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Ohio: Standards of Safe Nursing Practice

Persis Mary Hamilton, RN, CNS, MS, EdD

Lauren Robertson, BA, MPT

This course meets the requirement of the Ohio Board of Nursing for a one-hour course on the Ohio Nurse Practice Act.

Our courses fulfill continuing nursing education requirements in all 50 states. For more accreditation information, click here.

This course is derived from the Ohio Administrative Code, Section 4723, Chapter 4. To review the entire section of the OAC, see http://www.nursing.ohio.gov/Law_and_Rule.htm.

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 Ohio, the NPA is codified in Section 4723 of the Ohio Administrative Code (OAC). It establishes an Ohio Board of Nursing (OBN) and defines its structure and function.

The NPA authorizes the board to make and enforce rules for registered nurses, practical nurses, dialysis technicians, certified nurse-midwives, certified nurse practitioners, and certified registered nurse anesthetists (OAC, 2004). In 2003 community health workers were placed under the jurisdiction of the OBN.

The mission of the OBN is to promote and protect the health of citizens through safe nursing practice. 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 (OAC, 2004).

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. The board has the legal authority to administer and enforce all provisions of the NPA. It must review each rule within the NPA at least once every five years. The board is funded and supported by mandatory licensure fees paid by individual healthcare practitioners wishing to practice legally in the state of Ohio. The board does not have authority over employers.

The ONA was formed in 1904 and is a professional, voluntary membership organization for registered nurses living and working in the state. Associations bring practitioners together to develop professional standards and practices, codes of ethics, and to engage in peer review as a voluntary process (OBN, n.d.). Associations have no legal authority, but provide legislative, educational, practice consultation, and collective bargaining services for their members.

The mission of the ONA is to "advance professional nursing practice in Ohio through evidence-based practice, influencing legislators, promoting education, improving economic and general welfare, and advocating for quality healthcare in a cost effective and economically stimulating manner" (ONA, 2008a).

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). Chapter 4 of that section sets forth the standards of safe nursing practice for registered nurses (RNs) and licensed practical nurses (LPNs). This course is a review of that chapter. The other chapters of the section deal with other aspects of nursing practice, such as licensure, delegation, continuing education, chemical dependency abuse, and other standards related to nursing practice. Box 1 presents the terms used in Section 4723.

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 (OBN, 2004).

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 is based on legality, competency, safety, and accountability (ONA, 2008b). For more information see http://www.ohnurses.org/associations/2641/files/Decmodel.pdf.

STANDARDS OF COMPETENCE FOR RNs

[This segment of our course is taken from 4723-4-03, Standards Relating to Competent Practice as a Registered Nurse.]

Registered nurses provide nursing care within the scope of practice described in the Ohio Administrative Code and the rules of the Ohio Board of Nursing and maintain current knowledge of the duties, responsibilities, and accountabilities of safe nursing practice (OAC, 2004).

Registered nurses must 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 (OAC, 2004).

Registered nurses may provide nursing care beyond basic nursing preparation for an RN provided they obtain additional education, demonstrate appropriate knowledge, skills, and abilities, and maintain documentation of their additional education and training. Such nursing care must have a current order from an authorized individual and cannot perform a function or procedure that is prohibited by any law or rule (OAC, 2004).

An RN must clarify and implement any prescribed regimen, direction, or treatment for a client in a timely manner unless the RN believes the prescribed treatment is inaccurate, not properly authorized, not current or valid, harmful, or potentially harmful to a client or contraindicated by other documented information (OAC, 2004).

If an RN decides not to follow a direction or administer a prescribed medication, the RN must notify the prescribing practitioner, document that fact, and state the reason for not following the direction. No matter what the circumstances, however, the RN takes action to ensure the safety of the client (OAC, 2004).

An RN reports to and consults with other nurses or members of the healthcare team and makes referrals as appropriate (OAC, 2004).

An RN maintains the confidentiality of client data, only communicating appropriate client information to other members of the healthcare team for healthcare purposes. A RN does not disclose identifiable client healthcare information unless the client gives consent through a properly executed document. Only in limited circumstances, in accord with authorized law, rule, or legal authority, may an RN give out identifiable client information (OAC, 2004).

A RN uses acceptable standards of safe nursing care as a basis for any observation, advice, instruction, teaching, or evaluation and communicates information that is consistent with acceptable standards of safe nursing care (OAC, 2004).

When a RN gives direction to a LPN, the RN first assesses the condition and stability of the client who needs nursing care, including the type, complexity, and frequency of care. The RN also assesses the skill and ability of the LPN who is to perform the care and the availability and accessibility of resources needed to perform the procedure (OAC, 2004).

STANDARDS OF COMPETENCY FOR LPNs

[This segment of our course is taken from 4723-04-04, Standards Relating to Competent Practice as a Licensed Practical Nurse. A licensed practical nurse (LPN) functions within the scope of practice of a LPN as set forth in the Ohio Administrative Code and the rules of the Ohio Board of Nursing (OAC, 2004).]

An LPN maintains current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice. An LPN demonstrates competence 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 (OAC, 2004).

An LPN may provide nursing care beyond basic preparation for an LPN provided the LPN obtains appropriate education and 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 (OAC, 2004).

When an LPN is directed to do a specific function or procedure by an authorized professional practitioner and the action is not inaccurate, not properly authorized, not current or valid, harmful, or contradicted by other documentation, the nurse clarifies and implements the order. If an LPN decides not to follow the direction, the nurse documents the decision and notifies the practitioner of his or her reason and takes action to ensure the safety of the client (OAC, 2004).

An LPN must clarify an order when he or she has reason to believe the order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful, or contraindicated by other documentation. When clarifying an order the LPN must consult with the appropriate practitioner, notify the prescribing practitioner if a decision is made not to follow the prescribed treatment, document the notification, and take any action needed to assure the safety of the client (OAC, 2004).

An LPN reports to and consults with other nurses or other members of the healthcare team and makes referrals as appropriate. An LPN maintains the confidentiality of client information obtained in the course of nursing practice. The LPN communicates appropriate client information with other members of the healthcare team for healthcare purposes only (OAC, 2004).

An LPN does not disclose identifiable client healthcare information unless the client 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 client healthcare information without a written consent of the client (OAC, 2004).

When an LPN is directed to observe, advise, instruct, or evaluate the performance of a nursing task, the nurse 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 (OAC, 2004).

STANDARDS OF COMPETENCY FOR OTHER NURSING PROFESSIONALS

[This segment of our course is taken from 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 all function within the scope of practice of nursing for a registered nurse and within the nurse's applicable the scope of practice. When such an individual holds a certificate to prescribe, that person practices in accord with the Ohio Administrative Code (OAC, 2004).

When the practice of a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist is evaluated, the evaluation must be done by a collaborating licensed physician, podiatrist, or a nurse holding a similar current, valid certificate of authority (OAC, 2004).

When the practice of a certified registered nurse anesthetist is evaluated, the evaluation must be done by a supervising licensed physician, podiatrist, dentist, or nurse holding a similar current, valid certificate of authority (OAC, 2004).

A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist may provide care within their specialty, provided the nurse obtains appropriate education from a recognized body of knowledge, demonstrates knowledge, skills, and abilities, and maintains documented evidence of these skills and abilities (OAC, 2004).

STANDARDS THAT PROMOTE CLIENT SAFETY

[This segment of our course is taken from 4723-4-06, Standards of Nursing Practice Promoting Client Safety.]

When providing direct nursing care to clients or engaging in nursing practice, in person or by telecommunication, licensed nurses must display their applicable title or initials (degree) or identify to each client the nurse's title or initials (degree) as a registered nurse or licensed practical nurse (OAC, 2004).

When providing direct nursing care to clients or engaging in nursing practice in person or by telecommunication, a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist and clinical nurse specialist must display or identify the applicable title or initials identifying the approved title or initials (OAC, 2004).

Licensed nurses may delegate certain nursing tasks to a licensed or unlicensed person if they follow rules described in Section 4723, Chapter 13, of the OAC. They may delegate giving oral or applying topical medications as described in Section 4723, Chapter 21 or 22 of the OAC (OAC, 2004).

Licensed nurses must document their nursing assessments and observations, care provided, and the client's response to that care in a timely and accurate manner. Licensed nurses must document any errors or deviations from a prescribed regimen to the appropriate practitioner in a timely, complete, and accurate manner (OAC, 2004).

Licensed nurses must not falsify client records or any other document prepared or used in the course of nursing practice. This includes time cards, billing records, and other documents related to nursing services (OAC, 2004).

Licensed nurses must implement measures to promote a safe environment for clients and maintain a professional boundary between themselves and clients. They must provide privacy during examination and care and treat clients with individual dignity, courtesy, and respect (OAC, 2004).

Licensed nurses shall not engage in behavior that causes or may cause physical, verbal, mental, or emotional abuse to a client or engage in behavior that a reasonable person would interpreted as physical, verbal, mental, or emotional abuse (OAC, 2004).

A licensed nurse may not misappropriate the property of clients nor seek or obtain personal gain at their expense. A licensed nurse may not engage in behavior that constitutes an inappropriate involvement in a client's personal relationship or engage in sexual conduct with a client, or engage in conduct that may be interpreted as sexual, seductive, or demeaning to a client (OAC, 2004).

A licensed nurse may not engage in any verbal behavior with a client that is seductive or sexually demeaning. The client is always presumed to be incapable of free, full, or informed consent to sexual activities with a nurse (OAC, 2004).

When licensed nurses function in administrative roles, they must make sure that there are procedures in place and implemented to verify that every nurse or dialysis technician working under their administration has a current valid license to practice nursing in the role to which the nurse is assigned. Only RNs may 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.

STANDARDS FOR APPLYING THE NURSING PROCESS
AS AN RN

[This segment of our course is taken from 4723-4-07, Standards for Applying the Nursing Process as a Registered Nurse.]

Registered nurses and advance practice nurses give care to clients using a cyclic series of steps called the nursing process. With critical thinking and clinical judgment, RNs assess, analyze, plan, implement, and evaluate the changing status of clients. They apply the nursing process in various practice settings and collaborate with clients, family, significant others, and members of the healthcare team according to the following standards (OAC, 2004).

Assessment (Diagnosis)

In diagnosis, the assessment data is analyzed. Assessment involves the accurate and timely collection of both subjective and objective information about a client's condition from the client, 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 (OAC, 2004).

Analysis (Outcomes Evaluation)

Outcome evaluation looks at expected outcomes for a plan, individualized to the patient or the situation. In an accurate and timely way, RNs analyze the assessment data, identifying, organizing, and interpreting it. They then establish, accept, or modify the nursing diagnosis which is used as a basis for nursing interventions (OAC, 2004).

Planning

In an accurate and timely way, RNs develop, maintain, or modify the nursing care plan, including desired client outcomes and interventions. They communicate the plan to appropriate members of the healthcare team (OAC, 2004).

Implementation

In an accurate and timely way, RNs implement the current nursing care plan. They execute current valid orders or directions by a licensed practitioner, and give direct nursing care commensurate with their education, knowledge, skills, and abilities. They assist with care of the client as necessary, collaborate with other healthcare team members, and delegate nursing tasks appropriately (OAC, 2004).

Evaluation

In an accurate and timely way, RNs evaluate, document, and report client responses to nursing interventions and progress towards expected outcomes to appropriate members of the healthcare team. They then reassess the client's health status, revising the nursing diagnoses and nursing care plan and changing the nursing interventions as appropriate (OAC, 2004).

STANDARDS FOR APPLYING THE NURSING PROCESS
AS AN LPN

[This segment of our course it taken from 4723-4-08, Standards for Applying the Nursing Process as a Licensed Practical Nurse.]

Licensed practical nurses participate in the nursing process as set forth in the Ohio Administrative Code and rules of the board. The steps of the nursing process are cyclic in nature, so that the client's changing status affects the action of nurses as they assess, plan, implement, and evaluate the client's status. The LPN collaborates, as appropriate, with the client, family, significant others, and members of the healthcare team. The licensed practical nurse shall use the following standards for applying the nursing process (OAC, 2004):

Assessment

The LPN contributes to the nursing assessment of a client. In an accurate and timely manner, LPNs collect and document objective and subjective data related to the client's health status and report the data to other members of the healthcare team.

Planning

In an accurate and timely manner, LPNs contribute to the development, maintenance, or modification of the nursing component of the care plan and report 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:

• Administer medications and treatments prescribed by an authorized person.
• Give direct basic nursing care at the direction of an RN, physician, dentist, optometrist, chiropractor, podiatrist, certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.
• Assist in the care of the client at the direction of an RN, physician, dentist, optometrist, chiropractor, podiatrist, certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.
• Collaborate with other nurses and members of the healthcare team
• Delegate delegable nursing tasks in accordance with Chapter 4723-13 of the Ohio Administrative Code.
• Delegate giving oral or applying topical medications in accordance with the Ohio Administrative Code (OAC, 2004).

Evaluation

In an accurate and timely manner, LPNs contribute to the evaluation of client responses to nursing interventions, document and communicate client responses to nursing interventions to appropriate members of the healthcare team, and contribute to the revision of the nursing components of the plan of care on the basis of the evaluation (OAC, 2004).

SPECIALTY CERTIFICATION

[This segment of our course is taken from 4723-4-09, Specialty Certification. This section does not apply to advanced practices nurses (see 4723.55), certified nurse practitioners, certified nurse-midwife, certified registered nurse anesthetist, or clinical nurse specialist (see 4723.41—Application to practice nurse-midwifery or other specialty)(OAC, 2004).]

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" (OAC, 2003).

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 (OAC, 2003).

CONCLUSION

Section 4723 of the Ohio Administrative Code is called the Ohio Nurse Practice Act. The Act contains the rules and regulation for all aspects of nursing practice in the state of Ohio. Chapter 4 of the act discusses rules concerning the standards of competent nursing practice in Ohio, the scope of practice of nurses, and standards promoting client safety, thus fulfilling the mission of the Board of Nursing. Finally, Chapter 4 lays out the standards for applying the nursing process by registered nurses and licensed practical nurses.

Posted March 11, 2008

Expires March 1, 2010

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