Scope of practice concern

Hi - if you were not trained to diagnose, and your gut feeling is that it is out of your scope of practice - like I feel you do or you would not have posted this...then don't do it - if you are not trained, then you will lose your hard earned licence if something goes wrong - or if it doesn't!

Just because someone else does something doesn't automatically make it right...

You should call the board of nursing in your state, to get clarification about this issue. I am sure they would know if this is within your scope of practice. I personally would find out before starting the job. I am an LPN student and have always been told or had it pounded into me that a nurse does not do the diagnosing . Anyways, good luck and I hope you find the answers to your questions.

I searched the board of nursing and our scope for this one I was curious. I think you need to get futhur explanation on this though. Are you the first person that the pateints sees? and you are admitting them to the psych unit for suspected? until a doctor can assess them? orrrr are you making the actual diagnosis after other people have seen and admitted them. I can understand the suspected diagnosis until the doc can see but anything other than that seems to not be correct. and I would look into it. From what it sounds like is she is trying to talk you into doing it by explaining everyone else does it and the person before you did it, and something is just fishy ... personally I wouldn't take the job. Plus you don't seem excited about it anyway. :)

Definitely read your state's/area's nurse practice law and the hospital policy(ies) on this.

Sounds fishy to me.

You will find the answer to your question in a nursing legal handbook. Nurses are not allowed to make medical diagnoses. It is practicing outside of the nurses scope and is not legal. It doesn't make a difference if others on the healthcare team think it's ok for you to do. They are wrong. It is the MD's job.

In my days of old in being an outpt psych nurse in a CMHC, I can say I can relate to what you are asking. What the CMHC may be asking is NOT that you would be making a dx, but a "diagnostic impression" as evidenced by:____________________. This may seem like spiltting hairs, but there is a difference. It is NOT in the scope of practice for nurses to diagnose, but we do communicate as professionals about our impressions that a disorder or abnormality MAY exist. In CMHCs, providing diagnostic impressions are usually performed by staff in intake, seeing new folks coming into the door...just prior to seeing the doc. When an intake worker collects ALL the data (the CMHC often spells it out what to collect/assess), what is often part of the intake assessment is the diagnostic impression by that intake worker...often reported in all five Axes of the DSM criteria. When the patient does see the doc for the ist doc appointment, the doc has documentaion to refer to. Now, the doc may agree or very much so disagree with the diagnostic impression. However, the doc makes the dx, not intake. Intake may only give "impressions" of a diagnosis. The exception to this rule is if the member of intake, who makes the report, has a terminal license and is allowed by that state to diagnose...such as a licensed psychologist and in some states... Licensed Counselors in counseling or MISWs in social work or NPs/CNSs in nursing...but, it depends on that state. So check with your BON regarding your licensure and licensure laws. I hope this helps.

Wolfie

This is exactly why I love this website...there is usually always someone who has been in your situation or something very similar. Like the rest of the ladies who responded, I too thought something just wasn't right. But, after reading your reply, Wolfie, I remembered that my future boss did say that I could write "diagnostic impression" if that would be more comfortable for me (sorry - forgot to include that in the original message:imbar ). I guess what worried me was her saying, "You will be expected to diagnose" - kept ringing in my mind so much that I dismissed the possibility that a "diagnostic impression" could be different *enough* to keep me within my professional scope. Wolfie...thank you so much for helping me to clarify this issue! So, I guess I have no reason to worry if I always just make sure I write "diagnostic impression", right?

Cher

In my days of old in being an outpt psych nurse in a CMHC, I can say I can relate to what you are asking. What the CMHC may be asking is NOT that you would be making a dx, but a "diagnostic impression" as evidenced by:____________________. This may seem like spiltting hairs, but there is a difference. It is NOT in the scope of practice for nurses to diagnose, but we do communicate as professionals about our impressions that a disorder or abnormality MAY exist. In CMHCs, providing diagnostic impressions are usually performed by staff in intake, seeing new folks coming into the door...just prior to seeing the doc. When an intake worker collects ALL the data (the CMHC often spells it out what to collect/assess), what is often part of the intake assessment is the diagnostic impression by that intake worker...often reported in all five Axes of the DSM criteria. When the patient does see the doc for the ist doc appointment, the doc has documentaion to refer to. Now, the doc may agree or very much so disagree with the diagnostic impression. However, the doc makes the dx, not intake. Intake may only give "impressions" of a diagnosis. The exception to this rule is if the member of intake, who makes the report, has a terminal license and is allowed by that state to diagnose...such as a licensed psychologist and in some states... Licensed Counselors in counseling or MISWs in social work or NPs/CNSs in nursing...but, it depends on that state. So check with your BON regarding your licensure and licensure laws. I hope this helps.

Wolfie