Nursing Practice

Duty of a Nurse in any Practice Setting Position Statement 15.14

-15.14=Duty of a nurse in any practice setting -Duty to the patient is much more comprehensive than you might imagine. -Board emphasizes the nurse's responsibility and duty to the patient to provide safe, effective, nursing care.

Position Statement 15.14

-Based on a landmark case that helped define the issue of duty to the patient. -Lunsford v. Board of Nurse Examiners, the court held that a nurse's duty to the patient ranks higher than hospital policy or a physician's order

Court decision

-Court sided with the BNE and agreed that the nurse had the knowledge, skills and abilities to recognize the life-threatening nature of the man's symptoms -Because of this knowledge, the court maintained that it was the NURSE'S DUTY to act in the best interest of the client by assessing the man, taking measures to stabilize him and to prevent complications, and communicating his condition to other staff (such as the MD) in order to enlist appropriate medical care -Nurse ended up losing her license

Role of LVN

-Directed scope of practice that must be supervised -Educated to care for clients with stable and predictable conditions -Educated to do hands-on assessments using their senses

Duty of a Nurse in any Practice Setting cont.

-Duty to patient is ALWAYS higher -Regardless of instruction from a doctor or from your boss, you must determine whether tasks achieve your duty to the patient and are within your scope of practice

Lunsford v Board of Nurse Examiners

-Involved a man who arrived to a rural hospital via private vehicle -Man experiencing severe chest pain, nausea, and swearing (all hallmark symptoms of a heart attack) -Nurse Lunsford was summoned to the ER waiting room by this man's friend. Upon seeing the acute distress the man was experiencing and hearing his symptoms, she instructed his friend to drive the man to the nearest facility equipped to handle heart attack victims. This facility was 24 miles away. -The man succumbed to the heart attack 5 miles away from the small hospital

Duty of a Nurse in any Practice Setting

-Justices of the Appeals Court stated Nurse Lunsford was granted the PRIVILEGE of being licensed to practice her nursing -Her license did not belong to the physician or the hospital. It was HER license 24/7 -Once the nurse-patient relationship was formed Nurse Lundsford had an INDEPENDENT duty to the patient

All Nurses:

-Know and conform to Board rules -Promote safe environment -Ensure accurate documentation -Institue interventions to stabilize client condition -Accept assignment safely -Know about and correctly administer medication -Respect patient right to privacy -Know and maintain professional boundaries

Choices and Situation That Might Lead to Nursing Errors

-Lack of attention to repetitive tasks -Look alike medications/medication labels -Distractions / Task Light -Fatigue = Increased % of errors -Interruptions by staff and patients

Scope of Practice: RN

-Makes nursing diagnoses that serve as a basis for care -Develop nursing care plans -Implements nursing care -Preform comprensive nursing assessment -Evaluate patient response to nursing interventions -Delegate tasks to unlicensed personnel (LVN) -BSN safer being able to suspend a hypothesis

Scope of Practice: New Nurses and Transitioning Nurses

-New Nurses should be: supervised for 6 months or lesser time if mutually agreed upon by new nurse and supervising nurse. -Competence to perform independently should be mutually determined and documented -This also applies to nurses returning to work force or transitioning to a new area of practice -Transitioning nurses should not act as charge for 6 months unless a lesser time is MUTUALLY agreed upon

Duty to the Patient

-Nurses Duty to Patient ranks higher than physicians orders or hospital policy -Nurses Duty > Hospital Policy & Physicians Orders

Texas BON Position Statements

-Position Statements allows board to give opinion

APRN

-Practice in an advanced nursing role and speciality -Prescribe medication in accordance with prescriptive authority

Nursing Practice: Delegation (Rule 225)

-RN Delegation to unlicensed personnel and tasks not requiring delegation in independent living environments for clients with stable conditions

What are the differences between training, supervision, and delegation?

-RNs can delegate -LVNs can supervise or assign, but they CANNOT delegate -Training is not the same as delegation. Your responsibility to a trainee ends when his or her training is complete

*Scope of Practice

-Scope is of different for different kinds of nurses. This includes new nurses, and nurses who are transitioning back to practice -BON position statements are helpful -Six Step model is found on BON website

Parts of Nursing Practice

-Scope of Practice -Standards of Practice -Rules of supervision -Nurse's duty to the patient -Position statements -Preventing human error

Position Statements

-The Board's position statements are there to provide you with extra guidance and direction -They don't have the force of law, but the Board strongly encourages nurses to choose those position statements that are applicable to their practice setting and incorporate them into their daily practice to assure patient safety.

217.11

-The heart of nursing practice, the single most helpful point of reference, the one rule number that will mean the most to you in your practice

Scope of Practice: LVN

-Use a systematic approach to collect data -Participate in the planning of nursing care for patients -Implement appropriate aspects of nursing care -Perform focused nursing assessments (ex. focused assessment on the pain) -Assist in evaluating patient response to treatment -Collected subjective data

Role of the RN

-Works in both structured and unstructured health care environments -Responsible for well-being of all patients -Functions independently with the scope of NPA and Board rules

*6 Step Process to know if you're in Scope of Practice

1. Is the activity consistent with the NPA and Board rules? 2. Is it appropriately authorized? 3. Is it supported by nursing research or national nursing organizations? 4. Do you possess the required knowledge and competency? 5. Would a reasonable and prudent nurse perform this activity? 6. Are you prepared to assume accountability for the patient's safe care and outcome?

5 Parts of Jurisprudence

1. Nursing Licensure and Regulation in Texas 2. Nursing Ethics 3. Nursing Practice 4. Nursing Peer Review 5. Disciplinary Aciton

Rule 217.11 (2) (A)

(A) Shall utilize a systematic approach to provide individualized, goal-directed nursing care by: (i) collecting data and performing focused nursing assessments; (ii) participating in the planning of nursing care needs for clients; (iii) participating in the development and modification of the comprehensive nursing care plan for assigned clients; (iv) implementing appropriate aspects of care within the LVN's scope of practice; and (v) assisting in the evaluation of the client's responses to nursing interventions and the identification of client needs;

Chain of Command

Nurse has a duty to the patient-->when are you on duty-->it depends (nurse patient relationship). Had licensed and assessed patient that was seeking care. RMR: Duty of patient goes ABOVE hospital policy. At least call transportation.

Scope of Practice

All Nurses: RN, APRN, LVN -There are basic differences between nursing processes for vocation nursing and professional nursing. -APRN: Advanced Practice Registered Nurse (CRNA, NP, CP)

Which elements belong to professional nursing and which are vocational nursing? (Scope of Practice-217.11) 1. Practice independently 2. Assist in evaluation patient reponse to nursing care 3. Develop nursing care plan 4. Perform comprehensive assessment 5. Participate in planning of nursing care 6. Evaluate patient response to nursing care 7. Make nursing diagnoses 8. Perform focused assessment

Professional Nursing (RN): 1. Practice independently 3. Develop nursing care plan 4. Perform comprehensive assessment 6. Evaluate patient response to nursing care 7. Make nursing diagnoses Vocational Nursing (LVN): 2. Assist in evaluation patient response to nursing care 5. Participate in planning of nursing care 8. Perform focused assessment

What level of licensure is required for delegation? -LVN -GVN (graduate vocational nurse) -RN

RN

Impala Rule:

Stabilize & Transfer (Anti-dumping law).

Rule 217.11 (3) (A)

Standards Specific to Registered Nurses. The registered nurse shall assist in the determination of healthcare needs of clients and shall: (A) Utilize a systematic approach to provide individualized, goal-directed, nursing care by: (i) performing comprehensive nursing assessments regarding the health status of the client; (ii) making nursing diagnoses that serve as the basis for the strategy of care; (iii) developing a plan of care based on the assessment and nursing diagnosis; (iv) implementing nursing care; and (v) evaluating the client's responses to nursing interventions;

217.11

Standards of Nursing Practice

Are these delegation, supervision or training? 1. Demonstrate proper CPR techniques 2. Monitor an aide performing ADLs with a patient 3. Direct the aide to insert a Foley 4. Demonstrate now to use a blood glucose machine 5. Ensure that a nurse's aide takes vital signs as ordered 6. Direct the aide to perform non-sterile wound care 7. Ensure the dietary trays are delivered

Training: -Demonstrate proper CPR techniques -Demonstrate how to use a blood glucose machine Delegation: -Direct the aide to perform non-sterile wound care -Direct the aide to insert a Foley catheter Supervision: -Ensure a nurse's aid takes vital signs as ordered -Ensure that dietary trays are delivered -Monitor an aide performing ADLs with a patient