Legal or not?

[amadeus6]

I am a Board cert. Mental health RN on a hospital based psychiatric unit. We have a new psychiatrist who not only belittles,degrades,& humiliates staff (mostly the females-not males) but also expects us to do some things I don't feel are legal such as when he is on call for admissions.....we are NOT to call him to discuss the possible admission, but to use our discretion as to if they meet unit admitting criteria & if so, bring them on unit for him to see the next A.m , do admission process to include giving registration an admitting diagnosis, AND documenting which Dr was called, the date,time, decision to admit or refer elsewhere. As I see it, this is falsifying documentation, as well as practicing out of our scope of practice by signing admission standing orders as a verbal order with diagnosis filled in. Our policy & procedure states ONLY the MD can determine whether to admit a patient.
I spoke up about our concerns regarding the legality of these issues (everyone else was to fearful to say anything & just go along with it), and was told by supervisor that thre is nothing wrong with doing it his way, but if I was that uncomfortable with it, then I would no longer be placed in the charge nurse role (we rotate), would not be allowed to do the preliminary inquiry/eval to determine if patient does meet criteria to be admitted (our screening process to gather info to relay to MD to determine if he chooses to admit or not) nor am I to speak to or call this MD as he says I am "hostile" towards him for not wanting to do things his way. Our other Psychiatrist follows the process to a tee & follows all policy & procedures.
Now after having spoken up, I not only have the above listed restrictions, but the last 2 schedules has had me doing rotating shifts weekly ( 7A-7P, & 7p-7A) instead of my previous schedule of strictly 7P-7A that I have been on for the past year---although no one elses has changed any at all. My supervisor denies that these issues are any type of retaliation for speaking up but it sure seems like that to me. Any input on this will be appreciated --such as opinions of the legality of his practices.
P.S- his reason for not wanting to be called is that if he dont get adequate 8.5-9 hrs of sleep, he cant function well---(maybe he should've considered a different profession) and the few times I did call him regarding admission possibilites-I was told "You are not supposed to call me for admissions! If you are too incompetant to decide if they meet criteria, then let someone else decide!"

[ToddRN]

Amedeus - My best advise is to beginning running and get out of there. From what you describe here, it is a very un-healthy work environment and will only become more caustic as time goes on. If your insitutition's policy is clear, then it could be construed as he is not following policy and administration should be dealing with this and not staff. Best of luck.

[amadeus6]

Thanks! I did speak with our DON about this, but had to make an appointment to see him and I'm sure my supervisor spoke with him before I did because he seemed to have all his responses planned, & his solution was " Well we definitely need to revise the policy like yesterday, but you are not practicing out of your scope by bringing them on the unit until seen by the dr." BUT in order to do this they have to be admitted so therefore I still feel I am right on this . He also suggested I try to repair my relationship with the dr that has called me incompetant twice,said he would not speak to me on the phone unless the call is recorded & said I am hostile because I didnt just give in to his demands -my license is too important. I am considering notifying JCAHO on this issue.

[ToddRN]

Unfortunate.. May I suggest that in the future, if you have to contact this physician, you have another RN on the phone with you are very close by. I will tell you I had a physician once begin to yelling at one of my staff and we put him on speaker phone for everyone to hear...... Never happened again!

By having someone else with you, you have the suppor of your peer and other's around to help coaborate your "behavior" and "hostility."

Best of luck.

[NurseVentures]

Agree..always have another fellow nurse witness your conversations. Listen if you are not satisfied with what your director advised...I would bump it up. Most institutions now have a policy on how to do that (Check your policy book) .... if not make an appointment with a Director at Human Resources to talk about your concerns... They are there to help staff on issues like these.

Dallas

Dallas Piana
Nurse Ventures

[NURSEDETROIT]

Or do what I did! email me for details! Trust me you will be glad you did!!

nursehaber@optimum.net

Elisa Haber, RN, BSN

Noted the posts and your responses to the various threads. Now, I "gotta" ask sister, what's your angle and what are you selling here? Call me an old dog, a skeptic, cynic, or having been run around the block way too many times. . . Whatever. Start a new thread and do share with and for all those affected. . .

[JaneDoeRN]

lol... my thoughts exactly !

[maire]

In reply to the OP, I would start the job search and get out of there when you get something lined up. It is obvious to me that you have no backing and that will not set well for you in the future. Leave on your own terms.

[jayne1975]

Here is the dilemma as I see it from your post: Your facility has policies in place which require you to speak to the physician regarding the admitted patients and your physician isn't making this possible. Your state probably has a similar rule for physician orders regarding admissions.

Making those decisions as a charge nurse puts not only your license at risk, but your job. (Currently, by falsifying documentation to state that you've spoken to a physician regarding an admit, you can be fired for cause; and outside your particular facility you could face investigation by your state board of nursing.)

It seems to me, you need to find a new place of employment or accept that you will not be one of the nurses who rotates into the charge nurse role in your facility.

[TriciaB]

I'm thinking: find another job and drop a dime to JCAHO on your way out the door. I've seen this tactic before; put the nurse in an impossible position legally and then hang that person out to dry if anything goes wrong. This is a very messed-up workplace. Good luck.

[slashx]

Just like what im thinking

[kathy_vacationland]

Since you did not get anywhere going thru normal channels I would suggest that you look up hospitals policies and to note if there are certain regulations that are very specific to your unit. Myself as a Float RN not only observed clients but also found that Psych is a different entity in itself. The unit only holds 20 in-patients usually and each shift had a charge nurse and a RN to do intake on any ER patients that came thru the door to see if they needed to be admitted by how that person presented themselves at the time of ER admission. Any intake nurse was responsible to call MD and at least get a DX. and admission order and any medication orders. It may also help you to know that each MD for that unit had very different approaches as to how the rules & regs were set up. Now for JACHO you can call them at any time and do not have to give your name can be totally confidenial. If you feel that this MD is out of order write him up..and since you are getting grief already just file your complaint through out hospital like Risk Management etc..but look for a new job so you do not have to work in a hostile environment.