Notice of Intended Action - ARC 5172C - Proposed 655 IAC Chapter 6
To: Nurse Licensees
From: Kathy Weinberg, Executive Director
Subject: Notice of Intended Action – ARC 5172C
Proposed 655 IAC Chapter 6 –
Nursing Practice for Registered Nurses/Licensed Practical Nurses
Board staff and legal counsel have met regularly since September 2018 to review and revise 655 Iowa Administrative Code, Chapter 6. In January 2020, staff, legal counsel and several nursing stakeholders met to review the initial draft of the new Chapter 6. Chapter 6 governs the minimum standards of practice for RNs and LPNs. The chapter had not been reviewed in its totality for many years. Accordingly, the rules committee considered the chapter as a whole and made changes to both its phrasing and organization, in an effort to bring the chapter in line with modern practices and terminology.
When making amendments, the committee was guided by (1) current trends in discipline, (2) model rules suggested by NCSBN, and (3) staff experiences, including common questions and rules that have proven confusing for the public to understand. The ultimate goal was to increase compliance by making the rules easier to understand.
Because the committee’s goal was to provide clarity, and not alter the substantive duties of RNs or LPNs, the new chapter does not contain many practice-related changes. Most changes are sentence-level revisions to promote clarity. However, there are three substantive changes that should be noted and discussed:
- Proximate area. Previously, an LPN was required to have an RN or physician present in the “proximate area” if the care provided by the LPN required the “knowledge and skill level” of an RN. However, the rules also stated that if a task required the knowledge and skill level of an RN, the LPN was prohibited from performing that task. Thus, the “proximate area” standard needed revision. In the new chapter, the task-based proximity standard is replaced by a settings-based standard. Now, if an LPN is working in any acute care setting, or a specified non-acute care setting, an RN, ARNP, or physician must be in the proximate area.
- Unimplemented interventions. Previously, if an RN or LPN did not implement an ordered intervention, the RN or LPN was required to document the reason for not performing the task, as well as inform the prescriber why it wasn’t implemented. In the new chapter, RNs and LPNs must also, if appropriate, inform “other persons who, based on the patient’s circumstances, should be notified of any orders which were not implemented.” This changed is aimed at situations where a minor patient’s parents or guardians should be notified of a missed medication or other change in care plan. It allows for the nurse to exercise discretion to decide who, in addition to health care staff, must be informed of unimplemented interventions.
- Professionalism, accountability, and advocacy. NCSBN Model Rules contain provisions instructing nurses to demonstrate professionalism and accountability through their actions and interactions with patients and other facility staff. The Model Rules also contain provisions instructing nurses to act as patient advocates by respecting their needs, boundaries, and environment. The new chapter incorporates many of these model rules, which aim to promote safe and respectful environments for patients and health care professionals.
The rules were also re-organized to help licensees more easily navigate the chapter. Previously, rules relating to RNs and LPNs were intermingled, and spread across the entire chapter. In the new chapter, all the rules relating to RNs are in rule 6.2, and all the rules relating to LPNs are in 6.3. As well, multiple rules that were related have been combined to allow a licensee to easily determine whether a rule or exception applies, without having to read the entire chapter.
Due to COVID-19 the rule making process was halted until July 2020, when the Iowa Board of Nursing voted to notice the rule. The notice of intended action may be found at this LINK.
Per the published rules, public comments may be made in writing and must be sent to Kathy Weinberg, Executive Director, no later than 4:30 p.m. on September 29, 2020. Email: Kathy.firstname.lastname@example.org.
A public hearing will be held on September 29, 2020, between 9 a.m. and 10 a.m. Persons who wish to make oral comments at the public hearing may be asked to state their names for the record and to confine their remarks to the subject of this propose rule making.
Any person who intends to attend the public hearing and has special requirements, such as those related to hearing or mobility impairments, should contact the Board and advise of specific needs.
Due to COVID-19, social distancing measures will be observed.