An RN says she and her colleagues have been performing certain nursing procedures for more than 15 years, but they are now being told these procedures are outside their scope of practice.
They've also been instructed to perform some procedures differently than they have in the past. Yet, the facility hasn't updated the written policies and procedures to reflect these changes.
The nurse is concerned that she can be held liable if the treatment she's instructed to provide is inconsistent with written policies and procedures.
Nursing procedures should align with scope of practice
The RN didn't say which procedures changed. However her statement about the procedures not aligning with the "old" policies does raise potential liability concerns.
For instance, an employer doesn't have the authority to determine a nurse's scope of practice. If this were the case, there wouldn't be a need for a state board of nursing (BON). Only a state BON can evaluate and enforce the scope of nursing practice based on the state's Nurse Practice Act and its rules.
An employer can determine its scope of employment for nurse licensees, which is included in the employer's policies and procedures. But it must conform to the state's scope of nursing practice.
According to the nurse, the facility changed its policies and procedures. The question is why? Were they inconsistent with the state's scope of nursing practice? Or are there other motives for the change?
Whatever the motivation, from a professional negligence perspective nursing care must be consistent with a facility's official policies and procedures. Doing so can prevent a nurse from being found negligent in a lawsuit. The facility can also be found liable if a patient injury is attributed to policies and procedures that are inconsistent with a state's scope of nursing practice.
How to protect yourself
If you find yourself in a situation like this, you need to consult with a nurse attorney or attorney who’s familiar with your state’s Nurse Practice Act and rules. Be sure to take pertinent documents with you to the consultation, including copies of the old policies and procedures.
The attorney will review your documents and your verbal statements about the new policies and procedures (since they haven’t been officially documented) and can ascertain whether either set of policies conforms to the state Nurse Practice Act and rules. If they do, they need to be reduced to writing and used facility wide. Your attorney can offer suggestions on how to facilitate this.
If the new policies aren’t reduced to writing and adopted by the facility or they’re not consistent with the state Nurse Practice Act’s, the attorney will most likely counsel you to share your concerns with those within the institution, such as the risk manager and your CNO. If these steps aren’t successful, your attorney may recommend that you report this situation to the applicable outside agencies.
For example, the hospital’s refusal to reduce the new policies to writing could be reported to the agency that certifies and accredits hospitals for licensure in your state. In addition, Medicare and Medicaid certification may be threatened if the policies are not managed correctly.
Any nurse leaders, including the CNO, who don't enforce the need to reduce new policies and procedures to writing can be reported to the state BON based on the state Nurse Practice Act and rules' requirements of providing safe and competent care to patients.
Reporting to outside agencies, which may be called whistleblowing, is not without its ramifications. Future employers may be hesitant to hire you. Even so, correcting unacceptable working conditions that put you and your colleagues at risk for potential liability and compromises patients' safety is a worthwhile goal.
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