Nursing scope of practice questions

[royr]

I have some general questions about nursing scope of practice and how it aplies to nursing students. Several times in my clinical practice as a nursing student, I have been assigned to work with floor RN's as well as Doctors by my instructors and told to "do whatever they tell you to do, as you are working under their licence as soon as you leave my sight". I have always followed directions to the letter, with the one exception being a drug administration order that in my judgement would have hurt my patient (giving injection of heparin to a 3 hour post hip replacement surgical patient that was also taking cumaden orally. I held my ground, and it turned out to be a transcription error that the Doctor corrected and thanked me for my patient advocacy and invited me on rounds whenever he was working my shift. My question is this - if a doctor or RN asks me to do an action outside of my scope of practice in an emergency - do I decline - or do I do what is needed at the time to insure the safety of my patient if my hands are the ones that are available? I am personally inclined to help, but do not want any problems if a teacher comes back to me after the shift and says "and you did WHAT? - and if that Dr or Nurse jumped off a bridge, would you follow?" type of reaction for helping out. All ideas are welcome.

[bonesrn]

Good for you for standing your ground. What does your instructor say? Personally, I wouldn't do something I am not comfortable with no matter who is telling me to do so. Ultimately the RN/MD are responsible for the patient and their safety. Aks a lot of questions and do only what you feel comfortable with. In a true emergency, say a code, offer to do what you know..compressions, bagging. Good Luck..sounds like you will be a great nurse and patient advocate!

[Retired R.N.]

...

My question is this - if a doctor or RN asks me to do an action outside of my scope of practice in an emergency - do I decline - or do I do what is needed at the time to insure the safety of my patient if my hands are the ones that are available? I am personally inclined to help, but do not want any problems if a teacher comes back to me after the shift and says "and you did WHAT? - and if that Dr or Nurse jumped off a bridge, would you follow?" type of reaction for helping out. All ideas are welcome.

As a student, you can always say, "I'd like to help you, but I'm not allowed to do that procedure yet." This answer may provoke a few dirty looks, but it also gets you out of a possible confrontation about the superiority of conflicting views.

More than once, as an experienced nurse, I felt an obligation to say that I would not do something because I did not feel competent to do it in a safe manner that would not be harmful to my patient. I don't think anyone is ever expected to be an expert at everything, and it's always better to tell the truth about one's shortcomings.

Fortunately, all my colleagues and supervisors were wonderful people, and they always gave me an opportunity to learn new skills in a safe environment.

[elkpark]

Several times in my clinical practice as a nursing student, I have been assigned to work with floor RN's as well as Doctors by my instructors and told to "do whatever they tell you to do, as you are working under their licence as soon as you leave my sight".

I question this statement by your instructors; there may be some variation from state to state, but in my role as a faculty member and clinical instructor, I am fully (legally) responsible/accountable for the actions of "my" students at all times in clinical, NOT the hospital staff, regardless of whether or not they are directly under my supervision at any given moment. (That's what makes being a clinical instructor so scary ... :uhoh21:)

My students are expected to stay within the scope of their practice/experience (i.e., only what they have been instructed/approved to do by their school faculty, not by anyone else) at all times, even in emergencies, and would be in serious trouble if they failed to do so. Students are in clinical to learn; the final responsibility for patient care, including dealing with emergencies, lies with the hospital staff.

As bonesrn noted, in an emergency, it is perfectly fine to offer to do what you know you are qualified/permitted to do. Otherwise, it is only your instructor whom you need to answer to, not the hospital staff.

[EricJRN, MSN, RN]

Think about it like this:

If you're not permitted to perform a certain skill, the rationale probably involves patient safety. Wouldn't it actually be far more dangerous to perform said skill under emergency conditions - with people running around in a hurry, probably with minimal to no supervision, and likely with your adrenaline seriously pumping?