Title: Administration of Immunizing Agents or Vaccines

Advisory Ruling Number: 9804

Authority: The Massachusetts Board of Registration in Nursing (Board) issues this Advisory Ruling on Nursing practice pursuant to Massachusetts General Laws (MGL) chapter 30A, section 8 and chapter 112, section 80B.

Date Issued: May 13, 1998

Date Revised: January 12, 2000; May 8, 2002; March 14, 2007; November 14, 2012

Scope of Practice: Registered Nurse and Licensed Practical Nurse

Purpose: To guide the practice of the Registered Nurse and Licensed Practical Nurse ("the nurse") who as part of their nursing practice, may administer immunizing agents or vaccines to any member of the public in any and all settings.

Such practice must be in compliance MGL c. 112, s. 80B, 244 CMR 3.02: Responsibility and Functions - Registered Nurse; 244 CMR 3.04: Responsibilities and Functions - Practical Nurse; 244 CMR 9.03(5): Adherence to Standards of Nursing Practice; 244 CMR 9.03(6): Compliance with Laws and Regulations Related to Nursing; 244 CMR 9.03 (8): Identification Badge; 244 CMR 9.03 (9): Responsibility and Accountability; 244 CMR 9.03 (10): Acts within Scope of Practice; 244 CMR 9.03 (11): Performance of Techniques and Procedures; 244 CMR 9.03 (12): Competency; 244 CMR 9.03 (14): Asepsis and Infection Control; 244 CMR 9.03 (16):  Patient Confidentiality; 244 CMR 9.03 (35): Security of Controlled Substances; 244 CMR 9.03 (38): Administration of Drugs; 244 CMR 9.03 (39):  Documentation of Controlled Substances; 244 CMR 9.03 (44): Documentation; and 244 CMR 9.03(46): Responsibilities of Nurse in Management Role.           

Advisory: It is within the scope of the Registered Nurse and Licensed Practical Nurse to administer immunizing agents or vaccines.  The nurse may only assume the duties and responsibilities related to the administration of immunizing agents or vaccines for which he or she has acquired and maintained the necessary knowledge, skills and abilities including storage, handling, administration, contraindications, reporting of adverse effects, and documentation of the immunizing agent or vaccine.

The nurse is responsible and accountable for his or her nursing judgments, actions and competency related to the administration of immunizing agents or vaccines.

The nurse will not administer any immunizing agent or vaccine to any person in the course of nursing practice except as directed by an authorized prescriber. 

The immunizing agent or vaccine may be administered only under the following provisions.  The nurse must:

  • Complete an assessment including an allergy history of the patient of the immunizing agent or vaccine prior to the administration of an immunizing agent or vaccine;
  • Verify the orders from a duly authorized prescriber.  A nurse may administer an immunizing agent or vaccine ordered from a Standing Order Protocol. A standing order protocol must include:
    • The name(s) of the immunizing agent or vaccine to be administered;
    • The dose to be administered;
    • The route or method of administration;
    • Inclusion/Exclusion criteria that the nurse will assess for before administering the immunizing agent or vaccine; and
    • The signature or approval by a duly authorized prescriber either directly on the standing order or on file with the facility/agency/program providing individual or mass immunization or vaccinations; 
  • Provide education to the patient, parent or guardian of the immunizing agent or vaccine on the risks and benefits of accepting or refusing the opportunity to receive the immunizing agent or vaccine;
  • Document a process of informed consent with the patient, parent or guardian of the immunizing agent or vaccine that is reflective of the educational materials provided;
  • Obtain parental or guardian permission in the case of administration to children in compliance with local, state and federal requirements;
  • Demonstrate competencies for assessment and management of possible local, systemic or allergic reactions related to immunizing agent or vaccine administration
  • Document the handling, administration and destruction of immunizing agents and vaccines in accordance with all federal and state laws and regulations, and in a manner consistent with accepted standards of practice.  Among the relevant state laws, MGL c. 111, s. 24M specifies Massachusetts Immunization Registry reporting requirements unless the patient, parent or guardian asserts their right to object to the disclosure of such information into the registry.   All documentation must be complete, accurate and legible.

This information is provided by the Division of Health Professions Licensure within the Department of Public Health.