Scope of Practice question

[jnurse35]

I am a registered nurse practicing in an ICU. I had a patient who's airway was becoming more compromised with increasing oxygen demand, in an acute renal emergency with ECG changes and who was unable to clear his airway from post nasal bleeding. After waiting ten minutes for RT to come draw an ABG I decided to draw the ABG and the patient was intubated shortly after. I was told later that nurses can draw ABGs at my facility by my manager. A couple days later my manager calls and tells me they decided only RTs are allowed to draw ABGs and this was "quite serious". I have had training on ABGs at the bedside and in school. My manager could not tell me what the competencies were for ABGs and in fact, most nursing tasks (for example starting IVs, setting up art lines, etc...) do not have recorded competencies at my facility, even in orientation. I feel that I did what was necessary for my patient at the time within my scope of practice. All in all it was somewhere between 15-20 minutes before the RT arrived to do the gas after I called. Has anyone had a similar experience or any advice in this situation?

[Here.I.Stand, BSN, RN]

Is the RRT-only policy in writing? You were trained on it during orientation, your manager told you RNs can draw them, and now changing her story? Does your state's nurse practice act say art sticks are out of the RN's scope?

I'm failing to see what was "so serious." Maybe because we draw our own all the time where I work; the only time I call the RRT is if I can't get it myself. I can see if you decided to throw an IJ in the pt or write an Rx, but unless your state says that art sticks are outside of your scope? Why would you wait for the RT for something you were able to do -- and until now, no policy against? That is YOUR pt.

[jnurse35]

Is the RRT-only policy in writing? You were trained on it during orientation, your manager told you RNs can draw them, and now changing her story? Does your state's nurse practice act say art sticks are out of the RN's scope? I'm failing to see what was "so serious." Maybe because we draw our own all the time where I work; the only time I call the RRT is if I can't get it myself. I can see if you decided to throw an IJ in the pt or write an Rx, but unless your state says that art sticks are outside of your scope? Why would you wait for the RT for something you were able to do -- and until now, no policy against? That is YOUR pt.

It is within my scope of practice in my state (missouri) and my facilty's policy states that nurses can draw abgs if competencies are met. I did have some undocumented training from some RTs at the same facility plus training in school. The problem is other skills we do such as starting IVs, setting up art line, starting foleys, etc... also do not have any documented competencies. Typically the RTs do the ABGs at my facility but I have always know that per policy a nurse can do them if necessary. I've never been told otherwise. I was being pressured to get the sample and decided to do what I determined was in the best interest of my patient at that time. I don't know what was keeping the RT but the results were needed and we actually had them by the time they got to the room to draw the ABG. I drew the ABG successfully without complication and with one attempt. I feel that they are picking and choosing what competencies they want to enforce. I have considered a grievance because I cannot get a straight answer from my manager but I would like to avoid it. Problem is they took me off the schedule and now I feel like I'm entering the realm of a hostile work environment. I've never had to deal with anything like this and I just feel like it's being taken out of proportion.

[jnurse35]

It is within my scope of practice in my state (missouri) and my facilty's policy states that nurses can draw abgs if competencies are met. I did have some undocumented training from some RTs at the same facility plus training in school. The problem is other skills we do such as starting IVs, setting up art line, starting foleys, etc... also do not have any documented competencies. Typically the RTs do the ABGs at my facility but I have always know that per policy a nurse can do them if necessary. I've never been told otherwise. I was being pressured to get the sample and decided to do what I determined was in the best interest of my patient at that time. I don't know what was keeping the RT but the results were needed and we actually had them by the time they got to the room to draw the ABG. I drew the ABG successfully without complication and with one attempt. I feel that they are picking and choosing what competencies they want to enforce. I have considered a grievance because I cannot get a straight answer from my manager but I would like to avoid it. Problem is they took me off the schedule and now I feel like I'm entering the realm of a hostile work environment. I've never had to deal with anything like this and I just feel like it's being taken out of proportion.

Also, the RRT only "policy" in not in writing as far as I know. I was told by mgmt that the written policy is that RNs can draw ABGs.