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Ohio Nurse Practice Act: 1 Hour Category A

1 Contact Hour
Approved for nurses currently licensed in Ohio.
This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Registered Nurse (RN)
This course will be updated or discontinued on or before Wednesday, July 20, 2022

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

This nursing continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91) ONA#2020-0000000404
Outcomes

≥ 90% of will know the Ohio Nurse Practice Standards.

Objectives

At the completion of this module, the learner will be able to:

  1. Discuss the application process to be a licensed nurse in Ohio.
  2. Discuss established standards of nursing practice in Ohio.
  3. Discuss the Ohio Board of Nursing provisions for LPN intravenous therapy.
  4. Define the steps for renewal of a license.
  5. List two potential results that might occur as a result of disciplinary action to a nurse in Ohio.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Introduction

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:

  • Define who may be called a nurse
  • What the process is for achieving and maintaining that title
  • What a nurse may or may not do
  • To whom they are responsible
  • How correction of those who fail to comply with the state NPA will be applied

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/.

State Governing Body Duty and Obligation

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.

Application for Licensure

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:

  • A clean criminal and disciplinary action background check comes back
  • The applicant provides proof of graduation from an education program approved either by Ohio or a fellow member of the national council of state boards of nursing
  • Along with documentation of completion of at least two contact hours of continuing education directly related to the laws and rules that govern the practice of nursing in Ohio (ORC 4723.09)

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.

Ohio Standards of Practice

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!

Registered Nurse Standards

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)): 

  • Maintenance of current knowledge in the areas of duties, responsibilities, and accountabilities required for safe nursing practice
  • The ability to demonstrate both competence and accountability in all the areas of practice. This includes, but is not limited to the following:
    • Consistent performance in all aspects of nursing care
    • The ability to assess health status to provide nursing care
    • Health counseling and teaching abilities
    • Skills for safe administration of medications/treatments and executing regimens appropriate for a nurse's professional practice
    • The ability to teach, administer, supervise, delegate, and evaluate nursing practice
    • The ability to recognize and intervene appropriately and consult or refer when a complication arises

Duties that RNs are expected to complete within a "timely manner" include the following:

  • Implementation of any order for a client unless the RN believes or should have reason to believe the order is:
    • Inaccurate
    • Not properly authorized
    • Not current or valid
    • Harmful or potentially harmful to that client
    • Contraindicated by other documented information
  • Clarify any order for a client when the RN believes or should have reason to believe the order is:
    • Inaccurate
    • Not properly authorized
    • Not current or valid
    • Harmful or potentially harmful to that client
    • Contraindicated by other documented information

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 condition of the client, including their stability
  • The type of nursing care required by the client
  • The complexity and frequency of any nursing care needed
  • The training, skill, and ability of that LPN about their ability to perform specific needed functions or procedures
  • The availability and accessibility of resources needed to perform the specified function or procedure safely

LPN Standards

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:

  • Implement any order or direction for a client unless the LPN believes or should have reason to believe the order is:
    • Inaccurate
    • Not properly authorized
    • Not current or valid
    • Contraindicated by other documented information
  • Obtain clarification for any order or direction for a client when the LPN believes or should have reason to believe the order or direction is:
    • Inaccurate
    • Not properly authorized
    • Not current or valid
    • Contraindicated by other documented information

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.

APRN Standards

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)):

  • Certified nurse midwife
  • Certified nurse practitioner
  • Certified registered nurse anesthetist
  • Clinical nurse specialist

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)):

  • Signatures of each nurse, and collaborator, indicating a review and agreement to abide by the terms
  • The date when the arrangement is initially executed
  • The date of the most recent review of the arrangement
  • The complete name, specialty and practice area, business address, and business phone number or number at which the individual can be reached at any time for all participants
  • A statement of services offered, a certificate to prescribe, and a description of the scope of prescriptive practice
  • A plan for incorporation of new technology or procedures

Quality assurance provisions (ORC 4723.50):

  • Periodic review and reapproval of the standard care arrangement. Criteria for referral of a patient by the nurse to a collaborating physician or podiatrist.
  • Collaborating physician or podiatrist must be within an acceptable travel time between their location and the APRN's location when the APRN is prescribing medications.
  • Other criteria recommended by the committee on prescriptive governance.

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:

  1. The ability to prescribe the drug or therapeutic device is within the scope of practice in the nurse's specialty area
  2. The prescription is consistent with the terms of a standard care arrangement
  3. The prescription would not exceed the prescriptive authority of the collaborating physician
  4. The individual drug or subtype or therapeutic device is not one excluded by the formulary
  5. The prescription meets the requirements of state and federal law
  6. A valid prescriber-patient relationship exists. This relationship may include, but is not limited to:
    1. Obtaining a thorough, relevant history of the patient
    2. Conducting a physical or mental examination of the patient
    3. Rendering a diagnosis
    4. Prescribing medication, ruling out the existence of any recognized contraindications
    5. Consulting with the collaborating physician when necessary
    6. Documenting these steps in the patient's medical records

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:

  • Limitation on prescribing Schedule II controlled substance (ORC 4725.48)
  • Limitation on prescribing controlled substances
  • Limitation on the delegation to administer medication (ORC 4723.489)
  • An exclusionary formulary species
  • Authority may not exceed the prescriptive authority of the collaborating physician or podiatrist.

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.

LPN IV Therapy

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:

  • Blood or blood components
  • Solutions for total parenteral nutrition
  • Any cancer therapeutic medication including, but not limited to, cancer chemotherapy or an antineoplastic agent
  • Solutions administered through any central venous line or arterial line or any other line that does not terminate in a peripheral vein; except that a LPN authorized by the board to perform IV therapy may maintain the solutions specified that are being administered through a central venous line or peripherally inserted central catheter
  • Any investigational or experimental medication

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:

  • Discontinuing a central venous, arterial, or any other line that does not terminate in a peripheral vein
  • Initiating or discontinuing a peripherally inserted central catheter
  • Mixing, preparing, or reconstituting any medication for IV except that an IV authorized LPN may prepare or reconstitute an antibiotic additive
  • Administering medication via the IV route, including all of the following activities:
  • Adding medication to an IV solution or an existing infusion except that an IV authorized LPN may do any of the following:
    • Initiate an IV infusion containing one or more of the following elements: 
      • Dextrose 5% 
      • Normal saline
      • Lactated ringers
      • Sodium chloride 45%
      • Sodium chloride 0.2%
      • Sterile water
  • Hang subsequent containers of the IV solutions vitamins or electrolytes, if a RN initiated the infusion of that same IV solution
  • Initiate or maintain an IV piggyback infusion containing an antibiotic additive
  • Inject medication via a direct IV route, except that an IV authorized LPN heparin or normal saline to flush an intermittent infusion device or heparin lock
  • Change tubing on any line including, but not limited to, an arterial line or a central venous line, except that an IV authorized LPN may change tubing on an IV line that terminates in a peripheral vein
  • Program or set any function of a patient-controlled infusion pump.

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:

  1. The LPN acts at the direction of a RN or a licensed physician, dentist, optometrist, or podiatrist; and the RN, physician, dentist, optometrist, or podiatrist is on the premises where the procedure is to be performed or accessible by some form of telecommunication.
  2. The LPN demonstrates the knowledge, skills, and abilities to perform the procedure safely.

The IV therapy procedures that any LPN may perform are limited to the following:

  • Verification of the type of peripheral IV solution being administered
  • Examination of a peripheral infusion site and the extremity for possible infiltration
  • Regulation of a peripheral IV infusion according to the prescribed flow rate
  • Discontinuation of a peripheral IV device at the appropriate time
  • Performance of routine dressing changes at the insertion site of a peripheral venous or arterial infusion, peripherally inserted central catheter infusion, or central venous pressure subclavian infusion

At the direction of a physician or a RN, an authorized LPN may perform the following activities to perform dialysis:

  • The routine administration and regulation of saline solution to maintain an established fluid plan
  • The administration of a heparin dose IV
  • The administration of a heparin dose peripherally via a fistula needle
  • The loading and activation of a constant infusion pump or the
  • The intermittent injection of a dose of medication physician for dialysis that is administered via the hemodialysis blood circuit and through the patient's venous access  

License Renewal and Education Requirements

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:

  • Has been inactive or lapsed in Ohio less than two years
  • Or the applicant holds a current, valid license in another jurisdiction

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:

  • Has been inactive or lapsed in Ohio for two years or more
  • And the applicant does not hold a current, valid license in another jurisdiction,

Then the continuing education must consist of 24 contact hours and must include all of the following:

  • Two contact hours of category A with learning outcome that addresses scopes of practice for registered and LPNs, standards of safe practice, and nursing delegation
  • Six contact hours with learning outcome that relates to the application of the nursing process and critical thinking, clinical reasoning, or nursing judgment related to patient care
  • Six contact hours in pharmacology with learning outcome that include drug classifications, medication errors, and patient safety
  • Two contact hours that include learning outcome related to clinical or organizational ethical principles in health care
  • Eight contact hours related to an area relevant to the nurse's practice

Investigation of Complaints

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):

  • Deny, revoke, suspend, or place restrictions on any nursing license or dialysis technician certificate issued by the board
  • Reprimand or otherwise discipline a holder of a nursing license or dialysis technician certificate
  • Impose a fine of not more than five hundred dollars per violation

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:

  • A nurse license holder not using universal and standard infection control precautions
  • Offering to 'waive' client fees/co-payments or otherwise alter billing records as applies to nursing services (ORC 4723.28)
  • Reports of a nurse supplying more than a 72-hour quantity of sample medications or therapeutic devices (ORC 4723.481)

Activities that may result in disciplinary action (ORC 4723.28):

  • Fraud in passing an examination required to obtain a license or certificate
  • Working with an expired or suspended license
  • The practice of nursing or a dialysis technician, having failed to renew a nursing
  • Conviction of:
    • A plea of guilty to, a judicial finding of guilt of
    • A judicial finding of guilt resulting from a plea of no contest
    • A judicial finding of eligibility for a pretrial diversion or similar program or intervention instead of conviction for, a misdemeanor committed during practice
    • A felony
    • A crime of immorality or moral turpitude
  • Selling, giving away, or administering drugs or therapeutic devices for other than legal and legitimate therapeutic purposes
  • Violating any municipal, state, county, or federal drug law
  • An act in another jurisdiction that would constitute a felony or a crime of moral turpitude in Ohio
  • An act during practice in another jurisdiction that would constitute a misdemeanor in Ohio
  • Illegal drug use
  • Impairment of the ability to practice according to acceptable and prevailing standards of safe care due to:
    • Habitual or excessive use of drugs or substances
    • Use of drugs, alcohol, or other chemical substances
    • A physical or mental disability
  • Assaulting or causing harm to a patient or depriving a patient of the means to summon assistance
  • Stealing anything of value
  • Adjudication by a probate court of being mentally ill or mentally incompetent
  • Violation of any restrictions placed by the board on a nursing license or dialysis technician certificate
  • Failure to use universal and standard precautions
  • Failure to practice following acceptable and prevailing standards of safe care
  • Exceeding practice standards
  • Aiding and abetting a person in that person's practice without a license or certificate
  • A nurse waiving the payment of all or any part of the bill to entice patients
  • Failure to comply with:
    • Substance use disorder monitoring program
    • Practice intervention and improvement program
  • APRN failure to:
    • Meet the quality assurance standards
    • Maintain a standard care arrangement
    • Practice following the standard care arrangement
    • Prescribing drugs and therapeutic devices incorrectly
  • Prescribing any drug or device to perform or induce an abortion
  • Failure to establish and maintain professional boundaries with a patient
  • Regardless of whether the contact or verbal behavior is consensual, engaging with a patient other than your partner in any of the following:
    • Sexual contact
    • Verbal behavior that is sexually demeaning to the patient
  • Assisting suicide
  • Failure to comply with the requirements before issuing for a minor a prescription for an opioid analgesic
  • Failure to comply with the state board of pharmacy database
  • Revocation, suspension, restriction, reduction, or termination of clinical privileges
  • Termination or suspension of a certificate of registration to prescribe drugs

Case Study

Scenario/situation/patient description:

  • During morning rounds, Jane RN assessed her patients including stability, nursing care needed, complexity and frequency of care, and availability of unit stock. It is a busy day and one of the staff is an LPN from another unit. Jane does not know the training, skills, or ability of the LPN. Jane would like to delegate some IV responsibilities to this LPN.

Intervention/strategies:

  • Jane called the nurse manager of the unit the LPN came from to identify IV training. The nurse manager is not available. She speaks with the charge nurse who says that LPN is authorized to do IV therapy. The charge nurse does not have the documentation, but has observed the LP performing IV therapy.
  • Jane decided to not delegate any IV therapy to the LPN from another unit except discontinuation of peripheral lines that any LPN can do.

Discussion of outcomes:

  • Jane was busy and could have used the LPN to do IV therapy. But, Jane delegated other tasks to the LPN.
  • Jane could have taken the charge nurse's confirmation that the LPN is authorized for IV therapy. However, Jane does not know the charge nurse and would be more comfortable discussing the situation with the nurse manager who has access to the LPN's competency file. Jane felt she did not have any more time to commit to identifying the LPN's authorization for IV therapy.

Strengths and weaknesses of the approach used in the case:

  • Another 15 minutes of questioning could probably have identified a supervisor or manager who could confirm the LPN’s authorization for IV therapy. Jane did not want to spend any more time on the issue. Had Jane taken the extra time, she could have delegated IV responsibilities that amounted to more than 15 minutes.
  • Delegating the search for authorization for IV therapy to the supervisor or her nurse manager would have been a better use of time.
  • Jane is responsible for knowing the training, skill, and ability of that LPN about their ability to perform specific needed functions or procedures, time was short, and resources were limited. Jane made the safe decision.
  • Jane also knew that resources were available, but accessibility to resources is limited for someone who has not orientated to the unit.

Summation

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!

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)

References

Ohio Revised Code. Chapter 4723. Nurses. Accessed February 13, 2020. Visit Source.

  1. Ohio Board of Nursing. New APRN law: delegation of authority to administration drugs. Momentum. 2015; 4(13). Accessed February 13, 2020. Visit Source.
  2. Ohio Board of Nursing. Administrative rule update. Momentum. 2016; 14(1). Accessed February 13, 2020. Visit Source.