The RN Law on Suturing

by Sharon Perkins

Each state sets its own laws on what registered nurses -- or RNs -- can and cannot do. These laws determine the scope of nursing practice within the state. Because suturing is considered a minor surgical procedure, it doesn't fall within the general scope of nursing duties unless your state specifically allows it. States more often allow advanced practice nurses to suture than RNs without an advanced practice degree.

Definitions and Requirements

Suturing means closing a wound with stitches, using material such as silk or catgut. Laws that address whether a nurse can perform suturing often also address whether or not the nurse can staple wounds shut or close wounds with an adhesive. Laws might also define the knowledge required for a nurse to place sutures. A nurse who sutures, for example, must understand the potential complications of the procedure, recognize adverse reactions and act appropriately if they occur.

State Laws

If your facility asks you to start suturing patients, check your state law first to make certain you're covered if anything goes wrong. Some states allow RNs to suture only under certain conditions. In North Carolina, for example, nurses cannot place sutures that involve muscle, tendons or blood vessels. In 2012, a Nevada State Board of Nursing survey reported that 24 percent of states allow RNs to place sutures, while 18 percent deemed that it was not within the scope of practice for an RN. Another 18 percent said that it was in the scope of practice for registered nurse first assistants -- advanced practice nurses who work alongside surgeons in the operating room -- to place sutures. The rest had no policy on suturing.

Advanced Practice Nurses

Advanced practice nurses, such as nurse practitioners or nurse-midwives, can suture in most states. For nurse-midwives, the ability to sew up tears or repair an episiotomy -- a cut made to widen the vaginal opening during birth -- is an essential part of their job description. To suture, you need to know not only how to place sutures but also what type of suture material and needle to use. Advanced practice nurses in some states can learn to do more advanced suturing procedures.

Suture Removal

In many states, RNs can remove sutures even if they can't place them, under the direction of a physician. The RN must assess whether or not the wound has healed well enough for suture removal and follow any written orders from physicians for suture removal. In some cases, the attending physician must examine the wound to ensure that the stitches are ready for removal. He can then delegate removal to the RN. Some hospitals have written policies that specify procedures to follow when removing sutures.

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