Based on three surveys of critical care nursing practice around the United States, practice and opinion regarding the nurse's role in PA catheter manipulation is clearly varied. If it is determined that a change in practice is indicated, the scope of practice must be examined. The potential for risk to patients and a facility's cultural and political barriers require discussion and resolution. Policy guidelines, educational programming to teach the skills involved, and plans for competency verification are necessary. Our intention is not specifically to promote nurse manipulation of PA catheters. However, because some RNs perform this task, we advocate approved guidelines and adequate training.