scope of practice issue

[nminodob]

Hi all-

Recently graduated nursing school and about to begin training as a per-diem nurse on a stepdown unit where I have several years experience as nurse assistant and as a paid intern. Long story short: I am very comfortable on the unit and when the phlebotomists were facing layoffs, began doing the phlebotomy when I worked as an intern. Everyone, including the nurse manager, was aware I was doing this, and the job description of an intern is written so vaguely it is hard to know exactly what I am allowed to do or not do. A new charge nurse with limited people skills called me on it the other day, and basically told me that I had been allowed to do things she never had when she was a student, and that from now on I would be stocking gloves, etc. and that she "didn't appreciate my taking advantage of her as a new charge nurse" by doing these types of tasks that were outside my scope! (By the way, she was so new I had only worked under her one time before - we butted heads that time about something else, too.) I pointed out to her that I was offended that she thought I was taking advantage of her, and that the nurse manager was aware of what I was doing for quite some time.

I don't see how I can continue to do the tasks I had been doing after being thrown under a microscope by this new charge nurse. I realize I was operating in a gray area to begin with, but I was allowed to perform these tasks because I was able to do them safely and quickly - my competence was never called into question. As for the nurse manager, I knew better than to appeal to her in this situation, because it might expose her to liability if the charge nurse continued to make an issue.

The irony is that this charge nurse really shot herself in the foot. If she had asked my civilly to refrain from doing invasive procedures while an intern because it raised liability concerns, I would have been unhappy, but not incensed. I am familiar with the hospital overall, and when patient belongings are lost, or there is a shortage of lancets, specialized equipment, etc., I can usually get a hold of what is needed. I also help at the nurse's station when there is no unit clerk to take off orders. Because I have always been willing to take on new tasks without rigid adherence to "scope," many of the other charge nurses regard me as a "bonus." However, because of her attitude - and because as an intern I can make my own hours - I have simply decided I will no longer work the shifts this person is charge. My only concern is working as a per diem nurse in the future whenever this particular person is charge.

Whew! Long post - thanks for letting me blow off steam!

[Aneroo, LPN]

Regardless of it is in your job description, is it something you're allowed to do with your certification? I'm assuming you have not taken boards yet.

"Rigid adherence to scope" isn't about letting you do things b/c you know how or because it's nice to let you get the experience- It's about patient safety and board of nursing rules. If a patient got an infection and it was traced to a blood draw and they saw someone who is not certified to do that was doing it, it'll ruin your career, as well as the drag the charge nurse down. I can understand her concern, although she should have went about it in a better way.

[Whispera, MSN, RN]

You must not do things that are not within your scope of practice as written by your state and the facility in which you work. Even if you are capable of doing things. For instance, I am an advanced practice nurse and have license to prescribe. While working as an instructor, however, I can not prescribe because that job doesn't include prescribing.

[Aneroo, LPN]

You must not do things that are not within your scope of practice as written by your state and the facility in which you work. Even if you are capable of doing things. For instance, I am an advanced practice nurse and have license to prescribe. While working as an instructor, however, I can not prescribe because that job doesn't include prescribing.

Exactly. I know how to intubate thanks to ACLS training (when they included that) and EMT training. Not in my scope as a nurse (and certainly not in my scope as a school nurse ).

[RNperdiem, RN]

I am a little confused. Are you a student intern or a licensed RN?

If you are a licensed nurse, and blood draws are now in your scope of practice, perform your job.

The past is gone; now is time to let grudges go.

Venting about them is a start.

[nminodob]

Thanks for all your replies - and yes, I have taken the boards and I am licensed (for the last 3 months), and I am due to start new grad training the 27th of April.

As I said, I won't do anything that will jeopardize my future position - so even though I have done phlebotomy in the past with the nurse manager's knowledge, I will not be doing it in the future.

[Aneroo, LPN]

Thanks for all your replies - and yes, I have taken the boards and I am licensed (for the last 3 months), and I am due to start new grad training the 27th of April.

As I said, I won't do anything that will jeopardize my future position - so even though I have done phlebotomy in the past with the nurse manager's knowledge, I will not be doing it in the future.

If you're a licensed or registered nurse, you should be good.

[pagandeva2000, LPN]

I strongly believe that some policies are purposely vague so that they can be manipulated as management sees fit. Selfish of them, I know, but that is the sum of my experiences.

This new person, however, seems to me to be a troublesome power keg that is waiting to explode if you even sneeze at it. She is correct in saying that she should not delegate tasks that are not within your scope of practice, but is wrong for accusing you of trying to take advantage of her. In fact, it makes me wonder how much experience she really has, because, maybe reading the job descriptions of her subordinates would have been a good idea...she may have seen for herself how vague they were and questioned the powers that be for herself.

[nminodob]

Thanks all for the replies-

I am licensed since January.

Until then - I will do nothing that could jeopardize my job, which begins the 27th. I still think that the charge nurse was wrong in the way she approached the whole thing though.