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

Tenn. Comp. R. & Regs. 1000-02-.02

Original rule certified May 10, 1974. Amendment filed February 28, 1983; effective March 30, 1983. Amendment filed March 14, 2006; effective May 28, 2006. Amendment filed March 23, 2007; effective June 6, 2007. Repeal and new rules filed July 10, 2024; effective 10/8/2024.

Authority: T.C.A. §§ 63-7-108, 63-7-109, and 63-7-207.