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Ohio Laws and Rules
(A) The purpose of this chapter is to establish:
(1) Minimal acceptable standards of safe and effective nursing practice for a registered nurse and a licensed practical nurse in any setting;
(2) Minimal acceptable standards of safe and effective practice for a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, and clinical nurse specialist in any setting. Additional standards for practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, and clinical nurse specialist are established in Chapters 4723-8 and 4723-9 of the Administrative Code; and
(B) For purposes of this chapter, the following definitions shall apply:
(1) “Certified nurse-midwife” means a registered nurse who has met the requirements of section 4723.41 of the Revised Code, and who holds a current valid certificate of authority issued by the board under section 4723.42 of the Revised Code.
(2) “Certified nurse practitioner” means a registered nurse who has met the requirements of section 4723.41 of the Revised Code, and who holds a current valid certificate of authority issued by the board under section 4723.42 of the Revised Code.
(3) “Certified registered nurse anesthetist” means a registered nurse who has met the requirements of section 4723.41 of the Revised Code, and who holds a current valid certificate of authority issued by the board under section 4723.42 of the Revised Code.
(4) “Client” means the recipient of nursing care, which may include an individual, a group, or a community.
(5) “Clinical judgment” is the application of the nurse’s knowledge and experience in making decisions about client care.
(6) “Clinical nurse specialist” means a registered nurse who has met the requirements of section 4723.41 of the Revised Code, and who holds a current valid certificate of authority issued by the board under section 4723.42 of the Revised Code.
(7) “Direction” means communicating a plan of care to a licensed practical nurse. Direction by a registered nurse is not meant to imply the registered nurse is supervising the licensed practical nurse in the employment context.
(8) “Licensed nurse” means a registered nurse or a licensed practical nurse who holds a current valid license to practice nursing in Ohio.
(9) “Nursing diagnosis” means the identification of a client’s needs or problems which are amenable to nursing intervention.
Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01, 4723.28 (B)(19)
Prior Effective Dates: 12/1/1995, 4/1/1999, 2/1/2002, 2/1/2003, 2/1/2004
(A) A registered nurse shall provide nursing care within the scope of practice of nursing for a registered nurse as set forth in division (B) of section 4723.01 of the Revised Code and the rules of the board.
(B) A registered nurse shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice.
(C) A registered nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following:
(1) Consistent performance of all aspects of nursing care; and
(2) Recognition, referral or consultation, and intervention, when a complication arises.
(D) A registered nurse may provide nursing care which is beyond basic nursing preparation for a registered nurse, provided:
(1) The nurse obtains education which emanates from a recognized body of knowledge relative to the nursing care to be provided;
(2) The nurse demonstrates knowledge, skills, and abilities necessary to provide the nursing care;
(3) The nurse maintains documentation satisfactory to the board of meeting the requirements set forth in paragraphs (D)(1) and (D)(2) of this rule;
(4) When the nursing care to be provided is in accordance with division (B)(5) of section 4723.01 of the Revised Code, the nurse has a specific current order from an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice; and
(5) The nursing care does not involve a function or procedure which is prohibited by any other law or rule.
(E) A registered nurse shall, in a timely manner:
(1) Implement any order for a client unless the registered nurse believes or should have reason to believe the order is:
(a) Inaccurate;
(b) Not properly authorized;
(c) Not current or valid;
(d) Harmful, or potentially harmful to a client; or
(e) Contraindicated by other documented information; and
(2) Clarify any order for a client when the registered nurse believes or should have reason to believe the order is:
(a) Inaccurate;
(b) Not properly authorized;
(c) Not current or valid;
(d) Harmful, or potentially harmful to a client; or
(e) Contraindicated by other documented information.
(F) When clarifying an order, the registered nurse shall, in a timely manner:
(1) Consult with an appropriate licensed practitioner;
(2) Notify the ordering practitioner when the registered nurse makes the decision not to follow the order or administer the medication or treatment as prescribed;
(3) Document that the practitioner was notified of the decision not to follow the order or administer the medication or treatment, including the reason for not doing so; and
(4) Take any other action needed to assure the safety of the client.
(G) A registered nurse shall, in a timely manner, report to and consult as necessary with other nurses or other members of the health care team and make referrals as necessary.
(H) A registered nurse shall maintain the confidentiality of client information. The registered nurse shall communicate client information with other members of the health care team for health care purposes only.
(I) To the maximum extent feasible, identifiable client health care information shall not be disclosed by a registered nurse unless the client has consented to the disclosure of identifiable client health care information. A registered nurse shall report individually identifiable client information without written consent in limited circumstances only and in accordance with an authorized law, rule, or other recognized legal authority.
(J) The registered nurse shall use acceptable standards of safe nursing care as a basis for any observation, advice, instruction, teaching, or evaluation and shall communicate information which is consistent with acceptable standards of safe nursing care.
(K) When a registered nurse provides direction to a licensed practical nurse in accordance with Chapters 4723-1 to 4723-23 of the Administrative Code, the registered nurse shall first assess:
(1) The condition of the client who needs nursing care, including, but not limited to, the stability of the client;
(2) The type of nursing care the client requires;
(3) The complexity and frequency of the nursing care needed;
(4) The training, skill, and ability of the licensed practical nurse who will be performing the specific function or procedure, to perform the specific function or procedure; and
(5) The availability and accessibility of resources necessary to safely perform the specific function or procedure.
Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01, 4723.28 (B)(19)
Prior Effective Dates: 12/1/1995, 4/1/1997, 4/1/1999, 2/1/2002, 2/1/2003, 2/1/2004
(A) A licensed practical nurse shall function within the scope of practice of nursing for a licensed practical nurse as set forth in division (F) of section 4723.01 of the Revised Code and the rules of the board.
(B) A licensed practical nurse shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice.
(C) A licensed practical nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged which includes, but is not limited to, the following:
(1) Consistent performance of all aspects of nursing care; and
(2) Recognition, referral or consultation, and intervention, when a complication arises.
(D) A licensed practical nurse may provide nursing care in accordance with division (F) of section 4723.01 of the Revised Code which is beyond basic preparation for a licensed practical nurse provided:
(1) The nurse obtains education which emanates from a recognized body of knowledge relative to the nursing care to be provided;
(2) The nurse demonstrates knowledge, skills, and abilities necessary to perform the nursing care;
(3) The nurse maintains documentation satisfactory to the board of meeting the requirements set forth in paragraphs (D)(1) and (D)(2) of this rule;
(4) When the nursing care to be provided is in accordance with division (F)(3) of section 4723.01 of the Revised Code, the nurse has a specific current valid order or direction from an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice; and
(5) The nursing care does not involve a function or procedure which is prohibited by any other law or rule.
(E) A licensed practical nurse shall, in a timely manner:
(1) Implement any order or direction for a client unless the licensed practical nurse believes or should have reason to believe the order or direction is:
(a) Inaccurate;
(b) Not properly authorized;
(c) Not current or valid;
(d) Harmful, or potentially harmful to a client; or
(e) Contraindicated by other documented information; and
(2) Clarify any order or direction for a client when the licensed practical nurse believes or should have reason to believe the order or direction is:
(a) Inaccurate;
(b) Not properly authorized;
(c) Not current or valid;
(d) Harmful, or potentially harmful to a client; or
(e) Contraindicated by other documented information.
(F) When clarifying an order or direction, the licensed practical nurse shall, in a timely manner:
(1) Consult with an appropriate licensed practitioner or directing registered nurse;
(2) Notify the ordering practitioner or directing registered nurse when the licensed practical nurse makes the decision not to follow the order or direction or administer the medication or treatment as prescribed;
(3) Document that the practitioner or directing registered nurse was notified of the decision not to follow the direction or order, or administer the medication or treatment, including the reason for not doing so; and
(4) Take any other action needed to assure the safety of the client.
(G) A licensed practical nurse shall, in a timely manner report to and consult as necessary with other nurses or other members of the health care team and make referrals as necessary.
(H) A licensed practical nurse shall maintain the confidentiality of client information obtained in the course of nursing practice. The licensed practical nurse shall communicate client information with other members of the health care team for health care purposes only.
(I) To the maximum extent feasible, identifiable client health care information shall not be disclosed by a licensed practical nurse unless the client has consented through a properly executed release to the disclosure of identifiable client health care information. A licensed practical nurse shall report individually identifiable client information without written consent in limited circumstances only, and in accordance with an authorized law, rule, or other recognized legal authority.
(J) When a licensed practical nurse is directed to observe, advise, instruct, or evaluate the performance of a nursing task, the licensed practical nurse shall use acceptable standards of safe nursing care as a basis for that observation, advice, instruction, teaching, or evaluation and shall communicate information which is consistent with acceptable standards of safe nursing care.
Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01, 4723.28 (B)(19)
Prior Effective Dates: 12/1/1995, 4/1/1997, 4/1/1999, 2/1/2002, 2/1/2003, 2/1/2004
(A) A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist shall do all of the following:
(1) Function within the scope of practice of nursing for a registered nurse as set forth in division (B) of section 4723.01 of the Revised Code and the rules of the board.
(2) Function within the nurse’s applicable scope of practice as set forth in section 4723.43 of the Revised Code and the rules of the board.
(3) Practice in accordance with section 4723.481 of the Revised Code and Chapter 4723-9 of the Administrative Code if the individual holds a certificate to prescribe.
(B) When the practice of a certified nurse-midwife, certified nurse practitioner, or clinical nurse specialist is evaluated, the evaluation shall be provided by a collaborating licensed physician, podiatrist, or a nurse holding a similar current, valid certificate of authority.
(C) When the practice of a certified registered nurse anesthetist is evaluated, the evaluation shall be provided by a supervising licensed physician, podiatrist, dentist or a nurse holding a similar current, valid certificate of authority.
(D) A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist may provide care within their specialty provided:
(1) The nurse obtains education which emanates from a recognized body of knowledge relative to the nursing care to be provided;
(2) The nurse demonstrates knowledge, skills, and abilities necessary to provide the nursing care; and
(3) The nurse maintains documentation satisfactory to the board of meeting the requirements set forth in paragraphs (D)(1) and (D)(2) of this rule.
Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.28 (B)(19), (27), (28), 4723.43
Prior Effective Dates: 12/1/1995, 4/1/1997, 4/1/1999, 2/1/2002, 2/1/2003, 2/1/2004
(A) At all times when a licensed nurse is providing direct nursing care to a client the licensed nurse shall display the applicable title or initials set forth in division (C) of section 4723.03 of the Revised Code to identify the nurse’s relevant licensure as a registered nurse or as a licensed practical nurse.
(B) At all times when a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist is providing direct nursing care to a client, the nurse shall display the applicable title or initials set forth in division (C) of section 4723.03 of the Revised Code to identify relevant approval either as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.
(C) At all times when a licensed nurse is engaged in nursing practice and interacting with the client, or health care providers on behalf of the client, through any form of telecommunication, the licensed nurse shall identify to each client or health care provider the nurse’s title or initials set forth in division (C) of section 4723.03 of the Revised Code to identify applicable licensure or approval as a registered nurse, licensed practical nurse, certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.
(D) A licensed nurse shall delegate a nursing task, including medication administration, only in accordance with Chapter 4723-13, 4723-23, 4723-26, or 4723-27 of the Administrative Code.
(E) A licensed nurse shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the client’s response to that care.
(F) A licensed nurse shall, in an accurate and timely manner, report to the appropriate practitioner errors in or deviations from the current valid order.
(G) A licensed nurse shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services.
(H) A licensed nurse shall implement measures to promote a safe environment for each client.
(I) A licensed nurse shall delineate, establish, and maintain professional boundaries with each client.
(J) At all times when a licensed nurse is providing direct nursing care to a client the licensed nurse shall:
(1) Provide privacy during examination or treatment and in the care of personal or bodily needs; and
(2) Treat each client with courtesy, respect, and with full recognition of dignity and individuality.
(K) A licensed nurse shall not:
(1) Engage in behavior that causes or may cause physical, verbal, mental, or emotional abuse to a client;
(2) Engage in behavior toward a client that may reasonably be interpreted as physical, verbal, mental, or emotional abuse.
(L) A licensed nurse shall not misappropriate a client’s property or:
(1) Engage in behavior to seek or obtain personal gain at the client’s expense;
(2) Engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client’s expense;
(3) Engage in behavior that constitutes inappropriate involvement in the client’s personal relationships or financial matters; or
(4) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the client’s personal relationships or financial matters.
For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the nurse set forth in this paragraph.
(M) A licensed nurse shall not:
(1) Engage in sexual conduct with a client;
(2) Engage in conduct in the course of practice that may reasonably be interpreted as sexual;
(3) Engage in any verbal behavior that is seductive or sexually demeaning to a client; or
(4) Engage in verbal behavior that may reasonably be interpreted as seductive, or sexually demeaning to a client.
For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to sexual activity with the nurse.
(N) A licensed nurse, when functioning in an administrative role, shall verify that each nurse, dialysis technician, or medication aide under the nurse administrator has:
(1) A current valid license to practice nursing in Ohio or a current valid certificate to practice as a dialysis technician or medication aide in Ohio; and
(2) If applicable, other documents of approval or certification as required by the board.
(O) When nursing practice, as set forth in section 4723.01 of the Revised Code, is supervised or evaluated, only a registered nurse shall:
(1) Supervise the practice of nursing, as set forth in Chapter 4723. of the Revised Code and the rules of the board, by other registered nurses and licensed practical nurses; or
(2) Evaluate the practice of nursing, as set forth in Chapter 4723. of the Revised Code and the rules of the board, by other registered nurses and licensed practical nurses.
Nothing in this paragraph shall be construed to prohibit a licensed practical nurse from participating in activities which contribute to the delivery of patient care services. Such participation may include, but is not limited to, scheduling of coverage for nursing services and observation and documentation by a licensed practical nurse regarding care provided by assistive personnel.
In matters other than the practice of nursing, a non-nursing supervisor may evaluate a nurse employee.
(P) A licensed nurse shall not make any false, misleading, or deceptive statements, or submit or cause to be submitted any false, misleading or deceptive information, or documentation to:
(1) The board or any representative of the board;
(2) Current employers;
(3) Prospective employers when applying for positions requiring a nursing license;
(4) Facilities in which, or organizations for whom, the nurse is working a temporary or agency assignment;
(5) Other members of the client’s health care team; or
(6) Law enforcement personnel.
Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.28
Prior Effective Dates: 12/1/1995, 4/1/1997, 4/1/1999, 2/1/2002, 2/1/2003, 2/1/2004
(A) A registered nurse shall apply the nursing process in the practice of nursing as set forth in division (B) of section 4723.01 of the Revised Code and in the rules of the board. The steps of the nursing process are cyclical in nature so that the nurse’s actions are directed by the client’s changing status throughout the process. The nurse may collaborate with the client, family, significant others, and other members of the health care team in applying the steps of the nursing process. The following standards shall be used by a registered nurse, using critical thinking and clinical judgment, in applying the nursing process for each client under the registered nurse’s care:
(1) Assessment:
The registered nurse shall, in an accurate and timely manner:
(a) Collect data. This includes:
(i) Collection of subjective and objective data from the client, family, significant others, or other members of the heath care team. The registered nurse may direct or delegate the performance of data collection; and
(ii) Documentation of the collected data.
(2) Analysis and reporting:
The registered nurse shall, in an accurate and timely manner:
(a) Identify, organize, and interpret relevant data;
(b) Establish, accept, or modify a nursing diagnosis to be used as a basis for nursing interventions; and
(c) Report collected data as necessary to other members of the health care team;
(3) Planning: The registered nurse shall, in an accurate and timely manner:
(a) Develop, maintain, or modify the nursing component of the plan of care, including establishing desired client outcomes and interventions; and
(b) Communicate the nursing component of the plan of care and all modifications of the plan to members of the health care team;
(4) Implementation:
The registered nurse shall, in an accurate and timely manner implement the current nursing plan of care which may include:
(a) Executing the current valid order or regimen by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice;
(b) Providing direct nursing care which is commensurate with the education, knowledge, skills, and abilities of the registered nurse;
(c) Assisting with care of the client;
(d) Delegating nursing tasks, including medication administration, only in accordance with Chapter 4723-13, 4723-23, 4723-26, or 4723-27 of the Administrative Code;
(5) Evaluation:
The registered nurse shall, in an accurate and timely manner:
(a) Evaluate, document, and report the client’s:
(i) Response to nursing interventions; and
(ii) Progress towards expected outcomes of the plan of care; and
(b) Reassess the client’s health status, revise the nursing diagnoses or the nursing component of the client’s plan of care, and make changes in the nursing interventions as necessary.
(B) For purposes of this rule, standards for implementing the nursing process also apply to a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.
Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01, 4723.28 (B)(19), (27), (28), 4723.43
Prior Effective Dates: 12/1/1995, 4/1/1997, 4/1/1999, 2/1/2000, 2/1/2002, 2/1/2003, 2/1/2004
(A) The licensed practical nurse shall contribute to the nursing process in the practice of nursing as set forth in division (F) of section 4723.01 of the Revised Code and in the rules of the board. The steps of the nursing process are cyclical in nature so that the nurse’s actions are directed by the client’s changing status throughout the process. The nurse may collaborate with the client, family, significant others, and other members of the health care team in applying the steps of the nursing process. The following standards shall be used by a licensed practical nurse in utilization of the nursing process:
(1) Assessment:
The licensed practical nurse shall contribute to the nursing assessment of the client. The licensed practical nurse shall, in an accurate and timely manner:
(a) Collect and document objective and subjective data related to the client’s health status; and
(b) Report objective and subjective data to other members of the health care team;
(2) Planning:
The licensed practical nurse shall, in an accurate and timely manner:
(a) Contribute to the development, maintenance, or modification of the nursing component of the care plan;
(b) Communicate the nursing component of the care plan and all modifications of the plan to members of the health care team.
(3) Implementation:
The licensed practical nurse shall, in an accurate and timely manner, implement the nursing plan of care, which may include:
(a) Administering medications and treatments prescribed by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice;
(b) Providing direct basic nursing care at the direction of:
(i) A registered nurse;
(ii) A licensed physician, dentist, optometrist, chiropractor, or podiatrist; or
(iii) A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist;
(c) Assisting with care of the client at the direction of:
(i) A registered nurse;
(ii) A licensed physician, dentist, optometrist, chiropractor, or podiatrist; or
(iii) A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist;
(d) Collaborating with other nurses and other members of the health care team; and
(e) Delegating nursing tasks, including medication administration, only in accordance with Chapter 4723-13, 4723-23, 4723-26, or 4723-27 of the Administrative Code; and
(4) Evaluation:
The licensed practical nurse shall, in an accurate and timely manner:
(a) Contribute to the evaluation of the client’s response to nursing interventions;
(b) Document the client’s responses to nursing interventions;
(c) Communicate the client’s responses to nursing interventions to members of the health care team; and
(d) Contribute to the revision of the nursing component of the client’s plan of care on the basis of the evaluation.
Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01, 4723.28 (B)(19)
Prior Effective Dates: 12/1/1995, 4/1/1997, 4/1/1999, 2/1/2000, 2/1/2002, 2/1/2003, 2/1/2004
(A) Nothing in this rule shall apply to an advanced practice nurse authorized to practice pursuant to section 4723.55 of the Revised Code, or to a certified nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist, or clinical nurse specialist authorized to practice pursuant to section 4723.41 of the Revised Code.
(B) A registered nurse with a current, valid license to practice nursing in Ohio may use a title or initials denoting specialty certification in a particular area of specialty in nursing granted by a national certifying organization that has established standards for:
(1) Practice qualifications, formal education, continuing education, or other demonstration of knowledge in specialty practice; and
(2) The construction and administration of a psychometrically sound examination for a registered nurse applying for certification in a particular area of specialty in nursing.
(C) The title to be used by the registered nurse who focuses in a particular area of specialty in nursing shall be the title granted by the national certifying organization to those nurses who meet the requirements for specialty certification established by the national certifying organization. The registered nurse may use such title or initials following the title “Registered Nurse” or the initials “RN”.
(D) No person shall use any title or initials implying or representing specialty certification unless that person has been granted a specialty certification title in nursing by a national certifying organization as set forth in paragraph (B) of this rule.
HISTORY: Eff 4-1-91; 4-1-98; 2-1-01
Rule promulgated under: RC 119.03
Rule authorized by: RC 4723.07
Rule amplifies: RC 4723.02
Replaces rule 4723-9-02
RC 119.032 review date: 10/16/2008 and 10/01/2013
Rescinded eff 2-1-05