Scope of Practice

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Specializes in LTC, Home Health.

I have been in LTC for 20 years, and have never had a problem like this. Myself, and one CNA were working a certain hall this particular weekend. Another nurse and two CNA's were working the other hall. The nurse on the other hall asked if I would come and assist her with a difficult catheter change. As I had been putting people to bed, and assisting my CNA with her work, I had to stop and wash my hands before proceeding. When I entered the room, the other nurse was standing at the foot of the resident's bed watching my CNA attempting to insert the catheter. As the light was not sufficient in the room, I asked someone to go and get a flashlight and a new sterile catheter. As I was inspecting the resident, attempting to locate the urinary meatus, someone returned with the sterile catheter. My CNA took the catheter from her, and before I could say anything, inserted it. Well, needless to say, I have never been in a situation like this before, but we have all received suspensions for 3 days pending the state investigation. Should I just burn my license now...or what should I do?? Any advice, criticisms, suggestions, or anything at all would be very sincerely appreciated. Thank you.

Auntie

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Specializes in Med/Surg,.

I don't think this board allows legal advice. I can say at my, um, former hospital Nursing Assistants and transporters were allowed to place foley cath if they had "proper" training.

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write out a statement now while the facts are fresh and give the name of the person who asked you to assist the nurse and the name of the cna who was with you

the name of the nurse and the cna who were in the room, and the facts of the case as you presented them

i believe that you are in pretty good shape but i don't know about the other nurse and the cna

what were you doing when she opened the new catherter?

what explanation did the other nurse give to you

did you say anything to the cna while the other person went for the sterile cath

put down all the facts but don't put down too much...if this extends beyound the 3 days suspension then your best interests might be served by retaining a lawyer

sorry this happen to you

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Specializes in LTC, Home Health.

Thanks to ya'll for responding. Firstly, I am not sure what the other nurse told my aide, as the procedure was already in progress when I arrived in the room. Secondly, the other nurse offered me no explaination for anything, so I only have what I saw for myself to go on. I will write out a statement, as suggested, whether it does any good or not. As for the lawyer, if it comes to that I think I had rather go to work at Wal-Mart...less stress....ha ha.

Thanks again,

Auntie

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Specializes in Pediatric Psychiatry, Home Health VNA.

How did it come down to the three of you receiving suspensions? Did the resident file a complaint?

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Specializes in LTC, Home Health.

One of the other two CNA's (or both) who were working on that particular hall made a complaint that my CNA was practicing out of her scope. And indeed she was, but under what circumstances remains unclear. I suppose I will find out in the morning whether I still have a right to be a nurse or not :(

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Specializes in Emergency, Case Management, Informatics.

Were you the charge nurse for the unit, or were you simply assisting a peer, as you indicated? If the other nurse was supervising the CNA, I fail to see how you can be held responsible.

You did not instruct the CNA to perform the catheterization, and the patient's nurse was already in the room, AND the procedure had already started. The other nurse should have stopped this from happening.

If the pt was in imminent danger, I would say that you should intervene, but if the other nurse is in the room and he/she is supervising the procedure, it's on them.

This isn't legal advice by any means, but from the limited information we have here, I don't think you'll be interrogated by your BON any time soon.

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Were you the charge nurse for the unit, or were you simply assisting a peer, as you indicated? If the other nurse was supervising the CNA, I fail to see how you can be held responsible.

You did not instruct the CNA to perform the catheterization, and the patient's nurse was already in the room, AND the procedure had already started. The other nurse should have stopped this from happening.

If the pt was in imminent danger, I would say that you should intervene, but if the other nurse is in the room and he/she is supervising the procedure, it's on them.

This isn't legal advice by any means, but from the limited information we have here, I don't think you'll be interrogated by your BON any time soon.

That's exactly how I understood the situation as well and I'd point all this out to them. I don't think you will lose your license over this. It doesn't sound like you were responsible here.

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i don't think it matters which nurse the cna was assigned to...

generally speaking, a nurse is responsible for the tasks s/he delegates and supervises to the cna's.

if i ever noticed a cna doing something that wasn't within facility's normal practice, i would intervene.

i don't care who the cna was working for.

when push comes to shove, it's my backside on the line, regardless.

leslie:twocents:

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Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

Why was 'your' CNA inserting the cath for the other nurse?? What was SHE thinking? I don't think you are liable, I'm just unsure why the other nurse was having her do the procedure while she was watching??:confused:

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Specializes in Emergency, Case Management, Informatics.
Why was 'your' CNA inserting the cath for the other nurse?? What was SHE thinking? I don't think you are liable, I'm just unsure why the other nurse was having her do the procedure while she was watching??:confused:

Oops. I failed to note the part about 'her' CNA in the room in addition to the other CNA. Still, I don't see how this would make it to the BON. The procedure was directly observed and supervised by a licensed nurse. That doesn't mean it's right, and it must be outside the CNA's scope of practice in the OP's state (based on the suspension), but there was presumably no imminent threat to the pt based on the face value of the facts presented.

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Specializes in LTC,Hospice/palliative care,acute care.

That is beyond the cna's scope of practice in my facility and would probably result in termination for the cna and at least the nurse that was in the room with her initially.But in this state cna's can perform this type of procedure under the direct supervision of an RN or MD.They are doing EKG's,catheter insertions,blood glucose monitoring at our local community hospital and various procedures in physician's offices (injections,ekg's) I don't think this will be of interest to the BON and I don't think both nurses are responsible but good luck-keep us posted. I have worked with cna's that overstep both technically and in communicating with patients and their families.They are usually good cna's and smart but lack basic understanding of nursing care (infection control,privacy issues,individual careplans) It can be very difficult to redirect this type person.

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