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?

[doctoral_candidate17, BSN, MSN, RN]

Can you partner with a local school/college/university?

[feelix, RN]

Your state has set you up for failure. If tube feeding and suctioning were non-licensed skills, they would have been taught in CNA school. However, they are not.

Please look into the law and see if delegation is OK in institutional setting where an RN is present to supervise? Or is it OK in the field whee the assistive personnel is alone and supervision is not possible immediately. Maybe your company is overstepping legal boundaries. They do it all the time. Once they asked me to start an infusion on a patient residing in a group home and go see another patient while it was infusing. I refused. A lot could go wrong while I was gone. I could have been stuck in traffic and the IV run out. Then what?

[moeBSN1988]

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!

Sorry for the late reply. I have been on vacation. Thank you. I will look into it.

[moeBSN1988]

Sorry for the late response. I have been on vacation. I really appreciate your support. It is tough out there with blurred boundries and BON unwilling to answer any questions directly due to risk of liability. You are left to determine whay you think the rules and regs are.

[moeBSN1988]

Thank you for your response. The challange of finding enough caregivers at $10/hr that you can trust is a huge issue. CNA are a blessing to those in need and it is a shame they are not paid more for what they do. I think higher pay would attract more quality candidates.