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Am I right to be reluctant to sign off on a "new" nurse's chemo competency form after shadowing me for one eight-hour shift as their training?

Friday November 15, 2013
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Question:

Dear Nancy,

I work in the hematology/oncology department of a county hospital. Our department, until last year, was a private clinic the hospital bought just prior to the owner's death. We were able to remain employed because the hospital created a corporation, which is now our employer. The hospital-employed nurses are unionized, we are not.

We have been asked to have hospital nurses, who have very little or no hematology/oncology background to shadow us for one eight-hour shift and then sign off on a chemotherapy administration competency form for these nurses. We are extremely concerned this is going to get us in trouble, if something happens to a patient who receives chemo from a nurse unfamiliar with the treatment/potential reactions/side effects. In addition to the eight hours spent in our department, the hospital nurses did attend the two-day ONS chemo/biotherapy course.


Audrey



Dear Nancy replies:

Dear Audrey,

There are a lot of details not included in your question that would bear evaluating, such as what is included in the eight-hour shadowing and what is included for evaluation in the chemotherapy administration competency form. Also important is how competency is defined. Without a clear, organized orientation procedure for all who go through this process, its quality and trustworthiness could be easily questioned.

It also is important to consider if there are any regulatory requirements for nurses in your state who administer chemotherapy. Must they be certified? How many hours of education and clinical must they have to administer chemotherapy? It also would be interesting to know the "new" nurses union's position on this addition to their role.

A resource for you to explore is the Oncology Nursing Society and its website www.ons.org. As you probably know, the association presents courses for oncology nurses (indeed, your nurses new to the unit did take one of their courses) and it also has a certification program (that link is on the left hand side of the association's home page).

If a patient were to experience an injury that might be directly linked to a "new" nurse, your potential liability would rest on whether your evaluation of that nurse’s competency was consistent with what other reasonable, prudent and ordinary (experienced) oncology nurses would have determined about the nurse in the same or similar circumstances in the same or similar community. If your evaluation was not consistent with this overall standard of care, you might bear liability for the injury as well. In addition, you may face a reporting to the state board of nursing for an applicable violation of the act or rules (e.g., unprofessional conduct).

You and your colleagues might want to consult with a nurse attorney or attorney in your state who is familiar with nursing practice and can provide you with some ways to protect yourselves in this process and, at the same time, provide a better orientation for the "new" nurses.

Respectfully,
Nancy




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.