Patients, healthcare recipients, and Nevada's citizens rely on the proficiency and sympathy of the state's nurses to provide medical guidance and life-saving treatment. To ensure proper and legal care standards, Nevada has strict guidelines to uphold nursing competency and fulfillment based on the nationwide Nurse Practice Act (NPA).
The NPA is a foundational source for state healthcare organizations to create the framework for nursing care with the primary aim of promoting and protecting public health, welfare, and safety. While Nevada nurses are instructed on NPA tenets throughout their time in schools, residency, and progressing through their practice, the risk for discipline remains. With rules and regulations subject to legislative changes and the fact that even unfounded allegations of any kind can threaten one's career, licensed nurses must exercise caution. When individuals violate the NPA and its Nevada guidelines, it commonly has effects such as:
- Financial stress from fines and restitution.
- Damaged professional reputation damage from practice restrictions or limitations.
- Struggling with employment after a suspension or revocation of credentials.
While Nevada nurses may run into trouble with state authorities or medical facilities over alleged NPA breaches, they can call on the assistance of the Lento Law Firm. We will direct any Nevada nurse on how NPA changes may affect them and their practice and defend them against sanctions and corrective actions related to violations. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 now or submit your details online, and we will contact you.
Scope of Practice for Different Types of Nurses
Nevada's NPA is a set of laws and regulations that define the scope of practice and professional expectations for nurses within the state. It outlines what nurses are permitted to do and cannot do, the standards they must uphold to maintain care, and, therefore, their licenses to practice. Among those listed to practice nursing care in the state include:
- Medication Aide Certified (MAC)
- Practical Nurse (PN)
- Registered Nurse (RN)
- Advanced Practice Registered Nurse (APRN)
Nurses must obtain licensure through the Nevada State Board of Nursing (NSBN), which employs the NPA to create levels of credentials consistent with education and medical training. Therefore, the scope of practice for nursing professionals in Nevada depends on the level of licensure. Each licensing designation has specifics of maintaining credentials, authorized duties, and prohibited acts outlined by the NPA.
Medication Aide Certified
MACs act as a link between assistive personnel—also called unlicensed assistive personnel (UAP)—and licensed nursing professionals. The Nevada NPA requires MACs to hold an active certification as a nurse aide and have at least one year of continuous full-time employment as a nursing assistant, among other prerequisites. Their scope of practice typically includes basic medical tasks, such as the following:
- Patient Documentation: Recording medication administration and all patient interventions accurately for official records.
- Observation: Monitoring patients to report findings to supervising nurses in a principally educative role.
- Medication Administration: Giving patients general medication prescribed by physicians or supervising nurses, such as topical, oral, eye, ear, and some inhaled medications.
The Nevada NPA forbids MACs from acting with autonomy and cannot make independent decisions about patient care or perform surgical procedures. Although they have the opportunity to administer intravenous drugs or scheduled narcotics, MACs must obtain the necessary training, education, and endorsement with NSBN approval.
Practical Nurses
Known as licensed practical nurses in other states, PNs provide basic nursing care, all the while working with a supervisor—usually a physician or RN. PNs must graduate from an accredited program, pass an exam, and obtain licensure to practice medicine in Nevada. The scope of practice for PNs under the NPA includes:
- Patient Care Assistance: Executing portions of patient care plans developed by an RN, physician, or other higher-level licensee.
- Care Delivery: Administering basic medications, wound triage, and responding to patient needs.
- Data Collection: Monitoring patient conditions and recording changes but not interpreting them to make independent decisions.
PNs are not permitted to make comprehensive patient assessments—such as diagnoses—or modify nursing care plans independently. Also, PNs cannot administer blood products or chemotherapy without an endorsement, NSBN approval, and a superior's supervision.
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 Nevada. 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 medications and controlled substances, with corresponding state endorsements.
- Supervision and Delegation: Overseeing PNs and UAPs to ensure safe and effective care.
RNs are not authorized to perform medical diagnoses or prescribe treatments. They also cannot order diagnostic tests, such as MRIs or CT scans, without authorization from an APRN or physician.
Advanced Practice Registered Nurses
APRNs have the most education and training, and therefore, they 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. The Nevada NPA authorizes them to have the following responsibilities:
- Autonomous Practice: Assess, diagnose, and manage medical conditions within their scope of practice.
- Prescriptive Authority: Prescribe medications, including controlled substances, provided they comply with state and federal requirements.
- Specialized Procedures: Perform advanced interventions specific to their certifications.
APRNs must practice within the bounds of their specialization and training. To gain prescriptive authority, they must complete a minimum of two-semester credits or 15 contact hours of graduate-level education in pharmacotherapeutic decision-making, safe prescribing practices, and medication management relevant to their population focus. The Nevada NPA also details that the NSBN can compel APRNs to maintain a certain amount of professional liability insurance.
Supervision and Delegation Rules
The NPA also provides guidelines related to on-the-job delegation and supervision of nursing care. Improper delegation or failure to supervise effectively can result in disciplinary action for the supervising nurse. In the case of UAPs, the Nevada NPA details their scope of practice as anything that does not require the knowledge and skill of a licensed professional nurse or a licensed practical nurse.
RNs and APRNs may delegate nursing care to other personnel, but before, they must consider the following:
- The amount of direction required by the delegatee from the delegator.
- The complexity of the nursing care needed by the patient.
- The educational preparation and competency demonstrated by the delegatee.
Delegators are ultimately responsible for the care provided to the patient. Therefore, RNs and APRNs can be subject to sanctions that may arise through complaints.
In terms of supervision, nurses also have a checklist of duties for those over whom they hold authority. The NPA requires supervisors to:
- Prioritize the needs of patients over the extent of supervised duties.
- Provide direction to interpret and carry out the objectives related to patient care.
- Assist PNs, MACs, and others to develop the skills needed for nursing competence.
- Evaluate the effectiveness of care given by supervisees.
In some cases, nurses must establish written guidelines if delegated tasks are engaged multiple times, as well as when administering patient medication. The guidelines must include procedures for identifying the type of patient to be served, the intended medical treatment, and resolving any questions related to prescribed medications.
Continuing Education and Competence
Nevada 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.
PNs or RNs must complete the following:
- 30 hours of CE
- Four hours of bioterrorism (one time)
- Four hours of cultural competency (every cycle)
APRNs must complete the following:
- 15 hours of CE
- Four hours of bioterrorism (one time)
- Four hours of cultural competency (every cycle)
- Two hours of Screening, Brief Intervention, and referral to treat approaches of SUD (every cycle)
- Two hours of opioid training (every cycle)
- Two hours of managing and treating opioids (one time)
MACs must complete 24 hours of CE related to medications or their administration. Regardless of what level of medical license, all individuals must maintain documentation of completed CE activities for at least four years in case of an audit. Failure to complete CE requirements can result in license suspension or additional conditions for renewal.
Unprofessional Conduct and Discipline
Another significant tenet of the Nevada NPA is to outline professional standards for nurses. While each level of licensure has its own authorized acts in the medical field, all licensees, no matter what caliber, must follow the state's code of conduct. Each state's guidelines vary slightly, but all are based on NPA provisions.
While there are many issues that may warrant disciplinary action, the following are also frequent reasons for disciplinary investigations:
- Falsification of personal or patient documents or records.
- Engaging in disruptive behavior.
- Boundary violations like sexual contact outside the scope of medical practice.
- Drug diversion and misappropriation of medical resources.
- Errors in distributing medication to patients or failure to keep accurate records.
- Impairment on the job, including positive drug screen without valid prescriptions.
- Failure to supervise or delegate tasks adequately.
- Sharing patient information without consent or legal justification.
- Exploitation, neglect, or abuse of patients.
- Failure to assess a patient accurately or intervene appropriately on their behalf.
- Practicing beyond the scope of licensure.
In the event that allegations of misconduct or NPA violation arise from recipient complaints or Nevada agencies, the grievance process presents a significant threat to nurses at any license level. Whether individuals approach informal or formal disciplinary measures, sanctions can include the following:
- Fines and restitution
- Practice limitations or restrictions
- Mandatory CE hours or courses
- License suspension for up to five years
- License revocation with or without the ability to reapply
Most states are part of the Nurse Licensure Compact (NLC), which allows healthcare workers, such as PNs, RNs, and others, to practice in multiple states without additional or supplementary licensing. While the NLC enables reciprocity, any disciplinary action in Nevada will affect the status in other NLC-compliant states. Therefore, Nevada nurses will not be able to work in much of the country until their license is permitted to be reinstated or limitations and restrictions are removed.
Contact the Lento Law Firm for Nevada NPA Defense
The Lento Law Firm Professional License Defense Team understands that even the most minor NPA violation can spell the end of a nurse's career, and our team has what it takes to ensure you get back on track with professional obligations. Nurses can become implicated for something as seemingly innocuous as forgetting to log a patient's status when they arrive on shift. However, while some may think a short departure from duties deserves a second chance, that is not how the NPA directs the NSBN to handle it.
While Nevada nurses may think an attorney is too intense a selection to protect their ability to practice, think again. Nurses need an experienced team that knows how to negotiate with state authorities, understands the administrative proceedings used by the NSBN, and ensures every means of defense and appeals are exhausted. Furthermore, resist the confidence local lawyers may have who believe they can help you with shock-and-awe tactics and lawsuits against governing bodies. Nurses require a team that has a delicate approach toward protecting a license to practice, such as negotiating with the NSBN to promote a beneficial resolution.
From monitoring changing CE requirements, assisting in obtaining licenses, and defending nurses against NPA violations, we are an ally of healthcare professionals nationwide. Don't wait until the complaint or investigation process has begun; when nurses are worried about their practice, call the Lento Law Firm Professional License Defense Team at 888-535-3686 today or fill out our consultation form.
