practice without specifically being hired?

Sour Lemon · Nov 29, 2018

I'm having a difficult time finding a good answer to this question: If you are a nurse but not specifically hired as a nurse, can you still perform nurse-level duties? As an example, if you are a registered nurse but are hired as something else and thus have a different title, say maintenance, then can you still give an insulin injection if the facility needs someone to do it?
More particularly: Is it actually LEGAL for you to do it? If it is legal, then is it still a good idea to refuse due to possible liability issues? If it is not legal, then can someone point me to the legislation that specifically states so?
I would imagine that it is not, but sadly I cannot find anything that specifically says so one way or the other.
Thanks for any help!

It might help to know where in the big world you happen to be. I would imagine that every employer out there has some sort of policy against their maintenance man giving insulin to patients, though.

stellarfirefly · Nov 29, 2018

United States, specifically California.

I was actually thinking that it may be somewhat more common. Some place needs a nursing task done but the nurse isn't around at the moment, but hey Jenny the secretary also has an LPN license, maybe we can get her to do it.

Triddin · Nov 29, 2018

I wouldn't as its outside of the scope of the job youve been hired for

Daisy4RN · Nov 29, 2018

It has always been my understanding that you cannot work as a nurse if not hired as a nurse. You could go the other way though, for instance, if you are hired as a nurse but filling in as secretary then you could perform nurse tasks. But if you are hired as a secretary, even though you have a nurse license, then no you cannot perform tasks other than the secretary. It all depends what you were hired for, what title is actually on the hire paperwork.

Sour Lemon · Nov 29, 2018

United States, specifically California.
I was actually thinking that it may be somewhat more common. Some place needs a nursing task done but the nurse isn't around at the moment, but hey Jenny the secretary also has an LPN license, maybe we can get her to do it.

I'm in California and have actually worked with two different secretaries who were new graduate LVNs. Under no circumstances were they allowed to give medication or do any other nursing tasks.

An employer's insurance wouldn't typically allow for that, and the facility had not hired them for, or established their competency (remember those GIANT stacks of paper where you and your supervisor have to initial each thing?), for nursing tasks.

Now on occasion we may have a nurse who "plays secretary" and has been checked off and hired for nursing tasks. In that case, it would be allowed.

JKL33 · Nov 29, 2018

I won't speak to the legality of it. But here's the general concern according to my belief/understanding:

If you are hired into an RN position, the employer typically goes to some length to vet you for the position and to ensure that you are educated on their policies and procedures and have up-to-date competencies completed/on record, etc, and they have policies describing how they will vet/educate/orient you regarding your job duties. Many even keep employees on probationary status for a pre-determined length of time - - part of that is ensuring you are competent to do the position you have been hired into. If you were hired into, say, a maintenance or strictly secretarial or food service role, they would not have undertaken the expense of all the education/orientation efforts required for nursing practice.

It is just generally understood that prudent nursing practice involves operating not just within the RN (or LPN) scope, but, if you're employed, operating according to your employer's policies and procedures - - which you would not be doing under the circumstances of your question, due to the reasons I've described.

Even if a supervisor/manager said they want you to do this thing that you weren't hired for, should a problem arise the first questions that will be asked was whether you were operating within your scope and according to company policies/procedures. Also, there's no guarantee that (after something goes wrong) your employer would go on record saying that you were directed by them to do this thing; there's a risk they would say or imply that you went rogue and just decided to do it on your own.

Seaofclouds, BSN, RN · Nov 29, 2018

I agree with everyone else. It goes by what your job title is. When the state department of health comes in to do surveys, they look at personnel files. They will look at your job titles, your job description, and then all of the competencies you have been signed off on. If you are doing work/tasks that you have not been signed off as being competent in, there could be issues for your employer from the state.

Kooky Korky, BSN, RN · Nov 29, 2018

Perhaps in an emergency, one in which the circumstances were just so dire that there was a completely inadequate number of nurses, plus patients critically ill or actively dying and no one around to save them and no one would be available in time to save them - well, PERHAPS in that case a secretary licensed as a nurse could do nursing tasks.

I don't know. Why don't you ask the Attorney?

verene, MSN · Nov 29, 2018

You cannot operate as a nurse if that is not your role with the organization. For example when I was a hospice volunteer many of the volunteers came from health care backgrounds, but since we were there in volunteer capacity we could not work the extent of our training/roles (though it was expected if our training/roles allowed us to note something some one else wouldn't that we would inform the care team). Does that make sense?

For example: As a CNA I routinely provided ADL assistance to patients in my day-to-day work, as a volunteer - many of those same ADLs were out of my scope. For instance I could not ambulate a patient or get one up to use a commode - I would need to assist the patient in calling for the CNA or RN to come help. I could however use my knowledge of providing ADLs to start setting up supplies for the CNA when they got to the room.

The only exceptions I can think of are a) in a crisis situation where there is no one else around who could preform the skill, or b) if the employer knows of the additional license AND has cleared the employee to preform those RN tasks that are outside of their primary role AND has this written into policy or employee contract (e.g. I worked for a hospital that had all unit secretaries trained as CNAs or MAs and had them go through facility orientation and training for those roles such that if they needed to jump in on something they could - having them actually do so was extremely rare, - in this case the "extra" role was actually covered under their job description so not really outside of their role).

stellarfirefly · Nov 29, 2018

Thank you all for the great responses. I had figured that was the case, but was just wondering if anybody knew if it was actually spelled out somewhere. I did search my state's Nursing Practice Acts, but I couldn't find anything. So if someone does know, then please share! :)

As for asking a lawyer, it's not a pressing matter so I have no reason to spend money to hire one. I was really just curious.

Though I do recall some years ago an LPN acquaintance who was working part-time as something else (officework?) was asked by her facility to perform something (injection?) because they knew she worked as an LPN elsewhere... and they for a time gave her flak for being unhelpful and not a "team player" for refusing to do it. I don't think anything too bad came from it, since she worked there for at least another year afterward. Now that I think back on it, I wonder if she had agreed to do it, would it have been a risk to her license.

chare · Nov 29, 2018

[...]
As for asking a lawyer, it's not a pressing matter so I have no reason to spend money to hire one. I was really just curious.
[...]

https://allnurses.com/legal-advice-column/