Scope of Practice?

[ibmanda2000, LVN]

Hello!

I am a new LVN, home health nurse. My patient has had a trache since March. He is pretty stable respiratory wise, however he cannot seem to swallow whatsoever or cough up secretions on his own. Today, they took his trache out. I was not working, so I am not sure the full logical understanding for this, I just heard from another nurse that it was done. We have respiratory therapists that work with us during the day with this pt. One of them, the "charge" RT, is very pushy with keeping this pt on fulltime and tries to say that the things she does, us LVNs cannot, ie. suctioning and ect. Obviousluy she is lying, we can and DO suction him when they are not on duty. Now that the trache is out and there is not quite so much for the RTs to do, she is saying that us LVNs cannot do nasal suctioning. I do not know if this is true or not.... i have tried to find the scope of practice online, however it is proving to be difficult.

PLEASE HELP! I am willing to do anything that I can, but I am not sure if I am ALLOWED to do this.

Oh yea......I am practicing in California.

[justiceforjoy]

I'm sorry I can't answer for your state, but here in BC we have a fairly large scope of practice, which I imagine is quite close to yours and we cannot do nasal suctioning.

[NurseCubanitaRN2b, BSN, RN]

In California WE ARE ALLOWED TO SUCTION PATIENTS. Now nasal suctioning I'm unsure of, but if the RT can do it, I don't see why we can't do it. Usually what a RT can do WE CAN DO TOO. We are the nurses. The RTs do have a vital role in the health care system, but we are the nurses. Can a RT give Lovenox via injection? Can the RT give immunizations? Can the RT give tylonol to a patient? The answer to all three questions is NO. I have the LVN scope of practice for California. Let me do some searching and I will post it for you.

[NurseCubanitaRN2b, BSN, RN]

http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=02001-03000&file=2859-2873.6 This is straight from the BVNPT. It doesn't really say anything under suctioning nasally per say, but I do know that we are allowed to suction patients. I can't remember if we practiced doing it nasally during nursing school or not. But I'm pretty sure LVN's can do it. I don't see why the RT can do it and a nurse can't. But maybe there is a California LVN who knows more and can shed some more light.

[pagandeva2000, LPN]

Can you check the website of your state and see if there is a contact number or email address so you can reach someone and specifically ask this question? My BON usually answers my email within the same day (in fact, the woman is quite familiar with me, now...).

Good luck, I know the feeling. You don't want to inadvertently do the wrong thing.

[ibmanda2000, LVN]

Thanks everyone for the replies!

unfortunately..... my patient got pnuemonia from not being able to clear his secretions very well when the trache was taken out. he is ICU and they are re-inserting the trache in a couple days

i know we are able to sxn him through the trache, we do that all the time. i was not taught in school how to sxn nasaly, however we were taught how to put in an NG tube... but never how to distinguish going into the trachea vs esophagus. i dont know.. im still confused on LVN vs RTs. They tell us we cannot use the cough assist on my patient either, but i really just think they are trying to keep this patient and not lose their positions with him.

Thanks again everyone! if you have anymore insight, please keep me posted!

[KAYBDT6, BSN, RN]

It all depend on your state. Check on your state website for confirmation.

[LovebugLPN]

I assume you work for an agency? They would (or should) be able to answer all of these questions for you. You are a fairly recent grad and I am sure they would be glad (and relieved) if you would go to them with questions like these.

[flightnurse2b, LPN]

i would call the board when in doubt.

that's what i've always done regarding scope of practice since i've worked in a few different states and everywhere is different.

many times what the state allows you to do though, the facility you work for may not, so i would check with them too.

i know here in FL we can perform deep suctioning nasally, orally and via trach. however, if you've never done it before it may be best to have someone show you how to do it before you perform it on a patient as it is very uncomfortable for them and they need to be hyperoxygenated beforehand (esp with hx of a trach!)

good luck :)

[BabyLady, BSN, RN]

This is where you defer to your facility as well as patient safety.

When confronted with decisions such as this, you need to remember, "Just because you can, doesn't mean you should."

To me, if the RT wants to do all the suctioning, and unless I had been trained on it, I wouldn't touch it and I would call him each time the patient needs to be suctioned.

Respiratory Therapy does a lot more than show up and hook up machines. They are trained in every aspect of respiratory care. Unless you have specifically been trained to suction a Trach patient, my advice is not to.

[AllwaysB+]

Caution is allways key!