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. These are legend drugs, and not categorized as a controlled substance. Nurses must follow the delegation process following the RCW 18.79.260. (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. Curriculum for registered nurse refresher course. The procedure may be performed in a home setting or an in-center setting. The facility can be more restrictive. 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. If you have a question related to nursing practice in the state of Washington, please [email protected]@doh.wa.govfor questions about advanced nursing practice. It may be within the scope of practice for the licensed practical nurse to perform respiratory therapy procedures and activities such as administering or adjusting oxygen settings, adjusting ventilator settings, nebulizer treatments, suctioning, chest physical therapy, nebulizer treatments, intermittent positive pressure breathing therapy, or pulmonary function testing. Is the nursing assistant or home care aide trained in diabetes care and insulin injections when delegating insulin? Philosophy governing approval of nursing education programs. See theWashington State Department of Health Overdose Education and Naloxone Distribution Webpagefor more information. You should contact your legal advisor to obtain advice with respect to any particular issue or problem. TheRCW 18.79 Nursing Careand theWAC 246-840 Practical and Registered Nursingallow nurses to employ their full scope of practice in multiple settings. A prescription or order from an authorized health care practitioner is required. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Functions of a registered nurse and a licensed practical nurse. 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. 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 Centers for Medicaid and Medicare Services (CMS) and accreditation organizations (such as the Joint Commission) may have specific requirements. 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 To complete the free and publicly available telemedicine training, see theWashington State Medical Professional Telemedicine Training website. 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. Standing orders are certainly not to be used in lieu of medical consultation or intervention. 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. 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. Seeking mental health care is both safe and encouraged. 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. Off-label use should be done with careful insight and understanding of the risks and benefits to the patient considering high-quality evidence supporting efficacy, effectiveness, and safety. Washington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree. The LPN may follow POLST in any setting based on regulatory and individual scope of practice. 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. A licensed practical nurse may be a supervisor of a registered nurse in an organizational structure related to human resource and administrative functions. The method of communication must be appropriate for the situation. Degree requirements for nursing faculty teaching in a graduate nursing education program not leading to licensure as an advanced registered nurse practitioner. 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 nurse may get a prescription from a pharmacist with a Collaborative Drug Therapy Agreement (CDTA) or use the Washington State Department of HealthStatewide Standing Order to Dispense Naloxoneto get a prescription from a pharmacy. 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. 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 assist in carrying out the assessment process and carrying out these plans. It will produce withdrawal symptoms. 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. It is within the scope of practice of an appropriately prepared and competent licensed practical nurse to perform peritoneal dialysis under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. Splitting medications may result in dosage errors. 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. It is within the scope of practice of an appropriately prepared and competent licensed practical nurse to replace a suprapubic in an established tract under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. Conditions for participants entering the approved substance abuse monitoring program. 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. The registered nurse delegator makes independent professional decisions of the delegation of a nursing task. Licensed prescriber reviews the medications list and reconciles. The registered nurse delegator previously provided written instructions for the care and treatment of the patient. 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. 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. See theCompounding Medications by Licensed Practical Nurses, Registered Nurses, and Advanced Registered Nurse Practitioners Advisory Opinionfor more information. Section B may require nursing delegation for some tasks following the delegation 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. 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. Degree and licensing requirements for nursing faculty teaching in a nursing education program leading to licensure as an advanced registered nurse practitioner. These procedures require a prescription from an authorized health care practitioner. 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. Web(a) Delegating nursing care function or responsibilities to a person the nurse knows or has reason to know lacks the ability or knowledge to perform the function or responsibility, or delegating to unlicensed persons those functions or responsibilities the nurse knows or has reason to know are to be performed only by licensed persons. The nursing laws and rules do not prohibit the licensed practical nurse from taking a verbal or telephone order. Licensure for nurses by interstate endorsement. (1) Administration of medications by injection (by intramuscular, intradermal, subcutaneous, intraosseous, intravenous, or otherwise) with the exception of insulin injections. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to lead this activity due to the complexity of the procedure. 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 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. Internationally educated registered nurse program in an approved nursing education program. Medications being placed into an organizer or individual pill container must already be dispensed by a pharmacist or other authorized health care provider; The medication organizer or individual pill container must be properly labeled with the patient's name, name of the medication, dosage of each medication, frequency which the mediation is given; The licensed practical nurse must consult with the prescriber, pharmacist or other health care provider as appropriate; and. Exceptions to nursing faculty degree requirements in prelicensure registered nurse nursing education programs. 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. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. Some facility laws do address medication refusal. The nursing laws and rules allow a licensed practical nurse to provide care in an ICU, PCU, or recovery room. Curriculum for LPN nurse refresher course. The licensed practical nurse may initiate the evaluation and/or respiratory fit testing following standing orders. (13) "Procedure" means a series of steps with a desired result; a particular course of action or way of doing something. WAC 246-330 Ambulatory Surgical Facilitiesrequire at least one registered nurse to have current ACLS certification. Another option is for the facility or employer to become an authorized entity. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to perform an amniotomy. 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. The nurse may want to consult with an authorized health care practitioner or a registered nurse in situations when the nurse is unsure if the patient still requires an intravenous line or if the patient's intravenous line is insufficient to support the therapy needed. 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. Credentials issued to an LPN, RN, or ARNP in Washington state. The LPN and RN may provide telehealth nursing services within their scope of practice to patients in Washington state. (WAC 388-76-10405) The LPN should call the nursing supervisor, 911, or hospice for emergency help, and stay with the patient. Anursing care assessmentgathers information about the person's health status through the collection of data and/or physical examination. RCW 28A.210.383(2)(b). 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 commission provides advisory opinions and interpretive statements about specific areas of nursing practice. 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. 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. A prescription or order from an authorized provider is required. See theNCQAC's Prevention and Treatment of Opioid-Related Overdoses Advisory OpinionandFrequently Asked Questions for Nursing Professionals of the Prevention and Treatment of Opioid-Related Overdoses for more information. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform a routine and non-complex cardiac stress test under the direction of an authorized health care practitioner, or under the direction and supervision of a registered nurse, 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. 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. Is the task within the registered nurse's scope of practice? 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. 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. 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. A prescription or order from an authorized provider is required. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical to provide epidural care during labor and delivery. Medical regimens require a prescription or order from an authorized health care practitioner. Triaging occurs in various setting such as managed care organization, primary and specialty care, emergency departments, and crisis lines. 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). These procedures require a prescription from an authorized health care practitioner. The physician rules allow delegation to a properly trained and licensed professional and require a physician to be on the immediate premises during the patient's initial treatment. Is appropriate supervision available? The pre-admission/resident assessment findings may identify needs for a comprehensive nursing care assessment. These procedures require a prescription from an authorized health care practitioner. See theNCQAC Standing and Verbal Orders Advisory Opinionfor guidelines and recommendations. 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 delegating nurse shall: 3. Yes, licensed nurses (RN, LPN, or ARNP) in Washington state are required to take telemedicine training if the nurse provides telemedicine services. 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. The licensed practical nurse practices in an interdependent role when carrying out nursing care and a dependent role when carrying out medical regimens. The licensed practical nurse must be competent to carry specific steps identified in the standing order or verbal order. However, theMedical Quality Assurance Commission WAC 246-919-606 Nonsurgical Medical Cosmetic Proceduresapplies to nonsurgical medical cosmetic procedures that involve the injection of a medication or substance for cosmetic purposes, or use of a prescriptive device for cosmetic purposes (except for laser, light, radiofrequency and plasma devices). The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. 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