Scope of Practice for 4thSemester Nursing Students

NURS 479 Transition to the Professional Nursing Role

Students in NURS 479 are expected to perform the following patient care activities:

1. Patient assessments, including physical assessments, admission assessments and post procedure
assessments. In addition, these students are expected to assess, monitor and chart on patients who
have intravenous infusions, blood product infusions, chemotherapy, TPN, PCA and Epidural
analgesia.
2. Care Management: Students will assume increasing responsibility for organizing, prioritizing and
coordinating patient care for the group of patients to whom they have been assigned, in conference
with their preceptor for the day of care. Students will work towards assuming care for the entire RN to
patient assignment.
3. Delegation and supervision of appropriate unit personnel/care team.
4. Documentation: Complete written and computer notes for admissions, transfers, discharges and all
assessments listed above.
5. Plan of care: initiates, reviews, revises, and evaluates the patient plan of care in discussion with RN
Preceptor. This includes teaching of patients and their families, with documentation of teaching in the
P.O.C.
6. Interdisciplinary collaboration/coordination of care.
7. Participate in patient care conferences when possible.
8. Team communication: assumes increasing responsibility for reporting patient status within
multidisciplinary team as part of care for assigned patients.
9. Patient care technical tasks: may perform only the psychomotor skills which have been previously
taught in the College of Nursing skills lab such as but not limited to IV starts, heparin lock
conversions; discontinuing IV catheter; nasogastric tube insertion; urinary catheterization, including
intermittent catheterization and insertion of indwelling urinary catheters; enteral feedings, oral
feedings (e.g., babies, children, adults); dressing changes; central line site care/dressings; colostomy
care; hygiene; range of motion – and other procedures and tasks as agreed with Preceptors, provided
the procedure does not require a hospital course or certification.
10. Unit specific specimen testing which would be done by RNs on that unit, under the direct supervision
of the RN Preceptor.
11. Accessing/flushing central /arterial lines, and obtaining blood samples from a central line for
lab work are within the RN scope of practice, but are done only in the presence of the RN
Preceptor. Arterial Lines are not to be removed by the student, but they can draw labs from
the Arterial line device port while the RN is supervising this procedure.
12. Medication administration, including Schedule 1-3 drugs, provided Preceptor countersigns controlled
substance records. Exception – administering regimens, such as chemotherapy, which require
special certification. If patients under the care of a student are receiving chemotherapy or blood
products or any other treatment which can be performed by certified/licensed RNs only, the student is
expected to monitor that administration; perform continuing assessment of the patient; identify
problems and report observations to Preceptor promptly.
13. IV therapy: may hang IV bags; change IV tubing; monitor IV therapy; document response and I&O.
14. Oxygen therapy: initiate, monitor, discontinue per physician’s written orders and document response to
therapy.
15. IV starts: Under the supervision of the RN, students may start Peripheral IV’s.
Phlebotomy: Students are able to draw blood from an IV start, central line, may also draw via
Butterfly
Needles and may perform Heel sticks on infants only if student completes unit glucometer
competency.
4th Semester STUDENTS MAY NOT: May not independently perform any procedure which hospital
policy requires an RN be certified to perform. These include and are not limited to:
● Conscious sedation; However, students may under the supervision of the RN assist with setting up or
adjusting pump or tubing for epidural analgesia;
● Co-signing as second RN for narcotics and/or cardiotonic drips, TPN, blood products, heparin insulin;
● Initiating and administering chemotherapy (or co-signing as second RN);
 ● No Phlebotomy Unless: IV start or drawing from Central Line and or Arterial Line or using Butterfly
needles occurs under the Supervision of the RN.
● No TB patients (unless students have been fitted with special Hepa filter masks);
● NO VERBAL ORDERS! Students will advise providers that they are students. The provider must
speak to a hospital employed RN. If the provider is trying to give a verbal order, rather than write it;
students are advised to hand the provider the chart and ask that s/he write the order;
● Push IV drugs without an RN present; May NOT "cover" for their Preceptors or any other RN when
that RN is off the assigned unit.
● May NOT provide care to Department of Corrections Prisoners at Carondelet Hospitals.

PLEASE NOTE: For needlesticks or blood and body fluid exposure, please refer to the blue laminated
card "Student Exposure to Blood/Body Fluids Procedures, July 2015." All questions relating to scope of
practice are to be referred to the Clinical Faculty, RN Preceptor, or the appropriate Nurse Manager.