Shouldn't Nurses Have the Power to Isolate Patients?

[BostonTerrierLover, BSN, RN]

I have seen patients with Scabies, Lice, and other known really contagious bugs in regular rooms lately with NO MARKERS to warn staff members!!!!!!!!!!!!!

When I confronted the Charge Nurse on a Pediatric Patient with SEVERE SCABIES, ACTIVE, 2 HOURS S/P ADMISSION TO FLOOR, . . . .

"WHY IS THIS PT NOT IN ISOLATION?". . .

"We don't have the authority to isolate here according to policy and procedure without an Physician Orders, and (HONESTLY) THAT PATIENT DOESN'T HAVE INSURANCE TO COVER THE COST OF AN ISOLATION ROOM AND SUPPLIES!" So his Doc would not sign off on Isolative Measures NOT EVEN CONTACT ISOLATION STATUS!!!!

I was floored. Family coming in and out with sores and scabs, scratching, THIS WAS A NIGHTMARE.

SHOULDN'T ALL NURSES HAVE THE AUTHORITY TO ISOLATE PATIENTS?

[guest2012]

No , definitely i don't think that's a good idea for nurses to issue a isolation to any kind of patients, actually the nurses shouldn't have this kind of authority, if it really happens like what you said, primarily you should report to doctor , and i am sure doctor may have some authority to take measures.

if it is really serious, you get to report tell the truth, i am sure there would be somebody take charge of this .

but the nurse, i don't think that's good to make their authorize to issue isolation patients.

[anotherone, BSN, RN]

Most of our patients are on iso for something or the other and RARELY do drs order it officially it seems. Most of the time nursing will see the lab result, + mrsa,vre, being treated for cdiff, rule out flu etc etc etc and set up isolation and send one of the doctors a page. What does the actual hospital policy say? Can you contact infectious disease at your hospital? My hospital has a list of what patients should be isolated for and what kind of isolation. What is to stop you from wearing a gown when going into that room, and head covering, aside from the whole stirring the pot issue. ?

[canoehead, BSN, RN]

In every hospital I've worked at the nurses initiated isolation, then got an order. At times the doc wouldn't want to order it, we'd consult with infection control, but the patient stayed isolated until IC cleared them.

[ScarryBear,RN]

At our facility we automatically place pts in isolation even if they have a history of anything that would warrant the status such as mrsa, c-diff, etc. If they have had two negative results in a row since being infectious we do not isolate them. Our doctors also don't write orders, it is primarily up to the nurse and our infectious disease personnel who determine if it is necessary. Even if it is suspected, we place them in iso status until we receive negative results.

[rn undisclosed name]

We have a list that we follow. For example, if we are ruling out c-diff they are placed in contact isolation. It is a nursing decision for the most part. We can't just start isolating all of our patients just to block beds. Our docs don't care if a pt is placed in isolation. If patients aren't being isolated I would think this would be a HUGE legal issue for the hospitals. Especially if certain bugs are picked up in the hospital. They will not be getting reimbursed!

[MunoRN, RN]

Nurses initiate isolation at both hospitals I've worked at. We write it as a protocol order based on the indications which are pretty straightforward.

[merlee]

Since when does lack of insurance dictate isolation precautions??? This is protect everyone, and it is usually absorbed by the hospital.

[GitanoRN, BSN, MSN, RN]

certainly, in several instances we nurses initiate isolation i'm guilty of it, is our responsibility to ensure the welfare of our patients...therefore, i have no problem initiating isolation. however, in a case like the one you have presented it's a bit more challenging, although i would still iniciate the isolation process...i have always said it's better to be safe than sorry~

[loriangel14, RN]

Where I work we can put them in isolation and then get the order fro the Infection Control nurse.She is also the only one that can DC isolation.The doc can suggest DCing if but the actual order has to come from the IC nurse.

[KelRN215, BSN, RN]

Nurses initiate isolation precautions at my hospital. We have patients all the time who we've known for YEARS and we know these patients have MRSA, VRE or C-Diff and haven't been cleared yet. I've had it happen many times that a well known patient with a history of VRE is admitted to my floor but to a different service than his/her primary service. We know this child is VRE positive so we initiate precautions per hospital policy, the next morning the team rounds and says "why is this kid on precautions?" and are happy that we know them and their history. I don't need a physician's order to put a sign on the door.

[gracieD]

Sounds like you need to initiate a policy revision or get the powers that be to consider writing a new policy with infection control. If another patient or staff has symptoms of said condition, absolultely write a variance!

That being said, YOU are allowed to wear whatever PPE (gown, mask, hat) you think is appropriate for any given situation to protect yourself from being in contact with the patient, patient's bodily fluids, etc. You don't have to put the patient on isolation, but you can certainly 'isolate' them from yourself. If you get pushback on this, talk to someone at Occupational Health or even OSHA. You have a right to a safe work environment!