Should nurses perform outside scope of practice during emergency situations? - page 2

by chels0641 8,340 Views | 21 Comments

For my ethics class we have to write a synthesis paper on an ethical issue in nursing. I chose to write about whether or not nurses should act outside of their scope of practice during emergencies. For example, if a patient... Read More


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    I might approach your paper from a different angle, and a little lesser degree of severity.
    I'm thinking about hospitalist physicians that trust the nursing staff enough to issue very lenient standing med orders to prevent calling them in the middle of the night for something minimal.
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    Each of us makes her/his own decisions about what we're comfortable doing in emergency situations, but there is no US law, Good Samaritan or otherwise, that will protect a nurse who acted outside the legal scope of her/his practice if the individual is taken to court or the BON afterwards (as far as I know; I am happy to be corrected if I'm wrong ).
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    Quote from elkpark
    Each of us makes her/his own decisions about what we're comfortable doing in emergency situations, but there is no US law, Good Samaritan or otherwise, that will protect a nurse who acted outside the legal scope of her/his practice if the individual is taken to court or the BON afterwards (as far as I know; I am happy to be corrected if I'm wrong ).
    This is true, but if you make it a practice never to exceed your level of licensure, training, and experience (note, this may be different from your current job description) you can be sued but you will prevail even if things didn't work out well.

    If you have exceeded your licensure, training, and experience, you can be held accountable for any adverse effects and damages if someone thinks to sue you.
    twinmommy+2 likes this.
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    I don't know all the rules of the law, but I'm skeptical if the law applies within the hospital setting. I would think the law of the land within the hospital is the policies and procedures for the facility. Helping on the side of the road or in a restaurant is one thing, but intubating a pt or doing the needle decompression in the hospital setting...I don't think the law would really hold.(again, I could be totally wrong..I'm just speculating). Everyday, I would hear medics in the ER complain that they can't do certain things in the department that they do on the street every shift. Even if it was an emergency and there wasn't a doc around, they could intubate but they would get in trouble for it unless someone let it slide. With other docs in the hospital, anesthesia, the code team, rapids responses... a nurse who is practicing out-of-scope would probably get fired b/c the hospital isn't going to risk the liability. Plus, I don't think a nurse could claim they were being a good samaritan and not get fired if the hospital wanted to. If that was the case, then any nurse could practice out-of-scope and just claim they were being a good samaritan. And it's not a question of what's the right thing to do for a pt in an emergency, but strictly from a legal point of view. We can defib a pt and give ACLS meds during a code, but that's an approved policy. Anything out of scope or unapproved, the law wouldn't apply in the hospital and you are history. Am I wrong?
    KelRN215 likes this.
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    Quote from chels0641
    For my ethics class we have to write a synthesis paper on an ethical issue in nursing. I chose to write about whether or not nurses should act outside of their scope of practice during emergencies. For example, if a patient needs intubated and no physican is around (and can't be around fast enough), should the nurse perform the intubation if it will save the patient's life? I'm having a lot of trouble finding information on this topic and have only found one source that is hardly helpful. Is my topic too narrow? Any suggestions on what to search when i'm looking for sources?
    I don't think you will find a lot of information specifically with intubation though it is a true legal and ethical problem. I recommend looking at nurses performing outside of scope in general during ER or Trauma situations and tie it with legal cases of intubation charges where the nurse was found both innocent and guilty. Then question charges based on ANA code of ethics as well as question hospital policies/state or federal law interpretation of the ANA code of ethics. Truly a great topic because that is a problem for nurses who once were EMS and know how to do a correct intubation. Good choice! And good luck!
    theantichick likes this.
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    This is a difficult question. Nursing practice is governed by state nurse practice acts. Using your example of intubation in an Emergency situation.....Nurse practice acts do not forbid nurses from intubation but they do need to have training and experience for it to be within their practice and covered by hospital policy. If you have the training and experience and there is an emergent situation that a MD will not be there is a "reasonable amount of time" AND the patient will die....so you intubate and save the patient....but it will probably will not save your job in most cases for there is ALWAYS a MD near by.

    Now if your hospital has just been struck by a tornado like in Joplin and you know how to intubate and the MD is nowhere near....you will be fine...IF you know how. If you don't and you try and save the patient but hurt their vocal chords....just because you saved their life will not absolve you from malpractice and losing your license. But if you know how and don't...you might be liable for delay of treatment......if you know how and still damage their vocal chords you are still liable.

    In medicine.....there are many grey areas and doing the right thing is a leap of faith. I know of a nurse who lost it all by doing what a MD was screaming at the bedside for her to do in a code situation on a young patient that was not in her scope (give epi intra arterial) but knew the MD can do this but it was physically impossible for the MD to get to the art line......she gave it a nurse reported her and she lost her job and license.

    Essentially it is never a good thing to act outside your scope of practice...because you have not been trained for the task which will find you liable in every situation....even with good Samaritan laws....because it is not in your scope of practice. If you have been trained with experience...that is now your scope of practice.

    I found a website you might find interesting.....http://kcsun3.tripod.com/id110.htm

    Nurse Practice Acts
    (NPAs) are laws in each state that are instrumental in defining the scope of nursing practice. NPAs protect public health, safety, and welfare. This protection includes shielding the public from unqualified and unsafe nurses. In each state, statutory law directs entry into nursing practice, defines the scope of practice, and establishes disciplinary procedures. State boards of nursing oversee this statutory law. They have the responsibility and authority to protect the public by determining who is competent to practice nursing. NPAs are the most important pieces of legislation related to nursing practice.


    Common Law is derived from principles or social mores rather than from rules and regulations. It consists of broad, interpretive principles based on reason, traditional justice and common sense.

    Together, the NPAs and Common Law define nursing practice. It is a nurse's responsibility to be informed on both the NPA and Common Law for the state(s) in which they are licensed and practice.

    Listed below are links to the state boards of nursing for the United States. Each website has information on that particular state's NPA. Also listed is a link to the National Council of State Boards of Nursing, which maintains an online database of NPAs.

    National Council of State Boards of Nursing:
    The NCBSN maintains a database which contains available NPAs from 49 states, the District of Columbia, and four U.S. territories (Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands). Maryland's NPA is not available, per state restrictions.
    Last edit by Esme12 on Feb 4, '13
    pmabraham likes this.
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    I'd also be interested in what you find out. I was a Paramedic years ago, and still carry an emergency kit in my car with full airway equipment (no cric kit, tho... I never trained on that and would be too scared to try it). I'm also a newly minted R.N. During the period of time after my EMT-P certification expired, I researched enough to know that I should be covered under Good Samaritan if I should have to intubate to save a life. (Though I'd try an OPA first.) While I still held an active cert, it was debatable because I'd be acting without medical control.

    Now that I have a new license to protect, I'd be very curious what the ramifications are, and there are several angles: 1) criminal - could I be charged with some level of battery? (I doubt it, but it's a possibility.) 2) civil liability - could I be sued (successfully) because I practiced outside my current scope? and 3) would I be subject to action up to and including losing my license with my BoN? (And frankly, #3 is my biggest concern.)

    If I were researching it (which now I'm tempted to do) I would ask for a position statement from the BoN, the A.G.'s office, and consult someone like a nursing professional liability insurance rep.
    bigsick_littlesick likes this.
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    Quote from theantichick
    I'd also be interested in what you find out. I was a Paramedic years ago, and still carry an emergency kit in my car with full airway equipment (no cric kit, tho... I never trained on that and would be too scared to try it). I'm also a newly minted R.N. During the period of time after my EMT-P certification expired, I researched enough to know that I should be covered under Good Samaritan if I should have to intubate to save a life. (Though I'd try an OPA first.) While I still held an active cert, it was debatable because I'd be acting without medical control.

    Now that I have a new license to protect, I'd be very curious what the ramifications are, and there are several angles: 1) criminal - could I be charged with some level of battery? (I doubt it, but it's a possibility.) 2) civil liability - could I be sued (successfully) because I practiced outside my current scope? and 3) would I be subject to action up to and including losing my license with my BoN? (And frankly, #3 is my biggest concern.)

    If I were researching it (which now I'm tempted to do) I would ask for a position statement from the BoN, the A.G.'s office, and consult someone like a nursing professional liability insurance rep.
    Even when I was a flight nurse/paramedic I never carried full equipment with me.....There is a ton of grey areas that you aren't covered. Unless you are very rural.....and EMS is greater than 1 hour away...carrying and using emergency equipment is not necessary. I carried gloves and an ambu/oral airway (because I'm not doing mouth to mouth) some basic drsgs to apply pressure if necessary but EMS is so close these days....it isn't necessary and the risk too great. You can be sued even for doing everything right.

    Just because you know how doesn't mean you carry it in your private car. Of course accident scenes are very different that a town devastated by a tornado or you are very rural
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    Esme - you make good points. I grew up very rural - EMS was volunteer and almost always BLS when they did show up 45 min + later. I still do a lot of travelling in very rural areas of Texas. In the 20 years since I got my first EMT cert, I've stopped at maybe a half-dozen accidents, and have never had to do anything but stabilize c-spine (once), get vitals (twice), and put gauze/pressure on a cut (twice) until EMS got there.

    And honestly, I probably would never drop a tube unless I had reason to believe the airway was going to compromise (facial/airway burns or such) before EMS got there, and would usually choose to just use an OPA & BVM if I was going to have to do CPR. I just don't know how I'd live with myself if someone would have survived but for an airway I could have provided if I'd just had the equipment with me.
    GrnTea likes this.
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    Quote from theantichick
    Esme - you make good points. I grew up very rural - EMS was volunteer and almost always BLS when they did show up 45 min + later. I still do a lot of travelling in very rural areas of Texas. In the 20 years since I got my first EMT cert, I've stopped at maybe a half-dozen accidents, and have never had to do anything but stabilize c-spine (once), get vitals (twice), and put gauze/pressure on a cut (twice) until EMS got there.

    And honestly, I probably would never drop a tube unless I had reason to believe the airway was going to compromise (facial/airway burns or such) before EMS got there, and would usually choose to just use an OPA & BVM if I was going to have to do CPR. I just don't know how I'd live with myself if someone would have survived but for an airway I could have provided if I'd just had the equipment with me.
    I have stopped as well....I feel "dropping a tube" is way out of your scope, especially if you are not a practicing medic.....or you are rural AND a volunteer fighter (still and active position) You are going past the "reasonable and prudent" nurse and medic....Good Samaritan will only go so far (and I'm not familiar with Texas) and your insurance malpractice will probably not cover you. When you get into what would another professional do....you can get in trouble.

    Just because you know how doesn't mean you should.........But I am no lawyer.

    See OP? it is quite the dilemma


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