Ok, so maybe that wasn't the most objective thread title, but it is certainly the most honest.
I am already struggling with the "personality" of my new job working as the sole RN at a plastic surgery center, but we have reached a new low. I need to get opinions on whether I need to start job searching, trying to change things or????
Amongst many other tasks, I circulate. By law, in my state (Texas), only RNs can circulate unless they are "directly supervising an LVN" to circulate. The other day I was ordered by my surgeon to go to lunch during a case and be relieved by the LVN. I protested and explained. She said I was wrong and made me leave. (Being an anal-retentive RN, of course I documented every aspect of this event.)
So yesterday I asked our office manager, who has worked with the surgeon the longest, the best way to approach her with my concerns. I told the manager I did not want us to get shut down or sued. She not-so-politely "informed" me that I was wrong, and that according to AAAASF (the surgery center accrediting body) we were fine, and that the surgeon's husband (also a surgeon) sent his RN away all of the time.
I was not trying to start a fight (honestly!), but I felt like this needed to be addressed. (I mean, I work with mostly nice enough people, but I am not giving up my license for them.). So I emailed the manager a copy of the state health code and law stating all of the facts.
No response. Tumbleweed blows by.
The rest of the day was short and snappy comments, but NO emails regarding anything whatsoever were returned, some of which were crucial to running this place.
Should I take this to be indicative of some kind of immature corporate culture? Should I let it go for now? What did I do wrong?
"Prior to 2/1/04, LVNs were permitted to perform “first assistant” duties for a physician or surgeon under the delegation of the physician. The NPA became applicable to LVNs with the combining of the boards, and thus NPA
sections 301.1525-301.1527 have precluded the performance of first assistant duties under medical delegation by
That statement is entirely false. CRNA's are independent providers. Supervision and medical direction are used for billing purposes in ACT settings so the Anesthesiologist can get paid. The only anesthesia providers that need to be supervised are Anesthesia Assistants.
CRNA's are still legally required to work under a Physicians supervision in the majority of States:
I still don't know how the RN who is not there is breaking the law. Maybe the surgeon is. the LVN may be doing stuff outside his/her scope. But how can you be breaking the law if you are not there? I work in an ER. If I go on a lunch break and a CNA starts an IV, or an LVN does something out of their scope while I am eating, I haven't broken any rules or laws.[/quote']
Yes, with a surgeon or Anesthesiologist, it doesn't have to be an Anesthesiologist. The "independent" states are just the opt out states. Again this is all has to do with billing and not actual clinical practice.
Yes, with a surgeon or Anesthesiologist, it doesn't have to be an Anesthesiologist. The "independent" states are just the opt out states. Again this is all has to do with billing and not actual clinical practice.
No, in some states it is a state legal requirement for practice, not just a billing issue.
Despite apparently being in the right, I think your employment at this facility may shortly be coming to an end. Those who rock the boat in small facility (even when they rock it for the right reasons) rarely last long.
Sadly, this is true. And it sucks because we are only looking out for everyone's safety.
It would make no sense for them to hire an LVN if they had to have a RN standing next to them the whole time. But at the end of the day, if you decide to push this issue, you will probably be fired by the end of the week. Do you really think a surgeon cares at all what you think? They will just get rid of you for someone who keeps there mouth shut.
Wow. I am more confused than ever. I am still waiting for the BON to call me back. It seems like the opinions of the board are: you are at risk of board sanctions, MYOB or get fired, everything is fine just fine. I guess only the BON has the final legal say.
And if I get fired, do I really have a choice ethically? What if someone died while I was out of the room? Just FYI: the LVN had never started an IV before starting there recently. The scrub is fresh out of the box as well.
Wow. I am more confused than ever. I am still waiting for the BON to call me back. It seems like the opinions of the board are: you are at risk of board sanctions, MYOB or get fired, everything is fine just fine. I guess only the BON has the final legal say.
And if I get fired, do I really have a choice ethically? What if someone died while I was out of the room? Just FYI: the LVN had never started an IV before starting there recently. The scrub is fresh out of the box as well.
Your nurse practice act and the ANA Scope and Standards of Nursing Practice both have something to say about the RN's responsibility to delegate safely, knowing that the person to whom you delegate is qualified and able to do the job.
MunoRN, RN
8,058 Posts
"Prior to 2/1/04, LVNs were permitted to perform “first assistant” duties for a physician or surgeon under the delegation of the physician. The NPA became applicable to LVNs with the combining of the boards, and thus NPA
sections 301.1525-301.1527 have precluded the performance of first assistant duties under medical delegation by
LVNs since 2/1/04."
Texas BON LVN interpretive guidelines