Tenn. Comp. R. & Regs. 1000-02-.02 - LICENSED PRACTICAL NURSE LIMITED, DIRECTED SCOPE OF PRACTICE
(1) Licensed Practical Nurses have knowledge
and preparation in nursing, but not to the extent required of Registered
Nurses. Licensed Practical Nurses may only perform activities to the extent
that the activity is included in the basic practical nurse curriculum. The LPN
maintains competence through ongoing learning and application of knowledge
within practical nursing education.
(2) The LPN scope of practice is a directed
scope of practice and requires appropriate supervision. The LPN, practicing
under the supervision of an RN, APRN, licensed physician or dentist:
(a) Participates in nursing care, health
maintenance, patient teaching, counseling, collaborative planning and
rehabilitation, to the extent of the LPN's generic and continuing education and
experience.
(b) Contributes to the
nursing assessment by collecting, reporting, and recording objective and
subjective data.
(c) Plans for
patient care, including:
1. Planning episodic
nursing care for a patient whose condition is stable or predictable.
2. Assisting the certified nurse aide,
medication aide, or unlicensed supervisee in identification of patient needs
and goals.
3. Determining
priorities of care together with the supervisor.
(d) Demonstrates attentiveness and provides
patient surveillance and monitoring.
(e) Seeks clarification of orders when
needed.
(f) Assists and contributes
in the evaluation of the patient-centered health care plan.
(g) Obtains orientation/training for
competency when encountering new equipment and technology or unfamiliar care
situations.
(h) Recognizes patient
characteristics that may affect the patient's health status.
(i) Implements nursing interventions and
prescribed medical regimens in a timely and safe manner.
(j) Documents nursing care provided
accurately and timely.
(k)
Collaborates and communicates relevant and timely patient information with
patients and other health team members to ensure quality and continuity of
care, including:
1. Patient status and
progress.
2. Patient response or
lack of response to therapies.
3.
Changes in patient condition.
4.
Patient needs and special requests.
(l) Takes preventive measures to promote an
environment that is conducive to safety and health for patients, others and
self.
(m) Respects patient
diversity and advocates for the patient's rights, concerns, decisions and
dignity.
(n) Maintains appropriate
professional boundaries.
(o)
Participates in the health teaching required by the patient and
family.
(p) Participates in
systems, clinical practice and patient care performance improvement efforts to
improve patient outcomes.
(q)
Contributes to evaluation of the plan of care by:
1. Gathering, observing, recording, and
communicating patient responses to nursing interventions.
2. Modifying the plan of care in
collaboration with a registered nurse based on an analysis of patient
responses.
(r) Assigns
and delegates nursing activities appropriately. The LPN shall:
1. Only assign nursing care within the LPN
scope of practice to other LPNs.
2.
Delegate to another only those nursing measures for which that person has the
necessary skills and competence to accomplish safely. In maintaining
accountability for the delegation, an LPN shall ensure that the:
(i) Unlicensed assistive personnel (UAP) has
the education, legal authority, and demonstrated competency to perform the
delegated task;
(ii) Tasks
delegated are consistent with the UAP's job description and can be safely
performed according to clear, exact, and unchanging directions;
(iii) Results of the task are reasonably
predictable;
(iv) Task does not
require assessment, interpretation, or independent decision-making during its
performance or at completion;
(v)
Selected patient and circumstances of the delegation are such that delegation
of the task poses minimal risk to the patient and the consequences of
performing the task improperly are not life-threatening;
(vi) LPN provides clear directions and
guidelines regarding the delegated task or, for routine tasks on stable
patients, verifies that the UAP follows each written facility policy or
procedure when performing the delegated task;
(vii) LPN provides supervision and feedback
to the UAP; and
(viii) LPN observes
and communicates the outcomes of the delegated task.
(s) Functions as a member of the
health care team, contributing to the implementation of an integrated
patient-centered health care plan.
(t) Acts as an advocate for the
patient.
(u) Assumes responsibility
for the LPN's own decisions and actions.
(v) Attends to patient concerns or
requests.
(3) Licensed
Practical Nurses shall not administer the following fluids/medication/agents or
drug classifications in the context of intravenous therapy:
(a) Chemotherapy;
(b) Serums;
(c) Oxytocics;
(d) Tocolytics;
(e) Thrombolytics;
(f) Blood or blood products;
(g) Titrated medications and dosages
calculated and adjusted by the nurse based on patient assessment and/or
interpretation of lab values and requiring the nurse's professional
judgment;
(h) Moderate
sedation;
(i)
Anesthetics;
(j) Paralytics;
or
(k) Investigative or
experimental drugs.
(4)
Intravenous (IV) Push Medications - The administration of intravenous push
medications refers to medications administered from a syringe directly into an
ongoing intravenous infusion or into a saline or heparin lock. Intravenous push
does not include saline or heparin flushes.
(a) Licensed Practical Nurses may deliver
selected intravenous push medications when prescribed by a licensed health care
professional who has legal authority to prescribe such medications, and when
under the supervision of a licensed physician, dentist or registered nurse
pursuant to T.C.A. § 63-7-108, provided:
1. The Licensed Practical Nurse administers
IV push medications in peripheral lines only; and
2. The Licensed Practical Nurse administers
IV push medications only to adults weighing over eighty (80) pounds;
and
3. The Licensed Practical Nurse
has successfully completed a course of study developed from the Infusion Nurse
Society Standards; or
4. The
Licensed Practical Nurse has successfully completed a formal
(institutional/agency-based) intravenous therapy training and competency
program prior to January 1, 2007.
(b) Licensed Practical Nurses shall not
administer IV push medications to pediatric or prenatal obstetrical
patients.
Notes
Authority: T.C.A. §§ 63-7-108, 63-7-109, and 63-7-207.
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