How can hospital legally do this?

  1. I'm wondering about something, and although this has probably been discussed here somewhere, I can't find anything, so I'm posting it.

    When I was studying for NCLEX, going over the do's and don'ts of licensure, I remember distinctly the BON stating that once a candidate takes the test and fails that (s)he must notify his/her employer immediately and within ten days CANNOT work as a GN any longer. If they have a permit, it's pulled immediately. When I got my Pass notice from Pearson, it said right on there that if my results were Fail, then I had to notify employer, cannot work, etc etc. Okay.

    So why is it that I'm seeing people who I KNOW have failed the NCLEX (they've said so) and are still working as GNs? They still have the same patient loads, still doing assessments, admissions and discharges, nursing judgments, still passing meds and doing pushes that the LPNs who have passed their NCLEX's cannot legally do. They sign off as "Jane Smith, GN".

    This is in two hospitals in the area that I know of. At orientation, the hospital I'm now in sounded positively retentive about JCAHO and policies and maintaining legal standings, but this is ok?? I know we're short-staffed (who isn't) but how come something as glaringly illegal as this gets ignored when not filling out a form in triplicate will get Compliance Dept down on your butt in a heartbeat?
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    About RNsRWe

    Joined: May '05; Posts: 10,813; Likes: 25,387
    pulling patients back from The Light; from US
    Specialty: pulling patients back from The Light


  3. by   cardiacRN2006
    I knew of a girl that did that also. But, she didn't tell the hospital that she had failed, she told them that she hadn't taken the test yet.

    Maybe the hospital doesn't know??
  4. by   Altra
    If the situation is as you say, that nursing school graduates who have failed NCLEX are working as GNs ... then it is absolutely illegal.

    It's the same in my state ... your temporary permit is valid for up to one year or until your NCLEX results are reported. When your results are reported your temp permit becomes null and void, either replaced by an RN license, or you are no longer a GN and cannot work as one.
  5. by   RNsRWe
    Well, I know for sure that two of them have made no secret of their results; I suppose it's possible that they didn't tell their supervisors, but since everyone knew WHEN they were testing, I can't see it as likely it hasn't made it higher up the chain by now. Perhaps the unit managers did one of those "I didn't hear that" things.

    I'm not sure that in each case each GN GOT a permit. I know of one hospital that DID require it, and the GN that failed there continued to work as a GN. So if the hospital got notified, obviously they didn't care. In another case, I don't think the GN got the official permit (hospital didn't require it?) so maybe she's hiding behind that: not "officially" failing by not telling (omission).

    I like both of those people and don't want to see them lose their jobs, that's not it. I just get annoyed when a hospital makes a stink about keeping legalities straight when it's convenient for them (and inconvenient for staff, of course) but when it comes to inconveniencing THEM (shortstaffing), they suddenly can't remember the law.

    I know the ones who failed are no threat to MY license, they never work "under" me, but it does make me think. What else is administration going to do illegally when it works for them?
  6. by   ZASHAGALKA
    You ask the wrong question.

    The right question is can that student act as a nurse without credentials.

    No, and they could lose their right to eventually secure a license or begin practice with a serious reprimand on their license.

    More to the point, in most states, YOU have a legal obligation to protect the practice of nursing. IF something happened to patients under their care, and YOU knew about it and did nothing, YOU are also liable.

    Just because they don't work under you doesn't absolve you of liability.

    Think about it this way: THEIR defense if gonna be that other nurses knew, "so and so knew", YOU knew.

    I know confrontation is difficult. But I would go in this order: discuss it with them, discuss it with your manager, discuss it w/ your ethics line, discuss it with you peer review committee, notify the board.

    At each step, if the situation isn't resolved, take it to the next step. Confrontation or no, it IS your legal and moral obligation to protect those patients and preserve the integrity of nursing, assuming you have the facts correct.

    Last edit by ZASHAGALKA on Sep 18, '06
  7. by   RNsRWe
    Well, I DON'T know what I'm going to do about this. You're right, of course (except for the part where you called them "students". They're graduates). I'm not going to argue that. It'd be great if the people who have failed would go up to the boss, turn in their badge and say "can I please be a tech for the next coupla months until I test again?". But if their defense to getting caught would really be "she knew, and she knew..." then I'd hope she'd have a backup plan! That wouldn't hold water.

    My guess is, if the upper level hospital administration were to get wind of it, they'd be gone. The manager DOES know as far as I know (and truthfully, I CAN'T swear to that, I just don't know for sure). But a "she knew" would stick there before it'd drop any lower.

    I know one of them is due to retake test very shortly. Here's to hoping she passes and that's the end of it (at least as far as I'm concerned it WILL be the end of it).
    Last edit by RNsRWe on Sep 18, '06
  8. by   Altra
    The important point is that these individuals ARE NOT graduate nurses if they have no properly issued permit from your state's BON to work as graduate nurses. I can hold a degree in accounting ... doesn't make me a licensed CPA. I can have graduated from law school ... that is a separate issue from whether or not I have a license to practice law. Nursing is a profession which requires a license or temporarily granted permission to function as a nurse from the appropriate licensing body, period. No ifs, ands or buts.

    Have you or could you possibly in the future receive report on patients from these individuals? Would you accept report from them as unlicensed individuals with no legal status as nurses? What if one of them asked you to co-sign something that requires 2 nurses - waste narcs, check insulin, etc.?

    I agree with Timothy - as uncomfortable as it may be, you have an obligation to attempt to do something about this. I'm willing to bet money that somewhere in your hospital orientation was a presentation on ethics and policies, and included in it was the clear expectation that ANY employee who has knowledge of ANY PRACTICE which jeopardizes patient safety and/or opens the facility up to liability issues will bring it to the attention of their supervisor or some other appropriate person.

    I feel for you - you're in a tough spot. Ideally, you'll find a way to speak privately with these individuals, and they'll do the right thing. Let us know how this goes.
    Last edit by Altra on Sep 18, '06
  9. by   RNsRWe
    Ok, I have an idea on this. I'm quite sure that I can ask questions to my preceptor about this very subject without it being odd. And I'm quite sure I can word it in such a way so he knows that it's an issue at THIS hospital, as opposed to a general question.

    I can cover my butt and still "keep out of it" if I do this carefully! Thanks for all the input...I hate things like this coming up already
    Last edit by RNsRWe on Sep 23, '06
  10. by   RNKay31
    Wow, the most important thing to do is to report, but giving the circumstances now a days, where the older nurses eat their young, it is a very hard situation, also we as nurses have to be able to be honest and be our patient's advocate, and also remember when you were graduating, and saying the nightingale pledge, that says to pass life in purity and to practice my profession faithfully, I will do all in my power to maintain and elevate the standards of my profession, I know it is hard for you, it is so difficult, you do not want anyone saying you are a snitch, but kindly use your own judgement and do what's right for the safety of your patients, and the keeping of your license you work so hard for, all the best.
    Last edit by RNKay31 on Sep 19, '06
  11. by   colleennurse
    I am sorry that as a new RN you are already in this sort of position. You need to say something. What if something happens to one of thier patients? Or a law suit? Maybe I am a paranoid person, but I cannot understand why someone would want to work as a nurse knowing that legally they cannot. I realize that stepping down to a tech position after being a GN would be hard for an individual, but I would not want to risk my chances of licensure in the future. Maybe you can approach these people and tell them that they could be in jeopardy (sp?) of future licensure, and you would hate to see that after all the hard work of nursing school. I know this might sound shady, but you could tell them that people are talking about it. That might be enough for them to go forward themselves. I am sure of you talk to them and they do nothing you could anonymously tell the NM. Again I feel for you this situation sucks! Like you or someone else said, how could the management not know. When I was getting ready for my boards my NM knew when I was going to test. Let us know how it turns out.
  12. by   Marie_LPN, RN
    So why is it that I'm seeing people who I KNOW have failed the NCLEX (they've said so) and are still working as GNs? They still have the same patient loads, still doing assessments, admissions and discharges, nursing judgments, still passing meds and doing pushes that the LPNs who have passed their NCLEX's cannot legally do. They sign off as "Jane Smith, GN".
    That floor would wind up in a load of crap with the state for allowing that to happen.

    If i had failed the NCLEX, failed to inform my employer, continued to work in the role of an LPNA (not AS an LPNA), and my employer found out, i'd been out of a job and reported to the state.
  13. by   RNsRWe
    Well yes, this does suck, does it not?

    I figure if the preceptor gives me the impression he can't or won't pursue it, I know that there's a compliance department that takes anonymous calls. I wouldn't be required to say who I was or even exactly who I'm concerned about, that would be up to them to do the math and figure out which (how many, actually) of their new grads aren't legally allowed to practice right now. I don't have to put my neck on the line that way, which frankly I'm not prepared to do. Required to inform of problem, ok, I can do that, but I'm not required to hang myself personally. Guess that's the point of the anonymous line, huh??

    And I'm still hoping that by the time someone upstairs decides to deal with it, the point will be moot because there'll be an actual license in place. And that's not my call, thankfully.

    I swear, next time I come across anyone with a GN I'm just not gonna ask when they are taking their test, or anything, should they tell me they already did and failed!
    Last edit by RNsRWe on Sep 25, '06
  14. by   RNKay31
    Wow! All the best to you and hope everything works out fine.