Legal Regulations and Professional Standards for Ohio Nurses Edition 6

---

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, a. 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.

The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every individual. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal care. 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.

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. 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.

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

Because the Nurse Practice Act is a legal document, nurses need to understand the meaning of the words used in the statute. Following are terms used in Section of the Ohio Administrative Code. Registered nurses provide nursing care within the scope of practice described in the Ohio Revised Code and the rules of the Ohio Board of Nursing and maintain current knowledge of the duties, responsibilities, and accountabilities of safe nursing practice. 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.

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. The RN 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.

An RN must clarify and implement any prescribed regimen, direction, or treatment for a patient 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 patient or contraindicated by other documented information. If an RN decides not to follow a direction or administer a prescribed medication or treatment, 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 must take action to ensure the safety of the patient. In a timely manner, an RN reports to and consults with other nurses or members of the healthcare team and makes referrals as appropriate. An RN maintains the confidentiality of patient data, only communicating appropriate patient information to other members of the healthcare team for healthcare purposes.

An RN does not disclose identifiable patient healthcare information unless the patient gives consent through a properly executed document. Only in limited circumstances, in accordance with authorized law, rule, or legal authority, may an RN give out identifiable patient information. An 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.

When an RN gives direction to an LPN , the RN first assesses the condition and stability of the patient 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 safely perform the procedure. 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. An LPN may 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. An LPN will clarify and implement any order or direction from an authorized professional practitioner unless the LPN believes the order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful to the patient, or contraindicated by documented information. When clarifying an order or direction, the LPN will consult with an authorized practitioner or directing RN.

If the LPN decides not to follow the direction, the LPN notifies the ordering practitioner or directing registered nurse, documents the notification including the reason for not carrying out the direction, and takes any action necessary to assure patient safety. 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 patient information obtained in the course of nursing practice.

The LPN communicates appropriate patient information with other members of the healthcare team for healthcare purposes only. An LPN 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 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.

When such an individual holds a certificate to prescribe, that person practices in accord with Section 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 nurse holding a similar current, valid certificate of authority. 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.

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. When providing direct nursing care to patients 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.

Not an OH Licensee?

Licensed nurses may delegate certain nursing tasks to an unlicensed person when they follow rules described in , , , or of the OAC. 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. Sabrina consults the electronic medication administration record eMAR and sees that Mr.

Winters has IV morphine ordered for severe pain. 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. 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. 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. Martha finds Sabrina as she is coming out of the room next door and reports that Mr. She thanks Martha for her help and then returns to her other patients. Take a moment to think of a situation in your own practice when you may need to delegate a task to assistive personnel. Licensed nurses must document any errors or deviations from a prescribed regimen to the appropriate practitioner in a timely, complete, and accurate manner.

Licensed nurses must not falsify patient 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. Licensed nurses must implement measures to promote a safe environment for patients and maintain a professional boundary between themselves and patients.

They must provide privacy during examination and care and treat patients with individual dignity, courtesy, and respect. Licensed nurses shall 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 may not misappropriate the property of patients or seek or obtain personal gain at their expense. A licensed nurse may not engage in sexual conduct with a patient, or engage in conduct that may be interpreted as sexual, seductive, or demeaning to a patient. A licensed nurse may not engage in any verbal behavior with a patient that is seductive or sexually demeaning.

The patient is always presumed to be incapable of free, full, or informed consent to sexual activities with a nurse. A licensed nurse will not make or submit or cause to be submitted any false, misleading, or deceptive statements to the OBN, employers or employing agencies, members of the healthcare team, or law enforcement personnel. When licensed nurses 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 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. To maintain standards and safety and improve knowledge and skills, licensed nurses practicing in Ohio must meet the continuing education requirements as described in Section of the OAC.

A nurse applying to renew an active license to practice nursing in Ohio must complete 24 contact hours of continuing education during the renewal period, unless an exception applies, and at least one of the required hours needs to be in category A continuing education. Registered nurses and advanced practice nurses give care to patients using a cyclic series of steps called the nursing process.

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 RN may direct or delegate the gathering of data but must document and report it, as appropriate, to other members of the healthcare team.

In an accurate and timely manner, RNs identify, organize, 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. In an accurate and timely way, RNs develop, establish, maintain, or modify the nursing care plan, including the nursing diagnosis, desired patient outcomes, and nursing interventions.

They communicate the plan of care and all modifications to members of the healthcare team. 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 and collaborate with other healthcare providers in the care of the patient, and delegate nursing tasks appropriately. 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. Licensed practical nurses contribute to the nursing process as set forth in the Ohio Administrative Code and rules of the board. 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. The LPN contributes to the nursing assessment of a patient.

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

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 analyzes the collected data, determines Henry has impaired gas exchange nursing diagnosis , and contacts the physician to report the findings and receive direction. This section does not apply to advanced practice nurses see The Patient's Bill of Rights states that the patient has the right to expect confidentiality in the healthcare relationship.

Be careful of what you say and whom you say it to. You are still responsible for reporting certain information as imposed by state law. However, if you report "legally reportable" information and later learn that your finding was erroneous, you may be held liable for the disclosure, BUT you can be protected if your error was in good faith.

Although the terms "negligence" and "malpractice" are often used interchangeably, you should be aware of the difference. Carelessness or a failure to act that is owed to another person that a "reasonable and prudent" person, facing the same circumstances, would not commit or omit. This is similar to negligence but is more specific in that the act is committed or omitted by a professional person who has deviated from a standard of care.

There are four elements of malpractice that must be proven in order for a plaintiff to recover damages. Duty of Due Care: This is the easiest to prove especially if you practice in a hospital setting. The only proof needed is that a relationship existed between the nurse and patient at the time of the alleged injury.

Legal Regulations and Professional Standards for Ohio Nurses

For example, if you walk past a room of a patient NOT assigned to you and the patient requests assistance. This is defined as the failure to adhere to the standard of care set by the nursing profession thus departing from the specific duty owed to the patient. Evidence of breach of duty presented to a jury includes: Reasonably Prudent Person Doctrine: This "test" relies on the doctrine that asks, "Did the defendant nurse act reasonably under the circumstances? This element not only includes physical harm but also mental anguish and other invasions of plaintiff's patient rights.

The nurse may be negligent but not liable if no injury results to the patient. A plaintiff must show some measurable harm occurred to win the case. This involves the concept of "foresee ability". A logical link must exist between the nurse's act and the injury suffered. It also relies on the "but for" test: It must be clearly understood that the mere departure from a standard procedure alone in not enough evidence to allow a patient to recover damages.

Therefore, if there exists a logical link, but NO proximate cause, there is NO liability. After hearing the facts and testimony of a case, the jury will be asked to examine two questions:. Did the nurse fail to adhere to the standard of care practiced by the nursing profession in this situation, if so, was it foreseeable that harm would result? Also, the sole fact that injury is suffered without proof that the nurse deviated from the practice of competent members of the profession, is NOT sufficient for imposing liability upon the nurse.

With the legal foundation laid and the framework of laws, standards, and practice issues in place, let's delve into some specifics of how Ohio Laws and Rules apply to everyday practice in protecting ourselves and our patients. The mission of the Ohio Board of Nursing OBN is to actively safeguard the health of the public through the effective regulation of nursing care.

The OBN is empowered to determine that applicants are eligible to sit for the examination to practice; issue and renew licenses; determine disciplinary action for nurses; define minimum curricula and standards for educational programs of schools of nursing; grant approval for prelicensure nursing programs; approve continuing nursing education programs; establish a program for monitoring chemical dependency; and issue and certify authority to practice nursing for selected advanced practice nurses. The OAC contains rules and regulations for all aspects of nursing practice in the state of Ohio.

It also includes the organization and record keeping of the Board of Nursing. The OBN differs from the Ohio Nurses Association ONA in that the OBN derives its authority from state law and is part of the state government, while the association is a professional, voluntary membership organization for professional nurses living and working in the state.

The ONA has no legal authority, but provides legislative, educational, practice consultation, and collective-bargaining services for its members. Chapter 4 outlines the minimal acceptable standards of safe and effective nursing practice for a registered nurse RN and a licensed practical nurse LPN in any setting.

Other chapters of the code deal with aspects of nursing practice, such as licensure, delegation, continuing education, chemical dependency abuse, and other standards related to nursing practice. Registered nurses provide nursing care within the scope of practice as defined by Ohio Revised Code The Ohio Administrative Code OAC interprets the statute so that nurses will know standards of care that is expected of them.

These regulations guide the nurse to maintain knowledge of the duties, responsibilities, and accountabilities for safe nursing practice. 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. RNs may provide nursing care beyond basic nursing preparation for an RN provided they obtain additional education, demonstrate appropriate knowledge, skills, and abilities, and document their action.

Such nursing care cannot involve a function or procedure that is prohibited by any law or rules. An RN must clarify and implement any prescribed regimen, direction, or treatment for a patient 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 patient or contraindicated by other documented information.

When an RN decides not to follow a direction or administer a prescribed medication, she or he 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 patient. Registered nurses maintain the confidentiality of patient data, only communicating appropriate patient information to other members of the healthcare team for healthcare purposes.

The RN shall access patient information only for purposes of patient care, or for otherwise fulfilling the nurse's assigned job responsibilities and shall not disseminate patient information for purposes other than patient care or for otherwise fulfilling the nurses' assigned job responsibilities through social media, texting, emailing, or any other form of communication. The RN does not disclose identifiable patient healthcare information unless the patient gives consent through a properly executed document.

Only in limited circumstances, in accordance with authorized law, rule, or legal authority, may an RN give out identifiable patient information. An 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.

When an RN gives direction to a LPN, the RN first assesses the condition of the patient 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. This section is adapted from OAC accessed from website codes.

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. 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 documentation of meeting these requirements.

When an LPN is directed to do a specific function or procedure by an authorized professional practitioner and the action is not illegal, harmful, inaccurate, 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 patient. An LPN reports to and consults with other nurses or other members of the healthcare team and make referrals as appropriate.

An LPN maintains the confidentiality of patient information obtained in the course of nursing practice. The LPN communicates appropriate patient information with other members of the healthcare team for healthcare purposes only. An LPN does not disclose identifiable patient healthcare information unless the patient gives written consent by a properly executed release of information. See section on RN competency standards.

One of the legal issues that may need clarification to licensed nurses both RN's and LPN's is in the area of delegation to unlicensed persons to perform selected nursing tasks. This has been increasingly important in the care of patients outside hospitals and nursing homes. The Ohio Board of Nursing has authorized criteria and standards for the licensed nurse to follow.

The definition of delegation in this chapter is defined as: Criteria and standards of the licensed nurse delegating to unlicensed persons are listed in OAC The licensed nurse may delegate if all the conditions for delegation set forth in this chapter are met. Prior to delegating a nursing task to an unlicensed person, the nurse must determine if the task is within the scope of practice of the delegating nurse and that the nursing task is within the knowledge, skill, and ability of the nurse delegating.

In addition the delegating nurse must identify if the nursing task is within the training, ability, and skill of the unlicensed person. Supervision by the licensed nurse must be adequate and available. See OAC for all the conditions. Some of the tasks that may be delegated are over-the-counter topical medications, over-the-counter eye drops, ear drops, and suppository medications, foot soak treatment, and enemas. Conditions for delegation include that the nursing task:.

Adapted from OAC The licensed nurse will be responsible for teaching the nursing task. The teaching content must include presentation of information on infection control and universal precautions; information and directions on the concepts of performing the task, and demonstration by the licensed nurse by performing the task correctly.

The delegating nurse must then observe and document a satisfactory return demonstration by the unlicensed person.

Ohio Nurse

Promoting patient safety is a top priority in professional nursing practice. The purpose of this section, established by the board of nursing is to enforce: A registered nurse shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice. At all times when a licensed nurse is providing direct nursing care to a patient the licensed nurse shall display the applicable title or initials to identify the nurse's relevant licensure as a registered nurse or as a licensed practical nurse.

A registered nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged that includes, but is not limited to, the following:. The nurse obtains appropriate education that emanates from a recognized body of knowledge relative to the nursing care to be provided. Licensed nurses must implement measures to promote a safe environment for patients and maintain a professional boundary between themselves and patients.

They must provide privacy during examination and care and treat patients with individual dignity, courtesy, and respect. Licensed nurses shall 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 abuse. A licensed nurse may not engage in behavior that constitutes an inappropriate personal relationship or engage in sexual conduct with a patient, or engage in conduct that may be interpreted as sexual, seductive, or demeaning to a patient.

When licensed nurses function in administrative roles, they must make sure that there are procedures in place and implemented to verify that every nurse working under their direction 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.

Supervision by the registered nurse requires that the nurse be continuously available through some form of telecommunication with the nurse being supervised and at times make on-site visits to insure that the one being supervised is practicing within the current standards of nursing practice.

In order to make periodic evaluations the supervising nurse must make periodic on-site visits in order to prepare an evaluation of the nurse's performance. Registered nurses and advance practice nurses give care to patient using the steps of the nursing process that are cyclical in nature so that the nurse's actions are directed by the patient's changing status throughout the process. The nurse collaborates, as appropriate, with the patient, family, significant others, and other members of the health care team in applying the steps of the nursing process.

The following standards shall be used by a registered nurse, using critical thinking and clinical judgment, in applying the nursing process for each patient under the registered nurse's care:. 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, analyze and report, plan, implement, and evaluate the patient's status. RN's 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.

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

In an accurate and timely way, RNs analyze data, identifying, organizing, and interpreting it. They then establish, accept, or modify the nursing diagnosis that is used as a basis for nursing interventions. Registered nurses establish, maintain, or improve the nursing care plan, including desired patient outcomes and interventions.

They communicate the plan to appropriate members of the healthcare team. Registered nurses 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 patient as necessary; collaborate with other healthcare team members, and delegate nursing tasks appropriately.

In an accurate and timely way, RNs evaluate, document, and report patient responses to nursing interventions to appropriate members of the healthcare team. They assess the patient's response to nursing interventions; and progress towards expected outcomes of the plan of care. Evaluation includes the always important step of documentation and communication of the patient's response to nursing interventions.

For purposes of this rule, standards for implementing the nursing process also apply to advanced practice nurses as well. Licensed practical nurses participate in the nursing process set in place in the Ohio Administrative Code as rules of the ONB. They collaborate, as appropriate, with the patient, family, significant others, and members of the healthcare team. The standards for applying the nursing process follow.

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

• Just to Be Close to You
• Fred the Pokka-Dot Fox Jake & Me
• Counseling Suicidal People
• Thomas William Robertson, Actor and Dramatist
• 20 Essential Tips for Buying an Above Ground Pool
• Strange But True Book 2