5514 SCOPE OF PRACTICE

5514.1 The practice of practical nursing means the following:

1. (a) The performance of actions of preventive health care, health maintenance, and the care of persons who are ill, injured, or experiencing alterations in health processes at the direction of the delegating or supervisory registered nurse; and
2. (b) The basic knowledge, judgment, and skills in nursing procedures gained through successful completion of an approved educational program in practical nursing.

5514.2 A practical nurse shall accept only those assigned nursing activities and responsibilities as set forth in the Act and this chapter, which the practical nurse can safely perform. That acceptance shall be based on the following requirements in each practice setting which shall include:

1. (a) The qualifications of the practical nurse in relation to the client's needs and the integrated plan of care, including:
2. (1) Basic education and preparation of the practical nurse; and
3. (2) Knowledge and skills subsequently acquired through continuing education and practice.
4. (b) The degree of supervision by a registered nurse;
5. (c) The stability of each of the clients' condition;
6. (d) The complexity and frequency of nursing intervention to address the needs of the client or client group;
7. (e) The accessible resources within the agency or facility; and
8. (f) The established policies, procedures, standards of practice, and communication channels, which lend support to the model of nursing services offered by the agency or facility.

5514.3 The practice of practical nursing shall include the following:

1. (a) Participating in the performance of the ongoing comprehensive nursing assessment process of the client's biological, physiological, and behavioral health, including the client's reaction to an illness, injury, and treatment regimens by collecting data and performing focused nursing assessments;
2. (b) Recording and reporting the findings and results of the ongoing nursing assessment process;
3. (c) Participating in the development and modification of the client-centered plan of care;
4. (d) The administration of medication and treatment as prescribed by a legally authorized health care professional, licensed in the District of Columbia, and that is within the scope of practice of a practical nurse;
5. (e) Implementing appropriate aspects of the integrated plan of care in which the practical nurse is knowledgeable, skilled, and competent to perform and that is within the scope of practice of the practical nurse;

(f) Participating in the nursing care management through assigning and directing nursing interventions that may be performed by unlicensed, trained personnel;

(g) Participating in the evaluation of the client response and outcome to interventions;

(h) Promoting and maintaining a safe and therapeutic environment;

(i) Participating in health teaching and counseling to promote, attain, and maintain the optimum health level of the client;

(j) Communicating and collaborating with other health care team members and other professionals;

(k) Monitoring intravenous infusion;

(l) Inserting nasogastric tubes; and

(m) Other acts or services which are beyond the basic education of a practical nurse as approved by the Board. The acts or services shall be commensurate with the practical nurse's experience, continuing education, and demonstrated competencies.

5514.4 A practical nurse shall not:

(a) Function as a director of nursing or as an administrator of nursing;

(b) Supervise the clinical practice of a registered nurse;

(c) Administer the following medications:

(1) Investigational or toxins;

(2) Antineoplastic agents;

(3) Anesthesia or conscious sedation;

(4) Hypnotics;

(5) Oxytocics; or

(6) Medications by way of intrathecal or epidural route;

5514.5 A practical nurse may administer medications intravenously if the following conditions are met:

(a) The Administrator for Nursing Services has developed policies, procedures, and practice standards governing the practice of medication administration by practical nurses and established specific criteria for use when approving medications for intravenous administration by practical nurses;

(b) The practical nurse has successfully completed an educational program for intravenous medication administration;

(c) The practical nurse has been evaluated and validated for clinical competency in intravenous medication administration; and

(d) The practical nurse administers the approved medications under the general

supervision of a licensed, registered nurse.

5514.6 A practical nurse shall not:

(a) Administer any medications prohibited under § 5514.4(d); or

(b) Perform intravenous therapy or administer any intravenous medications in home care settings or community based residential care settings.

5514.7 A practical nurse shall only administer medications which have been approved by the Administrator for Nursing Services.

5514.8 A practical nurse may perform infusion therapy upon successfully completing an approved program of infusion therapy approved by the Board and if the following requirements are met:

(a) The Administrator of Nursing Services has developed policies, procedures and practice standards which govern the practice of infusion therapy;

(b) The supervisor maintains documentation to validate the competency of the practical nurse; and

(b) A registered nurse is present in the facility or on the unit when the practical nurse is performing infusion therapy.

5514.9 A practical nurse may perform the following infusion therapy acts:

(a) Insertion of a peripheral intravenous catheter that is no more than three (3) inches in length;

(b) Discontinuing peripheral intravenous catheters that are no more than three (3) inches in length;

(c) Initiation of prescribed intravenous fluids;

(d) Calculating and adjusting intravenous flow rate, including infusion pumps;

(e) Adding intravenous fluids to an established peripheral line. Fluids must be non-medicated, commercially prepared or prepared by a licensed pharmacist. Accepted fluids are limited to those fluids that are generally used as maintenance, and isotonic in nature;

(f) Administering pharmacy prepared medications;

(g) Insertion of heparin locks, including flushing with normal saline or heparin 100 units;

(h) Venipuncture or withdrawal of a blood specimen from a peripheral catheter site; and

(i) Changing of injection cap or intravenous tubing for peripheral lines only.

5514.10 A practical nurse shall wear a picture identification badge with lettering clearly visible to a client bearing the name of the practical nurse and the title "Licensed Practical Nurse" or "L.P.N.".

SOURCE: Final Rulemaking published at 54 DCR 701 (January 26, 2007).