Nebraska employs the Nationwide Nurse Practice Act (NPA) to create regulations governing safe and legal nursing care and oversight of patients and professionals through state agencies. This critical piece of legislation also outlines the scope of practice and professional standards for nurses at varying levels of education, experience, and licensing.
Understanding the NPA is imperative for Nebraska's nurses. Despite best intentions, misunderstandings or missteps can occur in the fast-paced and complex world of healthcare. Even a single violation or false allegation can upend a nurse's career, no matter how innocuous it may seem, meaning acts like the following have the potential to derail a career:
- Forgetting to record a patient's change in condition
- Recording important medical information illegibly
- Controlling medications without certification
- Independently diagnosing a patient without proper credentials
Nebraska's nurses earned their practice through years of education and licensing compliance to have the ability and authority to render life-saving care daily. While challenges exist in educating patients, administering medications, and performing medical interventions, any allegation must be taken seriously. When NPA violations threaten nurses' careers, the Lento Law Firm stands prepared to help.
The Lento Law Firm Professional License Defense Team understands the risk placed on Nebraska nurses with public-facing professional duties. Regardless of whether the alleged NPA violation emanates from patient complaints, facility reports, or notices from the state health agency, we will ensure you mount a robust defense. To mitigate the potential for corrective action, contact a dedicated ally of the nursing community and 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
The NPA is a series of regulations standardizing ethical and legal medical care. To enforce the provisions, the Nebraska Department of Health and Human Services (DHHS) uses the NPA to create the Nebraska Board of Nursing (NBON) to organize requirements for licensure, nursing practice boundaries, education initiatives, and other provisions. Among the types of nurses licensed by the NBON are Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). While most states put all nursing professionals under one agency, DHHS created a second organization for higher-level nurses, who receive their license to practice from the Nebraska Advanced Practice Registered Nurse Board (APRN Board).
Nurses are closely monitored by their respective state agencies to ensure Nebraska residents receive top-tier nursing care. This includes but is not limited to the identification of and intervention in actual or potential health problems of individuals, families, or groups to maintain a specific health status, prevent illness, injury, or infirmity, improve health status, and provide restorative care. Each type of licensee has clear distinctions, which sets them apart in terms of education, duties, and authorized and prohibited acts.
Licensed Practical Nurses
LPNs provide basic nursing care under the direction of RNs or physicians. After obtaining licensure from the NBON, the scope of practice for LPNs includes:
- Contributing to the assessment of the health status of individuals and groups
- Participating in the development and modification of care plans
- Implementing appropriate aspects of patient care plans
- Maintaining safe and effective nursing care rendered directly or indirectly
- Participating in the evaluation of responses to medical interventions
- Providing intravenous therapy with proper certification
While LPNs may assume some duties and perform specific procedures beyond their educational preparation, they are responsible for obtaining the appropriate knowledge, skills, and supervision to ensure competent patient care. Moreover, LPNs are authorized to suggest interventions related to diagnoses, but they may not make an official assessment.
After receiving the necessary training and under the authority of an RN or higher-level nurse, LPNs may direct, assign, and supervise other LPNs. They also delegate tasks to unlicensed assistive personnel (UAPs), like medication aides.
Registered Nurses
RNs have a broader scope of practice to conduct and document nursing assessments. They are licensed by the NBON to identify responses to actual or potential health conditions and engage in the following:
- Assessing health conditions to establish nursing diagnoses
- Establishing goals and outcomes to meet healthcare needs
- Prescribing interventions to implement care plans
- Teaching healthcare practices and delegating, directing, or assigning nursing interventions
- Evaluating responses to physical and psychological interventions
- Collaborating with other health professionals to manage patient care
RNs must work under the supervision or direction of a physician or APRN, and independent practice is not permitted. While they may develop and implement care plans related to diagnoses, they must have authorization from an APRN or physician. RNs also cannot perform surgical procedures and other interventions requiring advanced or specialized medical training.
Advanced Practice Registered Nurses
APRNs are the highest level of nurses and are licensed and authorized to make independent decisions about specialist nursing needs. They are directly accountable and responsible to the patient or care recipient and are often specialized in one of four areas:
- Certified Nurse Specialists
- Certified Registered Nurse Anesthetists
- Certified Nurse Midwives
- Nurse Practitioners
The Nebraska NPA authorizes APRNs to assess, diagnose, and manage medical conditions within their scope of practice. Duties include the following:
- Ordering and interpreting laboratory tests and diagnostic imaging
- Ensuring compliance with medical policies, practices, and protocols
- Conducting daily onsite evaluation
- Providing clinical supervision over residents and staff
- Recommending and developing practice standards
APRNs must practice within the bounds of their specialization and training. With the necessary education and certification, they may prescribe any medication, including controlled substances and chemotherapy drugs required in their practice.
Supervision and Delegation Rules
Most delegation within Nebraska healthcare facilities is carried out by RNs. Nevertheless, LPNs have the authority to delegate some tasks reserved to their scope of practice, as do APRNs.
RNs may delegate nursing tasks to UAPs but retain accountability for the outcome. Prior to delegation, RNs must fulfill the following responsibilities when selecting delegatees:
- The patient's needs and the appropriate times for delegation
- The competency of the delegatee
- The method of supervision required
- The means to provide feedback
Those accepting nursing tasks hold responsibility for what they choose to take on. For instance, UAPs and other nursing professionals selecting delegated tasks must:
- Accept activities based on their level of competence
- Maintain competence for the delegated responsibility
- Retain accountability for the delegated activity or task
- Communicate with delegating nurse regarding feedback
When tasks are delegated repeatedly, the NPA asserts that written protocols are necessary for delegatees. Procedures should clearly outline the intended medical treatments and the process for addressing any issues that may arise. Selected interventions must utilize standard and unchanging procedures for frequently occurring care protocols that do not require a complex application of the nursing process or independent judgment.
Nurses must determine the method of supervision on an individual basis and identify any other licensed nurses who have been assigned such responsibilities. They may utilize both direct and indirect methods of supervision.
Appropriate circumstances for direct supervision are when patient conditions are unstable, and responses to medical interventions are unpredictable. Additionally, when the patient lacks the ability to provide necessary information, frequent assessment by nurses with more experience is required. If protocols provide direction to an LPN, indirect supervision by an RN or APRN is required and must include periodic inspection and evaluation.
Continuing Education and Competence
Nebraska's DHHS requires nurses to complete continuing education (CE) contact hours to maintain their licenses. The regulation ensures 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, LPNs and RNs must meet one of the following competency requirements:
- Practiced nursing for at least 500 hours during the past five years and completed 20 contact hours of CE
- Graduated from a nursing program in more than two but less than five years and completed 20 contact hours of CE
- Graduated from a nursing program within the last two years and completed an approved refresher course
- or maintained current certification in a nursing specialty granted by a nationally recognized certifying organization.
On the other hand, APRNs only need a current national certification, but a Certified Nurse Midwife must complete a four-hour opiate prescribing course, and a Nurse Practitioner must complete the same course and verify 2,080 hours practiced in the previous five years.
All nurses must maintain documentation to verify CE contact hours for at least four years. Failure to prove completion can result in unprofessional conduct charges.
Unprofessional Conduct and Discipline
The Nebraska NPA outlines the scope of practice and authorized acts among various levels of nursing. Yet, all nurses, no matter what type of license, are subject to the NPA's guidelines for professional behavior and conduct.
While there are many issues that may warrant disciplinary action, the following are listed as grounds for unprofessional conduct by the Nebraska NPA:
- Failure to utilize appropriate judgment or technical competence in nursing practices based on the level of license
- Violating the confidentiality of a patient's information or knowledge
- Falsification or intentional unauthorized destruction of patient records
- Disregarding policies or procedures implemented to safeguard patient care
- Abridging a patient's dignity, including verbal or physical abuse
- Misappropriating medications, supplies, or the personal items of a patient or facility
- Leaving a patient care nursing assignment without notifying personnel or failing to exercise supervision
- Accepting a task outside the nurse's scope of practice or unauthorized delegation
- Failure to maintain accurate patient records
- Violating patient boundaries like the nurse-patient relationship or engaging in any activities of a sexual nature with a patient
Not only will certain prohibited acts in the workplace garner discipline, but if nurses don't keep their education loans up to date, they may receive sanctions. The NPA asserts that those who fail to meet the repayment provisions for a loan received under the Nursing Student Loan Act or the Nursing Faculty Student Loan Act are liable for unprofessional conduct.
Misconduct allegations related to NPA violations may arise from patient complaints, staff members, supervisors, and even anonymously through the state's complaint portal. The NPA directs the NBON or the APRN Board to investigate all allegations and gives the state agency the authority to levy disciplinary action against nurses who fail to report rule breaches immediately.
While nurses have the opportunity to defend themselves in a formal hearing before the NBON or the APRN Board and may appeal corrective action, oftentimes, nurses come away with restrictions and limitations on their practice. Furthermore, punishment doesn't end at the state's political or administrative boundaries.
As a signatory of the Nurse Licensure Compact (NLC), Nebraska enables nurses and other healthcare workers to become licensed through reciprocity in other states. This means that licensees have an easier time transferring credentials to find employment in over 40 states. However, discipline on a nurse's license in Nebraska follows them to any NLC-compliant state. Any practice restrictions or limitations, such as probation, suspension, or revocation, affect the ability to practice elsewhere until the sanction period is over.
Contact the Lento Law Firm for Nebraska NPA Defense
When Nebraska nurses face allegations of NPA violations, they need a dedicated ally of healthcare professionals nationwide. No matter what situation LPNs, RNs, or APRNs encounter, the Lento Law Firm Professional License Defense Team stands ready to begin their defense.
Our team realizes that even the most minor violation can end a nurse's career, such as:
- Allegations of patient-nurse boundary violations
- Losing records related to CE contact hours during an audit
- Making illegible marks on a patient's medical record
- Working outside of delegated or supervised care duties
While some may think a short departure from official responsibilities deserves a second chance, DHHS is strict with its application of the NPA. While you may think an attorney is too extreme of an option to protect your credentials, think again. Nurses need an experienced team that knows how to negotiate with state authorities like the NBON and the APRN Board and ensure every means of redress is exhausted.
Don't wait until the complaint or investigation process begins. When nurses are worried about their license status, call the Lento Law Firm Professional License Defense Team at 888-535-3686 today or fill out our consultation form.
