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COVER STORY


Know Your State’s Nursing Scope of Practice Definitions


Educate yourself to avoid adverse outcomes and litigation BY SAHELY MUKERJI


T


he term “scope of practice” has different definitions in policy and professional documents, which is why it is critical to know how your state’s regulations define the term, says Debra Stinchcomb, RN, CASC, consultant with Progressive Surgical Solutions in Fayetteville, Arkansas.


“The management team of an ASC needs to understand how its state laws define the administrative and clini- cal scope of practice for circulating RNs, monitoring RNs, licensed prac- tical nurses (LPN)/licensed vocational nurses (LVN) and medical assistants (MA) or nursing assistants (NA),” she says. “The management team also needs to know the clinical and legal ramifications arising from scope of practice issues and identify practi-


8


cal solutions to minimize the risk of adverse clinical and legal outcomes.”


Problem Areas As an ASC consultant, Stinchcomb performs mock surveys in many dif- ferent ASCs and says that she sees cases where center staff are not func- tioning within their scope. “The pri- mary reason behind this is that nurs- ing schools are not teaching the legal issues associated with nursing prac- tice anymore,” she says. “I lucked out because I had an instructor who was an RN and an attorney.”


Examples of some of the breaches Stinchcomb has observed include fail- ure to assign RN circulators to each operating room (OR) in YAG, pain and GI cases, a surgeon treating a certified registered nurse anesthetist (CRNA)


ASC FOCUS AUGUST 2017|www.ascfocus.org


as a circulating nurse and an RN cir- culator working with more than one patient.


“These kinds of breaches can occur


because ASCs and their staff often face competing and conflicting demands,” says William A. Miller, partner


at


Higgs, Fletcher & Mack LLP in San Diego, California. “The staff is trying to provide excellent care, sometimes with a heavy patient load. That puts demands on the staff, which could result in staff members performing services beyond their qualifications.” To elaborate, Miller gives the


example of administering an anes- thetic agent and monitoring a patient when the patient comes out of anes- thesia. “If the person administering the agent is not the anesthetist or a staff member qualified to do so under the applicable state laws and regulations, who is administering it?” he ques- tions. “And if something happens dur- ing the administration process when an unqualified staff member adminis- ters the agent, that could lead to seri-


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