Labor Nurses regulating epidurals

nursie-babie, ASN, RN · Jun 1, 2006

The only thing that we can do with the epidural infusion is turn it off. We can not bolus/titrate, or even turn it back on if it has been turned off

:monkeydance: :monkeydance: :monkeydance: :monkeydance: :monkeydance:

terig63 · Jun 1, 2006

Thanks Nursie babie! AWHONN has a position statement out supporting just that however our anesthesiologist wants our RN's to bolus and regulate the pumps. I appreciate the feedback!

nursie-babie, ASN, RN · Jun 2, 2006

Sheesh! :nono: I sure wouldn't want that responsibility. Especially when we aren't getting their paycheck!! :rotfl:

htrn · Jun 2, 2006

We only turn them to pause/off for pushing. :nono:

skipaway · Jun 2, 2006

Thanks Nursie babie! AWHONN has a position statement out supporting just that however our anesthesiologist wants our RN's to bolus and regulate the pumps. I appreciate the feedback!

As a CRNA, I'd not want you to have that responsibility. The possible complications that you've seen when we bolus epidurals, should be ours to fix (so to speak). I think you all have enough to do without taking on that task too. Sounds like the anesthesiologist just wants to control the epidural practice from home or office.

RNLaborNurse4U · Jun 2, 2006

We do not start, restart, bolus or change the rate (increase or decrease) of epidurals. We only document start time, dosages, whether the PCEA is being used, what the bolus rates are, and we can stop the infusion for s/s of toxicity or if the MD/CNM wants the epidural off for pushing. We can also change the bag (with a 2nd RN check) and do some minor trouble shooting of the pump, as well as physically remove the epidural catheter.

We abide by the AWHONN guidelines for epidural infusions. Whether the MDA likes it or not :trout: I have come to heads with many MDA's over this policy. I whip the hospital policy out and wave it in their faces to remind them (but in a professional manner) that anything outside of our scope that needs done is THEIR responsibility to do. I have even brought the head of OB into the discussion/argument with the MDA.

I won't hesitate to stand up for my patient, and for my license, when an arrogant MDA won't do his job, and tries to force me to go beyond my scope.

And with the head of OB backing me up, as well as the official policy backing me up, the MDA cannot argue his way out of it. Well, he can try.

As you can see, our OB unit has had a multitude of MDA attitude problems. I swear, some of them hate coming up at all to do epidurals or c/s.

Jolie, BSN · Jun 2, 2006

Thanks Nursie babie! AWHONN has a position statement out supporting just that however our anesthesiologist wants our RN's to bolus and regulate the pumps. I appreciate the feedback!

Please check with your BON. I doubt this is within your scope of practice as an RN. When I worked in NC, we had to complete a state-approved education course and demonstrate continuing competence in order to perform "Category II" procedures such as changing the cassette on a PCEA set-up. Even then we were not allowed to bolus or change the infusion rate. I should add that this was on post-op C-section patients, not laboring moms, which increases the liability even more! Stand your ground!

JaneyW · Jun 3, 2006

Check your state's BRN website. I am in CA and ours has specific guidelines regarding scope of practice for epidural infusions of any sort. I doubt that it is within your scope as an RN to do anything other than turn it off. Be careful. MDs really have no idea about what we can and can't do.

palesarah · Jun 3, 2006

when I worked in L&D, the nurses were responsible for setting up, programming, starting, stopping, restarting and changing the rate on the epidurals within a written set of parameters given by anesthesia when they placed it. The only thing we did not do, was bolus; the epidurals were continuous with a patient-controlled self bolus available (which we also programmed). I was never comfortable with it, but these things are specifically permitted by my state's nurse practice act and the anesthesia docs most certainly did not want to have to stay on the floor all night managing epidurals, so I was fighting a loosing battle. When I went to my supervisor with my concerns (citing AWHONN's position), I was told that the BON and hospital policy protected the practice... but it was still one of the reasons I eventually left both that hospital and L&D.

Mrs.S · Jun 4, 2006

when I worked in L&D, the nurses were responsible for setting up, programming, starting, stopping, restarting and changing the rate on the epidurals within a written set of parameters given by anesthesia when they placed it. The only thing we did not do, was bolus; the epidurals were continuous with a patient-controlled self bolus available (which we also programmed). I was never comfortable with it, but these things are specifically permitted by my state's nurse practice act and the anesthesia docs most certainly did not want to have to stay on the floor all night managing epidurals, so I was fighting a loosing battle. When I went to my supervisor with my concerns (citing AWHONN's position), I was told that the BON and hospital policy protected the practice... but it was still one of the reasons I eventually left both that hospital and L&D.

labor nurses at both the hospital where I work now and the one I worked in previously have these responsibilities as well; I've never even heard anyone question it.

ragingmomster, BSN, MSN, RN · Jun 4, 2006

The conversation got me curious, so I went and had a look.

From NC BON Website:

"Administration of subsequent doses of epidural anesthesia/analgesia and the removal of epidural/caudal catheters is within the scope of nursing practice for the REGISTERED NURSE. (Jan. 1986)"

Now the MDA who hands me a syringe and tells me how much more fentanyl to add to the catheter directly if the pt needs it (and this has happened) is dreaming, I just smile and nod, then waste the med, and call if I have trouble.