LPN Scope of Practice Michigan PDF

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Michigan LPN scope of practice...

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ich igan Licensed Pr actical Nurses Association Mic 20 Long g Blv lvd. Suit e 6, 6, Lansing, g, MI 489 89111 1020 7-694 94-17 1700 Fax ax: 517-69 4-1 -1702 517E-mail: i n fo@ o@mlpn pna.orgg

LICENSED PRACTICAL NURSE * SCOPE OF PRACTICE MICHIGAN In 1978, Michigan incorporated its Nurse Practice Act into the Michigan Public Health Code (MPHC). Formerly called “Nurse Practice Act”, it is now called “Practice of Nursing” under Michigan Public Health Code. Each state has its individual definitions for the Practice of Nursing. This ‘scope’ of practice helps define what range of practice a nurse can or cannot legally perform. Scope is not the same as Standards. In 1978, Michigan legislature combined all laws regulating health personnel into one statute consolidating the legal framework for nursing in the Michigan Public Health Code, rather than a separate Nurse Practice Act. Rules governing nursing found in the Occupational Codes and in the Administrative Rules of Nursing are used by the Michigan Board of Nursing as the guidelines to issue licenses and promote the health, safety and welfare of the public. LICENSING & REGULATION GUIDELINES Nurses are licensed to ensure that the public receives a high level of care consistent with the law and the standards set by the state. Legal regulation(s) of nursing practice are based on the definition of nursing in the Nursing Section ( Part 172 ) of the Michigan Public Health Code. Legal boundaries are derived from this Section and are used as the basis for interpreting the safe practice of nursing. Occupational Regulation Sections help define licensure, delegation, and supervision. The Bureau of Health Professions provides administrative support services for licensure and regulation licensed under MPHC. Such services include mailing licenses & renewal notices, collecting license fees, investigating activities related to the practice of nursing, holding hearings and ordering relevant testimony to be taken, and then reporting the findings to the Board of Nursing. NURSING STANDARDS OF PRACTICE State government plays a role in ensuring that nursing maintains appropriate standards of patient care. The legislative branch establishes laws based on input from nursing professionals. The judicial branch applies and interprets the laws. The executive branch provides the administrative structure to enforce the laws. Governmental regulation, however, sets only minimum standards. It is up to nursing professionals individually and through their professional Association to encourage excellence. PREVAILING STANDARDS OF CARE Standards are derived from many sources: legal regulation, professional regulation, professional literature, educational program curricula, research and other areas. Standards determine qualifications for persons to perform delegated functions. While an individual may claim she/he is capable of performing a certain task, the acceptable and prevailing standards of care determines the appropriateness of delegating that task.

Michigan Public Health Code 1978 PA 368, as amended: I.

OCCUPATIONAL REGULATIONS --MICHIGAN PUBLIC HEALTH CODE

R 333.16106 License means an authorization issued under state law to practice where practice would otherwise be unlawful. R 333.16174 License/registration requirement—be of good moral character & have specific education or experience, or training equivalent, or both, necessary to promote safe & competent practice & informed consumer choice.

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LPN Scope of Practice - Michigan

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DEFINITION OF NURSING R 333.17201 NURSING “Practice of nursing” means the systemic application of substantial specialized knowledge and skill, derived from the biological, physical, and behavioral sciences, to the care, treatment, counsel, and health teaching of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury, or disability. “Practice of nursing as a licensed practical nurse” or ”l.p.n.” means the practice of nursing based on less comprehensive knowledge and skill than that required of a registered professional nurse and performed under the supervision of a registered professional nurse, physician, or dentist. R 333.16105 Health profession subfield means an area of practice established under this article (Art. 15 Health Occupations) which is within the scope of activities, functions, and duties of a licensed health profession, and requires less comprehensive knowledge and skill than is required to practice the full scope of the health profession. R 333.17208 The practice of nursing as a licensed practical nurse is a health profession subfield of the practice of nursing.

SUPERVISION R 333.16109 Definitions S to T (2) Supervision The overseeing of or participation in the work of another individual by a health professional licensed under this article in circumstances where at least all of the following conditions exist: (a) The continuous availability of direct communication in person or by radio, telephone, or telecommunication between the supervised individual and a licensed health professional. (b) The availability of a licensed health professional on a regularly scheduled basis to review the practice of the supervised individual, to provide consultation to the supervised individual, to review records, and to further educate the supervised individual in the performance of the individual’s functions. (c) The provision by the licensed supervising health professional of predetermined procedures and drug protocol. [note: ‘supervision’ does not conclude a nurse’s title as ‘supervisor’]

DELEGATION

Article 15 Occupations; Part 161 General Provisions

R 333.16104; Definitions “Delegation” means an authorization granted by a licensee to a licensed or unlicensed individual to perform selected acts, tasks, or functions that fall within the scope of practice of the delegator and that are not within the scope of practice of the delegatee and that, in the absence of the authorization, would constitute illegal practice of a licensed profession. R 333.16215 Delegation of acts, tasks, or functions to a licensed or unlicensed individual; supervision: A licensee who holds a license other than a health profession subfield license may delegate to a licensed or unlicensed individual who is otherwise qualified by education, training, or experience the performance of selected acts, tasks, or functions where the acts, tasks, or functions fall within the scope of practice of the licensee’s profession and will be performed under the licensee’s supervision. An act, task, or function shall not be delegated under this section which, under standards of acceptable & prevailing practice, requires the level of education, skill and judgement required of a licensee under this article. [Licensee = RN, MD, DO?] An individual who performs acts, tasks, or functions delegated pursuant to this section does not violate the part that regulates the scope of practice of that health profession.

II.

ADMINISTRATIVE RULES--BOARD OF NURSING

R 338.10104: Delegation Only a registered nurse may delegate nursing acts, functions or tasks. R 338.10201 Licensure Core Curriculum for practical nurse applicants--means courses in both didactic instruction and planned clinical learning in each of the following 4 areas of nursing: (i) Medical nursing, nursing care for the adult patient who is in the acute or chronic phases of a medical illness. Includes geriatric nursing.

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LPN Scope of Practice – Michigan (ii) (iii)

(iv)

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Obstetrical nursing, nursing care for women in phases of pregnancy, and includes the care of the newborn infant. Gynecological nursing alone does not fulfill this obstetric nursing education requirement. Pediatric nursing, nursing care for children whose ages range from birth through adolescence and who are receiving nursing care for both medical and surgical reasons. Does not include newborn nursing education. Surgical nursing, nursing care for the adult patient who is receiving nursing care for a surgical procedure.

MLPNA COMMENT Note that Michigan law governing LPNs is very general and does not mention specific tasks or functions the LPN can or cannot perform, nor does it prohibit the LPN from doing specific tasks or functions. However, there may be additional regulations in other sections of the Michigan Public Health Code or through additional regulatory bodies that further help define nurse practices. It is up to the practicing health care professional to know the specific regulations that apply to their practice and kind of facility or care setting in which they are working. From MLPNA contacts with LPNs throughout the state, it remains clear there continues to be a great variation in LPN practice from facility to facility. It is also clear that there is very little restriction placed on the LPN by the state of Michigan. It is our conclusion that most restrictions placed on LPN Practice are those by individual facilities..

MLPNA 4 POINT SUMMARY OF THE LPN SCOPE OF PRACTICE The LPN must be trained to perform the nursing tasks he or she does. The LPN must hold a current license. The LPN must work under the supervision of a physician, dentist or RN. The LPN may not delegate LPN tasks or functions to unlicensed personnel.

NURSING PROFESSIONAL ACCOUNTABILITY The degree to which an individual nurse functions is influenced by license, experience, level of education, and by needs of the recipients served. The legal regulation of nursing practice applies to all licensed nurses regardless of the practice setting or employment status. The employer is the facilitator of care. Providing safe care to the public is dependent on both the nurse and the employer fulfilling their appropriate roles. (MNA, pg. 30) In each setting, nurses need to be clear about the standards for which they are accountable, and what nursing functions must be done by the RN. The RN determines which tasks may be delegated to a LPN if client condition warrants delegation. Then the RN determines which tasks may be delegated to unlicensed assistive personnel, if client condition warrants delegation.

Unlicensed Assistive Personnel (UAP) As defined by American Nurses Association (ANA): Individuals who are trained to function in an assistive role to the registered professional nurse in the provision of patient/client care activities as delegated by and under the supervision of the registered professional nurse. UAP’s include such job titles as: Hospital setting: nurse aides, patient care aides, orderlies, assistants, attendants, technicians. Long-term care: the competency-evaluated nurse’s aide (CENA), defined in federal statute. Home Care: certified home health aide (CHHA) MLPNA--Working to Promote, Support, and Protect the Profession of Practical Nursing

LPN Scope of Practice – Michigan

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In 1987, the Division of Federal Support Services, which implements certain amendments to Medicare & Medicaid regulations mandated that each state must have training & competency evaluation programs for nurse aides employed by Medicare participatory skilled nursing facilities, & to establish a nurse aide registry. Michigan has a Nurse Aide Registry.

ADMINISTRATION OF PARENTERAL FLUIDS & BLOOD PRODUCTS NURSING HOMES & NURSING CARE FACILITIES RULES, Division of Licensing & Certification R 325.20504-5: Parenteral fluid, blood and blood substitute administration “shall be started by a physician or registered nurse”; parenteral fluids “shall be supervised in the course of administration by a physician or licensed nurse.” MLPNA comment: In Nursing Homes, LPNs could monitor but not start IV’s. Adding medications is determined by facility policy. There is no mention specifically for LPNs, but rules clearly state that “staffing” must be by a physician or registered nurse. MDCH has not provided any interpretation of the word “staffing”.

ADMINISTRATIVE RULES OF THE MICHIGAN BOARD OF NURSING PROVIDING SAFE CARE TO THE PUBLIC Providing safe care to the public is dependent on both the nurse and the employer fulfilling their appropriate roles. The employer** is the facilitator of care. The nurse is the provider and coordinator of direct care services. Both are legally accountable under law for what they do. Registered nurses are identified as licensed health professionals who are independently accountable for their own actions in nursing. The independent license of a RN imposes as a primary responsibility a legal accountability to the patient/ recipient of care. Accountability to other disciplines or the employer is secondary. A non-nurse cannot assume the performance of nursing acts, functions or tasks. Under MPHC Part 161 333.16215 (1) a licensee who holds a license other than a health profession subfield license may delegate to a licensed or unlicensed individual who is otherwise qualified by education, training, or experience….An act, task, or function shall not be delegated which, under standards of acceptable and prevailing practice, requires the level of education, skill, and judgement required of a licensee under this article. Kinds of Licensees who may delegate: MD, DO, RN Licensees of this level may delegate to: RNs, LPNs, Unlicensed assistive personnel (UAP) when appropriate.

DISCIPLINARY ACTION The Public Health Code grants the Michigan Board of Nursing the authority to discipline licensees for infractions of the law. Improper performance or activities by nurses may merit a complaint or allegation to the Department of Consumer & Industry Services. The department has an allegation form that can be used to lodge such charges. The allegation must be in detailed and in writing. When a nurse violates the Public Health Code, that nurse must be reported. State law 333.16222--Knowledge of a violation--states that “a licensee or registrant having knowledge that another licensee or registrant has committed a violation under Sect. 16221 or Article 7 (see rules below) shall report the conduct and the name of the subject of the report to the department” (CIS). Information obtained by the department under this subsection is confidential.

MICHIGAN BOARD OF NURSING In 1909, the Michigan Nurse Practice Act. Public Act 319 was passed, and imposed the legal obligation upon the Michigan Board of Nursing as the Regulator of nursing practice. In 1952, provision was made for licensure of practical nurses. Functions of the Board of Nursing include:  Grant licenses to RNs and LPNs  Impose disciplinary action on licensees, which includes levying fines for violations  Establish standards for education & approve education programs  Grant certification of specialties  Generate/update administrative rules concurrent with the Michigan Public Health Code and Amendments  Review test items for NCLEX exams.  Determine distribution of Nurse Scholarships MLPNA--Working to Promote, Support, and Protect the Profession of Practical Nursing

LPN Scope of Practice – Michigan

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INFLUENCE OF ACCREDITING & REGULATORY BODIES ON THE PRACTICE OF NURSING CONDITIONS FOR MEDICAID/MEDICARE PARTICIPATION FOR HOSPITALS AND NURSING HOMES Medicaid/Medicare Conditions for Participation are not law, but are interpreted and enforced by the Michigan Department of Public Health (now Michigan Dept. of Community Health). Facilities are not required by law to adhere to these Conditions, but a facility may jeopardize their reimbursement from Medicare/Medicaid by not adhering to such Conditions. Medicaid/Medicare Conditions for Participation continually change, yet may not be up to date with today’s practical nurse training. In 1984, Conditions were: LPN as OR NURSE--The LPN may not serve as an OR (Operating room) circulating nurse. Phone Orders--The LPN may not take phone orders in hospitals;The LPN MAY take phone order in nursing homes. IV Therapy IV medications must be administered according to state law. The LPN must follow special rules on IV Therapy as interpreted by the MDCH. State Law states: Hospitals—Medicare/Medicaid Conditions: “If IV medications are administered by registered nurses, they must be trained for this duty”. The Medicaid/Medicare Conditions do not mention LPNs. MDCH recognizes that LPNs commonly work with IV medications and that the rules do not take into account for current LPN training. MDCH interpretation is: “LPNs may be involved with the administration of IV medications in accordance with established hospital policies and procedures.” LPNs must also receive special IV Therapy training. ( 2001 Update ) Michigan Medicaid uses the following rules for nurses: R 333.17201, R. 333.16109, R333.16104, and 338.10104. (Listed above ) Note: Under Medicare/Medicaid Conditions of Participation, individual facilities determine staff functions and may further limit the LPN practice regardless of the rules.

DEFINITION OF EMPLOYER Under Michigan Compiled Law, an employer (under this section of the act--PA 368) are defined as health facilities or agencies that employ, contract with or grant privileges to a health professional licensed or registered under Article 15. Employers must report violations of the Public Health Code.

DIVISION OF HEALTH FACILITY LICENSING & CERTIFICATION This division serves the public by reviewing care in health facilities which include:  Intermediate care facilities/mentally  Advocacy groups retarded(ICF/MR) programs  Ambulatory surgical centers  Nursing homes  Corrections department infirmaries  Other state offices  End state renal disease facilities (ESRD)  Outpatient physical therapy services  Freestanding outpatient surgical facilities  Patients’/ residents families (FSOF)  Portable X-ray programs  Home health agencies  Provider organizations  Hospices  Psychiatric hospitals  Hospitals--accredited & non-accredited  Rural health clinics This division works closely with the US Dept. of Health & Human Services (HCFA) to survey, certify, and enforce Medicare & works with state level agencies similarly for Medicaid programs. Compiled by: Michigan Licensed Practical Nurses Association References: Occupational Regulation Sections & Administrative Rules of Nursing are available from Web Site: www.michigan.gov/health license or by calling (517) 373-8068. Portions of commentary from MNA Regulation of Nursing Practice, 1999 (with permission).. C:LPN Scope of Practice\Scope & MCL Codes.doc Revised Fall 2001

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