Few guarantees on a pay increase

In September, I accepted a position as a registered nurse. I was offered $22 an hour and accepted this salary. Three weeks later and less than one week before my orientation date, I was notified that an error was made and that I would be making only $17.70 an hour. I was making just under $20 an hour with my previous employer and had turned down $22 an hour to stay.
After many conversations with the human resources department, they decided in late October to pay me what was originally offered. However, the decision also was made to freeze my salary until my years of full-time working experience matched their grid.
Is it legal for them to freeze my salary under these conditions?

~D.Z.
Indiana

No employee is guaranteed any form of a raise absent a contract or writing to the contrary. So in effect, your employer can freeze your salary. You did have an oral contract for the amount of your starting wage and your employer was correct to honor this agreement.

Inexperienced nurses
I work at a correctional facility in Washington state. I am an RN and have worked in the prison system for 14 years. I have been at this institution a little more than a year as it is a new facility and they have just opened up the inpatient part of this particular center.

I am the only nurse with Department of Corrections experience and am used to dealing with security issues and offenders. My major concern is the opening of the hospital with inexperienced nurses. They are concerned as well.

They have not been given any orientation as to the paperwork, tools or basic security issues of the setting they will be working in. We have made our protests known to our supervisor and we have notified our union. We would like to know the legalities of working in the conditions we are in.

This facility is new to me also, so I feel vulnerable with all the questions that are unanswered. I know of two facilities in this state with problems in the past with deaths that have been due to medical understaffing.

What can we do to protect ourselves, other than not showing up for work?

~S.T.
Washington

Put your concerns in writing, stating the facts, not your opinions, and get as many nurses and prison officers to sign as you can. Then send your letter by certified mail, restricted delivery to your supervisor and to the Director of the Department of Corrections in your state.

Get a copy to your medical director and to your union rep as well. It is outrageous to employ an inexperienced nurse in the prison system without an orientation.

Written policies
What does the law say about techs doing stress tests? I recently have changed jobs. For adenosine, dipyridamol (Persantine) and dobutamine stress tests, an advanced cardiac life support RN is required to be in the room for the tests. Regular stress tests are done with just a cardiologist and a tech. The tech can't administer the meds and the meds are supposed to be locked up with only the MD or nurse to have access. Whether we are stressing the heart chemically or physically, the risks are the same for the patient.

We do a stress test called Myoview, in which the RN starts the IV and leaves, and the nuclear med tech injects the radioactive isotope and the cardiologist and tech do the test themselves.

Could I be liable if something happens because I started the IV? Also, would I be liable if something happens if I start an IV and give CCK and leave the room right afterward? I can't find a policy at our hospital. I don't feel comfortable walking in, starting an IV, injecting a medicine and walking away without knowing anything about the patient. Am I right to be concerned with this kind of practice?

~B.R.

The last question is the only easy one to answer and the answer is yes. There is no real law for these types of matters, which should be controlled by a hospital or departmental policy.

If you follow the written policy of your employer, you are "within the scope of your employment" and you would be covered by your hospital's insurance should the patient suffer a bad event. That is why you should demand a written policy to cover any and all of your job duties.

The situations you describe involve several clinical disciplines, each of which is held to a different standard of care. (A law scholar could probably write a major law review article on liability in the situations you describe.) I would interpret as follows:

In the first situation (starting an IV only), you have minimal contact with the patient and an MD is present and the MD would be the responsible individual. In the second situation (administering the med), you have definite responsibilities, as nursing standards require that you have both knowledge of the patient and the medication including contraindications to administration and side effects.

If I were in your shoes, I would refuse to administer any medications until you get a written policy from your employer that specifies who does what in these procedures.