Nursing Trends 1
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| BON Rule 224 | Delegation
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| BON Rule 224.8 (a) | Tasks Most Commonly Delegated
-Assistance with ambulation
-Assistance with positioning
-Collecting/reporting/documenting data (VS, I&O)
-ADLs assist
-Reinforcement of health teaching
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| BON Rule 224.8 (b) | Discretionary Tasks
-More invasive/complicated tasks
-RN directly responsible for client's care
-i.e. Sterile procedures, invasive procedures, care of broken-skin, dressing/wound cleansing
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| BON Rule 224.7 | Supervision
-Depends on:
1) condition of client
2) Competency of UAP
3) nature of task
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| BON Rule 224.8 (c)1 | Tasks Prohibited from Delegation
-Assessments requiring nursing judgment, formulating care
-Client teaching
-Med administration, except special circumstances
-Nurses students working as UAPs (enrolled in accredited RN program) MUST DEMONSTRATE COMPET
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| BON Rule 224.6 (2) | 5 Rights of Delegation
-Right task
-Right person
-Right circumstance
-Right direction & communication
-Right supervision
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| TOC 301.352 | Safe Harbor: Protection for Refusal to Engage in Certain Conduct
Refuse assignment and request Peer Review if disciplined
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| TOC 303.005 | File Safe Harbor and accept (pending) unsafe assignment
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| BON Rule 217.20 Timeline | • PRC shall complete review and notify nurse administrator within 14 days of request
• Nurse administrator shall review and notify nurse within 48 hrs of findings and agreement
• Up to 16 days you will be notified
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| BON Rule 217.20 | Safe Harbor Peer Review for Nurses [with TOC 303.005]
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| BON Rule 217.19 | Incident-based Peer Review - does not apply for Safe Harbor Peer Review
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| BON Rule 217.11 | Standards of Nursing Practice:
o Examples of conduct required in ANY practice setting for ANY level of nursing
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| BON Rule 217.11 - Preamble | Minimum acceptable level
Failure to meet standards may result in action against license even if no actual harm
Investigated just for placing the pt at risk
Applies to actions even if nurse was not at work
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| BON Rule 217.11 - Part 1 | ALL LVNs/RNs/APNs
-Know the law
-Implement measures for safe environment
-Know rationales/effects/how to correctly administer all medications/treatments
-Maintain professional boundaries
-Do not take OR give any inappropriate assignments
-Documentat
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| BON Rule 217.11 - Part 2 | LVNs
-Directed scope of nursing under RN/APN/PA/Physician
-Assist in predictable healthcare needs
-FOCUSED assessments
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| BON Rule 217.11 - Part 3 | RNs
-Comprehensive assessments
-Making nursing diagnoses
-Implement appropriate aspects of care within RN scope
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| BON Rule 217.11 - Part 4 | APNs
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| BON Rule 217.12 | Unprofessional Conduct:
o Unsafe practice, failure of CNO – Chief Nursing Officer, outside scope, misconduct, failure to repay student loan, drug diversion or drug related, unlawful practice, leaving assignment, criminal conduct
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| BON Rule 217.16 | Minor Incident Rule:
ANY 1 Criteria PRESENT = REPORT TO BOARD:
-Have significant risk of substantial harm
-Lacks conscientious approach or accountability for involvement
-Lacks easily remediated knowledge/ competencies
- 5/year minor incidents
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| BON Rule 217.19 | Incident Based Peer Review and Whistle Blower Protections
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| TOC 301.413 | Nursing Practice Act- Provides the nurse the right to file civil suit to recover damages
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| Typical Investigation Process - BON receives complaints by: | PR referral
Terminated for practice employer reports to BON
Involved in malpractice suit
Found guilty/deferred adjudication from criminal complaint
Public member calls BON
Is part of & violates professional org.
DA notifies BON if convicted of crime
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| Change of Address protocol | Nurse has 10 days to file a change of address or name with the BON
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| BON prioritization of cases | Priority 1 - Serious injury to a patient, death of patient, felony conviction
• Generally takes 9 months to a year for procedures
• Some very serious cases, BON can use emergency removal of nurse’s license [rare]
Priority 4 – less serious
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| Anthony Diggs | head of BON Enforcement division
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| Agreed Order | Nurse has 3 weeks to decide if they agree with stipulations
-Sign proposal as is
-Representation negotiate for milder punishment
-Ask BON for informal settlement conference
-Take case to formal hearing
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| Levels of Discipline | Remedial Education
Warning
Reprimand
Suspension
Revocation
Surrender
*minimum of 64 hours per month under the following stipulations for 1 year
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| Remedial education | Gentlest for of discipline; may be accompanied by fine
Only category that has no clinical/practice restrictions
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| Warning | Generally for one year (with indirect supervision, remedial education)
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| Reprimand | o Under disciplinary action for 2+ years
o 1st year directly supervised
o 2nd year indirect
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| Suspension | o Probated – on record as having been suspended; nurse doesn’t have to stop working
o Enforced – nurse has stopped working; license is inactive during period; License is active after period; does not have to reapply
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| Revocation | o License is revoked, he or she can typically reapply after a year (after fulfilling other requirements)
o License is null/void for time period
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| Surrender | o Nurse can surrender license
o Can reapply a year after surrender typically
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| Deferred Discipline | o Will no longer be public information after 5 years if there’s no further complaints against your license
o Currently only with remedial education and warning [not always granted]
o STILL in quarterly bulletin initially
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| Types of Law | Statutory
Administrative
Common Law
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| Statutory Law (def.) | Law that is made by elected officials
i.e. Texas Nursing Practice Act (1909)
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| Administrative Law (def.) | Law that is made by regulatory or licensing bodies/agencies
i.e. Board of Nursing (BON) Rules and regulations that define parameters and help nurses understand statutory law
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| Common Law | Law that is generated from trying cases at courthouses
i.e. jury decisions set precedents
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| Katherine Thomas | Executive Director, highest ranking staff member of BON
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| Board Divisions | Licensing Division
Consultation Division
Enforcement Division
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| Characteristics of a Profession | Unique body of knowledge
Scientific method to enlarge body of knowledge
Education within institutions of higher learning
Control of professional policy/activity
Code of Ethics
Lifetime Commitment
Service to the Public
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| TOC 301.257 | Declaratory Order of License Eligibility:
One may petition BON for Yes to any eligibility Qs
BON investigates each potential reason; writes determination for each
If found ineligible, petitioner can ask for State Office of Administrative Hearings
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| BON Rule 213.30 | Declaratory Order of Eligibility for Licensure
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