Medical patients in facilities and home settings throughout Alabama rely on the competent care given by the state's licensed nurses. To gain the ability and authority to render life-affirming and life-saving care as a professional healthcare provider, nurses dedicate significant time and money to education, training, and licensing. Adhering to the provisions and practices outlined in the Nurse Practice Act (NPA) is one of the most integral parts of a beginning and continuing career.
Through the NPA, Alabama's legislature creates rules and regulations governing safe and legal nursing care, with oversight and enforcement provided by state agencies. Along with giving guidelines for certifying nurses, the NPA also details the scope of practice, professional expectations, and prohibited acts for nurses. It also contains all of the reasons a nurse may face discipline.
Errors and mistakes happen in the fast-paced world of healthcare. However, even minor NPA violations can be grounds for punishment, such as restrictions and limitations that can harm a nurse's professional reputation and a career-ending license suspension or revocation.
Alabama nurses facing alleged NPA breaches must seek assistance from the Lento Law Firm Professional License Defense Team. We're known nationwide for defending nurses and their practices against sanctions and corrective action. Call us now at 888-535-3686 or fill out our confidential consultation form.
Scope of Practice for Alabama Nurses
Alabama's application of the NPA defines the scope of practice and professional expectations for nurses within the state. It provides guidelines on what exactly nurses are authorized to do in a given placement or facility and those that are prohibited or require additional certification. Those given the authority to practice nursing care in the state include:
- Licensed Practical Nurses (LPNs)
- Registered Nurses (RNs)
- Advanced Practice Registered Nurses (APRNs)
RNs and APRNs engage in professional nursing, which includes promoting and maintaining health using systematic data gathering, assessment, appropriate nursing judgment, and evaluation of human responses to actual or potential health problems. Additionally, they carry out services like case finding, teaching, and healthcare counseling and execute medical regimens and therapies prescribed by a licensed or otherwise legally authorized physician or dentist.
Practical nursing, on the other hand, centers around utilizing standardized nursing procedures under the direction of a licensed professional nurse, like an RN or APRN, or a licensed physician or dentist. Critically, practical nursing and the duties of an LPN do not require substantial specialized skill, independent judgment, or knowledge required in the practice of professional nursing.
Yet, there are others in the healthcare workplace that fall outside of professional and practical nursing. Unlicensed assistive personnel (UAPs), which can include nursing aides, medication aides, and others work alongside licensed nurses to render basic care to patients. UAPs cannot administer medications, including over-the-counter drugs unless they have additional certification and are delegated that task by a supervisor. Although UAPs must maintain registration with the Alabama Board of Nursing (ABN), LPNs, RNs, and APRNs are fully licensed.
Licensed Practical Nurses
LPNs perform nursing acts under the direction of an RN, a licensed physician. Patient comfort, medication administration, and checking vital signs are just some of an LPN's primary duties, but the NPA doesn't explicitly list responsibilities. Instead, it deems the scope of an LPN's practice includes, but is not limited to, anything within:
- License status
- Educational preparation (initial and continued)
- State, federal, and facility regulations
- State and national standards of practice type
- Nursing experience and competence
LPNs can only administer certain intravenous drug therapies with verified certification and supervision. While they often assist in wound care and triage, sharp debridement is reserved for RNs with national certification that includes didactic instruction, supervised clinical practice, and demonstrated competence. Furthermore, LPNs may not complete any task that requires independent decision-making on behalf of a patient to diagnose, alter, or intervene in a condition.
Registered and Advanced Practice Nurses
As those who engage in professional nursing, RNs and APRNs have a broader scope of practice and are responsible for delivering more complex patient care. In addition to providing hands-on nursing care, RNs serve in capacities including, but not limited to, workplace administration, patient management, clinical instruction, and task delegation.
Some other functions of Alabama RNs include:
- Identifying and documenting diagnoses
- Developing medical intervention plans
- Monitoring care plan outcomes and coordinating responses
- Implementing orders for medications and treatments
RNs monitoring patients receiving moderate sedation may not take on further responsibilities during procedures that would leave the patient unattended or compromise continuous monitoring. That also includes not delegating tasks to LPNs.
With more advanced education and experience, APRNs have the most expansive scope of practice among nursing professionals and are often specialized in one of four areas:
- Certified Registered Nurse Practitioner
- Certified Registered Nurse Anesthetist
- Certified Nurse Mid-Wife
- Clinical Nurse Specialist
APRNs engage in autonomous practice and may assess, diagnose, and manage patients within their competence, education, and regulations from national boards and organizations. The Alabama NPA asserts that APRNs in collaborative practice may not discontinue treatment of a patient, as long as further treatment is medically indicated, without giving the patient reasonable written notice and sufficient opportunity to make alternative arrangements for medical care.On-going collaboration between physicians and APRNs may include but is not limited to direct consultation, patient care, and other activities to promote positive patient outcomes.
Delegation and Supervision Rules
One of the most significant tenets of providing effective patient care is delegating duties to various nurse licensees. In many cases, these duties require some amount of direct or indirect supervision. Therefore, the Alabama NPA also provides guidelines to mitigate improper delegation or supervision to ensure patient safety.
RNs, which include APRNs, have the authority to delegate and assign nursing tasks to other personnel and subsequently supervise. They are accountable and responsible for the activities assigned and the patient's outcome and must consider the following:
- The delegatee's knowledge, skills, and experience
- Complexity of the delegated tasks
- The patient's health status
Tasks delegated to unlicensed assistive personnel may not include tasks that require independent nursing judgment or invasive or sterile procedures. However, the Alabama NPA expresses that neither "finger sticks" nor "peripheral venous phlebotomies for laboratory analysis" are invasive or sterile procedures. Overall, delegation may not exceed the delegatee's educational preparation, practice license, and nursing experience in consideration of patient safety.
For practice beyond a nurse's basic education, a standardized procedure is required for the licensed nurse in any practice setting wherein a licensed nurse demonstrates competence through a medical facility's initial training and educational records. UAPs and LPNs may not supervise, direct, or evaluate the nursing care provided by an RN. For medication assistance, supervision is provided to individuals to whom nursing functions or responsibilities are delegated or assigned.
Alabama NPA Recordkeeping Rules
Maintaining accurate patient records is fundamental to upholding legal and professional responsibilities under the Alabama NPA. Mandating structured and timely recordkeeping safeguards patient health and well-being promotes nurse accountability, and prevents potential liability issues.
Every caliber of nurse, from UAP to ARPN, must follow the standards for nursing care documentation based on three principles:
- Legible
- Accurate
- Complete
Complete documentation includes reporting and appropriately recording a patient's status. It may include signs and symptoms, responses, treatments, or other nursing care rendered, including that which was delegated. Nurses must sign the documentation (electronically or in writing) for completion. Moreover, if documentation isn't timely, it must be recorded as a "late entry," including a date and time the entry was made, as well as the date and time the care was provided.
Mistaken entries by a licensed nurse (not a UAP) are corrected by a method that does not "obliterate, white-out, or destroy" the entry. Corrections must include the name or initials of the person making it.
Continuing Education and Competence
The Alabama NPA requires nurses to complete continuing education (CE) programs to maintain their credentials. Renewal dates run on a two-year cycle, and CE—measured in contact hours—is completed within that timeframe. One contact hour equals 50 minutes of instruction or 50 minutes of clinical or laboratory practice and must come from the list of board-approved providers.
All licensed nurses must complete 24 contact hours of CE per period. RNs and APRNs must include four CE contact hours related to NPA provisions during their first renewal. APRNs with prescriptive authority must also have six contact hours in pharmacology.
The contact hours required may be obtained from the following activities:
- Workshops
- Seminars
- Classrooms
- Webcasts
- Internet and intranet courses
- Home study courses
- CE contained in medical journals
- Podcasts
- Oral presentations of professional papers (if approved)
- Authoring, conducting, or contributing to an article, book, or publication
Serving as an appointed facility preceptor for students or new hire orientation may be recognized for eight contact hours. CE courses or activities may not be repeated during the renewal period, but nurses may audit them.
Retaining CE documentation is essential. During the license renewal period, nurses must provide a signed statement of affirmation of the degree of compliance with the following:
- Earning the required number of contact hours within the designated period
- Using a board-approved CE course with acceptable content and activities
- Not repeating CE activities during the earning period
Nurses must maintain records for four years following the year in which the contact hours were earned with certificates, transcripts, or other documentation to substantiate attendance and education. Failure to provide the board CE record upon request can result in disciplinary action or additional conditions for renewal.
Unprofessional Conduct and Discipline
Another significant aspect of the Alabama NPA is educating nurses on appropriate workplace behavior. While each level of licensure has its own authorized acts in the medical field, all licensees, no matter what caliber, must follow professional guidelines.
The ABN has the authority to reprimand, restrict, or revoke a nursing license as it deems necessary with its grievance procedures. Grounds for disciplinary action include the following:
- Failure to maintain medical records professionally, falsifying, or altering them
- Practicing while a physical or emotional condition impairs an individual's ability
- Inappropriately delegating tasks or failing to adequately supervise
- Violating patient confidentiality or professional boundaries
- Misappropriation of medical supplies or facility equipment
- Terminating patient responsibility without properly notifying the appropriate personnel
- Practicing while under the influence of mood-altering substances, including drug addiction and chronic alcoholism
- Felony convictions and those related to crimes of moral turpitude or gross immorality
Allegations of misconduct can come from a myriad of sources. Coworkers and supervisors can notify the board; patients can lodge complaints through facilities, and they can also come through anonymous reports. Whether the ABN uses informal or formal disciplinary measures, corrective action presents a significant threat to a nurse's career longevity.
Although Alabama nurses may practice in over 40 states through the Nurse Licensure Compact's (NLC) reciprocity protocols, discipline in one jurisdiction carries into others nationwide. Therefore, nurses will not be able to practice in full capacity in other NLC-compliant states until sanction periods in Alabama end.
Despite the risk of discipline, whenever nurses face allegations of unprofessional conduct or any discipline related to NPA violations, they must understand that they can obtain help to mount a defense. The NPA is a complex set of rules and regulations, and nurses must protect the years of education and training by contacting the Lento Law Firm.
Contact the Lento Law Firm for Alabama NPA Defense
The Lento Law Firm Professional License Defense Team stands prepared to begin building a defense strategy for you. We understand that even minor NPA violations can derail career aspirations, such as forgetting to record a patient's change in condition or making illegible marks on official records. While some may think a short departure from duties deserves a second chance, that isn't how the NPA directs the ABN to manage rule violations.
Nurses need an experienced team that is well-versed in the administrative proceedings used to adjudicate and levy sanctions. We provide a delicate approach to protecting licenses to practice and will promote a beneficial resolution before adverse action. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 today or fill out our consultation form.