Board of Registration Board of Registration

in Nursingin Nursing

Module: Module: Legal Scope of Legal Scope of

RN, LPN, and APRN Practice RN, LPN, and APRN Practice

244 CMR 3.00: Registered 244 CMR 3.00: Registered Nurse Nurse and Licensed Practical and Licensed Practical NurseNurse

3.01: Registered Nurse3.01: Registered Nurse• Graduate of a Board approved Graduate of a Board approved

schoolschool• Holds ultimate responsibility for careHolds ultimate responsibility for care• Scope includes: nursing care, health Scope includes: nursing care, health

maintenance, teaching, counseling, maintenance, teaching, counseling, plans and restoration for optimal plans and restoration for optimal functioning & comfort functioning & comfort

244 CMR 3.00 244 CMR 3.00

3.02: Responsibilities & Functions (RN)3.02: Responsibilities & Functions (RN)• Systematically assess health status Systematically assess health status

of individuals or groupsof individuals or groups• Analyze & interpret data; and make Analyze & interpret data; and make

informed judgementsinformed judgements• Plan & implement care - prescribed Plan & implement care - prescribed

medical or therapeutic regimes, medical or therapeutic regimes, scientific principles, recent scientific principles, recent advances & current researchadvances & current research

3.02 - continued3.02 - continued• Provide & coordinate health teachingProvide & coordinate health teaching• Evaluate outcomesEvaluate outcomes• Collaborate, communicate and Collaborate, communicate and

cooperates to ensure quality and cooperates to ensure quality and continuity of carecontinuity of care

• Serves as a patient advocate within Serves as a patient advocate within the limits of the lawthe limits of the law

• MAY DELEGATE . . . MAY DELEGATE . . .

244 CMR 3.00244 CMR 3.003.03: Practical Nurse3.03: Practical Nurse

• Graduate of a Board approved schoolGraduate of a Board approved school• Bears full responsibility for the quality Bears full responsibility for the quality

of health care she/he providesof health care she/he provides• Scope includes: Scope includes: participationparticipation in in

nursing care, health maintenance, nursing care, health maintenance, teaching, counseling, collaborative teaching, counseling, collaborative planning and rehabilitation, planning and rehabilitation, to the to the extent of his/her education extent of his/her education

244 CMR 3.00244 CMR 3.00

3.04: Responsibilities & Function (PN)3.04: Responsibilities & Function (PN)• Assess individuals Assess individuals basicbasic health status health status• ParticipatesParticipates in analyzing data & in analyzing data &

making informed judgementsmaking informed judgements• ParticipatesParticipates in planning & in planning &

implementing interventions including implementing interventions including recent advances & current recent advances & current knowledge in the fieldknowledge in the field

• Incorporates medical regimesIncorporates medical regimes

3.04 – continued 3.04 – continued • ParticipatesParticipates in health teaching in health teaching• When appropriateWhen appropriate, evaluates , evaluates

outcomes, initiates or outcomes, initiates or encourages change in the planencourages change in the plan

• Collaborates, cooperates, Collaborates, cooperates, communicates to ensure quality communicates to ensure quality and continuity of careand continuity of care

• MAY DELEGATE . . .MAY DELEGATE . . .

244 CMR 4.00: The Practice 244 CMR 4.00: The Practice of of Nursing in the Expanded Nursing in the Expanded RoleRole

• Establishes the conditions under which Establishes the conditions under which RNs may practice in the advanced role.RNs may practice in the advanced role.

• Governs education & practice Governs education & practice requirements.requirements.

• Criteria for authorization to practice.Criteria for authorization to practice.• Criteria for prescriptive authority.Criteria for prescriptive authority.• Requirements for guidelinesRequirements for guidelines• Details “Scope of Practice” Details “Scope of Practice”

Advisory Rulings On Advisory Rulings On Nursing PracticeNursing Practice

Advisory Rulings on Nursing Advisory Rulings on Nursing Practice are declarative Practice are declarative statements of the Board which:statements of the Board which:• carry with them the full weight of carry with them the full weight of

lawlaw• represent the Board’s represent the Board’s

interpretation of the legal scope interpretation of the legal scope of nursing practiceof nursing practice

Determining Scope of Determining Scope of PracticePractice

• Describe nursing practice or activity.Describe nursing practice or activity.• Is it supported by statute or regulation?Is it supported by statute or regulation?• Does entry into practice education Does entry into practice education

provide the necessary knowledge/ provide the necessary knowledge/ skill/ability? Or Continuing Education?skill/ability? Or Continuing Education?

• Is this a practice that is consistent with Is this a practice that is consistent with the nursing literature and/or research?the nursing literature and/or research?

• Does the nurse have a documented Does the nurse have a documented competence?competence?

Scope of Practice - continuedScope of Practice - continued

• Is this within a standard of care Is this within a standard of care that another reasonable & prudent that another reasonable & prudent would do?would do?

• Is the patient’s safety assured?Is the patient’s safety assured?• Is the nurse prepared to accept Is the nurse prepared to accept

accountability for performing the accountability for performing the activity?activity?

Scope of Practice - continuedScope of Practice - continued

• Apply the Board’s Apply the Board’s Decisionmaking Decisionmaking GuidelinesGuidelines to a clinical situation to to a clinical situation to determine if the selected activity is determine if the selected activity is within the nurse’s scope of within the nurse’s scope of practice. practice.