another scenario

In hospital:
Patient is an elderly woman who is mildly confused and depressed. She crys at the drop of a dime. The pt is a DNR and has no telemetry on. Family comes to visit and asks to take her via wheelchair out to the hospital courtyard as it was a beautiful day. The primary nurse stands firm in not allowing her to go until she gets an order from MD.
The only floor policy there is refers to patients on telemetry. Those on tele are not allowed to leave floor.
What is you alls take on this situation? Is a doctors order really necessary?
We alls don't do your homework for you. So tell us: What do you think, and why? Sometimes when you get questions like this in school the point is to see what you do to find an answer (hint: "ask on an internet forum" is not high on your faculty's list of acceptable resources ) and how you defend it. Let's hear your thoughts and then we can chime in.

This is not homework. .this is a real scenario and I did not think the nurse was correct but maybe just covering her tail.I have no school homework anymore..Im a RN now thank the Lord

Seems pretty cut and dry to me. Wait for the order.

You're a nursing student? "2013SNGrad"? You're entitled to think that (and you may be right) but why do you think so? Merely because the floor rule says "tele patients must stay on the floor"? (You know why that rule is a good one, I think.)What have you learned about patient autonomy and RN responsibility to provide nursing plans of care (as opposed to medical plans of care)? What is the RN's first duty? Here's an excellent scenario for you to think about how you would exercise some of your nursing judgment beyond "that's policy" and "she's just covering her tail" or "call the MD." Hint: This is NOT an MD call, as described.

I WAS a nursing student..I have graduated and passed my boards within the last 2 weeks. I dont know how to change my name on here however, I would have let her go to the courtyard without an order. She was not leaving the premises or in any distress. I just wondered what other nurses thought based on their experiences.

I was a floor nurse a few years back and many of the pts left the floor to go outside, go downstairs to the cafeteria etc..I never heard of a nurse get upset about it as long as the pt was stable. Families also took them in wheelchairs at times for the ones that didn't walk very well.. On the floor, I see nothing wrong with it. Now I am in the ICU and if they are asking to go outside, I call the doc to get a transfer LOL..Now I am wondering if we have a policy re this

In my opinion, you are correct. Hospital is not jail. Even a tele patient can leave the unit if you explain that this means he will no longer be monitored and the floor cannot vouch for his safety under those circumstances. Document, document, document. If he keeps it up the MD may wish to discharge him as he is not adhering to the medical plan of care, and therefore his insurance may not pay for his stay. But he can still go outside if he wants to. She was in no danger. Your nursing judgment would be that this would be good for her -- spiritual distress, sadness, whatever you assessed. You would document that, make sure the family member knows how to call for help prn, and see that she's adequately dressed for the weather/has shade/whatever. To change your name, go to Account > Dashboard > Help Desk tab. Make your request in the space there and an Admin will help you do it.

But if the policy says tele pts need an order to leave the floor, why not just get the order first? This woman was going to have a complete emotional break down if she had to wait 15 min for an order?? It may be a silly policy, but it is what it is. Why risk getting in trouble?EDIT: ok, I re-read the OP and see that the pt does NOT have tele on. My bad. That primary nurse was just being silly.

Quote from BrandonLPNBut if the policy says tele pts need an order to leave the floor, why not just get the order first? This woman was going to have a complete emotional break down if she had to wait 15 min for an order?? It may be a silly policy, but it is what it is. Why risk getting in trouble?.

I'd let them go. Don't see a reason not to.

Could be considered leaving AMA unless you have an activity order that says "ad lib". Otherwise, if you have an order that reads "bed to bedside chair" or some other restricted activity order, it can fall on the nurse if say the patient gets hurt on hospital grounds while outside when the order reads differently.See what the actual activity order says. You can not hold someone against their will, but your activity order needs to be correct.

Yea most of our activity orders are "advance as tolerated" so it leaves it up to the RN to assess if the patient can be up, but my issue with this was the whole civil rights perspective.