BON part 2
Unprofessional Conduct
-Engaging in sexual conduct with a client, touching a client in a sexual manner, requesting or offering sexual favors, or language or behavior suggestive of the same; - Threatening or violent behavior in the workplace; **Failure to repay a guaranteed student loan, as provided in the Texas Education Code §57.491, or pay child support payments as required by the Texas Family Code §232.001, et seq. -A positive drug screen for which there is no lawful prescription;
Guidelines: refusal of Care Based on religious and Moral Principles
-If an emergency occur, you must provide for the care as required, regardless of any personal objections you may have. -In an non-emergency situation, follow the institution's policy and procedures for refusing assignments. Be sure your refusal is based on religious or moral grounds. -If there is a dispute about the appropriateness of your refusal, work with the nursing team, risk manager, or other appropriate persons to resolve the issue to everyone's satisfaction.
Criteria for Determining If Minor Incident Is Board-Reportable. A nurse involved in a minor incident need not be reported to the Board unless the conduct:
-creates a significant risk of physical, emotional or financial harm to the client - indicates the nurse lacks a conscientious approach to, or accountability for his/her practice; -indicates the nurse lacks the knowledge and competencies to make appropriate clinical judgments and such knowledge and competencies cannot be easily remediated -indicates a pattern of multiple minor incidents demonstrating that the nurse's continued practice would pose a risk of harm to clients or others.
Good Faith
Actions supported by a Reasonable factual or Legal Basis
Minor Incident Exclusions
An Error that contributed to a patient's death or serious harm Criminal Conduct A serious violation of Unprofessional Conduct, (i.e Fraud, theft, patient abuse, or exploitation).
Nurse's responsibility
As a nurse in Texas, you have the responsibility to know, and follow the Nursing Practice Act and all applicable BNE Rules and Regulations relating to your nursing practice
Delegation (Definition, BNE rule 224.4)
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 the RN. **Transfer of responsibility for the performance of an activity from one person to another while retaining accountability for the outcome.
Reportable Behaviors and Conduct
Behaviors which likely expose a patient or other person unnecessarily to the risk of harm; -Unprofessional conduct by the nurse, as defined by 22 Tex. Admin. Code §217.12; -Failure to adequately care for a patient; -Failure to conform to the minimum standards of acceptable nursing practice, as defined by 22 Tex. Admin. Code §217.11; and/or -Impairment or likely impairment of the nurse's practice by chemical dependency, alcohol or mental illness.
Simplifying Safe harbor
Can use quick Request Form Comprehensive request Form—If time to complete before accepting assignment—Do not have to use quick form
Rule 217.3 GVNs and GNs
Cannot practice in independent settings, i.e. home health care, school health. Must function under direct supervision Must not function in supervisory position Guideline: Amount of supervision and charge positions should be agreed upon 12—18 months experience in a structured setting before practicing in independent living environments
Unprofessional Conduct
Careless or repetitive conduct that may endanger a client's life, health, or safety. Actual injury to a client need not be established.
Unprofessional Conduct Unsafe practice, whether actions or conduct including, but not limited to:
Carelessly or repeatedly failing to conform to generally accepted nursing standards in applicable practice settings; Improper management of client records; Delegating or assigning nursing functions or a prescribed health function when the delegation or assignment could reasonably be expected to result in unsafe or ineffective client care; Accepting the assignment of nursing functions or a prescribed health function when the acceptance of the assignment could be reasonably expected to result in unsafe or ineffective client care; Failing to supervise the performance of tasks by any individual working pursuant to the nurse's delegation or assignment
What is a Minor Incident?
Conduct that does not indicate the nurse's continuing to practice professional nurses poses a risk of harm to a client or other person. ***Nurse manager shall report to PRC if 5 minor incidents occur in one year.*** Peer review Committee review 5 minor incidents and determine if a report to the BON is warranted.
Supervision versus Delegation
Defined as the active process of directing, guiding, and influencing the outcome of a person's performance of a task. Mere act of supervision does not infer RN delegation
What are Disciplinary Actions?
Disciplinary Sanctions imposed by the BON for violations and conducts of the NPA and the BON's Rules and Regulations.
Unprofessional Conduct Misconduct included, but not limited to:
Falsifying reports, client documentation, agency records or other documents; Causing or permitting physical, emotional or verbal abuse or injury or neglect to the client or the public, or failing to report same to the employer, appropriate legal authority and/or licensing board;
Delegation (Rules 224 & 225) Exclusions
Gratuitous nursing care Faculty or preceptor Part of an education course RN assigns tasks and supervises other licensed practitioners (i.e. LVNs) UAP directly assisting
Guidelines: refusal of Care Based on religious and Moral Principles
If you have such beliefs, inform your supervisor or nurse manager and request that you not be assigned to such cases. If you are currently caring for a client and conditions suddenly warrant and aspect of care that you object to, alert your supervisor or nurse manager so that the patient can be reassigned or other arrangements made. Once you have accepted assignment for a patient's care, you are legally responsible for that care until the patient has been reassigned
Who has a Duty to Report?
Individual Nurse Peer review Committee Nursing educational Program Employer State Agency Liability Insurer Prosecuting Attorneys
Safe Harbor Exclusions
Invoke Safe Harbor in Bad Faith Conduct Engaged In Prior to the Nurse Requesting Safe Harbor. Conduct unrelated to the request for Safe Harbor
Bad Faith Reporting
Knowing or reckless Act/Action Not supported by a reasonable or Legal basis Misrepresenting facts Acting out of Malice, Personal Animosity Acting from a Conflict of Interest Denying a nurse Due Process
Unprofessional Conduct Unlawful conduct:
Knowingly aiding, assisting, advising, or allowing an unlicensed person to engage in the unlawful practice of vocational, registered or advanced practice nursing; Failing to report violations of the Nursing Practice Act and/or the Board's rules and regulations. Leaving a nursing assignment, including a supervisory assignment, without notifying the appropriate personnel.
Supervision versus training
Mere act of training does not infer RN delegation Teaching client's family is not delegation
Does Safe Harbor Protect the Nurse from Civil or Criminal Liability?
No. Safe Harbor has no effect on a nurse's civil or criminal liability for his/her nursing practice. The BON does not have any authority over civil or criminal liability issues. Safe Harbor does protect the nurse from retaliation by an employer or contracted entity for whom the nurse performs nursing services.
Tasks which are most commonly delegated
Non-invasive and non-sterile treatments Collection, Reporting and Documentation of data (Vital signs, ht, wt, I&O, finger-stick blood sugar). Ambulation, positioning,, and turning Transportation of client within the facility Personal hygiene and elimination, including enemas Feeding, cutting up food, or placing meal trays Socialization activities ADL's Reinforcement of health teaching planned/or provided by the RN
Safe Harbor: Two Protections for the Nurse
Nurse is not reportable to the Board Employer retaliation prohibited by law.
Safe Harbor Process [Rule 217.20(d)]
Nurse is requested to engage in Conduct subject to reporting. Nurse invokes SH at the time of the requested activity before accepting the assignment. Nurse must believe in Good faith that the requested conduct violates the nurse's duty to the patient
Minimum Required Information (To make initial request invoking Safe Harbor)
Nurse(s) Name(s) invoking Safe Harbor Date/Time of Request Location of requested conduct/assignment Name of person/supervisor making assignment or requesting the conduct Brief explanation of why invoking Safe Harbor Document collaboration between nurse(s) and supervisor (always recommended; required if nurse(s) refuse assignment/conduct requested).
Reporting Professional Violations
Nurses who report in good faith are protected from defamation lawsuits, because they are required to report violations.
Prohibited Tasks for UAPs
Nursing Assessments Plan of care Professional judgment and Intervention Responsibility of initial teaching Medication administration including IV fluids (acute) An acute health condition considered unstable and unpredictable, or an acute care environment where nursing services are continuously provided e.g hospitals, clinics, skilled nursing facilities or rehabilitation centers
DELEGATION; Nursing Tasks Prohibited
Physical, Psychological, and social assessments Formulation of the nursing care plan 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 Administration of medications( unless MedAid in LTC)
BON Position Statement 15.24 post-licensure training and competency
RNs and LVNs must complete post-licensure training and competency ***Advise caution in using the feeding tube unless absolutely certain of placement.
Position Statements
Represent the Board's position on issues Provides guidance for decisions, policies, and practice Do not have the force of law Reviewed annually
Nursing Tasks not usually Delegated:
Sterile Procedures Non-sterile procedures (i.e. cleansing penetrating wounds, or deep burns) Invasive procedures Care of broken skin other than minor abrasion or cuts
When can a Nurse Refuse to accept an assignment when invoking Safe Harbor?
The Assignment would: Constitute Unprofessional or Criminal Conduct. The nurse lacks the basic knowledge to perform the assignment without potential for unjustifiable risk of harm.
How chemical dependency, or related drug conditions, mental illnesses, or diminished mental capacity can relate to a nurse's fitness to practice.
The Nursing Practice Act requires that a person report to the Board a nurse suspected of being impaired by chemical dependency or diminished mental capacity. If the person believes that an impaired nurse committed a practice violation. A nurse need not be "diagnosed" with an addictive/abusable or dependence problem to be reported to the board for impaired behavior and/or practice. The Board may rely solely on the conviction for a crime or probation for a crime, with or without an adjudication of guilt to impose a disciplinary sanction on a nurse.
Minimum information required to invoke Safe Harbor:
The nurses(s) name(s) making the safe harbor request and his/her signature(s); The date and time of the request; The location of where the conduct or assignment is to be completed; The name of the person requesting the conduct or making the assignment; and A brief explanation of why safe harbor is being requested
BON Position Statement 15.11 Each nurse has a duty to his or her patients
This duty supersedes any physician order and any facility policy Patients are vulnerable and the nurse must act in the best interest of the patient.
Unlicensed person---
an individual not licensed as a HCP, who is monetarily compensated to provide certain health related tasks and functions in a complementary or assistive role to the RN providing direct care .(i.e. nurses aides, orderlies, technicians, med aides, professional nursing student not licensed, but providing care for monetary compensation and not part of their formal educational program) **This rule does not apply to the RN's civil liability
Unprofessional Conduct Criminal Conduct:
conviction or probation, with or without an adjudication of guilt, or receipt of a judicial order involving a crime or criminal behavior or conduct that could affect the practice of nursing
Unprofessional Conduct Inability to Practice Safely--
demonstration of actual or potential inability to practice nursing with reasonable skill and safety to clients by reason of illness, use of alcohol, drugs, chemicals, or any other mood-altering substances, or as a result of any mental or physical condition.
Types of Peer Review Incident-based (IBPR),--
in which case peer review is initiated by a facility, association, school, agency, or any other setting that utilizes the services of nurses;
Safe Harbor Peer Review for Nurses (BNE Rule 217.20)
is an internal process, between you and your employer. The BON cannot provide legal advice, and has no authority in civil matters. Texas Occupation Code 303.005 requires a person who regularly employs, hires or contract for the services of at least ten (10) nurses to permit a nurse to request Peer Review when requested to engage in conduct that the nurse believes is in violation of his/her duty to a patient
Safe Harbor Protection (BNE Rule 217.20) To activate protections outlines in Texas Occupations Code 303.005, the nurse shall: Invoke safe harbor in Good faith
means that the nurse believes that the requested conduct violates a nurse's duty to a patient and that belief is one a reasonable nurse could hold. At the time the nurse is requested to engage in the activity, notify the supervisor making the assignment that the nurse is invoking Safe Harbor. At the time of supervisor's notification, also submit a written request for Safe Harbor utilizing the Safe Harbor form provided on the Board's web site.
Unprofessional Conduct 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);
Types of Peer Review Safe Harbor (SHPR)--
which may be initiated by a LVN, RN or APN 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.
