Office for People With Developmental Disabilities

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Frequently Asked Questions

03/02/12

Licensed Practical Nurses (LPN) / RN Practice Issues

Question: Has OPWDD established specific guidelines as to what tasks can only be done by RNs, LPNs, direct care staff?

Answer: The practice of nursing is not regulated by OPWDD. That responsibility lies with the New York State Education Department. All RNs and LPNs in New York State, including those who work in programs certified by OPWDD must practice within the standards of practice established by the Board of Regents, in consultation with the State Board for Nursing.
It has long been the position of the State Board of Nursing that any task that requires assessment may only be done by an RN. Assessment should not be confused with collection of data. Assessment is really the "so what"; that is, the determination of what action should be taken as a result of the data.
In addition, the State Board for Nursing has determined that the following specific tasks are outside of the scope of practice of an LPN:

  • patient assessments
  • triage, either in person or on the telephone (e.g. being "on call")
  • independent development of a nursing care plan
  • mental health counseling
  • case management
  • executing a non-patient specific order (sometimes called a standing order)
  • administering chemotherapy
  • administering bolus IV medications

The Nurse Practice Act in New York State allows unlicensed staff in facilities certified by OPWDD to perform nursing duties if there is adequate medical and nursing supervision. It is the responsibility of the supervising nurse to determine the appropriateness of the delegation of any particular task. In making a decision, the RN should consider such issues as the condition of the consumer, the competency of the staff, the complexity of the task, the predictability of the outcome and the potential for harm. The RN is responsible for the training of the staff, the determination of initial and on going competency and the monitoring of performance.

RN & LPN Practice Issues can be found on the New York State Education Department Office of the Professions web site at:
http://www.op.nysed.gov/nurse-rnlpnissues.htm

Question: Can LPNs administer medications or tests without a patient specific order from an authorized prescriber?

Answer: No. LPNs are required to have patient-specific orders for the medications and tests that they administer.

Question: Can an LPN do the assessment and be “signed off” by the RN?

Answer: NO. According to 6901 of Article 139 of the Education Law only a RN may plan nursing care. LPNs in NYS do not have assessment privileges; they may not interpret patient clinical data or act independently on such data.

Question: Can LPNs take calls from staff if there is an RN in case s/he needs them? What if they are in the house?

Answer: LPNs may not triage, either in person or on the phone

Question: Can LPNs implement non-person specific (standing) orders?

Answer: NO. LPNs may not initiate the implementation of a standing order or protocol that has not been individualized to a specific person by a physician, nurse practitioner or physician’s assistant, unless directed to administer a part of the order by a registered nurse who has evaluated the individual in person.

Question: State Education Department (SED) regulation section 64.7 refers to registered professional nurses administering immunizations. Can LPNs administer immunizations to consumers and/or employees?

Answer: SED regulations section 64.7 refers to immunizations given pursuant to a non-patient specific orders. So, if the physician wrote a "standing order" such as:

"May administer influenza immunization to any employee who requests the same."

Only a registered professional nurse may carry out this order, and all of the provisions of SED regulations 64.7 apply.

If the physician wrote a patient specific order, such as:

"Administer influenza immunization to Jane Doe" or in Jane Doe's chart he wrote "administer influenza immunization" than an LPN can administer the immunization.

Question: Can an LPN change a trach tube?

Answer: No. A LPN cannot change tracheostomy tubes. An LPN can not intervene sufficiently, nor assess the person sufficiently, in situation where the outer cannula of a tracheostomy needs to be reinserted.

Question: Can an LPN plant and read a PPD?

Answer: LPNs can plant a PPD provided there is a person-specific order. LPNs may read a PPD, provided the LPN is properly trained on how to read the PPD and how to document the observation. Reading a PPD is not an "assessment". The LPN is only required to observe the site, and report the observation. (e.g. no area of induration; 1 mm area of induration, etc.) However, they may not determine if the reading indicates a positive or negative test result.

Question: Can an LPN replace a gastronomy tube?

Answer: Yes, provided:

  • It is a “mature” (well-established) track
  • There is a person-specific order
  • The LPN has been appropriately trained and determined competent to perform the task.

Question: Can an LPN substitute for an RN to provide oversight and supervision in a residence?

Answer: No. According to the State Board of Nursing, this is outside the scope of practice of an LPN.

Question: Can an LPN irrigate a urinary catheter?

Answer: Yes, provide:

  • There is a person-specific order
  • The LPN has been appropriately trained and determined competent to perform the task
  • LPNs MAY NOT irrigate nephrostomy tubes

Question: Can an LPN perform venipuncture?

Answer: Yes, for the purpose of drawing blood or for administering non-medicated IV solutions.

Question: Can an LPN Administer medication via IV in a community setting?

Answer:

  • LPNs can replace bags of the same intravenous fluid, including medicated fluid but can not initiate new or different medicated intravenous fluid
  • LPNs cannot administer any direct IV push medications, except for saline and heparin flushes

Question: Can LPNs care for PICC lines?

Answer: Not in the community. LPNs cannot access any form of central line, venous chest or arm port line device.  This includes changing, inserting, removing, flushing, or changing dressings.

Question: Do LPNs have to take the medication administration course?
Answer: It is the responsibility of the RN to determine the competency of everyone she/he supervises, including LPNs, to administer medications. Many agencies give the LPN a written test, and then do a supervised pour. If the LPN passes, then he/she is allowed to give medications. If he/she does not pass, then they attend the medication administration course.