Embedded Files
spell out the RN’s responsibility to organize, manage, and supervise the practice of nursing. Indeed, the rules can delineate the specific steps for effective delegation by an RN as ensuring: ⦁ unlicensed assistive personnel (UAP) have the education, legal authority, and demonstrated competency to perform the delegated task ⦁ task is consistent with UAP’s job description ⦁ task can be safely performed according to clear, exact, and unchanging directions ⦁ results of the task are reasonably predictable ⦁ task does not require assessment, interpretation, or independent decision making ⦁ patient and circumstance are such that delegation of the task poses minimal risk to the patient ⦁ consequences of performing the task improperly are not lifethreatening ⦁ RN provides clear directions and guidelines regarding the task (NCSBN, 2012b). Title and Licensure The use of the title nurse by unlicensed individuals misleads and endangers the public. “This poses a serious threat to patient care and safety. Reserving the title nurse for only those meeting the legal and educational standards allows the public to consult with professionals required to adhere to professional codes of practice and ethics” (Pennsylvania State Nurses Association, 2011). NPA language generally includes a statement regarding the title of RN and LPN/VN. By specifying that the title of RN is “given to an individual intended to practice nursing” and LPN/VN is “given to an individual licensed to practice practical/ vocational nursing,” the NPA protects these titles from being used by unauthorized persons and therefore protects the public (NCSBN, 2012a). Each state’s NPA also includes statements regarding examination for licensure as RNs and LPN/VNs, including frequency and requisite education before examination and reexamination. Additional requirements of licensure by examination typically include: ⦁ application and fee ⦁ graduation from an approved prelicensure program or a program that meets criteria comparable to those established by the state ⦁ passage of the professional examination ⦁ attestation of no report of substance abuse in the last 5 years ⦁ verification of no report of actions taken or initiated against a professional license, registration, or certification ⦁ attestation of no report of acts or omissions that are grounds for disciplinary action as specified in the NPA. The majority of jurisdictions include criminal background checks as an additional requirement for licensure (NCSBN, 2012c). Further requirements are included in NPAs for licensure by examination of internationally educated applicants, licensure by endorsement, as well as licensure renewals, reactivation, and continuing education. Endorsement is an approval process for a nurse who is licensed in another state. Obtaining licensure by endorsement often includes prelicensure requirements and verification of licensure status from the state where the nurse obtained licensure by examination (NCSBN, 2012a). Although statutory language varies from state to state regarding the licensure of APRNs, most states recognize clinical nurse specialist, nurse midwife, nurse practitioner, and registered nurse anesthetist as APRN roles and require certification by a national nurse certification organization. Education and specific scope of practice vary from state to state. Volume 3/Issue 3 October 2012 www.journalofnursingregulation.com 39 Grounds for Disciplinary Action, Other Violations, and Possible Remedies The majority of nurses are competent and caring individuals who provide a satisfactory level of care. However, when a problem is experienced with a nurse and the nurse’s performance is not acceptable, a complaint may be filed with the BON. The BON, through its statutory authority specified in the NPA, is responsible for review and action regarding complaints. A BON can take formal action only if it finds sufficient basis that the nurse violated state laws or regulations. Each case varies and needs to be considered on its own merits (Brous, 2012, pp. 510–511; NCSBN, 2012d). For an overview of the disciplinary process from receipt of complaint to resolution, see Figure 1. Disciplinary cases are often grouped into the following categories: ⦁ Practice-related: breakdowns or errors during aspects of the nursing process ⦁ Drug-related: mishandling, misappropriation, or misuse of controlled substances ⦁ Boundary violations: nontherapeutic relationships formed between a nurse and a client in which the nurse derives a benefit at the client’s expense (NCSBN, 2009) ⦁ Sexual misconduct: inappropriate physical or sexual contact with a client ⦁ Abuse: maltreatment of clients that is physically, mentally, or emotionally harmful ⦁ Fraud: misrepresentation of the truth for gain or profit (usually related to credentials, time, or payment) ⦁ Positive criminal background checks: detection of reportable criminal conduct as defined by statute (NCSBN, 2011b, 2012e). If a substance use disorder is suspected from the evidence and there is no diversion of medication, BONs may offer the nurse a nondisciplinary alternative-to-discipline program. These programs are not treatment programs—they are monitoring programs. The possibility of avoiding the public notoriety of discipline can be an important factor in breaking through the nurse’s denial of substance use disorder and movement to a program that will assist the nurse in
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