Out of my scope - NEED HELP!!!!!!

  1. I need some help. I work in a MICCU 23 bed very large teaching facility in Chicago. The story goes like this; 2 nurse from us and the SICU respond to codes throughout the hospital. We go to a woman that is in respiratory distress and is actively seizing. After 4 attempts at an IV and 2 attempts at a central line, I attempted and gained access to a left EJ with a 20 gage angio that I was instructed to do by 2 residents. Patients intubated, stopped seizing and extubated 3 hours after getting to the unit and discharged home 2 days later. After code go to my manager explain to her what had happened and a hour later I was FIRED!!! Met with my boss and my bosses boss and HR today to see if I could get my job back , but to no avail didn't. I was told that I was outside my scope of practice. After reading all policies and procedures of the hospital and state practice act, I do not understand what the problem is. Can anyone help, it would be greatly appreicated. Thanks in advance.
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  2. 2 Comments

  3. by   MorganO
    Quote from militaryRN
    I need some help. I work in a MICCU 23 bed very large teaching facility in Chicago. The story goes like this; 2 nurse from us and the SICU respond to codes throughout the hospital. We go to a woman that is in respiratory distress and is actively seizing. After 4 attempts at an IV and 2 attempts at a central line, I attempted and gained access to a left EJ with a 20 gage angio that I was instructed to do by 2 residents. Patients intubated, stopped seizing and extubated 3 hours after getting to the unit and discharged home 2 days later. After code go to my manager explain to her what had happened and a hour later I was FIRED!!! Met with my boss and my bosses boss and HR today to see if I could get my job back , but to no avail didn't. I was told that I was outside my scope of practice. After reading all policies and procedures of the hospital and state practice act, I do not understand what the problem is. Can anyone help, it would be greatly appreicated. Thanks in advance.
    MilitaryRN- Although you feel that you practiced within your state practice act you must also show competency for stated procedure. We can't defibrillate a patient without showing competency here in my state. I would not try to access an EJ without prior education. The risks are extremely high for your patient although you did what you thought you needed to do.
  4. by   moia
    Were you ever at any time instructed on accessing the external jugular?

    Can you remember anyone ever explaining the risks?
    If at some point in your job an educator ever talked about this you may have one very shaky leg to stand on. Also check all the guidelines and make sure that they actually state that what you did was beyond your scope.
    It has to be in writing and you must have been expressly told that the EJ was beyond your scope.
    If the hospital has no documentation that says they told you not to do it and you can remember someone telling you about the procedure and the risks you could actually get your job back.
    The third thing is to have both doctors who were present sign an affidavit saying they delegated the task to you and supervised the procedure and both were more than willing to accept responsibility for a bad outcome.

    You need a lawyer and some luck but it might not be impossible.

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