Texas Nurse Practice Act, questions and answers with rated solutions

Texas Nurse Practice Act, questions and answers with rated solutions Texas Nurse Practice Act - it is considered nursing law and applies to all licensed nurses regardless of educational level - This Occupations Code defines nursing practice and gives the BON the authority to make rules which are then implemented and interpreted in the Texas Nurse Practice Act Legislature only the Legislature can change the NPA but the BON can make rule changes as needed to help in the application of the NPA due to evolving practice and settings. (TOC makes "sec" Board of Nursing Mission/ Primary Purpose - To regulate the practice of nursing, approval of nursing programs. - protect and promote the welfare of the people of Texas by ensuring that each person with a nursing license is competent to practice safely - derived from NPA, supersedes interest of individual, nursing profession or any special interest group. Board of Nursing Purpose - Protect the public —Regulation of the practice of both professsional (PN) and vocational nursing (VN) — accreditation of schools of nursing Board of Nursing Functions - establish standards of nursing practice and regulate the practice of PN and VN - interpret the NPA and Rules and Regs r/t nurse Ed, licensure, and practice to nurses, employers and the public to ensure that HC professionals and consumers are informed - receive complaints and investigate violations of the NPA - Discipline violators through appropriate legal actions - Provide a mechanism for public comment about rules and regulations - examine and license qualified applicants of GVN, GN, & APN - Grant licensure by endorsement qualified applicants - recommend to legislature appropriate changes to NPA - EST. Nursing ed standards and accredit or deny accreditation to programs - Monitor examination (NCLEX, Board scores) results to determine effectiveness of school programs (reason for Exit Exam) - provide consultation & guidance to nurse Ed institutions to improve their program - Provide advice and counsel to faculty of educational programs to continually improve delivery - Implement and manage all other programs and responsibilities authorized and mandated by Texas legislature BON Membership consists of 13 members appointed by governor - 6 nurse members —- 1 APN, 2 RN, 3 VN -who are not faculty - 3 members who are nurse faculty —- 1 BSN, 1 ADN, 1 VN - 4 member who represent the public Executive Director: CEO of BON, paid job by BON, not a member of board, keeps record of meetings and name of each nurse registered BON General Powers - general "rule" making authority —Filling in details of laws/policies set by legislature, puts law into practice - regulates nursing both in practice and education - establish standards of professional and vocational nursing — TXBON disciplines nurse/license - determine whether an act constitutes the practice of professional or vocational nursing Role of the Legislature - NPA can only be changed by the Texas Legislature which convenes every 2 years for 140 days or in special sessions called by the Governor - Legislature gives the BON general rule-making authority which allows them to develop more details - Lobbying by interested parties is done by professional organizations - Texas Occupational code "sec" Sunset Review - Process by which Texas Legislature determines if state agencies should continue to exist or be "sunset" (Discontinued) - sunset review occur every 12 years - BON underwent Sunset review during the 2007 legislative session Licensure - Background check - Application - Declaratory order - Temp permit (if passed NJE, but still need NCLEX) - NCLEX pass required (results in 3 was, can re-take,) - Issuance of license- once all requirements met Licensure - Is necessary to practice or offer to practice as a RN or VN - Acceptable titles: RN, GN, or Professional Nurse, LVN, GVN, Vocational nurse (LPN) - Only these titles may use the term "Nurse" - NOT. A CNA Licensure renewal - Licenses must be renewed every 2 years based on birth month and year. - Includes requirements for continuing education (20 hrs q 2 yr) - Failure to renew on time (4yrs) and continue to work will result in disciplinary actions which may include revoking your license. Must reapply, complete a refresher course= temp permit. Nurse Licensure Compact (NLC) Primary state of residence (PSOR) - state in which you hold a DL, registered to vote, and file federal income tax TX is NLC state, so apply for licensure with TXBON: -multi-state license grants privilege to practice in all NLC states contingent upon remaining a resident of issuing state. - party state- other than Home state (PSOR) you have to follow their rules Initial licensure - NJE BON developed NJE - Nursing Jurisprudence Exam - taken by each applicant seeking initial licensure - minimum of 50q, open book - Must be taken /passed before graduation in order to sit for NCLEX - can retake Name Badges - Name according to nurse's preference - Must include type of license (RN, LVN) - May include: degrees, certifications, position, picture, employer Nurse Imposters Some people with either a revoked license or a little knowledge will hire into a doctor's office or home health agency with the promise of a license to come. - These people will be arrested and prosecuted for being a nurse imposter. Your picture will show up in the BON Nursing Quarterly Professional Nursing Definition Performance of an act that requires substantial specialized judgment and skill. Which is acquired by a completed course in an approved school of nursing Includes: - the observation, assessment, intervention, evaluation, rehabilitation, care/counsel, or health teachings of a person is ill, injured, infirm, or experiencing a health change - Maintenance of health/prevention of illness - Administration of medication - Supervision of teaching of nursing - administration, Supervision & evaluation of nursing practices, P& Ps - The requesting/receiving/signing for/ and distribution of prescription drug - performance of act delegated by physicians - development of a nursing care plan Basics of Nursing Practice - you must keep the Board informed of your current address at all times. Do this by sending written notice, clearly marked "change of address" to the Board's office any time you move. - failure to do so can result in a lapse of your license and potential disciplinary action Standards of Nursing Practice - Rule 217.11 - Standards of Practice establish a minimum acceptable level of nursing practice in any setting for each level of nursing licensure - Failure to adhere standards may result in action against the nurse's license even if no harm occurred to patient - the hospital administrators, the Chief Nursing Officer and Nurse Managers all have duty to uphold all recognized standards. Standards of Nursing Practice RN /LVN - "Professional nursing: performance of an act which requires substantial specialized judgment and skill...based on the knowledge and application of the principles of bio, physical, and social science" - Vocational nursing: "means a directed scope of practice" - This means a LVN must always be under the supervision of a licensed practitioner such as RN, physician, podiatrist. - This supervision does not necessarily mean on-site but may be by phone, but must be easily reached. Standards of Nursing Practice Rule 217.11 1/2 - Know and conform to the laws, regulations, standards of TX NPA: Patient's Bill of Rights, Code of Ethics, Abuse laws, etc.. ignorance is not a defense, following institutional policies is not a defense - Implement measures to insure a safe environment. this may come partly from institutional policies, but nurses have a direct duty to the patient and following policies is not enough - Know purpose and side effects of every medication and treatment the patient receives. duty is to the patient so do not blindly follow orders or policies - Documentation . Accurately and thoroughly document aspects of care - Provide for privacy and confidentiality - Promote and provide education and counseling Standards of Nursing Practice Rule 217.11 2/2 - Obtain instruction and Supervision - Obtain orientation, and training, this includes safe and correct handling of all equipment. - Leaving an Assignment - Professional Boundaries- maintain nurse client relationship - Reporting- includes reporting another nurse who poses a risk of harm to patient - Non discriminant Care. Examples: homeless - Nursing Intervention . stabilize and or prevent clients condition - Clarify orders . duty to question incomplete or questionable orders: name, dose, route, frequency - Infection control policies. hand washing; sterile fields - Collaboration with other HC Providers - Consultation/referrals for continuity of care - Professional growth. responsible for own continuing competence and individual growth - Making Assignments. Client safety in mind. Fair to ability and knowledge - Accepting Assignments. Ability and knowledge. client safety in mind - Supervising. Care provided by other you are responsible for - license verification, ensure verification of current Texas license or other compact state Duty to Report - Nurses have a duty to patients based on: -- the patients vulnerability -- the nurse's position of power - Every nurse either RN or LVN has a duty to report any of the following: -- Violations of the NPA or a BON rule which results or contributes to the death or serious injury of a client Duty to Report - Suspicions of a nurse who may be impaired due to drugs or alcohol - Commissions of abuse, neglect, fraud, exploitation of any patient - Violations of professional boundaries -- Remember: financial, sexual, emotional, physical, etc. - Actions which indicate the nurse lacks the judgment, or consciousness that continuing practice may result in harm to a client - Any peer review committee results except for minor incidents Others with a Duty to Report - Nursing schools: legally and ethically obligated to report students who break any of these standards - employers - professional organizations which expels or takes disciplinary action against a nurse - State agencies such as Dept of Health and Human Services, Child Protective services, etc. - Liability insurer - Prosecuting attorney Standards Specific to R.N.s Nursing process: R.N.s utilize a systematic holistic approach to care for patients. Only a RN can do the initial assessment of every patient. Nursing Process Differences: LVN - collecting data and focused assessments - participate in planning care - development & modification of the plan - implement the plan under the scope of practice - assist in evaluation of response to nursing Nursing Process Differences: RN - Systematic approach to individualized, goal-oriented care - obtain a comprehensive assessment - develop nursing diagnoses - develop a plan of care based on assessments and diagnoses - implement the plan - evaluate the responses Delegations by R.N.s - authorizing an unlicensed person to provide nursing services while retaining accountability for how the unlicensed person performs tasks - RNs delegate to unlicensed persons - UP= unlicensed personnel - Delegation may only be done by a RN - LVN may only assign tasks because they must be under the supervision of a RN Delegation 1. The RN must make an assessment of nursing needs before delegating tasks 2. The nursing task must be one that a reasonable and prudent RN would find within the scope of nursing to delegate. The most fundamental criteria for delegation is the professional judgment of the RN. 3. The nursing task must be one that can be safely delegated 4. The nursing task must not require professional nursing judgment 5. The unlicensed person must be adequately identified. 6. The RN must have either instructed the unlicensed person or verified competency to perform nursing task 7. The RN shall supervise the performance of delegated task 8. If the delegation occurs over time the RN shall evaluate the delegation of task on a regular basis. Five Rights of Delegation 1. The right task 2. The right person to whom the delegation is made 3. The right circumstance (stable patient) 4. The right direction/communication with R.N 5. Right supervision of the task Supervision after Delegation - Degree of supervision is determined by the RN - Need to consider many factors such as: -- stability of patient -- training and experience of UP -- nature of task being delegated -- proximity and availability of the RN to the UP Tasks Most Often Delegated - Non-invasive and non-sterile treatments - collecting, reporting, and documenting of data: V/S, pulse ox, height/ weight, I&O blood test and urine test for sugar environmental situations (cleanliness of patient & room) client/ family comments related to patient care turning & positioning & ambulation transportation of client in facility personal hygiene, elimination, vaginal irrigations, enemas feeding socialization activities ADLs (note: UP can assist with self-medication, this is defined as an ADL Reinforcement of health teaching given by RN. Be careful about this Nursing Tasks Prohibited from Delegation - initial assessment & physical, psychological, & social assessment - formulation/ evaluation of the nursing care plan - specific tasks within the care plan that require nursing judgment - the responsibility for health teaching to client & family - administration of meds - including IV fluids except as permitted to the title of Medication Aide (long-term care facilities/home health) Tasks Which usually Should Not be Delegated - sterile procedures (wound care) - non-sterile procedures (dressing changes) - invasive procedures such as putting tubes into a cavity, instilling or inserting substances into an indwelling tubes (IVs, foley catheters, NG tubes) - care of broken skin except for first aid Delegation to Nursing Students nursing students performing tasks as part of educational program (clinical only) are exempted from the application of delegation rules however, when performing nursing tasks outside of educational program (for money or volunteer) they are in fact functioning as unlicensed persons Discretionary Delegation - This is the rule which applies to all unlicensed nursing students who are working in a health care facility or company -- nurse extern, PCA, etc. - Rn must be directly responsible for the patient - Facility must have a protocol or policy which addresses: -- the complexity of the task -- how the UP demonstrates competency -- a method and frequency for revaluation of the competency -- a method to determine who should be allowed to do the task Assignment-Making - Assignment-making is from one licensed nurse to another licensed nurse - Assigning: Administratively directing a person to perform a task that they have the legal authority to perform - RNs assign tasks to LVNs - BON regulates both making and accepting assignments in that the nurse should only make and accept assignments in coordination with their educational preparation, experience and knowledge and are capable of doing based on the nurse's physical and emotional health. LVNs and Assignments LVNs operate under authority of their own license and delegation is not required for them to perform tasks falling within scope of their practice. Delegation is related only to unlicensed personnel New Graduates: Temporary Authorization to Practice - Must be under direct supervision of appropriate nurse who must be on the same "unit" and readily available for 6 months - New RN should not charge for at least 1 year - New grads should not practice in unsupervised settings such as home health for at least 12-18 months Continuing Education Requirements Every licensed nurse must complete 20 hours of continuing education related to their practice area every 2 years. - the education must be approved by the TNA Continuing Education committee or and approved person/facility - 60 minutes equals one CE credit - The BON may require specific topics to be studied according to national concerns or related to a specific clinical area: Bioterrorism, forensic nursing - There are rules regarding what is accepted as continuing education because it must be patient centered. - can not be about new equipment at the facility - very long detailed process for approval - Process is done through Texas Nurses Association who approves providers and programs. Nursing Ethics Ethical conduct = Good Professional Character (Honesty, accountability, trustworthiness, reliability, integrity) Unprofesssional Conduct: - criminal behaviors - professsional boundaries - intemperate use of alcohol mental illness Ethical conduct- Good Professional Character - ethical conduct is necessary because of the relationship of the nurse to vulnerable populations - BON requires Good Professional Character which is determined by consistent behaviors in personal, academic, and occupational history Ethical Conduct- Good Professional Character - Expected behaviors include but are not limited to honesty, accountability, trustworthiness, reliability, and integrity - And the nurse should be able to: -- distinguish right from wrong -- think and act rationally -- keep promises and honor obligations -- be accountable for his or her own behaviors -- practice autonomously -- recognize and honor interpersonal boundaries appropriate to therapeutic relationship* -- promptly and fully self-disclose facts, circumstances, events, errors, etc. which might effect health and well-being of patients/clients to protect from unnecessary risk of harm* Unprofessional Conduct - the unprofessional conduct rules are intended to protect the public from unethical and illegal conduct - the rules are different from 217.11 because these rules place emphasis on blameworthy behavior rather than a nurse failing to comply with standard Unsafe Practice - Failure to comply with BON standards - Failure to comply with accepted standards (infection control principles) - Improper record management (documentation or storage of data) - improper assignment making or delegation - Improper acceptance of assignment - Improper Supervision - Improper Supervision by Faculty Unprofessional Conduct- Certain Prohibited Practices Sec. 301.451 a person may not - sell or assist in the selling of, fraudulently obtain, or fraudulently furnish a nursing diploma, license, or record. - practice under a fraudulently or unlawfully obtained license - practice under a suspended or revoked license Unprofessional Conduct-Intemperate Use Being on duty or on call under the influence is intemperate use. It is improper for nurse to be in duty or in call under the influence of prescription drugs or alcohol. Or prior to being on duty or on call. Unprofessional Conduct Rule 217.12 1) Unsafe Practice 2) Lack of Responsible Oversight by CNO 3) Failure to Comply with License Restrictions 4) Endangering Patients 5) Fitness for Duty mental/physical illness, substance abuse 6) Misconduct 7) Failure to Repay Student Loan 8) Diverting Narcotics 9) Dismissal from Leer Assistmace 10)Drug Related Misconduct 11) Unlawful Practice 12) Inappropriate Leaving of Assignment 13) Criminal Conduct Boundary Violations- Misconduct 217.12 (6) (D) misconduct - actions or conduct that include, but are not limited to: - violating professional boundaries of the nurse/client relationship including but not limited to physical, sexual, emotional, or financial exploitation of the client or clients significant other(s) Misconduct Examples - Falsifying Records - Failure to Cooperate with lawful investigation - Patient Harm, Neglect or Abuse - Violating Professional Boundaries of nurse/client relationship - Sexual Misconduct with client - Violent or Threatening Behavior in workplace - Misappropriation anything of value real/personal or client, employer - Giving False Information - False Employment Information - Improper Solicitation or Referral