Description

Primary resources for state law - ANSWER Texas Board of Nursing Nursing Practice Acts Nursing Jurisprudence - ANSWER Rules/ Ethics/ Morals and how the nurses function in a healthcare setting Texas Nurse Practice Acts - ANSWER 301 -BON, , defines responsibility for regulating nursing education, licensure and practice 303 -Regulates nursing peer review 304 -Relates to nursing Licensure compact Texas BON Mission Statement - ANSWER Protect and promote welfare of the people of Texas by ensuring that each person holding a license as a nurse is competent to practice safely. -Protects the interest of the public Chapter 301 NPA - ANSWER How board is appointed General powers/duties License requirements/renewal Practice by holder Reporting violations and patient care concerns Prohibited practices/disciplinary actions Other penalties and enforcement previsions Anesthesia in outpatient settings Corrective action proceeding Board of Nursing - ANSWER Represent the people of Texas Can't lobby the legislature Does not regulate practice settings -Licensing -Enforcement Services -Audit of CE -Information Services Professional Associations - ANSWER Represent their members Do lobby legislature Efforts to improve work condition/benefit for nurses -Job referral services -Legal Referral -Salary Q -Co-Worker Disputes -Employment issues Licensure and Regulation - ANSWER Temporary Permit -GN permit expires in 75 days -When pass/fail NCLEX Renew Online -60 days prior to expiration BON will send card Continuing Education -20 hours in 2 years -Fist time renewal exempt -CE hours in area of practice -Keep records for 4 years Initial Licensure by Examination - ANSWER Must submit criminal background check Submit a sworn application fee Verify completion of an approved nursing edu. Pass NCLEX Pass NJE with 75%>, NPA/BON rules, 50Q Disclosure of Criminal Behavior - ANSWER Must report any past criminal behavior or pending charges -Minor class C misdemeanors excluded (parking tickets, speeding tickets, jaywalking) Five Categories of Trust by BON - ANSWER Honesty Accountability Trustworthiness Reliability Integrity Good Professional Character - ANSWER Distinguish right from wrong Think and act rationally Keep promises and honor obligations Be accountable for own behavior Promptly disclose facts that could enhance health of pt. and protect from harm Professional boundaries - ANSWER Must recognize/maintain professional boundaries -Do or say nothing that can't be documented Violations -Physical, Sexual, Emotional, Financial exploitation Nursing Peer Review - ANSWER Separate from BON review Confidential (incident based or Safe harbor) -Rule 217.19-PR and Whistleblower -Rule 217.20-SH PR and Whistle blower protections Incident Based Peer Review - ANSWER Any facility employing 10+ must have one Referral starts with error/incident PR without administrators Fact finding mission Eval. of practice in atmosphere of collegiality Determine if incident merit or should be to BON RN Standards - ANSWER Make Nursing Dx Develop nursing care plan Eval. pt response to care Perform Comprehensive assessment Delegate tasks to UAP Practice independently w/in NPA board rules Edu. to care for all pt's stable and unstable LVN Standards - ANSWER Participate in planning of nursing care Assist in evaluation pt response to tx Complete focused assessment Implement appropriate aspects of care Practice must be supervised Educated to care for pt. with stable predictable Duty to pt - ANSWER Make/accept only assignments that take into consideration safety and commensurate with nurse's educational preparation, experience, knowledge, and physical/emotional ability. Step 1 - ANSWER Is the activity consistent with the NPA and BON rules? Step 2 - ANSWER Is the activity appropriately authorized? - Valid order? - Current policy exist regarding procedure? - Clarify any questionable orders Step 3 - ANSWER Is it supported by nursing research? - EBP Step 4 - ANSWER Do you possess the required knowledge and competency to carry out the act? Step 5 - ANSWER Would a reasonable and prudent nurse perform this activity in this setting? Step 6 - ANSWER Are you prepared to accept the consequences of your actions? Prohibited Delegation Tasks - ANSWER Nursing assessments Plan of care Professional Judgement/Intervention Responsibility for initial teaching Medication administration, IV fluids as well -Prohibited in acute care settings -may be delegated in independent living situations Minor Incident - ANSWER Conduct that does not indicate the nurses continuing to practice professional nursing poses a risk fo harm to the pt. or other person Exclusion to Minor Incident Rule - ANSWER A nurse involved in a MI does not need to reported to BON unless... -Creates sig. risk fo physical, emotional, financial harm -Lacks a conscientious approach for accountability -Lacks knowl. and compet. and not easily remedial -Pattern of multiple minor incidents -5 minor incidents in a 12 month period must be reported to peer review NEVER a Minor Incident - ANSWER Error contributed to pt. death/serious harm Criminal conduct Serious violation (theft, faud, pt. abuse, exploiting) Impairment/suspected impairment by chem. dep. IBPR Due Process Rights - ANSWER Facility must have policies in place for PR PR committee must comply with req. Nurse must receive notice/ opportunity to review documents/submit a response Nurse may hire own attorney Nurse will get feedback after decision Nurse will have a chance to respond Safe Harbor Peer Review - ANSWER Allows a nurse to accept an assignment and provide best care without fear of licensure action if there is a practice error. -Does not protect civil rights -Before refusing assignment must recog. pt is 1st May refuse an assignment if lack basic knowledge/ability to render care Safe Harbor - ANSWER Must be invoked BEFORE care given Or anytime assignment has changed and pt may be in harm -Must notify in writing -Supervisor can't refuse -May use quick req form to make initial req. -Comprehensive request must be completed before leaving work setting Quick Request Form - ANSWER Written on blank piece of paper but must include -Name/Signature -Date/Time of request -Location of where it is to be completed -Name of person making assignment -Brief explanation of why safe harbor is being req. Chain after Safe Harbor Nurse completion - ANSWER Nurse supervisor/administrator who gave assignment. Nurse administrator Peer Review Committee Physician who reviews med reasonableness Nurse administrator who reviews PR findings Nurse who initiated request Mandatory Overtime - ANSWER Making you work extra shifts, you have the right to refuse. NOT when -Emergency disasters -Ongoing procedure requires nurses presence -Certain emergencies Take Mandatory Overtime Concerns to - ANSWER Unit manager Staffing Committee DSHS-if not addressed internally Nurses duty is always - ANSWER In the best interest of the patient Patient Abandonment - ANSWER NPA/BON do not define abandonment -leaves employment-employment issue -leaves patient-licensure issue Not abandonment - ANSWER Resignation without notice- assuming shift has been completed Refusal to work additional shifts either doubles or extra shifts on days off Floating to an unfamiliar area - ANSWER Always responsible for providing safe patient care May request training prior to having to float May invoke safe harbor May refuse assignment What do I do if I question safety of assignment - ANSWER 1st- clear about what you are being asked to do 2nd- consider what can change during assignment 3rd- state concern to person making assignment, brainstorm ways to modify 4th- Listen to response Disciplinary Action - ANSWER Chemical Dependency Alcohol Dependency Mental Illness Even some prescription drugs Red Flags - ANSWER Lack of energy Frequent absences Spike in pt. need for pain meds Lateness to work Red Eyes No/unusual documentation Frequently stands behind other nurses signing out meds Unprofessional Conduct - ANSWER Drug Diversion Unsafe practice Failure to pay student loans Dismissal peer assistance program Drug related actions Criminal conduct Board process for investigating complaints - ANSWER Nurse notified of investigation and invited to respond Investigator gathers and reviews evidence Decision made by board Nurses's responsibility during investigation - ANSWER Respond promptly to all requests Keep contact information current Feel free to contact investigator Do not ignore any mail from BON Types of Nurse Remediation - ANSWER Remedial education -Classes specific to issue Supervision -Work under direct/indirect supervision. Work environment -stable environment not home health Losing license is not uncommon Filing a complaint against another nurse - ANSWER Any violation of BON rules needs to be reported Must be written/signed by person making report Include ID of nurse being reported Contain any additional info required All complaint information is confidential Duty to pt. and mandatory reporting req. Failure to report violation! Texas Nursing Jurisprudence Exam - ANSWER Exam based on NP/BON rules/regulations 50 Questions 75% or > Must pass prior to taking NCLEX Eligible to test about 10 days after application to BON 2 hours to complete exam May retest if not successful Home State License - ANSWER Nurse must be licensed in state in which he/she permanently resides -if you move you have 30 days to change your license over. Party State License - ANSWER Other states belong to the compact nurse may practice in any party state on his/her home state license