Nurse NUMBER 2 SUMMER2013 EDUCATION

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1 VOL. 9 Nurse NUMBER 2 SUMMER2013 R E P O R T E R WYOMING EDUCATION

2 Ally Cordonier, RN

3 WYOMING Summer 2013 VOL. 9 NUMBER 2 Nurse R Serving and safeguarding the people of Wyoming through the regulation of nursing education and practice E P O R T E R Published by the Wyoming State Board of Nursing 130 Hobbs Ave., Suite B Cheyenne, Wyoming Phone: Fax: Web Address: Mission: To serve and safeguard the people of Wyoming through the regulation of nursing education and practice. Vision Statement: Acknowledging the dynamic nature of healthcare, provides the climate, collaboration and regulatory framework for nurses to practice to the fullest extent of their scope. Values: Excellence, Ethics, Education, Safety and Competence. EDITORS Kathleen Laidlaw, RN Marguerite Herman BOARD PRESIDENT Carrie Deselms, MSN, APRN, FNP-BC VICE PRESIDENT Marcie Burr, RN, RD, CCHP SECRETARY Lori Johnson, LPN APRN MEMBER Donna Nurss, MS, APRN, BC RN MEMBER Cindy Woods, BSN, RN, BC RN MEMBER Tracy Wasserburger, RNC,NNP PUBLIC MEMBER Barbara Summers T A B L E O F C O N T E N T S Wyoming State Board of Nursing Meetings 4 Executive Director s Message 5 Message from the Board President 6 Reporting Violations of the Wyoming Nurse Practice Act and Wyoming State Board of Nursing Rules and Regulations: Facility and Licensee Obligations 8 New HIPPA Rules 10 Medical Malpractice Cases, Nurses are not Out of the Woods 11 Wyoming Stakeholders Meet to Discuss Nurse Licensure Compact 12 Nurse Monitoring Program and Incidental Exposure to Alcohol 14 Revolutionizing Nursing Education in Wyoming (ReNEW) 16 Recent Cases of Interest 18 Donate to our Wall of Caps 19 Wyoming Council for Advanced Practice Nursing 19 Two board members drive more than 1,100 miles to attend Midyear Meeting 20 Wyoming Center for Nursing and Health Care Partnerships Corner 24 What Can a Baccalaureate Degree Do For Me? 27 Disciplinary Actions ON THE COVER: Associate degree nursing students from Central Wyoming College in Riverton auscultate lung sounds in the simulation lab. Students are (left to right): Bridget Carlson Gardner, Lacey Mills, Natalie Hawk WYOMING STATE BOARD OF NURSING MEETINGS All board meetings are held in accordance with Wyoming Public Meetings Statutes and are open to the public. Unless otherwise specified, all Board meetings are at 138 Hobbs Ave, Cheyenne WY Please feel free to join us in person or via teleconference at the regularly scheduled quarterly meeting or interim teleconference meetings. Minutes of past meetings are available on the WSBN Web site under Board Meetings. Requests for agenda items must be submitted at least two business weeks prior to the scheduled board meeting. If you have questions regarding a board meeting or agenda item, or if you have special needs for access to a board meeting, please contacts our Executive Assistant at pcipublishing.com Created by Publishing Concepts, Inc. David Brown, President For Advertising info contact Victor Horne ext. 114 ThinkNurse.com EDITION 33 July 8-11 Board Meeting July 29 Teleconference, time to be determined October 7-10 Board Meeting October 28 Teleconference, time to be determined WYOMING NURSE REPORTER 3

4 reetings From Cynthia LaBonde, MN, RN Executive Director The theme of this issue of WNR is Education, so I thought I would begin by explaining how the Wyoming State Board of Nursing -- a regulatory agency -- is connected to education. The mission of the Board of Nursing is to serve and safeguard the people of Wyoming through the regulation of nursing education and practice. That mission drives everything we do, and Chapter VI of our Administrative Rules and Regulations is devoted to Standards for Nursing Education Programs. Quoting directly from Rules: The purpose of the board in adopting rules and regulations is to: (i) Serve as a guide for the development of new nursing education programs; (ii) Provide criteria for the evaluation and approval of new and established nursing education programs; (iii) Foster the continued improvement of established nursing education programs; (iv) Ensure that graduates of nursing education programs are prepared for safe nursing practice; (v) Assure eligibility for admission to the licensure examination for nurses; and (vi) Facilitate interstate endorsement of graduates of board-approved nursing education programs. The Board initially considers the characteristics of the program to confirm that it meets minimum expectations of providing the educational foundation to prepare future nurses in practice, both in organization and in curriculum. Ideally, the curriculum includes solid clinical and classroom components to The mission of the Board of Nursing is to serve and safeguard the people of Wyoming through the regulation of nursing education and practice. That mission drives everything we do, and Chapter VI of our Administrative Rules and Regulations is devoted to Standards for Nursing Education Programs. provide nursing students with practical exposure and practice in a variety of clinical settings. Once a program is approved, the Board reevaluates the program every eight years, which includes a site visit. Each program also submits an annual report with documentation of continued compliance with the standards for nursing education, projected program changes, faculty data forms and current college catalog. The process for Board approval of a program can be compared to a recipe. As with any good recipe, there must be ingredients that are very familiar and those that provide for more creativity. It is an evolving process not only for the programs but for the Board as well. The programs themselves are also developing creative methods for education, including different types of opportunities for clinical experiences and partnerships to accommodate the needs of both the student population and an ever evolving nursing environment. The Board has received a multitude of requests for approval by online out-of-state programs for approval. Technology has changed the landscape of traditional nursing programs. The population of students also demands the accommodations and conveniences online programs may offer. However, the expectations for these programs to provide a solid educational background for nurses do not change. In fact, the Board s Practice and Education Committee, which is also assigned to respond to practice and education questions on a continuing basis, has established an objective that all nursing education programs, whether brick-and-mortar or online, will meet the standards expected of programs. In other words, there is process improvement even with the Board to meet the needs of nursing education. The Board is committed both to keep up with the times and to actively effect improvement of formal educational programs, both traditional and emerging. This requires attentiveness to the trends in nursing practice, which are also influenced by technology. In addition, this requires the Board to hear the challenges the programs themselves face. After all, we all have a common goal: to equip nurses to meet competency expectations and, by doing so, prepare a professional workforce that provides safe practice to the people of Wyoming. 4 WYOMING NURSE REPORTER

5 PRESIDENT S OPINION From Carrie Deselms President of Wyoming State Board of Nursing Congratulations to the many new nursing graduates who have recently completed their program of studies and are preparing for that final exam, the NCLEX. Each and every one of the seven schools of nursing located within the State of Wyoming has been granted approval by the Wyoming State Board of Nursing. All provide excellent education, training and clinical experiences for their nursing students. Wyoming nursing schools are indeed exceptional. Many new nursing graduates talk about how they can t wait to get out in the real world of nursing and put in PICC lines, draw blood, administer medications, work a code, defibrillate V-Tach -- in general many of the fast paced technical activities of being a nurse. Few nursing graduates ever say they want to teach. They want the Emergency Department or Intensive Care Unit action. Yet every licensed nurse is truly an educator. It might be explaining to a patient to avoid grapefruit juice with certain medications, or training a family member how to do home peritoneal dialysis, or preparing a disaster plan for a community. Nurses are natural teachers of health promotion. We teach and support our communities through outreach like health fairs and immunization clinics. We also teach each other through peer review, orientations, precepting and mentoring. The spirit of learning and teaching is intrinsic to the profession. Nurses have the knowledge, skills and attitudes to be remarkable educators with their patients, families, communities and each other. We welcome our new graduates as peers into this wonderful profession of nursing and we hope some will even consider teaching nursing as a Nurse Educator in their future. WSBN STAFF CHANGES Laura Rowe, JD, our Nurse Monitoring Program Manager and Investigator, has added a new WSBN title: Compliance and Discipline Department Manager. Laura joined the WSBN staff 18 months ago and had been Interim Compliance and Discipline Manager for six months. She assumed the permanent position on June 1, Lacey Osburn has accepted the job of Investigative Assistant, effective June 17, She comes to WSBN from the Wyoming Department of Transportation, where she has been integrally involved with preparing documents for hearings and working with the state s Office of Administrative Hearings. The Board s position for Practice and Education Consultant is open until filled. WSBN LICENSES AND CERTIFICATES RENEWED FOR The statistics are compiled on the number of nurses and certified nursing assistants who renewed their licenses and certificates with the Wyoming State Board of Nursing by the deadline Dec. 31, The next renewal deadline is Dec. 31, The renewal tally: 1,925 in October 3,199 in November 6,442 in December Another 675 renewals were processed in January and February of That is a total of 12,241 renewals out of 17,129 licenses and certificates that expired at the end of 2012, a rate of 71.5 percent. The Board also issued 1,647 initial licenses and certificates by the end of February 2013 for a total of 13,890. WYOMING NURSE REPORTER 5

6 Laura C. Rowe, JD, Nurse Monitoring Program Manager / Investigator Reporting Violations of the Wyoming Nurse Practice Act and Wyoming State Board of Nursing Rules and Regulations: Facility and Licensee Obligations The mission of the Wyoming State Board of Nursing is to serve and safeguard the people of Wyoming through regulation of nursing education and practice. License- and certificate-holders in Wyoming have an important role to play in this mission. The Board carries out its mission in part by ensuring that licensees continue to adhere to the standards of nursing practice and follow the provisions of the Wyoming Nurse Practice Act (NPA) and the Board s rules and regulations. The Board accomplishes this task primarily through investigation of complaints and grievances filed with the Board. Complaints allege a licensee or certified nurse assistant (CNA) is not meeting the standard of nursing or nursing assistant practice or in some other manner is in violation of the NPA or Boards rules. The nursing profession is highly selfregulated. Employers, nurses and nursing assistants have obligations to tell the Board of violations of the NPA and Board s rules and regulations. Patients and citizens with concerns about nursing practice and care can also file complaints with the Board.Following is a discussion of these reporting requirements. Employers of nurses and certified nurse assistants have an obligation under the NPA to report to the Board those nurses and CNAs who are terminated or resign as a result of a violation of the NPA. Specifically, the NPA provides: Wyo. Stat. Ann Names of terminated licensees to board; enforcement by court order; civil contempt for noncompliance; immunity. (a) Hospitals, nursing homes and other employers of registered nurses, licensed practical nurses, and advanced practice registered nurses shall report to the board the names of those licensees whose employment has been terminated voluntarily or involuntarily for any reasons stipulated in W.S (b) The board may seek an order from a proper court of competent jurisdiction for a report from any of the parties stipulated in subsection (a) of this section if one is not forthcoming voluntarily. (c) The board may seek a citation for civil contempt if a court order for a report is not obeyed by any of the parties stipulated in subsection (a) of this section. (d) Any institution or person reporting in good faith and without fraud or malice, information to the board under this section, is immune from civil action as provided in W.S A majority of the complaints filed with the Board are those from facilities that have terminated a nurse or CNA for alleged violations of the NPA as required under subsection (a). Upon receipt of these complaints Board staff evaluates their content to determine if an investigation is warranted to further review the allegations. It should be noted that not every termination of a nurse or CNA warrants a complaint or report being filed with the Board. For example, a nurse or CNA who is terminated as a result of employmentrelated issues (i.e. numerous absences and tardiness, failure to follow policies on appropriate dress code, etc.) has not violated the NPA or the Board s rules and regulations, as these actions do not relate to patient care and safety. When the board receives complaints of this nature, our staff will not open an investigation but will notify the complainant that the conduct is not a violation of the NPA or Board s rules and regulations. Board staff will also provide the licensee with a copy of the complaint with notification that no investigation was opened, resulting in dismissal of the complaint. Nurses and CNAs also have an obligation to report licensees engaging in unfit or unsafe practice or who are otherwise committing violations of the NPA and the Board s rules and regulations. These reporting requirements are as follows: Chapter 3, Section 2(a) [Standards of Nursing Practice for the Registered Professional Nurse] of the Board s Rules: (i) The registered professional nurse shall: (G) Report unfit or incompetent nursing practice to the recognized legal authorities [.] Chapter 3, Section 2(a) [Standards of Nursing Practice for the Licensed Practical Nurse] of the Board s Rules: (i) The licensed practical nurse shall: (J) Report unfit or incompetent nursing practice to the board. Report unsafe conditions for practice to recognized legal authorities [.] Chapter 7, Section 7(b) (vi) [Basic Nursing Functions, Task, and Skills that may be Delegated] for Certified Nursing Assistants: (vi) Nursing Team Member Skills of the Certified Nursing Assistant: (J) Reporting unsafe, neglectful or abusive care [.] In addition, a nurse or CNA can face disciplinary action for not reporting unsafe nursing practice. The NPA provides as follows: Wyo. Stat. Ann Disciplining licensees and certificate holders; grounds. (a) The board of nursing may... suspend or revoke the license, certificate or temporary permit of any person, or 6 WYOMING NURSE REPORTER

7 to otherwise discipline a licensee or certificate holder, upon proof that the person: (viii) Has knowingly and willfully failed to report to the board any violation of this act or of board rules and regulations [.] Nurses and CNAs, as well as their employers, play an important role in the regulation of nursing practice. The continuing integrity of the nursing profession requires that those nurses and CNAs who are engaging in acts inconsistent with the standards of nursing practice be reported to the Board for investigation and possible remediation, including additional training, and potential removal from nursing practice until they can demonstrate they are able to provide safe and adequate patient care. For more information on the disciplinary process or complaint procedures please visit https://nursingonline.state.wy.us/default.aspx and click on the Discipline tab or You realized your nursing dream. Now Realize Your POTENTIAL. Earn your BSN or MSN Online. You ve come a long way since your first day as an RN. Go even further with one of Jacksonville University s acclaimed nursing programs, offered in a 100% online classroom. RN to BSN Now Offering Scholarships! MSN: Leadership in Healthcare Systems MSN: Clinical Nurse Educator JacksonvilleU.com/OnlineProgram Or, talk with a specialist: week classes 6 sessions per year 2012 All Rights Reserved. Made Available by University Alliance The Nation s Leading Universities Online. SC: ZJ1 MCID: One of America s Best Colleges U.S. News & World Report DOCTORAL NURSING DEGREES NOW TAKIN G APPLICATION S The Ph.D. in Nursing program will prepare graduates to conduct Summer 2013 independent research, collaborate as scholars, and educate for improving health and health care globally. The application is available at School of Nursing The Doctor of Nursing Practice degree program will prepare Fall 2013 the graduate for practice in the Family Nurse Practitioner role with an emphasis on innovation and evidence based practice. The application is available at MS and BSN options are also available at ISU School of Nursing. (208) Now Recruiting! Welcome to Wyoming Behavioral Institute, a 90-bed acute care psychiatric hospital in Casper, Wyoming, specializing in the treatment of children, adolescents and adults. Our philosophy is intensity of service with a true patient focus. We believe in providing the highest quality treatment services available for long-term healing and improved quality of life. If you have a commitment to service excellence, join our team today! RNs LPNs New Grads Welcome! We offer excellent compensation and full benefits package. The state of Wyoming has no state income tax! Interested applicants please visit our website and apply online today! Wyoming Behavioral Institute has been accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and is licensed by the State of Wyoming s Department of Health. Wyoming Behavioral Institute is owned, managed and operated by a subsidiary of Universal Health Services, Inc., one of the largest providers of high-quality health- care in the nation. WYOMING NURSE REPORTER 7

8 GOOD TO KNOW... New federal regulations must be implemented by Sept. 24, 2013, so the public can better protect and control their personal or protected health information. The new regulations also implement tougher privacy and security provisions for covered entities by lowering the security breach notification standard. The Department of Health and Human Services released new regulations under the Health Insurance Portability and Accountability Act (HIPAA) on Jan. 17, 2013, to become effective March 26.Many of the changes must be implemented on Sept. 24. The HIPAA Privacy and Security Rules have focused on health care providers, health plans and other entities that process health insurance claims. The regulations expand many of the requirements to business associates of these entities that receive protected health information (PHI), such as contractors and subcontractors. Some of the largest breaches reported to HHS have involved business associates. Penalties are increased for noncompliance based on the level of negligence with a maximum penalty of $1.5 million per violation. The changes also strengthen the Health Information Technology for Economic and Clinical Health (HITECH) Breach Notification requirements by clarifying when breaches of unsecured health information must be reported to HHS. Although the new regulations do not substantially alter the fundamental structure of HIPAA compliance, covered entities and employers will likely need to make some changes to ensure continued compliance. Changes to Security Breach Notification Standards The new regulations establish a lower standard for determining whether a covered entity must notify a patient or health plan participant of a security breach involving their PHI. The old standard required notification only if an unauthorized use or disclosure of PHI posed a significant risk of financial, reputational, or other New HIPAA Rules harm to the subject. Under the new regulations, the covered entity is required to notify of a security breach following any unauthorized disclosure of unencrypted PHI unless the entity can prove that there is a low probability that the PHI has been compromised based on a four-part risk assessment. The risk assessment must consider: (1) The nature and extent of the PHI involved, including the types of identifiers and the likelihood of reidentification; (2) The unauthorized person who used the information or to whom the disclosure was made; (3) Whether the PHI was actually acquired or viewed; and (4) The extent to which the risk to the PHI has been disclosed. If the covered entity determines there is a low probability the PHI has been compromised, it must document its risk assessment supporting the decision not to notify patients or participants of the breach. Changes to Individual Rights -- New Notice of Privacy Practices Individual rights are expanded in important ways. Patients can ask for a copy of their electronic medical record in an electronic form. When individuals pay by cash they can instruct their provider not to share information about their treatment with their health plan. The new regulations set new limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of an individuals health information without their permission. The new regulations also streamline individuals ability to authorize the use of their health information for research purposes. The new regulations require certain statements in the Notice of Privacy Practices ( NPP ) regarding uses and disclosures that require authorization. The NPP must contain a statement indicating that an authorization is required for: (1) most uses and disclosures of psychotherapy notes; (2) uses and disclosures of PHI for marketing purposes; and (3) disclosures that constitute a sale of PHI; as well as a statement that other uses and disclosures not described in the NPP will be made only with authorization from the individual. If a covered entity does not record or maintain psychotherapy notes, it need not include the requisite statement in its NPP. The new regulations require a statement in the NPP indicating the individual s new right to restrict certain disclosures of PHI to a health plan where the individual pays out of pocket in full for the healthcare item or service. Only healthcare providers are required to include such a statement in the NPP. The new regulations also require that covered entities include in their NPP a statement of the right of an affected individual to be notified following a breach of unsecured NPP. 8 WYOMING NURSE REPORTER

9 RN OPPORTUNITIES RegisteredNurses Seeking a great work/life balance in a fulfilling environment? Then explore contributing your efforts for a dynamic team in beautiful Sheridan, Wyoming. Sheridan Memorial Hospital is recruiting for Registered Nurses in a variety of departments. Work with a great team of healthcare professionals within a growing organization with tremendous opportunity. Ideal candidates are detail oriented, organized, critically thinking in a fast-paced environment, effective communicators & provide service excellence to all. Positions require Wyoming Registered Nurse license. Living at the base of the Big Horn Mountains offers a beautiful setting with four seasons and unlimited recreational opportunities. Superb fishing, hiking, bicycling, backpacking, boating & hunting are right out the back door. Apply your talents and passion for excellence at Sheridan Memorial Hospital, where the role of nursing is a highly valued! For more information & to apply, please visit and view Career Opportunities. EOE/AAP Jackson Hole, a Great Place to Live & Work St. John s Medical Center, located in beautiful Jackson, Wyoming is accepting applications for Registered Nurses. We offer: Relocation Assistance Hospital-based Childcare Discounted Ski Pass Competitive Salary/Benefits For more information, please visit Click on the careers tab to apply. PO Box 428, Jackson, WY EOE/Drug Free Employer Nurses Wanted Tuition Reimbursement Great Benefits Sign-on Bonus Competitive Wages Relocation Assistance Free Housing for 6 months Continuous Opportunities for Training In All Specialties Memorial Hospital of Converse County is an equal opportunity employer. Behavioral Health Care Making a difference in the lives of patients and their families NursiNg OppOrtuNities Student Loan Repayment Continuing Education License Fee Reimbursement Excellent Pay and Benefits Learn more at prairie-stjohns.com Fargo, ND WYOMING NURSE REPORTER 9

10 By Robert J. Walters, Senior Assistant Attorney General, State of Wyoming In Medical Malpractice Cases, Nurses Are Not Out of the Woods A six-member state court jury heard 10 days of evidence and argument and then took less than four hours to determine that Riverton OB/GYN Stephen Rotholz did not commit medical malpractice in the 2008 delivery of a baby who sustained injuries in the process. (Docket No in the Ninth Judicial District Court Lander Wyoming. Brandi Jo Veach and Anthony James Rodriguez v. Stephen S. Rotholz, M.D.) The Lawsuit Against the Physician Brandi Jo Veach and Anthony James Rodriguez filed suit and made two claims against Dr. Rotholz. One was for negligence by failure to act within the applicable standard of care. The other claim was lack of informed consent. The plaintiffs contended that, after an induction of labor and administration of regional anesthesia and after approximately two hours of pushing, Dr. Rotholz performed a vacuum extraction without adequately informing the mother of the potential risks of vacuum extraction or informing the mother of alternate delivery procedures, including a caesarean section. During the delivery, the infant sustained bilateral clavicular fractures and permanent brachial nerve damage to her left arm, so she cannot raise her left arm above her shoulder. The parents sought compensation for their daughter for future lost wages and earning potential as well as pain and suffering. Important Lessons for Nurses None of the nurses involved in this birth was named in the lawsuit, but four nurses were called to testify in this case. Nurses should always be aware that they can become witnesses who may be compelled to provide testimony against other members of the health care team or an employer. Lawsuits create an opportunity for discovery the process attorneys use to seek out evidence supporting their clients claims or defenses. In the discovery process, information could reveal that a nurse s acts or omissions provide a defense for the physician. If the nurse s conduct has independent significance of culpability, he or she could become a party to the lawsuit. In cases where a nurse has not engaged in acceptable nurse practice, claims have been made by physicians that the nurse s negligence at least contributed to the negative outcome. If those types of claims are made, the focus of the physician s acts or omissions may shift to the nurse. In depositions, medical records may be presented that reveal, for example, a lack of appropriate documentation. A nurse might be questioned regarding his or her own actions, including communications with the physician, which may not be reflected in the medical records. Claims of failure to meet acceptable standards of nursing practice may result if testimony indicates the nurse did not communicate properly with the physician or did not take actions ordinarily required in the presenting situation. This may lead to the nurse becoming a party to the litigation or at the very least testifying as a witness regarding his or her own deficiencies in nursing practice. It also is possible that information developed in the course of a lawsuit results in a complaint to the Wyoming State Board of Nursing, which may evolve into an independent investigation and a sanction that is not tied to the outcome. The focus of that investigation would be the nurse s deviation from acceptable standards of practice. In this situation the nurse would be required to provide information or a response related to allegations of substandard practice as well as other related misconduct. The significance of engaging in proper nursing practice cannot be over emphasized. There is a risk that what has been done (or omitted) during practice may be closely scrutinized. If the evidence reflects appropriate nurse practice, the nurse is not subjected to criticism. But if the evidence reflects substandard or unsafe practice, or negligence, the nurse s professional integrity may be questioned. One important lesson from this Fremont County case is that medical records and any testimony that may be elicited from a nurse should document the adherence to the standards of nursing practice and patient advocacy. This may not prevent the nurse from becoming embroiled in litigation, but proof of appropriate nursing practice may prevent turning the focus of litigation to the nurse or leading to a WSBN complaint. 10 WYOMING NURSE REPORTER

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