TheWashington State Department of Health COVID-19 Guidance for Home Care, Home Health, and Hospice Agenciesprovides guidance and resources for health care professionals providing services in these settings. Minimum standards for registered nurses include the following: Minimum standards for licensed practical nurses include the following: (A) Delegating selected nursing functions to others in accordance with their education, credentials, and demonstrated competence as defined in WAC, (A) The practical nurse may delegate selected nursing tasks to competent individuals in selected situations, in accordance with their education, credentials and competence as defined in WAC, (B) Supervising others to whom they have delegated nursing functions as defined in WAC. It is expected that the registered nurse would complete an appropriate age-specific nursing assessment and nursing care plan. The Centers for Medicare and Medicaid Services (CMS) does not allow the licensed practical nurse to perform a pre-anesthesia assessment. Medication reconciliation is a formal process for creating the most complete and accurate list possible of a patient's current medications and comparing the list to those in the patient record or medication orders. A prescription or order from an authorized provider is required as TB skin test formulations are legend drugs. Then the withheld medications are given post dialysis, usually with communication to the provider on the patient's tolerance and outcomes for a successful dialysis and the provider's determination of the next dialysis. 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. 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. 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. It is within the scope of an appropriately prepared and competent licensed practical nurse to assist an authorized health care practitioner or the registered nurse, in providing epidural care, following clinical practice standards. 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. A licensed practical nurse may assist in providing training, performing appraisals, or competency validation related to nursing practice within the scope of the licensed practical nurse and under the direction of the registered nurse or advanced registered nurse practitioner. For example,WAC 246-320 Hospital Licensing Regulationsrequire at least one nurse to have CPR and at least one nurse to have advanced cardiac life support (ACLS) in recovery areas and in critical care units. Delegation in community and in-home care settings is defined by WAC 246-840-910 through 246-840-970. It is within the scope of practice of an appropriately trained and competent licensed practical nurse assist with an authorized health care practitioner or registered nurse to insert a PEG tube, . 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. The complexity and seriousness of the test results may also determine who gives the results and by what method test results should be given. This does not mean the licensed practical nurse may not work in a pharmacy setting administering immunizations. 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. (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. However, theMedical Quality Assurance Commission WAC 246-919-606 Nonsurgical Medical Cosmetic Proceduresapplies to nonsurgical medical cosmetic procedures that involve the injection of a medication or substance for cosmetic purposes, or use of a prescriptive device for cosmetic purposes (except for laser, light, radiofrequency and plasma devices). To complete the free and publicly available telemedicine training, see theWashington State Medical Professional Telemedicine Training website. (c) Writing prescriptions for drugs unless authorized to do so by the commission; (a) Appropriating for personal use medication, supplies, equipment, or personal items of the client, agency, or institution. The licensed practical nurse must have the training, knowledge, skills and abilities to perform triage competently(RCW) 18.79,(WAC) 245-840andAdvisory Opinion on Telenursing. 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. WebIf the home identifies that a resident has a need for nursing care and the home is not able to provide the care per chapter 18.79 RCW, the home must contract with a nurse currently licensed in the state of Washington to provide the nursing care and service, or hire or contract with a nurse to provide nurse delegation. The Nursing Care Quality Assurance Commission recommends the licensed practical nurse use the Scope of Practice Decision Tree to determine if an activity is within the nurse's scope of practice. 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. The person giving the test results or diagnosis must be competent to answer the patient's questions. 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.. 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 The patient must be in a stable condition. 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). (3) "Complex task" means that a nursing task may become more complicated because of: (c) The nursing care task(s) and involved risks; and. The licensed practical nurse may assist an authorized health care practitioner or the registered nurse in performing this activity. 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 must apply adequate knowledge and skills in determining the dosage to be administered at any given time. The Nursing Care Quality Assurance Commission determines it is beyond the scope of the licensed practical nurse to lead this activity due to the complexity of the procedure. It is within the scope of practice of the appropriately prepared and competent licensed practical nurse to perform an EEG or EMG under the direction of an authorized health care practitioner or under the direction and supervision of a registered nurse, following clinical practice standards. Any CLIA waived test involving puncturing the skin requires an order from an authorized health care practitioner. WebRepealed by Order 71-3, filed 3/25/71. Distance-learning nursing education course or courses offered by approved nursing programs. The nurse must follow Federal and State blood-borne pathogen andClinical Laboratory Improvement Amendments (CLIA)regulations. WebThe nurse delegating the task supervises the performance of the unlicensed person. 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 prescription or order may be done following standing orders. 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. Any changes to the standing order must be documented and communicated to an authorized health care practitioner or the registered nurse. It is not within the LPNs scope of practice to certify death. Commission action regarding refresher course programs. The method of communication must be appropriate for the situation. 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. Students enrolled in a nontraditional nursing program. The telemedicine training provides a valuable overview of the roles, responsibilities, liability, and legal requirements when providing telehealth services. Application requirements for ARNP prescriptive authority. It has often been considered a community practice' and has been taken for granted that medications could be withheld whether written orders by an authorized provider are obtained or not. Receiving telephone and verbal prescription orders, transcribing, and transmitting prescription orders are activities often performed by nurses and appropriately included by many organizations in the responsibilities of the licensed practical nurse. WebRCW 18.79 Nursing Care and WAC 246-840 Practical and Registered Nursing. Appropriate documentation of a focused patient assessment and evaluation must substantiate intervention. 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. An employer or institution may have specific requirements for training or certification. See theNCQAC's Administration of Sedating, Analgesic, and Anesthetic Agents Advisory Opinionfor more information. Standing orders may be used. 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. ThePublic Health Nurses: Dispensing Medications/Devices for Prophylactic and Therapeutic Treatment of Communicable Diseases and Reproductive Health Advisory Opinionprovides guidelines and recommendations. 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. 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 does not practice nursing independently. Collect and verify the patient's complete medication history. The nursing law and rules do not prohibit the competent and appropriately trained licensed practical nurse from giving experimental drugs by any route under the direction of an authorized provider or under the direction and supervision of the registered nurse. The planning conference should include the patients or residents medical provider, the patient and/or surrogate decision-maker, and key family members. Standards and evaluation of nursing education programs. The licensed practical nurse must be competent and follow the standards for medication administration. (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. See theWashington State Department of Health Overdose Education and Naloxone Distribution Webpagefor more information. Bedside caregivers and supervisors should be familiar with this detail in the patient care plan and POLST. These online courses are on-demand eLearning with virtual proctored final exams. WebThe Revised Code of Washington (RCW) 18.79 and Washington Administrative Code (WAC) 246-840 provide the statutory and legal basis of nursing practice. This includes preparing and monitoring the dialysis machine, accessing an arteriovenous (AV) fistula or graft or a central venous catheter, initiating or discontinuing hemodialysis, collecting specimens, catheter site care, and performing tubing or adaptor changes. The goal of the pre-admission/resident assessment is to determine the personal care services needs of a potential resident and at times, the nursing care needs of said resident. Manipulate, advance, irrigate, milk, or remove a chest tube. PO Box 47852 Olympia, Washington 98504-7852 . No, the telemedicine training requirement doesn't apply to audio-only telephone (telephone triage), facsimile, or email. Refresher course program for advanced registered nurse practice nurses. The Nurse Delegation Program, under Washington State law, allows nursing assistants working in certain settings to perform certain tasks--such as administration of prescription medications or blood glucose testing--normally performed only by licensed nurses. This communication shall take place in a time period consistent with the client's need for care. 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. Stable and predictable may include a patient with sliding scale insulin orders. Use of simulation for clinical experiences in LPN, RN, or RN to BSN nursing education programs located in Washington state. Is the task within the registered nurse's scope of practice? (15) "Stable and predictable condition" means the registered nurse delegator determines the patient's clinical and behavioral status is nonfluctuating and consistent. 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. Faculty requirements for nursing education programs. WebContact Information Health Services Annie Hetzel 360-725-6040 The follow A-Z Index of health topics includes OSPI resources and external hyperlinks to resources produced by our partners. 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 have policies or guidelines about crushing or splitting medications. The nursing laws and rules allow a competent and appropriately trained licensed practical nurse to apply eyelash extensions under the direction of an authorized health care practitioner 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 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 licensed practical nurse should use nursing judgment and determine whether additional verification or clarification is required. An exception exists in the physician rules that require a physician to be on the immediate premises during the patient's initial treatment when a nurse is performing laser therapy:WAC 246-919-605 Use of Laser, Light, Radiofrequency, and Plasma (LLRP) Devices as Applied to the Skin. Please see the regulations forOSHA Respirator Medical Evaluations. It is within the scope of the appropriately prepared and competent LPN to discuss end-of-life care with the patient or surrogate under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse (RN). A facility or employer may require a specific certification or training program. It is within the scope of an appropriately prepared and competent licensed practical nurse to perform routine and non-complex diagnostic imaging procedures 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 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 implements health care plans developed by the registered nurse or other authorized health care practitioner. Employer: Washington Department of Labor & Industries - Insurance Services . The licensed nurse (RN, LPN, or ARNP) providing telemedicine clinical services licensed prior to January 1, 2021, will need to complete telemedicine training by December 31, 2021. The same standards apply regardless of whether the services are provided face-to-face or through telecommunication technology. It is not within the scope of practice of the licensed practical nurse to perform an assessment by proxy. These procedures require a prescription from an authorized health care practitioner. The nursing law and rule does not require the registered nurse or an authorized health care practitioner to be on the premises when a licensed practical nurse provides care in any setting. Overdose education and Naloxone Distribution Webpagefor more information responsibilities, liability, and legal requirements when providing telehealth.... 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