Policy contradicts State Law

Nurses Safety

Published

Good afternoon,

I need to know what to do when state law contradicts a policy in a facility.

This is related to conscious sedation where state law says that an RN cannot be performing any other tasks when administering sedating medications.

The policy, however, states that the RN CAN perform interruptible tasks (and this is currently happening) unless patient falls under deep sedation.

To me, I think the RN should be fully concentrated on the patient, the IV Demerol and Versed is quick acting and can provide undesirable effects suddenly. If the RN is distracted, how would he/she identify a change in a patient's condition?

This is not safe for the patient and the Director is not on board with my observations and concerns even when I presented the website for the board that states this clearly.

What should I do?

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Specializes in NICU.

If something goes wrong and a patient or family sues you and your employer, do you think your director will support you or throw you under the bus? The lawyers will look at your state's RN Scope of Practice. They will ask "You knew that you were practicing nursing outside your scope of practice and you still allowed distractions to injure/ kill my client?"

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I've resisted into going in while this is happening and told her I'll stay out in pre/PACU.

The day of, she tells me that I am to relieve her for breaks because there isn't nobody else. Since when does consensus overrule patient safety?

She says she will have my back but doesn't come back in when I expect her.

She tells me if I need anything to call for her but I feel so anxious about it all.

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I would contact the state BON, describe the situation, and ask their advice about what you can and can't do in those circumstances. I would ask them to provide me with a written statement (on the regulatory limitations on your situation) and show that to your director. I agree with Guy -- if you just go along with what your director wants, in violation of state regs, your employer will throw you under the bus in a heartbeat as soon as something goes wrong. Your director is not going to stand up and say oh, wait, it wasn't her fault, I made her do that. No employer is every going to care about you or your license as much as you do. You have to be savvy about protecting yourself.

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Specializes in Case Manager/Administrator.

Not sure what state you are in but I am assuming most all states have some form of patient safety verbiage, the state I come from has this: The nurse may perform the activity, intervention, or role to acceptable and prevailing standards of safe nursing care. With that said if I am tasked with this procedure and I have all the necessary training and current knowledge I would have a print out saying please do not disturb unless an emergency and have it so everyone can see. Before I start the procedure I would ask those who I am supervising to 1. Ask if there is anything pressing, 2. I am getting ready to complete this procedure and cannot have any interruptions unless an emergency. Good Boundaries go along way. If I the expectation is to be multitasking then I would say no I cannot do this, if it means getting reassigned or terminated then so be it. I am coming from a nursing and Administrator background so walk both sides but in this case there is really only two issues that are side patient safety and scope of practice. This pertains to complete and partial sedation to me it is patient safety.

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I realize you may not want to divulge your state, but if you don't mind can you post the website and/or a clip of the related state law verbiage to which you refer?

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Thank you all for responding and supporting my stance. I've been a nurse for one year and the nurses I work with have been working in ICU and ER For over ten years, but I've been taught to go with my gut instinct.

I have quit working there (unlike me to do this) but there had been no changes and nobody can plan when an emergency should happen.

http://www.rn.ca.gov/pdfs/regulations/npr-b-06.pdf Here you go, JKL33

Also, to elaborate on interruptible tasks, this includes labeling the GI specimen, filling out the entire pathology requisition form, clicking on the cecum tracker, entering in, start times for procedure on one laptop, drawing up meds, selecting and making notes on the docs computer (to show that the doctor did physically assess the patient) which he does not auscultation he heart and lungs as TJC wanted,(this was a safety feature, which the nurses override by having the doctor log in in the morning and he does not do his own charting or reassessment).

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True. Also, would like to add this is an outpatient ASC with no anesthesiologist on site for conscious sedation and likely not within a 5 mile radius (they leave after mac sedation cases are over). There were so many red flags, I hightailed it like anything

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Specializes in ER, ICU.
Thank you all for responding and supporting my stance. I've been a nurse for one year and the nurses I work with have been working in ICU and ER For over ten years, but I've been taught to go with my gut instinct.

I have quit working there (unlike me to do this) but there had been no changes and nobody can plan when an emergency should happen.

http://www.rn.ca.gov/pdfs/regulations/npr-b-06.pdf Here you go, JKL33

Also, to elaborate on interruptible tasks, this includes labeling the GI specimen, filling out the entire pathology requisition form, clicking on the cecum tracker, entering in, start times for procedure on one laptop, drawing up meds, selecting and making notes on the docs computer (to show that the doctor did physically assess the patient) which he does not auscultation he heart and lungs as TJC wanted,(this was a safety feature, which the nurses override by having the doctor log in in the morning and he does not do his own charting or reassessment).

Please notify the state. It is illegal to chart under anyone else's login, fines and firings await... I'm glad you quit but please consider the patients who are still going there.

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I'll work on that right now. It is extremely difficult to get through to someone in the state BON, but I'll start with the medical board.

Thank you

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I have quit working there (unlike me to do this) but there had been no changes and nobody can plan when an emergency should happen.

http://www.rn.ca.gov/pdfs/regulations/npr-b-06.pdf Here you go, JKL33

Also, to elaborate on interruptible tasks, this includes labeling the GI specimen, filling out the entire pathology requisition form, clicking on the cecum tracker, entering in, start times for procedure on one laptop, drawing up meds, selecting and making notes on the docs computer (to show that the doctor did physically assess the patient) which he does not auscultation he heart and lungs as TJC wanted,(this was a safety feature, which the nurses override by having the doctor log in in the morning and he does not do his own charting or reassessment).

Thanks for posting your reference material. I was curious because as I suspected, it doesn't really say that th RN can't be performing any other tasks. However, I understand the spirit of your concern and agree with you. It sounds like things were fairly messed up there and you made a good decision to leave!

Take care ~

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I do feel like I made the right choice. During my time there, I had documented and time stamped my actions and the responses. I filed them in a binder along with a print out of the state law. I made copies and kept one set.

If an EGD is done, you would spend all your time doing all the other busy work and barely look at the patient themselves. I would not want to be at the receiving end of a complication because I was busy charting for the doctor.

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