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Continuing Education (CEU) course for healthcare professionals. Visitwww.athomeprep.com/my-account/ and select My Courses to takethe quiz and access your certificate. The information provided in thiscourse is to be used for educational purposes only. It is not intendedas a substitute for professional healthcare.Contact Hours: 2Ohio Nurse Practice Act (2 Hours)Law and Rules – Category ACOPYRIGHT 2021, WILD IRIS MEDICAL EDUCATION, INC. ALL RIGHTS RESERVED.BY Adrianne E. Avillion, DEd, MSN, RN; Persis Mary Hamilton, EdD, MSN, BSN, RN, PHN, PMHNLEARNING OUTCOME AND OBJECTIVES: Upon completion of this continuing educationcourse, you will have increased your knowledge of the standards of safe nursing practice asoutlined in the Ohio Nurse Practice Act and the rules of the Ohio Administrative Code as writtenby the Ohio Board of Nursing in accordance with Section 4723 of the Ohio Revised Code.Specific learning objectives to address potential knowledge gaps include: Describe the Ohio Scope of Practice Decision-Making Model. Compare the roles of the Ohio Board of Nursing and Ohio professional associations. Discuss the standards for competent nursing practice of RNs and LPNs in Ohio. Explain standards for the promotion of patient safety by licensed nurses in Ohio. Summarize the RN and LPN standards for applying the nursing process in Ohio. Describe violations of nursing laws and rules that may result in disciplinary action.The establishment of standards for nursing education and practice is the result of efforts bynursing associations that began over 100 years ago. Currently in each state or territory,a law known as the Nurse Practice Act designates an authoritative body that defines andregulates the nursing practice of every nurse in every role. This authoritative body, known as aboard of nursing, is responsible for ensuring that nurses who practice in the state for whichthey have responsibility are competent, safe, skilled, and knowledgeable about the standardsset forth in that state’s scope of practice for nurses (NCSBN, 2018). This course presents thosestandards for the state of Ohio written by the Ohio Board of Nursing in accordance with theNurse Practice Act.
wildirismedicaleducation.comOH NPA Laws and Rules - Category A 2.0 HoursOHIO BOARD OF NURSING AND OHIO ADMINISTRATIVECODEAll licensed medical professionals work under accepted standards derived from local, state, andfederal laws as well as professional guidelines. Licensed nurses are no exception. Their scope ofpractice is defined by the Nurse Practice Act (NPA) of the state in which they practice. In Ohio,the NPA is codified in Section 4723 of the Ohio Revised Code (ORC). It establishes an OhioBoard of Nursing (OBN) and defines its structure and function.Ohio Board of Nursing (OBN)The Nurse Practice Act (ORC 4723) authorizes the OBN to make and enforce rules andregulations for registered nurses, licensed practical nurses, advanced practice nurses (certifiednurse-midwives, certified nurse practitioners, certified nurse specialists, and certified registerednurse anesthetists), dialysis technicians, and community health workers. The board regulatesover 300,000 licenses and certificates. Its top priorities are to efficiently license the nursingworkforce and remove dangerous practitioners from practice in a timely manner to protect Ohiopatients (OH BON, 2021).MEMBERSHIPBoard members are public officials and meetings are open to the public. The board is made up ofthirteen members: eight registered nurses, four licensed practical nurses, and one consumerappointed by the governor. At least two of the registered nurses shall hold a current, valid licenseissued under the ORC that authorizes the practice of nursing as an advanced practice registerednurse. The board has the legal authority to administer and enforce all provisions of the NPA. Itmust review each rule within the Ohio Administrative Code (OAC) at least once every fiveyears. The board is funded and supported by mandatory licensure fees paid by nurses wishing topractice legally in the state of Ohio. The board does not have authority over employers (ORC4723.02).SCOPE OF PRACTICEBecause nursing is a dynamic practice, questions may arise about whether certain tasks arewithin the nurse’s scope of practice. All nursing care should be consistent with the nurse’spreparation, education, experience, knowledge, and demonstrated competency.The Ohio Board of Nursing has developed a Scope of Practice Decision-Making Model to helpnurses determine whether a task is within their scope of practice. The model uses a decision treewith references and is based on legality, competency, safety, and accountability. 2021 WILD IRIS MEDICAL EDUCATION, INC.2
wildirismedicaleducation.comOH NPA Laws and Rules - Category A 2.0 HoursOBN SCOPE OF PRACTICE DECISION-MAKING MODELThe Scope of Practice Decision-Making Model includes the following steps:1. Define/describe the activity or task: Is the activity or task within the scopeof practice and not prohibited or precluded by any other law or rule?2. Can the nurse perform the activity or task and meet the standards of safenursing practice as defined in OAC, chapter 4723-4? Can the nursedemonstrate and document current knowledge, skills, and abilities?3. Is this activity or task safe and appropriate to perform with this patient atthis time?4. The nurse may perform the activity/task according to acceptable and prevailingstandards of safe nursing care and prepare to accept accountability for the nursingactions.Each of these steps must be answered with a “yes” before proceeding to the next step. If at anypoint an answer is “no,” the nurse must not perform the action (OBN, 2019).CASE: Scope of Practice Decision-MakingMycee is a licensed practical nurse (LPN) with five years of experience who has recentlymoved from Indiana to Ohio. This is her first shift on a surgical floor following orientation,and she is responsible for five patients who are 1 to 4 days post-op. A new order has beenwritten for Mr. Hansen, who is receiving patient-controlled analgesia (PCA). The order is fora change in PCA dosage.In Indiana, Mycee was not restricted from performing this task, but she does not recallwhether she is allowed to do so in Ohio. Since she can’t look up the Ohio AdministrativeCode right now to see if the task is within her scope of practice, she consults with her chargenurse. The charge nurse tells Mycee that this is not within the scope of the LPN in Ohio. As aregistered nurse (RN), the charge nurse addresses the new order.Later, when Mycee has a break, she refers to “Using the Scope of Practice Decision-MakingModel” and then visits the Ohio Administrative Code website indicated in that document. Shereads Chapter 4723-17-03 (A) (4) of the code, which describes the role of the LPN inintravenous therapy procedures. There she finds that an LPN may not “program or set anyfunction of a patient-controlled analgesic,” thereby confirming that the task is not within herlegal scope of practice in Ohio.Applying the Model YourselfTake a moment to think of a situation that could arise in your practice. Then ask yourselfthe following questions. If you cannot answer yes to each question, you should not undertakethe action. 2021 WILD IRIS MEDICAL EDUCATION, INC.3
wildirismedicaleducation.comOH NPA Laws and Rules - Category A 2.0 Hours1. Is this activity or task within my scope of practice and not prohibited or precludedby any other law or rule?2. Can I perform the activity or task and meet the standards of safe nursing practiceas defined in OAC, chapter 4723-4? Can I demonstrate and document currentknowledge, skills, and abilities?3. Is this activity or task safe and appropriate to perform with this patient at this time?4. Can I perform the activity or task according to acceptable and prevailing standardsof safe nursing care and prepare to accept accountability for the nursing actions?Ohio Administrative CodeThe rules of the Board of Nursing regulate nursing practice in Ohio and are contained inSection 4723 of the Ohio Administrative Code (OAC). This course reviews those chaptersin Section 4723 that set forth the standards of competency, safe nursing practice, delegation,application of the nursing process, and discipline for registered nurses and licensed practicalnurses in the state of Ohio.OHIO ADMINISTRATIVE CODE, SECTION 4723, BOARD OF NURSINGChapter 4723-1Chapter 4723-2Chapter 4723-3Chapter 4723-4Chapter 4723-5Chapter 4723-6Chapter 4723-7Chapter 4723-8Chapter 4723-9Chapter 4723-13Chapter 4723-14Chapter 4723-16Chapter 4723-17Chapter 4723-18Chapter 4723-20Chapter 4723-23Chapter 4723-25Chapter 4723-26Chapter 4723-27Board Organization and RecordsPublic NoticeDefinitionsStandards of Practice Relative to Registered Nurse or Licensed PracticalNurseNursing Education ProgramAlternative Program for Substance Use Disorder MonitoringExamination and LicensureAdvanced Practice Nurse Certification and PracticePrescriptive AuthorityDelegation of Nursing TasksContinuing Nursing EducationHearingsIntravenous Therapy Courses for Licensed Practical NursesPractice Intervention and Improvement Program (PIIP)Prevention of Disease TransmissionDialysis TechniciansNurse Education Grant ProgramCommunity Health WorkersMedication Administration by Certified Medication Aide 2021 WILD IRIS MEDICAL EDUCATION, INC.4
wildirismedicaleducation.comOH NPA Laws and Rules - Category A 2.0 HoursCONTINUING EDUCATION FOR RENEWAL FOR RNs and LPNsFor the period immediately following Ohio licensure by NCLEX examination, the nurseis not required to complete any contact hours of CE for the first license renewal. Other thanthe first renewal immediately following licensure by exam, nurses must complete at least24 contact hours of CE that includes at least one contact hour of Category A CE for eachrenewal. A nurse who has been licensed in Ohio by reciprocity for less than or equal toone year prior to the first Ohio license renewal must complete at least 12 contact hours,rather than 24 (OBN, 2020).PROFESSIONAL ORGANIZATIONSOne of the hallmarks of a profession is that its members band together in collegial association toprovide a variety of services for its members. These services include such things as continuingeducation, collective bargaining, legislative advocacy, and information about the profession.These organizations are not set up by state laws or through the government.The American Nurses Association is the nationwide professional organization representing theinterests of nurses. In Ohio, professional associations include the Ohio Nurses Association,Licensed Practical Nurses Association of Ohio, Ohio Association for Advanced Practice Nurses,Ohio State Association of Nurse Anesthetists, and state chapters of other specialty associationssuch as perioperative nurses, critical care nurses, nephrology nurses, dialysis technicians, andother groups. Typically, associations are run by boards of trustees elected by members who payvoluntary membership dues.OHIO NURSES ASSOCIATIONVision: The Ohio Nurses Association is the recognized leader and advocate for professionalnurses and nursing in Ohio.Mission: To advance professional nursing in Ohio. This will be accomplished through: Evolving evidence-based practice Influencing legislators Promoting education Improving economic and general welfare Advocating for quality healthcare in a cost-effective andeconomically stimulating mannerCore Values: Social Responsibility Collaboration 2021 WILD IRIS MEDICAL EDUCATION, INC.5
wildirismedicaleducation.comOH NPA Laws and Rules - Category A 2.0 Hours Integrity Professionalism(ONA, 2021)The primary difference between the Ohio Board of Nursing and professional organizations is thatprofessional organizations have no legal authority, whereas the Ohio Board of Nursing hasauthority because it was established by the Nurse Practice Act with the unambiguous function ofpromoting and protecting the health of citizens through safe nursing practice.CODE OF ETHICS FOR NURSESIn addition to abiding by the laws established in the Nurse Practice Act, every member of aprofession is expected to read, understand, and abide by the ethical standards of its occupation.In the case of nursing, the American Nurses Association (ANA) publishes the Code of Ethicsfor Nurses with Interpretive Statements to guide nurses’ professional practice.The following provisions of the code broadly describe the ethical obligations of nurses:Provision 1. The nurse practices with compassion and respect for the inherent dignity,worth, and unique attributes of every individual.Provision 2. The nurse’s primary commitment is to the patient, whether an individual,family, group, community, or population.Provision 3. The nurse promotes, advocates for, and protects the rights, health, and safetyof the patient.Provision 4. The nurse has authority, accountability, and responsibility for nursingpractice; makes decisions; and takes action consistent with the obligation to provideoptimal care.Provision 5. The nurse owes the same duties to self as to others, including theresponsibility to promote health and safety, preserve wholeness of character and integrity,maintain competence, and continue personal and professional growth.Provision 6. The nurse, through individual and collective effort, establishes, maintains, andimproves the ethical environment of the work setting and conditions of employment thatare conducive to safe, quality health care.Provision 7. The nurse, in all roles and settings, advances the profession through researchand scholarly inquiry, professional standards development, and the generation of bothnursing and health policy. 2021 WILD IRIS MEDICAL EDUCATION, INC.6
wildirismedicaleducation.comOH NPA Laws and Rules - Category A 2.0 HoursProvision 8. The nurse collaborates with other health professionals and the public toprotect human rights, promote health diplomacy, and reduce health disparities.Provision 9. The profession of nursing, collectively through its professional organizations,must articulate nursing values, maintain the integrity of the profession, and integrateprinciples of social justice into nursing and health policy.(ANA, 2015)STANDARDS OF COMPETENCY FOR RNs[This section covers subsections (A) thru (K) of the OAC 4723-4-03, Standards relating to competent practice as aregistered nurse.]Registered nurses (A) provide nursing care within the scope of practice described in the OhioRevised Code and the rules of the Ohio Board of Nursing and (B) maintain current knowledgeof the duties, responsibilities, and accountabilities of safe nursing practice.RNs must (C) be competent and accountable in all areas of practice, including consistentperformance of all aspects of nursing care and appropriate recognition, referral or consultation,and intervention when complications arise.RNs may (D) provide nursing care beyond basic nursing preparation for an RN provided they: Obtain additional education Demonstrate appropriate knowledge, skills, and abilities Maintain documentation of their additional education and training Have a specific current order from an authorized individual acting within theirprofessional practice Do not carry out a function or procedure prohibited by any law or ruleRNs must (E) implement any order in a timely manner unless they believe or have reason tobelieve the order is: Inaccurate Not properly authorized Not current or valid Harmful or potentially harmful to a patient Contraindicated by other documented informationRNs must (E) clarify an order that meets any of the above criteria by consulting with anappropriate licensed practitioner. 2021 WILD IRIS MEDICAL EDUCATION, INC.7
wildirismedicaleducation.comOH NPA Laws and Rules - Category A 2.0 HoursWhen RNs (F) decide not to follow an order or prescribed medication or treatment afterconsulting with an appropriate licensed practitioner, the RN must: Notify the ordering practitioner of the decision not to follow the order Document that the practitioner was notified and state the reason fornot following the direction Take any other action to ensure the safety of the patientRNs (G) report to and consult with other nurses or members of the healthcare team and makereferrals as necessary in a timely manner.RNs must (H) maintain the confidentiality of patient information, communicating patientinformation with other members of the healthcare team for healthcare purposes only andaccessing patient information only for patient care purposes or for fulfilling nursingresponsibilities. This includes not disseminating patient information through social media,texting, emailing, or any other form of communication for purposes other than patient care.To the maximum extent feasible, RNs must (I) not disclose identifiable patient healthcareinformation unless the patient has consented to such disclosure and must report individuallyidentifiable patient information without written consent in limited circumstances only and inaccordance with authorized laws and rules.RNs must (J) use acceptable standards of safe nursing care as a basis for any observation,advice, instruction, teaching, or evaluation and communicate information that is consistent withacceptable standards of safe nursing care.When RNs (K) give direction to LPNs, they must first assess: Condition and stability of the patient who needs nursing care The type of nursing care required The complexity and frequency of the care required The training, skill, and ability of the LPN who is to perform thespecific function or procedure The availability and accessibility of resources needed to safely performthe function or procedureThe tasks assigned to LPNs must also be within the licensed practical nurse’s legalscope of practice. 2021 WILD IRIS MEDICAL EDUCATION, INC.8
wildirismedicaleducation.comOH NPA Laws and Rules - Category A 2.0 HoursSTANDARDS OF COMPETENCY FOR LPNs[This section covers subsections (A) thru (J) of the OAC 4723-4-04, Standards relating to competent practice as alicensed practical nurse.]A licensed practical nurse (LPN) must (A) function within the scope of practice of an LPN asset forth in division (F) of Section 4723.01 of the Ohio Revised Code and the rules of the OhioBoard of Nursing.An LPN must (B) maintain current knowledge of the duties, responsibilities, andaccountabilities for safe nursing practice.An LPN must (C) demonstrate competency and accountability in all areas of practice,including consistent performance of all aspects of nursing care and appropriate recognition,referral or consultation, and intervention when complications arise.An LPN may (D) provide nursing care beyond basic preparation for an LPN provided the LPNobtains appropriate education; demonstrates knowledge, skills, and abilities; and maintainssatisfactory records of meeting these requirements. The LPN must have a valid order or directionfrom an authorized individual acting within their professional practice, and the nursing carecannot involve a function or procedure prohibited by any law or rule.LPNs must (E) implement or clarify an order in a timely manner unless or whenever theybelieve or have reason to believe the order is: Inaccurate Not properly authorized Not current or valid Harmful or potentially harmful to a patient Contraindicated by other documented informationWhen (F) clarifying an order or direction, the LPN must consult with an authorized practitioneror directing RN. If the LPN decides not to follow the direction, the LPN, in a timely manner,must: Notify the ordering practitioner or directing RN of the decision not to follow the order Document that the ordering practitioner or directing RN was notified and state the reasonfor not following the direction Take any other action to ensure the safety of the patientAn LPN must (G) report to and consul
The Nurse Practice Act (ORC 4723) authorizes the OBN to make and enforce rules and regulations for registered nurses, licensed practical nurses, advanced practice nurses (certified nurse-midwives, certified nurse practitioners, certified nurse specialists, and certified registered
