Skilled nursing services will be provided by a Registered Nurse or a Licensed PracticalN ocational Nurse under the supervision of a Registered Nurse and in accordance with a medically approved Plan of Care (physician’s orders).

ln determining whether a service requires the skills of a Nurse, the inherent complexity of the service, condition of the client, and accepted standards of medical and nursing practice will be considered.

The staff education and experience that a special procedure or treatment is ordered, prior to assignment.


To abide by state/federal guidelines and offer guidelines to the agency staff, physicians, and community for the appropriate utilization of professionally skilled nursing services.


1. The registered nurse:

a. Performs the initial assessment visit.

b. Regularly reevaluates the client needs and coordinates the necessary services.

c. Initiates the Plan of Care and necessary revisions and updates to the plan of care and the care plan.

d. Provides services requiring specialized nursing skill and initiates appropriate preventative and rehabilitative nursing procedures.

e. Informs the physician and other personnel of cl:ianges in the client condition and needs.

f. Counsels the client and family/caregivers in meeting their needs.

g. Prepares clinical and progress notes.

h. Supervises and teaches other nursing personnel and home health aides as appropriate.

i. Participates in continuing education programs.

2. The Licensed Practical Nurse:

a. Provides service in accordance with agency policy and nursing standards of practice.

b. Assists the registered nurse to complete the physician plan of care for skilled services.

c. Assists the client in learning appropriate self-care techniques.

d. Reports findings and observations to the registered nurse and other members of the team to assure coordination and timely response to client changes or needs.

e. Prepares clinical and progress notes.

3. Skilled nursing activities in the home care setting may include: observation and assessment, teaching and training activities. Management and evaluation of the

care plan and routine and complex skilled procedures.

4. The nurse will demonstrate competency in providing procedures such as:

a. Insertion and irrigation of urinary catheters.

b. Ostomy care and teaching.

c. Documenting and implementing physician orders.

d. Wound care involving prescription medication and aseptic technique.

e. Care of extensive pressure or stasis ulcers or other significant problems with skin integrity.

f. Venipuncture and intravenous therapy, as allowed by state practice act.

5. Specialized services such as Pediatric Nursing, Infusion Therapy, and other

services as appropriate will be provided only when the agency has sufficient staff with training and experience to manage and provide care for these populations.

6. The staff education and experience will be taken into consideration to render a

special procedure or treatment is ordered, prior to assignment.