Scope
of Practice Decision Tree - Guidelines for R.N. and L.P.N. Licensure
Patient
Abandonment
Use
of Intermediaries
Use
of Nurse Technicians
Performance
of IV Therapy by LPNs
Delegation
Telephone
Triage
Q: Will the new Doctorate
of Nursing Practice (DNP) degree be an acceptable alternative to the
master's degree requirement for Advance Practice Nurse Prescribers (APNPs)?
A: Yes. Currently,
the Chapter N8 certification qualifications for Advanced Practice Nurse
Prescribers (APNPs) require “a master's degree in nursing or related
health field” for those applicants who received national certification
as a nurse practitioner, certified nurse-midwife, certified registered
nurse anesthetist or clinical nurse specialist after July 1, 1998. Prior
to this date, the master's degree was not required for APNP certification
in Wisconsin . The master's degree was an additional and higher requirement
added for those certified after July 1, 1998. Most nursing schools now
offer a Bachelor of Science in Nursing (BSN) to a Master's of Science
in Nursing (MSN) program for those seeking to obtain an advance practice
nursing degree.
An emerging alternative for advance
practice qualifying education is the Doctorate of Nursing (DNP), a degree
above the master's level. Some nursing programs have proposed to change
their advanced practice nurse programs from a BSN-to-MSN program to
a BSN-to-DNP without the intermediate master's degree in nursing. Because
the doctorate degree is inherently a higher degree than the master's
degree, it meets and exceeds the standard set by the master's degree
requirement. Accordingly, a nurse who obtains the higher DNP degree
will be deemed to have satisfied the educational requirements for licensure
as an APNP. All other requirements for certification of advance practice
nurse prescribers in Chapter N8 remain the same. This position is consistent
with the Wisconsin Board of Nursing's position in accepting doctoral
level nursing education in lieu of a master's degree in nursing requirement
for nursing faculty as set forth in Chapter N1.06 (4), Wisconsin Administrative
Code. The faculty position requirements can be found in the Wisconsin
Board of Nursing Guidelines for Nursing Program Administrators, May
2008.
Q: Is it permissible
for a registered nurse to directly supervise a licensed esthetician
who is performing a delegated medical act, such as a laser chemical
peel or medical grade microdermabrasion?
A: An RN is not allowed to supervise
a licensed esthetician who is performing a delegated medical act. Although
it is true that an RN may delegate and supervise the performance of
a nursing act to an unlicensed person who has the educational preparation
and ability to perform the act, that does not apply to delegated medical
acts. The physician who delegated the medical act must supervise the
unlicensed person who is performing the medical act.
For further information on the
topic of delegation, please review the position papers of the Board
of Nursing. The paper on delegation can be accessed through the consumer
links on the DRL webpage. Use the "All Boards" link, then
select "Board of Nursing," then click on the title "White
Papers" and click on the paper on “Delegation.”
Q: Is it permissible
for a registered nurse, who is not a nurse anesthetist/CRNA, to administer
Propofol for moderate sedation?
A: The question of who can administer
the drug Propofol has arisen, particularly in free-standing ambulatory
surgery centers and in endoscopic procedure suites. As with any IV medication,
the person who gives the medication should have knowledge of the medication
that is being delivered, should be properly educated in the administration
of the drug, have the appropriate skill level in monitoring the patient
and have appropriate medical personnel available in the event of an
adverse reaction. Every institution that uses Propofol should have a
policy and procedure regarding the administration of the drug.
Q:
Can an LPN act as the charge nurse in a clinic when there are RN's present?
A:
The assumption of charge responsibilities by an LPN is only codified
for nursing homes. The laws are silent relative to any other setting.
In order to determine whether it is appropriate for the LPN to assume
charge responsibilities would depend on the duties connected with the
charge nurse function. For example: an LPN may gather patient data,
but a RN must perform the full patient assessment and formulate a nursing
plan of care. If the charge nurse is responsible for patient assessments,
it cannot be an LPN
Q:
Can an LPN act as a charge nurse in a clinic when the RN is not present,
but available by phone?
A:
If the patient situation meet the definitions of basic patient care,
per Chapter N6.02 and N6.04, general supervision of the LPN by the RN
who is available by telephone is acceptable. However, if the situation
is complex, then the supervisory level is defined as “direct supervision”
and the RN must be present in the facility. If the RN delegates a nursing
act to the LPN, the RN must ensure that the LPN is prepared by education,
training and experience to perform the tasks assigned. The RN is required
to supervise and direct the delegated nursing acts commensurate with
the education, preparation and demonstrated abilities of the person
supervised. Also, a RN is required 1) to direct and assist as well as
2) to observe and monitor the activities of those supervised and 3)
to evaluate the effectiveness of the acts performed under supervision.
Finally, the LPN must be willing to accept the delegated tasks. The
delegated acts performed by the LPN are considered to be the actions
of both the RN and the LPN, and they together will be held responsible
for the safety of the patient.
