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.
    •  
  2. 5 Comments

  3. by   kc ccurn
    whew boy, what a situation. I am assuming that the central line attempts were not by you. I think that the EJ would be outside the scope of RN practice. You would have to check with the BON on that one. Did the residents tell you to do the EJ or did they "walk you through it"? They should have been the one's doing the EJ then. I think that getting fired for it is a bit harsh, I would have thought that a verbal or written warning would have been appropriate. I'm afraid I don't have any great advice for you. I would recommend adding this thread to the legal nursing side and see what they have to say. Did your risk manager have anything to say? I wish you luck. I'm sorry this happened to you.
  4. by   louloubell1
    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.
    So what was it that they took issue with exactly? Just your placement of an EJ line? An EJ is a peripheral IV and as long as you have a MD order to place it, & its not against your facilities policy they I can't see why it would be out of your scope of practice. I work in a neighboring state and we get patients all the time who have had an EJ placed in the ER (by the RN) before transfer to our ICU. Now, that being said, I have had MDs ask me a few times to place an EJ and I have politely refused because even though I know it is technically ok for me to do so because I just don't feel real comfortable with it. To be honest, unless it is an emergency I feel uncomfortable even using an EJ. That's just me though.......
  5. by   traumaRUs
    Thought I posted to this thread. I live in Illinois also and in our ER (downstate, level one) the RNs do EJ's as long as an MD has seen them do it or they state they have learned how. No problems. Good luck.
  6. by   MaleAPRN
    Hi,

    I work in the ED, both as an RN and an NP. Even before becoming an NP in the ED, the RNs would start EJ lines on patients who are very hard sticks. I remember being TRAINED by the educator in the ED then, to start IV's almost anywhere I could to help save a patient's life (central lines exluded. Well, as an NP, I am able to do central lines because it's within our protocol). Your being fired is too extreme. If you were trained to be an ED nurse, starting EJ lines should be in your scope of practice. It's not considered a central line.

    Vince.
  7. by   Diprivan/Vented
    Yeah, I think being fired is really extreme. How long have you worked there? If it was a short period of time, I'd say be thankful and use those unemployment benefits to your advantage. Just in case they report you to the board, have a story ready that says the pt's life required it and that the doctors were at your side.

close