Standards of Nursing Practice For 2009 ALAA Fall Conference

2. Standards of Nursing Practice For2009 ALAA Fall Conference Presented by Cathy Boden, MSN, RN Nurse Consultant for Legal Division Alabama Board of Nursing September 2009

3. Objectives • Identify factors that determine what a nurse can do once they are hired by an employer. • Discuss standards of nursing practice. • Recognize and report substandard nursing practice.

10. Who is the Alabama Board of Nursing? What is the mission of the ABN?

11. Alabama Board of Nursing • Legislature passed first law establishing Board in 1915 • Initial approach was to standardize nursing education requirements • Voluntary registration • Practical nurses first came into being after World War II

12. Composition of the ABN • Established by The Alabama Nurse Practice Act • 13 members - as of July 2009, one RN nursing education position was vacant • Appointed by the Governor for 4 year terms – max of 2 consecutive terms or 8 consecutive years

13. Composition of the ABN Cont’d • 8 RN Positions • 3 (Three) must be from practice or administration • 3 (Three) must be from nursing education • 2 (Two) must be advance practice nurses • 4 LPN Positions • 2 Nominated by Licensed Practical Nurses Association of Alabama (LPNAA) • 2 Nominated by Alabama Federation of Licensed Practical Nurses (AFLPN) • 1 Consumer • No financial gain from health care and not previously a health care professional

14. Nurse Consultants of ABN under Executive Officer, Genell Lee Legal Division VDAP Education Advanced Practice Continuing Education/Practice

15. Mission of the ABN • The mission of the Alabama Board of Nursing is • public protection • through the regulation of • nursing education • nursing practice

16. Who does the ABN work/advocate for?

17. Board Information www.abn.state.al.us

18. ABN Attorney & Investigators • ABN Attorney is a Deputy Attorney General • Investigators have law enforcement background, no power to arrest

19. Patients? Nurses? Who does the ABN work/advocate for?

20. Professional Associations • American Nurses Association (ANA) • – ASNA (Alabama State Nurses Association) • Specialty Associations (Incomplete list) • AACN • AORN (Association of Peri-Operative Nurses) • ENS (Emergency Nurses Association) • Infusion Nurses Society • American Gastroenterology Association • WOCN (Wound Ostomy & Continence Nurses Society) • Nephrology Nursing Association

21. Patients? Nurses? Who do the Associations work/advocate for?

22. Is it true that “A nurse is a nurse is a nurse…..”?

23. What determines differences? Is it the nurse’s education program? Is it what the nurse wears to work? Is it the facility where the nurse works? Is it the license the nurse holds?

24. Differences determined by…. • Educational preparation • Licensure • Roles & Scope of Practice • Nursing Experiences • Competency

25. LPN 1 Year RN ADN = 2 years BSN = 4 years Differences in Basic Educational Preparation Begin with type of Nursing Education Program

26. Additional Factors of Basic Nursing Education Including but not limited to • Clinical experiences available in school • Expertise of Instructors • Student motivation/reason for entering program

27. Basic Education for Nursing Programs Practices/Procedures/Treatments taught in the nurse’s basic educational program (RN & LPN). • Vital Signs* • Make a Bed • Bed Baths • Comfort Care • Administer Medications • -Oral -Topical - Inhalation • Perform Injections • - IM - SQ - Intradermal- Z track

28. Basic Nursing Education RN & LPNCont’d • Insert Foley Catheters • Females • Maybe Males • Change basic dressings • Basic Infection Control • Sterile gloving • Sterile field: create & maintain • Biohazard waste disposal

29. Additional Basic Nursing Education for the RN (incomplete listing) • Cardiovascular Alterations - Hemodynamic Monitoring • Respiratory Alterations • Endotracheal Tube Management • Tracheostomy Management • Ventilator Monitoring • Neurological Alterations • Glascow Coma Scale • Intracranial Pressure Monitoring • Management & Prioritizing • Nursing Leadership & Management

30. Specifics of LPN Education • Until 2005/2006, Basic IV Therapy was not in curriculum • Until August 2008, Body Structure & Function is in the curriculum instead of Anatomy & Physiology with corresponding lab • Curriculum does not include • Microbiology • Chemistry • Clinical many times does not include • Psychiatric Nursing

31. ADMISSION TO PRACTICE Licensure

32. Licensure • Represents • Specialized knowledge • Independent judgment • Fitness and Capacity to Practice • Required to practice nursing in the state of Alabama

33. Licensure • Alabama is NOT part of the licensure compact at this time.

34. Temporary Permit • New graduates may request a nonrenewable temporary permit to practice nursing that is valid until • The applicant fails the licensing examination. • The expiration date on the permit is reached. • A license is issued. • The applicant is denied licensure.

35. Temporary Permit Administrative Code § 610-X-4-.07 • Signatures: • Practical Nurse (PN) Program = NG-PNP • RN Program = NG-RNP • Restrictions: The Nursing Graduate • Must function under DIRECT Supervision of a currently licensed Registered Nurse • Shall not assume nor be assigned charge responsibilities

36. Licensure Renewal • LPN’s - odd numbered years • December 31, 2009 • RN’s - even numbered years • December 31, 2010 • Continuing education is required for renewal

37. License Renewal • “The licensed nurse shall have the active license renewal card available for employer inspection by January 1 of the new license period.” Administrative Code § 610-X-4-.08(4)

38. License Lookup • This application is for LICENSE LOOKUP. • Updated daily by 8:00 am. • Search by entering the license number or the entire last and first name or by portions of last and first name.

39. License Lookup

40. GROUP ONLINE LICENSE VERIFICATION BY SUBSCRIPTION • You can subscribe annually and once you input the license numbers of the nurses employed in your facility/agency, you will receive electronic notification at any time the license status of your nursing employees changes, including renewal.

41. Why should I subscribe? • Provides license verification information without phone calls or written requests. • PUSH technology will notify you within 24-48 hours if the license status changes. • Reduces the risk of individuals working without proper authorization from the Board of Nursing. • Provides information to employer about the individual nurse.

42. LEVEL ONE: Subscription fee of $100 annually • PUSH technology • Name of licensee • License Number • License status (including temporary permits) • Expiration date of license • Original date of licensure • LEVEL TWO: Subscription fee of $750 annually • LEVEL THREE: Subscription fee of $1500 annually

43. Legal Foundation of Nursing Nurse Practice Act And Administrative Code

44. Nurse Practice Act And ABN Administrative Code

45. Legal Foundation of Nursing Practice • Nurse Practice Act: statutes passed by legislature; broad language; provides authority for Board to pass regulations • ABN Administrative Code: regulations passed by Board to clarify, amplify, and explain the statutes • Proposed rules posted on Board’s web site • Requires 35 day public notice and comment period • If Board approves, rules become effective in another 35 days after filing

46. Definition of RN in Statute • PRACTICE OF PROFESSIONAL NURSING. The performance, for compensation, of any act in the care and counseling of persons or in the promotion and maintenance of health and prevention of illness and injury based upon the nursing process which includes systematic data gathering, assessment, appropriate nursing judgment and evaluation of human responses to actual or potential health problems through such services as case finding, health teaching, health counseling; provision of care supportive to or restorative of life and well-being; and executing medical regimens including administering medications and treatments prescribed by a licensed or otherwise legally authorized physician or dentist. A nursing regimen shall be consistent with and shall not vary any existing medical regimen. Additional acts requiring appropriate education and training designed to maintain access to a level of health care for the consumer may be performed under emergency or other conditions which are recognized by the nursing and medical professions as proper to be performed by a registered nurse. • Code of Ala., 1975, §34-21-1(3)(a)

47. Practice of Professional Nursing(Registered Nurse) • The performance, for compensation, of any act in the • Care and counseling • Promotion and maintenance of health • Prevention of illness and injury

48. Practice of Professional Nursing Cont’d • Based upon the nursing process including • Systematic data gathering • Assessment • Appropriate nursing judgment and evaluation of human response • Case finding • Health Teaching • Health counseling

49. Practice of Professional Nursing Cont’d • Provision of care supportive to or restorative of life and well-being • Executing medical regimens including administering medications and treatments prescribed by a licensed…..physician or dentist

50. Definition of LPN in Statute • PRACTICE OF PRACTICAL NURSING. The performance, for compensation, of acts designed to promote and maintain health, prevent illness and injury and provide care utilizing standardized procedures and the nursing process, including administering medications and treatments, under the direction of a licensed professional nurse or a licensed or otherwise legally authorized physician or dentist. Such practice requires basic knowledge of the biological, physical and behavioral sciences and of nursing skills but does not require the substantial specialized skill, independent judgment and knowledge required in the practice of professional nursing. Additional acts requiring appropriate education and training may be performed under emergency or other conditions which are recognized by the nursing and medical professions as proper to be performed by a licensed practical nurse. • Code of Al., 1975, § 34-21-1(3)(b)