Nurses, R.N.'s are bound to their states nurse practice act. There are some procedures that can be done with extra training and competency reviews that hospitals can maintain. However Ive foung that many administrators fail to get clearance from the state board and rely on the MD's opinion that " oh yeah, they'll be covered for that" and allow questionable practices, [ its a lot cheaper to use a nurse tham to have a MD on standby]. Placing vas caths and other central venous lines have never been in the realm of any R.N. unless they are educated in advanced practice, ie..CRNP, CNP. Tim