I Need Advice. May Lose Rn License!!

barefootlady, ADN, RN · Jun 10, 2005

I think you may get a reprimand from the board over the insulin, but CNA's do caths some places and also chem sticks. Is it allowable in your state? Why would you let anyone do something if you do not know what the nurse practice act states? Was what this person did within the policy of the facility? Good luck and seek legal representation.

barefootlady, ADN, RN · Jun 14, 2005

Do we have any updates to post on this situation?

Shell5 · Jun 14, 2005

Texas: I have been stressed and scared not knowing what is going to happen. The board is not a like a regular criminal system and you don't have the same rights. I feel powerless right now.

This delegation/supervision rule can be quite confusing, especially when there is no policy at the nursing home. The CNA that I supervised doing chemsticks, insulin injection and in and out cath can be in serious trouble as can I. I was the RN on duty. I was working the weekend and was instructed by a LVN, who had been a nurse for appx. 20 years, and who has worked at nursing homes for probably about the same, it was okay to allow the CNA, LVN graduate to perform these tasks as long as I supervised him. He had taken his boards, but flunked them, but was waiting to take them again. He did not have to assess, evaluate for any adverse SE because I was right there watching every step of the way. As a matter of fact, the last time, I drew up the insulin. He just injected it into the skin. Now, I could loose my license. I am not trying to project the blame. I am responsible for my own actions. I could have lied about the time from I allowed him to do these tasks because I'm sure there are many who would have gone along with it, but I didn't. No one was harmed at all. I realize there are laws and some laws vary from state to state. I see the rationale with many of the rules of the board. I guess right now I am afraid. The state investigator that questioned me said, "this is unprofessioanl behavior" as if I had committed some hanious crime. I MADE A FRIGGEN MISTAKE FOR GOD'S SAKE!!!!! GIVE ME A BREAK!!!!!!!! "I HAVE TO REPORT THIS TO THE BOARD." I had no clue that because he had not passed boards, even though he was waiting to take them again and becasue he was working as a CNA but had still graduated from LVN school and had done these tasks in school that he couldn't do them because he was working in a CNA capacity. I would NEVER deliberately hurt my patients or put them at risk. I was not trying to help myself, but help the guy pass his boards by giving him opportunities. It just didn't sit right with me. Not only this, but they look at your record for the last 5 years. I completed a program TPAPN, Texas Peer Assistance Program for Nurses, which is a nursing program for us who are (or were) impaired by chemical dependency, alcohol, and or mental illness. It is kinda like a nursing probation. I completed it a little over about 4 yrs. ago and have been completely clean and sober for over 4 yrs. I am afraid that they will look at that and this mistake and kick me out of nursing because of my past. I guess I don't have very much faith in the Texas BNE. On top of that, when I called to speak with 2 separate people at the BNE and gave them a sitation like mine without telling them specifics about my case to find out what can usually happen in a case like mine ie; suspension, reprimend, etc.. neither one of them could or would even come close to giving me an idea of the type of punishment a person usually gets in this particual case ie; like a person would get for DWI or possession

barefootlady, ADN, RN · Jun 14, 2005

Thanks for the update, I would get an attorney quickly and allow him to deal with corespondence from the board. I really do understand what you say happened, I understand your good intentions, but I do understand that the injections may cause you a problem. I would not sweat the Glucose checks, the vital signs, or the in and out cath, now that is because it is standard for most CNA's to do them from my area. I don't know the story in Texas, what CNA's do or don't do. This should be a very powerful reminder, never, ever allow another staff member to do any task they are not covered under a policy to do. If there is no policy, stay safe, do not allow them to do the care until you have spoken to the DON and know who can do what. Again, I wish you luck. Keep us posted on what happens. Are you still working at the facility? What is their take on this situation? Do they support you or are you hanging on the think end of the limb?

CHATSDALE · Jun 15, 2005

i don't know what else to add but i totally agree that a good nursing attorney would be your best bet right now...see if you can get some one who is reccommended

you don't need a fresh out of law school person for this...your license is on the line and if you can get out with a reprimand instead of a six month probation it would be worth it

check about the injection regs this seems like the one that will give you the most problem

good luck..keep us posted of what goes down

Shell5 · Jun 15, 2005

yes, I am still working at the facility. State has found many complaints and there are some against the DON herself. Right before state came, a lady choked to death at our facility and they are looking into this as well. As a result, the staff where I work are very busy getting there own selves in order and the facility. I don't think they think one way or another about me. I am out their on a limb on my own. It is scarey. I have been looking for a nurse attorney located in the central Texas area and am waiting for replies from them, but have yet heard nothing. Does anyone know if it has to be a nurse attorney if I can't find one or will a labor attorney work? :rolleyes: Thanks for all your input and suggestions. They are very much appreciated. I'm just glad there are people out there who care.

Texas, RN

pricklypear · Jun 16, 2005

Shell5, I just wanted to lend you some support, and wish you well. Hopefully the board will take all circumstances into consideration. I really don't think anything to do with chem. dep. in you past should have any bearing. One has nothing to do with the other. The fact that your rationale for what you did was to give the CNA some experience, and you supervised his actions, sets well with me. Another nurse could have delegated these tasks so he/she didn't have to do it themself, and that could have posed a threat to a patient.

I wish I had some good advice for you, but all I can give you is an arm around your shoulder!:) Good luck.

pumpkinsooner · Jun 23, 2005

I want to lend you my support too, but I have to say something after reading your reaction to this investigation. I'm sorry you're in this situation, but I think you do deserve some type of disciplinary action against your license -- not for the glucose checks or even the cath, but for allowing an unlicensed person to give insulin.

CNAs (at least in Oklahoma) aren't allowed to give injections. Until this guy passes his LPN/LVN boards, he's a CNA, and he's unlicensed. There's no way in the world I would allow an assistant to deliver any type of medication, no matter how well I knew that assistant or how close he/she was to passing the boards for the next step. I'm shuddering just thinking about it.

I know you were trying to help the guy, and while that's admirable, you went about it all wrong. Demonstrating to him would have been okay. Showing him how to do a correct assessment, the five Rs of med administration, correct technique -- all good. But you crossed the line when you allowed him to actually administer the insulin. And you did it more than once, if I read you correctly -- you say:

As a matter of fact, the last time, I drew up the insulin.

The last time? You allowed him to draw up the insulin, too? How many times did you allow an unlicensed person to draw up and adminster insulin on one (or more) of your patients?

I know you must be frightened, and I'm sorry for that. The most the board can do is take away your license; they can't put you in jail, so don't worry about that kind of stuff. There will be a hearing, and you'll be allowed to present your side of the story. I think a nurse attorney would help you make an effective case for yourself in front of the board, because if you tell the board what you're telling us, the board won't be happy. While you see this as a 'friggin mistake', what you actually did was allow battery on your patient. It could have been a 'heinous crime,' and I think you're minimizing its importance and your unprofessional behavior.

I really don't mean to come down on you like a ton of bricks, despite the tone of this post. I'm not a mean old nurse or a hard-ass. I just don't know any other way to say it. All of us have made mistakes, and we've all learned from them. I hope you learn from this one and grow to understand why these actions are illegal and unethical and unprofessional. Good luck.

ZASHAGALKA, RN · Jun 23, 2005

You have to relax.

Any board process is going to be measured in months.

And I think you're ok. Everything but the insulin falls under the BNE's delegation protocol which basically says you can delegate anything you are comfortable delegating, but you maintain responsibility.

Of course, med passes are different. But, the CNA was a GVN (grad voc nurse) until he failed. Just present it as a misunderstanding of what his change of status meant, as you could have delegated the insulin stick to a GVN.

Do you see what I mean: you knew you could delegate this at one point, but his status changed when he failed the exam and it was just momentarily lost on you what the implications of that change meant in terms of delegating this task.

From what you've said, this is the truth.

4 things:

1. You will not lost your license. At worst, you'll get a reprimand. You should see some of the stuff the board has to deal with. In a hospital, the board wouldn't even have been notified as this would be more appropriately handled in a 'peer-review'.

2. If you have nursing insurance, call them and tell them you will need an attorney to represent you to the board. Your malpractice insurance is supposed to cover that. If you don't, lesson learned - buy insurance. at 80 bucks a year, what kind of peace of mind would that be buying you now.

3. TPAPN is considered 'expunged' once completed. Do they have a record you took it - of course. But it's not supposed to be used against you. This shouldn't be an issue.

4. Don't contact the board again until you've been contacted and have a file/case number. Don't send any rebuttals or call for advice until you hear from them. It's possible that they will consider the report so low priority as to no follow up on it. Don't give them pause to say -- ah, this is the complaint that girl keeps bugging us about.

It's not the end of the world, it's not the end of your career. I wouldnt' be surprised if the BNE just dismissed it with a 'don't do it again'.

Breathe. You might not hear anything about this for months. You have to be able to function in the meantime.

~faith,

Timothy.

ZASHAGALKA, RN · Jun 23, 2005

I personally wouldn't spring for an attorney until I actually heard something from the board.

There's a big difference between 'i'm going to report you!' and the board actually investigating.

Any notice from the board will give you time to hire an atty in order to rebut.

However, I would start saving for one.

~faith,

Timothy

Fiona59 · Jun 23, 2005

Heck, unlicensed family members draw up and give insulin at home, unsupervised. I hardly think you drawing up the dose and supervising your NA is a crime.