​​Frequently Asked Questions (FAQs)

 

Click on the department link below to view FAQs by department or proceed to topic index to view FAQ's by topic:

Practice & Licensing

Recovery Nurse Program​

Advance Practice Registered Nurse (FAQs coming soon)


Practice & Licensing​

 

Since nursing practice is reflective of ​the dynamic changes occurring in healthcare and society, it is impossible for the Mississippi Nursing Practice Law and the Mississippi Board of Nursing Administrative Code to provide a comprehensive listing of the duties that licensed nurses are permitted to perform. The licensed nurse is charged with providing nursing care in circumstances which are consistent with the nurse’s education.

Frequently asked question​s regarding practice and licensure for the registered nurse (RN) and licensed practical nurse (LPN) are provided below. For responses indicating that a function or a procedure is within the scope of practice of an appropriately prepared licensed nurse provided the following basic requirements are met, unless otherwise specified by additional or specifically stated requirements:

  1. The licensed nurse is educa​ted and competent in the procedure. This education and competency must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The licensed nurse practices according to generally accepted standards of practice;
  4. All necessary resources are available; and
  5. The facility has policies and procedures in place addressing all aspects of the issue.
 

BASIC INFORMATION
For fundamental information about the practice of nursing and functions of the licensed nurse please view the links provided below:

INDEX
A
Active License Definition
After Hours Access to Pharmacy
Ambulance
Anodyne Therapy
Approval of Nursing School Programs
Arterial Sheath Removal
Assessment

B

Bladder Instillation of Chemotherapy

C
Capsule Endoscopy
Cerebrospinal Fluid (CSF) Collection
Cardiac Stress Testing
Chemical Peels
Chemotherapy Certification
Chest Tube
Compact (Multi-State) License/Privilege
Compression Bandages/Dressings
Compression Drains
Conservative Sharp Wound Debridement
Continuing Education Units (CEUs)
Coumadin

D
Declotting Central Lines
Delegation
Discharge Summary & Dictation
Disciplinary Action
Documentation
Drug Samples

E
Emergency and Disaster Management
Emergency Shelters
Ear Stapling
Endoscope Manipulation
Endorsement
Ephedrine IV Push
Epicardial Pacing Wires
External Cerebral Ventricular Catheter
External Jugular Line Insertion

F
Femoral Nerve Block Catheter Removal
Fentanyl IV Push
Foot Care
Function of the LPN
Function of the RN

G
Gastrostomy/Peg Tube
Graduate Nurses

H
Heparin
Hemovac
Hyperbaric Oxygen Therapy

I
Immunizations
Inactive License
Induction of Labor
Intraosseous Cannulation and Infusion
Intravenous Contrast
IV Care by the LPN in the Long Term Care Facility

J
Jackson-Pratt

K

L
Lapsed License Definition
Laser Treatment
Late Entries
Licensure
LPN Expanded Role
LPN Expanded Role Renewal
LPN Practice of Nursing Definition

M
Maximum Hours Allowed to Work
Medical Orders
Medicated Ointments and Lotions
Medication Administration
Microdermabrasion
Moderate Sedation

N
Nasogastric Tube Insertion
Nurse/Patient Ratio
NCLEX

O
Obstetrics and Gynecology

P
Patient Abandonment
Patient Teaching
PCA Pump
Peripheral Artery Line Insertion
Peripherally Inserted Central Catheter (PICC)
Postmortem Care
Prescriptions
Primary State of Residence Definition
Pronounce Death

Q

R
Range Orders
Recovery Nurse Program
Registered Nurse First Assistant
Reinstatement Without Practice in Last 5 Years
Removal of Vaginal Packs
Renewal of License
Respiratory Nebulizers and Aerosol
Restraint/Seclusion Evaluation
Restricted License Definition
RN Practice of Nursing Definition

S
Safety to Practice
School Nurses
Suctioning
Supervision of Expanded Role LPN IV Therapy
Suprapubic Catheter
Surgical Site Marking
Suture

T
TB Skin Testing
Telenursing
Thrombolytics via Chest Cavity
Tracheostomy

U

V
Vasopressors
Venipuncture/Phlebotomy

W
Wound Debridement
Working at a Lower Level than Licensed

X

Y

Z


Nursing Schools and New Graduates

 

1. Does the Board regulate and approve nursing programs?

The Mississippi Board of Nursing does not regulate or approve nursing programs. The Board of Nursing is a consumer protection agency with the authority to regulate the practice of nursing through licensure as provided for the by the Mississippi Nursing Practice Law. Registered nurse programs are accredited and regulated by the Institutions of Higher Learning (www.ihl.state.ms.us). Licensed practical nurse programs are accredited and regulated by the Mississippi State Board for Community and Junior Colleges (www.sbcjc.cc.ms.us). These agencies should be contacted for information about various nursing programs, statistics and degrees.

 

2. Are temporary permits issued for new graduates before a license has been issued?

The Mississippi Board of Nursing does not issue temporary permits for new graduates prior to licensure.

 

3. What content should and should not be included during orientation for new graduates?

The Mississippi Board of Nursing does not mandate the content/curriculum for graduate student orientation.

 

4. Is a graduate nurse allowed to identify themselves as a licensed nurse (RN or LPN)?

According to the Mississippi Nursing Practice Law, it is unlawful for any person not licensed or holding the privilege to practice or offer to practice as a registered nurse or licensed practical nurse, and/or to use a sign, card or device to indicate that such person is a registered nurse or licensed practical nurse.

 

5. What is the scope of practice for the graduate nurse?
Can a graduate nurse perform the same functions of a licensed nurse before he/she is actually licensed?

Nursing student graduates who have not received their official license may not assume any nursing duties, other than those duties routinely performed by the nursing assistant.

 

Compact License (Multi-State)

 

6. What is the Nurse Licensure Compact?

Effective July 1, 2001, Mississippi entered into the Nurse Licensure Compact. Under the Compact, the registered nurse/licensed practical nurse license is issued by your primary state of residence (home state) will be recognized among all Compact states. Please note that when you are practicing in another Compact state, you must abide by the Nursing Practice Law of that state where you are practicing. The Compact defines "primary state of residence" as "the state of a person's declared fixed permanent and principal home for legal purposes." If your primary state of residence is Mississippi your license will be designated as MULTI-STATE.

Under the Compact, nurses with current, unrestricted multi-state licenses may practice in any state which is a member of the Compact. However, the nurse may only hold a license in one Compact state which is determined by the primary state of residence. Thus, if you currently live in Mississippi and obtain/hold an unrestricted license here, you would have privilege to practice nursing in the other Compact states.

 

7. Where can I find a current listing of states that participate in the Compact?

The most current listing of states participating in the Nurse Licensure Compact can be obtained from the National Council of State Boards of Nursing website at www.ncsbn.org.

 

8. What evidence can I provide to prove my primary state of residence is Mississippi?

Driver’s license with a home address; voter registration card displaying a home address; or federal income tax return declaring the primary state of residence.

 

9. If I move to a state that participates in the Compact, do I have to obtain license in that state? Will I still be able to practice in Mississippi?

A licensed nurse may only hold one Compact state license at a time which is determined by the primary state of residence. If you move to another Compact state, you may practice in that state on your Mississippi license for 90 days while you are applying for license in the new state. Your Mississippi issued license would be invalid 90 days after you have declared another Compact state your primary state of residence. 30 Mississippi Administrative Code, Part 2850, Chapter 1, addresses nursing licensure requirements for nurses requesting licensure in a Compact state. The Mississippi Nursing Practice Law and the Administrative Code for the Mississippi Board of Nursing can be accessed in their entirety on the Board's Web site. If you meet all of the licensing requirements for another Compact state you may receive a multi-state license which includes the state of Mississippi. Therefore, allowing you to practice in Mississippi under the Compact license.

 

10. Why did I receive a single-state license if Mississippi participates in the Compact?

The multi-state license benefit is only for nurses whose primary state of residence is Mississippi. Issuance of a single-state license may be the result of disciplinary restrictions or being a resident of a state that does not participate in the Compact.

 

11. Who should I contact regarding practice issues when I am a multi-state licensed Mississippi nurse practicing in a participating Compact state? Whose jurisdiction am I under?

When you are practicing nursing in another Compact state you must abide by the Nursing Practice Law and Rules and Regulations of that state. You are under the jurisdiction of the regulatory Board in the state in which you practice nursing, and should contact the appropriate state board. The practice of nursing will subject a nurse to the jurisdiction of the nurse licensing board and the courts, as well as the laws, in that state.

 

12. Does the multi-state license recognize expanded roles, such as advanced practice registered nurses, and LPNs with expanded role certification in IV therapy or hemodialysis?

Under the Compact, only the RN and LPN roles will be recognized among all the Compact states. The expanded role certification recognition is not included in the multi-state license. Therefore, you must apply for an expanded role or advanced practice certification if you apply for licensure in another state.

 

13. If a nurse has a multi-state license from another Nurse Licensure Compact party state, may that nurse practice nursing in the State of Mississippi?

If the nurse has ever had a Mississippi compact privilege or license denied, revoked, suspended, surrendered or restricted, and that disciplinary action has not been cleared, the nurse may not practice nursing in Mississippi until such time as the disciplinary action has been cleared. Employers should verify the status of each nurse's license or privilege to practice pursuant to a license from another compact state with the Mississippi Board of Nursing using the online license status check system which is accessible through the homepage of the Board's website.

 

The nurse may practice in Mississippi if:

 
  1. The nurse has a valid multi-state compact license;
  2. The nurse still meets the multi-state licensure requirements of the state that issued the compact multi-state license;
  3. The nurse's permanent state of residence is still the state that issued the compact multi-state license, and
  4. The nurse has not had a Mississippi compact privilege or license denied, revoked, suspended, surrendered or restricted.
 

 

Licensure

 

14. Are continuing education units (CEUs) required to maintain or renew a RN and /or LPN license?

The Mississippi Nursing Practice Law does not mandate CEUs as a prerequisite to renewing or maintaining a RN or LPN license. The law does require the nurse to maintain competency in his/her nursing practice, but that responsibility rests with each nurse as pertinent to his/her field of practice.

 

15. How do I obtain an inactive license?

In order to be considered for an inactive license, you will need to submit a written request to the Board. Upon completion of the appropriate application and fee, inactive licensure may be conferred if all requirements are met.

 

16. What nursing services can be provided if my license is inactive?

Pursuant to the Mississippi Board of Nursing Rules and 30 Miss. Admin. Code, Part 2810, Chapter 4, Rule 4.5, inactive licensure means that you are not engaged in the active practice of nursing but desire to maintain licensure. Any person practicing as a RN or LPN during the time the nurse holds inactive licensure shall be considered to be practicing illegally and shall be subject to disciplinary action by the Board.

 

17. What are the requirements to change licensure status from inactive to active?

Pursuant to the 30 Miss. Admin. Code, Part 2810, Chapter 4, Rule 4.6, licensees holding inactive licensure will need to apply for reinstatement of an active license. Upon completion of the reinstatement process, licensure may be conferred if all licensing requirements are met. Any RN or LPN applying to change from inactive to active status must submit evidence of continuing basic nursing competencies when you have not practiced nursing for compensation or performed the function of a RN or LPN in a voluntary capacity with or without compensation with the five (5) year period immediately prior to the application.

 

18. What are the rules regarding reinstatement of license if I have not practiced nursing in five (5) years or more?

Any registered nurse or licensed practical nurse applying for a license by endorsement, renewal of an active license, reinstatement of a lapsed license or change from inactive to active status must submit evidence of continuing basic nursing competencies when such nurse has not practiced nursing for compensation or performed the function of a registered nurse or licensed practical nurse in a voluntary capacity with or without compensation within the five (5) year period immediately prior to such application for a license, renewal, reinstatement, or change of status. Evidence of continuing basic nursing competencies shall include submission of the written documentation of 1, 2, or 3 below:

 
  1. Successful completion of a Board-approved Reorientation Program for RNs or LPNs with the five (5) year period immediately prior to such application for renewal or reinstatement of the nursing license. The Board may issue a temporary permit to any nurse during the time enrolled in a Board-approved nursing reorientation program upon submission of required application and fees;
  2. Completion of twenty contact hours of continuing education directly related to nursing practice within the two (2) year period immediately prior to such application for renewal or reinstatement of the nursing license. Acceptable continuing education offerings are those which are currently approved, accredited, provided, or offered by recognized credentialing agency;
  3. Successful completion of a minimum of three (3) semester hours of nursing credit offered by a nursing education program within the two (2) year period immediately prior to such application for renewal or reinstatement of the nursing license. An acceptable nursing program is one which is approved or accredited by the appropriate agency within the state.
 

Documentation of continuing basic nursing competencies not included in 30 Miss. Admin. Code, Part 2810, Chapter 4, Rule 4.7, may be considered by the Board on an individual basis. Documentation of one of the above options must be submitted with the application for licensure. Obtaining 20 contact hours of nursing continuing education via the internet would be acceptable contingent upon such nursing continuing education courses being currently approved, accredited, provided, or offered by a recognized credentialing agency. The American Nurses Credentialing Center (ANCC) is such an agency.

 

19. How many days or hours do I need to work in order to maintain an active nursing license?

The Board does not mandate the number of hours or days per year that you must work to maintain an active license. However, if you have not performed nursing in five (5) years or longer you will be required to take a refresher course.

 

20. How do I apply for licensure in Mississippi if I currently hold a RN or LPN license from another state that is not Compact?

You will need to apply for a Mississippi license by endorsement if you have never held a Mississippi license. If you have held a Mississippi license at some point, you will need to apply by reinstatement. The endorsement and reinstatement applications can be downloaded from the Applications section of our website. The steps for the endorsement and reinstatement processes are outlined on the application.

 

Continuing Education Units (CEUs)

 

21. Are CEUs required in order to maintain a nursing license?

The Mississippi Nursing Practice Law does not mandate continuing education as a prerequisite to renewing or reinstating a registered nurse or licensed practical nurse license. The law does require the nurse to maintain competency in his/her nursing practice, but that responsibility rests with each nurse as pertinent to his/her field of practice. However, if a nurse has not practiced nursing for compensation or performed the function of a registered nurse or licensed practical nurse in a voluntary capacity with or without compensation within the five (5) year period immediately prior to application for a license, renewal of an active license, reinstatement of a lapsed license or change from inactive status to active status, evidence of continuing basic nursing competencies must be submitted to the Board. Options for proof of continuing basic nursing competencies are outlined in 30 Miss. Admin. Code, Part 2810, Chapter 4.7, of the Board of Nursing.

 

Advanced practice registered nurses and licensed practical nurses with expanded role certification in IV therapy and hemodialysis are required to have continuing education prior to the renewal of those licenses or certifications. Documentation of a least forty (40) contact hours of continuing education concerning the advanced practice must be submitted prior to renewal of nurse practitioner certification and 2 hours must concern the use of controlled substances). Documentation of ten (10) contact hours of continuing education are required for the licensed practical nurse certified in IV therapy and/or hemodialysis for renewal of certification.

 

22. Does the Board approve and/or accredit continuing education programs?

No. Review and approval of educational programs for continuing education accreditation is not within the purview of the Mississippi Board of Nursing.

 

Documentation

 

23. What should be documented in the clinical record?

Documentation of all nursing activities should be clear, concise, complete and contemporaneous with the activity/observation.

 

24. What are the rules and regulations for writing clarification orders and late entries?

Documentation of all nursing activities should be clear, concise, complete and contemporaneous with the activity/observation. The documentation should be done as soon as possible after the activity is performed, medication is administered, etc. Regarding late entries, a specific time limit or time frame for late entries into the clinical record is not suggested in resources consulted. The nurse must use professional judgment and be able to factually remember the activity/observation in question in determining what can honestly be entered into the clinical record, after a period of time. The date/time of the late entry must be current and reflect the date and time for which the entry is being made. The nurse should follow the facility's policies and procedures on documentation of late entries. In the event an order clarification is needed, it should be given as a usual medical order, whereas, the licensed nurse is educated and competent, there is a medical order, the licensed nurse practices according to accepted standards of care, and the facility has policies and procedures in place to address all aspects of the issue.

 

Medical Orders

 

25. Is it within the scope of practice for a licensed nurse to administer vaccines per medical protocols?

Yes, it is within the scope of practice of the appropriately prepared RN or LPN to administer vaccines per medically approved protocols and/or standing orders.

 

26. Can a licensed nurse implement range orders?

The Board of Nursing has no guidelines prohibiting the appropriately prepared licensed nurse from implementing a drug order that has a dosage range. The medical provider makes the "medical judgment" as to the specific medication and dosage. The nurse is given the latitude to use "nursing judgment" in determining the amount to be administered based on the client's clinical status. The nurse must apply adequate knowledge and skills in determining the dosage to be administered at any given time. Appropriate documentation of client assessment and evaluation must substantiate intervention. It is recommended that medication orders be patient/condition specific even if prescribed PRN. This would take away some of the notion of the nurse "prescribing" the medication. There should certainly be some consultation with the physician to initiate a standing order particularly if the signs/symptoms are deviations from the patient's norm. Standing orders are certainly not to be used in lieu of medical consultation/intervention.

 

27. Who is a licensed nurse permitted to take medical orders from?

Please refer to the Medical Orders position statement.

 

Nurse/Patient Ratios

 

28. What should the nurse/patient ratio be?

The number of patients a nurse may care for with reasonable skill and safety should be determined by evaluation of the nurse's educational preparation, experience and competencies; acuity of the patients; layout of the facility and equipment; and other resources available for care of the patient.

 

Pursuant to the Nursing Practice Law and the Administartive Code of the Board of Nursing, the registered nurse shall be held accountable for the quality of nursing care given to patients. This includes, but is not limited to, assessing the patient's needs, formulating a nursing diagnosis, planning for, implementing and evaluating the nursing care in the promotion and maintenance of health of each patient for whom responsibility has been accepted. Furthermore, the registered nurse is accountable for the quality of nursing care given by self or others being supervised. The registered nurse may assign nursing duties to other qualified personnel; assign duties of medication administration or patient medications to other licensed nurses only except as set out in 30 Miss. Admin. Code, Part 2860, Chpater 1; and assign duties for giving patient treatments to licensed nurses and/or auxiliary workers based upon knowledge of their education preparation and experience. However, the registered nurse remains accountable for the acts delegated. Negligently or willfully acting in a manner inconsistent with the health and safety of the persons under the licensee's care, including, but not limited to, inappropriately delegating or accepting a patient assignment, and assuming duties and responsibilities in the practice of nursing when competency has not been maintained may compromise the health and safety of patients and are grounds for disciplinary action against the nurse's license.

 

The licensed nurse is responsible for assuring he/she is educated and competent to care for the number of patients assigned, to perform necessary procedure(s), or to administer medication(s) prior to accepting such a patient assignment or task. Federal and state regulations contain mandates and regulate healthcare staffing. In situations regarding consistent understaffing, the nurse should be aware of federal and state regulations regarding the facility's responsibility to assure safe staffing and avenues to report this situation when the nurse feels that it endangers the patient's health and safety. A Condition of Participation in the Federal Regulations governing hospital services mandates that the "hospital have an organized nursing service that provides 24 hour nursing services." Regulations further state that "the Director of Nursing Services is responsible for the operation of the service including the types and numbers of nursing personnel as needed. Nursing administration duties include a review of nursing staffing and making adjustments for absenteeism, as necessary." The Federal regulations also mirror the Nursing Practice Law by state the "registered nurse must assign the nursing care of each patient to other personnel in accordance with the patient's needs and the specialized qualifications and competencies of the nursing staff available." State regulations for hospitals state that the facility must provide nursing services for each unit sufficient to meet the needs of the patients. There are similar state and federal regulations for other health care facilities.

 

29. If I feel that my unit or facility is consistently understaffed, what should I do?

The Mississippi State Department of Health is responsible for enforcement of federal and state regulations for healthcare facilities. Consistent understaffing which endangers the health and safety of the patient should be reported to the Mississippi State Department of Health, Division of Health Facilities and Licensure and Certification at 601-576-7300.

 

Maximum Hours Allowed to Work

 

30. How many hours can a licensed nurse work per day or per week?

The Mississippi Nursing Practice Law does not specify the number of hours that a nurse may work per day or week. Each nurse must realistically evaluate his/her abilities to determine the number of hours in which he/she can safely provide nursing care. The Mississippi Nursing Practice Law and the Administrative Code of the Board of Nursing, state negligently or willfully acting in a manner inconsistent with the health and safety of the persons under the licensee's care, including, but not limited to, inappropriately delegating or accepting a patient assignment, and assuming duties and responsibilities in the practice of nursing when competency has not been maintained may compromise the health and safety of patients and are grounds for disciplinary action against the nurse's license. The licensed nurse is responsible for assuring that he/she is educated and competent to care for the number of patients assigned, to perform the necessary procedure(s), or to administer the medication(s) prior to accepting such a patient assignment or task.

 

Gastrostomy/Peg Tube

 

31. Can a licensed nurse replace a peg tube that becomes dislodged?

The appropriately prepared registered nurse or licensed practical nurse may replace a gastrostomy tube provided:

 
  1. The licensed nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure, including the type tube to be used for replacement;
  3. There are no contraindications related to the patient's condition;
  4. The licensed nurse practices according to accepted standards of practice;
  5. There is a well-healed tract without sign/symptoms of infections; and
  6. The facility has policies procedure in place addressing all aspects of the issue.
 

Surgical Site Marking

 

32. Can a licensed nurse mark a surgical site?

No. The marking of the surgical site is not within the scope of practice of the RN or LPN. It is within the scope of practice of the following advanced practice registered nurses: FNP, PNP, ANP, NNP, CNM, FPNP, OBGYNNP, WHCNP and ACNP. Refer to the Surgical Site Marking position statement.

 

Postmortem Care

 

33. Can a licensed nurse provide postmortem care?

The appropriately prepared registered nurse or licensed practical nurse may provide postmortem care provided:

 
  1. There is documentation that the nurse has the knowledge and skills to perform the procedure;
  2. The procedure is performed in accordance with all applicable federal, state, and local laws, regulations and guidelines including, but not limited to, those pertaining to determination of death, deaths that may be under the jurisdiction of the medical examiner, and disposition of bodies. (For example, Miss Code of 1972, As Amended, Title 41, Chapter 036, Determination of Death; Title 41, Chapter 037, Autopsies; Title 41, Chapter 039, Disposition of Human Bodies; and Title 41, Chapter 061, Medical Examiner.)
  3. The procedure is performed according to generally accepted standards; and
  4. The facility/agency has policies and procedures in place addressing all aspects of the issue including, but not limited to, determination of whether tubes such as urinary catheters, intravenous lines and endotracheal tubes are removed or tied off.
 

Laser Hair Removal and Treatment

 

34. Can a LPN perform laser hair removal, chemical peels or microdermabrasion?

No. It is not within the scope of practice of the LPN to perform any of these procedures.

 

35. Can a RN perform laser hair removal?

It is within the scope of the appropriately prepared RN to perform laser hair removal.

 

36. Can a RN perform Parisian chemical peels and microdermabrasion?

It is within the scope of practice of the appropriately prepared RN to perform chemical peels that do not exceed 10% strength. It is within the scope of practice of the appropriately prepared RN to perform microdermbrasion that does not exceed moderate settings. In addition, the RN may perform these procedures provided:

 
  1. The registered nurse has satisfactorily completed a documented special education and training program on applicable techniques and laser safety, which includes supervised practice and clinical skills competency. Evidence of the initial education and competence must be on file in the facility. Continuing education for these procedures must be ongoing and documented;
  2. The supervising physician or advanced practice registered nurse (APRN) must have expertise in laser therapy and be immediately available and able to respond within five (5) minutes to any question or adverse event;
  3. The supervising physician or APRN performs and documents an initial assessment prior to treatment and as needed during the course of therapy;
  4. There is a medical order for the procedure, to include control settings and/or strength of solutions to be used;
  5. The registered nurse practices according to accepted standards of practice; Necessary resources are available; and
  6. The facility has policies and procedures in place to address all aspects of this issue.
 

37. Is it within the scope of practice of the RN or LPN to perform sclerotherapy for varicose vein removal, Botox injections, laser vascular lesion removal?

It is not within the scope of practice of the registered nurse or licensed practical nurse to perform laser vascular lesion removal, sclerotherapy for varicose veins, or Botox injections.

 

Anodyne Therapy

 

38. Can a licensed nurse apply Anodyne therapy (monochromatic infrared photo energy)?

It is within the scope of practice of the appropriately prepared registered nurse to apply Anodyne Therapy System Home Unit.

 

It is not within the scope of practice of the licensed practical nurse to apply the Anodyne Therapy System Home Unit.

 

Cardiac Stress Testing

 

39. Is it within the scope of practice of the LPN or a LPN certified in the expanded role of IV therapy to perform stress test and administer Dobutamine or Adenosine?

It is not within the scope of practice of the LPN or the LPN certified in the expanded role of IV therapy to perform stress tests or to administer IV Dobutamine or Adenosine.

 

40. Can a licensed nurse supervise a cardiac stress test?

Supervising cardiac stress testing is within the scope of practice of the appropriately prepared registered nurse provided:

 
  1. The registered nurse is educated and competent in the procedure, in EKG interpretation, must be ACLS certified and capable to respond to adverse events. This education and competence must be documented initially and on an ongoing basis;
  2. The physician or advanced practice registered nurse (APRN) must be immediately available in the facility;
  3. The facility and staff must possess the ability to run a full code;
  4. The patient must be previously evaluated and cleared for testing by the physician or APRN;
  5. There must be a medical order for the procedure; and
  6. The facility must have policies and procedures in place to address all aspects of this issue.
 

The registered nurse may not administer agents or medications for the purpose of pharmacologic or nuclear stress testing unless the physician or APRN is immediately available.

 

LPN Expanded Role

 

41. What are the supervision requirements for the LPN certified in the IV therapy expanded role?

30 Miss. Admin. Code Pt.2840, R 3.3(d),states, "Unless otherwise specified in these regulations, the LPN certified in IV therapy may perform advanced acts of IV therapy if the supervisor is physically on the premises where the patient is having nursing care provided. The physician or dentist may provide supervision in the medical or dental office. In all other settings, supervision and delegation must be by a registered nurse."

 

The supervising registered nurse must be physically present on the premises where the patient is having nursing care provided for the licensed practical nurse certified in IV therapy to perform advanced acts of IV therapy.

 

The physician or dentist may provide supervision in the medical or dental office. In all other settings, supervision and delegation must be by a RN.

 

42. Where can I find the rules and regulations for LPNs certified in expanded role IV therapy rules and regulations?

The rules and regulations for the expanded role LPN in IV therapy can be found in 30 Miss. Admin. Code Pt. 2840, Chapter 3. The scope of practice for the LPN expanded role in IV therapy is addressed in Rule 3.3.

 

TB Skin Testing

 

43. What are the Board requirements for TB skin test certification?

The Board of Nursing does not have specific regulations or require special certification for the administration or reading of a TB skin test. The appropriately prepared RN or LPN may perform this procedure provided the nurse is educated and competent in the procedure. However, it should be noted that some state and federal regulatory agencies including, but not limited to, the Mississippi State Department of Health and the Occupational Safety and Health Administration (OSHA) require nurses to be certified in the administration and reading of TB skin tests in order for such tests and results to be considered valid.

 

After Hours Access to Pharmacy

 

44. When is it acceptable to have after hours access to the pharmacy by a licensed nurse?

It is not within the scope of practice of the licensed practical nurse to access the pharmacy after hours to obtain medication.

 

It is within the scope of practice of the appropriately prepared registered nurse in certain limited situations, to access the pharmacy during the pharmacist’s absence as provided for in the Mississippi Pharmacy Practice Regulations. Article XXIX, Section 4, Subsection C of the regulations states, “Whenever any drug is not available from floor supplies or other storage areas and such drug is required to treat the immediate needs of a patient whose health would otherwise be jeopardized (emphasis added), such drug may be obtained from the pharmacy in accordance with the requirements of this subsection. Only designated nurses in any one shift may be given access to the pharmacy and may remove drugs therefrom. Nurses allowed access to the pharmacy shall receive thorough education and training in the proper method of access, removal of drugs and records and procedures by the Director of Pharmacy, who shall require at a minimum the following: 

     A. Drugs may be removed from the pharmacy only in an amount necessary to treat a patient’s immediate needs until the pharmacy is once again attended by a pharmacist;
Removal of any drug from the pharmacy by an authorized nurse must be recorded on a suitable form showing patient name and room number, name, strength and amount of drug, date, time and signature of nurse;
     B. The completed form and a copy of the practitioner’s order shall be placed conspicuously so they will be found by a pharmacist and verified promptly;
     C. The director or his pharmacist designee shall check and initial the order.” The dispensing of medication is outside of the scope of practice of the licensed nurse, unless the nurse is a registered nurse certified in advanced practice. The licensed nurse may administer the medications, once they have been appropriately prepared and labeled by the pharmacist, provided:
 
  1. The nurse is educated and competent in the procedure. This education and competence are documented initially and on an ongoing basis. (The nurse must be knowledgeable of all components related to administration of the medications ; i.e., indications and use, actions, dosages, contraindications, precautions, side effects, antidote, recommended monitoring and emergency resources/equipment, etc.);
  2. There is a medical order for the procedure;
  3. The procedure is reviewed periodically to assess changes in the patient’s condition;
  4. All necessary resources including, but not limited to, essential monitoring and emergency equipment, are available;
  5. The procedure is performed and the patient monitored according to accepted standards of practice; and
  6. The facility has policies and procedures in place regarding all aspects of the issue. The Board of Nursing does not maintain a listing of specific medications acceptable for administration by registered nurses and licensed practical nurses. When administering any medication, the nurse should be knowledgeable of and comply with all applicable state and federal laws, rules, regulations and guidelines pertaining to the specific medication including, but not limited to, those of the Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), the Mississippi Board of Pharmacy and the Board of Nursing.
 

Medication Administration

 

45. Can a RN delegate the administration of medicated ointments, lotions, and protective skin barriers to unlicensed personnel?

Pursuant to 30 Miss. Admin. Code Pt. 2830, Chapter 1, R 1.3: The RN shall be held accountable for the quality of nursing care given by self or others being supervised. The registered nurse may:

 
  1. Assign specific nursing duties and/or patient treatments to other qualified personnel based on educational preparation, experience, knowledge, credentials, competency, and physical and emotional ability to perform the duties.
  2. Assign duties of administration of patient medications to other licensed nurses only (either a RN or LPN or one authorized by a temporary permit to practice) except as set out in Miss. Admin. Code Part 2860
 

46. Can a registered nurse or licensed practical nurse administer chemotherapeutic agents via bladder instillation?

The appropriately prepared registered nurse or licensed practical nurse may administer a chemotherapeutic agent (e.g., BCG) via bladder instillation provided:

 
  1. The nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis (The nurse must be knowledgeable of all components related to administration of the medications; i.e., indications and use, actions, dosages, contraindications, precautions, side effects, antidote, recommended monitoring and emergency resources/equipment, etc.);
  2. The procedure is the generally accepted standard of practice;
  3. There is a medical order for the procedure;
  4. The nurse is practicing according to accepted standards of practice;
  5. Patients are evaluated on an individual basis for these procedure to be performed;
  6. The patient must be assessed initially and on an ongoing basis as needed by the registered nurse to determine whether there are contraindications or changes which require additional resources or expertise;
  7. There is informed consent to administer chemotherapy;
  8. All aspects of the patient's condition are monitored according to accepted standards of practice;
  9. The registered nurse develops and revises as necessary the patient's care plan to include, but not be limited to, patient and family education;
  10. The licensed practical nurse is appropriately supervised;
  11. All necessary resources are available; and
  12. The agency/facility has policies and procedures in place regarding all aspects of this issue.
 

The Board does not maintain a listing of specific medications acceptable for administration by registered nurses and licensed practical nurses. When administering any medication, the licensed nurse should be knowledgeable of and comply with all applicable and state and federal laws, rules, regulations and guidelines pertaining to the specific medication, including but not limited to, those of the Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), the Mississippi Board of Pharmacy, and the Mississippi Board of Nursing. The nurse/facility must determine which medication is appropriate for the nurse to safely administer based on the nurse’s education and competence, current standards of practice, and the facility’s policies and procedures. The nurse is responsible to assure that she/he is educated and competent to perform the procedure or administer the medication in question prior to accepting such a task.

 

47. Does the Board require that a RN be “certified” in order to administer intravenous (IV) chemotherapy?

The appropriately prepared Registered Nurse may administer IV chemotherapeutic agents.

 

The Board of nursing does not require "certification" as a pre-requisite for the nurse to provide education regarding chemotherapy or as a pre-requisite to providing care to chemotherapy patients. According to the Mississippi Nursing Practice Law, Rules and Regulations, the nurse shall be held accountable for the quality of nursing care given to patients and failure to maintain competency or accepting an assignment in which a nurse is not competent may be grounds for disciplinary action against the nurse’s license. The nurse is responsible to assure that he/she is trained and competent to do the procedure or administer the medication prior to accepting such a task.

 

48. Is it within the scope of practice of the RN to instill medication via a chest tube?

It is within the scope of practice of the appropriately prepared registered nurse to instill medication into the chest cavity via chest tube. In addition, there must be a patient specific order for the procedure.

 

49. Is it within the scope of practice of the RN to irrigate chest tubes, mediastinal catheters and pericardial catheters with thrombolytics?

It is within the scope of practice of the appropriately prepared registered nurse to irrigate chest tubes, mediastinal catheters, and pericardial catheters with thrombolytics. In situations involving the irrigation of chest tubes, mediastinal catheters and pericardial catheters with thrombolytics, the following stipulations must be met:

 
  1. The registered nurse is educated and competent in the procedure. The education and competence must be documented initially and on an ongoing basis;
  2. The procedure is performed in a controlled setting where the patients are monitored according to accepted standards of practice;
  3. There is a patient specific medical order for the procedure;
  4. The initial procedure of irrigation of the mediastinal catheter and pericardial catheter is done by the physician or advanced practice registered nurse (APRN) [subsequent procedures may be performed by the registered nurse provided there are no complications]; and
  5. The facility has policies and procedures in place addressing all aspects of this issue, including a quality assurance component.
 

50. Is it within the scope of practice of the RN to administer paralytic agents and/or sedative analgesics/anesthetics during critical care transport of ventilator patients?

It is within the scope of practice of the appropriately prepared registered nurse to administer paralytic agents and/or sedative analgesics/anesthetics as part of rapid sequence intubation and for the purpose of maintaining a patient on the ventilator in critical care units, emergency departments and in prehospital/interhospital response and transportation provided:

 
  1. The registered nurse is educated and competent in all aspects of rapid sequence intubation, mechanical ventilation and cardiovascular resuscitation, including knowledge of all equipment and medical devices to be used and medications to be administered (i.e., indications and use, actions, dosage, contraindications, precautions, side effects, antidote, etc., The education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The procedure is performed and the patient is monitored according to accepted standards of practice;
  4. If in a facility, the physician or nurse practitioner who is performing the intubation is physically present when giving orders for the medication and while the medication is being administered;
  5. If in a facility, the registered nurse is educated and competent and is the most qualified individual to perform the procedure present;
  6. If in the pre-hospital setting or during interhospital air/ground transport, the physician or nurse practitioner is in direct contact with the registered nurse;
  7. All the necessary resources are available; and
  8. The facility and/or transportation provider has policies and procedures in place addressing all aspects of this issue. The policies should include specific medications to be used for the particular procedure(s) and should be developed with input/expertise from all involved parties, based on accepted standards of practice.
 

51. Is it within the scope of practice of the registered nurse to administer anesthetic agents for the purpose of moderate sedation?

Refer to the Administration and Management of Moderate Sedation position statement.

 

52. Can a registered nurse administer anesthetic agents in a critical care setting?

The registered nurse who is not a qualified anesthesia provider, who has specialized education and training, in settings where critical care nursing can be provided, may initiate, titrate, and bolus intravenous agents provided the patient's airway is secured and mechanically assisted. A qualified physician or certified registered nurse anesthetist (CRNA) must select and order the agent to be used. Refer to the Administration and Management of Moderate Sedation position statement.

 

53. Can a registered nurse administer Fentanyl or Versed for sedation?

The administration of Fentanyl and Versed (midazolam) are not prohibited by the RN provided:

 
  1. The registered nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The patient retains control of reflexes and can be aroused;
  4. The registered nurse practices according to accepted standards of practice;
  5. The drugs and dosages must be clearly intended for maintaining the patient in a conscious state;
  6. The physician or CRNA ordering the sedation should be present and immediately available to respond in the case of an emergency;
  7. The patient is monitored according to currently recognized standards of practice;
  8. All necessary resources are available; and
  9. The facility has policies and procedures in place addressing all aspects of the issue.
 

The Board does not maintain a listing of each medication/anesthetic agent which a nurse can administer. The nurse/facility must determine which of these drugs are appropriate based on the nurse’s education and competence, current standards of practice, and the facility’s policies and procedures. When administering any medications, the registered nurse should be knowledgeable of and comply with all applicable state and federal laws, rules, regulations and guidelines pertaining to the specific medication, including but not limited to, those of the Food and Drug Administration, Drug Enforcement Administration, the Mississippi Board of Pharmacy, and the Mississippi Board of Nursing.

 

54. It is within the scope of practice of the RN to administer Vasopressors IV (Dobutrex, Primacor, Natrecor) in the outpatient and home setting?

It is within the scope of practice of the appropriately prepared registered nurse to administer Dobutrex (dobutamine) and Primacor in the out-patient setting provided:

 
  1. The registered nurse is educated and competent in the procedure. This education and competence are documented initially and on an ongoing basis;
  2. There is a medical order defining the specifics for the procedure;
  3. Administration of the medication has previously occurred in the hospital for the purpose of dose adjustment and monitoring patient response. Continuous infusion must have been given in the hospital on an intermittent basis;
  4. For both intermittent and continuous infusions, judicious oversight of the patient by the registered nurse is required. For intermittent infusions, vital signs must be obtained every 10-15 minutes for one hour after initiation of the infusion. These vital signs must be stable and within the desired parameters for the individual patient;
  5. The medication is administered via an infusion pump. A central line is the recommended route for administration;
  6. The patient is monitored according to accepted standards of practice; There is documentation of appropriate patient/caregiver teaching for monitoring for drug-related problems of the therapy; and
  7. The facility must have policies and procedures in place addressing all aspects of this issue.
 

On April 11, 2004, the Board reviewed a request for clarification of the role of the registered nurse in the administration of Nesiritide (Natrecor) in the home-health/hospice setting. The Board determined that the information submitted for review was insufficient for the Board to establish the nurse’s role or safety issues concerning this procedure. The Board further determined it is not within the scope of practice of the registered nurse to administer Natrecor in the home-health/hospice setting.

 

55. Is it within the scope of practice of the registered nurse to administer Ephedrine IV push for maternal hypotension?

It is within the scope of practice of the appropriately prepared registered nurse to administer Ephedrine IV push for maternal hypotension.

 

56. Is it within the scope of practice of the licensed practical nurse to administer Coumadin and subcutaneous Heparin?

It is within the scope of practice of the appropriately prepared licensed practical nurse to administer Coumadin and subcutaneous heparin provided:

 
  1. The licensed practical nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis. (The nurse must be knowledgeable of all components related to administration of the medications; i.e., indications and use, actions, dosages, contraindications, precautions, side effects, antidote, recommended monitoring and emergency resources/equipment, etc.);
  2. There is a medical order for the procedure;
  3. The procedure is a generally accepted standard of practice; The procedure is performed and the patient monitored according to accepted standards of practice;
  4. All necessary resources including, but not limited to, essential monitoring and emergency equipment are available; and
  5. The facility has policies and procedures in place regarding all aspects of the issue.
 

The Board does not maintain a listing of specific medications acceptable for administration by registered nurses and licensed practical nurses. When administering any medication, the licensed nurse should be knowledgeable of and comply with all applicable state and federal laws, rules, regulations and guidelines pertaining to the specific medication, including, but not limited to, those of the Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), the Mississippi Board of Pharmacy and the Mississippi Board of Nursing. The nurse/facility must determine which medication is appropriate for the nurse to safely administer based on the nurse's education and competence, current standards of practice, and the facility's policies and procedures.

 

57. Is it within the scope of practice of a licensed practical nurse to administer respiratory nebulizers and aerosol treatments?

It is within the scope of practice of the licensed practical nurse to administer respiratory nebulizer/aerosol treatments.

 

58. Is it within the scope of practice of the licensed nurse to give out drug samples?

Giving out drug samples is considered dispensing. The dispensing of medication is outside of the scope of practice of the licensed nurse.

 

It is within the scope of practice of the licensed nurse to hand a patient pre-packaged pharmaceutical samples with the original label and packaging intact or a medication that a physician or pharmacist has appropriately repackaged and labeled from a bulk container and meets the Board of Pharmacy, Medical Licensure Board, Food and Drug Administration (FDA), and Drug Enforcement Administration (DEA) guidelines provided:

 
  1. The nurse is educated and competent regarding the medication to include but not limited to indications, contraindications, and side effects;
  2. There is a medical order for the medication;
  3. The sample is in the original unopened package with the original label intact and unaltered or if the medication has been repackaged by a pharmacist or physician it was repackaged and labeled according to all state and federal guidelines;
  4. The facility must have policy and procedures in place regarding all aspects of this issue.
 

Chest Tube

59. What tasks are within the licensed practical nurse scope of practice when providing nursing care to a patient with a chest tube?

It is within the scope of practice of the appropriately prepared licensed practical nurse to perform the following tasks related to chest tube care:

  1. Chest tube insertion site care/dressing change;
  2. Clamp the tube in an emergency;
  3. Monitor patency of the draining system;
  4. Assist the physician, advanced practice registered nurse or registered nurse in changing bottles and/or disposable collection system.

The appropriately prepared licensed practical nurse may perform these tasks provided:

  1. The licensed practical nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The patient must be assessed initially and on an ongoing basis as needed by the registered nurse to determine whether there are contraindications or changes which require additional resources or expertise;
  4. The licensed practical nurse practices according to accepted standards of practice;
  5. The procedure is performed and the patient is monitored according to accepted standards of practice;
  6. All necessary resources including, but not limited to emergency resources/equipment are available; and
  7. The facility/agency has policies and procedures in place to address all aspects of the issue.

It is not within the scope of practice of the licensed practical nurse to perform the following tasks:

     A. Independently change out chest tube bottles;

     B. Independently change a disposable collection system; or

     C. Manipulate, advance, irrigate, milk or remove a chest tube.

 

60. Is it within the scope of practice of the registered nurse to remove a chest tube?

Refer to the Removal of Chest Tubes Position Statement.

 

Immunizations

61. Can a nurse administer immunizations or vaccinations based on standing orders?

It is within the scope of practice of the appropriately prepared licensed nurse (registered nurse or licensed practical nurse) to administer vaccines per medically approved protocols and/or standing orders. These protocols or standing orders should contain provisions to treat adverse vaccine events including, but not limited to, medication administration and emergency transfer. Mississippi has no statue that would require an individual order for vaccination or prohibit the administration of this medication in the outpatient or home settings.

 

School Nurses

62. Is it within the scope of practice for a LPN to be a school nurse?

The school nurse’s role encompasses much more than the implementation of medications and procedures. A large component of the school nurse’s role is providing student, parental, and community education which requires a thorough assessment/evaluation of the family/student physical status, knowledge-level, dynamics and resources. The school nurse’s role also includes administering medication and responding to emergencies both of which require an initial and ongoing patient assessment. Based on the substantial knowledge required in assessing and identifying not only the diseases but also the physiological and psychological needs of the students the scope of practice of the school nurse requires the knowledge of the registered nurse. Thus, a licensed practical nurse may not function in the role of “school nurse.”

 

63. If a LPN can not be a school nurse can they work in a school setting?

The provisions of the Mississippi Nursing Practice Law do not preclude a licensed practical nurse from working in the school setting if the licensed practical nurse functions within the applicable scope of practice. Situations in which licensed practical nurses are functioning within their scope in the school setting include those in which:

After an RN makes an initial assessment of students, the RN may assign care of these students to a LPN who has been determined by the RN to be appropriately trained, educated and competent. The RN must provide evidence of ongoing assessment of these students and must be available to the LPN at all times to respond to a change or potential change in condition. This would allow a RN supervisor to float between school settings provided the RN remains available to the LPN at all times.
The LPN working under the direct supervision of a RN who is physically present on the premises at all times the LPN is “on duty”.
The RN must perform the initial assessment of all students. The LPN may not administer medications to a student who has not been assessed by the registered nurse prior to the administration of the medication.
 

64. Can other unlicensed school personnel administer medications to students and what is the role of the RN in this situation?

Per 30 Mississippi Administrative Code the registered nurse may assign duties of administration of patient medications to other licensed nurses only (either a registered nurse or licensed practical nurse). It is the position of the Board of Nursing that a registered nurse should administer medications to students. Should the school elect to allow someone other than the registered nurse to observe students with stable conditions self administering oral, topical, ear, eye, nasal and inhalation medications or epinephrine pens as authorized by a parent/legal guardian, the designated school personnel may only do the following:

  1. Remind the student when to take the medication and observe to ensure that the student follows the direction on the container;
  2. Assist a student in the self administration of medication by taking the medication in its container from an area where it is stored and handing the container, with the medication in it, to the student. If the student is physically unable to open the container, the designated school personnel may open the container for the student and assist the student in taking or applying the medication. In schools that opt to have designated school personnel observe students self administering medication during the nurse’s absence, prior to the initiation of the provision of any medication at the school, the registered nurse should:
         A. Obtain a complete initial nursing history and assessment of the student.
         B. Review the parental consent for completeness.
         C. Verify that there is a medical order for the medication to include the student’s name, specific medication, specific dosage, specific route, and length of time to be administered- beginning date and ending date, and reason for taking medication.

In these schools, the registered nurse should also:

  1. Perform an ongoing assessment of the child’s status and communicate the nursing assessment to appropriate individuals. The nursing assessment must include monitoring of medication administration record.
  2. Provide an eight (8) hour educational in-service to the designated school personnel to include but not be limited to the information set forth in the Assisted Self Administration Curriculum approved by the Board of Nursing.
  3. Provide a Medication Administration Record for documentation of all doses of medication provided in the school setting. The Medication Administration Record must include the date, identity of school personnel providing the medication and documentation of missed doses (i.e. holiday, out of medication, school absence, illness).
  4. Assure that the parent/legal guardian is notified that in the registered nurse’s absence from the school, the parent/legal guardian has the option of coming to the school and providing the medication or authorizing designated school personnel to assist students with self administration of the medication.
 

Emergency and Disaster Management

65. As a licensed nurse, what is my scope of practice during an emergency at a shelter setting?

The Mississippi Nursing Practice Law and the Administrative Code require licensed nurses in shelter settings to provide care which adheres to the law and to applicable standards of care. Medical orders concerning administration of medications at home which are evidenced by pill bottles or IV bags etc. should be followed as they would in the home. If interventions other than those covered by existing medical prescriptions/ orders are necessary or a question concerning existing medical prescriptions/orders arise, the nurse should provide necessary first aid and contact medical control through the mechanisms which are established by the State Department of Health. If a nurse is assigned to a shelter in which people are taking refuge at the last minute, the nurse should perform emergency first aid, follow applicable written protocols and contact medical control through the established mechanisms as soon as possible.

 

66. What is the Emergency Management Assistance Compact?

Mississippi is a member of the Emergency Management Assistance Compact which provides that "in managing any emergency disaster that is duly declared by the Governor of the affected state, whether arising from natural disaster, technological hazard, manmade disaster, civil emergency aspects of resources shortages, community disorders, insurgency or enemy attack....Whenever any person holds a license, certificate, or other permit issued by any state party to the compact evidencing the meeting of qualifications for professional, mechanical, or other skills, and when such assistance is requested by the receiving party state, such person shall be deemed licensed, certified, or permitted by the state requesting assistance to render aid involving such skill to meet a declared emergency or disaster, subject to such limitations and conditions as the Governor of the requesting state may prescribe by executive order or otherwise."

 

67. What other states are members of the Emergency Management Assistance Compact?

Other member states of the Emergency Management Assistance Compact are Alabama, Alaska, Arizona, Arkansas, Colorado, Congress Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia and Wisconsin.

 

Ambulance

68. Is it within the registered nurse scope of practice to work on an ambulance?

It is within the scope of practice of the appropriately prepared registered nurse to function as a registered nurse on an ambulance provided:

  1. The registered nurse is trained and competent in the care necessary for the patient and knowledgeable regarding the use of available equipment. This training and competence should be documented initially and on an ongoing basis;
  2. There is a medical order, emergency protocol or standing orders directing the care of the patient;
  3. The registered nurse functions according to accepted standards of practice;
  4. The ambulance provider/facility has policies and procedures in place addressing all aspects of the issue.
 

Gastrointestinal

69. Can a RN manipulate the endoscope during a procedure?

The appropriately prepared registered nurse who is experienced and competent in gastroenterological nursing may manipulate the endoscope as directed to facilitate an endoscopic procedure provided:

  1. There is direct supervision by the physician or advanced practice registered nurse (that is, the physician or advanced practice registered nurse is physically present);
  2. The registered nurse has knowledge of the techniques of endoscopic manipulation, understands the complications associated with endoscopy, is competent to identify the associated symptoms and will initiate appropriate interventions as directed by the physician or advanced practice registered nurse;
  3. The nurse has full view of the lumen (via teaching adapter or video screen) throughout the entire manipulation process;
  4. Another registered nurse is responsible for monitoring the patient if the patient is sedated (that is, the same registered nurse may not accept responsibility for manipulation of the endoscope and monitoring a sedated patient); and
  5. The facility has policies and procedures that address all aspects of the procedure.
 

70. Is it within the scope of practice of the RN to administer an endoscopy capsule?

It is within the scope of practice of the appropriately prepared registered nurse to administer an endoscopy capsule, in addition to the standard requirements, provided:

  1. The registered nurse is educated and competent in the administration of the capsule and is knowledgeable regarding the indications, contraindications, complications, side effects and possible adverse reactions and recommended monitoring.
  2. This education and competence must be documented initially and on an ongoing basis; and
  3. There is an informed consent (obtained by the physician) for the procedure; There is a medical order for the procedure;
  4. The registered nurse practices and the patient is monitored according to generally accepted standards;
  5. Necessary resources including, but not limited to, emergency resources and personnel are available; and
  6. The facility has policies and procedures in place addressing all aspects of this issue.
 

Wound & Foot Care

71. Is it within the scope of practice of the registered nurse to perform conservative sharp wound debridement?

The appropriately prepared registered nurse may perform conservative sharp wound debridement. If performed in the home setting, patients should be evaluated on an individual basis for these procedures.

 

72. Can a RN perform nail/foot care?

The appropriately prepared registered nurse may provide specialized nail care/foot care for patients including but not limited to, diabetic patient. The registered nurse may not delegate the task of specialized nail/foot care to the licensed practical nurse.

 

73. Can a LPN perform nail/foot care?

Specialized foot care for the diabetic patient is outside the scope of practice of the licensed practical nurse due to the assessment skills and knowledge of the disease process required for this procedure. The licensed practical nurse may provide patient education as indicated by the plan of care developed by the Registered Nurse.

 

Ear Stapling

74. Is it within the scope of practice of the RN or LPN to perform ear stapling for weight loss, treatment of migraines, treatment of insomnia, etc.?

On April 7, 2006, the Board of Nursing completed its review of a request for clarification of the role of the registered nurse in performing ear stapling for weight loss, treatment of migraine headaches, treatment of insomnia, etc.

It was determined that it is within the scope of practice of the appropriately prepared registered nurse to perform ear stapling provided:

  1. The registered nurse is educated and competent in the procedure. The registered nurse must have satisfactorily completed a documented special education program on applicable techniques and device safety, which includes supervised practice and clinical skills competency. This education and competency must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The ordering physician or advanced practice registered nurse must have expertise in the specific therapy and be readily available for consultation and able to respond to any question or adverse event;
  4. The ordering physician or advanced practice registered nurse perform and documents an initial assessment prior to treatment and as needed during the course of therapy; The registered nurse practices according to accepted standards of nursing practice; The procedure is performed according to national standards for the specific therapy; Necessary resources are available; and
  5. The facility has policies and procedures in place to address all aspects of the issue.

It was further determined that it is not within the scope of practice of the licensed practical nurse to perform ear stapling as treatment for obesity, migraine headaches, insomnia, etc.

 

Obstetrics and Gynecology

75. Can registered nurses remove the initial post-operative vaginal pack?

On April 13, 2007, the Board of Nursing's Nurse Practice Committee completed its review of a request for reconsideration of the role of the registered nurse in removing the initial post-operative vaginal pack.

The Nurse Practice Committee determined that it is within the scope of practice of the appropriately prepared registered nurse to remove the initial post-surgical vaginal pack provided:

  1. The vaginal pack was not placed to stop or slow bleeding/hemorrhage;
  2. The registered nurse is educated and competent in the procedure. This education and competency must be documented initially and on an on-going basis;
  3. There is a medical order for the procedure;
  4. The registered nurse practices according to accepted standards of practice;
  5. All necessary resources are readily available; and
  6. The facility/agency has policies and procedures in place addressing all aspects of this issue.

As noted above, the patient who has a vaginal pack in place to stop or slow bleeding/hemorrhage is not a candidate for the packing to be removed by the registered nurse.

The Nurse Practice Committee further determined that it is not within the scope of practice of the licensed practical nurse to remove the initial post-surgical vaginal pack.

 

76. Can registered nurses remove subsequent vaginal packs postoperatively?

It is within the scope of practice of the appropriately prepared registered nurse to remove subsequent vaginal packs provided the standard requirements are met, the vaginal pack was not placed to stop or slow bleeding/hemorrhage, and the original vaginal pack has been removed postoperatively by the physician or advanced practiced nurse. As previously noted, the patient who has a vaginal pack in place to stop or slow bleeding/hemorrhage is not a candidate for the packing to be removed by a registered nurse.

 

77. If an obstetric patient presents to the hospital with an obstetric related complaint, what is the role of the registered nurse in performing a nursing assessment?

On July 27, 2007, the Board of Nursing’s Nurse Practice Committee reviewed the role of the registered nurse in assessing obstetrical patients who present to the hospital with an obstetric-related complaint. The Nurse Practice Committee determined that it is within the scope of practice of the qualified obstetrical registered nurse to perform a nursing assessment of the obstetrical patient per hospital protocol and/or policy provided:

  1. The registered nurse is educated and demonstrates current competency in obstetrical nursing;
  2. The registered nurse’s education and competency are documented in the facility’s records initially and on an ongoing basis;
  3. The registered nurse communicates with (e.g. telephone, e-mail, etc.) the attending physician or advanced practice registered nurse (APRN) to report the assessment and physical findings;
  4. The registered nurse obtains an order from the attending provider to admit the patient to the hospital or discharge the patient home.
  5. The registered nurse practices according to generally accepted standards or practice;
  6. All necessary resources are available; and
  7. The facility has policies and procedures in place to address all aspects of the issue.
 

78. Can a regsitered nurse administer Pitocin, Prostin E3, prostaglandin gels, Cervidil, Hemabate or Cytotec for the induction of labor?

On April 16, 2004, the Board of Nursing revisited the issue of administration of Pitocin, Prostin E2, prostaglandid gels, Cervidil, Hemabate and Cytotec to a gravid female. The Board decided that the registered nurse, acting in accordance with the provisions of the Mississippi Nursing Practice Law, Rules and Regulations of the Board of Nursing and other Mississippi laws concerning abortion, may administer these and other medications to the gravid female provided:

  1. The registered nurse is educated and competent in the administration of the medication, including but not limited to actions, adverse reactions, monitoring criteria and emergency management procedures;
  2. There is a medical order for the medication;
  3. The registered nurse administers the medications and monitors the patient according to accepted standards of practice; and
  4. The facility has policies and procedures in place to address all aspects of this issue, including but not limited to, physician availability.
 

Vascular Access and Devices

79. Is it within the scope of practice of the registered nurse to administer TPA in declotting a central line?

It is within the scope of practice of the appropriately prepared registered nurse to administer TPA for the purpose of declotting central lines.

 

80. Is it within the scope of practice of the RN to perform intraosseous cannulation and infusions?

The appropriately prepared registered nurse may perform intraosseous cannulation and infusion provided:

  1. The registered nurse is educated and competent in the procedure;
  2. The registered nurse's education and competence are documented initially and on an ongoing basis;
  3. There is a medical order for the procedure;
  4. There is an emergent situation necessitating that the registered nurse performs intraosseous cannulation;
  5. The registered nurse is the most qualified person available;
  6. All the necessary resources are available; and
  7. The facility or agency has policies and procedures in place addressing all aspects of this issue to include, but not limited to:
         A. Specific guidelines/criteria for candidates for the procedure;
         B. A mechanism of data collection for quality control; and
         C. Guidelines for maintenance, use and care

There is no specific reference to or distinction between the types of devices which may be utilized to perform the procedure. As with any nursing procedure, the nurse must be competent to perform the specific procedure and the procedure must be performed according to accepted standards of practice.

 

81. Are RNs allowed to insert external jugular lines?

The appropriately prepared registered nurse may insert an external jugular line in the emergency setting provided:

  1. The registered nurse is educated and competent in the procedure. This education should contain all components of a formal certification course, including insertion, use, care and maintenance;
  2. The registered nurse's education and competence are documented initially and on an ongoing basis;
  3. There is a medical order for the procedure;
  4. All the necessary resources are available; and
  5. The facility or agency has policies and procedures in place addressing all aspects of this issue including, but not limited to:
         A. Specific guidelines/criteria for candidates for this procedure;
         B. A mechanism of data collection for quality control; and
         C. Guidelines for maintenance, use and care.
 

82. Is it within the scope of practice of the RN to remove a femoral arterial sheath or a femoral venous sheath?

It is within the scope of the appropriately prepared registered nurse to remove a femoral arterial sheath or a femoral venous sheath provided:

  1. The registered nurse is educated and competent in the procedure. This education and competence are documented initially and on an ongoing basis. The documented competencies should include hemodynamic monitoring and skills included in ACLS and basic critical care;
  2. There is a medical order for the procedure;
  3. The procedure is performed and the patient is monitored according to accepted standards of care; and
  4. The facility has policies and procedures in place addressing all aspects of the issue.

The registered nurse may not delegate the removal of arterial or venous sheaths to unlicensed personnel.

 

83. Is it within the scope of practice of the RN to insert a peripheral arterial line for blood pressure monitoring?

It is within the scope of practice of the appropriately prepared registered nurse to insert a peripheral arterial line for the purpose of blood pressure monitoring.

 

84. Can a RN remove epicardial pacing wires?

The appropriately prepared registered nurse may remove epicardial pacing wires provided:

  1. The registered nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis. The documented competencies should include hemodynamic monitoring and skills include in ACLS and basic critical care;
  2. There is a medical order for the procedure;
  3. The registered nurse practices and the patient is monitored according to accepted standards or practice;
  4. All necessary resources, including emergency equipment and resources, are readily available;
  5. The facility has policies and procedures in place addressing all aspects of this issue; and
  6. In regard to removal of epicardial wires, the patient does not also have a pacemake in place.
 

Peripherally Inserted Central Catheter (PICC)

85. Can a registered nurse insert or remove a PICC line and what are the requirements?

 

Death Pronouncement

87. Is it within the scope of practice of the registered nurse or licensed practical nurse to certify and/or sign a death certificate?

Registered nurses and licensed practical nurses may not certify death or sign the death certificate.

 

88. Is it within the scope of practice of the registered nurse and licensed practical nurse to pronounce death?

It is within the scope of practice of the appropriately prepared registered nurse to pronounce death provided:

  1. There is documentation that the registered nurse has the knowledge and skills to perform this procedure;
  2. The patient is not connected to or dependent upon a life support device;
  3. There has been contact with the medical provider regarding the patient’s care within the preceding thirty days;
  4. The registered nurse is the most qualified person available; and
  5. The facility has policies and procedures in place addressing all aspects of this issue.

It is not within the scope of practice of the licensed practical nurse to pronounce death or certify death.

 

Registered Nurse First Assistants (RNFA)

89. Is it within the registered nurse scope of practice to be a RNFA?

The appropriately prepared registered nurse may function in the role of RNFA according to the position statement adopted by the Association of Peri-operative Registered Nurses (AORN). The title RNFA should only be used by persons prepared/educated according to AORN’s requirements for RNFAs and functioning in the capacity for which they were educated.

The Board has determined two tasks, suturing and procurement of the saphenous vein, belong solely to the RNFA. Along with other operative nursing behaviors, the RNFA practices under the direct supervision of the surgeon and does not concurrently function as the scrub nurse. Advanced surgical assisting skills may be performed by the registered nurse who has been appropriately educated in the expanded role of first assisting and who has met the criteria for using the title RNFA in accordance with AORN requirements. As additional education and experience are required to obtain the necessary technical skills and knowledge to function as the assistant to the surgeon during an operation, advanced surgical assisting skills are outside the scope of practice the registered nurse. Such expanded perioperative nursing concepts and perioperative nursing behaviors using the nursing process as the basis for providing nursing care to patients experiencing surgical intervention may be assumed only by the RNFA. The RNFA may not delegate advanced surgical assisting interventions/tasks to the registered nurse. Further the registered nurse and RNFA may not supervise an individual practicing beyond his/her scope.

Information regarding educational requirements and the RNFA role can be obtained from AORN, 10170 East MS Avenue, Denver, Colorado 80231, Telephone: (303) 755-6300.

 

Tracheostomy

90. Is it within the scope of practice of the registered nurse to change the inner cannula of a new tracheostomy?

The appropriately prepared registered nurse may change the inner cannula on a new tracheostomy.

 

91. What is the role of the licensed practical nurse in providing tracheostomy care?

It is within the scope of practice of the licensed practical nurse to perform tracheostomy care, nasopharyngeal suctioning and to suction secretions from a trach/endotracheal tube. It is within the scope of practice of the licensed practical nurse to suction secretions from a tracheostomy. However, it is not within the scope of practice of the licensed practical nurse to perform deep right main stem suctioning. If deep right main stem suctioning is required for the patient, a registered nurse must perform this procedure.

Furthermore, the appropriately prepared licensed practical nurse may replace a tracheostomy provided:

  1. The nurse is educated and competent in the procedure. This education and competence are documented initially and on an ongoing basis;
  2. The tract is well healed (for replacement);
  3. There is a medical order for the procedure;
  4. The nurse practices according to generally accepted standards;
  5. All the necessary resources are available;
  6. The patient's status does not contraindicate the procedure; and
  7. The agency/facility has policies and procedures addressing all aspects of this issue. (Policies should specifically address protocols related to elective versus accidental dislodgment of tracheostomy.)
 

Suturing

92. Is it within the scope of a RN to suture?

It is not within the scope of practice of the registered nurse to suture, unless the registered nurse is an advanced practice registered nurse or the registered nurse who meets the definition of a registered nurse first assistant (RNFA).

 

Telenursing

93. Is telephonic case referrals and telephonic case management within the scope of practice of the LPN?

Telephonic case referrals and case management (on-site and telephonic) are not within the scope of practice of the licensed practice nurse in Mississippi. They are within the scope of practice of the registered nurse.

 

94. Do I need to be licensed in Mississippi to provide telephonic case referrals, telephonic case management, and field base case management to residents if I am licensed in another state, and not physically in Mississippi?

In situations of telephonic case referrals, telephonic case management, and field base case management in which the patient is in Mississippi, the practice occurs where the patient is located. Therefore, the nurse must maintain a current, active Mississippi license or a current, active unrestricted multi-state license from another state participating in the Nurse Licensure Compact.

 

Intravenous (IV) Contrast

95. Can a RN teach IV skills and injection of IV contrast agents to registered diagnostic cardiac sonographers(RDCS), medical assistants, nursing assistants, or other unlicensed individuals?

It is not within the scope of practice of the registered nurse to teach IV skills and/or injection of an IV contrast agent to a RDCS, medical assistant, nursing assistant or other unlicensed individual. Furthermore, the registered nurse may not delegate such interventions/tasks to the RDCS, medical assistant, nursing assistant or other unlicensed individual or supervise, in any capacity, the RDCS, medical assistant, nursing assistant or other unlicensed individual performing such interventions/tasks.

 

Cerebrospinal Fluid (CSF) Collection

96. What is the role of the registered nurse in obtaining a cerebrospinal fluid (CSF) sample collection?

It is within the scope of practice of the appropriately prepared registered nurse to obtain a sample of CSF provided:

  1. The registered nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. The specimen is obtained without actively aspirating - a passive drip method could be used;
  3. Sterile techniques are maintained;
  4. There is a medical order for the procedure;
  5. The registered nurse practices according to generally accepted standards; and
  6. The facility has policies and procedures in place addressing all aspects of this issue.​​​​​​​
 
 

Femoral Nerve Block Catheter

97. Is it within the scope of practice of a registered nurse to discontinue femoral nerve block catheters?

On July 27, 2007, the Board of Nursing's Nurse Practice Committee determined that it is within the scope of practice of the appropriately prepared registered nurse to discontinue a femoral nerve block catheter.

 

One-Hour Face-to-Face Evaluation Following Restraint/Seclusion

98. It is within the scope of practice of the appropriately prepared registered nurse to perform a nursing assessment of the patient following restraint or seclusion per facility protocol and/or policy provided:

  1. The registered nurse demonstrates education and current competency in the biological, physical, behavioral, psychological and sociological sciences and of nursing theory as the basis for assessment, diagnosis, planning, intervention and evaluation of the restrained or secluded patient; demonstrates knowledge of all aspects of safe and appropriate application and use of restraints or seclusion including, but not limited to: types or techniques of restraint or seclusion used in the facility, identification of staff and patient behaviors, identification of events and/or environmental factors that may trigger behavioral changes in the patient, and recognition of and response to adverse events (e.g., signs and symptoms of physical and psychological distress);
  2. The registered nurse's education and competency are documented in facility records initially and on an on-going basis;
  3. The registered nurse communicates with (e.g., telephone, e-mail, etc.) the attending physician or advanced practice registered nurse to report the nursing assessment and physical findings;
  4. The registered nurse obtains an order from the attending provider to continue or terminate the restraint seclusion;
  5. The registered nurse practices according to generally accepted standards of practice;
  6. All necessary resources are available; and
  7. The facility has policies and procedures in place to address all aspects of the issue.

It should be further noted that, in accordance with Section 73-15-5 (2) of the Mississippi Nursing Practice Law, it is outside of the scope of practice of the registered nurse to make a medical diagnosis or to draw medical conclusions. Thus, the registered nurse may not make an independent determination to terminate or continue restraints or seclusion.

 

Prescriptions

99. What is the role of the nurse in assisting with prescriptions?

It is within the scope of practice of the appropriately prepared registered nurse and licensed practical nurse to write the patient demographic information, as well as the drug, dosage, frequency and number of refills on a medical prescription as pursuant to a medical order. The nurse may not sign the nurse's name or the name of the individual authorizing the prescription on the prescription.

 

100. Can a licensed nurse document on a prescription based on a prescription bottle and/or based on the medical chart?

It is within the scope of practice of the appropriately prepared registered nurse and licensed practical nurse to write the patient demographic information, as well as the drug, dosage, frequency and number of refills on a medication prescription as pursuant to a medical order. The nurse may not sign the nurse’s name or the name of the individual authorizing the prescription on the prescription. The same standard applies to electronic prescriptions

 

101. Is it within the scope of practice of a licensed nurse to phone-in a prescription to an outside pharmacy for a physician?

It is within the scope of practice of the appropriately prepared registered nurse and licensed practical nurse to communicate the physician's or advanced practice registered nurse's order to the pharmacist.

 

Delegation

102. What tasks are appropriate to delegate to auxiliary workers?

Refer to the Delegation position statement.

 

Assessment

103. Is it within the scope of practice of the licensed practical nurse to perform assessments?

Nursing assessment is outside the scope of practice of the licensed practical nurse. As stated in 30 Miss. Admin. Code Pt. 2830, Chapter I and pursuant to the Mississippi Nursing Practice Law, "The registered nurse shall be held accountable for the quality of nursing care given to patients. This includes assessing the patient's needs, formulating a nursing diagnosis, planning for, implementing and evaluating the patient's care..." It is further stated that the licensed practical nurse "may assist the registered nurse in the planning, implementation and evaluation of nursing care by," in part, "observing, recording and reporting to the appropriate person the signs and symptoms that may be indicative of change in the patient's condition." Therefore, it is the registered nurse's responsibility to perform the initial systems and collective assessment of the patient. The licensed practical nurse may assist the registered nurse with collecting data for that initial assessment and must document and sign the portion of the assessment he/she did. The registered nurse must document and sign the portion of the assessment which he/she completed.

The registered nurse may delegate the observation and recording of a patient's ongoing or subsequent status to the appropriately educated and competent licensed practical nurse. However, the registered nurse is held accountable for the quality of nursing care given by self or others being supervised. There must be documentation that the licensed practical nurse is educated and competent. This education and competence must be documented initially and on an ongoing basis.

Refer to the LPN and Assessment Functions Position Statement
 

Application of Compression Bandages/Dressings (e.g., Unna Boots)

104. Is it within the scope of practice of the licensed practical nurse to apply compression bandages and dressings?

It is within the scope of practice of the appropriately prepared licensed practical nurse to apply compression bandages/dressings provided:

  1. The licensed practical nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The patient must be assessed initially and on an ongoing basis as needed by the registered nurse to determine whether there are contraindications or complications which require additional resources or expertise;
  4. The registered nurse develops and revises as necessary the patient's care plan to include, but not be limited to patient and family education;
  5. The licensed practical nurse is under the supervision of a registered nurse who is available for consultation on a 24-hour basis;
  6. The licensed practical nurse practices and monitors the patient according to accepted standards of practice;
  7. All necessary resources are available; and
  8. The facility/agency has policies and procedures in place to address all aspects of the issue.
 

Compression Drain Care (e.g., emptying, compressing, recompressing, Hemovac/Jackson-Pratt drains)

105. What is the role of the licensed practical nurse when providing nursing to a patient with a compression drain?

It is not within the scope of practice of the licensed practical nurse to irrigate, advance, or remove a compression drain.

It is within the scope of practice of the appropriately prepared licensed practical nurse to perform the following tasks related to compression drain care (e.g., Hemovac, Jackson-Pratt):

  1. Empty and measure drainage;
  2. Tube/catheter insertion site care;
  3. Compress/recompress bulb/evacuator; and
  4. Monitor patency of drainage system.

The appropriately prepared licensed practical nurse may perform these tasks provided:

  1. The licensed practical nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The patient must be assessed initially and on an ongoing basis as needed by the registered nurse to determine whether there are contraindications or changes which require additional resources or expertise;
  4. The licensed practical nurse practices according to accepted standards of practice;
  5. The procedure is performed and the patient is monitored according to accepted standards of practice;
  6. All necessary resources including, but not limited to, emergency resources/equipment are available; and
  7. The facility/agency has policies and procedures in place to address all aspects of the issue.
 

External Cerebral Ventricular Catheter

106. What is the role of the licensed practical nurse in caring for a patient with an external cerebral ventricular catheter?

The licensed practical nurse's role in performing external cerebral ventricular catheter care is limited to the provision of catheter insertion site care.

 

Hyperbaric Oxygen Therapy

107. Is it within the scope of practice of the licensed practical nurse to provide hyperbaric oxygen therapy?

On August 9, 2002, the Board of Nursing's Nurse Practice Committee approved the expansion of the scope of practice of the licensed practical nurse to include providing hyperbaric oxygen therapy in monoplace chamber units provided:

  1. The licensed practical nurse is appropriately educated and certified in hyperbaric oxygen therapy in accordance with National Board of Diving standards. (During the certification training/process, after completion of the mandated 40 hours theory component of the educational program, the licensed practical nurse student (termed hyperbaric technologist student in program) must function under the direct supervision of a registered nurse preceptor certified in hyperbaric oxygen therapy for the required 480 hours clinical practice.) Educational preparation, continuing education and competency evaluations must be in accordance with stated national standards and maintained on file at the facility;
  2. There are medical orders for the procedure, to include control settings and length of therapy;
  3. The physician or nurse practitioner must be present in the facility at all times during the hyperbaric oxygen therapy/treatment. A completed medical history/physical must be on file prior to the implementation of the hyperbaric oxygen therapy;
  4. There is a registered nurse present in the unit responsible for the nursing assessment, planning, and implementation of the patient's plan of care;
  5. The nurse practices according to accepted standards of practice;
  6. Necessary resources are readily available; and
  7. The facility has policies and procedures in place addressing all aspects of this issue.
 

Long Term Care Facility Licensed Practical Nurse IV Care

108. What is the role of the licensed practical nurse, not certified in the IV therapy expanded role, when providing nursing to patients in a long term care facility with an IV?

The appropriately prepared licensed practical nurse who is not certified in the expanded role of IV therapy may:

  1. Monitor/regulate the rate of the plain fluids being administered through a peripheral line.
  2. Monitor the site for infiltration;
  3. Discontinue peripheral IVs;
  4. "Drop" standard IV fluid from bag into buretrol (cannot hang new bag);
  5. Monitor patient receiving intermittent antibiotic infusion provided it is not the first dose.

The licensed practical nurse may perform the above referenced functions concerning IVs provided:

  1. The nurse is educated and competent in the procedures. There should be documentation of the initial evaluation/competency and ongoing competency evaluations;
  2. There is a medical order for the procedure(s);
  3. The nurse practices according to accepted standards of practice; and
  4. The facility has policies and procedures in place to address these issues.

The licensed practical nurse may not:
     A. Initiate a peripheral IV
     B. Hang (spike) a new bag of fluid
     C. Regulate fluids of a central access
     D. Discontinue a central line
     E. Flush a peripheral intermittent vascular access device (Hep lock/INT)

The scope of practice of the licensed practical nurse certified in IV therapy is defined in 30 Miss. Admin. Code Pt. 2840 Chapter 3, and the Mississippi Nursing Practice Law, which can be accessed through the board's website.

 

Nasogastric Tube Insertion

109. What is the board's position on the insertion of nasogastric tubes by licensed practical nurses?

Refer to the Role of the Licensed Practical Nurse in Nasogastric Tube Insertion position statement. It is within the scope of practice of the licensed practical nurse to insert and to discontinue a nasogastric tube. The board does not mandate certification as a prerequisite for the licensed practical nurse to perform this procedure.

 

Patient Teaching

110. Is it within the scope of practice of the licensed practical nurse to provide patient teaching?

Pursuant to Miss. Code Ann. § 73-15-5(2) & (3), the registered nurse may delegate patient education to the appropriately prepared licensed practical nurse provided:

  1. The licensed practical nurse is educated and competent concerning patient education;
  2. The licensed practical nurse's education and competence are documented initially and on an ongoing basis;
  3. The licensed practical nurse is following an education program developed by the registered nurse and practices according to generally accepted standards of care;
  4. The registered nurse develops and documents an educational program for and specific to the patient and re-evaluated the patient and revises the educational program as needed;
  5. All the necessary resources are available; and
  6. The facility/agency has policies and procedures in place addressing all aspects of this issue.
 

PCA Pump

111. What is the role of the licensed practical nurse in monitoring and documenting a patient's response to pain therapy when they have a PCA pump?

The appropriately prepared licensed practical nurse may monitor and document the patient's response to pain control therapy administered via PCA pump in accordance with the following stipulations:

  1. The licensed practical nurse must have successfully completed orientation to the equipment, the agent, and all aspects of related monitoring and documentation. There should be documentation of the initial education/competency and ongoing competency evaluations;
  2. There is a medical order for the procedures;
  3. The nurse practices according to accepted standards of practice;
  4. A registered nurse must be readily available to respond;
  5. The PCA pump must be programmed by either a registered nurse or registered pharmacist and must be locked to prevent rate change;
  6. Re-dosing of the PCA pump must be performed by the registered nurse; The licensed practical nurse may not change or regulate the rate but may stop the infusion if necessary; and
  7. The facility has policies and procedures in place addressing all aspects of this issue.

The Mississippi Nursing Practice Law and the Administrative Code of the Board of Nursing do not preclude the appropriately prepared licensed practical nurse from verifying the PCA pump setting and documenting the same. The record should be clear that the licensed practical nurse is only verifying the pump setting and is not initiating or regulating the PCA infusion.

 

Phlebotomy/Venipuncture

112. Is it within the licensed practical nurse scope of practice to perform phlebotomy/venipuncture to collect blood?

It is within the scope of practice of the appropriately prepared licensed practical nurse to perform phlebotomy for the purpose of specimen collection provided:

  1. The nurse is educated and competent in the procedure. There must be documentation on file of the education and competency initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The nurse practices according to accepted standards of practice; and
  4. The facility has policies and procedures in place addressing all aspects of this issue.

The licensed practical nurse who is not certified in the expanded role of the licensed practical nurse in IV therapy may not perform the phlebotomy procedure for purposes of initiating an IV.

 

Suprapubic Catheter Insertion

113. Can a licensed practical nurse replace a suprapubic catheter?

It is within the scope of practice of the appropriately prepared licensed practical nurse to replace a suprapubic catheter provided:

  1. The licensed practical nurse is educated and competent in the procedure. There is documentation of this education and competence initially and on a ongoing basis;
  2. The registered nurse has determined that this task can be delegated to the licensed practical nurse;
  3. The tract is well healed;
  4. There is a medical order for the procedure;
  5. All necessary resources are available; and
  6. The facility has policies and procedures in place addressing all aspects of this issue.
 

Safety to Practice

114. Am I considered safe to practice if I am taking certain prescription medication or have a certain condition?

Refer to the Safety to Practice position statement.

 

115. Does the Board maintain a list of medications that licensed nurses can not take while practicing nursing?

Refer to the Safety to Practice position statement.

 

Patient Abandonment

116. What constitutes patient abandonment?

Refer to the Patient Abandonment position statement.

 

117. Definition of the practice of nursing by a registered nurse as defined by the Mississippi Nursing Practice Law, §73-15-5:

“The practice of nursing by a registered nurse means the performance for compensation of services which requires substantial knowledge of the biological, physical, behavioral, psychological and sociological sciences and of nursing theory as the basis for assessment, diagnosis, planning, intervention and evaluation in the promotion and maintenance of health; management of individuals' responses to illness, injury or infirmity; the restoration of optimum function; or the achievement of a dignified death. Nursing practice includes, but is not limited to, administration, teaching, counseling, delegation and supervision of nursing, and execution of the medical regimen, including the administration of medications and treatments prescribed by any licensed or legally authorized physician or dentist. The foregoing shall not be deemed to include acts of medical diagnosis or prescriptions of medical, therapeutic or corrective measures, except as may be set forth by rules and regulations promulgated jointly by the State Board of Medical Licensure and the Mississippi Board of Nursing and implemented by the Mississippi Board of Nursing.”

 

118. Definition of the practice of nursing by a licensed practical nurse as defined by the Mississippi Nursing Practice Law, §73-15-5:

“The practice of nursing by a licensed practical nurse means the performance for compensation of services requiring basic knowledge of the biological, physical, behavioral, psychological and sociological sciences and of nursing procedures which do not require the substantial skill, judgment and knowledge required of a registered nurse. These services are performed under the direction of a registered nurse or a licensed physician or licensed dentist and utilize standardized procedures in the observation and care of the ill, injured and infirmed; in the maintenance of health; in action to safeguard life and health; and in the administration of medications and treatments as prescribed by any licensed physician or licensed dentist authorized by state law to prescribe. On a selected basis, and within safe limits, the role of the licensed practical nurse shall be expanded by the board under its rule-making authority to more complex procedures and settings commensurate with additional preparation and experience.”

 

119. Function of the registered nurse according to 30 Miss. Admin. Code, Pt. 2830, Chapter 1:

The registered nurse shall be held accountable for the quality of nursing care given to patients. This includes but is not limited to, assessing the patient’s needs, supervising, formulating a nursing diagnosis, planning for, implementing and evaluation of the nursing care in the promotion and the maintenance of health of each patient for whom responsibility has been accepted.

The registered nurse is accountable for the quality of care given by self or others being supervised. The registered nurse may assign nursing duties to other qualified personnel; assign duties of medication administration of patient medications to other licensed nurses only except as set out in Part 2860, Rule 1.3(a)(2)of the Administrative Code; and assign duties for giving patient treatments to licensed nurses and/or auxiliary workers based upon knowledge of their educational preparation and experienced. The registered nurse remains accountable for the acts carried out, as well as, the outcome of the acts delegated.

 

120. Function of the licensed practical nurse according 30 Miss. Admin. Code, Pt. 2830, Chapter 2:

 

121. Function of the LPN

The licensed practical nurse gives nursing care under the direction of the RN, licensed physician or licensed dentist which does not require the specialized skill, judgment and knowledge required of a RN. This includes but it not limited to assisting the RN in the planning, implementation and evaluation of nursing care, observing, recording, reporting, and performing procedures for which the LPN has the necessary degree of skill and judgment. The LPN shall not be supervised by unlicensed personnel.

 

Working at a Level Lower than Licensed

 

122. Can a LPN work as a nursing assistant? Can a RN who is also licensed as a LPN work as a LPN? Can a licensed nurse work in a lower level certification or licensure status?

The Mississippi Board of Nursing is a consumer protection agency with the authority to regulate the practice of nursing through licensure. Should a licensed individual decide to be employed in any healthcare or non-healthcare setting, The Mississippi Board of Nursing is only charged with the duty to hold that licensee to the pertinent scope of practice.

 

Administration of Blood in Home

 
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123. Can a registered nurse administer blood or blood components in the home setting?

It is within the scope of practice of the appropriately prepared registered nurse to administer blood or blood components in the home setting.

 

Discharge Summary & Dictation

 
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124. Is it within the scope of practice of the registered nurse to dictate a discharge summary?

It is within the scope of practice of the appropriately prepared registered nurse to dictate history and physical, progress/consultation notes and/or discharge summaries provided the physician and/or APRN provides the nurse with the data pertinent to the formulation of the medical conclusion and the medical diagnosis. The registered nurse may not draw medical conclusions, make a medical dianosis or sign for the physician.

 
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Recovery Nurse Program

 
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125. Will I lose my license if I participate in the Recovering Nurse Program?

No, participation in the Recovering Nurse program is a way to help you keep your license while adhering to certain limitations.

 
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126. Who qualifies for inclusion in the Recovering Nurse Program?

The RNP is a program for nurses who have a substance dependency problem and have violated the nursing practice law by diverting medication, forging prescriptions, doctor shopping, and excesive use of prescribed and/or unprescribed medications, work impairment, a history of failed treatments, and the use of illict drugs.

 
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127. How do nurses get into the RNP?

Usually nurses self report or are reported by the facilities they are employed by. The case is opened by an investigator and if the person admits to the actions that violated the NPL and wants to get help then they are referred to the RNP by the investigator in charge of the case.

 
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128. What steps need to be taken to initiate participation?

Nurses are asked to fill out an interest form, a release of information, a questionnaire and agree to pay for an assessment with a professional who meets the board’s criteria. Upon receipt of the assessment, the monitoring staff will contact the nurse about treatment options. Upon completion of treatment, the nurse meets with the monitoring staff, is oriented to and signs an affidavit and enrolls in the drug testing program.

 
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129. Will the nurse be out of practice for a period of time?

Excessive and inappropriate use of drugs and alcohol impairs the user’s judgments, performance, insight and ability to function at their highest level of competence. For healing to occur, most nurses will need to be taken out of the employment environment for a period of time in order to learn appropriate coping skills and boundaries for a successful return.

 
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130. How will I afford the treatment costs?

The monitoring staff of the RNP refers to a wide array of treatment centers from which there has been a history of positive outcomes. There are options ranging from hospital based programs focused on professionals to those of the regional mental health system.

 
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131. How long will I be monitored by the Board before the restrictions are removed from my license?

Nurses in the RNP are monitored for a period of 60 months.

 
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132. What are the benefits of participation?

Recovery from substance dependency is an ongoing process that requires life changing actions and decisions made on a daily basis. The RNP provides the advocacy, structure, accountability, and repetition that assist nurses to achieve transformation of their lives. Combined with attendance and participation in twelve stop programs and periodic therapeutic groups, these principles have been shown to have the most success in supporting and sustaining long term recovery in individuals suffering from this disease.

 
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133. What are the costs of the program?

Once the initial treatment costs have been met, the only other costs are for the random drugs screens, and transportation costs to and from meetings and groups. There are no participation fees.

 
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134. What restrictions will the participant have upon return to practice?

The employment restrictions are designed to provide the participants with safe boundaries for a successful return to practice. Initially participants have no narcotic access, limited work hours, and no return to critical care areas, emergency room or independent settings. Privileges are gradually restored throughout the monitoring period.

 
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Renewal of License

 
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135. Who is eligible to renew on-line?

RNs and APRNs with an active or inactive license that expire December 31st of the immediately prior to a two years within even numbered years. LPNs with an active or inactive license that expire December 31st of the immediately prior two years within odd numbered years. You may renew online if your primary state of residence is Mississippi or another state that is not a member of the Nursing Licensure Compact. ***(A nurse whose primary state of residence is another Compact state is not eligible for licensure in Mississippi. However, an APRN holds a RN license from another Compact state may renew the Mississippi privilege to practice as an APRN online.

 
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136. Which states participate in the Nurse Licensure Compact?

The most current information concerning the Nurse Licensure Compact can be found at www.ncsbn.org

 
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137. If my nursing license expired more than 2 years before the current renewal cycle, can I renew it on-line?

No, you must apply for license reinstatement. Please access the link for Forms and follow the instructions.

 
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138. Can I change my name when I renew online?

No. If you wish to change your name, you must complete a name change form and submit it to the Board office with a fee of 25 dollars and required documentation. Please access the link for Forms and follow the instructions.

 
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LPN Expanded Role Renewal

 
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139. Do expanded role LPNs who renew online have to send in additional documentation to renew certification?

Yes, IF you have been selected by an audit. No, if you have not been selected for an audit. Audits are random. You will be notified upon online renewal if you have been selected. DO NOT send in documenation if you have not been audit.

 
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140. I am an expanded role LPN and I was selected for an audit, what do I need to do to satisfy the requirements of this audit?

You must submit evidence of completion of a minimum of 10 contact hours by December 31st of odd number years in order for you certifciation to be renewed. You must complete and submit the required audit form. The audit form will only be avaliable during renewal. You must download and print during your online renewal. A link to the form will be shown at that time. The evidence of completion must include: the name of the course provider and/or agency; name of course and/or in-service; date(s) of course and/or in-service; name, title, and signature of personnel responsible for course; and the number of hours earned. If you are certified in both IV therapy and hemodialysis you must submit 10 contact hours for each certification, 10 for IV therapy and 10 for hemodialysis. Your LPN expanded role certification will NOT be renewed until the required documentation is submitted, unless you have notified the Board in writing or through the online renewal that you do no wish to renew your certification. Course and/or in-services accredited by the American Nurses Credentialing Center (ANCC) are acceptalbe and must be related to the applicable expanded role. In addition, courses and/or in-services offered through the Mississippi LPN Association and/or through a facility's educational program that are related to the expanded role may be accepted. The Board does not provide continuing education for the LPN expanded role. It is the responsiblity of the licensee to obtain the required contact hours and to find a source.

 
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141. I am a recent LPN graduate within the year. I am certified in IV therapy. It is a LPN renewal year, will I be required to have 10 contact hours?

By virtue of being newly licensed and newly certified you will have met continuing education requirements for the renewal cycle immediately following your graduation. However, you must meet continuing education requirements for the exapanded role after your first renewal.

 
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Active License Definition

 

142. Definition of Active License

The licensee may engage in the practice of nursing at the level indicated.

 
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Inactive License Definition

 

143. Definition of Inactive License

The licensee may not engage in the practice of nursing.

 

Lapsed Licensed Definition

 

144. Definition of Lapsed License

The licensee did not renew their license within the specified time period and may not engage in the practice of nursing.

 

Restricted License Definition

 

145. Definition of Restricted License

The licensee is restricted, ususally as a result of disciplinary action, to practicing nursing in Mississippi and does not have the privilege to practice nursing in any state other than Mississippi.

 

Primary State of Residence Definition

 

146. Definition of Primary State of Residence

Primary state of residency (PSOR) is the state that the licensee declares under penalty of perjury to be their home state. It is the state of a person's declared fixed permanent and principal home for legal purposes. The licensee must be able to provide acceptable forms of proof residency upon request from the Board of Nursing.

 

147. Definition of Multi-State License

The licensee has the privilege to practice nursing in all states which have adopted and implemented the Nurse Licensure Compact.

 

148. Definition of Single State License

The licensee is limited to practicing nursing in Mississippi and does not have the privilege to practice nursing in any other state unless he/she hold a license in that jurisdiction.

 

Disciplinary Action

 

149. How do I obtain information concerning disciplinary actions taken by the Board?

Information concerning disciplinary actions for past years is available on our web site under the Discipline link. Request for additional information concerning past discipline must be submitted in writting with a 20 dollar fee(for record retrieval and the first 50 pages.

 
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