She doesn't have access to the medical charts, thank God, beyond what is on a flow sheet in the kardex. All of the charts are electronic, and she doesn't have a passcode. She has access to the Kardex, and that is not a HIPPA violation as it gives her need to know information as it pertains to her duties.
When it comes to her picking apart nursing assessments, it's always because she has watched a nurse do something and is tattling. I shut this PSW down the other day by asking her, "Oh? Nurse ABC did it wrong? How do you know? Please, walk me through the correct way to do that assessment as laid out by the nursing regulatory body of our province and our policy and procedure manual." When she said she couldn't, I said, "You don't know how to do that assessment correctly, so you cannot tell me whether a nurse did it right or wrong, nor are you qualified, licenced, or even legally allowed to do that assessment. You need to focus on your work and leave nursing work to the nurses." I'm finding that by not giving in to her requests, and reminding her that she is not qualified or licenced, is putting a quick stop to her. Shutting her down at the source is very effective, and my director is on board with this new plan of reminding the PSW of her role, reminding her that nurses have to be licenced, and ignoring further comments from the PSW.
As for Doctor's orders, as a courtesy, we'll tell our PSWs that someone is on antibiotics (watch out for diarrhea!) or has had a medication change. These changes are in the kardex too. While the nurse is monitoring that patient, the PSW has been asked to report changes they notice, like changes in bowel habits, ease with ADLs related to decreased pain, and the like. It's not an assessment by the PSW and it is always guided by the nurse (ie, "let me know if Mr. B has loose BMs"), but it helps the nurse catch things in addition to the care the nurse gives. Unfortunately, the PSW I posted about takes very medication change as an opportunity to rip apart the doctors and talk about why doctors don't know what they're doing.
Now when she starts into a rant about doctor's orders, I just talk over her and cut her off with a firm, "I didn't ask you for your input on the medication, thank you." and then I just ignore her. This has so far been effective at shutting her down and we haven't had a medication rant in about 5 days!
She is getting a bit better, and I have had her write down her questions and hand them in to the director instead of me. I have yet to see any action from the director, but the PSW has improved and isn't tattling all the time. I think part of it too was that she spent a great deal of time writing down her questions and got sick of her own game.