NEVADA NURSE PRACTICE ACT

1. NEVADA NURSE PRACTICE ACT MURPHY JONES, LLP Attorneys & Counselors at Law

2. The Nurse Practice Act • The Nursing Practice Act (NPA) is the body of law that mandates the Board to set out the scope of practice and responsibilities for Nurses. • Nevada Revised Statutes (NRS) - Chapter 632 “The Nurse Practice Act” - laws governing nursing • Nevada Administrative Code (NAC) - Chapter 632 Rules regarding the implementation of the N.P.A. Nursing Board website: www.nursingboard.state.nv.us

3. Nevada State Board of Nursing • The Mission of the Board is to protect the public’s health, safety and welfare through effective regulation of nursing. • Primary Goal: Protect the public from unsafe practice by nurses. • Jurisdiction: RNs, LPNs, CNAs, APNs, and CRNAs. • No authority over facilities where nurses practice • Duties: • Licensing of nurses • Regulation of nursing practice • Discipline of nurses • Board Members: Appointed by the Governor, 4 year term. • 7 Members: 4 RNs, 1 LPN, 1 CAN, and 1 Consumer member.

4. License Statistics Licenses or certificates issued in FY 2014 RNLPNCNA Examination 1,067 127 1,082 Endorsement 2,959 302 443 Total Active Licenses & Certificate Holders 2014 42,958 2010 38,424

5. Board Functions ADMINISTRATION • Establish minimum practice standards • Develop and adopt regulations • Appoint advisory committees • Publish and provide education on the NPA • Collaborate with consumers and organizations • Provide education to increase public awareness of the Board's role and purpose • Appoint an executive director (RN) responsible for Board staff

6. Board Functions (continued) LICENSURE, CERTIFICATION, EDUCATION • Approve schools of nursing and nursing assistant training programs • Adopt exams for licensing/certification • Issue certificates to nursing assistants • License registered and practical nurses • Certify advanced practitioners of nursing, certified registered nurse anesthetists, and emergency medical service/registered nurses • Approve education/training programs for ongoing competency

7. License Application (& renewal) Five Screening Questions Applications with Yes to any of the five screening questions must be reviewed by Board staff. 2014: Total of 665 “yes” responses • Disposition may include full licensure/certification, restricted, limited/conditional, or denial of licensure. • If the Application is denied, the action will be reported to national disciplinary databanks.

8. Screening Question 1 Has your occupational or professional license or privilege to practice, registration, or certificate of any level (does not include driver’s license or car registration) ever been denied? Ever been disciplined? Ever been the subject of a non-disciplinary probation or monitoring program? Are you the subject of a current investigation or inquiry in any state or jurisdiction? Are you the subject of a pending hearing, settlement or action in any state or jurisdiction? Second highest “yes” response to screening questions. • 132 initial applications • 25 renewal applications NSBN Annual Report 2014

9. Screening Question 2 Have you ever had a criminal conviction, including a misdemeanor or felony, or had a civil judgment rendered against you? Most common “YES” answer to 5 screening questions • 434 on initial applications 42 on renewal applications NSBN Annual Report 2014

10. Criminal Convictions - Licensure All applicants for licensure must disclose any criminal convictions: If a conviction exists, the applicant must attach: a. A letter of explanation including the date of offense, circumstances of the arrest, actual conviction, sentence; b. Copies of court documents identifying actual conviction and sentence and current status of sentence; c. A letter from Parole/Probation Officer regarding completion of sentence, if applicable; and d. A letter of reference from the current/last employer.

11. Criminal Convictions (cont.) All applicants must submit fingerprints for a criminal check. If you fail to disclose a criminal conviction and the Board finds out, your application will be denied as fraudulent. Failure to provide the required documents - the Board will not consider the application.

12. Criminal convictions (cont.) POINTS TO REMEMBER: Even if you have been told a conviction has been expunged, sealed, dismissed,
dropped, closed, etc., it may show up on your fingerprint report. You could have been convicted even if you did not spend any time in jail. Criminal convictions include misdemeanors and felonies.

13. Criminal Convictions (cont.) Board staff may clear your application and may grant you a license or certificate, if the conviction is: A minor traffic-related matter or criminal citation. A juvenile offense(s) that occurred with seven years before application. Three minor events that occurred between seven and ten years before application. Multiple minor events that occurred more than ten years before application. A Minor event is defined as any conviction that is not a felony or one of the eight convictions listed below.

14. Criminal Convictions Board staff will bring your application before the Board if you have: • More than one criminal conviction within the last seven years; • A felony conviction You have the right to appear before the Board to present information on your rehabilitation and reasons you believe the Board should accept your application. - The Board may deny your application, which is reported as a disciplinary action. - The Board may accept your application, granting you a license or certificate, possibly with restrictions.

15. Criminal Convictions (cont.) Board will deny any application for convictions of: 1.  Murder, voluntary manslaughter or mayhem; 2.  Assault with intent to kill or commit sexual assault or mayhem; 3.  Sexual assault, lewdness, indecent exposure or any other sexually related crime (including prostitution); 4.  Abuse or neglect of a child or contributory delinquency; 5.  Possession, distribution or use of any controlled substance or any dangerous drug within seven years; 6.  Abuse, neglect, and exploitation of an older person; 7.  Any offense involving fraud, theft, robbery, fraudulent conversion or misappropriation of property, within the preceding seven years; 8.  Any felony involving the use of a firearm or other deadly weapon, within the preceding seven years.

16. Screening Question 3 Do you currently use chemical substances in any way which impairs or limits your ability to practice the full scope of nursing? Least common “yes” response to screening questions. • 1 initial applications • 2 renewal applications NSBN Annual Report 2014

17. Screening Question 4 Are you currently in recovery for chemical dependency, chemical abuse or addiction? Third most common “yes” response to screening questions. • 22 initial applications • 7 renewal applications NSBN Annual Report 2014

18. Screening Question 5 Do you currently have a medical or psychiatric/mental health condition which in any way impairs or limits your ability to practice the full scope of nursing? Second least common “yes” response to screening questions. • 3 Initial applications • 5 renewal applications NSBN Annual Report 2014

19. Board Functions (cont.) DISCIPLINE AND INVESTIGATIONS • Investigate complaints against nurses and nursing assistants • Conduct disciplinary proceedings • Administer remediation and rehabilitation programs • Monitor nurses and nursing assistants who are on disciplinary probation • Administer alternative program for nurses recovering from chemical dependency.

20. RN/LPN Investigation Statistics Most common causes for investigations in FY 2014 TypeNumber% of Total Yes; screening question 509 37.3 Yes; screening Q (renewal) 73 5.4 Fraudulent application 155 11.4 CE audit 117 8.6 Violation of Board order 54 4.0 Customary standards 81 5.9 Abuse/cause harm 35 2.6 Drug diversion 36 2.6

21. RN/LPN Complaints Opened Five year comparison of Complaints opened: 2014: 1,363 = 4% of total RN/LPN population of 33,414 2013: 1,274 2012: 1,187 2011: 1,108 2010: 975 NSBN Annual Report 2014

22. Nursing Board Committees Five (5) Advisory Committees: • Advanced Practice Advisory Committee • Certified Nursing Assistant Advisory committee • Disability Advisory Committee • Education Advisory committee • Nursing Practice Advisory Committee

23. Scope of Practice - RN Roles & Duties specified in NAC 632.214 - 632.224 • Assessment • Identification of Health Care Problems • Establishing Goals • Planning a Strategy of Care • Implementing Strategy of Care • Delegation & Supervision of Nursing Care • Maintaining a Safe Environmnet & Effective Care • Evaluating Reponses to Interventions • Collaborating with Other Health Professionals

24. Scope of Practice - RN ASSESSMENT • Independent, dependent, interdependent functions (RN, MD, APN, PA) • Assess & Evaluate health status • Collect objective & subjective data • Analyze, report & record data • Validate, refine & modify data

25. Scope of Practice (cont.) IDENTIFICATION OF HEALTH CARE PROBLEM Utilize all data to identify and document health care problems

26. Scope of Practice (cont.) ESTABLISH GOALS Collaborate with patient, family & health team to: Identify present & predicted needs Establish short & long term goals Set realistic & measurable goals

27. Scope of Practice PLANNING A STRATEGY OF CARE Develop a written care plan to include: - Cultural, ethnic, spiritual aspects re: treatment - Measures to support and maintain hygiene, comfort and safe environment - Educational & counseling needs to promote, maintain & restore health - Community resources for continued care - Prioritize patient care needs - Review & revise care plan as necessary

28. Scope of Practice (cont.) IMPLEMENTING STRATEGY OF CARE • Initiates & assists w/ delegating & assigning care • Verifies medical orders for accuracy, proper authorization, & documented contraindications • Administers prescribed medications & IV therapy • Provides education & counseling • Documents interventions & responses • Communicates interventions & responses • Makes judgments, decisions & modifies care

29. Medication of Patients A registered nurse shall: • Verify the order to ensure it is appropriate/authorized; • Understand the purpose and effect of medications; • Take orders only from a licensed physician, dentist, podiatric physician or advanced practitioner of nursing. A registered nurse may refuse an order if he takes appropriate action to ensure the safety of a patient. NAC 632.220

30. Scope of Practice (cont.) DELEGATION & SUPERVISION OF CARE • A RN may delegate nursing care and supervise other personnel in the provision of care if those persons are qualified to provide that care. • A RN shall perform or supervise any act necessary to ensure the quality & sufficiency of the nursing care • Before delegating the care to another nurse, consider: • Amount of direction required by the nurse • Complexity of the nursing care needed • Education and competency of the nurse • Established policies & procedures • RN is responsible for the acts delegated or assigned NAC 632.222

31. Scope of Practice (cont.) MAINTAINS SAFE & EFFECTIVE CARE • Maintains safe environment • Institutes standard procedures to stabilize patient’s condition or to prevent serious complications • Acts as a patient advocate

32. Refusing an Unsafe Assignment “Accepting an assignment that the nurse knows she/he is not qualified for and/or accepting an assignment that places a patient in jeopardy are violations of the Nurse Practice Act and may result in disciplinary action. The Board has never disciplined a nurse for properly refusing an unsafe assignment. NSBN “Refusing an unsafe assignment under the Nurse Practice Act.”

33. Patient Abandonment An act of patient abandonment occurs if: • A licensee has been assigned and accepted a duty of care to a patient; • The licensee departed from the site of the assignment without ensuring that the patient was adequately cared for; and • As a result of the departure, the patient was in potential harm or actually harmed. NAC 632.895(6)

34. Scope of Practice (cont.) EVALUATING RESPONSE TO INTERVENTIONS • Determine data needed to evaluate outcome of care • Document & communicate evaluation data • Evaluate responses to nursing interventions • Use evaluation data to reassess patient status, modify problems, and revise care plans

35. Acts NOT w/in Scope of Practice RNs and LPNs MAY NOT: - Perform intrauterine insemination (12/92) - Administer epidural anesthetics (6/90) - Accept employment as a nursing assistant, unless they hold a CNA certificate; activity must be limited to CNA scope of practice. (8/90) - Remove medications in the event of death of a home care client. (12/87) - Perform apnea testing to confirm brain death. (6/90) - Advance a Swan-Ganz catheter. (12/88)

36. Scope of Practice - Decision Tree • Is the act/duty within the scope of practice? • Do you have the knowledge to perform the act safely and effectively? • Do you possess clinical skills necessary to perform the act safely? • Is the act within the standard of care? • Does the facility have a policy/procedure for this activity? • Are you prepared to accept responsibility for your actions?

37. CONCLUSION PROTECT YOUR LICENSE • Know your Nurse Practice Act & Regulations • Always act within your scope of practice • Keep Current on Board Communications • Comply with CEU requirements • Notify the Board of any changes in name or address When in doubt either: - Consult an Attorney who has experience in Board-related matters - Contact the Nursing Board