La. Admin. Code tit. 46 § XLVII-3703

Current through Register Vol. 50, No. 9, September 20, 2024
Section XLVII-3703 - Definition of Terms Applying to Nursing Practice
A. Terms applying to legal definitions of nursing practice, R.S. 37:913(13) and (14).

Accountability- being answerable for one's actions or inactions. The registered nurse answers to self, patient, agency, profession and society for the effectiveness and quality of nursing care rendered. It is the personal responsibility of each nurse to maintain competency in practice. If the assigned nurse does not possess the specialized nursing knowledge, skills and abilities required to provide the required care, said nurse shall notify the appropriate supervisory nursing personnel.

Additional Acts- activities beyond those taught in basic nursing education programs. Additional acts are authorized by the board through rules and regulations or declaratory statements interpreting the legal definition of nursing. Registered nurses are accountable for attaining and maintaining competency when performing approved additional acts.

Assessing Health Status- gathering information relative to physiologic, behavioral, sociologic, spiritual and environmental impairments and strengths of an individual by means of the nursing history, physical examination, and observation, in accordance with the board's Legal Standards of Nursing Practice.

Assignment-designating nursing activities to be performed by an individual consistent with his/her licensed scope of practice.

Care Supportive to or Restorative of Life and Well-Being- activities designed to resolve, diminish, or prevent the needs that are inferred from the individual's problem; includes the planning, implementation and evaluation of said activities in accordance with the board's legal standards of nursing practice.

Case Finding- identifying human responses which indicate existing or potential unwellness.

Collaborating- a process involving two or more health care professional working together, though not necessarily in each other's presence, each contributing one's respective area of expertise to provide more comprehensive care than one alone can offer.

Delegating Nursing Interventions- entrusting the performance of selected nursing tasks by the registered nurse to other competent nursing personnel in selected situations. The registered nurse retains the accountability for the total nursing care of the individual. The registered nurse is responsible for and accountable to each consumer of nursing care for the quality of nursing care he or she receives, regardless of whether the care is provided solely by the registered nurse or by the registered nurse in conjunction with other licensed or unlicensed assistive personnel.

a. The registered nurse shall assess the patient care situation which encompasses the stability of the clinical environment and the clinical acuity of the patient, including the overall complexity of the patient's health care problems. This assessment shall be utilized to assist in determining which tasks may be delegated and the amount of supervision which will be required.
i. Any situation where tasks are delegated should meet the following criteria.
(a). The person has been adequately trained for the task.
(b). The person has demonstrated that the task has been learned.
(c). The person can perform the task safely in the given nursing situation.
(d). The patient's status is safe for the person to carry out the task.
(e). Appropriate supervision is available during the task implementation.
(f). The task is in an established policy of the nursing practice setting and the policy is written, recorded and available to all.
ii. The registered nurse may delegate to licensed practical nurses the major part of the nursing care needed by individuals in stable nursing situations, i.e., when the following three conditions prevail at the same time in a given situation:
(a). nursing care ordered and directed by R.N./M.D. requires abilities based on a relatively fixed and limited body of scientific fact and can be performed by following a defined nursing procedure with minimal alteration, and responses of the individual to the nursing care are predictable; and
(b). change in the patient's clinical conditions is predictable; and
(c). medical and nursing orders are not subject to continuous change or complex modification.
iii. In complex (unstable) situations, the registered nurse may utilize the expertise of the licensed practical nurse by delegating selected tasks. The registered nurse may not delegate the following nursing functions relative to intravenous medications and fluids:
(a). administration of investigational drugs;
(b). administration of cancer therapeutic drugs;
(c). administration of medications by IV push, other than those defined by health agency protocol for emergency situations;
(d). administration of blood and blood products;
(e). administration of total parenteral nutrition solutions;
(f).accessing the implanted device:
(i). in situations where registered nurse supervision is unavailable or limited, such as in home health, the administration of intravenous medications and fluids may not be delegated;
(ii). the registered nurse is responsible for knowing the cause and effect of every medication (s)he administers personally or through delegation. Delegation carries with it the responsibility to ascertain the competence of persons to whom delegation is made. Since supervision of personnel associated with nursing functions are included in the legal definition of nursing, it is the responsibility of the registered nurse to ascertain the competency of the persons to whom (s)he delegates the administration of medication.
iv. Contingent upon the registered nurse's evaluation of each patient's condition and also upon the registered nurse's evaluation of the competency of each unlicensed nursing personnel, registered nurses may delegate non-complex tasks to unlicensed nursing personnel.
(a). A non-complex task is one that can safely be performed according to exact directions, with no need to alter the standard procedure, and the results are predictable.
(b). A complex task is one that requires judgment to safely alter the standard procedure in accordance with the needs of the patient; or requires the consideration of a number of factors in order to perform the procedure; or requires judgment to determine how to proceed from one step to the next.
(c). The administration of medications is a complex task when it requires the consideration of a number of factors and the formulation of judgments according to those factors. Delegation of medication administration to unlicensed assistive personnel is prohibited except as authorized and provided for in LAC 46:XLVII.3709.

Evaluating Human Responses to Interventions-measuring the effectiveness of the nursing actions in achievement of established goals.

Executing Health Care Regimes as Prescribed by a Licensed Physician, Dentist or Authorized Prescriber-carrying out the medical orders of a physician, dentist or other authorized prescriber licensed in Louisiana.

a. Registered nurses may, based on their individual judgment of each situation, accept verbal orders initiated by an authorized prescriber and transmitted through a licensed or certified health care practitioner, provided the order is related to the said practitioner's scope of practice.
b. Registered nurses may execute standing orders of an authorized prescriber provided the said prescriber initiates the standing orders and provided, further, that the said orders do not require the nurse to make a medical diagnosis or to engage in prescriptive activity or to administer anesthetic agents other than in accordance with R.S. 37:930.D and E, R.S. 37:935 and LAC 46:XLVII.3705.
c. Registered nurses employed in the public school system are authorized to execute health care regimens prescribed by physicians licensed in adjacent states, pursuant to R.S. 17:436(B)(3)(a) and R.S. 17:436.1(B)(1)(a).

Goals to Meet Identified Health Care Needs- statements which facilitate the patient's achievement of expected outcomes of care.

Health Counseling-those nursing measures that assist an individual in analyzing his/her health status, formulating health goals and planning activities to reach these goals.

Health Instruction- those nursing measures that provide health information and explanation.

Maintaining Nursing Care Rendered Directly or Indirectly- preserving the continuity of safe and effective nursing care, including the delegated nursing activities.

Managing and Supervising the Practice of Nursing- those activities which serve to fulfill the accountability of the registered nurse for the total nursing care of the individual when tasks in the nursing care are delegated to other nursing personnel. These activities include:

a. judging the priority of nursing needs of the individual(s);
b. determining actions required to meet the needs;
c. assigning personnel, including self, qualified to implement the prescribed nursing care or components of that care;
d. providing information needed by personnel for the implementation of the assigned nursing care and ascertaining the assimilation of same information;
e. directing the nursing care and evaluating the outcomes of that care;
f. determining and initiating changes in nursing care or in assignment of nursing personnel.

Medical Diagnosis- the conclusion reached in identification of the patient's disease, especially the art of distinguishing among several possibilities with the intent of prescribing relevant treatment. Ordinarily, the pronouncement of death requires a medical diagnosis. However, in a non-acute care setting, when an anticipated death has apparently occurred, registered nurses may cause to have the decedent removed to the designated funeral home in accordance with a standing order of a medical director/consultant setting forth basic written criteria for a reasonable determination of death.

Medical Prescriptions- medical interventions. These include all medications and medical treatments of therapeutic or corrective nature.

Planning Nursing Care Measures- documenting all activities, to be performed by the registered nurse or delegated by the nurse to other nursing personnel, which facilitate achievement of expected patient care outcomes.

R.N. Applicant-a person who has completed the educational requirements and whose application to take the required examination for licensure as a registered nurse has been accepted by the board.

Specialized Knowledge and Skills- required for the practice of nursing means the current theory and practice taught in basic nursing education programs preparing persons for R.N. licensure as well as information in the biological, physical and behavioral sciences.

Student Nurse- a person who is engaged in learning experiences in a program of study leading to candidacy for licensure to practice as a registered nurse. The term applies only when the person is participating in an integral part of the program of study, and not when that person is engaged in an employment situation.

Teaching the Theory and Practice of Nursing-instructing basic or advanced nursing students and providing continuing nursing education to registered nurses.

Unlicensed Assistive Personnel- an unlicensed individual who is trained to function in an assistive role to the licensed nurse in the provision of patient activities as delegated by the nurse.

La. Admin. Code tit. 46, § XLVII-3703

Promulgated by the Department of Health and Human Resources, Board of Nursing LR 7:79 (March 1981), amended LR 10:598 (August 1984), LR 12:677 (October 1986), amended by the Department of Health and Hospitals, Board of Nursing, LR 24:1293 (July 1998), LR 32:245 (February 2006), Amended by the Department of Health, Board of Nursing, LR 42873 (6/1/2016).
AUTHORITY NOTE: Promulgated in accordance with R.S. 37:918, R.S. 37:911, R.S. 37:913 and R.S. 37:935.