Quote from Larry77
I hope that a hospital policy would not be able to over-ride any BON guidelines or limitations. You would think that if so this might and should be discovered by a JCAHO survey?
This same type of question came up the last time I did ACLS when the paramedics asked if RN's can intebate. All of us RN's quickly answered "No", but then an older RN who has experience in other states said she has seen ICU nurses with special training intebate when necessary.
Larry (a non chest-tube pulling, non intebating, plain ol' RN)
Registered Nurses are licensed by the state. Your state's nursing practice act defines your scope of practice. If you practice outside of your scope of practice then your state's board of nursing can discipline that RN. This is true regardless of whether or not a physician or your hospital "gives permission" to exceed your scope through an order or a policy.
Unfortunately, whether or not a specific procedure is outside the scope of nursing practice may not be entirely clear. Some states offer specific advisories/directives regarding certain procedures. However many do not, essentially pleading that to define all procedures as permissable (or not) would be overly cumbersome for the board and the nurse alike. Typically, they provide a decision tree to aid the nurse in determining whether a procedure is permitted under the act. Usually the decision tree requires that the procedure is not specifically prohibited by the board, that the facility's nurse executive has blessed the procedure, that a policy/procedure exists for its performance, that the individual has had the education/skills checked off to perform the procedure safely etc....... So be aware that even though a procedure may potentially be within the scope of nursing practice, if your facility has no relevent written policy/procedure, you are subject to be found practicing outside of your scope of practice should an adverse event occur.
As mentioned above, the completion of a course in ACLS in and of itself does not bestow immunity from the above facts. But some RNs can and do perform intubation-----not because they have completed ACLS but rather because their employer has a policy permitting same, they have verified/documented the nurse's training and proficiency etc.
My advice: If your facility does not have a policy regarding a procedure....don't perform it until one is formulated/approved. If you have any doubts regarding whether or not a procedure is within the scope of practice ask for a determination from the board; they might provide a straight answer to your inquiry or refer you to a prior determination they have made------or likely as not refer you to one of those damn decision trees.