I work in long term care. Occasionally, a client must be sent to the emergency department (ED) for assessment of their condition. Can I make this decision independently or do I need to consult with the RN first? As an LPN, can I accept the client back from the ED if there is no RN on site?

First, always know and follow your agency policy related to transfers.

If the transfer is ‘booked’ and part of the plan for the client and if the team is aware, then you should update the RN about when the client leaves and returns and the client’s overall status and experience.

Ideally, the RN should be notified whenever you have determined there has been a change or decline in the client’s status. Together you can decide the best action for this client, which may or may not include a trip to the ED.

In emergency situations whereby the time associated with an RN consultation could greatly impact the client outcome, you should proceed with the transfer and notify the RN as soon as possible.

Cases where there is a difference of opinion regarding the need for transfer, require finesse and negotiation. You are expected to have a conversation with your colleague about your assessment and why you think a transfer is required. You should also be open to hearing your colleague’s interpretation of the situation.  In the end, you are expected to critically think through the situation taking into account your assessment findings and the input of your colleague and make whatever decision you feel is most appropriate to manage the client. Regardless of your decision, you are required to inform your colleague and document your assessment, your conversation and your actions.

You are accountable for the action you choose, including engaging your colleague in a discussion about the circumstances which may have led to the difference of opinion and strategies to prevent similar situations in the future.

You may receive the client returning from an inpatient or outpatient stay. In doing so, you may perform an assessment and review the plan and orders. Once you have the necessary client data, you are expected to communicate with the RN to determine the next best action. For instance, if the pre-hospital plan is not substantially changed, you both may decide it is sufficient and carry on as before the hospital visit.  If the plan has substantially changed, then you and the RN should collaborate to revise the existing plan of care, to ensure it meets the client’s current health care needs.

Document your action and discussions in the client record (including the collaboration with the RN or others).

Still have a question? Email a practice consultant at practiceconsultant@clpnns.ca