Working with an unlicensed RN

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Here’s my issue: I’m trying to figure out if I am in any way legally liable for a “nurse” at my company, if I should stay because I like the work, or if I should run for the hills because this company is being super shady.
 

Here’s the deal: I currently work for a company that contracts the medical department for a small county jail. I am the only RN, another LPN, and a new grad RN who’s apparently been working on a temporary license. Her name on all legal documentation is listed an “Grad RN”. The state I’m in allows new graduates to work (under direct supervision of a licensed RN) for 90 days. I’ve been there for almost 90 days now and she is not yet listed on the state BRN as licensed. She has been working independently on the day shift with no other RN in the facility, I’m in the PM shift. I see her for 15-30min during shift change. I am 95% certain she is working on an expired temporary license.

 

My long winded question in all this: As the only licensed RN working at this facility, am  I responsible for anything she does? Should I try to address this with the company or take it as a sign of poor management and quit? Are there any other ramifications I’m not thinking of? And lastly, do I have no liability and it’s really none of my business and I should just steer clear of the whole situation?

 

I have had other concerns about the professionalism and integrity in this company as well, but it’s very small and minimally staffed, so it’s also going to be informal as well I would guess. I like the work and hours, so I’d like to stay, but I’m super nervous right now.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

If you are not her direct supervisor and you don't even work the same shift, then you are not responsible for her.  The responsibility lies with whomever does the hiring and firing.  If you are noticing glaring holes in her practice, you:  1.  Address it with her in a mentoring kind of way  2.  Notify management if it becomes a concern  3.  Notify the Board if it becomes a major concern that management isn't addressing.

As far as whether to stay or go, that depends on the big picture.  Sometimes it's worth it to tolerate a few aggravations.  Decide now what you could live with and what would start being a deal breaker.  Keep your resume up-to-date and keep an eye on the job listings in case you have to jump ship.

But from what you've described, you have no liability for your (possibly unlicensed) coworker.  By the way, you do have your own professional liability coverage, right?

 

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Specializes in Travel, Home Health, Med-Surg.

Agree with TriciaJ if you are not in any way her supervisor and not working the same shifts I don't see how this could come back to you. The only way I see a potential problem would be if you are required to co-sign her paperwork. When I worked with an IP (many moons ago) a RN was required to co-sign all paperwork. 

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

Don’t co-sign your shift change med counts, narc sheets, report sheets, etc. with her. If she is signing “Suzie Q , RN” she must stop, because she is not an RN (you should be able to verify this online at your BON website... do it and then you’ll know how to proceed). You are not in danger if you are not supervising her in any way (including precepting/orienting her as a new hire) but I’d make your concerns known in writing to the facility/org risk manager stat if you discover she is not licensed or about not to be. If she’s the only one on duty on a shifts supervising UAPs, giving meds, etc., she has to be a real RN, not a graduate nurse. 

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Specializes in retired LTC.

Question - how's this nurse's practice? Has she given you reason to be concerned re some poss negative outcome?

That being questioned, you have the responsibility to talk with Admin re her license status. Sometimes these things DO get overlooked (altho doubt it here). TPTB can be dinged if they are out of compliance re her license.

And as an RN, there is the obligation to respond when an RN KNOWS that the law is being broken. You're merely reporting 'in good faith' what you believe to be wrong. It is the BON's job to investigate further.

Kinda like when one suspects child abuse or elder abuse 'in good faith', then  you report. 

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I wonder if the regulations have been temporarily relaxed due to covid.

My state temporarily extended the amount of time that a nurse could work as a 'graduate RN' since our testing centers were so backlogged, and people would have had to wait for several months before being able to work.

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Specializes in retired LTC.

^^^ good possibility.

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On 4/22/2021 at 10:13 AM, TriciaJ said:

If you are not her direct supervisor and you don't even work the same shift, then you are not responsible for her.  The responsibility lies with whomever does the hiring and firing.  If you are noticing glaring holes in her practice, you:  1.  Address it with her in a mentoring kind of way  2.  Notify management if it becomes a concern  3.  Notify the Board if it becomes a major concern that management isn't addressing.

As far as whether to stay or go, that depends on the big picture.  Sometimes it's worth it to tolerate a few aggravations.  Decide now what you could live with and what would start being a deal breaker.  Keep your resume up-to-date and keep an eye on the job listings in case you have to jump ship.

But from what you've described, you have no liability for your (possibly unlicensed) coworker.  By the way, you do have your own professional liability coverage, right?

 

Unfortunately a mentoring approach has not worked. I think due to a perfect set of circumstances she landed in a day shift spot and believes she knows how to do the job better than anyone else. Her mistakes have not been major ones, no significant patient harm has been done. But things like using incorrect bandaging or simply not having enough experience to know a lot of the day to day tips and tricks we use. 
I do have thru NSO, got that right out of school. And I like the idea of setting my limits ahead of time, my make or break point so to say. I genuinely like the work, the shift works well for me, and the other folks I work with (the deputies) are a blast.

thanks for the input! 

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On 4/22/2021 at 12:53 PM, Hannahbanana said: If she’s the only one on duty on a shifts supervising UAPs, giving meds, etc., she has to be a real RN, not a graduate nurse. 

This is exactly where my concern lies..... she is. There is no other licensed personal in the building. She has access by phone to other RNs and NPs, but they do not check in or observe. She gives meds, both PO and IM, monitors insulin administration, answers meds questions from the med passers, etc.  She also takes on-call and is expected to respond to emergency situations that occur. 

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On 4/22/2021 at 4:16 PM, amoLucia said:

And as an RN, there is the obligation to respond when an RN KNOWS that the law is being broken. You're merely reporting 'in good faith' what you believe to be wrong. It is the BON's job to investigate further.

Kinda like when one suspects child abuse or elder abuse 'in good faith', then  you report. 

Very good point...... I’ve reached out to one of the administrators and got a “um...... you should direct this quest to the nursing supervisor “. I figured Id see if it’s an issue already being dealt with that I can’t see because it’s at a management level. I’ve already decided that if they know she’s unlicensed and knowingly continue to have her working like she is, I’d have to quit and go straight the BRN. 

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28 minutes ago, adventure_rn said:

I wonder if the regulations have been temporarily relaxed due to covid.

My state temporarily extended the amount of time that a nurse could work as a 'graduate RN' since our testing centers were so backlogged, and people would have had to wait for several months before being able to work.

I was wondering this as well, and my state has done this on a (rare) case by case basis according the BRN when I called. It’s hard know where my responsibility ends, or my duty to act ends.....

If there are extenuating circumstances that as just a fellow employee I’m not privy to, I completely understand and can happily stay out of the whole thing. 

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Sounds like your facility might be desperate for a warm body and inclined to tolerate a lot.  Just keep a close eye on anything that can bleed over into your practice.  Bravo for having liability coverage.

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