A nurse submitted a question asking whether an RN can admit a patient whose glucose level had dropped even though the healthcare team, including a physician and an APRN, had decided against admitting the patient to the unit.
The submitted question lacks details, but it raises some important points for discussion.
It's unclear why the team members wrote orders that prevented the patient's admission. Also, what was the patient’s glucose level? Was it simply below normal or dangerously low?
Despite the lack of answers to these questions, one of the RN’s first concerns is that, as an RN – not an APRN – their scope of practice is limited in terms of issuing orders for admission and treatment.
Even so, the RN may have ethical concerns given their responsibilities under Provision 3 of the American Nurses Association’s Code of Ethics for Nurses. Provision 3 states that the RN has a duty to protect patients' safety. If the patient's blood sugar level was too low, this could place the patient in serious jeopardy.
Explore policies about hospital admissions
One of the RN's first steps should be to make sure they understand the institution’s policies and procedures for patient admissions. Key questions include:
- Who can admit a patient?
- Under what circumstances is admission an option?
- Who has the authority to order a hospital admission?
If the RN feels strongly that the patient should be admitted, they should contact their immediate supervisor and express their concerns.
If this is not helpful, the nurse should escalate the issue to the chief nursing officer (CNO), who can bring their concerns to the chief medical officer (CMO).
Another potential resource for the RN is the facility’s risk manager. The role of the risk manager is to help minimize patient harm and reduce the facility’s liability. Their intervention could be invaluable in this situation.
Following the grievance process
If the RN were to admit the patient without proper authorization, they could face disciplinary action, including termination.
If this were to happen, the RN should use the facility’s grievance process to formally dispute the discipline. Even if unsuccessful, the grievance would provide a record of the arguments and actions. This could be helpful when seeking future employment or if the RN is reported to the state board of nursing for practicing outside of their scope.
Practicing nursing in today’s healthcare climate is challenging due to multiple factors, including the complexity of roles and chain-of-command structures. These issues, however, should not stand in the way of advocating for patients.
Although the nurse’s question lacked specific details, this situation serves as an important reminder that nurses have an ethical and legal responsibility to advocate for patients' health and safety within their scope of practice. Generally, policies and procedures are in place to support them in doing so effectively and safely.
