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Can a Licensed Practical Nurse (LPN) administer I.V. Hydration Treatments in Florida?

As the booming world of I.V. Hydration continues to flourish, it has proven to become a reliable source of revenue for many in the healthcare industry. While these therapies were offered well before 2019, the pandemic has skyrocketed their popularity. Many celebrities have since been known to promote the efficacy and benefits to receiving vitamins intravenously.  I.V. Hydration treatments allow vitamins to be delivered directly into the veins. This can deliver almost immediate results and is a quick outpatient procedure. Because of these benefits and the increasing convenience, the world of intravenous drip therapies has grown in popularity. The world is now debatably much more health conscious and pro-active when it comes to individualized care.

Who Can Administer Intravenous Therapies?

There are various I.V. Hydration clinics opening statewide run by medical professional and non-medical professionals alike. There is guidance on who can run these clinics, and who can and cannot administer these such treatments or if specific medical professionals in the nursing field can administer these treatments under limited supervisions. As for licensed practical nurses, Florida law distinguishes their scope of practice when it comes to intravenous procedures. According to Chapter 464, Section 003, subsection (14) a licensed practical nurse is defined as any person licensed in this state or holding an active multistate license under s. 464.0095 to practice practical nursing. Florida Administrative Code 64B9-12.004 states that with the exception of aspects deemed outside of the scope of practice, a licensed practical nurse who meets competency requirements is authorized to administer intravenous therapy under the direction of a registered nurse or other healthcare provider.

What is Considered “Outside of the Scope of Practice”?

Florida’s Administrative Code Rule 64B9-12.003 says that an IV certified LPN should not perform the initiation of administration of cancer chemotherapy, plasma expanders, administration of investigational drugs, or blood and blood products. Although LPN’s are not to perform these duties without direct supervision of a registered nurse or a health care practitioner, they can however, care for patients who have received these procedures under proper care.

What are the ‘Competency Requirements’ to be Met?

In order to meet the Knowledge and Competency requirements outlined by the Florida Administrative code governing IV Hydration, an LPN must take a course with no less than thirty (30) hours of post-graduation level IV Hydration training. The didactic course must contain specific materials listed in rule 64B9-12.005 such as aspects of policies and procedures, psychological preparation and support for patients, and many more. After the course, interested LPN’s must partake in supervised clinical practice to demonstrate capability and proficiency. For a licensed practical nurse to be able to perform intravenous therapy under the direction of a registered nurse or health care practitioner via central and PICC lines, four (4) hours of appropriate education on Central Venous Lines (CVL) and Peripherally Inserted Central Catheter Lines (PICC) should be included within the required thirty (30) post graduate hours.  It is important to note that this I.V. Hydration education must be sponsored by a provider of continuing education courses approved by the Florida Board of Nursing.

For more information on the rules and regulations for Licensed Practical Nurses and IV Hydration, see the full chapter from the Florida Department of State here:

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B9-12

If you are interested in learning more about starting your own I.V. Hydration business, schedule a consultation with Jamaal R. Jones via our Calendly app: https://calendly.com/joneshealthlaw/iv-hydration-consultation or sign up for one of our comprehensive Webinars. For more information or direct assistance call our offices at (305) 877 – 5054.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

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Board of Nursing Issues Declaratory Statement Regarding Botox Injections by RNs

The Scope of Practice for a Registered Nurse isn’t always clear. The Florida Nurse Practice Act (Florida Statute Ch. § 464) and the Rules of the Florida Board of Nursing (Florida Administrative Codes, Title 64B9) exist to establish regulations, authority, and guidance regarding the practice of nursing. The issue of whether a registered nurse can legally administer Botox has been clearly addressed under Florida law. Previous rulings set a precedent when a nurse was disciplined for performing Botox injections on a client without a physician’s direct orders (Department of Health v. Trisha Lorraine White, R.N. Case Number 2016-13884). However, this ruling seemed to leave more questions than answers. The ruling did not clearly state whether a nurse is allowed to perform Botox injections if acting pursuant to a physician’s orders. In White, the court held that even pursuant to a physician’s orders a registered nurse does not possess the requisite educational preparation to perform the procedure and that doing so would be practicing beyond the scope of a nursing license. Without clarification, this matter left unanswered questions for nurses, med spas, and clinics who could potentially benefit from having nurses perform Botox procedures.

Per the Board of Nursing, if a specific act is questionable, a declaratory statement may be requested to provide clarity. The Board of Nursing defines a declaratory statement as a means for resolving a controversy or answering questions or doubts concerning the applicability of statutory provisions, rules, or orders over which the board, or department when there is no board. On September 26, 2022, Jessica James, a registered nurse (R.N.) from Pensacola, Florida requested a declaratory statement on clarification for the task delegation of Botox Cosmetic. The case referenced Florida Statute § 464.003, specifically quoting, “The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments.” Jessica James’ request went on to identify some prerequisites in her case for Botox task delegation eligibility by stating that the physician would first examine the patient and write an order detailing the specific muscles to be injected as well as the units per injection site before delegating the task to a registered nurse.

The Board of Nursing concluded that it is within the scope of practice for this particular case to allow the task delegation of administering of Botox. It should be noted that the Board of Nursing mentioned the “Petitioner’s specific and particular education, training, and experience” when making this decision. In this particular case, Jessica James, stated that she had experience in this field because she had observed aesthetic injections for 4 years and had completed Method Aesthetics Academy Level I training. This finding opens the door to the possibility for other qualified nurses to administer Botox under the supervision of a physician with the appropriate trainings and education. At the very least, this finding displays more progressive thought than previous rulings and statements that disallowed nurses to partake and assist in Botox injections. While this matter remains open ended and subject to specific conditions, it most definitely provides some transparency for those concerned.

 

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Physician Assistants Scope of Practice Expansion in Florida

Physician Assistants Scope of Practice Expansion in Florida

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Just as is the case with Advanced Practice Registered Nurses, the Florida Legislature has recognized that Physician Assistants (PA) are capable of performing certain health care activities that they were previously prohibited from performing. The changes are largely administrative and does not significantly increase the independent clinical services that they may provide to a patient. On June 29, 2021, the governor approved House Bill 431, which expands the scope of practice for Physician Assistants. The provisions set forth in the House Bill 431 took effect on July 1, 2021.

Notably, the law does not permit PA to sign for medical marijuana certification, workers compensation medical examinations required to determine maximum medical improvement, and impairment ratings. Florida PA are bound by the requirements contained in Florida Statute §§458.347 and 459.022.

One of the more noteworthy changes to the law is that it deletes the requirement that a physician assistant must inform his or her patients that they have the right to see a physician before the physician assistant prescribes or dispenses a prescription (amendment to Fla. Stat. §458.347(4)(e)(1)) and Fla. Admin. Code R. 64B8-30.012.  Also, physician assistants are now authorized to procure drugs and medical devices and revising the requirements for a certain formulary (amendment to Fla. Stat. §458.347(4)(f)(1) and Fla. Admin. Code R. 64B8-30.008).

 

 

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