DAR File No. 27992

Commerce, Occupational and Professional Licensing

R156-31b

Nurse Practice Act Rules

NOTICE OF PROPOSED RULE

DAR File No.: 27992
Filed: 06/06/2005, 02:44
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

As a result of H.B. 12 and H.B. 243 which were recently passed during the 2005 Legislative Session, amendments to the rule are being proposed. (DAR NOTE: H.B. 12 is found at UT L 2005 Ch 50, and was effective 05/02/2005. H.B. 243 is found at UT L 2005 Ch 134, and was effective 05/02/2005.)

Summary of the rule or change:

As a result of H.B. 12 (2005) deleting the regulation of health care assistants from the Nurse Practice Act (Title 58, Chapter 31b), amendments are made throughout the rule to delete any reference to health care assistants or any definitions associated with health care assistants. Also, as a result of H.B. 243 (2005) deleting the regulation of Licensed Practical Nurse-Geriatric Care Managers (LPN-GCM), amendments are made throughout the rule to delete any reference to LPN-GCM. Also, several statute citations have been updated in the rule. In Section R156-31b-202, a Nursing Education Peer Committee to the Nursing Board has been established as allowed under Subsection 58-1-203(1)(f).

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)

Deletes "Nursing: Scope and Standards of Practice", 2003 edition, as published by the American Nurses Association

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs, approximately $50, to reprint the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget. Any decrease in revenue to the state budget as a result of no longer regulating health care assistants and LPN-GCM has already been addressed in the fiscal notes attached to H.B. 12 and H.B. 243 (2005).

local governments:

The Division has determined that the proposed amendments may have a savings effect on local governments if a local government paid for any application and/or renewal fees for health care assistants that may be employed by any local government agency. The Division is unable to determine if any local governments paid the application and/or renewal fees for health care assistants.

other persons:

As a result of the passage of H.B. 12 and H.B. 243 (2005), individuals will no longer need to be registered as health care assistants or LPN-GCM. Anyone who would have been required to be regulated before the statute changes will save the costs of initial licensure application and renewal fees. It should be noted that the LPN-Geriatric Care Manager pilot program was never implemented so there is no impact on anyone regarding this change. An individual who was previously required to be registered as a health care assistant will no longer be required to pay an application fee of $69, which includes the criminal background check fee, and the renewal fee of $27 every 2 years. The Division estimates it received approximately 2,000 new applications for registration as a health care assistant for an aggregate savings amount of $138,000 on a yearly basis to the regulated occupation in application fees that would have been paid. The Division had approximately 9,000 registered health care assistants at the time the legislation was passed which would result in an aggregate savings amount of $243,000 every 2 years to the regulated occupation as a result of renewal fees not being paid for health care assistants.

Compliance costs for affected persons:

An individual who was previously required to be registered as a health care assistant will no longer be required to pay an application fee of $69, which includes the criminal background check fee, and the renewal fee of $27 every 2 years.

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

In accordance with the passage of H.B. 12 and H.B. 243 in the 2005 General Session, this rule filing eliminates all references to health care assistants and geriatric care managers. No fiscal impact to businesses is anticipated beyond those already considered in the passage of these bills. This rule filing also corrects code and rule references and establishes standards for advisory peer review committees as required by statute. No fiscal impact to businesses is anticipated as a result of these technical and clarifying amendments. Russell C. Skousen, Executive Director

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

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 lpoe@utah.gov

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:

08/01/2005

This rule may become effective on:

08/02/2005

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]5)(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]2) "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]3) "APRN" means an advanced practice registered nurse.

([5]4) "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]5) "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]6) "CCNE" means the Commission on Collegiate Nursing Education.

([8]7) "CGFNS" means the Commission on Graduates of Foreign Nursing Schools.

([9]8) "COA", as used in these rules, means the Council of Accreditation of Nurse Anesthesia Education Programs.

([10]9) "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]10) "Comprehensive nursing assessment", as used in Section R156-31b-704, 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]11) "Contact hour" means 50 minutes.

([13]12) "CRNA" means a certified registered nurse anesthetist.

([14]13) "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.

([15]14) "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.

([16]15) "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]16) "Focused nursing assessment", as used in Section R156-31b-703, means an appraisal of an individual's status and situation at hand, contributing to the 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]17) "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 Sections R156-31b-601 and R156-31b-603.

([20]18) "LPN" means a licensed practical nurse.

([21]19) "NLNAC" means the National League for Nursing Accrediting Commission.

([22]20) "NCLEX" means the National Council Licensure Examination of the National Council of State Boards of Nursing.

([23]21) "Non-approved education program" means any foreign nurse education program.

([24]22) "Other specified health care professionals", as used in Subsection 58-31b-102([12]13), 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]23) "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]24) "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]25) "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]26) "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]27) "RN" means a registered nurse.

([31]28) "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]29) "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]30) "Unprofessional conduct" as defined in Title 58, Chapters 1 and 31b, is further defined in Section R156-31b-502.

R156-31b-202. Advisory Peer Committee created - Membership - Duties.

(1) In accordance with Subsection[s] 58-1-203([6]1)(f)[ and 58-31b-202(2)], there is created the Psychiatric Mental Health Nursing Peer Committee and the Nursing Education Peer Committee.

(2) Psychiatric Mental Health Nursing Peer Committee.

(a) The [whose] duties and responsibilities of the Psychiatric Mental Health Nursing Peer Committee are to:

(i) [include ]review[ing] applications for licensure as an APRN [applications,]specializing in psychiatric mental health nursing when appropriate; and

(ii) [, and advising]advise the board and division regarding practice issues.

([2]b) The composition of the [committee]Psychiatric Mental Health Nursing Peer Committee shall be:

([a]i) three APRNs specializing in psychiatric mental health nursing;

([b]ii) at least one member shall be a faculty member actively teaching in a psychiatric mental health nursing program; and

([c]iii) at least one member shall be actively participating in the supervision of an APRN intern.

(3) Nursing Education Peer Committee.

(a) The duties and responsibilities of the Nursing Education Peer Committee are to:

(i) review applications for approval of nursing education programs;

(ii) advise the board and division regarding standards for approval of nursing education programs; and

(iii) assist the board and division to conduct site visits of nursing education programs.

(b) The composition of the Nursing Education Peer Committee shall be:

(i) five RNs or APRNs actively involved in nursing education; and

(ii) members of the board may also serve on this committee.

R156-31b-302d. Qualifications for Licensure - Criminal Background Checks.

(1) In accordance with Subsection 58-31b-302([7]5), an applicant for licensure under this chapter who is applying for licensure from a foreign country shall meet the fingerprint requirement by submitting:

(a) a visa issued within six months of making application to Utah; or

(b) a copy of a criminal background check from the country in which the applicant has immigrated, provided the check was completed within six months of making application to Utah.

R156-31b-306. Inactive Licensure.

(1) A licensee may apply for inactive licensure status in accordance with Sections 58-1-305 and R156-1-305.

(2) To reactivate a license which has been inactive for five years or less, the licensee must document current compliance with the continuing competency requirements as established in Subsection R156-31b-303(3).

(3) To reactivate a RN or LPN license which has been inactive for more than five years but less than 10 years, the licensee must document active licensure in another state or jurisdiction, pass the required examinations as defined in Section R156-31b-302c within six months prior to making application to reactivate a license, or successfully complete an approved re-entry program.

(4) To reactivate a RN or LPN license which has been inactive for 10 or more years, the licensee must document active licensure in another state or jurisdiction, or pass the required examinations as defined in Section R156-31b-302c within six months prior to making application to reactivate a license and successfully complete an approved re-entry program.

(5) To reactivate an APRN or CRNA license which has been inactive for more than five years, the licensee must document active licensure in another state or jurisdiction or pass the required examinations as defined in Section R156-31b-302c within six months prior to making application to reactivate a license.

R156-31b-307. Reinstatement of Licensure.

(1) In accordance with Section 58-1-308 and Subsection R156-1-308[e]g(3)(b), an applicant for reinstatement of a license which has been expired for five years or less, shall document current compliance with the continuing competency requirements as established in Subsection R156-31b-303(3).

(2) The Division may waive the reinstatement fee for an individual who was licensed in Utah and moved to a Nurse Licensure Compact party state, who later returns to reside in Utah.

R156-31b-401. Disciplinary Proceedings.

(1) An individual licensed as a LPN who is currently under disciplinary action and qualifies for licensure as an RN may be issued an RN license under the same restrictions as the LPN.

(2) A nurse [or health care assistant ]whose license [or registration ]is suspended, may under Subsection 58-31b-401[(2)(d) may] petition the division at any time that he can demonstrate that he can resume competent practice.

R156-31b-402. Administrative Penalties.

In accordance with Subsections 58-31b-102(1) and 58-31b-402(1), unless otherwise ordered by the presiding officer, the following fine schedule shall apply.

(1) Using a protected title:

initial offense: $100 - $300

subsequent offense(s): $250 - $500

(2) Using any title that would cause a reasonable person to believe the user is licensed [or registered ]under this chapter:

initial offense: $50 - $250

subsequent offense(s): $200 - $500

(3) Conducting a nursing education program in the state for the purpose of qualifying individuals for licensure without board approval:

initial offense: $1,000 - $3,000

subsequent offense(s): $5,000 - $10,000

(4) Practicing or attempting to practice nursing [or health care assisting ]without a license [or registration ]or with a restricted license[ or registration]:

initial offense: $500 - $2,000

subsequent offense(s): $2,000 - $10,000

(5) Impersonating a licensee[ or registrant], or practicing under a false name:

initial offense: $500 - $2,000

subsequent offense(s): $2,000 - $10,000

(6) Knowingly employing an unlicensed person:

initial offense: $500 - $1,000

subsequent offense(s): $1,000 - $5,000

(7) Knowingly permitting the use of a license [or registration ]by another person:

initial offense: $500 - $1,000

subsequent offense(s): $1,000 - $5,000

(8) Obtaining a passing score, applying for or obtaining a license[ or registration], or otherwise dealing with the division or board through the use of fraud, forgery, intentional deception, misrepresentation, misstatement, or omission:

initial offense: $500 - $2,000

subsequent offense(s): $2,000 - $10,000

(9) violating or aiding or abetting any other person to violate any statute, rule, or order regulating nursing[ or health care assisting]:

initial offense: $500 - $2,000

subsequent offense(s): $2,000 - $10,000

(10) violating, or aiding or abetting any other person to violate any generally accepted professional or ethical standard:

initial offense: $500 - $2,000

subsequent offense(s): $2,000 - $10,000

(11) Engaging in conduct that results in convictions of, or a plea of nolo contendere, or a plea of guilty or nolo contendere held in abeyance to a crime of moral turpitude or other crime:

initial offense: $500 - $2,000

subsequent offense(s): $2,000 - $10,000

(12) Engaging in conduct that results in disciplinary action by any other jurisdiction or regulatory authority:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(13) Engaging in conduct, including the use of intoxicants, drugs to the extent that the conduct does or may impair the ability to safely engage in practice as a nurse[ or a health care assistant]:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(14) Practicing or attempting to practice as a nurse [or health care assistant ]when physically or mentally unfit to do so:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(15) Practicing or attempting to practice as a nurse [or health care assistant ]through gross incompetence, gross negligence, or a pattern of incompetency or negligence:

initial offense: $500 - $2,000

subsequent offense(s): $2,000 - $10,000

(16) Practicing or attempting to practice as a nurse [or health care assistant ]by any form of action or communication which is false, misleading, deceptive, or fraudulent:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(17) Practicing or attempting to practice as a nurse [or health care assistant ]beyond the individual's scope of competency, abilities, or education:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(18) Practicing or attempting to practice as a nurse [or health care assistant ]beyond the scope of licensure:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(19) Verbally, physically, mentally, or sexually abusing or exploiting any person through conduct connected with the licensee's [or registrant's ]practice:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(20) Failure to safeguard a patient's right to privacy:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(21) Failure to provide nursing service in a manner that demonstrates respect for the patient's human dignity:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(22) Engaging in sexual relations with a patient:

initial offense: $5,000 - $10,000

subsequent offense(s): $10,000

(23) Unlawfully obtaining, possessing, or using any prescription drug or illicit drug:

initial offense: $200 - $1,000

subsequent offense(s): $500 - $2,000

(24) Unauthorized taking or personal use of nursing supplies from an employer:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(25) Unauthorized taking or personal use of a patient's personal property:

initial offense: $200 - $1,000

subsequent offense(s): $500 - $2,000

(26) Knowingly entering false or misleading information into a medical record or altering a medical record:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(27) Unlawful or inappropriate delegation of nursing care:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(28) Failure to exercise appropriate supervision:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(29) Employing or aiding and abetting the employment of unqualified or unlicensed person to practice:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(30) Failure to file or impeding the filing of required reports:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(31) Breach of confidentiality:

initial offense: $200 - $1,000

subsequent offense(s): $500 - $2,000

(32) Failure to pay a penalty:

Double the original penalty amount up to $10,000

(33) Prescribing a schedule II-III controlled substance without a consulting physician or outside of a consultation and referral plan:

initial offense: $500 - $1,000

subsequent offense(s): $500 - $2,000

(34) Failure to confine practice within the limits of competency:

initial offense: $500 - $1,000

subsequent offense(s): $500 - $2,000

(35) Any other conduct which constitutes unprofessional or unlawful conduct:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000

(36) Engaging in a sexual relationship with a patient surrogate:

initial offense: $1,000 - $5,000

subsequent offense(s): $5,000 - $10,000

(37) Engaging in practice in a disruptive manner:

initial offense: $100 - $500

subsequent offense(s): $200 - $1,000.

R156-31b-502. Unprofessional Conduct.

"Unprofessional conduct" includes:

(1) failing to destroy a license which has expired due to the issuance and receipt of an increased scope of practice license;

(2) a RN issuing a prescription for a prescription drug to a patient except in accordance with the provisions of Section 58-17[a]b-620, or as may be otherwise provided by law;

(3) failing as the nurse accountable for directing nursing practice of an agency to verify any of the following:

(a) that standards of nursing practice are established and carried out so that safe and effective nursing care is provided to patients;

(b) that guidelines exist for the organizational management and management of human resources needed for safe and effective nursing care to be provided to patients;

(c) nurses' knowledge, skills and ability and determine current competence to carry out the requirements of their jobs;

(4) engaging in sexual contact with a patient surrogate concurrent with the nurse/patient relationship unless the nurse affirmatively shows by clear and convincing evidence that the contact:

(a) did not result in any form of abuse or exploitation of the surrogate or patient; and

(b) did not adversely alter or affect in any way:

(i) the nurse's professional judgment in treating the patient;

(ii) the nature of the nurse's relationship with the surrogate; or

(iii) the nurse/patient relationship; and

(5) engaging in disruptive behavior in the practice of nursing[;

(6) unauthorized disclosure of confidential information obtained as a result of practice as a health care assistant; and

(7) engaging in any regulated health care practice for which the person is not registered, certified, or licensed].

R156-31b-701. Delegation of Nursing Tasks.

In accordance with Subsection 58-31b-102([10]11)(g), the delegation of nursing tasks is further defined, clarified, or established as follows:

(1) The nurse delegating tasks retains the accountability for the appropriate delegation of tasks and for the nursing care of the patient/client. The licensed nurse shall not delegate any task requiring the specialized knowledge, judgment and skill of a licensed nurse to an unlicensed assistive personnel. It is the licensed nurse who shall use professional judgment to decide whether or not a task is one that must be performed by a nurse or may be delegated to an unlicensed assistive personnel. This precludes a list of nursing tasks that can be routinely and uniformly delegated for all patients/clients in all situations. The decision to delegate must be based on careful analysis of the patient's/client's needs and circumstances.

(2) The licensed nurse who is delegating a nursing task shall:

(a) verify and evaluate the orders;

(b) perform a nursing assessment;

(c) determine whether the task can be safely performed by an unlicensed assistive personnel or whether it requires a licensed health care provider;

(d) verify that the delegatee has the competence to perform the delegated task prior to performing it;

(e) provide instruction and direction necessary to safely perform the specific task; and

(f) provide ongoing supervision and evaluation of the delegatee who is performing the task.

(3) The delegator shall evaluate the situation to determine the degree of supervision required to ensure safe care.

(a) The following factors shall be evaluated to determine the level of supervision needed:

(i) the stability of the condition of the patient/client;

(ii) the training and capability of the delegatee;

(iii) the nature of the task being delegated; and

(iv) the proximity and availability of the delegator to the delegatee when the task will be performed.

(b) The delegating nurse or another qualified nurse shall be readily available either in person or by telecommunication. The delegator responsible for the care of the patient/client shall make supervisory visits at appropriate intervals to:

(i) evaluate the patient's/client's health status;

(ii) evaluate the performance of the delegated task;

(iii) determine whether goals are being met; and

(iv) determine the appropriateness of continuing delegation of the task.

(4) Nursing tasks, to be delegated, shall meet the following criteria as applied to each specific patient/client situation:

(a) be considered routine care for the specific patient/client;

(b) pose little potential hazard for the patient/client;

(c) be performed with a predictable outcome for the patient/client;

(d) be administered according to a previously developed plan of care; and

(e) not inherently involve nursing judgment which cannot be separated from the procedure.

(5) If the nurse, upon review of the patient's/client's condition, complexity of the task, ability of the unlicensed assistive personnel and other criteria as deemed appropriate by the nurse, determines that the unlicensed assistive personnel cannot safely provide care, the nurse shall not delegate the task.

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

In accordance with Subsection 58-31b-102([17]13), the LPN practicing within the generally recognized LPN scope of practice practices as follows:

(1) In demonstrating professional accountability shall:

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

(b) demonstrate honesty and integrity in nursing practice;

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

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

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

(2) In demonstrating the responsibility for nursing practice implementation shall:

(a) conduct a focused nursing assessment;

(b) plan for episodic nursing care;

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

(d) assist in identification of client needs;

(e) seek clarification of orders when needed;

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

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

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

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

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

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

(ii) implement treatments and procedures; and

(iii) administer medications accurately;

(k) document care provided;

(l) communicate 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) participate in nursing management;

(i) assign nursing activities to other LPNs;

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

(iii) observe nursing measures and provide feedback to nursing manager; and

(iv) observe and communicate outcomes of delegated and assigned activities;

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

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

(p) promote a safe client environment;

(q) maintain appropriate professional boundaries; and

(r) assume responsibility for own decisions and actions.

(3) In being a responsible member of an interdisciplinary health care team shall:

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

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

(c) protect 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]14), the RN practicing within the generally recognized RN scope of practice practices as follows:

(1) In demonstrating professional accountability shall:

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

(b) demonstrate honesty and integrity in nursing practice;

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

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

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

(2) In demonstrating the responsibility for nursing practice implementation shall:

(a) conduct a comprehensive nursing assessment;

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

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

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

(f) seek clarification of orders when needed;

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

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

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

(j) identify 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) evaluate 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) document nursing care;

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

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

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

(3) In demonstrating the responsibility to act as an advocate for patient/client shall:

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

(b) identify patient/client needs;

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

(d) promote safe patient/client environment;

(e) communicate 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) maintain appropriate professional boundaries;

(g) maintain patient/client confidentiality; and

(h) assume responsibility for own decisions and actions.

(4) In demonstrating the responsibility to organize, manage and supervise the practice of nursing shall:

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

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

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

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

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

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

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

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

(j) promote 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) teach and counsel patient/client families regarding health care regimen, which may include general information about health and medical condition, specific procedures and wellness and prevention.

(5) In being a responsible member of an interdisciplinary health care team shall:

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

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

(c) protect confidential information.

(6) In being the chief administrative nurse shall:

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

(b) assure 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) assure 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) assure 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 shall:

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

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

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

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

KEY: licensing, nurses

[February 17, ]2005

Notice of Continuation June 2, 2003

58-31b-101

58-1-106(1)(a)

58-1-202(1)(a)

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Laura Poe at the above address, by phone at 801-530-6789, by FAX at 801-530-6511, or by Internet E-mail at lpoe@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.