Nursing
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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?
Answer: 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?
Answer: 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?
Answer: 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?
Answer: 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?
Answer: 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?
Answer: For the 48 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 four 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. See Online Registration Renewal and Professional Photo ID Requests for more information.
- Do nurses have to keep their registration certificates on themselves in order to practice?
Answer: 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?
Answer: 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. That Web site address is www.ncsbn.org.
- How do I satisfy the infection control course requirement every four years?
Answer: 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. Additional information and a list of approved providers for this training is provided on this Web site.
- Can a Licensed Practical Nurse (LPN) practice independently?
Answer: 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"?
Answer: 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 Licensed Practical Nurses (LPNs) prohibited from performing?
Answer: 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?
Answer: No. Medical assistants are non-licensed personnel who may not legally administer medications to patients, by any route.
- Can a Licensed Practical Nurse (LPN) be a charge nurse or supervisor in a nursing home or outpatient clinic?
Answer: An LPN may not assess (interpret clinical data) or develop nursing care plans. To the extent that charge nurse or supervisor responsibilities require ongoing assessment, LPNs accepting such positions could have a disciplinary charge against their license for working beyond their lawful scope of practice.
- Can nurses administer medications or tests without a patient specific order from an authorized prescriber?
Answer: No. Nurses are required to have patient-specific orders for the medications and tests that they administer. There is one exception provided by §6909 of Education Law and §64.7 of the Regulations of the Commissioner of Education which authorizes a registered nurse to administer certain immunization, anaphylaxis treatment agents, purified protein derivative (PPD) tests and Human Immunodeficiency Virus (HIV) tests based on non-patient specific orders and protocols.
- What immunizations can Registered Professional Nurses (RNs) provide under a non-patient specific order?
Answer: Registered Professional Nurses may provide a broad range of immunizations to children and adults following a non-patient specific order. For adults, these include: Acellular Pertussis, Diphtheria, Hepatitis A, Hepatitis B, Human Papilloma Virus (HPV), Inactivated Polio, Influenza, Measles, Meningococcus, Mumps, Pneumococcus, Rubella,Tetanus, Varicella, Smallpox and Herpes Zoster vaccine. For children the list includes: Acellular Pertussis, Diphtheria, Haemophilus Influenza Type b (HIB), Hepatitis A, Hepatitis B, Human Papilloma Virus (HPV), Inactivated Polio, Influenza, Measles, Meningococcus, Mumps, Pneumococcal Conjugate, Rubella, Tetanus, and Varicella. See Practice Alerts and Guidelines for this list and other related information.
- What do I do about obtaining syringes and needles and substances such as immunizing agents so that I can implement a non-patient specific order?
Answer: Provision has been made in the law for pharmacists to provide registered professional nurses with syringes, needles and immunizing agents. Procurement of such items may be considered a wholesale transaction. However, a wholesale registration does NOT have to be made with the State Board of Pharmacy in order for the pharmacist to provide you with such items.
- Can a Registered Professional Nurse (RN) provide care to a pregnant woman who is receiving an analgesic agent(s) by catheter techniques?
Answer: 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 available 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.
- To what degree is a Registered Professional Nurse (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)
Answer: 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 Professional Nurse (RN) with a private practice, how long must I retain patient records?
Answer: 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.
- Can a Registered Professional Nurse (RN) be hired by a business corporation to practice nursing?
Answer: No. Business ventures such as med spas, nutrition stores and durable equipment companies may not hire licensed professionals to provide professional health care services in New York State.
- Can a Registered Professional Nurse (RN) administer botox, sclera therapy, dermabrasion, laser hair removal and other alternative or cosmetic procedures to a patient?
Answer: Yes. The RN, who has been found competent in these procedures, may carry them out upon the prescription of an authorized provider who has examined the patient.
- Can a Registered Nurse (RN) carry out medical tasks at the delegation of a physician or nurse practitioner?
Answer: In New York State, a licensed professional such as a physician, may not delegate tasks that fall exclusively within that practitioner's scope of practice, such as performing spinal taps, to another licensed professional, such as an RN, who does not have that task within her/his licensed scope of practice.
- Who is the best person/agency to contact regarding information about the legal practice of school nurses?
Answer: The New York State Education Department's Division 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 or, for more information, you can visit thier Web site at www.emsc.nysed.gov.
- To what extent is an employer mandated to report nursing errors or instances of conduct to the Office of Professional Discipline?
Answer: It is up to the Chief Nurse Officer to determine if an error or instance of conduct reaches the level of concern that would suggest an official report to the Office of Professional Discipline or to the Department of Health. There are three events regarding medication errors that require a report to the Department of Health's patient tracking system (NYPORT system): permanent patient harm, near death as evidenced by cardiac or respiratory arrest, and death. Other reporting references are Public Health Law 2803-e, Education Law 6510 b, Title 10 NYCRR 405.3.
- Can an unlicensed person use the title "nurse" or be referred to as "the nurse" in New York State?
Answer: No. The law requires that the title "nurse" be used to refer only to persons who hold a license under Article 139 of the Education law, commonly referred to as the "nurse practice act".
- Can a Nurse Practitioner (NP) diagnose illness and prescribe treatment for all persons?
Answer: While Nurse Practitioners can diagnose illness and prescribe treatment, their practice is limited to a specialty area that is determined by their educational preparation and stated on their State issued certificate to practice.
- As a newly certified Nurse Practitioner, is completion of the 4NP form equivalent to a collaborative practice agreement?
Answer: 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 is provided here (PDF).
- As a Nurse Practitioner (NP), where do I need to file the practice agreement and practice protocol?
Answer: 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.
- Can a Nurse Practitioner (NP) who has a collaborative agreement with a collaborator continue working if the collaborator dies?
Answer: No. The law requires that there be an active collaborative agreement in place, for the Nurse Practitioner to practice. If there is already a designated resource physician for vacations and illness, that physician could agree to become the official collaborator.
- Can a Nurse Practitioner (NP) continue working when the collaborating physician is on vacation or out due to a prolonged illness?
Answer: Yes. The collaborator can designate a resource person to be available to the nurse practitioner as needed during the collaborator's absence. It is best if the resource person is named in the collaborative agreement if the absence is prolonged.
- Can a Geriatric Nurse Practitioner take a position as a Pediatric NP if s/he has years of pediatric nursing experience as a Registered Nurse (RN)?
Answer: No. Experience as an RN is not sufficient to be licensed
as a nurse practitioner (NP) as the scope of practice of an NP is distinctly
different from that of an RN. An NP must be a graduate of an educational program
for nurse practitioners and licensed by the State of New York in a specialty,
in this case pediatrics, or s/he is not practicing lawfully.
- Must the collaborating physician co-sign the Nurse Practitioner's (NP) orders and charts?
Answer: No. Nurse practitioners (NPs) 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. We do not recommend co-signatures as it transfers responsibility of the care from the NP to the physician.
- What additional requirements are there for a Nurse Practitioner (NP) to prescribe medications?
Answer: You will need to obtain certain forms or identification numbers as follows:
- National Provider Identifier (NPI)
All health care providers- including those serving Medicare beneficiaries- are now required to apply for a new National Provider Identifier (NPI) that will be used in all electronic health care transactions. The NPI will replace all other provider identifiers currently being used. The National Provider Identifier initiative was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPAA) and requires that NPIs be used by health plans, health care clearinghouses, and health care providers that process claims, handle claim status inquiries/responses and eligibility inquiries/responses, as well as other transactions. Nurse practitioners can apply for an NPI by going to nppes.cms.hhs.gov. Applications can be submitted online now or via regular mail.
- Federal Drug Enforcement Administration (DEA) Number:
A Federal Drug Enforcement Administration (DEA) Number is required to prescribe and dispense narcotic and controlled substances. A DEA number may be obtained from:
United States Department of Justice
Drug Enforcement Administration
99 10th Avenue
New York, NY 10011
Web: www.DEAdiversion.USDOJ.gov
Telephone: 1-877-883-5789, 1-800-882-9539 or 212-337-1593.
Fax: 212-337-2867 or 2895.
- New York State Official Prescription Forms may be obtained from:
New York State Department of Health
Bureau of Narcotic Enforcement
433 River Street, Suite 303
Troy, NY 12180
Telephone: 866-811-7957 or 518-402-0708
- Is there any limitation on the medications that a Nurse Practitioner (NP) may prescribe under a DEA number?
Answer: 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 co-signature from the collaborating physician.
- Can a Nurse Practitioner (NP) also practice as a Registered Nurse First Assistant (RNFA)?
Answer: 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.
- Does the State Board for Nursing determine insurance reimbursement for nursing services?
Answer: No. 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.
- If I have been to court for an alleged violation of the law can it affect my license?
Answer: Yes. Conviction of a misdemeanor or a crime may affect your license. You are required to answer the following questions on your re-registration form.
- Have you been found guilty after trial, or
- pleaded guilty, no contest or nolo contendere to a crime (felony or misdemeanor) in any court?
- Are criminal charges pending against you in any court?
A "yes" answer will trigger a review of your circumstances. Please note that the courts often notify the Office of Professional Discipline when a known licensee is convicted of a crime.
- What options are available to a nurse if a co-worker is suspected of diverting medications?
Answer: 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 through their Web site at www.nysna.org/programs/span/home.htm or the New York State Education Department's Professional Assistance Program (PAP) at, 518-485-9353.
- Can a Registered Nurse (RN), recognized by another state as a clinical nurse specialist/advanced practice registered nurse, be recognized to practice as a Nurse Practitioner (NP) in New York State?
Answer: Not usually. New York State Law does not recognize a clinical nurse specialist as an advanced practice registered nurse (APRN); only Nurse Practitioners (NPs) are recognized as APRNs. Clinical nurse specialists must complete additional education in order to be certified as Nurse Practitioners in New York State.
- If I am unsure about whether something falls within my legal scope of practice, how can I find out?
Answer: 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 telephone at 518-473-3817 ext. 120.
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