NH BOARD OF NURSING Margaret Walker, Ed.D,. RN

1. NH BOARD OF NURSINGMargaret Walker, Ed.D,. RN The role of the LNA and MNA in Assisted Living Residences

2. Board of Nursing Law • Licensed Nursing Assistants RSA 326-B:14 • Medication Nursing Assistants RSA 326-B:27

3. What is new since 2008? • Legislation in 2008-2009 included changes in the title of the Advanced Nurse. Nationally the term Advanced Practice RN is used. NH now uses APRN instead of ARNP. • The Joint Health Council was repealed as it was a duplicative committee.

4. What else? • Administrative rules have refined nursing education issues, fee schedules, and licensing procedures with very little change to actual practice. • Note: Administrative rules and the law are located on our website under “Nurse Practice Act”.

5. Licensed Nursing Assistants (LNAs) and the Law • RSA 326-B:14 “An LNA shall, with or without compensation or personal profit, practice under the supervision of an RN, APRN, or LPN” and “Provide safe nursing-related activities under the supervision of an RN or an LPN. • Scope of practice based on activities taught during initial educational program, Nur 704.09

6. LNA Scope of Practice • Additional activities may be added based on specific BON approval, Nur 404.12, such as: Straight urinary catheters, application of TENS unit, feeding tubes, phlebotomy, wound care, vagus nerve stimulation, pulse oximetry, incentive spirometry, oral suctioning, oxygen mask placement/cannula placement, chest physiotherapy, peripheral vein IV removal, colostomy irrigations, medicated lotions, ointments and creams, blood glucose monitoring, fingerstick PT/INR testing, reminding clients to take their medications and transcribing medical orders.

7. LNA Scope of Practice • The LNA may also assist in oxygen as a treatment therapy and change the collar that holds a tracheostomy tube in place as delegated by the nurse. It is not within the scope of practice for a Licensed Nursing Assistant to engage in the following activities: • Insertion of intravenous catheters, • Calling in Prescribing Practitioner orders to the Pharmacy • Insertion of indwelling catheters

8. Medication Nursing Assistants • A Medication Nursing Assistant (MNA) is a Licensed Nursing Assistant (LNA) with a NH Board Approved Certificate to administer medications under the supervision of a RN/LPN to “stable” clients living in facilities and in the community.

9. What’s the definition of “stable”? • The client whose health status is under control and raises no expectations that the client’s symptoms, vital signs or reactions to medications will suddenly change. There are predictable outcomes to care.

10. The BON definition of supervision October 20, 2005 Clinical Practice Advisory Question: How does the Board define direct vs. indirect supervision? Board Response: The board affirmed a previous definition that direct supervision refers to having the supervisor in close proximity to the licensee either in the same room or the same building. Indirect supervision requires the supervisor to be readily accessible but not necessarily on the floor or in the building. Thus, having telephone communication with a supervisor who is available to assist in an identified problem would meet the definition of indirect supervision.

11. Nursing Delegation Rules Nur 404 • Nurse Practice Act revised in 2005 and Nursing Rules updated in 2001 • Pertains to delegation among licensees as well as to delegation to unlicensed assistive personnel • Must be in keeping with Nur 404 • RSA-B:33 III “No person may coerce a licensed nurse into compromising patient safety by requiring the licensed nurse to delegate if the license nurse determines it is inappropriate to do so…….”

12. What is Delegation? • Nur 401.01(f): The transfer, at the discretion of the nurse, of authority for the performance of a task of client care from the licensed nurse with the authority to perform the task to someone who does not otherwise have such authority

13. Nur 404.05 • A MNA shall NOTperform a task involving the administration of medication if: -the task requires the determination of the client’s need for the medication, the calculation of the dosage or the conversion of the dosage; -the delegating nurse is unavailable to monitor the progress of the client and the effect of the medication; -the client is not stable or has changing needs.

14. Can LNAs administer medications? The short answer is no. But we now have the new role of LNA-MC that allows assistance! • If the facility has an approved program and the LNA successfully completes the program they can provide assistance and documentation to the residents in the Assisted Living.

15. How can I become a LNA Medication Certified? • Facilities requesting approval for a LNA Medication Certified education program must submit a curriculum to the Board of Nursing. LNA Medication Certified individuals must successfully complete a minimum of four (4) hour, NH Board of Nursing approved educational program that includes: • Medication assisting techniques; • Infection Control; • Observational and documentation techniques; • Resident rights; • Communication and interpersonal skills; • Response to resident behavior; • Recognizing and reporting resident changes; and, Safety and emergency procedures.

16. Medication AdministrationHand-over-Hand From BON Clinical Practice Advisory 1998-1999 QUESTION: Can a LNA assist clients with medication administration using a hand over hand approach? ANSWER: Yes, the LNA can place hands over clients hands to assist client with medication administration is within the scope of the LNA practice when the client has cognitive abilities to determine medication needs. This process is utilized for the motor process or becomes the hands of an individual who is physically impaired.

17. Medication AdministrationHand-over-Hand The resident: • must have a care plan specific to their impairment with hand over hand details, must be self directed, can be prompted or reminded of medication needs

18. LNA Scope of Practice • There has been a “blurring” of LNA and MNA roles in the healthcare community • LNA Scope of Practice has not changed and remains consistent within the Nurse Practice Act and Nursing Administrative rules across all practice areas

19. Common Questions re: LNA-MC • Can I take my certification with me from facility to facility? • Answer: No, the certification is facility-specific as you need to complete the orientation processes in each facility you work. There may be differences in: • 1. Policies and procedures • 2. Approaches to care • 3. Facility documentation procedures.

20. How do I become a LNA-MC in my new employing facility? • Ask your new employer if they are a board-approved LNA-MC training site. • If yes, request facility-specific education to become a LNA-MC. • The board-approved educator will then notify the board via letter so that we can document your LNA-MC status on the board database. • Review the board verification website (located in the quick link section of our website).

21. What happens if I leave my current employer who is a board approved LNA-MC training site? • You employer will notify the board that you are no longer employed. • The board will then modify your licensing data to reflect your inactive LNA-MC status.

22. What happens if I find another job at an approved LNA-MC site? • Your approved educator at the site will evaluate your level of competency to perform observations and documentation of medication administration by the resident. • The educator will complete your facility-specific training. • The educator/administrative staff will notify the board via letter that you have met the educational requirements.

23. Where is the information located on the board website? • Go to www.state.nh.us/nursing • Then, go to Educational Programs; • Scroll to Licensed Nursing Assistant-Medication Certified.

24. Contact us… Telephone: 271-2323, 271-6282 mwalker@nursing.state.nh.us Lori.tetreault@nursing.state.nh.us web site: www. state.nh.us/nursing email: boardquestions@nursing.state.nh.us