A non-nurse may be a supervisor of a licensed practical nurse. The licensed practical nurse (LPN) or registered nurse (RN) should consider what they are trying to accomplish based on the patient needs and safety and within their scope of practice. The licensed practical nurse may follow standing orders or verbal orders to renew an existing medication. The licensed practical nurse should use theScope of Practice Decision Treeto determine if any of the activities the licensed practical nurse is assisting with, is within the nurse's legal and individual scope of practice. Determination and pronouncement of death by a licensed registered nurse. In no case, may administration of medications by injection with the exception of insulin injections, sterile procedures and central line maintenance be delegated. A facility or employer may require a specific certification or training program. In an emergency it may be difficult to determine whether the family member is the legal surrogate. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. The nursing laws and rules allow the competent and appropriately trained licensed practical nurse to perform therapeutic phlebotomy for conditions, such as polycythemia vera, under the direction of an authorized health care practitioner or under the direction and supervision of a RN. These procedures require a prescription from an authorized health care practitioner. 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. Exceptions to nursing faculty degree requirements in prelicensure registered nurse nursing education programs. Has the patient or authorized representative given consent to the delegation? 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. 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. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to perform medical tattooing, permanent makeup application, body piercing, and electrolysis under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The order may be made using a standing order. 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. A competent adult patient or the legal surrogate may always change their medical decisions and request alternative treatment. The licensed practical nurse implementing the order is required to see clarification of the order when the licensed practical nurse believes or has any reason to believe one of these contraindications exists, and to take any other action necessary to assure the safety of the patient. PO Box 47852 Olympia, Washington 98504-7852 . The employer may also decide whether they want to require an in-person course or on-line course and other parameters. You should contact your legal advisor to obtain advice with respect to any particular issue or problem. Degree and licensing requirements for nursing faculty teaching in a nursing education program leading to licensure as an advanced registered nurse practitioner. Medical test results must be interpreted by an authorized health care practitioner. These procedures require a prescription from an authorized health care practitioner. (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. Apply here. The licensed practical nurse does not work under authorized health care practitioner's license the registered nurse's license. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to apply eyelash extensions under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the licensed practical's legal and individual scope of practice. The nursing commission provides advisory opinions and interpretive statements about specific areas of nursing practice. Initial licensure for registered nurses and practical nurses. 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. The prescriber or the registered nurse does not need to be on onsite when the licensed practical nurse administers medications. Standards and evaluation of nursing education programs. 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. For more information, go to theWashington State Department of Overdose Education and Naloxone Distribution Website. WebIf the home identifies that a resident has a need for nursing care and the home is not able to provide the care per chapter 18.79 RCW, the home must contract with a nurse currently licensed in the state of Washington to provide the nursing care and service, or hire or contract with a nurse to provide nurse delegation. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing a lumbar puncture, following clinical practice standards. There must be an order from an authorized provider. 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. 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. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. (3) "Complex task" means that a nursing task may become more complicated because of: (c) The nursing care task(s) and involved risks; and. TheWAC 388-76 Adult Family Home Minimum Licensing Requirementsaddresses medication refusal:WAC 388-76-10435 Medication Refusal. Faculty requirements for nursing education programs. Curriculum for practical nurse nursing education programs. The licensed practical nurse must follow theWAC 246-878 Compounding Practicesand theUnited States Pharmacopeia (USP)compounding guidelines. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse follow theWashington State Tuberculosis Laws and Guidelinesand theCenters for Disease Control Guidelines for TB Screening and Follow-Up. WebWe offer certification in two nurse delegation training topics; Nurse Delegation and Nurse Delegation Focus on Diabetes. WebNursing Pool | Washington State Department of Health You & Your Family Community & Environment Licenses, Permits, & Certificates Data & Statistical Reports Emergencies For Public Health & Health Care Providers In this section Nursing Pool Laws Licensing Information Rules in Progress Nursing Pool We can help you: ARNP designations, certification, and approved certification examinations. 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. 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. Collect and verify the patient's complete medication history. 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 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. The nurse must use nursing judgment and consider what aspects of the initial and ongoing assessment, supervision, and evaluation need to be done face-to-face. If the person has no pulse or becomes nonresponsive, begin cardiopulmonary resuscitation (CPR) even if the POLST indicates DNAR. Are the results of the task reasonably predictable? Out-of-state distance learning nursing program approval for practice experiences in Washington state. WebRegistered nurses delegating tasks are accountable to the Washington state nursing care quality assurance commission. The nursing laws and rules do not prohibit the competent and appropriately trained licensed practical nurse from initiating the admission of a patient to a hospital or SNF. The licensed practical nurse may administer medications by any route. It is not within the scope of a licensed practical nurse to practice independently. 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. For example,WAC 246-320 Hospital Licensing Regulationsrequire at least one nurse to have CPR and at least one nurse to have advanced cardiac life support (ACLS) in recovery areas and in critical care units. Philosophy governing approval of nursing education programs. Telemedicine training taken prior to January 1, 2021 meets the requirement if it includes the content defined inRCW 43.70.495(2). Please see the regulations forOSHA Respirator Medical Evaluations. These directions may come through standing orders or verbal orders. How to make changes to the delegated tasks. They may administer or provide an epinephrine autoinjector to people who are experiencing anaphylaxis. The facility or employer may require a specific certification or training program. 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. Standing orders may be an option to allow the nurse to start an intravenous line based on specific criteria (such as a high acuity patient), admission to a specific unit (such as intensive care), or for a specific condition. Curriculum for approved nursing education programs. 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'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. (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. (16) "Supervision" means the guidance and evaluation by a registered nurse delegator for the accomplishment of a nursing task or activity, including the initial direction of the task or activity; periodic inspection at least every ninety days of the actual act of accomplishing the task or activity; and the authority to require corrective action. Credentials issued to an LPN, RN, or ARNP in Washington state. The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. For example, it would not be within the licensed practical nurse's scope of practice to modify the standing or verbal order without consulting with the registered nurse or other authorized health care practitioner. This procedure requires a prescription from an authorized health care practitioner. The licensed practical nurse implementing the order is required to see clarification of the order when the licensed practical nurse has any reason to believe any contraindications exists, and to take any other action necessary to assure the safety of the patient. 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. Minimum standards for registered nurses include the following: Minimum standards for licensed practical nurses include the following: (A) Delegating selected nursing functions to others in accordance with their education, credentials, and demonstrated competence as defined in WAC, (A) The practical nurse may delegate selected nursing tasks to competent individuals in selected situations, in accordance with their education, credentials and competence as defined in WAC, (B) Supervising others to whom they have delegated nursing functions as defined in WAC. The commission's advisory opinion on providesStanding Orders and Verbal Orders (PDF)additional information and guidance. 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 nurse must be competent and getting a certificate may be one method to demonstrate training, knowledge, skills, and abilities. 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 registered nurse delegator, home care aide and nursing assistant are each accountable for their own individual actions in the delegation process. It is within the scope of an appropriately prepared and competent licensed practical nurse to insert prostaglandin into the vagina for a chemical abortion under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. Abnormal test results should be communicated by someone who can provide supporting information about the test, implications, and follow-up care. 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 Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if this activity is within the nurse's regulatory and individual scope of practice. 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. 296-04-150: Delegation to director of apprenticeship. The Licensed Practical Nurse, just as in all care the nurse provides, must be appropriately prepared and competent to perform the activity safely. This section has been decodified as it was omitted from "The rules and regulations of the Washington state apprenticeship council," filed 2/12/65 and 10/11/65. 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. (i) Failure to protect clients from unsafe practices or conditions, abusive acts, and neglect; (3) Failure to adhere to the standards in WAC, (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 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. The licensed practical nurse must apply adequate knowledge and skills in determining the dosage to be administered at any given time. 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. 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. 296-04-160: Apprenticeship committees. An order is required from an authorized health care practitioner for laboratory tests involving puncturing of the skin. 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). A prescription or order from an authorized provider is required. 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 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. WebWhat is nurse delegation? 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. It is within the scope of practice of an appropriately prepared and competent licensed practical nurse to remove a suprapubic under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. It is not within the Licensed Practical Nurse's scope of practice to delegate administration of an opioid antagonist by any route in any setting. 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. 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.