Regulations for Safe Nursing Care

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1 Regulations for Safe Nursing Care Practice 1

2 Nursing Practice Is not just a list of tasks It is a process that changes & advances. Any definition of the scope of practice must be flexible & broad enough to permit changes in practice consistent with trends in nursing and related health professions. Practice 2

3 The rules, the regulations, and the boundaries within which a fully qualified practitioner with substantial and appropriate training, knowledge, and experience may practice in a field of medicine or surgery, or other specifically defined field. Such practice is also governed by requirements for continuing education and professional accountability. Federation of State Medical Boards, 2005 Practice 3

4 Nursing laws & rules Chapter RCW Nursing Care Chapter WAC Practical & Registered Nursing Chapter 18.88A.030 RCW Nursing Assistant Scope of Practice Chapter WAC Nursing Assistant Standards of Care It is unlawful for a person to practice or offer to practice as a RN, LPN, ARNP, NAC, NAR without a Washington State license Practice 4

5 Responsibility & accountability is fundamental to giving safe nursing care Changes in scope of practice are inherent in the current health care system Scope of practice is individualized for each nurse and nursing assistant Overlap of scope of practice among professions is a reality Public protection is the priority in making practice decisions Practice 5

6 Defined Boundaries Federal laws RCWs & WACS Interpretive Statements Advisory Opinions Policy Educational Qualifications Formal nursing training Formal nursing assistant training Knowledge Experience Training Competency Expertise & interest Standards of Practice Professional organizations Accrediting organizations Laws and regulations for each level of licensure Evidence-based nursing Turf wars Facility Boundaries Policies & Procedures Protocols Patient population Reimbursement Risk & liability Turf wars Practice 6

7 Purpose Identifies responsibility & accountability of the nurse Violations may be grounds for disciplinary action The nurse shall be responsible & accountable for the quality of nursing care given Responsibility cannot be avoided by accepting orders or directions of another person WAC Practice 7

8 Communicate significant changes in status Document Advocate Know & understand nursing laws & rules Function within legal & individual SOP Maintain current knowledge in area of practice Follow privacy and HIPAA laws Practice 8

9 RN Initiate nursing process Assessment & analysis Nursing diagnosis based on assessment Planning nursing care Implementation of nursing interventions Evaluation of responses to nursing interventions & adjusting the care plan LPN Assist in implementing nursing process Assist in assessment Assist in developing nursing diagnosis Assist in developing nursing care Carry out nursing interventions Assist with evaluating responses & adjusting the care plan NAC Assist in delivering nursing care Report changes in patient condition Not allowed Follow nursing instructions for patient care Carry out nursing interventions Report changes in patient condition Practice 9

10 RN LPN NAC Delegate according to education, credentials, competencies & laws/rules Supervise delegated activities Delegate according to education, credentials, competencies & laws/ rules Supervise delegated activities Follow nursing instructions Not allowed Outcome Evaluation provided by credentialed & other paraprofessionals Health teaching based on learning needs assessment, develops, implements & evaluates plan Report outcomes of care Assist in health teaching & provides routine health information Report changes in patient condition Report patient questions to nurse Practice 10

11 RN Functions LPN Functions NAC Functions Independent Role: Uses substantial or specialized knowledge in performing nursing process Interdependent Role: Carries out medical regimens Coordinates & evaluates nursing care Interdependent Role: Carries out selected, routine, aspects of nursing care under direction & supervision of RN or assists the RN in performing complex nursing care Dependent Role: Carries out medical regimens Assists in coordinating & evaluating nursing care Dependent Role: Carries out selected routine and care under direction and supervision of a RN or LPN Dependent Role: Act under supervision of a nurse Reports changes in patient condition Practice 11

12 Is the act consistent with WA State Nurse Practice Act & other regulations? Is the act supported by evidencebased research, professional organizations or interpretive statements? Is the act supported by facility policies & procedures? Do you have the required knowledge, skills & competency to perform this act safely? Would a reasonable & prudent nurse perform this act in this setting? Are you prepared to assume accountability for the provision for safe care & the outcome of the care given? Practice 12

13 Step 1 Is the act consistent with WA State Laws, Rules & other regulations? Practice 13

14 Step 2 Is the act supported by evidence-based research, professional organizations or interpretive statements? Practice 14

15 Step 3 Do you have the required knowledge, skills & competency to perform this act safely? Practice 15

16 Step 4 Is the act supported by facility policies & procedures? Practice 16

17 Step 5 Would a reasonable & prudent nurse perform this act in this setting? Practice 17

18 Step 6 Are you prepared to assume accountability for the provision for safe care & the outcome of the care given? Practice 18

19 Washington Center for Nursing Is your organization facilitating or impeding nurses practicing to their full extent of their education, training & competencies within the legal scope of practice of Washington State? Final_SCOPE_Toolkit(1).pdf Practice 19

20 Who can direct an RN or LPN to carry out a medical regimen? Advanced Registered Nurse Practitioner (ARNP) Medical Physician (MD) Osteopathic Physician (DO ) Doctor of Podiatric Medicine (DPM) Naturopathic Physician (ND) Physician Assistant (PA) Dentist (DDS) Optometrists (ODs) Practice 20

21 May involve severing or penetrating tissues, judgment & skill: Administer legend drugs, including controlled substances Perform medical treatments & tests RNs may perform minor surgery Prescriber does not need to be on-site Practice 21

22 May involve severing or penetrating tissues, judgment & skill: Administer legend drugs, including controlled substances Perform medical treatments & tests Prescriber does not need to be on-site Practice 22

23 Follow the direction of a RN, LPN, or other higher level professional such as a doctor. Fall under the supervision of RN or LPN. Report all changes in patient condition to the RN or LPN and follow their direction in handling the change. Responsible for own scope of practice in providing the activities of daily living that was taught to them in their pre-licensure programs. Practice 23

24 Direction & Supervision Dependent Role Authorized Prescriber ARNP MD DO ND DPM PA DDS Delegation & Supervision LPN RN General Direction Interdependent Role Credentialed UAP MA-Hemodialysis MA-Registered (MAR) MA-Certified (MAC) MA-Phlebotomist Delegation & Supervision Credentialed UAP Home Care Aide (HCA) NA-Registered (NAR) NA-Certified (NAC) Delegation & Supervision Other Non- Credentialed Unlicensed Assistive Personnel (UAP) NAC-Medication Assistant Endorsement (MAE) Practice 24

25 Unprofessional conduct which includes the following: Failure to make mandatory reports for unsafe or unprofessional conduct Practicing nursing without a Washington State nursing license or letting someone else use the license Aid, abet or assist others in violating laws or rules specific to nursing Disclosing contents of licensing examinations Practice 25

26 Attesting to controlled substance wasting not personally witnessed Failure to protect patients from unsafe practices or conditions, abusive acts or neglect Delegating care inappropriately Failing to supervise, or provide reasonable supervision of, delegated care Violating confidentiality laws Practice 26

27 Writing prescriptions without prescriptive authority Using medication, supplies, equipment or personal items of a patient, agency or institution Soliciting or borrowing money, materials or property from patients Practicing nursing while impaired Failing to use nursing process Practice 27

28 Failing to document accurately &/or legibly or altering/destroying documentation Failing to give medications or treatments following acceptable standards Failing to follow policies/procedures for wasting medications Patient abandonment Criminal conviction for physical or sexual abuse Practice 28

29 Suspicion that a nurse is not safe to practice Criminal conviction Violation of nursing standards Sexual misconduct Patient abuse or neglect Practice 29

30 Conduct that may contribute to a patient death or patient harm requiring medical intervention Conduct that may create risk of harm to a patient Repeated acts or omissions that may create risk of harm to a patient Drug trafficking Misuse of alcohol/drugs Practice 30

31 Fraud Conduct diminishing the nursing profession in the eyes of the public Practicing beyond scope Violation of disciplinary sanction imposed by NCQAC Practice 31

32 Practice 32

33 Chapter RCW Nursing Care: Chapter WAC Practical & Registered Nursing: Nursing Care Quality Assurance Commission Practice Information: NursingCommission/PracticeInformation.aspx Chapter 18.88A.030 RCW Nursing Assistant Scope of Practice Chapter WAC Nursing Assistant Standards of Care Practice 33

34 Debbie Carlson, RN, MSN, Nurse Practice Advisor Linda Patterson, RN, BSN, Nurse Consultant Margaret Holm, RN, JD, Nurse Consultant Practice 34

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