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
Specializes in med/surg, telemetry, IV therapy, mgmt.
I used to work for a nurse advice line. We documented every call since by taking a call we set up the nurse/patient relationship. The patients could remain totally anonymous if they wanted or we could identify them from their insurance ID information which showed up on the caller ID screen. Either way, we still had to document every call. For this reason, every thing we advised that patient to do while on the phone with them had to typed into the computer program. To make things easier, the program had printed responses on the screen in front of us that we just cut and pasted into the electronic chart. When in training the supervisor would cringe and come running over to any trainees that were giving their own brand of advice. For the same reason, they only had RNs working the phones since the nurse practice act did not cover LPNs giving nursing advice.
This is why if anyone does decide to take that step to take a blood pressure, listen to a heart, take a pulse, etc., you need to CYA by documenting what you have done. Just because you don't have a chart in front of you for a visitor doesn't mean that you don't record what you did with them. The easiest thing is to grab an incident report form and fill it out, particularly because it often asks the important information needed. However, any blank piece of paper works.
What concerns me is if a visitor falls to the ground in front of a staff nurse, you just can't step over them and go about your job, which is the tone I'm picking up from reading everyone's replies to this. You have to do something, even if it's to pick up the phone and call for help. You can talk about the establishment of the nurse-patient relationship all you want, but as a human and as a citizen you have a minimal duty to do something for a person who is asking for help. Some of the posts here sound like people would just turn around and walk away from a situation like that without giving it another thought. You can't do that, and I refuse to believe that you would despite what some of you have written. When a patient tells you they have some little ache or pain you are obligated to investigate those statements and take some kind of action even if the action is to end up doing nothing. What I'm saying is that when a visitor gives you some information that you know could very well play out to a bad scenario, you better do something--anything, to get the ball rolling on it or you are going to look very, very bad and have some explaining to do if things end up going terribly wrong! Better safe than sorry. This is what makes us professionals and not just workers.
I disagree with some of what you have written.
I don't think it is staff nurses responsibility to check out every little ache and pain and complaint that a visitor has.
We are there to treat the patients legally admitted to the hospital or whatever facility it is.
If a visitor comes up to me with a headache, wanting their B/P checked, etc, I do NOT feel it is MY responsibility to accommodate their every request.
They need to go see their own doctor and have him/her evaluate and treat their complaints.
Now if someone is obviously in distress, having obvious chest pain, heart attack symptoms, respiratory distress, or if they have fallen and injured themselves and are bleeding, or obviously have fractured something, then I feel it is the nurses, or any staff members, place to get help immediately.
I posted a question several posts back, to which only one person responded to my question....thank HER, very much, but there is a difference to what I'm
willing to step out for.
In my previous post I was asking about a STAFF member who requests tylenol for his chest pain, and asks questions about his medications. I feel those are complaints he needs to address to his physician. I am NOT his doctor, and I canNOT prescribe treatment for him. But he will come to work at 10:00 at night having chest pain and full of questions for us LPN's and wanting his b/p checked. We told him he needed to have someone in his family come pick him and take to the ER. NO dice. He wouldn't do it.
Then on another day I was involved in another emergency where a staff member had been walking down the sidewalk, on our campus grounds, and tripped over some sidewalk repair work, and fell...hit her head, got a laceration at the eyebrow line, swelling, bleeding, some obvious confusion, etc. She was assisted to get to the medical department, we evaluated her, checked her b/p, treated the laceration, and with HER permission we sent her on to the emergency room, for further evaluation. She ended up being very sore from this fall and off work several days. I didn't have a problem at all with the treatment we provided for her. I think we did what we should have done, and got her sent on to the ER. I think they did some X-rays, she c/o of rib cage pain, also, but no FX's.
MY concern is what we're going to liable for in the case with the first staff member who comes to work at 10:00 at night comlaining of chest pain and thinking us LPN's are his emergency room nurses there to treat him, answer his questions and bring him tylenol, but refuses to take the advice that we give....which is GO to the emergency room for evaluation, now, of chest pain. He refuses to take that advice.
Specializes in rehab; med/surg; l&d; peds/home care.
I disagree with some of what you have written.
I don't think it is staff nurses responsibility to check out every little ache and pain and complaint that a visitor has.
We are there to treat the patients legally admitted to the hospital or whatever facility it is.
If a visitor comes up to me with a headache, wanting their B/P checked, etc, I do NOT feel it is MY responsibility to accommodate their every request.
They need to go see their own doctor and have him/her evaluate and treat their complaints.
Now if someone is obviously in distress, having obvious chest pain, heart attack symptoms, respiratory distress, or if they have fallen and injured themselves and are bleeding, or obviously have fractured something, then I feel it is the nurses, or any staff members, place to get help immediately.
I posted a question several posts back, to which only one person responded to my question....thank HER, very much, but there is a difference to what I'm
willing to step out for.
In my previous post I was asking about a STAFF member who requests tylenol for his chest pain, and asks questions about his medications. I feel those are complaints he needs to address to his physician. I am NOT his doctor, and I canNOT prescribe treatment for him. But he will come to work at 10:00 at night having chest pain and full of questions for us LPN's and wanting his b/p checked. We told him he needed to have someone in his family come pick him and take to the ER. NO dice. He wouldn't do it. "
I totally agree with your statements of visitors above. I also agree, that I am not there to hand out tylenol, mylanta, etc to a staff member. I used to do it, but after rumors that I was handing out MORE than tylenol, I stopped. Now the aides go to someone else to get something from. they know i won't accomodate them. i tell them to go to their doctor, or go buy their own medications at the pharmacy on their break. but no way to i give out anything.
I called my BON this morning, to find out this is not addressed at all in the practice act. our NPA is notorious for being so very vague.
my DON was no help whatsoever. she may make a p&p stating staff nurses may treat visitors with noninvasive measures as they see fit. now, i'm all for helping someone who is indeed in trouble (CP, MI, resp distress, fall or fx); but i refuse to do anything other than offer to call an ambulance for anyone else. i am not a doctor, and i do not work in a clinic, or the er. if they have a medical problem, they need to go to er, or follow up with their primary physician, end of story.
i am so tired of endless things being piled upon the staff nurse, and then when something with one of our real patients goes wrong, it will still be "well why were you helping a VISITOR?":uhoh3: .
Specializes in Critical Care, Pediatrics, Geriatrics.
rehab nurse...
You are completely validated in your actions and I am afraid that if it had been me, I would have left myself open for a world of probs.
I am so glad that I read this thread...super informative and raises alot of questions that I have now for my state NPA and facility P&P on the issue.
Like another person stated, if you had taken her b/p it still does not give you the authority to recommend/dissuade the pt from going to the ER. I posted a thread awhile back about nursing triage over the phone and almost everyone responded that their facility/state policy was to simply tell the pt that they should come to the ER if THEY FEEL THEY NEED TO. They have to have a thorough and appropriate assessment which you are not capable of doing within your facility. The visitor clearly declined an ambulance. There was no P&P written requiring you to attend to the visitor and I would fight this all the way to the top. Hope you documented well.
I guess after contemplating the situation, I would have taken her B/P just to shut her up only AFTER i explained that no matter what the results she must seek medical attention thru another facility because I can only inform her of what her vitals are, not offer medical advice. It must be her decision. Then I would have documented, documented, documented that visitor c/o dizziness, found lying in residents bed, pt asked for VS to be taken, VS were _______, visitor informed that further assessment would be needed by qualified medical facility, offered to call ambulance and visitor refused, nurse manager notified of situation...and that would be that
in the uk we are expected to treat the ill. If a relative cuts themselves it is our responsibility to treat the or give them the advice of where to get help. I feel its sad people are so scared of being sued at every opportunity
I'm not a nurse, but I have a little story to add to this. While working in the hospital as a transporter/housekeeper, a patient in one of my rooms died. He was in his 60s and his 90+ y/o mother was there. When he was pronounced, the mother fainted. Thankfully, she fell right back into one of those visitor chairs that you're able to push. So, I had to take her down to the ER right away. The nurses on that floor weren't allowed to do anything.
challenged annie. I'd like to hear more about how things differ in the ER from the US to the UK.
You stated
I feel its sad people are so scared of being sued at every opportunity
Yes we are. We are liable for what we do, and unfortunately we live in a litigious society. The majority of US nurses are privately employed even if the agency is county or state owned.
How is your employment different? I hate to say socialized medicine because I don't really understand it completely.
"She may make a p&p stating staff nurses may treat visitors with noninvasive measures as they see fit. now, i'm all for helping someone who is indeed in trouble (CP, MI, resp distress, fall or fx); but i refuse to do anything other than offer to call an ambulance for anyone else."
Great - so a visitor falls, a nurse from your facility gives that visitor some advil - to which he has an allergice reaction and dies - now who is liable? I would hope she would reconsider that idea or at least talk to an attorney first!
As for "responsible for treating the ill" Yes we are responsible for treating the ill WITHIN OUR CAPACITY, LEGAL ABILITY AND THE LIMITIATIONS IMPOSED BY THE NURSE PRACTICE ACT.
A visitor for whom there is no known history, no established relationship and no physcian available should be sent to the ER or to their own physician for evaluation. Period. We would be doing them no favors by offering them treatment if we really do not have the whole picture!!! Some folks really are that allergic to the most mundane of medications! You have no way of knowing!
The advice of two neighbors who consult each other regarding medication, treatment and the provision of first aid changes drastically when one of those neighbors is a medical professional...
In other words - you can't tell your neighbor to do the same thing you would tell a patient to do, because your neighbor hasnt had the benefit of a full workup. Unless you have the licensing, equipment and resources to work them up and prescribe treatment, you can't do that.
In a doctors 0ffice - what happens to the patient who walks in with chest pain? He gets an ambulance ride to the hospital - even the doctors office doesnt have the resources, staff and equipment to do a full workup and potential resucitaition for someone with chest pain.
Patients need to be handled in the environment best suited to their needs.
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.
As a first year (first semester) RN student, I may be putting my foot in my mouth but I do believe that I recently learned that only an RN can ASSESS a patient. LPNs are able to gather data but not assess. I'm not sure if this is a state by state rule. I am in NY. This would lead me to believe that the NM incorrectly identified the problem.
You did the right thing. I tell my staff not to do it even for employees of other hospital departments who just "want you to check my BP, its been up". You assume the liability if you take that VS and don't act if its abnormal.
You can't do that, and I refuse to believe that you would despite what some of you have written. When a patient tells you they have some little ache or pain you are obligated to investigate those statements and take some kind of action even if the action is to end up doing nothing. What I'm saying is that when a visitor gives you some information that you know could very well play out to a bad scenario, you better do something--anything, to get the ball rolling on it or you are going to look very, very bad and have some explaining to do if things end up going terribly wrong! Better safe than sorry. This is what makes us professionals and not just workers.
Daytonite, BSN, RN
1 Article; 14,604 Posts
I used to work for a nurse advice line. We documented every call since by taking a call we set up the nurse/patient relationship. The patients could remain totally anonymous if they wanted or we could identify them from their insurance ID information which showed up on the caller ID screen. Either way, we still had to document every call. For this reason, every thing we advised that patient to do while on the phone with them had to typed into the computer program. To make things easier, the program had printed responses on the screen in front of us that we just cut and pasted into the electronic chart. When in training the supervisor would cringe and come running over to any trainees that were giving their own brand of advice. For the same reason, they only had RNs working the phones since the nurse practice act did not cover LPNs giving nursing advice.