State laws and regulations specific to dialysis: an overview

State laws and regulations specific to dialysis: an overview

Cathleen O’Keefe

The renal community has long had need for a thorough compilation of information on laws and regulations specific to dialysis on a state by state basis to guide the clinical practice of dialysis and for compliance purposes. In recognition of that need, Fresenius Medical Care North America (FMCNA) undertook the process of gathering such information. The final product has been offered to the community through the American Nephrology Nurses’ Association since much of the information relates to the scope of practice and delegation authority of registered nurses and the licensed practical/vocational nurses and unlicensed dialysis technicians they supervise. FMCNA has made a commitment to update this information on a regular basis for publication annually. ANNA is grateful to Fresenius for this contribution to the industry.

PCTs

Allowed to

Administer

Heparin and Delegation Authority of RNs/

State Saline Limitations on LPN/LVNs or UAP

ALABAMA NO Tasks that may not be delegated

to UAP include administration of

medications. Limits on IV

therapy by LPN–no direct IV

bolus meds.

www.abn.state.al.us/welcome.html

ALASKA NO Nursing tasks that shall not be

delegated from RNs to LPNs include

“Administer IV push medications

–RNs Only.”

www.dced.state.ak.us/occ/pub/Nursing

Statutes.pdf

ARKANSAS NO Nursing tasks that shall not be

delegated … “Administration of

any medications or IV therapy,

including blood or blood products.”

http://www.arsbn.org/

ARIZONA YES Dialysis technician certification

through a national organization

(NANT) or have completion of

minimum training requirements.

www.azleg.state.az.us/legtext/45leg/2r/

summary/h.hb2359 2-08-02 health.doc.htm

Experienced hemodialysis technician trainees

may administer local anesthetic, anticoagu-

lants, or replacement saline.

www.azsos.gov/public_services/Title_09/

9-10.rtf.

CALIFORNIA YES Cannulation, administration of local

anesthetics, heparin, and sodium chloride

solutions allowed for technicians.

Certification required.

www.caselaw.1p.findlaw.com/cacodes/bpc/

1247%2D1247.9.html

LPNs may not access central line catheters.

http://www.bvnpt.ca.gov/pdf/vnregs.pdf

COLORADO No Express Broad delegation language.

Prohibition http://www.dora.state.co.us/nursing/

statutesandrules/npa.htm

CONNECTICUT NO Staffing requirements include 50% licensed

nurses. PCTs may initiate, monitor, and

terminate dialysis treatments.

www.dph.state.ct.us/phc.doc

DELAWARE NO Delegation by RNs only. RNs may not dele-

gate administration of meds to UAP.

www.professionallicensing.state.de.us/

boards/nursing/renewal.shtml

DISTRICT of No Express Scope of Practice for LPNs includes adminis-

COLUMBIA Prohibition tering medication.

www.dchealth.dc.gov/prof license/services/

pdffile/PDF_frameset.asp?id=Nursing/Munici

palNursingRegulations.pdf&strAppld=11

FLORIDA No Heparin No RN delegation language.

Yes Saline www.fisenate.gov/Statutes/index.cfm

Agency for Healthcare Administration

position statement prohibits heparin

administration.

GEORGIA No Heparin Requires training program for hemodialysis

Yes Saline PCTs. National certification exam not

required. LPNs required to meet the same

training and competency requirements as

PCTs.

http://www2.state.ga. us/Departments/DHR/

ORS/esrdrules.htm#290-9-9-.11

HAWAII No Express No delegation of IV meds unless criteria for

Prohibition delegation is met.” Delegation criteria…

“the delegating RN shall teach UAP special

tasks of nursing care and verify the UAP’s

competency to perform the tasks.”

www. hawaii.gov/dcca/pdf/hrs_pvl_457.pdf

IDAHO NO May not delegate to UAPs preparation or

administration of injections, or start,

stop, or adjust any IV therapy.

http://www2.state.id.us/adm/adminruies/rul

es/idapa23/0101.pdf

ILLINOIS NO Delegation: The transfer of responsibility

for the performance of selected tasks by

the registered nurse (RN) to qualified,

competent assistive personnel in a

selected situation, based upon the

RN’s plan of care.

www.ildpr.com/WHO/nurs.asp

INDIANA No Express RNs can delegate if task does not exceed

Probibition the scope of practice of delegatee. Nurses

must balance with ethical duty where there

can be no delegation if the nurse

knows/should know it is detrimental to

patient’s health.

www.state.in.us/hpb/boards/isbn/nursing_

compilation.pdf

IOWA No Express In a dialysis unit, RN may delegate heparin

Prohibition and saline administration to an LPN. RN

cannot delegate to UAP anything beyond the

scope of practice of LPN.

www.legis.state.ia.us/Rules/2003/lac/655/65

56/6556.pdf

KANSAS YES All nursing procedures, including, but not

limited to, the administration of

medication, delegated by a licensed nurse

to a designated unlicensed person shall be

supervised.

www.ksbn.org/npatoc.htm

KENTUCKY YES Dialysis Tech Credentialing. PCTs may

cannulate, and administer heparin

(specified doses), normal saline,

intradermal lidocaine.

www.kbn.ky.gov/practice.htm

LOUISIANA No IV Push Advisory Opinion allows LPN administration

of IV heparin for hemodialysis.

http://www.isbpne.com/practice_opinions.htm

http://www.isbn.state.1a.us/Documents/sco

pe/rnscope.pdf

MAINE No Express Rules mention UAPs and CNAs. Nothing spe-

Prohibition cific on dialysis PCTs. Certified Nursing

Assistants may administer meds, but only

if a med course is taken, certain meds

only, and no IV meds.

http://janus.state.me.us/legis/statutes/32/

title32ch31sec0.html

MARYLAND YES Dialysis technicians are listed as a

specific category of certified nursing

assistant, CAN–DT Approved training

program is required; two year renewal

period.

http://www.dsd.state.md.us/comar/subti-

tie chapters/10 Chapters.htm#Subtitle27

MASSACHU- YES Delegation to Unlicensed Personnel. Nursing

SETTS advisory ruling.

www.mass.gov/dpVboardstrn/cmr/24403.htm#3.05

Mass Nurses Organization Position

Statement.

http://www.massone.org/main/Position%20

Statements/Unlicensed%20Assistive%20Per

sonnel.htm

MICHIGAN No Express Broad delegation language.

Prohibition http://www.state.ml.us/orr/emi/admincode.a

sp?AdmiinCode=Single&Admin Num=3381

0101& Dpt=CH&RngHigh=

MINNESOTA No Express In a nursing home setting, medications by

Prohibition injection can be given only by physician,

physician’s assistant, RN, LPN. Nothing on

dialysis.

http://www.state.mn.us/cgibin/portal/mn/jsp

/content.do?rc layout=bottom&subchan-

nel=null&programid=536898085&sc3=null&

sc2=null&id=-

536882405&agency=N u rsi ng Board

MISSISSIPPI NO Administration of meds can be delegated only

to licensed nurses, either an RN or LPN.

Nursing rules allow LPNs to cannulate and

administer IV heparin or IV saline.

Technicians may not cannulate.

http://www.msbn.state.ms.us/pdf/

RulesRegs.pdf

MISSOURI No Express LPNs allowed to administer IV heparin. No

Prohibition specific language regarding delegating to

dialysis technicians.

http://www.sos.mo.gov/adruies/csr/cur-

rent/4csr/4c200-6.pdf

MONTANA No Express Nurses cannot delegate administration of

Prohibition medications.

http://www.discoveringmontana.com/dil/bs

d/license/bsd_boards/nur_board/pdf/prac-

tice_statements.pdf

NEBRASKA YES Specific hemodialysis functions allowed for

LPNs and PCTs include cannulation and

administration of heparin and saline.

http://www.hhs.state.ne.us/crl/nursing/rn%

2DIpn/advisory.htm#DELEGATION

NEVADA YES A drug or medicine referred to in NRS

454.181 to 454.371, inclusive, may be

possessed and administered by: “A

dialysis technician, under the direction

or supervision of a physician or

registered nurse only if the drug or

medicine is used for the process of renal

dialysis.”

http://www.leg.state.nv.us/NRS/NRS-454.html

NEW YES RNs only can delegate IV administration of

HAMPSHIRE meds. Delegation of a task of client care

involving the administration of medication

shall specify the med, dosage, route.

Pharmacy rules allow PCTs to administer

saline and heparin.

http://gencourt.state.nh.us/rules/nur100-

900.html#nur400

NEW JERSEY No Express An RN may delegate selected nursing tasks to

Prohibition the LPN and ancillary nursing personnel

(including aids, assistants, attendants and

technicians). Nothing specific as to

administration of medications or dialysis

technicians.

http://www.state.nj.us/lps/ca/nursing/nursel

aws.pdf

NEW MEXICO YES Hemodialysis Technician can cannulate and

administer heparin bolus. Training and

testing required for certified

hemodialysis technicians.

http://www.state.nm.us/clients/nursing/pdf/

nmacpart4.pdf

NEW YORK NO Properly trained dialysis technicians are

allowed to flush IV lines with pre-

determined doses of heparin when

initiating dialysis.

http://www.nysna.org/programs/practice/ale

its/alert5.htm

Limitations on LPNs administering IV meds.

No IV push except saline or heparin.

http://www.op.nysed.gov/nurse-lpn-iv-

longterm.htm

NORTH NO The dialysis technician may administer

CAROLINA heparin, lidocaine, and normal saline.

Cannulation may be done by licensed nurse or

competent dialysis technician.

http://www.ncbon.com/prac-hemo.asp

NORTH DAKOTA YES Delegation rules for UAPs do not allow

IV meds.

http://www.ndbon.org/unlicensed/

medication_admin.html

OHIO NO Delegation–Dialysis Technicians can

administer IV heparin. Tech rules

require certification.

http://www.nursing.ohio.gov/pdfs/NewLaw

Rules/CHAPT 23.pdf

OKLAHOMA NO Administration of meds may not be delegated.

www.youroklahoma.com/nursing/delegation.pdf

BONPosition Paper on LPN administration of

IV meds, May 2002 … “IV therapy and

medication administration may be within the

scope of practice of LPN who has appropriate

educational training and under supervision.”

http://www.youroklahoma.com/nursing/

prac1.html

OREGON YES Effective August 2001. Requires

certification by a nationally

standardized exam

http://www.sos.state.or.ustarchivestruies/

OARs_300/OAR_333/333_275.html

PENNSYLVANIA YES [section] 18.402. Delegation A medical

doctor may delegate to a health care

practitioner or technician the

performance of a medical service if

certain conditions are met.

www.pacode.conVsecure/data/049/chapter18/

subchapGtoc.html

LPNs can administer IV meds after

completing an approved course.

www.dos.state.pa.ustbpoa/lib/bpoa/20/

nurs_board/nurseact.pdf

RHODE ISLAND No Express Broad delgation language. State approved

broad Prohibition delegation course for

nursing students , no controlled substances

allowed.

http://www.health.ri.gov/hsr/regulations/

proposed/nursing_prop.pdf

SOUTH NO After June 30, 1985, unlicensed nursing

CAROLINA personnel shall not administer medications.

BON–the reguations preclude the licensed

nurse from delegating administration of

medications to UAP

http://www.llr.state.sc.us/pol/nursing/

index.asp?file=uaptasks.htm

LPNs may administer IV saline /heparin push.

www.llr.state.sc.us/poVnursingrndex.asp?

file=advisoryop10b.htm

SOUTH DAKOTA YES LPNs may cannulate and administer IV saline

and heparin.

http:/Aegis.state.sd.ustruiestrules/2048.

htm#20:48:04.01:12

Dialysis techs may administer loading and

maintenance doses of heparin according to

prescribed protocol.

http:/Aegis.state.sd.ustruiestruies/2048.

htm#20:48:04.02:05

TENNESSEE NO LNPs may administer IV meds in ESRD

settings–BON Position Statement.

http://www2.state.tn.usthealth/Downloads/

g4014009.pdf

BON will not approve a program for UAPs to

administer meds.12/01

http://www2.state.tn.usthealth/Downloadstg

4021186.pdf

TEXAS YES Licensure law/regs allow cannulation,

administration of heparin, saline, and

lidocaine. Requires training for dialysis

technicians, certification by a

nationally standardized examination may be

substituted.

http://www.tdh.state.tx.us/hfc/esrd%5F117.pdf

UTAH No Express Broad delegation language from RN to UAP.

Prohibition http://www.dopl.utah.gov/licensing/

statutes_and_rules/13156-31b.PDF

VERMONT No Express LPNs allowed to perform IV therapy. Nothing

Prohibition specific to dialysis technicians.

http://vtprofessionals.org/oprl/nurses/

forms/nursingopinions.pdf

VIRGINIA YES PCTs may administer heparin, saline PCT

training program.

www.dhp.state.va.us/bhpfeg/Dialysis%20

regs.doc

WASHINGTON YES July 2001–Dialysis regulations requires

standardized training of technicians.

LPNs may administer IV push if protocols

in place

https://wws2.wa.gov/doh/hpga-licensing/

HPS6/Nursing/documents/LPN-ivtherapypdf

A health care assistant trained by a

federally-approved ESRD facility may

perform venipuncture for blood withdrawal,

venipuncture for placement of fistula

needles, IV administration of heparin and

saline as an integral part of dialysis

treatment

www.leg.wa.gov/si/2001-02/1309_sltxt

www.leg.wa.gov/RCW/index.cfm?se-

tion=18.135.060&fuseaction=section

WEST VIRGINIA NO Additional limitations on medication

administration by facility staff members

include injections or parenteral

medications. No delegation authority

for techs to administer saline or heparin;

recent law passed, requires subsequent

legislation.

http://www.wvrnboard.com/scope.pdf

WISCONSIN No Express LPNs may administer IV medications with

Prohibition supervision if competent.

http://dri.wi.gov/dept/papers/pap04.pdf

Delegation language is very broad.

http://drl.wi.gov/dept/papers/pap05.pdf

WYOMING No Express Broad delegation language. Regulations

Prohibition defining the role of certified nursing

assistants.

No dialysis technician language.

http://nursing.state.wy.us/

Dialysis

Technician Dialysis Facility

State Legislation Legislation

ALABAMA NO CON

and Licensure

ALASKA NO

ARKANSAS NO

ARIZONA YES Licensure

Included with

facility licensure

law

CALIFORNIA YES Licensure

COLORADO NO Licensure

CONNECTICUT YES Licensure

DELAWARE NO

DISTRICT of NO CON

COLUMBIA

FLORIDA NO

GEORGIA Licensure

HAWAII NO CON

IDAHO NO NO

ILLINOIS NO Licensure law

passed; no rules

promulgated

INDIANA

IOWA

KANSAS

KENTUCKY Licensure

LOUISIANA Licensure

MAINE CON

Licensure

MARYLAND YES

MASSACHU- Licensure

SETTS

MICHIGAN

MINNESOTA

MISSISSIPPI CON

MISSOURI CON

MONTANA Dialysis technician

language in pro-

posed delegation

rules as of 1/05.

NEBRASKA YES

NEVADA Licensure

NEW Licensure

HAMPSHIRE

NEW JERSEY Licensure

NEW MEXICO YES Licensure

NEW YORK YES CON

Licensure

NORTH YES CON

CAROLINA

NORTH DAKOTA

OHIO YES CON

OKLAHOMA Proposed

Licensure Law

OREGON Licensure

PENNSYLVANIA

RHODE ISLAND YES Licensure

SOUTH YES Licensure

CAROLINA

SOUTH DAKOTA NO

TENNESSEE Licensure

TEXAS Licensure

UTAH

VERMONT

VIRGINIA

WASHINGTON CON

WEST VIRGINIA CON

WISCONSIN

WYOMING

Acknowledgement: The author would like to thank Kasia Januszewski Bartos, Esq., and Mary B. Snyder, MA, JD, Regulatory Affairs Manager, both of Fresenius Medical Care North America, for conducting much of the initial state-by-state research on which this final document is based.

Disclaimer: The information contained in the document is limited to the information published on Board of Nursing (BoN) websites, BoN advisory opinions, and the accessibility of other communications; rules and regulations. It is intended as a general reference tool to facilitate state-specific research, is current only through December 2004, does not constitute legal advice, and should not be used as a substitute for review of the actual statutes and regulations governing scope of practice in any jurisdiction.

Cathleen O’Keefe, JD, RN, is Executive Director, Regulatory, Government Affairs, and Compliance, Spectra, Laboratory Division of Fresenius at Fresenius Medical Care North America, Lexington, MA.

COPYRIGHT 2005 Jannetti Publications, Inc.

COPYRIGHT 2007 Gale Group