What is a Licensed Vocational Nurse (LVN)?
A California licensed vocational nurse, or LVN, is licensed and regulated by the Board of Vocational Nursing and Psychiatric Technicians (BVNPT) and has completed an approved practical nursing program. LVNs provide skilled nursing care and execute nursing interventions under the direction of a California licensed Registered Nurse (RN), Nurse Practitioner (NP), physician, or other authorized health care provider – which now includes California licensed naturopathic doctors beginning January 1, 2023.
What is the scope of practice for a LVN working under the supervision of a California Licensed Naturopathic Doctor?
LVNs perform services requiring those technical, manual skills acquired in an approved school of vocational nursing, or its equivalent, practiced under the direction of a licensed physician, RN, NP or Naturopathic Doctor.
Working under the supervision of a California licensed Naturopathic Doctor, LVNs can perform many of the same tasks as a Naturopathic Assistant. However, in addition, if certain requirements are met (listed below), they can administer IV therapy (vitamins, minerals and blood products only – no medications or herbs), and they can treat patients carrying out the ND’s treatment orders without the ND needing to be present in the office at all times.
LVNs, when directed and supervised by a Naturopathic Doctor, may do all of the following:
Administer medications by hypodermic injection.
Withdraw blood from a patient, if prior thereto such LVN has satisfactorily completed a prescribed course of instruction approved by the Board of Vocational Nursing and Psychiatric Technicians (BVNPT);
Start and superimpose intravenous fluids under the supervision of a Naturopathic Doctor after completing a BVNPT-approved IV therapy certification course.
As noted above, in order to perform blood draws or IVs, an LVN must have completed additional training approved by the Board of Vocational Nursing and Psychiatric Technicians (BVNPT). Unlike Naturopathic Assistant training for blood draws, this training cannot be done by you in your office. The LVN must have a certificate from a training provider approved by the BVNPT for both phlebotomy and IV therapy prior to performing these functions.
You can find more information and a list of training providers on the BVNPT website online.
Intravenous/Blood Withdrawal/Continuing Education
A licensed vocational nurse must be certified by the Board to perform intravenous therapy or blood withdrawal.
If a licensee is certified by the Board, the certification should show on the license.
Approved IV/BW course providers are listed on the Board's website under "Education."
Contact the Board at (916) 263-7800 or by email at bvnpt@dca.ca.gov for information regarding verification of competency for IV/BW certification.
If you hire an LVN who doesn’t have this training, they must complete the training before they can administer IVs or draw blood in your office.
Important note: LVNs can be trained to draw blood in an office setting by an MD or DO, but not by an ND. Any LVN that you hire must take a BVNPT-approved IV and blood draw training.
Can LVNs perform IV therapy?
Yes – when all the following apply:
The ND supervising the LVN has obtained an Intravenous Therapy (IVT) Specialty license from the California Board of Naturopathic Medicine (formerly the Naturopathic Medicine Committee)
The LVN has completed an IV certification course approved by the Board of Vocational Nursing and Psychiatric Technicians (BVNPT).
The supervising ND has ordered the IV treatment. (In other words, a new patient cannot just walk into the office and receive an IV treatment without the ND conducting an initial appropriate prior examination and ordering the IV with specific ingredients and dosages. This examination doesn’t have to be done before every IV, just ordered by the ND before the first IV treatment and again if the patient’s health changes or the IV ingredients change and at appropriate intervals). Remember, LVNs cannot take over patient care – they are only carrying out your treatment decisions.
Assuming the above requirements are met, then:
Can LVNs prepare IVs?
Yes.
Can LVNs start IVs?
Yes, but only peripheral lines. They cannot access ports.
What can LVNs infuse?
LVNs can infuse fluids, vitamins, minerals, nutrients and blood products.
LVNs CANNOT infuse medications or herbs – so this means, for example, LVNs cannot infuse chelating agents, Zofran, curcumin, or other medications or herbs.
Can an ND give an order to an LVN to give someone medication or an injection or to perform an IV at a patient’s home?
No, the patient needs to be in a doctor’s office or a health care setting, like a skilled nursing facility.
Can LVNs give IM and SC injections?
Yes. LVNs can give IM and SC injections, such as vitamins and hormones under the supervision of a California licensed ND (*Note this does not include hormone pellets). However, the LVN cannot give IM and SC injections of any other medications unless the supervising ND has a supervising California physician (MD/DO) to allow the ND to prescribe such medications. In other words, the LVN cannot administer medications that the supervising ND is not authorized to prescribe or administer.
Additionally, LVNs CANNOT inject glutathione.
If the ND has a supervising MD/DO, then the LVN can also administer injections of non-hormonal medications ordered by the ND, such as Benadryl or vaccines, provided that the supervising MD/DO agrees to this ahead of time.
If you have a supervising MD/DO for prescriptions, and you want the LVN to administer medications that are not within the ND independent scope (e.g., any medications that aren’t hormones), you need to get your MD/DO supervising physician’s approval in advance for that (as an extension of your general agreement, not each time).
Can an LVN administer vaccines?
Yes, pursuant to the standing orders of the Naturopathic Doctor, if the Naturopathic Doctor has a supervision agreement in place with an MD/DO for prescribing vaccines. And the Naturopathic Doctor must ensure that the LVN demonstrates competence in the administration of the vaccines and knowledge of all the indications and contraindications and recognition and treatment of any emergency reactions.
Does the ND need to be in the office when the LVN is taking care of patients?
No. The ND’s physical presence on site is not required for the LVN to do their job. HOWEVER, the supervising ND MUST be available by phone at all times that the LVN is providing patient care and must always be the one that does all diagnosis and ordering of treatments. The LVN is only carrying out the supervising ND’s orders. The LVN cannot determine treatment and then carry it out.
Can LVNs do triage or answer patient’s questions about their care?
No. Unlike NPs and RNs with appropriate standardized procedures, LVNs cannot triage patients or do assessments.
What else do I need to know?
The LVN must be an employee of the supervising Naturopathic Doctor and you must have a written supervision protocol in place, which can be part of the LVN’s employment agreement or can be a standalone document separate from their employment agreement.
The written supervision protocol must include the following:
A description of the duties and responsibilities of the LVN;
Policies and procedures tailored to your clinic to ensure adequate supervision of the LVN, including, but not limited to, appropriate a communication between the Naturopathic Doctor and LVN, availability of supervision, location(s) of where services are to be provided, and availability of consultations between the Naturopathic Doctor and LVN regarding the services provided; and
The methods for the training and continuing evaluation of the competency and qualifications of the LVN.
What can the LVN NOT do?
LVNs are NOT permitted to:
administer any botulinum toxin, dermal filler or glutathione injections.
perform platelet rich plasma treatments;
remove skin growths;
perform any other cosmetic treatments outside of the scope of an LVN; or
administer laser, light, steam, or UV treatment therapies unless directed by the ND for a medically necessary purpose (not cosmetic).
How soon can I hire an LVN?
An LVN can start working for you on January 1st, 2023.
Can I hire an RN (registered nurse) and have them do only the things listed as in the scope of an LVN?
No, an ND cannot hire, direct or supervise an RN or NP under any circumstances. RNs can only perform patient care services ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist, as defined by Section 1316.5 of the Health and Safety Code.