Ohio Nursing Law & Rules – Current Issues in Practice

DIRECTIONS & CRITERIA FOR SUCCESSFUL COMPLETION

1.   Please read carefully the below article “Ohio Nursing Law & Rules – Current Issues in Practice.”

2.   Complete and submit the post-test, evaluation form and the registration form.

The post-test will be reviewed. If a score of 70 percent or better is achieved, a certificate will be emailed to you and contact hours will be awarded. If a score of 70 percent is not achieved, a letter of notification of the final score and instructions on how to take second post-test will be sent to you. We recommend that this independent study be reviewed prior to taking the second post-test. If a score of 70 percent is achieved on the second post-test, a certificate will be issued.

If you have any questions, please contact the Ohio Nurses Association’s CE department at sswearingen@ohnurses.org or 614-323-1164.

STUDY

The laws and rules surrounding nursing don’t have to be overwhelming. They exist to not only protect the patients nurses care for, but to protect the nurses themselves as well.

This independent study activity will cover the role of the Ohio Board of Nursing in supporting these rules, as well as some important and relevant information on current nursing practice issues including staffing, documentation, and patient rights. This study will also discuss how these current issues relate to Ohio nursing law and rules.

1.0 Contact Hour that will satisfy the Ohio Category A requirement will be awarded with successful completion of this activity.

 Who Makes the Rules?

All nurses in Ohio are familiar with the Ohio Board of Nursing, or “the board”. In addition to auditing things like continuing education hours, the board investigates complaints against nurses and administers discipline as appropriate (Ohio Board of Nursing [BON], 2017). The board works diligently to ensure the public is being cared for by safe, competent and qualified nurses.

Not Just for Nurses

While it is titled the Board of Nursing, the board oversees additional healthcare professions. Dialysis technicians, community health workers and certified medication aides all fall under the Board of Nursing (OAC, 2017).  Topics such as education requirements, intravenous therapy rules, and delegation practices are all set forth by the board.

The board consists of thirteen members, eight of which are registered nurses. Two of these nurses must be APRNs and four must be LPNs. Additionally, there is a “consumer” member, who represents the interest of the public (ORC, 2017).

The board contains 3 advisory groups: continuing education, dialysis, and nursing education. Additionally, there is a committee on prescriptive governance and an advisory committee on advanced practice registered nursing (OAC, 2017).

The basics

Nurses practicing in Ohio must be aware of both the Ohio Administrative Code, OAC, and the Ohio Revised Code, ORC. The ORC consists of the laws passed by the Ohio legislature, while the OAC has the specific ways those rules are to be carried out at the recommendation of entities such as the Board of Nursing (BON).

To make a continuing education activity qualify for Category A credit, it must include specific information related to ORC and OAC 4723. The law states,
“…portion of continuing education that meets the one hour requirement directly related to Chapter 4723. of the Revised Code and the rules of the board as described in rule 4723-14-03 of the Administrative Code” (OAC, 2018).

Additionally, the activity must be approved by the board or an approved provider of continuing education in Ohio, such as Ohio Nurses Association.

 So, what else can the OBN do? (4723)

In addition to audits and investigations, the board also manages the issuance and revocation of nursing licensure. They decide who gets a license and who doesn’t.

If a complaint is filed, the board does have a due process that it needs to follow. With a few serious exceptions, a full investigation must be done before disciplinary action is taken against the nurse, such as license suspension or revocation. This investigational process involves a hearing, where the nurse can share his/her side of the story.

It is also important to note that the board must follow the law. The board can make clarifying rules (OAC), but they must align with the laws passed by the Ohio legislature (ORC).

Disciplinary action taken by the board is not one size fits all. There are varying levels of discipline. One that not all nurses and students are aware of is the board’s ability to deny taking the NCLEX (4723-7-02 OAC).

Per ORC 4823.28 (2017), the board can: “…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; or impose a fine of not more than five hundred dollars per violation”.

4723.33 in the ORC explains that there is protection for the nurse filing a complaint against retaliatory action. Anyone who has a concern is encouraged to report it to the board and should feel comfortable doing so. The concern for patient safety is always a priority, as well as the protection of their rights.

What is Nursing?

The ORC defines the practice of nursing as, “…providing to individuals and groups nursing care requiring specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences” (ORC, 2017).

In other words, nurses take care of people, in more ways than one. Nurses have specialized knowledge of many fields that are combined to provide holistic and effective care to all patients. With that knowledge comes a great responsibility, one that all nurses must take seriously.

Suggested Resources:

http://codes.ohio.gov/orc/4723

http://codes.ohio.gov/oac/4723

 

OAC 4723-4-06 (2017) states that nurses must “provide privacy during examination or treatment and in the care of personal of bodily needs”. It goes on to say that nurses must “treat each client with courtesy, respect and full recognition of dignity…”.

What is important to take away from this is that nurses must be mindful of what this means for each patient. Not everyone’s idea of modesty or even privacy is the same. There are cultural considerations that nurses and healthcare professionals may not even be aware of. While it is not always possible to accommodate every cultural practice or preference, for example in the event of an emergency, nurses should strive to understand what the patient’s comfort level is and how they can meet it.

In addition to providing competent and respectful care to all patients, nurses have a responsibility to ensure they are practicing safely to the best of their abilities.

Practice Issues

 Nurse Fatigue: Why It Matters

While the board’s goal is to protect the public, it has no authority over healthcare facilities or staffing issues. If a nurse is fatigued and makes an error, the board’s responsibility is to investigate it.

When nurses are exhausted and overworked, patient care and public health suffers. There is overwhelming evidence that nurse fatigue puts patients, nurses and the public at risk (Emergency Nurses Association [ENA], 2013). Fatigue, whether physical, mental or both, can cause delayed response time, impaired decision making, and negative health outcomes (Drake, Luna, Georges, & Steege, 2012). Claire Caruso, PhD, RN describes in her article for American Nurse Today (2012) that studies show that a person who has been awake for 17 hours or more has similar levels of performance to a person with alcohol intoxication

When you think of the job nurses are assigned to do, those three things do not fit in the equation. Patients need nurses with fast response times to emergent situations, top-notch decision making and critical thinking skills, and, obviously, positive health outcomes.

The ANA, American Nurses Association, issued several recommendations and a position statement on the issue. ANA recommends that the Registered Nurse have the right to decline or accept a work assignment or shift based on evaluation of their own fatigue (American Nurses Association [ANA], 2014). This should not be considered patient abandonment. Additionally, ANA advocates for a 40-hour work week, with no more than 12 hour shifts, and a ban on mandatory overtime (ANA, 2014).

Patient Safety and Patient Rights

Keeping patients safe and satisfied is not always an easy task.

Nurses must honor patient’s requests, even when they don’t agree. A common area of concern for nurses is when a patient refuses treatment or wishes to leave Against Medical Advice or “AMA”.  “Most of all, nurses can help by not perpetuating the concepts that AMA means you leave with nothing” (Barkley, 2014, para. 1).  The nurse’s role in AMA discharges is similar to their role in any other patient’s care.

The nurse is in a unique position to educate and advocate for their patient. It is the nurse’s role to support them even if we do not agree. All information should be provided unbiased, and all available options discussed. When a patient states they wish to sign out AMA, the nurse can use this opportunity to have an honest conversation. The nurse can ask why or what factors are driving the patient to this potentially dangerous decision. Sometimes, there are modifiable reasons or solutions that can be created in order to get the patient the safest care. Patients questioning or deciding to leave AMA still deserve the same education as any other patient.

As with all patient teaching, it should be documented in detail. Additionally, it is important to note how you as the nurse determined that the patient truly understands the information.

Interventions such as: any communication between the nurse and the physician, patient teaching, interventions made by the nurse, and resources contacted should all be documented. Documentation should be done real-time to avoid missing something. The use of quotes is especially useful in the case of refusal of care and/or AMA discharges.

Documenting something that happened earlier in the shift, or “back-charting”, is acceptable because it makes the documentation more thorough.

DOCUMENTATION DOs & DON’Ts

Do Example Don’t Example
Chart objective information Side rails up x2, fall risk sticker on the door, yellow non-skid footwear on. Patient education on preventing falls given. Patient verbalized understanding. Insert bias The patient is clearly making a bad choice by leaving AMA and does not seem to care about their health.
Utilize quotations when necessary “I will use the yellow socks you gave me before I get up to go to the bathroom”

“I want to leave the hospital. I understand the risks but I do not want a big bill.”

“… chart only what you – not what you infer or assume.” see, hear, feel, measure, and count”

Source: (American Society of Registered Nurses, 2008, para. 3)

 

Be judgmental The patient didn’t seem to understand what I said about preventing falls. I think she just doesn’t care about her safety.

 

 

Social Media

With social media rising in popularity, more people are using it now than ever before. Nurses must remain mindful of everything they post, share, and tweet.

According to the American Nurses Association’s position statements on social media: think before you post. Best practice is to treat everything you post as if your boss, employer, school, and/or patients will see it (American Nurses Association [ANA], 2011).

Even if the post or picture does not contain patient identifiable information, it may still be inappropriate for the professional nurse to post. While there is no current legislation in Ohio regarding the use of social media, the code of ethics for nurses still applies and the OAC standard for competent practice speaks to the need for nurses to uses social media wisely.

Ohio Administrative Code [OAC] 4723-4-03 Standards relating to competent practice as a registered nurse (2014).

“A registered nurse shall maintain the confidentiality of patient information. The registered nurse shall communicate patient information with other members of the health care team for health care purposes only, shall access patient information only for purposes of patient care, or for otherwise fulfilling the nurse’s assigned job responsibilities, and shall not disseminate patient information for purposes other than patient care, or for otherwise fulfilling the nurse’s assigned job responsibilities, through social media, texting, emailing or any other form of communication.

To the maximum extent feasible, identifiable patient health care information shall not be disclosed by a registered nurse unless the patient has consented to the disclosure of identifiable patient health care information. A registered nurse shall report individually identifiable patient information without written consent in limited circumstances only and in accordance with an authorized law, rule, or other recognized legal authority” (OAC, 2014).

“…a nurse shall not use social media, texting, emailing, or other forms of communication with, or about a patient, for non-health care purposes or for purposes other than fulfilling the nurse’s assigned job responsibilities” (OAC, 2014).

References

American Nurses Association. (2011). ANA’s principles for social networking and the nurse. Retrieved from https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/social-networking.pdf

American Nurses Association. (2014). Addressing nurse fatigue to promote safety and health: Joint responsibilities of registered nurses and employers to reduce risks. Retrieved from https://www.nursingworld.org/~49de63/globalassets/practiceandpolicy/health-and-safety/nurse-fatigue-position-statement-final.pdf

American Society of Registered Nurses. (2008). Charting and documentation. Retrieved from https://www.asrn.org/journal-chronicle-nursing/341-charting-and-documentation.html

Barkley, M. (2014). Against medical advice. Journal of Trauma Nursing, 21(6), 314-318. https://doi.org/10.1097/JTN.0000000000000091.

Caruso, C. (2012). Better sleep: Antidote to on-the-job fatigue. American Nurse Today, 7(5). Retrieved from https://www.americannursetoday.com/better-sleep-antidote-to-on-the-job-fatigue/

Drake, D., Luna, M., Georges, J., & Steege, L. (2012). Hospital nurse force theory: A perspective of nurse fatigue and patient harm. Advances in Nursing Science, 35(4), 305-314. https://doi.org/10.1097/ANS.0b013e318271d104.

Dyrbye, L., Shanafelt, T., Sinsky, C., Cipriano, P., Bhatt, J., Ommaya, A., … Meyers, D. (2017). Burnout among health care professionals:A call to explore and address thisunderrecognized threat to safe, high-qualitycare. Retrieved from https://nam.edu/wp-content/uploads/2017/07/Burnout-Among-Health-Care-Professionals-A-Call-to-Explore-and-Address-This-Underrecognized-Threat.pdf

Emergency Nurses Association. (2013). Nurse fatigue. Retrieved from https://www.ena.org/docs/default-source/resource-library/practice-resources/white-papers/nurse-fatigue.pdf?sfvrsn=f28a91eb_8

Ohio Administrative Code. (OAC). 4723 Ohio board of nursing. Retrieved August 24, 2018 from http://codes.ohio.gov/oac/4723

Ohio Board of Nursing. (2017). The Ohio board of nursing. Retrieved August 24, 2018, from http://www.nursing.ohio.gov/Law_and_Rule.htm

Ohio Revised Code. (ORC). Chapter 4723 Nurses. Retrieved August 24, 2018 from http://codes.ohio.gov/orc/4723

 

Ohio Nursing Law & Rules – Current Issues in Practice

Contact Hours Awarded: 1.0 Contact Hours of Category A Ohio Nursing Law and Rules
ONA-18-10-122
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