Should nurses perform outside scope of practice during emergency situations?

[chels0641]

For my ethics class we have to write a synthesis paper on an ethical issue in nursing. I chose to write about whether or not nurses should act outside of their scope of practice during emergencies. For example, if a patient needs intubated and no physican is around (and can't be around fast enough), should the nurse perform the intubation if it will save the patient's life? I'm having a lot of trouble finding information on this topic and have only found one source that is hardly helpful. Is my topic too narrow? Any suggestions on what to search when i'm looking for sources?

[labradorloverrn344]

I don't know if you will be able to find a lot of material on this subject because of the high risk associated (no matter what the situation with the patient). If you take the risk and something goes wrong the nurse involved could be looking at lawsuits and/or misconduct or worse from the BON

[nurseprnRN, BSN, RN]

Suggest you look up "Good Samaritan Laws." You will find exactly what you want. Let us know what you learn.

[gonzo1, ASN, RN]

As a nurse I would never work outside my scope of practice. Let's use the intubation as an example. As an ER RN I have seen many pts intubated. I have intubated many maniquins in practice. However, if a pt had to be intubated and I had the equiptment and I was the only one there, I would never do it. I really don't know how and I could do more damage by trying to help.

In an emergency all you need to do to keep someone alive is chest compressions and rescue breathing. And apply pressure to any bleeding.

You have to look at the whole picture, future and present. Is it correct for you to do something that is out of your scope of practice to save one life? But then you lose your license and can never save another life. Or support your family.

Usually something is out of scope of practice because it is something a nurse rarely does and therefore does not have the skills to do it correctly. A lot of harm can occur when we try to do things that we are not trained for.

After you become a nurse you will more fully understand what I mean.

[KelRN215, BSN, RN]

As a nurse, I am not trained to intubate a patient. I would keep bagging the patient until the MD arrived.

[nurseprnRN, BSN, RN]

I took ACLS donkey's years ago and was sort of an idiot savant for intubation. I got to practice on live people in the OR c an anesthesiologist. So yes, if the opportunity presented itself I could do it, and would. See "Good Samaritan Laws," seriously.

[BlueChocolateCat]

Fortunately, many hospitals provide automatic protocol for emergency situations (such as a code blue) in which the nurse does not have to practice outside of her boundaries. However, my suggestion is that a nurse should never try to take action that he/she does not feel capable or confident in doing.

[dah doh, BSN, RN]

In the hospital setting, there should be protocols to cover certain things a nurse can do without a doctor's order that would normally outside your scope of practice. Can I intubate or place a central line? Nope! I'm not a doctor nor a CRNA. You can call someone who is qualified to and support the airway and place a peripheral line or intraosseous line. If its an outside the hospital setting or nonworking time, the Good Samaritan law should protect you in your assistance efforts, but I still wouldn't try to intubate someone or place a central line in the field either!

[KelRN215, BSN, RN]

My understanding of the Good Samaritan law is that it applies if you, say, decide to trach someone with a straw at McDonalds but not so much if you act outside of your scope of practice while at work.

I'm trying to imagine a situation where a patient is respiratory arresting and in need of intubation, no one responds and the nurse would be put in this situation... even when I worked at a community hospital, a Rapid Response or Code Blue brought 45 people to the room within 17 seconds.

[nurseprnRN, BSN, RN]

If you try to trach somebody in the field and you have experience and training in cricothyrotomy and it goes badly, the GSL will protect you. if you try to do it without experience and training and it goes badly, you're screwed.

[blt99]

I might approach your paper from a different angle, and a little lesser degree of severity.

I'm thinking about hospitalist physicians that trust the nursing staff enough to issue very lenient standing med orders to prevent calling them in the middle of the night for something minimal.

[elkpark]

Each of us makes her/his own decisions about what we're comfortable doing in emergency situations, but there is no US law, Good Samaritan or otherwise, that will protect a nurse who acted outside the legal scope of her/his practice if the individual is taken to court or the BON afterwards (as far as I know; I am happy to be corrected if I'm wrong :)).