Practice

​​​​​​​​​​​​​​​​​​​​​It is not within the scope of practice for the LPN or RN to independently practice, order products, or prescribe treatments.


Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) Owning a Practice​​

  • RNs may administer medication and treatment as prescribed by a physician, physician assistant, dentist or advanced practice registered nurses. See KRS 314.011(6)
  • LPNs may identify, observe, and care for the ill, injured, or infirm under the direction of a registered nurse, advanced practice registered nurse, physician assistant, licensed physician, or dentist. See KRS 314.011(10)

RN or LPN Owning a Practice
Statutes and regulations do not prohibit a nurse from owning a practice.

An RN or LPN may use standing orders or protocols that have been established by a physician or an Advanced Practice Registered Nurse (APRN).

AOS #14 Implementation of Patient Care Orders and AOS #15 Supervision and Delegation of Nursing Acts to Unlicensed Personnel are in the document library.

Kentucky Cabinet for Health and Family Services (CHFS)
The Kentucky board of Nursing has no jurisdiction over long-term care facilities, home health agencies, ambulatory infusion facilities, family care home, personal service agencies, tattoo parlors, etc. These types of facillities are regulated by CHFS. The link provided may help. CHFS link application for health care and long-term care – cabinet for health and family services


A Nurse’s Responsibility and Accountability


Each nurse is individually responsible and accountable for their individual's acts based upon the nurse's education and experience. Each nurse must exercise professional and prudent judgment in determining whether the performance of a given act is within the scope of practice for which the nurse is both licensed and clinically competent to perform. See KRS 314.021


Practice Authority and the Professional Scope and Standards of Practice

Practice​ authority (legal scope of practice) i​s granted by the Kentucky General Assembly, and is defined by statutes and regulations governing the Board of Nursing


The Board of Nursing

  • The Board is responsible for regulation of nursing practice.
The Board’s Mission is to protect the public from unsafe nursing practice.

Professional Organizations
  • Protect, define the nature of, and advance scope of practice.
  • The Nursing Scope and Standards of Practice describe the following:
    • Who: Licensees who have been educated, titled, and maintain active licensure to practice nursing.
    • What: Protection, promotion, and optimization of health; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment; and advocacy.
    • Where: All patient healthcare settings.
    • When: Whenever there is a need for nursing knowledge, compassion, and expertise.
    • Why: The profession exists to achieve the most positive patient outcomes in keeping with nursing’s social contract and obligation to society.
  • American Nurses Association (ANA)
  • National Council of State Boards of Nursing (NCSBN)
Determining Scope of Practice
In addition to Kentucky Nursing Laws, the KBN issues Advisory Opinion Statements (AOSs) as guidelines to assist nurses in the safe practice of nursing.

When the performance of a specific act is not definitively addressed in the Kentucky Nursing Laws or in an advisory opinion of the Board, the nurse must exercise professional judgment in determining whether the performance of the act is within the scope of practice for which the nurse is licensed.


Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)


The Kentucky Board of Nursing RN-LPN Scope of Practice Comparison Chart provides a snapshot comparison on the role of the RN and the LPN in components of nursing practice with web links to references.

You can find AOS #41 – RN/LPN Scope of Practice Determination Guidelines​ including the KBN Decision-Making Model for Determining Scope of Practice for RNs-/LPNs ​and AOS #27 Components of LPN Practice in the Document Library.


Delegation and Supervision



Who is responsible and accountable for delegation of nursing tasks?


Only a licensed nurse can delegate.


In accordance with KRS 314.021(2), nurses are held responsible and accountable for their decisions regarding the supervision and delegation of nursing acts to unlicensed personnel who provide nursing assistance, based upon the nurse's educational preparation and current clinical competence in nursing.

How do I determine what nursing tasks may be delegated?

When aspects of nursing care need to be delegated beyond the traditional role, nurses may delegate some nursing acts to Unlicensed Assistive Personnel (UAP). UAP who provide assistance to nurses may contribute to the implementation of the plan of nursing care when the delegation of the task does not jeopardize the client welfare. Tasks may be delegated only after a nursing assessment is made and, in the nurse’s judgment, it is decided that delegation of the task is appropriate.

Guidance Related to Delegation

Delegation of Nursing Tasks is discussed in 201 KAR 20:400;
Advisory Opinion Statement (AOS) #15 Supervision and Delegation of Nursing Tasks to Unlicensed Personnel, found in the Document Library; and
The Decision Tree for Delegation to UAP (Unlicensed Assistive Personnel), found in the Document Library.


Guidance Related to Supervision
Supervision is defined as “the provision of guidance by a qualified nurse for the accomplishment of a nursing task with periodic observation and evaluation of the performance of the task including validation that the nursing task has been performed according to established standards of practice.” See 201 KAR 20:400.

Determining the Degree of Supervision


Factors to be determined by the delegator include:
  • The stability and acuity of the patient;
  • The training and competency of the delegatee;
  • The complexity of the nursing task being delegated; and
  • The proximity and availability of the delegating nurse to the dele​gate when the nursing task is performed.
Degree of Supervision of the LPN:

  • Determined by the LPN’s supervisor; and
  • Is based on a patient’s condition, as determined by the LPN’s supervisor.
A supervisor may provide supervision without being physically present in the immediate vicinity of the LPN, when:
  • A patient’s condition is stable;
  • Predictable, and Rapid change is not anticipated; but
  • The supervisor must be readily available.
A supervisor must be physically present in the immediate vicinity of the LPN and immediately available to intervene in care, when:
  • A patient’s condition is or becomes unstable.
  • A patient is receiving blood, blood components, or plasma volume expanders.
  • A patient is receiving peritoneal dialysis or hemodialysis.
Guidance Related to LPN Practice
The Advisory Opinion Statement (AOS) #27 Components of Licensed Practical Nursing Practice may be found in the Document Library


​Scope of Practice Related to Cosmetic and Dermatological Procedures



​​​​Can a nurse engage in the practice of cosmetology and esthetics?

Aesthetic, cosmetic, and dermatological procedures may be performed by a nurse as a part of a medically prescribed plan of care for treatment of various dermatological conditions.

The Kentucky statutes applicable to cosmetologists, and estheticians licenses are not applicable to nursing practice. They are regulated under KRS Chapter 317A.

No person shall engage in the practice of cosmetology, esthetic practices, or nail technology for other than cosmetic purposes nor shall any person engage in the practice of cosmetology, esthetic practices, or nail technology for the treatment of physical or mental ailments. This chapter does not apply to . . . Persons authorized by the law of this state to practice . . . nursing . . . who perform incidental practices of cosmetology, esthetic practices, and nail technology in the normal course of the practice of their profession.

See KRS 317A.020.

However, you may wish to acquaint yourself with the practice standards followed by non-nurse estheticians, as there is likely overlap in terms of accepted professional practices in the provision of esthetic services.


Advisory Opinion Statement (AOS)
In the Document Library, you can find additional information in AOS #35 Cosmetic and Dermatological Procedures by Nurses, to assist nurses who wish to engage in the safe practice of nursing.

Scope of Practice of LPNs and RNs in the Performance of Cosmetic and Dermatological Procedures
LPNs and RNs are able to implement interventions and administer medications and treatments as prescribed and supervised by a physician, physician assistant, dentist, or APRN. These healthcare providers are able to delegate tasks to the RN or LPN.

The LPN or RN may follow standing orders/protocol after the healthcare provider has established a treatment plan.

In the Document Library, you can learn about standing orders and protocols in AOS #14: Roles of Nurses in the Implementation of Patient Care Orders: Use of Protocols, Standing Orders, and Routine Orders​.

Best Practices APRNs Interested in Providing Cosmetic and Dermatological Procedures
In the Document Library, you can find additional information AOS #35 Cosmetic and Dermatological Procedures by Nurses, which lists a set of recommended best practices for APRNs who are interested in providing cosmetic and dermatological procedures in a responsible, safe, and effective manner.

Nurses - Neurotoxins and Derm Fillers
It is not within the scope of practice for an LPN or RN to independently practice, order products, prescribe treatments, or perform medical aesthetic procedures such as Botox© or Derm fillers.

APRNs

APRNs should consult the APRN Scope of Practice and Decision Making Model as well as AOS #35, both are found in the Document Library, to determine if it is within their scope of practice to assess, diagnosis, administer, prescribe treatments, and order products.


Offsite Neurotoxins (e.g. Botox©)

No statute, regulation, or published decision precludes an APRN from lawfully taking a multi-dose vial of Neurotoxin to a patient’s home, a hair salon, or any other place where the conditions are sufficiently sanitary for the administration of Neurotoxins.

However, the assessment, diagnosis, prescription and administration of Neurotoxins  must be within the APRN’s scope of practice as measured pursuant to the APRN Scope of Practice Decision Making Model, which can be found in the Document Library. For more information, please see the webpage at the following link,​Advanced​ Practice Registered Nurses (APRNs) Dispensing Drug Samples - Kentucky Board of Nursing.


APRNs as Medical Director for a Med Spa
An APRN who meets the requisite educational and experiential requirements may own a med spa and function as the medical director. One of the responsibilities of a medical director is to stay informed regarding developments in both law and practice.


An APRN medical director of a med spa in a clinical setting, without a physician or pharmacist on staff, may order and stock nonscheduled legend drugs, including neurotoxins or dermal f​​​iller medications, for th​e specific purpose of direct administration. However, an APRN may not dispense nonscheduled legend drugs, except as provided in KRS 314.011(17).

However, i​f the facility has a physician or pharmacist on staff, the applicability of the physician or pharmacist broadens the scope of what may lawfully occur at the facility.

In the Document Library, you can find the APRN Scope of Practice Decision Making Model​, which can assist in determining whether you are qualified to serve as the medical director of a med ​spa.

Additional Suggestions