Can an Lpn Draw Blood in Oklahoma

MEDICAL PERSONNEL;

NURSING;

Connecticut laws/regulations;

July 22, 2003		2003-R-0546
LPN PRACTICE ACTS
By: John Kasprak, Senior Attorney

You asked for information on Connecticut's practice act for licensed practical nurses (LPNs) and whether it addresses "nursing assessments" and "triage. " You are also interested in LPN practice acts in other states.

SUMMARY

Connecticut's practice act for LPNs does not explicitly address the nursing assessment or triage issues raised. But the State Board of Examiners for Nursing issued a declaratory ruling in 1989 that addressed the LPN's role in the nursing process. It concluded that LPNs are properly allowed to participate in all phases of the nursing process under the direction of a registered nurse (RN), as outlined in its ruling. The board concluded that an LPN can contribute to the nursing assessment by collecting, reporting, and recording subjective and objective patient-related data in an accurate and timely manner. But an LPN cannot perform the assessment independently.

We reviewed nine other states (Alabama, Colorado, Maine, Massachusetts, Minnesota, New York, Oklahoma, Oregon, and Rhode Island). Of these, specific references to LPNs' involvement with "nursing assessments" were found in the state's practice act or corresponding nursing board or regulatory agency rules and regulations in Alabama, Massachusetts, Oklahoma, and Oregon. (Please note that this review of other states is not exhaustive but meant to give some indication of other states' direction on this issue. )

We did not find a reference to "triage" in any of the states.

CONNECTICUT

Statutory and Pubic Health Code References

State law defines the practice of nursing by an LPN as "the performing of selected tasks and sharing of responsibility under the direction of a registered nurse or an advanced practice registered nurse and within the framework of supportive and restorative care, health counseling and teaching, case finding and referral, collaborating in the implementation of the total health regimen and executing the medical regimen under the direction of a licensed physician or dentist" (CGS � 20-87a(c)).

Under Public Health Code regulations, the curriculum of an approved LPN education program must integrate theory and clinical practice and provide skills for safe practice in the following areas: 1) elementary principles of physical-biological and behavioral sciences; 2) fundamentals of nursing; 3) medical-surgical nursing; 4) maternal/child health nursing; and 5) geriatric nursing (DPH Regs. , � 20-90-55).

"Fundamentals of nursing" includes the basic needs of people during illness, application of principles of medical/surgical asepsis and techniques of medication administration. "Medical –surgical nursing" includes content and application of basic principles in caring for common physical illnesses and trauma and should include preventive, restorative, and rehabilitative aspects and the integration of appropriate nutritional, mental health, and medical therapeutic content. Emergency intervention must be included. Also, experiences must be provided for supervised application of principles with patients with selected medical-surgical problems for assisting the RN in caring for the patient with complex health problems.

"Maternal/Child health nursing" includes meeting the basic needs of the mother, infant, and the family during the pregnancy and post-natal period. This must extend to the well and ill child with emphasis on short and long term health deviations in childhood. Basic aspects of physical, intellectual, social and emotional development through age 18 must be included.

Finally, "geriatric nursing" includes content and experience with the elderly with an emphasis on assisting the individual patient in meeting his potential.

Board of Examiners for Nursing Declaratory Ruling

In February 1987, the Connecticut Board of Examiners for Nursing issued a notice of a hearing to consider clarification of the LPN's role in (1) the application of the nursing process, (2) performing "selected tasks and sharing of responsibility under the direction of an RN" (CGS � 20-87a), and (3) "collaborating in the implementation of the total health care regimen. " As noted, the statute at issue was Section 20-87a(b) (now 20-87a(c) which defined the scope of practice of an LPN. In particular, the board wanted to clarify the meaning of selected tasks and sharing of responsibility under the direction of an RN, including the assessment issue. The board viewed 'assessment" as making observations, gathering data, identifying needs and problems, and diagnosing human responses relevant to the client. Other aspects of the LPN's role examined by the board included planning and implementation issues.

In January 1989, the board made the following findings of fact:

1. the LPN is properly prepared to function under the definition and framework of her role as specified in section 20-87a of the statutes and

2. the selected tasks and shared responsibilities of the LPN are continually changing as the art and science of nursing changes.

The board then made a number of conclusions including:

1. the LPN must perform her nursing functions and shared nursing responsibilities under the direction of an RN;

2. the LPN can contribute to the nursing assessment by collecting, reporting and recording objective and subjective data in an accurate and timely manner, that includes observation about the condition or change in the patient's condition, and signs and symptoms of deviation from normal health;

3. the LPN can participate in the development of a strategy of care in consultation with other nursing personnel; and

4. participate in the assisting, delegating and giving of directed care.

(The Board's decision is attached. )

OTHER STATES

Alabama

Alabama Board of Nursing regulations provide that the LPN "shall contribute to the nursing assessment by collecting, reporting and recording objective and subjective data in an accurate and timely manner. " Data collection includes (a) observation about the condition or change in condition of the client and (b) signs and symptoms of deviation from normal health status. (Alabama Board of Nursing Administrative Code, � 610-X-7-. 01; see attached).

Colorado

LPN practice means "the performance, under the supervision of a dentist, physician, podiatrist, or professional nurse authorized to practice in this state, of those services requiring the education, training, and experience, as evidenced by knowledge, abilities, and skills required in this article for licensing as a practical nurse… in caring for the ill, injured, or infirm, in teaching and promoting preventive heath measures, in acting to safeguard life and health, or in administering treatments and medications prescribed by a legally authorized dentist, podiatrist, or physician, or physician assistant implementing a medical plan…Nothing in this article shall limit or deny a practical nurse from supervising other practical nurses or other health care personnel" (Colorado Nurse Practice Act, � 12-38-103 (9)).

The law defines "medical plan" as a written plan, verbal order, standing order, or protocol, whether patient specific or not, that authorizes specific discretionary medical action, which may include but is not limited to the selection of medication (� 12-38-103(4)).

An approved education program for LPNs must include (1) content fundamental to the knowledge and skills required for clinical nursing appropriate to the practice of practical nursing and (2) content relating to the principles of biological, physical, social, and behavioral sciences (� 12-38-116(2)).

Maine

Maine defines the practice of practical nursing as "performing tasks and responsibilities, by a licensed practical nurse, for compensation within a structured health care setting, reinforcing the patient and family teaching program through health teaching, health counseling and provision of supportive and restorative care, under the direction of a registered nurse or licensed or otherwise legally authorized physician, podiatrist, or dentist (Maine Statutes, Chapter 32, � 2102(3)).

The law allows registered nurses to delegate selected nursing services to LPNs when the services use standardized protocols and procedures leading to predictable outcomes in the observation and care of the ill, injured and infirm; in the maintenance of health; in action to safeguard life and health; and in the administration of medications and treatments prescribed by an individual authorized to do so (Chap. 32, � 2102(2)).

The Maine Board of Nursing has determined that the act of performing a nursing assessment cannot be delegated by a registered nurse (RN) to an LPN on the basis of the limitations within the curricula of practical nursing programs. "Such criteria do not include the theorectical and clinical preparation necessary for the effective performance of nursing assessments. "

Massachusetts

Regulations of the Massachusetts Board of Registration in Nursing provides that an LPN participates in direct and indirect nursing care, health maintenance, teaching, counseling, collaborative planning and rehabilitation, to the extent of her generic and continuing education and experience in order to:

1. assess an individual's basic health status, records and related health data;

2. participate in analyzing and interpreting said recorded data, and making informed judgments as to the specific elements of nursing care mandated by a particular situation;

3. participate in planning and implementing nursing intervention, including appropriate health care components in nursing care plans that take account of the most recent advancements and current knowledge in the field;

4. incorporate the prescribed medical regimen into the nursing plan of care;

5. participate in the health teaching required by the individual and family so as to maintain an optimal level of health care;

6. when appropriate evaluate outcomes of basic nursing intervention and initiate or encourage change in plans of care; and

7. collaborate, cooperate, and communicate with other health care providers to ensure quality and continuity of care (244 Code of Massachusetts Regulations (CMR) � 3. 04).

Minnesota

Minnesota defines the practice of practical nursing as "the performance for compensation or personal profit of any of those services in observing and caring for the ill, injured, or infirm in applying counsel and procedure to safeguard life and health, in administering medication and treatment prescribed by a licensed health professional, which are commonly performed by LPNs and which require specialized knowledge and skill such as are taught or acquired in an approved school of practical nursing, but which do not require the specialized education, knowledge, and skill of a registered nurse" (Minnesota statutes, Chapter 148, � 148. 171(14)).

New York

The practice of nursing as an LPN in New York 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 provider legally authorized under this title and in accordance with the commissioner's regulations" (NY Education Law, Title VIII, Nurse Practice Act (Article 139, Section 6902)). "Under the direction of a registered professional nurse" is understood to mean that a registered nurse should be present on the premises or immediately available by telephone when an LPN renders professional services.

Oklahoma

The Oklahoma Nursing Practice Act states that "licensed practical nursing means the practice of nursing under the supervision or direction of an RN, licensed physician or dentist. This directed scope of practice includes, but is not limited to: contributing to the assessment of the health status of individuals and groups…" (see Okla. Nursing Practice Act, 59 O. S. � 567).

Oregon

The Oregon State Board of Nursing Standards and Scope of Practice for the LPN and RN states that "the Board recognizes that the role of the licensed practical nurse and registered nurse will change over time. Basic education which leads to licensure as a practical nurse or registered nurse establishes entry level competencies. The licensee may add technical skills to practice following initial licensure through such methods as in-service education, on the job training or continuing education…" (� 851-045-0000 (2)).

Under the board's standards, an LPN :

1. collects data on a client's status, records objective and subjective data in an accurate and timely manner, and reports the data in a timely manner to an RN to utilize in completing a nursing assessment of the client;

2. contributes to the establishment of the nursing diagnosis;

3. participates in the development of the plan of care by providing data, contributing to the identification of priorities, contributing to setting realistic and measurable goals, and assisting in the identification of nursing interventions;

4. participates in the implementation of the plan of care; and

5. contributes to the evaluation of the responses of individuals or groups to nursing interventions by documenting and communicating evaluation data to appropriate members of the health care team, contributing to the modification of the care plan based on the evaluation, and evaluating the responses of individuals to nursing interventions (see � 851-045-0005, attached).

Rhode Island

Rhode Island's practice act defines practical nursing as "an integral part of nursing based on a knowledge and skill level commensurate with education. It includes promotion, maintenance, and restoration of health and utilizes standardized procedures leading to predictable outcomes, which are in accord with the professional nurse regimen under the direction of a professional nurse. In situations where professional nurses

are not employed, the licensed practical nurse functions under the direction of a licensed physician, dentist or podiatrist. Each LPN is responsible for the nursing care rendered" (Rhode Island Statutes, � 5-34-3(g)).

JK: ro

Can an Lpn Draw Blood in Oklahoma

Source: https://www.cga.ct.gov/2003/olrdata/ph/rpt/2003-R-0546.htm

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