Is RN Co-Signing Appropriate?
There are times when it is appropriate for nurses to co-sign, such as when narcotics are discarded by a licensed nurse with an RN observing for the record. In this case you are observing the activity, and fulfilling a leagl policy for double checking.
Co-signing is generally identified as a student/instructor relationship. It implies that the instructor has approved the care given, has personal knowledge of it, and assumes responsibility for it. When co-signing is demanded of employees in the workplace it may be because the activities the LPNs are being required to perform are not within their legal scope of practice. requiring RNs to co-sign for LPN work does not make it legal. It also implies that the RN has approved the care given, has personal knowledge of it, and assumes responsibility for it.
What do you do if an employer orders you to co-sign? Educate that then that it is not necessary to co-sign. When the RN or LPN performed the care, they should sign for the care and assume responsibility for what they have done. Politely refer then to the MN Board of Nursing Laws. However, be aware that there are those employers that will pull rank and threaten discipline due to "insubordination". In this situation, protect yourself. Ask that the request be put in writing. This may be enough to make the employer stop and think. You have the right and duty to refuse to perform illegal or unethical acts. In order to show you were coerced into signing for work you did not partake in, or observe, you may want to add a disclaimer statement such as: "I am signing this at the direct order of my employer. I did not observe or give this care."
For more information on scope of practice, check out Ecumen Consulting's 2 part series on LPN Empowerment coming in September. If you are unable to join us at one of the sessions, Ecumen Consulting will conduct training at your site.
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