[The following is taken from Chapter 4723-4-09 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-4.]
Nothing in this rule shall apply to an advanced practice nurse authorized to practice pursuant to section 4723.55 of the Revised Code, or to a certified nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist, or clinical nurse specialist authorized to practice pursuant to section 4723.41 of the Revised Code.
An RN with a current, valid license to practice nursing in Ohio may use a title or initials denoting specialty certification in a particular area of specialty in nursing granted by a national certifying organization that has established standards for:
- Practice qualifications, formal education, continuing education, or other demonstration of knowledge in specialty practice; and
- The construction and administration of a psychometrically sound examination for an RN applying for certification in a particular area of specialty in nursing.
The title to be used by the RN who focuses in a particular area of specialty in nursing shall be the title granted by the national certifying organization to those nurses who meet the requirements for specialty certification established by the national certifying organization. The RN may use such title or initials following the title “Registered Nurse” or the initials “RN”.
No person shall use any title or initials implying or representing specialty certification unless that person has been granted a specialty certification title in nursing by a national certifying organization as set forth in paragraph (B) of this rule.
[The above effective as of 02/01/2014]
Patient Safety Initiative
The Patient Safety Initiative guides hospitals in the event a nurse commits a practice error. It includes 3 components: (1) the Practice Intervention and Improvement Program (PIIP), (2) TERCAP (Taxonomy of Error, Root Cause Analysis and Practice-Responsibility), and (3) Just Culture.
- PIIP is the Board’s confidential alternative to discipline program for eligible licensees. The program establishes a structured remedial education and monitoring program to document that the participant’s practice deficiency has been corrected (OBN, 2018d).
- The TERCAP systematically tracks and evaluates the causes of adverse events from both individual and system perspectives, and enables the development of proactive interventions to protect patient health and safety (NCSBN, 2015). According to data reported to the TERCAP system between 2008 and 2016, the most common practice breakdowns were:
- Lack of professional responsibility: 73%
- Lack of clinical reasoning: 47%
- Lack of intervention: 49%
- Documentation error: 42%
- Misinterpretation: 37%
- Medication error: 33%
- Lack of attentiveness: 25%
- Lack of prevention: 27%
- Just Culture, a risk management model, is a systematic method that can be used by nursing employers and the Board to increase patient safety by recognizing and modifying system flaws, and by holding individuals accountable for reckless behavior or repeated behavior that poses increased risk to patients (OBN, 2018d).
Genoa Receives a 2-month Suspension from the Board of Nursing
Background
Genoa is a registered nurse working in the emergency department at a large hospital in Akron, Ohio. On a busy Saturday evening, she was assigned to assess a 72-year-old woman admitted for light-headedness and rash. Her patient load was higher than usual because two nurses had called in sick and three critically injured people had just arrived following a car accident.
Patient History
Martha is a 72-year-old woman with a history of HTN for which she is taking beta blockers. She also has diabetes and elevated cholesterol. She had been in 3 times last month with complaints of headache and dizziness.
Nursing Assessment
BP: 105/52
Heart rate: 68
O2 sat: 90
Blood sugar: 105
Weight: 175
Patient c/o light-headedness, itching, rash on her arms and chest lasting more than an hour, and slight wheezing.
Treatment
Genoa asked the physician to evaluate Martha for a suspected allergic reaction. The physician did a quick exam, noted that Martha’s tongue was slightly swollen, and ordered 0.01/mg/kg IM of epinephrine, then quickly left the room. Another nurse joined Genoa and told her that the dose was too high and that epinephrine was not weight-based with adults, only children. Genoa called the pharmacy and was told the dose ordered by the doctor was correct. The second nurse repeated that the dose was incorrect, instructed Genoa not to give the medication, and left the room to check with the doctor. Because Genoa was busy and Martha said she was having trouble breathing, Genoa gave the 0.79 mg of epinephrine 1:1000 IV and left the room.
When the second nurse returned she found the patient on the floor. She yelled for help and started checking Martha’s vitals. When help arrived Martha’s neck was stabilized and she was lifted onto a gurney. Martha received immediate treatment and recovered.
Discussion
In Ohio, section 4723.28 describes actions for which a nurse can be disciplined. Genoa’s hospital has adopted the Patient Safety Initiative. Using TERCAP as a guide, the hospital conducted an analysis and determined that Genoa had committed several practice breakdowns, including a medication error, lack of intervention, lack of professional responsibility, lack of attentiveness, and lack of prevention. They further determined that Genoa breached the standard of nursing care and had breakdowns or errors during aspects of the nursing process:
- Leaving the room after administering a potentially dangerous medication.
- Failing to implement the appropriate intervention even after she was told by another nurse that the epinephrine dose was incorrect.
- Giving the wrong dose, by the wrong route.
- Failing to assess her patient’s change of condition.
Outcome
The hospital filed a report with the Ohio Board of Nursing that identified the licensee and described the alleged error. The nursing board assigned an investigator who contacted the hospital for documents about the complaint. The investigator visited the hospital, interviewed Genoa’s co-worker and asked Genoa to provide a written description of her actions during the incident. Although Genoa’s participation with the board’s investigation was voluntary, she decided to consult with a lawyer, after which she decided to participate in the investigation.
After reviewing the complaint, the board’s investigator decided to proceed with a disciplinary action. Genoa was given the opportunity to request an administrative hearing but declined to do so. She agreed to sign a consent agreement with the Board, which was submitted to the Board for approval. Genoa was subsequently placed on 3-year probation.
The consent agreement allowed Genoa to continue to work and outlined the conditions for her probation, which included:
- Completing additional pharmacotherapy continuing education coursework
- Checking in with the nursing supervisor twice during each shift
- Checking in with a board-assigned probation monitor
- Submitting a quarterly report to the OBN
- Following all laws
Genoa successfully completed her 3-year probation.
For more information about disciplinary actions, please see the Ohio Revised Code, chapter 4723.28: http://codes.ohio.gov/orc/4723.28.
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