fter taking their state boards, few nurses think about their license to practice except when the time comes to renew it. a surprise, then, when the family member you couldn't get along with files a complaint with the board of nursing. So what? you think. What are they going to do? Take away my license? Actually, in some states, the board of nursing could use just those grounds for a cause summons-a summons for you to appear before the board to show why your license should not be revoked or suspended. In Alaska's revised nursing practice act, for example, unprofessional conduct is listed as grounds for loss of license. So, while the statutory language of state nursing practice acts, at first blush, may seem less than exciting, the acts are invaluable reading because of their importance in defining and regulating your But the real meat of what nurses can do under the law is often found in the nursing board's rules and regulations. Although these are not law, they have the force of law. Board rulings, a third source for determining the scope of nursing in your state, have no force of law. Nevertheless, before you embark on a gray area of practice, you might want to ask the board if it has issued (or will issue) an advisory opinion or ruling. Advisory opinions are rulings formulated by nursing boards, often in response to a formal request by a nurse or facility for clarification of a clinical practice activity. In addition, the board may submit a question to a specific state agency or department such as the Attorney General's department. Advisory opinions from the Attorney General's office are not law but can be persuasive in a judicial proceeding. As nursing and medical activities increasingly overlap, courts are being petitioned to interpret challenged sections of nurse practice.acts. In one of the most important cases dealing with advanced nursing practice thus far, the Missouri Supreme Court reviewed the (1975) nursing statute in light of the old law.1 The case went to court when the Board of Registration for the Healing Arts (medical board) threatened to sue nurse practitioners in a family planning clinic for the alleged unauthorized practice of medicine. The nurses were doing breast and pelvic exams, lab tests, and birth control counseling and were providing birth control products. When the court looked at the nurse practice act to determine whether the nurses were practicing within the scope of nursing, it found an open-ended definition of professional nursing introduced by the phrase including, but not limited to... . The court said that the use of this language evidences an intent to avoid statutory constraints on the evolution of new functions for nurses delivering health services. When the court compared the existing act with the earlier act, it noted that the requirement for a physician to directly supervise nursing functions had been eliminated. This was interpreted as a legislative desire to expand the scope of authorized nursing practice. More commonly, a court is called on to interpret the nursing practice act when a dispute arises from a disciplinary action or negligence suit. In Massachusetts, the board of nursing suspended an RN's license for practicing as a nurse midwife without credentials.2 The nurse, Janet Leigh, argued that she was engaged in lay midwifery, not nurse midwifery. Massachusetts has no statutory prohibition against lay midwifery. Leigh, who graduated from a college nursing program in 1969, practiced predominantly in obstetrics. She testified that she had begun to practice as a lay midwife in 1977 and had delivered more than 600 infants, including home births. She maintained her nursing license and did a little private duty, but never sought approval from the board to practice as a nurse midwife. The incident that occasioned the disciplinary action involved the death of an infant, whose umbilical cord prolapsed during a home delivery. Leigh called an ambulance to take the mother to a hospital where Leigh had back-up physician coverage. Leigh's hand was in the woman's vagina and she was trying to hold back the cord. The ambulance crew announced that they would take over and did not want Leigh in the ambulance. The ambulance personnel testified that after Leigh said she was a registered nurse they let her accompany the patient in the ambulance. The baby was strangled by the cord. The court found Leigh guilty not because she practiced lay midwifery, but because she violated the nursing practice law and board regulations. The question before the board became whether the nurse's conduct was a violation of the nursing practice statute or whether the nurse was merely practicing lay midwifery. The board could not impose sanctions if the nurse was practicing lay midwifery, since the court held that such midwife practice by non-
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