Nursing Education Trends in the US

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1 Quarterly circulation approximately 320,000 to all RNs, LVNs, and Student Nurses in Texas. Volume 8 Number 2 April, May, June 2014 An Open Letter from TNA Executive Director to TNV Readers by Cindy Zolnierek, PhD, RN, TNA Executive Director Greetings! As a licensed nurse in Texas, I receive several regional nursing newsletters that do not require a subscription. The Texas Nursing Voice (TNV) is one of these. So what makes the TNV special? The TNV is unique in that it comes from the Texas Nurses Association (TNA) a 107-year-old membership organization of nurses in Texas. Our members represent all corners of the state, all practice arenas, and all educational levels. Our members represent nurses who value association membership as an investment in their profession and practice. By virtue of its presence and participation in legislative and policy arenas, TNA has timely and comprehensive information about nursing practice. You ll find examples of this information in the TNV. There are updates from state meetings where nursing was represented by TNA, where TNA represented nurses, Texas Team (action coalition implementing recommendations from the 2010 Institute of Medicine report), as well as clinical perspectives affecting your practice. TNV, Informing All Texas Nurses So why not restrict the TNV to dues-paying members? Most simply, because the TNA membership and board of directors believe that all nurses deserve to be informed about critical news and events potentially affecting them. And we fill the role of informant. We also believe that the TNV provides TNA with an opportunity to inform nurses about what it is that we do, and that, as nurses come to appreciate the value we offer, nurses will consider membership in their professional organization. There is no better time to join than now. We are participating with our national affiliate, the American Nurses Association, to offer membership to both organizations at a significantly reduced rate. (See page 19 for TNA/ ANA Membership Application.) A member of your specialty organization? Great! Specialty organizations represent interests and concerns specific to the particular area of practice emergency nurses have been concerned about violence in the workplace, school nurses about parental notification for nursing presence/absence on school campuses, perioperative nurses about protecting their ability to perform in the scrub role, advanced practice registered nurses about their ability to function to the full extent of their education and competency. TNA, Advocating for All Nurses TNA hosts a coalition of specialty organizations (the Nursing Legislative Agenda Coalition), which support a common legislative agenda. We capture the power of a unified voice among all nurses to accomplish policy changes. We have worked with specialty organizations to accomplish their legislative goals for example, elevating assault against emergency department nurses to a felony level (2013). Yet, there are many issues that affect all nurses regardless of practice level, specialty, or setting our right and responsibility to advocate for our patients and need for protection from retaliation, our interest in having the Board of Nursing (BON) focus on those nurses who truly threaten public safety, and the need to ensure adequate numbers of nurses to care for the aging population. Specialty organizations generally do not focus on these broad issues and alone cannot effectively influence these issues. TNA is there whatever your practice setting or specialty. Whatever your educational preparation, population of interest, or clinical specialty. TNA represents all nurses everywhere in practice, policy, and education arenas. We ensure nurses have advocacy protections by successfully supporting key state legislation (H.B. 581), work to implement alternatives to disciplinary action (e.g. corrective action or deferred disciplinary action) by the BON, and secure funding for nursing education ($34 million secured in 2013). These efforts benefit all nurses as well as all Texas citizens. Don t you owe it to yourself to join TNA? Don t you owe it to those who follow you in this proud profession of nursing? current resident or Presort Standard US Postage PAID Permit #14 Princeton, MN Texas Team Dreams Big at Dallas Second Summit Associations Must Innovate, Foster Leadership Skills to Prosper What You Need to Know About New BON Rules on Pain Management Prescribing Rules for Refills Clarified for APRNs... 9 INDEX Texas Academic Progress in Nursing (APIN): Building on the Past to Improve the Future What Are the Key Differences Between TNA and BON? NOEP Celebrates 27th Anniversary ANA/TNA Membership Application... 19

2 Page 2 Texas Nursing Voice April, May, June 2014 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 1: Laura Sarmiento Phone: laurasarmiento01@aol.com District 2: Ruth Whitehead Phone: ruth.whitehead@ttuhsc.edu District 3: Shakyrn Napier Phone: napier043@aol.com District Address: P.O. Box 16958, Ft. Worth, TX Office: tna3@usapathway.com Website: tna3.org District 4: Nancy Roper Willson Phone: nwillson@roperwillson.com District Address: Pat Pollock P.O. Box , Dallas, Texas Office: d4tna@flash.net Website: tnad4.org District 5: Crystal Wilkinson Phone: crystal.wilkinson@ttuhsc.edu Website: tna5.org District 6: Rebeka Watson Campbell Phone: rebwatso@utmb.edu Website: tna6.org District 7: Donna Finto Phone: donnafinto@att.net District Address: P.O. Box 1475, Belton, TX District 8: Sarah Williams Phone: williajs@uiwtx.edu Website: texasnurses.org/districts/08/ District 9: Patrick Laird Phone: patrick_laird@me.com District Office: Melanie Truong 2370 Rice Blvd., #109, Houston, TX Office: tna9@tnadistrict9.org Website: tnadistrict9.org Legal Issues? Call Joe Flores, JD, NP Attorneyjoeflores@ gmail.com 24 / 7 Texas Nurses Association Districts and Presidents Clinical Directors OCC & NICU Trinity Mother Frances, the preferred health care provider in east Texas, has an exciting healthcare opportunity. We are seeking highly motivated Clinical Directors. The Clinical Director will collaborate with the Divisional Director regarding the daily clinical leadership for the division. Texas RN license Bachelor s Degree in Nursing, Masters degree is strongly preferred 3 to 5 years clinical exp; prefer at least 3 years management experience in related areas of nursing Apply online at tmfjobs.org or contact recruitment at floydj2@tmfhs.org for more information. District 10: Helen Woodson Phone: Helen.Woodson@va.gov District 11: Vacant District 12: Gerald Bryant Phone: gerald.bryant@bhset.net District 13: Vacant District 14: Joe Lacher Phone: joe.lacher@utb.edu District 15: Andrea Kerley Phone: akerley@hendrickhealth.org Website: texasnurses.org/districts/15/ District 16: Judith (Ski) Lower Phone: skiwee43@aol.com Web site: districts/16/ District 17: Eve Layman Phone: evelayman@yahoo.com Web site: texasnurses.org/districts/17/ District 18: Pat Francis Johnson Phone: ext patricia.francis@ttuhsc.edu Website: texasnurses.org/districts/18/ District 19: Karen Koerber-Timmons Phone: ktimmons@uttyler.edu Website: texasnurses.org/districts/19/ District 20: Christine Krause Phone: cjasmine1111@gmail.com District 21: Rebekah Powers Phone: Rebekah.powers@midlandmemorial.com District 22: Toni McDonald 3tmcdonald@windstream.net District 25: Vacant District 26: Esmeralda Garza Phone: tacuaro48@yahoo.com District 28: Vacant District 29: Tina Cuellar Phone: ehcuella@utmb.edu District 35: Chrystal Brown Phone: cbrown@ntcc.edu District 40: Contact TNA Phone: ext brichey@texasnurses.org TEXAS NURSING Voice A publication of Texas Nurses Association April, May, June 2014 Volume 8, Number 2 Editor-in-Chief Cindy Zolnierek, PhD, RN Interim Managing Editor Karen F. Aroian Creative Communications Deborah Taylor Circulation Manager Belinda Richey Editorial Contributors Karen Aroian; Stacey Cropley, DNP, RN, CPN; Toni Inglis, MSN, RN, CNS, FAAN; Helen Reid, Ed.D, RN; Lauren Smitherman; Susan Sportsman, PhD, RN, ANEF, FAAN; Kathryn Tart, Ed.D, RN; Adam Wasch; Lisa Kathleen Watson, MLA; Cindy Zolnierek, Ph.D, RN Board of Directors Officers Margie Dorman-O Donnell, MSN, RN, President Karen Lyon, PhD, APRN, ACNS, NEA, Vice-President Terry Throckmorton,PhD, RN Secretary Sarah Moody, MS, RN, NEA-BC Treasurer Regional Directors Kim Belcik, PhD, RN-BC Central June Marshall, DNP, RN, NEA-BC North Eve Layman, PhD, RN, NEA-BC South Pam Greene, PhD, RN East Patty Esposito, MSN, RN, NEA-BC, LNFA West Executive Director Cindy Zolnierek, PhD, RN Editorial Office TEXAS NURSING VOICE is published quarterly January, February, March; April, May, June; July, August, September; and October, November, December by Texas Nurses Association, 8501 North MoPac Expressway, Suite 400, Austin, TX , tnveditorial@texasnurses.org Address Changes Send address changes to Texas Nurses Association, 8501 North MoPac Expy, Suite 400, 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 2014 by Texas Nurses Association, a constituent member of the American Nurses Association. Published by: Arthur L. Davis Publishing Agency, Inc.

3 April, May, June 2014 Texas Nursing Voice Page 3 Texas Team Dreams Big at Dallas Second Summit by Toni Inglis, MSN, RN, CNS, FAAN A dream implemented is a vision; a dream without action is a hallucination. Beverly Malone, PhD, RN, FAAN and CEO of the National League for Nursing, speaker at the 2014 Texas Summit Conference in Dallas on February 12. Dr. Malone has served as the president of the American Nurses Association, U.S. Deputy Assistant Secretary of Health, and general secretary of the United Kingdom s Royal College of Nursing. The Dream A blue-ribbon committee met in 2008 to dream. It was chaired by former U.S. Secretary of Health Donna Shalala and called the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. The committee decided on Better Care, Better Health, Reduced Cost as its ultimate goal. They dreamed that nurses would: practice to the full extent of their education and training. achieve higher levels of education through an improved and seamless education system. be full partners with physicians and other health professionals in redesigning U.S. healthcare. have access to better data collection and an improved information infrastructure that could serve as the basis for workforce planning and policy-making. The Report In 2010, they published their landmark report, The Future of Nursing: Leading Change, Advancing Health. It made eight specific recommendations: 1. Remove scope-of-practice barriers. 2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. 3. Implement nurse residency programs. 4. Increase the proportion of nurses with a baccalaureate degree to 80 percent by Double the number of nurses with a doctorate by Ensure that nurses engage in lifelong learning. 7. Prepare and enable nurses to lead change to advance health. 8. Build an infrastructure for the collection and analysis of inter-professional healthcare workforce data. Had the report sat on a shelf gathering dust, it may have been a collective hallucination. But it didn t, and it wasn t. The report and the action following it may be as big a game-changer for nursing and public health as the development of the advanced practice roles in the 1960s. At the Texas Team Summit Feb. 12, from left: Campaign for Action Director Dr. Sue Hassmiller, PhD, RN, FAAN, Texas Team Strategic Advisory Committee member Dr. Alexia Green, PhD, RN, FAAN, and National League for Nursing CEO Dr. Beverly Malone, PhD, RN, FAAN, updated hundreds of nurses on the progress toward realizing the IOM vision for the future of nursing. The Action To implement the report s eight recommendations, a Campaign for Action was formed, sponsored by the Robert Wood Johnson Foundation and AARP. RWJF senior adviser for nursing, Sue Hassmiller, PhD, RN, FAAN, was named director. Texas Team Dreams Big continued on page 4 When you re ready to advance. You are ready for American Public University. Expand your opportunities with a CCNEaccredited RN to BSN program. APU can help you balance your personal and professional life while pursuing a respected degree online at the university that is the only 3-time Effective Practice Award winner from the Sloan Consortium. Visit: StudyatAPU.com/ALD We want you to make an informed decision about the university that s right for you. For more about our graduation rates, the median debt of students who completed each program, and other important information, visit

4 Page 4 Texas Nursing Voice April, May, June 2014 Texas Team Dreams Big continued from page 3 Regional action coalitions sprang up throughout the nation to implement the work. The Texas Team coalition comprises hundreds of organizations and thousands of individuals committed to achieving the IOM future of nursing goals. The Summit On February 12, hundreds of nurses from across Texas and beyond gathered in Dallas to hear the progress of the Texas Team. In her keynote, Dr. Hassmiller discussed Texas s unique and serious challenges, namely the highest rate of uninsured, a rate of persons reporting poor health that s twice the national average, and a critical shortage of dentists and primary care physicians. But she noted these challenges make it a ripe time for change. She congratulated the Texas Team as a top performer and as a leader in diversity and in finding innovative solutions to strengthen nursing leadership, practice, and education. Alexia Green, PhD, RN, FAAN, co-led the Texas Team through 2013 and is a member of its Strategic Advisory Committee. She is a professor and dean emeritus at Texas Tech University Health Sciences Center School of Nursing. She spoke about all the utility of coalitions and what high-velocity edge leadership looks like. She provided an overview of the work of Texas s regional teams. It may be as big a game-changer for nursing and public health as the development of the advanced practice roles in the 1960s. The Breakout Sessions In breakout sessions, the practice, education, and leadership teams from the North, Central, East, Upper Rio Grande, and Panhandle regions informed engaged audiences of their local gains as well as lessons learned. A critical boost to the groups efforts was provided by the Perryman Group, a leading economic analysis firm that published a report in 2012, detailing the considerable local and statewide economic benefits of removing barriers to APRN practice. The report helped TNA work to pass favorable legislation such as SB 406, which significantly enhanced APRN prescriptive authority. Also, the University of Texas at Arlington, Western Governors University, and Texas Tech HSC all created innovative delivery models to increase the number of RNs with BSNs and diversity in the workforce. Fundraising to sustain work and develop leadership so that more nurses can effectively serve on boards is solidly underway, too. A Texas Team gala, held the evening of the conference and sponsored by Johnson & Johnson and Blue Cross Blue Shield of Texas, raised $372,000 to support the work of the Texas Team. The Vision By Malone s standards, the IOM committee s dream definitely was not just a hallucination. Progress has been made nationally: Eight states have removed major barriers to APRN practice. Fifteen states introduced legislation in 2013 to expand scope of practice. Nine states requested and received a Federal Trade Commission opinion on removing barriers. Nine states (including Texas) received grants to test one of four promising models to help more diverse nurses continue their education. Medicare is paying for graduate nursing education in five states. Texas has increased diversity in BSN programs and 34 states have prioritized diversity initiatives. Action coalitions have raised $6.9 million as of October Green observed that the needle has begun to move, but not fast enough. She challenged nurses to find the courage to fully commit to doing the work, month-in, month-out to reach the IOM goals by The Call What can you do? The most basic step to affect legislation and further the IOM effort is to become a dues-paying, active member of the Texas Nurses Association. Go to texasnurses. org. You may also join the Texas Team online community at campaignforaction.org. About the Author: Toni Inglis is a retired neonatal intensive care nurse and editor of NursingNews at the Seton Healthcare Family in Austin. She also writes a monthly opinion column for the Austin American-Statesman editorial page. THE STRENGTH TO HEAL and the training that will advance my career. As a nurse anesthetist on the U.S. Army health care team, you ll work shoulder-to-shoulder with recognized leaders in their fields, use the most sophisticated technology, learn from extensive case diversity and benefit from educational opportunities that will help you develop your skills and prepare you to advance. You may qualify for many financial benefits, including opportunities for student loan repayment. See how serving your country can help you realize your fullest potential. For more information on an Army career visit, healthcare.goarmy.com/nursing or call SFC Robert Moffett at Paid for by the United States Army. All rights reserved.

5 April, May, June 2014 Texas Nursing Voice Page 5 Associations Must Innovate, Foster Leadership Skills to Prosper by Adam Wasch Professional associations must adapt to changing times and find ways to help nurses grow their leadership skills, according to prominent international nursing expert and CEO of the National League of Nursing (NLN) Dr. Beverley Malone, PhD, RN, FAAN. Dr. Malone addressed the Texas Team Summit in Dallas in February. Beverley Malone We re all going to have to change how we perform our business, Dr. Malone states. Founded in 1893, NLN focuses on nurse education and school faculty. If we don t watch it and consistently innovate, we ll end up looking like we re 120 years old when the rest of the world is moving at a much swifter pace. I think that s the issue and challenge for all our nursing professional associations. To succeed, nurse associations need to engage their members in tangible ways that recognize the reality of the profession today while helping build a path to the future, Dr. Malone explains. An association must produce benefits to members to help them grow and develop their careers. They must see a place for themselves in their careers and see membership as part of their career enhancement. We have to give them something that makes a difference in their professional lives. Dr. Malone s opinion has clout. Her 44 years in nursing has placed her at the center of leadership, scholarship, and public policy. Beginning as a bedside surgical staff nurse, Dr. Malone went on to become a two-term president of the American Nurses Association, Deputy Assistant Secretary for Health within the U.S. Department of Health and Human Online Convenience ith a Tradition of Excellence Services, and the general secretary of the Royal College of Nursing, the United Kingdom s largest professional union of nurses. Figuring Out Which Way is Up Helping to develop leadership skills in nurses is top among Dr. Malone s goals. By leadership, Dr. Malone specifically means the skills necessary to evaluate problems, set agendas, make decisions, and build effective coalitions skills to which entry-level nurses generally are not exposed or have had the time on which to focus. These skills only take root as nurses careers and educational development progress, she says. With your first degree, you re basically doing well just to be on the floor and working you re just trying to figure out which way is up, continues Dr. Malone, who started her nursing career after graduating in 1970 with a bachelor s degree. She later earned a master s in psychiatric nursing and a doctorate in clinical psychology in But with that second degree, that master s, you should have received some leadership lessons along the way. You should understand return on investment, what missions and goals mean, how budgets work, how to collaborate, and how to bring people to the table. Nurses are pushed into leadership positions for which they were never prepared, Dr. Malone says. You re a great nurse; you re doing great work, so you should lead, you re told. But you have no idea how to do that. So you get clobbered in those leadership positions because you don t know what to expect when you get there. Leadership seeds planted and theorized in the academic environment only prepare a nurse Associations Must Innovate continued on page 6 RISE WITH THE TIDE Online Convenience with a Tradition of Excellence DISTANCE NURSING PROGRAMS UNDERGRADUATE RN to BSN (Online) GRADUATE RN to BSN/MSN (Online) MSN-Case Management Leadership (Online) MSN-Clinical Nurse Leader (Online) MSN/EdD or EdD in Instructional Leadership for Nurse Educators (Online & Weekend) DNP-Doctor of Nursing Practice (Online) get started today! BamaByDistance.ua.edu/nurseTX

6 Page 6 Texas Nursing Voice April, May, June 2014 Associations Must Innovate continued from page 5 so much, Dr. Malone says. The work world, whether in hospitals or universities, requires leadership skills that must be practiced in actual work settings. To learn on the job, a nurse must cooperate with peers and, to be really successfully, be mentored by other leaders. But nurses don t know about mentoring, much less how to do it or how to ask for it, she argues. These are areas where professional associations can make a real difference, by providing this coaching and connecting rising leaders to mentors. It can t only be about formal, in-class learning, Dr. Malone continues. Why wouldn t we want to teach nurses, of whatever specialty group, how to survive and bring people with them, to understand that it s not all on your shoulders when you re a leader when, in fact, Navy Nursing. Truly an Honor. There are opportunities for nurses to gain extraordinary experience serving as an officer in the Navy (Active Duty) or Navy Reserve, while maintaining a civilian career. 19 specializations from Critical Care to Nurse Anesthetist. Excellent benefits including a potential sign-on bonus of up to $30,000 (based on specialty). WANT TO LEARN MORE? CONTACT YOUR NAVY RESERVE MEDICAL RECRUITER TODAY. (877) JOBS_SANANTONIO@navy.mil Paid for by the U.S. Navy. All rights reserved. it means surrounding yourself with people who complement your knowledge and who may know some things better than you do? That s the meaning of leadership understanding what the system needs and then developing and attracting the people who can help you do it. What an opportunity for all the professional associations! A Role for Everyone For all this talk of leadership, some nurses may not be interested in assuming formal leadership roles; they may want to dedicate themselves to clinical work. By 2018, forecasts predict that 20 percent more nurses will be needed than were in demand in The two primary drivers of that demand an aging population and a retiring nurse workforce ensure that there will be plenty of work to do without aiming for the position of board chairman. Love what you do. Touch a life, share your compassion and make a difference to those in need. Be a part of a team that believes in the principles of Christian service, clinical excellence and healthy communities. Come join our ministry and love what you do. Apply at covenanthealth.org I think we all have roles at home, with our friends and families, and at work, Dr. Malone says. Everyone cannot do everything. We have to give each other some room to be who we are, including in roles we choose. I ve got to show appreciation for my colleagues who can t make the meeting like I can, whose work is expressed differently. At the same time, I just need them to send an to their congressperson, for example. An is very simple, but when we work together, we can pull all of the power of nursing together. TNA Fights for All Nurses In Texas alone, there are more than a dozen nursing-related professional associations representing LVNs to APRNs and emergency nurses to nurse anesthetists. Because the Texas Nurses Association is concerned with all nurses in Texas, it is in a unique position to bring the profession together on important issues such as workplace safety, adequate staffing, and educational advancement. Broad coalitions are important when it comes to effective legislative and regulatory advocacy. Members of the Texas Legislature are much more likely to act on key nursing issues, such as autonomous practice or whistleblower protections, if the various nursing groups are in agreement. TNA is respected by Texas legislators and has a longstanding productive relationship with the Board of Nursing. Unfortunately, nurses may join just one professional association, if they join one at all, and forego opportunities to form larger coalitions. In contrast, the large majority of Texas physicians, for example, join both the leading statewide medical association and their respective specialty associations. In the world of politics and professional advancement, joiners tend to be winners, too. What do you want from a professional nurse association? Join the conversation on TNA s Facebook page, facebook.com/texas. Nurses.Association. RN Positions Available Care Manager Opportunity - Per Diem Focus Care Inc. is seeking nurses for an exciting PRN employment opportunity providing non-clinical, in-home care management services to Medicare members. Providers receive a competitive compensation package and liability coverage. Referral bonus available for providers in the states listed below. Interested applicants, please resume to Maro Titus Vice President, Business Development & Operations mtitus@focuscares.com Focus Care, Inc. is a privately owned organization with a nationwide presence. Opportunities are available in the states of AZ, FL, GA, IN, KY, LA, MA, ME, NH, NM, NC, OH, PA, SC, TN, TX, VA, WV and WI.

7 April, May, June 2014 Texas Nursing Voice Page 7 What You Need to Know About New BON Rules on Pain Management by Stacey Cropley, DNP, RN, CPN, TNA Practice Director Pain management clinics frequently dispense prescription drugs inclusive of opioids and other highly addictive medication in the treatment of pain. The increased incidence of the treatment of pain within the clinic setting has created an opportunity for pill mills. These illegal clinics are typically operating under the guise of legitimate medical clinics. In reality, they are less than legitimate, distributing large quantities of controlled substances and medications without regard to the medical necessity or therapeutic benefit and in exchange for significant monetary rewards. As a result, pill mills have been linked to an increased incidence and risk of prescription drug abuse and overdose. Pill mill activity within Texas has been reported to take place in clinics primarily staffed by Advanced Practice Registered Nurses (APRNs) with the authority to diagnose and prescribe medications under the delegated authority of a physician. Because APRNs have been linked to pill mill activity and clinics closed by law enforcement, the Board of Nursing (BON) has determined that additional guidance is needed for APRNs who may practice in the area of pain management. The treatment of pain is complex, requiring in-depth treatment plans and a collaborative health care team working together to reduce a patient s pain and improve quality of life. Legitimate treatment of pain may indeed include prescribed opioids and other controlled substances. The new rule is not intended to prevent APRNs from providing legitimate pain management services or impede the practice of pain management, but rather sets forth the minimum standards of practice to which an APRN must adhere when providing pain management services and care. The standards within the rule are intended to protect the public from inappropriate care that deviates from the currently accepted evidence-based interventions and that represent dangerous, non-therapeutic treatment practices. The rule is set out in the Texas Administrative Code, Title 22, Part 11, Chapter 228, Rule entitled Standards of Practice, and became effective on February 23, The rule can be accessed at Rule ( Rule-228-1) and the subsections of the rule are summarized in the table to the right: Subsection Subsection (a) Subsection (b) Subsection (c) Subsection (d) Section Summary Sets the definitions to be used in the chapter. Identifies the purpose and expectations regarding the provision of pain management services, inclusive of: Therapeutic efficacy of proposed pain treatment Complete patient assessment Sound clinical judgment Legible, accurate, and complete documentation Mutual agreement between the patient and provider of the proposed treatment plan with a documented rationale for the intervention Describes the minimum standards that apply to patient assessments, inclusive of: A documented physical assessment of the patient including a problemfocused exam specific to the presenting chief complaint Documented current and complete health history A completed physical assessment each time an APRN prescribes/orders new medication or refills for a patient Pain assessment and documentation must include The nature and intensity of pain All current and past treatments for pain Underlying conditions and co-existing physical and psychiatric disorders The effect of pain on physical and psychological function History and potential for substance misuse, abuse, dependence, addiction, or other substance use disorder One or more recognized clinical indications for the use of a medication if prescribed Describes the requirements related to a patient s treatment plan, ensuring that there is a written treatment plan documented in the record, inclusive of: Written explanation of how the medication ordered relates to the chief presenting complaint and the treatment of pain Name, dose, frequency, and quantity of any medication prescribed and the number of authorized refills Lab testing and diagnostic evaluations ordered All other treatment options that are planned or considered Plans for ongoing monitoring and outcomes of the treatment plan Subjective and objective measures that will be used to determine treatment outcomes Any and all consultations and referrals including date made, to whom, the time frame for completion, and the results Documentation of informed consent as required in subsection (e) What You Need to Know continued on page 8 PROTECT YOUR LICENSE!! If you have received: Letter of Investigation from the Texas Board of Nursing Notice of Peer Review Contact Joyce Stamp Lilly RN JD or jslilly@nurse-lawyer.com Registered Nurse and Attorney Call today, delay is not an option!

8 Page 8 Texas Nursing Voice April, May, June 2014 Denton State Supported Living Center Looking for LVNs & RNs to serve individuals with Developmental Disabilities Paid Time Off Paid Health Insurance After 90 Days Excellent Retirement Plan Job Stability Denton State Supported Living Center 3980 State School Rd., Denton, TX EEO/ADA Employer Apply Online Today Texas Department of Aging and Disability Services What You Need to Know continued from page 7 Subsection (e) Requires the discussion of informed consent to be documented by either a written signed document or a contemporaneous notation within the patient s medical record. The discussion of risks and benefits should include: The diagnosis Treatment plan Expected therapeutic outcomes Non-pharmacologic therapies Potential side-effects of treatments and drug therapy and how to manage common side effects Adverse effects of medication use Potential for impaired judgment and motor skills The University of Texas of the Permian Basin Nursing Clinical Director and Assistant/Associate Professors The University of Texas of the Permian Basin invites applications for the multiple positions: Clinical Director position is a member of the full-time faculty who also holds an administrative appointment related to managing all aspects of clinical and preceptor experiences for UT Permian Basin Nursing students as designated by the Director of the Program. Requirements include a doctorate in Nursing or related field. Assistant or Associate Professor of Nursing, (Doctorate required) Master s degree for clinical and classroom teaching. We are seeking individuals who are highly innovative to participate in teaching in a new Bachelor of Science Degree Nursing Program. The Nursing program is also developing an RN-to-BSN program to open soon with face-to-face and online formats. All Applicants must have or be eligible for current licensure as a registered nurse in the State of Texas and have clinical teaching experience. Responsibilities include teaching undergraduate students in classroom and clinical facilities. Interested candidates should submit a C.V. and cover letter to: Dorothy Jackson, PhD, RN, Director of Nursing, The University of Texas of the Permian Basin, 4901 E. University Blvd., Odessa, Texas , Jackson_d@utpb.edu. EOE/AA New Low Rates for Texas Nurses Up to $1 MILLION each claim/ up to $6 MILLION Aggregate Professional Liability Insurance for $106 * a year. Now available through Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc. (TX License 13695). *Full-time employed rate. TNV0414 Subsection (f) Subsection (g) Subsection (h) Subsection (i) Requires the use of a written pain management agreement if a treatment plan includes the use of drug therapy for longer than 90 days. The written agreement must outline the patient responsibilities that include: Lab testing for drug confirmation upon the request of the APRN, delegating physician, and/or any other health care providers Adhere to the number and frequency of prescription refills Use only one provider to prescribe controlled substances related to pain management Use of only one pharmacy for all prescriptions for controlled substances related to pain management Acknowledge potential consequences of non-compliance with the agreement Acknowledge process following successful completion of treatment goals, including weaning medications Relates to the ongoing monitoring of the treatment plan by the APRN at reasonable intervals and documentation of: Patient progress or lack of progress Any adjustments to the treatment plan based on patient need and based on evaluation of progress toward the treatment plan goals as well as consideration of any new factors Objective evidence of improved or diminished function Continuation of scheduled drugs shall include consultation with the delegating physician and documentation of such in the patient record Relates to consultation and patient referral. In certain situations further evaluation may be indicated, inclusive of: Patients at risk for substance use disorders or addiction Patients with chronic pain and histories of substance use disorders with coexisting psychological and/or psychiatric disorders Document referrals of in-patient record Relates to pain management clinics in the state of Texas, requiring APRNs to verify that the clinic has been properly and is currently certified as a pain management clinic by the Texas Medical Board prior to providing pain management services in that setting, and that each APRN: Be available on site with the physician at least 33 percent of a pain management clinic s total operating hours Meet all other statutory requirements Is treating patients in the APRN s area of specialty Personally uses other forms of treatment with the issuance of a prescription to the majority of the APRN s patients Not own or operate a pain management clinic. This prohibition does not apply to the APRN who owns or operates a clinic that is exempt from the certification requirements set forth in the Occupations Code Chapter 168 and the Texas Medical Board. The requirements outlined in the new rule are intended to ensure the protection of the public s health, safety, and welfare by ensuring that APRNs provide legitimate pain management services that are based upon sound clinical judgment and are consistent with generally accepted standards of care. In addition, thoughtful patient assessment, monitoring, and accurate, adequate documentation are further reiterated, highlighting the importance of these core functions in all nursing care. The new rule further emphasizes the importance of regularly monitoring the efficacy of the treatment plan, amending as necessary and when appropriate and engaging in meaningful patientcentered dialogue with patients regarding the realistic expectations of the treatment plan, and including the patient s corresponding responsibility for meeting treatment goals. Essentially, the new rule is intended to ensure improved quality of care for patients through clear role delineation and responsibility for both the APRN and patient engaged in the management of pain.

9 April, May, June 2014 Texas Nursing Voice Page 9 Prescribing Rules for Refills Clarified for APRNs APRNs who ve had trouble prescribing refills for controlled substances should find relief due to a clarification recently approved by the Texas Board of Nursing (BON), Texas Medical Board, Texas Pharmacy Board, and the Texas Department of Public Safety. The difficulty arose as a result of wording in Section (b) of the Medical Practice Act (Texas Occupations Code) that addresses physician delegation of prescriptive authority for controlled substances, according to BON, and rested on the word a. Although the law allows prescriptions for up to a 90 day supply of controlled substances, some pharmacists refused to fill prescriptions that were written with more than one refill (e.g. 30 day supply with two refills), said BON Advanced Practice Nurse Consultant Jolene Zych, PhD, RN. As rationale, the pharmacists cited the above section of the law and indicated that a refill means only one refill. Therefore, in order to prescribe the 90 day supply, the prescription would have to be written to dispense the full 90 day supply or to dispense a 45 day supply with one refill, Zych said. In November 2013, staff of the BON, the Texas Medical Board, Texas Pharmacy Board, and the Texas Department of Public Safety met and agreed that the statute should be interpreted to allow a prescription for controlled substances for up to a 90 day supply, BON said. As long as the original prescription plus the number of refills permitted does not exceed a 90 day supply of the controlled substance, the prescription should be filled as written. The Texas State Board of Pharmacy posted information regarding this issue on its website ( BON asks APRNs to refer pharmacists to this site if needed. Call TNA Practice Director Stacey Cropley, DNP, RN, at (512) , ext. 132, if you have questions. Received a Board of Nursing complaint for failing to report criminal charge on application or renewal? Fingerprint background check leading to more complaints for criminal charges 5, 10, 20, 30, yes even 40 years old! Call today for experienced and affordable legal help. Payment plans available on most cases. Oscar San Miguel, Attorney at Law OSMLAW.COM Oscar@osmlaw.com fax phone Come Join Us in Sunny South Texas! Corpus Christi, TX Protect your baby. Immunize at every pregnancy. Pregnant women need to know about the risks pertussis poses to them and their babies. And there is no healthcare provider they trust more than you. So it s vital that you educate them about the risks of getting the pertussis vaccine at every pregnancy and tell them how safe and effective the pertussis vaccine is for them and their babies. PreventPertussis.org Texas Department of State Health Services Immunization Branch Now hiring immediately for the following positions: ECMO Advanced Heart-Pump Technologies Coordinator Neonatal Nurse Practitioner RN NICU Nurse Practitioner Cardiac RN PICU Director of Surgical Services RN Special Work Clinical Educator NICU Assignment Team For additional information visit our website at or contact Mandy Jameson at Federal Correctional Institution in Fort Worth, Texas is seeking RNs, LVNs, CNAs & EMT/Paramedics. We offer competitive salaries including extra pay for working nights, Sundays, and federal holidays. Great law enforcement retirement benefits including Health/Life insurances, TSP, and a possible recruitment bonus. Apply for openings at: Address questions to: FTW/Recruiter@bop.gov EOE

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12 Page 12 Texas Nursing Voice April, May, June 2014 Texas Academic Progress in Nursing (APIN): Building on the Past to Improve the Future by Susan Sportsman, PhD, RN, ANEF, FAAN, Helen Reid, Ed.D, RN, Kathryn Tart, Ed.D, RN, and Lauren Smitherman In March of 2012, the Tri-Council for Nursing, consisting of the American Association of Colleges of Nursing (AACN), National League for Nursing, American Nurses Association and the American Organization of Nurse Executives (AONE) announced a $4.3 million, two-year initiative, funded by the Robert Wood Johnson Foundation (RWJF), to advance state and regional strategies to create a more highly educated nursing workforce. Specifically, the initiative was designed to achieve the 2010 Institute of Medicine (IOM) goal that 80 percent of the RN workforce should hold a Bachelor of Science in Nursing (BSN) or higher by Action Coalitions across the country that were working toward achievement of the IOM Future of Nursing recommendations were encouraged to apply for the $300,000 twoyear grants. Academic-service partnerships were key to receiving funding. Successful grants demonstrated partnerships between community colleges and universities to ensure seamless transition throughout the various nursing educational programs. In addition, the grant proposals were to include strategies to insure that nurses have critical competencies, such as leadership, cultural competence, interprofessional collaboration, and quality and safety. Plans to increase the diversity of the nursing workforce in the grant area were also important for success. The Texas Team Advancing Health through Nursing Action Coalition ( state.tx.us/chs/cnws/texasteam/) was one of nine state coalitions to receive this grant. This success can be attributed to the work of many nursing organizations working together over the years to improve nursing education in the state. Historical Context in Texas Texas nurse educators, partnering with regulatory bodies such as the Texas Board of Nursing (BON) and the Texas Higher Education Coordinating Board (THECB), have a long history of working together to improve the nursing education. More than 15 years ago, a variety of professional organizations, including the Texas Nurses Association (TNA), Texas Organization of Associate Degree Nursing (TOADN), Texas Organization of Baccalaureate and Graduate Nursing Education (TOBGNE) and the Texas Association of Deans & Directors of Professional Nursing Programs (TADDPNP), developed an articulation agreement which allowed AD nursing courses completed prior to licensure to be accepted in total by baccalaureate nursing programs. The same group of organizations, in collaboration with other stakeholders such as the Texas Hospital Association (THA) and the Texas Association of Businesses (TAB), advocated for increased funding for nursing programs to combat the most recent nursing shortage. As a result of this advocacy, nursing programs received a $55.7 million legislative appropriation specifically for nursing education in 2008, the largest legislative appropriation for nursing in the country. Despite a worsening economy, the same group advocated for and received a $35.4 million appropriation in 2010 and a $30 million appropriation in In 2008, ten leaders involved in nursing education were appointed by the governor of Texas to participate in an initiative of the Center to Champion Nursing in America (CCNA) and the American Association of Retired Persons (AARP). This initiative challenged states to create a team of leaders that focused on nursing capacity. Over the next two years, a diverse array of partners, including 100 nursing programs, hospitals, regional workforce groups, foundations, and the Texas Workforce Commission (TWC) worked together to develop a plan to strategically increase the number of RNs produced in Texas. This group established a trajectory toward doubling the number of professional nursing graduates, began to address nursing education retention issues, developed regional coalitions among nursing programs to support nursing education among regional partners, and completed a grant funded by TWC via the American Reinvestment and Recovery Act (Green, et. al, 2011). Additional Collaborative Efforts Consortium for Advancing Baccalaureate Nursing Education in Texas (CABNET) Project: In September, 2011, a consortium of eight Texas Associate Degree (ADN) and four Bachelor of Science Nursing (BSN) programs received a 12-month, $120,000 Perkins Leadership Grant from the THECB to create a competency based, BSN curriculum with an AD exit. The purpose of the Perkins Leadership Grant project was to develop a seamless BSN curriculum in which student outcomes were defined by the 25 competencies included in the Texas BON Differentiated Competencies (DECs). Upon receiving the Perkins Leadership Grant funding, representatives from each partnering college and university, as well as staff from the Texas BON and THECB, began by proposing standardization of general education requirements required for nursing. This standardized approach was designed to improve transferability between colleges and universities, decrease barriers to AD nurses continuing their nursing education, and to allow some local control for colleges for prerequisites and to complete the core curriculum. Texas APIN continued on page 13

13 April, May, June 2014 Texas Nursing Voice Page 13 Texas APIN continued from page 12 The Perkins Leadership Grant committee proposed a list of required courses (45 semester credit hours) designed to meet the general education core curriculum required by the state. Nine additional SCHs were allocated for any general education courses that individual community colleges determined met their mission. If these nine additional hours were not used to meet general education course prerequisites, or complete the core curriculum requirements, the community college would select courses from a preferred list of additional general education courses selected by the university. The standardization of general education and prerequisite courses was designed to reduce the amount of time students spend in this component of their education and facilitate their transferability. This standardization made possible a reduction of total SCH required for a BSN to 120, if the nursing courses are decreased to 36 SCHs. General education courses included English, anatomy and physiology, microbiology, general psychology, human growth and development, fine arts, government, history, and humanities. The Perkins Leadership Grant group proposed creation of the Consortium for Advancement of Baccalaureate Nursing Education in Texas (CABNET) to promote wider adoption of the standardized general education courses and minimum admission criteria. Universities in the consortium agree not to require other lower-division general education courses beyond the 54 hours set by each community college as long as the student is core complete and has successfully completed the standardized general education courses above. Concept-Based Curriculum (CBC) The Perkins Leadership Group also developed a concept-based curriculum to help nursing programs handle content saturation and provide a method for content management. Students experience deep learning of concepts with key exemplars and will be able to apply what they have learned to other patient situations. This type of curriculum allows AD programs to decrease the SCHs in nursing to 36, making the 120-hour curriculum possible. The curriculum framework designed for CABNET concept-based curriculum is based upon the North Carolina Community Colleges Curriculum Improvement Project (CIP) ( adn-cip.waketech.edu/curriculumfiles.html), as well as the work of the Oregon Consortium of Nursing Educators (OCNE), the University of New Mexico s (UNM) College of Nursing and the University of Kansas (KU) School of Nursing. After this review, the Perkins Leadership Grant group identified 51 concepts to be included in the proposed curriculum. The group defined these concepts and developed key exemplars for each concept. The concepts also were allocated to specific courses across the educational continuum. The consortium also created course descriptions and learning outcomes for both AD and BSN curricula. AACN Essentials, QSEN, Interprofessional Education Competencies (IPEC), Informatics Competencies and other needed competencies were included in the curriculum. TNA Education Committee Framework As the recent nursing shortage in the country escalated, Texas nurses, led by TNA, focused on implementing policies to increase the production of registered nurses in the state. After the Institution of Medicine (IOM) published the Future of Nursing Recommendations, it became clear that given the size of Texas and the diversity of urban and rural areas, there must be a variety of strategies put in place to increase the total number of RNs graduating with either an AD or BSN degree and also increase the number of ADNs returning to school for a BSN. The TNA Education Committee developed an organizing framework to accomplish both goals. In this framework, three strategies were identified as necessary: 1) Expand direct BSN production, 2) Increase concurrent ADN/BSN enrollments, and 3) Expand current RN to BSN programs and add new ones. In order to meet the total number of RNs projected to meet the health care needs of the citizens of Texas AND reach the goal of 80 percent BSN-prepared nurses by 2020, the state must produce 57,359 generic BSN graduates and 87,798 RN to BSN graduates by Fifty percent of the 55,233 pre-licensure AD graduates projected to graduate between Academic Year (AY) and AY must return immediately upon graduation for a BSN, contributing 27,626 nurses to the total of BSN prepared RNs practicing in An additional 60,182 AD RNs who are already practicing must also return to school and graduate over the designated nine year period. The organizing framework also defined several ways to increase the number of RN to BSN prepared nurses in the state. The first includes various partnerships between AD and BSN schools which are already established, such as the University of Arlington (UTA) Pathway Model. Other schools in Texas also use a variety of partnerships, including dual enrollment, to encourage AD nurses to return to school for a BSN. The second approach includes facilitating the transfer of RNs to BSN programs by accepting standardized pre-requisites and general education courses proposed by CABNET. The third involves further facilitation of the RN s educational progress through the use of concept-based curriculum as a framework for AD and BSN courses, as well as core courses in a MSN curriculum, if appropriate. Academic Progression Grant In this environment, in August of 2012, the Texas Team Action Coalition was awarded one of the nine RWJF Academic Progression in Nursing (APIN) grants. Dr. Helen Reid, Provost of Health Sciences at Trinity Valley Community College was the PI of the grant; Dr. Kathryn Tart, Dean at the University Houston, Victoria and Dr. Susan Sportsman, Director of Academic Consultant Group were Co- PIs. The goal of the Texas grant was to develop a multi-focused statewide model to assist all Texas APIN continued on page 14 OUR LAWYERS DEFEND TEXAS NURSES! BON Defense Peer Review Assistance TPAPN Assistance Formal Charges Malpractice RN/LVN Reinstatements (800) Austin Houston San Antonio and throughout Texas BERTOLINO LLP Clinical Director CICU The new Louis & Peaches Owen Heart Hospital at TMFHS is seeking a highly motivated individual for the Clinical Director for CICU. Texas RN license BSN, Master in Nursing or Healthcare Administration preferred, certification in specialty area desirable 3-5 years experience; 1-3 years related management experience Experience with a busy open heart unit is required Apply online at tmfjobs.org or contact recruitment at floydj2@tmfhs.org for more information.