Your Daily Relationship with the Board and Your License Wendy - - PowerPoint PPT Presentation

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Your Daily Relationship with the Board and Your License Wendy - - PowerPoint PPT Presentation

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Your Daily Relationship with the Board and Your License Wendy Bigelow, BSN, RN Nurse Investigator and Public Education OSBN Oregon State Board of Nursing 1 Learning Objectives Describe the daily relationship the licensed nurse has with

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Your Daily Relationship with the Board and Your License

Wendy Bigelow, BSN, RN Nurse Investigator and Public Education Oregon State Board of Nursing

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Learning Objectives

  • Describe the daily relationship the licensed

nurse has with the Board of Nursing.

  • Describe how the Nurse Practice applies to

your work setting

  • Employ self-regulation in adherence to the

laws and rules governing RN practice.

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Organization of the Nurse Practice Act

  • Oregon Revised Statute 678: Legal authority establishing the

definition of the practice of nursing and the legal authority of the Board to “exercise general supervision over the practice of nursing in this state” and “…determine the scope of practice as delineated by the knowledge acquired through approved courses of education or through experience”.

  • The Statute allows the Board to enact “rules” to clarify the

intent of 678: These rules are divided into specific chapters called “Divisions”. Divisions within the NPA are designated as “851” and there are 16 Divisions different divisions.

  • Both statute and rules carry the weight of law and together

they make up the Nurse Practice Act.

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What this means to you..

  • Your education allows you to sit for a test…
  • Passing the test allows you to apply for a

license…

  • If licensed, the state allows you to call

yourself a Registered Nurse…

  • The state decides what the rules are that

allow you to keep the license.

  • The rules are the Nurse Practice Act.

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What is the purpose of licensure?

  • Legal contract between you and the state

that you will assure the safety of the public by maintaining the requirements of the Nurse Practice Act and all other laws aimed at public safety.

  • The Board is in place to assure public

safety, not professional advocacy.

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When you accept the license…

  • You are entering into a legal contract with the state and

the people of the state…

  • “ I will abide by the requirements of my contract to act as

an agent of the state in keeping the public safe”

  • Safe nursing practice keeps the public safe.
  • This contract is regardless of work setting, the rules are

the same.

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Regulation

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“Need to Know” Divisions

  • Division 45: Standards and Scope of Practice for the Licensed

Practical Nurse and Registered Nurse. (Handout)

  • Division 63: Standards and Authorized Duties for the Certified

Nursing Assistant and Certified Medication Aide.

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Boundaries of the Nurse Practice Act

  • The NPA is only applicable to individual licensees.
  • The NPA has no authority over the employers of nurses.
  • The NPA does not regulate individual organizational policies .
  • It is up to the nurse to determine if a policy is in violation of

the NPA.

  • Organizational policies may not supersede the requirements
  • f a licensee to adhere to the requirements of the NPA.
  • However…organizations may further define how employees

implement the NPA as a condition of employment (organizational policies, procedures, by-laws) This is where other laws that affect nursing are pertinent…

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How do I define my scope of practice???

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The Scope of Nursing Practice Decision- Making Framework (The Scope Tree)

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Think of a task, intervention, role or situation where you asked yourself ...is this in my scope?

  • Define the activity/tasks/role: Identify, describe, clarify the

problem/need.

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Then….

  • Is the activity/task precluded by any law, rule, or policy

including the nurse practice act?

  • Rules of other Boards, other state laws, or not allowed under

your organizational policy.

  • If yes :
  • If no: Go to next step

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Then…

  • Is the activity consistent with Nursing Educational Standards,

National Professional Nursing Standards, Nursing Literature/research, OSBN, Institutional policies, Applicable Accreditation Standards and Community Standards?

  • If No:
  • If Yes: Go to next step

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Then…

  • Has the Nurse completed the necessary education?
  • If no:
  • If yes: Go to next step

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Then…

  • Does the nurse possess the appropriate knowledge?
  • If no:
  • If yes: Go to next step

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Then…

  • Is there documented evidence of current competency & skill?
  • If no:
  • If yes: Go to next step

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Then…

  • Would a reasonable and prudent nurse perform the activity?
  • If no:
  • If yes: Go to next step

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Then…

  • Is the nurse prepared to accept and manage the

consequences of his/her actions?

  • No:
  • If yes: go to next step

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If you get to this step without encountering

  • Then the nurse may perform this

activity/task/role/intervention according to acceptable and prevailing standards of safe nursing care. Policies and procedures must be in place to support the activity prior to performance.

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IF

  • Then the nurse can not/may not perform

the activity/task/role/intervention. Must be referred to a professional qualified to perform the activity/task/role/intervention.

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So What is considered practicing at the “top of your license?”

The requirements of the NPA + your knowledge of those requirements + knowledge/skill/competency (ability) + Employing the characteristics of a profession= _______________________________________ Practice at the top of your license.

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Top of your license also means…

  • The routine stuff….
  • Assessments as required.
  • Development of the plan of care.
  • Changing the plan of care as the patient’s condition warrants.
  • Hand off report appropriate for the needs of the patient.
  • Documentation
  • Following organizational policies
  • In other words…everything in Division 45 based upon your

education and competency.

  • And the not routine stuff…
  • Expanding your scope through education, competency validation

and participating in policy development, example RNFA, transport teams, SANE Forensic Nursing.

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Don’t try the following…

  • Getting a provider to write you an order letting you do

the thing you really want to do…

  • Thinking that once there is a protocol written you are ok

to follow it without assuring it is within your scope…

  • Writing a policy that supersedes the practice act…
  • Stating that you did not know the law…you accepted a

license…you are accountable to the law.

  • Saying it was the right thing to do for your patient…if you

were not qualified it is never the right thing to do for your patient…you promised to keep them safe.

  • Thinking your practice area is different and the NPA just

does not apply….

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What Stops you from Practicing at the top of your license?

We tend to lose perception of the risk attached to everyday activities or mistakenly believe in some situations the risk is justified. Often our decisions to circumvent a real or perceived workflow hindrance are based on immediate

  • utcomes (time saver, for the benefit of my

patient) in order to meet a goal or achieve it more readily. We do not consider the potential or uncertain consequence (patient harm) which is more remote than the immediate expediency that the circumvention provides.

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Most RNs , LPNs, and APRNs are employees of Organizations, therefore…

  • Barriers to practice at the top of your license may be related

to :

  • The skill mix of your organization: Are RNS doing CNA work?
  • Are managers expected to step into staffing frequently which

does not allow them time to create patient centered environments.

  • Are Nurse Practitioner staff allowed to become credentialed in

the facility as Licensed Independent Practitioner’s (LIP)

  • Organizational culture that allow other professionals to decide

nursing practice.

  • Computerized Documentation

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What would violation of the practice act look like?

  • Not reporting an impaired professional.
  • Accepting an assignment that you are not competency validated to

accept, includes assignments given by another licensed professionals

  • Failing to question an order that is not in the best interest of your

patient and not consistent with the plan of care.

  • Practitioner errors that either did or continue to place the patient at

risk.

  • Patient harm directly related to clinical decision making.
  • Abandonment of an assignment.
  • *Not reporting violent or abusive behavior of other RNs or other

licensees that impact your practice adversely.

  • *Violation of other state/federal laws.

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Case Scenarios

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Case #1

  • You are a nurse in a community-based setting. You are asked

to take a patient to the airport with a travel nurse attendant. You post a photo of the patient on your personal Facebook which also identifies you as a nurse and where you work.

  • Discuss…

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Case #2

  • You are a nurse in the ICU. Patient alarms are constantly going
  • ff. You note one patient who is agitated (assigned to another

nurse) and keeps setting off the heart rate alarm as tachycardia with artifact. You make the decision to turn off the heart rate alarm on the monitor in the room. Later that day the patient has a cardiac arrest and a code is called.

  • Discuss…

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Case #3

  • You are an Emergency Department nurse at a Critical Access
  • Hospital. A patient arrives by car to an area outside of your ED

and you are asked to assess them. They refuse to go in the

  • building. Does this change your course of action? What can

you do? Do you document the assessment? What laws impact this scenario?

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Case #4

  • You have a nurse co-worker who you follow often. You note

that your patients often report being painful and/or frequently display signs of pain after the co-worker leaves. When you review the MAR you see that the patient(s) received regularly scheduled or prn pain medication.

  • Concerns?
  • What do you do?

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Case #5

As a nurse you have opened a cosmetic practice. You have a physician who is assigned to the clinic and is available by phone from a practice in Washington. They come to the clinic once a week to sign charts and re-order medication and/or supplies. Is this appropriate? Why or Why not? Is this in scope of Practice for a Nurse? (Use the Scope Tree)

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The Take Away

  • Your license is 24/7 therefore your

relationship with the Board is 24/7

  • The Nurse Practice Act does apply to you
  • The Scope Tree is a great tool for

determining scope of practice

  • Self Regulation is the most important part
  • f your practice

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Questions?

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Contact Information

  • Wendy Bigelow, BSN, RN

wendy.bigelow@state.or.us

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Resources

  • OSBN Website:

http://www.oregon.gov/osbn/pages/index.aspx

  • Nurse Practice Act Division 45
  • Scope Tree (Handout)

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