The purpose of this module is to provide information regarding the minimum acceptable standards of safe, effective nursing practice for a registered nurse (RN), licensed practical nurse (LPN), or advanced practice registered nurse (APRN) in any setting in Ohio as outlined in the Ohio Revised Code (ORC) Section 4723. (1 CH version)
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Category A - Approval Letter
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The purpose of this module is to provide information on the minimum acceptable standards of safe, effective nursing practice for a registered nurse (RN), licensed practical nurse (LPN), or advanced practice registered nurse (APRN) in any setting in Ohio as outlined in the Ohio Revised Code (ORC)-Chapter 4723.
After the completion of this module, the learner should be able to:
- examine the Ohio Board of Nursing’s (OBN’s) standards of practice for registered nurses (RNs), licensed practical nurses (LPNs), and advanced practice registered nurses (APRNs)
- outline the OBN Scope of Practice Decision Making Model
- list the steps in the OBN's disciplinary process and discuss the OBN's most recent annual reports and identify the number of complaints received by the OBN as well as specific types of complaints alleging misconduct by licensees
- define the steps for license renewal and continuing professional development requirements in the Ohio Nurse Practice Act
Standards of nursing education and practice result from the efforts of nursing associations dating back over 100 years to protect the public. Each state within the US provides nurses with guidance and regulations to practice through a law known as the Nurse Practice Act (NPA). This law designates the authoritative body in each state known as the Board of Nursing that ensures the nursing workforce in their state delivers safe, competent, skilled, and knowledgeable care (National Council of State Boards of Nursing [NCSBN], 2019a). This course explores the standards for the Ohio Nurse Practice Act outlined within Chapter 4723 of the Ohio Revised Code (ORC), intending to protect the public and ensure minimum competencies and requirements are met and maintained by all nurses. The ORC is comprised of laws that are passed by the state of Ohio legislative bodies. The Ohio Administrative Code (OAC, chapters 4723-1 through 4723-27) is an adjunct document outlining the rules that assist in implementing and interpreting the ORC passed by the state board of nursing to operationalize the ORC (OBN, 2019b). This training will focus primarily on the OAC.
Structure of the OBN
The structure of the OBN is specified in ORC 4723-02. The OBN is comprised of 13 members who must be US citizens and residents of Ohio.
- Eight members are RNs who must hold an active license in Ohio and have been actively engaged in nursing practice as an RN for the five years immediately preceding the member’s initial appointment to the OBN. In addition, at least two of the eight RNs must hold a current license to practice as an APRN (i.e., certified nurse-midwife [CNM], certified nurse practitioner [CNP], certified registered nurse anesthetist [CRNA], or clinical nurse specialist [CNS]).
- Four members are LPNs who must hold an active license in Ohio and have been actively engaged in nursing practice as an LPN for the five years immediately preceding the member’s initial appointment to the OBN.
- One consumer member represents individuals that receive care from nurses licensed by the state.
A president and vice-president are elected for a one-year term from the 13 members. OBN board members serve four-year terms beginning on January 1st and ending on December 31st. Additionally, the OBN hires a full-time Executive Director that is an RN (ORC, 2016).
Standards of Practice
The OBN has the authority to enforce and expand on state statutes through their written rules. Additionally, the OBN has the power to conduct investigations and to impose discipline when a licensee violates a statute or regulation.
The minimally acceptable standards of safe and effective practice for the RN and LPN can be found in Chapters 4723-4-03 and 4723-4-04 of Ohio’s Administrative Code (OAC, 2019).
Nurses are required to provide care within their scope of practice. Nursing care should be aligned with the individual nurse’s education, knowledge, experience, and demonstrated competency. Since nursing is a dynamic practice, questions related to the nurse’s scope of practice may arise. To assist in delineating the scope of practice, the OBN developed a Scope of Practice Decision Making Model (see Figure 1 below). The model incorporates a decision tree that includes references and is based on safety, competency, legality, and accountability (OBN, 2019a).
Figure 1
OBN RN and LPN Decision Making Model
(OBN, 2019a)
Specific areas addressed in the rules include maintaining and demonstrating competency; assuring patient safety; maintaining confidentiality; delineating, establishing, and maintaining professional boundaries; and applying the nursing process (OAC, 2019):
- The rules related to competency are found in 4723-4-03(A)-(G) for RNs and 4723-4-04 (A)-(G) for LPNs. Both LPNs and RNs are accountable for maintaining current knowledge and demonstrating competency and consistent performance of nursing care. In addition, when providing care beyond the basic nursing preparations, the nurse must maintain documentation to demonstrate that they obtained the advanced knowledge from a credible source.
- The rules related to safety are discussed in greater detail below. The OBN expects nurses to implement orders from licensed providers in a timely manner unless there is a reason to believe that the order is inappropriate for the patient. Additional details about this can be found in 4723-4-03 (E) and 4723-4-04 (E). The OBN expects the nurse to report to and consult with other nurses and members of the healthcare team and make necessary referrals. This information is detailed in 4723-4-03 (G) and 4723-4-04 (G). 4723-4-03 (J) and 4723-4-04 (J) outline the OBN’s regulations regarding acceptable standards of safe nursing care as a basis for providing advice, instruction, teaching, and evaluation of nursing care.
- The regulations related to confidentiality are found in 4723-4-03 (H) and 4723-4-04 (H). The OBN requires the nurse to carefully safeguard patient information and only access and disseminate information to provide patient care or fulfill job responsibilities.
- The regulations related to professional boundaries and misappropriation of property are found in 4723-4-06(H), (I) (J), (K) (L), (M). The OBN requires the nurse to provide privacy during examination, treatment, and when providing personal care. In addition, the OBN requires the nurse to demonstrate courtesy and respect each patient’s individuality.
Promoting Patient Safety: OAC 4723-4-06
The OAC prohibits engaging in the following:
- behavior that causes or may cause verbal, physical, mental, or emotional abuse of a patient
- conduct that might reasonably be interpreted as verbally, physically, mentally, or emotionally abusive
- misappropriation of a patient’s personal property
- behavior to seek personal gain at the patient’s expense
- behavior that can be reasonably interpreted as inappropriate in the p
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atient’s personal relationships or financial behaviors
sexual conduct with a patientconduct or verbal exchanges during practice that might reasonably be interpreted as sexual, seductive, or demeaning to the patient (OAC, 2019)The OAC establishes standards for applying the nursing process. These regulations can be found in OAC-4723-4-07 and are outlined as follows (OAC, 2019):
- RNs are required to use the steps of the nursing process (assessment, analysis, planning, implementation, and evaluation) in the practice of nursing.
- Effective use of the nursing process requires recognizing its dynamic nature and thus, enables the nurse to respond to changes in the patient’s health status.
- The nurse should begin with assessing the patient’s status (collecting subjective and objective data from the patient, family, and other sources).
- The nurse then documents findings, analyzes, and reports those findings, develops and modifies the plan of care as needed, and communicates the plan of care to other members of the healthcare team.
- The nurse implements the plan of care by executing the nursing regimen.
- The nurse provides care that is within their scope of practice.
- The nurse assists and collaborates with other members of the health care team.
- Finally, the nurse evaluates the patient’s response to determine the effectiveness of treatment and care plan. The nurse might need to revise the plan of care based on this evaluation. The nurse may also need to notify the provider if an adjustment in the patient’s care plan is warranted based on the evaluation findings.
According to OAC 4723-4-08, the standards for applying the nursing process are slightly different as an LPN. LPNs are required to contribute to the nursing process in the practice of nursing by providing care based on the established nursing plan (OAC, 2019).
Standards of Competency for RN and APRNs
Section 4723-4-03 notes the standards for RNs, as outlined in Table 1
Section 4723-4-04 contains similar standards for LPNs, and section 4723-4-05 notes the standards for APRNs. According to Section 4723-9 of the OAC, APRNs must also function within the regulations of the Ohio law to prescribe medications (OAC, 2018c).
Evaluations of an APRN must be completed by a collaborating physician, dentist, podiatrist, or registered anesthetist with a current and valid license with the same designation as the APRN being evaluated (OAC, 2018a).
The APRN can provide care within their specialty provided they:
demonstrate the knowledge and abilities of the specialty
obtain appropriate education from a recognized body of knowledge
document evidence of skills and abilities and maintain records as required (OAC, 2018a)
Another aspect of the OAC for APRNs is title protection, which prohibits using an inappropriate or unearned credential when functioning as a licensed APRN. Additional information on title protection for the APRN can be found within OAC 4723-8-03 (OAC, 2018a).
Disciplinary Process
According to the NCSBN (2019b), most licensed nurses in the US provide safe, competent, and compassionate nursing care. Less than 1% of nurses are disciplined by their board of nursing. Likewise, the OBN reports that most Ohio nurses practice with high standards; however, they are subject to discipline when a nurse has allegedly violated OBN’s laws or rules (NCSBN, 2019b).
In carrying out its disciplinary responsibilities, the OBN has the authority to revoke and suspend licenses and certificates; impose probationary requirements, reprimands, fines, or practice restrictions; and deny initial or renewal licenses or certifications. The disciplinary process typically begins when a patient, family member, nurse manager, or employer files a complaint. See Table 2 for detailed information about the number of complaints and a partial list of the types of complaints the OBN received from 2016 to 2020. This information was retrieved from the OBN’s Annual Reports from 2016 thru 2020, which is available on the OBN’s website (OBN, 2020).
The OBN is the governing body that upholds the NPA and the rules found in the OAC. The NPA lays out the process by which the OBN investigates evidence having the appearance that a nurse has failed to practice in accordance with acceptable standards of safe practice. After the evidence has been gathered, a thorough review by the OBN will be performed to determine the presence of wrongdoing or a deficiency in practice without harm or risk of serious imminent harm (indicating that the NPA may offer a less stringent alternative; ORC, 2019).
License Renewal and Education Requirements
Most states require evidence of continued professional development or competency as part of the license renewal process for nurses to renew their license. For nurses in Ohio, the renewal cycle is every 2 years from November 1st to October 31st. Specific requirements for initial licensure and renewal for LPNs, RNs, and APRNs can be found on the OBN website. The current continued competency requirements for license renewal for LPNs/RNs are listed in Table 3.
As with RNs, APRNs in Ohio are not required to submit proof of CE hours obtained during their first licensure renewal after initial licensure by examination. CE hours for all other renewing APRNs in Ohio must be completed between November 1st and October 31st of odd-numbered years. APRNs are required to obtain 24 contact hours of CE in the 24-month renewal cycle starting in 2021, including 12 hours of advanced pharmacology training if they are active prescribers, in addition to the 24 hours of CE they are required to obtain for the RN licensure renewal. This results in a total of 48 contact hours for the 2-year renewal period. These hours may also be used towards their national specialty certification (OBN, 2021).
Important Note and Disclaimer
The information in this module is general in nature and is not, nor intended to be, legal advice. The laws are complex, and circumstances vary. Therefore, you should consult an attorney for advice regarding your individual situation.
References
National Council of State Boards of Nursing. (2019a). About US boards of nursing. https://www.ncsbn.org/about-boards-of-nursing.htm
National Council of State Boards of Nursing. (2019b). Discipline. https://www.ncsbn.org/discipline.htm
Ohio Administrative Code (2018a). Advanced practice registered nurse certification and practice. http://codes.ohio.gov/oac/4723-8
Ohio Administrative Code. (2018b). Continuing education (CE). http://codes.ohio.gov/oac/4723-14
Ohio Administrative Code. (2018c). Prescriptive authority. http://codes.ohio.gov/oac/4723-9
Ohio Administrative Code. (2019). Standards of practice relative to registered nurse or licensed practical nurse. http://codes.ohio.gov/oac/4723-4
The Ohio Board of Nursing. (2019a). RN and LPN decision-making model. http://nursing.ohio.gov/wp-content/uploads/2019/10/decision-making-model20191007_14055357.pdf
The Ohio Board of Nursing. (2019b). The practice of nursing and scopes of practice. Ohio Board of Nursing: Momentum, 17(3), 8. https://nursing.ohio.gov/wp-content/uploads/2019/10/Summer-Issue-2019-Momentumn.pdf
The Ohio Board of Nursing. (2020). Fiscal and annual reports. https://nursing.ohio.gov/forms-publications/annual-reports/
The Ohio Board of Nursing. (2021). Continuing education for renewal- APRNs. https://nursing.ohio.gov/wp-content/uploads/2021/07/CE-FAQs-APRN-updated-June-2021.pdf
Ohio Revised Code. (2016). Nurses. http://codes.ohio.gov/orc/4723
Ohio Revised Code. (2019). Disciplinary actions. http://codes.ohio.gov/orc/4723.28
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