Utah's medical patients and healthcare recipients rely on nurses' compassion and expertise to provide affirming and life-saving care. Licensed nurses expend a small fortune and a large portion of their lives gaining the education and training required to live up to state-implemented standards. Like other states, Utah has strict guidelines for nurse conduct and competency based on the nationwide Nurse Practice Act (NPA).
The NPA is a source text for healthcare professionals with the primary goal of protecting public welfare and providing the framework for responsible and legal medical care. While nurses may believe the NPA provisions become second nature when they're seasoned professionals, the risk for discipline doesn't diminish with time. With guidelines subject to legislative alterations and a stringent application of the rules for nurses of any caliber or longevity, allegations of any kind can threaten one's career, with common effects like:
- Damaged professional reputation damage from practice restrictions or limitations.
- Financial stress from fines and restitution.
- Struggling with employment after a suspension or revocation of credentials.
Despite the challenges involved in keeping up to date with the NPA, nurses can call on the assistance of the Lento Law Firm. We will guide any Utah nurse on how NPA changes may affect them and their practice and defend them against the repercussions of 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
Utah'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 include:
- Medication Aide Certified (MAC)
- Licensed Practical Nurses (LPN)
- Registered Nurse (RN) and RN Apprentice (RNA)
- Advanced Practice Registered Nurse (APRN)
Nurses must provide care that is consistent with their education, medical training, and policies of the employing organization. Although Utah nurses must obtain licensure through the Division of Occupational and Professional Licensing (DOPL) while maintaining the Utah Board of Nursing and Certified Nurse Midwives (Board) standards, neither organization delineates nor describes the individual tasks that may be associated with their nursing practice. The scope of practice for licensed nursing professionals in Utah is defined by the state legislature's interpretation of the NPA. How the NPA is applied to nurses and the boundary of their authorized practice depends on the level of licensure.
Medication Aide Certified
MACs are a bridge between unlicensed assistive personnel (UAPs) and licensed nursing professionals, allowing provider facilities to streamline routine tasks. The Utah NPA requires individuals to hold an active certification as a nurse aide, have a minimum of 2,000 hours of experience within the two years before application, and obtain letters of recommendation, among other qualifiers. Their scope of practice includes the following tenets:
- Medication Administration: Administering oral, topical, eye, ear, and certain inhaled medications to patients.
- Documentation: Recording medication administration accurately in patient records.
- Observation: Monitoring patients for side effects or adverse reactions to medications and reporting findings to supervising nurses.
- Assisting Nurses: Supporting RNs or LPNs and ensuring patient compliance with care plans.
MACs lack the authority to make independent decisions about medication or administering intravenous drugs or scheduled narcotics without training and approval from the Board. Moreover, they cannot provide nursing assessments or perform complex medical procedures.
Licensed Practical Nurses
LPNs provide basic nursing care under the supervision of an RN or physician. Following a 12 to 18-month educational program, individuals must pass an NCLEX (National Council Licensure Examination) to obtain licensure from the Board. An LPN's scope of practice under the NPA includes:
- Data Collection: Gathering information about the patient's condition but not interpreting it to make an independent diagnosis.
- Care Delivery: Administering medications (excluding high-risk substances, unless specially trained), provide wound care, and assist with basic patient needs.
- Assisting in Care Plans: Implementing portions of care plans developed by an RN, physician, or other higher-level provider.
LPNs are not authorized to perform comprehensive patient assessments or modify nursing care plans independently. Also, they may not administer blood products or chemotherapy without additional certification and supervision.
Registered Nurse Apprentice
RNAs are licensed under the guise of learning and engaging in medical practice under the indirect supervision of higher-level licensees. The Utah NPA restricts practices to the following:
- Administering Medications: Giving medically stable individuals established, routine medications, and not controlled substances or narcotics.
- Assisting in Procedures: They may help licensed RNs or physicians during medical procedures by preparing equipment, positioning patients, or providing other forms of support.
- Monitoring Patient Vital Signs: Apprentices may take and record vital signs, such as blood pressure, temperature, pulse, and respiration rates, under supervision.
RNAs do not have the authority to make independent medical decisions or lead complex medical procedures. Each must have supervision—even if indirect—to carry out their duties. This is also a Utah-only designation, meaning one's RNA credentials are non-transferable to other state jurisdictions.
Registered Nurses
RNs have a broader scope of practice and are responsible for delivering more complex patient care. Their roles include:
- Assessment and Care Planning: Conduct comprehensive assessments to identify healthcare needs and develop and implement nursing care plans.
- Medication Administration: Administering all forms of medication, including intravenous medications, as prescribed.
- Supervision and Delegation: Overseeing LPNs and UAPs to ensure safe and effective care.
RNs are not authorized to perform medical diagnoses or prescribe treatments (unless they are also licensed as APRNs). They also delegate tasks that require specialized nursing knowledge or skills to unlicensed personnel.
Advanced Practice Registered Nurses
APRNs, including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives, and Certified Registered Nurse Anesthetists, have the most expansive scope of practice. The Utah 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. They are prohibited from performing procedures or managing conditions outside their scope or certification.
The Utah legislature also allows DOPL, in consultation with the Board, to define some elements of the NPA in more detail, such as obtaining and maintaining nursing licensure in Utah. The NPA also provides guidelines related to on-the-job delegation, professional accountability, and implementation of nursing care.
Supervision and Delegation Rules
Improper delegation or failure to supervise effectively can result in disciplinary action for the supervising nurse. In the case of UAPs, the Utah NPA details their scope of practice, which includes but is not limited to:
- Assistance with patient breathing treatments
- Recording vital signs
- Administering over-the-counter medications
- Skin checks and applying topical ointments
DOPL does not dictate to healthcare facilities how a UAP may or may not perform a listed task, but one who performs a task in accordance with this list will not be subject to sanctions as DOPL has jurisdiction over unlicensed practice outside of the parameters of this list, but not over health care facilities and care providers. Accordingly, all decisions to allow or not allow the performance of a listed task by an unlicensed individual belong solely to the health care facility or employer.
The Utah Department of Health and Human Services uses the NPA to explain that nursing delegation to medical students in a school setting is an "assignment by the school nurse," not an administrative task, whereby the nurse facilitates UAP training, evaluation, and ongoing supervision of outcomes, but the nursing process "can never be delegated."
Outside of the school setting, nurses, particularly RNs and APRNs, are responsible for the supervision and delegation of UAPs and LPNs. Before determining which, if any, nursing tasks may be delegated, the delegator must evaluate the following factors to determine the degree of supervision required for safe care:
- Stability and condition of the patient.
- Training, capability, and willingness of the delegatee.
- Nature of the task being delegated, including the complexity, irreversibility, predictability of outcome, and potential for harm.
- Proximity and availability of other qualified nurses during the task to mitigate immediate patient risk.
For instruction and demonstration of competency, the delegator provides necessary information on how to intervene in any foreseeable risks that may be associated with the task. Delegated tasks may not:
- Requires the specialized knowledge, judgment, or skill of a licensed nurse.
- Involve areas outside of the delegator's responsibility, such as personal knowledge, skills, or ability.
- Be beyond the delegatee's ability or competence.
Delegators must provide recurrent evaluations for the ongoing supervision and monitoring of UAPs, LPNs, and other lower-level personnel. If the delegated task is to be performed more than once, nurses must establish a system for ongoing monitoring of the delegatee.
Continuing Education and Competence
Utah requires nurses to engage in continuing education (CE) to maintain their licenses. This ensures licensees remain current with medical knowledge and practice standards. Moreover, there are stipulations about the amount of required work to maintain credentials. Renewal dates run on a two-year cycle, and all hours of CE must be completed within that timeframe.
LPNs or RNs must complete one of the following during the two-year period:
- Non-licensed practice of at least 400 hours
- Licensed practice of at least 200 hours and 15 CE hours
- At least 30 hours of CE
APRNs must be certified or recertified in a specialty area of practice or complete 400 hours of practice and 30 hours of CE, but only if licensed before July 1, 1992. MACs must complete eight 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 in case of a Board audit. Failure to complete CE requirements can result in license suspension or additional conditions for renewal.
Unprofessional Conduct and Discipline
Among fulfilling licensure requirements, the scope of practice, and CE standards, a significant part of remaining in good standing as a nurse is appropriate 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.
- Drug diversion and misappropriation of medical resources.
- 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.
- Practicing beyond the scope of licensure.
- Engaging in disruptive behavior.
- Errors in distributing medication to patients or failure to keep accurate records.
- Failure to assess a patient accurately or intervene appropriately on their behalf.
- Boundary violations like sexual contact outside the scope of medical practice.
While engaging in sexual contact with a patient or their surrogate is prohibited by the Utah NPA, there is an exception to the rule. The nurse may be absolved of misconduct by showing clear and convincing evidence that the contact did not result in any form of abuse or exploitation of the surrogate or patient, adversely alter or affect the nurse's professional judgment, or the nature of the nurse's relationship with the patient or the surrogate.
In the event that allegations of misconduct or NPA violation arise from recipient complaints or Utah 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
- Practice limitations or restrictions
- Mandatory CE
- License suspension
- License revocation
Most states are part of the Nurse Licensure Compact (NLC), which allows healthcare workers, such as LPNs, RNs, and others, to practice in multiple states without additional or supplementary licensing. While the NLC enables credential reciprocity, any disciplinary action in Utah will affect the status in other NLC-compliant states. Therefore, Utah 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 Utah 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. From defending nurses against NPA violations to keeping nurses abreast of changing CE requirements, we are an ally of healthcare professionals nationwide.
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, understands administrative proceedings used by the DOPL and the Board, and ensures every means of redress.
Don't wait until the complaint or investigation process has begun; 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.
