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Questions
Related to Registered Professional
Nurses (RN)
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
Anesthetic
Agents
At its April 10-11,
2002 meeting the Board reiterated that a registered professional
nurse may not administer anesthetic medications for the purpose
of anesthesia unless the nurse is a certified registered nurse
anesthetist. However a registered professional nurse may administer
anesthetic agents, such as Diprivan, for the purpose of analgesia,
muscle relaxation, or sedation provided that the nurse has
received the appropriate documented training based on the
facility's established policies and procedures.
Reviewed March 2, 2006.
Arterial
Lines
At its April, 1996 meeting, the
Board determined that registered
professional nurses with documented
training may perform arterial line
insertions.
Assessment
The
Board determined that the performance
of a nursing assessment is a proper
function of the registered professional
nurse and is NOT within the purview
of a practical nurse license. The
act of performing a nursing assessment
can NOT be delegated by a registered
nurse to a licensed practical nurse
on the basis of the limitations
within the curricula of practical
nursing programs. Such curricula
do not include the theoretical and
clinical preparation necessary for
the effective performance of nursing
assessments. December 18, 1990
Cardioversion
At
its October, 1993 meeting, the Board
determined that it is not within
the scope of practice for the registered
professional nurse (RN) to independently
perform synchronized cardioversion.
This is not intended to preclude
the RN performing cardioversions
in life-threatening emergencies.
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.
Chest
Tubes
At
its August 2-3, 2000 meeting, the
Board reaffirmed that a registered
professional nurse may not remove
chest tubes.
Defibrillation
RNs
do not have to be ACLS certified
to use a defibrillator. (1988-89)
In
June, 1984, the Board determined
that the procedure of defibrillation
is not within the usual scope of
practice of the LPN, but if the
LPN is ACLS certified, s/he may
perform defibrillation under the
delegation and supervision of the
MD or the ACLS certified RN in an
emergency situation.
On
September 28,1990 the Board stated
that a registered professional nurse,
who holds a current certificate
of completion from an American Heart
Association sponsored certificate
program for life support, may perform
those functions for which s/he has
received the required education
and training and has been deemed
qualified to perform. Policies and
procedures should be agreed upon
by medical, nursing, administrative
and legal staffs before implementation.
Device
to Insert Hair
At
its June 9-10, 1999 meeting, the
Board determined that it is not
within the scope of practice for
a registered professional nurse
to utilize a device which forms
needle-like openings in the scalp
and inserts hair.
Dextro
Stix
At
its October 22, 1984 meeting, the
Board discussed whether a registered
nurse could use Dextrostix for the
assessment of blood glucose levels
in evaluating diabetic clients without
orders from a physician. The Board
agreed that because assessment is
a nursing function and the responsibility
of the RN, the nurse may utilize
the best methods available in order
to make a proper assessment.
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.
Electrical
Stimulaton for Incontinence
At
its October 17 and 18, 2001 meeting,
the Board determined that a registered
professional nurse with appropriate
education and supervision according
to defined competencies and established
facility/organization policies and
procedures, may perform electrical
stimulation for the treatment of
incontinence.
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.
Endotracheal
Intubation
The
RN who has had the required educational
preparation and supervised clinical
practice may perform endotracheal
intubation when such function is
delegated by a physician, in a health
care facility that has written institutional
policies and procedures regarding
such practice. (1986)
The
RN who has had the required educational
preparation and supervised clinical
practice may perform endotracheal
intubation on the neonate when the
function is delegated by a physician,
in a health care facility that has
written institutional policies and
procedures regarding this practice.
(1989)
Epidural
Catheters
At
its February, 1987 meeting, the
Board was requested to issue an
advisory ruling regarding the instillation
of medications into epidural catheters
for long term pain management. It
is the opinion of the Board that
it is within the scope of practice
of a registered professional nurse
to instill analgesics into an epidural
catheter as follows:
1. Bolus doses of epidural analgesics
may be given by a registered nurse
(RN) who has had supervised instruction
in the proper method of bolus administration.
2. Nursing responsibilities re:
instillation of medications into
epidural catheters are as follows:
(a) assessment of medication effectiveness;
(b) assessment and management of
side effects related to the epidural
administration of narcotics;
(c) maintenance of the integrity
and sterility of the epidural line;
and
(d) patient/family teaching.
In
June, 1987, the Board amended the
previous advisory ruling re instillation
of medications into epidural catheters
by a registered nurse to include
the additional method of continuous
infusion.
In
May,1988, the Board included postoperative
pain management via epidural catheter.
In
December, 1988, the Board determined
by consensus that it is within the
scope of practice of a RN to instill
anesthetic medications, e.g., marcaine
.5% into epidural catheters for
pain management, under the conditions
indicated in the previous advisory
ruling.
In
February, 1993, the Board determined
that the RN may manage the care
of patients in labor receiving epidural
analgesia by continuous infusion
under the following conditions:
1. Placement of catheter, administration
of the initial dose of medication
and establishment of analgesic dosage
parameters are done by the specialty
of anesthesia or an obstetrician
who has been granted privileges
by the institution;
2. A qualified anesthesia provider
must be immediately available as
defined by institutional policy;
3. Only those RNs with documented
education beyond licensure which
is specific to obstetric analgesia
may adjust the drug infusion rates
in compliance with the anesthesia
provider's specific written orders
and institutional policy.
At
its February, 1996 meeting, the
Board determined that a RN with
documented training may remove epidural
catheters.
Extubation
The
Board determined that extubation
of the patient is within the scope
of practice of the RN who has had
appropriate education and supervised
clinical practice, provided that
anesthesia back up is available
in the facility, patient criteria
are clearly delineated and policies
and procedures agreed upon by nursing,
medical, legal and administrative
staff. October 2, 1991
Fetal
Pulse Oximetry
At
its December 8-9, 1999 meeting,
the Board determined that a registered
professional nurse may place a fetal
pulse oximetry sensor if he or she
has had the appropriate documented
training according to protocols
established by the health care facility.
Fetal
Scalp Electrodes
The
registered professional nurse may
place fetal scalp electrodes if
he or she has been trained to do
so.
Halo
Traction
At
its February, 1995 meeting, the
Board determined that a registered
professional nurse may tighten the
loosened bolts on a halo traction
if he or she is properly trained
to do so.
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.
Intrathecal
Catheters
At
its October, 1993 meeting, the Board
determined that it is within the
scope of practice of a registered
professional nurse (RN), who has
had appropriate supervised training
in intrathecal management, to instill
medications via bolus or continuous
infusion into an intrathecal catheter
for the purposes of pain management,
administration of chemotherapy,
spasmolytics and antibiotics. Administration
of neurolytic agents by a RN is
prohibited. Nursing responsibilities
regarding administration of medications
into intrathecal catheters include:
(a) assessment of medication effectiveness
(b) assessment and management of
side effects related to intrathecal
administration of drugs
(c) maintenance of the integrity
and sterility of the intrathecal
line, and
(d) patient/family teaching.
Laryngeal
Mask Airway
At
its June 9-10, 1999 meeting, the
Board determined that it is not
within the scope of practice
of a registered professional nurse
to intubate and/or place the Laryngeal
Mask Airway (LMA) for patient airway
management.
At
its February 14-15, 2001 meeting,
the Board revisited the issue based
on changes in national standards
and determined that a registered
professional nurse, who is educationally
prepared
according to the organization/facility's
established policies and procedures,
may intubate and/or place the Laryngeal
Mask Airway (LMA) for patient airway
management.
Lumbar
Punctures
On
June 25,1984 the Board determined
that the performance of lumbar punctures
by registered professional nurses
in advanced roles is not considered
to be within the scope of nursing
practice in Maine.
Neuromuscular
Blockers
At
its December 13, 1995 meeting, the
Board determined that appropriately
trained registered nurses may, under
the direction of a physician, administer
neuromuscular blockers for ventilation
support.
At
its December 6-7, 2000 meeting,
the Board reaffirmed its December
13, 1995 decision that appropriately
trained registered nurses may, under
the direction of a physician, administer
neuromuscular blockers for ventilation
support. The intent of this decision
was not to limit this practice to
a hospital setting.
Registered
professional nurses may deliver
a neuromuscular block, in support
of a ventilator patient, while caring
for a patient in transport from
one hospital to another in an ambulance.
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.
Paracentesis
At its March 1-2,
2006 meeting, the Board stated that there are no provisions
in the Law Regulating the Practice of Nursing or in the Board's
opinion to preclude a registered professional nurse from removing
a paracentesis tube from a patient in an acute care setting
provided that the nurse has had the appropriate training based
on the facility's established policies and procedures.
PICCs
- Peripherally Inserted Central Catheters
At
its April, 1992 meeting, the Board
determined that it is within the
scope of practice for a registered
professional nurse to insert a biocompatible,
flexible venous catheter via a peripheral
vein under the following circumstances:
1. The registered nurse has substantial
experience in intravenous therapy
and a solid understanding of central
lines
2. The registered nurse has undergone
a specialized educational program
which includes but is not limited
to:
(a) anatomy and physiology of the
insertion site and venous and arterial
systems
(b) patient screening
(c) equipment
(d) sterile insertion technique
(e) supervised clinical experience
(f) complication identification
management
(g) catheter care, and
(h) a mechanism for quality assurance
and periodic review for competency
3. The peripheral catheter insertion
site is the antecubital area or
the optimal vessel in one of the
extremities.
4. The catheter length for each
patient is measured using specified
anatomical landmarks for the tip
location intended. The catheter
tip destination may be the axillary,
subclavian or brachiocephalic vein
or the superior vena cava.
5. The catheter location is confirmed
radiographically prior to administration
of any solutions when the tip is
advanced beyond the axilliary vein.
The
role of the registered nurse in
placing the peripherally inserted
central catheter includes patient
assessment, pre-procedure instructions,
post-procedure assessment of patient
tolerance and frequent, periodic
examinations of the site including
dressing changes. The registered
nurse is responsible for possessing
the level of knowledge and skill
to administer a variety of solutions
safely through the catheter including
antibiotics, antineoplastics, blood
components, and parenteral nutrition.
The registered nurse may also be
responsible for teaching the patient/family
self-care of the device and management
of the symptoms.
The Board at its
June 9-10, 1992 meeting determined that a registered nurse
may use a guidewire when inserting a peripherally inserted
central catheter (PICC).
At its April 2-3, 2003 meeting, the Board determined that
a registered professional nurse may use the Microintroducer
and Ultrasound Technique to place peripherally inserted central
lines (PICC) provided that the nurse has had the appropriate
education and training according to the organization/facility's
policies and procedures.
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
Prostaglandin
Suppositories
At
its October 11-12, 1996 meeting,
the Board revisited its previous
ruling re: registered professional
nurses inserting prostaglandin suppositories.
The Board determined that procedurally
a registered professional nurse
could insert a vaginal suppository
but with respect to this particular
drug, the facility must have policy
and procedural safeguards, sufficient
documented education and training
of the registered professional nurse
and agreement among medical, nursing
and administrative staff.
Scabies
Scrapings
At
its December 8-9, 1999 meeting,
the Board determined that skin scraping
with subsequent microscopic examination
for the purpose of identifying the
presence or absence of a scabies
infestation is within the scope
of practice of a registered professional
nurse providing he or she receives
the appropriate, documented training
based on the following diagnostic
procedure:
1. apply mineral oil to the skin
in an area which is not excoriated
but where papules appear to be present
2. with a #15 blade or curette,
scrape the area
3. apply scale to slide
4. view the slide under a low magnification
microscope and observe for mites,
or eggs.
Skin
Anesthetic
In
1988-1989, the Board determined
that a registered professional nurse
who has had appropriate instruction
and supervision, may inject an anesthetic
medication prior to the insertion
of a peripheral intravenous line
for the purpose of providing comfort
to the patient, providing that the
procedure has been delegated to
the nurse by a physician
Spiral
Electrodes
Registered
professional nurses licensed in
Maine may apply internal spiral
electrodes if the following conditions
are met:
(a)
the nurse has had appropriate education
and supervised clinical practice
following NAACOG certification guidelines
(b) the above is documented and
(c) the health care facility has
established policies and procedures
regarding such application which
are agreed upon by nursing, medical,
administrative and legal staff.
(April
12, 1990)
Subfascial
Catheter
At
its April, 1993 meeting, the Board
determined that it is within the
scope of practice for the registered
professional nurse to inject 10
cc of ).5% marcaine with epinephrine,
for the purpose of pain management,
into the subfascial catheter inserted
by the physician. the nurse should
have the appropriate training and
supervision prior to assuming responsibility
for subfascial administration.
The
Board at its October 6-7, 1999 meeting
determined that it is not within
the registered professional nurse's
scope of practice to inject Marcaine
into an interscalene catheter, placed
by the anesthesiologist into the
brachial plexus, for the purpose
of anesthetic block to the patient's
shoulder.
Sutures
At
its October 13-14, 1983 meeting,
the Board ruled that simple suturing,
although the practice of medicine,
can be delegated by a physician
to a registered nurse who has the
required knowledge, skill and competence
and when policies have been developed
by the health care agency or facility
regarding the matter.
In
June 1983 the Board ruled that the
removal of sutures is not within
the scope of nursing practice. This
has led to inquiries from RNs who
are being delegated this function
in the health care facilities in
which they are employed. The Board
has responded that the removal of
sutures is medical practice, but
it may be delegated by the physician
to the nurse who has the knowledge,
skill and competence to carry out
the order.
Tracheostomy
At
its October 6-7, 1992 meeting, the
Board determined that it is within
the scope of practice for the registered
professional nurse to remove a tracheostomy
apparatus and replace it with a
new apparatus in patients who have
had tracheostomies for a long period
of time.
At
its April 7 and 8, 1999 meeting,
the Board determined that it is
within the scope of practice for
the licensed practical nurse to
remove a tracheosotomy apparatus
and replace it with a new apparatus
in patients that have well established
stomas.
Transfusions
The
Board determined that it is appropriate
for RNs in Maine to participate
in out of hospital transfusions
provided that the agency has policies
and procedures in place that are
in accord with the current AABB
protocol for out of hospital transfusions.
(January 28, 1991)
Unna
Boots
At
its December 13-14, 1983 meeting,
the Board ruled that the application
of Unna Boots is within the scope
of practice of the registered nurse
under the following conditions:
1) the nurse has received the necessary
education and supervised clinical
practice and such training is documented
2) the nursing, medical and administrative
staffs have established policies
and procedures for such a procedure;
and
3) the physician who delegates the
application of Unna Boots knows
that the nurse is capable of carrying
out this function and understands
the possible complications.
Vaginal
Exam
ADVISORY
RULING June 12, 1997
It is within the scope of practice
of a registered professional nurse
(RN) to perform vaginal speculum
examinations and collect specimens
for cytology and/or culture if the
following requirements are met:
1. General Requirements
A. Written policy and procedures
are maintained by the employer.
B. The registered professional nurse
performing the procedure must have
satisfactorily completed an instructional
program that included supervised
clinical practice.
C. Documentation of satisfactory
completion of the course of instruction
and supervised practice is on file
with the employer.
2. Course of Instruction
The course of instruction shall
include, but not be limited to,
the following:
A. anatomy and physiology of the
female reproductive system
B. indications and contraindications
for performing speculum examinations
C. proper methods of specimen collection
D. intervention for potential side
effects
E. nursing care responsibilities
Vagus
Nerve Stimulator
At
its December 6-7, 2000 meeting,
the Board determined that a registered
professional nurse may use the vagus
nerve stimulator on demand therapy
to end or shorten seizure activity.
The registered professional nurse
must have appropriate documented
training according the facility/organization's
established policies and procedures.
The Board determined that a registered
professional nurse may not delegate
the task of performing this type
of therapy to certified nursing
assistants.
At
its October 17-18, 2001 meeting,
the Board determined that a licensed
nurse may use the vagus nerve stimulator
on demand therapy to end or shorten
seizure activity. The licensed nurse
must have appropriate education
and supervision based on defined
competencies and established facility/organization
policies and procedures. The Board
revisited the issue of a registered
professional nurse delegating this
task to a certified nursing assistant.
The Board determined that a registered
professional nurse may delegate
this task to a certified nursing
assistant who has had appropriate
education and supervision based
on defined competencies and established
facility/organization policies and
procedures.
Wound
Debridement
At
its April, 1992 meeting, the Board
determined that it is within the
scope of nursing practice for a
registered professional nurse to
debride non-viable tissue provided
that he/she has had appropriate,
documented training according to
protocols established by a health
care facility. Sharp debridement
may be included with the same conditions.
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