Scope of Practice Paper



Scope of Practice Paper

POLICY

Nurses have many duties and responsibilities. Patient advocate is the nurses' priority. The nurse is who the patient may have to rely on if no one else will listen to his or her wishes. Therefore, nurses have guidelines, regulations, and a code of ethics that as a nurse they must follow and have to guide them when the nurse becomes confronted with a situation as in this particular case study. The nurse has a right to autonomy as a professional, which aides in assisting patients with their rights (Eriksen, 1992).

In California the nurse practice act states that “Subsection (b)(4) of Section 2725, authorizes observation of signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition and determination of whether these exhibit abnormal characteristics; and based on this determination, the implementation of appropriate reporting or referral, or the initiation of emergency procedures. These independent nursing functions have long been an important focus of nursing education, and an implied responsibility of the registered nurse.”

Licensed Vocational Nurses (LVNs) are NOT independent practitioners. It is not within the scope of LVN practice to function independently. The LVN must practice under the

direction of a licensed physician or Registered Nurse (RN) at all times. Such direction may

be provided verbally, telephonically, or by written order (Buccini, 1994).

NURSING PROCESS

Nursing assessment is defined as the collection of data. The LVN may assist in the

collection of data during the assessment process. VALIDATION of assessment data,

however, must be done by the RN. The LVN may perform and document a basic assessment on assigned patients in emergency (Kelly, 1974).

and non-emergency situations. A basic assessment is defined as the collection of subjective

and objective data and recognition of problems or abnormal conditions specific to the patient.

In addition to subjective symptoms reported by the patient, examples of objective data that

may be collected by the LVN as part of a basic assessment include:

vitals signs, including apical pulse;

height and weight;

general appearance of the skin and nails (e.g., color, pigmentation, lesions, jaundice,

cyanosis, scars, moisture, edema, elasticity, temperature);

hair distribution and gross masses or swelling of the scalp;

pupil size, shape, symmetry and reaction to light;

general appearance of the lips (e.g., observe lips for color, moisture, pigment, gross

masses or ulcerations);

general appearance of the mouth (e.g., bleeding gums, dental caries, cracked or chipped teeth);

general appearance of the eye lids (e.g., scaling, secretions, erythema) and color of the sclera;

reath sounds (e.g., rales, wheezes, rhonchi);

presence or absence of bowel sounds and abdominal tenderness;

gait, posture, curvatures of the spine, range of motion problems;

obvious joint injuries or deformities;

peripheral pulses (e.g., brachial, radial, dorsalis pedis, posterior tibial);

edema of any extremity;

involuntary muscular movements.

The LVN may perform a psychosocial assessment using active listening, verbal

communication, and non-verbal communication to observe and document the patient's

Discussion and Analysis

The LVN may withdraw blood from a patient provided the licensee:

? has been instructed and has ...