Assessing the assessment label

Due to the nursing shortage at the hospital where I work, a new plan has been formulated that would allow LPNs to take their own group of patients, in which they would be responsible for doing physical assessments. Many LPNs and RNs are uncomfortable with this, as previously only an RN was allowed to do an assessment.

To get around this, our facility has relabeled the assessment as "data collection." LPNs still would have an RN available as a resource if needed, but otherwise would be responsible for their own patients. Because the LPN is working under the license of the RN, many of the RNs are not comfortable with the LPN doing the assessment because, from a legal standpoint, they feel as though they still would be held accountable for the LPN's documentation.

Is it legal for an LPN to do an assessment, even though it is labeled as data collection? If so, would an RN be required to co-sign the documentation? Many would not want to sign if they did not personally do the assessment.

~P.B., Wisconsin

It probably will take a lawsuit that garners national attention to persuade health care providers that "relabeling" a procedure does not protect them from legal liability. It is not legal for an LPN to do an assessment if your state's Nurse Practice Act reserves that function to RNs, and calling it "data collection" does not change that.

Saying that, I am aware that LPNs do assessments in many states and RNs are required to sign behind them. In those states that reserve the assessment task to RNs, I would suggest that it is a violation of nursing practice to blindly sign behind an LPN without having done the assessment yourself.

As far as I can determine, the Wisconsin definition of the Practice of Professional Nursing { codified at 441.11(4)} is broadly drafted and not specific to the performance of specific tasks. For this reason, you need to direct your question to the Wisconsin Board of Nursing. I strongly urge all nurses to obtain a copy of your state's Nurse Practice Act and read it carefully.

Field calls
In the June issue of NurseWeek, you responded to a question about practicing disability management across state lines. Do you see phone triage across state lines as a different issue?

We have the understanding that our nurses cannot gather patient information or give direction to a patient in another state unless they also are licensed in that state. This situation arises when our pharmacy is providing service to a patient of another state and an after-hours call comes to the nurse on call for our agency.

We make a point of having the pharmacist call the patient back and assess their concern and follow through with directions.

~B.V., Minnesota

Yes, I would definitely see patient triage, assessment and the giving of directions to a patient differently. In those instances, you no longer are "processing information," you are practicing nursing.

This merger and acquisition of health care companies across state lines is opening up a host of nurse practice questions that should be answered by each state's board of nursing or via an interstate compact. Until then, access your state board of nursing as to their determination of these issues. If enough nurses have the same questions, your state board will seek legislative assistance if they haven't already done so.

Nurses should have a copy of their state's Nurse Practice Act to determine if their questions already have been answered. In your situation, it appears that your employer already has sought assistance from a legal or nursing board source. You are correctly fielding patient questions to the pharmacist on call.

Act now
I work at a small Catholic hospital in Illinois. I know we have a policy that states that you can be mandated to stay over after your shift. Is that legal? Can they make you work overtime and more than 40 hours per week?

Also, staffing recently called up to the floor and told the nurses that one of them had to stay over and the other nurse had to work the next day.

I know there is a nursing shortage (our hospital is very short-staffed), but I think they should keep the patient ratio down and not expect nurses to work extra and cover the load.

~M., frustrated in Illinois

Your frustration is shared by many nurses across the country, but federal labor law does not address this mandatory overtime problem.

It is for this reason that you need to gather all your co-workers and each of you should contact your representative in the House. HR 1289 was introduced by Rep. Tom Lantos et al. in March. It is called the "Registered Nurses and Patients Protection Act."

If passed, this law would amend the Federal Fair Labor Standards Act to prevent employers from requiring health care employees to work overtime. Voluntary overtime would not be affected.

Where there's smoke
We had a 20-year-old man admitted to our med/surg unit with a diagnosis of LOC due to acute ETOH intoxication. A park ranger brought him to the ER. When we admitted him, he was alert, oriented and cheerful. He wanted to go to the patio to smoke. His nurse agreed to take him out by wheelchair.

He asked her to get his cigarettes out of his bag and when she did this, she saw a large homemade cigarette in the bag in addition to his cigarettes. She sent him out with an aide and called her charge nurse. They removed the homemade cigarette from the bag and notified the house supervisor, who called security.

They were unable to locate a hospital policy addressing the subject. At the direction of the administrator on call, they turned it over to the police. The patient was dismissed without any further mention of the incident.

~P.P., Texas

You are correct; your hospital does need to address this via policies. There are several issues here.

Because the patient was brought into the ER by a park ranger, he may or may not have been in police custody at the time he was in your ER.

Your hospital should have a policy regarding patients who are in police custody and the policy should address how this needs to be communicated by the officer to the nurse; a nurse should not have to make a legal decision as to a patient's custodial status.

There is also a second issue here regarding a patient's right to privacy. Your hospital no doubt has a policy on this, but it may need some amending to address the discovery of a possibly illicit substance.

In the situation you described, someone at the hospital made a decision that this homemade cigarette was marijuana, necessitating police notification. I would suggest a criminal label should not have been attached to this particular item because it could have been regular tobacco.

A third issue is whether your hospital's smoking policy permits hospital personnel to accompany a patient outdoors to smoke. Your hospital correctly provided an administrator to make the ultimate decisions.

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