An Overview of the Kentucky Nursing Laws and the Kentucky Board of Nursing

1

• An Overview of the Kentucky Nursing Laws and the
  Kentucky Board of Nursing
• Sharon Eli Mercer, MSN, RN NEA, BC
• Nursing Practice Consultant
• Kentucky Board of Nursing

2
Mission Statement

• The Kentucky Board of Nursing protects public
  health and welfare by development and enforcement
  of state laws governing the safe practice of
  nursing.

3
Board Composition

• State government agency
• 16 members appointed by the Governor
• Members serve four (4) year terms
• Ten (10) Registered Nurse Members
• One (1) ARNP Member
• Three (3) Licensed Practical Nurse Members
• Two (2) Citizens-at-Large

4
Standing Committees

• Practice Committee
• Education Committee
• Consumer Protection Committee

5
Standing Committees
Practice Committee - considers those matters
related to the interpretation of the legal scope
of nursing practice as defined in the Kentucky
Nursing Laws and KBN administrative regulations. 
6
Standing Committees

• Education Committee - The Education Committee
  considers those matters related to mandatory
  continuing competency and prelicensure nursing
  education in the Commonwealth.

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Standing Committees

• Consumer Protection Committee -considers those
  matters related to investigation and disciplinary
  processes and preparation of hearing panel
  members.

8
Councils and Special Committee

• Advanced Registered Nurse Practice Council
• Dialysis Technician Council
• Controlled Substances Formulary Development
  Committee
• UAP Medication Administration Taskforce

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OPEN MEETINGS
All meetings of the Board and its advisory
councils or committees are open to the public.
10
Kentucky Board of Nursing Activities

• Approve Prelicensure Programs of Nursing
• Issue RN and LPN licenses
• Issue ARNP registrations
• Issue DT and SANE Credentials

11
Kentucky Board of Nursing Activities (Contd)

• Approve Continuing Education Providers
• Renew licenses
• Administer special programs as directed by
  legislature
• Investigate Complaints/
• Disciplinary Action
• Nursing Incentive Scholarship Fund

12
Licensure and Certification

• Nursing Licensure is renewed each year
• If you hold a Certificate for School Nurse issued
  by the Education Professional Standards Board,
  that is issued for a five (5) year period
• 16 KAR 2060 School Nurse, does not require
  certification to work as a school nurse
• KBN does not require certification of
• school nurses

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Kentucky Nursing Laws, Nurse Accountability
and Responsibility, and Nursing Practice
Information

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Kentucky Revised StatutesChapter 314

• The Kentucky Nursing Laws

15
Scope of Practice Definitions

• KRS 314.011(6) Registered nursing practice
  use of substantial specialized knowledge,
  judgment and nursing skill
• -----no prescriptive authority
• KRS 314. 011(10) Licensed practical nursing
  practice under the direction of a RN, physician
  or dentist
• ------not licensed for independent practice

16
Accountability

• KRS 314. 021(2) Individually responsible and
  accountable
• Based on educational preparation and experience
  in nursing
• Practice with reasonable skill
• and safety

17
CompetencyNurse is accountable for being
educationally prepared and clinically competent
in any act performed
18
Competency Defined

• Nurse is knowledgeable and skillful in the use of
  critical thinking, effective communication,
  nursing interventions and caring behaviors
  consistent with the nurse's practice role KRS
  314.011(15)

19
KRS 314.011(6)(d)

• Gives the Registered Nurse the authority to
  delegate
• (d) The supervision, teaching of, and
  delegation to other personnel in the performance
  of activities relating to nursing care

20
KRS 314.011(17)DISPENSE

• To receive and distribute noncontrolled legend
  drug samples from pharmaceutical manufacturers to
  patients at no charge to the patient or any other
  party
• To distribute noncontrolled legend drugs from a
  local, district and independent health department
  subject to the direction of the appropriate
  governing board of the
• individual health depart.

21
KRS 314.011(6)(c)Components of Medication
Administration

• Preparing and giving medications in the
  prescribed dosage, route and frequency, including
  dispensing medications only as defined in
  subsection (17)(b) of this section
• Observing, recording, and reporting desired
  effects, untoward reactions and side
• effects of drug therapy

22
KRS 314.011(6)(c)

• Intervening when emergency care is required as a
  result of drug therapy
• Recognizing accepted prescribing limits and
  reporting deviations to the prescribing individual

23
KRS 314.011(6)(c)

• Recognizing drug incompatibilities and reporting
  interactions or potential interactions to the
  prescribing individual
• Instructing an individual regarding medications

24
KRS 156.502 Health services in school
settingDesignated providerLiability protection

• Defines Health Services
• Provision of direct health care, including the
  administration of medication the operation,
  maintenance, or health care through the use of
  medical equipment or the administration of
  clinical procedures
• Does not include first aid or emergency
• procedures

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Health Services

• Provided within the health care professionals
  current scope of practice
• May be provided by
• - Physician, advanced registered nurse
  practitioner, registered nurse, or licensed
  practical nurse

26
Health Services

• Services may be provided by a school employee who
  is delegated responsibility to perform the health
  services by a physician, advanced registered
  nurse practitioner, or registered nurse

27
School Employee Providing Health Services

• Trained by the delegating physician or delegating
  nurse for the specific health services, if that
  health service is one that could be delegated by
  the physician or nurse within his or her scope of
  practice

28
School Employee Providing Health Services

• Has been approved in writing by the delegating
  physician or delegating nurse
• Approval states
• - Employee consents to perform the health
  service
• - Possesses sufficient training and skills
• - Has demonstrated competency to safely and
  effectively perform the health services
• - Delegation is valid for the current school
• year

29
School Health Services

• If no school employee is trained and delegated
  responsibility, school district makes
  arrangements for provision of health services to
  the student in order to prevent loss of health
  services affecting students attendance or
  program participation.

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201 KAR 20400 Delegation of Nursing Tasks
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201 KAR 20400 Delegation of Nursing Tasks

• Definitions
• SUPERVISION guidance periodic observation
  evaluation and validation
• UNLICENSED PERSON is not the patient/client or
  his delegatee

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Delegation of Nursing Tasks (continued)

• Nurse Responsibility
• Determine need of client prior to delegating
• Retain accountability for nursing assessment,
  planning, evaluation, and assuring documentation
• Assure delegatee is trained and competent to do
  task
• Inappropriate delegation violation of
  law/disciplinary action

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Delegation of Nursing Tasks (continued)

• Delegation Criteria
• Task must be reasonable and prudent to delegate
• Task can be done/and is done competently and
  safely without compromising patient welfare
• Task does not require independent nursing
  judgment or intervention

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Delegation of Nursing Tasks (continued)

• Degree of Supervision is based on
• Patient stability and acuity
• Delegatees training and competency
• Complexity of task
• Proximity and availability of supervisor to
  delegatee

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Advisory Opinion Statements

• Issued by the Board to provide guidelines on safe
  patient care
• Written to reflect the statutes and
  administrative regulations
• Does not have force and effect of law

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Scope of Practice Decision Tree

• KY Nursing Laws?
• Advanced education required?
• Scope of practice support?
• Personal knowledge and skill?
• Reasonable/Prudent?
• Accountability assumed?

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AOS 15 on Delegation

• Provides guidelines to nurses on the appropriate
  delegation of tasks to UAPs, and gives specific
  examples

38
Decision Tree for Delegation to UAPs

• Describes steps in deciding to delegate a nursing
  act
• The UAP is responsible for accepting only those
  delegated acts for which they are competent to
  perform. Only the implementation of a
  task/activity may be delegated. Assessment,
  planning, evaluation, and nursing judgment cannot
  be delegated.

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AOS 30 School Nursing Practice

• Addressed Nursing Practice in the School
• Setting for
• Advanced Registered Nursing Practice
• Registered Nursing Practice
• Licensed Practical Nursing Practice

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Advanced Registered Nursing Practice

• ARNP or CNS- within scope of practice to provide
  primary healthcare services to students in
  accordance with 201 KAR 20057
• The ARNP may also perform acts within the scope
  of registered nursing practice.

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Registered Nursing Practice

• Education, experience and current clinical
  competence
• A. Utilizes substantial, specialized nursing
  knowledge, judgment and skill in providing
  primary healthcare to students

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Registered Nursing Practice, (cont.)

• Initial assessment, management of minor illnesses
  and/or referral to other health professionals,
  monitoring of chronic diseases, health
  supervision, counseling, disease prevention,
  promotion of healthy life-styles and coordination
  of services when specialized care is required.
  (National Association of School Nurses,
  Resolution-Primary Health Care, June 1981)

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Registered Nursing Practice (cont.)

• B. Serve as Health advocate of students and a
  consultant to educational staff.
• C. Serve in family resource and youth services
  centers.
• D. Provide health teaching with a focus on
  disease prevention, health promotion, and
  health restoration.
• E. Monitor the quality of the healthcare
• services provided to students.

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Registered Nursing Practice (cont.)

• F. Provide direct clinical services for
  students with special needs. Teach and verify
  competency, supervise and delegate the selected
  acts to unlicensed school personnel in
  accordance with 201 KAR 20400.

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Registered Nursing Practice (cont)

• G. Participate in the development of policies
  and procedures related to nursing practice in
  school settings
• H. Delegate select health services to a school
  employee in accordance with KRS 156.502 and 201
  KAR 20400

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Licensed Practical Nursing Practice

• Practice under the direction of a registered
  nurse, physician or dentist
• Not licensed for independent nursing practice
• Performs acts within scope of practice as defined
  in KRS 314.011(10)
• Under KRS 156.502(2) the LPN does not delegate
  health services to school employees
• Practice components for LPN in AOS
  27-Components of Licensed Practical
• Nursing Practice

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Practice Opinions and Current Issues

• KBN has issued multiple practice related
  opinions in response to individual questions.
  See Summary Reports on web site for the past 6
  years.
• www.kbn.ky.gov

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KBN CONTACT

• Sharon Eli Mercer, MSN, RN NEA, BC
• Nursing Practice Consultant
• Phone [phone]
• Fax [phone]
• SharonE.Mercer_at_ky.gov
• www.kbn.ky.gov