CLOSE
WEBSITE OF THE STATE OF SOUTH DAKOTA DEPARTMENT OF HEALTH
Doneen Hollingsworth, Secretary of Health

South Dakota Board of Nursing

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

The list of topics is organized alphabetically.
Below the list, topics are organized from the most recently to the least recently issued. 
If you have questions regarding any of this information, please contact the Board of Nursing staff

__________________________________________________________________________________________

Laser Utilization by Certified Nurse Practitioners, Certified Nurse Midwives and Physician                Assistants - Advisory Opinion    

The overlapping scope of medicine may include the use of lasers according to the following guidelines:       

1.  Have an approved collaborative or supervisory agreement on file with the Board of Medicine and

    Osteopathic Examiners and/or the Board of Nursing.

Documentation available upon request supporting:

2.  Completion of initial training conducted by a qualified practitioner/trainer skilled in the use of    

     lasers.

3.  Demonstration of competency through the performance of the laser procedures under the    

     direct observation of the practitioner/trainer for each laser type.

4.  Demonstration of continued competence through continuing education and ongoing              

     performance of the laser procedures.

Source:  SDCL 36-4A; SDCL 36-9A; SDCL 36-4-8.2

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 practicesThis advisory opinion was adopted at the South Dakota Joint Board of Nursing and Medical and Osteopathic Examiners meeting, September 14, 2011


Delegation of Dialing a Dose on an Insulin Pen

The South Dakota Board of Nursing affirms that a licensed nurse may delegate to a trained medication assistant, having met the competency requirements pursuant to ARSD 20:48:04.01, the task of dialing a dose on an insulin pen for a client who is capable of insulin self-administration.

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 June 16, 2011.


Gastric Band Adjustments by Registered Nurses

The South Dakota Board of Nursing affirms that it is within the scope of practice of the Registered Nurse to perform gastric band adjustments provided:

  • The Registered Nurse has completed additional education and has demonstrated competence in performing the procedure; and
  • A Physician/Licensed Independent Practitioner competent in bariatric medicine has examined the patient and determined the amount of solution to add or subtract from the band prior to the trained registered nurse performing the procedure.

 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 June 16, 2011.


SD Certified Nurse Practitioner / Certified Nurse Midwife Collaboration with Federally Employed Physicians Working in South Dakota — Resolution

  • Whereas:  A federal exemption exists for physicians, CNPs, and CNMs who are licensed in another state and who are employed by the US government and performing official duties in this state.
  • Whereas:  A South Dakota license is required for practice in South Dakota outside of the federal facility.
  • Whereas:   Exemptions to licensure for physicians, CNPs, and CNMs are addressed in statutes SDCL 36-4-10 and SDCL 36-9A-3.
  • Whereas:  Federal facilities in South Dakota employ physicians in accordance with the federal exemption and may not have South Dakota licensed physicians employed.
  • Whereas:  The procedure of the Joint Boards has been to require CNPs and CNMs licensed in South Dakota and working in federal facilities to obtain collaborative agreements with South Dakota licensed physicians only.
  • Whereas:  SDCL 36-9A-17 requires collaboration with a physician licensed under Chapter 36-4.


Therefore, be it resolved that:  A physician licensed in another state working in a federal facility pursuant to SDCL 36-4-10 qualifies as a physician who meets the requirements for collaboration in accordance with SDCL 36-9A-15 and 17. 
This Resolution was approved by the South Dakota Board of Medical and Osteopathic Examiners and by the South Dakota Board of Nursing at its Joint Board Meeting on September 15, 2005.


Administration of Propofol (Diprivan®) by the Registered Nurse – Resolution

Whereas the South Dakota Board of Nursing has been asked to determine whether the administration of Propofol (Diprivan®) is within the scope of practice for a Registered Nurse; and,
Whereas the South Dakota Board of Nursing issued Declaratory Ruling 89-1 which states:
“Although registered nurses, under the direction of a physician, may administer narcotics, analgesics, sedatives, and tranquilizing medications to patients, registered nurses may not administer any medication for the purpose of inducing general anesthesia.  It is not within the authority of the board to determine how or for what purpose a specific drug with multiple uses is being administered at any given time.  Institutional or agency protocol must address this.”; and,
Whereas Propofol (Diprivan®) is classified by the FDA as a sedative/hypnotic agent at lower doses and an anesthetic agent when given at sufficiently high doses according to information provided by the drug manufacturer AstraZeneca LP; and,
Whereas Propofol (Diprivan®) has been utilized by physicians in low doses as an anti-emetic agent; and,
Whereas it has been determined that it is not within the authority of the Board of Nursing to determine how or for what purpose a specific drug with multiple uses is being administered at any given time;
Be It Therefore Resolved That:
the Board of Nursing rescinds the Position Statement on the Administration of Propofol (Diprivan®) by the Registered Nurse dated July 2004; and,
the Board of Nursing reaffirms the position that the administration of anesthetic agents is not within the scope of practice for the Registered Nurse; and,
Be It Further Resolved That:
the Board of Nursing affirms that the administration of sedative/hypnotic agents including Propofol (Diprivan®) by the Registered Nurse must be guided by the South Dakota Board of Nursing’s Position Statement on the Role of the Registered Nurse in the Management of Adult Clients Receiving IV Moderate Sedation for Short-Term Therapeutic, Diagnostic, or Surgical Procedures issued April 2003.
This Resolution was approved by South Dakota Board of Nursing at its regular meeting, April 8, 2005.
Bibliography
"Pain Management/Clinical Policy," Annals of Emergency Medicine, Volume 45, No. 2; The American College of Emergency Physicians, February 2005.


Performance of Intrathecal Injection of Contrast Media by CRNAs – Advisory Opinion

The South Dakota Board of Nursing affirms that it is within the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) to perform intrathecal injection of contrast media.
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, February 9, 2005.


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.


Prevention of HIV, HBV, and HCV Position Statement

The Board of Nursing is responsible for protecting the health, welfare, and safety of the public through regulation of nursing practice.  Periodically, challenges to the public health and safety arise.  One of the most serious challenges has come in the form of blood borne pathogens causing human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).
Federal law (Section 633 of Public Law 102-141) enacted in 1991, mandated that all states adopt guidelines for the prevention of the HIV and HBV transmission.  The South Dakota Department of Health adopted such guidelines in December 1993.  The Board of Nursing recognizes these guidelines as the most effective way to protect South Dakota residents from possible exposure to HIV, HBV, and HCV in the healthcare setting.
To prevent transmission of HIV to healthcare personnel in the workplace, the Centers for Disease Control and Prevention (CDC) offers the following recommendations:
Preventive Strategies
Healthcare personnel should assume that the blood and other body fluids from all patients are potentially infectious.  They should therefore follow infection control precautions at all times, including:

      • The routine use of barriers (such as gloves and/or goggles) when anticipating contact with blood or body fluids.
      • Washing hands and other skin surfaces immediately after contact with blood or body fluids.
      • The careful handling and disposing of sharp instruments during and after use.

The Board of Nursing acknowledges as the acceptable standard of care the CDC standards and recommendations, revised December 2001, that all nurses and nursing students:

  • Should receive instruction on barrier techniques, universal precautions, other scientifically accepted infection control practices, and the importance of reporting occupational exposures.
  • Adhere to universal precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments.
  • Comply with current guidelines for disinfection and sterilization of reusable devices used in invasive procedures.
  • Refrain from direct patient contact and from handling patient-care equipment and devices used in performing invasive procedures if the nurse has exudation, lesions, or weeping dermatitis.
  • Know his/her HIV antibody status if performing exposure-prone procedures in the provision of care; nurses who perform exposure-prone procedures and who do not have serologic evidence of immunity to HBV or HCV from vaccination or from previous infections should know their HbsAG status.
  • Should not perform exposure-prone procedures if infected with HIV, HCV, or HBV (and are HbeAG Positive) unless they have sought counsel from an expert review panel.

The Board of Nursing may, while investigating possible violations of the Nurse Practice Act, consider the following as evidence:

  • Non-compliance with universal precautions.
  • Performance of invasive procedures by an HIV, HBV, or HCV infected nurse or nursing student without first seeking counsel from an expert review panel.
  • Non-compliance with the recommendations of an expert review panel.

The Board of Nursing recommends that healthcare organizations continue to work in the following areas to reduce the risk of occupational HIV, HBV, or HCV transmission to healthcare personnel:
Administrative Efforts.  All healthcare organizations should train healthcare professionals (HCP) and students in infection control procedures and on the importance of reporting occupational exposures.  They should develop a system to monitor reporting and management of occupational exposures.
Develop and Promote the Use of Safety Devices.  Effective and competitively priced devices engineered to prevent sharps injuries are needed for healthcare providers who frequently come into contact with potentially HIV-infected blood and other body fluids.  Proper and consistent use of such safety devices should be evaluated.
Monitor the Effects of Post-Exposure Prophylaxis (PEP).  More data are needed on the safety and acceptability of different regimens of PEP, particularly those regimens that include new antiretroviral agents.  Furthermore, improved communication prior to treatment about possible side effects and close follow-up of HCP receiving treatment is needed to increase compliance with the PEP.
The Board of Nursing recommends that reasonable policies be implemented by healthcare agencies and nursing education programs to ensure that licensed nurses and students infected with HIV, HBV, or HCV are given reasonable opportunities to continue their nursing career or complete all of the required components of their nursing education program, including clinical experiences.  All nurses and nursing students with HIV, HBV, or HCV are entitled to the same protections guaranteed by law for other persons with disabilities.
References
CDC. Preventing occupational hiv transmission to healthcare personnel. Retrieved August 25, 2003 from http://www.cdc.gov/hiv/pubs/facts/hcwprev.htm .
CDC. (1991). Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone procedures. MMWR, 40 (Supp. No. RR-8).
Hodge, G. (1993). Framework for decision-making regarding HIV/HBV/AIDS. National Council of State Boards of Nursing Issues, 14, (2).
Idaho Board of Nursing, Position Statement: Regarding Prevention of Transmission of HIV/HBV. Adopted 2/11/93.
MMWR. Updated u.s. public health service guidelines for the management of occupational exposures to hbv, hcv, and hiv and recommendations for postexposure prophylaxis. Recommendations and Reports, June 29, 2001/50 (RR11); 1-42. Retrieved August 25, 2003 from http://www.cdc.gov/preview/mmwrhtml/rr5011a1.htm .
SD Board of Nursing Position Statement September 1994 - Revised August 2003


Scope of Practice for LPNs Refilling Baclofen Pumps – Advisory Opinion

The South Dakota Board of Nursing met and determined that the refilling of Baclofen pumps by a Licensed Practical Nurse is beyond the scope of practice of LPNs.
Baclofen, an automatic nervous system agent and central-acting skeletal muscle relaxant, is used with implantable intrathecal infusion pumps.  Uses include the symptomatic relief of painful spasms in multiple sclerosis and in the management of detrusor sphincter dyssynergia in spinal cord injury or disease. 
“Medtronic ITB Therapy (Intrathecal Baclofen Therapy) delivers a liquid form of baclofen, Lioresal Intrathecal (baclofen injection), directly into the intrathecal space where fluid flows around the spinal cord.  ITB Therapy may relieve severe spasticity with small amounts of Lioresal Intrathecal delivered via a programmable pump that is surgically placed and connected to a catheter in the body.  Because the drug is delivered directly to where it is needed in the spinal fluid, it does not circulate throughout the body in the blood.”  (www.medtronic.com , July 7, 2003)


The Role of the Registered Nurse in the Management of Adult Clients Receiving IV Moderate Sedation for Short-Term Therapeutic, Diagnostic, or Surgical Procedures — Position Statement

Sedation has recently been recognized as occurring on a continuum.  Therefore, it is not always possible to anticipate how an individual client will respond.  Practitioners intending to produce a given level of sedation should be able to rescue clients whose level of sedation progresses to a state deeper than intended.  Individuals administering moderate sedation (conscious sedation) should be able to rescue clients who enter a state of deep sedation.
Definitions
Moderate Sedation is a drug-induced depression of consciousness during which clients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.  No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.  Cardiovascular function is usually maintained.
Deep Sedation is a drug-induced depression of consciousness during which clients cannot be easily aroused, but respond purposefully following repeated or painful stimulation.  The ability to independently maintain ventilatory function may be impaired.  Clients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate.  Cardiovascular function is usually maintained.
Management and Monitoring
It is within the scope of practice for a registered nurse to manage the care of adult clients receiving IV moderate sedation, which may progress to deep sedation during therapeutic, diagnostic, or surgical procedures under the direct supervision of an anesthesia provider or physician, provided the following criteria are met:

      • The RN is ACLS certified.
      • Institutional policy, procedures and protocol allow administration of the prescribed medications by non-anesthetist RNs.
      • A qualified anesthesia provider or attending physician selects and orders the medications necessary to achieve the required level of sedation.
      • Guidelines for client monitoring, drug administration, and managing complications or emergency situations are available and reflect accepted national standards of professional nursing practice and the most recent research and technological advances.

The RN managing the care of the adult client receiving IV moderate sedation shall have no other responsibilities that would leave the client unattended or compromise continuous monitoring.
The RN managing the care of adult clients receiving IV moderate sedation is able to:

      • Assess total client care requirements during the administration of and recovery from moderate sedation.
      • Physiologic measurements should include, but not be limited to respiratory rate, oxygen saturation, blood pressure, cardiac rate and rhythm, and level of consciousness.
      • Anticipate and recognize potential complications of moderate sedation in relation to the type of medication being administered.
      • Intervene in the event of complications or unexpected outcomes in compliance with physician orders, standing orders, or medical protocols/guidelines.
      • Demonstrate skills in the use of oxygen delivery devices, airway management and resuscitation.

The institution or practice setting has in place an educational/competency validation mechanism that includes a process for evaluating and documenting the RN’s demonstration of the knowledge, skills, and abilities related to the management of adult clients receiving IV moderate sedation. Evaluation and document of competence shall occur on a periodic basis according to institutional policy.
Intravenous access must be continuously maintained in the client receiving IV moderate sedation.
All clients receiving IV moderate sedation will be continuously monitored throughout the procedure as well as the recovery phase by physiologic measurements as described in #6b.
Supplemental oxygen will be immediately available to all clients receiving moderate sedation and administered per order, including medical standing orders.
An emergency cart with a defibrillator must be immediately accessible to every location where IV moderate sedation is administered. Suction and a positive pressure breathing device, oxygen, and appropriate airways must be in each room where moderate sedation is administered.
On-site personnel who are experts in airway management, emergency, and advanced cardiopulmonary resuscitation must be immediately available whenever moderate sedation is administered.
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 April 23-24, 2003 Board meeting.
Bibliography
“The Role of the Registered Nurse in the Management of Clients Receiving IV Conscious Sedation for Short-Term Therapeutic, Diagnostic, or Surgical Procedures,” South Dakota Board of Nursing, February 1993.
“Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists,” American Society of Anesthesiologists, October 2001.
Standards for Sedation and Anesthesia Care from the Joint Commission.  “Moderate/Deep Sedation Standards Comprehensive Accreditation Manual for Hospitals”, February 1, 2003 update. 


Injectable Medications / Oral Medications by Licensed Nurses – Memorandum of Understanding

Injectable Medications
Licensed Nurses may load and label Insulin and Heparin dispensed by a pharmacist provided the following criteria are met:

  • The pre-loaded Insulin or Heparin syringes are intended for residents capable of self-injection.
  • The storage time for pre-loaded Insulin and Heparin syringes does not exceed the manufacturer's recommendation or seven (7) days, whichever is less.
  • The pre-loaded Insulin and Heparin syringes are stored in a safe and appropriate area.
  • If Insulin pens are used, a licensed nurse must be available at the time of administration if the resident needs assistance in selecting the dose.
  • If it is necessary to load two types of Insulin in the syringe, the nurse is responsible to assure that the medications are compatible.

Oral Medications
Licensed nurses may transfer prescribed medications from a container labeled and dispensed by a pharmacist or an over-the-counter medication to a medication planner which is labeled by the nurse under the following condition: The medication planner is intended for use by a resident who has been assessed as capable of self-administration.
This Memorandum of Understanding Between South Dakota Department of Health Office of Health Care Facilities Licensure and Certification, South Dakota Board of Nursing, and South Dakota Board of Pharmacy became effective April 2, 2003.


Approved Flight Nurse Skills – Advisory Opinion

The South Dakota Board of Nursing affirmed that the procedures listed below are within the scope of practice for the RN practicing in a flight program with additional training and demonstrated competence:

      • Intubation
      • Needle Thoracotomy
      • Chricothyrotomy
      • Administration of Pancuronium Bromide (Pavulon)
      • Rapid Sequence Induction
      • Blunt Insertion of Chest Tubes (September 2005)
      • Low-lying Umbilical Venous Catheter (UVC) Placement (February 2010)

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 March 2003 Board meeting and revised at the September 205 and February 2010 Board meetings.


Nursing Care in an Emergency – Advisory Opinion

The South Dakota Board of Nursing supports that nursing care provided in an emergency is not restricted to the basic scope of practice identified in ARSD 20:48:04:01.
This clarifies scope of practice for nurses in an emergency under SDCL 36-9-28 Practice not prohibited by chapter.
South Dakota Board of Nursing Advisory Opinion - March 2003


Performance of Microdermabrasion and Other Dermatological Procedures by Registered Nurses — Advisory Opinion

The South Dakota Board of Nursing affirms that the performance of certain dermatological procedures is not the practice of nursing, such as microdermabrasion, chemical peels, and sclerotherapy. These procedures are delegated medical acts. Under appropriate circumstances a physician may delegate certain procedures to a registered nurse possessing additional education, training, and competence in the procedure, pursuant to SDCL 36-9-3 and ARSD 20:48:04:01. The ultimate responsibility for delegation and supervision of the delegated dermatologic procedures lies with the physician. The nurse must exercise clinical judgment and is personally responsible when accepting delegated medical acts from physicians who are not available on site.

The South Dakota Joint Board of Nursing and Medical and Osteopathic Examiners affirmed on November 17, 2003 that only physicians, nurse practitioners, and physician assistants may be trained to use lasers pursuant to SDCL 36-4-8.2 and approved the ‘Laser Utilization by Nurse Practitioners and Physician Assistants’ protocol.

Regarding the performance of body piercings, tattoos, permanent make-up, and electrolysis, the Board affirmed that these functions are not the practice of nursing and hours worked performing such acts may not be used for initial licensure or renewal of a nursing license.

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 2002 Board meeting, revised at the April 2010 and March 2011 Board meetings.


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

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:

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

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
      • Monitor the status of the fetus
      • 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
      • Stop the continuous infusion if there is a safety concern or the woman has given birth
      • 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.
      • Initiate emergency therapeutic measures according to institutional policy and/or protocol if complications arise

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.


Advanced Trauma Life Support (ATLS) Training – Advisory Opinion

The Joint South Dakota Board of Nursing and South Dakota Board of Medical and Osteopathic Examiners considered the issue of Advanced Trauma Life Support training for those physicians and nurse practitioners practicing in South Dakota emergency rooms.  The Joint Board highly recommends that Nurse Practitioners and Collaborating Physicians working in the Emergency Room obtain Advanced Trauma Life Support training; the Joint Board firmly believes that such training will significantly enhance patient care for those patients suffering severe trauma. 
Issued by the South Dakota Board of Medical and Osteopathic Examiners and South Dakota Board of Nursing, January 2001.


Sexual Assault Nurse Examiners Training — Advisory Opinon

The South Dakota Board of Nursing considered a request for an advisory opinion regarding the Sexual Assault Nurse Examiners training and competencies for registered nurses.  Board members were provided information related to the Sexual Assault Response Team (SART).
In 1993, the Board considered a scope of practice request from the South Dakota Department of Health regarding the role of registered nurses in public health clinics, providing care to patients with sexually transmitted diseases.  In this related ruling, the Board determined that RNs with additional specialized training could provide this care, which included taking an STD history and risk assessment, conducting physical exams, collecting and testing of specimens, providing care management (under physician protocol), and counseling and education.  The type of care described for certification of SART nurses would be similar to that described above, although SART certified nurses would also perform pelvic exams on alleged assault victims for the purpose of collecting evidence.  The Board reviewed these materials and affirmed by unanimous vote that the competencies identified in the S.A.N.E. training program are within the scope of practice for the registered nurse.
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.  The South Dakota Board of Nursing adopted this advisory opinion at its November 30-December 1, 2000 meeting.


Abandonment — Advisory Opinion

The South Dakota Board of Nursing has received numerous inquiries regarding which actions by a nurse constitute patient abandonment.  For patient abandonment to occur, the nurse must have accepted the patient assignment, thus establishing a nurse-patient relationship, and then have terminated that relationship without giving reasonable notice so that arrangements can be made for continuation of nursing care by others.
Refusal to accept an assignment is not considered patient abandonment by the Board of Nursing.  Failure to notify the employing agency that the nurse will not appear to work an assigned shift or refusal to work additional hours or shifts would not be considered patient abandonment.
It should be noted that the Board of Nursing has no jurisdiction over employment or contract issues.  Once the nurse has accepted responsibility for the nursing care of a patient, severing of the nurse-patient relationship may lead to discipline of the nurse's license.
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.  The South Dakota Board of Nursing during its April 27-28, 2000 adopted this advisory opinion 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.


Nurse Practitioner / Nurse Midwife Drug Sample Authority — Position Statement

A nurse practitioner or nurse midwife may request, receive, and dispense prepackaged drug samples which the nurse practitioner/nurse midwife is authorized to prescribe.  A drug sample means a prepackaged unit of a prescription drug supplied by the manufacturer and provided at no charge to the patient.  A nurse practitioner or nurse midwife may dispense prepackaged-labeled drug samples only to the nurse practitioners'/nurse midwives’ patients and only for conditions being treated by the nurse practitioner/nurse midwife.  Samples of medications packaged by licensed manufacturers or repackagers of medication for individual use may be dispensed without a prescription order.
Each sample drug shall be accompanied with written administration instructions.  When dispensing drug samples, the nurse practitioner or nurse midwife shall enter an appropriate record in the patient’s medical record.
Prescriptive authority, including drug sample dispensation, falls within the overlapping shared scope of Advanced Practice Nursing and Medicine.  The overlapping scope of Advanced Practice Nursing and Medical functions as described in SDCL 36-9A may be performed only under the terms of a collaborative agreement with a collaborating physician.
This Position Statement approved by the  South Dakota Board of Medical and Osteopathic Examiners on June 8, 2009 and by the South Dakota Board of Nursing on April 16, 1999.


Placement of Medications in a Mediplanner - Advisory Opinion

The South Dakota Board of Nursing reaffirms that the placement of medications in a mediplanner is withing the scope of practice for a licensed nurse.  A license nurse may delegate placement of medications in a mediplanner to unlicensed personnel who have completed the Board approved twenty hour training program.  Supervision of Unlicensed Assistive Personnel should occur according to ARSD 20:48:04.01.02 (1) that the licensed nurse determine the degree of supervision required after an evaluation and should occur a minimum of at least monthly.
The Board of Nursing rendered this opinion upon 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.  The South Dakota Board of Nursing adopted this advisory opinion at its April 1998 meeting. 


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 n safe nursing practices.  South Dakota Board of Nursing, November 13-14, 1996 meeting, adopted this advisory opinion.


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.