Where are my rights as a RN? Is this true...

TheCommuter, BSN, RN · Apr 23, 2014

Although I am not in Florida, my former nurse manager's RN license was revoked by the Texas Board of Nursing in 2010 due to the substandard care of the nursing staff who worked under her.

I also personally know two other nurse managers whose licenses were referred to the Board of Nursing for mistakes made by nursing staff. One of these mistakes (failure to check the INR for several weeks in a row while receiving Coumadin) resulted in the death of a patient.

Ruas61, BSN, RN · Apr 23, 2014

I have seen DON of LTC go before the board and receive discipline for negligence under their watch by nurses.

It was for failing to follow up, monitor or be aware of conditions or situations that were harmful to clients.

That said, each nurse is still responsible for their own licenses.

It would depend on the situation and the interpretation of it by the BON.

She sounds a tad OCD.

ausrnurse · Apr 23, 2014

I have seen DON of LTC go before the board and receive discipline for negligence under their watch by nurses.
It was for failing to follow up, monitor or be aware of conditions or situations that were harmful to clients.
That said, each nurse is still responsible for their own licenses.
It would depend on the situation and the interpretation of it by the BON.
She sounds a tad OCD.

Some managers should be held responsible. Particularly when there is a documented history of unsafe practice with no action taken by the manager or the provision of an unsafe workplace, but I don't believe it is an excuse for micromanagement.

ceebeejay · Apr 23, 2014

Yes, the RN is liable for their patients' assessments. If the RN delegates the assessments to another, the RN is still liable to know the assessment was done, know the result, and follow up when there are unusual results. So, yes, you are responsible for the PCA's that work on your assigned patients and since all patients are assigned to the managing RN on the unit, that RN is responsible for the care rendered by all personnel on the floor and can be held liable. Your manager may be just a bad manager, or have bad people skills, but they are correct in stating that they are responsible in the end.

Think of it this way, if you take your car for brake repair and then your brakes fail on the highway resulting in injury are you going after the individual person that fixed your brakes or are you going after the establishment that you took it to? All of the above, no?

HappyWife77, BSN, RN · Apr 23, 2014

Basically managers are there to manage things. That's why we have them, they also have accountability over their units.

She sounds a little much with "bizarre threats" as OP stated. It's sad that type of leader usually doesn't have the best results with morale and team work. Maybe look elsewhere for work....or just be on your game so she leaves you alone.

Best wishes!?

classicdame, MSN, EdD · Apr 23, 2014

The Texas NPA clearly states that a nurse does not act under the license of another nurse. Each licensed individual is responsible for his/her own actions and, as a professional, should be able to discern what is safe for the patient. That said, a nurse is not to coerce someone else to do the wrong thing either. It is assumed, I guess, that the individual will know to refuse such coercion and maybe claim safe harbor to protect their own license, but it might mean losing a job. Still have a license though. Probably best to get clarity from your BON.

chare · Apr 23, 2014

She is egotistic and uses fear tactics. Constantly tossing bizarre threats.

What exactly has she done that makes you come to this conclusion?

She has this unrealistic belief that she owns the floor and is responsible for it like a captain on a ship.

Although this might surprise you, that’s what a nurse manager is hired to do; ensure the efficient operation of the unit. While I can’t speak to how she conveyed this to you, the analogy to a ship’s captain is not that unrealistic.

Regarding delegation, the Florida Nurse Practice Act, section 64B9-14.002 Delegation of Tasks or Activities, paragraph 4 states:

Initial allocation of the task or activity to the delegate, periodic inspection of the accomplishment of such task or activity, and total nursing care responsibility remains with the qualified nurse delegating the tasks or assuming responsibility for supervision.

One that really makes me question her sanity is her saying, "the PCAs work under our license(RN)...

While the PCA doesn’t work “under your license” you retain total responsibility for all delegated tasks.

...and WE (RNs) WORK UNDER HER RN LICENSE ".

Likewise, if your nurse manager views your job responsibilities as being delegated from her, this might what she is basing this comment on.

In an effort to control how we practice OUR nursing skills that is not to her standard or liking, but is definitely safe and within the scope of practice. In other words her attempt to eliminate autonomy and operate under her regimen.

I don’t see this as an attempt to eliminate autonomy. As she is responsible for ensuring safe and effective nursing care within her unit, she is entirely within her right to determine standards.

Now, I'm located in Florida and I have never read under the Florida board of Nursing Act, that another RN is liable for another RN. Manager or not. Is she bluffing or is it just me?

Again, if she views these as delegated acts, she might, in her opinion, remain responsible.

BlueDevil, DNP · Apr 23, 2014

She can be held liable for "failure to supervise" for issues that arise while she is the responsible manager. So I don't blame her for holding staff to higher standards. She may not be a joy to work with, but she's not wrong.

nurseprnRN, BSN, RN · Apr 23, 2014

There is a difference between delegating assignments and taking responsibility for another RN's practice "under one's license."

First, no nursing personnel practice "under" another's license. This includes CNAs, who do NOT practice "under the nurse's license;" students, who do NOT practice "under the instructor's license;" new hires, who do NOT practice "under the preceptor's license;" and nurse practitioners in collaborative relationships with physicians, who do NOT practice "under the physician's license." (Physicians have responsibilities to sign for their PAs' work, but that's different, because the PA does not have licenses for autonomous practice.) All these people have their own scopes of practice.

Second, the RN can delegate some actions to another RN if they are within RN scope of practice, to an LPN if they are within LPN scope of practice, and to a CNA if they are within CNA scope of practice. This is not having these people practice "under the (delegating) RN's license," because all of those people practice under their own licenses/certifications.

Your charge nurse is wrong about the "under her license" part. To be charitable, it may be that she is poorly-educated on this concept (she wouldn't be the first one), or that she expresses herself poorly (ditto).

If she delegates something to someone who is not qualified to perform it, then that person must refuse; she can't, for example, show a CNA how to give a subq injection and then have her give all the morning insulins. That CNA would not be acting under the RN's license, and the RN cannot delegate a task that is not in the CNA's scope of practice.

However, as a manager, she is in charge and does delegate care on the floor to the staff. If the staff are operating within their own scopes of practice, then from a legal standpoint they're fine. Whether she's a good or lousy manager is another matter entirely; if you are seriously concerned about her competence from that standpoint, you (staff) should go through channels to address her assignments/regimens*/standards/interpersonal skills.

* Are there policies and procedures for the things she insists on? Facilities rarely have unit-specific ones for general nursing activities. There are many resources online for standards of practice, if that's an issue. Just sayin' ...

HouTx, BSN, MSN, EdD · Apr 23, 2014

^^^^ This ^^^^^

There is a difference between 'delegating' and 'assigning' which determines accountability.

Delegation is when a nurse directs a non-licensed person to perform a task (that is within the nurse' scope of licensure). The nurse remains 100% accountable for the task. Prior to delegating, the nurse must ensure that that person is competent and able to perform the task and that the context (patient stability, potential for problems/complications, etc) is appropriate.

Assignment - is when a supervising nurse directs another licensed person to perform a task. The supervisor is not 100% responsible for problems that may arise because each licensed person is accountable for practicing within his/her own scope of licensure. If the subordinate is not competent or cannot perform the task, it is his/her responsibility to inform the supervisor and refuse to accept the assignment. The supervisor however, is accountable for ensuring appropriate oversight and making sure that the assignment is actually do-able and with the subordinate's scope of licensure.

In Texas, we are fortunate to have a process called "safe harbor" which protects nurses from liability arising out of issues related to the assignment itself, but it DOES NOT grant immunity from performance issues related to individual competence.

RNperdiem, RN · Apr 23, 2014

A manager works under pressure to be "compliant" with certain things if the manger wants to keep his/her job. Restraint documentation, following up with pain scores one hour after intervention, making sure chargeable things are charged to patients.

Sometimes managers do not know how to go about getting their staff to do what needs doing. Things that are far down the list of importance to staff nurses are important to managers.