In
an earlier post, we detailed the advantages that both hospitals and patients gain when non-physician vascular access specialists (VAS’s) are allowed to place central venous catheters (CVCs) and arterial lines. Now a recently published article describes how a vascular access team at a large community hospital in Illinois expanded its scope of practice to encompass these lines.
The team’s story has much to teach those with an interest in the issue, from hospital decisionmakers to VAS’s who want to apply their expertise in new ways. The peer-reviewed article, titled “A Vascular Access Team’s Journey to Central Venous Catheter and Arterial Line Placement,” appears in the June 2015 issue of the Journal of the Association for Vascular Access (JAVA).
With some added training, VAS’s can quickly become competent to place CVCs and arterial lines. In doing so, they bring unique advantages to the patient. For instance, they are generally more experienced in line placement than are physicians. They are more experienced placing lines with ultrasound guidance and tend to have more time available for placing lines. They are also paid much less than doctors. This means patients can receive important therapies earlier and with fewer complications, while hospitals make better use of physicians’ more highly compensated time.
A vascular access team may encounter challenges along the way, however. Physicians are often reluctant to delegate these responsibilities. The Illinois team handled both the politics and the clinical transition exceedingly well. The obstacles they overcame were not much different from what nurses in other facilities would face. That’s why the article is so instructive.
The team built its case to expand its scope of practice carefully and methodically by:
- Nurturing relationships with physicians who respected team members’ knowledge and skills
- Enlisting those doctors as mentors
- Documenting the team’s competence to the appropriate hospital committees
- Pursuing training in CVC and arterial line placement
- Writing a formal business plan and presenting it to the hospital’s chief nursing officer
- Relying on the team’s physician allies to reassure reluctant decisionmakers that the change was worthwhile and important
The article concludes with authors Constance Girgenti, RN, VA-BC, Elizabeth Donnellan, BSN, RN, VA-BC, and Teon Smith, BSN, RN, VA-BC reporting results from the VAT’s first year of expanded practice. The project has achieved fast and skillful line placements, a far more efficient use of clinical staff, and no placement-related complications.
With an ongoing physician shortage, an aging population, and more patients in the healthcare system because of the Affordable Care Act (aka Obamacare), the stars are aligning for more teams to follow in the Illinois team’s footsteps. There’s more emphasis than ever on providing healthcare more efficiently, improving outcomes and reducing costs. Expanding the scope of practice among vascular access specialists is one of the tools hospitals can use to get there.
More resources:
- White paper on nurse placement of central lines.
- Info about Teleflex course on CVC insertion
- U.S. map showing the status of nurses’ scope of practice for CVC placement state-by state, available here.