OUTCOME: The learner will demonstrate sufficient knowledge related to the Ohio CE requirements for nursing re-licensure.

1.3 Category A contact hour will be awarded with successful completion.

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91).

Expires 6/11/2021

DIRECTIONS
1. Please read the study.
2. Complete the post test. To be awarded contact hours, you must achieve a score of 70% or higher.

If you have any questions, please feel free to contact Sandy Swearingen (sswearingen@ohnurses.org).

This independent study was developed by: Barbara Brunt, MA, MN, RN-BC, NE-BC, FABC
There is no conflict of interest among anyone with the ability to control content for this activity.

Ohio Law and Rules: Continuing Education Requirements for Relicensure
Written by Barbara Brunt, MA, MN, RN-BC, NE-BC, FABC

Since license renewal is coming soon for registered nurses, this program will describe the continuing education (CE) requirements for nurses as outlined in the Ohio Board of Nursing (OBN) law (ORC 4723.24) and rules (OAC 4723-14). The outcome for this activity is that licensed nurses can describe CE requirements for license renewal.

To ensure that everyone is on the same page, some of the definitions found in OAC 4723-01 are given below:

Accredited provider – an entity that has received accreditation through a nationally recognized system. An accredited provider is authorized to plan, present and award contact hours for continuing education activities.

Approved provider unit – an entity who continuing education system has been approved by an OBN approver, or who has been approved by a national accrediting body to provide continuing education in a health care field.

Blended learning – a combination of independent study materials and faculty directed.

Category A – the portion of CE that meets the one-hour requirement directly related to Chapter 4723 of the ORC and the rules of the board as described in OAC 4723-14-03. To qualify for category A, the CE must be approved by the board, an OBN approver, or offered by an OBN approved provider unit headquartered in the state of Ohio. Note: this means you cannot receive category A credit for any program that is developed by a CE provider outside of Ohio.

Contact hour – sixty minutes of continuing education. Note: contact hour is the approved terminology – this is not the same as continuing education units (CEUs). The CEU is an educational measurement utilizing criteria of the International Association for Continuing Education and Training. Nursing continuing education programs award contact hours, not CEUs.

Continuing education – a learning activity that builds upon a prelicensure or precertification education program and enables a licensee of certificate holder to acquire or improve knowledge or skills that promote professional or technical development to enhance the licensee’s or certificate holder’s contribution to quality health care and pursuit of health care career goals.The American Nurses Credentialing Center (ANCC) defines continuing education as “activities intended to build upon the educational and experiential bases of the professional RN for the enhancement of practice, education, administration, research, or theory development, to the end of improving the health of the public and RN’s pursuit of their professional career goals” (ANCC, 2015, p. 44).

Faculty-directed continuing education activity – an activity in which faculty facilitate the pace and content of the activity, and the activity is one for which contact hours may be awarded. This activity may occur is setting such as a classroom, on-line, or via teleconference provided that one or more individuals is facilitating the pace of the activity.

Independent study activity – a self-paced learning activity for which contact hours may be awarded that includes both a mechanism for evaluation of learning and feedback to the learner.

Outcome-based education – education focused on educational experience leading to learning, learner confidence and ultimately, improvements in practice and patient care.

Continuing Education for Renewal

The CE requirements for renewal for registered nurses (RNs) and licensed practical nurses (LPNs) are that nurses must complete at least 24 contact hours of CE that includes at least one contact hour of Category A CE for each renewal. Requirements for Advanced Practice Registered Nurses (APRNs) are outlined later in this article. Note: for the period immediately following Ohio licensure by NCLEX examination the nurse is not required to complete any contact hours of CE for the first license renewal. After that first renewal, they are required to complete the 24-hour requirement. Nurses who have been licensed by endorsement in Ohio for less than one year must complete 12 contact hours of CE and nurses who have been licensed by endorsement in Ohio for more than one year must complete 24 contact hours of CE.

RNs and LPNs renew their license in different years. The time period for renewal for RNs is from November 1, 2017 to October 31, 2019. The time period for renewal for LPNs is from November 1, 2018 to October 31, 2020. An application for renewal is due on the fifteenth day of September of the renewal year. A late application may be submitted before the license lapses, which is on the first day of November of the renewal year.

If the license of a RN or LPN has been inactive or lapsed in Ohio for two years or more and the applicant does not hold a current, valid license in another jurisdiction, the CE requirement is more restrictive and must include the following:

1. Two contact hours of category A with learning outcomes that address scopes of practice for RNs and LPNs, standards of safe practice, and nursing delegation;

2. Six contact hours with learning outcomes that address application of the nursing process and critical thinking, clinical reasoning, or nursing judgment related to patient care;

3. Six contact hours in pharmacology with learning outcomes that include drug classifications, medication errors, and patient safety;

4. Two contact hours that include learning outcomes related to clinical or organizational ethical principles in health care; and

5. Eight contact hours that include learning outcomes related to an area relevant to the nurse’s practice.

The board performs random audits of compliance with the CE requirements. The time period for the audit will be stated in the “CE Audit” letter. If audited, the nurse will be asked to send photocopies of CE certificates or school transcripts to the board within 60 days of the mailing of the audit notice. The board requires nurses to keep proof of completion of CE for six years. Everyone should have a system to ensure they have the documentation needed for an audit. This can be as simple as putting all CE certificates together in a file folder. A nurse who fails to respond to an audit or fails to provide proof of meeting the CE requirement will not be provided a renewal application, and is not eligible for renewal, reactivation, or reinstatement of the license until all CE requirements are satisfied. These individuals must complete up to 48 hours of CE in the 48-month period immediately before the application date in order to renew, reinstate, or reactivate their license.

Documentation of Continuing Education

In order to renew, applicants must attest to completion of the CE required to meet the CE requirements to practice as a nurse. The board may require a renewal applicant to show proof of completion of CE. If the board requests proof of CE and the applicant fails to provide proof to the board before the end of the renewal period, the license shall lapse. The applicant may request a waiver to satisfy the CE requirements for one renewal period only if the nurse notifies the board in writing requesting the waiver. Once a nurse notifies the board of the intent to use the waiver, the board will not accept a withdrawal of the request. Note: The waiver cannot be used after receiving an audit notice.

Rule 4723-14-06(A), OAC specifies the proof needed. An acceptable CE document must contain your name, title of the program, date of program completion, number of contact hours, the OBN approver name and number, or name of the provider and the name of the authorized approver or the name of the approval body. For academic credit, a school transcript or grade report must include your name, the name of the school, and the dates attended, and credit hours awarded. The transcript may be unofficial.

Volunteer Nursing Certificate (Section 4723.24 ORC & 4723-14-03(K) OAC )

The board may issue, without examination, a volunteer’s certificate to a qualified person who is retired from practice so that the person may provide nursing services to indigent and uninsured persons at any location, including a free clinic. A person is considered retired from practice if the person’s licensed has expired with the intention of ceasing to practice nursing as a RN, LPN, or APRN for renumeration. The nurse is prohibited from accepting any form of renumeration for providing nursing services while holding a certificate. The certificate is valid for a period of two years and may be renewed.

There are specific CE requirements to renew a volunteer certificate, which are listed below:

1. Two contact hours of category A with learning outcomes that address standards of safe practice and nursing delegation;

2. One contact hour that includes content in patient abuse, patient rights, and professional boundaries;

3. Two contact hours that include content in the scope of practice of the LPN and RN;

4. Two contact hours in nursing documentation;

5. Three contact hours in principles of pain management;

6. One contact hour that addresses the application of the nursing process and critical thinking related to patient care;

7. One contact hour that include content in maintaining patient confidentiality;

8. Four contact hours in patient assessment and wound care;

9. Four contact hours in medication administration and preventing medication errors; and

10. Four contact hours relevant to the nurse’s practice setting.

Activities that can be used to meet CE Requirements

Any of the following options may be used by a nurse to satisfy the CE requirements.

1. A CE activity that has been approved by an OBN approver or provided by an approved provider unit. An OBN approver is an approver of CE headquartered in the state of Ohio that is authorized by the board to approve CE activities offered by a provider or to approve a provider unit. Category A CE must be approved by an OBN approver or offered by an OBN approved provider unit headquartered in the state of Ohio. There currently are 8 approved OBN providers, and the Ohio Nurses Association (ONA) is one of these providers. They can be identified by the following after their approval statement (OBN – applicant number-year approved) The statement for ONA is followed by (OBN-001-91), as they were the first approved OBN approver and received that designation in 1991. The law and rules outline the process to become an OBN approver and outline the reapproval process, as well as the process to approve providers of CE.

2. A CE activity approved or provided by a nationally recognized accreditation system of CE, such as the American Nurses Credentialing Center (ANCC), the Accreditation Council for Continuing Medical Education (ACCME), the International Association for Continuing Education and Training (IACET), or a national certifying organization that meets the requirements in Section 4723.46(a), ORC. Nurses can use continuing medical education (CME) to meet the CE requirements.

3. Academic credit for successful completion of a course taken through an accredited educational institution, such as a college or university. The conversion from academic credit to CE is as follows:

1 credit hour in a quarter system = 10 contact hours of CE
1 credit hour in a trimester system = 12 contact hours of CE
1 credit hour in a semester system = 15 contact hours of CE
A three-hour semester course would be the equivalent of 45 contact hours.

4. An independent study that includes both a mechanism for evaluation of learning and feedback to the learner. There is no limit to the number of contact hours obtained through independent studies. These can be taken through mail order courses or on the internet.

5. Interprofessional CE, designed for a target audience made up of members of two or more different professions. Note: Joint accreditation for interprofessional continuing education for physicians, pharmacists, nurses, physician assistants, optometrists, psychologists, and social workers is available as a provider of CE for the healthcare team. It focuses on continuing education planned by the team for the team.

6. A CE activity approved by a board or agency that regulates a health care professional or related discipline in Ohio, such as the State of Ohio Medical Board, State of Ohio Board of Pharmacy, State Board of Psychology, and the Counselor, Social Worker and Marriage and Family Therapist Board.

7. A recent addition to the law was that hours worked as a volunteer may apply toward CE for RN and APRN renewal. (Rule 4723-8-10(B)(4), OAC). A RN or APRN who serves as a volunteer for indigent and uninsured persons, without compensation, may use up to eight (8) hours of the volunteer service towards the CE requirement. One hour of CE may be awarded for each 60 minutes documented as spent providing uncompensated health care service as a volunteer. Documentation must include a signed statement from a person at the health care facility or location where the health care services were performed indicating the date and time the health care services were performed, that the recipient was indigent and uninsured and that the nurse provided services as a volunteer.

Activities that do NOT meet the OBN requirements for CE (Rule 4723-14-05(B) OAC)

The following activities/events do not meet the board requirements for CE. Note: there are some exceptions for APRNs. which will be outlined in the section on requirements for APRNs.

1. Repetition of any educational activity with identical content and course outcomes within a single reporting period;

2. Self-directed learning such as reading texts or journal articles that have not been approved as an independent study or awarded contact hours by an accredited or approved provider or provider unit;

3. Participation in clinical practice or research that is not part of a CE activity;

4. A personal development activity;

5. Professional meetings or conventions except for those portions designated as a CE activity

6. Community service

7. Volunteer service or practice that does not qualify under Rules 4723-14-03(L) or 4723-8-10(B)(4), OAC, as discussed above

8. Board-ordered CE

9. Membership in a professional organization

Additional APRN Renewal Requirements

APRNs must meet all the renewal requirements for RNs and have additional requirements specific to their role. In 2017, the board outlined licensure and CE requirements for APRNs. The term APRN includes clinical nurse specialists (CNSs), certified nurse-midwives (CNMs), certified nurse practitioners (CNPs), and certified registered nurse anesthetists (CRNAs).

Certification is now required for APRNs, with one exception (Rule 4723.41(B) (2) (b) ORC). The CNSs who, on or before December 31, 2000, obtained a master’s or doctoral degree with a major in a clinical area of nursing from an education institution accredited by a national or regional accrediting organization, the applicant is not required to have passed a certification exam. In addition, CNSs, CNMs, and CNPs may practice only in accordance with a standard care arrangement (SCA) entered into with each physician or podiatrist with whom the nurse collaborates (Rule 4723.431 ORC). The rules identify specific requirements for what is included in the SCA. A copy of the standard care arrangement shall be retained on file by the nurse’s employer.

Certified nurse midwives, certified nurse practitioners, and clinical nurse specialists can prescribe drugs and therapeutic devices through a certificate to prescribe (CTP) as outlined in Rule 4723.481, ORC. They are only allowed to prescribed drugs listed on the formulary and have limitations with schedule II controlled substances.

Similar to RNs, for the first period of renewal immediately following the initial issuance of the APRN license, the APRN is not required to complete any contact hours of CE, although they are required to maintain their national certification, with the exceptions of CNSs who were originally issued a COA on or before December 31, 2000 and are not nationally certified. Starting on November 1, 2019, to renew their license APRNs must complete 24 hours of CE for each APRN license held. For an APRN-CNP, APRN-CNS, or APRN-CNM, at least 12 of the 24 contact hours must include CE in advanced pharmacology (Rule 4723.24 (C), ORC). The 24 hours of CE required to renew each APRN license are in addition to the 24 hours of CE required to renew the RN license. Contact hours of CE completed for the APRN national certification may be used to meet the required hours.

APRNs have the same rules about what meets and does not meet the CE requirements as the RNs have. However, for APRNs, Rule 4723-14-05(C) allows APRN CE for activities that may be otherwise excluded including (1) self-directed learning such as reading or reviewing of texts or journal articles; (2) participation in clinical practice, research or mission trips; (3) professional meetings or conventions, or (4) precepting, teaching or conducting public education courses. Random audits are conducted for APRNs as they are for RNs and the same conditions apply.

Evaluating the quality of CE programs

There is no shortage of CE activities available for nurses to complete. This section will outline some tips for choosing CE programs to meet your needs and meet the OBN CE requirements for relicensure. First you need to determine your professional goals and needs. Ask yourself the question, what are the problems and issues I face that education could help resolve?

Review the promotional materials and/or brochure for the following information:

Course title/program description – does it adequately describe program content? Is the target audience identified? Is there a limit to the number of participants who can attend?

Learning outcomes – Are they stated? Do they indicate what the participant will be able to do as a result of the program? Is the number of learning outcomes reasonable for the length of the program? Is the outcome measurable and realistic for the time frame of the program? ANCC criteria focus on outcomes, rather than objectives. Although it is perfectly acceptable to use objectives, programs using ANCC criteria should list the outcome(s).

Faculty credentials – Look at the stated instructor qualifications. Is the instructor presenting within her/his area of expertise?

Disclosures -Has everyone involved in the planning disclosed relevant financial and non-financial relationships (or lack thereof) related to the course content? Disclosures help determine if the instructor may have a bias towards the products, services or practices associated with the activity. It is acceptable for an instructor to have a conflict of interest, as long as it is disclosed.

Instructional methods – Are they described? Do they include active involvement of the learner?

Credit – Does the advertising refer to contact hours? Is it offered by an OBN approved provider or a national accrediting body? Does the information indicate requirements for successful completion?

Registration fees – Are they reasonable when compared to similar programs?

Refund/cancellation policy – Is this clearly stated in the promotional materials?

Follow-up from program provider – Is there contact information if there are questions? Has the provider responded to your requests for information?

Even after reviewing promotional activities for relevance using the criteria listed above, you may find yourself attending a program that was not what you had anticipated. There may not be anything you can do about that. However, if it is a conference with multiple sessions going on at the same time, you may be able to attend a different session that you think will better meet your needs.

It is important to provide feedback to the provider of the activity at the end of the program. Take the time to share your candid, constructive feedback on the evaluation form(s) provided, if there is one. There are various ways that a provider can measure if the desired outcome was achieved, so there may not always be an evaluation form. The criteria for successful completion on the promotional materials should identify if completion of an evaluation is required to receive contact hours.

Future trends with continuing education

 The Future of Nursing Report, published by the Institute of Medicine (2011) had four key messages:

1. The need to transform practice: Nurses should practice to the full extent of their education and training (p. 29).

2. The need to transform education: Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression (p. 30).

3. The need to transform leadership: Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States (p. 32).

4. The need for better data on the health care workforce: Effective workforce planning and policy making require better data collection and an improved information infrastructure (p. 33).

Continuing nursing education is one way that nurses can practice to the full extent of their education and training.

Other trends that will be discussed in this article are a focus on outcomes, increased attention on interprofessional education activities, and unhealthy work environments.

ANCC and other organizations are focusing on outcomes as a method of evaluating CE activities. However, empirical evidence to support the unique contributions of nurses to quality outcomes is currently lacking. Nurses have a social and economic imperative to measure outcomes (Jones, 2016). Value-based purchasing (VBP) policies are predicated on the fact that what gets measured, gets managed, yet unique nursing contributions to patient outcomes is difficult to measure. Jones concluded that nurses have a social responsibility to evaluate the effect of nursing practice on patient outcomes in the areas of health promotion, injury and illness prevention, and alleviation of suffering.

No discipline works in a vacuum and more focus is being placed on education by the team for the team. There was a Joint Accreditation Leadership Summit in 2016 to allow an opportunity for jointly accredited providers to identify organizational models that were effective in promoting and improving interprofessional collaborative practice through interprofessional continuing education (IPCE). They shared success stories that demonstrated the impact of their educational efforts on optimal patient care. IPCE does not just mean bringing multiple professions together for an activity. It means educating the professions together as a team, so that learners understand their roles and goals related to patient care. Joint accreditation reduces redundancies and creates efficiencies, enabling educators to focus their attention on creating high-quality, strategic team interventions, rather than multiple, similar activities for multiple professions (Joint Accreditation, 2016).

Promotion of a healthy work environment is critical in today’s healthcare arena, where there is a constant focus on providing high quality care with diminishing resources. Events that creae an unhealthy work environment, such as incivility, bullying, and workplace violence are on the rise. This can lead to anger, decreased self-esteem, depression, stress and burnout, and have a negative effect on patient safety. Identifying factors that contribute to the occurrence is the first step in dealing with this issue. Continuing education programs can help nurses identify unhealthy situations and provide strategies on how to deal with those.

This article has outlined the CE requirements for relicensure for RNs, LPNs, and APRNs, as well as those seeking a volunteer certificate. It also provided tips on how to evaluate if a program would meet your needs and mentioned just a few trends relating to CE.

References

American Nurses Credentialing Center. (2015). 2015 ANCC primary accreditation provider application manual. Silver Spring,                 MD: Author.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National                               Academies Press.
Joint Accreditation. (2016). By the team for the team: Evolving interprofessional continuing education for optimal patient care.        Report from the 2016 Joint Accreditation Leadership Summit. Chicago, IL: Author
Jones, T., (May 31, 2016). Outcomes measures in nursing: Imperatives, ideals, history, and challenges, OJIN: The Online Journal          of Issues in Nursing Vol. 21, No. 2, Manuscript 1. DOI: 10.3912/OJIN.Vol21No02Man01
Ohio Board of Nursing Law (ORC 4723.24) and Rules (OAC 4723-14). Retrieved from                                                                                  http://www.nursing.ohio.gov/Law_and_Rule.htm
Warren, J. I. & Harper, M. G. (2017). The complex healthcare environment in P. C. Dickerson (Ed) Core curriculum for nursing              professional development, (5th Ed). (pp. 16-26), Chicago, IL: Association for Nursing Professional Development.

Disclosures

1 Contact Hour will be awarded with successful completion.
Criteria for Successful Completion: view entire webinar and submit an evaluation form.

Expiration: 7/31/2021

There is no conflict of interest among anyone with the ability to control content of this activity, except for Susan Salsbury who is on speaker’s bureau for Sage Products, LLC.

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91)

Slides

Learning Outcome: The learner will self-report an increase in knowledge related to pressure injury prevention, assessment and treatment.

1 contact hour will be awarded with successful completion.

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91).

Expires 5/31/2021

Criteria for Successful Completion:
1. Please view the webinar and complete the evaluation.

If you have any questions, please feel free to contact Sandy Swearingen (sswearingen@ohnurses.org).

This webinar was developed and presented by: Alyssa Mauser, BSN, RN. There is no conflict of interest among anyone with the ability to control content for this activity.

OUTCOME: The learner will demonstrate sufficient knowledge related to the legal and ethical principles of medication safety and nursing practice by achieving a score of 80% or higher on post-test.

1 Category A contact hour will be awarded with successful completion.

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91).

Expires 5/31/2021

DIRECTIONS:
1. Please read the study.
2. Complete the post test. To be awarded contact hours, you must achieve a score of 80% or higher.

If you have any questions, please feel free to contact Sandy Swearingen (sswearingen@ohnurses.org).

This independent study was developed by: Jessica Dzubak, MSN, RN. There is no conflict of interest among anyone with the ability to control content for this activity.

The profession of nursing has come a long way from white dresses and caps. Nurses are no longer viewed as servants to doctors, but as our own profession with a unique set of skills and expertise. With this increased respect comes an increased responsibility. While nurses are taught to carry out orders placed by physicians or other advanced practice personnel, there are critical steps that must be taken before any order is completed.
Unfortunately, the media has shown us that medical errors continue to happen all across the country. It isn’t just small, rural hospitals with limited resources. Mistakes can happen anywhere in any healthcare facility. The good news is, with diligence and good clinical judgement, many medical errors can be prevented or stopped before it is too late.

The American Nurses Association (ANA) describes “culture of safety” as “describes the core values and behaviors that come about when there is a collective and continuous commitment by organizational leadership, managers and health care workers to emphasize safety over competing goals” (American Nurses Association, 2016, para. 3). The “culture of safety” concept as described by the Patient Safety Network, a subset of the Agency for Healthcare Research and Quality, (2019) recommends these key essential qualities:

– acknowledgment of the high-risk nature of an organization’s activities and the determination to achieve consistently safe operations (Patient Safety Network, 2019)
– a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment
– encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems
– organizational commitment of resources to address safety concerns

While it is important to maintain a “blame-free” environment and an organizational culture of safety, nurses must understand their responsibilities and ethical commitment to safe practice. Nurses must also be aware of the potential legal repercussions that may ensue if an error should occur, such as lawsuits or licensure revocation.

A 2018 article on safety culture in American Nurse Today identified four takeaways
• Direct care nurses are error identifiers.
• Organizations are accountable for their systems.
• Nurse leaders are responsible for developing an environment where it’s safe to speak up.
• Collaboration is essential to patient safety (Paradiso, 2018).

We must not only be aware of our own actions and processes, but be confident in our abilities to speak up. Nurses can lead by example and empower their healthcare colleagues to create a culture of safety and uphold the Provisions detailed in the ANA Code of Ethics.

In the Media
In 2019, a nurse was charged with reckless homicide for a fatal medication error. Prosecutors allege she made at least 10 mistakes during medication administration, including overriding safety measures. This case gained a lot of media exposure and begged the question of whether or not criminal charges were appropriate for this nurse. While everyone may have a different personal opinion on the case, the takeaway is that safety measures are put in place for a reason and should always be followed. This case highlights the impact one medication error can have on both the patient’s and the nurse’s life.

What everyone should be asking after hearing about these situations is ‘how can we do better?’ What could be done differently next time? The goal is not to place blame, but to place emphasis on the importance of adhering to safety measures and speaking up for safety.

What does the law say?

OAC 4723:
(4) When the nursing care is to be provided according to division (B)(5) of section 4723.01 of the Revised Code, the nurse has a specific current order from an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice; and
(5) The nursing care does not involve a function or procedure that is prohibited by any other law or rule.
(E) A registered nurse shall, in a timely manner:
(1) Implement any order for a patient unless the registered nurse believes or should have reason to believe the order is [emphasis added]:
(a) Inaccurate;
(b) Not properly authorized;
(c) Not current or valid;
(d) Harmful, or potentially harmful to a patient; or
(e) Contraindicated by other documented information; and
(2) Clarify [emphasis added] any order for a patient when the registered nurse believes or should have reason to believe the order is:
(a) Inaccurate;
(b) Not properly authorized;
(c) Not current or valid;
(d) Harmful, or potentially harmful to a patient; or
(e) Contraindicated by other documented information.

Reflection Question #1: Can you think of a time when a situation like this happened in your own practice? Have you ever had to question an order? What did you do? How were your actions received?

Once you determine you need further clarification before carrying out the order, what do you do next?
4723-4-03 OAC states:
(F) When clarifying an order, the registered nurse shall, in a timely manner:
(1) Consult with an appropriate licensed practitioner;
(2) Notify the ordering practitioner [emphasis added] when the registered nurse makes the decision not to follow the order or administer the medication or treatment as prescribed;
(3) Document that the practitioner was notified of the decision not to follow the order or administer the medication or treatment, including the reason for not doing so; and
(4) Take any other action needed to assure the safety of the patient.

Notice how the law explicitly states that the registered nurse has full authority to make the decision not to carry out the order or administer the medication. With a valid reason, this is within the nurse’s scope of practice in the state of Ohio.

Some examples of medication orders that may need clarified:
1. The nurse receives an order for pain medication higher than the standard dose.
2. The physician orders a medication that the nurse knows is contraindicated for this patient.
3. The nurse receives an order for a medication they are unfamiliar with.

Just because the order seems confusing in the beginning does not mean there is a problem. Sometimes there may be a valid reason for the order, but it is the nurse’s responsibility to seek clarification and document the information received. The documentation shows that the nurse did his/her due diligence to practice the five rights of medication administration and can make a big impact should there ever be a review or legal case.

In all cases, the ordering practitioner should be notified that the medication was not given or the order not carried out. If the nurse feels that further action is necessary but does not feel comfortable with the original ordering practitioner, another licensed practitioner should be immediately consulted and all actions documented.

Special Situations:
Say the nurse clarifies an order for pain medication at a higher than usual dose. The nurse knows her patient is already lethargic and confused, and she is concerned about administering the medication. The physician states that is the dosage she wants to order, but the nurse feels very uncomfortable. What should the nurse do?
a. Administer the medication anyway. The physician said it was safe.
b. Give the medication, but at a lower dosage.
c. Do not administer the medication, notify physician and follow appropriate chain of command, and document accordingly.

The best course of action is C: Do not administer the medication and document accordingly. Per 4723, the nurse has a legal obligation to only carry out orders he/she believes is safe and in the best interest of the patient, not just because an order is present.

It is within the nurse’s professional rights to explain why he/she does not feel comfortable administering the medication and documenting as such. The nurse is “legally and ethically bound to question an inappropriate order from a physician” (Reuter & Fitzsimons, 2013).
Say the nurse does give the medication and an adverse event occurs as a result. Is the nurse responsible?

Reflection Question #2: Say the nurse does give the medication and an adverse event occurs as a result. Is the nurse responsible?

When a nurse administers a medication, he/she is acknowledging the responsibility that comes with it. By administering, the nurse is demonstrating that he/she understands the purpose of the medication and have deemed it safe and appropriate.

4723-4-03 states that:
(B) A registered nurse shall maintain current knowledge of the duties, responsibilities, and accountabilities for safe nursing practice.
(C) A registered nurse shall demonstrate competence and accountability in all areas of practice in which the nurse is engaged including:

Maintaining current knowledge and accountabilities for safe nursing practice includes medications and medication safety. If the nurse is unclear about a specific medication or its dosage, further clarification is needed. Simply saying you don’t know is unacceptable. An article on Best Practices for Medication Errors states “Continuing education of the nursing staff can help reduce medication errors. Medications that are new to the facility should receive high teaching priority. Staff should receive updates on both internal and external medication errors, as an error that has occurred at one facility is likely to occur at another” (Anderson, 2015, para. 21).
“The nurse, on the other hand, is not expected to share the doctor’s knowledge of drugs and their reactions, although she is expected to have sufficient grasp of these things to recognise unusual drugs and dosages and thus to query them if she is unsure. She must also have some grasp of side effects to alert her quickly to a patient’s adverse reactions. In addition, the nurse is expected to address herself swiftly to any deficiencies in the above by asking for information or looking it up” (de Raeve, 2002, para. 7).

In the case of the higher dosage pain medication, the nurse knew using his/her clinical judgment that the dosage may result in adverse effects but still went ahead and administered the drug. Therefore, he/she is still responsible.

“In clinical judgment, with the existing condition, after deep thinking and reflective thinking based on observation, the nurse can collect the data purposefully by interview and examination. Based on the interpretation of data, the nurse performs information processing. After analysis, with rethinking and reflection on the subject, the nurse reaches a final conclusion. In this process, the nurse uses skills such as experience, knowledge, evidence, critical thinking, reasoning, and intuition” (Seidi, Alhani, & Ardalan, 2017, para. 4). Technology cannot replace the critical thinking and judgment nurses possess. In a busy world with many automated processes, it can be easy to fall into auto-pilot, but we must be cognizant of our practices in order to avoid this. Nurses remain the most trusted profession year after year because of our reputation to do the right thing and keep our patient’s welfare as our first priority. We do this by following the nursing process and utilizing the skills we have in order to provide the best, and safest, care.

4723-4-07 discusses how the nursing process is applied to nursing law in Ohio.

It states:
(1) Assessment of health status:
The registered nurse shall, in an accurate and timely manner:
(a) Collect data. This includes:
(i) Collection of subjective and objective data from the patient, family, significant others, or other members of the heath care team. The registered nurse may direct or delegate the performance of data collection; and
(ii) Documentation of the collected data.
(2) Analysis and reporting:
The registered nurse shall, in an accurate and timely manner:
(a) Identify, organize, assimilate and interpret data;
(b) Establish, accept, or modify a nursing diagnosis that is to be addressed with applicable nursing interventions; and
(c) Report the patient’s health status and nursing diagnosis as necessary to other members of the health care team;
(3) Planning:

The registered nurse shall, in an accurate and timely manner:
(a) Develop, establish, maintain, or modify the nursing plan of care consistent with current nursing science, including the nursing diagnosis, desired patient outcomes or goals, and nursing interventions; and
(b) Communicate the nursing plan of care and all modifications of the plan to members of the health care team;

All of these responsibilities should be applied in each day of one’s nursing practice regardless of setting. Administering medications requires diligent, careful consideration of all of these steps prior to doing so.

Using 4723-4-07, think through the following case study:

The nurse is caring for a patient on the floor. A new antibiotic is ordered, and when the nurse pulls it from the electronic medication dispensary, a flag appears that there is a contraindication with another medication the patient is taking. The nurse recognizes this interaction and knows it can be very serious. However, the pharmacist verified the medication. The nurse asks the patient about it and the patient confirms he is taking the medication that may interact.

What should the nurse do?
A. The pharmacist verified it and the physician ordered it, so the interaction must not be that bad. OK to administer.
B. Give the medication, but warn the patient there may be an interaction.
C. Do not give the medication and discuss with the ordering physician and/or pharmacist.

The best answer is option C. This situation warrants further investigation prior to the nurse administering the drug. The nurse’s own clinical knowledge tells her that there is a known interaction between the two drugs. The system flags it as well. By hitting ‘acknowledge’ on the system, the nurse is signifying that she is aware of the potential risk of administering the drug.

The nurse took the next step and confirmed the patient is actually taking the medication in question. While there is an active and verified order for the medication, it is still the nurse’s duty to do the safest intervention for the patient. The nurse can have a discussion with the ordering practitioner about her concerns. Regardless of what information is learned, if the nurse does not feel comfortable administering this medication knowing about the interaction, she may decline and should document appropriately.

The nurse manager on the unit praised the nurse in the above example for this “near miss”. There could have been a potential medication error and patient safety could have been jeopardized. The nurse’s diligence protected the patient and this behavior should be emulated. Many organizations have “near miss” reporting systems and policies to encourage the reporting of incidents like this (National Safety Council, 2013). The benefits of reporting near misses include the prevention of future incidents and promoting a safety culture (National Safety Council, 2013).
An important aspect of clarifying and refusing orders is adequate documentation.

Tips for Documenting
• Use quotation marks to document verbatim conversations with patients, families or other staff. Never use quotations when paraphrasing.
• Objective information only
• Describe in detail why you made the decision not to administer the medication or carry out the order
• Note who you notified and when, as well as their response
• If there is concern about another clinician’s unsafe practice, follow the organization’s chain of command, file an incident report (per hospital policy) but do not document in the medical record that an incident report was filed.

Perhaps there is another medication that can be administered to counteract a negative effect or the timing of the medication could be changed. Sometimes, we know that some medication’s benefits outweigh the risks. This underlines the importance of having open, honest discussions between physician, nurse, pharmacist and patient to determine the best plan of care.

Reflection Question #3:
You are visiting your family member who is hospitalized for post-operative complications. Your family member has a history of several chronic conditions. The nurse comes in and begins preparing a medication for your loved one. You ask, “What is that medicine for? What does it do?”
The nurse responds, “I’m not sure.”
Think about that. Have you ever witnessed this happening in your practice? Has it happened to you, maybe when you were a new nurse first starting out on the unit?

It is understandable, and common, that a physician may order a medication for a patient that the nurse is unfamiliar with. Maybe he/she is floating on a different unit or the medication is new. Or perhaps it is just an uncommon drug or a rare condition. The nurse then has the legal and ethical responsibility to find out what medication he/she is giving and why. Without understanding the drug’s purpose and possible side effects, how can the nurse monitor effectively for adverse events? How can he/she provide patient education? How can he/she evaluate whether or not the drug had its intended effect?

The Nursing Process
The nursing process dictates that nurses must evaluate all of their interventions in order to provide the best care.

4723-4-07 OAC:
5) Evaluation:
The registered nurse shall, in an accurate and timely manner:
(a) Evaluate, document, and report the patient’s:
(i) Response to nursing interventions; and
(ii) Progress towards expected outcomes; and
(b) Reassess the patient’s health status, and establish or modify any aspect of the nursing plan as set forth in this rule.

Error Reporting
Medication safety remains a National Patient Safety Goal by The Joint Commission (Agency for Healthcare Research and Quality, 2019).

Many medication errors go unreported out of fear or embarrassment (Okuyama, Wagner, & Bijnen, 2014). Research suggests that organizations are encouraged “…to develop a non-blaming, non-punitive and non-fearful learning culture at unit and organizational level. Anonymous, effective, uncomplicated and efficient reporting systems and supportive management behavior that provides open feedback to nurses is needed. All play a role in increasing the rate of reporting medication errors and near-misses amongst nurses” (Vrbnjak, Denieffe, O’Gorman, & Pajnkihar, 2016, p. 162). The ANA Code of Ethics, Provision 3.4, describes the nurse’s ethical responsibility to “promote patient health and safety” and “reduce errors”. It goes on to say that in the event of an error or near miss, the nurse has an obligation to report this per institutional policy and “must ensure responsible disclosure of errors to patients” (American Nurses Association, 2015, p. 11).

Provision 3.5 (Protection of Patient Health and Safety by Acting on Questionable Practice) states “Nurses must be alert to and must take appropriate action in all instances of incompetent, unethical, illegal, or impaired practice or actions that place the rights or best interests of the patient in jeopardy” (American Nurses Association, 2015, p. 12). In other words, although reporting “questionable practice, even when done appropriately, may present substantial risk to the nurse; however such risk does not eliminate the obligation to address threats to patient safety” (American Nurses Association, 2015, p. 13).

Medication Administration Safety
A 2017 study found that improper administration techniques related to asepsis and deviating from patient identification protocols accounted for most of the “medication administration-related deviations from safe practice” (Blignaut, Coetzee, Klopper, & Ellis, 2017). Researchers also found that interruptions during medication administration and patient acuity had a significant impact on the number of wrong-dose and wrong-route medication errors (Blignaut, Coetzee, Klopper, & Ellis, 2017). There have been innovations in making medication administration safer, including adding signage that medication preparation and/or administration is in progress and the nurse should not be interrupted (Pape, et al., 2005).These measures help improve focus and decrease distractions during critical times. As with any other safety measure, it will only work if nurses and other staff are compliant with the process.

A study published in 2019 found that “Nurses are able to identify medication errors, but are reluctant to report them. Fear of the consequences was the main reason given for not reporting medication errors” (Dirik, Samur, Seren Intepeler, & Hewison, 2019). Studies have shown that “speaking up training” to improve communication and encourage healthcare professionals to speak up did increase the comfort level of providers in speaking up as well as the act of “speaking-up behaviors” among staff (Okuyama, Wagner, & Bijnen, 2014, para. 15). What are some other reasons you can think of why a nurse would be reluctant to report an error? Are there processes in your organization for anonymous reporting?

A 2016 article published in the New England Journal of Medicine suggests that there should be a sixth right to medication administration: the right indication (Schiff, Seoane-Vazquez, & Wright, 2016).The article goes on to say that if indications are listed, “staff and patients will be able to more easily recognize any mismatches and intercept prescribing or dispensing errors” (Schiff, Seoane-Vazquez, & Wright, p. 306, 2016). They add, “knowledge of indications is key to getting prescribers, pharmacists, nurses, and patients on the same page regarding what is being treated and what outcomes are desired” (Schiff, Seoane-Vazquez, & Wright, p. 308, 2016). Regardless of whether or not the indication is explicitly listed, the nurse has the obligation to make sure he/she is aware of and understands that indication. It may take a few extra minutes on the part of the nurse, but those few minutes may save a life or prevent a very serious incident from occurring.

Conclusion
The nurse at the bedside using sound clinical judgement is key to safe medication administration. For both ethical and legal reasons, nurses must do their due diligence to give medications safely and document the care they are giving appropriately.
All of the technology in healthcare is only as good as those who operate it. If nurses are not properly trained on using the technology, if the process is too lengthy or too complicated, or if nurses do not see the value or importance of it, then compliance will be jeopardized. A culture focused on interpersonal accountability and safety above all else will be more effective in decreasing medical errors. Nurses need to speak up for safety and always remember the duty and responsibility that comes with the two letters after our names, R.N.

For more information, check out the Culture of Safety Webinar – Coming July 2019

References:
Agency for Healthcare Research and Quality. (2019, January). Medication Errors and Adverse Drug Events. Retrieved April 2019, from Patient Safety Network: https://psnet.ahrq.gov/primers/primer/23/medication-errors-and-adverse-drug-events

American Nurses Association. (2015). ANA Code of Ethics. Silver Spring, Maryland: American Nurses Association. Retrieved from https://www.nursingworld.org/coe-view-only

American Nurses Association. (2016). Culture of Safety. Retrieved 2019, from ANA: https://www.nursingworld.org/practice-policy/work-environment/health-safety/culture-of-safety/

Anderson, P. (2015). Medication Errors: Best Practices. American Nurse Today. 10(9). Retrieved April 2019, from https://www.americannursetoday.com/medication-errors-best-practices/

Blignaut, A., Coetzee, S., Klopper, H., & Ellis, S. (2017, January 19). Medication administration errors and related deviations from safe practice: an observational study. Journal of Clinical Nursing, 26(21-22). doi:https://doi.org/10.1111/jocn.13732

de Raeve, L. (2002). Medical authority and nursing integrity. Journal of Medical Ethics, 28, 353-357. doi:http://dx.doi.org/10.1136/jme.28.6.353

Dirik, H., Samur, M., Seren Intepeler, S., & Hewison, A. (2019). Nurses’ identification and reporting of medication errors. Journal of Clinical Nursing, 28(5-6), 931-938. doi:10.1111/jocn.14716
National Safety Council. (2013). Near Miss Reporting Systems. Retrieved April 25, 2019, from National Safety Council: https://www.nsc.org/Portals/0/Documents/WorkplaceTrainingDocuments/Near-Miss-Reporting-Systems.pdf

National Safety Council. (2013). Near miss reporting systems. Retrieved from https://www.nsc.org/Portals/0/Documents/WorkplaceTrainingDocuments/Near-Miss-Reporting-Systems.pdf

Okuyama, A., Wagner, C., & Bijnen, B. (2014). Speaking up for patient safety by hospital-based health care professionals: a literature review. BMC Health Services Research, 14. doi: 10.1186/1472-6963-14-61

Pape, T., Guerra, D., Muzquiz, M., Bryant, J., Ingram, M., Schranner, B., . . . Welker, J. (2005). Innovative approaches to reducing nurses’ distractions during medication administration. Journal of Continuing Education in Nursing, 36(3), 141-142. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16022030

Paradiso, L. (2018, March). Everyone is responsible for a culture of safety. American Nurse Today, 13(3). Retrieved from https://www.americannursetoday.com/everyone-responsible-culture-safety/

Patient Safety Network. (2019, January). Culture of safety. Retrieved April 2019, from Patient Safety Network: https://psnet.ahrq.gov/primers/primer/5/culture-of-safety

Reuter, C., & Fitzsimons, V. (2013, August). Physician Orders. American Journal of Nursing, 113(8), 11. doi:10.1097/01.NAJ.0000432941.27219.95

Schiff, G., Seoane-Vazquez, E., & Wright, A. (2016). Incorportating indications into medication ordering – Time to enter the age of reason. New England Journal of Medicine, 375(4). doi:10.1056/NEJMp1603964

Seidi, J., Alhani, F., & Ardalan, F. (2017). Exploring nurses’ experience about facilitating factors in medication administration based on clinical judgment of nurses: A content analysis. Electronic Physician, 9(12), 6063-6071. doi:10.19082/6063

Vrbnjak, D., Denieffe, S., O’Gorman, C., & Pajnkihar, M. (2016). Barriers to reporting medication errors and near misses among nurses: A systematic review. International Journal of Nursing Studies, 63, 162-178. doi:https://doi.org/10.1016/j.ijnurstu.2016.08.019

OUTCOME: The learner will identify one way to use nursing clinical judgment in the assessment and/or reporting of elder abuse.

1 Category A contact hour will be awarded with successful completion.

Criteria for Successful Completion: Watch presentation and submit an evaluation form

This information is not intended as legal advice. For specific advice, please contact legal counsel.

There is no conflict of interest for anyone with the ability to control content for this activity

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91)

This study is valid through 5/1/2020

If you have any questions, please feel free to contact Sandy Swearingen (sswearingen@ohnurses.org).

This independent study was developed and presented by: Jessica Dzubak, MSN, RN and Kelli Schweitzer, MSN, RN-BC

OUTCOME: The learner will self-report an increased knowledge related to medical cannabis in Ohio.

1 contact hour will be awarded with successful completion.

Criteria for Successful Completion: Watch presentation and submit an evaluation form

This information is not intended as legal advice. For specific advice, please contact legal counsel.

There is no conflict of interest for anyone with the ability to control content for this activity

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91)

This study is valid through 4/1/2020

If you have any questions, please feel free to contact Sandy Swearingen (sswearingen@ohnurses.org).

This independent study was developed and presented by: Kelli Schweitzer, MSN, RN-BC and Jessica Dzubak, MSN, RN

OUTCOME: The learner will self-report and increase in knowledge related to 4723-14 and the ethical importance of maintaining their own professional development.

1 Category A contact hour will be awarded with successful completion.

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91).

Expires 3/1/2021

DIRECTIONS
1. Please view the video presentation in its entirety.
2. Complete the evaluation.

If you have any questions, please feel free to contact Sandy Swearingen (sswearingen@ohnurses.org).

This independent study webinar was developed and presented by: Kelli Schweitzer, MSN, RN-BC and Jessica Dzubak, MSN, RN
There is no conflict of interest among anyone with the ability to control content of this activity.

OUTCOME: The learner will identify one strategy learned to create an effective resume or CV.

0.5 contact hour will be awarded with successful completion.

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91).

Expires 1/30/2021

DIRECTIONS
1. Please read carefully the attached article entitled, “Resume Writing for Nurses”
2. Then complete the evaluation.

If you have any questions, please feel free to call Sandy Swearingen at sswearingen@ohnurses.org.

This independent study was developed by: Jane Unsworth and Jessica Dzubak, BSN, RN The authors and planning committee members have declared no conflict of interest.

The number of registered nurses needed in the United States is set to rise by more than 28 percent to 3.6 million by 2030 according to analysts at RegisteredNursing.org. The same report, however, noted that Ohio will have more registered nurses than they need, which is an indicator of the need to be competitive and empower yourself in everything from your qualifications to your experience when you are applying for a job in this state. Getting the job of your dreams may involve stiff competition, especially if you wish to carry out a specialist role such as that of a nurse anesthetist, mental health nurse practitioner, or nurse research scientist. Research shows that recruiters spend just a few seconds looking at resumes (University of California Davis, 2018).
How can you condense and highlight your skills and experience to impress a recruiter in 30 seconds or less?

What is a CV and Why Do I Need One?
A CV, or curriculum vitae, is typically a longer document displaying your full academic credentials, publications, research projects, presentations and awards (University of California Davis, 2018). CVs are more commonly used in academia, such as those seeking positions in fellowships and academic settings. Using a CV is also helpful when applying for a grant. Developing a CV early in your career may be beneficial as you continue to add experiences and grow your skills. Typically, CVs are much lengthier than the one-page resume. Information is more detailed and gives a complete overview of your professional and educational achievements.

Matching Your Skills to those of the Job Description
Pay close attention to the competencies listed in the job description and make sure that a majority are listed down on your CV as well. For nursing, core competencies may include efficiency, keen observation and judgement, gentleness, and willing to serve.

Curating your CV to the job posting is key, especially recruiters are receiving hundreds of applications. Try to be as specific as possible. For instance, if you already have experienced as a certified nurse midwife, state how many deliveries you assisted with. If you are a nurse researcher, list all of the studies you have been involved in. Specialty skills and certifications should be included relevant to the job description. Include projects you have implemented, changes you have made in your organization, or new programs

You may have several versions of your resume if you are applying for multiple positions with varying details and requirements. You want to highlight the skills and experience you have tailored to the job description. Often times recruiters will search resumes and CVs by searching for keywords related to the job description.
Detail makes for interesting reading, but you need to be selective so as not to drown the recruiter in information. Keep your details simple, direct and to the point. Avoid using extra words that do not add value.
Paying Attention to Formatting
As a person who works in a scientific field, you may be surprised to learn that simple things in the format of your resume – including the type of font you choose – can have a significant impact on the personality you convey to recruiters. Most online formatted CVs use ‘serious’ fonts like Arial, Calibri, Times New Roman, or Cambria, sized 10-12 point. These fonts have a formal yet simple air that lend professionalism to your CV. Use black font and avoid images.

You will also need to use bold type and shading selectively and intelligently, highlighting the most important parts of your CV – including your previous experience in posts that demanded similar capabilities to those the job you are applying for demands. Creativity should be implemented sparingly, while emphasis should be placed on more important information such as skills, previous duties performed, and how they exemplify what you can bring to the table.

Showing Flexibility and other Soft Skills
Studies have shown that for scientific and non-scientific jobs alike soft skills are playing an increasingly important role. Recruiters will be looking for more than experience at a hospital; they will also be paying attention to your ability to portray ‘soft skills’. In the nursing realm, these include integrity, teamwork, and responsibility. Make sure to include a couple of instances in which you displayed a select list of soft skills.
Applying for your dream job in nursing begins with an eye-catching resume. Use online templates to your advantage, remembering to attract the eye to the most important information in your resume. Be specific when indicating your skills, but don’t forget to show vital soft skills as well.

Tips:
• Consider including bilingual status. Especially in the very culturally diverse field of healthcare, the ability to speak more than one language can be impressive (The Graduate College at the University of Illinois, 2018).

• Be specific. Show not Tell.
Instead of saying: Effective communicator and leader
Say: Lead a group of five nurses to start a Shared Governance committee.
• Avoid simply listing job duties.
Instead of saying: Provided nursing care
Say: Cared for pediatric trauma patients on a 30-bed monitored unit. Care included:
-Procedural Sedation
-Telemetry
-Invasive Monitoring, etc.
• Use numbers to highlight your experience and skills whenever possible
• Use strong action verbs.
• Make sure a consistent verb tense is used.
• Keep resumes one page in length.
• Avoid personal information such as a photograph, age, marital status, and Social Security number.

OUTCOME: Every learner will self-report an increased knowledge related to the differences between EBP, research and QI.

1 contact hour will be awarded with successful completion.

The Ohio Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91).

Expires 12/1/2021

DIRECTIONS
1. Please view the video presentation in its entirety.
2. Complete the evaluation.

If you have any questions, please feel free to call Sandy Swearingen at 614-448-1030 (sswearingen@ohnurses.org).

This independent study was developed and presented by: Inga Zadvinskis, PhD, RN
The authors and planning committee members have declared no conflict of interest.