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. 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. Telemedicine as defined inRCW 70.41.020(13)means, the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment [but] does not include the use of audio-only telephone, facsimile, or email.. 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 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. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides additional guidance and recommendations. Off-label use should be done with careful insight and understanding of the risks and benefits to the patient considering high-quality evidence supporting efficacy, effectiveness, and safety. 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. These are legend drugs, and not categorized as a controlled substance. It is not within the scope of practice for the licensed practical nurse to delegate nursing tasks to non-credentialed assistive personnel in the public and private, kindergarten through twelve grade school setting (RCW 28A.210 Common School Provisions: Health-Screening and Requirements). Nurses may carry and administer an opioid antagonist (such as naloxone) in a suspected opioid overdose whether the person is a family member, friend, stranger, or a patient. Standing orders are certainly not to be used in lieu of medical consultation or intervention. The licensed practical nurse must be competent to carry specific steps identified in the standing order or verbal order. 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 licensed practical nurse may destroy, witness, and/or cosign the destruction of wasting of controlled substances in a SNF home. [Statutory Authority: RCW 18.79.110, 18.79.260, 2012 c 164, and 2012 c 10. The licensed practical nurse should consider consulting with a pharmacist and follow current guidance or standards and/or contact the prescriber or pharmacist to see if there is another alternative, such as liquid form or getting the medication in the appropriate dose. Must 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 A competent adult patient or the legal surrogate may always change their medical decisions and request alternative treatment. 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. This assessment includes the use of the nursing process (WAC 246-840-700). The licensed practical nurse may initiate the evaluation and/or respiratory fit testing following standing orders. 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. Chest tube insertion site are and dressing change; Assist an authorized health care practitioner or the registered nurse in removing a chest tube; and. Distance-learning nursing education course or courses offered by approved nursing programs. 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. Collect and verify the patient's complete medication history. 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. Use of alternative modalities for pain 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. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. A prescription or order from an authorized provider is required as TB skin test formulations are legend drugs. Refer to theStanding Order Advisory Opinionfor more information on use of standing orders. The Nursing Care Quality Assurance Commission determines that it is not within the scope of a licensed practical nurse to perform electrodessication and curettage due to the complexity of the procedure. RCW 18.20 Assisted Living Facilities and WAC 388-78A Assisted Living Facility Licensing Rules for more information. CNA may administer in a nursing home setting with a medication assistant endorsement. Licensed prescriber reviews the medications list and reconciles. The medical provider makes the "medical judgment" as to the specific medication and dosage. It is not acceptable for the licensed practical nurse to routinely withhold medications without any medication prior to dialysis without an order from an authorized provider. A licensed practical nurse does not require additional licensure as an esthetician to perform laser therapy for cosmetic purposes. Anursing care assessmentgathers information about the person's health status through the collection of data and/or physical examination. 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. The LPN should call the nursing supervisor, 911, or hospice for emergency help, and stay with the patient. The facility can be more restrictive. Criteria for approval of refresher course program located outside Washington state. 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 licensed practical nurse may assist the registered nurse in performing the MSE collecting the information and data and performing a focused assessment. Is appropriate supervision available? For more information, see the Washington State Department of Health'sSuicide Prevention Training for Health Professionals Approved Courses. Curriculum for practical nurse nursing education programs. Independently insert or remove a CVAD, arterial catheter, or intraspinal catheter; Insert a peripherally inserted midline catheter. The licensed practical nurse not analyze, synthesize, or evaluate the data or develop the nursing care plan. RCW 69.41.095does not require the Licensed Practical Nurse to carry an opioid antagonist, such as naloxone. Assist an authorized health care practitioner or the registered nurse in changing bottles and/or disposable collection system. 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. It is in the scope of an appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner or the registered nurse, in providing IUI or other ART procedures, following clinical practice standards. 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. (d) The skill level required to perform the task. 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. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse to remove the device, following clinical practice standards. See the Nursing Care Quality Assurance Commission'sNeonatal Intubation and Related Procedures Advisory Opinionfor additional information. 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. This should be noted in the POLST, or a statement should be included in the POLST with any exceptions. If a patient is deemed potentially dangerous to others, the licensed practical nurse may need to consult with the registered nurse cases are considered more complex and are often deferred to the registered nurse or other professional team member who is trained to handle the needs and complexities of the patient. 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. It is within the scope of practice of an appropriately prepared and competent licensed practical nurse to replace a suprapubic in an established tract under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. Washington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree. The registered nurse delegator, home care aide and nursing assistant are each accountable for their own individual actions in the delegation process. The delegating nurse shall: 3. Using synchronous and asynchronous VDOT for tuberculosis treatment adherence is occurring across the United States and in Washington State. Please refer to theScope ofPractice Decision Treethat will help you walk through your scope area. The licensed practical nurse must follow theWAC 246-878 Compounding Practicesand theUnited States Pharmacopeia (USP)compounding guidelines. Symjepi (https://www.symjepi.com/) is not classified as an EAI. 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. See theNCQAC Standing and Verbal Orders Advisory Opinionfor guidelines and recommendations. 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