The Nurse Practice Act (NPA) is the foundation of nursing rules and regulations in Kansas. It outlines the scope of practice for licensed healthcare workers, including the legal responsibilities and professional standards required. While the NPA promotes effective and competent patient care, complexities can create challenges for nursing professionals. Unfortunately, even a single violation or false allegation can upend a nurse's career, no matter how seemingly minor it may be, such as:
- Forgetting to record a patient's change in condition
- Keeping unintelligible medical records
- Violating boundaries within the nurse-patient relationship
- Monitoring vital signs without authorization
Nurses invest years of their lives in fulfilling education and licensing requirements to earn authority in the medical field, and any allegation must be taken seriously. Trials exist around every corner, educating patients, administering medications, and performing medical interventions, but when Kansas nurses run into trouble with state authorities or medical facilities, they can call on the assistance of the Lento Law Firm.
The Lento Law Firm Professional License Defense Team understands the risk placed on Kansas nurses to provide life-affirming and life-saving care on a daily basis. We will ensure that you can mount a robust defense against alleged NPA violations to mitigate sanctions and corrective actions. Get in touch with a fierce ally of the Kansas nursing community and call the Lento Law Firm Professional License Defense Team at 888-535-3686 now or submit your details online.
Scope of Practice for Different Types of Nurses
The NPA is a nationwide series of regulations standardizing ethical and legal medical care. In Kansas, the Kansas State Board of Nursing (KSBN) uses NPA guidelines to codify requirements for licensure, professional conduct, practice authorizations, and personnel limitations.
In creating distinct boundaries on who may render nursing care, those authorized to practice in Kansas are those with the following credentials:
- Medical Aides (MAs)
- Certified Nursing Aides (CNAs)
- Licensed Practical Nurses (LPNs)
- Registered Nurses (RNs)
- Advanced Practice Registered Nurses (APRNs)
Nurses are closely monitored by the KSBN for compliance to ensure top patient care standards in facilities and home settings throughout the state. The NPA also defines the expectations for nurses, divided as follows among licensees:
Medical Aides and Certified Nurse Aides
MAs and CNAs provide care under the supervision of licensed healthcare professionals and receive their credentials from the Kansas Aging and Disability Services Department, not the KSBN. The NPA defines the two positions under unlicensed assistive personnel (UAP) that primarily assist with basic nursing care and daily living activities, like the following:
- Patient Assistance: Helping with hygienic activities, supporting patient mobility, and assisting with comfort measures.
- Nutrition Assessments: Monitoring dietary intake and assisting patients with eating and drinking.
- Basic Reporting: Recording vital signs, documenting changes in patient conditions, and conducting disease investigation (with adequate training).
Although MAs and CNAs are classified as UAPs, each has different authorized and prohibited duties. The Kansas NPA restricts CNAs from administering medication, even over-the-counter drugs, and providing vaccinations, whereas MAs can under delegation and direct supervision from a physician. Moreover, both can engage in family planning and care responsibilities, such as monitoring vital signs. However, delegation must come from only physicians for MAs, and tasks can be delegated to CNAs from RNs or APRNs.
Licensed Practical Nurses
LPNs provide basic nursing care while working with a supervisor—usually a physician or RN. They must graduate from an accredited program, pass mandatory exams, and obtain licensure from the KSBN. The scope of practice for LPNs under the NPA includes:
- Patient Care Assistance: Implementing segments of care plans developed by an RN, physician, or other higher-level provider.
- Care Delivery: Administering basic medications, wound triage, and responding to patient needs.
- Monitoring Patients: Overseeing patient conditions and recording changes but not interpreting them to make independent decisions.
LPNs are authorized to initiate patient care services, such as taking vital signs and collecting samples for disease investigation. Yet, for further duties, LPNs must have delegation. They may only administer medications, including vaccinations when permitted by an RN or APRN. Kansas LPNs also have the authority to maintain and calibrate equipment that collects height, weight, and blood work data.
Registered Nurses
RNs have a broader scope of practice and are responsible for delivering more complex patient care. Individuals must have a diploma from a medical-based program (two-year or four-year), a passing score on exams, and fulfillment of all requirements to become licensed in Kansas. An RN's scope of practice under the NPA includes:
- Assessment and Care Planning: Identifying patient care needs and implementing plans to oversee medical progress.
- Medication Administration: Administering all forms of medication, including intravenous drugs and controlled substances, with corresponding certification.
- Supervision and Delegation: Overseeing CNAs and LPNs to ensure safe and effective care for patients and healthcare recipients.
RNs are not authorized to perform medical diagnoses (even simple ones) or prescribe treatments without certification. They also cannot order diagnostic tests without an APRN or physician's authorization. Yet, they can perform KANBeHealthy assessments to determine eligibility for the state's Medicaid program for children, teenagers, and young adults.
Advanced Practice Registered Nurses
APRNs have the most education and training and, thus, an expansive scope of practice among nursing professionals. Each APRN is authorized to make independent decisions about advanced practice nursing needs and is directly accountable and responsible to the patient or care recipient. The roles of APRNs licensed by the KSBN are:
- Clinical nurse specialists
- Nurse anesthetists
- Nurse-midwives
- Nurse practitioners
The NPA authorizes APRNs to assess, diagnose, and manage medical conditions within their scope of practice. With the necessary education and certification, they may prescribe any medication, including controlled substances and chemotherapy drugs required in their practice. While they may perform WIC (Women, Infants, and Children) duties, including clerical roles and nutritional assessments, only a Registered Dietitian can conduct high-risk interventions and planning tasks. Moreover, any practice related to mental health technology is relegated to APRNs, who are also licensed health technicians.
Supervision and Delegation Rules
One of the most significant principles in providing effective patient care is how duties are delegated to nurses of varying certification and licensure. As such, the Kansas NPA establishes guidelines to ensure patient safety. Other than physicians, RNs and APRNs have the authority to assign nursing tasks to other licensed and unlicensed personnel. LPNs, however, may only assign basic tasks to UAPs like CNAs.
Before delegating tasks, individuals must consider a few key factors, including:
- The level of guidance and oversight the delegatee will need from the delegator.
- The complexity of the nursing care required by the patient.
- The educational background and demonstrated competence of the delegatee.
Delegators are accountable for the care provided to patients under their supervision. As a result, nurses may face disciplinary actions stemming from complaints related to delegation. For instance, an LPN may request a CNA to monitor a patient, but the LPN is not given the authority to delegate by a supervisor.
In terms of supervision, nurses with authority over others must adhere to specific responsibilities outlined in the NPA. Supervisors are required to:
- Prioritize patient needs above the scope of delegated or supervised duties.
- Support nurses and other personnel with clear directions to develop the skills necessary for competent nursing practice.
- Evaluate the quality and effectiveness of care delivered by those under their supervision.
When tasks are delegated repeatedly or involve administering medications, written protocols are necessary. Procedures should clearly outline procedures for identifying the types of patients to be treated, the intended medical treatments, and the process for addressing any issues related to prescribed medications.
Continuing Education and Competence
Kansas requires nurses to complete continuing nurse education (CNE) 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.
At the time of license renewal, any nurse—LPN, RN, or APRN—must complete 30 contact hours of approved CNE. Under NPA provisions, CNE is documented as follows:
- Certificates or a transcript clearly designating successfully completed CNE hours
- Name of CNE course and date(s) completed
- Name of the accrediting organization.
The required 30 contact hours of approved CNE shall have been completed during the most recent prior licensing period. Contact hours accumulated more than the 30-hour requirement are not carried over to the next renewal period.
Kansas requires 12 hours of continuing education for CNAs before renewing their certification. All nurses must maintain documentation to substantiate CNE contact hours for at least four years. In the case of a KSBN audit, failure to prove completion of CNE requirements can result in adverse actions.
Unprofessional Conduct and Discipline
The Kansas NPA also outlines professional standards for nurses. While each level of licensure has its own authorized acts in the medical field, all licensees, regardless of caliber, are subject to its guidelines.
While there are many issues that may warrant disciplinary action, the following are also frequent reasons for disciplinary investigations:
- Practicing nursing beyond the authorized scope of a license or outside of delegated tasks.
- Failure to maintain professional medical records.
- Practicing while a physical or emotional condition impairs the ability to practice.
- Willfully or negligently failing to take appropriate action to safeguard a patient or the public from an RN or LPN's incompetent practice.
- Inappropriately delegating tasks or failure to adequately supervise delegatees.
- Violating patient confidentiality or professional boundaries, including sexual, emotional, or financial exploitation.
- Failure to provide for falsifying CNE contact hour requirements.
- Disciplinary action on a license in another jurisdiction.
- Abandonment of patients or care duties.
- Attempting to carry out duties while under the influence of alcohol or other mood-altering substances.
- Misappropriation of medication, medical supplies, or equipment.
If allegations of misconduct or NPA violations arise from recipient complaints or coworkers and supervisors, the NPA directs the KSBN to launch an investigation. Nurses may also receive disciplinary action for failing to immediately report rule breaches.
The grievance process the KSBN employs presents a significant threat to licensees. Whether nurses undergo informal or formal adjudication, sanctions can include the following without an adequate defense:
- Fines and restitution
- Practice limitations or restrictions
- Mandatory CNE hours or courses
- License suspension for up to five years
- License revocation with or without the ability to reapply
While Kansas nurses may appeal corrective action, there is little bandwidth for eligibility. Moreover, finding the necessary evidence to take advantage of appeals can easily be too much for a full-time medical professional to handle.
Despite punishment from Kansas' medical licensing authority, limitations and restrictions don't end at the state borders. Over 40 states are part of the Nurse Licensure Compact (NLC), which enables nurses and other healthcare professionals to work in other states through reciprocity.
However, disciplinary action taken on an individual's license in Kansas will affect the status in other NLC-compliant states, meaning they may be unable to practice in the same capacity (or at all) until the sanction period is over. Since non-NLC states rely on the Nursys database from the National Council of State Boards of Nursing for the same information, Kansas nurses face the end of their careers—at least in the short term.
Contact the Lento Law Firm for Kansas NPA Defense
When Kansas nurses face allegations of NPA violations, they need a dedicated ally of healthcare professionals nationwide. No matter what situation UAPs, LPNs, RNs, or APRNs encounter, the Lento Law Firm Professional License Defense Team stands ready to begin their defense.
Our team understands that even the most minor violation can end a nurse's career. Something as seemingly innocuous as recording a patient's change illegibly can warrant sanctions that restrict one's practice and force them to endure hours of mandatory CNE. Repeated offenses often separate a nurse from employment.
While some may think a short departure from official duties deserves a second chance, that isn't how the NPA directs the KSBN to manage rule violations. Therefore, nurses need an experienced team that knows how to negotiate with state authorities to lessen the effects sanctions have on credentials. We provide a delicate, hands-on approach toward protecting a license to practice and promote any resolution that keeps nurses in facilities providing much-needed patient care. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 today or fill out our consultation form.
