Care of the Neonate on Nasal Continuous Positive Airway Pressure: A Bedside Guide.

Respiratory distress continues to be a major cause of neonatal morbidity. Current neonatal practice recommends the use of nasal continuous positive airway pressure (nCPAP) in the immediate resuscitation and continued support of neonates of all gestations with clinical manifestations of respiratory distress. Despite the many short- and long-term benefits of nCPAP, many neonatal care units have met resistance in its routine use. Although there have been numerous recent publications investigating the use and outcomes of various modes of nCPAP delivery, surfactant administration, mechanical ventilation, and other forms of noninvasive respiratory support (high-flow nasal cannula, nasal intermittent positive pressure ventilation), there has been a relative lack of publications addressing the practical bedside care of infants managed on nCPAP. Effective use of nCPAP requires a coordinated interprofessional team approach, ongoing assessment of the neonate, troubleshooting the nCPAP circuit, and parent education.

Registered nurse scope of practice and ED complaint-specific protocols.

INTRODUCTION: The use of complaint-specific protocols (CSPs) by emergency registered nurses (RNs) can improve ED efficiency. However, RN practice is influenced by regulatory environments that may facilitate or inhibit the use of protocols. The purpose of this policy analysis was to explore the language of state boards of nursing scope-of-practice documents related to the use of RN-initiated CSPs in the ED setting. METHODS: A qualitative descriptive design was used to investigate how the RN's scope of practice relates to the use of CSPs in ED settings across states. Data were collected from state boards of nursing Web site documents. RESULTS: Three major themes emerged: cautiously within scope, intentionally vague/silent, and outside scope. Seven states (Connecticut, Illinois, Kansas, Louisiana, New Jersey, New York, and Oklahoma) were identified where RN-initiated CSPs appear to be currently outside the RN's scope of practice. Therefore 18% of the US population, or 55,973,900 people, resides in states where CSPs are not allowed. DISCUSSION: State-to-state inconsistencies in the RN's scope of practice may interfere with the implementation of practices that enhance ED efficiency. RNs in all states must ensure that they have the requisite knowledge, skill, and documented competency to implement CSPs, if supported by their employing facility. Efforts to standardize ED RN education and policy are warranted. Continued research is needed assess the impact of RN-initiated CSPs on the efficiency of ED care.