BON/DADS Implementing UAP Administration of Meds, LVN Pilot Program

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1 Page 1 Page 8 Page 3 Quarterly circulation approximately 293,000 to all RNs, LVNs, and Student Nurses in Texas. BON/DADS Implementing UAP Administration of Meds, LVN Pilot Program by J. Cunningham, Texas Nursing Voice Staff In 2011, during the Texas Legislative Session, Senate Bill 1857 was passed. It amended the Texas Human Resources Code, Title 11, Chapter 161 by adding a Subchapter D-1. The subchapter, Administration of Medication for Clients with Intellectual and Developmental Disabilities, allowed as of September 1, 2011 an unlicensed person to administer specific types of medications to certain clients. SB 1857 identified the medications: an oral or topical medication, or a metered dose inhaler. And it specified the certain clients: persons with an intellectual and developmental disability who are served in small- (1-8 beds) or medium- (9-13 beds) sized intermediate care facilities (ICF), or by waiver programs administered by the Texas Department of Aging and Disability Services (DADS), specifically Home and Communitybased Services (HCS) and Texas Home Living (TxHmL). Join the Texas Nurses Association Today! current resident or Presort Standard US Postage PAID Permit #14 Princeton, MN What SB 1857 now allows is the administering of the identified medications to the certain clients by an unlicensed person who is defined as an individual not licensed as a health care provider who provides services at or for one a facility or program as defined by the legislation. The range is broad for who the unlicensed person could be, for instance, nurse aide, orderly, home health aide, unlicensed assistive personnel (UAP) to a licensed nurse, or professional nursing student (care provided for monetary compensation; not as part of a formal education program). SB 1857 does set out conditions under which unlicensed staff may administer medications without RN delegation and supervision. The clients must have stable or predictable health conditions and they must have been personally assessed by a registered nurse (RN). Additionally, the unlicensed person must have been trained or determined by an RN or licensed vocational nurse (LVN) under the direction of an RN, to be competent to administer the medications. Application on page 14. Under the set out conditions of the new law, the RN s liability is limited to performing the client assessment, providing the training, and determining competency of the UAP. The UAP would not be administering medication as a delegated function and therefore, the RN would not maintain accountability for the actual medication administration of the UAP. Background In community settings, for instance, many activities traditionally considered nursing tasks, such as medication administration or catheterization, become self-care or health maintenance activities. Many people perform these activities for themselves. Frequently, people with disabilities view those tasks simply as activities of daily life rather than tasks that need intervention. Sometimes, people with disabilities are not able to perform for themselves such activities of daily life BON/DADS Implementing UAP continued on page 11 Inside this Issue Nursing Practice Question: Is Texting/ Receiving Patient Information a HIPAA Rules Violation?... 3 Diversity Awareness in the Clinical Setting. 4 Texas Team Action Coalition Co-Leader Perryman Named Texan of the Year... 5 CMS Proposed Rule Changes Nurses Taking Action in Texas: A Series... 7 Texas Team Update A New Year s Story of Hope and Goodwill TPAPN Style Membership Application...14

2 Page 2 Texas Nursing Voice January, February, March 2012 Texas Nurses Association Districts and Presidents District 1: Laura Sarmiento Phone: laurasarmiento01@aol.com District 2: Beth Terry Phone: bterry@amarillo heartgroup.com District 3: Dennis Cheek Phone: d.cheek@tcu.edu District Address: Renee James P.O. Box Ft. Worth, TX Office: tna3@usapathway.com Website: District 4: Frances (Frankie) Phillips Phone: frances.phillips@va.gov District Address: Pat Pollock P.O. Box Dallas, TX Office: d4tna@flash.net Website: District 5: Gail Acuna Phone: gail.acuna@st.davids.com Website: District 6: Paula Stangeland Phone: pstangeland9@gmail.com Website: District 7: Linda Pehl Phone: lpehl@umhb.edu District Address: P.O. Box 3041 Temple, TX Presidents of the 28 state-wide Districts of Texas Nurses Association, as well as some District offices, are listed below. They invite you to contact them with questions or comments about TNA District membership and involvement. District 8: Sarah Williams Phone: williajs@uiwtx.edu Website: org/districts/08/ District 9: Dana Bjarnason Phone: dana_bjarnason@hchd. tmc.edu District Office: Melanie Truong 2370 Rice Blvd., #109 Houston, TX Office: tna9@tnadistrict9.org Website: District 10: Joyce Sims Phone: jsims@mclennan.edu District 11: Marcy Beck Phone: marcy.beck@mwsu.edu District 12: Alicia Boaze Phone: alicia.boaze@bhset.net District 13: Vacant Nationally accredited No campus visits Competitive Tuition Liberal Credit Transfers District 14: Joe Lacher Phone: joe.lacher@utb.edu District 15: Andrea Kerley Phone: akerley@ hendrickhealth.org Website: org/districts/15/ District 16: Wilma Powell Stuart Phone: wilmastuart@ shannonhealth.org Courses that fit your schedule. Enroll today! Go to: Toll Free: District 17: Eve Layman Phone: evelayman@yahoo.com Web site: org/districts/17/ District 18: Jeff Watson Phone: jeff.watson@ umchealthsystem.com Website: org/districts/18/ District 19: Tara Patton Phone: power4nurses@gmail.com Website: org/districts/19/ District 20: Denise Neill Phone: NeillD@uhv.edu District 21: Rebekah Powers Phone: Rebekah.powers@ midland-memorial.com District 22: Toni McDonald tmcdonald@ hcewildblue.com District 25: Inger Zerucha Phone: zinger65@sbcglobal.net District 26: Vacant District 28: Jenny Wilder Phone: jennyrwilder@gmail.com District 29: Beverly Howard Phone: brv1258@yahoo.com District 35: Kim Gatlin Phone: kgatlin@ntcc.edu District 40: Contact TNA Phone ext brichey@texasnurses.org Published by: Arthur L. Davis Publishing Agency, Inc. TEXAS NURSING Voice A publication of Texas Nurses Association January, February, March 2012 Volume 6, Number 1 Editor-in-Chief Clair B. Jordan, MSN, RN Managing Editor Joyce Cunningham Creative Communications Deborah Taylor Circulation Manager Belinda Richey Editorial Contributors Therese Clinch, MSN, RN; Ginger Coburn, LCDC; Joyce Cunningham; Alexia Green, PhD, RN, FAAN; Christy Meriwether; Michael Van Doren, MSN, RN, CARN Editorial Advisory Board Stephanie Woods, PhD, RN, Dallas Jose Alejandro, MSN, RN, MBA, CCM, Dallas Patricia Allen, EdD, RN, CNE, ANEF, Lubbock Sandra Kay Cesario, PhD, RN, C, Pearland Jennifer D.M. Cook, PhD, MSN, RN, San Antonio Anita J. Coyle, PhD, RN, CHES, Sanger Thelma L. Davis, LVN, Giddings Anita T. Farrish, RN, MHSM, NE-BC, Waco Patricia Goodpastor, RN, The Woodlands Patricia Holden-Huchton, RN, DSN, Denton Tara A. Patton, BSN, RN, Palestine Dianna Lipp Rivers, RN, CNAA, BC, Beaumont Executive Officers Margie Dorman-O Donnell, MSN, RN, President Victoria England, RN, MBA, Vice President Claudia Turner, MSN, RN, Secretary-Treasurer Regional Directors of Texas Nurses Association June Marshall, DNP, RN, NEA-BC North Region Eve Layman, PhD, RN, NEA-BC South Region Kim Belcik, BSN, RN-BC Central Region Viola Hebert, MA, BSN, RN East Region Jo Rake, MSN, RN, CNAA West Region Executive Director Clair B. Jordan, MSN, RN TEXAS NURSING Voice is published quarterly January, February, March; April, May, June; July, August, September; and October, November, December by Texas Nurses Association, 7600 Burnet Road, Suite 440, Austin, TX Editorial Office TEXAS NURSING Voice, 7600 Burnet Road, Suite 440, Austin, TX , tnveditorial@texasnurses.org Address Changes Send address changes to Texas Nurses Association, 7600 Burnet Road, Suite 440, Austin, TX , tnvcirculation@texasnurses.org Advertising Arthur L. Davis Publishing Agency, Inc., 517 Washington St. P.O. Box 216, Cedar Falls, Iowa , sales@aldpub.com Texas Nurses Association and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement. Acceptance of advertising does not imply endorsement or approval by Texas Nurses Association (TNA) of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. TNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect the views of the staff, board, or membership of TNA or those of the national or local associations. Copyright 2011 by Texas Nurses Association, a constituent member of the American Nurses Association.

3 January, February, March 2012 Texas Nursing Voice Page 3 Nursing Practice Question: Is Texting/Receiving Patient Information a HIPAA Rules Violation? by Therese Clinch, MSN, RN, Practice Director, Texas Nurses Association A growing trend in health care today is the practice of physicians texting patient information specifically, texting orders to other physicians, independent licensed practitioners, and nurses in hospitals or other health care settings. Sure, it s a fast, convenient method for physicians to relay information and orders but is it legal? The answer is No. Texting patient information is not legal unless the text messages are transmitted through a secure and encrypted network. According to The Joint Commission 1, it is not acceptable for physicians or licensed independent practitioners to text patient information or patient orders to nurses, physicians, licensed independent practitioners in the hospital or other health care setting. The reasons: Text messages do not provide message recipients with the ability to verify the identity of the person sending the text, and There is no way to keep the original text message as validation of what is entered into the medical record. This practice of sending/receiving text messages of patient information can lead to HIPAA violations for the hospitals or health care settings, and to the person or persons who accept and act upon the texted messages of patient information or orders. The violations can range from civil law suits to criminal suits resulting in fines up to $50,000 and up to one-year imprisonment for any person who knowingly obtains or discloses individually identifiable patient health information². The Standards for Privacy of Individually Identifiable Health Information, the Privacy Rule that implements the requirements of the Health Insurance Portability and Accountability Act of 1996, establishes the protection of certain health information. As is explained by the U.S. Department of Health & Human Services HIPAA Privacy Rule: A major goal of the Privacy Rule is to assure that individuals health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public s health and well being. The Rule strikes a balance that permits important uses of information, while protecting the privacy of people who seek care and healing. Given that the health care marketplace is diverse, the Rule is designed to be flexible and comprehensive to cover the variety of uses and disclosures that need to be addressed. The nurse s duty is to ensure patient safety and security of patient information in the workplace. Nurses need to know their workplace s policies or protocols on the texting of patient information. Most of all, nurses must report any repeated violations related to this practice through the workplace s chain of command to ensure that no HIPAA violation occurs. If the practice of texting patient information other than over a secure and encrypted network is going on in your workplace, it s your responsibility to immediately notify your supervisor. References 1. The Joint Commission (2011), Standards Frequently Asked Questions (FAQs) accessed on 11/23/2011 from www. jointcommission.org/standards. 2. US Department of Health and Human Services (2011), HIPAA rules accessed on 12/ 6/2011 from privacy/hipaa. Comments/questions are welcomed at practice@texasnurses.org I m not just a nurse. I m inventing new models of Veteran s health care. Chris, VA Nurse Apply Today: VAcareers.va.gov Follow VA Careers Start the New Year with New Surroundings Enjoy going to work each day without the hassle of heavy traffic. Have an uncomplicated drive in the country and come to a facility that cares enough to make a difference in the lives of our residents. Cypress Woods Care Center 135 ½ Hospital Dr. Angleton, TX RNs, LVNs, CNAs Education is a journey. Discover yours... Online. Registration is free, fast, confidential and easy! You will receive an when a new job posting matches your job search. Become Your Own Boss and LOVE Your NEW Nursing Career New Career for Nurses, 3-Day Certification Course, Receive continuing education credit and a new credential, Secret to Becoming a 6-Figure Nurse Revealed Here America s Favorite Nursing Educator Tracy McClelland Enterprise, Inc Nursing Success System 1214 North Peterson Ave Suite P Douglas, GA ycarte@windstream.net For my FREE Special Nursing Report visit me online Austin State Hospital RNs/LVNs who are able to work with persons with mental illness. Experience preferred but not required. Ability to communicate a must. Call , come by 4110 Guadalupe, or apply online at: hhsc.state.tx.us & select applicant under career opportunities and select facility location of Austin State Hospital and search. EEO. Drug Screen, references and criminal background check required. Partnering to Find Solutions Toward Wellness Take care of your patients AND your career with a CCNE-accredited nursing degree from WGU Texas! Relevant and Accredited CCNE-accredited degree programs designed to produce highly qualified, caring nurses, educators, and administrators. Flexible Log in and learn anytime, anywhere you can find the time before, during, and after rigorous nursing shifts. Affordable One of the best values in higher education, WGU Texas tuition is among the most affordable in the entire country. Competency-based Challenging programs that measure your learning rather than your time spent in class. Programs begin the first of every month. 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4 Page 4 Texas Nursing Voice January, February, March 2012 SAN marcos treatment center, in continuous operation for more than half a century, is recruiting Texas Licensed Registered Nurses to become part of an experienced and effective treatment team. Our highly specialized residential programs provide 24 hour care to a broad spectrum of adolescent boys and girls ages 8-17 with psychiatric, neuropsychiatric, and developmental disturbances. Apply in Person, Call, or Mail/Fax resume to: san marcos treatment center 120 Bert Brown Road San Marcos, TX robin.cunningham@psysolutions.com Phone: (512) Fax: (512) Attn: Human Resources Pre-employment Drug Screen, Health Assessment & Criminal History Check required An Equal Opportunity Employer WE DEFEND NURSES! (throughout the State of Texas) BON Defense TPAPN Assistance Peer Review Assistance RN and LVN Reinstatements Hearings and Appeals Nurse Malpractice Defense Are you under investigation or received a complaint letter? Call our law firm NOW! Austin: (Located six blocks from Texas Board of Nursing) Houston: San Antonio: belolaw.com Medication Reconciliation in the Clinical Setting Are you involved with medication reconciliation in your clinical setting? Many nurses are not aware of the medication reconciliation process being implemented in their clinical setting, yet as the primary coordinator of patient care, they have an integral part in the medication reconciliation process. Medication reconciliation is a complex process that impacts all patients as they move through all health care settings. The process involves comparison of a patient s current medication regimen against a physician s admission, transfer or discharge orders to identify discrepancies.¹ Hospitals and health care settings have developed medication reconciliation teams to implement medication reconciliation in stages. Medication reconciliation is part of the Meaningful Use of Electronic Medical Records initiative that is to be operational by Nurses, along with physicians and pharmacists, are part of the education and training on medication reconciliation to understand how the medication reconciliation process is designed to integrate into their current workflow and support medication management efforts to prevent medication errors and the potential for patient harm.¹ The nurses role during the implementation phases are: How to conduct a patient interview to inquire about patients current medications The thought process or critical thinking involved with performing medication reconciliation As a patient advocate, it s the duty of the nurse to be trained and educated on all aspects of medication reconciliation in order to ensure patient safety. Reference 1. US Department of Human and Health Resources, Agency for Healthcare Research and Quality (2011). Medication at Transitions and Clinical Handoffs (MATCH)Toolkit for Medication Reconciliation accessed on 12/9/2011 from www. ahrq.gov/qual/match. Search for Balance Find your perfect nursing career on nursingald.com Registration is free, fast, confidential and easy! You will receive an when a new job posting matches your job search. Diversity Awareness in the Clinical Setting Are You in the Know? Patients with varied cultural backgrounds are increasingly accessing the health care system every day. As patient advocate and coordinator of care, it s the nurse s duty to identify and be knowledgeable about these patients cultures, and to know how to modify and communicate the care of these patients to other health care providers and workers within the clinical setting. In your clinical setting, you may as of late be noticing workplace activities related to addressing patients with diverse cultural backgrounds, from your facility adding or changing communication/ linguistics services to improve patient-provider communication, to improving the cultural competencies of staff through training and education on population-specific patient care. These days, according to The Joint Commission, there is no one size fits all in an organization related to cultural competence and effective communication.¹ Health care workers and facilities should: Know the needs of the patient populations and how well their needs are being met within the clinical setting; Become aware of cultural and language barrier issues and implement a range of practices in a systemic manner aligned with patient needs and organizational resources. This flurry of activities is in relation to The Joint Commission patient-centered communication standards, approved in December 2009, released in January 2010, and effective July 1, There re two parts to the initiative: 1. Effective patient-provider communication Successful communication takes place only when providers understand and integrate the information gleaned from patients, and when patients comprehend accurate, timely, complete and unambiguous messages from providers in a way that enables them to participate responsibly in their care. Use of competent interpreters is part of this initiative too. 2. Cultural Competence Cultural competence requires organizations and their personnel to do the following: value diversity self assessment manage the dynamics of difference acquire and institutionalize cultural knowledge adapt to diversity and the cultural contexts of individuals and communities served. Nurses are responsible to act according to a strong code of ethics, i.e., to be aware of their own attitudes, beliefs, thoughts, and priorities in providing care to individual patients, families, communities, and populations.² Be in the know of your patient s diverse cultural background! References 1. The Joint Commission (2011), Advanced Effective Communication, Cultural Competencies and Patient-and Family-Centered care accessed on 11/30/2011 from www. jointcommission.org/avanced_effective_communications/ 2. American Nurses Association Nursing World (2011), Diversity Awareness accessed on 11/23/2011 from www. nursingworld.org

5 January, February, March 2012 Texas Nursing Voice Page 5 Texas Team Action Coalition Co-Leader Perryman Named Texan of the Year Dr. M. Ray Perryman, world renowned policy advisor and economist and co-leader of the Texas Team Action Coalition s Strategic Advisory Committee has been named Texan of the Year by the Texas Legislative Conference, a non-partisan organization of Texas business and political leaders who meet annually to look at public policy issues. At this year s conference, the group s 46th annual gathering set to be held March 22 and 23 at the New Braunfels Civic/Convention Center, Dr. Perryman will be presented the Texan of the Year award at a special reception in his honor on the evening of March 22. The award recognizes Perryman s tireless efforts in helping to build a better Texas. A prominent, innovative, influential and active contributor to the field of economic development, Dr. Perryman has long focused on the economics of the nursing shortage. As founder and president of The Perryman Group, an economic and financial analysis firm located in Waco, Dr. Perryman has examined at length the value of nursing and quality health care to future prosperity in a state. He is widely regarded as one of the world s most influential and innovative economists and his complex modeling systems form a basis for corporate and governmental planning around the globe. In speaking about Dr. Perryman s recognition, Alexia Green, PhD, RN, FAAN, co-chair of Texas Team Action Coalition s executive committee, said: Both Dr. Ray Perryman and his wife, Lorraine, have been long committed to the nursing profession. He has examined and later shared his insights on the economic impact of nursing on health care both at state-wide and national venues including several presentations to the American Association of Colleges of Nursing in Washington, D.C. Lorraine Perryman served as a Board member of the Texas Higher Education Coordinating Board at a time when the doctorate of nursing practice was approved to be offered at public universities in Texas. Without her support and that of other strong nursing advocates, the profession would have likely not received this approval as many in the state advocated against this advancement for the nursing profession. Summarizing, Dr. Green added, These two Texans exemplify the type of supporters that will be necessary to achieve in Texas by 2020, the IOM Future of Nursing recommendations. The Texas Team is very proud and privileged to have Dr. Perryman serve as co-chair of its Strategic Advisory Committee. The Texas Team Action Coalition, convened to advance the Future of Nursing: Campaign for Action, is a diverse group of stakeholders that can effect sustainable change in health care at the state or regional level. Named in September 2011 by the Campaign for Action as one of 36 official, state Action Coalitions, Texas Team will seek to collaboratively implement in Texas recommendations of the IOM s Future of Nursing: Leading Change, Advancing Health report. It will function as field operations for advancing comprehensive health care change and will work to collaboratively address the growing demand for high quality, cost-effective and accessible health care across the state. Serving alongside Dr. Perryman as the other co-chair of the Texas Team Strategic Advisory Committee is Patricia S. Yoder-Wise, EdD, RN, NEA-BC, ANEF, FAAN. Relates Dr. Yoder-Wise: Dr. Ray Perryman was the perfect selection as the co-chair for the Strategic Advisory Committee of Texas Team. His expertise in economics, his vision for the possible, his sense of humor, and his willingness to make things happen makes him the perfect fit with what we re trying to achieve for the citizens of Texas. We are so fortunate to recruit him for this work and are thrilled with the recognition he so richly deserves as Texan of the Year. In a nearly 30-year career, Dr. Perryman has held positions as university professor, economist-in-residence at Baylor University and businesseconomist-in-residence at Southern Methodist University. He is a popular speaker, book author, syndicated columnist and radio commentator on the topic of economic affairs. He also authors The Perryman Report & Texas Letter, a newsletter of vital information about various aspects of the Texas economy. He is a native Texan who earned a bachelor s degree in mathematics from Baylor University; a PhD in economics from Rice University. In being named a Texan of the Year of the Texas Legislative Conference, Perryman joins a prestigious group of former honorees that includes Barbara Jordan, Laura Bush, Lady Bird Johnson, T. Boone Pickens, Peter Holt, John Connally and Gov. Rick Perry. Information on attending the Perryman reception as well as the conference is available from the Greater New Braunfels Chamber of Commerce at or by to tlc@nbcham.org.

6 Page 6 Texas Nursing Voice January, February, March 2012 CMS Proposed Rule Changes to Hospital Medicare/Medicaid Participation Draw Public Response By the time the 60-day public comment period ended on December 23, 2011, more than 100 comments had been submitted to the Centers for Medicare & Medicaid Services (CMS) by individuals and organizations responding to proposed revisions to the Medicare Conditions of Participation (CoP) rules for hospitals and critical access hospitals participating in Medicaid and Medicare programs. The proposed rules revise the requirements that must be met to participate in Medicare and Medicaid programs. Since CoPs impact nursing practice and patient care for nurses both registered nurses (RN) and advanced practice nurses (APRN) the Texas Nurses Association and American Nurses Associations were among those organizations commenting. According to CMS, the proposed rules revisions were an attempt to reduce burden, maximize patient safety, and reflect current industry standards. As a matter of course, the Office of the Federal Register, National Archives and Records Administration publishes rules, proposed rules and notices from Federal agencies and organizations and solicits public comment on the proposed rules as part of a process of reviewing existing regulations to ensure they continue to make sense. Nursing s comments on some of the topics addressed by the CMS proposed rules follow. Even though submitted comments were removed from the website once the public comment period ended, the rules as proposed can be accessed in the Federal Register, www. gpo.gov/fdsys/pkg/fr /pdf/ pdf. Use of restraints Proposed Section Condition of participation: Patient s rights in their comments, TNA/ANA opposed the proposed section and urged CMS to reconsider the proposed rules change in the reporting requirement for patient deaths after soft wrist restraints had been used. TNA/ANA took the position that all deaths related to restraint and seclusion should be reported in the same manner regardless of their type. Clinical privileging of APRNs Proposed Section Condition of participation: Medical staff TNA/ANA recommended that CMS revise the proposed rules to require hospitals, in accordance with State law, to include practitioners other than physicians on their medical staffs, e.g., APRNs, as appointed by the hospital s governing body. Also recommended was the adding of language that would ensure all practitioners granted clinical privileges would also be accorded voting privileges and full due process. Nurse staffing Proposed Section Condition of participation: Nursing Services TNA/ANA recommended within , Staffing and Delivery of Care, that language is added to support and ensure adequate nurse staffing in Medicare and Medicaid hospitals, and to require those hospitals to have a nurse staffing plan that meets specific requirements, both procedural and substantive, i.e., implement a hospital-wide nurse staffing plan that sets an appropriate number of RNs on each unit to meet the needs of the patients. Since 2009, Texas has had a statute in place that requires hospitals to have a nurse staffing committee and staffing plans and believes they have promoted better nurse staffing. Nursing care plan Also within Proposed Section , TNA/ANA supports language that requires hospitals to ensure the nursing staff develops and keeps current a nursing care plan individualized for each patient that prescribes strategies and alternatives to attain expected outcomes. TNA/ANA also supports the CMS proposal of the nursing plan may be part of an interdisciplinary care plan. Self-administration of medications in hospitals Proposed Section (c)(6): Condition of Participation: Self-administration of medications in their comments, TNA/ANA supported the revised rules that would permit more self-administration of certain medications only if hospitals are kept to a very high standard in their required policies and procedures, and only if nurses retain the flexibility to determine which patients are capable of self-administration. It is believed that self-administration can be a helpful tool in teaching self-care for patients and family provided it s used properly and with the appropriate patients. The proposed rules are lengthy and detailed and the comments above address but a few of the proposed revisions. At press time, CMS had not announced a time line for issuing additional proposed rules or final rules on reforming hospital and critical access hospital conditions of participation in Medicare and Medicaid programs. Berwick is Out, Nurse Tavenner is In In early December 2011, Dr. Donald Berwick resigned and stepped down nearly a month early from his 17-month-long tenure as the administrator of the Centers of Medicare and Medicaid Services (CMS). His nominated replacement, Marilyn Tavenner, MHA, RN, joined the Obama administration in 2010 as Berwick s deputy principal administrator. Now she s up for the top job. Tavenner began her career as a diplomaeducated nurse at a Virginia hospital. She worked her way from staff nurse to president of outpatient services for Hospital Corporation of America to chief executive officer at two other hospitals to secretary of Health and Human Services for the Commonwealth of Virginia, a post she held for four years until the governor who appointed her left office. In that position, she oversaw 12 agencies that employed over 18,000 people. A Virginia native, Tavenner earned both a bachelor of science in nursing and a master s degree in health administration from Virginia Commonwealth University. She has been active in both Virginia and American Hospital Associations, as well as other community organizations. She is a fellow of the American College of Healthcare Executives. It has been reported that unlike her predecessor, Tavenner s health care experience is more management than policy; she is less of a reconceptualizer of an organization. Time will tell. First, Tavenner must be confirmed in the post. 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7 January, February, March 2012 Texas Nursing Voice Page 7 Nurses Taking Action in Texas: A Series Executive Nurse Bryant Actively Adopts Future of Nursing by Christy Meriwether, Texas Team Tactical Support and Operations Committee Texas Team Note: Have you wondered yet how you might actualize in your organization or community the recommendations from the Institute of Medicine Future of Nursing report? Maybe it would help to learn from other nurses and non-nurses in Texas about what they re doing to take action. In this first-in-a-series of personal reports, the Texas Team Action Coalition, convened to advance the Future of Nursing: Campaign for Action, is sharing some of the stories of those who have already joined the Campaign for Action and are moving forward to change the future of nursing in Texas. Gerald s story follows. We hope it gives you inspiration. And we d love to hear from you. If you ve already begun to take action for nursing in Texas, let us know. Send us your story about what you re doing so that we might share it. Please contact tnveditorial@texasnurses.org. Gerald s Story How often do you get the chance to make a difference in the future direction of your profession? I was apprehensive at best when my DNP (doctor of nursing practice) capstone advisor challenged me to read the Institute of Medicine s report, the Future of Nursing: Leading Change, Advancing Health, and make it actionable. As I read, I realized it was a roadmap that would significantly change nurses roles, responsibilities and education so they can better contribute to improving the U.S. health care delivery system. The report was truly a call to action and I could not ignore it! In my role as chief nursing officer for Baptist Hospitals of Southeast Texas, I am responsible for a two hospital, not-for-profit system. In the system, we have a total of 608 beds and about 700 registered nurses. I am a member of my organization s senior team and very fortunate to have an incredibly supportive CEO and Board of Trustees. With this said, I will explain my journey in the hope that it can possibly ignite your enthusiasm for participating in the Future of Nursing: Campaign for Action, the national implementation of recommendations in the IOM report. I have taken several steps to actively adopt the campaign. As a DNP student, I first presented an executive overview of the Future of Nursing report to my fellow students. Then, I presented the overview to my organization s senior team, Board of Trustees, nursing directors, and leaders and staff nurses from various shared governance councils at my organization s annual nursing leadership retreat. I have also seized the opportunity to share the report with the local chapter of Sigma Theta Tau International Honor Society of Nursing and the Rotary Club. Additionally, I am working with the local university nursing division leadership and other local CNOs to begin a grass roots communication campaign. Early on, it was crystal clear to me and my organization that we needed to internalize and act on two of the key messages in the report. One of the messages is: Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. I realized, BSN-prepared nurses are a MUST because they support my organization s commitment to assure the highest level of care delivery for our population of patients, thus improving community health and wellness. The second key message of the report is: Nurses should practice to the full extent of their education and training. This is definitely related but not limited to the Advanced Practice RN (APRN) and the confines placed on them by our state. Nurses play a critical role in health care and it would help greatly if payers and CMS (Centers for Medicare & Medicaid Services) would support regulatory requirements which allow them to practice to their full potential. The APRN s relationship with medical peers and other health care professionals needs to continue to evolve as a collaborative not subordinate practice. With incredible support from the Board of Trustees and system CEO, the IOM report and these two key messages were used to develop our nursing strategic plan for the next two years and support the following: Increase APRN roles by strategically hiring and placing them in primary care roles, disease management roles, and in positions to influence organizational clinical outcomes. Transition LVN employees and students from direct patient care by either supporting them in completing their RN education or placing them in non-direct care roles such as nursing assistants, unit clerks and techs. Set a goal to increase the percentage of BSNprepared nurses on staff by 20 percent over the next two years. Create selection criteria for new hires and nurse externs, such as hiring only BSN-prepared new graduates if possible; hiring ADN graduates who will contract to complete their BSN education within five years; and only making the nurse extern role available to BSN students. Develop tuition reimbursement guidelines and educational levels for both MSNprepared and doctorate nursing staff by establishing pay grades for advanced education. Tuition reimbursement plans for graduate and doctorate education is being developed and first priority is given to reimbursement candidates that are pursuing their RN-to-BSN. I challenge you to explore the IOM Future of Nursing report to determine actionable steps you can take in your personal career trajectory and/or as a leader to actualize the IOM goals and to advance the health care of Texans. About Gerald: Gerald Bryant, MSN, RN, NEA- BC is chief nursing officer at Baptist Hospitals of Southeast Texas in Beaumont and Orange. He will graduate from his DNP program in May of 2012.

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10 Page 10 Texas Nursing Voice January, February, March 2012 A New Year s Story of Hope and Goodwill TPAPN Style by Ginger Coburn, LCDC and Michael Van Doren, MSN, RN, CARN Nurses may have some preconceived notions of what Texas Peer Assistance Program for Nurses (TPAPN) is and what it does but ultimately, it is a program about people professional nurses, their peers and their families learning to cope with substance use disorders and psychiatric disorders, and demonstrating that renewal is possible. The following New Year s story of hope and goodwill is but one (condensed) tale of many that the case managers of TPAPN bear witness to. Nurse Gayle was originally referred by her employer to the Texas Board of Nursing (BON) for diversion of patient opiate medication. Upon review and permission by the BON, TPAPN was allowed to offer Gayle the opportunity to participate in TPAPN. Gayle agreed to do so and was assigned a TPAPN case manager. After treatment and monitoring of her seemingly successful participation in the program for close to nearly a year, Gayle had an exacerbation of her disease. It was evidenced by her relapsing (using) the Hydrocodone that she had left over from a prescription for back pain that had been aggravated by her recent pregnancy and delivery. As sometimes possible, TPAPN requested permission from the BON to continue working with Gayle. Permission was granted. Upon reassessment by a local mental health provider, it was identified that Gayle was Where friendly, diverse coworkers meet scenic beauty in the Tropical Tip of Texas. Situated in the beautiful Rio Grande Valley in Texas, our great location offers an average yearly temperature of 85 degrees, low cost of living and close proximity to beaches. South Texas Health System is an exceptional network of facilities comprised of over 800 beds. Our mission is to provide the most comprehensive healthcare services in the Rio Grande Valley. We have the following Nursing opportunities available: Adult and Pediatric Critical Care New Graduate Intern Program New Nursing Leadership Positions All Nursing positions require current Texas state licensure as a Registered Nurse, current compact state licensure, or a valid temporary RN license for the State of Texas while waiting to receive the permanent license. For more information please contact our Recruiter, JoAnn Rodriguez at Joann.rodriguez@uhsrgv.com, direct or or to apply online visit: We are an equal opportunity employer. struggling with post-partum depression. Not only that, but the reassessment also identified that both Gayle s husband and mother-in-law were abusing drugs. This was unfortunate in many ways but primarily because Gayle s TPAPN case manager had been advocating for longterm inpatient care, out of state. Learning that Gayle did not have a safe and stable environment in which to care for her newborn son, the treatment/case management team at TPAPN had to rethink what would be best for all concerned. Step one was to have a complete psychological evaluation. Next, Gayle s evaluator and her TPAPN case manager needed to develop a plan to address all of her needs. Ultimately, Gayle was able to be admitted to partial hospitalization treatment, allowing her to be home with her family and have the benefit of daily treatment. Once that was completed, she progressed directly to an Intensive Outpatient Treatment program for six weeks, coupled with individual therapy. This entire process helped Gayle identify the root causes and triggers that led to drug-seeking behaviors, depression, etc. So, how did this all begin? And why, after going to treatment for a year and being able to return to work in nursing would someone risk their health, their career, their family, their overall stability? As Gayle related to her case manager, she said she felt completely overwhelmed by wanting to be the perfect wife, the perfect first-time mother, a trusted employee and nurse, and being committed in recovery. Basically, she was trying to be all things to all Committed to Service Excellence Find the perfect nursing job where you can work smarter, not harder on nursingald.com Registration is free, fast, confidential and easy! You will receive an when a new job posting matches your job search. Stethoscope Skills! Are you certain of what you hear through your stethoscope? This one day class covers everything you always wanted to know about using the stethoscope: the basics and way beyond!! Covers Heart, Breath, & Abdominal Sounds and much more! Everything you need to know about the sounds you hear! Choose from these locations: Feb 17 Midland Feb 22 Brownsville Feb 23 Corpus Christi Feb 24 Laredo Feb 28 Denton Feb 29 Dallas Mar 22 College Station Mar 28 San Antonio Mar 29 Victoria Mar 30 Kerrville Apr 11 Texarkana Apr 12 Marshall Apr 13 Nacogdoches Apr 18 Arlington Apr 19 Austin Apr 25 Galveston Apr 26 Houston Apr 27 San Antonio Mar 1 Waco Mar 7 Amarillo Mar 9 Lubbock Mar 14 Sweetwater Mar 15 Abilene Mar 16 Ft. Worth Mar 20 Houston Mar 21 Beaumont May 1 May 2 San Angelo Odessa 9am - 4:30pm each day. Approved for 6 CEU s. Fee $79; Group & Student Discounts Available Call or visit: people, yet suffering by not asking for help Through TPAPN, Gayle has found that trying to be perfect is an illusion. She now accepts the help she receives with gratitude and remains humbly in the process of demonstrating that life for her is, as it is for each of us, a one day at a time process and journey. Throughout this process, her supervisor and employer, as well as her TPAPN volunteer nurse advocate and case manager, had great hope for her. They recognized and supported Gayle, believing she IS a good nurse who is also human, fallible and suffering from a disease that IS treatable. As of this writing, Gayle is clean, sober and healthy, which is allowing her to enjoy her role as a new mother. As her supervisor recently shared with her TPAPN case manager, You know, this could have been any one of us and I have the utmost respect for her willingness to stay the course and continue reaching toward the next day. Stories such as Gayle s serve to remind us, especially the approximate 575-plus nurses participating today in TPAPN, that hope is possible, always. In 2012, you can be a part of nurses liferenewing experiences by applying to become a volunteer, peer advocate with TPAPN. For a TPAPN Advocate application, go to org or request an application and/or obtain more information by phoning Shirley Baugh at ext. 127 or via to sbaugh@ texasnurses.org. All nurses whose TPAPN Advocate applications are approved must successfully attend a TPAPN Advocate Training Workshop before being able to advocate for a participant. On Friday, April 13 and Saturday, April 14, 2012, the Texas Peer Assistance Program for Nurses is offering a two-day Advocate Training Workshop and 25th Anniversary Gala in Austin, that will feature renowned speakers and provide the camaraderie and inspiration of other nurse volunteers and special guests. For approved applicants, the TPAPN Advocate Training Workshop registration, materials, breaks and lunches will be provided free of charge. The Texas Peer Assistance Program for Nurses is a program of the Texas Nurses Foundation, a 501(c)3 charitable/educational organization of the Texas Nurses Association. Find out more about TPAPN at About the authors: Ginger Coburn, LCDC, is a licensed chemical dependency counselor and a case manager for TPAPN. Michael Van Doren, MSN, RN, CARN is program director of Texas Peer Assistance for Nurses. LICENSING BOARD, PEER REVIEW, EMPLOYMENT PROBLEMS? DO NOT WAIT!!! Call before you respond to a letter or notice. Toll Free: Initial Consultation is Free Friend & Associates Nurse Health Care Attorneys Practice Throughout Texas

11 January, February, March 2012 Texas Nursing Voice Page 11 BON/DADS Implementing UAP continued from page 1 and instead must rely on another individual, for instance, a family member or personal attendant. The nursing question became: When is the performance of such activities considered nursing and requiring delegation to the UAP performing the task? In 2003, the BON adopted Rules 224 and 225 to address the issue. They are the most recent revisions to those rules. Rule 224 governs the delegation of nursing tasks by RNs to UAP for patients with acute conditions or in acute care environments. Rule 225 addresses RN delegation to UAP and tasks not requiring delegation in independent living environments for individuals with stable and predictable conditions. Rule 225 was intended to promote consumer independence by recognizing the ability and right of people with disabilities to direct and control their own services. As a reference, a Delegation Resource Packet can be found in the Nursing Practice section of the BON website (bon.texas.gov). Beginning in 2009, the Texas Board of Nursing began working with DADS on the application of Board rules and regulations. The effort was in response to concerns from providers that administered several of the DADS waiver programs. The providers believed that UAP should administer medications outside of RN delegation and that LVNs could provide telephone on-call services, a practice according to the BON that it believes is outside of the scope of practice for LVNs. In October of 2011, DADS and the BON began holding education workshops across Texas for HCS, TxHmL and intermediate care facility providers and nursing staff on implementing the new requirements of SB 1857, as well as the BON s expectations for nursing scope of practice and delegation. An in-depth Frequently Asked Questions on nursing services section for service providers can be found on the DADS website at dads.state.tx.us/providers/nschanges. LVN Pilot Program Passage into law of SB 1857 also requires the Texas BON and DADS to conduct a pilot program to evaluate licensed vocational nurses (LVN) providing on-call services by telephone to clients that were added by the new law and who are under the care of the LVN. The pilot requires LVNs to use standardized and validated protocols or decision trees in providing telephone on-call services. DADS is required to collect data to evaluate the effectiveness of LVNs performing on-call services in the pilot program which began in September As reference, there is currently within the Nursing Practice section of the BON website (bon.texas. gov) an FAQ section on LVNs Performing Triage/ Telephonic Nursing/Being On-Call. We are looking forward to learning more from the LVN On-Call Pilot, said Mary Beth Thomas, director of nursing for the Texas Board of Nursing. In conjunction with DADS, we will be collecting data to ensure that this is a safe practice and one that the Board can endorse. The BON and DADS in consultation with an advisory group of stakeholders will review the outcomes of the pilot program to make recommendations about potential regulatory or statutory changes. They will report by year end 2012 to Texas legislative committees on public health and health and human services. Recovery Isn t Simply a Goal, It s Our Mission. Simplify your nursing research... with access to over 10 years of nursing publications at your fingertips. nursingald.com Simply click on the Newsletter tab on the far right and enter your search term. Kindred Healthcare understands that when people are discharged from a traditional hospital, they often need continued care in order to recover completely. That s where we come in. Kindred offers services including aggressive, medically complex care, intensive care and short-term rehabilitation. Doctors, case managers, social workers and family members don t stop caring simply because their loved one or patient has changed location. Neither do we. Come see how we care at continuethecare.com ONLINE APPLICATION AVAILABLE or call Amy Crenwelge at (830) Guaranteed RN Scheduled Hours Visit us online: Dedicated to Hope, Healing and Recovery CONTINUE THE CARE NATIONALLY, KINDRED CARES FOR PATIENTS IN: LONG-TERM ACUTE CARE HOSPITALS NURSING AND REHABILITATION CENTERS INPATIENT REHABILITATION HOSPITALS TRANSITIONAL AND SUBACUTE CARE ASSISTED LIVING CONTRACT THERAPY SERVICES HOME CARE HOSPICE

12 Page 12 Texas Nursing Voice January, February, March 2012 OR MANAGER 2 OR suite/3 bay RR- Critical Access Hospital 6.6 FTEs SUMMARY: Assures the delivery of professional nursing care within the OR/RR areas by assessing, planning, organizing, directing and evaluating nursing care provided to all surgery patients; collaborates with Nursing Director; develops staff by department specific needs assessment, development of goals and objectives, implementation methods, evaluation measures; develops, maintains and interprets policy and procedures; maintains fiscal responsibility for department. Models excellent customer service relationships. MINIMUM REQUIREMENTS: Graduate of a Professional Nursing Program and current licensure with the Board of Nurse Examiners of the State of Texas. BSN preferred. Current CPR required. ACLS or CNOR preferred. The ideal candidate will be experienced in: Endoscopy/GI Pre-op Pain Management Operating Room - Bachelor s of Science in Nursing preferred with two years recent nursing experience. - Additional significant experience in area of specialty is preferred. - Two years of management experience preferred. Go online at to download application. Submit to psmithhart@cmhos.org or fax to , or call Human Resources at Board Issues? Medicare and Medicaid Questions? Joe Flores is One of Us. RN, FNP and Attorney! Joe is a nationwide lecturer on nursing and the law. He represents registered nurses and other healthcare providers in matters concerning Nursing Board Licensure Hospital Law Home Health Law Nursing Home Law Health Care Fraud Civil and Criminal R Trial Lawyer Call Today and Program His Number in Your Cell Phone joe@floreslawfirm.com AMERIGROUP Make a Difference. We are a different kind of health insurance company one that brings innovative solutions to families, children, seniors, and people with disabilities. Case Management Utilization Review We are looking for compassionate professionals throughout Texas. For details or to apply, please visit us at: amerigroup-jobs.com five Background Investigation Required. Amerigroup Community Care is an Equal Opportunity Employer/Drug-Free Workplace. M/F/V/D

13 January, February, March 2012 Texas Nursing Voice Page 13 Are You a Nursing Professional with a Passion for Education? Teach for the DCCCD! Dallas County Community College District, the largest undergraduate institution in the state of Texas, is a leading educator for Nursing and Allied Health! DCCCD offers excellent benefits, a great work environment and state-of-the-art educational facilities! Plus we offer full-time faculty teaching in the areas of RN, Surgical Technology, LVN, Biotechnology, Cardio Vascular Technology (CVT), Diagnostic Medical Sonography (Sonography, Medical Laboratory Technology, Echo cardiology), Magnetic Resonance Imaging (MRI), Radiological Technology and Respiratory Therapy an annual stipend ($5,000 to $8,000) to teach full-time at a DCCCD College. Give us a shot, visit our web site at edu/hr/jobs for more information! Board Investigation Peer Review Legal Problem Don t go it alone Before You Respond Call Joe Perdue for a free consultation Your license, your reputation is on the line. You have worked hard to earn them. Don t let them be tarnished. They may represent a governmental agency or your employer but you have rights that you should protect. A diligent defense begins early. Once retained, we will vigorously defend your license, your reputation. We have the knowledge and experience to help you. We will be by your side from day one to the end. Our principal office is located in downtown Houston just minutes from the Texas Medical Center at 1314 Texas Ave., Ste We will make time for you. For more go to: Perdueplummer.com Our web-based RN to BSN program allows working nurses to balance career, education and family. There have been many twists and turns in your career path. But all along the way, you ve envisioned a better professional and personal destination. Now it s time to actually experience your dreams with a career at Yavapai Regional Medical Center. This is a place where neighbors are friends, and friends are forever. Now Some recruiting of our current for current openings andinclude: future openings in: Seasonal RNs CVICU, CVOR ICU/CCU Med/Surg/Tele Cardiac Cath Lab Emergency Department L&D/Perinatal Services Surgical Services Pediatrics To take the first step, visit us online at: call our nurse recruiter at or VIPCareerNetwork@yrmc.org You ve had this coming nursing.tamhsc.edu Prescott, Arizona Two great hospitals. One caring spirit. EOE

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15 January, February, March 2012 Texas Nursing Voice Page 15 Adventure awaits. Imagine the possibilities. Skiing, hiking, camping and fishing make Alaska a pleasure-seeker s dream. Fairbanks Memorial Hospital, located in the Golden Heart of Alaska, in the second largest city in Alaska, is the perfect jumping off point for exploring the state. We at Fairbanks put the patients first and remain steadfast in our commitment to providing the highest quality healthcare to our friends and family. certification Opportunities available for Nurses! If you re looking for a career with great benefits that makes your future a priority, look to Banner Health. Visit or call Please reference keyword Alaska Careers when applying. EOE/AA. We support a tobacco-free and drug-free workplace. Connect with Banner Health Careers: Free CE credits. Available 24/7. Now you can choose the time and place to take the courses you need and want. We ve made it easy to take free CE courses online. We offer 24/7 access to more than 40 courses, including when to refer to a pediatric specialist. And even when you re not taking a course, you can access the latest references and resources you need. The CE courses were developed by the Texas Department of State Health Services and the Texas Health and Human Services Commission. All courses are comprehensive and accredited. * To view courses online, visit CE Courses Include: When to Refer to a Geneticist Children with Diabetes Children with Asthma Newborn Screening Case Management Developmental Screening Many others Referral Guidelines Pediatric Depression High Blood Pressures in the Office Atopic Dermatitis Gastroesophageal Reflux in Infants Exercise-Induced Dyspnea Referral Guidelines Overview Taking New Steps *Accredited by the American Nurses Credentialing Center, Texas Medical Association, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council of Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Dietetic Association, Texas Academy of Audiology, and International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for these events.

16 Page 16 Texas Nursing Voice January, February, March 2012 Advanced nursing education today for advanced healthcare tomorrow. On the front lines of patient care, nurses serve a critical role in shaping the future of healthcare delivery. For over 120 years, Chamberlain College of Nursing has been preparing compassionate and clinically proficient nurses by increasing access to quality nursing education nationwide and training aspiring nurses, nurse leaders and nurse educators. For aspiring nurses, Chamberlain offers a 3-year Bachelor of Science in Nursing (BSN) degree program* and a 13-month accelerated Second Degree BSN option. For nurse advancers, Chamberlain offers the RN to BSN online degree completion option and the Master of Science in Nursing (MSN) online degree program. With new locations and flexible online degree programs, Chamberlain gives you the tools to make a difference to improve the future of healthcare. Enhancing Education. Advancing Careers. Improving Outcomes. Now enrolling for spring, summer and fall semesters For more information, please visit chamberlain.edu or call CCN (8226) Comprehensive consumer information is available at: chamberlain.edu/studentconsumerinfo Chamberlain College of Nursing Equity Drive Houston, TX Chamberlain College of Nursing, LLC. All rights reserved. This program is not approved or regulated by the Texas Workforce Commission. *The on-site Bachelor of Science in Nursing (BSN) degree program can be completed in three years of year-round study instead of the typical four years with summers off. What if your patient needs help connecting to services? Refer your patient for case management services, a Texas Medicaid benefit for eligible children birth to age 20 with a health condition or health risk and high-risk pregnant women of any age. Case managers help patients access medical and dental services, specialty referrals, medical equipment and supplies, and mental health services. They also help patients and their families find services for educational, psychological, financial, and transportation needs that may impact the patient s health care. Learn more about case management services and get CE credit by taking the free Case Management Services in Texas course on the THSteps Online Provider Education website at txhealthsteps.com. To make a referral, call THSTEPS or obtain a referral form at If you are an RN or licensed social worker and are interested in becoming a case manager, call Bilingual case managers are needed.