Chapter 10. Standards of Practice for Licensed Practical Nurses
Regulation .01 Definitions.LinkCopy Citation
A.
The following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Assessment” means the act of gathering and identifying data about the client.
(2)
“Assign” means the transfer of responsibility from one nurse to another, each having legal authority to perform the function as permitted by the licensee’s scope of practice.
(3)
“Board” means the Board of Nursing.
(4)
“Case management” means a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet the client’s health needs through enhanced communication and use of available resources to promote quality client outcomes and cost effective care.
(5)
“Client” means an individual who is under the licensee’s direct or indirect care.
(6)
Comprehensive Nursing Assessment.
(a)
“Comprehensive nursing assessment” means an assessment performed by a registered nurse which is the foundation for the analysis of the assessment data to determine:
(i)
The nursing diagnosis;
(ii)
Expected client outcomes; and
(iii)
The client’s plan of care.
(b)
“Comprehensive nursing assessment” includes, but is not limited to:
(i)
Extensive initial and ongoing data collection for individuals, families, groups, and communities;
(ii)
A focused nursing assessment;
(iii)
Past history, current health status, and potential changes in the client’s condition;
(iv)
Identification of alterations to the client’s previous condition; and
(v)
Synthesis of the biological, psychological, spiritual, and social aspects of the client’s condition.
(7)
“Contributes” means to participate as a team member in the nursing team relationship.
(8)
“Delegating” means the act of authorizing an unlicensed individual, a certified nursing assistant, or a certified medication technician to perform selected acts of registered nursing or licensed practical nursing.
(9)
“Evaluation” means the review and analysis of the extent to which the assessment, planning, and implementation were effective in resolving the client’s health problem.
(10)
Focused nursing assessment.
(a)
“Focused nursing assessment” means an appraisal of a client’s current health status and situation at hand;
(b)
“Focused nursing assessment” includes the reporting of information to other members of the health care team.
(11)
“Goal” means a measurable result to be achieved by a client which is either long- or short-term.
(12)
“Implementation” means the carrying out of the nursing plan of care.
(13)
“Licensed nurse” means a licensed practical nurse or registered nurse.
(14)
“Licensed practical nurse (LPN)” means an individual who is licensed by the Board to practice licensed practical nursing or holds a multistate licensure privilege to practice licensed practical nursing.
(15)
“Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.
(16)
“Nursing plan of care” means an established set of goals, priorities, and methods designed to solve, prevent, and manage a client’s identified problems.
(17)
“Nursing team relationship” means that each licensed or certified individual who participates in providing care for a client is a part of the nursing team.
(18)
“ Nursing triage” means the systematic collection of client data at the client’s point of entry or re-entry into the health care system for the purpose of sorting clients by acuity levels to determine the allocation of available health care resources to direct each client to the right health care provider at the right time.
(19)
“Record” means a written retrievable document containing the client’s health information.
(20)
“Registered nurse (RN)” means an individual who:
(a)
Is licensed by the Board to practice registered nursing; or
(b)
Who holds a multistate licensure privilege to practice registered nursing.
(21)
Standards of Licensed Practical Nurse Practice.
(a)
“Standards of licensed practical nurse practice” means the minimum criteria to which the licensed nurse shall adhere in the practice of licensed practical nursing.
(b)
“Standards of licensed practical nurse practice” includes standards of professional performance as described in Regulation .03 of this chapter.
(22)
“Supervision” means the process of critically watching an individual’s performance with the intention of evaluating and directing the individual’s performance in the delivery of nursing care.
(23)
“Support” means to promote, assist, or help.
Regulation .02 Nursing Process.LinkCopy Citation
A.
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.
B.
Nursing Assessment. The LPN contributes to the nursing assessment by:
(1)
Collecting data for the assessment of the client:
(a)
Through direct observation;
(b)
From interviews with the client, client’s family, and significant others;
(c)
From the review of the client’s medical records including, but not limited to:
(i)
Past history;
(ii)
Laboratory studies;
(iii)
Medications; and
(iv)
Consultations; and
(d)
By assessing the environment;
(2)
Performing a focused nursing assessment of the client’s current conditions and problems or needs which includes:
(a)
The nursing interview;
(b)
A physical assessment;
(c)
The client’s common predictable, chronic, routine, recurrent health problems; and
(d)
Identification of any changes in the client’s symptoms and behavior;
(3)
Communicating the assessment on records that reflect:
(a)
Changes in the client’s health status; and
(b)
A continuous collection of data by updating and revising of the nursing assessment; and
(c)
Data recorded in a manner which is:
(i)
Complete, timely, and accurate;
(ii)
Consistent with general standards of nursing practice; and
(iii)
Consistent with the facility’s policies and procedures.
C.
Nursing Plan of Care.
(1)
Development. The LPN contributes to the development of the nursing plan of care by:
(a)
Reporting ongoing data collection;
(b)
Reporting changes that include, but are not limited to, the client’s;
(i)
Condition;
(ii)
Changed goals; and
(iii)
Changed priorities;
(c)
Making recommendations to individualize interventions specific to the client;
(d)
Reporting communication with;
(i)
The client;
(ii)
The client’s family;
(iii)
Significant others; and
(iv)
Other members of the health care team; and
(e)
Documenting in appropriate records.
(2)
Implementation. The LPN participates in the implementation of the nursing plan of care by:
(a)
Continuing to collect and report data;
(b)
Assisting in the coordination of client care with other health care team members as directed by the RN;
(c)
Implementing standardized or RN developed teaching plans under the direction of the RN;
(d)
Contributing to the nursing case management by:
(i)
Implementing assigned components of the nursing care plan; and
(ii)
Continuing to collect and report data regarding the implemented plan including the client’s response to intervention and problem identification;
(e)
Contributing to nursing management and supervision of the certified nursing assistant and unlicensed personnel by:
(i)
Assuring nursing functions are performed competently and timely; and
(ii)
Reporting to the leader of the nursing team; and
(f)
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:
(i)
The certified nursing assistant;
(ii)
The certified medication technician; and
(iii)
Unlicensed personnel;
(g)
Performing nursing interventions in a competent safe manner appropriate to the LPN’s scope of practice including:
(i)
Administration of medications and treatments;
(ii)
Administration of infusion therapy consistent with COMAR 10.27.20; and
(iii)
Nursing intervention consistent with any declaratory rulings and regulations issued by the Board;
(h)
Documenting implementation of nursing care timely, completely, and accurately; and
(i)
Utilizing identified nursing approaches which include, but are not limited to:
(ii)
Reflecting knowledge of scientific principles;
(iii)
Recognizing the rights of the client, the client’s family, and significant others; and
(iv)
Providing a safe and therapeutic environment.
(3)
Evaluation. The LPN contributes to the evaluation of the nursing plan of care by:
(a)
Collecting and communicating data on the client’s goal achievement;
(b)
Assisting in identifying barriers to the client’s meeting any identified goal;
(c)
Reporting to other members of the health care team in a timely, accurate, and complete manner on data collected from;
(i)
The client;
(ii)
The client’s family;
(iii)
Significant others; and
(iv)
Other health care providers;
(d)
Assisting in evaluating the client’s competency in performing any treatment and self administering medication by utilizing established competency based evaluation tools;
(e)
Making recommendations regarding modification of the teaching nursing plan based on the client’s response;
(f)
Making recommendations regarding any revision to the nursing plan of care; and
(g)
Documenting the evaluation data on appropriate records.
(4)
Nursing Team Relationship.
(a)
The LPN as a part of the nursing team:
(i)
Functions as a team member under the leadership of the RN who is the team leader;
(ii)
Participates in providing care for the client; and
(iii)
Provides care for the client to the fullest extent allowed by the LPN’s scope of practice.
(b)
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.
(5)
Documentation. The LPN shall maintain medical records in accordance with Health-General Article, Title 4, Subtitle 4, Annotated Code of Maryland.
Regulation .03 Standards of Professional Performance.LinkCopy Citation
A.
Quality of Care.
(1)
The LPN shall participate in evaluating the quality and effectiveness of nursing practice.
(2)
Measurement Criteria. The LPN shall:
(a)
Assist in collecting quality data; and
(b)
Participate in activities related to implementing changes designed to improve care.
B.
Performance Appraisal.
(1)
The LPN shall be accountable for evaluating the LPN’s own nursing practice on a regular basis in relation to:
(a)
Relevant professional practice standards; and
(b)
Relevant statutes and regulations governing licensed practical nursing.
(2)
Measurement Criteria.
(a)
The LPN shall:
(i)
Participate in peer review as appropriate; and
(ii)
As necessary, seek guidance, support, education, and supervision.
(b)
The LPN shall demonstrate knowledge of and comply with:
(i)
Relevant professional practice standards;
(ii)
Relevant statutes and regulations governing licensed practical nursing; and
(iii)
The policies and procedures of the practice setting.
C.
Education.
(1)
The LPN shall acquire and maintain current knowledge and continued competency in the practice of licensed practical nursing.
(2)
Measurement Criteria. The LPN shall:
(a)
Participate in educational opportunities and experiences to maintain professional competence; and
(b)
Obtain knowledge and skills appropriate to the practice setting.
D.
Collegiality.
(1)
The LPN shall support the professional development of the:
(a)
Licensed practical nurse;
(b)
Certified nursing assistant;
(c)
Certified medication technician; and
(d)
Unlicensed personnel.
(2)
Measurement Criteria.
(a)
As directed by the RN, the LPN shall share knowledge and skills with:
(i)
Other LPNs;
(ii)
Certified nursing assistants;
(iii)
Certified medication technicians; and
(iv)
Unlicensed personnel.
(b)
The LPN shall contribute to a supportive and healthy work environment.
E.
Ethics.
(1)
The licensed practical nurse’s decisions and actions shall reflect ethical principles.
(2)
Measurement Criteria. The LPN shall:
(a)
Comply with the Code of Ethics as described in COMAR 10.27.19;
(b)
Maintain client confidentiality within legal and regulatory standards;
(c)
Act as a client advocate;
(d)
Deliver care in a nonjudgmental and nondiscriminatory manner that is sensitive to client diversity;
(e)
Deliver care in a manner that preserves the client’s;
(i)
Autonomy;
(ii)
Dignity; and
(iii)
Rights;
(f)
Communicate with the RN regarding potential ethical issues; and
(g)
Communicate to the RN, observations of actions by other health care providers which may jeopardize the client’s safety and well being.
F.
Collaboration.
(1)
The LPN shall participate with the client, the client’s family, significant others, the RN, and other health care providers in providing care.
(2)
Measurement Criteria. The LPN shall:
(a)
Participate with the client, the client’s family, significant others, the RN, and other health care providers by contributing to:
(i)
The development of overall goals;
(ii)
The nursing plan of care; and
(iii)
Decisions related to care and the delivery of services; and
(b)
Consult with the RN and other health care providers regarding client care.
G.
Research.
(1)
The LPN shall support research activities appropriate to the LPN’s scope of practice.
(2)
Measurement Criteria. The LPN shall:
(a)
Have knowledge of the client’s rights related to research;
(b)
Participate in data collection; and,
(c)
Utilize established facility-approved research protocols.
H.
Resource Utilization.
(1)
The LPN shall consider factors related to safety and cost when participating in client care planning and implementing client care.
(2)
Measurement Criteria. The LPN shall:
(a)
Assist the client, the client’s family, and significant others to identify:
(i)
Unmet client needs; and
(ii)
Potential services to meet any unmet needs; and
(b)
Evaluate factors related to client safety and cost when performing or delegating client care.
I.
Delegation and Supervision.
(1)
When the delegation does not jeopardize the client’s welfare, the LPN may delegate nursing tasks to a certified nursing assistant, medication technician, or an unlicensed person who is competent to perform those acts or tasks.
(2)
Measurement Criteria.
(a)
When delegating a nursing task, the LPN shall assess the client and determine that the delegation is consistent with COMAR 10.27.11.
(b)
When delegating nursing tasks, the LPN shall assess the capabilities, experience, and competency of a person working under the LPN’s supervision.
(c)
When delegating a nursing task to a certified nursing assistant, medication technician, or an unlicensed person, the LPN shall:
(i)
Instruct;
(ii)
Direct;
(iii)
Regularly evaluate the performance of nursing tasks by the certified nursing assistant, medication technician, or unlicensed person;
(iv)
Rectify a situation in which the certified nursing assistant, medication technician, or unlicensed person under the LPN’s supervision is performing nursing tasks that are inconsistent with generally accepted professional standards and notify the registered nurse leader of the nursing team; and
(v)
Prohibit the continued performance of the certified nursing assistant, medication technician, or unlicensed person who is performing the delegated nursing task or tasks incompetently and notify the registered nurse leader of the nursing team.
J.
Refusal.
(1)
The LPN has the right and the responsibility to refuse to perform, or delegate nursing acts.
(2)
Measurement Criteria.
(a)
The LPN has the right and responsibility to refuse to perform a nursing act which is beyond the parameters of the LPN’s:
(i)
Education;
(ii)
Capabilities;
(iii)
Clinical competency; and
(iv)
Scope of practice.
(b)
The LPN shall obtain appropriate education, training, and supervision as required to perform nursing functions which are within the LPN’s scope of practice but are beyond the parameters of the licensee’s clinical competency.
(c)
The LPN has the right to refuse to accept responsibility and accountability for supervising, monitoring, instructing, or evaluating a certified nursing assistant, certified medication technician, or an unlicensed person performing a nursing task that has not been delegated by that licensee.
Regulation .04 Prohibited Acts.LinkCopy Citation
The LPN may not:
A.
Perform nursing triage;
B.
Perform the responsibilities of, or serve in the role of, the circulating nurse in the intraoperative phase of surgery including, but not limited to:
(1)
Assessing the client in the intraoperative phase of surgery to identify emerging client situations which would require anticipating and responding to the needs of the:
(a)
Client;
(b)
Anesthesiologist; and
(c)
Surgical team;
(2)
Administering or transporting to the surgical field medications, infusates, or solutions that may be required by the anesthesia or surgical team during the course of the intraoperative procedure;
(3)
Gathering needed equipment and anticipating resuscitation efforts during the intraoperative phase;
(4)
Collaborating with other members of the surgical team for ongoing assessment and planning for the client’s postoperative care; and
(5)
Documenting completely, timely, and accurately on appropriate records;
C.
Perform the comprehensive nursing assessment;
D.
Serve as the case manager for client care;
E.
Supervise the nursing practice of RNs and other LPNs; and
F.
Analyze client data in order to determine client outcome identification and formulation of a nursing diagnosis.
Chapter annotations
Authority: Health-General Article, §4-403; Health Occupations Article, §§8-205(a)(2) and 8-316, Annotated Code of Maryland
History: Effective date: February 20, 1989 (16:3 Md. R. 343)
History: Regulation .03 amended effective October 25, 1993 (20:21 Md. R. 1655)
History: Regulations .01—.03 repealed and new Regulations .01—.04 adopted effective May 2, 2011 (38:9 Md. R. 553)
History: Regulation .01B amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .02C amended effective October 13, 2025 (52:20 Md. R. 1002)