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Washington State Nursing Care Quality Assurance Commission ADVISORY OPINIONS INDEX Requester A A1 A2 A3 A4 A5 A6 A7 A8 A9 A9a A11 A12 A13 A14 A15 A16 A17 A18 A19 A20 Facility Response Date See H-18 ADMINISTERING ANESTHESIA Refer to Procedural Sedation policy statement adopted January 2000 Refer to Epidural Catheter position statement adopted September 2000 Archived 9/8/00 Archived 2/13/98 Archived 9/8/00 Archived 2/13/98 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Administering local anesthetic dental injections by RN’s Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 May a nurse practitioner perform epidural steroid injections, spinal nerve root blocks, and facet blocks, using fluoroscopy? Since fluoroscopy is necessary to perform these procedures I will need to extend my hospital privileges to allow me to perform these procedures in their radiology department. Archived 9/8/00 Archived 9/8/00. Archived 9/8/00 Cross References Dr. Ron Marsh Dr. Ron Marsh 2/10/94 Gretchen Doser ARNP Seattle WA 10/30/97 1 A21 A22 That the Nursing Commission render an opinion on the practice of allowing labor patients to self administer doses of epidural solution, because of the position statement issued on 10/8/2000 re: “Nurses Managing Patients Receiving Epidural Analgesia”. Specifically the : Exception: Monitoring OB Labor and Delivery Patients Receiving Epidural Analgesia”. A formal written view from the Nursing Care Quality Assurance Commission, regarding the administration of Propofol in children in the PICU setting and during pediatric sedation procedures when the physician responsible for ordering the drug is present in the unit, or at the bedside. B ADVANCED PRACTICE B1 B2 B3 Archived 9/8/00 Archived 9/8/00 Request for a review of the proposed change in role and responsibility of (the Dept. of Veterans Affairs Functional Statement for Cath Lab Nurse Coordinator-Senior Grade) ARNP’s Certified Women’s Health Care Practitioners doing well child examinations B4 B6 Is medical acupuncture within scope of an ARNP B-7 May a registered nurse with a Master’s Degree in Nursing, “Perform cardiac catheterization”, function as a “pseudo” Cardiology Fellow, perform cardiac interventional; procedures, (PTCA, Pericardiocentesis, and pacemaker implants), perform physical examinations, (Medical), order laboratory tests, write prescriptions for cardiac medications, develop medical plans of care. The RN is licensed as an RN in the State of Washington. No formal training beyond the Master’s Degree.” Is it within the scope of practice for ARNP’s to evaluate and treat work-related injuries in adults? B-8 C Requester Facility Response Date Cross References Cherelyn Childers, RNC St Joseph’s Hospital Bellingham 3/26/2002 Policy Statement on Epidural Analgesia 10/8/2000 Garry S Park, MD Jerry Zimmerman, MD, PhD, Daniel Brutacao, MD Kenneth Dietrich, MD, MBA Northwest Pediatric Critical Care Colloquium (NPCCC) 3/26/2002 Policy Statement RN’s performing Procedural Sedation an Analgesia Adopted 1/200 See L-2, L-6, H-10 Frankie T. Manning, RN VA Medical Center, Seattle 3/15/93 Frances J. Storlie, ARNP, Ph.D. Patricia De Smet Southwest WA Health District 6/8/88 Group Health NW 4/17/96 Frankie Manning, RN Chief, Nursing Services VA Puget Sound Health Care System Seattle, WA 4/10/98 Nick Mason, ARNP Leavenworth WA 12/12/01 T-1 See E-2 AMNIOTOMIES & CERVIX RIPENING 2 C1 RN’s performing amniotomies on obstetric patients C2 Amniotomies in the obstetrical unit also, separate letter re: ultrasounds date 6/24/92 C3 RN’s (1) inserting intrauterine pressure device, (2) artificial rupturing of membranes, (3) placing fetal scalp electrodes Archived 4/10/98 Archived 4/10/98 Archived 4/10/98 Archived 4/10/98 Archived 4/10/98 C4 C5 C-5a C6 C8 C-8a C10 C12 Facility Response Date Elizabeth Keesecker, Director Robin Peterson, Director OB Services Diane G. Marler, RNC Maternal-Child Health 4/28/93 Good Samaritan Hospital 12/4/92 Naval Hospital, Bremerton 10/1/86 Good Samaritan Hospital WSNA 2/27/95 Archived 4/10/98 Artificial rupture of membranes by RN C-12a Clarification regarding the artificial rupture of membranes and the differing scopes of practice of the RN and ARNP C13 Archived 4/10/98 C14 Is it within the scope of RN practice to use Ultrasound to assess fetal position in laboring patients with unknown fetal lie within the scope of practice of registered nursing May a registered nurse administer Cytotec (misoprostol) for cervical ripening? C15 Requester C16 “Is it within the scope of practice for a registered nurse to place a fetal oximeter in the labor and delivery environment?” D BOWEL CARE D2 D3 D4 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Karen Baker Linda Chagnon, RNC,MBAHCA Ulrike Lucas Naval Hospital Oak Harbor Deborah Swennes, RNC, Director, Maternal Child Health Martina Letco Porter, RNC, MS, MBA St. John Medical Center Longview, WA 3 Fernandina Beach FL 6/6/95 3/21/97 2/12/98 12/20/99 Cross References C1-3,7 D5 Training gastroenterology nurse to perform flexible sigmoidoscopies with careful supervision Role of LPN performing flexible sigmoidoscopies,can they do independent assessment of initial history, screening & classification of patient. E CATHETERIZATION E1 E2 Archived 9/8/00 Insertion of intrauterine pressure catheters by labor/delivery nurses E3 E4 Archived 9/8/00 Archived 9/8/00 F COUNSELING F1 F3 F4 (1) Do nurses under Chapter 18.88, have the right and obligation to interview, treat, assess and counsel CD patients within their scope of practice (2) Can nurses and nursing practice be directed and supervised by unlicensed individuals...such as orders for nursing and medical care not referring to indirect communication of physicians orders, but the direct planning, management, and evaluation of the medical and nursing care being delivered in a clinical setting Do nurses in a chemical dependency treatment facility need to be licensed separately as counselors for 1:1 or group counseling Archived 9/8/00 Archived 9/8/00 G DELEGATION G1 G-2 G3 G6 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Unlicensed personnel performing health assessments of prospective blood donors and exercising nursing judgment in accepting or deferring donors Archived 9/8/00 Does it require a RN or LPN to give tube-feedings and meds. F2 G9 G10 G11 Are personnel in hospital psychiatric care who are not otherwise licensed, but providing care under a nurse, be reg. or certified? Requester Facility Response Date Marshall E. McCabe III, MD Olympia Multispecialty Clinic 5/19/95 Cross References See B-3 Elizabeth Berkey, and Rosa Johnson Northwest Hospital 6/12/89 C-3 Michael Rice, Ph.D., RN Intercollegiate Center for Nursing Education 9/26/94 F-3 P-15 Barbara Proffitt Mountainview Hospital 11/21/88 F-1 See D-(1-4), E-3, H-(11, 1 K(1-4, 6), and L-2 Emma Jo Goodman American Red Cross 8/7/91 Sharon Emerson Island Home Nursing Fac & Svs. Lic 8/24/95 Fern Betteridge 4 2/14/95 K-6 G12 G13 G14 Can non-nurse school personnel provide tube feedings to students? Can non-nurse school personnel clean students excretory functions? May the RN delegate, to an unlicensed person, the procedure of reinserting a tracheotomy tube? Should feeding of nursing facility residents be done by only certified nursing assistant? Requester Facility Response Date Cross References Eric T. Nordolf Public Schools 2/14/95 S-1 Audrie Shagren Supervisor of Hlth Srvs. WA Health Care Association 3/4/96 Deborah Murphy 9/24/96 G15 Delegating Injection of glucagon to unregulated person or persons. Mary Ann Carr Eatonville School 11/1/96 G16 May a Nursing Assistant-Certified, turn on/off O2 concentrator and turn off small portable O2 tanks? (Not to include setting liter flow). Ginger Isenhour, RN 4/15/97 G17 Can Emergency Department Registered Nurses delegate tasks such as vital signs, starting an IV, or venipuncture for blood sampling, and the cleaning of minor wounds for suturing by the Emergency Department physician, to EMT/IV technician’s and or Paramedics who are not employed in the Department? May the prehospital personnel document on our Emergency Department flow sheet the delegated tasks they do? May a specially trained (didactic and clinical) nursing assistant certified, hand physicians instruments during a C/section or tubal? District Staff Development & Infect. Control Samaritan Hospital Moses Lake Southwest WA. Medical Center Vancouver, WA 2/12/98 G18 H DISPENSING AND ADMINISTERING MEDICATIONS H1 H2 Archived 9/8/00 Can non-licensed persons ‘pierce the skin’ to give emergency medication such as epinephrine, in the event of any anaphylactic reaction Delegation in a school setting. Administration of an experimental, unlabeled medication at school H3 H4 H6 H8 Archived 9/8/00 The assignment of RN’s to triage and dispense over the counter medications to inmates RN’s advising patients/parents of over-the-counter preparations and devices which may be employed for different complaints, usually, minor pain constipation, or diarrhea Kathleen Watkins, RN, Assistant Administrator Patient Care Serv Marcia Tolmasoff, RNC, Manager, Family Birth Cen. S-2 2/12/98 L Needs to be rescinded See G-(1-2, and 10) L-2, L-7 Debbie Kawakami, RN Sunnyside School District 9/16/91 S-3 Cathryn Eve Crowley Barker Auburn School District #408 8/7/91 S-4 H-18 (1) Dr. Dale Fetroe Department of Corrections Shriners Hospital for Crippled Children 12/29/89 Rae Swainson, RN 5 4/23/90 H10 H11 H12 H13 H14 H14a H17 H18 H19 H20 H21 H22 H23 H24 H25 H 26 “in the event that I am the provider “on call” for local county jail, may I authorize the administration of tranxene to inmates “per protocol” for alcohol withdrawal symptoms” Nursing technicians hanging plain I.V. bags Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 May a RN or LPN use a 14 or 16 gauge needle to subcutaneously implant a medication Compounding allergy extracts, inject, then transfer on to another physician for next injection? May a RN or ARNP administer controlled substances under protocols? RN,s to see inmates in a triage process that will control access to over-the-counter supplies. May nurses paint fluoride varnish on the teeth of infants and toddlers? May a Licensed / Registered nurse chart routine medications using one signature to indicate all routine medications were given at one time (modified charting by exception for routine medications) Is it within the practice of nursing to pre-fill insulin syringes for self-administration by an individual at a later date? H 27 May Licensed Practical Nurses or Registered Nurses close lacerations by applying Dermabond? May registered nurses in a community based maternity support services program dispense emergency contraceptive medications under standing order from a certified nurse midwife? I FOOTCARE I-4 Routine Footcare (defined as trimming toe-nails and removing corns and calluses), is this within the RN scope of practice Can the duties of foot care tech be delegated to a certified nursing assistant. I-5 Requester Facility Response Date Lori Roehl, ARNP Yakima Valley Farmworkers Clinic Virginia Mason Hospital 11/21/88 TAP Pharmaceutical Group Health Northwest Crisis Triage Center WA State Penitentiary DSHS, Medical Assistance Admin. ERA Care Inc and Ida Culver House DSHS Aging & Adult Serv. 1/22/96 DSHS/DDD 4/1/2002 First Steps/WIC Program Supervisor Wenatchee WA 9/6/2002 Bonnie Reid, Debra Schade Kim Orchard Chris Larson Dale T. Fetroe, MD Carree Moore Heather Young and Bonnie Blachly Pat Bossert, RN & Kathy Woods, RN Karen Maher Carol Diede, RD CD Robert Kaplan Maureen Flak 6 Cross References 12/2/91 3/6/96 9/19/97 2/11/00 6/16/88 Soundcare 3/6/95 G-7 Requester MISCELLANEOUS J1 J2 J4 J5 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 May nurses select orders from pre-printed physician orders J6 Is an RN practicing within her scope of practice who is asked to supervise or accept responsibility for a technician who is performing a skill or a functioning in a capacity that the RN is not competent to perform or function Archived 9/8/00 Archived 9/8/00 Advice of use of specific Homeopathic remedies Acupuncture and Auriculotherapy Archived 9/8/00 Training of RN’s for average risk colon cancer screening flexible sigmoidoscopies under supervision of a Gastroenterologists Virginia Wegenast, OB/OR Specialist J13 J15 Can a RN perform circumcision in the newborn period Documenting the physician history/physical and discharge summary Linda S. Johnson Jim Strain J16 RN’s performing ET Incubations on ambulances without direct physician’s orders for particular patients RN’s performing tracheotomy in an emergency situation for purposes of opening the airway RN’s discontinuing chest tubes (mediastinal post open heart surgery and/or pleural) Is the administration of X-rays within the scope of RN practice J11 J12 J17 J18 J19 J20 J21 J22 J22a J24 J25 Archived 9/8/00 Archived 9/8/00 Can an LPN do complex initial assessments without any additional medical personnel on premises Can an LPN do complex initial assessments without any additional medical personnel on premises Response Date Cross References See F-4, G-3, H-18 J J7 J8 J10 Facility Pam Conrath, RN Central Washington Hospital General Hospital Medical Center 7/2/92 11/6/92 Andy Taylor NA 12/1/94 Tamara Smith, RN Tri-State Memorial Hospital NA Sacred Heart Medical Center NA 2/10/94 11/4/92 Nancy Nowak Moss Oesting and Associates St. Peter Hospital Dianne Reynolds, RT Breast Diagnostic Centers 1/3/92 Margie Triplett Spokane County Jail Spokane County Jail 2/20/95 Harborview Medical Center 9/25/95 Perry Lamb Heather Oesting James J. Hill Steven Haskell attorney Archived 9/8/00 How much can a licensed volunteer RN perform Cindy Forney 7 T-3 8/7/91 11/4/92 12/1/92 9/16/91 P-8 4/18/95 Requester Facility Response Date Sandra Moody St. Peters Hospital WSNA 9/25/95 Controlled Care 2/14/95 J26 Can a LPN practice private massage therapy under a LPN license J28 Can LPN’s supervise RN’s and can the LPN write evaluations of RN’s Do nurse’s performing workman’s comp. reviews on phone in WA, required to have a current WA RN license? Joan Garner, MN, RN Gene Moyer Intubation of Neonates for resuscitative purposes? Is an RN allowed to sign an LPN evaluation written for another LPN without any Input? Is a nurse required by law to sign documentation on essential client records? Lynn Gallagher Robert Geiger, RN Barbara J. Deymonaz, RN J29 J30 J31 J32 J33 J34 J35 2.) Is it ever acceptable practice for a nurse to sign another nurse’s name including the RN title and to initial that signature on essential client records? What are the requirements for a medical person at camps? (4-H, church, etc.) If it is a nurse how is her/his license affected? “Is it within the scope of practice of a registered nurse in the State of Washington to transfer a patient from an Intensive Care Unit to a Step Down unit without notification of the physician or written orders from a physician?” “May a registered nurse remove chest tubes after cardiac surgery?” Donna Utter 1/22/96 Rainier School 4/17/96 3/21/97 Port Orchard WA 5/29/98 Bonnerserry, ID 4/9/99 Georgia Spalding, RN Seattle, WA 6/23/99 Barbara Godfrey, RN, MSN Providence St. Peter Hospital 12/20/99 J36 “ May an RN administer and review “medical evaluations” used to determine an employee’s ability to wear respiratory protection?” Michelle Kom Gochnour,RN,MN ,COHN-S Governmental Affairs Chair Seattle WA J37 Shall specially trained RN’s supervise cardiac stress tests? Judy Mitacek Practice Manager Polyclinic Cardiology Dept. Seattle WA K NA SCOPE OF PRACTICE K1 K3 K4 K8 K9 K10 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Cross References J-28 2/22/00 10/01/00 See D-1,2,4, and G-1,2,6E-3 8 K-11 K-12 May the Nursing Assistant perform the following procedures under the supervision of the Registered Nurse if the Nursing Assistant has received training in the procedure and competency has been verified?” 1 through 10 L NURSING PROTOCOLS L1 L2 L3 L4 L5 L9 L10 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Can RN’s suture in PICC lines after placement, can they replace sutures of CVC’s if they come out ( only for this facility ) Are the types of nursing orders in the attached procedure within the scope of practice of a RN Can a RN working under protocol in a STD clinic initially assess and treat external genital warts May a LPN perform women’s health examination using the proposed protocol? L12 L14 L15 IV nurse consultant to teach suturing PICC or Midline catheters L-16 Is it in violation of the Nurse Practice Act for RN’s to accompany patients on ambulance transfers to other hospitals; when the ambulance service is owned/operated by the facility and when it is operated independent of the transferring facility? Is there anything in the Nurse Practice Acts for either LPN’s and RN’s that would prohibit nurses from providing respiratory therapy? May a registered nurse employed by an individual surgeon, following specific instruction and precepting, discontinue epicardial pacing wires from patients in order to facilitate their progression through the post-operative course? Is oral feeding via syringe an acceptable practice to use with chronically ill, demented, developmentally disabled, elderly or other persons whose ability to eat adequately by spoon or other usual utensil is compromised? L-17 L-18 L-19 Facility Response Date Sandy Pendland, RN,MED Providence St Peters Hospital Olympia WA 2/4/00 Cross References Archived 9/8/00 Archived 9/8/00 K-13 L11 Requester See A-11, B-2, E-1, H-10 Diane Stobler Caremark, Inc. 3/13/92 Gail Lasci Eastern State Hospital SW WA Health District 9/25/95 Sharon Beckett Tina Vuong 12/20/95 7/26/96 Harriet Walker,RN Bruce Kirkland Allen Moore Hospital Risk Management Rep WA Casualty Co 10/30/97 Ellen Gerson RN M.ED Pamela Charboneau, RN, CCRN DSHS 10/30/97 Cardiopulmanary Surgery Group Tac WA 4/10/98 DSHS, Aging and Adult Serv Residential Care Serv. Division 4/10/98 Fay Helmon, RN, MSN DSHS 9 4/6/97 L-10 Requester L 20 Archived 9/8/00 L 21 May an LPN implement a written protocol for Preventative T. B. Therapy without the review and approval of an RN? M RECEIVING ORDERS M1 M2 Archived 9/8/00 Can RN’s in WA accept orders from physicians licensed in Idaho for care directed for patients residing in WA, can RN’s licensed in Idaho and WA accept orders from physicians licensed in Idaho for care directed for patients residing in WA 1. Can a nurse accept a faxed order that is not signed; can they accept an order signed in the physicians office, but not in the facility? 2. Is a physician order required when a resident specifies a DNR advanced directive? M3 N RN’S AS SURGERY FIRST ASSISTANTS N3 N4 N5 N6 N7 N11 N12 N15 N17 Refer to RNFA position statement adopted March 9, 2001 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 O TRANSMITTED ORDERS O1 RN’s accepting orders from a physicians office O2 A licensed nurse taking a telephone order from a physician via a nonlicensed physician employee ( i.e. non-licensed office nurse or technician) When requesting and order from a physician’s office, can one RN receive a verbal order from another RN for the doctor Can LPN receive verbal / telephone orders from physicians in an acute care facility? O3 O5 Terry Jones Facility Yakima Health District Response Date 5/21/99 Cross References L-2 See F-1, H-18 Sandra Kramer, RN Deaconess Medical Center Jane Burster Medical Record Consultant 12/20/93 12/22/97 See J-5, G-1, L-11 Connie DePond Pam Conrath, RN, MN Lela Vesa, RN Kathleen Watkins Martha Wong 10 Frank Toby Jones Retirement Estates Central Washington Hospital Northshore Manor Samaritan Hospital 3/14/94 9/29/92 4/26/88 9/24/96 H-18 (2) Requester O6 Can a pharmacist take nursing orders from a physician and relay those orders to the RN? P PREVIOUS LPN OPINIONS P1 P2 P4 P6 P7 P8 P9 P10 P13 P14 P15 P16 P17 P18 P19 P20 P21 P22 P23 P24 Refer to LPN and IV therapy position statement adopted September 2000 Archived 9/8/00 Archived 9/8/00 Is it appropriate in the scope of practice for LPN’s to act as nurse consultants in child care for infant care issues LPN delegated tasks pertaining to the management of intravenous therapy Archived 9/8/00 Archived 9/8/00 Is it within the scope of practice for LPN’s to do independent telephone advice and triage Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Is counseling within the LPN scope of practice Would a RN or physician be required on the premises to direct and supervise her LPN Archived 9/8/00 Can LPN’s do simple nail care on retirement home residents without a RN present The term “staff nurse” is not defined by statute in WA state by either the RN or LPN boards Podiatric services and treatments that an LPN may or may not do under the indirect supervision of a RN or under the prescribed treatment plan of a physician or consulting podiatrist Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Labor & Delivery Facility Patty Igarashi Branch Manager Coram Alt. Site Serv. Inc. Tish Culp Val Mukai Scott Neilson Cathy Johnson, LPN JL Domning Evelyn Blanchard, DNS Vernita Dinjian 11 Cross References 3/12/98 DOH Gloria McCarthy Diane Long, RN Response Date 4/24/92 12/7/92 Kaiser Permanente Vancouver Clinic Attorney 10/9/91 5/8/90 2/12/90 F-1 5/15/89 Cross Ref I American Assoc. of LPN’s WA Soldiers Home and Colony 4/22/89 Okg. Doug. Dist Hosp 2/14/95 3/28/88 Cross Ref I P25 Can an LPN pronounce death? Under what circumstance P26 What is the scope of practice for LPN phone assessment of patients with colds to chest pains without the supervision of an RN or MD? “Can a Licensed Practical Nurse perform the following duties?” 1 through 14 P27 Q Q1 Q2 Q3 Q4 Q4a Q5 Requester Facility Response Date Cross References Virginia Hilton Tacoma Lutheran Home &Ret Community Silverdale Group Health VA Puget Sound Health Care System Seattle, Wa 1/31/97 P-11 7/18/97 L Frank Baron, MD Minor and James Medical Clinic 1/22/96 Ginger Salvadalena, RN, Northwest Hospital 1/22/96 Shelley Klinger, RN Frankie T. Manning MINOR SURGERY Refer to Laser procedure position statement adopted September 2000 Can a RN perform a shave or punch biopsy in an area designated by the supervising physician, and may a RN close (suture) simple excisions and biopsy sites if supervised by a physician May a certified Enterostomal Therapy Nurse perform conservative sharp wound debridement in this state Archived 9/8/00 Archived 9/8/00 Archived 9/8/00 Can RN’s under the direction of the attending surgeon, suture simple lacerations? Lori Taylor, RN Manager Sacred Heart Medical Center Spokane WA 8/23/98 Mark Solleck, MD Regence BlueShield Credentialing Committee Seattle WA 9/23/99 Public Schools Eatonville School District Sunnyside School District Auburn School District #408 2/14/95 11/1/96 G-12 is now S-1 G-15 is now S-2 9/16/91 H-2 is now S-3 8/7/91 H-3 is now S-4 H-18(1) Q6 Q7 Archived 9/8/00 “Does it fall within the scope of practice for a licensed practical nurse practicing in the State of Washington to perform an excisional skin biopsy under the direction of a physician licensed in the State of Washington?” S SCHOOL SETTINGS S-1 S-2 Can non-nurse school personnel provide tube feedings to students Delegating Injection of glucagon to unregulated person or persons Eric T Nordolf Mary Ann Carr S-3 Can non-licensed persons “pierce the skin” to give emergency medication epinepherine, in the event of any anaphalactic reaction Administration of an experimental, unlabeled medication at school Debbie Kawakami, RN Cathryn Eve Crowley Barker S-4 7/13/99 12 S-5 S-6 S-7 S-8 S9 S-10 S-11 S-12 S-13 Request for a copy of regulations concerning the safe storage of medicines in the public school setting for schedule II stimulant drugs (Ritalin) Can LPN’s perform health assessments on migrant preschool children in consultation with a pediatric nurse practitioner May an RN delegate the health task of double-checking the dose of a self-drawn (syringe) of insulin by a student to unlicensed school staff? 1. May RN’s and LPN’s under the supervision of registered nurses, use a physician-ordered sliding dosage scale of insulin injections, which may, also at the direction of the physician, require the input of parents for dosage adjustment throughout a given school day? 2. What type of parameters should be included when nursing practice guidelines and protocols for care are developed? May an RN delegate to an unlicensed person in a school setting the task of double checking a dose of insulin for a student ordered by a physician, which is contained in a dial-a-dose pen injector system? In such a situation the student self-injects the insulin and the unlicensed person’s sole function is to verify the number reading on the pen injector system which does not involve handling the actual syringe. There were several questions related to nursing services in schools, supervision requirements for LPN’s and questions related to liability for services rendered. The questions were 1. How is indirect supervision defined? 2. What are the supervision requirements for LPN’s? 3. What should a certificated school nurse consider in terms of supervision and liability when a non-certificated school nurse is employed in the district? May a Registered nurse delegate the use of the vagal nerve stimulator magnet to an individual? May an RN delegate the task of deep tracheal suctioning and replacement of a tracheotomy tube to an LPN in the school setting, where the RN is not present at the school at all times? “Request to give the Bellevue School District the authority to train non-licensed personnel to administer non-oral emergency medicine to stop prolonged and cluster seizures.” Requester Facility Response Date Cross References Mary Hovander, RN Mukilteo School District 10/1/93 H-4 is now S-5 Barbara Schneider, ARNP, Becky Deeter, RN,MN Self-Employed 1/24/91 P-12 is now S-6 School Nurse 5/25/97 Amy Denver,RN School Nurse Renae Harris Instructional Support Administrator Jeff and Kristen Kuhns Heidi Higgins, Regional Program Director American Diabetes Assoc Mercer Island School District 9/19/97 Seattle WA 5/29/98 Marybelle Calhoun, RN, MSN Bremerton School District 11/13/98 Karen Heiberg, RN Sheri Siedentopf RN Riverview School District Kent School District 12/3/98 Ann Marie Thompson Bellevue WA 13 5/13/99 10/7/1999 S-14 May an RN in a school setting delegate to an unlicensed school employee, the following tasks related to the care of children with asthma? S-15 May a registered nurse, working in a school setting, delegate the task of injection of glucagons to a student in the event of severe hypoglycemia? May the school nurse transfer weekly student medications into a compartment with containers or into separate envelopes for each day of the week for later administration by non-licensed personnel or other licensed personnel? The school nurse would label the container with the medication name and strength at the time of repackaging it from the original pharmacy-labeled container. s-16 T Non – Traditional Practice T-1 T-2 Is medical acupuncture within scope of an ARNP Can an RN of Psychotherapy or mental health counseling-to diagnose and treat mental disorders and can they direct naturopathic treatment massage and midwifery Advise of use of specific Homeopathic remedies ( Acupuncture or Auriculotherapy ) T-3 T-4 Can an LPN practice private massage therapy under a LPN license T-5 May an RN independently perform massage therapy for pay without additional licensure? Can an RN perform acupuncture without a physician order, provided they have sufficient education and training? If not, is the attached sample prescription constitute a valid order? May an RN with adequate training, utilize a device which forms needle-like openings in the scalp and inserts hair?” T-6 T-7 Requester Facility Response Date American Lung Association Asthma Management Gary Olson Evergreen School District Barbara Cheney RN MS Health Services Facilitator Seattle Headquarters 9/8/2000 Vancouver WA 12/12/00 Burien WA 4/3/01 Patricia De Smet Group Health NW 4/28/93 B-6 Janice Stern, RN Blue Cross of WA and AK 10/30/94 F-4 Andy Taylor NA 12/1/94 J-10 Sandra Moody St. Peters Hospital Valley Hospital & Med Cen 9/25/95 Barbara Davisson RN Gloria Green RN Melvin A. Shiffman, MD INDEX UPDATED 7/2003 14 10/30/97 10/30/97 Tustin CA 10/8/99 Cross References J-26 15
