Scope Of Practice

meanmaryjean, DNP, RN · Jan 29, 2017

To actually do the swabbing? Of course it is. To order the test? Depends on the facility and their protocol.

I really cannot tell from your post which you are asking.

AJJKRN · Jan 29, 2017

My facility has protocols to follow as well. I don't think you're gonna find an answer in your nurse practice act, this one should be facility/floor specific.

Editorial Team / Admin · Jan 30, 2017

Hi Everyone! I am trying to find out if it is within my scope of practice, as an RN, to do a nasal swab for MRSA? I've Googled and not been able to come up with an answer. How can I find out?
Thanks in advance.

Refer to your facility's P&P, standing orders, etc. In my facility, it is an automatic order that anyone admitted from LTC/rehab into any unit and all patients admitted to critical units get swabbed nasally. Usually, it is the PCT who is actually getting the swab done. Seeing as the facility is perfectly fine with unlicensed personnel collecting the sample, it is also within the scope of a nurse. Pretty sure the only lab samples that would be out of scope are those involving invasive procedures, such as a lumbar puncture.

loriangel14, RN · Jan 30, 2017

I am a Practical Nurse and I can do MRSA swabs and enter the order. Who else would do them if not a not a nurse?

amysnurse · Jan 30, 2017

To actually do the swabbing, not order the test. May seem like funny question, but our doctor has always done it himself. Then a different doctor asked me to do it. No one seemed to know..... thank you for your answer.

AJJKRN · Jan 30, 2017

To actually do the swabbing, not order the test. May seem like funny question, but our doctor has always done it himself. Then a different doctor asked me to do it. No one seemed to know..... thank you for your answer.

Oh...once our CNA's know how to do it (mainly just nares though) then they can swab, label, and send to lab. It can really be done by anyone trained on it at my facility but if it's a wound, etc then it's usually the nurse unless only the MD's are changing the dressing.

loriangel14, RN · Jan 30, 2017

Oh...once our CNA's know how to do it (mainly just nares though) then they can swab, label, and send to lab. It can really be done by anyone trained on it at my facility but if it's a wound, etc then it's usually the nurse unless only the MD's are changing the dressing.

You have MDs that do dressings?

klone, MSN, RN · Jan 30, 2017

Yes, it's absolutely within the RN's scope.

If the physician is trying to clear a patient of the MRSA designation, it needs to be done bilateral nares, axillae, and groin. Nares is not sufficient.

Editorial Team / Admin · Jan 30, 2017

You have MDs that do dressings?

Several of the surgeons I've worked with prefer to do their own first dressing change. Once that first change is done, the nurse takes over for subsequent changes.

AliNajaCat · Jan 30, 2017

To actually do the swabbing, not order the test. May seem like funny question, but our doctor has always done it himself. Then a different doctor asked me to do it. No one seemed to know..... thank you for your answer.

Aha. The answer lies in the billing-- if the physician does it himself, it's billed as if he "collected a sample," and he gets paid more.

Hell, I did nasal swabs for culture when I was a student, and that was back when Florence was a probie.

AJJKRN · Jan 30, 2017

You have MDs that do dressings?

Sort of, often the doc's take down the dressing to look at it and expect whomever to drop whatever they're doing and redress it for them. As a PP said, pretty much all of our surgeons want to do the first change but after that we do them. We have had instances where only the MDs did the dressing changes on certain wounds but I wonder if that has more to do with us being a teaching hospital.