SCOPE OF PRACTICE: NURSING IN OHIO Pamela S. Dickerson, PhD, RN-BC, FAAN 2014 1.

1

SCOPE OF PRACTICE:NURSING IN OHIO

Pamela S. Dickerson, PhD, RN-BC, FAAN

2014

2

OBJECTIVE

Identify the parameters of the scopes of practice for RNs, LPNs, and Advanced Practice RNs in the state of Ohio.

3

DISCLOSURES

Criteria for Successful Completion: Submit registration and payment, listen to the webinar in its entirety, and complete the evaluation.

Conflict of Interest: There is no conflict of interest for any planner or presenter for this activity.

Provider Statement: The Ohio Nurses Association (OBN-001-91) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

JUST A REMINDER:

ORC is:

OAC is:

The purpose of the Ohio Board of Nursing is:

4

5

SCOPE OF PRACTICE

What do we mean by “scope of practice”?

What does the Ohio Board of Nursing regulate?

What is the difference between OBN Scope of Practice and “Scope and Standards of Practice” documents from professional associations?

6

SCOPE OF PRACTICE: RN

4723.01(B) ORC

6 functions of RNs; 5 independent and 1 dependent (1 indirect)

Apply in all settings

7

RN FUNCTIONS – 4723.01(B) ORC

Identify patterns of human responses to actual or potential health problems

Select, perform, manage, evaluate nursing actions

Assess health status to provide nursing care

8

RN FUNCTIONS – 4723.01(B) ORC

Provide health counseling / teaching

Administer meds, treatments as authorized

Teach, administer, supervise, delegate, evaluate nursing practice

NURSING PROCESS: RN 4723-4-07 OAC

Use clinical judgment to: Assess Analyze, including nursing diagnosis Plan, including desired outcomes consistent with current nursing science

Implement Evaluate, including progress toward achievement of desired outcomes and revision of nursing diagnosis

9

10

ADVANCED PRACTICE REGISTERED NURSES: CERTIFICATE OF AUTHORITY

Certified registered nurse anesthetist (CRNA)

Clinical nurse specialist (CNS)

Certified nurse midwife (CNM)

Certified nurse practitioner (CNP)

Specific scope of practice statements in 4723.43 (A), (B), (C), (D), ORC

11

SCOPE OF PRACTICE: CNP

4723.43(C) ORC

In collaboration with one or more physicians, provide acute (2013), preventive and primary care services and evaluate/promote wellness within the nurse’s specialty.

12

SCOPE OF PRACTICE: CNS

4723.43(D) ORC

In collaboration with one or more physicians, provide and manage the care of individuals and groups with complex health problems and provide health services that promote, improve, and manage health care within the nurse’s specialty.

13

SCOPE OF PRACTICE: CNM

4723.43(A) ORC:

In collaboration with one or more physicians, provide management of preventive services and primary care services for women antepartally, intrapartally, postpartally, and gynecologically.

14

SCOPE OF PRACTICE: CRNA

4723.43(B) ORC:

With the supervision and in the immediate presence of a physician, podiatrist, or dentist – administer anesthesia and perform anesthesia induction, maintenance, and emergence, and may perform with supervision preanesthetic preparation and evaluation, postanesthesia care, and clinical support functions.

15

STANDARD CARE ARRANGEMENT

Retained on file where APRN practices

Does not need to be approved by OBN except that board needs have name/address of collaborating physician and must be notified within 30 days when there is a new collaborating physician (2013)

May be reviewed by OBN Criteria for referral Process to obtain consultation Plan for coverage in instances of emergency or absence Process for resolving disagreements Procedure for review of referrals and care outcomes

16

CERTIFICATE TO PRESCRIBE (CTP)

Initially issued as externship certificate – prescribe with physician supervision – licensure by endorsement exempt (2013)

Follow formulary established by Committee on Prescriptive Governance (CPG)

Renewal requires 12 hours of continuing education in advanced pharmacology

17

SCOPE OF PRACTICE: LPN

4723.01(F) ORC

6 functions; apply in all settings

All dependent; act at direction of…

How does this work?

18

LPN FUNCTIONS – 4723.01(F) ORC

Observe, provide patient teaching and care

Contribute to planning, implementation, evaluation of patient care

Administer medications and treatments as authorized

LPN FUNCTIONS – 4723.01(F) ORC

Administer adult IV therapy as authorized (with presence of IV therapy recognition from OBN) – some changes in 2013

Delegate nursing tasks as directed by a registered nurse.

Teach nursing tasks to LPNs or UAP as directed by a registered nurse

19

20

NURSING PROCESS: LPN 4723-4-08 OAC

At direction of RN or others…

AssessPlan – contribute to… ImplementEvaluate

21

APPLICATION

RN or LPN in acute care, long term care, assisted living, etc.

Duties and responsibilities consistent with scope of practice

Standards of practice

Policies and procedures

22

APPLICATION

RN or LPN in clinic, physician’s office, etc.

Duties and responsibilities consistent with scope of practice

Policies and procedures consistent with law / rule

Interaction with others (office manager, CMA, etc.); APRN with prescriptive authority

23

APPLICATION

RN or LPN in business / industry, public health, school, prison, etc.

Duties and responsibilities consistent with scope of practice

Policies and procedures consistent with law / rule

Only an RN can supervise / evaluate nursing practice

24

APPLICATION

RN or LPN in other settings – case management, independent practice, etc.

Still required to adhere to scope of practice and standards for safe practice

If out-of-state, follow that state’s law / rules

WHAT ABOUT…

Volunteer activities

“Over-the-backyard fence” nursing

Currently not practicing

25

26

STANDARDS OF SAFE PRACTICE

“Minimal acceptable standards of safe and effective nursing practice for an RN or LPN in any setting”

4723-4-03 RN4723-4-04 LPN4723-4-05 APRN4723-4-06 Patient safety4723-4-07 Nursing process: RN4723-4-08 Nursing process: LPN

27

DIRECTION: RN TO LPN 4723-4-03(K) OAC

Conditions:

Assessment of the patient’s condition by the RN

Type of care required by the patient

Complexity and frequency of care needed

Training, skill, and ability of the LPN

Availability and accessibility of resources as needed for patient safety

DELEGATION: WORKING WITH UNLICENSED ASSISTIVE PERSONNEL 4723-13 OAC

Rules for delegation – evidence of effective use of resources

Transfer of responsibility for performance of a nursing task from someone who has authority to perform the task to someone who does not

28

29

DELEGATION

Conditions:

Task is within your scope of practice

You know how to do the task

The person receiving delegation knows how to do the task and knows to perform task as specified

Resources, support, and supervision available

30

DIRECTION AND DELEGATION

What evidence would support a decision not to direct or delegate?

What evidence dictates how direction and delegation decisions are made?

What evidence suggests that changes should be made in a decision to direct or delegate?

How does documentation support those decisions?

SUMMARY

Keep current with changes in the law and rules!

Practice safely – protect your patients and your nursing license!

For updates:

Read Momentum on line

Visit www.nursing.ohio.gov31

32

RESOURCES

Ohio Board of Nursing – law/rules regulating the practice of nursing in Ohio:

http://codes.ohio.gov/orc/4723http://codes.ohio.gov/oac/4723-4http://codes.ohio.gov/oac/4723-13