An intern nurse who was undergoing internship in a nursing home was asked to insert a nasogastric tube in a patient. Which among the following is the appropriate decision on the part of the intern nurse?

Appeared in: AIIMS Raipur NO - 2017 (Shift-1)

Explanation

An intern nurse is a student or trainee who is not yet a licensed independent practitioner.
Nasogastric (NG) tube insertion is an invasive procedure with significant risks, such as aspiration or injury, which requires demonstrated competency.
The standard of care and professional responsibility dictate that a trainee must perform such procedures under the direct supervision of a qualified, experienced nurse.
Requesting supervision from the senior nurse ensures patient safety while providing a crucial learning opportunity for the intern.

Option A: This action is unsafe and exceeds the legal and professional scope of practice for a nursing intern, placing the patient at risk of serious complications.
Option C: While a college instructor is a supervisor, the senior nurse on the unit holds the immediate responsibility for patient care and is the appropriate point of contact within the clinical chain of command.
Option D: Simply denying the task is unprofessional and does not contribute to patient care or the intern's learning. The professional response is to find a safe way to accomplish the task.

Visual 1: Diagram - A clear illustration showing the correct anatomical pathway of a nasogastric tube into the stomach versus an incorrect and dangerous placement into the trachea and lungs.
Visual 2: Flowchart - A decision-making flowchart for nursing students/interns when assigned a clinical task, starting with 'Am I competent to perform this alone?' and branching to 'Seek Supervision' or 'Proceed Safely'.

Clinical Relevance

Nursing practice connection: Use the key finding related to Scope of practice and supervision for nursing interns to guide bedside assessment, documentation, and the next nursing action.
Practicing outside one's scope of practice is a violation of the Nurse Practice Act and can lead to legal action, loss of future licensure, and significant patient harm.
This scenario highlights the importance of the supervising nurse's role in delegation and mentorship, ensuring that tasks are assigned appropriately and that trainees are given opportunities to learn in a safe, controlled environment.
What if? If the intern had previously performed the procedure multiple times under supervision and had been formally 'checked off' as competent by the facility? Even then, the best practice would be to inform the senior nurse, 'I am competent to perform the NG tube insertion, and I am proceeding to do so.' This maintains open communication and team awareness.

How to Approach the Question

Step 1: Identify the role and experience level of the nurse in the question. The term 'intern nurse' immediately signals a trainee who is not an independent practitioner.
Step 2: Identify the nature of the clinical task. 'Insert a nasogastric tube' is an invasive procedure with inherent risks.
Step 3: Apply the core nursing principle of 'patient safety first'. This principle overrides all other considerations.
Step 4: Connect the nurse's role and the task's risk. A trainee performing a risky procedure requires supervision. This is a non-negotiable standard of care.
Step 5: Evaluate the options based on this conclusion. Inserting it alone is unsafe. Refusing is unprofessional. Requesting supervision from the senior nurse on the unit is the only option that is both safe and professional.

Concept Tested & Keywords

Concept Tested: Scope of practice and supervision for nursing interns.
Stem keywords: intern nurse, nursing home, insert a nasogastric tube
Lead-in keywords: appropriate decision
Clinical cues: The role of 'intern nurse' is the key cue, indicating a trainee status with a limited scope of practice.

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