Title: Administration of Immunizing Agents and Vaccines

Advisory Ruling Number: 9804


The Massachusetts Board of Registration in Nursing (Board) is created and authorized by Massachusetts General Laws (M.G.L.) c. 13, §§ 13, 14, 14A, 15 and 15D, and G.L. c. 112, §§ 74 through 81C to protect the health, safety, and welfare of the citizens of the Commonwealth through the regulation of nursing practice and education.  In addition, M.G.L. c.30A, § 8 authorizes the Board to make advisory rulings with respect to the applicability to any person, property or state of facts of any statute or regulation enforced or administered by the Board.  Each nurse is required to practice in accordance with accepted standards of practice and is responsible and accountable for his or her nursing judgments, actions, and competency.  The Board’s regulation at 244 CMR 9.03(6) requires all nurses to comply with any other law and regulation related to licensure and practice.

Date Issued: May 13, 1998

Date Revised: January 12, 2000; May 8, 2002; March 14, 2007; November 14, 2012; September 9, 2015

Scope of Practice:

Registered Nurse and Licensed Practical Nurse


To guide Registered Nurse and Licensed Practical Nurse ("nurse") practice for administering immunizing agents and vaccines to any member of the public in any and all settings.


It is within the scope of the Registered Nurse and Licensed Practical Nurse to administer immunizing agents and vaccines.  A nurse may only assume duties and responsibilities for administering immunizing agents and vaccines after acquiring and maintaining necessary knowledge, skills and abilities including:

  • Storage
  • Handling
  • Administration
  • Contraindications and/or precautions
  • Assessment and management of possible local, systemic, and allergic reactions
  • Adverse effects reporting
  • Documentation

The nurse is responsible and accountable for nursing judgments, actions and competency related to administering immunizing agents and vaccines.  A nurse will administer immunizing agents and vaccines only as directed by an authorized prescriber.

The nurse will 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. 

Immunizing agents and vaccines may be administered only under the following provisions.  Prior to administering an immunizing agent or vaccine the nurse must:

  • Complete an assessment of the patient, including an allergy history
  • Verify the orders from a duly authorized prescriber.  A nurse may administer an immunizing agent and vaccine from a Standing Order Protocol[1] which 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 to identify (i.e., indications, contraindications, precautions)
    • 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 about the immunizing agent or vaccine including the risks and benefits of accepting or refusing
  • Obtain parental or guardian permission when administering to a child, in compliance with local, state and federal requirements
  • Comply with state MIIS reporting requirements (see resources below for MIIS requirements).  Among the relevant state laws, MGL c. 111, § 24M specifies Massachusetts Immunization Information System (MIIS) reporting requirements. 

Among the relevant federal laws, 42 U.S.C. § 300aa-26 requires all healthcare providers administering specific immunizing agents and vaccines provide to the patient, parent or guardian, prior to administration, a copy of the applicable, current Vaccine Information Statement (VIS)[2] developed by the Centers for Disease Control and Prevention (CDC). 

All documentation must be complete, accurate and legible and include at a minimum:

  • The edition date of the VIS
  • The date the VIS is provided
  • The office address and name and title of the person who administers the vaccine
  • The date the vaccine is administered
  • The vaccine manufacturer, lot number, and expiration date

Nurse in a Management Role

The nurse in a management role must ensure the availability of sufficient resources to provide for administering immunization agents and vaccines consistent with current nursing standards.  Resources must include, but not limited to, organizational evidence-based policies and procedures, consistent with local, state and federal requirements that provide protocols for:

  • Obtaining and documenting informed consent
  • Assessing, validating and documenting competency acquisition and maintenance for administering immunization agents and vaccines
  • Providing VIS consistent with 42 U.S.C. § 300aa-26
  • Reporting MIIS data, consistent with MGL c. 111, § 24M
  • Reporting errors and adverse events that comply with federal and state requirements
  • Nursing care responsibilities, including, but not limited to patient assessment, monitoring, education principles, response to potential complications and/or emergency situations, and documentation criteria


MA Department Public Health Immunization Program Website: www.mass.gov/dph/imm

Centers for Disease Control and Prevention (CDC) Vaccines Website: www.cdc.gov/vaccines/ 

See Advisory Ruling 9324: Accepting, Verifying, Transcribing and Implementing Prescriber Orders for Standing Order Protocol

Model Standing Orders:

Advisory Committee for Immunization Practices (ACIP) General Recommendations on Immunization: www.cdc.gov/vaccines/hcp/acip-recs/index.html


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