I am a school nurse, but I am not certified. I believe if I am giving a patient a medication, I should be the one putting it into the computerized system and initializing it. Sometimes, another nurse says, I will put this into the system.” I have watched her put her initials next to the med I have given to someone. I have confronted her and reminded her these records are legal documents. I have also gone to my supervisor, who is not an RN, but understands this is a dangerous procedure. The other nurse continues to do this. What can I do?
Concerned School Nurse
Dear Donna replies:
Dear Concerned School Nurse,
It is always challenging for me to respond to this type of question without knowing all the particulars. Your note is troubling for many reasons.
First, I am trying to figure your coworker’s motivation for wanting to sign for medications you give. Is she perhaps trying to make it look like she does more work than you or her role is more important? I’m only guessing here.
Second, you say your supervisor is aware of this activity and knows it is a dangerous procedure and yet allows it to continue. What could possibly motivate her to flagrantly (and potentially negligently) ignore safe and legal practice where children (or adults for that matter) are concerned?
Third, the fact that you are going along with it when you know it is illegal, unethical and even dangerous is troubling and makes you complicit. You are not absolved of responsibility or liability because your supervisor knows and because your coworker is doing what she is doing whether incompetent or certified or not. As a professional nurse, you have a legal, ethical and moral obligation to practice within the limits of the law and your scope of practice. You also have a legal and ethical obligation to protect the public you serve and your license. You can’t simply allow the other nurse to document the meds you give. If she wants to document them, then let her give them.
You can let your coworker and your supervisor know you will no longer allow this practice to continue and why. You have to be assertive and proactive. If the other nurse does not comply, you should put it in writing to your supervisor as a way to document what is happening. You also should be keeping detailed notes for your own records about what is happening (and has already happened), who you speak to, when, and what the response is from these individuals.
You cannot be passive in this situation. You are in a very vulnerable position. As a licensed RN, you are obligated to practice under the law and to report any actions by other nurses you believe are illegal, unethical or unsafe. You may want to seek the counsel of a nurse attorney for further advice and support. You also might contact your local or state chapter of the National Association of School Nurses (www.nasn.org) for additional advice and support. Whichever path you take, get it