Frequently Asked Practice Questions
- The scopes of practice for the professions of registered professional
nurse, licensed practical nurse and nurse practitioner are defined
in New York Law. Does that mean that I can do everything that
falls within the legal scope of the practice of my profession?
Answer: A nurse may provide nursing services allowed by New York law only if the nurse is personally competent to deliver the services. You are not legally allowed to provide nursing services that you are not personally competent to perform, even if New York law generally allows a nurse to provide the service. As a licensed professional, it is your responsibility to practice within the scope of your abilities and as authorized by New York law. If you practice outside your personal scope of competence or outside of what is allowed by New York law, you could be charged with professional misconduct.
- What services can a New York State licensed and registered Licensed Practical Nurse (LPN) provide?
Answer: According to New York State Education Law §6902, LPNs perform tasks and responsibilities within the framework of case finding, health teaching, health counseling and provide supportive and restorative care under the direction of a registered professional nurse (RN), physician, nurse practitioner, licensed midwife, physician assistant, specialist assistant, dentist or podiatrist. An LPN typically provides the following types services under the direction of an RN or other qualified practitioner (assuming that the LPN is personally competent to do so):
- Administers medications as directed.
- Provides bedside nursing care, including services requiring sterile techniques.
- Observes, measures, records, and reports indications of patient health status.
- Performs specialized tasks, such as catheterizations and suctioning.
- Administers blood and blood products provides IV therapy, with additional training.
- Administers dialysis treatments in outpatient dialysis ESRD facilities.
- Supervises unlicensed personnel, including Certified Nurse Aids in Nursing Homes.
New York law does not allow LPNs to determine nursing diagnoses, develop or change nursing care plans, perform triage or perform any service that the LPN is not personally competent to perform. There are many services not listed here that LPNs may or may not be allowed to perform. There are many New York laws and regulations that impact the practice of LPNs. To view some of these laws and regulations, click on “Laws Rules & Regulations” on the left side of the Nursing Homepage.
- What services can a New York State registered and licensed Registered Professional Nurse (RN) provide?
Answer: According to New York State Education Law §6902, RNs diagnose and treat human responses to actual or potential health problems through such services as case finding, health teaching, health counseling and providing care supportive to or restorative of life and well-being. RNs also execute medical regimens prescribed by a licensed physician, dentist, nurse practitioner, physician assistant, specialist assistant, midwife or podiatrist in accordance with New York State Education Department regulations. A nursing regimen must be consistent with any existing medical regimen. RNs may practice independently, in collaboration with other health care practitioners, or under the supervision of a physician, nurse practitioner, midwife, dentist or podiatrist. An RN typically provides the following types of services (assuming that the RN is personally competent to do so):
- Assesses patients, identifies unmet patient needs and plans comprehensive care to meet those needs in relation to the patient’s illness, condition or disability.
- Identifies unidentified co-morbidities or emergent complications and intervenes solely and also with health care team members to initiate additional exploration and treatment.
- Co-ordinate care with other health care providers such as respiratory therapists, social workers, physicians, nurse practitioners, dieticians and discharge planners.
- Provides patient care (i.e., administer medication, and perform nursing interventions).
New York Law does not authorize RNs to make medical diagnoses or prescribe medical treatments or medications or develop a medical plan of care. There are many New York laws and regulations that impact the practice of RNs. To view some of these laws and regulations, click on “Laws Rules & Regulations” on the left side of the Nursing Homepage.
- What services can a New York State certified a Nurse Practitioner (NP) provide?
Answer: According to New York State Education Law §6902, NPs diagnose illnesses and physical conditions and perform therapeutic and corrective measures within a specialty area of practice, in collaboration with a physician qualified to collaborate in the specialty involved and in accordance with a written practice agreement and written practice protocols. The New York State Education Department issues certificates to NPs to practice in the following specialty areas: Adult Health; Family Health; Gerontology; Neonatology; Obstetrics; Oncology; Pediatrics, Perinatology; Psychiatry; School Health; Women’s Health; Holistic, and Palliative care. In New York, licensed midwives are not nurse practitioners. Midwifery is a separate profession from the nursing professions. There are many New York laws and regulations that impact on the practice of NPs. To view some of these laws and regulations, click on “Laws Rules & Regulations” on the left side of the Nursing Homepage.
- Can an unlicensed person, such as a medical technologist, use the title "nurse" or be referred to as "the nurse" in New York State?
Answer: No. New York law restricts the use of the title “nurse” to persons who are licensed to practice nursing or hold a limited permit issued by the New York State Education Department.
- Do I have to be licensed and registered with the New York State Education Department (SED) in order to practice nursing, or can I just be licensed with the New York State Education Department?
Answer: You must be licensed and registered by SED in order to practice nursing and use a professional title. Your license to practice nursing does not expire. In contrast, your nursing registration expires every three years. You are responsible for renewing your nursing registration with SED.
- Do I have to keep my nursing registration certificate on me while I practice nursing?
Answer: No. New York regulations require that the nursing registration certificate be available for inspection upon request. In many health care facilities, a copy of the nursing registration certificate is maintained by the nursing office. The regulations are at 8 NYCRR §59.8(c).
- Must I wear an identification badge while I provide nursing services in a healthcare setting?
Answer: Yes. You are legally required to wear an identification badge indicating your name and your professional title if you are practicing at a hospital, clinic, group practice or other establishment offering health services to the public.
- Can a graduate of a nursing school practice nursing before being licensed and registered to practice nursing in New York?
Answer: The New York State Education Department (SED) issues limited permits to graduates of Registered Professional Nurse or Licensed Practical Nurse education programs who have met all legal requirements to be licensed and registered to practice nursing except for taking the National Council Licensure Examinations (NCLEX –RN or NCLEX –PN). A limited permit expires one year from the date that SED issues it or 10 days after a nurse with a limited permit is notified that she or he failed NCLEX, whichever happens sooner. An expired limited permit does not legally authorize a nurse to practice nursing.
Graduates of certain New York State nursing schools who submit to SED applications for a nursing license and registration and for a limited permit may practice nursing under the supervision of a Registered Professional Nurse for up to 90 days following graduation.
- What is the correct title for graduates of nursing schools who hold a limited permit issued by the New York State Education Department?
Answer: The correct title for a graduate of a Licensed Practical Nurse education program who holds a limited permit is Graduate Practical Nurse (GPN). The correct title for a graduate of a Registered Professional Nurse education program who holds a limited permit is Graduate Nurse (GN). This title must be displayed on the GPN’s or GN’s identification badge and must also be used when signing patient records.
- What practice restrictions apply to Graduate Practical Nurses (GPN) and Graduate Nurses (GN) as holders of a Limited Permit?
Answer: GPNs and GNs must practice at all times under the supervision of a registered professional nurse (RN). The supervising RN must be on the patient care unit at all times when professional services are being rendered by the GPN or GN. The supervising RN must provide an appropriate degree of supervision, which is determined by the care needs of the patients and the skill and experience of the GPN or GN and other relevant factors.
- Can a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN) work in a position that is below his/her level of licensure?
Answer: Yes. A licensed nurse may work in a position that he/she has the training to do and that is within his/her scope of practice. RNs have the training to perform LPN, Certified Nurses Aid and Home Care Aid functions and therefore could accept a work identified for these levels. An LPN has the training to perform Certified Nurses Aid and Home Care Aid functions, and could accept work identified for either of these positions. However, the nurse that does so would still be required to act prudently based on his/her educational preparation and would be held to that standard. In addition the nurse cannot refer to themselves as an “LPN” or “Certified Nurses Aid” unless it is, in fact, true.
- Can a Registered Professional Nurse (RN) be supervised by an unlicensed person or another licensed health care practitioner?
Answer: Only a licensed physician, nurse practitioner, midwife, podiatrist or dentist may supervise the nursing practice of an RN. All other licensed professionals (including licensed practical nurses) are not legally allowed to supervise the professional nursing practice of an RN. They could, however, supervise non-clinical matters such as attendance, dress code, etc.
- Can a Licensed Practical Nurse (LPN) be supervised by an unlicensed person or another licensed health care practitioner?
Answer: Only a licensed physician, nurse practitioner, midwife, podiatrist, dentist, physician assistant, specialist assistant, or registered professional nurse may direct the nursing practice of an LPN. Although no other licensed professionals or individuals are legally authorized to supervise the professional nursing practice of an LPN, they could supervise non-clinical matters such as attendance, dress code, use of paid and unpaid leave.
- Can a Licensed Practical Nurse (LPN) practice independently?
Answer: No. New York State Education Law §6902 requires LPNs to practice under the direction of a registered professional nurse, nurse practitioner, physician, dentist, physician assistant, specialist assistant, podiatrist, or midwife (“directing practitioner”). The directing practitioner must provide an appropriate degree of direction to the LPN, which is determined by the care needs of the patients and the skill and ability of the LPN. In most cases, the directing practitioner must be on premises when LPNs provide nursing care. The directing practitioner does not necessarily have to be on premises to direct an LPN where:
- the LPN has demonstrated competence to meet the nursing care needs of the LPN’s patients;
- the LPN’s patients are highly unlikely to require personal intervention by the directing practitioner; and
- the directing practitioner is available to direct the LPN by telephone and can personally intervene within 15 minutes to ensure timely and appropriate care.
The directing practitioner remains ultimately responsible for providing appropriate direction by phone or in person to ensure patient or client safety. LPNs must practice under the direction of a directing practitioner even if the LPN has been issued an “Independent Medicaid Provider Number” by the New York State Department of Health. The "Independent Medicaid Provider Number" merely allows the LPN to be paid for Medicaid services provided by the LPN; it doesn’t authorize the LPN to practice independently.
- Can a Licensed Practical Nurse (LPN) be a charge nurse or clinical supervisor in a nursing home or outpatient clinic?
Answer: New York law requires that all LPNs practice under the continuous direction of a registered professional nurse (RN), nurse practitioner, physician, dentist, specialist assistant, physician assistant, licensed midwife or podiatrist. LPN cannot legally “direct” the practice of other LPNs in lieu of an RN or other qualified practitioner. LPNs are not legally allowed to supervise RNs or other licensed health care professionals. New York law does not authorize LPNs to determine nursing diagnoses, or develop nursing care plans. To the extent that charge nurse or supervisor responsibilities are inconsistent with the above mentioned legal restrictions, LPNs accepting such positions could have a disciplinary charge against their license for working beyond their lawful scope of practice.
- Can a Registered Professional Nurse (RN) administer medications or tests without a patient specific order from a prescriber (i.e., physician or nurse practitioner)?
Answer: Not usually. Nurses are legally required to administer medications and tests pursuant to patient-specific orders, except for certain immunization, anaphylaxis treatments, purified protein derivative (PPD) tests and Human Immunodeficiency Virus (HIV) tests, which may be provided pursuant to non-patient specific orders issued by a nurse practitioner or physician. For more information concerning New York Laws that govern non-patient specific orders and protocols, see Education Law §6909 and 8 NYCRR §64.7.
- In a group home or residential facility licensed by New York State Office of People with Developmental Disabilities (OPWDD) are registered professional nurses (RN) responsible for medication administration services provided by “approved medication administration personnel” (AMAP)?
Answer: In an OPWDD licensed group home or residences, the RN is responsible for providing initial and on-going training to unlicensed staff for all nursing tasks that the staff 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. The RN is not accountable for the actions/or errors of the AMAP that the RN is not aware of and has no reason to know about.
- Can a business venture that is not licensed to provide medical care hire a Registered Professional Nurse, Licensed Practical Nurse or Nurse Practitioner to provide nursing services?
Answer: No. In New York, it is illegal for business ventures that are not specifically authorized by New York Law to provide medical or nursing care (i.e., salons or nutritional supplement stores) to hire licensed nurses to provide professional health care services in New York State.
- How long must a Registered Professional Nurse or Nurse Practitioner with a private practice retain patient records?
Answer: All licensed practitioners with private practices must retain patient records for at least six years. Some records must be retained for even longer periods of time. 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. See, 8 NYCRR §29.2(3).
- Can a Registered Professional Nurse (RN) perform services that constitute the practice of medicine (i.e., spinal taps) if delegated by a physician?
Answer: In New York, a licensed professional such as a physician, may not delegate tasks that fall exclusively within that practitioner's scope of practice to another licensed professional, such as an RN, who does not have that task within her/his licensed scope of practice.
- Where can I find information about school nurses?
Answer: The New York State Education Department's Office of Student Support Services provides technical assistance to school health service programs. School nurse practice questions can be e-mailed to: email@example.com or the program’s office can be called at 518-486-6090.
- Can a Nurse Practitioner (NP) diagnose illness and prescribe treatment for all persons?
Answer: The New York State Education Department certifies each NP to practice one or more of the following specialty areas: Adult Health; Family Health; Gerontology; Neonatology; Obstetrics; Oncology; Pediatrics, Perinatology; Psychiatry; School Health; Women’s Health; Holistic; and Palliative Care. An NP may diagnose illnesses and prescribe treatment for patients only within the specialty area(s) for which the NP is certified, provided that the NP is personally competent to provide the professional service.
- Can a Geriatric Nurse Practitioner take a position as a Pediatric Nurse Practitioner if s/he has years of pediatric nursing experience as a Registered Professional Nurse (RN)?
Answer: No. Experience as an RN does not legally authorize a nurse practitioner certified to practice in one specialty area (Geriatrics) to practice in another specialty area (Pediatrics). The Nurse Practitioner must be certified by the New York State Education department to practice in the specialty area of Pediatrics in order to practice as a Pediatric Nurse Practitioner.
- Does a Registered Nurse (RN) who is recognized by another state as a “clinical nurse specialist” or an “advanced practice nurse” automatically qualify to practice as a Nurse Practitioner (NP) in New York State?
Answer: No. In order to engage in advanced practice nursing in New York, an RN must be certified by the New York State Education Department as a NP or licensed as a Certified Nurse Midwife. New York law does not recognize a “clinical nurse specialist” or “advanced practice nurse” as a licensed profession or explicitly authorize a “clinical nurse specialist” or “advance practice nurse” to engage in advanced practice nursing.
- Does New York Law require physicians to supervise Nurse Practitioners (NPs) or co-sign their charts?
Answer: No. New York Education Law allows NPs to be independently responsible for the diagnosis and treatment of their patients. New York Law does require NPs to practice pursuant to a written collaborative agreement with a physician. This law does not require a physician to supervise the NP or co-sign any of the NP’s records or charts. Drugs, immunizing agents, tests, devices, and procedures ordered by NP do not require a co-signature from the collaborating physician.
- Where should a Nurse Practitioner (NP) file the collaborative practice agreement and practice protocol?
Answer: The collaborative practice agreement and practice protocols should be kept at the setting where the NP works and must be available to the New York State Education Department for inspection.
- Can a Nurse Practitioner (NP) who has a collaborative agreement with a physician continue working if the collaborator dies?
Answer: New York Law requires that a NP practice pursuant to a collaborative agreement with a physician. If the physician dies, then the collaborating agreement signed by NP and physician is no longer valid. In order to continue practicing, the NP should enter into a collaborative agreement with another physician.
- Can a Nurse Practitioner (NP) continue working while 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.
- What additional requirements must a Nurse Practitioner (NP) meet in order to prescribe medications?
Answer: A NP must demonstrate to the New York State Education Department completion of acceptable pharmacology coursework. In addition NPs typically obtain the following forms or identification numbers in order to prescribe medications:
- National Provider Identifier (NPI) issued by the US Center for Medicaid and Medicare Services (CMS) - Federal law requires that health care providers (including nurse practitioners) use NPIs on all electronic health care transactions relating to processing claims, status inquiries/responses, eligibility inquiries/responses, as well as other transactions. A NP can find out more about applying for a NPI by clicking here.
- Obtain a Federal Drug Enforcement Administration (DEA) Number issued by the US Department of Justice- Drug Enforcement Administration - A NP must obtain a DEA number in order to prescribe or dispense controlled substances. A NP find out more about applying for a DEA number by visiting www.DEAdiversion.USDOJ.gov or calling 1-877-883-5789, 1-800-882-9539 or 212-337-1593. The mailing address for the US Department of Justice Drug Enforcement Administration is: 99 Tenth Avenue, New York, NY 10011.
- Obtain New York State Official Prescription Forms or authorization to prescribe controlled substances from the New York State Department of Health - An NP must obtain official prescription forms to prescribe controlled substances. An NP can find out more about obtaining official prescription forms by contacting the New York State Department of Health Bureau of Narcotic Enforcement by telephone 866-811-7957 or 518-402-0708, or checking the New York State Department of Health website.
*** Please note that a New York State Law was recently passed that will require NPs E-prescribe certain medications by 2014.
- Is there any limitation on the medications that a Nurse Practitioner (NP) may prescribe under a DEA number?
Answer: New York law authorizes nurse practitioners to prescribe or dispense controlled substance (from Schedules II through IV) for the treatment of patients only within the specialty area of practice for which they have been certified by the New York State Education Department. In addition, federal law appears to prohibit NPs from prescribing Suboxone for treating drug dependence.
- What options are available to a nurse if a co-worker is suspected of diverting controlled substances or other medications?
Answer: Several options are available. You can share your concerns with your clinical supervisor or report your observations to the New York State Department of Health’s Bureau of Controlled Substances at 518-402-0707. If your co-worker is a nurse, you may also assist the nurse to contact:
- the New York State Nurses Association's Statewide Peer Assistance for Nurses (SPAN) program by phone 518-782-9400 ext. 304, or electronically through their Web site at http://www.nysna.org/span/main.htm; or
- the New York State Education Department's Professional Assistance Program (PAP)at 518-485-9353.
- If an insurance company or managed care organization refuses to pay for a nursing service, does it mean that it is not within my legal scope of practice to perform the service?
Answer: Insurance companies, managed care organizations and other health care payors do not define the legal scope of practice of nurses. However, they may determine which nursing services they will pay for and how much they will pay. The State Board for Nursing does not have the authority to resolve fee disputes between nurses and managed care organizations, insurance companies or other payors.
- If I am unsure about whether something falls within my legal scope of practice, how can I find out?
Answer: Please review the practice guidance information available on this website. You may also use the “Find Answers” button at the top of this webpage. If the information that you seek is not on this website, you may seek guidance from the Nursing Board office by e-mail at: firstname.lastname@example.org, or by telephone at 518-473-3817 ext. 120. You may also send a letter with your question to: New York State Education Department, 89 Washington Avenue-Education Building, State Board for Nursing, Second Floor, West Wing, Albany, New York, 12234.