Texas Nursing Practice Act & Board of Nursing: Rules, Regulations & Licensing for Nurses, Exams of Nursing

Download Texas Nursing Practice Act & Board of Nursing: Rules, Regulations & Licensing for Nurses and more Exams Nursing in PDF only on Docsity! Nursing Jurisprudence Texas 88 Questions & Answers 2023-20224 Jurisprudence - The science or philosophy of law Sources of Law - - Constitutional Law Federal State - Statutory Law Federal State - Common Law - Administrative Law Criminal Law - Federal or state government is attempting to deprive an individual of life or liberty for something the law considers an offense against society in general. Civil Law - Seeks to resolve disputes between private parties, which often results in the payment of money. Different Burden of Proof - Beyond a reasonable doubt A preponderance of the evidence Tort Law - A civil wrong that causes someone else to suffer loss or harm resulting in legal liability for the person who commits the tortious act. Types of Torts - - Negligence - Intentional Torts Assault Battery False Imprisonment - Quasi-Intentional Torts Defamaiton Libel Slander Malpractice - Negligence committed by a person in his or her professional capacity is malpractice. Also known as professional negligence. Medical and nursing malpractice occur when a doctor or nurse fails to do that which a reasonable, prudent doctor or nurse would do under the same or similar circumstances, or does that which a reasonable or prudent doctor or nurse would not do under the same or similar circumstances. P a g e 1 | 15 Elements of a Nursing Malpractice Lawsuit - Duty - the existence of a duty, owed by the nurse to a patient, to conform to a recognized standard of care Breach - a failure to conform to the required standard of care Harm - an actual injury Cause - there must be proof that the injury was caused by the nurse's act or omission Intentional Tort: Assault - Intentionally placing another in apprehension or fear that they will suffer harmful or offensive contact. Intentional Tort: Battery - Intentional contact that is harmful or offensive, or creating the apprehension that such contact is imminent. Intentional Tort: False Imprisonment - Willful detention without consent and without authority of law. Quasi-Intentional Tort: Defamation - A communication that tends to hold the plaintiff up to hatred, contempt or ridicule, or to cause him to be shunned or avoided. Tarnishing the reputation of someone. Quasi-Intentional Tort: Defamation Types - Types: Libel - printed or broadcast Slander - spoken Nurse Practice Act - The practice of nursing is a right granted by a state to protect those who need nursing care. The guidelines of the NPA and its rules provide safe parameters within which to work, as well as protect patients from unprofessional and unsafe nursing practice. The act is a dynamic document that evolves and is updated or amended as changes in scope of practice occur. All states and territories have enacted a NPA Generally, NPAs include: Authority, power and composition of a board of nursing Education program standards Standards and scope of nursing practice Types of titles and licenses Requirements for licensure Grounds for disciplinary action, other violations and possible remedies Rules & Regulations - The NPA itself is insufficient to provide the necessary guidance for the nursing profession, therefore, each NPA establishes a board of nursing (BON) that has the authority to develop administrative rules or regulations to clarify or make the law more specific. Rules and regulations must be consistent with the NPA and cannot go beyond it. These rules and regulations undergo a process of public review before enactment. Once enacted, rules and regulations have the full force and effect of law. P a g e 2 | 15 Nurses who hold licenses in other states and are obtaining a Texas license for the first time; and Nurses who receive full licensure as APRNs Licensure Verification - Employers may verify the licensure status of all nurses seeking employment online or by phone. Renewal of Licensure - 60 days prior to license expiration, the BON will mail a postcard reminder to renew online. This is one of the reasons it is important to keep your contact information up to date! Continuing Competency (TAC Chapter 216) - Purpose: to ensure nurses stay abreast of current industry practices, enhance their professional competence, learn about new technology and treatment regimens, and update their clinical skills. [TAC § 216.2] All nurses are required to demonstrate continuing competency for renewal of licensure. Methods: Complete 20 hours of continuing education, or Attain, maintain, or renew an approved national nursing certification in the area of practice Nursing Jurisprudence & Ethics - 2 hours [Rule 216.3 (g)] Older Adult or Geriatric Care - 2 hours [Rule 216.3 (h)] Nurse Licensure Compact - The Nurse Licensure Compact (NLC) allows RNs and LVNs to have one multistate license, with the ability to practice in both their home state and other NLC states. The APRN Compact allows an advanced practice registered nurse to hold one multistate license with a privilege to practice in other compact states. Agreement among states to mutually recognize each others' licenses Texas among first to adopt Premise: current licensure requirements essentially the same from state to state Does not interfere with each state defining scope of practice Only defines requirements to hold license Nurse Licensure Compact - Definitions - Party states - states who have adopted the compact Home state license - where you permanently reside Remote state - where you practice using multistate privilege (must be a party state) Nurse Licensure Compact - Requirements - Maintain home state license Adhere to state practice laws of state in which patient is located at the time care is provided Use multistate privilege only in party states Hold home state license in only one party state at a time. P a g e 5 | 15 Practice in a Non-Party State - To practice in a state that is not part of the Compact, the nurse must obtain license from the non-party state May concurrently hold a home state license and a license to practice in a non-party state If you live in a non-party state, you must obtain a non-resident Texas license in order to practice in Texas Ethical Conduct - Year after year, Nursing is recognized as one of the most trusted professions. It is important to maintain that trust, so we can practice efficiently. ...what is good and bad and with moral duty and obligation... Good Professional Character - Integrated pattern of personal, academic and occupational behaviors which, in the judgment of the Board, indicates that an individual is able to consistently conform his or her conduct to the requirements of the Nursing Practice Act, the Board's rules and regulations, and generally accepted standards of nursing practice including, but not limited to, behaviors indicating honesty, accountability, trustworthiness, reliability, and integrity [TAC § 213.27(a)]. Factors Indicating Good Professional Character - Distinguish right from wrong; Think and act rationally; Keep promises and honor obligations; Accountable for own behavior; Able to practice nursing in an autonomous role with patients/clients, their families, significant others, and members of the public who are or who may become physically, emotionally, or financially vulnerable; Recognize and honor the interpersonal boundaries appropriate to any therapeutic relationship or health care setting; and Promptly and fully self-disclose facts, circumstances, events, errors, and omissions when such disclosure could enhance the health status of patients/clients or the public or could protect patients/clients or the public from unnecessary risk of harm [ Rule 213.27(b)(2)(A-G)]. Any conviction for a felony or for a misdemeanor involving moral turpitude or order of probation with or without an adjudication of guilt for an offense that would be a felony or misdemeanor involving moral turpitude if guilt were adjudicated [Rule 213.27 (b)(3)]. Any revocation, suspension, or denial of, or any other adverse action relating to, the person's license or privilege to practice nursing in another jurisdiction [Rule 213.27 (b) (4)]. Criminal Behavior Disclosure - Requirement for criminal history for applicants for a license [NPA § 301.2511]. P a g e 6 | 15 Requirement for criminal history for renewal of license [NPA § 301.3011]. Disclose: Convictions Deferred adjudications Probated sentences Domestic offenses Professional Boundaries - The appropriate limits which should be established by the nurse in the nurse/client relationship due to the nurse's power and the patient's vulnerability. Refers to the provision of nursing services within the limits of the nurse/client relationship which promote the client's dignity, independence and best interests and refrain from inappropriate involvement in the client's personal relationships and/or the obtainment of the nurse's personal gain at the client's expense. A zone of patient-centered care is in the center of the professional behavior continuum. This is where the patient interactions should occur for effectiveness and patient safety. Over-involvement with a patient is on the right side of the continuum; this includes boundary crossings, boundary violations and professional sexual misconduct. Under- involvement lies on the left side; this includes distancing, disinterest and neglect, and can be detrimental to the patient and the nurse. Rule 217.11. Standards of Nursing Practice - Know, recognize, and maintain professional boundaries of the nurse-client relationship Rule 217.12. Unprofessional Conduct - Misconduct — actions or conduct that include, but are not limited to: (D) Violating professional boundaries of the nurse/client relationship including but not limited to physical, sexual, emotional or financial exploitation of the client or the client's significant other(s) Unprofessional Conduct - Using fraud or deceit in procuring a license Improperly using a nursing license Impersonating another person in examination Aiding and abetting someone in unlawful practice Failing to cooperate with a lawful investigation Behaving in a threatening or violent manner in the workplace Offering, giving, soliciting, or receiving or agreeing to receive, directly or indirectly, any fee or other consideration to or from a third party for the referral of a client in connection with the performance of professional services. Rule 217.12. Standards of Nursing Practice - This rule covers standards of nursing practice that apply to all nurses, including RNs, LVNs, and APRNs. P a g e 7 | 15 5. Would a reasonable and prudent nurse perform this activity in this setting? 6. Are you prepared to assume accountability for the provision of safe care and the outcome of the care rendered? Yes: Perform the activity. No: stop. Delegation - Authorizing an unlicensed person to provide nursing services while retaining accountability for how the unlicensed person performs the task. It does not include situations in which an unlicensed person is directly assisting a RN by carrying out nursing tasks in the presence of a RN [Rule 224.4 (3)]. RNs may delegate LVNs may supervise The RN is responsible for the evaluation of the delegated task to ensure it was completed and completed correctly [Rule 224.3]. According to the BON website, many find delegation to be a perplexing concept with multiple nuances. The BON created the Delegation Resource Packet to afford RNs clearer direction for delegation in a variety of settings thereby improving the delegation process Criteria for Delegation - RNs may delegate LVNs may supervise The RN is responsible for the evaluation of the delegated task to ensure it was completed and completed correctly [Rule 224.3]. Nursing Tasks Prohibited from Delegation - Formulation of the nursing care plan and evaluation of the client's response to the care rendered. Specific tasks involved in the implementation of the care plan which require professional nursing judgment or intervention. The responsibility and accountability for client health teaching and health counseling which promotes client education and involves the client's significant others in accomplishing health goals. Administration of medications, including intravenous fluids, except by medication aides as permitted under §224.9 of this title (relating to The Medication Aide Permit Holder). Mandatory Reporting Requirement - A nurse shall report to the board if the nurse has reasonable cause to suspect that: 1. Another nurse has engaged in conduct subject to reporting; or 2. the ability of a nursing student to perform the services of the nursing profession would be, or would reasonably be expected to be, impaired by chemical dependency. P a g e 10 | 15 Alternative to Mandatory Reporting - Instead of reporting to the board under a nurse may make a report to: 1. a nursing peer review committee under Chapter 303; or 2. to the nursing educational program in which the student is enrolled. Employer Duty to Report - If an employer terminates a nurse (voluntarily or involuntarily), suspends for seven (7) or more days, or takes other substantive disciplinary action against a nurse or substantially equivalent action against an agency nurse for nursing practice errors/concerns, the employer must report to the Board (BON) in writing [NPA § 301.405 (b)] Minor Incidents - "conduct that does not indicate that the continuing practice of nursing by an affected nurse poses a risk of harm to the client or other person." Minor Incident Exclusions - Conduct that cannot be considered a minor incident: 1. Any error that contributed to a patient's death; 2. Criminal conduct defined in NPA § 301.4535; or 3. A serious violation of the board's Unprofessional Conduct Rule 217.12 involving intentional or unethical conduct such as fraud, theft, patient abuse or patient exploitation. TOC Chapter 303. Nursing Peer Review - Defined by NPA §303.001(5) as the evaluation of: nursing services, the qualifications of a nurse, the quality of patient care rendered by a nurse, the merits of a complaint concerning a nurse or nursing care, and a determination or recommendation regarding a complaint. Incident-Based Peer Review - Incident-Based, because it relates to an incident reported after the fact, so it starts with an error or incident Initiated by a nurse, facility, association, school, agency, or any other setting that utilizes the services of nurses Safe Harbor Peer Review - May be initiated by a LVN, RN or APRN prior to accepting an assignment or engaging in requested conduct that the nurse believes would place patients at risk of harm, thus potentially causing the nurse to violate his/her duty to the patient(s). Invoking safe harbor in accordance with Rule 217.20 protects the nurse from licensure action by the BON as well as from retaliatory action by the employer. P a g e 11 | 15 Employers of 10 or more licensed nurses must have a Peer Review Committee [TOC § 303.0015 (a) (1) and (2)]. The committee shall give the nurse being reviewed at least minimum due process [TOC § 303.002 (e)]. Due Process Rights - A facility conducting incident-based peer review shall: Have written policies and procedures about peer review Nurse must receive notice regarding the review, and have an opportunity to respond to the notice Nurse may have an attorney, will get feedback after the decision, and have a chance to respond to the decision Minimum Due Process Rights Include - Notice must be provided in writing in person or by certified mail Notice must Include a description of the event(s) to be evaluated in sufficient detail to inform the nurse of the incident, circumstances and conduct (error or omission) The nurse must have the opportunity to: (i) submit a written statement regarding the event under review; (ii) call witnesses, question witnesses, and be present when testimony or evidence is being presented Employer Disciplinary Action - Employment and licensure issues are separate. An employer may take disciplinary action before review by the peer review committee is conducted, as peer review cannot determine issues related to employment. The role of incident-based peer review is to determine if licensure violations have occurred and, if so, if the violations require reporting to the board. Safe Harbor Peer Review - Safe Harbor must be invoked prior to engaging in the conduct or assignment for which peer review is requested, and may be invoked at any time during the work period when the initial assignment changes. Examples of Safe Harbor situations include clinical assignments related to staffing and/or acuity of patients where the nurse believes patient harm may result [TAC § 217.11(1)(B) and (T)]. Safe Harbor allows nurses to accept assignments, and do the best patient care they are capable of, without fear of licensure action by the Board if they accidentally commit an error. It is important to remember; however, that NPA § 301.352 gives a nurse the right to refuse to engage in conduct related to patient care if they believe the conduct would violate the NPA or any BON rule Activation of Safe Harbor Peer Review - Notify the supervisor making the assignment in writing that the nurse is invoking Safe Harbor. P a g e 12 | 15