Each state is responsible for creating its own nurse practice act, which has the purpose of reducing harm to patients by ensuring that licensed nurses are competent nurses. The act states that a board of nursing must be formed and established for the state to govern legal authority.
Through the nurse practice act, the board of nursing determines what legal authority nurses have over their practice. It also covers nursing standards and their scope of practice. However, as a professional who holds a license, it is our responsibility to know it and follow it. Even if a nurse has broken rules of the code in good faith, they can be held accountable.
If you ever have knowledge of a nurse working outside their scope of practice, putting the health of the community at risk, or falsifying documents or records, complaints to the state board of nursing need to be made so that they can conduct a proper investigation. A hospital can never have separate scope of practices that say nurses can perform a task outside of those already set in the nurse practice act.
Nurses should know where to access their state practice act as well as keep a copy of their job description, policies, and contracts. The Tri-Council of Nursing set in place a tool to make decisions easy to make by following a simple framework. This tool can be used by nurses or their employers to help determine what nurses can safely perform.
The emergency scope of practice modifications may or may not evolve into permanent scope of practice changes for a profession. Modifying scope of practice in emergencies generally involves addressing: 1 the types of activities permitted under the modified scope; 2 the types of practitioners permitted to engage in the modified activities; 3 the control or supervision requirements for the practitioners undertaking the modified activities; and 4 any new or supplemental training a practitioner is required to receive.
The H1N1 influenza pandemic saw broader use of modified scope of practice by states than in prior public health emergencies. There are, however, common elements addressed in a modified scope of practice decision:. Some regulated professionals, such as licensed medical doctors, are authorized to practice independently within the scope of practice specified by the state in which they are licensed; they do not require supervision or control by another licensed practitioner.
For many healthcare and other regulated professionals, however, their permitted scope of practice in nonemergency settings includes requirements for medical control—oversight by a more senior practitioner or one with additional training—or some other type of supervision.
Medical control or supervision is accomplished through personal oversight or written directions in the form of prescriptions, protocols, or orders. Temporarily modifying medical control and supervision requirements, either by altering, removing, or adding requirements, is a frequent consideration and strategy used to change a professional scope of practice during public health emergencies.
During H1N1, some states used this approach to allow physicians to issue standing orders permitting vaccination without issuing prescriptions to individual patients. Modifying scope of practice may be coupled with a requirement that practitioners acting under a modified scope must be working at the direction of or under the control of state or local government emergency response officials such as a health agency, emergency management agency, or incident commander.
During H1N1 some states limited the activities of healthcare practitioners operating under a modified scope of practice to settings such as public vaccination clinics or point of dispensing POD locations. Regulated professionals may be required to receive additional training before they are permitted to undertake activities in response to a public health emergency or other emergency event.
Training requirements can apply to professionals who will be acting under a modified scope of practice, as well as those who are acting within their existing scope. While modifying the scope of practice for some professions during specified circumstances in an emergency may be seen as less controversial than a permanent change, there remain areas of concern that arise when considering modifications to scope of practice during emergencies.
Some of the concerns raised include that practitioners will be performing tasks or procedures they have little or no prior experience doing and that just-in-time-training does not meet the level of training necessary to perform the tasks covered by the modified scope. The use of medical controls and other forms of supervision in concert with the modified practice activities is a strategy used to address these concerns.
Practitioners operating under a modified scope of practice also voice concerns about potential liability for their actions during a public health emergency.
New and existing federal and state legal protections against liability address these concerns. Many of the immunities and liability protections were newly developed or refined within the last decade, while others are fundamental principles of governmental immunity that continue to evolve as our understanding of modern emergencies likewise evolves.
The extent to which liability protections are available to an individual, entity, or class will depend on the actor, the law providing the protections, and the circumstances of a particular emergency response.
In addition to the issues that arise when a state temporarily or permanently modifies the scope of practice for certain regulated professions within that state, questions and conflicts can develop when healthcare or other licensed practitioners deploy as governmental employees, contractors, or volunteers to another state during an emergency response effort.
There may be differences between the allowed scope of practice in the home state and the state to which the practitioner is deployed.
This is especially relevant where the practitioner has a broader scope of practice in the home state than in the deployment state. Professional requirements and any legal restrictions should be carefully considered in development of a mutual aid agreement or other mechanism through which a practitioner is deployed.
Note: This document was compiled from June—December and reviewed in May ; it reflects the laws and programs current then. It reflects only portions of the laws relevant to public health emergencies and is not intended to be exhaustive of all relevant legal authority.
This resource is for informational purposes only and is not intended as a substitute for professional legal or other advice. Scope of Practice Toolkit.
Print Scope of Practice Issues in Public Health Emergencies Fact Sheet Overview States may find it necessary to modify the scope of practice for some of their regulated professions to meet increased demand for important services during an emergency. Modifying Scope of Practice State legislatures consider legislation that alters the routine, nonemergency scope of practice for a range of healthcare and other regulated professions annually.
Legal Authorities to Modify Scope of Practice The legal authorities and mechanisms for modifying scope of practice for a public health or other emergency vary among states.
Modified Scope of Practice Activities in Emergencies Modifying scope of practice in emergencies generally involves addressing: 1 the types of activities permitted under the modified scope; 2 the types of practitioners permitted to engage in the modified activities; 3 the control or supervision requirements for the practitioners undertaking the modified activities; and 4 any new or supplemental training a practitioner is required to receive.
There are, however, common elements addressed in a modified scope of practice decision: Types of practitioners allowed to engage in the modified practice activity. Not all regulated health professions in a state will be required or permitted to work under a modified scope of practice during an emergency.
Those professions with the same or similar skill sets necessary to meet the particular demands of specific emergency event are most likely to be considered for modified practice.
Other potential strategies include allowing experienced personnel to temporarily perform at the next level of credential within a field without qualifying education, training hours, or examination, and allowing prior licensees or retired practitioners who were in good standing to practice during the emergency event. Types of modified activities permitted. Modifying scope of practice can be accomplished by expanding or altering the scope of activities a practitioner is allowed to engage in and by removing or adding conditions on the permitted activities.
Overlapping and closely related skills are the foundation for modifying and expanding scopes of practice during emergencies. This practice allows practitioners to conduct activities they are not normally permitted to conduct or alters the conditions under which they practice e.
SOP in H1N1 Response— During the H1N1 influenza pandemic, a number of states authorized or used modified scope of practice, primarily to expand the number of persons eligible to perform vaccinations. These modified scopes of practice were generally temporary measures that were allowed during the duration of a declared emergency or until otherwise permitted by law or order. Other states did not use modified scope of practice during H1N1 because the capacity of healthcare providers was sufficient to respond to the outbreak in the state; some states pursued other strategies, such as the use of volunteer healthcare providers, to supplement their response capacity.
Some states have permanently authorized modified scopes of practice in emergencies for selected professions, either by statute or regulation, which are then activated by an emergency declaration by a governor, health officer, practice regulatory body, or other authorized official.
Other states have used orders from a governor, health officer, or practice regulatory bodies during a declared emergency to authorize and specify the modified scope of practice applicable for that emergency. Modified practice authority granted in an emergency generally lasts until the underlying emergency declaration expires or is otherwise cancelled by the health agency or professional regulatory body.
0コメント