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Scope of Practice Question

Posted

Specializes in Cardiac Telemetry, ED.

Is it within an RN's scope of practice to lance a boil, or to remove an embedded object, such as a piece of glass, from a finger/hand?

I have checked my State BON's website, with no luck.

opensesame

Specializes in acute/critical care. Has 11 years experience.

I think doing both of those things independently could be construed as diagnosing and treating, which is out of the scope of practice of an RN (other than an APRN) in all states. I could see it being in line with practicing medicine without a license.

P_RN, ADN, RN

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89. Has 30 years experience.

I would be quite wary of doing either of those. Suppose what looks like a boil-isn't a boil but a skin cancer, or a deep festering furuncle? Suppose the glass is keeping an artery from spewing blood all over. I believe the previous poster has said it best. What you suggest is diagnosing and treating without authority to do so.

himilayaneyes

Specializes in Critical Care/Coronary Care Unit,.

Agree with the previous two posts. It's one thing for you to do this to a family member at home...it's another thing to do it to a patient.

donsterRN, ASN, BSN

Specializes in Cardiac Care. Has 10 years experience.

Ditto...

Meriwhen, ASN, BSN, RN

Specializes in Psych ICU, addictions.

I have checked my State BON's website, with no luck.

Then call your BON or drop them an e-mail.

I've written my BON a few times and they usually respond pretty fast. I'm sure your BON will have the answer for you.

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

I would say it highly depends upon your education, training and State.

In Arizona the RN's SoP is defined as such;

R4-19-402. Standards Related to Registered Nurse Scope of Practice

A. A registered nurse (RN) shall perform only those nursing activities for which the RN has been prepared through basic registered nursing education and those additional skills which are obtained through subsequent nursing education and within the scope of practice of an RN as determined by the Board.

This covers things like intubation. Some RNs can because they have been trained and educated in intubation but if you don't know how then you cannot.

Check your BON, write them an email. Everytime I have written mine they have responded in 1-3 business days.

diane227, LPN, RN

Specializes in Management, Emergency, Psych, Med Surg. Has 32 years experience.

Generally no, unless your facility has given a specific class on these procedures and you have been checked off. Lancing a boil is not just a matter of getting the pus out. If you do not use the proper technique you can push bacteria further into tissue and get a spread of infection. And depending on the area where the infection is, you can infect the joint space or the tendons which takes much more time to heal or won't heal at all, depending on the type of bacteria growing there.

As far as FB removal like glass etc, I have removed VERY SUPERFICIAL pieces of glass etc from time to time but only after physician evaluation with minimal bleeding and in a wound that will not require a suture.

This type of wound care requires specific skills that are not taught in nursing school. I would not perform those procedures.

HamsterRN, ADN, RN

Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.

Diagnosing and treating is not outside the scope of practice of an RN, in fact it's the bulk of what we do.

The procedures you describe are are not by definition outside the scope of an RN, but they aren't in your scope if you are have been trained on that procedure where that training has been validated and maintained.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

Each state has different rules, but I seriously doubt the average RN is allowed to lance a boil or remove an embedded object in any of them. Only an advanced practice nurse can--or should--perform these procedures, and only if that nurse is trained to do them properly.

It's one thing when you're at home and your kid comes in with a piece of glass stuck in his knee that's easily seen and removed with tweezers; but I wouldn't even lance a boil on myself, let alone someone else. (What I did was apply a baking-soda poultice to mine for 20 minutes, 3x/day, until it burst and drained on its own; it's an old home remedy that can be quite effective. But you didn't hear it from me. ;) )

As some of the above posters have stated, it's best to err on the side of caution when it comes to scope-of-practice questions---when in doubt, check it out!