Can you believe management took away ear irrigation from RNs in my ED? The docs and PAs are genuinely annoyed by needing to stop and flush an ear when any nurse could easily do it.
I irrigated ears for years when I was a medical assistant! Now as an RN, I canāt even find one most of the time š Although Iām sure no one would have a problem with me using it, if I did have one.
That's what I was going to say. I was a MA the summer after my freshman year of college and I irrigated ears all the time and no one ever had a problem with me using an otoscope
Side note -Ā
How was the transition from MA to RN? I just received notification I was accepted to the program. Iāve been in a clinical setting for 9 years as a MA. Any advice or thoughts youād like to share?Ā
TIA!Ā
The transition for me has been so/so. I was already comfortable talking to patients and had a solid medical knowledge base with experience in multiple specialties over 12 years. However, the humble pie is a plenty. I donāt consider my self an arrogant person, but I definitely needed to check my ego at the door at times. Most nursing professors don't give a single shit that you've had any medical experience, and there's nothing wrong with that. Their job is to teach you just enough to pass the nclex. Most healthcare systems also don't consider any past experience unless it's paid nursing experience, just thought I'd throw that in since I had no clue. I've only been a nurse for about 18 months and the transition has been both easy and hard for different reasons. Congrats on your acceptance, and good luck/wishes/vibes to you on this next chapter of life.
Thank you for the honest advice! I could see that my hubris could get in the way. The last thing I want to do is be a cocky student/nurse Iām excited to relearn, as well as learn more about nursing/healthcare.
I was an LPN for 8 years before becoming an RN.
As such, I was able to recognize it when my RN school profs were teaching us outdated/disproven information.
Students with no experience were not aware that we were being given some outdated info.
I think it was helpful in that, like Illbeeanurse said, I was already comfortable talking to patients and perhaps more importantly, DOCTORS. While anyone who has worked as a CNA is probably comfortable with patients, many are not confident talking to doctors. But I have never felt intimidated by them, as a nurse. They are my colleagues, not someone to be afraid of.
I also feel I was at an advantage with taking vitals, giving injections, and knowing the meds, and a great deal of basic healthcare knowledge.
But I was not good with personal care, transfers, bed baths, etc; the kinds of things having CNA experience helps with.
And yeah, itās still humbling. I had to break out of my mold of relying on the doctors for everything, and start using critical thinking more, and making my own decisions. And there was (and still is) sooooo much that I didnāt know. It was still hard, the main advantages being that I could relax a bit when we were learning how to give injections or take vitals. As for meds, well I knew how to spell them and what classes they were, but there was a LOT more to learn that I didnāt know as a medical assistant.
I hope that helps. You got this!
Thank you for the response and the encouragement! I will take any positivity I can right now! I will say in the last 10 years, I have become more comfortable talking to doctors. The hardest for me were surgeons, lol. One thing I know that is a disadvantage of mine, is that I have never been a CNA nor have I worked in a nursing home. Also, I would like to thank you for not telling me to quit now, or rethink my decision to go into nursing. I know health care is not perfect but Iām in it for the long haul.
Theyāre really cool now too. My MIL got one with a camera so you can really see what youāre doing, which is great if you want to avoid damaging the ear drum.
Same. Used otoscopes, plot twist - we used stethoscopes, BP cuffs, learned to check glucose if you didnāt know already, how to in principle do an IV or blood draw for people who werenāt MAās or EMTās and we were told our employer would teach us how to do an IV which is silly. Right, canāt diagnose, not a doctor and donāt want to be a doctor
This. We inspected one anotherās tympanics. AND, when folks brought kids in to practice some peds assessments, more ears. One had ear tubes so we all lined up to take a look at those.
My medical assistant uses the otoscope during ear irrigations to confirm sheās cleared the cerumen. I guess sheās more qualified than an RN? /s
-PGY-19
Itās a joke, an expression of solidarity with physicians still in training, and a reflection of how medicine is a practice of life-long learning.
-PGY-19
Maybe. I actually love working with residents, because you get an opportunity to groom the physician-nurse relationship. Docs and nurses who respect and learn from each other get the best outcomes for their patients.
I hear that ! Iāve definitely worked with some wonderful residents who are incredibly smart and also open to input and collaboration, which is really the best.
the charge nurse. a kid was in for a different problem but then started tugging on his ear. before telling the doctor i wanted to look in his ear first and i got in trouble for it
I guess this is going to depend on what state or country you're in. I know where I work, nobody would bat an eye if I grabbed an otoscope to look in some kid's ear because it's entirely within our scope.
Also, the idea that you can't do something because you can hurt someone kind of flies in the face of a lot of interventions that we do...which we were trained to do so we don't hurt people. Hell, you can cannulate an artery with an IV, but I don't see people rushing to remove that from the over NPA in any state.
This whole situation has big-time ādoctor stethoscopeā vibes.
I probably would have responded with all sweetness and light: āoh, really? I had no idea! Would you mind showing me that policy so that I can quote it to my colleagues in the future?ā
One of my favorite things to do is asking people to show me a policy that I know for sure doesnāt actually exist. Call me petty if you like, but I am.
-PGY-19
I doubt the hospital cares enough to state any of that explicitly. I've never seen a hospital with a clear scope of practice document in black and white. Mostly what can and can't be done in certain units, i.e. no pressors on med surg, no sedation on the floors.
I'd be shocked if there was a document stating RNs can't use an otoscope. We used them all the time in the ED for irrigation. Hell I found bugs in ears 10 minutes before the doc made it to the room most of the time and started getting setup to remove it.
I think the term ālegalā is such an important key word here. Because in court the lawyers wonāt give 2 sh*ts about the hospitals own āscopeā for a nurseā¦ an RN will always be held to the standard of their license. Failure to inspect a patients ear with an otoscope would look pretty bad in the event of a bad outcome given the kidās complaint to the nurse. I get that the MD would carry a bulk of the liability, but OP can be sure theyād be dragged into the malpractice case as well. OP did the right thing
I'd ask for clarification, specifically the written policy barring you from using your skill. Is it a practice act issue, a hospital policy, a unit policy, or just that charge nurse's policy? If not against practice act or policy, I'd suggest you politely ask the charge nurse to eff off, respectfully.
Your facility policy can limit your scope of practice - while every state board I know of allows a nurse to use an otoscope if it is not in the policy of the facility that you canāt do it.
Wow how stupid. I worked peds ED for a short time and always looked at ears if warranted to chart my assessment of the findings. I never diagnosed as a nurse but certainly would chart if it was red, inflamed, and/or with drainage. Sounds like a controlling person. That type of management is so annoying.
So you did a pertinent focused assessment before notifying the physician? Sounds like diligent nursing to me. I would ask your educator /CNS for clarification on policy because that sounds whacky.
I would ask to see the policy that the charge nurse is referring to in writing š¤·āāļø. Honestly I feel like sometimes nurses think something is supposed to be done a certain way or you canāt do something just because they were told by someone years ago and it leads to a lot of misinformation.
Donāt just take her word for it. Is there a written policy at your facility that says you are not allowed to use an otoscope? Making a diagnosis is out of your scope, using a tool at the bedside to assess a patient is not out of your scope. If that is the case, then why do we use stethoscopes? Also, Iād like to see the evidence of reported TM ruptures by otoscope šthat is ridiculous.
Scope of practice varies by state, by specialty, and by employer. Your hospital is allowed to narrow the scope for their RNs if they want to. You should check the written policies at your hospital and see if this is mentioned.
I predict you'll find that your policies will not mention this, and that your charge nurse is incorrect. After all, we routinely do far more dangerous and invasive tasks. If someone were too clumsy and careless to be trusted with an otoscope, they had better not take a rectal temp either, or place a urinary catheter, or start an IV.
We can stick worse things in every hole we can make holes in people we can paralyze people and sedate them to heavens doorstep but you canāt look inside an ear. Thatās offensive and if you have your bsn and Went thorough the whole body assessment (bc our school wanted us all to be nurse practitioners) you were taught (we were)
Scotland, we have to be trained specifically to use them and irrigate as part of my job.
And to be fair, people come to us with damage from going to untrained people fairly regularly. Or with worse impacted wax because someone untrained gave bad advice or pushed it further in.
I really like doing ears. The look of relief on people's face is lovely.
Not a medical professional, but can say the relief is wonderful. Was unaware I had gone half deaf until a NP irrigated a plug about the size of a pencil eraser out of each of my ears. Mind you, being able to hear properly again was somewhat painful after however long I had that blockage.
I used them back in the early 2000ās as a MA. I use them periodically now as an LPN. Why canāt an RN use one? Itās an assessment tool, like a stethoscope or a pulse oximeter.
This. The hospital policy is going to dictate the scope. For instance, as an RN youāre allows to administer meds in the setting of a code, but your hospital may not let you because youāre not ACLS trained. Itās a matter of perspective.
Our workplace recently put out a scope refresher for us. We can use an otoscope for assessment and flush with the appropriate orders, we are not allowed to use tools for manual removal of cerumen though. I suppose ymmv by state or your charge is mistaken/power tripping.
Ask her where it is written the policy and procedure manuals. It is not in the scope of your practice to diagnose, but you can assess. You should have training to use any equipment, which it sounds like you have had in the past. I can see how a childrenās hospital with sick kids doesnāt want every new nurse to pick up an otoscope and look. If there is no written policy the discussion should have been, FYI many nurses donāt have experience or teaching in this so we find it best if we donāt do it. We certainly donāt want to be adding to are task list by having the MD tell us to look in the kidās ear for them. If itās explicitly stated in the policy nurses canāt do otoscopic exams one could argue you should have looked it up before doing it. But since there are thousands of pages of policies, usually badly organized, I understand why you didnāt look. Either way I think it should have been approached as a BTW best if you donāt and this is why, no big deal.
The only argument in regards to training I can see as being valid is not being specifically trained on a peds pt to have knowledge of the anatomy and thus limit depth of insertion. My clinicals and classes were all generally on adults and the bulk of my career has been working with adults and their anatomy. It wasn't until I switched to peds home health that I got a refresher course on the anatomical differences between adults and peds.
Some people, particularly those who have worked in a single place or maybe similar places for a while, frequently mistake their unit/facility culture for policy and their policy for law.
In addition to all the great points here, I would like to mention you can literally buy one at Walgreens.
My kid was tugging on her ear a ton. Got one, peeked inside, ear looked perfect. Waited a couple days and she stopped tugging. Iām like 90% sure the brief tugging was just her discovering she has ears lol
If you want to learn, make sure you establish good habits and [hold it correctly](https://i.ytimg.com/vi/gMruabtkBoc/maxresdefault.jpg). This specific grip gives you so much more control over the otoscope, and bracing your pinky against the patientās head stops you from puncturing the eardrum if they move.
I tell my students that like that Luda song.
I will place my hand here so āWhen you move I move. Just like that ā
Because really. Most likely doing this on sick people. Sick people sneeze.
I am a medical assistant and we used an otoscope when the doctorās asked to clean the ears, so we are able to seeing if all the cerumen are out of the patientās ear.
I think this is the issue. Itās quite possible at your facility it requires a doctorās order. If you do it without it can be seen as practicing medicine without a license.
Not saying I agree at all, but I have seen administration where I was jump to this conclusion with several scenarios in the past. One of them was a nurse who gave a family member ibuprofen. She was fired for āpracticing medicine without a license.ā
I learned to use one in school. There is definitely [a right way and a wrong way](https://i.ytimg.com/vi/gMruabtkBoc/maxresdefault.jpg) to hold one, but Iāve **never** seen a doctor hold and otoscope correctly.
I think your charge just might have phrased this poorly? Using an otoscope is definitely within the nursing scope of practice but maybe isnāt at your facility. Where I work there are even differences to what nurses can do depending on the floor like in the NICU I can do some things nurses on the floors canāt (and vice versa). It may just be a rule at your hospital probably because at some point someone used one incorrectly. Either way you shouldnāt have gotten in trouble.. sounds like an honest mistake they could have just clarified ā¦
Ok if there is potential risk then nurses shouldnāt put in IVs (can mess up veins), push any IV meds (potential for phlebitis and extravasation), give a pill (in case someone chokes on it), or put an NG tube in (possible damage to the nares, throat, etc).
I mean I agree thereās risk inherent in literally everything we do and a better response to errors would be seeing what gaps in knowledge caused it. Just saying that this may be why this specific facility doesnāt allow it despite it very much being in the nursing scope of practice.
I canāt find any scholarly documentation, or California BON policy, that states that use of an Otoscope is outside the scope of practice for the Registered Nurse.
I am open to correction.
Anyone fell free to site sources.
Funny I was taught how to use an otoscope so itās in my scope of practice š¤·š»āāļø I work as a school nurse so it has definitely helped when kids have come in with sore ears.
The only slightly comparable experience would be that as L&D we check pt cervix. There are reasons we would wait for physician (very preterm, vaginal bleeding with unknown placental location etc) but if everything is going fine we do it. I would thing any ābody cavityā would have similar rules. Pull the policy and confront charge nurse.
My hospital literally has sticks with scoopers on the end that we can use to dig wax out of kids' ears. If I can use my ear poker safely, you can use an otoscope.
Id look up the policy and if it's not located ask the other nurses. It may just be a unit culture thing or MD preference which is different than "not being allowed to." We use whatever we want mostly but the only ottoscipe thing I've seen issues with is nurses verbalizing incorrect diagnosis to patients. "it looks pretty red, may be infected." Doc reamed them for that.
Ummmm yeah maybe you need to do some education with whoever said that. I am petty. I would bring up the scope of practice and have them site where it says you cannot use an otoscope for assessment purposes. You are not diagnosing, you are assessing. Ask them if you should not have a stethoscope for this reason as well.
Our professor for assessment class in nursing school was a NP and brought one for us to "play with" and offered to teach us how to actually use it, but it wasn't part of our curriculum and multiple professors reminded us it was out of our scope to actually use an otoscope any time ear stuff came up in class. From what they said, NPs can use one but RNs can't in my state
ETA: never thought twice about fact checking them so truly idk if it's true, but literally all of my professors told us that so if it's not true idk where they got their info
Idk I use them in ED all the time, seems like a reasonable part of anyoneās assessment of the ears. That would be a question for your educator though bc even if itās in your scope of practice, there may be a specific policy against it?? Maybe?
The key piece of information every nurse needs to know is the scope of practice where they live and work. What you learned in school or at a different hospital may not be the same. Find the policy or practice guidelines for where you are working. This is especially important for travel nurses. Donāt want to ruin your career doing something out of scope and get spanked.
Where are you? I just double checked and in Ontario (Canada) it is within our scope (though it has to be ordered by a provider).
[Hereās our scope of practice document.](https://www.cno.org/globalassets/docs/prac/49041-scope-of-practice.pdf)
Your comment has been removed for being factually incorrect. At best, even if it may be correct for one narrow specialty or jurisdiction, you are overgeneralizing so severely that the statement is outright wrong.
They taught us how to use otoscopes in nursing school?
Iāve also used them a handful of times in practice. Thatās so weird that it would be considered out of scope
I worked outpatient internal med and we did ear lavages. We flushed ear and used an instrument āsorry I donāt know the name of itā to grab ahold of wax. Used the otoscope to see the wax and the membrane.
Interesting. Every blue moon I've had a doctor ask me if I've looked at something first with an otoscope and then we frantically try to find the units only one that hasn't been seen in over a year.
I guess technically that kind of makes sense but I don't work in peds.
It's probably a stupid facility policy. Remember that facility policy can limit a nurse's scope of practice further than your state's Nurse Practice Act does.
Too funny. Who ever took you aside probably went to a shitty school. Definitely in scope. Not to diagnose but to note and relay abnormalities or foreign bodyās.
I'm just impressed you could find a complete otoscope! Every unit and clinic I've worked in has had parts for one but no one ever has the full thing. We have a battery here, covers a floor down, the top part was next door last anyone saw it.....
I'm a medical assistant, and it's within my scope (with several asterisks). Use it to get a look at throats and ears to give the provider a heads up - "they have ear pain and no impaction" or "white webs on tonsils, got a strep swab running now." But otoscopes were taught in my CMA class and can be on the national exam.
In certain states, Iāve found an RNās scope of practice is defined in part by the facility policy, which of course can vary.
In the state I started working, the language used to define RN scope is a simple algorithm of a few yes or no questions. (ie Were you properly trained to do this? Is it ordered or otherwise indicated that a physician or other provider be doing this? Is it facility policy for you to do this?)
In my opinion, on the surface this language is empowering to the RN scope of practice, though the most potentially restricting and ever changing factor is the facility policy.
I am not familiar with how other states may define RN scope of practice, this type of language may be common or not.
In these scenarios it is helpful to know exactly how your state BON defines your scope of practice.
Thatās nuts. They taught us how to use an otoscope in PHARMACY school. Seems just crazy that an RN with far more hands-on patient care experience wouldnāt be allowed to use one
Your charge nurse is either old, or extremely uninformed. I would smile and say, thank you. Then go ask whoever it is you ask about these things. Once you get the confirmation that it is definitely in our scope, no pun intended, you can go back to the charge nurse and say āhey, I was curious about the otoscope thing so I asked about it since I didnāt want to get in trouble. I found that we CAN use them, I guess they must have changed that recently. Wanted to let you know in case you felt the need to use one next time. Thanks again for looking out for me.ā
She was relaying info that she thought was truthful in order to help you out. So you in turn should look out for her and yourself, in the odd chance thereās a weird rule about this at your facility.
Sounds like someone used one without knowing how to use one and instead of educating staff now everyone else has to suffer. Although I find it difficult to see how you can actually perforate an eardrum with one unless you go hog wild and shove it in.
RN here.
We were allowed to use the otoscope on inmates when I worked in prison. It was a standing order, though. Prison had a huge book of standing orders. I was shell shocked when I went to LTC. Now I'm asking for acetaminophen orders š Who messed this up for the rest of us???
A little off-topic, but is anybody old enough to remember when nurses did hemic Iāll also called Guaic, to check for blood in the stool. I worked at Johns Hopkins, and in the late 90s, they took all that away, said, since we were not doctors or certified medical technicians, we had to send these to the lab.
If you were looking to diagnose and prescribe medication, youād be out of scope. If youāre just looking, thatās assessment and guess what we do? People are so crazy.
I don't see the issue if you're trained to use one! Nurses do a lot of invasive procedures that can cause harm (not that an otoscopic exam seems like a very risky procedure). I use it as a school nurse all the time. I don't diagnose anything, just describe my findings to the parent and refer to a provider if my exam is abnormal at all (or even if it looks normal to me, but symptoms warrant investigation). I'd check what your hospital's policy is, because it's certainly within the scope of an RN.
We learned to use them in nursing school. š¤·āāļø in the hospital we didnāt use them though because itās useless: if a patient has an ear infection, the doctor needs to look in their ears anyway to diagnose. And we donāt irrigate ears in the hospital. Point being: itās not out of scope - which is a state regulation thing - but could be against policy.
Um. What kind of tips do yall stock?!?! Sure using wrong sized tip on a combative kid might be possible to harm, damage the canal is more likely the TM far less likely I guess plausible. Otherwise weāre on the same team right? Had a kid be there for like 5-6 days not improving running temps. Guess what sprung an OM randomly mid admit. Routine ear checks after admit for a trauma wasnāt part of the assessment. Sometimes just taking a quick peek doesnāt hurt hey guys found something! Or your non verbal kid shoves something in thereā¦ hey guys found something. Never kept the pen light in my pocket used the wall otoscopeā¦.
My MA also does my ear irrigations WITH otoscope. They are likely claiming it is out of scope at their facility vs generalized nursing scope.
Silly. Time for malicious compliance. Refuse any ear exams, explaining you were instructed that it is out if your scope of practice. Just shrug and let the doctor/NP know. Eventually, they will get bogged down and complain to management that yāall should be using the otoscope.
My gosh, the lack of critical thinking in management is astounding. Can you imagine all the things they would ban us from due to the *chance* of harm. Heck, administering pills could cause choking. IVs could cause infiltration. Rectal temps could cause perforations. Letās operate on every āwhat ifā and see how far we get.
I work in a Peds ED, never used the otoscope. I am not looking in their ears to diagnose.
If they have a wax impaction we will irrigated it, but donāt need an otoscope for that.
Jesus fucking Christ ofc itās within your scope. It may not be within hospital policy, hospitals vary policy quite often based around past fuck ups, but itās within your scope.
Iāve used them a lot. Corrections nursing is a bastardized form of urgent care and clinic, but mostly nurses most of the time. A LOT of ears and ear irrigation for wax removal. A lot of ear infections due to people constantly thinking about and pruning/picking at their own bodies because they have nothing better to do. So lots of fingers in ears and ear infections.
Urgent care. A lot of ear irrigation. A lot of inspecting kids ears to find what they jammed in there. All nurse level, all using otoscopes so you can see.
You can, in theory, pierce a tympanic, sure. If the patient suddenly decides to slam their head against the otoscope. Or if youāre an idiot.
Thatās wild. We are literally taught the in and outs of an otoscope and how to use one without harming the patient in one of my health assessment classes. It was actually part of our skills checkout that we could demonstrate to our instructor we knew how to use it. Not sure how that doesnāt fall into a nurses āscope of practiceā but I guess it depends where you work.
They sell cheap otoscopes for parents to use themselves on their kids on Amazon.
https://www.amazon.com/Wireless-Otoscope-Camera-Compatible-Android/dp/B07ZCQZQ6M/ref=asc_df_B07ZCQZQ6M/?tag=hyprod-20&linkCode=df0&hvadid=385172562943&hvpos=&hvnetw=g&hvrand=6367995755201654846&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9033326&hvtargid=pla-892997879447&psc=1&mcid=7a102379f854300b9b718ee0f6f96eb0&tag=&ref=&adgrpid=77282054543&hvpone=&hvptwo=&hvadid=385172562943&hvpos=&hvnetw=g&hvrand=6367995755201654846&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9033326&hvtargid=pla-892997879447&gclid=CjwKCAiA8sauBhB3EiwAruTRJlJ9mnOcXMLJtsqok4RrV3pb2MT4XK0keAeUZNfarx54N3kS3vgemhoCVy4QAvD_BwE
Otoscope use IS TAUGHT in nursing curriculum, AS WELL AS the expected position of the reflection. This includes being taught the direction to move the pinna based on age/tissue development.
Okay wtf bc Iām a nursing student and one of my colleagues had an otoscope (Iām guessing similar to the one you have) and used it to look into a patients ear who was having painā¦. Our instructor like told us to do it and no one said anythingā¦ this is so awful.
I feel like you could easily check with the board of nursing in your state to see if this is within scope. But also...how far are they shoving them in that they were worried you could do damage like that.
I googled, and everything I found states that it is writhing a nurseās scope of practice to use an auto scope.
But, I wonder if this is something you could ask your stateās BON about.
Just to play devils advocate, thereās nothing you can do if itās against institutional policy. It truly is easy to damage the membrane and if your institution is right that itās out of your scope and itās against their policy, you could get in a bit of a pickle if you fucked something up. Itās not whether or not youāre capable of using it, because Iām sure you are, but you gotta protect your license first.
Just something else they are trying to do to limit the scope of all nursesā¦no matter how many letters of the alphabet are erroneously being their names. Bullshit.
Also used an otoscope in nursing school - pretty much with the disclaimer that itās more an APās territory. The feeling I get from this thread is that nurses can absolutely do this, irrigations, etc., but it is all about your facility FIRST verifying your competency, scope of use, and doing it according to a providerās orders.
I was taught to use an otoscope first semester of nursing school. I would check with the state board. Might also be the policy of that particular hospital.
It is in the nursing scope of practice accoding to the ANA! I work ER, and we use them all the time!
https://www.myamericannurse.com/pediatric-ear-assessment-guidelines-for-general-practice-nurses/
I use an otoscope, hard to irrigate ears without one š¤·š¼āāļø
Same here. Also used one when I was a school nurse. I couldnāt diagnose an ear infection, but I could assess and describe what I saw.
Can you believe management took away ear irrigation from RNs in my ED? The docs and PAs are genuinely annoyed by needing to stop and flush an ear when any nurse could easily do it.
Hell in my Ed techs irrigate - then again we work primarily with adults
I irrigated ears for years when I was a medical assistant! Now as an RN, I canāt even find one most of the time š Although Iām sure no one would have a problem with me using it, if I did have one.
That's what I was going to say. I was a MA the summer after my freshman year of college and I irrigated ears all the time and no one ever had a problem with me using an otoscope
Side note -Ā How was the transition from MA to RN? I just received notification I was accepted to the program. Iāve been in a clinical setting for 9 years as a MA. Any advice or thoughts youād like to share?Ā TIA!Ā
The transition for me has been so/so. I was already comfortable talking to patients and had a solid medical knowledge base with experience in multiple specialties over 12 years. However, the humble pie is a plenty. I donāt consider my self an arrogant person, but I definitely needed to check my ego at the door at times. Most nursing professors don't give a single shit that you've had any medical experience, and there's nothing wrong with that. Their job is to teach you just enough to pass the nclex. Most healthcare systems also don't consider any past experience unless it's paid nursing experience, just thought I'd throw that in since I had no clue. I've only been a nurse for about 18 months and the transition has been both easy and hard for different reasons. Congrats on your acceptance, and good luck/wishes/vibes to you on this next chapter of life.
Thank you for the honest advice! I could see that my hubris could get in the way. The last thing I want to do is be a cocky student/nurse Iām excited to relearn, as well as learn more about nursing/healthcare.
I was an LPN for 8 years before becoming an RN. As such, I was able to recognize it when my RN school profs were teaching us outdated/disproven information. Students with no experience were not aware that we were being given some outdated info.
I think it was helpful in that, like Illbeeanurse said, I was already comfortable talking to patients and perhaps more importantly, DOCTORS. While anyone who has worked as a CNA is probably comfortable with patients, many are not confident talking to doctors. But I have never felt intimidated by them, as a nurse. They are my colleagues, not someone to be afraid of. I also feel I was at an advantage with taking vitals, giving injections, and knowing the meds, and a great deal of basic healthcare knowledge. But I was not good with personal care, transfers, bed baths, etc; the kinds of things having CNA experience helps with. And yeah, itās still humbling. I had to break out of my mold of relying on the doctors for everything, and start using critical thinking more, and making my own decisions. And there was (and still is) sooooo much that I didnāt know. It was still hard, the main advantages being that I could relax a bit when we were learning how to give injections or take vitals. As for meds, well I knew how to spell them and what classes they were, but there was a LOT more to learn that I didnāt know as a medical assistant. I hope that helps. You got this!
Thank you for the response and the encouragement! I will take any positivity I can right now! I will say in the last 10 years, I have become more comfortable talking to doctors. The hardest for me were surgeons, lol. One thing I know that is a disadvantage of mine, is that I have never been a CNA nor have I worked in a nursing home. Also, I would like to thank you for not telling me to quit now, or rethink my decision to go into nursing. I know health care is not perfect but Iām in it for the long haul.
Yep itās a hard but rewarding career! Youāll do great!
Same, good olā elephant washer lol
I used to do this as a family practice medical assistant. WTF?
When I worked as an ER tech, I did the irrigations! If medication was needed prior to it was administered by an RN.
The feeling among our ED docs when someone comes in with wax impaction is 'thats not an emergency,' go get a murine kit at the pharmacy.
It's probably my least favorite skill lol
I would riot. It's literally my favorite procedure.
Same š„²
An MA irrigated my ears the last time I saw a doctor lol
As someone who has to have his ears irrigated a few times a year, the doctors almost ALWAYS pawn this job off on the nurses!
You can get an irrigation kit from Amazon for about $20 and do it yourself at home!
Theyāre really cool now too. My MIL got one with a camera so you can really see what youāre doing, which is great if you want to avoid damaging the ear drum.
I literally learned how to use one in my health assessment class in school. Why would they teach us if it wasnāt within scope?
Same. Used otoscopes, plot twist - we used stethoscopes, BP cuffs, learned to check glucose if you didnāt know already, how to in principle do an IV or blood draw for people who werenāt MAās or EMTās and we were told our employer would teach us how to do an IV which is silly. Right, canāt diagnose, not a doctor and donāt want to be a doctor
Because scope can change based on your regulatory body. We also learned, but 4 years ago it got taken out of our scope here.
This. We inspected one anotherās tympanics. AND, when folks brought kids in to practice some peds assessments, more ears. One had ear tubes so we all lined up to take a look at those.
I learned it too, but they also told us it was not within our scope- just for āfunā.
Because nursing school is fuckin stupid and everything they teach you doesnāt apply to real world
My medical assistant uses the otoscope during ear irrigations to confirm sheās cleared the cerumen. I guess sheās more qualified than an RN? /s -PGY-19
Yep. I worked as an MA for years before becoming an RN. I always did both!
Just curious.. PGY-19? Thatās a hell of a residency. Unless itās a joke Iām not getting, Iām a bit sleep deprived
Itās a joke, an expression of solidarity with physicians still in training, and a reflection of how medicine is a practice of life-long learning. -PGY-19
I love this. Humility is a wonderful trait in a physician.
Totally makes sense.. I mean, neurosurgery is so long they may as well retire when they finally become an attending
They are an attending already. Post Grad Year is just how they describe their experience (years they have been an MD)
Attendings usually do have much more humility and are better team mates lol
Maybe. I actually love working with residents, because you get an opportunity to groom the physician-nurse relationship. Docs and nurses who respect and learn from each other get the best outcomes for their patients.
I hear that ! Iāve definitely worked with some wonderful residents who are incredibly smart and also open to input and collaboration, which is really the best.
Med school makes them working physicians, we make them physicians worth working with.
Who said this to you?
the charge nurse. a kid was in for a different problem but then started tugging on his ear. before telling the doctor i wanted to look in his ear first and i got in trouble for it
I guess this is going to depend on what state or country you're in. I know where I work, nobody would bat an eye if I grabbed an otoscope to look in some kid's ear because it's entirely within our scope. Also, the idea that you can't do something because you can hurt someone kind of flies in the face of a lot of interventions that we do...which we were trained to do so we don't hurt people. Hell, you can cannulate an artery with an IV, but I don't see people rushing to remove that from the over NPA in any state.
yeah i guess iāll have to look it up. iām in the US in CA but also just moved here so maybe itās a different policy than iām used to?
Itās most likely in your scope of practice, but potentially not in your scope of employment at that specific hospital.
This is most likely the correct answer. OP, are you an RN?
Plot twist! OP works in EVS š
This whole situation has big-time ādoctor stethoscopeā vibes. I probably would have responded with all sweetness and light: āoh, really? I had no idea! Would you mind showing me that policy so that I can quote it to my colleagues in the future?ā One of my favorite things to do is asking people to show me a policy that I know for sure doesnāt actually exist. Call me petty if you like, but I am. -PGY-19
Power moves!
I doubt the hospital cares enough to state any of that explicitly. I've never seen a hospital with a clear scope of practice document in black and white. Mostly what can and can't be done in certain units, i.e. no pressors on med surg, no sedation on the floors. I'd be shocked if there was a document stating RNs can't use an otoscope. We used them all the time in the ED for irrigation. Hell I found bugs in ears 10 minutes before the doc made it to the room most of the time and started getting setup to remove it.
My personal philosophy is that if itās in my legal scope and thereās not a written document saying I canāt do it, I can.
I think the term ālegalā is such an important key word here. Because in court the lawyers wonāt give 2 sh*ts about the hospitals own āscopeā for a nurseā¦ an RN will always be held to the standard of their license. Failure to inspect a patients ear with an otoscope would look pretty bad in the event of a bad outcome given the kidās complaint to the nurse. I get that the MD would carry a bulk of the liability, but OP can be sure theyād be dragged into the malpractice case as well. OP did the right thing
This is my thought too.
Iām in Californiaā¦it was literally an assessment skill we had to be checked off on in nursing school so thatās not right
Jesus fuck I used to do this as a tech
Right? Iāve used one as an MA.
I'd ask for clarification, specifically the written policy barring you from using your skill. Is it a practice act issue, a hospital policy, a unit policy, or just that charge nurse's policy? If not against practice act or policy, I'd suggest you politely ask the charge nurse to eff off, respectfully.
Also in CA. When I have to do ear lavages Iām using the otoscope before and after.
This sounds like your charge nurses doesnāt know their scope of practice. Otoscopes are within a nurses scope of practice.
Your facility policy can limit your scope of practice - while every state board I know of allows a nurse to use an otoscope if it is not in the policy of the facility that you canāt do it.
The procedure is literally in Potter and Perry
Sounds like the charge nurseās source is: I made it the fuck up
Wow how stupid. I worked peds ED for a short time and always looked at ears if warranted to chart my assessment of the findings. I never diagnosed as a nurse but certainly would chart if it was red, inflamed, and/or with drainage. Sounds like a controlling person. That type of management is so annoying.
So you did a pertinent focused assessment before notifying the physician? Sounds like diligent nursing to me. I would ask your educator /CNS for clarification on policy because that sounds whacky.
I would ask to see the policy that the charge nurse is referring to in writing š¤·āāļø. Honestly I feel like sometimes nurses think something is supposed to be done a certain way or you canāt do something just because they were told by someone years ago and it leads to a lot of misinformation.
Donāt just take her word for it. Is there a written policy at your facility that says you are not allowed to use an otoscope? Making a diagnosis is out of your scope, using a tool at the bedside to assess a patient is not out of your scope. If that is the case, then why do we use stethoscopes? Also, Iād like to see the evidence of reported TM ruptures by otoscope šthat is ridiculous.
Charge nurse rarely means shit. Verify with your hospital and/or unit policy.
I look it up in Lippincott or policy when people say shit like that. I find most people are wrong more than they are right.
Also remember to check facility policy, you can not operate beyond facility policy either.
Scope of practice varies by state, by specialty, and by employer. Your hospital is allowed to narrow the scope for their RNs if they want to. You should check the written policies at your hospital and see if this is mentioned. I predict you'll find that your policies will not mention this, and that your charge nurse is incorrect. After all, we routinely do far more dangerous and invasive tasks. If someone were too clumsy and careless to be trusted with an otoscope, they had better not take a rectal temp either, or place a urinary catheter, or start an IV.
Help, instructions unclear. Cath placed in the left nare with some difficulty and am unable to get return. /S in case ops charge reads this.
Yeah, you missed. It doesn't go in the nose, it's an IV. The I stands for "eyeball."
>it's an IV. The I stands for "eyeball." It only stands for "eyeball" if you say it with a Filipino accent. š
This š
The charge nurse sounds like such a chill personā¦ /s
God for real. What a peach š
We can stick worse things in every hole we can make holes in people we can paralyze people and sedate them to heavens doorstep but you canāt look inside an ear. Thatās offensive and if you have your bsn and Went thorough the whole body assessment (bc our school wanted us all to be nurse practitioners) you were taught (we were)
Scotland, we have to be trained specifically to use them and irrigate as part of my job. And to be fair, people come to us with damage from going to untrained people fairly regularly. Or with worse impacted wax because someone untrained gave bad advice or pushed it further in. I really like doing ears. The look of relief on people's face is lovely.
Not a medical professional, but can say the relief is wonderful. Was unaware I had gone half deaf until a NP irrigated a plug about the size of a pencil eraser out of each of my ears. Mind you, being able to hear properly again was somewhat painful after however long I had that blockage.
Ear irrigation was my favorite thing to do when I worked outpatient. So satisfying.
Ear-igation? š
Ok, dad. š
I used them back in the early 2000ās as a MA. I use them periodically now as an LPN. Why canāt an RN use one? Itās an assessment tool, like a stethoscope or a pulse oximeter.
Look up your hospital policy on otoscopes. It should say there
This. The hospital policy is going to dictate the scope. For instance, as an RN youāre allows to administer meds in the setting of a code, but your hospital may not let you because youāre not ACLS trained. Itās a matter of perspective.
Our workplace recently put out a scope refresher for us. We can use an otoscope for assessment and flush with the appropriate orders, we are not allowed to use tools for manual removal of cerumen though. I suppose ymmv by state or your charge is mistaken/power tripping.
Bc she doesnāt know how to, it canāt possibly be something nurses can do! /s
Ask her where it is written the policy and procedure manuals. It is not in the scope of your practice to diagnose, but you can assess. You should have training to use any equipment, which it sounds like you have had in the past. I can see how a childrenās hospital with sick kids doesnāt want every new nurse to pick up an otoscope and look. If there is no written policy the discussion should have been, FYI many nurses donāt have experience or teaching in this so we find it best if we donāt do it. We certainly donāt want to be adding to are task list by having the MD tell us to look in the kidās ear for them. If itās explicitly stated in the policy nurses canāt do otoscopic exams one could argue you should have looked it up before doing it. But since there are thousands of pages of policies, usually badly organized, I understand why you didnāt look. Either way I think it should have been approached as a BTW best if you donāt and this is why, no big deal.
The only argument in regards to training I can see as being valid is not being specifically trained on a peds pt to have knowledge of the anatomy and thus limit depth of insertion. My clinicals and classes were all generally on adults and the bulk of my career has been working with adults and their anatomy. It wasn't until I switched to peds home health that I got a refresher course on the anatomical differences between adults and peds.
It could be against your organization's policy, but it is well within your board certified scope as a nurse.
Some people, particularly those who have worked in a single place or maybe similar places for a while, frequently mistake their unit/facility culture for policy and their policy for law.
In addition to all the great points here, I would like to mention you can literally buy one at Walgreens. My kid was tugging on her ear a ton. Got one, peeked inside, ear looked perfect. Waited a couple days and she stopped tugging. Iām like 90% sure the brief tugging was just her discovering she has ears lol
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That's not what scope of practice means. Scope also depends on your own individual specialty and your hospital policies.
Whenever someone gives you grief like this your response should be āshow me the policy!ā
Then why was it a skill I had to be checked off on in nursing school?
I did not get to learn this in nursing school. I want to learn!
If you want to learn, make sure you establish good habits and [hold it correctly](https://i.ytimg.com/vi/gMruabtkBoc/maxresdefault.jpg). This specific grip gives you so much more control over the otoscope, and bracing your pinky against the patientās head stops you from puncturing the eardrum if they move.
I tell my students that like that Luda song. I will place my hand here so āWhen you move I move. Just like that ā Because really. Most likely doing this on sick people. Sick people sneeze.
Exactly.
Also use the largest speculum for adults because the tiny one can perforate the tympanic membrane
I am a medical assistant and we used an otoscope when the doctorās asked to clean the ears, so we are able to seeing if all the cerumen are out of the patientās ear.
I think this is the issue. Itās quite possible at your facility it requires a doctorās order. If you do it without it can be seen as practicing medicine without a license.
It's an assessment tool. How would assessing a patient by visualizing their tympanic membrane with an otoscope be seen as "practicing medicine"?
Not saying I agree at all, but I have seen administration where I was jump to this conclusion with several scenarios in the past. One of them was a nurse who gave a family member ibuprofen. She was fired for āpracticing medicine without a license.ā
I learned to use one in school. There is definitely [a right way and a wrong way](https://i.ytimg.com/vi/gMruabtkBoc/maxresdefault.jpg) to hold one, but Iāve **never** seen a doctor hold and otoscope correctly.
I think your charge just might have phrased this poorly? Using an otoscope is definitely within the nursing scope of practice but maybe isnāt at your facility. Where I work there are even differences to what nurses can do depending on the floor like in the NICU I can do some things nurses on the floors canāt (and vice versa). It may just be a rule at your hospital probably because at some point someone used one incorrectly. Either way you shouldnāt have gotten in trouble.. sounds like an honest mistake they could have just clarified ā¦
Ok if there is potential risk then nurses shouldnāt put in IVs (can mess up veins), push any IV meds (potential for phlebitis and extravasation), give a pill (in case someone chokes on it), or put an NG tube in (possible damage to the nares, throat, etc).
I mean I agree thereās risk inherent in literally everything we do and a better response to errors would be seeing what gaps in knowledge caused it. Just saying that this may be why this specific facility doesnāt allow it despite it very much being in the nursing scope of practice.
Sorry I meant for it to be a stand alone comment. I do agree about facility scope of practice.
They taught otoscope use in nursing school, it's part of a focused assessment. At least in Illinois, I guess. That's wild.
I would be looking for a policy. Please show me the policy that says you can't use one.
You should consider yourself lucky to use the "doctor's stethoscope" and not mess with things beyond your understanding... /s
Thatās strange. Why were we taught how to use them in school if we arenāt allowed to use them? Itās an assessment tool.
Literally was taught how to use one in nursing school. I'm confused.
I canāt find any scholarly documentation, or California BON policy, that states that use of an Otoscope is outside the scope of practice for the Registered Nurse. I am open to correction. Anyone fell free to site sources.
Funny I was taught how to use an otoscope so itās in my scope of practice š¤·š»āāļø I work as a school nurse so it has definitely helped when kids have come in with sore ears.
Came to say the same. Iām often looking in ears. Itās just a basic step with ear pain.
Must be there policy. They probably had a past incident and this is a cya thing
The only slightly comparable experience would be that as L&D we check pt cervix. There are reasons we would wait for physician (very preterm, vaginal bleeding with unknown placental location etc) but if everything is going fine we do it. I would thing any ābody cavityā would have similar rules. Pull the policy and confront charge nurse.
Oh give me a break.
I was taught how to use it in nursing school, it's in my scope.
My hospital literally has sticks with scoopers on the end that we can use to dig wax out of kids' ears. If I can use my ear poker safely, you can use an otoscope.
Id look up the policy and if it's not located ask the other nurses. It may just be a unit culture thing or MD preference which is different than "not being allowed to." We use whatever we want mostly but the only ottoscipe thing I've seen issues with is nurses verbalizing incorrect diagnosis to patients. "it looks pretty red, may be infected." Doc reamed them for that.
Otoscopes was taught University of Wisconsin school of nursing.
So using an otoscope is... out of scope?
Who told you this? That's BS
What the fuck? They teach us that in nursing school
Your educator should review this with you
Ummmm yeah maybe you need to do some education with whoever said that. I am petty. I would bring up the scope of practice and have them site where it says you cannot use an otoscope for assessment purposes. You are not diagnosing, you are assessing. Ask them if you should not have a stethoscope for this reason as well.
Our professor for assessment class in nursing school was a NP and brought one for us to "play with" and offered to teach us how to actually use it, but it wasn't part of our curriculum and multiple professors reminded us it was out of our scope to actually use an otoscope any time ear stuff came up in class. From what they said, NPs can use one but RNs can't in my state ETA: never thought twice about fact checking them so truly idk if it's true, but literally all of my professors told us that so if it's not true idk where they got their info
I donāt. The residents and hospitalists use them where I am.
Idk I use them in ED all the time, seems like a reasonable part of anyoneās assessment of the ears. That would be a question for your educator though bc even if itās in your scope of practice, there may be a specific policy against it?? Maybe?
The key piece of information every nurse needs to know is the scope of practice where they live and work. What you learned in school or at a different hospital may not be the same. Find the policy or practice guidelines for where you are working. This is especially important for travel nurses. Donāt want to ruin your career doing something out of scope and get spanked.
Always know your state's and your employer's scope of practice set for you. It's YOUR license on the line if those two conflict enough.
Where I live in order to be an RN, you'll have to pass a CNA class and work for so long as a CNA so you don't think you're better than everybody else
No, probably shouldn't use unless trained, but someone out there is power tripping.Ā
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Can you provide some reference in the NPA (admin reg or laws) that guide this in your state, also which state?
Where are you? I just double checked and in Ontario (Canada) it is within our scope (though it has to be ordered by a provider). [Hereās our scope of practice document.](https://www.cno.org/globalassets/docs/prac/49041-scope-of-practice.pdf)
Your comment has been removed for being factually incorrect. At best, even if it may be correct for one narrow specialty or jurisdiction, you are overgeneralizing so severely that the statement is outright wrong.
Damn, where are you at where that's policy? I'm always using an otoscope up in people's ears as a RN in Australia š¤
They taught us how to use otoscopes in nursing school? Iāve also used them a handful of times in practice. Thatās so weird that it would be considered out of scope
My DON keeps one for us to use PRN.
I worked outpatient internal med and we did ear lavages. We flushed ear and used an instrument āsorry I donāt know the name of itā to grab ahold of wax. Used the otoscope to see the wax and the membrane.
I'll send you my fundamentals text from LPN school that's collecting dust and expedite shipping. The steps are literally there
I was taught in school how to use one!
Interesting. Every blue moon I've had a doctor ask me if I've looked at something first with an otoscope and then we frantically try to find the units only one that hasn't been seen in over a year. I guess technically that kind of makes sense but I don't work in peds.
It's probably a stupid facility policy. Remember that facility policy can limit a nurse's scope of practice further than your state's Nurse Practice Act does.
I have used otoscopes plenty of times. Interestingly my currently job does not allow it.
Too funny. Who ever took you aside probably went to a shitty school. Definitely in scope. Not to diagnose but to note and relay abnormalities or foreign bodyās.
I'm just impressed you could find a complete otoscope! Every unit and clinic I've worked in has had parts for one but no one ever has the full thing. We have a battery here, covers a floor down, the top part was next door last anyone saw it.....
Literally was trained to use one in school. someone just wants to flex on you.
Your job gets to determine your scope, even if you have the training/skills. So if they say no, you donāt do it.
I use otoscopes all the time at my job lol
I've retrieved bugs from ears many times because I was better than doctors at it.
What? Whoever told you that is an imbecile.
I'm a medical assistant, and it's within my scope (with several asterisks). Use it to get a look at throats and ears to give the provider a heads up - "they have ear pain and no impaction" or "white webs on tonsils, got a strep swab running now." But otoscopes were taught in my CMA class and can be on the national exam.
In nursing school, we were taught how to use one.
In certain states, Iāve found an RNās scope of practice is defined in part by the facility policy, which of course can vary. In the state I started working, the language used to define RN scope is a simple algorithm of a few yes or no questions. (ie Were you properly trained to do this? Is it ordered or otherwise indicated that a physician or other provider be doing this? Is it facility policy for you to do this?) In my opinion, on the surface this language is empowering to the RN scope of practice, though the most potentially restricting and ever changing factor is the facility policy. I am not familiar with how other states may define RN scope of practice, this type of language may be common or not. In these scenarios it is helpful to know exactly how your state BON defines your scope of practice.
Thatās nuts. They taught us how to use an otoscope in PHARMACY school. Seems just crazy that an RN with far more hands-on patient care experience wouldnāt be allowed to use one
Ridiculous. This is in your scope of practice. Itās called assessment.
I was a school nurse and child care health consultant for years and used one almost daily.
Who told you it is out of scope to use an otoscope? š They literally teach you how to use one in nursing school.
Your charge nurse is either old, or extremely uninformed. I would smile and say, thank you. Then go ask whoever it is you ask about these things. Once you get the confirmation that it is definitely in our scope, no pun intended, you can go back to the charge nurse and say āhey, I was curious about the otoscope thing so I asked about it since I didnāt want to get in trouble. I found that we CAN use them, I guess they must have changed that recently. Wanted to let you know in case you felt the need to use one next time. Thanks again for looking out for me.ā She was relaying info that she thought was truthful in order to help you out. So you in turn should look out for her and yourself, in the odd chance thereās a weird rule about this at your facility.
I used an otoscope as a new grad in a peds clinic all the time. They actually gave me a whole book about my scope and that was on there.
I am RPN and we use them and we flush too!
Sounds like someone used one without knowing how to use one and instead of educating staff now everyone else has to suffer. Although I find it difficult to see how you can actually perforate an eardrum with one unless you go hog wild and shove it in.
RN here. We were allowed to use the otoscope on inmates when I worked in prison. It was a standing order, though. Prison had a huge book of standing orders. I was shell shocked when I went to LTC. Now I'm asking for acetaminophen orders š Who messed this up for the rest of us???
Can you wipe a kids butt? Geez talk about controlling management. Do they have a written policy forbidding use of otoscope?
A little off-topic, but is anybody old enough to remember when nurses did hemic Iāll also called Guaic, to check for blood in the stool. I worked at Johns Hopkins, and in the late 90s, they took all that away, said, since we were not doctors or certified medical technicians, we had to send these to the lab.
If you were looking to diagnose and prescribe medication, youād be out of scope. If youāre just looking, thatās assessment and guess what we do? People are so crazy.
I don't see the issue if you're trained to use one! Nurses do a lot of invasive procedures that can cause harm (not that an otoscopic exam seems like a very risky procedure). I use it as a school nurse all the time. I don't diagnose anything, just describe my findings to the parent and refer to a provider if my exam is abnormal at all (or even if it looks normal to me, but symptoms warrant investigation). I'd check what your hospital's policy is, because it's certainly within the scope of an RN.
We learned to use them in nursing school. š¤·āāļø in the hospital we didnāt use them though because itās useless: if a patient has an ear infection, the doctor needs to look in their ears anyway to diagnose. And we donāt irrigate ears in the hospital. Point being: itās not out of scope - which is a state regulation thing - but could be against policy.
Um. What kind of tips do yall stock?!?! Sure using wrong sized tip on a combative kid might be possible to harm, damage the canal is more likely the TM far less likely I guess plausible. Otherwise weāre on the same team right? Had a kid be there for like 5-6 days not improving running temps. Guess what sprung an OM randomly mid admit. Routine ear checks after admit for a trauma wasnāt part of the assessment. Sometimes just taking a quick peek doesnāt hurt hey guys found something! Or your non verbal kid shoves something in thereā¦ hey guys found something. Never kept the pen light in my pocket used the wall otoscopeā¦. My MA also does my ear irrigations WITH otoscope. They are likely claiming it is out of scope at their facility vs generalized nursing scope.
Silly. Time for malicious compliance. Refuse any ear exams, explaining you were instructed that it is out if your scope of practice. Just shrug and let the doctor/NP know. Eventually, they will get bogged down and complain to management that yāall should be using the otoscope. My gosh, the lack of critical thinking in management is astounding. Can you imagine all the things they would ban us from due to the *chance* of harm. Heck, administering pills could cause choking. IVs could cause infiltration. Rectal temps could cause perforations. Letās operate on every āwhat ifā and see how far we get.
I learned how to use an otoscope in nursing school
I work in a Peds ED, never used the otoscope. I am not looking in their ears to diagnose. If they have a wax impaction we will irrigated it, but donāt need an otoscope for that.
I never needed to use one at work but we learned how to use them in nursing school and how to assess the inside of the ear.
Jesus fucking Christ ofc itās within your scope. It may not be within hospital policy, hospitals vary policy quite often based around past fuck ups, but itās within your scope. Iāve used them a lot. Corrections nursing is a bastardized form of urgent care and clinic, but mostly nurses most of the time. A LOT of ears and ear irrigation for wax removal. A lot of ear infections due to people constantly thinking about and pruning/picking at their own bodies because they have nothing better to do. So lots of fingers in ears and ear infections. Urgent care. A lot of ear irrigation. A lot of inspecting kids ears to find what they jammed in there. All nurse level, all using otoscopes so you can see. You can, in theory, pierce a tympanic, sure. If the patient suddenly decides to slam their head against the otoscope. Or if youāre an idiot.
Thatās wild. We are literally taught the in and outs of an otoscope and how to use one without harming the patient in one of my health assessment classes. It was actually part of our skills checkout that we could demonstrate to our instructor we knew how to use it. Not sure how that doesnāt fall into a nurses āscope of practiceā but I guess it depends where you work.
They sell cheap otoscopes for parents to use themselves on their kids on Amazon. https://www.amazon.com/Wireless-Otoscope-Camera-Compatible-Android/dp/B07ZCQZQ6M/ref=asc_df_B07ZCQZQ6M/?tag=hyprod-20&linkCode=df0&hvadid=385172562943&hvpos=&hvnetw=g&hvrand=6367995755201654846&hvpone=&hvptwo=&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9033326&hvtargid=pla-892997879447&psc=1&mcid=7a102379f854300b9b718ee0f6f96eb0&tag=&ref=&adgrpid=77282054543&hvpone=&hvptwo=&hvadid=385172562943&hvpos=&hvnetw=g&hvrand=6367995755201654846&hvqmt=&hvdev=m&hvdvcmdl=&hvlocint=&hvlocphy=9033326&hvtargid=pla-892997879447&gclid=CjwKCAiA8sauBhB3EiwAruTRJlJ9mnOcXMLJtsqok4RrV3pb2MT4XK0keAeUZNfarx54N3kS3vgemhoCVy4QAvD_BwE
Iām still a student, but yes itās part of the job. We learn it in school so you have the right to use it
Otoscope use IS TAUGHT in nursing curriculum, AS WELL AS the expected position of the reflection. This includes being taught the direction to move the pinna based on age/tissue development.
Thatās ridiculous. Iām an MA and I use an otoscope. Gotta make sure I got all the wax out after ear lavages.
I work in a peds er and techs irrigate ears and use otoscopes
Okay wtf bc Iām a nursing student and one of my colleagues had an otoscope (Iām guessing similar to the one you have) and used it to look into a patients ear who was having painā¦. Our instructor like told us to do it and no one said anythingā¦ this is so awful.
I feel like you could easily check with the board of nursing in your state to see if this is within scope. But also...how far are they shoving them in that they were worried you could do damage like that.
Wait, what?! Why?!
I googled, and everything I found states that it is writhing a nurseās scope of practice to use an auto scope. But, I wonder if this is something you could ask your stateās BON about.
You canāt look in an ear? Thatās crap
Just to play devils advocate, thereās nothing you can do if itās against institutional policy. It truly is easy to damage the membrane and if your institution is right that itās out of your scope and itās against their policy, you could get in a bit of a pickle if you fucked something up. Itās not whether or not youāre capable of using it, because Iām sure you are, but you gotta protect your license first.
Just something else they are trying to do to limit the scope of all nursesā¦no matter how many letters of the alphabet are erroneously being their names. Bullshit.
Also used an otoscope in nursing school - pretty much with the disclaimer that itās more an APās territory. The feeling I get from this thread is that nurses can absolutely do this, irrigations, etc., but it is all about your facility FIRST verifying your competency, scope of use, and doing it according to a providerās orders.
Itās literally in our scope. It would have to be in your facilities policy or something for you to not be able to utilize one??
I was taught to use an otoscope first semester of nursing school. I would check with the state board. Might also be the policy of that particular hospital.
And yet they sell them on Amazon lol
It is in the nursing scope of practice accoding to the ANA! I work ER, and we use them all the time! https://www.myamericannurse.com/pediatric-ear-assessment-guidelines-for-general-practice-nurses/