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WEBSITE OF THE STATE OF SOUTH DAKOTA DEPARTMENT OF HEALTH
Kim Malsam-Rysdon, Secretary of Health

South Dakota Board of Nursing

Advisory Opinions, Memo of Understanding, Position Statements, and Resolutions

The South Dakota Board of Nursing is authorized by the state of South Dakota to safeguard life, health and the public welfare; and to protect citizens from unauthorized, unqualified and improper application of nursing practices. The practice of nursing pursuant to SDCL 36-9 allows nurses to perform other acts that require education and training consistent with professional standards as prescribed by the board, by rules promulgated pursuant to chapter 1-26, and commensurate with the nurse's education, demonstrated competence, and experience.  

The Board of Nursing issues opinions, position statements, or resolutions as to what constitutes safe nursing practice.  As such, these statements are not regulations of the Board and do not have the force and effect of law but are issued as guidelines to licensees who wish to engage in safe nursing practice, and to facilitate the delivery of safe, effective nursing care to the public.

If you have questions regarding any of this information, please contact Linda Young.

 

 
 

Scope of Practice for RNs and Electrical Stimulation (E-STIM) - Advisory Opinion

The South Dakota Board of Nursing affirms that it is within the scope of practice for registered nurses who hold an active specialty certification in a relevant area; i.e., Certified Continence Care Nurse (CCCN), Wound Ostomy Continence Nurse (WOCN), or Certified Would Ostomy Continence Nurse (CWOCN), to perform electrical stimulation for the purpose of continence training. 

This advisory opinion was rendered by the Board upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices. 
This advisory opinion was adopted at the regular meeting of the South Dakota Board of Nursing, November 13-14, 2003. 

 


Scope of Practice for RNs & LPNs to Apply and Remove Casts - Advisory Opinion

It was affirmed by the South Dakota Board of Nursing that it is within the scope of practice for licensed nurses to apply and remove casts. 

This advisory opinion was adopted at the regular meeting of the South Dakota Board of Nursing, September 2003.

 


 

The Role of the Registered Nurse in the Management of Analgesia by Catheter Technique for the Client Experiencing Acute or Chronic Pain - Advisory Opinion

It is within the scope of practice for the registered nurse to manage the care of clients receiving analgesia by catheter techniques as defined above when the following criteria are met:
Management and monitoring of analgesia by catheter techniques, including the alteration of infusion rate or administration of medication after the initial or test dose by registered nurses, is established by institutional policy and procedure.
The attending physician or qualified anesthesia provider, placing the catheter or infusion device, selects and orders the drugs, doses, and concentrations.
Guidelines for client monitoring, drug administration, and procedures for dealing with potential complications or emergency situations are available and have been developed in conjunction with the anesthesia or physician provider.
Intravenous access must be continuously maintained for administration of reversal agents and other required medications.
Validation of initial and ongoing competence must occur related to the management of nursing care provided to clients receiving analgesia by catheter or nerve infusion devices for all registered nurses who provide such care.
Management and Monitoring: For the client experiencing acute or chronic pain, the registered nurse may:  monitor the client’s response to the analgesia; replace empty infusion syringes or bags with new pre-prepared solutions; stop the infusion and initiate emergency therapeutic measures, under protocol, if complications arise; administer subsequent doses of medications after the initial or test dose following the established therapeutic range and/or adjustment of drug infusion rates in compliance with the anesthesia provider's or physician's client-specific written order.  A registered nurse may not alter the rate of a continuous infusion or administer additional doses of analgesia by way of standing orders or protocols.

Catheter Placement, Initial Test Dose, and Establishing Analgesic Dosage Parameters: Insertion and determination of placement of a catheter or infusion device, administration of the test dose or initial dose of medication, and establishment of analgesic dosage parameters for clients who need acute or chronic pain relief should be done only by licensed professionals educated in the specialty of anesthesia and physicians in other specialties who have been granted clinical privileges by the institution.

Removal of Catheter: Upon receipt of a specific order from a qualified provider or physician, the registered nurse may remove or discontinue epidural catheters, if educational criteria have been met and institutional policy allows.

This opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted by the South Dakota Board of Nursing at its September 15-16, 1993 Board meeting and revised at the April 1998 and January 2002 Board meetings.
References
Fulk C., and Hadley, J.C., (1990). "Something For Pain: New trends In Epidural Analgesia," Journal of Post Anesthesia Nursing, 5:4; 247-253.
"Provision of Pain Relief by Medication Administered Via Continuous Epidural, Intrathecal, Intrapleural, Peripheral Nerve Catheters, Or Other Pain Relief Devices", No. 2.8, Position Statement of the American Association of Nurse Anesthetists, 1995.
"Removal of Epidural Catheters," No. 2.9, Position Statement of the American Association of Nurse Anesthetists, 1989.

 


The Role of the Registered Nurse in Monitoring the Care of the Pregnant Woman Receiving Analgesia by Catheter Techniques - Advisory Opinion

Registered nurses who are not licensed anesthesia care providers should monitor, not manage, the care of pregnant patients receiving analgesia/anesthesia by catheter techniques. Safe anesthesia administration is a complex and specialized practice that relies on the education, experience, competence, and attentiveness of those responsible for its initiation and management. The requisite education and clinical skill acquisition necessary to provide safe management of regional analgesia/anesthesia for the pregnant woman are not included in basic education programs for entry into practice as a registered nurse; therefore such analgesia/anesthesia management should be reserved exclusively for licensed, credentialed anesthesia care providers.
Only licensed professionals educated in the specialty of anesthesia should perform the following procedures:

  • Increasing or decreasing the rate of the continuous infusion
  • Verification of correct catheter placement
  • Insertion, initial injection, bolus injection, rebolus injection, or initiation of a continuous infusion of catheters for analgesia/anesthesia

Following stabilization of vital signs after initial insertion, initial injection, bolus injection, rebolus injection, or initiation of continuous infusion, a registered nurse may:

  • Monitor the patient's vital signs, mobility, level of consciousness, and perception of pain.
  • Initiate emergency therapeutic measures according to institutional policy and/or protocol if complications arise
  • Remove the catheter, if educational criteria have been met and institutional policy allow. Removal of the catheter by a RN is contingent upon receipt of a specific order from a qualified anesthesia or physician provider.
  • Stop the continuous infusion if there is a safety concern or the woman has given birth
  • Replace empty infusion syringes or infusion bags with new, pre-prepared solutions containing the same medication and concentration, according to orders provided by the anesthesia care provider
  • Monitor the status of the fetus

Registered nurses should not:

  • Rebolus an epidural either by injecting medication into the catheter or increasing the rate of a continuous infusion
  • Increase/decrease the rate of a continuous infusion
  • Re-initiate an infusion once it has been stopped
  • Manipulate Patient Controlled Epidural Analgesia (PCEA) doses or dosage intervals
  • Be responsible for obtaining informed consent for analgesia/anesthesia procedures; however, the nurse may witness the patient signature for informed consent prior to analgesia/anesthesia administration.

Physiologic and anatomic changes of pregnancy increase the risk of regional analgesia/anesthesia complications. Pregnant women are especially susceptible to cardiovascular and central nervous system disturbances as a result of local anesthetics. Analgesia/anesthesia complications not only impact the mother, but the fetus as well. The fetus is dependent upon maternal physiology and can suffer the effects of maternal physiologic changes first. Fetal effects may be significant with only minimal maternal compromise. Clinicians responsible for managing regional labor analgesia/anesthesia must be prepared to handle both patients' complications, some of which may be life-threatening. Qualified, credentialed, licensed anesthesia care providers are trained to manage all anesthesia-related complications.
Patients receiving regional analgesia/anesthesia should have a specific pain management plan developed in consultation with an anesthesia care provider. This plan is ongoing and dependent upon thorough assessments of the appropriateness of regional analgesia/anesthesia. These assessments, based on a patient's medical history, physiologic condition, and her desire for pain management options, determine the optimal type and amount of medication to use in each individual circumstance. A multitude of anesthetic medications are used during labor and birth, each with specific indications, possible side effects, and potential adverse reactions. Because of the complexity of providing regional analgesia/anesthesia, only professionals specifically trained in anesthesia administration and management should alter the course of a patient's regional analgesia/anesthesia in any way, including rebolusing a catheter or changing the rate of a continuous infusion.

This opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted by the South Dakota Board of Nursing at its January 24-25, 2002 Board meeting.
Reference
"Role of the Registered Nurse In the Care of the Pregnant Women Receiving Analgesia by Catheter Techniques," Position Statement of the Association of Women's Health, Obstetric, and Neonatal Nurses, 2001.

 


Removal of Epidural Catheter - Advisory Opinion

Upon receipt of a specific order from a qualified anesthesia provider or physician, the registered nurse may remove or discontinue epidural catheters if educational criteria have been met and institutional policy allow.

References
Fulk C., and Hadley, J.C., (1990). "Something For Pain: New Trends in Epidural Analgesia," Journal of Post Anesthesia Nursing, 5:4; 247-253.
"Provision of Pain Relief by Medication Administered Via Continuous Epidural, Intrathecal, Intrapleural, Peripheral Nerve Catheters, Or Other Pain Relief Devices", No. 2.8, Position Statement of the American Association of Nurse Anesthetists, 1995.
"Removal of Epidural Catheters," No. 2.9, Position Statement of the American Association of Nurse Anesthetists, 1989.
South Dakota Board of Nursing Advisory Opinion September 1993 - Revised April 1998 - Revised January 2002.

 


Display of Nursing Credentials - Position Statement

A licensed practical nurse or licensed registered nurse, including those nurses licensed in advanced practice roles, should clearly identify himself or herself as officially licensed by the Board of Nursing.  Licensed nurses should display their legal title or abbreviation of their legal title, (i.e. RN, LPN, CRNA, CNS, CNP, or CNM ) on their identification badge or nametag when providing nursing care to clients.

This statement was issued by the Board of Nursing upon submission of a written request.  Although position statements are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  Issued by the South Dakota Board of Nursing at its July 19-20, 2001 Board meeting.

 


Performance of Medical Screening Examinations by Registered Nurses - Advisory Opinion

It is within the scope of practice for a registered nurse to conduct a medical screening examination and determine whether a patient has an emergency medical condition, pursuant to EMTALA.  Medical and nursing staff should be in agreement as to the written policies, procedures, and protocols regarding the nurse's responsibilities in assessing patient conditions and instituting appropriate nursing actions, including mutually agreed upon criteria for reporting the findings of assessments and life threatening conditions.  Only nurses who have satisfactorily demonstrated competency in the area of practice in the clinical setting should be allowed to perform such functions.

This opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as guidelines for nurses who wish to engage in safe nursing practices.  The South Dakota Board of Nursing adopted this advisory opinion at its November 18-19, 1999 meeting.

 


Occupational Health Recommendations by Registered Nurses - Advisory Opinion

The South Dakota Board of Nursing affirms that it is within the scope of practice for the South Dakota licensed registered nurse to make recommendations to employers and employees regarding accommodations that may be necessary for an employee to perform essential job functions.  The recommended accommodations should be based on a nursing assessment.  An occupational health nurse may refer an employee to a physician.

The Board of Nursing rendered this opinion upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted at the meeting of the South Dakota Board of Nursing on April 22-23, 1999.

   


Performance of Flexible Sigmoidoscopy by Registered Nurses - Advisory Opinion

The South Dakota Board of Nursing affirms that is beyond the scope of practice for the South Dakota licensed registered nurse to perform flexible sigmoidoscopy for colo-rectal cancer screening purposes.

This advisory opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted at the regular meeting of the South Dakota Board of Nursing, November 13-14, 1996.

 


Prescriptive Authority for Clinical Nurse Specialist - Advisory Opinion

A Clinical Nurse Specialist in South Dakota does not have prescriptive authority for medications.

The Board of Nursing rendered this opinion upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as guidelines for nurses who wish to engage in safe nursing practices. This advisory opinion was adopted at the regular meeting of the South Dakota Board of Nursing, November 13-14, 1996.

 


Removal of Mediastinal and Pleural Chest Tubes by Registered Nurses - Advisory Opinion

The South Dakota Board of Nursing affirms that it is within the scope of practice for the appropriately trained and competent registered nurse to remove pleural and mediastinal chest tubes, as ordered by a physician, in monitored nursing units.
The Board of Nursing recognizes this responsibility as an additional act for the RN and recommends the following:
The facility establish policies, procedures, and/or protocols that address:

  • proximity of the physician when tubes are removed by the RN
  • need for physician evaluation of patient condition prior to tube removal
  • type of physician supervision necessary
  • guidelines for patient monitoring prior to and after tube removal
  • guidelines for dealing with potential complications or emergency situations
  • nursing liability in the performance of additional/expanded act

The facility documents the nurse's completion of an organized course of study which includes didactic instruction followed by a period of supervised clinical instruction including return demonstrations.

This opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted at the South Dakota Board of Nursing meeting on July 19, 1996.

 


Administration of Prostaglandin Preparation by Registered Nurses - Advisory Opinion

The South Dakota Board of Nursing affirms that it is within the scope of practice for the South Dakota licensed registered nurse to administer prostaglandin preparations for the purposes of pre-induction cervical ripening and intrauterine fetal demise, in accordance with the following:

  • The RN has demonstrated competence in monitoring the stages of labor and assisting with the delivery of the products of conception.
  • The agency has developed and implemented, in collaboration with medical staff, policies, procedures, and/or protocols related to the administration of prostaglandins by registered nurses.
  • Mechanisms are established to ensure initial and ongoing competence in the administration of prostaglandins. The registered nurse is cautioned to verify that intrauterine fetal death is clearly documented in the medical record prior to the administration of prostaglandins for this indication.

This opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted at the regular meeting of the South Dakota Board of Nursing on April 11-12, 1996.

 


Telephonic Case Management - Advisory Opinion

The South Dakota Board of Nursing affirms that out-of-state nurses who provide telephonic case management services to the citizens of South Dakota must be licensed in this state as registered nurses.

This opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not carry the force and effect of law, they do serve as a guideline to nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted by the South Dakota Board of Nursing, November 1994.

 


Amniotomy - Advisory Opinion

The South Dakota Board of Nursing affirms that it is beyond the scope of practice for the registered nurse to perform amniotomy.

This opinion was rendered by the South Dakota Board of Nursing upon submission of a written request. Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This opinion was adopted the Board of Nursing at the November 1993 meeting.

 


Insertion of Fetal Scalp Electrodes and Intrauterine Pressure Catheters - Advisory Opinion

The South Dakota Board of Nursing affirms that it is within the scope of practice for the registered nurse, who has received additional training, to insert or apply fetal scalp electrodes and intrauterine pressure catheters. The Board recommends that mechanisms be established to ensure initial and ongoing competence.

This opinion was rendered by the South Dakota Board of Nursing upon submission of a written request. Although advisory opinions are not judicially reviewable and do not have the force and effect of law, the do serve as a guideline for nurse who wish to engage in safe nursing practices.  This opinion was adopted by the Board of Nursing during its November 1993 meeting.

 


Registered Nurse First Assistants in the Operating Room - Advisory Opinion

The South Dakota Board of Nursing acknowledges that the role of the Registered Nurse First Assistant in the Operating Room may be within the scope of practice of the registered nurse, with additional training, continued competence, and supervision by a physician.

This opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not have the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted at the South Dakota Board of Nursing meeting in April of 1993.

 


Peripherally Inserted Central Catheters - Advisory Opinion

The South Dakota Board of Nursing affirms that it is within the scope of practice for the registered nurse to insert peripherally inserted catheters, with the tip located peripherally or centrally, in accordance with the following stipulations:

Written physician's order for insertion is obtained

  • Catheters whose tips are located in a central position must be verified by physician interpreted chest x-ray prior to the catheter’s use as an infusion device
  • Written institutional/agency policy or procedures
  • Mechanism to ensure initial and ongoing competency
  • Ongoing quality assurance mechanism

This opinion was rendered by the Board of Nursing upon submission of a written request.  Although advisory opinions are not judicially reviewable and do not carry the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted at the South Dakota Board of Nursing meeting, September 1992.

 


Intraosseous Infusion - Advisory Opinion

The technique of intraosseous infusion does fall within the scope of practice for a registered nurse with additional education and training equivalent to PALS.

Although advisory opinions are not judicially reviewable and do not carry the force and effect of law, they do serve as a guideline for nurses who wish to engage in safe nursing practices.  This advisory opinion was adopted at the South Dakota Board of Nursing meeting, July 1992.