Transcript Nursing - FLORIDA NURSING PERSPECTIVES

FLORIDA NURSING
FLORIDA LAW AND PROFESSIONAL CONDUCT
PRESENTED BY EDWARD BRIGGS DNP
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
Legislation governs requirements for
licensure, scope of practice, supervisory
responsibility and educational
standards.
Legislators Draft and
approve legislation
Incorporated in the
Nurse Practice Act
Interpreted and
implemented by The
Board of Nursing
Nurse Practice Act
Chapter 464 Florida Statutes
Rules of the Board of Nursing
Chapter 64B9 Florida
Administrative Code
GOVERNANCE STRUCTURE
Surgeon General
Department of
Health
Office of Medical
Quality Assurance
RN
ARNP
Board of
Nursing
Other health
Boards
(Medicine,
etc.)
Agency for
Healthcare
Administration
LPN
Clinical Nurse
Specialist
CNAs/UAPs
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
THE NURSE PRACTICE
ACT
R E G U L A T I O N
O F
T I T L E X X X I I
P R O F E S S I O N S A N D
C H A P T E R 4 6 4
N U R S I N G
O C C U P A T I O N S
DEFINITION OF NURSING
TITLE 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 XXX11
ADVANCED 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 XXIII
CLINICAL 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 NURSING
464.003 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 TERMS
TITLE 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 REQUIREMENTS
TITLE 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
ARNP/RN
RN
LPN
RN
LPN
ARNP
UAP
CNA
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 FLOWCHART
Has there been an
assessment by an RN
Yes
Is the task within delegating
RN scope of practice?
Yes
Statutes/Regs support the
delegation of the task?
Yes
Does the organization
permit delegation?
Yes
Does the delegation
meet
the “five rights of
delegation”?
Yes
Organizations
polies/procedures for
delegation?
Yes
Is RN supervision available?
NO
NO
NO
NO
NO
NO
NO
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
FLORIDA BOARD OF
NURSING
PUNITIVE ACTIONS
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.
PUNITIVE ACTIONS
STAYING OUT OF TROUBLE
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
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WHAT IF I GET IN TROUBLE?
TITLE XXXII: 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
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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
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: 2155-8256
Overview 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: 1091-3734
The Five Rights of Delegation National Council of State Boards of Nursing,
Inc/1997 Retreived on 10/30/2013 from
https://www.ncsbn.org/fiverights.pdf
Florida Statutes Title XXXII, Chapter 464. Retrieved online on 10/30/2013
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statut
e&Search_String=&URL=0400-0499/0464/0464PARTIContentsIndex.html