Module 4, Legal Ethical, part 1
Health and Safety Code
BE AWARE Some facilities provide training for activities for LVNs that are not part of the LVN scope of practice according to the BON rules. This is accomplished through the section of the Health & Safety Code (which pertains to hospitals) that an agency may train a staff person (LVN) to carry out duties not normally part of their job IF they are willing to accept liability for the actions. (respondeatsuperior doctrine) NOTE: The LVN may still be held accountable by the BON for their actions.
217.11 (3)
*•(B) Delegate tasks to unlicensed personnel* in compliance with Chapter 224 of this title, relating to clients with acute conditions or in acute are environments, and Chapter 225 of this title, relating to independent living environments for clients with stable and predictable conditions. •In Texas, we assign duties to LVNs. In the US, the RN delegates to the LVN/LPN. Be aware of the nuance when taking standardized tests.
224.4 (3)
Delegation definition (3) 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. • Who is the unlicensed person? (4) Unlicensed person--An individual, not licensed as a health care provider: (A) who is monetarily compensated to provide certain health related tasks and functions in a complementary or assistive role to the RN in providing direct client care or carrying out common nursing functions; (B) including, but is not limited to, nurse aides, orderlies, assistants, attendants, technicians, home health aides, medication aides permitted by a state agency, and other individuals providing personal care/assistance of health related services; or (C) who is a professional nursing student, not licensed as a RN or LVN, providing care for monetary compensation and not as part of their formal educational program shall be considered to be unlicensed persons and must provide that care in conformity with this chapter.
224.8
Delegation of Tasks
213.29
Fitness to Practice: Intemperate Use: An individual's fitness to practice may be subject to Board review due to an individual's substance use disorder; possession, abuse, or misuse of alcohol or drugs, prescribed or otherwise; or physical or mental health condition. This is not an exhaustive list. If an individual exhibits any conduct that may prevent him/her from practicing nursing with reasonable skill and safety, the Board will review the individual's conduct to determine if he/she possesses current fitness to practice.
224.6
General Criteria for Delegation - the five rights of delegations
Position Statement 15.3
LVNs Engaging in IV Therapy, Venipuncture, or PICC Lines Summary: LVN must complete post-licensure training to engage in IV Therapy/Venipuncture (not typically included in LVN curriculum). Insertion of PICC lines is beyond the scope of practice for LVN.
Nurses Carrying Out Orders from PAs
Position Statement 15.1 Summary: Nurses may carry out physician orders relayed by a PA and/or which originate from a protocol between the PA and the physician. The nurse is expected to clarify any order he/she questions by communicating with the PA or the physician.
Board Jurisdiction Over a Nurse's Practice in Any Role and Use of the Nursing Title
Position Statement 15.15 Summary: If a RN or LVN functions in role of lower than that which for which each is licensed, or in another area with an overlapping scope of practice, the nurse is still held to the level of education and competency of their highest licensure. Also restricts use of the titles LVN or RN or any designation implying nursing licensure by non-nurses (Rule 217.10 and NPA Section 301.351)
LVN Scope of Practice
Position Statement 15.27 Summary: The LVN scope of practice is a *directed scope of practice and requires appropriate supervision.* The LVN is responsible for providing safe, compassionate and focused nursing care to assigned patients with *predictable* health care needs.
224.8 (b)
discretionary tasks - sterile procedures - non-sterile procedures such as dressing or cleansing penetrating wounds and deep burns - invasive procedures or inserting into tubes - care of broken skin other than minor abrasions or cuts classified as requiring only first aid treatment.
217.11 3(A)
rule for Nursing Process Professional Nurse: ADPIE (3) 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;
224.8 (a)
tasks commonly delegated - non-invasive, non-sterile - collecting reporting, documentation of data (vital signs, height, weight, intake and output, capillary blood and urine test, environmental situations, client or family comments relating to client's care, and behaviors related to the plan of care, - ambulation, positioning, turning, - transportation of the client within a facility, - personal hygiene and elimination, including vaginal irrigation and cleansing enemas, - feeding, cutting up of food, or placing of meal trays, - socialization activities, - activities of daily living, - reinforcement of health teaching planned and or provided by the registered nurse.
224.8 (c)
tasks prohibited from delegation - if it requires critical thinking - ADPIE, - administration of medications including i.v. fluids except by medication aides
RN prohibited from Delegation
- assessment - formulation of a nursing care plan - implementation of parts of the nursing care plan - responsibility and accountability of health education - dose calculation - injectable medication (except insulin) - medications via a non-permanent tube - verbal and telephone orders - initial dose
224.11
Application of Other Laws/Regulations (requires RN's to know and conform to all laws and regulations affecting their area of practice.
RN Scope of Practice
Position Statement 15.28 •Practice -Registered Nurse Scope of Practice •The Texas Nursing Practice Act (NPA) defines the legal scope of practice for professional registered nurses (RNs). "Professional nursing" means the performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures. •Practice -Registered Nurse Scope of Practice (continued) •Professional nursing involves: •the observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes; •the maintenance of health or prevention of illness; •the administration of a medication or treatment as ordered by a physician, podiatrist, or dentist; •Practice -Registered Nurse Scope of Practice (continued) •the supervision or teaching of nursing; •the administration, supervision, and evaluation of nursing practices, policies, and procedures; •the requesting, receiving, signing for, and distribution of prescription drug samples to patients at practices at which an advanced practice registered nurse is authorized to sign prescription drug orders as provided by Subchapter B, Chapter 157; •the performance of an act delegated by a physician under Section 157.0512, 157.054, 157.058, or 157.059; and •the development of the nursing care plan. •Practice -Registered Nurse Scope of Practice (continued) •The RN takes responsibility and accepts accountability for practicing within the legal scope of practice and is prepared to work in all health care settings, and may engage in independent nursing practice without supervision by another health care provider. The RN, with a focus on patient safety, is required to function within the parameters of the legal scope of practice and in accordance with the federal, state, and local laws; rules and regulations; and policies, procedures and guidelines of the employing health care institution or practice setting. The RN is responsible for providing safe, compassionate, and comprehensive nursing care to patients and their families with complex healthcare needs.
Use of Social Media by Nurses
Position Statement 15.29 Summary: The use of social media can be of tremendous benefit to nurses and patients alike. However, nurses must be aware of the potential consequences of disclosing patient-related information via social media. Nurses must always maintain professional standards, boundaries, and compliance with state and federal laws as stated in Board Rule 217.11(A). All nurses have an obligation to protect their patient's privacy and confidentiality [as required by Board Rule 217.11(E)] which extends to all environments, including the social media environment.
patient abandonment
Quit your job (without notice) at end of shift = No Leave your assignment without notifying supervisor = Yes Position Statement 15.6 Differentiates employment vs. licensure issues; addresses relevant Board rules when a nurse engages in unprofessional conduct with regard to being unavailable to provide care to assigned patients (such as sleeping on the job). Provides guidance for nurses in relation to emergency preparedness and workplace violence (including disasters, infectious disease outbreaks, or bioterrorism).
224.5
RN Accountability for Delegated Tasks
differences between RN and LVN
RN is critical thinker and independent, can delegate stable and predictable to LVN LVN is task oriented and dependent
133.41
Rule Staffing Committee TAC •(F) The hospital shall establish a nurse staffing committee as a standing committee of the hospital. •The committee shall be established in accordance with Health and Safety Code (HSC), §§161.031 -161.033, to be responsible for soliciting and receiving input from nurses on the development, ongoing monitoring, and evaluation of the staffing plan. •As provided by HSC, §161.032, the hospital's records and review relating to evaluation of these outcomes and indicators are confidential and not subject to disclosure under Government Code, Chapter 552 and not subject to disclosure, discovery, subpoena or other means of legal compulsion for their release. •As used in this subsection, "committee" or "staffing committee" means a nurse staffing committee established under this subparagraph. (i) The committee shall be composed of: •(I) at least *60% registered nurses* who are involved in *direct patient care at least 50% of their work time* and selected by their peers who provide direct care during at least 50% of their work time; •(II) at least one representative from either infection control, quality assessment and performance improvement or risk management; •(III) members who are representative of the types of nursing services provided at the hospital; and •(IV) the chief nursing officer of the hospital who is a voting member. •Texas Administrative Code: Hospital Functions and Services
301.353
Section Supervision of LVN Sec. ________________ Supervision of Vocational Nurse. • The practice of vocational nursing must be performed under the supervision of a registered nurse, physician, physician assistant, podiatrist, or dentist
217.11 (2)
Standards Specific to Vocational Nurses . • The licensed vocational nurse practice is a *directed* scope of nursing practice *under the supervision of a registered nurse*, advanced practice registered nurse, physician's assistant, physician, podiatrist, or dentist. Supervision is the process of directing, guiding, and influencing the outcome of an individual's performance of an activity. The licensed vocational nurse shall assist in the determination of predictable healthcare needs of clients within healthcare settings and: • (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; •(B) Shall assign specific tasks, activities and functions to unlicensed personnel commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made and shall maintain appropriate supervision of unlicensed personnel. •(C) May perform other acts that require education and training as prescribed by board rules and policies, commensurate with the licensed vocational nurse's experience, continuing education, and demonstrated licensed vocational nurse competencies.
217.11
Standards of Nursing Practice The standards of practice establish a minimum acceptable level of nursing practice in any setting for each level of nursing licensure or advanced practice authorization. Failure to meet these standards may result in action against the nurse's license even if no actual patient injury resulted. (1) Standards Applicable to All Nurses. All vocational nurses, registered nurses and registered nurses with advanced practice authorization shall: (A) Know and conform to the Texas Nursing Practice Act and the board's rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the nurse's current area of nursing practice; (B) Implement measures to promote a safe environment for clients and others; (C) Know the rationale for and the effects of medications and treatments and shall correctly administer the same; (D) Accurately and completely report and document: (i) the client's status including signs and symptoms; (ii) nursing care rendered; (iii) physician, dentist or podiatrist orders; (iv) administration of medications and treatments; (v) client response(s); and (vi) contacts with other health care team members concerning significant events regarding client's status; (E) Respect the client's right to privacy by protecting confidential information unless required or allowed by law to disclose the information; (F) Promote and participate in education and counseling to a client(s) and, where applicable, the family/significant other(s) based on health needs; (G) Obtain instruction and supervision as necessary when implementing nursing procedures or
224.10
Supervising Unlicensed Personnel
224.7
Supervision (of all nursing tasks delegated to unlicensed persons in accordance with certain conditions.)
217.11 1 (S) (U)
Supervision and Delegation (1) Standards Applicable to All Nurses. All vocational nurses, registered nurses and registered nurses with advanced practice authorization shall: *(S) Make assignments to others that take into consideration client safety and that are commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made; (U) Supervise nursing care provided by others for whom the nurse is professionally responsible;*
On discovery, when accepts responsibility for
When does nurses's duty to a patient begin? Lunsford case.
five rights of delegation
right task right circumstances right person right direction/communication right supervision/evalution
RN is responsible for
providing safe, compassionate, and comprehensive nursing care to patients and their families.
scope of practice
you are responsible for taking care of patient
Other Laws Impacting Practice
•Informed Consent •Good Samaritan Law •Volunteer immunity from liability •Sexual exploitation •Rights of elderly to be free from restraints •Pharmacists administering medications/immunizations •Hospital Staffing Committees