Do you know what your scope of practice (SOP) is as a licensed LPN, RN, or APRN? If not there are alot of materials out there (in your workplace and on the internet) to help you figure out if a particular task or procedure is within your legal scope of practice.
Did you know practicing outside of your legal scope of practice is violation of the State Nurse Practice Act and/or Board of Nursing regulations?
You may be thinking okay tell me something that I don't know.
Did you know most healthcare facilties terminate the nurse after the internal investigation of scope of practice allegations and then file a complaint against the nurse with the State Nursing Board?
Its early in 2010 but I have already received four phone calls and inquiries involving scope of practice allegations that have been reported to the State Nursing Boards in Ohio, Kentucky, and Indiana. Most employers terminate the nurse(s) involved in these types of cases and then file a complaint with the State Nursing Board. Some will initiate a corrective action plan in the workplace and continue employment with a Last Chance Agreement or workplace probation (I have seen 30 days, 90 days, 6 months, 1 year, and 2 years. I know). However the employer is still required (especially in mandatory reporting states) to filed a complaint with the State Nursing Board.
I don't know what the economy is like in your neck of the woods but I don't know anyone who wants to be fired or discharged and then reported to the State Nursing Board.
Employers have legitimate concerns with patient safety, the legal exposure, and the potential liability when allegations of practicing outside of the legally permissible boundaries of one's license surface. I had a nurse attorney (who I have known for several years) tell me in her position as in-house legal counsel for a large teaching hospital in a super-sized health system that "its just piss poor practice" for a nurse to practice outside of his/her SOP. She is of course looking at SOP violations from the healthcare organization's perspective.
From your perspective as an individual nurse at the bedside, do you think its just poor practice or do you think there are more compelling reasons why this frequently happens?
The State Nursing Board takes these types of cases serious, employers deal with these types of issues swiftly, and IMHO the only folks who don't take these types of cases and allegations serious are nurses. Its not okay to practice outside of your scope regardless of whether its "customary unit practice", "everyone else is doing it", and/or "you think or know you can get a doctor to cover the order."
For those of you who don't think its serious take a look at this link. http://www.wave3.com/Global/story.asp?S=1469399&nav=0RZEIM3P. This involved Kentucky nurses who were reported to the Kentucky Board of Nursng.
Before another State Nursing Board, one of my clients got nailed a few years ago with Board discipline for multiple SOP issues as a RN. She/he completed his/her probation and then continued his/her education as a APRN. The SOP issues as a RN reared its ugly head in regard to a hospital credentialing and privileging recently.
There are alot of resources for Scope of Practice and most State Nursing Board have decision trees for scope of practice considerations. For example see