The Board of Registration in Nursing uses Decisionmaking Guidelines to determine whether or not specific activities fall within the scope of practice for LPN’s, RN’s and APRN’s. Although an activity may be considered to be within the scope of nursing practice, the determination to allow a licensed nurse to perform a specific job function is at the discretion of the employer.
Organizational regulations and reimbursement guidelines may designate specific personnel that must complete tasks pursuant to statute or regulation, for payment, or for other considerations.
The Decisionmaking Guidelines are based in part on the:
- Statutory definition of the practice of nursing at Massachusetts General Law Chapter 112, s. 80B,
- Regulatory criteria for responsibilities and functions of the licensed nurse at 244 CMR 3.00 – 9.00,
- Available data from evidence based research and professional organizational standards,
- Presence of, or need for additional education,
- Activity being prudent and reasonable, and
- Licensee being prepared to accept accountability for the outcomes associated with performing this activity.
Typically, the Board would determine that an activity is within the scope of practice when the nurse has:
- Education and training to perform the activity,
- Demonstrated competency to safely and effectively perform the activity,
- Orders from a duly authorized prescriber, when required, or authorized post-procedure protocol to perform the activity,
- The understanding that he/she is accountable for the outcomes associated with performing this activity, and
- An organizational infrastructure of support through policy and procedure.
Pursuant to the regulations at 244 CMR 3.00, licensed nurses are responsible for their own individual practice; thus each nurse bears full responsibility for the quality of health care s/he provides to patients or health care consumers.
There is no Board requirement for RN supervision of LPN practice.
Individually listed tasks, skills or activities are not listed in any section of the regulations.