Time to stop limiting scope of practice! – Repost

Over the past few years state Boards of Nursing have passed rules limiting registered nurses ability to give certain medications. The primary medications are medications used for procedural sedation and rapid sequence intubation.

As i reviewed what documentation that was freely available from the BON’s it was obvious that these rules were based on the fact that themanufacture labeled the medication and anesthetic on the bottle. Not based on any fact, and in a few cases based on information that is at best outdated.

Primary example is the use of Ketamine. At our hospital, the surveyors from DNV (JC Clone) told our DON that it was illegal for nurses to give Ketamine. Didn’t qualify it, just made a blanket statement. Now it’s ok for me to push the paralytic, but I can’t push the Ketamine. I don’t know about you, but I”m scratching my head.

I understand the purpose of BON’s, but the implementation of them is shaky at best. A bunch of nurses who don’t practice nursing, making decision on how I’m going to practice. Some times their decisions don’t make sense. In one state I worked in, it was legal for me to pull a PA Catheter, but it was outside my scope of practice to take out the stitches that secured the inducer before I took it out.. DUH.

The use of medications like Ketamine are becoming a standard of care. Limiting nurses from being able to safely administer medications is actually keeping patients from getting the appropriate care that they need.

So what do we do?

1. Completely redesign and repurpose BON’s. Not going to happen anytime soon.

2. Get an interdisciplinary team together to establish scope of practice and instead of saying NO, establish standard for a safe environment to administer meds.

On a daily basis, I give many medications than can kill my patients. Oxygen, used incorrectly is a toxin. I give medications that have a high risk of anaphylaxis. I give medications that can stop my patients heart of cause him/her to have a stroke. we don’t limit those medication.

In the same states that limit specially trained RN’s from giving those medication, allow EMT-Paramedics with less training to give those medications. In GA the paramedic scope of practice allowed Paramedics to give medications that are approved by the Medical Director.  This means that when I transfer a patient, the paramedic can basically run with whatever meds I’ve got running.

Maybe it’s time for us to get involved.  Talk to our legislators, lobby our BON’s.  Don’t just take it sitting down, stand up and make your voice heard.


About craigb.rn

An aging health care provider thoughts on life, love and 30 years of wiping butts. I have a passion for both critical care and education, and my co-workers think I fall into lecture mode way to often.
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