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Ohio Nurse Practice Act (Category A)

Contact Hours: 2

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Contact Hours: 2

This online independent study activity is credited for 2 contact hours at completion.

Course Purpose

The purpose of this course is to provide healthcare professionals with an overview of Chapter 4723 of the Ohio Revised Code (law) also known as the Ohio Nurse Practice Act.

Contact Hour Designation

This CE Activity, OLN-I-3116-2023 offered by Fast CE For Less Inc has been approved for 2.0 contact hours Category A by the Ohio Board of Nursing through the approver unit at the Ohio League for Nursing (OBN-006-92) and the program is approved to be offered through January 30, 2025

Overview

The responsibilities of nurses in healthcare are increasing, and nurses must have full knowledge of their responsibilities while practicing as a nurse in the state of Ohio. This course provides an overview of the Ohio Nurse practice Act, including qualifications for licensure, nursing titles that are allowed to be used, the nurse’s scope of practice, and actions that can be taken against nurses who do not follow the nursing laws in Ohio.

Course Objectives

Upon completion of this course, the learner will be able to:

  • Describe the powers and duties of the Ohio Board of Nursing as defined in Chapters 4723.06 of the Ohio Revised Code.
  • Recall the requirements for nursing licensure and renewal in the state of Ohio.
  • Summarize the standards of nursing practice to promote patient safety as they relate to care within the scope of practice in Ohio.
  • Explain the standards for applying the nursing process by nurses in Ohio.
  • Describe practice failures that may result in disciplinary actions.

Successful completion of this course requires achieving a 70% or higher on the posttest, submitting an evaluation, and attestation of reading the course content.

Policy Statement

This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.

Disclosures

The planning committee of Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.

Ohio Nurse Practice Act (Category A)

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Definitions
Advanced Practice Registered Nurse (APRN)A person who holds a current, valid license and is authorized to practice nursing as an advanced practice registered nurse and is designated as any of the following: A certified registered nurse anesthetist A clinical nurse specialist A certified nurse-midwife A certified nurse practitioner
Board of NursingExercises all powers and performs all duties related to the Board. The board of nursing must include: 13 members who are US citizens and residents of Ohio. Of the 13 members: 8 must be Registered Nurses; 2 of which must be advanced practice registered nurses. 4 must be licensed practical nurses. 1 member who represents the consumers of healthcare.  
Certified Community Health WorkerA person who holds a current, valid certificate as a community health worker.
Certified Nurse Practitioner (CNP)An advanced practice registered nurse who holds a current, valid license and is designated as a certified nurse practitioner.  
Certified Nurse-Midwife (CNM)An advanced practice registered nurse who holds a current, valid license and is designated as a certified nurse-midwife.  
Certified Registered Nurse Anesthetist (CRNA)An advanced practice registered nurse who holds a current, valid license and is designated as a certified registered nurse anesthetist.
Clinical JudgementApplying nursing knowledge in the clinical environment and making decisions about patient care.  
Clinical Nurse Specialist (CNS)An advanced practice registered nurse who holds a current, valid license and is designated as a clinical nurse specialist.  
Delegating NurseThe nurse who delegates a nursing task or assumes responsibility for individuals who are receiving delegated nursing care.
DelegationThe transfer of responsibility for the performance of a selected nursing task from a licensed nurse authorized to perform the task to an individual who does not otherwise have the authority to perform the task.
Dialysis CareThe care and procedures that a dialysis technician or dialysis technician intern is authorized to provide and perform.  
Dialysis TechnicianA person who holds a current, valid certificate to practice as a dialysis technician.  
Dialysis Technician InternA person who holds a current, valid certificate to practice as a dialysis technician intern.  
DirectionCommunicating a plan of care to a licensed practical nurse by a Registered Nurse.  
DODDOhio department of developmental disabilities.
Licensed Practical Nurse (LPN)A person who holds a current, valid license and is authorized to practice nursing as a licensed practical nurse.  
Medication AideA person who holds a current, valid certificate to administer medication.  
Nursing DiagnosisThe identification of a patient’s needs or problems which are amenable to nursing intervention.  
Nursing SpecialtyA specialty in practice as a certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner.  
PatientThe recipient of nursing care that includes a person, a group, or a community.  
PhysicianA person who is authorized to practice medicine and surgery, or osteopathic medicine and surgery.  
Practice of Nursing as A Licensed PracticalProviding care that requires the application of basic knowledge of the biological, physical, behavioral, social, and nursing sciences at the direction of a registered nurse, physician, physician assistant, dentist, podiatrist, optometrist, or chiropractor.  
Practice of Nursing as a Registered NurseProviding care that requires specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences.  
Practice of Nursing as An Advanced Practice Registered NurseProviding nursing care that requires knowledge and skill obtained from advanced formal education, training, and clinical experience.
Registered Nurse (RN) A person who holds a current, valid license and is authorized to practice nursing as a registered nurse.  
Standard Care ArrangementA written guide for planning and evaluating a patient’s health care by an advanced practice nurse, physician, or podiatrist.  
SupervisionAs it pertains to a certified registered nurse anesthetist, means that when administering anesthesia, the certified registered nurse anesthetist is in the immediate presence of a podiatrist, dentist, or physician, while they act within their scope of practice.  
Unlicensed PersonAn individual, not currently licensed by the board as a registered nurse or licensed practical nurse, or an individual who does not hold a current valid certificate to practice as a dialysis technician or administer medications as a medication aide.  
Advanced Practice Registered Nurse (APRN)A person who holds a current, valid license and is authorized to practice nursing as an advanced practice registered nurse and is designated as any of the following: A certified registered nurse anesthetist A clinical nurse specialist A certified nurse-midwife A certified nurse practitioner  
Board of NursingExercises all powers and performs all duties related to the Board. The board of nursing must include: 13 members who are US citizens and residents of Ohio. Of the 13 members: 8 must be Registered Nurses; 2 of which must be advanced practice registered nurses. 4 must be licensed practical nurses. 1 member who represents the consumers of healthcare.  
Clinical JudgementApplying nursing knowledge in the clinical environment and making decisions about patient care.  
DirectionCommunicating a plan of care to a licensed practical nurse by a Registered Nurse.  
Dialysis CareThe care and procedures that a dialysis technician or dialysis technician intern is authorized to provide and perform.  
Dialysis TechnicianA person who holds a current, valid certificate to practice as a dialysis technician.  
Dialysis Technician InternA person who holds a current, valid certificate to practice as a dialysis technician intern.  
Nursing DiagnosisThe identification of a patient’s needs or problems which are amenable to nursing intervention.  
PatientThe recipient of nursing care, which includes a person, a group, or a community.  
Registered Nurse (RN) A person who holds a current, valid license and is authorized to practice nursing as a registered nurse.  
Practice of Nursing as a Registered NurseProviding care that requires specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences.  
Licensed Practical Nurse (LPN)A person who holds a current, valid license and is authorized to practice nursing as a licensed practical nurse.  
Practice of Nursing as A Licensed PracticalProviding care that requires the application of basic knowledge of the biological, physical, behavioral, social, and nursing sciences at the direction of a registered nurse, physician, physician assistant, dentist, podiatrist, optometrist, or chiropractor.  
Certified Community Health WorkerA person who holds a current, valid certificate as a community health worker.
Certified Registered Nurse Anesthetist (CRNA)An advanced practice registered nurse who holds a current, valid license and is designated as a certified registered nurse anesthetist.
Clinical Nurse Specialist (CNS)An advanced practice registered nurse who holds a current, valid license and is designated as a clinical nurse specialist.  
Certified Nurse-Midwife (CNM)An advanced practice registered nurse who holds a current, valid license and is designated as a certified nurse-midwife.  
Certified Nurse Practitioner (CNP)An advanced practice registered nurse who holds a current, valid license and is designated as a certified nurse practitioner.  
Medication AideA person who holds a current, valid certificate to administer medication.  
Nursing SpecialtyA specialty in practice as a certified registered nurse anesthetist, clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner.  
PhysicianA person who is authorized to practice medicine and surgery, or osteopathic medicine and surgery.  
Practice of Nursing as An Advanced Practice Registered NurseProviding nursing care that requires knowledge and skill obtained from advanced formal education, training, and clinical experience.
SupervisionAs it pertains to a certified registered nurse anesthetist, means that when administering anesthesia, the certified registered nurse anesthetist is in the immediate presence of a podiatrist, dentist, or physician, while they act within their scope of practice.  
Standard Care ArrangementA written guide for planning and evaluating a patient’s health care by an advanced practice nurse, physician, or podiatrist.  
Introduction

The responsibilities of nurses in healthcare are increasing and nurses must have full knowledge of their responsibilities while practicing as a nurse in the state of Ohio to provide safe patient care. The Ohio Revised Code (ORC) Chapter 4723, which is also called the Ohio Nurse Practice Act, establishes the laws for the practice of nursing in Ohio. Chapter 4723 of the Ohio Administrative Code (OAC) contains the administrative rules based on the Nurse Practice Act which have been adopted by the Ohio Board of Nursing (OBN).  The Ohio Board of Nursing is the government agency created by Ohio Law to regulate nursing practice in Ohio for the safety of the public. Chapters 4723-1 through 4723-27 of the Ohio Administrative Code, establish regulations for licensure and certification, standards of practice, discipline, delegation, continuing education, and pre-licensure nursing education.

This course provides an overview of the Ohio Nurse Practice Act, including qualifications for licensure, nursing titles that are allowed to be used, the nurse’s scope of practice, and actions that can be taken against nurses who do not follow the nursing law and rule in Ohio. All materials in this course are referenced from Chapter 4723 of the Ohio Revised Code (law) and Ohio Administrative Code (rule).

The Ohio Board of Nursing

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. The Ohio Board of Nursing recognizes that public protection is essential, as virtually every citizen of Ohio has encountered a nurse in healthcare. Therefore, the main priorities of the Ohio BON are to efficiently license the nursing workforce and remove dangers from nursing practice in a timely manner to protect Ohio patients.

4723.02: Board of Nursing

The board of nursing exercises all the duties in this chapter.

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 (RN); two of which must be advanced practice registered nurses (APRN), four members must be licensed practical nurses (LPN), and one member must represent the interests of consumers of health care. The Board member’s term of office is four years, however, if a vacancy must be filled prior to the expiration of the term, the qualified person who fills the vacancy will hold office for the remainder of the term. Any member of the board may be removed by the governor for neglect of duties or for incompetency or unprofessional or dishonorable conduct, after a hearing. The board must elect one of its nurse members as president and one as vice-president. The board must also select one of its RN members to serve as the supervising member for disciplinary matters.

Section 4723.02 – 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.

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

4723.24: License or Certificate Renewal; Notice of Change of Address

  • All the following apply to the schedules for renewal of licenses and certificates issued by the board of nursing:
    • A RN is subject to license renewal in odd-numbered years. The application for license renewal is due on September 15th of the renewal year. If a license is not renewed or classified as inactive, the license will lapse on November 1st of the renewal year.
    • A LPN is subject to renewal in even-numbered years. The application for license renewal is due on September 15th of the renewal year. If a license is not renewed or classified as inactive, the license will lapse on November 1st of the renewal year.
    • An APRN is subject to renewal in odd-numbered years. The application for license renewal is due on September 15th of the renewal year. If a license is not renewed or classified as inactive, the license will lapse on November 1st of the renewal year.
  • The board will provide an application for license renewal, except when an individual is ineligible for license or certificate renewal.
  • If the board provides a renewal application by mail, the application will be mailed to the last known address. The license holder must complete the renewal application and submit the renewal fee to the board. If the application is submitted after the due date but before the license lapses, the license holder must pay additional fees as stipulated by the board. The license holder must also report any conviction, plea, or judicial finding regarding a criminal offense that constitutes grounds for the board to impose sanctions. If the application is complete, and upon verification of findings, the board will issue a renewed license to the license holder.
  • A license holder must provide written notice to the board of any name change or address change within 30 days of the change.
  • With the exception of the first license renewal, all licensed nurses must complete the following nursing continuing education:
    • 24 hours of nursing continuing education for a two-year renewal period.
    • The number of hours of nursing continuing education specified by the board for a license that was issued for less than a two-year renewal period.
  • To practice nursing as an APRN, complete nursing continuing education as follows for a two-year renewal period:
    • 24 hours of nursing continuing education for a two-year renewal period. The contact hours earned may also be applied towards the RN license for renewal.
    • The number of hours of nursing continuing education specified by the board for a license that was issued for less than a two-year renewal period, including 12 contact hours in advanced pharmacology.
  • The board may request from a license holder documentation of completion of required contact hours.
  • To classify a license as inactive, an APRN, RN, or LPN must notify the board in writing prior to the date the license lapses. Once the license is classified as inactive, the license will no longer be active in Ohio, and nursing may not be practiced. The license may be reinstated after applying to the board and meeting the requirements for reinstatement. If the license has lapsed for more than five years, criminal records check and check of federal bureau of investigation records must be completed.

Section 4723.24 – Ohio Revised Code | Ohio Laws

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.

Section 4723.28 – Ohio Revised Code | Ohio Laws

Chapter 4723 of the Ohio Administrative Code – The Rules

Based on the Nurse Practice Act, the Board adopts rules, Chapters 4723-1 through 4723-27 of the Ohio Administrative Code, which establishes regulations for licensure and certification, standards of practice, discipline, and pre-licensure nursing education (Ohio Board of Nursing, 2022).

Chapter 4723-4: Standards of Practice Relative to Registered Nurse or Licensed Practical Nurse

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 MidwifeA RN who holds a current valid advanced practice registered nurse license issued by the board.
Certified Nurse PractitionerA RN who holds a current valid advanced practice registered nurse license issued by the board.
Certified Registered Nurse AnesthetistA registered nurse who holds a current valid advanced practice registered nurse license issued by the board.
Clinical JudgmentThe application of the nurse’s knowledge and reasoning to make decisions about patient care.
Clinical Nurse SpecialistA RN who holds a current valid advanced practice registered nurse license issued by the board.
DirectionCommunicating a plan of care to a licensed practical nurse. Direction by an RN does not mean that the RN is supervising the LPN.
Licensed NurseA RN or an LPN who holds a current valid license to practice nursing in Ohio.
Nursing DiagnosisThe identification of a patient’s needs or problems that are responsive to nursing intervention.
PatientAn 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.

Case Reflection

Justine is a registered nurse who is assigned to work in the medical surgical (MedSurg) ward. She just received a report on a new patient, Mrs. Roberts, who is being admitted after having a hysterectomy. Mrs. Roberts is transferring from the recovery area to the MedSurg ward. During the transfer report, the nurse said that Mrs. Roberts did not have any pain in the recovery area and did not request any pain medication. Upon arrival at the MedSurg ward, Justine assessed Mrs. Roberts, and Mrs. Roberts said that her pain level was 6/10 at the surgical site. Justine reviewed the order for pain medication and noted that hydromorphone (Dilaudid) 40 mg intravenous (IV) is ordered every four hours as needed for pain. Justine immediately recognizes the error in the medication dose and decides not to follow the order. What should Justine do once that decision is made? How can she correct the order? Who should Justine notify regarding the unsafe dose of pain medication, and what should she document?

 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

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

Michelle is an LPN in the emergency room. She is assigned to Mr. Campbell, a police officer who was involved in a car accident while on duty. Michelle’s colleagues are curious regarding the circumstances of the accident and question how bad Mr. Campbell’s injuries are, and if he was ‘chasing a bad guy.’ Michelle proceeds to tell her colleagues what she knows about the accident and Mr. Campbell’s injuries, and then says, “It’ll probably be on the news tonight.” Michelle then goes to the bedside of Mr. Campbell and begins to perform an assessment without closing the drape for privacy. One of Michelle’s colleague’s comments on Mr. Campbell’s physical appearance, saying “He must work out a lot. Look how broad his chest is. I bet he has washboard abs.”  What standards of nursing practice and promoting patient safety do you recognize as not being followed? Did Michelle promote a safe environment for her patient? What would you do in the same situation?

 

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

Case Reflection

Michael, a registered nurse, and Lindsey a licensed practical nurse, are working together as a team on the telemetry unit. Michael and Lindsey work collaboratively to divide the work of their assigned patients. Michael informs Lindsey that he will conduct and document the physical assessments on all the patients. He delegates the tasks of obtaining vital signs, administering medications, and performing glucose checks to Lindsey.

Lindsey is a new nurse to the telemetry unit, but thus far, she has not had any difficulties working within a team. She obtains vital signs and administers the medications without difficulty and as prescribed, however, she has not received training on the glucometer and is unfamiliar with how to use it. She informs Michael of her inability to use the glucometer. Michael hurriedly performs the glucose check on one of the patients, and based on the results, delegates Lindsey to administer insulin according to the sliding scale that is ordered. He does not inform her however, that the blood sugar must be rechecked after the sliding scale dose is administered, as stipulated in the written orders. Because Lindsey does not have the appropriate training, she is unable to recheck the glucose, and because Michael delegated the task of administering the sliding scale dose of insulin, he never rechecked the blood glucose. What standards of the nursing process were omitted in this scenario? What should have been reported? Given the situation, what would you do differently?

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

4723-13 Delegation of Nursing Tasks

Delegation describes when an RN directs another person to a set of tasks to perform involving a patient’s care. It is a nursing act that is distinct from teaching, supervising, consulting, and advising.

4723-13-01: Definitions

The following definitions apply to this chapter:

BoardThe Ohio board of nursing.
DelegationThe transfer of responsibility from a licensed nurse authorized to perform a task to an individual who does not have the authority to perform a task.
Delegating NurseThe nurse who delegates a nursing task or assumes responsibility for nursing care given.
Dialysis TechnicianAn individual who holds a valid certificate that authorizes dialysis care.
DirectionCommunicating a plan of care to an LPN. The RN does not supervise the LPN in this context.
Licensed NurseA RN or an LPN licensed to practice nursing in Ohio.
Medication AideAn individual who holds a valid certificate that authorizes the administration of medications in nursing homes or residential care facilities.
DoddThe Ohio department of developmental disabilities.
Nursing TaskActivities that constitute the practice of nursing as a licensed nurse, including assistance with activities of daily living, when the client is unable to perform that activity.
Unlicensed PersonAn individual, not currently licensed by the board.

Rule 4723-13-01 – Ohio Administrative Code | Ohio Laws

4723-13-02: General Information

  • A licensed nurse can delegate a nursing task to an unlicensed person in accordance with this chapter.
  • Nothing in this chapter prevents a registered, certified, or licensed nurse from engaging in the practice as a registered, certified, or licensed nurse.
  • Nothing in this chapter prohibits an unlicensed person from assisting an individual with their own self-directed care, including helping with self-administration of medications. An unlicensed person assisting with self-administration of medications may only perform the following:
    • Remind an individual when to take the medication and observe the individual follow the instructions on the container.
    • Assist an individual in the self-administration of medication by handing the container with the medication in it to the individual. The unlicensed person may open the container for the individual.
    • Assist upon request or consent, in removing medication from the container and assist in taking or applying the medication.
    • Assisting an individual with self-administration does not mean that an unlicensed person can administer medication orally, by injection, or by any other route.

Rule 4723-13-02 – Ohio Administrative Code | Ohio Laws

4723-13-03: Prohibitions

  • When a nursing task is delegated to a person, that person cannot delegate the task to someone else.
  • An unlicensed person who performs a nursing task and does not comply with this chapter’s provisions is engaging in the unauthorized practice of nursing, which is prohibited.
  • An unlicensed person cannot perform a delegated nursing task on anyone other than the person specified by the delegating nurse.

Rule 4723-13-03 – Ohio Administrative Code | Ohio Laws

4723-13-05: Criteria and Standards for a Licensed Nurse Delegating to an Unlicensed Person

  • An RN may delegate a nursing task to an unlicensed person.
  • An LPN may delegate a nursing task to an unlicensed person as directed by the RN.
  • An advanced practice registered nurse (APRN) may delegate the administration of medication to an unlicensed person.
  • A licensed nurse may delegate to an unlicensed person the administration of only the following medications:
    • Over-the-counter topical medications to be applied to intact skin.
    • Over-the-counter eye drops, ear drops, suppository medications, foot soak treatments, and enemas.
  • The delegating nurse must determine the following before delegating a task:
    • The nursing task is within the scope of practice of the delegating nurse.
    • The nursing task is within the knowledge, skill, and ability of the nurse delegating the nursing task.
    • The nursing task is within the training, ability, and skill of the unlicensed person who will perform the task.
    • The appropriate resources are available for the performance and outcome of the task.
    • Supervision by a licensed nurse is available.
    • The nursing task requires no judgment of nursing knowledge and expertise of the unlicensed person.
    • The results of the nursing task are predictable.
    • The nursing task can be performed without altering the procedures for the task.
  • Prior to delegating a nursing task, the delegating nurse must identify:
    • Whom the nursing task will be performed on.
    • A time when the delegated nursing task may be performed.
  • The delegating nurse must complete an evaluation of the person who needs nursing care.
  • The delegating nurse must assess the complexity and frequency of the nursing care needed, including the stability of the person who needs care.
  • The delegating nurse is accountable for the decision to delegate nursing tasks to an unlicensed person, and if the nurse determines that an unlicensed person is not correctly performing a task, the licensed nurse must intervene.

Rule 4723-13-05 – Ohio Administrative Code | Ohio Laws

4723-13-06: Minimum Curriculum Requirements for Teaching a Nursing Task

  • A licensed nurse must include the following when teaching an unlicensed person to perform a nursing task:
    • Information on infection control and universal precautions.
    • Direction on the concepts underlying the nursing task.
    • Direction on how to correctly perform the specific nursing task.
    • Demonstration of the nursing task.
    • Observation and documentation of a satisfactory return demonstration by the unlicensed person.

Rule 4723-13-06 – Ohio Administrative Code | Ohio Laws

4723-13-07: Supervision of the Performance of a Nursing Task Performed by an Unlicensed Person

  • When a licensed nurse delegates a nursing task to an unlicensed person, they are required to provide supervision, which includes initial and ongoing direction, procedural guidance, and evaluation.
  • If the nursing task is being performed within health care services, the supervision must be on-site direct supervision.
  • If a delegated nursing task is being performed outside health care services, the supervision may be on-site direct supervision, or indirect supervision if telecommunication is available.

Rule 4723-13-07 – Ohio Administrative Code | Ohio Laws

Medication administration and intravenous (IV) therapy may be indicated for many reasons and comes with many safety considerations and guidelines to decrease the risk of complications and ensure patient safety. It is important that all nurses are aware of safety precautions and always practice according to their skill level and state legislation.

4723.17: Administration of Medications

The board of nursing must authorize an LPN to administer medications if the nurse supplies satisfactory evidence of:

  • Successfully completing an LPN educational program.
  • Successfully completing a post-licensure course in basic pharmacology.

Section 4723.17 – Ohio Revised Code | Ohio Laws

4723.18: Administration of Adult Intravenous Therapy

The board of nursing will authorize an LPN to administer intravenous (IV) therapy to an adult if the nurse supplies evidence that of the following conditions:

  • The nurse holds a current, valid license to practice nursing as an LPN.
  • The nurse has been authorized to administer medications.
  • The nurse successfully completed either of the following:
  • A course of study in IV therapy.
  • A continuing education course that includes the following:
    • The curriculum is established by rules adopted by the board.
    • Training in the cardiovascular system, signs and symptoms of complications in the administration of fluids and antibiotics, and guidelines for management of complications.
    • Testing requires the LPN to perform a successful demonstration of IV procedures.

An LPN may perform IV therapy on an adult at the direction of one of the following:

  • A physician, physician assistant, dentist, optometrist, or podiatrist.
  • A registered nurse.

A registered nurse must be available and perform an assessment of the adult patient who needs IV therapy prior to it being initiated.

  • A registered nurse or licensed physician, physician assistant, dentist, optometrist, or podiatrist must be present or accessible by telephone for the LPN performing IV therapy.
  • An LPN cannot perform any of the following intravenous therapy procedures:
    • Initiate or maintain blood or blood components.
    • Initiate or maintain solutions for total parenteral nutrition.
    • Administer any cancer therapeutic medication.
    • Administer any solutions through a central venous line or arterial line.
    • Administer any investigational or experimental medication.
    • Initiate IV therapy in a vein other than the hand, forearm, or antecubital fossa.
    • Discontinue a central venous or arterial line.
    • Initiate or discontinue a peripherally inserted central catheter.
    • Mix, prepare, or reconstitute any medication for intravenous therapy, except an antibiotic.
  • An LPN cannot administer medication intravenously, or add medication to an intravenous solution, except for:
    • Initiate an IV infusion containing dextrose 5%, normal saline (NS), lactated ringers, NS .45%, NS 0.2%, sterile water.
    • Hang containers that contain vitamins or electrolytes after an RN initiates the infusion.
    • Initiate or maintain an IV infusion containing an antibiotic.
    • Inject heparin or NS to flush an intermittent infusion device or heparin lock.
  • The LPN may not change the tubing of an arterial line or a central venous line but may change tubing on a peripheral IV line when authorized.
  • The LPN may not program or set any function of a patient-controlled infusion pump.
  • An LPN may perform the following activities for dialysis:
    • Administer and regulate a saline solution to maintain an established fluid plan.
    • Administer a heparin dose intravenously.
    • Administer a heparin dose peripherally via a fistula needle.
    • Load and activate a constant infusion pump.
    • The intermittent injection of medication that is administered via the hemodialysis blood circuit and through the patient’s venous access.
  • Employing or directing an LPN to perform an IV therapy procedure without first verifying authorization by the board is prohibited.

Section 4723.18 – Ohio Revised Code | Ohio Laws

4723.18: Intravenous Therapy Procedures

An LPN may perform the following IV therapy procedures without board authorization:

  • The LPN acts at the direction of a registered nurse or a physician, physician assistant, dentist, optometrist, or podiatrist who is authorized to practice in Ohio and the registered nurse, physician, physician assistant, dentist, optometrist, or podiatrist is accessible by telephone or present where the procedure is to be performed.
  • The LPN can demonstrate the knowledge, skills, and ability to perform the procedure safely.
  • The IV therapy procedures that an LPN may perform are limited to:
    • Verification of the type of peripheral IV solution being administered.
    • Examination of the extremity and site of the peripheral infusion for infiltration.
    • Regulation of a peripheral IV infusion according to the prescribed flow rate.
    • Discontinuation of a peripheral IV device.
    • The performance of dressing changes at the insertion site of a peripheral venous or arterial infusion, peripherally inserted central catheter infusion, or central venous pressure subclavian infusion.

Section 4723.181 – Ohio Revised Code | Ohio Law

The following provides information on the LPN’s scope of practice in relation to IV therapy. Ohio law stipulates that before the board approves an LPN to administer IV therapy, the LPN must complete a 40-hour IV therapy course that includes supervised clinical practice 

4723-17-01: Definitions

The following definitions apply in this chapter:

AdultAnyone who is eighteen years of age or older.
AntibioticA medication that is administered to treat or prevent infectious disease.
DirectionCommunication of a plan of care that establishes the parameters for providing care or performing a procedure.
InitiateTo start or to begin.
MaintainTo administer or regulate an IV infusion according to the prescribed flow rate.
PiggybackAn intermittent or secondary intravenous infusion.
OBN ApproverApprover of continuing education

Rule 4723-17-01 – Ohio Administrative Code | Ohio Laws

4723-17-03:  Intravenous Therapy Procedures

An LPN may NOT perform any of the following IV therapy procedures:

  • Initiate or maintain:
    • Blood or blood components.
    • Solutions for total parenteral nutrition.
    • Cancer therapeutic medications.
    • Investigational or experimental medications.
    • Solutions administered through any central venous line or arterial line or any other line that does not terminate in a peripheral vein.
    • An intravenous piggyback infusion.
  • Discontinue any line that does not terminate in a peripheral vein, including central lines and arterial lines.
  • Initiate or discontinue a peripherally inserted central catheter, or any catheter that is longer than three inches.
  • Program or set a patient-controlled analgesic.
  • Mix any medication for intravenous therapy.
  • Administer medications by an intravenous route.
  • Inject medications by a direct intravenous route.
  • Change tubing on any line that does not terminate in a peripheral vein.
  • Change an intermittent infusion device.

An LPN authorized by the board to perform IV therapy procedures may perform the following procedures only on people aged 18 or older and only when directed to do so by a licensed provider:

  • Administer the following solutions, or combinations of the solutions, through a venous line:
  • Five per cent dextrose and water (D5W)
  • Five per cent dextrose and lactated ringers (D5LR)
  • Five per cent dextrose and normal saline (D5NS)
  • Normal saline (0.9%NS)
  • Lactated ringers (LR)
  • 0.45 per cent sodium chloride and water (0.45%NS)
  • 0.2 per cent sodium chloride and water (0.2%NS)
  • 0.3 per cent sodium chloride and water (0.3%NS)
  • Administer any of the solutions above that contain vitamins or electrolytes after a RN initiates the infusion.
  • Initiate or maintain an intermittent or secondary intravenous infusion containing an antibiotic.
  • Prepare or reconstitute an antibiotic additive to be administered through an intravenous infusion.
  • Inject heparin or normal saline to flush an intermittent infusion device or heparin lock.
  • Change tubing on an IV line if the line terminates in a peripheral vein.
  • Place a venous access catheter, no longer than three inches in length, in the hand, forearm or antecubital space, followed by the placement of a saline or heparin lock.
  • Stop a blood infusion or turn off a patient-controlled analgesic device when a complication arises.

In addition, the LPN may perform the above procedures ONLY if one of the following three requirements are met:

  • The LPN is directed to perform IV therapy by a licensed physician, physician assistant, dentist, optometrist, or podiatrist who is present and readily available at the facility where the intravenous therapy procedure is performed.
  • The LPN is directed to perform IV therapy by an RN who has personally performed an on-site assessment of the individual to receive intravenous therapy, and that RN or another RN is readily available at the site where the intravenous therapy procedure is performed.
  • If the intravenous therapy procedures are performed in a home as defined in section 3721.01 of the Revised Code, or in an intermediate care facility for individuals with intellectual disabilities as defined in section 5124.01 of the Revised Code, an RN who directs the authorized LPN to perform intravenous therapy is either:
    • On the premises of the home or facility; or
    • Accessible by some form of telecommunication

An LPN may perform any of the intravenous therapy procedures identified below without receiving authorization to perform intravenous therapy from the board of nursing under section 4723.18 of the Revised Code, if both of the following apply:

  • The licensed practical nurse acts at the direction of a registered nurse or a licensed physician, physician assistant, dentist, optometrist, or podiatrist and the registered nurse, physician, dentist, optometrist, or podiatrist is on the premises where the procedure is to be performed or accessible by some form of telecommunication.
  • The licensed practical nurse can demonstrate the knowledge, skills, and ability necessary to perform the procedure safely.

An LPN may perform the following:

  • Verify the type of IV solution being administered
  • Examine the peripheral infusion site and the extremity for infiltration
  • Regulate a peripheral IV infusion rate as prescribed
  • Discontinue a peripheral IV device at the appropriate time
  • Perform routine dressing changes at IV insertion sites

Rule 4723-17-03 – Ohio Administrative Code | Ohio Laws

The following information applies to continuing education requirements for nursing licensure in the state of Ohio.

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.
  • Any nurse who applies for licensure by endorsement to Ohio must complete two contact hours of Category A continuing education.
  • To reactivate an inactive license or to reinstate a lapsed license, the applicant must complete 24 contact hours of continuing education within 24 months of the application date.
  • If the license has been inactive for less than two years, if the applicant has a license in another jurisdiction, the 24 contact hours must include one hour of category A.
  • If the license has been inactive for more than two years, the 24 contact hours must include the following:
    • 2 contact hours of category A
    • 6 contact hours on the nursing process and critical thinking, clinical reasoning, or nursing judgment related to patient care
    • 6 contact hours in pharmacology
    • 2 contact hours on ethical principles in health care
    • 8 contact hours relevant to the nurse’s practice
  • A LPN or RN that has an inactive license is not required to meet the continuing education requirement. To return to active status, the nurse must meet the continuing education requirements.
  • An LPN or RN may use a waiver by notifying the board in writing to satisfy the continuing education requirement one time. Once submitted, the waiver cannot be withdrawn.
  • Extra contact hours earned during the renewal period cannot be applied to the consecutive renewal period.

Rule 4723-14-03 – Ohio Administrative Code | Ohio Laws

Multistate License

Effective January 1, 2023, Ohio will become part of the Nurse Licensure Compact (NLC). The terms multistate license (MSL) and compact license are interchangeable when referencing NLC. A MSL will allow a nurse to practice in their home state and any other compact state, if the nurse’s license is not under discipline or restriction.

Registered nurses and licensed practical nurses have the option to renew their Ohio nursing license or convert to a new multistate license. The application can be found on the Ohio Board of Nursing website. The renewal period for licensure will remain the same.

To apply for a MSL, a nurse must meet the following requirements:

  • Meet Ohio licensure requirements.
  • Graduate from a Board approved RN or LPN prelicensure program.
  • Pass the NCLEX.
  • Hold an active, unencumbered license.
  • Submit state and federal fingerprint based criminal background check. All nurse applicants for a MSL will need current BCI & FBI criminal record checks before a new MSL license or MSL conversion can take place.
  • No convictions or disciplinary action regarding felonies or misdemeanors related to nursing practice.
  • Not currently participating in an alternative program.
  • Self-disclosure of participation in an alternative program.
  • Have a valid US Social Security number.
  • Pass an English proficiency examination if a graduate of international education program not taught in English, or if English is not the nurse’s native language.

https://nursing.ohio.gov/licensing-and-certification/multistate-licensure/multistate-licensure-sa

Conclusion

The Board of Nursing is a government agency created by Ohio law to regulate the practice of nursing in Ohio for the safety of the public. The Ohio legislature enacts the Nurse Practice Act set forth in Chapter 4723 of the Ohio Revised Code, which fulfills the Ohio Board of Nursing’s mission in safeguarding the health of the public through regulation of nursing care. It is the responsibility of all nurses who practice by endorsement or initial licensure in the state of Ohio to be familiar with and to abide by these laws and rules.

References
  1. Chapter 4723-4 – Ohio administrative code | Ohio laws. (n.d.). Ohio Laws. https://codes.ohio.gov/ohio-administrative-code/chapter-4723-4
  2. Chapter 4723 – Ohio revised code | Ohio laws. (n.d.). Ohio Laws. https://codes.ohio.gov/ohio-revised-code/chapter-4723
  3. Laws & rules. (n.d.). Ohio Board of Nursing. https://nursing.ohio.gov/laws-rules/
  4. Multistate licensure. (n.d.). Ohio Board of Nursing. https://nursing.ohio.gov/licensing-and-certification/multistate-licensure/multistate-licensure-sa
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