Prepared by Jan Lanier, RN, JD

 UPDATED 09-22-2011

The following material was prepared to provide nurses the information they need to be knowledgeable about the law regulating their practice.  Changes to the law must be approved by both chambers of the General Assembly and then signed by the governor before becoming law.  While other legislation may contain provisions that affect nursing practice, HB 303 comprehensively addresses the regulation of individuals falling under the jurisdiction of the Board of Nursing.  It is important that nurses and others be aware of and follow the progress of  this legislation as it could impact their professional lives.  

 

Introduction

 

HB 303—The long-awaited bill that makes revisions to Chapter 4723. of the Revised Code (the Ohio Nurse Practice Act) was introduced July 26, 2011.  This marks the first time the law regulating nursing practice has been opened in its entirety since 1988[1].   The Board of Nursing (Board) has been working closely with legislators and interested parties for several years to fine-tune the proposal.  While many of the changes are cosmetic in nature, it is important for nurses and those regulated by the Board to follow the progress of this legislation closely and be aware of even the seemingly most innocuous revisions.  Following is a summary of the introduced version of the legislation.

 

Sponsor:        Rep. Kirk Schuring (R-Canton)

Co-Sponsor:  Rep. John Carney (D-Clintonville)

Committee:   House Health & Aging Committee

 

Summary

 

Technical  changes

Many of the changes are technical or cosmetic designed to update the law to reflect some of the technological advances affecting Board activities.  Others update the terminology used to refer to licensees and some of the activities that comprise nursing practice.  For example, all references to advanced practice nurses have been revised to read advanced practice registered nurses.  The terminology used to address “universal blood and body fluids” would become “universal standard precautions” upon enactment of this legislation. In addition:

• ·         The language dealing with the role of the licensed practical nurse (LPN) in intravenous therapy (IV) moves from sections 4723.17 and 4723.171 to 4723.18 and 4723.181.
• ·          The reference to pre-licensure “professional” nursing education programs has been changed to “registered” nursing education programs.
• ·          A distinction is made between reactivating a nursing license (after it has been placed on inactive status) and reinstating a nursing license (after it has been allowed to lapse).
• ·         Dates that are no longer relevant. Are eliminated
• ·         References to both licensees and certificate holders more efficiently encompass the various practitioners regulated by the Board.
• ·         Language dealing with the alternative program for chemical dependency clarifies that it is the Board’s supervising member for disciplinary matters who makes decisions regarding the program rather than the program coordinator.
• ·         Language that affected the regulation of medication aides is deleted to reflect that the initial pilot program and related requirements are no longer relevant because the time for the pilot has expired.
• ·         The references to the temporary dialysis certificates have been eliminated to avoid the confusion that accompanies the levels of temporary practice for dialysis technicians that exist in current law.  The term “Dialysis intern” will be the term to refer to individuals who have successfully completed a training program but have not yet satisfied the practice requirements needed to be eligible to take the approved national certification examination.
• ·         Board authority with respect to pre-licensure nursing education programs is revised to clarify that only programs located in Ohio come under the Board’s jurisdiction. Adds pre-licensure Master’s Degree programs to the list of programs that are subject to Board regulation.
• ·         The Board’s authority to approve peer support programs is eliminated.

 

Substantive changes

The most substantive changes contained in the bill address the Board’s disciplinary authority:

• ·         The language in section 4723.28 ORC dealing with use of chemical substances or alcohol has been revised to allow the Board to take action not only when there is “habitual indulgence” in these substances but also when there is “habitual or excessive” use of the substances to the extent it impairs the individual’s ability to provide safe nursing care (rather than current language that reads, “ impairs the individual’s ability to practice.”).
• ·         Allows Board action when an individual’s ability to practice according to safe and acceptable standards of safe care is impaired because of the use of drugs, alcohol, or chemical substance.  Current law ties the Board’s authority to habitual or excessive use.
• ·         Allows the Board to deny approval to a person who submits or causes to be submitted false, misleading, or deceptive statements, information, or documentation to the Board in the process of applying for approval of a new education or training program.  Clarifies that such denial must occur through a Chapter 119. ORC adjudication.
• ·         Adds language that would prevent a registered sex offender or someone who has been convicted of certain sexual offenses from obtaining a license or certificate in Ohio.
• ·         Allows Board disciplinary action when a licensee or certificate holder misappropriates or attempts to misappropriate money or anything of value. Deletes reference to “intentional misrepresentation” or “material deception” terminology.
• ·         Clarifies that Board action will be unaffected (go unchanged) not only when a record of a conviction is sealed but also when there is a guilty plea, judicial finding of guilt resulting from a no contest plea or judicial finding of eligibility for pre-trial diversion or treatment in lieu of program.
• ·         Allows Board to mandate that an individual complete a Bureau of Criminal Identification & Investigation (BCII) check at the individual’s own expense.
• ·         Clarifies that information obtained pursuant to an investigation is confidential and allows the Board to disclose information (even confidential information) to law enforcement and government entities for investigational purposes.
• ·         Allows the Board to place a dialysis technician training program on provisional approval when the program does not meet Board required standards.

 

Changes affecting the mandatory reporting requirements:

• ·         Revises reporting requirements for employers by requiring that the report to the Board be made by an individual who is licensed by the Board and designated by the employer to make the report.
• ·         Deletes the mandatory reporting requirement for nursing associations.

 

Changes affecting the licensure processes:

• ·         Individuals seeking licensure by endorsement (coming to Ohio from another state in which they are licensed to practice) would be required to hold a current, valid, and unrestricted license rather than a license in “good standing”.  Further, to obtain a temporary permit to practice, the license must be current, valid, and unrestricted.  This is a subtle change but could be significant.   These individuals must also complete two (2) hours of continuing education on Ohio laws and rules (Chapter 4723 of the Revised Code and the rules of the Board—Category A).
• ·         If a license or certificate has been inactive or lapsed for at least five (5) years the individual must complete a BCII check before obtaining a new license.

 

Changes affecting the role of the LPN in IV therapy:

• ·         Updates references to the role of the LPN with respect to initiating and maintaining an IV infusion containing an antibiotic additive.  (Deletes the term “piggyback”). 
• ·         Deletes prohibitions dealing with aspirating an IV line to maintain patency and changing tubing for central arterial or venous lines.
• ·         Expands the activities an LPN with IV authority may perform in a dialysis setting to include pediatric patients as well as adults and allows the LPN in dialysis to administer an intermittent injection of a dose of medication administered vial the hemodialysis blood circuit and through the patient’s venous access.

 

Changes specific to APRNs:

• ·         Allows APRNs to use the continuing education they obtain to meet national certification requirements for license renewal purposes only if it is obtained through a program or course approved by the Board or by a Board CE approver,
• ·          Establishes a thirty (30) day time frame for an APRN to report to the Board the name and business address of each collaborating physician or podiatrist.  Changes or deletions must also be reported to the Board within thirty (30) days after the change takes effect.

 

Conclusion

A copy of the bill in its entirety may be obtained by visiting the State of Ohio website (www.ohio.gov) and clicking on the link labeled “General Assembly”. At the prompt insert the bill number in the space provided.

 

The legislation is being touted as non-controversial so once legislators focus again on pending proposals, it is likely HB 303 could move quickly through the legislative process.  It will be important to be vigilant with respect to any amendments that may be proposed by non-nursing entities to address areas of concern about nursing practice that have surfaced over the years.  It is also important that any concerns nurses may have about the proposal be brought to the attention of the bill’s sponsors and the committee chair (once referral has been made) to make sure these issues are appropriately addressed in a timely manner.