or something similar. But they do not have their livelihood on the line. They are not held to a higher standard because of that license. If a narcotic medication isn't given or a critical medication is given late, someone needs to be ultimately accountable to be sure that those things don't happen. That person is the nurse. On the flip side, the nurse has the right to protect the license she worked so hard for by being sure of the chain of administration of the meds she is taking responsibility for. Nursing is more than putting pills in a cup.

You seem like an intelligent person, hopefully you can see the web of intricacies that go into just "giving meds to this patient."

[chicagoing, ADN, RN]

You've essentially summed up my entire point I was trying to make. Do you really think that nurses are more likely to hand pills to a patient correctly than any other person with general common sense? I'm sorry, but I cannot bring myself to believe that such tasks require 2-hour courses (or 4-year programs, for that matter) to be performed correctly 99.9% of the time. I believe you'd see the exact same percentage (or less) of error if volunteers were allowed to perform duties which could take stress off of nurses (and decrease the likelihood that, in their stress, they make a mistake due to their mental status).

"I'd sue them in a heartbeat" is the kind of attitude which puts great doctors out of work, and puts patients on the street due to a lack of common-sense and bureaucratic reasonability.

I believe I was addressing your point that nurses can pass on "menial duties" to the commonfolk. I don't believe I even mentioned physicians.

Even the most brilliant physician can make a costly mistake. That is what malpractice insurance is for. A mistake is a mistake. However, I do not consider the passing on of one's responsibilities to another who is not qualified to be acceptable or a mistake.

[chicagoing, ADN, RN]

Just because a person can (do x-y-z skill), doesn't mean he should if he is not qualified.

[Saysfaa]

"where did i do that?"

"... people who give their time for free tend to have much more positive interactions when dealing with patients because they want to be there, they are not required to be there."

"a passion for helping others that goes beyond money and compensation ... is something (unfortunately) rare in health care."

are you saying that volunteers should not be respect as much as paid janitors? respect is defined as: "willingness to show consideration or appreciation."are you saying that because someone doesn't receive monetary compensation for their efforts, they should be shown less consideration and less appreciation?"

"additional respect is earned individually and is irrespective of one's role"

if the volunteer/doctor/janitor/nurse/secretary is a jerk, he should not get more than the basic level of respect. if the volunteer/doctor/janitor/nurse/secretary is kind/respectful/willing/honest/etc he should get correspondingly more respect.

respect defined as: esteem for or a sense of the worth or excellence of a person, a personal quality or ability, or something considered as a manifestation of a personal quality or ability.

i think your definition is basic manners and politeness and even jerks get that much from me. with the definition i use, some people get more respect from me than other people do.

[Saysfaa]

"If you're interested in how I would go about making that case, feel free to request that I do."

I am interested. Perhaps I should tell you that I do not believe morality is subjective. However, I am more interested in how/why people think the way they do and in exploring other ways of doing things than I am in sparring so if your case requires subjective morality, please use it.

I'm not necessarily opposed to expanding the scope of practice of volunteers, depending on how it is done.

[ParkerBC,MSN,RN, PhD, RN]

I disagree. Also, you didn't specify what kind of tech. There are hundreds of different types. The point is, just because a task is out of someone's "scope of practice" doesn't always mean that they shouldn't be allowed to do it. If it's something that requires additional knowledge aside from common sense to perform correctly (like surgical procedures), then of course you wouldn't want someone untrained doing such a thing. However, if all you mean by "pass medications" is simply taking the pills from the nurse and handing them to the patient as instructed, why shouldn't someone be allowed to do such a task when all it requires is common sense?

There is a reason why we take Pharmacology. I hope you're not so acidic in your responses to the staff. If so, then I can understand why they are rude.

[sevensonnets]

FYI hospital volunteers have no scope of practice. They are allowed to perform only those unskilled tasks which do not require a nursing degree and knowledge such as filling water pitchers, delivering flowers and mail or giving directions to visitors. You need to get over the idea that you should be able to pass medications. It isn't a matter of common sense, it's the law. Nurses hold peoples' very lives in their hands, and that is a responsibility that will never be passed to an untrained volunteer.

[DolceVita, ADN, BSN, RN]

I have volunteered in many hospitals prior to nursing school. What I "get" from the OP is that she (he?) wants more responsibility and is maybe not treated very well be those for whom she volunteers.

1) Go volunteer at an institution that values volunteers. I volunteered for a big name NGO for years and was treated horrifically. When I jumped ship I luckily found a hospital with a fab volunteer director. Not all of the units at this hospital were great to work in so I changed twice early on.

Vote with your feet.

2) I confess I find your opinion of what should and should not be quite ill informed. Observing nurses and the goings on in a hospital is NOT the same thing as being a nurse. In a way I thought your post was hubris but really it just is not well informed. I never thought I would say this but....once you are in nursing school you will better grasp the implications of what you think are fairly basic nursing duties.

I know that sounds a bit patronizing. Sorry for that. So tired today I can't wrap up my opinion in an edible form.

[CuriousMe]

I have volunteered in many hospitals prior to nursing school. What I "get" from the OP is that she (he?) wants more responsibility and is maybe not treated very well be those for whom she volunteers.

.

The problem is that the OP wants more responsibility, with no training and doesn't even know enough to understand why that can't happen.

[mazy]

On the contrary, people who give their time for free tend to have much more positive interactions when dealing with patients because they want to be there, they are not required to be there.

I can say without question that I do my job because I want to be there.

Whatever you heard about the nurse and tech that got fired I would be willing to guess that there was a lot more to the story. Rumors are rumors. My rule of thumb is that the more salacious they are, the less likely they are to be true.

I agree that volunteers can have a very positive impact on the lives of patients -- and staff -- and I am always grateful to see them at my job.

But you are there because just like all of us you have a very specific role: to provide a type of positive and personal quality of interaction that those of us who are dealing with medical issues don't always have time for.

As to why volunteers aren't given a wider scope of practice, the reason is that you don't know everything that is going on with a patient medically. You don't have access to that information nor would you be able to understand all of it and how it impacts patient care.

The decisions and actions of healthcare professionals are based on a collaboration with other members of the healthcare team, all communicating within the framework of a very specific knowldege base, and targeted toward very specific goals, interventions, and outcomes.

And if you are running around helping us do our job, how are you able to do your job, which is to spend time interacting with the patients.

You may think it's no big deal to hand a patient the meds while the nurse is off doing something else, but you don't know what those meds are for, and you can't know, for example, that Mr. Smith pockets his pills so you have to stand there for however long it takes to convince him to take them, and you can't know why he takes those pills, what reactions he might have, what to look for if he decides to spit them out once you leave the room, or why his blood pressure suddenly spiked even though he supposedly took his HTN meds.

Your nurse doesn't have time to explain all of that too you, it's easier to just give the pills. Nor does he/she have any reason to know that you gave them, you are not licensed and you are not accountable.

The nurse, however, is accountable for whatever happens to that patient and the last thing I would want is to be sitting in a courtroom being asked to explain why I gave a volunteer the job of passing pills now that my patient is dead.

The fact that you think passing pills is a task that requires nothing more than common sense really scares the beejeezus out of me and indicates that you are really not very knowledgable of how fragile patients are and how easily things can go horribly awry.

It also sounds like you don't have a whole lot of respect for the complexities of the job that members of the healthcare team do.

[hiddencatRN, BSN, RN]

The point is, just because a task is out of someone's "scope of practice" doesn't always mean that they shouldn't be allowed to do it.

....that's EXACTLY what that means. I'm sorry you think that rules that protect patients are "unnecessary prerequisites" but frankly, you're a prime example of why such rules exist. You very clearly don't know what you don't know.