Is the RN liable for other's actions???????

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I'm an RN working in a rural outpatient clinic. Over the years the administration has reduced the number of RNs to 3 in a clinic with 9 providers onsite and 3 provider's at satellite clinics. They hire some MAs, CNAs, CMAs and in some cases, Jane Doe off the street. They "train" these new hires to check patients in, take histories, vitals and assist the physician with minor surgical procedures, start IVs and give injections. They are also "trained" to work the phone which involves appt scheduling, phone triage, dispensing medical advice regarding anything from constipation to chest pain and medications, calling test results-normal and abnormal. Not all of them call themselves nurses, but when a patient speaks to them, most of the patients assume they are talking with a nurse because of the way the office is set up. We're all referred to as "the nursing staff". I work directly for one physician, with an MA as my partner and a scheduler who also helps with some of the phone work. My question is how legally liable am I, as the RN, for actions by these co-workers, or information given to the patients by them? The clinic tells us we have no liability but it concerns me. Thanks for any feedback!!!!:cool:

Specializes in Critical Care, Education.

Yikers!

I think the relevant regs may vary somewhat depending on the state. Her in Tx - anyone who is working with patients has to display credentials. RNs must wear nametags that identify them as such. It is against the law to call yourself a nurse if you are not a licensed nurse. You will be prosecuted for fraud - if you try to pass yourself off as a nurse. If an employer allows it to happen, they can be charged with criminal negligence

Unfortunately, we are one of a very few places that still has "permissive licensure" when it comes to physician delegation - basically that means that a physician can have anyone do anything as long is it under her license.... like "home grown" scrub techs -- very scary.

In a multidisiplinary situation - Texas RNs are directly responsible for anyone they supervises BUT must also act to protect the patients if they feel that a physician 'designee' is incompetent. If we ignore, we can lose our own license for failure to report. It is very sticky - & IMHO this is why most physician offices don't employ RNs - they stick to LVN & 'aide' type of staff.

What I want to know is if an RN can be held liable for merely observing CMA/CNA and other unlicensed people doing things they aren't supposed to do?

If an RN works in a physician's office and witnesses MAs giving injections, starting IVs, and taking telephone orders etc does that RN have an obligation to report this to the correct authorities? Would that RN be risking their license even though the unlicensed people are working under the doc?

See, this is what I would be worried about too.

I wonder if she could call the BON and ask them...she wouldn't need to give away the name of the practice.

Specializes in Community Health, Med-Surg, Home Health.

MA: NO! and why are you questioning me? I am dr. soandso's nurse, not you!

Me: are you an LPN or an RN?

MA: I am a Medical assistant! I took a 6 week course! I know what I am doing.

Me: Could I just speak with dr. soandso

MA: Click

Hey, I WISH my nursing course was six weeks:confused: Where did SHE go??

It seems that more and more md's are working with MA's instead of nurses. I once had an MA start an IV on me (thought she was a nurse, and was to sick to question at the time), of course she bungled it and I had to walk her through the whole thing.

I've had MA's try to give me orders over the phone without consulting the MD, exp

Me: the pt has blah, blah blah going on

MA: well, give her blah, blah, po 2x a day

Me: ummm, shouldn't you speak with the doc first

MA: no, that is what he always orders, just go ahead and order it

Me: don't think so, could I speak directly with dr. soandso

MA: NO! and why are you questioning me? I am dr. soandso's nurse, not you!

Me: are you an LPN or an RN?

MA: I am a Medical assistant! I took a 6 week course! I know what I am doing.

Me: Could I just speak with dr. soandso

MA: Click

That was a day, I tell you. I got the don involved and she ended up taking the order! I couldn't believe it! Well, at least my name wasn't on it. After that, I spoke with the BON in my state, and they basically said the MA's can do anything they want, they are under the MD's license. They did send her a cease and desist order for using the nurse title.

This comment is in no way to slam MA's in general, because I am sure there are very knowledgeable and valuable ones out there.

However.

Some of them have just enough knowledge to be dangerous. As an upcoming second-year student, I am learning, every single day, that sometimes the seemingly insignificant, can be hugely important.

The problem, is that I don't think MA's, right out of school, are trained enough to understand, more importantly, what NOT to say. Then they start working in an office, they think they "know" by just being around the nurses and physicians, and then some of them start mimicing what they hear...not knowing that there is alot more to it.

Nursing school hasn't made me more confident...it's made me more terrified than ever that I'll make a mistake, or forget something, or leave something out in teaching a patient, etc....b/c we know just enough to know what all CAN go wrong...but not enough experience to make sure it doesn't...just yet.

It's just wrong that states even allow MA's and other unlicensed people to even work under physicians like this...there isn't a control, no training standard, and SO WHAT if the physician is ultimately responsible...

....does that help a patient that suffers the consequences?

You are never liable for someone else's actions. You are only liable for your own action or inaction.

The law would disagree with you on that one.

If I were working up a case that involved this clinic, I would be looking at EVERYONE. If the nurse did nothing to prevent these unlicensed people from performing things that are only in a nurse's scop of practice, I would be giving that nurse's name to the attorney as a person of interest.

Specializes in Family Practice.
The law would disagree with you on that one.

If I were working up a case that involved this clinic, I would be looking at EVERYONE. If the nurse did nothing to prevent these unlicensed people from performing things that are only in a nurse's scop of practice, I would be giving that nurse's name to the attorney as a person of interest.

All of us RNs have voiced our concerns to the administration, DON, and physicians. We were informed that in the state of Kansas, under rural health care guidelines, MAs, CNAs, CMAs, and even unlicensed personnel may be trained to perform any of the functions in our office and are working under the physician's license. Basically if the docs are fine with it, we have no choice. Where do I check this out to find out if it's factual info or just the admin/physcians telling us what they want us to hear? I love my job and more importantly, love my patients. My main concern is the safety of the patients, who are receiving tx and advice from unlicensed people. Thanks!!!! :banghead:

I have never heard of different laws for rural areas versus suburban/urban areas. That sounds like a crock to me.

Check out your state board's rules. And whatever agency governs nursing assistant/med asst certification. If you state government stuff is on the internet you should be able to find it. If not, call the BON and ask them where to look for your state's regs.

You may have laws that let the doctors delegate certain tasks to unlicensed personnel whether you like it or not. But I know of no state that allows them to give advice or mislead people into thinking that they are licensed nurses.

You probably don't have many choices. Even if your state laws allow certain things that really only a nurse should perform, if you stay at that job, you could become liable at some point. I would leave that job. That may not be something you can do.

To protect yourself, I would be putting into writing the issues, not just telling the boss. And always keep a copy for yourself. That way, if something happens, you may have a little protection by following the chain of command and writing up each and every incident and letting management know that this is unacceptable and dangerous.

Good luck. You are in a dangerous situation just as many nurses all over the country are. Yet another reason why nurses need to stand up as ONE, all over the country, and demand that this type of thing stop.

Are you a certified CPR/FA instructor? If not, that could be a problem also.

You need to get the rules/regs from the state licensing entity that certifies your facility to operate. In some states that is the Dept of Health. You may also find information in your nurse practice act and from the entity that certifies medication aides.

All of us RNs have voiced our concerns to the administration, DON, and physicians. We were informed that in the state of Kansas, under rural health care guidelines, MAs, CNAs, CMAs, and even unlicensed personnel may be trained to perform any of the functions in our office and are working under the physician's license. Basically if the docs are fine with it, we have no choice. Where do I check this out to find out if it's factual info or just the admin/physcians telling us what they want us to hear? I love my job and more importantly, love my patients. My main concern is the safety of the patients, who are receiving tx and advice from unlicensed people. Thanks!!!! :banghead:

I fail to see how if a nurse is interacting in a professional capacity in any setting with MAs, CNAs, UAPs, etc how they could not have any responsiblity and accountability.

If your involved with their training, you would have accountability and responsiblity as to the outcome and their competency of that training.

If you delegate to them, you would have accountability and responsiblity for what you've delegated.

If you function in a supervisory or administrative capacity over them, you would have accountability and responsiblity over them.

As a nurse, according to SBONs, state Nursing Practice Acts, and state legislation, if there are practices occurring that places patients in danger, you have a duty to report those practices to the appropriate people. Since your administration has decided to do nothing, you now need to go to the folks that accredit and license this place, and/or the State Board of Health. If these MAs and CNAs hold certification than you need to go those agencies that certify them.

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