slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Standards of Nursing Practice For 2009 ALAA Fall Conference PowerPoint Presentation
Download Presentation
Standards of Nursing Practice For 2009 ALAA Fall Conference

Loading in 2 Seconds...

play fullscreen
1 / 136

Standards of Nursing Practice For 2009 ALAA Fall Conference - PowerPoint PPT Presentation


  • 564 Views
  • Uploaded on

Standards of Nursing Practice For 2009 ALAA Fall Conference. Presented by Cathy Boden, MSN, RN Nurse Consultant for Legal Division Alabama Board of Nursing September 2009. Objectives. Identify factors that determine what a nurse can do once they are hired by an employer.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Standards of Nursing Practice For 2009 ALAA Fall Conference' - emily


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
standards of nursing practice for 2009 alaa fall conference

Standards of Nursing Practice For2009 ALAA Fall Conference

Presented by

Cathy Boden, MSN, RN

Nurse Consultant for Legal Division

Alabama Board of Nursing

September 2009

objectives
Objectives
  • Identify factors that determine what a nurse can do once they are hired by an employer.
  • Discuss standards of nursing practice.
  • Recognize and report substandard nursing practice.
who is the alabama board of nursing

Who is the Alabama Board of Nursing?

What is the mission of the ABN?

alabama board of nursing
Alabama Board of Nursing
  • Legislature passed first law establishing Board in 1915
  • Initial approach was to standardize nursing education requirements
  • Voluntary registration
  • Practical nurses first came into being after World War II
composition of the abn
Composition of the ABN
  • Established by The Alabama Nurse Practice Act
  • 13 members - as of July 2009, one RN nursing education position was vacant
  • Appointed by the Governor for 4 year terms – max of 2 consecutive terms or 8 consecutive years
composition of the abn cont d
Composition of the ABN Cont’d
  • 8 RN Positions
    • 3 (Three) must be from practice or administration
    • 3 (Three) must be from nursing education
    • 2 (Two) must be advance practice nurses
  • 4 LPN Positions
    • 2 Nominated by Licensed Practical Nurses

Association of Alabama (LPNAA)

    • 2 Nominated by Alabama Federation of

Licensed Practical Nurses (AFLPN)

  • 1 Consumer
    • No financial gain from health care and not previously

a health care professional

nurse consultants of abn under executive officer genell lee
Nurse Consultants of ABN under Executive Officer, Genell Lee

Legal Division VDAP

Education Advanced Practice

Continuing Education/Practice

mission of the abn
Mission of the ABN
  • The mission of the Alabama Board of Nursing is
    • public protection
    • through the regulation of
      • nursing education
      • nursing practice
board information
Board Information

www.abn.state.al.us

abn attorney investigators
ABN Attorney & Investigators
  • ABN Attorney is a Deputy Attorney General
  • Investigators have law enforcement background, no power to arrest
professional associations
Professional Associations
  • American Nurses Association (ANA)
    • – ASNA (Alabama State Nurses Association)
  • Specialty Associations (Incomplete list)
    • AACN
    • AORN (Association of Peri-Operative Nurses)
    • ENS (Emergency Nurses Association)
    • Infusion Nurses Society
    • American Gastroenterology Association
    • WOCN (Wound Ostomy & Continence Nurses Society)
    • Nephrology Nursing Association
what determines differences

What determines differences?

Is it the nurse’s education program?

Is it what the nurse wears to work?

Is it the facility where the nurse works?

Is it the license the nurse holds?

differences determined by
Differences determined by….
  • Educational preparation
  • Licensure
  • Roles & Scope of Practice
  • Nursing Experiences
  • Competency
differences in basic educational preparation
LPN

1 Year

RN

ADN = 2 years

BSN = 4 years

Differences in Basic Educational Preparation

Begin with type of Nursing Education Program

additional factors of basic nursing education
Additional Factors of Basic Nursing Education

Including but not limited to

  • Clinical experiences available in school
  • Expertise of Instructors
  • Student motivation/reason for entering program
basic education for nursing programs
Basic Education for Nursing Programs

Practices/Procedures/Treatments taught in the nurse’s basic educational program (RN & LPN).

  • Vital Signs*
  • Make a Bed
  • Bed Baths
  • Comfort Care
  • Administer Medications
    • -Oral -Topical - Inhalation
  • Perform Injections
    • - IM - SQ - Intradermal- Z track
basic nursing education rn lpn cont d
Basic Nursing Education RN & LPNCont’d
  • Insert Foley Catheters
    • Females
    • Maybe Males
  • Change basic dressings
  • Basic Infection Control
    • Sterile gloving
    • Sterile field: create & maintain
    • Biohazard waste disposal
additional basic nursing education for the rn incomplete listing
Additional Basic Nursing Education for the RN (incomplete listing)
  • Cardiovascular Alterations - Hemodynamic Monitoring
  • Respiratory Alterations
    • Endotracheal Tube Management
    • Tracheostomy Management
    • Ventilator Monitoring
  • Neurological Alterations
    • Glascow Coma Scale
    • Intracranial Pressure Monitoring
  • Management & Prioritizing
  • Nursing Leadership & Management
specifics of lpn education
Specifics of LPN Education
  • Until 2005/2006, Basic IV Therapy was not in curriculum
  • Until August 2008, Body Structure & Function is in the curriculum instead of Anatomy & Physiology with corresponding lab
  • Curriculum does not include
    • Microbiology
    • Chemistry
  • Clinical many times does not include
    • Psychiatric Nursing
licensure
Licensure
  • Represents
    • Specialized knowledge
    • Independent judgment
    • Fitness and Capacity to Practice
  • Required to practice nursing in the state of Alabama
licensure33
Licensure
  • Alabama is NOT part of the licensure compact at this time.
temporary permit
Temporary Permit
  • New graduates may request a nonrenewable temporary permit to practice nursing that is valid until
    • The applicant fails the licensing examination.
    • The expiration date on the permit is reached.
    • A license is issued.
    • The applicant is denied licensure.
temporary permit administrative code 610 x 4 07
Temporary Permit Administrative Code § 610-X-4-.07
  • Signatures:
    • Practical Nurse (PN) Program = NG-PNP
    • RN Program = NG-RNP
  • Restrictions: The Nursing Graduate
    • Must function under DIRECT Supervision of a currently licensed Registered Nurse
    • Shall not assume nor be assigned charge responsibilities
licensure renewal
Licensure Renewal
  • LPN’s - odd numbered years
    • December 31, 2009
  • RN’s - even numbered years
    • December 31, 2010
  • Continuing education is required for renewal
license renewal
License Renewal
  • “The licensed nurse shall have the active license renewal card available for employer inspection by January 1 of the new license period.”

Administrative Code § 610-X-4-.08(4)

license lookup
License Lookup
  • This application is for LICENSE LOOKUP.
  • Updated daily by 8:00 am.
  • Search by entering the license number or the entire last and first name or by portions of last and first name.
group online license verification by subscription
GROUP ONLINE LICENSE VERIFICATION BY SUBSCRIPTION
  • You can subscribe annually and once you input the license numbers of the nurses employed in your facility/agency, you will receive electronic notification at any time the license status of your nursing employees changes, including renewal.
why should i subscribe
Why should I subscribe?
  • Provides license verification information without phone calls or written requests.
  • PUSH technology will notify you within 24-48 hours if the license status changes.
  • Reduces the risk of individuals working without proper authorization from the Board of Nursing.
  • Provides information to employer about the individual nurse.
level one subscription fee of 100 annually
LEVEL ONE: Subscription fee of $100 annually
  • PUSH technology
  • Name of licensee
  • License Number
  • License status (including temporary permits)
  • Expiration date of license
  • Original date of licensure
    • LEVEL TWO: Subscription fee of $750 annually
    • LEVEL THREE: Subscription fee of $1500 annually
legal foundation of nursing

Legal Foundation of Nursing

Nurse Practice Act

And

Administrative Code

slide44

Nurse Practice Act

And

ABN Administrative Code

legal foundation of nursing practice
Legal Foundation of Nursing Practice
  • Nurse Practice Act: statutes passed by legislature; broad language; provides authority for Board to pass regulations
  • ABN Administrative Code: regulations passed by Board to clarify, amplify, and explain the statutes
    • Proposed rules posted on Board’s web site
    • Requires 35 day public notice and comment period
    • If Board approves, rules become effective in another 35 days after filing
definition of rn in statute
Definition of RN in Statute
  • PRACTICE OF PROFESSIONAL NURSING. The performance, for compensation, of any act in the care and counseling of persons or in the promotion and maintenance of health and prevention of illness and injury based upon the nursing process which includes systematic data gathering, assessment, appropriate nursing judgment and evaluation of human responses to actual or potential health problems through such services as case finding, health teaching, health counseling; provision of care supportive to or restorative of life and well-being; and executing medical regimens including administering medications and treatments prescribed by a licensed or otherwise legally authorized physician or dentist. A nursing regimen shall be consistent with and shall not vary any existing medical regimen. Additional acts requiring appropriate education and training designed to maintain access to a level of health care for the consumer may be performed under emergency or other conditions which are recognized by the nursing and medical professions as proper to be performed by a registered nurse.
          • Code of Ala., 1975, §34-21-1(3)(a)
practice of professional nursing registered nurse
Practice of Professional Nursing(Registered Nurse)
  • The performance, for compensation, of any act in the
    • Care and counseling
    • Promotion and maintenance of health
    • Prevention of illness and injury
practice of professional nursing cont d
Practice of Professional Nursing Cont’d
  • Based upon the nursing process including
    • Systematic data gathering
    • Assessment
    • Appropriate nursing judgment and evaluation of human response
  • Case finding
  • Health Teaching
  • Health counseling
practice of professional nursing cont d49
Practice of Professional Nursing Cont’d
  • Provision of care supportive to or restorative of life and well-being
  • Executing medical regimens including administering medications and treatments prescribed by a licensed…..physician or dentist
definition of lpn in statute
Definition of LPN in Statute
  • PRACTICE OF PRACTICAL NURSING. The performance, for compensation, of acts designed to promote and maintain health, prevent illness and injury and provide care utilizing standardized procedures and the nursing process, including administering medications and treatments, under the direction of a licensed professional nurse or a licensed or otherwise legally authorized physician or dentist. Such practice requires basic knowledge of the biological, physical and behavioral sciences and of nursing skills but does not require the substantial specialized skill, independent judgment and knowledge required in the practice of professional nursing. Additional acts requiring appropriate education and training may be performed under emergency or other conditions which are recognized by the nursing and medical professions as proper to be performed by a licensed practical nurse.
  • Code of Al., 1975, § 34-21-1(3)(b)
practice of practical nursing licensed practical nurse
Practice of Practical Nursing(Licensed Practical Nurse)
  • The performance, for compensation, of acts designed to
    • Promote and maintain health
    • Prevent illness and injury
    • Provide care utilizing standardized procedures and the nursing process
      • Including administering medications and treatments
practice of practical nursing cont d
Practice of Practical Nursing Cont’d
  • Under the direction of a
    • Licensed professional nurse
    • Licensed or otherwise legally authorized physician

Or

    • Licensed or otherwise legally authorized dentist
practice of practical nursing cont d53
Practice of Practical Nursing Cont’d
  • Such practice requires basic knowledge of the biological, physical and behavioral sciences and of nursing skills but
  • does not require
    • the substantial specialized skill,
    • independent judgment and
    • knowledge

required in the practice of professional

nursing

regulation
Regulation
  • ABN Administrative Code: regulations passed by Board to clarify, amplify and explain the statutes
examples of regulations chapter 610 x 6 standards of nursing practice
Examples of RegulationsChapter 610-X-6, Standards of Nursing Practice
  • -.02: Conduct and Accountability
    • (2) Function within the legal scope of nursing practice.
examples of regulations chapter 610 x 6 standards of nursing practice56
Examples of RegulationsChapter 610-X-6, Standards of Nursing Practice
  • -.02: Conduct and Accountability
    • (9) Respect dignity and rights of patients and their significant others including, but not limited to: (a) Privacy; (b) Protection of confidential information, unless disclosure is required by law; (c) freedom from exploitation of physical, mental, sexual, or financial boundaries; and (d) protection of real and personal property.
examples of regulations chapter 610 x 6 standards of nursing practice57
Examples of RegulationsChapter 610-X-6, Standards of Nursing Practice
  • -.03(2) and -.04(2) Competence…shall include, but is not limited to:

(e) Delegation of selected nursing functions to others in accordance with the education and demonstrated competence of the persons. Tasks delegated to unlicensed assistive personnel shall not require the exercise of independent nursing judgment or intervention. Selected nursing functions that may not be delegated include but are not limited to performance of invasive or sterile procedures or administration of medications except as provided in Rule 610-X-6-.06, -.07.

how do you access the alabama nurse practice act and administrative code

How do you access the Alabama Nurse Practice Act and Administrative Code?

www.abn.state.al.us

Nurse Practice Act

Administrative Code

Declaratory Rulings

Proposed Rule Changes

what are standards of practice
What are Standards of Practice?
  • Level of performance that is
    • Desired and
    • Achievable
  • Expectation for nurses’ conduct and practice
where do standards come from
Where do standards come from?
  • Laws and Regulations
    • Nurse Practice Act
    • ABN Administrative Code
  • Agency/Facility Policies & Procedures
  • Nursing Education
  • Professional Associations
example of a nursing standard
Example of a Nursing Standard

SEVEN Rights of Medication Administration

  • Right Patient
  • Right Medication
  • Right Time
  • Right Dose
  • Right Route
  • Right Reason
  • Right Documentation
documentation standard
Documentation Standard
  • If you didn’t chart it, it wasn’t done.
care standards
Care Standards
  • Knock before entering
  • Tell the patient what you are

going to do BEFORE you do it

care standards cont d
Care Standards Cont’d
  • Introduce self to patient
  • Wear a name tag that can be seen & read
care standards cont d65
Provide for Hand Hygiene before meals

Straighten sheets, particularly for bedbound patients

Care Standards Cont’d
additional substandard practice violations
Abandonment

Boundary violations

Confidentiality breach

Improper Delegation

Improper Supervision

Additional Substandard Practice Violations
adjudication of discipline

ADJUDICATION OF DISCIPLINE

Discipline,

Removal from Practice

and

Readmission to Practice

complaints to abn
Complaints to ABN
  • Must be in writing
    • Email (abn@abn.state.al.us)
    • Letter
    • Form (website under Forms & Other Information)
      • Employers Report of Possible Violation Form
      • Consumers Report of Possible Violation Form
complaints cont d
Complaints Cont’d
  • Can be anonymous
  • Must contain sufficient information to identify the nurse who is being reported and what the nurse is alleged to have done wrong
process
Process
  • Docketed in database
  • Reviewed by Executive Officer
  • Notice of Investigation sent to Nurse
  • Acknowledgment sent to Complainant
  • Subpoena(s) issued
  • Investigated
non discipline options
NON-Discipline Options
  • No violation: letter of closure
  • No provable violation but reported conduct inappropriate: Letter of Admonishment
  • VDAP
    • Drugs/Alcohol abuse & dependency
    • Mental Illness
    • Physical Impairment
discipline option board must be able to prove violation
Discipline Option: Board must be able to prove violation
  • Informal vs. Formal Disposition
    • Informal:
      • Consent Order
      • Voluntary Surrender (self-revocation by nurse)
    • Formal: Administrative Hearing
types of discipline
Types of Discipline
  • Reprimand
  • Reprimand and Fine
  • Probation
    • Fine
    • Until conditions met
    • Specific time period (1-5 years)
types of discipline cont d
Types of Discipline Cont’d
  • Suspension:
    • Fine
    • Until conditions met
    • Certain time period
    • May be followed by a period of Probation
    • One year: automatic revocation clause in order if suspension extends beyond 12 months
  • Revocation
  • Voluntary Surrender: Self-revocation
slide79

Board of Medical Examiners

Federal Laws Specific to Facility Type

Facility/Agency Policies & Procedures

NURSE PRACTICE ACT

&

ADMINISTRATIVE CODE

Board of Pharmacy

Accrediting Bodies

Federal Laws

HIPAA, ADA, EMTALA, CLIA, OSHA, Civil Rights, etc.

Other Professional Boards/Rules

Physical Therapy, Speech Therapy, etc

Rules/Laws of State Agencies (Departments)

ADEM, ADPH, etc

Other Laws, Rules and Regulations can NOT weaken the Nurse Practice Act and Administrative Code but do influence Nursing Practice

Non-Inclusive List

conduct and accountability administrative code 610 x 6 02
Conduct and AccountabilityAdministrative Code§ 610-X-6-.02
  • What is Accountability?

Answerable or responsible for actions

  • What is Responsibility?

The charge to do something that is expected performance.

  • Shall = mandatory

Administrative Code § 610-X-2-.06 (4)

conduct and accountability administrative code 610 x 6 02 6
Conduct and AccountabilityAdministrative Code § 610-X-6-.02(6)
  • The RN and LPN shall
    • Accept individual responsibility and accountability for judgments, actions and nursing competency.
substandard practice failure to intervene
Substandard PracticeFailure to intervene
  • Resident lying on floor, had large amount of feces on herself after she lost her step/blacked out while attempting to get to the bathroom
  • Nurse allowed the resident to be assisted to the shower prior to assessing the resident for injuries
  • Medical evaluation the next day-fracture of left proximal humerus
  • Probation for 12 months, $300 fine, courses on critical thinking, patient assessment, and professional accountability

Limestone Lodge Assisted Living

medication error
Medication Error
  • RN administered Morphine 40 mg IV push instead of ordered 4 mg
  • RN administered Morphine 50 mg IV push instead of ordered D50W for treatment of hypoglycemia
medication error cont
Medication Error Cont
  • LPN administered Tetanus intradermally instead of PPD
  • LPN administered multiple oral medications in error
  • RN administered 4 Restoril tablets instead of

4 Lyrica tablets

patient care orders

Patient Care Orders

Administrative Code§ 610-X-6-.09

patient care orders and the definition of professional nursing
Patient Care Orders and the Definition of Professional Nursing
  • ...executing medical regimens including administering medications and treatments prescribed by a licensed or otherwise legally authorized physician or dentist.

Code of Alabama, 1975 § 34-21-1(3a)

patient care orders and the definition of practical nursing
Patient Care Orders and the Definition of Practical Nursing
  • ... including administering medications and treatments, under the direction of a licensed professional nurse or a licensed or otherwise legally authorized physician or dentist.

Code of Alabama, 1975 § 34-21-1(3)(b)

patient care orders administrative code 610 x 6 09
Patient Care OrdersAdministrative Code § 610-X-6-.09
  • “Authorized prescriber”
    • Licensed physician or dentist
    • CRNP (Nurse Practitioner)
    • CNM (Nurse Midwife)
    • LICENSED Physician’s Assistant or Surgical Assistant
  • Lawful order
  • CRNPs & CNM may NOT order narcotic medications
verbal orders administrative code 610 x 6 09 2
Verbal Orders Administrative Code § 610-X-6-.09(2)
  • RN or LPN may receive verbal orders from an authorized prescriber relayed by
    • another licensed or registered health care professional or
    • CERTIFIED medical assistant
  • Implement standing orders at the direction of an authorized prescriber
telecommunication for pronouncement of patient death administrative code 610 x 6 10
Telecommunication for Pronouncement of Patient DeathAdministrative Code § 610-X-6-.10
  • The RN or LPN may receive a pronouncement of a patient’s death from a physician via telecommunication without a physical examination of the patient by that physician. A standardized procedure shall specify the permissible patient conditions for which the RN or LPN in a specific health care facility or agency may receive the pronouncement of a patient’s death by telecommunications.
substandard practice lack of md order scope of practice
Substandard PracticeLack of MD OrderScope of Practice
  • Gave another employee an injection of Rocephin with no MD order.
tips on charting
Tips on Charting
  • Write legibly in INK
  • Be accurate
    • Date & Time
    • NO Block Charting (7-3 Resting quietly)
    • Late Entries
abbreviations
Abbreviations
  • Use approved abbreviations
    • Accepted Standards vs specialty practice terms
      • VAD
        • Vascular Access Device
        • Ventricular Assist Device
    • JCAHO Patient Safety Program
      • Hazardous abbreviations in medication orders
tips on charting cont d
Tips on Charting Cont’d
  • Descriptive Terminology
      • “Punch” colored (what flavor punch?)
  • Be concise
  • Be objective; Write facts, not opinions
  • Assessment/interpretation
    • Behavior
      • “Resting comfortably” (Says who?)
      • “Confused” (Says who?)
grounds for disciplinary action regarding documentation
Grounds for Disciplinary Action regarding Documentation
  • Failure to make entries (NEVER discard pages from PERMANENT patient record)
  • Destroying or altering entries (Recopy, for legibility, and label the page: keep old and new pages together)
  • Pre-charting - Charting BEFORE assessment or delivery of care
    • Medication
    • Treatment
    • Assessment

Administrative Code § 610-X-8-.03(6)(g) and (h)

traditional standard of documentation
Traditional Standard of Documentation……
  • If you didn’t chart it, it wasn’t done.
abn added
ABN added…..
  • If you didn’t do it, DON’T chart it!
substandard practice false documentation
Substandard PracticeFalse Documentation
  • Documented the administration of Percocet and Lortab for which there was no record of sign out on the controlled drug record
    • boundary violation - accepted and cashed checks made out to her by a resident
    • exceeded LPN scope of practice - supervised all aspects of resident care provided by licensed and non-licensed staff and provided care without the direction of a Registered Nurse
  • Suspension until payment of $500 fine and courses on documentation, professional accountability, and chemical dependency followed by probation for 12 months

Mature Options Senior Services–Seasons of Talladega, Autumn Trace, & Summer Place

conduct and accountability administrative code 610 x 6 02 3
Conduct and AccountabilityAdministrative Code § 610-X-6-.02(3)
  • The RN and LPN shall
    • Be responsible and accountable for the QUALITY of nursing care delivered to patients
      • based on and LIMITED to
        • scope of education,
        • demonstrated competence, and
        • nursing experience.
conduct and accountability cont d administrative code 610 x 6 02
Conduct and Accountability(Cont’d) Administrative Code § 610-X-6-.02
  • Respect the dignity and rights of patients and their significant others including, but not limited to:
    • Privacy; protection of confidential information, unless disclosure is required by law;
    • Freedom from exploitation of physical, mental, sexual, or financial boundaries; and
    • Protection of real and personal property.
abuse

Abuse

“Intentionally or negligently causing or permitting physical, sexual, emotional or verbal abuse of a patient, willfully harassing or intimidating a patient.”

Administrative Code 610-X-8-.03(6)(o)

substandard practice patient abuse
Substandard PracticePatient Abuse
  • Repeatedly sprayed wound cleanser in the face of a quadriplegic resident during the resident’s care.
  • Subsequently disciplined on two other occasions
substandard practice patient abuse104
Substandard PracticePatient Abuse
  • Tied the resident in the wheelchair with a bed sheet.
substandard practice patient abuse105
Substandard PracticePatient Abuse
  • Verbally abused and used profanity with a patient in an attempt to get the patient to return to the other side of the patient’s semi-private room.
scope of practice administrative code 610 x 6 03 and 04
Scope of PracticeAdministrative Code § 610-X-6-.03 and -.04

…includes but is not limited to:

  • (a) Educational preparation, initial and continued;
  • (b) License status, including Board approval for advanced practice nursing;
  • (c) State and federal statutes, and regulations;
  • (d) State and national standards appropriate to the type of practice;
  • (e) Nursing experience;
  • (f) Demonstrated competence; and
  • (g) Knowledge, skills, and ability to manage risks and potential complications.
practice beyond scope illegal practice
Practice Beyond ScopeIllegal Practice
  • Practiced as RN supervisor for compensation while her license was lapsed
  • Public reprimand and payment of $600 fine

St. Martins in the Pines

please identify
Please Identify….
  • Any basic NURSING program that taught a student how to use a scalpel
substandard practice exceeded scope of practice
Substandard PracticeExceeded Scope of Practice
  • Nurse performed sharp debridement on a patient’s heel
conduct and accountability administrative code 610 x 6 02 4
Conduct and AccountabilityAdministrative Code § 610-X-6-.02(4)
  • The RN or LPN shall
    • Be responsible and accountable for the quality of nursing care delivered to patients by nursing personnel under the individual nurse’s supervision
responsibility accountability
RN supervises

Other RNs

LPNS

Nursing Assistants

LPN supervises

Other LPNs

Nursing Assistants

Responsibility & Accountability
delegation

Delegation

The act of authorizing a competent individual to perform acts supportive to RNs or LPNs in selected situations.

Administrative Code § 610-X-6-.03 (2e) & .04(2e)

delegation administrative code 610 x 6 03 2e 610 x 6 04 2e
DelegationAdministrative Code§ 610-X-6-.03 (2e) & 610-X-6-.04(2e)
  • Tasks delegated to UNLICENSED personnel shall involve
    • NO tasks or functions that require independent nursing judgment or intervention
    • NO invasive or sterile procedures
    • NO administration of medications
delegation administrative code 610 x 6 03 2 e 610 x 6 04 2 e
DelegationAdministrative Code§610-X-6-.03 (2)(e) & 610-X-6-.04(2)(e)
  • Consistent with
    • education AND
    • demonstrated competence of the PERSON to whom the task is delegated
substandard practice improper delegation supervision
Substandard PracticeImproper Delegation/supervision
  • Allowed unlicensed staff to administer medications to residents
  • Acknowledged that she prepared the medications and signed the MAR to reflect that the medication was given
  • Public reprimand and payment of $300 fine

TLC Assisted Living Home

abandonment

Abandonment

Acceptance of a patient assignment, thus

establishing a nurse-patient relationship, and

then Ending the nurse-patient relationship

Without Giving Reasonable Notice to

supervisory personnel so that others can make

arrangements for continuation of nursing care.

substandard practice abandonment
Substandard PracticeAbandonment
  • Abandoned her assignment without notice to supervisory personnel so that others could make arrangements for continuation of nursing care
    • Fraud/deceit - falsified time card
    • False documentation – falsified resident’s MAR
  • Probation for 12 months, payment of $300 fine and courses on professional accountability, documentation, and legal/ethical aspects of nursing

Cedar Hill Assisted Living Facility

unprofessional behavior conduct

Unprofessional Behavior/Conduct

Nursing behaviors

(acts, knowledge & practices)

failing to meet the minimal standards of acceptable and prevailing nursing practice,

which could jeopardize the health, safety and welfare of the public

substandard practice unprofessional conduct
Substandard PracticeUnprofessional Conduct
  • Completed terms of an Order (Probation until completion of course on legal/ethical aspects of nursing and payment of $250 fine) due to unprofessional conduct, THEN
  • Failed to observe that medications were administered as documented; left medication on a table; excessive amount of medication on hand when compared to MAR and date medication dispensed
  • Same conduct at a Nursing Home
  • Suspension until payment of $1000 fine and completion of pharmacology course followed by probation for 24 months

Ashton Gables in Riverchase and Lakeview Estates Assisted Living

substandard practice unprofessional conduct120
Substandard PracticeUnprofessional Conduct
  • Involved in altercation and assaulted PCT by slapping PCT in the face twice
frequent misconceptions often resulting in disciplinary action
Frequent Misconceptions often resulting in Disciplinary Action

From the Nurse

  • “Because a doctor told me to do a procedure/give a medication, it is OK.”

From the Physician

  • “Because I told the nurse to

do a procedure/give a medication,

it is OK”

conduct and accountability administrative code 610 x 6 02122
Conduct and AccountabilityAdministrative Code § 610-X-6-.02
  • Collaborate WITH other members of the health care team.
  • Practice WITHOUT discrimination on the basis of age, race, religion, gender, national origin, sexual orientation, patient diagnosis or disability.
professional boundary

Professional Boundary

Administrative Code § 610-X-8-.03(6p)

slide124
Grounds for disciplinary action related to Professional Boundary ViolationAdministrative Code § 610-X-8-.03(6)(p)(i), (ii), and (iii)
  • Sexual or Intimate Conduct
  • Emotional or Financial Exploitation
  • Inappropriate Disclosure

With/ to a patient, patient’s immediate family member(s) or significant other(s)

individual nurse s responsibility
Individual Nurse’s Responsibility
  • Accept individual responsibility and accountability for timely reporting of
    • illegal,
    • substandard,
    • unethical,
    • unsafe, or
    • incompetent nursing practice

DIRECTLY to the Board of Nursing.

Administrative Code § 610-X-6-.02(10)

competence

Competence

Administrative Code § 610-X-6-.03(2)

Administrative Code§ 610-X-6-.04(2)

competence in the practice of nursing administrative code 610 x 6 03 2 04 2
Competence in the Practice of Nursing Administrative Code§ 610-X-6-.03(2) & .04(2)
  • Includes but is not limited to:
    • Knowledge and compliance with:
      • Applicable statutes and regulations
      • Standards of nursing practice
      • Standardized procedures for nursing practice
competency cont d administrative code 610 x 6 02 6
Competency Cont’dAdministrative Code § 610-X-6-.02(6)

The RN and LPN shall

  • Accept individual responsibility and accountability for judgments, actions and nursing COMPETENCY.
competence shall include administrative code 610 x 6 03 2b
“Competence….shall include….”Administrative Code § 610-X-6-.03(2b)
  • “Maintenance of knowledge and skills in the area of practice.”
continuing education for renewal of license administrative code 610 x 4 08 3 b and c
Continuing Education for renewal of licenseAdministrative Code § 610-X-4-.08(3)(b) and (c)
  • A registered nurse and licensed practical nurse shall earn in each earning period not less than 24 contact hours of Board-approved or Board-recognized continuing education as a condition for renewal of license for the subsequent license period.
  • Failure to meet the continuing education requirement shall be cause for the license to lapse.
grounds for disciplinary action related to continuing education administrative code 610 x 10 02 4
Grounds for Disciplinary Action related to Continuing EducationAdministrative Code §610-X-10-.02(4)
  • Failure to comply with continuing education requirements may result in disciplinary action by the Board.
alabama nurse s
Alabama Nurse’s
  • FY 2008 - 68,145 nurse’s
    • 50, 184 RN’s
    • 17, 961 LPN’s
  • As of June 2009
    • 325 nurse’s monitored in VDAP
    • 317 nurse’s with license status of Active/Probation
      • 218 RN’s
      • 94 LPN’s
      • 3 CRNA’s
      • 2 CRNP’s
nursing education programs july 2009
Nursing Education ProgramsJuly 2009
  • 43 RN Programs
    • 27 ADN
    • 1 ADN mobility (LPN to RN)
    • 15 BSN
  • 24 PN Programs
what s new july 2009
What’s newJuly 2009
  • New Rules
    • Continuing Education 610-X-2-.10 and 610-X-10
      • eliminated the distinction between independent study and attended CE
    • Licensure 610-X-4-.07, -.08 and -.10
      • incorporated new CE rules
  • Rules under revision
    • Standards of Practice 610-X-6 and -7
    • Discipline 610-X-8
board vacancies as of jan 1 2010
Board Vacancies as of Jan 1, 2010
  • RN Nursing Practice Position (1)
  • RN Nursing Education Position (1)
  • Advanced Practice Nursing Position (1)
  • LPN Position through LPNAA (1)
    • The position is nominated by LPNAA.  Ms. Hopkins is eligible for reappointment. 
  • Consumer Position (1)
    • The consumer position is not nominated by any particular group and is appointed by the Governor.  Mr. Harry I. Brown, Jr. is eligible for reappointment.