How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask A. Schuyler, NP Your Own Question

A. Schuyler, NP
A. Schuyler, NP, Nurse Practitioner
Category: Health
Satisfied Customers: 14868
Experience:  Board Certified NP, MS, RN. Private practice & hospitalist
Type Your Health Question Here...
A. Schuyler, NP is online now
A new question is answered every 9 seconds

In New Jersey, can an LPN, under the supervision of an ...

Customer Question

In New Jersey, can an LPN, under the supervision of an RN, replace, change, or reinsert a NG tube (nasal-gastric tube)?

Where can you find clear distinctions between what an LPN can do as opposed to an RN?
Submitted: 7 years ago.
Category: Health
Expert:  A. Schuyler, NP replied 7 years ago.

Hello,Customer

The NG tube answer is "It depends."

Since the LPN is operating under the supervision of an RN, and the RN is ultimately responsible for the outcome (and her/his license is on the line), the decision remains with the RN whether a certain task will be delegated or not.

As for where you will find clear-cut distinctions, all you can do is check the rules and regulations at the BON and at your facility. Sometimes there are facility/unit protocols, under which trained individuals are allowed to do things that would normally be out of their scope of practice under the protocol.

Here is the link to the New Jersey Board of Nursing.

http://www.state.nj.us/lps/ca/medical/nursing.htm

Under Regulations, see 13:37-6.2 Delegation of Selected Nursing Tasks, which reads:

"13:37-6.2 Delegation of selected nursing tasks

(a) The registered professional nurse is responsible for the nature and quality of all nursing care including the assessment of the nursing needs, the plan of nursing care, the implementation, and the monitoring and evaluation of the plan. The registered professional nurse may delegate selected nursing tasks in the implementation of the nursing regimen to licensed practical nurses and ancillary nursing personnel. Ancillary nursing personnel shall include but not be limited to: XXXXX XXXXX attendants and technicians.

(b) In delegating selected nursing tasks to licensed practical nurses or ancillary nursing personnel, the registered professional nurse shall be responsible for exercising that degree of judgment and knowledge reasonably expected to assure that a proper delegation has been made. A registered professional nurse may not delegate the performance of a nursing task to persons who have not been adequately prepared by verifiable training and education. No task may be delegated which is within the scope of nursing practice and requires:

1. The substantial knowledge and skill derived from completion of a nursing education program and the specialized skill, judgment and knowledge of a registered nurse;

2. An understanding of nursing principles necessary to recognize and manage complications which may result in harm to the health and safety of the patient.

(c) The registered professional nurse shall be responsible for the proper supervision of licensed practical nurses and ancillary nursing personnel to whom such delegation is made. The degree of supervision exercised over licensed practical nurses and ancillary nursing personnel shall be determined by the registered professional nurse based on an evaluation of all factors including:

1. The condition of the patient;

2. The education, skill and training of the licensed practical nurse and ancillary nursing personnel to whom delegation is being made;

3. The nature of the tasks and the activities being delegated;

4. Supervision may require the direct continuing presence or the intermittent observation, direction and occasional physical presence of a registered professional nurse. In all cases, the registered professional nurse shall be available for on-site supervision.

(d) A registered professional nurse shall not delegate the performance of a selected nursing task to any licensed practical nurse who does not hold a current valid license to practice nursing in the State of New Jersey. A registered professional nurse shall not delegate the performance of a selected nursing task to ancillary nursing personnel who have not received verifiable education and have not demonstrated the adequacy of their knowledge, skill and competency to perform the task being delegated.

(e) Nothing contained in this rule is intended to limit the current scope of nursing practice.

(f) Nothing contained in this rule shall limit the authority of a duly licensed physician acting in accordance with N.J.S.A. 45:9-1 et seq."

Good luck!

Schuyler, MSN, RN. ANP

Customer: replied 7 years ago.
I'm sorry, but this does not help me at all. I already know about the Board of Nursing, and have been to its website. Therefore, I am familiar with the NJ Administrative Code Section you cited to, and literally cut and paste into your response. Nothing in this answer says anything that the Board of Nursing website does not already say.
Expert:  A. Schuyler, NP replied 7 years ago.

You're absolutely right, and I know you're frustrated. While it may not help your situation at all, it is the correct answer to your question.

There is nothing but what is in the rules and regulations. There is no place that lists what an LPN can and cannot do under supervision, so there are no distinctions in the regulations. Everything is on a case-by-case basis, and the decision rests with the RN.

It is the same for advanced practice nurses. We can do whatever a doctor delegates after s/he determines that we are trained to do it, and s/he is willing to be ultimately be responsible for our actions.

You may find that one nurse is willing to delegate the changing of NG tubes to you and the next one is not. That is how the regulation is written. It is the same in most states. Frustrating, but that's the fact.

Schuyler, MSN, RN, ANP

 

Customer: replied 7 years ago.
Reply to Schuyler_ANP's Post: I think it will help if I rephrase my question. If you are saying that the regulation provides for a case by case analysis, then can you point to a line of reasoning/piece of research (supported by a legitimate website or Board), that goes through the NG tube procedure in simple terms so it can be applied to the regulation? In other words, no one has ever written on NG tubes being reinserted, changed, or replaced by LPNs? That's the kind of answer I'm looking for.
Expert:  A. Schuyler, NP replied 7 years ago.

Hi again,

You've got it right. Tyring to figure out regulations is a real PITA for everybody concerned - and i'ts not just in NJ - it's every state.

There is nothing written anywhere about NG tubes being reinserted, changed, or replaced by LPNs.

In fact, there is little about any specific task. It talks about being qualified by learning (the LPN school program) or training (on-the-job). If anything isn't specifically allowed, then it is understood to be forbidden, unless it is delegated by someone holding a higher level license.

The only reasoning/piece of reseach involved is the delegation article from the BON. If it isn't delegated, you can't do it.

As for what to do about it, you can try to get protocols written on your unit, that specifically allow LPNs who have attended a training session and shown they are competent to do so, to be allowed to do NG tubes without the specific delegation of an RN. This is what is done in Emergency Departments where most LPNs and RNs are practicing outside their usual scopes of practice because they are following protocols. This kind of change in policy can take some time and effort to accomplish, but may be worthwhile.

Schuyler

Customer: replied 7 years ago.
Reply to Schuyler_ANP's Post: Per Andy, the Administrator's e-mail of January 16, 2007, I am writing to note that I am not satisfied with the answer I received. The response did not answer my question.

I spoke with the Board of Nursing in the State of New Jersey, and they assure me that there is a clear cut answer here. Someone there is looking for a definitive list that outlines acceptable procedures that may and may not be performed by an LPN. That is what I'm looking for, and the expert who has responded to my inquiry has not be able to help me.

Therefore, I do not accept the answer.

If you have more information, please let me know.

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery