Tenn. Comp. R. & Regs. 1000-03-.02 - SCOPE OF PRACTICE

(1) Standards Related to RN Scope of Practice. The RN:

(a) Conducts and documents a comprehensive nursing assessment.

(b) Applies nursing knowledge based upon the biological, psychological and social aspects of the patient's condition.

(c) Detects faulty or missing patient information.

(d) Plans nursing care and nursing interventions consistent with the patient's overall health care plan.

(e) Utilizes decision-making, critical thinking and clinical judgment to make independent nursing decisions and nursing diagnoses.

(f) Seeks clarification of orders when needed.

(g) Implements treatment and therapy, including medication administration and delegated medical functions as ordered, and independent nursing functions.

(h) Obtains orientation/training for competence when encountering new equipment and technology or unfamiliar care situations.

(i) Demonstrates attentiveness and provides patient surveillance and monitoring.

(j) Identifies changes in patient's health status and comprehends clinical implications of patient's signs, symptoms and changes as part of expected and unexpected patient course or emergent situations and reports such changes timely to the supervisor.

(k) Evaluates the patient's response to nursing care and other therapy, including:

1. Patient's response to interventions.

2. Need for alternative interventions.

3. Need to communicate and consult with other health team members.

4. Need to revise the plan of care.

(l) Communicates and consults with other health team members, including:

1. Patient concerns and special needs.

2. Patient status and progress.

3. Patient response or lack of response to interventions.

4. Significant changes in patient condition.

(m) Documents nursing care.

(n) Revises care plan as needed.

(o) Takes preventive measures to protect patient, others and self.

(p) Provides comprehensive nursing and health care education in which the RN:

1. Assesses and analyzes educational needs of learners.

2. Plans educational programs based on learning needs and teaching-learning principles.

3. Ensures implementation of an educational plan either directly or by delegating selected aspects of the education to other qualified persons.

4. Evaluates the education to meet the identified goals.

(2) Registered Nurses are not prohibited from expanding their roles by the Tennessee Code. However, RNs functioning in an expanded role assume personal responsibility for all of their acts. RNs who manage the medical aspects of a patient's care in situations not covered by T.C.A. § 63-7-103(c)(1)-(3) must have written medical protocols, jointly developed by the nurse and the sponsoring physician(s). The detail of medical protocols will vary in relation to the complexity of the situations covered and the preparation of the RN using them. This paragraph is not intended to authorize an RN, who does not also hold a current Advanced Practice Registered Nurse certificate, to engage in the practice of advanced nursing.

(3) Standards Related to RN Responsibility to Act as an Advocate for the Patient. The RN:

(a) Respects the patient's rights, concerns, decisions and dignity.

(b) Identifies patient needs.

(c) Attends to patient concerns or requests.

(d) Promotes a safe patient environment.

(e) Communicates patient choices, concerns and special needs with other health team members regarding:

1. Patient status and progress.

2. Patient response or lack of response to therapies.

3. Significant changes in patient condition.

(f) Maintains appropriate professional boundaries.

(g) Assumes responsibility for the RN's own decisions and actions.

(4) Standards Related to Registered Nurse Responsibility to Organize, Manage and Supervise the Practice of Nursing. The RN:

(a) Assigns to another only those nursing measures that fall within that nurse's scope of practice, education, experience and competence or that unlicensed person's role description, including:

1. Assigning nursing care within the Registered Nurse scope of practice only to other Registered Nurses.

2. Assigning nursing care to a Licensed Practical Nurse within the LPN scope of practice based on the RN's assessment of the patient and the LPN's ability.

3. Supervising, monitoring and evaluating the care assigned to a Licensed Practical Nurse.

(b) Delegates 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, a Registered Nurse shall ensure that the:

1. Unlicensed assistive personnel (UAP) has the education, legal authority, and demonstrated competency to perform the delegated task.

2. Tasks delegated are consistent with the UAP's job description and can be safely performed according to clear, exact, and unchanging directions.

3. Results of the task are reasonably predictable.

4. Task does not require assessment, interpretation, or independent decision-making during its performance or at completion.

5. 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.

6. Registered Nurse 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.

7. Registered Nurse provides supervision and feedback to the UAP.

8. Registered Nurse observes and communicates the outcomes of the delegated task.

(c) Matches patient needs with personnel qualifications, available resources and appropriate supervision.

(d) Communicates directions and expectations for completion of the delegated activity.

(e) Supervises others to whom nursing activities are delegated or assigned by monitoring performance, progress and outcomes and assures documentation of the activity.

(f) Provides follow-up on problems and intervenes when needed.

(g) Evaluates the effectiveness of the delegation or assignment.

(h) Intervenes when problems are identified and revises plan of care as needed.

(i) Retains professional accountability for nursing care as provided.

(j) Promotes a safe and therapeutic environment by:

1. Providing appropriate monitoring and surveillance of the care environment.

2. Identifying unsafe care situations.

3. Correcting problems or referring problems to appropriate management level when needed.

(k) Teaches and counsels patients and families regarding their health care regimen, which may include, but is not limited to, general information about health and medical condition, specific procedures and wellness and prevention.

(5) RN Determination and Pronouncement of Death. Pursuant to the restrictions and guidelines found in T.C.A. § 68-3-511, a Registered Nurse may make an actual determination and pronouncement of death.

Notes

Tenn. Comp. R. & Regs. 1000-03-.02

New rules filed July 10, 2024; effective 10/8/2024.

Authority: T.C.A. §§ 63-7-103, 63-7-207, and 68-3-511.