Nurse Practice Act: Every state has a law that the nursing board enforces called the Nurse Practice Act. As per the California law, this Act authorises the nursing board to identify the nurse’s scope of practice and responsibilities so that nurses protect people in need of nursing care whilst complying with the law and rules related to it. Failure to follow the rules may lead to their license’s disapproval. The NPA is found in California Business and Professions Code from Section 2700. NPA allows the collaboration between physicians and registered nurses within an organised healthcare system and also recognises an overlap in their functions. The Act defines nursing practices as the set of tasks carried out by RN requiring scientific knowledge and technical skills.

CNA: A CNA works under the supervision of an LPN or RN to aid the nursing team with the various scope of basic care units. Some activities require nurse supervision while some do not. Those that do not need guidance include the following; providing assistance to the patients with their necessary living activities that they currently cannot do for themselves. They help in bathing and cleaning the patients since most of them have difficulty in keeping themselves clean. CNAs assist them in brushing their teeth, combing hair and even trimming their fingernails. They serve patients with meals and help feed some of those who cannot feed themselves.

Moreover, they can listen to the patient’s health concern issues and note them down on either an electronic system or on a paper while they are doing their work. The CNAs take and measure patients vital signs. They take vital signs such as blood pressure and temperature to help the nurse to keep a record of the patient’s health. CNA have to ensure they take the vital signs as scheduled to provide accurate reporting. CNAs report to the nurse the new health information of the patient. However, they have to be under the nurse’s supervision to document the data obtained. That is, they report to the RN on the info before recording it. Also, they require RN’s presence to get vital signs per the protocol. CNA can look up their scope of practice from the RNs or the LNPs.

LPN: LPNs handle various tasks throughout the day in a hospital setting. If working in long-term care, they educate and advocate for patients and their families. LPN also ensures the patient follows the treatment plan. He/she also advises patients on treatment on treatment options and consults with superiors about patient care. Licensed Practical nurses’ scope of practice involves the following. They help RN with data collection and monitoring client’s findings and help in taking care of a patient with predictable outcomes. LPN also reinforce an RN’s patient teaching. However, it is not in their power to perform patient education and assessments independently. Lastly, they delegate tasks to UAP, thus can perform all tasks that the NPA permits UAPs. LPNs can take various tasks without the supervision of a physician. They can track the patient’s health progress, feed them, administer oral and intravenous medications, and accumulating patient’s blood, urine, sputum and blood for medicinal purposes. If one is an LPN working in a long-term care facility and exceeds the legally permissible scope of nursing practice; the state board of nursing might revoke or suspend their license. If an LPN performs a nursing function that is legally restricted to RNs, they may get sued for malpractice under RN standard. LPN can legally delegate the following tasks to the CNA. First, keeping track of the patient’s condition and feeding the patients through nasogastric and gastrostomy tube.

RN: Registered nurses’ functions as per the State of California’s Registered Nurse Practice Act. Their roles in long-term care are to ensure patients receive safe, ethical, compassionate and competent care.  Therefore, they initiate and do blood administration to the patient, administer high risk medications, monitor and titrate patients’ medications independently, and perform any tasks that UAP or LVN may perform. A registered nurse is the most linked health professional to non-fragmented and holistic care; thus do not need physician collaboration for most services unless diagnosing and treating. The scope of practice of an RN is to; teach patients on the care plan, initiate, administer, and titrate all medications, admit, discharge and refer patients to appropriate healthcare providers and delegate tasks to LVN and UAPs. RN uses the “Five Rights of Delegation” to delegate functions; that is, right task, person, circumstances, communication and supervision provided. LPN can do dressing changes for the patient, and RN can delegate to LPN the most stable patient showing a predictable outcome. Also, they can collect data on the client and monitor their findings. If an RN fails to follow the scope of practice and cause patient injury, he/she may suffer a malpractice lawsuit. One cannot defend themselves by claiming they were not trained.

Comparison: The healthcare system is evolving, and the structure and organisation are rapidly changing which is causing a change in the delivery of healthcare among different levels of professionals. The nursing personnel include RN, LPN and NA, all having different responsibilities. With the shift in service settings, healthcare systems have a different scope of personnel to differentiate on the different practices for each profession. Responsibilities of every individual differ, and they use their approved scope of practice to determine their capabilities and competencies. Each should understand their scope of practice details and practice to the fullest extent. The scope of practice is the professional activities that the state law uses for the quality of care provision and ensure that every individual understands their responsibility. They also help in the delegation of duties.

Nurse Practice Act is essential for nursing professional standards to maintain and direct a safe and clinically competent nursing practice in a healthcare setting. The rules are necessary for my future nursing career as they will guide and promote my clinical practice. If I found myself in need of guidance during a health situation, I would refer to the scope of practice to make sure I follow the rules to avoid punishment.

Besides, failing to follow the scope of practice, nurses can also lose their nursing licenses if they are abusing narcotics. The board will suspend nurses’ license and demand that the person in question joins an addiction recovery; he/she can retain the permit if they complete their therapy and remain clean. Also, one may lose their license if they impersonate another licensed practitioner; it is a felony as per the rules. Nurses can only have their RN license reinstated if they petition for Reinstatement to the Board of Registered Nursing.

References

Bodenheimer, T., & Bauer, L. (2016). Rethinking the primary care workforce—an expanded role for nurses. New England Journal of Medicine, 375(11), 1015-1017.

AbuDagga, A., & Weech-Maldonado, R. (2016). Do patient, hospital, and community characteristics predict variations in overall inpatient experience scores? A multilevel analysis of hospitals in California. Health Services Management Research, 29(1-2), 25-34.

Person, S. D., Allison, J. J., Kiefe, C. I., Weaver, M. T., Williams, O. D., Centor, R. M., & Weissman, N. W. (2004). Nurse staffing and mortality for Medicare patients with acute myocardial infarction. Medical care, 4-12.