Regarding IUPC placement: RN's are trained, checked off and do place our IUPC where I work. And you are right, in some teaching hospitals the residents do this mostly. But in smaller, community hospitals, they rely upon us to place our own IUPC and FSE after documented competency.
Regarding Epidural pump adjustment, NO--- we RNs may NOT adjust them in ANY way except turn OFF w/MD order. AWHONN www.awhonn.org
has a position statement that basically prohibits RN's from establishing or changing epidural rates for pregnant patients (we can
adjust rates for GYN patients who have post-op epidural). But on laboring women, in NO way are we to administer boluses, or set or adjust the rates, up or down; the CRNA Or MD must do this.
It is true: State BON/laws differ on this subject. You should always err on the more restrictive side, to be prudent. I would make sure I am following the more restrictive AWHONN policy myself. Today, would urge you or your manager to visit AWHONN policies regarding epidural rates adjustment by RN's, to be on the safe side.
We just had a big argument w/one of our MDAs regarding this, (he felt we should adjust rates w/his order)---and the State regs did not prohibit it specifically----- but---- once the AWHONN position statement was printed and shown the Perinatal Committee and this MD, there was no further argument. They (the MDAs) MUST come in and adjust rates and administer boluses on epidurals on laboring women. RN's MAY NOT DO THIS EVER at our institution.
Hope this helps.