Washington State Nursing Care
Quality Assurance CommissionADVISORY OPINIONS
INDEX
/ Requester / Facility / Response Date / Cross References /
A / ADMINISTERING ANESTHESIA / See H-18
Refer to Procedural Sedation policy statement adopted January 2000
Refer to Epidural Catheter position statement adopted September 2000
A1 / Archived 9/8/00
A2 / Archived 2/13/98
A3 / Archived 9/8/00
A4 / Archived 2/13/98
A5 / Archived 9/8/00
A6 / Archived 9/8/00
A7 / Archived 9/8/00
A8 / Archived 9/8/00
A9 / Administering local anesthetic dental injections by RN’s / Dr. Ron Marsh / Dr. Ron Marsh / 2/10/94
A9a / Archived 9/8/00
A11 / Archived 9/8/00
A12 / Archived 9/8/00
A13 / Archived 9/8/00
A14 / Archived 9/8/00
A15 / Archived 9/8/00
A16 / Archived 9/8/00
A17 / May a nurse practitioner perform epidural steroid injections, spinal nerve root blocks, and facet blocks, using fluoroscopy? Since fluoroscopy is necessary to perform these procedures I will need to extend my hospital privileges to allow me to perform these procedures in their radiology department. / Gretchen Doser ARNP / Seattle WA / 10/30/97
A18 / Archived 9/8/00
A19 / Archived 9/8/00.
A20 / Archived 9/8/00
A21
/ That the Nursing Commission render an opinion on the practice of allowing labor patients to self administer doses of epidural solution, because of the position statement issued on 10/8/2000 re: “Nurses Managing Patients Receiving Epidural Analgesia”. Specifically the : Exception: Monitoring OB Labor and Delivery Patients Receiving Epidural Analgesia”. / Cherelyn Childers, RNC / St Joseph’s Hospital Bellingham / 3/26/2002 / Policy Statement on Epidural Analgesia 10/8/2000A22
/ A formal written view from the Nursing Care Quality Assurance Commission, regarding the administration of Propofol in children in the PICU setting and during pediatric sedation procedures when the physician responsible for ordering the drug is present in the unit, or at the bedside. / Garry S Park, MD Jerry Zimmerman, MD, PhD, Daniel Brutacao, MD Kenneth Dietrich, MD, MBA / Northwest Pediatric Critical Care Colloquium(NPCCC) / 3/26/2002 / Policy Statement
RN’s performing Procedural Sedation and Analgesia Adopted 1/2000
B /
ADVANCED PRACTICE
/ See L-2,L-6, H-10
B1 / Archived 9/8/00
B2 / Archived 9/8/00
B3 / Request for a review of the proposed change in role and responsibility of (the Dept. of Veterans Affairs Functional Statement for Cath Lab Nurse Coordinator-Senior Grade) ARNP’s / Frankie T. Manning, RN / VA Medical Center, Seattle / 3/15/93
B4 / Certified Women’s Health Care Practitioners doing well child examinations / Frances J. Storlie, ARNP, Ph.D. / Southwest WA Health District / 6/8/88
B6 / Is medical acupuncture within scope of an ARNP / Patricia De Smet / Group Health NW / 4/17/96 / T-1
B-7 / May a registered nurse with a Master’s Degree in Nursing, “Perform cardiac catheterization”, function as a “pseudo” Cardiology Fellow, perform cardiac interventional; procedures, (PTCA, Pericardiocentesis, and pacemaker implants), perform physical examinations, (Medical), order laboratory tests, write prescriptions for cardiac medications, develop medical plans of care. The RN is licensed as an RN in the State of Washington. No formal training beyond the Master’s Degree.” / Frankie Manning, RN Chief, Nursing Services / VA Puget Sound Health Care System
Seattle, WA / 4/10/98
B-8 / Is it within the scope of practice for ARNP’s to evaluate and treat work-related injuries in adults? / Nick Mason, ARNP / Leavenworth WA / 12/12/01
C / AMNIOTOMIES & CERVIX RIPENING / See E-2
C1 / RN’s performing amniotomies on obstetric patients / Elizabeth Keesecker, Director / Maternal-Child Health / 4/28/93
C2 / Amniotomies in the obstetrical unit
also, separate letter re: ultrasounds date 6/24/92 / Robin Peterson, Director OB Services / Good Samaritan Hospital / 12/4/92
C3 / RN’s (1) inserting intrauterine pressure device, (2) artificial rupturing of membranes, (3) placing fetal scalp electrodes / Diane G. Marler, RNC / Naval Hospital, Bremerton / 10/1/86
C4 / Archived 4/10/98
C5 / Archived 4/10/98
C-5a / Archived 4/10/98
C6 / Archived 4/10/98
C8
C-8a / Archived 4/10/98
C10 / Archived 4/10/98
C12 / Artificial rupture of membranes by RN / Karen Baker / Good Samaritan Hospital / 2/27/95 / C1-3,7
C-12a / Clarification regarding the artificial rupture of membranes and the differing scopes of practice of the RN and ARNP / Linda Chagnon,
RNC,MBA-
HCA / WSNA / 6/6/95
C13 / Archived 4/10/98
C14 / Is it within the scope of RN practice to use Ultrasound to assess fetal position in laboring patients with unknown fetal lie within the scope of practice of registered nursing / Ulrike Lucas / Naval Hospital
Oak Harbor / 3/21/97
C15 / May a registered nurse administer Cytotec (misoprostol) for cervical ripening? / Deborah Swennes, RNC, Director, Maternal Child Health / St. John Medical Center Longview, WA / 2/12/98
C16 / “Is it within the scope of practice for a registered nurse to place a fetal oximeter in the labor and delivery environment?” / Martina Letco Porter, RNC, MS, MBA / Fernandina Beach FL / 12/20/99
D / BOWEL CARE
D2 / Archived 9/8/00
D3 / Archived 9/8/00
D4 / Archived 9/8/00
D5 / Training gastroenterology nurse to perform flexible sigmoidoscopies with careful supervision
Role of LPN performing flexible sigmoidoscopies,can they do independent assessment of initial history, screening & classification of patient. / Marshall E. McCabe III, MD / Olympia Multi-specialty Clinic / 5/19/95
E / CATHETERIZATION / See B-3
E1 / Archived 9/8/00
E2 / Insertion of intrauterine pressure catheters by labor/delivery nurses / Elizabeth Berkey, and Rosa Johnson / Northwest Hospital / 6/12/89 / C-3
E3 / Archived 9/8/00
E4 / Archived 9/8/00
F / COUNSELING
F1 / (1) Do nurses under Chapter 18.88, have the right and obligation to interview, treat, assess and counsel CD patients within their scope of practice (2) Can nurses and nursing practice be directed and supervised by unlicensed individuals...such as orders for nursing and medical care not referring to indirect communication of physicians orders, but the direct planning, management, and evaluation of the medical and nursing care being delivered in a clinical setting / Michael Rice, Ph.D., RN / Intercollegiate Center for Nursing Education / 9/26/94 / F-3
P-15
F2 / Do nurses in a chemical dependency treatment facility need to be licensed separately as counselors for 1:1 or group counseling / Barbara Proffitt / Mountainview Hospital / 11/21/88 / F-1
F3 / Archived 9/8/00
F4 / Archived 9/8/00
G / DELEGATION / See D-(1-4), E-3, H-(11, 18), K(1-4, 6), and L-2
G1 / Archived 9/8/00
G-2 / Archived 9/8/00
G3 / Archived 9/8/00
G6 / Unlicensed personnel performing health assessments of prospective blood donors and exercising nursing judgment in accepting or deferring donors / Emma Jo Goodman / American Red Cross / 8/7/91
G9 / Archived 9/8/00
G10 / Does it require a RN or LPN to give tube-feedings and meds. / Sharon Emerson / Island Home Nursing / 8/24/95
G11 / Are personnel in hospital psychiatric care who are not otherwise licensed, but providing care under a nurse, be reg. or certified? / Fern Betteridge / Fac & Svs. Lic / 2/14/95 / K-6
G12 / Can non-nurse school personnel provide tube feedings to students?
Can non-nurse school personnel clean students excretory functions? / Eric T. Nordolf / Public Schools / 2/14/95 / S-1
G13 / May the RN delegate, to an unlicensed person, the procedure of reinserting a tracheotomy tube? / Audrie Shagren / Supervisor of Hlth Srvs. / 3/4/96
G14 / Should feeding of nursing facility residents be done by only certified nursing assistant? / Deborah Murphy / WA Health Care Association / 9/24/96
G15 / Delegating Injection of glucagon to unregulated person or persons. / Mary Ann Carr / Eatonville School / 11/1/96 / S-2
G16 / May a Nursing Assistant-Certified, turn on/off O2 concentrator and turn off small portable O2 tanks? (Not to include setting liter flow). / Ginger
Isenhour, RN / District
Staff
Development
& Infect. Control / 4/15/97
G17 / Can Emergency Department Registered Nurses delegate tasks such as vital signs, starting an IV, or venipuncture for blood sampling, and the cleaning of minor wounds for suturing by the Emergency Department physician, to EMT/IV technician’s and or Paramedics who are not employed in the Department? May the prehospital personnel document on our Emergency Department flow sheet the delegated tasks they do? / Kathleen Watkins, RN, Assistant Administrator Patient Care Serv / Samaritan Hospital Moses Lake / 2/12/98
G18 / May a specially trained (didactic and clinical) nursing assistant certified, hand physicians instruments during a C/section or tubal? / Marcia Tolmasoff, RNC, Manager, Family Birth Cen. / Southwest WA. Medical Center Vancouver, WA / 2/12/98 / L Needs to be rescinded
H / DISPENSING AND ADMINISTERING MEDICATIONS / See G-(1-2, and 10)
L-2, L-7
H1 / Archived 9/8/00
H2 / Can non-licensed persons ‘pierce the skin’ to give emergency medication such as epinephrine, in the event of any anaphylactic reaction
Delegation in a school setting. / Debbie Kawakami, RN / Sunnyside School District / 9/16/91 / S-3
H3 / Administration of an experimental, unlabeled medication at school / Cathryn Eve Crowley Barker / Auburn School District #408 / 8/7/91 / S-4
H-18 (1)
H4 / Archived 9/8/00
H6 / The assignment of RN’s to triage and dispense over the counter medications to inmates / Dr. Dale Fetroe / Department of Corrections / 12/29/89
H8 / RN’s advising patients/parents of over-the-counter preparations and devices which may be employed for different complaints, usually, minor pain constipation, or diarrhea / Rae Swainson, RN / Shriners Hospital for Crippled Children / 4/23/90
H10 / “in the event that I am the provider “on call” for local county jail, may I authorize the administration of tranxene to inmates “per protocol” for alcohol withdrawal symptoms” / Lori Roehl, ARNP / Yakima Valley Farmworkers Clinic / 11/21/88
H11 / Nursing technicians hanging plain I.V. bags / Bonnie Reid, / Virginia Mason Hospital / 12/2/91
H12 / Archived 9/8/00
H13 / Archived 9/8/00
H14 / Archived 9/8/00
H14a / Archived 9/8/00
H17 / Archived 9/8/00
H18 / Archived 9/8/00
H19 / May a RN or LPN use a 14 or 16 gauge needle to subcutaneously implant a medication / Debra Schade / TAP Pharmaceutical / 1/22/96
H20 / Compounding allergy extracts, inject, then transfer on to another physician for next injection? / Kim Orchard / Group Health Northwest / 3/6/96
H21 / May a RN or ARNP administer controlled substances under protocols? / Chris Larson / Crisis Triage Center
H22 / RN,s to see inmates in a triage process that will control access to over-the-counter supplies. / Dale T. Fetroe, MD / WA State Penitentiary
H23 / May nurses paint fluoride varnish on the teeth of infants and toddlers? / Carree Moore / DSHS, Medical Assistance Admin.
H24 / May a Licensed / Registered nurse chart routine medications using one signature to indicate all routine medications were given at one time (modified charting by exception for routine medications) / Heather Young and Bonnie Blachly / ERA Care Inc and
Ida Culver House / 9/19/97
H25 / Is it within the practice of nursing to pre-fill insulin syringes for self-administration by an individual at a later date? / Pat Bossert, RN & Kathy Woods, RN / DSHS Aging & Adult Serv. / 2/11/00
H 26 / May Licensed Practical Nurses or Registered Nurses close lacerations by applying Dermabond? / Karen Maher / DSHS/DDD / 4/1/2002
H 27 / May registered nurses in a community based maternity support services program dispense emergency contraceptive medications under standing order from a certified nurse midwife? / Carol Diede, RD CD / First Steps/WIC Program Supervisor
Wenatchee WA / 9/6/2002
I / FOOTCARE
I-4 / Routine Footcare (defined as trimming toe-nails and removing corns and calluses), is this within the RN scope of practice / Robert Kaplan / 6/16/88
I-5 / Can the duties of foot care tech be delegated to a certified nursing assistant. / Maureen Flak / Soundcare / 3/6/95 / G-7
J / MISCELLANEOUS / See F-4, G-3, H-18
J1 / Archived 9/8/00
J2 / Archived 9/8/00
J4 / Archived 9/8/00
J5 / May nurses select orders from pre-printed physician orders / Pam Conrath, RN / Central Washington Hospital / 7/2/92
J6 / Is an RN practicing within her scope of practice who is asked to supervise or accept responsibility for a technician who is performing a skill or a functioning in a capacity that the RN is not competent to perform or function / Virginia Wegenast, OB/OR Specialist / General Hospital Medical Center / 11/6/92
J7 / Archived 9/8/00
J8 / Archived 9/8/00
J10 / Advice of use of specific Homeopathic remedies
Acupuncture and Auriculotherapy / Andy Taylor / NA / 12/1/94 / T-3
J11 / Archived 9/8/00
J12 / Training of RN’s for average risk colon cancer screening flexible sigmoidoscopies under supervision of a Gastroenterologists / Tamara Smith, RN / Tri-State Memorial Hospital / 2/10/94
J13 / Can a RN perform circumcision in the newborn period / Linda S. Johnson / NA / 8/7/91
J15 / Documenting the physician history/physical and discharge summary / Jim Strain / Sacred Heart Medical Center / 11/4/92
J16 / RN’s performing ET Incubations on ambulances without direct physician’s orders for particular patients / Perry Lamb / NA / 12/1/92
J17 / RN’s performing tracheotomy in an emergency situation for purposes of opening the airway / Heather Oesting / Moss Oesting and Associates / 11/4/92