North Carolina Board of Nursing

Nursing Practice

FAQ - Nursing Practice

  1. Can a LPN or RN work in a position that is below his/her level of licensure?

  2. May an LPN supervise an RN?

  3. Is it within the RN or LPN scope of practice to assist a licensed provider by administering anesthetic agents such as during regional block procedures?

  4. Can a nurse mark a surgical site?

  5. Do I have to let someone “work under my license” even if I don’t trust their work?

  6. The physicians I work with tell me I can do whatever they tell me to do. Is that true?

  7. Can I volunteer as a nurse even though I don’t keep my license active?

  8. How would a nurse go about working as a volunteer on a mission trip?

  9. Can an LPN administer and read TB skin tests?

  10. Can a nurse perform sports physical fitness and medical history assessments?

  11. Should a nurse follow the orders on a MOST (Medical Orders for Scope of Treatment) form?

  12. Is the Surgical First Assist role within the scope of practice of licensed nurses in North Carolina?

  13. Can a nurse be supervised by an unlicensed person or another discipline?

  14. Can an unlicensed person, such as a medical office assistant, be referred to as a “nurse”?

  15. How long after completion of a shift can a nurse go back into the medical record to add information?

  16. Is it permissible for the nurse to hand out samples of medications?

  1. Can a LPN or RN work in a position that is below his/her level of licensure?

    A licensed nurse may accept and work in a position that he/she has the training to do and that is within his/her scope of practice. A RN has the training to perform LPN and NA functions and therefore could accept a position identified for either of these levels. However, the nurse that does so would still be required to act prudently based on his/her educational preparation and would be held to that standard.

  2. May an LPN supervise an RN?

    No, it is beyond the scope of practice for an LPN to supervise an RN’s nursing practice.

  3. Is it within the RN or LPN scope of practice to assist a licensed provider by administering anesthetic agents such as during regional block procedures?

    Yes. Nurses may perform the mechanical task of pushing the plunger of the syringe as the “third hand” of the provider when requested by and performed under the direct supervision of the provider. The provider remains responsible for the appropriate administration of the medication.

  4. Can a nurse mark a surgical site?

    Individual facility policy should dictate which member of the surgical team marks the surgical site. Although it may be preferable for the person performing the procedure to mark the site, this is not always practical. The marking of the site does not require medical decision-making and does not conflict with nursing law. Therefore, it is within the scope of practice for the licensed nurse, as a member of the surgical team, to verify and mark the correct surgical site at the time of surgery, consistent with established agency procedures.

  5. Do I have to let someone “work under my license” even if I don’t trust their work?

    Delegating a task to another qualified individual or assigning work to another qualified staff member does not mean the individual is “working under your license”. The law allows a licensed nurse to delegate certain nursing responsibilities to individuals who are competent to perform the assignment. Each person caring for the patient is responsible for knowing the boundaries of their job and for knowing if he or she has the knowledge/skills/abilities to provide for the client’s needs. It is up to each nurse to decide what activities can safely be assigned to another individual based upon the agency policies/procedures, the education/training of the individual, and the validated competency of the individual. When the nurse has delegated appropriately he/she is not be accountable for the actions/errors of the individual assigned the task.

  6. The physicians I work with tell me I can do whatever they tell me to do. Is that true?

    No. Both the RN and LPN have their own scope of practice. The nurse’s practice is defined by the Nursing Practice Act (NPA), Rules, Level of Licensure, and Agency Policies. No one can expand the licensed nurse’s scope beyond what the law has approved.

  7. Can I volunteer as a nurse even though I don’t keep my license active?

    No. To provide nursing services, whether in a paid or voluntary position, you must have a current valid license.

  8. How would a nurse go about working as a volunteer on a mission trip?

    The mission organizers in the country you will be going to should be able to answer your questions. You must hold a current, valid license to practice nursing or meet that country’s requirements. You should ask the mission organizers what your scope of practice will be in that country. This may be available to you in the policies of the mission organization.

  9. Can an LPN administer and read TB skin tests?

    Under assignment by the registered nurse or other person authorized by State law to provide supervision, it is within the LPN’s scope of practice to administer prescribed TB tests and to assess (21 NCAC 36.0225 (b)) the results. The LPN must receive education/training, be observed reading positive and negative tests, and demonstrate competency with validation by a licensed provider. The employing facility must have the following in place:

    • A written policy allowing this practice by the LPN;
    • A written procedure detailing specific methods and guidelines used for storage, administration, assessment and documentation;
    • A written referral process for positive findings
  10. Can a nurse perform sports physical fitness and medical history assessments?

    Not if the purpose is to make a medical evaluation or interpretation. Medical interpretation is not within the RN or LPN scope of practice. The provider performing these sports assessments “attests” if the individual is physically fit and has no medical reason to prevent him/her from safely participating in a sports activity. This “medical interpretation” is not within the scope of nursing practice. It is, however, within the RN scope of practice to interview, perform and document a history and physical exam for health screening purposes and/or for use by and at the request of a physician. Refer to the Position Statement “History and Physical Examination -The Role of the RN” for specific guidance on the purposes and limitations of the RN’s role in this capacity (www.ncbon.com – Practice – Position Statements – History and Physical Examination – The Role of the RN).

  11. Should a nurse follow the orders on a MOST (Medical Orders for Scope of Treatment) form?

    A MOST form is an end of life directive, based on the patient’s medical condition and wishes that contains the legal orders of a physician, physician assistant or nurse practitioner. From the Board of Nursing perspective, congruent with agency policy and procedure, nurses may implement the orders on a MOST form as they would any legal orders.

    More information about MOST and end of life care may be found at http://www.ncmedsoc.org/pages/public_health_info/end_of_life.html

  12. Is the Surgical First Assist role within the scope of practice of licensed nurses in North Carolina?

    The Surgical First Assist role is within the scope of practice for the Registered Nurse in NC and is commonly titled Registered Nurse First Assist (RNFA). Performance of first assistant activities in the perioperative arena, consistent with agency policy, procedures, and client informed consent, includes but is not limited to preoperative interview for a comprehensive health history, completion of a nursing physical assessment, wound exposure, retraction, hemostasis, tissue handling, dissection, harvesting veins, suturing, stapling, participating in post-op rounds, and discharge teaching. Prior to the RNFA performing these activities, the RN must receive formal education or training in the activities; demonstrate competency in the activities; and the responsible RN manager or administrator must validate competency (this can be direct validation or the assurance that a validation process is in place and is effective).

    Note: Resources available to RNs and employers considering establishing the RNFA role include the Association of Operating Room Nurses (AORN) position statement on specific qualifications, educational preparation, and certification of the RNFA (www.aorn.org/PracticeResources/AORNPositionStatements/Position_RNFA/ ) and the NCBON Scope of Practice Decision Tree for the RN and LPN (www.ncbon.com - practice - position statements - decision trees).

  13. Can a nurse be supervised by an unlicensed person or another discipline?

    A non-nurse (other than a licensed physician) may not supervise nursing practice but could supervise basic employment issues (ie: administrative supervision, human resource issues – time, attendance, dress code).

  14. Can an unlicensed person, such as a medical office assistant, be referred to as a “nurse”?

    No. It is unlawful for any individual to practice or offer to practice as a nurse, or use the word “nurse” as a title for himself/herself, or use abbreviations to indicate that he/she is a RN or LPN, unless the person is currently licensed as a RN or LPN in NC, compact state, or federal government. Refer to the Badge Law (G.S. 90-640 and GS. 90-171.43)

  15. How long after completion of a shift can a nurse go back into the medical record to add information?

    Agency policy would dictate the answer to this. However, late entries should be dated for the date the entry is made and noted as being a late entry for the date of the event. The information must be truthful and not fabricated for purposes of receiving payment or being in compliance with regulation.

  16. Is it permissible for the nurse to hand out samples of medications?

    A nurse may only provide sample medications after the patient has been evaluated by a provider.

    Licensed nurses may provide patients with limited quantities of prescribed medication which has been pre-labeled and prepackaged (ie, starter packs) by the pharmacist or samples supplied by the manufacturer.