LPN Homecare Agency IV Laws

Licensed practical nurses (LPNs) often make up for a shortage of registered nurses (RNs) in the U.S. LPNs employed by home-care agencies are subject to specific restrictions in the delivery of services and procedures. Each state defines the scope of practice for their nurses through Nurse Practice Acts (NPA), including the ability to deliver intravenous fluids and medications.

Governing Entities

• All states in the U.S. have their own professional nursing boards and local legislation that regulates the practice of nursing. These boards and laws specify what services can be performed by nursing professionals. All state boards have representatives on the National Council of State Boards of Nursing (NSBCN), which serves as a cooperative group of members working collaboratively on issues that affect the health, safety and best interests of patients. NSBCN guides legislation, but each individual state board has authority to establish specific scope of practice for their state.

Expanded Practice

• Most nursing boards provide expanded practice regulations related to intravenous infusion, intravenous medications and hemodialysis administration delivered by LPNs through home-care agencies. LPNs must complete advanced training and/or certification in IV administration to provide this service. They must typically work under the supervision and direction of a registered nurse, physician or licensed healthcare professional.

Restrictiveness

• The Health Resources & Services Administration (HRSA) conducted an examination and devised a restrictiveness schedule that defines four levels of authority for each state's LPN scope of practice. The most restrictive Level 4 allows LPNs to administer some IV infusion with additional training, but they are not allowed to administer IV medications. Level 3 allows limited scope of practice and requires direct supervision for IV medication administration, insertion and maintenance. Level 2 gives LPNs authority to administer IV medication of premixed solutions, and manage IV insertion and maintenance. Level 1 is the least restrictive and allows a broader scope of practice for LPNs to administer IV therapy without direct supervision, and includes other advanced functions.

National Practice Act

• The HRSA report summary includes an outline for each state's LPN scope of practice guidelines. The chart includes a specific statement regarding the LPN's responsibility for IV administration, and a statement regarding IV therapy directly related to hemodialysis. LPNs should also review their state's NPAs to determine if they are allowed to deliver any level of IV services through home-care agencies.

Certification

• Homecare LPNs can enhance their skills by completing an IV therapy certification program. The National Federation of Licensed Practical Nurses offers an IV certification that is valid for two years from the date of award. Individual states and online schools also offer certification programs that prepare LPNs to deliver IV services through home-care agencies when allowed.