Practice Questions Related to Licensed Practical Nurses

Assessment

The Board determined that the performance of a nursing assessment is a proper function of the registered professional nurse and is NOT within the purview of a practical nurse license. The act of performing a nursing assessment can NOT be delegated by a registered nurse to a licensed practical nurse on the basis of the limitations within the curricula of practical nursing programs. Such curricula do not include the theoretical and clinical preparation necessary for the effective performance of nursing assessments. December 18, 1990

Chemotherapy Bladder Installation by LPN

At its December 6-7, 2000 meeting, the Board determined that it is not within a licensed practical nurse's scope practice to administer BCG/INTRON via bladder instillation.

Collection of Data

Clarified that a LPN may interview, collect data and make observations to contribute to the plan of care. The LPN may not
make an independent nursing diagnosis or initiate a plan of care. (7/16/97)

Dialysis

At its April 15-16, 1998 meeting the Board determined that it is not within the scope of a licensed practical nurse to administer a heparin bolus as part of the procedure for initiating dialysis.

At its October 21-22,1998 meeting the Board reconsidered its April 15-16, 1998 advisory ruling and determined that a licensed practical nurse may administer a heparin bolus as part of the procedure for initiating dialysis in a renal dialysis unit.

Gastronomy Tubes

By consensus the Board determined that LPNs, who have received the necessary training and supervised clinical practice, may be delegated the tasks of reinserting supra pubic and gastrostomy tubes provided that the patient has a well established tract. The health care facilities should develop policies and procedures which are agreed upon by both the nursing and medical staffs. November 2, 1989

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.

Midlines

At its December 9-10, 1998 meeting the Board determined that it is not within the scope of a licensed practical nurse's nursing practice to remove midline catheters that are placed in the peripheral circulation.

Peritoneal Dialysis

Peritoneal dialysis may be performed by an LPN who has received the required educational preparation and supervised clinical practice by a registered nurse with expertise in this area. (1988-1989)

The teaching of peritoneal dialysis to be performed in the home is not within the scope of practice of LPNs. (1989)

Private Duty

On the basis that the home setting does not fall within the Board's interpretation of a "structured health care setting", (e.g., hospital, nursing home), it is NOT permissible for a LPN to accept employment as a private duty nurse in the home setting, unless s/he is an employee of a community health agency. (March 1, 1990)

Subcutaneous Morphine Infusion

At its April 7-8, 1992 meeting the Board determined that it is not within the scope of an LPN's nursing practice to insert or monitor a morphine continuous infusion subcutaneously nor to program the computerized pump or assess patient's response.

At its April 15-16, 1998 meeting the Board reconsidered its 1992 ruling and determined it is within the scope of nursing practice for a licensed practical nurse to insert a needle subcutaneously for the purpose of administering a bolus of morphine via injection cap or continuous infusion provided that he/she has had appropriate, documented training according to protocols established by a health care facility.

At its December 9-10, 1998 meeting the Board determined that it is within the scope of a licensed practical nurses's nursing practice to:

  1. Change a subcutaneous needle on a continuous infusion set
  2. Change dose parameters of the narcotic in the pump based on the registered nurse's plan of care
  3. Change the infusion set provided that he/she has had appropriate, documented training according to protocols established by a health care facility.

Tracheostomy

At its October 6-7, 1992 meeting, the Board determined that it is within the scope of practice for the registered professional nurse to remove a tracheostomy apparatus and replace it with a new apparatus in patients who have had tracheostomies for a long period of time.

At its April 7 and 8, 1999 meeting, the Board determined that it is within the scope of practice for the licensed practical nurse to remove a tracheosotomy apparatus and replace it with a new apparatus in patients that have well established stomas.

Ventilators

A licensed practical nurse (LPN) may care for a patient on a ventilator if that nurse has been trained to do so and if in the judgment of the registered professional nurse it is an appropriate delegation. The patient's total condition and the LPN's experience and skill level must both be considered.

At its April 6-7,1994 meeting, the Board determined that a LPN may provide care to a patient on a ventilator in a home setting where the registered nurse is not on site but is available on call. The LPN should have the appropriate skills and training necessary to render the care.