Medication Mishap - page 6

Got a student who has ADHD badly and she tends not want to take her medication and I was told in the beginning that she's a liar and that we need to keep an eye on her to take her medication. I... Read More

  1. by   Viviana
    Hey Amethya,

    You should have someone who is your direct supervisor to ask advice of before you give a second dose of medication. Don't get nervous and get pressured into giving a second dose until you have contacted your supervisor to ask for guidance. That's what he or she is there for. Another option is to call in a second person by prearrangement to witness you dosing the patient. Talk to the secretary or the principal and ask who could come in to witness the patient being dosed.

    This is just a difficult patient, and you need additional skills to manage her. Until you can learn those skills, get a witness, get a pitcher from the dollar store and don't let the patient leave without swallowing, or get lunch cups of applesauce to open a capsule into.

    Please don't hesitate to inbox me if you need additional help. Hang in there!
  2. by   Amethya
    Quote from Viviana
    Hey Amethya,

    You should have someone who is your direct supervisor to ask advice of before you give a second dose of medication. Don't get nervous and get pressured into giving a second dose until you have contacted your supervisor to ask for guidance. That's what he or she is there for. Another option is to call in a second person by prearrangement to witness you dosing the patient. Talk to the secretary or the principal and ask who could come in to witness the patient being dosed.

    This is just a difficult patient, and you need additional skills to manage her. Until you can learn those skills, get a witness, get a pitcher from the dollar store and don't let the patient leave without swallowing, or get lunch cups of applesauce to open a capsule into.

    Please don't hesitate to inbox me if you need additional help. Hang in there!
    Thank you so much and I shall!
  3. by   halohg
    May I ask your age?
  4. by   MHDNURSE
    I think a lot of people need to remember that laws vary state by state. I looked up Texas Medical Asssistant Laws and found this link:

    Page not found

    Within the link I found this:

    "The term "medical assistant" has no real legal significance. MAs are not licensed, certified, or registered by any agency of the State of Texas, nor are they recognized under federal Medicare or Medicaid laws as a species of "provider." There is no reference to MAs in the Medical Practice Act or any other Texas Statute. Thus, there is no specific legal regulation of MAs.

    What can a Medical Assistant do? Since there is no specific legal regulation of MAs, one has to look to the general delegation clause in the Medical Practice Act, cited above. The scope of MA "practice" is governed by this general provision, meaning that the MA's education and experience are matters that the supervising physician must take into consideration when giving them direction. The supervising physician may delegate tasks to the MA when he or she is satisfied that they are "qualified and properly trained" and the task delegated can be "properly and safely performed."

    I think therein lies the problem. OP is practicing as an MA in a state with little to no regulation, allowing for the RN and or MD in charge to delegate whatever they see fit. It is a very unfortunate and dangerous position for OP to be in and it seems likely there are many other MAs in similar positions in her state of Texas.

    I also found this link:
    School Health Services - Nursing Practice Resources

    Clearly states schools cannot employ someone as "nurse" , without proper credentialing, but I am sure the school can just say since they don't call her a "school nurse" they aren't doing anything wrong.

    § 21.003. Certification Required.
    (a) A person may not be employed as a teacher, teacher intern or teacher trainee, librarian, educational aide, administrator, educational diagnostician, or school counselor by a school district unless the person holds an appropriate certificate or permit issued as provided by Subchapter B.
    (b) Except as otherwise provided by this subsection, a person may not be employed by a school district as an audiologist, occupational therapist, physical therapist, physician, nurse, school psychologist, associate school psychologist, licensed professional counselor, marriage and family therapist, social worker, or speech language pathologist unless the person is licensed by the state agency that licenses that profession and may perform specific services within those professions for a school district only if the person holds the appropriate credential from the appropriate state agency.

    If a school district hires a licensed vocational nurse (LVN), the LVN must be supervised in accordance with Chapter 301 of the Occupations Code. Supervision must be provided by a registered nurse, a physician, a physician's assistant, a podiatrist, or a dentist.

    According to the Texas Board of Nursing (BON), "The licensed supervisor is responsible for overseeing the LVN's nursing practice and actively engages in a supervisory process that directs, guides, and influences the LVN's performance of an activity.

    The NPA and Board rules and regulations prevent an LVN from practicing in a completely independent manner (that is, without a licensed supervisor); however, the NPA and rules are silent as to the proximity of the licensed supervisor. There are many factors to be considered in determining how quickly the licensed supervisor needs to be available to the LVN. Factors to be considered should include: (1) the type of practice setting; (2) the stability of the patient's condition; (3) the tasks to be performed; (4) the LVN's experience and (5) any laws and regulations that apply to the specific practice setting. The proximity to the LVN's practice setting and the type of licensure of the licensed supervisor should be determined on a case-by-case basis with input from the LVN and his/her licensed supervisor. The appropriate licensed supervisor must be accessible to the LVN at least telephonically or by similar means. To illustrate, compare the LVN who performs routine nursing tasks or nursing tasks learned through ongoing continuing nursing education (such as intravenous therapy) with an LVN who performs a delegated medical act (such as Botox administration). These are different situations and will differ in who (RN or physician) is appropriate to supervise the LVN as well as the proximity of the licensed supervisor. Other regulations, such as those related to reimbursement, may also be a factor in the latter situation."

    My whole point is that is seems OP is employed within a school that doesn't prioritize student safety over saving money, and OP will continue to be asked to perform duties that are outside either her scope of practice, her comfort zone, or both. I do not know what type of supervision you are getting OP (district RN, MD, etc.) but whoever is technically supervising you, is also putting their own license at risk.

    For your own sake, I would begin he process of finding a position where you have better supervision, collaboration with colleagues who can advocate for you and assist you, and in general, put yourself somewhere where you will be valued and not be put at risk on a daily basis. Just my .02
  5. by   Amethya
    Quote from MHDNURSE
    I think a lot of people need to remember that laws vary state by state. I looked up Texas Medical Asssistant Laws and found this link:

    Page not found

    Within the link I found this:

    "The term "medical assistant" has no real legal significance. MAs are not licensed, certified, or registered by any agency of the State of Texas, nor are they recognized under federal Medicare or Medicaid laws as a species of "provider." There is no reference to MAs in the Medical Practice Act or any other Texas Statute. Thus, there is no specific legal regulation of MAs.

    What can a Medical Assistant do? Since there is no specific legal regulation of MAs, one has to look to the general delegation clause in the Medical Practice Act, cited above. The scope of MA "practice" is governed by this general provision, meaning that the MA's education and experience are matters that the supervising physician must take into consideration when giving them direction. The supervising physician may delegate tasks to the MA when he or she is satisfied that they are "qualified and properly trained" and the task delegated can be "properly and safely performed."

    I think therein lies the problem. OP is practicing as an MA in a state with little to no regulation, allowing for the RN and or MD in charge to delegate whatever they see fit. It is a very unfortunate and dangerous position for OP to be in and it seems likely there are many other MAs in similar positions in her state of Texas.

    I also found this link:
    School Health Services - Nursing Practice Resources

    Clearly states schools cannot employ someone as "nurse" , without proper credentialing, but I am sure the school can just say since they don't call her a "school nurse" they aren't doing anything wrong.

    § 21.003. Certification Required.
    (a) A person may not be employed as a teacher, teacher intern or teacher trainee, librarian, educational aide, administrator, educational diagnostician, or school counselor by a school district unless the person holds an appropriate certificate or permit issued as provided by Subchapter B.
    (b) Except as otherwise provided by this subsection, a person may not be employed by a school district as an audiologist, occupational therapist, physical therapist, physician, nurse, school psychologist, associate school psychologist, licensed professional counselor, marriage and family therapist, social worker, or speech language pathologist unless the person is licensed by the state agency that licenses that profession and may perform specific services within those professions for a school district only if the person holds the appropriate credential from the appropriate state agency.

    If a school district hires a licensed vocational nurse (LVN), the LVN must be supervised in accordance with Chapter 301 of the Occupations Code. Supervision must be provided by a registered nurse, a physician, a physician's assistant, a podiatrist, or a dentist.

    According to the Texas Board of Nursing (BON), "The licensed supervisor is responsible for overseeing the LVN's nursing practice and actively engages in a supervisory process that directs, guides, and influences the LVN's performance of an activity.

    The NPA and Board rules and regulations prevent an LVN from practicing in a completely independent manner (that is, without a licensed supervisor); however, the NPA and rules are silent as to the proximity of the licensed supervisor. There are many factors to be considered in determining how quickly the licensed supervisor needs to be available to the LVN. Factors to be considered should include: (1) the type of practice setting; (2) the stability of the patient's condition; (3) the tasks to be performed; (4) the LVN's experience and (5) any laws and regulations that apply to the specific practice setting. The proximity to the LVN's practice setting and the type of licensure of the licensed supervisor should be determined on a case-by-case basis with input from the LVN and his/her licensed supervisor. The appropriate licensed supervisor must be accessible to the LVN at least telephonically or by similar means. To illustrate, compare the LVN who performs routine nursing tasks or nursing tasks learned through ongoing continuing nursing education (such as intravenous therapy) with an LVN who performs a delegated medical act (such as Botox administration). These are different situations and will differ in who (RN or physician) is appropriate to supervise the LVN as well as the proximity of the licensed supervisor. Other regulations, such as those related to reimbursement, may also be a factor in the latter situation."

    My whole point is that is seems OP is employed within a school that doesn't prioritize student safety over saving money, and OP will continue to be asked to perform duties that are outside either her scope of practice, her comfort zone, or both. I do not know what type of supervision you are getting OP (district RN, MD, etc.) but whoever is technically supervising you, is also putting their own license at risk.

    For your own sake, I would begin he process of finding a position where you have better supervision, collaboration with colleagues who can advocate for you and assist you, and in general, put yourself somewhere where you will be valued and not be put at risk on a daily basis. Just my .02
    Basically hit it right in the nail, it's in Texas where I live in.

    I am doing this at time, hopefully find something soon.
  6. by   MrNurse(x2)
    Quote from Amethya
    Basically hit it right in the nail, it's in Texas where I live in.

    I am doing this at time, hopefully find something soon.
    Print out the above and keep it handy. Your employer is operating against the law and the sate's Nurse Practice Act. They are liable for everything.
  7. by   dianah
    Thread closed for staff review.

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