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Commonly Asked Questions - Nursing Assistant

Overview

The broadly written laws and rules allow nurses to practice to their full scope of practice in any setting. It is impossible for the Nursing Care Quality Assurance Commission (NCQAC) to provide a comprehensive listing of the duties that licensed nurses are permitted to perform since nursing practice is reflective of the dynamic changes occurring in healthcare and society. The Revised Code of Washington (RCW) 18.79 and Washington Administrative Code (WAC) 246-840 provide the statutory and legal basis of nursing practice. The nursing commission provides advisory opinions and interpretive statements about specific areas of nursing practice.

These commonly asked questions and answers offer information and general guidance regarding the practice of professional nursing in the State of Washington and do not constitute legal advice. You should contact your legal advisor to obtain advice with respect to any particular issue or problem.

If you have a question related to nursing practice in the state of Washington, please contact nursingpractice@doh.wa.gov or arnppractice@doh.wa.gov for questions about advanced nursing practice.

Portable Orders for Life Sustaining Treatment
What is a Portable Order for Life Sustaining Treatment (POLST) form?

POLST is a set of portable medical orders, executed by an adult patient (or legal surrogate) and the patient's medical provider, to guide medical treatment based on the patient's current medical condition and goals.

POLST is usually for persons with serious illness or frailty. The “rule of thumb” is to recommend POLST for patients if their provider would not be surprised if they die within a year. Advanced care planning is thoughtful conversations between health care professionals, the patient and/or surrogate.

It is within the scope of the appropriately prepared and competent LPN to discuss end-of-life care with the patient or surrogate under the direction of an authorized health care practitioner or under the direction and supervision of the registered nurse (RN).

For more information and resources on POLST, go to:

Prevention and Treatment of Opioid-Related Overdoses
What opioid antagonists are commonly prescribed to reverse the effects of opioid overdose?

Opioid antagonists reverse the effects of an opioid overdose. Naloxone (Narcan®) is the current standard of treatment for opioid overdose. The Food and Drug Administration (FDA) approves administration by intravenous, intramuscular, or subcutaneous routes; a hand-held auto-injector (Evzio®) for intramuscular or subcutaneous injection; and, in 2018, approved the first generic Naloxone Hydrochloride nasal spray. These are legend drugs, and not categorized as a controlled substance. Naloxone has not been shown to produce tolerance or cause physical or psychological pain. It will produce withdrawal symptoms. Severity and duration of the withdrawal relate to the dose of naloxone and the degree and type of opioid dependency. See the Washington State Department of Health Overdose Education and Naloxone Distribution Webpage for more information.

Is the Nursing Assistant required to carry naloxone?

RCW 69.41.095 does not require the Nursing Assistant to carry an opioid antagonist, such as naloxone. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

Can the Nursing Assistant administer naloxone to a patient who has a prescription for a suspected opioid overdose?

The Nursing Assistant may administer an opioid antagonist (such as naloxone) by injection or by the intranasal route. The Nursing Assistant must have a valid prescription, either in the Nursing Assistant's name, in the name of an entity, in the name of a person/patient, or following a standing order approved by an authorized health care practitioner. For more information, go to the Washington State Department of Overdose Education and Naloxone Distribution Website.

Can the Nursing Assistant carry naloxone for emergent administration for suspected overdose and administer it to an unknown person?

RCW 69.41.095 allows the Nursing Assistant, or any person, to carry and administer an opioid antagonist (such as naloxone) to a person suspected of experiencing an opioid overdose in any setting. The Nursing Assistant must have a valid prescription, either in the Nursing Assistant's name, in the name of an entity, in the name of a person/patient, or following a standing order approved by an authorized health care practitioner.

Can the Nursing Assistant get a prescription for naloxone?

The Nursing Assistant may get a prescription from a pharmacist with a Collaborative Drug Therapy Agreement (CDTA), or use the Washington State Department of Health Statewide Standing Order to Dispense Naloxone. Anyone can take this standing order to a pharmacy to get a prescription. The Nursing Assistant may also get a prescription in their own name from their health care practitioner. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

Can the Nursing Assistant distribute naloxone?

RCW 69.41.095 allows the Nursing Assistant with a prescription, or following standing orders, to possess, store, deliver, distribute, or administer an opioid antagonist (such as naloxone) to a person at risk of experiencing an opioid related overdose. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

Is the Nursing Assistant required to have a special certification or specific training to distribute or administer naloxone for a suspected drug opioid overdose?

The Nursing Assistant is not required to have a specific training course or certification. Stop Overdose.com offers education, resources, and technical assistance for individuals, professionals, and communities in Washington State who want to learn to prevent and respond to overdose and improve the health of people who use drugs. An employer or institution may have specific training or certification requirements. For more information and training resources, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

Can the Nursing Assistant get a prescription to carry and administer naloxone in a non-work setting?

RCW 69.41.095 allows the Nursing Assistant to have a prescription for an opioid antagonist (such as naloxone) in the Nursing Assistant's name to carry and administer in the non-work setting. The Nursing Assistant may carry and administer an opioid antagonist in a suspected opioid overdose whether the person is a family member, friend, stranger, or a patient. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

Is Registered Nursing Delegation required for the Nursing Assistant to administer naloxone to a patient for a suspected opioid overdose?

RCW 69.41.095 provides an exception to the nursing delegation laws and rules and does not require Registered Nursing delegation to the Nursing Assistant to administer naloxone. The Nursing Assistant may administer an opioid antagonist (such as naloxone) to an assigned patient by intranasal spray or injection without delegation. This may be done for the patient with a prescription, using an entity's prescription, or done using the Nursing Assistant's personal naloxone prescription. Any person or entity may lawfully possess, store, deliver, distribute, or administer an opioid overdose reversal medication with a prescription or standing order. For more information, go to the Washington State Department of Health Overdose Education and Naloxone Distribution Website.

Telemedicine Training Requirements
Is the Nursing Assistant required to take telemedicine training?

The nursing assistant-registered (NA-R)/nursing assistant-certified (NA-C) is not required to take telemedicine training. It is not within the scope of practice of the NA-R/NA-C to function as a clinical provider for the purpose of diagnosis, consultation, or treatment. The NA-R/NA-C must function under the direction and supervision of a nurse. The NA-R/NA-C may function in the role of telepresenter to facilitate the visit including supporting communications, clinical (within their scope of practice), and technical workflows through the tele-encounter process.

RCW 43.70.495 requires health care professionals who provide clinical services through telemedicine independently or under the direction of an authorized health care practitioner to complete telemedicine training. “Telemedicine” as defined in RCW 70.41.020(13) means, “the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment [but] does not include the use of audio-only telephone, facsimile, or email.”