Roles in physician's office

  1. I know this has been discussed before, but I have some particular questions about the topic.

    I am newly working in a pediatrician's office, about 3 weeks now. I am the only RN, there are 2 LPNs, and the front office staff. The girl that does the triage is a phlebotomist, not a nurse. Before I came, she worked in the back, doing the same things I am doing now, including immunizations. Now in triage, she is dispensing medical advice, under the direction of the physician. Not only that, but the other day on the phone, she told a caller she was a nurse. Actually, I heard her say "you're speaking to one" and I know the caller asked to speak to a nurse. I'm wondering about the legality of all of these things, if my license is in any kind of jeopardy because I know about this and haven't reported it.

    That being said, I have to tell you that this girl is WONDERFUL. Before I started working there, I would call at least once a week and talk to her. She knows exactly what to say, how to calm down an hysterical mother (me!), and has the most soothing calming voice I have ever heard. She never gets irritated and always sounds happy to hear from me, even though I know she isn't really. I think she is perfect for what she does. I still wonder about the legal issues, though, if there even are any. Does her being a phlebotomist change anything?

    Any thoughts?

    Laura
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  2. 3 Comments

  3. by   mcl4
    Originally posted by LauraRN0501
    I know this has been discussed before, but I have some particular questions about the topic.

    I am newly working in a pediatrician's office, about 3 weeks now. I am the only RN, there are 2 LPNs, and the front office staff. The girl that does the triage is a phlebotomist, not a nurse. Before I came, she worked in the back, doing the same things I am doing now, including immunizations. Now in triage, she is dispensing medical advice, under the direction of the physician. Not only that, but the other day on the phone, she told a caller she was a nurse. Actually, I heard her say "you're speaking to one" and I know the caller asked to speak to a nurse. I'm wondering about the legality of all of these things, if my license is in any kind of jeopardy because I know about this and haven't reported it.

    That being said, I have to tell you that this girl is WONDERFUL. Before I started working there, I would call at least once a week and talk to her. She knows exactly what to say, how to calm down an hysterical mother (me!), and has the most soothing calming voice I have ever heard. She never gets irritated and always sounds happy to hear from me, even though I know she isn't really. I think she is perfect for what she does. I still wonder about the legal issues, though, if there even are any. Does her being a phlebotomist change anything?

    Any thoughts?

    Laura

    This seems unusual having an unlicense staff member triage phone calls. I've worked in a physician's office and have called my own ped and it was at the minimal a RN talking with family or patients. She may be wonderful, but there is more to triage that is beyond her job description and her education.
  4. by   P_RN
    It sounds like you already know what the answer will be.
    And I'm sorry to tell you that the doctor (s) already know that too.

    No, she cannot call herself a Nurse. That is not legal.

    It seems that the office may need a bit of reorganization. Perhaps the LPNs could be moved up to the immunization task and the RN (you) could be trained in triage. The phlebotomist would be OK at taking messages, I think and then you could follow a set protocol in actually doing the triage.
  5. by   NRSKarenRN
    this is a question that needs to be reviewed and answered by all nurses working in doctors/dentist offices.


    1. all nurses need to be aware of what the state practice act rules and regulations are (in the state they are practicing in) and follow them! they are held accountable to the practice states laws, not just to initial licensing state law. we have a duty to protect the title "nurse, lpn/lvn and rn".

    most practice acts are online (not all) and can be found via links at the national council of state boards of nursing website:
    http://www.ncsbn.org/public/regulati...g_board.htmate boards of nursing website.


    2. is nurse a protected title in your state (most but not all)? if its protected then only actively licensed lpn/lvn and rn's can use the title nurse.

    3. a physican/dentist can employee anyone to staff their office and perform any activity/procedure under the physicians license if given instruction and permission by the physician/dentist to do so unless a states law requires licensure or states differently under state law! if they permit non-license staff to call themselves nurses, they are liable for violation of state laws and fines, varies per state.

    4. who is in charge of the practice? individual physician or corporation? who is in charge of supervising the office staff, either verbally or in writing: that determines if the office staff are practicing under the office nurses license or the physicans/dentist license. if a nurse routinely gives direction/delegation to staff without a written document stating physician is responsible, it is assumed the staff to be practicing under the nurses license; the nurse can be held accountable of mistakes made or errors in judgment re advise given out by office staff.

    it is imperative that office nurses have a job description to protect themselves and to follow to minimize legal risk to their license from "delegation of duty."

    re: virginia laws:
    http://www.ncsbn.org/public/regulati...sing_board.htm

    chapter 30

    54.1-3008. particular violations; prosecution.
    it shall be a class 1 misdemeanor for any person to:

    1. practice nursing under the authority of a license or record illegally or fraudulently obtained or signed or issued unlawfully or under fraudulent representation;
    2. practice nursing unless licensed to do so under the provisions of this chapter;
    3. knowingly employ an unlicensed person as a professional or practical nurse or knowingly permit an unlicensed person to represent himself as a professional or practical nurse;
    4. use in connection with his name any designation tending to imply that he is a professional nurse or a practical nurse unless duly licensed to practice under the provisions of this chapter;
    5. practice professional nursing or practical nursing during the time his license is suspended or revoked;

    54.1-3016. use of title "registered nurse" or "r.n.".
    any person who holds a license to practice professional nursing in virginia shall have the right to use the title "registered nurse" and the abbreviation "r.n." no other person shall assume such title or use such abbreviation or any other words, letters, signs or devices to indicate that the person using the same is a registered nurse.
    54.1-3019. use of title "licensed practical nurse" or "l.p.n.".
    any person who holds a license to practice as a licensed practical nurse in virginia shall have the right to use the title "licensed practical nurse" and the abbreviation "l.p.n." no other person shall assume such title or use such abbreviation or any other words, letters, signs or devices to indicate that the person using the same is a licensed practical nurse.
    54.1-3022. use of the title "certified nurse aide" or "c.n.a.".
    no person shall use or assume the title "certified nurse aide" or abbreviation "c.n.a." or any words, letters, signs, or devices to indicate that person is a certified nurse aide unless certified by the board.

    it is your responsibility to bring this to the physician's attention, as you can be held liable for allowing this practice to continue.

    sounds like an office staff meeting after discussion with physican needed stat.

    ------------------------------
    see the thread is it legal? what's your opinion??
    where a physician in utah set up his practice's website and listed medical technologists under the term "nurse." a victory by nurse posters here @allnurses!.

    http://allnurses.com/forums/showthre...=is+this+legal
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    this information is presented based on nursing inservices, jcaho preparation and healthcare administration courses i've attended over the past 20 years. karen
    Last edit by NRSKarenRN on Dec 5, '01

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