Help: New Nurse-driected Health Center

[Nicole Weathers]

Hello All,

I have been working at a privately funded faith-based accredited 2-year institution in New York for this past school year working 1:1 directly with the on campus physician. The Doctor is about to leave and will not be replaced with another physician. Thus, I am left trying to see how I can keep functioning in the Health Office in the Registered Nurse capacity.

We have no written policies or procedures. Everything was done with direct collaboration with the physician and verbal orders.

Any advice about the process for finding a Medical Director to cover me and given me standing orders for first aid, basic care and OTC meds?

We have several AEDs on campus. Any advice or legal issues associated with this program that I should be aware of?

Any resources for criteria for referral or triage?

Any examples of paper documentation used for Nurse-Directed health center (they may get rid of the EMR when the physician leaves)

I really would appreciate any and all advice regarding this matter. I have the summer to try to pull something together before next school year starts.

Thank you,

Nicole Weathers, BSN, RN

[sagutri...@smcm.edu]

Nicole,

I have found this topic to be very difficult to navigate for myself in my position.  Though I do have advanced practice providers here on a part-time basis so my burden is bit lighter in regard to standing orders/Mutually Agreement Protocols (MAUP) .  But I took over a vacant position and unfortunately past health directors did not have current working P&Ps and no protocols/standing orders in place beyond expired emergent ones.  I'm now trying to reinvent the wheel. The only supportive references I have found are quite old and some I can not find beyond being referred to in other journal articles or papers.  And many refer to utilizing the medical director for guidance, but we do not have a medical director since we are nurse directed health services.  One of the more helpful articles can be found in JACH archives "Developing Protocols: A Guide for RN-Directed Student Health Services', Janice Kerwood Stump RN, BSN.  Each state has their own version of the nurse practice act, the state board of nursing should be a good resource of information though ours is not user friendly.  I was able to find guidance r/t OTC meds from our MBON website.  And somewhere in my research travels I stumbled on a document specifically about NY state having tight rules on RNs distributing OTC, so make sure you find out your state specific nursing laws, immunization, and pharmacy laws, etc...

We are switching from a paper based system to an EMR.  If you want any template forms (health history, immunization, etc...) I'm happy to send them to you. They aren't fantastic but utilitarian.

Best of luck to you!    

[Nicole Weathers]

Hello,

Thank you for your reply. Yes, I am very limited with that I can do without an advanced practice physician. I cannot give or recommend OTCs, I cannot follow any non patient specific standing orders unless it is for immunisations or anaphylaxis. So basically I will assess, triage, refer, and health promotion. I would really appreciate any paper templates that you have for your paper forms and any info you have on nursing triage. 

Thank you!!

Sent from my iPhone

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