Is there a place that lists everything within the RN scope of practice?

[zygee]

Is there a list of what skills, activities, etc. are within the RN scope of practice? Particularly within Florida? I've tried looking through the FBON resource page which includes the Florida Nurse Practice act. I found a "Help/FAQ" section which had the following question/answer:

Q:What can I do to determine if a nursing task which includes procedures/treatments is within my scope of practice?

A:

Nurses have the option of filing a Petition for Declaratory Statement”.In many instances nursing duties and responsibilities are not specifically addressed in the Florida Nurse Practice Act (Chapter 464, FS), or the Rules of the Florida Board of Nursing (Title 64B9, Florida Administrative Codes)

Declaratory statements are an agency's opinion as to the applicability of a statutory provision, or of any rule or order of the agency, as it applies to the petitioner's particular set of circumstances (s. 120.565, F.S.). This page is a listing of declaratory statements.

Requests to file a Petition for Declaratory Statement” can be located by selecting the link below:

Declaratory Statements | Florida Department of Health

That makes it sound to me like there may not be any place that says what we can or can't do; but I'm hoping that's wrong and I'm just missing something obvious.

Florida Board of Nursing >> Nursing FAQs - Licensing, Renewals & Information

Florida Board of Nursing >> Links and Resources - Licensing, Renewals & Information

[gcupid]

Scope varies a little between states... and a lot between RNs.

Scope of practice is based on need. Need is based on a combination of practice environment, patient population, and provider competence.

I can do things you can't. I bet you can do things I can't. Why? In most places, RN scope relies of skill/judgement competence supported by a foundation of education.

It is why a PICC Nurse can place a PICC and a Flight Nurse can intubate, but not vice versa.

It would be impractical to list out all the possible procedures, skills, and medications within the average RNs scope, much less all encompassing.

While I agree it may be impractical, can we at least both agree also that the BON should be more readily available and tangible asap when gray areas in practice ensue. For the nightshift nurse that is being bullied into doing a task who has 2 kids to support and extended family, forms of intimidation are ever so greater in the hands of the employer/supervisor etc. Whereas if a hotline clearly sends out asap responses via email, there's a less likely attempt for bully-like tactics to take place in the work setting.

We all know, every thing would be the nurses job if facilities could get away with it.

[SummitRN, BSN, RN]

If the BON is clearly here to protect the public.... Shouldn't there be clear cut tasks listed so that the nurses maintain practice within their designated safe guidelines?

Also, shouldn't the excuse of changes in healthcare be more of an argument for justification to having someone on payroll responsible for continually updating & amending the list because of our ever evolving role in healthcare?

I would say absolutely not. BON should provide clear guidance, not a dileneated list. Do you expect them to list 10s of thousands of medicines? Are YOU competent to give all of them? NO. Shall they make different lists based on your specialty? NO. Your scope is probably slightly different than even other RNs on your unit. BON must provide clear guidance on determining scope. Sure if there is truly a gray area, then yes they should be reachable. But most of the time the problem is:

1. Your facility restricts your practice by policy to less than your full scope. (This is normal)

2. Something would be in your scope if you had specialized training (but you haven't received it yet).

The BON doesn't exist solely to "protect the public." It has many roles.

[herring_RN, ASN, BSN]

In response to nurses seeking clarity regarding the use of new technology such as pulmonary artery catheters, intra-aortic balloon pumps and more the California legislature In it's 1973-74 session explained amplifying the role of the registered nurse and outlining activities which comprise the practice of nursing.

The Legislature recognized that nursing is a dynamic field, continually evolving to include more sophisticated patient care activities. It declared its intent to recognize the existence of overlapping functions between physicians and registered nurses and to permit additional such sharing and to provide clear legal authority for those functions and procedures which have common acceptance and usage.

I think these two documents explain it well. Most state practice acts are less explicit, but the same principles apply.

http://www.rn.ca.gov/pdfs/regulations/npr-b-03.pdf

http://www.rn.ca.gov/pdfs/regulations/npr-i-20.pdf

[SummitRN, BSN, RN]

In response to nurses seeking clarity regarding the use of new technology such as pulmonary artery catheters, intra-aortic balloon pumps and more the California legislature In it's 1973-74 session explained amplifying the role of the registered nurse and outlining activities which comprise the practice of nursing.

The Legislature recognized that nursing is a dynamic field, continually evolving to include more sophisticated patient care activities. It declared its intent to recognize the existence of overlapping functions between physicians and registered nurses and to permit additional such sharing and to provide clear legal authority for those functions and procedures which have common acceptance and usage.

I think these two documents explain it well. Most state practice acts are less explicit, but the same principles apply.

http://www.rn.ca.gov/pdfs/regulations/npr-b-03.pdf

http://www.rn.ca.gov/pdfs/regulations/npr-i-20.pdf

That's well done and straight forward.

Similar for example to the CO BON:

Board of Nursing: Laws, Rules and Policies | Department of Regulatory Agencies

SOP Algorithm (very similar to CA)

Scope of Practice Algorithm.pdf - Google Drive

[smartnurse1982]

This is awesome!

I have this topic as one of my homework assignments.

My assignment was to find the difference between scope of practice of Rn's vs Lpn's in NJ,and that was like finding a needle in a haystack.

I will say Idaho's was pretty clear cut.

[bgxyrnf, MSN, RN]

The list of things that fall under the scope of practice of California nurses includes:

Intubate

Perform surgical crichs

Administer RSI meds

Administer propofol and other sedatives

Needle a chest

Perform an escharotomy

Place umbilical lines

"What," you're saying, "I can't do that!"

Perhaps not, but that's not because the state says you can't, it's because your medical director doesn't say you can. These are all procedures which can be done by California RNs with appropriate training, demonstrated competency, and a medical director providing orders by way of protocols and procedures.

Nursing scope is incredibly broad... particularly when you include advanced practice nurses... who are still nurses.

At least in California, it really comes down to policies and protocols established by the agency for whom the nurse is providing hizzer services.

[zygee]

The specific issues I've listed came up in a staff huddle lead by the director of my floor during a JCAHO visit to our hospital.

JCAHO had found a blood sugar value in the computer for a patient that did not have orders for blood sugar checks in the computer. The story went something like "the tech overheard the doctors talking about how the patient was diabetic and the patient complained they felt they had low blood sugar and so they checked the sugar".

Another story the director gave as reported by JCAHO reps (apparently) was that a patient had somehow been transferred to a bed without admission orders and that patient had vitals taken and an admission documented etc. JCAHO said that's a no no.

[zygee]

Also, there is a doctor who has some office staff member that thinks they can be given patient information and that they can give orders for that doctor. They will not tell you who they are or what (if any) credentials they have. They will not take call back information or give the phone to the doctor so nurses can discuss information with the doctor.

When I said I will only speak with or take orders directly from the doctor they said "I do this every day with other nurses, what's the problem?"

Basically I just want to do things right and to not do anything that might risk my license or my patient's health, safety, and well-being within my scope of knowledge and skill set if that makes sense. Not having a place to turn to regarding what I can do for patients without losing my license or having other issues seems ridiculous to me.

[SummitRN, BSN, RN]

A tech is not licensed. BGL is a technically an invasive lab test requiring blood and a calibrated machine... even a RN shouldn't be doing finger sticks on their own volition unless there is a policy that says so (AKA standing order). Many units have a standing order for RNs to do this on their judgement and the EHR is designed to auto-generate an order after the fact, but techs usually need a provider order or RN delegation because they are operating under a RNs license.

Taking vitals doesn't require an order, but admitting a patient without order is a no-no everywhere.

Nebulous communications from office staff is not a RN scope of practice issue.