West Virginia's medical patients and healthcare recipients depend on empathetic nurses who provide life-saving care daily. To gain the authority to become a trusted member of the state's healthcare community, nurses of every caliber expend years of their lives to complete schooling, licensing, and on-the-job training. One of the most integral parts of a nurse's career is adhering to the provisions and practices outlined in the Nurse Practice Act (NPA).
West Virginia utilizes the nationwide NPA to create regulations governing safe and legal nursing care for patients and oversight for professionals through state agencies. The legislation also profiles nurses' scope of practice, professional guidelines, and matters related to authorized and prohibited medical interventions.
Understanding the NPA is imperative for West Virginia's nurses. Mistakes and misunderstandings can occur in the fast-paced world of healthcare. Even a single violation or false allegation can upend a nurse's career—no matter how small—which can have common effects like the following:
- Fines and mandatory education that place burdens on a nurse's ability to practice
- Restrictions and limitations that harm a nurse's professional practice and reputation
- Suspension or revocation of credentials that become a barrier to nursing practice
While West Virginia nurses may encounter trouble with state authorities or medical facilities over alleged NPA breaches, they can seek assistance from the Lento Law Firm. We will direct anyone on how NPA changes may affect them and their practice and defend them against sanctions and corrective actions related to violations. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 now or fill out our confidential consultation form, and we will contact you.
Scope of Practice for Different Types of Nurses
West Virginia's application of the NPA defines the scope of practice and professional expectations for nurses within the state. It provides guidelines on what exactly nurses are authorized to do in a given placement or facility and those that are prohibited or require additional certification. Among those listed to practice nursing care in the state include:
- Licensed Practical Nurses (LPNs)
- Registered Nurses (RNs)
- Advanced Practice Registered Nurses (APRNs)
In the healthcare workplace, there are others referred to as unlicensed assistive personnel (UAPs), which can include nursing aides, clinical aides, and medication aides. UAPs gain the ability to work with patients and medical facilities through registration with the West Virginia Department of Health and Human Services (DHHS).
Typically, UAPs work under the delegation and supervision of licensed nurses and assist with basic nursing care that does not require advanced practice or medical intervention. UAPs cannot administer medications, including over-the-counter drugs, unless they have additional certification and are delegated that task by a supervisor.
While most states govern all licensed nurses under one agency, West Virginia manages them with two. LPNs must obtain licensure and follow compliance protocols from the West Virginia Board of Examiners of Licensed Practical Nurses (WV LPN Board). RNs and those of advanced practice are beholden to the West Virginia Registered Nurse Board (WV RN Board).
Licensed Practical Nurses
In West Virginia, LPNs are defined as those who perform nursing acts under the direction of an RN, licensed physician, or dentist but do not have the specialized skill, judgment, and knowledge required for professional nursing. The WV LPN Board asserts that LPNs do not have specific duties spelled out by the NPA and only "recommend" that they perform procedures for which they have been educated and trained.
LPNs may use the following steps to determine on a case-by-case basis if an activity or task falls within their scope of practice:
- Clarification of the issue: Gather facts and cross-reference them with policies or procedures that influence the decision to act.
- Assessment of skills and knowledge: Determining what skills are required to complete activities or tasks and whether they have the competence and can access appropriate supervision.
- Identification of options: Defining the potential outcomes and solutions given the implications of choosing to perform an activity or task accurately and safely.
LPNs can only administer certain intravenous drug therapies, such as chemotherapy, with verified certification and adequate supervision. Moreover, they may only delegate tasks to UAPs and assign tasks to other LPNs.
Registered Nurses
RNs have a broader scope of practice and are responsible for delivering more complex patient care. With licensing from the WV RN Board, their scope of practice includes:
- Medical assessment and planning: Applying the principles of nursing from biological, physical, and social science to identify patient care needs and implement plans to oversee medical progress.
- Medication and drug administration: Administering all forms of medication, including intravenous drugs and controlled substances, with consistent certification.
- Delegation and personnel supervision: Giving tasks and overseeing LPNs and UAPs to ensure safe and effective care for patients and healthcare recipients.
In West Virginia, RNs are not authorized to perform medical diagnoses or prescribe treatments without further certification. They also cannot order diagnostic tests without the authorization of an APRN, licensed physician, or dentist.
Advanced Practice Registered Nurses
APRNs have the most education and training and, thus, an expansive scope of practice among nursing professionals. Licensed through the WV RN Board, they are directly accountable and responsible for care recipients and are often specialized in one of four areas:
- Certified Nurse Practitioner
- Certified Registered Nurse Anesthetist
- Certified Nurse Mid-Wife
- Clinical Nurse Specialist
APRNs normally engage in autonomous practice and may assess, diagnose, and manage patients within their competence and education. They also have the ability to prescribe medications, including controlled substances, provide care standards that comply with state and federal requirements, and have the proper certifications. The activities and tasks APRNs are prohibited from doing are anything not taught in their programs or renewal education and anything not recognized by their certifying body outside of the state agencies.
Critically, West Virginia nurses may hold all three active licenses—LPN, RN, and APRN. However, both boards caution individuals regarding role confusion related to their scope of practice differences based on their current occupation with patients or within a facility. The boards hold the licensee accountable to their highest level of education.
Supervision and Delegation Rules
One of the most significant tenets of providing effective patient care is delegating care duties to various nurse licensees. In many cases, these duties require some amount of direct or indirect supervision. Therefore, the West Virginia NPA also provides guidelines to mitigate improper delegation or supervision to ensure patient safety.
LPNs, RNs, and APRNs have the authority to assign nursing tasks to other personnel. Before doing so, they must evaluate using the five rights of delegation and assignment, which are:
- Right Task: Given the patient or recipient's condition, the right task is delegated or assigned.
- Right Person: The right person is delegating or assigning the right task.
- Right Direction: The delegatee is given clear and concise descriptions of the task, including objectives, limitations, and expectations.
- Right Supervision: Appropriate levels of monitoring the delegatee completing the task to then provide evaluation and intervention, if needed.
- Right Circumstances: Given patient stability and available resources to delegate a task, appropriate conditions exist.
There is a difference between delegation and assignment. The West Virginia NPA dictates that delegation is always downward, wherein an individual (RN or APRN) retains responsibility for tasks delegated. Assignment is when the authority for the tasks already exists, such as when a nurse, typically an LPN, assigns a task to another LPN or a UAP with the appropriate competence and certification.
While LPNs can delegate tasks within their scope to other LPNs and UAPs, they will also have tasks delegated to them by higher-level nurses. Activities appropriate for delegation to LPNs are only those that have been carefully evaluated by supervising RNs or APRNs to have only one option. That means that the LPN is expected to proceed through the task without encountering unexpected responses or reactions based on the nurse's competence. Nurses may not delegate tasks to LPNs who present decision-making situations or those who require professional judgment or in-depth assessment to complete.
In terms of delegating and supervising UAPs, any task must involve assisting a nurse with patient care and may not be independently assigned. The scope of UAPs is limited to the following under delegation:
- Taking vital signs
- Patient hygiene protocols and protection
- Ambulatory, comfort, and nutrition initiatives
Unless in a school setting, UAPs may not perform or be delegated to perform tasks reserved for licensed nursing personnel. Activities that are not appropriate for UAPs include those that require nursing judgment or skill and those that jeopardize the patient's safety or welfare.
Continuing Education and Competence
The West Virginia NPA requires nurses to complete continuing competence programs to maintain their credentials—also known as continuing education (CE). The provision ensures nurses at each level remain current with evolving medical knowledge and changing practice standards. Renewal dates run on a two-year cycle, and CE—measured in contact hours—is completed within that timeframe. Critically, one contact hour equals 50 minutes of instruction or 50 minutes of clinical or laboratory practice in an informal setting. Nevertheless, CE must come from the list of board-approved providers.
LPNs must complete 24 CE contact hours, including practicing at least 400 hours within the previous renewal period. The board may grant waivers based on education enrollment, practice engagement, or military service.
Renewing RNs need 12 contact hours of CE, whereas newly licensed RNs need only three hours of CE related to drug diversion and safe prescribing. APRNs must complete 24 contact hours of CE, with 12 in pharmacotherapeutics and 12 in clinical management. Those who prescribe controlled substances must complete three hours related to drug diversion, safe prescribing, and opioid antagonist training within one year of obtaining a new license.
Regardless of the level of medical license, all individuals must maintain renewal documentation. West Virginia requires nurses to keep records, such as certificates, transcripts, or other citations of attendance, for at least four years to provide verification of compliance for board audits. Failure to prove completion of CE requirements may invoke additional conditions for renewal and could lead to revocation of credentials.
Unprofessional Conduct and Discipline
The West Virginia NPA also outlines professional standards for nurses and is used by each nursing board. While each level of licensure has its own authorized acts in the medical field, all licensees, regardless of license level, are subject to professional behavior standards. Although not an exhaustive list, the following are some of its tenets:
- Practicing nursing beyond the authorized scope of a license or on a suspended, lapsed, or inactive license
- Failure to maintain medical records professionally, falsifying or altering them
- Practicing while a physical or emotional condition impairs an individual's ability
- Inappropriately delegating tasks or failing to adequately supervise
- Violating patient confidentiality or professional boundaries
- Failure to report an NPA violation to the board within 30 days
- Having a license reprimanded in another jurisdiction
- Terminating patient responsibility without properly notifying the appropriate personnel
- Failure to carry out board requests
- Practicing while under the influence of mood-altering substances, including drug addiction and chronic alcoholism
- Misappropriation of medical supplies or facility equipment
Allegations of misconduct can arise from coworkers or supervisor reports, patient complaints, and even anonymous reports through state agencies. The grievance process presents a significant threat to nurses, whether individuals approach informal or formal disciplinary procedures. Licenses to practice may be suspended for three months to several years. Even significant first-time charges can warrant permanent revocation.
Furthermore, just because a nurse is disciplined by one of the boards in West Virginia doesn't mean the effects remain within the state's borders. As a signatory of the Nurse Licensure Compact (NLC), West Virginia nurses may practice in over 40 states through license reciprocity. However, any disciplinary action taken on an individual's license in West Virginia affects the status in other NLC-compliant states until full reinstatement.
Whenever nurses face allegations of unprofessional conduct or any discipline, they must understand that they can obtain help. The NPA is a complex set of rules and regulations, and nurses must protect the years of education and training they have dedicated to their careers.
Contact the Lento Law Firm for West Virginia NPA Defense
The Lento Law Firm Professional License Defense Team understands that even minor NPA violations can end a nurse's career. Even the implications for forgetting to record a patient's change in condition can derail future prospects. While some may think a short departure from duties deserves a second chance, that isn't how the NPA directs West Virginia's nursing agencies to manage rule violations.
Nurses need an experienced team that is well-versed in the administrative proceedings used to adjudicate and levy sanctions. We provide a delicate approach to protecting a license to practice, such as negotiating with the RN and LPN boards to promote a beneficial resolution without discipline. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 today or fill out our consultation form.
