What are the ethical issues in this situation?

Scope and Standards of Practice


A young woman is admitted to the intensive care unit (ICU) after

having several episodes of nonsustained VT credited to a history of

viral cardiomyopathy. While she is being stabilized, she codes

(pulseless VT) and needs intubation. A nurse anesthetist tries to

intubate her 3 times unsuccessfully. There is an unforeseen delay in

the arrival of the anesthesiologist. P.F., an ICU nurse who is a

paramedic certified in advanced trauma life support (ATLS) and

advanced cardiovascular life support (ACLS), tries to intubate the

patient and does so successfully. The next day the nursing supervisor

questions P.F. about intubating the patient since this is not within the

scope of practice for an ICU nurse.

Ethical/Legal Points for Consideration

• The RN Scope of Practice, including rules and regulations that

guide practice, are defined by individual state boards of nursing

and can vary from state to state.

• Individual agencies have policies and procedures that describe

the scope of practice for nurses. These can be more restrictive

than those of the state.

• P.F. has had training, education, and certification beyond the

usual nursing role.

• The life-threatening situation is an extenuating circumstance.

• Negligence may have been a factor if P.F., who is a nurse with

training and experience, had not acted.

Discussion Questions

1. What would you have done in this situation?

2. How would you respond to the nursing supervisor?

3. What are the legal ramifications for P.F. in this situation?

4. What are the ethical issues in this situation?

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