<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 10.27.10.02" title_num="10" subtitle_num="27" chapter_num="10" heading="Nursing Process.">
  <paragraph num="A.">
    <text>In a team relationship the licensed practical nurse contributes to the nursing process. The nursing process shall include, but is not limited to, the following elements listed in §B—C of this regulation.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Nursing Assessment. The LPN contributes to the nursing assessment by:</text>
    <paragraph num="(1)">
      <text>Collecting data for the assessment of the client:</text>
      <paragraph num="(a)">
        <text>Through direct observation;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>From interviews with the client, client’s family, and significant others;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>From the review of the client’s medical records including, but not limited to:</text>
        <paragraph num="(i)">
          <text>Past history;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Laboratory studies;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Medications; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Consultations; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>By assessing the environment;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Performing a focused nursing assessment of the client’s current conditions and problems or needs which includes:</text>
      <paragraph num="(a)">
        <text>The nursing interview;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A physical assessment;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The client’s common predictable, chronic, routine, recurrent health problems; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Identification of any changes in the client’s symptoms and behavior;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Communicating the assessment on records that reflect:</text>
      <paragraph num="(a)">
        <text>Changes in the client’s health status; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A continuous collection of data by updating and revising of the nursing assessment; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Data recorded in a manner which is:</text>
        <paragraph num="(i)">
          <text>Complete, timely, and accurate;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Consistent with general standards of nursing practice; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Consistent with the facility’s policies and procedures.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Nursing Plan of Care.</text>
    <paragraph num="(1)">
      <text>Development. The LPN contributes to the development of the nursing plan of care by:</text>
      <paragraph num="(a)">
        <text>Reporting ongoing data collection;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Reporting changes that include, but are not limited to, the client’s;</text>
        <paragraph num="(i)">
          <text>Condition;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Changed goals; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Changed priorities;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Making recommendations to individualize interventions specific to the client;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Reporting communication with;</text>
        <paragraph num="(i)">
          <text>The client;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The client’s family;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Significant others; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Other members of the health care team; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>Documenting in appropriate records.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Implementation. The LPN participates in the implementation of the nursing plan of care by:</text>
      <paragraph num="(a)">
        <text>Continuing to collect and report data;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assisting in the coordination of client care with other health care team members as directed by the RN;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Implementing standardized or RN developed teaching plans under the direction of the RN;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Contributing to the nursing case management by:</text>
        <paragraph num="(i)">
          <text>Implementing assigned components of the nursing care plan; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Continuing to collect and report data regarding the implemented plan including the client’s response to intervention and problem identification;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>Contributing to nursing management and supervision of the certified nursing assistant and unlicensed personnel by:</text>
        <paragraph num="(i)">
          <text>Assuring nursing functions are performed competently and timely; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Reporting to the leader of the nursing team; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(f)">
        <text>In accordance with the nursing team’s plan of care for the client and with COMAR10.27.11, delegating acts of the LPN’s practice to:</text>
        <paragraph num="(i)">
          <text>The certified nursing assistant;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The certified medication technician; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Unlicensed personnel;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(g)">
        <text>Performing nursing interventions in a competent safe manner appropriate to the LPN’s scope of practice including:</text>
        <paragraph num="(i)">
          <text>Administration of medications and treatments;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Administration of infusion therapy consistent with COMAR 10.27.20; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Nursing intervention consistent with any declaratory rulings and regulations issued by the Board;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(h)">
        <text>Documenting implementation of nursing care timely, completely, and accurately; and</text>
        <paragraph num="(i)">
          <text>Utilizing identified nursing approaches which include, but are not limited to:</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Reflecting knowledge of scientific principles;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Recognizing the rights of the client, the client’s family, and significant others; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Providing a safe and therapeutic environment.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Evaluation. The LPN contributes to the evaluation of the nursing plan of care by:</text>
      <paragraph num="(a)">
        <text>Collecting and communicating data on the client’s goal achievement;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assisting in identifying barriers to the client’s meeting any identified goal;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Reporting to other members of the health care team in a timely, accurate, and complete manner on data collected from;</text>
        <paragraph num="(i)">
          <text>The client;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The client’s family;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Significant others; and</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Other health care providers;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>Assisting in evaluating the client’s competency in performing any treatment and self administering medication by utilizing established competency based evaluation tools;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Making recommendations regarding modification of the teaching nursing plan based on the client’s response;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Making recommendations regarding any revision to the nursing plan of care; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Documenting the evaluation data on appropriate records.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Nursing Team Relationship.</text>
      <paragraph num="(a)">
        <text>The LPN as a part of the nursing team:</text>
        <paragraph num="(i)">
          <text>Functions as a team member under the leadership of the RN who is the team leader;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Participates in providing care for the client; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Provides care for the client to the fullest extent allowed by the LPN’s scope of practice.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Each licensed nurse has responsibility for oversight or supervision of nursing practice appropriate to his or her level of licensure which includes critically watching, instructing, directing, and evaluating anothers nursing practice.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Documentation. The LPN shall maintain medical records in accordance with Health-General Article, Title 4, Subtitle 4, Annotated Code of Maryland.</text>
    </paragraph>
  </paragraph>
</regulation>