WebContact Information Health Services Annie Hetzel 360-725-6040 The follow A-Z Index of health topics includes OSPI resources and external hyperlinks to resources produced by our partners. 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. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform routine and non-complex tracheostomy care under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards including: The licensed practical nurse should use theScope of Practice Decision Treeto determine if the activity is within the nurse's legal and individual scope of practice. RCW 28A.210.383(2)(a). 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 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. With insulin injections, the supervision occurs at least weekly for the first four weeks. 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 The Washington state laws and rules do not require a specific training course or certification. Delegation is not required for the NA-R/NA-C or other UAP to follow the cardiopulmonary resuscitation (CPR)/DO NOT ATTEMPT RESUSCITATION (DNAR) POLST in Section A. The licensed practical nurse can use nursing judgment. 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. 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. 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. 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 practice nurse must work under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. However, theMedical Quality Assurance Commission WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skinincludes language and requirements for physicians. Itdoes notinclude the use of audio-only telephone, facsimile, or email.. There are no specific laws or rules prohibiting the delegation. The licensed practical nurse may destroy, witness, and/or cosign the destruction of wasting of controlled substances in a SNF home. Application requirements for ARNP prescriptive authority. Please refer to theScope ofPractice Decision Treethat will help you walk through your scope area. However, it may be feasible for OSPI and school districts to develop written policies to allow a substitution for the EAI for an individual student when the substitution is permitted by the prescriber according to the student's anaphylaxis care plan. The licensed practical nurse may be a member of the team and assist in performing individual activities during resuscitation based on theScope of Practice Decision Treeunder the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. The patient may want to refuse CPR under all circumstances including choking or accidents. Training and education of staff employed in these facilities that address personnel, performance and other administrative activities do not require the utilization of a registered nurse. Approval of substance abuse monitoring programs. TheRCW 18.79 Nursing Careand theWAC 246-840 Practical and Registered Nursingallow nurses to employ their full scope of practice in multiple settings. It is within the scope of an appropriately prepared and competent licensed practical nurse to follow standing orders to provide routine birth control or to screen for and treat sexually transmitted diseases. (d) The registered nurse and the licensed practical nurse shall be responsible for maintaining current knowledge in their field of practice; and, (e) The registered nurse and the licensed practical nurse shall respect the client's right to privacy by protecting confidential information and shall not use confidential health care information for other than legitimate patient care purposes or as otherwise provided in the Health Care Information Act, chapter. 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. [ IX, filed 3/23/60.] No. 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. Title: 107N-YN_CS_NPS - Program Coordinator. Is RN assessment of patient's nursing care needs completed? The licensed practical nurse may assist an authorized health care practitioner, or the registered nurse in performing colposcopy and collecting forensic evidence, following clinical practice guidelines. 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). Pharmacy Quality Assurance Commission . A prescription or order from an authorized health care practitioner is required. 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. This may apply to prescriptions for individual students as well as for the school supply. Delegation in community and in-home care settings is defined by WAC 246-840-910 through 246-840-970. Nurses must follow the delegation process following the RCW 18.79.260. 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 pre-admission/resident assessment (screening tool) does not necessarily require the services of a professional licensed nurse or the use of the nursing process (WAC 246-840-700). For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. A prescription or order from an authorized provider is required. Does the patient reside in one of the following settings? 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. These procedures require a prescription from an authorized health care practitioner. 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 Centers for Medicare and Medicaid Services (CMS) does not allow the licensed practical nurse to perform a pre-anesthesia assessment. A facility or employer may require a specific certification or training program. The telemedicine training provides a valuable overview of the roles, responsibilities, liability, and legal requirements when providing telehealth services. Is appropriate supervision available? The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing a lumbar puncture, following clinical practice standards. The employer may have policies or guidelines about crushing or splitting medications. The licensed practical nurse should use theScope of Practice Decision Treeto determine if any activities are within the nurse's legal and individual scope of practice. There may be other regulations, such as Centers for Medicare and Medicaid Services (CMS) who defines the requirements for supervision (general or direct), and other parameters for reimbursement 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 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 does not have authority to interpret the laws governing the provision of health care in K-12, public and private schools. The law, RCW 43.70.495, requires the nurse to sign and retain an attestation of completion. The nurse should use theScope of Practice Decision Treeto determine if specific 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. (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. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in reinsertion of a tracheostomy tube if the decannulation occurs before the tract is established. It is within the scope of an appropriately prepared and competent licensed practical nurse to perform a fetal NST and amniotic fluid index level using ultrasound under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. 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 may assist in gathering information for the nursing care assessment under the direction and supervision of the registered nurse. See theNCQAC Standing and Verbal Orders Advisory Opinionfor guidelines 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. It is not within the Licensed Practical Nurse's scope of practice to delegate administration of an opioid antagonist by any route in any setting. (WAC 388-76-10405) A prescription or order from an authorized provider is required. The licensed practical nurse may assist the registered nurse in performing the MSE collecting the information and data and performing a focused assessment. 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 nurse must follow clinical standards of care. Other professionals may also perform the pre-admission/resident assessment (WAC 388-76-10150andWAC 388-78A-2080). STATE OF WASHINGTON . (d) The skill level required to perform the task. It is within the scope of the appropriately prepared and competent LPN to discuss end-of-life care with the patient or surrogate under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse (RN). It is not within the scope of practice for a licensed practical nurse to practice independently. 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. Orders for OTC drugs or devices may be done using standing orders from an authorized health care practitioner or a registered nurse as identified in the nursing care plan. A prescription or order from an authorized provider is required. (15) "Stable and predictable condition" means the registered nurse delegator determines the patient's clinical and behavioral status is nonfluctuating and consistent. This includes preparing and monitoring the dialysis machine, accessing an arteriovenous (AV) fistula or graft or a central venous catheter, initiating or discontinuing hemodialysis, collecting specimens, catheter site care, and performing tubing or adaptor changes. The nursing diagnosis drives interventions and patient outcomes, enabling the registered nurse to develop the nursing care plan. The employer may also decide whether they want to require an in-person course or on-line course and other parameters. The licensed practical nurse may administer naloxone or other opioid antagonist to anyone at risk for having or witnessing an opioid overdose. 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. Curriculum for LPN nurse refresher course. Internationally educated registered nurse program in an approved nursing education program. It is within the scope of practice of an appropriately trained and competent licensed practical nurse assist with an authorized health care practitioner or registered nurse to insert a PEG tube, . Other examples include post-fall and pre-transfer assessments. 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 purpose of reconciliation is to avoid errors that include but are not limited to transcription, omissions, duplication, dosing errors, or drug interactions. The MSE requires a comprehensive assessment. 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. Commission action following commission site visit, complaint investigation, or national accreditation visits of nursing education programs located in Washington state. The licensed practical nurse may administer medications by any route. 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. (1) Administration of medications by injection (by intramuscular, intradermal, subcutaneous, intraosseous, intravenous, or otherwise) with the exception of insulin injections. It may be within the scope of practice of a competent and appropriately trained licensed practical nurse to perform a focused assessment and monitor the patient collecting the information and data related to pulmonary function. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to remove an IABP or temporary pacing wires due to the complexity of the procedure and concerns about the stability of the patient. The nursing laws and rules allow a licensed practical nurse to provide care in an ICU, PCU, or recovery room. (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. COURSES 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. Episodic care of chronic opioid patients. Standing orders may also be followed to direct occupational health activities. 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 LPNs scope of practice to certify death. WAC 246-840-700allows the licensed practical nurse to make basic observations, gather data and assist in identification of needs and problems relevant to the patient, collect specific data as directed, and, communicate outcomes of the data collection process in a timely manner to the registered nurse or other authorized health care provider. No, the telemedicine training requirement doesn't apply to audio-only telephone (telephone triage), facsimile, or email. The LPN should call the nursing supervisor, 911, or hospice for emergency help, and stay with the patient. There must be an order from an authorized provider. 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. Internationally educated nurse program approval criteria for nursing education programs approved in Washington state. The nursing laws and rules do not require the licensed practical nurse to maintain first aid certification, CPR or stipulate whether the licensed practical nurse needs to have Basic Cardiac Life Support (BLS) or have BLS for health care providers. Follow-up with the prescribing provider is warranted if a medication order states to crush or split the medication is necessary, but it is not recommended. See theDentist Scope of Practice - Use of Botulinum Toxin Injections/Dermal Fillers Interpretive Statementfor more information. 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. RCW 18.20 Assisted Living Facilities and WAC 388-78A Assisted Living Facility Licensing Rules for more information. RCW 69.41.095provides an exception to the nursing delegation laws and rules and does not require delegation for a nursing assistant to administer an opioid overdose medication by intranasal spray or by injection. 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. There may be other regulations, such as Centers for Medicare and Medicaid Services (CMS) who defines the requirements for supervision (general or direct), and other parameters, for reimbursement of the procedure. This procedure requires a prescription from an authorized health care practitioner. The licensed practical nurse needs to determine whether the medication can be safety split to ensure proper dosage. The nurse may not sign the nurse's name or the name of the individual authorizing the prescription on the prescription. See the Nursing Care Quality Assurance Commission (NCQAC)s Determining, Pronouncing, and Certifying Death Advisory Opinion for more information. How to make changes to the delegated tasks. 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. 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. These procedures require a prescription from an authorized health care practitioner. The delegating nurse shall: 3. The laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from triaging calls under the direction (direction can be following a standing order) of an authorized health care practitioner or under the direction and supervision of the registered nurse if the licensed practical nurse has the training, knowledge, skills and ability to carry out the activity safely and competently and is willing to accept any consequences of his/her actions. The licensed practical nurse implements health care plans developed by the registered nurse or other authorized health care practitioner. Patients with chronic pain, including those on high doses, establishing a relationship with a new practitioner. Other laws do allow exceptions for specific types of treatment: See theProviding Health Care to Minors under Washington Law Summaryfor more information. Bedside caregivers and supervisors should be familiar with this detail in the patient care plan and POLST. This includes initiating or discontinuing therapy using pre-mixed medicated peritoneal dialysis bags, collecting specimens, catheter site care, and performing tubing or adaptor changes. Use and protection of professional titles. 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. Additional student requirements for RN to BSN and graduate nursing education programs. It is within the scope of an appropriately prepared and competent licensed practical nurse to perform internal or external electronic fetal monitoring under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. 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. Continuing education requirements for opioid prescribing. 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. Degree requirements for faculty teaching in practical nursing education programs. See theCompounding Medications by Licensed Practical Nurses, Registered Nurses, and Advanced Registered Nurse Practitioners Advisory Opinionfor more information. 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 prohibit the competent and appropriately trained licensed practical nurse from administering medications following standing orders. Curriculum for nursing education programs preparing students for licensure as advanced registered nurse practitioners (ARNP). WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. The RN must be appropriately trained and competent to provide nursing telehealth services. The nurse must follow Federal and State blood-borne pathogen andClinical Laboratory Improvement Amendments (CLIA)regulations. RCW 28A.210.370allows self-administration of medications, including epinephrine, if the student meets the requirements under the treatment plan for anaphylaxis, and has a prescription from their health care practitioner. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to obtain a blood specimen via a capillary or venous blood sample to perform lead screening, hepatitis B screening, or other employee health laboratory tests under the direction of an authorized health care provider or under the direction and supervision of a registered nurse. Receiving telephone and verbal prescription orders, transcribing, and transmitting prescription orders are activities often performed by nurses and appropriately included by many organizations in the responsibilities of the licensed practical nurse. The licensed practical nurse may assist an authorized provider or registered nurse in carrying out a complex standing order or verbal order. 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. The laws and rules do not require a special certificate to perform cosmetic procedures. Patient notification, secure storage, and disposal. The person giving the test results or diagnosis must be competent to answer the patient's questions. WebHealthcare Delivery Systems (HCM340) Abnormal Psychology (PSY215) Community Health Nursing (NU 420) Care Management 2 (NUR 3219C) Human Physiology Laboratory (BIOL 3120 ) StuDocu Summary Library EN ATI Medical-Surgical (101) Marketing Management (BUS 5112) Biology: Basic Concepts And Biodiversity (BIOL 110) Trending Chemical Denial, statement of deficiencies, conditional approval or withdrawal of approval of nursing education programs located in Washington state. The registered nurse delegator, home care aide and nursing assistant are each accountable for their own individual actions in the delegation process. No color additives are approved by the FDA for permanent dyeing or tinting of eyelashes or eyebrows. This should be noted in the POLST, or a statement should be included in the POLST with any exceptions. WebChapter 246-841 WAC Nursing Assistants Chapter 246-888 WAC Medication Assistance Nurse delegation services can enhance the viability and quality of support for clients in their as appropriate, by following the rules and regulations of the Washington State Nurse Practice Act. Use of simulation for clinical experiences in LPN, RN, or RN to BSN nursing education programs located in Washington state. Curriculum for practical nurse nursing education programs. RCW 28A.210.380and28A.210.383regulations stipulate the requirements for epinephrine autoinjector use in public and private schools including the option of having a school stock supply of epinephrine autoinjectors for nurses to give following standing orders approved by an authorized health care practitioner. The Nursing Care Quality Assurance Commission (NCQAC) recommends telemedicine training be completed as soon as possible as a demonstration of competency. 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). 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. 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