?'s regarding LPN scope of practice (long)

[nurse_wannabe]

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! 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

© 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 © 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.

[st4304]

I have been a "camp nurse" in the past. I am an RN and this is Indiana, BUT I can't imagine summer camps are all that different (except special needs kids camps...). All I did was pass meds and inhalers. Each parent filled out a form with their child's list of meds and directions of each, with the meds in their original bottles. I was not allowed to give a Tylenol to a child if their parent did not send some with them. The year before I did this the first time, a child's parent was the 'camp nurse' and I believe she was a stay at home mom (no nursing degree). And this past year, the camp could not find a nurse, and the camp staff did it themselves. I cleaned scrapes, put on bandaids. I did have malpractice insurance of my own, but never signed a contract. Are you perhaps looking into this too deep? Maybe Missouri is different. . .

Sherri

[ICURN_NC]

Good ?- it's always a good idea to know what you're getting into.

I believe here in NC many LPN's work in home health, where there would be no MD around. Maybe a home health LPN could give you some insight?

Good luck!

[AMINI'SNURSE]

you have no contact with the state broad of nursing????

[nurse_wannabe]

I have been a "camp nurse" in the past. I am an RN and this is Indiana, BUT I can't imagine summer camps are all that different (except special needs kids camps...). All I did was pass meds and inhalers. Each parent filled out a form with their child's list of meds and directions of each, with the meds in their original bottles. I was not allowed to give a Tylenol to a child if their parent did not send some with them. The year before I did this the first time, a child's parent was the 'camp nurse' and I believe she was a stay at home mom (no nursing degree). And this past year, the camp could not find a nurse, and the camp staff did it themselves. I cleaned scrapes, put on bandaids. I did have malpractice insurance of my own, but never signed a contract. Are you perhaps looking into this too deep? Maybe Missouri is different. . .

Sherri

You know Sherri, I was wondering the same thing... that maybe I am looking into it too deeply. I think if it was just a week or two I wouldn't be so concerned. But I will be there for 9 weeks, with the last 2 of those weeks reserved for adults and children with disabilities. There will be 4 tube feeders, one who has to be straight cathed 4x's a day, insulins to give, growth hormone injections, and various other disabilities to contend with.

Plus, I read a post the other day in the camp nursing forum in which one nurse reports that the department of health showed up at her camp to do an inspection.

I want to keep my butt fully covered, if ya know what I mean!