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.

Disability management
Is it legal to practice disability management in a state other than Texas if the nurse resides in Texas with only a Texas RN license? Is it legal to call health care providers in other states with the intent of obtaining medical information necessary to certify disability leave and/or family medical leave in that state if the nurse is calling from Texas and only has a Texas RN license?

~LISA MCBRIDE
Dallas

As I understand this, you are in Texas and practicing disability management for a national company headquartered in Texas that has employees in need of your services who live in other states, at least one of which is not part of the Interstate Nursing Compact.

Given those facts, you are practicing in Texas and the only license you need is a Texas license. Although the people in need of your services may live elsewhere, you are nonetheless "practicing" in the state where you are physically present and doing the work. The decisions you make about these employees are made in Texas just as the answers I give to my readers are formulated in Arkansas, the only state in which I hold a law license.

Fair compensation
I am a salaried nurse working in medical audit. When I work overtime, I am not compensated. However, it is my understanding that if I must leave early (30 minutes to two hours), I cannot be docked. My employer does not dock our pay; however, she requires us to come in extra (over and above previously worked overtime) or to use vacation time. Is that legal?

~T.L., RN
Houston

Your employer is treating you as if you were an hourly employee. A true salaried employee is paid a wage because certain work is produced by that employee and the hours worked are irrelevant. Just because your employer labels you as "salaried" does not mean you are not an "hourly" employee within the meaning of the Fair Labor Standards Act. By all means, contact the federal Department of Labor office in your area for a determination of your status.