Nursing
Practice Alerts & Guidelines
Frequently Asked Practice Questions
- The scopes of practice for the professions of registered
professional nurse, licensed practical nurse and nurse practitioner
are defined in Education Law. Does that mean that I can do everything
that falls within the legal scope of the practice of my profession?
A licensee may legally perform services that are in the definition of the scope of practice but licensees must also be competent to deliver those services. Part 29 of the Rules of the Board of Regents requires that licensees practice within the scope defined in law and within their personal scope of competence. If you are not competent to provide a service that you are legally allowed to provide, then you may not provide that service. As a licensed professional, it is your responsibility to practice within the scope of your abilities and expertise. If you practice outside your personal scope of competence, you may be charged with professional misconduct.
- Must I wear an identification badge when I am providing nursing
services in a healthcare setting?
You must wear an identification badge indicating your name and your professional title if you are practicing as an employee of a hospital, clinic, group practice or multi-professional facility or at a commercial establishment offering health services to the public. This requirement is set out in Part 29.2(a)(9) of the Rules of the Board of Regents.
- What is the correct title for new graduates of Licensed Practical
Nursing and Registered Professional Nursing programs?
The correct title for a graduate of an LPN program who is not yet licensed is Graduate Practical Nurse (GPN). The correct title for a graduate of an RN program who is not yet licensed is Graduate Nurse (GN). This title must be displayed on the identification badge (see previous question) and used in signing official patient-care documents.
- How long can graduate nurses work under a limited permit?
The Education Department issues limited permits to graduates of RN or LPN programs who have met all licensure requirements except for successfully passing the licensure exam. Limited permits expire one year from the date of issuance or ten days after notification to the applicant of failure on the licensing exam. It is unlawful to work after expiration of a limited permit.
- What limitations do Graduate Practical Nurses (GPN) and Graduate
Nurses (GN) practice under as holders of a Limited Permit?
GPNs and GNs must practice under the supervision of a registered professional nurse (RN) while they are holders of a Limited Permit. This means that the supervising RN must be on the patient care ward/unit (whichever is smaller) at all times when professional services are being rendered by the limited permitee. The supervising RN must provide an appropriate degree of supervision which is determined by the specific circumstances of the patient care being provided.
- What is the difference between licensure and registration?
For the 44 professions regulated by the State Education Department, one is licensed for life unless that license is revoked or suspended by the Board of Regents. In order to practice, however, one must be registered with the Department. In nursing, registration is required every three years. The Department typically sends out a renewal request three months before the beginning of the new renewal cycle. However, you are responsible for renewing your registration even if you do not receive an automatic renewal form.
- Do nurses have to keep their registration certificates on
themselves in order to practice?
No, however, the registration certificate must be available for inspection upon request. In many facilities a copy of the registration certificate is maintained by the Nursing Office. This requirement is set out in Part 59.8(c) of the Regulations of the Commissioner of Education.
- I am licensed in New York and wish to be licensed in another
state. How do I go about that?
Each state has different licensure requirements, forms to complete and fees to pay. The National Council of State Boards of Nursing maintains a web site that lists addresses and other contact information for state boards throughout the United States.
- How do I satisfy the infection control course requirement every
four years?
Education Law (section 6505-b) requires all nurses to complete course work or training in infection control and barrier precautions, including engineering and work controls to prevent the transmission of human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) every four years. You must attest to having completed this requirement to the State Education Department on your first licensure/registration application and at every subsequent registration. If you graduated from a nursing program registered by the State Education Department after September 1, 1993, for your initial licensure, you are automatically credited with having completed the requirement as part of your coursework. All other applicants must complete approved coursework before licensure will occur. After the initial registration cycle, all nurses must take the training every four years and attest compliance to the requirement when renewing their registration every three years. Please see Mandated Training Related to Infection Control for further information and to access the list of approved providers.
- Can an LPN practice independently?
Section 6902 of Article 139 of the Education law and section 64.6 of the Regulations of the Commission of Education state that an LPN performs tasks and responsibilities under the direction of a registered professional nurse, nurse practitioner, physician, physician assistant, specialist assistant, dentist and podiatrist. Under the direction of a registered professional nurse means that a registered professional nurse must be present on the premises or immediately available by telephone when professional services are given by a licensed practical nurse. The degree of supervision should be appropriate to the circumstances.
- Can a Licensed Practical Nurse (LPN) practice independently if
the LPN has an "independent Medicaid provider number"?
No. By law, LPNs must practice under the direction of a registered nurse or physician. Issuance of an "independent Medicaid provider number" merely allows the LPN to be paid for the services provided.
- What tasks are LPNs prohibited from performing?
It is not possible to provide a comprehensive and exhaustive list of tasks that LPNs are prohibited from performing. In general, however, LPNs may not conduct a nursing diagnosis and may not conduct the assessment phase of the nursing process. In particular, LPNs may not:
- perform triage services,
- administer IV-push medications,
- perform blood transfusions until satisfactory completion of a transfusion training program meeting criteria specified by the DOH and the SED and only when a registered nurse or a physician or other person authorized by law to manage transfusion reactions is immediately available on-site.
- Can a Licensed Practical Nurse (LPN) supervise medical assistants
in giving allergy shots?
No. Medical assistants are non-licensed personnel who may not legally administer medications to patients, by any route.
- Can nurses give medications without an order from an authorized
prescriber?
No, nurses are required to have patient-specific orders for the pharmaceutical medications that they administer. There is one exception provided by section 6909 of Education Law and section 64.7 of the Regulations of the Commissioner of Education which authorizes a registered nurse to administer certain immunization, anaphylaxis treatment agents, and purified protein derivative tests based on non-patient specific orders and protocols.
- Can an RN provide care to a pregnant woman who is receiving an
analgesic agent(s) by catheter techniques?
In caring for the pregnant woman who is receiving analgesic agents by catheter technique, Registered Nurses who are not anesthesia care providers should not:
- Increase or decrease the rate of a continuous infusion per PRN order
- Increase or decrease the rate of a continuous infusion by direct order unless the anesthesia provider is on the unit and immediately availabile during the increase or decrease
- Rebolus an epidural either by injecting medication into the catheter or increasing the rate of a continuous infusion,
- Re-initiate an infusion once it has been stopped and,
- Manipulate PCEA (Patient Controlled Epidural Analgesia) doses or dosage intervals.
A qualified anesthesia care provider must be readily available to manage the mother and the fetus should the mother have an adverse reaction to the analgesic agent(s).
- Does a radiologist have to be physically present when an RN
injects contrast media?
An authorized prescriber, such as a physician or nurse practitioner, must be in the facility when a registered nurse administers contrast media. In the event of an anaphylactic reaction or other emergency, this prescriber must be competent to rescue the patient. The prescriber is not required to be a radiologist.
- To what degree is an RN, employed in an Office of Mentally
Retardation and Developmental Disabilities (OMRDD) group home,
responsible for the administration of medications by approved
medication administration personnel (AMAP)?
It is the responsibility of the RN to provide initial and on-going training to unlicensed direct care staff in all nursing tasks that they will perform, including medication administration. The RN is also responsible for periodically reviewing the performance of unlicensed staff to determine that their care is consistent with established standards. However, it is expected that once non-licensed persons have completed training and are recognized as AMAPS, they have met minimal standards of competency to safely administer medications.
- As a registered nurse with a private practice, how long must I
retain patient records?
All licensed practitioners with private practices must retain patient records for at least six years. Obstetrical records and records of minor patients must be retained for at least six years, and until one year after the minor patient reaches the age of 21 years. It is unprofessional conduct to fail to maintain a record for each patient which accurately reflects the evaluation and treatment of the patient. Additional information on record keeping can be found in Part 29.2(3) of the Rules of the Board of Regents.
- What immunizations can registered nurses provide under a
non-patient specific order and protocol?
Nurses may provide a broad range of immunizations to children and adults. For adults, these include: Hepatitis A, Hepatitis B, Influenza, Pneumococcus, Meningococcus, Diphtheria, Tetanus, Measles, Mumps, Rubella, Varicella, and Inactivated Polio. For children the list includes: Diphtheria, Tetanus, Acellular Pertussis, Measles, Mumps, Rubella, Varicella, Haemophilus Influenza Type b (HIB), Inactivated Polio, Hepatitis B, Pneumococcal Conjugate, Hepatitis A, Influenza, and Meningococcus. Please see Non-Patient Specific Standing Order and Protocol Guidelines for additional information about nurses' responsibilities related to non-patient specific orders and protocols.
- Who is the best person/agency to contact regarding information
about the legal practice of school nurses?
The New York State Education Department's Office of Elementary, Middle and Secondary and Continuing Education, 89 Washington Ave., Albany, NY 12234, supervises the New York Statewide School Health Services Program. Scope of practice questions can be mailed to this address or the Program's office can be called at 585-349-7630.
- To what extent is an employer mandated to report nursing errors
or instances of conduct to the Office of Professional Discipline?
It is up to the discretion of the Director of Nurses and/or supervisory staff to determine whether an error or questionable behavior reaches the level of concern suggesting a report to the Office of Professional Discipline. However, in cases of permanent patient harm, patient death, or near death, as defined by respiratory or cardiac arrest, the agency must report the error to the Department of Health as required by the New York State Patient Occurrence Report and Tracking (NYPORT) System.
- What options are available to a nurse if a co-worker is suspected
of diverting medications?
Several options are available depending upon the particular circumstances of the situation. You may wish to share your concerns with your nursing supervisor or report your findings to the Bureau of Controlled Substances in Troy, New York at 518-402-0707. You may also assist the nurse in contacting either the New York State Nurses Association's Statewide Peer Assistance for Nurses (SPAN) program, at 518-782-9400 ext.304, or the New York State Education Department's Professional Assistance Program (PAP) at, 518-485-9353.
- Does the State Board for Nursing determine insurance
reimbursement for nursing services?
The State Board does not have the authority to resolve disputes involving insurance fees or privileges. This function is regulated by the New York State Insurance Department.
- Can an RN, recognized by another state as a Clinical Nurse
Specialist/Advanced Practice Registered Nurse, be recognized to
practice as a Nurse Practitioner in New York State?
Not usually. New York State Law does not recognize a Clinical Nurse Specialist as an Advanced Practice Registered Nurse; only Nurse Practitioners are recognized as Advanced Practice Registered Nurses. Clinical Nurse Specialists must complete additional education in order to be certified as Nurse Practitioners in New York.
- Can a Nurse Practitioner also practice as a Registered Nurse
First Assistant (RNFA)?
It is within the scope of practice of any registered professional nurse (RN), including a Nurse Practitioner (NP), to function as a first assistant in surgery following completion of additional education and training that meets the Association of Operating Room Nurses' Recommended Education Standards for RN First Assistant programs. RN First Assistants in the Operating Room are credentialed by the education community and must establish privileges to First Assist from the Medical Staff Office credentialing/privileging department of each facility in which they intend to practice. Since surgery is not part of the scope of practice of the NP role, NPs must clearly differentiate between RNFA duties and NP practice.
- Can a nurse practitioner diagnose illness and prescribe treatment
for all persons?
While Nurse Practitioners can diagnose illness and prescribe treatment, their practice is limited to a specialty area that is determined by their educational preparation.
- As a nurse practitioner, how do I receive a DEA number so that I
may prescribe medications?
To obtain a DEA number you must apply to:
United States Department of Justice
Drug Enforcement Administration
99 10th Avenue
New York, NY 10011
Telephone: 212-337-1593 or 800-882-9539Controlled Substance Prescription Forms may be obtained from:
New York State Department of Health
Bureau of Controlled Substances
433 River Street, Suite 303
Troy, NY 12180
Telephone: 518-402-0708 - Is there any limitation on the medications that a nurse
practitioner may prescribe under a DEA number?
The law authorizes Nurse Practitioners to prescribe drugs for treatment of patients within their specialty area of practice. In terms of controlled substances, they may order drugs from Schedules II through IV without restriction. Drugs, immunizing agents, tests, devices, and procedures ordered by nurse practitioners do not require a cosignature from the collaborating physician.
- As a newly certified Nurse Practitioner, is completion of the 4NP
form equivalent to a collaborative practice agreement?
No. The 4NP is a signed document verifying that you have a written collaborative practice agreement with a physician that includes an approved protocol text related to your specialty area as designated on your certificate. A sample collaborative practice agreement can be obtained by contacting the Board for Nursing.
- As a nurse practitioner, where do I need to file the practice
agreement and practice protocol?
The collaborative practice agreement and practice protocols must be maintained in the practice setting and must be available to the Department for inspection. They may be updated periodically.
- Must the collaborating physician co-sign the nurse
practitioner's orders and charts?
No. Nurse practitioners do not function under the supervision of physicians-they function in collaboration with physicians. Nurse practitioners are independently responsible for the diagnosis and treatment of the patients that they serve.
- If I am unsure about whether something falls within my legal
scope of practice, how can I find out?
You can contact the New York State Board for Nursing by mail at New York State Education, 89 Washington Avenue-Education Building, State Board for Nursing, Second Floor, West Wing, Albany, New York, 12234, by e-mail at nursebd@mail.nysed.gov, or by phone at 518-474-3817 ext. 120.
