Although enrolled nurses (EN’s) work under the guidance of the registered nurse (RN’s), they are responsible for the decisions they make. With the recent increase in the demand for quality care and the emergent of more strict professional standards and legislation guiding the nursing and midwifery practice, it is becoming quite imperative for the EN’s to understand their Scope of Practice. One of the key areas where the EN’s are required to have a clear understanding of their Scope of Practice is the administration of intravenous (IV) medications. Involvement of EN’s in the administration of IV refers to process of giving “epioid infusion, cytotoxic, epidural or regional medication” to patients under the supervision of RN’s or where the RN’s have already initiated the medication (Nursing and Midwifery Board of Australia, 2012a, p. 9). The current paper explains why is becoming extremely important for the EN’s in Queensland to understand their scope of practice in relation to the IV medications. As well, the paper examines some of the risks involved in the administration of IV medications.

The Increasing Need for Understanding of Scope of Practice

There is an increasing demand for quality healthcare services by the public during the recent years. In response, government and professional bodies have defined clear standards and laws and regulations that guide the nursing practice in order to enhance the quality of the healthcare services given to the patients. In Queensland, there are various regulatory bodies that influence the Scope of Practice of the EN’s and their involvement in the administration of IV medications. To start with, the Australian Nursing and Midwifery Council (ANMC) established a Decision Making Framework that guides the involvement of the EN’s in the administration of IV medications (ANMC, 2010, p. 23). When making decisions regarding their extent of involvement in the IV medications, the EN’s must give consideration to the professional standards and all regulations that define their Scope of Practice (ANMC, 2010, p. 23). EN’s who have completed their education can be involved in IV medications only when guided by RN’s with knowledge and experience in the respective IV medication. The EN competency standards also require the EN’s not to engage in medical administration when they are not competent to do so. For an EN to be involved in the administration of IV medications, he/she must complete the intravenous unit titled ‘Administer and monitor intravenous medication in the nursing environment (HLTEN519C)’ (Nursing and Midwifery Board of Australia, 2012c, p. 8).

A Code of Ethics and Code of Conduct formulated by the Australian Health Practitioner Regulation Authority also requires EN’s not to engage in IV medication when they are not competent to do so. EN’s are only deemed competent to administer IV medications when they have completed the study of HLTEN519C and acquired any other relevant training (Nursing and Midwifery Board of Australia, 2012b, p. 17). The Health Practitioner Regulation Act 2010 stipulates that EN’s with a notation on their registrations should to administer medications (Parliamentary Council, 2014, p. 47). Sections 52 and 155 of the Health Drug and Poisons Regulation QLD 1966 stipulates that EN’s should not administer medications unless under the supervision of a registered nurse (Stainton et al et al. 2011, p. 55).

Section 18 of the Controlled Substances Act 1984 stipulates that only registered health practitioners can give prescriptions for drugs, unless they are endorsed by the Health Practitioner Regulation National Law (Australian Government Department of Health and Ageing, 2010, p. 85). Section 14 of the Drugs, Poisons and Controlled Substances Act 1981 also stipulates that only persons who are allowed by the Health Practitioner Regulation National Law and other regulations to administer medications can give prescriptions for drugs and other substances (Ministry of Health, 2012, p. 1). In short, the aforementioned frameworks and regulations define the scope of practice of the EN’s. Lack of knowledge regarding the scope of work can increase the risks involved in the IV medication, including causing harm to the patients. At the same time, engaging in IV medication administration when an EN is qualified involves violation of the aforementioned professional standards and legal requirements. The violation can lead to severe repercussions to the EN, including prohibition from engaging in the nursing practice, fines or even jail terms. As such, it is imperative for the EN’s to understand their scope of practice in relation to the IV medications. .

Risks in the Administration of IV Medications

            There are various risks involved in the administration of IV medications that students should be aware of. One of the risks involves lack of proper client identification. Precisely, there is a risk resulting from the possibility of mismatch between a given patient and the components of an IV medication care. Failure to identify the patient correctly may lead to errors such as treating the wrong person, giving the wrong medication and using wrong diagnostic testing procedures (Stainton et al., 2011, p. 117). Secondly, administering IV medication has potential side effects. One of the main side effects is allergic reaction to the IV drugs. In some cases, the body can react to the drugs, leading to severe complications, some of which can be life-threatening. The IV medications are injected into the body veins as infusions. Giving the injections rapidly may damage the vein or cause toxicity. Bubbles of air in the syringe can enter the blood circulation system, leading to problems in the circulation. IV therapy can lead to blood clots which can lead to tissue damage. Inability to determine whether a patient has been immunized before is also a risk that can lead to excess dosage or toxicity in the body due to repetition (Stainton et al., 2011, p. 117).

Another risk is the possibility for contra-indications for IV administration. Some irritant and vesicant solutions (pH>9 or pH<5) can lead to tissue necrosis and blistering if they leak into the body tissues (Stainton et al., 2011, p. 121). They include vasopressors, some chemotherapeutic agents and sclerosing solutions. The risk increases when they are given through the peripheral vein, rather than the central vein. Lastly, there is a risk of violation of the legislation requirements of IV medication administration. As such, the nursing students in Queensland need to discuss and understand the legal requirements of IV medication requirements mentioned earlier in this paper.

Conclusion

            In conclusion, there are various risks involved in the administration of the IV medication. At the same time, there is increased need for quality care by the public. As such, professional bodies and government agencies have established professional standards and legislation framework that defines the scope of work for the EN’s, with the aim of protecting patients from harm. Lack of proper understanding or failure to adhere to the guidelines that define the Scope of Practice for the EN’s can lead to severe repercussions. As such, it is quite imperative for the EN’s to understand their scope of practice.

References

Australian Government Department of Health and Ageing. 2010. Health Legislation

Amendment (Midwives and Nurse Practitioners) 2010, DoHA, Canberra

ANMC. 2010. National Framework for Decision Making by Nurses and Midwives on Scopes of

Practice, ANMC, Canberra.

Nursing and Midwifery Board of Australia. 2012a. Guidelines for Continuing Professional

Development, NMBA, Melbourne.

Nursing and Midwifery Board of Australia. 2012b. Endorsement as a nurse practitioner

registration standard, NMBA, Melbourne

Nursing and Midwifery Board of Australia. 2012c. Review of competency standards for the

enrolled nurse, NMBA, Melbourne.

Parliamentary Council. 2014. “Health Practitioner Regulation National Law Act 2010       (Queensland).” Viewed August, 12, 2014 < www.legislation.qld.gov.au>

Ministry of Health. 2012. “Drugs, Poisons and Controlled Substances Act 1981.” Viewed

August, 12, 2014 http://docs.health.vic.gov.au/docs/doc/4F84C891B6FFAC1ECA2579EC00037E7C/$FILE/gazette-rh.pdf

Stainton, K., Hughson, J., Funnell, R., Koutoukidis, G. & Lawrence, K. 2011. Tabbner’s

Nursing Care: Theory and Practice. London, UK: Elsevier Health Sciences

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