FAQs

General Scope of Practice Questions

  1. Is it within the Scope of Practice for the licensed practical nurse to change supra pubic catheters?

  2. Can an LPN perform peritoneal dialysis (PD)? Can an LPN mix medication in the PD bag?

  3. If the health care provider gives an order for a range dose, such as “morphine 4-8 mg IV every 4 hours PRN, is it within the nurses scope of practice to administer an initial dose, i.e. 4 mg and then give an additional 4 mg if the patient’s pain persists, as long as the maximum range (8 mg) is not exceeded within any 4-hour time frame?


Pain Management Questions

  1. Is it within the scope of practice for the RN/LPN to accept pain management orders written by health care providers such as Nurse Practitioners, Certified Nurse Anesthetists, and Physician Assistants?


Advisory Opinions

  1. Is it within the Scope of Practice for the Registered Nurse (RN) and/or Licensed Practical Nurse (LPN) to apply fluoride varnish in the course of an oral health screening?

  2. Is it within the Scope of Practice for the Licensed Practical Nurse (LPN) to change a low profile gastrostomy tube or other type of gastrostomy feeding tube?

  3. Is it within the Scope of Practice for the Registered Nurse (RN) and/or Licensed Practical Nurse (LPN) to prepare a medication device (e.g. Mediset, pillbox) for the purpose of facilitating the ultimate user’s self-administration or subsequent taking of the medication?

  4. Is it within the Scope of Practice for the RN and/or LPN to teach an individual how to prepare his/her own medication device (e.g. Mediset/pillbox)?

  5. Is it within the Scope of Practice for the licensed practical nurse (LPN) to remove sutures or staples?


  1. Is it within the Scope of Practice for the licensed practical nurse to change supra pubic catheters?

    It is within the Scope of Practice for the licensed practical nurse to change supra pubic catheters.

    Rationale:

    Practical nursing includes performing additional acts that require education and training as prescribed by the Board and that are recognized by the nursing profession as proper to be performed by the practical nurse, under the supervision of the physician or registered nurse.

    Licensed practical nurses must adhere to their facility’s policy.

    Reference:

    Article 1. Board of Nursing; 32-1601. Definitions #12(g)

  2. Can an LPN perform peritoneal dialysis (PD)? Can an LPN mix medication in the PD bag?

    It is within the scope of practice for an LPN with additional training and competency validation to perform chronic ambulatory peritoneal dialysis. This includes: initiating or discontinuing therapy using pre-mixed medicated peritoneal dialysis bags, collecting specimens, and performing tubing or adaptor changes. The patient must be in a stable condition and the LPN must be under the supervision of an RN or Licensed Independent Practitioner (LIP) who is responsible for periodic patient assessment.

    It is not within the scope of practice for an LPN to mix any medication(s) and/or add any medication(s) to the bag (i.e. antibiotics or electrolyte solutions). Nor is it within the scope of practice for an LPN to remove a peritoneal dialysis (PD) catheter.

    Rationale:

    The principle of sterile and aseptic technique, gravity drainage, osmotic fluid and electrolyte balances are within the scope and education of a practical nurse. The LPN who has received additional education including supervised clinical practice which is specific to the equipment being used may perform chronic ambulatory peritoneal dialysis.

    While an LPN can safely perform continuous ambulatory peritoneal dialysis, it is not within their scope or training to mix medications. The complexities of reconstitution related to the drugs and the solutions, drug stability and compatibility, and advanced infection prevention, are outside of the usual and standard education for an LPN.

    Complications can arise during the removal of a PD catheter, that may require a surgical repair or removal of the remainder of the catheter. Therefore, only an LIP can remove PD catheters.

    References:

    Iowa State Board of Nursing. (2014, November). Nursing practice: LPN functions. Retrieved from https://nursing.iowa.gov/practice/licensed-practical-nurse-information/…

    Maine State Board of Nursing. (1989). Questions related to Licensed Practical Nurses (LPN). Retrieved from http://www.maine.gov/boardofnursing/questions/questions_lpn.htm#periton…

    Mississippi Board of Nursing. (2000, April). Position statement: Role of the Licensed Practical Nurse in peritoneal dialysis. Retrieved from http://www.msbn.ms.gov/Documents/LPNPeriDialysis_2000.pdf

    Nebraska Board of Nursing . (2000, May). Advisory Opinion: Chronic Ambulatory Peritoneal Dialysis (CAPD). Retrieved from http://dhhs.ne.gov/publichealth/Licensure/Documents/CAPD.pdf

     

  3. If the health care provider gives an order for a range dose, such as “morphine 4-8 mg IV every 4 hours PRN, is it within the nurses scope of practice to administer an initial dose, i.e. 4 mg and then give an additional 4 mg if the patient’s pain persists, as long as the maximum range (8 mg) is not exceeded within any 4-hour time frame?

    The patient will be assessed by the nurse to determine their level of pain. After giving the "initially selected dose," the patient is reassessed to determine if additional medication is needed. If the patient’s pain is not controlled, and the maximum dose was not initially selected and given, additional medication may be given (within time frame stated in the order) until the maximum amount ordered by the health care provider is administered.

    If the health care provider writes an incomplete order for PRN pain medication, i.e., route of administration is not included, or frequency of administration is not indicated, it is not permissible to administer the medication orally or according to the “usual” frequency of the drug that is ordered.

    It is essential for health care providers to write clearly stated range orders. Range orders should ideally consist of:

    • The full name of the medication being ordered
    • The total amount of medication to be given in a specified time period
    • The order should state if the dose can be given in divided doses
    • The order should state if the dose can be repeated
    • If repeated, the order should indicate how frequently, and in what time frame
    • The order should include what action should be taken if pain is unrelieved

    Examples:

    Morphine Sulfate 2 mg to 8 mg may be given IV in divided doses up to a maximum of 8 mg in a 2-hour period. Call the provider if the pain is not controlled with this dosing schedule.

    OR

    Morphine Sulfate 2 mg to 4 mg IV, every hour not to exceed a total of 10 mg in 3 hours. If this does not relieve pain, please notify provider for change in order, along with current vital signs.

    Reference:

    American Society of Pain Management Nursing Position Statement


  1. Is it within the scope of practice for the RN/LPN to accept pain management orders written by health care providers such as Nurse Practitioners, Certified Nurse Anesthetists, and Physician Assistants?

    Yes, the RN/LPN may implement pain management orders given by:

    1. A Nurse Practitioner with prescribing and dispensing privileges
    2. A Certified Registered Nurse Anesthetist (CRNA) with prescribing privileges
    3. A Physician’s Assistant

    The RN/LPN may not accept pain management orders given by a Clinical Nurse Specialist. The Nurse Practice Act does not currently allow prescribing and dispensing privileges by a Clinical Nurse Specialist.

References

American Society of PeriAnesthesia Nurses. Position Statement on Pain Management. 11/04, ASPAN Board of Directors, 4/16/99

Living Initiatives for End-of-Life Care. Joint Policy Statement Kansas Board of Healing Arts, Board of Nursing and Board of Pharmacy. Life Project Foundation, 1901 University, Wichita, KS

Oncology Nursing Society Position on Cancer Pain Management. ONS Board of Directors, approved April 1998/November 2000

California Board of Registered Nurses. Frequently Asked Questions Regarding Pain Management

Policy and Procedure: Pain Management – Initial Interpretation of Range Orders: Adults. Banner Thunderbird Medical Center, March 25, 2003

Pasero,C. (1999). Self-Directed Learning Program: Epidural Analgesia for Acute Pain Management. Pensacola, FL. ASPMN


  1. Is it within the Scope of Practice for the Registered Nurse (RN) and/or Licensed Practical Nurse (LPN) to apply fluoride varnish in the course of an oral health screening?

    It is within the Scope of Practice for an RN and/or LPN to safely perform oral health screening and application of fluoride varnish procedures under the supervision of a licensed care provider who possesses specific knowledge, skills, and abilities in oral health screening and fluoride varnish application procedures within the appropriate client population.

    Rationale:

    The guiding principle is that it is recognized by evidence-based practice that oral health promotion screening and fluoride varnish application procedures for oral health disease prevention can be safely performed by a RN and/or LPN under the supervision of a trained licensed care provider with specialized training, skills, and knowledge.

    References:

    Arizona State Board of Nursing. Advisory Opinion Fluoride Varnish: Oral Health Screening.

    National Maternal and Child Oral Health Resource Center Georgetown University. (2014). Focus on fluoride varnish. Retrieved February 18, 2014 at http://www.mchoralhealth.org/highlights/flvarnish.html

    North Carolina Department of Health and Human Services. (2014). Oral health. Retrieved January 20, 2014 at http://www.ncdhhs.gov/dph/oralhealth/partners/IMB-toolkit.htm

  2. Is it within the Scope of Practice for the Licensed Practical Nurse (LPN) to change a low profile gastrostomy tube or other type of gastrostomy feeding tube?

    It is within the Scope of Practice for the LPN to replace gastrostomy tubes, under the direction of an RN, if the following parameters are met: The stoma must be completely healed (i.e. complete epithelialization of the stoma has occurred, there are no signs of infection, and the healing ridge is well defined), and a new tube/device must be inserted. (Do not re-use old device). The LPN also has received training specific to the type of device being used.

    If the tube was recently inserted, the stoma has not completely healed and/or there are signs of infection that would require an RN assessment, an LPN may not change the tube.

    Rationale:

    Licensed Practical nursing includes performing additional acts that require education and training as prescribed by the Board and that are recognized by the nursing profession as proper to be performed by the LPN, under the supervision of the physician or Registered Nurse.

    LPN’s must adhere to their employers/agency’s written policy and procedures.

    References:

    Article 1. Board of Nursing; 32-1601. Definition16(g)

    Trexler, R.A., (2011) Assessment of surgical wounds in the Home Health patient: Definitions and accuracy with OASIS-C. Home Health Nurse 29;9. October 2011. 550-559.

  3. Is it within the Scope of Practice for the Registered Nurse (RN) and/or Licensed Practical Nurse (LPN) to prepare a medication device (e.g. Mediset, pillbox) for the purpose of facilitating the ultimate user’s self-administration or subsequent taking of the medication?

    It is within the Scope of Practice for the RN and/or LPN to prepare a medication device such as a Mediset to facilitate the self administration of subsequent medications as long as a physician has prescribed the medication and the medications have been properly compounded, packaged, labeled, and delivered to the ultimate user. The nurse is not considered dispensing when a medication is taken from the ultimate user’s labeled package and placed in a device to facilitate the ultimate user’s self administration.

  4. Is it within the Scope of Practice for the RN and/or LPN to teach an individual how to prepare his/her own medication device (e.g. Mediset/pillbox)?

    It is within the Scope of Practice for the RN and/or LPN to instruct the individual or caregiver, the correct method for preparing a medication device such as a Mediset to facilitate the self-administration of subsequent medications.

    Rationale:

    Assisting the ultimate user’s independence and compliance with prescribed treatment modality is an important nursing function.

    References:

    Lam, A. Y., Anderson, K., Borson, S. & Smith, F. L. (2011). A pilot study to assess cognition and pillbox fill accuracy the community-dwelling older adults. The Consultant Pharmacist, 26(4), 256-263.

    Leendertse, A. J., Egberts, A.C., Stoker, L. J., van den Bemt, P.M., & HARM Study Group. (2008, September). Frequency of and risk factors for preventable medicationrelated hospital admissions in the Netherlands. Archives of Internal Medicine, 168(17), 1890-6. Retrieved from www.ncbi.nlm.nih.gov/pubmed/18809816

  5. Is it within the Scope of Practice for the licensed practical nurse (LPN) to remove sutures or staples?

    It is within the Scope of Practice for the licensed practical nurse to remove sutures or staples if the LPN has demonstrated clinical competency in suture/staple removal and the task is delegated to them by an RN or Licensed Independent Practitioner (LIP) who retains accountability for the delegation.

    Rationale:

    Practical nursing includes performing additional acts that require education and training as prescribed by the Board and that are recognized by the nursing profession as proper to be performed by the practical nurse, under the supervision of the physician or registered nursing.

    Licensed practical nurses must adhere to their employers/agency's written policy and procedures.

    References:

    Article 1. Board of Nursing; 32-1602. Definitions #12(g)

    Alabama State Board of Nursing. n.d. Procedures Beyond Basic Education that have been approved following the requirements of the Standardized Procedure Rule: Sutures and Staples Removal by LPN.

    Colorado Department of Regulatory Agencies, Division of Registrations. Board of Nursing. (2009). Personal Communication of 6/12/09.

    Iowa State Board of Nursing. 2012. LPN Functions.

    Louisiana State Board of Practical Nurse Examiners. (2009) Personal communication 6/15/09.

    South Carolina Board of Nursing. (2001). Advisory Opinion #14.