RN in non medical facility

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I am currently working in a non-medical facility and I can not believe the amount of Medicare and Medicaid fraud that goes on. I am an RN working with an LPN and have an RN,BSN manager but we can not do anything medical. The amount of times we have sent someone to ER or the hospital because we can not treat them is unreal.

Sending someone to the ER for a splinter in their hand, strong smelling urine. I need the input from others working in these types of facilities, Is this normal? Should I report what seems to be fraud to the CMS? How do you work in these facilities and not feel like you are losing your nursing skills. I got reprimanded for putting a pressure dressing on a head wound to stop the bleeding because "that has to be done in ER we don;t do that in the facility." So I'm suppose to let him bleed until EMS gets there?

Help I have only been there for a month and I feel so un-nurse like.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Moved to our General Nursing Discussion forum for member advice

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Sounds screwy to me. If the don't want you to apply a pressure dressing to a laceration, why do they even supply them?

Why even hire nurses if they can't do anything?

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Retirement communities and assistive living facilities do not provide NURSING care, suportive personal care only. Therefore, residents need to be sent to doctors/urgent care/ER for acute issues.

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Specializes in Hospital Education Coordinator.

I think your scope of practice may have something to do with how the facility is licensed and how they are insured. Why don't the nurses all get together and ask for a meeting to resolve these questions?

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Specializes in Critical Care, Education.

Quick question - how would your BON react if you did not respond 'like a prudent nurse' to a clinical situation because your company policy forbade it?

Are you required to wear an ID that identifies you as a nurse? Do the residents/clients know you are a nurse? If so, you are in a potentially disastrous situation. Why is the organization hiring nurses if they are forbidden to practice according to the terms of their professional practice? As a licensed professional, your NPA trumps any employer policies.

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Specializes in retired LTC.

This is distantly related to your post, but I would hope that you carry your own for reasons inherent in the responses made by classicdame and HouTx.

>>>>>>>>>>

Without knowing what type of facility you work in, we don't see the whole picture. To suspect 'care/'caid fraud may be premature as your employer may well be working within the rules & regs governing its industry.

As example, I work LTC and there are things that I'm just not permitted to do that I COULD if I worked in a hospital. I have education & experience that make me capable. But I can't push IV meds. Some places do allow it but it is regulated within the rules that govern LTC if the individual facilities choose to permit its nurses to push meds. So silly if I have a hypoglycemic pt (WITH A PICC LINE) bottomed out and I'm supposed to call 911 for the EMTs to give a dextrose bolus!!!

Waste of resources and $$$ as far as I'm concerned, but that's the way it is.

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Specializes in Critical Care.

It would help to know exactly what type of facility you are referring to. Each state's BON varies a little on this, but just because you are working, and happen to be a Nurse, doesn't mean you're necessarily working as a Nurse. My state's BON doesn't consider ALF residents to be patients, many ALF's employ LPN's and even RN's, but the BON doesn't consider that to be Nurse-Patient relationship. For liability reasons, this limits the scope of staff, even Nurses, to be that of non-Nurses. Again, states may differ on this.

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This is very similar to the 911 call from an ALF in CA where a resident wasn't breathing and the woman on the phone with 911 was a nurse but told the operator that she wasn't able to perform CPR because it was against company policy. As a current 911 operator I can only imagine how hard it was for that operator to not have anyone to help the resident because that is what we are trained to do - talk the common person through until EMS arrives. Although if you are employed with that facility and it is company policy then you would be giving up your job to help that person. It's a very tough spot, I can only imagine any nurse in that position would have some sort of internal struggle over what they feel they should do and what they can do per policy.

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What still puzzles me is why would any facility hire nurses and buy dressing/first aide supplies if they have a policy explicitly forbidding both nursing care and first aide?

Is the nurse just there to look pretty so they can say "we have nurses on staff"? Are all the medical supplies just for show? "See, we have a whole closet full of gauze and thermometers and stuff in case grandma gets sick!"

Do the families really know what kind of a facility this is? Seems to me they're going to great lenghths to make the family believe grandma will receive some form of skilled nursing when all it is is an apartment complex where, hopefully, someone will be there to call 911 real quick.

What a shady way to operate.

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Specializes in Pedi.

I'm not seeing any Medicare/Medicaid fraud described in the OP.

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