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. 12 Comments

  3. by   Noney
    What a tough break. I don't know the legalities of RN's starting IV in the EJ, but I'm someone will post that does. I'm glad the pt made it.


    Noney
  4. by   kmchugh
    Might your adminstrators have confused the placement of an EJ, which is considered peripheral IV access, with placement of an IJ, which is considered central access?

    Otherwise, the story you relate doesn't make much sense.

    Kevin McHugh, CRNA
  5. by   militaryRN
    I originally thought the same thing, but met with them today and they are standing by that in their 20 some odd years of practice they would never had started an angio in anyones EJ, because it is out of our scope. Hr did ask if I had done this before and I stated that I had, but not in their hospital in it was in the military that I received this training (8 year 8404 hospital corpsman).
  6. by   2ndCareerRN
    Only a couple of words of advice here....

    Call your BON and ask if in the scope of practice for an RN, and get a lawyer.

    If you carry your own malpractice insurance (which everyone should IMO) then the insurance company can help with a lawyer.

    Re-Read the P&P manuals and see if placing an EJ is mentioned anywhere. If the BON says it is in your scope, and the P&P does not adress it, they don't have much of a case.

    I feel an EJ placement should be in the scope for an RN, it is for paramedics in most states.

    bob
  7. by   curlynurse
    In the ER that I work in, RN's used to start EJ's frequently. I didn't simply because I am not comfortable with them. However, we have a new educator who has many, many years of experience who has told us that it is out of the RN's scope in the hospital setting (it may be different for CCT and other settings), therefore we are no longer allowed to do them. I would look up your state's nurse practice act and the hospital's P&P, as others have said.

    Good luck...
  8. by   militaryRN
    Thanks, Bob. Have already contacted an attorney and he feels they don't have much to stand on. I am waiting a response from the BON. I rewally just need to know where in the scope this falls under, if anywhere. Then I feel I can get somewhere. Thanks again.
  9. by   militaryRN
    Thanks curlynurse. Everything I have looked at is VERY vague. Nothing says I could or could not.
  10. by   curlynurse
    After I posted I looked at the California BRN website & the ENA website but couldn't find anything about EJ's. I have, in the past, called the BRN to ask scope of practice questions and have always been able to get an answer from a nurse within a few minutes. You might want to try that.

    I hope everything works out for you. This is truly a case of you doing what is best for the patient, with no negative outcome, and at the very most a write-up is all you should have received.

    Let us know what happens.
  11. by   Nurse Ratched
    Please keep us posted on the outcome (as much as you can given that there may be a legal matter.) I'm sorry this is happening to you.

    Let me guess - no repurcussions for the residents who told you to do this?
  12. by   militaryRN
    Definitely no repurcussions to the residents,but in their defense they both have stepped up and are my witnesses. They both stated whatever they need to do to help they would. New news though, researched all day yesterday and found out the the state boards for NC, AL and IL state that RN's can do it as long as there is an order, you have been train (we all can start IVs, I hope) and if the P&P says we can. The current facility's policy gives me choices for RN and if you need further call IV team, but for both RN and IV team EJ is not a choice. So hopsital should have covered it. So I told employer that if I could resign and get my pay through Feb I would not go any further. So we wait to hear from them. Will follow up.
  13. by   traumaRUs
    I work in an ER in downstate Illinois - and our nurses (once trained) start EJ's all the time. Nothing to it. So...I know it can be done in Illinois. Good luck. Hey - if you want to work in Peoria, PM me. Take care.
  14. by   Agnus
    Quote from militaryRN
    Definitely no repurcussions to the residents,but in their defense they both have stepped up and are my witnesses. They both stated whatever they need to do to help they would. New news though, researched all day yesterday and found out the the state boards for NC, AL and IL state that RN's can do it as long as there is an order, you have been train (we all can start IVs, I hope) and if the P&P says we can. The current facility's policy gives me choices for RN and if you need further call IV team, but for both RN and IV team EJ is not a choice. So hopsital should have covered it. So I told employer that if I could resign and get my pay through Feb I would not go any further. So we wait to hear from them. Will follow up.
    Given your research, and assuming your nurse practice act either specifically condones it OR specifically fails to mention it all together, then you are likely within your scope.

    I was taught in school that if the BON does not address it specifically in the nurse paractic act and you can show at least three references in the literature where RNs do it then you are within your scope of practice.

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