Nursing Jurisprudence

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What do I do if I question safety of assignment?

1st- clear about what you are being asked to do 2nd- consider what can change during assignment 3rd- state concern to person making assignment, brainstorm ways to modify 4th- Listen to response

Texas Nurse Practice Acts

301 -BON, , defines responsibility for regulating nursing education, licensure and practice 303 -Regulates nursing peer review 304 -Relates to nursing Licensure compact

Exclusion to Minor Incident Rule

A nurse involved in a MI does not need to reported to BOn unless... -Creates sig. risk fo physical, emotinal, financial harm -Lacks a consiencious approach for accontability -Lacks knowl. and compet. and not easily remediat -Pattern of multiple minor incidents -5 minor incidents in a 12 month period must bereported to peer review

Safe Harbor Peer Review

Allows a nurse to accept an assignment and provide best care without fear of licensure action if there is a practice error. -Does not protect civil rights -Before refusing assignment must recog. pt is 1st May refuse an assignemt if lack basic knowlege/ability to render care

Floating to an unfamiliar area

Always responsible for providing safe patient care May request training prior to having to float May invoke safe harbor May refuse assignment

Incident Based Peer Review

Any facility employing 10+ must have one Referral starts with error/incident PR without administrators Fact finding mission Eval. of paractice in atmosphere of collegiality Determine if incident merit or should be to BON

Filing a complaint against another nurse

Any violation of BON rules needs to be reported Must be written/signed by person making report Include ID of nurse being reported Contain any additional info required All complaint information is confidential Duty to pt. and mandatory reporting req. Failure to report violation!

Step 6

Are you prepared to accept the consequences of your actions?

Disciplinary Action

Chemical Dependency Alcohol Dependency Mental Illness Even some prescription drugs

Minor Incident

Conduct that does not indicate the nurses continuing to practice professional nursing poses a risk fo harm to the pt. or other person

Good Professional Character

Distinguish right from wrong Think and act rationally Keep promises and honor obligations Be accountable for own behavior Promptly disclose facts that could enhance health of pt. and protect from harm

Step 4

Do you possess the required knowledge and competency to carry out the act?

Unprofessional Conduct

Drug Diversion Unsafe practice Failure to pay student loans Dismissal peer assistance program Drug related actions Criminal conduct

NEVER a Minor Incident

Error contributed to pt. death/serious harm Criminal conduct Serious violation (theft, faud, pt. abuse, exploiting) Impairment/suspected impairment by chem. dep.

Texas Nursing Jurisprudence Exam

Exam based on NP/BON rules/regulations 50 Questions 75% or > Must pass prior to taking NCLEX Eligible to test about 10 days after application to BON 2 hours to complete exam May retest if not successful

IBPR Due Process Rights

Facility must have policies in place for PR PR committee must comply with req. Nuse must receive notice/ opportunity to review documents/submit a response Nurse may hire own attorney Nurse will get feedback after decision Nurse will have a chance to respond

Five Categories of Trust by BON

Honesty Accountability Trustworthiness Reliability Integrity

Chapter 301 NPA

How board is appointed General powers/duties License requirements/renewal Practice by holder Reporting violations and patient care concerns Prohibited practices/disciplinary actions Other penalties and enforcement previsions Anesthesia in outpatient settings Corrective action proceeding

Nurses duty is always

In the best interest of the patient

Step 3

Is it supported by nursing research? -EBP

Step 2

Is the activity appropriately authorized? -Valid order? -Current policy exist regarding procedure? -Clarify any questionable orders

Step 1

Is the activity consistent with the NPA and BON rules?

Red Flags

Lack of energy Frequent absenses Spike in pt. need for pain meds Lateness to work Red Eyes No/unusal documentaion Frequently stands behind other nurses signing out meds

RN Standards

Make Nursing Dx Develop nursing care plan Eval. pt response to care Perform Comprehensive assessment Delegate tasks to UAP Practice independently w/in NPA board rules Edu. to care for all pt's stable and unstable

Duty to pt

Make/accept only assignments that take into consideration safety and commensurate with nurse's educational preparation, experience, knowledge, and physical/emotional ability.

Mandatory Overtime

Making you work extra shifts, you have the right to refuse. NOT when -Emergency diasasters -Ongoing procedure requires nurses presence -Certain emergencies

Safe Harbor

Must be invoked BEFORE care given Or anytime assignment has changed and pt may be in harm -Must notify in writing -Supervisor can't refuse -May use quick req form to make initial req. -Comprehensive request must be completed before leaving work setting

Professional Boundaries

Must recognize/maintain professional boundaries -Do or say nothing that can't be documented Violations -Physical, Sexual, Emotional, Financial exploitation

Disclosure of Criminal Behavior

Must report any past criminal behavior or pending charges -Minor class C misdemeaners excluded (parking tickets, speeding tickets, jaywalking)

Initial Licensure by Examination

Must submit criminal background check Submit a sworn application fee Verify completion of an approved nursing edu. Pass NCLEX Pass NJE with 75%>, NPA/BON rules, 50Q

Patient Abandonment

NPA/BON do not define abandonment -leaves employment-employment issue -leaves patient-licensure issue

Home State License

Nurse must be licensed in state in which he/she permanently resides -if you move you have 30 days to change your license over.

Board Process for investigating complaints

Nurse notified of investigation and invited to respond Investigator gathers and reviews evidence Decision made by board

Chain after Safe Harbor Nurse completion

Nurse supervisor/administrator who gave assignm. Nurse adminstrator Peer Review Committee Physician who reviews med reasonableness Nurse administrator who reviews PR fidnigns Nurse who initiated request

Prohibited Delegation Tasks

Nursing assessments Plan of care Professional Judgement/Intervention Responsibility for initial teaching Medication administration, IV fluids as well -Prohibited in acute care settings -may be delegated in independent living situations

Party State License

Other states belong to the compact nurse may practice in any party state on his/her home state license

LVN Standards

Participate in planning of nursing care Assist in evaluationg pt repsonse to tx Complete focused assessment Implement appropriate aspects of care Practice must be supervised Educated to care for pt. with stable predictable

Texas BON Mission Statement

Protect and promote welfare of the people of Texas by ensuring that each person holding a license as a nurse is competent to practice safely. -Protects the interest of the public

Types of Nurse Remediation

Remedial education -Classes specific to issue Supervision -Work under direct/indirect supervis. Work environment -stable environment not home health Losing license is not uncommon

Board of Nursing

Represent the people of Texas Can't lobby the legislature Does not regulate practice settings -Licensing -Enforcement Services -Audit of CE -Information Services

Professional Associations

Represent their members Do lobby legislature Efforts to improve work cond/benef for nurses -Job referral services -Legal Referral -Salary Q -Co-Worker Disputes -Employment issues

Not abandonment

Resignation without notice- assuming shift has been completed Refusal to work additional shifts either doubles or extra shifts on days off

Nurse's responsibility during investigation

Respond promptly to all requests Keep contact information current Fee free to contact investigator Do not ignore any mail from BON

Nursing Jurisprudence

Rules/Ethics/Morals and how the nurses function in a healthcare setting.

Nursing Peer Review

Separate from BON review Confidential (incident based or Safe harbor) -Rule 217.19-PR and Whistleblower -Rule 217.20-SH PR and Whistle blower protections

Licensure and Regulation

Temporary Permit -GN permit expires in 75 days -When pass/fail NCLEX Renew Online -60 days prior to expiration BON will send card Continuing Education -20 hours in 2 years -Fist time renewal exempt -CE hours in area of practice -Keep records for 4 years

Primary resources for state law

Texas Board of Nursing Nursing Practice Acts

Take Mandatory Overtime Concerns to

Unit manager Staffing Committee DSHS-if not addressed internally

Step 5

Would a reasonable and prudent nurse perform this activity in this setting?

Quick Request Form

Written on blank piece of paper but must include -Name/Signature -Date/Time of request -Location of where it is to be completed -Name of person making assignent -Brief expalnation of why safe harbor is being req.


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