Practicing Out of Scope

Nurses Safety

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I am currently on assignment with a travel company at a facility located in Az. If any Az nurses can chime in here I wold appreciate it.

I want to make a complaint about nurses (more than one) practicing out of their scope. However, I'm not sure how to make a complaint about how the unit is run. Because it is not just one nurse, it is the entire unit. They are doing it knowing that the doctors should be the ones that should be preforming the task and none of them stand up for themselves. When I did, the Doc basically said they were taking me to administration becasue I refused to do the task that is completely their responsibility. I have already spoken to my company about it, but more needs to be done so that it does not occur any longer.

Is there any consulting perosn or group I can speak to first to determine how to best handle this? I have never been in a situation where there was blatant disregard for stand of practice.

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I have done Travel in AZ and other areas. Protect YOURSELF , your license and your reputation in this situation.

You've been reported, document everything in writing to your agency. I would quit the contract after the agency has been informed this is a safety issue.

Do this research when you are safely out of the situation.

Your agency and the AZ BON could be good resources for reporting the issue.

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Specializes in NICU, ICU, PICU, Academia.

I'm curious what is this task you are concerned about? You state it is the physician's 'responsibility', but not that it falls outside a nurses's scope of practice.

Color me: confused.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

What is it that you consider out of scope/ Many nurses believe that certain things are beyond their scope...when actually the Nurse practice act doesn't identify it specifically and is ok with proper training and oversight by by the MD's.

What one facility considers out of the nurses scope another will not.

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Specializes in NICU, ICU, PICU, Academia.
Esme12 said:
What is it that you consider out of scope/ Many nurses believe that certain things are beyond their scope...when actually the Nurse practice act doesn't identify it specifically and is ok with proper training and oversight by by the MD's.

What one facility considers out of the nurses scope another will not.

...in which Esme says it WAY better than I did.

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meanmaryjean said:
I'm curious what is this task you are concerned about? You state it is the physician's 'responsibility', but not that it falls outside a nurses's scope of practice.

Color me: confused.

The nurses are setting up, initiating, and connecting epidural pumps in OB patients. The board states in the Advisory opinion that to do this with an OB Pt the RN must be a licensed Independent Practitioner or CRNA. I have spoken to the sister facility also located in Az, and the director of that unit confirmed what I believed, that it is in fact out of scope to manage the epidural pumps

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Presumably they're not inserting the epidural catheters and this is being done by qualified anesthesiologists/CRNAs. Are you sure there are no policies/standing orders from the head of the OB medicine dept, or from various OB practice groups, that allows the nurses to then attach the pumps and regulate them per protocol/standing orders?

If yes, then you're wrong. If no, they are. I don't work OB and the only OB "epidural" I ever had made me numb waaaay north of my nipple line, but perhaps some folks in the OB forum could enlighten us how epidurals are regulated in practice. Do RNs do this with standing orders, or individual or hospital-based certification/education, or ???

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Specializes in OR, Nursing Professional Development.

Where I work, the nurses are responsible for setting up and maintaining the epidural pumps used in PACU (no experience with L&D). The anesthesiologist enters orders after the insertion, the PACU nurses keep an eye out for orders on patients where epidurals are expected, then get the pump ready and as soon as the patient enters PACU, someone hooks it up. On the floor, epidural pumps are limited to the IV team nurses.

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GrnTea said:

Presumably they're not inserting the epidural catheters and this is being done by qualified anesthesiologists/CRNAs. Are you sure there are no policies/standing orders from the head of the OB medicine dept, or from various OB practice groups, that allows the nurses to then attach the pumps and regulate them per protocol/standing orders?

If yes, then you're wrong. If no, they are. I don't work OB and the only OB "epidural" I ever had made me numb waaaay north of my nipple line, but perhaps some folks in the OB forum could enlighten us how epidurals are regulated in practice. Do RNs do this with standing orders, or individual or hospital-based certification/education, or ???

The state board states that it is not in our scope for an OB patient. We have the orders much like a PCA, and here it is widely accepted as common practice. But common practice is not always correct. IN this case, the advisory opinion states that unless we are a CRNA or LIP we can not do those things if there is an opioid in the bag. My concern is not only for myself but also the nurse that are doing this currently. They know they are not suppose to be initiating the pumps, literally connecting and setting bolus and basal rates (based on an order), and then starting with no MD in sight. That is not allowed in OB.

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Specializes in Critical Care.

I can't confirm this is the 'correct' way to go about it, but my response to things like this has always been to just e-mail the DOH/BON. It is also possible however that the DOH/BON doesn't actually care.

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