We have a sedation protocol that encourage diprivan first in MOST instances and then:
Morphine in hemodynamically stable pts
Fentanyl in hemodynamically compromised pts.
So, the fact that fentanyl is better for pts with lower bp is on point. AS far as RNs and anesthetic agents, in TEXAS at least, the BON specifically states that it is not referring to critical care pts on vents.
"Therefore, it is the position of the Board that the administration of anesthetic agents (e.g. propofol, brevitol, ketamine, and etomidate) is outside the scope of practice for RNs and non-CRNA advanced practice nurses except in the following situations:
- when assisting in the physical presence of a CRNA or anesthesiologist
- when administering these medications as part of a clinical experience within an advanced educational program of study that prepares the individual for licensure as a nurse anesthetist (i.e. when functioning as a student nurse anesthetist)
- when administering these medications to patients who are intubated and mechanically ventilated in critical care settings
- when assisting an individual qualified in advanced airway management, including emergency intubation procedures"
But, I can only speak for Texas because it's the only BNE NPA and rules that I study.
But a KEY question is also this: what is the PURPOSE of giving fentanyl? If it is specifically for pain management, then I believe it falls along the same lines as using morphine for pain control.
If it is for sedation, then it falls in the 'anesthetic' concerns and should not be used on unintubated pts by a non CRNA/ANP RN, except as outlined above.