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Discussion

I need help finding scope of practice for CVT's in Texas

Hi,

I have a situation in that the CVT's are stating they can push adenosine under physician delegation here in Texas. I have tried to find their regulations/scope of practice, but have been unsuccessful. Can anyone point me in the right direction?

Thanks!

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  • Experts

Board of Phamacy for your state as well as policy and procedure of your facility.

They should not be pushing any drugs like that as far as I am aware of. There should be an RN in the room when the procedure is being done and it would be their responsibility for it.

Physician's license does not cover them in the hospital, only in their own clinic.

And who is telling you that they can push it? If the CVT, then they need to bring you the proof that they can, and until that time, they should not be able to do so.

Unless they are licensed they have no "scope of practice". Therefore, the duties you describe, which are covered under the RN scope of practice, are reserved for RN's. Medical delegation in a hospital does not supercede the law (NPA). Nurse Practice Acts are designed to protect the public from well-meaning, ill-informed and uneducated people such as you describe.

I do think this hinges on where you practice. Are you in a hospital or are you in a physician office?

Typically hospital policies spell out who administers medications. And administration of Adenosine is certainly NOT something that I would delegte to a CVT.

This has got me thinking, however; that if you're in a physician office, the CVT may indeed be correct. (:uhoh21:let me move aside my personal feelings!) The Texas Occupations Code states that a physician can delegate to trained personnel...under physician supervision...etc. The "trained personnel" part is a gray area, since the physician gets to determine the so-called training. Here is the delegation link in the TOC: http://tlo2.tlc.state.tx.us/statutes/docs/OC/content/pdf/oc.003.00.000157.00.pdf

The Nurse Practice Act only discusses nursing practice. Classicdame, here is your last sentence: Nurse Practice Acts are designed to protect the public from well-meaning, ill-informed and uneducated people such as you describe. Yes, NPAs are meant to protect the public...but it's from US, since it guides our practice...not CVTs, MAs, etc. Delegation discusses what we can delegate, rather than what CVTs/MAs/etc. can or cannot do.

Again, I agree that an RN should be giving it, no matter where it's being given. But I think it boils down to the practice setting regarding legal vs illegal. (Right vs wrong is another ball of wax!)

  • Experts

If they are in the physician's office then anything can be done and it is under that physician's license; however, if in a hospital setting, and most cath labs are, then the CVT normally does not have permission to administer adenosine in any circumstance.

The hospital is run under its own rules and what a physician wants to do is not necessarily the case.

  • Experts
If they are in the physician's office then anything can be done and it is under that physician's license; however, if in a hospital setting, and most cath labs are, then the CVT normally does not have permission to administer adenosine in any circumstance.

The hospital is run under its own rules and what a physician wants to do is not necessarily the case.

The hospital rules will trump the state law but if they are silent or permit it then CVTs can give it under physician delegated authority. Its probably a matter of convenience. The CVT is already scrubbed and has access to the catheter. The RN doesn't. If you think about it there are states where Adenosine stress tests are done every day without an RN or physician present. The situation described above is much safer since its done under the direct observation of the physician. Generally for unlicensed personnel there is little that physicians cannot delegate (depending on the state). Radiation is actually regulated much more than medications.

David Carpenter, PA-C

  • Author

Thanks so much for all the replies/insights. I'm new to this EP lab in Texas and prior to me arriving, the CVT's were pushing 18mg of Adenosine per physician request as they were the ones scrubbed in and not the R.N.'s. The tech's are upset because their feeling is that they've always been doing it "under the physician's license", so what's the difference now? I know if varies state to state, so thanks for the info :o)

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