RN transporting pt. across state lines

  1. Recently another RN and I had to go w/ a pt. to a neighbouring state. There was no paramedic available, so as per our policy, we had 2 RN's go w/ a BLS crew from our local fire dept. We are not licensed to practice in the the state to which we travelled. The trip took about 1.5 hours and the pt. was 2nd trimester pg w/ severe PIH and had MGSO4 running. Are we covered if something had happened to this pt. enroute or we had to give meds, etc? I felt uneasy, but pt. really needed to go to the referral facility and it was in the middle of the night. Pt. could not be sent to a closer facility because of insurance issues. How is our license different than a paramedic's? We do not intubate babies which I know some paramedics do. I really don't have a clue re. emergency nursing practice as I work in ob. Due to changes at the facility we usually refer pt's to, this may soon happen again so I want to be prepared.
    •  
  2. 14 Comments

  3. by   medic1488
    I'm not sure where your from, but I know as a paramedic in a relatively small state in the Northeast we routinely bring pateints across state lines, as well as picking up and bring back to our state in a critical care transport capacity. We are covered by are license going out of state as long as we are licensed in the call orginating state. For example, CT to RI transfer must have CT license. As for RN's, I don't know their rules/regs but the local helicopter service regularly flies into other states with interfacility transfers. As for licensing differences, it varies state to state but were RN's are typically working under direct orders (for the most part) we are also operateing under MD orders, however there prewritten and on standing orders for most things. In a round about way we both operate similarly, none of us really can do anything without an MD signing off on it at some point either in the past or future. And additionally, one of the few times we transport with staff RN is during high risk OB mainly for fetal monitoring and expertise because we are trained and equipped to deal with most problems, when you have two lives in jepoardy (mom and baby) its nice to have someone who has 100's to 1000's of deliveries versus our 2-3 we have to see in school.
  4. by   JohnnyGage
    The company I fly for routinely does interstate transport. Because the company is licensed in Minnesota, and we as nurses are licensed in Minnesota, we are covered. Basically, while the patient is under your care and covered by your protocols, orders, etc., they are considered to be "in your state" until care is transferred.
  5. by   Peg804
    I do IFT both ground and fixed wing, many across many state lines. You need to look at the transferring facility-who is employing you to do this. They are responsible for you-liability wise. I don't like the situation you were in. All our IFT "nurses" are PHRN's-meaning we have medical command in the prehospital setting, should something happen. Not having an ALS provider in your situation, um.... As you said-you cannot intubate-what about IO lines in the newborn if needed??? I think your hospital needs to look at this. Why did they not fly the woman, or get a paramedic?? If you were on the road that long, waiting for an actual Interfacility Transfer Team wouldn't have held you up that much. Ask admin if they will cover you if the worst case senerio happens-I am interested in what they will say. Good luch
  6. by   imenid37
    Hi Peg,
    Thanks for the reply. I am not sure what part of PA you are in. We went from PA to MD. Our hospital paramedic team cannot go on a transport that long. That is what we were told. There was no helicopter service d/t weather conditions and dr. didn't want pt. to fly anyway. Their nurse and paramedic (from the flight crew) would've come instead, but that would have been another 45 min. if we were able to talk someone into picking them up. Their company operates a helicopter, but do not have a ground ambulance. I hope I don't have to deal w/ this one anytime soon again. Of course we're covered (wink) until something bad happens. For this and many other reasons, life at my present employer is getting a little old right now.
    Last edit by imenid37 on Mar 4, '05
  7. by   Peg804
    Hi, I work for the Geisinger System(we'll come get you no matter where you are). as well as several other transport services. I hope you never run into a problem a a transport./ Please as a nurse read the EMTLA guidelines. I work as a ER RN as well a a phrn or hp-so I am pretty well covered, I also make sure that I maintain medical command for every unit I work for-just uncase something awful happems. I have spoken to my sister in lau (actually the drinking was pretty heavy" -she is a CCU nurse who never thought about what could go wrong on "tranaport: Make some kind of agreement with an actual transport team. EMTLA says that the patient being transported must have the same case as in the hospital THINK ABOUT IT > WHAT CAN YOU DO FOR THE PATIENT> THINK ABOUT IT WHAT happend is the crump half way to their destinatoin with an EMT/EVO Driver and an RN from CCU= what happens
  8. by   mommatrauma
    Danger...danger..danger...good rule of thumb...if you have to ask if you are covered to do something...you probably aren't...You are not covered under your basic nursing license in PA to go on a 10 minute road trip if something goes wrong and that pt dies...You can't intubate...which is going to be a big one...and a 1.5 hour trip...at the very least an MD should have been on the tri if there couldn't be a medic...too many things could have gone wrong...If you felt uneasy about it...you should not have done it...because think about the pro's and con's...yes the patient needed to be at the other hospital...however...if they couldn't be transported and something went wrong...at least they are in a hospital where there are far more qualified staff and proper equipment....if something goes wrong enroute, what do you do? The patient needed to be transported to a higher level of care from what your hospital could offer...the transport was a lower level of care for the entire 1.5 hours...a big emtala no-no...There are a million and a half private ambulance transport companies in PA, with both BLS and ALS...You should or could have shopped around til you found one...someone would have done it...hopefully you won't ever have to be put in that situation again...
  9. by   Peg804
    I just wondered if you had approached admin to see if they would cover you if something awful happened. unfortunately I had something awful happen on a rountine retrieval for one of the units I work for. We transported a patient out of the Pittsburgh area, massive CVA-coming closer to home for rehab. actually was going to New Jersey Nursing. Rehab facility, No DNR, coded, awful trying to find a receiving facility, patient ended up intubated, etc when we arrived at a NY ed. Physician was not sure what to say Any way patient is still alive. A routine retrieval gone bad-just my luck. Let me know what happened at your facility. My inlaws lived in port deposit maryland for a while, sstill have friends there. Where are you located. perhaps I can help your situation
  10. by   BittyBabyGrower
    Hi, we transport across state lines and we are covered by the state from which we come, you follow your hospital policy and procedure as you are employed by them.
  11. by   Peg804
    Yes, you are employed by the hospital that sent you, but are you legally covered if something bad happens. I do not think you are covered by the state, you can only do what is in your nurse practice act. And that does not cover you for what could happen on a transport gone bad. You cannot perform the prehosptital skills of an paramedic or a phrn/hp. Can you legally intubate?? Perform a cric???? If you are not a prehospital provider, no you cannot. What is your hospital going to say when you have a patient go bad. Who are they going to protect???? Certainly not the lowly nurse who did not know any better, and only went for a ride. Better to have those trained and certified caring for the patient rather that risking your patients life and your license.
    Last edit by Peg804 on May 4, '05
  12. by   CraigB-RN
    Quote from Peg804
    Yes, you are employed by the hospital that sent you, but are you legally covered if something bad happens. I do not think you are covered by the state, you can only do what is in your nurse practice act. And that does not cover you for what could happen on a transport gone bad. You cannot perform the prehosptital skills of an paramedic or a phrn/hp. Can you legally intubate?? Perform a cric???? If you are not a prehospital provider, no you cannot. What is your hospital going to say when you have a patient go bad. Who are they going to protect???? Certainly not the lowly nurse who did not know any better, and only went for a ride. Better to have those trained and certified caring for the patient rather that risking your patients life and your license.
    Be carefull when you make absolute statements. In some states the nurse can do that. My nurse practice act is extremly broad and I CAN do those skills. Its not differnt than accepting a inpatient assignment. If you've never taken care of a post op heart before, you should accept that patient. Crossing the state line is not different as a nurse than it is as a paramedic. I've been both for 25 years now, and I've lost count of the number oftimes I've crossed a state line. MD, PA, NW, CA, NV, TX, OK, KS, NE, CO. I know my scope of practice and know my limitations and skills.
  13. by   mommatrauma
    Quote from CraigB-RN
    Be carefull when you make absolute statements. In some states the nurse can do that. My nurse practice act is extremly broad and I CAN do those skills. Its not differnt than accepting a inpatient assignment. If you've never taken care of a post op heart before, you should accept that patient. Crossing the state line is not different as a nurse than it is as a paramedic. I've been both for 25 years now, and I've lost count of the number oftimes I've crossed a state line. MD, PA, NW, CA, NV, TX, OK, KS, NE, CO. I know my scope of practice and know my limitations and skills.

    Craig, just curious which state you practice in that allows you to intubate and crich someone simply as an RN without further certification or training such as being a HP/PHRN or NP or NA...I read over Kansas Nurse Practice Act and saw nothing of the sort...maybe I missed it, or maybe I'm looking at the wrong state...let me know, thanks...
  14. by   CraigB-RN
    Quote from mommatrauma
    Danger...danger..danger...good rule of thumb...if you have to ask if you are covered to do something...you probably aren't...You are not covered under your basic nursing license in PA to go on a 10 minute road trip if something goes wrong and that pt dies...You can't intubate...which is going to be a big one...and a 1.5 hour trip...at the very least an MD should have been on the tri if there couldn't be a medic...too many things could have gone wrong...If you felt uneasy about it...you should not have done it...because think about the pro's and con's...yes the patient needed to be at the other hospital...however...if they couldn't be transported and something went wrong...at least they are in a hospital where there are far more qualified staff and proper equipment....if something goes wrong enroute, what do you do? The patient needed to be transported to a higher level of care from what your hospital could offer...the transport was a lower level of care for the entire 1.5 hours...a big emtala no-no...There are a million and a half private ambulance transport companies in PA, with both BLS and ALS...You should or could have shopped around til you found one...someone would have done it...hopefully you won't ever have to be put in that situation again...
    21.15. Monitoring, defibrillating and resuscitating.
    The use of monitoring, defibrillating or resuscitating equipment, or a combination of the three, hereinafter called ''therapy,'' is a proper function of a registered nurse and is a function regulated by this section; the function may not be performed unless all of the following provisions are met:

    (1) The employer, through written policy, has agreed that the registered nurse may administer the therapy.

    (2) A committee of licensed physicians and nurses within the employing agency has established written criteria prescribing when the therapy shall be administered by a registered nurse either in the presence or absence of the attending physician.

    (3) The techniques for administering the therapy have been established by a committee of licensed physicians and registered nurses within the employing agency.

    (4) The registered nurse has had instruction and supervised practice in administering the therapy.

    (5) The registered nurse has demonstrated competency in administering the therapy to the satisfaction of the employer.

    (6) The registered nurse shall have employed the prescribed techniques in administering the therapy in accordance with the established criteria.


    right from the PA nurse practice act. It comes down to policy, procedure and documentation of adaquat training.

close