Q. Can
a nurse take physician orders from an unlicensed person (ie; medical
assistant)?
A. Yes. Nothing in the Kansas Nurse Practice Act prevents a nurse
from receiving a physicians order through an unlicensed person.
The Healing Arts Act does not preclude a physician from relaying
an order through an unlicensed person. A nurse still has a duty
to know that it is a legitimate physician order and to question
the order if it does not seem standard/correct. Some liability
carriers preclude an insured from engaging in this practice because
having a middleman/unlicensed individual can increase the margin
for error. Check your facility policy/procedure to see if it is
prohibited or allowed.
Q. Can a nurse be supervised by a non-nurse?
A. Yes. As a rule the Kansas Nurse Practice Act requires that
an individual must be licensed to supervise the nursing process.
A non-nurse could not supervise nursing practice. However a non-nurse
could supervise basic employment issues (ie: cleanliness, appearance,
time issues, etc.).
Q. Can a non-nurse control the regular nursing time schedule?
A. No. A non-nurse could help draft the basic schedule according
to usual requirements but the final decision would be a nursing
decision because patient census/acuity factors must be considered.
Q. Can
a non-nurse make staff assignments?
A. No. Making assignments involves the nursing process and judgment
regarding patient acuity and staff skill mix.
Q. What
is the scope of practice for an LPN?
A. K.S.A. 1113(d)(2) sets three qualifiers for LPN practice: 1)
an LPN must have a supervisor that is an RN, someone licensed
to practice medicine and surgery (M.D. or D.O.) or a dentist;
2) an LPN must function in the area of supportive and/or restorative
care; 3) an LPN's activities must be based on acceptable educational
preparation. If these three criteria are met an LPN may engage
in care, nursing diagnosis, treatment, counsel and health teaching
, supervision, administration, teaching of the nursing process
and execution of the medical regimen. These activities are most
often limited by the LPN's educational preparation. Any post basic
education obtained can be considered and should meet the industry
standard.
Q. If
a nurse decides not to call in and is simply a no show for work
does that constitute patient abandonment?
A. No. A nurse must accept a specific patient assignment then
walk away during that work period without obtaining an appropriate
relief/replacement worker to constitute patient abandonment. No
call/no show may constitute job abandonment from an employment
perspective.
Q. Can
an unlicensed person call themselves a nurse?
A. No. K.S.A. 65-1114 makes it unlawful for any individual to
practice as, hold oneself out as, use any sign/card/device or
words to the effect they are licensed as an RN, LPN or ARNP unless
they are duly licensed or authorized. K.S.A. 65-1122 imposes a
criminal penalty for such actions.
Q. Can
an unlicensed person practice nursing?
A. No. The general rule of law (K.S.A. 65-1114) says they cannot.
See above answer. There are some exceptions to this answer and
they are found at K.S.A. 65-1124. They include but are not limited
to; gratuitous nursing by friends or family, domestic servants,
unlicensed people who have had a nursing action delegated to them
by a nurse, etc.
Q. Can
a non-nurse or non IV certified LPN engage in the practice of
IV therapy in a physician's office?
A. Yes. The Healing Arts Act allows physicians to delegate the
practice of medicine to anyone the physician deems qualified.
Qualified could mean by education, licensure, or on the job training.
When a physician delegates it must be appropriate (ie; a specific
task for a specific patient).
Q. Can
an LPN draw blood?
A. Yes. K.S.A. 65-1113(d)(2) would allow that authority if the
LPN had; 1) a supervisor that is an RN, MD DO, DDS; 2) the LPN
is functioning in supportive/restorative care and 3) the act was
based on acceptable educational preparation. The LPN would also
need a physician’s order.
Q. What
is acceptable educational preparation?
A. It is the education level and content most common to all individuals
that perform the same activity. Example; a phlebotomist receives
basic education on anatomy, tube selection for tests required,
blood drawing procedure. An LPN or RN would have to know/learn
the same information. The level of education required is not set
by statute or regulation but is industry driven. Look to see what
most facilities or liability carriers require.
Q. Are
nurses allowed to add patient information to a chart after their
shift is past?
A. Yes. But it must be done correctly or one will be guilty of
falsifying a patient record. First, the information must be truthful.
Example One cannot go back and make up vital signs and
fill-in blanks because a clerk says no payment will occur without
them. Second, check the facility policy and procedure and follow
those directions on late entries. Third, if there is no policy
or procedure it is probably most correct to identify the actual
time of information addition and circle the time of the actual
nursing act to show it is a late entry. Some people choose to
add an "Addendum" to the chart. It is not uncommon for
a nurse to forget to record something, remember it later and on
return to work make a late entry. It is the normal course of business.
One should never go back and change something on the original
writing. Late additions/entries should be set off and placed in
the next available chronological space.
Q. Can
an employer narrow a nurses scope of practice and is a nurse bound
by that?
A. Yes. Even though the legislature and Board through statutes
and regulations set a wide scope of practice for nurses, an employer
can choose what they will and won't allow a nurse to do. A nurse
is bound by the facility policy and procedure. K.S.A. 65-1120(a)(6)
unprofessional conduct is a ground for discipline of a nurses
license. At K.A.R. 60-3-110(c) unprofessional conduct is defined
as failing to follow policies and procedures in the practice situation
designed to safeguard the patient. You must know and follow your
facility policy and procedures unless you believe it is clearly
substandard.
