Nursing Practice
Minnesota Board of Nursing Report on LPN Scope of Practice Raises Concerns About Patient, RN Safety
Why is the Minnesota Nurses Association pursuing this action plan with the Board of Nursing at this time?
- MNA is seriously concerned that if this document is passed by the Board of Nursing as written, it will result in legitimizing the current illegal practice by employers of interchanging RNs and LPNs, jeopardizing the safety of patients in MN health care settings. The lack of communication by the Board regarding the content and time frame of implementation of this process has been vague and uncertain.
- MNA believes that these proposed changes, which re-interpret the definitions of the Nurse Practice Act and have significant ramifications for the safety of the public, should be required to be subjected to a formal public policy process.
- MNA does not believe that the Board of Nursing has addressed the clarity promised in the model for the change in practice of LPNs in the areas of assessment, supervision, and delegation.
- MNA’s Commission on Nursing Practice has repeatedly offered to meet and dialogue about the objections to this proposal with the intent of drafting language that may be more acceptable. To date, the Board has not agreed to meet.
What is nursing assessment?
The Board has not defined assessment or how it is using the term in the models of practice they have outlined. The term used by the Board is inconsistent with the historical, and current professional and legal interpretation and utilization of the term. It is a universal truth that most people have the ability to assess. However, the difference is that assessment needs to be within the context of nursing and safe patient care as well as the professional and technical differences in its application based on legal and professional definitions and the education and licensure level required.
Assessment – Definition: A systematic, dynamic process by which the registered nurse, through interaction with the patient, family, groups, communities, populations, and other healthcare providers, collects and analyzes data to then evaluate and progress the plan of care. Assessment may include the following dimensions: physical, psychological, socio-cultural, spiritual, cognitive, functional abilities, development, economic, and lifestyle. (Scope and Standards of Practice, 2004, ANA)
What is the difference in levels of assessment?
- The LPN participates in assessment with the RN by collecting data, recognizing alterations in the client’s condition and reporting to the RN. The LPN also participates in the plan of care and evaluating the response to interventions. Assessment is not an independent process for the LPN.
- The RN is educated to interpret and analyze data, attach nursing significance to the observations, develop a care plan by setting priorities, identify outcomes, write nursing actions, coordinate the different dimensions of the care plan, and evaluate the care for effectiveness and appropriateness. Both LPNs and RNs provide for the maintenance of safe and effective nursing care.
All health care workers as part of a team do some level of observation dependent upon their level of preparation/education. Only health care personnel educated at the professional level (i.e. physical therapy, occupational therapy, social worker) perform complete assessment, which means interpreting the findings with the purpose of developing a plan for intervention. Technically trained health care workers can perform some of the tasks involved in the assessment process (e.g. collecting data and reporting to the appropriate professional health care person).
Example of Pain Management
Any member of the health care team could report a patient’s pain to an RN, who would assess the need to change the pain medication by following up with the patient and considering all the information available. Nursing assistants, licensed practical nurses, or other disciplines such respiratory or physical therapists can provide this information. For example if the pain is abdominal, it may be from a variety of possible sources – bladder infection, bowel blockage, etc. The RN is educated to take all of these possibilities into account before making a decision to pursue a change in pain medication or implement other pain-relieving interventions. The LPN is licensed to be able to give the pain medications or implement pain-relieving interventions as assessed and directed by the RN.
Doesn’t MNA want APRNs to practice within the full scope of their practice? Why not allow LPNs to do the same?
APRNs are legally authorized to practice at this advanced level by the required level of education and a required specialty certification process. However, APRNs experience barriers to practice by external requirements of needing a collaborative management agreement with a physician. What the Board of Nursing is proposing for the expansion of the Licensed Practical Nurse scope is not currently contained within the legal definitions of the Nurse Practice Act or supported through additional education.
Call or e-mail the MNA Nursing Practice department with any further questions:
Carol Diemert, RN, MSN
Nursing Practice Specialist
1-800-536-4662, ext. 149, (651) 414-2862
Cindy Schoenecker, RN, MA
Nursing Practice Specialist
1-800-536-4662, ext. 126, (651) 414-2826
Nurses Guide to Electronic Health Records
To practice effective patient advocacy, we must effectively advocate for nursing practice.
Registered Nurse members and staff of MNA’s Nursing Practice Program help promote, guard and advance standards of practice and advocate for the effective and appropriate understanding and implementation of professional nursing practice. The foundation of the program is ANA Code of Ethics for Nurses, ANA Nursing’s Social Policy Statement, ANA Scope and Standards of Practice for Professional Nursing, and Minnesota’s Nurse Practice Act. Click here for information on the MNA Professional Practice, Ethics and Regulation Handbook.
Expanding Practice Through Research
To be viable and vital to quality patient care, nurses must continue to question their practice and support the development of new knowledge. MNA salutes and supports individuals who examine nursing practice through scientific research. Data supplied by exciting new research helps confirm the efficacy of nursing interventions for utilization in practice settings.
Nursing practice in Minnesota is enhanced by investigations conducted nationally and by our own colleagues here in the state. Your association has funded and continues to issue grants for projects that make a significant impact on the lives of nurses and the lives of the people served by nurses. Because of MNA and the American Nurses Association, we have evidence of the importance of nursing-based quality indicators and their relationship to patient outcomes.
Memorandum of Understanding for Written Prescribing Agreements Between Advanced Practice Registered Nursee and a Collaborating Physician
Model Form for the Development of a Prescribing Agreement.
Memorandum of Understanding for Written Prescribing Agreements Between a Clinical Nurse Specialist in Psychiatric and Mental Health Nursing and a Physician.
Model Form for the Development of a Prescribing Agreement for a Clinical Nurse Specialist in Psychiatric and Mental Health Nursing.
