K:\fla nursing law manual\x-2-1 appendix-i 1-6.rtf

APPENDIX I -- PART 1
DECLARATORY STATEMENTS OF THE BOARD OF NURSING
NUMBERS 1 TO 6
[NOTE: DELETED MATERIAL IS NOTED BY AN ELLIPSES (* * *)]
DEPARTMENT OF PROFESSIONAL REGULATION
BOARD OF NURSING
___________________________________________/ Notice was published in the Florida Administrative Weekly on April 10,1981, that the Board of Nursing had received a petition for declaratory statement from Estelle B. Williamson, R.N. requesting an interpretation of Chapter464, Florida Statutes. In accordance with Section 120.565, Florida Statutes, the Board has reviewed this petition andbeing fully advised in the premises, makes the following Findings of Fact and Conclusions of Law with regard to thePetitioner: FINDINGS OF FACT
The Petitioner seeks a declaratory statement from the Board concerning the legality of the "UTR” program in a hospital setting, maintaining that it places non-professional"staff in supervisory positions over other non-professionals in the rendering of services to patients. According to the petition, R.N's who are a part of the UTR teamhave no line authority over non-professionals resulting in their performing nursing services without being licensed asa nurse and without acting under a nurse's direct supervision. The Petitioner fears that nurses participating in the UTRare placing their licenses in jeopardy.
The UTR (Unit Treatment and Rehabilitation) concept has been in use for several years in Florida's Mental Health facilities. This concept contrasts with the traditional "medical model' of mental health treatment, andmay be variously referred to as the "unitization," "decentralization" and "multi disciplinary" approach to mental healthcare. The essence of this approach is the "teamwork" concept of mental health care delivery. Under this approach,all staff members directly involved in mental health treatment participate in the development of a patient's treatmentplan. That is, UTR specialists, rehabilitation therapists, social workers, and psychologists, as well as physicians,psychiatrists, and nurses participate in the development of the decision concerning the patient's treatment.
It is central to the UTR concept that non-medical and paraprofessional staff persons will participate in this decision-making process; at the same time, however, the Guide to Minimum Staffing Pattern Standards for StateMental Health Facilities in Florida, published by the Department of Health and Rehabilitative Services for use in theState mental health facilities, states: The purpose of the team is not to have social workers prescribemedication, psychologists take blood pressures and give Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ medications, or physicians administer Rorschachs. There aremany well defined functions which are clearly within thepurview of a particular profession (or job classification). Agreat majority of the necessary functions in quality patient care,however, are in a sense a disciplinary and could be performedby any team member.
In this sense, members of each discipline in the context of theteam, serve first as team members with the ability to performa common set of tasks. Secondly, each member serves as aconsultant to the team, contributing those skills which areunique to his or her profession when they are believed by theteam, to be needed. The team concept does not blur roles(Raskin, 1975), but rather it limits those occasions when teammembers function in manners totally unique to their respectivedisciplines. In most instances the number of these occasionswill be fewer than was formerly believed.
Supervision of a team physician by the team leader extends toadministration only. In medical matters, the physician issubordinate only to the clinical director. The intent of thePractice Act applying to the various disciplines such as dentists,nurses, physicians, and pharmacists will be strictly followed.
In summary, the team concept is meant to optimize theutilization of the skills of all mental health workers. (e.s.) It appears, then, that the UTR concept purports to recognize that mental health treatment is inter-disciplinary and that many aspects of a patient's' treatment are not "medical" and therefore do not necessarily require performanceof functions falling within a particular discipline as defined by one of the professional practice acts. At the same time,HRS stresses that in no event is a professional under the direction (as to professional or medical decisions) of a teamleader who is a non-professional and that all medical professionals will be solely responsible for carrying out thosefunctions unique to their respective professions.
CONCLUSIONS OF LAW
The statutory provisions applicable to this petition are as follows: (3)(a) "Practice of professional nursing" means the performanceof those acts requiring substantial specialized knowledge,judgment, and nursing skill based upon applied principles ofpsychological, biological, physical, and social sciences whichshall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning,intervention, and evaluation of care; health teaching andcounseling of the ill, injured, or infirm; and the maintenance ofhealth and prevention of illness of others.
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FLORIDA NURSING LAW MANUAL_____________________________ 2. The administration of medications and treatments asprescribed or authorized by a duly licensed practitionerauthorized by the laws of this state to prescribe suchmedications and treatments.
3. The supervision and teaching of other personnel in the theoryand performance of any of the above acts.
(b) "Practice of practical nursing" means the performance ofselected acts, including the administration of treatments andmedications, in the care of the ill, injured, or infirm and themaintenance of health and prevention of illness of others underthe direction of a registered nurse, a licensed physician, alicensed osteopathic physician, a licensed podiatrist, or alicensed dentist. Section 464.003(3)(a), Florida Statutes.
Section 464.016 Violations and penalties.
(l) Each of the following acts constitutes a felony of the thirddegree, punishable as provided in Section 775.082; 775.083; or775.084: (a) Practicing advanced or specialized,professional nursing, as defined in thischapter, unless holding an active license orcertificate to do so.
(c) Knowingly employing unlicensed personsin the practice of nursing.
(2) (c) Knowingly concealing information relating to violationsof this chapter. Sections 464.016(1)(a); 464.0l6(1)(c);464.0l6(2)(c), Florida Statutes.
No provision of this chapter shall be construed to prohibit: (5) The rendering of services by nursing assistants acting underthe direct supervision of a registered professional nurse. Section464.022(5), Florida Statutes.
The Board must limit its declaratory statement to an interpretation of the Nurse Practice Act and how it might prohibit a nurse from functioning in a certain capacity in the UTR system; however, the Board is notempowered to pass on the legality or wisdom of that system.
The Board recognizes that while certain functions relating to the treatment of mental illness may be encompassed within the practice of nursing as defined by Section 464.003(3)(a), Florida Statutes, many of thetreatment procedures fall within the practice of other medical professionals, psychologists, or outside a singleprofessional discipline. At the same time, it is recognized that certain functions may not be lawfully performed by Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ non-professionals, except under defined circumstances. The Board would emphasize that those procedures which arein fact nursing functions as defined by statute may only be carried out by those licensed under Chapter 464, FloridaStatutes, or in certain conditions by those under the supervision of a registered nurse. The Board considers thepractice of nursing by unlicensed persons to be unauthorized and further considers that any institution or facilityknowingly hiring unlicensed persons and allows them to practice nursing functions would be in violation of §464(1)(c), Florida Statutes. Of particular concern to Petitioner is administration of medications. If non-licensedpersonnel engage in administration of medications to patients, they may only lawfully so under direct supervision ofa registered professional nurse. Section 464.022(5); AGO's 075-218 and 076-149. As set forth by HRS, and UTRconcept does not contemplate that non-nurses perform nursing functions, but that if they do provide nursing services,they do provide nursing services, they do so only under direct supervision of an R.N. as required by law. Section464.016(1)(a) and (c), Florida Statutes.
4. Under the circumstances presented, it is concluded that the UTR concept, as defined, does not have the effect of causing nurses working within it to be in violation of Chapter 464, Florida Statutes. However, if in theimplementation of the program, as with any program, violations of the act are present, the Board considers itmandatory that they be reported to the Department so that, if warranted, proper action can be taken.
DONE AND ORDERED this 20th day of August, 1981.
__________________________________________MERN HENRYChairman STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION
BOARD OF NURSING
SEXUAL ABUSE TREATMENT CENTER,INC. AND PAM SEWELL, R.N.
__________________________________________________/ FINAL ORDER
This matter came before the Board of Nursing pursuant to Chapter 120.565, Florida Statutes, and Chapter 28-4, Florida Administrative Code, on February 6, 1987, in Miami, Florida, for the purpose of considering thePetition for Declaratory Statement filed by Sexual Abuse Treatment Center, Inc. and Pam Sewell, R.N. (hereinafter"Petitioners"). Petitioners were not present. Having considered the Petition and supporting documentation providedby Petitioners and being otherwise fully advised in the premises, the Board makes the following findings andconclusions: FINDINGS OF FACT
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FLORIDA NURSING LAW MANUAL_____________________________ 1. The Sexual Abuse Treatment Center, Inc. (SATC) is a non-profit organization located in Tampa, Florida, that conducts evidence-collecting examinations of female victims of sexual abuse.
2. Petitioner Pam Sewell, R.N., is a nurse examiner with SATC, and is licensed as a registered nurse in the 3. Petitioners are in doubt as to the authority of registered nurses to perform examinations in a non-hospital setting under the standing orders of a licensed physician, but without the physical presence of the physician. Althoughcurrently housed in Tampa General Hospital, SATC proposes to move its operations to a non-hospital setting toprovide a more emotionally supportive environment for rape victims and to substantially reduce costs of the program.
4. In their Petition for Declaratory Statement filed with the Board, Petitioners requested the Board to answer Whether registered nurses will be in compliance with Sections 464.003 and 464.018, Florida Statutes, by performing evidence-collecting examinations of female victims of sexual abuse, at a location where a medical doctoris not on site but available at all times by telephone, and where standing orders have been issued.
5. The Petition was noticed by the Board in the January 23, 1987, issue of the Florida Administrative 6. The Sexual Abuse Treatment Center is a non-profit organization that conducts the above-described examinations, which are forensic in nature and are intended to aid Hillsborough County law enforcement. For thelast five and one-half years, Hil1sborough County has contracted with SATC to provide nurse examiners to performthese examinations and to testify in court if necessary. Petitioner Pam Sewell is one of these nurse examiners.
7. Presently, the examinations are conducted in the emergency room of Tampa General Hospital under the standing orders of the medical director. The medical director and officials of SATC desire to move the examinationsfrom the Tampa General Hospital Emergency Room to a non-hospital setting to provide a more emotionally supportiveenvironment for rape victims and to substantially reduce costs of the program. The proposed move to a non-hospitalsetting will result in the following changes to the duties outlined in Attachment A, "Sexual Battery Examination"(Which is attached hereto and incorporated by reference): Any victim who is in need of immediate medical attention will be taken directly to thehospital and the nurse examiner will meet them there.
If a victim comes to the center and needs to be seen by a physician, she will be taken to thehospital.
A physician will be available by telephone at all times to provide consultations for the nurseexaminers.
Only medications offered by mouth as outlined in Attachment A will be administered atSATC.
The medical director will continue to provide standing orders to the nurse examiners.
No intra-muscular or subcutaneous medications will be given.
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FLORIDA NURSING LAW MANUAL_____________________________ Any unusual findings will be referred to the emergency room or a private doctor.
Petitioners assert that no treatment will be offered at the center, however, as reflected inAttachment A and other supporting documents, medication is to be dispensed, includingpregnancy prophylaxis.
8. Eight nurse examiners perform the duties outlined in Attachment A, as modified by the foregoing. Two of the nurses are advanced registered nurse practitioners, and the remainder are registered nurses. 9. Documentation offered by Petitioners indicates that a pelvic examination is performed, including a speculum examination of the vagina for purposes of collection of evidence and inspection of the vagina and cervix fortrauma on the victim.
10. Training of nurse examiners involves working under the direct supervision of the physician for the first twenty examinations. After the nurse examiner has been "certified" by a physician as proficient in the examination,she may do the examination without the direct supervision of the physician. Similar training by a physician is providedfor a limited anoscopic examination.
CONCLUSIONS OF LAW
1. The Board has jurisdiction over this matter pursuant to Section 120.565, Florida Statutes, and Chapter 2. The Petition filed by Petitioners is in substantial compliance with the provisions of chapter 120.565, Florida Statutes, and Rule 28-4.001, Florida Administrative Code, and Petitioners have the requisite interests tomaintain this proceeding.
3. Section 464.003(3), Florida Statutes, provides, in pertinent part: "Practice of professional nursing" means the performance ofthose acts requiring substantial specialized knowledge,judgment, and nursing skill based upon applied principles ofpsychological, biological, physical, and social sciences whichshall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning,intervention, and evaluation of care; health teaching andcounseling of the ill, injured, or infirm; and the promotion ofwellness, maintenance of health, and prevention of illness ofothers.
2. The administration of medications and treatments asprescribed or authorized by a duly licensed practitionerauthorized by the laws of this state to prescribe suchmedications and treatments.
3. The supervision and teaching of other personnel in thetheory and performance of any of the above acts.
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FLORIDA NURSING LAW MANUAL_____________________________ The professional nurse and the practical nurse shall beresponsible and accountable for making decisions that are basedupon the individual's educational preparation and experience innursing.
4. Issues of the scope of practice most often fall within the terms of Section 464.0l8(1)(f), Florida Statutes, (1) The following acts shall be grounds for disciplinary actions set forth in this section: (f) Unprofessional conduct, which shall include, but not be limited to, any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice, in which case actualinjury need not be established.
5. The examinations performed and medication dispensed as proposed by Petitioners, in the absence of a licensed physician, go beyond the "observation, assessment, nursing diagnosis,.and evaluation of care" normallyconsidered to be the practice of professional nursing. The proposed practice setting appears to contemplate a formof advanced practice, but without the benefit of the advanced education, training, and formal protocol arrangementanticipated by the statutory scheme for certification of advanced registered nurse practitioners. See Section 464.012,Florida Statutes. The training provided by a physician is not sufficient to authorize the proposed advanced practice byregistered nurses who are not advanced registered nurse practitioners.
6. Regardless of training provided to the R.N. nurse examiners, and the "standing orders" provided, the arrangement proposed by Petitioners does not lawfully fall within the scope of practice for a professional nurse. TheBoard does not reach the questions of whether the proposed arrangement could be cured by the on-site presence of alicensed physician.
WHEREFORE, it is ORDERED and ADJUDGED that the practice proposed by Petitioners of performing evidence-collecting examinations on victims of sexual battery, at a location where a medical doctor is not on-site, andwhere such examinations are performed by registered nurses, is beyond the scope of practice of a registered professionalnurse, and is not in compliance with Section 464.003(3)(a) and 464.018(1)(f), Florida Statutes.
Petitioners are hereby notified that they may appeal this Order by filing one copy of a notice of appeal with the clerk of the agency and by filing a filing fee and one copy of a notice of appeal with the District Court of Appealwithin thirty days of the date this Order is filed.
DONE and ORDERED this 6 day of July, 1987.
_______________________________JESSIE TRICE, Chairman _______________________________JUDIE RITTER ------------------------------------------------------------------------------------------------------------------------------------------- Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ SEXUAL BATTERY EXAM
SEXUAL ABUSE TREATMENT CENTER
NURSE EXAMINER PROGRAM
SEXUAL BATTERY EXAMINATION
Call must originate from the Sexual Abuse Treatment Center.
Note time of call. Your response is to be no longer than 45 minutes.
Call the Sexual Abuse Treatment Center, (228-7273/238-8411).
Your pay is calculated from records at the Center.
Volunteer counselors are dispatched from the Center at the same time the NurseExaminer is dispatched.
Get patient's chart and triage sheet.
Notify physician of ME Case (until Certified).
Notify law enforcement officer. Ask to speak to him/ her in PRIVATE, out of patient's or family'shearing.
Information to be obtained from officer, if possible.
Specific evidence required in addition to routine specimens Nurses examiner/law enforcement contact sheet should be have been filled byhim/her Give patient booklet "Understanding the System".
Have patient's parents or guardian sign consent.
Tell patient approximately how long it will"be before you are ready to examine her.
Collect all blank forms and equipment required for exam.
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FLORIDA NURSING LAW MANUAL_____________________________ Fill out all forms and evidence containers. Be careful not to place one set of carbon forms on topof another when writing. LEAVE NO ITEM BLANK. Write clearly.
Initiate Sexual Battery Examination sheet.
Have the patient give consent for the examination by signing on the line marked "Person examined"at the bottom of the form, if not done at interview.
Have patient change into hospital gown.
Allow to void If ABSOLUTELY NECESSARY. Pat dry, do not wipe.
Collect and save specimen for testing as indicated.
(1) Get brief history of incident and medical history.
Transcribe vital signs from the chart" to sexual battery examination sheet if the patient isstable and there is no history of loss of consciousness.
Recheck vital signs if there is history of loss of consciousness or condition is not stable.
Repeat prn. Chart on Flow Sheet (back of Triage sheet).
Inspect body for evidence of trauma.
Note all trauma on the APPROPRIATE diagrams. Use the neuter form for children.
Note all complaints of pain on appropriate diagrams.
Collect known head hair, if she plans to treat hair or change character of her hair.
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FLORIDA NURSING LAW MANUAL_____________________________ Collect specimens from around teeth, at gum line, in buckle folds, under tongue,and pharynx.
(1) Collect at time of interview and then allow patient to rinse mouth outwith water and collect saliva specimen at the end of exam.
Collect pharyngeal culture for gonorrhea.
Collect known pubic hair, if she plans to treat hair or change character of her hair.
Inspect external genitalia for trauma.
Inspect for vaginal or cervical trauma.
Collect specimens from vaginal pool with swabs.
Collect culture from cervical os for gonorrhea.
Inspect anus for trauilia if anal penetration has occurred.
Collect culture from anus for gonorrhea.
Inspect anus and lower rectum with anoscope.
Collect saliva specimen if not collected at beginning of the exam.
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FLORIDA NURSING LAW MANUAL_____________________________ Refer any vaginal trauma resulting from sexual battery to one of the volunteergynecologists.
(1) Patients with normal menstrual cycle.
Determine expected date of contraception (subtract 14 days from whennext menstrual period is due).
Subtract 5 days from EDC; add 5 days to EDC, and treat if exposure isduring that 10 day period.
Morning after pills are not available at Tampa General EmergencyRoom. If the patient desires prophylaxis, and it is indicated, ask ERphysician to give the patient a prescription for the medication.
Refer to Sexual Abuse Treatment Center.
Record as positive, inconclusive, or negative.
Use only "these terms to record results on record or when discussing the resultswith law enforcement officer.
Dispose of test tubes in container for needles and syringes.
Complete Sexual Battery Examination form and diagrams.
Diagrams must be included if there has been ,any trauma or complaints of pain.
Dirty linen hamper is in the lavatory.
Needles, syringes, and acid phosphatase test tubes are to be disposed of in the appropriatecontainer, not the trash cans.
Release evidence to the law enforcement officer.
Sign and date the envelope at the time it is given to the officer.
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FLORIDA NURSING LAW MANUAL_____________________________ If the law enforcement officer has left, call the law enforcement agency to notify them thatthe evidence is ready to pick up. Make it clear that you wil1 wait 30 minutes for theofficer. If he does not return in 30 minutes, call back and leave your address for pick-upat your home.
EVIDENCE MUST BE PLACED INTO THE LAW ENFORCEMENT OFFICER'S
HANDS. The case could be lost if this isn't done.
Original copy of Sexual Battery Examination form, all diagrams, and the green sheets from thepatient's chart are placed into a white TGH envelope.
Label "M.E. Case", patient's name and date.
The yellow copy of the Sexual Battery Examinations form, all diagrams and xeroxed copy of thepatient's chart are placed in a white TGH envelope and put into the distribution envelope for theSexual Abuse Treatment Center in the M.E. locker.
The pink copy of the Sexual Battery Examination form and diagrams go into the Sexual BatteryEvidence kit.
If no evidence is collected, these copies are placed in a long white envelope and given tothe law enforcement officer.
------------------------------------------------------------------------------------------------------------------------------------------- SEXUAL ABUSE TREATMENT CENTER
NURSE EXAMINER PROGRAM
STANDING ORDERS FOR SEXUAL BATTERY VICTIMS
A speculum examination of the vagina will be done for the purpose of collection of evidence andinspection of the vagina and cervix for trauma on the sexually battered victim. It may be performedby a nurse examiner who has been trained to do this examination. She will work under the directsupervision of a physician for the first twenty (20l examinations. After she has been certified by aphysician as proficient in this examination, she may do the examination without the directsupervision of a physician. However, if there is any trauma or any unusual findings in theexamination the nurse examiner will consult the attending Emergency Room Department physician.
When anal penetration has occurred, a limited anoscopic examination should be done to determineinjuries, collect specimens, and gonorrhea cultures. A digital examination is indicated to determinethe tone of the anal sphincter and to test for bleeding with a hemacult slide. The nurse of ARNPwill be taught by a physician to do this examination and will be supervised while doing the Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ examination until she is proficient. Then she will do this examination without the direct supervisionof a physician. However if there is trauma or any unusual findings, the nurse examiner will consultthe attending Emergency Room Department physician.
Gonorrhea cultures will be taken from each orifice that has been penetrated by a penis.
A serology for syphilis should be taken on all sexually battered patients.
A urinalysis for blood should be performed on any patient with a history of blows to the abdomenor the flank area.
A urinary Beta HCG should be performed on any patient whose menstrual period is late or if the lastmenstrual period was abnormal by date, flow, or other symptomatic criteria.
A quantitative serum Beta HCG level should be performed for any patient whose urine Beta HCGtest is negative but whose history suggest pregnancy.
If the patient is NOT allergic to Penicillin: If the patient IS allergic to penicillin: Tetracycline (TCN), 500 mg g.i.d. for 7 days or Doxycycline 100 mg b.id. for 7 days.
1.
The patient must purchase Tetracycline or Doxycycline. The Emergency RoomDepartment physician will provide a prescription for the medication.
Tetracycline is contraindicated in pregnancy. Consult with the attendingEmergency Room Department physician.
Criteria for post coital contraception.
Medication is offered during the period of five days before and after the expecteddate of ovulation.
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FLORIDA NURSING LAW MANUAL_____________________________ Since ovulation occurs two weeks before the onset of menses, the periods must beregular to determine the date of ovulation. For example: If the last normalmenstrual period was on 5 October and she has a regular cycle of once a monthor every 30 days her next period would be about 4 November.
4 November minus 14 days is 21 October.
5 days before 21 October is 16 October,5 days after 21 October is 26 October,thus the patient would be offered post coital contraception during the tendays from 16 to 26 October.
Post coital contraception should be offered to any patient with irregular periodsten days after her last normal menstrual period if a urine Beta HCG assay isnegative.
Contraindications for post coital contraception.
History of cancer of the breasts or reproductive organs.
History of abnormal vaginal bleeding.
History of cerebral vascular accident.
If there are no contraindications and the criteria for post coital contraception have been met, giveOvral #4, 2 stat and repeat in 12 hours.
A supply of Ovral has been donated to the Sexual Abuse Treatment Center for our patients.
It will be kept in the M.E. Locker at the hospital. Wen it is dispensed, give the patient thefirst two tablets and put the remaining two into the envelopes provided. Fill in all theinformation required.
Time that the next two tablets are to be taken.
Prior to dispensing the medication the nurse examiner will review the INFORMEDCONSENT with the patient to be sure that she understands all the possible side effects fothe medications. The INFORMED CONSENT must be signed prior to dispensing themedication.
All patients taking post coital contraception must be examined six weeks after taking themedication to ensure that no pregnancy occurred and that there has been a normalmenstrual period. A referral to one of the on call physicians will ensure this.
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FLORIDA NURSING LAW MANUAL_____________________________ Give the patient an information sheet.
Minor clean wounds, less than 8 hours old showing no clinical signs of infection should beprophylaxed by giving Tetanus Toxoid 0.5 cc I.M. if: The patient has NOT had a booster within the last ten years.
The patient HAS HAD a booster of the initial series within the past twenty years.
If these criteria have not been met, consult with the attending Emergency RoomDepartment Physician.
These orders expire one year after signed and must be reviewed annually.
______________________________J. PAUL MICHLINMedical DirectorNurse Examiner Program ------------------------------------------------------------------------------------------------------------------------------------------ SEXUAL ABUSE TREATMENT CENTER
NURSE EXAMINER PROGRAM
PATIENT INSTRUCTIONS FOR THE MORNING-AFTER PILL
Take two Ovral pills immediately (within 24 to 72 hours after intercourse). Then take two moreOvral pills 12 hours after your first dose of pills.
You may have nausea from the pills. The nausea is usually mild and should stop within a day orso after treatment. If you vomit within an hour after taking your two pills, call your clinician. Youmay need to take additional pills to make up for the ones lost in vomiting, and your clinician mayprescribe anti-nausea medication.
Your next menstrual period should begin sometime within the next two or three weeks. If yourperiod has not started in three weeks, see your clinician for an exam and pregnancy test.
Chest pain (severe), or shortness of breath Eye problems such as blurred vision or loss of vision Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ Complications are not likely with the short morning-after hormone treatment; but if you have anyof the danger signs, you should either see your clinician right away or go to a hospital emergencyroom.
Get started immediately afterwards with an acceptable ongoing method of birth control. Morning-after treatment is meant only for one-time protection.
Ovral is approved by the U.S. Food and Drug Administration as an oral contraceptive but is notapproved for this morning-after approach to pregnancy prevention.
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FLORIDA NURSING LAW MANUAL_____________________________ ------------------------------------------------------------------------------------------------------------------------------------------- DEPARTMENT OF PROFESSIONAL REGULATION
BOARD OF NURSING
NOTICE OF PETITION FOR DECLARATORY STATEMENT
NOTICE IS HEREBY GIVEN, pursuant to Section 120.565, Florida Statutes, that the Board of Nursing, within the Department of Professional Regulation, has received and may consider a petition for declaratory statementfrom the Sexual Abuse Treatment Center, Inc., Tampa, Florida, on substantially the following question: May sexualbattery examinations lawfully be performed by registered nurses and/or advanced nurse practitioners in a non-hospitalsetting without a medical doctor on site? The petition has been assigned case number BON-DS87-3. A copy of the petition may be obtained by writing to: Ms. Judie Ritter, Executive Director, Board of Nursing, 111 Coastline Drive East, Suite 504, Jacksonville, Florida32202.
STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION
BOARD OF NURSING
FINAL ORDER NO. BON-DS-87-1FILED DATE: 7/06/87 KALYNN PRESSLY, R.N., M.S.N.
__________________________________/ FINAL ORDER
This mattter came before the Board of Nursing pursuant to Chapter 120.565, Florida Statutes, and Chapter 28-4, Florida Administrative Code, on February 6, 1987, in Miami, Florida, for the purpose of considering thePetition for Declaratory Statement filed by Kalynn Pressly (hereinafter “Petitioner”). Petitioner was not present.
Having considered the Petition and supporting documentation provided by Petitioner, and being otherwise fully advisedin the premises, the Board makes the following findings and conclusions: FINDINGS OF FACT
Petitioner is a registered nurse in the State of Florida, employed at Bay Medical Center, Panama Petitioner is in doubt as to the scope of practice of a registered nurse with regard to the cannulation of the external jugular vein. Petitioner contends that critical care nurses who are certified as Advanced Cardiac LifeSupport (ACLS) providers and who complete additional training consisting of a c1ass on the techniques and risks ofthe procedure, should be allowed to perform cannulation of the external jugular vein.
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FLORIDA NURSING LAW MANUAL_____________________________ In her Petition for Declaratory Statement filed with the Board, Petitioner requested the Board to answer substantially the following question: Whether Section 464.003(3), Florida Statutes, which defines the practice of professional nursing, can be construed to authorize the performance by critical care registered nurses of cannulation, of the external jugular vein.
The Petition was noticed by the Board in the January 23, 1987, issue of the Florida Administrative Bay Medical Center is a 284 bed acute care hospital which currently possesses 19 intensive care unit beds. The critical care nursing staff is 90% R.N. and 10% L.P.N. There are no interns or residents on the staff.
Twenty-four hour physician coverage is provided to the Emergency Room.
The procedure at issue would be necessary in a situation where a critically ill patient has a limited number of veins suitable for intravenous therapy. With an accompanying state of vascular collapse, insertion of anI.V. catheter into a vein in the extremities is very difficult. Petitioner proposes to allow R.N.'s trained in theprocedure to cannulate the external jugular when intravenous access is imperative and the veins in the extremities arenot usuable.
In a condition of vascular collapse, the external jugular vein is also subject to collapse. The external jugular vein is therefore not necessarily a viable alternative. Consequently, the proposed procedure is not done inregular practice. Generally, when the procedure is performed, it is performed by a physician.
Risks of the procedure include sepsis, air embolism, thrombphlebitis, and potential airway Petitioner proposes that qualifications for the procedure be training as an ACLS provider and additional unspecified training. Because of the variance in advanced cardiac life support classes, such training is notby itself sufficient to qualify for an advanced procedure. The variation in ACLS programs extends to the ACLSproviders as well. Consequently, even if the procedure were authorized, the training proposed by Petitioner is notadequate.
Petitioner submitted for consideration the guidelines of the Alabama Board of Nursing, which authorize the procedure for specified registered nurses. The policies of the Alabama Board are not binding in Florida.
CONCLUSIONS OF LAW
The Board has jurisdiction over this matter pursuant to Section 120.565, Florida Statutes, and Chapter 28-4, Florida Administrative Code.
The Petition filed by Petitioner is in substantial compliance with the provisions of Section 120.565, Florida Statutes, and Rule 28-4.001, Florida Administrative Code, and Petitioner has the requisite interest to maintainthis proceeding.
Section 464.003(3), Florida Statutes, provides, in pertinent part: "Practice of professional nursing” means the performance ofthose acts requiring substantial specialized knowledge,judgment, and nursing skill based upon applied principles of Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ psychological, biologica1, physical, and social sciences whichshall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning,intervention, and evaluation of care; health teaching andcounseling of the ill, injured, or infirm; and the promotion ofwellness, maintenance of health, and prevention of illness ofothers.
2. The administration of medication and treatments asprescribed or authorized by a duly licensed practitionerauthorized by the laws of this state to prescribe suchmedications and treatments.
3. The supervision and teaching of other personnel in the theoryand performance of any of the above acts.
The professional nurse and the practical nurses shall be responsible andaccountable for making decisions that are based upon the individual's educationalpreparation and experience in nursing.
Any nurse is bound by her responsibility to practice within the scope of her abilities as well as the minimal standardsof acceptable and prevailing nursing practice. See Section 464.018(1)(f), Florida Statutes.
It is the opinion of the Board that the procedure proposed by Petitioner to be performed by a registered nurse with the level of training outlined by Petitioner, is not within the scope of practice of a registeredprofessional nurse in the absence of a physician. This conclusion is based upon the infrequency of the procedure'suse in regular practice, the viability of the procedure in the situation described by Petitioner, and the level of trainingproposed by Petitioner.
The Board takes note of the policies of the Alabama Board of Nursing, but is not persuaded that the Alabama Board's acceptance of the procedure is sufficient grounds to authorize the procedure in Florida. The Boardmust be guided by its own statutes and its knowledge of prevailing nursing practice in Florida.
WHEREFORE, it is ORDERED and ADJUDGED that, as proposed by Petitioner, the cannulation of the external jugular vein is beyond the scope of practice of a registered professional nurse and minimal standards ofacceptable and prevailing nursing practice.
Petitioner is hereby notified that she may appeal this Order by filing one copy of a notice of appeal with the clerk of the agency and by filing a filing fee and one copy of a notice of appeal with the District Court of Appealwithin thirty days of the date this Order is filed.
DONE and ORDERED this 6 day of July, 1987.
______________________________JESSIE TRICE, ChairmanFlorida Board of Nursing Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ CERTIFICATE OF SERVICE
________________________________JUDIE RITTERExecutive Director STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION
FINAL ORDER
This matter came before the Board of Nursing pursuant to Chapter 120.565, Florida Statutes and Chapter 28- 4, Florida Administrative Code on April 15, 1988 in Miami, Florida for the purpose of considering the Petition forDeclaratory Statement filed by Claudia B. Patterson (hereinafter petitioner).1 Petitioner was not present. Havingconsidered the Petition and supporting documentation provided by Petitioner, and being otherwise fully advised in thepremises, the Board makes the following finding and conclusions: Petitioner is a registered nurse in the State of Florida, employed at Humana Hospital-Orange Park, Petitioner is in doubt as to the scope of practice of a registered nurse with regard to pronouncement of death of a hospital patient in certain circumstances. Petitioner asserts that having either the attending physician orthe emergency room physician pronounce the patient's death can result in a delay in the pronouncement which mayin turn result in a period of anxiety for the patient's family.
In her Petition for Declaratory Statement filed with the Board, Petitioner requests the Board to answer substantially the following question: Whether Section 464.003(3), Florida Statutes, which defines the practice of professional nursing, can be construed to authorize a registered nurse in a hospital to pronounce a patient's death for those patients whose deathhad been anticipated, had occurred naturally, and/or for whom there were "do not resuscitate" orders on the record? The Petition was noticed by the Board in the May 25, 1988 issue of the Florida Administrative 1 Although Petitioner referred in her Petition to Section 464.003, it is the opinion of the Board that the appropriate subsection is 464.003(3).
Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ Petitioner, as the Associate Executive Director of Nursing at Humana Hospital-Orange Park, in Orange Park, Florida asserts, when a patient within that hospital expires and the patient's attending physician is notin the hospital at the time of death, the emergency room physician usually pronounces the patient's death. The factthat an emergency room physician may not be immediately available to pronounce the patient's death, may result ina delay in the pronouncement which may in turn result in a period of anxiety for the patient's family.
The circumstances in which Petitioner suggests that a registered nurse be permitted to pronounce a patient's death in the hospital would be limited to those in which: The patient's death had been anticipated: The patient's death had occurred naturally; or The patient's chart or other identification contains orders to not resuscitate.
CONCLUSIONS OF LAW
The Board has jurisdiction over this matter pursuant to section 120.565, Florida Statutes and Chapter The Petition filed by Petitioner is in substantial compliance with the provisions of Section 120 .565, Florida Statutes, and Rule 28-4.001, Florida Administrative Code, and Petitioner has the requisite interest to maintainthis proceeding.
Section 464.003(3)a, Florida Statutes in pertinent part provide: (3)(a) "Practice of professional nursing" means the performanceof those acts requiring substantial specialized knowledge,judgment, and nursing skill based upon applied principles ofpsychological, biological, physical, and social sciences whichshall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning,intervention, and evaluation of care: health teaching andcounseling of the ill, injured, or infirm; and the promotion ofwellness, maintenance of health, and prevention of illness ofothers. 2. The administration of education and treatments as prescribedor authorized by a duly licensed practitioner authorized by thelaws of this state to prescribe such medications and treatments.
Section 382.008(2), (3), Florida Statutes, in pertinent parts provide: (2) The funeral director who first assumes custody of a deadbody or fetus shall file the death or fetal death certificate. Inthe absence of such a person, tile physician or other person inattendance at or after the death shall file the certificate of deathor fetal death. The person who registers the certificate shallobtain the personal data from the next of kin or the best Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ qualified person or source available. The medical certificationof cause of death shall be furnished to the funeral director,either in person or via certified mail, by the physician ormedical examiner responsible for furnishing such information.
(3) Within 72 hours after receipt of a death or fetal deathcertificate from a funeral director, the medical certification shallbe completed, signed, and made available to the funeral directorby the physician in charge of the decedent's care for the illnessor condition which resulted in death, or the physician inattendance at the time of death or fetal death or immedia telybefore or after such death or fetal death, who shall certify overhis signature the cause of death to his best knowledge andbelief; except the provisions of Section 382.011 apply when thedeath or fetal death requires investigation pursuant to Section406.11 or the death or fetal death occurred without medicalattendance.
Section 382.009 (2), Florida Statutes regarding recognition of brain death provides as follows: (2) Determination of death pursuant to this section shall bemade in accordance with currently accepted reasonable medicalstandards by two physicians licensed under Chapter 458 orChapter 459. One physician shall be the treating physician, andthe other physician shall be a board-eligible or board-certifiedneurologist, neurosurgeon, internist, pediatrician, surgeon, oranesthesiologist.
It is the opinion of the Board that pronouncement of death of hospital patients whose death was anticipated, occurred naturally, or for whom there were orders to not resuscitate is within the scope of practice ofregistered nurses under Section 464.003, Florida Statutes. This conclusion was based upon the Board's under standingof the terms, "observation, assessment, nursing diagnosis" as used within section 464.003(3)(a)(1), and also theabsence of any express statutory provision regarding pronouncement of death, with the exception of Section382.009(2), regarding determination of brain death.
Although the Board is of the opinion that it is permissible for registered nurses to pronounce death for hospital patients in the circumstances enumerated above, the Board is also of the opinion that each hospital or otherinstitution rendering medical care must articulate its own policy regarding whether registered nurses within that facilitymay pronounce death, and if so, under what circumstances.
WHEREFORE, it is ordered that pronouncement of death of hospital patients whose death was anticipated, occurred naturally, or for whom there were orders to not resuscitate, is within the scope of practice of a registeredprofessional nurse. Each hospital is then responsible for articulating its policy regarding pronouncement of death byregistered nurses.
Petitioner is hereby notified that she may appeal this order by filing one copy of the Notice of Appeal with the Clerk of the agency, and by filing a filing fee and one copy of the Notice of Appeal with the District Court ofAppeal within 30 days of the date this order is filed.
DONE and ORDERED this 5th day of July, 1988.
Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ ____________________________________JEANNE STARK, ChairmanFLORIDA BOARD OF NURSING CERTIFICATE OF SERVICE
STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION
BOARD OF NURSING
FINAL ORDER
This matter came before the Board of Nursing pursuant to Chapter l20.565, Florida Statutes and Chapter 28-4, Florida Administrative Code on April 15, 1988 in Miami, Florida for the purpose of considering the Petitionfor Declaratory Statement filed by Darlene Adams (hereinafter Petitioner).2 Petitioner was present. Havingconsidered the petition and supporting documentation provided by Petitioner, and being otherwise fully advised in thepremises, the Board makes the following finding and conclusions.
FINDINGS OF FACT
All Petitioners are registered nurses in the State of Florida employed at Jackson Memorial Hospital Petitioners are in doubt as to the scope of practice of a registered nurse with regard to monitoring the infusion of Marcaine3 to patients in a hospital setting. Petitioners contend that the monitoring of Marcaine shouldfall within the scope of the administration of medications and treatments authorized or prescribed by a practitioner asdefined within Section 464.003 (3)(a). Petitioners assert that they would be responsible for the observing andmonitoring only of the interscalene infusion of Marcaine; the anesthesia department within Jackson Memorial Hospital 2 Owing to questions regarding the standing of Darlene Adams in her capacity as director of Risk Management, the following registered nurses also employed by Jackson Memorial joined in the petition: DariaBernstein, RN; Lise Garlarneau, RN; Rupert French, RN; and Jacqueline Zych, RN.
3 Marcaine or Marcaine Hydrochloride is a product of Winthrop-Breon Laboratories and is identified Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ would remain responsible for the preparation and insertion of the Marcaine. Petitioners assert that registered nurseswould monitor Marcaine infusions where protocols, guidelines, formal education and training permitted.
In their Petition for Declaratory Statement, Petitioners request the Board to answer substantially the Whether the monitoring of Marcaine infusions falls within the scope of, "administration of medication and treatments as prescribed or authorized by a duly licensed practitioner," pursuant to Section 464.003(3)a, FloridaStatutes.
The Petition was noticed by Board in the September 4, 1987 issue of the Florida Administrative Jackson Memorial Hospital is a hospital which contains both a nursing department and a department of anesthesia. Included within Jackson Memorial are orthopedic and general surgery floors where patients are in needof continuous interscalene Marcaine infusion.
The procedure in question would be the continued observation and monitoring of patients receiving Marcaine infusion. Registered nurse would be responsible for this observation and monitoring of the infusion; theanesthesiology department within the hospital would be responsible for the preparation and insertion of the infusion.
CONCLUSIONS OF LAW
The Board has jurisdiction over this matter pursuant to Section 120.565, Florida Statutes and Chapter The Petition filed by Petitioners is in substantial compliance with the provisions of Section 120.565, Florida Statutes, and Rule 28-4.001, Florida Administrative Code, and Petitioners have the requisite interest tomaintain this proceeding. (See footnote 1) Section 464.003(3)a, Florida Statutes in pertinent part provides: (3)(a) “Practice of professional nursing” means theperformance of those acts requiring substantial specializedknowledge, judgment, and nursing skill based upon appliedprinciples of psychological, biological, physical, and socialsciences which shall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning,intervention, and evaluation of care; health teaching andcounseling of the ill, injured, or infirm; and the promotion ofwellness, maintenance of health, and prevention of illness ofothers.
2. The administration of medications and treatments asprescribed or authorized by a duly licensed practitionerauthorized by the laws of this state to prescribe suchmedications and treatments.
Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ Any nurse is bound by her responsibility to practice within the scope of her abilities as well as the minimum standards of acceptable and prevailing nursing practice. See Section 464.018(1)(f), Florida Statutes.
It is the opinion of the Board that the procedure proposed by Petitioners, the monitoring of Marcaine infusions by registered nurses within a hospital setting, is within the scope ofpractice of a registered professional nurseunder Section 464.003, Florida Statutes. This conclusion is based upon the Board's interpretation of Section 464.003,more specifically Section 464.003(3)(a)2, and upon the Board's understanding that registered nurses would beresponsible for monitoring of Marcaine as a medication or treatment only, and would not be responsible for thepreparation, mixing, placing, or insertion, of Marcaine as an anesthesia. It is also the opinion of the Board thathospitals wishing to utilize registered nurses to observe and monitor patients receiving Marcaine must articulate andrely upon protocols, and guidelines which take into account the education and training of any registered nurse priorto permitting the registered nurses to monitor Marcaine infusion.
WHEREFORE, it is ORDERED that is proposed by Petitioner, the observation and monitoring of hospital patients receiving Marcaine infusions for purposes other than anesthesia is within the scope of practice of a registeredprofessional nurse. Each hospita1 is responsible for appropriate protocols, guidelines, and training prior to utilizingregistered nurses for this procedure.
Petitioners are hereby notified that they may appeal this order by filing one copy of the Notice of Appeal with the Clerk of the agency, and by filing a filing fee and one copy of the Notice of Appeal to the District Court of Appealwithin 30 days of this order is filed.
DONE and ORDERED this 21 day of July, 1988.
____________________________________JEANNE STARK,Chairman CERTIFICATE OF SERVICE
STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION
BOARD OF NURSING
FINAL ORDER
This matter came before the Board of Nursing pursuant to Chapter 120.565, Florida Statutes and Chapter 28-4, Florida Administrative Code on October 21, 1988 in Tallahassee, Florida for the purpose of considering thePetition for Declaratory Statement filed by Iris Helmuth (hereinafter Petitioner). Petitioner was not present. Having Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ considered the Petition and supporting documentation provided by Petitioner, and being otherwise fully advised in thepremises, the Board makes the following findings and conclusions: Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ FINDINGS OF FACT
Petitioner is a registered nurse in the State of Florida, employed by Sarasota Memorial Hospital, Petitioner is in doubt as to whether a registered nurse may increase the rate of an infusing epidural anesthesia solution under the general direction of a anesthesiologist within the hospital setting.
In her Petition for Declaratory Statement filed with the Board, Petitioner requests the Board to answer substantially the following question: Whether Section 464.003(3), Florida Statutes, which defines the practice of professional nursing, can be construed to authorized a registered nurse in a hospital to increase the rate of an infusing epidural anesthesia solutionunder the general direction of an anesthesiologist? The Petition was noticed by the Board in the October 21, 1988 issue of the Florida Administrative Petitioner, as head nurse of Obstetrical Services at Sarasota Memorial Hospital, in Sarasota, Florida asserts that the registered nurses at that hospital are providing patient care in the labor and delivery area includingmonitoring patients who are on continuous epidural anesthesia drips during labor and asserts further that nurses arebeing asked by the anesthesiologists to increase the anesthesia drip rate in response to patient's complaint thatanesthesia is not being maintained by the amount of medication being provided through the epidural drip at that time.
Petitioner notes that an anesthesiologist would not be in the immediate proximity at the time the drip rate would beincreased, but would be in the general area.
Petitioner points out that currently she and her staff have declined to assume the responsibility of increasing the drip rate on continuous epidural anesthesia patients in labor and delivery pending the interpretation fromthis Board.
Petitioner's particular question goes to Section 464.003 (3) (a) 2, Florida Statutes which includes within the practice of professional nursing: “The administration of medications and treatments as prescribedor authorized by a duly licensed practitioner authorized by thelaws of this state to prescribe such medications and treatments" CONCLUSIONS OF LAW
The Board has jurisdiction over this matter pursuant to Section 120.565, Florida Statutes and Chapter The Petition filed by Petitioner is in substantial compliance with the provisions of Section 120.565, Florida Statutes, and Rule 28-4.001, Florida Administrative Code, and Petitioner has the requisite interest to maintainthis proceeding.
Section 464.003 (3) (a), Florida Statutes in pertinent part provides: (3) (a) "Practice of professional nursing” means theperformance of those acts requiring substantial specialized Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.
FLORIDA NURSING LAW MANUAL_____________________________ knowledge, judgment, and nursing skill based upon appliedprinciples of psychological, biological, physical, and socialsciences which shall include, but not be limited to:1. The observation, assessment, nursing diagnosis, planning,intervention, and evaluation of care; health teaching andcounseling of the ill, injured, or infirm; and the promotion ofwellness, maintenance of health, and prevention of illness ofothers.
2. The administration of medications and treatments asprescribed or authorized by a duly licensed practitionerauthorized by the laws of this state to prescribe suchmedications and treatments.
Initially, the Board has considered whether a. epidural anesthesia is a medication or treatment within the context of Section 464.003 (3) (a) 2. The Board understands that the anesthesia in question is a regional anestheticagent and as such is not within the meaning of the terms "medications and treatments." It is the opinion of the Boardthat epidural anesthesia is a regional anesthetic agent and as such is not contemplated by the terms "medications andtreatments", contained within Section 464.003 (3) (a) 2, Florida Statutes.
The Board is of the opinion that it is beyond the scope of a registered nurse to alter the rate of a regional-anesthetic agent being received by a patient in the labor and delivery section of the hospital.
WHEREFORE it is therefore ORDERED that because continuous epidural anesthesia drips during labor and delivery is a regional anesthesia agent and as such is not within the Board's understanding of the meaning terms"medications and treatments," contained within Section 464.003 (3) (a) 2, Florida Statutes, it is beyond the scope ofa registered nurse to alter the rate of a regional anesthesia agent being received by patients in the labor and deliverysection of Sarasota Memorial Hospital.
Petitioner is hereby notified she may appeal this order by filing one copy of the Notice of Appeal to the Clerk of the agency, and by filing a filing fee and one copy of the Notice of Appeal with the District Court of Appeal withinthirty (30) days of the date this order is filed.
DONE and ORDERED this 6 day of January, 1989.
____________________________________JEANNE STARK, R.N., CHAIRMANFLORIDA BOARD OF NURSING CERTIFICATE OF SERVICE
Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved.

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