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CRITERIA FOR DETERMINING SCOPEOF PRACTICE FOR LICENSED NURSESAND GUIDELINES FOR DETERMININGACTS THAT MAY BE DELEGATED ORASSIGNED BY LICENSED NURSESINTRODUCTIONThe intent of this document is to presenta process to determine acts appropriateto nursing at various levels, and actsappropriate for delegation to the licensedpractical nurse, as well as to determinethose acts appropriate for assignment tounlicensed assistive personnel. The Boardhas reviewed and refreshed the Scope ofPractice and Delegation Models and theyare included in this magazine. They alsoreviewed and reframed how we issuea license. Individuals must consult thelaw, applicable rules and Board positionstatements in making a practice decision.Related position statements are includedin the Appendix of this document.Additional law, rules or position statementsmay be developed after the publication ofthis document. The nurse must assure thatcurrent publications are referenced whenusing the Models in this publication.Changes in health care delivery areoccurring in health care organizationsthroughout West Virginia and the nation.These changes could lead to role confusion.In view of the mandates of the WestVirginia Board of Examiners for RegisteredProfessional Nurses and the West VirginiaState Board of Examiners for LicensedPractical Nurses to act in the best interestof public safety and health, the respectiveboards support professional collaborationto deliver competent care and treatmentof the client in a safe, professional and costeffective manner.The guidelines contained in thisdocument provide comprehensive criteriaand examples for use in the decisionmaking process required to determine actsthat are appropriate to nursing at variousP A GE 6levels, and acts appropriate for delegationto the licensed practical nurse as wellas to determine those acts appropriatefor assignment to unlicensed assistivepersonnel. The guidelines, however, donot have the force and effect of law exceptas provided through the Legal Standardsof Practice, WV §19 CSR10 and WV§ 10CSR 3.Many nurses would like a “yes” or “no”answer to questions about the delegationof nursing practice; however, in mostcases it is not that simple. In reality, theanswer to most questions is “it depends.”It depends upon the complexity of thetask to be delegated. It depends upon thecare needs of the client, as assessed by theregistered professional nurse. It dependsupon the educational preparation, skills,and ability of the licensed practical nurseor unlicensed person to whom the task isto be delegated/assigned. And, it dependsupon the availability and accessibility ofessential resources, including supervision,while the task is being performed. Nursingjudgment is the essential element in everydelegation or assignment decision.Licensees are expected to read thescope and delegation information andthen refer back to the portions that willassist in making a final decision. Therefore,this information is best used when anindividual has the time to review allrelated information so the foundation fordecision-making is present when a quickdecision is required.DEFINITIONSAccountability - Being responsible oranswerable for actions or inactions of selfor others in the context of delegated orRevised by:The West Virginia Board of Examiners forRegistered Professional Nurses and TheWest Virginia State Board of Examinersfor Licensed Practical NursesJune 17, 2009assigned duties.Advanced Practice Nurse - A registeredprofessional nurse practicing nursing at alevel which requires substantial theoreticalknowledge in a specialized area of nursingpractice and proficient clinical utilizationof the knowledge in implementing thenursing process. The competencies ofspecialists include but are not limitedto the ability to assess, conceptualize,diagnose, analyze, plan, implement, andevaluate complex problems related tohealth.Assignment-Designating nursingactivities to be performed by another nurseor nursing assistive personnel that areconsistent with his/her scope of practice(licensed person) or role description(unlicensed person). (NCSBN)Competence-Possessing verifiableknowledge and skill to perform an activityor task safely and effectively.Delegation - Transferring to a competentindividual the authority to perform aselected nursing task in a selected situation.(NCSBN)Licensed Practical Nurse - “PracticalNursing” means the performance forcompensation of selected nursing acts inthe care of the ill, injured or infirm underthe direction of a registered professionalnurse or licensed physician or licenseddentist, and not requiring the substantialspecialized skill, judgment and knowledgerequired in professional nursing. (Code ofWV §30-7A-1)§30-7A-2. Use of titles. (a) Any personlicensed pursuant to this article may usethe title “licensed practical nurse,” “practicalnurse” and the abbreviation “L.P.N” or thecontinued

term “nurse.” Except as otherwise providedin article seven of this chapter, no otherperson may assume such title, or use suchabbreviation, or any other words, letters,figures, signs, or devices to indicate thatthe person using the same is a licensedpractical nurse or a practical nurse.Registered Professional Nurse “Registered professional nursing” shallmean the performance for compensationof any service requiring substantialspecialized judgment and skill based onknowledge and application of principles ofnursing derived from biological, physicaland social sciences, such as responsiblesupervision of a patient requiring skill inobservation of symptoms and reactionsand the accurate recording of the facts,or the supervision and teaching of otherpersons with respect to such principlesof nursing, or in the administration ofmedications and treatments as prescribedby a licensed physician or a licenseddentist, or the application of such nursingprocedures as involve understanding ofcause and effect in order to safeguard lifeand health of a patient and others. (Codeof WV §30-7-1)§30-7-10. Use of titles. - Any personlicensed pursuant to this article mayuse the title “registered nurse” and theabbreviation “R.N.” or the term “nurse.”Except as otherwise provided in articleseven-a of this chapter, no other personmay assume a title or use abbreviationsor any other words, letters, figures, signs,or devices to indicate that the personusing the same is a registered professionalnurse.Responsible - Liable to legal review orin the case of fault to penalties; able toanswer for one’s conduct or obligation;able to choose for one’s self right fromwrong.Unlicensed Assistive - Personnel(UAP) Any unlicensed person, regardlessof title, to whom nursing tasks aredelegated or assigned.AGENCY REFERENCESThere are a variety of agencies thathave laws and standards that directly affectthe practice of nursing and health care.Some of the most commonly referencedP A GE 8agencies are provided herein.OHFLAC Office of Health FacilityLicensure and Certification; a divisionof the West Virginia Departmentof Health and Human Resourcesresponsible for promulgation of Rulesregulating various types of health carefacilities.Web site: www.wvdhhr.org/ohflac/Phone: 304-558-0050NCSBN National Council for StateBoards of Nursing is the nationalassociation providing assistance tonursing regulatory boards. Thisassociation authors many regulatoryrelated documents and research. Thisassociation has also developed a paperon Delegation.Web site: www.ncsbn.orgPhone: 312-525-3600BOM Board of Medicine regulates thepractice of medical doctors, podiatristsand physician assistants.Web site: www.wvdhhr.org/wvbom/Phone: 304-558-2921BOO Board of Osteopathy regulates thepractice of osteopathicphysicians,surgeons and osteopathic physicianassistants.Web site: www.wvbodosteo.org/Phone: 304-723-4638BOP Board of Pharmacy regulates thepractice of pharmacists, pharmacytechnicians and pharmaceuticalservices.Web site: www.wvbop/Phone: 304-558-0558Nurse Aide Registry The state agencyresponsible for the regulationofcertified nurse aides and theabuse registry.Web site: http://www.wvdhhr.org/ohflac/NurseAide/Phone: 304-558-0688WVNA West Virginia Nurses Association(WVNA) is the West Virginia chapterof the American Nurses Association(ANA).Web site: www.wvnurses.orgPhone: 304-342-1169ANA American Nurses Association is thenational professional organization fornurses. This association has developedmany standards of practice for nursingincluding the Code of Ethics.Web site: www.nursingworld.orgCRITERIA FORDETERMINING SCOPE OFPRACTICE FOR THELICENSED NURSEYou may use the process explained belowto determine, on an individual basis, if aspecific activity or task is within the scopeof practice for a registered professionalnurse or a licensed practical nurse.I. DEFINE THE ISSUEClearly define the activity or task tobe performed. Steps essential in thisprocess include:A. CLARIFICATION OF THE ISSUE:What is the issue or problem? Gatherfacts that may influence the decision.Are there written policies andprocedures available that relate to thisact? Is this a new expectation or justnew to you? What is the decision tobe made and where (in what setting ororganization) will it take place? Hasthe issue been discussed previously?B. ASSESSMENT OF SKILLS ANDKNOWLEDGE: What skills andknowledge are required?Doyou possess those skills? Is yourcompetence documented? Who isavailable to assist you? Who has thatskill and knowledge? Is that personaccessible to you?C. IDENTIFICATION OF OPTIONS:What are possible solutions? What arethe risks? What are the implicationsof your decision: How serious are theconsequences? Should you choose toperform an act, you are responsible forperforming it accurately and safely.II. REVIEW EXISTING LAWS,POLICIES, AND STANDARDS OFNURSING PRACTICEBoth the RN and LPN are responsiblefor implementing the nursing process inthe delivery of nursing care. The Boardsreceive many questions about the LPN’srole in the assessment component of thenursing process. While the law does notspecifically address the issue of the LPN’srole in the assessment process, the rule

clearly places the responsibility for theanalysis of the data on the RN. It is theresponsibility of the LPN to contribute tothat data analysis by collecting objectiveand subjective data at the direction of theRN and by reporting and documenting theinformation collected (from the OBONSOP brochure 2005).The legislative rules which provide thelegal standards of practice for RNs andLPNs in West Virginia are included in thisdocument as appendices F and G. Based onthe definitions of practice in the Code, theRN can independently engage in activitiesincluding assessing the health status of anindividual, teaching, delegating, supervisingand evaluating nursing practice. The LPNhas a dependent role and provides careonly at the direction of the RN, physicianor dentist (portions reworded from theOBON SOP brochure 2005).cfm?chap 16&art 5O#05OD. School Nurse Law and RulesE.Dialysis Technician Law and Ruleshttp://www.wvrnboard.com/default2.asp?active page id 109F. Agency Accreditation StandardsG. National Council of State Boards ofNursing (NCSBN) www.ncsbn.orgH. Office of Health Facility Licensure andCertification (OHFLAC)http://www.wvdhhr.org/OHFLAC/I. Standards of practice of a nationalnursing specialty organization.J. Positive and conclusive data in nursingliterature and supported by nursingresearch.K. Established policy and procedure ofemploying facility or agency, as longas the policy and procedures are not inconflict with the law or rules.Following a review of these items, askyourself the following questions:continued Once the problem has been clearly defined,review existing laws, policies, andstandards of nursing practice:A. Definitions of nursing practice (§307-1.b) or advanced nursing practice(19 CSR 7) and the Legal Standards ofPractice for the Registered ProfessionalNurse (19 CSR 10).Link to the Lawh t t p : / / w w w. l e g i s. s t a t e.w v. u s / W V C O D E / c o d e.cfm?chap 30&art 7#1Link to the Ruleshttp://www.wvrnboard.com/default2.asp?active page id 74Scroll Down to 7B. Definition of practice for the licensedpractical nurse (§30-7A-1.a) and LegalStandards of Practice for the LicensedPractical Nurse (10 CSR 3).Link to Lawh t t p : / / w w w. l e g i s. s t a t e.w v. u s / W V C O D E / C o d e.cfm?chap 30&art 7A#07ALink to Ruleshttp://www.lpnboard.state.wv.us/Click on “Practice” and then on“Applicable Rules”C. Medication Administration byUnlicensed Personnel (WV Code §165O-1 et.seq.)Link to Lawh t t p : / / w w w. l e g i s. s t a t e.w v. u s

The Board of Nursing is mandated under Chapter 30 of the West Virginia Code to: 1. Review and evaluate National Council of State Boards of Nursing registered nurse licensure examination scores of each program in relation to the standard. 2. Conduct on-site visits to at least two nursing education programs annually. 3.