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Questions Related to Licensed Practical Nurses (LPN)

Assessment

The Board determined that the performance of a nursing assessment is a proper function of the registered professional nurse and is NOT within the purview of a practical nurse license. The act of performing a nursing assessment can NOT be delegated by a registered nurse to a licensed practical nurse on the basis of the limitations within the curricula of practical nursing programs. Such curricula do not include the theoretical and clinical preparation necessary for the effective performance of nursing assessments. December 18, 1990

BCG

At its August 28, 2002 meeting, the Board revisited the issue of Bacillus Calmette-Guerin (BCG) bladder instillation by a licensed practical nurse (LPN) and determined that an LPN may administer BCG according to defined protocols and under direct supervision. The LPN must have appropriate documented training.

Chemotherapy Bladder Installation by LPN

At its December 6-7, 2000 meeting, the Board determined that it is not within a licensed practical nurse's scope practice to administer BCG/INTRON via bladder instillation.

Collection of Data

Clarified that a LPN may interview, collect data and make observations to contribute to the plan of care. The LPN may not
make an independent nursing diagnosis or initiate a plan of care. (7/16/97)

Defibrillation

RNs do not have to be ACLS certified to use a defibrillator. (1988-89)

In June, 1984, the Board determined that the procedure of defibrillation is not within the usual scope of practice of the LPN, but if the LPN is ACLS certified, s/he may perform defibrillation under the delegation and supervision of the MD or the ACLS certified RN in an emergency situation.

On September 28,1990 the Board stated that a registered professional nurse, who holds a current certificate of completion from an American Heart Association sponsored certificate program for life support, may perform those functions for which s/he has received the required education and training and has been deemed qualified to perform. Policies and procedures should be agreed upon by medical, nursing, administrative and legal staffs before implementation.

Dialysis

At its April 15-16, 1998 meeting the Board determined that it is not within the scope of a licensed practical nurse to administer a heparin bolus as part of the procedure for initiating dialysis.

At its October 21-22,1998 meeting the Board reconsidered its April 15-16, 1998 advisory ruling and determined that a licensed practical nurse may administer a heparin bolus as part of the procedure for initiating dialysis in a renal dialysis unit.

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.

Gastronomy Tubes

By consensus the Board determined that LPNs, who have received the necessary training and supervised clinical practice, may be delegated the tasks of reinserting supra pubic and gastrostomy tubes provided that the patient has a well established tract. The health care facilities should develop policies and procedures which are agreed upon by both the nursing and medical staffs. November 2, 1989

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.

Jails

The Board at its October 19 and 20, 1994 meeting determined that an LPN who works in a jail setting does not require on-site RN supervision to perform job functions. Written protocols, medical direction, and RN consultation must be available to the LPN.

Midlines

At its December 9-10, 1998 meeting the Board determined that it is not within the scope of a licensed practical nurse's nursing practice to remove midline catheters that are placed in the peripheral circulation.

Nasogastric Tubes

In 1988-1989, the Board determined that a licensed practical nurse, who has had appropriate training and supervision by a registered professional nurse, may insert nasogastric tubes.

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.

PCA Pumps

The Board determined at its December, 1994 meeting that a licensed practical nurse can change PCA cassettes if the LPN is IV certified, on the basis that changing a cassette is similar in principle to programming an IV pump. The facility is responsible for proper training and documentation of such training.

Peritoneal Dialysis

Peritoneal dialysis may be performed by an LPN who has received the required educational preparation and supervised clinical practice by a registered nurse with expertise in this area. (1988-1989)

The teaching of peritoneal dialysis to be performed in the home is not within the scope of practice of LPNs. (1989)

Private Duty

On the basis that the home setting does not fall within the Board's interpretation of a "structured health care setting", (e.g., hospital, nursing home), it is NOT permissible for a LPN to accept employment as a private duty nurse in the home setting, unless s/he is an employee of a community health agency. (March 1, 1990)

RhoGam

At its April, 1992 meeting, the Board determined that licensed practical nurses may administer RhoGam.

Subcutaneous Morphine Infusion

At its April 7-8, 1992 meeting the Board determined that it is not within the scope of an LPN's nursing practice to insert or monitor a morphine continuous infusion subcutaneously nor to program the computerized pump or assess patient's response.

At its April 15-16, 1998 meeting the Board reconsidered its 1992 ruling and determined it is within the scope of nursing practice for a licensed practical nurse to insert a needle subcutaneously for the purpose of administering a bolus of morphine via injection cap or continuous infusion provided that he/she has had appropriate, documented training according to protocols established by a health care facility.

At its December 9-10, 1998 meeting the Board determined that it is within the scope of a licensed practical nurses's nursing practice to:

1. Change a subcutaneous needle on a continuous infusion set
2. Change dose parameters of the narcotic in the pump based on the registered nurse's plan of care
3. Change the infusion set
provided that he/she has had appropriate, documented training according to protocols established by a health care facility.

Tracheostomy

At its October 6-7, 1992 meeting, the Board determined that it is within the scope of practice for the registered professional nurse to remove a tracheostomy apparatus and replace it with a new apparatus in patients who have had tracheostomies for a long period of time.

At its April 7 and 8, 1999 meeting, the Board determined that it is within the scope of practice for the licensed practical nurse to remove a tracheosotomy apparatus and replace it with a new apparatus in patients that have well established stomas.

Vagus Nerve Stimulator

At its December 6-7, 2000 meeting, the Board determined that a registered professional nurse may use the vagus nerve stimulator on demand therapy to end or shorten seizure activity. The registered professional nurse must have appropriate documented training according the facility/organization's established policies and procedures. The Board determined that a registered professional nurse may not delegate the task of performing this type of therapy to certified nursing assistants.

At its October 17-18, 2001 meeting, the Board determined that a licensed nurse may use the vagus nerve stimulator on demand therapy to end or shorten seizure activity. The licensed nurse must have appropriate education and supervision based on defined competencies and established facility/organization policies and procedures. The Board revisited the issue of a registered professional nurse delegating this task to a certified nursing assistant. The Board determined that a registered professional nurse may delegate this task to a certified nursing assistant who has had appropriate education and supervision based on defined competencies and established facility/organization policies and procedures.

Ventilators

A licensed practical nurse (LPN) may care for a patient on a ventilator if that nurse has been trained to do so and if in the judgment of the registered professional nurse it is an appropriate delegation. The patient's total condition and the LPN's experience and skill level must both be considered.

At its April 6-7,1994 meeting, the Board determined that a LPN may provide care to a patient on a ventilator in a home setting where the registered nurse is not on site but is available on call. The LPN should have the appropriate skills and training necessary to render the care.