NCSBN Model Nursing Practice Act And Model Nursing .

www.ncsbn.orgSection 2. Registered Nurse (RN). Practice as an RN means the fullscope of nursing, with or without compensation or personal profit,that incorporates caring for all clients in all settings, is guided bythe scope of practice authorized in this section, through nursingstandards established or recognized by the BON and includes, butis not limited to:a. Providing comprehensive nursing assessment of thehealth status of clients.***Comprehensive nursing assessment is an extensive data collection (initial and ongoing) used for individuals, families, groups andcommunities in addressing anticipated changes in client conditionsas well as emergent changes in a client’s health status; recognizingalterations to previous client conditions; synthesizing the biological,psychological, spiritual and social aspects of the client’s condition;evaluating the impact of nursing care; and using this broad andcomplete analysis to make independent decisions and nursing diagnoses, plan nursing interventions, evaluate the need for differentinterventions, and assess the need to communicate and consult withother health team members.42.2.1 Standards Related to Registered Nurse (RN) ProfessionalAccountabilityThe RN:a. Practices within the legal boundaries for nursing through thescope of practice authorized in the Nurse Practice Act (NPA) andrules governing nursing.b. Demonstrates honesty and integrity in nursing practice.c. Bases professional decisions on nursing knowledge and skills,the needs of clients and the expectations delineated in professional standards.d. Accepts responsibility for judgments, individual nursing actions, competence, decisions and behavior in the course of nursing practice.e. Maintains continued competence through ongoing learningand application of knowledge in the client’s interest.***The first two standards reflect the need for any professional toaccept responsibility for knowing the legal, ethical, and professional parameters of practice, maintaining those boundaries andacknowledging when a decision or action has not been in thec. Developing a strategy of nursing care to be integrated within the best interest of a client while taking corrective action in the client’sclient-centered health care plan that establishes nursing diagnobehalf. Nursing judgments and actions include decisions madeses; sets goals to meet identified health care needs; prescribeswhen delegating nursing tasks to others and providing supervinursing interventions; and implements nursing care through the ex- sion for those activities. The delegating/supervising nurse is notecution of independent nursing strategies and regimens requestaccountable in the sense of having to stand at the delegate’sed, ordered or prescribed by authorized health care providers.elbow throughout the activity. The delegating/supervising nurse isaccountable for decisions made and actions taken in the course ofd. Delegating and assigning nursing interventions to implementthat delegation/supervision.the plan of care.b. Collaborating with health care team to develop anintegrated client-centered health care plan.e. Providing for the maintenance of safe and effective nursing carerendered directly or indirectly.f. Promoting a safe and therapeutic environment.g. Advocating the best interest of clients.h. Evaluating responses to interventions and the effectiveness ofthe plan of care.i. Communicating and collaborating with other health care providers in the management of health care and the implementation ofthe total health care regimen within and across care settings.j. Acquiring and applying critical new knowledge and technologiesto the practice domain.k. Managing, supervising and evaluating the practice of nursing.l. Teaching the theory and practice of nursing.m. Participating in development of policies, procedures and systems to support the client.n. Other acts that require education and training as prescribedby the BON commensurate with the RN’s continuing education,demonstrated competencies and experience.Copyright 2006 for current version. Originally adopted and copyrighted, 1982. Current version adopted in 2004, with revisions 2006, 2008, 2009.

www.ncsbn.org52.2.2 Standards Related to RN Responsibility for Nursing Practice ImplementationThe RN:a. Conducts a comprehensive nursing assessment that is an extensive data collection (initial and ongoing) regarding individuals,families, groups and communities.b. Detects faulty or missing patient/client information.c. Applies nursing knowledge effectively in the synthesis of thebiological, psychological and social aspects of the client’s condition.d. Uses this broad and complete analysis to plan strategies ofnursing care and nursing interventions that are integrated withinthe client’s overall health care plan.e. Provides appropriate decision-making, critical thinking andclinical judgment to make independent nursing decisions andnursing diagnoses.f. Seeks clarification of orders when needed.g. Implements treatment and therapy, including medicationadministration and delegated medical and independent nursingfunctions.h. Obtains orientation/training for competence when encountering new equipment and technology or unfamiliar care situations.i. Demonstrates attentiveness and provides client surveillance andmonitoring.j. Identifies changes in client’s health status and comprehendsclinical implications of client signs, symptoms and changes as partof expected and unexpected client course or emergent situations.k. Evaluates the impact of nursing care, the client’s response totherapy, the need for alternative interventions, and the need tocommunicate and consult with other health team members.l. Documents nursing care.m. Intervenes on behalf of client when problems are identifiedand revises care plan as needed.n. Recognizes client characteristics that may affect the client’shealth status.o. Takes preventive measures to protect client, others and self.Copyright 2006 for current version. Originally adopted and copyrighted, 1982. Current version adopted in 2004, with revisions 2006, 2008, 2009.

www.ncsbn.org62.2.3 Standards Related to RN Responsibility to Act as anAdvocate for ClientThe RN:a. Respects the client’s rights, concerns, decisions and dignity.***This standard includes respecting the client’s concerns regarding end-of-life care.b. Identifies client needs.c. Attends to client concerns or requests.d. Promotes safe client environment.e. Communicates client choices, concerns and special needs withother health team members regarding:1. Client status and progress.2. Client response or lack of response to therapies.3. Significant changes in client condition.f. Maintains appropriate professional boundaries.g. Maintains client confidentiality.h. Assumes responsibility for nurse’s own decisions and actions.2.2.4 Standards Related to RN Responsibility to Organize,Manage and Supervise the Practice of NursingThe RN:a. Assigns to another only those nursing measures that fall withinthat nurse’s scope of practice, education, experience and competence or unlicensed person’s role description.b. Delegates to another only those nursing measures for whichthat person has the necessary skills and competence to accomplish safely.c. Matches client needs with personnel qualifications, availableresources and appropriate supervision.d. Communicates directions and expectations for completion ofthe delegated activity.e. Supervises others to whom nursing activities are delegated orassigned by monitoring performance, progress and outcomes;and assures documentation of the activity.f. Provides follow-up on problems and intervenes when needed.g. Evaluates the effectiveness of the delegation or assignment.h. Intervenes when problems are identified and revises plan ofcare as needed.i. Retains professional accountability for nursing care as provided.Copyright 2006 for current version. Originally adopted and copyrighted, 1982. Current version adopted in 2004, with revisions 2006, 2008, 2009.

www.ncsbn.org7j. Promotes a safe and therapeutic environment by:1. Providing appropriate monitoring and surveillance ofthe care environment.2. Identifying unsafe care situations.3. Correcting problems or referring problems to appropriatemanagement level when neededk. Teaches and counsels client and families regarding their healthcare regimen, which may include, but is not limited to, generalinformation about health and medical condition, specific procedures and wellness and prevention.2.2.5 Standards Related to RN Responsibilities as a Member ofan Interdisciplinary Health Care TeamThe RN:a. Functions as a member of the health care team, collaboratingand cooperating in the implementation of an integrated clientcentered health care plan.b. Respects client property and the property of others.c. Protects confidential information.2.2.6 Standards Related to the RN When Functioning in a ChiefAdministrative Officer RoleThe RN as a chief administrative nurse:a. Assures that organizational policies, procedures and standards of nursing practice are developed, kept current, and implemented to promote safe and effective nursing care for clients.b. Assures that the knowledge, skills, and abilities of nursing staffare assessed and that nurses and nursing assistive personnel areassigned to nursing positions appropriate to their determinedcompetence and licensure/certification/registration level.c. Assures that competent organizational management andmanagement of human resources within the nursing organizationis established and implemented to promote safe and effectivenursing care for clients.d. Assures that thorough and accurate documentation of personnel records, staff development, quality assurance and otheraspects of the nursing organization are maintained.***Assessing the knowledge, skills, and abilities of nursing staffincludes initial and periodic validation of licensure status.2.2.7 Standards Related to the RN when Functioning in a Nursing Program Educator (Faculty) RoleThe RN as nursing faculty:a. Teaches current theory, principles of nursing practice andnursing management.b. Provides content and clinical experiences for students consistent with the MNPA, BON administrative rules and other relevantstate statutes.c. Supervises students in the provision of nursing services.d. Evaluates student scholastic and clinical performance withexpected program outcomes.Copyright 2006 for current version. Originally adopted and copyrighted, 1982. Current version adopted in 2004, with revisions 2006, 2008, 2009.

www.ncsbn.orgSection 3. Licensed Practical/Vocational Nurse (LPN/VN). Practiceas an LPN/VN means a directed scope of nursing practice, with orwithout compensation or personal profit, under the supervision ofan RN, advanced practice registered nurse (APRN), licensed physician or other health care provider authorized by the state; is guidedby nursing standards established or recognized by the BON; andincludes, but is not limited to:a. Collecting data and conducting focused nursing assessments ofthe health status of individuals.*** A focused assessment is an appraisal of an individual’s statusand situation at hand, contributing to comprehensive assessmentby the RN, supporting ongoing data collection and deciding whoneeds to be informed of the information and when to inform.b. Planning nursing care episodes for individuals with stable conditions.82.3.1 Standards Related to Licensed Practical/Vocational Nurse(LPN/VN) Professional AccountabilityThe LPN/VN:a. Practices within the legal boundaries for practical nursingthrough the scope of practice authorized in the MNPA and rulesgoverning nursing.b. Demonstrates honesty and integrity in nursing practice.c. Bases nursing decisions on nursing knowledge and skills, theneeds of clients and the expectations delineated by the BON.d. Accepts responsibility for individual nursing actions, competence, decisions and behavior in the course of practical nursingpractice.e. Maintains continued competence through ongoing learningand application of knowledge in the client’s interest.c. Participating in the development and modification of the comprehensive plan of care for all types of clients.d. Implementing appropriate aspects of the strategy of care withina client centered health care plan.e. Communicating and collaborating with other health care professionals.f. Providing input into the development of policies and procedures.g. Other acts that require education and training as prescribed bythe BON, commensurate with the LPN/VN’s experience, continuingeducation and demonstrated LPN/VN competencies.Each nurse is accountable to clients, the nursing profession and theBON for complying with the requirements of this Act and for ensuring the quality of nursing care rendered; for recognizing limits ofknowledge and experience; and for planning for the managementof situations beyond the nurse’s expertise.***Additions to the LPN/VN scope of practice are based on analysisof the various elements that make up this scope as evidenced bythe most recent LPN/VN job analysis. This remains a directed scopeof practice.***The first step in the nursing process assessment is the basis fornursing decisions and interventions. The subcommittee believesthat the first step is implemented in much the same way across jurisdictions, but that it is described and discussed very differently. Thesubcommittee members believe that both LPN/VNs and RNs assess,but the members identified a significant difference in the breadth,depth and comprehensiveness of the assessments conducted bythe two levels of licensed nurses. These differences are reflectedin the term “focused assessment” to describe the LPN/VN role inthe first step of the nursing process and the term comprehensiveassessment to describe the role of the RN (see definitions in Section4 below).***An alternative for BONs that have difficulty with the term assessment is to not use the term with either LPN/VN or RN practice, butrather describe what is expected of the level of licensee for the firststep of the nursing process. See definitions below for focused assessment and comprehensive assessment.Copyright 2006 for current version. Originally adopted and copyrighted, 1982. Current version adopted in 2004, with revisions 2006, 2008, 2009.

www.ncsbn.org92.3.2 Standards Related to LPN/VN Responsibilities for Nursing Practice Implementation.The LPN/VN, practicing under the direction of an RN, advancedpractice registered nurse (APRN), licensed physician or other authorized licensed health care provider:a. Conducts a focused nursing assessment, which is an appraisalof the client’s status and situation at hand that contributes toongoing data collection.b. Plans for episodic nursing care.c. Demonstrates attentiveness and provides client surveillanceand monitoring.d. Assists in identification of client needs.e. Seeks clarification of orders when needed.f. Assists in the evaluation of the impact of nursing care. Contributes to the evaluation of client care.g. Recognizes client characteristics that may affect the client’shealth status.h. Obtains orientation/training for competency when encountering new equipment and technology or unfamiliar care situations.i. Implements appropriate aspects of client care in a timely manner:1. Provides assigned and delegated aspects of client’s healthcare plan.2. Implements treatments and procedures.3. Administers medications accurately.j. Documents care provided.k. Communicates relevant and timely client information with otherhealth team members:1. Client status and progress.2. Client response or lack of response to therapies.3. Significant changes in client condition.4. Client needs.l. Participates in nursing management.1. Assigns nursing activities to other LPN/VNs.2. Delegates nursing activities for stable clients to assistivepersonnel.3. Observes nursing measures and provides feedback tonursing manager.4. Observes and communicates outcomes of delegated andassigned activities.m. Takes preventive measures to protect client, others and self.n. Respects the client’s rights, concerns, decisions and dignity.***This standard includes respecting the client’s concerns regarding end-of-life care.o. Attends to client or family concerns or requests.Copyright 2006 for current version. Originally adopted and copyrighted, 1982. Current version adopted in 2004, with revisions 2006, 2008, 2009.

www.ncsbn.org10p. Promotes safe client environment.q. Maintains appropriate professional boundaries.r. Assumes responsibility for nurse’s own decisions and actions.2.3.3 Standards Related to LPN/VN Responsibilities as a Member of an Interdisciplinary Health Care TeamThe LPN/VN:a. Functions as a member of the health care team, contributing tothe implementation of an integrated health care plan.b. Respects client property and the property of others.c. Protects confidential information unless obligated by law todisclose the information.Article III. DefinitionsChapter 3 – DefinitionsSection 1. BON. “BON” means the NAME OF STATE Board ofNursing.Section 2. Other BON. “Other BON” means the comparable regulatory agency in any U.S. state, territory or the District of Columbia.Section 3. License. “License” means current authority to practicenursing as an RN, LPN/VN or APRN.Section 4. Other Definitions.3.4 Other DefinitionsAbsolute discharge from sentenceCompletion of any sentence,including imprisonment,probation, parole, communitysupervision or any form of courtsupervision.Adjunct facultyTemporary nursing faculty, in addition to regular program faculty,used to enrich student experiences.Advanced assessmentAssessment by an APRN basedon additional knowledge andskill developed; a graduate levelnursing education program inthe APRN category; and thenurse’s experience working inthe APRN role.Advanced nurse refreshercourseFormal program with both didacticand clinical components, designedto prepare an APRN who has beenout of practice to re-enter into theprofession.Adverse actionA home or remote state disciplinary action.APRN practiceThe scope of practice associatedwith an APRN role and title.Alford pleaPlea agreements where the defendant may plead guilty, yet notadmit all the facts that comprisethe crime.North Carolina v Alford, 40 US25, 91 S Ct 160, 27 L Ed2d 162(1970).BONA party state’s regulatory body responsible for issuing nurse licenses.Alternative programA voluntary, non-disciplinarymonitoring program approvedby a nurse licensing BON.Clinical judgmentThe application of the nurse’sknowledge and experience in making decisions about client care.Copyright 2006 for current version. Originally adopted and copyrighted, 1982. Current version adopted in 2004, with revisions 2006, 2008, 2009.

www.ncsbn.org11APRNA nurse:Clinical learning experiences1. Who has completed an accredited graduate-level education program preparing him/herfor one of the four recognizedAPRN roles.2. Who has passed a nationalcertification examination thatmeasures APRN role andpopulation-focused competencies and who maintains continued competence as evidencedby recertification in the role andpopulation through the nationalcertification program.3. Who has acquired advancedclinical knowledge and skillspreparing him/her to providedirect care to patients, as wellas a component of indirect care;however the defining factor forall APRNs is that a significantcomponent of the education andpractice focuses on direct care ofindividuals.4. Whose practice builds on thecompetencies of RNs by demonstrating a greater depth andbreadth of knowledge, a greatersynthesis of data, increased complexity of skills and interventions,and greater role autonomy.5. Who has been educationallyprepared to assume responsibility and accountability for healthpromotion and/or maintenance,as well as the assessment,diagnosis and management ofpatient problems, which includesthe use and prescription ofpharmacologic and non-pharmacologic interventions.6. Who has clinical experience ofsufficient depth and breadth toreflect the intended license.7. Who has obtained a licenseas an APRN in one of the fourAPRN roles: CRNA, CNM, CNSor CNP.The planned, faculty-guided learning experiences that involve directcontact with patients.APRN licensure/authority topracticeThe regulatory mechanism used Competence assessmentby a party state to grant legalauthority to practice as an APRN.Evaluation of the practitioner’sknowledge, skills and abilities. Assessment mechanisms may includeexamination, peer review, professional portfolio and professionalcertification.Copyright 2006 for current version. Originally adopted and copyrighted, 1982. Current version adopted in 2004, with revisions 2006, 2008, 2009.

www.ncsbn.org12APRN uniform licensure/authority to practice requirementsThose minimum uniform licensure, education and examinationrequirements as agreed to bythe APRN Compact administrators and adopted by licensingboards for the recognized APRNrole and title.Competence developmentThe method by which a practitionergains, maintains or refines practiceknowledge, skills and abilities. Thisdevelopment can occur throughformal education program, continuing education or clinical practiceand is expected to continuethroughout one’s career.AssignmentDesignating nursing activities tobe performed by another nurseor assistive personnel that areconsistent with his/her scope ofpractice (licensed person) or roledescription (unlicensed person).Content validityThe degree to which an examination is representative of a definedbody of knowledge.Chief administrative nurseThe RN who overse

of nursing that creates and empowers the state board of nursing (BON) to regulate nursing and to enforce the provisions of this act. ***The language was changed to concisely describe the Act as con-cerning the regulation of nursing and creating the BON to enforce the act. ***If a board