In the state of Iowa, an LPN may not perform an initial assessment. Once the initial assessment has been completed by an RN or a physician, the LPN may then perform further assessments with collaboration and supervision of the RN or physician.
The RN or physician is responsible for verifying the LPN's assessment findings. The mechanism by which verification and supervision is carried out may be determined by institutional policy.
Triage is considered to be part of the assessment phase of the nursing process and considered to be the initial assessment in determining the care of the patient. Therefore, an LPN may not triage without the direct supervision of an RN or a physician and the RN would be responsible for verifying the assessment findings with the patient.
An LPN may not practice independently. An LPN must be supervised by a RN or physician.
The healthcare setting determines if the RN or physician must be present in proximate area, refer to IAC 655, Chapter 6, Section 6.3(5) and 6.3(6).
The facility defines the degree of supervision through institutional policy.
In order for an LPN to supervise in an intermediate or skilled health care facility, the LPN MUST have satisfactorily completed a course of study approved by the board, which is designed specifically for the supervision role in the long term care patient care setting. The board approved course is “Supervising in Health Care Facilities.” The course must be presented by a board-approved nursing program or a board approved provider of continuing education.
The LPN is required to complete the course within 6 months of employment in a supervisory position in a long-term care setting.
The course must be taught by a board-approved nursing program or a board-approved provider of continuing education. Many of the community colleges offer the course once a semester.
If the LPN cannot take the course within the six month time period due to extenuating circumstances or if the course is not available, the LPN may be granted a one-time waiver.
An LPN may supervise without the educational requirement if the LPN was performing in a supervisory role in long term care on or before October 6, 1982. (Proof of said employment may be requested)
An LPN who is enrolled full-time in an RN program and who plans to graduate within one year may request a one-time waiver. The request for a waiver due to FT enrollment in an RN program will need to include the LPN license number, expected RN graduation date, number of credit hours taken each semester and the reason the request is being made. Individuals who do not graduate from the RN program as scheduled or who are not successful on the RN-NCLEX must take the next available supervisory course.
The Iowa Board of Nursing does not have a rule, regulation or position on the RN administering anesthetic medications for the purpose of operative, invasive and diagnostic procedures.
As with any task/function that the nurse carries out, it is important to remember the nurse must be educated and competent in the task/function. The nurse retains accountability for her/his actions.
There are no laws or Iowa Board of Nursing rules that prohibit a licensed nurse from working in a position that is below the level of his or her licensure. However, the board has previously determined that the nurse who does so is held to the highest level of his or her education. If a nurse is working in a position lower than the nurse's licensure and fails to act prudently based on education preparation, the nurse's license would be subject to sanction by the board.
No, a graduate from an approved nursing program may not practice nursing in a role of the Licensed Practical Nurse or Registered Nurse until they have successfully passed the NCLEX and have been issued a nursing license. Practicing nursing without a license violates Iowa law and leads to discipline.
Until the graduate has become licensed they may work as a tech, aide or direct care worker in accordance with the facility's job description and policies and procedures.
The Board did determine that it is permissible for new graduates, who have not yet completed the process of licensure by examination, to begin the classroom portion of orientation to a nursing position. While there is no rule prohibiting orientation to patient care areas by observing a licensed nurse, board members did express concern about this type of activity. Employers are asked to consider the risk both the employer and the patients face if an emergency arises and a licensed nurse is not immediately available to respond.
Refer to the Iowa Administrative Code 655, Chapter 6, Section 6.2(5)" c", which states that, "Activities and functions which are beyond the scope of practice of the licensed practical nurse may not be delegated to unlicensed assistive personnel."
When deciding what functions to delegate to unlicensed assistive personnel please refer to the delegation information at this link: Delegation
When delegating it is always necessary to assess the individual patient, the task, and the individual personnel, to ensure that delegation is a safe plan of care for the patient.
Once the decision has been made to delegate a task, there must be adequate education and training, documentation of the competency of the individual, a plan for future evaluation and a written institutional policy for carrying out the procedure.
The RN and LPN maintain accountability for the delegation process, which includes: assessment, the decision to delegate, monitoring and evaluation of the nursing care.
The Board of Nursing does not certify CNA's or DCW's, please call 515.281.4115 for assistance. For questions regarding CMA's call 515.242.5991.
Though the rules do not specifically spell out the answer to this question, the sections cited below do speak to the qualifications of an ARNP's specialty area defined by education, prescriptive authority, the official board record and current license, stating name, title and specialty area.
IAC 655, Chapter 7, Section 7.1, under the definition of "Advanced Registered Nurse Practitioner (ARNP)" states; "The ARNP is prepared for an advanced role by virtue of additional knowledge and skills gained through a formal advanced practice education program of nursing in a specialty area."
The definition of "Prescriptive authority" is the authority granted to an ARNP licensed in Iowa in a recognized nursing specialty to prescribe, deliver, distribute, or dispense prescription drugs, devices, and medical gases when the nurse is engaged in the practice of that specialty area.
Section 7.2(2)"a" states "No person shall practice or advertise as, or use the title of Advanced Registered Nurse Practitioner for any of the defined specialty areas unless the name, title and specialty area appear on the official record of the board and on the current license.
In Iowa an ARNP may practice independently within their speciality area. The Iowa Board of Nursing does not require a collaborative agreement between an ARNP and physician.
It is the informal opinion and recommendation of the board that the ARNP establishes professional relationships with physicians to ensure patients/clients receive quality healthcare.