Commonwealth of Massachusetts
Board of Registration in Nursing

Case Study - Legal Scope of Practice
Decision Making Guideline

Question:  Is it within the scope of practice for the licensed nurse to remove a femoral sheath after an intra-arterial procedure?

1.	Is the activity to be performed described? 	
YES 		NO  		

2.	Do Board statutes or regulations authorize the performance of the activity being described?						
YES      	NO		NOT CLEAR	

Removing an intra-arterial sheath is part of the final phase of the procedure and is normally based upon the assessment conducted by a physician. The law at Massachusetts General Laws Chapter 112, section 80B authorizes the nurse to perform therapeutics as "ordered" by a prescriber.

3.	Did the basic education of the nurse provide the necessary knowledge, skills and abilities to perform this activity?			
YES		NO 	

Removing an arterial device is not usually part of generic nursing practice, although studying A&P and the physics of the care of the patient post-procedure is an expectation for the nurse.

4. Is performing this activity consistent with the literature and research? 
YES 		NO		

There is literature available from 1998 and 2004 suggesting that it could be considered an appropriate nursing activity with additional education and training.

5. Is there evidence of continued competence and experience in performing this activity?
YES 		NO		

The nurse will be required to engage in additional educational preparation and be deemed competent through a standardized competency measurement tool.

6. Is performing this activity reasonable and the prudent thing to do?
YES 	NO		

The nurse must be prepared in the event that an untoward reaction occurs, and know where and how to access resources.

 7. Can the nurse assure patient safety?		
YES 		NO		

The nurse must be willing to accept the responsibility for the outcome.

 8. Is the nurse prepared to accept accountability for the outcomes associated with performing this activity?				
YES 	NO 		

The nurse must be willing to accept accountability for his/her actions.

_____________________________

This activity is within the legal scope of nursing practice 

	Yes it is, based on the above criteria and in compliance with the definition of nursing pursuant to Massachusetts General Laws Chapter 112, section 80B and the regulations at 244 CMR 3.00.
	
	Comments:

This activity is not within the legal scope of nursing practice 
	
	Comments:

The activity described will allow 	RN   	  LPN     BOTH  to perform: 
	
	The standard of competency and responsibilities for being accountable for one's nursing practice is equally and consistently applied to the RN, LPN and APRN.

The activity described will not allow RN   LPN  BOTH  to perform: