General Practice Questions

Anesthesia

At its February 10-11, 1993 meeting, the Board reconsidered its position on its June, 1990 advisory ruling regarding injection of anesthetic agents to produce anesthesia following placement of the needle by the physician.

The Board has determined that the registered professional nurse (RN) may assist in the procedure by acting as a "third hand" for the anesthesiologist/anesthetist. The Board further determined that the anesthetic agents are to be drawn up by the anesthetist; the physician must be present and appropriate policy should be developed by the medical and nursing staff. The RN who is not a CRNA is not to insert or place the needle. The RN is strictly assisting as a "third hand" while the anesthetist administers the anesthesia.

Death Pronouncement

At its February 8, 1996 meeting, the Board reconsidered its 1986 ruling and determined that licensed nurses may pronounce death in the absence of any law to the contrary. However, certification of death must be pursuant to current state law which requires the signature of a physician on the death certificate. The facility that employs the licensed nurse should also consider JCAHO and insurance requirements when setting policies regarding this matter.

Dispensing Medication

A RN or LPN legally may NOT dispense drugs at any time. Dispensing means the pouring or placing of drugs from stock supplies into bottles or containers, the labeling of such items with the patient's name, medication, dosage and directions and the giving of such bottles or containers to personnel for administering to patients. This is the role of the pharmacist and may not be assumed by nurses. (1986)

The Board reaffirmed that LPNs and RNs are NOT authorized to dispense medications. The administration of medications as prescribed by a legally authorized person is within the scope of practice of nurses licensed in Maine. (Dec. 27, 1990)

The Board of Nursing determined that nurses licensed in Maine may provide patients with limited quantities of prescribed/ordered medication which has been pre-labeled and prepackaged by the hospital pharmacist. These "starter packs" will be administered to the patient in the emergency department setting following an evaluation by a physician. This same procedure will also be used in inpatient leave of absence situations. (May 1, 1991)

In response to a query in April, 1993, the Board stated that a telephoned order for drugs at night for an in-patient is an example of administering a medication, not dispensing.

A nurse providing medications to a patient not evaluated by a physician in the emergency department is acting as a pharmacist in dispensing medications and exceeds the scope of nursing practice.

Hypnotherapy

The use of complementary or alternative therapies in general or hypnotherapy specifically does not expressly come under the Law Regulating the Practice of Nursing or under any specific regulations of the Maine State Board of Nursing.

At its December 6-7, 2000 meeting, the Board determined that hypnotherapy is not exclusively nursing practice but may be considered a modality that a registered professional nurse may employ if he/she has been appropriately trained and competency has been maintained.

J-Tubes and T-Tubes

The Board at its February 10-11, 1993 meeting determined that with appropriate training and documented clinical competency, a LPN may irrigate J-tubes. It is not within the scope of practice of a LPN to irrigate T-Tubes. It is not within the scope of practice of a LPN to remove all types of ureteral catheters.

The Board at its October 21-22, 1998 meeting determined that a licensed nurse may perform the following skills related to the J-tube with training by a registered professional nurse and documented competency:

  1. Administer medications via J-Tube
  2. Flush a J-Tube with normal saline before and after administering a medication
  3. Insert and remove a J-Tube on a well established tract
  4. Check the sterile water level in the J-Tube Balloon and re-inflate the Balloon with saline
  5. Perform routine dressing changes on the J-Tube site

The Board at its June 7-8, 2000 meeting determined that it is not within the scope of practice of a licensed nurse to introduce a guide wire to unplug a J-Tube.

The Board at its August 2-3, 2000 meeting determined that it is not within a registered professional nurse's scope of practice to remove a Jackson-Pratt (J-P) draining device.

The Board at its June 5-6, 2002 meeting determined that with appropriate training a registered professional nurse may remove a J-P training device.

Physician Licensed in Another State

It is the opinion of the Board's legal counsel that "licensed physician" (32 M.S.R.A. section 2102 (2)(A)) does not refer exclusively to physicians licensed in Maine. As long as the physician is duly licensed in the jurisdiction in which he or she is in practice and issues orders, then it is appropriate for nurses to carry out those orders. Should the nurse have reason to suspect licensure status of any physician (allegedly licensed in Maine, New Hampshire, New Brunswick, etc.), s/he should follow the agency's policy for ensuring valid credentials. This is NOT intended to mandate home health agencies maintain credentials on providers but rather follow the protocol they normally would if questioning licensure status. April, 1992

Practice Below Level of Licensure

A licensed person who agrees to be employed in a position which requires less knowledge and skill than that for which s/he is prepared may find several problems:

  1. S/he may be expected to perform at the level for which s/he has been prepared even though classified at a lesser level; and
  2. S/he will be held to the standard expe cted of the higher licensure level should legal problems occur in that health care facility, no matter what the job classification.

The practice of employing licensed individuals to work below their level of preparation, as defined in the LAW REGULATING THE PRACTICE OF NURSING, places that licensed nurse in potential legal jeopardy and is of serious concern to the Board. (1985)

[The DATA BASE /The Bulletin /Spring 1985]

Refresher Course

The Board has a mandate to safeguard the life and health of the people in this state. To that end, the Board routinely recommends that individuals who have not practiced nursing in the past few years take a refresher course. The Board does not have any information regarding the availability of refresher courses and has no mandate to provide specific information about them to licensees. Licensed nurses have a legal and professional obligation to maintain their competency to practice nursing prior to their accepting employment in nursing. (March 15, 1990)

Telephone Orders

Maine Board of Licensure in Medicine and Maine State Board of Nursing
February, 1995 / Joint Advisory Opinion: Telephone Orders

Purpose:

  1. To clarify the roles and responsibilities of physicians and nurses regarding telephone orders.
  2. To insure public protection and assure quality of care.

Physicians, nurses and other health care providers rely on the professional skills and integrity of all participants in the health care delivery process.
Physicians are responsible to assure that the orders communicated are appropriate to the situation, and that orders are accurately relayed from the physician's office. Nurses may accept physician orders via telephone from office personnel designated by the physician. In receiving orders from physician offices, nurses are responsible for recognizing the appropriateness of the order with respect to the plan of care, and for implementing the order or obtaining clarification.