Know your obligations under the law
Know your obligations under the law
Clinicians shouldn't wait until they are ordered by law enforcement to draw blood from an unwilling patient to learn what their responsibilities are
Five states have passed blood alcohol reporting laws and several others are considering legislation, so be fully informed about your obligations under your state law. ED nurses at New London General Hospital (NH) learned about their state's recently-passed law when an injured drunk driver was brought to the ED and law enforcement officers ordered a nurse to draw the patient's blood against his will.
The patient was collared and strapped to a backboard, and hadn't been to X-ray yet, recalls Lois Rockwood, RN, CEN, the hospital's nursing director of emergency services. "He was afraid of needles, so the nurse was afraid he would thrash around and injure himself," she says. "When the nurse explained she needed to wait until the patient's X-ray was cleared, a state trooper threatened to have her arrested and thrown in jail for obstruction of justice."
Tempers flared, and the nurse stood her ground. "We offered to call the county attorney so we could understand what our obligation under the law was, but the troopers walked out of the ED, saying it was too late to do anything," says Rockwood.
After the unpleasant incident, a meeting was held with nursing staff, state police, and hospital and county attorneys. "A face-to-face makes all the difference in the world," says Rockwood. "It would have been better if that had been done prior to the incident so people were well informed prior to making a decision, but we did get clarification about exactly what we have to do."
The law mandates that clinicians draw a patient's blood alcohol in cases of death or serious bodily injury if police officers request it. Violating patient confidentiality was a major concern. "We were quite concerned this could be viewed as assault or violating patients' civil rights," says Rockwood. "Although it was explained to us that the wording gives you immunity from liability, it still doesn't make you feel good as a health care provider to do this to somebody against their will."
The hospital developed a policy for situations that may arise in the future. "If you get a trooper who is adamant and difficult, that can throw the whole interaction off," says Rockwood. "If one of the nurses is uncomfortable, then myself or the administrator on call would be involved, and the county attorney is called."
If a particular nurse isn't comfortable drawing a patient's blood for the police officer, another clinician is asked to do it, Rockwood explains. "You have to go by your own professional and personal comfort level, and each circumstance is a little different," she says.
Although some ED nurses remain conflicted at New London, most recognize the intent of the law is beneficial, says Rockwood. "We do have a good rapport with local law enforcement, so we feel we can make this law work, so we're not obstructing justice or violating patients' rights," she notes.
The bottom line is to save lives and avoid tragedies, Rockwood stresses. "We recognize that there is a specific obligation to emergency nurses to assist law enforcement in dealing with drunk drivers," she says. "We don't want to see innocent people being killed, so whatever we can do, we have to do."
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