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Standards of Nursing Practice For 2009 ALAA Fall Conference

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Title: Standards of Nursing Practice For 2009 ALAA Fall Conference


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Standards of Nursing Practice For 2009 ALAA
Fall Conference
  • Presented by
  • Cathy Boden, MSN, RN
  • Nurse Consultant for Legal Division
  • Alabama Board of Nursing
  • September 2009

3
Objectives
  • Identify factors that determine what a nurse can
    do once they are hired by an employer.
  • Discuss standards of nursing practice.
  • Recognize and report substandard nursing
    practice.

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10
Who is the Alabama Board of Nursing?
  • What is the mission of the ABN?

11
Alabama Board of Nursing
  • Legislature passed first law establishing Board
    in 1915
  • Initial approach was to standardize nursing
    education requirements
  • Voluntary registration
  • Practical nurses first came into being after
    World War II

12
Composition of the ABN
  • Established by The Alabama Nurse Practice Act
  • 13 members - as of July 2009, one RN nursing
    education position was vacant
  • Appointed by the Governor for 4 year terms max
    of 2 consecutive terms or 8 consecutive years

13
Composition of the ABN Contd
  • 8 RN Positions
  • 3 (Three) must be from practice or
    administration
  • 3 (Three) must be from nursing education
  • 2 (Two) must be advance practice nurses
  • 4 LPN Positions
  • 2 Nominated by Licensed Practical Nurses
  • Association of Alabama (LPNAA)
  • 2 Nominated by Alabama Federation of
  • Licensed Practical Nurses (AFLPN)
  • 1 Consumer
  • No financial gain from health care and not
    previously
  • a health care professional

14
Nurse Consultants of ABN under Executive Officer,
Genell Lee
  • Legal Division VDAP
  • Education Advanced Practice
  • Continuing Education/Practice

15
Mission of the ABN
  • The mission of the Alabama Board of Nursing is
  • public protection
  • through the regulation of
  • nursing education
  • nursing practice

16
Who does the ABN work/advocate for?
17
Board Information
  • www.abn.state.al.us

18
ABN Attorney Investigators
  • ABN Attorney is a Deputy Attorney General
  • Investigators have law enforcement background, no
    power to arrest

19
Who does the ABN work/advocate for?
  • Patients?
  • Nurses?

20
Professional Associations
  • American Nurses Association (ANA)
  • ASNA (Alabama State Nurses Association)
  • Specialty Associations (Incomplete list)
  • AACN
  • AORN (Association of Peri-Operative Nurses)
  • ENS (Emergency Nurses Association)
  • Infusion Nurses Society
  • American Gastroenterology Association
  • WOCN (Wound Ostomy Continence Nurses Society)
  • Nephrology Nursing Association

21
Who do the Associations work/advocate for?
  • Patients?
  • Nurses?

22
Is it true that A nurse is a nurse is a
nurse..?
23
What determines differences?
  • Is it the nurses education program?
  • Is it what the nurse wears to work?
  • Is it the facility where the nurse works?
  • Is it the license the nurse holds?

24
Differences determined by.
  • Educational preparation
  • Licensure
  • Roles Scope of Practice
  • Nursing Experiences
  • Competency

25
Differences in Basic Educational Preparation
Begin with type of Nursing Education Program
  • LPN
  • 1 Year
  • RN
  • ADN 2 years
  • BSN 4 years

26
Additional Factors of Basic Nursing Education
  • Including but not limited to
  • Clinical experiences available in school
  • Expertise of Instructors
  • Student motivation/reason for entering program

27
Basic Education for Nursing Programs
  • Practices/Procedures/Treatments taught in the
    nurses basic educational program (RN LPN).
  • Vital Signs
  • Make a Bed
  • Bed Baths
  • Comfort Care
  • Administer Medications
  • - Oral - Topical - Inhalation
  • Perform Injections
  • - IM - SQ - Intradermal - Z track

28
Basic Nursing Education RN LPN Contd
  • Insert Foley Catheters
  • Females
  • Maybe Males
  • Change basic dressings
  • Basic Infection Control
  • Sterile gloving
  • Sterile field create maintain
  • Biohazard waste disposal


29
Additional Basic Nursing Education for the RN
(incomplete listing)
  • Cardiovascular Alterations - Hemodynamic
    Monitoring
  • Respiratory Alterations
  • Endotracheal Tube Management
  • Tracheostomy Management
  • Ventilator Monitoring
  • Neurological Alterations
  • Glascow Coma Scale
  • Intracranial Pressure Monitoring
  • Management Prioritizing
  • Nursing Leadership Management

30
Specifics of LPN Education
  • Until 2005/2006, Basic IV Therapy was not in
    curriculum
  • Until August 2008, Body Structure Function is
    in the curriculum instead of Anatomy Physiology
    with corresponding lab
  • Curriculum does not include
  • Microbiology
  • Chemistry
  • Clinical many times does not include
  • Psychiatric Nursing

31
ADMISSION TO PRACTICE
  • Licensure

32
Licensure
  • Represents
  • Specialized knowledge
  • Independent judgment
  • Fitness and Capacity to Practice
  • Required to practice nursing in the state of
    Alabama

33
Licensure
  • Alabama is NOT part of the licensure compact at
    this time.

34
Temporary Permit
  • New graduates may request a nonrenewable
    temporary permit to practice nursing that is
    valid until
  • The applicant fails the licensing examination.
  • The expiration date on the permit is reached.
  • A license is issued.
  • The applicant is denied licensure.

35
Temporary Permit Administrative Code
610-X-4-.07
  • Signatures
  • Practical Nurse (PN) Program NG-PNP
  • RN Program NG-RNP
  • Restrictions The Nursing Graduate
  • Must function under DIRECT Supervision of a
    currently licensed Registered Nurse
  • Shall not assume nor be assigned charge
    responsibilities

36
Licensure Renewal
  • LPNs - odd numbered years
  • December 31, 2009
  • RNs - even numbered years
  • December 31, 2010
  • Continuing education is required for renewal

37
License Renewal
  • The licensed nurse shall have the active license
    renewal card available for employer inspection by
    January 1 of the new license period.
  • Administrative Code 610-X-4-.08(4)

38
License Lookup
  • This application is for LICENSE LOOKUP.
  • Updated daily by 800 am.
  • Search by entering the license number or the
    entire last and first name or by portions of last
    and first name.

39
License Lookup
40
GROUP ONLINE LICENSE VERIFICATION BY SUBSCRIPTION
  • You can subscribe annually and once you input the
    license numbers of the nurses employed in your
    facility/agency, you will receive electronic
    notification at any time the license status of
    your nursing employees changes, including
    renewal.

41
Why should I subscribe?
  • Provides license verification information without
    phone calls or written requests.
  • PUSH technology will notify you within 24-48
    hours if the license status changes.
  • Reduces the risk of individuals working without
    proper authorization from the Board of Nursing.
  • Provides information to employer about the
    individual nurse.

42
LEVEL ONE Subscription fee of 100 annually
  • PUSH technology
  • Name of licensee
  • License Number
  • License status (including temporary permits)
  • Expiration date of license
  • Original date of licensure
  • LEVEL TWO Subscription fee of 750 annually
  • LEVEL THREE Subscription fee of 1500 annually

43
Legal Foundation of Nursing
  • Nurse Practice Act
  • And
  • Administrative Code

44
Nurse Practice Act And ABN Administrative Code
45
Legal Foundation of Nursing Practice
  • Nurse Practice Act statutes passed by
    legislature broad language provides authority
    for Board to pass regulations
  • ABN Administrative Code regulations passed by
    Board to clarify, amplify, and explain the
    statutes
  • Proposed rules posted on Boards web site
  • Requires 35 day public notice and comment period
  • If Board approves, rules become effective in
    another 35 days after filing

46
Definition of RN in Statute
  • PRACTICE OF PROFESSIONAL NURSING. The
    performance, for compensation, of any act in the
    care and counseling of persons or in the
    promotion and maintenance of health and
    prevention of illness and injury based upon the
    nursing process which includes systematic data
    gathering, assessment, appropriate nursing
    judgment and evaluation of human responses to
    actual or potential health problems through such
    services as case finding, health teaching, health
    counseling provision of care supportive to or
    restorative of life and well-being and executing
    medical regimens including administering
    medications and treatments prescribed by a
    licensed or otherwise legally authorized
    physician or dentist. A nursing regimen shall be
    consistent with and shall not vary any existing
    medical regimen. Additional acts requiring
    appropriate education and training designed to
    maintain access to a level of health care for the
    consumer may be performed under emergency or
    other conditions which are recognized by the
    nursing and medical professions as proper to be
    performed by a registered nurse.
  • Code of Ala., 1975, 34-21-1(3)(a)

47
Practice of Professional Nursing (Registered
Nurse)
  • The performance, for compensation, of any act in
    the
  • Care and counseling
  • Promotion and maintenance of health
  • Prevention of illness and injury

48
Practice of Professional Nursing Contd
  • Based upon the nursing process including
  • Systematic data gathering
  • Assessment
  • Appropriate nursing judgment and evaluation of
    human response
  • Case finding
  • Health Teaching
  • Health counseling

49
Practice of Professional Nursing Contd
  • Provision of care supportive to or restorative of
    life and well-being
  • Executing medical regimens including
    administering medications and treatments
    prescribed by a licensed..physician or dentist

50
Definition of LPN in Statute
  • PRACTICE OF PRACTICAL NURSING. The performance,
    for compensation, of acts designed to promote and
    maintain health, prevent illness and injury and
    provide care utilizing standardized procedures
    and the nursing process, including administering
    medications and treatments, under the direction
    of a licensed professional nurse or a licensed or
    otherwise legally authorized physician or
    dentist. Such practice requires basic knowledge
    of the biological, physical and behavioral
    sciences and of nursing skills but does not
    require the substantial specialized skill,
    independent judgment and knowledge required in
    the practice of professional nursing. Additional
    acts requiring appropriate education and training
    may be performed under emergency or other
    conditions which are recognized by the nursing
    and medical professions as proper to be performed
    by a licensed practical nurse.
  • Code of Al., 1975, 34-21-1(3)(b)

51
Practice of Practical Nursing (Licensed Practical
Nurse)
  • The performance, for compensation, of acts
    designed to
  • Promote and maintain health
  • Prevent illness and injury
  • Provide care utilizing standardized procedures
    and the nursing process
  • Including administering medications and
    treatments

52
Practice of Practical Nursing Contd
  • Under the direction of a
  • Licensed professional nurse
  • Licensed or otherwise legally authorized
    physician
  • Or
  • Licensed or otherwise legally authorized
    dentist

53
Practice of Practical Nursing Contd
  • Such practice requires basic knowledge of the
    biological, physical and behavioral sciences and
    of nursing skills but
  • does not require
  • the substantial specialized skill,
  • independent judgment and
  • knowledge
  • required in the practice of professional
  • nursing

54
Regulation
  • ABN Administrative Code regulations passed by
    Board to clarify, amplify and explain the statutes

55
Examples of Regulations Chapter 610-X-6,
Standards of Nursing Practice
  • -.02 Conduct and Accountability
  • (2) Function within the legal scope of nursing
    practice.

56
Examples of Regulations Chapter 610-X-6,
Standards of Nursing Practice
  • -.02 Conduct and Accountability
  • (9) Respect dignity and rights of patients and
    their significant others including, but not
    limited to (a) Privacy (b) Protection of
    confidential information, unless disclosure is
    required by law (c) freedom from exploitation of
    physical, mental, sexual, or financial
    boundaries and (d) protection of real and
    personal property.

57
Examples of Regulations Chapter 610-X-6,
Standards of Nursing Practice
  • -.03(2) and -.04(2) Competenceshall include, but
    is not limited to
  • (e) Delegation of selected nursing functions to
    others in accordance with the education and
    demonstrated competence of the persons. Tasks
    delegated to unlicensed assistive personnel shall
    not require the exercise of independent nursing
    judgment or intervention. Selected nursing
    functions that may not be delegated include but
    are not limited to performance of invasive or
    sterile procedures or administration of
    medications except as provided in Rule
    610-X-6-.06, -.07.

58
How do you access the Alabama Nurse Practice Act
and Administrative Code?
  • www.abn.state.al.us
  • Nurse Practice Act
  • Administrative Code
  • Declaratory Rulings
  • Proposed Rule Changes

59
What are Standards of Practice?
  • Level of performance that is
  • Desired and
  • Achievable
  • Expectation for nurses conduct and practice

60
Where do standards come from?
  • Laws and Regulations
  • Nurse Practice Act
  • ABN Administrative Code
  • Agency/Facility Policies Procedures
  • Nursing Education
  • Professional Associations

61
Example of a Nursing Standard
  • SEVEN Rights of Medication Administration
  • Right Patient
  • Right Medication
  • Right Time
  • Right Dose
  • Right Route
  • Right Reason
  • Right Documentation

62
Documentation Standard
  • If you didnt chart it, it wasnt done.

63
Care Standards
  • Knock before entering
  • Tell the patient what you are
  • going to do BEFORE you do it

64
Care Standards Contd
  • Introduce self to patient
  • Wear a name tag that can be seen read

65
Care Standards Contd
  • Provide for Hand Hygiene before meals
  • Straighten sheets, particularly for bedbound
    patients

66
  • What is it called when a nurses practice is
    undesirable or unacceptable?

67
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68
Additional Substandard Practice Violations
  • Abandonment
  • Boundary violations
  • Confidentiality breach
  • Improper Delegation
  • Improper Supervision

69
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70
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71
ADJUDICATION OF DISCIPLINE
  • Discipline,
  • Removal from Practice
  • and
  • Readmission to Practice

72
Complaints to ABN
  • Must be in writing
  • Email (abn_at_abn.state.al.us)
  • Letter
  • Form (website under Forms Other
    Information)
  • Employers Report of Possible Violation Form
  • Consumers Report of Possible Violation Form

73
Complaints Contd
  • Can be anonymous
  • Must contain sufficient information to identify
    the nurse who is being reported and what the
    nurse is alleged to have done wrong

74
Process
  • Docketed in database
  • Reviewed by Executive Officer
  • Notice of Investigation sent to Nurse
  • Acknowledgment sent to Complainant
  • Subpoena(s) issued
  • Investigated

75
NON-Discipline Options
  • No violation letter of closure
  • No provable violation but reported conduct
    inappropriate Letter of Admonishment
  • VDAP
  • Drugs/Alcohol abuse dependency
  • Mental Illness
  • Physical Impairment

76
Discipline Option Board must be able to prove
violation
  • Informal vs. Formal Disposition
  • Informal
  • Consent Order
  • Voluntary Surrender (self-revocation by nurse)
  • Formal Administrative Hearing

77
Types of Discipline
  • Reprimand
  • Reprimand and Fine
  • Probation
  • Fine
  • Until conditions met
  • Specific time period (1-5 years)

78
Types of Discipline Contd
  • Suspension
  • Fine
  • Until conditions met
  • Certain time period
  • May be followed by a period of Probation
  • One year automatic revocation clause in order
    if suspension extends beyond 12 months
  • Revocation
  • Voluntary Surrender Self-revocation

79
Other Laws, Rules and Regulations can NOT weaken
the Nurse Practice Act and Administrative Code
but do influence Nursing Practice
Non-Inclusive List
80
Conduct and Accountability Administrative Code
610-X-6-.02
  • What is Accountability?
  • Answerable or responsible for actions
  • What is Responsibility?
  • The charge to do something that is expected
    performance.
  • Shall mandatory
  • Administrative Code 610-X-2-.06 (4)

81
Conduct and Accountability Administrative
Code 610-X-6-.02(6)
  • The RN and LPN shall
  • Accept individual responsibility and
    accountability for judgments, actions and nursing
    competency.

82
Substandard Practice Failure to intervene
  • Resident lying on floor, had large amount of
    feces on herself after she lost her step/blacked
    out while attempting to get to the bathroom
  • Nurse allowed the resident to be assisted to the
    shower prior to assessing the resident for
    injuries
  • Medical evaluation the next day-fracture of left
    proximal humerus
  • Probation for 12 months, 300 fine, courses on
    critical thinking, patient assessment, and
    professional accountability
  • Limestone Lodge Assisted Living

83
Medication Error
  • RN administered Morphine 40 mg IV push instead of
    ordered 4 mg
  • RN administered Morphine 50 mg IV push instead of
    ordered D50W for treatment of hypoglycemia

84
Medication Error Cont
  • LPN administered Tetanus intradermally instead of
    PPD
  • LPN administered multiple oral medications in
    error
  • RN administered 4 Restoril tablets instead of
  • 4 Lyrica tablets

85
Patient Care Orders
  • Administrative Code 610-X-6-.09

86
Patient Care Orders and the Definition of
Professional Nursing
  • ...executing medical regimens including
    administering medications and treatments
    prescribed by a licensed or otherwise legally
    authorized physician or dentist.
  • Code of Alabama, 1975 34-21-1(3a)

87
Patient Care Orders and the Definition of
Practical Nursing
  • ... including administering medications and
    treatments, under the direction of a licensed
    professional nurse or a licensed or otherwise
    legally authorized physician or dentist.
  • Code of Alabama, 1975 34-21-1(3)(b)

88
Patient Care Orders Administrative Code
610-X-6-.09
  • Authorized prescriber
  • Licensed physician or dentist
  • CRNP (Nurse Practitioner)
  • CNM (Nurse Midwife)
  • LICENSED Physicians Assistant or Surgical
    Assistant
  • Lawful order
  • CRNPs CNM may NOT order narcotic medications

89
Verbal Orders Administrative Code
610-X-6-.09(2)
  • RN or LPN may receive verbal orders from an
    authorized prescriber relayed by
  • another licensed or registered health care
    professional or
  • CERTIFIED medical assistant
  • Implement standing orders at the direction of an
    authorized prescriber

90
Telecommunication for Pronouncement of Patient
Death Administrative Code 610-X-6-.10
  • The RN or LPN may receive a pronouncement of a
    patients death from a physician via
    telecommunication without a physical examination
    of the patient by that physician. A standardized
    procedure shall specify the permissible patient
    conditions for which the RN or LPN in a specific
    health care facility or agency may receive the
    pronouncement of a patients death by
    telecommunications.

91
Substandard Practice Lack of MD Order Scope of
Practice
  • Gave another employee an injection of Rocephin
    with no MD order.

92
How does the nurse record pertinent patient data
as proof of the quality of care provided?
93
Tips on Charting
  • Write legibly in INK
  • Be accurate
  • Date Time
  • NO Block Charting (7-3 Resting quietly)
  • Late Entries

94
Abbreviations
  • Use approved abbreviations
  • Accepted Standards vs specialty practice terms
  • VAD
  • Vascular Access Device
  • Ventricular Assist Device
  • JCAHO Patient Safety Program
  • Hazardous abbreviations in medication orders

95
Tips on Charting Contd
  • Descriptive Terminology
  • Punch colored (what flavor punch?)
  • Be concise
  • Be objective Write facts, not opinions
  • Assessment/interpretation
  • Behavior
  • Resting comfortably (Says who?)
  • Confused (Says who?)

96
Grounds for Disciplinary Action regarding
Documentation
  • Failure to make entries (NEVER discard pages from
    PERMANENT patient record)
  • Destroying or altering entries (Recopy, for
    legibility, and label the page keep old and new
    pages together)
  • Pre-charting - Charting BEFORE assessment or
    delivery of care
  • Medication
  • Treatment
  • Assessment
  • Administrative Code 610-X-8-.03(6)(g) and (h)

97
Traditional Standard of Documentation
  • If you didnt chart it, it wasnt done.

98
ABN added..
  • If you didnt do it, DONT chart it!

99
Substandard Practice False Documentation
  • Documented the administration of Percocet and
    Lortab for which there was no record of sign out
    on the controlled drug record
  • boundary violation - accepted and cashed checks
    made out to her by a resident
  • exceeded LPN scope of practice - supervised all
    aspects of resident care provided by licensed and
    non-licensed staff and provided care without the
    direction of a Registered Nurse
  • Suspension until payment of 500 fine and courses
    on documentation, professional accountability,
    and chemical dependency followed by probation for
    12 months
  • Mature Options Senior ServicesSeasons of
    Talladega, Autumn Trace, Summer Place

100
Conduct and Accountability Administrative
Code 610-X-6-.02(3)
  • The RN and LPN shall
  • Be responsible and accountable for the QUALITY of
    nursing care delivered to patients
  • based on and LIMITED to
  • scope of education,
  • demonstrated competence, and
  • nursing experience.

101
Conduct and Accountability (Contd)
Administrative Code 610-X-6-.02
  • Respect the dignity and rights of patients and
    their significant others including, but not
    limited to
  • Privacy protection of confidential information,
    unless disclosure is required by law
  • Freedom from exploitation of physical, mental,
    sexual, or financial boundaries and
  • Protection of real and personal property.

102
Abuse
  • Intentionally or negligently causing or
    permitting physical, sexual, emotional or verbal
    abuse of a patient, willfully harassing or
    intimidating a patient.
  • Administrative Code 610-X-8-.03(6)(o)

103
Substandard Practice Patient Abuse
  • Repeatedly sprayed wound cleanser in the face of
    a quadriplegic resident during the residents
    care.
  • Subsequently disciplined on two other occasions

104
Substandard Practice Patient Abuse
  • Tied the resident in the wheelchair with a bed
    sheet.

105
Substandard Practice Patient Abuse
  • Verbally abused and used profanity with a patient
    in an attempt to get the patient to return to the
    other side of the patients semi-private room.

106
Scope of Practice Administrative Code
610-X-6-.03 and -.04
  • includes but is not limited to
  • (a) Educational preparation, initial and
    continued
  • (b) License status, including Board approval for
    advanced practice nursing
  • (c) State and federal statutes, and regulations
  • (d) State and national standards appropriate to
    the type of practice
  • (e) Nursing experience
  • (f) Demonstrated competence and
  • (g) Knowledge, skills, and ability to manage
    risks and potential complications.

107
Practice Beyond Scope Illegal Practice
  • Practiced as RN supervisor for compensation while
    her license was lapsed
  • Public reprimand and payment of 600 fine
  • St. Martins in the Pines

108
Please Identify.
  • Any basic NURSING program that taught a student
    how to use a scalpel

109
Substandard Practice Exceeded Scope of Practice
  • Nurse performed sharp debridement on a patients
    heel

110
Conduct and Accountability Administrative
Code 610-X-6-.02(4)
  • The RN or LPN shall
  • Be responsible and accountable for the quality of
    nursing care delivered to patients by nursing
    personnel under the individual nurses supervision

111
Responsibility Accountability
  • RN supervises
  • Other RNs
  • LPNS
  • Nursing Assistants
  • LPN supervises
  • Other LPNs
  • Nursing Assistants

112
Delegation
  • The act of authorizing a competent individual to
    perform acts supportive to RNs or LPNs in
    selected situations.
  • Administrative Code 610-X-6-.03 (2e) .04(2e)

113
Delegation Administrative Code 610-X-6-.03
(2e) 610-X-6-.04(2e)
  • Tasks delegated to UNLICENSED personnel shall
    involve
  • NO tasks or functions that require independent
    nursing judgment or intervention
  • NO invasive or sterile procedures
  • NO administration of medications

114
Delegation Administrative Code 610-X-6-.03
(2)(e) 610-X-6-.04(2)(e)
  • Consistent with
  • education AND
  • demonstrated competence of the PERSON to whom the
    task is delegated

115
Substandard Practice Improper Delegation/supervisi
on
  • Allowed unlicensed staff to administer
    medications to residents
  • Acknowledged that she prepared the medications
    and signed the MAR to reflect that the medication
    was given
  • Public reprimand and payment of 300 fine
  • TLC Assisted Living Home

116
Abandonment
  • Acceptance of a patient assignment, thus
  • establishing a nurse-patient relationship, and
  • then Ending the nurse-patient relationship
  • Without Giving Reasonable Notice to
  • supervisory personnel so that others can make
  • arrangements for continuation of nursing care.

117
Substandard Practice Abandonment
  • Abandoned her assignment without notice to
    supervisory personnel so that others could make
    arrangements for continuation of nursing care
  • Fraud/deceit - falsified time card
  • False documentation falsified residents MAR
  • Probation for 12 months, payment of 300 fine and
    courses on professional accountability,
    documentation, and legal/ethical aspects of
    nursing
  • Cedar Hill Assisted Living Facility

118
Unprofessional Behavior/Conduct
  • Nursing behaviors
  • (acts, knowledge practices)
  • failing to meet the minimal standards of
    acceptable and prevailing nursing practice,
  • which could jeopardize the health, safety and
    welfare of the public

119
Substandard Practice Unprofessional Conduct
  • Completed terms of an Order (Probation until
    completion of course on legal/ethical aspects of
    nursing and payment of 250 fine) due to
    unprofessional conduct, THEN
  • Failed to observe that medications were
    administered as documented left medication on a
    table excessive amount of medication on hand
    when compared to MAR and date medication
    dispensed
  • Same conduct at a Nursing Home
  • Suspension until payment of 1000 fine and
    completion of pharmacology course followed by
    probation for 24 months
  • Ashton Gables in Riverchase and Lakeview Estates
    Assisted Living

120
Substandard Practice Unprofessional Conduct
  • Involved in altercation and assaulted PCT by
    slapping PCT in the face twice

121
Frequent Misconceptions often resulting in
Disciplinary Action
  • From the Nurse
  • Because a doctor told me to do a procedure/give
    a medication, it is OK.
  • From the Physician
  • Because I told the nurse to
  • do a procedure/give a medication,
  • it is OK

122
Conduct and Accountability Administrative Code
610-X-6-.02
  • Collaborate WITH other members of the health care
    team.
  • Practice WITHOUT discrimination on the basis of
    age, race, religion, gender, national origin,
    sexual orientation, patient diagnosis or
    disability.

123
Professional Boundary
  • Administrative Code 610-X-8-.03(6p)

124
Grounds for disciplinary action related to
Professional Boundary Violation Administrative
Code 610-X-8-.03(6)(p)(i), (ii), and (iii)
  • Sexual or Intimate Conduct
  • Emotional or Financial Exploitation
  • Inappropriate Disclosure
  • With/ to a patient, patients immediate family
    member(s) or significant other(s)

125
Individual Nurses Responsibility
  • Accept individual responsibility and
    accountability for timely reporting of
  • illegal,
  • substandard,
  • unethical,
  • unsafe, or
  • incompetent nursing practice
  • DIRECTLY to the Board of Nursing.
  • Administrative Code 610-X-6-.02(10)

126
Competence
  • Administrative Code 610-X-6-.03(2)
  • Administrative Code 610-X-6-.04(2)

127
Competence in the Practice of Nursing
Administrative Code 610-X-6-.03(2) .04(2)
  • Includes but is not limited to
  • Knowledge and compliance with
  • Applicable statutes and regulations
  • Standards of nursing practice
  • Standardized procedures for nursing practice

128
Competency Contd Administrative Code
610-X-6-.02(6)
  • The RN and LPN shall
  • Accept individual responsibility and
    accountability for judgments, actions and nursing
    COMPETENCY.

129
Competence.shall include. Administrative
Code 610-X-6-.03(2b)
  • Maintenance of knowledge and skills in the area
    of practice.

130
Continuing Education for renewal of
license Administrative Code
610-X-4-.08(3)(b) and (c)
  • A registered nurse and licensed practical nurse
    shall earn in each earning period not less than
    24 contact hours of Board-approved or
    Board-recognized continuing education as a
    condition for renewal of license for the
    subsequent license period.
  • Failure to meet the continuing education
    requirement shall be cause for the license to
    lapse.

131
Grounds for Disciplinary Action related to
Continuing Education Administrative Code
610-X-10-.02(4)
  • Failure to comply with continuing education
    requirements may result in disciplinary action by
    the Board.

132
Alabama Nurses
  • FY 2008 - 68,145 nurses
  • 50, 184 RNs
  • 17, 961 LPNs
  • As of June 2009
  • 325 nurses monitored in VDAP
  • 317 nurses with license status of
    Active/Probation
  • 218 RNs
  • 94 LPNs
  • 3 CRNAs
  • 2 CRNPs

133
Nursing Education Programs July 2009
  • 43 RN Programs
  • 27 ADN
  • 1 ADN mobility (LPN to RN)
  • 15 BSN
  • 24 PN Programs

134
Whats new July 2009
  • New Rules
  • Continuing Education 610-X-2-.10 and 610-X-10
  • eliminated the distinction between independent
    study and attended CE
  • Licensure 610-X-4-.07, -.08 and -.10
  • incorporated new CE rules
  • Rules under revision
  • Standards of Practice 610-X-6 and -7
  • Discipline 610-X-8

135
Board Vacancies as of Jan 1, 2010
  • RN Nursing Practice Position (1)
  • RN Nursing Education Position (1)
  • Advanced Practice Nursing Position (1)
  • LPN Position through LPNAA (1)
  • The position is nominated by LPNAA.  Ms. Hopkins
    is eligible for reappointment. 
  • Consumer Position (1)
  • The consumer position is not nominated by any
    particular group and is appointed by the
    Governor.  Mr. Harry I. Brown, Jr. is eligible
    for reappointment. 

136
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