I am an RN in a college health setting. We have a family practice physician contracted only for our enrolled students. During the summer, we have multiple children’s programs on campus, but no physician available so the children often are referred to our office. They are minors and because we have no physician overseeing their care, I refuse to treat them. In the past, the minors have been local and we could call a parent to come and pick them up. Now we have children enrolling from out-of-state and a few from overseas. Can you tell me where we stand legally?
Nancy Brent replies:
The advice you need can be obtained through a consultation with a nurse attorney or attorney in your state. As you have underscored, one of the issues in your question deals with that of informed consent for treatment and who can provide it. For minors (usually defined as someone 17 and younger by state law), the parents are the ones who can do so. Some minors have the legal right to provide their own consent, despite their age, including married minors and a minor who is pregnant.
Obtaining the written consent of the parents of the minors who are in your programs in advance might be an alternative to discuss with an attorney. This is often done in school nursing. A form could be developed and then sent to any parent who would not be easily available for their child while in camp.
A second issue here is whether you, as an RN, can provide treatment without a physician’s order. If you are an advanced practice nurse and no physician collaboration is needed, you are most likely practicing within the scope of your APN practice. As an RN however, at a minimum, you would probably need physician-developed treatment protocols.
A third issue to explore with your attorney is when a child’s treatment requires emergent care. In that kind of situation, one is exempt from obtaining informed consent if trying to get it would endanger the life or well-being of the child. In other words, consent is implied.
Last, be sure to discuss the issues of volunteering one’s professional services and the Good Samaritan act in your state with your attorney. These statutes deal with liability for injury to one who uses your services and provide immunity from suit if certain conditions exist.