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 the Board of Nursing. • Describe how the Nurse Practice applies to OSBN your work setting • Employ self-regulation in adherence to the laws and rules governing RN practice. 2
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 OSBN 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. 3
What this means to you.. • Your education allows you to sit for a test… • Passing the test allows you to apply for a license… OSBN • 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. 4
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 OSBN Nurse Practice Act and all other laws aimed at public safety. • The Board is in place to assure public safety, not professional advocacy. 5
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” OSBN • Safe nursing practice keeps the public safe. • This contract is regardless of work setting, the rules are the same. 6
Regulation OSBN 7
“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 OSBN Nursing Assistant and Certified Medication Aide. 8
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 OSBN the NPA. • Organizational policies may not supersede the requirements of 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) 9 This is where other laws that affect nursing are pertinent…
How do I define my scope of practice??? OSBN 10
The Scope of Nursing Practice Decision- Making Framework (The Scope Tree) 4/16/2018 OSBN 11
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. OSBN 12
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. OSBN • If yes : • If no: Go to next step 13
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? OSBN • If No: • If Yes: Go to next step 14
Then… • Has the Nurse completed the necessary education? • If no: OSBN • If yes: Go to next step 15
Then… • Does the nurse possess the appropriate knowledge? • If no: OSBN • If yes: Go to next step 16
Then… • Is there documented evidence of current competency & skill? OSBN • If no: • If yes: Go to next step 17
Then… • Would a reasonable and prudent nurse perform the activity? • If no: OSBN • If yes: Go to next step 18
Then… • Is the nurse prepared to accept and manage the consequences of his/her actions? OSBN • No: • If yes: go to next step 19
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 OSBN safe nursing care. Policies and procedures must be in place to support the activity prior to performance. 20
IF • Then the nurse can not/may not perform the activity/task/role/intervention. Must be referred to a professional qualified to OSBN perform the activity/task/role/intervention . 21
So What is considered practicing at the “top of your license?” The requirements of the NPA + OSBN your knowledge of those requirements + knowledge/skill/competency (ability) + Employing the characteristics of a profession= _______________________________________ Practice at the top of your license. 22
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. OSBN • 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 23 teams, SANE Forensic Nursing.
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… OSBN • 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…. 24
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 OSBN outcomes (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. 25
Most RNs , LPNs, and APRNs are employees of Organizations, therefore… • Barriers to practice at the top of your license may be related to : OSBN • 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. 26 • Computerized Documentation
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. OSBN • 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. 27
Case Scenarios OSBN 28
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. OSBN • Discuss… 29
Case #2 • You are a nurse in the ICU. Patient alarms are constantly going off. 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 OSBN the patient has a cardiac arrest and a code is called. • Discuss… 30
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