DISCIPLINE RELATED TO NURSING PRACTICE

[This section covers ORC 4723.28, Disciplinary actions; OAC 4723-16, Hearings; and OAC 4723-18, Practice intervention and improvement program.]

The Ohio Board of Nursing protects the public’s health and welfare by overseeing and ensuring the safe practice of nursing. It regulates and oversees nursing practice by enforcing the nursing laws and rules of the state. Violations are serious and may result in discipline by the board.

Violations

Violations of nursing laws and rules can result in sanctions, including denial, revocation, suspension, or restriction of licenses; reprimand or discipline; and/or fines. Violations that may result in sanctions include, but are not limited to:

  • Denial, revocation, suspension, or restriction of authority to engage in a licensed profession or practice a healthcare occupation for any reason other than a failure to renew
  • Engaging in the practice of nursing, having failed to renew a license or while a license is under suspension
  • Conviction of, a plea of guilty to … a misdemeanor committed in the course of practice
  • Conviction of, a plea of guilty to … any felony or crime involving gross immorality or moral turpitude
  • Selling, giving away, or administering drugs or therapeutic devices for other than legal and legitimate therapeutic purposes; or … violating any municipal, state, county, or federal drug law
  • Self-administering or otherwise taking into the body any dangerous drug … that is not in accordance with a legal, valid prescription issued for that individual, or that is a schedule I controlled substance
  • Habitual or excessive use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs the individual's ability to provide safe nursing care
  • Impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of the use of drugs, alcohol, or other chemical substances, or because of a physical or mental disability
  • Assaulting or causing harm to a patient or depriving a patient of the means to summon assistance
  • Misappropriation or attempted misappropriation of money or anything of value in the course of practice
  • Adjudication by a probate court of being mentally ill or mentally incompetent
  • The suspension or termination of employment by the United States Department of Defense or Department of Veterans affairs for any act that violates or would violate ORC chapter 4723
  • Violation of ORC chapter 4723 or any rules adopted under it
  • Violation of any restrictions placed by the board on a nursing license
  • Failure to use universal and standard precautions established by rules adopted under ORC section 4723.07
  • Failure to practice in accordance with acceptable and prevailing standards of safe nursing care or
  • Engaging in activities that exceed the practice of nursing as a registered nurse or as a licensed practical nurse
  • Aiding and abetting a person in that person's practice of nursing without a license
  • In the case of an advanced practice registered nurse, advertising or waiving the payment of all or any part of a deductible or copayment that a patient would otherwise be required to pay if the waiver is used as an enticement to receive healthcare services from that provider
  • Failure to comply with the terms and conditions of participation in the substance use disorder monitoring program established under ORC section 4723.35
  • Failure to comply with the terms and conditions required under the practice intervention and improvement program established under ORC section 4723.282
  • In the case of an advanced practice registered nurse, engaging in activities that exceed those permitted for the nurse's nursing specialty, or failure to meet the quality assurance standards established under ORC section 4723.07
  • In the case of an advanced practice registered nurse other than a certified registered nurse anesthetist, failure to maintain or practice in accordance with a standard care arrangement in accordance with ORC section 4723.431
  • In the case of an advanced practice registered nurse who is designated as a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner, failure to prescribe drugs and therapeutic devices in accordance with ORC section 4723.481
  • Prescribing any drug or device to perform or induce an abortion, or otherwise performing or inducing an abortion
  • Failure to establish and maintain professional boundaries with a patient
  • Regardless of whether the contact or verbal behavior is consensual, engaging with a patient other than one’s spouse in any sexual contact, as defined in ORC section 2907.01, or verbal behavior that is or may be reasonably interpreted as sexually demeaning to the patient
  • Assisting suicide, as defined in ORC section 3795.01
  • Failure to comply with the requirements in ORC section 3719.061 before issuing for a minor a prescription for an opioid analgesic
  • Failure to comply with ORC section 4723.487, unless the state board of pharmacy no longer maintains a drug database
  • The revocation, suspension, restriction, reduction, or termination of clinical privileges by the United States Department of Defense or Department of Veterans Affairs or the termination or suspension of a certificate of registration to prescribe drugs by the drug enforcement administration of the United States Department of Justice
  • In the case of an advanced practice registered nurse who is designated as a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner, failure to comply with the terms of a consult agreement entered into with a pharmacist pursuant to ORC section 4729.39

(For a complete list, see ORC 4723.28, Disciplinary actions.)

Disciplinary Hearings

The Board of Nursing responds to possible violations of nursing laws and rules. This may include investigation of the complaint against a nurse, hearings, examination of evidence, and the calling of witnesses. The nurse may represent themself before the board or be represented by an attorney. Unless subpoenaed by the board, the nurse is not required to appear in person at any hearing.

When making a decision regarding disciplinary action, the board considers:

  • Any prior disciplinary action taken against the nurse
  • Any prior completion of the alternative program for chemical dependency, if applicable
  • Whether the act was willful, intentional, irresponsible, or unintentional
  • Whether the nurse cooperated with the board investigation
  • Whether the nurse provided false, misleading, or deceptive information
  • The frequency of the act at issue
  • Whether the act represents a pattern of commissions or omissions
  • The outcome of the nurse’s actions
  • The level of harm or potential harm to a patient
    (OAC, Chapter 4723-16)

As a resolution to the possible violation, the board may close the case, issue a nondisciplinary advisory letter, refer the nurse to the PIIP (see below) with employer remediation, or impose disciplinary sanctions. A matter may also be resolved through a settlement agreement submitted to and ratified by the board.

Practice Intervention and Improvement Program

The Practice Intervention and Improvement Program (PIIP) is a confidential alternative-to-discipline program for eligible licensees as authorized in section 4723.282 of the ORC. The program establishes a structured remedial education and monitoring program in cases where a nurse has failed to practice safe nursing but whose practice deficiency can be corrected through participation in the PIIP rather than through disciplinary action. The PIIP utilizes educational interventions such as continuing education activities, courses provided by a post-secondary educational institution, or activities provided by the nurse’s employer.

In order to determine a nurse’s eligibility for this program, the board applies these and other criteria:

  • That the public will be adequately protected from unsafe practice
  • Whether the nurse’s practice deficiency resulted in harm or other untoward outcome for the patient
  • The likelihood the practice deficiency can be corrected through remediation
  • The extent of the nurse’s cooperation with the board during the investigation
  • Whether the nurse’s practice deficiency was intentional or willful
  • The frequency of its occurrence
  • The adverse impact of the practice deficiency on others
  • Whether the practice deficiency affected a particularly vulnerable patient
  • Whether the nurse is eligible for participation in PIIP as specified in rule 4723-18-03 of the OAC
  • Whether the nurse has a mental or physical impairment that contributed to the practice deficiency
  • Whether the nurse has been the subject of other disciplinary action

Those eligible for the program must develop a participatory agreement that includes these and other elements, as detailed in the OAC:

  • Describes the practice deficiencies
  • Identifies the required remediation and educational interventions
  • Specifies the timeframe to fulfill the requirements
  • Requires the nurse to pay all expenses they incur as a result of remediation
  • Requires the nurse to provide documentation of participation to all employers or contracting entities
  • Requires the nurse to participate in workplace monitoring, including written progress reports by the monitors
  • Specifies the terms and conditions that must be met to successfully complete the remediation

If a PIIP participant fails to comply with or successfully fulfill the agreement, the board will proceed with disciplinary action.