4723-4-03 Standards relating to competent practice as a registered nurse.

(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 including:

(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 that is beyond basic nursing preparation for a registered nurse, provided:

(1) The nurse obtains education that 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 according to 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 that is prohibited by any other law or rule.

(E) A registered nurse shall, in a timely manner:

(1) Implement any order for a patient 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 patient; or

(e) Contraindicated by other documented information; and

(2) Clarify any order for a patient 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 patient; 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 patient.

(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 patient information. The registered nurse shall communicate patient information with other members of the health care team for health care purposes only, shall access patient information only for purposes of patient care, or for otherwise fulfilling the nurse's assigned job responsibilities, and shall not disseminate patient information for purposes other than patient care, or for otherwise fulfilling the nurse's assigned job responsibilities, through social media, texting, emailing or any other form of communication.

(I) To the maximum extent feasible, identifiable patient health care information shall not be disclosed by a registered nurse unless the patient has consented to the disclosure of identifiable patient health care information. A registered nurse shall report individually identifiable patient 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 the registered nurse shall first assess:

(1) The condition of the patient who needs nursing care, including, but not limited to, the stability of the patient;

(2) The type of nursing care the patient 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: 02/01/2014
R.C. 119.032 review dates: 10/17/2013 and 10/15/2018
Promulgated Under: 119.03
Statutory Authority: 4723.07
Rule Amplifies: 4723.01 , 4723.28(B)(19)
Prior Effective Dates: 12/01/1995, 04/01/1997, 04/01/1999, 02/01/2002, 02/01/2003, 02/01/2004, 2/1/09