Two situations occurred today that made me start to wonder exactly what my responsibility is, now that I have my RN license, in the event of an accident, etc.
First, I saw a woman slumped over on a bench in town, but firefighters were already there checking her out (they are typically the first responders in our town and have AEDs and such on their trucks). Then this afternoon, from my home I heard a car collision somewhere outside the neighborhood but not that far away. Within 2 minutes I heard sirens, and it turns out that the accident was on a main road near my house..
I know that states have laws about professional responsibility--i.e., if I had seen the woman on the bench before anyone came to treat her, because of my RN license I would be expected to do so. If that had been the case today, I would have immediately assessed her and called 911 as needed. Similarly, had I been in the vicinity of the car wreck, I would have immediately called 911 and gone to help the people involved in the accident. But where is the line? Should I have gone over to see what I could do for the woman on the bench once the first responders were there? Should I have thrown my kid in the car and driven in search of the accident? Was I wrong to assume (turns out correctly) that at rush hour there would be hundreds of cars going by who could call 911?
I am eager to help and would do so in any case where I was needed. I just wonder what people's experiences are with this sort of thing or if anyone knows how to get info about it. Thanks in advance.
"Not identifying yourself as an RN, for professional and moral reasons I would NEVER render aid to start with and hide who I was...to me, that is wrong on 300 levels." - not sure I understand... Are you saying it would be wrong to render aid and fail to mention you are an RN? I don't understand why in light of your argument that a simple RN who isn't trained in trauma is legally held to the same expectations as a lay person. If your training and the expectations placed upon you are the same as a lay person, your identity as an RN is irrelevant to the situation at hand. In that case, identifying yourself as an RN would be as relevant as another person announcing they are a chef or a roofing contractor before rendering aid. The only reason it would make sense for an RN to be required (legally or morally) to identify themself as an RN would be if the RN has certain legal expectations imposed on them due to the fact that they are an RN.
Please go back and read the post I responded to....that is important.
When somene says that they "would not reveal" that they were an RN if responding to an emergency situation because they think it would set them up somehow....how can RN's claim to want to be treated as educated professionals if we make decisions like that?
Nobody said anything about administering drugs or anything without an MD present...where did you get that I suggested that?
When I said that you had to function to your highest level of training.....think about that statement.
Different RN's have different certifications depending on where they work...if you touch a victim as a first responder, an RN that also has paramedic training is going to be held to a different standard than someone like me, who works with babies. If I perform CPR on someone, I am going to be required to perform that CPR on a healthcare provider level...not as a layperson. If a layperson moves a person with a spinal injury and causes further damage....chances are they are not going to be held liable because a layperson may not be fully aware of the danger...IF I MADE that same decision, I would probably be in serious trouble because as an RN, I should have known better.
Please go back and read the post I responded to....that is important.
When somene says that they "would not reveal" that they were an RN if responding to an emergency situation because they think it would set them up somehow....how can RN's claim to want to be treated as educated professionals if we make decisions like that?
Nobody said anything about administering drugs or anything without an MD present...where did you get that I suggested that?
When I said that you had to function to your highest level of training.....think about that statement.
Different RN's have different certifications depending on where they work...if you touch a victim as a first responder, an RN that also has paramedic training is going to be held to a different standard than someone like me, who works with babies. If I perform CPR on someone, I am going to be required to perform that CPR on a healthcare provider level...not as a layperson. If a layperson moves a person with a spinal injury and causes further damage....chances are they are not going to be held liable because a layperson may not be fully aware of the danger...IF I MADE that same decision, I would probably be in serious trouble because as an RN, I should have known better.
That is the point I am trying to make.
Almost everything you said is incorrect. I don't even know where to start.
Your RN license lets your practice under a MD. If you aren't at work, you aren't allowed to function as an RN. You can function as a first responder under your good samaratin law. Similarly, an off duty paramedic cannot show up off-duty with their personal Lifepack 12 and field cric kit. That's illegal.
Being an ER nurse from a trauma 1 vs a med surg nurse, there is no difference in what you can do for a patient when all you have is some gauze and gloves. You will function at a first responder level because that is all that is legally allowed and that is all that is practical with the resources you have until EMS arrives.
People talk about first air or first responder like it some huge class. I have news for you. First aid is an 4-8 hour class and you covered it in nursing fundamentals. It takes longer to become a CNA than a first responder. The name of the game is mindset.
It is not your emergency. Don't risk yourself. You are there to help if you safely can. That's all. Make good decisions for the simplistic care you can perform.
SO, when you leave work, do you put your license in a cubby hole, and turn into a layperson??? You are an RN 24/7. You can perform tasks within your scope of practice (each state different) because you are a nurse. You don't have to choose to do so, but as an RN, you can.
If someone is dying at an unattended (no EMS) scene, are they going to ask to see your paperwork? Can you do worse than just watching them die?
If you're not willing to help, don't stop :) We agree on that :)
You've never heard about off-duty emergency personnel using their work gear to help at accidents? It happens. And there has never been a follow up about any lawsuits for someone who didn't let someone die that I've seen- maybe there are- but the person wouldn't even be around to sue, were it not for the person who stopped to help...if they end up being a grumpy (not my first word choice:D) human being , that probably isn't' due to the accident
If ya don't want to help- that's a personal decision (and in some situations, I wouldn't feel OK about stopping). But don't hang it on not being an RN if you're not at work.... that's definitely NOT on my license.
Almost everything you said is incorrect. I don't even know where to start.
Maybe to you and in your opinion...but not in mine.
There is so much myth going around on this message board about the legalities of people that respond first on the scene, I could write a book if I drew them all out.
rn or not, i feel a personal responsibility to help out if i am needed and can do some good.
to date there are only 4 out of 50 states that have this requirement. personally i think they are short-sighted and, quite frankly dangerous, mandates. to legally require you to put yourself at risk to do a job for which you really are not trained is ludicrous. as for the second part of your post, that's why i added the sentence regarding moral/ethical responsibility.
show me...
a link perhaps to the law, otherwise, i think you are confusing duty to respond at work v/s out of work and the scope of practice as a rn.
vermont, minnesota, wisconsin and rhode island are the states with these mandates. they are minor misdemeanors punishable by fine or jail for up to one year. someone else said virginia but i'm not able to find it listed as having such a law.
to date there are only 4 out of 50 states that have this requirement. personally i think they are short-sighted and, quite frankly dangerous, mandates. to legally require you to put yourself at risk to do a job for which you really are not trained is ludicrous. as for the second part of your post, that's why i added the sentence regarding moral/ethical responsibility.
vermont, minnesota, wisconsin and rhode island are the states with these mandates. they are minor misdemeanors punishable by fine or jail for up to one year. someone else said virginia but i'm not able to find it listed as having such a law.
yes, but you have to read the fine print.
to borrow an example from minnesota:
"a person at the scene of an emergency who knows that another person
is exposed to or has suffered grave physical harm shall, to the extent
that the person can do so without danger or peril to self or others, give
reasonable assistance to the exposed person. reasonable assistance
may include obtaining or attempting to obtain aid from law enforcement
or medical personnel. a person who violates this subdivision is guilty
of a petty misdemeanor. "
notice that nowhere in this statute does it say that you have to directly render aid...in other words, it does not require you to touch the victim. it simply requires you to contact a medic or law enforcement.
it does not require you put yourself in danger in the process of attempting to obtain aid.
if you sit in your car and call 911...you have fulfilled your obligation under this statute.
i see nothing wrong with this law...as any medical professional or layperson with a cell phone can comply with it easily.
Your RN license lets your practice under a MD. If you aren't at work, you aren't allowed to function as an RN. You can function as a first responder under your good samaratin law. Similarly, an off duty paramedic cannot show up off-duty with their personal Lifepack 12 and field cric kit. That's illegal.
Being an ER nurse from a trauma 1 vs a med surg nurse, there is no difference in what you can do for a patient when all you have is some gauze and gloves. You will function at a first responder level because that is all that is legally allowed and that is all that is practical with the resources you have until EMS arrives.
People talk about first air or first responder like it some huge class. I have news for you. First aid is an 4-8 hour class and you covered it in nursing fundamentals. It takes longer to become a CNA than a first responder. The name of the game is mindset.
It is not your emergency. Don't risk yourself. You are there to help if you safely can. That's all. Make good decisions for the simplistic care you can perform.
What? I have never lived or practiced in any state that I practiced under the authority of an MD. I have never heard of such a thing. That is utter nonsense.
I do agree with you in principle however, and I personally am not going to get involved in other people's trauma or drama, lol. I am not a paramedic, and even if I were, I would not respond off duty.
What? I have never lived or practiced in any state that I practiced under the authority of an MD. I have never heard of such a thing. That is utter nonsense.
So if you start an IV, draw a lab off an IJ, give blood products, administer a medication, start a foley, under whose authority are you performing these actions? You have orders, direct or policy.
Is it legal for you to do these things on the side of the road on Joe Schmoe just because it would be the right thing for you to do at work where you have policies and orders? No, you'll lose your license.
As a RN, you do not have the ability to perform any interventions at the RN level when you not on duty at your place of employment. You can use your knowledge, reasoning, assessment, and judgement, but you may not perform to the full extent of your scope of practice. Few interventions can be performed by a RN without a direct or standing order from an MD/DO. It is not much different for an EMT-B or EMT-P except they usually have more standing orders while RNs usually have direct orders for each patient.
Once, I had a nurse on an accident scene. It was a 4 patient MCI and she had stopped on her way home from work. She was providing useless CPR to a DRT entrapped victim in a car. She later jumped into our ambulance and started trying to tell us what to do with another patient and demanding we take her along to the hospital. Long story short, she had to be escorted away when she grabbed our supplies and stuck the patient with an IV from our ambulance despite being told to get out. The officer asked us if we wanted her arrested. We were do busy trying to save the critical patient to bother with that at the time. She technically should have been arrested. She could have easily lost her license over it.
so if you start an iv, draw a lab off an ij, give blood products, administer a medication, start a foley, under whose authority are you performing these actions? you have orders, direct or policy.
is it legal for you to do these things on the side of the road on joe schmoe just because it would be the right thing for you to do at work where you have policies and orders? no, you'll lose your license.
as a rn, you do not have the ability to perform any interventions at the rn level when you not on duty at your place of employment. you can use your knowledge, reasoning, assessment, and judgement, but you may not perform to the full extent of your scope of practice. few interventions can be performed by a rn without a direct or standing order from an md/do. it is not much different for an emt-b or emt-p except they usually have more standing orders while rns usually have direct orders for each patient.
ok... do you need an md to tell you to hold pressure, retrieve a traumatically amputated body part, maintain body alignment, protect the person from people who don't have medical backgrounds, keep someone from getting up (as well as one can), cover someone who is in bits and pieces, for dignity's sake...perform cpr, hold a child still whose family is dead and they are injured, move a seatbelt that is cutting into someone's throat strangling them...etc ????
the good samaritan laws protect healthcare workers from lawsuits if they give assistance in a prudent manner. if a nurse does what the one you described did- yeah, she went a bit nuts. :)
how is it "reasonable" to not do what you can, in the situation you find yourself if you are qualified...??????
sometimes the perceived threat that everything leads to loss of license seems like an excuse to do nothing - jmho :)
i'm not saying i'd jump in at just any situation- but if i thought i could help, and wasn't at risk- i'd want to do what i could do...
in your particular situation, what license do you now have that would be at risk? :)
BabyLady, BSN, RN
2,300 Posts
Please go back and read the post I responded to....that is important.
When somene says that they "would not reveal" that they were an RN if responding to an emergency situation because they think it would set them up somehow....how can RN's claim to want to be treated as educated professionals if we make decisions like that?
Nobody said anything about administering drugs or anything without an MD present...where did you get that I suggested that?
When I said that you had to function to your highest level of training.....think about that statement.
Different RN's have different certifications depending on where they work...if you touch a victim as a first responder, an RN that also has paramedic training is going to be held to a different standard than someone like me, who works with babies. If I perform CPR on someone, I am going to be required to perform that CPR on a healthcare provider level...not as a layperson. If a layperson moves a person with a spinal injury and causes further damage....chances are they are not going to be held liable because a layperson may not be fully aware of the danger...IF I MADE that same decision, I would probably be in serious trouble because as an RN, I should have known better.
That is the point I am trying to make.