About this course:
The purpose of this module is to provide information on the minimum acceptable standards of safe, effective nursing practice for a registered nurse (RN), licensed practical nurse (LPN), or advanced practice registered nurse (APRN) in any setting in Ohio as outlined in the Ohio Revised Code (ORC)-Chapter 4723.
After the completion of this module, the learner should be able to:
- explore the origin and purpose of boards of nursing
- examine the Ohio Board of Nursing's (OBN's) standards of practice for registered nurses (RNs), licensed practical nurses (LPNs), and advanced practice registered nurses (APRNs)
- outline the OBN Scope of Practice Decision Making Model
- list the steps in the OBN's disciplinary process and discuss the OBN's most recent annual reports and identify the number of complaints received by the OBN as well as specific types of complaints alleging misconduct by licensees
- define the steps for license renewal and continuing professional development requirements in the Ohio Nurse Practice Act
Standards of nursing education and practice result from the efforts of nursing associations dating back over 100 years and serve to protect the public. Each state within the US provides nurses with guidance and regulations to practice through a law known as the Nurse Practice Act (NPA). Additionally, most states have copies of their NPA online or by request from the state board of nursing. The NPA designates the Board of Nursing, or the authoritative body within each state, with the responsibility of ensuring the nursing workforce delivers safe, competent, skilled, and knowledgeable care (National Council of State Boards of Nursing [NCSBN], 2019a). This course explores the Ohio Nurse Practice Act standards outlined in Chapter 4723 of the ORC to protect the public and ensure minimum competencies and requirements are met and maintained by all nurses. The ORC is comprised of laws that are passed by the state of Ohio legislative bodies. The Ohio Administrative Code (OAC, chapters 4723-1 through 4723-27) is an adjunct document outlining the rules that assist in implementing and interpreting the ORC passed by the state board of nursing to operationalize the ORC (OBN, 2019b). This training will focus primarily on the OAC.
History of Boards of Nursing
To regulate nursing practice, North Carolina established the first Board of Nursing in 1903. Soon afterward, many states enacted similar legislation and established their Boards of Nursing (North Carolina Board of Nursing, 2018). The OBN was established in 1915, and its mission is "to actively safeguard the health of the public through the effective regulation of nursing care" (OBN, 2019b).
Structure of the OBN
The structure of the OBN is specified in ORC 4723-02. The OBN is comprised of 13 members who must be US citizens and residents of Ohio.
- Eight members are RNs who must hold an active license in Ohio and must have been actively engaged in nursing practice as an RN for the five years immediately preceding the member's initial appointment to the OBN. In addition, at least two of the eight RNs must hold a current license to practice as an advanced practice registered nurse (APRN, including certified nurse-midwife [CNM], certified nurse practitioner [CNP], certified registered nurse anesthetist [CRNA], or clinical nurse specialist [CNS]).
- Four members are LPNs who must hold an active license in Ohio and have been actively engaged in nursing practice as an LPN for the five years immediately preceding the member's initial appointment to the OBN.
- One consumer member represents individuals that receive care from nurses licensed by the state.
A president and vice-president are elected for a one-year term from the 13 members. OBN board members serve four-year terms beginning on January 1st and ending on December 31st. Additionally, the OBN hires a full-time Executive Director that is an RN (ORC, 2016).
Standards of Practice
The OBN has the authority to enforce and expand on state statutes through their written rules. Additionally, the OBN has the authority to conduct investigations and to impose discipline when a licensee violates a statute or regulation.
The minimally acceptable standards of safe and effective practice for the RN and LPN can be found in Chapters 4723-4-03 and 4723-4-04 of Ohio's Administrative Code (OAC, 2019). Table 1 lists the standards from the OAC for the RN, and Table 2 lists the standards from the OAC for the LPN:
Nurses are required to provide care within their scope of practice. Nursing care should be aligned with the individual nurse's education, knowledge, experience, and demonstrated competency. Since nursing is a dynamic practice, questions related to the nurse's scope of practice may arise. To assist in delineating the scope of practice, the OBN developed a Scope of Practice Decision Making Model (see Figure 1 below). The model incorporates a decision tree that includes references and is based on safety, competency, legality, and accountability (OBN, 2019a).
OBN RN and LPN Decision Making Model
Specific areas addressed in the rules include maintaining and demonstrating competency; assuring patient safety; maintaining confidentiality; delineating, establishing, and maintaining professional boundaries; and applying the nursing process (OAC, 2019):
- The rules related to competency are found in 4723-4-03(A)-(G) for RNs and 4723-4-04 (A)-(G) for LPNs. Both LPNs and RNs are accountable for maintaining current knowledge and demonstrating competency and consistent performance of nursing care. When providing care beyond the basic nursing preparations, the nurse must maintain documentation to demonstrate that they obtained the advanced knowledge from a credible source.
- The rules related to safety are discussed in greater detail below. The OBN expects nurses to implement orders from licensed providers in a timely manner unless there is a reason to believe that the order is inappropriate for the patient. Additional details about this can be found in 4723-4-03 (E) and 4723-4-04 (E). The OBN expects the nurse to report to and consult with other nurses and members of the health care team and make necessary referrals. This information is detailed in 4723-4-03 (G) and 4723-4-04 (G). 4723-4-03 (J) and 4723-4-04 (J) outline the OBN's regulations regarding acceptable standards of safe nursing care as a basis for prov
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Promoting Patient Safety: OAC 4723-4-06
The OAC prohibits engaging in the following:
- behavior that causes or may cause verbal, physical, mental, or emotional abuse of a patient
- conduct that might reasonably be interpreted as verbally, physically, mentally, or emotionally abusive
- misappropriation of a patient's personal property
- behavior to seek personal gain at the patient's expense
- behavior that can be reasonably interpreted as inappropriate in the patient's personal relationships or financial behaviors
- sexual conduct with a patient
- conduct or verbal exchanges during practice that might reasonably be construed as sexual, seductive, or demeaning to the patient (OAC, 2019)
The OAC establishes standards for applying the nursing process. These regulations can be found in OAC-4723-4-07 and are outlined as follows (OAC, 2019):
- RNs 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 recognizing its dynamic nature and thus, enables the nurse to respond to changes in the patient's health status.
- The nurse should begin with an assessment of the patient's status (collecting subjective and objective data from the patient, family, and other sources).
- The nurse then documents findings, analyzes and reports those findings, develops and modifies the plan of care as needed, and communicates the plan of care to other members of the health care team.
- The nurse implements the plan of care by executing the nursing regimen.
- The nurse provides care that is within their scope of practice.
- The nurse assists and collaborates with other members of the health care team.
- Finally, the nurse evaluates the patient's response to determine the effectiveness of treatment and care plan. The nurse might need to revise the plan of care based on the evaluation. The nurse may also need to notify the provider if an adjustment in the patient's care plan is warranted based on the evaluation findings.
According to OAC 4723-4-08, the standards for applying the nursing process are slightly different as an LPN. LPNs are required to contribute to the nursing process in the practice of nursing by providing care based on the established nursing plan (OAC, 2019).
Standards of Competency for Advanced Practice Registered Nurses (APRNs)
Section 4723-4-05 notes the standards for APRNs, as outlined in Table 3.
According to Section 4723-9 of the OAC, each of these advanced practice roles must also function within the regulations of the Ohio law to prescribe medications (OAC, 2018c).
Evaluations of an APRN must be completed by a collaborating physician, dentist, podiatrist, or registered anesthetist with a current and valid license with the same designation as the APRN being evaluated (OAC, 2018a).
The APRN can provide care within their specialty provided they:
- demonstrate the knowledge, skills, and abilities of the specialty
- obtain appropriate education from a recognized body of knowledge
- document evidence of skills and abilities and maintain records as required (OAC, 2018a)
Additionally, Table 4 lists standards of practice from OAC 4723-8-02 for the APRN.
Another aspect of the OAC for APRNs is title protection, which prohibits using an inappropriate or unearned credential when functioning as a licensed APRN. Additional information on title protection for the APRN can be found within OAC 4723-8-03 (OAC, 2018a). For standard care arrangement information, Table 5 outlines a practice agreement(s) with their supervising physician.
According to the NCSBN (2019b), most licensed nurses in the US provide safe, competent, and compassionate nursing care. In addition, less than 1% of nurses are disciplined by their board of nursing. Likewise, the OBN reports that most Ohio nurses practice with high standards; however, when a nurse has allegedly violated OBN's laws or rules, they are subject to discipline (NCSBN, 2019b).
In carrying out its disciplinary responsibilities, the OBN 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 certifications. The disciplinary process typically begins when a patient, family member, nurse manager, or employer files a complaint. See Table 6 for detailed information about the number of complaints and a partial list of the types of complaints the OBN received from the fiscal year 2016 to 2020. This information was retrieved from the OBN's Annual Reports from 2016 thru 2020, which is available on the OBN's website (OBN, 2020).
The OBN is the governing body within the state that upholds the NPA and the rules found in the OAC. The NPA lays out the process by which the OBN investigates evidence having the appearance that a nurse has failed to practice in accordance with acceptable standards of safe practice. After the evidence has been gathered, a thorough review by the OBN will be performed to determine the presence of wrongdoing or a deficiency in practice without harm or risk of serious imminent harm (indicating that the NPA may offer a less stringent alternative; ORC, 2019).
License Renewal and Education Requirements
Most states require evidence of continued professional development as part of the license renewal process for nurses to practice. For nurses in Ohio, the renewal cycle is every 2 years from November 1st to October 31st. During each licensure cycle, the nurse must complete and maintain records of completion for 24 contact hours of continuing education (CE) approved by the OBN. One hour of these 24 hours must be regarding category A training (OAC, 2018b).
Those who hold a nursing license in Ohio for one year or less are only required to obtain 12 hours of continuing education (CE) for renewal. An example would be a new graduate nurse initially licensed for one year or less upon the renewal date (OAC, 2018b).
Each nurse applying for renewal must attest to having completed the required CE hours at an appropriate level within the 2-year timeframe. Documentation must be provided upon request by the OBN during routine audits. If evidence is not provided or the individual does not meet the requirements upon request, the license will lapse. To reactivate or reinstate a lapsed license, the nurse applicant must complete 24 hours of continuing education. At least one of these hours must pertain to category A, and the applicant must maintain documentation that the hours were completed during the 24 months before their reapplication date (OAC, 2018b).
Specific requirements for initial licensure and renewal for LPNs, RNs, and APRNs can be found on the OBN website. The current CE requirements for license renewal for LPNs/RNs are listed in Table 7.
Education activities for CE should be approved by an OBN approver or administered by an approved provider unit as listed by the OBN, which includes those accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Continuing Medical Education (ACCME), or the International Association for Continuing Education and Training (IACET). Academic credit taken through an accredited educational institution can also be utilized towards a nurse's CE requirements, along with an independent study or volunteer hours spent caring for indigent or uninsured populations (up to 8 hours/biennium). As with RNs, APRNs in Ohio are not required to submit proof of CE hours obtained during their first licensure renewal after initial licensure by examination. CE hours for all other renewing APRNs in Ohio must be obtained between November 1st and October 31st of odd-numbered years. APRNs are required to obtain 24 contact hours of CE in the 24-month renewal cycle starting in 2021, including 12 hours of advanced pharmacology training if they are active prescribers, in addition to the 24 hours of CE they are required to obtain for the RN licensure renewal. This requires a total of 48 contact hours for the 2-year renewal period. These hours may also be used towards their national specialty certification (OBN, 2021).
Important Note and Disclaimer
The information in this module is general in nature and is not, nor intended to be, legal advice. The laws are complex, and circumstances vary. Therefore, you should consult an attorney for advice regarding your individual situation.
National Council on State Boards of Nursing. (2019a). About US boards of nursing. https://www.ncsbn.org/about-boards-of-nursing.htm
National Council on State Boards of Nursing. (2019b). Discipline. https://www.ncsbn.org/discipline.htm
North Carolina Board of Nursing. (2018). Historical information. https://www.ncbon.com/Board-information-historical-information
Ohio Administrative Code (2018a). Advanced practice registered nurse certification and practice. http://codes.ohio.gov/oac/4723-8
Ohio Administrative Code. (2018b). Continuing education (CE). http://codes.ohio.gov/oac/4723-14
Ohio Administrative Code. (2018c). Prescriptive authority. http://codes.ohio.gov/oac/4723-9
Ohio Administrative Code. (2019). Standards of practice relative to registered nurse or licensed practical nurse. http://codes.ohio.gov/oac/4723-4
The Ohio Board of Nursing. (2019a). RN and LPN decision making model. http://nursing.ohio.gov/wp-content/uploads/2019/10/decision-making-model20191007_14055357.pdf
The Ohio Board of Nursing. (2019b). The practice of nursing and scopes of practice. Ohio Board of Nursing: Momentum, 17(3), 8. https://nursing.ohio.gov/wp-content/uploads/2019/10/Summer-Issue-2019-Momentumn.pdf
The Ohio Board of Nursing. (2020). Fiscal and annual reports. https://nursing.ohio.gov/forms-publications/annual-reports/
The Ohio Board of Nursing. (2021). Continuing education for renewal- APRNs. https://nursing.ohio.gov/wp-content/uploads/2021/07/CE-FAQs-APRN-updated-June-2021.pdf
Ohio Revised Code. (2016). Nurses. http://codes.ohio.gov/orc/4723
Ohio Revised Code. (2019). Disciplinary actions. http://codes.ohio.gov/orc/4723.28