Supervision of a Registered Nurse

netglow, ASN, RN · May 28, 2011

OP, I hope your screen name is not also your real name. If so I'd change that ASAP.

canesdukegirl, BSN, RN · May 28, 2011

Umm...I don't think that any office manager can do health care assessments. She can be your supervisor as far as doing payroll and making sure that your hours are in, correct, etc. She can supervise when your license is up for renewal and make sure that all of your documentation is in order...but supervising you as a health care provider? NOPE! Can you even imagine the litigation that would result should one of the unlicensed telephone schedulers give incorrect information?

Go directly to the medical director about this after looking through the laws in your state that govern telephone triage so that you have something concrete to show.

leslie :-D · May 28, 2011

yep, what canes said.

your non-rn supervisor, can supervise you administratively, but not clinically.

i am 100% certain.

snoop around your bon website.

the info you need is there...somewhere.:)

leslie

radioactivern · May 28, 2011

Do you have any suggestions for me other than changing my name?

caliotter3 · May 28, 2011

And the expedient course of action is to look for another job. I do not think this supervisor would be taking this tone with you if the medical director were on the ball.

Double-Helix, BSN, RN · May 28, 2011

Does it matter if the telephone schedulers ask the patient questions? Aren't you still going to get to talk to the patient and ask them the same questions yourself? Maybe the schedulers ask the patients questions to make sure they are calling for the right reasons- i.e to schedule an appointment. Have they been trained to recognize the symptoms of an emergecy and tell the patient to call 911?

For example, a patient calls to talk to an advice nurse. The scheduler asks them their symptoms. The patient replies "I'm 35 weeks and started gushing blood and have really bad cramps." The scheduler tells the patient to call 911. This takes about 20-30 seconds.

On the other hand, scheduler does not ask the patient any questions, just says "I'll put you through to the nurse." The nurse is on the phone with another patient and takes 4 minutes to answer the call. The nurse asks the patients her symptoms and tells the patient to call 911. This takes about 5 minutes and the patient might very well bleed to death.

Perhaps you should speak to your supervisor about the reasoning behind these policies and see if you can get some clarification.

As far as this unlicensed woman being your supervisor- she does not seem to be supervising you clinically, but administratively. i.e. professionalism, punctuality, attendance, attitude, etc.

bsnanat2 · May 28, 2011

she can supervise you administratively, not clinically. this person may suffer from the 'just a nurse syndrome' that so many office personnel do. they are either frustrated because of dropping out of or not being able to get into nursing school or never made the move to go at all. either way, they feel that you are 'just a nurse' and 'no better than i am.' also, some don't fully understand what being a nurse entails and think that 'well, i can do that. why do we need a nurse?' most of these people know enough to be dangerous. if you approach the medical director with clear role delineations in mind and focus on the potential liabilities, this problem will get taken care of. let the medial director know what you feel unlicensed people should be asking and passing on to you. control this situation because everything ultimately will fall on your shoulders. you must be an assertive professional or this unlicensed person will push you around. they will push you right out of a license. any explanation about policy and what unlicensed personnel insisted on doing will not be a defense for you in court. you will lose your license and they’ll keep working. the buck stops with the rn. period.

meandragonbrett · May 28, 2011

As far as who can be your supervisor.....anybody can be placed into a supervisory position regardless of their education, license, or degree. Anybody can be brought in off the street to run a department and to manage the employees of that department....including developing policy and procedures that affect the nurse. Just because she is your supervisor does not mean that she is able to dictate nursing practice. The only individual to dictate nursing practice is your BON.

Regarding your question with the telephone schedules asking assessment questions. I would not be as concerned about that as much as you are. These individuals are UAPs in an office setting...not a hospital setting. It would not be illegal for them to ask assessment questions as they are not assessing....they are collecting data.....which MANY disciplines participate in and they are not attempting to obtain a nursing health history nor a nursing assessment....therefore the BON does not govern over them in this instance as they are not practicing nursing.

canesdukegirl, BSN, RN · May 28, 2011

Does it matter if the telephone schedulers ask the patient questions? Aren't you still going to get to talk to the patient and ask them the same questions yourself? Maybe the schedulers ask the patients questions to make sure they are calling for the right reasons- i.e to schedule an appointment. Have they been trained to recognize the symptoms of an emergecy and tell the patient to call 911?
For example, a patient calls to talk to an advice nurse. The scheduler asks them their symptoms. The patient replies "I'm 35 weeks and started gushing blood and have really bad cramps." The scheduler tells the patient to call 911. This takes about 20-30 seconds.
On the other hand, scheduler does not ask the patient any questions, just says "I'll put you through to the nurse." The nurse is on the phone with another patient and takes 4 minutes to answer the call. The nurse asks the patients her symptoms and tells the patient to call 911. This takes about 5 minutes and the patient might very well bleed to death.
Perhaps you should speak to your supervisor about the reasoning behind these policies and see if you can get some clarification.
As far as this unlicensed woman being your supervisor- she does not seem to be supervising you clinically, but administratively. i.e. professionalism, punctuality, attendance, attitude, etc.

I understand your point, but must offer a different view.

The patient with gushing blood is not going to sift through their paperwork in the junk drawer of the kitchen to call the OB office. They will call 911 themselves. At least I HOPE they would. However, wonders never cease.

This scenario would make me squirm:

OB pt: Hi. I am Ms. X and I am scheduled for a c-section tomorrow. I know that I can't eat anything after midnight, but my doc said that I can have clear liquids. When do I have to stop with the clear liquids?

Unlicensed scheduler: You are right, you can't have anything to eat after midnight. If your doctor didn't give you parameters about the clear liquids, I feel certain that you can have them up until you come to the hospital.

OB pt: OK, great! Thanks! See you in the morning!

OB pt comes into pre-op having followed the advice of the scheduler and has had 200mls of apple juice. Yes, it is clear. However, surgery must now be delayed for 4 hours, sometimes 6 hours depending on the amount of intake and what kind it is (I actually had a pt that had a 40oz of Schlitz Malt Liquor on the ride to the hospital because it was 'clear', and in his mind, that was A-OK.).

I am simply pointing out that unlicensed staff mean well, but they don't have the knowledge or training to make seemingly benign decisions such as the scenario I outlined.

leslie :-D · May 28, 2011

quite a few offices have an "office manager", that staff np's.

this "manager" is NOT directly responsible to oversee the np's autonomy that s/he has earned...

but to keep the office (and only the office) running efficiently and professionally.

iow, offices have 'rules' and everyone needs to be on same page.

the manager/supervisor is there to ensure this.

seriously, don't sweat it.

leslie

AgentBeast, MSN, RN · May 28, 2011

Damn canesdukegirl you must work in one of the worlds finest ghetto's. The Schlitz malt liquor? Damn hard to find the stuff around here.