STANDARDS THAT PROMOTE PATIENT SAFETY
[This section covers subsections (A) thru (Q) of the OAC 4723-4-06, Standards of nursing practice promoting patient safety.]
(A–C) When providing direct nursing care to patients or engaging in nursing practice in person or by telecommunication, licensed nurses, certified nurse-midwives, certified nurse practitioners, certified registered nurse anesthetists, or clinical nurse specialists must display and identify their applicable title or initials (degree) or identify to each patient or healthcare provider the nurse’s title or initials (degree) as a registered nurse or licensed practical nurse.
Licensed nurses must (D) delegate nursing tasks, including medication administration, only in accordance with chapters 4723-13, 4723-23, 4723-26, or 4723-27 of the OAC. (See also “Delegation Guidelines” below.)
Licensed nurses must (E) report and document their nursing assessments and observations, care provided, and the patient’s response to that care in a complete, timely, and accurate manner. Licensed nurses must document any (F) errors in or deviations from a prescribed regimen to the appropriate practitioner in a timely and accurate manner.
Licensed nurses must (G) not falsify, or conceal by any method, patient records or any other document prepared or used in the course of nursing practice. This includes case management documents or reports, time records, reports, and other documents related to billing for nursing services.
Licensed nurses must (H) implement measures to promote a safe environment for patients and (I) delineate, establish, and maintain a professional boundary between themselves and patients. They must (J) provide privacy during examination and care and treat each patient with courtesy, respect, and full recognition of dignity and individuality.
Licensed nurses must (K) not engage in behavior that causes or may cause physical, verbal, mental, or emotional abuse to a patient or engage in behavior that a reasonable person would interpret as physical, verbal, mental, or emotional abuse.
A licensed nurse must not (L) misappropriate the property of patients or:
- Engage in behavior to seek or obtain personal gain at the patient’s expense, or that may reasonably be interpreted as such
- Engage in behavior that constitutes inappropriate involvement in the patient’s personal relationships or financial matters, or that may reasonably be interpreted as such
A licensed nurse must not (M):
- Engage in sexual conduct with a patient, or conduct that may be interpreted as sexual
- Engage in verbal behavior that is seductive or sexually demeaning to a patient, or that may be interpreted as such
The patient is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in (L) and (M) above.
When licensed nurses (N) function in administrative roles, they must make sure that there are procedures in place and implemented to verify that every nurse, dialysis technician, or medication aide working under their administration has a current valid license or valid certificate in Ohio to practice in the role to which they are assigned.
Only RNs may (O) supervise or evaluate the nursing practice of RNs and LPNs; however, non-nursing supervisors may evaluate nurse employees in matters other than the practice of nursing.
A licensed nurse must not (P) make, submit, or cause to be submitted any false, misleading, or deceptive statements to the OBN, current or prospective employers, facilities or organizations for whom the nurse is working, members of the healthcare team, or law enforcement personnel.
A nurse must (Q) not use social media, texting, emailing, or other forms of communication with or about a patient for nonhealthcare purposes or for purposes other than fulfilling the nurse’s assigned job responsibilities.
DELEGATION GUIDELINES
When all conditions for delegation set forth in Chapter 4723-13-05 of the OAC are met, a registered nurse may delegate a nursing task to an unlicensed person and a licensed practical nurse may delegate a nursing task to an unlicensed person at the direction of the registered nurse. These conditions are summarized below.
Except as otherwise authorized by law or this chapter, a licensed nurse may delegate to an unlicensed person the administration of only the following medications:
- Over-the-counter topical medications to be applied to intact skin for the purpose of improving a skin condition or providing a barrier
- Over-the-counter eye drop, ear drop, and suppository medications, foot soak treatments, and enemas
Prior to delegating a nursing task to an unlicensed person, the delegating nurse must make certain determinations regarding the nature of the task and the qualifications of the unlicensed person who will carry it out.
- The nursing task is within the scope of practice of the delegating nurse
- The nursing task is within the knowledge, skill, and ability of the nurse delegating the nursing task
- The nursing task is within the training, ability, and skill of the unlicensed person who will be performing the delegated nursing task
- Appropriate resources and support are available for the performance of the task and management of the outcome
- Adequate and appropriate supervision by a licensed nurse of the performance of the nursing task is available
- That:
- The nursing task requires no judgment based on nursing knowledge and expertise on the part of the unlicensed person performing the task
- The results of the nursing task are reasonably predictable
- The nursing task can be safely performed according to exact, unchanging directions, with no need to alter the standard procedures for performing the task
- The performance of the nursing task does not require that complex observations or critical decisions be made with respect to the nursing task
- The nursing task does not require repeated performance of nursing assessments
- The consequences of performing the nursing task improperly are minimal and not life-threatening
Prior to delegating a nursing task, the delegating nurse must also make certain determinations regarding the patient and the conditions:
- Identify the individual on whom the nursing task may be performed and a specific time frame during which it may be performed.
- Complete an evaluation of the conditions that relate to task to be performed, including:
- An evaluation of the individual who needs nursing care
- The types of nursing care the individual requires
- The complexity and frequency of the nursing care needed
- The stability of the individual who needs nursing care
- A review of the evaluations performed by other licensed healthcare professionals
The delegating nurse shall be accountable for the decision to delegate nursing tasks to an unlicensed person.
If a licensed nurse determines that an unlicensed person is not correctly performing a delegated nursing task, the licensed nurse shall immediately intervene.