Is this common at your facility?

[missnurse01, MSN, RN]

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?

[New 2 iceeYouRN]

We have a PICC nurse, all she does is insert PICC lines and is on call for this. We also have an ABC team of nurses who have set limits of what they can do but they do not intubate.

[sicushells, RN]

I don't think hospital policy covers you if you're working outside your nursing scope of practice. I have heard of RNs putting in a lines and drawing ABGs, and PICC lines after extra training. I'm pretty sure that dialysis catheters and central venous catheters are lines only physicians can put in, though.

[missnurse01, MSN, RN]

Yes it was the vascaths and central lines that I had never heard of...he was very nonchalante about the whole thing, which leads me to believe that it has been this way for a long time...just accepted. Hadn't seen this before across the country where I have worked...

[JustMe]

You can contact your state Board of Registered Nursing. Send them copies of the hospital policies that supposedly cover these activities and ask for their input. We had a similar situation where a private physician wanted his hired RN to do his rounds for him and he would come later to co-sign the orders. Problem was, this RN was not an NP, a CNS, not even a BSN. Since the hospital wanted to bow to this physician's request they wrote a special policy for it. We sent the policy and a request for the BRN to investigate and they put a stop to it. So just because they have a policy for it doesn't mean the nurse is working within their scope of practice.

[hypocaffeinemia, BSN, RN]

Sounds like the nurse is working essentially as an ACNP-- I wonder if that is their training?

[missnurse01, MSN, RN]

No that wasn't his training...RN only, not ACNP....

[Mrs.Rollins, ASN, RN]

JustMe said:

You can contact your state Board of Registered Nursing. Send them copies of the hospital policies that supposedly cover these activities and ask for their input. We had a similar situation where a private physician wanted his hired RN to do his rounds for him and he would come later to co-sign the orders. Problem was, this RN was not an NP, a CNS, not even a BSN. Since the hospital wanted to bow to this physician's request they wrote a special policy for it. We sent the policy and a request for the BRN to investigate and they put a stop to it. So just because they have a policy for it doesn't mean the nurse is working within their scope of practice.

We have the same thing on our unit. One of the surgeon's nurses makes rounds for him and writes orders, but she's not a NP. Don't get me wrong: she is a FANTASTIC CCRN with tons and tons of experience, and I'd trust her with my life, but...well, some things just shouldn't fly, you know? If I were her I would be so very worried about a negative outcome.

[JustMe]

Mrs.Rollins said:

We have the same thing on our unit. One of the surgeon's nurses makes rounds for him and writes orders, but she's not a NP. Don't get me wrong: she is a FANTASTIC CCRN with tons and tons of experience, and I'd trust her with my life, but...well, some things just shouldn't fly, you know? If I were her I would be so very worried about a negative outcome.

Yes, one of our surgeons has a nurse making rounds for him too, but this nurse is an NP and I have no problem taking his orders. In fact it's nice to be able to get orders when the surgeon is always in surgery.

[sethsdad]

Nurses, R.N.'s are bound to their states nurse practice act. There are some procedures that can be done with extra training and competency reviews that hospitals can maintain. However Ive foung that many administrators fail to get clearance from the state board and rely on the MD's opinion that " oh yeah, they'll be covered for that" and allow questionable practices, [ its a lot cheaper to use a nurse tham to have a MD on standby]. Placing vas caths and other central venous lines have never been in the realm of any R.N. unless they are educated in advanced practice, ie..CRNP, CNP. Tim

[txdude35]

Mrs.Rollins said:

We have the same thing on our unit. One of the surgeon's nurses makes rounds for him and writes orders, but she's not a NP. Don't get me wrong: she is a FANTASTIC CCRN with tons and tons of experience, and I'd trust her with my life, but...well, some things just shouldn't fly, you know? If I were her I would be so very worried about a negative outcome.

I wouldn't honor those orders. If you do, you're placing your license and liability right on the line with hers. I also feel as if I would have an ethical obligation to call the state board and put a stop to it. Of course, both she and the surgeon are exposing themselves to millions of dollars in malpractice suits not mention loss of license, etc. If your facility is aware of it, they risk losing accreditation. JCAHO would have a field day with this one.

[Mrs.Rollins, ASN, RN]

She skirts the issue by writing all orders as telephone orders from the surgeon. It's an issue.