Asked to break the law

[maxxilla]

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?

HELP

[OCNRN63, RN]

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.

^^THIS^^

I was in a similar situation years ago. I worked somewhere where there was fraud going on, as well as questionable practices regarding handling and documentation of narcotics.

I tried to discuss this with the NM and got stonewalled; talked to the office mgr. and got the same. Talked to the MD, who said he'd talk to the NM. Guess who got fired?

​It worked out in the long run, because I got a better job, which lead to an even better job. The office where I worked? It was eventually closed, and the doctor no longer able to practice.

[OCNRN63, RN]

​I also had plenty of legal advice while working there.

[BrandonLPN, LPN]

Accusing your employer of breaking the law is a bold accusation. Before doing so, it would be prudent to get clarification from the BON.

I work in LTC, and I know my state's scope of practice explicitly states that practical nurses practice nursing under the supervision of a registered nurse and/or a physician. However, any nurse who has ever worked in LTC will tell you that it is 100% common and 100% legal for the only licensed person in the buliding to be a LPN. We (LPNs) are still considered to be working "under supervision" in these cases because there is always a RN and/or physician on-call.

I have never worked in an OR. It's possible you are right, and a LPN cannot circulate without a RN physically present. But, it is also entirely possible that you misunderstood the use of the word "supervision". Perhaps it is perfectly legal for a RN to delegate a trained LPN to assume such duties in his/her absence.

I would discretly find out what exactly the BON means by "supervision" before saying anything to your employer.

[classicdame, MSN, EdD]

you are licensed by the BON. Other associations have no control over you. MD's do not grant your license either. I would contact the BON and then look for a job. "That is the way the have always done it" is not reason enough for a professionally licensed person. Glad you spoke up!

[youngheartoldhead]

I'm just curious how several nurses are not able to figure out the rule for this. obviously, boards need to be more clear on things that they felt it necessary to make rules FOR.

[jadelpn, LPN, EMT-B]

And one other thing to remember, OP, you are not the only one being "asked to break the law". The LPN is as well. And he/she has a license to protect just as you. There's nothing worse than being asked to do something that an LPN knows he/she is unable to do. Maybe join forces and have the LPN also say "I can't do this according to (my scope, the law, LPN nurse practice act....)

It also puts the LPN in a bind when they are delegated something that they should not be.

[LaRN]

if OP gets fired for refusing to break the law, her employer would be taking a mighty big risk.

I'm curious to know how this will turn out

[jadelpn, LPN, EMT-B]

if OP gets fired for refusing to break the law, her employer would be taking a mighty big risk.

I'm curious to know how this will turn out

And the LPN could be fired for working outside of scope. Especially if the employer gets in hot water over it. This is where RN's and LPN's are quite the same--the employer denies knowledge, and the nurses pay the price for not "knowing" what they needed to be doing, when, according to scope.

It will be interesting to see what the BON has to say about it, for sure.

[hope3456, ASN, RN]

I don't know much about OR...why were you asked to leave? Would it have anything to do with the Dr. "liking" the LPN more?

If you decide to report to BON I would be concurrently looking for another job. If you upset them over this they will probably be looking for a reason to get rid of you, set you up, cut your hours, ect. And you are in Texas, good old right to work state.

[classicdame, MSN, EdD]

better to be fired than lose your license. Also, the "we have always done it this way" argument rarely holds up in court.