Shouldn't Nurses Have the Power to Isolate Patients?

evolvingrn, BSN, RN · Mar 20, 2012

I order isolation all the time... idk...

Vespertinas · Mar 20, 2012

Walter Reed... what?

Oh and scabies are the pits.. I've had them :o/

DookieMeisterRN · Mar 20, 2012

We have many protocols that let us place patients in isolation. Common sense people, common sense.

Send a spec for C-diff? Iso til it comes back negative. Send a swab for influenza? Yep, the nurse will initiate iso. History of MRSA, C-diff, VRE? The admitting nurse will place the pt in iso.If my pt had scabies I sure wouldn't be waiting around all day for an MD order. I certainly think more of my co-workers (& other pts) than to let everyone go in a room without the proper PPE.

I can't believe a hospital would place all the other pts at risk just because a pt with scabies or whatever highly communicable didn't have insurance.I think this would be a great eye opening story for the local news.

BostonTerrierLover, BSN, RN · Mar 20, 2012

I thought Native Americans had some type of Health Coverage on Reservations at Tribal Hospitals, I know for a fact when I worked at a Small ER near a Tribe, NOT ON TRIBAL LANDs, and it was a public COUNTY HOSPITAL, . . .

We would have to call the Tribal Hospital when we recieved a Native American from their tribe, and get permission to treat, or they had the right under their sovereign nation protection by the Federal Government to withhold funds for that patient (leaving me to believe they had some type of coverage).

Now from what I (Barely) understand, a Native American carries a card as membership of their belonging to a certian tribe. All tribes have different requirements, half/third/quarter and so on ancestry. THIS PATIENT IS A "RESIDENT" OF THIS TRIBE, NOT A CARD HOLDER. That is why he is labeled "self pay."

DISCLAIMER, I NEVER BROUGHT UP OR SOUGHT OUT HIS INSURANCE STATUS, THIS WAS THROWN UP TO ME DURING MY SLAP ON THE WRIST FOR SETTING UP CONTACT ISOLATION WHEN I FOUND OUT HE WAS SEVERELY INFESTED WITH SCABIES. I WAS TOLD BASICALLY THE CULTURE OF THE HOSPITAL WAS TO DO NOTHING WITHOUT A DOCTORs' ORDERs, AND I DIDN'T HAVE THE AUTHORITY TO MAKE THAT CALL. AND SADLY, THERE ARE NO PROTOCOLS, STANDING ORDERS, or ANYTHING MENTIONED IN POLICY/PROCEDURE. I KNOW IT SHOULD BE TOTALLY COMMON SENSE, BUT THEY HAVE EVERY RIGHT TO WRITE ME UP. THE TENDER FOR THE FLAME ALSO WAS THAT ONCE HE WAS PLACED ON THIS STATUS, HE WOULD HAVE TO BE CLEARED OF THE INFECTION BEFORE DISCHARGE (ACCORDING TO THE CHARGE NURSE), and THIS WOULD PROLONG HIS "UNPAYED FOR STAY." . . . ATROCIOUS.

Also, they, like many small hospitals in the Rural South are affiliated with larger hospitals in the region. The care this patient anyway would better be served in THAT HOSPITAL, his accuity is outrageous, and there are many more factors at play. I also believe patient education is ABSENT, I don't think he understands his disease process (DM), the accuity of he END STAGE condition, and I feel like the ADVOCATE in me is ready to bust out, get SOCIAL SERVICES and OTHER RESOURCES ROLLING!!!

But the truth of the matter is, HE WILL PROBABLY BE D/C'd without Diabetic Education, Rehabilitation was ABSENT following an Amputation That is now SEVERELY INFECTED (once more education b/c he displayed ZERO knoweledge of clean dressing changes, or Medication Compliance). HIS SUPPORT GROUP IS A DYSFUNCTIONAL EXTENDED FAMILY THAT HAS DEEP HEALTH ISSUES, SEVERE POVERTY, and IMMENSE ALCOHOLISM.

I know we can't change people once they have made a decision, but WE CAN AT LEAST DO WHAT WE CAN DO!!!!

I Will make sure he gets thorough Discharge Teaching on Wound Care, Dealing with infestations of parasites and treatment, and set up for Rehabilitaton secondary to the amputation. BUT THIS IS JUST A FRACTION OF THIS PTs NEEDs.

Artistyc1 · Mar 21, 2012

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?

If it is only scabies or head lice, they are NOT needing isolation in the first place. For head lice, all you have to do is avoid head to head contact. Common scabies (not Norwegian scabies, which are more contagious) need fairly intimate contact to contract. (long hand holding,etc. ) If the patient has "running sores", they can be covered by loose dressings. The way this comment was written, it sounds like anything can turn the patient into a pariah. I remember when these were the philosophies taken for HIV patients, when avoiding blood and body fluids was the only precaution needed. Wash you hands a lot! By the tone of the OP, it sounds like the fear of Lepers in Biblical times.

Adalisa · Mar 21, 2012

I work in LTC and when someone comes to our sub-acute unit with a history of infection we as RN's have the right to put them on precautions and have them tested. Once they come back cleared infection control is notified and then & only then are they removed from precautions. We even do that w/our long term residents who become ill and the tests show an active infection. Either put the patient on precaution or risk having a whole infected building...

BostonTerrierLover, BSN, RN · Mar 22, 2012

I thought this would be an interesting Update, AND it validates my concerns.

Even though I did get the patient into contact isolation, as I said, it was scantly enforced. As far as the "intimate" contact, we as nurses, and doctors, assistants, and family do have VERY CLOSE CONTACT. And, yes basic PPE should be used by staff, but what about the family who touches them, and wants to shake your hand, hug the doctor, or just staff being close to the patient?

Anyway, a Certified Nursing Assistant, and a Licensed Practical Nurse are now infected with scabies, and can't come back until they are have a medical clearance.

I am not the kind of nurse that is going to sit here and say "I told you so. . ."

I am the kind of nurse that sighs, and says," . . .I tried!"

wanderlust99 · Mar 22, 2012

Where I work now, we have a protocol for isolating patients. If they come in with diarhhea, they get contact isolation. If they've been in another hospital within past month, or came from a long term care facility, etc... they get isolated. We rule out for cdiff, mrsa, vre in all these patients. I like it. It's just automatic, and the nurse can place the order in the computer under protocol.

I think it should be the nurse's role based on policy and an ID nurse as well. In my experience I've found the doctors aren't really on top of isolation status.

kmarie724 · Mar 22, 2012

I work in LTC where we need an MD order for EVERYTHING and even we can initiate isolation if they meet criteria for it.

Alnitak7 · Mar 29, 2012

I also have worked on nursing home floors where patients had scabies and no one was using isoloation techniques.

I was flabbergasted that a public, professional entity like them would be this ignorant.

The scabies spread into the next room and they did not seem to care.

It should be an automatic gloves and gown. I was so overwhelmed that I called the state.

sciencenurse · Jul 23, 2012

guest2012 post should be removed

Silverdragon102, BSN · Jul 23, 2012

guest2012 post should be removed

Please explain why?