1. Board of Registration in Nursing

2. Module: Legal Scope of RN, LPN, and APRN Practice

3. 244 CMR 3.00: Registered Nurse and Licensed Practical Nurse 3.01: Registered Nurse Graduate of a Board approved schoolGraduate of a Board approved school Holds ultimate responsibility for careHolds ultimate responsibility for care Scope includes: nursing care, health maintenance, teaching, counseling, plans and restoration for optimal functioning & comfortScope includes: nursing care, health maintenance, teaching, counseling, plans and restoration for optimal functioning & comfort

4. 244 CMR 3.00 3.02: Responsibilities & Functions (RN) Systematically assess health status of individuals or groupsSystematically assess health status of individuals or groups Analyze & interpret data; and make informed judgementsAnalyze & interpret data; and make informed judgements Plan & implement care - prescribed medical or therapeutic regimes, scientific principles, recent advances & current researchPlan & implement care - prescribed medical or therapeutic regimes, scientific principles, recent advances & current research

5. 3.02 - continued Provide & coordinate health teachingProvide & coordinate health teaching Evaluate outcomesEvaluate outcomes Collaborate, communicate and cooperates to ensure quality and continuity of careCollaborate, communicate and cooperates to ensure quality and continuity of care Serves as a patient advocate within the limits of the lawServes as a patient advocate within the limits of the law MAY DELEGATE...MAY DELEGATE...

6. 244 CMR 3.00 3.03: Practical Nurse Graduate of a Board approved schoolGraduate of a Board approved school Bears full responsibility for the quality of health care she/he providesBears full responsibility for the quality of health care she/he provides Scope includes: participation in nursing care, health maintenance, teaching, counseling, collaborative planning and rehabilitation, to the extent of his/her educationScope includes: participation in nursing care, health maintenance, teaching, counseling, collaborative planning and rehabilitation, to the extent of his/her education

7. 244 CMR 3.00 3.04: Responsibilities & Function (PN) Assess individuals basic health statusAssess individuals basic health status Participates in analyzing data & making informed judgements Participates in analyzing data & making informed judgements Participates in planning & implementing interventions including recent advances & current knowledge in the fieldParticipates in planning & implementing interventions including recent advances & current knowledge in the field Incorporates medical regimesIncorporates medical regimes

8. 3.04 – continued Participates in health teachingParticipates in health teaching When appropriate, evaluates outcomes, initiates or encourages change in the planWhen appropriate, evaluates outcomes, initiates or encourages change in the plan Collaborates, cooperates, communicates to ensure quality and continuity of careCollaborates, cooperates, communicates to ensure quality and continuity of care MAY DELEGATE...MAY DELEGATE...

9. 244 CMR 4.00: The Practice of Nursing in the Expanded Role Establishes the conditions under which RNs may practice in the advanced role.Establishes the conditions under which RNs may practice in the advanced role. Governs education & practice requirements.Governs education & practice requirements. Criteria for authorization to practice.Criteria for authorization to practice. Criteria for prescriptive authority.Criteria for prescriptive authority. Requirements for guidelinesRequirements for guidelines Details “Scope of Practice”Details “Scope of Practice”

10. Advisory Rulings On Nursing Practice Advisory Rulings on Nursing Practice are declarative statements of the Board which: Advisory Rulings on Nursing Practice are declarative statements of the Board which: carry with them the full weight of lawcarry with them the full weight of law represent the Board’s interpretation of the legal scope of nursing practicerepresent the Board’s interpretation of the legal scope of nursing practice

11. Determining Scope of Practice Describe nursing practice or activity.Describe nursing practice or activity. Is it supported by statute or regulation?Is it supported by statute or regulation? Does entry into practice education provide the necessary knowledge/ skill/ability? Or Continuing Education?Does entry into practice education provide the necessary knowledge/ skill/ability? Or Continuing Education? Is this a practice that is consistent with the nursing literature and/or research?Is this a practice that is consistent with the nursing literature and/or research? Does the nurse have a documented competence?Does the nurse have a documented competence?

12. Scope of Practice - continued Is this within a standard of care that another reasonable & prudent would do?Is this within a standard of care that another reasonable & prudent would do? Is the patient’s safety assured?Is the patient’s safety assured? Is the nurse prepared to accept accountability for performing the activity?Is the nurse prepared to accept accountability for performing the activity?

13. Scope of Practice - continued Apply the Board’s Decisionmaking Guidelines to a clinical situation to determine if the selected activity is within the nurse’s scope of practice.Apply the Board’s Decisionmaking Guidelines to a clinical situation to determine if the selected activity is within the nurse’s scope of practice.