Ohio Nurse Practice Act (Category A) – 1 Hour Program

The Ohio Board of Nursing (BON) is both a regulatory board and a state government agency. Its main responsibility is to impose and enforce state laws related to nursing education, licensure, and practices.

Board members are public officials and their meetings and most of their records are open to the public. The Ohio BON consists of thirteen members who are residents of Ohio. Of the thirteen members, eight members must be registered nurses; two of which must be advanced practice registered nurses, four members must be licensed practical nurses, and one member must represent the interests of consumers of health care. 

The powers and duties of the Ohio Board of Nursing are defined in Chapters 4723.06 of the Ohio Revised Code and include:

• Develop criteria for eligibility for nursing license consideration.
• Define the minimum educational standards for nursing programs.
• Issue and renew nursing licenses, dialysis technician certificates, and community health worker certificates.
• Inspect and grant approval for nursing education programs.
• Approve continuing education programs and courses.
• Approve national certifying organizations for advanced practice registered nurse (APRN) examination and licensure.

Licensees and certificate holders regulated by the Board include APRNs (certified nurse midwives, certified nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists), registered nurses (RN), licensed practical nurses (LPN), dialysis technicians, medication aides, and certified community health workers.

Section 4723.06 – Ohio Revised Code | Ohio Laws

4723.03: Unlicensed Practice

Engaging in practice as an advanced practice nurse, registered nurse, graduate nurse, licensed practical nurse, or using the acronyms APRN, CRNA, CNS, CNM, CNP, RN, or LPN without proper licensure is not allowed, as it would represent to the public that the person using the acronym is authorized to practice nursing in Ohio. In addition, no person or organization should employ anyone without licensure for the purpose of practicing as a nurse or advanced practice nurse and no person can fraudulently sell, obtain, or furnish any nursing diploma, license, certificate, renewal, or record, or assist an unlicensed person in obtaining such information.

Section 4723.03 – Ohio Revised Code | Ohio Laws

4723.05: Appointment of Executive Director -Duties

The board of nursing may appoint an executive director who will become a full-time employee of the board. The executive director must reside in Ohio and will not be considered as part of the board of nursing. The Executive director will be responsible for calling special meetings upon the request of two board members, and may appoint nursing education consultants, nursing practice consultants, investigative personnel, and any other employee required to conduct the board’s functions.

Section 4723.05 – Ohio Revised Code | Ohio Laws

4723.06: Board of Nursing – Powers and Duties

The powers and duties of the Ohio Board of Nursing are defined in Chapters 4723.06 of the Ohio Revised Code and include:

• Develop criteria for eligibility for nursing license consideration.
• Define the minimum educational standards for nursing programs.
• Issue and renew nursing licenses, dialysis technician certificates, and community health worker certificates.
• Inspect and grant approval for nursing education programs.
• Approve continuing education programs and courses.
• Approve national certifying organizations for advanced practice registered nurse (APRN) examination and licensure.

Licensees and certificate holders regulated by the Board include APRNs (certified nurse midwives, certified nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists), registered nurses (RN), licensed practical nurses (LPN), dialysis technicians, medication aides, and certified community health workers.

Section 4723.06 – Ohio Revised Code | Ohio Laws

4723.09: License Application

An applicant must apply for licensure by examination to practice as an RN or as an LPN. The application must include:

• Evidence that the applicant has met the educational requirements by completing a nursing education program, practical nurse course, community college, or allied health program.
• The application fee required by section.
• Results of a criminal records check.
• The board will grant a license to practice nursing as an RN or as an LPN if:
• The applicant passes the examination.
• The applicant passes a background check.
• The board determines that the applicant has not committed any act that is grounds for disciplinary action.

The board will grant a license to practice nursing as an RN or as an LPN if:

• The applicant passes the examination.
• The applicant passes a background check.
• The board determines that the applicant has not committed any act that is grounds for disciplinary action.

An application for licensure by endorsement must be submitted to the board and include:

• Evidence that the applicant holds a current, valid, and unrestricted license or equivalent authorization from another state that has been granted after passing a licensure examination.
• The application fee required.
• Evidence of meeting educational requirements.
• Evidence of completing two contact hours of continuing education that is related to Chapter 4723 of the ORC (law) or Chapter 4723 of the OAC (the rules adopted under it).
• Results of a criminal records check.

Section 4723.09 – Ohio Revised Code | Ohio Laws

4723-14-03: Continuing education requirement for licensed practical and registered nurses

• A nurse who applies to renew their nursing license must first complete 24 contact hours of continuing education, including at least one contact hour of continuing education in category A.
• An LPN who has an active license as an RN in Ohio does not need to take continuing education to practice as an LPN.
• A nurse who has been licensed by endorsement in Ohio for one year or less must complete twelve contact hours of continuing education.
• A nurse who has been licensed by endorsement in Ohio for more than one year must complete twenty-four contact hours of continuing education.
•  A nurse who earns more than the number of hours required during a single renewal period cannot apply the extra hours to meet future renewal period continuing education requirements.

4723.28: Disciplinary action

The board of nursing may deny, revoke, suspend, fine, or place restrictions on any nursing license if it finds that a person committed fraud, misrepresentation, or deception in passing an examination required to obtain a license. These sanctions may also be imposed for any of the following:

• Assaulting or causing harm to a patient.
• Conviction of a misdemeanor felony or of any crime involving gross immorality 
• Use of controlled substances or alcohol that impairs the ability to provide safe nursing care.
• Failure to renew a license.
• Found by a probate court of being mentally ill or mentally incompetent.
• Misappropriation of money while practicing as a nurse.
• Self-administering any drug without a valid prescription or using any schedule I controlled substance.
• Selling, giving away, or administering drugs for anything other than legal purposes.

Chapter 4723-4 of the Ohio Administrative Code

Chapter 4723-4 of the Ohio Administrative Code is one of 19 chapters that establishes rules for the practice of nursing in in the state of Ohio, including the minimal acceptable standards for safe and effective nursing practice by registered nurses, licensed practical nurses, and advanced practiced registered nurses; certified nurse-midwifes, certified nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.

Chapter 4723-4 consists of eight sections, including:

• 01: General Information
• 03: Standards Relating to Competent Practice as a Registered Nurse
• 04: Standards Relating to Competent Practice as a Licensed Practical Nurse
• 05: Standards Relating to Competent Practice as a Certified Nurse-Midwife, Certified Nurse Practitioner, Certified Registered Nurse Anesthetist, Or Clinical Nurse Specialist
• 06: Standards of Nursing Practice Promoting Patient Safety
• 07: Standards for Applying the Nursing Process as a Registered Nurse
• 08: Standards for Applying the Nursing Process as a Licensed Practical Nurse
• 09: Specialty Certification

Chapter 4723-4 – Ohio Administrative Code | Ohio Laws

4723-4-01: General Information

4723-4 of the Ohio Laws and administrative rules establishes the minimal acceptable standards of safe and effective nursing practice for a registered nurse, licensed practical nurse, an advanced practice registered nurse; certified nurse-midwifes, certified nurse practitioners, certified registered nurse anesthetists, or clinical nurse specialists in any setting.

The following definitions apply to this chapter:

Certified Nurse Midwife	A RN who holds a current valid advanced practice registered nurse license issued by the board.
Certified Nurse Practitioner	A RN who holds a current valid advanced practice registered nurse license issued by the board.
Certified Registered Nurse Anesthetist	A registered nurse who holds a current valid advanced practice registered nurse license issued by the board.
Clinical Judgment	The application of the nurse’s knowledge and reasoning to make decisions about patient care.
Clinical Nurse Specialist	A RN who holds a current valid advanced practice registered nurse license issued by the board.
Direction	Communicating a plan of care to a licensed practical nurse. Direction by an RN does not mean that the RN is supervising the LPN.
Licensed Nurse	A RN or an LPN who holds a current valid license to practice nursing in Ohio.
Nursing Diagnosis	The identification of a patient’s needs or problems that are responsive to nursing intervention.
Patient	An individual, group, or a community that is the recipient of nursing care.

Rule 4723-4-01 – Ohio Administrative Code | Ohio Laws

4723-4-03: Standards Relating to Competent Practice as a Registered Nurse

An RN must provide care that is within the scope of their practice, and must remain knowledgeable of the duties, responsibilities, and remain accountable for safe nursing practice by:

• Having consistent nursing performance.
• Recognizing, consulting, and intervening when a complication arises.

The RN must implement an order for a patient, unless the order appears to be:

• Contraindicated by other documented information.
• Inaccurate.
• Not current or valid.
• Not properly authorized.
• Potentially harmful to a patient.

When clarifying an order, the registered nurse must consult with the licensed provider, notify them when a medication or treatment is not followed, document who was notified, and any actions to assure patient safety.

A registered nurse may only provide nursing care beyond basic nursing preparation when:

• The nurse obtains the appropriate education.
• The nurse demonstrates knowledge, skills, and abilities necessary to provide nursing care.
• The nurse has documentation meeting board requirements.
• The nursing care does not involve anything that is prohibited by law.

When an RN provides direction to an LPN, they must first assess:

• The patient’s condition.
• The type of care the patient needs.
• The complexity of the care needed.
• The training, skill, and knowledge of the LPN who will perform the duties.

An RN must maintain the confidentiality of patient information and should only communicate patient information with other members of the patient’s health care team. To the maximum extent of the law, the RN must not disclose any patient healthcare information without the patient’s consent. Only in accordance with an authorized law or rule can an RN disclose patient healthcare information without the patient’s consent.

Rule 4723-4-03 – Ohio Administrative Code | Ohio Laws

Case Reflection

Julie Andrews is a registered nurse with more than 20 years’ experience. She is a new hire in your hospital’s medical-surgical ward and has received an order to administer 50,000 units of heparin subcutaneously. She knows that the dosage is incorrect and chooses not to administer the medication. Because Julie RN chose not to follow the order, what should she do next? Who should she notify, and how should it be documented? What else should she do to ensure patient safety?

4723-4-04: Standards Relating to Competent Practice as a Licensed Practical Nurse

• An LPN must function within the scope of practice of nursing for an LPN.
• An LPN must demonstrate competence and accountability in all areas of practice, including:
  • Consistent performance of nursing care.
  • Recognize and intervene when a complication arises.

• An LPN may provide nursing care that is beyond basic preparation provided:
  • The nurse obtains education that is relative to the nursing care to be provided.
  • The nurse demonstrates knowledge, skills, and abilities necessary to perform nursing care.
  • The nurse maintains documentation satisfactory to the board of meeting the requirements.
  • The nurse has a current valid order or direction from an individual who is authorized to practice in Ohio and is acting within the scope of the individual’s professional practice.
  • Nursing care does not include a procedure that is prohibited.
• In a timely manner, an LPN must:
  • Implement any order or direction for a patient unless the LPN believes the order or direction is:
    • Inaccurate.
    • Not properly authorized.
    • Not valid.
    • Harmful, or potentially harmful to a patient.
    • Contraindicated by other documented information.
  • Clarify any order or direction for a patient when the LPN believes the order or direction is:
    • Inaccurate.
    • Not properly authorized.
    • Not current or valid.
    • Harmful, or potentially harmful to a patient.
    • Contraindicated by other documented information.
• When clarifying an order or direction, the LPN must:
  • Consult with an appropriate licensed practitioner or directing registered nurse.
  • Notify the ordering practitioner or directing RN when the LPN makes the decision not to follow the order or administer the medication treatment as prescribed.
  • Document that the practitioner or directing RN was notified of the decision not to follow the order or administer the medication treatment as prescribed.
  • Take any other action needed to assure the safety of the patient.
• In a timely manner, an LPN must report to and consult with other members of the health care team and make referrals as necessary.
• An LPN must maintain confidentiality of patient information while practicing nursing and only communicate patient information to other members of the health care team for health care purposes.
• An LPN must only access patient information for the purpose of patient care.
• An LPN must not disseminate patient information for purposes other than patient care, including social media, texting, emailing or any other form of communication.
• Identifiable patient health care information must not be disclosed by an LPN unless the patient has consented to the disclosure of identifiable patient health care information, except in limited circumstances including authorized law, rule, or other recognized legal authority.
• When an LPN is directed to observe, instruct, or evaluate the performance of a nursing task, the LPN must use acceptable nursing standards and communicate information that is consistent with acceptable standards of safe nursing care.

Rule 4723-4-04 – Ohio Administrative Code | Ohio Laws

Case Reflection

Amy Duong is an LPN in labor and delivery. She is working with a registered nurse, and one of her patients has requested pain medication. Amy notes that Morphine 4 mg intravenous is ordered, but the patient is nursing her newborn. Amy is concerned about administering the medication, and how it may affect the baby who is being nursed. She consults with her team registered nurse, a new graduate, who states that it is ok to administer the morphine. Amy is not convinced and decides not to administer the medication. What steps should Amy take to address her concerns? Who else should she notify, and how should she document it? What should she do to ensure that the patient’s pain is addressed?

4723-4-05: Standards Relating to Competent Practice as a Certified Nurse-Midwife, Certified Nurse Practitioner, Certified Registered Nurse Anesthetist, or Clinical Nurse Specialist

 A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist must:

• Function within the scope of practice of nursing for a registered nurse.
• Function within the nurse’s applicable scope of practice.
• If authorized by Ohio law to prescribe, practice according to the Ohio laws and administrative rules.

A certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist may provide care after:

• The nurse obtains education from a recognized body of knowledge.
• The nurse demonstrates knowledge, skills, and abilities necessary to provide nursing care.
• The nurse maintains documentation evidence of meeting the requirements.

When the practice of a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist is evaluated, the evaluation must be provided by a licensed physician or podiatrist, or an advanced practice registered nurse with the same license designation as the nurse being evaluated.

Rule 4723-4-05 – Ohio Administrative Code | Ohio Laws

4723-4-06: Standards of Nursing Practice Promoting Patient Safety

• All licensed nurses must display their title or initials whenever providing care to a patient. A licensed nurse must also provide their title or initials when telecommunicating to a patient or a healthcare provider on the patient’s behalf.
• In a timely manner, a licensed nurse must accurately report and document nursing assessments or observations, the care provided, and the patient’s response to care, and must not falsify or conceal any part of the patient’s record.
• The licensed nurse must implement a safe environment for the patient, including:
  • Providing privacy during examination and treatment.
  • Treat the patient with courtesy and respect.
  • Not engage in behavior to obtain personal gain at the patient’s expense, including getting involved in patient’s personal relationships or financial matters.
  • Not engage in any verbal or physical behavior deemed to be sexual in nature, as a patient is always presumed to be incapable of giving informed consent to such behaviors.

Only an RN can supervise or evaluate another nurse, however, outside of nursing practice, a non-nursing supervisor may evaluate a nurse employee. Supervision by an RN does not require that the RN be present on-site, but the RN must conduct enough on-site visits to evaluate another nurse’s performance.

A licensed nurse must not make or submit any false, misleading, or deceptive statements, or information to:

• The board or any representative of the board.
• Current employers.
• Prospective employers.
• Any organization that employs the nurse, including a temporary, agency, or locum tenens assignments.
• Other members of the patient’s health care team.
• Law enforcement personnel.

Rule 4723-4-06 – Ohio Administrative Code | Ohio Laws

Case Reflection

Cynthia Mickelson is a registered nurse working in a trauma center’s intensive care unit. She has just gotten a new admission, a celebrity who was involved in a car accident. Cynthia begins to review her patient’s medical notes, and then decides to see what the celebrity blogs are writing about the patient. Shortly afterwards, a news channel calls the hospital and asks for information on the patient, which Cynthia provides. What standards to promote patient safety did Cynthia deviate from? What could she have done differently?

4723-4-07: Standards for Applying the Nursing Process as a Registered Nurse

A nurse must apply the nursing process when practicing nursing. The nursing process is cyclical and requires the nurse to respond to a patient’s changing status throughout the process. This includes:

• Assessing the health status.
• Collecting subjective and objective data and documenting such data.
• Establish, accept, or modify a nursing diagnosis and interventions.
• Report findings and nursing diagnosis to other team members.
• Develop, establish, maintain, or modify the nursing plan of care and communicate it with other team members.
• Implement valid orders within the nurse’s scope of practice.
• Delegate nursing tasks, including medication administration to the appropriate personnel.
• Evaluate, document, and report the patient’s response to interventions and progress to expected outcomes.
• Reassess and update the nursing plan, as necessary.

Rule 4723-4-07 – Ohio Administrative Code | Ohio Laws

4723-4-08: Standards for Applying the Nursing Process as a Licensed Practical Nurse

The LPN shall contribute to the nursing process when practicing nursing. The nursing process is cyclical and requires the nurse to respond to a patient’s changing status throughout the process. The LPN must maintain the following standards during the nursing process:

• Contribute to the assessment of a patient’s health status by collecting and documenting subjective and objective data and reporting such data to the registered nurse or other members of the healthcare team.
  • Contribute to the development, maintenance, or modification of the nursing care plan and communicate it with other healthcare team members.
  • Administer medications and treatments prescribed.
  • Provide basic nursing care and collaborate with other team members.
  • Delegate nursing tasks as directed, including medication administration.
  • Contribute to the evaluation of a patient’s response to nursing interventions and document and communicate such responses to member of the healthcare team.
  • Contribute to the reassessment of the patient and update the nursing plan, as necessary.

Rule 4723-4-08 – Ohio Administrative Code | Ohio Laws

4723-4-09: Specialty Certification

 A registered nurse with a current, valid license to practice nursing in Ohio may use a title or initials denoting specialty certification in a particular area of specialty in nursing that has been granted by a national certifying organization. The registered nurse may use initials following the title “Registered Nurse” or the initials “RN”.

No person can use any initials or title that implies they have specialty certification unless that person has been granted a specialty certification title in nursing by a national certifying organization.

Rule 4723-4-09 – Ohio Administrative Code | Ohio Laws