Our hospital is in the process of starting “nurse-supervised” stress tests. According to our state board of nursing, the cardiologist has to be “immediately” available to intervene if necessary. This appears to be a grey area; we could use some clarification. Our lab is on the second floor on one side of the hospital. Does the doctor have to be in the stress test lab area? Can the doctor be doing consults on the other side of the hospital on the sixth floor?
Nancy Brent replies:
The clarification you seek concerning nurses being involved in stress tests can come from many sources. First and foremost, because your state board of nursing has listed as a requirement that the cardiologist has to be “immediately” available, the best source would be from the board itself. This may be possible in your state by placing this issue on the board’s next public meeting’s agenda and being present to raise the issue and get a response. Another option, although quite lengthy, is to amend the nurse practice act and/or rules to clarify the definition of “immediately available.
The hospitals legal counselor and its risk manager also can be helpful with this clarification. Surely, they want the nurse’s role to be consistent with the nurse practice act and other state laws that may affect the procedure. As an example, what are the requirements, if any, concerning cardiac units and the administration of stress tests? And, what does the Joint Commission on Accreditation of Healthcare Organizations require? What about Medicare and its requirements?
Another issue to consider is what the qualifications of the nurse supervising the stress test should be. The American College of Cardiology/American Heart Association’s “Clinical Competence Statement on Stress Testing” should be reviewed. Moreover, it has been recommended that at least two qualified individuals be present during stress testing, especially when the radionuclide injection takes place during the procedure (Sloper (2010), “ICANL Report”, 38 (2) Journal of Nuclear Medicine Technology, 9A-10A. Available at http://tech.snmjournals.org/content/38/2/9A.full
You are wise to be concerned about this issue. Hopefully, a clarification can be made so the facility and its staff are functioning in accordance with all applicable state laws and standards of practice.