Understanding California's New Regulation on Basic Respiratory Tasks and Its Impact on LVNs
On June 5, 2025, the Office of Administrative Law approved the Respiratory Care Board of California's (RCB) regulation defining "Basic Respiratory Tasks and Services," codified at California Code of Regulations, Title 16, Section 1399.365. This regulation, effective October 1, 2025, delineates specific respiratory tasks that may be performed without conducting a respiratory assessment, thereby clarifying the scope of practice for various healthcare professionals, including Licensed Vocational Nurses (LVNs).
Overview of the New Regulation
The regulation specifies that certain respiratory tasks do not require a respiratory assessment and may be performed by non-licensed respiratory care practitioners under defined conditions. These tasks include:
- Patient data collection
- Application and monitoring of a pulse oximeter
- Medication administration by aerosol that does not require manipulation of an invasive or non-invasive mechanical ventilator
- Heat moisture exchanger (HME) and oxygen tank replacement for patients using non-invasive mechanical ventilation
- Hygiene care, including replacement of tracheostomy ties and gauze and cleaning of the stoma sites
- Use of a manual resuscitation device and other cardiopulmonary resuscitation technical skills (basic life support level) in the event of an emergency
- Documentation of care provided, which includes data retrieved from performing a breath count or transcribing data from an invasive or non-invasive ventilator interface
- Observing and gathering data from chest auscultation, palpation, and percussion
Conversely, the regulation excludes tasks that require a respiratory assessment, such as:
- Manipulation of an invasive or non-invasive ventilator
- Assessment or evaluation of observed and gathered data from chest auscultation, palpation, and percussion
- Pre-treatment or post-treatment assessment
- Use of medical gas mixtures other than oxygen
- Preoxygenation, or endotracheal or nasal suctioning
- Initial setup, change out, or replacement of a breathing circuit or adjustment of oxygen liter flow or oxygen concentration
- Tracheal suctioning, cuff inflation/deflation, use or removal of an external speaking valve, or removal and replacement of the tracheostomy tube or inner cannula
These distinctions are crucial for ensuring that respiratory care tasks are performed by appropriately trained and licensed personnel, thereby safeguarding patient safety and maintaining professional standards.
Implications for LVNs
The new regulation has significant implications for LVNs in California:
- Scope of Practice: LVNs may perform basic respiratory tasks as defined in the regulation, provided these tasks do not require a respiratory assessment.
- Supervision Requirements: LVNs must perform these tasks under the supervision of a licensed respiratory care practitioner, registered nurse, or physician, depending on the care setting.
- Training and Competency: Employers may require LVNs to complete specific training and demonstrate competency in performing these tasks to ensure patient safety and regulatory compliance.
- Exclusions: LVNs are not authorized to perform tasks that involve respiratory assessments or advanced respiratory procedures, such as ventilator management or suctioning, unless specific exemptions are established.
Additionally, Senate Bill 389 (SB 389) is currently under consideration, which would allow LVNs working under the supervision of a credentialed school nurse to perform suctioning and other basic respiratory tasks and services for students during the school day. However, as of now, this bill has not been enacted into law.
Conclusion
The implementation of California Code of Regulations, Title 16, Section 1399.365, effective October 1, 2025, provides a clear framework for LVNs regarding the performance of basic respiratory tasks. It is essential for LVNs to understand the scope of tasks they are authorized to perform and to seek appropriate training and supervision to ensure compliance with the regulation and to uphold the highest standards of patient care.
For more detailed information, please refer to the Respiratory Care Board of California's official pages:
