Is my license at risk?

Nurses Professionalism

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Hello all. I work in a urgent care setting, and over the years have been having issues with a provider, who is a PA. She has been practicing for about 18 years, and her treatments show it. She has very antiquated ideas of how to treat illness and injury. She is very stubborn and even when someone explains that science has changed, she won't hear it. She is hostile on some shifts, to staff and patients, and you never know which person she will be day to day, even hour to hour. I recently learned she does not know how to open a glass ampule and use a filter needle to give epi. This is necessary occassionally at my job. She also is not ACLS or PALS certified, which she has said is not required. I am not sure if this is required of our providers or not, but that worries me. She does not know how to use anything in our crash cart or how to do an EKG.

Fortunately, other than getting under my skin, we have averted disaster with a patient, but if a true emergency happens and I'm on duty with her and she cannot give correct direction, orders or perform skills, am I at risk of losing my license? I'm afraid to bring this up to management as I've seen retaliation first hand.

I love my job otherwise, but shifts with this provider have been annoying at best, but now has become frightening.

Any thoughts or insight?

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Question and, if necessary, refuse to follow any grossly incorrect and dangerous orders, documenting as needed. If you're in an acls situation and you are acls certified, typically you can follow acls protocols on your own without needing her orders (check facility policy though).

The PA in question isn't the first or only licensed prescriber to have bad or outdated ideas. If she's as terrible as you say, you may be more likely to get pulled into a lawsuit eventually, but I doubt your license is in any serious danger. For one, she can't force you to perform an order that you know to be harmful. For another, most nurses who lose their licenses get in trouble for felonies, substance abuse, etc. It's not as easy to lose it via poor practice as most are led to believe.

If she's genuinely dangerous and not merely kind of old school and unlikable, there's always the option of anonymous reporting. But be wary of making her into a supervillian if the real problem is just that you don't like her.

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Thank you for your reply.

I have in the past, refused to give medication based on allergies, and she has went ahead and given, which I have documented as such. But it still makes me uncomfortable. Her hostile attitude at times does not help, but that part I make do. I was just mostly worried about her being up to date on current practice. Thanks again, I will be sure to keep documenting as I have.

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On 1/9/2020 at 8:29 PM, Hollywood77 said:

She has been practicing for about 18 years, and her treatments show it.

I don't understand this comment. It brings your judgment into question immediately. If there is a problem it isn't related to being in practice for 18 years; it would be related to not having a good knowledge base and/or not staying up-to-date.

On 1/9/2020 at 8:29 PM, Hollywood77 said:

She is hostile on some shifts, to staff and patients, and you never know which person she will be day to day, even hour to hour.

That's a problem.

On 1/9/2020 at 8:29 PM, Hollywood77 said:

She also is not ACLS or PALS certified, which she has said is not required. I am not sure if this is required of our providers or not, but that worries me.

This is to be addressed with the UC admin. They either do or don't require her to be ACLS and PALS certified. If she cannot perform the provider role in an urgent situation, that is something worth discussing.

What is her role in an emergency? She is a provider. She either has the knowledge and skills necessary to perform the provider role in an urgent situation, or she doesn't. If she really doesn't then your option is to speak to the admin about it. But her appropriateness is not ultimately going to be judged based on the things you are mentioning such as filter needles and ampules and EKGs, etc.

It sounds like there was a situation that required urgent intervention and you are not satisfied with how it went. Talk to your administration about it. It's very possible that some employees do need additional education - but your specific examples are not adequate to independently impugn this provider. Did she give incorrect orders? Did she not function in the way the medical providers must function in an emergency at your site? Those are things worth discussing.

Remember, too, that if things only crop up rarely at a site, and if administration doesn't regularly require reviews/education/simulations of these high risk/low frequency types of things, it's quite unlikely that everyone is going to function perfectly when such things do crop up. You all should be reviewing, practicing and updating your emergency procedures on a regular basis.

On 1/10/2020 at 1:26 PM, Cowboyardee said:

But be wary of making her into a supervillian if the real problem is just that you don't like her.

Wise.

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2 hours ago, JKL33 said:
On 1/9/2020 at 7:29 PM, Hollywood77 said:

She has been practicing for about 18 years, and her treatments show it.

I don't understand this comment. It brings your judgment into question immediately. If there is a problem it isn't related to being in practice for 18 years; it would be related to not having a good knowledge base and/or not staying up-to-date.

Yes, that is exactly what I am saying - she is not up-to-date on her thinking and treatments, which is why I say she has antiquated ideas (that she learned 18 years ago and never updated) which cause more problems, unnecessary tests, more costs and referrals to the ED which are not required. This is another reason that I worry about my license.

As far as there being a situation in which I was not happy, no, it hasn't happened yet. One to four times a month, a nurse is not on duty, only a MA and RT with the provider. They are not able to perform specific duties, and with her being the provider and unable to do some tasks is concerning to me. MA's and RT's aren't allowed to draw up medications, etc., so I am just surprised/concerned that my company does not mandate that providers have that training. My teammates have expressed that they are fearful of an emergency event because they don't have faith in her abilities and thinking. I am not getting into specifics here, just noting on many occasions that she does not order the treatments that are the best intervention, etc. Coupled with the fact she is unable to be the leader in case of emergency is worrisome.

Now I am getting way off course here, and getting way more into what I was really asking, so my apologies. I just feel at times we are in the wrong hands with this provider and I have never worried about something like this before.

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

Does your facility routinely debrief emergencies after the fact? It might be a good practice for its own sake and would have the added bonus of identifying deficits in this person's level of competence.

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