Nurses are instrumental to the Ohio healthcare system, working hard to provide essential care to patients. Their tasks cover a vast range of responsibilities, including administering medication, monitoring patient health, ensuring that proper care is delivered, and offering emotional support to both patients and their families.
Whether in a hospital, clinic, school, or private home, nurses play an irreplaceable role in improving patient outcomes and promoting overall public health. However, as nurses take on more prominent roles in healthcare, they're also facing complaints or accusations of malpractice at an increased rate. Such allegations can affect their professional standing and reputations and may put their licenses at risk.
The Ohio Nurse Practice Act (ONPA) outlines the legal responsibilities and authorized scope of practice for nurses, specifying what is expected of Registered Nurses, Licensed Practical Nurses, and Advanced Practice Registered Nurses. The Act is supplemented by the Ohio Administrative Code (OAC), which provides additional rules for safe and effective nursing care.
Every Ohio nurse should be familiar with the ONPA and OAC to ensure they practice within their profession's legal boundaries. Understanding these statutes and codes helps protect you from unintentional violations that could lead to disciplinary actions, including fines, suspension, or even loss of your license. By staying informed and adhering to these regulations, you can continue providing safe, ethical, and effective care while safeguarding your career.
If you're a nurse facing disciplinary action, contact the Lento Law Firm's experienced Professional License Defense Team immediately. We have helped protect the licenses, reputations, and careers of numerous medical professionals nationwide, and we want to help you, too. Contact us today at 888.535.3686 or through our online contact form to discuss your case.
Nursing Scope of Practice
In Ohio, the scope of practice for each category of nurse license is defined within the ONPA and the OAC.
Registered Nurses (RNs)
RNs are responsible for a wide range of tasks that involve patient assessment, planning, and implementing care. In Ohio, RNs general responsibilities include:
- collecting both subjective and objective data from patients, their families, and healthcare teams. This crucial data forms the basis of care planning and treatment.
- interpreting the collected data and identifying nursing diagnoses that guide nursing interventions. They are also responsible for reporting relevant information to other healthcare professionals.
- developing and modifying nursing care plans based on patient diagnoses, goals, and interventions to ensure that all align with the most up-to-date nursing science.
- executing care plans, administering medications, providing nursing care, and collaborating with other healthcare providers. They are also responsible for delegating tasks to LPNs and other personnel, as appropriate.
- evaluating patient outcomes in response to nursing interventions, reassess patient health status, and adjust care plans as necessary.
RNs are also authorized to implement valid medical orders provided by physicians and other authorized healthcare providers within their professional practice.
Licensed Practical Nurses (LPNs)
LPNs operate under a more limited scope of practice than RNs. The Ohio Revised Code stipulates that LPNs can only practice under the direct supervision of an RN or other authorized healthcare providers, such as physicians, physician assistants, podiatrists, dentists, or optometrists. The ORC also specifies that LPNs may contribute to professional services by:
- collecting and documenting patient data and reporting this information to the supervising RN or healthcare provider.
- developing and updating nursing care plans based on patient needs and interventions.
- carrying out nursing interventions, administering medications, and collaborating with other healthcare providers as directed.
- documenting patient responses to interventions and reporting outcomes to the RN or healthcare provider, assisting with ongoing care adjustments.
Licensed Practical Nurses (LPNs) have defined limitations when it comes to performing certain therapies. For example, the OAC prohibits them from administering intravenous (IV) therapy procedures unless they meet particular conditions, such as acting as directed by and within the presence of an RN, physician, or other authorized medical professional. Failure to follow any of these rules can result in disciplinary action.
Advanced Practice Registered Nurses (APRNs)
APRNs include certified nurse practitioners (CNPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs), and certified registered nurse anesthetists (CRNAs). They execute all the responsibilities of RNs and LPNs but have a much broader scope of practice. APRNs are authorized to perform more complex tasks such as prescribing medications, diagnosing and treating illnesses, and, in some cases, pronouncing death.
Ohio APRNs practice independently in many areas and must adhere to specific regulations outlined in the Ohio Nurse Practice Act. For example, CNPs, CNSs, and CNMs (but not CRNAs) must enter into a Standard Care Arrangement (SCA) with one or more collaborating physicians to provide patient care, including the authority to prescribe medications. This arrangement ensures that the scope of practice for APRNs aligns with Ohio law and medical standards. The SCA must be in place before the APRN begins clinical practice and reviewed at least every two years.
APRNs must also follow strict rules regarding their authority to prescribe medications. These rules define different types of pain and set parameters for the responsible prescription of controlled substances. For example, with regard to opioid analgesics, APRNs must first consider non-opioid treatments for acute pain, and if opioids are necessary, they should prescribe the minimum dose for the shortest time possible, typically not exceeding a three-day supply. The use of extended-release or long-acting opioids is prohibited for acute pain.
In general, APRNs cannot prescribe beyond their scope of practice nor that of their collaborating physician. Additionally, they must establish a valid prescriber-patient relationship, which involves taking the patient's history, conducting exams, making a diagnosis, and documenting all steps.
Delegation and Scope of Nursing Tasks
Nurses often delegate tasks to ensure efficient and effective patient care, especially in fast-paced healthcare environments. Delegation allows nurses to focus on more complex aspects of patient care while ensuring that qualified team members handle routine or less critical tasks.
The ONPA provides clear guidelines for delegating nursing tasks. Only licensed nurses—RNs and APRNs—can delegate nursing tasks, and they must ensure that the task is within their own scope of practice and appropriate for the unlicensed individual performing it. LPNs are only allowed to delegate tasks under the direction of an RN.
Delegation involves non-complex tasks like administering over-the-counter medications such as topical creams, eye drops, and enemas. The task must not require nursing judgment, complex decision-making, or repeated assessments, and its consequences must be minimal. In cases where APRNs delegate medication administration, the drugs must not be controlled substances, and the process must comply with strict guidelines.
The delegating nurse is also responsible for evaluating the patient's condition, determining the complexity of care, and ensuring proper supervision. The nurse remains accountable for the decision to delegate and must intervene immediately if the unlicensed person fails to perform the task correctly.
Continuing Nursing Education
Continuing education is a learning activity that builds on pre-licensure or certification education, helping a licensee or certificate holder gain or improve skills for professional growth and better contribution to quality healthcare. RNs, LPNs, and APRNs are required to renew their licenses by fulfilling certain continuing education requirements.
Unless there's a specific exception, nurse licensees must complete 24 contact hours of continuing education for each renewal period. APRNs must complete an additional 24 hours for each APRN license held.
Licensees have several options to meet the CE requirements, including:
- CE activities approved by the Ohio Board of Nursing (OBN) or an approved provider.
- CE activities approved by a regulatory board in another jurisdiction.
- CE activities approved by nationally recognized accreditation systems or certifying organizations.
- Courses from accredited institutions for which academic credit is awarded.
- CE activities approved by a regulatory board of a health profession in Ohio or another jurisdiction.
- Developing and presenting a CE course or activity, with contact hours awarded for the first presentation only.
- Up to 8 hours of CE can be earned by providing volunteer healthcare services to indigent and uninsured individuals. Nurses are awarded one contact hour for every 60 minutes of documented volunteer work, provided that certain documentation and liability requirements are met.
Additionally, the Board may award contact hours for board-approved CE activities, and participants must retain proof of completion for audits.
Ohio nurses who hold both RN and LPN licenses do not need to complete additional CEs for their LPN license if they have completed the CE requirements for their RN license.
Prohibited Acts and Disciplinary Actions
The Ohio Board of Nursing is responsible for ensuring that nurses in the state comply with the standards set forth in the Ohio Nurse Practice Act. It has the authority to investigate complaints against nurses and take disciplinary action when necessary. Most disciplinary actions against nurses fall into the following six categories:
- Practice-related violations. These include errors in clinical judgment or neglecting to implement appropriate interventions. For example, such a violation might be found to occur if a patient suffers severe complications due to a nurse's failure to monitor a post-surgical patient's vital signs properly.
- Drug-related violations: Nurses can face discipline for issues related to medication errors, substance abuse, or drug diversion, including administering the wrong dosage of a painkiller to a patient or stealing narcotics for personal use.
- Boundary violations: Inappropriate relationships with patients, including emotional, physical, or financial boundary violations, can result in disciplinary actions. Examples might include exchanging personal text messages with a patient or accepting monetary gifts from the patient.
- Sexual misconduct: Engaging in any form of sexual misconduct with a patient is a serious violation of nursing ethics and can lead to revocation of a nursing license.
- Fraud: Nurses may be disciplined for falsifying documentation, such as misrepresenting qualifications or filing false insurance claims.
- Criminal background: Convictions for criminal activities, particularly those related to healthcare, such as stealing drugs, can result in the suspension or revocation of a nursing license.
Disciplinary Actions
If someone alleges that a nurse has violated Ohio's Nurse Practice Act, the Ohio Board of Nursing will investigate the matter. If the investigation reveals that the nurse violated the scope of practice or engaged in unsafe or unethical behavior, the Board may impose various sanctions, including fines, probationary periods, license suspension, or license revocation, depending on the severity of the violation.
Alternative programs, such as the Practice Intervention and Improvement Program, may also be offered as a path to remediation for minor violations. More serious violations, however, may lead to emergency actions–such as immediate suspension—if there is clear and convincing evidence that a nurse poses a danger to the public.
The Board of Nursing will also monitor nurse compliance with disciplinary actions and may reinstate licenses when nurses demonstrate corrective behavior and adherence to professional standards.
How Professional License Defense Lawyers Can Help
Allegations of misconduct can be a career-threatening situation for a nurse. A misunderstanding or misinterpretation of an event can result in serious disciplinary actions such as suspension, license revocation, or fines. If you've been accused of misconduct or malpractice, the experienced Professional License Defense Team of the Lento Law Firm can play a crucial role in helping you navigate the complex legal and administrative processes involved and help protect your nursing career.
We can help by thoroughly investigating the accusations and gathering evidence to build a strong defense. We will review your professional conduct, documentation, and any relevant medical records to ensure all aspects of the case are considered. We can further ensure that your legal rights are protected during hearings with the Board of Nursing and help you prepare the nurse for interviews or testimonies. In cases where settlement is possible, our team can negotiate terms that might avoid harsher penalties.
With skilled and experienced lawyers by your side, you can increase your chances of a favorable outcome and potentially save your professional licenses. Call Lento Law Firm's Professional License Defense team today at 888.535.3686 or through our online contact form. No matter in which state you practice, we're ready to help protect your nursing license–and your career.
