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Questions
Related to Licensed Practical Nurses
(LPN)
Assessment
The Board determined
that the performance of a nursing assessment is a proper function
of the registered professional nurse and is NOT within the
purview of a practical nurse license. The act of performing
a nursing assessment can NOT be delegated by a registered
nurse to a licensed practical nurse on the basis of the limitations
within the curricula of practical nursing programs. Such curricula
do not include the theoretical and clinical preparation necessary
for the effective performance of nursing assessments. December
18, 1990
BCG
At its August 28,
2002 meeting, the Board revisited the issue of Bacillus Calmette-Guerin
(BCG) bladder instillation by a licensed practical nurse (LPN)
and determined that an LPN may administer BCG according to
defined protocols and under direct supervision. The LPN must
have appropriate documented training.
Chemotherapy
Bladder Installation by LPN
At its December
6-7, 2000 meeting, the Board determined that it is not within
a licensed practical nurse's scope practice to administer
BCG/INTRON via bladder instillation.
Collection
of Data
Clarified that
a LPN may interview, collect data and make observations to
contribute to the plan of care. The LPN may not
make an independent
nursing diagnosis or initiate a plan of care. (7/16/97)
Defibrillation
RNs
do not have to be ACLS certified
to use a defibrillator. (1988-89)
In
June, 1984, the Board determined
that the procedure of defibrillation
is not within the usual scope of
practice of the LPN, but if the
LPN is ACLS certified, s/he may
perform defibrillation under the
delegation and supervision of the
MD or the ACLS certified RN in an
emergency situation.
On
September 28,1990 the Board stated
that a registered professional nurse,
who holds a current certificate
of completion from an American Heart
Association sponsored certificate
program for life support, may perform
those functions for which s/he has
received the required education
and training and has been deemed
qualified to perform. Policies and
procedures should be agreed upon
by medical, nursing, administrative
and legal staffs before implementation.
Dialysis
At
its April 15-16, 1998 meeting the
Board determined that it is not
within the scope of a licensed practical
nurse to administer a heparin bolus
as part of the procedure for initiating
dialysis.
At
its October 21-22,1998 meeting the
Board reconsidered its April 15-16,
1998 advisory ruling and determined
that a licensed practical nurse
may administer a heparin bolus as
part of the procedure for initiating
dialysis in a renal dialysis unit.
Dispensing
Medication
A
RN or LPN legally may NOT dispense
drugs at any time. Dispensing means
the pouring or placing of drugs
from stock supplies into bottles
or containers, the labeling of such
items with the patient's name, medication,
dosage and directions and the giving
of such bottles or containers to
personnel for administering to patients.
This is the role of the pharmacist
and may not be assumed by nurses.
(1986)
The
Board reaffirmed that LPNs and RNs
are NOT authorized to dispense medications.
The administration of medications
as prescribed by a legally authorized
person is within the scope of practice
of nurses licensed in Maine. (Dec.
27, 1990)
The
Board of Nursing determined that
nurses licensed in Maine may provide
patients with limited quantities
of prescribed/ordered medication
which has been pre-labeled and prepackaged
by the hospital pharmacist. These
"starter packs" will be
administered to the patient in the
emergency department setting following
an evaluation by a physician. This
same procedure will also be used
in inpatient leave of absence situations.
(May 1, 1991.
In
response to a query in April, 1993,
the Board stated that a telephoned
order for drugs at night for an
in-patient is an example of administering
a medication, not dispensing.
A
nurse providing medications to a
patient not evaluated by a physician
in the emergency department is acting
as a pharmacist in dispensing medications
and exceeds the scope of nursing
practice.
Gastronomy
Tubes
By
consensus the Board determined that
LPNs, who have received the necessary
training and supervised clinical
practice, may be delegated the tasks
of reinserting supra pubic and gastrostomy
tubes provided that the patient
has a well established tract. The
health care facilities should develop
policies and procedures which are
agreed upon by both the nursing
and medical staffs. November 2,
1989
J-Tubes
and T-Tubes
The
Board at its February 10-11, 1993
meeting determined that with appropriate
training and documented clinical
competency, a LPN may irrigate J-tubes.
It is not within the scope of practice
of a LPN to irrigate T-Tubes. It
is not within the scope of practice
of a LPN to remove all types of
ureteral catheters.
The
Board at its October 21-22, 1998
meeting determined that a licensed
nurse may perform the following
skills related to the J-tube with
training by a registered professional
nurse and documented competency:
1. Administer medications via J-Tube
2. Flush a J-Tube with normal saline
before and after administering a
medication
3. Insert and remove a J-Tube on
a well established tract
4. Check the sterile water level
in the J-Tube Balloon and re-inflate
the Balloon with saline
5. Perform routine dressing changes
on the J-Tube site
The
Board at its June 7-8, 2000 meeting
determined that it is not within
the scope of practice of a licensed
nurse to introduce a guide wire
to unplug a J-Tube.
The Board at its
August 2-3, 2000 meeting determined that it is not within
a registered professional nurse's scope of practice to remove
a Jackson-Pratt (J-P) draining device.
The Board at its
June 5-6, 2002 meeting determined that with appropriate training
a registered professional nurse may remove a J-P training
device.
Jails
The
Board at its October 19 and 20,
1994 meeting determined that an
LPN who works in a jail setting
does not require on-site RN supervision
to perform job functions. Written
protocols, medical direction, and
RN consultation must be available
to the LPN.
Midlines
At
its December 9-10, 1998 meeting
the Board determined that it is
not within the scope of a licensed
practical nurse's nursing practice
to remove midline catheters that
are placed in the peripheral circulation.
Nasogastric
Tubes
In
1988-1989, the Board determined
that a licensed practical nurse,
who has had appropriate training
and supervision by a registered
professional nurse, may insert nasogastric
tubes.
Operating
Room (O.R.) Circulating Nurse
In
December, 1984, the Board stated
that it believed that the registered
professional nurse is the appropriate
person to be the circulating nurse
in the operating room and that this
function should not be delegated
to the licensed practical nurse.
Again
in September, 1990, the Board determined
that the registered professional
nurse circulating in the operating
room cannot be replaced by the licensed
practical nurse or an unlicensed
technician.
In
1989 the Board determined that the
Law Regulating the Practice of Nursing
does not govern scrub technicians.
PCA
Pumps
The
Board determined at its December,
1994 meeting that a licensed practical
nurse can change PCA cassettes if
the LPN is IV certified, on the
basis that changing a cassette is
similar in principle to programming
an IV pump. The facility is responsible
for proper training and documentation
of such training.
Peritoneal
Dialysis
Peritoneal
dialysis may be performed by an
LPN who has received the required
educational preparation and supervised
clinical practice by a registered
nurse with expertise in this area.
(1988-1989)
The
teaching of peritoneal dialysis
to be performed in the home is not
within the scope of practice of
LPNs. (1989)
Private
Duty
On
the basis that the home setting
does not fall within the Board's
interpretation of a "structured
health care setting", (e.g.,
hospital, nursing home), it is NOT
permissible for a LPN to accept
employment as a private duty nurse
in the home setting, unless s/he
is an employee of a community health
agency. (March 1, 1990)
RhoGam
At
its April, 1992 meeting, the Board
determined that licensed practical
nurses may administer RhoGam.
Subcutaneous
Morphine Infusion
At
its April 7-8, 1992 meeting the
Board determined that it is not
within the scope of an LPN's nursing
practice to insert or monitor a
morphine continuous infusion subcutaneously
nor to program the computerized
pump or assess patient's response.
At
its April 15-16, 1998 meeting the
Board reconsidered its 1992 ruling
and determined it is within the
scope of nursing practice for a
licensed practical nurse to insert
a needle subcutaneously for the
purpose of administering a bolus
of morphine via injection cap or
continuous infusion provided that
he/she has had appropriate, documented
training according to protocols
established by a health care facility.
At
its December 9-10, 1998 meeting
the Board determined that it is
within the scope of a licensed practical
nurses's nursing practice to:
1. Change a subcutaneous needle
on a continuous infusion set
2. Change dose parameters of the
narcotic in the pump based on the
registered nurse's plan of care
3. Change the infusion set provided
that he/she has had appropriate,
documented training according to
protocols established by a health
care facility.
Tracheostomy
At
its October 6-7, 1992 meeting, the
Board determined that it is within
the scope of practice for the registered
professional nurse to remove a tracheostomy
apparatus and replace it with a
new apparatus in patients who have
had tracheostomies for a long period
of time.
At
its April 7 and 8, 1999 meeting,
the Board determined that it is
within the scope of practice for
the licensed practical nurse to
remove a tracheosotomy apparatus
and replace it with a new apparatus
in patients that have well established
stomas.
Vagus
Nerve Stimulator
At
its December 6-7, 2000 meeting,
the Board determined that a registered
professional nurse may use the vagus
nerve stimulator on demand therapy
to end or shorten seizure activity.
The registered professional nurse
must have appropriate documented
training according the facility/organization's
established policies and procedures.
The Board determined that a registered
professional nurse may not delegate
the task of performing this type
of therapy to certified nursing
assistants.
At
its October 17-18, 2001 meeting,
the Board determined that a licensed
nurse may use the vagus nerve stimulator
on demand therapy to end or shorten
seizure activity. The licensed nurse
must have appropriate education
and supervision based on defined
competencies and established facility/organization
policies and procedures. The Board
revisited the issue of a registered
professional nurse delegating this
task to a certified nursing assistant.
The Board determined that a registered
professional nurse may delegate
this task to a certified nursing
assistant who has had appropriate
education and supervision based
on defined competencies and established
facility/organization policies and
procedures.
Ventilators
A
licensed practical nurse (LPN) may
care for a patient on a ventilator
if that nurse has been trained to
do so and if in the judgment of
the registered professional nurse
it is an appropriate delegation.
The patient's total condition and
the LPN's experience and skill level
must both be considered.
At
its April 6-7,1994 meeting, the
Board determined that a LPN may
provide care to a patient on a ventilator
in a home setting where the registered
nurse is not on site but is available
on call. The LPN should have the
appropriate skills and training
necessary to render the care.
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