RN Supervision of Certified Emergency Care Providers

September 13, 2002

Linda Goeldner, CHE, CAE
1501 42nd Street
Suite 471
West Des Moines, IA 50266

Dear Ms. Goeldner:

The Iowa Board of Nursing considered your request for a statement from the board on RN supervision of EMS personnel. The board's motion was to provide the Iowa Nurses Association with the board's statement regarding Registered Nurse Supervision of Certified Emergency Care Providers Employed to Perform Nonlifesaving Procedures in a Hospital The statement may be published in the Iowa Nurse Reporter, posted on the website and distributed upon request.

The statement is enclosed. If you have questions, feel free to contact me at 515/281-4827. Sincerely,

Lois Churchill, RN, MN
Associate Director
Nursing Practice

Iowa Code 1 47A. 8 sets out the legal requirements for certified emergency medical care providers. Iowa Code 147A.8 subsection "d" authorizes the certified emergency care provider to function in any hospital or any other entity in which health care is provided when:

Employed by or assigned to a hospital or other entity in which health care is ordinarily provided only when under the direct supervision of a physician, as a member of an authorized ambulance, rescue, or first response service, or in an individual capacity, to perform nonlifesaving procedures for which those individuals have been certified and are designated in a written job description. Such procedures may be performed after the patient is observed by and when the emergency medical care provider is under the supervision of the physician, physician assistant, or registered nurse, including when the registered nurse is not acting in the capacity of a physician designee, and where the procedure may be immediately abandoned without risk to the patient.

Minimum standards for nursing practice are set out in 655 IAC 6. Accountability is defined as being obligated for one's acts, including the act of supervision. Supervision is addressed in 655-6.2(5) "d" which is found below:

Supervision, among other things, includes any or all of the following:

1. Direct observation of a function or activity.
2. Assumption of overall responsibility for assessing, planning, implementing, and evaluating nursing care.
3. Delegation of tasks while retaining accountability.
4. Determination that nursing care is adequate and appropriately delivered.

• The law specifically states that nonlifesaving procedures may be performed by EMS personnel after the patient is observed by and when the emergency medical care provider is under the supervision of the physician, physician assistant, or registered nurse,
• EMS personnel may function within the same scope of practice as in the prehospital setting, but the agency retains the prerogative to narrow the scope of practice and is obligated to limit the scope of practice of EMS personnel only to functions which are within the scope of practice as designated in the Iowa Code (147) and Administrative Rules 641-Chapter 131.
• The higher level of care is to be given by nursing staff EMS personnel are present to augment, not replace the care provided by the registered nurse. The registered nurse is responsible for using the nursing process to assure that nursing care is adequate and delivered appropriately.
• EMS personnel assist registered nurses in providing care and do not independently provide patient care. The registered nurse is accountable for using professional judgment in assigning and delegating activities and functions to EMS personnel.
• The registered nurse is responsible for the management of care.
• EMS personnel employed in the hospital setting or other entity are under the supervision of the either the registered nurse, physician, or physician assistant.
• When EMS personnel are under the supervision of the registered nurse, the principles of delegation are to be used. For each situation the registered nurse must consider the patient, the complexity of the care needed, the individual certified emergency medical care provider's competency and the registered nurse's availability for supervision.
• The registered nurse may only delegate functions for which the EMS personnel have been certified. Task, which may be delegated to EMS personnel, are limited to those, which are found in the written job description, and to persons who have been adequately prepared by verifiable training and education.
• The registered nurse retains accountability for the delegated tasks.

The registered nurse must recognize and understand the legal aspects of nursing practice. This responsibility includes, but is not limited to the laws and rules provided above. Licensees are accountable for understanding the legal requirements set out in all of the laws and rules applicable to nursing practice. The Iowa Code and Iowa Administrative Code may be accessed at www.state.ia.us/nursing.

Additional information regarding the practice of certified emergency medical care providers is available at www.idph.state.ia.us/EMS/default.asp.

Adopted by the Iowa Board of Nursing on September 6, 2002.

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