Ohio Nurse - March 2021

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Page 10 Ohio Nurse March 2021 (A) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner who holds a license to practice nursing issued under section 4723.42 of the Revised Code may delegate to a person not otherwise authorized to administer drugs the authority to administer to a specified patient a drug, unless the drug is a controlled substance or is listed in the formulary established in rules adopted under section 4723.50 of the Revised Code. The delegation shall be in accordance with division (B) of this section and standards and procedures established in rules adopted under division (O) of section 4723.07 of the Revised Code. (B) Prior to delegating the authority, the nurse shall do both of the following: (1) Assess the patient and determine that the drug is appropriate for the patient; (2) Determine that the person to whom the authority will be delegated has met the conditions specified in division (D) of section 4723.489 of the Revised Code. Question: I put my Ohio RN License on inactive status a few years ago, but I want to help administer the COVID vaccine. Is there a way I can do this? Nurse Jesse: While those with an active nursing license can work safely to the highest extent of that license, Ohio does have provisions for administering the vaccine without a current, active license. Currently, SB 310 authorizes RNs, APRNs, and LPNs who hold Ohio licenses that lapsed or were placed on inactive status within the past five years, to practice without reactivating or reinstating the license, through May 1, 2021. This does not apply to revoked, surrendered, or suspended licenses. In accordance with Ohio law and rules, it may be possible for you to administer the vaccine without an active nursing license under proper, authorized supervision by an authorized provider. The Ohio Revised Code (Nurse Practice Act) Section 4723.48 states [emphasis added]: EXPERIENCE THE DIFFERENCE CHOOSE YOUR PATH TO SUCCESS! Offering online options for both MBA & Health Information Management Programs! FOR QUESTIONS ABOUT ADMISSIONS: Contact the Office of Graduate Admissions at graduate.admissions@sru.edu. A member of Pennsylvania’s State System of Higher Education WWW.SRU.EDU/GRADUATE This means that under current law, if one is a former Ohio registered nurse with an inactive license chooses not to reactivate/reinstate the license, it is possible they could, with training updates and competency determinations (see 4723.489 ORC below), administer immunizations via applicable Delegation Rules if an APRN or physician is on site. APRNs must however comply with all requirements of Section 4723.48, ORC, and Section 4723.489, ORC, including specific requirements as to the unlicensed person’s documented education and demonstrated knowledge, skills, and ability to administer the drug safely, and the requirement that the APRN is on site during the delegated medication administration. Sections 4723.489 ORC for reference [emphasis added]: ORC Section 4723.489, Delegated authority to administer drugs. A person not otherwise authorized to administer drugs may administer a drug to a specified patient if all of the following conditions are met: (A) The authority to administer the drug is delegated to the person by an advanced practice registered nurse who is a clinical nurse specialist, certified nursemidwife, or certified nurse practitioner and holds a license issued under section 4723.42 of the Revised Code. (B) The drug is not listed in the formulary established in rules adopted under section 4723.50 of the Revised Code, is not a controlled substance, and is not to be administered intravenously. (C) The drug is to be administered at a location other than a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department or a freestanding emergency department; or an ambulatory surgical facility, as defined in section 3702.30 of the Revised Code. (D) The person has successfully completed education based on a recognized body of knowledge concerning drug administration and demonstrates to the person’s employer the knowledge, skills, and ability to administer the drug safely. (E) The person’s employer has given the advanced practice registered nurse access to documentation, in written or electronic form, showing that the person has met the conditions specified in division (D) of this section. (F) The advanced practice registered nurse is physically present at the location where the drug is administered. Amended by 131st General Assembly File No. TBD, HB 216, §1, eff. 4/6/2017. Note: What a physician is authorized to delegate and under what circumstances, etc., is governed by law and rule enforced by the Board of Medicine. https://med.ohio.gov/ How to Volunteer The Ohio Responds Volunteer Registry (https://www.ohioresponds.odh.ohio. gov) is the State of Ohio’s online system for managing public health and healthcare professionals who wish to volunteer. This site supports a variety of personnel who may be called to action during disasters, all-hazards response efforts, and public health activities. Ohio Responds is the system used to notify volunteers of the specific events happening in their community.
March 2021 Ohio Nurse Page 11 The Year of the Nurse and the Midwife – An Interview with Penny Marzalik, PhD, APRN-CNM, IBCLC Jeri A. Milstead, PhD, RN, NEA-BC, FAAN, ANA Hall of Fame Introduction The World Health Organization designated 2020 as the Year of the Nurse and Midwife. The COVID-19 pandemic curtailed many celebrations world-wide, so WHO extended the honor through June 2021. The designation is to advance nurses’ and midwives’ vital position in transforming healthcare around the world as well as honor the 200th anniversary of Florence Nightingale’s birth. In this interview, Penny Marzalik discusses the role and education of the U.S. midwife and provides a perspective of midwives globally. JM: What do midwives do? PM: The Ohio Board of Nursing determines the legal scope of practice for this state. The role includes primary health care for individuals from adolescence through menopause and care during pre-conception, prenatal, labor and birth. Postpartum and lactation care as well as gynecology and family planning services are provided. CNMs support pregnancy, birth, and menopause as normal physiologic processes and support non-intervention in the absence of complications. CNMs prescribe medications and repair episiotomies and lacerations as needed. Newborn care for the first 28 days of life is required in midwifery education but is not within Ohio scope of practice for Certified Nurse-Midwives (CNMs). The American College of Nurse-Midwives (ACNM) is the national professional specialty organization for CNMs and CMs representing 12,000 professionals who attend 9% of U.S. births. The Core Competencies for Basic Midwifery Practice as disseminated by ACNM define the professional scope of practice. Certified Nurse-Midwives (CNMs) are recognized as Advanced Practice Registered Nurses (APRNs) and are licensed to practice and prescribe in all 50 states, territories, and the District of Columbia. There are 431 CNMs in Ohio. Certified Midwives (CMs) are not nurses but have the same scope of practice as CNMs and practice in six states (DE, HI, ME, NJ, NY, RI). The Certified Professional Midwife (CPM) is recognized in 34 states and the District of Columbia. CPMs practice in the State of Ohio but are not recognized by any government board. The International Confederation of Midwives represents two million midwives around the globe including in the United States. Most CNMs in Ohio attend births within a hospital setting although some provide care in birthing centers and the patient’s home. The support of physiologic birth is provided no matter the setting and evidence-based care as well as person-centered care are hallmarks of midwifery practice. If desired by the patient or required by the circumstance, the CNM can consult with the nurse-anesthetist or anesthesiologist for an epidural for labor and birth. Midwives work in the community at Federally Qualified Health Centers, private practices, and outpatient clinics. An important component of midwifery education is understanding and reducing increased risks, barriers to care, and disparities in health outcomes faced by many marginalized communities. JM: What education is required to become a midwife? PM: A graduate degree is required to be eligible for board certification as a Certified Nurse-Midwife (CNM) or Certified Midwife (CM). The nurse-midwife in the U.S. is an RN with a specialized master’s degree. There are three academic graduate programs located in Ohio: Case Western Reserve University, University of Cincinnati, and The Ohio State University. I had the pleasure of serving as Director of the OSU program from 2016 to 2020. In addition to these programs, several institutions outside of Ohio offer distance education with students attending classes online and completing clinical experiences throughout the state. The Certified Professional Midwife (CPM) is educated through an independent apprenticeship prior to a written examination and portfolio evaluation. JM: What is different in the global education and role of midwives? PM: Globally, nursing and midwifery are two distinct professions with separate education pathways and clinical expectations. The International Confederation of Midwives provides Global Standards for Midwifery Education that serves as a benchmark for the preparation of midwives. The role of midwives outside the United States and the Certified Professional Midwife within the U.S. includes pre-pregnancy and antenatal care, care during labor and birth, and ongoing care of women and newborns. Primary care such as annual examinations for cervical cancer screening or acute care for cystitis are typically not within the role. JM: What is one of your best memories about your midwifery career? PM: The ultimate compliment I received about half-way through my 37-year career as a CNM was during a six-week postpartum visit. As the new mother recounted her birth story, she explained that when I arrived at her labor, she knew everything was going to be ok. She continued to explain that “ok” meant that whatever happened I would be there to guide her. I became a midwife for exactly that reason and continue to strive to be a guide to every patient and student I encounter. The Year of the Nurse and Midwife officially ends June 20, 2021, but the contributions made by these two professions are at a pinnacle that must be sustained. Recognition of midwives will continue in the U.S. with National Midwifery Week which is celebrated the first week of October each year. International Midwives’ Day will be May 5th, 2021. So, let’s acclaim and cheer on this important group of nurses—seek out a midwife and congratulate her/him (0.6% of U.S. midwives are males) for a successful career. Mail a card…send an email note…make a phone call…bring flowers or chocolate…celebrate!!
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Ohio Nurse - March 2021

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