Guidance regarding the interpretation and application of the Nurse Practices Act (NPA) may be adopted by the ND Board of Nursing (Board) as a means of providing direction to licensees and stakeholders who seek to ensure safe nursing practice and to address issues of concern relevant to public protection. (North Dakota Century Code (NDCC) 43-12.1-08(2)(p)).
Board approved practice guidance does not carry the force and effect of the law/rules. Each licensed nurse (nurse) is “responsible and accountable to practice according to the standards of practice prescribed by the board and the profession”; and must “accept responsibility for judgments, individual nursing actions, competence, decisions, and behavior in the course of nursing practice.” (Standards of Practice, North Dakota Administrative Code (NDAC) 54-05-01-07 and 54-05-02-04). “Competence": means the application and integration of knowledge, skills, ability, and judgment necessary to meet standards. (NDAC 54-01-03-01(16)).
Licensed nurses are accountable for the care they provide and must have the appropriate knowledge and skills before accepting assignments or responsibilities. Accepting an assignment and providing care without the appropriate knowledge and skills places both the recipient of the care and the licensed nurse in jeopardy.
The Board of Nursing encourages employers to take steps to provide adequate orientation and cross-training before reassigning licensed nurses to areas outside of their usual work assignment. Such orientation and cross-training must occur prior to the expected reassignment. If the census requires that nurses “float” to unfamiliar clinical settings, the nurse must be assigned to work with another licensed nurse who has the requisite knowledge and skills to provide the specialized care.
Role of the Nurse
The Board of Nursing interprets the Nurse Practices Act (N.D.C.C. 43-12.1) to clearly indicate that the licensed nurse must refuse to accept assignments for which they do not have the knowledge and skills necessary to deliver safe care. The Board further believes that the employing agency has an obligation to ensure that the clients within the agency’s domain are cared for by competent practitioners and must make appropriate provisions for orientation and cross-training if experience has shown that temporary reassignments will be necessary.