I work in a GP clinic and the GPs and RNs agreed on an iron infusion protocol which everyone follows. Recently one GP has been pressuring me not to follow it, but I feel uncomfortable. What should I say to her? 

If you have been asked to deviate from the documented and agreed clinic protocol, and you are concerned about the requested practice and your patient’s safety, advise her this is an RN scope of practice issue. An individual’s scope of practice is influenced by:  

• context in which they practice (your clinical environment)  

• clients’/patients’ health needs  

• level of competence and confidence of the nurse 

• service provider policies.  

This is set out in the NMBA’s Fact sheet: Scope of practice and capabilities of nurses. To remain within your scope of practice, and therefore meet your professional obligations as an RN, you must follow your service provider policies, which set out practice requirements in your clinical environment. This means you are obligated to follow the protocol regarding iron infusions that was agreed upon with your practice GPs.