Liability of teaching an outside nurse

[Blindsided]

I work in a busy family practice office. We have a client that comes in for a routine injection. She wants a family member (a nurse) to start giving the injections. The doctor agrees to do this, but wants me to teach the family member to give the first one in office. The more I think about it, I'm undecided about it. What would you do?

[Asystole RN]

We often teach patients, and their family, how to self-administer medications. Like all interventions, you need to document what you taught and their response to the teaching.

My question is, who is going to supply the medication and supplies?

Edit:

A licensed nurse, regardless of location or current employment status, is liable for their own practice. That nurse needs to know that if she/he is going to practice on a friend or family member that they need to consider the ethical and legal implications of doing so.

[Hygiene Queen]

Hmmm.

Is that really much different than teaching a patient's family to give insulin or manage the patient's medications in general?

I don't think there would be a problem, but maybe someone else here will see one.

[netglow, ASN, RN]

No. No difference. This other nurse is not considered a "nurse" in this situation as much as she is a caring family member - probably going thru hell with the patient too, and doing what she can with the situation as family often are the worst to take care of.

[LynnLRN]

I don't see the problem. Someone has to give the injection. I teach family members/friends to care for my patients all the time. Where I live I feel like the only jobs are in health care, I feel like pretty most of my patients have a family member who happens to be a nurse.

[Kooky Korky, BSN, RN]

Ask the doc for a written order to teach (name) to give (specify med) to (patient's name).

Then you will at least have an order.

I doubt there's a problem, as long as you document specifically what you taught and that there was a correctly done return demonstration. Quote the learner saying something like, "I'm an RN and have been giving shots for 50 years" and have her sign something or something like that.

Have her sign that she knows complications of that particular injection, sterile technique, proper syringe disposal, actions and side effects of the med, where to give it, where not to give it, etc.

Get the doc to have his lawyer have a Release of Liability drawn up if you're worried. Is this type of shot-giving typical in this doc's practice and in your locale?

[merlee]

As a home health nurse I have taught soooo many family members to give injections, IV meds, tube feedings, etc.

You say this is a nurse already? Then just have the doc write an order to teach a family member how to give the shot. This should NOT be a major liability issue. You teach it, watch the person do it, and document it.

Many, many family members - non-health care types - give injections and more every day.

There are people who do home hemodialysis.

Before I went to nursing school, my mom was taught to give my grandmother Demerol injections!

Best wishes!

[Esme12, ASN, BSN, RN]

If they are already a "nurse" why do you have to teach them how?????

[netglow, ASN, RN]

Here is the difference legally. When you are taking care of a family member it is recognized as just that. From the physician's office side of things, you would show the nurse/family member what to do (no matter if it is redundant) and then document that you taught the family member how to administer what ever to their family member (the patient). The family member being a nurse thing has nothing to do with anything here.

You should not however show a family member who happens to be a nurse how to do a procedure that you would not normally allow a family member to do. This is where you get into trouble.

[Meriwhen, ASN, BSN, MSN, RN]

IMO you are not teaching a nurse: you are teaching a family member who just happens to be a nurse.

Safest thing to so is as netglow suggested: act as though she's not a nurse and teach it exactly the same way that you would teach any other family member. Also document what you teach and whether they understand. If she brushes off your teaching or says you don't need to explain it to her because she already knows, document that meticulously as well.

If she takes it upon herself to do things differently, then anything that happens will be on her and not you because you've documented that you taught (or attempted to teach) her how it should be done. We can't control the actions of patients or their families once they leave the facility.

[HippyDippyLPN]

I used to work as an allergy nurse and we used to teach people all the time and most of them were not in the medical field on how to administer their own injections. They came to a class, signed a waiver, and were responsible for themselves and the injections from there on out, no liability on me.

[Blindsided]

Thanks everybody for your input. Will medicaid even pay for the supplies to give the intended med? Syringes, alcohol wipes, etc. Or do they have to come to the office for injection? They have some strange rules sometimes. Just seems weird that I would have to teach anything since she's a nurse. Why can't the doc just write the script, client fills it, family member/nurse gives it, and leave me out of it? Not sure why I'm balking on this, sorry. Happy for your responses though :)