REPORT: December 2006

Ask the Experts

Precepting graduate nurses

Q.: I am the primary preceptor on our unit for graduate nurses (GNs). While I love this activity, I am concerned about three issues:

1. Am I legally responsible for the actions of a GN?
2. If a patient is injured, is it possible for the patient or the family to include me in litigation?
3. Am I responsible for cosigning a GN’s documentation?

A.: Your willingness to provide your years of accumulated wisdom to novice nurses is commendable. The answer to your questions depends on levels of responsibility and the circumstances involved.

First, GNs are responsible for their actions or inactions based on applicable law, standards of care, and their personal scope of competence. Upon graduation from an accredited nursing program, a GN may apply for a limited permit and is considered minimally competent to perform nursing functions.

RNs also have a level of responsibility, as they must supervise and appropriately delegate nursing functions to GNs. GNs must practice under the supervision of RNs who are present when professional services are being rendered. If an RN inadequately supervises a GN or delegates a function that he or she knows the GN lacks the proper training and competence to perform, the RN could be held responsible if an untoward event occurred.

If, however, a supervising RN cannot reasonably foresee that a GN does not have competence to perform a procedure or deliver a certain type of care, the GN is responsible for these actions. Preceptor RNs must properly prepare for the role, communicate their expectations to GNs, be comfortable with the number of patients they have been assigned, voice and document any concerns about GNs’ competence, be aware of their own personal scope of competence, know GNs’ abilities, and properly supervise GNs during their transition into the workplace environment.

It is unnecessary for an RN to cosign the notes of a student nurse, LPN, GN, GPN or any unlicensed assistive personnel. More importantly, it is an inappropriate and potentially dangerous practice.