For Nurses

Standing Orders for LPNs, RNs, MAs

Nursing Policy N 001

Note: All test results will be shown to provider for review. This policy and procedure shall remain in effect for all patients of CrossOver Healthcare Ministry until rescinded.

N

Glucose

Perform a glucose test on patients showing symptoms of hypoglycemia or hyperglycemia.
N

Pulse Oximetry

Perform a pulse oximetry on patients who are on home oxygen, are actively wheezing, experiencing chest pain, complain of fatigue, or are in respiratory distress.
N

PPD

Perform a PPD on patients who require testing for school, shelter needs, or employment, who deny a past positive PPD. Give it within a three day time frame for a return visit to get the spot read recorded.
N

Flu Shot

Please see nursing policy N-XXX for standing order for flu shots.
N

Hemoglobin

Check hemoglobin on patients who are anemic, and have not had hemoglobin checked in the last 6 months. Also check hemoglobin on patients who complain of unusual, excessive bleeding or complain of fatigue.
N

A1C

Perform an A1C test if the patient is diabetic and an A1C test has not been performed in the last 3 months. Check the progress note, Pharm D form, and the lab section of the chart for previous results
N

Urine Pregnancy

Perform a urine pregnancy test on women who have missed a period, report a positive home pregnancy test, and prior to a depo provera injection. Be sure to record the date of their LMP.
N

Urine Dip

Perform a urine dip for patients with dysuria, gross hematuria, frequent urination, or other urinary tract symptoms, or TIPS patients who have not had this test in the past year. Keep and hold the urine sample.
N

INR

Perform an INR on all new patients that are on Warfarin. For existing CrossOver patients that are on Warfarin, perform an INR only on patients that are being followed by CrossOver. Do not perform an INR on patients being followed by an outside Warfarin clinic unless instructed to do so by a clinician.
N

EKG

Perform an EKG on any patient that presents with chest pain.

Nursing Roles at CrossOver

Triage
RNs and LPNs may perform triage duties on their own without consulting with a clinician, although consultation is encouraged when possible. A MA could only do triage if they report to a NP/MD/PA to finalize the disposition. A MA would only be used in this manner if a RN or LPN is not available.
Phlebotomy/Injections/Immunizations
These higher order invasive procedures will be done only by competently trained and credentialed RN/ LPN / MA. Phlebotomists may perform phlebotomy, but not injections or immunizations. PharmDs perform immunizations.
Other procedures
A competently trained and credentialed RN/ LPN /MA/CNA performs the following procedures:

  • Finger-stick tests: hemoglobin, Hemoglobin A1c, blood sugar, INR
  • Urine tests: pregnancy, urinalysis
  • Vital signs (including height, weight, temperature, pulse, respirations, blood pressure)
Medical Histories and Medication Lists
Medical information gathering activities will be done by competently trained and credentialed RN/ LPN / MA /CNAs.
Credentialing
A staff nurse coordinator will orient and credential the various nursing health professionals with respect to various procedures and information gathering activities in the clinical setting. A credentialing document will be maintained by the staff nurse.
Other Professionals
Certified EMTs, Paramedics, and other health professionals will be considered for service in the nursing setting on a case by case basis by the Medical Director of the clinic site, and if approved credentialed by the process listed above.
Students
Please refer to CrossOver’s policy on students of the health professions.

If this is a medical emergency, please call 911 immediately.

Both CrossOver Healthcare Ministry clinics have received certification by the National Committee for Quality Assurance. NCQA recognition signifies that CrossOver is "patient-centered" and offers a true medical home for our patients.

CrossOver Healthcare Ministry

Mailing Address:  8600 Quioccasin Rd, Suite 101, Richmond, Va 23229 • (804) 655-2794 • info@crossoverministry.org
Downtown Clinic:  108 Cowardin Ave, Richmond, Va 23224 • (804) 233-5016
Western Henrico Clinic:  8600 Quioccasin Rd, Suite 105, Richmond, Va 23229 • (804) 622-0803