Impact of the New Regulation on Licensed Vocational Nurses (LVNs)

The Respiratory Care Board (RCB) has adopted a regulation at California Code of Regulations section 1399.365 that defines which respiratory tasks and services may be performed without a respiratory assessment. While the regulation does not specify particular license types, it provides important clarity regarding the performance of basic respiratory tasks and services by health care personnel, including licensed vocational nurses (LVNs), within clearly defined limits. This page explains how section 1399.365 applies in practice and what it means for LVNs when performing basic respiratory tasks consistent with applicable law.

What the Regulation Means for LVNs

• Under this regulation, LVNs may perform defined basic respiratory tasks that do not require a respiratory assessment, such as pulse oxmetry, medication administration by aerosol, and hygiene care related to respiratory devices.
• This regulation excludes respiratory tasks and services that require respiratory assessments or evaluations.
• LVNs must continue to work under the supervision of a registered nurse or physician, depending on the care setting.
• Delegation of basic respiratory tasks should be consistent with the LVN’s demonstrated competency, employer policies, and all applicable laws and regulations.

Frequently Asked Questions

• Can LVNs perform tracheostomy care under this regulation?

  Yes. Basic hygiene care, such as replacing tracheostomy ties and cleaning stoma sites, is listed as a basic respiratory task under section 1399.365(b). Invasive tasks, such as suctioning, inner cannula replacement, cannula or tube changes, and procedures requiring respiratory assessment, remain outside the LVN scope of practice.
  
  Exemption: In school settings only, SB 389 (in progress) would allow LVNs, under the supervision of a credentialed school nurse, to perform suctioning and other basic respiratory tasks and services. See the SB 389 page for details.

• What respiratory tasks are LVNs now allowed to perform under the new regulation?

  LVNs may perform basic respiratory tasks that do not require respiratory assessment, as listed in section 1399.365(b). Examples include pulse oximetry, patient data collection, aerosol medication administration without ventilator manipulation (e.g., handheld nebulizers or MDIs with spacers), and basic tracheostomy site hygiene (tie replacement and stoma cleaning). Tasks excluded in subdivision (c), such as ventilator manipulation, CPAP/BiPAP, and oxygen titration, are not permitted.

• Do LVNs need additional training or certification to perform these basic tasks?

  Employers may require training or competency validation related to the basic tasks outlined in section 1399.365. The RCB supports clear training standards to ensure tasks are performed safely and competently.

• Can LVNs perform ventilator management or suctioning under this regulation?

  Ventilator manipulation, non-invasive ventilator operation (CPAP/BiPAP), and nasal, tracheal, and endotracheal suctioning are excluded from basic tasks under section 1399.365(c) and remain outside the LVN scope of practice.
  
  Exemption: In school settings only, SB 389 allows LVNs, under the supervision of a credentialed school nurse, to perform suctioning and other basic respiratory tasks and services. See the SB 389 page for details.

• Can LVNs initiate or adjust oxygen therapy?

  No. Initial setup or adjustment of oxygen liter flow or concentration is specifically excluded under section 1399.365(c)(6). Initiation of oxygen therapy requires a respiratory assessment and clinical judgment, which must be performed by a licensed RCP, or other providers authorized by law, such as RNs.

  LVNs and other trained personnel may assist by physically applying oxygen delivery devices (e.g., nasal cannula, face mask) only after an RCP or RN has made the clinical decision to initiate therapy. They may not independently decide to start or adjust oxygen, even under a standing PRN order, since determining when oxygen is needed requires a respiratory assessment.

• Can an LVN move a patient from an oxygen concentrator to a portable E-tank?

  Yes. If the patient is already receiving oxygen and the prescribed flow rate is not changed. Moving a patient’s oxygen source from a concentrator to a portable E-tank for transport or temporary mobility is generally considered part of routine patient care, not a respiratory care service under the Respiratory Care Practice Act.

  However, if oxygen therapy is being initiated, titrated, or adjusted in any way, those functions must be performed by a licensed RCP, or other providers authorized by law, such as an RN.

  In short, LVNs may transfer a patient’s existing oxygen source for mobility or transport, but any task that involves clinical assessment, decision-making, or changes to oxygen therapy must be handled by an RCP or RN to ensure patient safety.

• Can LVNs apply CPAP or BiPAP masks?

  No. Initial setup, placement of CPAP/BiPAP interfaces, and any operation of non-invasive ventilators are excluded under section 1399.365(c)(6) and fall within the scope of a licensed RCP, or other providers authorized by law, such as RNs. Because CPAP and BiPAP require clinical assessment, adjustment, and monitoring, LVNs may not initiate or manage this therapy.

• Can LVNs replace oxygen tanks?

  Yes. Under 16 CCR section 1399.365(b)(5), LVNs may replace empty oxygen cylinders and related administration equipment when the patient is in a stable condition and the task does not require clinical assessment.

  This activity is considered maintenance of an existing therapy, not initiation. Initiation of oxygen therapy including deciding when oxygen is needed and at what flow, requires a respiratory assessment and remains outside the LVN scope. LVNs may not independently start oxygen under a PRN order or adjust flow settings when changing a tank.

Need More Information?

Contact the RCB at (916) 999-2190 or rcbinfo@dca.ca.gov for questions.