Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-840 - Practical and registered nursing › PRACTICE STANDARDS › Section 246-840-700 - Standards of nursing conduct or practice

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
				  defining standards of nursing conduct or practice through WAC
				  246-840-700 and
				  246-840-710 is to identify
				  responsibilities of the professional registered nurse and the licensed
				  practical nurse in health care settings and as provided in the Nursing Practice
				  Act, chapter 18.79 RCW. Violation of these standards may be grounds for
				  disciplinary action under chapter 18.130 RCW. Each individual, upon entering
				  the practice of nursing, assumes a measure of responsibility and public trust
				  and the corresponding obligation to adhere to the professional and ethical
				  standards of nursing practice. The nurse shall be responsible and accountable
				  for the quality of nursing care given to clients. This responsibility cannot be
				  avoided by accepting the orders or directions of another person. The standards
				  of nursing conduct or practice include, but are not limited to the
				  following;
(2) The nursing process
				  is defined as a systematic problem solving approach to nursing care which has
				  the goal of facilitating an optimal level of functioning and health for the
				  client, recognizing diversity. It consists of a series of phases: Assessment
				  and planning, intervention and evaluation with each phase building upon the
				  preceding phases.
(a)
Registered Nurse:
Minimum standards for registered nurses include the
								following:
(b)
Licensed Practical Nurse:
Minimum standards for licensed practical nurses
								include the following:
(i)
Standard I Initiating the Nursing
								Process:
(i)
Standard I -Implementing the Nursing
								Process:
The practical nurse assists in implementing the nursing
								process;
(A)
Assessment and Analysis:
The
								registered nurse initiates data collection and analysis that includes pertinent
								objective and subjective data regarding the health status of the clients. The
								registered nurse is responsible for ongoing client assessment, including
								assimilation of data gathered from licensed practical nurses and other members
								of the health care team;
(A)
Assessment:
The licensed practical
								nurse makes basic observations, gathers data and assists in identification of
								needs and problems relevant to the clients, collects specific data as directed,
								and, communicates outcomes of the data collection process in a timely fashion
								to the appropriate supervising person;
(B)
Nursing Diagnosis/Problem
								Identification:
The registered nurse uses client data and nursing
								scientific principles to develop nursing diagnosis and to identify client
								problems in order to deliver effective nursing care;
(B)
Nursing Diagnosis/Problem
								Identification:
The licensed practical nurse provides data to
								assist in the development of nursing diagnoses which are central to the plan of
								care;
(C)
Planning:
The registered nurse
								shall plan nursing care which will assist clients and families with maintaining
								or restoring health and wellness or supporting a dignified death;
(C)
Planning:
The licensed practical
								nurse contributes to the development of approaches to meet the needs of clients
								and families, and, develops client care plans utilizing a standardized nursing
								care plan and assists in setting priorities for care;
(D)
Implementation:
The registered
								nurse implements the plan of care by initiating nursing interventions through
								giving direct care and supervising other members of the care team; and
(D)
Implementation:
The licensed
								practical nurse carries out planned approaches to client care and performs
								common therapeutic nursing techniques; and
(E)
Evaluation:
The registered nurse
								evaluates the responses of individuals to nursing interventions and is
								responsible for the analysis and modification of the nursing care plan
								consistent with intended outcomes;
(E)
Evaluation:
The licensed practical
								nurse, in collaboration with the registered nurse, assists with making
								adjustments in the care plan. The licensed practical nurse reports outcomes of
								care to the registered nurse or supervising health care provider;
(ii)
Standard II Delegation and
								Supervision:
The registered nurse is accountable for the safety of
								clients receiving nursing service by:
(ii)
Standard II Delegation and
								Supervision:
Under direction, the practical nurse is accountable for the
								safety of clients receiving nursing care:
(A) Delegating selected nursing functions to others
								in accordance with their education, credentials, and demonstrated competence as
								defined in WAC
								246-840-010(10);
(A) The practical nurse may delegate selected
								nursing tasks to competent individuals in selected situations, in accordance
								with their education, credentials and competence as defined in WAC
								246-840-010(10);
(B) Supervising others to whom they have delegated
								nursintions as defined in WAC
								246-840-010(10);
(B) The licensed practical nurse in delegating
								functions shall supervise the persons to whom the functions have been
								delegated;
(C) Evaluating the outcomes of care provided by
								licensed and other paraprofessional staff;
(C) The licensed practical nurse reports outcomes
								of delegated nursing care tasks to the RN or supervising health care provider;
								and
(D) The registered nurse may delegate certain
								additional acts to certain individuals in community-based long-term care and
								in-home settings as provided by WAC
								246-840-910 through
								246-840-970 and WAC
								246-841-405; and
(D) In community based long-term care and in-home
								settings as provided by WAC
								246-840-910 through
								246-840-970 and WAC
								246-841-405, the practical nurse
								may delegate only personal care tasks to qualified care givers;
(E) In a home health or hospice agency regulated
								under chapter 70.127 RCW, a registered nurse may delegate the application,
								instillation, or insertion of medications to a registered or certified nursing
								assistant under a plan of care pursuant to chapter 246-335 WAC;
(iii)
Standard III Health Teaching.
The registered nurse assesses learning needs including learning readiness for
								patients and families, develops plans to meet those learning needs, implements
								the teaching plan and evaluates the outcome.
(iii)
Standard III Health Teaching.
The practical nurse assists in health teaching of clients and provides routine
								health information and instruction recognizing individual differences.
(3) The following standards apply to
				  registered nurses and licensed practical nurses:
(a) The registered nurse and licensed
				  practical nurse shall communicate significant changes in the client's status to
				  appropriate members of the health care team. This communication shall take
				  place in a time period consistent with the client's need for care.
				  Communication is defined as a process by which information is exchanged between
				  individuals through a common system of speech, symbols, signs, and written
				  communication or behaviors that serves as both a means of gathering information
				  and of influencing the behavior, actions, attitudes, and feelings of others;
				  and
(b) The registered nurse and
				  licensed practical nurse shall document, on essential client records, the
				  nursing care given and the client's response to that care; and
(c) The registered nurse and licensed
				  practical nurse act as client advocates in health maintenance and clinical
				  care.