Nursing: ADVICE, P.R.N.

UNLICENSED ASSISTANT

Gambling with patient safety

In the independent surgical center where I work as an RN, we don't have enough nurses or surgical technicians on staff to handle the patient load. So in a pinch, one of the surgeons pulls in an office clerk to help with procedures! Normally, this woman makes appointments and orders supplies. As far as I know, her only qualification is being the office manager's daughter.

All the nurses are concerned about patient safety and professional liability, but we're reluctant to confront the surgeon because he's so chummy with the office manager. What do you say?-S.S., VT.

Don't be shy. This is a dangerous situation that must be corrected immediately. Qualifications for surgical assistants are delineated by various professional organizations, including the American College of Surgeons (http://www.facs.org) and the Association of Perioperative Registered Nurses (http://www.aorn.org). State and federal laws and regulations also apply to safe staffing for surgical centers, as do accreditation standards set by the Joint Commission on Accreditation of Healthcare Organizations (http://www. jcaho. org/htba/ambulatory+care/ surgical/index.htm).

In a nutshell, this surgeon is gambling with his patients' welfare, the surgical center's future, and his own license. Team members should never perform duties outside the scope of their competency, education, and licensure. Follow the chain of command, starting with your nursing supervisor or nurse-manager, to stop this unacceptable practice.

RN CREDENTIALS

Mad about badge

I'm an RN working as a coder and chart auditor at a community hospital. Several months ago, the hospital transferred me to a new supervisor, a radiologic technologist with the title "technical coordinator." (My previous supervisor was an RN.) Although my new supervisor has neither a college degree nor a license to practice nursing, she's been given the authority to supervise RNs, clerical staff, and other technicians.

Last week this supervisor told me to remove the "RN" from my name badge, even though I'm in good standing with the licensing board. Outraged, I went up the chain of command to her supervisor, another RN. He backed her up, saying that displaying my credentials exposes the hospital to possible liability because I'm not working in a clinical position. Coincidentally (or maybe not), all this developed just after a visit by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Besides my RN, I have several educational degrees. I think this demand has more to do with professional jealousy than "liability." What does your legal consultant say?-B.P., TEX.

She sees no liability issue in the situation as you've described it. Even though you're not working in a clinical position, your role draws on your expertise as an RN, and disclosing your credentials to others you deal with is appropriate. In fact, your employer should regard your credentials as a credit to the organization, not a liability.

Has the same demand been made of all RNs working in nonclinical positions? The fact that the request followed a JCAHO inspection makes us wonder if the reviewer made the suggestion. Even if this is the case, you have a right to know why.

Check your hospital policy to see what it says about identification of professional employees. If you believe that this is primarily a personality or jealousy issue, continue up the chain of command. Provide documentation of incidents illustrating harassment, including dates, specific statements, and so on, to demonstrate that your experience is real. Be prepared to face your supervisor when you make your claims; she has a right to defend herself too.

You worked hard for your credentials and have the right to wear them with pride. Good luck.

OTC PRODUCTS

Giving patients the slip

As a recent graduate, I'm having trouble reconciling what I was taught in nursing school with a questionable practice I've witnessed on the job. A veteran nurse I work with sometimes "slips" her patients antacids, pain relievers, laxatives, and other over-the-counter (OTC) preparations without an order. When I asked her about this, she said she'd seen too many patients experience prolonged headaches, indigestion, constipation, and so on while waiting for a physician to order a simple remedy. What should I do?-J.P., MICH.

Stick to your guns. Legally, a nurse can't give patients unordered, unrecorded medications, OTC or not. Diagnosing illness and prescribing medication is beyond the scope of your colleague's nursing license (unless she's an advanced practice nurse). By giving an antacid, for example, she's assuming the patient has simple indigestion and is treating it. But suppose the antacid masks the symptoms of something more serious, such as a myocardial infarction? Another danger is that an OTC medication will interact with another drug in the patient's regimen, causing unexpected adverse reactions.

The bottom line? Your colleague is risking her patients' welfare and her own nursing license by handing out these "simple remedies." Urge her to stop. If she won't, alert your manager so she can educate your colleague about her scope of practice.

DRUGS VIA ET TUBE

A sip of ALE

Our hospital's policy on drugs that can be administered through an endotracheal (ET) tube during CPR is unclear. A nursing colleague says that sodium bicarbonate can be given endotracheally, but I disagree. Who's right about this?-H.W., WASH.

You are. Never give sodium bicarbonate through an ET tube. According to the latest American Heart Association advanced cardiac life support (ACLS) guidelines updated in 2004, you can give three ACLS drugs via ET tube (in addition to oxygen). You and your colleagues can remember them by using the ALE acronym: Atropine, Lidocaine, Epinephrine.