The licensed practical nurse may administer medications by any route. 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. 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. The licensed practical nurse may assist an authorized health care practitioner, or the registered nurse, in performing a vaginal examination, following clinical practice standards. No. The code, RCW 18.79.260 specifies the process as: 1. (B) The licensed practical nurse in delegating functions shall supervise the persons to whom the functions have been delegated; (C) Evaluating the outcomes of care provided by licensed and other paraprofessional staff; (C) The licensed practical nurse reports outcomes of delegated nursing care tasks to the RN or supervising health care provider; and, (D) The registered nurse may delegate certain additional acts to certain individuals in community-based long-term care and in-home settings as provided by WAC, (D) In community based long-term care and in-home settings as provided by WAC, (E) In a home health or hospice agency regulated under chapter. Inactive and reactivating an ARNP license. The nursing commission provides advisory opinions and interpretive statements about specific areas of nursing 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. Naloxone has not been shown to produce tolerance or cause physical or psychological pain. 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. Curriculum for approved nursing education programs. Nurse administrator qualification requirements in nursing education programs located in Washington state. Common interventional radiology procedures include thrombolysis, needle biopsies, paracentesis, and thoracentesis. DELEGATION OF NURSING CARE TASKS IN COMMUNITY-BASED AND IN-HOME CARE SETTINGS. Curriculum for registered nurse refresher course. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. Joint Commission Nursing Assessmentstandards require the registered nurse to perform the nursing assessment within twenty-four hours after admission to a hospital. The laws and rules do not prohibit the licensed practical nurse from accepting an order from an authorized medical provider through another unlicensed or licensed person. A dentist may prescribe neuromodulators (such as Botox) or dermal fillers when it is used to treat functional esthetic dental conditions and their direct esthetic consequences. The medical provider makes the "medical judgment" as to the specific medication and dosage. For more information, go to theWashington State Department of Overdose Education and Naloxone Distribution Website. A pharmacist is not identified as an authorized health care practitioner that the licensed practical nurse may take orders or direction from. 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 should use theScope of Practice Decision Treeto determine if these activities are within the nurse's legal and individual scope of practice. The laws and rules do not require a special certificate to perform cosmetic procedures. (3) "Complex task" means that a nursing task may become more complicated because of: (c) The nursing care task(s) and involved risks; and. Splitting medications may result in dosage errors. It is acceptable for orders for immunizations to be made by an authorized health care practitioner using standing orders. Internationally educated practical nurse program in an approved nursing education program. The laws states, The system shall provide an audit trail of all prescriptions electronically transmitted that documents for retrieval all actions and persons who have acted on a prescription, including authorized delegation of transmission. The order must be authenticated. (5) "Home care aide" means a person certified under chapter. 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 must be competent to carry specific steps identified in the standing order or verbal order. (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 order may be made using a standing order. Philosophy governing voluntary substance abuse monitoring programs. It is not within the scope of practice for a licensed practical nurse to practice independently. Stop Overdose.comoffers education, resources, and technical assistance for individuals, professionals, and communities in Washington State who want to learn to prevent and respond to overdose and improve the health of people who use drugs. Employer: Washington Department of Labor & Industries - Insurance Services . The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. 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. Licensed prescriber reviews the medications list and reconciles. (c) The registered nurse and licensed practical nurse act as client advocates in health maintenance and clinical care. There must be an order from an authorized provider. The nursing laws and rules allow the licensed practical to relay test results or a medical diagnosis if already made by an authorized health care practitioner. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. There must be an order from an authorized provider. WAC 246-330 Ambulatory Surgical Facilitiesrequire at least one registered nurse to have current ACLS certification. It is also an expectation. The facility can be more restrictive. 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. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to insert a FSE or IUPC. Generally, a prescription from an authorized health care practitioner is required for reimbursement of medical supplies. 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 employer may not expand licensed practical nurse scope of practice. 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. The licensed practical nurse may administer naloxone or other opioid antagonist to anyone at risk for having or witnessing an opioid overdose. Continuing education for ARNP license renewal. Is the nursing assistant or home care aide, registered or certified and properly trained in the nurse delegation for nursing assistants or home care aides? See the Nursing Care Quality Assurance Commission (NCQAC)s Determining, Pronouncing, and Certifying Death Advisory Opinion for more information. The prescription or order may be done following standing orders. The RN must be appropriately trained and competent to provide nursing telehealth services. Itdoes notinclude the use of audio-only telephone, facsimile, or email.. It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner, or the registered nurse, in removing trans-thoracic (epicardial) pacing wire following open-heart surgery, following clinical practice standards. Stable and predictable may include a patient with sliding scale insulin orders. (10) The nurse shall not disclose the contents of any licensing examination or solicit, accept or compile information regarding the contents of any examination before, during or after its administration. The licensed practical nurse must work under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. Facilities should develop policies to manage legal risk in such a situation. 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 registered nurse delegator previously provided written instructions for the care and treatment of the patient. TheInstitute for Safe Medication Practices (ISMP)is a good resource for determining whether a medication is safe to crush. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's regulatory and individual scope of practice. The focused assessment may include obtaining health care history information and physical assessment. Telemedicine training taken prior to January 1, 2021 meets the requirement if it includes the content defined inRCW 43.70.495(2). Naloxone(Narcan) is the current standard of treatment for opioid overdose. 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 nursing law and rules do not prohibit the competent and appropriately trained licensed practical nurse from administering intra-articular injections under the direction of an authorized provider, or under the direction and supervision of the registered nurse. This procedure requires a prescription from an authorized health care 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 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. Advanced care planning is thoughtful conversations between health care professionals, the patient and/or surrogate. The LPN and RN may provide telehealth nursing services within their scope of practice to patients in Washington state. Chapter 28A.210.383 RCWprovides that the Office of the Superintendent of Public Instruction (OSPI) and school districts have the authority to develop anaphylactic policies for schools. WAC 388-112-0260 Adult Family Homes and Assisted Living Facilitiesalso have specific requirements for CPR and first aid training. The nursing care plan may only be developed, implemented, and evaluated by a 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 licensed practical nurse must practice within his or her legal scope of practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are the nurse's legal and individual scope of practice. Web(a) The delegating nurse shall: (i) Determine the competency of the individual to perform the tasks; (ii) Evaluate the appropriateness of the delegation; (iii) Supervise the actions of the person performing the delegated task; and (iv) Delegate only those tasks that are within the registered nurse's scope of practice. The LPN should call the nursing supervisor, 911, or hospice for emergency help, and stay with the patient. In an emergency it may be difficult to determine whether the family member is the legal surrogate. 296-04-150: Delegation to director of apprenticeship. This does not mean the licensed practical nurse may not work in a pharmacy setting administering immunizations. 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. Licensure for nurses by interstate endorsement. Purposes of commission approval of nursing education programs. The licensed practical nurse may assist an authorized provider or registered nurse in carrying out a complex standing order or verbal order. Dispensing of medication is outside the scope of practice of the licensed practical nurse. EMTALA requires the assessment of a patient for the existence of an emergency medical condition before the patient can be transferred or released from the emergency department. Distance-learning nursing education course or courses offered by approved nursing programs. Technology requirements include a strong internet connection, a webcam, a microphone, and access to a laptop or desktop computer. 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. A prescription or order from an authorized provider is required. This assessment includes the use of the nursing process (WAC 246-840-700). It is within the scope of practice of an appropriately trained and competent licensed practical nurse to perform routine and non-complex respiratory therapy procedures under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. Internationally educated registered nurse program in an approved nursing education program. Licensure for ARNP applicants educated and licensed outside the United States. (12) "Personal care services" as defined in WAC. The LPN should begin CPR and continue until help arrives if a valid POLST indicating CPR/Attempt Resuscitation. The general age of majority for health care is eighteen years old in Washington State as defined in . SSB 6421was passed in 2016 allowing authorized entities to obtain epinephrine autoinjectors. A licensed practical nurse may administer medications and perform treatments or procedures without the registered nurse or other authorized health care practitioner on the premises. 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. Continuing competency audit process and compliance. These are legend drugs, and not categorized as a controlled substance. This should be noted in the POLST, or a statement should be included in the POLST with any exceptions. The Nursing Care Quality Assurance Commission determines that it is not within the scope of a licensed practical nurse to perform iliac crest bone marrow aspirations and biopsies due to the complexity of the procedure. 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. For more information go to the Washington State Department of Health Tuberculosis Website(this site is accessible only to LHJs at this time). Not all medications may be split. Communication is defined as a process by which information is exchanged between individuals through a common system of speech, symbols, signs, and written communication or behaviors that serves as both a means of gathering information and of influencing the behavior, actions, attitudes, and feelings of others; and, (b) The registered nurse and licensed practical nurse shall document, on essential client records, the nursing care given and the client's response to that care; and. 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 licensed practical nurse does not practice nursing independently. Short peripheral catheter line intraosseous access device, and subcutaneous infusion device insertion and removal; Preparing, initiating, managing, and monitoring infusion pumps; Peripheral (including short peripheral or midline), CVAD, arterial, umbilical arterial catheter (UAC) or umbilical venous catheter (UVC), intraspinal, intraosseous access device, and subcutaneous infusion device site monitoring, care, and dressing changes; Administration of infusion fluids and medications via peripheral, CVAD, and arterial catheters including through an implanted vascular access port, hemodialysis VAD, and UAC) or UVC; Medication administration via a VAD using piggyback, push, or bolus methods; Blood sampling via a peripheral, VAD, and arterial device; Administration of total parenteral nutrition; Monitor patency of the peripheral, CVAD, and arterial catheters; Assist an authorized health care practitioner or registered nurse in removing or reinserting a CVAD or arterial catheter. The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. 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 licensed practical nurse should use theScope of Practice Decision Treeto determine if crushing a medication is within the nurse's regulatory and individual scope of practice. The licensed practical nurse should use theScope of Practice Decision Treeto determine if performing compounding medications and preparing and administering allergenic extracts is within the licensed practical nurse's regulatory and individual scope of practice. Independently insert or remove a CVAD, arterial catheter, or intraspinal catheter; Insert a peripherally inserted midline catheter. STATE OF WASHINGTON . The SNF may allow the licensed practical nurse to initiate the admission assessment within licensed practical nurse's scope of practice including collecting information and data without a registered nurse on the premises with the intent that the registered nurse will complete the comprehensive assessment and care planning. 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. Such person shall be a member of one of the classes of persons as directed in RCW. 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 Standing orders may be used. Internationally educated registered nurse program in an approved nursing education program. 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 apply medications, such as Latisse, used for eyelash growth under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. 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.. Appropriate documentation of a focused patient assessment and evaluation must substantiate intervention. The licensed practical nurse may not use the title of respiratory therapist unless the nurse is dually licensed. 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. Clinical and practice experiences for students in approved nursing education programs. Ongoing evaluation and approval of nursing education programs located in Washington state. This page also includes links to laws and regulations on the Washington State Legislature website. The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. Refresher course program for advanced registered nurse practice nurses. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to apply cold therapy (cryotherapy) or heat therapy for fat removal under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. 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