|Ohio Nurse Practice Act
The goal of this program is to provide RNs, licensed practical nurses (LPNs), and advanced practice nurses (APNs) in Ohio, and those who seek licensure in Ohio, with a basic overview of the Ohio Nurse Practice Act. After you study the information, you will be able to —
Suppose you are a newly licensed RN in the State of Ohio and you are interviewing for a position that sounds interesting. You are concerned, though, that some of the job responsibilities are outside of what you understand RNs can do in Ohio. You think about calling your favorite instructor from the nursing program, but you feel a little funny about doing so since she knows you were never that clear about nursing liability issues, whether in malpractice areas or licensing areas. You do not know any RNs currently working in Ohio either. Where do you turn? You can, and should, turn to the Ohio Nurse Practice Act — a detailed framework of nursing practice in the state of Ohio. Because the act is a regulatory state law (one that controls or regulates something), it also provides parameters of acceptable—and unacceptable—nursing practice in that state. Moreover, it delineates the Ohio Board of Nursing’s powers to administer and enforce the act. Nurse licensees can use the knowledge of these powers to evaluate board actions. This knowledge can also be used as a guide for understanding nurse licensees’ rights.
Board Membership and General Provisions
The Ohio Board consists of 13 members, eight of whom are RNs. One of these nurses must be certified by the board to practice as a certified RN anesthetist (CRNA), a certified nurse midwife (CNM), a clinical nurse specialist (CNS), or a certified nurse practitioner (CNP). The remaining members are four LPNs and one “consumer interest” representative. The RN and LPN members must meet certain requirements to sit on the Board. For example, they must be graduates of an approved program of nursing education specific to their practice and hold a current license in the state of Ohio as an RN or LPN. All nurse board members must also have been actively engaged in the practice of nursing as an RN, LPN, or in an advanced practice role for the five years immediately preceding board membership.
The consumer interest board member cannot be a member of any healthcare profession or be a healthcare provider (neither can any of his or her family members). In addition, the consumer interest representative cannot have a financial interest in the delivery of healthcare or its financing.
Nursing organizations in Ohio nominate board of nursing members; they can submit up to five nominees to the governor. After receiving nominations from these organizations and other sources, the governor decides, with the advice and consent of the Ohio General Assembly, who will sit on the board. This process differs from those in some other states, such as Illinois, where nursing board members are nominated by the same groups, but appointed by the head or director of the regulatory agency administering and enforcing the nurse practice act.
The Ohio Nurse Practice Act clearly identifies the Ohio Board of Nursing’s powers and duties. The board has full authority to administer and enforce the act, its rules, and disciplinary actions against nurse licensees. Other Ohio Board of Nursing powers are similar to those of other state boards of nursing. For instance, the Board is obligated to establish rules to approve continuing nursing education programs and standards and to define the minimum curricula and standards for educational programs of schools of professional and licensed practical nursing in the state. Board members must provide guidance and make recommendations to the general assembly, the governor, state agencies, and the federal government with respect to the regulation of nursing practice and the enforcement of the Ohio Nurse Practice Act. The board is also mandated to issue and renew nursing licenses and certificates of authority to those who meet the requirements to practice in advanced practice roles. And, because CNMs, CNSs, and CNPs in Ohio can obtain prescriptive authority if prerequisites are met, the board has the ability to issue and renew certificates to prescribe medications and therapeutic devices and to promulgate and adopt rules concerning this prescriptive authority.
Scope of Nursing Practice and Other Definitions
Licensed Practical Nursing: LPNs in Ohio provide to individuals and groups nursing care that requires basic knowledge of biological, physical, behavioral, social, and nursing sciences. They provide nursing care at the direction of a licensed physician, dentist, podiatrist, optometrist, chiropractor, or RN. Nursing care provided by LPNs occurs in diverse healthcare settings. Care includes contributing to the planning, implementation, and evaluation of nursing and administering medications and treatments when authorized by a provider who is able to legally prescribe medications and treatments and who is functioning within the course of that individual’s scope of professional practice. However, LPNs must complete a course of medication administration that is approved by the Ohio Board before they can administer medications.
To administer IV therapy to adult patients, LPNs must be licensed, successfully complete a course in IV therapy with content required by the board, and function at the direction of one of the healthcare providers listed above. Moreover, the provider at whose direction the LPN provides IV therapy must be “readily available” within the facility where the IV therapy is administered. Before the IV therapy is initiated, an RN must personally perform an on-site assessment of the patient who is to receive the therapy.
There are limitations on the type of IV therapy LPNs can administer. For example, LPNs cannot initiate or maintain the administration of blood or blood components, total parenteral nutrition, cancer therapeutic medications (e.g., antineoplastic agents), central venous lines, or investigative drugs. Nor can LPNs discontinue central venous, arterial, or other lines not terminating in a peripheral vein, nor mix, prepare, or constitute any medication except preparing or reconstituting antibiotic additives (so long as the LPN is authorized by the Board to perform IV therapy).
Last, LPNs can perform some IV procedures without prior authorization by the Ohio Board to perform IV therapy. To do these procedures, LPNs must act under the direction of an RN or other healthcare provider listed above and they must demonstrate the skills, knowledge, and ability to perform the procedure safely. If these conditions are met, LPNs may, for example, regulate a peripheral IV infusion according to the prescribed flow rate or discontinue a peripheral IV device.
Registered Professional Nursing: RNs in Ohio use specialized knowledge, judgment, and skill derived from biological, physical, behavioral, social, and nursing sciences when providing nursing care to individuals and groups of patients. Their scope of practice includes many professional responsibilities, such as assessing the health status of patients for the purpose of providing nursing care, health counseling, and health teaching. RNs administer medications, provide treatments, and execute regimens prescribed by other healthcare providers who are authorized to do so when acting within the course of their respective professional practice. RNs also teach, administer, supervise, delegate, and evaluate nursing practice.
RNs’ scope of practice is further refined by the definition of several terms that delineate the practice. For example, “nursing regimen” in Ohio may include preventative, restorative, and health-promotion activities. The assessment of a patient’s health status includes the collection of data through nursing assessment techniques, such as observation and interviewing, for the purpose of providing nursing care.
Advanced Practice Nursing: Advanced practice roles comprise the CRNA, the CNS, the CNM, and the CNP. All nurses practicing in advanced practice roles must hold an Ohio license as an RN and a certificate of authority authorizing and designating their right to practice in one of the four categories. To obtain a certificate of authority to practice in an advanced role, an RN must meet the prerequisites established by the board for that specific role.
For example, to practice as a CNP, an applicant must earn a graduate degree with a major in nursing or in a related field and pass a board-approved national certification examination by a national certifying organization, such as the American Nurses Credentialing Center or the National Certification Corporation. Until December 31, 2008, the only exception to the requirement of a graduate degree for a nurse practitioner applicant is someone who has successfully completed a nurse practitioner certificate program that receives funding under and who is employed by a public agency or a private, nonprofit entity that receives funding under Title X of the Public Health Services Act. In addition, an affidavit of the applicant must include, among other things, details about current or former practice as a nurse practitioner and the names and business addresses of the applicant’s current collaborating physician(s) and podiatrist(s).
The scope of practice for each advanced practice role is clearly outlined in the act. Generally, CRNAs, CNSs, CNMs, and CNPs provide nursing care that requires knowledge and skill obtained from advanced formal education and clinical experience.
CNMs, collaborating with one or more physicians, may provide the management of preventive care as well as primary care services to women gynecologically and during all phases of pregnancy. CNMs cannot treat abnormal conditions, including using forceps or delivering a baby with a face presentation, except in an emergency. Prescribing drugs and therapeutic devices may be part of CNM practice if a practitioner has a certificate to prescribe and does so in collaboration with the physician with whom he or she works. Last, normal vaginal deliveries, repairing vaginal tears, and performing episiotomies are also part of the Ohio CNM’s practice.
CRNAs provide such anesthesia services as anesthesia induction, maintenance, and emergence with the supervision and in the immediate presence of a physician, dentist, or podiatrist. However, when performing preanesthetic preparation and evaluation, postanesthetic care, and clinical support functions, only supervision (defined as “under the direction of the physician, dentist, or podiatrist”) is required. CRNAs need not obtain a certificate to prescribe to provide anesthesia services as described thus far. When CRNAs are supervised by a podiatrist, they do not administer general anesthesia in the practitioner’s office because podiatrists are not authorized to provide general anesthesia. Moreover, when a dentist or podiatrist is supervising, the scope of the CRNA practice is limited to those anesthesia services the dentist or podiatrist is authorized to provide.
CNPs have the authority to prescribe drugs and therapeutic devices when collaborating with a physician(s) or a podiatrist, if they has been issued a certificate to prescribe under the act. The focus of CNP practice is preventive care, primary care, and evaluating and promoting patient wellness consistent with the CNP’s nursing specialty. When a CNP collaborates with a podiatrist, however, the CNP’s scope of practice is limited to the procedures that the podiatrist is legally authorized to perform.
CNSs also collaborate with physicians or podiatrists to provides healthcare and management services to individuals or groups with complex health problems. In addition, CNSs provides healthcare services that promote, improve, and manage healthcare within their nursing specialty. CNSs may have the authority to prescribe drugs and therapeutic devices after obtaining the required certificate and in collaboration with a physician or podiatrist. As with CNPs, the CNS scope of practice when collaborating with a podiatrist is limited to the procedures the podiatrist is granted by the state to perform.
The act defines additional practice parameters for those practicing in Ohio in advanced roles. One such practice parameter for CNSs, CNPs, and CNMs is the “standard care arrangement” (SCA), a mandated document under the act, except for the CNS in mental health who does not hold a certificate to prescribe medications, but practices in collaboration with one or more physicians. The SCA is a written, formal guide for planning and evaluating a patient’s healthcare. The collaborating physician(s) or podiatrist(s) and the CNS, CNM, or CNP develop it. The SCA must be present at each site where the nurse practices. A collaborating physician or podiatrist is not permitted to enter into an SCA at the same time with more than three CNSs, CNPs, or CNMs in their prescriptive abilities. The SCA must contain specific provisions, including —
If a CNS, CNM, or CNP is employed by a hospital rather than by an individual employer, the hospital and the practitioner can also negotiate a SCA. The medical staff and the governing body of the hospital must approve the SCA before its implementation at the hospital.
The requirement of “collaboration” in the definitions of the scope of practice of all the nurses practicing in the advanced role except the CRNA means that the physician or podiatrist with whom the nurse has a SCA is always available to communicate with the nurse in person, by radio, by telephone, or by some other form of telecommunication. The CNM’s requirement of collaboration is the same with the physician with whom he or she collaborates. A CNS in mental health nursing who is not authorized to prescribe drugs and therapeutic devices must have at least one physician with whom he or she can continuously collaborate.
Prescriptive authority for all Ohio CNSs, CNPs, and CNMs is obtained through specific procedures established by the board and its Committee on Prescriptive Governance. Initially, for CNSs, CNMs, and CNPs, certain requisites apply (which are listed in sidebar 1).
CNSs, CNPs, and CNMs must apply for a prescriptive
certificate. In addition to other qualifying factors, applicants must
successfully complete a course in advanced pharmacology and related topics
as detailed in the act. The certificate is valid for a two-year period.
Renewals occur only after the CNS, CNP, or CNM completes at least 12 hours
of continuing education (CE) in advanced pharmacology during the previous
two years or other hours required by the board if the certificate has been
held for less than the full renewal period.
Disciplinary Process and Procedures
Basis for Discipline: The Ohio Board of Nursing has the power to deny a license to practice nursing or a certificate of authority required under the act. Moreover, the board is granted disciplinary powers against nurse licensees for substantiated violations of the act or its rules. Generally, disciplinary actions that can be imposed against a license or certificate holder include revocation of the license or certificate, suspension of either document, the placement of restrictions on the licensee or certificate holder’s ability to practice, reprimand of the licensee or certificate holder, imposition a fine of not more than $500. per violation, and “otherwise disciplining” the licensee or certificate holder.
Like other nurse practice acts, the Ohio act lists the basis for discipline. The Ohio Act includes a total of 32 grounds. Some of the more common reasons for discipline are listed in the sidebar “Common Reasons Listed in
Act for Discipline of an Ohio Nurse Licensee.”
Failing to practice in accordance with the standards of practice as set forth in the Ohio Act’s rules apply to all Ohio nurse licensees. The standards, which set minimal acceptable standards of safe and effective nursing practice, are listed separately in Chapter 4 of the rules. A summary of selected standards for all three nurse licensee groups is listed in the sidebar “Selected Standards of Safe Nursing Practice in Ohio.”
In addition to the reasons for disciplining a nurse that are listed in Sidebar 2, Ohio has several unique reasons for discipline. For example, the Board can discipline a RN, LPN, or a APN for prescribing any drug or device to perform or induce an abortion, or otherwise performing or inducing an abortion. The Ohio Board can also discipline a nurse licensee who does not use universal blood precautions and body fluid precautions rules established by the board.
Specific disciplinary grounds apply to Ohio nurses in advanced roles as well. They may also be disciplined if, for example, they induce patients to receive healthcare from them by waiving fees or copayments for nursing services that would normally be payable under the plan of insurance or healthcare policy. Likewise, practitioners who fail to have the required standard care arrangement or fail to practice in accordance with the arrangement also face disciplinary action. And, CNSs, CNPs, CNMs, or CNRAs who sell, give away, or administer drugs or therapeutic devices for any purpose other than legal and legitimate therapeutic purposes can also be disciplined.
Disciplinary Parameters: Upon information that a licensee appeared to have violated any provision of the act or its rules, the board is required to investigate evidence that appears to show that a violation has occurred. The Ohio Board’s powers in disciplinary proceedings provide for the board to resolve disciplinary situations by either a hearing before a hearing examiner or by consent agreement. In either case, the board must vote by a quorum for any action taken. The board can initiate disciplinary proceedings against a licensee or holder of a certificate of authority even when those documents are on inactive status or when the renewal of either document has not occurred.
The board is also obligated to summarily suspend (e.g., without a hearing before the suspension) the license of any individual licensed under the act if there is “clear and convincing” evidence that the person poses a danger of immediate and serious harm to the public. The president and executive director of the board determines whether to suspend a license after considering the evidence. After issuing a written order of suspension, the board must notify the licensee. If requested by the licensee, a hearing must take place within 15 days, but not earlier than seven days after the request. Until the hearing, the suspension remains in effect. The board must make a determination whether to lift or continue the suspension within 90 days after the hearing.
Certain criminal convictions, guilty pleas, or other judicial findings automatically require suspension of a license and certificate of authority, including aggravated murder, kidnapping, rape, sexual battery, and murder. The suspension remains in effect until the individual requests a hearing. If that does not occur, or the individual does not participate in the hearing, the board can enter a final order permanently revoking the person’s license or certificate.
However, the board can abstain from taking disciplinary action against a licensee or certificate holder in three instances. One is when there is a minor violation of the act. If, in the board’s discretion, it decides that the issuance of a notice or warning is sufficient to protect the public, no further action at that time is necessary. The second instance is if the licensee has a practice deficiency that can be corrected through remediation. A practice deficiency is an activity that does not meet acceptable and prevailing standards of safe and effective nursing care. If the nurse’s practice deficiency is one that can be corrected through this remediation, and the individual enters into an agreement with the board to participate in the process, follows the agreement’s terms and conditions, and successfully completes the remediation, this alternative is of great benefit to the person. Records concerning the remediation program are confidential, except for information shared with the entity that is providing services to the person in the remedial program. If the nurse is not able to successfully complete the remedial program, or the board determines that remediation cannot correct the licensee’s or certificate holder’s practice, the board must then initiate disciplinary proceedings.
The third instance in which the board can abstain from initiating disciplinary action against a nurse or holder of a certificate of authority is when chemical dependency is present. First, the board must determine that the person can be treated effectively and that there is no impairment of the nurse’s ability to practice according to acceptable and prevailing standards of safe nursing care. If these requisites are met, the option of monitoring the person in the board’s chemical dependency monitoring program can occur. The person monitored must surrender his or her license or certificate of authority to the program coordinator and not practice nursing during the period of monitoring. After the person successfully completes the program, the document surrendered is returned and nursing practice can resume. If the individual nurse or certificate holder is not able to successfully complete the program, the board can then take formal action.
The board is obligated to maintain the confidentiality of the records of those in the monitoring program. Its records are not public records and can only be disclosed in limited circumstances, for example, when the nurse participating in the program gives written consent for such disclosure and signs the required waivers to allow the coordinator of the monitoring program to obtain and release information necessary to evaluate the person’s readiness and continued participation in the program.
The board is unable to accept a unilateral surrender of a nursing license or certificate of authority without a majority vote in any disciplinary action. Similarly, an application for nursing license or certificate of authority cannot be withdrawn unless the board votes to do so by a majority vote.
Rights of Nurse Licensee and Holders of a Certificate of Authority: Nurse licensees and certificate of authority holders in Ohio possess rights granted them by the Ohio Nurse Practice Act and the US and Ohio Constitutions. These rights are located in various places in the Ohio statutes. One such statute granting the Ohio nurse rights throughout the disciplinary process is in a section of Ohio’s Revised Code. That section deals with administrative procedures that agencies must follow when promulgating rules to further define statutes and when disciplinary proceedings against a person are initiated by an administrative agency such as a board of nursing. One group of rights included in this statute are the rights of “due process” — defined as what is fair in the situation in which a right is threatened.
The ability to practice a profession is granted by a state after a person meets certain requirements. After it is earned, a license to practice a profession is seen as a “property right.” As a result, the nurse has protections when a governmental entity, such as the board of nursing, takes an action that threatens an individual’s constitutional rights. There are many due process rights afforded the nurse when there is a threat to his or her license or certificate of authority. Rights include the ability to retain an attorney to represent the licensee in the proceeding, the right to present witnesses on one’s own behalf, the right to notice of any allegations against the individual, and the right of judicial review of a decision by the Ohio Board of Nursing.
In addition to the constitutional protections of due process, the Ohio nurse enjoys other protections granted by the nursing act and its rules. Some have already been discussed, such as the confidentiality of records when undergoing monitoring in the board’s chemical monitoring program and the ability to go through a remediation program rather than a disciplinary proceeding if the nurse qualifies. Other protections center around the hearing process. For example, the act’s rules provide that no ex parte communications (without all parties present) can occur before the board or a hearing officer about a pending matter, unless the communication concerns procedural or other matters affecting the efficient conduct of the hearing with representatives of record. A second nurse licensee right is the ability to request the board to issue subpoenas for the hearing to compel a witness to attend the hearing or to compel the production of documents essential to the nurse licensee’s case. This is an important right because the request for witnesses to be present or the licensee’s request for certain documents may not be heeded voluntarily. Since a subpoena carries a penalty for failure to comply with its mandates, it is an important tool for the nurse licensee in defending himself or herself in board proceedings.
When disciplinary actions take place before the board because nurse licensees are involved in the criminal justice system, the board’s powers and nurse licensees’ right are spelled out in the act. If nurse licensees are charged with certain crimes, such as a crime of moral turpitude, a misdemeanor committed in the course of practice, or any felony, the board may require them to undergo mental and/or physical examinations if the board finds reason to believe a physical or mental impairment exists that may affect the nurse’s ability to provide safe nursing care. If impairment is present, the nurse is granted the option of mandated treatment as a condition of continued practice, reinstated practice, or renewed authority to practice. The decision to allow the nurse licensee to practice again is then based on the ability of the person to demonstrate that he or she can begin or resume practice in compliance with acceptable and prevailing standards.
Moreover, a licensee whose criminal action is dismissed by the criminal court for any other reason than the fact that the nurse was found not guilty or was wrongly charged has the opportunity to further defend his- or herself before the board. The board is required to conduct a hearing to determine whether the nurse committed the act he or she was charged with for the purposes of any disciplinary action against the licensee. The board’s powers to order discipline is limited, however. Only if the board determines that the nurse committed the criminal violation or does not participate in the hearing can the board discipline the nurse as though he or she had been convicted of the crime.
If the nurse licensee or holder of a certificate of authority appeals a conviction, plea, or other judicial finding of a crime and the conviction is overturned, the board is mandated to take certain steps in those situations where discipline has been imposed. At the completion of the appeals process, the nurse licensee can petition the board for a reconsideration of its action. Upon the receipt of the petition and court documents detailing the successful appeal, the board is required to temporarily rescind its action. If the appellate court’s decision was a reversal of the lower court decision for any other reason than a procedural one, the board must permanently rescind its discipline against the nurse licensee.
A decision by the appellate court to reverse a lower court due to an error in procedure or other technicality requires board action as well when the board has taken disciplinary action against the nurse licensee. The board must conduct a hearing to determine whether the original crime with which the nurse licensee was charged was committed. If so, the board is able to reinstate its action against the nurse. Reinstatement of its action can also occur if the nurse does not request a hearing by the board. If the board determines that the nurse did not commit the criminal act that formed the basis of the criminal case against the nurse, it must permanently rescind its discipline.
Nurse licensees and holders of certificates necessary of authority are also afforded the protection of clarity under the Ohio Act and rules. For example, if the board decides to suspend a license or certificate of authority, the nurse must be informed in writing of the conditions under which reinstatement to practice can occur. The conditions that must be met by the nurse licensee vary according to the reasons for the suspension. Some of them include evidence of the licensee’s recovery and continued sobriety; letters from employer(s), and the full payment of any fines assessed against the nurse license for their violation.
Nurse licensees and holders of certificates of authority possess certain general rights not connected with being named the subject of a disciplinary action. All nurse licensees and holders of certificates who in good faith make a report to the board regarding a suspected violation of the act or its rules or participates in any investigation or in any administrative or judicial proceeding resulting from the reporting are immune from suit. The reporting nurse is protected from civil damages by the person or agency that is the subject of the report. The second protection is that of immunity when professional association of nurses (both RN and LPN associations) sponsors a committee or programs to provide peer assistance to individuals with substance abuse problems. In the absence of fraud or bad faith, no representative or agent of those committees or programs can be liable to any person in a civil suit for any actions taken to refer a nurse to a treatment program.
Special Provisions of the Ohio Act and Rules
Approved Business Structures For Nurse Entrepreneurs: In today’s healthcare delivery environment, many nurses elect to leave more traditional healthcare delivery settings and establish their own agencies, clinics, or other types of business for the purpose of providing nursing care to clients. Most often, the state’s business organization statute(s) govern the form of business organization that are elected by the nurse entrepreneur. Although such Ohio statues also govern business establishments by nurses, the Ohio Nurse Practice Act provides fixed options for the nurse entrepreneur, whether a RN or LPN. The options supported by the Ohio Act are —
The corporation, limited liability company, partnership, or professional association can include a combination of professions for the purpose of providing professional services to the business’s clients. All of the professionals must be licensed, certified, or otherwise legally authorized to practice their respective professions. (See sidebar “Professionals Who Can Associate with RN/LPN Business.”)
Delegation by RN to Others: The delegation of nursing tasks to unlicensed health team members has been the subject of controversy in the nursing profession for some time. Even so, it is a process that is used in all areas of nursing practice. Delegation occurs when a nurse transfers the authority to perform a selected nursing task in selected situation to a competent individual. As an integral part of nursing practice, some states, like Ohio, include guidelines in the practice act and rules to aid in the establishment of standards and parameters for the teaching, practice, and evaluation of delegating to others and for the process of delegation itself.
The Ohio Act details delegation by RNs in intermediate care/mentally retarded (ICF/MR) group homes of 15 beds or less. Before delegation can occur, RNs must successfully complete a course consistent with the requirements set by the board (i.e., an approved training program for instruction of ICF/MR workers on giving oral and applying topical medications). Moreover, RNs must meet continuing eligibility standards to continue teaching ICF/MR workers. In addition, nurses must consistently meet standards concerning on-site or off-site direction and supervision of ICF/MR workers who administer oral or apply topical medications. ICF/MR workers must also complete required training courses and criterion.
The board is empowered to accept complaints from any person or entity about ICF/MR workers’ performance or qualifications to administer approved medications. The board then refers the complaint to the Ohio Department of Mental Retardation and Developmental Disabilities and can assist in the investigation of the complaint.
The Ohio Act also governs delegation in mental retardation/developmental disabilities (MR/DD) county board facilities. In contrast to delegation in ICF/MR facilities, nurses can delegate “nursing tasks” in addition to delegating medication administration, both of which must be consistent with standards established by the board. MR/DD workers who will be providing their allowable services must also successfully complete a training course. RNs and LPNs (under the direction of RNs) can teach the training courses for the MR/DD workers. Interestingly, other healthcare professionals may also provide instruction to the MR/DD workers if the board promulgates a rule allowing for that instruction and it is within the scope of practice of the other healthcare professionals.
Guidelines for RNs delegating to dialysis technicians also appear in the Ohio Act. The Ohio Nursing Board also regulates dialysis technicians, which is a unique provision in a nursing practice act. The scope of practice of dialysis technicians includes drawing blood, administering specified medications (e.g., IV normal saline, IV heparin, intradermal lidocaine), responding to complications that might arise during dialysis, and performing and monitoring dialysis procedures. Technicians can perform these responsibilities only when delegated by a physician or RN and when either is in the immediate presence of the technician. The administration of medications by the dialysis technician can be administered only upon the order of a licensed health professional authorized to prescribe medications. The training of dialysis technicians must be done in a program approved by the Board of Nursing.
The Ohio rules further detail the process of delegation by licensed nurses in all settings where nursing and dialysis care are rendered, including those situations detailed in the act itself. Several prohibitions are included in Chapter 13 of the act. To illustrate, a licensed nurse cannot delegate to an unlicensed person — a person not currently licensed by the Ohio Board as an RN or LPN or who does not have a current valid certificate as a dialysis technician — any nursing task that requires judgment based on nursing knowledge and expertise. When a nursing task, that is, an activity that constitutes the practice of nursing, is delegated, that person can not delegate it to another person.
The rules also contain criteria and standards for the licensee delegating to a “trained unlicensed person” — one who fits the definition of an unlicensed person but who has been trained by the RN in accordance with the rules’ requirements. In addition, an LPN can not automatically delegate to an unlicensed person. Rather, the LPN can do so only at the direction of the RN and if all other conditions surrounding delegation in Chapter 13 are met. Some of those conditions are that the nursing task is within the skill, knowledge, and ability of the nurse delegating the nursing task and that the trained unlicensed person performs the delegated task only as specified by the licensed nurse. Moreover, adequate and appropriate supervision by the licensee of the performance of the nursing task delegated is available and consistent with the rules (e.g., initial and ongoing direction, observation, and evaluation).
The Ohio nurse is fortunate to have a detailed guide
within which to practice as a RN, LPN, or APN. A quick reading of the act
and its rules does not provide nurse licensees with all they need to know
about the Ohio Nurse Practice Act. Continued review of the act and rules,
including any changes, and serious deliberation about one’s professional
practice with an eye toward the act and rules can aid licensees to remain
well within the protective boundaries of professional and legally
authorized nursing practice.
Brent NJ. Protect yourself: know your nurse practice act. CE 28A. Nursing Spectrum 2002 Career Fitness® Guide. 2001;152-159.
Brent NJ. Nurses and the Law: A Guide to
Principles and Applications. 2nd Ed. Philadelphia, PA: WB Saunders; 2001.
Ohio Nurse Practice Act and Rules. Anderson’s Ohio Revised Code, Title 47 Section 4723 et seq. (1956), as amended; related Act Rules Chapters 4, 13, and 16.