Role of RN in the Administration of Fentanyl PCA to Intrapartum Patients in Labor

A request was received for an opinion as to whether it is within the scope of practice for a RN to initiate, bolus, and titrate Fentanyl PCA for an intrapartum patient in labor.

Following discussion of the question, statutes governing nursing practice, and the Scope of Practice Determination Guidelines, it was the advisory opinion of the Board that since the medication is being prescribed for a non-Food and Drug Administration (FDA) approved/non-indicated use, and no literature or standards of practice were found to support the safe administration of the medication by nurses, the administration of Fentanyl PCA for intrapartum patients in labor is not within the scope of RN practice.  Nursing practice should be consistent with the Kentucky Nursing Laws, established standards of practice, and be evidenced based.