Scope Of Practice

[amysnurse]

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.

[loriangel14, RN]

Lol I would love to call the MD to do all my dressing changes for me. Some days I have several.

[myoglobin, ASN, BSN, MSN]

I believe that the most correct answer would technically be that it must be ordered by a licensed provider unless a hospital protocol covers the situation (as is frequently the case with ICU admissions). However, the actual collection can be performed by any worker trained in the process and isn't specifically a scope of practice issue. Obviously, state laws and hospital policies will differ and serve as the ultimate authority. It is also possible that an anally retentive MD might prefer to do the swab himself/herself so that they can be satisfied that there was no cross contamination in the collection process (although it could still be contaminated in the lab). Then there is also the possibility as referenced above that a provider might wish to do the test for some sort of billing enhancement. It also provides an additional opportunity to interact with the patient which some providers try to maximize to improve patient satisfaction. Also, like bathing a patient it is also another opportunity to conduct an assessment for the provider.

[mmc51264, BSN, MSN, RN]

I do them all the time. If we had to wait for the doctor to do them, they would never get done. I had an NP do a flu swab on me when I went to the urgent care, but in the hospital, the nurses all do them.

[Davey Do]

AliNajaCat said:

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

Did you have a textbook to go by, AliNajaCat?

[Meriwhen, ASN, BSN, MSN, RN]

Yes, it's in your scope of practice to swab a nose for a sample. Whether it's permitted for you to do it at your facility would be up to your facility though--check their P&P.

You can usually find your state's scope of nursing practice on your state's BON website or your state's government website.

[applewhitern, BSN, RN]

We only do the nares at my hospital.

[Julius Seizure]

If the nurses at your hospital are allowed to order MRSA swab testing yourselves, it is because there are policies or standing orders directing that action. You can't choose to do one yourself outside of having one of those things supporting it.

[LovingLife123]

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.

A lot of our surgeons do their own dressing changes. They may designate it to a resident but there are some dressings they are very particular about.

[applesxoranges, BSN, RN]

I think it would fall under protocol orders. So it is not really an RN ordering it, they are given permission to order this order under X. We can do the actual swabs.