 |
Nevada State
Board of Nursing |
|
|---|
|
February 2004 Governor Appoints Three Board Members Board and Advisory Committee Meetings On-Line License Renewal Is Here! Board Increases CNA Fees to Offset Loss of CNA Contract Funds Fred Olmstead Joins Board as General Counsel Legislature Mandates Bioterrorism CEs National Council Honors Nevada Board Member Changes to LPN Intravenous Therapy Regulations Board Adopts Practice Decision on Vein Harvesting
A message from the executive director
As we all know, in our ever-changing world, there is one thing we can count on, and that is change. Over the past year or so, we’ve seen many changes at the Nevada State Board of Nursing. Whether we made them ourselves, or they were the result of outside forces, we’ve found that for the most part, the changes have been good. Good for the Board and good for the public that it is charged with protecting. However, we did have to deal with some negative changes, such as the loss of funding for the Certified Nursing Assistant program. The magazine you have in your hand is one of the changes we’re excited about. The Board continually searches for ways to reduce costs and increase effectiveness. The cost to publish three issues of our former newsletter, not including staff time, was about $33,000 (for printing, sorting, labeling and mailing). We knew other nursing boards around the country contracted with publishers to produce their newsletters, newspapers or magazines at no cost to the boards, in exchange for allowing the publishers to sell advertising. After researching various publishers and speaking with several nursing boards, we entered into an agreement with Publishing Concepts, Inc., (PCI) to produce the NSBN News four times a year, at no cost to the Board. We’re not only excited about the substantial cost savings, we’re also pleased that for the first time, the magazine will be mailed to CNAs, as well as all licensees. We’re proud that the new full-color magazine format presents a more professional and attractive image. And we’re especially glad we’ll be able to give you more “news that you can use,” more often. When we considered this change, we had two concerns about accepting advertising. One was how our readers would react. When we spoke to other boards, they told us that their reader feedback was overwhelmingly positive. They said their readers felt the advantage of a professional portrayal of nursing far outweighed any perceived disadvantage of including advertisements. Our other concern was the type of advertising that would be accepted. PCI has agreed not to accept any advertisements from out-of-Nevada organizations seeking to recruit employees, or entities with politically related agendas. PCI has also agreed to ensure that advertisers are offering a product or service that would be of interest to our readers, e.g. uniform companies, recruiters, or providers of continuing education. Other changes you’ll read about in this first issue of our new magazine include the appointments of two new Board members, the reappointment of our CNA Board member, the hiring of an in-house legal counsel, newly adopted regulations regarding LPNs and IV therapy, a practice decision on vein harvesting, and an increase in CNA fees to offset the loss of federal funding. You’ll find articles on our new Education Advisory Committee; the relocation of our Las Vegas Office of Licensure, Certification and Education; new Board-sponsored continuing education courses; and the arrival of on-line licensure renewal. The mission of the Nevada State Board of Nursing is to protect the public’s health, safety and welfare through effective nursing regulation. One of the ways we do that is to keep nurses and nursing assistants informed of regulatory changes that affect you, through our web site, presentations, continuing education courses, telephone calls, letters, emails, and the magazine you are holding in your hand. We hope you’ll take a moment to read through it and call or email if you have questions, suggestions, or comments. After all, each one of us has to deal with rapid change every day of our lives. The more we pull together, the easier it is for all of us. Debra Scott, MS, RN, APN Executive Director
Governor Appoints Three Board Members New members David Burgio and Joseph Cortez join reappointed member, Dorothy Perkins Gov. Kenny Guinn recently appointed David Burgio, an APN who works for a homeless health clinic, and Joseph Cortez, an internationally known boxing referee, to the Nevada State Board of Nursing. Burgio replaces Ellie Lopez-Bowlan, MS, RN, FNP, whose term expired in October. Cortez fills the consumer member position formerly held by Merle Lok. The governor reappointed Dorothy Perkins, the Board’s CNA member, to a second four-year term. David Burgio,
MS, RN, APN RN Member David Burgio, MS, RN, APN, is the second male RN member in the Board’s 80-year history. Douglas Fantazia, also an APN, was the first, serving from 1987-88. Burgio is the sole nurse practitioner for the HAWC (Health Access Washoe County) Outreach Medical Clinic. The clinic provides free health care to homeless individuals and families. He is also HAWC’s clinical liaison for doctors and nurse practitioners and serves as an adjunct faculty member for the Orvis School of Nursing. Burgio earned his bachelor’s of science in nursing and his master’s of science in community health nursing from D’Youville College in Buffalo, New York. He received the “D'Youville Medal," the college's highest award given to only one graduating senior each year. Burgio completed his post-master’s work for family nurse practitioner certification at the University of Pittsburgh in Pennsylvania. From 1981 through 1992, Burgio held registered nursing positions in hospitals and as a visiting nurse in New York, Pennsylvania and Florida. From 1993 to 1996, he worked as an APN at clinics for Charles Cole Hospital in Caudersport, Pennsylvania. In 1996, he moved to Reno to work for the Medical Group of Northern Nevada. Burgio has worked for the HAWC homeless clinic since it opened in 1997. He served on the Board’s Advanced Practice Advisory Committee from 2001 to 2003. Regarding
his appointment to the Board, Burgio said, “My wish is to be able to
adequately protect the public as well as help the nurses of Nevada. I have been
in health care since I was 18 years old, starting as an orderly and then
progressing to an LPN and RN. I hope to bring this and my 22 years of RN
experience in four states to the Board.” He added, “I brought my wife and two children here seven years ago and we’ve adopted Nevada as our home. We love the people and places here and appreciate all the work of those nurses before me who helped make this a great state to practice in.” Joseph Cortez Consumer Member Joseph Cortez has been a boxing referee for more than 20 years, refereeing 160 World Title Championship fights in more than 11 countries. He has refereed Oscar De La Hoya, Julio Caesar Chavez, Mike Tyson, Roberto Duran, George Foreman, and Lennox Lewis, to name a few. Born and raised in New York City in Spanish Harlem, Cortez began his career in 1960 as an amateur Bantamweight boxer, earning four Golden Gloves in two years. In 1963, he turned professional, fighting as a Bantamweight until 1967. His last professional fight was in 1971, when he retired with a record of 18 wins, one loss. Cortez began a career in the hotel industry after he and his family moved to Puerto Rico in 1969. He worked his way up the ranks from front desk clerk to executive assistant manager of the El Conquistador Hotel in Fajardo. They moved back to New York in 1976, where Cortez served as assistant casino operating manager for the El San Juan Hotel Corporation, The Palace, and El Conquistador Hotels. At the same time, he began his career as a boxing referee. Cortez also became very involved in the community, serving as both a speaker and a sponsor for several youth organizations. He then developed and implemented a successful community vision outreach program with leading ophthalmologists in New York, New Jersey, Las Vegas, and Chicago to provide those in need with eye-care services. “Boxing has afforded me a spot in the limelight and I intend to use the opportunity to help set a good role model to the youth and minorities and help wherever I can,” Cortez explained. In 1992, he brought his community spirit to Las Vegas, where he and Sylvia, his wife of 38 years, now reside with their daughters Cindy, Sandy, and Christine, and grandsons Ricky, 12, and Bryce, 4. In addition to helping at-risk youth with a boxing program designed to teach not only boxing, but also discipline and self esteem, he has volunteered time and funds to several health-related organizations in Clark County. Cortez’s current focus is raising awareness and funds for spinal cord research. His daughter, Cindy, is a quadriplegic, after suffering a serious spinal cord injury in a 1996 automobile accident. Cortez said, “Because of Cindy’s fighting spirit and determination to get better, my focus is now to create awareness and raise research funds for spinal cord injuries.” Regarding his newest area of public service, Cortez said, “I’m very honored to be appointed by the governor to represent the consumers of Nevada. I look forward to working on the Board as part of a team.” Dorothy
Perkins, CNA CNA Member Dorothy Perkins was first appointed in 1998 by Gov. Bob Miller to serve the remaining year of Eleanor Zamora’s term. Zamora resigned after moving to California. Gov. Miller then appointed Perkins to a full four-year term in 1999. A resident of Las Vegas since 1972, Perkins has worked as a nursing assistant for the Clark County Health District for almost three decades. In September, 1974, she started working at the Clark County Health District as a nursing assistant, then became certified in 1990 when the state mandated certification for all nursing assistants. Her major responsibility is the Senior Foot Clinic. “I am so proud that I am able to provide such a needed service to the seniors of Clark County,” Perkins said. “Every week, I look forward to seeing my clients, some that I have known for over thirteen years. And they tell me that they are happy to see me too! The relationships I have made with them through the years are some of the most rewarding of my career.” She added that she wanted to mention how much she respects and appreciates the nurses she works with at the Health District: “They have taught me so much and I have always felt respected and valuable as a member of the team.” When asked to reflect on her experience with the Board, Perkins said, “I didn’t know exactly what my role as a CNA on the Board would entail. I have learned so much in the years since then, and have a much better appreciation for nursing and the law and how it works in the state of Nevada. It is my job to be fair and honest for CNAs and other licensed personnel that come before the Board. What I am most proud of is the reputation I have with my fellow Board members and how this has helped all CNAs to earn a more respected role in the health care profession.” Regarding her reappointment, Perkins said she plans to “continue to serve the Board with diligence and integrity, showing that being a CNA is a very rewarding, honest and needed profession, and one in which I am proud to be counted among.” Perkins also serves on a HeathInsight Committee that hears complaints from the public regarding personnel or environmental issues with nursing homes. She has two sons, Preston and Wade, and four grandchildren. The
seven-member Board consists of four registered nurses, one practical nurse, one
certified nursing assistant, and one consumer member. They are appointed by the
governor to four-year terms.
Board and Advisory Committee Meetings BOARD MEETINGS A seven-member board appointed by the governor, the Nevada State Board of Nursing consists of four registered nurses, one practical nurse, one certified nursing assistant and one consumer member. Its meetings are open to the public; agendas are posted on the Board’s web site and at community sites. MEETING DATES (March 31), April 1, 2, 2004 - Reno April 19, 2004 - Las Vegas (Reno) May 19-21, 2004 - Las Vegas June 18, 2004 - Reno (Las Vegas) July 14-16, 2004 - Mt. Charleston September 22-24, 2004 - Las Vegas October 25, 2004 - Las Vegas (Reno) November (17) 18, 19, 2004 - Reno (Meetings may be held on dates and in locations in parentheses, depending on Board business.) ADVISORY COMMITTEES The Nevada State Board of Nursing is advised by and appoints members to five standing advisory committees. Committee meetings are open to the public; agendas are posted on the Board’s web site and at community sites. If you are interested in applying for appointment to fill an upcoming opening, please visit the Board’s web site or call the Reno office for an application. MEETINGS AND OPENINGS The openings (listed in parentheses) will occur in the next six months. All meetings will be held via videoconference in Reno and Las Vegas, except for the Disability Advisory Committee. Advanced Practice Advisory Committee (three) May 11, 2004 August 17, 2004 November 2, 2004 CNA Advisory Committee (four) May
12, 2004 Disability Advisory Committee (none) April 23, 2004 - Las Vegas October 1, 2004 – Reno Education Advisory Committee (one) February 27, 2004 April 30, 2004 July 23, 2004 November 5, 2004 Nursing Practice Advisory Committee (three) April 14, 2004 June 9, 2004 August 11, 2004 October 13, 2004 December 8, 2004 COME TALK TO THE BOARD During each regularly scheduled meeting of the Nevada State Board of Nursing see above for dates), Board members hold a Public Comment period for people to talk to them on nursing-related issues. If you want to speak during the Public Comment period, please call the Reno office at least two weeks before the meeting for detailed information. Public Comment time is divided equally among those who wish to speak. WE’LL COME TALK TO YOU Board staff will come speak to your organization on a range of nursing-related topics, including delegation, the impaired nurse, licensure and discipline processes, and the Nurse Practice Act. Call the Reno office if you’re interested in having us come speak to your organization.
Look for the
postcard in the mail Beginning with April renewals, all you’ll need to renew your Nevada RN or LPN license is a MasterCard™ or Visa™ debit or credit card and access to the internet. Instead of receiving a renewal application in the mail, all of you whose license expires in April or later will mailed a postcard with a Personal Identification Number (PIN) and instructions to access the Board’s web site at www.nursingboard.state.nv for on-line renewal. Once you’ve successfully completed the process, your license will be renewed within two business days. Your hard card will follow in the mail. If you don’t have a MasterCard™ or Visa™ debit or credit card, the post card will direct you to complete and print a license renewal application from the Board’s web site. So, make sure the Board has your correct address—and don’t throw away that postcard! If you have any questions regarding this new renewal process, please call the Las Vegas office.
Board
increases CNA fees to offset loss of CNA contract funds Under the regulation change, a CNA now pays $25 a year for a nursing assistant certificate. The Board recently adopted a regulation change which increased CNA fees, effective December 1. The Board did this to offset a decrease in the amount of federal funding it receives to run the CNA program and an increase in the cost of the program’s discipline cases. Most of the CNA fees had been at or near the bottom of the fee range since the Board was first given the statutory responsibility of regulating CNAs in 1989. (It has regulated RNs and LPNs since 1923.) While the Board is in sound financial health overall, this regulation change will reduce the financial shortfall in the CNA program, and as a result, reduce the subsidy currently provided by RN and LPN licensure fees. Before the Board adopted the change, it held meetings with several affected organizations and individuals. It held two public workshops, one in Las Vegas on June 9, and a second in Reno on June 10. It then held a public hearing on July 23 at its regular meeting in Genoa. The Board advertised the workshops and hearing and posted the proposed regulations in local newspapers, on its web site and in 17 public libraries. It also mailed notices to interested individuals and organizations. In adopting the regulations, the Board considered all written comments it received, as well as public testimony from the workshops and hearings. A total of 11 people attended the workshops and hearings; of the four who testified, all spoke in support of the regulations. One written comment was received; it expressed opposition to the fee increase. If you have any questions about the newly adopted regulations, please call the Board’s Las Vegas office. The amended regulation reads: 632.190 Fees. The following fees are established: 4. For nursing assistants:
Application for a certificate
[
Biennial renewal fee
[
Duplicate certificate
[ Certification examination 90.00 Approval of proctors for certification examination 50.00 Approval of training programs:
If using model curriculum
[
If using alternate curriculum
[
Annual approval of instructors of training programs
[
Annual fee for review of training programs
[
Fred Olmstead joins Board as general counsel Bringing legal services in-house saves costs, increases effectiveness In a move that saved costs and increased effectiveness, the Board recently hired its own full-time legal counsel. Fred Olmstead joined the Board in August, after serving three years as a deputy attorney general for the state of Nevada. For the past 14 years, the Board had a capped contract with the Nevada Attorney General’s office for legal services. In 2003, the Attorney General’s office informed the Board that it would no longer be negotiating capped contracts. Instead, it explained, all boards would be charged an hourly rate for all legal services provided by its attorneys. That rate, extended over a year’s period, would have amounted to an almost doubling of the amount paid under the Board’s capped contract. After carefully considering its options, the Nevada State Board of Nursing decided to join the ranks of the state’s other major health care boards and hire its own in-house attorney. “We were pleased with the legal services we received from the Attorney General’s office, “ Executive Director Debra Scott, MS, RN, explained. “Yet given the amount of legal services our Board needs, employing a full-time legal counsel was the next logical step. It has saved us a substantial amount of money and has improved our effectiveness.” Olmstead earned his Doctor of Jurisprudence from Golden Gate University School of Law in 1995, and his Bachelor of Science in Business Administration from California State University at Long Beach in 1988. After earning his law degree, Olmstead served as a law clerk for Judge Connie Steinheimer, of the Second Judicial District Court in Reno. In 1997, he joined the Law Office of David R. Houston as associate attorney, and then in 1999, Olmstead opened his own law practice. He joined the Attorney General’s office in 2000 as a deputy attorney general, where his responsibilities included conducting disciplinary hearings for state regulatory boards, investigating and prosecuting criminal cases involving insurance fraud, and drafting changes to Nevada’s statutes and regulations. Olmstead’s responsibilities at the Nevada State Board of Nursing include preparing and reviewing contracts, prosecuting violators of the Nurse Practice Act, and providing legal advice and counsel to Board members and staff. “I’m honored to serve as the Board’s first general counsel,” Olmstead said. “I look forward to helping the Board protect the citizens of Nevada.” He and his wife, Patty, have a five–month-old daughter, Teagan.
Address changes, telephone and email remain the same The Board’s Las Vegas office moved to 2500 W. Sahara Ave., Suite 207, Las Vegas, NV 89102-4392. It is on Sahara just west of I-15 across the street from the Palace Station. The telephone, fax and email address did not change. Legislature mandates bioterrorism CEs RN and LPN renewal requirement goes into effect January 1, 2005 The 2003 Nevada legislature passed Assembly Bill 250, which requires that several types of health care professionals, including nurses, take four hours of continuing education “relating to the medical consequences of an act of terrorism that involves the use of a weapon of mass destruction.” The bill specifies that the course of instruction must include: a. An overview of acts of terrorism and weapons of mass destruction; b. Personal protective equipment required for acts of terrorism; c. Common symptoms and methods of treatment associated with exposure to, or injuries caused by, chemical, biological, radioactive and nuclear agents; d. Syndromic surveillance and reporting procedures for acts of terrorism that involve biological agents; and e. An overview of the information available on, and the use of, the Health Alert Network. Completing a bioterrorism course which meets the requirements of the law is a one-time requirement of all RNs and LPNs with active Nevada licenses. Once the course is completed during the two-year renewal period, it doesn’t have to be taken again. Beginning January 1, 2005, all nurses renewing their licenses must have completed this four-hour bioterrorism course as part of their CE renewal requirement. On that date, the Board’s random CE audits will begin to include auditing for proof that renewing nurses have completed the bioterrorism course. The four hours may be counted as part of the 30-hour CE requirement for RN and LPN renewal, and as part of the 45-hour CE requirement for APN and CRNA renewal. While the legislature didn’t mandate the course for CNAs, the Board highly encourages them to take it as part of their 24 hour in-service training renewal requirement. When considering any continuing education course, please make sure that the CE provider is approved by the Board (see below). If the course is not presented by a Board-approved provider, it won’t count toward the 30-hour renewal requirement. In addition, when reviewing a potential bioterrorism course, make sure the course content covers the subject matter mandated by the Nevada legislature. Be aware—many courses entitled “Bioterrorism” only cover one or two of the mandated subjects. If a continuing education provider is an academic institution or recognized by one of the organizations below, it is considered an "approved provider" by the Nevada State Board of Nursing. If a provider doesn’t fall into one of those two categories, please call the Las Vegas office to verify the provider is approved by the Board.
If you have any questions regarding this new requirement, please feel free to call the Las Vegas office.
National Council Honors Nevada Board Member Cookie Bible Receives Exceptional Leadership Award A crowd of 300 applauded Cookie Bible, BSN, RNC, APN, as she accepted the Exceptional Leadership Award from the National Council of State Boards of Nursing (NCSBN) during its annual awards luncheon this August in Arlington, Virginia. NCSBN grants the Exceptional Leadership Award to “an individual who has served as a member board president and who has made significant contributions to NCSBN as well as to the regulation of nursing.” Here are excerpts from her nomination: Cookie Bible believes strongly in the Nevada State Board of Nursing’ s mission to protect the public’s health, safety and welfare through effective regulation of the practice of nursing. So strongly that she is now serving her fourth term as a Board member. Ms. Bible served two terms from 1983 to 1989 and a third term from 1996 to 2000. Her current term expires in 2004. During her 13 years of distinguished service, her fellow Board members have elected her president five times. She has also served three terms as secretary and two terms as vice president. Ms. Bible believes strongly in the mission of National Council of State Boards of Nursing. She has served as a member of the Nursing Practice and Education Committee and its Continued Competence Subcommittee, has been elected twice to the Committee on Nominations, and is in her second year as chair of the Practice, Regulation and Education Committee. The number of elected and appointed positions Ms. Bible has held in the field of nursing regulation shows that she is a leader. What she has accomplished in those positions is exceptional. As chair of NCSBN’s Practice, Regulation and Education Committee, she led the major revision of the Model Nursing Practice Act, which was adopted by the 2002 Delegate Assembly. The importance of this document is reflected in the assembly’s observation that it will serve as a blueprint for nursing regulation in the 21st century. On the state level, Ms. Bible literally led the Nevada State Board of Nursing into a new era of nursing regulation. The last two decades have been a tremendous time of change for health care in general and nursing in particular. Ms. Bible’s leadership helped ensure that nursing regulation kept pace with that change, while keeping public protection as its highest priority. During her first two terms (1983-1989), Ms. Bible led the development of statutes and regulations regarding collaborative practice and prescriptive privileges for advanced practitioners of nursing and the practice of certified registered nurse anesthetists. Under her leadership, the Board began regulating certified nursing assistants and established its highly successful Alternative Program for Chemically Dependent Nurses. Since Ms. Bible was appointed to her third term in 1996, and fourth in 2000, the Board has made progress on many fronts, including expanding efforts increase consumer awareness and access; increasing communication, cooperation and collaboration with the health care community and related state agencies; strengthening competency requirements for certified nursing assistants; and shortening the amount of time it takes to process complaints. Ms. Bible’s contributions to nursing regulation are numerous and far-reaching. Her leadership has shaped the way nurses are educated, how competence is measured, how practice is defined, the way nursing assistants are certified, how impaired nurses are rehabilitated, and the way consumers access Board services. These are just a few examples of the impact she has had on the state and national regulatory environments. Her accomplishments as a leader in nursing regulation are exceptional. Yet, more important than what she has done is how she has done it. Ms. Bible is a true public servant who works tirelessly to advance the mission of the Board. In all that she does, she never loses sight of the fact that the Board’s only reason for existence is to protect the public it serves. For 13 years, she has successfully instilled this unwavering commitment in her fellow Board members and Board staff. As an advanced nurse practitioner currently working for the State Division of Health, Planned Parenthood, Washoe County Health Department, and the University of Nevada Orvis School of Nursing, Ms. Bible brings a wealth of expertise that enriches and informs Board discussions and decisions. She is a leader who understands that one of her most important roles is that of mentor. In that role, she has mentored more than 15 Board members and four executive directors. Now that she is close to her final year of her fourth term, she chose not to run for office and is sharing her invaluable expertise with those who are succeeding her. Given her extraordinary contributions as a leader in nursing regulation over the last two decades, it seems fitting to conclude this nomination of Cookie Bible, BSN, RNC, APN, for the NCSBN Exceptional Leadership Award, with the inscription on a crystal gavel presented to her at the end of her last term as Board president: “Example
is Leadership” Albert Schweitzer Cookie
Bible Presented by the Nevada State Board of Nursing, January 2003
Changes to LPN Intravenous Therapy Regulations Board adopts regulations after public workshops and hearing
In September, the Board amended regulations regarding the delegation of
intravenous therapy by RNs to LPNs. The amendments, which are now in effect,
delete the requirement for 1,500 hours of clinical experience in nursing after
receiving initial LPN licensure and delete the one year experience in nursing
requirement before LPNs are allowed to begin a certification class in IV
therapy. They also allow IV-certified LPNs to administer steroids, to flush
locks, and to assist the RN in administering blood and blood products. The
entire text of the regulations is below. The issue of LPNs administering intravenous therapy has been active for
more than 20 years, since regulations allowing RNs to delegate IV therapy to
LPNs were first adopted in 1981. Changes in practice and knowledge led to
regulation changes in the 1990s, and requests for further changes were brought
to the Board’s Nursing Practice Advisory Committee in 2002. The committee
formed an LPN IV Therapy Task Force to collect data on national practices and
outcomes. As a result of its research, and input from the Nevada nursing
community, the task force recommended changes in regulation that the committee
considered, revised, and approved. The Board accepted the recommendation of its
advisory committee and began the process of adopting the regulation changes. It held two public workshops, one in Las Vegas on August 21, and a
second in Reno on August 28. It then held a public hearing on September 24 at
its regular meeting in Las Vegas. The Board advertised the workshops and hearing
and posted the proposed regulations in local newspapers, on its web site and in
17 public libraries. It also mailed notices to interested individuals and
organizations. In adopting the regulations, the Board considered all written
comments it received, as well as public testimony from the workshops and
hearings. A total of 13 people attended the workshops and hearings; 11 testified
in support of the regulations. Of the 200 written comments received, three
opposed the regulations. If you have any questions about the newly adopted regulations, please
call the Board’s Reno office at 775-688-2620. Text
of Changes to LPN IV Therapy Regulations
The
first regulation amends NAC 632.242 to delete the requirement for 1,500 hours of
clinical experience in nursing after receiving initial LPN licensure. The
second regulation amends NAC 632.450 to delete the one (1) year experience in
nursing requirement prior to allowing LPNs to begin a certification class in IV
therapy, to allow IV certified LPNs to administer steroids, to flush locks, and
to assist the RN in administering blood and blood products. The
last regulation amends NAC 632.455 to delete the prohibition against RNs
delegating to IV certified LPNs the task of administering intravenously blood
and blood products. Items
in bold italic are new, items in brackets and lined through are deleted. NAC 632.242 Additional duties in area of specialization. 1. A licensed practical nurse may collect data and perform a skill, intervention or other duty in addition to those taught in an educational program for practical nurses if:
(a)
(b)
(c)
(1) Has completed a comprehensive program of study and supervised clinical practice which was approved by the board on or after January 1, 1986; (2) Has completed a comprehensive program of study and supervised clinical practice from another state; or (3) Has acquired the additional knowledge, skill and ability. 2. The licensed practical nurse and his employer shall each maintain evidence of: (a) The original documentation and demonstration of the acquired knowledge, skill and ability; and (b) Annual verification of the nurse’s continued competency regarding that knowledge, skill and ability through annual recertification or records of annual evaluations documenting satisfactory repeated performances of the knowledge, skill and ability in the nurse’s area of practice. 3.
For the purposes of paragraph (a) (a) Are listed in the annual Cumulative Index to Nursing and Allied Health Literature that was most recently approved by the board; or (b)
Have been individually approved by the board. NAC
632.450. Procedures delegable to licensed practical
nurses. 1.
A licensed practical nurse
(d)
Administer any of the following medications by adding a solution by
piggyback[
(1)
Antibiotics; (2)
Steroids; and (3)
Histamine H2 receptor antagonists; (e) Administer fluid from a container which is properly labeled and contains antibiotics, steroids, or histamine H2 receptor antagonists that were added by a pharmacist or a registered nurse designated by the pharmacist;
(g)
Except as otherwise provided in
continuous or intermittent infusion through a peripheral device which uses an electronic mechanism to control the flow;
[ 2.
In addition to the procedures set forth in subsection 1, a licensed practical
nurse who has completed a course in intravenous therapy approved by the Board
pursuant to NAC 632.242 and who acts pursuant to a written order of a physician
and under the direct supervision of a registered nurse may assist the registered
nurse in the intravenous administration of blood and blood products by
collecting data and performing simple nursing tasks related to that
administration of blood or blood products. NAC 632.455 A licensed practical nurse may not administer intravenously: 1. Any drug other than an antibiotic or histamine H2 receptor antagonist; 2. Any drug which is under investigation by the United States Food and Drug Administration, is an experimental drug or is being used in an experimental method; 3. Any antineoplastic medications; 4.
Colloid therapy, including hyperalimentation 5. Any medication administered by intravenous push. Local nurses serve on national committees The National Council of State Boards of Nursing recently recognized Nevada nurse Joanne McDaniel, RN, for serving as an item reviewer for the NCLEX-RN Examination. In its press release, the National Council said the NCLEX relies on the commitment of nurses such as McDaniel “to maintain high standards for the assessment of nursing competence at entry level.” The National Council recently named Board member Cookie Bible, BSN, RNC, APN, to a second term on its Practice, Regulation and Education Committee, of which she is chair. It also named Board Vice President Mary Ann Lambert, MSN, RN, to its NCLEX Item Review Committee and Board Executive Director Debra Scott, MSN, RN, APN, to its Model Rules Subcommittee. If you would like to participate in the review or development of items for the national nursing licensure exam, you can learn more by going to the National Council’s web site at www.ncsbn.org, clicking NCLEX Examination, then Developing the NCLEX Examination, then Item Development Application. If you don’t have web access, call 312-787-6555, ext. 496 and leave a message with your name, address and phone number.
Board
adopts practice decision on vein harvesting Acting upon the recommendation of its Nursing Practice Advisory Committee, the Board at its September meeting adopted a practice decision allowing CRNFAs to prepare/harvest a saphenous vein for coronary artery bypass grafting. Below is the text of the decision, which is also on the Board’s web site www.nursingboard.state.nv.us in the Practice Information section. If
the RN is a Certified Registered Nurse First Assist, prepare/harvest a
saphenous vein for coronary artery bypass grafting. This procedure is within the
scope of nursing for a Certified Registered Nurse First Assist (CRNFA) provided
the following guidelines are followed:
If you have questions regarding nursing practice, the first place to look is inside your Nurse Practice Act. If after reading it, you still have questions, call the Reno office. If it is an issue that needs further definition, you may request the Board issue a practice decision. The Board will then ask its Nursing Practice Committee to research the issue and make a recommendation. FOR MORE ANSWERS—GET INTO THE ACT The Nevada Nurse Practice Act is a 5-1/2” by 8-1/2” booklet. It’s just $5 if you buy it at the Reno or Las Vegas office, and $8 by mail (make check or money order payable to the Nevada State Board of Nursing). THE ACT IS ON THE WEB The Board’s web site nursingboard.state.nv.us has a link to the state laws (NRS), regulations (NAC), and practice decisions which make up the Nurse Practice Act. It also contains a separate section on practice information, including guide-lines for determining scope of practice.
What are they and how can you stay within them? As nurses increasingly find
themselves providing care in patient homes or involved in long-term care giving
roles with the chronically ill, the opportunities to “talk about their
troubles” or accept that “little gift” seem to occur innocently and
naturally. But
beware–those behaviors could represent inappropriate involvement in a
patient’s personal life and constitute “boundary crossings” that can have
harmful consequences for the patient and ultimately for the nurse. For
the patient, inappropriate relationships with caregivers can disrupt the ability
of the nurse to respond objectively to the patient’s health care needs. For
the nurse, it can result in disciplinary action by the Nevada State Board of
Nursing. According to Nevada law, engaging in conduct “outside professional
boundaries” with a patient is a violation of the nurse practice act (NAC
632.890 (38). It’s about power and
vulnerability Professional
boundaries are defined as the space between the nurse’s power and the
client’s vulnerability. The power of the nurse comes from the professional
position and the access to private knowledge about the patient. By virtue of
their control over life-sustaining therapies and complex equipment, nurses hold
subtle but tremendous influence over their patients’ behaviors. This
power, which is an essential element in the nurse/patient relationship, enables
the nurse to positively influence the patient’s health status. However, if the
extent of that power is not limited through the establishment of appropriate
professional boundaries, the patient is subjected to unacceptable risks that
could ultimately negatively affect the patient’s physical and emotional
health. Defining and maintaining these professional boundaries are
responsibilities of the nurse, not the patient. Meeting these responsibilities
can be challenging, particularly in today’s healthcare environment. Where exactly are the
boundaries? Boundaries
and professionalism may be defined differently by members of the same staff.
What some consider casual conversation may actually be excessive personal
disclosure when more than mundane personal information is shared with a patient.
Joking and camaraderie may be seen as contributing to a pleasant atmosphere in
some circumstances, but may lead to boundary crossings in others, particularly
if the jovial atmosphere is not counter-balanced by a solid understanding of
professionalism. The same activity engaged in by one nurse may fall within
appropriate boundaries when the clear intent behind the activity is therapeutic,
yet fall outside that line when done by another who has a more personal motive
for the behavior. Consider,
for example, the nurse who gives a young female patient a compact disc featuring
a favorite pop singer. The music is intended to provide a welcome distraction
during strenuous rehabilitation exercises. Conversely,
another nurse gives the same patient the same gift but does it secretly,
indicating that the gift reflects how special the patient is to the nurse. One
nurse has a therapeutic motive for the gift while the other is trying to be
friends. One has crossed a professional boundary, the other has not. Always consider your motivation When
providing “special” privileges to a patient, always consider the motive
behind the action. Was it done openly as encouragement or as a reward for
efforts to comply with the care plan, or was it to gain approval and acceptance
from the patient? Interactions that are well-intended can become boundary
violations when nurses meet their own needs at the expense of their clients. Many
boundary crossings arise out of the helpful, nurturing personality that
motivates people to become nurses in the first place. Avoiding inappropriate
involvement with patients does not mean sacrificing that helping nature.
Instead, helpfulness must be carefully centered along a so-called continuum of
professional behavior. Over-involvement with a patient, which occurs when nurses
engage in excessive personal disclosure, secrecy, or even role reversal is at
one end of the continuum while under involvement (distancing, disinterest and
neglect) is at the other. There are no definite lines separating the zone of
helpfulness from the ends of the continuum; instead, it is a gradual transition
or melding. Even well-meaning involvement
can have bad consequences Dealing
with these issues is further complicated because the concept of boundary
crossings is often poorly understood and resisted. Many nurses find it difficult
to analyze their own motives and fail to see when their well-meaning involvement
with their patients could have dire consequences. Take
for example the nurse who needs a car for his teenage son and knows that his
patient has a car to sell. The nurse buys the car at fair market value and all
seems well. But several days later the car stops running. How will that
situation affect the ability of the nurse to continue to provide care to his
patient? Or
what about the nurse in the nursing home who frequently takes a lonely patient
home with her for the weekend? The nurse decides to accept a new job and leaves
the facility and her patient behind. Will the patient be able to accept the
sudden loss of her weekend excursions with her “friend” without feeling
abandoned? Finally,
what about the home-health nurse whose husband has lost his job and whose
three-year-old son needs intensive speech therapy that is not covered under the
nurse’s health insurance? One day the nurse shares her problems with her
patient who then offers to loan her money to take care of all of her financial
obligations. The nurse accepts the loan fully intending to repay the money. How
will this financial arrangement affect the ability of the nurse to be an
objective, effective caregiver, even if the money is eventually repaid? Your employer can help When
a relationship is strictly professional, it
has checks and balances that help prevent patients from getting upset with staff
interactions. Helping staff to understand this very complex issue and to
appreciate the importance of professional checks and balances is a challenge
faced by most supervisors and managers. Employers
can help by developing policies and guidelines specific for their own
institutional circumstances that define a caring, professional relationship and
discourage or forbid inappropriate personal friendships with patients. To
be effective these policies must reflect the sorts of care relationships that
are commonplace in the particular setting. For example, nurses in acute care
typically do not have the same relationship issues as nurses in long-term care
settings who see the same patients for prolonged periods of time. Employers
should be sensitive to boundary issues and offer timely advice or counseling
when it appears that a nurse may be risking over-involvement with a patient. In
those settings especially at risk for boundary crossings, staff orientation
should deal with the issue proactively, and there should be ongoing in-service
presentations on the topic. Awareness is the key What
can the individual nurse do to assure boundary crossings do not occur? Awareness
is the key. Nurses who are clear about their own needs and the needs of their
patients, and who can separate the personal from the professional, will find
themselves acting in the best interest of their patients. It is possible to
maintain a caring professional relationship with a patient without sacrificing
the patient’s autonomy or dignity. Patients
come to nurses because they need professional healthcare, not because they need
a friend. Being that professional caregiver is really what it is all about. (Adapted with permission from an article in Momentum, the Ohio Board of Nursing’s Newsletter, and Professional Boundaries, a National Council of State Boards of Nursing publication.) Have you ever . . . shared your
personal problems with a patient? . . . given a
patient a gift? . . . complained to
a patient about a co-worker? . . . socialized
with a patient outside of your professional capacity? . . . flirted with a
patient or engaged in sexual banter “all in good fun”? . . . accepted a
gift of more than minimal value from a grateful patient or family member? . . . you may have crossed the line. Does client consent make a
sexual relationship acceptable? The Nurse Practice Act specifically prohibits nurses from engaging in sexual conduct with a patient or client (NAC632.890 (29). If the patient accepts, even if the patient initiates the sexual contact, a sexual relationship is still considered sexual misconduct for the healthcare professional. It is an abuse of the nurse-client relationship that puts the nurse’s needs first. It is always the responsibility of the healthcare professional to establish appropriate boundaries with present and former clients. Warning signsExcessive self-disclosure The nurse discusses personal problems or aspects of
his or her intimate life with the patient, or discusses feelings of sexual
attraction. Secretive behavior The nurse keeps secrets with the client and/or
becomes guarded or defensive when someone questions their interaction. “Super Nurse” behavior The nurse believes that he or she is immune from
fostering a nontherapeutic relationship and that only he or she understands and
can meet the client’s needs. Singled-out patient The nurse spends inappropriate amounts of time with
a particular patient, visits the patient when off duty or trades assignments to
be with the patient. This may also be reversed, with the patient paying special
attention to the nurse, such as giving the nurse gifts. Selective communication The nurse fails to explain actions and aspects of
care, reports only some aspects of the patient’s behavior, or gives “double
messages.” In the reverse, the patient turns repeatedly to the nurse because
other staff members are “too busy.” Flirtation The nurse communicates in a flirtatious manner,
perhaps employing sexual innuendo, off-color jokes, or offensive language. “You and me against the
world” behavior The nurse views the patient in a protective manner
as his or her patient, tends not to accept the patient as merely a patient or
sides with the patient’s position regardless of the situation. Failure to protect the patient The nurse fails to recognize feelings of sexual attraction to the patient, consult with supervisor or colleague, or transfer care of the patient when needed to support boundaries. |