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Discussion

Surrendering RN Scope!

I have serious concern about how willing RNs are in the hospital to shrink their scope of practice and be relegated more and more to merely following MD orders. Case in point: our hospital recently created a policy that Ensure drinks required MD order. We're talking food! If that's not firmly still in the RN scope, then what is?? I understand the need for MDs to define parameters for intake, calories, etc. But deciding whether to use a particular drink to accomplish those parameters should be an RN-level decision.

What gets me is that so many coworkers were relieved that they didn't have to make the decision of whther or not to give a patient Ensure if they asked for it. They would much rather follow orders than to think critically about their patient's needs. They had no idea that this is actually a BAD step for nursing, not a good one.

There are many more examples. What do we need to do in hospitals to RECLAIM RN scope of practice?

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    One thing comes to mind: at my facility, we get "critical values." This is typically a lab value that is out of range, but can also be a call from tele about bradycardia, etc. No matter what it is, we MUST call the physician and report it and write down date/time/dr name, etc. I work on an Onc floor, so a low WBC is not an earthshattering issue and does not need to be called at 0400. But we don't get to make that judgment call. I kind of feel it's insulting to my intelligence. I'm sure it's a liability issue too, though.

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    One thing comes to mind: at my facility, we get "critical values." This is typically a lab value that is out of range, but can also be a call from tele about bradycardia, etc. No matter what it is, we MUST call the physician and report it and write down date/time/dr name, etc. I work on an Onc floor, so a low WBC is not an earthshattering issue and does not need to be called at 0400. But we don't get to make that judgment call. I kind of feel it's insulting to my intelligence. I'm sure it's a liability issue too, though.

    I think that is a TJC mandate. It seems like a great deal of the regulations that remove our autonomy come from TJC

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    I think that is a TJC mandate. It seems like a great deal of the regulations that remove our autonomy come from TJC

    I think it is more that hospital administrators choose to implement ridiculous rules based on their interpretation of what TJC wants.

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