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Bùi Thị Vân Thiện đang tìm kiếm từ khóa According to the Standards of nursing practice, Board Rule 217.11 a comprehensive nursing assessment được Update vào lúc : 2022-09-02 06:45:17 . Với phương châm chia sẻ Bí quyết về trong nội dung bài viết một cách Chi Tiết Mới Nhất. Nếu sau khi Read Post vẫn ko hiểu thì hoàn toàn có thể lại Comments ở cuối bài để Admin lý giải và hướng dẫn lại nha.On September 28, 2004, new Rules 217.11, Standards of Nursing Practice, and 217.12, Unprofessional Conduct, were adopted. Since that time, many questions have arisen regarding issues such as licensed vocational nurse (LVN) scope of practice and the nursing process, "supervised practice," and registered nurse (RN) co-signature of LVN documentation. The most frequently asked questions regarding these issues and staff's responses to those questions are provided below. It is important to note that the answers to these questions are interrelated and rely on the Nursing Practice Act (NPA) and Board Rules as well as other applicable laws and regulations related to the specific practice and employment setting. Additional resources that address differences in scope of practice based on educational preparation of LVNs and RNs are available on the "Nursing Practice Information" page of the BNE web site under the "Scope of Practice" heading.
Nội dung chính- Which of the following statements best describes the Texas Board of Nursing position statements?Which of the standards of the nursing process is specific to the scope of practice for a registered nurse?What Texas Board of Nursing Resource s may be utilized to decide if an employer's job position policy or assignment is safe and legally within the nurse's scope of practice?What is an incident based nursing peer review committee?
Q.: Can a LVN perform an "initial" assessment?
A: As with most practice questions, the answer depends on many factors. Board of Nurse Examiners' (BNE) Rule 217.11, Standards of Nursing Practice, refers to focused assessments performed by LVNs [section] 217.11(2)(A)] and comprehensive assessments performed by RNs [section] 217.11(3)A)]. Nothing in Board Rule refers to initial assessments; therefore, the BNE does not define nor does it determine whether a LVN may complete an initial assessment. Staff recommends contacting the agency that regulates the specific type of practice setting to determine if other laws and regulations apply. If other regulations require that a RN perform the initial patient/client assessment, then the LVN cannot perform the assessment by proxy for the RN.
In situations requiring comprehensive assessments by a RN, the LVN cannot begin by performing a focused assessment and have the RN follow up with an assessment of only those parameters not assessed by the LVN. A comprehensive assessment is a different level of assessment requiring that the RN use his/her own independent nursing judgment. Rule 217.11(1)(S) and (T) clarifies that a nurse is responsible for accepting assignments within his/her individual educational preparation, experience, knowledge, skills and abilities. Likewise, these same factors must be considered when nurses make assignments to other nurses.
Q.: Can a LVN initiate/develop the nursing care plan?
A: Staff recommends you review Rule 217.11, Standards of Nursing Practice, as well as the Guideline for LVN Scope of Practice (available on the "Nursing Practice Information" section of the BNE web site under "Scope of Practice.") Rule 217.11(2)(A)(ii) and (iii) clarifies that LVNs may not initiate care plans, but they should contribute to the planning and carrying out of nursing care and participate in the development of and modifications to the ongoing nursing care plan. Only the RN may develop the initial nursing care plan and make nursing diagnoses [Rule 217.11(3)(A)(ii) and (iii)]. This difference between LVN and RN scope of practice is based on differences in educational preparation of nurses licensed each level as defined in the Differentiated Entry Level Competencies for Graduates of Basic Nursing Education Programs in Texas (DELC). DELC may be viewed in its entirety or downloaded from the "Nursing Education Information" page of the BNE web site.
Q.: Must a RN sign behind or "co-sign" nursing actions performed by a LVN?
A: In general, BNE staff does not recommend a nurse co-sign anything unless he/she has directly witnessed an act (such as narcotic wastage) or has gone behind another nurse and personally performed the same assessment with the same findings.
As discussed above, each licensed nurse is responsible for accepting assignments that are within the educational preparation, experience, knowledge, and physical and emotional ability of the individual nurse [Rule 217.11(1)(T)]. Both LVNs and RNs are required to document the nursing care they render; each is held accountable for doing it accurately and completely.
The question of a RN co-signing after a LVN most often arises in situations when an attempt is made to expand the LVN's scope of practice by holding the RN responsible for expanded tasks performed by the LVN. The RN co-signing for something that is beyond the LVN's scope of practice does not legitimize the LVN's actions. A nurse never functions "under the license" of another nurse. Therefore, if a patient requires a comprehensive assessment performed by a RN, the assignment (or a portion thereof) may not be given to a LVN. If such an assignment is inadvertently given to a LVN, he/she is responsible for notifying the nurse who made the assignment that it is beyond his/her scope of practice to perform the assigned task. Each nurse has a duty to maintain client safety [217.11(1)(B)] that includes communication with appropriate personnel. Position Statement 15.14, Duty of a Nurse in Any Setting, further explains a nurse's duty to a client.
Q.: Describe what "supervision of practice" means in relation to a LVN functioning with a directed scope of practice "under the supervision of...."
A: Section 301.353 of the NPA and Rule 217.11(2) require a LVN to practice under the supervision of a RN, advanced practice nurse, physician, podiatrist, dentist or physician assistant. The supervision requirement correlates with [section] 301.002(5) of the NPA that states that LVNs have a directed scope of practice. It should be noted that Position Statement 15.25 clarifies that supervision and carrying out medication orders may be expanded to include "any other practitioner legally authorized to prescribe the ordered medication(s)."
Although BNE requirements preclude a LVN from practicing in a completely independent manner (that is, without supervision), there is nothing in the NPA or rules that requires direct (on site or on unit) supervision of a LVN. A resource person must be accessible to the LVN least telephonically or by similar means. However, proximity to the LVN's practice setting and the type of licensure of the supervisor should be determined on a case-by-case basis with input from the LVN and his/her supervisor. Factors to be considered should include: (1) the type of practice setting; (2) the stability of the patient's condition; (3) the tasks to be performed; (4) the LVN's experience and (5) any laws and regulations that apply to the specific practice setting. To illustrate, consider the LVN who performs routine nursing tasks or nursing tasks learned through ongoing continuing education (such as intravenous therapy) and compare with a LVN who performs a delegated medical act (such as botox administration). These are different situations and will differ in who (RN, physician) is appropriate to supervise the LVN as well as the proximity of the supervisor. Other regulations, such as those related to reimbursement, may also be a factor in the latter situation.
As noted previously, remember that whether a task is a nursing act or a delegated medical act, the nurse (LVN or RN) is responsible for the tasks he/she chooses to perform. See Position Statement 15.14, Duty of a Nurse in Any Setting, located under the Nursing Practice Information section of the web page for complete information on a nurse's duty. Staff further recommend review of documents listed on the BNE web page under "Scope of Practice" in the Nursing Practice Information section for additional guidance on how a nurse can determine what is within his/her scope of practice.
Paramedics/EMTs in the Emergency Department (ED)
Q.: Can a RN delegate starting a peripheral IV saline lock to an EMT/Paramedic in the Emergency Department (ED)? Some of the "techs" in our ED are "licensed paramedics" who also work for EMS. What other kinds of tasks can be delegated to Emergency Medical Technicians (EMTs)/Paramedics in the ED setting?
A: The rules governing EMTs and Paramedics are located in Title 25, Texas Administrative Code, Section 157.2. This rule limits the scope of practice of EMTs/Paramedics to performing duties in the "pre-hospital and inter-facility transport" settings. Therefore, whether certified or licensed, the BNE delegation rules view EMTs, Paramedics, or other similarly trained staff as "unlicensed assistive personnel" (UAPs) when working in acute care settings, such as the ED.
Each RN decides on a case-by-case basis what nursing tasks may be delegated to unlicensed personnel in accordance with Rule 224 (relating to RN delegation in acute care settings or for patients with acute conditions). It should be noted that position descriptions developed by employing institutions can neither mandate RN delegation, nor force RN delegation by facility policy or physician order.
The BNE's delegation Rule 224 is not prescriptive to specific procedures or tasks that may or may not be delegated. Rule 224 permits a RN to delegate starting a peripheral IV saline lock to an unlicensed person providing all of the delegation criteria are met. The applicable section of Rule 224 in delegating this task is [section] 224.8(b), Discretionary Delegation Tasks, under (2)(A), Sterile Procedures. Section 224.8(c)(5) does prohibit delegation of administration of IV fluids, so an unlicensed tech in the ED could not connect and administer a bag of IV fluid under RN delegation.
Other laws outside of the BNE's jurisdiction may prohibit performance of certain tasks by unlicensed personnel, even if a physician is willing to delegate a task. Under physician delegation, the physician must willingly make the decision and delegate the task(s) and such delegation must be permitted by hospital/facility policy. BNE staff cannot speak as experts on the Texas Medical Board's (TMB) rules; however, Rule 193 of the TMB Rules addresses "physician delegation." You may wish to contact the TMB (512) 305-7010, or check their web site www.tmb.state.tx.us for more information on this law.
The delegation rules also address the RN who may be supervising an unlicensed person to whom the physician has delegated tasks. The RN always has a responsibility to protect client safety [section] 217.11(1)(B)], so the RN has a duty to intervene if he/she sees something being done incorrectly by the unlicensed person, and to notify the delegating practitioner of the incident. For additional information on EMTs and Paramedics in the pre-hospital and interfacility transport setting, check the Texas Department of State Health Services web site ://www.tdh.state.tx.us/hcqs/ems/default.htm, or, to access applicable laws, see Texas Legislature Online www.capitol.state.tx.us.
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Which of the following statements best describes the Texas Board of Nursing position statements?
Which of the following statements best describes the Texas Board of Nursing Position Statements? The Position Statements are a collection of guidelines designed to help nurses position patients for different procedures.Which of the standards of the nursing process is specific to the scope of practice for a registered nurse?
Rule 217.11 - Standards of Nursing Practice.What Texas Board of Nursing Resource s may be utilized to decide if an employer's job position policy or assignment is safe and legally within the nurse's scope of practice?
Board Rule 217.20 is the Board's rule concerning safe harbor nursing peer review, and §217.20(e) outlines the requirements the nurse must meet in order to secure the protections, what the protections are, and where they are listed in the law [Texas Occupations Code Section 303.005].What is an incident based nursing peer review committee?
Incident-based nursing peer review focuses on determining if a nurse's actions, be it a single sự kiện or multiple events (such as in reviewing up to five (5) minor incidents by the same nurse within a year's period of time), should be reported to the Board or if the nurse's conduct does not require reporting because the ... Tải thêm tài liệu liên quan đến nội dung bài viết According to the Standards of nursing practice, Board Rule 217.11 a comprehensive nursing assessment