Ohio Nurse Practice Act: 1 Hour Category A

Are you a nurse? How do you know? Only when you pick up the Nurse Practice Act (NPA) written by the state legislature of the state where you are applying for licensure can you know if you meet the specific definition of who may go by the title of nurse.

Each state governing body has the duty and obligation to its citizens to :

• Define who may be called a nurse.
• Define the process for achieving and maintaining that title.
• Determine what a nurse may or may not do.
• Outline to whom they are responsible.
• Determine appropriate corrections for those who fail to comply with state NPA and how they 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 complying 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 and professional practice guidelines.

Maybe it is time to dust off your copy of the NPA you have sworn to follow. An application for professional licensure with acceptance is a legally binding contract to uphold your practice to the level mandated by the 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. Nurses can only function properly if they know their state's current regulations and governing practices. To find the NPA, go to the State of Ohio Board of Nursing web page to access the most recent copy here.

The goal is safety. The NPA is Chapter 4723 of the Ohio Revised Code (ORC). The ORC are statutes that aim to protect the public from unsafe care by ensuring that a minimum set of requirements are met and maintained by those whose practice in the area the state defines as nursing. An adjunct document is the Ohio Administration Code (OAC) Chapters 4723-1 through 4723-27 and Chapter 4743 Standards for Telehealth Services (ORC 4723.431, 2023a). The OAC is a set of rules that assist in implementing and interpreting the ORC.

The Ohio Board of Nursing is the administrative agency that implements and interprets 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 legislators, who listen to suggestions from the board, professional organizations, legal counsel, and the citizens of Ohio. In the end, however, the state legislature determines the content 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 its rulings and how to appeal or question its decisions.

The Ohio Board of Nursing is composed of thirteen members, selected by the Governor of Ohio specifically for this duty (ORC 4723.2, 2017b). Eight of the members are to be RNs. Of these, at least two of the RNs are in advanced practice. Four of the five remaining positions on the board are reserved for LPNs, with the last remaining seat being occupied by what is referred to as a ‘consumer interest’ representative (ORC 4723.2, 2017a).

Each of the LPN and RN members is required to meet specific minimum standards. Each must have graduated from an approved nursing education program and hold a current nursing license in Ohio. Board members must have actively practiced for 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, nor may they or anyone in their family be employed in healthcare. As a further requirement, no financial association can be related to financing or delivering health-related items or services.

This group, 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. Their terms of office are four years, commencing on the first day of January and ending on the thirty-first day of December (ORC 4723.02, 2017a).

No one can practice nursing in Ohio without a license from the Ohio Board of Nursing. This includes RN, LPN, CRNA, CNS, CNM, CNP, and APRN(ORC 4723.03, 2017b).

The NPA defines the conditions under which a person can be called by the professional title “nurse” (ORC 4723.01, 2023b). To be known as a nurse in Ohio, an application must be submitted to the state Board of Nursing (ORC 4723.09, 2023c). This application will serve as a request to take the licensing examination. (We will discuss transferring out-of-state licenses in 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 are assigned. Once the testing is completed, the board issues a discipline-specific license, along with instructions on how to maintain current licensure through board-approved continuing education courses.

Nurses who possess active licenses outside of Ohio and request an Ohio nursing license, known as 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
• This will also include 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, 2023c)

Foreign-born applicants seeking a nursing license in Ohio who possess licensure outside of the country must provide proof that they have passed the Test of English as a Foreign Language(ORC 4723.11, 2023d).

Don’t despair. A 180-day temporary permit to practice nursing is available to those 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 (ORC 4723.09, 2023c).

APRN licensure includes prescriptive authority for all CNPs, CNSs, and CNMs who meet the requirements (ORC 4723.481, 2023e).

The Legislature in each state may establish 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's intent is to protect the public from unsafe practitioners and to provide competent, quality nursing care by qualified practitioners. The NPA also protects you, the nurse, by defining what is and is not a responsibility or duty required from you.

In Ohio, “registered nurse” means an individual who holds a current, valid license under the Ohio NPA that authorizes the practice of nursing as a registered nurse (RN) (ORC 4723.01, 2023b). Registered nurses 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, 2023b):

1. Maintenance of current knowledge of the duties, responsibilities, and accountabilities required for safe nursing practice.
2. The ability to demonstrate competence and accountability in all practice areas. This includes, but is not limited to, the following:
   • Consistent performance in all aspects of nursing care
   • Identifying patterns of human responses to actual or potential health problems amenable to a nursing regimen
   • Executing a nursing regimen through the selection, performance, management, and evaluation of nursing actions
   • Assessing health status for the purpose of providing nursing care
   • Providing health counseling and health teaching
   • Administering medications, treatments, and executing regimens authorized by an individual who is licensed to practice in this state and is acting within the course of the individual’s professional practice
   • Prevent, restore, and promote health activities
   • 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 

An RN must report or consult with other members of the health care team whenever necessary and make referrals if 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 using written consent permissions in all circumstances appropriate for their use.

RNs practicing in Ohio are expected to maintain acceptable standards of safe nursing care in observation, advice, instruction, teaching, or evaluation. They are also expected to communicate information acceptably within these standards. 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

The eternal question of “Vocational vs Practical” is answered by the Ohio NPA. In Ohio, the title is Licensed Practical Nurse (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 under 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, any rules by the Board of Nursing, applicable laws, rules, and professional standards (ORC 4723.01, 2023b).

It is expected that LPNs maintain current knowledge of duties, responsibilities, and accountabilities necessary for safe nursing practice and can demonstrate competence and accountability in the care 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, valid, or 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, current, valid, or 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 healthcare team members 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 using 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.

There are special requirements for LPNs to perform IV therapy procedures (ORC 4723.18, 2023f). 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. 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 an 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(ORC 4723.18, 2023f):

1. Discontinuing a central venous, arterial, or any other line that does not terminate in a peripheral vein.
2. Initiating or discontinuing a peripherally inserted central catheter.
3. Mixing, preparing, or reconstituting any medication for IV except that an IV-authorized LPN may prepare or reconstitute an antibiotic additive.
4. Administering medication via the IV route, including all the following activities:
   1. Adding medication to an IV solution or an existing infusion except that an IV authorized LPN may 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% and sterile water.
   2. Hang subsequent containers of the IV solutions, vitamins, or electrolytes if an RN initiated the infusion of that same IV solution.
   3. Initiate or maintain an IV piggyback infusion containing an antibiotic additive.
   4. 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.
   5. 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.
   6. 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 an RN or a licensed physician, dentist, optometrist, or podiatrist. The RN or a licensed physician, dentist, optometrist, or podiatrist is on the premises where the procedure will 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 an 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 intermittent injection of a dose of medication for dialysis that is administered via the hemodialysis blood circuit and through the patient’s venous access point.

Ohio joined the Nurse Licensure Compact (NLC) on January 1, 2023, allowing nurses (RNs and LPNs only) who hold a valid, unrestricted license in Ohio to practice virtually or over state lines in the 40 other compact states across the country without obtaining additional licenses. The multi-state license is like having a driver’s license in that it is recognized across state lines (NLC, 2024).

Kelly is an advanced practice registered nurse who was contracted by a hospital system in Cleveland, Ohio, to complete yearly physicals for clients within their healthcare system. Kelly lives in Missouri and holds an unrestricted multi-state registered nurse license in her home state. She knows that she can use her Missouri multi-state license for registered nursing as a basis for applying for an Ohio APRN license.

In Ohio, the NPA recognizes that nurses can be found everywhere, doing many different tasks at all levels of care. Therefore, it has specifically addressed the standards expected from advanced practice registered nurses (OAC 4723-7-08, 2024). These standards apply to the following titles:

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

Ohio is a reduced-practice state for nurse practitioners, meaning that 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 practices 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, 2021) and must be authorized to practice in Ohio. The agreement is renewed annually. The Ohio Board of Nursing does not need to approve the agreement but may review it for compliance.

A standard care arrangement includes at least (ORC 4723.431, 2021):

• Criteria for referral of a patient by the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner to a collaborating physician or podiatrist or another physician or podiatrist
• A process for the clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner to obtain a consultation with the collaborator
• A plan for coverage in instances of emergency or planned absences
• A process for resolution of disagreements regarding matters of patient management between the clinical nurse specialist, certified nurse-midwife, certified nurse practitioner a collaborating physician or podiatrist, or another physician or podiatrist

Quality assurance provisions (ORC 4723.50, 2023g):

• When the APRN is prescribing medications, the collaborative physician or podiatrist must be within an acceptable travel time between their location and the APRN’s location.
• 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 APRN's practice occurs. Upon the board's request, the nurse must provide a copy of the standard care arrangement and 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 arrangement must follow the hospital governing body's policies and procedures and the hospital medical staff's bylaws, policies, and procedures. The nurse must notify the board within 30 days of the identity of a collaborating physician or podiatrist and any change in the name and business address of a collaborating physician or podiatrist.

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 (ORC 4723.481, 2023e):

1. The ability to prescribe the drug or therapeutic device is within the scope of the 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, 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 (APRN) with prescriptive authority may delegate medication administration to an unlicensed person. Before delegating this authority, the APRN must 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, 2017c).

An APRN with prescriptive authority has many requirements and limitations. These include:

• Limitation on prescribing Schedule II controlled substances(ORC 4723.481, 2023e).
• Limitation on prescribing controlled substances.
• Limitation on the delegation to administer medication (ORC 4723.431, 2021).
• 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(OBN, n.d.).

The Ohio Automated RX Reporting System is a resource available to APRNs by the State of Ohio Board of Pharmacy. The Morphine equivalent daily dose (MED) helps to calculate a client’s opioid intake (OARxRS, n.d). The MED is used to convert various opioid analgesics to a morphine equivalent dose using accepted conversion tables provided by the state board of pharmacy. The calculator can be found here.

Ohio Administrative Code, Rule 4723-7-08 (OAC 4723-7-08, 2024), went into effect February 1, 2024, requiring all individuals who hold a certificate or license issued by the Ohio Board of Nursing (OBN) to “report a misdemeanor, felony conviction, guilty plea, a judicial finding of guilt resulting from a plea of no contest or a judicial finding of eligibility for a pretrial diversion or similar program, or for intervention in lieu of conviction within 30 days to the OBN.”

Many states require proof of ongoing professional learning as a condition for gaining and renewing a license to practice nursing in their jurisdiction. We will examine the continuing professional education expectations 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 directly related to the statutes and rules pertaining to the practice of nursing in the state of Ohio. For APRNs, at least 12 of the 24 contact hours must include continuing education in advanced pharmacology (ORC 4723.24, 2017d).

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 contact 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 4723.24, 2017d).

To reactivate or reinstate a lapsed license, the nurse applicant must complete 24 contact hours of continuing education and possess documentation that completion occurred during the 24 months immediately before their reapplication date (ORC 4723..07, 2023h; ORC 4723.24, 2017d).

The applicant must apply to the Ohio State Board of Nursing for license reactivation or reinstatement. The applicant must report any conviction, pleas, or judicial finding regarding a criminal offense that constitutes grounds for the board to impose sanctions under section 4723.28 of the Revised Code. Twenty-four hours of continuing education must have been completed within the last two years of license reactivation.  One hour of continuing nursing education must be directly related to the statutes and rules of nursing practice within Ohio (ORC 4723.24, 2017d).

If more than five years have passed since the nursing license was active, the applicant must submit a request to the Bureau of Criminal Identification and Investigation for a criminal records check and a check of Federal Bureau of Investigation records (ORC 4723.091, 2024). Applying for license reactivation must be done on forms specifically provided by the Ohio State Board of Nursing.

It is an assigned duty for the board to investigate evidence that appears to show a violation has occurred (ORC 4723.28, 2023i). The NPA spells out the process by which the board investigates evidence having the appearance that a license or certificate holder has committed fraud, misrepresentation, or depiction in applying for or securing a license or 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, 2023i).

Powers held by the board include the ability to (ORC 4723.28, 2023i):

• Deny, revoke, suspend, or place restrictions on any nursing license
• Reprimand or otherwise discipline a holder of a nursing license
• 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 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 to submit to a mental or physical examination (ORC 4723.28, 2023i). Failure to submit to a mental or physical examination when directed constitutes an admission of guilt. 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 (ORC 4723.28, 2023i).

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, 2023i)
• Reports of a nurse supplying more than a 72-hour quantity of sample medications or therapeutic devices (ORC 4723.481, 2023e)

Activities that may result in disciplinary action include (ORC 4723.28, 2023i):

1. Fraud in passing an examination required to obtain a license or certificate.
2. Working with an expired or suspended license.
3. The practice of nursing or a dialysis technician, having failed to renew a nursing license.
4. Conviction of:
   • A plea of guilty to a judicial finding of guilt.
   • A judicial finding of guilt resulting from a plea of no contest.
   • A judicial finding of eligibility for a pretrial diversion or similar program of intervention instead of conviction for a misdemeanor committed during practice.
   • A felony.
   • A crime of immorality or moral turpitude.
5. Selling, giving away, or administering drugs or therapeutic devices for other than legal and legitimate therapeutic purposes.
6. Violating any municipal, state, county, or federal drug law.
7. An act in another jurisdiction that would constitute a felony or a crime of moral turpitude in Ohio.
8. An act during practice in another jurisdiction that would constitute a misdemeanor in Ohio.
9. Illegal drug use.
10. Impairment of the ability to practice according to acceptable and prevailing standards of care due to:
    • Habitual or excessive use of drugs or substances.
    • Use of drugs, alcohol, or other chemical substances.
    • A physical or mental disability.
11. Assaulting or causing harm to a patient or depriving a patient of the means to summon assistance.
12. Stealing anything of value.
13. Adjudication by a probate court of being mentally ill or mentally incompetent.
14. Violation of any restrictions placed by the board on a nursing license or dialysis technician certificate.
15. Failure to use universal and standard precautions.
16. Failure to practice following acceptable and prevailing standards of safe care.
17. Exceeding practice standards.
18. Aiding and abetting a person in that person’s practice without a license or certificate.
19. A nurse waiving the payment of all or any part of the bill to entice patients.
20. Failure to comply with:
    • Substance use disorder monitoring program.
    • Practice intervention and improvement program.
21. 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.
22. Prescribing any drug or device to perform or induce an abortion.
23. Failure to establish and maintain professional boundaries with a patient.
24. 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.
25. Assisting suicide.
26. Failure to comply with the requirements before issuing a minor a prescription for an opioid analgesic.
27. Failure to comply with the state Board of Pharmacy database unless the state Board of Pharmacy no longer maintains a drug database (ORC 4723.75, 2019).
28. Revocation, suspension, restriction, reduction, or termination of clinical privileges.
29. Termination or suspension of a certificate of registration to prescribe drugs.

In response to the COVID-19 pandemic, the Ohio Revised Code was updated to allow synchronous or asynchronous technology to provide services within the professional’s scope of practice (ORC 4723.09, 2023a). Telehealth services are defined as the use of technology by the healthcare professional to provide services to a patient at a site other than the provider's location. The standard of care for such services must be equal to the standard of care for in-person services. When a patient consents to receiving telehealth services, the healthcare provider is not liable for damages under any claims made that the services provided do not meet the same standard of care that would apply if the service was provided in person.

When prescribing a schedule II-controlled substance, an initial in-person visit is required; however, if the patient is receiving palliative or hospice care, this requirement is waived. The requirement is also waived for a patient who meets any of the following: medication-assisted treatment or any other medication for opioid-use disorder, who is a patient with a mental health condition, or who, as determined by the clinical judgment of a health care professional, is in an emergency (ORC 4723.09, 2023a). It should be noted that medical marijuana is not considered a Schedule II controlled substance (ORC 4723.09, 2023a).

Telehealth services may be denied, and the healthcare professional may require the patient to attend in-person visits only. If the client is present in another state, Ohio allows the healthcare provider to complete the visit if it is permitted by the laws of the state in which the patient is located.

Sarah, a Registered Nurse (RN) with five years of experience in a busy medical-surgical unit at a large urban hospital, is known for her excellent clinical skills and compassionate patient care. She recently encountered a situation that required careful consideration of delegation practices, particularly involving peripheral intravenous (IV) therapy.

Scenario:

Sarah's unit was experiencing a particularly hectic shift. The patient census was high, and the complexity of patient needs required efficient task management and delegation. One of Sarah's patients, Mr. Johnson, was admitted with severe dehydration and required immediate IV fluid therapy. At the same time, several other patients needed urgent care.

After doing an initial assessment of Mr. Johnson, Sarah recognized the need to manage her time effectively and decided to delegate the task of starting Mr. Johnson's peripheral IV to Lisa, a Licensed Practical Nurse (LPN) on her team. Lisa has been an LPN for three years and is certified in IV therapy, a skill she frequently utilizes.

Considerations for Delegation:

Sarah's decision to delegate the IV therapy to Lisa involved several critical considerations:

Scope of Practice:

RN Scope: As an RN, Sarah is responsible for the overall assessment, planning, and evaluation of patient care. She can delegate tasks but must ensure they are within the LPN's scope of practice.

LPN Scope: LPNs can perform peripheral IV therapy if they have received the necessary training and certification. Lisa meets these criteria, enabling her to start and manage IVs under RN supervision.

Competence and Experience:

Through her certification and experience, Lisa has demonstrated competence in IV therapy. Sarah has observed Lisa's proficiency in this area, reinforcing her confidence in delegating this task.

Patient Safety and Outcome:

Sarah ensured that delegating the IV therapy would not compromise patient safety. She considered Mr. Johnson's condition and recognized that timely IV therapy was crucial. Given Lisa's skills, Sarah trusted that the task would be performed safely and effectively.

Supervision and Support:

Sarah provided clear instructions to Lisa, outlining the specifics of the IV therapy needed for Mr. Johnson. She remained available for consultation and supervision, ready to step in if complications arose.

Execution:

Lisa approached Mr. Johnson to explain the procedure and ensure his comfort. She skillfully inserted the IV catheter and initiated the fluid therapy per the doctor's orders and Sarah's instructions. Lisa monitored Mr. Johnson for any adverse reactions throughout the process, ensuring the IV therapy progressed smoothly.

Sarah checked in regularly to oversee the procedure, verifying that everything was proceeding according to plan. She praised Lisa for her competence and thanked her for her assistance, reinforcing a collaborative and supportive team environment.

Outcomes:

The delegation of IV therapy to Lisa resulted in several positive outcomes:

Timely Patient Care. Mr. Johnson received the necessary IV fluids promptly, improving his condition and stabilizing his vital signs.

Efficient Workload Management. By delegating the task, Sarah managed her workload more effectively, allowing her to attend to other critical patient needs without delay.

Enhanced Team Collaboration. The successful delegation reinforced trust and collaboration between Sarah and Lisa, promoting a positive working relationship and mutual respect.

Professional Development. Lisa gained further confidence in her IV therapy skills and appreciated Sarah's trust in her, which contributed to her professional growth.

Case Study Conclusion:

This case study highlights the importance of thoughtful delegation in nursing practice. By considering the scope of practice, competence, patient safety, and supervision needs, Sarah successfully delegated IV therapy to Lisa, resulting in improved patient care and effective teamwork. This scenario underscores the critical role of delegation in optimizing nursing workflows and enhancing patient outcomes.

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 as a specific and special means for the provision of nursing care indicates an understanding of what nurses are and what nurses do.

• Nurse Licensure Compact (NLC). (2024). About the NLC. Nurse Licensure Compact. Visit Source.
• Ohio Administrative Code (OAC). (2019). Ohio Administrative Code, Rule 4723-4-03 Standards relating to competent practice as a registered nurse. Visit Source.
• Ohio Administrative Code (OAC). (2024). Ohio Administrative Code, Rule 4723-7-08 Reporting a misdemeanor or felony. Visit Source.
• Ohio Automated Rx Reporting Systems (OARxRS). (n.d.). Med Calculator Prescription History. Visit Source.
• Ohio Board of Nursing (OBN). (n.d). Exclusionary Formulary for APRN Prescribers. Visit Source.
• Ohio Revised Code (ORC). (n.d.). Ohio Revised Code, § 4723 Nurses. Visit Source.
• Ohio Revised Code (ORC). (2017a). Ohio Revised Code, § 4723.02 Board of Nursing. Visit Source.
• Ohio Revised Code (ORC). (2017b). Ohio Revised Code, § 4723.489 Delegated authority to administer drugs. Visit Source.
• Ohio Revised Code (ORC). (2017c). Ohio Revised Code, § 4723.24 License or certificate renewal; notice of change of address. Visit Source.
• Ohio Revised Code (ORC). (2019). Ohio Revised Code, § 4729.75 Drug database may be established by board of pharmacy. Visit Source.
• Ohio Revised Code (ORC). (2021). Ohio Revised Code, § 4723.431 Standard care arrangements. Visit Source.
• Ohio Revised Code (ORC). (2023a). Ohio Revised Code § 4743.09 Standards for telehealth Services. Visit Source.
• Ohio Revised Code (ORC). (2023b). Ohio Revised Code, § 4723.01 Nurse definitions. Visit Source.
• Ohio Revised Code (ORC). (2023c). Ohio Revised Code, § 4723.09 License application. Visit Source.
• Ohio Revised Code (ORC). (2023d). Ohio Revised Code, § 4723.11 Nurse licensure compact. (2023). Visit Source.
• Ohio Revised Code (ORC). (2023e). Ohio Revised Code, § 4723.481 Authority of A.P.R.N. designated as clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner to prescribe drugs and therapeutic devices. Visit Source.
• Ohio Revised Code (ORC). (2023f). Ohio Revised Code, § 4723.18 Administration of adult in intravenous therapy. Visit Source.
• Ohio Revised Code (ORC). (2023g). Ohio Revised Code, § 4723.50 Administrative rules for prescribing drugs and therapeutic devices. Visit Source.
• Ohio Revised Code (ORC). (2023h). Ohio Revised Code, § 4723.07 Administrative rules. Visit Source.
• Ohio Revised Code (ORC). (2023i). Ohio Revised Code, § 4723.28 Disciplinary actions. Visit Source.
• Ohio Revised Code (ORC). (2024). Ohio Revised Code, § 4723.091 Request for criminal records. Visit Source.