Specific Issues
Among the many issues covered by the Ohio Nurse Practice Act, the following are specifically chosen to discuss in detail:
Death pronouncement: Only a person holding an active certificate to practice medicine, surgery, or osteopathic medicine or surgery may pronounce a person dead. However, if a licensed nurse, or other competent observer, has provided the physician with sufficient facts, the physician can pronounce the patient dead without personally examining the body of the deceased.
Delegation: Non-licensed staff, such as medical assistants and nurse aids, may be delegated to administer ONLY topical medications to intact skin as a barrier to improve skin condition, such as:
Delegation of tasks must always be within the scope of practice of the person to whom the task is delegated, whether the person be licensed or unlicensed. Standard unchanging procedures - - such as bathing a patient, obtaining a routine urine specimen - - are usually those that can be delegated because they don’t involve assessment or evaluation. Delegated tasks should hold little/no risk to the patient, require specific non-complex skills, and have a predictable outcome.The delegating nurse must always maintain patient contact despite delegation of some duties and must continue to evaluate and assess the patient’s condition and response to treatment. Additionally, the delegating nurse must remain responsible for supervising the person to whom tasks are delegated.
A good example of responsible delegation vs. non delegation is the admission of a new patient to the nurse's care. Though 'taking routine vital signs' is often a task that is delegated to unlicensed personnel, admission to care is not a routine experience. The licensed nurse obtains valuable assessment data by taking the patient's vital signs him/herself, and use this information during the initiation of a nursing care plan for use by the entire unit. Depending on the patient's state of consciousness, this may be a good time to explain who else will be involved in the patient's care, and how to get in touch with them.
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School nurse: As of September 2007, the Board of Nursing approved a two-part decision-making model for school nurses. The local Board of Education must have a policy that specifically authorizes or prohibits administration of medications by school personnel. Since 1983, Ohio law has allowed non-licensed school employees to administer medications according to school board policy. Therefore, because this is authorized by law, a licensed nurse does not “delegate” the administration of medications by unlicensed persons. The nurse may provide training for safe medication administration; the school nurse must provide care that is legal, competent, safe, and accountable.
Peripherally inserted central catheters (PICC line): Licensed registered nurses may insert and remove PICC lines if they have obtained appropriate education, such as certification and supervised practice. When directed to do so by a physician, registered nurse, or advanced practice nurse, a licensed practical nurse may only administer the following through a central venous line or PICC: Dextrose 5%, NS, lactated ringers, sodium chloride 0.45%, sodium chloride 0.2%, or sterile water. If an RN initiates treatment of adding vitamins or electrolytes to these same solutions, the LPN can administer these also. LPNs may not insert or remove PICC lines.
Termination of pregnancy: It is considered unauthorized practice (4723.44) for a licensed nurse in Ohio to "prescribe any drug or device to perform or induce an abortion, or otherwise perform or induce an abortion." This holds true for advanced practice nurses also, who would normally have the necessary valid certificates to prescribe other drugs and/or therapeutic devices. In the case of a molar pregnancy, the nurse may administer drugs to induce expelling of the mass of non-embryonic tissue.
Physician Assistant’s (PA) orders: The Ohio legislature revised the laws regarding PAs in 2006, allowing individual PAs to obtain prescriptive authority. Previously it was required that a supervising physician countersign PA orders, prior to a licensed nurse implementing them. At this time, the supervising physician may still choose to require a countersigning.
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