Connecticut Public Health Code CT allows med administration by Unlicensed
Personnel in Residential Care Facilities...see PHC pages 18-25
Chapter 378 - Connecticut NURSING Scope of Practice
LPN Declaratory Ruling / Scope of Practice
Decision-Making Model Competency / Scope of Practice
Connecticut General Statutes: Nursing Chapter 378
Substitute House Bill # 7155: Professional Assistance Program
Delegation to Unlicensed Personnel
Personnel in Residential Care Facilities...see PHC pages 18-25
Chapter 378 - Connecticut NURSING Scope of Practice
LPN Declaratory Ruling / Scope of Practice
Decision-Making Model Competency / Scope of Practice
Connecticut General Statutes: Nursing Chapter 378
Substitute House Bill # 7155: Professional Assistance Program
Delegation to Unlicensed Personnel
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LPN's take Note! Gaylord Hospital has demoted it's LPN's, then had the nerve to ask the BOEN
if UNLICENSED nursing assistants can perform Endotracheal Suctioning, intermittent
catheterization, and tube feeding! Pay close attention to the yellow highlighted text.....You, as
an Licensed Nurse are viewed the same as an Unlicensed aides; you are also not allowed to
(or able!) to assess, because you do not possess the ability to employ "critical thinking" while
you suction your resident.
The Board of Examiners for Nursing held a meeting on October 3, 2007 at the Legislative
Office Building, Room 1-A, 300 Capitol Avenue, Hartford, Connecticut.
SCOPE OF PRACTICE – UNLICENSED ASSISTIVE PERSONNEL
Janet Williams, Public Health Services Manager, Facility Licensing and Investigation Section,
DPH, requested that the BOEN review within the context of the BOEN’s Declaratory Ruling
issued in April 1995 regarding the delegation of nursing tasks by licensed nurses to unlicensed
assistive personnel and the appropriateness of delegating endotracheal suctioning to nursing
assistants at Gaylord Hospital. Diane L. Cybulski, RN, Department of Public Health, presented
Ms. Williams’ concerns to the Board members.
The BOEN then held a discussion in which they reviewed the job description of unlicensed
nursing assistants at Gaylord Hospital with attention to the delegation of endotracheal
suctioning to nursing assistants. It is the BOEN’s position that the delegation of endotracheal
suctioning in a skilled nursing facility is inappropriate. The discussion centered on the need to
assess the patient pre-procedure, during the procedure and post procedure. The discussion
also identified the BOEN’s concern that the employment of critical thinking skills, part of the
ongoing nursing assessment process, might also involve such patient assessments as the
patient’s tolerance to the procedure and providing interventions (i.e., O2 or saline) that may be
required during the procedures, which is not a skill expectation of unlicensed nursing
assistants.
The BOEN members further commented that this concern also extended to intermittent
catheterization and tube feeding, which they also felt was an inappropriate delegation by
licensed nurses to unlicensed assistive personnel in a skilled nursing facility
LPN's, take note: The following directive by the BOEN was communicated to facilities via "Blast
Fax" in 2004, but as of this date, it is nowhere to be found in the Public Health Code. Notice the
"double-speak" applied throughout the LPN Scope of Practice. We are allowed to "collect data",
but not assess. How do you do one without the other? We can speak to the doctor, write the
order, but get disciplined for not collaborating with an RN. Did you know "critical thinking" is not
within your scope??
The Board of Examiners for Nursing held a meeting on February 4, 2004 at the Hartford
Hospital Newington Campus, Curtis Building, Amphitheater, 181 Patricia M. Genova Drive,
Newington, Connecticut.
SCOPE OF PRACTICE – VERBAL ORDERS
Chair Bafundo discussed the issue of LPNs receiving verbal orders. The LPN can assist in the
collection of data, which is then turned over to the RN. The RN has the responsibility of
evaluating and assessing the patient. If it is a new order or a change in order the RN must
determine if it is consistent with the current plan of care. When the LPN is receiving a verbal
order for an anticipated change, the RN should be notified and consulted. If the LPN
implements the order without notifying and collaborating with the RN, the LPN is acting out of
his/her scope of practice and disciplinary action could occur. The LPN would be brought before
the Board of Examiners for Nursing for disciplinary action. The RN would not be held
responsible if the LPN acted independently, and failed to notify the RN. A misconception has
developed that an LPN “cannot speak to the doctor.” This is false as anyone on the health care
team may speak to the physician.
Public Health Code:
19-13-D8t. (5) Physician Visits.
(11) "Licensed nursing personnel" means registered nurses or licensed practical
nurses licensed in Connecticut;
No medication or treatments shall be given without the order of a physician or a health care
practitioner with the statutory authority to prescribe medications or treatments. If orders are
given verbally or by telephone, they shall be recorded by an on duty licensed nurse or on duty
health care practitioner with the statutory authority to accept verbal or telephone orders with
the physician's name, and shall be signed by the physician on the next visit.
How about this gem? Are you aware that you cannot work under the supervision of an MD? (but
you can take his verbal order, as long as there is an RN around; any RN)
The Board of Examiners for Nursing held a meeting on May 7, 2003 at the Hartford Hospital -
Newington Campus, Curtis Building Amphitheater, 181 Patricia Genova Drive, Newington,
Connecticut.
LPN ADVANCING FLEXIBILE SIGMOIDSCOPE UNDER THE DIRECTION OF MDs
The Board stated that this would be inappropriate as LPNs must work under the supervision or
direction of an RN not an MD.
Connecticut General Statutes: Chapter 378 NURSING
Sec. 20-87a. Definitions. Scope of practice.
(c) The practice of nursing by a licensed practical nurse is defined as the performing of
selected tasks and sharing of responsibility under the direction of a registered nurse or an
advanced practice registered nurse and within the framework of supportive and restorative
care, health counseling and teaching, case finding and referral, collaborating in the
implementation of the total health care regimen and executing the medical regimen under the
direction of a licensed physician or dentist.
(d) In the case of a registered or licensed practical nurse employed by a home health care
agency, the practice of nursing includes, but is not limited to, executing the medical regimen
under the direction of a physician licensed in a state that borders Connecticut.
Take note how this is written (c).....it is the RN you are taking direction from; it is the RN who
takes direction from the MD.
UNLESS you are an LPN working in home care (d) ..... now you can take direction from an MD.
So under which directive does advancing a flexible sigmoidscope fall under? Are we allowed to
take direction from an MD in his office? What if there is no RN working in his office? What about
a Med Tech working in an MD's office? Can they take direction from the MD and advance the
scope??
Also from the BOEN Meeting on May 7, 2003.......
FOOT CARE WITHOUT A PHYSICIAN’S ORDER The Board reviewed a request received by the
Podiatry Board regarding foot care without a physician’s order. The Board also reviewed the
advice from Jane Comerford, Assistant Attorney General, dated June 9, 1993 concerning the
performance of foot care by registered nurses. The Board concurred that the tasks of soaking
feet, cleaning of toenails with no cuticle disturbance, and the lotioning and powdering of feet
are tasks which the RN can delegate to an LPN or a CNA. In the past, with other questions of
nursing competence/scope of practice, the Board has referred individuals to the Decision-
Making Model. In this case, the question of nursing competence/scope of practice for providing
foot care would also be determined using this Decision-Making Model, as well as the Board’s
Declaratory Ruling on Delegation to the Unlicensed Assistive Personnel.
LPN's, PLEASE ask your RN supervisor if you can perform ROUTINE FOOT CARE. Always be
sure to check your Decision-Making Model before performing this task. By the way, did you
wash your feet today?!
if UNLICENSED nursing assistants can perform Endotracheal Suctioning, intermittent
catheterization, and tube feeding! Pay close attention to the yellow highlighted text.....You, as
an Licensed Nurse are viewed the same as an Unlicensed aides; you are also not allowed to
(or able!) to assess, because you do not possess the ability to employ "critical thinking" while
you suction your resident.
The Board of Examiners for Nursing held a meeting on October 3, 2007 at the Legislative
Office Building, Room 1-A, 300 Capitol Avenue, Hartford, Connecticut.
SCOPE OF PRACTICE – UNLICENSED ASSISTIVE PERSONNEL
Janet Williams, Public Health Services Manager, Facility Licensing and Investigation Section,
DPH, requested that the BOEN review within the context of the BOEN’s Declaratory Ruling
issued in April 1995 regarding the delegation of nursing tasks by licensed nurses to unlicensed
assistive personnel and the appropriateness of delegating endotracheal suctioning to nursing
assistants at Gaylord Hospital. Diane L. Cybulski, RN, Department of Public Health, presented
Ms. Williams’ concerns to the Board members.
The BOEN then held a discussion in which they reviewed the job description of unlicensed
nursing assistants at Gaylord Hospital with attention to the delegation of endotracheal
suctioning to nursing assistants. It is the BOEN’s position that the delegation of endotracheal
suctioning in a skilled nursing facility is inappropriate. The discussion centered on the need to
assess the patient pre-procedure, during the procedure and post procedure. The discussion
also identified the BOEN’s concern that the employment of critical thinking skills, part of the
ongoing nursing assessment process, might also involve such patient assessments as the
patient’s tolerance to the procedure and providing interventions (i.e., O2 or saline) that may be
required during the procedures, which is not a skill expectation of unlicensed nursing
assistants.
The BOEN members further commented that this concern also extended to intermittent
catheterization and tube feeding, which they also felt was an inappropriate delegation by
licensed nurses to unlicensed assistive personnel in a skilled nursing facility
LPN's, take note: The following directive by the BOEN was communicated to facilities via "Blast
Fax" in 2004, but as of this date, it is nowhere to be found in the Public Health Code. Notice the
"double-speak" applied throughout the LPN Scope of Practice. We are allowed to "collect data",
but not assess. How do you do one without the other? We can speak to the doctor, write the
order, but get disciplined for not collaborating with an RN. Did you know "critical thinking" is not
within your scope??
The Board of Examiners for Nursing held a meeting on February 4, 2004 at the Hartford
Hospital Newington Campus, Curtis Building, Amphitheater, 181 Patricia M. Genova Drive,
Newington, Connecticut.
SCOPE OF PRACTICE – VERBAL ORDERS
Chair Bafundo discussed the issue of LPNs receiving verbal orders. The LPN can assist in the
collection of data, which is then turned over to the RN. The RN has the responsibility of
evaluating and assessing the patient. If it is a new order or a change in order the RN must
determine if it is consistent with the current plan of care. When the LPN is receiving a verbal
order for an anticipated change, the RN should be notified and consulted. If the LPN
implements the order without notifying and collaborating with the RN, the LPN is acting out of
his/her scope of practice and disciplinary action could occur. The LPN would be brought before
the Board of Examiners for Nursing for disciplinary action. The RN would not be held
responsible if the LPN acted independently, and failed to notify the RN. A misconception has
developed that an LPN “cannot speak to the doctor.” This is false as anyone on the health care
team may speak to the physician.
Public Health Code:
19-13-D8t. (5) Physician Visits.
(11) "Licensed nursing personnel" means registered nurses or licensed practical
nurses licensed in Connecticut;
No medication or treatments shall be given without the order of a physician or a health care
practitioner with the statutory authority to prescribe medications or treatments. If orders are
given verbally or by telephone, they shall be recorded by an on duty licensed nurse or on duty
health care practitioner with the statutory authority to accept verbal or telephone orders with
the physician's name, and shall be signed by the physician on the next visit.
How about this gem? Are you aware that you cannot work under the supervision of an MD? (but
you can take his verbal order, as long as there is an RN around; any RN)
The Board of Examiners for Nursing held a meeting on May 7, 2003 at the Hartford Hospital -
Newington Campus, Curtis Building Amphitheater, 181 Patricia Genova Drive, Newington,
Connecticut.
LPN ADVANCING FLEXIBILE SIGMOIDSCOPE UNDER THE DIRECTION OF MDs
The Board stated that this would be inappropriate as LPNs must work under the supervision or
direction of an RN not an MD.
Connecticut General Statutes: Chapter 378 NURSING
Sec. 20-87a. Definitions. Scope of practice.
(c) The practice of nursing by a licensed practical nurse is defined as the performing of
selected tasks and sharing of responsibility under the direction of a registered nurse or an
advanced practice registered nurse and within the framework of supportive and restorative
care, health counseling and teaching, case finding and referral, collaborating in the
implementation of the total health care regimen and executing the medical regimen under the
direction of a licensed physician or dentist.
(d) In the case of a registered or licensed practical nurse employed by a home health care
agency, the practice of nursing includes, but is not limited to, executing the medical regimen
under the direction of a physician licensed in a state that borders Connecticut.
Take note how this is written (c).....it is the RN you are taking direction from; it is the RN who
takes direction from the MD.
UNLESS you are an LPN working in home care (d) ..... now you can take direction from an MD.
So under which directive does advancing a flexible sigmoidscope fall under? Are we allowed to
take direction from an MD in his office? What if there is no RN working in his office? What about
a Med Tech working in an MD's office? Can they take direction from the MD and advance the
scope??
Also from the BOEN Meeting on May 7, 2003.......
FOOT CARE WITHOUT A PHYSICIAN’S ORDER The Board reviewed a request received by the
Podiatry Board regarding foot care without a physician’s order. The Board also reviewed the
advice from Jane Comerford, Assistant Attorney General, dated June 9, 1993 concerning the
performance of foot care by registered nurses. The Board concurred that the tasks of soaking
feet, cleaning of toenails with no cuticle disturbance, and the lotioning and powdering of feet
are tasks which the RN can delegate to an LPN or a CNA. In the past, with other questions of
nursing competence/scope of practice, the Board has referred individuals to the Decision-
Making Model. In this case, the question of nursing competence/scope of practice for providing
foot care would also be determined using this Decision-Making Model, as well as the Board’s
Declaratory Ruling on Delegation to the Unlicensed Assistive Personnel.
LPN's, PLEASE ask your RN supervisor if you can perform ROUTINE FOOT CARE. Always be
sure to check your Decision-Making Model before performing this task. By the way, did you
wash your feet today?!