Urgent response needed on RN Competencies after 3 years as a non clinical nurse

[moeBSN1988]

I am DON of a home care company. I over see approximately 100 patients and the CNA's that provide care. I have been asked to do a nurse by proxy case involving g- tube bolus feeds and oral suctioniing. It has been 7 years since I worked in a GI lab and 3 years since I have worked in a hospital. I have researched current practices but what do I need to do to ensure my competency and to be able to teach others? I am very opposed to doing this nurse by proxy program unless it is done correctly to protect the patient and myself. I am being pressured to do this proxy care and am very close to resigning. My employers do not understand that I can't just get a check sheet and check off skills. It doesn't seem to matter what literature I present on the requirements of proxy care in GA. I will resign before I would be forced to do this. Does anybody have any advice?

[meanmaryjean, DNP, RN]

I don't understand the concept of 'nurse by proxy'. Do you mean training a family member to perform these skills?

[moeBSN1988]

No, GA and other states have passed a law to allow nurses to teach unlicensed caregivers (CNA's) to provide some nursing tasks in patients homes to lessen somewhat of the burden on families. G tube feedings are one task allowed. There are strict guidelines set up by the state that have requirements for such a program. You must write a curriculum that has competencies,have policies and proceedures on any problems and what to do if they occur, obtain informed consent, have a doctor's order and many other requirements. (Basically you would need to teach them what a nurse needs to know to be considered competent.) Then they would be working under your liciense. The requirements are very vague and the BON has not been helpful. The teaching needs to be more involved than what you teach the family because the person you are teaching is a paid caregiver and so the liability risk is huge should something go wrong. My employer seems to think you just print a check sheet and consent and check them off. This type of client would bring in a lot of money for them. They want to start it in 2 weeks. You would also have to find enough CNA's that you would feel comfortable with to work under your license to cover the case 24/7.

[Lunah, MSN, RN]

I don't suppose you have an educator on staff anywhere?

[moeBSN1988]

No. That is all me also.

[DizzyJ DHSc PA-C]

Nobody would be working "under your license". Your RN license is yours and nobody can share it with you. Is tube feeding and suctioning something that is done in your facility? If so, then you should be competent in any nursing care procedures that are performed in your facility. Over years of interacting with nurses, the most hated person was the RN manager that could no longer actually be a nurse as they lost their skills crossing over into administration.

[litbitblack, ASN, RN]

Maybe check with the nursing schools in your area and see if they have a skills lab....Then you could see if it is something you can refresh yourself with....That was stuff I learned on the job-

[moeBSN1988]

Feeding and suctioning is not done in non-medical home health. I am mainly in the office.

[moeBSN1988]

I would feel pretty comfortable with just reading up on the current practices as I worked in a GI lab for several years. I want to make sure the BON would consider me competent. Thanks for responding.

[RN.on.the.move]

Hello, I can understand your frustration. Do you have any RN's on staff? Most places have at least 3 and in this case what a great opportunity for them to do educational in-services or at least be involved in a PI project to help you facilitate this change. Assign them aspects of the task and complete the project using a PI poster. Include the skills checklist in the project and assign that part as well. Here is a government website that may be useful.

Performance Improvement (PI) Plan and Template | AHRQ Health Care Innovations Exchange.

Best of luck, don't surrender or quit you can do this!

[nurse2033, MSN, RN]

Just hire a nurse who works medsurg and has the right skills to teach it. You develop the curriculum based on the requirements. Good luck!

[doctoral_candidate17, BSN, MSN, RN]

Agree about "under your license" ... however I think this would best be termed as delegation. Which if the RN that is licensed would inappropriately delegate to someone that is not competent then that is where the issue would lie.