March 18, 2004 - The Transpacific Renal Network (#17) has posted on its web site a brief recap of the LVN's role in administering specific intravenous medications in California. News item from ESRD Network 17.

April 21, 2003 - This article from the Sacramento Business Journal outlines the dispute between RNs and LVNs on medication administration practices in California dialysis centers.

April 16, 2003 - The California Dialysis Council (CDC) is reporting that the Sacramento Superior Court has reaffirmed its tentative decision to deny the California Nurses Association�s request for a preliminary injunction to stop the application of the new LVN regulations which became effective on February 28, 2003. In the tentative ruling issued by the Sacramento Superior Court, the court stated as follows:

"The application for preliminary injunction is denied. The plaintiff has not established a probability of success on the merits."

News item and pdf document from the CDC web site.

April 15, 2003 - The California Nurses Association (CNA web site) is making claims that the Service Employees Union (SEIU) and "major dialysis corporations" are actively collaborating in a new campaign to attack CNA, patient protections, and professional RN practice. Flyer from the CNA web site (pdf format).

April 4, 2003 - The California Nurses Association (CNA) is taking on the California Dialysis Council (CDC) over regulations that would expand the scope of LVN practice in dialysis centers. Web page from the CNA web site.

March 1, 2003 - The California Dialysis Council (CDC) is reporting that a judge has denied the California Nurses Association's request for a Temporary Restraining Order on the LVN regulations. News page from the CDC.

February 19, 2003 - The California Nurses Association (CNA), in cooperation with the Service Employees International Union (SEIU), is filing a law suit to overturn the recent decision by the California Office of Adminstrative Law (OAL) on permitted practices by LVNs as a violation of the Nursing Practice Act that puts patients at risk.

In January the Office of Administrative Law granted LVNs the authority to administer IV medications in hemodialysis, pheresis, and blood bank settings, a major expansion of LVN scope of practice. Press release from the CNA (pdf format). (link is no longer available)

February 11, 2003 - The California Office of Administrative Law (OAL) has approved regulations developed by the Board of Vocational Nursing and Psychiatric Technicians (BVNPT) that permit Licensed Vocational Nurses (LVNs) to administer IV medications integral to hemodialysis, pheresis, or blood bank procedures.

Here is the full story and a copy of the regulations (pdf format) from the California Dialysis Council (CDC) web site.

Importantly, the regulations authorize LVNs to function in accordance with standardized
procedures adopted by the dialysis facility. The BVNPT staff has advised that the standardized procedures may state that properly-trained LVNs may initiate and terminate dialysis via a central line.


June 19, 2002 - The California Board of Vocational Nursing and Psychiatric Technicians (BVNPT) has proposed regulations permitting licensed vocational nurses (LVNs) to administer IV medications integral to hemodialysis, pheresis, or blood bank procedures. This action is being opposed by the California Nurses Association (CNA), which has begun a letter writing campaign against the proposed changes. The CNA sample letter points out:

"The dialysis setting provides an excellent example of the sound reasons behind the current limitation on LVN practice. Medications introduced in hemodialysis are circulated rapidly through the system; any medication introduced will have an immediate and irretrievable effect on the patient. A nurse must be able to assess and respond rapidly to any complications. In addition the nurse must be a skilled manager of the equipment and the vascular access devices.

There is no reason for the proposed change, and were it to go into effect, patient care would be harmed. LVNs are an important part of the patient care team in dialysis facilities. Their function should not be jeopardized by the expansion of their scope of practice beyond statutory authority and beyond what the requirements of patient safety allow."

Here is the CNA Nursing Practice Alert on this issue.

The California Dialysis Council (CDC) has been advocating a limited increase in the scope of LVN nursing practices in dialysis units. Here is a November 28, 2001 update on the issue from the CDC web site.

On April 12, 2002, a written decision from the Office of Administrative Law (OAL) rejected proposed LVN regulations from the Board of Vocational Nurses and Psychiatric Technicians (BVNPT). However, the OAL left open the possibility of change by stating, "If the Board can supplement the record with facts, studies, expert opinion or other information that tends to show this evolution in nursing practice, these regulations could be submitted within 120 days of receipt of this decision for further OAL review and consideration."

Here is the April 12 disapproval notice that is available on line at http://www.oal.ca.gov/notice/18z-2002.pdf (See page 881):

DECISIONS OF DISAPPROVAL OF REGULATORY ACTIONS
Printed below are the summaries of Office of Administrative Law disapproval decisions. Disapproval decisions are published in full in the California Code of Regulatory Decisions. You may request a copy of a decision by contacting Mike Ibold, Law Librarian at the Office of Administrative Law, 300 Capitol Mall, Suite 1250, Sacramento, California 95814-4339, (916) 323-8906�FAX (916) 323-6826. Please request by OAL file number.

STATE OF CALIFORNIA
OFFICE OF ADMINISTRATIVE LAW OAL File No. 02-0228-09S
VICTORIA S. CLINE
Staff Counsel for: DAVID B. JUDSON
Deputy Director/Chief Counsel
In re:
AGENCY: BOARD OF LICENSED VOCATIONAL NURSES AND PSYCHIATRIC TECHNICIANS
ACTION: Amend sections 2542, 2542.1, 2547, and 2547.1 of Title 16 of the California Code of Regulations

SUMMARY OF RULEMAKING ACTION

The Board of Licensed Vocational Nurses and Psychiatric Technicians (��Board��) proposed regulatory amendments that would have permitted a licensed vocational nurse (��LVN��) with a Board-certification in intravenous therapy to administer intravenous medications in hemodialysis, pheresis and blood bank settings under certain conditions. The regulations were submitted to the Office of Administrative Law (��OAL��) for review on February 28, 2002, and disapproved on April 12, 2002.

Date: April 19, 2002
Original: Teresa Bello-Jones, Executive Officer
cc: Kim Frankland
Marina Okimoto

Here is the California Board of Vocational Nursing and Psychiatric Technicians web site.


[This message has been edited by Gary Peterson (edited 04-18-2004).]