Ohio Nurse Practice Act

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This fulfills the continuing education requirement of 1.5 contact hours relating the Ohio Nurse Practice Act for the state of Ohio.  

Modern nursing has been standardized nationwide in the way that nurses are educated and the standards they are held to when performing their jobs. While the minimum proficiency exam, the National Council Licensure Exam (NCLEX), is used to determine who qualifies to be a nurse, each state has its own Nurse Practice Act that oversees the nurses of that state and sets ensures the standards for safe and skilled care are being followed (1). This course will cover Ohio Nurse Practice Act in detail to best prepare Ohio nurses to provide the best care possible. 

Introduction and Objectives 

Nursing as a trained profession has been around for over 200 years in the United States, with the first courses on caring for maternity patients taught by Dr. Valentine Seaman in 1798 in New York. Over the next 100 years, nursing education became more standardized and widespread, following the overseas lead of Florence Nightingale and rising to meet the need for skilled health professionals with the outbreak of the Civil War. In 1873, there were three schools for nursing education in the United States; by 1900, there were more than 400 schools (8)! Fast forward another 120 years, and there are now 3.8 million nurses caring for the citizens of this country, and the demand for more is expected to grow as the Baby Boomer population ages (1).  

Modern nursing has been standardized nationwide in the way that nurses are educated and the standards they are held to when performing their jobs. While the minimum proficiency exam, the National Council Licensure Exam (NCLEX), is used to determine who qualifies to be a nurse, each state has its own Nurse Practice Act that oversees the nurses of that state and sets ensures the standards for safe and skilled care are being followed (1). Upon completion of this course, the learner should have increased knowledge of the standards outlined by the Ohio Nurse Practice Act and demonstrate an understanding of:  

1. The definition and roles of the Ohio Board of Nursing and the Ohio Administrative Code. 
2. Differences between scopes of practice and nursing process for RNs and LPNs. 
3. Basic concepts included in Standards of Competency for nurses. 
4. Standards of care required to maximize patient safety. 

Ohio Administrative Code and Board of Nursing  

The Ohio Administrative Code (OAC) delineates the rules and regulations of various licensed professions, and Section 4723 is specific to nursing practice. This section of the OAC (based on the Ohio Nurse Practice Act) outlines specifics in ensuring proper safety, delegation, competency standards, applying the nursing process, and disciplinary action for nurses with an Ohio license.  

While the OAC sets the standards and scope of practice of nurses in the state, there needs to be a governing body to enforce the rules and regulations. This is where the Ohio Board of Nursing (OBN) comes in. The OAC dictates that the OBN be composed of thirteen members; at least eight of which should be registered nurses (RNs), at least two licensed practical nurses (LPNs), two advanced practice registered nurses (APRNs), and one consumer representative. All licensed members of the board should have an active, unencumbered license and at least five recent years of experience in the workforce (3). 

The board is legally authorized to enforce the rules put forth by the Ohio Nurse Practice Act’s OAC and must review each rule at least once every five years. Among other duties, they are also responsible for reviewing and granting approval to nursing education programs, issuing and renewing nursing licenses, and regulating the substance abuse monitoring program for nursing professionals. The funding for the OBN comes from licensure fees for nurses practicing in the state of Ohio (4). 

Scopes of Practice and Application of Nursing Process

The scopes of practice within the Ohio Nurse Practice Act encompass a list of duties, services, and tasks that Ohio nurses are qualified and permitted to perform under their license. The scope of practice varies by level of licensure (LPN, RN, APRN) and allows nurses to effectively carry out their roles while maintaining maximum patient safety.  

RN Scope of Practice

Section 4723.01 of the OAC specifies that RNs can utilize the specialized training and multifaceted, holistic knowledge gained from an accredited nursing education program to provide nursing care to individuals or groups. Tasks considered “nursing care“ include: 

1. Identifying patterns in human response to actual or potential health issues that could be altered by a preventative, restorative, or health-promotion “nursing regimens.“ 
2. Delivering nursing regimens/interventions utilizing the nursing process (outlined below). 
3. Using interviews, observation, and physical exam techniques to assess a patient‘s health status to provide appropriate nursing care.  
4. Providing patients with health–related counseling and teaching. 
5. Administering medications, treatments, and other interventions as specified in orders given by a qualified and licensed professional. 
6. Teaching, supervising, delegating, and evaluating the practice of nursing (2).
   

RN Application of Nursing Process

The Nursing Process is a standard sequence of steps used to guide patients’ holistic, safe, and effective care. The five steps always include Assessment, Diagnosis, Planning, Implementation, and Evaluation. Further review of each of these steps, as supported by the OAC, is below:

1. Assessment– Collect data from patients via history, observations, and physical exam. This can also include data reported to the nurse from a patient‘s family or an LPN.
2. Diagnosis– Establish or modify the nursing diagnosis.
3. Planning– Analyze collected data to form a plan for nursing interventions
4. Implementation– Communicate and carry out the plan of care within the scope of practice.
5. Evaluation– Assess patient response to plan, modify as needed (7). 

LPN Scope of Practice

The Ohio Nurse Practice Act’s OAC also specifies the LPN scope of practice, which is similar to the RN scope but it has less autonomy and requires more collaboration. Tasks within the LPN scope of practice include:  

1. Observation, focused assessments, care, and patient teaching in a variety of settings. 
2. Contributing to the planning, implementation, and evaluation of nursing care. 
3. Administration of medication and treatments as ordered by a qualified professional and after documented completion of a medication proficiency course. IV medications are excluded from this and require further training.  
4. Delegating nursing tasks outlined by an RN. The LPN may delegate to unlicensed assistive personnel such as CNAs. 
5. Teaching nursing tasks to other LPNs or unlicensed assistive personnel (2).  

 Of note, tasks prohibited for LPNs include:  

1. Engaging in nursing practice without direction from an RN or qualified professional. 
2. Administering IV push medications (though extra training for this is possible). 
3. Teaching the practice of nursing. 
4. Supervising or evaluating the nursing practice. 
5. Performing comprehensive assessments to provide nursing care (2). 

LPN Application of Nursing Process

The Nursing Process varies for the LPN in that these professionals mostly contribute to the process rather than initiating or carrying it out. Specifics of this process, as outlined by the Ohio Nurse Practice Act’s OAC, include: 

1. Collecting objective and subjective data about patient condition and reporting it to the RN. 
2. Implementing the existing plan of care at the direction of the RN or other qualified professional. 
3. Documentation of patient response to care. 
4. Communicating with members of the healthcare team to contribute to evaluation and revision of the nursing plan of care (2). 

Case Study

The charge nurse is making patient assignments for a med– surg unit that currently has six patients. The oncoming shift has one RN and one LPN with a CNA to assist with the entire unit. The charge nurse assigns four patients to the RN and two patients to the LPN.  

1. Which factors of the patients‘ care will need to be considered when making assignments?
2. What responsibilities will the RN have in regards to the LPN‘s patients? 
3. Are both licensed nurses able to delegate tasks to the CNA on the unit? 

Standards of Competency

Standards of competency within the Ohio Nurse Practice Act’s OAC outline the qualifications a nurse must have to operate within their scope of practice. If the scope of practice details what nurses can do, then standards of competency outline how they must do it. These standards include:  

1. Understanding and operating within the scope of practice appropriate for licensure level. 
2. Maintaining current knowledge of duties, responsibilities, and accountabilities for safe practice. 
3. Demonstrating consistent practices of care and recognizing when to consult with colleagues or refer care. 
4. Providing care beyond basic nursing education only when additional education and training has been obtained and documented, appropriate skills demonstrated, and the tasks within the laws of that state. 
5. Implementing provider orders within a reasonable time frame unless an order is determined to be invalid. 
6. Demonstrating the ability to identify invalid, harmful, or unauthorized orders and consulting with the ordering provider to rectify the situation by either obtaining a corrected order or maintaining patient safety by deciding not to follow an order. 
7. Collaborating with and referring to other members of the nursing team when appropriate. 
8. Maintaining patient confidentiality within the realm of legal and safety considerations. 
9. Keeping identifiable patient information (name, birth date, etc.) confidential to the greatest extent possible. 
10. Using standards of care that promote patient safety (5). 

In addition to the above standards, RNs must also consider competency standards when delegating tasks to an LPN or unlicensed assistive personnel (CNA, patient care technician, etc.). Ultimately, the Ohio Nurse Practice Act outlines that the care of a patient falls on the nurse, and delegation is safe and appropriate only when the below criteria have been met:  

1. The condition and stability of the patient is appropriate for LPN or CNA care. 
2. The type of care or tasks required are within the LPN or CNA scope of practice. 
3. The complexity and frequency of said tasks are within the capabilities of the LPN or CNA. 
4. The training and skill level of the LPN or CNA will allow them to complete the delegated task competently. 
5. Resources needed to complete the task are readily available and accessible (5). 

Standards for Promoting Patient Safety 

Proper understanding of the Ohio Nurse Practice Act’s Scope of Practice, Nursing Process, and Standards of Competency should lead a nurse to provide care in such a way that promotes the best outcomes for patients, including maintaining patient safety. In case there are any situations where it is unclear what is most safe, the OAC has outlined some standards. They are: 

1. Nursing professionals will wear proper identification with their name and title, visible to patients at all times when providing care. 
2. Nurses must delegate tasks and medication administration only within the scope of the professional being delegated to. 
3. Nurses must document assessments, care, patient responses to care, and any errors in a timely manner. 
4. Nurses must not falsify or alter documentation of nursing care in any manner. 
5. Nurses must maintain professional boundaries, ensure privacy and a safe environment for patients. 
6. Nurses must not engage in any physically, verbally, or emotionally abusive behavior when caring for patients. 
7. Nurses must not misappropriate patient property in any way, accept or seek monetary gain at a patient‘s expense, or become involved in patients‘ personal or financial matters. 
8. Nurses must not engage in sexual conduct with patients or sexually harass or exploit patients. 
9. Nurses in administrative roles are responsible for ensuring their staff have valid and appropriate licensure, education, and training to provide safe care for patients. 
10. Nurses must not make false claims to the OBN, law enforcement, or hospital administration. 
11. Nurses may not use texting, email, or social media to communicate patient information for purposes other than carrying out the responsibilities of their job (6).

Conclusion 

There are many more subsections to the OAC that detail more specifics about licensure, disciplinary action, and APRNs but it is beyond the knowledge needed for basic competency as a nurse practicing in the state of Ohio. While most nurses will find the scope of practice, safety guidelines, and minimum competency standards as outlined in the Ohio Nurse Practice Act to be similar from state–to–state, there is the potential for differences across state lines. Having familiarity with the state in which you practice is always a good idea. Depending on your workplace setting, understanding the relationship between the RN and LPN scopes of practice and nursing processes may be of particular importance. The OAC is public domain and can be easily accessed to clarify any questions, and the OBN can be contacted for guidance on any gray areas. 

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