RESPONSIBILITIES OF THE REGISTERED NURSE

1. (a) The registered nurse assesses human responses and plans, implements and evaluates nursing care for individuals or families for whom the nurse is responsible. In carrying out this responsibility, the nurse performs all of the following functions:

   1. (1) Collects complete and ongoing data to determine nursing care needs.
   2. (2) Analyzes the health status of the individuals and families and compares the data with the norm when possible in determining nursing care needs.
   3. (3) Identifies goals and plans for nursing care.
   4. (4) Carries out nursing care actions which promote, maintain and restore the well-being of individuals.
   5. (5) Involves individuals and their families in their health promotion, maintenance and restoration.
   6. (6) Evaluates the effectiveness of the quality of nursing care provided.
2. (b) The registered nurse is fully responsible for all actions as a licensed nurse and is accountable to clients for the quality of care delivered.
3. (c) The registered nurse may not engage in areas of highly specialized practice without adequate knowledge of and skills in the practice areas involved.
4. (d) The Board recognizes standards of practice and professional codes of behavior, as developed by appropriate nursing associations, as the criteria for assuring safe and effective practice.

Source

The provisions of this § 21.11 amended October 22, 1976, effective October 23, 1976, 6 Pa.B. 2677. Immediately preceding text appears at serial page (9690).

Cross References

This section cited in 49 Pa. Code § 21.411 (relating to interpretations regarding the general functions of registered nurses—statement of policy); 49 Pa. Code § 21.412 (relating to interpretations regarding venipuncture, intravenous fluids, resuscitation and respiration—statement of policy); 49 Pa. Code § 21.413 (relating to interpretations regarding the administration of drugs—statement of policy); and 49 Pa. Code § 21.803 (relating to applicability of rules relating to professional nurses).

Notes of Decisions

Nursing Care Actions

Where nurse had disconnected patient from respirator to perform unauthorized evaluation of spontaneous respiration, failed to perform external cardiac resuscitation, etc., subsection (a)(2) and (4) was not unconstitutionally vague with respect to nurse’s conduct since nurse’s actions were ‘‘unauthorized, contra-indicated and a serious deviation from acceptable nursing practice.’’ Rafferty v. State Board of Nurse Examiners, 471 A.2d 1339 (Pa. Cmwlth. 1984); reversed in part 499 A.2d 289 (Pa. 1995); on remand 505 A.2d 359 (Pa. Cmwlth. 1986).

A nurse violated subsection (a)(4) by leaving patient experiencing rare premature ventricular contractions failing to call code team when so instructed and failing to attach cardiac monitor strip to patient’s chart, but such actions did not constitute violations of 49 Pa. Code § 21.13 which merely establishes limitations on who may perform resuscitation and respiration and circumstances under which those procedures may be performed. State Board of Nurse Examiners v. Rafferty, 471 A.2d 1339 (Pa. Cmwlth. 1984); reversed in part 499 A.2d 289 (Pa. 1995); on remand 505 A.2d 359 (Pa. Cmwlth. 1986).

Nurse violated subsection (a)(4) by disconnecting comatose patient from respirator to check for spontaneous respirations, leaving patient without oxygen for 30 seconds, when there had been no special circumstances such as patient displaying signs of becoming conscious. State Board of Nurse Examiners v. Rafferty, 471 A.2d 1339 (Pa. Cmwlth. 1984); reversed in part 499 A.2d 289 (Pa. 1995); on remand 505 A.2d 359 (Pa. Cmwlth. 1986).

A nurse did not wilfully violate subsection (a)(4) in lightly slapping the hand of a patient who had a grip on her arm, since the nurse had to have the use of her arm in order to keep the patient from falling and other attempts to make the patient loosen his grip had failed. Leukhardt v. State Board of Nurse Examiners, 403 A.2d 645 (Pa. Cmwlth. 1979).

Vagueness

Where the Board of Nurse Examiners found no willful, repeated, deliberate or knowing violation, but merely acts which were deemed to deviate from accepted practice and errors of judgment, the court held that there was no violation of subsection (a) (1) and (4). Rafferty v. State Board of Nurse Examiners, 471 A.2d 1339 (Pa. Cmwlth. 1984); reversed in part 499 A.2d 289 (Pa. 1995); on remand 505 A.2d 359 (Pa. Cmwlth. 1986).

Willful Violations

Board of Nurse Examiners need not prove specific intent to violate the statute or regulations in order to establish a ‘‘willful’’ violation. State Board of Nurse Examiners v. Rafferty, 471 A.2d 1339 (Pa. Cmwlth. 1984); reversed in part 499 A.2d 289 (Pa. 1995); on remand 505 A.2d 359 (Pa. Cmwlth. 1986).