Nursing

This page provides resources for registered nurses employed by facilities operated/certified by the New York State Office for People With Developmental Disabilities.

Article 139, §6902.2 of Education Law states that “the practice of nursing as a licensed practical nurse is defined as performing tasks and responsibilities within the framework of case finding, health teaching, health counseling, and provision of supportive and restorative care under the direction of a registered professional nurse or licensed physician, dentist or other licensed health care provider legally authorized under this title and in accordance with the commissioner’s regulations.”

Under the direction of a registered professional nurse (RN) is “understood to mean that a registered nurse should be present on the premises or immediately available by telephone when professional services are rendered by a licensed practical nurse. The degree of supervision shall be appropriate to the circumstances.” (NYS Nursing Handbook). While not stated, “immediately available by telephone” has been further interpreted to mean that the RN must respond within 30 minutes.

In addition to law, the State Board for Nursing has issued opinions regarding the legal scope of practice for licensed practical nurses. While not law or regulation, these opinions are binding upon the profession. Decisions may vary by practice setting (acute care; long term care; community).

Prior to performing any task that is part of the LPN’s legal scope of practice, the LPN must be trained in the task and must have demonstrated initial and continuing competence in the task. The training and a periodic evaluation of competency of the individual to perform the task must be noted in the employee record. All training and evaluation of competency must be performed by a RN.

The tasks listed below may only be done under the direction of a RN (as defined above).

• Plant a tuberculin skin test (PPD) that is administered pursuant to a person-specific order. The LPN may “read” the PPD in millimeters of induration but may not indicate that the reading is “positive’ or “negative”.

• Replace a gastrostomy tube for a person with an established, stable gastrostomy tube upon the patient specific order of a physician or other qualified health care provider.

• Irrigate the urinary bladder. However, an LPN may not irrigate a nephrostomy tube. Irrigation of a nephrostomy tube involves assessment; therefore it must be done by a RN..

• Perform venipuncture for the purpose of drawing blood or initiating the administration of unmedicated intravenous fluids.

• Replace bags of the same intravenous fluid, including medicated fluid but not initiate new or different medicated intravenous fluid. The LPN may change dressings over peripheral intravenous site (but not a central line), monitor intravenous flow rates; change intravenous tubing and/or discontinue intravenous administration of peripherally inserted IV lines.

• Collect clinical data or information. However, only the RN may interpret that clinical data/information and determine what clinical action is needed.

The tasks listed below may not be done by a licensed practical nurse:

• interpret clinical data

• take independent action on clinical data

• do patient assessments

• triage, either in person or over the telephone

• develop a nursing care plan

• care for a person on mechanical ventilation (i.e, a respirator or a ventilator) in a community setting.

• do mental health counseling

• perform case management

• supervise aides in administration of medications to persons who are not self-directed

• 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 patient in person

• directly access or flush any venous chest or arm port central line, nor may they deliver intravenous therapy through such a device

• administer any medication (except saline and heparin flushes) by direct IV push technique or administer an IV fluid bolus for plasma volume expansion (except in a hemodialysis unit)

• draw blood from any central line

• insert or remove any central line

• administer IV antineoplastic medications. However, bladder instillation of antineoplastic medications by LPNs is permissible.

• change tracheostomy tubes. An LPN can not intervene sufficiently, nor assess the patient sufficiently, in situations where the outer cannula of a tracheostomy needs to be reinserted.

Reviewed and approved by the State Board for Nursing May 2008