DO YOU KNOW THE ANSWERS TO THESE CRITICAL QUESTIONS?
- When you are talking to a patient in another state, where are you practicing...in your state or in theirs?
- Is interstate practice legal, and if so, under what circumstances?
- If you are speaking with your own patient who is vacationing (or a "snow bird" in another state), must you be licensed in that state?
- May you recommend prescription medications according to a medically approved protocol?
- Is it within your scope of practice to independently recommend OTC drugs to patients?
- What are the differences between the scope of practice of RNs and LP/VNs as it pertains to the practice of Telephone Triage?
- What are the rules governing the use of UAPs (unlicensed assistive personnel) in providing care to patients by phone?
THE ANSWERS TO THESE AND OTHER QUESTIONS VARY FROM STATE TO STATE. WHERE DOES YOUR STATE STAND ON THESE ISSUES?
Nurse Licensure Compact
TELEPHONE TRIAGE AND SCOPE OF PRACTICE
Carol Rutenberg has been recognized as a leading authority on Telephone Triage and Scope of Nursing Practice. The findings of her study on this topic have been published in Telephone Triage Times (April and May, 1999) and Viewpoint (January, 2000). This information was first presented at the Contemporary Forums Conference, Essentials for Expert Practice in 1998 and have been provided to the 50 state boards of nursing and the National Council for State Boards of Nursing (NCSBN). A copy of the Executive Summary shared with the boards of nursing is available for review.
Boards of Nursing vary on their positions relative to Telephone Triage nursing practice. Specifically, wide variability exists regarding recommendation of medications according to medically approved protocols and recommendation of over-the-counter medications with (or without) protocols. In 1999, twenty-six states agreed that it is within scope of practice for RNs to recommend prescription drugs and 32 states said that RNs could recommend over-the-counter medications (most requiring protocol). Twenty states reported that it is within scope of practice for LPNs and LVNs to triage patients by telephone (19/20 stating that this must be done with adequate supervision). However, only 11 states responded that LPNs/LVNs could recommend prescription medications according to protocol and only 15 states felt that this was acceptable practice in reference to over-the-counter medications.
Recommendation of Meds
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OTC (without protocol)
OTC (with protocol)
LPN / LVN
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OTC (without protocol)
OTC (with protocol)
A second survey, conducted in 2001, (findings were presented at the AAACN National Convention that year), found that only 14 states felt that telephone triage was within the scope of practice of the LPN/LVN. Additionally, results regarding recommendation of medications continued to vary from state to state.
A third study has been conducted and data is currently being compiled and analyzed. In addition to questions about recommendation of medications with protocols and the role of LPNs/LVNs, clarification of the states' positions on licensure requirements involving interstate care to patients who are in their state temporarily (snowbirds, vacationers) has been sought. [Preliminary findings suggest that licensure is generally required for care of snowbirds and at least half of the states currently feel that licensure is required for care of vacationers.]
Interstate Practice Issues
88% (43/49*) require licensure in their state"Snow Birds"
80% (39/49*) require licensure in their state Vacationers / Business Travelers
59% (29/49*) require licensure in their state
*to date, no response has been received from Michigan
Dialogue is critically needed to address ambiguity in policy and inconsistency among the State Boards of Nursing relative to the practice of Telephone Triage. For information about scope of practice relative to Telephone Triage in your state, please contact your board of nursing at the website provided by the National Council of State Boards of Nursing.
FOR MORE INFORMATION:
- Visit the NCSBN website to get up to date information on the Nurse Licensure Compact and to find out how to contact your board of nursing;
- The NCSBN posts an up-to date chart and map of current Interstate Compact status and updates this chart as legislative action takes place;
- Find contact information so you may review the nurse practice act for your state and search for policies, declaratory rulings, position papers or FAQs on telephone triage
Conflicts and Controversies Regarding Scope of Practice
(Executive Summary of Study Given to Boards of Nursing Feb, 2000)
“Talking Paper” and PowerPoint presentation for Telephone Triage and Scope of Practice.
(Content presented at the AAACN Annual Conference in Atlanta , March, 2006)
Rutenberg, C. (2000). Nursing licensure: states' conflicting stances pose challenges. AAACN Viewpoint, 22(1), pp. 1, 5-8. (PDF)
Reprinted with permission of the publisher, American Academy of Ambulatory Care Nursing, East Holly Avenue Box 56, Pitman, NJ 08071-0056; Phone 800.AMB.NURS; FAX 609.589.7463
Rutenberg, C. (1999). Telephone triage: A practice in search of standards, Parts I & II. Telephone Triage Times, 2(4 ), pp. 4-7; 2(5), pp. 7-9.
Reprinted with Permission of Telephone Triage Times. For more information about this publication please call 770.457.6106