Challenging Traditional Workplace Structure

Cait Snow was adjusting a pair of eyeglasses for one of her patients when she overheard Mr. Wells, her boss, asking one of the non-licensed staff to conduct an automated refraction on another patient while he took his lunch break. Mr. Wells proceeds to go to a café a few blocks away and Cait witnesses her coworker conduct an automated refraction. What should Cait do?
There are multiple issues to consider:
1) Unauthorized practice
2) Duty of Care
3) Supervision
Unauthorized practice
Only prescribers (physicians, optometrists) and opticians certified by the COBC are allowed to conduct independent automated refractions. That means if a non-registrant conducted an automated refraction, the results of the automated refraction are considered invalid and cannot be used for dispensing eyewear. Mr. Wells and the non-licensed staff put the patient at risk of harm and risk of losing the patient’s trust.
Duty of Care
In this scenario, Cait is put into an awkward situation. If she reports her boss and her non-licensed coworker, she feels that she risks losing her job. At the same time, Cait is an optician, which means she is supposed to be ethical and has a duty to care for patients. Ultimately Cait is a health professional first and foremost.  
Cait consults with her other coworkers and brainstorm on how to overcome the situation. Their ideas included educating Mr. Wells on the Opticians Regulation, explaining why only competent eye care professionals should conduct independent automated refractions, and the major risks when refractions aren’t done properly. They also came up with having an office roundtable to brainstorm how to help the office practice to a high standard of care and how to create an office culture everyone can be proud of.
As an optician, Cait is responsible for supervising the non-registrants at her workplace and is responsible for anything they do with patients. Cait is liable for anything that goes wrong with the patient who had an independent automated refraction that was conducted by a non-registrant. Also, Cait has a professional obligation to prevent uauthorized practice from happening.
They brainstormed how to overcome the situation. The non-licensed staff expressed to Cait that they were uncomfortable conducting automated refractions and only agreed because Mr. Wells is their boss. They all agree that Cait’s duties as a health care professional need to be expressed to Mr. Wells. The staff agreed that it was important to talk about the issues to ensure unauthorized practice does not happen in the future. Cait confronts her boss after having a discussion with her colleagues about possible resolutions. Cait expresses her concerns and mentions the issues of unauthorized practice, duty of care, and supervision. The staff members decide to have a roundtable discussion in order to help everyone understand unauthorized practice, duty of care, and supervision. This roundtable discussion also helped the staff to address the power dynamics of the workplace.