Describe what "supervision of practice" means in relation to a LVN functioning with a directed scope of practice “under the supervision of. . . .”
Section 301.353 of the NPA and Rule 217.11(2) require a LVN to practice under the supervision of a RN, advanced practice nurse, physician, podiatrist, dentist or physician assistant. The supervision requirement correlates with § 301.002(5) of the NPA that states that LVNs have a directed scope of practice. It should be noted that Position Statement 15.25 clarifies that supervision and carrying out medication orders may be expanded to include “any other practitioner legally authorized to prescribe the ordered medication(s).”
Although BON requirements preclude a LVN from practicing in a completely independent manner (that is, without supervision), there is nothing in the NPA or rules that requires direct (on site or on unit) supervision of a LVN. A resource person must be accessible to the LVN at least telephonically or by similar means. However, proximity to the LVN’s practice setting and the type of licensure of the supervisor should be determined on a case-by-case basis with input from the LVN and his/her supervisor. Factors to be considered should include: (1) the type of practice setting; (2) the stability of the patient’s condition; (3) the tasks to be performed; (4) the LVN’s experience and (5) any laws and regulations that apply to the specific practice setting. To illustrate, consider the LVN who performs routine nursing tasks or nursing tasks learned through ongoing continuing education (such as intravenous therapy) and compare with a LVN who performs a delegated medical act (such as botox administration). These are different situations and will differ in who (RN, physician) is appropriate to supervise the LVN as well as the proximity of the supervisor. Other regulations, such as those related to reimbursement, may also be a factor in the latter situation.
As noted previously, remember that whether a task is a nursing act or a delegated medical act, the nurse (LVN or RN) is responsible for the tasks he/she chooses to perform. See Position Statement 15.14, Duty of a Nurse in Any Setting, located under the Nursing Practice Information section of the web page for complete information on a nurse’s duty. Staff further recommend review of documents listed on the BON web page under “Scope of Practice” in the Nursing Practice Information section for additional guidance on how a nurse can determine what is within his/her scope of practice.