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Discussion

Stress Testing

Hi all, I am employeed at a small hospital that has a nuclear stress lab, where I have worked for the last three years. Last summer I had to train a RN to take my place in the stress lab so that when I started the nursing program in Jan there would be some one there to do my job.

Now since I have been in the RN program the hospital administration has decided to make a few changes to our stress lab. 1 the Dr will not have to be present for the test but only be 100 feet away and "easily obtained" 2. RN with ACLS will be present for the test along with Nuc/Med tech 3 there will be standing order for all the what ifs??? I have been asked to help ensure the what ifs are covered, 4 no dobutamine stress test will be performed with out dr present and the Lexascan stress is questionable at the moment if he has to be present (or I may have misunderstood).

My question is this safe practice, walking nuc stress test with only a RN with ACLS and Nuc Med tech present (ofcourse we would have a crash cart). I know there are occasions that the test is changed from walking to chemical because patients heart rate doesnt increase to the 85 - 90% of max. I am told that if that happens then patient will be rescheduled so the dr can be present for the chemical but that it may not be necessary with lexascan......

I am wondering about the risk that the nurse performing these exams is taking and if there are any guidelines I can refer to?????

Thank you for any help anyone can give

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    Wave of the future... I've seen it at several hospitals, including my own.

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    My hospital has been doing it this way for several years. The physician does not have to be present for ANY of the stresses, only has to be "in the facility." Check with your state board to see if it is within the scope of an RN to perform stresses without an MD present. We had to get a statement from the board clarifying what the limitations are for nurses doing the test.

    That being said, I do not necessarily agree with how we are doing it. The physician "supervising" the test may be present in the facility, but that doesn't mean they are readily available. It is usually a cardiologist and they are typically doing caths, so they wouldn't be able to "come running" if there was a problem.

    Good luck.

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