LPN scope of practice in Michigan

[happynewLPN]

Hi all,

I am a new(er) LPN who will finish her RN in about 12 weeks! In the meantime, I am employed at long-term care facility and there is question regarding my scope of practice, what things I can and cannot do as a licensed practical nurse.

For example:

1. Can we pass oral medications without having taken any sort of test, such as NAPNES?

2. Are we allowed to transcribe verbal/telephone orders from a physician?

3. Are we allowed to flush PICC lines? We have a resident with a PICC line and we flush it q 12 hrs using saline and heparin.

4. Are we allowed to hang new IV antibiotics or monitor the IV without prior training?

5. Also, we do not always have an RN on site to supervise activities on off-shifts (2nd and 3rd shifts). Is this permissible?

Thanks for any info. I will be calling the State Board of Nursing tomorrow, but I just wondered if anyone could give me a heads-up in the meantime.

[Corey Narry, MSN, RN, NP]

The State of Michigan is one of those states that do not go into much detail when it comes to its Nurse Practice Act. We actually no longer have a nurse practice act per se but the Michigan Public Health Code is the law that defines the practice of nursing in Michigan. This law also creates the Board of Nursing for our state.

As far as LPN's the Michigan Public Health Code merely states, "Practice of nursing as a licensed practical nurse" or "l.p.n." means the practice of nursing based on less comprehensive knowledge and skill than that required of a registered professional nurse and performed under the supervision of a registered professional nurse, physician, or dentist. (see http://www.legislature.mi.gov/(S(utsigsuv34bya245nscjcw2g))/mileg.aspx?page=getObject&objectName=mcl-333-17201). Pretty darn simple isn't it?

Anyway maybe I can take a shot at your questions but do talk to someone at the BON so you can get the definitive answer.

1. Technically, yes. You have learned pharmacology in your program so you should be able to pass oral meds.

2. Yes, the law states that LPN's are under supervision of a physician (or an RN or a dentist as the law states) so if the physician orders something, an LPN is qualified to transcribe and carry out the order written or verbal.

3. Now, I do not know if IV flushes and IV meds are part of the competencies included in an LPN program. I always thought they are not. However, I think that is where NAPNES comes in. I believe NAPNES offers IV lines and drug management courses for LPN's and that's how they can practice IV lines and drug management.

4. Same answer as number 3.

5. There is no definite language in the law that states that on-site supervision is the requirement.

[happynewLPN]

Thanks for the reply. I know that some LTCF's require NAPNES certification before they will even hire a new LPN, so apparently this might be optional?...

Being that I've received no formal IV training, I do not feel comfortable flushing PICC lines, manipulating drip rates, etc. Granted, I'm getting exposure to that during my clinical time right now, but that is as a 'student', not an 'LPN'.

I'll be sure to post an update when I talk to the BON tomorrow.

Thanks again!

[Sirena922]

Welcome Happy, where did you go for your LPN and what school are you attending now for your RN?

[happynewLPN]

I am currently attending Mott CC for my ADN.

I'll be finished on Dec 18th!!!

[William VanOrden LPN]

These are the Job Duties listed on Michigan.gov page

JOB DUTIES

Licensed Practical Nurses may:

Assist in the development and modification of patient plans of care

Take and record temperature, pulse, blood pressure, respiration rate, height, and weight

Dress wounds, draw blood samples, and give tube feedings

Give enemas, douches, irrigations and catheterizations

Apply compresses, ice bags, or hot water bottles

Observe patients and chart and report reactions to registered nurse or physician in charge

Sterilize equipment and supplies, using germicides, sterilizers, or autoclaves (a pressurized, steam-heated vessel)

Give prescribed medication or start intravenous fluids when authorized by a licensed physician, dentist or registered nurse

Assist patients in activities of daily living, such as eating, exercising, bathing, oral hygiene, and making beds

Assist with teaching patients good health habits

Perform simple diagnostic tests

Turn patients in bed, position, and help them walk

Record the intake and output of food and fluids

Care for mothers in labor and after childbirth

Feed infants and newborn babies

Provide emotional support for patients and families

Provide post-mortem care for patients who have died

Provide pre-operative and post-operative care

Care for patients in isolation, in casts, or in traction

Observe patient monitoring equipment

Supervise care delivered by nurse aides as delegated by a registered nurse