Nursing Jurisprudence Examination Notes: Texas Board of Nursing Rules and Regulations, Exams of Law

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Nursing Jurisprudence

examination notes

 Primary resources for state law - Correct answer Texas Board of Nursing  Nursing Practice Acts  Nursing Jurisprudence - Correct answer Rules/Ethics/Morals and how the nurses function in a healthcare setting.  Texas Nurse Practice Acts - Correct answer 301  -BON, , defines responsibility for regulating nursing education, licensure and practice  303  -Regulates nursing peer review  304  -Relates to nursing Licensure compact  Texas BON Mission Statement - Correct answer Protect and promote welfare of the people of Texas by ensuring that each person holding a license as a nurse is competent to practice safely.  -Protects the interest of the public  Chapter 301 NPA - Correct answer How board is appointed  General powers/duties  License requirements/renewal  Practice by holder  Reporting violations and patient care concerns  Prohibited practices/disciplinary actions  Other penalties and enforcement previsions  Anesthesia in outpatient settings  Corrective action proceeding  Board of Nursing - Correct answer Represent the people of Texas  Can't lobby the legislature  Does not regulate practice settings  -Licensing  -Enforcement Services

 -Audit of CE  -Information Services  Professional Associations - Correct answer Represent their members  Do lobby legislature  Efforts to improve work cond/benef for nurses  -Job referral services  -Legal Referral  -Salary Q  -Co-Worker Disputes  -Employment issues  Licensure and Regulation - Correct answer Temporary Permit  -GN permit expires in 75 days  -When pass/fail NCLEX  Renew Online  -60 days prior to expiration BON will send card  Continuing Education  -20 hours in 2 years  -Fist time renewal exempt  -CE hours in area of practice  -Keep records for 4 years  Initial Licensure by Examination - Correct answer Must submit criminal background check  Submit a sworn application fee  Verify completion of an approved nursing edu.  Pass NCLEX  Pass NJE with 75%>, NPA/BON rules, 50Q  Disclosure of Criminal Behavior - Correct answer Must report any past criminal behavior or pending charges  -Minor class C misdemeaners excluded  (parking tickets, speeding tickets, jaywalking)  Five Categories of Trust by BON - Correct answer Honesty  Accountability  Trustworthiness  Reliability  Integrity  Good Professional Character - Correct answer Distinguish right from wrong

 Think and act rationally  Keep promises and honor obligations  Be accountable for own behavior  Promptly disclose facts that could enhance health of pt. and protect from harm  Professional Boundaries - Correct answer Must recognize/maintain professional boundaries  -Do or say nothing that can't be documented  Violations  -Physical, Sexual, Emotional, Financial exploitation  Nursing Peer Review - Correct answer Separate from BON review  Confidential  (incident based or Safe harbor)  -Rule 217.19-PR and Whistleblower  -Rule 217.20-SH PR and Whistle blower protections  Incident Based Peer Review - Correct answer Any facility employing 10+ must have one  Referral starts with error/incident  PR without administrators  Fact finding mission  Eval. of paractice in atmosphere of collegiality  Determine if incident merit or should be to BON  RN Standards - Correct answer Make Nursing Dx  Develop nursing care plan  Eval. pt response to care  Perform Comprehensive assessment  Delegate tasks to UAP  Practice independently w/in NPA board rules  Edu. to care for all pt's stable and unstable  LVN Standards - Correct answer Participate in planning of nursing care  Assist in evaluationg pt repsonse to tx  Complete focused assessment  Implement appropriate aspects of care  Practice must be supervised  Educated to care for pt. with stable predictable  Duty to pt - Correct answer Make/accept only assignments that take into consideration safety and commensurate with nurse's educational preparation, experience, knowledge, and physical/emotional ability.

 Step 1 - Correct answer Is the activity consistent with the NPA and BON rules?  Step 2 - Correct answer Is the activity appropriately authorized?  -Valid order?  -Current policy exist regarding procedure?  -Clarify any questionable orders  Step 3 - Correct answer Is it supported by nursing research?  -EBP  Step 4 - Correct answer Do you possess the required knowledge and competency to carry out the act?  Step 5 - Correct answer Would a reasonable and prudent nurse perform this activity in this setting?  Step 6 - Correct answer Are you prepared to accept the consequences of your actions?  Prohibited Delegation Tasks - Correct answer Nursing assessments  Plan of care  Professional Judgement/Intervention  Responsibility for initial teaching  Medication administration, IV fluids as well  -Prohibited in acute care settings  -may be delegated in independent living situations  Minor Incident - Correct answer Conduct that does not indicate the nurses continuing to practice professional nursing poses a risk fo harm to the pt. or other person  Exclusion to Minor Incident Rule - Correct answer A nurse involved in a MI does not need to reported to BOn unless...  -Creates sig. risk fo physical, emotinal, financial harm  -Lacks a consiencious approach for accontability  -Lacks knowl. and compet. and not easily remediat  -Pattern of multiple minor incidents  -5 minor incidents in a 12 month period must bereported to peer review  NEVER a Minor Incident - Correct answer Error contributed to pt. death/serious harm  Criminal conduct  Serious violation (theft, faud, pt. abuse, exploiting)  Impairment/suspected impairment by chem. dep.

 IBPR Due Process Rights - Correct answer Facility must have policies in place for PR  PR committee must comply with req.  Nuse must receive notice/ opportunity to review documents/submit a response  Nurse may hire own attorney  Nurse will get feedback after decision  Nurse will have a chance to respond  Safe Harbor Peer Review - Correct answer Allows a nurse to accept an assignment and provide best care without fear of licensure action if there is a practice error.  -Does not protect civil rights  -Before refusing assignment must recog. pt is 1st  May refuse an assignemt if lack basic knowlege/ability to render care  Safe Harbor - Correct answer Must be invoked BEFORE care given  Or anytime assignment has changed and pt may be in harm  -Must notify in writing  -Supervisor can't refuse  -May use quick req form to make initial req.  -Comprehensive request must be completed before leaving work setting  Quick Request Form - Correct answer Written on blank piece of paper but must include  -Name/Signature  -Date/Time of request  -Location of where it is to be completed  -Name of person making assignent  -Brief expalnation of why safe harbor is being req.  Chain after Safe Harbor Nurse completion - Correct answer Nurse supervisor/administrator who gave assignm.  Nurse adminstrator  Peer Review Committee  Physician who reviews med reasonableness  Nurse administrator who reviews PR fidnigns  Nurse who initiated request  Mandatory Overtime - Correct answer Making you work extra shifts, you have the right to refuse.  NOT when  -Emergency diasasters

 -Ongoing procedure requires nurses presence  -Certain emergencies  Take Mandatory Overtime Concerns to - Correct answer Unit manager  Staffing Committee  DSHS-if not addressed internally  Nurses duty is always - Correct answer In the best interest of the patient  Patient Abandonment - Correct answer NPA/BON do not define abandonment  -leaves employment-employment issue  -leaves patient-licensure issue  Not abandonment - Correct answer Resignation without notice- assuming shift has been completed  Refusal to work additional shifts either doubles or extra shifts on days off  Floating to an unfamiliar area - Correct answer Always responsible for providing safe patient care  May request training prior to having to float  May invoke safe harbor  May refuse assignment  What do I do if I question safety of assignment? - Correct answer 1st- clear about what you are being asked to do  2nd- consider what can change during assignment  3rd- state concern to person making assignment, brainstorm ways to modify  4th- Listen to response  Disciplinary Action - Correct answer Chemical Dependency  Alcohol Dependency  Mental Illness  Even some prescription drugs  Red Flags - Correct answer Lack of energy  Frequent absenses  Spike in pt. need for pain meds  Lateness to work  Red Eyes  No/unusal documentaion  Frequently stands behind other nurses signing out meds  Unprofessional Conduct - Correct answer Drug Diversion  Unsafe practice

 Failure to pay student loans  Dismissal peer assistance program  Drug related actions  Criminal conduct  Board Process for investigating complaints - Correct answer Nurse notified of investigation and invited to respond  Investigator gathers and reviews evidence  Decision made by board  Nurse's responsibility during investigation - Correct answer Respond promptly to all requests  Keep contact information current  Fee free to contact investigator  Do not ignore any mail from BON  Types of Nurse Remediation - Correct answer Remedial education  -Classes specific to issue  Supervision  -Work under direct/indirect supervis.  Work environment  -stable environment not home health  Losing license is not uncommon  Filing a complaint against another nurse - Correct answer Any violation of BON rules needs to be reported  Must be written/signed by person making report  Include ID of nurse being reported  Contain any additional info required  All complaint information is confidential  Duty to pt. and mandatory reporting req.  Failure to report violation!  Texas Nursing Jurisprudence Exam - Correct answer Exam based on NP/BON rules/regulations  50 Questions  75% or >  Must pass prior to taking NCLEX  Eligible to test about 10 days after application to BON  2 hours to complete exam  May retest if not successful

 Home State License - Correct answer Nurse must be licensed in state in which he/she permanently resides  -if you move you have 30 days to change your license over.  Party State License - Correct answer Other states belong to the compact nurse may practice in any party state on his/her home state license