A prescription or order from an authorized provider is required for legend drugs, controlled substances, over-the-counter drugs, or for medical treatments.RCW 18.79.270 LPN - Activities Allowed. 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. Application requirements for ARNP prescriptive authority. These procedures require a prescription from an authorized health care practitioner. Degree and licensing requirements for nursing faculty teaching in a nursing education program leading to licensure as an advanced registered nurse practitioner. See theFood and Drug Administration's website, Using Eye Cosmetics Safely, for more information. TheEMTALA Interpretive Guidelinesidentify the licensed registered nurse to be considered qualified medical personnel who can perform the EMTALA MSE and circumstances where the registered nurse consult with a physician. The order may be made using a standing order. 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. Stable and predictable may include a terminally ill patient whose deteriorating condition is expected. The licensed practical nurse may collect demographic data from the caller and screen the patient who presents with suicide thoughts. 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 nursing laws and rules allow a competent and appropriately trained licensed practical nurse to perform phototherapy such as Type B Ultraviolet (UVB), Grenz Ray, or Psoralen and Long-Wave Ultraviolet Radiation (PUVA) under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. The pre-admission/resident assessment findings may identify needs for a comprehensive nursing care assessment. TheWAII Handbookidentifies a Medical Doctor (MD), Doctor of Osteopathy (DO), Advanced Registered Nurse Practitioner (ARNP), Physician' Assistant (PA), and Naturopathic Physician as a medical authority to perform a sports physical examination. A prescription or order from an authorized provider is required. The nursing laws and rules allow the competent and appropriately trained licensed practical nurse to perform infusion therapy. Interventional radiology is performed using minimally invasive therapies under imaging guidance. Can the task be performed without repeated nursing assessments? 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. This plan should be made in advance as part of the patient plan of care. 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. A facility or employer may require a specific certification or training program. The licensed practical nurse implements health care plans developed by the registered nurse or other authorized health care practitioner. The procedure may be performed in a home setting or an in-center setting. 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? A prescription or order from an authorized provider is required. It is within the scope of practice of an appropriately trained and competent licensed practical nurse to assist in performing an endoscopy, sigmoidoscopy, or colonoscopy. Training and competency assessment for personal care services (non-nursing care) does not require the services of a Washington state licensed professional nurse. 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. Denial, statement of deficiencies, conditional approval or withdrawal of approval of nursing education programs located in Washington state. It involves determining the meaning and significance of what is observed or expressed to determine need for action. For more information and training resources, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. The licensed practical nurse must be competent to carry specific steps identified in the standing order or verbal order. Chest tube insertion site are and dressing change; Assist an authorized health care practitioner or the registered nurse in removing a chest tube; and. The licensed practical nurse needs to be competent regarding the specific medication including the indications, contraindications, and side effects that is being delivered to the patient. It is expected that the registered nurse would complete an appropriate age-specific nursing assessment and nursing care plan. The nurse may also get a prescription in their own name from their health care practitioner. Does the patient reside in one of the following settings? Dispensing of medication is outside the scope of practice of the licensed practical nurse. In neonatal and pediatric services in hospitals, at least one registered nurse or physician must be trained in infant/pediatric resuscitation; in obstetrics, at least one registered nurse must be trained in neonatal resuscitation when infants are present. Yes, licensed nurses (RN, LPN, or ARNP) in Washington state are required to take telemedicine training if the nurse provides telemedicine services. Another option is for the facility or employer to become an authorized entity. The nurse must be competent and getting a certificate may be one method to demonstrate training, knowledge, skills, and abilities. See theWashington State Department of Health Patient Rights Guidelinesfor more information. (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. Patient notification, secure storage, and disposal. WebWhat Is Nurse Delegation? Severity and duration of the withdrawal relate to the dose of naloxone and the degree and type of opioid dependency. Such supervision shall be adequate to prevent an unreasonable risk of harm to clients; (4)(a) Performing or attempting to perform nursing techniques and procedures for which the nurse lacks the appropriate knowledge, experience, and education and failing to obtain instruction, supervision and consultation for client safety; (b) Violating the confidentiality of information or knowledge concerning the client, except where required by law or for the protection of the client; or. RCW 69.41.095allows the Licensed Practical Nurse to dispense or distribute an opioid antagonist (such as naloxone) for a high-risk person, their family members, or friends following standing orders or a prescription from an authorized health care practitioner. It is acceptable for the licensed practical nurse to prepare a medication organizer or individual pill containers under the following conditions: See theAdvisory Opinion on Medisets, theMedication Organizer Device Letter from Secretary of Health (PDF), and theMedication Organizer Device (PDF)for more information. 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). Hiding medications and not notifying the patient may be a violation of patient rights. The licensed practical nurse must provide nursing care within the nurse's statutes and regulations that govern nursing practice. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse, in inserting a FSE or IUPC, following clinical practice standards. 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: The Nursing Care Quality Assurance Commission supports the use of medication organizers following standards of practice for medication administration. To complete the free and publicly available telemedicine training, see theWashington State Medical Professional Telemedicine Training webpage. The registered nurse delegator determines the patient does not require frequent nursing presence and evaluation. The nursing laws and rules do not require a licensed practical nurse to get a special certification to perform infusion therapy, phlebotomy, or laboratory tests. 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. WebLocation: Spokane, WASHINGTON. Students enrolled in a nontraditional nursing program. It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to apply and operate a TENS for chronic and acute pain, following clinical practice standards. (b) Failure to supervise those to whom nursing activities have been delegated. The licensed practical nurse may provide data to assist in the development of a nursing diagnosis. Using synchronous and asynchronous VDOT for tuberculosis treatment adherence is occurring across the United States and in Washington State. 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. 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. (a) The registered nurse and the licensed practical nurse shall have knowledge and understanding of the laws and rules regulating nursing and shall function within the legal scope of nursing practice; (b) The registered nurse and the licensed practical nurse shall be responsible and accountable for his or her practice based upon and limited to the scope of their education, demonstrated competence, and nursing experience consistent with the scope of practice set forth in this document; and. The licensed practical nurse does not need an additional order from an authorized health care practitioner to restart an intravenous line that is no longer patent. An employer or institution may have specific requirements for training or certification. This order may be written for an individual patient or through a standing order. False eyelashes and extensions, as well as their adhesives, must meet the safety and labeling requirements for cosmetics. 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. WebThe registered nurse delegator identifies and facilitates any additional training of the nursing assistant or home care aide needed prior to delegation. The licensed practical nurse may assist an authorized provider or registered nurse in carrying out a complex standing order or verbal order. WAC 388-112-0260 Adult Family Homes and Assisted Living Facilitiesalso have specific requirements for CPR and first aid training. DELEGATION OF NURSING CARE TASKS IN COMMUNITY-BASED AND IN-HOME CARE SETTINGS. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. RCW 28A.210.380andRCW 28A.210.383specifically require the use of an autoinjector to administer epinephrine. 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 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. It is within the scope of practice of an appropriately prepared and competent licensed practical nurse to perform peritoneal dialysis under the direction of an authorized health care practitioner, or under the direction and supervision of the registered nurse, following clinical practice standards. The RN must be appropriately trained and competent to provide nursing telehealth services. Delegation in community and in-home care settings is defined by WAC 246-840-910 through 246-840-970. (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. WebThe Revised Code of Washington (RCW) 18.79 and Washington Administrative Code (WAC) 246-840 provide the statutory and legal basis of nursing practice. The licensed practical nurse is required to use critical thinking in clinical problem-solving and decision-making processes relative to scope of practice, knowledge, competency, and experience. 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. RCW 28A.210.383(2)(a). No, the telemedicine training requirement doesn't apply to audio-only telephone (telephone triage), facsimile, or email. 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. [Statutory Authority: RCW 18.79.110, 18.79.260, 2012 c 164, and 2012 c 10. 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. See theNCQAC Standing and Verbal Orders Advisory Opinionfor guidelines and recommendations. POLST is a portable medical order, and the LPN should follow it within scope of practice and standard of care. 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. 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). Conditions for participants entering the approved substance abuse monitoring program. An individual with a nursing license (licensed practical nurse or registered nurse) meets the qualifications to perform the pre-admission/resident assessment. Curriculum for registered nurse to bachelor's or master's in nursing education programs. 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. The planning conference should include the patients or residents medical provider, the patient and/or surrogate decision-maker, and key family members. 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 rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. The Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionprovides guidance and recommendations. 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. There must be an order from an authorized provider. Commission action following commission site visit, complaint investigation, or national accreditation visits of nursing education programs located in Washington state. (12) "Personal care services" as defined in WAC. Withholding medications, primarily anti-hypertensives, prior to dialysis is not uncommon. Licensure for ARNP applicants by interstate endorsement. The nursing laws and rules allow a licensed practical nurse to provide care in an ICU, PCU, or recovery room. 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. 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. See theCompounding Medications by Licensed Practical Nurses, Registered Nurses, and Advanced Registered Nurse Practitioners Advisory Opinionfor more information. The nurse should use theScope of Practice Decision Treeto determine if these activities are within the nurse's regulatory and individual scope of practice. Accreditation requirements for all nursing education programs located in Washington state. A prescription or order from an authorized provider is required as TB skin test formulations are legend drugs. Mitomycin C), and Bacillus Calmette-Gurin (immunotherapy) drugs. The nurse would need to contact the other state(s) to see if they can practice in their state with a Washington state license during the pandemic. The licensed practical nurse should communicate with the medical provider or registered nurse as appropriate or follow standing orders for additional follow-up and referral. A licensed practical nurse may assist an authorized health care practitioner or registered nurse in performing the procedure, including administering the local anesthetic. The licensed practical nurse should use theScope of Practice Decision Treeto determine if performing these activities is within the licensed practical nurse's regulatory and individual scope of practice. Criteria for approval of LPN and RN refresher course program located in Washington state. Nursing preceptors, interdisciplinary preceptors, and proctors in clinical or practice settings for nursing students located in Washington state. Medications being placed into an organizer or individual pill container must already be dispensed by a pharmacist or other authorized health care provider; The medication organizer or individual pill container must be properly labeled with the patient's name, name of the medication, dosage of each medication, frequency which the mediation is given; The licensed practical nurse must consult with the prescriber, pharmacist or other health care provider as appropriate; and. It is within the scope of practice of the appropriately prepared licensed practical nurse to write or enter the information into an electronic health record system the patient demographic information, as well as the drug, dosage, frequency and number of refills on a medical prescription as pursuant to a medical order. 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. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to administer intralesional injections under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. 296-04-150: Delegation to director of apprenticeship. The nursing law and rule does not prohibit the competent and appropriately trained licensed practical nurse from administering any medication legend or controlled substance (Schedule II-IV) or over-the-counter medications. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in suctioning a fresh tracheostomy stoma; Changing, repositioning, or reinserting a tracheostomy tube in an established tracheostomy tract, (Decannulation before a mature tract is an emergency situation as well as a complex procedure and is not within the scope of the licensed practical nurse. Out-of-state distance learning nursing program approval for practice experiences in Washington state. Degree requirements for nursing faculty teaching in a graduate nursing education program not leading to licensure as an advanced registered nurse practitioner. The facility can be more restrictive. For more information, go to theWashington State Department of Health Overdose Education and Naloxone Distribution Website. The licensed practical nurse should use theScope of Practice Decision Treeto determine if administering medications following a specific standing order within the licensed practical nurse's regulatory and individual scope of practice. Curriculum for prelicensure registered nursing education programs. The state and federal laws and regulations do not require the licensed practical nurse to have a special certification to give chemotherapy in the home setting. Established numerous primary care clinics. Commission action regarding refresher course programs. Facilities should develop policies to manage legal risk in these situations. The Centers for Medicaid and Medicare Services (CMS) and accreditation organizations (such as the Joint Commission) may have specific requirements. The licensed practical nurse works under the direction of an authorized health care practitioner within the practitioner's. (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 medication must be stored properly and safely in a secured system. The following conduct may subject a nurse to disciplinary action under the Uniform Disciplinary Act, chapter, (2) Failure to adhere to the standards in WAC. The licensed practical nurse may perform a focused nursing assessment. The Nursing Care Quality Assurance Commission determines that it is not within the scope of the licensed practical nurse to administer stem cell transplants by intravitreal infusion, retrobulbar infusion, spinal infusion, or other complex administration techniques. Extended or satellite nursing campus of nursing education programs approved in Washington state. See theWashington State Department of Health Overdose Education and Naloxone Distribution Webpagefor more information. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use theScope of Practice Decision Treeto determine if the administration of intra-articular injections with within his or her regulatory 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. (c) The registered nurse and licensed practical nurse act as client advocates in health maintenance and clinical care. The focused assessment may include obtaining health care history information and physical assessment. (1) Administration of medications by injection (by intramuscular, intradermal, subcutaneous, intraosseous, intravenous, or otherwise) with the exception of insulin injections. 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. If the patient's wishes are not known, the POLST should direct care in the patient's best interest. 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