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Nursing Scope of Practice and Delegation

by Samantha Rhea

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    00:01 So, now, let's talk nursing scope of practice. First of all, what is that? All that means, it's what we are legally allowed to do as a nurse.

    00:09 So, just know that this is gonna vary from state to state, so, make sure you keep that in mind.

    00:14 Here's a great example about scope of practice.

    00:17 A registered nurse or an RN can hang blood products but most states, a licensed practical nurse or LPN cannot.

    00:25 So, also consider, we have professional license we are accountable to and know that the activities we can perform are defined under each state law.

    00:36 Now, how do we get this license? To obtain it, we have a national exam called the NCLEX.

    00:42 Boy, if you're in nursing school, as soon as you hit day one, you're gonna hear about the NCLEX.

    00:48 This gives nurses cold sweats, backflashes about the trauma we had, don't worry.

    00:54 These videos are there to help you with that but the NCLEX exam is basically what you need to pass to get your professional license.

    01:03 So, and again, just know, once you pass your exam and you pass that big NCLEX, it's gonna vary from state to state what you're able to perform.

    01:11 So, now, let's look at scope and who can actually prescribe meds.

    01:16 So, let's look at the question, who can write a prescription for medication? So, first of all, no, as a registered nurse without a shadow of a doubt, we have no prescriptive authority.

    01:30 Sorry guys, we are not to write scripts. That's a big nursing no-no.

    01:35 Let me give you an example of this nursing no-no.

    01:38 So, as a nursing student, I got to sit on the board of nursing practice.

    01:43 So, basically, what that means, we got to view when nurses messed up or did something that was against their nursing practice act.

    01:51 Well, we got to watch a case where a nurse basically wrote her own prescriptions with a prescription pad that was not hers.

    01:59 Well, you can imagine, she got in a lot of trouble, lots of fines, but just know again, a registered nurse has no prescriptive authority.

    02:09 We cannot prescribe meds.

    02:11 So, only advanced practice registered nurse or what we call nurse practitioners, them and physicians can prescribe medications.

    02:20 So, you may hear APRN, nurse practitioner, it's all the same thing.

    02:27 Commonly, we usually call them a nurse practitioner in the healthcare setting and they can allow for medication prescriptions within their state's scope of practice.

    02:37 And of course, don't forget about your physicians.

    02:40 They definitely have prescriptive authority as long as they have an MD or a DO behind their name.

    02:46 So, now, let's talk about delegation.

    02:50 So, what's the scope regarding this with us as a registered nurse? So, we define delegation as the process for a nurse to just give another person a task.

    03:01 Now, we've gotta make sure that stays within their scope of practice.

    03:06 So, let's look at this grid here. Pretty simple, right? But really important.

    03:10 So, at the top of this triangle, you see a registered nurse or an RN.

    03:14 So, notice it goes out on both ways that we can delegate either to a licensed practical nurse or a nursing assistive personnel.

    03:23 So, what's interesting about this triangle is know that RN's are equally both to delegate to both of these and we're responsible for that delegation.

    03:33 So, now, let's look at each role of delegation. Let's look at the RN.

    03:38 So, we're the only ones that are allowed to evaluate, assess, or teach a patient otherwise known as EAT.

    03:46 As you know, nurses love to eat, I love to eat, we often get patient treats or snacks.

    03:52 It's a favorite nursing pastime. So, don't forget, EAT when you're talking about delegation with an RN.

    03:58 Next, let's look at the LPN or licensed practical nurse.

    04:03 Now, here's the difference. They cannot admit or discharge the patient.

    04:08 They can only care for patients that are stable such as we say the patient can monitor, the LPN can monitor a patient and they cannot do any initial treatment.

    04:18 So, here's an example of that.

    04:20 Let's say a patient transfers from the emergency room to your unit on the med-surg unit.

    04:26 So, as the RN, if a patient is assigned to this LPN, I am the one to have to actually admit the patient and do the initial assessment and initial teaching.

    04:36 And next off, we have the nursing assistive personnel.

    04:40 So, they can be delegated standardized procedures within their certification but again, no initial assessments.

    04:47 What this is probably gonna look like is like I said, a vital signs or maybe a blood glucose.


    About the Lecture

    The lecture Nursing Scope of Practice and Delegation by Samantha Rhea is from the course Management of Care (Nursing).


    Included Quiz Questions

    1. An RN asking another RN to place a nasogastric tube
    2. An RN asking a nursing assistant to check a client's vital signs
    3. An RN asking another RN to write a prescription for a high dose of ibuprofen
    4. An RN asking a nursing assistant to assess a client's pain level
    5. An RN asking a licensed practical nurse to provide discharge teaching
    1. What the nurse is deemed competent to perform
    2. What the nurse is capable of doing
    3. What the nurse can do and is being educated to do
    4. What the nurse determines is safe for the client
    1. Passing the National Council Licensure Examination (NCLEX)
    2. Passing nursing school at a university
    3. Passing the Basic Life Support (BLS) course from the American Heart Association
    4. Passing a 600-hour clinical course

    Author of lecture Nursing Scope of Practice and Delegation

     Samantha Rhea

    Samantha Rhea


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