Effective: 5/04 Review: 5/06
MHS PRACTICE GUIDE (Clinical Scopes of Practice) PURPOSE: HCA Paramedic PCT/HCA RN LPN MA NT SN SPN SP/NA-R SURG T PST RT RT/NA-R EST CNA RPh
Clarify which job classifications may perform the following procedures Health Care Assistant – Category A - E Health Care Assistant - Category F (also paramedic credentials) Patient Care Technician (Holds HCA & CNA certification)/Health Care Assistant - Category A (may perform venous and capillary invasive procedures for blood withdrawal) Registered nurse or ARNP not functioning as a Licensed Independent Practitioner Licensed Practical Nurse Medical Assistant with HCA A, C, E Nurse Technician –Refer to Attachment C Student Nurses (must be under supervision by faculty or appropriate licensed personnel.) Student Practical Nurse (must be under supervision by faculty or appropriate licensed personnel.) Nursing Assistant-Registered Surgical Technologist Perioperative Services Technician Respiratory Therapist Respiratory Therapist with NA-R Emergency Services Technician/HCA Category A Certified Nursing Assistant Registered Pharmacist
X XX XC XD * +
May be performed by this job classification May be performed by this job classification only upon verification of skill or completion of department orientation May be performed by this job classification with competency, credentials, and/or certification May be performed only under direct visual supervision of preceptor, RN, or physician Primary Responsibility Used only for nursing process Delegated Responsibility Used only for nursing process
Attachment A Radiology grid Attachment B Therapy grid Attachment C Nurse Technician Functions (RCW 18.79.350) All Non-RN caregivers must function under the supervision of an RN. Appropriate tasks may be delegated. Note: The Lippincott Manual of Nursing Practice is to be used as an additional reference to guide nursing practice and procedures in support of MHS Policies and Procedures on the MHSnet. RN
LPN
SN
SPN
HCA F Para
Ace Bandage
X
X
X
X
X
Acuity
XX
AED
XX
XX
XD
XD
XX
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
XX
XX
XX
XX
XX
XX
Comments
XX See splints also
XX
XX
XD
XD
XX
XX
XX
X
X
X
X
X
XX
XX
XX
Airway Monitoring
RPh
XX
Adaptive Devices Application of
MA
X
X
XX
Patient Services Practice Guide Page 2 RN
LPN
SN
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
XC
XC
XC
EST
MA
RPh
Comments
Endotracheal Insertion of
XC*
Emergency situation and Transport only
Removal
X
XD
XC
X
X
Repositioning
XX
XD
XC
X
X
Suctioning
X
XX
XD
XD
X
X
X
Nasal Airway
X
X
X
X
X
X
X
Oral Airway
X
X
X
X
X
X
X
X
X
XX
XC
XC
XD
XD
XX
XC
XC
X
X
XC
Assist devices
X
X
X
X
X
X
XX
X
X
XX
Transfer devices
X
X
X
X
X
X
XX
X
X
XX
Antiembolic Hose
X
X
X
X
X
X
XX
X
X
XX
Apgar Scoring Systems
XX
Bag-Valve-Mask Ambulation
X
X
X
XD
Arterial Blood Gas Obtaining via puncture Adult Obtaining via puncture Pediatric Obtaining via line Adult
X
XD
Obtaining via line Pediatric
XX
XD
Arterial Compressor Application Adult
XX
XD
Arterial Cut down Assist
X
Arterial Closure Device
XX
X
XD XD
X
X
X
X
XX
XX XX
XD
X
XX
XX
X
Patient Services Practice Guide Page 3 RN
LPN
SN
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
MA
Aseptic Technique
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Assessment
X
X
X
X
X
XX
X
X
X
X+
X+
X
X
X
X
X
XX
Collection of data
X
X
X
X
X
X
X*
X*
X+
X+
X+
Independent
X
X
X
X
X
X
XX
X
XX
XX
Set-up and assist
X
X
X
X
X
X
XX
X
XX
XX
Postop/partial
X
X
X
X
X
X
XX
X
XX
XX
Total bath
X
X
X
X
X
X
XX
X
XX
XX
Bimanual exam, GYN
XC
XD
XX
XX
Plan:/Evaluation (Clinical Pathway/Plan of Care)
X X+
X
X
Comments
RT – Respiratory only
Assist With
XX
RPh
X
Bathing
Bladder instillation
X
X
X
Bladder Scan
XX
XX
XD
XX
XX
Blood & Blood Product Auto transfusion
XX
*Only in ED, may set up
XC*
See Blood Policy for verification
Verification of product Administration
XX
XD
Monitoring
X
X
X
X
Rhogam
X
XX
X
XD
Peripheral line
X
XX
X
XD
Central line, Adult
XX
XD
XX
Central line, Pediatric
XX
XD
XX
Shunt -
XX
X
X
X
Blood Draw
XX
XX
XX
Patient Services Practice Guide Page 4 RN
LPN
SN
SPN
HCA F Para
PCT HCA
XX
XX
XD
XD
XX
XX
Measurement
X
X
X
X
X
XX
XX
Postural
X
XX
X
XD
X
XX
XX
Blood Warmer – use
X
Venipuncture
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
MA
XX
XX
XX
X
XX
X
XX
XX
XX
RPh
Comments
Blood Pressure
X
X
.
XX
Setup
X
X
X
X
XX
XX
Breast care
X
X
X
X
Breast pump, electric
XX
XX
XD
XD
Setup
XX
XX
XD
XD
Teaching
XX
XX
XD
XD
XX
XX
XD
XD
XX
XX
XX
XX
XD
XD
XX
XX
XX
Cardiac Arrest Tray Open procedure, assist with Setup
XX
XX XX
Cardiac Output Determination
XX
XD
Cardio Pulmonary Resuscitation (CPR)
XC
XC
XC
XC
XC
Cardioversion
XX
XX
XD
XD
XD
C-Arm Assist
XX
XX
XD
XD
XX
XX
XX
Setup
XX
XX
XD
XD
Monitoring
XX
XX
XD
XD
Bivalve/Spreading
XX
XX
XX
XX
Requires Physician order
Removal
XX
XD
Requires order
XC
XC
XC
XC
XC
XC
XC
XC
XC
XC
CPR Physician present.
Car Seat Challenge
Cast
XX
XD
XD
XD
Patient Services Practice Guide Page 5 RN
LPN
SN
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
MA
RPh
Comments
Catheters, Hemodynamic Monitoring
XX
XD
Care of
XX
XD
Calibration Adult
XX
Calibration Pediatric
XX
XX
XD
XX XD
XX
XD
Leveling Adult
XX
XX
Leveling, Pediatric
XX
XD
Removal of
XX
XD
Zeroing
XX
XX
XD
XD
XD
XD
XX
Arterial lines Accessing
XX
XD
Insertion
XX
XD
Insertion assist
X
Removal
XX
XD*
XX
XX
XD
XX
XD
XX
In OR only
CVP Insertion assist
XX
XX
XD
XD
Monitoring, Adult
X
XX
XD
XD
Monitoring, Pediatric
X
XD
Removal non-tunnel
XX
XD
Dressing Change
XX
XD
Insertion assist
XX
Removal
XX
X
XD XD
XX XX XX
Epidural
XX
X
XD
XX
XX
Patient Services Practice Guide Page 6 RN
LPN
SN
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
MA
RPh
Comments
Intracranial pressure Monitoring
XX
XD
Subarachnoid screw
XX
Ventriculostomy
XX
Insertion assist
XX
XX
XD
XD
Insertion assist
XX
XX
XD
XD
Management Adult
XX
XX
XD
XD
Management, Pediatric
XX
XX
Swan Ganz
XX
XD
Catheterization, Bladder Application/change drainage bag
X
X
X
X
XC
XX
XX
Straight catheter
X
X
X
X
XC*
XX
XX
XC
Pediatric under age 2 requires RN oversight
Indwelling catheter
X
X
X
X
XC*
XX
XX
XC
Pediatric under age 2 requires RN oversight
Removal of retention
X
X
X
X
XC
XX
XX
X
XX
XC
XX
XC
XX
X
Catheter, Central Venous Tunneled, Non Tunneled, & PICC Accessing
XX
Insertion
XC
XD
Insertion assist
X
X
XD
X
Care of, adult
XX
XX
XD
XD
Care of Pediatric
XX
Care of Neonate
XX
XX
Dressing, Adult
XX
XX
XD
XD
XD
X
Patient Services Practice Guide Page 7 RN
Dressing, Pediatric
XX
Dressing, Assist with
X
Repair
XX
LPN
SN
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
X
X
MA
XD X
XD
X
XX
XD
XD
Removal, Non-tunneled (PICC) Adult
XX
Removal, Non-tunneled (PICC), Pediatric
XX
Removal Non-tunneled
XX
XX
XD
XD
Culture
X
XX
XD
XD
XX
XX
Dressing
X
XX
XD
XD
X
XX
Insertion, Adult
X
XC
X
XD
Insertion Pediatric/Neonatal
X
Monitor Site
X
X
X
X
X
XX
XX
XX
Removal
X
X
X
X
XX
XX
XX
XX
XX
XX
XX
XD
Peripheral
X
X
Port, Arm or Chest Access/ De-access
XX
Dressing change, Adult
XX
Dressing change, Ped
XX
XD XC
XD
XD
XD
X
XX
X
XD
X
Hard collar
XX
XX
XD
XD
X
XX
XX
XX
XX
Soft collar
X
XX
X
XD
X
XX
XX
XX
XX
Chest Physiotherapy
X
XX
X
XD
XX
XX
XD
XD
Cervical immobilization
XX
X
X
Chest Tube Back strip, Adult
XX
RPh
Comments
Patient Services Practice Guide Page 8 RN
LPN
SN
SPN
HCA F Para
Back strip, Pediatric
XX
Care of
X
XX
X
XD
XX
Drainage system set-up
X
XX
X
XD
XX
Drainage system disposal
X
X
X
X
XX
Insertion assist
X
X
X
X
XX
Circulator - OR
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
XD
RT NAR
EST
MA
RPh
Comments
XX XX XX XX
XX
XX
XX
XX
X
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
X
X
X
X
X
XX
XX
XX
XX
XX
Circumcision Care of
X
X
X
X
XX
Assist with
X
X
X
X
XX
Equipment
XX
XX
XD
XD
XX
XX
XX
XX
X
XX
Rooms
X
X
X
X
X
XX
XX
XX
X
X
Cold - application of
X
X
X
X
X
X
X
Care of
X
XX
X
XD
XX
XX
Emptying
X
X
X
X
XX
X
X
X
X
X
XX
X
X
Cleaning
XX
X
Colostomy
Compresses
XX
X
X
X
X Refer to Consent Policy
Consent: Contact Lenses Application
X
X
X
X
Removal of
X
X
X
X
X
X
X
X
Continuous Passive motion device
XX
XX XX
XX
XX
X
XX
Patient Services Practice Guide Page 9 RN
LPN
SN
SPN
HCA F Para
X
X
X
X
X
Management of Adult
X
XX
X
XD
XX
X
X
Management of Pediatrics
X
XX
X
X
XX
X
X
XC
XC
XC
Cord care
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
XX
XX
MA
RPh
Comments
CPAP -
Assist with Cricothyroidotomy
X
X
XX
X
XD
XC
Emergency situations only
Death When physician is not available, i.e. Hospice, Home Health
Pronouncing
X
Care of body, belongings
X
X
X
X
X
X
XX
X
XX
XX
X
X
XX
Transport of body
X
X
XD
XD
X
X
XX
X
X
XX
X
X
X
X
X
X
X
XX
XX
XC
XC
XC
XC
XC
XC
XC
Decubitus care Defibrillation (Manual)
XX
XX XC
XC
Provided by contracted staff
Dialysis, Hemodialysis, Peritoneal dialysis, CVVH CVVH monitoring
XX
XD
Documentation
X
X
X
X
X
X
Doppler
X
X
X
X
X
X
X
XX
X
X
X
X
X
X
X
XX
XX
X
X
X
X
XX
Insertion
X
XX
XD
XD
Feeding
X
XX
XD
XD
XX
Removal
X
XX
X
XD
XX
XX
X
X
XX
XX
X
XX
X
Dressing Application non- medicated, non circumferential Circumferential
ACLS/PALS
X XD
XC
Duodenal feeding tube
X
Patient Services Practice Guide Page 10 RN
LPN
SN
SPN
X
XX
XD
XD
Performance of
XX
XX
XD
XD
Interpretation
XX
Ear exam
HCA F Para
PCT HCA
SP/ NA-R
CNA
XX
XX
XX
XX
Surg Tech
PST
RT
RT NAR
EST
MA
XX
XX
XX
XX
XX
X
X
XX
X
X
X
X
XX
XX
XX
RPh
Comments
EKG
XX
ENDTIDAL CO 2 Monitoring, Adult
X
XX
X
XD
Monitoring, Pediatric
X
Setup
XX
XX
XD
XD
XX
Instillation of artificial tears
X
X
X
X
XX
X
X
X
X
XC
XX
XX
Cup, neonatal
XX
XX
XD
XD
Breast, Assist
XX
XX
XD
XD
Bottle
X
X
X
X
X
X
X
Tube Feeding
X
XX
X
XD
Application, External
XX
XX
XD
XD
Interpretation
XX
X
Eye
Fecal impaction, treatment of
XC
Feeding
X
X
XX
Fetal Monitoring:
Fluid Warmer Setup
X
XX
X
XD
XX
XX
XX
Monitor/use
X
XX
X
XD
XX
Foot or hand soak
X
X
X
X
X
X
XX
X
Footboard Application
X
X
X
X
XX
X
XX
X
XX
XX
XX
XX
XX
X
XX
XX
X
X
XX
X
X
XX
Monitor Tech = XX
Patient Services Practice Guide Page 11
Gastric Gavage Feeding Gastric Lavage Tube Placement
RN
LPN
SN
SPN
X
XX
X
XD
X
X
X
X
X
XX
X
XD
X
XX
X
XD
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
MA
XD
EST May set up and assist with RN oversight
XC*
See Feeding Tube Guidelines
Heat, application of, Adult
X
X
X
X
X
XX
XX
X
X
XX
Heat, application of, Pediatric
X
XX
X
XD
XX
XX
XX
XX
XX
XX
Hemodynamic/shunt calculation
XX
XX
XX
Hemofiltration
XX
Hemovac management
X
XX
X
XD
Empty containers
X
XX
XD
XD
Removal
X
XX
XD
XD
Hot ice machine
X
XX
X
XD
Hyper/Hypothermia Blanket
X
XX
X
XD
Application of
XX
XX
XD
XD
XX
XX
XX
XX
XX
Setup
X
X
X
X
X
X
X
X
X
Monitoring
X
X
X
X
X
X
X
Incentive spirometry
X
X
X
X
XX
XX
Initial instruction
X
XX
X
XD
XC
X
X
X
X
X
XX
Monitoring
X
X
X
X
XX
XX
Setup
X
X
X
X
X
XD
XX
XX
XX
XX
XX
XX
XX
XX
XX
X
XX
XX
X
X
X
XX
X
X
X
X XX
Infant warmers/isolettes
Intra Aortic Balloon Pump Adult
Comments
XC
Gastrostomy tube replacement
Infant U-bag Application
RPh
X
X
XX
XX
Patient Services Practice Guide Page 12 RN
Assist with insertion
XX
Management
XC
Assist with removal
XX
Transport of
XC
LPN
SN
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
XD
XD
XD
EST
MA
XX
XX
XX
XX
Irrigation
X
X
XD
XD
XD
X
XX
X
XD
XD
Ear (Non-Medicated)
X
XX
X
XD
XX
Eye (Non-medicated)
X
X
X
X
XX
Ostomy-(colostomy)
XX
XX
XD
XD
XD
Ileostomy
XX
XX
XD
XD
XD
Wound
X
X
XD
XD
XX
Management
XX
XX
XD
XD
Empty container
XX
XX
XD
XD
Removal
XX
XX
XD
XD
K Pad Placement
X
X
X
X
Knee immobilizer
XX
XX
XD
XD
AP abdomen/ series
XC
XC
XC
Chest/Ribs
XC
XC
XC
Extremities
XC
XC
XC
Fluoroscopy
XC
XC
Sinus/nasal
XC
XC
Bladder Continuous
XX
XX
XX
XX
Jackson Pratt
XX XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX
XX XX
Limited Radiology Technician
XC
XC XC
RPh
Comments
Patient Services Practice Guide Page 13 RN
LA line management, pediatric
XX
MAST garment - placement & removal
XX
Medication Central Venous Access Tunneled, Non tunneled, & PICC IV push, non- narcotic, Pediatric IV push, non- narcotic, Adult
LPN
SN
SPN
XD
HCA F Para
XX
X
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
MA
RPh
Comments
XX
XC
X
X
XX
IV Piggy back, Adult
X
XX*
X
IV Piggy back, Pediatric
X
XX
XD
XC
Heparin/Saline Flush Adult
X
XC*
XD
XX
Heparin/Saline Flush Pediatric
X
XD
XX
Declotting
XX
Initiation/Replace fluid without additives, Adult
X*
Initiation of fluid, without additives, Pediatric
X
Regulation of fluids
X
Titration narcotic
X
XD
TPN
X
XD
Medication: Implantable port
PCT HCA
X*
X
X
XD
XX
X
*Only if maintenance fluids are infusing, except first dose
*To ensure patent line
*Replace-RN or LPN *Initiate-RN Only
X X*
X
X XC
XC XC
*May change rate under direction of RN
Patient Services Practice Guide Page 14 RN
Flush
XX
Extravasations
XX
Medication: Arterial Lines
X
Medication: Epidural
LPN
SN
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
XX
Titrate to comfort
XX
Infusion
XX
MA
RPh
Comments
XD **For analgesia only. Test Dose must be given by anesthesia only.
XC
Bolus
EST
Medication, Peripheral IV Access
XC
*Only saline/heparin flush in short IV catheters & H2 antagonists with verified training
XD
XC
* Except for first dose antibiotics
XD
XC
X
XC*
XD
IVPB/Syringe pump
X
X*
XD
IVPB, neonatal
X
XX
XD
Heparin Flush
X
X
XD
Saline Flush
X
X
XD
XD
X
Hang and replace fluids
X
X*
XD
XD
X
*Maintenance fluids for hydration/line maintenance with no rate changes
Maintain & regulate fluids
X
X*
X
X
X
*Maintenance fluids for hydration/line maintenance with no rate changes
IV Starts
X
XC
XD
XD
XC
Vasoactive Infusions
X
Antiarrythmic Infusions
X
Iron Dextran
X
X
IV Phenytoin or Fosphenytoin
X
X
Continuous IV rates greater than 250cc/hr for over 8 hours
X
IV push, non- narcotic,
X*
X
X
XC
X
XC
XD XD
X
XC
*In ACC only
Patient Services Practice Guide Page 15 RN
IV Investigational Drugs
LPN
SN
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
MA
RPh
Comments
X
Medications Refer To Med. Admin. Policy
Verification of dose Chemotherapy
XC
Extravasation, Tx
XX
Waste Handling
XC
XX
XX
Spill
XX
XX
XX
Non-Chemotherapy Biohazard Drug
XC*
*Cytotoxic agent handling only.See l;ist of agents in Chemotherapy Administration Policy
Chemo agents for Non-chemo indicators
XC*
*Cytotoxic agent handling only. See list of agents in Chemotherapy Administration Policy.
Insulin Insulin drip
XX
Insulin SQ
X
Insulin SQ pump
XX
XD
Programming
XX
XD
Bolus, shift total, syringe change
XX
XD
Site change
XX
Heparin Drip
XD X*
XX
X
X
XD
*After consulting with RN
XD
XD
XD
XC
X
Narcotic Administration IV
X
X*
XD
PCA pump
X
X*
XD
Oxytocin challenge test
XX
Surfactant
XC
*LPN may D/C at direction of RN *LPN may D/C at direction of RN
Patient Services Practice Guide Page 16 RN
LPN
SN
Thrombolytics
X
Terbutaline Infusion
XX
XD
Programming
XX
XD
XX
XD
Bolus, shift total, syringe change Tocolytics, Oral only
X
SPN
HCA F Para
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
MA
RPh
Comments
XC
X
XD
Medication, Other Chest tube Instillation adult
XX MD only
Instillation pediatrics Chemotherapy adult
XC MD only
Chemotherapy pediatrics Douche, vaginal
X
Endotracheal
X
Enema
X
X
X
X
XX
Eyedrops
X
X
X
X
XX
SQ
X
X*
X*
X
XX
XX
IM
X
X
X
X
XX
XX
ID
X
X
X
X
XX
XX
Ommaya reservoir injection Adult
X
X
X
X
XX
XX*
XX
X XX
*Non-medicated douche only by EST
X
XX
XX *Heparin and insulin after consulting with RN
XC
PO
X
X
X
X
Sublingual
X
X
X
X
Ear
X
X
X
X
Topical
X
X
X
X
X
XC*
*EST-Neosporin/Bacitracin only
Patient Services Practice Guide Page 17 RN
LPN
SN
SPN
Vaginal
X
X
X
X
Rectal
X
X
X
X
Oxygen therapy
X
X
X
X
Transdermal/Topical
X
X
X
MDI
X
X
X
SVN
X
X
X
Assist OOB Turn or assist
HCA F Para
PCT HCA
X
XX
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
XX
X
XX
XX
X
X
X
XX
X
X
X
X
X
X
XX
X
XX
XX
X
X
X
XX
Monitoring cardiac rhythm
XX
XX
XX
XX
XX
Nasal snuffer/mustache dressing
X
X
X
X
X
XX
X
XD
XX
MA
RPh
Comments
Initiated in emergency situations without a physician order
Respiratory Therapy
Sedation Suppositories
XC
Mobility
Monitor Tech = XC
XX XX
XX
XX
Nasogastric Tube Insertion Needle thoracotomy for tension pneumothorax
XC
Non-stress test
XX
XD
Order Transcription
X
X
XC XC
Transport RT
XC
Unit Secretaries Refer to Order Processing & Turn Around Time Policy
Order verification Oximetry, Pulse
X
X
X
X
XX
XX
XD
XD
X
XX
XX
X
X
XX
XX
Pacemaker Adult Internal, care of
XX
XX
Patient Services Practice Guide Page 18 RN
LPN
SN
SPN
HCA F Para
External pacer, care
XX
XX
XD
XD
XX
Wires - care of epicardial
XX
XX
XD
Epicardial removal
XC
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
XX
XX
EST
MA
X
RPh
Comments
XX
Patient Education Plan
X
X
X
Teaching
X
X
X
X
X
X
X
Perineal care
X
X
X
X
X
X
X
Photo therapy
XX
XX
XD
XD
POCT (Point of Care Testing)
XC
XC
XD
XD
Monitoring Adult
XX
XX
XD
XD
Monitoring Pediatric
XX
XD
Measurement Adult
XX
XD
Measurement Pediatric
XX
XC
XC
XC
X
X
X
X
X
XX
XX
XX
XX
XC
XC
X
X
X
X
XC
XC
Pressure Transducer system
Pulmonary Artery Pressure
Radiant Warmer, Pediatric Monitoring
X
X
X
X
Set up
X
X
X
X
Radiation Therapy, Care of I31 implant
X
X
XX
X
XX
Restraints
Refer to Restraint Policy
Safety Devices
Refer to Restraint Policy
Scale - bed weight
X
X
X
X
X
X
Shaving - skin prep
X
X
X
X
X
X
XX
X X
X XX
XX
X
X
X
X
X
Patient Services Practice Guide Page 19 RN
LPN
SN
SPN
HCA F Para
PCT HCA
Skin Care
X
X
X
X
X
Skin Preparation
X
X
X
X
X
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
EST
X
X
XX
XX
X
X
X
X
X
XX
XX
MA
RPh
Comments
X
Specimen collection Refer to POCT Venipuncture & Specimen Collection Policy
Blood Gastric indwelling NG
X
X
X
X
XX
Sputum
X
X
X
X
X
XX
XX
Stool
X
X
X
X
X
XX
XX
Throat
X
X
X
X
X
Clean catch
X
X
X
X
XX
X
X
XX
Indwelling catheter
X
X
X
X
XX
XX
XX
XX
Urostomy
X
XX
X
XD
XX
XX
Vaginal
X
XX
XD
XD
Wound
X
X
X
X
XX
Application/removal noncircumferential
XX
XX
XD
XD
XX
Sterile field and Procedural trays set-up of
XX
XX
X
XD
XX
Oral
X
X
X
X
X
Nasal
X
X
X
X
Nasotracheal
X
XX
X
Endotracheal
X
XX
X
X
XX
X
XX
XX
X
X
X
XX
X
X
X
X
Urine
XX
XX
XX
X
XX
XX
XX
XX XX XX
XX
XX
XX
Splint
XX XX
XX
XX
XX
XX
X
X
XC
X
X
X
XC
XD
X
X
X
XD
X
X
X
Suctioning
XX
XX
XX
Patient Services Practice Guide Page 20
Tracheostomy
RN
LPN
SN
SPN
HCA F Para
X
XX
X
XD
XX
PCT HCA
SP/ NA-R
CNA
Surg Tech
PST
RT
RT NAR
X
X
EST
MA
RPh
Comments
Refer to Suicide policy
Suicide precautions Sutures, removal
X
XX
X
XD
XX
XX
XX
X
Staples, removal
X
XX
X
XD
XX
XX
XX
XX
Management
X
X
X
X
XC
XX
XX
Set-up
XX
XC
XX
XX
X
X
Traction
XD
XC
Transport of patient Stable
X
X
X
Unstable
X
XD
XD
Uterine massage
XX
XX
XD
Ventricular Assist Device (LVAD)
XC
Vaginal exam
XX
Assist With
X
X
XX
X
X
XX
XD
XD
XD
X
X
X
XX
X
XD
XD
XD
X
XD X
X
X
X
Ventilator Change Settings
XX
Care of patient with
XX
XX
XD
XD
XX
Vital signs
X
X
X
X
X
X
Wheelchair assist
X
X
X
X
X
X
Cleaning
X
XX
XD
XD
XX
Debridement Simple
X
XX
XD
XD
Debridement Complex
X
Physician ORDER REQUIRED
X
X
X
X
X
X
X
X
XX
XX
X
X
X
XX
XX
XX
XX
XX
X
XX
XX
XX
XX
X
X XX
X
XX
XX
Wound
X
Patient Services Practice Guide Page 21 RN
LPN
SN
SPN
HCA F Para
PCT HCA
Dressing, simple
X
X
X
X
X
X
Dressing, complex
X
XX
XD
XD
XX
Date of Origin: Review: Revise: Approval: Distribution:
SP/ NA-R
CNA
Surg Tech
X
8/90 8/91, 10/92, 5/93, 3/97 8/93, 3/94, 7/94, 9/94, 10/94, 1/95, 3/95, 10/95, 2/99, 1/01, 07/04 Clinical Practice Council All holders Patient Services Department Standards of Practice Manual
January 2001 (PT SERVICES PRACTICE GUIDE)
PST
RT
RT NAR
EST
MA
X
X
X
X
XX
X
XX
XX
XD
RPh
Comments
Patient Services Practice Guide Page 22
Radiology Grid PURPOSE = Clarify which job classifications may perform the following procedures RN = Registered nurse ARRT = American Registry of Radiologic Technologist RDMS/RVT = Registered Diagnostic Medical Sonographer/Registered Vascular Technologist CNMT = Certified Nuclear Medicine Technologist I.R/CCL = Interventional Radiology/ Cardiac Cath Lab X = May be performed by this job classification XX = May be performed by this job classification only upon completion of approved department orientation XC = May be performed by this job classification with certification XD = May be performed only under direct supervision of preceptor, RN, or physician * = Primary Responsibility Used only for nursing process + = Delegated Responsibility Used only for nursing process ** Indicates separate grid
Separate grid for Radiology, Rehabilitation, Therapy RN
ARRT
RDMS/RVT
NMT
Imaging students
CCL RN
CCL/IR ARRT/CVT
Comments
Airway
Ambulation Assessment
X
X
Assist devices
XX
XX
Transfer devices
XX
XX
XX
X
XX
XX
Obtaining via line Adult
X
XX
XD
In I.R and CCL only
Obtaining via line
XX
XX
XD
In I.R. and CCL only
XX
XX
XX
In I. R. AND CCL Only
Antiembolic Hose
XX
XD
XX
XX
XD
Accessing blood
Arterial Compressor Arterial Cutdown assist
Pediatric Application ADULT
X
XX X
Patient Services Practice Guide Page 23 RN
ARRT
Arterial Closure Device
XX
XX
Aseptic Technique
X
XX
Bladder catheterization
X
XC
Bladder instillation
X
X
Bladder Scan
XX
RDMS/RVT
NMT
Imaging students
CCL RN
CCL/IR ARRT/CVT
XX XX
XX
XD
X
X
XD
X
XX
Comments
In I.R. and CCL Only
X
Blood Draw Peripheral line
X
XX
X
X XD
Only in I.R.and CCL
Central line, Adult
XX
XX
X
X XD
Only in I.R.and CCL
X
X
X
X
XX
XX
XC
XC
XC
X
XX
X
Blood Pressure Measurement
X
X
X
Cardiac Output determination
XX
Cardio Pulmonary Resuscitation (CPR)
XC
XC
C-Arm Assist
XX
X
Monitoring
XX
XX
XX
XX
In I.R. and CCL Only
Removal of
XX
XX
XX
XX
In I.R. and CCL Only
Zeroing
XX
XX
XX
XX
In I.R. and CCL Only
Accessing
XX
XX
XX
X XD
In I.R.and CCL Only
Removal
XX
XX
XX
X XD
In I.R. and CCL Only
XX
XX
XX
XX
In I.R. and CCL Only
Insertion assist
XX
XX
XX
XX
In I.R. and CCL Only
Removal nontunnel
XX
XX
XX
XX
In I.R. and CCL Only
XC
XC
CPR
Catheters, Hemodynamic
Arterial lines
Central Access Device Removal CVP
Patient Services Practice Guide Page 24
Application/change of drainage bag
RN
ARRT
X
XX
X
XX
RDMS/RVT
NMT
Imaging students
CCL RN
CCL/IR ARRT/CVT
Comments
In I.R. only
Chest Tube Drainage system set-up
X
In I.R. only
Consent: Defibrillation
Refer to Consent Policy XC
XC
ACLS/PALS
XX
XX
XC
Monitor Tech = XX
XX
XX
XX
X
XC
XC
XC
XC
XC
XC
EKG Performance of Intra Aortic Balloon Pump Adult Assist with insertion
X
XC
Benadryl po
X
XD
Contrast po/ IV/ rectal
X
X
CCK/Sinclide IV
X
Heparin flush IV/ IA
X
Lasix IV
X
IV starts
X
XD
Medication administration In CT only XD
X
X
X XD X X
Radionucleide IV/ Inhalaton XD
Chemotherapy
XD
Vesicant
XC
Extravasation, tx
XX
Waste Handling
XC
XD
Collection of Data
X
XX
XX
XX
XX
X
XX
Documentation
X*
XX
XX
XX
XX
X
XX
Pulmonary Artery Pressure
In I.R./Diag. With Radiologist present
Patient Services Practice Guide Page 25 Imaging students
CCL/IR
ARRT
Measurement Adult
XX
XX
XX
XX
Measurement Pediatric
XX
XX
XX
XX
X
X
X
X
XD
X
X
Drainage (ie plural)
X
XX
XX
XX
XD
X
XX
Biopsy
XX
XX
XX
XX
XD
XX
XX
CSF
X
X
Urine
X
XX
XX
XX
XD
X
XX
Sterile field and trays - set-up of
X
X
X
X
XD
X
Stocking (Rooms, equipment)
X
X
X
X
X
X
X
X
XX
X
XX
Stable
X
X
X
X
X
X
X
Vital signs
X
X
X
X
X
X
X
Skin Preparation,
RDMS/RVT
NMT
RN
CCL RN
ARRT/CVT
Specimen collection Blood
Suctioning Oral Transport of patient
Date of Origin: Review: Revise: Approval: Distribution:
8/90 8/91, 10/92, 5/93, 3/97 8/93, 3/94, 7/94, 9/94, 10/94, 1/95, 3/95, 10/95, 2/99, 1/01,4/05 Clinical Practice Council All holders Patient Services Department Standards of Practice Manual
January 2001 (PT SERVICES PRACTICE GUIDE)
Comments
Patient Services Practice Guide Page 26
Attachment 3 Nurse Technician
RCW 18.79.350 Nursing technicians -- Nursing functions. (1) Nursing technicians are authorized to perform specific nursing functions within the limits of their education, up to their skill and knowledge, but they may not: (a) Administer chemotherapy, blood or blood products, intravenous medications, or scheduled drugs, or carry out procedures on central lines; (b) Assume ongoing responsibility for assessments, planning, implementation, or evaluation of the care of patients; (c) Function independently, act as a supervisor, or delegate tasks to licensed practical nurses, nursing assistants, or unlicensed personnel; or (d) Perform or attempt to perform nursing techniques or procedures for which the nursing technician lacks the appropriate knowledge, experience, and education. (2) Nursing technicians may function only under the direct supervision of a registered nurse who agrees to act as supervisor and is immediately available to the nursing technician. The supervising registered nurse must have an unrestricted license with at least two years of clinical practice in the setting where the nursing technician works. (3) Nursing technicians may only perform specific nursing functions based upon and limited to their education and when they have demonstrated the ability and been verified to safely perform these functions by the nursing program in which the nurse technician is enrolled. The nursing program providing verification is immune from liability for any nursing function performed or not performed by the nursing technician. (4) Nursing technicians are responsible and accountable for their specific nursing functions. [2003 c 258 § 3.]
NOTES: Severability -- Effective date -- 2003 c 258: See notes following RCW 18.79.330.
