Scope of Practice and Licensure

1. Scope of Practice and Licensure Medical Law and Ethics

2. Scope of Practice • Based in state licensing laws and rules • Sets legal framework for service delivery by a specific health profession in a state • Defines parameters of practice for a profession • Limits practice to people who successfully complete specified education and/or training • Restricts use of title and/or credential to license holders in the profession • Designed to provide consumer protection

3. Scope of Practice • “One hallmark of a professional is to know the limits of one’s own professional knowledge.” • Legal and Ethical Perspectives in Health Care

4. Texas Scope of Practice Issues • http://www.amednews.com/article/20090309/profession/303099970/2/ • http://www.acfas.org/uploadedFiles/Physicians/Research_and_Publications/Update_Newsletter/v17n6.pdf

5. From the Texas Nursing Board http://www.bon.texas.gov/practice/apn-scopeofpractice.html • The following questions may help to clarify whether a new activity/procedure can be incorporated into an individual's scope of practice: • Is it consistent with one's professional scope of practice? • Is it consistent with statutory or regulatory laws? • Is it consistent with one's education in the role and specialty?

6. From the Texas Nursing Board http://www.bon.texas.gov/practice/apn-scopeofpractice.html • Is it consistent with the scope of one's recognized title or does it evolve into another advanced practice title recognized by the board requiring additional formal education and legal recognition? • Is it consistent with the Standards of Nursing Practice outlined in Board Rule 217.11? • Is it consistent with evidence-based care? • Is it consistent with reasonable and prudent practice? • Are you willing to accept accountability and liability for the activity and outcomes?

7. Licensure • Defined as - “A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors.” • Each state offers its own examination for licensure for physicians. Some allied health professions have national licensure/certification exams.

8. To apply for a license: • Provide proof of education and training • Provide detailed work history • Pass an examination designed to assess knowledge and their ability to apply that knowledge and other concepts and principles important to ensure safe and effective patient care • Reveal information about past medical history (including alcohol and drug abuse), arrests, and convictions

9. Loss of license through: • Physical abuse of a patient • Inadequate record keeping • Failure to recognize or act on common symptoms • The prescription of drugs in excessive amounts or without legitimate reason • Impaired ability to practice due to addiction, or physical or mental illness

10. Failure to meet continuing education requirements • Performance of duties beyond the scope of a license • Dishonesty • Conviction of a felony • Delegation of practice of medicine to an unlicensed individual

11. Certification • Defined as – “A voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate.” • Certification by a professional organization, usually through an examination, signifies that an applicant has attained a certain level of knowledge and skill.

12. Registration • Defined as – “A credentialing procedure whereby one’s name is listed on a register as having paid a fee and/or met certain criteria within a profession.

13. Accreditation • Defined as – “Official authorization or approval for conforming to a specified standard.” • Example – Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredits health care organizations that meet certain standards. • What are the organizations? Hospitals of any type, HMOs, PPOs, Home Health services, Medical Equipment Supply companies, Nursing homes, Mental health facilities, any outpatient treatment facilities, laboratories including blood donation organizations, etc.

14. http://usnews.nbcnews.com/_news/2013/03/03/17167379-nurse-refuses-to-perform-cpr-despite-911-dispatchers-plea?litehttp://usnews.nbcnews.com/_news/2013/03/03/17167379-nurse-refuses-to-perform-cpr-despite-911-dispatchers-plea?lite