RNs functioning as assistants, and license rules

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  • #42380
    Gretchen Cyros
    Participant

    Hi,
    I am the nursing supervisor for a camp foundation in Vermont. We hire a head nurse (RN) at each camp, plus 4 assistants (usually nursing students). This year, I have 3 assistants who are either new grads or not experienced enough to be Head nurse, but are licensed RNs in other states. Do you think that they need to transfer their RN licenses to VT even though they aren’t functioning in an RN role? It’s a fine line as it is a nurse adjacent role and they are licensed in other states. Does anyone have experience with this or knowledge about the rules? I’m inclined to have them get an RN license in VT just to cover our butts, but I’m getting push back from them saying they aren’t hired to perform duties as an RN, which is true.
    Thanks for any and all input / advice!
    Gretchen

    #42434
    Mary Marugg
    Member

    Gretchen,

    Interesting situation! It would be great practice to have them licensed as RN’s, but I understand the hesitancy if they are not hired in the RN role. They would be in the position of the RN delegating to them. You would need to have very clear boundaries, and have those clarified in writing. There is some great information about delegating duties and Licensed Nurse responsibilities in the Basics of Camp Nursing book (Erceg and Gaslin 2020) pages 390-401.
    Best to you! Nice to have that depth of experience and training for assistants, it may take a bit of intentional work to be sure they don’t end up using their RN skills without a VT license.

    #42480
    Beth Schultz
    Participant

    I would have them get a VT license. Once camp begins and needs arise I could see them slipping into the nurse role very easily. Better to not put them in a position that they could get in trouble with the VT Board of Nursing.
    Beth

    #42438

    Gretchen:

    Thanks for sharing. I think Mary’s feedback is right on target. It is often very hard to know where the RN scope of practice starts/stops in relation to the nursing assistant role. If these individuals truly want to work as nursing assistants, please put in writing what they can and cannot do. For example, with medication management, all they will be able to do is give the pill as directed by the RN. They cannot make any decisions about doing things differently without the input of the RN. Let’s say a nursing assistant is helping to give medications and a camper says “Wait, I take two blue pills, not just one”. The nursing assistant has to tell the RN who must do the investigation and then decide on the next action step. If a camper gets hurt and injures their knee, the nursing assistant cannot make a judgment on the severity of that injury or how to treat. The RN must do that.

    The nursing assistant does not have the authority other than to complete tasks as assigned to them. Just tasks – no judgment or decision-making regarding health services. Therefore, at times, you may be increasing the workload of your one nurse. However, having nursing assistants (we call them UAPs – unlicensed assistive personnel) at other times can be a real benefit. This is an interesting situation, as most new nurses, want to be a nurse, not revert to an assistant role. I am thrilled you have adequate staff, you will just need clear lines of understanding about each of their roles. I would encourage you to have them all (RN included) review the VT nursing practice act before starting camp. This may help stimulate questions or get clarification to their roles before the summer starts.

    https://legislature.vermont.gov/statutes/section/26/028/01641
    https://legislature.vermont.gov/statutes/fullchapter/26/028

    Best to you
    Tracey Gaslin

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