Scope and Standards of Practice
Situation
A young woman is admitted to the intensive care unit (ICU) after
having several episodes of nonsustained VT credited to a history of
viral cardiomyopathy. While she is being stabilized, she codes
(pulseless VT) and needs intubation. A nurse anesthetist tries to
intubate her 3 times unsuccessfully. There is an unforeseen delay in
the arrival of the anesthesiologist. P.F., an ICU nurse who is a
paramedic certified in advanced trauma life support (ATLS) and
advanced cardiovascular life support (ACLS), tries to intubate the
patient and does so successfully. The next day the nursing supervisor
questions P.F. about intubating the patient since this is not within the
scope of practice for an ICU nurse.
Ethical/Legal Points for Consideration
• The RN Scope of Practice, including rules and regulations that
guide practice, are defined by individual state boards of nursing
and can vary from state to state.
• Individual agencies have policies and procedures that describe
the scope of practice for nurses. These can be more restrictive
than those of the state.
• P.F. has had training, education, and certification beyond the
usual nursing role.
• The life-threatening situation is an extenuating circumstance.
• Negligence may have been a factor if P.F., who is a nurse with
training and experience, had not acted.
Discussion Questions
1. What would you have done in this situation?
2. How would you respond to the nursing supervisor?
3. What are the legal ramifications for P.F. in this situation?
4. What are the ethical issues in this situation?
