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?

[TypicalFish]

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.

1) Contact ANA-they will certainly help you, maybe contact them first

2) Contact your BON, and see where they stand

3) Contact a lawyer

4) Sit down and write everything out; document, document.

[Dayray, RN]

To the Op - you did the right thing.

Taking vital sighs is an indication that you are accepting care of that patient as a nurse. If she did have abnormal vitals you would then be in the bad position of needing to obtain orders for treatment and that would dig you even deeper into legal problems because she is not an inpatient at your facility her attending may not have privileges there and your facility is not a cardiac/emergent care facility.

To those saying she should have just taken the vitals- I agree that as nurses we should act when we are able to help people. Still this woman was not dyeing. She wasn't in cardiac arrest and wasn't actively bleeding. In all cases you must approach the situation with the best interest of the person in mind. In this case if she had found abnormal vital sighs she wouldn't have been able to anything about them. She offered the best solution to the problem available, Ill call the ambulance, the person declined. If it had been me I would have gone a step further and would have called the ambulance even though she declined because if the patient had then coded and died on the floor the facility could be liable because they were aware of the situation.

I often have visitors ask if I can take their BP or give them a Tylenol, Motrin, Midol. I explain that I cant because they aren't a patient but tell them if they choose to use hospital equipment while I am out of the room to take a BP to please not tell me that they have or direct them to the public pharmacy across the street.

In the case of injuries/emergent situations with the visiting family members I do an ABC assessment and have had to do CPR on 2 and a few times put pressure to stop bleeding. Also being that I work L&D I once admitted a patients sister and we treated her for PTL once she was an inpatient and we had received orders from her attending. If a patient can be moved to the ER then we move them their otherwise all I do is make sure they aren't in need on emergency treatment and then suggest they visit the ER.

If you choose to treat visitors you are accepting legal responsibility for them and you do them an injustice if you can't treat them appropriately.

[Balder_LPN, LPN]

As far as this on the write up, "LPN incorrectly assessed situation, and did not render care as appropriate"

I am still a student, but my wife is an LPN, and my understanding (maybe it is just here in WA) that LPN's cannot independantly access a pt anyway, only under the direct supervision of an RN, NP, or MD

not that it changes the overall situation, but it should give the OP more ammo in her "rage against the machine"

With my prior life experience of standing up for myself (even in the military) my biggest fear of becoming a nurse is exactly this type of thing happening to me, cause I wont be bullied into doing things that I know are wrong (ask that lieutenant that wanted me (as a private) to take a dud mortar round out of his hummer, and I told him he was supposed to have left it on the range and I was calling EOD cause he had an explosive in a barracks area) I hope my carreer is never jeopardized for doing the right thing.

[BabyRN2Be]

What was that manager thinking in writing you up?? :angryfire You are absolutely correct in that once you take VS you enter into a nurse/pt relationship, and you become responsible. Would the NH would that riding on their back?

You did the right thing in offering to call 911. That's all you should have done. I also think you need to point out the above argument in you are defending the writeup.

I'm a little behind on posts and things may have changed since you first wrote this, but I just wanted to let you know that initially you did the right thing.

[gr8rnpjt, RN]

my mind just keeps pouring over the possible outcomes. what if the rn went and took the bp, and got 200/100? what are you gonna do? pop her out a catapres? give me a break!

My only question would be-if you did take the bp and it was 200/100, do you think maybe you would have been a little more forceful in calling an ambulance or having the family members take her to an appropriate acute facility?

Not that I think what happened to you was right, because if it is against your facilitys policy, then your supervisor was not correct in writing you up.

[flaerman]

I think you are not wrong, your supervisor went way overboard too(I am a supervisor in a 142 bed acute facility) because she was not your pt or responsibility. By offering to call an ambulance you did what was right. In any facility I have ever worked in (acute care) if some visitor or family member doesn't feel good, they go to the ER, the only VS I have ever taken on someone like that is in an emergent or Code Blue situation. You get involved and start treating someone on your unit your put yourself and your facility in jeopardy. flaerman

[CoffeeRTC, BSN, RN]

What about legal department? If you are a corprorate facility, I'm sure there is one. This is a great topic to discus.

[IMustBeCrazy]

the write up said partly "LPN incorrectly assessed situation, and did not render care as appropriate."

The word "assessed" has me concerned. I know in many states, LPN/LVN's are *not allowed* to assess patients, it's in their nurse practice act.

So, what does yours say???

~IMBC

[CoffeeRTC, BSN, RN]

Actually, you refused to assess..

[rehab nurse]

yes, to those who questioned the word "assessed", lpn's in michigan are allowed to collect data and report it to rn or physician. we function under the direction of the rn or md. which is why i refused to take the vs and got the rn on duty, only after offering to call 911 twice and telling the family after refusal that they should drive her around the corner to our sister hospital. i do not know what the rn stated to the family, as i left the room. all i know is she got me in trouble for not taking the bp.

i tried to contact the michigan nurses association today, they didn't want to help me cause i'm only an lpn. so i will try calling the BON tomorrow and see if they can get me something concrete here.

thanks everyone for the continuing replies....

[Noryn]

oh, and the write up said partly "LPN incorrectly assessed situation, and did not render care as appropriate."

I was quoting the write up statement. Anyway just read closely it doesnt say LPN incorrectly assessed the patient but incorrectly assessed the SITUATION. LPNs, CNAs all assess different situations and either it is something they can take care of or something they have to refer up the chain of command.

My main point was (despite what the nurse manager said) the LPN did correctly assess the situation and did not render care because it was not appropriate.

[CseMgr1, ASN, RN]

oh, and the write up said partly "LPN incorrectly assessed situation, and did not render care as appropriate."

I hope you didn't sign it. How can they hold you accountable for an action that they don't even have a policy for???

The whole idea of having a Policy and Procedure in place is to cover your rear end in such scenarios...and in a court of law. And, since you were told that they don't have a policy in place for this particular situation, I would consider this write-up to be null and void. I'm sure that a good attorney would agree with you.