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Registered nurses (RNs) and licensed practical nurses (LPNs) in Ohio are legally bound to "practice in accordance with acceptable and prevailing standards of safe nursing care." This course will acquaint nurses with the basics of the Ohio Revised Code, which is the legal parameter for evaluating and disciplining nurses within this State. The Board and Legislature use national practice standards, current, nationally recognized periodicals, and professional expertise to update or modify Ohio Code. The Board evaluates reported deviation from standards with relation to intent, pattern and circumstance. After the evaluation of the violation a nurse is adjudicated through due process action. The board may revoke or place restrictions on the nurse's license, reprimand, and levy a fine or take no action when standards have been breached with regard to competent practice, nursing process, patient safety, or delegation of duty. Thus, it becomes the prudent practice for each Ohio nurse to become familiar with the basic standards which govern the major areas of practice for both the RN and LPN.
Education Category: Management
Release Date: 02/01/2011
Expiration Date: 01/31/2014
This continuing nursing education activity was approved by the Ohio Nurses Association (OBN-001-91), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Approval valid through January 11, 2015. Assigned ONA #15,820-I, 1 contact hour for Category A.
This one-contact hour course is designed for all Ohio registered and licensed practical nurses.
CME Resource is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. CME Resource has been accredited as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102. In obtaining this approval, CME Resource has demonstrated that it complies with the ANSI/IACET Standard which is widely recognized as the Standard of good practice internationally. As a result of their Authorized Provider accreditation status, CME Resource is authorized to offer IACET CEUs for its programs that qualify under the ANSI/IACET Standard.
CME Resource designates this continuing education activity for 1 ANCC contact hour(s). CME Resource designates this continuing education activity for 1.2 hours for Alabama nurses. AACN Synergy CERP Category B. CME Resource is authorized by IACET to offer 0.1 CEU(s) for this program.
In addition to states that accept ANCC, CME Resource is approved as a provider of continuing education in nursing by: Alabama, Provider #ABNP0353, (valid through December 12, 2017); California, BRN Provider #CEP9784; California, LVN Provider #V10662; California, PT Provider #V10671; Florida, Provider #50-2405; Iowa, Provider #295; Kentucky, Provider #7-0054 through 12/31/2017.
This continuing nursing education activity was approved by the Ohio Nurses Association (OBN-001-91), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Approval valid through 01/11/2015. Assigned ONA #15,820-I, 1 contact hour for Category A.
The purpose of this course is to provide basic knowledge of the current Ohio Revised Code and the Ohio Administrative Code for registered nurses (RNs) and licensed practical nurses (LPNs) in order to increase compliance and improve patient care. Ohio nurses are legally obligated to be aware of standards that govern professional accountability. Information contained in this course is not intended to be used in lieu of lawful guidelines, but as a learning tool that increases the understanding of some regulations as they apply to nurses who are licensed within the state of Ohio.
Upon completion of this course, you should be able to:
Sally Anthony, MS, RN, Paralegal, received her paralegal certification in 1992. She received her master\'s degree in health education in 1982 and has been a registered nurse for 27 years. As a medical-legal consultant for the past 11 years she has worked with attorneys on medical malpractice cases and personal injury cases. In addition, she donates her time to work with legal interns at the Gonzaga University Legal Assistance program. Her nursing practice has taken place in a variety of clinical settings that are as diverse as post-open heart advanced care and child legislative testimony. She had also worked as a health educator, consulting nurse, psychiatric/chemical dependency assistant nurse manager, regional poison center director and medical-surgical nurse. She currently works as a medical-legal consultant and is an award winning medical writer.
Contributing faculty, Sally Anthony, MS, RN, Paralegal, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The division planner has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The reading committee member has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.
The purpose of CME Resource is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.
It is the policy of CME Resource not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
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The Nurse Practice Act dates back to 1915, when the Ohio Legislature sought to regulate and reform nursing in the state with regard to education, competence, and standards of practice, and although it was initially met with resistance by healthcare professionals, the intent was for patients to receive a higher level of care . Today, registered nurses (RNs), licensed practical nurses (LPNs), and advanced practice registered nurses in the state of Ohio are legally bound to "practice in accordance with acceptable and prevailing standards of safe nursing care" established and codified as a result of the Act .
The Ohio Board of Nursing, as an agency of the state, is charged with the responsibility of administering and enforcing Chapter 4723 of the Ohio Revised Code (ORC), the legislation that arose from the Nurse Practice Act and which established the Board of Nursing. The practice of registered nurses, advanced practice registered nurses (certified nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists), licensed practical nurses, dialysis technicians, medication aides, and community health workers is regulated by the Board, which has set forth administrative rules in Chapter 4723 of the Ohio Administrative Code (OAC)  . According to state law, the Ohio Board of Nursing is required to review their Code at least once every five years. Thus, it becomes the prudent practice for each Ohio nurse to become familiar with and periodically review the basic standards of practice and the laws and rules that govern the major areas of practice for both the RN and LPN. This course will acquaint nurses with the basics of Chapter 4723, which is the legal parameter for evaluating and disciplining nurses within this state.
The Ohio Board of Nursing consists of 13 members and includes eight registered nurses (one of which must be authorized to practice as an advanced practice registered nurse), four licensed practical nurses, and one consumer member that represents the interests of consumers of healthcare. A president and vice-president are elected from among the members; these positions are one-year terms. Board members serve four years, commencing on the 1st day of January and ending on the 31st day of December. In addition, the Board employs a full-time Executive Director who is a registered nurse.
The Board's mission is "to actively safeguard the health of the public through the effective regulation of nursing care"  . The Board evaluates reported deviation from standards with relation to intent, pattern, and circumstance. After evaluating a possible violation, a nurse is adjudicated through due process action. The Board may revoke or place restrictions on the nurse's license, reprimand and levy a fine, or take no action when standards have been breached with regard to nursing process, patient safety, competent practice, or proper delegation.
The basic standards of competent practice directly impact how both RNs and LPNs provide care . Not only must a nurse possess the knowledge of lawful and current care standards, but the knowledge must be demonstrated through consistent practice and intervention to prevent unauthorized, inappropriate, erroneous, illegal, contraindicated, or intentional nonperformance of care.
According to the Ohio Nurse Practice Act, the practice of nursing as a registered nurse means "providing to individuals and groups nursing care requiring specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences" . The ORC further defines the scope of practice of a registered nurse as :
Identifying patterns of human responses to actual or potential health problems amenable to a nursing regimen
Executing a nursing regimen through the selection, performance, management, and evaluation of nursing actions
Assessing health status for the purpose of proving nursing care
Providing health counseling and health teaching
Administering medications, treatments, and executing regimens authorized by an individual who is authorized to practice in Ohio and is acting within the course of the individual's professional practice
Teaching, administering, supervising, delegating, and evaluating nursing practice
In conjunction with his or her knowledge, the RN uses the nursing processes of assessment, analysis, planning, implementation, and evaluation to perform duties as outlined by the OAC :
Assessment involves collecting and documenting data from the client, family members, significant others, and other members of the healthcare team.
Analysis of individual patient needs should utilize skills and reasoning, including identification, organization, and interpretation of relevant data to establish, accept, or modify a nursing diagnosis. Important information must be reported to other members of the healthcare team.
Planning for care involves the creation, maintenance, or modification of an ongoing regimen. The plan is based on the individual needs of the patient and the care setting. It must be communicated to other team members in a timely fashion to allow for input and modification or implementation.
Implementation involves executing the current plan of care competence that is within the RN's scope of practice, knowledge, or abilities; assisting with client care; and delegating appropriate nursing tasks. In some cases, this also involves collaboration in the administration of care that has been ordered by a licensed practitioner.
Evaluation of the patient's response to nursing treatment and is a critical component of nursing practice. Progress toward expected outcomes should be documented. After performing the evaluation, the RN must communicate the patient's response to others who are involved in the patient's care and seek medically prescribed modification when indicated by prudent nursing judgment.
The Board has provided a tool for scope of practice decision making (Figure 1). This tool may be helpful in determining if an activity or task is within the defined scope of practice.
Under the Nurse Practice Act, practicing as an LPN is defined as "providing to individuals and groups nursing care requiring the application of basic knowledge of the biological, physical, behavioral, social and nursing sciences at the direction of a licensed physician, dentist, podiatrist, optometrist, chiropractor, or registered nurse" . When the LPN is properly trained and supervised, this care may consist of special tasks. The practical nurse contributes to the assessment, planning, implementation, and evaluation of care while communicating information to others :
The knowledge and ability of the LPN are significant contributions to the assessment of the effect of medical orders and nursing diagnoses. Therefore, it is important that this information, whether objective or subjective, be imparted in a careful and timely fashion to the rest of the healthcare team.
This data will be interpreted by an RN or other certified practitioner for the purpose of planning an individualized system of care for each client. Notification of the possible need for modification of a new or ongoing plan or emergent intervention is a critical duty.
The LPN will then be involved in the implementation of the intervention when directed by an appropriate practitioner. The LPN may perform tasks alone, when they are within his or her scope of practice, with a group of treatment team members, or solely under the supervision of the licensed practitioner.
While contributing to ongoing care in a skillful and efficacious manner, the LPN is able to observe client outcomes and provide further evaluation reports to the directing RN and documentation for members of the treatment team.
In addition to competency, licensed nurses have the responsibility to provide safe patient care. This requires the nurse, at all times, to :
Display applicable identification indicating licensure as a registered nurse or licensed practical nurse, including area of practice (e.g., certified nurse-midwife).
Identify to each client or healthcare professional the nurse's title or initials when engaged in nursing practice through telecommunications.
Delegate a nursing task only in accordance with Board rules.
Report and document nursing assessments or observations in a complete, accurate, and timely manner. This includes care provided by the nurse for the client, and the client's response to that care.
Report to the appropriate practitioner errors in or deviations from the current valid order.
The OAC 4723-4-06 states that all licensed nurses must take measures to promote a safe environment for each client. Specifically, this includes delineating, establishing, and maintaining professional boundaries with each client. When providing direct nursing care to a client, licensed nurses should treat each client with courtesy, respect, and with full recognition of dignity and individuality. During examination or treatment and in the care of personal or bodily needs, privacy should be respected and given. Licensed nurses should not engage in behavior that causes or may cause physical, verbal, mental, or emotional abuse to a client.
Licensed nurses are strictly prohibited from misappropriating client property or becoming inappropriately involved in personal relationships. This includes :
Engaging in behavior to seek or obtain personal gain at the client's expense or behavior that may reasonably be interpreted as such an attempt
Engaging in behavior that constitutes or may reasonably be interpreted as inappropriate involvement in the client's personal relationships
This delineation extends to engaging in inappropriate sexual relationships with clients. A licensed nurse shall not :
Engage in sexual conduct with a client
Engage in conduct in the course of practice that may reasonably be interpreted as sexual
Engage in any verbal behavior that is seductive or sexually demeaning to a client
Engage in verbal behavior that may reasonably be interpreted as seductive or sexually demeaning to a client
Clients are always presumed incapable of giving free, full, or informed consent to sexual activity with the nurse.
A nurse who commits fraud through misrepresentation or deception when applying for renewal of a nursing license may have his or her license revoked by the Board. The Board may also deny, revoke, suspend, or place restrictions on any nursing license; reprimand or otherwise discipline a holder of a nursing license; or impose a fine of not more than $500 per violation for a multitude of reasons. Violations can be grouped into general areas; the following is not meant to be an inclusive account of every type of infringement . (Please refer to Section 4723.28 of the Ohio Revised Code for a complete list of violations.)
Engaging in criminal activity, either in the course of practice or outside of a practice setting, may be grounds for disciplinary action. Criminal activity is defined as being convicted of or pleading guilty to a misdemeanor or felony. In the case of a misdemeanor, there may be a finding of "eligibility for a pretrial diversion or similar program or intervention" . The Board may impose sanctions for being convicted of a felony in relation to gross immorality or moral turpitude, the illegal sale of drugs or therapeutic devices, or committing a crime outside of the jurisdiction of the state that would constitute a felony in the state of Ohio . Additionally, committing certain violent or aggravated offenses warrants automatic suspension when evidence exists that suggests continued practice places patients at risk.
Any action that causes impairment is also grounds for sanction by the Board. This includes self-administering dangerous drugs without a prescription and habitual indulgence of habit-forming drugs, alcohol, or other chemical substances. A physical or mental disability may also impair the nurse's ability to practice according to acceptable and prevailing standards of safe nursing. If a nurse's license has been revoked due to mental illness or incompetence, the Board may reinstate the license upon proof of competence through adjudication of a probate court .
Other violations include assaulting or causing harm to a patient, depriving a patient of the means to summon assistance, and using intentional misrepresentation or material deception to obtain money and/or anything of value in the course of practice. The nurse who fails to establish and maintain professional boundaries with a patient or engages in sexually inappropriate behavior, physically or verbally, is also eligible for disciplinary action .
Disciplinary action may also result from violating safety precautions. Safety violations include the failure to use universal blood and body fluid precautions, established by rules adopted under section 4723.07 of the Ohio Revised Code, and the failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Engaging in activities that exceed the scope of practice of the licensee is deemed unsafe. In addition, aiding and abetting the practice of nursing by a person who does not hold a license is grounds for sanction by the Board .
When a complaint is filed and before disciplinary action is taken, the Board's Compliance Section Member will determine if there has been a violation of nursing laws and rules. If the Board has jurisdiction over the complaint and it has been determined that a violation has been committed, the Board will conduct an investigation, which may involve communication with relevant individuals and/or agencies, including co-workers, hospitals, pharmacies, and other healthcare facilities. The Board will then make a disciplinary recommendation . In keeping with due process, as defined in Chapter 119 of the Ohio Revised Code, the nurse is provided the opportunity for a hearing, the outcome of which may be to deny, revoke, suspend, or place restrictions on the license; reprimand, fine, or otherwise discipline the nurse; or take no action .
Nurse B is 44 years of age and has been an RN for almost 20 years. One night, there is an unusually heavy caseload at the emergency care facility where she works. One patient at the facility is 32 years of age and presented with dehydration and heat stroke. The patient is showing signs of altered consciousness and has a rapid heartbeat and low blood pressure. Nurse B is one of two RNs on duty, so the task of starting the patient on a 0.9% normal saline IV has fallen to Nurse W, an LPN who began administering intravenous therapies approximately 2 weeks ago. With the initial assessment and plan of care complete, Nurse B decides to leave Nurse W to start the rehydration drip unsupervised because he seems confident in his ability to administer IV fluids; this frees her up to assist patients with multiple trauma. Although Nurse B has not personally supervised Nurse W during IV administration, she knows that this LPN is quite competent in other nursing tasks. When Nurse W offered to administer the saline, he confirmed that he has completed a Board-approved IV therapy course pursuant to ORC 4723.17. Additionally, Nurse B states that she will check back soon, and if any problems should arise, that she is to be notified immediately.
The task of administering IV saline is within a LPNs scope of practice and is within the rules governing LPNs (Section 4723.17.03B of the Ohio Revised Code). With the patient assessment completed and the results of the nursing task reasonably predictable, the RN may be generally correct in directing an LPN to complete this procedure. She was also correct in reminding the LPN to notify her pending a change in patient status and that she would return to check on the patient. However, Nurse W is relatively new to administering IV fluids, and it is unclear whether he has attempted to establish a line on a dehydrated patient with the possibility of collapsed veins. Before directing Nurse W, Nurse B should have evaluated whether an improperly performed task could cause a life-threatening consequence. In this case, an improperly placed IV line or failure to access a vein may very well lead to a worsening of the patient's condition. Furthermore, because supervision was not available at the time and because Nurse B failed to ascertain from a supervisor whether Nurse W was competent in IV administration to dehydrated individuals, directing Nurse W to complete the task was not in the best interest of the patient.
Nurse A is a female RN, 37 years of age, working in a busy university hospital's cardiac intensive care unit who possesses a good deal of first-hand experience monitoring anticoagulant therapies. An obese male patient, 65 years of age, is admitted early in the morning with acute bilateral deep vein thrombosis in his femoral veins, confirmed by ultrasonography; the patient has a history of chronic heart failure and his international normalized ratio (INR) is 0.5.
Attending Physician G, an intern, has ordered the patient started on an initial dose of warfarin 5 mg and enoxaparin. The patient care plan involves daily monitoring of INR and possibly titrating the warfarin dose to achieve a therapeutic INR of 2.5. For three days the patient's INR has been rising slowly to 1.5 on dosages of 7.5 mg and then 10 mg of warfarin. When Nurse A arrives for her shift after her day off (on day 5 of the patient's treatment), she discovers that in an attempt to speed the therapy, the intern has titrated the warfarin to 20 mg and the patient's INR is at 2.4. She knows from experience that warfarin dosages of 10 mg for heavier patients are acceptable, but 20 mg seems to be an overly aggressive approach, considering a peak effect of 36 to 48 hours, so she decides to ask Physician G to reduce the dosage back to 10 mg or to discontinue use. The physician admits not having experience administering anticoagulants and agrees to lower the dose to 5 mg.
As a member of the healthcare team, it is a registered nurse's duty to contribute his or her knowledge, experience, and observations to improve patient safety and outcomes. Pursuant to OAC Section 4723-4-03-E, nurses should implement a current valid order unless they feel the order is inaccurate; not properly authorized; not current or valid; harmful or potentially harmful to a client; or contraindicated by other documented information. In this instance, the nurse's judgment dictated that implementing the current order of administering warfarin 20 mg had serious potential to be harmful to the client. It is important to remain vigilant regarding patient safety and to document and voice concerns regarding the patient's individualized system of care.
It is the responsibility of the Ohio Board of Nursing to enforce the laws and rules regulating the practice of nursing as the law is currently stated and not how individuals may wish the law to be. However, as nurses are affected by these rules and regulations, they have the responsibility to keep informed of regulatory changes and provide public comment regarding regulations. All Board meetings, held every two months, are open to the general public. In addition, the Board seeks public input through its newsletter, Momentum. For those individuals with special concerns, the Board may hold special forum sessions. For more information please contact the Board at 614-466-3947 or http://www.nursing.ohio.gov. Practice issues or questions may be sent directly to the Board by email to firstname.lastname@example.org.
1. Ohio Board of Nursing. The Ohio Board of Nursing: The Guide to Public Participation in Rulemaking and Overview of Board Operation. 2008. Available at http://www.registerofohio.state.oh.us/pdfs/rmg/RMG_4723_20080911.pdf. Last accessed December 15, 2010.
7. Ohio Board of Nursing. Guide to the Ohio Board of Nursing's Complaint and Investigation Process. 2008. Available at http://www.nursing.ohio.gov/PDFS/ComplaintProcessJune08.pdf. Last accessed December 15, 2010.
8. Ohio Board of Nursing, Decision Making Model. Pub No: OBN-103. Available at http://nursing.ohio.gov/pdfs/Decmodel.pdf. Last accessed December 20, 2010.