By Kathleen Morris, Director of Nursing Practice
Health care practices, including nursing practice, are altered by the development of new technology, new medications, research outcomes, manifestations of previously unknown disease entities (Remember when AIDS was new? SARS? Bird flu?), population demographics, and public health concerns…even changes in the resistance of bacteria. Changes to practice often engender concern among nurses about their scope of practice and accountability for performing new nursing care techniques, perhaps wondering if what they are doing is even a recognized, approved practice. Am I allowed to do this procedure, give this medication, or include this treatment in my care plan for the patient? Do I need to have an order from an authorized prescriber? Does the physician/anesthesiologist/respiratory therapist/code team need to be at the bedside?
Practice, in many cases, changes prior to modification of law and rules. Regulatory agencies may be forced to play a game of catch-up due to the nature of advances in technology, research, and the like. You can catch a glimpse of these phenomena by consulting the Ohio Board of Nursing’s guidance statements on a variety of clinical issues, including monitoring epidural infusions, filling and unfilling gastric bands, confirming PICC placement, sharp wound debridement, and aesthetic treatments. The necessity for these guidance statements was, in part, driven by the number of questions concerning nursing practice received by the board. Guidance statements are not regulations, but instead lead the registered nurse to those existing law and rules relevant to the issue, as well as the knowledge, skills, and abilities that should be gained prior to incorporating a new technique or procedure into their personal nursing practice
Competency to do what you are doing is nearly always going to be the bottom line for any new activity not outright prohibited by existing law. Do you possess the competency to perform this activity? Is this competency development documented by competency testing, certification, or continuing education? The requirement to develop competency for those nursing activities which are beyond what you learned in nursing school already exists in rule 4723-4-03 (D) OAC:
(D) A registered nurse may provide nursing care that is beyond basic nursing
preparation for a registered nurse, provided:
(1) The nurse obtains education that emanates from a recognized body of
knowledge relative to the nursing care to be provided;
(2) The nurse demonstrates knowledge, skills, and abilities necessary to provide
the nursing care;
(3) The nurse maintains documentation satisfactory to the board of meeting
the requirements set forth in paragraphs (D)(1) and (D)(2) of this rule;
(4) When the nursing care to be provided according to division (B)(5) of
section 4723.01 of the Revised Code, the nurse has a specific current order
from an individual who is authorized to practice in this state and is acting
within the course of the individual's professional practice; and
(5) The nursing care does not involve a function or procedure that is prohibited
by any other law or rule.
These rules are the baseline for incorporating any new procedure into your nursing practice. If your employer is encouraging or requiring that you adopt new techniques and procedures, they should also be providing the wherewithal to do so. Policies regarding new practices, including the who, what, where, when, and why should also be adopted by the institution.
Guidance statements and a decision-making tool regarding scope of practice can be located on the Ohio Board of Nursing’s website.
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