Insubordination????

Insubordination is a pretty strong word. I don't know about that. But I don't think that your wife should just refuse the duties. Now that the "bomb" has dropped, could your wife gather her thoughts over the next couple of days and ask to sit down with the supervisor and discuss the issue? If she can articulate her fears regarding safe med passing, doing justice to both positions, etc., perhaps management will listen. Who knows? They may already have a plan in place to ensure that she has enough assistance/time to accomplish both tasks.

Personally, the more varied duties I have during the day, the more I like it. Does your wife feel that the secretary's job is beneath her now that she has her LPN license?

That is hard. It is not insubordinate as a nurse to refuse to do something that puts your patients or your license in jeopardy. But how you word that refusal is the key.

It is time to sit down and see what she can negotiate. If she feels she is capable, but maybe needs some time as a new nurse...ask for that. But if she takes both jobs and she does make a med error, it will be on her because she accepted that role. As someone else mentioned, maybe they have made arrangements for her to do this. She needs to ask about her patient load and what exactly is expected of her. Is this common practice? If not, why her?

Honestly this a one the reasons why people really shouldn't stay on the same unit after getting a new job title.

Your wife is well within her rights to address a situation that she feels may impact her license.

As a general rule of thumb, when addressing potential problems within the healthcare setting, it always helps to address the issue with management under terms of "Patient Impact".

Patient Impact is Manager-Speak for the nursing term of "Patient Advocacy". To Nurses, patient advocacy means looking out for the patient's best interests (and your license). To the upper level management, Patient Impact means looking out for the bottom line and their, ahem, "rear quarters".

Since you are a nurse as well, you have an excellent opportunity to impart ways to address this issue from a patient advocacy standpoint. Patient advocacy, after all, is the central theme of good nursing care.

"I can't do all of that safely" is not going to fly with management. Pick apart each job function and present scenarios in which patient care is severely impacted in a negative way with the combined duties.

Good luck. Let us know how it turns out.

that is a fine line...since what is a nurses duty? as an RN we had no unit cordinator part of the shift, and we had to answer phones, take off orders, make out lab slips and the kardex.... a lot of the secretarial duties are directly related to patient care... making sure the orders get placed, making calls to make sure diets get changed. but, if they are trying to eliminate a job and see if others can pick up the slack, errors will get made.

are they making any other LPN's do ward clerk duties?

I have also worked on units that had no unit secretary. If your wife is being told that she must do her LPN duties as well as the "secretarial" responsibilities pertaining to her own patient load, I would say that is probably the norm.

If she is being told that she must carry her own patient load and perform the secretarial duties for all of the patients/nurses on th unit, that would be a problem.