Is this outside my scope of practice?

netglow, ASN, RN · May 28, 2012

Ish. Hmmm.

Are you an RN? or a student working the summer?

If I were you I'd research this a bit to be sure you know what all is going on with "things". Don't hesitate to ask for someone to watch you if you are unsure. Thing is, sometimes CNAs have been to formal training on phlebotomy, and you might have got a one look/do. To be sure, I'd ask your NM if it was OK. Sometimes it's great that you find people who want to let you do things, as long as you are being supervised. If you are not an RN, you are working under the supervision of the hospital. So, the NM should clarify for you, I would think.

FORTHELOVEOF!!!! · May 28, 2012

I am a student but also an employee, this position is different than externships that I hear other students talk about. I am a paid PRN nurse intern, I shadow nurses and can do many tasks under supervision and I also pick up nursing assistant shifts as well. It's basically a semster long training program to shorten our residency, getting trained for cheap rather than at an RN salary but it makes the transition a lot easier. I am also a phlebotomist but was never taught to draw from an art line, we are only taught to draw from veins with our own supplies, no PICCs, no ports, and no art lines. What are some things that could happen if someone were to screw up an art line draw?

netglow, ASN, RN · May 28, 2012

Sounds like you have a good situation. These specifics you need to ask the RNs who taught you. You also need to look things up if you want to know more. You might post this in the Critical care forum: asking for Art line does and don'ts.

FORTHELOVEOF!!!! · May 28, 2012

Thank you

NicuGal, MSN, RN · May 28, 2012

We have a list of who can do what tasks. Our nurse interns aren't allowed to access art lines without supervision in our hospital, and never a CNA. You should also be following policy and procedure, and be familiar with them if they are assigning you these types of tasks. Remember, in a court of law, the first thing they will look at is if the P/P was followed.

FORTHELOVEOF!!!! · May 28, 2012

Thanks for your response. I will check into our policies and procedures, but every unit is different. For instance, CNA's are allowed to draw blood in the ED but not on med/surg floors, CNA's can access art lines in the ICU's but it is unheard of in other hospitals and dept's. I'm just confused on where to look, do different units have different policies and procedures? As far as my job description, the only things I'm not allowed to do is give meds, chart assessments, and start IV's, everything else is fair game as long as I'm supervised. I will talk with my NM but I'm on a different unit than where I worked yesterday so I'm not sure if she will have any answers about how other units function.

Hoozdo, ADN · Jun 1, 2012

You will love A-lines once you become more comfortable with them. There are a few BIG mistakes you can make with them though and they all involve having stopcocks turned in the wrong direction, forgetting to flush back back the blood when you are done, and pulling off the wrong port cap when you are done, and having a confused pt pull the a-line.

The next time you are working in ICU or CVICU ask the RN for a 5 minute, (or so), lesson on what can go wrong with drawing blood from a-lines. It is better than learning the hard way! Also, whenever you hear an alarm for the a-line BP and the wave form is flat on the monitor RUSH into the room. Guaranteed a pt pulled it and blood will be spurting EVERYWHERE.

MattNurse, MSN, RN · Jun 1, 2012

One thing to keep in mind is we all have a different scope of practice based on what state's we practice in. You may want to direct your questions to someone at your specific hospital about your scope of practice. Last thing you want to do is put your future license in jeopardy.

classicdame, MSN, EdD · Jun 1, 2012

I would go online to look at the nurse practice act. I cannot concieve of any state allowing a CNA to access an arterial line. In Texas the student extern and the CNA have the same duties. Both are unlicensed assistive personnel. I would talk to the manager before doing anything that generally requires a nurse's license. You have no documented competencies and are simply NOT LICENSED so this may be outside your scope of practice. Glad you had sense enough to ask.

FORTHELOVEOF!!!! · Jun 1, 2012

Thanks for the info, I appreciate it! @classicdame, I have the same scope as a CNA when I'm not being observed and can do anything I want when I am being observed (except give meds). My confusion on this came in when the charge nurse told me that their full time CNA's were trained to draw blood from art lines, just seems to be a little much to have someone who is not trained properly or licensed to do something that can be dangerous for the patient. What if they forgot to check and see if the bag of saline was full and ran air instead?

klone, MSN, RN · Jun 1, 2012

In AZ, the nurse interns (externs) scope of practice fall under the BON's nurse practice act. You need to find out if that is the case in your state, and then talk to your state board of nursing to find out if it's in your scope of practice as an intern. It would definitely NOT be the case in AZ.