A position statement that recently went into effect changes what nurses can be assigned to do in emergency rooms in Arkansas.
On May 8, the Arkansas State Board of Nursing approved registered nurses to use staples, sutures or tissue adhesive to close superficial wounds as delegated by the attending provider in the emergency department. This dramatically changes the scope of practice from a 1997 position statement, which allowed RN’s to do this only if directed by the surgeon in the operating room. However, nurses cannot suture muscle, nerve, fascia or tendon.
Nurses who staple, suture or apply tissue adhesive to close superficial wounds are responsible for being adequately prepared and experienced to perform such procedures, according to the position statement. Nurses must have documents showing that they have been trained and are competent to carry out the procedures. They also must keep their training up to date.
David Cavins, an ER nurse for The Right Solutions, has the training to meet the new requirements. He said his 14 years of experience as a flight nurse gave him the necessary training in closing superficial wounds with adhesive or sutures.
“I’m not your typical ER nurse,” Cavins said. During his career, he performed sonograms and handled duties of a respiratory therapist such as intubation. He also has experience in operating rooms and intensive care units.
Cavins is working for TRS at Oklahoma State University Medical Center in Tulsa, and he currently lives in Fayetteville, Ark.
A nurse could complete the required training to learn how to apply sutures in a week, he said. He explained how different sutures are used for different cuts, such as straight or jagged cuts.
“I already have that training,” Cavins said. “I know how to do it.”
Cheryl Williams, clinical liaison for The Right Solutions, said the new position statement “could make the demand for ER nurses greater.” Williams explained that while a doctor would still see patients who receive sutures, nurses might be given some of the duties that the position statement allows.
The position statement went into effect May 8, said Mary Trentham, attorney specialist for the Arkansas State Board of Nursing.
Trentham wrote a memo, detailing the Nevada State Board of Nursing’s survey in 2012 which lists states where RN’s are allowed place sutures.
Survey results showed 24 percent of states that responded to the survey reported that placing sutures is within the scope of practice for a registered nurse. About 18 percent of the states reported that placing sutures is only within the scope of practice for registered nurse first assistants. An additional 18 percent reported that placing sutures is not within the scope of practice for registered nurses.
The remaining states were silent on the issue but encouraged nurses to use a Scope of Practice Decision Tree as a guide for scope of practice questions.
According to the minutes from the Feb. 28, 2012, meeting of the Nursing Practice Advisory Committee of the Nevada State Board of Nursing, the committee voted that applying sutures is not within the scope of practice for registered nurses in Nevada.
In Trentham’s memo, she included several articles and information that showed “no adverse outcomes” when nurses were allowed to place sutures in the emergency room.