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 Nursing Practice > You Asked Us Online 

Last modified: Feb. 28, 2006  

Subluxation

Q

I work in the ER of a rural hospital. The other night, a young man arrived with a painful subluxation (partial dislocation) of his right elbow that required a reduction, and the physician wouldn’t be available for almost six hours. I have frequently assisted with this type of procedure. To prevent clients from waiting to be treated, may I reduce subluxations?

A

The Regulated Health Professions Act, 1991, does not authorize “setting or casting a fracture of a bone or dislocation of a joint” to nurses; however, a health professional with the authority to perform this controlled act, such as a physician, can delegate the authority to reduce subluxations to nurses. The act of delegation is a formal, documented transfer of authority, including a mechanism to determine the ongoing competence of the nurse. This mechanism may include formally evaluating skills at regular intervals.

Before nurses are delegated the authority to reduce subluxations, they should consult with their unit managers and consider whether they’re appropriate care providers to perform this procedure. Nurses need to consider whether they have the competence to reduce subluxations and manage the outcomes. As a regulated health professional, you are accountable for your decisions about the care you provide.

The broader nursing role must also be considered. Think about the possible risks or side effects to clients of a nurse performing this procedure and how the delegation will affect nursing workload.

If the procedure is delegated to nurses at your facility, they will need client-specific orders or medical directives to perform subluxations. Together with the delegating physician(s), nurses must determine if they have the necessary knowledge, skill and judgment to proceed with the procedure; are able to decide when the procedure is appropriate for particular clients at given times; can perform the procedure safely; and can manage any outcomes. Staff will also need to determine whether they have the appropriate resources to support the safe performance of reductions of subluxations. Are there also medical directives for pain management and X-rays? What resources are in place for situations in which it’s unsafe for nurses to perform a reduction?

Consideration of the above factors will assist you in determining if the decision to delegate reducing subluxations continues to support safe, effective and ethical care. For more information, refer to the College’s Medical Directives practice guideline and Decisions About Procedures and Authority practice standard on the College website, www.cno.org.

 

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