Working outside my scope of practice?

Nurses General Nursing

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I am not sure if I am really working outside my scope of practice, or just my comfort zone. I have worked on multiple different floors and have been pulled to multiple others. I do not mind being pulled, sometimes it is a nice changenof pace, but, where I am being pulled to now is different. I am now a labor nurse and have found myself being pulled to a higher level of care (Level 3 NICU). I am really not comfortable with this pull, I do not feel that I have the advanced training needed to adequately care for these infants. If they are too sick to be under my care on the floor, then shouldn't they be too sick to be under my care in a NICU? To make matters worse, the parents of these babies are not told that a labor nurse is caring for their infant, so you look ignorant when parents ask you about the well being of their baby and you have no idea. If it were my child in the NICU I would be very angry that a basically 'untrained' nurse is caring for my baby.

If something were to happen to an infant under my care (in my control or not), would I be considered outside my scope of practice to where my facility can say that they never told me I could work in there and risk my license?

So am I just belly aching, or is this a valid worry? Any thoughts are appreciated.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

An RN providing nursing care in a NICU is quite obviously not out of your scope of practice. That doesn't mean it's appropriate to have a labor nurse staffing in a NICU without training.

It is conceivable that you could held accountable for accepting a patient assignment for which you are not trained to care for, certainly NOT outside your scope of practice.

Specializes in Psychiatric Nursing.

Can you ask for extra training ?

Thank you for getting back with me PMFB-RN :)

Would I have any course of action in this matter? Being pulled to the NICU is not an option, we have to go when it is our turn. I don't mind caring for infants, I really like it, but if they are that sick, it makes me nervous. I know we all go through peds during school, but I feel that 26 week infants are outside this training. Makes me really nervous.

Psychcns: The NICU staff are the only ones that can be trained, and I am part of a different department. My department will not take the money out of their budget to train us for a different unit, and the other unit is getting staff without needing to pay for the education, they are not willing to change that.

Specializes in Med-Surg.

Hmm, yea, sending untrained staff to a floor and refusing to train them...I'm sure you could have done recourse. Do you have ? Can you speak to a labor attorney who specializes in nursing? Perhaps a little anonymous tip to your BON...

Specializes in Med-Surg.

To add to what I just said...I'm a float nurse, and frequently go to places I don't really have experience, like onco or cardio-thoracic or renal. But they won't give me active chemo or PD or fresh open heart patients! I wouldn't know what to do if the poop hits the fan with those patients!

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Thank you for getting back with me PMFB-RN :)

Would I have any course of action in this matter? Being pulled to the NICU is not an option, we have to go when it is our turn. I don't mind caring for infants, I really like it, but if they are that sick, it makes me nervous. I know we all go through peds during school, but I feel that 26 week infants are outside this training. Makes me really nervous.

*** The first thing I would do is notify your supervisor in writing of your concerns. Do it in a way you have proof that you notified her. Our email program allows us to send emails that notify us when the email is opened. I would send such and email to my supervisor and their supervisor. Print off the email you send and any notifications you receive that the email was opened and any responses you get. take the printed copies home with you and file them away in a safe place.

I would simply refuse to accept such an assignment. In my hospital we can not refuse to float but we can reuse to accept an assignment we are not qualified for. For example I have been sent to L&D and I have NO idea what I am doing so they usually just have me take vital signs and do other chores I can do, but I do not take an assignment.

Refusing may be very difficult for you depending on the culture where you work. Whether or not you refuse the assignment make sure you notify your boss of your concerns in writing.

In the mean time I would start looking for another job. Getting in contact with your board of nursing may be appropriate too.

I would take it on a case by case basis, and if you feel like the acuity is too high, you are expected to do interventions you aren't properly trained on, etc. then notify the charge nurse that this is an inappropriate assignment. I would expect that they would be giving you the lowest acuity babies.

I am a tele nurse and I get pulled to the ICU and ER sometimes, I feel like this is a similar situation. If there are orders such as drips, CVP monitoring, etc ordered I go to the charge nurse and tell them I have not been trained. From there, we have to decide, does this mean I can't take this patient? Which would be the case if the patient needs, for instance, a titrated drip that I do not know about. Or does this mean that the charge nurse will help me with the tasks, such as the charge nurse will monitor the CVP reading for me. Sometimes I feel like I am thrown under the bus and again, these patients and families don't know there's a floor nurse providing their "critical care" but often if I am asked questions I just simply say, "Let me discuss this with the charge nurse. I float to different floors, so I want to clarify before I give you an answer."

Good luck, I know it can be an uneasy feeling, but follow your gut and communicate with the other nurses for help.

Specializes in Hospital Education Coordinator.

it may be that legally speaking you are not outside your scope any more than a new grad would be. You are a novice to this area. Since you are used to being proficient or expert in L&D then you feel anxiety about the gap. I would expect the NICU Director to be sure you are accomplishing certain competencies and that they are documented BEFORE you perform certain tasks. Since you are responsible and accountable for your license, I would expect you to request this training. Good luck!! THis is not a comfortable situation.

Specializes in Critical Care, Education.

As things become tighter, labor-budget wise, I think that floating is going to become more common. Facilities that I work with have a different type of assignment model that we use when someone is floated in to an unfamiliar unit.

They switch into a 'team' mode for assignments when working with an float nurse that is not competent for that unit. The float nurse works with a 'regular' nurse who functions as the 'lead'. The float nurse is assigned patients that have the fewest 'specialized' interventions. The 'lead' assumes responsibility for any tasks/interventions that are outside the float's area of competency. BUT the float nurse can assume responsibility for all of the other nursing care - routine meds, IV mgmt, tubes, drains, baths, tube feeds, etc... that is common to most inpatient units. The 'lead' is always available to answer questions or validate decisions that have to be made.

This even works well in ICU environments, because there are usually some patients that are fairly stable with less 'special' interventions required; a float nurse could probably manage most of their care with minimal assistance.

IF floating becomes commonplace or "predictable", the organization needs to provide appropriate cross-training (JC regulations).. this is also true for pool nurses that are expected to function in specialty areas.

Is the same nursing director in charge of both departments? If so, perhaps it would be reasonable for him/her to develop a "flying squad" of nurses who are interested in seeing both departments and can be cross-trained. Having a nurse in the del room with experience in sick babies would be useful (I know the NICU nurses fly down there in a flash prn when they know about a high-risk delivery, but sometimes you get no advance notice). Having a postpartum-experienced nurse in the NICU could be a real asset to the new postpartum parents there.

If there are different managers for the two units, suggest that they get together to work out a way to serve both patient populations. "We've always done it this way" isn't always working out for everyone, least of all the patients.

(Scope of practice is a legal definition. Experience level is what you're talking about.)

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