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Legal and Ethical Issues in Nursing 5th Edition Guido Wacker Ginny Instructors Manual

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Legal and Ethical Issues in Nursing 5th Edition Guido Wacker Ginny Instructors Manual

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Legal and Ethical Issues in Nursing 5th Edition Guido Wacker Ginny Instructors Manual

  • ASIN:B00BR5MVZE

 

 

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PART IV: Impact of the Law on the Professional Practice of Nursing

 

Chapter 11: Nurse Practice Acts, Licensure, and the Scope of Practice

……………………………………………………………………………………………

OBJECTIVES

11.1 Define licensure, including mandatory, permissive, and institutional licensure.

 

11.2 Describe the process of how state nursing acts define professional practice.

 

11.3 Describe entry into practice in relationship to state nurse practice acts and means of granting licensure.

 

11.4 Describe disciplinary actions for nursing misconduct and diversion programs.

 

11.5 Describe medical practice acts and their importance to the discipline of nursing.

 

11.6 Analyze scope of practice issues.

 

11.7 Discuss updating nurse practice acts.

 

11.8 Analyze the impact of continuing education on nursing practice.

 

11.9 Discuss reporting professional violations of the nurse practice act.

 

11.10 Discuss the National Practitioner Data Bank.

 

11.11 Analyze certification.

 

11.12 Describe the legal ramifications of complementary and alternative medicine, including the medical use of cannabis.

 

11.13 Discuss the status of multistate licensure and mutual recognition compacts today.

 

11.14 Analyze some of the ethical issues surrounding licensure, certification, and scope of practice.

 

………………………………………………………………………………………………

OBJECTIVE 1

Define licensure, including mandatory, permissive, and institutional licensure.

Concepts for Lecture

  1. Credentials are proof of qualifications, stating that an individual or organization has met specific standards. Two types of credentials used in health care that affect nursing are:
  • licensure
  • certification

 

  1. Professional licensure is the legal process by which an authorized authority grants permission to a qualified individual or entity to perform designated skills and services in a jurisdiction in which such practice would be illegal without a license. For nurses the authorized authority is the state board of nursing or the state board of nursing examiners. The qualified individual, a graduate nurse who has successfully completed all requirements, is the candidate for licensure.

 

  1. Licensure is enacted through state legislative action by governmental agencies and enforced by the police power of the state. Part of the statutory law in all jurisdictions of the U.S. is the state nurse practice act.

 

  1. State boards of nursing. Means of ensuring enforcement of nurse practice acts is through the state board of nursing or other state board of nurse examiners. A board of nursing has no greater authority that that which the statute, enacted by the legislature, grants to it.
  1. State boards of nursing are mandated in the state nurse practice acts; the specific act sets the number of members of the board (typically 7–17), qualifications, and terms of appointment.
  2. Generally boards of nursing:
    • Govern their individual operation and administration.
    • Approve or deny approvals to schools of nursing.
    • Examine and license applicants.
    • Review licenses, grant temporary licenses, and provide for inactive status for those already licensed.
    • Regulate specialty practice.
    • Discipline those who violate provisions of the licensure law.
  3. Most state boards of nursing have published standards of professional conduct and guidelines for unprofessional conduct, with enforcement assured by the board’s ability to revoke, stipulate, or suspend a previously granted license or to deny licensure.
  4. The board’s authority arises from various sources of the law:
    • legislative
    • quasi-judicial
    • administrative
  5. State board of nursing may have as its concern only the professional practice of nursing or professional and practical licensed nurses. Some states have separate boards for professional and practical licensure and some have joint boards.
  1. Mandatory licensure requires that all persons who are compensated as a member of a licensed profession obtain licensure prior to practicing actions of the profession. It regulates the practice of the profession and requires compliance with the statute if an individual engages in activities defined within the scope of the profession. Both the title of registered nurse and the professional actions are protected. All states have mandatory licensure for RNs.
  1. There are several exceptions to mandatory licensure, depending on the specific jurisdiction:
    • performance of nursing actions by unlicensed practitioners in emergency conditions
    • practice by nursing students incidental to their current course of study, including students who are licensed and those who are not licensed
    • nursing actions by employees of the federal government, provided the nurse holds a valid and current license in a state or territory
    • practice by graduate nurses for a specific length of time during which licensure is being processed, provided the nurse has been issued a temporary permit to practice nursing within the state
    • nursing care given to patients by qualified nurses during transportation of the patient through a given state
    • unpaid persons caring for family members or friends
    • nurses working for the Red Cross during a disaster
    • caregivers who conduct religious services and rites and who do not purport to be registered nurses

 

  1. Permissive licensure regulates only the use of the title and does not protect nursing actions.  Nurses cannot use the title RN unless duly licensed, but may perform many or all of the same nursing actions.

 

  1. Institutional licensure is the process by which a state government regulates health institutions; it is an alternative to individual licensure. Theoretically it gives nonprofessionals the regulation of a given profession without standard criteria for such regulation. Most government agencies issue licenses to health care facilities granting permission for the facility to operate. The issuing body allows the institution authority to directly hire staff and holds the facility responsible for:
  • maintaining sanitation
  • fire safety
  • staffing
  • equipment

 

  1. Crucial differences between institutional and individual licensure are more philosophical than practical.
  • Individual licenses reinforce the responsibility of the professional to the individual client rather than the employer.
  • In a climate where quality is sacrificed to lower costs, there is a strong argument against institutional licensure, because a nurse’s employer is also her or his regulator. Advocates, however, argue that it allows nurses more flexibility and responsiveness to changing needs, as well as being more cost-effective.

 

PowerPoint Lecture Slides

11-1-1  Credentials: proof of qualifications, stating that an individual/organization has met specific standards. Two types of credentials that affect nursing:

  • licensure
  • certification

 

11-1-2  Professional licensure: the legal process by which an authorized authority grants permission to a qualified individual or entity to perform designated skills and services in a jurisdiction in which such practice would be illegal without a license.

 

11-1-3  Licensure: enacted through state legislative action by governmental agencies and enforced by the police power of the state.

 

11-1-4  State boards of nursing: means of ensuring enforcement of nurse practice acts through the state board of nursing or other state board of nurse examiners. This board has no greater authority than that which the statute, enacted by the legislature, grants to it.

  • Generally boards of nursing:
  • Govern their individual operation and administration.
  • Approve or deny approvals to schools of nursing.
  • Examine and license applicants.
  • Review licenses, grant temporary licenses, and provide for inactive status for those already licensed.
  • Regulate specialty practice.
  • Discipline those who violate provisions of the licensure law.

 

  • The board’s authority arises from various sources of the law:
  • legislative
  • quasi-judicial
  • administrative

 

11-1-5  Mandatory Licensure requires that all persons who are compensated as a member of a licensed profession obtain licensure prior to practicing actions of the profession. All states have mandatory licensure for RNs. There are exceptions to mandatory licensure.

 

11-1-6  Permissive licensure regulates only the use of the title and does not protect nursing actions.

 

11-1-7  Institutional licensure is the process by which a state government regulates health institutions; it is an alternative to individual licensure.

11-1-8  Crucial differences between institutional and individual licensure are more philosophical than practical.

  • Individual licenses reinforce the responsibility of the professional to the individual client rather than the employer.
  • Institutional licensure may allow nurses more flexibility and responsiveness to changing needs, as well as be more cost-effective.

 

………………………………………………………………………………………………

OBJECTIVE 2

Describe the process of how state nursing acts define  professional  practice.

 

Concepts for Lecture

  1. Nurse practice acts, designed to protect the public at large, define the practice of nursing, give guidance within the scope of practice issues, and set standards for the nursing profession.

 

  1. The practice act affects all facets of nursing practice. The nurse practice act is the law, and state boards cannot grant exemptions or waive its provisions.

 

  1. By 1923 every state had some type of nurse registration act. By the 1950s all states had mandatory nurse practice acts that established two types of nursing practice: licensed RNs and LPNs/LVNs.

 

  1. In 1955 the American Nurses Association (ANA) approved a model definition for nursing practice and has continued to broaden the definition. The latest model nurse practice act incorporates the advanced nurse practitioner as well as the registered nurse.

 

  1. All nurse practice acts vary and are worded in general terms and give guidance as to acceptable actions. Nurse practice acts are not checklists.

 

  1. Nurses must incorporate the nurse practice act with their educational background, previous work experience, institutional policies, and technological advancements.

 

PowerPoint Lecture Slides

11-2-1  Nurse practice acts: protect the public at large, define the practice of , give guidance for, and set standards for the nursing profession.

 

11-2-2  The practice act affects all facets of nursing practice.

 

11-2-3  All states have mandatory nurse practice acts.

 

11-2-4  The current American Nurses Association (ANA)  model nurse practice act incorporates the advanced nurse practitioner as well as the registered nurse.

11-2-5  All nurse practice acts vary and are worded in general terms, they are not checklists.

 

11-2-6  Nurses must incorporate the nurse practice act with their educational background, previous work experience, institutional policies, and technological advancements.

 

………………………………………………………………………………………………

OBJECTIVE 3

Describe entry into practice in relationship to state nurse practice acts and means of granting licensure.

 

Concepts for Lecture

  1. Three approaches to statutory definitions of professional nursing:
  • Traditional: based on ANA’s original model definition. Does not include diagnosis, treatment, or prescription.
  • Transitional: allows some expanded roles beyond those described in the nurse practice act through use of standing orders and supervision by physician.
  • Administrative: uses a broader definition of nursing and allows additional acts as may be authorized by appropriate state agencies.

 

  1. Advanced nurse practitioners and expanded nursing roles are incorporated, relying on the authority granted to the state board of nursing to promulgate rules for such advanced roles. This allows physicians and nurses to diagnose and treat patients within the respective realms of their disciplines.

 

  1. Requirements for licensure center on personal characteristics and educational requirements to ensure candidate is minimally competent to practice professional nursing. Criteria include:
  • academic and clinical performance
  • passing score on licensing examination
  • personal qualities

 

  1. Academic and clinical performance are validated by transcripts from approved schools of nursing. State may use their own criteria or rely on national accreditation agencies, i.e., National League for Nursing Accreditation Commission (NLNAC) and Commission on Collegiate Nursing Education (CCNE).

 

  1. Passing score: All states administer licensing examinations and use a standardized, nationally normed test.

 

  1. Personal qualifications and attributes generally include:
  • citizenship/visa permit
  • physical and mental health fitness
  • minimal age requirements
  • fluency in English
  • moral character references

 

  1. Payment to meet licensure includes:
  • processing and administrative fees for the licensure examination
  • interim work permit fees
  • temporary licensure fees

 

  1. Exemptions: Most states allow exemptions from state licensure in a few circumstances.

 

  1. The grandfather clause describes an exemption for persons who were working within the profession prior to a deadline date. Individuals are granted a privilege of applying for licensure without having to meet all the requirements for licensure or without having to take the licensing examination.

 

  1. In 1964 the ANA proposed entry level for professional nursing be baccalaureate of science in nursing. Associate degree nurses (ADNs) would be technical nurses. Previously licensed RNs could retain their title. The proposal has not gone far; however, research indicates a correlation between nurses’ education level and patient mortality rates. The higher the education level, the lower the mortality rates.

 

  1. Four means of granting licensure across jurisdictions:
  • Reciprocity, an agreement by two states or more granting recognition to licensure by other state boards of nursing. Requirements for both states must be equivalent.
  • Endorsement allows a state to grant licensure to an already licensed nurse from another state if the state’s qualifications and licensure requirements are comparable. The distinction between endorsement and reciprocity is that no prior agreement existed between the two involved states.
  • Licensure by examination is required when the petitioned state does not grant licensure by reciprocity or by endorsement. The individual must meet all state requirements and successfully complete a licensing examination before licensure is granted.
  • Licensure by waiver, similar to licensing by examination. Requirements for licensure that have been previously demonstrated may be waived for candidate.

 

  1. Temporary licenses may be granted to out-of-state nurses while permanent licensure is pending so they may practice for a limited time.

 

  1. Foreign nursing school graduates who want to practice in the U.S. must:
  • Meet requirements of the state/territory in which they reside.
  • Pass licensing examination.
  • Apply for an occupational visa.
  • Successfully complete a Visa Screen to verify proficiency in English.
  • Earn a certificate from the Commission of Graduates of Foreign Nursing Schools or pass the National Council Licensure Examination for Registered Nurses.

 

PowerPoint Lecture Slides

11-3-1  Three approaches to statutory definitions of professional nursing:

  • Traditional
  • Transitional
  • Administrative

 

11-3-2  Advanced nurse practitioners and expanded nursing roles are incorporated, allowing physicians and nurses to diagnose and treat patients within the respective realms of their disciplines.

 

11-3-3  Requirements for licensure criteria include:

  • academic and clinical performance
  • passing score on licensing examination
  • personal qualities

 

11-3-4  Academic and clinical performance are validated by transcripts from approved schools of nursing.

 

11-3-5  Passing score: All states administer licensing examinations and use a standardized, nationally normed test.

 

11-3-6  Personal qualifications and attributes include:

  • citizenship/visa permit
  • physical and mental health fitness
  • minimal age requirements
  • fluency in English
  • moral character references

 

11-3-7  Payment to meet licensure includes:

  • processing and administrative fees for the licensure examination
  • interim work permit fees
  • temporary licensure fees

 

11-3-8  Most states allow exemptions from state licensure in a few circumstances.

 

11-3-9  Grandfather clause describes an exemption for persons who were working within the profession prior to a deadline date.

11-3-10  Research indicates that the higher the education level of a nurse, the lower the patient mortality rates.

 

11-3-11  Four means of granting licensure across jurisdictions:

  • Reciprocity
  • Endorsement
  • Licensure by examination
  • Licensure by waiver

 

11-3-12  Temporary licenses are granted to out-of-state nurses while permanent licensure is pending so they may practice for a limited time.

 

11-3-13  Foreign nursing school graduates who want to practice in the U.S. must:

  • Meet requirements of the state/territory in which they reside.
  • Pass licensing examination.
  • Apply for an occupational visa.
  • Successfully complete a Visa Screen to verify proficiency in English.
  • Earn a certificate from the Commission of Graduates of Foreign Nursing Schools or pass the National Council Licensure Examination for Registered Nurses.

 

………………………………………………………………………………………………

OBJECTIVE 4

Describe disciplinary actions for nursing misconduct and diversion programs.

 

Concept for Lecture

  1. Allowable disciplinary actions include:
  • private reprimand or censure
  • public reprimand or censure
  • probation
  • suspension of licensure
  • refusal to renew licensure
  • revocation of licensure
  • imposition of a fine
  • other discipline, e.g., requiring a specific continuing education course related to discipline

 

  1. Some violations for which disciplinary actions may be instigated include, but are not limited to:
  • conviction of a felony or crime involving turpitude
  • fraud or deceit in obtaining licensure
  • violation of the provisions of the nurse practice act
  • aiding or abetting any unlicensed person with unauthorized practice of nursing
  • revocation, suspension, or denial of licensure to practice nursing in another jurisdication
  • habitual use of, or addiction to alcohol or drugs
  • unprofessional conduct that is likely to deceive, defraud, or injure the public or patients
  • lack of fitness by reason of physical or mental health that could result in injury to the public or individual patients

 

  1. During licensure suspension or probation, the board of nursing has the authority to impose conditions such as:
  • obtaining substance abuse rehabilitation and counseling
  • obtaining special counseling
  • requiring supervision for specific techniques or procedures to validate competency
  • requiring satisfactory completion of education programs

 

  1. Disciplinary actions may arise in several ways:
  • Generally a written complaint is filed with the state board of nursing by an individual, a health care agency, or a professional organization.
  • The complaint triggers action on the part of the board (board may initiate complaint directly).
  • Complaint is screened and investigation initiated, if appropriate. (If drugs are involved the Drug Enforcement Agency may become involved.)
  • Board hearing is scheduled at which nurse is entitled to clear statement of the charges, right to question witnesses, right to an attorney, etc. [see table 11-1]

 

  1. Common due process rights of nurses include:
  • clear statement of the allegations
  • notice of time and place of hearing, disciplinary conference, or other proceeding
  • right to legal counsel or to consult with legal counsel
  • presentation of one’s own witnesses and challenge of state evidence
  • full hearing before an authorized board that functions in a fair manner
  • written record of the hearing transcript
  • judicial review, if requested, of the board’s decision

 

  1. Following announcement of disciplinary action to be taken, a nurse may file a lawsuit to appeal the board’s decision.

 

  1. Among the more common reasons for the state board of nursing to investigate a nurse are:
  • negligent or substandard care provided to a patient
  • sexual relations with a patient
  • abusive behavior, either physical or oral
  • substance abuse and/or diversion of narcotics
  • physical or mental impairment
  • fraud, usually committed in the application process

 

  1. Adequate notice of an alleged misconduct means more than just 10 to 20 days’ notice that a hearing will be held by the state board of nursing.

 

  1. A person licensed as a professional health care provider must report to the board of nursing personal knowledge of any conduct of a licensed professional nurse believed to be grounds for disciplinary knowledge, such as conduct that appears:
  • incompetent
  • unprofessional
  • unethical
  • fraudulent
  • indicative that nurse is mentally or physically unable to engage safely in the nursing profession

 

  1. Penalties for practicing without license may be a fine ($50–$500) or imprisonment (not to exceed 60 days). Civil suits may also be filed against the nonlicensed practitioner. They may be filed prior to, concurrent with, or after criminal charges.

 

  1. Diversion programs are for nurses who are psychologically unable to function or addicted to drugs or alcohol. Instead of disciplining these nurses they are diverted to rehabilitation programs. Diversion programs allow the state board of nursing to protect the public while complying with the Americans with Disabilities Act of 1990.

 

  1. Peer assistance programs are voluntary alternatives to traditional disciplinary actions and entail such groups as Alcoholics Anonymous, Narcotics Anonymous, or counseling session, testing, etc. While in the program nurses must comply with specific guidelines. Nurse can petition for reinstatement of full licensure after 12–24 months and proving compliance and ability to perform in workplace. If nurse fails to comply the board of nurses institutes more traditional disciplinary provisions.

 

PowerPoint Lecture Slides

11-4-1  Allowable disciplinary actions include:

  • private reprimand or censure
  • public reprimand or censure
  • probation
  • suspension of licensure
  • refusal to renew licensure
  • revocation of licensure
  • imposition of a fine
  • other discipline

 

11-4-2  Violations for which disciplinary actions may be instigated include:

  • conviction of a felony or crime involving turpitude
  • fraud or deceit in obtaining licensure
  • violation of the provisions of the nurse practice act
  • aiding or abetting any unlicensed person with unauthorized practice of nursing
  • revocation, suspension, or denial of licensure to practice nursing in another jurisdication
  • habitual use of, or addiction to alcohol or drugs
  • unprofessional conduct that is likely to deceive, defraud, or injure the public or patients
  • lack of fitness by reason of physical or mental health that could result in injury to the public or individual patients

 

11-4-3  During licensure suspension or probation, the board of nursing has the authority to impose conditions such as:

  • obtaining substance abuse rehabilitation and counseling
  • obtaining special counseling
  • requiring supervision for specific techniques or procedures to validate competency
  • requiring satisfactory completion of education programs

 

11-4-4  Disciplinary actions may arise in several ways:

  • A written complaint is filed with the state board of nursing.
  • The complaint triggers action on the part of the board.
  • Complaint is screened and investigation initiated, if appropriate.
  • Board hearing is scheduled at which nurse is entitled to clear statement of the charges, etc.

 

11-4-5  Common due process rights of nurses include:

  • clear statement of the allegations
  • notice of time and place of hearing, disciplinary conference, or other proceeding
  • right to legal counsel or to consult with legal counsel
  • presentation of one’s own witnesses and challenge of state evidence
  • full hearing before an authorized board that functions in a fair manner
  • written record of the hearing transcript
  • judicial review, if requested, of the board’s decision

 

11-4-6  Following announcement of disciplinary action to be taken, a nurse may file a lawsuit to appeal the board’s decision.

11-4-7  State board of nursing investigates a nurse because of:

  • negligent or substandard care provided a patient
  • sexual relations with a patient
  • abusive behavior, either physical or oral
  • substance abuse and/or diversion of narcotics
  • physical or mental impairment
  • fraud, usually committed in the application process

 

11-4-8  Adequate notice of an alleged misconduct means more than just 10 to 20 days’ notice that a hearing will be held by the state board of nursing.

 

11-4-9  Licensed professional health care providers must report any misconduct of a health care colleague to the board of nursing. Misconduct is conduct that appears:

  • incompetent
  • unprofessional
  • unethical
  • fraudulent
  • indicative that nurse is mentally or physically unable to engage safely in the nursing profession

 

11-4-10  Penalties for practicing without license may be a fine or imprisonment.

 

11-4-11  Diversion programs are for nurses who are psychologically unable to function or addicted to drugs or alcohol.

 

11-4-12  Peer assistance programs are voluntary alternatives to traditional disciplinary actions.

 

………………………………………………………………………………………………

OBJECTIVE 5

Describe medical practice acts and their importance to the discipline of nursing.

 

Concepts for Lecture

  1. Medical practice acts are to physicians what nurse practice acts are to nurses—state laws that allow the individual to practice in a given discipline.

 

  1. Most medical practice acts define medicine as acts of:
    • diagnosis
    • prescription
    • treatment
    • surgery

 

  1. The language of medical practice acts is broad, enabling physicians to delegate to qualified and skilled persons the legal ability to perform certain actions and skills. This, along with standing orders and protocols, has increased the functions of nurses while causing an overlap between nurse practice acts and medical practice acts.

 

  1. Not all states recognize standing orders in the same way. Some states allow standing orders to take precedence if patient fits a particular category, other states require patient to be seen by the physician and the standing orders signed by a physician before they are implemented.

 

  1. Incorporating medical practice acts with nurse practice acts is bypassing laws that make some functions common to both professions.

 

  1. Joint statements between disciplines of medicine and nursing are stopgap measures until states are able to develop and implement broader definitions of nursing practice. Thus they serve as the basis for expanded nursing practice.

 

PowerPoint Lecture Slides

11-5-1  Medical practice acts are state laws that allow the individual to practice in a given discipline.

 

11-5-2  Most medical practice acts define medicine as acts of:

  • diagnosis
  • prescription
  • treatment
  • surgery

 

11-5-3  The language of medical practice acts is broad, enabling physicians to delegate to qualified and skilled persons the legal ability to perform certain actions and skills.

 

11-5-4  Some states allow standing orders to take precedence, other states require patient be seen by the physician and standing orders signed by a physician before implementation.

 

11-5-5  Incorporating medical practice acts with nurse practice acts is bypassing laws that make some functions common to both professions.

 

11-5-6  Joint statements are stopgap measures until states are able to develop and implement broader definitions of nursing practice.

 

………………………………………………………………………………………………

 

OBJECTIVE 6

Analyze scope of practice issues.

 

Concepts for Lecture

  1. Scope of practice issues speak to the actions or duties of a given profession. Legally it refers to permissible boundaries of practice for the health professional and the scope of practice by statute, rule, or a combination of statute and rule.

 

  1. Scope of practice usually arises in one of two instances:
    • Some negligent act was associated with the scope of practice issue.
    • The standard of care owed the patient is increased because of the medical or nursing action.

 

  1. Standards of care issues frequently arise with nurses in expanded roles, such as nurse anesthetists and nurse midwives. A medical standard of care is applied by the reasoning that a greater duty is owed the patient because the nurse is performing actions the physician typically performs.

 

  1. Policies and procedures specify the allowable scope of practice within the given setting. They may be more narrow than the scope of practice stated within the nurse practice act, but they may extend the nurse practice act scope of practice. The nurse must choose the nurse practice act over the hospital policy if there is a discrepancy.

 

  1. To be of value to nurses the policies and procedures must be current. They should be developed jointly by medical and nursing committees, updated periodically, and be reflective of community standards, and policies and procedures should be written to allow nurses to meet and exceed the public standard.

 

  1. Institutional policies and procedures mandate that nurses remain current in their practice, either through:
  • continuing education classes
  • in-service classes
  • reading current journal articles and publications
  • knowing institutional policies and procedures

 

  1. Other means of preventing scope of practice differences include:
  • listing accepted procedures in the nurse practice act
  • requesting the attorney general’s opinions for clarification on allowed or prohibited procedures
  • reviewing recent judicial decisions for definition of roles
  • requesting joint statements from professional organizations clarifying roles and practices
  • reviewing rules and regulations of the state board of nursing concerning the permitted scope of practice

 

  1. Scope of practice issues also concern a nurse’s right to refuse patient assignments. The Joint Commission (JC) created a standard to help create policies to address staff who request not to participate in aspects of care that conflict with their cultural values or religious beliefs. The standard requires facilities to:
  • Specify aspects of patient care that might conflict with staff members’ beliefs.
  • Have a written policy on how requests to be excused from care are handled and make that policy available to all staff members for review.
  • Develop a process for deciding whether staff requests not to participate in care are legitimate and should be granted.
  • Ensure the safe delivery of care in instances in which a staff member’s request to be excused is granted.

 

  1. Conscience clauses (state and federal) provide for more specific protection of a nurse’s refusal for patient assignments. The clause protects only nurses who refuse to assist with abortions and sterilizations because of religious or moral beliefs.

 

PowerPoint Lecture Slides

11-6-1  Scope of practice issues speak to the actions or duties of a given profession.

 

11-6-2  Scope of practice arises in one of two instances:

  • Some negligent act was associated with the scope of practice issue.
  • The standard of care owed the patient is increased because of the medical or nursing action.

 

11-6-3  Standards of care issues frequently arise with nurses in expanded roles. The reasoning is that a greater duty is owed the patient because the nurse is performing actions the physician typically performs.

 

11-6-4  Policies and procedures specify the allowable scope of practice within the given setting.

 

11-6-5  To be of value to nurses the policies and procedures must be current.

 

11-6-6  Institutional policies and procedures mandate that nurses remain current in their practice.

 

11-6-7  Means of preventing scope of practice differences include:

  • listing accepted procedures in the nurse practice act
  • requesting the attorney general’s opinions for clarification on allowed or prohibited procedures
  • reviewing recent judicial decisions for definition of roles
  • requesting joint statements from professional organizations clarifying roles and practices
  • reviewing rules and regulations of the state board of nursing concerning the permitted scope of practice

 

11-6-8  Scope of practice issues also concern a nurse’s right to refuse patient assignments if aspects of care conflict with the nurse’s cultural values or religious beliefs.

 

11-6-9  Conscience clauses provide more specific protection of a nurse’s refusal for patient assignments.

 

………………………………………………………………………………………………

OBJECTIVE 7

Discuss updating nurse practice acts.

 

Concepts for Lecture

  1. Because nurse practice acts are legislative enactments, any changes must be channeled through the state legislative body. Ways to update individual nurse practice acts are:
  • simple revision of the original act
  • complete rewriting
  • amendments

 

  1. Redefinitions to a nurse practice act involve a rewriting of the definition of nursing and as such automatically change the force of the entire act.

 

  1. Sunset laws keep nurse practice acts current and call for a review of the act at a fixed time, such as 6-10 years after enactment of the original act. The purpose is to force periodic review by legislative bodies and prevent an act from becoming hopelessly outdated. Most acts are updated during the legislative year preceding application of the sunset law.

 

  1. Action may need to be taken to revise or amend the nurse practice act by the appropriate legislative body by lobbying for changes. Or the state board of nursing may enact new rules and regulations to ensure that the nurse practice act meets the prevailing community standards.

 

  1. Nurses must do more than just know the original nurse practice act. They must remain current on newly adopted rules and regulations of the state board of nursing and efforts of professional organizations.

 

 

PowerPoint Lecture Slides

11-7-1  Nurse practice acts are legislative enactments. Any changes must be channeled through the state legislative body. Updating individual nurse practice acts is done by:

  • simple revision of the original act
  • complete rewriting
  • amendments

 

11-7-2  Redefinitions to a nurse practice act involve a rewriting of the definition of nursing and as such automatically change the force of the entire act.

 

11-7-3  Sunset laws keep nurse practice acts current and call for a review of the act at a fixed time, such as 6–10 years after enactment of the original act.

 

11-7-4  Action may need to be taken to revise or amend the nurse practice act by the appropriate legislative body by lobbying for changes. Or the board may enact new rules/regulations to ensure the nurse practice act meets the prevailing community standards.

 

11-7-5 Nurses must know the original nurse practice act and remain current on newly adopted rules and regulations.

 

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OBJECTIVE 8

Analyze the impact of continuing education on nursing practice.

 

Concept for Lecture

  1. Continuing education is a way nurses ensure that they remain current in their practice—whether voluntary or mandatory—it ensures that they remain competent in all practice settings. However, merely attending a conference or taking a quiz does not ensure a nurse remains competent. Continuing education better ensures that nurses are lifelong learners and remain competent.

 

PowerPoint Lecture Slide

11-8-1  Continuing education ensures that nurses remain current and competent in all practice settings. Continuing education better ensures that nurses are lifelong learners and remain competent.

 

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OBJECTIVE 9

Discuss reporting professional violations of the nurse practice act.

 

 

Concepts for Lecture

  1. Nurses must know how and when to report violations of the state nurse practice act. Mandatory reporting exists to protect the public’s health and safety. Failing to report violators becomes grounds for disciplinary action. Reporting may be for
  • unprofessional conduct
  • the inability of a nurse to practice with reasonable skill and safety
  • conduct that appears to be a contributing factor in death/harm of a patient
  • conduct involving patient abuse
  • extended scope of practice
  • substance abuse

 

  1. Report violations to organizational structure. Reports should:
  • be factual and documented in writing
  • include complete description of the violation
  • list other witnesses
  • give patient name
  • be completeRemember, that staff can investigate

 

  1. Administrative personnel must act on reported violations, and insist violator receive counseling, education classes, or supervised demonstrations to ensure quality nursing. In case violator leaves and goes to another hospital, administrator and individual nurses have the duty to report the violator to the state board of nursing.

 

  1. Reporting a violator of the nurse practice act may be done by writing to the state board of nursing, describing the abuse and including all documentation. Sign the letter. Confidentiality will be preserved.

 

PowerPoint Lecture Slides

11-9-1  It is mandatory for nurses to report violations of the state nurse practice act. Failing to report violators becomes grounds for disciplinary action.

 

11-9-2  Report violations to organizational structure. Reports should:

  • be factual and documented in writing
  • include complete description of the violation
  • list other witnesses
  • give patient name
  • be completeRemember, that staff can investigate

 

11-9-3  Administrative personnel must act on reported violations, insist violator receive treatment as necessary, and report the violator to the state board of nursing.

 

11-9-4  Reporting a violator of the nurse practice act may be done by writing to the state board of nursing.

 

………………………………………………………………………………………………

OBJECTIVE 10

Discuss the National Practitioner Data Bank.

 

Concepts for Lecture

  1. The National Practitioner Data Bank (NPDB) was created by the Health Care Quality Improvement Act. Aimed at affecting the practice of medicine, it also affects the professional practice of nursing. The NPDB records three types of data:
  • information relating to medical malpractice payments on behalf of health care practitioners
  • information relating to adverse actions taken against clinical privileges of physicians, osteopaths, and dentists
  • information concerning actions by professional societies that adversely affect membership

 

  1. Information from the NPDB is available to health care facilities needing verification of credentialing, tracking and identifying professionals found liable for malpractice, or who have had professional memberships or privileges revoked.

 

PowerPoint Lecture Slides

11-10-1  The National Practitioner Data Bank (NPDB) records three types of data:

  • information relating to medical malpractice payments on behalf of health care practitioners
  • information relating to adverse actions taken against clinical privileges of physicians, osteopaths, and dentists
  • information concerning actions by professional societies that adversely affect membership

 

11-10-2  Information from the NPDB is available to health care facilities needing verification of credentials, identifying professionals found liable for malpractice, or who have had professional memberships or privileges revoked.

 

………………………………………………………………………………………………

OBJECTIVE 11

Analyze certification.

 

Concepts for Lecture

  1. Certification is a form of credentialing that has both legal and professional implications. It indicates a level of competence above minimum criteria for licensure and verifies that the individual has met certain standards of preparation and performance. It allows the person to use the title conferred by the certificate and affirms that the individual has achieved in the defined area of clinical practice.

 

  1. Some nursing organizations offer certification, others advanced degrees in nursing as prerequisites for certification. There are a wide variety of certifications.

 

PowerPoint Lecture Slides

11-11-1  Certification is a form of credentialing with both legal and professional implications indicating competence and verifying that the individual has met certain standards of preparation and performance.

 

11-11-2  Some nursing organizations offer certification, others advanced degrees in nursing as prerequisites for certification.

 

………………………………………………………………………………………………

OBJECTIVE 12

Describe the legal ramifications of complementary and alternative medicine, including the medical use of cannabis.

 

Concepts for Lecture

  1. Complementary and alternative medicine (CAM)Remember,metime referred to as integrative medicine, are modalities not generally used by the health profession to treat illness. Examples are:
  • therapeutic touch
  • biofeedback
  • guided imagery
  • acupuncture
  • massage therapy

 

  1. Washington state was the first to pass legislation in this area, addressing insurance benefits.

 

  1. In 1992 the National Institutes of Health established the Office of Alternative Medicine to promote unbiased study of nonconventional therapies.

 

  1. Many medical schools now offer course work in alternative medicine—typically elective, not required.

 

  1. In a 2002 survey, the most common CAM therapies in the U.S. are:
  • prayer
  • herbalism
  • breathing meditation
  • meditation yoga
  • diet-based therapy
  • progressive relaxation
  • mega-vitamin therapy
  • visualization

 

  1. Although the popularity of CAM is increasing, there is a lack of uniform standards. Some state outlaw alternative therapies, others require licensure or standards of education. Nurses should know their state law and individual institution’s policy before performing such therapies.

 

  1. Before considering the use of alternative therapies:
  • Patients should be fully informed about the alternative therapy before its use.
  • Consent forms may need to be signed.
  • Therapy provided must be fully documented in the patient record.
  • Patient questions about alternative therapies must be fully addressed.

 

  1. Cannabis. Although possession of marijuana remains illegal under federal law, 34 states currently have some type of legislation recognizing marijuana’s medical valueRemember,me with guidelines for the legal medical possession thereof.

 

  1. Legislation does not legalize marijuana, but changes the way medical patients and their primary caregivers would be treated by the court system. The burden of proof is on the patient to show that the drug was used on the recommendation of a prescribing physician.

 

  1. Researchers face obstacles obtaining cannabis for research trials.

 

  1. The majority of patients using cannabis as medication suffer from:
  • cancer
  • AIDS
  • glaucoma

 

  1. Cannabis helps:
  • reduce nausea
  • increase appetite
  • reduce eye pressure
  • control muscle spasms

 

  1. Currently there is a pill version of cannabis called Marinol used to treat severe nausea and vomiting caused by chemotherapies.

 

  1. Issues for nurses in this area are numerous. Patients must understand that consumption of marijuana currently violates federal law.

 

 

PowerPoint Lecture Slides

11-12-1   Complementary and alternative medicine (CAM) or integrative medicine are modalities not generally used by the health profession to treat illness, e.g., therapeutic touch.

 

11-12-2   Washington state was the first to pass legislation for medicinal marijuana.

 

11-12-3   The National Institutes of Health established the Office of Alternative Medicine to promote unbiased study of nonconventional therapies.

 

11-12-4   Many medical schools now offer course work in alternative medicine.

 

11-12-5   Most common CAM therapies in the U.S. are:

  • prayer
  • herbalism
  • breathing meditation
  • meditation yoga
  • diet-based therapy
  • progressive relaxation
  • mega-vitamin therapy
  • visualization

 

11-12-6   There is a lack of uniform standards with CAM. Some state outlaw alternative therapies, others require licensure or standards of education.

 

11-12-7   Before considering the use of alternative therapies:

  • Patients should be fully informed about the therapy.
  • Consent forms may need to be signed.
  • Therapy must be fully documented in patient record.
  • Patient questions must be fully answered.

 

11-12-8   Possession of marijuana remains illegal under federal law; however,  several states currently have legislation recognizing marijuana’s medical value.

 

11-12-9   Legislation does not legalize marijuana; it changes the way medical patients and their primary caregivers would be treated by the court system.

 

11-12-10  Researchers face obstacles obtaining cannabis for research trials.

 

11-12-11  Majority of patients using cannabis as medication suffer from:

  • cancer
  • AIDS
  • glaucoma

 

11-12-12  Cannabis helps:

  • reduce nausea
  • increase appetite
  • reduce eye pressure
  • control muscle spasms

 

11-12-13  An  oral tablet  version of cannabis is called Marinol.

 

11-12-14  Issues for nurses in this area are numerous.

 

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OBJECTIVE 13

Discuss the status of multistate licensure and mutual recognition compacts today.

 

Concepts for Lecture

  1. New telecommunication technologies raise questions related to regulation of health care. Historically it was a state-based function, within geographic boundaries, with health care workforce licensed by the jurisdiction in which they practice. Practice is no longer limited to geographic boundaries.

 

  1. Telehealth is the removal of time and distance barriers for the delivery of health care services and related health care activities. Communication technologies provide a means for health care professionals to practice across state lines, perhaps in states in which the professional does not hold a current license.

 

  1. Telehealth employers and nurses may not understand that they may be performing unlicensed practice on some patients.

 

  1. One solution of providing care/medical advice in this manner is through mutual recognition, which allows a nurse to have a valid nursing license in his or her state of residency and practice in reciprocal states through the nurse licensure compact.

 

  1. The mechanism to implement mutual recognition of nurse licensure is the interstate compact—an agreement between two or more states for the purpose of addressing a problem that transcends state lines. Because the compact is law, it is subject to the traditional principles of statutory interpretation.

 

  1. The compact ensures that the nurse is properly licensed in the state of residence. Nurses must meet their state’s licensure requirements and abide by the nurse practice act of their home state.

 

  1. Remote states are other states where the compact is in effect and where the nurse practices but does not live. Nurses are granted the privilege to practice in their state as part of the interstate compact and are expected to practice within the scope of practice/standards of the remote state.

 

  1. Both state of residence and remote state boards of nursing must take action to limit or stop the practice of an incompetent/unethical nurse. The state of residence acts against the license per se, and the remote state acts against the practice privilege granted by the compact by limiting/stopping the practice with a cease and desist order.

 

  1. Opponents of the compact argue that nurses working within the compact language could find themselves subject to multiple investigations and disciplinary proceedings arising from one incident.

 

  1. The compact includes a Coordinated Licensure Information System (CLIS), which gives the compact state boards of nursing timely licensure and discipline information. The CLIS is primarily for use by the compact states’ boards of nursing, but with limited access to providing public information to employers and consumers as exists under the current regulatory system.

 

PowerPoint Lecture Slides

11-13-1 New telecommunication technologies raise questions related to regulation of health care. Practice is no longer limited to geographic boundaries.

 

11-13-2 Telehealth is the removal of time and distance barriers for the delivery of health care services and related health care activities.

 

11-13-3 Telehealth employers and nurses may not understand that they may be performing unlicensed practice on some patients.

 

11-13-4 Mutual recognition allows nurses to have a valid nursing license in their state of residency and practice in reciprocal states through the nurse licensure compact.

 

11-13-5 The implementation of mutual recognition of nurse licensure is the interstate compact.

 

11-13-6 The compact ensures that the nurse is properly licensed in the state of residence.

 

11-13-7 Remote states are other states where the compact is in effect, where nurse practices but does not live.

 

11-13-8 Both state of residence and remote state boards of nursing must take action to limit or stop the practice of an incompetent/unethical nurse.

11-13-9 Working within the compact language, nurses could find themselves subject to multiple investigations and disciplinary proceedings arising from one incident.

 

11-13-10  The compact includes a Coordinated Licensure Information System (CLIS) giving the compact state boards of nursing timely licensure and discipline information.

 

………………………………………………………………………………………………

OBJECTIVE 14

Analyze some of the ethical issues surrounding licensure, certification, and scope of practice.

 

Concepts for Lecture

  1. When patients reveal to nurses their use of over-the-counter medications or other alternative modalities, nurses need to help patients understand why such knowledge is needed to ensure optimal health.

 

  1. There are no regulations regarding vitamins and herbals, nor is there a standardized dosage for vitamins.

 

  1. Complementary and alternative medicines can cause clashes in health care services. Health care providers need to know how to respond to nontraditional health care measures. Ethical issues may also surface with patients using cannabis.

 

  1. The nurse’s rights to refuse care (i.e., based on religious rights) can cause ethical issues.

 

PowerPoint Lecture Slides

11-14-1 Nurses need to explain the use of over-the-counter medications and other alternative modalities.

 

11-14-2 Patients need to understand dosage with regard to alternative medicines.

 

11-14-3 Clashes in health care services may surface over complementary and alternative medicines, including cannabis.

 

11-14-4 Ethical issues arise over a nurse’s right to refuse care.

 

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