scope of practice for new grads

[octopus]

i provide clinical support to new graduates on three surgical wards. this fri we are meeting for formal reflection and discussion. i would like to structure the session around scope of practice - have the grads been asked to work outside of their scope of practice? have they caught themselves doing it without thinking? have they been in the middle of a task when they realised they didn't know what they were doing? how can they protect themselves from working outside of their scope of practice?

do any of you have a story about a time when you were asked to do something that you didn't feel comfortable or confident doing (ie outside of your scope of practice)? how did it make you feel? what did you do about it? what advice do you have for avoiding these situations?

by way of clarification, in the state i work we have a new 'decision making framework'. if we cannot answer yes to a series of questions in a flow chart (eg "is my education, experience and competence sufficient for me to undertake this activity safely?" or "am i permitted to undertake this activity under law and organisational policy?") then the activity is outside of our scope of practice and we must not undertake it. graduate rns are advised to make decisions about their work using this framework, and if they cannot answer yes to every question, they must tell somebody that they are unable to complete the task. that would mean a lot of things are outside of their scope of practice. in order to grow and learn, they must request supervision or further education before they complete the task.

thanks in advance for your stories!

[grentea]

I really haven't found myself in very many of those situations. Usually, I'll think through whatever a situation involves and if I realize that I might not know what I'm doing, I will always, always ask for help. I guess just thinking ahead is how i avoid being in scary situations where I have no idea what I'm doing. I think one of the most anxiety-provoking things for a new grad is taking care of a patient with a trach. The first time I had a patient with a trach, I asked my perceptor to be with me whenever I did care on my patient. It really took a few times before I felt comfortable and even after that, I would still ask for help now and then. It's just an awfully scary feeling at first to be putting things in someone's airway while they are gagging and coughing and all of that. My preceptors really made me feel a lot better about it, and they assured me that if I was ever not sure about something that they would be there with me. I have refused a few tasks I had little to no knowledge about, but I always closely watched another nurse/preceptor do it or I would help them.

[christvs, DNP, RN, NP]

I've been an RN for 8 months now & I too have always asked more experienced nurses for help when I'm not familiar with a procedure, med, treatment, etc. I always put my patients' safety above all else.