10/30/2025
Independent Skilled Nurses can do all of the same things that an agency nurse can do. Below is a detailed breakdown of some of the medically necessary nursing interventions that require an RN’s professional skill and judgment:
Comprehensive assessments: Vital signs, respiratory, cardiac, neurological, and developmental checks.
Medication administration: Oral, injectable, G-tube, or IV medications as prescribed.
Feeding tube management: G-tube, J-tube, or NG-tube feedings and care.
Ventilator or trach care: Routine suctioning, trach changes, ventilator monitoring, and emergency airway management.
Wound care: Dressing changes, infection prevention, and skin integrity monitoring.
Seizure management: Observation, documentation, and administration of rescue medications if ordered.
Catheter care: Foley or suprapubic catheter maintenance and output tracking.
Oxygen therapy: Monitoring and equipment management for children requiring supplemental oxygen.
*The Independent Skilled Nurse also provides a great deal of developmental & family support by:
Monitoring developmental milestones and alerting families or providers of delays.
Teaching families and caregivers how to safely perform daily care tasks (e.g., tube feedings, suctioning).
Promoting age-appropriate activities within the child’s health limitations.
Helping parents navigate medical systems, appointments, or care coordination.
*The Independent Skilled Nurses also handle all administrative and clinical documentation themselves:
Writing nursing care plans and updating them as the child’s condition changes.
Documenting each skilled visit or shift, noting progress, interventions, and any physician communication.
Coordinating with physicians, therapists, schools, and specialists through release-of-information forms (ROI).
Maintaining HIPAA-compliant records and ensuring family rights and responsibilities are clearly communicated.
*The Independent Skilled Nurse also acts as the business operator:
Verifies orders from the child’s provider before initiating skilled services.
Ensures compliance with state nurse practice act and home health regulations.
Manages billing and documentation (private pay, MaineCare).
Maintains professional liability insurance, licenses, and continuing education.
Creates required forms such as consent for nursing services, patient rights and responsibilities, and discharge from care notices.
