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. It is important to consider what types of questions or discussion the patient might have when receiving test results or when a diagnosis is relayed to the patient by the nurse. Degree requirements for nursing faculty teaching in prelicensure registered nurse or for RN to BSN education programs. Curriculum for approved nursing education programs. This plan should be made in advance as part of the patient plan of care. See theNCQAC's Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinionfor more information. The registered nurse delegator documents in the patient record the instruction to the nursing assistant or home care aide, observation of the delegated task, and confirmation of the nursing assistant's or home care aide's understanding the directions. 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. There should be some consultation with the physician to initiate a standing order particularly if the signs/symptoms are deviations from the patient's norm. 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. The nursing laws and rules do not require an authorized health care practitioner or RN to be on the premises when a LPN provides nursing care or performs 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. See theRCW 18.20 Assisted Living Facilities and WAC 388-78A Assisted Living Facility Licensing Rules for more information. WebIf the home identifies that a resident has a need for nursing care and the home is not able to provide the care per chapter 18.79 RCW, the home must contract with a nurse currently licensed in the state of Washington to provide the nursing care and service, or hire or contract with a nurse to provide nurse delegation. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from initiating the admission of a patient to a hospital or SNF. The standing orders are often used to renew medication prescriptions. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical to provide epidural care during labor and delivery. The Washington State Department of Social and Health Services issued the following policies related to COVID-19, telehealth services, and delegation requirements: The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to administer neuromodulators (such as Botox, Dysport, or Xeomin) or administering medications for sclerotherapy, asclerotherapy, or dermal fillers under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The licensed practical nurse may assist an authorized provider or the registered nurse in performing these procedures following clinical practice standards. Not all medications may be split. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. Internationally educated practical nurse program in an approved nursing education program. Curriculum for registered nurse refresher course. Hiding medications and not notifying the patient may be a violation of patient rights. Are the results of the task reasonably predictable? Telemedicine training taken prior to January 1, 2021 meets the requirement if it includes the content defined inRCW 43.70.495(2). 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. The licensed practical nurse administering the medication is responsible for ensuring the medication is safe to crush or split before giving it. 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. Only the registered nurse may delegate to assistive personnel to perform asthma management tasks in this setting. In an emergency it may be difficult to determine whether the family member is the legal surrogate. 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. Can the task be performed without repeated nursing assessments? Some facility laws and rules require nurses to have a CPR certification. RCW 69.41.095does not require the Licensed Practical Nurse to carry an opioid antagonist, such as naloxone. The laws and rules do not prohibit the licensed practical nurse from calling in a medication ordered by an authorized health care provider order, or under the direction and supervision of the registered nurse, to a pharmacist. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. (16) "Supervision" means the guidance and evaluation by a registered nurse delegator for the accomplishment of a nursing task or activity, including the initial direction of the task or activity; periodic inspection at least every ninety days of the actual act of accomplishing the task or activity; and the authority to require corrective action. [ IX, filed 3/23/60.] 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 nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. There are no specific laws or rules prohibiting the delegation. 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 his or her regulatory and individual scope of practice. 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). Nursing assistant (CNA or NAR) (chapter 18.88A RCW) May administer in community-based care settings or in-home care settings under nurse delegation. Standing orders may also be used to allow a nurse to start more than one intravenous line based on specific criteria. 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. Such supervision shall be adequate to prevent an unreasonable risk of harm to clients; (4)(a) Performing or attempting to perform nursing techniques and procedures for which the nurse lacks the appropriate knowledge, experience, and education and failing to obtain instruction, supervision and consultation for client safety; (b) Violating the confidentiality of information or knowledge concerning the client, except where required by law or for the protection of the client; or. RCW 7.70.065(1)(c). The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. The registered nurse delegator decides if the task is not delegable. A licensed practical nurse must have direction from an authorized health care practitioner or a registered nurse to perform tests such as a human chorionic gonadotropin (hCG), urine dipstick, occult blood screening, blood glucose capillary tests or otherCLIAapproved waiver under the CLIA criteria. The nursing laws and rules allow a licensed practical nurse to take direction for a medical regimen from a dentist or other authorized health care practitioners practicing within their scope of practice. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to apply cold therapy (cryotherapy) or heat therapy for fat removal under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. Authorized prescriptions by ARNP with prescriptive authority. 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. This procedure requires a prescription from an authorized health care practitioner. A licensed practical nurse may assist an authorized health care practitioner or registered nurse in performing the procedure, including administering the local anesthetic. Although a nursing care assessment may include elements of a non-skilled personal care assessment, it is a comprehensive nursing care evaluation and must be performed by the registered nurse. The planning conference should include the patients or residents medical provider, the patient and/or surrogate decision-maker, and key family members. Delegation in community and in-home care settings is defined by WAC 246-840-910 through 246-840-970. 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. Yes, licensed nurses (RN, LPN, or ARNP) in Washington state are required to take telemedicine training if the nurse provides telemedicine services. 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. The delegating nurse shall: 3. See theWashington State Department of Health Overdose Education and Naloxone Distribution Webpagefor more information. A facility or employer may require a specific certification or training program. The ALF may choose to provide, but is not required to provide, intermittent nursing services. The nursing commission provides advisory opinions and interpretive statements about specific areas of nursing practice. The Revised Code of Washington (RCW) 18.79 and Washington Administrative Code (WAC) 246-840 provide the statutory and legal basis of nursing practice. 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. All nurses in Washington State are required to complete a suicide prevention training course from an approved list. A prescription or order from an authorized provider is required. Determination and pronouncement of death by a licensed registered nurse. See theWAC 246-874-050 Accountability Requirements for an Automated Drug Dispensing Device (ADDD)if using an ADDD. 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. 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. (c) Willfully abandoning clients by leaving a nursing assignment, when continued nursing care is required by the condition of the client(s), without transferring responsibilities to appropriate personnel or caregiver; (d) Conviction of a crime involving physical abuse or sexual abuse including convictions of any crime or plea of guilty, including crimes against persons as defined in RCW, (e) Failure to make mandatory reports to the Nursing Care Quality Assurance Commission concerning unsafe or unprofessional conduct as required in WAC. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from collecting the information for a pre-anesthesia assessment. The licensed practical nurse may contribute to the patient assessment in a hospital, SNF, or other health care facility under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse. Licensure for ARNP applicants by interstate endorsement. Telehealth may not be appropriate in some circumstances. An individual with a nursing license (licensed practical nurse or registered nurse) meets the qualifications to perform the pre-admission/resident assessment. Withholding medications, primarily anti-hypertensives, prior to dialysis is not uncommon. The licensed practical nurse not analyze, synthesize, or evaluate the data or develop the nursing care plan. In no case, may administration of medications by injection with the exception of insulin injections, sterile procedures and central line maintenance be delegated. 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. A prescription or order from an authorized provider is required. Coprescribing of opioids for patients receiving medication assisted treatment (MAT). 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. (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. WAC 246-870 Electronic Transmission of Prescription Informationallows electronic prescriptions for legend drugs and controlled substances (except for Schedule II controlled substances). WebThis CNE activity does not include any unannounced information about off-label use of a product for a purpose other than that for which it was approved by the Food and Drug Administration (FDA). Collect and verify the patient's complete medication history. The order or prescription may be for a specific patient or through the use of standing orders. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. See theFood and Drug Administration's website, Using Eye Cosmetics Safely, for more information. No color additives are approved by the FDA for permanent dyeing or tinting of eyelashes or eyebrows. There are models of care in place that involve a medical team including nursing staff. 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. Short peripheral catheter line intraosseous access device, and subcutaneous infusion device insertion and removal; Preparing, initiating, managing, and monitoring infusion pumps; Peripheral (including short peripheral or midline), CVAD, arterial, umbilical arterial catheter (UAC) or umbilical venous catheter (UVC), intraspinal, intraosseous access device, and subcutaneous infusion device site monitoring, care, and dressing changes; Administration of infusion fluids and medications via peripheral, CVAD, and arterial catheters including through an implanted vascular access port, hemodialysis VAD, and UAC) or UVC; Medication administration via a VAD using piggyback, push, or bolus methods; Blood sampling via a peripheral, VAD, and arterial device; Administration of total parenteral nutrition; Monitor patency of the peripheral, CVAD, and arterial catheters; Assist an authorized health care practitioner or registered nurse in removing or reinserting a CVAD or arterial catheter. The licensed practical nurse must have the training, knowledge, skills and abilities to perform triage competently(RCW) 18.79,(WAC) 245-840andAdvisory Opinion on Telenursing. Other laws do allow exceptions for specific types of treatment: See theProviding Health Care to Minors under Washington Law Summaryfor more information. (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. Web(1) The purpose of defining standards of nursing conduct or practice through WAC 246-840-700 and 246-840-710 is to identify responsibilities of the professional registered nurse and the licensed practical nurse in health care settings and as provided in the Nursing Practice Act, chapter 18.79 RCW. Naloxone(Narcan) is the current standard of treatment for opioid overdose. The nursing commission provides advisory opinions and interpretive statements about specific areas of nursing practice. The employer may also decide whether they want to require an in-person course or on-line course and other parameters. It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to perform the following tasks related to chest tube care 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 the licensed practical nurse to perform the following tasks: The nursing and nursing assistant laws and rules do not prohibit the registered nurse delegator from using telehealth services to initiate or provide ongoing evaluation, or supervision of delegated tasks to UAP. The Nursing Care Quality Assurance Commission determines it is beyond the scope of a licensed practical nurse to perform a sterile speculum examination. Clinical judgment (critical thinking) is used throughout all components of the nursing process. 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 is always individually accountable and responsible for the nursing care the licensed practical nurse provides. The Washington state laws and rules do not require a specific training course or certification. 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. A licensed practical nurse may be a supervisor of a registered nurse in an organizational structure related to human resource and administrative functions. Can the task be safely performed according to exact, unchanging directions? These directions may come through standing orders or verbal orders. L&I Occupational Nurse Consultant at Washington Department of Labor & Industries . The licensed practical nurse may follow standing orders or verbal orders to renew an existing medication. RCW 28A.210.383(4)(b) provides: In the event a school nurse or other school employee administers epinephrine in substantial compliance with a student's prescription that has been prescribed by an authorized health care practitioner with prescriptive authority and written policies of the school district or private school, then the school employee, the school district or school of employment, and the members of the governing board and chief administrator are not liable in any criminal action or for civil damages as a result of administering epinephrine. (RCW 28A.210.383). Internationally educated practical nurse program in an approved nursing education program. (1) Administration of medications by injection (by intramuscular, intradermal, subcutaneous, intraosseous, intravenous, or otherwise) with the exception of insulin injections. There must be an order from an authorized provider. (c) The registered nurse and the licensed practical nurse shall obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or procedures which are in their scope of practice. Student requirements in all approved nursing education programs. (1) Administration of medications by injection (by intramuscular, intradermal, subcutaneous, intraosseous, intravenous, or otherwise) with the exception of insulin injections. The nurse must follow clinical standards of care. Has the patient or authorized representative given consent to the delegation? PO Box 47852 Olympia, Washington 98504-7852 . 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. 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