Ethics question

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This is a question about nursing ethics. Sorry this is so long-winded. But I would very much appreciate any guidance and information anyone can offer.

I am a RN. I have a sister who dropped out of nursing school in 1975 and never went back. To this day she says she very much wishes she was a nurse. I have encouraged her many times over the years to finish but to no avail. Nursing is a late career change for me after lay off as a pharmaceutical scientist. I knew my going back to school to become an RN was going to be a really big deal for my sister, considering she never finished. She does private duty companion/home care work under the table. She is not licensed and has no interest in becoming licensed. She doesn't even have any interest in becoming CPR certified. She has no education beyond a high school diploma. When she and her army husband were stationed in Germany, she worked for a dentist who called her a scrub nurse. She often refers to this experience, telling clients and people she was a scrub nurse. She has worked as a receptionist in an orthopedic office and as a dental assistant. She often competes with me. If health issues are being discussed with friends or family, she often dispenses medical advice. This morning our brother wanted to talk to us about a health issue he is having. He opened the conversation with "Since you and Liz are in the medical field..." Because I have had enough of this nonsense, in front of my sister I stopped him and corrected him by saying "I, (I was certain to emphasize "I"), am in the medical field. I am a Registered Nurse." She was not happy I did this but blew me off and went about dispensing her medical advice. She often openly disagrees with me and often is easily offended when I try to correct her incorrect information. She will have none of it. She becomes indignant and angry. I have asked her if she tells her clients and people she is a nurse. She insists she does not yet I have heard her on numerous occasions tell people she was a scrub nurse.

Recently she was hired to take care of an elderly client with Myasthenia gravis. My sister asked me how she should feed this client because she was having problems with dysphagia and aspiration. I reluctantly explained how to safely feed her for the lowest risk of aspiration. After the fact, I realized I should have just referred my sister to her client's doctor. Not that that would matter, considering my sister also argues with and disagrees with doctors. Either way, she disagreed with me and went on feeding the client the way she thought best which did lead to continued aspiration, including an episode of aspiration pneumonia.

Also just 4 days ago, on Christmas Eve, our 90 year-old aunt fell and broke 4 metatarsals. Aunt Mabel also has dementia with some times of clarity. Because my sister so often dispenses medical advice and tells people she was a scrub nurse, my cousin called my sister immediately after our aunt fell. My sister instructed our cousin to flex her foot. I was shocked and angry that my sister gave this instruction. I asked my sister why she instructed our cousin to do that. She responded that she wanted to see if it caused Aunt Arlene any pain. After this I told my sister that she is playing with fire if she insists on misrepresenting herself as a nurse. I told her it's wrong and possibly illegal, not to mention inflicting harm. Needless to say this is causing tension between us. I admit I struggle with being disrespected by her but realize there is nothing I can do about that and have to let that go. I am also really tired of feeling like I'm competing with a sister I love very much but drives me crazy. However, I am very angry and not willing to let go of the fact that she is putting her fragile, selfish ego above the welfare of her clients, including our dearly beloved Aunt Arlene. I am thinking it's time for me to try have another serious heart-to-heart with her. If we do, I know she will blow up. I also feel certain she will not stop her misrepresentation and will continue to dispense incorrect medical advice. But I feel that what my sister is doing has to stop.

Finally, here's my question: What is my legal obligation as a RN for safety in these situations?

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On 12/27/2019 at 2:04 PM, jamiew said:

Finally, here's my question: What is my legal obligation as a RN for safety in these situations?

I don't know exactly, but I'm not sure that what your sister is doing is any different than they types of things a whole slew of lay/unlicensed people do. If it isn't claiming to be a "scrub nurse" it's dispensing advice from Google or from what they heard through the grapevine or what they think they know about what happened to their neighbor's aunt's ex-boyfriend.

On 12/27/2019 at 2:04 PM, jamiew said:

I admit I struggle with being disrespected by her but realize there is nothing I can do about that and have to let that go.

Yes, you should let it go. I wouldn't even consider it being disrespected as much as it is just someone trying to feel useful and struggling with self-esteem challenges. It's rather pitiful actually.

On 12/27/2019 at 2:04 PM, jamiew said:

I am thinking it's time for me to try have another serious heart-to-heart with her. If we do, I know she will blow up.

That is a decision you will have to make. You can have your say one more time or you can take a different approach....

On 12/27/2019 at 2:04 PM, jamiew said:

I also feel certain she will not stop her misrepresentation and will continue to dispense incorrect medical advice.  But I feel that what my sister is doing has to stop.

I know what I would do: I would immediately cease entertaining any related discussions with her. If she is chatting up the family members about their health concerns I would leave the room. I definitely would not advise her how to care for her clients or any other thing remotely related to medical/nursing advice. I would have no health/nursing/medical related conversations with her at all, period.

I would not correct her, I would wash my hands of it completely. You are not going to make any progress by chastising or voicing your disapproval. I understand you are offended, but you're letting it get the best of you - - you have no reason to be threatened or even insulted by her behavior; you are the RN and she is not. I think you're half hoping that what she is doing is illegal and/or that you have an obligation to report her for something, because of your offense. I'm not convinced that she is doing anything illegal or that you have any obligation to report her; at least it is not clear that she is/you do.

I have a suspicion that she wants your attention and approval more than anything (despite not knowing the appropriate way to go about it) and for that reason I think the above would be a very interesting experiment. If I were you I would step away completely and just wait. That should decrease your aggravation and if she happens to miss having you in her life, you will have an opening to respectfully and sincerely tell her that you aren't going to maintain a relationship under the previous conditions, but that you care deeply for her and would love to continue a more honest relationship with her.

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Specializes in Short Term/Skilled.

I mean, when a patient of mine falls I generally assess their ROM unless there is an obvious injury.

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Specializes in RHIT with a crap load of medical experience..

Leave her be. She is just digging a deeper hole for herself. What is with your family calling her for advice? Don't they know she is not a nurse in any sense of the word.

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Specializes in ICU, ER, Home Health, Corrections, School Nurse.

Your legal obligation is Zero. Anyone can call themselves a nurse. Nursing is a verb that has multiple meanings: we nurse our infants; we nurse our dog/cat back to health; etc etc. When you got hired wherever you work, you didn't get hired because you are a "nurse," you got hired because you are a Licensed Registered Nurse, and you showed proof of licensure. Seeking advice from your sister is no different than seeking advice from Dr Google. Your problem is plain old typical sibling rivalry, or whatever you want to call the interaction between siblings. I am not being judgemental, in fact I have very similar issues with my sister, and things bother me about her, that are out of proportion to the severity of the issues, yet she drives me nuts. But that's on me. And I work very hard to try to disengage and mind my own business. I suggest you do the same, make life easier on yourself.

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Am I the only one that thinks OP has a moral, ethical, and LEGAL obligation to report this to someone? Anyone??

OP says the sister's actions of improperly feeding the woman directly attributed to the person developing aspiration pneumonia. She might not have a license, but she's still inflicting harm!

In my state, the it is against the law to impersonate and present yourself as an RN if you are not one.

Yes, it will definitely stir up family drama but someone needs to know that your sister is causing harm. If not anyone else, at least the families of the people she cares for in the home (unless they know she is not licensed and they're fine with that).

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Specializes in ICU, ER, Home Health, Corrections, School Nurse.
14 minutes ago, Mavnurse17 said:

OP says the sister's actions of improperly feeding the woman directly attributed to the person developing aspiration pneumonia.

In my state, the it is against the law to impersonate and present yourself as an RN if you are not one.

"OP says" are the key words here. There is no proof of anything. Was the sister there 24/7? Was she the only one feeding the patient?

And nowhere does the OP state the sister was impersonating and presenting herself as an RN. Only as a "nurse, " which can mean anything.

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5 hours ago, Mavnurse17 said:

Am I the only one that thinks OP has a moral, ethical, and LEGAL obligation to report this to someone? Anyone??

What would she report? That her sister works as a companion helping people with things that would otherwise be self-care/ADLs? And tells them that she has experience working for a dentist as a "scrub nurse" in Germany?

5 hours ago, Mavnurse17 said:

In my state, the it is against the law to impersonate and present yourself as an RN if you are not one.

The OP makes no charge that her sister is doing this.

5 hours ago, Mavnurse17 said:

OP says the sister's actions of improperly feeding the woman directly attributed to the person developing aspiration pneumonia. She might not have a license, but she's still inflicting harm!

No one knows the truth of the situation. People with swallowing struggles are not required to hire someone with a college degree to feed them properly, and even if they were that would not mean that they would never have difficulties with aspiration or with pneumonia or with aspiration pneumonia--or that the person they hired would necessarily be guilty of inflicting harm should the person develop a problem. I'm sure you know people can develop aspiration pneumonia/pneumonitis due to even such things as GERD or their altered ability to handle their own secretions.

The bottom line is that people are free to hire lay persons to assist them with ADLs if they wish to.

Likewise the OP's family is free to seek advice from this lay-person family member even though they know darn well that she is not a licensed nurse--and that they do. There are plenty of poor choices that aren't illegal.

If she is representing herself as a licensed nurse that is a different matter.

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I really hate to say this but no matter what you do or say, your sister will not change her ways. I would never give her any medical advice. If she wants to perform surgery, she will end up getting onto legal trouble, that's on her. If you hang around while she behaves like this and she ends up in trouble, who do you think she's going to blame! I think you should distance yourself a bit and avoid at all costs medical advice. If someone else asks you a question you can answer, but tell her to stay out of it. It's just not worth it, you don't need the added stress.

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Specializes in Med-surg, school nursing..

I would be thankful that my family isn't asking me for advice. ? Kidding. Sort of.

They may be asking her for advice as opposed to you because they know that you, as an actual nurse, will likely tell them to see their PCP, as you should. Whereas she gives them her advice, though it may be wrong at times.

I know it's frustrating, I hate when the MA's at my kiddos peds office are called nurses. But, you must realize that this is only causing YOU more added stress. No one else seems to care. The only way I would intervene is if the home care patients family thinks that she is a licensed nurse. It's not illegal for her to give in home care, and unfortunately things like aspirating can happen with anyone, even an actual nurse.

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I agree with what others have posted. I can not help but (the optimist in me) think that something could be done to help your sister work on her self esteem through actual achievement in the health care field. Offer to be her private mentor/tutor through a CNA/HHA course. Almost everybody can become a CNA/HHA if they apply themselves. Then your sister can work through an agency and get the benefits of higher pay, etc. If she starts a spark, then offer to help her progress through an LPN/LVN program. It seems obvious from your post that your sister would be a much happier person if she got some of the positive vibes that would come her way as a CNA/HHA, or LPN. It is not too late for this. Worth at least one sister to sister conversation.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I think I'm crustier than most, and I would tell the sister plainly "Do not give medical advice. You are not qualified to do so." When she starts giving advice to family members, I do agree with the others that you should leave the room and not even be part of that conversation.

You can always take the family member aside later and offer more appropriate advice. I certainly would not give the sister any advice on how to do her caregiver job. She'll screw it up and blame you. Her employer should already be vetting and training her to do what they need her to do. If she screws that up, that's between her and them.

If you want to salvage some kind of relationship with your sister, is there a hobby or interest you both share? If there's something she's good at but you're not? That would be the thing to embrace and she could enjoy being better than you at something. If she starts talking medical issues just tell her you don't want to spend your days off talking about work.

In any case, don't get sucked into competing with her. There is no point to that.

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