Journal of Advanced Practice Nursing
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New Mexico Nurses Change Anesthesiologists Laws, With Emergency Docs Help

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The New Mexico Society of Anesthesiologists says a rule change adopted Monday by the state Board of Nursing “greatly compromises patient safety” but an emergency doctors group says it simply formalizes what nurses have been doing safely for years.

The rule changes to the New Mexico Nurse Practice Act allows registered nurses, under the guidance of doctors, to administer deep sedating drugs, something that “goes way beyond the scope of their practice and beyond the periphery of their capabilities,” said Dr. Cameron Burrup, president of the New Mexico Society of Anesthesiologists.

The New Mexico chapter of the American College of Emergency Physicians, however, supports the rule changes, and a spokesman said registered nurses have been administering these sedating drugs for years. The new rules simply give more formalized structure and guidelines concerning the nurse’s role.

Anesthesiologists administer drugs along a “continuum of depth of sedation” that progresses from mild to moderate to deep to general anesthesia, Burrup said. Among the more potent of these drugs are ketamine and propofol, drugs that require a great deal of training to use and should be administered only by physician anesthesiologists, certified registered nurse anesthetists and anesthesiology assistants, he maintains.

Also of concern, Burrup says, is the rule changes do not restrict registered nurses to administering the anesthetizing drugs in a hospital’s emergency room or intensive care unit.

“You could go to a clinic for a colonoscopy where a registered nurse administers propofol, and let’s say you have a bad reaction and stop breathing. You might expect the gastroenterologist to save you, but they’re not trained to deal with the adverse effects of deep sedation due to general anesthesia and they are not trained to secure a person’s airway to make sure the patient is breathing.”

While the concern expressed by Burrup and his anesthesiologists group is genuine, it also is misplaced, says Dr. Eric Ketcham, medical director of the emergency department at the San Juan Regional Medical Center, and president-elect of the state chapter of the American College of Emergency Physicians.

“The new rules do not change a nurse’s scope of practice,” rather it gives “structure to the nurse’s role and provides requirements and guidelines,” he said.

Nurses must “demonstrate clinical competency as well as an understanding of the physiology of the medications.” Further, Ketcham says, the new rules address the equipment that must be present when deep sedation is administered, and they specify that an “airway expert” must be available when procedural sedation is performed.

Deep sedation is regularly performed in emergency rooms across the country and ketamine and propoful “are the workhorse drugs of emergency medical procedural sedation.” Registered nurses have been administering them for years under the supervision of physicians, Ketcham says.

If anything, he says, the new rules should make anesthesiologists feel better knowing that registered nurses who work outside emergency rooms and intensive care units have clearer guidelines regarding their role in administering procedural sedation.



 
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