Chapter 2
THE LEGAL REGULATION OF NURSING IN NEVADA
INTRODUCTION
2:2
STRUCTURE OF
THE BOARD OF NURSING
2:2
DEFINITION OF
SCOPES OF PRACTICE IN THE NURSE PRACTICE ACT
2:4
LICENSING
REQUIREMENTS AND CONTINUING EDUCATION
2:6
Registered Nursing
2:6
Licensed Practical Nursing
2:7
Interim licensure
2:7
Failure/reapplication
2:7
License renewal
2:8
Continuing education requirement
2:8
ADVANCED
PRACTICE NURSING (APN) 2:9
Requirements for certification
2:10
Scope of practice
2:10
Renewal of APN
2:13
Revocation 2:14
APPLICATION
FOR APN CERTIFICATION 2:14
NURSE
SPECIALTY CERTIFICATION 2:15
Requirements for title
2:15
Scope of practice
2:16
Renewal 2:16
Revocation 2:16
Certified Registered Nurse Anesthetists (CNAs)
2:16
Scope of practice
2:16
Requirements for CNA certification
2:18
License renewal
2:18
Revocation 2:19
STANDARDS OF
NURSING PRACTICE
2:19
DELEGATION AND
SUPERVISION OF NURSING CARE 2:24
Delegating 2:24
Supervising 2:25
DISCIPLINARY
ACTION BY THE BOARD
2:27
General procedure
2:27
Grounds for disciplinary action 2:28
Statutes
& Regulations 
INTRODUCTION
The nursing profession is directed and regulated by numerous laws and
by a variety of institutions. In
Nevada, nurses are legally bound by the applicable laws found in the Nevada
Revised Statutes, the nursing regulations found in the Nevada Administrative
Code, case law handed down by Nevada courts, and sometimes by the professional
and ethical standards of nursing organizations, such as the American Nurses
Association. The primary source
and authority for the legal regulation of Nevada nurses is the Nevada State
Board of Nursing. This chapter
first explores the structure, functions, and authority of the Nursing Board,
and focuses on the nursing regulations promulgated by it.
Various other facets of the legal regulation of nursing, such as case
law written by courts, and the legal regulation of nursing specialties will
also be detailed. The following
chapter, “The Legal Regulation of Nursing in Nevada,” focuses on the
self-regulating aspects of the profession, rather than those regulations
imposed upon it by law.
STRUCTURE OF
THE BOARD OF NURSING
The Nevada Nurse Practice Act created the structure and functions of the
Nevada State Board of Nursing (Board). NRS
632.005. The Nevada legislature
gave the Board the primary responsibility of protecting the public’s health
from unprofessional and unqualified nurses, thus granting the Board broad
powers to regulate the nursing profession.
The Board establishes the scope of nursing practice and monitors nurses
to ensure that the established standards of practice are met.
It is also responsible for establishing standards for the licensing of
nurses and, when necessary, for administering professional sanctions and
discipline.
The Nevada State
Board of Nursing (Board) consists of seven members appointed by the governor.
NRS 632.020.
The members are:
Four Registered Nurses (RNs) who are graduates of an accredited school
of nursing, are licensed as professional nurses in the State of Nevada and
have been actively engaged in nursing for at least five years preceding the
appointment.
One practical nurse who is a graduate of an accredited school of
practical nursing, is licensed as a practical nurse in the State of Nevada and
has been actively engaged in nursing for at least five years preceding the
appointment.
One nursing assistant who is certified pursuant to the provisions of
the chapter.
One member who is a representative of the general public.
NRS 632.030.
The Board members must be United States citizens, and residents of the
state of Nevada for at least two years. The
members appointed to the Board must be selected to provide the broadest
representation of the various activities, responsibilities and types of
service within the practice of nursing and related areas.
Each member serves a term of four years, and may serve no more than two
consecutive terms.
Nevada law also provides for a nursing assistant advisory committee to
assist the Board. The members of the advisory committee consist of: one
representative of a long-term care facility, one representative of an acute
care facility, one representative from a home health agency, one
representative from the health division of the Department of Human Resources,
one representative of the welfare division of the Department of Human
Resources, one representative of the aging services division of the Department
of Human Resources, one representative of the American Association of Retired
Persons, a nursing assistant, a registered nurse, and a licensed practical
nurse.
The Board meets at least every four months to set policy and conduct
business as may properly come before it.
This includes determining the time, location and content of the nursing
examinations, making financial decisions, and holding disciplinary hearings.
Each year the Board meets and elects from its membership a president,
vice president and secretary. The
Board employs an executive director and such staff as the Board and the
executive director deem necessary. The
executive director must be currently licensed
to practice nursing in the State of Nevada.
NRS 632.030 - 632.125.
The Board can be reached at the following address and phone number:
Nevada State
Board of Nursing
1755 E. Plumb
Lane, Suite 760
Reno, Nevada
89505
Phone: (775)
688-2620
Fax: (775)
688-2628
DEFINITION OF
SCOPES OF PRACTICE IN THE NURSE PRACTICE ACT
The legal guidelines for the practice of nursing are detailed in the
Nevada Revised Statutes (NRS) and the Nevada Administrative Codes (NAC).
The NRS statutes are the laws enacted by the state legislature which
provide, among other things, the broad conceptual framework for the regulation
of nursing. The legislature
grants the Board of Nursing authority to draft the regulatory code sections of
the NAC which provide more specific rules regarding the practice of nursing.
The regulatory language in the NAC is remarkably readable, when
compared to many other state or federal codes, and thus needs very little
interpretation. In this text, all
relevant statutory and code sections are included at the end of each
applicable section. For full
copies of the statutes and regulations, write to the Nevada Board of Nursing
or download them from the Nevada State website at:
www.leg.state.nv/nac
and www.leg.state.nv/nrs
The NRS also contains Nevada’s Nurse Practice Act, which sets out the
scopes of practice for various types of recognized nurses in the state.
The Nurse Practice Act defines “registered nurse,” “licensed
practical nurse,” and “nursing assistants” and sets forth the legal
scope for the practice of nursing as one of these types of nurses.
In general, the practice of nursing is the general observation,
diagnosis and treatment of changes in a person’s health.
The term does not include acts of medical diagnosis or prescriptions of
therapeutic or corrective measures, except as authorized by specific statute.
NRS 632.0169.
A registered nurse in Nevada is a person who is licensed to practice
professional nursing. NRS
632.019. The scope of the practice of professional nursing is defined
as the performance for compensation of any act in the observation, care and
counsel of the ill, injured or infirm, in the maintenance of health or
prevention of illness of others, in the supervision and teaching of other
personnel, in the administration of medications and treatments as prescribed
by an advanced practitioner of nursing, a licensed physician, a licensed
dentist, or a licensed podiatric physician, requiring substantial specialized
judgement and skill based on knowledge and application of the principles of
biological, physical and social science, but does not include acts of medical
diagnosis or prescription of therapeutic or corrective measures. NRS 632.018.
More specifically, the administrative code lists several specific tasks
that a registered nurse is authorized to perform competently:
(a)
The diagnosis and treatment of human responses to actual or potential
health problems;
(b)
Exercising sound judgment;
(c)
Making decisions;
(d)
Carrying out his duties based on an established plan of care;
(e)
Evaluating, assessing and altering, if appropriate, the established
plan of care;
(f)
Delegating appropriate duties to other nurses;
(g)
Supervising a nurse to whom he has delegated nursing duties;
(h)
Maintaining accountability in the delegation of care;
(i)
Administering medication and carrying out treatments which are properly
authorized;
(j)
Determining the necessity and appropriateness of health care services
for a patient or prospective patient and determining that patient’s
eligibility for payment of those health care services by a licensed insurer;
(k)
Managing the cases of patients assigned to him by coordinating services
and collaborating with other health care professionals in the provision of
health care services;
(l)
Planning for the discharge of patients; and
(m)
Managing risk in the provision of health care services.
NAC 632.212
A registered nurse is further authorized to perform or supervise the
assessment and evaluation of the health of patients, the development of care
plans, and the provision of direct or delegated care.
NAC 632.216. The code also
authorizes registered nurses several tasks related to patient health
maintenance, the treatment of patients with medication, and additional duties
in her area of specialization. NAC
632.220-225 lists these tasks in detail.
The practice of practical nursing is the performance for compensation
of selected acts in the care of the ill, injured or infirm under the direction
of a registered professional nurse, and advanced practitioner of nursing, a
licensed physician, a licensed dentist or a licensed podiatric physician, not
requiring the substantial specialized skill, judgment and knowledge required
in professional nursing. NRS
632.017. Thus a LPNs scope of practice is legally limited, in some
cases, not by detailing what she may do in her job, but by limiting her from
performing those tasks that require the skill of an RN.
The specific scope of practice of a LPN is detailed in NAC 632.230 to
632.242. LPNs may perform
additional tasks other than those learned in a LPN educational program if she
has at least 1500 hours of clinical experience and meets other stringent
requirements. NAC 632.242.
A nursing assistant is any person, except a nursing assistant trainee,
who for compensation practices or offers to practice as a nursing assistant
and has submitted evidence that she is qualified to so practice and is
certified as required by the NRS statutes.
NRS 632.285.
In many instances, Nevada law authorizes nurses to perform additional
tasks in cases of emergencies. Despite
any statutory authorization, nurses should of course ensure that they are in
compliance with their employers’ policies regarding emergency care.
LICENSING
REQUIREMENTS AND CONTINUING EDUCATION
Registered Nursing
Persons interested in receiving a license to practice as a registered
nurse in Nevada must qualify for and pass the State licensing exam.
The content of this exam is at the discretion of the Board, but
currently the National Council Licensure Exam for Registered Nursing or
“NCLEX-RN” is used. NCLEX is
a set of standardized national tests used by most states as their licensing
tests. The Nevada Board also has
the option of administering oral or practical tests in addition to this
written test. NRS 632.150.
In order to qualify to take the licensing exam, the applicant must have
graduated from or received a certificate of completion from an approved
program of registered nursing. This
program must include theoretical and clinical course work in medical-surgical
nursing, maternal (obstetric) and child nursing, and psychiatric nursing.
If the applicant graduated in Nevada, the Director of the School of
Nursing will send an Affidavit of Graduation to the Board documenting that the
applicant has graduated and is eligible to take the examination.
The applicant may also request that the registrar's office of her
nursing school send an official transcript (after the degree is posted) to the
Board of Nursing. The out of
state graduate must request the registrar's office to send the Board of
Nursing an official transcript (after the degree is posted).
NRS 632.150 and NAC 632.150.
To take the exam, a completed application must be filed with the board
four months before the date of the examination.
The application must include:
2-inch by
2-inch photograph taken of the applicant within the past 2 years;
a complete set of the applicant’s fingerprints; and
the appropriate fee, currently $100.
NAC 632. 155.
Licensed Practical Nursing
The applicant for an LPN license must have successfully completed high
school or passed the GED. The
applicant must pass the approved test for licensure as an LPN, the NCLEX-PN.
Also, the applicant must have successfully completed a course of study
in an accredited school of practical or vocational nursing.
The curriculum must have included theoretical and clinical courses in
medical-surgical nursing, maternal-child nursing, and mental health concepts.
To take the licensing exam, the applicant must file a completed
application with the Board at least four months before the date of the
examination. The application must
include:
2-inch by 2-inch photograph taken of the applicant within
the past 2 years;
a complete set of the applicant’s fingerprints; and
the fee, currently $90.
NAC 632.150,
632.155.
The LPN applicant is additionally required to submit to the Board
written proof that she is:
over 18 years old; and is
of good moral character.
Interim Licensure
Both RN and LPN applicants may obtain interim licenses which allow them
to practice in a limited capacity while awaiting the results of their
licensure exam. This interim license is limited to three months. NAC 632.160.
Failure/Reapplication
If an applicant fails either the RN or the LPN exam, they may apply for
and take the exam a second time. If
an applicant fails a second time, the applicant must submit to the Board a
plan of study before reapplying a third time.
An applicant who fails a third time must re-enter and complete a course
in nursing theory at an accredited school before reapplying to take either
examination. NAC 632.120-166.
License Renewal
The Nurse Practice Act requires that licensees renew their licenses
every two years. The renewal requires:
submission of a completed renewal application;
payment of the renewal fee (currently $100);
proof of successful completion of the continuing education requirement
(see below);
submission of a complete set of fingerprints;
attestation that the applicant has committed no act which could subject
the application to denial; and
attestation that the applicant has developed no condition which might
interfere with the ability to practice nursing.
NRS 632.341 and
NAC 632.192.
Continuing Education Requirement
The Nurse Practice Act requires that licensees complete 30 hours in a
continuing education program during the 2 years before the license renewal
date. The licensee’s birthday
is the renewal date. A licensee
who has graduated from an accredited school of professional nursing or
practical nursing, is exempt from the continuing education requirement for the
first biennial period after graduation.
The Board pre-approves certain continuing education programs.
However, the Board may approve other courses which are directly related
to the practice of nursing. The
Board may also approve course work which “bears a reasonable relationship to
current developments within the field of nursing or in any special area of
practice in which the licensee engages.”
NRS 632.343. This
provision is slightly vague and allows the licensee some latitude in choosing
courses which are not already approved. Caution
should be used when submitting credit for course work which has not been
pre-approved because the Board is under no obligation to give credit for
course work beyond that which they have explicitly approved.
NRS 632.343.
In addition to
the content requirements the NAC imposes certain requirements upon continuing
education providers. The course
provider must be one of the following:
a Board-approved provider;
a national nursing organization;
an academic institution;
a provider of continuing education that is recognized by another board
of nursing; or a provider that is recognized by the regulatory board of a
related discipline that approves courses of continuing education.
NAC 632.355.
Original certificates of completion of the course work must be kept for
four years after the course was presented and must contain the following
information:
the title of the course;
the name of the provider;
the name of the entity which approved the course;
the date the course was given;
the name and license number of the nurse; and
the number of continuing education hours earned
NAC 632.340.
The licensee is not required to submit proof of the continuing
education hours at the time of license renewal, but rather is only required to
show successful completion during the Board’s periodic audits.
If audited, the nurse has 30 days to provide copies of the
above-described certificates of completion of the requisite number of
continuing education hours.
ADVANCED
PRACTICE NURSING
The state of Nevada authorizes the Board to certify and regulate
advanced practitioners of nursing. Nevada
recognizes advanced practitioners of nursing in the following areas: nurse
midwife, nurse psychotherapist, nurse practitioner, or clinical nurse
specialist. A practitioner may
obtain a certificate of recognition as an advanced practitioner of nursing if
she meets the requirements established by the Board for such certification,
and successfully completes approved educational programs designed to prepare
the nurse to perform designated acts of medical diagnosis, prescribe
therapeutic or corrective measures, and prescribe certain poisons, dangerous
drugs and devices. NRS 632.237.
Requirements for Certification
Applicants for
certification as an advanced practitioner of nursing (APN) currently must have
a bachelor’s degree in nursing. Starting
in the year 2005, the minimum entry degree will be a master’s degree.
To obtain certification as an APN, the applicant must have successfully
completed an accredited or approved program of instruction.
The program must be at least 1 year long with both classroom and
clinical components. The program
must include an advanced course in health assessment, pathophysiology, and the
preparation for independent practice as an advanced practitioner of nursing. The program must also include concentration courses in at
least one medical specialty.
The clinical experience must allow the student to integrate the
theoretical knowledge and skill taught in the classroom, with emphasis in the
medical specialty chosen by the student.
It must also train the student to make clinical decisions, including
diagnosing medical conditions and initiating proper treatment.
The applicant must submit proof of having performed as an advanced
practitioner for a minimum of 400 hours a year for 3 out of the previous 5
years. These hours are likely to
be acquired while the applicant works as a student under the auspices of the
advanced practice program. Alternately,
an applicant is not required to comply with the 400 hour requirement, if
evidence is submitted that she will complete 1,000 hours of practice without
prescribing privileges under a collaborating physician.
This alternative permits an apprenticeship in instances when the
applicant already has a sponsoring physician.
NRS 632.120, 632.237; NAC 632.260.
Scope of Practice
In Nevada, a registered nurse may become an APN as a nurse midwife,
nurse psychotherapist, nurse practitioner, or clinical nurse specialist.
Once certified the APN may:
engage in selected medical diagnosis and treatment; and
prescribe poisons, dangerous drugs and devices under protocols
developed with and approved by a collaborating physician.
NRS 632.237.
In addition to the ordinary functions of a registered nurse, the APN
may engage in the following acts, if they are within the standard of medical
practice in which she is certified and appear in her protocols:
systematically assess the health status of persons and families by:
taking, recording and interpreting medical histories and performing
physical examinations; and
performing or initiating selected diagnostic procedures.
based on information obtained in the assessment of a person’s health,
manage the care of selected persons and families with common, acute, recurrent
or long-term health problems.
Management may include:
initiation of a program of treatment;
evaluation of responses to health problems and programs of treatment;
informing a person or family of the status of the
patient’s health and alternatives for care;
evaluation of compliance with a program of treatment agreed upon by the
person or family and the advanced practitioner of nursing;
modification of programs of treatment based on the response of he
person or family to treatment;
referral to appropriate providers of health care;
treatment of minor lacerations which do not involve damage to a nerve,
tendon or major blood vessel; and
commencement of care required to stabilize a patient’s condition in
an emergency until a physician can be consulted.
In addition to the above acts which are specifically defined by
statute, the Board allows the APN to perform any other act if:
the advanced practitioner is certified to perform that act by an
organization recognized by the Board;
the performance of the act was taught in a program of education
attended by the advanced practitioner of nursing;
the performance of the act was taught in a comprehensive program of
instruction successfully completed by the advanced practitioner, which
included clinical experience; or
the act is within the scope of practice of an advanced practitioner of
nursing as determined by the Board.
NAC 632.255.
As recognized by the state of Nevada, the advanced practitioner of
nursing is a protocol-driven practice. Protocols
are the written directions for assessment and management of specified medical
conditions upon which the APN and physician have agreed as a basis for their
practice. Protocols must include guidelines for assessment and treatment of
the medical conditions, and must establish when the APN will treat and when
physician consultation or referral must be obtained. The Board explicitly
requires that the protocols must:
reflect the current practice of the advanced practitioner
of nursing;
reflect established national or customary standards for
the medical specialty;
be maintained at the place where the advanced nurse
practitioner practices; and
be available for the board to review.
The requirement of articulated guidelines that are written and
available to the APN avoids some problems encountered early in the history of
APNs where the protocols were vague unwritten rules often disputed between the
physician and APN.
The Board also
requires the APN to accurately document and maintain appropriate records
concerning her patients. These
records must then be reviewed by the collaborating physician who monitors
compliance with the established protocols.
These records may also be reviewed by the Board.
One of the more
important differences between the registered nurse and the APN is the
prescribing privilege. The
regulation of this privilege is monitored by both the Board of Nursing and the
Pharmacy Board. Additionally, the
collaborating physician is monitored in this area by the Board of Medical
Examiners. In order to receive
authorization to prescribe the APN must:
successfully complete a recognized program of advanced
nursing which includes an advanced course in pharmacotherapeutics; or
successfully complete a program of academic study that:
a.
is approved by the Board;
consists of at least 2 semester credits in advanced
pharmacotherapeutics; and
is completed within the 2 years immediately preceding the
date the application is submitted to the Board; and
successfully pass a state examination on Nevada law
relating to pharmacy.
Additionally, the applicant must document 1,000 hours of active
practice in the preceding 2 years as an advanced practitioner under a
collaborating physician. The
physician must submit a signed statement that indicates her belief that the
applicant is qualified to prescribe drugs listed in the practitioner’s
protocols.
Only over‑the‑counter medications may be listed in
protocols. Prescription
medications are added when applying for the authority to prescribe, but may
not be included in protocols when applying for basic APN certification.
Controlled substances may not be included in protocols under treatment or
management.
An applicant who has practiced in a state other than Nevada within the
two years immediately preceding the application to write prescriptions must
describe the requirements of that state, including what she was authorized to
prescribe and any disciplinary action taken against her.
An APN authorized to prescribe certain poisons, dangerous drugs, or
devices, and who changes specialties must reapply for authority to prescribe,
meeting all the requirements above-stated, unless the new specialty is
sufficiently similar to the current area of practice. Should the collaborating physician change or expand his area
of specialty, such that the APN has to prescribe new items, the physician will
need to submit a list of the new items and develop new protocols appropriate
to these items. The new protocols
must follow the same standards set forth above.
NRS 632.120,632.237, NAC 632.257, 632.258, 632.259, 632.2595.
Forms and regulations regarding authority to prescribe as well as
copies of regulations regarding collaborating physicians and dispensing of
medication may be obtained from:
Nevada State
Board of Pharmacy
1201 Terminal
Way, Room 212
Reno, NV 89502
(702)
322‑0691
Nevada State
Board of Medical Examiners
1105 Terminal
Way, Room 301
Reno, NV 89502
(702)
688‑2559
Renewal
To renew the advanced practitioner certification, the APN must submit
proof that she has reviewed the relevant protocols with the collaborating
physician, and show proof of completing a minimum of 800 hours in the
specialty area. The APN must also
submit a statement that no disciplinary actions have been brought against her,
including malpractice actions. Finally,
the APN must submit proof of completing 45 contact hours of continuing
education.
Revocation
after a hearing, the Board may deny the issuance or renewal of, or
suspend or revoke, a certificate of recognition as an Advanced Practitioner of
Nursing if it finds that an Advanced Practitioner of Nursing has:
Performed tasks beyond those permitted pursuant to this
chapter or otherwise authorized by the board, or breached an approval
agreement or a protocol;
Been negligent in performing services for patients;
Impersonated a physician or permitted others to represent
to the public that he is a physician;
Represented himself as able to practice without a
collaborating physician;
Violated any provision or failed to meet any requirement
of this chapter;
Made, or caused to be made, a false, fraudulent or forged
statement or representation to procure or attempt to procure a certificate of
recognition as an advanced practitioner of nursing;
Violated any statute or regulation relating to
prescribing, dispensing or administering any controlled substance, poison,
dangerous drug or device; or
Failed to perform nursing functions in a manner
consistent with established or customary standards.
A nurse has a constitutionally guaranteed “property” right in her
license. The Fifth Amendment to
the United States Constitution has been interpreted as requiring that a
practitioner who faces revocation of her license be granted a full hearing
prior to such revocation. The
requirements for this hearing are described in the section on disciplinary
hearings. It is unclear if revocation of the advanced practitioner
certification inevitably results in the revocation of the practitioner’s
nursing license.
APPLICATION
FOR ADVANCED PRACTITIONER OF NURSING CERTIFICATION
Following are the
instructions for the APN certification application:
No processing of
application can be completed until ALL items are received. Temporary
certification cannot be issued until temporary Nevada RN license number has
been issued. A COMPLETE APPLICATION INCLUDES:
Completed
application form(s); be certain all "initials" areas are filled.
1.
If prescribing and/or dispensing privileges are desired, complete
application(s) for that authority. Submit all documentation requested therein.
Applicants for dispensing privileges need to contact the Board office
concerning taking the pharmaceutical examination. There is no fee for
prescribing or dispensing privileges; dispensing exam fee is $150. Dispensing
privileges will not be granted (nor the test administered) until prescribing
privileges have been granted.
2.
Check/money order in the amount of two hundred ($200) dollars for the
application fee.
3.
Official transcript from an accredited/approved practitioner program.
The transcript must come directly from the institution which conferred it. The
program must be one academic year or longer in length, and must include four
(4) months of classroom instruction.
4.
Documentation of accreditation/approval of practitioner program
attended. A letter from program director/school is sufficient.
5.
If applicant completed APN program after July 1, 1992, official
transcript documenting graduation from an accredited BSN program OR evidence
of current national certification (copies of certificate must be notarized)
All other requirements to which applicant attests on the application
form(s) must be on file at each practice site and available for review upon
request from the Board of Nursing. The
Board staff will conduct random annual audits among certified APNs.
Once an
application is completed, a qualified applicant may be issued a temporary
certification for basic privileges (no temporary certification is issued for
prescribing privileges). Temporary certification is valid until the
application is ratified by the Board of Nursing at a regularly scheduled Board
meeting. The applicant's
completed file must be received at least four (4) weeks before the Board
meeting to be eligible for placement on the meeting agenda. Incomplete files
will be held until the next scheduled Board meeting.
NURSE
SPECIALTY CERTIFICATION
The State of Nevada recognizes and regulates the clinical nurse
specialist. Currently the
regulation of the specialist is considerably less detailed than that of the
advanced practitioner. Nonetheless,
there are several requirements that a nurse must adhere to before she can
legally use the “Clinical Nurse Specialist” title.
Requirements for Title
The minimum requirement for practice are a master’s degree in nursing
with education in an approved area of clinical specialty.
The program of education must be specifically intended for and designed
to prepare clinical nurse specialists. There
is also a somewhat vague requirement that the clinical nurse specialist must
demonstrate competence in the ability to assess, conceptualize and diagnose
nursing and complex health problems.
Scope of Practice
The clinical nurse specialist may act directly as an expert clinician
in the care of patients. She may
also act as a consultant, nurse leader, educator, researcher, or agent.
Renewal
The clinical nurse specialist is not a certified skill, but rather a
title recognizing an advanced degree in the field of nursing.
As such there is no separate renewal necessary.
Revocation
Because the clinical nurse specialist is not a state certified
practitioner, there is no procedure to separately revoke this title.
The clinical nurse specialist is subject to all normal disciplinary
actions available to the registered nurse and, where degree of skill is an
issue, is held to the higher standard of the clinical nurse specialist title.
Thus, in malpractice cases, the law will find that a nurse who holds
herself out as a clinical nurse specialist should be able to perform nursing
functions with the degree of skill of a specialist, rather than that of a
registered nurse.
Certified Registered Nurse Anesthetists
Scope of Practice
In contrast to the regulation of certified nurse specialists, the
regulation for Certified Registered Nurse Anesthetists (CNA) is extremely
specific and detailed. The CNA
does not make the determination to administer anesthesia.
The doctor, dentist, or podiatrist maintains the decision-making power
regarding use of anesthesia. However,
the CNA has a broad range of functions under Nevada law once a doctor,
dentist, or podiatrist makes the decision to use anesthesia for a test or
procedure. Their functions may
include the following tasks:
a.
Obtain a history of the patient's health, as appropriate to the
anticipated procedure, test or treatment;
b.
Assess the client's condition, as appropriate to the anticipated
procedure, test or treatment;
c.
Recommend, request, and order pertinent diagnostic studies and evaluate
the results of those studies;
d.
Prepare a written preanesthetic evaluation of the patient and obtain
the patient's informed consent for the anesthesia;
e.
Select, order and administer preanesthetic medications;
f.
Order, prepare, and use any equipment and supplies necessary for the
administration of anesthesia and perform or order any necessary safety checks
on the equipment;
g.
Order and prepare any drugs used for the administration of anesthesia;
h.
Select and order anesthesia techniques, agents and adjunctive drugs;
i.
Perform and manage general, regional and local anesthesia and
techniques of hypnosis;
j.
Perform tracheal intubation and extubation and provide mechanical
ventilation;
k.
Provide perianesthetic invasive and noninvasive monitoring, as
appropriate, and respond to abnormal findings with corrective action;
l.
Manage the patient's fluid, blood and balance of electrolytes and acid
base;
m.
Recognize abnormal response by a patient during anesthesia, select and
take corrective action;
n.
Identify and manage any related medical emergency requiring such
techniques as cardiopulmonary resuscitation, airway maintenance, ventilation,
tracheal intubation, pharmacological cardiovascular support and fluid
resuscitation;
o.
Evaluate the patient's response during emergence from anesthesia and
institute pharmacological or supportive treatment to ensure adequate recovery
from anesthesia;
p.
Provide care consistent with the principles of infection control and
anesthesia safety to prevent the spread of disease and prevent harm to the
anesthetized patient and others in the anesthetizing environment;
q.
Select, order and administer post-anesthetic medication;
r.
Report to the person providing post-anesthetic the patient's physical
and psychological condition, perioperative course and any anticipated
problems;
s.
Initiate, order and administer respiratory support to ensure adequate
ventilation and oxygenation in the immediate post-anesthetic period;
t.
Release the patient from the post-anesthetic care unit or discharge the
patient from the ambulatory surgical setting;
u.
Include in a timely manner as a part of the patient's medical records a
thorough report on all aspects of the patient's anesthesia care; and
v.
Assess the patient's post-anesthetic condition, evaluate the patient's
response to anesthesia and take corrective action.
NAC 632.500.
Additionally, the nurse anesthetist may accept additional
responsibilities which are appropriate to the practice setting and within her
expertise. Such responsibilities may include, but are not limited to, the
selection and administration of drugs and techniques for the control of pain
in the preoperative, intraoperative and postoperative setting.
The Nevada
regulations also require the CNA to follow any guidelines established by the
facility in which she works. These
guidelines must be in writing and approved by the facility and must conform to
all applicable statutory and regulatory codes of the state.
Requirements for Certification as a Certified Nurse Anesthetist
The applicant for certification as a certified nurse anesthetist (CNA)
must have either a bachelor’s or master’s degree in nurse anesthesia from
an accredited school and currently hold a valid license as a registered nurse.
Additionally, the applicant must successfully complete a program of
training which has been approved by the State Board of Nursing and pass a
qualifying exam from a recognized organization.
License Renewal
Certification as a CNA must be renewed biennially when the nurse’s
license is renewed. In addition to meeting the RN license renewal
requirements, the CNA must also submit proof of current certification and
satisfaction of the continuing education requirements.
The CNA must submit evidence of current certification as a nurse
anesthetist from the Council on Certification of Nurse Anesthetists or the
Council on Recertification of Nurse Anesthetists.
The continuing education requirement for the CNA is 45 contact hours
related to the practice of nurse anesthesia, 15 of which must be in anesthesia
pharmacology. If the CNA has
recertified with the national body within a year of the renewal, the
recertification will be considered to have satisfied 40 contact hours of the
continuing education requirement. Presumably
these hours will also satisfy the continuing education requirement for the RN
license renewal.
Revocation
A CNA’s license may be revoked as part of a disciplinary action by
the Board. Exceeding authority,
failing to follow designated procedures, or administering anesthetic without
the consent of a doctor, dentist, or podiatrist are grounds for revocation.
Additional grounds for revocation include: falsification of
certification materials, violations of regulations relating to prescription
privileges, and any other practice which is determined to fall below accepted
standards of practice. Finally,
all grounds for disciplinary action against the CNA’s license as a
registered nurse are grounds for revocation of the CNA license also.
To obtain more
information on advanced nursing practice or the CNA specialty visit the
following websites:
National Association of Pediatric Nurse Associates and Practitioners at
www.napnap.org
American Association of Nurse Anesthetists at
www.aana.com
American College of Nurse Midwives at
www.midwife.org
Association of
Women’s Health, OB, and Neonatal Nurses at
www.awhonn.org
STANDARDS OF
NURSING PRACTICE
The Nevada State Board of Nursing has created several committees in
varying areas of nursing and specialty practices to advise the Board on
aspects of their particular standards of nursing practice. These committees appointed by the Board include:
(a)
The committee to advise and report on complaints concerning the
practice of nursing;
(b)
The committee to advise and report on matters relating to the
establishment of state standards;
(c)
The committee to advise and report on matters relating to national
standards of nursing;
(d)
The committee to interpret and comply with the statutory changes within
the field of nursing;
(e)
The committee to report on matters relating to the practice of advanced
practitioners of nursing; and
(f)
The committee to review and maintain standards of education and
continuing education programs for all areas of nursing.
NRS 632. 073;
632.120; NAC 632.211.
The regulations divide the standards of care into general areas of
concern or emphasis. The regulations first identify areas in which a registered
nurse shall show competence, including the following:
The diagnosis and treatment of human responses to actual
or potential health problems;
Exercising sound judgment;
Carrying out his duties based on an established plan of
care;
Evaluating, assessing and altering, if appropriate, the
established plan of care;
Delegating appropriate duties to other nurses;
Supervising a nurse to whom he has delegated nursing
duties;
Maintaining accountability in the delegation of care;
Administering medication and carrying out treatments
which are properly authorized;
Determining the necessity and appropriateness of health
care services for a patient or prospective patient and determining that
patient’s eligibility for payment of those health care services by a
licensed insurer;
Managing the cases of patients assigned to him by
coordinating services and collaborating with other health care professionals
in the provision of health care services;
Planning for the discharge of patients; and
Managing risk in the provision of health care services.
NAC 632.212.
The regulations describe standards of practice which relate to
interpersonal dynamics between the registered nurse and colleagues, other
healthcare providers, and patients. These
regulations state that a nurse shall:
(a)
Perform or supervise the direct observation of patients under his care;
(b)
Ensure the effectiveness, use and maintenance of procedures used to
communicate to other providers of health care a patient’s symptoms,
reactions and progress; and
(c)
Recognize, understand and allow for a patient’s choice regarding his
psychological, biological, social and cultural needs and religious beliefs.
NAC 632.214.
The Board has created regulations which detail the standards that apply
to patient care as performed by the registered nurse.
Registered nurses shall perform the following:
The assessment and evaluation of the health of each
patient under his care based on his knowledge or understanding of the
biological, psychological, social and cultural factors affecting the
patient’s condition;
The development of a written plan for the care of each
patient under his care based on the present and predicted needs of the
patient, and shall review and revise that plan if necessary;
The evaluation of a patient’s health and the initiation
of acts which are necessary to provide adequate care to a patient when needed,
giving direct care to a patient, assisting with the care of the patient or
delegating the care of the patient to persons qualified to provide that care;
Making judgments and decisions regarding the status of a
patient and the planning, carrying out, evaluation, and modification of the
patient’s care as needed;
The documentation of observations, assessments and
responses of patients and the care provided by nurses for those patients; and
In situations which threaten the life of a patient, acts
which are necessary to stabilize the patient’s condition and prevent more
serious complications, performed pursuant to an established policy.
The regulations involving the operating or delivery room setting
provide that the registered nurse may perform:
(a)
The duties of a circulating nurse or surgical first assistant in an
operating room;
(b)
Uncomplicated deliveries of infants if:
He is an advanced practitioner of nursing; and
The delivery is performed under the direction of a
physician; and
iii.
The duties of a licensed practical nurse.
NAC 632. 216.
The Board has promulgated regulations regarding the registered
nurse’s standard of care for maintaining the patient’s health.
These regulations require that the registered nurse must perform or
supervise the following:
1.
The identification of the immediate and long‑term goals for the
care of patients under his care;
2.
The assessment of the need for and the provision of health education
and counseling of a patient under his care based on the needs of the patient,
involving the patient and his family and friends, so that the patient may
better understand the immediate and long‑term goals for his care;
3.
The recognition of the various psychological and social needs of the
patients;
4.
The provision and encouragement of an environment conducive to the
safety and health of patients;
5.
The collaboration with other providers of health care to provide safe
care for the patient; and
6.
The use of resources in the community to continue the proper care of a
patient after he leaves the care of the registered nurse.
NAC 632.218.
Finally, the board defines the registered nurse’s scope of practice
with regard to taking physician orders and administering medications as
follows:
1.
A registered nurse shall perform or supervise:
(a)
The verification of an order given for the care of a patient to ensure
that it is appropriate and properly authorized and that there are no
documented contraindications in carrying out the order;
(b)
Any act necessary to understand the purpose and effect of medications
and treatments and to ensure the competence of the person to whom the
administration of medications is delegated; and
(c)
The initiation of intravenous therapy and the administration of
intravenous medication.
2.
A registered nurse shall take orders only from a licensed physician,
dentist, podiatric physician or advanced practitioner of nursing. A registered
nurse may refuse an order if he takes appropriate action to ensure the safety
of a patient.
NAC 632. 220.
The above regulations are more likely to expose the registered nurse to
potential litigation and disciplinary action than any other part of the law.
It also gives the least deference to the reality of hospital based
nursing practice because the code does not take into account the decreasing
numbers of nurses, the increasing acuity of the patients cared for by nurses,
and the decreased amount of time available for each task.
This code section sets the nurse up as the gatekeeper for any decision
made by the physician, dentist, or podiatrist, and requires the nurse to pass
judgment on physician orders at the risk of employment reprisals or
litigation. On the positive side,
it is possible that this code section might be used to protect the nurse from
such employment based reprisals for refusing to perform a physician order.
A recent case illustrates the potential conflict that occurs when a
nurse questions the treatment given to a patient.
In Missouri, a nurse noticed that a recently-admitted patient showed
several signs of toxic shock syndrome, and attempted to relate her findings to
a physician. The physician disagreed and did not order the necessary
antibiotics. The nurse went to
her supervisor, who also disagreed. Eventually,
the nurse contacted a hospital administrator, who agreed with the nurse’s
evaluation. Unfortunately the
patient ultimately died from toxic shock syndrome.
The nurse, who complained to several other people that her findings
were ignored, was fired for violating hospital policy.
The Missouri court found that the nurse had a absolute duty to speak up
on behalf of her patient, and could not have her employment terminated simply
for attempting to advocate for her patient.
Kirk v. Mercy Hosp., 851 S.W.2d 617 (Mo. 1993).
The case is not binding on Nevada courts; however, Nevada nursing
regulations are substantially similar in nature, it is likely that a nurse who
exercises her duty to advocate on behalf of a patient, even if doing so goes
against a physician’s order or even perhaps against hospital policy, cannot
be terminated. Nonetheless, it is
always advisable to carefully follow the policies of an institution for
disagreeing with the care of a patient.
Nevada regulations require a registered nurse to verify any order given
for the care of a patient to ensure that it is appropriate and that there are
no documented contraindications in carrying out the order.
NAC 632.220. Nevada
specifically gives registered nurses the authority to “refuse an order if
[s]he takes appropriate action to ensure the safety of the patient.”
Similarly, nursing regulations require that a licensed practical nurse
exercise some independent judgment before carrying out an order.
A LPN must verify that the order given is appropriate and must verify
that there are no documented contraindications in carrying out the order.
NAC 632.236. Although not given the specific authority to refuse an order,
the LPN is nonetheless given quite a bit of legal freedom to question and
verify an order before carrying it out.
Finally, a nurse
should not refuse a physician’s order unless she is absolutely certain that
the patient’s health will not be further jeopardized by refusing the order.
Nevada law only allows a nurse the discretion to refuse an order if she
can ensure the continued safety of the patient.
In other words, if a nurse refuses an order and she is wrong, and the
patient is harmed because the order was not followed and alternative steps to
maintain the patient’s health were not instituted, the nurse will be liable.
Although Nevada law gives a nurse considerable discretion, it is always
advisable, whenever possible to follow the hospital’s policy for recording
grievances and disagreements. In
particular, follow the hospital’s established chain of command, except
perhaps in situations when it is clear that following a physician’s order
will result in immediate irreparable harm to a patient.
DELEGATION AND
SUPERVISION OF NURSING CARE
Delegating
The Board recognizes that the registered nurse frequently needs to
delegate certain tasks and supervise the practice of others, and has developed
regulations to both authorize and control delegations and assignments.
Despite the authorization, a nurse who delegates tasks should remain
aware of the potential liability if she makes an assignment or delegation that
is beyond the scope of the abilities of the person to whom the task is
assigned. In general, a
registered nurse or a licensed practical nurse may not delegate a task to a
person who is not authorized to perform that task.
NAC 632.244. Thus, a nurse may not delegate a task to a person if that
task is beyond the scope of practice of the person to whom it is assigned.
In addition, a nurse who delegates tasks is usually responsible for the
performance of the assigned work, thus potentially doubling the liability of a
nurse supervisor. As with most
instances of negligence, the standard of care is “reasonable prudence”; if
the assignment is made with the level of skill exercised by a reasonably
prudent nurse supervisor, she may be able to avoid liability in the event that
an incident occurs.
The following
regulations provide the guidelines regarding this area:
1.
A registered nurse may delegate nursing care to other nurses and
supervise other personnel in the provision of care if those persons are
qualified to provide that care.
2.
A registered nurse shall perform or supervise any act necessary to
ensure the quality and sufficiency of the nursing care of a patient which is
delegated to or by other nurses under his supervision.
3.
Before delegating the care of a patient to another nurse, a registered
nurse shall consider the following:
(a)
The amount of direction required by the nurse to whom the care is being
delegated;
(b)
The complexity of the nursing care needed by the patient, recognizing
that simple care may be performed by following an established policy while
more complex care requires greater knowledge and a higher level of judgment,
direction and supervision;
(c)
The educational preparation and demonstrated competency of the nurse to
whom the care is delegated; and
(d)
The established policies and procedures relating to the care of the
patient and the procedures used to communicate to other providers of health
care the patient’s symptoms, reactions and progress.
4.
A registered nurse who delegates nursing care to another nurse or
assigns duties relating to that care to other personnel is responsible for the
actions taken by those persons in carrying out the duties delegated or
assigned.
NAC 632.222.
Subsections 1 and
2 primarily grant authority to the nurse to delegate procedures when it is
necessary and the procedure can be accomplished safely.
Sections 3 and 4 set out the requirement that the delegating nurse have
extensive knowledge of the skills and competency possessed by the co-worker to
whom duties are being delegated prior to delegating such duties.
Significantly, these sections provide that liability falls on the
registered nurse for the actions taken by a co-worker to whom duties were
delegated.
This
section also raises questions about who assumes liability for patient care
mishaps during break relief. Is
the nurse originally assigned to a patient’s care responsible for delegating
care during a break, or is the charge nurse or the hospital responsible for
requiring the original nurse to take a break?
These sections also raise the question of whether the hospital has a
responsibility to ensure that any nurse working in one of its settings is
qualified to practice there. If
this is the case, the delegating nurse should be absolved of responsibility
for relying on the hospital’s decision.
Unfortunately, these regulations probably leave the nurse open to
litigation any time she delegates any care to another practitioner.
Supervising
The tort of
“negligent supervision” often includes within its scope the idea of
negligent assignment. Liability
can be imposed on a nurse manager who fails to properly supervise a nurse to
whom a task was assigned,
particularly if the nurse manager was aware, or should have been aware, that
the employee was not competent to perform the task.
Clearly, if a nurse employee indicates that she is unqualified to
perform a procedure, the supervisor will have received the requisite knowledge
of incompetence that could lead to liability.
In addition, even the failure of a nurse manager to properly allocate
the time and resources of the available staff, which was a factor in causing a
patient’s injury, can lead to liability.
Despite the above
discussion, taken from common law (case law), the Nevada regulations which
govern the supervision of others by the registered nurse are more reasonable
than those concerning delegation, mainly because the nurse who undertakes the
task of supervision does so voluntarily.
The regulations state:
A registered
nurse who supervises other persons shall:
(a)
Determine the priority of the needs of each patient and group of
patients under his care;
(b)
Provide direction in formulating, interpreting and carrying out the
objectives and policies related to nursing care;
(c)
Assist those persons who are being supervised to develop the skills
needed for their competence in providing for the care of a patient;
(d)
Assist the persons who are being supervised in carrying out the planned
care of a patient; and
(e)
Evaluate the effectiveness of the nursing care given to each patient or
group of patients under his care.
NAC 632.224.
The regulations
for the nurse acting or employed as a charge nurse or nurse supervisor provide
that:
A registered
nurse who is employed as a charge nurse is responsible for the management of
other personnel under his supervision and shall:
(a)
Establish the authorized scope of practice for the nurses he supervises
and establish and document a process to carry out, maintain and improve the
knowledge, skills and ability of those nurses to provide safe and effective
care.
(b)
Before assigning those persons, verify their ability to carry out
safely duties which are identified in a written policy and to follow the
procedures established by the employing agency.
(c)
Establish written guidelines to be followed by personnel under his
supervision for receiving and administering prescriptions. The guidelines must
include procedures for:
(1)
Identifying the type of patient to be served;
(2)
Identifying the intended medical treatment; and
(3)
Resolving any questions related to a prescription, if the prescription
is not received directly from an advanced practitioner of nursing, a licensed
physician, a licensed dentist or a licensed podiatric physician.
(d)
Ensure that the guidelines established pursuant to paragraph (c) are
available at each site where nursing care is provided under the supervision of
the chief nurse.
(e)
Create a safe and effective system for delivery of nursing care which
complies with nationally recognized standards.
(f)
Maintain a copy of the references used to determine the authorized
scope of practice for the nurses he supervises and make them available to
governmental agencies upon request.
If a chief nurse
is not assigned to the practice area of a registered nurse, the registered
nurse shall determine the authorized scope of his practice and establish and
document verification of his competency.
NAC 632.224.
To limit legal liability, a supervising nurse should always try to
anticipate and prevent problems before they arise.
If staffing shortages force you to make assignments of unqualified or
minimally qualified persons, document your actions and the reasons for them.
Send a memo to the appropriate supervisor and administrator stating
that you were forced to assign unqualified individuals to tasks unsuited to
their skills. If appropriate,
communicate to other personnel that a unqualified individual will be
performing a task and will require additional supervision and assistance.
In addition to legal liability for negligent selection (assignment) and
negligent supervision, nurse managers and supervisors face disciplinary action
from the Nevada State Board of Nursing. Even
if a patient is not harmed, a nurse may be disciplined for “assigning or
delegating functions, tasks or responsibilities” to “unqualified
persons.” Another section of the same regulation states that “failing
to supervise a person to whom functions of nursing are delegated or
assigned” will be considered unprofessional conduct that will be
disciplined. NAC 632.890.
DISCIPLINARY
ACTION BY THE BOARD
General Procedure
One of the most challenging tasks assigned to the Board is to act as
the disciplinary body for all categories of nursing licensees.
A nursing license is a constitutionally protected property right and
the Board is a governmental body regulated not only by Nevada law but also by
the due process requirements of the Fifth Amendment of the United States
Constitution. Therefore, before
suspending or revoking any license or certification, or taking any other
action, the Board is required to provide the licensee or certificate holder
with proper notice and a hearing.
Proper notice
requires that the licensee or certificate holder receive, in writing, a list
of the charges against him or her and a copy of any complaint that has been
filed. This notice must be either
delivered in person or sent via certified or registered mail.
This notice must be sent at least 20 days before the hearing date.
The licensee must raise any issues of improper notice at the beginning
of the hearing, or they will be considered waived.
The licensee or certificate holder may request in writing copies of any
communications, reports, and affidavits that the board has which relate to the
matter under consideration.
Within 30 days of notice or as soon as practicable, the Board must
conduct a hearing on the matter. If
requested by the licensee or certificate holder, the hearing must be held in
the county where she resides. The
Board may delegate the actual hearing to a hearing officer, and
the officer then acts on her recommendations.
The Board is required to reach a decision and notify the licensee or
certificate holder of its decision within 60 days after the final hearing.
If disciplinary action is taken, the investigative information and the
Board’s ruling become a public record.
NRS 632.350; 632.400.
Nothing in the statutes prevents the licensee or certificate holder
from hiring an attorney to represent her before and during a disciplinary
hearing. In fact, the regulations
explicitly encourage the licensee or certificate holder to seek legal
representation. Because few
things are as distressing or detrimental to one’s career as the loss or
suspension of one’s license, it is highly recommended that an attorney be
consulted before facing the hearing. It
is also recommended that the nurse employ an attorney who is independent of
the facility where the nurse is employed.
This ensures that the attorney will focus on the nurse’s interests.
Grounds for Disciplinary Action
NAC 632.890 lists thirty-eight separate, specific grounds for which
disciplinary actions may be brought. Because
these grounds are very specific and exhaustive, they are listed here verbatim:
1.
Discriminating on the basis of race, religious creed, color, national
origin, age, disability, ancestry, or sex in the rendering of nursing
services;
2.
Performing acts beyond the scope of the practice of nursing;
3.
Assuming duties and responsibilities within the practice of nursing
without adequate training;
4.
Assuming duties and responsibilities within the practice of nursing if
competency is not maintained, or the standards of competence are not
satisfied, or both;
5.
Disclosing the contents of the examination for licensure or
certification, or soliciting, accepting, or compiling information regarding
the contents of the examination before, during, or after its administration;
6.
Assigning or delegating functions, tasks, or responsibilities of
licensed or certified persons to unqualified persons;
7.
Failing to supervise a person to whom functions of nursing are
delegated or assigned, if responsible for supervising that person;
8.
Failing to safeguard a patient from the incompetent, abusive, or
illegal practice of any person;
9.
Practicing nursing while, with or without good cause, his physical,
mental, or emotional condition impairs his ability to act in a manner
consistent with established or customary nursing standards, or both;
10.
Practicing nursing if any amount of alcohol, a controlled substance, or
dangerous drug that is not legally prescribed is present in the body of the
nurse or nursing assistant as determined by a test of the blood, saliva,
breath, or urine of the nurse or nursing assistant given while the nurse or
nursing assistant is on duty;
11.
Having present in the body of the nurse or nursing assistant, alcohol,
a controlled substance, or dangerous drug that is not legally prescribed
during a test of the blood, saliva, breath, or urine of the nurse or nursing
assistant given as a condition of employment;
12.
Failing to respect and maintain a patient’s right to privacy;
13.
Violating a patient’s confidentiality;
14.
Performing or offering to perform the functions of a licensee or holder
of a certificate by false representation or under a false or an assumed name;
15.
Failing to report the gross negligence of a licensee or holder of a
certificate in the performance of his duties or a violation of the provisions
of chapter 632 of NRS or this chapter;
16.
Failing to document properly the administration of a controlled
substance, including, but not limited to:
(a)
Failing to document the administration of a controlled substance on the
Controlled Substance Administration Record, the patient’s Medication
Administration Record and the Nursing Progress Notes, including the
patient’s response to the medication;
(b)
Documenting as wastage a controlled substance and taking that
controlled substance for personal or other use;
(c)
Failing to document the wastage of a controlled substance that was not
legally administered to a patient;
(d)
Soliciting the signature on any record of a person as a witness to the
wastage of a controlled substance when that person did not witness the
wastage; or
(e)
Signing any record as a witness attesting to the wastage of a
controlled substance which he did not actually witness;
17.
Soliciting services, soliciting or borrowing money, materials or other
property, or any combination thereof, from a:
Patient;
Family member of a patient;
Person with significant personal ties to a patient,
whether or not related by blood; or
Legal representative of a patient;
18. Diverting
supplies, equipment, or drugs for personal or unauthorized use;
19.
Aiding, abetting, or assisting any person in performing any acts
prohibited by law;
20.
Inaccurate recording, falsifying or otherwise altering or destroying
records;
21.
Obtaining, possessing, furnishing, or administering prescription drugs
to any person, including himself, except as directed by a person authorized by
law to prescribe drugs;
22.
Leaving an assignment without properly notifying the appropriate
personnel or abandoning a patient in need of care;
23.
Exploiting a patient for financial gain or offering, giving,
soliciting, or receiving fees or gifts for the referral of a:
Family member of a patient;
Person with significant personal ties to a patient, whether or not
related by blood; or
Legal representative of a patient;
24.
Failing to collaborate with other members of a health care team as
necessary to meet the health needs of a patient;
25.
Failing to observe the conditions, signs, and symptoms of a patient, to
record the information or to report significant changes to the appropriate
persons;
26.
Failing to abide by any state or federal statute or regulation relating
to the practice of nursing;
27.
Failing to perform nursing functions in a manner consistent with
established or customary standards;
28.
Causing a patient physical, mental, or emotional harm by taking direct
or indirect actions or failing to take appropriate actions;
29.
Engaging in sexual contact with a patient or client;
30.
Failing as a chief nurse to:
(a)
Institute standards of nursing practice so that safe and effective
nursing care is provided to patients;
(b)
Institute standards of competent organizational management and
management of human resources so that safe and effective nursing care is
provided to patients; or
(c)
Create a safe and effective environment, including the failure to
assess the knowledge, skills and ability of a licensee or holder of a
certificate and determine his competence to carry out the requirements of his
job;
31.
Failing to report the unauthorized practice of nursing;
32.
Endangering the safety of the general public, patients, clients, or
coworkers by making actual or implied threats of violence or carrying out an
act of violence;
33.
Abusing or neglecting a patient;
34.
Misappropriating the property of a patient;
35.
Failing to comply with a condition, limitation, or restriction which
has been placed on his license or certificate;
36.
Engaging in the practice of nursing or performing the services of a
nursing assistant without a license or certificate issued pursuant to the
provisions of this chapter and chapter 632 of NRS;
37.
Displaying a license, certificate, diploma, or permit, or a copy of a
license, certificate, diploma, or permit, which has been fraudulently
purchased, issued, counterfeited, or materially altered;
38.
Engaging in any other unprofessional conduct with a patient or client
that the Board determines is outside the professional boundaries generally
considered acceptable in the profession.
NAC 632.890.
Note that a nurse need not actually engage in unprofessional conduct in
order to be disciplined by the Board. Merely
aiding another to commit an unprofessional act or failing to report
unprofessional conduct is grounds for discipline.
The Board is not
restricted to bringing disciplinary action for these listed violations only.
As the ultimate arbiter of what is reasonable practice, the Board has
wide discretion to bring disciplinary action for any conduct which it
considers detrimental either to the individual patient or to the practice of
nursing. Beyond formal revocation
or fines, the Board is granted regulatory authority to take “informal”
action against a nurse who has received complaints against her.
These informal procedures may include conferences or meetings.
Such informal proceedings do not preclude the Board from bringing
future disciplinary actions against a nurse.
The Board has
broad discretion in its choice of disciplinary action. In response to the outcome of a disciplinary hearing, the
Board can dismiss the complaint, reprimand the licensee or certificate holder,
temporarily suspend the license or certificate, or impose and collect an
administrative fine with revocation of a license invoked for failure to pay.
The Board may also revoke or deny the license or certification or
renewal of same, or put the practitioner on probation, with the terms
determined by the Board.
You may obtain notice of proposed regulations, disciplinary hearings,
and Nursing Board meetings by filing out the provided form.
The request to be placed on the “mailing list” is valid for six
months and must be renewed by mail.
Date
________________________________
Executive Director
Nevada State Board
of Nursing
1755 E. Plumb Lane,
Suite 760
Reno, Nevada 89505
Dear Executive
Director:
As the Nevada legislature has provided in Nevada’s Administrative
Procedures Act, Nevada Revised Statutes (NRS) 233B.0603, I hereby request
to be placed on the Board of Nursing’s mailing list for all public
notices including intent to adopt, amend or repeal regulation(s).
Pursuant to NRS 233B.061, I request to be placed on the mailing
list for proposed regulations including workshops and/or hearings.
As provided in Nevada’s Open Meeting Act, NRS 241.020, I request
written notice of all meetings of Board of Nursing and specifically request all materials
as provided in NRS 241.020.4 (agenda for public meeting, proposed
ordinance or regulation to be discussed, including any other supporting
material provided to members of the Board except materials pertaining to the
closed portion of the meeting, or materials confidential by law or agreement).
My mailing address
is:
Name
____________________________________________
Street Address
_____________________________________
City, State
Zip ____________________________________
Sincerely,
_____________________________
Signature