Ohio Nurse Practice Act 1.5 CE

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This fulfills the continuing education requirement of 1.5 contact hours relating the Ohio Nurse Practice Act for the state of Ohio.  

Modern nursing has been standardized nationwide in the way that nurses are educated and the standards they are held to when performing their jobs. While the minimum proficiency exam, the National Council Licensure Exam (NCLEX), is used to determine who qualifies to be a nurse, each state has its own Nurse Practice Act that oversees the nurses of that state and sets ensures the standards for safe and skilled care are being followed (1). This course will cover Ohio Nurse Practice Act in detail to best prepare Ohio nurses to provide the best care possible. 

Introduction

Nursing as a trained profession has been around for over 200 years in the United States, with the first courses on caring for maternity clients taught by Dr. Valentine Seaman in 1798 in New York. Over the next 100 years, nursing education became more standardized and widespread, following the overseas lead of Florence Nightingale and rising to meet the need for skilled health professionals with the outbreak of the Civil War. In 1873, there were three nursing education schools in the United States; by 1900, there were more than 400 schools (101)! This rapid growth was fueled by the increasing demand for healthcare professionals and the recognition of nursing as a distinct and valuable profession. Fast forward another 120 years, and there are now 3.8 million nurses caring for the citizens of this country, and the demand for more is expected to grow as the Baby Boomer population ages (1).

Modern nursing has been standardized nationwide, so that nurses are educated and the standards they are held to when performing their jobs. While the minimum proficiency exam, the National Council Licensure Exam (NCLEX), is used to determine who qualifies to be a nurse, each state has its own Nurse Practice Act that oversees the nurses of that state and ensures the standards for safe and skilled care are being followed (1). This course aims to explore the rules and regulations for the state of Ohio and familiarize the learner with the Ohio Nurse Practice Act.

Ohio Administrative Code, Revised Code, and Board of Nursing

The Ohio Administrative Code (OAC) delineates the rules and regulations of various licensed professions, and Section 4723 of the Ohio Revised Code (ORC, 2023) is specific to nursing practice. This section of the ORC (based on the Ohio Nurse Practice Act) outlines specifics for ensuring proper safety, delegation, competency standards, application of the nursing process, and disciplinary action for nurses with an Ohio license.

While the OAC sets the standards and scope of practice of nurses in the state, a governing body must enforce the rules and regulations. This is where the Ohio Board of Nursing (OBN) comes in. ORC Section 4723-02 (2017) dictates that the OBN be composed of thirteen members; at least eight of whom should be registered nurses (RNs), at least two licensed practical nurses (LPNs), two advanced practice registered nurses (APRNs), and one consumer representative. All licensed members of the board should have an active, unencumbered license and at least five years of recent experience in the workforce.

The board is legally authorized to enforce the rules by the Ohio Nurse Practice Act's OAC and must review each rule at least once every five years. They are also responsible for reviewing and granting approval to nursing education programs, issuing and renewing nursing licenses, and regulating the substance abuse monitoring program for nursing professionals. The funding for the OBN comes from licensure fees for nurses practicing in the state of Ohio.

Scopes of Practice and Application of Nursing Process

The scopes of practice within the Ohio Nurse Practice Act encompass a list of duties, services, and tasks that Ohio nurses are qualified and permitted to perform under their license. The scope of practice varies by level of licensure (LPN, RN, APRN) and allows nurses to carry out their roles while effectively maintaining maximum client safety.

RN Scope of Practice

Section 4723.01 of the ORC (2023)  specifies) RNs can utilize the specialized training and multifaceted, holistic knowledge gained from an accredited nursing education program to provide nursing care to individuals or groups. Tasks considered "nursing care" include:

1. Identifying patterns in human response to actual or potential health issues that could be altered by a preventative, restorative, or health-promotion "nursing regimen."
2. Delivering nursing regimens/interventions utilizing the nursing process (outlined below).
3. Using interviews, observation, and physical exam techniques to assess a client's health status and provide appropriate nursing care.
4. Providing clients with health-related counseling and teaching.
5. Administering medications, treatments, and other interventions as specified in orders given by a qualified and licensed professional.
6. Teaching, supervising, delegating, and evaluating nursing practice (6).

RN Application of Nursing Process

The Nursing Process is a standard sequence of steps to guide clients' holistic, safe, and effective care. The five steps always include Assessment, Analysis and Reporting, Planning, Implementation, and Evaluation. Further review of each of these steps, as supported by the OAC, is below:

1. Assessment of health status-
   1. Collect subjective and objective data from clients via history, observations, and physical exam. This can also include data reported to the nurse from a client's family or an LPN.
   2. Documentation of that data
2. Analysis and Reporting-
   1. Identify, organize, and interpret data
   2. Establish or modify the nursing diagnoses
   3. Report nursing diagnoses and health status to other healthcare team members as necessary.
3. Planning-
   1. Establish or modify a plan of care, including nursing interventions and client outcomes or goals.
   2. Communicate the nursing plan to other healthcare team members
4. Implementation-
   1. Carry out the plan within the scope of practice
   2. Implement orders from the prescribing members of the healthcare team
   3. Provide care within the nurse's education and training
   4. Assist and collaborate with other members of the healthcare team
   5. Delegate tasks as appropriate within the Administrative Code
5. Evaluation-
   1. Evaluate, document, and report as necessary
   2. Client's response to performed interventions
   3. Progress towards identified goals
   4. Reassess the clients' status and modify the nursing plan as needed (4)

LPN Scope of Practice

The Ohio Administrative Code Section Rule 4723-4-08 (2024) also specifies the LPN scope of practice, which is similar to the RN scope but has less autonomy and requires more collaboration. Tasks within the LPN scope of practice include:

1. Contribute to Observation, focused assessments, care, and client teaching in various settings.
2. Contributing to the planning, implementation, and evaluation of nursing care.
3. Implementation of interventions, collection and reporting of data, administration of medication and treatments as ordered by a qualified professional, and after completion of a medication proficiency course. Along with providing basic nursing care, collaboration with healthcare providers, and delegation of tasks
4. The LPN may delegate to unlicensed assistive personnel, such as CNAs, within the rules of the Administrative Code.
5. Contribute to evaluating client response to nursing interventions via documentation, communication, and contribution to reassessing the client and their care plan. Teaching nursing tasks to other LPNs or unlicensed assistive personnel (5).

Of note, tasks prohibited for LPNs include:

1. Engaging in nursing practice without direction from an RN or a qualified licensed professional such as a physician, physician assistant, dentist, podiatrist, optometrist, or chiropractor (6).
2. Administering IV push medications.
3. Teaching the practice of nursing.
4. Supervising or evaluating the nursing practice.
5. Performing comprehensive assessments to provide nursing care (5).

LPN Application for Nursing Process

The nursing process varies for the LPN in that these professionals mainly contribute to the process rather than initiate or carry it out. Specifics of this process, as outlined by Ohio Administrative Code Section Rule 4723-4-08 (2024) , include:

1. Contribute to the client's assessment
   1. Through collecting objective and subjective data about the client's condition as part of the health status assessment
2. Reporting assessments to the registered nurse or other members of the healthcare team
3. Contributing to the planning of nursing care
   1. Including the development or modification of care plans
   2. Communicate the plan of care to the necessary healthcare team members
   3. Implementation and provide nursing interventions within the scope of care
   4. Administer ordered medications and treatment
   5. Provide nursing care as directed by a registered nurse or healthcare provider.
   6. Collaborating with other nurses and team members
   7. Delegate to unlicensed assistive personnel only per the Administrative Code
4. Contributing to evaluation.
   1. Client response to nursing interventions
   2. Documentation of client response
   3. Communicate results to a registered nurse or healthcare provider
5. Contribute to reassessment of the clients' health and any modifications to the plan of care (5)

Case Study

Scenario: Ruby, an RN, is assigned as the charge nurse on a busy medical-surgical unit. She oversees client care, manages staff assignments, and ensures all nursing tasks are completed within the appropriate scope of practice. On this shift, she works with Tania, an LPN, and Ben, a CNA.

One of Ruby’s clients, Mr. Brown, is a postoperative client recovering from orthopedic surgery. His care includes frequent pain assessments, wound care, IV medication administration, and ongoing monitoring for post-operative complications. Ruby must ensure that all tasks are completed appropriately while delegating within the scope of practice outlined by the Ohio Nurse Practice Act.

Assessment: Ruby evaluates the complexity of Mr. Johnson’s condition and the necessary nursing interventions. She determines that administration of IV medications and administering IV medications and conducting comprehensive physical assessments fall within the RN’s scope of practice and cannot be delegated to Tania.

However, under Ruby's direction, Tania can monitor his vital signs, reinforce client education, and assist with wound care. Ruby also considers delegating basic tasks, such as repositioning and assisting with hygiene, to Ben, the CNA. Before proceeding, Ruby ensures that Tania and Ben are comfortable with the delegated tasks.

Plan: Ruby develops a delegation plan that aligns with the Ohio Nurse Practice Act. She retains responsibility for administering Mr. Brown's IV medication, conducting comprehensive physical assessments, and evaluating his overall response to treatment. She assigns Tania to monitor his vital signs every four hours, report any abnormalities, and assist with non-complex wound care. Ben is instructed to help Mr. Brown with ambulation and daily living activities. Ruby communicates expectations, ensures Tania and Ben understand their roles, and remains available for questions or intervention.

Outcome Evaluation: Throughout the shift, Ruby monitors Mr. Brown's progress and evaluates the effectiveness of her delegation. Tania successfully reports vital sign trends and assists with wound care as directed. Ben helps Mr. Brown with mobility, reducing the risk of post-operative complications such as deep vein thrombosis. By adhering to the delegation guidelines set forth by the Ohio Nurse Practice Act, Ruby ensures that Mr. Brown receives safe and effective care while efficiently utilizing the skills of the healthcare team. At the end of the shift, Ruby documents the interventions performed, reviews client outcomes, and discusses any necessary adjustments to the care plan with the team. Her delegation decisions promote client safety, optimize workflow, and uphold the standards of nursing practice in Ohio's nursing practice standards.

Standards of Competency

Standards of Competency within the Ohio Administrative Code, Rule 4723-4-03 (2024).

Outline the qualifications a nurse must have to operate within their scope of practice. If the scope of practice details what nurses can do, then standards of competency outline how they must do it. These standards include:

1. Understanding and operating within the scope of practice appropriate for licensure level.
2. Maintaining current knowledge of duties, responsibilities, and accountabilities for safe practice.
3. Demonstrating consistent care practices and recognizing when to consult with colleagues or refer care.
4. Providing care beyond basic nursing education only when additional education and training have been obtained and documented, appropriate skills demonstrated, an order from a qualified provider, and the tasks are within the laws of that state.
5. Implementing provider orders within a reasonable time frame, unless an order is determined to be invalid, dangerous, or contraindicated, and clarifying provider orders where necessary
6. Demonstrating the ability to identify invalid, harmful, or unauthorized orders and consulting with the ordering provider to rectify the situation by either obtaining a corrected order or maintaining client safety by deciding not to follow an order and documenting the entirety of the encounter
7. Collaborating with and referring to other nursing team members when appropriate.
8. Maintaining client confidentiality within the realm of legal and safety considerations.
9. Keeping identifiable client information (name, birth date, etc.) confidential to the greatest extent possible.
10. Using standards of care that promote client safety (2)

In addition to the above standards, RNs must consider competency standards when directing tasks to an LPN or unlicensed assistive personnel (CNA, client care technician, etc.). Ultimately, Rule 4723-4-03 of the Ohio Administrative Code (2024) outlines that the care of a client falls on the nurse, and delegation to unlicensed personnel is safe and appropriate only when the following criteria have been met:

1. The condition and stability of the client are appropriate for CNA care.
2. According to the Administrative Code, the type of care or tasks required are within the scope of practice of the LPN or CNA.
3. The complexity and frequency of said tasks are within the capabilities of the CNA.
4. The training and skill level of the LPN or CNA's training and skill level will allow them to complete the delegated task competently.
5. Resources needed to complete the task are readily available and accessible (2)

Standards for Promoting Client Safety

Understanding the Ohio Nurse Practice Act's Scope of Practice, Nursing Process, and Standards of Competency should lead a nurse to provide care that promotes the best outcomes for clients, including maintaining client safety. If there are any situations where it is unclear what is safest, Section 4723-4.06 of the OAC (2024) has outlined some standards. They are:

1. Nursing professionals will wear proper identification with their name and title, visible to clients always when providing care, as outlined in the ORC Section 4723.03
2. Nurses must delegate tasks and medication administration only within the scope of the profession to which they are delegated, as outlined in the OACAs outlined in the OAC.
3. Nurses must document assessments, care, client responses to care, and any errors promptly.
4. Nurses shall report any errors or deviations from ordered interventions
5. Nurses must not falsify or alter documentation of nursing care in any manner.
6. Nurses must maintain professional boundaries, ensure privacy, and create a safe environment for clients.
7. Nurses must not engage in any physical, verbal, mental, or emotionally abusive behavior when caring for clients or any behavior that could be interpreted as such
8. Nurses must not misappropriate client patient property in any way, accept or seek monetary gain at a client patient's expense, or become involved in client patients' personal or financial matters.
9. Nurses must not engage in sexual conduct with clients or sexually harass or exploit clients in any verbal or physical manner
10. Nurses in administrative roles are responsible for ensuring their staff have valid and appropriate licensure, education, and training to provide safe care for clients.
11. Nurses must not falsely claim to the OBN, law enforcement, or hospital administration.
12. Nurses may not use texting, email, or social media to communicate client information for purposes other than carrying out the responsibilities of their job (3)

Conclusion

There are many more subsections to the OAC that detail more specifics about licensure, disciplinary action, and APRNs. Still, it is beyond the knowledge needed for basic competency as a nurse practicing in Ohio. While most nurses will find the scope of practice, safety guidelines, and minimum competency standards outlined in the Ohio Nurse Practice Act to be similar from state to state, there is the potential for differences across state lines.

Familiarizing yourself with the state in which you practice is always a good idea. Understanding the relationship between the RN and LPN scopes of practice and nursing processes may be particularly important depending on your workplace setting. The OAC is in the public domain and can be easily accessed to clarify any questions, and the OBN can be contacted for guidance in any gray area.

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