RN responsibility--how far do you go in being a first responder?

[wannabecnl]

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.

[akulahawkRN, ADN, RN, EMT-P]

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.

In California, all the EMS systems that I'm familiar with would have limited that RN's assistance to that of rendering First Aid (BLS) only. If the RN was an MICN and had been given base orders to initiate ALS care, then that MICN could assist the on-duty personnel but may NOT take control of the patient OR the scene. Generally speaking, the only people that can take over patient care from a Paramedic without consent are Physicians. Flight RN's can have care transferred to them. If that were my scene, I would have warned, then had the RN ejected from my scene. If she persisted in returning to the scene, I would have had her arrested.

Incidentally, in my County, a properly accredited Paramedic that works for a company/agency that provides ALS care (in any capacity) is explicitly authorized to provide full scope of practice care even if off-duty.

[SummitRN, BSN, RN]

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.

Wow... no you can't. RN licenses do not cover prehospital care for professional practice except in special situation like flight RN (except in a few states that have prehospital RNs) much less good-sam practice at the RN level.

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 perform acts covered by your good state's good Samaritan act, you are fine. That act doesn't involve RN skills, paramedic skills, etc.

What you can do, so can John and Jane Q. Public if they've had their 6 hour first aid or 40 hour First Responder. BLS only!!! Nobody will complain if you go apply direct pressure, put someone in trendelenburg, provide nonrestrainted spinal precautions, CPR, jaw thrust, OPA, oral glucose appropriately, or put someone in a recovery position. Those are NOT RN specific skills. Those are trained lay rescuer skills. Those are about all you can do as an RN anyway unless you are a Ricky Rescue who carries around more gear than they should.

If any off duty non-MD medical provider starts doing things like soft restraints, initiating backboarding, suction, applying traction splints, CT/KA, ETT, IV starts or infusion, drugs of any kinds even O2, etc without jurisdictionally authorized on-duty EMS provider or an MD telling you to (and in some cases even if they do), you are practicing medicine without a license.

[xtxrn, ASN, RN]

Wow... no you can't. RN licenses do not cover prehospital care for professional practice (except in a few states that have prehospital RNs) much less vigilante practice.

If you perform acts covered by your good state's good Samaritan act, you are fine. That act doesn't involve RN skills, paramedic skills, etc.

What you can do, so can John and Jane Q. Public if they've had their 6 hour first aid or 40 hour First Responder. Nobody will complain if you go apply direct pressure, put someone in trendelenburg, provide spinal immobilization, CPR, jaw thrust, OPA, oral glucose appropriately, or put someone in a recovery position. Those are NOT RN specific skills. Those are trained lay rescuer skills. Those are about all you can do as an RN anyway unless you are a Ricky Rescue who carries around more gear than they should.

You start doing things like restraints, backboarding, suction, applying traction splints, CT/KA, ETT, IV starts or infusion, drugs of any kinds even O2, etc without jurisdictionally authorized on-duty EMS provider or an MD telling you to (and in some cases even if they do), you are practicing medicine without a license.

Who said anything in the OP about doing something outside of the scope of practice? I missed it... All I saw was stopping and doing what one could do.... Then it got turned into who can legally do what. :) I didn't get the idea that the OP was going to do anything that wasn't basic assistance.

If John and Jane Q Public aren't there, and a nurse is, should he/she just stand around and hope John and Jane stop by? And John and Jane may be a mailman and florist- how are they going to know what those first aid skills are?

SO- nurses are just first aid providers..... WOW.... I could have saved SO much time in school

[SummitRN, BSN, RN]

Several things I mentioned are RN skills. People are saying that RN's have to function to their full scope of practice. That's where I disagree.

I disagree every bit as much as the people who say that RNs shouldn't help because they are somehow more liable than the average John or Jane.

You can reason at your max, but you can practice at what the law allows and in most states that is first responder.

It makes no difference if you hand off someone and identify yourself as an RN. This is why...

An RN has a scope of practice and you are only responsibile for legally performing to your highest level of training...so that would differ in NO WAY from any layperson that would sit with a victim until EMS arrives to explain what you know so far and what has been done so far.

Not really. You cannot provide your full scope for the first reason of being outside the hospital environment and not having adequate equipment.

Second, abandonment can only occur if you do not have a duty to act (if you are working or if you are in a duty-to-act state).

Third, failing a duty to act, standing would have to come from harm through action. There would be only be standing for liability if injury and causation can be shown from action of the good sam.

And to the comment that a RN moving a crash victim being liable if moving a crash victim while a lay person is not, you are wrong and there is case law to back that up.

[xtxrn, ASN, RN]

Several things I mentioned are RN skills. People are saying that RN's have to function to their full scope of practice. That's where I disagree.

I disagree every bit as much as the people who say that RNs shouldn't help because they are somehow more liable than the average John or Jane.

Not really. You cannot provide your full scope for the first reason of being outside the hospital environment and not having adequate equipment.

Second, abandonment can only occur if you do not have a duty to act (if you are working or if you are in a duty-to-act state).

Third, failing a duty to act, standing would have to come from harm through action. There would be only be standing for liability if injury and causation can be shown from action of the good sam.

And to the comment that a RN moving a crash victim being liable if moving a crash victim while a lay person is not, you are wrong and there is case law to back that up.

Whatever..... this has turned into something that isn't even in the OP.... Obviously you can't do anything without equipment, legal or not.... I don't carry much medical stuff in my purse:D. Nothing was in the OP about doing everything an RN is qualified to do- in or out of a hospital. It was about helping someone until help came.

Maybe arguing is the big perk with this thread, when it seemed to start out legitimately....IDK.

[OhioCCRN, MSN, NP]

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.

my point exactly!

if you read the fine print, you will realize that in no way does it compel you on pain of death/disfigurement/incarceration- to be a hero. aaaand no one is going to secretly write down your license number and report you to the board of nursing...

oh... and you wont lose your license...

calling ems is different from extracting someone from a wreckage (just an example)

[nurseprnRN, BSN, RN]

just as a small clarification: your rn license does not mean you "practice under an md." physicians do not train, hire, evaluate, or fire nurses unless they are the direct employer, as in an office; even then physicians are not legally able to testify as experts in nursing, since they do not have, duh, nursing educations or licenses. try to wrap your head around that-- it's very empowering.

your rn license empowers (yea, requires) you to do a great many things, very little of which require md involvement. some of the acts nurses perform in hospitals and other facilities are collaborative with mds or require md actions first because of insurance or licensing requirements; for example, a physician prescribes a medication, and the rn gives it. this is not, however, practicing "under" the md. you do a great many things--and your nurse practice act and ana scope of practice insists that you do-- that have nothing to do with that. and of course the bazillions of nurses who do not work in hospitals know this already.

[xtxrn, ASN, RN]

Just a comment from a post a while back (don't remember who)...

Wants are not any type of need.... needs mean necessary to optimum functioning....wants are extras/treats/fun....knowing the difference is huge. :)

Water is a need...Iced tea is a want (simple example, I know).

A decent, competitive salary is a need.....every holiday off is a want (for some).

Working full time is a need (for most)....working days Mon-Fri is a want (for some).

Clothing is a need....Louis Vuitton is a want....

A person can live without wants...not much fun, but the needs have to be prioritized.

:)

[BabyLady, BSN, RN]

Wow... no you can't. RN licenses do not cover prehospital care for professional practice except in special situation like flight RN (except in a few states that have prehospital RNs) much less good-sam practice at the RN level.

If you perform acts covered by your good state's good Samaritan act, you are fine. That act doesn't involve RN skills, paramedic skills, etc.

Uh, I can tell you right now...this isn't true. You can bet your bottom dollar if I touch a victim and have an RN license and something goes wrong? I am going to be considered by a court to have "unique knowledge" over that of a layperson. That means (as an example that I cited earlier)....if a layperson moves a person with an unknown spinal injury that results in further injury when there was no immediate threat of life ie. fire...then it is going to most likely be chalked up to an honest mistake....if an RN does that? You can bet he/she will be sued because an RN should know better than to try to move a victim without the proper equipment. I also read of a case a few years back where a woman had her throat crushed in an accident...who would have suffocated to death...and took a knife and attempted to insert an airway...HOPING she would do it correctly and insert a pen casing...the RN was successful and the patient would have otherwise died as it took over 15 minutes for EMS to respond...the victim sued the RN and collected for disfigurement...b/c the RN, even though experts testified that she correctly created the airway...the RN had NEVER BEEN TRAINED TO PERFORM THE PROCEDURE.

What you can do, so can John and Jane Q. Public if they've had their 6 hour first aid or 40 hour First Responder. BLS only!!! Nobody will complain if you go apply direct pressure, put someone in trendelenburg, provide nonrestrainted spinal precautions, CPR, jaw thrust, OPA, oral glucose appropriately, or put someone in a recovery position. Those are NOT RN specific skills. Those are trained lay rescuer skills. Those are about all you can do as an RN anyway unless you are a Ricky Rescue who carries around more gear than they should.

If any off duty non-MD medical provider starts doing things like soft restraints, initiating backboarding, suction, applying traction splints, CT/KA, ETT, IV starts or infusion, drugs of any kinds even O2, etc without jurisdictionally authorized on-duty EMS provider or an MD telling you to (and in some cases even if they do), you are practicing medicine without a license.

I would really like to see your source if I am an RN that assists at a scene and Mr. Ego Paramedic can't seen to get it in his thick skull that a patient is having a possible MI and needs O2 NOW because he is fiddling with non-essential things (Which I have personally witnessed, by the way)...that as an RN that has been trained in BLS, ACLS, PALS and NRP, I can assure you that I would be WELL WITHIN my scope to apply O2 if available in an EMERGENCY.

I also saw a Mr. Ego Paramedic refuse to drive a conscious victim 8 miles to the hospital while he tried to start an IV (which was not emergent at the time) and he didn't have the skills to start one....and she was having early stroke symptoms and he got mad when I said the IV could wait that he needed to get on to the hospital NOW because he was taking so long he could have already been there. The husband was getting ready to pull her off the ambulance and take her to the hospital himself before Mr. Ego finally figured out he couldn't start the IV and had the driver pull out.

Oh yeah, then there was the other case where RN's told EMTs not to lay a COPD patient supine because he couldn't breathe when transporting him to another facility, because he was in a crisis..that he needed to stay in high-fowlers. They argued with the RN's about it...well, they killed the guy by the time they got to the receiving hospital and when the RN's from the first hospital called the other one to find out HOW the patient was positioned upon arrival? Supine.

I mean, darn those RN's.

[Nascar nurse, ASN, RN]

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 ???? :)

This is exactly what I think of when I state I would stop and offer assist if EMS is not on scene. I would also add that as a nurse, I am probably more used to the chaos and drama then the average lay person. I would like to think that if nothing else, I may be able to keep the situation calm and offer support...ie: a bleeding teenager freaking out over wrecking dad's car, a mother with an injured child, etc.

It's about being a human more than being a nurse. Again, I could only hope that someone would take the 5-10 minutes out of their life to offer the kindness and support to one of my family members on the side of the road.

[MN-Nurse, ASN, RN]

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.

It's been shown. A few times. It is clear you are confused. The subject is not what happens at work nor doing anything outside scope of practice.

A lot of posters are trying to drive this conversation away from reasonable scenarios and into out of context situations like interfering with EMS personnel, performing procedures out of scope of practice, chasing ambulances, and the like. That's not it.

People need to calm down. Part of our job is to assess the situation and do what makes sense. For some on this thread, what always makes sense is to run away as fast as you can.

No one is ever going to convince people like this any different and they will continue to make up crazy scenarios.

[xtxrn, ASN, RN]

It's been shown. A few times. It is clear you are confused. The subject is not what happens at work nor doing anything outside scope of practice.

A lot of posters are trying to drive this conversation away from reasonable scenarios and into out of context situations like interfering with EMS personnel, performing procedures out of scope of practice, chasing ambulances, and the like. That's not it.

People need to calm down. Part of our job is to assess the situation and do what makes sense. For some on this thread, what always makes sense is to run away as fast as you can.

No one is ever going to convince people like this any different and they will continue to make up crazy scenarios.

:yeah::yeah: