Jane Smith an RN worked in a busy, free standing women’s health clinic that was affiliated with a 2000 bed healthcare center complex. Jane was very comfortable in this setting as she had been employed in the clinic for the past two years. There were four other RNs in the clinic along with one unlicensed technician; all of the staff practiced under the supervision of one or more of the seven OB/GYN physicians who staffed the clinic.
Jane was reported to the Chief Nursing Officer (CNO) of the facility for suspected violations of nursing standards, specifically, practicing beyond the scope of practice. An investigation was conducted and subsequently Jane was notified two weeks in advance that there would be a Peer Review Committee (PRC) hearing to discuss potential nursing practice violations and/or Unprofessional Conduct. The CNO suspended Jane from working until the PRC meeting was held.
Information presented to the PRC included that Jane had been doing “complete” work ups on some of the patients presenting to the clinic. This involved performing a bilateral breast exam along with a pelvic exam and Pap smear. Jane also independently diagnosed medical conditions on some patients and wrote prescriptions using the physician’s DEA number to a local pharmacy. One of the physicians was signing off on Jane’s charts at a later time and documenting as if he had actually seen the female patients and conducted the medical evaluations of their specific conditions. This had been a long standing practice of at least 18 months between Jane and the physician
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