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Thread: Non-RN doing bowel routine

  1. #1

    Non-RN doing bowel routine

    I'm a C4/5 complete quad, and I have caregivers that help me morning and night. I hire caregivers privately and train them myself. I do my program three days a week in the evening. It's great when I can find someone with experience, but generally I have to train most people in at least a few skills. My bowel program is certainly one of those things that usually needs training. As long as people are comfortable with the subject, they usually learn just fine.

    I'm posting because I have one caregiver who has brought up whether she is technically "allowed" to do my program. She is an LPN, and she has a couple of semesters left before she is an RN. She correctly noted that in facilities and agencies, only an RN can do bowel program in many states (or is it all states by now?). However, since I hire people on my own, I have always assumed that I can have my employees do whatever I train them to do. In this case, I am not asking my caregiver to call on her training as an LPN to do my program; I am giving her all the training she needs to be able to do it. An example that I gave her to try to explain why it's okay is: if my injury was low enough to where I had the mobility and dexterity to do my own program, I could do that. And I'm not an RN either!

    My new caregiver wasn't especially convinced that she should be allowed to do my program, since she's not an RN yet. Any advice for what I can tell her? Am I even correct in assuming that I can hire someone who is not trained as an RN and have them do my bowel program?

    For those who will inevitably correctly: Replace "program" or "bowel program" with "bowel movement" or "BM" if that floats your boat. I know the difference between the two, but I've always liked using "program" better; it sounds less gross.

  2. #2
    I think you're correct in assuming you can hire and train anyone you like in a private situation as you describe. The problem, as I see it, is that your caregiver isn't comfortable with doing the bowel program and not being an RN. In that she is reluctant, she doesn't seem to be a good match for your needs and you should think about replacing her with someone who is comfortable with performing the duties for which you are paying.

    All the best,

  3. #3
    This varies somewhat with the state when it is someone from an agency (for example, in CA, an LVN can do bowel care but a CNA or HHA cannot) but in CA if you private hire, and the person is not delegated the activity by an RN (i.e., a supervisor) you are considered to be providing the care as "an extension of the person themselves", so you can train anyone to do bowel care, caths, tube feedings, suctioning, etc. You might want to check with your local Independent Living Center to see if they have someone who is aware of the laws and regulations on this in Texas, but I think your LVN-who-is-not-working-as-an-LVN is fine doing bowel care that includes suppository insertion and digital stimulation/manual removal.


  4. #4
    Super Moderator Sue Pendleton's Avatar
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    Jul 2001
    Wisconsin USA
    I lost a soon to be RN when she went to her supervisor to brush up on CIC since most nurses are only taught how to insert foleys or one time ER catherizations. In Maryland that meant she would be practicing medicine without a license. Same with bowel care. But had she been a computer science student we would both be fine legally. Techs in most hospitals can do these things because they are considered under the supervision of a specific nurse. I think Maryland is doing away with the LPN position since they began the 2 year RN programs at the county community colleges. It did create a run on new name tags for those who wanted "Jane Smith/BSN" front and center and I definitely wanted a BSN for certain things when I needed to be inpatient occasionally.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  5. #5
    Thanks for the replies. I also asked for input from an RN who comes and changes my catheter every four weeks. She explained that it was just fine to have anyone come in and do the work because they are being hired privately to be my hands/legs. If any health issues were to come up, I would go to the ER just as if I was doing all of my own care.

    Here's the kicker. Before I even got a chance to call my new caregiver and explain this to her, she called me this afternoon while I was at work. She had already called the board of nursing and asked whether she was permitted to do my program in this private duty home health setting. The person from the board of nursing said that she can't do ANY home health as an LPN. She said that all kinds of other qualifications were permitted (CNA, MA, etc.), but an LPN is not permitted to do anything… Even help me brush my teeth.

    I live in Oklahoma (I started this account when I lived in Texas). Does this sound absurd? If it's not likely to be the case, she is probably just making excuses to not take the job, like GJ mentioned. Nonetheless, it would be good for me to understand for the future.

  6. #6
    In my facility for caregivers do bowel care. I don't know if any of them are CNA's but there is a special license or something to become a caregiver I think. When I hired privately, all my main concern was CPR because of my seizures. Good luck on your quest
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

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