NYS Nursing:Practice Alerts & Guidelines:RN & LPN Practice Issues:Administration of Medications

To: Interested Parties

From: Barbara Zittel, Executive Secretary

Re: Medication Administration by Unlicensed Persons

Date: August 2006

It has come to our attention that there is a need to clarify the use of unlicensed personnel in the administration of medications in New York State. Unlicensed persons are not permitted to administer medication to patients in New York State except in a few well delineated areas. This memorandum provides information about those few exceptions.

The administration of medication is a function that is statutorily authorized to a limited number of professions. A nurse or a physician may not legally delegate the administration of medications to unlicensed personnel, no matter what the experience or education of that unlicensed person. Section 1(b)(10) of Part 29 of the Rules of the Board of Regents specifically prohibits delegation of this professional responsibility by licensed persons to an individual who the licensee knows or has reason to know, lacks the education, experience or licensure to perform those tasks.

The following limited circumstances permit unlicensed persons to administer medications because they have exempt status within the Nurse Practice Act (Section 6908 of Article 139 of the Education Law):

This article shall not be construed:

As prohibiting
1. the domestic care of the sick, disabled or injured by any family member, household member or friend, or person employed primarily in a domestic capacity who does not hold himself or herself out, or accept employment as a person licensed to practice nursing under the provision of this article; provided that if such person is remunerated, the person does not hold himself or herself out as one who accepts employment for performing such care; or the administration of medications or treatment by child day care providers or employees or caregivers of child day care programs where such providers, employees or caregivers are acting under the direction and authority of a parent of a child, legal guardian, legal custodian, or an adult in whose care a child has been entrusted and who has been authorized by the parent to consent to any health care for the child and in compliance with the regulations of the office of children and family services pertaining to the administration of medications and treatment; or
2. any person from the domestic administration of family remedies; or
3. the providing of care by a person acting in the place of a person exempt under clause (i) of this paragraph, but who does hold himself or herself out as one who accepts employment for performing such care, where nursing services are under the instruction of a licensed nurse, or under the instruction of a patient or family or household member determined by a registered professional nurse to be self-directing and capable of providing such instruction, and any remuneration is provided under section thirty-six hundred twenty-two of the public health law or section three hundred sixty-five-f of the social service law; or
4. the furnishing of nursing assistance in case of an emergency;
As including services given by attendants in institutions under the jurisdiction of or subject to the visitation of the state department of mental hygiene if adequate medical and nursing supervision is provided;
As prohibiting such performance of nursing service by students enrolled in registered schools or programs as may be incidental to their course of study;
As prohibiting or preventing the practice of nursing in this state by any legally qualified nurse or practical nurse of another state, province, or country whose engagement requires him or her to accompany and care for a patient temporarily residing in this state during the period of such engagement provided such person does not represent or hold himself or herself out as a nurse or practical nurse registered to practice in this state;
As prohibiting or preventing the practice of nursing in this state during an emergency or disaster by any legally qualified nurse or practical nurse of another state, province, or country who may be recruited by the American National Red Cross or pursuant to authority vested in the state civil defense commission for such emergency or disaster service, provided such person does not represent or hold himself or herself out as a nurse or practical nurse registered to practice in this state;
As prohibiting or preventing the practice of nursing in this state, in obedience to the requirements of the laws of the United States, by any commissioned nurse officer in the armed forces of the United States or by any nurse employed in the United States veterans administration or United States public health service while engaged in the performance of the actual duties prescribed for him or her under the United States statutes, provided such person does not represent or hold himself or herself out as a nurse registered to practice in this state; or
As prohibiting the care of the sick when done in connection with the practice of the religious tenets of any church.

Examples of exemptions where unlicensed persons, under the supervision of a registered nurse, may administer medications include the Office of Mental Retardation and Developmental Disabilities (OMRDD) ¹, the Office of Children and Family Services ², and public schools in specifically defined emergencies ³. Such applications of the exemptions are specific to limited settings and only explicitly allowed by law. The Board for Nursing is concerned about and systematically examining the various medication administration practices in other settings including youth homes, adult homes, and jails in order to inform staff of the law and ensure public safety in this important matter.

We hope this clarification is helpful. If you have questions or need additional information, please contact the New York State Board for Nursing at the letterhead address above, by phone 518-474-3817 ext. 120, or by e-mail nursebd@nysed.gov.

¹ Refer to: Memorandum of Understanding between the Office of Mental Retardation and Developmental Disabilities and the State Education Department and Administrative, # 2003-01, Registered Nursing Supervision of Unlicensed Direct Care Staff in Residential Facilities Certified by the Office of Mental Retardation and Developmental Disabilities, related to Section 6908 (b) of Article 139 of Education Law.

² Section 6908(a) of Article 139 of the Education Law, line 6, re: administration of medications in child day care centers.

³ Refer to: Use of Epinephrine Auto-Injector Devices in the School Setting. June, 2002. Joint memorandum of the Office of the Professions and the Office of Elementary and Middle, Secondary and Continuing Education, State Education Department (EMSC/SED). And: Training of Unlicensed Individuals in the Injection of Glucagon in Emergency Situations. November, 2003. Memorandum, EMSC/SED.