What liability does a remote-monitoring RN (checking for blood pressure, weight, oxygen saturation, glucose) have when the service is considered health coaching and not a health service?
We don’t have written policies or procedures, and we reach out to the patient and primary care physician if needed. My director is clinically inexperienced and doesn’t understand the legal ramifications of not having policies for our role and where our liability ends.
Whether one calls the provision of any kind of nursing services health coaching or a health service, you are still using your nursing skills, expertise and judgment to monitor the patients for whom you have responsibility. Although you gave few details about your responsibilities, your director’s background and how patients are referred to you for monitoring, established policies and procedures should be in place. Such policies would help you when decisions must be made about the patient’s well-being and communicating concerns to the primary care physician.
It is assumed that the primary care physician provides orders for you for the patient and includes parameters for your monitoring. How are these orders documented? How are they obtained? Where are the original orders and any changes kept?
If your remote monitoring is across state lines, keep in mind that you must have a license to practice nursing both in the state in which you monitor and in the state where the patient resides. If you are a member of a state included in the Nurse Licensure Compact, in which the remote state in which you practice is also a member of the compact, and you have requested and received a multistate license from your home state, you can seamlessly practice across that state line without applying for an additional license.
You can learn more about the NLC, which states have adopted the NLC and those contemplating doing so, and also learn about the new NCL adopted by the National Council of State Boards of Nursing in May of 2015.