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Brent's Law

Nancy J. Brent, RN, MS, JD received her Juris Doctor from Loyola University Chicago School of Law and concentrates her own solo law practice in health law and legal representation, consultation, and education for health care professionals, school of nursing faculty, and health care delivery facilities.

Brent has conducted many seminars on legal issues in nursing and health care delivery across the country and has published extensively in the area of law and nursing practice.


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Can an LPN be written up for refusing to give “first” allergy injections?
Thursday September 25, 2008
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Question:

Dear Nancy,

Can an employer write up an LPN for refusing to give “first” allergy injections? My current employer has informed me that by refusing to give the very first allergy injection to a patient, I am refusing to perform a procedure of their policy, and that the next time I refuse I would be written up. I have not seen this policy in writing, but I am still searching. So far, I have refused to give two first allergy injections. My last employer had a policy refusing to do any first allergy injections.

Lee



Nancy Brent replies:

Dear Lee,

Whenever an employer states that something is against a policy or procedure in a facility, an employee should be able to review the policy and/or procedure. “Searching” for it is strange indeed. If Policy and Procedure Manuals are not available on each unit (they should be), then check with risk management in order to review the manual and the specific policy/procedure.

Requiring employees to adhere to a policy or procedure that is not made available to them is unfair at best. While reviewing the policy on allergy injections, you should also review the disciplinary policy and grievance procedure. If you are written up, you may want to consider grieving that discipline. A nurse attorney or attorney in your state who works with employees can provide specific guidance for you should you decide to challenge the write up.

Your state nurse practice act defines the scope of practice of the LPN. In addition, there may be regulations that further explain the role of the LPN. Although there may not be a specific list of what an LPN can or cannot do, you should consult with the attorney you see for some guidance on this particular aspect of patient care.

Because a “first” allergy shot may result in an adverse event for the patient, it is a good idea that an RN administer the first shot, since a nursing assessment concerning the patient’s propensity for an adverse event can only be done by an RN. After the RN does the assessment, he or she may delegate the giving of the injection to another RN or LPN if the nurse practice act allows for this.

Sincerely,
Nancy



Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.



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