While nurses like to believe that the nurses in charge of them have the information necessary to make good decisions, often the decisions are not evidence-based or in the best interest of our patients, or our nursing license. Rather the decisions may be made to save time, thereby saving money (often from a non-medically trained consultant) or upon the request of physicians. Therefore, each nurse MUST know the law and standards of nursing care for your area. Do not blindly follow new mandates. You, and only you, are responsible for your nursing license and the care you provide. What follows is the first of several examples that I have seen in my nursing career.
It was decided that nursing staff would administer Ketamine to treat patients with chronic pain on a medical-surgical floor. The first question should be: What is this drug? Answer: It is classified as an anesthetic. The next question: Am I allowed to administer an anesthetic under my nurse practice act (NPA)? See Minnesota Board of Nursing. Answer: Yes, as long as certain organizational policies and procedures permit this administration.
Prior to this, we had been told that as PACU nurses we could administer Ketamine by this same group of managers/CNS’s. However, I refused until the policy accurately reflected our practice. This, despite management telling us, ‘Don’t worry, the policy is wrong. It will get fixed and in the meantime, you may administer Ketamine in PACU’. I said no. Not until the policy is updated. Never practice outside of your facility’s policies/procedures.
The Board states that there must be guidelines in place to monitor/assess the patient, provide emergency care, educate the patient, and each nurse must personally possess the knowledge of anatomy and physiology, pharmacology, cardiac arrhythmia recognition, etc.
In this circumstance, a lower dose of ketamine was to be given for pain versus a sedation dose. However, each nurse should have a good understanding of the sedation continuum. When the policy was presented to us at the hospital practice committee, it stated that the patient would have their heart rate and rhythm monitored. However, this floor did not have telemetry. I stated that they would either have to change the policy/order-set to remove the word “rhythm” or put the patients on a tele floor. Despite the eye-rolling of some managers, the policy and order-set were both changed to reflect what would be the actual practice and procedure of Ketamine administration on this unit.
As you see, the CNS in charge of this project was not putting her nursing license on the line. Certainly,But my Manager/Supervisor/DON/CNO/CNS said she did not intend to put the staff nurses in jeopardy either. But it would have. That is the reason that each new policy, procedure, and/or medication must be carefully vetted to ensure that nurses are: 1) acting within their scope of practice; 2) acting under a facility policy that accurately reflects the actual procedure/practice; 3) thoroughly educated in each medication as well as any reversal agents, if available; and 4) able to provide emergency care in the event the patient reacts negatively to the administration of the medication.