Nursing Jurisprudence: Key Principles and Practices

Nursing Jurisprudence Primary resources for state law Texas Board of Nursing Nursing Practice Acts Nursing Jurisprudence Rules/Ethics/Morals and how the nurses function in a healthcare setting. 301 -BON, , defines responsibility for regulating nursing education, licensure and practice Texas Nurse Practice Acts 303 -Regulates nursing peer review 304 -Relates to nursing Licensure compact 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 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 Chapter 301 NPA Represent the people of Texas Can't lobby the legislature Does not regulate practice settings Board of Nursing -Licensing -Enforcement Services -Audit of CE -Information Services Represent their members Do lobby legislature Efforts to improve work cond/benef for nurses Professional Associations -Job referral services -Legal Referral -Salary Q -Co-Worker Disputes -Employment issues Temporary Permit -GN permit expires in 75 days -When pass/fail NCLEX Renew Online -60 days prior to expiration BON will send card Licensure and Regulation Continuing Education -20 hours in 2 years -Fist time renewal exempt -CE hours in area of practice -Keep records for 4 years Must submit criminal background check Submit a sworn application fee Verify completion of an approved nursing edu. Initial Licensure by Examination 1/5 Pass NCLEX Pass NJE with 75%>, NPA/BON rules, 50Q Must report any past criminal behavior or pending charges Disclosure of Criminal Behavior -Minor class C misdemeaners excluded (parking tickets, speeding tickets, jaywalking) Five Categories of Trust by BON Honesty Accountability Trustworthiness Reliability Integrity 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 Must recognize/maintain professional boundaries -Do or say nothing that can't be documented Professional Boundaries Violations -Physical, Sexual, Emotional, Financial exploitation Separate from BON review Confidential (incident based or Safe harbor) Nursing Peer Review -Rule 217.19-PR and Whistleblower -Rule 217.20-SH PR and Whistle blower protections 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 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 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 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. Step 1 Is the activity consistent with the NPA and BON rules? Step 2 Is the activity appropriately authorized? -Valid order? -Current policy exist regarding procedure? -Clarify any questionable orders Step 3 Is it supported by nursing research? -EBP 2/5 Step 4 Do you possess the required knowledge and competency to carry out the act? Step 5 Would a reasonable and prudent nurse perform this activity in this setting? Step 6 Are you prepared to accept the consequences of your actions? 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 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 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 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. 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 Allows a nurse to accept an assignment and provide best care without fear of licensure action if there is a practice error. Safe Harbor Peer Review -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 Must be invoked BEFORE care given Or anytime assignment has changed and pt may be in harm Safe Harbor -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 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. Chain after Safe Harbor Nurse completion Nurse supervisor/administrator who gave assignm. Nurse adminstrator Peer Review Committee 3/5 Physician who reviews med reasonableness Nurse administrator who reviews PR fidnigns Nurse who initiated request Making you work extra shifts, you have the right to refuse. NOT when -Emergency diasasters -Ongoing procedure requires nurses presence -Certain emergencies Mandatory Overtime Take Mandatory Overtime Concerns to Unit manager Staffing Committee DSHS-if not addressed internally Nurses duty is always In the best interest of the patient Patient Abandonment NPA/BON do not define abandonment -leaves employment-employment issue -leaves patient-licensure issue Resignation without notice- assuming shift has been completed Not abandonment Refusal to work additional shifts either doubles or extra shifts on days off 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 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 Chemical Dependency Alcohol Dependency Mental Illness Disciplinary Action Even some prescription drugs 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 Unprofessional Conduct Drug Diversion Unsafe practice Failure to pay student loans Dismissal peer assistance program Drug related actions Criminal conduct Board Process for investigating complaints Nurse notified of investigation and invited to respond Investigator gathers and reviews evidence Decision made by board 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 4/5 Remedial education -Classes specific to issue Supervision -Work under direct/indirect supervis. Types of Nurse Remediation Work environment -stable environment not home health Losing license is not uncommon 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! 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 Nurse must be licensed in state in which he/she permanently resides Home State License -if you move you have 30 days to change your license over. Party State License Other states belong to the compact nurse may practice in any party state on his/her home state license 5/5