The purpose of this module is to provide comprehensive information pertaining the minimum acceptable standards of safe, effective nursing practice for a registered nurse and licensed practical nurse in any setting. Participants will also be provided with information about administrative law and the Board’s disciplinary process.
After the completion of this module, you will be able to:
· Identify the sources of law
· Identify when Boards of nursing where created
· Describe the purpose of Boards of nursing
· Examine the Ohio Board of Nursing’s (Board’s) standards of practice for registered nurses and licensed practical nurses
· Identify the duties of the registered nurse and the licensed practical nurse as set out by the Board
· List the steps in the Ohio Board of Nursing Disciplinary Process
Examine the Ohio Board of Nursing’s most recent annual reports and identify the number of complaints received by the Board as well as specific types of complaints alleging misconduct by licensees.
Sources of Law
Laws are rules of conduct that are promulgated and enforced by a governmental body. The rules of conduct typically also identity sanctions that can be imposed when an individual is in violation of a law. It is important for you understand the laws that govern nursing practice. Knowledge of the law augments your ability to provide safe, effective respectful care to patients in all settings. The sources of law are as follows.
As a nurse you should understand the laws that govern nursing practice to provide competent patient care and to protect yourself from liability. If you encounter a legal issue, you can face charges in many legal arenas including criminal law, statutory, administrative law and civil law.
History of Boards of Nursing
North Carolina established the first Board of Nursing in 1903, Soon afterwards, many states enacted legislation to establish Boards of Nursing for the purpose of regulating nursing practice. The Ohio Board of Nursing was established in 1915. The current mission of the Board is available on the Board’s web site and is provided below:
The mission of the Ohio Board of Nursing is to actively safeguard the health of the public through the effective regulation of nursing care.
Structure of the Ohio Board of Nursing
The structure of the Board is specified in ORC 4723.02. The Board consists of 13 members who must be US citizens and residents of Ohio.
· 8 members are registered nurses who must hold an active license in Ohio and must have been actively engaged in nursing practice as a registered nurse for the five years immediately preceding the member’s initial appointment to the Board. At least two of the 8 registered nurses must hold a current license to practice as an advanced practice registered nurse. (certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.
· 4 members are licensed practical nurses must hold an active license in Ohio and must have been actively engaged in nursing practice as a licensed practical nurse for the five years immediately preceding the member’s initial appointment to the Board.
· 1 consumer member who represents individuals who receive care from nurses licensed by the state.
Consideration is given to areas of nursing service and nursing education as well as various geographic areas of the state when making appointments.
Standards of Practice
The Board of nursing has the authority to enforce state statute by writing rules that expand on the statute. Equally important, the Board has the authority to conduct investigations and to impose discipline when a licensee is in violation of a statute or rule.
You can find the minimal acceptable standards of safe effective practice for the RN and LPN in Chapter 4723-4-03 and 4723-4-04 of the Ohio Board of Nursing’s administrative rules. As a nurse you are required to provide care within your scope of practice. Specific area addressed in the rules include maintaining and demonstrating competency, assuring client safety, maintaining confidentiality, delineating, establishing, and maintaining professional boundaries, and applying the nursing process.
· The rules related to competency are found in 4723-4-03(A)-(G) for registered nursing and 4723-4-04 (A)-(G) for licensed practical nursing. You accountable for maintain and demonstrating competency, and consistent performance of nursing care. When you are providing care that is beyond your basic nursing preparations, you must maintain documentation to demonstrate that you obtained the advanced knowledge from a credible source.
· The rules related to safety are discussed below. The Board expects you to implement an order from a provider in a timely manner unless you have reason to believes that the order is inappropriate for your client. You can find more details about when the nurse should withhold implementing an order and your responsibility in a situation such as this at 4723-4-03 (E) and 4723-4-04 (E). The Board expects you to report to and consult with other nurses and members of the health care team and make necessary referrals. You can find this information at 4723-4-03 (G) and 4723-4-04 (G). You can go to 4723-4-03 (J) and 4723-4-04 (J) to review the Board’s regulation about using acceptable standards of safe nursing care as a basis for providing advice, instruction, teaching, and evaluation of nursing care.
· The regulations related to confidentialityare found in 4723-4-03 (H) and 4723-4- (H). The Board requires you to carefully safeguard patient information and only access and disseminate information for the purpose of providing client care or in fulfilling your job responsibilities. Disclosure is allowed in situations where the patient has consented to the release of his or her information. In some situations, you are required by law to disclose a patient’s information. For example, chlamydia, gonorrhea, syphilis, chancroid and HIV infections are reportable to local health authorities in every state.
· The regulations related to professional boundaries and misappropriation of property are found in 4723-4-06(H), (I) (J), (K) (L), (M). The Board requires you to delineate, establish, and maintain professional boundaries with every patient. Specifically, the Board requires you to provide privacy and during examination, treatment and when providing personal care. The Board requires you to demonstrate courtesy, respect, and to display dignity and respect for your patient’s individuality.
The Board’s regulations prohibit:
-verbal, physical, mental or emotional abuse of a patient.
-behavior that might reasonably be considered verbal, physical, mental or emotional abuse of a patient.
-misappropriation of a patient’s personal property
-engaging in behavior that can be reasonability interpreted as behavior to seek personal gain at the patient’s expense.
-engaging in behavior that can be reasonability interpreted as behavior as inappropriate in the patient’s personal relationships or financial behaviors
-engaging in sexual conduct with a patient
- engaging in conduct during practice that might reasonably interpreted as sexual.
-engaging in verbal behavior that is seductive or demeaning to the patient.
-engaging in any verbal behavior that might be reasonably interpreted as seductive, or sexually demeaning to the patient.
· The Board’s regulations require you to use thenursing process. You can find these regulations at 4723-4-07.
Standards for applying the nursing process as a registered nurse
-As an RN you are required to use the steps of the nursing process. (assessment, analysis, planning, implementation, and evaluation) in the practice of nursing.
Effective use of the nursing process requires you to recognize its dynamic nature and thus, enables you to respond to changes in your patient’s health status. In addition to assessment of the patient’s status (collecting subjective and objective data from patient, family and other sources)
- you must document findings, analyze and report the findings,
-develop and modify the plan of care as needed,
- communicate the plan of care to other members of the health care team
- implement the plan of care by executing the nursing regimen
- provide care that is within your scope of practice
- and assist and collaborate with other members of the health care team.
Evaluation of your patient’s response is a critical step of the nursing process because it allows you to determine the effectiveness of treatment and to the plan of care. You might need to revise the plan of care based on your findings from the evaluation. You may, also, need to notify the provider if an adjustment in the patient’s plan of care may be warranted based on your evaluation findings.
Standards for applying the nursing process as a licensed practical nurse
As an LPN you are required to contribute to the nursing process in the practice of nursing. You are directed in providing care by using the established nursing plan. You must contribute to the assessment of the patient’s status, collect, document, and report objective and subjective data from the patient, and contribute to the development, maintenance, or modification of the plan of nursing care. During the implementation step of the nursing process, you must provide nursing interventions, basic nursing care as directed by the RN, APRN, physician, dentist, optometrist, chiropractor, or podiatrist. During the implementation step of the nursing process, you must collaborate with other members of the health care team. During the evaluation step of the nursing process, you must contribute to the evaluation of the patient’s response to nursing interventions, document and communicate the patient’s response to nursing interventions, and contribute to the reassessment of the patient’s health status and to modifications of the nursing care plan.
According to the National Council of State Boards of Nursing, the majority of licensed nurses in the US provide safe, competent, compassionate nursing care. In fact, the number of nurses who are disciplined by their Board of nursing is less than one percent. Likewise, the Ohio Board of Nursing reports that most Ohio nurses practice with high standards, but when a nurse has allegedly violated The Board’s laws or rules, he or she is subject to discipline by the Board.
In carrying out its disciplinary responsibilities, the Board has the authority to revoke and suspend licenses and certificates; impose probationary requirements, reprimands, fines, or practice restrictions, and deny initial or renewal licenses or certificates. The disciplinary process typically begins when a complaint is made by a patient, family member, a nurse manager or employer. Below is information about the number of complaints and a partial list of the types of complaints the Ohio Board of Nursing received in 2016 and 2017. This information was retrieved from the Ohio Board of Nursing’s Annual Reports from 2016 and 2017 which is available on the Board’s web site.
Stages in the disciplinary process
The stages of the Ohio Board of Nursing Disciplinary Process are found below:
A complaint is filed by a member of the public such as a patient or a family member of a patient. An employer of a nurse who believes that a current or former nurse employee engaged in conduct that might be grounds for disciplinary action is required by law to file a complaint to the Board. The complaint should include the name of the person filing the complaint, the name of the nurse and the conduct at issue.
The complaint is assigned to one of the Board’s investigators who gathers data from the complainant, from relevant medical records, employer records, criminal records if applicable, witnesses as well as the licensee. The Board cautions its licensees to seek legal counsel before speaking with or responding in writing to a Board investigator.
After the investigation is completed the evidence is reviewed and a decision is made about whether to pursue disciplinary action against the nurse. If there is not enough evidence to prove that a violation occurred a decision is made to not proceed to disciplinary action. If the there is evidence to prove a minor violation and that there is not risk to the public, an advisory letter is sent to the licensee. The advisory letter includes recommendations that the nurse should take to avoid future violations. When the evidence is sufficient to proceed and the violation is not minor, the Board sends a Notice of Opportunity for Hearing or a Notice of Suspension. The Notice will include the laws and rules which the nurse allegedly violated. The nurse has 30 days (from the time the Notice is issued, not the time the nurse received it) to respond to the notice and request a hearing. If the nurse does not respond within the timeframe, the nurse has assumed to have waived his or her rights to a Hearing and the Board can proceed without further input from the nurse.
In some cases, the Board will offer the nurse a consent agreement. The consent agreement which is a written agreement between the Board and the nurse. It takes the place of a hearing. The nurse must make specific admission to the charges and agree to the discipline imposed. The Board can require fines, reprimand, probation, suspension, revocation, continuing education, periodic drug screening, psychological or dependency evaluations and counseling and restrictions on future practice. Again, the Board cautions the nurse to seek legal counsel regarding the consent agreement. When the nurse chooses to sign the consent agreement, it must then be signed by the Board. If the Board rejects the consent agreement, the case is referred to the investigative team.
If the matter is not resolved by a consent agreement, the matter proceeds to a hearing. An Ohio Assistant Attorney General represents the Board. The nurse can have a lawyer represent him or her. Both sides present evidence and argue the case before a Hearing Examiner. The Hearing Examiner reviews the evidence and sends a written report and recommendations to the Board.
The Board reviews the report and recommendations at the next regularly scheduled Board meeting. The Board has the authority to adopt the recommended discipline or reject it and order discipline as it seems appropriate. The nurse has the right to appeal the Board’s decision to the Court of Common Pleas, but the Court can overturn the Board’s decision only if the decision was not supported by reliable, probative and substantial evidence.