The rules and regulations for the expanded role LPN in IV therapy can be found in the Mississippi Board of Nursing Rules and Regulations, Chapter IV, Section 3. The scope of practice for the LPN expanded role in IV therapy is addressed in Section 3.3. You may access the rules and regulstions at www.msbn.state.ms.us<Laws, Rules, and Regulations<Rules and Regulations.

TB Skin Testing

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

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:

• 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;
• 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;
• 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.

Return to Index 

Medication Administration

Pursuant to Chapter III, Section 1.3 of the Rules and Regulations of the Mississippi Board of Nursing: 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 to other qualified personnel;

2. Assign duties of administration of patient medications to other licensed nurses only (either a RN or LPN)

3. Assign duties for giving patient treatments to licensed nurses and/or auxiliary workers based upon knowledge of their educational preparation and experience. Thus, medication administration may only be delegated to another registered nurse or licensed practical nurse and not to an unlicensed person, except as set out in Chapter VI of the rules and regulations for certified hemodialysis technicians. This would include medicated ointments, lotions and protective barriers, regardless of skin integrity.

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.

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. 

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.

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.

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.

Return to Index

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

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.

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.

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. This education and competence must be documented initially and on an ongoing basis; and
2. There is an informed consent (obtained by the physician) for the procedure;
3. 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.

Return to Index 

Wound & Foot Care

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.

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.

Ear Stapling

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;
5. The registered nurse practices according to accepted standards of nursing practice;
6. The procedure is performed according to national standards for the specific therapy;
7. Necessary resources are available; and
8. 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

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.

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.

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.

Return to Index 

Vascular Access and Devices

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

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:
1. Specific guidelines/criteria for candidates for the procedure;
2. A mechanism of data collection for quality control; and
3. 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.

The appropriately prepared registered nurse may insert an external jugular line 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:
1. Specific guidelines/criteria for candidates for this procedure;
2. A mechanism of data collection for quality control; and
3. Guidelines for maintenance, use and care.

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.

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)

Return to Index 

Medical Screening Examination

The performance of a medical screening examination is outside the scope of practice of the registered nurse, unless the nurse is functioning as an advanced practice registered nurse.

The  Mississippi Nursing Practice Law 73-15-5 states “…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.”  It is outside the scope of nursing practice to draw medical conclusions and/or make a medical diagnosis.  Therefore, it is the continued position of the Board that a medical screening examination must be performed by a nurse practitioner or a physician.

The registered nurse may perform a nursing history and physical assessment.  The nurse’s findings may be communicated to the physician/nurse practitioner, who could provide appropriate orders for intervention to be implemented by the nurse.  The nurse may not make an independent determination concerning treatment or discharge of a patient without appropriate medical intervention and/or consultation.

Death Pronouncement

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

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)

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.

Return to Index 

Suctioning

The appropriately prepared registered nurse may perform deep right main stem suctioning.

Tracheostomy

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

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

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

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.

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.

Return to Index 

Intravenous (IV) Contrast

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 Sample

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

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

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.

Return to Index

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.

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.

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

 Refer to the Delegation position statement.

Assessment

Nursing assessment is outside the scope of practice of the licensed practical nurse. As stated in Chapter III of the Rules and Regulations of the Mississippi Board of Nursing 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. This education/competence must be specific to the tasks being assigned. The facility/agency must have policies and procedures in place addressing all aspects of this issue including policies and procedures which assure that the patient's needs are met should a patient be admitted and the registered nurse is not immediately available. As is the case with initial systems and collective assessments as described above, it is the registered nurse's responsibility to do the initial and ongoing assessments of wounds. The interval/frequency of nursing assessments is dependent upon the patient's status and accepted standards of practice. The observation and recording of the patient's ongoing and subsequent status may be delegated to the appropriately prepared licensed practical nurse. It should be noted that the registered nurse remains responsible for the clinical nursing record which reflects the patient's nursing care and progress. Furthermore, the registered nurse is responsible and accountable for communicating patient response to nursing interventions to other members of the health care team.

In April 2003, The Board of Nursing reviewed a request to expand the scope of practice of the licensed practical nurse to include the assessment and evaluation of patients during or immediately after restraint or seclusion. The Board determined it is not within the scope of practice of the licensed practical nurse to independently initiate seclusion and/or restraint of a patient/client or to complete the mandated assessments. The licensed practical nurse may not make independent decisions regarding the care of the patient and gives patient care under the direction of the registered nurse, physician, or licensed dentist which does not require the specialized skill, judgment and knowledge required of a registered nurse.

Return to Index

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

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.

Return to Index

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

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

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

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

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:

• Initiate a peripheral IV

• Hang (spike) a new bag of fluid

• Regulate fluids of a central access

• Discontinue a central line

• 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 Chapter 4, Section 3.3 of the Rules and Regulations of the Board of Nursing and the Mississippi Nursing Practice Law, which can be accessed through the board's website.

Return to Index

Nasogastric Tube Insertion

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

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

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;

7. The licensed practical nurse may not change or regulate the rate but may stop the infusion if necessary; and

8. The facility has policies and procedures in place addressing all aspects of this issue.

The Mississippi Nursing Practice Law and the Rules and Regulations 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

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

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

Return to Index

Safety to Practice

Refer to the Safety to Practice position statement.

Refer to the Safety to Practice position statement.

Patient Abandonment

Refer to the Patient Abandonment position statement.

Return to Index

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.”

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.”

Return to Index 

Function of the registered nurse according to the Mississippi Board of Nursing Rules and Regulations, Chapter III, §1.2:

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 Chapter VI of the Rules and Regulations; 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.

Function of the licensed practical nurse according the Mississippi Board of Nursing Rules and Regulations, Chapter III, §2:

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.

Return to Index 

Return to Top of Page