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Can my employer make me perform a procedure without formal training? How can I say no without jeopardizing my job?

Wednesday January 4, 2012
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Dear Nancy,

Is it legal for my employer to insist I perform plasma pheresis with only sporadic training during five or six treatments within a couple of weeks? I can prepare the equipment and access the patient catheter, but I don’t completely understand why I am doing what I am doing. Shouldn’t I have formal training that includes a theory class? How do I request this without putting my job in jeopardy? Can I legally say “no” to performing this procedure until I can perform it safely and with confidence?


Nancy Brent replies:

Dear Michael,

As you know, when taking on any responsibility for patient care, a nurse is required to be competent in providing that care. Competency includes many things, such as adequate training in the care or procedure, skill in performing it and confidence in being able to perform the patient care required. Those factors certainly do not seem present in the situation you describe.

As a nurse licensed in your state, you, and only you, are accountable and responsible for care you provide within your scope of practice. If you do not feel capable or skilled to perform patient care, or do not feel adequately trained, you need to consider the consequences of performing nursing responsibilities if the patient is injured or dies because of your lack of skill and training.

It seems foolish for the employer not to want you to be capable and competent to perform plasma pheresis correctly and understand exactly what you are doing for the patient. If something were to happen to the patient that can be linked directly to your breach of duties in the situation, your employer also faces liability.

You did not indicate whether you raised your concerns with anyone in the facility, but doing so might be quite helpful. Your risk manager and CNO should be willing to listen to your concerns and hopefully act to get you the training and education you are requesting. If you think you need help preparing for conversations with them, you could contact a nurse attorney or attorney for a consultation on how to do so in the best way possible for all.

The attorney also will be able to advise you of any state requirements for someone who performs plasma pheresis in your state. It may be, for example, that a CE course or certification is required before performing this patient care procedure.


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.