No. 27600 (Amendment): R156-31b. Nurse Practice Act Rules

DAR File No.: 27600
Filed: 12/23/2004, 01:56
Received by: NL

 

RULE ANALYSIS

Purpose of the rule or reason for the change:

Amendments are being proposed to establish the specific scope of practice for a person licensed as a licensed practical nurse (LPN) or registered nurse (RN). Also updates a references to the Pharmacy Practice Act which was renumbered during the 2004 Legislative Session.

 

Summary of the rule or change:

In Section R156-31b-102, definitions for "comprehensive nursing assessment" and "focused assessment" are added and the remaining subsections are renumbered. In Section R156-31b-702, the statute citation is updated from Section 58-17a-620 to 58-17b-620. Two new sections are added: Section R156-31b-703 and Section R156-31b-704.

 

State statutory or constitutional authorization for this rule:

Section 58-31b-101, and Subsections 58-1-106(1)(a) and 58-1-202(1)(a)

 

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs, approximately $75, to reprint the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget.

 

local governments:

Proposed amendments do not apply to local governments. Therefore, there is no anticipated cost or savings to local government.

 

other persons:

The Division does not anticipate any costs or savings associated with these proposed amendments as the amendments are only clarifying the scope of practice for LPNs and RNs.

 

Compliance costs for affected persons:

The Division does not anticipate any costs or savings associated with these proposed amendments as the amendments are only clarifying the scope of practice for LPNs and RNs.

 

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule filing includes technical changes to correct a statute reference and defines two terms. The proposed rule also documents the generally recognized scope of practice for registered nurses and licensed practical nurses. No fiscal impact to businesses is anticipated as a result of these technical and clarifying amendments. Klarice A. Bachman, Executive Director

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

 

Direct questions regarding this rule to:

Laura Poe at the above address, by phone at 801-530-6789, by FAX at 801-530-6511, or by Internet E-mail at [e-mail]

 

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

02/14/2005

 

Interested persons may attend a public hearing regarding this rule:

1/28/2005 at 9:00 AM, Heber Wells Building, 160 E 300 S, Conference Room 4A, Salt Lake City, UT

 

This rule may become effective on:

02/15/2005

 

Authorized by:

J. Craig Jackson, Director

 

 

RULE TEXT

R156. Commerce, Occupational and Professional Licensing.

R156-31b. Nurse Practice Act Rules.

R156-31b-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 31b, as defined or used in these rules:

(1) "Absolute discharge", as used in Subsection 58-31b-302(7)(b), means the completion of criminal probation or parole.

(2) "Activities of daily living (ADLs)" means those personal activities in which individuals normally engage or are required for an individual's well-being whether performed by them alone, by them with the help of others, or for them by others, including eating, dressing, mobilizing, toileting, bathing, and other acts or practices to which an individual is subjected while under care in a regulated facility or under the orders of a licensed health care practitioner in a private residence.

(3) "Affiliated with an institution of higher education", as used in Subsection 58-31b-601(1), means the general and science education courses required as part of a nursing education program are provided by an educational institution which is approved by the Board of Regents or an equivalent governmental agency in another state or a private educational institution which is regionally accredited by an accrediting board recognized by the Council for Higher Education Accreditation of the American Council on Education; and the nursing program and the institution of higher education are affiliated with each other as evidenced by a written contract or memorandum of understanding.

(4) "APRN" means an advanced practice registered nurse.

(5) "Approved continuing education" in Subsection R156-31b-303(3) means:

(a) continuing education that has been approved by a professional nationally recognized approver of health related continuing education;

(b) nursing education courses taken from an approved education program as defined in Section R156-31b-601; and

(c) health related course work taken from an educational institution accredited by a regional institutional accrediting body identified in the "Accredited Institutions of Postsecondary Education", 2003-04 edition, published by the American Council on Education.

(6) "Approved education program" as defined in Subsection 58-31b-102(3) is further defined to include any nursing education program published in the documents entitled "Directory of Accredited Nursing Programs", 2003, published by the National League for Nursing Accrediting Commission, which are hereby adopted and incorporated by reference as a part of these rules.

(7) "CCNE" means the Commission on Collegiate Nursing Education.

(8) "CGFNS" means the Commission on Graduates of Foreign Nursing Schools.

(9) "COA", as used in these rules, means the Council of Accreditation of Nurse Anesthesia Education Programs.

(10) "Clinical mentor/preceptor", as used in Section R156-31b-607, means an individual who is employed by a clinical health care facility and is chosen by that agency, in collaboration with the Parent-Program, to provide direct, on-site supervision and direction to a nursing student who is engaged in a clinical rotation, and who is accountable to both the clinical agency and the supervisory clinical faculty member.

(11) "Comprehensive nursing assessment", as used in these rules, means an extensive data collection (initial and ongoing) for individuals, families, groups and communities addressing anticipated changes in patient/client conditions as well as emergent changes in patient's/client's health status; recognizing alterations to previous patient/client conditions; synthesizing the biological, psychological, spiritual and social aspects of the patient's/client's condition; evaluating the impact of nursing care; and using this broad and complete analysis to make independent decisions and identification of health care needs; plan nursing interventions, evaluate need for different interventions and the need to communicate and consult with other health team members.

(12) "Contact hour" means 50 minutes.

[ (12) "Consultation", as used in Subsection R156-31b-703, means the LPN-GCM may develop or revise a treatment plan without the direction or immediate oversite of the RN. The LPN-GCM is to confer with or ask the advice of the RN as needed. However, the RN must review and approve treatment plans as required in Subsection R156-31b-703.

(13) "Contributing to or participating in", as used in Subsection 58-31-102(17), means a LPN makes observations, provides data, and input into the nursing process while under the direction of a RN, MD or other licensee as defined by these rules, who is responsible for developing and documenting the plan of care.

]([14]13) "CRNA" means a certified registered nurse anesthetist.

([15]14) "Delegation" means transferring to an individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.

([16]15) "Direct supervision" is the supervision required in Subsection 58-31b-306(1)(a)(iii) and means:

(a) the person providing supervision shall be available on the premises at which the supervisee is engaged in practice; or

(b) if the supervisee is specializing in psychiatric mental health nursing, the supervisor may be remote from the supervisee if there is personal direct voice communication between the two prior to administering or prescribing a prescription drug.

([17]16) "Disruptive behavior", as used in these rules, means conduct, whether verbal or physical, that is demeaning, outrageous, or malicious and that places at risk patient care or the process of delivering quality patient care. Disruptive behavior does not include criticism that is offered in good faith with the aim of improving patient care.

(17) "Focused assessment", as used in these rules, means an appraisal of an individual's status and situation at hand, contributing to comprehensive assessment by the registered nurse, supporting ongoing data collection and deciding who needs to be informed of the information and when to inform.

(18) "Generally recognized scope and standards of nursing practice", as referred to in Subsections 58-31b-102(17), (18), and (19), means the "Nursing:Scope and Standards of Practice", 2003, published by the American Nurses Association, which is hereby adopted and incorporated by reference, or as established by the professional community.

(19) "Licensure by equivalency" as used in these rules means licensure as a licensed practical nurse after successful completion of course work in a registered nurse program which meets the criteria established in Section R156-31b-601.

(20) "LPN" means a licensed practical nurse.

(21) "NLNAC" means the National League for Nursing Accrediting Commission.

(22) "NCLEX" means the National Council Licensure Examination of the National Council of State Boards of Nursing.

(23) "Non-approved education program" means any foreign nurse education program.

(24) "Other specified health care professionals", as used in Subsection 58-31b-102(12), who may direct the licensed practical nurse means:

(a) advanced practice registered nurse;

(b) certified nurse midwife;

(c) chiropractic physician;

(d) dentist;

(e) osteopathic physician;

(f) physician assistant;

(g) podiatric physician;

(h) optometrist;

(i) certified registered nurse anesthetist.

(25) "Parent-program", as used in Section R156-31b-607, means a nationally accredited, Board of Nursing approved nursing education program that is providing nursing education (didactic, clinical or both) to a student and is responsible for the education program curriculum, and program and student policies.

(26) "Patient surrogate", as used in Subsection R156-31b-502(4), means an individual who has legal authority to act on behalf of the patient when the patient is unable to act or decide for himself, including a parent, foster parent, legal guardian, or a person designated in a power of attorney.

(27) "Personal assistance and care", as used in Subsection 58-31b-102(11), means acts or practices by an individual to personally assist or aid another individual in activities of daily living. These activities do not include those services provided by physical therapy, occupational therapy, or recreational therapy aides/assistants.

(28) "Postsecondary school", as used in Section R156-31b-607, means a program registered and in good standing with the Utah Department of Commerce, Division of Consumer Protection, that offers coursework to individuals who have graduated from high school or have been awarded a GED.

(29) "Psychiatric mental health nursing specialty", as used in Subsection 58-31b-302(3)(g), includes psychiatric mental health nurse specialists and psychiatric mental health nurse practitioners.

(30) "RN" means a registered nurse.

(31) "Supervision" in Section R156-31b-701 means the provision of guidance or direction, evaluation and follow up by the licensed nurse for accomplishment of a task delegated to unlicensed assistive personnel or other licensed individuals.

(32) "Supervisory clinical faculty", as used in Section R156-31b-607, means one or more individuals employed by an approved nursing education program who meet the accreditation and Board of Nursing specific requirements to be a faculty member and are responsible for the overall clinical experiences of nursing students and may supervise and coordinate clinical mentors/preceptors who provide the actual direct clinical experience.

(33) "Unprofessional conduct" as defined in Title 58, Chapters 1 and 31b, is further defined in Section R156-31b-502.

 

R156-31b-702. Scope of Practice.

(1) The lawful scope of practice for an RN employed by a department of health shall include implementation of standing orders and protocols, and completion and providing to a patient of prescriptions which have been prepared and signed by a physician in accordance with the provisions of Section 58-17[a]b-620.

(2) An APRN who chooses to change or expand from a primary focus of practice must be able to document competency within that expanded practice based on education, experience and certification. The burden to demonstrate competency rests upon the licensee.

(3) An individual licensed as either an APRN or a CRNA may practice within the scope of practice of a RN under his APRN or CRNA license.

(4) An individual licensed in good standing in Utah as either an APRN or a CRNA and residing in this state, may practice as an RN in any Compact state.

 

R156-31b-703. Generally Recognized Scope of Practice of a LPN.

In accordance with Subsection 58-31b-102(17), the LPN practicing within the generally recognized scope of practice of a LPN practices as follows:

(1) As related to professional accountability:

(a) practices within the legal boundaries for practical nursing through the scope of practice authorized in statute and rule;

(b) demonstrates honesty and integrity in nursing practice;

(c) bases nursing decisions on nursing knowledge and skills, the needs of patients/clients;

(d) accepts responsibility for individual nursing actions, competence, decisions and behavior in the course of practical nursing practice; and

(e) maintains continued competence through ongoing learning and application of knowledge in the client's interest.

(2) Responsibilities for nursing practice implementation:

(a) conducts a focused nursing assessment;

(b) plans for episodic nursing care;

(c) demonstrates attentiveness and provides patient/client surveillance and monitoring;

(d) assists in identification of client needs;

(e) seeks clarification of orders when needed;

(f) demonstrates attentiveness and provides observation for signs, symptoms and changes in client condition;

(g) assists in the evaluation of the impact of nursing care, and contributes to the evaluation of patient/client care;

(h) recognizes client characteristics that may affect the patient's/client's health status;

(i) obtains orientation/training competency when encountering new equipment and technology or unfamiliar care situations;

(j) implements appropriate aspects of client care in a timely manner;

(i) provides assigned and delegated aspects of patient's/client's health care plan;

(ii) implements treatments and procedures; and

(iii) administers medications accurately;

(k) documents care provided;

(l) communicates relevant and timely client information with other health team members including:

(i) patient/client status and progress;

(ii) patient/client response or lack of response to therapies;

(iii) significant changes in patient/client condition; or

(iv) patient/client needs;

(m) participates in nursing management;

(i) assigns nursing activities to other LPNs;

(ii) delegates nursing activities for stable patients/clients to unlicensed assistive personnel;

(iii) observes nursing measures and provides feedback to nursing manager; and

(iv) observes and communicates outcomes of delegated and assigned activities;

(n) takes preventive measures to protect patient/client, others and self;

(o) respects patient's/client's rights, concerns, decisions and dignity;

(p) promotes safe client environment;

(q) maintains appropriate professional boundaries; and

(r) assumes responsibility for own decisions and actions.

(3) Responsibilities as a member of an interdisciplinary health care team:

(a) functions as a member of the health care team, contributing to the implementation of an integrated health care plan;

(b) respects client property and the property of others; and

(c) protects confidential information unless obligated by law to disclose the information.

 

R156-31b-704. Generally Recognized Scope of Practice of a RN.

In accordance with Subsection 58-31b-102(18), the RN practices within the generally recognized scope of practice of a RN practices as follows:

(1) As related to professional accountability:

(a) practices within the legal boundaries for nursing through the scope of practice authorized in statute and rules;

(b) demonstrates honesty and integrity in nursing practice;

(c) bases professional decisions on nursing knowledge and skills, the needs of patients/clients;

(d) accepts responsibility for judgments, individual nursing actions, competence, decisions and behavior in the course of nursing practice; and

(e) maintains continued competence through ongoing learning and application of knowledge in the patient's/client's interest.

(2) Responsibility for nursing practice implementation:

(a) conducts a comprehensive nursing assessment;

(b) detects faulty or missing patient/client information;

(c) applies nursing knowledge effectively in the synthesis of the biological, psychological and social aspects of the patient's/client's condition;

(d) uses this broad and complete analysis to plan strategies of nursing care and nursing interventions that are integrated within the patient's/client's overall health care plan;

(e) provides appropriate decision making, critical thinking and clinical judgment to make independent nursing decisions and identification of health care needs;

(f) seeks clarification of orders when needed;

(g) implements treatments and therapy, including medication administration, delegated medical and independent nursing functions;

(h) obtains orientation/training for competence when encountering new equipment and technology or unfamiliar situations;

(i) demonstrates attentiveness and provides client surveillance and monitoring;

(j) identifies changes in patient's/client's health status and comprehends clinical implications of patient/client signs, symptoms and changes as part of expected and unexpected patient/client course or emergent situations;

(k) evaluates the impact of nursing care, the patient's/client's response to therapy, the need for alternative interventions, and the need to communicate and consult with other health team members;

(l) documents nursing care;

(m) intervenes on behalf of patient/client when problems are identified and revises care plan as needed;

(n) recognizes patient/client characteristics that may affect the patient's/client's health status; and

(o) takes preventive measures to protect patient/client, others and self.

(3) Responsibility to act as an advocate for patient/client:

(a) respects the patient's/client's rights, concerns, decisions and dignity;

(b) identifies patient/client needs;

(c) attends to patient/client concerns or requests;

(d) promotes safe patient/client environment;

(e) communicates patient/client choices, concerns and special needs with other health team members regarding:

(i) patient/client status and progress;

(ii) patient/client response or lack of response to therapies; and

(iii) significant changes in patient/client condition;

(f) maintains appropriate professional boundaries;

(g) maintains patient/client confidentiality; and

(h) assumes responsibility for own decisions and actions.

(4) Responsibility to organize, manage and supervise the practice of nursing:

(a) assigns to another only those nursing measures that fall within that nurse's scope of practice, education, experience and competence or unlicensed person's role description;

(b) delegates to another only those nursing measures which that person has the necessary skills and competence to accomplish safely;

(c) matches patient/client needs with personnel qualifications, available resources and appropriate supervision;

(d) communicates directions and expectations for completion of the delegated activity;

(e) supervises others to whom nursing activities are delegated or assigned by monitoring performance, progress and outcome, and assures documentation of the activity;

(f) provides follow-up on problems and intervenes when needed;

(g) evaluates the effectiveness of the delegation or assignment;

(h) intervenes when problems are identified and revises plan of care as needed;

(i) retains professional accountability for nursing care as provided;

(j) promotes a safe and therapeutic environment by:

(i) providing appropriate monitoring and surveillance of the care environment;

(ii) identifying unsafe care situations; and

(iii) correcting problems or referring problems to appropriate management level when needed; and

(k) teaches and counsels patient/client families regarding health care regimen, which may include general information about health and medical condition, specific procedures and wellness and prevention.

(5) Responsibility as a member of an interdisciplinary health care team:

(a) functions as a member of the health care team, collaborating and cooperating in the implementation of an integrated patient/client-centered health care plan;

(b) respects patient/client property, and the property of others; and

(c) protects confidential information.

(6) As chief administrative nurse:

(a) assures that organizational policies, procedures and standards of nursing practice are developed, kept current and implemented to promote safe and effective nursing care;

(b) assures that the knowledge, skills and abilities of nursing staff are assessed and that nurses and nursing assistive personnel are assigned to nursing positions appropriate to their determined competence and licensure/certification/registration level;

(c) assures that competent organizational management and management of human resources within the nursing organization are established and implemented to promote safe and effective nursing care; and

(d) assures that thorough and accurate documentation of personnel records, staff development, quality assurance and other aspects of the nursing organization are maintained.

(7) When functioning in a nursing program educator (faculty) role:

(a) teaches current theory, principles of nursing practice and nursing management;

(b) provides content and clinical experiences for students consistent with statutes and rules;

(c) supervises students in the provision of nursing services; and

(d) evaluates student scholastic and clinical performance with expected program outcomes.

 

KEY: licensing, nurses

[December 21, 2004]2005

Notice of Continuation June 2, 2003

58-31b-101

58-1-106(1)(a)

58-1-202(1)(a)