print this pageNeither a License Nor a Certification is Required to Perform Certain Nursing Services*
* Including: catheterization, skin puncture, bowel care, tube feeding, ventilator care, tracheostomy care, suctioning and assistance with self-administration of medications.
Division 2 of the Business and Professions Code is entitled Healing Arts. Chapter 6 of that Division is entitled Nursing and is referred to as the Nursing Practice Act (Business and Professions Code, Section 2700). Chapter 6.5 is entitled Vocational Nursing and is referred to as the Vocational Nursing Practice Act. (Business and Professions Code, Section 2840).
The Nursing Practice Act in Business and Professions Code subdivision (b) of Section 2725 describes the practice of nursing as follows:
"The practice of nursing within the meaning of this chapter means those functions, including basic health care, which help people cope with difficulties in daily living which are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill..." (emphasis added.)
The Vocational Nursing Practice Act defines the practice of vocational nursing in Code Section 2859 as follows:
"The practice of vocational nursing within the meaning of this chapter is the performance of services requiring those technical, manual skills acquired by means of a course in an accredited school of vocational nursing, or its equivalent, practiced under the direction of a licensed physician, or registered professional nurse, as defined in section 2725 of the Business and Professions Code." (emphasis added.)
The Legislature's definition of the practice of nursing focuses on those acts which require a substantial amount of scientific knowledge or technical skill. The definition of the practice of vocational nursing focuses on the performance of services requiring technical, manual skills.
Exceptions to the Nursing Practice Act and to the Vocational Nursing Practice Act are contained in Sections 2727 and 2861, respectively. Section 2727 is entitled "Exceptions in General", and provides in relevant part as follows:
"This chapter does not prohibit:
(c) Domestic administration of family remedies by any person.
(e) The performance by any person of such duties as required in the physical care of a patient and/ or carrying out medical orders prescribed by a licensed physician; provided, such person shall not in any way assume to practice as a professional, registered, graduate, or trained nurse."
Subdivision (e) provides for physical care of a patient and/or carrying out medical orders prescribed by a licensed physician. Additionally, subdivision (c) allows any person to administer in a domestic as opposed to institutional setting any family or non-prescription remedies. Clearly, the definition of the practice of registered nursing coupled with these exceptions allow persons other than registered nurses to perform services including catheterization, bowel care, tube feeding, ventilator care, tracheostomy care, suctioning and assistance with self-administration of medications.
The dispute is whether services including catheterization, bowel care, tube feeding, ventilator care, tracheostomy care, suctioning and assistance with self-administration of medications are functions that can only be performed by to a licensed vocational nurse as opposed to an unlicensed person such as a certified nursing assistant or equivalent. However, the fact that these services can be done by a licensed vocational nurse in and of itself establishes that they can also be performed by any other person.
Business and Professions Code, section 2861 is part of the Vocational Nursing Practice Act. It is entitled Services by Unlicensed Person and provides as follows:
"This chapter does not prohibit the performance of nursing services by any person not licensed under this chapter; provided, that such person shall not in any way assume to practice as a licensed vocational nurse."
Since these services are such that they can be provided by a licensed vocational nurse, then under section 2861 they can also be provided by any person as long as that person does not hold themselves out as a licensed vocational nurse. Therefore, they can be performed by a certified nurse assistant.