hello, all. i have some questions regarding lpn scope of practice here in missouri. now, i consider myself to be somewhat intelligent, but reading this has my head spinning! :spin: why can't they just say what they mean in plain english and leave out all the legal jargon?!
first of all, the reason i am asking this is that i am considering a position at a summer camp. i will be the only nurse there. no r.n. i asked the camp owner if there was a physician for the camp. she stated, "yes, there is a doctor in town who can see the campers if needed." okay, fine. then she went on to say, "but if there was something serious enough to call a doctor, we would go ahead and send the camper to the er."
so now i don't know if there is a formal relationship between this camp and the physician or not. i don't even know if this physician has written standing orders. and even if he has, according to the last paragraph below, that's not good enough anyway.
so i would like some input as to exactly what i need to have in place to ensure that i am operating within my scope of practice.
our nurse practice act states:
lpn scope of practice
pursuant to the nursing practice act (1999), licensed practical nurses[statute, 335.016 (9), rsmo] are able to perform nursing acts that they defensibly have the requisite specialized skill, judgment, and knowledge to perform only "under the direction of a person licensed by a state regulatory board to prescribe medication and treatments [banana]this would include a physician, right?[/banana] or under the direction of a registered professional nurse" [see also statute, 335.016 (10) (e), rsmo, and rule, 4 csr 200-5.010 definitions (i.e., proper supervision)]. licensed practical nurses, by statutory law, are not authorized to independently perform nursing care/acts. it is essential, therefore, for licensed practical nurses to have ongoing defensibility with respect to under whose specific direction (i.e., supervision) they are working at any given time. [banana]huh? can you rephrase the question? [/banana] furthermore, it is important for licensed practical nurses to have immediate access, at all times, [banana]is on-call okay?[/banana] to the individual (e.g., physician, registered professional nurse) under whose direction they are working when, for example,:
(a) patients' care needs exceed their legal scope of practice;
(b) patients' care needs surpass their knowledge, education, skills, training, or experience; or
(c) patients' conditions indicate pressing importance of consultation or imminent referral consideration.
if licensed practical nurses (lpns) are to perform acts prescribed by "a person licensed by a state regulatory board to prescribe medications and treatments" [335.016(9), rsmo] as part of a patient's care, an authorized prescriber-licensed practical nurse relationship must clearly be in place [banana]does this mean that i need some kind of written agreement stating such? and if so, what should said agreement state?[/banana] and verbal or written orders from and cosigned by the authorized prescriber delegating the acts would be needed by licensed practical nurses. the acts being delegated must be within the scope of practice of the authorized prescriber and licensed practical nurses must ensure that appropriate oversight is in place (see rule, 4 csr 200 -5.010) and that they possess the ability to perform the delegated acts defensibly, safely, and competently.
for example, a physician-licensed practical nurse relationship may be established for the performance of physician-delegated acts that are associated with prescribed medications and treatments: (a) through specific, and later cosigned, verbal orders from a physician; (b)
through specific written orders from a physician; or (c) through written orders, possibly in the form of protocols or standing orders, generated and signed by a physician. the acts being delegated must be within the scope of practice of the prescribing physician and the licensed practical nurse must ensure that appropriate oversight is in place (e.g., physician, registered professional nurse) and that s/he possesses the ability to perform the delegated acts defensibly, safely, and competently. licensed practical nurses must keep in mind that merely having physicians' orders for patients, however, does not mean that they also have physician oversight
for their practice. [banana]so what do i have to have, if not written orders, for the physician-lpn relationship to be considered "physician oversight?"[/banana]
thank you all for any help or advice you can give. and if your advice is to call the b.o.n., how do you suggest i do that? telephone? email? i have never had to contact them about anything so far.