treating a visitor of your pt? reprimanded for not doing it....

[rehab nurse]

am i right or wrong here? just fyi, i work in a subacute rehab attached to ltc.

during report, had a nurse manager come in, tell me pt "had fainting spell" and to go see her. i get up, go in the pt's room, ready to do VS and assess, etc. four family members in the room with pt, one of whom is lying in bed next to pt. i say "what happened?", pt sitting up, a/o, no c/o. i go to take a BP on her, and another family member says "no, it's not her, it's my sister". sister laying in bed, says she has a "heart problem" and is vague with her symptoms. i say "sorry, i am not allowed to take your VS, but i will call an ambulance for you". rest of the family says, "no thanks, she's been complaining for the last hour, but we don't know why the nurses can't just give her a BP pill and check her VS every so often.":uhoh3: offer again to call ambulance, declined offer. so i go to nurse manager who's supervising building for the weekend, who goes to talk to family, and then writes me up for not taking the woman's vs. :stone

am i completely wrong here?

[hrtprncss]

When something like this happens, usually what we do is just send them to the ER. If a family member codes in the hospital, of course the code would be called overhead too, because someone would call a code. And we will respond. But at the same time, 911 is usually called and they will also respond. By the time they come the patient is ready to go to the ER. I remember one case where a patient passed away and the family member was quite hysterical. The doctor deemed that it was truly necessary for the family member to recieve some sort of anti anxiety. Did we dispense it? No. We had the doctor call the outpatient pharmacy and send one of the family members to pick up the medication. It did help the family member. Did we help? In some way, but indirect though.

[Cute_CNA, CNA]

unfortunately, i believe that the nurse manager would write her up. it's happened to me!

years ago, i had an italian patient with a very demonstrative italian family. when he died in our ccu, the daughter who was with him began to shriek. understandably, this startled his roommate, who was sorry that the patient had died but not all that inclined to try to recover from his heart attack in the midst of a ruckus. we tried to guide daughter out of the room, but she flung herself on the body and hanging on for dear life, proceeded to kick, scream, swear, and carry on the likes of which i have rarely seen. (and my husband's family is latin!)

once it was established that the daughter would have nothing to do with any comfort, redirection, etc. that i tried to offer, i called both the social worker and the priest on call, then helped move the roommate down the hall. meanwhile, the shrieking continued at full volume.

the patient's doctor came in to pronounce him, and refused to even go into the room "until you sedate that woman." i told him she wasn't a patient, i couldn't sedate her. "just giver her 10 mg. of valium im, " he said. i refused. i told him that both the priest and the social worker were on the way, or we could have security scrape her off the body and take her to the er for treatment. "just give her the damned valium," he bellowed. "or i'll have your job!" (not sure what he'd want with my job, he who was making enough to afford the mansion on the hill, a few mercedes' and regular safaris in africa -- first class, of course.) at that point, my nurse manager entered the fracus and ordered me to give the valium. again, i refused, stating that she wasn't a patient, i didn't know her history and it wasn't safe.

"wait for me in my office," the nurse manager said. "we'll discuss your employment status. you might want to consider wisely what you'll bring to the discussion. i"ll give the valium."

as i waited in the nurse manager's office reflecting that i'd rather lose my job than my license but preferred not to lose either, i heard a code called in the ccu. i rushed out of the office to find my nurse manager, the attending physician and a few other folks doing cpr on the patient's daughter -- who had respiratory arrested after getting 10 mg. of valium im.

the discussion in my nurse manager's office, when it finally happened, went someone differently than she had anticipated. it was one of the few times a manager has ever apologized to me.

oh and shrieking woman? she recovered, and last i heard, was suing the hospital and the physician.

this is what happens when people let the emotional stress of a situation and pressure from others influence their decision-making over their common sense.

thank goodness you stuck to your guns, and reacted on what you knew, rather than what someone verbally ordered you to do. hurray! :) :balloons:

[Daytonite, BSN, RN]

When at work, as an RN or LPN, and someone, anyone, tells me they are having some kind of problem (in this case a "heart" problem) I must do something, even if it is just to turf the problem off to someone else. While on the job I am a walking advertisement that I am a licensed nurse. So, if someone approaches me with a problem that needs immediate attention, or if I witness anyone who has an accident, I must act. There is no hiding from this responsiblity. My nursing license is in jeopardy if I do nothing. The other problem is that it also puts the facility in jeopardy as they are liable if something happens to a visitor. Think about it, if a visitor has an acute medical problem, it's going to look pretty bad that not one of the many licensed nurses did anything about it. It would be all over the news, the hospital's reputation would be ruined, and the person who suffered any injury would win a huge lawsuit against the hospital, and me too for failing to respond to their request for help. I cannot assume anyone is faking. I must make an assessment. And even then, it's best and safest to pass the buck and insist the person go to the ER so they can be evaluated by a doctor. It's always safest to get a doctor involved somehow. Then, I have to document everything, usually on an incident report or a free-hand written note. In the situation you described, I would assess the woman and call the supervisor for assistance. As the supervisor I would have taken over the situation while you went back to your job. I would have insisted the woman accompany me to the ER (in your case, called 911) and stayed with her until she had gone out through the doors of the facility. Then I would have written up an incident report for my boss. All of us licensed nurses have a professional obligation that far exceeds our status as an employee.

[Noryn]

Well she did do something which was offer to call an ambulance but this was declined. You cant make someone seek treatment. In this case the blood pressure didnt matter. Whether the blood pressure was 120/80 or 240/100 she needed to be evaluated further immediately with a history of a heart problem and syncope. Grabbing at straws here but if she was having an arrythmia we need to make sure she wasnt going into V-tach or something close. Most people dont see the entire picture. Lets say her blood pressure was 110/80 then what was the nurse going to do? Say, "Ok your blood pressure is fine." With this statement the family may even think well lets just drive her to the ER then when the patient dies in the car guess who they will place the blame on.

The original poster did everything right. Unfortunately management doesnt have the knowledge or experience to back her up. Anyway like you said if someone approached you with a situation you would act. Well she did act. My concern and the original poster can contact the board about this would be establishing the patient/nurse relationship once vital signs are taken then you go into a route of treatment or assessment you shouldnt. If you take vital signs then you need to collect all of the important data such as description of symptoms, history of patient along with physical assessment but realize they also need a physician's assessment, possibly lab work, ekg, etc.

Vital signs should never be a subsitute for complete medical care and should never supercede a patient's complaint such as this. If you are in healthcare management you should know this. Of course if there is an emergent problem such as seizures or bleeding then you would provide some measures until EMS arrives.

As far as this on the write up, "LPN incorrectly assessed situation, and did not render care as appropriate" there are so many things wrong with it and I would honestly have a field day with the nurse manager. I would have her list out the appropriate care. If there was something that needed a doctor's order then I would have her show me the order. If she thought vital signs were an appropriate care measure for this I would ask her why she thought the patient didnt need someone there with the capability to actually treat the underlying cause. Does a LPN or even RN at a ltc facility readily have a defribrillator or emergency medications to utilize? They sure dont have the doctor's order to use them.

The thing about it is this manager is probably not going to listen to you regardless. I would fight the write up and take it to the highest level possible. I also dont want you to get fired though--I stated that I would have a field day with the nurse manager but fortunately I have always been in a situation where I can quit or get fired :chuckle and not worry too much. But with any argument or disagreement you shouldnt have to worry about getting fired. Just state your case, the facts, if there wasnt a policy in place then bring that up as well. Be nice though, be professional but I would also be tough!

[TypicalFish]

When at work, as an RN or LPN, and someone, anyone, tells me they are having some kind of problem (in this case a "heart" problem) I must do something, even if it is just to turf the problem off to someone else. While on the job I am a walking advertisement that I am a licensed nurse. So, if someone approaches me with a problem that needs immediate attention, or if I witness anyone who has an accident, I must act. There is no hiding from this responsiblity. My nursing license is in jeopardy if I do nothing. The other problem is that it also puts the facility in jeopardy as they are liable if something happens to a visitor. Think about it, if a visitor has an acute medical problem, it's going to look pretty bad that not one of the many licensed nurses did anything about it. It would be all over the news, the hospital's reputation would be ruined, and the person who suffered any injury would win a huge lawsuit against the hospital, and me too for failing to respond to their request for help. I cannot assume anyone is faking. I must make an assessment. And even then, it's best and safest to pass the buck and insist the person go to the ER so they can be evaluated by a doctor. It's always safest to get a doctor involved somehow. Then, I have to document everything, usually on an incident report or a free-hand written note. In the situation you described, I would assess the woman and call the supervisor for assistance. As the supervisor I would have taken over the situation while you went back to your job. I would have insisted the woman accompany me to the ER (in your case, called 911) and stayed with her until she had gone out through the doors of the facility. Then I would have written up an incident report for my boss. All of us licensed nurses have a professional obligation that far exceeds our status as an employee.

No one here is suggesting that the OP should of ignored the ill person, or that the ill person was faking. If you would of assessed the woman you would of legally been considered to be taking responsibility for that patient; if you would of then, after assessing the patient, sent them to an ED, technically you would of been practicing medicine-ie you diagnosed the need for the patient to receive futher care; -I checked with the head of the nursing program from where I graduated (She was, until last year, the president of my states BON)-she stated that the OP did EXACTLY the correct thing; that to treat-and even assessing is considered in this-a visitor in a hospital (or LTC) without any MD involvement would of been out of that nurses scope of practice. And she would of been open to disciplinary action by the BON (by this state anyway). It is one thing to help at the scene of some kind of accident- in that situation, a nurse is not being paid to help, the good samaritan law protects a nurse.

No one is suggesting that the OP ignore the situation, and certainly if the person would of coded, there would of been a different course of action. I think the secondary poster made the perfect point of why the OP was correct in her actions.

[rehab nurse]

thanks so much everyone for your thoughts, and everything. it helps me step back and realize what others would do, broadens my thinking a bit.

ok, so today i actually had a meeting with my DON. i fought the write up, professionally as i could (not easy being seething mad), but asked for their policy, for which they stated they did not have one on this issue. i suggested they make one. DON said, a few weeks ago on the ltc side of the building a nurse did an ekg and vs when a visitor c/o chest pain, BEFORE calling 911. :stone she said "anything noninvasive" would be ok to do. i told her i disagreed, and will seek legal advice on the matter. there is nothing in my nurse practice act about this. i live in michigan. does anyone know of a site that shows a situation like this in black and white?

i'm at a loss here. i now my actions were right. now i need to find something that proves it.

[HappyJaxRN]

When something like this happens, usually what we do is just send them to the ER. If a family member codes in the hospital, of course the code would be called overhead too, because someone would call a code. And we will respond. But at the same time, 911 is usually called and they will also respond. By the time they come the patient is ready to go to the ER. I remember one case where a patient passed away and the family member was quite hysterical. The doctor deemed that it was truly necessary for the family member to recieve some sort of anti anxiety. Did we dispense it? No. We had the doctor call the outpatient pharmacy and send one of the family members to pick up the medication. It did help the family member. Did we help? In some way, but indirect though.

Yes, us too. Has happened. We take the visitor to the ER.

[tiffanycmt]

Okay i may rock the boat here by having a different opinion i'm not saying you did the wrong thing but i dont think it would of hurt just to take her b/p but OF COURSE you can not administer medication to someone who is not your pt. But, we've had a few ppl come in from off the streets c/o dizziness and asking for us to take there b/p and i dont see a problem with that. Just my opinion.

[rehab nurse]

oy...i just typed this huge reply and poof....gone.

it's been a super long 12 hours for me at work. i am exhausted.

basically, my thoughts were that i welcome others opinions, thoughts, etc. i enjoy knowing different ways of thinking, that i may not have otherwise thought of. so please, if others have a differing opinion than my own, i welcome to hear it...

however, i believe i am right. i would love to be able to just help people and everything, but with society as litigous (spelling?) as it is, i certainly understand trying to avoid being sued as well. this situation is kinda similar to dealing with people who ask for medical advice, just because they know you're a nurse you know? what you read about in nursing journals about malpractice suits, and such. edited to add: think of all the emphasis put on hipaa and making sure we're talking to the right person, not giving out too much info, etc. gets almost ridiculous the amount of things we have to be "wary" of on a daily basis. i'm all for privacy, but i just went through our yearly inservice on hipaa compliance and how we can't even direct people through the facility looking for a person, but the DON says its ok to start doing non invasive procedures on anyone who walks through the door? makes no sense to me.

i asked five different docs, who i am close to, the same thing. all agreed with me. i guess it doesn't make it right, though.

so for now, i am trying to find a journal i have with a similar topic discussed in it. anyone read nursing 2005? that's what i think i read it in. anyways, thank you so much to all who replied and helped me here. i love to hear your opinions!

still...trying to find something concrete. either way, if i'm right, or if i'm wrong, i would still like to have a policy presented that addresses this issue.

[LPN1974, LPN]

Okay, I've been reading this thread with great interest and concern.

It is not my intention to derail the thread from the original poster, but I have a question, and figured since this thread is so close in similarity it would be best to jump right in and ask.

I am an LPN in a facility for mentally and physically challenged people.

I work on evenings from 2 pm til 12 midnight. Our evening RN leaves at 8pm, so we are there for 4 hours after all the RN's are gone home, however one is on call. And the nearest hospital/er is about 5-6 miles away.

We have some staff who frequently ask for Tylenol, and I have been giving that much out, and administration knows that we do.

Some staff will ask for more tho, anything from tylenol to benadryl, maalox, dulcalax suppositories, and cold medications. I won't give anything but Tylenol.

Alot of staff want their b/p checked, even their blood sugar sometimes.

I have checked B/P's, but not blood sugars.

Anyway, my main concern is that on the night shift we have a male aide who frequently complains of "heart pain". He says he's had heart surgery, and wants us to check his b/p and he will ask us {the LPN's} questions about his medications. The last time this happened I told him he needed to have someone in his family come pick him up and take him to the ER. He refused, and stayed on the job all night. This man also frequently asks for Tylenol.

Do any of you think that the LPN's have been stepping out too far for staff and could we get into trouble legally by treating staff with tylenol and taking b/p's? And what if we refuse to give tylenol or check a b/p and someone gets ill?

We are not an ER, just a first aide station really and supposedly for the people who live there, not staff.

I am not sure, but I don't think we have a policy on treating staff. It's just always been expected.

Any comments are welcome and advice will be taken to heart. I'm going to check tomorrow on policies for staff treatment.

Thanks in advance and I hope I don't derail the thread but the OP got me to thinking about my own situation at work.

[HappyJaxRN]

Okay, I've been reading this thread with great interest and concern.

It is not my intention to derail the thread from the original poster, but I have a question, and figured since this thread is so close in similarity it would be best to jump right in and ask.

I am an LPN in a facility for mentally and physically challenged people.

I work on evenings from 2 pm til 12 midnight. Our evening RN leaves at 8pm, so we are there for 4 hours after all the RN's are gone home, however one is on call. And the nearest hospital/er is about 5-6 miles away.

We have some staff who frequently ask for Tylenol, and I have been giving that much out, and administration knows that we do.

Some staff will ask for more tho, anything from tylenol to benadryl, maalox, dulcalax suppositories, and cold medications. I won't give anything but Tylenol.

Alot of staff want their b/p checked, even their blood sugar sometimes.

I have checked B/P's, but not blood sugars.

Anyway, my main concern is that on the night shift we have a male aide who frequently complains of "heart pain". He says he's had heart surgery, and wants us to check his b/p and he will ask us {the LPN's} questions about his medications. The last time this happened I told him he needed to have someone in his family come pick him up and take him to the ER. He refused, and stayed on the job all night. This man also frequently asks for Tylenol.

Do any of you think that the LPN's have been stepping out too far for staff and could we get into trouble legally by treating staff with tylenol and taking b/p's? And what if we refuse to give tylenol or check a b/p and someone gets ill?

We are not an ER, just a first aide station really and supposedly for the people who live there, not staff.

I am not sure, but I don't think we have a policy on treating staff. It's just always been expected.

Any comments are welcome and advice will be taken to heart. I'm going to check tomorrow on policies for staff treatment.

Thanks in advance and I hope I don't derail the thread but the OP got me to thinking about my own situation at work.

I'm not sure of the answer here, but I can say that we (at my hospital) will take blood pressures, blood sugars and even hook someone up to one of our EKG boxes if it's needed. I think that's okay depending on the hospital's/facility policy. This happened to me about 2 weeks ago. My coworkers stopped working to take my blood pressure and assess if it was SAFE for me to WALK to the ER with my symptoms. I ended up having to leave work early. I was in the ER for the rest of the shift with HTN, SOB, and chest pain.

We are not allowed to administer meds other than the ones that are given to us. We have a stock supply of tylenol and ibuprophen. No one gets meds from the med drawers. The nurses who do this can get into a lot of trouble. Seen it done tho. I would never do it. Occasionally, I've heard of nurses saying that the pharmacy dispensed maalox to a nurse for personal use, but that's not common practice.

[DusktilDawn]

thanks so much everyone for your thoughts, and everything. it helps me step back and realize what others would do, broadens my thinking a bit.

ok, so today i actually had a meeting with my don. i fought the write up, professionally as i could (not easy being seething mad), but asked for their policy, for which they stated they did not have one on this issue. i suggested they make one. don said, a few weeks ago on the ltc side of the building a nurse did an ekg and vs when a visitor c/o chest pain, before calling 911. :stone she said "anything noninvasive" would be ok to do. i told her i disagreed, and will seek legal advice on the matter. there is nothing in my nurse practice act about this. i live in michigan. does anyone know of a site that shows a situation like this in black and white?

i'm at a loss here. i now my actions were right. now i need to find something that proves it.

hi rehab,

no i don't know of any black and white specific instance to provide. i also work in michigan. michigan has no standards of practice acts for nurses. michigan bon, michigan's public health act, and the ana standards of nursing are what you need to refer to. this is a link to the michigan legislature and the public health act which covers our practice.

http://www.legislature.mi.gov/mileg.asp?page=getobject&objname=mcl-act-368-of-1978&queryid=11818225&highlight=

http://www.michigan.gov/mdch/0,1607,7-132-27417_28139_28150-43523--,00.html

i would contact the michgan bon also in regards to this situation. you can also obtain a copy of ana standards of practice via their web site.

http://www.nursingworld.org/

i do believe the bon will back you in this situation.

http://www.michigan.gov/mdch/0,1607,7-132-27417_27529---,00.html

http://www.michigan.gov/mdch/0,1607,7-132-27417_28139_28150-43523--,00.html

you will note that actually contacting the mi bon on-line is not that easy. hope this helps. i have not been able to find an e-mail address to contact them.

once you assume care, which in this case would have been assessing the patient, yes collection of data is part of assessment and that includes vs, you are then liable and required to follow through in regards to care of this person. you also can be held accountable when a friend, family member, aquaintance, or complete stanger seeks medical advice, yes even outside of the work place, even if they seek this advice over the phone, you can be held accountable.

tiffanycmt: okay i may rock the boat here by having a different opinion i'm not saying you did the wrong thing but i dont think it would of hurt just to take her b/p but of course you can not administer medication to someone who is not your pt. but, we've had a few ppl come in from off the streets c/o dizziness and asking for us to take there b/p and i dont see a problem with that. just my opinion.

and in this situation, you could be held liable because you assumed care of these people. you have now put yourself and the facility in an awkward position. you are assessing people in a situation in which you have no medical history. taking a bp on a visitor may not seem like a big deal, however if one of these "dizzy" people fall 5 blocks away after you have assessed their bp, you can now be held accountable for injuries incurred in that fall. every action taken by you will be scrutinized if such a situation occurs.