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

2. OBJECTIVE  Identify the parameters of the scopes of practice for RNs, LPNs, and Advanced Practice RNs in the state of Ohio. 2

3. DISCLOSURES  Criteria for Successful Completion: Submit registration and payment, listen to the webinar in its entirety, and complete the evaluation.  Conflict of Interest: There is no conflict of interest for any planner or presenter for this activity.  Provider Statement:  The Ohio Nurses Association (OBN-001-91) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. 3

4. JUST A REMINDER:  ORC is:  OAC is:  The purpose of the Ohio Board of Nursing is: 4

5. SCOPE OF PRACTICE  What do we mean by “scope of practice”?  What does the Ohio Board of Nursing regulate?  What is the difference between OBN Scope of Practice and “Scope and Standards of Practice” documents from professional associations? 5

6. SCOPE OF PRACTICE: RN  4723.01(B) ORC  6 functions of RNs; 5 independent and 1 dependent (1 indirect)  Apply in all settings 6

7. RN FUNCTIONS – 4723.01(B) ORC  Identify patterns of human responses to actual or potential health problems  Select, perform, manage, evaluate nursing actions  Assess health status to provide nursing care 7

8. RN FUNCTIONS – 4723.01(B) ORC  Provide health counseling / teaching  Administer meds, treatments as authorized  Teach, administer, supervise, delegate, evaluate nursing practice 8

9. NURSING PROCESS: RN 4723-4-07 OAC Use clinical judgment to:  Assess  Analyze, including nursing diagnosis  Plan, including desired outcomes consistent with current nursing science  Implement  Evaluate, including progress toward achievement of desired outcomes and revision of nursing diagnosis 9

10. ADVANCED PRACTICE REGISTERED NURSES: CERTIFICATE OF AUTHORITY  Certified registered nurse anesthetist (CRNA)  Clinical nurse specialist (CNS)  Certified nurse midwife (CNM)  Certified nurse practitioner (CNP)  Specific scope of practice statements in 4723.43 (A), (B), (C), (D), ORC 10

11. SCOPE OF PRACTICE: CNP  4723.43(C) ORC  In collaboration with one or more physicians, provide acute (2013), preventive and primary care services and evaluate/promote wellness within the nurse’s specialty. 11

12. SCOPE OF PRACTICE: CNS  4723.43(D) ORC  In collaboration with one or more physicians, provide and manage the care of individuals and groups with complex health problems and provide health services that promote, improve, and manage health care within the nurse’s specialty. 12

13. SCOPE OF PRACTICE: CNM  4723.43(A) ORC:  In collaboration with one or more physicians, provide management of preventive services and primary care services for women antepartally, intrapartally, postpartally, and gynecologically. 13

14. SCOPE OF PRACTICE: CRNA  4723.43(B) ORC:  With the supervision and in the immediate presence of a physician, podiatrist, or dentist – administer anesthesia and perform anesthesia induction, maintenance, and emergence, and may perform with supervision preanesthetic preparation and evaluation, postanesthesia care, and clinical support functions. 14

15. STANDARD CARE ARRANGEMENT  Retained on file where APRN practices  Does not need to be approved by OBN except that board needs have name/address of collaborating physician and must be notified within 30 days when there is a new collaborating physician (2013)  May be reviewed by OBN  Criteria for referral  Process to obtain consultation  Plan for coverage in instances of emergency or absence  Process for resolving disagreements  Procedure for review of referrals and care outcomes 15

16. CERTIFICATE TO PRESCRIBE (CTP)  Initially issued as externship certificate – prescribe with physician supervision – licensure by endorsement exempt (2013)  Follow formulary established by Committee on Prescriptive Governance (CPG)  Renewal requires 12 hours of continuing education in advanced pharmacology 16

17. SCOPE OF PRACTICE: LPN  4723.01(F) ORC  6 functions; apply in all settings  All dependent; act at direction of…  How does this work? 17

18. LPN FUNCTIONS – 4723.01(F) ORC  Observe, provide patient teaching and care  Contribute to planning, implementation, evaluation of patient care  Administer medications and treatments as authorized 18

19. LPN FUNCTIONS – 4723.01(F) ORC  Administer adult IV therapy as authorized (with presence of IV therapy recognition from OBN) – some changes in 2013  Delegate nursing tasks as directed by a registered nurse.  Teach nursing tasks to LPNs or UAP as directed by a registered nurse 19

20. NURSING PROCESS: LPN 4723-4-08 OAC At direction of RN or others…  Assess  Plan – contribute to…  Implement  Evaluate 20

21. APPLICATION  RN or LPN in acute care, long term care, assisted living, etc.  Duties and responsibilities consistent with scope of practice  Standards of practice  Policies and procedures 21

22. APPLICATION  RN or LPN in clinic, physician’s office, etc.  Duties and responsibilities consistent with scope of practice  Policies and procedures consistent with law / rule  Interaction with others (office manager, CMA, etc.); APRN with prescriptive authority 22

23. APPLICATION  RN or LPN in business / industry, public health, school, prison, etc.  Duties and responsibilities consistent with scope of practice  Policies and procedures consistent with law / rule  Only an RN can supervise / evaluate nursing practice 23

24. APPLICATION  RN or LPN in other settings – case management, independent practice, etc.  Still required to adhere to scope of practice and standards for safe practice  If out-of-state, follow that state’s law / rules 24

25. WHAT ABOUT…  Volunteer activities  “Over-the-backyard fence” nursing  Currently not practicing 25

26. STANDARDS OF SAFE PRACTICE  “Minimal acceptable standards of safe and effective nursing practice for an RN or LPN in any setting”  4723-4-03 RN  4723-4-04 LPN  4723-4-05 APRN  4723-4-06 Patient safety  4723-4-07 Nursing process: RN  4723-4-08 Nursing process: LPN 26

27. DIRECTION: RN TO LPN 4723-4-03(K) OAC  Conditions:  Assessment of the patient’s condition by the RN  Type of care required by the patient  Complexity and frequency of care needed  Training, skill, and ability of the LPN  Availability and accessibility of resources as needed for patient safety 27

28. DELEGATION: WORKING WITH UNLICENSED ASSISTIVE PERSONNEL 4723-13 OAC  Rules for delegation – evidence of effective use of resources  Transfer of responsibility for performance of a nursing task from someone who has authority to perform the task to someone who does not 28

29. DELEGATION  Conditions:  Task is within your scope of practice  You know how to do the task  The person receiving delegation knows how to do the task and knows to perform task as specified  Resources, support, and supervision available 29

30. DIRECTION AND DELEGATION  What evidence would support a decision not to direct or delegate?  What evidence dictates how direction and delegation decisions are made?  What evidence suggests that changes should be made in a decision to direct or delegate?  How does documentation support those decisions? 30

31. SUMMARY  Keep current with changes in the law and rules!  Practice safely – protect your patients and your nursing license!  For updates: Read Momentum on line Visit www.nursing.ohio.gov 31

32. RESOURCES  Ohio Board of Nursing – law/rules regulating the practice of nursing in Ohio:  http://codes.ohio.gov/orc/4723  http://codes.ohio.gov/oac/4723-4  http://codes.ohio.gov/oac/4723-13 32