Chapter 4723-4 | Standards of Practice Relative to Registered Nurse or Licensed Practical Nurse

Rule 4723-4-01 | General information.

• Effective: February 1, 2024
• Promulgated Under: 119.03

(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 an advanced practice registered nurse designated as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or 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;

(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 advanced practice registered nurse license 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 advanced practice registered nurse license 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 advanced practice registered nurse license issued by the board under section 4723.42 of the Revised Code.

(4) "Clinical judgment" is the application of the nurse's knowledge and reasoning within the context of the clinical environment in making decisions about patient care.

(5) "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 advanced practice registered nurse license issued by the board under section 4723.42 of the Revised Code.

(6) "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.

(7) "Licensed nurse" means a registered nurse or a licensed practical nurse who holds a current valid license to practice nursing in Ohio.

(8) "Nursing diagnosis" means the identification of a patient's needs or problems which are amenable to nursing intervention.

(9) "Patient" means the recipient of nursing care, which may include an individual, a group, or a community.

(C) For purposes of this chapter, with respect to LPN IV therapy, the following definitions shall apply:

(1) "Adult" means anyone who is eighteen years of age or older.

(2) "Antibiotic" means a medication, including an anti-infective or anti-fungal, administered to inhibit the growth of, or destroy, microorganisms in the treatment or prevention of infectious disease.

(3) "Direction" means communication of a plan of care, based upon assessment of the patient by the registered nurse, or licensed physician, physician assistant, dentist, optometrist, or podiatrist, that establishes the parameters for providing care or performing a procedure. Unless otherwise provided by law, the registered nurse, or licensed physician, dentist, optometrist, or podiatrist shall be available on site to assess and evaluate the patient's response to the plan of care.

(4) "Initiate" means to start or to begin.

(5) "Maintain" means to administer or regulate an intravenous infusion according to the prescribed flow rate.

(6) "Piggyback" means an intermittent or secondary intravenous infusion.

Last updated February 1, 2024 at 9:29 AM

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.01, 4723.28(B)(19), 4723.18, 4723.181
Five Year Review Date: 2/1/2029
Prior Effective Dates: 4/1/1993, 2/1/2003

Rule 4723-4-02 | Intravenous therapy procedures for licensed practical nurses.

• Effective: February 1, 2024
• Promulgated Under: 119.03

(A) Except as provided in paragraph (B) of this rule, a licensed practical nurse shall not perform any of the following intravenous therapy procedures:

(1) Initiate or maintain any of the following:

(a) Blood or blood components;

(b) Solutions for total parenteral nutrition;

(c) Cancer therapeutic medications including, but not limited to, cancer chemotherapy or an anti-neoplastic agents;

(d) Investigational or experimental medications;

(e) Solutions administered through any central venous line or arterial line or any other line that does not terminate in a peripheral vein, except as provided in paragraph (B)(1) of this rule;

(f) An intravenous piggyback infusion, except as provided in paragraph (B)(3) of this rule.

(2) Discontinue a central venous, arterial, or any other line that does not terminate in a peripheral vein;

(3) Initiate or discontinue a peripherally inserted central catheter, or any catheter that is longer than three inches;

(4) Program or set any function of a patient controlled analgesic;

(5) Mix, prepare or reconstitute any medication for intravenous therapy, except as provided in paragraph (B)(4) of this rule;

(6) Administer medications by an intravenous route, except as provided in paragraph (B)(3) of this rule;

(7) Inject medications by a direct intravenous route, except as provided in paragraph (B)(5) of this rule;

(8) Change tubing on an arterial line, a central venous line, or on any line that does not terminate in a peripheral vein;

(9) Change an intermittent infusion device, unless the tip of the connected intravenous catheter terminates in a peripheral vein.

(B) A licensed practical nurse may perform the following procedures only for individuals aged eighteen or older and only when directed to do so by a licensed physician, physician assistant, dentist, optometrist, podiatrist, or registered nurse in accordance with section 4723.18 of the Revised Code:

(1) Administer the following solutions, or combinations of the solutions, through a venous line:

(a) Five per cent dextrose and water;

(b) Five per cent dextrose and lactated ringers;

(c) Five per cent dextrose and normal saline;

(d) Normal saline;

(e) Lactated ringers;

(f) 0.45 per cent sodium chloride and water;

(g) 0.2 per cent sodium chloride and water; or

(h) 0.3 per cent sodium chloride and water.

(2) Administer any of the solutions set forth in paragraph (B)(1) of this rule that contain vitamins or electrolytes after a registered nurse initiates the first infusion of the solution containing vitamins or electrolytes.

(3) Initiate or maintain an intermittent or secondary intravenous infusion containing an antibiotic;

(4) Prepare or reconstitute an antibiotic additive to be administered through an intravenous infusion;

(5) Inject heparin or normal saline to flush an intermittent infusion device or heparin lock, including, but not limited to, bolus or push;

(6) Change tubing on an intermittent infusion device and on an intravenous line if the line terminates in a peripheral vein;

(7) Place a venous access catheter, no longer than three inches in length, in the hand, forearm or antecubital space, followed by the placement of a saline or heparin lock, either for purposes of intermittent infusions, or to initiate infusions of any of the solutions set forth in paragraph (B)(1) of this rule; or

(8) Stop an infusion of blood or blood component, or turn off the function of a patient-controlled analgesic device when a complication arises.

(C) A licensed practical nurse may perform the procedures set forth in paragraph (B) of this rule only if one of the following requirements are met:

(1) The licensed practical nurse is directed to perform intravenous therapy by a licensed physician, physician assistant, dentist, optometrist, or podiatrist who is present and readily available at the facility where the intravenous therapy procedure is performed;

(2) The licensed practical nurse is directed to perform intravenous therapy by a registered nurse who has personally performed an on-site assessment of the individual to receive intravenous therapy, and that registered nurse or another registered nurse is readily available at the site where the intravenous therapy procedure is performed; or

(3) If the intravenous therapy procedures are performed in a home as defined in section 3721.01 of the Revised Code, or in an intermediate care facility for individuals with intellectual disabilities as defined in section 5124.01 of the Revised Code, a registered nurse who directs the authorized licensed practical nurse to perform intravenous therapy is either:

(a) On the premises of the home or facility; or

(b) Accessible by some form of telecommunication.

Last updated February 1, 2024 at 9:29 AM

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.18, 4723.181
Five Year Review Date: 2/1/2029
Prior Effective Dates: 2/1/2020

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

• Effective: February 1, 2019
• Promulgated Under: 119.03

(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 is 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.

Last updated January 3, 2024 at 2:02 PM

Supplemental Information

Authorized By: ORC 4723.07
Amplifies: ORC 4723.01, 4723.28(B)(19)
Five Year Review Date: 10/2/2028
Prior Effective Dates: 12/1/1995

Rule 4723-4-04 | Standards relating to competent practice as a licensed practical nurse.

• Effective: February 1, 2019
• Promulgated Under: 119.03

(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 that is beyond basic preparation for a licensed practical 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 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 is to be provided according to 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 that 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 patient 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 patient; or

(e) Contraindicated by other documented information; and

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

(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 patient information obtained in the course of nursing practice. The licensed practical 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 licensed practical nurse unless the patient has consented to the disclosure of identifiable patient health care information. A licensed practical 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) 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 that is consistent with acceptable standards of safe nursing care.

Last updated January 3, 2024 at 2:02 PM

Supplemental Information

Authorized By: ORC 4723.07
Amplifies: ORC 4723.01, 4723.28(B)(19)
Five Year Review Date: 10/2/2028
Prior Effective Dates: 12/1/1995, 4/1/1999, 2/1/2003, 2/1/2004, 2/1/2009

Rule 4723-4-05 | Standards relating to competent practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist.

• Effective: February 1, 2019
• Promulgated Under: 119.03

(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) If authorized by Ohio law to prescribe, practice according to section 4723.481 of the Revised Code and Chapter 4723-9 of the Administrative Code.

(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 or podiatrist, or an advanced practice registered nurse holding a current, valid license with the same designation as the individual being evaluated.

(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 certified registered nurse anesthetist whose license is current and valid.

(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 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; 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.

Last updated January 3, 2024 at 2:02 PM

Supplemental Information

Authorized By: ORC 4723.07
Amplifies: ORC 4723.28(B)(19), 4723.43, (28), (27)
Five Year Review Date: 10/2/2028
Prior Effective Dates: 12/1/1995, 4/1/1999, 2/1/2009

Rule 4723-4-06 | Standards of nursing practice promoting patient safety.

• Effective: February 1, 2021
• Promulgated Under: 119.03

(A) At all times when a licensed nurse is providing direct nursing care to a patient the licensed nurse shall display the applicable title or initials set forth in division (E) 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 patient, the nurse shall display the applicable title or initials set forth in division (E) 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 patient, or health care providers on behalf of the patient, through any form of telecommunication, the licensed nurse shall identify to each patient or health care provider the nurse's title or initials set forth in division (E) of section 4723.03 of the Revised Code to identify applicable licensure 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 patient, and the patient'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, or conceal by any method, any patient 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 patient.

(I) A licensed nurse shall delineate, establish, and maintain professional boundaries with each patient.

(J) At all times when a licensed nurse is providing direct nursing care to a patient the licensed nurse shall:

(1) Provide privacy during examination or treatment and in the care of personal or bodily needs; and

(2) Treat each patient 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 patient;

(2) Engage in behavior toward a patient that may reasonably be interpreted as physical, verbal, mental, or emotional abuse.

(L) A licensed nurse shall not misappropriate a patient's property or:

(1) Engage in behavior to seek or obtain personal gain at the patient's expense;

(2) Engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the patient's expense;

(3) Engage in behavior that constitutes inappropriate involvement in the patient's personal relationships or financial matters; or

(4) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the patient's personal relationships or financial matters.

For the purpose of this paragraph, the patient 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 patient;

(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 patient; or

(4) Engage in verbal behavior that may reasonably be interpreted as seductive, or sexually demeaning to a patient.

For the purpose of this paragraph, the patient 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:

(1) Only a registered nurse shall supervise or evaluate the practice of nursing, as set forth in Chapter 4723. of the Revised Code and the rules of the board, performed by other registered nurses and licensed practical nurses; or

(2) In matters other than the practice of nursing, a non-nursing supervisor may evaluate a nurse employee.

(3) Supervision or evaluation by a registered nurse does not require that the registered nurse be present on-site on a routine basis, but at minimum:

(a) Supervision requires that the registered nurse be continuously available through some form of telecommunication with the supervised nurse, and take all action necessary, including but not limited to conducting periodic on-site visits, to insure that the supervised nurse is practicing in accordance with acceptable and prevailing standards of safe nursing care as set forth in Chapter 4723. of the Revised Code and the rules of the board; and

(b) Evaluation requires that the registered nurse conduct periodic on-site visits sufficient to enable the evaluating nurse to evaluate the evaluated nurse's performance.

Nothing in this paragraph shall be construed to authorize a licensed practical nurse to practice without direction, as required by division (F) of section 4723.01 of the Revised Code.

Nothing in this paragraph shall be construed to prohibit a licensed practical nurse from participating in activities that 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.

(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, agency, or locus tenens assignment;

(5) Other members of the patient's health care team; or

(6) Law enforcement personnel.

(Q) For purposes of paragraphs (I), (J), (K), (L), and (M) of this rule, a nurse shall not use social media, texting, emailing, or other forms of communication with, or about a patient, for non-health care purposes or for purposes other than fulfilling the nurse's assigned job responsibilities.

Last updated January 3, 2024 at 2:02 PM

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.28
Five Year Review Date: 10/2/2028
Prior Effective Dates: 12/1/1995, 4/1/1997, 2/1/2009, 2/1/2019

Rule 4723-4-07 | Standards for applying the nursing process as a registered nurse.

• Effective: February 1, 2014
• Promulgated Under: 119.03

(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 nursing process is cyclical in nature and requires that the nurse's actions respond to the patient's changing status throughout the process. The following standards shall be used by a registered nurse, using clinical judgment, in applying the nursing process for each patient under the registered nurse's care:

(1) Assessment of health status:

The registered nurse shall, in an accurate and timely manner:

(a) Collect data. This includes:

(i) Collection of subjective and objective data from the patient, 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, assimilate and interpret data;

(b) Establish, accept, or modify a nursing diagnosis that is to be addressed with applicable nursing interventions; and

(c) Report the patient's health status and nursing diagnosis as necessary to other members of the health care team;

(3) Planning:

The registered nurse shall, in an accurate and timely manner:

(a) Develop, establish, maintain, or modify the nursing plan of care consistent with current nursing science, including the nursing diagnosis, desired patient outcomes or goals, and nursing interventions; and

(b) Communicate the nursing 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 nursing regimen;

(b) Implementing the current valid order authorized by an individual who is authorized to practice in this state and is acting within the course of the individual's professional practice;

(c) Providing nursing care commensurate with the documented education, knowledge, skills, and abilities of the registered nurse;

(d) Assisting and collaborating with other health care providers in the care of the patient;

(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;

(5) Evaluation:

The registered nurse shall, in an accurate and timely manner:

(a) Evaluate, document, and report the patient's:

(i) Response to nursing interventions; and

(ii) Progress towards expected outcomes; and

(b) Reassess the patient's health status, and establish or modify any aspect of the nursing plan as set forth in this rule.

(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.

Last updated January 3, 2024 at 2:02 PM

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.01, 4723.28 (B)(19), (27), (28), 4723.43
Five Year Review Date: 10/2/2028
Prior Effective Dates: 12/1/1995, 2/1/2002, 2/1/2009

Rule 4723-4-08 | Standards for applying the nursing process as a licensed practical nurse.

• Effective: February 1, 2014
• Promulgated Under: 119.03

(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 nursing process is cyclical in nature so that the nurse's actions respond to the patient's changing status throughout the process. The licensed practical nurse is directed in providing nursing care by the established nursing plan. The following standards shall be used by a licensed practical nurse in utilization of the nursing process:

(1) Contribution to assessment of patient health status:

The licensed practical nurse shall contribute to the nursing assessment of the patient. The licensed practical nurse shall, in an accurate and timely manner:

(a) Collect and document objective and subjective data related to the patient's health status; and

(b) Report objective and subjective data to the directing registered nurse or health care provider, and 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 plan of care and all authorized 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) Providing nursing interventions;

(b) Collecting and reporting patient data as directed;

(c) 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;

(d) Providing basic nursing care as directed by a registered nurse, advanced practice registered nurse, or licensed physician, dentist, optometrist, chiropractor or podiatrist;

(e) Collaborating with other nurses and other members of the health care team;

(f) Delegating nursing tasks as directed, including medication administration, only in accordance with Chapter 4723-13, 4723-23, 4723-26, or 4723-27 of the Administrative Code; and

(4) Contributing to evaluation:

The licensed practical nurse shall, in an accurate and timely manner:

(a) Contribute to the evaluation of the patient's response to nursing interventions;

(b) Document the patient's responses to nursing interventions;

(c) Communicate the patient's responses to nursing interventions to the directing registered nurse or health care provider, and members of the health care team; and

(d) Contribute to the reassessment of the patient's health status and to the modifications of any aspect of the nursing plan of care as set forth in this rule.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.07
Amplifies: 4723.01, 4723.28 (B)(19)
Five Year Review Date: 10/2/2028
Prior Effective Dates: 4/1/1999

Rule 4723-4-09 | Specialty certification.

• Effective: February 1, 2019
• Promulgated Under: 119.03

(A) Nothing in this rule shall apply to an advanced practice registered nurse licensed 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.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: ORC 4723.07
Amplifies: ORC 4723.42
Five Year Review Date: 10/2/2028
Prior Effective Dates: 4/1/1991, 2/1/2001