For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. Perform infusion-related tasks under the supervision of a registered nurse or other authorized health care practitioner with appropriate infusion therapy knowledge and skills. Curriculum for registered nurse refresher course. [ IX, filed 3/23/60.] The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to administer intralesional injections under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The nursing laws and rules allow a licensed practical nurse to provide care in an ICU, PCU, or recovery room. 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. The nurse must be competent and getting a certificate may be one method to demonstrate training, knowledge, skills, and abilities. The LPN should suggest a care planning conference to evaluate whether POLST is appropriate when the patient or resident is admitted to a long-term care facility without POLST. MSE is beyond initial triage. 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. ); Tracheostomy site care and dressing changes; and. The delegating nurse shall: 3. These procedures require a prescription from an authorized health care practitioner. Joint Commission Nursing Assessmentstandards require the registered nurse to perform the nursing assessment within twenty-four hours after admission to a hospital. It is not within the scope of the licensed practical nurse to replace a suprapubic catheter in a non-established tract. Closing of an approved nursing education program located in Washington state. Abnormal test results should be communicated by someone who can provide supporting information about the test, implications, and follow-up care. Invasive procedures require an order from an authorized health care practitioner. These procedures require a prescription from an authorized health care practitioner. A prescription or order from an authorized health care practitioner is required. 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 licensed practical nurse must be competent to do these activities. Laser treatment requires a prescription from an authorized health care practitioner. These procedures require a prescription from an authorized health care practitioner. 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. WebTAB II- NURSE DELEGATION RULES: WAC 246-846-910 through 246-846-970 TAB III- MEDICATION ASSISTANCE RULES: WAC 246-945 REVIEW PRIOR TO CLASS: TAB I- NURSE DELGATION LAW: RCW 18.88B TAB II- SELF DIRECTED CARE: RCW 74.39.050 TAB III - EXEMPT HSC LTCW WACS: WAC 388-112A-0090 TAB IV - EXEMPT DDA The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to insert a FSE or IUPC. A focused nursing assessment means recognizing patient characteristics that may affect the patient's health status, gathering and recording nursing assessment data and demonstrating attentiveness by observing, monitoring and reporting signs, symptoms, and changes in patient conditions in an ongoing manner to the registered nurse or other authorized medical provider. All nurses in Washington State are required to complete a suicide prevention training course from an approved list. The employer may have policies or guidelines about crushing or splitting medications. Appropriate documentation of a focused patient assessment and evaluation must substantiate intervention. BOX 47864, Olympia, WA 98504-7864, Location: 111 Israel Road SE, Tumwater, WA 98501, Subscribe to receive updates from the Nursing Commission, About | News| Meeting Schedule | Contact, Nursing Care Quality Assurance Commission, Washington Administrative Code (WAC) 246-840, Neonatal Intubation and Related Procedures Advisory Opinion, Standing Orders and Verbal Orders Advisory Opinion, WAC 246-320 Hospital Licensing Regulations, WAC 246-330 Ambulatory Surgical Facilities, WAC 388-112-0260 Adult Family Homes and Assisted Living Facilities, D20-010 Assessment and Person-Centered Service Planning Process during COVID-19 Outbreak Policy (March 17, 2020), D20-028 Delivery of Skilled Nursing, Nurse Delegation, and Private Duty Nursing Services during the COVID-19 Outbreak (April 10, 2020), Medical Quality Assurance Commission WAC 246-919-606 Nonsurgical Medical Cosmetic Procedures, Dentist Scope of Practice - Use of Botulinum Toxin Injections/Dermal Fillers Interpretive Statement, Medical Quality Assurance Commission WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin, Food and Drug Administration's website, Using Eye Cosmetics Safely, NCQAC Standing and Verbal Orders Advisory Opinion, WAC 246-870 Electronic Transmission of Prescription Information, Washington State Department of Health Pharmacies website, Compounding Medications by Licensed Practical Nurses, Registered Nurses, and Advanced Registered Nurse Practitioners Advisory Opinion, Washington State Tuberculosis Laws and Guidelines, Centers for Disease Control Guidelines for TB Screening and Follow-Up, Medication Organizer Device Letter from Secretary of Health (PDF), Food and Drug Administration Understanding Unapproved Use of Approved Drugs "Off-Label" website, Institute for Safe Medication Practices (ISMP), WAC 388-76 Adult Family Home Minimum Licensing Requirements, Washington State Department of Health Patient Rights Guidelines, Epinephrine Autoinjectors and Anaphylaxis Training and Reporting for Authorized Entities Frequently Asked Questions, NCQAC's Prevention and Treatment of Opioid-Related Overdoses Advisory Opinion, Frequently Asked Questions for Nursing Professionals of the Prevention and Treatment of Opioid-Related Overdoses for more information, WAC 246-865-060 Pharmaceutical Services-Extended Care Facility, WAC 246-874-050 Accountability Requirements for an Automated Drug Dispensing Device (ADDD), WAC 246-840 Practical and Registered Nursing, advisory opinions and interpretive statements, WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin. The licensed practical nurse must apply adequate knowledge and skills in determining the dosage to be administered at any given time. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. False eyelashes and extensions, as well as their adhesives, must meet the safety and labeling requirements for cosmetics. Independently change out chest tube bottles; Independently change a disposable collection system; or. 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. This procedure requires a prescription from an authorized health care practitioner. Have now Craig Ritchie moves to approve the amended language for WAC 246-945-014 and authorize staff to file a CR-103 under joint authority Internationally educated registered nurse program in an approved nursing education program. The licensed practical nurse may not use the title of respiratory therapist unless the nurse is dually licensed. Any CLIA waived test involving puncturing the skin requires an order from an authorized health care practitioner. ARNP designations, certification, and approved certification examinations. 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. These commonly asked questions and answers offer information and general guidance regarding the practice of professional nursing in the State of Washington and do not constitute legal advice. The nursing law and rule does not require the registered nurse or an authorized health care practitioner to be on the premises when a licensed practical nurse provides care in any setting. The LPN should call the nursing supervisor, 911, or hospice for emergency help, and stay with the patient. (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 nursing commission provides advisory opinions and interpretive statements about specific areas of nursing practice. Use of alternative modalities for pain treatment. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform routine and non-complex pulmonary functioning testing under the direction of an authorized health care practitioner, or under the direction and supervision of a registered nurse, following clinical practice standards. The goal of the pre-admission/resident assessment is to determine the personal care services needs of a potential resident and at times, the nursing care needs of said resident. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to apply superficial chemical peels or microdermabrasion under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. Additional student requirements for RN to BSN and graduate nursing education programs. Only the registered nurse may delegate to assistive personnel to perform diabetes management tasks in this setting. Approval of initial (new) in-state nursing education programs. The Centers for Medicaid and Medicare Services (CMS) and accreditation organizations (such as the Joint Commission) may have specific requirements. 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. CPR should be stopped in absence of a pulse if CPR is started for a patient with a POLST indicating DNAR. 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'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 specific activities are within the licensed practical 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 to perform an amniotomy. VDOT is the use of a videophone or other video/computer equipment to observe clients taking their medications remotely. It has often been considered a community practice' and has been taken for granted that medications could be withheld whether written orders by an authorized provider are obtained or not. These directions may come through standing orders or verbal orders. Section B may require nursing delegation for some tasks following the delegation process. Violations of standards of nursing conduct or practice. See the Nursing Care Quality Assurance Commission (NCQAC)s Determining, Pronouncing, and Certifying Death Advisory Opinion for more information. [Statutory Authority: RCW 18.79.110, 18.79.260, 2012 c 164, and 2012 c 10. 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. Staff must meet the credentialing, training and competency requirements established in the state and federal laws and rules specific to the setting. (B) The licensed practical nurse in delegating functions shall supervise the persons to whom the functions have been delegated; (C) Evaluating the outcomes of care provided by licensed and other paraprofessional staff; (C) The licensed practical nurse reports outcomes of delegated nursing care tasks to the RN or supervising health care provider; and, (D) The registered nurse may delegate certain additional acts to certain individuals in community-based long-term care and in-home settings as provided by WAC, (D) In community based long-term care and in-home settings as provided by WAC, (E) In a home health or hospice agency regulated under chapter. Training and competency assessment for personal care services (non-nursing care) does not require the services of a Washington state licensed professional nurse. See theWAC 246-865-060 Pharmaceutical Services-Extended Care Facilityfor more information. Facilities should develop policies to manage legal risk in these situations. The licensed practical nurse should make the decision whether or not to crush or split the medication based on patient needs, prescribing information by the provider, and safety of the medication being administered in this form. The licensed practical nurse must follow theWAC 246-878 Compounding Practicesand theUnited States Pharmacopeia (USP)compounding guidelines. The licensed practical nurse does not work under authorized health care practitioner's license the registered nurse's license. (3) The following standards apply to registered nurses and licensed practical nurses: (a) The registered nurse and licensed practical nurse shall communicate significant changes in the client's status to appropriate members of the health care team. The LPN honoring those wishes would have legal protection under the Chapter 70.122 RCW: Natural Death Act if POLST reflects patients wishes stated in an advance directive. The licensed practical nurse should use theScope of Practice Decision Treeto determine if administering medications following a specific standing order within the licensed practical nurse's regulatory and individual scope of practice. Purposes of commission approval of nursing education programs. 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. RCW 69.41.095allows the Licensed Practical Nurse to dispense or distribute an opioid antagonist (such as naloxone) for a high-risk person, their family members, or friends following standing orders or a prescription from an authorized health care practitioner. The procedure may be performed in a home setting or an in-center setting. WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. It is in the scope of an appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner or the registered nurse, in providing IUI or other ART procedures, following clinical practice standards. 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. Nursing preceptors, interdisciplinary preceptors, and proctors in clinical or practice settings for nursing students located in Washington state. (2) The nursing process is defined as a systematic problem solving approach to nursing care which has the goal of facilitating an optimal level of functioning and health for the client, recognizing diversity. The licensed practical nurse may enter medication prescriptions into an electronic health system under the direction of an authorized health care practitioner. The RN must be appropriately trained and competent to provide nursing telehealth services. The licensed practical nurse should consider consulting with a pharmacist and follow current guidance or standards and/or contact the prescriber or pharmacist to see if there is another alternative, such as liquid form or getting the medication in the appropriate dose. Only the registered nurse may delegate to assistive personnel to perform asthma management tasks in this setting. Exceptions to nursing faculty degree requirements in prelicensure registered nurse nursing education programs. In an emergency it may be difficult to determine whether the family member is the legal surrogate. It is not within the scope of practice for a licensed practical nurse to practice independently. Suctioning of a non-established or established tracheostomy stoma. (1) "Authorized representative" means a person allowed to provide written consent for health care on behalf of a patient who is not competent to consent. Chapter 28A.210.383 RCWprovides that the Office of the Superintendent of Public Instruction (OSPI) and school districts have the authority to develop anaphylactic policies for schools. It is the employer's decision as to the first aid and CPR requirements including and what type (BCLS or BLS for Health Care Providers) in the absence of accreditation or facility regulations. The patient must be in a stable condition. 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. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. POLST should not be written as part of routine admission paperwork without medical professional involvement and extensive discussion. Functions of a registered nurse and a licensed practical nurse. The ALF may choose to provide, but is not required to provide, intermittent nursing services. Standing orders are certainly not to be used in lieu of medical consultation or intervention. (c) The registered nurse and licensed practical nurse act as client advocates in health maintenance and clinical care. 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. 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 plan may only be developed, implemented, and evaluated by a registered nurse. Nurse Delegation Program Contacts nursedelegation@dshs.wa.gov 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. The nursing law and rule does not prohibit the licensed practical nurse in making a decision to crush or split medications without an order. 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. Use and protection of professional titles. 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 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. 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's role in implementing the care plan includes the following activities: The licensed practical nurse's role, in collaboration with the registered nurse, assists in making adjustments in the care plan and reporting outcomes of care to the registered nurse or other authorized health care practitioner. Reinstatement of approval for nursing programs located in Washington state. The Nursing Care Quality Assurance Commission determines it is beyond the scope of a licensed practical nurse to perform a vaginal examination. The laws and rules found in Aging and Adult Service Section ofWAC 388-78A(assisted living facilities) and388-76(adult family homes) define the qualifications required for an individual to perform the required pre-admission/resident assessment. These procedures require a prescription from an authorized health care practitioner. A competent adult patient or the legal surrogate may always change their medical decisions and request alternative treatment. Please see the regulations forOSHA Respirator Medical Evaluations. An order is required from an authorized health care practitioner. These procedures require a prescription from an authorized health care practitioner. An exception exists in the physician rules that require a physician to be on the immediate premises during the patient's initial treatment when a nurse is performing laser therapy:WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin. Curriculum for approved nursing education programs. 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. The nursing laws and rules allow the competent and appropriately trained licensed practical nurse to obtain an arterial blood gas directly from an artery or through an arterial line under the direction of an authorized health care practitioner or under the direction and supervision of a RN. This is an example of a situation where health care providers caring for the patient must be aware of the POLST. The nursing law and rules do not prohibit the competent and appropriately trained licensed practical nurse from giving drugs, including antineoplastic drugs, under the direction of an authorized provider or under the direction and supervision of the registered nurse. A licensed practical nurse may assist an authorized health care practitioner or registered nurse in performing the procedure, including administering the local anesthetic. Purpose and outcomes for approved nursing education programs. Internationally educated practical nurse program in an approved nursing education program. 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 state and federal laws and regulations do not require the licensed practical nurse to have a special certification to give chemotherapy in the home setting. The authorized health care practitioner may provide treatment following an established treatment plan during temporary absences of the prescribing physician provided there is a local back-up physician who will be available by telephone and see the patient within sixty minutes. However, it may be feasible for OSPI and school districts to develop written policies to allow a substitution for the EAI for an individual student when the substitution is permitted by the prescriber according to the student's anaphylaxis care plan. See WAC 296-04-045. It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to perform an EEG or EMG under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse, following clinical practice standards. An authorized entity is required to report to the Washington State Department of Health each incident of use of an obtained epinephrine autoinjector that was provided or administered to a person. Submitted by Anonymous on Fri, 01/27/2023 - 07:56. Different types of assessments, such as initial, admission, or event-focused assessment, are not defined in the nursing law and rules. No, the telemedicine training requirement doesn't apply to audio-only telephone (telephone triage), facsimile, or email. These terms are often used by health care agencies to describe different types of assessment. 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