By LENORE BORIS, RN
Interference into nursing practice by unlicensed staff is a common problem for PEF nurses. At some locations, the problem is reaching extremes.
At Sunmount Developmental Disabilities Services Office in the Adirondacks, for instance, community mental health nurses have found themselves caught between treatment teams and physicians.
Sometimes, treatment-team members at Sunmount, who are neither physicians nor nurses, have disagreed with a physician’s treatment order and directed the registered nurse not to execute it. But the nurse is legally obligated to execute the physician’s order, unless the physician amends or withdraws it.

Such conflicts of professional judgement and authority can create a stressful situation that may be difficult to resolve.
Meanwhile, the nurse is caught in the middle. Obeying the physician would protect the license, but could jeopardize the job. And while obeying the directive to ignore the physician’s order may seem safer in the short term, no nurse can practice without a license.

Professional boundaries
Non-nurse supervisors can ensure the day-to-day operations of a unit. Approval of time off, time-and-attendance actions and ordering supplies are examples of acceptable activities.
But, non-nurse supervisors act illegally when they make decisions that require professional nursing judgement.
The NYS Board for Nursing puts the onus on the registered nurse to fulfill the obligations of licensure. These obligations must be fulfilled, regardless of the obstacles. Failure to execute the medical regimen as ordered is grounds for charges of professional misconduct.

Forewarned is forearmed
Caught between obligations as a professional and workplace obstacles, what can you do?
You can take four steps to protect your license, your job and your patients’ welfare:
1. Learn your legal and professional obligations —
• Read the Nurse Practice Act;
• Learn the standards of care for your area;
• Know your job responsibilities; and
• Review your worksite’s policies and procedures.

2. Identify who deals with nursing issues at your facility —
• If your facility is subject to review by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), a program to measure, assess and improve nursing care must be in place; and
• If no one handles such issues where you work, pressure management to create a mechanism to raise nursing issues.

3. Advocate for yourself —
• Let others know when they put you in a position that jeopardizes your ability to fulfill legal and professional obligations; and
• Put your concern in writing and demand a response.

4. Pursue resolution of the practice dispute until you are satisfied you can safely execute your professional obligations —
• If the supervisor is unresponsive, raise the issue at a labor-management meeting; and/or
• If a nursing practice council exists, work with it to resolve the issue.|

At Sunmount, the issue has been brought up by PEF in the joint labor-management forum.
Safe, effective, quality patient care depends on a nurse’s ability to provide care within the legally protected scope of practice.
The nurse’s ability must not be jeopardized by interference from a non-nurse.
The bottom line is that your license is your livelihood. Protect it.

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