Who is working under my license?

Altra, BSN, RN · Apr 18, 2015

This is a common myth, and a misinterpretation of the responsibilities of licensed clinicians.

klone, MSN, RN · Apr 18, 2015

Nobody works under anyone else's license except for the person whose license it is.

As an RN, you are responsible for appropriate delegation. If you delegate inappropriately, or don't follow up to make sure the delegated task was completed, you may be held responsible for the outcome.

BrandonLPN, LPN · Apr 18, 2015

You are the only one working under your license.

Eru IlÃºvatar · Apr 19, 2015

I am currently working as a dialysis nurse. I have had several PCTs state they are working under my license. Is this correct? Is there Information somewhere that defines how exactly this works and how my license may be affected by fellow teammates? I would appreciate any input on this topic and thanks for your help.

Unlicensed personnel would only be working under your license when you delegate something to them. You should clarify this situation with your charge nurse or DON.

BrandonLPN, LPN · Apr 19, 2015

Unlicensed personnel would only be working under your license when you delegate something to them. You should clarify this situation with your charge nurse or DON.

But are they really working under your license? Isn't that kind of a misconception? Just because a UAP is delegated something doesn't mean they're doing anything "under" anyone else's license. If a nurse delegates something inappropriately, he can of course be held accountable for that, but that's not really the same thing. Splitting hairs, I know, but still....

jadelpn, LPN, EMT-B · Apr 19, 2015

You just need to be sure of the PCT's scope in your facility, in your unit. And delegate appropriately. If the PCT's are doing all SORTS of things that are dancing around their scopes, believing themselves to be not responsible, then that is an issue that needs to be addressed.

Know their scopes, and what you can delegate them to do. Be sure each has competencies that are signed off before you allow them to do stuff. I have not a clue what a PCT does in a dialysis setting, however, be sure YOU are comfortable with what each are doing, that is in their scope, that they are competent to do it. If you are finding THEY are "running the show" then you really need to take control of the unit and what each person is doing.

So as the licensed person, you are responsible for the care the patient's receive. PCT's are delegated to complete tasks. Should they do or not do tasks that may or may not be within their scope, they can lose their job. But you need to be sure YOU know what that is, and respond accordingly. I am sure more than one nurse was thrown under the bus for allowing things to go on that are clearly nursing tasks. In my neck of the woods, there are no UAP's that can do a thing in dialysis, which apparently is not the norm everywhere, but be careful.

Get malpractice insurance today!! It is always a good thing to have, even moreso when you are the only nurse on a unit.

And just as a thought--the only person who works under your license is you. But part of your license--well nursing practice is probably a better description-- is delegating appropriately. So the PCT's aren't working "under you license" but rather on your delegation.

TheCommuter, BSN, RN · Apr 19, 2015

As the RN, you work under your own licensure. You are responsible and accountable for the level of care that you render.

However, I have personally known several RNs whose nursing license numbers were referred to the state BON for investigation due to improper delegation. One of these nurses, a director of nurses at a skilled nursing facility, lost her license for inappropriately delegating pressure ulcer care to unlicensed assistive staff.

Here are some other real-life examples of improper delegation: instructing unlicensed medication aides to administer high risk drugs such as Coumadin without any type of licensed nursing assessment of the patient for side effects.

Several years ago a patient died because her INR had not been checked in six weeks. She was bleeding out of every bodily orifice prior to her demise. The medication aides had been administering Coumadin, but the DON had no anticoagulation care plan in place, and therefore, delegated this task inappropriately. In addition, the primary nurses of this patient had not documented a routine assessment for common anticoagulant side effects.

Eru IlÃºvatar · Apr 19, 2015

But are they really working under your license? Isn't that kind of a misconception? Just because a UAP is delegated something doesn't mean they're doing anything "under" anyone else's license. If a nurse delegates something inappropriately, he can of course be held accountable for that, but that's not really the same thing. Splitting hairs, I know, but still....

Well is kind of the same thing at the end, even if technically is not. When you delegate you are supposed to make sure that it was done correctly ( whats the point of delegating then). What i understand from it is that if they do something wrong that you told them to do, you, as the licensed worker, will be held accountable from their actions.

Too much legal mumbo jumbo.

klone, MSN, RN · Apr 19, 2015

No, you would not be held accountable if they did something wrong, as long as the task was appropriately delegated.

An example, if I delegate to a NA to assist someone to the bathroom, and I tell them to make sure they have another NA with them, as the patient fell yesterday, and the NA did not get another NA to assist her but tried to do it alone and the patient fell, this would not be on me or my license.