Scope of practice in the ER

If you work in an ER.. A recently discharged newborn that rolls in could be your patient. Yes, you are expected to know how to care for that age range. 1 minute to 1,000 is not just some bs management is trying to feed you.

Think of it this way.. Your unruly, psychotic pt that is unstable that needs an rn to accompany them to ct.. Are you going to say 'shouldn't the resident be doing that?'.

Please don't take this the wrong way, but it seems you have an issue with that age range because you haven't had a comfortable exposure to that age. I think you need to find a way to gain more education/experience with the youngsters.

As long as you're working in an ER, your scope and license depends on competent care. If you don't know what you're doing with those patients, please say so to your staff. That's not a 'I hate caring for kids don't give me them' but more of a I need help with these wee ones because I struggle delivering care.

What I want to know is as a Nurse who works in the ER what is my scope of practice, my facility tells me I am responsible for ages 1second old to 1000 years old, but I'm having a hard time believing a lot of what Management says. Am I responsible for peds too or should the Residents be in charge of cathing, ivs holding down kids in the Xray machines?

Licensed nurses care for patients of all ages -- there is no different licensure or different scope of practice for varying age groups or specific patient populations. Urinary catheterization, vascular access, and assisting with diagnostic testing/procedures are definitely typical nursing activities, regardless of the age of the patient.

And you've chosen to work in the emergency department, which as a rule - by definition - sees patients of all ages, all medical histories, all backgrounds, and all disease processes.

You are not the first ED nurse to be uncomfortable with peds ... particularly infants. But this is where you work. So you could continue to avoid pedi patients ... not gain additional experience, familiarity and comfort ... and worry about that day when you're going to HAVE to take a pedi patient who is going to need your skills and your care. Or, as suggested in the post above, you can make it a point to seek out pedi patients and gain that experience so that your care improves.

Fiona,

I know how you feel. If more parents took their babies to their pediatrician instead of the ED, the little ones wouldn't be exposed to the urinary caths, IV sticks, and rarely, CTs. Unfortunately, many parents don't understand this and use the ED as their peds office. The MDs hands are tied then, because it will become "why didn't you run xyz test - you were in the ED!" if something goes wrong later. I don't mind working on them when they are really sick, but the ones with congestion and fever x 4 hours and no other symptoms and no antipyretics bother me because you know they are going to go home after all the procedures.

The other scary thing about working with infants is how quickly they can crash - hence all the caution regarding them. Yes, we nurses do all these procedures in our ED and it's something you eventually get used to.

What I want to know is as a Nurse who works in the ER what is my scope of practice, my facility tells me I am responsible for ages 1second old to 1000 years old, but I'm having a hard time believing a lot of what Management says. Am I responsible for peds too or should the Residents be in charge of cathing, ivs holding down kids in the Xray machines?

I hate to tell you, but you're expected to care for patients that are -1 second old, i.e. still in the womb.

That's the beauty of being an ED nurse, is we take care of people from cradle to grave.

When I find myself uncomfortable with a specific patient population, I take that as a challenge to learn more and become more competent with those patients. Sometimes that means asking for help if I'm not sure about something. Is that an option for you?

Our docs follow a protocol similar to this when determining whether or not to CT a kiddo:

http://www.mayoclinic.org/mcitems/mc1800-mc1899/mc1887-96.pdf

I too hate taking peds cases, especially when there is a pediatric hospital in the area. But the reality is that these patients to present to our ED and they have to be taken care of. I have gotten some what more comfortable, but having to stick a newborn to gain IV access still makes me cringe. My suggestion is to look for and ENPC course and sign up. It helped me a lot in my practice. Remember, knowledge is power.

I felt the same way, so I took NRP and PALS, then started studying for the CPEN and passed then took ENPC. all of these are pediatric certs. it made me feel less insecure, however I still get nervous with the truly sick Kiddos. I think its normal.

Hope this helps/

Traci

PS I would start with ENPC if I had to do it over its a whole kid course

Esme pretty much nailed it. Loud baby, good baby & what do mom/dad think, baby acting/doing what is normal?

Thank you everyone, I approached my ADN and NS Manager to clarify a few things, they were more than helpful but shocked when I admitted I was a wreck with the kids. We have a free clinic in my hospital I'm going to work a few days there to get more comfortable! We also went over policy and procedures with pediatric cases and now I have a better grasp on what I can do and what has to handed off to the MD . Tomorrow starts a 12 hour shift with the clinic, I'm packing a crucifix, holy water and a good peds book!

Good for you for facing your fears! I never liked pediatric patients and did my best to expose myself as much as possible until I felt comfortable with them. You are doing yourself and your future peds patients a great service by getting in there. Good luck and I'm sure you'll get into your comfort zone with them.