Title: The Use of a Vagal Nerve Stimulator Magnet

Advisory Ruling Number: 0802

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

Date Issued: May 14, 2008

Date Revised: June 10, 2009; November 14, 2012

Scope of Practice: Registered Nurses and Licensed Practical Nurses.

Purpose: The purpose of this Advisory Ruling is to guide the practice of the Registered Nurse and Licensed Practical Nurse (nurse) in the training unlicensed persons when managing the care of an individual with a Vagal Nerve Stimulator (VNS) device who requires the use of a hand-held magnet to activate the generator transcutaneously if the individual experiences an aura or if an observer witnesses the individual having a seizure.  Using a hand-held magnet to activate the VNS generator can be carried out by an appropriately trained unlicensed person. The use of a VNS magnet is not the practice of nursing.

A nurse’s use of the VNS magnet must be in compliance with: Massachusetts General Laws (MGL) c. 112, s. 80B; 244 CMR 3.02: Responsibilities and Functions - Registered Nurse; 244 CMR 3.04: Responsibilities and Functions- Practical Nurse; 244 CMR 9.03 (5): Adherence to the Standards of Nursing Practice; 244 CMR 9.03(9): Responsibility and Accountability; 244 CMR 9.03 (12): Competency; and 244 CMR 9.03(44): Documentation.

Advisory: The nurse licensed by the Massachusetts Board of Registration in Nursing (Board) will engage in the practice of nursing in accordance with accepted standards. It is the Board's position that these standards, in the context of training unlicensed persons in the use of VNS magnets when managing of the care of an individual with a VNS, recognize the licensed nurse responsibility and accountability for:

  • Ensuring a valid health care provider order for the use of the VNS magnet;
  • The acquisition and maintenance of competencies related to the VNS device and the use of the hand-held magnet;
  • The assessment and development of a plan of care that specifically documents the individual's seizure prevention needs. The specific focus shall be on the signs and symptoms of the seizure in the particular individual, the presentation of the aura if applicable, the location of the VNS in the body, the direction and duration of the magnet while swiping, and any associated policies which must include immediate notification of defined staff and circumstances that require notification of emergency personnel when the magnet has been used to deploy the VNS;
  • Collaborating and communicating in the development, implementation, monitoring and evaluation of the training and performance of unlicensed persons who may use the hand-held magnet to activate the generator transcutaneously.  Such training, monitoring, and performance evaluation does not constitute delegation or supervision by the licensed nurse because the use of the VNS magnet is not the practice of nursing;
  • Appropriate and timely communication with the patient and/or responsible party, physicians and other healthcare personnel; and
  • Complete, accurate and legible entries in any and all records required by federal and state laws, regulations, and accepted standards of nursing practice.

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