Scope Of Practice TELEMEDICINE Dilemma

[rachelm68]

I've recently started working at a TeleMedicine Urgent Care clinic here in CALIFORNIA.. I am an LVN and I'm concerned the work my boss is having me so is not under my scope of practice..

the rundown of this place: I am the only nurse on hand, there is no MA, no Physician or second nurse in the clinic. I have an iPad with the app Dr. Chronos on it where I was trained to register new/established patients, document chief complaint, history of present illness, family and social hx, a complete initial physical assessment and I am expect to run standing orders based on their CC.. After all of this admissions stuff I am doing by myself, I log into a website called ChironHealth where i am able to connect with a provider (MD,PA,NP) at another location and create a virtual appointment for my patient, I sit in the room during the appointment and scribe SOAP notes and then establish the plan of care & carry out the orders.. my giant issue is a HUUUUGE chunk of this process I have to do is out of my scope of practice legally according to BVNPT.. has anyone else expirence a scope of practice issues or telemedicine & tell me if there is a loophole? My boss has no medical background & I don't think she understands anything I try to tell her.

[Archerlpvn, LPN, LVN]

You are absolutely performing outside your scope in California as an LVN. In fact you aren't even legally able to document or state you "assessed" a patient, rather you performed "data collection." Initial assessments I think are a no no because of this, as they are usually "comprehensive" which typically requires RN licensure unless you're in LTC which in many states/facilities allow LPNs to perform these initial assessments. And LVNs in CA to my knowledge cannot Establish a care plan, they can only contribute to the plan of care in collaboration with an RN. California is pretty clear with what is and isn't in the scope of practice legally permissible for LVNs. Be very careful, especially if you're aware that you are outside of your scope. If an investigation happens against your license for whatever reason, you will be found to be practicing outside of your scope, and that may have ever lasting blemishes on your license for the rest of your career.

[rachelm68]

Thank you so much for your reply, this is my first week at this company and I have already worked 9 days straight and a few of my new hire co workers are concerned as well. We've looked up our scope and talked amongst ourselves about it but aren't but entirely sure how to take it up with our bosses. On top of it, a couple of the clinics are understocked as in has NO sharps, no rapid tests and they have told us we do not need the rapid tests to Dx a patient with strep or flu, and have had doctors prescribed ZPAK without an official Diagnosis of strep. I didn't prescribe it so I'm not worried about it but I did lent it be known I had no rapid tests in my clinic and just described what I saw based on this "initial assessment" so...

[rachelm68]

Also to be clear, when I say establish a POC it is with the physician as well, not a decision of my own. I just carry out orders like shots, wound Tx, blood draws, orthopedic wrapping and slings, and other things.. everything I can carry out is in my scope, it is the registration, admissions, assessment, insurance & billing referrals and follow up I am concerned about lol

[rachelm68]

A coworker who had been there a lot longer said the "loophole" and what made it within our scope was that the patient is "stating" what it is to us, and we type it into the iPad, thus making is Subjective data in our SOAP notes.. very confusing, and hoping to get better insight from an outside source as I am a newer nurse and have only worked in LTC until this job

[Archerlpvn, LPN, LVN]

You're walking a fine line I think in regards to your scope in general, at least for CA lol. If you just "collect data" then you're fine, you just can't legally "assess." Billing, insurance prior auths, claims, and generating a referral per a physicians order is within anyone's scope per say because it's probably part of the job description that anyone "trained" can do and doesn't involve nursing judgment per se. I think you're good with those things. MA's can do all of those front office tasks as can an LVN/RN. :)