An Overview of the Kentucky Nursing Laws and the Kentucky Board of Nursing Sharon Eli Mercer, MSN, RN NEA, BC Nursing

1. An Overview of the Kentucky Nursing Laws and the Kentucky Board of Nursing Sharon Eli Mercer, MSN, RN NEA, BC Nursing Practice Consultant Kentucky Board of Nursing

2. Mission Statement The Kentucky Board of Nursing protects public health and welfare by development and enforcement of state laws governing the safe practice of nursing.

3. Board Composition • State government agency • 16 members appointed by the Governor • Members serve four (4) year terms • Ten (10) Registered Nurse Members • One (1) ARNP Member • Three (3) Licensed Practical Nurse Members • Two (2) Citizens-at-Large

4. Standing Committees • Practice Committee • Education Committee • Consumer Protection Committee

5. Standing Committees Practice Committee - considers those matters related to the interpretation of the legal scope of nursing practice as defined in the Kentucky Nursing Laws and KBN administrative regulations. 

6. Standing Committees Education Committee - The Education Committee considers those matters related to mandatory continuing competency and prelicensure nursing education in the Commonwealth.

7. Standing Committees Consumer Protection Committee -considers those matters related to investigation and disciplinary processes and preparation of hearing panel members.

8. Councils and Special Committee • Advanced Registered Nurse Practice Council • Dialysis Technician Council • Controlled Substances Formulary Development Committee • UAP Medication AdministrationTaskforce

9. Kentucky Board of Nursing OPEN MEETINGS All meetings of the Board and its advisory councils or committees are open to the public.

10. Kentucky Board of Nursing Activities • Approve Prelicensure Programs of Nursing • Issue RN and LPN licenses • Issue ARNP registrations • Issue DT and SANE Credentials

11. Kentucky Board of Nursing Activities (Cont’d) • Approve Continuing Education Providers • Renew licenses • Administer special programs as directed by legislature • Investigate Complaints/ Disciplinary Action • Nursing Incentive Scholarship Fund

12. Licensure and Certification • Nursing Licensure is renewed each year • If you hold a Certificate for School Nurse issued by the Education Professional Standards Board, that is issued for a five (5) year period • 16 KAR 2:060 School Nurse, does not require certification to work as a school nurse • KBN does not require certification of school nurses

13. Kentucky Nursing Laws, Nurse Accountability and Responsibility, and Nursing Practice Information

14. Kentucky Revised StatutesChapter 314 The Kentucky Nursing Laws

15. Scope of Practice Definitions •KRS 314.011(6) Registered nursing practice – use of substantial specialized knowledge, judgment and nursing skill -----no prescriptive authority • KRS 314. 011(10) Licensed practical nursing practice – under the direction of a RN, physician or dentist ------not licensed for independent practice

16. Accountability • KRS 314. 021(2) Individually responsible and accountable • Based on educational preparation and experience in nursing • Practice with reasonable skill and safety

17. CompetencyNurse is accountable for being educationally prepared and clinically competent in any act performed

18. Competency Defined Nurse is knowledgeable and skillful in the use of critical thinking, effective communication, nursing interventions and caring behaviors consistent with the nurse's practice role [KRS 314.011(15)]

19. KRS 314.011(6)(d) • Gives the Registered Nurse the authority to delegate: (d) The supervision, teaching of, and delegation to other personnel in the performance of activities relating to nursing care

20. KRS 314.011(17)DISPENSE • To receive and distribute noncontrolled legend drug samples from pharmaceutical manufacturers to patients at no charge to the patient or any other party • To distribute noncontrolled legend drugs from a local, district and independent health department subject to the direction of the appropriate governing board of the individual health depart.

21. KRS 314.011(6)(c)Components of Medication Administration • Preparing and giving medications in the prescribed dosage, route and frequency, including dispensing medications only as defined in subsection (17)(b) of this section • Observing, recording, and reporting desired effects, untoward reactions and side effects of drug therapy

22. KRS 314.011(6)(c) • Intervening when emergency care is required as a result of drug therapy • Recognizing accepted prescribing limits and reporting deviations to the prescribing individual

23. KRS 314.011(6)(c) • Recognizing drug incompatibilities and reporting interactions or potential interactions to the prescribing individual • Instructing an individual regarding medications

24. KRS 156.502 Health services in school setting—Designated provider—Liability protection • Defines Health Services • Provision of direct health care, including the administration of medication; the operation, maintenance, or health care through the use of medical equipment; or the administration of clinical procedures • Does not include first aid or emergency procedures

25. Health Services • Provided within the health care professional’s current scope of practice • May be provided by: - Physician, advanced registered nurse practitioner, registered nurse, or licensed practical nurse

26. Health Services Services may be provided by a school employee who is delegated responsibility to perform the health services by a physician, advanced registered nurse practitioner, or registered nurse

27. School Employee Providing Health Services • Trained by the delegating physician or delegating nurse for the specific health services, if that health service is one that could be delegated by the physician or nurse within his or her scope of practice

28. School Employee Providing Health Services • Has been approved in writing by the delegating physician or delegating nurse • Approval states: - Employee consents to perform the health service - Possesses sufficient training and skills - Has demonstrated competency to safely and effectively perform the health services - Delegation is valid for the current school year

29. School Health Services • If no school employee is trained and delegated responsibility, school district makes arrangements for provision of health services to the student in order to prevent loss of health services affecting student’s attendance or program participation.

30. 201 KAR 20:400Delegation of Nursing Tasks

31. 201 KAR 20:400 Delegation of Nursing Tasks Definitions: • SUPERVISION = guidance; periodic observation; evaluation; and validation • UNLICENSED PERSON is not the patient/client or his delegatee

32. Delegation of Nursing Tasks (continued) Nurse Responsibility: • Determine need of client prior to delegating • Retain accountability for nursing assessment, planning, evaluation, and assuring documentation • Assure delegatee is trained and competent to do task • Inappropriate delegation = violation of law/disciplinary action

33. Delegation of Nursing Tasks(continued) Delegation Criteria: • Task must be reasonable and prudent to delegate • Task can be done/and is done competently and safely without compromising patient welfare • Task does not require independent nursing judgment or intervention

34. Delegation of Nursing Tasks(continued) Degree of Supervision is based on: • Patient stability and acuity • Delegatee’s training and competency • Complexity of task • Proximity and availability of supervisor to delegatee

35. Advisory Opinion Statements • Issued by the Board to provide guidelines on safe patient care • Written to reflect the statutes and administrative regulations • Does not have force and effect of law

36. Scope of Practice Decision Tree • KY Nursing Laws? • Advanced education required? • Scope of practice support? • Personal knowledge and skill? • Reasonable/Prudent? • Accountability assumed?

37. AOS # 15 on Delegation Provides guidelines to nurses on the appropriate delegation of tasks to UAPs, and gives specific examples

38. Decision Tree for Delegation to UAPs • Describes steps in deciding to delegate a nursing act • The UAP is responsible for accepting only those delegated acts for which they are competent to perform. Only the implementation of a task/activity may be delegated. Assessment, planning, evaluation, and nursing judgment cannot be delegated.

39. AOS # 30 School Nursing Practice Addressed Nursing Practice in the School Setting for: • Advanced Registered Nursing Practice • Registered Nursing Practice • Licensed Practical Nursing Practice

40. Advanced Registered Nursing Practice • ARNP or CNS- within scope of practice to provide primary healthcare services to students in accordance with 201 KAR 20:057 • The ARNP may also perform acts within the scope of registered nursing practice.

41. Registered Nursing Practice • Education, experience and current clinical competence A. Utilizes substantial, specialized nursing knowledge, judgment and skill in providing primary healthcare to students…

42. Registered Nursing Practice, (cont.) • Initial assessment, management of minor illnesses and/or referral to other health professionals, monitoring of chronic diseases, health supervision, counseling, disease prevention, promotion of healthy life-styles and coordination of services when specialized care is required. (National Association of School Nurses, Resolution-Primary Health Care, June 1981)

43. Registered Nursing Practice (cont.) B. Serve as Health advocate of students and a consultant to educational staff. C. Serve in family resource and youth services centers. D. Provide health teaching with a focus on disease prevention, health promotion, and health restoration. E. Monitor the quality of the healthcare services provided to students.

44. Registered Nursing Practice (cont.) F. Provide direct clinical services for students with special needs. Teach and verify competency, supervise and delegate the selected acts to unlicensed school personnel inaccordance with 201 KAR 20:400.

45. Registered Nursing Practice (cont) G. Participate in the development of policies and procedures related to nursing practice in school settings H. Delegate select health services to a school employee in accordance with KRS 156.502 and 201 KAR 20:400

46. Licensed Practical Nursing Practice • Practice under the direction of a registered nurse, physician or dentist • Not licensed for independent nursing practice • Performs acts within scope of practice as defined in KRS 314.011(10) • Under KRS 156.502(2) the LPN does not delegate health services to school employees • Practice components for LPN in AOS #27-”Components of Licensed Practical Nursing Practice”

47. Practice Opinions and Current Issues • KBN has issued multiple practice related opinions in response to individual questions. See Summary Reports on web site for the past 6 years. www.kbn.ky.gov

48. KBN CONTACT Sharon Eli Mercer, MSN, RN NEA, BC Nursing Practice Consultant Phone 502 429-3307 Fax 502-696-3937 SharonE.Mercer@ky.gov www.kbn.ky.gov