≥ 90% of will know the Ohio Nurse Practice Standards.
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≥ 90% of will know the Ohio Nurse Practice Standards.
At the completion of this module, the learner will be able to:
Are you a nurse? How do you know? It is only when you pick up the Nurse Practice Act (NPA) written by the state legislature of the state in which you are applying for licensure that you can know if you meet the specific definition of who may go by the title, nurse.
Each state governing body has the duty and obligation to its citizens to:
Be aware while all NPAs discuss similar topics and share comparable content, the NPAs of any two states will not be identical!
As a professional, you are legally responsible for remaining in compliance with the laws and regulations that govern you. Each licensed medical professional works under laws, statutes, and standards derived from local, state, and federal governing bodies in addition to the professional practice guidelines.
Maybe it is time to dust off your copy of the NPA you have sworn to abide by. An application for professional licensure with acceptance is a legally binding contract to uphold your practice to the level mandated by that authorizing body. The practice of nursing is a right granted by a state to protect those who need nursing care. Safe, competent nursing practice is grounded in the law as written in the state NPA and its rules. The nurse can only function properly if they know the current laws governing practice in their state.
| To find the NPA, go to the state of Ohio Board of Nursing web page to access the most recent copy: nursing.ohio.gov/laws-rules/. |
The goal is safety. The NPA is Chapter 4723 of the Ohio Revised Code (ORC). The ORC is statutes, with the expressed goal of protecting the public from unsafe care by ensuring that a minimum set of requirements are met and maintained by those whose practice is in that area the state defines as nursing. An adjunct document is the Ohio Administrative Code (OAC) Chapters 4723-1 through 4723-27. The OAC is a set of rules that assist in the implementation and interpretation of the ORC.
The Ohio Board of Nursing acts as the administrative agency charged with implementing and interpreting the state's NPA. This authority is granted to the board by the NPA itself. However, the board has no actual control over the formation of the Act. That burden is the duty of the state legislature, who listens to suggestions from the board, professional organizations, legal counsel, and the citizens of Ohio. In the end, however, it is the state legislature that determines the contents of the NPA. As the Board of Nursing is the implementation aspect of the NPA governing nurses and nursing, some knowledge of how it is composed and formed may help understand the rulings it makes and how to appeal or question its decisions.
The Ohio Board of Nursing is composed of thirteen members picked by the Governor of Ohio specifically for this duty (ORC 4723.02). Eight of the members are to be RNs. Of these, at least two of the RNs are advanced practice. Of the five remaining positions on the board, four of those seats are reserved for LPNs, with the last remaining seat being occupied by what is referred to as a 'consumer interest' representative (ORC 4723.02).
Each of the LPN and RN members are required to meet certain minimum standards. Each must be a graduate of an approved nursing education program and hold a current nursing license in the state of Ohio. Board members must have actively practiced for the five years immediately before being selected for a position on the Board of Nursing.
That odd man out, the single citizen consumer interest representative, is forced to meet requirements that, in many ways, are the opposite of the nurses seated on the board. The consumer representative is not required to be a member of any healthcare profession. Neither may they or anyone in their family be employed in healthcare. As a further requirement, there can be no financial association related to financing or delivering health-related items or services.
This group composing the Board of Nursing is charged with administering and enforcing the NPA and is equipped with an array of clearly defined powers, duties, and responsibilities.
No one is allowed to practice a nursing profession in Ohio without a license from the Ohio Board of Nursing. This includes RN, LPN, CRNA, CNS, CNM, CNP, APRN (ORC, 4723.03).
A NPA defines the conditions under which a person can be called by the professional title "nurse" (ORC, 4723.01). To be known as a nurse in Ohio, an application must be presented to the state Board of Nursing (ORC 4723.09). This application will serve as a request to take the licensing examination. (We will discuss transferring out-of-state licenses into Ohio later). For a fee, determined by the board, the application for examination follows a process described in the NPA that will determine if the educational program you have attended meets the minimum level acceptable for your requested credential. A criminal record background check is also conducted, and a testing date and location assigned. Once the testing is completed, a discipline specific license is issued by the board, along with instructions on how to maintain current licensure through a board approved continuing education courses.
Nurses who possess active licenses outside of Ohio who are requesting an Ohio nursing license, known as by licensure by endorsement, may apply to the board to grant them Ohio licensure. Ohio's board of nursing is willing to grant endorsement provided:
Foreign born applicants seeking a nursing license in the state of Ohio that possess licensure out of the country are required to provide proof that they have passed the Test of English as a Foreign Language.
Don't despair. A 180-day temporary permit to practice nursing is available to those who are having trouble getting their documentation together as long as they have a current license from a recognized state or national nursing board. However, do not get complacent either. You can only be issued that temporary permit once.
APRN licensure includes prescriptive authority for all CNPs, CNSs, and CNMs who meet the requirements.
The Legislature in each state may set in place rules and standards separate from any professional organization. For health professionals, the acts they may or may not do (as well as a minimum standard for measuring professional competency) are defined by the state in which they choose to practice or be employed.
The NPA intent is to protect the public from unsafe practitioners, with the ultimate goal of competent, quality nursing care provided by qualified practitioners. The NPA also protects you, the nurse, by defining what is and what is not a responsibility or duty required from you!
In Ohio, RNs are expected to provide nursing care in a manner defined by the Board of Nursing, as stipulated within the NPA. What is expected, at a minimum, is composed of the following (ORC, 4723.01 (B)-(D)):
Duties that RNs are expected to complete within a "timely manner" include the following:
When it is necessary to clarify an order, the RN is expected to (promptly) consult with an appropriate licensed practitioner. If a decision is made not to follow the direction to administer the medication or treatment as ordered, it is up to the RN to notify the prescribing practitioner (again promptly) and document the notification along with the reason for not following the order. The most important thing, however, is the mandate to take action as needed to ensure the safety of the client.
A RN must report or consult whenever necessary with other members of the health care team, as well as make referrals if that seems appropriate. While doing so, care must be taken to maintain client confidentiality and limit the communication of nonessential information to other health professionals as much as possible. What would be optimal is to involve the client by allowing consent decisions regarding what information may be communicated to others. This includes the use of written consent permissions in all circumstances appropriate for their use.
It is expected that RNs practicing in Ohio maintain acceptable standards of safe nursing care in the areas of observation, advice, instruction, teaching, or evaluation. They are also expected to communicate information acceptably within the standards of safe nursing care. This includes identifying their title to the person with whom they are communicating.
When providing direction to an LPN, it is up to the RN to first assess:
The eternal question "Vocational vs. Practical" is answered by the Ohio NPA. In Ohio, the title is LPN.
The practice of an LPN means providing care to individuals and groups requiring the application of basic knowledge of the biological, physical, behavioral, social, and nursing sciences. The LPN practices at the direction of an RN, physician, physician assistant, dentist, podiatrist, optometrist, or chiropractor.
In Ohio, an LPN is expected to function within the limits of practice set out by the Ohio Revised Code as well as by any rules by the Board of Nursing, applicable laws, rules, and professional standards (ORC, 4723.01 (B)-(D)).
It is an expectation that current knowledge of duties, responsibilities, and accountabilities necessary for safe nursing practice be maintained and that an LPN can demonstrate competence and accountability in the care that they deliver. LPNs are also expected to possess the skills necessary to recognize, refer, seek consultation, or implement interventions that may be needed to handle complications that may arise.
In the state of Ohio, it is expected that an LPN will, promptly, complete the following:
Clarification for an order or direction requires a timely consultation with an appropriate licensed practitioner and notification of the prescribing practitioner should the LPN decide not to follow the direction or administer the medication or treatment as prescribed. Following administration, document that the practitioner was notified of the decision and the reason for that decision. Above all, the LPN is expected to act when needed to ensure the safety of the client.
An LPN is expected to report to and consult with other nurses or members of the health care team promptly. They are also expected to make referrals for the client as appropriate. When discussing client information with other health providers, the LPN must maintain client confidentiality to the greatest extent possible. The client has the right to give or withhold consent regarding the release of information. This includes the use of written consent when appropriate or in all circumstances identified by law.
In those instances, in which an LPN is directed to observe, advise, instruct, or evaluate the performance of a nursing task, they are expected to use acceptable standards of safe nursing care as a basis. Any information they communicate should be within the acceptable standards of safe nursing care.
In Ohio, the NPA recognizes that nurses can be found everywhere, doing many different tasks at all levels of care. For that reason, it has specifically addressed the standards it expects from advance practice registered nurses (ORC 4723.01 (G)-(J)):
Before beginning practice, a standard care arrangement shall be entered into with each physician or podiatrist with whom the certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist collaborates. The standard care arrangement can be revised to add or delete a physician or podiatrist within that employment setting instead of making a new arrangement. A new standard care arrangement is needed when the nurse is employed in a different setting and engages in practice with different collaborators. The collaborating physician's or podiatrist's practice must be the same or similar to the nurse's practice (ORC 4723.431).
A standard care arrangement includes at least (ORC 4723.431 (B)):
Quality assurance provisions (ORC 4723.50):
The most current copy of the standard care arrangement, and any legal authorization signed by a physician must be available upon request at each site where the practice of the occurs. Upon request of the board, the nurse must provide a copy of the standard care arrangement to the board. Retain copies of previously effective standard care arrangements for three years.
When a hospital negotiates a standard care arrangement, the review and approval of the standard care arrangement must be following the policies and procedures of the hospital governing body and the bylaws, policies, and procedures of the hospital medical staff.
A nurse must notify the board of the identity of a collaborating physician or podiatrist any change in the name and business address of a collaborating physician or podiatrist within 30 days.
A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner may prescribe any drug or therapeutic device in any form or route of administration if:
An advanced practice registered nurse may delegate the administration of medication to an unlicensed person. Before delegating this authority, the APRNs with prescriptive authority is required to assess the patient, determine that the drug is appropriate for the patient, and determine that the person to whom the authority will be delegated has met the conditions (ORC 4723.489).
An APRN with prescriptive authority has many requirements and limitations. These include:
The exclusionary formulary is on the Board website at nursing.ohio.gov/practice-resources/prescribing-resources/ (ORC 4723.431 (E) and ORC 4731.27).
Morphine equivalent daily dose (MED) means a conversion of various opioid analgesics to a morphine equivalent dose by the use of accepted conversion tables provided by the state board of pharmacy at www.ohiopmp.gov/MED_Calculator.aspx.
No person shall employ or direct an LPN to perform an IV therapy procedure without first verifying that the LPN is authorized by the board to perform IV therapy.
LPNs in Ohio may be eligible for intravenous (IV) therapy privileges after licensure in the state.1,2 If this is desired, they must demonstrate successful completion of a Board-approved course of study in the safe performance of IV therapy. The laws for IV therapy by LPNs are very specific. In this section, the term authorized LPN applies to LPNs authorized by the board to perform IV therapy.
There are special requirements for LPNs to perform IV therapy procedures (ORC 4723.18).
When an authorized LPN is delegated an IV therapy procedure, an RN shall be readily available at the site where the IV therapy is performed. Before the LPN initiates the IV therapy, the RN shall personally perform an on-site assessment of the adult patient who is to receive the IV therapy.2
An LPN shall not initiate or maintain any of the following:
An LPN shall not initiate IV therapy in any vein, except that an IV-authorized LPN may initiate IV therapy in a vein of the hand, forearm, or antecubital fossa.
An LPN cannot perform any of the following procedures:
Any LPN may perform on any person some IV therapy procedures without receiving authorization to perform IV therapy from the board of nursing if both of the following apply:
The IV therapy procedures that any LPN may perform are limited to the following:
At the direction of a physician or a RN, an authorized LPN may perform the following activities to perform dialysis:
Many states require proof of ongoing professional learning as a condition for gaining and renewing a license to practice nursing in their jurisdiction. As an example, we will look at the continuing professional education expectations as outlined in the Ohio NPA.
License renewal for nurses in Ohio is on a two-year cycle.
Every two years, nurses must complete and possess documentation that they have completed 24 contact hours of continuing education, one hour of which must be a category A level training. For APRNs, at least 12 of the 24 contact hours must include continuing education in advanced pharmacology (ORC 4723.24).
For those who come to a renewal date after holding an Ohio licensure for one year or less, there is a lessened expectation of 12 contact hours of continuing education. If an individual has held an Ohio license for more than one year, they are held to the higher renewal standard of 24 hours.
Each applicant for renewal must attest that they have completed the required number and levels of continuing education within the two-year time window. Documented evidence of completion must be available on request by the board. Should evidence of completion be lacking and the applicant fails to provide proof to the board before the end of the renewal period, the license will lapse (ORC 4723.14).
To reactivate or reinstate a lapsed license the nurse applicant will need to complete 24 contact hours of continuing education, with one of the hours being a category A, and possess documentation that completion occurred during the 24-month period immediately before their reapplication date.
Reactivation of Lapsed License (ORC 4723.07 (G)-(P)).
Applicant must complete 24 contact hours during the 24 months immediately before the application date.
If the license of a RN or LPN:
Then the continuing education shall be 24 contact hours of continuing education that includes one hour of category "A."
If the license of a RN or LPN:
Then the continuing education must consist of 24 contact hours and must include all of the following:
It is an assigned duty for the board to investigate evidence that appears to show a violation has occurred (ORC 2743.28). The NPA spells out the process by which the board investigates evidence having the appearance that a licensee or certificate holder has failed to practice following acceptable standards of safe practice. Once the evidence has been gathered, a review by the board determines wrongdoing, lack of wrongdoing, or the presence of a deficiency in practice without actual harm or risk of imminent serious harm (ORC 4723.28).
Powers held by the board include the ability to (ORC 4723.02):
Disciplinary proceedings that take place after an investigation may appear before a hearing examiner, or they may be resolved by a consent agreement. When findings indicate that an individual's practice is substandard yet not posing a serious risk, the board can recommend participation in the state guided practice intervention and improvement program (PIIP) rather than formal disciplinary action.
During the investigation, the board can compel the subject of the investigation to submit to a mental or physical examination.
If the board finds that an individual is impaired, the individual may have to submit to care, counseling, or treatment, as a condition for initial, continued, reinstated, or renewed authority to practice.
The individual shall be allowed to demonstrate to the board that the individual can begin or resume the individual's occupation in compliance with acceptable and prevailing standards of care under the provisions of the individual's authority to practice.
Not all reasons for discipline are major violations. The board oversees all aspects of nursing practice within the area of its jurisdiction and may choose to investigate and discipline such things as reports of:
Activities that may result in disciplinary action (ORC 4723.28):
Scenario/situation/patient description:
Intervention/strategies:
Discussion of outcomes:
Strengths and weaknesses of the approach used in the case:
The NPA is the definition set by a state for what a nurse is and what requirements they must meet to practice within that state. The NPA is put in place for the protection of the public. When we seek initial licensure or renewal of license from a state, we agree to practice our profession in such a manner as to meet or exceed the level of care that they have set for us.
In Ohio, we have seen an example of a well-crafted NPA. An Act that recognizes the many functions, and levels at which a professional nurse might practice. Recognition of professional nursing practice, in particular, as a specific and special means for the provision of nursing care, indicates an understanding of what nurses are, and what nurses do.
Do you know what you are supposed to be? What you are allowed to do?
You may. Yet, I challenge you to take that extra step to be sure. Read YOUR NPA! You may be surprised by what you find there. Just maybe, at some time to come, you might be very glad you took the time to find out what your state expects of you!
Ohio Revised Code. Chapter 4723. Nurses. Accessed February 13, 2020. Visit Source.
