Scope of Practice?

[lblondie1128]

So, as a floor nurse, I rarely questioned "would that be in my scope of practice?" but as an ER nurse I find myself doing that frequenly. Problem solved if I could look it up, but I have searched and searched, to no avail. I live in Tennessee and apparantly they like to keep what I am and am not allowed to do a secret. I did find some things for say, North Carolina, but,,,, again, no help. Any suggestions? My current query is EJ IV insertion. Was asked to do so the other day and I know a few nurses who do, I thought I should look it up first. I forget what some of my other querys were, but there should be a document somewhere, no?

thanks if anyone has help/input!

[MajorDomo]

Each state has their BON which tends to have a link to the state's nurse practice act on a .gov website. You also need to find each hospital's regulations on nursing care and job description as they tend to limit practice dpending on area of specility. Some ERs allow more skills to be performed by RNs than others such as ABGs, suturing, and EJs.

Hope this doesn't muddle things for you

MajorDomo

[suzanne4, RN]

First thing to say about it, if you have never done it and been certified in it by your facility, then don't. Anything that your facility wants you to be able to do, they will make sure that you are checked off on that training. And just because a physician tells you that you can, that doesn't hold water with hospital administratrion or the BON for your state. Adn this goes for any procedure, if it was not on your checklist when you started there, then you should not be doing it, until it is added to your checklist.

This is one way to keep things very clear with what you can and cannot do. The state's BON is the first that needs to be followed, then the facility can also have their own rules and regulations but they canot permit you to do more than what your facility says that you can. And every procedure that you can do should be in your facility's Policy and Procedure Manual.

[suzanne4, RN]

Each state has their BON which tends to have a link to the state's nurse practice act on a .gov website. You also need to find each hospital's regulations on nursing care and job description as they tend to limit practice dpending on area of specility. Some ERs allow more skills to be performed by RNs than others such as ABGs, suturing, and EJs.

Hope this doesn't muddle things for you

MajorDomo

Suturing is not under the Scope of Practice of an RN in any state. Only as a Nurse Practitioner or as an RNFA. Otherwise you have no covereage if something were to happen.

External Jugular placments can only be done with certification by the facility in advance with training, and if it is not beyond the scope of practice of the BON for that state.

[SVSK]

Suturing is not under the Scope of Practice of an RN in any state. Only as a Nurse Practitioner or as an RNFA. Otherwise you have no covereage if something were to happen.

External Jugular placments can only be done with certification by the facility in advance with training, and if it is not beyond the scope of practice of the BON for that state.

Suzanne, I'm an economist writing about scope of practice. You wrote "if you have never done it and been certified in it by your facility, then don't." You wrote about a facility specific checklist and BON rules. You used the term "Policy and Procedure Manual." An NP that has been helping me talked about his tasks being defined by "standardized procedures and protocols" which are determined by the hospital nursing director, medical director and the NP. Do the terms differ by type of health care professional and geographic location? Are there specific terms that everyone uses or is that not the case?

I need to get this straight and I would really like to find an article that explains this. Have you written something that I could cite? I see you are a "super moderator." I'm not sure what that means, but it seems you have a lot of answers! I hope you'll be able to help me on this. If you would be willing to talk with me privately, my email address is [email protected]. Thanks!

[Altra, BSN, RN]

Suzanne, I'm an economist writing about scope of practice. You wrote "if you have never done it and been certified in it by your facility, then don't." You wrote about a facility specific checklist and BON rules. You used the term "Policy and Procedure Manual." An NP that has been helping me talked about his tasks being defined by "standardized procedures and protocols" which are determined by the hospital nursing director, medical director and the NP. Do the terms differ by type of health care professional and geographic location? Are there specific terms that everyone uses or is that not the case?

I need to get this straight and I would really like to find an article that explains this. Have you written something that I could cite? I see you are a "super moderator." I'm not sure what that means, but it seems you have a lot of answers! I hope you'll be able to help me on this. If you would be willing to talk with me privately, my email address is [email protected]. Thanks!

Not to answer for Suzanne ... and I have no doubt she can provide very helpful info. But just to answer a few things quickly:

"If you've never done it and been certified in it by your facility, don't do it."

This truism Suzanne stated means ... if there is some bad outcome and a patient's case is reviewed (internally, by Risk Management and/or whatever QA process is in place; or externally, as in legal proceedings) all persons who provided care to that patient better be able to demonstrate that they are competent to perform whatever tasks they performed. Picture the questioning that could follow: "how many times have you performed X before?" "what documentation of your competency in X skill is there?"

BON rules: state boards of nursing are regulatory bodies. The scope of practice of licensed health care workers is defined by that state's legislation, usually referred to as the nurse practice act. Just as with any governmental verbiage, some state nurse practice acts are more clearly defined than others.

Policy & Procedure Manual/P&P: every hospital or other facility has a set of polices and procedures which delineate exactly who/what/when/where/how everything which makes up patient care can be performed. Different hospitals dream up different names for these -- my hospital has "Patient Care Guidelines" "Medication Administration Guidelines" etc. (and don't let the term "guidelines" fool you -- not following the "guidelines" is grounds for disciplinary action)

This what your NP friend means by "standardized procedures & protocols defined by the nursing director and medical director.

An individual facility may restrict a clinician's practice more narrowly than the state nurse practice act, but it may not broaden it to include a skill/task not permitted by the nurse practice act.

Hope this helps a little. Good luck with your project. I'm sure many here would like to see the results.

[SVSK]

You wrote: Hope this helps a little. Good luck with your project. I'm sure many here would like to see the results.

Thank you, your explanation helped a lot. I'm making a case that oversight at the facilty level is far greater than what the consumer gets from state licensing. And that the turf wars over scope of practice could leave us with an inflexible political outcome, not necessarily one that is best for patients. So, I'm suggesting that the best outcome is to take the legislature out of the picture and allow facilities to use accrediting and credentialing organizations and other information (verified information about education and experience and adverse judgments) to decide what an individual is allowed to do. I'm suggesting that the fact that hospitals, health maintenance organizations and managed care organizations can be held liable for negligence in credentialing is what probably protects consumers the most. Have I missed something important?

[alkaleidi]

Wouldn't the answer to this question ultimately be first and foremost in the Nurse Practice Act and then in the Policy and Procedure Manual of the specific facility?

[ZippyGBR, BSN, RN]

You wrote: Hope this helps a little. Good luck with your project. I'm sure many here would like to see the results.

Thank you, your explanation helped a lot. I'm making a case that oversight at the facilty level is far greater than what the consumer gets from state licensing. And that the turf wars over scope of practice could leave us with an inflexible political outcome, not necessarily one that is best for patients. So, I'm suggesting that the best outcome is to take the legislature out of the picture and allow facilities to use accrediting and credentialing organizations and other information (verified information about education and experience and adverse judgments) to decide what an individual is allowed to do. I'm suggesting that the fact that hospitals, health maintenance organizations and managed care organizations can be held liable for negligence in credentialing is what probably protects consumers the most. Have I missed something important?

pretty much like it is in the UK, where there are few cast in stone rules aobut scopes of practice and for registered health Professionals , the biggest determinant is your education, training and supervised experience ...