The Nurse Practice Act (NPA) is a nationwide set of rules and regulations giving state agencies the authority to establish frameworks for nursing practices and provisions. The aim is to ensure medical patients and healthcare recipients get competent and compassionate care from nursing professionals, from routine medication administration to life-saving interventions.
To become a member of Hawaii's nursing community, individuals dedicate years of their lives to school, on-the-job training, and fulfilling licensing requirements from governing organizations. Even though Hawaii nurses are expected to align with NPA guidelines while progressing through their practice, situations can arise that present the risk for discipline. From anonymous complaints to false allegations, even minor violations can lead to the following:
- Probation that restricts or limits a nurse's ability to practice
- Mandatory education that can place a burden on a nurse's already busy schedule
- Suspension or revocation of credentials that make employment next to impossible
When Hawaii nurses are threatened with adverse action from medical facilities or state authorities, they can call on the support of the Lento Law Firm. We protect nurses against NPA violations and allegations of misconduct, keeping them intact with their practice and ability to earn a living by rendering life-saving care. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 now or fill out our confidential consultation form.
Scope of Practice for Different Types of Nurses
Hawaii's nursing laws and regulations define the scope of practice and professional expectations, including guidelines on what exactly nurses are authorized to do in a given placement or facility and those that are prohibited or require additional certification. They are based on the National Council of State Boards of Nursing (NCBSN) Model Act and Rules, which is cited as Hawaii's NPA.
The practice of nursing in Hawaii is directed toward assisting patients, clients, and healthcare recipients in attaining or maintaining optimal health, implementing strategies to accomplish patient-centered care plans, and evaluating responses to nursing care and treatment. Among those listed to practice nursing care in the state include:
- Licensed Practical Nurses (LPNs)
- Registered Nurses (RNs)
- Advanced Practice Registered Nurses (APRNs)
There are others in the healthcare workplace, referred to as unlicensed assistive personnel (UAPs), who perform nursing care under the direction and supervision of licensed nurses. UAPs are prohibited from performing any professional nursing tasks, such as:
- Patient therapy or treatment decision-making
- Implementing parts of nursing plans
- Emergency interventions and medical procedures
- Medication administration
- Delegating workplace duties
While UAPs need not be licensed, like nurse aides, they must be eligible for registration with the state. Otherwise, those who render professional nursing care must obtain licensure through the Hawaii Board of Nursing (HBN), which is part of the Department of Commerce and Consumer Affairs Professional and Vocational Licensing Division.
The HBN utilizes the NPA to create credentials that are consistent with education and medical training. Therefore, the scope of practice for nursing professionals in Hawaii depends on the level of licensure.
Licensed Practical Nurses
LPNs provide basic nursing care, many times at the delegation of an RN, APRN, licensed physician, dentist, osteopath, or podiatrist. Care delivery, medication administration, and responding to patients encompass an LPN's primary duties. Yet, they will also perform the following in their scope of practice:
- Collecting and reporting patient medical data such as vital signs and response to interventions
- Advocating the best interest of patients
- Implementing parts of care plans and monitoring outcomes
- Fulfilling charge nurse responsibilities as permitted
- Assign and delegate tasks to UAPs and other LPNs
Although LPNs monitor patients at the behest of higher-level nurses, they may not independently assess or diagnose patients or change any aspect of a care plan. Moreover, LPNs can only administer medications when the task is delegated and have the appropriate board-certified training.
Registered Nurses
RNs have a broader scope of practice and are responsible for more complex tasks. In addition to rendering hands-on nursing care and taking responsibility for patients, RNs delegate tasks, manage patient cases, and serve as a teaching resource. Their scope demands competent judgment, decision-making, and implementation of NPA practices and provisions.
Some other duties of RNs include:
- Identifying and documenting medical diagnoses
- Developing patient care and emergency intervention plans
- Implementing orders for medications and treatments
- Teaching the theory and practice of nursing
- Monitoring care plan outcomes and coordinating responses
RNs are not authorized to perform medical diagnoses or prescribe treatments. They also cannot order diagnostic tests, such as MRIs, CT scans, and nuclear tests, without authorization.
Advanced Practice Registered Nurses
APRNs have the most education and training and, therefore, have the most expansive scope of practice among nursing professionals. Acting as the first line of assistance to physicians, they also provide the first point of contact with patients on a daily basis. They assume primary responsibility for patient care and incorporate professional judgment to focus on an area of specialization in one of four disciplines:
- Nurse Practitioner
- Certified Registered Nurse Anesthetist
- Certified Nurse Mid-Wife
- Clinical Nurse Specialist
APRNs normally engage in autonomous practice and may assess, diagnose, and manage patients within their competence and education. They also have the ability to prescribe medications, including controlled substances, provided their care standards comply with state and federal requirements with proper certifications. However, they may not prescribe drugs listed on the Exclusionary Formulary and any legislatively revised formularies.
In addition to functions specified for RNs, APRNs may perform the following acts, which include, but are not limited to:
- Provide indirect care through delegation to other personnel associated with the healthcare team.
- Serve as a consultant and resource of advanced clinical knowledge and skills to those involved directly or indirectly in patient care.
- Develop and implement professional and community healthcare educational programs.
- Participate in policy analysis and development in practice specialties.
Furthermore, under Hawaii's Our Care, Our Choice Act, APRNs are authorized to practice medical aid-in-dying. Within their scope of practice, advanced nurses who have responsibility for the care of a patient with a terminal disease or illness may carry out requests for prescription medication that allows the individual to die in a peaceful, humane, and dignified manner.
Supervision and Delegation Rules
Hawaii's nursing regulations include strict guidelines for on-the-job delegation. Improper assignment or duty allocation and violations of supervision protocols can result in disciplinary action for licensed nurses and delegatees.
Only an RN has the authority to practice professional nursing; therefore, only they have the authority to delegate. When LPNs give tasks to others, it can be referred to as assigning, not delegating. The HBN asserts that delegation of nursing tasks to UAPs should be the exception rather than the rule unless RNs can justify the need for delegation. Moreover, the board states that UAPs can be utilized to provide care under the specific delegation and supervision of an RN and not an LPN.
RNs may delegate in any setting at any time, provided that they offer indirect supervision when they are not regularly scheduled and are not available to provide direct supervision. When delegating, nurses use the NCSBN decision-making process to consider and carefully analyze:
- Patient needs and circumstances
- Qualifications of the delegatee
- The nature of the delegating nurse's authority
- The delegating nurse's competence in the nursing task
- The Continuum of Care Framework
The delegating nurse is responsible for individually assessing patients and outcomes related to medications, interventions, or treatments. Nevertheless, the delegatee ultimately assumes liability for accepting the delegated task, including their own actions when providing patient care. The only tasks that may not be delegated are practice-pervasive functions of nursing assessment, evaluation, and judgment.
Continuing Education and Competence
Hawaii requires nurses to complete continuing education (CE) to maintain their licenses to ensure they remain current with medical knowledge and practice standards. Renewal dates run on a two-year cycle, and all hours of CE must be completed within that timeframe.
All Hawaii nurses are required to complete 30 contact hours of CE in order to renew a license, wherein one contact hour equals 60 minutes of instruction or laboratory work through educative supervision. Other than the 30-hour requirement, LPNs and RNs must complete one of the learning activity options to fulfill CE:
- National certification of recertification related to the nurse's practice role
- Completion of a board-approved refresher course
- Completion of two-semester credits of post-licensure academic education related to nursing practice
- Participation as a preceptor for at least one nursing student or employee transitioning into new clinical practice areas for at least 120 hours
- Completion as principal or co-principal investigator of a nursing research project
- Authoring or coauthoring a peer-reviewed nursing or health-related publication
- Developing and conducting a nursing education presentation totaling at least five contact hours
APRNs must also complete 30 contact hours of CE, which includes eight contact hours in pharmacology. Nurses are required to maintain CE completion certificates for at least four years, and if audited by the HBN, licensees are required to submit records within 60 days. Failure to complete CE requirements or provide appropriate documentation can result in license suspension or additional conditions for renewal.
Unprofessional Conduct and Discipline
Not only do Hawaii nurses have specific rules about practice authorizations and prohibitions, but they must also adhere to a set of official guidelines. Nursing behavior that fails to conform to legal and accepted standards of professional nursing organizations and which adversely affects the health and welfare of the public constitutes unprofessional conduct.
Willful and repeated instances of professional conduct give the HBN the grounds to initiate grievance procedures. Although it's not an exhaustive list, violations like the following can lead to disciplinary action like license limitation, suspension, or revocation:
- Misrepresenting personal or professional information to gain licensure
- Performing unsafe or unacceptable patient care that poses a danger to their welfare
- Intentionally or negligently causing physical or emotional injury to a patient
- Administering medication and treatment carelessly or negligently
- Failing to protect patients from incompetent healthcare practices
- Performing nursing techniques or procedures without proper education and training
- Violating patient confidentiality, dignity, or right to privacy
- Abandoning a patient or assignment without notifying the appropriate personnel
- Practicing nursing under physical or mental impediments
- Unauthorized use or diversion of drugs, supplies, or property from a patient or healthcare facility
If allegations of misconduct arise from patient complaints or those of coworkers and supervisors, Hawaii nurses will be subject to the HBN's grievance process. Whether approaching informal or formal disciplinary measures, even minor violations can disrupt the career of any caliber licensee.
At a minimum, practice limitations and restrictions, as well as the imposition of fines and mandatory CE, will place stress on nurses. Frequently, the effects of minor violations can create conditions for future misconduct allegations, putting nurses behind in advancing their careers.
Still, just because a nurse faces sanctions in Hawaii doesn't mean they may be able to relocate to another state to practice. Discipline affects the ability to practice nearly anywhere in the U.S. Even though Hawaii is not a Nurse Licensure Compact (NLC) state, non-NLC jurisdictions use the NCSBN's Nursys Database to verify licensing eligibility nationwide. Therefore, Hawaii nurses won't be able to practice until their sanctioning periods have passed and their credentials are fully reinstated.
Contact the Lento Law Firm for Hawaii NPA Defense
Violations of Hawaii's NPA present a daunting challenge for the state's nurses. In the complex world of healthcare, allegations of misconduct can turn a rewarding career upside down. However, when nurses face discipline, they can rely on the support of the Lento Law Firm Professional License Defense Team.
While some believe a simple mistake or a short departure from nursing duties deserves a second chance, the HBN is tasked with levying sanctions for even the most minor violations. Even though nurses have the opportunity to defend themselves, the administrative procedures used often make it difficult for healthcare professionals to achieve a beneficial outcome.
Our team provides a delicate approach to protecting a license to practice, such as negotiating with the HBN outside of formal procedures to mitigate sanctions. From monitoring changing state nursing requirements to building a defense against NPA violations, we are an ally of healthcare professionals nationwide. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 today or fill out our consultation form.
