F L O R I D A L A W A N D P R O F E S S I O N A L C O N D U C TP R E S E N T E D B Y E D W A R D B R I G G S D N P

FLORIDA NURSING

CONFLICT OF INTEREST

• I have no conflict of interest• I have nothing to declare and no vested

interested in the content included in this presentation.

OBJECTIVES

• Discuss the role and responsibilities of the Board of Nursing• Discuss licensure procedures for nursing in Florida• Discuss punitive actions available to the Board of

Nursing and methods to avoid actions against your license.• This program will review content included in:• Chapters 456 and 464 of the Florida Statutes• Rules in Title 64B9 of the Florida Administrative Code

DECLARATORY STATEMENT

• I have nothing to declare• I have no vested or financial interest in this

presentation• Any opinions expressed are mine and do not

reflect the opinions of the Florida Nurses Association

OBJECTIVES

• This presentation will review the Florida Statutes that govern the roles and responsibilities of:• Licensed Practical Nurse• Registered Nurse• Clinical Nurse Specialist• Advanced Practice Nurses• Nursing assistants

INTRODUCTION

• The practice of nursing is becoming more complex and demanding with rapidly changes rules and guidelines• As a result the Board of Nursing disciplines

hundreds of nurses annually for not complying with the nurse practice act/standards• This course will review the governance of the

practice of nursing and discuss how to remain in compliance with the regulations

NURSING LICENSURE/PRACTICE

Nurse Practice Act Chapter 464 Florida Statutes Rules of the Board of NursingChapter 64B9 Florida Administrative Code

Legislation governs requirements for licensure, scope of practice,

supervisory responsibility and educational standards.

GOVERNANCE STRUCTURE

Office of MedicalQuality Assurance

Surgeon General

BOARD OF NURSING

• Is established by Chapter 64B9 Florida Administrative Code • Has the responsibility for interpreting and

implementing the Nurse Practice Act• Responsible for:• Licensure (practitioners and educational

institutions) of nurses• Education and training of nurses• Investigating actions of nurses• Punitive and corrective actions

BOARD OF NURSING

• The Board meets bimonthly, generally during the first week of every even month. The full board meetings include:• disciplinary cases• application review• committee reports• rule discussions • other necessary Board actions.

• Has an executive director responsible for it’s operations

BOARD OF NURSING

• The board is made up of 13 members: • seven Registered Nurses who have been engaged in the

practice of professional nursing at least four years (one must be an advanced registered nurse practitioner, one must be a nurse executive, and one must be a nurse educator member of an approved program);

• three Licensed Practical Nurses who have been engaged in the practice of practical nursing at least four years;

• three consumer members who have never been connected with the practice of nursing.

• All board members must be Florida residents and one must be at least 60 years old.

BOARD OF NURSING

• Members are appointed by the Governor• Have legal council appointed to advise the board

on all actions• Has rule/regulation making authority for

implementation of the Nurse Practice Act but cannot modify legislation.

BOARD MEMBERS

Next meeting is December 4th in Tampa / floridanursing.gov

T I T L E X X X I IR E G U L A T I O N O F P R O F E S S I O N S A N D O C C U P A T I O N S

C H A P T E R 4 6 4N U R S I N G

THE NURSE PRACTICE ACT

DEFINITION OF NURSINGTITLE XXX11 CHAPTER 262

PURPOSE OF THE NURSE PRACTICE ACT

• 464.002 Purpose.--The sole legislative purpose in enacting this part is to ensure that every nurse practicing in this state meets minimum requirements for safe practice. It is the legislative intent that nurses who fall below minimum competency or who otherwise present a danger to the public shall be prohibited from practicing in this state.

DEFINITIONS TITLE XXIII

• 464.003 (2) “Advanced or specialized nursing practice” means, in addition to the practice of professional nursing, the performance of advanced-level nursing acts approved by the board by an advanced registered nurse practitioner. • may perform acts of nursing diagnosis and nursing

treatment of alterations of the health status. • acts of medical diagnosis and treatment, prescription,

and operation which are identified and approved by a joint committee

DEFINITIONS TITLE XXIII

• 464.003 (2) …such acts must be performed under the general supervision of a practitioner licensed under chapter 458, chapter 459, or chapter 466 within the framework of standing protocols which identify the medical acts to be performed and the conditions for their performance. The department may, by rule, require that a copy of the protocol be filed with the department along with the notice required by s. 458.348.

• Not stated in the Nurse Practice Act is the information that must be included in protocols between an ARNP and a physician. These requirements are listed in the Florida Administrative Code, Subtitle 64B9

DEFINITIONS TITLE XXIII

• 464.003 (3) “Advanced registered nurse practitioner” means any person licensed in this state to practice professional nursing and certified in advanced or specialized nursing practice, including certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners.

DEFINITIONS TITLE XXX11ADVANCED PRACTICE NURSES

• 464.012 Certification of advanced registered nurse practitioners;

• (1) Any nurse desiring to be certified as an advanced registered nurse practitioner shall …hold a current license to practice professional nursing and that he or she meets one or more of the following requirements as determined by the board:• (a) Satisfactory completion of a formal post-basic

educational program…the primary purpose of which is to prepare nurses for advanced or specialized practice. (Graduation from a program leading to a master’s degree in a nursing clinical specialty area with preparation in specialized practitioner skills)

• (b) Certification by an appropriate specialty board.

DEFINITIONS TITLE XXIIICLINICAL NURSE SPECIALIST

• 464.00 (6) "Clinical nurse specialist practice" means the delivery and management of advanced practice nursing care to individuals or groups, including the ability to: • Assess the health status of individuals and families using

methods appropriate to the population and area of practice.

• Diagnose human responses to actual or potential health problems.

DEFINITIONS TITLE XXIII• 464.00 (6) Clinical Nurse Specialists (con’t)

• Plan for health promotion, disease prevention, and therapeutic intervention in collaboration with the patient or client. • Implement therapeutic interventions based on

the nurse specialist's area of expertise and within the scope of advanced nursing practice, including, but not limited to, direct nursing care, counseling, teaching, and collaboration with other licensed health care providers. • Coordinate health care as necessary and

appropriate and evaluate with the patient or client the effectiveness of care.

CLINICAL NURSE SPECIALIST• 464.0115 Certification of clinical nurse specialists.—• (1) Submit proof that he or she holds a current license to

practice professional nursing, a master’s degree in a clinical nursing specialty, and either:

• (a) Proof of current certification in a specialty area as a clinical nurse specialist from a nationally recognized certifying body as determined by the board; or

• (b) Proof that he or she holds a master’s degree in a specialty area for which there is no certification within the clinical nurse specialist role and specialty and proof of having completed 1,000 hours of clinical experience in the clinical specialty for which he or she is academically prepared, with a minimum of 500 hours of clinical practice after graduation.

• (2) The board shall certify, and the department shall issue a certificate to, any nurse who fulfills the qualifications of this section.

464.027 REGISTERED NURSE FIRST ASSISTANT.—

• (3) QUALIFICATIONS.—A registered nurse first assistant is any person who:

• (a) Is licensed as a registered nurse under this part;

• (b) Is certified in perioperative nursing; and• (c) Holds a certificate from, and has successfully

completed, a recognized program.• (4) INSTITUTIONAL POWERS.—Each health care

institution must establish specific procedures for the appointment and reappointment of registered nurse first assistant staff members and for granting, renewing, and revising their clinical privileges.

DEFINITIONS TITLE XXII

• 464.003 (20) "Practice of professional nursing" means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to:

DEFINITION OF NURSING464.003 20 Practice of Professional Nursing (con’t)• (a) The observation, assessment, nursing

diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others.• (b) The administration of medications and

treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments.• (c) The supervision and teaching of other

personnel in the theory and performance of any of the acts described in this subsection.

DEFINITION OF NURSING• 464.003 (19) "Practice of practical nursing"

means the performance of selected acts, including • the administration of treatments and

medications, in the care of the ill, injured, or infirm• promotion of wellness, maintenance of health,

and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. • (Not stated in the Nurse Practice Act are the

specific guidelines that must be followed so that licensed practical nurses can legally give Intravenous medications. These are listed in the Florida Administrative Code Subtitle 64B9.)

DEFINITIONS TITLE XXIII

• The professional nurse and the practical nurse shall be responsible and accountable for making decisions that are based upon the individual's educational preparation and experience in nursing.

DEFINITIONS OF NURSING

• 464.201 (3) “Certified nursing assistant” means a person who meets the qualifications specified in this part and who is certified by the board as a certified nursing assistant.

DEFINITIONS OF NURSING• 464.201 (5) “Practice of a certified nursing assistant”

means providing care and assisting persons with tasks relating:

• to the activities of daily living• personal care• maintaining mobility• nutrition and hydration • toileting and elimination/assistive devices• safety and cleanliness• data gathering/reporting abnormal signs and symptoms• postmortem care• patient socialization and reality orientation• end-of-life care• cardiopulmonary resuscitation and emergency care• Other duties appropriately trained and delegated

DEFINITION OF TERMSTITLE XXX11 CHAPTER 262

DEFINITIONS "Nursing diagnosis" means the observation and evaluation of physical or mental conditions, behaviors, signs and symptoms of illness, and reactions to treatment and the determination as to whether/he such conditions, signs, symptoms, and reactions represent a deviation from normal "Nursing treatment" means the establishment and implementation of a nursing regimen for the care and comfort of individuals, the prevention of illness, and the education, restoration, and maintenance of health.

DEFINITIONS• "Registered nurse" means any person licensed in this state

to practice professional nursing. • "Licensed practical nurse" means any person licensed in

this state to practice practical nursing • "Clinical nurse specialist" means any person licensed in this

state to practice professional nursing and certified in clinical nurse specialist practice.

• "Advanced registered nurse practitioner" means any person licensed in this state to practice professional nursing and certified in advanced or specialized nursing practice.

• "Approved program" means a nursing program conducted in a school, college, or university, which is approved by the board pursuant to s. 464.019 for the education of nurses.

LICENSURE REQUIREMENTSTITLE XXX11 CHAPTER 262

LICENSURE REQUIREMENTS

• Professional and Practical Nurses• 464.008 Licensure by examination.—• (1) Any person desiring to be licensed as a registered nurse or licensed

practical nurse shall apply to the department to take the licensure examination. The department shall examine each applicant who:• (a) Has completed the application form and remitted a fee set by the board • (b) Has provided sufficient information on or after October 1, 1989, which must be

submitted by the department for a statewide criminal records correspondence check through the Department of Law Enforcement.

• (c) Is in good mental and physical health, is a recipient of a high school diploma or the equivalent, and has completed the requirements for:

• 1. Graduation from an approved program;• 2. Graduation from a pre-licensure nursing education program that the board

determines is equivalent to an approved program;• Graduation on or after July 1, 2009, from an accredited program; or• Graduation before July 1, 2009, from a pre-licensure nursing education program

whose graduates at that time were eligible for examination.• (d) Has the ability to communicate in the English language, which may be

determined by an examination given by the department.

LICENSURE REQUIREMENTS

• Professional and Practical Nurses• 464.008 Licensure by examination.-

• (2) Each applicant who passes the examination and provides proof of meeting the educational requirements specified in subsection (1) shall, unless denied pursuant to s. 464.018, be entitled to licensure as a registered professional nurse or a licensed practical nurse, whichever is applicable.

• (3) Any applicant who fails the examination three consecutive times shall be required to complete a board-approved remedial course before the applicant will be approved for reexamination. After taking the remedial course, the applicant may be approved to retake the examination up to three additional times before the applicant is required to retake remediation. The applicant shall apply for reexamination within 6 months after completion of remediation. The board shall by rule establish guidelines for remedial courses.

LICENSURE REQUIREMENTS

• Professional and Practical Nurses• 464.009 Licensure by endorsement.—• (1) The department shall issue the appropriate license by

endorsement to practice professional or practical nursing to an applicant who, upon applying to the department and remitting a fee and demonstrates to the board that he or she:

• (a) Holds a valid license to practice professional or practical nursing in another state or territory of the United States, provided that, when the applicant secured his or her original license, the requirements for licensure were substantially equivalent to or more stringent than those existing in Florida at that time;

• (b) Meets the qualifications for licensure in s. 464.008 and has successfully completed a state, regional, or national examination which is substantially equivalent to or more stringent than the examination given by the department; or

LICENSURE REQUIREMENTS

• Professional and Practical Nurses• 464.009 Licensure by endorsement.—• (c) Has actively practiced nursing in another

state, jurisdiction, or territory of the United States for 2 of the preceding 3 years without having his or her license acted against by the licensing authority of any jurisdiction.

• (2) Examinations from other states will be deemed equivalent to Florida Examination standards.

• (4) Applicants must submit fingerprint card from criminal background check with Florida Law Enforcement and Federal Bureau of Investigation.

LICENSURE REQUIREMENTS

• Professional and Practical Nurses• 464.009 Licensure by endorsement.—• (5) The department shall not issue a license by

endorsement to any applicant who is under investigation in another state, jurisdiction, or territory of the United States

• (6) The department shall develop an electronic applicant notification process and provide electronic notification when the application has been received and when background screenings have been completed, and shall issue a license within 30 days after completion of all required data collection and verification.

LICENSURE

464.014 Inactive status.—(1) The board shall adopt rules relating to application procedures for inactive status. -Requires application for status

LICENSURE

464.0205 Retired volunteer nurse certificate.—(1) Any retired practical or registered nurse desiring to serve indigent, underserved, or critical need populations in this state may apply to the department for a retired volunteer nurse certificate-Must apply for status-Works under supervision of physician, medical provider or registered nurse-Limited scope of practice

LICENSURE

464.013 Renewal of license or certificate.—(1) The department shall renew a license upon receipt of the renewal application and fee.(2) The department shall adopt rules establishing a procedure for the biennial renewal of licenses.(3) The board shall by rule prescribe continuing education not to exceed 30 hours biennially as a condition for renewal of a license or certificate. The criteria for programs shall be approved by the board.

CE REQUIREMENTS

• Any nurse who is currently nationally certified by a nationally accredited agency is waived all mandatory ce’s but must maintain that certification• Must register with CE broker (free) and must

forward a copy of certificate to CE broker

RULES AND RESPONSIBILITIES

TITLE XXX11 CHAPTER 262

TITLE PROTECTION

(9) A person may not practice or advertise as, or assume the title of, registered nurse, licensed practical nurse, clinical nurse specialist, certified registered nurse anesthetist, certified nurse midwife, or advanced registered nurse practitioner or use the abbreviation “R.N.,” “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,” or “A.R.N.P.” or take any other action that would lead the public to believe that person was certified as such or is performing nursing services pursuant to the exception set forth in s. 464.022(8), unless that person is licensed or certified to practice as such.

(b) Knowingly concealing information relating to violations of this part.

(10) A violation of this section is a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.

DELEGATION AND SUPERVISION

• The ability to delegate duties and supervise duties is dependent several factors:• Education and training• Skills and experience• Facilities policies and procedures

DELEGATION AND SUPERVISION

• Registered nurses may not delegate functions fundamental to professional nursing to anyone other than a professional nurse.• These functions include:• Assessment• Nursing diagnosis• Planning and intervention• Evaluation of care

DELEGATION AND SUPERVISION

• § 64B9-14.002. Delegation of Tasks or Activities Unlicensed Assistive Personnel

• In the delegation process, the delegator must use nursing judgment to consider the suitability of the task or activity to be delegated.• (1) Factors to weigh in selecting the task or activity include:• (a) Potential for patient harm.• (b) complexity of the task.• (c) Predictability or unpredictability of outcome including the reasonable

potential for a rapid change in the medical status of the patient.• (d) Level of interaction required or communication available with the patient.• (e) Resources both in equipment and personnel available in the patient setting.• (2) Factors to weigh in selecting and delegating to a specific delegate include:• (a) Normal assignments of the UAP.• (b) Validation or verification of the education and training of the delegate.

DELEGATION AND SUPERVISION

DELEGATION AND SUPERVISION• When delegating duties or responsibilities the professional nurse should

consider the “five rights of delegation”: (Mikos, et. al. 2002).

• 1. Right Task: The task is within a persons training, experience and scope of practice.

• 2. Right Circumstances: The task is performed in an appropriate setting with adequate resources.

• 3. Right Person: The delegator is at the right level of profession to delegate and is delegating a task to a person at the right level of profession to perform the task. The person delegated to must have shown competency for that task.

• 4. Right Communication: A concise, clear description of the task is communicated at the person's level of understanding, including an explanation of the objectives, limits and expectations.

• 5. Right Supervision: The task is within the Scope of Practice of the delegator and the delegator provides appropriate monitoring, intervention, evaluation and feedback

Source: National Council of State Boards of Nursing, Inc/1997

ROLES AND RESPONSIBILITIES

• The Board of Nursing is tasked with ensuring public safety through ensuring nurses can practice safely and responsibly.• The Board has a primary role of enforcing the

rules and regulations included within the nurse practice act.• The Board has the authority to deny, limit or

revoke licensure of any nurse who wishes to practice in the state of Florida consistent with the rules included in the Nurse Practice Act.

DELEGATION FLOWCHARTHas there been an

assessment by an RN

Is the task within delegating RN scope of

practice?

Statutes/Regs support the delegation of the task?

Does the organization permit delegation?

Does the delegation meet the “five rights of

delegation”?Organizations

polies/procedures for delegation?

Is RN supervision available?

Yes

Yes

Yes

Yes

Yes

Yes

MAY PROCEED WITH DELEGATION

Requires an assessment/evaluation by a professional nurse.

Do not delegate

Do not delegate

Do not delegate

Do not delegate

Do not delegate

Do not delegate

Source: Mueller, M. and Vogelseier, A. 2013

NO

NO

NO

NO

NO

NO

NO

P U N I T I V E AC T I O N S

FLORIDA BOARD OF NURSING

PUNITIVE ACTIONS

• The Board of Nursing typically takes punitive actions for:• Unprofessional conduct (Conduct not consistent with

accepted nursing practice (i.e. fraud, drug related offenses, DUI, etc.)

• Negligence (Practice not consistent with accepted nursing standards)

PUNITIVE ACTIONS

• The Florida Board of Nursing can take punitive action against any nurse that is in violation of rules, regulations or statute that governs nursing practice.• Punitive action may include, but is not limited to,

limitation or withdrawal of licensure and implementation of corrective actions (i.e. remedial education, IP program, etc.)

PUNITIVE ACTIONS • 464.016 Violations and penalties.—• (1) Each of the following acts constitutes a felony of the

third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084:

• (a) Practicing advanced or specialized, professional, or practical nursing, as defined in this part, unless holding an active license or certificate to do so.

• (b) Using or attempting to use a license or certificate which has been suspended or revoked.

• (c) Knowingly employing unlicensed persons in the practice of nursing.

• (d) Obtaining or attempting to obtain a license or certificate under this part by misleading statements or knowing misrepresentation.

PUNITIVE ACTIONS • 464.018 Disciplinary actions.—• (1) The following acts constitute grounds for

denial/revocation of a license or disciplinary action, as specified in s. 456.072(2):

• (a) Procuring, attempting to procure, or renewing a license to practice nursing by bribery, by knowing misrepresentations, or through an error of the department or the board.

• (b) Having a license to practice nursing revoked, suspended, or otherwise acted against, including the denial of licensure, by the licensing authority of another state, territory, or country.

• (c) Being convicted or found guilty of, or entering a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction which directly relates to the practice of nursing or to the ability to practice nursing.

PUNITIVE ACTIONS • 464.018 Disciplinary actions.—

• (d) Being found guilty, regardless of adjudication, of any of the following offenses:• 1. A forcible felony as defined in chapter 776.• 2. A violation of chapter 812, relating to theft,

robbery, and related crimes.• 3. A violation of chapter 817, relating to

fraudulent practices.• 4. A violation of chapter 800, relating to

lewdness and indecent exposure.• 5. A violation of chapter 784, relating to assault,

battery, and culpable negligence.

PUNITIVE ACTIONS • 464.018 Disciplinary actions.—• 6. A violation of chapter 827, relating to child abuse.• 7. A violation of chapter 415, relating to protection from

abuse, neglect, and exploitation.• 8. A violation of chapter 39, relating to child abuse,

abandonment, and neglect.• (e) Having been found guilty of, regardless of adjudication,

or entered a plea of nolo contendere or guilty to, any offense prohibited under s. 435.04 or similar statute of another jurisdiction; or having committed an act which constitutes domestic violence as defined in s. 741.28.

• (f) Making or filing a false report or record, which the licensee knows to be false, intentionally or negligently failing to file a report or record required by state or federal law, willfully impeding or obstructing such filing or inducing another person to do so.

PUNITIVE ACTIONS • 464.018 Disciplinary actions.—• (g) False, misleading, or deceptive advertising.• (h) Unprofessional conduct, as defined by board

rule.• (i) Engaging or attempting to engage in the

possession, sale, or distribution of controlled substances as set forth in chapter 893, for any other than legitimate purposes authorized by this part.• (j) Being unable to practice nursing with

reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition.

PUNITIVE ACTIONS • 464.018 Disciplinary actions.—• (k) Failing to report to the department

any person who the licensee knows is in violation of this part or of the rules of the department or the board; • (l) Failing to comply with a ruling of the

Board of Nursing or failure to comply with a legally issued subpoena• (m) Failing to report to the department

any licensee under chapter 458 or under chapter 459 who the nurse knows has violated the grounds for disciplinary action

PUNITIVE ACTIONS • 464.018 Disciplinary actions.—• (n) Failing to meet minimal standards of

acceptable and prevailing nursing practice, including engaging in acts for which the licensee is not qualified by training or experience.• (o) Violating any provision of this chapter or

chapter 456, or any rules adopted pursuant thereto.

PUNITIVE ACTIONS

• 464.017 Sexual misconduct in the practice of nursing.• Sexual misconduct in the practice of nursing

means violation of the nurse-patient relationship through which the nurse uses said relationship to induce or attempt to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient.

S TAY I N G O U T O F T R O U B L E

PUNITIVE ACTIONS

HOW TO STAY OUT OF TROUBLE

• Familiarize yourself with appropriate Florida Statutes:• Title XXXII, Regulation of Professions and Occupations

under Chapter 464 (The Nurse Practice Act)• Subtitle 64IB9 of the Florida Administrative Code

• Avoid violating any regulations identified in the statutes.• Ensure you are in compliance with any federal

Statutes or regulations (HIPAA, EMTALA, etc).

HOW TO STAY OUT OF TROUBLE

• Ensure that you are familiar with the requirements and responsibilities of any position you take:• Within your scope?• Are you adequately trained/educated in the area?• Are you responsible for supervising anyone? Are you

familiar with their skills and abilities?

HOW TO STAY OUT OF TROUBLE

• Familiarize yourself with the policies and procedures of the institution where you are practicing.• Are you practicing in compliance with those policies and

procedures.• Is your training and education consistent with identified role.• Familiarize yourself with the chain of command for the

institution.

• If you are uncomfortable with something, discuss it with your immediate supervisor.

• If unsure consult with the Board of Nursing or legal council. (If you are a member of the Florida Nurses Association you have access to free legal consultation.)

HOW TO STAY OUT OF TROUBLE

• Document, document, document.• Clear and concise documentation• Share your rational for decision making• Record any directions given to you by a physician, supervisor,

etc. that you are unsure of. Confirm all verbal orders

• Never accept an assignment that you do not have the training or education to carry out.

• Once accepted, never abandon an assignment. Document any concerns you have regarding assignments.

HOW TO STAY OUT OF TROUBLE

• Abandonment (section 64B9-8.005(1) © of the Florida Administrative code). Abandonment is considered unprofessional conduct, which constitutes grounds for denial of a license or disciplinary action. Abandonment includes: • a. Leaving a nursing assignment before advising licensed

nursing personnel. • b. Withdrawal of services/care without provision of qualified

coverage. • c. Failure to provide competent intervention if patient's

condition changes. • e. In Florida, once a nurse accepts responsibility for an

assignment, she/he cannot leave or cease care until relief is available.

HOW TO STAY OUT OF TROUBLE

• Never alter or modify an existing medical record. Document any amendments or corrections in the record in accordance with the facility policy and date and time the entry.

• Never falsify a record.• Always conduct yourself in a professional manner.• If you have violated any statutes detailed in the Nurse

Practice Act seek appropriate legal council as soon as possible.

HOW TO STAY OUT OF TROUBLE

• Always refer to facility policies or procedures prior to performing tasks and comply with these procedures

• Ensure that professional actions are consistent with accepted nursing standards of practice

• Always practice within accepted Code of Ethics

WHAT ISN’T COVERED UNDER THE NURSE PRACTICE ACT?

• Specific procedures.• Employee/Employer relations.• Physician actions/conduct• Roles and responsibilities of other professions

(PT/OT/RT)• Federal rules or regulations (HIPAA, EMTALA)

(However the Board of Nursing may take action for non-compliance with Federal Statutes

WHAT IF I GET IN TROUBLE?TITLE XXXI I : THE NURSE PRACTICE ACT

PUNITIVE PROCEDURES

• Anyone can file a complaint against a nurse with the Department of Health (patient, employer, family members, etc.)• The Department of Health has the burden of proof

to prove that some violation of the Nurse Practice Act occurred.• The standard of prudent practitioner is

predominant

PUNITIVE PROCEDURES

• Once a complaint has been filed:• The Board will review the complaint and determine if a

possible violation has occurred• If suspicion of violation the nurse will be notified of the

complaint and be provided with a form to reply to the complaint

• The complaint will be forwarded for initial evaluation and legal review

PUNITIVE PROCEDURES

• Once a complaint has been filed:• If violation is suspected then a board subcommittee will

review the complaint and make a report with recommendations.

• If the subcommittee finds validity it will make proposed settlement to the nurse

• The nurse may request a hearing before the full board

PUNITIVE PROCEDURES

• Once a complaint has been filed:• All board actions must be in compliance with accepted

legal standards and procedures• Any nurse who has proceedings before the board may

(and should) seek legal council with experience in such matters to represent them

• All documentation relating to the complaint may be used against the nurse in formal proceedings

• Outcomes of civil litigation (malpractice) may not affect Board of Nursing Proceedings

PUNITIVE PROCEDURES

• Discipline & General Business F. RN, LPN, and ARNP Settlement Agreements

• Recused Members: Lavigne Kirkpatrack and Mary Jane Herrera• 1. Lucas, Cynthia Marie, RN 9322104 Cases #2013-03750 File#424277• 2. Dubois, Terica Delace, LPN 5190233 Case #2012-16289 File #138226• 3. Morgan, Debbie Ann, RN 2826232 Case #2013-05053 File #146363• 4. Montgomery, Eileen Ann, LPN 5154037 Case #2013-00597 File #99069• 5. Herold, Cary Murphy, RN 9344682 Case #2013-07852 File #447897• 6. Carlson, Dina Marie, RN 9183714 Case #2012-15058 File #270977• 7. Jimenez, Crista Michelle, RN 9204774 Case #2013-09441 File #294854• 8. Robinson, Lakeitha Mae, LPN 5195287 Case #2013-08966 File #143592• 9. Sloan, Betty Jean Evans, LPN 346201 Case #2013-00320 File #81464• Recused Members: Mary K Habgood and Barbara Kemp• 10. Parson, Tanya Marie, RN 9255137 Case#2013-03342 File#348255• 11. Raykhelson, Victoria, RN 3350362 Case# 2012-16439 File# 200564• 12. Barthelemy, Jean Gasner, RN 9179494 Case #2013-03179 File #238828• Recused Members: Ann-Lynn Denker and Mary K. Habgood• 13. Mejia, Carlos A., LPN 5150576 Case #2013-05699 File #94300 • 14. Smith, Tamara Janelle, LPN 5208672 Case #2013-07969 File #156972 • 15. Ranes, Deborah, ARNP 1874582 Case #2013-06789 File #73501 • Recused Members: Jody Bryant Newman and Claydell Horne • 16. Howard, Pamala Scott, RN 9248930 Case# 2013-00226 File# 342681 • 17. Sirinek, Justin Livingstion, RN 9257893 Case# 2013-05339 File# 348958 • 18. Leone, Tara Connell, RN 9180575 Case #2012-18399 File #267690 • 19. Baker, Rachael Elizabeth, LPN 5205525 Case #2013-06742 File #155583 • 20. Forehand, Michael Anthony, RN 2892752 Case #2013-06158 File #153265 • 21. Lee, Jennifer K., LPN 5170323 Case #2013-08319 File #115358 • Recused Members: Lavinge Kirkpatrick and Mary K. Habgood • 22. Shuford, Pattie Lynn, LPN 5161261 Case# 2013-01700 File# 101530 • 23. Bowker, Kelly Ann, LPN 5155518 Case #2013-08692 File #100607 • Recused Members: Mary K. Habgood and Linda Horton • 24. Jenkins, Judy Ann, RN 3389162 Case #2013-07703 File #204541 • Recused Members: Jessie Colins and Mary Jane Herrera • 25. Woods, Melinda Diane, LPN 5196974 Case #2013-05748 File #146997 • 26. Pinero, Maria E., RN 9323167 Case #2013-06180 File #425596 • Recused Members: Sandra Walker and Mary K. Habgood • 27. Ruebusch, Leslie Ann, RN 9274776 Case #2013-06697 File #371003 Board

Announce

ment

SUMMARY

• It is the responsibility of the nurse to be familiar with the Nurse Practice Act and all associated statutes, rules and regulations.• All nurses must be in compliance with all

licensure requirements including CE’s• Domestic violence• Medical Malpractice• Professional Licensure

SUMMARY

• It is the responsibility of the professional nurse to know their skills and abilities and those of anyone they supervise• Any proceeding before the Board of Nursing are

legal procedures and are conducted as such• Legal Council is encouraged

• It is the responsibility of the licensee to ensure that the Board has the most up to date information

QUESTIONS AND ANSWERS

REFERENCES

Effective Delegation: Understanding Responsibility, Authority, and Accountability.Mueller, Christine; Vogelsmeier, Amy; Journal of Nursing Regulation, 2013 Oct; 4 (3): 20-7. (journal article - tables/charts) ISSN: 2155-8256Overview and summary: delegation dilemmas: standards and skills for practice.Cipriano PF; Online Journal of Issues in Nursing, 2010 May; 15 (2): 9. (journal article) ISSN: 1091-3734The Five Rights of Delegation National Council of State Boards of Nursing, Inc/1997 Retreived on 10/30/2013 from https://www.ncsbn.org/fiverights.pdfFlorida Statutes Title XXXII, Chapter 464. Retrieved online on 10/30/2013 http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/0464PARTIContentsIndex.html