Shouldn't Nurses Have the Power to Isolate Patients?

[BostonTerrierLover]

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?

[HeartsOpenWide, RN]

We have an isolation protocol. We dont have to get orders.

[Anna Flaxis, BSN, RN]

Isolation precautions are nurse initiated at my facility. We do not need a doctor's order.

[Esme12, ASN, BSN, RN]

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.

Well, in a 50 states there are CDC guidelines the must be adhered to according to law. I have come across a few scattered MD's that feel threatened by nurses that are simply applying the standard of practice for the benefit of the patient themselves and protection of the other patients on the floor.

In the climate today and reimbursement being affected for hospital acquired infections and non-payment, the move has been to empower nurses with the first line of defense to protect all healthcare and patients involved with hospital policy providing the nurses with the "power" (which is the word some MD's find offensive). A nurse does not have to wait to isolate a potential Small Pox or TB while she wait for the MD's agreement and subsequent order.

The initiation of isolation is NOT a medical treatment, by law, and therefore does not require an order. However, MD's have traditionally been involved in an acute care setting as a means of obtaining insurance reimbursement from the insurance companies looking for any excuse decrease reimbursement.

http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

"Healthcare-associated infections (HAI) are infections caused by a wide variety of common and unusual bacteria, fungi, and viruses during the course of receiving medical care.

Medical advances have brought lifesaving care to patients in need, yet many of those advances come with a risk of HAI. These infections related to medical care can be devastating and even deadly. As the CDC's ability to prevent HAI grows, these infections are increasingly unacceptable.

Recent successes in HAI elimination have been very encouraging. Reductions have been demonstrated for other HAIs as well, but much more remains to be done.

Wherever patient care is provided, adherence to infection prevention guidelines is needed to ensure that all care is safe care. This includes traditional hospital settings as well as outpatient surgery centers, long-term care facilities, rehabilitation centers, and community clinics. The information on this website is intended to inform patients and healthcare personnel and help move healthcare systems toward elimination of HAIs."

CDC - State-based HAI prevention - HAI

State-based HAI prevention

CDC’s work with state health departments improves HAI tracking and prevention by implementing successful prevention strategies in the entire state and tracking the impact of that strategy across all hospitals

CDC - Healthcare-associated infections - HAI

That being said there remains some scattered hospital policy and POLITICS (orchestrated by MD's) ensure nurses remain powerless to protect themselves and protect their patients. The nurse would be held accountable in a court of law if she fails to isolate an infectious disease patient and an epidemic ensues whether the MD "wanted" the isolation or not.

OP, you are allowed by law to protect yourself and maintain a safe work environment, therefore you can leave all the PPE at the door to protect yourself and your other patients. You are also required by law to report suspected abuse or neglect. As a mandated reporter you are completely within you legal obligation to report the child's condition to the Department of Social Services to get the family also educated and treated.

There is always more that one way to skin a cat....

[Anna Flaxis, BSN, RN]

I also wanted to add that we've recently switched to "Symptom Based Precautions", which means that nurses initiate appropriate isolation precautions for the patient's symptoms, rather than just looking at the medical diagnosis.

Someone comes in with a big oozing purulent wound? Contact precautions.

Diarrhea after recent course of antibiotics? Contact enteric.

Cough and fever? Droplet.

Of course, we still continue to flag patients with a history of infections such as MRSA or C-Diff who have still not had enough negative test results to "clear" them.

Nurses are not "allowed" to do this, we are *expected* to.

[classicdame, MSN, EdD]

we allow nurses to initiate the order for patient safety. MD will sign order later. Infection Control nurse is notifed as well

[Purple_Scrubs, BSN, RN]

There really should be a hospital protocol that could be initiated by nurses, ideally. In the case of scabies, since it is spread by direct, prolonged skin to skin contact, the likelihood of it being transmitted in the hospital setting is miniscule, so I can see the doctor's POV, although contact precautions would be ideal. The family members probably already have it, so that is not really an issue. The person next to you in line at Walmart or jammed in next to you on the bus may have it too. As long as you avoid prolonged skin to skin contact, you're fine.

[nurseprnRN, BSN, RN]

you are entitled to keep yourself safe and clean at any time. of course it would be perfectly appropriate to put a note on the chart/kardex/emr that the patient has scabies and personal protective equipment (gowns) should be worn by all caregivers. you do not need a medical order for that; it is not part of the medical plan of care. it's a nursing order. do not let your um be confused as to the difference; it has nothing to do with reimbursement.

if you need to engage the support of your infection control nurse, do that. every one i have ever met would be pleased as punch to help.

[BostonTerrierLover, BSN, RN]

Hey guys, UPDATE!

I got it resolved by calling the Physician, I was doing some continuing education back in the States to keep up with demand on my license. This is a Tribal Hospital, NOT TO DOWN IT, but that's why the nurses' insurance answer looped me. I have as a Staff Nurse implemented Isolation for all the common uses as well, THAT'S WHY I WAS SO FLOORED AND AMAZED HERE, . . .

The Patient in question was not my patient, but to make a long story short, there is a lot of interaction between patients here, and I see a Horror Movie unfolding. THIS IS JUST THE TIP OF THE ICEBERG, OMG Guys, I don't know what I have got myself into. I am just doing the best job I can while I am here. I HAVE WORKED AT REALLY NICE STATE OF THE ART TRIBAL HOSPITALS, THESE PEOPLE DESERVE SOOOOOOOOOO MUCH MORE, I am in AWE!!!!!!!

GUYS, There are STILL hospitals in this NATION that are, I just don't have the words, I HAVEN'T ENCOUNTERED ANYTHING LIKE THIS IN MY CAREER,

I THINK OF HOW OUR TROOPS WERE TREATED IN THOSE VA HOSPITALs, LIKE WALTER REED,. . .

IF WALTER REED WAS ANYWHERE NEAR THIS PLACE (BOTH FEDERAL), I HAVE HAD AN EPIPHANY.

I Cannot believe the conditions here. The building itself should be condemned.

I DON'T WANT TO SOUND JUDGEMENTAL, I HONESTLY AM NOW JUST SLEEP DEPRIVED AND SICK THAT THIS FACILITY IS IN THE UNITED STATES IN 2012, and NO ONE TALKED ABOUT THIS BEFORE HERE, I GREW UP WITHING AN HOUR OF HERE!!!!!

I appreciate the feedback, Thanks for each of your great points and inputs, and Esme12 your research was SO helpful.

[Daisy_08, BSN, RN]

wow! here we do not need/get orders to isolate, (maybe after the fact but i'm just oblivious to it?). we see them + for whatever (mrsa,esbl,vre, cdiff) ect and just isolate them without even thinking about it. even if a pt seems to have a cold we put them on droplet to protect the staff.

it seems crazy to me not to. the cost is so much more if that is passed around.

[Esme12, ASN, BSN, RN]

There are hospitals in the US that are remote acute care SMALL facilities with antiquated ideals and policies. There are even some not so remote facilities in the US that are shocking in their beliefs and practices. I have an inside track to a prominent accrediting board and the stories are nothing short of unbelievable. I wish I could share further but the source and stories must remain anonymous. When the leave their position......I will spill my guts and you won't believe the stuff that goes on out there.

The reality of some situations are far more unbelievable than any fictional story could ever be. I like to back up my arguments with evidence not only to prove a point but to educate those who just may not know.

If you are on a travel assignment.....be aware of yourself and be safe. Some will protect their beliefs forcibly.

[Lynx25, LPN]

We SHOULD, but at least here, the IC nurse has to initiate it. They wouldn't isolate one gentleman with scabies until I told them I'd call out if I got it... and since I'm the only one who will work the 16 hour shifts all weekend... guess who got put on isolation? Fun!

Usually I just go locate a pile of the PPE and stick it where the Aides and I can get to it, as we are not allowed a 'cart' until the IC nurse thinks it's appropriate.

[anotherone, BSN, RN]

Hey guys, UPDATE!

I got it resolved by calling the Physician, I was doing some continuing education back in the States to keep up with demand on my license. This is a Tribal Hospital, NOT TO DOWN IT, but that's why the nurses' insurance answer looped me. I have as a Staff Nurse implemented Isolation for all the common uses as well, THAT'S WHY I WAS SO FLOORED AND AMAZED HERE, . . .

The Patient in question was not my patient, but to make a long story short, there is a lot of interaction between patients here, and I see a Horror Movie unfolding. THIS IS JUST THE TIP OF THE ICEBERG, OMG Guys, I don't know what I have got myself into. I am just doing the best job I can while I am here. I HAVE WORKED AT REALLY NICE STATE OF THE ART TRIBAL HOSPITALS, THESE PEOPLE DESERVE SOOOOOOOOOO MUCH MORE, I am in AWE!!!!!!!

GUYS, There are STILL hospitals in this NATION that are, I just don't have the words, I HAVEN'T ENCOUNTERED ANYTHING LIKE THIS IN MY CAREER,

I THINK OF HOW OUR TROOPS WERE TREATED IN THOSE VA HOSPITALs, LIKE WALTER REED,. . .

IF WALTER REED WAS ANYWHERE NEAR THIS PLACE (BOTH FEDERAL), I HAVE HAD AN EPIPHANY.

I Cannot believe the conditions here. The building itself should be condemned.

I DON'T WANT TO SOUND JUDGEMENTAL, I HONESTLY AM NOW JUST SLEEP DEPRIVED AND SICK THAT THIS FACILITY IS IN THE UNITED STATES IN 2012, and NO ONE TALKED ABOUT THIS BEFORE HERE, I GREW UP WITHING AN HOUR OF HERE!!!!!

I appreciate the feedback, Thanks for each of your great points and inputs, and Esme12 your research was SO helpful.

I was wondering what kind of facility this was ! Thanks for your replies and insight. Things are scary indeed .