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Actions Registered Nurses Should Take to Avoid Being Sued for Negligent Supervision of Subordinates

Charge nurses, preceptors, managers, and directors need to take note. Registered Nurses may find themselves addressing the allegation “failure to provide adequate supervision” if they are named in a lawsuit. Follow these 3 actions to assure this does not happen to you.

Action One. Know the competency of those you supervise. Nurses may supervise practical or vocational nurses, nursing assistants, new graduates of nursing programs, new employees during orientation, and nursing students (this list is not comprehensive). How does a nurse know the competency of those supervised?

Health care providers who hold a professional license would be practical nurses or vocational nurses and new licensed employees in orientation. Each employee completes a self-assessment as part of the hiring process. The education department provides the self-assessments with the nurse manager or director of each nursing department so a competency grid can be formulated and made available to all nursing staff for reference. A competency grid assists the charge nurse in making appropriate assignments based on the needs of the patients and according to the competencies of the assigned staff member. Likewise, nursing staff members can reference the competency grid specific to those being supervised to assure patient assignments and aspects of patient care are delegated appropriately. A team leader’s responsibility is to periodically follow-up during a shift to assure that patient care is provided according to the current and acceptable standard of care.

Action Two. Be aware that any person who holds a license is and will be held accountable for their personal actions. A supervisor may be considered negligent if specific aspects of patient care that were delegated are considered inappropriate. Negligence may also be alleged when follow-up with a subordinate is considered inadequate or not done at intervals frequent enough to assure the delivery of quality care. Registered nurses are required to oversee patient care that is delivered by others and intervene when warranted. The license granted by a state specific licensing board dictates the expectations and limitations of patient care provided by licensed healthcare providers. The registered nurse must know what various licenses permit and the limitations that exist of a license that is held by those they supervise.

Action Three. Team up with those who are unfamiliar to you; those who you do not know their competencies. Working alongside them for a short period of time provides you the opportunity to observe, discuss, and evaluate their skills and knowledge base so you are confident to appropriately delegate aspects of patient care.

The unlicensed assistive personnel may have the title nursing assistant, certified nursing assistant, graduate nurse, patient care tech, etc. The registered nurse will be held accountable for assuring that the skills and data collection are done correctly and timely with this level of employee. This requires coordination, observation, and timely follow-up. It may also require re-education of knowledge and skills. The easiest and most reliable method to accomplish coordination of care is to have effective communication.

When report is given to unlicensed assistive personnel, be very specific with directions or instructions. For example: Instead of saying “Take Mr. Smith’s blood pressure every four hours and let me know if it is high.” Say: “Take Mr. Smith’s blood pressure at 8 am, 12 (noon), and 4 pm and let me know immediately if either number of his blood pressure is higher than 175/90. Call me on my portable phone (make certain to write the number down), or page me overhead (assure they know how to use the paging system or they know who to ask to do this for them).” When you are specific with your instructions there is no room for judgement because unlicensed assistive personnel are not qualified to make any judgements regarding patient care. Make it a practice to give report with this kind of direction every single time. Remember this… unlicensed assistive personnel do not give unlicensed assistive personnel report; registered nurses give unlicensed assistive personnel report! The unlicensed assistive personnel can report on tasks done or not done to the oncoming shift unlicensed assistive personnel but the patient care report and direction of patient care must come from the registered nurse.

Communication is a two-way process.

The nurse:

  1. Assesses the assistant’s understanding. How the task is to be accomplished. When and what information is to be reported including the expected observations to report and record, and specific client concerns that would require prompt reporting.
  2. Prioritizes the tasks for the assistant and client situation.
  3. Addresses any unique client requirements, characteristics and clear expectations of each.
  4. Assesses the assistant’s understanding of expectations, providing clarification as needed.
  5. Communicates willingness to be available to guide and support the assistant.
  6. Assures appropriate accountability by verifying that the receiving person accepts the delegation and accompanying responsibility.

The nursing assistive personnel:

  1. Asks questions regarding the delegation and seeks clarification of expectations as needed.
  2. Informs the nurse if the assistant has not completed a task, function, or activity before.
  3. Asks for additional training or asks to be supervised.
  4. Affirms understanding of expectations.

Documentation:

  1. Timely, complete, and accurate of care provided.
  2. Facilitates communication with other members of the health care team.
  3. Records the nursing care provided which should demonstrate adherence to standards of practice.

Apply critical thinking and professional judgment when following the Five Rights of Delegation to assure delegation or assignments are appropriate:

1. The right task

2. Under the right circumstances

3. To the right person

4. With the right directions and communication; and

5. Under the right supervision and evaluation

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