Question: Do ER nurses do more things independently?

[nocturne716]

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?

[janet r. gowen]

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.

[RNCENCCRNNREMTP]

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 appreciate your concern. But how do you explain nurses putting in chest tubes in helicopters? Or intubating? They are still nurses, guided by their highest license (RN) but their "unique practice setting" allows for that procedure. This skill set was approved by our administrative processes, not just a whim between the docs and myself.

[JessicRN]

Yikes with all that a nurse does in the ER, I need to ask you why take the risk? I was a paramedic as well but I did not nor would I ever want to intubate in the ER. They do not pay me enough and I do not think my Liability Insurance would cover me should something go wrong. Good Luck to you :uhoh21:

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

[pamalicia]

hi my name is pam I am an Rn I have worked in Maternal child,NICU, homecare, Pediatrics and med surg. Recently I became certified as a forensic nurse examiner SAFE.

I am really drawn to trauma and child abuse, advocacy ect. I am considering strongly applying to work in an ER.

Problem-I am not very outgoing. Is this even possible?

Any thoughts thanks? Pam

[witnurse]

I am the Regulations Coordinator at our rural hospital. I am also the Inf Control, Employee Health/Worker's comp Nurse as well as Education Coordinator.I have come accross a situation that makes me a bit uncomfortable. We have 24 hr coverage by a "provider " in our ED. We have 1 NP and 1 PA. They do everything the MD providers would do. They have medical b/u by phone only and can ask those docs to come in however that can take anywhere from 10 minutes to 30 minutes depending on the doc. Our Nurse Practice act for NP's in NH does state that NP's can perform urgent lifesaving procedures in "unusual" situations. We get our fair share of acute MI's and traumas. Is anyone else using PA's and NP's in this capacity? They were both credentialed by our credentialing committee.