Team Mate working out of scope or practice?

[SoCalRN1970]

Here we are with another bizarre twist with my agency.

I was just handed my own assignment about 2 weeks ago. I like to especially on higher levels of care have a very clear frequent line of communication with my team and social worker and or chaplain. It helps alot to have them in the loop espeically since they dont' see these people daily like I do.

I went out with my new SW about 2 week ago. She took me to my first CC patient and met with the family. It was a stressful meeting, family anxious, etc. The patient at the warranted stronger better med for pain management. I suggested the morphine in the comfort kit to try. The social worker told me she'd get it while I was with the patient. She came back with the syringe filled. It was appropriate, but I was OK. Thank you. The anxious daughter sat down and talked to me about her fears of the Morphine. I attempted to speak openly about this and the SW kept chiming in. Saying the morphine does this, we use it for that. here are some side affects! I was dumb founded. Good news? She gave the correct info. I don't know if she thinks I know nada, but that did not impress me.

Scenario #2. I got a call from the SW telling me the new patient we admitted did not have a comfort pack in the home and I needed to look into this. I told her I'd be there in a few hours. I arrived to the home. The son who is the PCG sat down with me and gave me a box of where they keep the meds. Long story short? Yes, the medications were there, but the pharmacy did not have them in a magic box or a bag. They were mixed in with the other drugs. The son told me the SW was checking her medications and was concerned as there was no CP. The son also asked me. Why is your social worker looking at meds? Isn't that your job? I told him. Yes, it is. He said he was about to ask her if she was an RN? I told him well, you should of if you thought it was an appropriate question. He was calmed down when I gave my access info, I also encouraged him to understand we all have different role. I made it very clear what mine is, and what hers is. He seemed concerned, but dismissed it.

I am new. I spoke to a colleague about this. She seemed unconcerned. She said that the SW is supportive of staff and that she thought it was helping. I have already been spoken too from management because they feel I am "dominant" which I have never been called in all my years of this gig.

Suggestions? If family members question the SW should I have them complain to the bossy boss? I am fearful of mentioning anything to anyone as I have already been labeled. "Dominant."

[Whispera, MSN, RN]

What do you interpret dominant to mean? I don't think it's necessarily a bad thing.

The SW should not have drawn up the morphine. What if she made a mistake and drew up the incorrect drug? It would be on your head because you're the nurse, and were there when it happened and didn't do anything (and gave it? never give something someone else draws up!). I know family members of hospice patients give meds, but that's in their role. It's not the SW's role.

I wouldn't have a problem with her telling the family about the drugs, to a point. She probably knows about them from being in her job awhile. I doubt she thought you didn't know things. I think she's just more likely used to giving information when people ask. She's probably had to learn the basics for when she visits patients on her own. I bet questions come up that she's had to find answers for, rather than telling the family to call the nurse. If it's an easy answer, what's the harm? Do you think she would give more than basic information, that she couldn't know the details of? You can always talk to her about your concerns, when no one else is around. There's no need to go to the boss if you haven't talked with the social worker first.

As for the CP. She's probably used to it being a separate bag or box. When she didn't see it, she assumed. The important thing for her to do if she's being helpful when the nurse isn't there, is to help the family find the medication, not a specific container.

[tewdles, RN]

If I were in your shoes I would have lunch with the MSW and discuss how we would work together as a team. As the case nurse you are responsible for the implementation of the plan of care so it is natural for you to pursue this type of conversation.

In my practice the MSWs may share the factual information they have regarding hospice care. Many times they have important and correct information about medications common to our work. They must always defer to the physician or nurse on those topics but can certainly correctly answer some questions from patients or families. MSWs or Pastoral care staff should NEVER prepare or administer medications! You will want to address the prep of the morphine with the MSW in question...it is important to NOT be a partner to bad professional practice in this field.

Dominant vs. assertive vs. straightforward vs. bossy...whatever...as long as you have effective communication skills and good practice habits you will do fine!

[nhelkhound]

Let's see, a SW administering and educating about drugs. Not a good idea. Definitely out of her "scope of practice". If this happened with my SW I would arrange a sit-down, inform her that she should not be administering any meds, and that although she may have some basic med knowledge, education re: meds is your job. If someone said I was "dominant" I would simply smile and say "thank you".

[Old.Timer]

Hello:

I usually just read this forum vs post since my hospice experience is very outdated. I have to say , the very first thing that jumped out a me reading this thread was diversion. It sure seems like she is creating a lot of different reasons and opportunities to be nosing around the meds. I'd almost be willing to bet money on it.

[tablefor9, RN]

Hey, Old.Timer...nice to see someone with the same dirty, suspicious mind I have. It's what happens when you've been around the block a time or two, right?

Also, to OP: If one is going to thrive in nursing, it behooves one to be somewhat assertive. Learn the Southern art of smiling beautifully while telling the SW to keep her hands to herself.

[SoCalRN1970]

I have taken care of this. The SW understands I know my role.... and that I "appreciate" her

"input" on the issue. "I have taken care of it".

The family has been educated to call upon the RN (not the SW ) for all and ANY medical issues.. After all, that's my role.