arizona VOL1 • NO4 • NOV 2006 4TH QUARTER STATE BOARD OF NURSING REGULATORY JOURNAL Arizona Nurse Practitioner Summit SEPTEMBER 29TH, 2006 PUBLISHED BY ARIZONA STATE BOARD OF NURSING 4747 North 7th Street, Suite 200 Phoenix, AZ 85014-3653 Phone: 602.889.5150 Main fax: 602.889.5155 CANDO fax: 602.889.5238 General e-mail: arizona@azbn.gov Website: www.azbn.gov GOVERNOR The Honorable Janet Napolitano Joey Ridenour, RN, MN EXECUTIVE DIRECTOR Judy Bontrager, RN, MN VO L 1 • N O 4 • N OV 2 0 0 6 4 T H Q UA R T E R 4 F rEoxme ctuhtei v e D i r e c t o r 6 From the President 8 WP ai ltlhi adtriavwe aCl aorfe f o r Mechanical Ve n t i l a t o r / E x t u b a t i o n ASSOCIATE DIRECTOR/OPERATIONS Valerie Smith, RN, MS 12 4 t h A n n u a l C N A ASSOCIATE DIRECTOR/INVESTIGATIONS Educators Retreat Registration Form BOARD MEMBERS Kathy Malloch, PhD., MBA, RN, FAAN, 13 E d u c a t i o n C o r n e r 16 C a s e S t u d y : PRESIDENT Theresa Crawley, CRNA, MSHSA VICE PRESIDENT Karen Hodges Hardy, RN, MSN Sexual Misconduct SECRETARY Patricia A. Johnson, LPN MEMBER Denise Link, RNP, DNS, FNAP MEMBER Judith F. Rich, RN, MSN MEMBER Steven T. Robertson, LPN, CHPLN MEMBER Kathryn L. Busby, J.D. PUBLIC MEMBER From Right to Left - Top: Sally Reel, PhD, FNP; Renee McLeod, DNSc, APRN, CPNP Center: Karen Grady, RN, MS, FNP; Pamela Randolph, RN, MS, PNP; Tracy Klein, MS, WHCNP, FNP 17 C a s e S t u d y : Substance Abuse 22 Tw o C a s e S t u d i e s : Multi-State Compact Investigations 24 C a s e S t u d y : M. Hunter Perry PUBLIC MEMBER arizona Prescribing Outside Scope of Practice EDITION 4 STATE BOARD OF NURSING CREATED BY: REGULATORY JOURNAL Virginia Robertson, PRESIDENT vrobertson@pcipublishing.com Publishing Concepts, Inc. 14109 Taylor Loop Road Little Rock, AR 72223 FOR ADVERTISING INFORMATION: Steve McPherson smcpherson@pcipublishing.com 501.221.9986 • 800.561.4686 This magazine is mailed quarterly to over 90,000 Arizona licensed nurses and reaches every nursing student, hospital administrator and nursing school administrator in the state 28 C a s e S t u d y : Sexual Assault of a Patient 30 D i s c i p l i n a r y Actions 36 R e g u l a t i o n R u n d o w n From the Executive Director JOEY RIDENOUR, RN, MN Holiday Greetings, The Arizona State Board of Nursing (AzBN) in partnership with the AzBN Advanced Practice Advisory Committee hosted the “first time ever” Arizona Nurse Practitioner Summit on September 29, 2006. Over one hundred sixty- five Nurse Practitioners, Nurse Practitioner faculty and Nurse Practitioner students attended the conference. The overall goal of the conference was to encourage communication and increase understanding about the educational and clinical preparation, certification requirements and scope of practice of Nurse Practitioner specialty areas. Special thanks are given to the eleven outstanding speakers who presented at the conference. Nationally recognized guest speakers included Tracy Klein, MS, WHCNP, FNP, author of Medscape article, Scope of Practice and the Nurse Practitioner: Regulation, Competency, Expansion and Evolution. Dr. Renee McLeod, DNSc, APRN, CPNP, Director of Graduate Education & Advanced Practice Programs at Arizona State University College of Nursing & Healthcare Innovation presented on the foundations of Nurse Practitioner practice: specialty area educational preparation & competencies. Sally Reel PhD, FNP, University of Arizona College of Nursing and Donald Pierce RN, MSN, FNP presented information on how educational preparation drives scope of practice. Denise Link DNSc, WHCNP, and Honorable Brian Tully explored establishing credentials within a scope of practice. Kathy Player EdD, RN and Pat Shannon, MS, MA RN, CS, PNP, summarized the evolution of the Nurse Practitioner role from a leadership and practice perspective. Karen Grady RN, MS, FNP, did an excellent job in chairing/moderating the event as well as presenting information on the Arizona Nurse Practice Act and NP Case Studies. Pam Randolph RN, MS, PNP, AzBN Education Consultant presented information on increasing competencies within a scope of practice. Special thanks also to Dr. Anne McNamara and Rio Salado Community College for providing the room for the conference. The Arizona State Board of Nursing cordially invites you to join us in Celebrating AzBN’s 85th Anniversary and opening of new offices during an open house on Friday, November 17, 2006, 4:30 pm to 6:30pm. Stop by for refreshments and a tour of our new facilities. Please RSVP Lila Wiemann at lwiemann@azbn.gov by Thursday, November 16th! To a joyful present and well remembered past, best wishes for happy holidays and a magnificent new year. Joey Ridenour, RN, MN EXECUTIVE DIRECTOR 4 arizona STATE BOARD OF NURSING REGULATORY JOURNAL From the President KATHY MALLOCH PHD, MBA, RN Greetings! Most individuals are aware of the licensing and discipline roles of the board of nursing. What many individuals may not be aware of are the other resources available from both the Arizona State Board of Nursing (AzBN) and the National Council of State Boards of Nursing (NCSBN). As a newly elected member of the NCSBN Board of Directors, I was recently reacquainted with their many resources and would like to share them with you. Often times as new regulatory issues emerge; discussions and information can be found on either of these websites or other state nursing board websites. Please feel free to access these websites at any time and also encourage others to use this important resource. Arizona State Board of Nursing Website: www.azbn.gov Resources: o Nursing statistics for Arizona: Includes the number of actively practicing nurses in Arizona. o Advisory opinions specific to interpretations of the Nurse Practice Act. Currently there are over 60 Advisory Opinions available. o Advanced Practice information o Board committee information. Advanced Practice, Scope of Practice, Education, Pilot Medication Technician, committees meet regularly throughout the year to address nursing regulatory issues. Committees are always looking for interested individuals to learn about the work and become members. o Fee structures for licensure and certification o Imposter alerts o Scope of Practice information and link for on-line discussion o Nurse Practice Act o Multi-state Licensure overview o Proposed rules Online tools Online licensure verification Community o AzBN Nursing Regulatory Journal o Upcoming conferences related to nursing regulation Board staff directory, Board members and links to other state regulatory agencies. 6 arizona STATE BOARD OF NURSING REGULATORY JOURNAL National Council of State Boards of Nursing Website: www.ncsbn.org General information topics: news and upcoming events, NURSYS license verification, nurse licensure compact, nursing regulation, other resources and testing services. Examples of information available include: o Nursing regulation and delegation o Model Nurse Practice Act o Model Act and Rules for delegation o Nursing Assistant Regulatory Model o Continued Competence Concept paper o American’s for Nursing Shortage Relief document o National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) document o Citizens Advocacy Center (CAC) PREP project document Testing Service (NCLEX®) includes information for candidates, the on-line application, item development and many others. NURSYS®: National database for licensure verification and disciplinary actions on individual nurses. Updates & Contacts: Information and websites for 59 boards of nursing in the US, continued competence activities, and media inquiries. Most recently, a joint statement on delegation was issued by NCSBN & ANA, NCSBN response to HR 5688 Healthcare Truth and Transparency Act of 2006, and Criminal Background Check resolution. Products & Services: Research services, Center for Regulatory Excellence Research program, NCSBN’s learning extension. As you can see, there is a wealth of information about nursing regulation at both the state level and the national level. Feel free to access this information at any time. Also, if there is additional information that you would like to see available on either website, please email Joey Ridenour at jridenour@azbn.gov or myself at Kathy@kathymalloch.com. Kathy Malloch, President ARIZONA STATE BOARD OF NURSING Palliative Care for Withdrawal of Mechanical Ventilator/Extubation Dear Readers • As you recall, in the last Arizona State Board of Nursing Regulatory Journal, facilities were asked to contribute articles regarding patient safety initiatives. Kathy Scott RN PhD, CHE, Regional VP, Clinical Services of Banner Health Arizona Region sent the following policy as developed by BTMC, Karen Barkus, Critical Care Director. Joey Ridenour I. PURPOSE: A. To provide guidelines for providing care to patients at end of life who have agreed to removal of ventilator support. II. DEFINITIONS: A. Palliative Care- For the purposes of this policy palliative care is consistent with the World Health Organization’s definition of: an approach, which improves the quality of life of patients and their families facing life-threatening illness, through the prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems. B. SCALE – refers to Spiritual Care at Life’s End C. Neuromuscular blockades – are pharmacological agents that are utilized to intentionally interrupt transmission at the neuromuscular junction resulting in paralysis. III. POLICY: A. Performed by physician with agreement from the attending; performed by Registered Nurse (RN) or physician in collaboration with Respiratory Care Practitioner (RCP). B. Physician order required. The pre printed physician order set titled Palliative Care for Withdrawal of Mechanical Ventilation/Extubation, will be used for all end of life weaning from a ventilator. C. Notify bioethics or risk management if appropriate prior to termination of life support (refer to other related policies and procedures). D. The decision to wean and remove from the ventilator for end of life care requires: 1. A care conference to involve the physician regarding the plan of care. 2. A do not resuscitation order. 3. Document physician consensus to withdraw life support by patient and/or family, Medical Power of Attorney, understanding of goals of care, alternatives and clinical outcomes. 4. Comfort measures to include the promotion of compassionate and comprehensive pain relief and/or light sedation based on established evidence-based scales i.e. John Hopkins. 5. Determination of noninvasive monitoring needs is assessed by the physician. E. In order to give the patient an opportunity for spontaneous respiration prior to removal of mechanical ventilator support. 1. Discontinue neuromuscular blocking agents for a minimum of 4 hours or observe for a spontaneous breath. F. Discontinue sedation medications prior to weaning or withdrawal of mechanical ventilation. G. Deviation from policy on withdrawal of life support requires notification and initiation of the chain of command (Refer to Chain of Command Policy and Procedure). 8 IV. PROCEDURE/INTERVENTION(S): A. Educate patient, family, and/or Medical Power of Attorney of weaning process, therapeutic goals, and participation in care, which includes: (RN) 1. Discussion and agreement of possible clinical outcomes 2. Treatment for pain and/or anxiety. 3. Availability of other healthcare disciplines such as SCALE, Social Services, Case Management and so on. 4. Collaboration between all health care professionals in determining process of terminal weaning and plan of care. B. Maintain IV access for administration of analgesics and sedation. C. Discontinue neuromuscular blockade and sedation, and assess patient every 15 minutes. D. Medicate for pain and light sedation per standardized physician order set, Palliative Care for Withdrawal of Mechanical Ventilation/Extubation. E. Suction endotracheal tube of all secretions prior to extubation. F. Notify chain of command if any deviation from policy. V. DOCUMENTATION (DOCUMENTS & FORMS): A. Physician progress note: to include discussion with patient, family, caregiver, and/or Medical Power of Attorney regarding plan of care, plan of care goals, and alternatives. B. Nurses Notes C. Ventilator Record VI. ADDITIONAL INFORMATION: A. The American Society of Pain Nurses Position Statement on End of Life Care: 1. Terminal illness is often accompanied by severe pain and other unpleasant symptoms that cause undue suffering. The fundamental principal of palliative care is to alleviate suffering caused from intractable symptoms such as pain, dyspnea, agitation, and anxiety. The relief of these symptoms is not considered passive euthanasia or assisted suicide. 2. The goals of prolonging life and alleviating pain/suffering do not always coincide, however, effective pain and symptom management at the end of life may prolong life rather than accelerate death. It is well documented that the majority of terminally ill patients can be provided effective relief from pain and other symptoms by welltrained clinicians. 3. Nurses who specialize in pain management, as a part of the healthcare team, are in a position to advocate for effective pain relief and symptom management for the terminally ill regardless of whether that care prolongs life or hastens death. 4. ASPMN (American Society of Pain Management Nurses) supports the ANA position of 1998 that states: Nurses individually and collectively have arizona STATE BOARD OF NURSING REGULATORY JOURNAL an obligation to provide comprehensive and compassionate end of life care, which includes the promotion of comfort and the relief of pain, and at times, forgoing life-sustaining treatments. 5. ASPMN supports the Agency for Health Care Policy and Research (1994) that states: There is an ethical obligation to provide relief that is based on the pain report and mutually agreed upon goals as defined by the patients in collaboration with the healthcare team. B. Ethical issues at end of life: 1. Withholding/withdrawing of treatment: a. Common reasons why withholding/withdrawing therapy is considered: i. Patient choice ii. Undesirable quality of life iii. Burdens outweigh benefits iv. Prolonging dying b. When a capacitated patient or designated power of attorney decides that a proposed treatment will impose undue burdens, the patient or designee should be entitled to refuse treatment, based on the patient’s right to self-determination. c. Similarly, when a patient or designated power of attorney, in collaboration with the healthcare team decides that a treatment has become more burdensome than beneficial to the patient, it is appropriate to withdraw that care. d.Common situations of withholding or withdrawal of treatment included: withholding or withdrawing of medically provided hydration and nutrition, ventilation, cardiopulmonary resuscitation, dialysis, antibiotic use, turning off pacemakers, and other therapies. e. Withdrawal or withholding treatment is a decision/action that allows the disease to progression its natural course. It is not a decision/action intended to cause death. VII. REFERENCES: A. Agency for Health Care Policy and Research (AHCPR), (1992). Clinical practice guidelines for acute pain management in adults: operative procedures (Publication #92-0032). B. American Nurses Association. (1998). Position Statement: Assisted suicide. Washington D.C. C. American Pain Society, (1998). Bulletin index: Treatment of pain at the end of life. Glenview: IL. D. Campbell, M.L., Bizel, K., & Stewart, R. (1998). Ethics in critical care: integrating technology with compassionate care, withdrawal of ventilation in a conscious patient with apnea. American Journal of Critical Care, 7(2), 85-89. E. Draper, K. (2005). Rights and the doctrine of doing and allowing. Philosophy and Public Affaris. 33(3), 253-281. CONTINUED on PAGE 17 STAFF DIRECTORY ADMINISTRATION Joey Ridenour, RN, MN Executive Director 602.889.5200 jridenour@azbn.gov Judy Bontrager RN, MN Associate Director-Operations & Licensing 602.889.5204 jbontrager@azbn.gov Valerie Smith RN, MS Associate Director-Nursing Practice, Complaints & Investigations 602.889.5206 vsmith@azbn.gov Lila Wiemann Administrative Assistant to the Executive Director 602.889.5202 lwiemann@azbn.gov Dolores Hurtado Assistant to Associate Director/Nursing Practice, Complaints & Investigations 602.889.5158 dhurtado@azbn.gov Thereasa Huff Assistant to Associate Director/Nursing Practice, Complaints & Investigations 602.889.5208 thuff@azbn.gov ADVANCED PRACTICE Karen Grady, MS, RN, FNP, BC Advanced Practice/RN/LPN 602.889.5182 kgrady@azbn.gov EDUCATION Pamela Randolph RN, MS Education Consultant/Educational Programs RN/LPN 602.889.5209 prandolph@azbn.gov James Williams 602.889.5167 jwilliams@azbn.gov FISCAL SERVICES Norma Salter Accounting Technician 602.889.5211 nsalter@azbn.gov Kirk Olson 602.889.5171 kolson@azbn.gov HEARINGS Susan Barber, RN, MSN Nurse Practice ConsultantHearing Dept 602.889.5151 sbarber@azbn.gov Debra Blake, Paralegal Legal Assistant -Hearing Dept. 602.889.5183 dblake@azbn.gov Vicky Driver Admin. Assistant-Hearing Dept 602.889.5162 vdriver@azbn.gov INVESTIGATIONS NURSE PRACTICE CONSULTANTS Betty Nelson, RN, MS 602.889.5169 bnelson@azbn.gov Jeanine Sage, RN, MSN 602.889.5174 jsage@azbn.gov Mary Rappoport, RN, MN 602.889.5184 mrappoport@azbn.gov CANDO Nan Twigg, RN, MSN 520.615.4945 ntwigg@azbn.gov Connie Linck, RN, MN, CNAA, BC Nurse Consultant – CANDO 602.889.5156 clinck@azbn.gov Sister Rachel Torrez, RN, MS 602.889.5180 srachel@azbn.gov Olga Zuniga Administrative Secretary – Monitoring & CANDO 602.889.5157 ozuniga@azbn.gov Stephanie Nelson, RN, MS 602.889.5179 snelson@azbn.gov Sydney Munger, RN, MS 602.889.5186 smunger@azbn.gov SENIOR INVESTIGATORS Duncan “Cory” Polak 602.889.5172 cpolak@azbn.gov 10 arizona STATE BOARD OF NURSING REGULATORY JOURNAL Jeanne Bauer 602.889.5178 jbauer@azbn.gov Donna Frye Advance Practice – School Nurses 602.889.5194 dfrye@azbn.gov Helen Tay CNA Exam/Endorsements 602.889.5189 htay@azbn.gov Ronald “Ron” Lester 602.889.5159 rlester@azbn.gov Paula Delphy RN/LPN Endorsements 602.889.5192 pdelphy@azbn.gov LEGAL SECRETARIES Barbara Melberg 602.889.5193 bmelberg@azbn.gov Rhonda Rogers CNA.Renewals 602.889.5188 rrogers@azbn.gov Dorothy Lindsey 602.889.5177 dlindsey@azbn.gov MAILROOM Esther Garcia 602.889.5173 egarcia@azbn.gov Karen Gilliland 602.889.5187 kgilliland@azbn.gov Trina Smith 602.889.5175 tsmith@azbn.gov INFORMATION TECHNOLOGY Cory Davitt Network Operations Director 602.889.5213 cdavitt@azbn.gov Adam Henriksen Information Technology Director/Webmaster 602.889.5231 ahenriksen@azbn.gov LICENSING Becky Melton RN/LPN Exam 602.889.5190 baranyos@azbn.gov Debbie Kunkle RN/LPN Renewals 602.889.5195 dkunkle@azbn.gov Cristina Oates RN/LPN Endorsements 602.889.5191 coates@azbn.gov MONITORING Erica Bailey Senior Investigator 602.889.5160 ebailey@azbn.gov Pamm Wiggin, RN, JD Nurse Consultant 602.889.5170 pwiggin@azbn.gov Brent Sutter Legal Secretary Monitoring & CANDO 602.889.5168 bsutter@azbn.gov RECEPTIONISTS Jene Martinez 602.889.5196 jmartinez@azbn.gov Marlane Brosseau 602.889.5199 mbrosseau@azbn.gov Susan Kingsland 602.889.5224 skingsland@azbn.gov PROGRAM SCHEDULE 8:00-8:30 8:30-9:30 9:30-10:15 10:15-10:30 10:30-11:30 11:30-12:45 12:45-1:45 1:45-3:15 3:15-3:30 3:35-4:15 4:15-4:30 12 Registration Continental Breakfast Board of Nursing Update Pamela Randolph Department of Health Services Report • Sylvia Balistreri Break Working With Higher Ups: A Nursing Process Approach Dr. Sheila Sorrentino Buffet Lunch Resonating With Stress: Re-energize, Relax, Renew Dr. Sue Roe Round Tables: CNA Certification CNA Misconduct Continuing Education Critical Thinking High School Programs Implementing a Board Approved Curriculum Medication Technician Pilot Facilities Skill Testing in a Clinical Laboratory Teaching Methods Test Observers Update on Management of Alzheimer's Patients Break D&S Diversified Technology Testing Update • Paul Dorrance , Jennifer Underwood Wrap-Up and Evaluations arizona STATE BOARD OF NURSING REGULATORY JOURNAL FOURTH ANNUAL CNA EDUCATORS RETREAT Friday, January 12, 2007 Mountain Preserve Reception Center 1431 East Dunlap, Phoenix, Arizona 85281 REGISTRATION FORM Early Registration: $60 prior to December 15th Late Registration: $75 after December 15th On-site/Walk-in Registration $100 per person Space Permitting Purchase Orders WILL NOT be accepted in lieu of payment. Name: Facility/School/Affiliation: Address: City, State, Zip: E-Mail Address: Business Phone: Mobile: Submit form and check or money order made payable to: Arizona State Board of Nursing/Attn: CNA Retreat 2007 4747 North 7th Street, Ste 200 Phoenix, Arizona 85014-3653 Education Corner PAMELA RANDOLPH RN, MS EDUCATION CONSULTANT Update on Pilot Study Medication Technician Project The pilot-study medication technician (PSMT) project was a result of legislation (HB 2256), passed in 2004 which allowed the Arizona State Board of Nursing to establish a medication technician pilot program. Significant progress has been made implementing the following requirements of the legislation: • Determining the impact to patient health safety of delegating medication administration to certified nursing assistants with extra training in medication administration; Data on medication error rates using licensed nurs- es has been collected through observation of over 3000 medication administrations revealing an overall error rate of 10.6%. Another round of data collection will be completed six months after the use of medication techni- cians. • Board responsibility for developing protocols and prescribing the education needed: Protocols, curriculum and secure, legally defensible competency tests (written and manual skills) have arizona STATE BOARD OF NURSING REGULATORY JOURNAL 13 been developed and are being implemented. • Limited to six skilled nursing facilities: The six pilot facilities are Silver Ridge Village, Bullhead City; Good Shepherd Health Care, Peoria; Shadow Mountain, Scottsdale; Mountain View, Tucson; Heritage Health Care, Globe; and Copper Mountain Inn, Globe. • Board assessment of a fee to partici- pating facilities: $90,000 has been raised through donations and fees assessed to pilot facilities. Other accomplishments include: • At least 2 instructors from each facility have completed Board-sponsored training; • Training has been completed in two facilities with 13 PSMTs now administering medications delegated by a licensed nurse according to the protocols of the Board. • Training is ongoing in 2 more facilities. Feedback The following comments were received regarding the program: “Congratulations to the PSMT’s. You’ve come a long way. Thank you for helping us pass medications—it relieves us of some responsibility to do more nursing care.” J. C. LPN “Thank you for making my work load lighter. I have more time to listen to residents. I used to go home thinking I haven’t paid enough attention to residents. Now with the PSMT helping, I perform my duty as a nurse, which gives me (peace) of mind.” V. B.G., LPN Please contact me for more information on the project at prandolph@azbn.gov BOARD ACTIONS ON EDUCATION MATTERS September 2006 • Granted initial program approval to CNA programs at: AZ Pioneer Home, Evergreen Mesa Christian Health and Rehabilitation Center, Grace Institute Inc, Palm View Rehab and Care Center, Shadow Mountain, and Tucson Medical Center. • Granted provisional approval for an LPN program at East Valley Institute of Technology • Granted proposal approval for an RN program at Everest College • Approved North Dakota CNE RN Refresher Program • Approved applications for program change from: Maricopa Community Colleges District Nursing Program, Northern Arizona University, and Arizona State University 14 arizona STATE BOARD OF NURSING REGULATORY JOURNAL Case Study: SEXUAL MISCONDUCT PAMM WIGGIN, RN, JD, NURSE PRACTICE CONSULTANT In May 2003, the Board received a complaint alleging that Nurse A had invited patient B to reside in his home and was engaged in sexual relations with the patient while assigned as patient B’s Home Health nurse. The complaint was filed by the Director of the Home Health Agency. Investigation revealed that Nurse A had previously allowed another patient to move into his home while assigned as the patient’s case manager. Nurse A was subsequently reassigned, but his actions violated his employer’s policies and constituted a violation of the Nurse Practice Act. (Nurse A continued to care for this patient until his death, in a jointly owned residence. Nurse A denied being a beneficiary of the patient’s estate.) In February 2003, Nurse A had reported to local police that he was being blackmailed by a woman, (patient B). Nurse A admitted that he had first met patient B at her residence when assigned as her home health nurse. Nurse A reported that patient B informed him that she was residing with a friend and her husband and stated that she was being sexually harassed by the friend’s husband. When patient B stated that she needed to leave but had nowhere to go, Nurse A admitted offering a room in his home until she could find another residence. Nurse A reports being subsequently seduced by patient B at his home. Some days later, after being absent from the residence, patient B attempted to blackmail Nurse A, demanding money and property. When Nurse A subsequently attempted to argue about the amount of money demanded, patient B accused him of rape and molestation. Nurse A informed the police that he was aware that patient B had a drug history prior to inviting her into his home. He stated that he did not want her charged, he just wanted her to leave him alone. Nurse A described the relationship with patient B as consensual, “on their own time and in his private home”. Nurse A also admitted ongoing friendships with two widowers of former patients. A psychological evaluation was conducted prior to the matter being reviewed by the Board. A consent agreement for 36 months probation with terms and conditions was offered to Nurse A and accepted. Terms included a psychiatric evaluation, psychological counseling and monthly performance evaluations. Nurse A was precluded from working directly with any patients. Nurse A was compliant with the terms of the agreement but had difficulty finding employment and after twelve months petitioned the Board for early termination of the agreement. Because Nurse A had not complet16 arizona STATE BOARD OF NURSING REGULATORY JOURNAL ed the entire work requirement, the request was denied Two years after the consent agreement was signed, a new complaint was received alleging that Nurse A had been sexually inappropriate with his colleagues. Various peers were interviewed and reported frequent lewd remarks and sexual innuendo... Those interviewed reported that Nurse A was dismissive of requests to cease the remarks stating that “he was just joking” or that he “didn’t mean anything”. When subsequently interviewed by Board staff, Nurse A denied making any of the remarks ascribed to him and had no explanation for her colleagues accusations. The complaint was presented to the Board who voted Notice of Charges. Nurse A has the option of responding to the charges. If he does so, a hearing will be scheduled. Prior to the hearing there may be a settlement conference. If Nurse A does not respond to the charges, they will be deemed true and Board action against nurse A’s license will follow. In the alternative, Nurse A may elect to surrender his license. If he does so, he will be eligible to apply for reinstatement after five years. In order for his license to be reinstated, Nurse A will need to show that he has effectively addressed the issues precipitating Board discipline and ultimately, the surrender of his license. Prior to November 2005, boundary violations were subsumed in “unprofessional conduct”. In November 2005, the Board implemented Rules specifically prohibiting any dual relationship between a patient and any nurse regulated by the Board of Nursing. AAC R 403A (1) defines “failure to maintain professional boundaries “ as any conduct or behavior that… is likely to lessen the benefit of care to a patient, resident or the family of a patient or a resident and places the patient, resident or family of the patent or resident at the risk of being exploited financially, emotionally or sexually…” The intent of the nurse is irrelevant. Where a nurse simultaneously engages in both a professional and nonprofessional relationship with a patient that is avoidable, non-incidental and results in the patient being exploited financially, emotionally or sexually, (AAC R4-19-403A (2),) the nurse has violated the Nurse Practice Act and their license is subject to discipline. Since the care-giver/patient relationship is inherently unequal, the patient must be protected from abuse, however good the intentions of the professional nurturer. Likewise, the professional is required to accord their peers respect and not undermine their colleagues personally or professionally by inappropriate remarks, particularly in the workplace. Case Study: SUBSTANCE ABUSE SISTER M. RACHEL TORREZ RN, MS, NURSE PRACTICE CONSULTANT This case study deals with a professional nurse who was employed by a local registry and was working in a variety of facilities in the metropolitan Phoenix area. From on or about September 2005 through January 2006 the Board received four complaints from four different facilities alleg- ing that the nurse might be diverting and tampering with narcotics. Because of the number and nature of the complaints this case rose to a priority one level which meant it needed to be resolved quickly. The nurse was notified in the usual manner which included a letter and a ques- tionnaire with a short summary of the allegation(s). Please note that all complaints are initially considered allegations because it has not been determined that the Nurse Practice Act (NPA) has been violated. In this case the nurse was mailed continued on page 19 CONTINUED FROM PAGE 8 F. Feudtner, C. (2005). Control of suffering on the slippery slope of care. The Lancet, 365(9467), 12841286. G. Hayes, C. (2004). Ethics in end-of-life care. Journal of Hospice and Palliative Nursing, 6(1), 3643. H. Hoffman, D.E., Tarzian, (2003). Achieving the right balance in oversight of physician opiod prescribing for pain: the role of State Medical Boards. The Journal of Law, Medicine and Ethics, 31(1), 2140. I. Kirchhoff, K., Anumandia, P.R., Foth, K.T., Lues, S.N., and Gilbertson-White, S.H. (2004). Documentation on withdrawal of life support in adult patients in the intensive care unit. American Journal of Critical Care, 13(4), 328-334. J. New England Journal of Medicine Sounding Board (1997). Withdrawing intensive life-sustaining treatment – recommendations for compassionate clinical management, 336, 652-657. K. Orentlicher, D. (1997). The Supreme Court and physical-assisted suicide. The New England Journal of Medicine, 337(17), 1236-1240. L. Thorns, A. (2000). Opioid use in the last week of life and implications for end-of-life decision-making. The Lancet, 356(9227), 398 M. Truog, R.D., Burns, J.P., Mitchell, C., Johnson, and Robinson, W. (2000). Sounding board: pharmacologic paralysis and withdrawal of mechanical ventilation at the end of life. N. Ziegler, S.J. (2005). Are physicians at risk? The Journal of Law, Medicine and Ethics, (33(2), 349358. O. End of Life Nursing Education Consortium (2001) AACN. P. World Health Organization (2005). Palliative Care. Retrieved November 30, 2005 on the World Wide Web: http://www.who.int/hiv/topics/palliative/care/eN/ VIII. OTHER RELATED POLICY/PROCEDURES: A. Chain of Command B. Withholding/Withdrawal of Life Support Policy C. Sedation Analgesic Policy IX. Cross Index As: A. Withdrawal of Life Support B. Terminal Extubation arizona STATE BOARD OF NURSING REGULATORY JOURNAL 17 continued from page 17 two questionnaires because she did not respond to the initial one. The nurse finally responded to the second letter and said she would mail in her response but it was never received by our Board. The Nurse Consultants provide nurses every opportunity to provide their side of any allegation before proceeding. In cases where nurses fail to respond, the Nurse Consultants have no choice but to proceed without input from the nurse. After a nurse submits her written response Board staff wants to meet with the individual to discuss the case. This particular nurse was contacted by phone and mail but she never responded, so staff had no choice but to proceed. It is important to note that it is a violation of the Nurse Practice Act (NPA), R4-19-403.25(a) to fail to furnish in writing a full and complete explanation covering the matter reported pursuant to A.R.S. 32-1664. It was determined that there was enough evidence and supporting documents from four different facilities that this nurse could be harmful to the public or to herself. The Board staff made the decision that the nurse should be summarily suspended and the case should be ! the allegations. At some point the nurse admitted she had tampered with some narcotics and she also believed she had a chemical dependency problem. It is IF THE BOARD FINDS THAT THE PUBLIC HEALTH, SAFETY, OR WELFARE IMPERATIVELY REQUIRES EMERGENCY ACTION, THE BOARD HAS THE AUTHORITY...TO ISSUE AN ORDER OF SUMMARY SUSPENSION OF A LICENSE. expedited. If the Board finds that the public health, safety, or welfare imperatively requires emergency action, the Board has the authority under A.R.S. 41-1092.11(B) and 41-1064(C) to issue an order of Summary Suspension of a license. The Board decided this case met those requirements and the case was prepared for the Board to act in this manner. When the nurse was noticed by mail regarding the date of the Board meeting she wanted to meet with Board staff. The Board staff met with her in order to allow her to provide her explanation regarding important to understand that Board staff is always ready to provide nurses with the resources they need in order to enter treatment. There are many programs and services available to professional staff for treatment. The outcome of this case was not positive. The nurse said she wanted treatment but she failed to obtain the services she needed in order to address her chemical dependency problem and the Board had no choice but to eventually revoke the license. arizona STATE BOARD OF NURSING REGULATORY JOURNAL 19 Two Case Studies: SYDNEY M. MUNGER, RN, MS, NURSE PRACTICE CONSULTANT MULTI-STATE COMPACT INVESTIGATIONS CASE 1 Nurse A came to Arizona from Texas in 2004, and worked registry on her multi-state privileges. Until she tested positive for methamphetamines on a pre-employment urine drug screen, the Arizona State Board of Nursing (AzBN) had no record of her arrival in Arizona, as is the case with nurses working on the multi-state privilege. When AzBN was notified of her positive drug screen, as much demographic information as possible was collected, and a case was opened. AzBN Board staff notified the Texas Board of Nurse Examiners (TBNE) so that coordination of the case could begin. Because Nurse A was not licensed in Arizona, prior to the complaint being filed, she was not required to notify AzBN of her change of address. Correspondence was sent to her last known address; however, the correspondence was returned. The Board’s investigator located Nurse A after several weeks by following leads in Nurse A’s employment file. Correspondence, including 22 an Investigative Questionnaire, was re-sent to Nurse A’s most recent address. Nurse A never completed the Board’s questionnaire, but did come to the Board office for an interview. Nurse A admitted she had used methamphetamine and cocaine for the previous 6 months, but denied any prior use. Towards the end of the interview, Nurse A finally admitted drug use that had begun approximately 4 years ago, when her life had begun to “self-destruct”, following the death of her husband. Nurse A stated she had not used drugs again after her positive drug screen. Nurse A stated she had been contacted by TBNE about the complaint, and worried she might lose her Texas license, but admitted she had not responded to correspondence from TBNE related to the investigation. The Board’s investigator provided Nurse A with the name and telephone number of a contact at TBNE, and encouraged her to make contact. Nurse A also worried arizona STATE BOARD OF NURSING REGULATORY JOURNAL about losing her new job at a small rural hospital, if her employer became aware of the complaint. The Board’s investigator explained to Nurse A that AzBN’s options to act were limited in her case. According to the Compact regulations: “A remote state may take adverse action affecting the multistate licensure privilege to practice within that party state. However, only the home state shall have the power to impose adverse action against the license issued by the home state.” (A.R.S. § 32-1668, Article V [C]). The first option was to refer the case back to Texas to complete the investigation and determine if discipline was warranted. This was usually done if AzBN’s investigation showed the nurse’s conduct did not rise to the level of requiring monitoring. The second option was to revoke the privilege to practice nursing in Arizona, and to issue a cease and desist order. To revoke the privilege, the Board needed to determine that if this nurse were licensed in Arizona, his/her conduct warranted monitoring, suspension, or revocation of the license to protect the public. Because AzBN cannot take any of these actions for nurses that do not hold Arizona licenses, and the nurse clearly required monitoring, the only option was to revoke the privilege to practice nursing in Arizona. Nurse A’s privilege to practice nursing in Arizona was revoked, and the appropriate information was placed in Nursys©, the national nursing data base. However, this action did not affect her ability to work in other states participating in the interstate compact, until TBNE revoked Nurse A’s license several months later. Nurse A no longer has the ability to work legally in any state. CASE 2 Nurse B came to Arizona from Tennessee, and worked as a traveler in various Valley hospitals. The Arizona State Board of Nursing (AzBN) received an anonymous complaint that Nurse B had been arrested for driving under the influence (DUI) and was thought to be impaired at work. The complainant was unable to provide dates or witnesses to Nurse B’s alleged impairment on duty. As is part of AzBN’s process, the Tennessee Board of Nursing was informed of the complaint that had been opened on Nurse B. Staff from the two Boards determined that Arizona would take the lead in the investigation, and would transfer information to Tennessee as it became available. Nurse B immediately responded to AzBN’s correspondence, and completed the Board’s Investigative Questionnaire. She disclosed she had been arrested for DUI with a blood alcohol content of .199. Nurse B pled down to a charge of Reckless Driving, and she quickly completed all court requirements. Nurse B was interviewed by Board staff, and no ongoing chemical dependency or substance abuse issues were identified. There were no documented problems in her personnel file, including no issues of impairment on duty, and no incidents in which other staff smelled alcohol on her breath. Nurse B arrived on time to work, and her cur- 24 rent supervisor had nothing but good things to say about her current performance. Had Nurse B been licensed in Arizona, she likely would not have required monitoring to ensure patient safety. Therefore, because AzBN’s options were limited to either closing the case without action in Arizona, or revoking the privilege to practice in Arizona, the decision was made to close the case and send the file to the Tennessee Board of Nursing. That Board assumed the lead in the investigation, and did not discipline Nurse B’s Tennessee license. LESSONS LEARNED: • Nurses who are working on the multi-state privilege are not required to inform AzBN that they are here. Therefore, until a complaint is filed, there is no demographic information on them in AzBN’s data base. Investigations may be expedited by the complainant collecting and reporting as much information to AzBN soon as possible, including all known addresses and a social security number. • Both AzBN and the nurse’s home state are involved in the investigation. The two states will determine which will take the lead, and how information will be exchanged. Information flows freely between the involved Compact states. • AzBN’s options in deciding the case of a compact nurse are limited. If monitoring or more discipline is needed to protect the public, the privilege to practice in Arizona will be revoked, and a cease and desist order will be issued. If this is not the case, the investigation will be closed with no action and Arizona, and the case referred to the home state. • Revoking the privilege to practice in Arizona does not affect the nurse’s ability to work in another compact state. • Employers should verify the license of a compact nurse with the home state before hiring. If the home state has disciplined the license with probation, suspension, or revocation, the nurse is not eligible to work in Arizona. This information is not available in AzBN’s data base because AzBN has no record that nurse is in our state but the information would be available from the primary state of licensure. Case Study: PRESCRIBING OUTSIDE SCOPE OF PRACTICE JEANINE SAGE, RN, MSN, NURSE PRACTICE CONSULTANT As nurses we all tend to want to relieve people's sufferings. This was the case with LPN, Nurse B, who was working at a Care Center a few months ago. She noticed that the unit clerk, Janie, was having some distress from a cold. Nurse B was going to give Janie some Claritin, but none was available. There were, however, vitamins available and Nurse B felt these would help Janie. Nurse B inadvertently poured the vitamins into a medication cup in which she had already placed a resident's methadone. After Janie took the vitamins, Nurse B began looking around for the methadone, and decided she had accidentally thrown it out. After awhile, Janie began to feel drowsy, so much so that her parents had to come and take her home. A few hours later, her parents were unable to waken Janie and took her to the hospital. Three lab tests failed to reveal any substance that would be causing Janie's symptoms, but a fourth specimen, sent to Banner Good Samaritan Hospital Lab detected the Methadone. Janie was unconscious for nearly twenty hours. Fortunately, she recovered with no ill effects. Nurse B was devastated to learn what she had done. She was only trying to help Janie, but her well-meaning assistance took a nasty turn. She violated the Nurse Practice Act, R4-19-403 (B), (12), "Assuming patient care responsibilities that the nurse lacks the education to perform, for which the nurse has failed to maintain nursing competence, or that are outside the scope of practice of the nurse." The Board offered a Consent Agreement for a Degree of Censure, which is discipline. arizona STATE BOARD OF NURSING REGULATORY JOURNAL From the Executive Director: Joey Ridenour RN MN Flu season is a busy time of the year for nurses. Many find themselves being asked to provide vaccinations to clients, the public, family, friends and colleagues. A prescription by a health care professional with the authority to prescribe the vaccine is needed before the vaccine can be administered. This can take the form of a client specific order or a medical directive/standing order/protocol that is applicable to a range of clients. Health Services Advisory Group submitted the following article to encourage vaccinations for seniors. Please also consider vaccination of health care workers in your facility to reduce influenza infection and absenteeism. JER Joint Commission Approves Use of Physician-Approved Protocols for Flu and Pneumococcal Vaccination Control and Prevention’s (CDC’s) Advisory Effective July 1, 2007, the Joint Commission Committee on Immunization Practices on Accreditation of Healthcare (ACIP) have advocated that health care Organizations has approved two new elements of performance (EPs) in Standard providers (i.e., ambulatory care, hospitals, MM.3.20. These new EPs align Joint long-term care, and home health) help to Commission standards with current CMS improve influenza and pneumococcal immurequirements by allowing administration of nization coverage through the use of standinfluenza and pneumococcal vaccines—as ing orders/protocols. Standing orders/protopermitted by law and regulation—according • HOWARD PITLUK, MD, MPH, FACS cols are an organization-based intervention to specific physician-approved organization • SUSAN SUMWALT, RN, MA, CPHQ that allows appropriate non-physician staff protocols. • HERB RIGBERG, MD • EP14- which applies to ambulatory to routinely offer vaccinations—after assesscare, critical access hospital, hospital, ment for contraindications—without an indiand long term care-states, “Influenza and Influenza and invasive pneumococcal disvidual physician order, according to the facilpneumococcal polysaccharide vaccine are adminisease together result in more than 40,000 ity or agency physician-approved policy. tered according to a physician order, or, as perdeaths in the United States each year; most While Medicare Conditions of mitted by law and regulation, according to physiof the victims are 65 years of age or older. Participation (CoPs) for providers were cian-approved, organization-specific protocol(s).” Vaccines for these diseases have been found changed in 2002 to allow the use of standing • EP15-which applies to home carestates, “Influenza and pneumococcal polysacchato be safe and effective, but immunization orders/protocols for influenza and pneumoride vaccines are administered according to a rates among the elderly remain low. coccal vaccinations, providers have somephysician order, or, as permitted by law and reguThe Centers for Medicare & Medicaid times been reluctant to adopt this approach. lation, according to approved protocol(s) developed Services (CMS) and the Centers for Disease With the Joint Commission’s recent addition in consultation with a physician.” STANDING ORDERS/ PROTOCOLS FOR INPATIENT FLU & PNEUMOCOCCAL VACCINATIONS to its vaccination standards (see sidebar), it is anticipated health care providers will now be more receptive to taking an organizational approach to ensuring that their patients receive vaccinations in accordance with national guidelines. Because not all seniors seek routine physician-office care, failure to offer vaccines to all inpatients 65 years of age or older represents a missed opportunity for preventing serious illness and death. It is imperative that care providers develop and rigorously implement standing orders/protocols so that no opportunity is missed for influenza or pneumococcal immunization in this vulnerable population. Dr. Pitluk is Medical Director, Ms. Sumwalt is a Clinical Quality Specialist, and Dr. Rigberg is CEO for Health Services Advisory Group. This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-8SOW-1C-101706-01 26 arizona STATE BOARD OF NURSING REGULATORY JOURNAL Case Study: SEXUAL ASSAULT OF A PATIENT BETTY NELSON RN MS, NURSE PRACTICE CONSULTANT CNA X worked the evening shift in a nursing home for several years. He was very well-liked by his supervisors and peers, and was considered an excellent worker. Resident Y was a 31-year-old, female resident with a history of brain damage and manipulative behavior. CNA X began flirting with Resident Y, always trying to seek her out or peek around her privacy curtain when she changed her clothing. One evening when all the staff was busy in the dining room, CNA X entered Resident Y’s room and soon began to kiss and undress her. Resident Y was terrified. She tried to fight him off, but he was too strong. Resident Y didn’t know what to do. She knew she needed to report what happened, but who would believe her? She kept flashing back to another traumatic experience when she was raped by a caregiver in an assisted living facility. No one believed her then, not even the police. She went and sat near the kitchen, where a kitchen worker noticed that she was crying. Resident Y was too upset to even explain what happened; all she could do was cry. Finally, the kitchen worker convinced her she needed to tell her what happened, and learned that Resident Y had been molested. The kitchen worker immediately went to the charge nurse and reported the incident. The nursing staff followed procedure even though they knew there was no way CNA X could have done such a thing. CNA X was interviewed and suspended pending the outcome of their investigation. They contacted the Police Department and AZ Department of Health Services (DHS), but through an oversight, failed to report the incident to the AZ State Board of Nursing (AzBN). The police completed interviews and sent Resident Y to the emergency room where she was given a sexual assault examination. The facility was unable to substantiate the 28 allegation. Resident Y had a history of making a similar complaint in her previous care home and after all, she was known to have brain damage and be manipulative. The facility learned that a couple other residents reported concerns that CNA X made them feel uncomfortable by the way he hugged and touched them. They decided to terminate CNA X’s employment. DHS completed an investigation of the incident and discovered from the police that Resident Y’s forensic examination revealed the presence of semen. They also learned that DNA testing was in process and that the police were looking for CNA X in order to collect his DNA sample. DHS reported the incident to the Board, but by this time several months had gone by with CNA X continuing to work with vulnerable nursing home patients. Previous to receiving DHS’s notification to the Board, there was nothing in the Board’s system to warn the public/employer’s regarding CNA X. CNA X contacted the Board when he was sent notification that a complaint was received regarding his CNA certificate. An interview was scheduled with CNA X to allow him the opportunity to explain his side of the allegation. CNA X repeatedly denied any contact with Resident Y. The police also repeatedly questioned CNA X to explain if it was possible his DNA might be present on Resident Y. CNA X finally admitted to the officers that he kissed and fondled Resident Y. CNA X agreed to submit to a collection of his DNA, which later turned out to match the DNA found on Resident Y. During the course of AzBN’s investigation, it was discovered that CNA X was arizona STATE BOARD OF NURSING REGULATORY JOURNAL previously disciplined by his employer for sexually harassing a co-worker. It was learned that he had two previous complaints of resident abuse, one from AzBN and one in California, both resulting in non disciplinary actions. In addition, CNA X had a previous arrest for assault/domestic violence and a conviction for domestic violence in California, which he failed to disclose at the time of his endorsement into Arizona. It was determined that CNA X was a threat to the public health, safety and welfare and required an emergency action. Several weeks later the Board issued Finding of Public Emergency and an Order of Suspension, which summarily suspended CNA X’s CNA certificate. A hearing was then held before an Administrative Law Judge. The Judge subsequently recommended to affirm and uphold the Board’s Order of Summary Suspension and revoke CNA X’s CNA certificate. The Board reviewed and accepted the Judge’s recommendations and revoked the certificate. VIOLATIONS OF LAW: ARS § 32-1663 (F) AS DEFINED IN A.R.S. § 32-1601 (16) (d), (h) and (j). (16) “Unprofessional conduct” includes the following whether occurring in this state or elsewhere: (d) Any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public. (h) Committing an act that deceives, defrauds or harms the public. (j) Violating a rule that is adopted by the board pursuant to this chapter. VIOLATIONS OF RULES: A.A.C. R4-19-814 (3), (6), (8), (9), (18) and (21) (adopted effective February 4, 2000) For purposes of ARS § 32-1601 (16) (d), a practice that is or might be harmful or dangerous to the health of a patient or the public includes the following: (3) Failing to follow an employer’s policies and procedures designed to safeguard the client. (6) Failing to respect client rights and dignity. (8) Neglecting or abusing a client physically, verbally, emotionally or financially. (9) Engaging in sexual misconduct or boundary violations with a client. (18) Using violent or abusive behavior in any work setting. (21) Practicing in any other manner that gives the Board reasonable cause to believe that the health of a client or the public may be harmed. A.A.C. R4-19-814 (B) (23. a and c) (adopted effective December 5, 2005) B. For purposes of A.R.S. § 32-1601 (16), a ! c. Not completing and returning a Board-issued questionnaire within 30 days. LESSONS LEARNED: • Listen to your patients and take immediate action. From experiences with sexual misconduct cases, patients are often PREVIOUS TO RECEIVING DHS’S NOTIFICATION TO THE BOARD, THERE WAS NOTHING IN THE BOARD’S SYSTEM TO WARN THE PUBLIC/EMPLOYER’S REGARDING CNA X. practice or conduct that is or might be harmful or dangerous to the health of a patient or the public and constitutes a basis for disciplinary action on a certificate includes the following: (23) Failing to cooperate with the Board during an investigation by: a. Not furnishing in writing a complete explanation of a matter reported under A.R.S. §32-1664; afraid to report sexual abuse. They feel humiliated to talk about it and are afraid no one will believe them. • Avoid thinking that it couldn’t be true. • Call the police and advocate for a forensic examination. • Follow your policy/procedure and notify all appropriate agencies. arizona STATE BOARD OF NURSING REGULATORY JOURNAL 29 *Not reported in previous Newsletter CNA DISCIPLINARY ACTION JULY-AUGUST-SEPTEMBER 2006 EFFECTIVE DATE NAME 9/5/2006 Anderson, Carolyn F 8/8/2006 Anor, Pedro L 8/29/2006 Asaro, Josephine S 7/19/2006 Ault, Wendy H 7/31/2006 Avila, Kathy L 8/4/2006 Bates, Alice L 7/19/2006 Bowden, Amy C 8/29/2006 Brown, Elizabeth 9/1/2006 Burnside, Phillip D 8/28/2006 Clark, Alma 8/11/2006 Clyde, Sylvia A 9/6/2006 Colazo, Beatrice L 7/19/2006 Collins, Brigette E 7/19/2006 Concepcion, Celso D CERTIFICATE CNA Applicant CNA1000004519 CNA1000010307 CNA999993610 CNA Applicant CNA028539803 CNA1000009801 CNA Applicant CNA1000004193 CNA Applicant CNA1000006330 CNA Applicant CNA999994039 CNA451479901 DISCIPLINE Certificate Denied Voluntary Surrender Stayed Suspension Stayed Suspension Certificate Denied Stayed Revocation Stayed Revocation Certificate Denied Revocation Certificate Denied Stayed Suspension Certificate Denied Stayed Revocation Revocation 7/17/2006 8/29/2006 9/1/2006 9/1/2006 8/29/2006 7/19/2006 Dalton, Anastasia D Diaz, Alfredo Dorosky, Ricky E Dotson, Amelia N Eliosa, Edilberta Escobedo, Carmen F CNA1000009906 CNA Applicant CNA456437803 CNA999987210 CNA Applicant CNA999990558 Civil Penalty Certificate Denied Revocation Revocation Certificate Denied Stayed Revocation 7/2/2006 Eubanks, Phyllis V CNA1000009714 Stayed Revocation 8/29/2006 8/29/2006 9/6/2006 Flory, Kenneth R CNA Applicant Garcia Jimenez, Teresa CNA Applicant Garza, Asuncion H CNA Applicant Certificate Denied Certificate Denied Certificate Denied 9/9/2006 8/1/2006 8/29/2006 9/1/2006 Gogolin, Benjamin R Golden, Jake M Gore, Felicia A Greenwald, Keri V CNA1000010450 CNA1000010091 CNA Applicant CNA999997034 Civil Penalty Civil Penalty Certificate Denied Revocation 9/1/2006 9/27/2006 9/1/2006 8/9/2006 8/22/2006 Greenwalt, Kathie L Gutierrez, Maria B Hamlin, John R Hartsock, Patti S Henderson, Stephanie G CNA803880103 CNA999947875 CNA999999054 CNA1000009955 CNA Applicant Revocation Civil Penalty Revocation Stayed Suspension Certificate Denied 9/27/2006 9/1/2006 8/23/2006 9/1/2006 8/7/2006 9/1/2006 8/24/2006 7/17/2006 9/1/2006 9/19/2006 Hernandez, Eugenio Hernandez, Norma J Hill, Edith Hollingsworth, Cindy R Hughens, Cynthia K Hutchison, Deborah L Jabaar, Shahidah C Jackson, Lydia J Jenkins, Genice D Joy, Josephine H CNA Applicant CNA999947410 CNA923541809 CNA445443286 CNA999990640 CNA042589613 CNA999998960 CNA1000009775 CNA1000010316 CNA595542003 Certificate Denied Revocation Voluntary Surrender Revocation Civil Penalty Revocation Civil Penalty Civil Penalty Civil Penalty Voluntary Surrender 9/1/2006 8/16/2006 9/1/2006 Koos, David A Lavoie, Vivian A Lomayaktewa, Ruthena G Lorah-Smith, Charlene R McIntosh, Lauren L Mendivil, Maria A Montano, Olivia Y Morris, Michelle Muhammad, Hakim A CNA999995467 CNA999993005 CNA710593103 Revocation Voluntary Surrender Revocation VIOLATION(S) Criminal Conviction-Misdemeanor; Misconduct; Failure to Cooperate Boundaries; Sexual Abuse; Failure to Follow Orders Criminal Conviction-Misdemeanor Criminal Conviction-Felony; Drug Related; Obtaining Certificate by Fraud Criminal Conviction-Felony Criminal Conviction-Drug Related Criminal Conviction Criminal Conviction-Misdemeanor Violating Board Order Obtaining Certificate by Fraud; Failure to Cooperate Criminal Conviction-Misdemeanor Criminal Conviction-Felony Neglect; False Documentation Failure to Follow Orders; Practicing Beyond Scope; Drug Use on Duty; Physical Abuse Failure to Follow Orders; Diversion Program Obtaining Certificate by Fraud; Failure to Cooperate Drug Abuse; Failure to Cooperate Violating Board Order Obtaining Certificate by Fraud; Failure to Cooperate Criminal Conviction-Misdemeanor; Failure to Follow Orders; Misconduct Criminal Conviction-Felony; Criminal Conviction-Misdemeanor; Criminal Conviction-Against Property Criminal Conviction-Misdemeanor; Failure to Cooperate Obtaining Certificate by Fraud; Failure to Cooperate Criminal Conviction-Misdemeanor; Obtaining Certificate by Fraud; Failure to Cooperate Criminal Conviction-Misdemeanor Criminal Conviction-Misdemeanor Criminal Conviction-Misdemeanor; Failure to Cooperate Failure to Maintain Minimal Standards; Failure to Follow Orders; Verbal Abuse Theft - Client; Drug Diversion - Self; Criminal Conviction-Misdemeanor Failure to Follow Orders Violating Board Order Criminal Conviction-Misdemeanor; Criminal Conviction-Drug Related Criminal Conviction-Felony; Criminal Conviction-Drug Related; Obtaining Certificate by Fraud Obtaining Certificate by Fraud; Failure to Cooperate Violating Board Order Fraud/Deceit; Theft - Client Violating Board Order False Documentation; Theft - Employer; Fraudulent Billing Violating Board Order Fraudulent Billing; False Documentation; Failure to Follow Orders Criminal Conviction-Misdemeanor; Against Person Criminal Conviction-Felony; Drug Related Criminal Conviction-Misdemeanor; Alcohol Abuse; Failure to Report Violations Criminal Conviction-Felony; Violating Board Order Failure to Follow Orders; Drug Related Violating Board Order CNA Applicant CNA Applicant CNA127593803 CNA999997789 CNA276511299 CNA Applicant Certificate Denied Certificate Denied Reinstatement Denied Civil Penalty Revocation Certificate Denied Criminal Conviction Criminal Conviction-Misdemeanor; Failure to Cooperate Criminal Conviction-Felony; Drug Related; Failure to Cooperate Leaving Duty Station Violating Board Order Criminal Conviction-Felony 8/29/2006 9/5/2006 8/24/2006 8/2/2006 9/1/2006 9/1/2006 30 arizona STATE BOARD OF NURSING REGULATORY JOURNAL *Not reported in previous Newsletter CNA DISCIPLINARY ACTION JULY-AUGUST-SEPTEMBER 2006 EFFECTIVE DATE NAME 9/1/2006 Murray, Daniel H 8/8/2006 North, Angela L 8/18/2006 Nowlin, Charlotte L 9/20/2006 Osuagwu, Lulu 9/5/2006 Perez, Lisa M CERTIFICATE CNA1000000837 CNA999992742 CNA Applicant CNA999950318 CNA Applicant DISCIPLINE Revocation Voluntary Surrender Certificate Denied Civil Penalty Certificate Denied 9/28/2006 9/1/2006 Phillips, Melinda R Romero, Rosann M CNA1000010563 CNA777814803 Civil Penalty Revocation *6/29/2006 8/14/2006 9/1/2006 *4/11/2006 9/1/2006 8/3/2006 9/11/2006 *5/4/2006 9/1/2006 8/21/2006 8/25/2006 7/14/2006 8/29/2006 9/19/2006 7/12/2006 Sawyer, Pamela L Sjoberg, Thomas W Smith, Annitra M Smothers, Lori L Stewart, Elizabeth C Valev, Galin S Vanderplas, Adrienne R Veiver, Tena A Vindiola, Dolores B Wamsley, Jenny L Ward, Lee W Wilkinson, Denise A Wilson, Evon Woolsey, Levi G Yazzie, Darlene D CNA Applicant CNA1000010093 CNA592664441 CNA999948763 CNA999993872 CNA1000009927 CNA999995508 CNA1000009119 CNA999989181 CNA1000003697 CNA Applicant CNA Applicant CNA Applicant CNA1000004814 CNA597918353 Certificate Denied Stayed Suspension Revocation Voluntary Surrender Revocation Stayed Revocation Stayed Suspension Civil Penalty Revocation Stayed Revocation Certificate Denied Stayed Revocation Certificate Denied Voluntary Surrender Stayed Revocation VIOLATION(S) Violating Board Order Criminal Conviction-Misdemeanor; Drug Related; Drug Use on Duty Criminal Conviction-Felony; Obtaining Certificate by Fraud Failure to Follow Orders; Mental Abuse; Verbal Abuse Criminal Conviction-Felony; Misdemeanor; Obtaining Certificate by Fraud Criminal Conviction-Misdemeanor; Alcohol Abuse Failure to Maintain Minimal Standards; Failure to Follow Orders; Theft - Client Criminal Conviction-Misdemeanor Criminal Conviction-Misdemeanor Violating Board Order Drug Abuse; Criminal Conviction-Misdemeanor; Drug Related Criminal Conviction-Misdemeanor; Failed to Respond Alcohol Abuse; Criminal Conviction-Misdemeanor Criminal Conviction-Misdemeanor Criminal Conviction-Misdemeanor; Alcohol Abuse Violating Board Order Drug Abuse Criminal Conviction-Misdemeanor; Alcohol Abuse Criminal Conviction-Misdemeanor Criminal Conviction-Misdemeanor; Other; Drug Abuse Verbal Abuse; False Documentation; Failure to Follow Orders Criminal Conviction-Misdemeanor; Alcohol Abuse; Failure to Cooperate CNA ACTION CLEARED NOVEMBER-DECEMBER 2006 EFFECTIVE DATE 8/14/2006 8/24/2006 8/2/2006 NAME Adeyemi, Adewale Curtis, Roxanne N Dufault, Lori L CERTIFICATE CNA722308499 CNA1000001269 CNA827875057 EFFECTIVE DATE 8/21/2006 9/28/2006 8/15/2006 • JANUARY 2007 NAME Magdaleno, Corena V Rivera, Albert Wise, Erika CERTIFICATE CNA1000005208 CNA999987708 CNA999950977 RN/LPN DISCIPLINARY ACTION JULY-AUGUST-SEPTEMBER 2006 EFFECTIVE DATE 9/1/2006 9/1/2006 8/10/2006 7/21/2006 8/13/2006 6/12/2006* NAME Ashenbaum, Joel C. Ashford, Betty F. Bartley, Pamela K. Bellman, Jeanne A. Beyer, Ann Bleimeyer, Marianne DISCIPLINE Revocation Revocation Voluntary Surrender Revocation Decree of Censure Stayed Suspension w/Probation 6/30/2006* 8/9/2006 7/28/2006 8/22/2006 LICENSE RN102801 LP026706 RN082767 RN069621 RN127151 TLP042312 Refresher Course only Blevins, James A. LP011787 Bousquette, Christine L. RN131168 Braun, Alice L. RN081483 Brown, Laurie Jo RN Endorsement 9/1/2006 9/11/2006 Burson, Helen E. Caldwell, Wanda Jo LP035197 LP037689 Decree of Censure with Fine Probation 6/12/2006* 7/19/2006 Cambron, Lori D. Campise, Steven E. RN083249/LP018754 RN083833 Stayed Suspension w/Probation Civil Penalty 9/12/2006 7/16/2006 Campos, Danielle Rae Carroll, Dulce E. RN140740 RN136807 Civil Penalty Civil Penalty Voluntary Surrender Decree of Censure Decree of Censure License Denied VIOLATION(S) Violating Board Order Drug Abuse, Drug Use on Duty Failure to Intervene, Medication Errors, Drug Abuse Alcohol Abuse, Violating Board Order Documentation Errors, Wastage Errors Drug Abuse, Drug Diversion, Action in Another Jurisdiction Misconduct-Physical Abuse Failure to Report Violations Unsafe Practice, Failure to Follow Orders Failure to Maintain Minimal Standards, Failure to Follow Orders, Practicing Beyond Scope Misconduct-Breach of Confidentiality Failure to Maintain Minimal Standards, Failure to Follow Orders, Failure to Assess Alcohol Abuse, Violating Board Order Practicing Beyond Scope, Misconduct-False Documentation Practicing without License Criminal Conviction, Fraud, Deceit-Obtaining License arizona STATE BOARD OF NURSING REGULATORY JOURNAL 31 RN/LPN DISCIPLINARY ACTION JULY-AUGUST-SEPTEMBER 2006 *Not reported in previous Newsletter EFFECTIVE DATE 6/19/2006* 7/20/2006 9/1/2006 NAME Chiha, Soraya Cline, Jamie D. Close, Mark A. LICENSE RN129289 RN139871 RN097272/SN0347 DISCIPLINE Probation Civil Penalty Revocation 8/16/2006 8/29/2006 6/9/2006* 7/20/2006 Coats, Sharon S. Colgin, Katherine E. Collier, Deanna L. Dahl, Melinda Lou Decree of Censure License Denied Decree of Censure Indefinite Suspension 9/1/2006 Dillistin, Nellie V. LP011311 RN Endorsement RN035358/AP0045 TRN123635 Refresher Course Only RN049116 8/21/2006 9/1/2006 Dollard, Sally A. Dorn, Pamela E. LP018624 LP035555 Decree of Censure Revocation 9/5/2006 9/11/2006 7/20/2006 9/1/2006 Dutchover, Eric P. Eakerns, Jeanette R. Eastman, Carla D. Edwards, Angela M. RN076370 RN066788/LP021937 RN140581 RN126465/LP038940 Probation Civil Penalty Civil Penalty Revocation 6/14/2006* 9/12/2006 Erkfitz, Karen R. Ernst, Alycia S. Suspension Decree of Censure 7/19/2006 Fairman, Penny L. LP035842 RN101841/SN0915/ LP032282 RN038753 Probation 8/27/2006 Faulkner, Robert D. RN083342 Stayed Revocation w/Suspension 7/27/2020 7/20/2006 Findlay, Shannon E. Freeman, Mary A. LP039249 RN140595 Revocation Civil Penalty 6/30/2006* Gage, Marcy K. RN135019 Stayed Suspension w/Probation 9/15/2006 Gale, Holly H. RN107134/LP029607 Stayed Revocation w/Suspension 8/29/2006 9/12/2006 7/19/2006 Gilbride, Annette M. Giron, Marites P. Gutierrez, Janice M. LP017990 TRN141417 RN092079 License Renewal Denied Civil Penalty Probation 6/20/2006* Hagen, Linda L. RN034150 Probation w/Limited Licensure 7/14/2006 8/28/2006 7/6/2006 5/18/2006* Hand, Allison K. Hart, Brenda M. Hayse, Melanie R. Helms, Criss J. RN117438 RN117921 RN127984 Compact State – TX 8/6/2006 Henderson, Madeline S. RN057322 Voluntary Surrender Probation Voluntary Surrender Voluntary Surrender-Privilege to Practice Civil Penalty 9/1/2006 Herbein-Miner, Heather A. Jennings, Marvin K. Johnson, Margene A. Joyce, Patricia T. 6/18/2006* 5/19/2006* 7/25/2006 6/23/2006* 8/20/2006 7/20/2006 7/19/2006 7/26/2006 7/19/2006 32 Kennedy, Kimberly R. Kennedy, Mary Lagourgue, Tammy Lee R. Loos, Kenneth A. Lopez, Ivylinn D. Lunn, Judy J. Revocation VIOLATION(S) Alcohol Abuse Practicing without License Failure to Maintain Minimal Standards, Failure to Assess, Violating Board Order Failure to Follow Orders, Medication Errors Alcohol Abuse, Action in Another Jurisdiction Failure to Assess, Documentation Errors Failure to Maintain Minimal Standards, Medication Errors, Practicing Beyond Scope Drug Abuse, Drug Use on Duty, Failure to Comply with Requirements of Impaired Nurse Program Drug Abuse Action in Another Jurisdiction, Failure to Cooperate with Board Alcohol Abuse Practicing Beyond Scope Practicing without License Drug Abuse, Failure to Comply with Requirements of Impaired Nurse Program Violating Board Order Failure to Assess, Documentation Errors Drug Diversion, Presenting Illegal RX, Fraud, DeceitObtaining License Failure to Comply with Requirements of Impaired Nurse Program Violating Board Order Failure to Maintain Minimal Standards, Unsafe Practice, Misconduct-False Documentation Failure to Maintain Minimal Standards, Documentation Errors, Wastage Errors Drug Diversion, Failure to Comply with Requirements of Impaired Nurse Program Drug Abuse, Drug Diversion, Presenting Illegal RX Practicing without License Failure to Maintain Minimal Standards, Medication Errors, Misconduct Failure to Maintain Minimal Standards, Practicing Beyond Scope, Inability to Practice Safely Drug Abuse, Violating Board Order Drug Abuse Incompetent Practice Failure to Follow Orders, Medication Errors LP037944 Revocation RN098694 RN055320 LP027960 Stayed Revocation w/Probation License Renewal Denied Voluntary Surrender RN119727 RN041515 LP015525 Revocation Decree of Censure Voluntary Surrender Failure to Follow Orders, Misconduct-False Documentation Alcohol Abuse, Failure to Comply with Requirements of Impaired Nurse Program Alcohol Abuse, Violating Board Order Drug Abuse, Writing Illegal RX, Fraud, Deceit Failure to Maintain Minimal Standards, Inability to Practice Safely Violating Board Order Failure to Follow Orders, Practicing Beyond Scope Inability to Practice Safely RN034971/CRNA0052 RN140739 RN134650 Probation Civil Penalty Voluntary Surrender Misconduct, Alcohol Abuse Misconduct-Theft Violating Board Order arizona STATE BOARD OF NURSING REGULATORY JOURNAL *Not reported in previous Newsletter RN/LPN DISCIPLINARY ACTION JULY-AUGUST-SEPTEMBER 2006 EFFECTIVE DATE 7/19/2006 NAME Luscumb, Jane M. LICENSE RN096938 DISCIPLINE Stayed Suspension w/Probation 9/5/2006 Lutzow, Michael J. RN Endorsement License Denied 7/21/2006 9/9/2006 7/25/2006 Lynch, Loris L. Lyon, Kimberly K. Malone, Erin E. RN077453 RN110171/LP029566 RN066940 Probation Decree of Censure Voluntary Surrender 6/30/2006* 5/18/2006* 6/27/2006* 7/19/2006 Maurer, Tamara L. McFall, Peggy L. McPherson, Cyndi J. Mehrbrodt, Jane A. RN078464/LP025203 RN122704 RN075808 RN061650 Voluntary Surrender Decree of Censure Stayed Revocation w/Probation Probation 7/19/2006 Moore, Jennifer L. LP041064 Probation 8/29/2006 6/20/2006* 7/5/2006 Murphy, Patrick S. Nelson, Abigail J. Neville, Marilyn R. RN Endorsement RN128856 LP036560 License Denied Civil Penalty Suspension 6/26/2006* 9/25/2006 Pearson, Wendi Rae Powell, Stacie RN131444 RN080022 Decree of Censure Stayed Revocation w/Suspension 9/11/2006 6/30/2006* 9/1/2006 9/17/2006 8/28/2006 Reising, Karen S. Riedinger, Robin R. Roberts, Nancy L. Rodenbeck, Louise A. Rollins, Kevin B. RN130192 RN109342 RN109737 RN141602 RN133543 Stayed Suspension w/Probation Revocation Revocation Civil Penalty Voluntary Surrender 9/1/2006 Romine, Linda R. RN090488 Stayed Revocation w/Probation 9/11/2006 Rosalik, Kathryn A. RN087989/AP049 Stayed Suspension w/Probation 7/23/2006 Roshan, Babak LP040953 Decree of Censure 8/10/2006 6/28/2006* 7/21/2006 9/5/2006 Ruiz, Patricia P. Sanchez, Martin E. Santiago, Margaret L. Schafer, Bradley C. LP023719 LP036693 LP033453 LP Endorsement Decree of Censure Suspension/Indefinite Revocation License Denied 8/18/2006 9/11/2006 Scott, Rachel C. Selman, Carol A. LP034329 RN081747 Probation Civil Penalty 9/7/2006 6/30/2006* 7/21/2006 7/19/2006 7/19/2006 Somplasky, Margaret A. Sones, Philip C. Soulik, Bareana T. Speer, Kenneth D. Stilwell, Deanne M. RN057264 RN114031 LP032393 RN099044/CRNA0432 RN091345 Voluntary Surrender Decree of Censure Stayed Revocation w/Probation Civil Penalty Decree of Censure with Fine 8/14/2006 6/30/2006* Vovakes, Susan E. Washington, Chanelle M. Webb, Virginia Wienefeld, Susan L. Wilkinson, Linda K. Willeford, Christina M. Wilson Dakin, Connie S. Winters, Jennifer L. RN051643/AP0297 RN Endorsement Decree of Censure License Denied RN057564 RN037536 RN Endorsement RN133982 RN136109 RN123841 Revocation Revocation-Privilege to Practice License Denied Suspension Probation Stayed Revocation w/Suspension 7/21/2006 7/13/2006 8/29/2006 8/7/2006 7/24/2006 9/20/2006 VIOLATION(S) Failure to Maintain Minimal Standards, Unsafe Practice, Failure to Follow Orders Criminal Conviction-Against Person, Unprofessional Conduct, Sexual Misconduct Alcohol Abuse Practicing Beyond Scope Violating Board Order, Failure to Cooperate with Board Drug Abuse Documentation Errors, Practicing Beyond Scope Drug Diversion, Action in Another Jurisdiction Criminal Conviction-Misdemeanor, Failure to Follow Orders, Alcohol Abuse Criminal Conviction-Misdemeanor, Fraud, Deceit, Failure to Cooperative with Board Alcohol Abuse, Action in Another Jurisdiction Criminal Conviction-Misdemeanor Unsafe Practice, Failure to Follow Orders, Medication Errors Documentation Errors Failure to Comply with Requirements of Impaired Nurse Program Drug Abuse, Drug Related-Impaired on Duty Action in Another Jurisdiction Violating Board Order Practicing without License Drug Diversion, Failure to Comply with Requirements of Impaired Nurse Program Criminal Conviction-Misdemeanor, Documentation Errors, Failure to Report Violations Failure to Maintain Minimal Standards, Unsafe Practice, RX Errors (APRN) Failure to Maintain Minimal Standards, Medication Errors Failure to Follow Orders, Documentation Errors Criminal Conviction-Misdemeanor, Drug Related, Violating Board Order Criminal Conviction-Drug Related, Fraud, DeceitObtaining License Drug Abuse Failure to Follow Orders, Practicing Beyond Scope, Misconduct Violating Board Order Failure to Follow Orders, Documentation Errors Violating Board Order Practicing without License Failure to Maintain Minimal Standards, Failure to Follow Orders, Failure to Assess DX Errors (APRN) Misconduct, Failure to Cooperate with Board Violating Board Order Unsafe Practice Alcohol Abuse, Action in Another Jurisdiction Practicing without License, Violating Board Order Criminal Conviction-Misdemeanor Drug Abuse, Drug Diversion, Failure to Comply with Requirements of Impaired Nurse Program arizona STATE BOARD OF NURSING REGULATORY JOURNAL 33 Termination of Board Agreements/Order for RNs/LPNs *NOT REPORTED IN PREVIOUS JOURNAL EFFECTIVE DATE 7/19/2006 7/20/2006 9/11/2006 7/19/2006 8/16/2006 7/19/2006 9/11/2006 9/11/2006 9/11/2006 8/15/2006 8/24/2006 7/19/2006 NAME Allen, Christina Andrick, Terrence M. Coleman, Julie Collins, Roxann K. Cooper, George T. Corti-Phillips, Valerie A. Dame III, Alfred O. Gonzalez, Marlon R. Henely, Richard J. Herstein, Sara J. Howard, Jeffery L. Koepfer, Dawn M. LICENSE RN093569 RN110826 RN095173/LP026339 RN055574 RN050434 RN094717/LP030694 RN124740 RN131289 RN046579 RN105847/LP030215 LP028220 LP038838 EFFECTIVE DATE 7/19/2006 9/12/2006 9/11/2006 9/19/2006 9/11/2006 9/11/2006 8/25/2006 7/19/2006 7/20/2005* 9/11/2006 9/11/2006 NAME Marshall, Judy M. Mazzarella, Lisa K. Moran, Lukaea E.S. Robbins, Jill Walters, Phyllis G. Webber, Beverly M. Willeford, Christina M. Williams, Cynthia F. Wohead, Kimberly S. Wood, Lorie S. Youngreen, Susan A. LICENSE LP035271 RN129917/LP038370 LP040810 RN088386 RN105226 RN087510/AP0565 RN133982 RN054806 RN107542 RN053359 RN131707 THE ARIZONA NURSES ASSOCIATION is looking for a dynamic articu- Notice of Retraction Discipline for Timothy Hicks, RN051708 printed on page 34 of the third quarter issue of the Arizona State Board of Nursing’s Regulatory Journal contains an error. Mr. Hicks was issued a Civil Penalty for Failure to Follow Orders. 34 arizona STATE BOARD OF NURSING REGULATORY JOURNAL late person who can share our vision of the Association as the voice of nursing. This position requires administrative experience, good communication skills and an understanding of small business finances. The Executive Director works with volunteer members to; • Promote professional advocacy • Influence healthcare policy • Sponsor and approve continuing education • Network locally, statewide and nationally SEND A LETTER OF INTEREST AND RESUME BY FAX TO 480-839-4780 OR EMAIL TO DEBBY@AZNURSE.ORG TEST Your Knowledge of the Nurse Practice Act The items below are part of a 50 item exam developed to help RNs, LPNs and CNAs to increase your knowledge and understanding of the Arizona Nurse Practice Act. Try it and see how you score! Answers can be found on page 37. Visit our website soon to take the entire exam. 1. WHICH OF THE FOLLOWING ACTIVITIES WOULD BE A SCOPE OF PRACTICE VIOLATION FOR AN RN: a. b. c. d. Ordering laboratory tests Administering blood products Evaluating the effects of medication Initiating a drug regimen based on protocols 2. IT IS OUTSIDE THE SCOPE OF PRACTICE FOR AN LPN TO: a. b. c. d. Perform an electrocardiogram on a client Assess a client’s report of chest pain Reinforce foot care in a diabetic client Obtain a blood specimen from a client 3. UNDER THE DEFINITION OF DELEGATION, A NURSE MAY DELEGATE: a. Decision making and nursing judgment to other licensed nurses b. To a person whose job description includes the delegated activity c. All assessments except the initial assessment d. A selected task to a competent person 4 UNPROFESSIONAL CONDUCT: a. Is limited to acts committed in this state b. Is limited to acts performed on duty as a licensee c. Includes any conduct that may be harmful to the public d. Includes all misdemeanor offenses 5 IT WOULD BE UNPROFESSIONAL CONDUCT FOR A NURSE TO: a. Fail to report another nurse with evidence of impairment while on duty b. Fail to show up for a scheduled shift at a health care facility c. Practice nursing with a diagnosis of bipolar disorder d. Fail to honor an agreement to work for a hospital after accepting a scholarship 6. IT WOULD BE A VIOLATION OF THE NURSE PRACTICE ACT FOR A REGISTERED NURSE PRACTITIONER (RNP) TO: a. Prescribe narcotics to a chronic pain client b. Prescribe in a different specialty than the RNP’s certification c. Delegate the administration of parenteral drugs to a medical assistant d. Dispense controlled substances 7. AN RN LICENSE APPLICANT WAS CONVICTED OF A CLASS 5 FELONY IN 2003 AND APPLIES FOR LICENSURE IN 2006. THE APPLICANT WILL BE: a. b. c. d. Given a civil penalty Placed on probation Denied a license Granted a conditional license 8. THE ARIZONA STATE BOARD OF NURSING HAS AUTHORITY OVER: a. b. c. d. Nursing students RN, LPN and CNA nursing programs All college nursing programs Continuing education nursing programs 9. A NURSE WHO CHANGES HIS/HER RESIDENCE ADDRESS SHALL NOTIFY THE BOARD OF THE NEW ADDRESS WITHIN: a. b. c. d. 10 days 15 days 30 days 45 days 12. IN ARIZONA A NURSING LICENSE MUST BE RENEWED EVERY: a. b. c. d. File a direct petition with the Board Take NCLEX review and refresher courses Inactivate her physician license Complete an approved nursing program 11. ONE WAY THE BOARD ENSURES THAT NURSES WHO RENEW THEIR LICENSES ARE COMPETENT AND QUALIFIED IS TO: a. Conduct a criminal background check on each nurse. b. Require inactive nurses to retake and pass the NCLEX exam. 1 year 2 years 4 years 5 years 13.ALL RNS AND LPNS ARE DUE TO RENEW THEIR LICENSES IN THE YEAR THEY EXPIRE BY: a. June 30. b. The last day of their birthday month. c. December 30. d. November 1. 14. IF THE BOARD BELIEVES THAT THERE IS INSUFFICIENT EVIDENCE TO SUPPORT A DISCIPLINARY ACTION BUT SUFFICIENT EVIDENCE TO NOTIFY A LICENSEE OR CERTIFICATE OF ITS CONCERN, THE BOARD MAY ISSUE: a. b. c. d. 10. A PHYSICIAN TELLS YOU THAT SHE WOULD LIKE TO CHALLENGE THE NCLEX EXAM SO SHE CAN WORK AS AN RN ON THE WEEKENDS. YOU WOULD TELL THE PHYSICIAN THAT IN ORDER TO DO THIS SHE WOULD NEED TO: a. b. c. d. c. Require that nurses practice 960 hours in the past 5 years. d. Require nurses who do not work at the bedside to take a refresher course A letter of admonition. An administrative penalty. A decree of censure. A letter of concern. 15.THE TITLE “NURSE” MAY BE USED BY: a. All persons licensed in any jurisdiction. b. Only RNs and LPNs currently licensed to practice in Arizona. c. RNs and LPNs who are either currently or previously licensed to practice in AZ or d. All licensees and other persons performing nursing duties in a health care setting. 16. IF THE BOARD FINDS THAT A NURSE HAS COMMITTED AN ACT OF UNPROFESSIONAL CONDUCT, IT MAY: a. b. c. d. Issue a letter of concern Issue an administrative penalty. Issue a decree of censure Withdraw the application. >>> arizona STATE BOARD OF NURSING REGULATORY JOURNAL 35 Regulation by Pamela Randolph RN, MS RUNDOWN 17. THE NURSE LICENSURE COMPACT ALLOWS: a. Any nurse licensed in another state to practice in Arizona. b. A nurse licensed and residing in a compact state to practice in Arizona. c. A nursing student from another state to complete clinical training in Arizona. d. A nurse practitioner licensed in compact state to practice in Arizona. 18. IF A NURSE FROM A COMPACT STATE CHANGES THEIR PRIMARY STATE OF RESIDENCE TO ARIZONA THEY MUST: a. Inform the Board if they will be practicing on the compact license issued by the original state. b. Obtain another compact license in Arizona within 60 days. c. Inactivate their home state license and obtain a compact license in AZ. d. Apply to the Board for a temporary license. 19. IT IS AN ACT OF UNPROFESSIONAL CONDUCT FOR A NURSE TO: a. Fail to provide for the comfort of a patient’s family. b. Refuse to follow a physicians order. c. Be absent for a scheduled shift without prior notice. d. Fail to document the care the patient received. 20. AN ACTIVITY THAT WOULD MEET THE PRACTICE REQUIREMENT OF THE ARIZONA STATE BOARD OF NURSING WOULD BE: a. Raising children and attending to their needs. b. Coordinating care and appointments for elderly parents. c. Consulting on staffing plans with a health care facility d. Attending continuing education activities. 36 Rulemaking R4-19-215; R419-301; R4-19-302; R4-19-505; R4-19506; R4-19-507; and R4-19-508. These individual rules need revisions to address issues that have arisen since their adoption. A rulemaking docket was filed and published the Administrative Register on March 3rd, 2006. Amendments to Article 2 (R4-19215) will incorporate a process for rescinding the approval of an out-ofstate nursing program that does not substantially meet Board standards. In Article 3 (R4-19-301), the Board is considering changing the minimum scores for English language proficiency examinations based on research from National Council of State Boards of Nursing. On June 9th, the Education Committee and about 50 interested members of the public attended an information session featuring Dr. Tom O’Neill (Associate Director of NCLEX) regarding the National Council of State Boards of Nursing recommended cut scores for English language proficiency. O’Neill discussed the validity of the research leading up to the recommended scores and how they are consistent with other professions. Several members of the public expressed concern that raising the cut score on the TOEFL (Test of English as a Foreign Language) could pose a barrier to licensure of internationally educated nurses. Other audience members expressed concern for patient welfare and safety when the nurse has limited English proficiency. The Education Committee considered all the evidence at their August 31, 2006 meeting and recommended that English language proficiency standards be studied further and that there be no change to the current standards. Other amendments to Article 3 (R4-19-302) will give the Board discretion to prescribe addi- arizona STATE BOARD OF NURSING REGULATORY JOURNAL tional licensure requirements for an individual who graduates from a revoked nursing program. Amendments to Article 5 (R4-19-505) will extend the waiver of certification for clinical nurse specialists practicing in the area of maternal/infant health or women’s health since there is no certification exam. The Board is also proposing a practice requirement for advanced practice nurses within their specialty similar to the 960 hour (in 5 years) requirement for RNs and LPNs. In R419-508, the Board stipulates that nurse practitioners only provide those health care services for which they are educationally prepared. Other rules were opened for technical and grammatical changes to improve clarity and internal consistency (R4-19-506; R4-19-507). The proposed rules are expected to be posted on the website sometime in late November. Articles 1 and 4 Extensive revisions of Articles 4 (Regulation) and 1 (Definitions and Time-frames) are underway. Please check the Board website (www.azbn.gov) for more information and a draft of the proposed rules. 5-year Rule Review The five year rules review for Articles 4, 6, and 7 was submitted to GRRC in October. The Board is extensively revising Article 4 to improve clarity and differentiation of RN and PN standards of practice and plans no revisions to Articles 6 and 7. The person to contact at the Board regarding rules is: Pamela Randolph Nurse Practice Consultant 602-889-5209 e-mail: prandolph@azbn.gov Fax: 602-889-5155 TEST Your Knowledge of the Nurse Practice Act Questions can be found on page 36. Visit our website soon to take the entire exam. 1. a. 2. b. 3. d. 4. c. 5. a. 6. b. 7. c. 8. b. 9. c. 10. d. 11. c. 12. c. 13. a. 14. d. 15. b. 16. c. 17. b. 18. c. 19. d. 20. c. arizona STATE BOARD OF NURSING REGULATORY JOURNAL 37