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Ohio Nurse Practice Act (2 Hours)
Law and Rules - Category A

Online Continuing Education Course

Course Description

MANDATORY OHIO NURSING CEU. Ohio Law and Rules Category A 2-hour course. Fulfills the requirement for 2 contact hours of Category A CE for individuals applying for licensure by endorsement (from another state). Ohio Nurse Practice Act covers standards for competent nursing practice of RNs and LPNs.

Course Price: $20.00

Contact Hours: 2

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This course fulfills the Category A requirement for 2 contact hours of CE on the Ohio Nurse Practice Act and the rules of the Ohio Board of Nursing.
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Ohio Nurse Practice Act (2 Hours)
Law and Rules – Category A

LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this continuing education course, you will have increased your knowledge of the standards of safe nursing practice as outlined in the Ohio Nurse Practice Act and the rules of the Ohio Administrative Code as written by the Ohio Board of Nursing in accordance with Section 4723 of the Ohio Revised Code. Specific learning objectives to address potential learning gaps include:

  • Describe the Ohio Scope of Practice Decision-Making Model.
  • Compare the roles of the Ohio Board of Nursing and Ohio professional associations.
  • Summarize the American Nurses Association Code of Ethics for Nurses.
  • Discuss the standards for competent nursing practice of RNs and LPNs in Ohio.
  • Explain standards for the promotion of patient safety by licensed nurses in Ohio.
  • Contrast the RN and LPN standards for applying the nursing process in Ohio.
  • Describe violations of nursing laws and rules that may result in disciplinary action.

The establishment of standards for nursing education and practice is the result of efforts by nursing associations that began over 100 years ago. Currently in each state or territory, a law known as the Nurse Practice Act designates an authoritative body that defines and regulates the nursing practice of every nurse in every role. This authoritative body, known as a board of nursing, is responsible for ensuring that nurses who practice in the state for which they have responsibility are competent, safe, skilled, and knowledgeable about the standards set forth in that state’s scope of practice for nurses (NCSBN, 2018). This course presents those standards for the state of Ohio written by the Ohio Board of Nursing in accordance with the Nurse Practice Act.

OHIO BOARD OF NURSING AND OHIO ADMINISTRATIVE CODE

All licensed medical professionals work under accepted standards derived from local, state, and federal laws as well as professional guidelines. Licensed nurses are no exception. Their scope of practice is defined by the Nurse Practice Act (NPA) of the state in which they practice. In Ohio, the NPA is codified in Section 4723 of the Ohio Revised Code (ORC). It establishes an Ohio Board of Nursing (OBN) and defines its structure and function.

Ohio Board of Nursing (OBN)

The Nurse Practice Act (ORC 4723) authorizes the OBN to make and enforce rules and regulations for registered nurses, licensed practical nurses, dialysis technicians, and advanced practice nurses (certified nurse-midwives, certified nurse practitioners, certified nurse specialists, and certified registered nurse anesthetists). In 2003, community health workers were placed under the jurisdiction of the OBN.

MISSION AND MEMBERSHIP

The mission of the Ohio Board of Nursing is to “actively safeguard the health of the public through the effective regulation of nursing care” (OBN, 2019a). It accomplishes this mission by establishing educational criteria for schools of nursing, promulgating rules to regulate the scope and practice of nursing, issuing licenses, and disciplining licensees who fail to follow the rules.

Board members are public officials and meetings are open to the public. The board is made up of thirteen members: eight registered nurses, four licensed practical nurses, and one consumer appointed by the governor. At least two of the registered nurses shall hold a current, valid license issued under the ORC that authorizes the practice of nursing as an advanced practice registered nurse. The board has the legal authority to administer and enforce all provisions of the NPA. It must review each rule within the Ohio Administrative Code (OAC) at least once every five years. The board is funded and supported by mandatory licensure fees paid by nurses wishing to practice legally in the state of Ohio. The board does not have authority over employers (ORC 4723.02).

SCOPE OF PRACTICE

Because nursing is a dynamic practice, questions may arise about whether certain tasks are within the nurse’s scope of practice. All nursing care should be consistent with the nurse’s preparation, education, experience, knowledge, and demonstrated competency.

The Ohio Board of Nursing has developed a Scope of Practice Decision-Making Model to help nurses determine whether a task is within their scope of practice. The model uses a decision tree with references and is based on legality, competency, safety, and accountability.

OBN SCOPE OF PRACTICE DECISION-MAKING MODEL

The Scope of Practice Decision-Making Model includes the following steps:

  • Defining and describing the activity/task that is to be performed
  • Determining whether the activity/task is within the scope of practice and not precluded or prohibited by any other law or rule
  • Evaluating self-competency to perform the activity/task; meet the standards of safe nursing practice; and demonstrate current knowledge, skills, and abilities
  • Assessing the safety and appropriateness of performing the activity/task at this time
  • Preparing to accept accountability for nursing actions

Each of these steps must be answered with a “yes” before proceeding to the next step. If at any point an answer is “no,” the nurse must not perform the action (OBN, 2015).

CASE
Scope of Practice Decision-Making

Mycee is a licensed practical nurse (LPN) with five years of experience who has recently moved from Indiana to Ohio. This is her first shift on a surgical floor following orientation, and she is responsible for five patients who are 1 to 4 days post-op. A new order has been written for Mr. Hansen, who is receiving patient-controlled analgesia (PCA). The order is for a change in PCA dosage.

In Indiana, Mycee was not restricted from performing this task, but she does not recall whether she is allowed to do so in Ohio. Since she can’t look up the Ohio Administrative Code right now to see if the task is within her scope of practice, she consults with her charge nurse. The charge nurse tells Mycee that this is not within the scope of the LPN in Ohio. As a registered nurse (RN), the charge nurse addresses the new order.

Later, when Mycee has a break, she refers to “Using the Scope of Practice Decision-Making Model” and then visits the Ohio Administrative Code website indicated in that document. She reads Chapter 4723-17-03 (A) (4) of the code, which describes the role of the LPN in intravenous therapy procedures. There she finds that an LPN may not “program or set any function of a patient-controlled analgesic,” thereby confirming that the task is not within her legal scope of practice in Ohio.

Applying the Model Yourself

Take a moment to think of a situation that could arise in your practice. Then ask yourself the following five questions. If you cannot answer yes to questions 2 through 5, you should not undertake the action.

  1. What patient care task am I being asked to do, and what is this patient’s current condition?
  2. Does the nurse practice act in my jurisdiction permit me to perform this task?
  3. Do I have current, evidence-based knowledge and skills to correctly and safely perform what I am being asked to do for this patient?
  4. Is this the most appropriate action to take for this patient at this time?
  5. Do I accept accountability for completing this task?

Ohio Administrative Code

The rules of the Board of Nursing regulate nursing practice in Ohio and are contained in Section 4723 of the Ohio Administrative Code (OAC). This course reviews those chapters in Section 4723 that set forth the standards of competency, safe nursing practice, delegation, application of the nursing process, and discipline for registered nurses and licensed practical nurses in the state of Ohio.

OHIO ADMINISTRATIVE CODE, SECTION 4723, BOARD OF NURSING

4723-1      Board Organization and Records
4723-2      Licensing for Active Duty Military and Veterans
4723-3      Definitions
4723-4      Standards of Practice Relative to Registered Nurse or Licensed Practical Nurse
4723-5      Nursing Education Programs
4723-6      Alternative Program for Chemical Dependency/Substance Use Disorder Monitoring
4723-7      Examination and Licensure
4723-8      Advanced Practice Registered Nurse Certification and Practice
4723-9      Prescriptive Authority
4723-10   Courses in Medication Administration [Rescinded]
4723-11   Peer Support Program [Rescinded]
4723-12   Personal Information System [Rescinded]
4723-13   Delegation of Nursing Tasks
4723-14   Continuing Education
4723-16   Hearings
4723-17   Intravenous Therapy Courses for Licensed Practical Nurses
4723-18   Practice Intervention and Improvement Program (PIIP)
4723-19   Advanced Practice Nurses
4723-20   Prevention of Disease Transmission
4723-21   Delegation in MR/DD County Board Facilities [Rescinded]
4723-22   Delegation of the Authority to Give Oral and/or Apply Topical Medications in ICFS/MR with Fifteen or Fewer Residents [Rescinded]
4723-23   Dialysis Technicians
4723-25   Nurse Education Grant Program
4723-26   Community Health Workers Chapter
4723-27   Medication Administration by Certified Medication Aide

CONTINUING EDUCATION FOR RENEWAL FOR RNs and LPNs

For the period immediately following Ohio licensure by NCLEX examination, the nurse is not required to complete any contact hours of CE for the first license renewal. Other than the first renewal immediately following licensure by exam, nurses must complete at least 24 contact hours of CE that includes at least one contact hour of Category A CE for each renewal. A nurse who has been licensed in Ohio by reciprocity for less than or equal to one year prior to the first Ohio license renewal must complete at least 12 contact hours, rather than 24 (OBN, 2019b).

PROFESSIONAL ORGANIZATIONS

One of the hallmarks of a profession is that its members band together in collegial association to provide a variety of services for its members. These services include such things as continuing education, collective bargaining, legislative advocacy, and information about the profession. These organizations are not set up by state laws or through the government.

The American Nurses Association is the nationwide professional organization representing the interests of nurses. In Ohio, professional associations include the Ohio Nurses Association, Licensed Practical Nurses Association of Ohio, Ohio Association for Advanced Practice Nurses, Ohio State Association of Nurse Anesthetists, and state chapters of other specialty associations such as perioperative nurses, critical care nurses, nephrology nurses, dialysis technicians, and other groups. Typically, associations are run by boards of trustees elected by members who pay voluntary membership dues.

OHIO NURSES ASSOCIATION MISSION

The mission of professional associations is characterized by that of the Ohio Nurses Association (ONA).

Its mission is to advance professional nursing in Ohio. This will be accomplished through:

  • Evolving evidence-based practice
  • Influencing legislators
  • Promoting education
  • Improving economic and general welfare
  • Advocating for quality healthcare in a cost-effective and economically stimulating manner
    (ONA, 2016)

The primary difference between the Ohio Board of Nursing and professional organizations is that professional organizations have no legal authority, whereas the Ohio Board of Nursing has authority because it was established by the Nurse Practice Act with the unambiguous function of promoting and protecting the health of citizens through safe nursing practice (OBN, n.d.).

CODE OF ETHICS FOR NURSES

In addition to abiding by the laws established in the Nurse Practice Act, every member of a profession is expected to read, understand, and abide by the ethical standards of its occupation. In the case of nursing, the American Nurses Association publishes the Code of Ethics for Nurses with Interpretive Statements to guide nurses’ professional practice.

The following provisions of the code broadly describe the ethical obligations of nurses:

Provision 1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every individual.

Provision 2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

Provision 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

Provision 4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal care.

Provision 5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

Provision 6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.

Provision 7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

Provision 8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.

Provision 9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy

(ANA, 2015)

STANDARDS OF COMPETENCY FOR RNs

[This section covers subsections (A) thru (K) of the OAC 4723-4-03, Standards relating to competent practice as a registered nurse.]

Registered nurses (A) provide nursing care within the scope of practice described in the Ohio Revised Code and the rules of the Ohio Board of Nursing and (B) maintain current knowledge of the duties, responsibilities, and accountabilities of safe nursing practice.

RNs must (C) be competent and accountable in all areas of practice, including consistent performance of all aspects of nursing care and appropriate recognition, referral or consultation, and intervention when complications arise.

RNs may (D) provide nursing care beyond basic nursing preparation for an RN provided they:

  • Obtain additional education
  • Demonstrate appropriate knowledge, skills, and abilities
  • Maintain documentation of their additional education and training
  • Have a specific current order from an authorized professional
  • Do not carry out a function or procedure prohibited by any law or rule. The RN must act within the course of his/her professional practice.

RNs must (E) implement any order in a timely manner unless they believe or have reason to believe the order is:

  • Inaccurate
  • Not properly authorized
  • Not current or valid
  • Harmful or potentially harmful to a patient
  • Contraindicated by other documented information

RNs must (E) clarify an order that meets any of the above criteria by consulting with an appropriate licensed practitioner.

When RNs (F) decide not to follow an order or prescribed medication or treatment after consulting with an appropriate licensed practitioner, the RN must:

  • Notify the ordering practitioner of the decision not to follow the order
  • Document that fact and state the reason for not following the direction
  • Take any other action to ensure the safety of the patient

RNs (G) report to and consult with other nurses or members of the healthcare team and make referrals as appropriate in a timely manner.

RNs must (H) maintain the confidentiality of patient information, communicating patient information with other members of the healthcare team for healthcare purposes only and accessing patient information only for healthcare and patient care purposes or for fulfilling nursing responsibilities. This includes not disseminating patient information through social media, texting, emailing, or any other form of communication for purposes other than patient care.

To the maximum extent feasible, RNs must (I) not directly disclose identifiable patient healthcare information unless the patient has consented to such disclosure and must report individually identifiable patient information without written consent in limited circumstances only and in accordance with authorized laws and rules.

RNs must (J) use acceptable standards of safe nursing care as a basis for any observation, advice, instruction, teaching, or evaluation and communicate information that is consistent with acceptable standards of safe nursing care.

When RNs (K) give direction to LPNs, they must first assess:

  • Condition and stability of the patient who needs nursing care
  • The type of care required
  • The complexity and frequency of care required
  • The training, skill, and ability of the LPN who is to perform the care
  • The availability and accessibility of resources needed to safely perform the function or procedure

The directed tasks must also be within the licensed practical nurse’s legal scope of practice.

STANDARDS OF COMPETENCY FOR LPNs

[This section covers subsections (A) thru (J) of the OAC 4723-4-04, Standards relating to competent practice as a licensed practical nurse.]

A licensed practical nurse (LPN) must (A) function within the scope of practice of an LPN as set forth in division (F) of Section 4723.01 of the Ohio Revised Code and the rules of the Ohio Board of Nursing.

An LPN must (B) maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice.

An LPN must (C) demonstrate competency and accountability in all areas of practice, including consistent performance of all aspects of nursing care and appropriate recognition, referral or consultation, and intervention when complications arise.

An LPN may (D) provide nursing care beyond basic preparation for an LPN provided the LPN obtains appropriate education; demonstrates knowledge, skills, and abilities; and maintains satisfactory records of meeting these requirements. The LPN must have a valid order or direction from an authorized individual and the nursing care cannot involve a function or procedure prohibited by any law or rule.

LPNs must (E) implement or clarify an order in a timely manner unless or whenever they believe or have reason to believe the order is:

  • Inaccurate
  • Not properly authorized
  • Not current or valid
  • Harmful or potentially harmful to a patient
  • Contraindicated by other documented information

When (F) clarifying an order or direction, the LPN must consult with an authorized practitioner or directing RN. If the LPN decides not to follow the direction, the LPN, in a timely manner, must:

  • Notify the ordering practitioner of the decision not to follow the order
  • Document that fact and state the reason for not following the direction
  • Take any other action to ensure the safety of the patient

An LPN must (G) report to and consult with other nurses or other members of the healthcare team and make referrals as appropriate.

An LPN must (H) maintain the confidentiality of patient information, communicating patient information with other members of the healthcare team for healthcare purposes only and accessing patient information only for healthcare and patient care purposes or for fulfilling assigned job responsibilities. This includes not disseminating patient information through social media, texting, emailing, or any other form of communication for purposes other than patient care.

An LPN (I) does not disclose identifiable patient healthcare information unless the patient gives written consent by a properly executed release of information. Only in limited circumstances in accord with authorized legal authority does an LPN release individually identifiable patient healthcare information without a written consent of the patient.

When directed to observe, advise, instruct, or evaluate the performance of a nursing task, the LPN (J) uses acceptable standards of safe nursing care as a basis for that observation, advice, instruction, teaching, or evaluation and communicates information consistent with acceptable standards of safe nursing care with respect to the nursing task.

STANDARDS OF COMPETENCY FOR ADVANCED PRACTICE NURSES

[This section covers subsections (A) thru (D) of the OAC 4723-4-05, Standards relating to competent practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.]

A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, and clinical nurse specialist must (A):

  • Function within the scope of practice of nursing for a registered nurse as set forth in division (B) of Section 4723.01 of the Ohio Revised Code and the rules of the Ohio Board of Nursing.
  • Function within the nurse’s applicable scope of practice.
  • If authorized by Ohio law to prescribe, practice according to Section 4723.481 of the Revised Code and Section 4723-9 of the Administrative Code.

When the practice of a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist is evaluated, the (B) evaluation must be done by a collaborating licensed physician or podiatrist, or an advanced practice registered nurse holding a current, valid license with the same designation as the individual being evaluated.

When the practice of a certified registered nurse anesthetist is evaluated, the (C) evaluation must be done by a supervising licensed physician, podiatrist, dentist, or certified registered anesthetist whose license is current and valid.

A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist may provide care within their specialty, provided the nurse (D):

  • Obtains appropriate education from a recognized body of knowledge
  • Demonstrates knowledge, skills, and abilities
  • Maintains documented evidence of these skills and abilities

STANDARDS THAT PROMOTE PATIENT SAFETY

[This section covers subsections (A) thru (Q) of the OAC 4723-4-06, Standards of nursing practice promoting patient safety.]

(A–C) When providing direct nursing care to patients or engaging in nursing practice in person or by telecommunication, licensed nurses, certified nurse-midwives, certified nurse practitioners, certified registered nurse anesthetists, or clinical nurse specialists must display and identify their applicable title or initials (degree) or identify to each patient the nurse’s title or initials (degree) as a registered nurse or licensed practical nurse.

Licensed nurses must (D) delegate nursing tasks, including medication administration, only in accordance with chapters 4723-13, 4723-23, 4723-26, or 4723-27 of the OAC. (See also “Delegation Guidelines” below.)

Licensed nurses must (E) report and document their nursing assessments and observations, care provided, and the patient’s response to that care in a timely and accurate manner. Licensed nurses must document any (F) errors or deviations from a prescribed regimen to the appropriate practitioner in a timely, complete, and accurate manner.

Licensed nurses must (G) not falsify, or conceal by any method, patient records or any other document prepared or used in the course of nursing practice. This includes case management documents or reports, time records, reports, and other documents related to billing for nursing services.

Licensed nurses must (H) implement measures to promote a safe environment for patients and (I) maintain a professional boundary between themselves and patients. They must (J) provide privacy during examination and care and treat each patient with courtesy, respect, and full recognition of dignity and individuality.

Licensed nurses must (K) not engage in behavior that causes or may cause physical, verbal, mental, or emotional abuse to a patient or engage in behavior that a reasonable person would interpret as physical, verbal, mental, or emotional abuse.

A licensed nurse must not (L) misappropriate the property of patients or:

  • Engage in behavior to seek or obtain personal gain at the patient’s expense, or that may reasonably be interpreted as such
  • Engage in behavior that constitutes inappropriate involvement in the patient’s personal relationships or financial matters, or that may reasonably be interpreted as such

A licensed nurse must not (M):

  • Engage in sexual conduct with a patient, or conduct that may be interpreted as sexual
  • Engage in verbal behavior that is seductive or sexually demeaning to a patient, or that may be interpreted as such

The patient is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in (L) and (M) above.

When licensed nurses (N) function in administrative roles, they must make sure that there are procedures in place and implemented to verify that every nurse, dialysis technician, or medication aide working under their administration has a current valid license or valid certificate in Ohio to practice in the role to which they are assigned.

Only RNs may (O) supervise or evaluate the nursing practice of RNs and LPNs; however, non-nursing supervisors may evaluate nurse employees in matters other than the practice of nursing.

A licensed nurse must not (P) make or submit or cause to be submitted any false, misleading, or deceptive statements to the OBN, current or prospective employers, facilities or organizations for whom the nurse is working, members of the healthcare team, or law enforcement personnel.

A nurse must (Q) not use social media, texting, emailing, or other forms of communication with or about a patient for non-healthcare purposes or for purposes other than fulfilling the nurse’s assigned job responsibilities.

DELEGATION GUIDELINES

When all conditions for delegation set forth in Chapter 4723-13-05 of the OAC are met, a registered nurse may delegate a nursing task to an unlicensed person and a licensed practical nurse may delegate a nursing task to an unlicensed person at the direction of the registered nurse. These conditions are summarized below.

Except as otherwise authorized by law or this chapter, a licensed nurse may delegate to an unlicensed person the administration of only the following medications:

  • Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier
  • Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas

Prior to delegating a nursing task to an unlicensed person, the delegating nurse must make certain determinations regarding the nature of the task and the qualifications of the unlicensed person who will carry it out.

  • The nursing task is within the scope of practice of the delegating nurse
  • The nursing task is within the knowledge, skill, and ability of the nurse delegating the nursing task
  • The nursing task is within the training, ability, and skill of the unlicensed person who will be performing the delegated nursing task
  • Appropriate resources and support are available for the performance of the task and management of the outcome
  • Adequate and appropriate supervision by a licensed nurse of the performance of the nursing task is available
  • That:
    • The nursing task requires no judgment based on nursing knowledge and expertise on the part of the unlicensed person performing the task
    • The results of the nursing task are reasonably predictable
    • The nursing task can be safely performed according to exact, unchanging directions, with no need to alter the standard procedures for performing the task
    • The performance of the nursing task does not require that complex observations or critical decisions be made with respect to the nursing task
    • The nursing task does not require repeated performance of nursing assessments
    • The consequences of performing the nursing task improperly are minimal and not life-threatening

Prior to delegating a nursing task, the delegating nurse must also make certain determinations regarding the patient and the conditions:

  • Identify the individual on whom the nursing task may be performed and a specific time frame during which it may be performed.
  • Complete an evaluation of the conditions that relate to task to be performed, including:
    • An evaluation of the individual who needs nursing care
    • The types of nursing care the individual requires
    • The complexity and frequency of the nursing care needed
    • The stability of the individual who needs nursing care
    • A review of the evaluations performed by other licensed healthcare professionals

The delegating nurse shall be accountable for the decision to delegate nursing tasks to an unlicensed person.

If a licensed nurse determines that an unlicensed person is not correctly performing a delegated nursing task, the licensed nurse shall immediately intervene.

CASE
Delegating Tasks

Sabrina is an RN in a busy medical-surgical department at a hospital in Columbus. She is in the middle of passing morning medications when her new post-op patient, Mr. Winters, rings in complaining of severe pain. When she arrives to Mr. Winters’ room, Sabrina performs a focused assessment of his surgical dressing and finds everything within normal limits. Sabrina consults the electronic medication administration record (eMAR) and sees that Mr. Winters has IV morphine ordered for severe pain. She also recalls the report from the PACU nurse stating that Mr. Winters’ blood pressure was running low.

In reviewing the tasks at hand, Sabrina knows she needs to continue with medications for her other patients, to get a new set of vitals on Mr. Winters to be sure his blood pressure won’t bottom out with a new dose of IV morphine, and then to administer the pain medication to Mr. Winters. In order to accomplish her tasks in a timely manner, Sabrina determines that it is necessary to delegate something to the appropriate assistive personnel. She remembers that Martha, a CNA, has also been assigned to her patients.

Sabrina contacts Martha to see if she is available to take Mr. Winters’ blood pressure, knowing that taking patients’ vitals is within Martha’s education and training and is part of her normal assignment as a CNA. Sabrina indicates to Martha that she will continue passing medications while Martha gets the patient’s vitals, which she should carry out right away. Sabrina informs Martha that she will be with the patient in the next room by the time Martha has the vital signs. Martha agrees and begins to take Mr. Winters’ blood pressure.

Martha finds Sabrina as she is coming out of the room next door and reports that Mr. Winters’ blood pressure is 118/58, which presents no contraindication to administering the IV morphine. Sabrina goes to the department’s med room to obtain the pain medication and administers the morphine, relieving Mr. Winters’ pain. She thanks Martha for her help and then returns to her other patients.

Applying the Model Yourself

Take a moment to think of a situation in your own practice when you may need to delegate a task to assistive personnel. Then review each of the delegation guidelines in the box above and ask yourself whether you may delegate the task or not according to Ohio’s nursing rules.

STANDARDS FOR APPLYING THE NURSING PROCESS FOR RNs 

[This section covers subsections (A) and (B) of the OAC 4723-4-07, Standards for applying the nursing process as a registered nurse.]

A registered nurse must apply the nursing process in the practice of nursing as set forth in division (B) of section 4723.01 of the Revised Code and in the rules of the board. Nurses give care to patients using a cyclic series of steps called the nursing process. With critical thinking and clinical judgment, RNs assess, analyze/report, plan, implement, and evaluate the changing status of patients. They apply the nursing process in various practice settings and collaborate with patients, family, significant others, and members of the healthcare team according to the following standards.

The standards for implementing the nursing process also apply to a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.

Assessment

Assessment involves the accurate and timely collection of both subjective and objective data about a patient’s condition from the patient, family members, significant others, and members of the healthcare team. The RN may direct or delegate the gathering of data but must document and report it, as appropriate, to other members of the healthcare team.

Analysis and Reporting

In an accurate and timely manner, RNs identify, organize, assimilate, and interpret relevant data. They establish, accept, or modify a nursing diagnosis, which is used as a basis for nursing interventions, and report collected data as needed to other members of the healthcare team.

Planning

In an accurate and timely way, RNs develop, establish, maintain, or modify the nursing care plan, including the nursing diagnosis, desired patient outcomes or goals, and nursing interventions. They communicate the plan of care and all modifications to members of the healthcare team.

Implementation

In an accurate and timely way, RNs implement the nursing care plan. They execute the nursing regimen; implement current valid orders or directions by other licensed practitioners; and give direct nursing care commensurate with their education, knowledge, skills, and abilities. They assist and collaborate with other healthcare providers in the care of the patient and delegate nursing tasks, including medication administration, in accordance with applicable rules and laws (see also “Delegation Guidelines” earlier in this course).

Evaluation

In an accurate and timely way, RNs evaluate, document, and report patient responses to nursing interventions and progress toward expected outcomes to appropriate members of the healthcare team. They then reassess the patient’s health status, establishing or modifying the nursing diagnoses and nursing care plan and changing the nursing interventions as appropriate.

STANDARDS FOR APPLYING THE NURSING PROCESS FOR LPNs

[This section covers the OAC 4723-4-08, Standards for applying the nursing process as a licensed practical nurse.]

Licensed practical nurses contribute to the nursing process as set forth in division (F) of section 4723.01 of the Revised Code and rules of the board. The steps of the nursing process are cyclic in nature, so that the patient’s changing status affects the action of nurses as they assess, plan, implement, and evaluate the patient’s status. The LPN collaborates, as appropriate, with the patient, family, significant others, and members of the healthcare team. The licensed practical nurse shall use the following standards for applying the nursing process.

Assessment

The LPN contributes to the nursing assessment of a patient. In an accurate and timely manner, LPNs collect and document objective and subjective data related to the patient’s health status and report the data to the directing registered nurse or healthcare provider and other members of the healthcare team. The subsequent analysis and reporting of this data, however, is not part of the LPN’s role.

Planning

In an accurate and timely manner, LPNs contribute to the development, maintenance, or modification of the nursing component of the care plan and communicate the nursing component and all modifications of the plan to appropriate members of the healthcare team.

Implementation

Licensed practical nurses implement the nursing care plan in an accurate and timely manner as follows:

  • Provide nursing interventions
  • Collect and report patient data as directed
  • Administer medications and treatments prescribed by an authorized person
  • Give direct basic nursing care at the direction of an RN, advanced practice registered nurse, licensed physician, dentist, optometrist, chiropractor, or podiatrist
  • Collaborate with other nurses and members of the healthcare team
  • Delegate tasks as directed, including medication administration, only in accordance with the OAC (see also “Delegation Guidelines” earlier in this course)

Evaluation

In an accurate and timely manner, LPNs contribute to the evaluation of patient responses to nursing interventions, document and communicate patient responses to nursing interventions to appropriate members of the healthcare team, and contribute to the reassessment of the patient’s health status and to modifications of any aspect of the nursing plan of care.

CASE
Nursing Process

Jeffrey is a registered nurse supervising the care for Henry, who is one day post total hip replacement. This afternoon Judy, the LPN providing direct nursing care for Henry, reports to Jeffrey that Henry has developed chest discomfort and shortness of breath. Jeffrey gathers data that includes Henry’s appearance, vital signs, oxygen saturation, heart sounds, and breath sounds (assessment).

Jeffrey then analyzes the collected data, determines Henry has impaired gas exchange (nursing diagnosis), and contacts the physician to report the findings and receive direction (analysis/reporting).

Jeffrey and Judy together modify Henry’s nursing care plan to reflect the care required of a patient with suspected pulmonary embolism. The plan includes measures to address Henry’s chest discomfort and shortness of breath (planning). They communicate the plan of care to other members of the nursing team.

Judy carries out the modified nursing care plan, providing direct patient care and/or delegating nursing tasks to other members of the team as needed (implementation).

Throughout the day, Jeffrey and Judy evaluate Henry’s status frequently and find that Henry’s chest discomfort and dyspnea are improving (evaluation).

SPECIALTY CERTIFICATION

[This section covers OAC 4723-4-09, Specialty certification. This section does not apply to advanced practice nurses (see 4723.41 of the Revised Code).]

An RN with a current, valid license to practice nursing in Ohio may use a title or initials denoting specialty certification in a particular area of specialty in nursing granted by a national certifying organization with established standards. The certifying organization must have established standards stating the requirements for specialty practice, including practice qualifications, formal education, continuing education, or demonstration of knowledge, and must include an examination in the particular area of specialty nursing.

The title to be used by the RN who focuses in a particular specialty in nursing shall be the title granted by the national certifying organization. The registered nurse may use such title or initials following the title Registered Nurse or the initials RN.

No person may use any title or initials implying or representing specialty certification unless that person has been granted a specialty certification title in nursing by a national certifying organization.

DISCIPLINE RELATED TO NURSING PRACTICE

[This section covers ORC 4723.28, Disciplinary actions; OAC 4723-16, Hearings; and OAC 4723-18, Practice intervention and improvement program.]

The Ohio Board of Nursing protects the public’s health and welfare by overseeing and ensuring the safe practice of nursing. It regulates and oversees nursing practice by enforcing the nursing laws and rules of the state. Violations are serious and may result in discipline by the board.

Violations

Violations of nursing laws and rules can result in sanctions, including reprimands; denial, revocation, suspension, or restriction of licenses; and/or fines. Violations that may result in sanctions include, but are not limited to:

  • Fraud in passing a licensing exam
  • Fraud, misrepresentation, or deception in applying for a license
  • Practicing nursing without properly renewing a nursing license or with a suspended license
  • Aiding and abetting a person in practicing nursing without a license
  • Committing a misdemeanor in the course of practice
  • Committing any felony
  • Selling, giving away, or administering drugs or therapeutic devices for other than legal or legitimate therapeutic purposes
  • Violating any municipal, state, county, or federal drug law; taking any dangerous drug without a valid prescription; or taking any Schedule-I controlled substance
  • Impaired practice of safe nursing care due to drugs, alcohol, or other chemical substances
  • Impaired practice of safe nursing care due to physical or mental disability
  • Assaulting or causing harm to a patient
  • Misappropriation of money or anything of value in the course of practice
  • Being adjudicated as mentally ill or mentally incompetent
  • Failing to use Universal and Standard Precautions
  • Engaging in activities that exceed one’s scope of practice
  • Prescribing any drug or device to perform or induce, or otherwise performing, an abortion
  • Failure to maintain professional boundaries with a patient
  • Engaging with a patient in any sexual contact or verbal behavior that is sexually demeaning
  • Assisting suicide
  • Violation of any nursing laws and rules

Disciplinary Hearings

The Board of Nursing responds to possible violations of nursing laws and rules. This may include investigation of the complaint against a nurse, hearings, examination of evidence, and the calling of witnesses. The nurse may represent him or herself before the board or be represented by an attorney. Unless subpoenaed by the board, the nurse is not required to appear in person at any hearing.

When making a decision regarding disciplinary action, the board considers:

  • Any prior disciplinary action taken against the nurse
  • Any prior completion of the alternative program for chemical dependency, if applicable
  • Whether the act was willful, intentional, irresponsible, or unintentional
  • Whether the nurse cooperated with the board investigation
  • Whether the nurse provided false, misleading, or deceptive information
  • The frequency of the act at issue
  • Whether the act represents a pattern of commissions or omissions
  • The outcome of the nurse’s actions
  • The level of harm or potential harm to a patient
    (OAC, Chapter 4723-16)

As a resolution to the possible violation, the board may close the case, issue a non-disciplinary advisory letter, refer the nurse to the PIIP (see below) with employer remediation, or impose disciplinary sanctions. A matter may also be resolved through a settlement agreement submitted to and ratified by the board.

Practice Intervention and Improvement Program

The Practice Intervention and Improvement Program (PIIP) is a confidential alternative to discipline program for eligible licensees as authorized in section 4723.282 of the Revised Code. The program establishes a structured remedial education and monitoring program in cases where a nurse has failed to practice safe nursing but whose practice deficiency can be corrected through participation in the PIIP rather than through disciplinary action. The PIIP utilizes educational interventions such as continuing education activities, courses provided by a post-secondary educational institution, or activities provided by the nurse’s employer.

In order to determine a nurse’s eligibility for this program, the board applies these and other criteria:

  • That the public will be adequately protected from unsafe practice
  • Whether the nurse’s practice deficiency resulted in harm or other untoward outcome for the patient
  • The likelihood the practice deficiency can be corrected through remediation
  • The extent of the nurse’s cooperation with the board
  • Whether the nurse’s practice deficiency was intentional or willful
  • The frequency of its occurrence
  • Whether the nurse has been the subject of other disciplinary action

Those eligible for the program must develop a participatory agreement that includes these and other elements, as detailed in the OAC:

  • Describes the practice deficiencies
  • Identifies the required remediation and educational interventions
  • Specifies the timeframe to fulfill the requirements
  • Requires the nurse to pay all expenses of remediation
  • Requires the nurse to provide documentation of participation to all employers
  • Requires the nurse to participate in workplace monitoring, including written progress reports by the monitors
  • Specifies the terms and conditions that must be met to successfully complete the remediation

If a PIIP participant fails to comply with or successfully fulfill the agreement, the board will proceed with disciplinary action.

CONCLUSION

The Ohio Nurse Practice Act defined the scope of practice for nurses in Chapter 4723 of the Ohio Revised Code and established the Ohio Board of Nursing. The Board of Nursing is responsible for the administration and enforcement of the Nurse Practice Act. This responsibility is accomplished through Section 4723 of the Ohio Administrative Code (OAC). The OAC are the rules written by the Ohio Board of Nursing in accordance with the Ohio Nurse Practice Act.

Chapters 1 through 27 of the OAC contain the rules and regulations for all aspects of nursing practice in the state of Ohio. It sets forth the standards of competent nursing practice and standards for promoting patient safety. By so doing, OAC 4723 fulfills the mission of the Board of Nursing to actively safeguard the health of the public through the effective regulation of nursing care. It is the responsibility of all nurses in the state of Ohio to be familiar with and to abide by these laws and rules.

REFERENCES

NOTE: Complete URLs for references retrieved from online sources are provided in the PDF of this course.

American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Retrieved from http://nursingworld.org

National Council of State Boards of Nursing (NCSBN). (2016). Nurse practice act, rules, and regulations. Retrieved from https://www.ncsbn.org

National Council of State Boards of Nursing (NCSBN). (2018). What every nurse needs to know about state and territorial boards of nursing. Retrieved from https://www.ncsbn.org

Ohio Board of Nursing (OBN). (n.d.). The Board of Nursing & nursing & dialysis technician associations: what’s the difference? Retrieved from http://www.nursing.ohio.gov

Ohio Board of Nursing (OBN). (2019a). Welcome to the Ohio Board of Nursing. Retrieved from http://www.nursing.ohio.gov

Ohio Board of Nursing (OBN). (2019b). Continuing education for renewal. Retrieved from http://www.nursing.ohio.gov

Ohio Board of Nursing (OBN). (2015). Decision-making model. Retrieved from http://www.nursing.ohio.gov

Ohio Nurses Association (ONA). (2016). About ONA: ONA vision and mission. Retrieved from http://www.ohnurses.org

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