The licensed practical nurse (LPN) or registered nurse (RN) should consider what they are trying to accomplish based on the patient needs and safety and within their scope of practice. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from following a standing order or obtaining and carrying out a verbal order that is non-complex and routine. Is the nursing assistant or home care aide, registered or certified and properly trained in the nurse delegation for nursing assistants or home care aides? The registered nurse delegator makes independent professional decisions of the delegation of a nursing task. WebLocation: Spokane, WASHINGTON. A prescription or order from an authorized provider is required. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. WAC 388-112-0260 Adult Family Homes and Assisted Living Facilitiesalso have specific requirements for CPR and first aid training. A nursing diagnosis is used to determine the appropriate nursing care plan for the patient. If the person has no pulse or becomes nonresponsive, begin cardiopulmonary resuscitation (CPR) even if the POLST indicates DNAR. The procedure may be performed in a home setting or an in-center setting. The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. There must be an order from an authorized provider. You should contact your legal advisor to obtain advice with respect to any particular issue or problem. This should be noted in the POLST, or a statement should be included in the POLST with any exceptions. The licensed practical nurse is a valuable member of the health care team and should contribute to the development of the nursing care plan. Previous Next 1 of 3 The licensed practical nurse practices interdependently when providing nursing care and dependently when carrying out medical regimens. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. There may be other regulations, such as Centers for Medicare and Medicaid Services (CMS) who defines the requirements for supervision (general or direct), and other parameters, for reimbursement of the procedure. The nursing law and rule does not prohibit the competent and appropriately trained licensed practical nurse from administering any medication legend or controlled substance (Schedule II-IV) or over-the-counter medications. Manipulate, advance, irrigate, milk, or remove a chest tube. (10) "Outcome" means the end result or consequence of an action after following a plan of care. EMTALA requires the assessment of a patient for the existence of an emergency medical condition before the patient can be transferred or released from the emergency department. Internationally educated registered nurse program in an approved nursing education program. POLST is a set of portable medical orders, executed by an adult patient (or legal surrogate) and the patient's medical provider, to guide medical treatment based on the patient's current medical condition and goals. Training and education of staff employed in these facilities that address personnel, performance and other administrative activities do not require the utilization of a registered nurse. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Seeking mental health care is both safe and encouraged. Do assessment, then proceed with a consideration of delegation. A prescription or order from an authorized health care practitioner is required. It is within the scope of an appropriately prepared and competent licensed practical nurse to perform routine and non-complex diagnostic imaging procedures under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. The Nursing Care Quality Assurance Commission determines it is beyond the scope of a licensed practical nurse to perform a vaginal examination. The Food and Drug Administration (FDA) approves cosmetics. WebThe nurse delegating the task supervises the performance of the unlicensed person. No, the telemedicine training requirement doesn't apply to audio-only telephone (telephone triage), facsimile, or email. Routine radiology tests (such as chest, extremity); Computerized axial tomography (CAT) scans; Fluoroscopy, including upper gastrointestinal and barium enema procedures; Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA); Nuclear medicine such as bone scans, thyroid scans, and thallium cardiac stress tests; The nurse providing synchronous (real-time audio and video) VDOT is required to take the telemedicine training. Orders for OTC drugs or devices may be done using standing orders from an authorized health care practitioner or a registered nurse as identified in the nursing care plan. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. TheEMTALAis a federal law established in 1986 that requires hospitals or other acute care facilities who offer emergency services to provide MSE to each person presenting to the emergency department to determine if a medical emergency exists. WebThe Revised Code of Washington (RCW) 18.79 and Washington Administrative Code (WAC) 246-840 provide the statutory and legal basis of nursing practice. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform routine and non-complex respiratory therapy procedures under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. It is important to remember that the licensed practical nurse is not authorized or approved to sign orders that must be reconciled with patient medication. It would be prudent to identify steps in the standing order as to what level a triage call becomes complex requiring the licensed practical nurse to refer to or consult with the registered nurse or other authorized health care practitioner. The licensed practical nurse should use theScope of Practice Decision Treeto determine if performing compounding medications is within the licensed practical nurse's regulatory and individual scope of practice. The licensed practical nurse practices in an interdependent role when carrying out nursing care and a dependent role when carrying out medical regimens. This procedure requires a prescription from an authorized health care practitioner. This section has been decodified as it was omitted from "The rules and regulations of the Washington state apprenticeship council," filed 2/12/65 and 10/11/65. To learn more about the different training options available and access additional resources, see theWashington State Telehealth Collaborative Training webpage. Patient notification, secure storage, and disposal. However, theMedical Quality Assurance Commission WAC 246-919-606 Nonsurgical Medical Cosmetic Proceduresapplies to nonsurgical medical cosmetic procedures that involve the injection of a medication or substance for cosmetic purposes, or use of a prescriptive device for cosmetic purposes (except for laser, light, radiofrequency and plasma devices). It would be within the scope of practice for the licensed practical nurse to assess lung sounds before and after treatments. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to perform sexual assault examinations and perform colposcopy to collect forensic evidence. (c) The registered nurse and licensed practical nurse act as client advocates in health maintenance and clinical care. The facility or employer may require a prescription or other authentication/documentation for verification. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. A licensed practical nurse may assist an authorized health care practitioner or registered nurse in performing the procedure. The Licensed Practical Nurse may administer an opioid antagonist following a standing order from an authorized health care practitioner. The RN must be appropriately trained and competent to provide nursing telehealth services. Degree requirements for nursing faculty teaching in a graduate nursing education program not leading to licensure as an advanced registered nurse practitioner. There must be an order from an authorized provider. The medication must be stored properly and safely in a secured system. RCW 28A.210.380and28A.210.383regulations stipulate the requirements for epinephrine autoinjector use in public and private schools including the option of having a school stock supply of epinephrine autoinjectors for nurses to give following standing orders approved by an authorized health care practitioner. The nurse should use theScope of Practice Decision Treeto determine if specific activities are within the nurse's legal and individual scope of practice. See theCompounding Medications by Licensed Practical Nurses, Registered Nurses, and Advanced Registered Nurse Practitioners Advisory Opinionfor more information. The nurse must use nursing judgment and consider what aspects of the initial and ongoing assessment, supervision, and evaluation need to be done face-to-face. These procedures require a prescription from an authorized health care practitioner. RCW 28A.210.383(2)(b). The licensed practical nurse may assist an authorized health care practitioner or the registered nurse to remove the device, following clinical practice standards. The newly licensed RN, LPN, or ARNP or the RN, LPN, or ARNP licensed through the endorsement process who provides clinical services will need to meet the requirement one year after the initial license is issued. It may be within the scope of practice of the competent and appropriately trained licensed practical nurse to prepare allergenic extracts as compounded sterile preparations under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse. The laws and rules do not require a special certificate to perform cosmetic procedures. No. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to insert a FSE or IUPC. RCW 69.41.095allows the Licensed Practical Nurse to have a prescription for an opioid antagonist in the nurse's name to carry and administer in the non-work setting. The licensed practical nurse works under the direction of an authorized health care practitioner within the practitioner's. The licensed practical nurse must be competent. SSB 6421was passed in 2016 allowing authorized entities to obtain epinephrine autoinjectors. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse due to the complexity of the activity to perform endotracheal intubation. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of the off-label medication is within the nurse's regulatory and individual scope of practice. The nurse shall document 2 . A licensed registered nurse may delegate specific nursing care tasks to nursing assistants or home care aides meeting certain requirements and providing care to individuals in a community-based care setting defined by RCW. Only the registered nurse may delegate to assistive personnel to perform diabetes management tasks in this setting. TheWAII Handbookidentifies a Medical Doctor (MD), Doctor of Osteopathy (DO), Advanced Registered Nurse Practitioner (ARNP), Physician' Assistant (PA), and Naturopathic Physician as a medical authority to perform a sports physical examination. The U.S. Office of Health and Human Services-Office of Civil RightsFrequently Asked Questions on Telehealth and HIPAAprovides information on waivers and exceptions and guidance during the COVID-19 emergency about HIPAA and telehealth services. Nursing assistant (CNA or NAR) (chapter 18.88A RCW) May administer in community-based care settings or in-home care settings under nurse delegation. Any person or entity may lawfully possess, store, deliver, distribute, or administer an opioid overdose reversal medication with a prescription or standing order. These terms are often used by health care agencies to describe different types of assessment. (3) "Complex task" means that a nursing task may become more complicated because of: (c) The nursing care task(s) and involved risks; and. The facility can be more restrictive. It is within the scope of practice of an appropriately prepared and competent licensed practical nurse to replace a suprapubic in an established tract under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. It is not acceptable for the licensed practical nurse to routinely withhold medications without any medication prior to dialysis without an order from an authorized provider. The laws and rules require the licensed practical nurses to demonstrate competence and accountability in all areas of practice in which the nurse is engaged. For more information and resources on POLST, go to: The patient (or surrogate decision-maker) and the health care provider should discuss information to assure the POLST reflects the patient's wishes, as expressed in an advance directive or through communications with family or others. (14) "Registered nurse delegation" means the registered nurse transfers the performance of selected nursing tasks to competent nursing assistants or home care aides in selected situations. Using synchronous and asynchronous VDOT for tuberculosis treatment adherence is occurring across the United States and in Washington State. TheEMTALA Interpretive Guidelinesidentify the licensed registered nurse to be considered qualified medical personnel who can perform the EMTALA MSE and circumstances where the registered nurse consult with a physician. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. These procedures require a prescription from an authorized health care practitioner. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to remove an IABP or temporary pacing wires due to the complexity of the procedure and concerns about the stability of the patient. Can the task be performed without requiring judgment based on nursing knowledge? The registered nurse delegator previously provided written instructions for the care and treatment of the patient. Frequency of assessment may be determined by institutional policy, patient condition, CMS requirements, and accreditation standards. RCW 69.41.095allows the Licensed Practical Nurse to carry and administer an opioid antagonist (such as naloxone) to a person suspected of experiencing an opioid overdose in any setting. It is recommended that medication orders be patient/condition specific even if prescribed pro re nata (PRN), when needed. These directions may come through standing orders or verbal orders. WAC 246-840-700allows the licensed practical nurse to make basic observations, gather data and assist in identification of needs and problems relevant to the patient, collect specific data as directed, and, communicate outcomes of the data collection process in a timely manner to the registered nurse or other authorized health care provider. It is beyond the scope of the licensed practical nurse to apply or remove an internal electronic fetal monitor. (a) The registered nurse and the licensed practical nurse shall have knowledge and understanding of the laws and rules regulating nursing and shall function within the legal scope of nursing practice; (b) The registered nurse and the licensed practical nurse shall be responsible and accountable for his or her practice based upon and limited to the scope of their education, demonstrated competence, and nursing experience consistent with the scope of practice set forth in this document; and. If a patient is deemed potentially dangerous to others, the licensed practical nurse may need to consult with the registered nurse cases are considered more complex and are often deferred to the registered nurse or other professional team member who is trained to handle the needs and complexities of the patient. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing a lumbar puncture, following clinical practice standards. Standards of nursing conduct or practice. Is the nursing assistant or home care aide trained in diabetes care and insulin injections when delegating insulin? The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the registered nurse's legal and individual scope of practice. The nursing law and rules do not prohibit the competent and appropriately trained licensed practical nurse from administering intra-articular injections under the direction of an authorized provider, or under the direction and supervision of the registered nurse. The commission's advisory opinion on providesStanding Orders and Verbal Orders (PDF)additional information and guidance. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. Stable and predictable may include a terminally ill patient whose deteriorating condition is expected. (d) The registered nurse and the licensed practical nurse shall be responsible for maintaining current knowledge in their field of practice; and, (e) The registered nurse and the licensed practical nurse shall respect the client's right to privacy by protecting confidential information and shall not use confidential health care information for other than legitimate patient care purposes or as otherwise provided in the Health Care Information Act, chapter. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to perform medical tattooing, permanent makeup application, body piercing, and electrolysis under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. A registered nurse may delegate tasks of nursing care to other individuals where the registered nurse determines that it is in the best interest of the patient. 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