Nurse Administered Sedation : The Legal Aspects

Recently, my business partner and I were invited to speak at a nursing conference. He did his portion of the talk on sedation techniques and considerations. My portion was to focus on the legal aspects of nurse administered sedation and scope of practice issues. At the conclusion of our talk, about 12 nurses came up to me with concerns they were having, such as being asked to preform tasks in which they felt uncomfortable. The concerns ranged from being asked to administer propofol, to " our administrator wants us to disregard the n.p.o status so that we can squeeze in more cases". This reinforced my desire to help nurses in such situations.
As a former nurse turned consultant, I receive many similar inquires vie e-mail and phone calls.
Some cases are rather disturbing, I have spoken with several nurses that have resigned from their positions as a result of not being able to reach a resolution in similar situations. On one hand this appears unfortunate, on the other, I have to applaud the courage of those who stood and said "I will not do that". Now I am not a lawyer and I have never played one on T.V. so the following is simply for your consideration.

As registered nurses respond to the increased number of procedures that require sedation services and become more involved in the administration of these services, scope of practice issues arise. As a result many state boards of nursing have enacted formal policy statements that define and identify the responsibilities and requirements of the registered nurse involved in the administration of sedation services. It is the nurses responsibility to know what the policy is in his/her state, organization, department and job description.
After reviewing many of these states requirements some common threads emerge. 1) That the nurse be able to demonstrate competence. 2) The nurse must have specialized education. If one can at least provide documentation to support these two items, negligence or malpractice is more difficult to prove, at least in most reasonable cases.

Here are a few suggestions for demonstrating competence and having specialized education;

• Understanding the objectives and definitions of sedation
• Understanding the continuum of sedation and analgesia
• Understanding the ASA classification system
• Knowing when to seek a consult
• Maintaining ACLS certification
• Receiving conscious sedation training, certification and credentials
• Being current with state and organizational sedation policy
• Understanding of best practice monitoring techniques
• Becoming involved in a peer review and process improvement program
• Being current with national and local nursing standards of accepted practices
• Demonstrate continuing education specific to your field
• Understanding of core principles established by national specialty societies involved in sedation and anesthesia
• Fostering of communication between all members of the sedation team and others teams in your community
• Join and be involved in specialty professional associations

Nurses have a duty to deliver safe nursing care to their patients. To that end, their standards of care include being cognizant of their "actions" for which nurses are liable. Through utilizing an ethical decision making process, appropriate training, experience and logical analysis on a case by case basis, nurses will be competent, confident, and as always, be acting in the best interests of the patient.

Best wishes,

Randy Pigg BSN

www.sedationconsulting.com