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Notice of Intent to Adopt RulesA copy of the proposed rules may be obtained at http://rules.wyo.govRevised November 20161. General Informationa. Agency/Board Name*Nursing, Board ofb. Agency/Board Addressc. Cityd. Zip Code130 Hobbs Ave., Suite BCheyennee. Name of Agency Liaisonf. Agency Liaison Telephone Number82002Cynthia LaBonde307-777-8504g. Agency Liaison Email Addresscynthia.labonde@wyo.govh. Date of Public NoticeMay 12, 2017j. Public Comment URL or Email Address:i. Comment Period End DateJune 30, 2017cynthia.labonde@wyo.govk. ProgramGeneral*By checking this box, the agency is indicating it is exempt from certain sections of the Administrative Procedure Act including public comment period requirements. Please contactthe agency for details regarding these rules.2. Legislative Enactment For purposes of this Section 2, “new” only applies to regular rules promulgated in response to a Wyoming legislative enactment notpreviously addressed in whole or in part by prior rulemaking and does not include rules adopted in response to a federal mandate.a. Are these rules new as per the above description and the definition of “new” in Chapter 1 of the Rules on Rules? No.Yes. Please provide the Enrolled Act Numbers and Years Enacted:3. Rule Type and Informationa. Provide the Chapter Number, Title, and Proposed Action for Each Chapter.Please use the Additional Rule Information form for more than 10 chapters, and attach it to this certification.Chapter Number:Chapter Name:3Scope and Standards of Nursing Practice & CNA RoleChapter Number:Chapter Name:9Delegation & AssignmentChapter Number:New AmendedRepealedNewAmended RepealedChapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealed1
4. Public Comments and Hearing Informationa. A public hearing on the proposed rules has been scheduled.Date:Time:No.Yes. Please complete the boxes below.City:Location:b. What is the manner in which interested persons may present their views on the rulemaking action?By submitting written comments to the Agency at the physical and/or email address listed in Section 1 above.At the following URL:A public hearing will be held if requested by 25 persons, a government subdivision, or by an association having not less than 25 members.Requests for a public hearing may be submitted:To the Agency at the physical and/or email address listed in Section 1 above.At the following URL:c. Any person may urge the Agency not to adopt the rules and request the Agency to state its reasons for overruling the consideration urged against adoption.Requests for an agency response must be made prior to, or within thirty (30) days after adoption, of the rule, addressed to the Agency and Agency Liaison listed inSection 1 above.5. Federal Law Requirementsa. These rules are created/amended/repealed to comply with federal law or regulatory requirements.No.Yes. Please complete the boxes below.Applicable Federal Law or Regulation Citation:Indicate one (1):The proposed rules meet, but do not exceed, minimum federal requirements.The proposed rules exceed minimum federal requirements.Any person wishing to object to the accuracy of any information provided by the Agency under this item should submit their objections prior tofinal adoption to:To the Agency at the physical and/or email address listed in Section 1 above.At the following URL:6. State Statutory Requirementsa. Indicate one (1):The proposed rule change MEETS minimum substantive statutory requirements.The proposed rule change EXCEEDS minimum substantive statutory requirements. Please attach a statement explaining the reason that the rulesexceed the requirements.b. Indicate one (1):The Agency has complied with the requirements of W.S. 9-5-304. A copy of the assessment used to evaluate the proposed rules may be obtained:By contacting the Agency at the physical and/or email address listed in Section 1 above.At the following URL:Not Applicable.2
7. Additional APA Provisionsa. Complete all that apply in regards to uniform rules:These rules are not impacted by the uniform rules identified in the Administrative Procedure Act, W.S. 16-3-103(j).The following chapters do not differ from the uniform rules identified in the Administrative Procedure Act, W.S. 16-3-103(j):(Provide chapter numbers)These chapters differ from the uniform rules identified in the Administrative Procedure Act, W.S. 16-3-103(j) (see Statement of Principal Reasons).(Provide chapter numbers)b. ChecklistThe Statement of Principal Reasons is attached to this Notice and, in compliance with Tri-State Generation and Transmission Association, Inc. v.Environmental Quality Council, 590 P.2d 1324 (Wyo. 1979), includes a brief statement of the substance or terms of the rule and the basis and purpose of therule.If applicable: In consultation with the Attorney General’s Office, the Agency’s Attorney General representative concurs that strike and underscore is notrequired as the proposed amendments are pervasive (Chapter 3, Types of Rules Filings, Section 1, Proposed Rules, of the Rules on Rules).8. Authorizationa. I certify that the foregoing information is correct.Printed Name of Authorized IndividualCynthia LaBondeTitle of Authorized IndividualExecutive Director, WSBNDate of AuthorizationApril 27, 20173
Additional Rule InformationRevised November 20161. General Informationa. Agency/Board Name*Nursing, Board ofb. Agency/Board Addressc. City130 Hobbs Ave., Suite BCheyennee. Name of Agency Liaisonf. Agency Liaison Telephone NumberCynthia LaBonde307-777-8504d. Zip Code82002g. Agency Liaison Email Addresscynthia.labonde@wyo.govh. ProgramGeneral2. Rule Type and Information, Cont.a. Provide the Chapter Number, Title, and Proposed Action for Each Chapter.Chapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedChapter Number:Chapter Name:NewAmendedRepealedIf Needed
WyomingMatthew H MeadGovernorSTATE BOARD OF NURSINGCynthia LaBonde MN, RNExecutive Director130 Hobbs Ave., Suite B Cheyenne, Wyoming 82002 Phone: 307-777-7601 FAX: 307-777-3519 http://nursing.state.wy.usStatement of Principal ReasonsChapter 3 - Scope and Standards of Nursing Practice and CNA RoleChapter 9 - Delegation and AssignmentThe Wyoming State Board of Nursing is proposing Chapter 3: Scope and Standards of NursingPractice and CNA Role, and repeal Rules in Chapter 9: Delegation and Assignment. Theamendments update language in Chapter 3 to reflect the suggested language provided by theNational Council of State Boards of Nursing’s model rules and add relevant language fromChapter 9. Combining the two chapters is necessary for clarity and to keep the common conceptsin the same chapter. The new language reflects modern processes and standards of the nursingprofession. Enclosed is a “crosswalk” identifying the specific amendments and supportingdocumentation or direction for each section. Also included in the crosswalk are the reasonedreferences and authoritative sources for the changes.The major changes to Chapter 3 relate to the Board's authority to regulate the scope and practiceof nursing and provide guidance for APRNs, RNs, LPNs and CNAs via the establishment ofacceptable standards of safe nursing tasks. The proposed language also provides the Board withcriteria to evaluate safe and competent nursing tasks and removes redundancy.The amendments to Chapter 3 also add language from Chapter 9 relating to the Board’s power toestablish acceptable standards of delegation by defining responsibilities among nursingprofessionals. The new language provides the Board with criteria to evaluate safe and competentdelegation of nursing tasks and removes redundancy. Chapter 9 will be repealed in its entiretyand the content integrated into Chapter 3, a more appropriate location for its concepts.By combining Chapter 3 and Chapter 9, the Board can clarify any ambiguity that may occurfrom redundancy and provide succinct and comprehensive regulatory framework. Thisamendment promotes a common understanding of what constitutes the practice of nursing andthe process of delegation among nursing professionals.Respectfully submitted,Cynthia LaBonde MN, RNExecutive Director, WSBN
Crosswalk for Chapters 3 & 9 Most of the changes recommended by the Practice and Education Committee for the Administrative Rules and Regulations of the Wyoming State Board of Nursing, Chapters 3 & 9 are based on NationalCouncil of State Boards of Nursing’s (NCSBN) Model Rules (2014). https://www.ncsbn.org/14 Model Rules 0914.pdfChapters 3 & 9 are being combined to simplify language, decrease redundancies and meet recommendations of NCSBN Model RulesProposed Chapter 3 RulesCurrent Chapter 3 & 9 RulesRationale for ChangeCHAPTER 3Simplifies and updateslanguage based onNCSBNrecommendations.CommentsBOX 11.1Section 1.Statement of Purpose. These Board Rules areadopted to implement the Board’s authority to:1.2(a)Regulate the scope and practice of nursing forAPRN, RN, LPN and the role of the CNA;1.3(b)Provide standards of nursing practice thatintegrate knowledge, skills, abilities and judgment;Section 1.Statement of Purpose. These Board Rules are adoptedto implement the Board's authority to regulate the scope and practiceof nursing and provide guidance for APRN, RN, LPN and the role ofthe CNA.Source2 6.1Simplifies languageDo we need to includeexpanded role of LPNIV, CNA II and MA-C?ANA definition ofcompetency.Source1 p. 78CHAPTER 91.4Section 2.Statement of Purpose.Redundant, combiningchapters(a)These Board Rules are adopted to implement theBoard’s authority to:1.5(c)Establish acceptable standards of safe delegationof nursing tasks; andCh 9, Sect. 2(a)Unchanged(i) To establish acceptable standards of safe delegation ofnursing tasks.Updated 6.3.16Page 1 of 25
Proposed Chapter 3 Rules1.6Current Chapter 3 & 9 Rules(d)Provide clear direction and standardization of thedelegation process, from a systems (employer) and client careperspective.1.7Rationale for ChangeRecommended languagefrom NCSBNCommentsSource2Ch 9, Sect. 2(a)(ii) To provide criteria for the Board to evaluate safe andcompetent delegation of nursing tasks.Removed – theestablishment ofstandards provide criteriafor evaluation. Languageis redundant.BOX 2Note – definitions are not currently included in chs 3 & 9. Definitions arebeing moved from Ch 1 when used exclusively in a single chapter.More terms will need to be added when chapter finalized such asdelegation? Accountability?2.12.22.32.4Section 2. Definitions.(a)“Assignment” means the routine care activities thatare within the authorized scope of practice or the RN, LPN, or part ofthe role of the UAP.Previously not defined(b)“Delegatee” means one who is delegated anursing responsibility by either an APRN, RN, or LPN, iscompetent to perform it, and verbally accepts the responsibility.A delegatee may be an RN, LPN, or UAPPreviously not defined(c)“Employer/Nurse Leader” means the personresponsible for the oversight of delegated responsibilities for thefacility.2.5“FCSA” means Foreign Credential Services of America corporation2.6“Peer Review” means evaluation of scientific, academic, orprofessional work by others working in the same field.Updated 6.3.16Source2 p. 6-7Source2 p. 7Previously not definedSource2 p. 9Page 2 of 25
Proposed Chapter 3 Rules2.7(d)“Licensed Nurse” means those holding an activeWyoming license as an APRN, RN, or LPN.2.8(e)“Predictable” means behaving or occurring in away that is expected.2.92.10Current Chapter 3 & 9 RulesRationale for ChangeComments(f) “Scope and Standard”(g)“UAP” means unlicensed assistive personneltrained to function in a supportive role, regardless of title, towhom a nursing responsibility may be delegated. This includesbut is not limited to CNAs, patient care technicians, CMAs,certified medication aides, and home health aides.2.11(h)2.12(i)Previously not definedSource2 p. 7“WCSA”“WPA”BOX 33.1Section 3.the APRN.3.2(a)Scope and Standards of Nursing Practice forUnchanged – ch 3APRN Scope and Standards.Unchanged – ch 33.3(i) The APRN is subject at all times to the standardsand scope of practice established by national professionalorganizations and/or accrediting agencies representing thevarious core, role and population focus areas for APRNs, andthe NPA.Unchanged – ch 33.4(ii) The Board recognizes APRN core, role andpopulation focus areas described in the scope of practicestatements for APRNs issued by national professionalUnchanged – ch 3Updated 6.3.16Page 3 of 25
Proposed Chapter 3 RulesCurrent Chapter 3 & 9 RulesRationale for ChangeCommentsorganizations and/or accrediting agencies.3.5(iii) Role and population focus of the APRN shall bedeclared, and the role and population focus to be utilized shallbe the title(s) granted by nationally recognized professionalorganization(s) and/or accrediting agency(ies) or the title(s) ofthe role and population focus of nursing practice in which theAPRN has received postgraduate education preparation.Unchanged – ch 33.6(iv) In order to practice in one of the four roles and ina defined population, the APRN shall be recognized by theBoard in that particular role with a population focus of advancedpractice nursing.Unchanged – ch 33.73.8(b)(i) The Board may authorize an APRN to prescribe,order, procure, administer, dispense and furnish over thecounter, legend and controlled substances pursuant to applicablestate and federal laws and within the APRN’s role andpopulation focus.3.9(ii)Authorized prescriptions by an APRN shall:3.10(A)Comply with all current and applicablestate and federal laws; and3.11(B)Be signed by the APRN with the initials"APRN" or the initials of the nationally recognized role andpopulation focus.Updated 6.3.16Unchanged – ch 3Prescriptive Authority.Ch 3, Sect. 2(b)(i) The Board may authorize an APRN to prescribemedications and devices, within the recognized scope of APRN’s roleand population focus, and in accordance with all applicable state andfederal laws including, but not limited to, the WPA, WCSA, theFCSA, and their applicable Rules and Regulations.Ch 3, Sect. 2(b)(iii)Reflects language andrecommendations fromNCSBN Model Rules.Do WPA, WCSA, etcall need to be listed?What about DEA?Source3 11.5.1Wording unchanged ch3– relocated for bettercomprehensionPage 4 of 25
Proposed Chapter 3 Rules3.123.13Current Chapter 3 & 9 Rules(iii) APRNs may receive, sign for, record anddistribute samples to clients. Distribution of drug samples shallbe in accordance with state law and DEA laws, regulations andguidelines.(iv) The Board shall transmit to the Board ofPharmacy a list of all APRNs who have prescriptive authority.The list shall include:3.14(A)The name of the authorized APRN;Rationale for ChangeReflects language andrecommendations fromNCSBN Model Rules.Source3 11.5.2Ch 3, Sect. 2(b)(ii)Unchanged – ch 3Ch 3, Sect. 2(b)(ii)(A-CUnchanged – ch 33.15(B)The RN license number, role andpopulation focus of the APRN recognized by the Board; andUnchanged – ch 33.16(C)The effective date of prescriptiveauthority authorization.Unchanged – ch 33.17(v) The Board will notify the Board of Pharmacywithin two working days after termination of or change in theprescriptive authority of an APRN.3.18CommentsCh 3, Sect. 2(b)(vi)Does this need to bechanged to APRNnumber?Wording unchanged ch3– relocated for Updated 6.3.16(A)Page 5 of 25
Proposed Chapter 3 Rules3.23(B)3.24(C)3.25(D)3.26Current Chapter 3 & 9 RulesRationale for ChangeCommentsCh 3, Sect. 2(b)(iv) Prescriptive authorization will be terminated if theAPRN has:(A)Prescribed outside the scope of recognizedAPRN's role and population focus or for other than therapeuticpurposes;Removed – informationredundant from Ch 2 /8Ch 3, Sect. 2(b)(iv) Prescriptive authorization will be terminated if theAPRN has:(A)Not maintained current recognition as anAPRN;(C)Not completed four hundred (400) hours ofpractice as an APRN within the past two (2) years;(D)Not documented fifteen (15) contact hours ofpharmacology within the past two (2) years; or(E)Violated the standards of practice, Board Rules,or the NPA.3.273.28(d)Applicability.Ch 3, Sect. 2(c)Unchanged – ch 3(i) The provisions of this chapter are only applicableto an APRN who is recognized as an APRN, whoseauthorization to perform advanced and specialized acts ofnursing practice, advanced nursing and medical diagnosis, andthe administration and prescription of therapeutic and correctiveUpdated 6.3.16Page 6 of 25
Proposed Chapter 3 RulesCurrent Chapter 3 & 9 RulesRationale for ChangeCh 3, Sect. 2(c)Unchanged – ch 3Ch 3, Sect. 2(c)Removed – redundantto authority granted inCh 3, Sect. 2(b)Commentsmeasures comes from educational preparation, nationalcertification, and recognition to practice in compliance withBoard Rules.3.29(ii) Nothing in this chapter prohibits the usual andcustomary practice of an APRN in the State from directlyadministering prescribed controlled substances under derivedauthority. In addition, the direct administration, or the orderingof controlled substances preoperatively, intraoperatively orpostoperatively, by an APRN (certified registered nurseanesthetist) does not involve prescribing within the meaning of21 CFR 1308.02(f) or the Board Rules. These rules do notrequire any changes in the current practice and procedures ofAPRN who are certified registered nurse anesthetists or theinstitutional and individual practitioners with whom they maypractice.3.30(iii) Nothing in this chapter prohibits the usual andcustomary practice of APRNs in the State from providing/dispensingdrugs in accordance with applicable state and federal laws.3.31BOX 44.14.24.3(iii) Nothing in this section limits or enhances theusual and customary practice of a RN or LPN in the State.Ch 3, Sect. 2(c)(iv)Standards of practice arethe same for both the RNand LPN. Combiningremoves redundancy.Section 4.Standards of Nursing Practice forthe RN and LPN.(a)Accountability. The RN/LPN shall:(i) Practice within the legal boundaries for nursingthrough the scope of practice authorized in the Nurse PracticeCh 3, Sect. 3(a)(i)Updated 6.3.16Unchanged – ch 3Have knowledge of the statutes and regulationsReflects language andrecommendations fromNCSBN Model Rules.Page 7 of 25
Proposed Chapter 3 RulesCurrent Chapter 3 & 9 RulesAct (NPA) and rules governing nursing;governing nursing;(ii) Practice within the legal boundaries for nursingthrough the scope of practice authorized in the NPA and the BoardRules;Rationale for ChangeCommentsSource3 3.1.1/3.2.1Removes redundancy bycombining RN/LPNstandardsCh 3, Sect. 4(b)(i) Have knowledge of the statutes and regulationsgoverning nursing;4.4(ii)Reflects language andrecommendations fromNCSBN Model Rules.Demonstrate honesty and integrity in nursingpractice;4.5(iii) Base nursing decisions on nursing knowledgeand skills, the needs of clients and nursing standards;Ch 3, Sect. 3(a)(iv) Base professional decisions on nursing knowledge andskills, the needs of clients and the expectations delineated inprofessional standards;Source3 3.1.1/3.2.1Removes redundancy bycombining RN/LPNstandardsCh 3, Sect. 4(a)(ii)(E)Base nursing decisions on nursing knowledge,skills, and needs of clients.4.6(iv) Accept responsibility for judgments, individualnursing actions, competence, decisions and behavior in thecourse of nursing practice;4.74.8(v)Ch 3, Sect. 4(b)(ii) Accept individual responsibility and accountability fornursing actions and competency;Seek clarification of orders when needed;(vi) Maintain competence through ongoing learningand application of knowledge in nursing practice;Ch 3, Sect. 3(a)(v) Maintain continued competence through ongoinglearning and application of knowledge to nursing practice;Updated 6.3.16Page 8 of 25
Proposed Chapter 3 RulesCurrent Chapter 3 & 9 RulesRationale for ChangeCommentsCh 3, Sect. 4(b)(xi) Maintain continued competency through ongoinglearning and application of knowledge to nursing practice;4.9(vii) Participate in the evaluation of nursing practicethrough quality and safety activities including peer review;Ch 3, Sect. 3(a)(vii) Participate in the evaluation of nursing practicethrough quality and safety activities including peer review;Removes redundancy bycombining RN/LPNstandardsCh 3, Sect. 4(b)(v) Participate in the evaluation of nursing practicethrough quality and safety activities;4.10(viii) Take preventive measures to protect the client,others, and self;Ch 3, Sect. 3(a)Unchanged – Ch 3(iii) Take preventive measures to protect the client, others,and self.Ch 3, Sect. 4(c)(ii)Take preventive measures to protect client, others, andself;4.114.13(ix) Participate in the development of continuedcompetency in the performance of nursing care activities fornursing personnel and students; andCh 3, Sect. 4(b)(x) Report violations of the NPA or Rules by self orother licensees. Report unsafe conditions for practice toCh 3, Sect. 3(a)(xii) Participate in the development of continuedcompetency in the performance of nursing care activities for nursingpersonnel and students; and(vi) Report unfit or incompetent nursing practice toUpdated 6.3.16Reflects language andrecommendations fromNCSBN Model Rules.Page 9 of 25
Proposed Chapter 3 RulesCurrent Chapter 3 & 9 Rulesrecognized legal authorities.recognized legal authorities;Rationale for ChangeCommentsSource3 3.1.1/3.2.1Ch 3, Sect. 4(b)(vi) Report unfit or incompetent nursing practice to theboard. Report unsafe conditions for practice to recognized legalauthorities;4.14(b)Client Advocacy. The RN/LPN haveresponsibility to advocate for the client and shall:4.15(i) Conduct practice without discrimination on thebasis of age, race, religion, sex, life style, national origin,medical diagnosis, or handicap;Ch 3, Sect. 3(a)(x) Conduct practice without discrimination on the basis ofage, race, religion, sex, life style, national origin, medical diagnosis,or handicap.Removes redundancy bycombining RN/LPNstandardsRemoves redundancy bycombining RN/LPNstandardsCh 3, Sect. 4(b)(vii) Conduct practice without discrimination on the basis ofage, race, religion, sex, life-style, national origin, or disability;4.164.17(ii) Respect the dignity and rights of clients and theirsignificant others, regardless of social or economic status,personal attributes, or nature of health problems;Ch 3, Sect. 4(b)(iii) Maintain client confidentiality unless obligatedby law to disclose the information;Ch 3, Sect. 3(a)(viii) Respect the dignity and rights of clients and theirsignificant others, regardless of social or economic status, personalattributes, or nature of health problems;(ix) Maintain client confidentiality unless obligated by lawto disclose the information; andRemoves redundancy bycombining RN/LPNstandardsRemoves redundancy bycombining RN/LPNstandardsCh 3, Sect. 4(b)(ix) Protect confidential information, unless obligated byUpdated 6.3.16Page 10 of 25
Proposed Chapter 3 RulesCurrent Chapter 3 & 9 RulesRationale for ChangeCommentslaw to disclose the information;4.18(iv) Maintain appropriate professional boundaries,including sexual boundaries;Ch 3, Sect. 3(a)(viii) Maintain appropriate professional boundaries,including sexual boundaries;Ch 3, Sect. 4(b)(x)4.194.20(v)Maintain boundaries, including sexual boundaries;Reflects language andrecommendations fromNCSBN Model Rules.Promote a safe and therapeutic environment by:(A)Appropriate monitoring and surveillanceof the care environment;4.21(B)Source3 3.2.4Identifying unsafe care situations; and4.22(C)Correcting problems or referringproblems to appropriate management level when needed.5.1Section 5.the RN.5.2(a)RN Standard. The RN has the responsibility toorganize, manage, and supervise the practice of nursing.Scope of Nursing Practice forReflects language andrecommendations fromNCSBN Model Rules.Source3 3.2.45.3(b)5.4RN Scope of Practice. The RN shall:(i)Retain professional accountability for nursingCh 3, Sect. 3(a)Unchanged – ch 3care;Updated 6.3.16Page 11 of 25
Proposed Chapter 3 RulesCurrent Chapter 3 & 9 Rules5.5Ch 9, Sect. 2(a)5.6(i) The RN takes responsibility and accountability for theprovision of nursing practice.Ch 3, Sect. 3(ii) Participate as a member of the interdisciplinaryhealthcare team;(b)The RN shall participate of an interdisciplinaryhealthcare team and organize, manage, and supervise the practice ofnursing.5.7(iii) Implement the nursing process:5.8(A)Conduct a comprehensive nursingRationale for ChangeRemoved – redundantinformation Ch 9Language from Ch 3 part of section moved tostandardCh 3, Sect. 3(d)Unchanged – Ch 3Ch 3, Sect. 3(d)Reflects language andrecommendations fromNCSBN Model Rules.assessment;(i) Conduct a comprehensive health assessment that is anextensive data collection (initial and ongoing) regarding individuals,families, groups, and communities; andCommentsSource3 3.2.2(ii) Collect objective and subjective data fromobservations, examinations, interviews, and written records in anaccurate and timely manner.5.9(B)Plan nursing care and nursinginterventions consistent with the client’s overall health careplan;5.10(C)Utilize decision-making, critical thinkingand clinical judgment to make independent nursing decisionsand nursing diagnoses;5.11(D)Implement treatment and therapy,including medication administration and delegated medical andindependent nursing functions; andUpdated 6.3.16Reflects language andrecommendations fromNCSBN Model Rules.Source3 3.2.2Page 12 of 25
Proposed Chapter 3 Rules5.12(E)Evaluate the client’s response to nursingcare and other therapy.5.13(iv) Identify changes in client’s health status andcomprehend clinical implications of client’s signs, symptomsand changes as part of expected and unexpected client course oremergent situations;5.14(v)Rationale for ChangeCommentsDocument nursing care;5.15(vi) Communicate and consult with other health teammembers;5.16(vii) Provide comprehensive nursing and health careeducation in which the RN:5.17Current Chapter 3 & 9 Rules(B)Assesses and analyzes educational needsof learners;5.18(C)Plans educational programs based onlearning needs and teaching-learning principles;5.19(D)Ensures implementation of an educationalplan either directly or by delegating selected aspects of theeducation to other qualified persons; and5.20(E)identified goals.5.21(viii) Provide delegation to the RN, LPN and UAP.Match client needs with personnel qualifications, availableresources and appropriate supervision using delegationguidelines in this chapter, sections nine (9) through eleven (11).Evaluates the education to meet theReflects language andrecommendations fromNCSBN Model Rules.Source3 3.2.4BOX 5Updated 6.3.16Page 13 of 25
Proposed Chapter 3 Rules6.16.26.36.4Section 6.(a)Current Chapter 3 & 9 RulesRationale for ChangeCh 3, Sect. 4(a)(iii)Reflects language andrecommendations fromNCSBN Model Rules.Scope of Nursing Practice for the LPN.LPN Standards.(i) Practice under the supervision of an RN, APRN,licensed physician or other authorized licensed independenthealth care provider.(A)Provide care for clients under the direction of alicensed physician, dentist, APRN, or RN.Source3 3.1.2Reflects language andrecommendations fromNCSBN Model Rules.(ii) Participate in nursing care, health maintenance,patient teaching, counseling, collaborative planning andrehabilitation, to the extent of his/her generic and continuingeducation and experience.Ch 3, Sect. 4(b)6.5(iii) Initiate appropriate standard emergencyprocedures established by the institution until a licensedphysician, dentist, APRN or RN is available.Ch 3, Sect. 4(a)(iii)(B)Unchanged – Ch 36.6(iv) Contribute to the formulation, interpretation,implementation, and evaluation of the objectives and policiesrelating to practical nursing practice within the employmentsetting.Ch 3, Sect. 4(a)(i)Unchanged – Ch 3Ch 3, Sect. 4(a)Reflects language andrecommendations fromNCSBN Model Rules.6.76.8(b)(iii) Accept client care assignments from the licensedphysician, APRN, dentist, or RN only for which they areeducationally prepared and adequately trained;Source3 3.1.2LPN Scope of Practice. The LPN shall:(i) Conduct a focused nursing assessment, which isan appraisal of the client’s health status and needs thatcontributes to ongoing data collection;Updated 6.3.16Comments(i) Contribute to the nursing assessment by collecting,reporting, and recording objective and subjective data in an accurateand timely manner. Data collection includes observations about thecondition or change in condition of the client.Source3 3.1.2Page 14 of 25
Proposed Chapter 3 Rules6.9Current Chapter 3 & 9 Rules(ii) Recognize patient characteristics that may affectthe patient’s health status;6.10(iii) Contribute to the plan of care by:(A)Gathering, observing, recording, andcommunicating patient responses to nursing interventions; andCh 3, Sect. 4(a)Rationale for ChangeReflects language andrecommendations fromNCSBN Model Rules.CommentsSource3 3.1.2(ii) Participate in the development and modification of theplan of care by:(B)Modifying the plan of care incollaboration with a registered nurse based on an analysis ofpatient responses.(A)Provide data;(B)Contribute to the identification of priorities;(C)Contribute to setting realistic and measurablegoals;(D)Assist in the identification of measures tomaintain comfort, support human functi
The Statement of Principal Reasons is attached to this Notice and, in compliance with Tri-State Generation and Transmission Association, Inc. v. Environmental Quality Council, 590 P.2d 1324 (Wyo. 1979), includes a brief statement of the substance or terms of the rule and the basis and purpose of the . A delegatee may be an RN, LPN, or UAP .
