HCFA rules leave nurses out of picture
Because newly released restraint regulations from the Health Care Financing Administra tion (HCFA) in Baltimore don’t allow the use of medical staff protocols, it hinders the collaborative working relationship between ED nurses and physicians, says Toni Mitchell, MD, FACEP. Mitchell is a member of the Dallas-based American College for Emergency Physicians (ACEP) board of directors and chief consultant for acute care at the Veterans Health Administration in Washington, DC.
"The regulations essentially left nurses and psychiatric social workers completely out of this," she notes. "This is completely inconsistent with how HMOs deliver mental health care today."
New rules hinder decision making
Previously, nurses were able to make the initial assessment and tell the physician that a patient needed chemical or physical restraint, she notes. The regulations diminish the nursing role in the clinical decision-making process, Mitchell emphasizes. "They can’t do anything other than tell the physician the patient needs to be seen right now."
Nurses are not able to perform what is covered under their clinical practice, she says. "So there may be some disruption of established relationships and styles of practice," Mitchell warns.
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