Virginia Law LPN Administering TB Tests

[Cindpi]

I am a newbie to Virginia nursing so a question for those who may have history on the law, how did this come about?

How many Virginia LPNs knew that the State regulations do not allow an LPN to administer the Tuberculosis tests without an RN present? I am originally licensed in Missouri, practicing now in under compact in Virginia and recently found that an LPN can not plant a TB test without direct supervision of an RN. This policy is enforced at the facility's in which I work and rightfully so based on law. It is their interpretation that the RN must have DIRECT Supervision of the administration of the test.

Although, LPNs may be left to run an entire shift for 12 hours without an RN or other superior medical professionals available or on site. They must have direct supervision from an RN to plant a Mantoux Test? Evidently this law was passed and has been enforced since 2003.

HB 2302 Administration of controlled substances by nurses.

This law provides that prescribers may authorize RNs or LPNs under the supervision of an RN to possess and administer PPD in keeping with Department of Health guidelines. It also establishes that the Commissioner of Health can authorize RN's to possess and administer PPD at their discretion, based upon policies and guidelines of VDH.

[HouTx, BSN, MSN, EdD]

Not from VA, but FWIW - all legislation is the result of political machinations... special interest lobbying efforts and to push their issues. All it takes is a couple of convincing nutcases and our duly elected "representatives" go off on a tangent. I'm sure that there is a convoluted story behind this one also.

Heck, I'm from Texas.... the epicenter of legislative loonies.

[Cindpi]

HouTx, that is kind of my thoughts as well. I am thinking that maybe the organizations who represent the LPN's should push back. In my humble opinion, this specific legislation is absurd and a hindrance to daily operations. LPN's can draw labs, start IV's, in some states hang blood and do almost everything an RN does with minimal exceptions (chemo, IV push, etc....) Planting a Montoux test isn't quite the litigation magnet that they seem to infer with this ridiculous law. There are LPN's who would love to have no responsibility but I am not one of them.

I may have to push some buttons and rattle some cages. I need a new challenge anyway.

[IsmeAmanda, LPN]

Man thats crazy! Whats more simple than a PPD?

[pixiestudent2]

What about unlicensed persons like MAs? I don't even think I've ever had a RN nor LPN actually do my TB test. I

[CaliBoy760]

I think that your facility is reading more in to the law than is required. Licensed Nurses do everything "under the supervision of an RN", which does not mean that the RN is actually observing the procedure. Also, are you sure that the law actually reads "supervision", and not "direction"?

[NRSKarenRN, BSN, RN]

Actual bill language:

§ 32.1-50.3. Administration of tuberculin purified protein derivative by nurses; policies and guidelines.

The Department shall issue policies and guidelines for prescribers as defined in § 54.1-3401 to follow when authorizing registered nurses or licensed practical nurses under the immediate and direct supervision of a registered nurse to possess and administer tuberculin purified protein derivative (PPD) in the absence of the prescriber pursuant to § 54.1-3408. The Department's policies and guidelines shall be consistent with applicable guidelines developed by the Centers for Disease Control and Prevention for preventing transmission of mycobacterium tuberculosis and shall be updated to incorporate any subsequently implemented standards of the Occupational Safety and Health Administration and the Department of Labor and Industry to the extent that they are inconsistent with the Department's policies and guidelines. Such policies and guidelines shall include standing protocols that explicitly describe the categories of persons to whom the tuberculin test is to be administered and shall provide for appropriate medical evaluation of those in whom the test is positive.

[CaliBoy760]

Actual bill language:

§ 32.1-50.3. Administration of tuberculin purified protein derivative by nurses; policies and guidelines.

Sounds like you need to rally your state board, or your local Licensed Nurse organization. Placing a PPD is, essentially, child's play when compared to evaluating and implementing venous access.