|
General
Questions
Anesthesia
At
its February 10-11, 1993 meeting,
the Board reconsidered its position
on its June, 1990 advisory ruling
regarding injection of anesthetic
agents to produce anesthesia following
placement of the needle by the physician.
The
Board has determined that the registered
professional nurse (RN) may assist
in the procedure by acting as a
"third hand" for the anesthesiologist/anesthetist.
The Board further determined that
the anesthetic agents are to be
drawn up by the anesthetist; the
physician must be present and appropriate
policy should be developed by the
medical and nursing staff. The RN
who is not a CRNA is not to insert
or place the needle. The RN is strictly
assisting as a "third hand"
while the anesthetist administers
the anesthesia.
C-ARM
At
its June 1993 meeting, the Board
determined that while positioning
a C-arm over a patient is not nursing,
it is certainly permissible for
a registered nurse to lend in positioning
the machine as long as the physician
is actually operating the fluoroscopy
C-arm and the nurse has been instructed
on how to move the C-arm.
Chapter
6 Clarification
At
its October 22-23, 1997 meeting,
the Board determined that it would
maintain Chapter 6 as adopted and
provide clarification through the
following advisory ruling in situations
where care is directed by the consumer:
In consumer-directed care provided
by an unlicensed assistive person
(UAP), the registered nurse's responsibility
is to provide the consumer with
appropriate information regarding
the task to be performed by the
UAP.
Chiropractic
Orders
In
accordance with THE LAW REGULATING
THE PRACTICE OF NURSING, licensed
nurses are authorized to execute
the medical regimen prescribed by
a physician, dentist, or otherwise
legally authorized person acting
under the delegated authority of
a physician or dentist (i.e. physician
assistant or nurse practitioner).
On this basis, licensed nurses are
not authorized to execute the medical
regimen prescribed by a chiropractor.
(March 6, 1990)
Coude Catheter
At
its April 12-13, 2000 meeting, the
Board determined that it is within
the scope of practice of a licensed
nurse to insert a coude catheter
providing that he/she has had appropriate
documented training according to
polices and procedures established
by the facility.
Death
Pronouncement
At
its February 8, 1996 meeting, the
Board reconsidered its 1986 ruling
and determined that licensed nurses
may pronounce death in the absence
of any law to the contrary. However,
certification of death must be pursuant
to current state law which requires
the signature of a physician on
the death certificate. The facility
that employs the licensed nurse
should also consider JCAHO and insurance
requirements when setting policies
regarding this matter.
Dispensing
Medication
A
RN or LPN legally may NOT dispense
drugs at any time. Dispensing means
the pouring or placing of drugs
from stock supplies into bottles
or containers, the labeling of such
items with the patient's name, medication,
dosage and directions and the giving
of such bottles or containers to
personnel for administering to patients.
This is the role of the pharmacist
and may not be assumed by nurses.
(1986)
The
Board reaffirmed that LPNs and RNs
are NOT authorized to dispense medications.
The administration of medications
as prescribed by a legally authorized
person is within the scope of practice
of nurses licensed in Maine. (Dec.
27, 1990)
The
Board of Nursing determined that
nurses licensed in Maine may provide
patients with limited quantities
of prescribed/ordered medication
which has been pre-labeled and prepackaged
by the hospital pharmacist. These
"starter packs" will be
administered to the patient in the
emergency department setting following
an evaluation by a physician. This
same procedure will also be used
in inpatient leave of absence situations.
(May 1, 1991)
In
response to a query in April, 1993,
the Board stated that a telephoned
order for drugs at night for an
in-patient is an example of administering
a medication, not dispensing.
A
nurse providing medications to a
patient not evaluated by a physician
in the emergency department is acting
as a pharmacist in dispensing medications
and exceeds the scope of nursing
practice.
EKG
The
Board determined that the taking
of EKGs is not necessarily nursing
practice; however, if any licensed
nurse performs this task, they must
have received the appropriate education
and supervised clinical practice.
Policies and procedures should be
in place to define the appropriate
initial education and continuing
competence of the licensed nurses
involved. The Board has defined
competence in nursing as the ability
of the licensed nurse to perform
skillfully and proficiently the
functions within the current role
of the licensee. The role encompasses
the possession and interrelation
of essential knowledge, judgment,
attitudes, skills and abilities
which are varied and range in complexity.
Competence is a dynamic concept,
changing as the licensed nurse achieves
a higher state of development within
the role. Therefore, if licensed
nurses were expected to perform
and/or "read" EKGs, they
must be currently competent in such
a procedure. September
26, 1990
Endoscope
At
its February 1993 meeting, the Board
determined that it is not within
the scope of practice for nurses
to maintain the position of the
endoscope.
At
its June 9-10, 1999 meeting, the
Board restated its position that
it is not within the scope of a
registered professional nurse's
practice to advance the endoscope
under any circumstances.
At
its February 14-15, 2001 meeting,
the Board revisited the issue and
determined that licensed nurses,
who are educationally prepared according
to the organization/facility's established
policies and procedures, may assist
the physician, who is present in
the procedure room, to maintain
the position of the endoscope, advance
the endoscope, and manipulate the
polypectomy snares as directed by
the physician.
Ergonomics
The
Board at its June 7-8, 1995 meeting
determined that while ergonomics
is not included in basic nursing
curricula, licensed nurses may include
ergonomics in their nursing practice
if appropriately trained.
Hypnotherapy
The
use of complementary or alternative
therapies in general or hypnotherapy
specifically does not expressly
come under the Law Regulating the
Practice of Nursing or under any
specific regulations of the Maine
State Board of Nursing.
At
its December 6-7, 2000 meeting,
the Board determined that hypnotherapy
is not exclusively nursing practice
but may be considered a modality
that a registered professional nurse
may employ if he/she has been appropriately
trained and competency has been
maintained.
Intrauterine
Pressure Catheters
Placement
of intrauterine pressure catheters
is not considered within the scope
of nursing practice.
Investigational
Drugs
At
its February 8-9, 1995 meeting,
the Board determined that licensed
nurses may administer investigational
drugs. The Board is of the understanding
that guidelines and requirements
for investigational drugs are so
strict as to safeguard the public's
health. The licensed nurse should
be familiar with these guidelines
and requirements and exercise the
same caution in administration as
with any other drug.
J-Tubes
and T-Tubes
The Board at its
February 10-11, 1993 meeting determined that with appropriate
training and documented clinical competency, a LPN may irrigate
J-tubes. It is not within the scope of practice of a LPN to
irrigate T-Tubes. It is not within the scope of practice of
a LPN to remove all types of ureteral catheters.
The
Board at its October 21-22, 1998
meeting determined that a licensed
nurse may perform the following
skills related to the J-tube with
training by a registered professional
nurse and documented competency:
1. Administer medications via J-Tube
2. Flush a J-Tube with normal saline
before and after administering a
medication
3. Insert and remove a J-Tube on
a well established tract
4. Check the sterile water level
in the J-Tube Balloon and re-inflate
the Balloon with saline
5. Perform routine dressing changes
on the J-Tube site
The
Board at its June 7-8, 2000 meeting
determined that it is not within
the scope of practice of a licensed
nurse to introduce a guide wire
to unplug a J-Tube.
The Board at its
August 2-3, 2000 meeting determined that it is not within
a registered professional nurse's scope of practice to remove
a Jackson-Pratt (J-P) draining device.
The Board at its
June 5-6, 2002 meeting determined that with appropriate training
a registered professional nurse may remove a J-P training
device.
Lymphedema
At
its July 9, 1998 meeting, the Board
determined that within the framework
of a nurse's license, and with the
appropriate knowledge and skill
training, the method of manual lymph
drainage may be performed.
At
its September 10, 1998 meeting,
the Board revised the advisory ruling
of July 9, 1998 to read: that within
the framework of a nurse's license,
and with appropriate knowledge and
skill training, the method of combined
decongestive therapy may be performed.
Myringotomy
The
Board at its October 23-24, 1996
meeting determined that it is not
within the scope of advanced practice
nursing to perform myringotomies.
Operating
Room (O.R.) Circulating Nurse
In
December, 1984, the Board stated
that it believed that the registered
professional nurse is the appropriate
person to be the circulating nurse
in the operating room and that this
function should not be delegated
to the licensed practical nurse.
Again
in September, 1990, the Board determined
that the registered professional
nurse circulating in the operating
room cannot be replaced by the licensed
practical nurse or an unlicensed
technician.
In
1989 the Board determined that the
Law Regulating the Practice of Nursing
does not govern scrub technicians.
Phlebotomy
The
Board determined that the performance
of phlebotomy is not considered
the practice of nursing; therefore,
it is not necessary for the registered
nurse to be physically present in
the facility when the LPN performs
phlebotomy. September 28, 1990
Physician
Licensed in Another State
It
is the opinion of the Board's legal
counsel that "licensed physician"
(32 M.S.R.A. section 2102 (2)(A))
does not refer exclusively to physicians
licensed in Maine. As long as the
physician is duly licensed in the
jurisdiction in which he or she
is in practice and issues orders,
then it is appropriate for nurses
to carry out those orders. Should
the nurse have reason to suspect
licensure status of any physician
(allegedly licensed in Maine, New
Hampshire, New Brunswick, etc.),
s/he should follow the agency's
policy for ensuring valid credentials.
This is NOT intended to mandate
home health agencies maintain credentials
on providers but rather follow the
protocol they normally would if
questioning licensure status. April,
1992
Practice
Below Level of Licensure
A
licensed person who agrees to be
employed in a position which requires
less knowledge and skill than that
for which s/he is prepared may find
several problems:
1. S/he may be expected to perform
at the level for which s/he has
been prepared even though classified
at a lesser level; and
2. S/he will be held to the standard
expe cted of the higher licensure
level should legal problems occur
in that health care facility, no
matter what the job classification.
The
practice of employing licensed individuals
to work below their level of preparation,
as defined in the LAW REGULATING
THE PRACTICE OF NURSING, places
that licensed nurse in potential
legal jeopardy and is of serious
concern to the Board. (1985)
[The
DATA BASE /The Bulletin /Spring
1985]
Refresher
Course
The
Board has a mandate to safeguard
the life and health of the people
in this state. To that end, the
Board routinely recommends that
individuals who have not practiced
nursing in the past few years take
a refresher course. The Board does
not have any information regarding
the availability of refresher courses
and has no mandate to provide specific
information about them to licensees.
Licensed nurses have a legal and
professional obligation to maintain
their competency to practice nursing
prior to their accepting employment
in nursing. (March 15, 1990)
Telephone
Orders
Maine
Board of Licensure in Medicine and
Maine State Board of Nursing
February, 1995 / Joint
Advisory Opinion: Telephone Orders
Purpose:
1.
To clarify the roles and responsibilities
of physicians and nurses regarding
telephone orders.
2. To insure public protection and
assure quality of care.
Physicians, nurses and other health
care providers rely on the professional
skills and integrity of all participants
in the health care delivery process.
Physicians are responsible to assure
that the orders communicated are
appropriate to the situation, and
that orders are accurately relayed
from the physician's office. Nurses
may accept physician orders via
telephone from office personnel
designated by the physician. In
receiving orders from physician
offices, nurses are responsible
for recognizing the appropriateness
of the order with respect to the
plan of care, and for implementing
the order or obtaining clarification.
VA
License Requirement
The
Board's legal counsel has advised
that any nurse from the VA Hospital
who participates in an educational
clinical experience at Maine Medical
Center or any other health care
facility within the state would
be required to have a current Maine
license. (June 22, 1984)
Vaccines
At
its 4-5, 2000 meeting, the Board
reiterated that a nurse may not
administer vaccine without a physician's
order.
|
