Is this common at your facility?

[missnurse01]

OK, just heard something I have never heard before and thought I would shoot it by you guys.

A nurse I work with works prn at another hosp where he is on the code team, but with additional duties. They sit in their office all day, run (and I mean run) codes, intubate, do the rapid response stuff (and order labs and diagnostics), as well as insert invasive lines. I asked if he was nervous about this, as I was wondering about scope of practice issues-he said they are completely covered for everything they do by hosp policy. They insert a-lines, central lines, vascaths for dialysis, and I don't remember what else.

Anyone have RNs doing this kind of thing at their facilities?

[lvICU]

Are these nurse's actually getting orders from the MD though? Maybe the surgeon tells her to go check on the patient and write orders for specific things based on her findings. Like a bolus for low UOP?

[HyperTension]

missnurse01 said:

OK, just heard something I have never heard before and thought I would shoot it by you guys.

A nurse I work with works prn at another hosp where he is on the code team, but with additional duties. They sit in their office all day, run (and I mean run) codes, intubate, do the rapid response stuff (and order labs and diagnostics), as well as insert invasive lines. I asked if he was nervous about this, as I was wondering about scope of practice issues-he said they are completely covered for everything they do by hosp policy. They insert a-lines, central lines, vascaths for dialysis, and I don't remember what else.

Anyone have RNs doing this kind of thing at their facilities?

I'm calling "shens", with a high degree of horse manure. IF (and I do mean "IF") there is an institution that allows this, stay far, far, far, far, far away. Common sense tells you that this is unsafe practice at best, and that's minimizing that statement to a degree of stupid.

Outside of an advanced practice nurse (NP, CRNA) establishing those lines that you mentioned, your coworker is full of it (excluding PICC for obvious and mentioned rationale).

I have seen patients die from complications directly stemming from placement of these lines by experienced and trusted physicians, what the heck even compells this individual (RN) to say this is beyond me. Bleeding, infection, perforation of vessels and organs, air emboli, loss of distal perfusion secondary to spasm / thrombus / emboli, .... umm death are all potiential complications that are listed on the consents that patients / families sign (outside of emergent placement).

With regards to "running a code". I done this, and I'm sure there are many other seasoned ED/ICU nurses that have had to do the same, but there is a protocol (ACLS) to follow, in conjunction with hospital policy, and state established scope of practices that play in here as well. Also, a physician has to sign off on your paperwork, medications administered, and any procedures (intubation) that may have occured, regardless of protocol, as well as a death certificate if things evolve and a celestial transfer occurs (thats a very simplified version).

The same thing goes for "ordering diagnostics". Just on the standard of hospital / insurance reimbursement alone this guy is full of crap. Even if you order a EKG / portable chest film as part of a rapid response protocol, a physicial still has to sign off on it, and that about as far as diagnostics go. The same goes for labs. Insurance can refuse to pay for testing that is deemed excessing / or has no medical / clinical indication.

On a personal note, I'd like nothing more than to contact this person and start asking a few questions, just to hear the "stutter factor". This fellow is full of crap, and more than likely his ability to provide care is at the same level.

[missnurse01, MSN, RN]

Unfortunately this is happening...I have spoken to other nurses that I have worked with at other facilities that this is truly how it is done-even spoke to a nursing supervisor one night about the issue as I had to call her about another issue from our hosp. So I am not doubting this is done, just wondering if anyone else had heard of it since I sure haven't!

[HyperTension]

His license is just one litigation away from from gone, and thats the best case senario. All that "glory" about playing doctor will cease to exist with a single adverse outcome, and then the attempt to cover it up by said individual / facility will enhance this just that much more.

I would not want to be anywhere near him, much less when this blows up (and it will sooner or later). Shame on nursing supervision for even allowing this. Their silence makes them just as guilty, and just a liable if and when things go bad.

Granted, I'm all for pushing the envelop, but you have to deploy a degree of common sense / critical thinking. Schmucking around with a large-bore needle in somebodies chest is not the most tatical way of providing nursing care. This is not the military / combat situation, and he (assuming its a "he") does NOT have anywhere close to the trainging / background / license to even think about performing this. Yea, it sounds really cool, but when the **** hits the fan, and your the cause for it......

Sigh... fools like that (and their's more than one it sounds like) do absolutly NOTHING for our profession. Much less to the patients and their families that blindly trust us to care for them.

[PICNICRN, BSN, RN]

To run a code- intubate and place lines is not out of the scope if the RN is trained to do so. Think about transport teams... I did transports and was trained to intubate, place lines, art sticks ect.,needle a chest, ect. I am "just" and RN and was totally within my scope because I worked from a protocol of Dr's orders.

These "code nurses" are following ACLS algorythms and a standing set of Dr. orders. I don't see a huge problem. And remember- you are in a hospital, surgeons, anesthesia, intensivists are all page away.

[HyperTension]

I definitely agree with what you posted, especially regarding greater autonomy for CC transport teams. My frustration evolves from the posting that this individual can and has placed central lines (TLC, Cordis), and dialysis cath's. within the institution.

CCT (including scene transport) have the greater autonomy due to the nature of what you do, and the needs of the patient within the realm of established protocols. I rank CCT in a "grey area" of nursing because of what we can do is outside of traditional critical-care nursing roles.

The feeling I got though when reading through the above posts is an "eager beaver" who has not learned the limits of inpatient nursing regardless of what a physician "tells or asks" you to do. Again, I'm just a guilty as the next when it comes to pushing the envelope, but I also balance that out with common sense. Heck, I can even overlook the placement of art-lines to a certain degree, but when a RN is beating his chest about placing the above mentioned lines in an inpatient setting, when not in a advance practice role (minus CCT teams) I cannot even begin to tell you how concerning that is, on many levels.

To specific points about needle decompression as an RN, thats where getting your EMT-P absolves those issues (or running RN + EMT-P / Resident).

[PICNICRN, BSN, RN]

HyperTension said:

I definitely agree with what you posted, especially regarding greater autonomy for CC transport teams. My frustration evolves from the posting that this individual can and has placed central lines (TLC, Cordis), and dialysis cath's. within the institution.

CCT (including scene transport) have the greater autonomy due to the nature of what you do, and the needs of the patient within the realm of established protocols. I rank CCT in a "grey area" of nursing because of what we can do is outside of traditional critical-care nursing roles.

The feeling I got though when reading through the above posts is an "eager beaver" who has not learned the limits of inpatient nursing regardless of what a physician "tells or asks" you to do. Again, I'm just a guilty as the next when it comes to pushing the envelope, but I also balance that out with common sense. Heck, I can even overlook the placement of art-lines to a certain degree, but when a RN is beating his chest about placing the above mentioned lines in an inpatient setting, when not in a advance practice role (minus CCT teams) I cannot even begin to tell you how concerning that is, on many levels.

To specific points about needle decompression as an RN, thats where getting your EMT-P absolves those issues (or running RN + EMT-P / Resident).

I can totally see your point... I mean there are a hospital full of DOCTORS there 24 hours a day. Why not just have a Doc come and place those lines ect??? I do agree.