I work in an outpatient department. We had a patient come in who needed chemotherapy. I have been working in the department for several years and have never seen it given in the outpatient department.

My supervisor wanted one of our nurses to give it, but nobody had ever given any type of chemotherapy. We refused, so they finally found a nurse on the floor to give it.

My concerns are that our department is not really set up for this and we really need training in this. They are supposed to set up an inservice for us soon because this patient will be coming in monthly for this medication.

My question is, will one inservice be enough training to give the chemotherapy and is it legal?

~L.D.

You were right to refuse to perform a procedure you know nothing about and your facility is responding correctly if it provides you with the education, equipment and environment needed to perform the procedure correctly the next time the patient comes in.

It is "legal" to perform the procedure if your facility policy/procedure manual says that a person with your credentials is expected to perform that procedure. Whether one inservice is enough depends upon the presentation and your grasp of the material.

If you do not feel comfortable performing the procedure after the inservice, it is your duty to notify your educator and/or supervisor.

At that point, you should take some initiative. Ask to observe the administration of chemo on the oncology unit if possible. Surf the Net for the many helpful nursing Web sites. Good nursing today requires nurses to continually learn about and adjust to new technology and new ideas.

Violent patients
Is it a waste of time to prosecute a suicidal psych patient for intentionally striking an emergency room nurse? Is it, as the police say, a waste of time because the court will throw it out because the person is a psych patient?

~J.P.

No person acquires the right to assault hospital personnel by virtue of their status as a patient, even a psych patient. Prosecutors however, generally have discretion as to whether they will prosecute a given case and not all jurisdictions are alike in the types and numbers of cases prosecuted.

Having said that, I firmly believe that as long as nurses think that filing and following up on police reports is a waste of time, no message will be sent to the local constituents that this abuse is occurring at their neighborhood hospital. It is time for this message to get out there.

For those of you not in the know, a Florida nurse was brutally beaten to death April 10 by a psychiatric patient. For further information on this story and other workplace violence, see www.nurseadvocate.org.

Nurse liability
I work registry throughout Southern California. At present, I am contracted at a small community hospital. A case manager and I were wondering about a case in which a 23-year-old male was found down at home and paramedics brought him to this facility. He suffered an anoxic event and ended up in the ICU, on and off of a ventilator. There was definite brain injury and it was felt that a neurologist should have at least evaluated the case. Without a specialist to manage the neuro part of this complicated case, the patient remained at this small hospital for two weeks.

To just watch the posturing really bothered me; an EEG was never done and it was felt that he was greatly mismanaged. The primary physician said that he was too unstable for transfer. The patient eventually was transferred to a county facility, on a ventilator.

My question is, what liability falls on the RN caring for this patient? The family will probably seek legal counsel. In the end, an anoxic event is just that-permanent. A delay in having a neurologist on the case, even under these circumstances, is unacceptable. How can a facility open its ER to the community, knowing that it is not equipped to handle crises?

~A.F.

Unfortunately, this situation exists all across rural America, but the trend is toward hospital systems that do include at least one tertiary care facility accessible via air transport. As long as you perform your nursing care up to standards and notify the attending physician of any changes in patient condition, just as you would at any other hospital, you should not incur any liability with regard to your care of the patient. Develop a rapport with the family and be open and honest when answering questions. Resist the urge to come right out and tell them to have their loved one transferred to another physician and/or facility. Theoretically, a nurse could be sued by a physician under the legal theory of tortious interference with contract if the nurseactions result in termination of the physician-patient relationship.