Legal responsibility of RN

[nurseREA]

So in my outpatient clinic, and I think that in most outpatient clinics, CCHT's are given the responsibility of the water room duties. All the nurse does is observe the chlorine checks every 4hrs. My question is if something was to happen in the water room and the CCHT made a mistake and the patients were harmed could the nurse's license be in jeopardy even though she was not in charge of the water? Is the nurse responsible for every single thing the CCHT does even if they are not in the water room with them? I know we have alarms and bypasses etc tp protect the patient's, I'm just wondering how much legal responsibility the CCHT has and the RN has for their actions.

[madwife2002, BSN, RN]

Yes you are accountable for every action you tech takes. I advise the RN to know how the water room functions, know how to test for chloramines, go with the tech at least once a shift and watch them perform the test or do it yourself. When you sign off to say the test is within a normal range, you are saying you agree with the findings

You are the charge nurse, which means in the absence of the manager you are in charge of the HD unit. You need to make sure you understand the water room!

[FransBevy]

Nurses do the Chlorine/Chloramine checks where I work so you aren't worrying about it being done correctly.

[NurseRies, BSN, RN]

Where I used to work, the techs came out to the main station and showed the charge nurse the actual chlorine check, although, we didn't see where the water came from. The way I see it and from talking with other nurses in the dialysis industry, you are responsible for what you sign off on. If you sign off on chlorine, you are saying you checked it. However, if the tech didn't check the water resevior for residual bleach in the morning, and the biomed had bleached the entire RO system the night before, you would have no knowledge of this potentially. You don't sign off on all the meter checks, residual checks, pH testing do you? I don't think that would be on your back if something happened. Patients have been harmed from someone pouring bleach into the big bicarb mixing tank because they were mad at their manager. The charge nurse was not responsible for this, it was the tech who did it and went to jail. The techs are trained and certified, they are expected to be professional, accountable individuals. I don't think it would hold up in court for the nurse to be responsible for every little thing that happened, if we weren't required to check it or sign off on it. It's impossible to know.

I have gotten upset at techs before, for not telling me that a patient's blood pressure was 70/45, next thing you know, the patient was passing out and then throwing up. Ultimately, as the charge nurse, we need to be walking around the room and at least visualizing recent vital signs. It is hard to be in charge of 40 patients per day, let alone all the water duties. My advice is, be aware of the chlorine checks, and insist to go back with the tech if you're worried. I think techs understand how important negative chlorines are though, and I hope no one would be employed that was careless or dishonest.