Nurse. Time for Renewals is Approaching! Nurse Monitoring Program Overview. License Renewal Requirements: Page 5

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1 Vol. Nurse 8 Number 3 Fall 2012 R E P O R T E R Wyoming Time for Renewals is Approaching! License renewal period will begin October 1st. Nurse Monitoring Program Overview License Renewal Requirements: Page 5

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3 Fall 2012 Wyoming Published by the Wyoming State Board of Nursing 1810 Pioneer Ave. 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. Interim Executive Director Cynthia LaBonde, MN, RN Assistant Executive Director, Practice and Education Consultant Todd Berger, MSN, APRN, ACNS-BC Nurse Investigator Cynthia LaBonde, MN, RN NMP Manager/Investigator Laura Rowe, J.D. Financial and Human Resources Officer Cindy Stillahn Executive Assistant Tambra Shafer Licensing Coordinators Maxine Hernandez LaVelle Ojeda Investigative Assistant Debra Ball Board of Nursing Members Tracy Wasserburger, APRN, NNP-BC, RN-C, President - RN Representative Carrie Deselms, APRN, FNP-BC, Vice-President - Education Representative Cynthia Woods, RN, Secretary - RN Representative Marguerite Herman, - Consumer Representative Donna Nurss APRN Representative Lori Johnson, LPN - LPN Representative Marcie Burr, RN, HSA, CCHP - Administrative Representative Wyoming Nurse Reporter does not necessarily endorse advertisements contained herein. The publisher reserves the right to accept or reject advertisements for Wyoming Nurse Reporter. For Advertising Information: Victor Horne vhorne@pcipublishing.com or ext. 114 Created By: Publishing Concepts, Inc. Virginia Robertson, Publisher vrobertson@pcipublishing.com ThinkNurse.com Publishing Concepts, Inc Taylor Loop Road Little Rock, AR EDITION 30 Vol. 8 Number3 Co-Editors Todd Berger and Patti Gardner Nurse R T a b l e o f C o n t e n t s 3 Cynthia LaBonde, MN, RN Editorial 4 Message from the Board President 5 Renewal Requirements 6 The Road To Decreasing Substance Use Disorders And Drug Diversion In Nurses 10 Nurse Monitoring Program An Overview 11 Faith Jones elected to ANA Board of Directors 12 The Wyoming Center for Nursing and Health Care Partnerships Corner 14 Educators on Education 20 Wyoming State Board of Nursing Updates 22 Legal Decisions You Should Know About 24 Disciplinary Actions 28 PQRST by Todd Berger Greetings Dear Colleagues, It is an honor to be the Board appointed Interim Executive Director for the Wyoming State Board of Nursing. Having been a Registered Nurse in Wyoming for the past 31 years, I can honestly say I am very proud to be a nurse in the great State of Wyoming and to be surrounded by such a talented pool of individuals. We now have approximately 17,000 licensed persons in our state, covering an amazing variety of nursing roles. As we look forward to this year s licensure/ certification renewal period, October 1 - December 31, we have attempted to streamline the process, utilizing the power of Serving and safeguarding the people of Wyoming through the regulation of nursing education and practice E P O R T E R From Cynthia LaBonde, MN, RN Interim Executive Director technology, by providing on-line applications and payments and have recently updated some rules to benefit all licensees. Information regarding the renewal process is available on the WSBN website and board staff are always available to answer questions. We will continue to review our processes to ensure efficiencies at all levels. I look forward to meeting many of you in the upcoming months. Cynthia LaBonde, MN, RN Interim Executive Director cynthia.labonde@wyo.gov (Editor s note: Dr. Mary Kay Goetter submitted her resignation as Executive Director July 31, 2012 after 4 years of service to the Board.) Wyoming Nurse Reporter 3

4 President s Opinion From Tracy Wasserburger President of Wyoming State Board of Nursing Education is a pillar in the nursing field How many of us ever had the thought, gee, if I could just be done with school, my life would be so easy. Well, I believe I thought that all of my high school years, particularly as I sat through algebra class, and then multiple times during semesters when I enrolled in yet another higher education degree program. I thought I was being some kind of genius by choosing a diploma nursing program and saving myself a fourth full year of school. Little did I know how many years I would be enrolled in nursing programs. I still don t regret that option, and am in fact, very proud of it because it opened me to a word in which lifelong learning would be a must in the profession of nursing. Serving my terms on the WY State Board of Nursing (WSBN), I have had reinforcement of how important education is, specifically for regulatory nursing. Education is a pillar in this field and I have come to appreciate how interwoven it is to the activities and decisions that occur through the Board. At a functional level, I m sure all licensees are aware that oversight of Wyoming s nursing education programs are one of the key Board duties. Nursing programs in WY are unique and dynamic and forever feeling the impacting changes through national regulations, testing models, budget constraints, scarcity of faculty, and the unique needs of individual students. I believe in the incredible work that our educators do in producing competent and skilled nursing professionals, and their work is certainly not limited to the class room or clinical setting. One of the greatest comingtogethers for me regarding education has been the work that Nursing Educators of Wyoming (NEW) volunteered in working on the revision to the education rules (Chapter 6). The work of the Board could not have been done without their expertise, their time, and their talent. There is still work to be done on this rules revision but they have set the stage and their involvement was key. I publically thank them again for their commitment to this project. Safety and competence are two of the core values of WSBN. These things cannot be accomplished without education. Remediation and on-going training are ways in which the Board can help ensure public safety and nursing competence. I believe most competency issues can be remediated with the assistance of education. The discipline division of our office is working hard to secure a library of educational resources that we hope to be of assistance to our licensees who are requiring remediation. Granted, more education isn t always the sole answer to some of our cases, but I believe empowering the foundational mind of the nursing professional is paramount in promoting good patient outcomes and professional performance. This, along with positive environments to work in, being surrounded by other positive professionals, and an individual commitment to pursuing education can set the stage for nursing success. My dad always said he wanted to go to college. Growing up in the time that he did, and being the son of an Iowa farmer, he didn t get the opportunity to pursue a formal academic degree. However, he pursued lifelong learning in every aspect of his life. In fact, I feel that he would have enjoyed the following definition in which Wikipedia writes Lifelong learning is the lifelong, voluntary, and self-motivated pursuit of knowledge for either personal or professional reasons. As such, it not only enhances social inclusion, active citizenship and personal development, but also competitiveness and employability. The term recognizes that learning is not confined to childhood or the classroom, but takes place Education is a pillar in this field and I have come to appreciate how interwoven it is to the activities and decisions that occur through the Board. throughout life and in a range of situations. Learning can no longer be divided into a place and time to acquire knowledge (school) and a place and time to apply the knowledge acquired (the workplace). Instead, learning can be seen as something that takes place on an on-going basis from our daily interactions with others and with the world around us. No matter if we are looking at regulatory nursing or not, I would encourage everyone to adopt the concept of lifelong learning. Know that developing the powers of reasoning and judgment, and generally of preparing oneself intellectually for a mature life, will bring great personal and professional satisfaction. 4 Wyoming Nurse Reporter

5 Renewal Requirements The License renewal period will begin October 1st. Online applications will be available then at Following are the basic renewal requirements. APRN: APRNs must meet ONE of the RN requirements and: Provide proof of National Certification OR If recognized as an APRN prior to July 1, 2005, and has maintained continuous recognition but is not nationally certified 1. Provide proof of completion of 60 contact hours of continuing education in the last 2 years related to your specialty area(s) of advanced practice AND 2. Have 400 hours of employment as an APRN in the last 2 years in your specialty area(s) of advanced practice APRNs with Rx Authority must also: Complete fifteen contact hours of education in pharmacology and clinical management of drug therapy or pharmacotherapeutics within the last 2 years (proof required). (The CEs must specifically identify the hours applicable to pharmacology) RN: RNs must meet ONE of the following requirements: Worked a minimum of 500 hours as an RN in the last 2 years Worked a minimum of 1600 hours as an RN in the last 5 years 20 RN continuing education hours in the last 2 years (proof required) Complete a refresher course in the last 5 years (proof required) Certification in a specialty area of nursing practice by a nationally recognized accrediting agency accepted by the board in the last 5 years (copy required) Pass the NCLEX in the last 5 years LPN: LPNs must meet ONE of the following requirements: Worked a minimum of 500 hours as an LPN in the last 2 years Worked a minimum of 1600 hours as an LPN in the last 5 years 20 LPN continuing education hours in the last 2 years (proof required) Complete a refresher course in the last 5 years (proof required) Certification in a specialty area of nursing practice by a nationally recognized accrediting agency accepted by the board in the last 5 years (copy required) Pass the NCLEX in the last 5 years CNA: CNAs must meet ONE of the following requirements: Complete a board approved nursing assistant training program and competency evaluation AND passed a national nursing assistant certifying examination within the last 2 years OR Worked a minimum of 16 hours as a CNA AND completed 24 hours of in-service education in the last 2 years OR Participated in direct patient care through an approved nursing program since the last renewal u All renewals are processed online and applications will be available online ( ) starting October 1. u Renewal items requiring documentation (CEs, National Certification, Refresher courses, etc) can be entered electronically. If there are questions regarding the information or you are chosen for audit you may be required to send in the documentation. u Continuing education hours may be obtained from conferences, seminars, lectures, in-services, and online programs. Make certain you receive proof of attendance showing title, date, hours, provider, and contact information. u If you choose not to pay by Credit Card, complete the online application, print the payment page at the end, submit the application electronically, and send in payment (money order, cashier s check, or personal check) with the payment page. Cash is not accepted. If paying by personal check, processing may be delayed up to 3 weeks while the check clears through state channels (not just your bank). The application will not be processed until the fees are deposited in the WSBN account. u If you have a yes answer to a selfdisclosure question continue to submit the application and fees. Refer to the instructions regarding any additional documents needed. The application will be on hold until that material is received and a determination is made regarding the renewal request. Your license will not expire while under review. u If the WSBN Compliance and Discipline Department is investigating a complaint against you at the time your renewal application is received, you will receive a letter from our office indicating that you may continue to work under your current license or certificate, but your license or certificate will not be renewed until the complaint is resolved. Wyoming Nurse Reporter 5

6 Paula Davies Scimeca, RN, MS Copyright 2012 The Road to Decreasing Substance Use Disorders and Drug Diversion in Nurses Between 1996 and 2006, there were 217,957 violations reported to the National Council of State Boards of Nursing (NCSBN, unpublished) by 44 of the 60 member boards of nursing in the United States. Of these, 60,010 (27.53%) were coded as alcohol and/ or other drug related, with 16,268 specifically categorized as drug diversion by the nurse for their own use. In 2011, the Minnesota Department of Health and the Minnesota Hospital Association in conjunction with other organizational stakeholders in that state, formed the Minnesota Controlled Substance Diversion Prevention Coalition. Their final report, which was released in March of 2012, indicated that reports of drug diversion by healthcare professionals in Minnesota had more than doubled between 2005 and Although the prevalence of substance use, 6 Wyoming Nurse Reporter abuse and dependence in nursing professionals has been noted to parallel that of other health professions and that of the general public (Trinkoff, 1991), the potential risk to the nurse as well as the public cannot be underestimated. As distressing as the above statistics from the NCSBN and Minnesota are, there is strong evidence to suggest that the actual frequency of drug diversion by nurses and other health professionals throughout the U.S. is greater since some instances of drug diversion may go unidentified or, if detected, unreported. While college students may engage in binge drinking, use tobacco and misuse or abuse prescription drugs, a 1999 study of nursing students revealed that nearly 20% had experienced alcohol-related blackouts in the year prior to the survey. Over 6% of the students sampled reported attending class while under the influence of a substance and nearly 4% reported rendering care to patients under the influence. Additionally, nearly 44% of the 929 student respondents reported that they received inadequate substance abuse education in nursing school. (Baldwin, 1999). More recently, the NCSBN released, Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs, which underscored the belief that a lack of education about substance use disorders is a significant risk factor for nurses. (NCSBN, 2011). Issues related to substance use disorders are multifaceted, far-reaching and further complicated by stigma. In spite of the American Nurses Association (ANA) Code of Ethics which mandates nurses to extend compassion towards colleagues with health issues, there are many anecdotal reports by Continued on page 8>>

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8 <<Continued from page 6 nurses and nursing students in recovery from substance use disorders which attest to a pervasive element of stigma within the profession (Scimeca, 2010). At a time when there is a shortage of nurses which is projected to continue into the foreseeable future, it is a major concern that any highly skilled nurse or student nurse with a documented recovery from substance use disorders would encounter anything less than compassion and support within the profession to successfully re-enter or begin nursing practice. Building resilience in nurses and students to reduce substance use disorders and drug diversion can only be achieved by the inclusion of content in the curriculum and clinical experiences regarding this potentially lethal and career-ending disease. Individually and collectively, those of us who are in the profession have the responsibility to support the provision and development of exemplary educational initiatives regarding substance use disorders so that all nurses and nursing students are protected from the lack of education which the NCSBN has found to be one of the top four risk factors in nursing. (NCSBN, 2011). RECOMMENDATIONS Pre-Licensure Education and Policies Faculty should be knowledgeable regarding primary prevention and earliest detection and intervention regarding substance use disorders in their students and their peers. Faculty and administrators of nursing programs should be responsible for creating and maintaining a supportive environment for learning and working, which minimizes stress, encourages creativity, and strengthens self-esteem, resilience and productivity. Nursing students should be given incentives to have at least one family member or significant other in attendance for a mandatory presentation on the risk of substance use disorders within the profession before the student crosses the threshold into the nursing program. All nursing students should receive thorough education about substance use disorders interspersed throughout the curriculum, including the etiology, prevalence and warning signs, as well as the inherent risk of substance use disorders in the nursing profession. Course content should include information about the professional responsibility nurses have regarding selfregulatory activities and the ethical mandate to respond compassionately to nurses who have or are in recovery from substance use disorders. Information on the occupational exposure and the risk mood-altering substances pose to anyone, especially nursing students and nurses, should be a required component of coursework. Academic policies should be in place to deal safely, effectively and proactively with any nurse faculty or nursing student who participates in academic or clinical activities under the influence. Written policies should exist for responding effectively, appropriately and promptly when any faculty member or student nurse exhibits signs or symptoms of a substance use disorder. Employee assistance program and student health services personnel should be educated to recognize the signs and symptoms of substance use and/or abuse in faculty or students. Formal intervention protocols should be established which include provisions to protect the confronted individual from selfharm after intervention. The intervention process should be conducted by a team that includes at least one addiction professional to maximize any opportunities for appropriate diagnosis, optimal treatment, and state-of-the-art follow-up care. The treatment and monitoring of the faculty member or student who has been identified as having a substance use disorder should be consistent with the most current guidelines set forth in the literature. Post-Licensure Education In addition to completing a nursing curriculum enriched with thorough content on all aspects of substance use disorders including professional issues, licensed nurses should be required to keep abreast of current research and treatment for substance use disorders with current information on local resources, legislation and policies that apply to nurses with, and in recovery from, substance use disorders. On-going education underscoring the risk of substance use disorders in anyone, including signs and symptoms to look for in a colleague, should be a mandatory requirement for renewal of nursing licenses in every state. Educational activities should highlight selfcare practices to enhance resilience and decrease stress. Workplace Initiatives Institutions which employ nurses should provide annual mandatory in-service education that includes the latest research on substance use disorders, including updated information on prevention, identification, intervention, treatment and peer support. All institutions employing nurses should have a policy developed by nurses and supported by the institutions senior management regarding nurse-employees whose job performance is affected by a substance use disorder. Nursing supervisors should receive training in the identification of substance use disorders in nurses. All management and leadership personnel should be well-versed in the institution s procedure regarding suspicions of substance use in a nurse. Management and leadership should be an available and highly visible resource to their staff, encouraging dialogue and the earliest report of any suspicions of an issue in a colleague. Employee assistance program and human resource personnel should be knowledgeable in addictions, trained in intervention techniques, and capable of making appropriate referrals for employees who exhibit signs of a substance use disorder. Drug Diversion Prevention Initiatives Facilities and nursing schools should actively support and promote the phasing-out of the terms waste medication, substituting accurate terms such as partially nonadministered dose, totally non-administered dose, expired dose, contaminated dose, spilled dose, etc. Facilities and nursing schools should actively support and promote phasing-out use of the term wasting medication, substituting the term collected medication. Facilities should develop and institute protocols which direct nurses to bag, tag and label all non-administered controlled substance doses and deposit them into a locked container designated for their collection. Facilities should inform all personnel that all collected medication doses are subject to random and for cause quantitative and qualitative assay in order to verify the integrity of the labeled medication. Facilities should develop state-of-the-art protocols to ensure that collected medication is secure and that adequate measures are 8 Wyoming Nurse Reporter

9 undertaken to ensure the optimal safety of any personnel involved in the quantitative or qualitative assay of collected medication. SUMMARY There are clear occupational risks of substance use disorders in nurses and nursing students which pose a significant threat to nurses, student nurses and the public. Establishment of an entry-level knowledge base and exemplary educational programs for nurses and student nurses can better prepare them to address and more readily identify issues related to substance use disorders in themselves and colleagues. Since the risk of developing a substance use disorder is life-long and there are numerous occupational factors which increase the vulnerability of nurses, the nursing profession has a clear duty to support and lobby for the creation and implementation of optimal risk reduction measures in nursing schools as well as the workplace. Time is of the essence and it is incumbent upon the profession as a whole to secure firm commitments as quickly as possible from professional nursing organizations, nurse leaders and nurse academia to develop and implement educational initiatives which can begin to address what has been a long-recognized shortfall in our profession and is now an imminent threat to the very integrity of the profession. REFERENCES American Nurses Association (2001). Code of Ethics for Nurses with Interpretive Statements. Accessed online on at nursingworld.org/mainmenucategories/ethicsstandards/ CodeofEthicsforNurses/Code-of-Ethics.aspx Baldwin, Jeffrey N., Bartek, Jean K., Scott, David M., Davis-Hall, R. Ellen & DeSimone II, Edward M.(2009) Survey of Alcohol and Other Drug Use Attitudes and Behaviors in Nursing Students. Substance Abuse, 30:3, Minnesota Controlled Substance Diversion Final Report, March Accessed online on at National Council of State Boards of Nursing, (2011). Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs. NCSBN, Chicago, IL. National Council of State Boards of Nursing, Discipline Data Chicago: Unpublished. Scimeca, P.D. (2010). From Unbecoming A Nurse to Overcoming Addiction. Sea Meca, Inc., N.Y., N.Y. Trinkoff, A.M., Eaton, W.W., and Anthony, J.C. (1991). The prevalence of substance abuse among registered nurses. Nursing Research, 40, Outstanding Quality Delivered by People Who Care. GREAT Nursing Opportunities! Relocation Assistance is Available Wyoming Medical Center is a state-of-the-art 207 bed acute care hospital in the heart of Wyoming. We offer over 50 specialties and place high value on the role of nursing throughout our system. If you are a committed nurse looking for a rewarding career with a top nursing employer, we welcome you to explore our opportunities and apply to join our team. To apply & view all of our current openings, visit Contact: Sammie Stephens, RN - Nurse Recruiter 1233 E. 2nd St., Casper, WY sstephens@wyomingmedicalcenter.org SCHOOL O F N U R S I N G Equal Opportunity Employer ONLINE NURSING PROGRAMS > RN-BS Online/Completion Option Boise State supports RNs who wish to complete a Bachelor s degree. We understand both professional and personal commitments play a factor in your decision to return to school. > Graduate Program in Nursing (MSN or MN): Nursing of Populations Combine clinical expertise, passion, and knowledge to partner with populations in promoting health, disease prevention and addressing health inequities. Visit Boise State, School of Nursing Programs University Drive Boise, ID Online! Part-time/Full time! Convenient! Wyoming Nurse Reporter 9

10 The Nurse Monitoring Program (NMP) is a program managed by Wyoming State Board of Nursing (WSBN) staff that provides the framework and guidelines necessary to promote safe and competent nursing practice for any nurse or nurse aid under a conditional license or certificate. The ultimate goals of the NMP are to: provide a clear structure for nurses and CNAs with substance use disorders (SUDs) to seek recovery while retaining the ability to practice nursing. provide monitoring and structure for nurses and CNAs with mental health and practice safety issues to seek professional help and further education and training while retaining the ability to practice nursing. verify that conditions placed on the licensee by the Board are met. allow the WSBN to be directly accountable and transparent in its mission to protect the public through regulation of nursing practice. Nurses and nurse aids are enrolled in the NMP because in order for them to continue to practice nursing in the State of Wyoming, the WSBN has determined one or more of the following: that they need monitoring, including random drug screens, for a substance abuse disorder (SUD) that has been diagnosed by a third party addiction specialist or mental health professional; that their ability to practice safely requires further mental health counseling including, potentially, counseling regarding boundary issues, or; that they require additional training and education in one or more areas of nursing practice, which may include the use of a peer review committee. Enrolling in the NMP and successfully completing the requirements of the Program requires that time, effort, and financial resources be expended. Though the participants do not pay a fee to enroll in the NMP, participation may include mandatory multiple monthly drug screens; mental health evaluations and treatment; and continuing education courses. A professional license is a valuable item. It is up to the individual to decide what it is worth to them to keep it while getting the help necessary for safe practice. Participants of the NMP with substance use disorders are required to undergo random drug screens on a monthly basis. Participants are tested from one to four times a month for the duration of their conditional license or certificate (which is generally three to five years). These drug screens can cost between $53.00 and $ each depending upon the urinalysis panel tested for and the collection fee charged by the testing facility. Participants may also be asked to submit to hair and nail tests which can cost from $150 to $375 depending upon the panel and substances tested for. Participants of the NMP for both SUD and non-sud purposes usually must obtain certain mental health evaluations and updates. These evaluations can include substance abuse evaluations (SAEs), psychological evaluations, psychiatric evaluations or neuropsychological evaluation. Substance abuse evaluations can range in cost from $175 to $300, depending upon the evaluator. Psychological evaluations, psychiatric evaluations and neuropsychological evaluations can range in cost from $1500 to $2500 depending upon the evaluator and the type of evaluation. Participants in the NMP may also be required to undergo certain treatment if their SAE or mental health evaluation recommends such treatment. Treatment can include inpatient (residential) Laura C. Rowe, J.D., Nurse Monitoring Program Manager Nurse Monitoring Program An Overview treatment; intensive outpatient (IOP) treatment or ongoing mental health counseling. The cost of treatment varies depending upon the treatment required and may be covered under certain health insurance plans. For example, inpatient (residential) treatment can cost up to $500 a day for thirty days depending upon the facility and the type of treatment required; health insurance may cover some of this cost. Ongoing mental health counseling can cost up to $200 per session depending upon the provider and the type of treatment sought; with health insurance covering some of this cost and requiring possible co-payments. Additionally, the NMP may monitor completion of certain educational requirements as fulfillment of the Board s conditions to continue practicing. These education programs can vary in cost from $30 to several hundred dollars each. The WSBN does not provide financial assistance to participants for covering these various costs. However, some treatment facilities may provide for payment on a sliding scale based on income and health insurance may be used to defray some of the cost. These costs may seem high but they are the price one pays to retain a professional license to practice and earn a living. The NMP offers a path for recovery for those nurses and nurse aids that need help overcoming a professional license violation. For more information on the NMP please visit the NMP website at nursingonline.state.wy.us and click on the Nurse Monitoring Program tab or contact the NMP Manager at or bonwsbnnursemonitoring@wyo.gov. 10 Wyoming Nurse Reporter