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Within scope of practice?


I'm working in outpatient cardiology where i deal with telemedicine calls to our CHF patients. I usually call them ask them for their BP weight log, their medications and compliance to meds, etc.

So yesterday I encountered a situation where I did not know how to respond...

I spoke to a patient and relayed all of the information to the attending that I work with. She then asks me what I thought the patient's volume status was and if I would increase, decrease or keep the medications all the same. She asked me this via email. I felt really uncomfortable responding to this as it felt like it's not within my scope of practice. In addition to that this patient has a very complicated history with many conditions that the symptoms can be attributed to. Am I wrong in thinking this way?

The attending has done something similar while in person and while I appreciate that she seems to value my input I also feel like she's treating me like a resident of fellow which I am not.

What are your thoughts ?

~Mi Vida Loca~RN, ASN, RN

Specializes in Emergency Dept. Trauma. Pediatrics. Has 6 years experience.

To me, it sounds like the attending is trying to see what and how much you know. For what reasoning I am not sure, but it could be to help teach you which could be invaluable. It could be because

One of my best friends was a 3rd, 4th and 5th year resident while I worked with him. (he did emergency medicine and internal medicine so 6 year residency) and then his 6th year he was an ICU fellow *actually was for 16 months*.

Anyway, when he would work rotations in the ER we would work together and he would pick up my patients. He absolutely treated me like an intern/resident but by my choice and his willingness to teach me. I would go in to see my patient like any other day, I would come back and present the case to him, tell him what I felt we should do and differential diagnosis and treatments.

I LOVED IT. I didn't work out of my scope. You answering her questions is not out of your scope. If she told you to determine treatment and prescribe and change doses; then yes, you would be working out of your scope.

But that's not what she is doing. She is seeing where your thought process is. If I were you I would absolutely embrace this and take advantage of the attending coming to you like this. I am someone that is always wanting to learn. Having my best friend do this with me taught me to be a better ER nurse. Not just that but because he is boarding in triple specialties it has also taught me to expand my thinking to not just in the ER but looking at the big picture when they leave the ER.

littlelimabean01, LPN

Specializes in Geriatrics, Trach Care, Diabetes. Has 5 years experience.

Wow, You are lucky. I agree with Mi Vida Loca. Absolutely, you should embrace this as a learning opportunity. I love when doctors respect and seek nurses opinions. After all we are the ones there with them for 8,12 hours a day. BKchick you should take it as a complement, also this doctor could be unsure of themselves and see you and someone who is good to bounce ideas off of.

~Mi Vida Loca~RN, ASN, RN

Specializes in Emergency Dept. Trauma. Pediatrics. Has 6 years experience.

Somehow part of my post didn't come through. I had stuff written after the because in the first paragraph. lol

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

As a nurse helping to manage heart failure patients in the outpatient setting, assessing volume status is usually the number one expectation. The HF clinic nurses in my area are generally expected to independently adjust diuretics based on this assessment (some patients even do this themselves), as long as the nurse and the ordering provider have a common understanding of how the diuretics will be managed (either based on specific parameters or thorough understanding of the providers intentions) then it's not necessarily out of your scope.

Scope of practice is generally anything that is not specifically prohibited to part of your scope, where a competency is initially established, evaluated, and kept current. So if you're not familiar with how to evaluate volume status then it's not in your scope, if this is an established and properly maintained competency for you then it is within your scope.

caffeinatednurse, BSN, RN

Specializes in Med-surg, telemetry, oncology, rehab, LTC, ALF. Has 4 years experience.

No, it's not outside of your scope of practice. She respects your opinion - I would take that as a compliment.

Over the past several months, I've built a good working relationship with one of our providers. She knows that I won't call her unless the problem is legitimate and requires her attention. More than once, she's asked me over the phone what I thought was going on with the patient. It felt weird at first to answer her but now I realize she's giving me credit for being at the bedside and seeing exactly what is going on with the patient. You should, too.