Supervision of a Registered Nurse

1 I need help. I am a telephone advice RN for a large OB/GYN practice and I am curious who can be my direct supervisor. Our supervisor is simply a unlicensed office manager and she did proceed to tell me that she may not be a nurse, but she can supervise me. I have no nursing supervisor and the polices for the nurses are dictated by her. I was told that the telephone schedulers could ask the patient assessment questions when they called in before transferring the patient to me-the advice nurse. I am uncomfortable with them doing any kind of assessment of the patients signs and symptoms due to the fact they are non licensed personnel with no medical training? We are now in a debate between the supervisor and myself on whether I can question their doing assessments of patients. I beleive based on nurse practice act that this is illegal. Can you help offer some insight.-Thanks
OP, I hope your screen name is not also your real name. If so I'd change that ASAP.

Umm...I don't think that any office manager can do health care assessments. She can be your supervisor as far as doing payroll and making sure that your hours are in, correct, etc. She can supervise when your license is up for renewal and make sure that all of your documentation is in order...but supervising you as a health care provider? NOPE! Can you even imagine the litigation that would result should one of the unlicensed telephone schedulers give incorrect information?Go directly to the medical director about this after looking through the laws in your state that govern telephone triage so that you have something concrete to show.

yep, what canes said.your non-rn supervisor, can supervise you administratively, but not clinically.i am 100% certain.snoop around your bon website.the info you need is there...somewhere.leslie

Do you have any suggestions for me other than changing my name?

And the expedient course of action is to look for another job. I do not think this supervisor would be taking this tone with you if the medical director were on the ball.

Does it matter if the telephone schedulers ask the patient questions? Aren't you still going to get to talk to the patient and ask them the same questions yourself? Maybe the schedulers ask the patients questions to make sure they are calling for the right reasons- i.e to schedule an appointment. Have they been trained to recognize the symptoms of an emergecy and tell the patient to call 911? For example, a patient calls to talk to an advice nurse. The scheduler asks them their symptoms. The patient replies "I'm 35 weeks and started gushing blood and have really bad cramps." The scheduler tells the patient to call 911. This takes about 20-30 seconds. On the other hand, scheduler does not ask the patient any questions, just says "I'll put you through to the nurse." The nurse is on the phone with another patient and takes 4 minutes to answer the call. The nurse asks the patients her symptoms and tells the patient to call 911. This takes about 5 minutes and the patient might very well bleed to death. Perhaps you should speak to your supervisor about the reasoning behind these policies and see if you can get some clarification. As far as this unlicensed woman being your supervisor- she does not seem to be supervising you clinically, but administratively. i.e. professionalism, punctuality, attendance, attitude, etc.

she can supervise you administratively, not clinically. this person may suffer from the 'just a nurse syndrome' that so many office personnel do. they are either frustrated because of dropping out of or not being able to get into nursing school or never made the move to go at all. either way, they feel that you are 'just a nurse' and 'no better than i am.' also, some don't fully understand what being a nurse entails and think that 'well, i can do that. why do we need a nurse?' most of these people know enough to be dangerous. if you approach the medical director with clear role delineations in mind and focus on the potential liabilities, this problem will get taken care of. let the medial director know what you feel unlicensed people should be asking and passing on to you. control this situation because everything ultimately will fall on your shoulders. you must be an assertive professional or this unlicensed person will push you around. they will push you right out of a license. any explanation about policy and what unlicensed personnel insisted on doing will not be a defense for you in court. you will lose your license and they’ll keep working. the buck stops with the rn. period.

As far as who can be your supervisor.....anybody can be placed into a supervisory position regardless of their education, license, or degree. Anybody can be brought in off the street to run a department and to manage the employees of that department....including developing policy and procedures that affect the nurse. Just because she is your supervisor does not mean that she is able to dictate nursing practice. The only individual to dictate nursing practice is your BON. Regarding your question with the telephone schedules asking assessment questions. I would not be as concerned about that as much as you are. These individuals are UAPs in an office setting...not a hospital setting. It would not be illegal for them to ask assessment questions as they are not assessing....they are collecting data.....which MANY disciplines participate in and they are not attempting to obtain a nursing health history nor a nursing assessment....therefore the BON does not govern over them in this instance as they are not practicing nursing.

Quote from ashepherdDoes it matter if the telephone schedulers ask the patient questions? Aren't you still going to get to talk to the patient and ask them the same questions yourself? Maybe the schedulers ask the patients questions to make sure they are calling for the right reasons- i.e to schedule an appointment. Have they been trained to recognize the symptoms of an emergecy and tell the patient to call 911? For example, a patient calls to talk to an advice nurse. The scheduler asks them their symptoms. The patient replies "I'm 35 weeks and started gushing blood and have really bad cramps." The scheduler tells the patient to call 911. This takes about 20-30 seconds. On the other hand, scheduler does not ask the patient any questions, just says "I'll put you through to the nurse." The nurse is on the phone with another patient and takes 4 minutes to answer the call. The nurse asks the patients her symptoms and tells the patient to call 911. This takes about 5 minutes and the patient might very well bleed to death. Perhaps you should speak to your supervisor about the reasoning behind these policies and see if you can get some clarification. As far as this unlicensed woman being your supervisor- she does not seem to be supervising you clinically, but administratively. i.e. professionalism, punctuality, attendance, attitude, etc.

quite a few offices have an "office manager", that staff np's.this "manager" is NOT directly responsible to oversee the np's autonomy that s/he has earned...but to keep the office (and only the office) running efficiently and professionally.iow, offices have 'rules' and everyone needs to be on same page.the manager/supervisor is there to ensure this.seriously, don't sweat it.leslie

Damn canesdukegirl you must work in one of the worlds finest ghetto's. The Schlitz malt liquor? Damn hard to find the stuff around here.

I agree, but this woman can be difficult to talk to. You hit the nail on the head. I have been working in this clinic for many years as the advice nurse and have seen supervisors come and go. Trust me I have spoken to and will speak to many of the doctors regarding this subject. You validated everything I thought and believed regarding this situation. I just get shut down so much and told I am wrong that I sometimes questions what I have known and been practicing for 28 years.