The licensed practical nurse is always individually accountable and responsible for the nursing care the licensed practical nurse provides. How to make changes to the delegated tasks. (6) "Immediate supervision" means the registered nurse delegator is on the premises, within audible and visual range of the patient and the patient assessment by the registered nurse delegator occurs prior to the delegation of duties to any care giver. Scope of practice remains the same regardless of setting. A pharmacist is not identified as an authorized health care practitioner that the licensed practical nurse may take orders or direction from. Internationally educated nurse program approval criteria for nursing education programs approved in Washington state. Does the patient reside in one of the following settings? A licensed practical nurse must have direction from an authorized health care practitioner or a registered nurse to perform tests such as a human chorionic gonadotropin (hCG), urine dipstick, occult blood screening, blood glucose capillary tests or otherCLIAapproved waiver under the CLIA criteria. 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. Provision for continuity of drug therapy for residents. (15) "Stable and predictable condition" means the registered nurse delegator determines the patient's clinical and behavioral status is nonfluctuating and consistent. Some settings may use the licensed practical nurse to manage calls after specialized training and under the supervision of the registered nurse or other authorized health care provider. (14) "Registered nurse delegation" means the registered nurse transfers the performance of selected nursing tasks to competent nursing assistants or home care aides in selected situations. Can the task be performed without a need for complex observations or critical decisions? (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. A licensed practical nurse may provide nursing care in an ALF within the licensed practical nurse's scope of practice under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. A community-based care setting as defined by RCW. Other professionals may also perform the pre-admission/resident assessment (WAC 388-76-10150andWAC 388-78A-2080). If there are signs of infection or other concerns, the licensed practical nurse should seek advice from an authorized provider or the registered nurse before attempting to re-insert. 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. (b) Failure to supervise those to whom nursing activities have been delegated. They may administer or provide an epinephrine autoinjector to people who are experiencing anaphylaxis. The licensed practical nurse may perform a focused nursing assessment. Examples of diagnostic imaging procedures include: While the licensed practical nurse may perform routine, diagnostic imaging procedures, because of the complexity, it is not within the scope of the licensed practical nurse to perform interventional radiology procedures. Under delegation from the Department Administrator for the Department of Medical Education and Clinical Sciences, the position is responsible for independently performing a variety of confidential administrative projects (2) "Coercion" means to force or compel another, by authority, to do something that he/she would not otherwise choose to do. 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. 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 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 Nursing Care Quality Assurance Commission determines it is beyond the scope of a licensed practical nurse to perform a vaginal examination. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical to provide epidural care during labor and delivery. 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. Itdoes notinclude the use of audio-only telephone, facsimile, or email.. The licensed practical nurse should use theScope of Practice Decision Treeto determine if these activities are within the registered nurse's legal and individual scope of practice. The medical provider makes the "medical judgment" as to the specific medication and dosage. 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. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse due to the complexity of the activity to perform endotracheal intubation. Approval of substance abuse monitoring programs. Technology requirements include a strong internet connection, a webcam, a microphone, and access to a laptop or desktop computer. Symjepi (https://www.symjepi.com/) is not classified as an EAI. This assessment includes the use of the nursing process (WAC 246-840-700). Some facility laws and rules require nurses to have a CPR certification. The Food and Drug Administration (FDA) approves cosmetics. Web(1) The purpose of defining standards of nursing conduct or practice through WAC 246-840-700 and 246-840-710 is to identify responsibilities of the professional registered nurse and the licensed practical nurse in health care settings and as provided in the Nursing Practice Act, chapter 18.79 RCW. (4) "Direct supervision" means the registered nurse delegator on the premises, quickly and easily available and the patient assessment by the registered nurse delegator occurs prior to the delegation of the duties to any care giver. Episodic care of chronic opioid patients. The Nursing Care Quality Assurance Commission recommends the nurse follow theWAC 246-919-605for physicians when carrying out laser treatment procedures under the direction of an authorized health care practitioner. The licensed practical nurse practices interdependently when providing nursing care and dependently when carrying out medical regimens. See theNCQAC Standing and Verbal Orders Advisory Opinionfor guidelines and recommendations. This is an example of a situation where health care providers caring for the patient must be aware of the POLST. 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. The Washington State Department of Social and Health Services issued the following policies related to COVID-19, telehealth services, and delegation requirements: The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to administer neuromodulators (such as Botox, Dysport, or Xeomin) or administering medications for sclerotherapy, asclerotherapy, or dermal fillers under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse. Initial licensure for registered nurses and practical nurses. It is up to the nurse, using nursing judgment, to determine which patients and services are appropriate for telehealth. 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. 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 commission's advisory opinion on providesStanding Orders and Verbal Orders (PDF)additional information and guidance. The licensed practical nurse does not practice nursing independently. VDOT is the use of a videophone or other video/computer equipment to observe clients taking their medications remotely. (c) The registered nurse and licensed practical nurse act as client advocates in health maintenance and clinical care. 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. 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. Internationally educated registered nurse program in an approved nursing education program. This rule defines a consistent standard of nursing care with the delegation of nursing tasks to nursing assistants or home care aides. It is not within the scope of practice for the licensed practical nurse to delegate to assistive personnel nursing tasks in the public and private, kindergarten through twelve grade school setting (RCW 28A.210 Common School Provisions: Health-Screening and Requirements). SSB 6421was passed in 2016 allowing authorized entities to obtain epinephrine autoinjectors. 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. See the Nursing Care Quality Assurance Commission'sStanding Orders and Verbal Orders Advisory Opinionfor additional information. 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. The competent and appropriately trained licensed practical nurse may also perform specific assessments or screening activities, such as mental health status screening, suicidal risk screening, substance use screening, behavioral health screening, oral health screening, growth and developmental screening, neonatal abstinence syndrome scoring system, or nutritional health screening. These procedures require a prescription from an authorized health care practitioner. 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