SCOPE OF PRACTICE: NURSING IN OHIO Pamela S. Dickerson, PhD, RN-BC, FAAN 2014 1.
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Transcript of SCOPE OF PRACTICE: NURSING IN OHIO Pamela S. Dickerson, PhD, RN-BC, FAAN 2014 1.
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SCOPE OF PRACTICE:NURSING IN OHIO
Pamela S. Dickerson, PhD, RN-BC, FAAN
2014
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OBJECTIVE
Identify the parameters of the scopes of practice for RNs, LPNs, and Advanced Practice RNs in the state of Ohio.
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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.
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JUST A REMINDER:
ORC is:
OAC is:
The purpose of the Ohio Board of Nursing is:
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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?
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SCOPE OF PRACTICE: RN
4723.01(B) ORC
6 functions of RNs; 5 independent and 1 dependent (1 indirect)
Apply in all settings
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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
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RN FUNCTIONS – 4723.01(B) ORC
Provide health counseling / teaching
Administer meds, treatments as authorized
Teach, administer, supervise, delegate, evaluate nursing practice
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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
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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
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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.
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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.
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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.
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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.
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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
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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
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SCOPE OF PRACTICE: LPN
4723.01(F) ORC
6 functions; apply in all settings
All dependent; act at direction of…
How does this work?
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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
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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
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NURSING PROCESS: LPN 4723-4-08 OAC
At direction of RN or others…
AssessPlan – contribute to… ImplementEvaluate
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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
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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
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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
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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
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WHAT ABOUT…
Volunteer activities
“Over-the-backyard fence” nursing
Currently not practicing
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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
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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
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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
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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
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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?
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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
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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