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Our hospital recently hired paramedics to work in our emergency department. They work 7 p.m. to 7 a.m. and are the duty crew, which means they leave if they have a call. They have a job description similar to unlicensed personnel, but have a large list of skills they can perform, such as starting IVs, giving IV meds, etc.

My concern is what liability we have if they give drugs IV or IM, especially narcotics. Now, we take the drugs out of our Pyxis, using our password, and the drug is given to the medic, who then administers it. If the drug needs to be wasted, two RNs must waste the drug.

I am wondering who would be liable if the patient should have a bad outcome if the RN did not administer the drug.

~P.W.

In addition to the written job description for the paramedics, your hospital or emergency department needs a written policy regarding the administration of medications, especially narcotics, by the paramedics.

If an RN signs out a narcotic for the paramedic, the nurse remains responsible and accountable that the drug was indeed delivered to the patient. Your question, however, assumes the patient received the drug and had an unfavorable reaction. Because the paramedics leave the ED to take a call, it would appear that the RN is responsible for the patient and the paramedics are performing delegated tasks.

Know your rights

I work in a busy outpatient clinic in Southern California. It is required that an RN be available at all times. I have worked many days-some 12-hour shifts-without a lunch break. I'd be lucky just to get a 10-minute break to myself. When I do get a rare moment to hide in our break room, I'm almost immediately called out for a triage, telephone call, dispensary fill or case management issue.

My questions are: Is this legal? What are my rights? What can I do to protect myself? Should my employer pay me for my missed break/lunch?

~W.M.

Your employer should provide someone to relieve you of your duties so that you can take your breaks.

California Labor Code Section 512 requires an employer to provide one 30-minute meal break if the employee works five hours and a second 30-minute meal break if the employee works more than 10 hours. If you work 12 hours, only one of these breaks can be waived by mutual consent of the employee and employer.

Additionally, federal law says that the test is not whether you leave the work area for a break, but rather whether you perform job duties during a break period. If it is the latter, your employer is required to pay you for that time.

Flu shot administration

I am an RN working for a social service agency of aging and adult services. My title there is nurse consultant. During this flu season, I have been approached by many of my co-workers about the flu shot.

Am I, as an RN, entitled to order the flu shot vaccines and administer them to my co-workers? What is the limitation on an RN regarding the flu shot? Do you know of any resources in Washington state where I can check on those kinds of questions?

~H.L.

My understanding is that only MDs and advanced practice RNs can order vaccines. In the situation you describe, it would be highly risky to even administer the vaccine. Allergic reactions have been known to occur. It's best to leave vaccine administration to the clinics.

Your state nursing board is your best resource for the limits of your licensure. Your state pharmacy board also could have answered your question.