Section R4-19-402. Standards Related to Registered Nurse Scope of Practice

A.      A registered nurse (RN) shall perform only those nursing activities for which the RN has been prepared through basic registered nursing education and those additional skills which are obtained through subsequent nursing education and within the scope of practice of an RN as determined by the Board.

B.       A RN shall:

1.        Practice within the legal boundaries of registered nursing within the scope of practice authorized by A.R.S. Title 32, Chapter 15 and 4 A.A.C. 19;

2.        Demonstrate honesty and integrity;

3.        Base nursing decisions on nursing knowledge and skills, the needs of clients, and registered nursing standards;

4.        Accept responsibility for individual nursing actions, deci- sions, and behavior in the course of registered nursing practice;

5.        Maintain competence through ongoing learning and application of knowledge in registered nursing practice;

6.        Protect confidential information unless obligated by law to disclose the information;

7.        Report unprofessional conduct, as defined in A.R.S. § 32- 1601(22) and further specified in R4-19-403 and R4-19- 814, to the Board;

8.        Respect a client’s rights, concerns, decisions, and dignity;

9.        Maintain professional boundaries;

10.     Respect a client’s property and the property of others; and

11.     Advocate on behalf of a client to promote the client’s best interest.

C.      In utilizing the nursing process to plan and implement nursing care for clients across the life-span, a RN shall:

1.        Conduct a nursing assessment of a client in which the nurse:

a.         Recognizes client characteristics that may affect the client’s health status;

b.        Gathers or reviews comprehensive subjective and objective data and detects changes or missing infor- mation;

c.         Applies nursing knowledge in the integration of the biological, psychological, and social aspects of the client’s condition; and

d.        Demonstrates attentiveness by providing ongoing client surveillance and monitoring;

2.        Use critical thinking and nursing judgment to analyze cli- ent assessment data to:

a.         Make independent nursing decisions and formulate nursing diagnoses; and

b.        Determine the clinical implications of client signs, symptoms, and changes, as either expected, unex- pected, or emergent situations;

3.        Based on assessment and analysis of client data, plan strategies of nursing care and nursing interventions in which the nurse;

a.         Identifies client needs and goals;

b.        Formulates strategies to meet identified client needs and goals;

c.         Modifies defined strategies to be consistent with the client’s overall health care plan; and

d.        Prioritizes strategies based on client needs and goals;

4.        Provide nursing care within the RN scope of practice in which the nurse:

a.         Administers prescribed aspects of care including treatments, therapies, and medications;

b.        Clarifies health care provider orders when needed;

c.         Implements independent nursing activities consis- tent with the RN scope of practice;

d.        Institutes preventive measures to protect client, oth- ers, and self;

e.         Intervenes on behalf of a client when problems are identified;

f.         Promotes a safe client environment;

g.        Attends to client concerns or requests;

h.        Communicates client information to health team members including:

i.         Client concerns and special needs;

ii.        Client status and progress;

iii.      Client response or lack of response to interven- tions; and

iv.       Significant changes in client condition; and

i.         Documents the nursing care the RN has provided;

5.        Evaluate the impact of nursing care including the:

a.         Client’s response to interventions;

b.        Need for alternative interventions;

c.         Need to communicate and consult with other health team members; and

d.        Need to revise the plan of care;

6.        Provide comprehensive nursing and health care education in which the RN:

a.         Assesses and analyzes educational needs of learners;

b.        Plans educational programs based on learning needs and teaching-learning principles;

c.         Ensures implementation of an educational plan either directly or by delegating selected aspects of the education to other qualified persons; and

d.        Evaluates the education to meet the identified goals;

D.      A RN assigns and delegates nursing activities. The RN shall:

1.        Assign nursing care within the RN scope of practice to other RNs;

2.        Assign nursing care to a LPN within the LPN scope of practice based on the RN’s assessment of the client and the LPN’s ability;

3.        Supervise, monitor, and evaluate the care assigned to a LPN; and

4.        Delegate nursing tasks to UAPs. In maintaining account- ability for the delegation, an RN shall ensure that the:

a.         UAP has the education, legal authority, and demon- strated competency to perform the delegated task;

b.        Tasks delegated are consistent with the UAP’s job description and can be safely performed according to clear, exact, and unchanging directions;

c.         Results of the task are reasonably predictable;

d.        Task does not require assessment, interpretation, or independent decision making during its performance or at completion;

e.         Selected client and circumstances of the delegation are such that delegation of the task poses minimal risk to the client and the consequences of performing the task improperly are not life-threatening;

f.         RN provides clear directions and guidelines regard- ing the delegated task or, for routine tasks on stable clients, verifies that the UAP follows each written facility policy or procedure when performing the delegated task;

g.        RN provides supervision and feedback to the UAP; and

h.        RN observes and communicates the outcomes of the delegated task.

Historical Note

Former Section III, Part I; Amended effective February 20, 1980 (Supp. 80-1). Former Section R4-19-43 renum- bered as Section R4-19-402 (Supp. 86-1). Section repealed, new Section adopted effective July 19, 1995 (Supp. 95-3). Section repealed, new Section made by final rulemaking at 14 A.A.R. 4621, effective January 31, 2009 (Supp. 08-4). Subsection (B)(7) amended at request of Board, Office File No. M11-423, filed November 18, 2011 (Supp. 11-4). Pursuant to authority of A.R.S. § 41- 1011(C), Laws 2012, Ch. 152, § 1, provides for A.R.S. references to be corrected to reflect the renumbering of definitions. Therefore the A.R.S. citation in subsection (B)(7) was updated. Agency request filed July 12, 2012, Office File No. M12-242 (Supp. 12-3).