Years ago, a seasoned nurse told me she wasn't permitted to take blood pressures early in her career. At the time, physicians "owned" that task.
I too can see how nursing has evolved since the early days of my career. In 1979, ICU nurses weren't permitted to in flate the balloon of a pulmonary artery catheter. Today, ICU nurses routinely perform this and many other critical tasks.
This month's article "Shades of Sedation" (see page 36) provides an excellent example of how the scope of nursing practice continues to evolve-and in the process, provoke controversy. In some states, RNs who've had specialized training-but who aren't certified registered nurse-anesthetists-routinely administer propofol to induce moderate sedation and analgesia during endoscopies and other diagnostic procedures. This practice, nurse-administered propofol sedation (NAPS), is legal in six states but prohibited or not addressed in others. Some nursing and medical organizations support NAPS under various criteria. But others, including the American Association of Nurse Anesthetists, oppose it on the grounds that only practitioners qualified to administer general anesthesia are properly prepared to manage inadvertent oversedation.
Nursing organizations, state legislatures, and health care facilities aren't the only players in controversies like this one. Individual nurses like you also play a part in the evolution of nursing practice. By advocating for changes supported by nursing science, nurses have helped advance nursing duties from sharpening needles in years past to wedging pulmonary artery catheters today.
If you have an idea for expanding nursing practice at your facility, I urge you to launch your own investigation. Study your state's nurse practice act to learn about regulations on nursing practice. Check with appropriate specialty organizations for information on common practices and outcome data. If you find evidence that a nurse can do a procedure more cost effectively, with better outcomes, and within the limits of your state law, advocate for change.
Because no law can specifically address every potential change in practice, nursing boards look at education, clinical competence, facility policy, and the standards of nursing organizations to determine what falls within the general scope of practice. To guide the process, some use a decision tree (and you can too). For an example, see Nebraska's decision tree at http://www.hhs.state.ne.us/crl/nursing/rn-lpn/scope.pdf.
We can be proud of how our scope of practice has grown and our role in shaping it. Who knows better than we do what nurses can offer patients? And can you imagine what lies ahead?
Cheryl L. Mee, RN, BC, CMSRN, MSN
Editor-in-Chief, Nursing2006