Can nurse practitioners sign death certificates in mississippi

Under the Compact, only the RN and LPN roles will be recognized among all the Compact states. The expanded role certification recognition is not included in the multi-state license. Therefore, you must apply for an expanded role or advanced practice certification if you apply for licensure in another state.

Who should I contact regarding practice issues when I am a multi-state licensed Mississippi nurse practicing in a participating Compact state? Whose jurisdiction am I under?

When you are practicing nursing in another Compact state you must abide by the Nursing Practice Law and Rules and Regulations of that state. You are under the jurisdiction of the regulatory Board in the state in which you practice nursing, and should contact the appropriate state board. The practice of nursing will subject a nurse to the jurisdiction of the nurse licensing board and the courts, as well as the laws, in that state.

Why did I receive a single-state license if Mississippi participates in the Compact?

The multi-state license benefit is only for nurses meet the eleven (11) uniform licensure requirements set by the National Council for State Boards of Nursing. Issuance of a single-state license may be issued if the nurse does not meet all of these requirements.

If I move to a state that participates in the Compact, do I have to obtain license in that state? Will I still be able to practice in Mississippi?

A licensed nurse may only hold one multistate license at a time. If you declare another state your primary residence, you must apply for licensure in your new home state. If your new home state is a compact state and you hold a Mississippi multistate license, you may continue to practice in your new home state while awaiting the issuance of your new license. If you are issued a single state license only, your Mississippi license will remain active but changed to single state. If you are issued a multistate license, your Mississippi license will become inactive but you will still have the privilege to practice in Mississippi and other compact states. More information can be found on the NCSBN website under Licensure Compacts.

What evidence can I provide to prove my primary state of residence is Mississippi?
Where can I find a current listing of states that participate in the Compact?

The most current listing of states participating in the Nurse Licensure Compact can be obtained from the National Council of State Boards of Nursing website at www.ncsbn.org.

What is the Nurse Licensure Compact?

Effective July 1, 2001, Mississippi entered into the Nurse Licensure Compact. Under the Compact, the registered nurse/licensed practical nurse license is issued by your primary state of residence (home state) will be recognized among all Compact states. Please note that when you are practicing in another Compact state, you must abide by the Nursing Practice Law of that state where you are practicing. The Compact defines "primary state of residence" as "the state of a person's declared fixed permanent and principal home for legal purposes." If your primary state of residence is Mississippi your license will be designated as MULTI-STATE. Under the Compact, nurses with current, unrestricted multi-state licenses may practice in any state which is a member of the Compact. However, the nurse may only hold a license in one Compact state which is determined by the primary state of residence. Thus, if you currently live in Mississippi and obtain/hold an unrestricted license here, you would have privilege to practice nursing in the other Compact states.

Compression Drain Care (e.g., emptying, compressing, recompressing, Hemovac/Jackson-Pratt drains)

What is the role of the licensed practical nurse when providing nursing to a patient with a compression drain?
  1. Empty and measure drainage;
  2. Tube/catheter insertion site care;
  3. Compress/recompress bulb/evacuator; and
  4. Monitor patency of drainage system.

The appropriately prepared licensed practical nurse may perform these tasks provided:

  1. The licensed practical nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The patient must be assessed initially and on an ongoing basis as needed by the registered nurse to determine whether there are contraindications or changes which require additional resources or expertise;
  4. The licensed practical nurse practices according to accepted standards of practice;
  5. The procedure is performed and the patient is monitored according to accepted standards of practice;
  6. All necessary resources including, but not limited to, emergency resources/equipment are available; and
  7. The facility/agency has policies and procedures in place to address all aspects of the issue.

Continuing Education Units (CEUs)

Does the Board approve and/or accredit continuing education programs?

No. Review and approval of educational programs for continuing education accreditation is not within the purview of the Mississippi Board of Nursing.

Are CEUs required in order to maintain a nursing license?

The Board may conduct periodic audits to ensure compliance. Upon notification of audit by the Board, the APRN shall submit to the Board any certificates, transcripts, or other documentation evidencing compliance with these rules, within ten (10) business days of receiving such notification. Failure to comply with this rule may subject the APRN to disciplinary action or other administrative sanction. APRNs graduating from an accredited master's degree or higher APRN program within the last two (2) years are exempt for this requirement for the first renewal of State Certification only.

Death Pronouncement

Is it within the scope of practice of the registered nurse and licensed practical nurse to pronounce death?
  1. There is documentation that the registered nurse has the knowledge and skills to perform this procedure;
  2. The patient is not connected to or dependent upon a life support device;
  3. There has been contact with the medical provider regarding the patient’s care within the preceding thirty days;
  4. The registered nurse is the most qualified person available; and
  5. The facility has policies and procedures in place addressing all aspects of this issue.

It is not within the scope of practice of the licensed practical nurse to pronounce death or certify death.

Is it within the scope of practice of the registered nurse or licensed practical nurse to certify and/or sign a death certificate?
Registered nurses and licensed practical nurses may not certify death or sign the death certificate.

Delegation

What tasks are appropriate to delegate to auxiliary workers?
Refer to the Delegation position statement.

Discharge Summary & Dictation

Is it within the scope of practice of the registered nurse to dictate a discharge summary?

It is within the scope of practice of the appropriately prepared registered nurse to dictate history and physical, progress/consultation notes and/or discharge summaries provided the physician and/or APRN provides the nurse with the data pertinent to the formulation of the medical conclusion and the medical diagnosis. The registered nurse may not draw medical conclusions, make a medical dianosis or sign for the physician.

Disciplinary Action

How do I obtain information concerning disciplinary actions taken by the Board?

Information concerning disciplinary actions for past years is available on our web site under the Discipline link. Request for additional information concerning past discipline may be requested through our online license verification system. There is a $20 fee for record retrieval and the first 50 pages. There is an additional charge of $0.50 per page for each page over the first 50.

Documentation

What should be documented in the clinical record?

Documentation of all nursing activities should be clear, concise, complete and contemporaneous with the activity/observation.

What are the rules and regulations for writing clarification orders and late entries?

Documentation of all nursing activities should be clear, concise, complete and contemporaneous with the activity/observation. The documentation should be done as soon as possible after the activity is performed, medication is administered, etc. Regarding late entries, a specific time limit or time frame for late entries into the clinical record is not suggested in resources consulted. The nurse must use professional judgment and be able to factually remember the activity/observation in question in determining what can honestly be entered into the clinical record, after a period of time. The date/time of the late entry must be current and reflect the date and time for which the entry is being made. The nurse should follow the facility's policies and procedures on documentation of late entries. In the event an order clarification is needed, it should be given as a usual medical order, whereas, the licensed nurse is educated and competent, there is a medical order, the licensed nurse practices according to accepted standards of care, and the facility has policies and procedures in place to address all aspects of the issue.

Ear Stapling

Is it within the scope of practice of the RN or LPN to perform ear stapling for weight loss, treatment of migraines, treatment of insomnia, etc.?
  1. The registered nurse is educated and competent in the procedure. The registered nurse must have satisfactorily completed a documented special education program on applicable techniques and device safety, which includes supervised practice and clinical skills competency. This education and competency must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The ordering physician or advanced practice registered nurse must have expertise in the specific therapy and be readily available for consultation and able to respond to any question or adverse event;
  4. The ordering physician or advanced practice registered nurse perform and documents an initial assessment prior to treatment and as needed during the course of therapy; The registered nurse practices according to accepted standards of nursing practice; The procedure is performed according to national standards for the specific therapy; Necessary resources are available; and
  5. The facility has policies and procedures in place to address all aspects of the issue.

It was further determined that it is not within the scope of practice of the licensed practical nurse to perform ear stapling as treatment for obesity, migraine headaches, insomnia, etc.

Emergency and Disaster Management

As a licensed nurse, what is my scope of practice during an emergency at a shelter setting?

The Mississippi Nursing Practice Law and the Administrative Code require licensed nurses in shelter settings to provide care which adheres to the law and to applicable standards of care. Medical orders concerning administration of medications at home which are evidenced by pill bottles or IV bags etc. should be followed as they would in the home. If interventions other than those covered by existing medical prescriptions/ orders are necessary or a question concerning existing medical prescriptions/orders arise, the nurse should provide necessary first aid and contact medical control through the mechanisms which are established by the State Department of Health. If a nurse is assigned to a shelter in which people are taking refuge at the last minute, the nurse should perform emergency first aid, follow applicable written protocols and contact medical control through the established mechanisms as soon as possible.

What is the Emergency Management Assistance Compact?

Mississippi is a member of the Emergency Management Assistance Compact which provides that "in managing any emergency disaster that is duly declared by the Governor of the affected state, whether arising from natural disaster, technological hazard, manmade disaster, civil emergency aspects of resources shortages, community disorders, insurgency or enemy attack. Whenever any person holds a license, certificate, or other permit issued by any state party to the compact evidencing the meeting of qualifications for professional, mechanical, or other skills, and when such assistance is requested by the receiving party state, such person shall be deemed licensed, certified, or permitted by the state requesting assistance to render aid involving such skill to meet a declared emergency or disaster, subject to such limitations and conditions as the Governor of the requesting state may prescribe by executive order or otherwise."

What other states are members of the Emergency Management Assistance Compact?

Other member states of the Emergency Management Assistance Compact are Alabama, Alaska, Arizona, Arkansas, Colorado, Congress Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia and Wisconsin.

External Cerebral Ventricular Catheter

What is the role of the licensed practical nurse in caring for a patient with an external cerebral ventricular catheter?

The licensed practical nurse's role in performing external cerebral ventricular catheter care is limited to the provision of catheter insertion site care.

Femoral Nerve Block Catheter

Is it within the scope of practice of a registered nurse to discontinue femoral nerve block catheters?

On July 27, 2007, the Board of Nursing's Nurse Practice Committee determined that it is within the scope of practice of the appropriately prepared registered nurse to discontinue a femoral nerve block catheter.

Gastrointestinal

Is it within the scope of practice of the RN to administer an endoscopy capsule?
  1. The registered nurse is educated and competent in the administration of the capsule and is knowledgeable regarding the indications, contraindications, complications, side effects and possible adverse reactions and recommended monitoring.
  2. This education and competence must be documented initially and on an ongoing basis; and
  3. There is an informed consent (obtained by the physician) for the procedure; There is a medical order for the procedure;
  4. The registered nurse practices and the patient is monitored according to generally accepted standards;
  5. Necessary resources including, but not limited to, emergency resources and personnel are available; and
  6. The facility has policies and procedures in place addressing all aspects of this issue.
Can a RN manipulate the endoscope during a procedure?
  1. There is direct supervision by the physician or advanced practice registered nurse (that is, the physician or advanced practice registered nurse is physically present);
  2. The registered nurse has knowledge of the techniques of endoscopic manipulation, understands the complications associated with endoscopy, is competent to identify the associated symptoms and will initiate appropriate interventions as directed by the physician or advanced practice registered nurse;
  3. The nurse has full view of the lumen (via teaching adapter or video screen) throughout the entire manipulation process;
  4. Another registered nurse is responsible for monitoring the patient if the patient is sedated (that is, the same registered nurse may not accept responsibility for manipulation of the endoscope and monitoring a sedated patient); and
  5. The facility has policies and procedures that address all aspects of the procedure.

Gastrostomy/Peg Tube

Can a licensed nurse replace a peg tube that becomes dislodged?
  1. The licensed nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure, including the type tube to be used for replacement;
  3. There are no contraindications related to the patient's condition;
  4. The licensed nurse practices according to accepted standards of practice;
  5. There is a well-healed tract without sign/symptoms of infections; and
  6. The facility has policies procedure in place addressing all aspects of the issue.

Hyperbaric Oxygen Therapy

Is it within the scope of practice of the licensed practical nurse to provide hyperbaric oxygen therapy?
  1. The licensed practical nurse is appropriately educated and certified in hyperbaric oxygen therapy in accordance with National Board of Diving standards. (During the certification training/process, after completion of the mandated 40 hours theory component of the educational program, the licensed practical nurse student (termed hyperbaric technologist student in program) must function under the direct supervision of a registered nurse preceptor certified in hyperbaric oxygen therapy for the required 480 hours clinical practice.) Educational preparation, continuing education and competency evaluations must be in accordance with stated national standards and maintained on file at the facility;
  2. There are medical orders for the procedure, to include control settings and length of therapy;
  3. The physician or nurse practitioner must be present in the facility at all times during the hyperbaric oxygen therapy/treatment. A completed medical history/physical must be on file prior to the implementation of the hyperbaric oxygen therapy;
  4. There is a registered nurse present in the unit responsible for the nursing assessment, planning, and implementation of the patient's plan of care;
  5. The nurse practices according to accepted standards of practice;
  6. Necessary resources are readily available; and
  7. The facility has policies and procedures in place addressing all aspects of this issue.

Immunizations

Can a nurse administer immunizations or vaccinations based on standing orders?

It is within the scope of practice of the appropriately prepared licensed nurse (registered nurse or licensed practical nurse) to administer vaccines per medically approved protocols and/or standing orders. These protocols or standing orders should contain provisions to treat adverse vaccine events including, but not limited to, medication administration and emergency transfer. Mississippi has no statue that would require an individual order for vaccination or prohibit the administration of this medication in the outpatient or home settings.

Inactive License Definition

Definition of Inactive License
The licensee may not engage in the practice of nursing.

Intravenous (IV) Contrast

Can a RN teach IV skills and injection of IV contrast agents to registered diagnostic cardiac sonographers(RDCS), medical assistants, nursing assistants, or other unlicensed individuals?

It is not within the scope of practice of the registered nurse to teach IV skills and/or injection of an IV contrast agent to a RDCS, medical assistant, nursing assistant or other unlicensed individual. Furthermore, the registered nurse may not delegate such interventions/tasks to the RDCS, medical assistant, nursing assistant or other unlicensed individual or supervise, in any capacity, the RDCS, medical assistant, nursing assistant or other unlicensed individual performing such interventions/tasks.

Lapsed Licensed Definition

Definition of Lapsed License

The licensee did not renew their license within the specified time period and may not engage in the practice of nursing.

Laser Hair Removal and Treatment

Can a LPN perform laser hair removal, chemical peels or microdermabrasion?
No. It is not within the scope of practice of the LPN to perform any of these procedures.
Can a RN perform laser hair removal?
It is within the scope of the appropriately prepared RN to perform laser hair removal.
Can a RN perform Parisian chemical peels and microdermabrasion?
  1. The registered nurse has satisfactorily completed a documented special education and training program on applicable techniques and laser safety, which includes supervised practice and clinical skills competency. Evidence of the initial education and competence must be on file in the facility. Continuing education for these procedures must be ongoing and documented;
  2. The supervising physician or advanced practice registered nurse (APRN) must have expertise in laser therapy and be immediately available and able to respond within five (5) minutes to any question or adverse event;
  3. The supervising physician or APRN performs and documents an initial assessment prior to treatment and as needed during the course of therapy;
  4. There is a medical order for the procedure, to include control settings and/or strength of solutions to be used;
  5. The registered nurse practices according to accepted standards of practice; Necessary resources are available; and
  6. The facility has policies and procedures in place to address all aspects of this issue.
Is it within the scope of practice of the RN or LPN to perform sclerotherapy for varicose vein removal, Botox injections, laser vascular lesion removal?

It is not within the scope of practice of the registered nurse or licensed practical nurse to perform laser vascular lesion removal, sclerotherapy for varicose veins, or Botox injections.

Licensure

How do I apply for licensure in Mississippi if I currently hold a RN or LPN license from another state that is not Compact?

You will need to apply for a Mississippi license by endorsement if you have never held a Mississippi license. If you have held a Mississippi license at some point, you will need to apply by reinstatement. You will register or enter your username & password to excess the nurse gateway to submit the online application & fee.

How many days or hours do I need to work in order to maintain an active nursing license?

The Board does not mandate the number of hours or days per year that you must work to maintain an active license. However, if you have not performed nursing in five (5) years or longer you will be required to take a refresher course.

What are the rules regarding reinstatement of license if I have not practiced nursing in five (5) years or more?
  1. Successful completion of a Board-approved Reorientation Program for RNs or LPNs with the five (5) year period immediately prior to such application for renewal or reinstatement of the nursing license. The Board may issue a temporary permit to any nurse during the time enrolled in a Board-approved nursing reorientation program upon submission of required application and fees;
  2. Completion of twenty contact hours of continuing education directly related to nursing practice within the two (2) year period immediately prior to such application for renewal or reinstatement of the nursing license. Acceptable continuing education offerings are those which are currently approved, accredited, provided, or offered by recognized credentialing agency;
  3. Successful completion of a minimum of three (3) semester hours of nursing credit offered by a nursing education program within the two (2) year period immediately prior to such application for renewal or reinstatement of the nursing license. An acceptable nursing program is one which is approved or accredited by the appropriate agency within the state.

Documentation of continuing basic nursing competencies not included in 30 Miss. Admin. Code, Part 2810, Chapter 4, Rule 4.7, may be considered by the Board on an individual basis. Documentation of one of the above options must be submitted with the application for licensure. Obtaining 20 contact hours of nursing continuing education via the internet would be acceptable contingent upon such nursing continuing education courses being currently approved, accredited, provided, or offered by a recognized credentialing agency. The American Nurses Credentialing Center (ANCC) is such an agency.

What are the requirements to change licensure status from inactive to active?

Pursuant to the 30 Miss. Admin. Code, Part 2810, Chapter 4, Rule 4.6, licensees holding inactive licensure will need to apply for reinstatement of an active license. Upon completion of the reinstatement process, licensure may be conferred if all licensing requirements are met. Any RN or LPN applying to change from inactive to active status must submit evidence of continuing basic nursing competencies when you have not practiced nursing for compensation or performed the function of a RN or LPN in a voluntary capacity with or without compensation with the five (5) year period immediately prior to the application.

What nursing services can be provided if my license is inactive?

Pursuant to the Mississippi Board of Nursing Rules and 30 Miss. Admin. Code, Part 2810, Chapter 4, Rule 4.5, inactive licensure means that you are not engaged in the active practice of nursing but desire to maintain licensure. Any person practicing as a RN or LPN during the time the nurse holds inactive licensure shall be considered to be practicing illegally and shall be subject to disciplinary action by the Board.

How do I obtain an inactive license?

During renewal time you will have the option to renew your license as active or inactive. If you choose to renew your license has inactive you will submit the $25.00 fee to put your license in an inactive status for that renewal period.

Are continuing education units (CEUs) required to maintain or renew a RN and /or LPN license?

The Mississippi Nursing Practice Law does not mandate CEUs as a prerequisite to renewing or maintaining a RN or LPN license. The law does require the nurse to maintain competency in his/her nursing practice, but that responsibility rests with each nurse as pertinent to his/her field of practice. If the RN or LPN has been out of practice for greater than five (5) years, the RN or LPN will be required to comply with Continuing Education requirements for the renewal. The RN or LPN shall complete a minimum of twenty (20) contact hours of accepted continuing education earned in the previous 2-year period immediately prior to such application toward satisfying the requirement.

Long Term Care Facility Licensed Practical Nurse IV Care

What is the role of the licensed practical nurse, not certified in the IV therapy expanded role, when providing nursing to patients in a long term care facility with an IV?
  1. Monitor/regulate the rate of the plain fluids being administered through a peripheral line.
  2. Monitor the site for infiltration;
  3. Discontinue peripheral IVs;
  4. "Drop" standard IV fluid from bag into buretrol (cannot hang new bag);
  5. Monitor patient receiving intermittent antibiotic infusion provided it is not the first dose.

The licensed practical nurse may perform the above referenced functions concerning IVs provided:

  1. The nurse is educated and competent in the procedures. There should be documentation of the initial evaluation/competency and ongoing competency evaluations;
  2. There is a medical order for the procedure(s);
  3. The nurse practices according to accepted standards of practice; and
  4. The facility has policies and procedures in place to address these issues.

The licensed practical nurse may not:
A. Initiate a peripheral IV
B. Hang (spike) a new bag of fluid
C. Regulate fluids of a central access
D. Discontinue a central line
E. Flush a peripheral intermittent vascular access device (Hep lock/INT)

The scope of practice of the licensed practical nurse certified in IV therapy is defined in 30 Miss. Admin. Code Pt. 2840 Chapter 3, and the Mississippi Nursing Practice Law, which can be accessed through the board's website.

LPN Expanded Role

Where can I find the rules and regulations for LPNs certified in expanded role IV therapy rules and regulations?

The rules and regulations for the expanded role LPN in IV therapy can be found in 30 Miss. Admin. Code Pt. 2830, Chapter 2. The scope of practice for the LPN expanded role in IV therapy is addressed in Rule 2.4.

What are the supervision requirements for the LPN certified in the IV therapy expanded role?

30 Miss. Admin. Code Pt.2830, R 2.4(G),states, "Unless otherwise specified in these regulations, the LPN certified in IV therapy may perform advanced acts of IV therapy if the supervisor is physically on the premises where the patient is having nursing care provided. The physician or dentist may provide supervision in the medical or dental office. In all other settings, supervision and delegation must be by a registered nurse." The supervising registered nurse must be physically present on the premises where the patient is having nursing care provided for the licensed practical nurse certified in IV therapy to perform advanced acts of IV therapy. The physician or dentist may provide supervision in the medical or dental office. In all other settings, supervision and delegation must be by a RN.

LPN Expanded Role Renewal

Do expanded role LPNs who renew online have to send in additional documentation to renew certification?

No, additional documentation is not required to renew LPN Expanded Therapy Role. On the renewal application simply click that you wish to renew your LPN Expanded IV Therapy along with your LPN license.

Maximum Hours Allowed to Work

How many hours can a licensed nurse work per day or per week?

The Mississippi Nursing Practice Law does not specify the number of hours that a nurse may work per day or week. Each nurse must realistically evaluate his/her abilities to determine the number of hours in which he/she can safely provide nursing care. The Mississippi Nursing Practice Law and the Administrative Code of the Board of Nursing, state negligently or willfully acting in a manner inconsistent with the health and safety of the persons under the licensee's care, including, but not limited to, inappropriately delegating or accepting a patient assignment, and assuming duties and responsibilities in the practice of nursing when competency has not been maintained may compromise the health and safety of patients and are grounds for disciplinary action against the nurse's license. The licensed nurse is responsible for assuring that he/she is educated and competent to care for the number of patients assigned, to perform the necessary procedure(s), or to administer the medication(s) prior to accepting such a patient assignment or task.

Medical Orders

Who is a licensed nurse permitted to take medical orders from?
Please refer to the Medical Orders position statement.
Can a licensed nurse implement range orders?

The Board of Nursing has no guidelines prohibiting the appropriately prepared licensed nurse from implementing a drug order that has a dosage range. The medical provider makes the "medical judgment" as to the specific medication and dosage. The nurse is given the latitude to use "nursing judgment" in determining the amount to be administered based on the client's clinical status. The nurse must apply adequate knowledge and skills in determining the dosage to be administered at any given time. Appropriate documentation of client assessment and evaluation must substantiate intervention. It is recommended that medication orders be patient/condition specific even if prescribed PRN. This would take away some of the notion of the nurse "prescribing" the medication. There should certainly be some consultation with the physician to initiate a standing order particularly if the signs/symptoms are deviations from the patient's norm. Standing orders are certainly not to be used in lieu of medical consultation/intervention.

Is it within the scope of practice for a licensed nurse to administer vaccines per medical protocols?

Yes, it is within the scope of practice of the appropriately prepared RN or LPN to administer vaccines per medically approved protocols and/or standing orders.

Medication Administration

It is within the scope of practice of the RN to administer Vasopressors IV (Dobutrex, Primacor, Natrecor) in the outpatient and home setting?
  1. The registered nurse is educated and competent in the procedure. This education and competence are documented initially and on an ongoing basis;
  2. There is a medical order defining the specifics for the procedure;
  3. Administration of the medication has previously occurred in the hospital for the purpose of dose adjustment and monitoring patient response. Continuous infusion must have been given in the hospital on an intermittent basis;
  4. For both intermittent and continuous infusions, judicious oversight of the patient by the registered nurse is required. For intermittent infusions, vital signs must be obtained every 10-15 minutes for one hour after initiation of the infusion. These vital signs must be stable and within the desired parameters for the individual patient;
  5. The medication is administered via an infusion pump. A central line is the recommended route for administration;
  6. The patient is monitored according to accepted standards of practice; There is documentation of appropriate patient/caregiver teaching for monitoring for drug-related problems of the therapy; and
  7. The facility must have policies and procedures in place addressing all aspects of this issue.

On April 11, 2004, the Board reviewed a request for clarification of the role of the registered nurse in the administration of Nesiritide (Natrecor) in the home-health/hospice setting. The Board determined that the information submitted for review was insufficient for the Board to establish the nurse’s role or safety issues concerning this procedure. The Board further determined it is not within the scope of practice of the registered nurse to administer Natrecor in the home-health/hospice setting.

Is it within the scope of practice of the registered nurse to administer Ephedrine IV push for maternal hypotension?

It is within the scope of practice of the appropriately prepared registered nurse to administer Ephedrine IV push for maternal hypotension.

Is it within the scope of practice of the licensed practical nurse to administer Coumadin and subcutaneous Heparin?
  1. The licensed practical nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis. (The nurse must be knowledgeable of all components related to administration of the medications; i.e., indications and use, actions, dosages, contraindications, precautions, side effects, antidote, recommended monitoring and emergency resources/equipment, etc.);
  2. There is a medical order for the procedure;
  3. The procedure is a generally accepted standard of practice; The procedure is performed and the patient monitored according to accepted standards of practice;
  4. All necessary resources including, but not limited to, essential monitoring and emergency equipment are available; and
  5. The facility has policies and procedures in place regarding all aspects of the issue.

The Board does not maintain a listing of specific medications acceptable for administration by registered nurses and licensed practical nurses. When administering any medication, the licensed nurse should be knowledgeable of and comply with all applicable state and federal laws, rules, regulations and guidelines pertaining to the specific medication, including, but not limited to, those of the Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), the Mississippi Board of Pharmacy and the Mississippi Board of Nursing. The nurse/facility must determine which medication is appropriate for the nurse to safely administer based on the nurse's education and competence, current standards of practice, and the facility's policies and procedures.

Is it within the scope of practice of a licensed practical nurse to administer respiratory nebulizers and aerosol treatments?

It is within the scope of practice of the licensed practical nurse to administer respiratory nebulizer/aerosol treatments.

Is it within the scope of practice of the licensed nurse to give out drug samples?
  1. The nurse is educated and competent regarding the medication to include but not limited to indications, contraindications, and side effects;
  2. There is a medical order for the medication;
  3. The sample is in the original unopened package with the original label intact and unaltered or if the medication has been repackaged by a pharmacist or physician it was repackaged and labeled according to all state and federal guidelines;
  4. The facility must have policy and procedures in place regarding all aspects of this issue.
Can a RN delegate the administration of medicated ointments, lotions, and protective skin barriers to unlicensed personnel?
  1. Assign specific nursing duties and/or patient treatments to other qualified personnel based on educational preparation, experience, knowledge, credentials, competency, and physical and emotional ability to perform the duties.
  2. Assign duties of administration of patient medications to other licensed nurses only (either a RN or LPN or one authorized by a temporary permit to practice) except as set out in Miss. Admin. Code Part 2860
Can a registered nurse or licensed practical nurse administer chemotherapeutic agents via bladder instillation?
  1. The nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis (The nurse must be knowledgeable of all components related to administration of the medications; i.e., indications and use, actions, dosages, contraindications, precautions, side effects, antidote, recommended monitoring and emergency resources/equipment, etc.);
  2. The procedure is the generally accepted standard of practice;
  3. There is a medical order for the procedure;
  4. The nurse is practicing according to accepted standards of practice;
  5. Patients are evaluated on an individual basis for these procedure to be performed;
  6. The patient must be assessed initially and on an ongoing basis as needed by the registered nurse to determine whether there are contraindications or changes which require additional resources or expertise;
  7. There is informed consent to administer chemotherapy;
  8. All aspects of the patient's condition are monitored according to accepted standards of practice;
  9. The registered nurse develops and revises as necessary the patient's care plan to include, but not be limited to, patient and family education;
  10. The licensed practical nurse is appropriately supervised;
  11. All necessary resources are available; and
  12. The agency/facility has policies and procedures in place regarding all aspects of this issue.

The Board does not maintain a listing of specific medications acceptable for administration by registered nurses and licensed practical nurses. When administering any medication, the licensed nurse should be knowledgeable of and comply with all applicable and state and federal laws, rules, regulations and guidelines pertaining to the specific medication, including but not limited to, those of the Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), the Mississippi Board of Pharmacy, and the Mississippi Board of Nursing. The nurse/facility must determine which medication is appropriate for the nurse to safely administer based on the nurse’s education and competence, current standards of practice, and the facility’s policies and procedures. The nurse is responsible to assure that she/he is educated and competent to perform the procedure or administer the medication in question prior to accepting such a task.

Does the Board require that a RN be “certified” in order to administer intravenous (IV) chemotherapy?

The appropriately prepared Registered Nurse may administer IV chemotherapeutic agents. The Board of nursing does not require "certification" as a pre-requisite for the nurse to provide education regarding chemotherapy or as a pre-requisite to providing care to chemotherapy patients. According to the Mississippi Nursing Practice Law, Rules and Regulations, the nurse shall be held accountable for the quality of nursing care given to patients and failure to maintain competency or accepting an assignment in which a nurse is not competent may be grounds for disciplinary action against the nurse’s license. The nurse is responsible to assure that he/she is trained and competent to do the procedure or administer the medication prior to accepting such a task.

Is it within the scope of practice of the RN to instill medication via a chest tube?

It is within the scope of practice of the appropriately prepared registered nurse to instill medication into the chest cavity via chest tube. In addition, there must be a patient specific order for the procedure.

Is it within the scope of practice of the RN to irrigate chest tubes, mediastinal catheters and pericardial catheters with thrombolytics?
  1. The registered nurse is educated and competent in the procedure. The education and competence must be documented initially and on an ongoing basis;
  2. The procedure is performed in a controlled setting where the patients are monitored according to accepted standards of practice;
  3. There is a patient specific medical order for the procedure;
  4. The initial procedure of irrigation of the mediastinal catheter and pericardial catheter is done by the physician or advanced practice registered nurse (APRN) [subsequent procedures may be performed by the registered nurse provided there are no complications]; and
  5. The facility has policies and procedures in place addressing all aspects of this issue, including a quality assurance component.
Is it within the scope of practice of the RN to administer paralytic agents and/or sedative analgesics/anesthetics during critical care transport of ventilator patients?
  1. The registered nurse is educated and competent in all aspects of rapid sequence intubation, mechanical ventilation and cardiovascular resuscitation, including knowledge of all equipment and medical devices to be used and medications to be administered (i.e., indications and use, actions, dosage, contraindications, precautions, side effects, antidote, etc., The education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The procedure is performed and the patient is monitored according to accepted standards of practice;
  4. If in a facility, the physician or nurse practitioner who is performing the intubation is physically present when giving orders for the medication and while the medication is being administered;
  5. If in a facility, the registered nurse is educated and competent and is the most qualified individual to perform the procedure present;
  6. If in the pre-hospital setting or during interhospital air/ground transport, the physician or nurse practitioner is in direct contact with the registered nurse;
  7. All the necessary resources are available; and
  8. The facility and/or transportation provider has policies and procedures in place addressing all aspects of this issue. The policies should include specific medications to be used for the particular procedure(s) and should be developed with input/expertise from all involved parties, based on accepted standards of practice.
Is it within the scope of practice of the registered nurse to administer anesthetic agents for the purpose of moderate sedation?
Refer to the Administration and Management of Moderate Sedation position statement.
Can a registered nurse administer anesthetic agents in a critical care setting?

The registered nurse who is not a qualified anesthesia provider, who has specialized education and training, in settings where critical care nursing can be provided, may initiate, titrate, and bolus intravenous agents provided the patient's airway is secured and mechanically assisted. A qualified physician or certified registered nurse anesthetist (CRNA) must select and order the agent to be used. Refer to the Administration and Management of Moderate Sedation position statement.

Can a registered nurse administer Fentanyl or Versed for sedation?
  1. The registered nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
  2. There is a medical order for the procedure;
  3. The patient retains control of reflexes and can be aroused;
  4. The registered nurse practices according to accepted standards of practice;
  5. The drugs and dosages must be clearly intended for maintaining the patient in a conscious state;
  6. The physician or CRNA ordering the sedation should be present and immediately available to respond in the case of an emergency;
  7. The patient is monitored according to currently recognized standards of practice;
  8. All necessary resources are available; and
  9. The facility has policies and procedures in place addressing all aspects of the issue.

The Board does not maintain a listing of each medication/anesthetic agent which a nurse can administer. The nurse/facility must determine which of these drugs are appropriate based on the nurse’s education and competence, current standards of practice, and the facility’s policies and procedures. When administering any medications, the registered nurse should be knowledgeable of and comply with all applicable state and federal laws, rules, regulations and guidelines pertaining to the specific medication, including but not limited to, those of the Food and Drug Administration, Drug Enforcement Administration, the Mississippi Board of Pharmacy, and the Mississippi Board of Nursing.

Nasogastric Tube Insertion

What is the board's position on the insertion of nasogastric tubes by licensed practical nurses?

Refer to the Role of the Licensed Practical Nurse in Nasogastric Tube Insertion position statement. It is within the scope of practice of the licensed practical nurse to insert and to discontinue a nasogastric tube. The board does not mandate certification as a prerequisite for the licensed practical nurse to perform this procedure.

New Graduates

Are temporary permits issued for new graduates before a license has been issued?

In accordance with the Nurse Practice Law, the board may issue a temporary permit to practice nursing to a graduate of an approved school of nursing pending the results of the first licensing examination in Mississippi, and to a qualified applicant from another state, territory or possession of the United States, or District of Columbia, or pending licensure procedures as provided for elsewhere in this article. The fee shall not exceed Twenty-five Dollars ($25.00). (Temporary permits are issued for 90 days from the date of issuance/approval. See temporary permits for New Graduates under Licensure and Practice).

What content should and should not be included during orientation for new graduates?

The Mississippi Board of Nursing does not mandate the content/curriculum for graduate student orientation.

What is the scope of practice for the graduate nurse? Can a graduate nurse perform the same functions of a licensed nurse before he/she is actually licensed?
  1. Manage PCA pumps infusion devices.
  2. Administer blood or blood components, plasma, plasma expanders.
  3. Change tubing on or administer IV chemotherapeutic agents.
  4. Administer IV immunosuppressive drugs.
  5. Manage epidural analgesia infusions.
  6. Administer experimental or investigative/research drugs.
  7. Manage respiratory support equipment (excluding trach care/suctioning).
  8. Perform arterial puncture or draw blood from arterial catheters.
  9. Manage renal dialysis or access devices used for renal dialysis.
  10. Perform peritoneal dialysis.
  11. Advance or remove chest tubes.
Is a graduate nurse allowed to identify themselves as a licensed nurse (RN or LPN)?

No. New graduates may only sign off on paperwork using the initials to signify they are a graduate nurse (i.e. G.N.). Signing as a R.N. or L.P.N. is only allowed when a license is obtained as those legal credentials have title protection afforded by law.

Nurse/Patient Ratios

What should the nurse/patient ratio be?

The number of patients a nurse may care for with reasonable skill and safety should be determined by evaluation of the nurse's educational preparation, experience and competencies; acuity of the patients; layout of the facility and equipment; and other resources available for care of the patient. Pursuant to the Nursing Practice Law and the Administartive Code of the Board of Nursing, the registered nurse shall be held accountable for the quality of nursing care given to patients. This includes, but is not limited to, assessing the patient's needs, formulating a nursing diagnosis, planning for, implementing and evaluating the nursing care in the promotion and maintenance of health of each patient for whom responsibility has been accepted. Furthermore, the registered nurse is accountable for the quality of nursing care given by self or others being supervised. The registered nurse may assign nursing duties to other qualified personnel; assign duties of medication administration or patient medications to other licensed nurses only except as set out in 30 Miss. Admin. Code, Part 2860, Chpater 1; and assign duties for giving patient treatments to licensed nurses and/or auxiliary workers based upon knowledge of their education preparation and experience. However, the registered nurse remains accountable for the acts delegated. Negligently or willfully acting in a manner inconsistent with the health and safety of the persons under the licensee's care, including, but not limited to, inappropriately delegating or accepting a patient assignment, and assuming duties and responsibilities in the practice of nursing when competency has not been maintained may compromise the health and safety of patients and are grounds for disciplinary action against the nurse's license. The licensed nurse is responsible for assuring he/she is educated and competent to care for the number of patients assigned, to perform necessary procedure(s), or to administer medication(s) prior to accepting such a patient assignment or task. Federal and state regulations contain mandates and regulate healthcare staffing. In situations regarding consistent understaffing, the nurse should be aware of federal and state regulations regarding the facility's responsibility to assure safe staffing and avenues to report this situation when the nurse feels that it endangers the patient's health and safety. A Condition of Participation in the Federal Regulations governing hospital services mandates that the "hospital have an organized nursing service that provides 24 hour nursing services." Regulations further state that "the Director of Nursing Services is responsible for the operation of the service including the types and numbers of nursing personnel as needed. Nursing administration duties include a review of nursing staffing and making adjustments for absenteeism, as necessary." The Federal regulations also mirror the Nursing Practice Law by state the "registered nurse must assign the nursing care of each patient to other personnel in accordance with the patient's needs and the specialized qualifications and competencies of the nursing staff available." State regulations for hospitals state that the facility must provide nursing services for each unit sufficient to meet the needs of the patients. There are similar state and federal regulations for other health care facilities.

If I feel that my unit or facility is consistently understaffed, what should I do?

The Mississippi State Department of Health is responsible for enforcement of federal and state regulations for healthcare facilities. Consistent understaffing which endangers the health and safety of the patient should be reported to the Mississippi State Department of Health, Division of Health Facilities and Licensure and Certification at 601-576-7300.

Obstetrics and Gynecology

Can registered nurses remove the initial post-operative vaginal pack?
  1. The vaginal pack was not placed to stop or slow bleeding/hemorrhage;
  2. The registered nurse is educated and competent in the procedure. This education and competency must be documented initially and on an on-going basis;
  3. There is a medical order for the procedure;
  4. The registered nurse practices according to accepted standards of practice;
  5. All necessary resources are readily available; and
  6. The facility/agency has policies and procedures in place addressing all aspects of this issue.

As noted above, the patient who has a vaginal pack in place to stop or slow bleeding/hemorrhage is not a candidate for the packing to be removed by the registered nurse.

The Nurse Practice Committee further determined that it is not within the scope of practice of the licensed practical nurse to remove the initial post-surgical vaginal pack.

Can registered nurses remove subsequent vaginal packs postoperatively?

It is within the scope of practice of the appropriately prepared registered nurse to remove subsequent vaginal packs provided the standard requirements are met, the vaginal pack was not placed to stop or slow bleeding/hemorrhage, and the original vaginal pack has been removed postoperatively by the physician or advanced practiced nurse. As previously noted, the patient who has a vaginal pack in place to stop or slow bleeding/hemorrhage is not a candidate for the packing to be removed by a registered nurse.

If an obstetric patient presents to the hospital with an obstetric related complaint, what is the role of the registered nurse in performing a nursing assessment?
  1. The registered nurse is educated and demonstrates current competency in obstetrical nursing;
  2. The registered nurse’s education and competency are documented in the facility’s records initially and on an ongoing basis;
  3. The registered nurse communicates with (e.g. telephone, e-mail, etc.) the attending physician or advanced practice registered nurse (APRN) to report the assessment and physical findings;
  4. The registered nurse obtains an order from the attending provider to admit the patient to the hospital or discharge the patient home.
  5. The registered nurse practices according to generally accepted standards or practice;
  6. All necessary resources are available; and
  7. The facility has policies and procedures in place to address all aspects of the issue.
Can a regsitered nurse administer Pitocin, Prostin E3, prostaglandin gels, Cervidil, Hemabate or Cytotec for the induction of labor?
  1. The registered nurse is educated and competent in the administration of the medication, including but not limited to actions, adverse reactions, monitoring criteria and emergency management procedures;
  2. There is a medical order for the medication;
  3. The registered nurse administers the medications and monitors the patient according to accepted standards of practice; and
  4. The facility has policies and procedures in place to address all aspects of this issue, including but not limited to, physician availability.

One-Hour Face-to-Face Evaluation Following Restraint/Seclusion

It is within the scope of practice of the appropriately prepared registered nurse to perform a nursing assessment of the patient following restraint or seclusion per facility protocol and/or policy provided:
  1. The registered nurse demonstrates education and current competency in the biological, physical, behavioral, psychological and sociological sciences and of nursing theory as the basis for assessment, diagnosis, planning, intervention and evaluation of the restrained or secluded patient; demonstrates knowledge of all aspects of safe and appropriate application and use of restraints or seclusion including, but not limited to: types or techniques of restraint or seclusion used in the facility, identification of staff and patient behaviors, identification of events and/or environmental factors that may trigger behavioral changes in the patient, and recognition of and response to adverse events (e.g., signs and symptoms of physical and psychological distress);
  2. The registered nurse's education and competency are documented in facility records initially and on an on-going basis;
  3. The registered nurse communicates with (e.g., telephone, e-mail, etc.) the attending physician or advanced practice registered nurse to report the nursing assessment and physical findings;
  4. The registered nurse obtains an order from the attending provider to continue or terminate the restraint seclusion;
  5. The registered nurse practices according to generally accepted standards of practice;
  6. All necessary resources are available; and
  7. The facility has policies and procedures in place to address all aspects of the issue.

It should be further noted that, in accordance with Section 73-15-5 (2) of the Mississippi Nursing Practice Law, it is outside of the scope of practice of the registered nurse to make a medical diagnosis or to draw medical conclusions. Thus, the registered nurse may not make an independent determination to terminate or continue restraints or seclusion.

Patient Abandonment

Function of the licensed practical nurse according 30 Miss. Admin. Code, Pt. 2830, Chapter 2:
Function of the LPN

The licensed practical nurse gives nursing care under the direction of the RN, licensed physician or licensed dentist which does not require the specialized skill, judgment and knowledge required of a RN. This includes but it not limited to assisting the RN in the planning, implementation and evaluation of nursing care, observing, recording, reporting, and performing procedures for which the LPN has the necessary degree of skill and judgment. The LPN shall not be supervised by unlicensed personnel.

What constitutes patient abandonment?
Refer to the Patient Abandonment position statement.
Definition of the practice of nursing by a registered nurse as defined by the Mississippi Nursing Practice Law, §73-15-5:

“The practice of nursing by a registered nurse means the performance for compensation of services which requires substantial knowledge of the biological, physical, behavioral, psychological and sociological sciences and of nursing theory as the basis for assessment, diagnosis, planning, intervention and evaluation in the promotion and maintenance of health; management of individuals' responses to illness, injury or infirmity; the restoration of optimum function; or the achievement of a dignified death. Nursing practice includes, but is not limited to, administration, teaching, counseling, delegation and supervision of nursing, and execution of the medical regimen, including the administration of medications and treatments prescribed by any licensed or legally authorized physician or dentist. The foregoing shall not be deemed to include acts of medical diagnosis or prescriptions of medical, therapeutic or corrective measures, except as may be set forth by rules and regulations promulgated jointly by the State Board of Medical Licensure and the Mississippi Board of Nursing and implemented by the Mississippi Board of Nursing.”

Definition of the practice of nursing by a licensed practical nurse as defined by the Mississippi Nursing Practice Law, §73-15-5:

“The practice of nursing by a licensed practical nurse means the performance for compensation of services requiring basic knowledge of the biological, physical, behavioral, psychological and sociological sciences and of nursing procedures which do not require the substantial skill, judgment and knowledge required of a registered nurse. These services are performed under the direction of a registered nurse or a licensed physician or licensed dentist and utilize standardized procedures in the observation and care of the ill, injured and infirmed; in the maintenance of health; in action to safeguard life and health; and in the administration of medications and treatments as prescribed by any licensed physician or licensed dentist authorized by state law to prescribe. On a selected basis, and within safe limits, the role of the licensed practical nurse shall be expanded by the board under its rule-making authority to more complex procedures and settings commensurate with additional preparation and experience.”

Function of the registered nurse according to 30 Miss. Admin. Code, Pt. 2830, Chapter 1:

The registered nurse shall be held accountable for the quality of nursing care given to patients. This includes but is not limited to, assessing the patient’s needs, supervising, formulating a nursing diagnosis, planning for, implementing and evaluation of the nursing care in the promotion and the maintenance of health of each patient for whom responsibility has been accepted. The registered nurse is accountable for the quality of care given by self or others being supervised. The registered nurse may assign nursing duties to other qualified personnel; assign duties of medication administration of patient medications to other licensed nurses only except as set out in Part 2860, Rule 1.3(a)(2)of the Administrative Code; and assign duties for giving patient treatments to licensed nurses and/or auxiliary workers based upon knowledge of their educational preparation and experienced. The registered nurse remains accountable for the acts carried out, as well as, the outcome of the acts delegated.

Patient Teaching

Is it within the scope of practice of the licensed practical nurse to provide patient teaching?
  1. The licensed practical nurse is educated and competent concerning patient education;
  2. The licensed practical nurse's education and competence are documented initially and on an ongoing basis;
  3. The licensed practical nurse is following an education program developed by the registered nurse and practices according to generally accepted standards of care;
  4. The registered nurse develops and documents an educational program for and specific to the patient and re-evaluated the patient and revises the educational program as needed;
  5. All the necessary resources are available; and
  6. The facility/agency has policies and procedures in place addressing all aspects of this issue.

PCA Pump

What is the role of the licensed practical nurse in monitoring and documenting a patient's response to pain therapy when they have a PCA pump?
  1. The licensed practical nurse must have successfully completed orientation to the equipment, the agent, and all aspects of related monitoring and documentation. There should be documentation of the initial education/competency and ongoing competency evaluations;
  2. There is a medical order for the procedures;
  3. The nurse practices according to accepted standards of practice;
  4. A registered nurse must be readily available to respond;
  5. The PCA pump must be programmed by either a registered nurse or registered pharmacist and must be locked to prevent rate change;
  6. Re-dosing of the PCA pump must be performed by the registered nurse; The licensed practical nurse may not change or regulate the rate but may stop the infusion if necessary; and
  7. The facility has policies and procedures in place addressing all aspects of this issue.

The Mississippi Nursing Practice Law and the Administrative Code of the Board of Nursing do not preclude the appropriately prepared licensed practical nurse from verifying the PCA pump setting and documenting the same. The record should be clear that the licensed practical nurse is only verifying the pump setting and is not initiating or regulating the PCA infusion.