Nursing, Board of

General

Chapter 3: Standards of Nursing Practice

Effective Date: 03/28/1996 to 03/16/1998

Rule Type: Superceded Rules & Regulations

Reference Number: 054.0002.3.03281996

CHAPTER III

STANDARDS OF NURSING PRACTICE

Section 1. Statement of Purpose.

(a) The purpose of the board in adopting rules and regulations in this Chapter is:

(i) To establish minimal acceptable levels of safe nursing practice.

(ii) To provide criteria for the board to evaluate safe and competent nursing practice.

(iii) To clarify the scope of practice for the registered professional nurse and licensed practical nurse.

(iv) To identify behaviors which impair the licensee's ability to practice with reasonable skill and safety, including, but not limited to:

(A) Fraud and deceit;

(B) Unsafe practice;

(C) Misappropriation of property;

(D) Abandonment;

(E) Abuse, including sexual abuse;

(F) Neglect;

(G) Chemical dependency;

(H) Drug diversion - self/others;

(I) Sale of illicit drugs;

(J) Criminal conviction;

(K) Failure to supervise or to monitor the performance of acts by any individual working at the licensed nurse's direction;

(L) Unprofessional conduct; and

(M) Boundary violations, including sexual boundaries.

(b) The standards of nursing practice interpret the statutory definitions of professional and practical nursing. The standards of nursing practice evolve from the nursing process.

(c) Violations of the standards of nursing practice may result in disciplinary action as the board may determine.

Section 2. Standards of Nursing Practice for the Registered Professional Nurse

(a) Standards related to the registered professional nurse's responsibility to apply the nursing process.

(i) The registered professional nurse shall:

(A) Conduct and document nursing assessment of the health status of individuals and groups by:

(I) Collecting objective and subjective data from observations, examinations, interviews, written records in an accurate and timely manner. The data includes but is not limited to:

(1.) Biophysical and emotional status; (2.) Growth and development; (3.) Cultural, religious and socioeconomic background; (4.) Family health history; (5.) Information collected by other health team members; (6.) Client knowledge and perception about current or potential health status, or maintaining health status; (7.) Ability to perform activities of daily living; (8.) Patterns of coping and interacting; (9.) Consideration of patient's health goals; (10.) Environmental factors (e.g. physical, social, emotional, and ecological); and (11.) Available and accessible human and material resources.

(II) Sorting, selecting, reporting, and recording the data;

(III) Validating, refining and modifying the data by utilizing available resources including interactions with the client, family, significant others, and health team members.

(B) Establish and document nursing diagnoses which serve as the basis for the plan of care.

(C) Develop and modify the plan of care based on nursing assessment and nursing diagnoses. This includes:

(I) Identifying priorities in the plan of care;

(II) Setting realistic and measurable goals to implement the plan of care;

(III) Identifying nursing interventions based on the nursing diagnosis;

(IV) Identifying measures to maintain comfort, support human functions and responses, maintain an environment conducive to well being, and provide health teaching and counseling.

(D) Implement the plan of care by:

(I) Initiating nursing interventions through:

(1.) Giving direct care;

(2.) Assisting with care;

(3.) Delegating care (as outlined in but not limited to Chapter VII, Section 6., Standards for Delegation of Basic Nursing Tasks and Skills);

(II) Providing an environment conducive to safety and health;

(III) Documenting nursing interventions and responses to care; and

(IV) Communicating nursing interventions and responses to care, to other members of the health team.

(E) Evaluate the responses of individuals or groups to nursing interventions. Evaluation may involve the client, family, significant others and health team members.

(I) Evaluation data shall be documented and communicated to appropriate members of the health team.

(II) Evaluation data shall be used as a basis for reassessing client's health status, modifying nursing diagnoses, revising plan of care, and determining changes in nursing interventions.

(b) Standards related to the registered professional nurse's responsibilities as a member of the nursing profession.

(i) The registered professional nurse shall:

(A) Have knowledge of the statutes and regulations governing nursing;

(B) Accept individual responsibility and accountability for nursing actions and competency;

(C) Obtain instruction and assistance as necessary when implementing nursing techniques or practices;

(D) Accept only client care assignments for which educationally prepared and adequately trained;

(E) Function as a member of the health team;

(F) Collaborate with other members of the health team to provide optimum patient care;

(G) Consult with nurses, other health team members, and resources, making referrals as necessary;

(H) Contribute to the formulation, interpretation, implementation and evaluation of the objectives and policies related to nursing practice within the employment setting;

(I) Participate in the evaluation of nursing practice through quality assurance activities, including peer review;

(J) Report unfit or incompetent nursing practice to the board and unsafe conditions for practice to recognized legal authorities.

(K) Delegate to another only those nursing interventions which a person is prepared or qualified to perform;

(L) Provide direction and/or supervision for others to whom nursing interventions are delegated;

(M) Evaluate the effectiveness of delegated nursing interventions performed under direction and/or supervision;

(N) Retain professional accountability for nursing care when delegating nursing interventions;

(O) Conduct practice without discrimination on the basis of age, race, religion, sex, life-style, national origin, or handicap;

(P) Respect the dignity and rights of clients and their significant others regardless of social or economic status, personal attributes or nature of health problems;

(Q) Respect the client's rights to privacy by protecting confidential information, unless obligated by law to disclose such information in a court of law or before duly authorized regulatory agencies;

(R) Respect the property of all individuals and facilities;

(S) Maintain boundaries, including sexual boundaries.

(T) Participate in the development of continued competency in the performance of nursing care activities for nursing personnel and students.

(U) Comply with the standards of nursing practice, the rules and regulations, and the Act.

Section 3. Standards of Nursing Practice for the Licensed Practical Nurse

(a) Standards related to the licensed practical nurse's contribution to the nursing process.

(i) The licensed practical nurse shall;

(A) Contribute to the nursing assessment by:

(I) Collecting, reporting and recording objective and subjective data in an accurate and timely manner. Data collection includes:

(1.) Observation about the condition or change in condition of the patient;

(2.) Signs and symptoms of deviation from normal health status;

(B) Participate in the development and modification of the plan of care by;

(I) Providing data;

(II) Contributing to the identification of priorities;

(III) Contributing to setting realistic and measurable goals;

(IV) Assisting in the identification of measures to maintain comfort, support human functions and responses, maintain an environment conducive to well being, and provide health teaching and counseling.

(C) Participate in the implementation of the plan of care by:

(I) Carrying out such interventions as are taught in board approved curriculum for practical nurses and as allowed by institutional policies;

(II) Providing care for clients in basic patient care situations under the direction of a licensed physician, dentist or licensed professional nurse. Basic patient care situations as determined by a licensed physician, dentist or licensed professional nurse mean the following three (3) conditions prevail at the same time in a given situation:

(1.) The client's clinical condition is predictable and the responses of the client to the nursing care are predictable;

(2.) Medical or nursing orders do not change frequently and do not contain complex modifications; and

(3.) The client's clinical condition requires only basic nursing care.

(III) Providing care for clients in complex patient care situations under the supervision of a licensed physician, dentist or licensed professional nurse. Complex patient care situations as determined by a licensed physician, dentist or licensed professional nurse mean any one or more of the following conditions exist in a given situation:

(1.) The client's clinical condition is not predictable;

(2.) Medical or nursing orders are likely to involve frequent changes or complex modifications; or

(3.) The client's clinical condition indicates care that is likely to require modification of nursing procedures in which the responses of the patient to the nursing care are not predictable.

(IV) Initiating appropriate standard emergency procedures established by the institution until a licensed physician, dentist or registered professional nurse is available;

(V) Providing an environment conducive to safety and health;

(VI) Documenting nursing interventions and responses to care;

(VII) Communicating nursing interventions and responses to care to appropriate members of the health team.

(D) Contribute to the evaluation of the responses of individuals or groups to nursing interventions by:

(I) Documenting evaluation data and communicating the data to appropriate members of the health team;

(II) Contributing to the modification of the plan on the basis of the evaluation.

(b) Standards relating to the licensed practical nurse's responsibilities as a member of the health team.

(i) The licensed practical nurse shall:

(A) Have knowledge of the statutes and regulations governing nursing;

(B) Accept individual responsibility and accountability for nursing actions and competency;

(C) Function under the direction of a licensed physician, dentist or registered professional nurse;

(D) Consult with registered professional nurses and other appropriate sources and seek guidance as necessary;

(E) Obtain direction and supervision as necessary when implementing nursing interventions;

(F) Accept only client care assignments from the licensed physician, dentist or registered professional nurse for which educationally prepared and adequately trained;

(G) Function as a member of the health team;

(H) Contribute to the formulation, interpretation, implementation and evaluation of the objectives and policies relating to practical nursing practice within the employment setting;

(I) Participate in the evaluation of nursing practice through quality assurance activities, including peer review;

(J) Report unfit or incompetent nursing practice to the board and unsafe conditions for practice to recognized legal authorities;

(K) Delegate to another only those nursing interventions which a person is prepared or qualified to perform;

(L) Provide direction for others to whom nursing interventions are delegated;

(M) Evaluate the effectiveness of delegated nursing interventions performed under direction;

(N) Retain accountability for nursing care when delegating nursing interventions;

(O) Conduct practice without discrimination on the basis of age, race, religion, sex, life-style, national origin or handicap;

(P) Respect the dignity and rights of clients and their significant others, regardless of social or economic status, personal attributes or nature of health problems;

(Q) Respect the client's rights to privacy by protecting confidential information, unless obligated by law to disclose such information in a court of law or before duly authorized regulatory agencies;

(R) Respect the property of all individuals and facilities;

(S) Maintain boundaries, including sexual boundaries.

(T) Participate in the development of continued competency in performance of nursing care activities for auxiliary personnel.

(U) Comply with the standards of nursing practice, the rules and regulations, and the Act.