Students and Licensed Nurses Practice Parameters
RN AND LPN PRACTICE IN NARROWER SCOPE OF PRACTICE
The board has been asked whether a RN can perform the duties normally assigned to a LPN or delegated to a Unlicensed Assistive Person or whether a LPN can perform the duties normally delegated to a Unlicensed Assistive Person. The registered nurse is responsible and accountable to practice according to the standards of practice prescribed by the board. The licensed practical nurse is responsible and accountable to practice according to the standards prescribed by the board under the direction of a registered nurse, advanced practice registered nurse, or licensed practitioner.
Specific job descriptions for the licensed nurse can be as broad as the scope of practice allowed in NDCC 43-12.1 Nurse Practices Act or narrower depending on the employer's job description. The employer develops the job descriptions for the institution and within the job descriptions establishes the minimum qualifications necessary to perform the job, the responsibilities and accountability within the job, and establish the salary range. Many times a job description's name includes a nursing legal title which confuses the issue.
If the minimum qualification for a job is UAP competencies, the RN and LPN have the competencies necessary to perform the interventions instead of delegating the intervention to a UAP. It is an employer and employee decision whether the licensed nurse will perform the intervention found in the job description and be paid the wages associated with that job description. To avoid salary inequities, it is to the best interest of the nurse and employer that the nurse practices only in the job description for which the nurse is employed. An example is the UAP in a hospital would not be involved in medication administration. Therefore, if the licensed nurse has accepted a position requiring the competencies of a UAP and if the nurse performs task beyond the job description requiring the minimal competencies of a UAP, it becomes a wage and hour issue, not a licensure issue.
If the minimum qualification for a job is a practical nurse license, the LPN has the required license and the RN is licensed to perform those interventions instead of assigning the intervention to the LPN. It is an employer and employee decision whether the registered nurse will perform the intervention found in the job description and be paid the wages associated with that job description. To avoid salary inequities, it is once again a decision between the employer and employee whether the position will be filled by a LPN or RN. Again, the nurse should only practice in the job description for which the nurse was hired. An example is the LPN cannot administer chemotherapy. Therefore, if the RN functioning in a position with minimum qualification of LPN is asked to administer chemotherapy which is beyond the job description requiring the minimal competencies of a licensed practical nurse, it becomes a wage and hour issue, not a licensure issue.
Licensed nurses many times are employed for different job descriptions within the same institution. The key issue is that the nurse, employer, and co-workers on each unit are very clear about the minimum qualifications required for each job description the nurse is filling. Then the nurse should practice within the specific job description for each specific unit. In other words, the responsibility and accountability for the employee should not be above the minimum requirements of the job description. The registered nurse remains an RN and the licensed practical nurse remains a LPN even if practicing at a given time in a position that does not require that level of licensure. The licensed nurse would use the legal licensure credential (LPN or RN) when signing records. The licensed nurse could claim those hours for nursing practice for purposes of maintaining eligibility for licensure. A nurse with a suspended or revoked license cannot practice as a nurse, UAP or certified nurse aide while under suspension or revocation.
It is not the intention of the board to degrade the status of a LPN or RN. The board's responsibility is to establish the requirements for licensure and the standards for practice. The employer establishes the minimal qualifications for each job description and hires persons who meet or exceed the minimal requirements to fill the position and determines the salary range. The board believes they cannot place limits on an employer related to hiring a person with higher credentials to fill a position.
LICENSED NURSE EMPLOYED IN NON-NURSING POSITIONS
Another question raised is whether a licensed nurse can work as a desk clerk. If a licensed nurse chooses to work as a desk clerk, and the job description does not include any nursing intervention or nursing functions, the individual is free to do so. However, the individual could not claim those hours for nursing practice hours for purposes of maintaining eligibility for licensure. Each individual has the right to work and holding a license does not mean the individual can not go outside the profession to be gainfully employed.
NURSING STUDENTS EMPLOYED AS OR NURSE INTERNS
The Board affirmed that the exemption NDCC 43-12.1-04(2) (12) applies only to students who are enrolled in a course at a board approved program and are participating in clinical experience as part of an educational program. Nursing students assuming internship roles must be enrolled in a course in a board approved nursing education program that is designed to provide supervision for the student in the clinical setting. The supervised clinical practice of the internship/cooperative student must be based on content from required nursing courses that the student has completed and has received a grade acceptable for progression in the nursing program.
Nursing students employed and providing nursing care to clients in other capacities must be on the Unlicensed Assistive Person registry. The applicant for medication assistant III registration must have registration on the Unlicensed Assistive Person registry.
EMPLOYMENT OF GRADUATE NURSES
Questions also arise related to graduates from a nursing education program who receive a work authorization for license by examination from the board and whether they can continue to work as a UAP or a graduate nurse.
If the employer decides to retain the employee in a UAP or graduate nurse role they may do so. The employer needs to verify permits, licenses, and registrations.