Ok, I need some input. I have a Critical Care Director (R.N.mind you ) who doesnt understand why I always reference and make my decisions based on what the INS Standards of Care say, and am encouraging updating of our polices to reflect such. She says it is a group of nurses , not Doctors. She would prefer to do or follow along with what a MD says than these standards.
I have told her these standards are what you will judged by in the court of law in the event of any complication related to infusion therapy. She seems to think they are just advice that we can take and chose at will. That ultimately what the DR says goes and not what the standards say.
It is my understanding that these are legal standards that ALL nurses are held accountable to is that not right. I see in the Preface of the Standards it says; Clinicians whould be advised that the Standards is a legally recognized document. Does this appply to some and not others? can we pick and chose??
I tried to compare it to the AORN, or Critical Care Recommendations, but....she thinks if there is not MDs who sit on the board or who are actively involved in the decision making process that these are not items that will we be held accountable for.
Please help me with words of wisdom to help her understand the importance of this.
Thank you in advance, Gina Ward R.N.
Wow you do have a problem when an RN does not understand this. Over the past 17 years, I have been contacted by lawyers to review ~250 to 275 medical records involved in lawsuits. These are all cases involving some type of infusion complications. The very first document I use to measure the practice of the nurses is the INS Standards of Practice. This document identifies what is the actions, interventions, decisions, that a nurse shall and should be doing. Please understand that this document is not the only one used in a lawsuit. The Standard of Care is broader. The legal defnition of standard of care is what any reasonable, prudent nurse would do in the same or similar situation. Many documents come together to determine what the SOC actually is. This depends upon the facts of the case. If this involves contrast extravasation in radiology, the American College of Radiology is added to the INS Standards of Practice and the package insertion information on the specific contrast used. If the case involves an oncology medication, ONS documents are added. If there is a question of infection, then CDC guidelines along with SHEA, IDSA, and APIC are used. Drug and device literature are also used.
In a legal case, the experts used will most often be the same type of professional as the ones named in the case. So nurses testify for or against other nurses. A few states allow physicians to testify as to the standard of care for nurses, but in some of those states that allow this, many lawyers still prefer to have the same type of professional.
I am shocked at her insistent that nurses need to be following only what a medical doctors tells them to do. Nursing is a science with its own set of evidence based practices. There is certainly overlap between nursing and medicine especially in critical care. Many of these studies about infusion/VA conducted by MDs are not going to address all nursing questions because they simply do not have a good understanding of what the nurses are doing. I have also testified many, many times that insertion of a PIV and PICC is nursing scope of practice and not medical scope of practice. Giving all the infusion, fluids, meds, blood, etc is nursing, not medicine. Physicians could not even begin to tell you how to give an IV medication. And I have also seen physicians testify to the fact that a certain question about how catheters are insserted or infusion is given is not in his area of expertise and that would be a question for the nurses.
Additionally, the INS Standards of Practice are used for quality improvement practices as there are numerous areas identified where measurement of nursing practice should be done. This document, along with others that are applicable should be used to establish policies and procedures. These are not simply opinions. This document is based on evidence, some of it is research conducted by nurses and some by physicians. We should not be practicing in solo towers because there is so much collaboration that is needed. And nurses have just as much to teach physicians as physicians have to teach nurses.
Is this nurse a member of AACN or some other nursing organization? I would bet those organizations also have standards and guidelines documents. What does she say about them? What about the ANA Standards for all nurses? How does she think they should be used?
Good luck with your efforts to education her, but keep in mind that you may have to enlist the help of your infection preventionist and risk manager/QI/PI people. They will understand the importance of this document. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you, great info!
Gina Ward R.N., VA-BC
For some unknow reason this reminded me of a statement my dentist uses about flossing.....
Is it essential?? No...but just floss the ones you want to keep! :)
I read your question (and had not scrolled down the page yet to see the comments). My first thought was "Oh, boy, wait until Lynn Hadaway sees this!" And Lynn, you didn't let us down. Could not have said it any better! As far as I am concerned, the INS Standards are equivalent to the Bible in the world of vascular access and infusion therapy. I would NEVER blindly follow what a doctor says in regard to this field - WE are the experts here. Thankfully I have a great medical staff who, for the most part, recognize our skills and expertise, and defer to us. You have a quite a challenge ahead but we all support your efforts - it is very distressing that this RN Director thinks so little of nursing!
Wendy Erickson RN
Eau Claire WI