How Can I Solve a 'Scope-of-Practice' Dilemma?

Carolyn Buppert, MSN, JD

Disclosures

October 01, 2013

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Question

Can LPNs change tracheostomies in emergency situations if this is prohibited by Board of Nursing regulation?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney, Boulder, Colorado

A Scope-of-Practice Dilemma

Here are the details about the dilemma posed to Medscape:

"I work as a clinical supervisor/case manager for a private duty company in Tennessee. The Board of Nursing issued a position paper about the scope of practice for licensed practical nurses (LPNs) with respect to tracheostomies and ventilators. In brief, the paper states that LPNs may not change a tracheostomy or the circuit for the ventilator. However, they may change the inner cannula, place the client on and off the ventilator, and deliver nebulizer treatments through the ventilator system. My colleagues write in their plans of care that the LPN may change the tracheostomy in an emergency, but I believe that if the Board states that the LPN may not change a tracheostomy, then that includes emergencies and to do so would be outside their scope of practice. Would you please comment on this?"

I agree with you. I can't speak for the Tennessee Board of Nursing, but I assume that the Board, whose mission is to protect patient safety, considered emergencies and would have authorized LPNs to change a tracheostomy in an emergency if the Board thought it appropriate and safe. (Because I can't speak for the Board, I recommend that you take your question about emergency situations to the Board.)

Your colleagues don't have any authority to increase the scope of practice of LPNs through their care plans. If this were a gray area, my answer might be different. However, the Board is very specific that LPNs can't change the outer tracheostomy cannula in their policy on "LPN Care of Ventilator Dependent Patients in the Home Health Setting."

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