Yes, I know. I have done mostly those things you mentioned as an ICU RN for many years. Doesn't mean I should be running the show, especially for peds or high-risk patients. I am an open heart recovery nurse for peds and adults. I have managed but with the information given to the surgeon or ologist on the phone or in person. I know my limits. That's why I stopped working in an adult open heart recovery unit that refused to have a CT fellow or surgery resident covering the unit. You could call the surgeons directly at home. If that attending surgeon was committed to what he was doing and wasn't being a j.o., then many times, it was fine. But OMG in that unit some of the attending CT surgeons were, let's say, less than stellar as compared w/ those I had mostly worked with in other units. I can't get specific, but I could tell you it would make the hair stand up on the back of your neck. And when the place just wouldn't staff CT fellows to cover the unit, when there were really seriously problematic patients at night, well, I sweated more bullets and was so overwhelmed, b/c 1. I still need orders for pretty much anything. And 2. when the chest tube is dumping out tons of blood and the pt's beginning to crash, and there is no one to come and help me and give me the necessary orders and guidance, well, it's ethically wrong to me, and it was a liability nightmare. I mean with doc, who I think is a lawyer now, I had to get strong and say, "I can't take the pt back into the OR, open us his chest, look for bleeders, etc. I am not a surgeon. Hell, I am not a physician. I haven't been to med school or through a rigorous residency and fellowship program." Won't say anymore about situation or situations similar to that in that particular unit. Suffice it to say, I happily left there. It just wasn't safe.
There are limits in the scope of what you can do, even if you have an idea of what should be done or are a good critical thinker. There's a point when this overstepping is going to get so out of control; but hey. Everyone wants caps on liability. The hospitals should have to eat large settlements if they refuse to staff with the appropriate amount of quality physicians, instead of putting less educated and less trained personnel to handle situations they should not be handling alone.
I have been in the field long enough to tell you that s^!t happens, and it happens a lot more than people think--especially with more and more complex patients. When it does hit the fan, peeing in your pants is the least of the upset. And if I were a CRNA, I wouldn't work anywhere without good anesthesiologist there, on site. I say this having worked years in ICUs. Too much crap can go wrong too quickly.
What is the point of scope of practice for God's sake?
