NEW YORK NURSE: July/August 2011
Q.: My employer just instituted a policy that requires supervising RNs to co-sign documentation placed in the medical record by newly hired RNs, LPNs, graduate nurses and student nurses. Is this appropriate or necessary?
A.: No, it is unnecessary for RNs to co-sign the notes of newly hired RNs, LPNs, graduate nurses and student nurses, and more importantly, this is an inappropriate and potentially dangerous practice.
It is inappropriate for the supervising RN to co-sign medical record entries for assessment or care that was not directly observed and performed by the RN. A signature in the medical records suggests that the individual documenting is the one who rendered the care.
The licensed practical nurse should only document that which they are authorized to carry out. Even if the LPN contributes to the admission assessment, the RN is still ultimately responsible for ensuring the data is analyzed, which implies more than co-signing that they have reviewed the data. The same principle applies if permitting unlicensed assistive personnel (UAP) to contribute to the patient care record.
It is unnecessary to co-sign for students because a nursing student is exempt, according to the Nurse Practice Act. This means that students may perform nursing services based upon their enrollment in a registered nursing education program. Graduate nurses have a permit authorizing them to deliver nursing care until that permit becomes invalid.
Graduate and student nurses deliver care under the supervision of a registered professional nurse. The supervising RN or faculty member and the individual graduate or student nurse determines the degree of supervision. The graduate or student nurse’s knowledge and competencies determine the level of supervision. Regardless, graduate or student nurses are accountable for their actions or inactions in rendering nursing services.
This is a sample of the questions NYSNA’s experts answer each day. The advice given is specific for the situation described and may not be applicable generally. If you have questions about your own work setting, it is recommended that you contact your NYSNA nursing representative or the Education, Practice, and Research Program, 11 Cornell Road, Latham, New York 12110-1499 or call 800-724-NYRN, ext. 282.