There are several lectures from nursing school that reside somewhere in the foggy abyss of my brain, yet I distinctly remember the lectures regarding the Nurse Practice Act. Mostly, I recall feeling confused. Of course I will be ethical and will act within my scope of practice. Why do we need to be tested on such seemingly intuitive rules?
While my professors emphatically stressed the importance of understanding the Nurse Practice Act, I admittedly dismissed their advice and memorized what I needed to know to pass the NCLEX (fortunately I passed). Fast-forward 15 years, and here I am, emphatically stressing to you, my fellow nurses, the importance of understanding the Nurse Practice Act.
Little did I know that when I was an impressionable and eager nursing student, I would later become an attorney and represent the providers with whom I have shed blood, sweat and tears. Well, perhaps our patients were shedding the blood, but we were definitely shedding sweat and at least a few tears.
In 2001, I graduated from Johns Hopkins University School of Nursing and worked for the next 7-ish years as a cardiac, critical care and float nurse. As I gained experience in nursing, I gradually became fascinated with the relationship between medicine and the law. So I did what any inquisitive nurse would do and enrolled in law school. I focused my studies on health care law, and here I am, another 8 years later and writing this article to you.
Essentially, the Nurse Practice Act is your nursing rulebook within the state you practice. Each state has its own Nurse Practice Act and lays out the rules of professional and ethical conduct nurses must adhere to.
In my practice, I represent a number of nurses and other health care providers who are being investigated or disciplined by the state’s nursing board for allegedly violating the Nurse Practice Act. Common violations of the Nurse Practice Act are as follows.
1. Failure to promote patient safety. Rightfully so, patient safety is of upmost importance to nursing boards. Errors that result in patient harm are more likely to be reported. Be proactive in maintaining competency, education and training in your area of expertise. Patient safety should always be priority.
2. Dishonesty. Thou shalt not tell a lie on your application for licensure or during the course of your employment. If you have a criminal history, you must disclose it. Double and triple check your hours before affirming that you have the required hours for renewal. Be honest with your employer and your patients.
3. Controlled substances. Do not steal drugs from work or your patients. Do not engage in illegal drug activity. If you have a valid prescription for a controlled substance, this is generally allowable.
4. Improper delegation or supervision. When mentoring or supervising a nursing student, new graduate or new nurse to the unit, be aware of their experience and skill level. Do not delegate tasks to them that are outside of their scope or skill level. When delegating tasks to nursing aides or other assistive personnel, delegate tasks within their scope of practice.
5. Poor Documentation and Communication. When documenting in the patient record, be thorough, accurate and never alter the record. Amending a previous entry or adding a late entry is entirely acceptable, so long as the documentation is appropriate. Regularly communicate with your supervisor, colleagues, patients and families with important information regarding the patient’s plan of care.
This article is not meant to incite panic or crippling paranoia in your nursing career. Rather, it is meant to encourage mindfulness and forethought in your practice. Utilize your superior critical thinking skills when approached with professional or ethical dilemmas. And never underestimate the power of intuition. Do not ignore that unconscious reasoning in driving your decision to act or not act. Stop and think. Ask questions.
And finally... a word of gratitude. I know how challenging nursing can be. Your work is so important and is often unacknowledged. So I salute you, my fellow nurses, for doing what many cannot.