Ethics question

[jamiew]

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?

[jtpesek]

“Boundaries” by Dr. Henry Cloud and Dr. John Townsend is a great book and wonderful place to start (or was for me and several I know) when addressing that type of frustration with family.