ATrain Education

 

Continuing Education for Health Professionals

OH: Standards of Nursing Practice, 1 contact hour

Module 4

The Ohio Nurse Practice Act: Standards of Practice

Chapter 4723-4 of the Ohio Administrative Code is one of 19 chapters that establish rules and laws for the practice of nursing in Ohio. It describes and establishes the minimal acceptable standards for safe and effective nursing practice by RNs, LPNs, certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, and clinical nurse specialist in any setting.

Chapter 4723-4 is contained within 8 sections, which are covered in this course:

  • 01: General information
  • 03: Standards relating to competent practice as a registered nurse
  • 04: Standards relating to competent practice as a licensed practical nurse
  • 05: Standards relating to competent practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist
  • 06: Standards of nursing practice promoting client safety
  • 07: Standards for applying the nursing process as a registered nurse
  • 08: Standards for applying the nursing process as a licensed practical nurse
  • 09: Specialty certification
General Information (4723-4-01)

[The following is taken from Chapter 4723-4-01 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-4]

The purpose of chapter 4723-4-01 is to establish minimal acceptable standards of safe and effective nursing practice for:

  • RNs and LPNs in any setting and
  • Minimal acceptable standards of safe and effective practice for a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, and clinical nurse specialist in any setting.

Additional standards for practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, and clinical nurse specialist are established in Chapters 4723-8 and 4723-9 of the Administrative Code.

[The above effective as of 02/01/2014]

 

Competent Practice as an RN (4723-4-03)

[The following is taken from Chapter 4723-4-03 of the Ohio Administrative Code, 2017. http://codes.ohio.gov/oac/4723-4]

A standard or scope of practice defines the procedures and actions that are permitted by law for licensed individuals of certain professions. It restricts the practice of a licensed professional to what the law permits for specific education, experience, and demonstrated competency.

RNs have specific and well-defined responsibilities that are distinct from those of an LPN. Registered nurses are expected to use their education and judgment to ensure patient safety by reviewing and clarifying orders and, in some instances, can refuse to implement an order.

According to the standards relating to competent practice as a registered nurse, the RN in Ohio shall:

  • Provide nursing care within the scope of practice of nursing for an RN as set forth in Chapter 4723.01 of the Revised Code and the rules of the board,
  • Maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice,
  • Demonstrate competence and accountability in all areas of practice in which the nurse is engaged, which includes, but is not limited to, the following:
    • Consistent performance of all aspects of nursing care
    • Recognition, referral or consultation, and intervention, when a complication arises

An RN may provide nursing care that is beyond basic nursing preparation for a registered nurse, provided the nurse:

  • Obtains education from a recognized body of knowledge relative to the nursing care to be provided.
  • Demonstrates knowledge, skills, and abilities necessary to provide the nursing care.
  • Maintains documentation satisfactory to the board of meeting its requirements.
  • Has a specific current order from an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice.

The nursing care cannot involve a function or procedure that is prohibited by any other law or rule.

An RN shall, in a timely manner, implement any order for a client unless the RN believes the order is:

  • Inaccurate
  • Not properly authorized
  • Not current or valid
  • Harmful, or potentially harmful to a client
  • Contraindicated by other documented information

An RN must clarify any order for a client when the RN believes the order is:

  • Inaccurate
  • Not properly authorized
  • Not current or valid
  • Harmful, or potentially harmful to a client
  • Contraindicated by other documented information

When clarifying an order, the RN shall, in a timely manner:

  • Consult with an appropriate licensed practitioner.
  • Notify the ordering practitioner when the RN makes the decision not to follow the order or administer the medication or treatment as prescribed.
  • Document that the practitioner was notified of the decision not to follow the order or administer the medication or treatment, including the reason for not doing so.
  • Take any other action needed to ensure the safety of the client.

An RN shall, in a timely manner, report to and consult as necessary with other nurses or other members of the healthcare team and make referrals as necessary.

The RN shall maintain the confidentiality of client information and communicate this information with other members of the healthcare team for healthcare 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, client healthcare information shall not be disclosed by an RN unless the client has consented to the disclosure. An RN shall report client information without written consent in limited circumstances only and in accordance with an authorized law, rule, or other recognized legal authority.

The RN shall use acceptable standards of safe nursing care as a basis for any observation, advice, instruction, teaching, or evaluation and shall communicate information that is consistent with acceptable standards of safe nursing care.

When an RN provides direction to a licensed practical nurse, the RN shall first assess:

  • The condition of the patient who needs nursing care, including, but not limited to, the stability of the patient
  • The type of nursing care the patient requires
  • The complexity and frequency of the nursing care needed
  • The training, skill, and ability of the licensed practical nurse who will be performing the specific function or procedure, to perform the specific function or procedure
  • The availability and accessibility of resources necessary to safely perform the specific function or procedure

[The above effective as of 02/01/2014]

 

Competent Practice as a LPN (4723-4-04)

[The following is taken from Chapter 4723-4-04 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-4]

A licensed practical nurse (LPN) functions within the scope of practice of nursing for an LPN as set forth in division (F) of section 4723.01 of the Revised Code and the rules of the board.

An LPN shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice and shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged, which includes, but is not limited to, the following:

  • Consistent performance of all aspects of nursing care; and
  • Recognition, referral or consultation, and intervention, when a complication arises

An LPN may provide nursing care in accordance with division (F) of section 4723.01 of the Revised Code that is beyond basic preparation for a licensed practical nurse provided:

  • The nurse obtains education that emanates from a recognized body of knowledge relative to the nursing care to be provided;
  • The nurse demonstrates knowledge, skills, and abilities necessary to perform the nursing care;
  • The nurse maintains documentation satisfactory to the board of meeting the requirements set forth in paragraphs (D)(1) and (D)(2) of this rule;
  • When the nursing care to be provided is in accordance with division (F)(3) of section 4723.01 of the Revised Code, the nurse has a specific current valid order or direction from an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice; and
  • The nursing care does not involve a function or procedure which is prohibited by any other law or rule.

An LPN shall, in a timely manner implement any order or direction for a client unless the LPN believes, or should have reason to believe, the order or direction is:

  • Inaccurate
  • Not properly authorized
  • Not current or valid
  • Harmful, or potentially harmful to a client, or
  • Contraindicated by other documented information

An LPN shall clarify any order or direction for a client when the LPN believes or should have reason to believe the order or direction is:

  • Inaccurate
  • Not properly authorized
  • Not current or valid
  • Harmful, or potentially harmful to a client, or
  • Contraindicated by other documented information

When clarifying an order or direction, the LPN shall, in a timely manner:

  • Consult with an appropriate licensed practitioner or directing registered nurse
  • Notify the ordering practitioner or directing RN when the LPN makes the decision not to follow the order or direction or administer the medication or treatment as prescribed
  • Document that the practitioner or directing RN was notified of the decision not to follow the direction or order, or administer the medication or treatment, including the reason for not doing so, and
  • Take any other action needed to assure the safety of the client

An LPN shall, in a timely manner, report to and consult as necessary with other nurses or other members of the healthcare team and make referrals as necessary, maintain the confidentiality of client information obtained in the course of nursing practice, and communicate client information with other members of the healthcare team for healthcare purposes only.

To the maximum extent feasible, identifiable client healthcare information shall not be disclosed by an LPN unless the client has consented to the disclosure of identifiable client healthcare information. An LPN shall report individually identifiable client information without written consent in limited circumstances only, and in accordance with an authorized law, rule, or other recognized legal authority.

When an LPN is directed to observe, advise, instruct, or evaluate the performance of a nursing task, the LPN shall use acceptable standards of safe nursing care as a basis for that observation, advice, instruction, teaching, or evaluation and shall communicate information which is consistent with acceptable standards of safe nursing care.

[The above effective as of 02/01/2014]

 

Competent Practice as a Certified Nurse-Midwife, Certified Nurse Practitioner, Certified Registered Nurse Anesthetist, or Clinical Nurse Specialist (4723-4-05)

[The following is taken from Chapter 4723-4-05 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-4]

A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist shall do all of the following:

  • Function within the scope of practice of nursing for a registered nurse as set forth in division (B) of section 4723.01 of the Revised Code and the rules of the board.
  • Function within the nurse’s applicable scope of practice as set forth in section 4723.43 of the Revised Code and the rules of the board.
  • Practice in accordance with section 4723.481 of the Revised Code and Chapter 4723-9 of the Administrative Code if the individual holds a certificate to prescribe.

When the practice of a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist is evaluated, the evaluation shall be provided by a collaborating licensed physician, podiatrist, or a nurse holding a similar current, valid certificate of authority that is the same as the person being evaluated.

When the practice of a certified registered nurse anesthetist is evaluated, the evaluation shall be provided by a supervising licensed physician, podiatrist, dentist or a certified registered nurse anesthetist whose certificate is current and valid.

A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist may provide care within their specialty provided:

  • The nurse obtains education that emanates from a recognized body of knowledge relative to the nursing care to be provided;
  • The nurse demonstrates knowledge, skills, and abilities necessary to provide the nursing care; and
  • The nurse maintains documentation satisfactory to the board of meeting the requirements set forth in paragraphs (D)(1) and (D)(2) of this rule.

[The above effective as of 02/01/2014]

 

Promoting Patient Safety (4723-4-06)

[The following is taken from Chapter 4723-4-06 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-4]

At all times, when a licensed nurse is providing direct nursing care to a patient, the licensed nurse shall display the applicable title or initials set forth in division (C) of section 4723.03 of the Revised Code to identify the nurse’s relevant licensure as a registered nurse or as a licensed practical nurse.

At all times, when a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist is providing direct nursing care to a patient, the nurse shall display the applicable title or initials set forth in division (C) of section 4723.03 of the Revised Code to identify relevant approval either as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.

At all times, when a licensed nurse is engaged in nursing practice and interacting with the patient, or healthcare providers on behalf of the client, through any form of telecommunication, the licensed nurse shall identify to each client or healthcare provider the nurse’s title or initials set forth in division (C) of section 4723.03 of the Revised Code to identify applicable licensure or approval as a registered nurse, licensed practical nurse, certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.

A licensed nurse shall delegate a nursing task, including medication administration, only in accordance with Chapter 4723-13, 4723-23, 4723-26, or 4723-27 of the Administrative Code.

A licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the patient, and the patient’s response to that care.

A licensed nurse shall, in an accurate and timely manner, report to the appropriate practitioner errors in, or deviations from, the current valid order.

A licensed nurse shall not falsify any patient record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services.

A licensed nurse shall implement measures to promote a safe environment for each patient and shall delineate, establish, and maintain professional boundaries with each patient.

At all times when a licensed nurse is providing direct nursing care to a patient, the licensed nurse shall:

  • Provide privacy during examination or treatment and in the care of personal or bodily needs, and
  • Treat each patient with courtesy, respect, and with full recognition of dignity and individuality

A licensed nurse shall not engage in behavior:

  • That causes or may cause physical, verbal, mental, or emotional abuse to a patient
  • Toward a patient that may reasonably be interpreted as physical, verbal, mental, or emotional abuse

A licensed nurse shall not misappropriate a client’s property or engage in behavior:

  • To seek or obtain personal gain at the patient’s expense;
  • That may reasonably be interpreted as behavior to seek or obtain personal gain at the patient’s expense;
  • That constitutes inappropriate involvement in the patient’s personal relationships or financial matters; or
  • That may reasonably be interpreted as inappropriate involvement in the patient’s personal relationships or financial matters.

For the purpose of this paragraph, the patient is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph.

A licensed nurse shall not engage in:

  • Sexual conduct with a patient;
  • Conduct in the course of practice that may reasonably be interpreted as sexual;
  • Verbal behavior that is seductive or sexually demeaning to a patient; or
  • Verbal behavior that may reasonably be interpreted as seductive, or sexually demeaning to a patient.

For the purpose of this paragraph, the patient is always presumed incapable of giving free, full, or informed consent to sexual activity with the nurse.

A licensed nurse, when functioning in an administrative role, shall verify that each nurse, dialysis technician, or medication aide under the nurse administrator has:

  • A current valid license to practice nursing in Ohio or a current valid certificate to practice as a dialysis technician or medication aide in Ohio; and
  • If applicable, other documents of approval or certification as required by the board.

When nursing practice, as set forth in section 4723.01 of the Revised Code, is supervised or evaluated:

  • Only a registered nurse shall supervise the practice of nursing, as set forth in Chapter 4723 of the Revised Code and the rules of the board, performed by other registered nurses and licensed practical nurses; or
  • In matters other than the practice of nursing, a non-nursing supervisor may evaluate a nurse employee.
  • Supervision or evaluation by a registered nurse does not require that the registered nurse be present on-site on a routine basis, but at minimum:
    • Supervision requires that the registered nurse be continuously available through some form of telecommunication with the supervised nurse, and take all action necessary, including but not limited to conducting periodic on-site visits, to ensure that the supervised nurse is practicing in accordance with acceptable and prevailing standards of safe nursing care as set forth in Chapter 4723. of the Revised Code and the rules of the board; and
    • Evaluation requires that the registered nurse conduct periodic on-site visits sufficient to enable the evaluating nurse to evaluate the evaluated nurse’s performance.

Nothing in this paragraph shall be construed to authorize a licensed practical nurse to practice without direction, as required by division (F) of section 4723.01 of the Revised Code.

Nothing in this paragraph shall be construed to prohibit a licensed practical nurse from participating in activities that contribute to the delivery of patient care services. Such participation may include, but is not limited to, scheduling of coverage for nursing services and observation and documentation by a licensed practical nurse regarding care provided by assistive personnel.

A licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to:

  • The board or any representative of the board;
  • Current employers;
  • Prospective employers when applying for positions requiring a nursing license;
  • Facilities in which, or organizations for whom, the nurse is working a temporary, agency, or locus tenens assignment;
  • Other members of the patient’s healthcare team; or
  • Law enforcement personnel.

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.

[The above effective as of 02/01/2015]

    Instructions
  • Online
  • Study the course, take the test, register and pay, print your certificate. Done!

  • Print Option
  • Click "Print Option" to print a hard copy with mail-in instructions.

  • Take the Test