Nursing Jurisprudence
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.
