Question: Do ER nurses do more things independently?

I guess what you've posted is true... but ER Nurses should know the limit of their responsibilities... Because they might be sued for what have they done.

For example, you dont delegate things like VS checks, neurovascular, neurologic checks go LPNs/CNAs/PCTs as per your protocol guidelines or ENA guidelines.

It seems that some ER nurses are allowed more leeway on otherwise "MD only" porcedures such as intubation...when usually on other floors, RNs cannot initiate.

Does this sound relatively true, or does this differ according to where you work also?

In our level one trauma center, we have pre-approved protocols for common complaints that we do initiate w/o MD seeing patient. However, as the above poster stated, one must be very careful to ensure you are practicing within your scope. If you step outside, like intubating a patient - you will be in BIG trouble.

I have a unique situation, I am an RN and a paramedic and have an approved skill-set with the ED physicians and administration. I am allowed, with approval, to intubate, place chest tubes and central lines and more. I wrote a very restrictive protocol that requires quarterly reporting of skills and annual re-verification with a physician for all skills.

Andrew B

For example, you dont delegate things like VS checks, neurovascular, neurologic checks go LPNs/CNAs/PCTs as per your protocol guidelines or ENA guidelines.

It seems that some ER nurses are allowed more leeway on otherwise "MD only" porcedures such as intubation...when usually on other floors, RNs cannot initiate.

Does this sound relatively true, or does this differ according to where you work also?

i do alot of things in the ED that i can't do on the floor such as hang an extra .9ns on a hypotensive patient, give nitro, and do the entire cardiac work up before the docs even get in the room. when i work on the floor i have to get an order for EVERYTHING. which i think is ridiculous because nurses should be able to use their own judgement when caring patients. sometimes it isn't necessary to page a doc for something you know how to treat. i agree with the above posters though that you must know your limits and there are definitely some things i would not do without an order but overall i like ED because i feel like i am really involved with the care of the patient as oposed to waiting for the doc to make all the decisions. and most ED docs are very respectful of nurses and work with you as a team.

alot of it depends on the MD as well. one of our docs won't let us start a heplock without his order. another expects us to. go figure.

I'll go as far as to say it also depends on the hospital. I have been in one you couldnt even give a chest pain patient oxygen until the MD was at bedside and saw the patient. Another ED the patient had the full cardiac workup done with EKG, results back... except for xray, ASA, nitro times 3 and morphine IV before the doctor even saw the patient, now if they were actually having a MI on the EKG they were seen sooner.

It also depends on the patient complaint, some have very extensive protocols/pathways and others dont. Your more likely to find the looser ones in teaching hospitals or very busy ones, but than isnt always the case either.

Rj:rolleyes:

alot of it depends on the MD as well. one of our docs won't let us start a heplock without his order. another expects us to. go figure.

In our ED we have a set of standard orders, arranged by triage colors. If a patient is going to be waiting more than 10 minutes to see a doc, we pick up the color coded sheet, place it on the chart and start the orders, CP, AP, SOB, etc. It took several years of committee meetings with the docs/nurses/administration to get this set up - they tell us that it's a rare system.

We have Advanced Triage Protocols. They allow us to start treatment when the patient will be waiting more than a few minutes. We can order x-rays, start labwork and even give some meds. This helps us shorten turn around time considerably. Often the whole workup is resulted before the MD sees the patient and the MD can do a MSE and disposition the patient without further delay.

I work in a CICU recovering patients from cardiac surgery. This institution has protocol orders for the treatment of almost everything for these patients. We have NPs and/or PAs on the unit at almost all times, but it is very seldom that I need them for anything. I enjoy a very high degree of autonomy in this position...and I get to play with all sorts of neat stuff that you ER RNs never do. (VADs, IABPs, CVVHD, etc.)

I work in a CICU recovering patients from cardiac surgery. This institution has protocol orders for the treatment of almost everything for these patients. We have NPs and/or PAs on the unit at almost all times, but it is very seldom that I need them for anything. I enjoy a very high degree of autonomy in this position...and I get to play with all sorts of neat stuff that you ER RNs never do. (VADs, IABPs, CVVHD, etc.)

Oh yeah? Well, I get to play with drunks! (Hey, wait a minute...)

I have a unique situation, I am an RN and a paramedic and have an approved skill-set with the ED physicians and administration. I am allowed, with approval, to intubate, place chest tubes and central lines and more. I wrote a very restrictive protocol that requires quarterly reporting of skills and annual re-verification with a physician for all skills.

Andrew B

Pleas use common sense and check with your state board of nursing regarding the intubation and chest tube insertion.

The practice setting is unique (beenthere done that) however your scope of practice is govened bythe highest level of licensing this in your case is Registered Nurse, Ihave been nursing for over twenty five years and traveled extensively for nine of those years all over the US after being licensed by many states I have never encountered the authorization that a registered nurse could perform any of the procedures you indicate, they are crossing over into medical practice no matter how you cut it. Also after my yearsI can attest that if an error is made it will be you that pays the penalty not the physician.

The scope of practice in nursing is quite extensive and we all expand our knowledge and skills to meet the need of the patient but the key to be understood is understand your scope of practice and stay within it for the benifit of your patient and your self.

I have a unique situation, I am an RN and a paramedic and have an approved skill-set with the ED physicians and administration. I am allowed, with approval, to intubate, place chest tubes and central lines and more. I wrote a very restrictive protocol that requires quarterly reporting of skills and annual re-verification with a physician for all skills.

Andrew B

The scope of practice is dictated by the state board of nursing, please use caution as you can lose your license for expanding your scope without board approval. Intubation, initiation of central lines and inservion of chest tubes are medical procedures my friend not nursing procedures. you are walking on a thin line and could end up on the sinking side falling into deep water

As a paramedic I too could intubate in the field and use needle thoracotomy to decompress a pneumothorax but in a hospital setting with physicians present it is best to allow the ones licensed to do the procedures to do them I can guarentee that should an error result in a suit you will stand alone infront of that judge and jury even if you have an "agreement" because "agreements " do not supercede laws.