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. Facilities should develop policies to manage legal risk in such a situation. The nursing laws and rules do not prohibit the licensed practical nurse from taking a verbal or telephone order. Under delegation from the Department Administrator for the Department of Medical Education and Clinical Sciences, the position is responsible for independently performing a variety of confidential administrative projects A prescription or order from an authorized provider is required. Commission action regarding refresher course programs. These procedures require a prescription from an authorized health care practitioner. A prescription or order from an authorized provider may be necessary if complications occur or if medical treatment is required. Another option is for the facility or employer to become an authorized entity. The Food and Drug Administration (FDA) approves administration by intravenous, intramuscular, or subcutaneous routes; a hand-held auto-injector (Evzio) for intramuscular or subcutaneous injection; and, in 2018, approved the first generic Naloxone Hydrochloride nasal spray. WAC 388-97-1080addresses the nursing services requirements in a SNF. Dedicated education units for practical nurse or registered nurse nursing education programs. This is different than the definition of supervision of a nursing activity. This procedure requires a prescription from an authorized health care practitioner. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to manipulate the endoscope when assisting in performing an endoscopic procedure. The Washington State Telehealth Collaborative uses the following slightly different Medicaid definition of telemedicine in the training: Telemedicine is when a health care practitioner uses HIPAA-compliant, interactive, real-time audio and video telecommunications (including web-based applications) or store and forward technology to deliver covered services that are within his or her scope of practice to a client at a site other than the site where the provider is located. WAC 182-531-1730(1). The Licensed Practical Nurse should use theScope of Practice Decision Treeto determine if specific activities are within the registered nurse's legal and individual scope of practice. Provision for continuity of drug therapy for residents. The licensed practical nurse may assist in gathering information for the nursing care assessment under the direction and supervision of the 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. Other laws may apply depending on the setting. The licensed practical nurse may document symptoms or other findings and may document using a nursing diagnosis already made by the registered nurse. Yes. A licensed practical nurse may assist an authorized health care practitioner or registered nurse in performing the procedure. This plan should be made in advance as part of the patient plan of care. The LPN should not initiate CPR if valid POLST exists indicating Do Not Attempt Resuscitation (DNAR). The LPN should give comfort care and wait for help to arrive. Can the task be performed without repeated nursing assessments? The licensed practical nurse is required to use critical thinking in clinical problem-solving and decision-making processes relative to scope of practice, knowledge, competency, and experience. Telemedicine training taken prior to January 1, 2021 meets the requirement if it includes the content defined inRCW 43.70.495(2). TheWAC 388-76 Adult Family Home Minimum Licensing Requirementsaddresses medication refusal:WAC 388-76-10435 Medication Refusal. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to assist in performing an endoscopy, sigmoidoscopy, or colonoscopy. Delegating specific nursing tasks as outlined in the plan of care and consistent with nursing delegation laws and rules. Critical thinking is purposeful and reflective judgment in response to events, observations, experiences, and verbal or written expressions. Only a registered nurse may delegate nursing activities to a nursing assistant-certified (NA-C), nursing assistant-registered (NA-R), or home care aid-certified (HCA-C) in an ALF. Curriculum for practical nurse nursing education programs. 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. Examples of settings include (but not limited to): Hospitals, nursing homes, assisted living facilities, adult family homes, schools, camps, clinics, public health clinics, homes, hospice, community health centers, homeless shelters, insurance companies and other businesses, law offices, travel clinics, occupational health centers, private clinics, outpatient clinics, ambulatory surgery centers, dialysis centers, mental health centers, infusion centers, medical spas, nursing informatics programs, correctional centers/jails, county health departments, government offices, cruise ships, churches, casinos, and retail clinics. See the Washington State Department of Health'sEpinephrine Autoinjectors and Anaphylaxis Training and Reporting for Authorized Entities Frequently Asked Questionsand theSSB 6421 Status Update Documentfor more information. 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. Most health care facilities or employers include an organizational structure that defines a person's manager or supervisor. 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. These procedures require a prescription from an authorized health care practitioner. If a comprehensive nursing assessment is contemplated as part of the care plan, the registered nurse must undertake that portion of the pre-admission assessment. It is within the scope of an appropriately prepared and competent licensed practical nurse to apply or remove an external electronic fetal monitor under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. 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 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. Is the task within the registered nurse's scope of practice? CNA may administer in a nursing home setting with a medication assistant endorsement. It would be within the scope of practice for the licensed practical nurse to assess lung sounds before and after treatments. See the Nursing Care Quality Assurance Commission's for additional information. Credentials issued to an LPN, RN, or ARNP in Washington state. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse from performing laser therapy for cosmetic purposes under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The licensed practical nurse may carry and administer epinephrine under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse. These procedures require a prescription from an authorized health care practitioner. The licensed practical nurse administering the medication is responsible for ensuring the medication is safe to crush or split before giving it. In an emergency it may be difficult to determine whether the family member is the legal surrogate. It is within the scope of the appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner, or the registered nurse, in performing the OSHA Respirator Medical Evaluation Questionnaire and perform a respiratory fit test, following clinical practice standards. (1) Nurse delegation services are services in compliance with WAC 246-840-910 through 246-840-970 by a registered nurse to provide training and nursing management for nursing assistants who perform delegated nursing tasks. Please refer to theScope ofPractice Decision Treethat will help you walk through your scope area. Web10987 Luddington Street (818) 253-5989 Care provided: Assisted Living, Respite Care Brookdale Vista Grande 2780 Vickers Drive (719) 598-0400 Care provided: Assisted Living, Respite Care American Life Adult Care Center 8849 NW 169 Terrace (305) 827-3100 Care provided: Assisted Living, Respite Care Amor De Jesus Corp 14283 Sw 177 Street The licensed practical nurse must work under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. (12) "Personal care services" as defined in WAC. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The patient's care plan should include details specifying actions in the POLST applies in all circumstances, including whether CPR should be initiated if a patient is choking. The Nurse Delegation Program, under Washington State law, allows nursing assistants working in certain settings to perform certain tasks--such as administration of prescription medications or blood glucose testing--normally performed only by licensed nurses. Curriculum for registered nurse to bachelor's or master's in nursing education programs. (b) Failure to supervise those to whom nursing activities have been delegated. Employer: Washington Department of Labor & Industries - Insurance Services . School registered nurses or licensed practical nurse (LPN) may provide telehealth services to students during the COVID-19 emergency within their legal scope of practice. 2. Providing Health Care to Minors under Washington Law Summary, National Infusion Center Association (NICA), RCW 18.71.011 Definition of the Practice of Medicine, Clinical Laboratory Improvement Amendments (CLIA), NCQAC's Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinion, WAC 246-840-700 Standards of Nursing Conduct or Practice, National Council State Boards of Nursing (NCSBN) Model Act (2012), RCW 28A.600.200 Interscholastic Athletic and Other Extracurricular Activities for Students, Washington Interscholastic Activities Association (WIAA), Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinion, Public Health Nurses: Dispensing Medications/Devices for Prophylactic and Therapeutic Treatment of Communicable Diseases and Reproductive Health Advisory Opinion, Advance Care Planning Washington State Medical Association, POLST/POLST Form/POLST Brochure Washington State Medical Association, POLST Washington State Department of Health, Washington State Department of Health Overdose Education and Naloxone Distribution Webpage, Washington State Department of Health Overdose Education and Naloxone Distribution Website, Statewide Standing Order to Dispense Naloxone, Washington State Department of Overdose Education and Naloxone Distribution Website, RCW 28A.210 Common School Provisions: Health-Screening and Requirements, Suicide Prevention Training for Health Professionals Approved Courses, Washington State Department of Health Tuberculosis Website, Emergency Volunteer Health Practitioners Program, Washington State Department of Health COVID-19 Guidance for Home Care, Home Health, and Hospice Agencies, Frequently Asked Questions on Telehealth and HIPAA, Washington State Telehealth Collaborative Training webpage, Washington State Medical Professional Telemedicine Training website, Washington State Medical Professional Telemedicine Training webpage, Information for Nursing Assistant Programs, About a Nursing Assistant Training Program. The licensed practical nurse must be competent. 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 ALF may choose to provide, but is not required to provide, intermittent nursing services. The licensed practical nurse must practice within his or her legal scope of practice. Purposes of commission approval of nursing education programs. The competent and appropriately trained licensed practical nurse may compound medications under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse. The licensed practical nurse must be competent and follow the standards for medication administration. The Licensed Practical Nurse may administer an opioid antagonist following a standing order from an authorized health care practitioner. These are legend drugs, and not categorized as a controlled substance. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. It is up to the nurse, using nursing judgment, to determine which patients and services are appropriate for telehealth. 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. The licensed practical nurse may collect the data and then have the registered nurse review the data and complete the assessment to determine the patient' needs and developing the nursing care plan. The laws and rules do not prohibit the competent and appropriately trained licensed nurse from implementing a drug order that has a dosage range. The licensed practical nurse's scope of practice in the nursing process is limited and focused. In most circumstances, if the patients heartbeat stops during a witnessed choking incident or other accident, the LPN should perform first aid measures. The nursing law and rules do not prohibit the competent and appropriately trained licensed practical nurse from giving experimental drugs by any route under the direction of an authorized provider or under the direction and supervision of the registered nurse. If the patient's wishes are not known, the POLST should direct care in the patient's best interest. The licensed practical nurse should use nursing judgment and determine whether additional verification or clarification is required. Different types of assessments, such as initial, admission, or event-focused assessment, are not defined in the nursing law and rules. Curriculum for graduate nursing education programs. The law specifies that epinephrine autoinjectors may be prescribed to be maintained by schools for use when necessary. 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. In an emergency it may be difficult to determine whether the family member is the legal surrogate. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to insert a feeding tube in a neonate, infant, child, or adult under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. These rules allow delegation of these procedures to a properly trained licensed practical nurse. The person giving the test results or diagnosis must be competent to answer the patient's questions. It may be within a licensed practical nurse's scope of practice to provide routine or basic training to UAP if the licensed practical nurse is competent under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse based on the nursing care plan. A competent adult patient or the legal surrogate may always change their medical decisions and request alternative treatment. See theFood and Drug Administration's website, Using Eye Cosmetics Safely, for more information. Licensure for nurses by interstate endorsement. The licensed practical nurse may assist an authorized provider or registered nurse in carrying out a complex standing order or verbal order. Criteria for approval of LPN and RN refresher course program located in Washington state. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from administering medications following standing orders. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to re-insert a gastrostomy tube in a mature stoma site 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 within the scope of a licensed practical nurse to practice independently. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform ostomy care under the direction of an authorized provider or under the direction and supervision of a registered nurse, following clinical practice standards. POLST should not be written as part of routine admission paperwork without medical professional involvement and extensive discussion. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionand Verbal Orders provides additional guidance and recommendations. 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. WebSee WAC 246-827-0240 for MA-certified. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of experimental drugs is within his or her regulatory and individual scope of practice. A licensed practical nurse may work in any setting where nursing care is provided. The Nursing Care Quality Assurance Commission determines it is beyond the scope of a licensed practical nurse to perform a vaginal examination. The nursing laws and rules do not require an authorized health care practitioner or registered nurse to be on the premises when a licensed practical nurse provides nursing care or performs medical regimens. In neonatal and pediatric services in hospitals, at least one registered nurse or physician must be trained in infant/pediatric resuscitation; in obstetrics, at least one registered nurse must be trained in neonatal resuscitation when infants are present. WebThe nurse delegating the task supervises the performance of the unlicensed person. While this is specific to public health nurses, the general concepts apply to any setting. Standing orders may also be followed to direct occupational health activities. Curriculum for nursing education programs preparing students for licensure as advanced registered nurse practitioners (ARNP). The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical to provide epidural care during labor and delivery. To complete the free and publicly available telemedicine training, see theWashington State Medical Professional Telemedicine Training webpage. 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