Would you work outside of your scope of practice to save a life?

[metallaces]

We had a group discussion in my class today about a hypothetical scenario and I'm curious to see what some of you on here would do.

You have a patient who needs a procedure done that is outside of your scope of practice. They will for certain die if it is not done and nobody who is able to do it is available within the necessary time frame. You know, in theory, how to do the procedure, but you've never done it yourself. Your patients only chance of survival is if you do the procedure. Do you do it?

[OrganizedChaos, LVN]

There's a difference between giving a med you know a doctor will give you orders for later (when in the midst of a code & can't get ahold of the doctor) versus needing to insert a chest tube or PEG. I would *never* do that!

Sorry, I worked too hard for my license.

[Kuriin, BSN, RN]

In anaphylaxis, you bet your sweet toosh I would override the Pyxis for epinephrine. You should know the doctor will order it ANYWAYS. Or just open the crash cart.

Any procedures such as intubation and such -- no, I will not do it.

[Kuriin, BSN, RN]

Nope. In anaphylaxis, I would call a code. In any potentially life threatening situation, I would call a code or ambulance and the supervisor. I might have the supervisor give meds the patient needs but I have a hard time thinking of a circumstance where a doc would not be present/ emergency services are not available to get direction first.

Please, please, PLEASE DO NOT follow your instructions. You are a nurse to critically think. If you are unable to predict orders in easy situations (anaphylaxis or hypoglycemia), then I would recommend avoiding the hospital setting! You are more likely to be sued for NOT DOING ANYTHING than doing something.

[OB/TICURN]

There are protocols, chains of command, and "scopes of practice" for a reason. Too many times, I have seen residents attempt procedures in emergencies that they have studied and seen performed multiple times yet they mess up and have serious complications. It is not my place to step outside of my scope of practice, to risk my license and a law suit to attempt to save someone who may have possibly died anyway. Critical thinking and training will allow you to anticipate the next move but patients are not guinea pigs, even if they are dying. Unfortunately, we cannot save every patient.

[chris21sn, BSN, RN]

I'm sorry I worked hard for my license and I have many dreams and goals in my future. I'll call a code if for example a patient is having an active MI.

[NICU Guy, BSN, RN]

Here is a scenario: You are a school nurse. A student comes into your office after a bee sting. After a few minutes has signs of an anaphylactic reaction. This is the first time being stung by a bee. You have an EPI pen. You called EMS, but they have been delayed due to a train. Do you give the EPI or do you tell Billy you are not risking your license to save his life and hope that EMS gets there before he goes into respiratory arrest?

The purpose of the OP hypothetical question is a moral/ethical dilemma. The cop-out of "calling a code" is not an option. There is no code team, doctor, or EMS to bail you out. Do you help the patient or let them die?

[elijahvegas, ASN, RN, EMT-P]

If only in theory i knew how to do it, absolutely not. If i had never done it before, absolutely not. This sounds like every episodeof greys anatomy scrubs night shift and every other med drama where an intern or newbie has to save the day with no experience and a less than favorable situation.

With that said, there are things that are technically out of my (nursing) scope that i know i can do and am confident in my skills, and if the situation truly called for it id probably take the plunge. The thing is , unless everyone else around, docs and nurses included, have your back and are willibg to defend you especially when it turns into a legal issue, its almost not worth pursuing.

If youre asking me to lose my nursing license and possibly face criminal charges just to save a life, im pretty sure with or without hindsight bias the answer is no