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Pennsylvania Code



Subchapter D. INTERPRETATIONS


GENERAL PROVISIONS

Sec.


21.401.    Interpretations: scope of practice.

STATEMENT OF POLICY


21.411.    Interpretations regarding the general functions of registered nurses—statement of policy.
21.412.    Interpretations regarding venipuncture, intravenous fluids, resuscitation and respiration—statement of policy.
21.413.    Interpretations regarding the administration of drugs—statement of policy.
21.414.    Interpretations regarding the functions of Licensed Practical Nurses (LPN)—statement of policy.
21.415.    Interpretations regarding the applicability of nursing standards and qualifications to all nurses practicing in this Commonwealth—statement of policy.
21.416.    Conversion therapy, sexual orientation change efforts and reparative therapy—statement of policy.

Authority

   The provisions of this Subchapter D issued under section 2(k) of The Professional Nursing Law (63 P.S. § §  212.1(k)); and section 17.6 of the Practical Nurse Law (63 P.S. §  667.6), unless otherwise noted.

Source

   The provisions of this Subchapter D adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 811, unless otherwise noted.

GENERAL PROVISIONS


§ 21.401. Interpretations: scope of practice.

 (a)  The Board may, upon request of a licensed nurse, nursing association, health care facility or licensed health care professional, or upon its own motion, issue interpretations of this chapter as they apply to the question of whether the execution of specific practices are within the scope of professional or practical nursing.

 (b)  Interpretations issued by the Board will not conflict with this chapter, or enlarge or restrict this chapter, but will solely address the matter of applying principles set forth in this chapter to specific practices.

 (c)  Interpretations issued under this section do not constitute an exercise of delegated legislative power by the Board and will be expressly subject to modification by the Board in an adjudicative proceeding based upon the particular facts and circumstances relevant to a proceeding. Interpretations are not intended to be legally enforceable against a licensed person by the Board. In issuing adjudications, the Board may consider, but is not bound by, interpretations.

 (d)  Prior to issuing interpretations, the Board will submit to the Legislative Reference Bureau for recommended publication in the Pennsylvania Bulletin a notice indicating its intent to adopt interpretations, and making available upon request to interested persons copies of proposed or draft interpretations. The notice shall also indicate the date and place for the conduct of hearings proposed regarding the interpretations. The notice shall contain the full statement of policy or a description of the substance of the statement of policy.

 (e)  The Board will not adopt statements of policy until the time for public comment has elapsed. A minimum of 60 days from publication in the Pennsylvania Bulletin of notice of intention to adopt shall be provided for public comment. Following a review and consideration of comments received concerning a proposed interpretation, the Board may adopt interpretations by a majority vote taken at a scheduled public meeting of the Board.

 (f)  Interpretations adopted by the Board under this chapter will be reviewed for form and legality under Chapter 3 of the Commonwealth Attorneys Act (71 P.S. § §  732-301—732-303) and, upon approval, will be submitted to the Legislative Reference Bureau for recommended publication in the Pennsylvania Bulletin and Pennsylvania Code as a statement of policy of the Board as a part of this subchapter.

 (g)  If a nurse executes a practice which the Board has interpreted to be within the scope of nursing practice, the nurse shall only undertake the practice if the nurse has the necessary preparation, experience and knowledge to properly execute the practice. The execution of the procedures shall include the identification and discrimination of expected and unexpected human responses and the effective management of nursing actions.

 (h)  Interpretations of the Board will not be deemed to impose requirements upon educational institutions to include the teaching of practices within their curricula.

 (i)  The procedure for issuing interpretations will not prohibit the Board from answering specific inquiries involving individual factual situations, which answers will be limited in application to the individual factual situation involved in the inquiry.

Source

   The provisions of this §  21.401 adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 811.

STATEMENT OF POLICY


§ 21.411. Interpretations regarding the general functions of registered nurses—statement of policy.

 The following nursing practices fall within the scope of registered nurse practice under §  21.11 (relating to general functions):

   (1)  Collection of arterial and venous blood samples.

   (2)  Collection of arterial and venous blood samples from indwelling arterial/venous catheters.

   (3)  Arterial puncture for blood samples in infant intensive care units.

   (4)  Vaginal examination using a speculum to include:

     (i)   Testing for ruptured membranes.

     (ii)   Doing Pap smears.

     (iii)   Doing cervical smears.

   (5)  Application of intraocular pressure reducer.

   (6)  Internal fetal monitoring including the application of leads.

   (7)  Insertion of nasogastric tubes.

   (8)  Insertion and removal of enteric double or multilumen tubes with or without mercury bags.

   (9)  The changing of an outer tracheostomy tube after stoma is healed.

   (10)  The change of an cystostomy tubes.

   (11)  The changing of a gastrostomy tube when stoma is healed.

   (12)  Removal of sutures.

   (13)  Use of hypnosis.

   (14)  Surgical debridement of decubiti.

   (15)  The programming of permanent pacemakers.

   (16)  Documenting the fact that a patient has died.

Source

   The provisions of this §  21.411 adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 811; amended November 4, 1988, effective November 5, 1988, 18 Pa.B. 4996; amended December 15, 1989, effective February 14, 1990, 19 Pa.B. 5315; amended June 21, 1991, effective June 22, 1991, 21 Pa.B. 2817. Immediately preceding text appears at serial pages (143338) to (143339).

§ 21.412. Interpretations regarding venipuncture, intravenous fluids, resuscitation and respiration—statement of policy.

 The following nursing practices fall within the scope of registered nursing practice under § §  21.11 and 21.12 (relating to general functions; and venipuncture; intravenous fluids):

   (1)  Introduction of percutaneous catheters for intravascular infusion of infant intensive care unit.

   (2)  Insertion of angiocath into an A-V Fistula.

   (3)  Changing a subclavian catheter over guidewire after it had been placed by a physician.

   (4)  Removal of central venous line.

   (5)  Teaching patients and families the administration of intravenous medications in the home.

Source

   The provisions of this §  21.412 adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 811.

§ 21.413. Interpretations regarding the administration of drugs—statement of policy.

 (a)  The following nursing practices fall within the scope of registered nursing practice under § §  21.11, 21.12 and 21.14 (relating to general functions; venipuncture; intravenous fluids; and administration of drugs):

   (1)  Intravenous administration of Pavulon to a patient maintained on a mechanical ventillator.

   (2)  Use of lidocaine as an analgesic prior to venipuncture.

   (3)  Use of lidocaine or xylocaine for analgesia prior to use of a vascular access device of an implantable infusion pump.

 (b)  The following nursing practices fall within the scope of registered nursing practice under § §  21.11 and 21.14:

   (1)  The addition of medications to peritoneal dialysate.

   (2)  The administration of chemotherapy.

   (3)  The refilling of implantable drug delivery systems following placement by a physician in the proper anatomical site.

   (4)  The administration of intrathecal medications by an externalized ventriculoperitoneal shunt.

   (5)  Monitoring and administering medications by epidural catheter or other pain relief devices to be used as analgesia for pain control. Administration of medications as used in this paragraph does not include initiation of the medication.

   (6)  When a physician writes a prescription order for a patient for a specific medication with a range of dosage, the registered nurse shall use professional judgment to determine the amount of medication within the range to be given to the patient.

 (c)  The following nursing practices fall within the scope of registered nursing practice under §  21.11 and §  21.15 (relating to monitoring, defibrillating and resuscitating):

   (1)  Measurement of a cardiac output by thermodilution method.

   (2)  Inflation of a Swan-Ganz catheter balloon for the purpose of obtaining intermittent pulmonary capillary wedge pressure readings.

   (3)  Establishment of arterial lines with or without a cannula.

   (4)  Analysis of rhythm strips of patients with permanent programmable pacemakers.

   (5)  Endotrachael intubation and extubation.

   (6)  Endotracheal intubation in infant intensive care unit.

   (7)  Needle aspiration of pneumothorax in infant intensive care unit.

   (8)  Performance of cardioversion in the presence or absence of a physician.

   (9)  Umbilical vessel catheterization in infant intensive care units.

   (10)  Pulling back on Swan-Ganz catheter when it is wedged.

 (d)  As used in this subsection, ‘‘conscious sedation’’ is defined as a minimally depressed level of consciousness in which the patient retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands. The registered nurse who is not a certified registered nurse anesthetist may administer conscious sedation medications, under §  21.14, during minor therapeutic and diagnostic procedures, when the following conditions exist:

   (1)  The specific amount of conscious sedation medications has been ordered in writing by a licensed physician or certified registered nurse practitioner and a licensed physician or certified registered nurse practitioner is physically present in the room during administration.

   (2)  Written guidelines specifying the medications that the registered nurse may administer in a particular setting are available to the registered nurse.

   (3)  Electrocardiogram, blood pressure and oximetry equipment are used for both monitoring and emergency resuscitation purposes pursuant to written guidelines which are provided for minimum patient monitoring. Additional emergency resuscitation equipment is immediately available.

   (4)  The patient has a patent intravenous access when the conscious sedation is administered intravenously.

   (5)  The registered nurse involved in direct patient care is certified in advanced cardiac life support (ACLS). Provisions shall be in place for back-up personnel who are experts in airway management, emergency intubation and advanced life support if complications arise.

   (6)  The registered nurse possesses the knowledge, skills and abilities related to the management of patients receiving conscious sedation with evaluation of competence on a periodic basis. This includes, but is not limited to, arrhythmia detection, airway management and pharmacologic action of drugs administered. This includes emergency drugs.

   (7)  The registered nurse managing the care of the patient receiving conscious sedation medication may not have other responsibilities during the procedure. The registered nurse may not leave the patient unattended or engage in tasks which would compromise continuous monitoring.

   (8)  The registered nurse monitors the patient until the patient is discharged by a qualified professional authorized to discharge the patient in accordance with established criteria of the facility.

Authority

   The provisions of this §  21.413 amended under sections 8.2(c) and 8.3(b) of the Professional Nursing Law (63 P.S. § §  218.2(c) and 218.3(b)).

Source

   The provisions of this §  21.413 adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 811; amended June 21, 1991, effective June 22, 1991, 21 Pa.B. 2818; amended January 17, 1992, effective January 18, 1992, 22 Pa.B. 300; amended November 12, 1993, effective November 13, 1993, 23 Pa.B. 5404; amended October 23, 1998, effective October 24, 1998, 28 Pa.B. 5345; amended March 31, 2023, effective April 1, 2023, 53 Pa.B. 1806. Immediately preceding text appears at serial pages (385240) and (409283).

§ 21.414. Interpretations regarding the functions of Licensed Practical Nurses (LPN)—statement of policy.

 (a)  Collection of venous blood samples fall within the scope of Licensed Practical Nurse (LPN) practice under §  21.145(a) (relating to functions of the LPN).

 (b)  The following nursing practices fall within the scope of LPN practice under §  21.145(b):

   (1)  Changing cystostomy tubes after the stoma heals.

   (2)  Changing gastrostomy tube when stoma is healed.

 (c)  The following nursing practices fall within the scope of LPN practice under §  21.145(a) and (b):

   (1)  Insertion of nasogastric tubes.

   (2)  Changing outer tracheostomy tube after stoma is healed.

   (3)  Addition of medications to peritoneal dialysate in the care of those patients with chronic renal disease.

   (4)  Removal of sutures of a simple and uncomplicated nature.

Source

   The provisions of this §  21.414 adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 811.

§ 21.415. Interpretations regarding the applicability of nursing standards and qualifications to all nurses practicing in this Commonwealth—statement of policy.

 For the purposes of applying statutory and regulatory nursing standards and qualifications in this Commonwealth, the following apply:

   (1)  For a licensed practical nurse, the term includes an individual licensed under the laws of this Commonwealth to practice practical nursing or an individual who holds a privilege to practice as a practical nurse in this Commonwealth under the Nurse Licensure Compact Act (35 P.S. § §  10291—10295).

   (2)  For a registered nurse, the term includes an individual licensed under the laws of this Commonwealth to practice professional nursing or an individual who holds a privilege to practice as a registered nurse in this Commonwealth under the Nurse Licensure Compact Act.

Authority

   The provisions of this §  21.415 added under the Nurse Licensure Compact Act (35 P.S. § §  10291—10295).

Source

   The provisions of this §  21.415 added January 12, 2024, effective January 13, 2024, 54 Pa.B. 148.

§ 21.416. Conversion therapy, sexual orientation change efforts and reparative therapy—statement of policy.

 (a)  Background. Conversion therapy, also known as sexual orientation change efforts or reparative therapy, poses critical health risks to lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual individuals, including suicidality, substance abuse, confusion, depression, guilt, helplessness, hopelessness, shame, social withdrawal, stress, disappointment, self-blame, decreased self-esteem and authenticity to others, increased self-hatred, hostility and blame toward parents, feelings of anger and betrayal, loss of friends and potential romantic partners, problems with sexual and emotional intimacy, sexual dysfunction, high-risk sexual behaviors, a feeling of being dehumanized and untrue to self, a loss of faith and a sense of having wasted time and resources. The American Medical Association, the American Nurses Association, the American Academy of Nursing and the International Society of Psychiatric-Mental Health Nurses oppose the use of conversion therapy for sexual orientation or gender identity. Due to the lack of scientific evidence supporting conversion therapy and the risk of harm to minors, the practice of conversion therapy is also strongly opposed by the American Academy of Child Adolescent Psychiatry, American Academy of Pediatrics, American Association for Marriage and Family Therapy, American College of Physicians, American Psychiatric Association, American Psychoanalytic Association, American Psychological Association, National Association of Social Workers, Pan American Health Organization and the World Psychiatric Association.

 (b)  Board authority. The Board has statutory authority to license, regulate and discipline a licensee in this Commonwealth. Under section 14(a)(9) and (b) of the act (63 P.S. §  224(a)(9) and (b)), the Board is authorized to impose disciplinary or corrective measures on a licensee for being guilty of immoral or unprofessional conduct, which includes departure from or failing to conform to an ethical or quality standard of the profession.

 (c)  Guidelines. The following conversion therapy guidelines should be considered by a licensee to ensure compliance with the act and the Board’s regulations.

   (1)  Being lesbian, gay, bisexual, transgender, queer/questioning, intersex or asexual is not a disease, disorder, illness, deficiency or shortcoming.

   (2)  Conversion therapy includes the following conduct:

     (i)   A practice or treatment that seeks to change an individual’s sexual orientation or gender identity.

     (ii)   An effort to change the behavioral expression of an individual’s sexual orientation, change gender expression, or eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender.

   (3)  Conversion therapy does not include a practice or treatment that provides counseling for an individual undergoing gender transition, counseling that provides acceptance, support, and understanding, or the facilitation of coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices. Conversion therapy does not include a practice that does not seek to change sexual orientation or gender identity.

   (4)  In a disciplinary action brought against a licensee, the Board may find the use of conversion therapy on an individual under 18 years of age to be unethical, immoral or unprofessional conduct. A licensee who uses conversion therapy on an individual under 18 years of age may be subject to discipline by the Board.

Authority

   The provisions of this §  21.416 added under section 14(a)(9) and (b) of the Professional Nursing Law (63 P.S. §  224(a)(9) and (b)).

Source

   The provisions of this §  21.416 added June 7, 2024, effective June 8, 2024, 54 Pa.B. 3163.



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