Non-licensed staff providing medical treatment

[dawn71c]

Hi All!

This is my first post, so I will offer a brief introduction. I am an RN with 22 years of experience in ED, Case Management and Orthopedics. I recently began working as an Occupational Health Nurse.

I need some advice about a situation at my work involving our screening specialist. My department has been short staffed for quite some time until about 7-8 months ago. Because of this she has been working independently pretty regularly. Currently she is working at least 1 day a week without RN on-site because the first shift nurse works 4 ten hour shifts per week.

She has a habit of providing care and making clinical decisions and assessments without contacting our NP who is always available by phone. My other co-workers are aware of the situation and collectively we have approached our manager regarding this.

The latest incidents have included assessing a wound, documenting that the employee states swelling has increased significantly since he was seen by NP earlier in the day, had pain at 10/10 and unable to bend his finger because of the swelling. She basically did nothing but dress the wound. Unfortunately he continued to have swelling and when he came back in to work on Sunday he was sent to ED for evaluation, sent to ortho and is having to have an I & D of the wound. The second incident this week involved a worker who got stung by yellow jacket. She provided first aid treatment, which I think is okay, but then she also gave him 2 benadryl and sent him back to his job, which was working on the roof of building!!

She does these things and it is mind blowing to me that this has been tolerated. I brought this issues up today when my manager came to check in with me. We also spoke with the NP.

So here is my question. If this issue does not get addressed and she continues to do these types of things what would be my next step?

I am really concerned that something really unfortunate and avoidable happen, but I am afraid that I am going to be seen as going on a witch hunt if I keep bringing this topic up. I have only been with this company for 5 months.

Any advice would be much appreciated.

Thanks for reading!!

[Rbeck911, BSN, RN]

Hi there,

Sorry to see we left you hanging on this for so long.

First, you have multiple ethical and legal aspects to this and I need more information. What state are you in? I am not familiar with "screening specialist" but assume that it is similar to a medical assistant?

In my state, we don't have to have an RN on site at all times. "medical professionals" can act under protocols set by our MD. We have an EMT on site that treats patients without direct supervision, and a night shift LPN who is on her own for 8 hours.

As far as the amount of care that a medical assistant renders..... What level of certification does your manager have? How much experience. At the end of the day, the risk management side of me says that I would abstain and let my manager handle it. The nurse in me says to do your best to protect patients, especially if great harm may come. In Occ health, most injuries can wait until tomorrow. Especially on a night shift when the alternative is to send them to the ER. If they need to see a provider, they can usually go in the morning no problem. As long as your specialist has the knowledge to make that determination, I wouldn't worry... Unless there are legal ramifications to her doing so.

Don't blow the whistle until you do the research.

[dawn71c]

Thanks for the response. To answer your questions, I am in South Carolina and the title screening specialist is similar to a medical assistant. This employee has not had any formal training in the medical field except for OJT as far as I know. When she is by herself it is mostly on day and evening shifts as I work the night shift. Our standing orders do specifically say that the RN may follow the protocols that we have in place.

I have brought these issues to my manager, who is not a nurse, my department is part of the health and wellness division at the hospital so we do not have a nurse manager. My fellow nurses at the plant have also voiced their concerns, and she has been talked to my my manager about what her role is, which is really just to perform physicals and and some administrative work.

I do not feel like she has the knowledge to make determinations and to treat employees. I have kind of resigned myself to the fact that nothing is really going to change, so I am just gonna keep my eyes open and lips closed for now, as I feel that I have done all that I can at this point.

[skyburp27]

for me i'll just have my manager deal with her. It's enough that you have told him already how your screening specialist handled such cases. On the otherhand I can also send an email to my manager just to remind him of the issue.

[amoLucia]

Inform your Risk Management Dept of the parent hospital. I think they might be interested.