ThePublic Health Nurses: Dispensing Medications/Devices for Prophylactic and Therapeutic Treatment of Communicable Diseases and Reproductive Health Advisory Opinionprovides guidelines and recommendations. To complete the free and publicly available telemedicine training, see theWashington State Medical Professional Telemedicine Training webpage. 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. Licensure for nurses by interstate endorsement. Any CLIA waived test involving puncturing the skin requires an order from an authorized health care practitioner. An order from an authorized health care practitioner is required. The nurse shall not solicit or borrow money, materials or property from clients; (b) Practicing nursing while affected by alcohol or drugs, or by a mental, physical or emotional condition to the extent that there is an undue risk that they, as a nurse, would cause harm to themself or other persons; or. (7) "Indirect supervision" means the registered nurse delegator is not on the premises. The label will suffice if the label completed following state law, is legible, properly identified, has the name of the patient on it, and the medication prescription has not expired. A licensed practical nurse may administer medications and perform treatments or procedures without the registered nurse or other authorized health care practitioner on the premises. A competent adult patient or the legal surrogate may always change their medical decisions and request alternative treatment. 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. The medical provider makes the "medical judgment" as to the specific medication and dosage. 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. This may include self-administering epinephrine using an EAI or a prefilled medication device if authorized in the prescription. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. Such person shall be a member of one of the classes of persons as directed in RCW. WebRepealed by Order 71-3, filed 3/25/71. 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. Examples of diagnostic imaging procedures include: While the licensed practical nurse may perform routine, diagnostic imaging procedures, because of the complexity, it is not within the scope of the licensed practical nurse to perform interventional radiology procedures. 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. Continuing competency audit process and compliance. 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. WebThe registered nurse delegator previously provided written instructions for the care and treatment of the patient. 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 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. MSE is beyond initial triage. The delegating physician need not be on the premises during the procedure, but the physician must be reachable by telephone to be able to respond within thirty minutes to treat complications. Standards of nursing conduct or practice. Implementing nursing interventions and medical orders consistent with nursing rules and within an environment conducive to patient safety; Prioritizing performance of nursing interventions within the assignment; Recognizing responses to nursing interventions; Modifying immediate nursing interventions based on changes in the patient's status; and. (3) "Complex task" means that a nursing task may become more complicated because of: (c) The nursing care task(s) and involved risks; and. Clarify that the medications and dosages taken by the patient are correct and enter the information into the patient's record. The newly licensed RN, LPN, or ARNP or the RN, LPN, or ARNP licensed through the endorsement process who provides clinical services will need to meet the requirement one year after the initial license is issued. The procedure may be performed in a home setting or an in-center setting. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse from administering stem cell-based products via a peripheral intravenous line, intra-arterial catheter, intradermal technique, or intramuscular technique. RCW 69.41.095allows the Licensed Practical Nurse to carry and administer an opioid antagonist (such as naloxone) to a person suspected of experiencing an opioid overdose in any setting. A prescription or order from an authorized provider may be necessary if complications occur or if medical treatment is required. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of intra-articular injections with within his or her regulatory and individual scope of practice. VDOT is the use of a videophone or other video/computer equipment to observe clients taking their medications remotely. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionand Verbal Orders provides additional guidance and recommendations. Ongoing approval, accreditation and commission reviews. The nurse must follow Federal and State blood-borne pathogen andClinical Laboratory Improvement Amendments (CLIA)regulations. The RN must be appropriately trained and competent to provide nursing telehealth services. See the Nursing Care Quality Assurance Commission'sNeonatal Intubation and Related Procedures Advisory Opinionfor additional information. If the patient is not in a stable condition, the licensed practical nurse may assist an authorized provider, or the registered nurse, in performing these procedures. The licensed practical nurse not analyze, synthesize, or evaluate the data or develop the nursing care plan. 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 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 employer may not expand licensed practical nurse scope of practice. The facility can be more restrictive. The laws and rules do not prohibit the competent and appropriately trained licensed nurse from implementing a drug order that has a dosage range. This is an example of a situation where health care providers caring for the patient must be aware of the POLST. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical to perform IUI. 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. 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. WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. Functions of the registered nurse supervising the nursing technician. Licensure for ARNP applicants by interstate endorsement. The facility or employer may require a specific certification or training program. The laws and rules place accountability on the nurse who is implementing the order to implement or clarify that the order is accurate, valid, properly authorized, and is not harmful or potentially harmful to the patient, or is not contraindicated by documented information. Application requirements for ARNP prescriptive authority. Interventional radiology is performed using minimally invasive therapies under imaging guidance. 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. Resources, facilities and services for approved nursing education programs. 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. The order may be made using a standing order. 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. Commission action regarding refresher course programs. These directions may come through standing orders or verbal orders. The nursing law and rule does not prohibit the licensed practical nurse in making a decision to crush or split medications without an order. Only a registered nurse or advanced registered nurse practitioner may supervise and evaluate the practice of nursing provided by a licensed practical nurse. Is RN assessment of patient's nursing care needs completed? Authorized entities that choose to acquire epinephrine autoinjectors must have people connected with the entity, such as employees, who have completed an anaphylaxis and epinephrine autoinjector training. Is appropriate supervision available? Some facility laws and rules require nurses to have a CPR certification. Internationally educated nurse program approval criteria for nursing education programs approved in Washington state. 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. 296-04-160: Apprenticeship committees. For more information and training resources, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. This includes following the Washington State Department of HealthStatewide Standing Order to Dispense Naloxone. 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. Established numerous primary care clinics. 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 practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Patient notification, secure storage, and disposal. Some settings may use the licensed practical nurse to manage calls after specialized training and under the supervision of the registered nurse or other authorized health care provider. Using synchronous and asynchronous VDOT for tuberculosis treatment adherence is occurring across the United States and in Washington State. This does not mean the licensed practical nurse may not work in a pharmacy setting administering immunizations. 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. 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 licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. CPR should be stopped in absence of a pulse if CPR is started for a patient with a POLST indicating DNAR. Follow the policies and procedures relative to the documentation (paper or electronic) system used by the organization. Collect and verify the patient's complete medication history. 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. Students enrolled in a nontraditional nursing program. Can the task be performed without requiring judgment based on nursing knowledge? 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 perform wart removal using liquid nitrogen or topical medications under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. These procedures require a prescription from an authorized health care practitioner. It is not within the LPNs scope of practice to certify death. 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. To learn more about the different training options available and access additional resources, please visit theWashington State Telehealth Collaborative Training webpage. CNA may administer in a nursing home setting with a medication assistant endorsement. 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 The Nursing Care Quality Assurance Commission recommends following theWAC 246-919-606for physicians. The ALF may choose to provide, but is not required to provide, intermittent nursing services. Reporting and recordkeeping requirements for nursing education programs. An individual with a nursing license (licensed practical nurse or registered nurse) meets the qualifications to perform the pre-admission/resident assessment. The nursing commission provides advisory opinions and interpretive statements about specific areas of nursing practice. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of the off-label medication is within the nurse's regulatory and individual scope of practice. See theWAC 246-865-060 Pharmaceutical Services-Extended Care Facilityfor more information. The licensed practical nurse may perform some activities related to ART within the nurse's scope of practice, such as medication administration, routine laboratory testing, and basic education, under the direction of an authorized health care practitioner, or under the direction and supervision, of the registered nurse. For more information go to the Washington State Department of Health Tuberculosis Website(this site is accessible only to LHJs at this time). It is not within the scope of practice for the licensed practical nurse to delegate to assistive personnel nursing tasks in the public and private, kindergarten through twelve grade school setting (RCW 28A.210 Common School Provisions: Health-Screening and Requirements). 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. Philosophy governing approval of nursing education programs. The nurse should use theScope of Practice Decision Treeto determine if specific activities are within the nurse's legal and individual scope of practice. WebWhat Is Nurse Delegation? (6) The nurse shall only practice nursing in the state of Washington with a current Washington license; (7) The licensed nurse shall not permit their license to be used by another person; (8) The nurse shall have knowledge of the statutes and rules governing nursing practice and shall function within the legal scope of nursing practice; (9) The nurse shall not aid, abet or assist any other person in violating or circumventing the laws or rules pertaining to the conduct and practice of professional registered nursing and licensed practical nursing; or. 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. The licensed practical nurse must be competent to carry specific steps identified in the standing order or verbal order. 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. Appropriate documentation of a focused patient assessment and evaluation must substantiate intervention. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from administering medications following standing orders. Denial, statement of deficiencies, conditional approval or withdrawal of approval of nursing education programs located in Washington state. POLST is a set of portable medical orders, executed by an adult patient (or legal surrogate) and the patient's medical provider, to guide medical treatment based on the patient's current medical condition and goals. 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. This assessment includes the use of the nursing process (WAC 246-840-700). The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionand Verbal Orders provides additional guidance and recommendations. The delegating nurse shall: 3. The Washington state laws and rules do not require a specific training course or certification. The law, RCW 43.70.495, requires the nurse to sign and retain an attestation of completion. Curriculum for graduate nursing education programs. Student requirements in all approved nursing education programs. The Licensed Practical Nurse may administer an opioid antagonist following a standing order from an authorized health care practitioner. The Nursing Care Quality Assurance Commission also approvesadvisory opinions and interpretive statementsthat address specific nursing practice questions. It is not within the scope of practice of the LPN to sign POLST. 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. 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