Where I work we have medical assistants who are allowed to access and de-access mediports. I noted recently that some of them have been flushing them with the inappropriate amount of heparin although it was the correct type. The nurses in our unit are not allowed to be responsible for the training or certification of the assistants, but they do work under our license under Florida law. How does this put us at risk, and how should we go about correcting this if possible since we have no say in how they are trained?
Nancy Brent replies:
Although as an RN you may not be involved in the training or certification of the medical assistants with whom you work, if you are responsible in some way for them due to your license as an RN (e.g., supervision). It is essential that any observed problems with the assistants clinical practice be reported. You did not include how the assistants are trained or certified, but there must be a chain-of-command for them that you can use within the institution to report your concerns. It may be, for example, that all voiced concerns go to the chief nurse officer (CNO). Or, it may be that such concerns be documented in an incident/occurrence report that goes to the facilitys risk manager who can then intervene by contacting those who do train and certify the assistive workers in order to change their training and future certification. Or, if they are certified under the state nurse practice act or another state statute, guidance may exist about how to deal with practice not consistent with the assistants required care. A consultation with a nurse attorney or attorney in your state who can guide you about where to best lodge your concerns would be most helpful.
It would be important, though, to ensure that your concerns are registered. As the last resort of safety for the patient, any observed practice that is potentially a risk for the patient cannot be ignored. Ensuring that whatever approach is taken results in a documented sharing of your concerns with those who have the responsibility and the power to change the incorrect practice is essential for the nursing staff. If a patient is injured due to this practice, and nursing staff knew (or should have known) that it existed but did nothing within their power to change it, liability for the nursing staff may occur. The consultation with the attorney of your choice should include an exploration of this liability as well.
Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.