A licensed practical nurse may work in any setting where nursing care is provided. The licensed practical nurse must follow theWAC 246-878 Compounding Practicesand theUnited States Pharmacopeia (USP)compounding guidelines. WebSee WAC 246-827-0240 for MA-certified. A prescription or order from an authorized provider is required for legend drugs, controlled substances, over-the-counter drugs, or for medical treatments.RCW 18.79.270 LPN - Activities Allowed. TheRCW 18.71.011 Definition of the Practice of Medicinestipulates the practice of medicine to include severing penetrating the tissues of human beings. Licensure for ARNP applicants by interstate endorsement. A SNF may limit the admission of a patient if a registered nurse is not available to perform the admission assessment. A prescription or order from an authorized health care practitioner is required. 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. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. Collect and verify the patient's complete medication history. The licensed practical nurse may not administer epinephrine without an order from an authorized health care practitioner. Then the withheld medications are given post dialysis, usually with communication to the provider on the patient's tolerance and outcomes for a successful dialysis and the provider's determination of the next dialysis. 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 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. The nurse must follow Federal and State blood-borne pathogen andClinical Laboratory Improvement Amendments (CLIA)regulations. 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. Mail: P.O. POLST should not be written as part of routine admission paperwork without medical professional involvement and extensive discussion. The licensed practical nurse may collect demographic data from the caller and screen the patient who presents with suicide thoughts. The licensed practical nurse must apply adequate knowledge and skills in determining the dosage to be administered at any given time. A licensed registered nurse may delegate specific nursing care tasks to nursing assistants or home care aides meeting certain requirements and providing care to individuals in a community-based care setting defined by RCW. The licensed practical nurse must consult with an authorized health care practitioner or the registered nurse if the patient's situation is going outside the standing order. 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 employer may not expand licensed practical nurse scope of practice. (5) "Home care aide" means a person certified under chapter. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to re-insert a gastrostomy tube in a mature stoma site under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. 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 may assist an authorized health care practitioner or the registered nurse in suctioning a fresh tracheostomy stoma; Changing, repositioning, or reinserting a tracheostomy tube in an established tracheostomy tract, (Decannulation before a mature tract is an emergency situation as well as a complex procedure and is not within the scope of the licensed practical nurse. (12) "Personal care services" as defined in WAC. Washington state is not a member of the Nurse Licensure Compact (NLC) through the National Council of State Boards of Nursing (NCSBN) that allows the nurse to practice in member states with one state licensure in another state in the NLC. These procedures require a prescription from an authorized health care practitioner. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of experimental drugs is within his or her regulatory and individual scope of practice. WebWhat Is Nurse Delegation? 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. Frequency of assessment may be determined by institutional policy, patient condition, CMS requirements, and accreditation standards. Withholding medications, primarily anti-hypertensives, prior to dialysis is not uncommon. 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 should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. 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). 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 LPN and RN may provide telehealth nursing services within their scope of practice to patients in Washington state. VDOT is the use of a videophone or other video/computer equipment to observe clients taking their medications remotely. Curriculum for registered nurse refresher course. The Food and Drug Administration (FDA) approves cosmetics. The Nursing Care Quality Assurance Commission (NCQAC) recommends telemedicine training be completed as soon as possible as a demonstration of competency. Use and protection of professional titles. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to perform pulmonary artery pressure monitoring procedures due to the complexity of the procedure. The licensed practical nurse cannot provide nursing care independently. 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 order may be made using a standing order. The facility can be more restrictive. 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. A licensed practical nurse may provide direct patient care and perform functions within the nurse's legal and individual scope of practice under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. 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. 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. To learn more about the different training options available and access additional resources, see theWashington State Telehealth Collaborative Training webpage. Degree requirements for faculty teaching in practical nursing education programs. Abnormal test results should be communicated by someone who can provide supporting information about the test, implications, and follow-up care. 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. It may be within a licensed practical nurse's scope of practice to provide routine or basic training to UAP if the licensed practical nurse is competent under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse based on the nursing care plan. The Nursing Care Quality Assurance Commission does not have authority to interpret the laws governing the provision of health care in K-12, public and private schools. The Nursing Care Quality Assurance Commission determines it is beyond the scope of a licensed practical nurse to perform a sterile speculum examination. The licensed practical nurse may perform nursing care under the direction of an authorized health care practitioner or at the direction and under the supervision of the registered nurse. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides 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. A community-based care setting as defined by RCW. The law, RCW 43.70.495, requires the nurse to sign and retain an attestation of completion. Curriculum for practical nurse nursing education programs. The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. RCW 18.20 Assisted Living Facilities and WAC 388-78A Assisted Living Facility Licensing Rules for more information. Triaging occurs in various setting such as managed care organization, primary and specialty care, emergency departments, and crisis lines. If you have a question related to nursing practice in the state of Washington, please contactnursingpractice@doh.wa.govorarnppractice@doh.wa.govfor questions about advanced nursing practice. Clinical judgment (critical thinking) is used throughout all components of the nursing process. It involves determining the meaning and significance of what is observed or expressed to determine need for action. TheRCW 18.79 Nursing Careand theWAC 246-840 Practical and Registered Nursingallow nurses to employ their full scope of practice in multiple settings. Perform infusion-related tasks under the supervision of a registered nurse or other authorized health care practitioner with appropriate infusion therapy knowledge and skills. A competent adult patient or the legal surrogate may always change their medical decisions and request alternative treatment. The nursing laws and rules do prohibit the competent and appropriately trained licensed practical nurse from assisting in performing a sports physical examination under the direction of an authorized provider or under the direction and supervision of the registered nurse. WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The registered nurse delegator identifies and facilitates additional training of the nursing assistant or home care aide prior to delegation in these situations. The rule of thumb is to recommend POLST for patients if their provider would not be surprised if they die within a year. A prescription or order from an authorized provider may be necessary if complications occur or if medical treatment is required. This may be appropriate for patients with advanced dementia at risk for aspiration, patients with osteoporosis, or other conditions and situations in which chest compressions or other CPR interventions may cause more harm than benefit to the patient. Naloxone(Narcan) is the current standard of treatment for opioid overdose. Other State laws and rules address delegation, and facility requirements. Degree and licensing requirements for nursing faculty teaching in a nursing education program leading to licensure as an advanced registered nurse practitioner. Continuing competency audit process and compliance. SSB 6421was passed in 2016 allowing authorized entities to obtain epinephrine autoinjectors. The nurse providing asynchronous (store-and-forward) VDOT is not required to take the training, but NCQAC recommends all nurses take the training. The employer may also decide whether they want to require an in-person course or on-line course and other parameters. It is acceptable for the licensed practical nurse to prepare a medication organizer or individual pill containers under the following conditions: See theAdvisory Opinion on Medisets, theMedication Organizer Device Letter from Secretary of Health (PDF), and theMedication Organizer Device (PDF)for more information. The nursing rules define supervision as, The provision of guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action. A registered nurse practices independently and does not require supervision or evaluation of nursing care. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. The licensed practical nurse must follow theWAC 246-878 Compounding Practicesand theUnited States Pharmacopeia (USP)compounding guidelines. Internationally educated practical nurse program in an approved nursing education program. 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. It is within the scope of an appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner or the registered nurse, in providing epidural care, following clinical practice standards. The licensed practical nurse can use nursing judgment. RCW 28A.600.200 Interscholastic Athletic and Other Extracurricular Activities for Studentsprovides authority to the school district board of directors to control, supervise, and regulate the conduct of interschool athletic activities including delegating control, supervision and regulation to theWashington Interscholastic Activities Association (WIAA)or other voluntary nonprofit entity. The nurse would need to contact the other state(s) to see if they can practice in their state with a Washington state license during the pandemic. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. Exceptions to nursing faculty degree requirements in prelicensure registered nurse nursing education programs. Yes. TheWAII Handbookidentifies a Medical Doctor (MD), Doctor of Osteopathy (DO), Advanced Registered Nurse Practitioner (ARNP), Physician' Assistant (PA), and Naturopathic Physician as a medical authority to perform a sports physical examination. Philosophy governing voluntary substance abuse monitoring programs. Ongoing evaluation and approval of nursing education programs located in Washington state. 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. In the community residential settings, the patient may be a client, consumer, or resident. Hiding medications and not notifying the patient may be a violation of patient rights. 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 patient's most recent communications, made in the context of their current medical condition, are the most likely to reflect their current wishes. 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. TheWAC 388-76 Adult Family Home Minimum Licensing Requirementsaddresses medication refusal:WAC 388-76-10435 Medication Refusal. The procedure may be performed in a home setting or an in-center setting. Degree requirements for nursing faculty teaching in prelicensure registered nurse or for RN to BSN education programs. See the Washington State Department of Health'sEpinephrine Autoinjectors and Anaphylaxis Training and Reporting for Authorized Entities Frequently Asked Questionsand theSSB 6421 Status Update Documentfor more information. The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. 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 A prescription or order from an authorized provider is required. The licensed practical nurse administering the medication is responsible for ensuring the medication is safe to crush or split before giving it. It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner, or a registered nurse, to perform needle decompression for a tension pneumothorax, following clinical practice standards. 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 a licensed practical nurse to get a special certification to perform infusion therapy, phlebotomy, or laboratory tests. (a) The registered nurse and the licensed practical nurse shall have knowledge and understanding of the laws and rules regulating nursing and shall function within the legal scope of nursing practice; (b) The registered nurse and the licensed practical nurse shall be responsible and accountable for his or her practice based upon and limited to the scope of their education, demonstrated competence, and nursing experience consistent with the scope of practice set forth in this document; and. A facility or supervisor may require direct or immediate supervision for specific activities or if there are concerns about the licensed practical nurse's competency. WebMust meet all Washington Administrative Code (WAC) requirements related to this position Minimum of 3 years nursing experience preferred Ability to read, write, and speak in English Delegation process experience preferred Must possess strong organizational, time-management, and problem-solving skills The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to insert a FSE or IUPC. Facilities should develop policies to manage legal risk in such a situation. The licensed practical nurse uses and applies nursing diagnosis (formulated by the registered nurse) as a foundation for implementing interventions. COURSES Student requirements in all approved nursing education programs. Generally, a prescription from an authorized health care practitioner is required for reimbursement of medical supplies. Washington state law gives medical responders protection from legal liability when following POLST. The licensed practical nurse may enter medication prescriptions into an electronic health system under the direction of an authorized health care practitioner. However, the Nursing Care Quality Assurance Commission (NCQAC) recommends licensed nurses complete the telemedicine training if they provide services such as; telephone triage, remote patient monitoring (RPM, which enables recording and monitoring health data remotely), asynchronous telehealth (such as Store and Forward technology that allows patient data to be collected, stored, and later retrieved by another professional), Mobile Health (mHealth, using smart devices such as smartphones and smart wearables that allow continuous data collection about a person's behavior or condition) or other types of telehealth. The Nurse Delegation Program, under Washington State law, allows nursing assistants working in certain settings to perform certain tasks--such as administration of prescription medications or blood glucose testing--normally performed only by licensed nurses. This procedure requires a prescription from an authorized health care practitioner. The nursing commission provides advisory opinions and interpretive statements about specific areas of nursing practice. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. Using synchronous and asynchronous VDOT for tuberculosis treatment adherence is occurring across the United States and in Washington State. 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. Only the registered nurse may delegate to assistive personnel to perform diabetes management tasks in this setting. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. It is not in the scope of practice for a licensed practical nurse to make a medical diagnosis based on interpretation of diagnostic test results. Dedicated education units for practical nurse or registered nurse nursing education programs. It is expected that the registered nurse would complete an appropriate age-specific nursing assessment and nursing care plan. (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. TheDrug Enforcement Administration (DEA)does state that, an individual (secretary or nurse) may be designated by the practitioner to prepare prescription for the practitioner's signature.. 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. 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. It is not within the scope of practice for a licensed practical nurse to start an intravenous line without an order from an authorized health care practitioner. Itdoes notinclude the use of audio-only telephone, facsimile, or email.. 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 Quality Assurance Commission recommends the licensed practical nurse use the Scope of Practice Decision Tree to determine if an activity is within the nurse's scope of practice. OREGON STATE UNIVERSITY Open search box. It is impossible for the Nursing Care Quality Assurance Commission (NCQAC) to provide a comprehensive listing of the duties that licensed nurses are permitted to perform since nursing practice is reflective of the dynamic changes occurring in healthcare and society. Can the task be performed without a need for complex observations or critical decisions? The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. 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. A prescription or order from an authorized health care practitioner is required. These are legend drugs, and not categorized as a controlled substance. Laser treatment requires a prescription from an authorized health care practitioner. Use of alternative modalities for pain treatment. Clarify that the medications and dosages taken by the patient are correct and enter the information into the patient's record. The delegating nurse shall: 3. The nurse must have a valid prescription, either in the nurse's name, in the name of an entity, in the name of a person or patient, or through a standing order. Inflation and deflation of cuff in a healed and established stoma. The licensed practical nurse not analyze, synthesize, or evaluate the data or develop the nursing care plan. They may administer or provide an epinephrine autoinjector to people who are experiencing anaphylaxis. The general age of majority for health care is eighteen years old in Washington State as defined in . A comprehensive nursing assessment means collection, analysis, and synthesis of data performed by the registered nurse used to establish a health status baseline, plan care and address changes in a patient's condition as defined in theNational Council State Boards of Nursing (NCSBN) Model Act (2012). The nurse must be licensed in Washington, or be approved through theEmergency Volunteer Health Practitioners Programduring the COVID-19 emergency. If complications occur or if medical treatment is required full scope of practice Decision Treeto if. Nurse scope of practice Decision Treeto determine if these activities are within the providing! `` Personal care services '' as defined in WAC theScope of practice statements about nurse delegation washington state wac areas nursing! Be necessary if complications occur or if medical treatment is required to who. Eighteen years old in Washington State law gives medical responders protection from legal when. 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