What are the Nurse Interns on your unit allowed to do?

classicdame, MSN, EdD · Jun 18, 2008

In Texas the Nurse Practice Act defines externs as unlicensed assistive personnel. Therefore, they are not allowed to do any task for which a license is required. They may not delegate. They may not be assigned patients or insert foley catheter's or change sterile dressings. There is a list of don'ts in the NPA (www.bne.state.tx.us). HOWEVER, the nurses try to pull them in to teach them assessment, order transcription, protocols --- all with nurse supervision. They may only document what they do.

llg, PhD, RN · Jun 18, 2008

By law, our externs are also not allowed to perform any task "independently" that requires an RN license. So, their role is limited to CNA tasks when they are working without an RN at their side providing direct supervision.

However, our externs get to do a lot of more advanced RN skills (everything, no specific limits) as we consider our extern program an educational program -- not just a "cheap labor" program. Externs are assigned to an RN preceptor and together, that preceptor-extern pair provides care for a 1-nurse assignment. The extern can perform any RN task as long as the RN is at her side, directly involved with the procedure, taking full legal responsibility for it. In those cases, the extern is doing the task "together, with the RN -- assisting the RN" and not doing the procedure "on her own" in any sense of the word.

Of course, that means we have to utilize a preceptor for every shift worked by an extern -- and that severely limits the amount we can hire.

babyktchr, BSN, RN · Jun 18, 2008

To be honest, I allow externs to do a LOT more than what is allowed. I am supervising anything I do with them, and it isn't anything that would cause harm to the patient. When I was in nursing school, I worked as a nurse tech/CNA in ICU. Those girls taught me EVERYTHING. When I graduated, I was an easy orientation right into ICU. It was an invaluable time for me, and, in my opinion, if you are externing and this is your area you want to work in, then you shoud experience what it is to work there. MANY do not agree, and that is fine.

In answer to your question though, what you are allowed to do is dictated by the facility you are working at for your externship.

justme1972 · Jun 18, 2008

To be honest, I allow externs to do a LOT more than what is allowed. I am supervising anything I do with them, and it isn't anything that would cause harm to the patient. When I was in nursing school, I worked as a nurse tech/CNA in ICU. Those girls taught me EVERYTHING. When I graduated, I was an easy orientation right into ICU. It was an invaluable time for me, and, in my opinion, if you are externing and this is your area you want to work in, then you shoud experience what it is to work there. MANY do not agree, and that is fine.
In answer to your question though, what you are allowed to do is dictated by the facility you are working at for your externship.

Here is a list of our restrictions.

1. We an insert an IV, change the tubing, but cannot start it.

2. We cannot program the IV pump.

3. We can prepare the meds, but administer them.

There are a few more.

We were told that the legal liability is different on the hospital when you are a student versus an employee of the hospital.

We were also told that violating the rules for the intern guidelines is grounds for dismissal from the program.

countdown2RN · Jun 18, 2008

we were told that the legal liability is different on the hospital when you are a student versus an employee of the hospital.
we were also told that violating the rules for the intern guidelines is grounds for dismissal from the program.

i am actually considered an employee of the hospital. so far i haven't really preformed cna/tech duties, except for sometimes giving the babies baths. i am able to do many things, (with the exception to drawing blood and meds) but am usually supervised by another nurse. there are still [color=dimgray]some gray areas where i am (not only for me, but for the rn's orienting me too).

thank you all for your the input!

justme1972 · Jun 18, 2008

i am actually considered an employee of the hospital. so far i haven't really preformed cna/tech duties, except for sometimes giving the babies baths. i am able to do many things, (with the exception to drawing blood and meds) but am usually supervised by another nurse. there are still [color=dimgray]some gray areas where i am (not only for me, but for the rn's orienting me too).
thank you all for your the input!

well, the reason was, that who caused the transport of the medication from point a to point b falls under "requiring a license" in our state...supervised by an rn or not. because when you are an employee of the hospital, you are not performing as a student, so anything requiring a license to do, you can't do.

in other words, if something happens to that patient after you administer the medication, the rn supervising you is not responsible...it's between you and the hospital, and legally that means (if your state requires a license to give meds), you did something that was against the law.

did your program not give you guidelines for the program?

there weren't any gray areas in ours...it was plain black and white.

when you are a student, the laws permits you to do more, and you fall under the license of the clinical instructor and the school.

eandgsma · Jun 18, 2008

I externed for a year before being hired into L&D. I was allowed to do everything along with my RN. I started IVs, I gave meds, I interpreted FHT tracings, I did VEs, I helped with deliveries, I did baby assessments, I inserted foleys, I placed cytotec, I charted everything I did. All the RN did was show me how, back check what I did, checked my charting, made a preceptor note to show they were responsible for me. It was an invaluable learning experience for me. It helped me in school as well because I became more confident in caring for my patients in clinicals. I was no longer afraid every morning when I stepped into a patient's room to do assessments, etc. I was hired to the floor I externed on as a new grad and I was an easy preceptee. There were a few things I hadn't had a chance to do when I was an extern that I did when I was a new grad though, like put on an FSE. I still have not been successful putting in an IUPC. That's because we don't do them very often.

Take this time to learn all you can, asks lots of questions! And have fun!