I need a little guidance

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I recently changed locations but with the same company. The position has the same title but at this location the duties are different. I work within the military base daycare centers.

I stated to an employee that I hadn't used my stethoscope since coming on board and it was weird. I used it all the time and my nursing skills at the previous location. This person went on to say that the nurses couldn't use it because they weren't under a doctor's supervision. Um I'm a nurse and have my own scope of practice that includes a nursing assessment.

I found some thing today that could be the reason they think this way. It stated Nurses DO NOT perform medical procedures. My question from you guys because I feel like I'm crazy but a normal nursing assessment is not considered a medical procedure? Also, if there is an order for medication then the doctor has authorized a trained professional to carry out the order.

Please shed some knowledge if I am wrong. I'm so confused.

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Are you sure you're in the right forum? This is the School Nurses forum; is that what you wanted?

mc3

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I'm a nurse within the daycare centers we basically track imms, health assessments, and look to see if there are any trends with communicable diseases. So most duties a school nurse does. At my last position I did temp checks and assessed a child's lungs prior to inhalers. Now I am being told by non medical staff members that the previous nurses didn't do anything of that nature because we don't have a doctor over us. There was the sentence nurses do not perform medical procedures and I'm thinking they have a misinterpretation of what a medical procedure is.

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Specializes in School Nurse, Pediatrics, Surgical.

Yeah show them your scope of practice for your state.

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Assessing breath sounds and HR are well within your scope of practice. I use my stethoscope a lot, especially if I have an asthmatic child who is having issues. (70 asthmatics in my building.) Are you expected to not take a BP either?

And what of this "nurses don't perform medial procedures." What is that supposed to mean? You can't put a dressing on a scrape?

Ridiculous....

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Assessing breath sounds and HR are well within your scope of practice. I use my stethoscope a lot, especially if I have an asthmatic child who is having issues. (70 asthmatics in my building.) Are you expected to not take a BP either?

And what of this "nurses don't perform medial procedures." What is that supposed to mean? You can't put a dressing on a scrape?

Ridiculous....

These are my thoughts!!! When I see medical procedures I go to invasive procedures or a task that takes away or adds something to a persons body. The thing is the UAPs are administering inhalers and giving meds. I never gave an inhaler at my previous location unless I assessed their lungs first. If they can perform those duties without a license why can't I use my nursing assessments and judgment. It's beyond me so I'll be talking with my supervisor.

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Specializes in Reproductive & Public Health.
These are my thoughts!!! When I see medical procedures I go to invasive procedures or a task that takes away or adds something to a persons body. The thing is the UAPs are administering inhalers and giving meds. I never gave an inhaler at my previous location unless I assessed their lungs first. If they can perform those duties without a license why can't I use my nursing assessments and judgment. It's beyond me so I'll be talking with my supervisor.

This is probably obvious, but assessing lung sounds prior to inhaler use is fine, as long as it doesn't play a part in whether or not you give the med. PRN inhalers should be given on request to any patient with the cognitive ability to ask for it. I did not check lung sounds prior to administering inhalers when I worked as a school nurse at a high school, because I did not want to delay administration and I knew that WOB often increases before any audible wheezing can be heard, and best practice is to avoid getting to that point in the first place. If it is a new dx of asthma or a recent change in meds, or a change in pt status (like increased requests for inhaler use etc), that is a different story of course.

But this is not my specialty at ALL, so I am sure others have more insightful advice.

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These children are 6 wks to 5 years then 6 years and above. Normally the caregivers will say they are wheezing etc and then I'll check and sometimes it's not a wheeze. I also always check so I can have a baseline and let the parent know. That may be just my practice but I don't feel comfortable giving an inhaler in that type of setting and it's not my child without having some kind of information prior.

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I'll check and sometimes it's not a wheeze. I also always check so I can have a baseline and let the parent know

I agree...Important to assess the child before PRN inhaler use. It doesn't meant that if the child sounds ok, I won't give it, it just means I know the baseline they presented with. And I document accordingly.

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I think it's totally appropriate for you to assess the kids in your care. If you feel they need treatment you can always advise the parents that they may want to see their MD. We are a military family, and I know military facilities do things a little differently. Still, you asses a child's wound, and -as a nurse- you can advise the family to see a Dr for stitches if you feel they are needed. You don't do the medical procedure, the stitches themselves, but your professional assessment is important to those children and their parents. Keep doing what you are doing. I've been that mom of that pre-schooler in day care at the base, and I would have appreciated your professional assessment.

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Thank you so very much. I have definitely witnessed first hand how parents feel when they know a nurse is present while their child is in care. Just this past week I ran into a mom from our previous base, she hugged me and was happy to know that I was here. I took care of her daughter at 6wks to 12 months and they were so appreciative.

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Specializes in School Nursing, Hospice,Med-Surg.

Wait, what?

We're allowed to use a doctor's stethoscope??

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