Scope of Practice
The Board has developed the following statements for use in determining scope of practice. Individual situations should be reviewed against these statements for verification of scope of practice.
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- General Scope of Practice Information
- Scope of Practice for the Registered Nurse (RN)
- Scope
of Practice for the Licensed Practical Nurse (LPN)
- Frequently Asked Scope of Practice Questions and Answers
- Frequently Asked Questions - Supervision and Independent Practice
Scope
of Practice for the Registered Nurse (RN)
In
Colorado, the practice of professional nursing (including those
listed on the advanced practice registry) includes the performance
of both independent nursing functions and delegated medical functions.
The Board of Nursing (BON) considers RNs to be independent practitioners.
Two things limit the independent scope of nursing practice:
- Task/practice must be within the field of nursing, and
- RN must possess the specialized knowledge, judgment and skill required to complete the job/task undertaken. There is no BON requirement for physician oversight of nurses during the course of independent nursing practice. However, individual facilities or physician practices may have policies requiring some level of physician involvement or oversight.
Dependent nursing function falls under delegated medical. CRS 12-38-103 (4) defines delegated medical function to include the RN implementation of a medical plan. ".a written plan, verbal order, standing order, or protocol - whether patient specific or not, that authorizes specific or discretionary medical action, which may include but is not limited to the selection of medication." The amount of physician oversight would be determined by the physician and nurse involved in this process.
Determining
Your RN Scope Of Practice
The
Board of Nursing has been working to empower Colorado nurses to
determine their own scope of practice. The Board's mission is
the regulation of nursing practice in Colorado; this regulation
does not mean dictating how individual nurses should carry out
that practice, but whether or not the practice meets the standards
established by the Nurse Practice Act. Using the following guidelines
and the attached flow chart, a nurse may decide what is within
scope, and to make certain the task or practice is documented
in facility or institution policies and procedures.
Begin by asking the following question: Is this task/practice within my scope of practice?
-
Was the skill/task taught in your basic nursing program?
OR - If it was not included in your basic nursing education, have you since completed a comprehensive training program, which included clinical experience?
- Has this task has become so routine in the nursing literature and in nursing practice (e.g. sharp wound debridement), it can be reasonably and prudently assumed within scope?
- Is the skill/task in your hiring agency policy and procedure manual?
- Does carrying out the duty pass the "Reasonable and Prudent" standard for nursing?
If you can answer "yes" to all the above questions, the task is within your scope of practice and you do not need to seek a practice question decision from the Board. If you cannot answer "yes" to all of the above, proceed to option B.
B. If you answer "no" to any of the questions above, consider two possible outcomes:
- The task is not within your scope of practice - Omit task
-
The task may not be within your scope of practice - Request Board of Nursing advisory opinion if needed.
Scope
of Practice for the Licensed Practical Nurse
The
Nurse Practice Act defines the scope of practice of the licensed
practical nurse (LPN) as that which is taught in schools of practical
nursing in Colorado at this time. Therefore, all decisions regarding
which tasks may be performed by a LPN are based on the present
curriculum criteria. The LPN curriculum in Colorado is a 9 to
11 month course focusing on the care of patients with predictable
outcomes. The curriculum emphasizes the maintenance of those patients
and performance of nursing skills with a high degree of technical
expertise. The practical nursing student is taught to identify
normal from abnormal in each of the body systems and to identify
changes in the patient's condition which are then reported to
the RN or MD for further or "full" assessment. For further
information regarding the specific tasks and skills taught in
the LPN curriculum, you may wish to contact one of the many
Colorado colleges offering an LPN program.
Most
Frequently Asked Scope of Practice Q&As
The Colorado
Board of Nursing receives a large volume of phone calls each day
concerning scope of practice questions or issues. The Board's
Nurse Practice Consultants have developed these FAQs to share
and, we hope, answer some of your questions. This list is sorted
alphabetically by topic. This page will be added to on an ongoing
basis.
Add-Vantage
IV System
Q.
Can an IV certified LPN administer IV antibiotics
via an Add-Vantage system, considering it as "pre-mixed"?
A. Yes. If a Pharmacist or Registered Nurse assembles the
self-contained administration unit, the IV certified LPN may then
"activate" and administer the antibiotic solution.
Delegation
Q.
What is the main concept of the delegation
rules?
A. All the components of the law and rules are important.
However, the rules are based in a concept which limits the RN
delegation to a specific delegatee, for a specific client, and
within a specific time frame. Thus, it would NOT be acceptable
for a Director of Nurses to delegate the intravenous administration
of medications to all LPNs in the facility, for any client of
the facility, at any time in the future. The rules are based on
a belief that ongoing RN assessment is needed of each delegatee,
each client, each task, and over each time frame.
Q.
Can an RN delegate to an LPN?
A. Yes. In 3.6 of the rules, a delegatee is defined as
any person who is not otherwise authorized to perform the task.
Thus, a delegatee could be an LPN, a CNA, another health care
professional, or an unlicensed person.
Q.
Can an LPN delegate?
A. No. The law provides that only a registered nurse may delegate.
Q.
Can
a delegatee refuse to perform a task?
A. Yes. The rules in 4.3 require that the nurse assure
that the delegatee can and will perform the task. If the delegatee
is not willing to perform the task, there can be no delegation.
Q.
What can't be delegated?
A. The law enacted relating to delegation provides that
an RN cannot delegate the ability to select medications if the
delagatee is not able on his own to select medications from a
protocol [C.R.S. 12-38-132(1)]. The law also states that the delegated
task shall not require any delegatee to exercise the judgment
required of a nurse [C.R.S. 12-38-132(2)]. Other statutory provisions
and portions of the rule relate to judgments the RN must make
about whether a task should be delegated but do not specifically
prohibit any other task. It is impossible to create a laundry
list of tasks which can never be delegated.
Q.
What
things should a nurse consider to determine if a task should be
delegated?
A. Part 4.1 of the rules specify the criteria for delegation.
Each criteria must be met with each delegation. In addition, 5.1
of the rules state that delegation shall be based on the assessments
of factors which are specified in the rules. Please review the
rules for the details in those parts of the rules.
Q.
If an orderly has taken a class in how to insert
a urinary catheter or any other task and received a certificate
from my facility, can I delegate the task to him without reevaluating
his competency to perform the task?
A. No. The rules in 5.3 provide that the delegator shall
instruct and/or verify competency to perform the task. There is
no provision for certificate-granting programs to establish competency;
it is the sole responsibility of the RN delegating the task to
determine that the delegatee is able to safely perform the task.
Q.
How
much supervision do I have to give? Do I have to be in the facility
at the time the task is performed?
A. The rule provides in 5.5 that the RN delegating the
task must provide appropriate and adequate supervison to the delegatee
to the degree determined by the delegator. The delegator must
consider the factors listed in 5.1 to determine the amount of
supervision. For example, a more complex delegated task would
require closer supervision than a simple task but the exact amount
of supervision is determined by the delegator's judgment.
Q.
It seems like everything is determined by judgment.
Don't you have any quick and easy guidelines?
A. No. Delegation is an extremely sophisticated process
based on the judgment of a professional nurse. The Board will
hold the nurse responsible for the judgments made.
EKG
Q. Is performing an EKG within the scope of practice
for a licensed practical nurse?
A. The placing of leads and performing an EKG is within
the scope of practice of an LPN, however, reading or interpreting
the results of an EKG are not within the scope of an LPN. CRS
12-38-117(1)(c) gives the Board statutory authority to discipline
any nurse upon evidence that the person has willfully or negligently
acted in a manner inconsistent with the health or safety of a
person under his care.
Hypnotherapy
Q. Is hypnotherapy within the scope of practice
for a registered nurse?
A. Yes. The independent practice of a registered nurse
includes hypnotherapy provided that the nurse has the specialized
knowledge, judgement and skills to safely perform the technique.
CRS 12-38-117(1)(c) gives the Board statutory authority to discipline
any nurse upon evidence that the person has willfully or negligently
acted in a manner inconsistent with the health or safety of a
person under his care.
LPN Authority Scope of Practice FAQ's
Q. Is it within the scope of practice for an LPN with the IV authority draw blood directly from the venous system?
A. Yes. Board of Nursing Chapter IX – Rules and Regulations for the Licensed Practical Nurse in Relation to IV Authority, section 3.1 G address this question and the definition of “IV Authority” in section 2.5 includes ‘venous blood sampling’.
Q. Is it within the scope of practice for an LPN with the IV authority to administer pre-mixed antibiotic solutions via venous access devices, delivered per labeled instructions, via gravity or pump by IV Piggyback?
A. Yes. See Board of Nursing Chapter IX – Rules and Regulations for the Licensed Practical Nurse in Relation to IV Authority section 3.1 H.
Q. Is it within the scope of practice for an LPN with the IV authority to administer pre-mixed antibiotic solutions via venous access devices, delivered per labeled instructions, via IV push?
A. No. The scope of practice of the LPN with IV authority does not include administering any medications by way of IV push.
Q. Is it within the scope of practice for an LPN with the IV authority to administer pre-mixed antibiotic solutions, IV fluids, flush with normal saline and or heparin, and change dressings to central venous catheters originating in either the femoral and/ or saphenous vein and terminating in the inferior vena cava?
A. Yes, as long as the LPN remains within his or her scope of practice with patients who have predictable and stable outcomes.
Nutrition
Counseling
Q.
Are
there any restrictions in the Nurse Practice Act regarding becoming
a distributor of a nutritional supplement product?
A. No. Health counseling (including nutrition) is within
the scope of practice of a registered nurse provided that the
nurse has the specialized knowledge, judgment and skill to safely
provide these services. CRS 12-38-117(1)(c) gives the Board statutory
authority to discipline any nurse upon evidence that the person
has willfully or negligently acted in a manner inconsistent with
the health or safety of a person under his care.
Out of
State Students
Q.
Our graduate nursing program includes a "hands-on"
clinical training component. To participate in this training,
nurses licensed in their home states often travel to another state
in which they are not licensed. Do our students need a Colorado
license to engage in this clinical training?
A. No. CRS 12-38-115(3) states "...the board may issue
a permit to practice as a practical or professional nurse
for a period of time not to exceed two years or as determined
by the board to any person from another state or territory of
the United States or a foreign country who is in this state for
special training or for observation of nursing educational programs
upon proof to the board by such person that he is currently licensed
to practice as a nurse in the state, territory, or country of
his residency. The nursing practice permitted for by permit shall
be limited to that practice performed as part of the special training
or nursing program." For information regarding special or student
permits, please call (303) 894-2432.
Pool Nurses
Q.
I
am one of two primary charge nurses on the night shift at our
276 bed rural hospital. What are my responsibilities regarding
the care provided by "agency" nurses?
A. You may first need to clarify your institution definition
of charge nurse. To the extent that the charge nurse position
has supervisory responsibilities for the delivery of patient care,
the charge nurse is responsible for assuring pool nurses are competent
to deliver safe, effective care, and that they are delivering
such care. Furthermore, the Board has determined the charge nurse
is responsible for notifying her supervisor if persons are delivering
care which is not safe and effective and that the supervisor would
then bear the subsequent burden of accountability.
Therapeutic
Massage
Q.
Is therapeutic massage within the scope of practice
of a registered nurse?
A. Yes. The independent practice of a registered nurse
includes therapeutic massage provided that the nurse has the specialized
knowledge, judgement and skills to safely perform the technique.
CRS 12-38-117(1)(c) gives the Board statutory authority to discipline
any nurse upon evidence that the person has willfully or negligently
acted in a manner inconsistent with the health or safety of a
person under his care.
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