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Practice Questions

General Questions

Anesthesia

At its February 10-11, 1993 meeting, the Board reconsidered its position on its June, 1990 advisory ruling regarding injection of anesthetic agents to produce anesthesia following placement of the needle by the physician.

The Board has determined that the registered professional nurse (RN) may assist in the procedure by acting as a "third hand" for the anesthesiologist/anesthetist. The Board further determined that the anesthetic agents are to be drawn up by the anesthetist; the physician must be present and appropriate policy should be developed by the medical and nursing staff. The RN who is not a CRNA is not to insert or place the needle. The RN is strictly assisting as a "third hand" while the anesthetist administers the anesthesia.

C-ARM

At its June 1993 meeting, the Board determined that while positioning a C-arm over a patient is not nursing, it is certainly permissible for a registered nurse to lend in positioning the machine as long as the physician is actually operating the fluoroscopy C-arm and the nurse has been instructed on how to move the C-arm.

Chapter 6 Clarification

At its October 22-23, 1997 meeting, the Board determined that it would maintain Chapter 6 as adopted and provide clarification through the following advisory ruling in situations where care is directed by the consumer:

In consumer-directed care provided by an unlicensed assistive person (UAP), the registered nurse's responsibility is to provide the consumer with appropriate information regarding the task to be performed by the UAP.

Chiropractic Orders

In accordance with THE LAW REGULATING THE PRACTICE OF NURSING, licensed nurses are authorized to execute the medical regimen prescribed by a physician, dentist, or otherwise legally authorized person acting under the delegated authority of a physician or dentist (i.e. physician assistant or nurse practitioner). On this basis, licensed nurses are not authorized to execute the medical regimen prescribed by a chiropractor. (March 6, 1990)

Coude Catheter

At its April 12-13, 2000 meeting, the Board determined that it is within the scope of practice of a licensed nurse to insert a coude catheter providing that he/she has had appropriate documented training according to polices and procedures established by the facility.

Death Pronouncement

At its February 8, 1996 meeting, the Board reconsidered its 1986 ruling and determined that licensed nurses may pronounce death in the absence of any law to the contrary. However, certification of death must be pursuant to current state law which requires the signature of a physician on the death certificate. The facility that employs the licensed nurse should also consider JCAHO and insurance requirements when setting policies regarding this matter.

Dispensing Medication

A RN or LPN legally may NOT dispense drugs at any time. Dispensing means the pouring or placing of drugs from stock supplies into bottles or containers, the labeling of such items with the patient's name, medication, dosage and directions and the giving of such bottles or containers to personnel for administering to patients. This is the role of the pharmacist and may not be assumed by nurses. (1986)

The Board reaffirmed that LPNs and RNs are NOT authorized to dispense medications. The administration of medications as prescribed by a legally authorized person is within the scope of practice of nurses licensed in Maine. (Dec. 27, 1990)

The Board of Nursing determined that nurses licensed in Maine may provide patients with limited quantities of prescribed/ordered medication which has been pre-labeled and prepackaged by the hospital pharmacist. These "starter packs" will be administered to the patient in the emergency department setting following an evaluation by a physician. This same procedure will also be used in inpatient leave of absence situations. (May 1, 1991)

In response to a query in April, 1993, the Board stated that a telephoned order for drugs at night for an in-patient is an example of administering a medication, not dispensing.

A nurse providing medications to a patient not evaluated by a physician in the emergency department is acting as a pharmacist in dispensing medications and exceeds the scope of nursing practice.

EKG

The Board determined that the taking of EKGs is not necessarily nursing practice; however, if any licensed nurse performs this task, they must have received the appropriate education and supervised clinical practice. Policies and procedures should be in place to define the appropriate initial education and continuing competence of the licensed nurses involved. The Board has defined competence in nursing as the ability of the licensed nurse to perform skillfully and proficiently the functions within the current role of the licensee. The role encompasses the possession and interrelation of essential knowledge, judgment, attitudes, skills and abilities which are varied and range in complexity. Competence is a dynamic concept, changing as the licensed nurse achieves a higher state of development within the role. Therefore, if licensed nurses were expected to perform and/or "read" EKGs, they must be currently competent in such a procedure. September 26, 1990

Endoscope

At its February 1993 meeting, the Board determined that it is not within the scope of practice for nurses to maintain the position of the endoscope.

At its June 9-10, 1999 meeting, the Board restated its position that it is not within the scope of a registered professional nurse's practice to advance the endoscope under any circumstances.

At its February 14-15, 2001 meeting, the Board revisited the issue and determined that licensed nurses, who are educationally prepared according to the organization/facility's established policies and procedures, may assist the physician, who is present in the procedure room, to maintain the position of the endoscope, advance the endoscope, and manipulate the polypectomy snares as directed by the physician.

Ergonomics

The Board at its June 7-8, 1995 meeting determined that while ergonomics is not included in basic nursing curricula, licensed nurses may include ergonomics in their nursing practice if appropriately trained.

Hypnotherapy

The use of complementary or alternative therapies in general or hypnotherapy specifically does not expressly come under the Law Regulating the Practice of Nursing or under any specific regulations of the Maine State Board of Nursing.

At its December 6-7, 2000 meeting, the Board determined that hypnotherapy is not exclusively nursing practice but may be considered a modality that a registered professional nurse may employ if he/she has been appropriately trained and competency has been maintained.

Intrauterine Pressure Catheters

Placement of intrauterine pressure catheters is not considered within the scope of nursing practice.

Investigational Drugs

At its February 8-9, 1995 meeting, the Board determined that licensed nurses may administer investigational drugs. The Board is of the understanding that guidelines and requirements for investigational drugs are so strict as to safeguard the public's health. The licensed nurse should be familiar with these guidelines and requirements and exercise the same caution in administration as with any other drug.

J-Tubes and T-Tubes

The Board at its February 10-11, 1993 meeting determined that with appropriate training and documented clinical competency, a LPN may irrigate J-tubes. It is not within the scope of practice of a LPN to irrigate T-Tubes. It is not within the scope of practice of a LPN to remove all types of ureteral catheters.

The Board at its October 21-22, 1998 meeting determined that a licensed nurse may perform the following skills related to the J-tube with training by a registered professional nurse and documented competency:

1. Administer medications via J-Tube
2. Flush a J-Tube with normal saline before and after administering a medication
3. Insert and remove a J-Tube on a well established tract
4. Check the sterile water level in the J-Tube Balloon and re-inflate the Balloon with saline
5. Perform routine dressing changes on the J-Tube site

The Board at its June 7-8, 2000 meeting determined that it is not within the scope of practice of a licensed nurse to introduce a guide wire to unplug a J-Tube.

The Board at its August 2-3, 2000 meeting determined that it is not within a registered professional nurse's scope of practice to remove a Jackson-Pratt (J-P) draining device.

The Board at its June 5-6, 2002 meeting determined that with appropriate training a registered professional nurse may remove a J-P training device.

Lymphedema

At its July 9, 1998 meeting, the Board determined that within the framework of a nurse's license, and with the appropriate knowledge and skill training, the method of manual lymph drainage may be performed.

At its September 10, 1998 meeting, the Board revised the advisory ruling of July 9, 1998 to read: that within the framework of a nurse's license, and with appropriate knowledge and skill training, the method of combined decongestive therapy may be performed.

Myringotomy

The Board at its October 23-24, 1996 meeting determined that it is not within the scope of advanced practice nursing to perform myringotomies.

Operating Room (O.R.) Circulating Nurse

In December, 1984, the Board stated that it believed that the registered professional nurse is the appropriate person to be the circulating nurse in the operating room and that this function should not be delegated to the licensed practical nurse.

Again in September, 1990, the Board determined that the registered professional nurse circulating in the operating room cannot be replaced by the licensed practical nurse or an unlicensed technician.

In 1989 the Board determined that the Law Regulating the Practice of Nursing does not govern scrub technicians.

Phlebotomy

The Board determined that the performance of phlebotomy is not considered the practice of nursing; therefore, it is not necessary for the registered nurse to be physically present in the facility when the LPN performs phlebotomy. September 28, 1990

Physician Licensed in Another State

It is the opinion of the Board's legal counsel that "licensed physician" (32 M.S.R.A. section 2102 (2)(A)) does not refer exclusively to physicians licensed in Maine. As long as the physician is duly licensed in the jurisdiction in which he or she is in practice and issues orders, then it is appropriate for nurses to carry out those orders. Should the nurse have reason to suspect licensure status of any physician (allegedly licensed in Maine, New Hampshire, New Brunswick, etc.), s/he should follow the agency's policy for ensuring valid credentials. This is NOT intended to mandate home health agencies maintain credentials on providers but rather follow the protocol they normally would if questioning licensure status. April, 1992

Practice Below Level of Licensure

A licensed person who agrees to be employed in a position which requires less knowledge and skill than that for which s/he is prepared may find several problems:

1. S/he may be expected to perform at the level for which s/he has been prepared even though classified at a lesser level; and
2. S/he will be held to the standard expe cted of the higher licensure level should legal problems occur in that health care facility, no matter what the job classification.

The practice of employing licensed individuals to work below their level of preparation, as defined in the LAW REGULATING THE PRACTICE OF NURSING, places that licensed nurse in potential legal jeopardy and is of serious concern to the Board. (1985)

[The DATA BASE /The Bulletin /Spring 1985]

Refresher Course

The Board has a mandate to safeguard the life and health of the people in this state. To that end, the Board routinely recommends that individuals who have not practiced nursing in the past few years take a refresher course. The Board does not have any information regarding the availability of refresher courses and has no mandate to provide specific information about them to licensees. Licensed nurses have a legal and professional obligation to maintain their competency to practice nursing prior to their accepting employment in nursing. (March 15, 1990)

Telephone Orders

Maine Board of Licensure in Medicine and Maine State Board of Nursing
February, 1995 /
Joint Advisory Opinion: Telephone Orders

Purpose:
1. To clarify the roles and responsibilities of physicians and nurses regarding telephone orders.
2. To insure public protection and assure quality of care.

Physicians, nurses and other health care providers rely on the professional skills and integrity of all participants in the health care delivery process.
Physicians are responsible to assure that the orders communicated are appropriate to the situation, and that orders are accurately relayed from the physician's office. Nurses may accept physician orders via telephone from office personnel designated by the physician. In receiving orders from physician offices, nurses are responsible for recognizing the appropriateness of the order with respect to the plan of care, and for implementing the order or obtaining clarification.

VA License Requirement

The Board's legal counsel has advised that any nurse from the VA Hospital who participates in an educational clinical experience at Maine Medical Center or any other health care facility within the state would be required to have a current Maine license. (June 22, 1984)

Vaccines

At its 4-5, 2000 meeting, the Board reiterated that a nurse may not administer vaccine without a physician's order.