The Alabama Nurse Practice Act and the ABN Administrative Code are written broadly, to apply to nursing practice in any setting. As such, the ABN does not provide lists of tasks. Key elements that should be considered in determining which procedures/tasks a nurse, regardless of classification, can perform include:
- The nurse’s basic education
- The facility/agency/company policies and procedures
- ABN Administrative Code Chapter 610-X-6-.12, “Practice Beyond Basic Nursing Education: Standardized Procedures”
Standardized procedures are defined in Administrative Code Section 610-X-6-.01(21), which states: “Written policies and protocols establishing the permissible functions, activities, and level of supervision of registered nurses and licensed practical nurses for practice beyond basic nursing education preparation.” This rule requires that a facility/agency apply for and receive approval for standardized procedures for practice beyond basic nursing education. The application is available on the website under the “Nurses” tab/Standardized Procedures/Application. The standardized procedure process mandates that agencies/facilities develop policies and procedures approved by the chief nursing administrator, the chief medical officer, and the chief executive officer, as demonstrated by their signature on the application form. Additionally, the agency/facility must provide an organized program of study for staff, supervised clinical practice, and demonstration of competency that prepares nursing staff to expand the scope of practice for the selected procedure.
In accordance with ABN Administrative Code, Section 610-X-6-.12, any practice beyond a nurse’s basic education requires an application and subsequent approval by the Board. The process begins by completing an Application form found on the ABN website under the Nurses tab. The facility/agency/company chief nursing administrator, chief medical officer, and chief executive officer must approve the application by signing it. Accompanying this application must be the following:
- Policy and procedure, including level of supervision
- Organized program of study, including instructor qualification
- Plan for supervised clinical practice
- Plan for demonstration of competency, initially and at periodic intervals
- Approval
- Approval as a pilot project for a period of time not to exceed twelve months, with reports to the Board at intervals specified by the Board
- Denial of the request
The process begins by completing an application form found on the ABN website under the “Nursing Practice” tab. The facility/agency/company chief nursing administrator, chief medical officer, and chief executive officer must approve the application by signing it. Accompanying this application must be the following:
- Policy and procedure, including level of supervision
- Organized program of study including instructor qualification
- Plan for supervised clinical practice
- Plan for demonstration of competency, initially and at periodic intervals
- Approval
- Approval as a pilot project for a period of time not to exceed twelve months, with reports to the Board at intervals specified by the Board
- Denial of the request
ABN Administrative Code § 610-X-6-.11(3)(4) states that the licensed nurse shall delegate only after considering various factors, including but not limited to:
- Knowledge, skills, and experience of the person receiving the delegation
- Complexity of the delegated tasks
- Health status of the patient
- The exercise of independent nursing judgment or intervention
- Invasive or sterile procedures
- Finger sticks are not an invasive or sterile procedure within the meaning of these rules
- Peripheral venous phlebotomy for laboratory analysis is not an invasive or sterile procedure within the meaning of these rules
- Assistance with medications except as provided in Chapter 610-X-7 and 610-X-14
The Alabama Nurse Practice Act states: “In order to safeguard life and health, any person practicing or offering to practice professional nursing or practical nursing in this state, for compensation, shall hereafter be required to submit evidence that he or she is qualified so to practice and shall be licensed as hereinafter provided.” ABN Administrative Code §610-X-4-.16(4) states: “Telephonic or electronic services used to communicate with patients and provide direction regarding nursing and medical care require an active license to practice nursing in Alabama.” Therefore, any nurse who is using his/her nursing education and judgment in the care of patients living in Alabama, whether telephonically or in person, must have an Alabama nursing license. Applications for licensure by endorsement, including the instructions and requirements, are available on our website: www.abn.alabama.gov.
A student’s role with faculty supervision does not carry over to a role as an unlicensed employee of the hospital, when the nursing student is working as a nursing assistant or patient care technician. However, nursing students working in the classification of Nursing Student Aide may have an expanded role, as defined in ABN Administrative Code §610-X-7-.12 and your facility policies and procedures.
As defined in the Alabama Board of Nursing Administrative Code, Chapter 610-X-4-.04(5bi)(5bii), the stipulations that impact the nursing graduate with a temporary permit include:
- The Nursing Graduate must function under direct supervision of a currently licensed registered nurse.
- The Nursing Graduate shall not assume nor be assigned charge responsibilities.
Nurse:patient ratio and number of hours worked is left to the discretion of nursing leadership in individual facilities and agencies. Their decision should be based upon ABN Administrative Code §610-X-6-.03(4), which states that the registered nurse and licensed practical nurse shall “be responsible and accountable for the quality of nursing care delivered to patients based on and limited to scope of education, demonstrated competence and nursing experience.” Supervisors have responsibility for the care provided to patients as directed in Administrative Code §610-X-6-.03(5), which states, “the registered nurse and licensed practical nurse shall be responsible and accountable for the quality of nursing care delivered to patients by nursing personnel under the individual nurse’s supervision.”
The name on the license originates from the nurse’s application for Alabama licensure. The name remains the same, unless the nurse requests a name change in writing from the Board. The request may be made online at the ABN website: www.abn.alabama.gov. A name change will not be processed until appropriate documentation is received by the Board. Please visit My Profile to request a name change and upload the required documentation. Facility policy dictates whether to allow nametags to reflect the name on the license or another name.
The Alabama Board of Nursing does not maintain a position regarding competency determination. Several rules regarding competency must be considered by the facility, the nursing supervisor, and the nurse. Excerpts from the ABN Administrative Code are listed below: Rule 610-X-6-.03 (4) – “The registered nurse and licensed practical nurse shall: Be responsible and accountable for the quality of nursing care delivered to patients based on and limited to scope of education, demonstrated competence, and nursing experience.” Rule 610-X-6-.03 (5) – “The registered nurse and licensed practical nurse shall: Be responsible and accountable for the quality of nursing care delivered to patients by nursing personnel under the individual nurse’s supervision.” Rule 610-X-6-.03 (7) – – “The registered nurse and licensed practical nurse shall: Accept individual responsibility and accountability for judgments, actions and nursing competency, remaining current with technology and practicing consistent with facility policies and procedures.” Rule 610-X-6-.04(2) (a)(b)(c)(d) and 610-X-6-.05(2) (a)(b)(c)(d) – “Competence in the practice of nursing by a… [registered nurse/licensed practical nurse] …shall include, but is not limited to:
- Knowledge and compliance with:
- Applicable statutes and regulations;
- Standards of nursing practice; and
- Standardized procedures for nursing practice including but not limited to facility policies and procedures.
- Maintenance of knowledge and skills in the area of practice
- Assumption of responsibility for recognizing personal limits of knowledge and experience
- Consulting with or referring patients to other healthcare providers to resolve situations beyond the expertise of the registered nurse/practical nurse
In accordance with ABN Administrative Code § 610-X-6-.14(7), Intravenous (IV) Therapy by Licensed Practical Nurses, an LPN may administer blood and blood components, after the facility has submitted a Standardized Procedure application and received approval from the ABN.
The following must accompany the application:
- Policy and procedure, including level of supervision
- Organized program of study, including instructor qualification(s)
- Plan for supervised clinical practice
- Plan for demonstration of competency, initially and at periodic intervals
Stock bottles of medication for multiple campers are unacceptable. Medications must be camper specific and have specific instructions as to when or why such medicines may be necessary. It is the responsibility of the nurse to determine whether the OTC medicine is appropriate and whether a provider order is necessary.
Repackaging of medications by nurses, other than those who work in Public Health clinics, is a violation of state law.
The label will suffice if:
- The label is legible, properly identified and has the name of the camper and
- The orders are clear regarding the administration of the medication
Providing nursing care at a camp in Alabama for more than seven (7) days in a calendar year requires a license to practice nursing in Alabama.
Yes. Compensation includes services.
Without a direct physician order, you can perform basic nursing care, such as vital signs and physical assessments. You can also provide emergency first aid.
The camp should have a clear policy regarding self-administration.
The camper may be able to self-administer the Epi-pen. If not, a counselor who has been trained can assist the camper or administer the emergency injection with the written consent of the parent/guardian and prescriber.
A nurse should administer the Glucagon.
You should maintain documentation that includes, but is not limited to:
- Camper’s medical history including any food or drug allergies
- Camper’s medication history including any allergies
- List of medications being taken by each camper
- Medication Administration Record
- Record to document any nursing assessment or care provided
- Emergency consent signed by parent/guardian
- Name and telephone number of primary care physician
- Emergency contact information
The law requires that the nursing care provided by an LPN be under the direction of a registered nurse or physician.
In September 2004, the Alabama Board of Medical Examiners issued an opinion stating that procedures involving Botox, Restylane, Collagen, and Mesotherapy are be the practice of medicine and, as such, each procedure must be performed by a licensed physician.
In March 2006, the Alabama Board of Medical Examiners issued a subsequent opinion, affirmed by the Alabama Board of Nursing, that the nurse’s injection of Botox is within the scope of nursing practice, when the nurse is assisting a physician who is actively involved in a procedure, such as in the Gastrointestinal Endoscopy laboratory.
According to Alabama Board of Pharmacy, a licensed nurse may prefill a patient’s medication planner only if all of the following criteria are met:
- The medication planner is filled by the licensed nurse at the individual patient’s home for use by the individual patient in the patient’s home. The patient’s home does not include an assisted living facility, nursing home, community residential facility, or other group home.
- The medications are legend drugs, over-the-counter drugs, vitamins, or food supplements, which have been ordered by a legally authorized prescriber. No controlled drugs may be removed from their packaging and placed in a planner.
- The legend medications have been dispensed by a pharmacist or dispensing physician directly to the patient.
- The licensed nurse prefills the medication planner pursuant to agency policy and procedure that includes compliance with all relevant standards of practice.
The Board does not issue rulings on specific medications. The general rules governing medication administration are included in ABN Administrative Code 610-X-6-.07, “Medication Administration And Safety,” as follows: “The RN or LPN shall not administer medications for anesthetic purposes or to render an individual unconscious without meeting the requirements of Chapter 610-X-9-.02.” [“Application For Approval To Practice As A Certified Registered Nurse Anesthetist”] However, RNs may be authorized to administer medications for Moderate Sedation in accordance with Standards established in Chapter 610-X-6-.08 and always within scope of practice. Rule 610-X-6-.07(5): “Administration of medications by routes beyond basic educational preparation, including but not limited to intrathecal, intracavitary, intraosseous require a standardized procedure.” For administration of any medication, the nurse is expected to utilize a complex set of knowledge, skills, and abilities necessary to ensure the safety of the individual receiving the medication. The components of medication administration are listed below.
- Knowledge
- Drug action, classifications
- Expected therapeutic benefit of medication
- Expected monitoring
- Illness or injury processes
- Developmental stages
- Possible side effects/adverse reactions & interventions for same
- Emergency interventions for anaphylactic reactions
- Seven rights of administration
- Drug/Drug and Food/Drug Interactions
- Calculation of drug dosages
- Federal and state legal requirements related to storage, controlled substances, etc.
- Decision-Making
- When, how, and whether medications should be administered
- Assessment of individual’s complaint prior to administering PRN medications
- When to contact the prescriber
- Skills
- Dexterity to open medication packaging
- Read, write English
- Read, write, and comprehend Latin phrases relevant to administration of medication
- Measuring medication dosages
- Math calculations
- Routes of administration
- Documentation
- Administration
- Therapeutic effect
- Principles of documentation
- Seven rights of administration
- Controlled drug records per federal and state law
In accordance with the Alabama Nurse Practice Act, Section 21-21-1, the Professional Nurse and the Licensed Practical Nurse administer medications prescribed by the licensed or otherwise authorized physician or dentist. If there is a physician’s order and the pre-packaged sample has been appropriately labeled with the name of medication, strength per dosage unit, directions for use, and physician’s name, the nurse may hand the properly labeled packaged medication to the patient.
The Alabama Board of Nursing does not have rules or make recommendations on any specific medication. Several rules must be considered, including, but not limited to, ABN Administrative Code Rule 610-X-6-.07, “Medication Administration and Safety,” Rule 610-X-6-.12, “Standardized Procedures”, and Rules 610-X-6-.04 and 610-X-6-.05, “Practice of Professional Nursing” and “Practice of Practical Nursing.” Once the rules have been reviewed and a determination has been made that the administration (including route of administration) is within basic education and scope of practice, the presence of any black box warnings by the FDA must be explored. If no black box warnings against a nurse administering the medication exist, and the nurse has the knowledge of the medication(s), including routes of administration, as required in the rules, a facility/agency policy must be written that includes the knowledge, skills, and abilities that the nurse must have to manage risks and any potential complications. The policy also should include requirements for supervised clinical practice and demonstration of competency, initially and at periodic intervals.
LPNs are prohibited from administering any medications via IV push in any practice setting, unless the facility/agency has applied for a standardized procedure and it has been approved by the Board, per Administrative Code Rule 610-X-6-.14. The minimum requirements found in Rule 610-X-6-.14 that must be included in the Standardized Procedure application include:
- On-site supervision by a registered nurse any time IV push medication therapy is performed by a licensed practical nurse. The registered nurse is required to be physically present and immediately available in the facility.
- According to Rule 610-X-6-.12(2), there shall be evidence of successful completion of an organized program of study, supervised clinical practice, and demonstrated clinical competence.
- The minimum training for the LPN who performs selected tasks associated with IV therapy shall include:
- Anatomy and physiology
- Fluid and electrolyte balance
- Equipment and procedures in intravenous therapy
- Complications, prevention, and nursing intervention
- Introducing a peripheral intravenous device on an adult patient
- Set-up, replaces, and removes intravenous tubing for gravity flow and/or pump infusion
- Intravenous fluid infusion calculations and adjustment of flow rates on intravenous fluids and administration of intravenous medications by piggyback
- Procedures for reconstituting and administering intravenous medications via piggyback, including, but not limited to, pharmacology, compatibilities, and flow rates
- The minimum training for the LPN who performs selected tasks associated with IV Push therapy shall include:
- Pharmacology of specific drugs and reversal agents, if applicable, including, but not limited to:
- Classification
- Indications
- Usual IV dosage
- Dilution
- Contraindications and precautions
- Side effects
- Antidote, if applicable
- Nursing considerations and implications
- Procedure for reconstituting medications including compatibilities
- Technique of medication administration by IV push
- Pharmacology of specific drugs and reversal agents, if applicable, including, but not limited to:
Standardized procedures are defined in Administrative Code Section 610-X-6-.01(21), which states: “Written policies and protocols establishing the permissible functions, activities, and level of supervision of registered nurses and licensed practical nurses for practice beyond basic nursing education preparation.” This rule requires that a facility/agency apply for and receive approval for standardized procedures for practice beyond basic nursing education. The application is available on the website under the “Nurses” tab/Standardized Procedures/Application. The standardized procedure process mandates that agencies/facilities develop policies and procedures approved by the chief nursing administrator, the chief medical officer, and the chief executive officer, as demonstrated by their signature on the application form. Additionally, the agency/facility must provide an organized program of study for staff, supervised clinical practice, and demonstration of competency that prepares nursing staff to expand the scope of practice for the selected procedure.
In accordance with ABN Administrative Code, Section 610-X-6-.12, any practice beyond a nurse’s basic education requires an application and subsequent approval by the Board. The process begins by completing an Application form found on the ABN website under the Nurses tab. The facility/agency/company chief nursing administrator, chief medical officer, and chief executive officer must approve the application by signing it. Accompanying this application must be the following:
- Policy and procedure, including level of supervision
- Organized program of study, including instructor qualification
- Plan for supervised clinical practice
- Plan for demonstration of competency, initially and at periodic intervals
- Approval
- Approval as a pilot project for a period of time not to exceed twelve months, with reports to the Board at intervals specified by the Board
- Denial of the request
The submission begins with completion of an application form found on the ABN website under “Nursing Practice.” This application form must be approved by the facility/agency/company chief nursing administrator, chief medical officer and chief executive officer as evidenced by their respective signatures.
Accompanying this application form must be the following:
- Policy and procedure including level of supervision
- Organized program of study including instructor qualification
- Plan for supervised clinical practice
- Plan for demonstration of competency, initially and at periodic intervals
- Approval
- Approval as a pilot project for a period of time not to exceed twelve months with reports to the Board at intervals specified by the Board
- Denial of the request
The ABN Administrative Code includes rules specific to school nursing in section 610-X-7-.02 – Delegation by School. This section only applies to delegation to unlicensed personnel. In addition, school nurse practice is also governed by Nurse Practice Act and general nursing practice rules in the ABN Administrative Code, regardless of practice setting. The Alabama Department of Education provides additional policies and resources for school nurses. Please access: http://www.alsde.edu/#, select Support Systems>Preventions and Support Services. Then, select the Alabama School Health tab.
The provision of nursing care to students from another state, while accompanying them to Alabama, requires an Alabama nursing license, but only if the care in Alabama extends beyond seven (7) calendar days.
Please contact the Board of Nursing in the destination state for its notification and licensure requirements.
Medications should be stored in a securely locked, clean container or cabinet, unless the prescriber authorizes a different arrangement (e.g. asthma inhalers) for specific students. Controlled substances should be double-locked to ensure security. Medications that require refrigeration should be refrigerated in a secure, locked area.
School personnel should not give any substance that could be construed as a drug or medication, including natural remedies, herbs, and nutritional supplements, without the explicit order of an authorized prescriber, parent authorization, verification that the product is safe to administer to children in the prescribed dosage, and reasonable information regarding therapeutic and untoward effects (Curriculum to Teach Unlicensed to Assist with Medication Administration, page 44). The complete Curriculum may be found on the Alabama State Department of Education website. The Alabama Department of Education provides additional policies and resources for school nurses. Please access: http://www.alsde.edu/#, select Support Systems>Preventions and Support Services. Then, select the Alabama School Health tab.