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. These directions may come through standing orders or verbal orders. Abnormal test results should be communicated by someone who can provide supporting information about the test, implications, and follow-up care. The Nursing Care Quality Assurance Commission determines it is beyond the scope of a licensed practical nurse to perform a vaginal examination. Stop Overdose.comoffers education, resources, and technical assistance for individuals, professionals, and communities in Washington State who want to learn to prevent and respond to overdose and improve the health of people who use drugs. Is the task within the registered nurse's scope of practice? Denial, statement of deficiencies, conditional approval or withdrawal of approval of nursing education programs located in Washington state. Minimum standards for registered nurses include the following: Minimum standards for licensed practical nurses include the following: (A) Delegating selected nursing functions to others in accordance with their education, credentials, and demonstrated competence as defined in WAC, (A) The practical nurse may delegate selected nursing tasks to competent individuals in selected situations, in accordance with their education, credentials and competence as defined in WAC, (B) Supervising others to whom they have delegated nursing functions as defined in WAC. The general age of majority for health care is eighteen years old in Washington State as defined in . Does the patient have a stable and predictable condition? The laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from triaging calls under the direction (direction can be following a standing order) of an authorized health care practitioner or under the direction and supervision of the registered nurse if the licensed practical nurse has the training, knowledge, skills and ability to carry out the activity safely and competently and is willing to accept any consequences of his/her actions. To learn more about the different training options available and access additional resources, see theWashington State Telehealth Collaborative Training webpage. See theWashington State Department of Health Overdose Education and Naloxone Distribution Webpagefor more information. A prescription or order from an authorized health care practitioner is required. WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. The nurse must have a valid prescription, either in the nurse's name, in the name of an entity, in the name of a person or patient, or through a standing order. The medication must be stored properly and safely in a secured system. WebWashington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree. The registered nurse delegator ensures the task to be delegated can be properly and safely performed by the nursing assistant or home care aide. 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. The nursing diagnosis drives interventions and patient outcomes, enabling the registered nurse to develop the nursing care plan. Washington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree. Nurses may carry and administer an opioid antagonist (such as naloxone) in a suspected opioid overdose whether the person is a family member, friend, stranger, or a patient. 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. Not all medications may be split. nurse practitioner. Previous Next 1 of 3 Standing orders may also be used to allow a nurse to start more than one intravenous line based on specific criteria. 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. It is within the scope of practice of the appropriately prepared licensed practical nurse to write or enter the information into an electronic health record system the patient demographic information, as well as the drug, dosage, frequency and number of refills on a medical prescription as pursuant to a medical order. The order may be made using a standing order. The licensed practical nurse administering the medication is responsible for ensuring the medication is safe to crush or split before giving it. (1) Administration of medications by injection (by intramuscular, intradermal, subcutaneous, intraosseous, intravenous, or otherwise) with the exception of insulin injections. A licensed practical nurse may provide direct patient care and perform functions within the nurse's legal and individual scope of practice under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. It is within the scope of an appropriately prepared and competent licensed practical nurse to perform a fetal NST and amniotic fluid index level using ultrasound under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. These procedures require a prescription from an authorized health care practitioner. The licensed practical nurse does not work under authorized health care practitioner's license the registered nurse's license. RCW 28A.210.383(2)(b). The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. There are models of care in place that involve a medical team including nursing staff. The nursing laws and rules allow the competent and appropriately trained licensed practical nurse performing venipuncture to obtain blood samples for laboratory testing in any setting. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical nurse's legal and individual scope of practice. The licensed practical nurse may administer medications by any route. (12) "Personal care services" as defined in WAC. Apre-admission/resident assessmentis a needs assessment screening tool used to obtain information about the personal care needs and requests of a potential resident. Curriculum for graduate nursing education programs. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. Seeking mental health care is both safe and encouraged. Licensure for nurses by interstate endorsement. Only the registered nurse may delegate to assistive personnel to perform asthma management tasks in this setting. The nursing rules define supervision as, The provision of guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action. A registered nurse practices independently and does not require supervision or evaluation of nursing care. 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 nursing commission provides advisory opinions and interpretive statements about specific areas of nursing practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical's legal and individual scope of practice. How to make changes to the delegated tasks. Must meet all Washington Administrative Code (WAC) requirements related to this position Minimum of 3 years nursing experience preferred Ability to read, write, and speak in English Delegation process experience preferred Must possess strong organizational, time-management, and problem-solving skills The nurse shall document 2 . The LPN and RN may provide telehealth nursing services within their scope of practice to patients in Washington state. The licensed practical nurse should consider the area of practice in which the nurse is working. 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. If the patient's wishes are not known, the POLST should direct care in the patient's best interest. The nursing laws and rules do prohibit the competent and appropriately trained licensed practical nurse from assisting in performing a sports physical examination under the direction of an authorized provider or under the direction and supervision of the registered nurse. Withholding medications, primarily anti-hypertensives, prior to dialysis is not uncommon. The licensed practical nurse needs to be competent regarding the specific medication including the indications, contraindications, and side effects that is being delivered to the patient. The licensed practical nurse should use theScope of Practice Decision Treeto determine if handing out a pre-labeled, pre-packed sample is within the licensed practical nurse's regulatory and individual scope of practice. The licensed practical nurse needs to determine whether the medication can be safety split to ensure proper dosage. The Nursing Care Quality Assurance Commission determines that it is not within the scope of the licensed practical nurse to administer stem cell transplants by intravitreal infusion, retrobulbar infusion, spinal infusion, or other complex administration techniques. The licensed practical nurse implementing the order is required to see clarification of the order when the licensed practical nurse believes or has any reason to believe one of these contraindications exists, and to take any other action necessary to assure the safety of the patient. The competent and appropriately trained licensed practical nurse may also perform specific assessments or screening activities, such as mental health status screening, suicidal risk screening, substance use screening, behavioral health screening, oral health screening, growth and developmental screening, neonatal abstinence syndrome scoring system, or nutritional health screening. Faculty requirements for nursing education programs. The licensed practical nurse should use theScope of Practice Decision Treeto determine if performing compounding medications and preparing and administering allergenic extracts is within the licensed practical nurse's regulatory and individual scope of practice. The licensed practical nurse practices interdependently when providing nursing care and dependently when carrying out medical regimens. Advanced care planning is thoughtful conversations between health care professionals, the patient and/or surrogate. The nurse should use theScope of Practice Decision Treeto determine if specific activities are within the nurse's legal and individual scope of practice. 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. It is acceptable for the licensed practical nurse to prepare a medication organizer or individual pill containers under the following conditions: See theAdvisory Opinion on Medisets, theMedication Organizer Device Letter from Secretary of Health (PDF), and theMedication Organizer Device (PDF)for more information. (3) "Complex task" means that a nursing task may become more complicated because of: (c) The nursing care task(s) and involved risks; and. An agency or employer may restrict the nurses scope of practice or require specialty certifications or specific training courses. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical to provide epidural care during labor and delivery. A SNF may limit the admission of a patient if a registered nurse is not available to perform the admission assessment. (1) The purpose of defining standards of nursing conduct or practice through WAC 246-840-700 and. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from working as a case manager or care coordinator. The licensed nurse (RN, LPN, or ARNP) providing telemedicine clinical services licensed prior to January 1, 2021, will need to complete telemedicine training by December 31, 2021. 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. The Community Based Nurse Delegation Program is authorized through the written rules within the Nurse Practice Act (WAC) and through Washington State Law (RCW). If there are signs of infection or other concerns, the licensed practical nurse should seek advice from an authorized provider or the registered nurse before attempting to re-insert. 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. 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 do not prohibit the competent and appropriately trained licensed nurse from implementing a drug order that has a dosage range. The licensed practical nurse must be competent to carry specific steps identified in the standing order or verbal order. Approval of initial (new) in-state nursing education programs. 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. Invasive procedures require an order from an authorized health care practitioner. In an emergency it may be difficult to determine whether the family member is the legal surrogate. Curriculum for nursing education programs preparing students for licensure as advanced registered nurse practitioners (ARNP). A dentist may prescribe neuromodulators (such as Botox) or dermal fillers when it is used to treat functional esthetic dental conditions and their direct esthetic consequences. Facilities should develop policies to manage legal risk in such a situation. The licensed practical nurse may contribute and assist in collecting information and performing case management or care coordination activities identified in the nursing care plan within the licensed practical nurse's scope of practice. A prescription or order from an authorized provider is required. Facilities should develop policies to manage legal risk in these situations. However, the Nursing Care Quality Assurance Commission (NCQAC) recommends licensed nurses complete the telemedicine training if they provide services such as; telephone triage, remote patient monitoring (RPM, which enables recording and monitoring health data remotely), asynchronous telehealth (such as Store and Forward technology that allows patient data to be collected, stored, and later retrieved by another professional), Mobile Health (mHealth, using smart devices such as smartphones and smart wearables that allow continuous data collection about a person's behavior or condition) or other types of telehealth. Telemedicine training taken prior to January 1, 2021 meets the requirement if it includes the content defined inRCW 43.70.495(2). In no case, may administration of medications by injection with the exception of insulin injections, sterile procedures and central line maintenance be delegated. This is an example of a situation where health care providers caring for the patient must be aware of the POLST. The licensed practical nurse may assist in carrying out the assessment process and carrying out these plans. The prescriber or the registered nurse does not need to be on onsite when the licensed practical nurse administers medications. RCW 43.70.495 requires the nurse who provides clinical services through telemedicine independently or under the direction of anauthorized health care practitionerto complete telemedicine training. The process for reconciliation of medication is the responsibility of the prescriber. Follow the policies and procedures relative to the documentation (paper or electronic) system used by the organization. Inactive and reactivating an ARNP license. The nursing law and rule does not prohibit the licensed practical nurse in making a decision to crush or split medications without an order. Initial licensure for registered nurses and practical nurses. The facility or employer may require a prescription or other authentication/documentation for verification. The employer may also decide whether they want to require an in-person course or on-line course and other parameters. See the Nursing Care Quality Assurance Commission (NCQAC)s Determining, Pronouncing, and Certifying Death Advisory Opinion for more information. The nurse does not need to send the attestation or documentation to the NCQAC unless requested. Use of simulation for clinical experiences in LPN, RN, or RN to BSN nursing education programs located in Washington state. The full name of the medication being ordered; The total amount of medication to be given in a specified time period; The order should state if the dose can be given in divided doses; The order should state if the dose can be repeated; If repeated, the order should indicate how frequently, and in what time frame; and, The order should include what action should be taken if pain is unrelieved. The person giving the test results or diagnosis must be competent to answer the patient's questions. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to remove a SAVI applicator device. A licensed practical nurse may be a supervisor of a registered nurse in an organizational structure related to human resource and administrative functions. A licensed practical nurse may assist an authorized health care practitioner or registered nurse in performing the procedure. The licensed practical nurse may perform a focused nursing assessment. The most important consideration is whether it is safe for the patient to perform the initial and ongoing assessment, evaluation, or supervision using telehealth services following the nursing and delegation laws and rules (RCW 18.79,WAC 246-840,RCW 18.88A,WAC 246-841). The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. The licensed practical nurse may assist an authorized provider or the registered nurse in performing these procedures following clinical practice standards. The licensed practical nurse should use theScope of Practice Decision Treeto determine if specific activities are within the licensed practical nurse's legal and individual scope of practice. It is within the scope of an appropriately prepared and competent licensed practical nurse to perform internal or external electronic fetal monitoring under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. Students enrolled in a nontraditional nursing program. 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. (7) "Indirect supervision" means the registered nurse delegator is not on the premises. These procedures require a prescription from an authorized health care practitioner. Innovation projects or program approach for approved nursing education programs located in Washington state. Other professionals may also perform the pre-admission/resident assessment (WAC 388-76-10150andWAC 388-78A-2080). Commission action following commission site visit, complaint investigation, or national accreditation visits of nursing education programs located in Washington state. The same standards apply regardless of whether the services are provided face-to-face or through telecommunication technology. 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. Web(a) The delegating nurse shall: (i) Determine the competency of the individual to perform the tasks; (ii) Evaluate the appropriateness of the delegation; (iii) Supervise the actions of the person performing the delegated task; and (iv) Delegate only those tasks that are within the registered nurse's scope of practice. Examples include theInfusion Nurses Society (INS)and theNational Infusion Center Association (NICA)practice, training, and competency standards for the licensed practical nurse. POLST is a portable medical order, and the LPN should follow it within scope of practice and standard of care. 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 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 nurse would need to contact the other state(s) to see if they can practice in their state with a Washington state license during the pandemic. 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. You should contact your legal advisor to obtain advice with respect to any particular issue or problem. Triaging occurs in various setting such as managed care organization, primary and specialty care, emergency departments, and crisis lines. The nursing law and rules do not prohibit the competent and appropriately trained licensed practical nurse from giving off-label medications under the direction of an authorized provider or under the direction and supervision of the registered nurse. Conditions for participants entering the approved substance abuse monitoring program. It is within the scope of the licensed practical nurse to use critical thinking skills. Criteria for approval of LPN and RN refresher course program located in Washington state. The Nursing Care Quality Assurance Commission determines that it is not within the scope of a licensed practical nurse to perform electrodessication and curettage due to the complexity of the procedure. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. The licensed practical nurse should use theScope of Practice Decision Treeto determine if performing these activities is within the licensed practical nurse's regulatory and individual scope of practice. A licensed practical nurse does not require additional licensure as an esthetician to perform laser therapy for cosmetic purposes. 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 registered nurse delegator determines the patient does not require frequent nursing presence and evaluation. The Nursing Care Quality Assurance Commission (NCQAC) recommends all Washington nurses complete the telemedicine training as a demonstration of competence as soon as practical to provide an overview of the roles, responsibilities, liability, and legal requirements for providing telehealth services. (6) "Immediate supervision" means the registered nurse delegator is on the premises, within audible and visual range of the patient and the patient assessment by the registered nurse delegator occurs prior to the delegation of duties to any care giver. 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. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to perform an amniotomy. The Nursing Care Quality Assurance Commission does not have authority to interpret the laws governing the provision of health care in K-12, public and private schools. The procedure may be performed in a home setting or an in-center setting. 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. It is expected that the registered nurse would complete an appropriate age-specific nursing assessment and nursing care plan. These procedures require a prescription from an authorized health care practitioner. The registered nurse delegator, home care aide and nursing assistant are each accountable for their own individual actions in the delegation process. Clinical judgment (critical thinking) is used throughout all components of the nursing process. 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