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When is a task a medical task versus a nursing task? If an RN trains UAPs on tasks, does the RN become the respondeat superior?

Friday July 4, 2014
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Dear Nancy,

When is a task a medical task versus a nursing task? I am unclear as to how this effects the delegation process.
I am an RN. I am being asked to only train and not supervise a task (ie tube feeding, oral suctioning, etc). in the school setting. I am being told the physician is delegating directly to unlicensed assistive personnel in the school although I am providing the training and determining competency. I am aware that once the training is completed, there is no mechanism in place for the task to be supervised.
Because I am taking on the training of the task, do I become the respondeat superior and own the delegation, or can I do the training only while the ordering physician retains the delegation of the task?

Kelley



Dear Nancy replies:

Dear Kelley,

There are many legal issues contained in your question so this response will be to only a few of them. You might be wise to consult with a nurse attorney or attorney in your state who works with nurses and works in the area of school health services and school nursing specifically.

The most important point to emphasize in your question is that regardless of your title or role in the school setting, you are a registered nurse and therefore must practice consistent with the state nurse practice act and its rules. As a result, what responsibilities you take on in the school setting always are governed by the act and its rules.

Your training of the UAPs is something you can have liability for, should the training be negligent or not up to standards of care of other nurses who would train UAPs in the same situation. This liability would be based on professional negligence, should an injury occur that is directly related to your training, and under the nurse practice act, whether or not there was an injury to a student, if your training did not meet applicable standards of nursing practice.

The delegation issue is legally more complex. First, respondeat superior does not apply to you. It applies to the school board or district that hired the physician. Since you appear to be an independent contractor, there is no employer-employee relationship between you and the school, so any liability the school might also share with you, if there would be any, would be under a different theory.

However, what is unclear is under what authority the physician is delegating these tasks to the UAP. Is it the state medical practice act or his or her own authority? Moreover, there should be some supervision of the UAPs in order to determine if they have truly learned the task and are doing it properly. It is assumed that your training requires some demonstration and evaluation of the UAPs ability to perform the "tasks" once they have been trained. Ongoing supervision and evaluation would be vital.

Without more information about your role and the school nurse guidelines, it is difficult to determine if you would become the "school nurse" under them. For example, if you are required to be a certified school nurse in the school, then the guidelines might not apply. If a "school nurse" is defined in the school code as an RN providing nursing services in the school only, then the guidelines arguably
would apply.

One last comment is the issue of the definition of a task in your state's nurse practice act. Are the tasks you are training the UAPs really tasks? Or, are they nursing responsibilities only a nurse can undertake? Your consultation with your attorney can help you clarify this, and the other, points
you raise.

Cordially,
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.