The Annual Business Meeting of the Nevada State Board of Nursing was called to order by President Helen Vos, MSN, RN, at 9:15 a.m. on July 19, 2006, at the Great Basin College,

1500 College Parkway, Elko, Nevada 89801.

MEMBERS PRESENT

Helen Vos, MSN, RN, President

David Burgio, MS, RN, APN, Vice President

Dorothy Perkins, CNA, Secretary

Doreen Begley, MS, RN, Member

Joseph Cortez, Consumer Member

Mary Ann Lambert, MSN, RN, Member

Betty McKay, LPN, Member

OTHERS PRESENT

Debra Scott, MS, RN, Executive Director

Chris Sansom, RN, Director of Operations

Fred Olmstead, General Counsel

Cindy Kimball, Information Officer
Donna Cowling, MSN, RN, Education Consultant

Dean Estes, Accountant/Technology Officer

Patty Shutt, Site Operations Supervisor

CALL TO ORDER – 9:15 a.m.

PUBLIC COMMENT: Olena Dorin, RN, staff nurse in Obstetrics with Northeastern Nevada Regional Hospital in Elko and member of SEIU Nurse Alliance, gave testimony on possible legislation banning mandatory overtime and requested the Board support such legislation. O. Dorin also gave testimony on possible legislation regarding certified medication aides and requested the Board oppose such legislation. Jessica Borkman, RN, staff nurse in the Emergency Room with Northeastern Nevada Regional Hospital in Elko and member of SEIU Nurse Alliance, gave testimony on possible legislation mandating numeric nurse to patient ratios and requested the Board support such legislation.

APPROVAL OF CONSENT AGENDA

It was moved and seconded to approve the Consent Agenda, identified as items: A.1-4, 6, 13, B.1, E.1, F.1 MOTION CARRIED.

A.     BOARD GOVERNANCE AND ADMINISTRATION

1. Approval of minutes of Board Meeting, May 17-19, 2006: Approved under the Consent Agenda.

2. Annual approval of authorization of executive director to act as Board agent for financial transactions, keeper of the records (for issuing of and responding to subpoenas) and authority to accept voluntary surrender of licenses/certificates, and as spokesperson for actions with other community groups or the media and in other routine business functions: Approved under the Consent Agenda.

3. Annual review of Code of Ethics, Board member roles and responsibilities, and Board function list: Approved under the Consent Agenda.

4. Annual adoption of Non-Discrimination Policy: Approved under the Consent Agenda.

5. Contract ratifications: Kohn Colodny LLP: Removed from agenda.

6. Annual review of the Board of Nursing Mission Statement: Approved under the Consent Agenda.

7. Preliminary review of FY 05/06 financial statement: D. Estes presented the preliminary review of FY 05/06 financial statement and responded to Board member questions.

8. Final progress report on FY 05/06 Goals and Objectives: D. Scott reviewed the progress made on the Board’s FY05/06 Goals and Objectives and responded to Board member questions.

9. Review, discussion and action on Board’s long-term goals: Board members discussed its long-terms goals and whether they needed revising. They decided to change Goal C to delete the words “Implement and update the plan” before “to expand use of information technology,” broaden the scope of Goal D to encompass reviewing and updating regulatory processes governing education programs, and to add Goal F: Active involvement in legislative processes.

10. Review statistics and trends: C. Sansom presented information and responded to Board member questions on statistics and trends in scope of practice inquiries, licensure, certification, discipline, investigations, and compliance for FY 05/06.

11. Discussion of the results of the Self-Assessment for Nonprofit Governing Boards: H. Vos led the discussion and the Board discussed each item of self-assessment, considering all responses and comments.

12. National Council of State Boards of Nursing

1. Approval of delegates for Delegate Assembly 2006: The Board named H. Vos and D. Scott delegates and D. Cowling and C. Sansom alternates.

2. Direction to delegates for Delegate Assembly 2006: D. Scott reviewed the information and agenda prepared by the National Council for the Delegate Assembly. She said a major item is a change in the bylaws to give more authority to National Council Board members. Board members discussed the proposed change from area representation to at-large members, and giving greater decision-making authority to Board members.

13. Annual approval of Board policy and procedure manuals

1. General Policies and Procedures: Approved under the Consent Agenda.

2. Employee Handbook: Approved under the Consent Agenda.

3. Board Resource Manual: Approved under the Consent Agenda.

14. Discussion regarding hearing costs: D. Estes presented information regarding the amount charged and collected in FY05/06 for hearing costs. F. Olmstead described why costs are usually not collected for default hearings where the respondent fails to appear. He added the Board does not collect costs if the respondent stipulates to the guilt of the allegations.

15. Discussion and direction regarding the 2007 legislative session. H. Vos led the discussion.

1. Discussion regarding mandatory overtime: D. Scott said there may be a bill sponsored by SEIU banning mandatory overtime. The Board members reviewed the state of Washington’s legislation, as provided by SEIU. Discussion ensued, regarding how important it is that nurses work a safe number of hours and that it is the individual nurse’s responsibility to know they are safe to practice. Board members expressed concern regarding the lack of data on how many hospitals actually require mandatory overtime and said they would need to see the actual bill before they could decide if they would take a position, and if so, what that position would be. David Henson, chief executive officer of Northeastern Nevada Regional Hospital in Elko, testified that his hospital does not have mandatory overtime and that safety issues encompass nurses who choose to work too many hours, and even the 12-hour shifts themselves. He added the definitions and exact language in a proposed bill would be important to scrutinize.

2. Discussion regarding numeric staffing ratios: D. Scott said there will be a numeric staffing ratio bill introduced this legislative session, but the Board is unaware of who may bring it forward or what the language will be. The Board reviewed a letter in support of numeric staffing ratios from Linda Morton, RN, and a news release regarding the American Nurses Association suing the federal Department of Health and Human Services for inadequate staffing in hospitals. H. Vos reminded the Board its position in the 2003 legislative session was to support safe staffing, not to take a position for or against numeric staffing ratios. D. Burgio asked if there was now data regarding how well the California ratio law was working; discussion ensued regarding how recently it was implemented and differing opinions regarding its success. H. Vos said the Aiken study, referenced during Public Comment, addressed outcomes, but not necessarily what would be the “correct” ratios. Discussion ensued regarding differing acuity levels, different nurse expertise levels, and different hospital types. H. Vos concluded the discussion by stating that the Board would need to see the bill draft and any data that is available before it could take a position or decide if it was appropriate to take a position.

3. Discussion regarding Board sponsored BDR. F. Olmstead said the Board’s initial bill draft request includes a request to raise some of the fee ranges, a clarification of unprofessional conduct, and increasing hours for nursing assistant training programs. Regarding the fee range request, D. Estes stated the 2005 auditor’s report showed expenditures outpacing revenue. D. Scott said the Board, at its March meeting, directed staff to request a statutory revision to increase the fee range in 2007. She said there were no immediate plans to introduce regulatory increases, but the Board needs to be prepared so it can ensure it does not run into a deficit position. She further stated that the Board has not raised nursing fees for 12 years. D. Estes described ways the Board has saved expenditures, especially through the use of technology. However, demand for services continues to increase. Regarding the nursing assistant training programs, the bill draft requests an increase in the number of hours required for CNA training programs from 75 hours to no less than 120 hours. The CNA Advisory Committee had recommended the change in statute, and the Board agreed to accept the recommendation at its March meeting, based on several factors: an Office of the Inspector General study which found that nurse aide training, training hours, clinical hours, and teaching methods do not meet current patient needs; the amount of instruction that needs to be accomplished; and the current number of hours in Nevada’s 21 nursing assistant training programs (13 require more than 120 hours, five require more than 100 hours, and three require less than 100 hours).

4. Discussion of legislative issues regarding education: This item was discussed under Agenda Item E.2.

5. Discussion regarding certified medication aides: C. Sansom said that while the Board has no plans to introduce legislation regarding certified medication aides, there is interest in the state to allow certified medication aides in long-term health care settings. She said that while there is much concern regarding safety, 47 states have medication aides in some form, and in 21 of those states, it is the nursing boards which regulate the aides. Board members asked questions and discussed issues regarding safety, costs, and how the addition of the aides would affect the roles of RNs, LPNs and CNAs. H. Vos concluded the discussion by stating that its purpose was to initially explore the issue, rather than take a position on a bill the Board has not yet seen.

6. Discussion regarding nurse licensure compact: D. Scott stated the Board is not planning to go forward with a 2007 bill to introduce the nurse licensure compact, after attempts by the Nevada Hospital Association in 2001 and the Board in 2003 both failed. She said that since then, more states have joined the compact (22 states have enacted legislation), and there is interest on the part of the Legislative Health Care Committee and the Governor’s Commission on Medical Education, Research and Training to introduce a bill giving the Board authority to enter the compact. She said that in 2003, the Board went to extensive lengths to craft language in collaboration with NNA, and that the compact would not be used to break strikes. F. Olmstead discussed how other states have implemented the compact in statute and in rules. He said that rather than requiring states to meet the fingerprinting requirement in a certain number of years, the compact rules now require states to “work toward requiring fingerprinting” as a condition of licensing. Board members expressed concern about this change and discussed the pros and cons of entering into the compact.

7. Discussion of other legislative issues: Board reviewed the latest list of bill draft requests published on the Nevada Legislative Counsel Bureau’s website.

16. Review, discussion and action regarding travel policy. D. Estes reviewed the Board Salary and Travel Reimbursement Policy for the Board’s information and reference, and responded to Board member questions.

17. Review and discussion regarding staff survey results: D. Scott reviewed the results of the 2006 staff survey, highlighted comparisons with the 2005 survey, and responded to Board member questions.

18. Review, discussion and action regarding Unscheduled Absences policy: D. Scott explained staff was recommending a change to the Unscheduled Absence policy to address leave taken due to a death in the immediate family and incorporate the language in state regulation NAC 284.562. It was moved and seconded to accept the changes to the Unscheduled Absences policy as written.  MOTION CARRIED.

 B.     LICENSURE PROGRAMS

1. Annual adoption of NCLEX passing scores as determined by National Council as the official competency examination for licensure: Approved under the Consent Agenda.

2. Review, discussion and possible action regarding licensure requirements

1. Discussion regarding CES foreign graduates: C. Sansom gave the background regarding the Board’s requirement for all graduates of international nursing schools to have their professional credentials (nursing education and professional licenses) evaluated by the Commission on Graduates of Foreign Nursing Schools (CGFNS). C. Sansom said, in the past, the Board has made an exception in the case of CGFNS certificate holders, where Board staff reviews the transcripts, rather than asking for a CGFNS Credential Evaluation Service (CES) Healthcare Profession and Science Course by Course report. She explained this is burdensome to staff and the Board often does not have the expertise to review the transcripts and must hire outside experts to do so. The Board directed staff to make no exception to the Board’s CES requirement for any new applicants to continue to meet the Board's mission of public protection.

C.     CERTIFICATION PROGRAMS: No business.

D.    DISCIPLINE PROGRAMS

1. Discussion regarding continuing education remediation: C. Sansom reviewed the list of possible continuing education courses compiled for Board members for use when imposing discipline.

E.     EDUCATION

1. Annual Board approval of recognized accrediting bodies: Approved under the Consent Agenda.

2. Review, discussion and action regarding proposed revision of the Request For Waiver of Faculty Education Requirements policy: D. Cowling presented background regarding this agenda item and D. Scott discussed the latest developments regarding this issue, saying it was important to have a public discussion of the issues. The Board directed D. Scott to bring forward concept and wording for a regulation change that would allow a BSN-prepared faculty member to teach in a clinical setting in nursing education programs. D. Scott said she would bring the proposed concept and wording to the Board’s Education Advisory Committee meeting in August, and then to the Board’s regular meeting in September.

3. Review, discussion and possible action regarding draft proposal of advisory opinion to the Board that would require both didactic and clinical content for RN and LPN refresher courses: D. Cowling presented the research and discussion by the Board’s Education Advisory Committee which led to the recommendation that both didactic and clinical content be required for RN and LPN refresher courses. The Board directed D. Cowling to research the number of hours the Board-approved programs currently require and bring that data to its September meeting.

4. Review, discussion and action regarding composition of the Education Advisory Committee: D. Cowling presented a plan to increase the number of practice-related members on the Education Advisory Committee to two. Board discussion ensued regarding the type of nursing practice the new members should represent. It was moved and seconded to add two “nursing practice” positions, defined as nurses who are “actively engaged in the education of nurses in a practice setting,” to the Education Advisory Committee. MOTION CARRIED.

5. Review, discussion and action regarding applications for the Education Advisory Committee: It was moved and seconded to appoint Robert Rowe, Jr., MSN, RN, to represent rural acute care practice, and Mable H. Smith, PhD, JD, RN, to represent the University of Southern Nevada, on the Education Advisory Committee. MOTION CARRIED. M.A. Lambert abstained.

6. Review and discussion of Board's regulatory oversight of nursing education programs: D. Scott gave the background regarding this item and D. Cowling presented information that 48 out of 50 boards of nursing regulate nursing education programs. Board members had questions regarding how many boards specified the number of clinical hours required for graduation and how many defined clinical practice. The Board directed staff to put the question of the definition of clinical component on the August Education Advisory Committee meeting agenda.

7. Review, discussion and action regarding the Apprentice Nurse Skills List: D. Cowling presented the research and discussion that led the Education Advisory Committee to recommend the Apprentice Nurse Skills List be revised to clarify that the apprentice nurses are employees of health care facilities. Board member discussion ensued regarding the possibility that a student could be failing her courses, but still be employed as an apprentice nurse. It was moved and seconded to approve the revision and add, or failure to progress in the program for any reason, regarding a student's eligibility to participate in the Apprentice Nurse program, to the Apprentice Nurse Skills List. MOTION CARRIED.

F.      NURSING PRACTICE:

1. Annual adoption of Board practice decisions: Approved under the Consent Agenda.

2. Discussion regarding APN independent practice: D. Scott stated it appears that the NNA Special Practice Group will not pursue independent practice this legislative session.

3. Review, discussion and action regarding the advisory opinion regarding the role of the school nurse in delegation or assignment to a parent designee: B. McKay, Board member liaison to the Nursing Practice Advisory Committee, described the discussion that led to the committee recommendation to revise the School Nurse Advisory Opinion to remove the unintended implication that nurses would delegate to family members/friends and clarify that family members/friends are not subject to the Nurse Practice Act. It was moved and seconded to approve the proposed revisions to the advisory opinion as written. MOTION CARRIED.

4. Review, discussion and action regarding practice decision, Epidural Catheter Removal: D. Scott described the research and discussion that led to the Nursing Practice Advisory Committee’s recommendation to revise the Epidural Catheter Removal Practice Decision to allow RNs to remove an epidural catheter in situ for greater than 72 hours and to clarify that they may not remove any tunneled epidural catheter. Board members discussed that this revision reflected the changes in length of hospital stays and current literature. H. Vos asked the decision include the results of the most recent literature search. It was moved and seconded to approve the revision to the Epidural Catheter Removal Practice Decision with the addition of the most recent literature citations. MOTION CARRIED.

5. Review, discussion and action regarding application(s) for the Nursing Practice Advisory Committee: It was moved and seconded to reappoint Karen Winter, RN, and Cheryl McKinney, RN and appoint Joseph Rosich, RN, and Caroline Copeland, RN, to the Nursing Practice Advisory Committee. MOTION CARRIED.

6. Review, discussion and action regarding application for the Advanced Practice Advisory Committee: It was moved and seconded to appoint Susan VanBeuge, MSN, RN, APN, to the Advanced Practice Advisory Committee. MOTION CARRIED.

ADJOURNMENT

Meeting adjourned at 9:13 a.m. on July 21, 2006.