As a registered nurse, do you know the scope of practice? Have you reviewed the Nurse Practice Act of your State? Even with the Nurse Practice Act, what does failure to keep abreast of current theory and practice mean?
The policies and procedures of the facility at which you work are your guiding source. If your policies and procedures covers you, and you are following them, you are practicing within the scope.
However, if there is no official policies and procedures, you may not be practicing within your scope.
If a physician offers to teach you how to suture in place a PICC line, is that acting within the scope? Check you policies and procedures!
If it is the norm in the emergency room that when a patient with abdominal pains arrives to start an IV, draw labs and order a flat plate of the abdomen before the physician sees the patient, do you have standing orders to cover you or is this just a unit norm? Again, your policies and procedures will guide you.
What if a physician orders a medication that is contraindicated and, without speaking to the physician, you write an order to discontinue it and planning to speak with the physician later? I am sure that your policies and procedures do not allow you to discontinue orders without speaking with the doctor.
You may think you are helping the patient in expediting the health care process but, once again, if your facility does not have policies and procedures to cover you, you are practicing medicine without a license and practicing outside the scope of your nursing license.
When a physician issues a verbal order, make sure that you review and verify the order with the doctor. Also, document your conversation in the nurse’s note because, if the physician does not remember giving you that order, by placing a summary of your conversation in the nurses’ notes will help prove that the conversation indeed took place.
Remember that each facility has its own policies and procedures. At one facility, you may be able to do something which is not allowed at another. So, make sure that you not only know your facility’s policies and procedures but that you follow them.
If you are asked to do something that just doesn’t feel right in your gut, talk to your risk manager. The risk manager is here to help and make sure that the patients are getting the best of care.