Do not have a medical director - need source to win battle

DusktilDawn · Aug 23, 2008

permalink
I am wondering if any other nurses have experienced the problem I am now dealing with and if they can offer any answers/solutions/information.
I am the only RN working for a non-profit agency that supports (houses/staffs/provides day habituation programs) for the adult DD/MR population. My title is Medical Services Coordinator. I have three LPN's working under me. Between the four of us we teach unlicensed staff the "Supervision of self-administration of medications". Most of our clients are unable to read/write/and/or understand their meds/reasons for taking them or even how to take them. We also teach all CPR/FA class to the staff.
My concern is that we do not have a medical director and our executive director feels that as long as there is a prescription from an MD that we (the nurses) are covered. Does anyone have a concrete answer/source I can refer to so that I can "win" this battle. I have assured her over and over that all these people are working under my license and that I need an MD to work under - all to no avail. I can't afford to consult an attorney and unfortunetly the ANA will only give me assistance/answers if I become a member which I can't do at this time (cost $300/annually). This is very dissappointing to me as it makes me believe the time honored phrase of nurses eating their young. If anyone has an answer or suggestion it would be most appreciated. Thanks!!

Your executive director is WRONG, and either she/he knows they're wrong or they're just plain ignorant. As long as the doctor writes a prescription your covered, NO WAY. That would be like me arguing that because the doctor "prescribes" the treatment I implement, that I am not responsible when implementing that treatment at any health care facility that employs me, the doctor is. We know that's not true. As nurses, we know we should be aware of what the medication is, what it is used for, and SEs we should observe and assess for before administering them to patients. That fact that you are dealing with a population where the majority cannot read, write, understand information about the medications you give them or what they are for, puts them in a high risk category where advocacy would be of the utmost importance.

As a nurse you are responsible for what you delegate:

The right task: that means as a nurse you have to ask yourself if it is appropriate to even delegate a task.

The right circumstances: that means as a nurse that although you could delegate the task, is there a situation or circumstance where it may not be appropriate to do so. Given the situation, would it be more appropriate for you, as the nurse, to do.

The right person: that means as a nurse you need to be aware of whether or not to whom you delegate to has the appropriate knowledge and skill for the task. You should know if this person has been educated to this task and has demonstrated competency performing this task.

The right direction: that means as a nurse did you provide adequate instructions for the task. Are these instructions comprehensible to the one they are being given to, are they clear and concise.

The right supervision: that means as a nurse your providing adequate supervision for the tasks you delegate. This also includes determining competency. It can include providing education. It includes the knowledge that the task was completed correctly.

Have you contacted your SBON? They should be able to answer your questions regarding this situation and what your accountable for, you shouldn't need to contact the ANA. You should also be looking at the policies and procedures for the place you work for and your state's legislature that governs your practice. You can also look to who accredits or provides licensure for this facility.

Babarnurse · Aug 24, 2008

I am dealing with the exact same issue. That is the main reason I have submitted my resignation to leave this wonderful facility. Unfortunately, you, as the RN are liable. You are liable for the LPN's and the unlicense personnel. Now, the ULP are held to a "certain" amount of liability because they have a certificate. But, when push comes to shove, you are the one who is going to go down.

As you stated, many of the ULP don't have a GED, can't read and don't have enough common sense to be dangerous. (I'm not being a b*tch, it is the truth). You have to decide what you are willing to put up with liability wise.

Good luck