OH: Standards of Nursing Practice, 1 contact hour

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Approval Statement
1 Catergory A contact hour. This continuing nursing education activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91). Approval # ONA 21000.

ATrain Education, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Course Summary

Historical review of the establishment nurse practice acts and nursing boards. Comprehensive discussion of Chapter 4723-4, Rules Related to Standards of Practice for Registered Nurses and Licensed Practical Nurses in Ohio. Meets the 1-unit requirement for coursework related to rules and laws for Ohio nurses.

ATrain Education, Inc. is an approved provider by the American Occupational Therapy Association. The following course information applies to occupational therapy professionals:

  • Target Audience: Occupational Therapists, OTAs

COI Support
Accredited status does not imply endorsement by ATrain Education Inc. or by the American Nurses Credentialing Center or any other accrediting agency of any products discussed or displayed in this course. The planners and authors of this course have declared no conflict of interest and all information is provided fairly and without bias.

Commercial Support
No commercial support was received for this activity.

This course will be reviewed every two years. It will be updated or discontinued on September 18, 2019.

Criteria for Successful Completions
80% or higher on the post test, a completed evaluation form, and payment where required. No partial credit will be awarded.

Accreditations

Course Objectives

When you finish this course you will be able to:

The History of Nursing Practice Acts

Nursing is among the many professions regulated by state-based practice acts. The emergence of these acts is historically important because they parallel the development and growth of the nursing profession.

Prior to 1900, no state had a nurse practice act and nurses were neither registered nor licensed. The vast majority of working nurses had no formal education and most worked in unregulated, crowded workplaces or as private nurses in homecare settings.

The first hospital in North America, Our Lady of Solitude, was established by the Spanish in 1597 in St. Augustine, Florida. More than two centuries later medical training in the United States was still largely through apprenticeships. In the 1800s, folk medicine, homeopathy, herbal medicine, and midwifery predominated. Midwives, mostly African American women, provided much of the medical care, particularly maternity care, in impoverished and isolated rural communities throughout the South (Florida Memory, n.d.).

Around the time of the American Civil War (1861–1865), there were only about 150 hospitals in the United States. There were no formal schools of nursing, no nursing credentials, and no “trained” nurses (Egenes, 2009). In England, Florence Nightingale had only just succeeded in establishing the first professional nurse training school in the world at St. Thomas’ Hospital in London, with the first class starting on July 9, 1860.

Dorothea Lynde Dix

image: photo of Dorothea Lynde Dix

Circa 1850–1855. Public domain.

The Civil War had a profound effect on the development of the nursing and medical professions and in many ways laid the foundation for modern nursing (Egenes, 2009). The hundreds of thousands of casualties created a need for caregivers and tens of thousands of women offered their services, mostly on a volunteer basis. In 1861, responding to the strong opposition to female volunteers, Dorothea Dix (1802–1887) organized a march on Washington demanding that women be allowed to treat Union soldiers. She was quickly put in charge of nurses assigned to the U.S. Army.

Dix initially required nurses to be over 30 years of age, “plain looking” and without curls, and forbade them to wear anything except brown or black clothing without ornaments, jewelry, or hoops. The age requirement was soon dropped as the number of wounded soldiers began to overwhelm the medical system. It is estimated that 3,000 nurses served in the Civil War (Egenes, 2009), although as many as 30,000 women worked as volunteers.

The sacrifices made by nurses and other female volunteers during the war succeeded in changing public opinion about women working in healthcare. In 1868, just three years after the end of the Civil War, Samuel Gross, president of the American Medical Association, strongly endorsed the formation of training schools for nurses (Egenes, 2009).

 

photo: wounded men and nurse

Nurse with wounded men after the Battle of Nashville, 1864. Public domain.

 

Just five years later, in 1873, the first educational programs for nurses in the United States were established in New York, Massachusetts, and Connecticut. Teaching techniques were largely based on the Nightingale Method, although there were some differences, particularly in hospital oversight of the nursing students. This period—from 1873 to 1893—is considered by some to be a “pioneering period” of nursing education (Stewart, 1935). The new nursing schools were so popular and successful that soon every hospital wanted a school of nursing.

Early Nursing Registration: Late 1800s

In the late 1800s, women’s organizations began organizing to improve working conditions for nurses by encouraging nursing licensure (then referred to as “nursing registration”). The development of licensure and standards of practice was seen as a way to ensure public safety and improve working conditions for nurses. As the nineteenth century drew to a close, nurses themselves, along with many women’s organization, lobbied for nurse registration as well the development of standards for nursing education and establishment of nurse practice acts.

Both support for and opposition against regulation of nursing practice was strong. Although a vocal proponent for improvements in education and working conditions, an aging Florence Nightingale was famously opposed to nurse registration. Nightingale stated in 1890,

The tendency is now to make a formula of nursing, a sort of literary expression. Now, no living thing can less lend itself to a formula than nursing. It cannot be tested by public examinations, though it may be tested by current supervision. (Goodnow, 1916)

As the twentieth century dawned, intense political lobbying led to the establishment of nursing registration as well as the development of the first state-based nursing practice acts. The New York State Nurses Association, formed in 1901, led the charge, working to gain legal status for nurses. The preliminary political work was spearheaded by a handful of women, most notably Isabel Hampton Robb, Sophia Palmer, Sylveen Nye, and members of the New York Federation of Women’s Clubs, which a few years earlier had passed a resolution urging the formation in New York State of a Nursing Board of Examiners chosen by a state society of nurses. They argued that nursing education should be included in the list of professions supervised by the New York State Board of Regents.

 

Pioneers of Nursing

photo of Isabel Hampton Robb

Isabel Hampton Robb (1860–1910), pictured here in 1891, was the first president of the Society for Superintendents of Training Schools for Nurses, which was a forerunner of the National League for Nursing. She was also the first president of the Associated Alumnae Association, which eventually became the American Nurses Association.

Source: The Alan Mason Chesney Medical Archives. Public domain.

photo of sophia palmer

Sophia Palmer (1853–1920) shown here in 1900, was a leader in the development of nursing organizations and licensure for nurses. She was one of the founders of the New York State Nurses Association and the first editor of the American Journal of Nursing.

Source: New York Heritage Digital Collections. Public domain.

 

The First Nurse Practice Act: 1902

In 1902 a group of women from New York Nurses Association met at the Rochester City Hospital to discuss the establishment of the nation’s first nurse practice act. In attendance was an elderly and frail Susan B. Anthony, who urged the attendees to remember the influence and power of their work. Anthony predicted in a speech to the group, “The day is coming when trained nurses will be required to possess a college education before being admitted to training” (Willis et al., n.d.).

In 1903 North Carolina passed the first registration law for nurses and, along with this, the first nurse practice act. New York, New Jersey, and Virginia succeeded in passing nurse registration laws by the end of 1903 and by 1921, 48 states, the District of Columbia, and the territory of Hawaii had enacted laws that regulated the practice of professional nursing (Egenes, n.d.).

The Ohio State Nurses Association was formed in 1904. Ohio enacted its first nursing practice act in 1915 by creating a Nurses Examining Committee (NEC) under the jurisdiction of the state medical board. In 1941 the NEC separated from the state medical board and became an autonomous state nursing board.

Since these humble beginnings in the early twentieth century, nurse practice acts have been revised, updated, and modernized. Gone are rules related to moral character, marriage restrictions, pregnancy, and age limits. Added are updated definitions of professional nursing, educational requirements, regulations for licensed practical nurses, nurse practitioners, nurse midwives, clinical nurse specialists, and certified nurse anesthetists. Computerized licensure databases have been developed, as have rules related to continuing nursing education, chemical dependency, delegation, and criminal background checks, among other additions.

Now, each state and territory of the United States has a law called the Nurse Practice Act (NPA) that is enforced by each state’s nursing board. Nurses are required to understand and comply with the laws and related rules of their own NPA in order to maintain their licenses (NCSBN, 2017).

In general, nurse practice acts describe:

  • Qualifications for licensure
  • Nursing titles that are allowed to be used
  • Scope of practice
  • Actions that can be taken against nurses who do not follow nursing law

The Ohio Nurse Practice Act: Established 1915

The Ohio Nurse Practice Act (NPA), established in 1915, sets guidelines for nurses who practice in the State of Ohio. It is codified in Chapter 4723 of the Ohio Revised Code (ORC). Nineteen chapters within the Ohio Administrative Code (OAC) fill out the ORC with additional rules regarding nursing practice.

An amendment to the Ohio Nurse Practice Act [Chapter 4723, Ohio Revised Code (ORC)] authorizes certified nurse practitioners, clinical nurse specialists, and registered nurses, under specific circumstances, to determine and pronounce death. The new law, Section 4723.36, ORC, which became effective March 22, 2013, authorizes certified nurse practitioners, clinical nurse specialists, and registered nurses to determine and pronounce death if an individual’s respiratory and circulatory functions are not being artificially sustained, and certain other circumstances exist (Ohio BON, 2017a).

Ohio nurses and others covered by the nurse practice act are responsible for understanding the laws and rules that govern and define their scope of practice. To determine if a procedure or activity is within a nurse’s scope of practice, see the Decision Making Model available on the BON website. The most up-to-date version of rules pertaining to scope of practice is also available on the Ohio Board of Nursing website.

As licensed nurses take an ever larger role in the delivery of healthcare, complaints against nurses have increased. The National Council of State Boards of Nursing reported that 1,015 licensed nurses in Ohio received a disciplinary action during 2012. Of those, 284 were placed on probation, 87 had their licenses revoked, and 400 had their licenses suspended (NCSBN, 2013).

The Ohio Board of Nursing

Nursing boards, including the Ohio Board of Nursing, are legally responsible for enforcing their state’s nurse practice act. They establish standards for safe nursing care and issue licenses to practice nursing. They monitor compliance with state laws and are empowered to take action against licensees who have exhibited unsafe nursing practice. Nursing boards oversee education requirements, rules for licensure, and define the scope of nursing practice in their state (NCSBN, 2017).

Nursing scope of practice and responsibilities vary from state to state. Because of this, nurses in the United States are responsible for knowing the regulatory requirements for nursing and the nurse practice act in every state in which they are practicing (NCSBN, 2017).

 

Guiding Principles of Boards of Nursing

Nursing boards are responsible for:

  • Protecting the public
  • Ensuring the competence of all practitioners regulated by the board
  • Ensuring due process and ethical decision making
  • Sharing accountability
  • Engaging in strategic collaboration
  • Developing evidence-based regulations
  • Responding to the marketplace and healthcare environment
  • Understanding the globalization of nursing

Source: National Council of State Boards of Nursing, 2017.

 

The Ohio Board of Nursing (BON) is both a regulatory board and a state government agency. Its chief responsibility is to implement and enforce state laws related to nursing licensure, nursing practices, nursing education, and Ohio nursing schools.

The Ohio BON was established by the Ohio state legislature through enactment of a law, which mandates its structure and functions. Board members are public officials and their meetings and most of their records are open to the public. Members of the Ohio BON may be appointed by the governor or the state legislature. Individual healthcare practitioners must pay licensure fees to the BON in order to practice legally in the state of Ohio (Ohio BON, 2016).

The powers and duties of the Ohio Board of Nursing are defined in Chapters 4723.02 and 4723.06 of the Ohio Revised Code. The overall mission of the board is “to actively safeguard the health of the public through effective regulation of nursing care” (Ohio BON, 2016).

Licensees and certificate holders regulated by the Board include registered nurses, advanced practice registered nurses (certified nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists), licensed practical nurses, dialysis technicians, medication aides, and certified community health workers (Ohio BON, 2016).

Eight registered nurses, four licensed practical nurses, and one consumer make up a thirteen-member board appointed by the governor. Of the eight registered nurses on the board, one must be authorized to practice as an advanced practice registered nurse. The consumer member of the board, who is not a nurse, is appointed to represent the interests of consumers of healthcare. The board elects one of its registered nurse members to serve as the supervising member for disciplinary matters (Ohio BON, 2016).

The Board regulates about 280,000 licenses and certificates. More than 180,000 are registered nurses (92% female, 8% male) while nearly 50,000 are licensed practical nurses (93% female, 7% male) (Ohio BON, 2017b).

The Ohio Nurses Association

The duties of the Ohio Nurses Association (ONA) and other professional nurses associations differ from those of the Ohio Board of Nursing. Boards are responsible for legal regulations, while associations are responsible for professional regulations, standards of professional practice, the promotion of quality nursing, legislative advocacy, collective bargaining, and public protection.

The ONA is a nongovernmental organization and membership is voluntary. Its mission is to promote and advance professional nursing in Ohio. It does so by influencing legislation, promoting education, and advocating for improved quality and availability of healthcare services in Ohio.

The Ohio Nurses Collective Bargaining Program (CBP), ONA’s union arm, represents and advocates for nurses at their workplace. The CBP gives nurses a strong voice to:

  • Negotiate fair wages and benefits
  • Advocate for safe working environments
  • Stand up for safe patient care
  • Shape working conditions, among other factors (ONA, 2016)

Specialty organizations such as operating room nurses, emergency nurses, critical care nurses, nephrology nurses, and other specialty groups also have professional associations. A board of trustees elected by association members typically runs an association. Association meetings can be closed to the general public and the elected leaders remain private citizens.

Associations and regulatory boards have a long history of close collaboration. Associations have traditionally set forth the nature and scope of the profession and used that as the basis for influencing the law regulating practice. These laws are then enforced by the regulatory board.

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]

Standards for Applying the Nursing Process as an RN (4723-4-07)

[The following is taken from Chapter 4723-4-07 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-4]

A registered nurse shall apply the nursing process in the practice of nursing as set forth in division (B) of section 4723.01 of the Revised Code and in the rules of the board. The nursing process is cyclical in nature and requires that the nurse’s actions respond to the patient’s changing status throughout the process. The following standards shall be used by a registered nurse, using clinical judgment, in applying the nursing process for each patient under the registered nurse’s care.

Assessment of Health Status

The RN shall, in an accurate and timely manner collect data. This includes:

  • Collection of subjective and objective data from the client, family, significant others, or other members of the healthcare team. The RN may direct or delegate the performance of data collection.
  • Documentation of the collected data.

Analysis and Reporting

The registered nurse shall, in an accurate and timely manner:

  • Identify, organize, and interpret relevant data;
  • Establish, accept, or modify a nursing diagnosis that is to be addressed with applicable nursing interventions; and
  • Report the patient’s health status and nursing diagnosis as necessary to other members of the health care team.

Planning

The registered nurse shall, in an accurate and timely manner:

  • Develop, establish, maintain, or modify the nursing plan of care consistent with current nursing science, including the nursing diagnosis, desired patient outcomes or goals, and nursing interventions; and
  • Communicate the nursing plan of care and all modifications of the plan to members of the health care team.

Implementation

The registered nurse shall, in an accurate and timely manner, implement the current nursing plan of care, which may include:

  • Executing the nursing regimen;
  • Implementing the current valid order authorized by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice;
  • Providing nursing care commensurate with the documented education, knowledge, skills, and abilities of the registered nurse;
  • Assisting and collaborating with other healthcare providers in the care of the patient;
  • Delegating nursing tasks, including medication administration, only in accordance with Chapter 4723-13, 4723-23, 4723-26, or 4723-27 of the Administrative Code.

Evaluation

The registered nurse shall, in an accurate and timely manner:

  • Evaluate, document, and report the patient’s response to nursing interventions; and progress towards expected outcomes of the plan of care; and
  • Reassess the patient’s health status, and establish or modify any aspect of the nursing plan as set forth in this rule.

For purposes of this rule, standards for implementing the nursing process also apply to a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.

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

Standards for Applying the Nursing Process as an LPN (4723-4-08)

[The following is taken from Chapter 4723-4-08 of the Ohio Administrative Code, 2017; http://codes.ohio.gov/oac/4723-4]

The licensed practical nurse shall contribute to the nursing process in the practice of nursing as set forth in division (F) of section 4723.01 of the Revised Code and in the rules of the board. The nursing process is cyclical in nature so that the nurse’s actions respond to the patient’s changing status throughout the process. The licensed practical nurse is directed in providing nursing care by the established nursing plan.

The following standards shall be used by a licensed practical nurse in utilization of the nursing process.

Contribution to the Assessment of a Patient’s Health Status

The LPN shall contribute to the nursing assessment of the client. The LPN shall, in an accurate and timely manner:

  • Collect and document objective and subjective data related to the patient’s health status; and
  • Report objective and subjective data to the directing registered nurse or health care provider, and other members of the healthcare team.

Planning

The LPN shall, in an accurate and timely manner:

  • Contribute to the development, maintenance, or modification of the nursing component of the care plan;
  • Communicate the nursing component of the care plan and all modifications of the plan to members of the healthcare team.

Implementation

The LPN shall, in an accurate and timely manner, implement the nursing plan of care, which may include:

  • Providing nursing interventions;
  • Collecting and reporting patient data as directed;
  • Administering medications and treatments prescribed by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice;
  • Providing basic nursing care as directed by a registered nurse, advanced practice registered nurse, or licensed physician, dentist, optometrist, chiropractor or podiatrist;
  • Collaborating with other nurses and other members of the health care team;
  • Delegating nursing tasks as directed, including medication administration, only in accordance with Chapter 4723-13, 4723-23, 4723-26, or 4723-27 of the Administrative Code.

Contributing to Evaluation

The LPN shall, in an accurate and timely manner:

  • Contribute to the evaluation of the patient’s response to nursing interventions;
  • Document the patient’s responses to nursing interventions;
  • Communicate the patient’s responses to nursing interventions to the directing registered nurse or health care provider, and members of the health care team; and
  • Contribute to the reassessment of the patient’s health status and to the modifications of any aspect of the nursing plan of care as set forth in this rule.

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

Specialty Certification (4723-4-09)

[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]

Concluding Remarks

Nurse Practice Acts delineate the laws and rules that regulate nursing. They are enacted by the legislatures of every state and territory of the United States. The Ohio Nurse Practice Act ensures the health and safety of the people of Ohio by establishing guidelines for nurses who practice in the state and is contained in Chapter 4723 of the Ohio Revised Code. The Ohio Administrative Code expands on and fills out this law with additional rules regarding nursing practice.

The guidelines for RN and LPN practice are contained within the Ohio Nurse Practice Act. Nurses in Ohio provide nursing care based on specialized knowledge, judgment, and skill that have been gained from the principles of biological, physical, behavioral, social, and nursing sciences.

An RN is authorized to engage in all aspects of nursing practice. It is the RN who determines the data to be collected in order to assess the client’s health status and the nursing care that should be provided to the client. The LPN has a dependent role and may provide nursing care only at the direction of a registered nurse, licensed physician, dentist, podiatrist, optometrist, or chiropractor.

Ohio RNs and LPNs are accountable for knowing the laws and rules of the Ohio Nurse Practice Act that govern and define their own scopes of practice.

References

Egenes KJ. (2009). Nursing during the U.S. Civil War: A movement toward the professionalization of nursing. Hektoen International: a Journal of Medical Humanities 1(2). Retrieved May 15, 2017 from http://www.hektoeninternational.org/Journal_NursingduringCivilWar.html.

Egenes KJ. (n.d.). History of Nursing. Retrieved May 15, 2017 from http://www.jblearning.com/samples/0763752258/52258_CH01_Roux.pdf.

Florida Memory. (n.d.). Pestilence, Potions, and Persistence in Early Florida Medicine. Division of Library and Information Services. Retrieved May 5, 2017 from http://www.floridamemory.com/exhibits/medicine/.

Goodnow M. (1916). Goodnow’s History of Nursing, Volume 11, Part 1963.

Common Sense Initiative Ohio. (2012). Five-year review of administrative rules and continuing education along with technical changes. Ohio Board of Nursing. Retrieved May 16, 2017 from http://www.nursing.ohio.gov/PDFS/Business%20Impact%20Analysis%20Final%202012%20FYR.pdf.

National Council of State Boards of Nursing (NCSBN). (2017). Boards of Nursing. Retrieved May 15, 2017 from https://www.ncsbn.org/boards.htm.

National Council of State Boards of Nursing (NCSBN). (2013). Board Action. Retrieved September 26, 2017 from https://www.ncsbn.org/673.htm.

Ohio Administrative Code. (2017). Chapter 4723-4 Standards of Practice Relative to Registered Nurse or Licensed Practical Nurse. Retrieved August 31, 2017 from http://codes.ohio.gov/oac/4723-4.

Ohio Board of Nursing (Ohio BON). (2017a). Ohio Board of Nursing—Nursing Practice. Retrieved May 24, 2017 from http://www.nursing.ohio.gov/Practice.htm.

Ohio Board of Nursing (Ohio BON). (2017b). Ohio Board of Nursing—Nursing Workforce Data. Retrieved May 15, 2017 from http://www.nursing.ohio.gov/Workforce.htm.

Ohio Board of Nursing (Ohio BON). (2016). Overview of Board Operations and Guide to Public Participation in Rule Making. Retrieved May 15, 2017 from http://www.nursing.ohio.gov/PDFS/Board/GuideToRulemaking.pdf.

Ohio Board of Nursing (Ohio BON). (2013). New Ohio Law: Determination and Pronouncement of Death. Retrieved May 16, 2017 from http://www.nursing.ohio.gov/PDFS/Momentum_Article_HB_284.pdf.

Ohio Nurses Association (ONA). (2016). Collective Bargaining Nurses are Empowered Professionals. Retrieved May 25, 2017 from http://www.ohnurses.org/ohio-nurses-cbp/.

Stewart IM. (1935, January). Curriculum revision: An essential step in the reconstruction of nursing education. Am J Nursing 35(1). pp. 58–66. Retrieved September 26, 2017 from http://www.jstor.org/stable/3412556.

Willis D, Maples PG, Britton K. (n.d.). The Nurse Practice Act. Retrieved May 26, 2017 from https://www.rochesterregional.org/about/history/rochester-medical-museum-and-archives/digital-exhibits/the-nurse-practice-act/.

Post Test

Use the answer sheet following the test to record your answers.


  • a. In California in 1850.
  • b. In North Carolina in 1903.
  • c. In Ohio in 1915.
  • d. In Puerto Rico in 1897.


  • a. Who can and cannot apply to nursing school.
  • b. Staff ratios—how many patients can be assigned to each nurse in a given day.
  • c. The role and behavior of lobbyists.
  • d. Scope of practice and qualifications for licensure.


  • a. Are responsible for understanding the laws and rules that govern and define their scope of practice.
  • b. Must understand the laws and rules of any profession they come in contact with.
  • c. Are not responsible for understanding their practice act unless they are sued.
  • d. Are required to join the Ohio Nurses Association.


  • a. To encourage nurses to advance in their careers.
  • b. To negotiate fair wages and benefits.
  • c. To oversee and regulate nursing care under Ohio law.
  • d. To protect nurses who are involved in legal disputes.


  • a. The professional associations advise the BON and can override its decisions.
  • b. The board of nursing is a public regulatory board, while the associations are private and voluntary.
  • c. Professional associations carry more weight because of their larger memberships.
  • d. The board of nursing can disband a professional association if it so desires.


  • a. To provide licensed nurses with a forum for professional development.
  • b. To establish minimal acceptable standards of safe and effective nursing practice.
  • c. To set forth rules and laws related to collective bargaining.
  • d. To provide professional services for licensed nurses in Ohio.


  • a. Applies to RNs but not LPNs.
  • b. Is the same for all nurses licensed in Ohio.
  • c. Establishes ethical standards for each level of nursing practice.
  • d. Define the procedures and actions permitted by law for licensed professionals.


  • a. Other patients are not neglected while the care is being given.
  • b. The care is provided with the help of an assistant rather than independently.
  • c. There is a documented staff shortage.
  • d. The nurse has obtained education from a recognized body that is relative to the care provided.


  • a. If asked to do so by a certified nursing assistant.
  • b. When the LPN believes or should have reason to believe the order or direction is harmful to a client.
  • c. When the LPN is working alone on the night shift in a nursing home.
  • d. When it is the policy of the hospital to do so.


  • a. May engage in sexual conduct with a patient if the patient has given free, full, and informed consent.
  • b. May take control of a patient’s property or money without the client’s consent.
  • c. Shall not engage in behavior that causes or may cause physical, verbal, mental, or emotional abuse to a patient.
  • d. May use verbal language that is seductive or sexual in nature when appropriate.


  • a. The steps by which a person qualifies for licensure.
  • b. The core of nursing practice for licensed nurses.
  • c. The career path that leads from graduation through the highest levels of nursing.
  • d. Different for every licensed nurse.


  • a. Both RNs and LPNs assess the client, direct or delegate, and document their findings.
  • b. Only RNs establish, accept, or modify a nursing diagnosis to be used as a basis for nursing interventions.
  • c. LPNs can provide direct basic nursing care without direction from a registered nurse.
  • d. LPNs are solely responsible for revising and updating nursing diagnoses.


  • a. Can follow the title “RN” when a person considers themselves to be an expert in a specialty area of practice.
  • b. Can follow the title “RN” when a nurse has worked in a specialty area for more than 10 years.
  • c. Is the title granted by the national certifying organization to nurses who meet the requirements for specialty certification established by that organization.
  • d. Should be displayed on a separate badge so as not to contradict or cause confusion about the title “RN.”

Answer Sheet

OH: Standards of Nursing Practice, 1 contact hour

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