Chapter N 6

N 6.01(2) (2) The intent of the board of nursing in adopting this chapter is to specify minimum practice standards for which R.N.s and L.P.N.s are responsible, and to clarify the scope of practice for R.N.s and L.P.N.s.

N 6.01 History History: Cr. Register, May, 1983, No. 329, eff. 6-1-83; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register, May, 1990, No. 413; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register June 2006 No. 606.

N 6.02 N 6.02 Definitions. As used in this chapter,

N 6.02(1) (1) “Advanced practice nurse prescriber” means a registered nurse who holds an advance practice nurse prescriber certificate under s. 441.16, Stats.

N 6.02(1m) (1m) “Basic nursing care” means care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable.

N 6.02(2) (2) “Basic patient situation” as determined by an R.N., physician, podiatrist, dentist or optometrist means the following 3 conditions prevail at the same time in a given situation:

N 6.02(2)(a) (a) The patient’s clinical condition is predictable;

N 6.02(2)(b) (b) Medical or nursing orders are not changing frequently and do not contain complex modifications; and,

N 6.02(2)(c) (c) The patient’s clinical condition requires only basic nursing care.

N 6.02(3) (3) “Complex patient situation” as determined by an R.N., physician, podiatrist, dentist or optometrist means any one or more of the following conditions exist in a given situation:

N 6.02(3)(a) (a) The patient’s clinical condition is not predictable;

N 6.02(3)(b) (b) Medical or nursing orders are likely to involve frequent changes or complex modifications; or,

N 6.02(3)(c) (c) The patient’s clinical condition indicates care that is likely to require modification of nursing procedures in which the responses of the patient to the nursing care are not predictable.

N 6.02(5) (5) “Delegated act” means acts delegated to a registered nurse or licensed practical nurse.

N 6.02(6) (6) “Direct supervision” means immediate availability to continually coordinate, direct and inspect at first hand the practice of another.

N 6.02(7) (7) “General supervision” means regularly to coordinate, direct and inspect the practice of another.

N 6.02(8) (8) “Nursing diagnosis” means a judgment made by an R.N. following a nursing assessment of a patient’s actual or potential health needs for the purpose of establishing a nursing care plan.

N 6.02(9) (9) “Patient” means a person receiving nursing care by an R.N. or L.P.N. performing nursing services for compensation.

N 6.02(10) (10) “Protocol” means a precise and detailed written plan for a regimen of therapy.

N 6.02(10m) (10m) “Provider” means a physician, podiatrist, dentist, optometrist or advanced practice nurse provider.

N 6.02 Note Note: There was an inadvertent error in CR 15-099. “Advanced practice nurse provider” should be “advanced practice nurse prescriber” consistent with sub. (1) and s. 441.16, Stats. The error will be corrected in future rulemaking.

N 6.02(11) (11) “R.N.” means a registered nurse licensed under ch. 441, Stats., or a nurse who has a privilege to practice in Wisconsin under s. 441.51, Stats.

N 6.02(12) (12) “L.P.N.” means a licensed practical nurse licensed under ch. 441, Stats., or a nurse who has a privilege to practice in Wisconsin under s. 441.51, Stats.

N 6.02 History History: Cr. Register, May, 1983, No. 329, eff. 6-1-83; reprinted to correct error in (7), Register, July, 1983, No. 331; am. (5) and (12), Register, May, 1990, No. 413, eff. 6-1-90; CR 00-167: am. (2) (intro.), (3) (intro.) and (4), Register August 2001 No. 548, eff. 9-1-01; CR 15-099: renum. (1) to (1m), cr. (1) r. (4), r. and recr. (5), cr. (10m), am. (11), (12) Register August 2016 No. 728, eff. 9-1-16; correction in (1) made under s. 35.17, Stats., Register August 2016 No. 728, eff. 9-1-16; correction in (11), (12) made under s. 13.92 (4) (b) 7., Stats., Register December 2018 No. 756.

N 6.03 N 6.03 Standards of practice for registered nurses.

N 6.03(1) (1) General nursing procedures. An R.N. shall utilize the nursing process in the execution of general nursing procedures in the maintenance of health, prevention of illness or care of the ill. The nursing process consists of the steps of assessment, planning, intervention and evaluation. This standard is met through performance of each of the following steps of the nursing process:

N 6.03(1)(a) (a) Assessment. Assessment is the systematic and continual collection and analysis of data about the health status of a patient culminating in the formulation of a nursing diagnosis.

N 6.03(1)(b) (b) Planning. Planning is developing a nursing plan of care for a patient which includes goals and priorities derived from the nursing diagnosis.

N 6.03(1)(c) (c) Intervention. Intervention is the nursing action to implement the plan of care by directly administering care or by directing and supervising nursing acts delegated to L.P.N.’s or less skilled assistants.

N 6.03(1)(d) (d) Evaluation. Evaluation is the determination of a patient’s progress or lack of progress toward goal achievement which may lead to modification of the nursing diagnosis.

N 6.03(2) (2) Performance of delegated acts. In the performance of delegated acts an R.N. shall do all of the following:

N 6.03(2)(a) (a) Accept only those delegated acts for which there are protocols or written or verbal orders.

N 6.03(2)(b) (b) Accept only those delegated acts for which the R.N. is competent to perform based on his or her nursing education, training or experience.

N 6.03(2)(c) (c) Consult with a provider in cases where the R.N. knows or should know a delegated act may harm a patient.

N 6.03(2)(d) (d) Perform delegated acts under the general supervision or direction of provider.

N 6.03(3) (3) Supervision and direction of delegated acts. In the supervision and direction of delegated acts an R.N. shall do all of the following:

N 6.03(3)(a) (a) Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised.

N 6.03(3)(b) (b) Provide direction and assistance to those supervised.

N 6.03(3)(c) (c) Observe and monitor the activities of those supervised.

N 6.03(3)(d) (d) Evaluate the effectiveness of acts performed under supervision.

N 6.03 History History: Cr. Register, May, 1983, No. 329, eff. 6-1-83; am. (1) (c) and (2) (intro.), Register, May, 1990, No. 413, eff. 6-1-90; CR 00-167: am. (2) (c) and (d), Register August 2001 No. 548, eff. 9-1-01; CR 15-099: am. (2), (3) (intro.), (a) to (c) Register August 2016 No. 728, eff. 9-1-16.

N 6.04 N 6.04 Standards of practice for licensed practical nurses.

N 6.04(1) (1) Performance of acts in basic patient situations. In the performance of acts in basic patient situations, the L.P.N. shall, under the general supervision of an R.N. or the direction of a provider:

N 6.04(1)(a) (a) Accept only patient care assignments which the L.P.N. is competent to perform.

N 6.04(1)(b) (b) Provide basic nursing care.

N 6.04(1)(c) (c) Record nursing care given and report to the appropriate person changes in the condition of a patient.

N 6.04(1)(d) (d) Consult with a provider in cases where an L.P.N. knows or should know a delegated act may harm a patient.

N 6.04(1)(e) (e) Perform the following other acts when applicable:

N 6.04(1)(e)1. 1. Assist with the collection of data.

N 6.04(1)(e)2. 2. Assist with the development and revision of a nursing care plan.

N 6.04(1)(e)3. 3. Reinforce the teaching provided by an R.N. provider and provide basic health care instruction.

N 6.04(1)(e)4. 4. Participate with other health team members in meeting basic patient needs.

N 6.04(2) (2) Performance of acts in complex patient situations. In the performance of acts in complex patient situations the L.P.N. shall do all of the following:

N 6.04(2)(a) (a) Meet standards under sub. (1) under the general supervision of an R.N., physician, podiatrist, dentist or optometrist.

N 6.04(2)(b) (b) Perform delegated acts beyond basic nursing care under the direct supervision of an R.N. or provider. An L.P.N. shall, upon request of the board, provide documentation of his or her nursing education, training or experience which prepares the L.P.N. to competently perform these assignments.

N 6.04(3) (3) Assumption of charge nurse position in nursing homes. In assuming the position of charge nurse in a nursing home as defined in s. 50.04 (2) (b), Stats., an L.P.N. shall do all of the following:

N 6.04(3)(a) (a) Follow written protocols and procedures developed and approved by an R.N.

N 6.04(3)(b) (b) Manage and direct the nursing care and other activities of L.P.N.s and nursing support personnel under the general supervision of an R.N.

N 6.04(3)(c) (c) Accept the charge nurse position only if prepared for the responsibilities of charge nurse based upon education, training and experience beyond the practical nurse curriculum. The L.P.N. shall, upon request of the board, provide documentation of the nursing education, training or experience which prepared the L.P.N. to competently assume the position of charge nurse.

N 6.04 History History: Cr. Register, May, 1983, No. 329, eff. 6-1-83; CR 00-167: am. (1) (intro.), (d), (e) 3., (2) (a) and (b), Register August 2001 No. 548, eff. 9-1-01; CR 15-099: am. (1) (intro.), (a) to (d), (e) (intro.), 1. to 3., am. (2) (intro.), (b), (3) (intro.), (a), (b), r. and recr. (3) Register August 2016 No. 728.

N 6.05 N 6.05 Violations of standards. A violation of the standards of practice constitutes unprofessional conduct or misconduct and may result in the board limiting, suspending, revoking or denying renewal of the license or in the board reprimanding an R.N. or L.P.N.

N 6.05 History History: Cr. Register, May, 1983, No. 329, eff. 6-1-83; am. Register, May, 1990, No. 413, eff. 6-1-90.