Course

Ohio Nurse Practice Act

 Course Highlights


  • In this course we will learn about the Ohio Nurse Practice Act and how its guidelines further promote patient care and safety.
  • You’ll also learn the basics of the Ohio Administrative Code, including both its standards of competency and scope of practice for RNs and LPNs, as required by the Ohio Nursing Association.
  • You’ll leave this course with a broader understanding of how to apply these guidelines into real-life practice in order to provide exceptional care to patients.

About

Contact Hours Awarded: 1.5

Course By:
Charmaine Robinson

MSN-Ed, BSN, RN, PHN, CMSRN

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The following course content

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 and Objectives 

Nursing as a trained profession has been around for over 200 years in the United States, with the first courses on caring for maternity patients 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 schools for nursing education in the United States; by 1900, there were more than 400 schools (8)! 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 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). Upon completion of this course, the learner should have increased knowledge of the standards outlined by the Ohio Nurse Practice Act and demonstrate an understanding of:  

  1. The definition and roles of the Ohio Board of Nursing, and the Ohio Administrative Code, and Revised Code. 
  2. Differences between scopes of practice and nursing process for RNs and LPNs. 
  3. Basic concepts included in Standards of Competency for nurses. 
  4. Standards of care required to maximize patient safety. 

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, 2022) is specific to nursing practice. This section of the ORC (based on the Ohio Nurse Practice Act) outlines specifics in ensuring proper safety, delegation, competency standards, applying the nursing process, and disciplinary action for nurses with an Ohio license.  

While the ORC (2022) sets the standards and scope of practice of nurses in the state, there needs to be a governing body to enforce the rules and regulations. This is where the Ohio Board of Nursing (OBN) comes in. The ORC Section 4723-01 (2022) dictates that the OBN be composed of thirteen members; at least eight of which 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 recent years of experience in the workforce (3). 

The board is legally authorized to enforce the rules put forth by the Ohio Nurse Practice Act’s OAC and must review each rule at least once every five years. Among other duties, 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 (4). 

Quiz Questions

Self Quiz

Ask yourself...

  1. Why do you think each state might need its own Nurse Practice Act, or in this case, "Administrative Code?" 
  2. What are the benefits of having a non-nurse consumer representative on the OBN?  
  3. What might be some challenges of including the consumer representative? 
  4. Rules of the OAC must be reviewed at least once every five years. Are there any situations you can think of where rules might need to be revisited before that five years is up?

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 effectively carry out their roles while maintaining maximum patient safety.  

RN Scope of Practice

Section 4723.04 of the ORC (2019) specifies that 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 preventative, restorative, or health-promotion "nursing regimens." 
  2. Delivering nursing regimens/interventions utilizing the nursing process (outlined below). 
  3. Using interviews, observation, and physical exam techniques to assess a patient's health status to provide appropriate nursing care.  
  4. Providing patients 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 the practice of nursing (2).
RN Application of Nursing Process

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

  1. Assessment- Collect data from patients via history, observations, and physical exam. This can also include data reported to the nurse from a patient's family or an LPN.
  2. Diagnosis- Establish or modify the nursing diagnosis.
  3. Planning- Analyze collected data to form a plan for nursing interventions
  4. Implementation- Communicate and carry out the plan of care within the scope of practice.
  5. Evaluation- Assess patient response to plan and modify as needed (7). 
LPN Scope of Practice

The Ohio Revised Code Section 4723.4.04 (2019) also specifies the LPN scope of practice, which is similar to the RN scope but it has less autonomy and requires more collaboration. Tasks within the LPN scope of practice include:  

  1. Observation, focused assessments, care, and patient teaching in a variety of settings. 
  2. Contributing to the planning, implementation, and evaluation of nursing care. 
  3. Administration of medication and treatments as ordered by a qualified
    professional and after documented completion of a medication proficiency
    course.
  4. The LPN may delegate to unlicensed assistive personnel such as CNAs.
  5. Teaching nursing tasks to other LPNs or unlicensed assistive personnel (2).  

 Of note, tasks prohibited for LPNs include:  

  1. Engaging in nursing practice without direction from an RN or qualified licensed professional. 
  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 (2). 
LPN Application of Nursing Process

The Nursing Process varies for the LPN in that these professionals mostly contribute to the process rather than initiating or carrying it out. Specifics of this process, as outlined by the Ohio Nurse Practice Act’s ORC Section 4723.01 (2023), include: 

  1. Collecting objective and subjective data about the patient's condition as part of
    the health status assessment
    . 
  2. Contributing to the planning, implementation, and evaluation of nursing care.
  3. Documentation of patient response to care. 
  4. Communicating with members of the healthcare team to contribute to the evaluation and revision of the nursing plan of care (2). 

Case Study

The charge nurse is making patient assignments for a med- surg unit that currently has six patients. The oncoming shift has one RN and one LPN with a CNA to assist with the entire unit. The charge nurse assigns four patients to the RN and two patients to the LPN.  

  1. Which factors of the patients' care will need to be considered when making assignments?
  2. What responsibilities will the RN have in regards to the LPN's patients? 
  3. Are both licensed nurses able to delegate tasks to the CNA on the unit? 

Standards of Competency

Standards of competency within the Ohio Nurse Practice Act’s ORC Sections 4732.4.04 (2019) 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 practices of care and recognizing when to consult with colleagues or refer care. 
  4. Providing care beyond basic nursing education only when additional education and training has been obtained and documented, appropriate skills demonstrated, and the tasks within the laws of that state
  5. Implementing provider orders within a reasonable time frame unless an order is determined to be invalid. 
  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 patient safety by deciding not to follow an order
  7. Collaborating with and referring to other members of the nursing team when appropriate. 
  8. Maintaining patient confidentiality within the realm of legal and safety considerations. 
  9. Keeping identifiable patient information (name, birth date, etc.) confidential to the greatest extent possible. 
  10. Using standards of care that promote patient safety (5). 

In addition to the above standards, RNs must also consider competency standards when directing tasks to an LPN or unlicensed assistive personnel (CNA, patient care technician, etc.). Ultimately, Section 4723-13.05 of the Ohio Revised Code (2022) outlines that the care of a patient falls on the nurse, and delegation to unlicensed personnel is safe and appropriate only when the below criteria have been met:  

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

Self Quiz

Ask yourself...

  1. Imagine you are working on a cardiac floor, and your patient has a chest tube. You have not worked with chest tubes before and are unfamiliar with the care required. What is your responsibility as a nurse to uphold the standards of competency?
  2. Now consider how you might handle an order for a medication that you understand to be contraindicated for a patient. How would you handle that situation?

Standards for Promoting Patient Safety 

Proper understanding of the Ohio Nurse Practice Act’s Scope of Practice, Nursing Process, and Standards of Competency should lead a nurse to provide care in such a way that promotes the best outcomes for patients, including maintaining patient safety. In case there are any situations where it is unclear what is most safe, the ORC Section 4723-4.06 of the ORC (2021) has outlined some standards. They are: 

  1. Nursing professionals will wear proper identification with their name and title, visible to patients at all times when providing care. 
  2. Nurses must delegate tasks and medication administration only within the scope of the professional being delegated to. 
  3. Nurses must document assessments, care, patient responses to care, and any errors in a timely manner. 
  4. Nurses must not falsify or alter documentation of nursing care in any manner. 
  5. Nurses must maintain professional boundaries, ensure privacy, and a safe environment for patients. 
  6. Nurses must not engage in any physically, verbally, or emotionally abusive behavior when caring for patients. 
  7. Nurses must not misappropriate patient property in any way, accept or seek monetary gain at a patient's expense, or become involved in patients' personal or financial matters. 
  8. Nurses must not engage in sexual conduct with patients or sexually harass or exploit patients. 
  9. Nurses in administrative roles are responsible for ensuring their staff have valid and appropriate licensure, education, and training to provide safe care for patients. 
  10. Nurses must not make false claims to the OBN, law enforcement, or hospital administration. 
  11. Nurses may not use texting, email, or social media to communicate patient information for purposes other than carrying out the responsibilities of their job.
Quiz Questions

Self Quiz

Ask yourself...

  1. What sort of problems might occur if documentation is not completed in a timely manner?
  2. Suppose you have developed a close rapport with a patient and their family. One day the patient's daughter hands you a check for $500 and says her mother wants you to have it for all your help. How do you handle this situation?  

Conclusion 

There are many more subsections to the OAC that detail more specifics about licensure, disciplinary action, and APRNs but it is beyond the knowledge needed for basic competency as a nurse practicing in the state of Ohio. While most nurses will find the scope of practice, safety guidelines, and minimum competency standards as outlined in the Ohio Nurse Practice Act to be similar from state-to-state, there is the potential for differences across state lines. Having familiarity with the state in which you practice is always a good idea. Depending on your workplace setting, understanding the relationship between the RN and LPN scopes of practice and nursing processes may be of particular importance. The OAC is public domain and can be easily accessed to clarify any questions, and the OBN can be contacted for guidance on any gray areas. 

References + Disclaimer

  1. American Association of Colleges of Nursing. (2109). Nursing fact sheet. Retrieved from: https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet#:~:text=Nursing%20is%20the%20nation’s%20largest,84.5%25%20are%20employed%20in%20nursing.&text=Employment%20of%20registered%20nurses%20is,the%20average%20for%20all%20occupations. 
  2. Ohio Revised Code. (2023). Chapter 4723.01 Nurses. Retrieved from: https://codes.ohio.gov/ohio-revised-code/section-4723.01 
  3. Ohio Revised Code. (2017). Chapter 4723.02 Board of nursing. Retrieved from:  http://codes.ohio.gov/orc/4723.02v1 
  4. Ohio Revised Code. (2019). Chapter 4723.06 Board of nursing- powers and duties. Retrieved from: http://codes.ohio.gov/orc/4723.06v1 
  5. Ohio Revised Code. (2019). Chapter 4723-4-03 Standards relating to competent practice as a registered nurse. Retrieved from: http://codes.ohio.gov/oac/4723-4-03v1 
  6. Ohio Revised Code. (2019). Chapter 4723-4-06 Standards of nursing practice promoting patient safety. Retrieved from: http://codes.ohio.gov/oac/4723-4-06v1 
  7. Toney-Butler, T. J. and Thayer, J. M. (2020). Nursing process. Stat Pearls. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK499937/#:~:text=The%20nursing%20process%20functions%20as,planning%2C%20implementation%2C%20and%20evaluation.&text=Assessment%20is%20the%20first%20step,data%20collection%3B%20subjective%20and%20objective. 
  8. University of Pennsylvania School of Nursing. (n. d.). American nursing: an introduction to the past. Retrieved from: https://www.nursing.upenn.edu/nhhc/american-nursing-an-introduction-to-the-past/

 

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Use of Course Content. The courses provided by NCC are based on industry knowledge and input from professional nurses, experts, practitioners, and other individuals and institutions. The information presented in this course is intended solely for the use of healthcare professionals taking this course, for credit, from NCC. The information is designed to assist healthcare professionals, including nurses, in addressing issues associated with healthcare. The information provided in this course is general in nature and is not designed to address any specific situation. This publication in no way absolves facilities of their responsibility for the appropriate orientation of healthcare professionals. Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication. Knowledge, procedures or insight gained from the Student in the course of taking classes provided by NCC may be used at the Student’s discretion during their course of work or otherwise in a professional capacity. The Student understands and agrees that NCC shall not be held liable for any acts, errors, advice or omissions provided by the Student based on knowledge or advice acquired by NCC. The Student is solely responsible for his/her own actions, even if information and/or education was acquired from a NCC course pertaining to that action or actions. By clicking “complete” you are agreeing to these terms of use.

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