Scope of Nursing Practice

Chapter 464 outlines the statutory limits of practice for each class of nursing license: 1) Licensed Practical Nurse, 2) Professional Nurse (RN), 3) Certified Clinical Nurse Specialist, 4) Advanced Registered Nurse Practitioner, 5) Retired volunteer nurse certificate.

• The Licensed Practical Nurse (PN) applies educational preparation and experience in nursing to administer "performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm; the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist; and the teaching of general principles of health and wellness to the public and to students other than nursing students."•
  • Intravenous Therapy Within the Scope of the Practical Nurse:•
    • perform calculation and adjust flow rate
    • observe and report subjective and objective signs of adverse reactions to IV administration
    • inspect insertion site, change dressing, and remove intravenous needle or catheter from peripheral veins
    • hanging bags or bottles of hydrating fluid.
  • Intravenous Therapy Outside the Scope of the Practical Nurse:•
    • initiation of blood and blood products
    • initiation or administration of cancer chemotherapy
    • initiation of plasma expanders
    • initiation or administration of investigational drugs
    • mixing IV solution
    • IV pushes, except heparin flushes and saline flushes.
      
• The Professional Nurse (RN) employs individual nursing education and experience to perform acts requiring substantial specialized knowledge, judgment, and nursing skill grounded in applied principles of psychological, biological, physical, and social sciences which include, but are not limited to:
  • observation, assessment, diagnosis (nursing), planning, intervention, and evaluation of care
  • health teaching and counseling of the ill, injured, or infirm
  • promotion of wellness, maintenance of health, and prevention of illness of others
  • teaching, and supervision of other personnel
  • administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of the state to prescribe such medications and treatments
• The Certified Clinical Nurse Specialist is a licensed Professional Nurse (RN), with a master’s degree in a clinical nursing specialty, and the clinical experience to:
  • assess the health status of individuals and families using methods appropriate to the population and area of practice
  • diagnose human responses to actual or potential health problems
  • plan for health promotion, disease prevention, and therapeutic intervention in collaboration with the patient or client
  • implement therapeutic interventions based on the nurse specialist’s area of expertise and within the scope of advanced nursing practice, including, but not limited to, direct nursing care, counseling, teaching, and collaboration with other licensed health care providers
  • coordinate health care as necessary and appropriate and evaluate with the patient or client the effectiveness of care.
• The Advanced Registered Nurse Practitioner (ARNP) is a licensed Professional Nurse (RN), certified in advanced or specialized nursing practice, including certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners." Advanced or specialized nursing practice "means, in addition to the practice of professional nursing, the performance of advanced-level nursing acts approved by the board which, by virtue of postbasic specialized education, training, and experience, are appropriately performed by an advanced registered nurse practitioner."
  
  Within the context of advanced or specialized nursing practice, the advanced registered nurse practitioner may perform acts of:
  • nursing diagnosis and nursing treatment of alterations of the health status
  • medical diagnosis, treatment, prescription and operation which are identified and approved by a joint committee appointed by the Board of Nursing.
• A Certificate Retired Volunteer Nurse, either Licensed practical or Registered:
  • work under the direct supervision of the director of a county health department, a physician, advanced registered nurse practitioner or a registered nurse;
  • provide services under the certificate only in settings whose sponsors have been approved by the board;
  • the scope of practice for certified volunteers shall be limited to primary and preventive health care, or as further defined by board;
  • a retired volunteer nurse shall not:
    (a) administer controlled substances;
    (b) supervise other nurses;
    (c) receive monetary compensation.