Scope of Practice?

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  • Specializes in ER/Forensics/Disaster. Has 15 years experience.

I'm a new grad nurse, and have heard misleading flip-flopping answers on this throughout nursing school. I live in a very hurricane-prone area, and just want to clarify before I am licensed what is/is not acceptable..

Are there times that an RN can act outside of his/her scope? Such as mass casualty nursing, car accidents or other incidents where there may not be other help available? In cases where we know how to help, how can we just stand by while someone dies and do nothing? Aren't there some circumstances where we can go above and beyond our 'hospital scope'?

Hope this is the right place to ask this, couldn't find any boards more suitable. Thanks!

Pepperlady

151 Posts

I am by no means an expert and I am not in the USA but I believe that you are allowed to assist as long as you stay within your scope of practice. For instance, you are probably qualified to maintain an airway but not to intubate, if you intubate and cause injury then you would be liable, if you assisted in maintaining an airway you would be okay. You could probably control bleeding by providing direct pressure and a dressing, but you could not suture (if that is not in your scope of practice.)

Having said that, I have read some interesting articles regarding Good Samaritans being sued ....... so I guess its up to you whether that is a chance you want to take. Personally, I am still going to stop and assist in a disaster/MVC/trauma.

RedCell

436 Posts

Specializes in CRNA.
I'm a new grad nurse, and have heard misleading flip-flopping answers on this throughout nursing school. I live in a very hurricane-prone area, and just want to clarify before I am licensed what is/is not acceptable..

Are there times that an RN can act outside of his/her scope? Such as mass casualty nursing, car accidents or other incidents where there may not be other help available? In cases where we know how to help, how can we just stand by while someone dies and do nothing? Aren't there some circumstances where we can go above and beyond our 'hospital scope'?

Hope this is the right place to ask this, couldn't find any boards more suitable. Thanks!

I am SO glad you brought this up! Just last week my Uncle Rico (a recent nursing grad) responded to an MVC where a bus full of illegals crashed into a Jose Cuervo delivery truck down near Brownsville, TX. What a mess. He had to personally deliver a baby with no help and then performed a cricothyrotomy on Cuervo's delivery guy using nothing more than his rusted switch blade and a Big Gulp straw. Amazing stuff!!!! He said he saw both procedures completed a few times on General Hospital and felt pretty confident.

Seriously dude, I do not know what you carry in your car, but I don't have any defibrillators/pacers or any other cool toys like that in my truck. There is not much as a first responder to your above mentioned accident/catastrophe scenarios that would be out of your scope of practice. I mean its just you and two hands. CPR (while it is usually a waste of time), spinal immobilization, first aid, etc...are about all you can do without any equip. Personally if it was me, I would keep driving anyways and avoid being summoned by some cremepuff trial lawyer later. Maybe I would call 911 based on some recently changed personal beliefs that occurred while reading another thread on this board.

I never doubted Rico's natural talents however, back in 1982 he could throw a football a quater of a mile.

EricJRN, MSN, RN

1 Article; 6,681 Posts

Has 17 years experience.

Usually for out-of-hospital (or out-of-your-job-setting) incidents, your scope of practice would actually be limited rather than expanded. While you might start an IV or give some drugs to a patient at work, on the side of the road you aren't working under a physician's order or under yout hospital's P&P's, so it would be inappropriate to perform those interventions even if you could access the supplies.

Even in the situation where licensed or certified EMS providers roll upon an accident scene while off duty in another jurisdiction, they are usually advised to perform BLS care only (call 911, direct pressure, hold C-spine, CPR, etc).

flygirls2, BSN

100 Posts

Specializes in ER/Forensics/Disaster. Has 15 years experience.

Yeah I've heard of people using pencils to establish airways, all kinds of stuff. You do have a good point, that ordinarily there wouldn't be much I 'could' do that would be out of my scope with the materials I'd have available..

But in mass casualty incidents, we would likely have a lot of medical equipment around.. So just theoretically.. I should not act out of my scope? Or is it kind of a 'judgement call'? Assuming of course there are no docs around and none will be(you're on the top of Mt. Everest on a hike)

I live in the area where Katrina hit and I know some nurses got in trouble locally for acting out of their scope, but I never heard if anything came of it.. They saved people's lives!

shodobe

1,260 Posts

Specializes in O.R., ED, M/S.

Just go and do a search on the recent California Supreme Ct decision on good samaritans and you might think twice about helping people.

Specializes in ER/ICU/Flight. Has 18 years experience.

RedCell said it great (are you in training to be a cage fighter?).

There isn't much you can do without equipment and if you were in a mass casulaty incident then there would be equipment around you. I wouldn't act outside my scope and do something I hadn't been trained to do. You can look at California recently or even NYC about 14 years ago, a couple medics delivered a baby by c-section on a peri-mortem woman. All with on-line medical direction to "walk them through it". Baby survived and was brought to the ER. Did they do the right thing to save the life of a baby? I think so, but the paramedics lost their certification and the MD was only reprimanded. My advice is "do all you can with what you can while you can"...if you've done that, you don't have anything legally or ethically to worry about.

lpnflorida

1,304 Posts

Specializes in psych. rehab nursing, float pool. Has 30 years experience.

If you ever are outside of work. Basic first aide, cpr would be as far as one should go. Never under any circumstances go outside of scope of practice. As you would not have a doctor at your side giving you orders. Much more beyond first aide and cpr is outside of your practice then.

Most doctors even drive past accidents, they will notify 911, but they realize the quandry they can be in unless of course they are a trauma dr.

Trauma Columnist

traumaRUs, MSN, APRN

165 Articles; 21,214 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

Your scope of practice is just that: YOUR scope of practice. Just because you've seen a procedure done, doesn't mean you can do it.

MajorDomo

55 Posts

Most state BON have a statement to the effect that you can go outside your scope of practice for major mass cas incidents, the Katrina or 9/11 type incidents. "Normal" emergencies you should just stick to the ABC to CYA (cover your assets).

MajorDomo

Mr Ian

340 Posts

Specializes in mental health; hangover remedies. Has 15 years experience.

I'm not sure on USA 'scope' definitions - is it a proscribed list of competencies?

I'm used to 'scope' being defined by the nurse themselves and using the full extent of their individual accountability.

With nursing I would be content to work within my own assessment of ability. eg if I saw someone with an arterial bleed not slowing with external pressure and needed to get to the site to clamp it - in the necessary circumstances - I would incise and apply a clamp.

That's way out of my scope - as in mental health I only usually deal with stuff above the eyebrows.

My understanding is that any action taken by an indiivdual nurse that is later called to question must be validated as a 'clinically defensible' action. ie the clinical need outweighed the risk.

pererau

44 Posts

Specializes in Emergency Nursing.

It is my understanding that the good samaritan law covers you as long as you are within your scope of training and practice, but if you are acting outside of that scope, then you are on your own from a legal standpoint.

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