non-medical boss

Straydandelion · Oct 10, 2008

I guess your doc doesn't want to rock the boat by taking a firmer stand on his orders but it seems there has to be something in the clinic structure related to chain of command and medical issues since it IS a clinic. I would discuss this with the doctor and the supervisor, if there is nothing written in the facillity's policy related to this it should definitely be written.

There is information in the pdf file related to the scope of nursing practice and what you can and can't do as a professional, hope this helps. http://www.bon.state.tx.us/nursinglaw/npa.html

txredheadnurse, BSN, RN · Oct 10, 2008

I have worked corrections and half the time had a non medical direct supervisor. I can understand your frustration.

I would suggest you speak privately with the doctor about this issue first. He needs to know if his orders are being contramanded by a non medical person. Most of the docs I know do not take kindly to a "civilian" overturning their orders. The doctor has a professional obligation to render appropriate care so his orders being blatantly ignored, sidestepped or altered can place him in an untenable position legally.

If the doctor is unwilling to confront your supervisor and inform him that his orders have to be carried out unless there is a blatant security violation from doing so then you have a real problem since you also have an obligation to render appropriate care which includes following doctors orders (unless they will cause harm to the patient ). Part of the way you follow orders is to seek clarification if needed. No one, regardless of whether or not they are a medical person has the right to interfere with any nurse seeking communication with a patients doctor regarding care of said patient.

You need to have a discussion with your supervisor about the fact that you and the doctor are licensed and have certain professional standards and obligations to follow or you are exposing the facility to a lawsuit. It has been my experience that when I presented information in that fashion it made the non medical supervisor stop and think. Because inmates or juvenile offenders families will be more than happy to file a lawsuit at the drop of a hat.

The bon website states that they do not control or regulate work issues but they do remind the nurse that she has an obligation to perform within her scope and to perform her job in a professional manner and in the way a "reasonable and prudent nurse would do".

Bottom line inform the doctor, ask him to inform your supervisor of the necessity of orders being followed, regardless of what the supervisor's opinion of the orders or the necessity of the orders may be, educate your supervisor to the fact that following orders & adhering to professional standards prevents "winnable" lawsuits and be prepared to have to stand your ground multiple times until this supervisor realizes they can not force you to perform your job in a non professional capacity. Also remember your boss has a boss and that bosses' boss might be very interested to know that your boss is putting the facility and the juvenile offenders at risk by trying to play doctor.

I was already a pretty tough cookie before I walked through my first set of steel security doors but nearly 11 years in various big houses in several states molded me into someone that does not suffer fools gladly and highly aware of the need to practice in a preventive fashion so get tough sister and it will pay off in the end. :wink2:

classicdame, MSN, EdD · Oct 10, 2008

The Texas nurse practice act clearly defines YOUR first responsibility as a licensed professional is to the patient, not the employer. Losing your job is one thing, losing your license is another. I would talk to the supervisor over that person. Remind them there are legal ramifications to not abiding by the NPA for you, and the State may followup to be sure other rules/laws are not being maintained. No facility wants the State after them because it tends to get in the paper and cause bad publicity. Stick to your guns! You are responsible and accountable for what you do, regardless of bad management.

Murse901, MSN, RN · Oct 10, 2008

How about giving your non-medical supervisor a reminder that because he isn't involved in patient care, he's violating HIPAA by obtaining access to the medical information you're handling?

I just recently started working in a correctional facility myself. While I love the work, I'm a little dismayed by the fact that the medical administrator has absolutely no medical credentials whatsoever, but routinely reads through the medical records/sick call reports/etc and attempts to direct nursing care.

I had the same problem on an inpatient psych unit where the director of the unit was a psychologist with no medical background trying to tell the nurses how to do their jobs. Unsurprisingly, that unit had a high turnover rate on nurses, while the other 2 units that had RN's as administrators had few problems.

**NickiLaughs, ADN, BSN, RN** · Oct 10, 2008

There should also be some provision of a Title 22 act or something along those lines as it sounds like a residential facility. I'm from california and worked residential care. The only medical orders you take are from a physician. If your supervisor is taking medical orders, they can be charged with fraud for doing nursing duties.

I would make sure that you had your facts with you when you talk to them. This supervisor sounds as though they don't realize the seriousness of doing this. If you can put it in legal terms to show how it affects them, the supervisor might change his tune.

Good luck!

debi49 · Oct 10, 2008

Your boss sounds like a control freak. Be willing to go to his superior or start looking around.

My supervisor is non-medical as well, but he told me when I started the job a couple years ago, he would be "hands off" re: medical, as thats why he hired me. He has been 100% true to his word and a great boss! Dont put up with your guys ****.

Thornbird · Oct 10, 2008

From the Texas BON site:

"Definitions of Key Terms Used in 217.11(2) Standards Specific to Vocational Nurses

Some of the following terms may require further clarification in order to accurately apply and/or comply with the rule:

1) Supervision:

"Supervision" is defined in 217.11(2) as the "process of directing, guiding, and influencing the outcome of an individual's performance of an activity." Since NPA 301.353 and Rule 217.11(2) require the LVN to function "under supervision" of specific licensed practitioners, this precludes the LVN from functioning in a completely independent (without supervision) manner. However, direct (onsite or on-unit) supervision is not required. The LVN must have a resource person accessible at least telephonically or by some other similar means. Proximity to the LVN's practice setting and the level of licensure of a supervisor (RN, MD, etc.) must be determined by the LVN and his/her supervisor on a case-by-case basis and in accordance with any other laws that are applicable in the practice setting. "

Explain this to whoever oversees your boss and the MD. If things don't change, you need to leave. Better to lose your job than your license.

BTW, I left my favorite job ever because an "office manager" my supervisor. She had worked her way up in the clinic from secreatary to manager with some time in between as a medical assistant (on the job training not certified). She had no clue what nurses are supposed to do. Law in my state is that the LPN can't work unless an RN is physically in the same building to supervise. In spite of my objection that I was legally under supervision of the APRN's, nobody cared. They just got LPN's that didn't care. I cried when I had to give up that job.

pagandeva2000, LPN · Oct 11, 2008

I would call the BON, or write them, explaining the situation and ask for their insight. Don't know about your state, but, my BON here in New York is very responsive. I usually get answers within a few hours when I send emails, and they are very informative and the answers are understandable-no double language. It does not wash when you state that you followed the orders of a non-nursing person if it ever appeared in court. Yes, they would probably hire LPNs that don't question their authority, but, that is their license to put in jeopardy.

I also agree with speaking to the doctor privately to get his stance on it, because it seems to me that he would be the only other licensed person to support you, and if you are doing things contrary to what his orders are, then, you would be sitting in a sinking ship.

houstonlvn · Oct 12, 2008

THANK YOU SO MUCH everyone for the true help you've given me.

I don't know if it will make a difference or if I will end up having to leave a job I love, but you've given me so much info and reasons that I was able to write my grieveance in a true professional manner and give verse/chapter etc of WHY HE COULDN"T DO IT!

:yeah:THANK YOU ALL!