arizona vol3 • No4 • NOV 2008 4th Quarter state board of nursing R e g u l a t o r y J o u r na l FINAL REPORT: ARIZONA STATE BOARD OF NURSING ARIZONA MEDICATION TECHNICIAN PILOT PROJECT Sarah Ellis: Team Leader, Hospice of the Valley, Peoria, AZ Prior Director of Nursing, Good Shephard Retirement Center, Peoria, AZ AzBN Welcomes Kathy Scott, rn, mpa, phD, FACHE newest member to the board Published by Arizona State Board of Nursing 4747 North 7th Street, Suite 200 Phoenix, AZ 85014-3655 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, FAAN Executive Director vol 3• N o 4• NOV 2008 4th Quarter 4 6 From the Executive Director: Staff Directory Judy Bontrager, RN, MN Associate Director/Operations Valerie Smith, RN, MS, FRE Associate Director/ Investigations/ Compliance 8 Final Report: Arizona State Board of Nursing Arizona Medication Technician Pilot Project Pamela Randolph, RN, MS Associate Director/Education & Evidence Based Regulation BOARD MEMBERS Karen Hodges Hardy, RN, MSN President Patricia A. Johnson, LPN Secretary Constance Woulard, RN, MSN Member Denise Link, RNP, DNS, FNAP Member Kathy Malloch, RN, MBA, PhD, FAAN Member Steven T. Robertson, LPN, CHPLN Member Kathy Scott, RN, MPA, PhD, FACHE Member Kathryn L. Busby, J.D. PUBLIC Member M. Hunter Perry PUBLIC Member edition 12 18 20 Regulation Rundown Education Corner 24 Arizona Board of Nursing Welcomes New Board Member Kathy Scott arizona 26 Arizona State Board of Nursing Job Opening: Education Program Administrator Position state board of nursing R e g u l a t o r y J o u r na l Created By: Virginia Robertson, PUBLISHER 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 www.thinkaboutitnursing.com 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 29 32 CNA Disciplinary Actions RN/LPN Disciplinary Actions F r om the Ex e c uti v e Di re cto r & Staff Joey Ridenour, RN, MN, FAAN 2008 Arizona Research Data Regarding Effectiveness & Safety of Pilot Study Medication Aides Approximately 47 states have medication aides in some form in nursing homes, assisted living facilities, correctional institutions, elementary schools and other facilities. In 21 of those states, the board of nursing regulates the medication aides (Debra Scott, 2007) In 2002, the Governor’s Task Force on the Nursing Shortage appointed a subcommittee entitled “Removing Regulatory Barriers”. One recommendation made by the subcommittee co-chaired by Kathy Malloch RN PhD FAAN and Peggy Mullan, CEO Beatitudes Campus of Care was that research be conducted to determine if medication aides are safe and competent to administer specific medications in long term care facilities. In 2004 the Arizona Legislature approved House Bill 2256 authorizing research on “Pilot Study Medication Technicians” be conducted and outcomes of the study be reported back to the Arizona Legislature by December 1, 2008. Pam Randolph RN MSN, Associate Director Education & Evidence Based Regulation took the lead role over the past four years to accomplish the outcomes as reported in this edition of the AzBN Journal, “Medication Technician Final Report“. D & S Diversified Technologies conducted the research in collaboration with Dr. Jill Scott-Cawiezell RN FAAN to explore the impact to patient health and safety if trained and certified medication technicians were added to select Arizona nursing home care teams. Results of the research are: 1.) During the pre-implementation naïve observations at six nursing homes, 31 LPN’s and 7 RN’s were observed to delivering 3,039 medications. The initial error rate was 10.4% (LPN-10.12%; RN- 11.54%). There were no statistical or clinical differences among the medication errors observed based on a credential. 2.) During the post-implementation naïve observations of the remaining five nursing homes, 6 LPN’s, 2 RN’s and 7 Medication Technicians were observed delivering 2,151 medications. The mean error rate of 6.6% (LPN-7.25%; RN – 2.75%; Medication Technician- 6.06%). There were no statistical or clinical differences noted among those administering medications regardless of the credential level. These findings are similar to a national study funded in 2007 by the Agency for Healthcare Research & Quality conducted by Scott-Cawiezell and colleagues: Final Report: Technology to Improve Medication Safety in Nursing Homes. The study found that members of the medication team were positively impacted by the presence of the medication technician over time. 3.) Staff members and leaders of the five nursing homes were interviewed after the post pilot study data collection period. The 22 staff members included Directors of Nursing, RN’s, LPN’s and Pilot Study Medication Technicians. The informants were asked to discuss changes in their roles with the addition of the medication technician to the care team. Interviews of the study participants are found on page 12 of this edition of the Journal. Even though many of those interviewed had “early misgivings” about the new medication technician role, all persons interviewed “reported they were able to partner with the medication technician, had more time to work directly with residents and reported feeling better about their treatments and completed assessments.” In summary, this study adds to the body of “evidenced based regulation” regarding unlicensed care givers administering routine medications. The findings suggest that the introduction of a medication technician does not alter the rate of medication error when the medication system includes the RN and Medication Technicians as partners (Scott-Cawiezell, 2007). The “evidenced based public policy” to be shared with the legislature supports there appears to be no reduction in the quality of care for Arizona nursing home residents when medication technicians are included on the health care team. The Board of Nursing extends appreciation to the “many partners” who participated in this research study as noted on pages15, 22 & 23. Want to particularly thank: 1.) Kathleen Collins Pagels, Executive Director, Arizona Health Care Association and Members for the significant financial contributions. 2.) St. Luke’s Initiatives for the grant funding; 3.) Six participating nursing homes for their time and funds; 4.) D&S Diversified, Paul Dorrance and Dr. Jill Scott-Cawiezell for their outstanding research support. Finally, want to acknowledge Sarah Ellis, RN, prior Director of Nursing, Good Shepherd who is on the cover page of this Journal. It is her passion and commitment to the residents in long term care that helped all of us to be anchored in a timeless statement made by Florence Nightingale almost 170 years ago that transcends to 2008: “…..in both hospitals and private houses, let whoever is in charge keep this simple question in their head, not how can I always do this right thing myself, but how can I provide for this right thing to be always done.” Joey Ridenour, RN, MN, FAAN 4 arizona STATE BOARD OF NURSING Regulatory Journal Staff Directory ADMINISTRATION Joey Ridenour, RN, MN, FAAN Executive Director 602.889.5200 jridenour@azbn.gov Judy Bontrager RN, MN Associate Director-Operations & Licensing 602.889.5204 jbontrager@azbn.gov Norma Salter Administrative Assistant Accounting Technician 602.889.5211 nsalter@azbn.gov Valerie Smith RN, MS, FRE Associate Director Investigations/Compliance 602.889.5206 vsmith@azbn.gov HEARINGS Susan Barber, RN, MSN Nurse Practice Consultant-Hearing Dept 602.889.5161 sbarber@azbn.gov Pamela Randolph RN, MS Associate  Director Education & Evidenced Based Regulation 602.889.5209 prandolph@azbn.gov MaryPat Healey, RN, LNCC Legal Nurse Consultant mphealey@azbn.gov 602.889.5182 Lila Wiemann Administrative Assistant to the Executive Director 602.889.5202 lwiemann@azbn.gov Vicky Driver Admin. Assistant-Hearing Dept 602.889.5162 vdriver@azbn.gov Cristina Oates Administrative Assistant to Associate Director Operations/Licensing 602.889.5205 coates@azbn.gov INVESTIGATIONS NURSE PRACTICE CONSULTANTS Betty Nelson, RN, MS 602.889.5169 bnelson@azbn.gov ADVANCED PRACTICE Janeen Dahn, MSN, FNP-C Advanced Practice Nurse Consultant 602.889.5233 jdahn@azbn.gov Janeen Dahn, MSN, FNP-C Advanced Practice Nurse Consultant 602.889.5233 jdahn@azbn.gov Karen Grady, MS, RN, FNP, BC Advanced Practice Nurse Consultant 602.889.5218 kgrady@azbn.gov CANDO Connie Linck, RN, MN Nurse Consultant – CANDO 602.889.5170 602.889.5156 clinck@azbn.gov Olga Zuniga Administrative Secretary – Monitoring & CANDO 602.889.5157 ozuniga@azbn.gov EDUCATION Karen Gilliland Administrative Assistant 602.889.5187 kgilliland@azbn.gov Lila Van Cuyk, RN, BSN Nurse Practice Consultant/CNA Programs 602.889.5176 lvancuyk@azbn.gov 6 FISCAL SERVICES Randi Orchard Fiscal Services Manager 602.889.5210 rorchard@azbn.gov Jeanine Sage, RN, MSN 602.889.5174 jsage@azbn.gov Karen Grady, MS, RN, FNP, BC Complaints/Triage Coordinator 602.889.5218 kgrady@azbn.gov Mary Rappoport, RN, MN 602.889.5184 mrappoport@azbn.gov Nan Twigg, RN, MSN 520.615.4945 ntwigg@azbn.gov Sister Rachel Torrez, RN, MS 602.889.5180 srachel@azbn.gov Stephanie Nelson, RN, MS 602.889.5179 snelson@azbn.gov Sydney Munger, RN, MS 602.889.5186 smunger@azbn.gov arizona STATE BOARD OF NURSING Regulatory Journal Tammi Bymers, RN, MSN 601.889.5170 mbymers@azbn.gov V. Ann Schettler, RN, MHL, CLNC 602.889.5207 aschettler@azbn.gov SENIOR INVESTIGATORS Doug Parlin 602.889.5172 dparlin@azbn.gov Frank Curatola 602.889.5159 fcuratola@azbn.gov Kirk Olson 602.889.5171 kolson@azbn.gov Ron Lester 602.889.5178 rlester@azbn.gov Stoney Blair 602.889.6167 sblair@azbn.gov LEGAL SECRETARIES Barbara Melberg 602.889.5193 bmelberg@azbn.gov Dorothy Lindsey 602.889.5177 dlindsey@azbn.gov Esther Garcia 602.889.5173 egarcia@azbn.gov Jene Martinez jmartinez@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 bmelton@azbn.gov Donna Frye Fingerprints/Endorsements 602.889.5191 dfrye@azbn.gov Hazel Degrate Licensing Tech 602.889.5224 hdegrate@azbn.gov Helen Tay CNA Exam/Endorsements 602.889.5189 htay@azbn.gov Jennifer McWilliams RN/LPN Renewals 602.889.5195 jmcwilliams@azbn.gov Paula Delphy RN/LPN Endorsements 602.889.5192 pdelphy@azbn.gov Rhonda Rogers CNA.Renewals 602.889.5188 rrogers@azbn.gov MAILROOM Debra Kunkle 602.5215 dkunkle@azbn.gov MONITORING Michelle Mills, RN, MA Nurse Practice Consultant 602.889.5183 mmills@azbn.gov Dolores Hurtado Legal Assistant 602.889.5158 dhurtado@azbn.gov Brent Sutter Legal Secretary Monitoring & CANDO 602.889.5168 bsutter@azbn.gov RECEPTIONISTS Marlane Brosseau 602.889.5196 mbrosseau@azbn.gov Nancy Davis 602.889.5199 ndavis@azbn.gov Susan Kingsland 602.889.5221 skingsland@azbn.gov RECORDS Anne Parlin 602.889.5217 aparlin@azbn.gov FINAL REPORT: ARIZONA STATE BOARD OF NURSING ARIZONA MEDICATION TECHNICIAN PILOT PROJECT Introduction A sunrise report was filed in 2002 by the Arizona Association of Homes and Housing for the Aging and the Arizona Health Care Association requesting regulatory oversight of a medication technician pilot study. The legislature approved the pilot study concept outlined in the sunrise report, leading to the introduction and passage of legislation enacted for the pilot to be overseen by the Board of Nursing (Laws 2004 (2nd Reg. Session) Ch. 121). This law authorized the Board to establish a pilot program “to determine the impact to patient health and safety of allowing nursing assistants…and acting as pilot study medication technicians to administer medications under educational requirements and conditions prescribed by the board (Laws 2004, Ch. 121, section A).” With funding secured from non-governmental sources, the pilot study involved 6 long-term care facilities throughout the state. As discussed below, the pilot study produced positive results. Although the study included only a small number of participants, the results do suggest that when facilities have properly integrated medication technicians into the care delivery system, resident care improves because the work of the medication technicians frees up nurses to perform higher level tasks. The legislature enacted House Bill 2256 (2004) to determine the impact to patient health and safety when licensed nurses delegate medication administration to certified nursing assistants (CNAs) with additional education in medication administration. The bill made the Board responsible for developing protocols, prescribing the education, overseeing the project and preparing this report to the legislature by December, 2008. The legislation limited the pilot study to no more than six facilities. It 8 also incorporated patient safety-related measures including: prohibitions to keep facilities from requiring a nurse to delegate medication administration to medication technicians, prohibitions against medication technicians administering medications to unstable or subacute residents, prohibitions against a medication technician administering any medication by needle and other measures incorporated within the study. Steering Committee The Board formed a steering committee to oversee the project. Membership on the committee included stakeholders from long-term care facilities, the Arizona Board of Pharmacy, the Arizona Health Care Association, a professional association of skilled nursing facilities, the Arizona Association of Homes and Housing for the Aging, another professional association of residential facilities for the aged, the Arizona Nurses Association, the Southern AZ Nurses Coalition, and nursing education. The Steering Committee developed protocols regarding which medications could be delegated to a medication assistant. In addition to the prohibitions in the legislation, the Board approved the recommendations that certain medications and tasks associated with medications could not be delegated to a medication technician. The Board based the decision on whether the task would require the skill of a licensed nurse and whether the task had an increased potential for harm to residents. Tasks that could not be delegated included: • The first dose of a medication, • A medication requiring a complex mathematical conversion, • Inhalant medications, • Skin patches, • Vaginal medications, • Sublingual medications, arizona STATE BOARD OF NURSING Regulatory Journal • PRN or “as needed” medications with some exceptions for low risk medications. The Steering Committee then formed three subcommittees: Research, Education and Funding. The research subcommittee determined the research priorities and design of the Pilot Study. The funding subcommittee worked to secure funding to conduct the research. Finally, the education subcommittee developed course guidelines, curriculum, and contributed to a legally defensible competency exam. The Steering Committee reviewed all subcommittee actions and in turn, made recommendations to the Board for its approval. Research The Research Subcommittee and Steering Committee reviewed various indicators and approaches to research the safety of using medication technicians in order to compare patterns of medication errors before and six months after the use of medication technicians in selected facilities. The original sunrise legislation and HB 2256 identify safety of medication administration by medication technicians as the central issue to be explored by the Board. The Board also believed that participant satisfaction would be an important indicator of acceptance of the medication technician role. Therefore the pilot study was limited to these two indicators. The research subcommittee reviewed various methods to measure medication error. The subcommittee recommended the Flynn and Barker Naïve Observation Method2, the method recognized as the most valid and reliable for measuring medication error rates in health care settings. Under this approach, an observer watches and records each medication pass and then compares what the resident received to the medication ordered in the resident’s chart with no knowledge of the resident’s prescribed medications and without reviewing the administration record (MAR) during the observation. The Board decided to measure satisfaction using structured interviews of pilot program participants including medication technicians, delegating nurses and directors of nursing. . Funding At the outset, special note should be made that Kathleen Collins Pagels, Executive Director of the Arizona Health Care Association, proved to be the key in terms of obtaining the funding for this project. Without her leadership and the Arizona Health Care Association’s support, the study could not have been accomplished. pating in the Pilot Study. Given the small number of participating facilities and the possibility of diverse geographic locations, facility-based training proved to be the most feasible model to adopt. The subcommittee designed a 100 hour medication technician course consisting of 45 hours of didactic instruction, 15 hours of skill lab, and 40 hours of supervised medication administration to residents. The subcommittee created course guidelines and a curriculum. The curriculum consisted of basic pharmacology information and safe medication administration principles. Members of this subcommittee also wrote approximately 300 multiple-choice item for the state administered competency exam. The subcommittee also established a training program for all instructors. Scope of work After the establishment of the curriculum, research, and funding mechanisms, the Board and the Arizona Health Care Association issued a “Scope of Work” for a researcher to determine the impact to patient health and safety of allowing nursing assistants, who met requirements prescribed by the Board, to act as pilot study medication technicians and administer medications under specified conditions. In response to the Scope of Work, the Board hired D and S Diversified Technologies (DSDT), the current vendor for the Arizona certified nursing assistant exam, to conduct the research. In turn, DSDT hired Dr. Jill Scott-Cawiezell RN, Ph.D., a nationally recognized expert on medication delivery and error in long-term care facilities to serve as a consultant. DSDT also developed a standardized competency exam with both written and manual-skills portions based on the approved curriculum. The Board estimated that the research cost of the Pilot Study would total approximately $90,000. The Arizona Health Care Association contributed $30,000 seed money to the pilot study. St. Luke’s Health Initiatives approved a grant proposal for an additional $30,000. When no other funding option became available, the Board used the fee authorization contained in HB 2256 and collected $5000 from each of the facilities participating in the pilot study. Education Education Subcommittee members consisted of RN, LPN and CNA educators. The subcommittee reviewed course requirements in 19 states that allow for the delivery of medications by unlicensed persons under a licensed nurse’s delegation and supervision. The educational setting options considered by the subcommittee included community colleges or facilities partici- Site selection The steering committee developed criteria to select up to six sites to implement the pilot program. All long-term care facilities were sent invitations to a public meeting on September 20, 2005 to learn more about the project and the criteria for selection including the deadlines and time-frames for gathering data and submitting this report. The Board received seven applications, and of these, the Board approved the six facilities recommended by the steering committee: • Shadow Mountain (Scottsdale), • Good Shepherd (Peoria), • Mountain View (Tucson), • Heritage Health Care (Globe), • Copper Mountain Inn (Globe), • Silver Ridge Village (Bullhead City). The Board conducted its first training session with instructors in March 2006 with additional training sessions conducted in 2007. Silver Ridge Village became the first facility to implement continued >>> arizona STATE BOARD OF NURSING Regulatory Journal 9 training in April, 2006. All facilities had conducted at least one training session by July 2007. One facility (Heritage Health Care) dropped out of the pilot because it was unable to utilize medication technicians by October 1, 2007. Board staff visited all facilities during training, which included a specific education program directed at all delegating nursing staff of the facility. Testing With significant contribution from Board staff and the Education Subcommittee, DSDT developed an item pool for a written competency medication technician exam consisting of over 1200 items. The test pool contained 761 total active items with each exam consisting of 50 items distributed according to a Board approved test plan. The Education Subcommittee designed the test plan based on time allotted in the curriculum for each topic and the importance of each topic in terms of patient safety. Other states that draw from the item pool include Arkansas, Oklahoma, Montana, and Ohio. DSDT also developed a skills competency exam, using checkoff lists developed by the Education Subcommittee. Students in the pilot study received a limited number of chances to pass the test before being required to re-take the course. In total, 21 persons passed both the written and manual skills tests out of 32 total exam administrations. The skills exam proved less challenging than the written exam with 78% passing the skills exam on the first attempt and only 41% passing the written exam on the first attempt. All but one student passed the skills exam on the second attempt and 59% of takers passed the written exam on the second attempt. implementation by facilities All six participating facilities sent representatives to a 2-day “Train the Trainer” session held on March 3-4, 2006. The training sessions provided needed opportunities for participants in the pilot study 10 to discuss the unique features of the project, reinforce teaching-learning principles, including test construction, and augment the textbook adopted by the Board. Twenty five persons attended at least one of the two days with 17 persons attending both days. Evaluations were overwhelmingly positive for the training. Board staff visited all participating facilities during training, with five of the six facilities receiving two visits, one in the classroom portion, and one during the clinical practice. When visiting >>> the training programs, the following observations were made: • Remedial instruction was needed to help students develop basic algebra skills needed to calculate simple divided dosages (e.g. if a tablet contains 250 mg of a drug, how many tablets would you give if the order were for 500 mg?). Facilities received direc- • Instructors stated that teaching the course benefited them and updated their knowledge of pharmacology. Several facilities failed to implement the medication technician training within a year of attending the “Train the Trainer” course due to turnover of teaching personnel, lack of qualified CNAs, shortage of CNA coverage, and administrative changes at the facility. The Board offered an additional “Train the Trainer” session on March 1-2, 2007 and has conducted additional informal training sessions as needed to train new teachers. All facilities implemented training by July 1, 2007. Extensive training sessions will not be necessary in the future as the Board anticipates that textbooks geared to the medication technician role in long-term care facilities will soon be released 5, 6 and statutory and rule requirement for training will be well known. Additional the role of the licensed nurse remains critical to the management of the resident’s health and medications. tion about the need to screen for basic math ability but allowed students who failed testing to enter and continue in the program to encourage interest and participation. • Board staff discouraged facilities seeking to condense the program into consecutive 8-hour lecture/lab days. Program personnel stated that the students could only attend the classes if such a schedule were offered. • Nurses on the units, while initially skeptical, enthusiastically embraced the concept once implemented. They also appeared to be reassured by the Board’s presentation on “Delegation to Medication Technicians”. arizona STATE BOARD OF NURSING Regulatory Journal training needed to enhance instruction will be addressed at the Board’s annual conference for CNA instructors. All steering committee participants recommended that the current 80% passing standard for the CNA written exam remain in effect until additional data supports a change in the standard. One DON of a long-term care facility reported that her students did not initially take the exam seriously until the first failure. Once they studied and re-took the exam, most of them passed. One facility trained three persons, however only one person passed the exam and then left the facility before ever practicing as a medication continued >>> technician. Unfortunately, the Board had to drop this facility (Heritage Health Care) from the project due to their inability to implement the role in time to collect postimplementation data. The Steering Committee invited all pilot study participants to attend all steering committee meetings and offer their perspective. Some common themes include: • Difficulty Recruiting CNAs for the Role. Many facilities found that attract- 12 ing CNAs to the program presented more challenges than anticipated and that they needed to increase hourly wages and offer other incentives to gain participation. • CNA Shortages. Even with an adequate number of CNAs trained and qualified for the role, shortages of CNAs in the facility necessitated that they work primarily as CNAs rather than as medication technicians. • Positive Acceptance of Delegation to arizona STATE BOARD OF NURSING Regulatory Journal Medication Technicians. Nurses delegating to CNAs reported very positive results and experiences. In some facilities additional CNAs became attracted to the role after observing their colleagues functioning as medication technicians. • Positive Impact on Medication Administration by Nurses. The medication technicians discovered and reported unsafe medication practices and RN/ LPN medication errors. One facility changed its medication administration schedule in response to a medication technician’s concern that resident’s medications were inappropriately scheduled. The Board received a report, late in the project, that one of the participating facilities received a negative federal survey resulting in a sanction. A sanction prohibits the facility from conducting CNA training for two years (OBRA 87). The surveyors cited medication errors by both medication technicians and nurses but also found improper labeling by the pharmacist which contributed to the errors. One error involved a simple math miscalculation by the medication technician. Department of Health officials concluded that the sanction stemmed chiefly from a lack of evaluation for physical therapy services. Based on the recommendation of the steering committee, the Board decided to continue the facility’s participation in the project with monthly medication error audit reports to the Board. The facility submitted error-free reports, except for a single report concerning a medication technician found to have a high error rate. After retraining, the technician had errorfree reports. At present, a total of 21 qualified medication technicians continue to administer medications under the delegation of a licensed nurse in five long-term care facilities. Participating facilities want to continue to use medication technicians, but face the continuing challenge of CNA shortages, high staff turnover, and other fiscal constraints. Offering the program on a state-wide basis will solve some of the challenges that the participating facilities have faced. Further, a statewide program may lead recognized educational institutions to participate in training with a resultant increase in training opportunities, higher passing rates on the competency exam and less reliance on facility staff for training. Research Results as Reported by D and S Diversified Technologies4 This section contains a summary of the report from the researcher, DSDT. 1 to 23 years. All nurses interviewed indicated that despite some early misgivings about the new medication technician role, when they were able to partner with a PSMT, they had more time to work directly with the residents. Because of this, nurses reported feeling better about their resident care and assessments (p. 4). These findings closely align with another study7 that provides empirical evidence supporting the medication technician role in reducing job stress and increasing satisfaction among licensed nurses. Nurses reported that: ”The concept is fabulous; I now have more time to assess my residents and work with other staff. In the past, I felt stuck behind the med cart.” “…nurses are now more available.” “…it is hard when the techs aren’t here, they are good partners.” The medication technicians reported that it was their perception that nurses continued >>> Medication error rates Pre-implementation mean medication error rate of 10.4% (LPN, 10.12%; RN, 11.54%) were obtained. These rates are not statistically or clinically different for RN and LPN levels of licensure. Post-implementation observation revealed a mean medication error rate of 6.6% (LPN, 7.25%; RN, 2.75%; Medication Technician, 6.06%). Again, there were no statistical or clinically significant differences noted among the medication administrators based on credential. There were no statistically significant differences in either rate or pattern of error before or after the utilization of medication technician. While it appears that there was an actual lowering of the medication error rate, due to limited power of the study, the result is not considered significant. staff satisfaction Interviews of study participants from the five nursing homes after the post pilot study intervention data collection period allowed some insight into staff perceptions and acceptance of the project. Persons interviewed included Directors of Nursing (DONs), Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Pilot Study Medication Technician (PSMTs). The majority of respondents worked at least of 35 hours per week and ranged in experience from arizona STATE BOARD OF NURSING Regulatory Journal 13 • Speed comes with time, the key is being very careful. were spending more time with residents. However, medication technicians were affected by the delegating nurse’s acceptance of the role. “I had a very difficult time in my new role at first. My nurse was constantly looking over my shoulder and making me very nervous. I could not get the pass done. Now, I have a new partner and I love what I am doing. We work really well together. “(p. 4-5) One facility had a great deal of difficulty in securing adequate staffing to fully and consistently implement the medication technician role. Although nurses could see benefit from the addition of the role, they also reported frustration when medication technicians were not assigned as a partner. Medication technicians also functioned in additional roles along with their medication administration responsibilities. Some reported tailored shifts to maximize the medication administrations opportunities. All reported that they assisted other staff and residents when not administering medications. The informants clearly delineated the protocols regarding which medications could be passed by the medication technicians and which were the responsibility of the nurse. Nurses were sometimes challenged by the sharing of medication administration responsibility. However, it was reported that systems to track medications that require administration by a nurse (PRN narcotics, inhalers) were being developed and implemented. All informants, except one nurse who felt she pampered her residents, reported the residents were very happy with the addition of the medication technician role. “They miss her when she is gone, the resident keeps asking me where [she] is today.” “Residents are glad for the change; they don’t have to wait for their meds.”(p.5) Informants reported minimal changes to the medication 14 arizona STATE BOARD OF NURSING Regulatory Journal administration procedure. Many informants reported they believed there were fewer medication errors and a noticeable improvement in timely delivery of medications. (p.5) Informants provided recommendations and lessons learned during the pilot medication technician project. The recommendations include: • The timeframe for the training was too condensed. The training needs to be more spread out to allow time to study the critical concepts. • We need more medication technicians and they need to be consistently assigned to the role to improve and build systems. • Licensed staff would like to review the training so there can be consistent reinforcements for the medication technicians. The lessons learned include: • Speed comes with time, the key is being very careful. • I now understand why blood pressures are so important for the medication pass and I always double check them myself. Now I know why my nurse was always asking me what their blood pressure is. • PSMT add flexibility to staffing.” (p. 5-6) Conclusions Findings suggest that the introduction of medication technicians to the medication team in a long-term care facility will not negatively alter the rate or pattern of medication error. Significantly, an AHRQ funded medication safety study (ScottCawiezell et al., 20071; 20073) reached similar conclusions. In addition to the safety data presented, health care personnel consistently reported positive results with the addition of the medication technician to the healthcare team. In addition the study found no evidence that facilities replaced licensed nurses with medication technicians and no incidents of drug diversion by medication technicians. In short, the Arizona pilot study confirms earlier studies which indicate that medication technicians can provide safe medication delivery. However, the Board also recognizes that many factors remain to be addressed. Nursing home residents have many illnesses, take many medications, and therefore are vulnerable to subtle alterations in their medication regimens. Many of the medications delivered in a routine medication administration do require assessment for potential adverse effects. CNAs and medication technicians lack assessment skills and knowledge to make adjustments or watch for many potential changes that a resident may undergo, including adverse drug effects. Thus, as recognized in the sunrise report and the enactment of HB 2256, the role of the licensed nurse remains critical to the management of the resident’s health and medications. As stated by DSDT in its report: “Nursing homes have many challenges in the midst of very fiscally constrained budgets to provide safe care. Innovation and evidence must be a critical part of how care is delivered to this ever growing and very frail population. In an ideal world, the frail and vulnerable residents would have RNs providing all aspects of their care. However, in a fiscally constrained world, staff representing many levels of credentialing must be maximized to assure that care can be given. This study provides some initial evidence to suggest that medication technicians can be effectively used for routine medication administration. Understanding the limitations of the CMT/A (medication technicians) and creating medication systems that include the RN and the CMT/A as partners, could provide safe medication administration where residents get the right medication, at the right time, in the right dose, through the right route, and prepared in the right method to assure the most therapeutic result (Scott-Cawiezell, 2007a)” 4 (p. 6). Based upon their experience with the project and the results of the pilot study the Steering Committee recommends that: • Legislation be pursued to extend the role of the medication technician statewide; • All features of the pilot study remain including protocols, education, setting, and testing; • The time frame for the training be paced so students can better comprehend the material; • The role of the RN in delegation and medication management be specifically addressed; • That the Board collaborate with the Department of Health Services and other licensing boards in crafting legislation. references 1. Scott-Cawiezell, J., Pepper, G., Madsen, R., Petroski, G., Vogelsmeir, A., and Zellmer, D. (2007). Nursing home error and level of staff credentials. Clinical Nursing Research. Vol. 16, No. 1, 72-78. continued on page 22 arizona STATE BOARD OF NURSING Regulatory Journal 15 by Pamela Randolph RN, MS Regulation ASSOCIATE DIRECTOR/EDUCATION AND EVIDENCE BASED REGULATION Rundown Nurse Practice Act Changes Every five years, the Board considers what changes may need to be made to the statutes governing the Board of Nursing. The Board appointed approximately eighteen members from diverse positions and perspective to the Nurse Practice Act Steering Committee. The committee began meeting in September 2007 and was charged to review the relevance of current laws and to also identify potential regulatory barriers. The Board will be reviewing the committees recommendation at the November Board Meeting and will introduce changes in the 2009 legislative session. Potential substantive changes include: • An increase in the number of Board members. The Board currently has nine members. The proposed legislation expands the membership to 11 members, which is the average number of members on nursing boards throughout the country. The two new positions are for an advanced practice nurse and 18 a CNA or CNA educator. The Board currently regulates 4,090 advanced practice nurses and approximately 22,000 CNAs. • The authority to engage in innovative programs and projects. The Board received the authority to conduct a pilot study for the use of medication technicians in long-term care which was very successful in providing evidenced based policy and regulation (see report in this issue). The Board is seeking authority to engage in other studies relating to its mission and regulatory function. • Recognition of retirement status for licensed nurses. Since the advent of the practice requirement for maintaining a license, the Board has received requests for retirement status for nurses who no longer practice but wish to use their nursing licensure credentials (RN/LPN). Several other boards of nursing have a status which allows retiring nurses to retain the use of the title they have used for their career and preserves their sense of identity with the profession. • Issuing a modified license to a person with a disability. Currently, if a nurse has a disability and needs a modified license, the only way to issue one is with formal discipline. This option would allow a nurse in good standing to request a modified license based on a disability that limits his/her practice without a disciplinary finding. • Increasing the authority of the Executive Director (ED) to make decisions based on board policy and provide the board reports at their next scheduled meeting for information or final acceptance. Through the adoption of a substantial policy statement, the Board may authorize the ED to carry out certain functions where a timely decision either is low risk and of benefit to regulated parties or high risk and requires immediate action. Low risk situations and the arizona STATE BOARD OF NURSING Regulatory Journal rationale for transferring this authority to the ED include: o Approving CNA programs that meet Board standards to allow qualified CNA programs to start classes without awaiting a Board decision. o Dismissing cases without a basis or where there is no substantial evidence to support the allegation to save licensees with an unfounded complaint the anguish of awaiting a Board meeting. If the complainant wishes to address the Board, the complaint cannot be dismissed by the ED. o Issuing letters of concern to expedite dismissed complaints where there is sufficient concern about the conduct of the licensee to warrant a letter but not a violation of rule or statute. o Closing complaints resolved through mediation and settlement conference where the Board directs the ED regarding the discipline to be imposed and gives the ED the authority, within parameters set in policy, to set the terms. This expedites these complaints and places the licensee in monitoring whereby the public is further protected. o The other situation where a timely decision is needed to protect the public is when there is substantial evidence that a nurse is an imminent threat to the public health, safety and welfare and the nurse agrees to a suspension of practice. The proposed changes allow the ED to accept the agreement to suspend practice. • The ability to accept monies. This will allow the Board to more fully engage in research studies related to its mission and function. • The specific authority to provide education. The Board provides education to the regulated community and the continued on page 21 Education Corner: By Karen Grady, RN, MS, FNP How to Navigate the Board Web Site and Find the Resources You Need Whether you are a new or existing program, new or experienced faculty or administrator, or current or prospective student, there is a wealth of information available on the Board’s Web site that will allow you to avoid telephone tag or waiting for a call back. The Web site is easy to navigate once you understand the basics. For your convenience, a search option has recently been added to the top right hand corner of the home page. Using keywords such as Education Committee Meetings or NCLEX Reports should take you directly to the relevant pages. If this does not work for you or if you prefer to navigate via the links, most of the resources related to education can be found by placing your cursor over the Resources tab at the top of the home page which will open a drop-down menu. The drop-down menu list includes links to Committees, Educational Resources, NCLEX, the Nurse Practice Act, Board Meetings, and Advisory Opinions. Committees Under the Committees link, select Education Committee from the dropdown menu. On the Education Committee page, you will find links to the Meeting Schedule, the Policy on Submission of Materials to Education Committee, Meeting Agendas, and Meeting Minutes. Educational Resources Under Educational Resources, you will find links to Program Application Packets, Annual Reports from Arizona Prelicensure Nursing Education Programs, Nursing Education Programs 20 Approved by the Arizona State Board of Nursing, Refresher Courses, documents related to CNA education programs, and other documents that may be of interest to educators. NCLEX Here you will find the NCLEX Quarterly Reports, a summary of the Annual Statewide NCLEX Pass Rates, the NCLEX RN Detailed Test Plans, NCLEX Progress Reports, an FAQ for Candidates Who Failed NCLEX, and the AZBN Policy on Special Accommodations Requests for NCLEX. Nurse Practice Act Under the Nurse Practice Act, select the link to Rules. This will take you to the entire rules section of the Nurse Practice Act. Simply scroll down to Article 2, Arizona Professional and Practical Nursing Programs, to find R4-19-201206 and beyond. Board Meetings To find information about regularly scheduled Board meetings and to view the agenda, the Board Meeting link under the Resources tab will take you to the Board Meeting Calendar, Board Meeting Agenda, and to the Board Meeting Minutes which can be downloaded. Advisory Opinions The Advisory Opinions are listed alphabetically. An Advisory Opinion is an official opinion of the Arizona State Board of Nursing regarding the practice of nursing as it relates to a specific standard of care. The opinions most applicable to nursing programs/students are: • Preceptorship for Prelicensure Students • Supervision of Nurse Externs by Registered Nurse For information related to education not found on the Web site, contact arizona STATE BOARD OF NURSING Regulatory Journal Karen Gilliland at kgilliland@azbn.gov. Board Actions on Education Matters September 2008 • Accepted Emmanuel School of Nursing’s Plan of Correction as satisfactorily implemented and the identified deficiencies as corrected. • Received information on Pima Community College’s one-year final report and that deficiencies had been remedied. • Granted Provisional Approval to Pima Medical Institute-Tucson RN program with a report to the Board in 12 months and a site visit 12 to 18 months after admission of first class. • Granted Full Approval for three years to Apollo College. • Granted approval for ASU Geriatric Nurse Practitioner program. • Granted approval for Abrazo Health Care RN Refresher program. • Received Notice of Correction of Deficiency from Chamberlain College and removed deficiency status. • Reviewed information on NCLEX 2008 2nd quarter reports. • Reviewed notices of change in administrator for Pima Medical InstituteTucson, Maricopa Community College District Nursing Program, and Central Arizona College. Regulation Rundown continued from page 18 public on Board functions and processes. This statutory provision establishes a statutory basis for this important function and supports the ability of the Board to sponsor high-quality conferences and meetings. • Exempting advanced practice nursing students from certification. This provision provides a legal basis for advanced practice students to practice advanced practice nursing while in the clinical experiences in their approved program under supervision. • Exempting nurses from other states from licensure in low risk situations. This provision allows Arizona nurses to consult national experts without the excessive regulatory burden of requiring a license. The situations where this is allowed are where the nurse is: o Either teaching or consulting in Arizona, o Not supervising or providing patient care, and o Not engaged in the activity for more than six months in any calendar year. • Cheating. Additional provisions have been added requiring a licensing exam retake if there is evidence that the exam is compromised by cheating. • Obtaining records. A provision is added to increase the Board’s ability to obtain records pertinent to a complaint in a timely manner similar to the Arizona Medical Board and other health care professional boards. • A draft of proposed changes will be posted at a future date on the Board’s Web site for public comment and information following acceptance by the Board. Articles 1 and 4, R4-19-509, R4-19-814 This rulemaking is expected to be approved by the Governor’s Regulatory Review Council (GRRC) in December and effective in February. The Notice of Final Rulemaking can be obtained by accessing the Board’s Web site: www.azbn.gov under resources/proposed rules. The person to contact at the Board regarding regulation is: Pamela Randolph Associate Director Education and Evidence-based Regulation 602-889-5209 • Fax: 602-889-5155 E-mail: prandolph@azbn.gov arizona STATE BOARD OF NURSING Regulatory Journal 21 continued from page 15 2. Barker, K., Flynn, E., & Pepper, G. (2002). Observation method of detecting medication errors. Am.J.Health Syst. Pharm. Vol. 59, Dec. 1, 2002; 3. Scott-Cawiezell, J., Pepper, G., Madsen, R., Petroski, G. Vogelsmeier, A., & Zellmer D (2007b). Final Report: Technology to Improve Medication Safety in Nursing Homes, submitted to the Agency for Healthcare Research and Quality. 4. D & S Diversified Technologies (2008). Arizona Pilot Study Medication Technician Final Report, submitted to the Arizona State Board of Nursing on 6/13/08. 5. Personal communication from Sheila Sorrentino, Mosby Author, regarding current work on a medication technician textbook due for release in 2008 on or about August 11, 2008. 6. Sorrentino, S. and Remmert, L. (2009) Mosby’s Textbook for Medication Assistants. Mosby, Inc. 7. Walker, M. (2008). Effects of the Medication Nursing Assistant Role on Nurse Job Satisfaction and Stress in Long-Term Care. Nursing Administration Quarterly. Vol. 32, No. 4, pp 296-300. Persons Contributing to the PMST Project* Board Member Chairs Sharon Molleo, LPN Steve Roberston, LPN M. Hunter Perry, Public Member Board Staff Joey Ridenour RN, MN, Executive Director Pamela Randolph RN, MS, Associate Director of Education and Evidencebased Regulation Lila Van Cuyk, RN, BSN, Education Consultant Rose Wilcox, RN, M.Ed., Education Consultant Karen Gilliland, Legal Secretary Facility Representatives Armida Dixon/Karen Truett, Heritage Health Care Debbie Madrid/Paula Mitchell, Copper Mountain Inn 22 Sarah Ellis/Cathie Hauf, Good Shepherd Phyllis Jordan/Pat Collea/Regina Tutor, Silver Ridge Village Marie Montion/Jackie Arnett, Mountain View Barbara King/Annie Quarles, Shadow Mountain Committee Members 2004 Betty Earp RN, BSN, CNA Instructor Catherine Corbin, M.H.S., Arizona Department of Health Services Christine Walker, RN, NHA, Administrator, Kachina Point Dean Wright, R. Ph., Compliance Officer, AZ Board of Pharmacy Jane Black, RN, MS Southern Arizona Nurses Coalition John Durbin, Alzheimer’s Association Joyceen Boyle, RN, Ph.D., Associate Dean, University of Arizona Kathleen Collins-Pagels, Executive Director, Arizona Health Care Association Lindsey Norris, Executive Director, AZAHA Marla Weston, RN, MS, Executive Director, Arizona Nurses Association Mary Fermazin, MD, MPA, VP, Health Services Advisory Group Rose Pfefferrbaum, Ph.D, MPH, Director of Gerontology, Phoenix College Sarah Ellis, RN, DON, Good Shepherd Sue Macdonald RN, MS Director Cochise College Nursing Program Committee Members 2005 Betty Earp RN, BSN, CNA Instructor Catherine Corbin, M.H.S., Arizona Department of Health Services Christine Walker, RN, NHA, Administrator, Kachina Point Dean Wright, R. Ph., Compliance Officer, AZ Board of Pharmacy Debra Piluri, AZ Dept of Health Services Helen Houser, RN, Director of Gerontology, Phoenix College Jane Black, RN, MS, Southern Arizona Nurses Coalition John Durbin, Alzheimer’s Association Joyceen Boyle, RN, Ph.D., Associate Dean, University of Arizona Kathleen Collins-Pagels, Executive Director, Arizona Health Care Association Lindsey Norris, Executive Director, AZAHA arizona STATE BOARD OF NURSING Regulatory Journal Marla Weston, RN, MS, Executive Director, Arizona Nurses Association Mary Fermazin, MD, MPA, VP, Health Services Advisory Group Patt Rehn, RN, MS, Arizona Nurses Association Sarah Ellis, RN, DON, Good Shepherd Sue Macdonald RN, MS Director Cochise College Nursing Program Members 2006 Anna Marie McNeese, RN, Graduate student ASU Betty Earp RN, BSN, CNA Instructor Cheryl Roat RN, MS, Associate Dean, Grand Canyon University Christine Walker, RN, NHA, Administrator, Kachina Point Dean Wright, R. Ph., Compliance Officer, AZ Board of Pharmacy Debra Piluri, AZ Dept of Health Services Helen Houser, RN, Director of Gerontology, Phoenix College Jane Black, RN, MS, Southern Arizona Nurses Coalition Jo Podjaski, RN, MSN, Clinical Educator, Sun Health John Durbin, Alzheimer’s Association Julie Gordon, Executive Director, AZAHA Kathleen Collins-Pagels, Executive Director, Arizona Health Care Association Patt Rehn, RN, MS, Arizona Nurses Association Members 2007 Betty Earp RN, BSN, CNA Instructor Cheryl Roat RN, MS, Associate Dean, Grand Canyon University Christine Walker, RN, NHA, Administrator, Kachina Point Dean Wright, R. Ph., Compliance Officer, AZ Board of Pharmacy Debra Piluri, AZ Dept of Health Services Genny Rose, Executive Director, AZAHA Jane Black, RN, MS, Southern Arizona Nurses Coalition Jo Podjaski, RN, MSN, Clinical Educator, Sun Health John Durbin, Alzheimer’s Association Kathleen Collins-Pagels, Executive Director, Arizona Health Care Association Mary Griffith/Laurie House, Arizona Nurses Association Members 2008 Betty Earp RN, BSN, CNA Instructor Cheryl Roat RN, MS, Associate Dean, Grand Canyon University Christine Walker, RN, NHA, Administrator, Kachina Point Dean Wright, R. Ph., Compliance Officer, AZ Board of Pharmacy Debra Piluri, AZ Dept of Health Services Genny Rose, Executive Director, AZAHA Jane Black, RN, MS Southern Arizona Nurses Coalition John Durbin, Alzheimer’s Association Kathleen Collins-Pagels, Executive Director, Arizona Health Care Association Mary Griffith/Laurie House/Rory Hays, Arizona Nurses Association The following persons provided expert advice to the committee and the Board: Paul Dorrance/Chad Solis—D & S Diversified Technologies Jill Scott-Cawiezell, RN, Ph.D Ginny Pepper, RN, Ph.D Sue Roe, RN, Ph.D * While we have attempted to be inclusive in this list, we apologize for any inadvertent omissions arizona STATE BOARD OF NURSING Regulatory Journal 23 Arizona Board of Nursing Welcomes New Board Member Kathy A. Scott, RN, PhD, FACHE Governor Janet Napolitano recently appointed Dr. Kathy Scott to a five year term to the Arizona Board of Nursing. Dr. Scott is a healthcare executive and fellow in the American College of Healthcare Executives. She currently serves as the Regional Vice President of Clinical Services for Banner Health Arizona, providing leadership through the strategic direction, development and implementation of system-wide professional practice and clinical standards, new care-delivery models, integrative technology, nursing and health-care-system research, and clinical and team education/training for nursing and other professional disciplines. Dr. Scott has served in a variety of healthcare leadership roles for the past 20 years which include chief operation officer, chief nursing officer, national consultant, educator, researcher and author. She is a national leader in redesign of patient care delivery models, leadership development, and highreliability research and operational redesign to improve patient care. Dr. Scott currently serves in many capacities to advance the quality of health-care and the nursing profession including consultant to the National Council of State Boards of Nursing Practice Breakdown Committee; board member--Arizona State Board of Nursing; Adjunct Faculty--ASU Masters of Healthcare Innovations program, teaching Critical Thinking in Complex Systems course; board member and Past-President of the Arizona Organization of Nurse Executives; and chair-elect and board member of the Arizona Healthcare Institute Advisory Board. 24 arizona STATE BOARD OF NURSING Regulatory Journal Arizona Nurses Below • Nurse Exemplars 2008 Top Right • Jean Watson - 6 West Bottom Right • Jean Watson - 3rd Floor arizona STATE BOARD OF NURSING Regulatory Journal 25 Arizona State board of Nursing Job Opening EDUCATION PROGRAM ADMINISTRATOR POSITION There is an opening at the Arizona State Board of Nursing for a full-time Education Program Administrator. The position will involve conducting surveys and providing education and consultation to LPN, RN, and advanced practice nursing programs. Requirements include a master’s degree in nursing and at least 5 years experience as full-time faculty or director in a pre-licensure nursing program. The successful candidate will have exceptional written and oral communication skills, curriculum development and evaluation experience, classroom teaching expertise and effective time management. The position requires frequent travel within the state including overnight stays in rural areas. For more information, please contact Pamela Randolph RN, MS, Associate Director of Education and Evidence-based Regulation at 602-8895209 or prandolph@azbn.gov 26 arizona STATE BOARD OF NURSING Regulatory Journal *Not reported in previous Journal CNA Disciplinary Action JULY - AUG - SEPT 2008 effective date name certificate discipline violation(s) 10/1/2008 Anderson, Gloria K. CNA Applicant Certificate Denied Criminal Conviction; Misappropriation of Property; Fraud 9/15/2008 Anderson, Tracy R. CNA110555353 Revoked Substance Abuse; Failure to Meet Licensing Board Reporting Requirements; Criminal Conviction 9/15/2008 Bautista, Daniel P. CNA999991777 Revoked Patient Abuse; Fraud; Failure to Cooperate 8/22/2008 Bernal, Michael W. CNA Applicant Certificate Denied Criminal Conviction; Failure to Cooperate 9/15/2008 Blue, Debra D. CNA948304837 Revoked Failure to Comply Board Order; Substance Abuse; Failure to Cooperate 7/31/2008 Burnett, Tonya CNA999949756 Stayed Revocation w/ Civil Penalty Patient Abuse; Patient Neglect 8/15/2008 Burns, Deidre C. CNA1000001777 Revoked Failure to Comply Board Order 9/15/2008 Castro, Ladislado CNA999991351 Suspension Misappropriation of Property 9/19/2008 Cecilia, Emily V. CNA1000014373 Civil Penalty Unprofessional Conduct 8/15/2008 Chapley, David M. CNA1000003380 Civil Penalty Negligence; Substandard or Inadequate Care Substance Abuse; Practicing Beyond Scope 8/12/2008 Christophel, Nancy B. CNA182507904 Stayed Revocation 8/22/2008 Chupin Ventura, Veronica CNA999991755 Civil Penalty Fraud/Deceit; Failure to Cooperate 8/17/2008 Coker, Rochelle L. CNA295208043 Civil Penalty False Reports/Falsifying Records 9/15/2008 Colby, Brent D. CNA999998328 Revoked Violation of Fed/State Statutes/Rules; Failure to Meet Licensing Board Reporting Requirements; Criminal Conviction 7/28/2008 Patient Abuse; Substance Abuse Cunha, Sharon R. CNA1000006119 Stayed Revocation 9/23/2008 Daniel, Manuel E. CNA999993555 Voluntary Surrender Criminal Conviction; Failure to Cooperate 9/15/2008 Delucci, Michael J. CNA1000002319 Revoked Patient Abuse; Unprofessional Conduct 9/15/2008 Douglas, David B. CNA999998553 Revoked Criminal Conviction; Failure to Meet Licensing Board Reporting Requirements; Failure to Cooperate 7/29/2008 Dubuisson, Carmel CNA1000005684 Stayed Revocation 9/15/2008 Edwards, Malinda L. CNA999951135 Revoked Substandard or Inadequate Care Substance Abuse; Patient Neglect; Unprofessional Conduct 9/15/2008 Ervin, Mary A. CNA999997056 Revoked Patient Abandonment; Practicing Without Valid Certification; Practicing Beyond Scope 8/20/2008 Ferreira, Malia J. CNA1000008539 Patient Abuse 9/15/2008 Franklin, Chris N. CNA702896303 Revoked Criminal Conviction; Failure to Cooperate 9/15/2008 Gallegos, Uvaldo Q. CNA1000013266 Revoked Sexual Misconduct; Dual Relationship/Boundaries; Patient Abuse 9/15/2008 Garcia, Sharita M. CNA Applicant Certificate Denied Stayed Revocation Criminal Conviction; Substance Abuse; Failure to Cooperate 9/16/2008 Hansen, Brean J. CNA Applicant Certificate Denied Substance Abuse; Violation of Fed/State Statutes/Rules 8/26/2008 Harper, Rosemary CNA1000001792 Stayed Revocation Patient Abuse; Patient Neglect 9/15/2008 Hern, Timothy J. CNA999999521 Revoked Failure to Comply Board Order 8/28/2008 Hernandez, Rafaela I. CNA791599803 Civil Penalty 9/15/2008 Hilyard, Emily H. CNA999999783 Revoked 9/15/2008 Hines, Adell M. CNA999997903 Criminal Conviction Criminal Conviction; Substance Abuse; Failure to Cooperate Revoked Fraud; Criminal Conviction; Failure to Meet Licensing Board Reporting Requirements 7/23/2008 Hooks, Shavona R. CNA1000016498 Stayed Revocation Criminal Conviction; Substance Abuse 9/16/2008 Hoppe, Joseph CNA Applicant Certificate Denied Violation of Fed/State Statutes/Rules; Failure to Cooperate 9/4/2008 Hudson, Crystal J. CNA Applicant Certificate Denied Criminal Conviction; Unprofessional Conduct 8/19/2008 Hunsaker, Joshua D. CNA1000016956 Civil Penalty Criminal Conviction; False Reports/Falsifying Records 9/4/2008 Jenkins, Shujuan T. CNA1000011754 Civil Penalty Patient Abuse 9/15/2008 Kinney, James M. CNA1000006580 Revoked Misappropriation of Property; Criminal Conviction; Failure to Meet Licensing Board Reporting Requirements 8/15/2008 Civil Penalty Criminal Conviction Criminal Conviction; Violation of Fed/State Statutes/Rules; Failure to Cooperate Kitcheyan, Fernando A. CNA1000017033 9/15/2008 Koch, Christopher O. CNA Applicant Certificate Denied 9/12/2008 Lemon, Angela C. CNA999948721 Revoked Failure to Comply Board Order 9/18/2008 Leon, Norma I. CNA1000007499 Revoked Failure to Cooperate 9/16/2008 Lester, Marlana A. CNA Applicant Certificate Denied Substance Abuse; Violation of Fed/State Statutes/Rules; Failure to Cooperate arizona STATE BOARD OF NURSING Regulatory Journal 29 CNA Disciplinary Action *Not reported in previous Journal Continued JULY - AUG - SEPT 2008 effective date name certificate discipline violation(s) 9/18/2008 Louis, Emmett CNA Applicant Certificate Denied Violation of Fed/State Statutes/Rules; Misappropriation of Property 7/31/2008 Macdonald, Elizabeth A. CNA1000003581 Suspension Failure to Comply Board Order 8/9/2008 Maher, Jodi L. CNA1000012637 Civil Penalty Patient Abandonment 9/15/2008 Mchenry, Randy S. CNA1000007408 Revoked Dual Relationship/Boundaries; Sexual Misconduct; Unprofessional Conduct 8/21/2008 Mendivil, Karina CNA999992082 Civil Penalty Violation of Fed/State Statutes/Rules; Failure to Cooperate 9/16/2008 Miller, Jessica L. CNA Applicant Certificate Denied Substance Abuse; Criminal Conviction; Narcotics Violation or Other Violation of Drug Statutes 7/9/2008 Criminal Conviction; Failure to Cooperate Miller, Joseph F. CNA426485803 Certificate Denied 9/4/2008 Mori, Deloni A. CNA999999485 Voluntary Surrender Criminal Conviction; Misrepresentation of Credentials; Failure to Cooperate 10/2/2008 Ohaverty, Robin H. CNA999949637 Civil Penalty Substance Abuse 9/18/2008 Ortega, Armando CNA Applicant Civil Penalty Criminal Conviction 9/15/2008 Osuna, Iliana S. CNA1000007015 Revoked Criminal Conviction; Failure to Comply Board Order; Substance Abuse 8/20/2008 Pace, Edward B. CNA999952551 Voluntary Surrender Sexual Misconduct 8/29/2008 Paddock, Geraldine A. CNA1000016980 Civil Penalty Disciplinary Action Taken by any Licensing Authority; Failure to Cooperate 9/16/2008 Pemberton, Tyler J. CNA Applicant Certificate Denied Substance Abuse; Criminal Conviction; Failure to Cooperate 8/7/2008 Pozzi, Cathlena S. CNA999999389 Stayed Revocation Substance Abuse 8/5/2008 Rascon, Stephanie A. CNA999991015 Stayed Revocation w/ Fine Patient Abuse 8/15/2008 Robillard, Casey L. CNA1000016988 Civil Penalty Criminal Conviction 7/22/2008 Robinson, Charlotte M. CNA1000016497 Stayed Revocation Substance Abuse 8/12/2008 Ross, Wendy A. CNA1000014030 Stayed Revocation Substance Abuse 8/21/2008 Rowe, Rachel S. CNA Applicant Certificate Denied Violation of Fed/State Statutes/Rules; Narcotics Violation or Other Violation of Drug Statutes 7/7/2008 Sanchez, Steven CNA559161803 Stayed Suspension Criminal Conviction; Substance Abuse 8/8/2008 Sayer, Tiffani N. CNA999990687 Revoked Substance Abuse; Failure to Comply Board Order 7/28/2008 Schwartz, Rebecca S. CNA999996440 Stayed Revocation Substance Abuse; Patient Abuse; Unprofessional Conduct 9/23/2008 Schwartz, Rebecca S. CNA999996440 Revoked Failure to Comply Board Order 9/15/2008 Scrivano, Karen M. CNA999953351 Stayed Revocation Dual Relationship/Boundaries; Failure to Comply Board Order; Unprofessional w/ Suspension Conduct 7/1/2008 Shorb, Kenneth M. CNA1000002755 Stayed Revocation False Reports/Falsifying Records 9/15/2008 Smith-Warner, Eulalie CNA615401754 Revoked Dual Relationship/Boundaries; Exploiting a Patient for Financial Gain; False Reports/Falsifying Records 8/5/2008 Sosa Nunez, Angela CNA1000015171 Stayed Revocation w/ Civil Penalty Patient Abuse; Unprofessional Conduct 9/15/2008 Stizza, Chantal S. CNA999999793 Revoked Criminal Conviction; Misappropriation of Property; Fraud 9/1/2008 Sweeney, Tara P. CNA1000017380 Civil Penalty Patient Abuse; Misrepresentation of Credentials 8/5/2008 Taylor, Donna R. CNA878303403 Civil Penalty Practicing Beyond Scope 7/2/2008 Taylor, Luciana L. CNA427491103 Civil Penalty Violation of Fed/State Statutes/Rules; Criminal Conviction; Failure to Cooperate 8/25/2008 Tewayguna, Sonia K. CNA999993734 Stayed Revocation Substance Abuse 8/22/2008 Vick, Deborah K. CNA Applicant Certificate Denied Substance Abuse; Failure to Cooperate 3/31/2008* Whiten, Curtasca L. CNA1000015521 Stayed Revocation Criminal Conviction 9/23/2008 Whiten, Curtasca L. CNA1000015521 Revoked Failure to Comply Board Order 8/25/2008 Whitmore, Laura L. CNA999995069 Civil Penalty Practicing Beyond Scope 8/21/2008 Yazzie, Kimberly A. CNA1000005155 Civil Penalty Patient Abuse 9/16/2008 Yazzie, Lucinda M. CNA Applicant Certificate Denied Criminal Conviction; Violation of Fed/State Statutes/Rules; Failure to Cooperate 9/12/2008 Yazzie, Vernita CNA1000003056 Civil Penalty Criminal Conviction; Substance Abuse; Failure to Cooperate 7/8/2008 Zastrow, Brenda K. CNA Applicant Certificate Denied Criminal Conviction; Failure to Cooperate 30 arizona STATE BOARD OF NURSING Regulatory Journal CNA Discipline ACTION CLEARED April-May-June 2008 effective date name LICENSE 7/29/2008 Perez, Julius A. CNA999996346 9/17/2008 Effiong, Edidiong E. CNA999997703 8/13/2008 Decore, Sandra M. CNA1000013354 9/17/2008 Vanderplas, Adrienne R. CNA999995508 7/9/2008 Montano, Olivia Y. CNA999997789 7/29/2008 Van Looy, Christel M. CNA392123113 RN/LPN Disciplinary Action *Not reported in previous Journal JULY - AUG - SEPT 2008 effective date LICENSE discipline 7/9/2008 Aemisegger, James R. name RN Endorsement License Denied Patient Abuse, Unprofessional Conduct violation(s) 8/27/2008 Alden, Jodi L. RN102459 Voluntary Surrender Failure to Comply Board Order, Criminal Conviction, Fraud 6/11/2008* Allen, Sandra E. RN118216 Probation 9/2/2008 Altman, Teresa W. RN Endorsement Substance Abuse License Denied Disciplinary Action Taken by any Licensing Authority 8/23/2008 Andro, Marianne S. RN065335 Decree of Censure Practicing Beyond Scope, False Reports/Falsifying Records 7/10/2008 Armbrust, Eva M. RN000099592 Decree of Censure w/ Civil Penalty Criminal Conviction, False Reports/Falsifying Records, Substandard or Inadequate Care 7/18/2008 Ash, Doris B. RN063856 Voluntary Surrender Failure to Comply Board Order 7/28/2008 Austin, Shirley G. LP026550 Probation 9/23/2008 Banchy, Annette J. RN057843 Civil Penalty Practicing Without Valid License 9/12/2008 Barnhart, Malisa S. RN145630 Revocation Substandard or Inadequate Care Unprofessional Conduct, Narcotics Violation or Other Violation of Drug Statutes, Diversion of Controlled Substance 8/22/2008 Barton, Marvin RN124273 Revocation Failure to Comply Board Order 7/31/2008 Bates, Amy L. RN134521 Stayed Revocation w/ Probation Failure to Comply Board Order, Substance Abuse 8/18/2008 Behrends, Jason A. LP041192 Decree of Censure Error in Administering Medication 9/12/2008 Bennett, Janice F. RN078710 8/12/2008 Bigley, Karla A. RN116064 Voluntary Surrender Disciplinary Action Taken by any Licensing Authority, Unable to Practice Revocation Failure to Comply Board Order, Unable to Practice - Substance Abuse Substance Abuse, Diversion of Controlled Substance 8/8/2008 Bolinger, Connie A. RN114839 9/3/2008 Bolton, Pamela S. RN154233 Probation Criminal Conviction, Fraud/Deceit - License/Credentials, Substance Revocation Patient Abuse, Substandard or Inadequate Care Abuse 9/12/2008 Boniella, Joseph M. LP038899 Revocation Unable to Practice Safely, Failure to Maintain Records, Failure to Cooperate with Board 7/9/2008 Bouis, John LP Endorsement License Denied Violation of Fed/State Statutes/Rules, Narcotics Violation or Other Violation of Drug Statutes, Failure to Cooperate with Board 9/12/2008 Bustillos, Ryan E. LP040705/ Revocation Failure to Comply Board Order, Narcotics Violation or Other Violation of CNA155700441 Drug Statutes 8/27/2008 Campbell, Hallie C. RN154101 Suspension/Indefinite Disciplinary Action Taken by any Licensing Authority, Criminal Conviction, 7/16/2008 Castelhano, Sarah A. 32 RN134520 Unable to Practice - Substance Abuse Revocation Failure to Comply Board Order, Unable to Practice - Substance Abuse arizona STATE BOARD OF NURSING Regulatory Journal RN/LPN Disciplinary Action *Not reported in previous Journal JULY - AUG - SEPT 2008 effective date name LICENSE discipline 9/12/2008 RN052464 Christmann, Patricia A. violation(s) Revocation Failure to Meet Licensing Board Reporting Requirement, Criminal Conviction, Failure to Cooperate with Board 8/7/2008 Colon Segarra, Kelly A. LP041322 Decree of Censure Practicing Beyond Scope 9/17/2008 Cracraft, Patricia K. RN069056 Civil Penalty Violation of Fed/State Statutes/Rules, Criminal Conviction, Fraud/Deceit - License/Credentials 9/17/2008 Crawford, Susan R. RN115472 Probation Criminal Conviction, Unprofessional Conduct, Substance Abuse 9/2/2008 Davis, John D. RN129018 Revocation Failure to Comply Board Order 4/28/2008* Day, Jared A. LP Exam License Denied Failure to Comply Board Order, Unable to Practice - Substance Abuse 9/18/2008 Dean, Jennifer A. RN127746 Voluntary Surrender Failure to Comply Board Order 7/8/2008 DeBruyne, David B. RN153293 Civil Penalty Criminal Conviction, Failure to Cooperate with Board 8/18/2008 Digiacomo, Jennifer M. RN137637 Voluntary Surrender Unable to Practice - Substance Abuse, Diversion of Controlled 7/28/2008 Dixon, Debra S. RN119800 Substance Voluntary Surrender Failure to Comply Board Order 8/18/2008 Fidler, Frederick L. LP033544 Decree of Censure w/ Civil Penalty Submitting False Claims 9/2/2008 Fijalka, Rayell M. RN121561 Suspension/Indefinite Unable to Practice Safely, Substandard or Inadequate Care, Failure to Maintain Records 9/8/2008 Finley, Merry Ann LP Endorsement License Denied Unable to Practice - Psych/Mental 9/18/2008 Gentner, Kevin K. RN108292 Revocation Unprofessional Conduct, Unable to Practice - Substance Abuse 7/9/2008 Gorski, Carl J. RN085409 Revocation Failure to Comply Board Order 8/9/2008 Hannasch, Joseph G. RN079732 Decree of Censure Practicing Beyond Scope 8/15/2008 Hanner, Colleen E. RN095369 Decree of Censure Practicing Beyond Scope 9/12/2008 Harjo, Christie D. LP039371 Revocation Failure to Comply Board Order, Unable to Practice - Substance Abuse, Failure to Cooperate with Board 9/22/2008 Harlan, Sherry A. RN102537 Revocation Failure to Comply Board Order, Unable to Practice - Substance Abuse 9/12/2008 Hastings, Kerry Lynn RN105992/ Revocation Unable to Practice - Substance Abuse, Failure to Cooperate with Board License Renewal Denied Disciplinary Action Taken by any Licensing Authority, Failure to LP032715 9/5/2008 LP024667 Hermiston, Patricia M. Cooperate with Board 9/13/2008 Higginbotham, Shawn M. RN148332 Decree of Censure Unable to Practice Safely, Substandard or Inadequate Care 8/30/2008 Hill, Brenda Y. LP023929 Decree of Censure Failure to Consult or Delay in Seeking Consultation with Supervisor/ Proctor, Failure to Maintain Records 9/12/2008 Substandard or Inadequate Care, Error in Administering Medication, Hilton, Ethel J. LP042140 Revocation Failure to Cooperate with Board 9/12/2008 Hinske, Linda J. RN059168 Revocation Failure to Comply Board Order, Unable to Practice Safely 8/12/2008 Hodges, Katherine L. LP034290 Decree of Censure Failure to Consult or Delay in Seeking Consultation with Supervisor/ 6/27/2008* Horney, Melody L. LP036900 Proctor Suspension Failure to Comply Board Order 9/12/2008 Hosick, Alice A. LP021403 Revocation Unprofessional Conduct, Fraud, Failure to Cooperate with Board 8/25/2008 Irvine, Rachel D. LP044863/ Civil Penalty Criminal Conviction Practicing Beyond Scope CNA1000017213 8/15/2008 Ishie, Catherine M. LP029637 Decree of Censure 8/22/2008 John, Philipose J. RN144697 Civil Penalty False Reports/Falsifying Records 6/21/2008* Johnson, Danette L. RN154190 Probation w/ Civil Penalty Practicing Without Valid License, Fraud/Deceit - License/Credentials 7/28/2008 Jurow, James RN107786/AP0075 Voluntary Surrender Unable to Practice Safely, Substandard or Inadequate Care 8/5/2008 Kasten, Nancy A. RN051764 Decree of Censure Practicing Beyond Scope 7/11/2008 Kaufman, Sally C. RN123997 Probation Substandard or Inadequate Care, Failure to Maintain Records, Failure to Cooperate with Board 7/28/2008 Disciplinary Action Taken by any Licensing Authority, Monitoring for Knight, Susan F. RN153649 Probation relapse prevention therapy/counseling 9/15/2008 Kohlerman, Nancy R. RN101222/ AP2558 Civil Penalty Criminal Conviction 7/28/2008 Lakatosh, Sarah A. RN126060 Decree of Censure Criminal Conviction, Fraud 8/14/2008 Lawrence-Andrade, Kelly J. RN095241/ LP030404 Probation Substance Abuse 7/28/2008 Lee, Vicki K. Suspension Substandard or Inadequate Care, Incompetence RN131699 arizona STATE BOARD OF NURSING Regulatory Journal 33 *Not reported in previous Journal RN/LPN Disciplinary Action JULY - AUG - SEPT 2008 effective date name LICENSE discipline violation(s) 5/16/2008* Leek, Tian N. LP042691 Civil Penalty Violation of Fed/State Statutes/Rules 9/17/2008 Lesch, Rachael A. RN Endorsement Civil Penalty Practicing Without Valid License 8/21/2008 Lewallen, Bonnie J. RN104566 Decree of Censure Practicing Beyond Scope, Substance Abuse 8/13/2008 Mabansag, Liza Marie A. RN128998 Civil Penalty False Reports/Falsifying Records 8/29/2008 Majewski, John R. LP038295 Revocation Failure to Comply Board Order 8/20/2008 Martinez, Patricia A. RN069641 Stayed Revocation/Suspension w/ Civil Penalty 7/1/2008 Voluntary Surrender McCormack, Kimberly M. LP042423/ Unable to Practice - Substance Abuse Unable to Practice - Substance Abuse, Diversion of Controlled CNA999995781 Substance 8/11/2008 McElvain, Kerstin A. RN154705/LP039812 Probation Criminal Conviction; Substance Abuse 12/26/2007* Meek, Steve H. CRNA Applicant Certificate Denied Denial of CRNA Prescribing Authority; Revocation of Privilege to Practice 8/28/2008 Mettler, Stefan B. RN154147 Probation Disciplinary Action Taken by any Licensing Authority 7/23/2008 Milliken, Cynthia G. RN148429 Suspension/Indefinite Criminal Conviction, Substandard or Inadequate Skill Level 8/27/2008 Molina Jr., William M. RN128359 Voluntary Surrender Criminal Conviction 8/25/2008 Montgomery, Kelly S. RN122001 Decree of Censure Patient Abandonment 9/17/2008 Moore, Barbara E. TRN154337 Civil Penalty Practicing Without Valid License 8/22/2008 Muir, Bryan K. LP044840 Probation Criminal Conviction 9/5/2008 Munoz, Simon M. RN120517 Probation Substandard or Inadequate Care 7/28/2008 Neufeldt, Greg S. RN133097 Voluntary Surrender Disciplinary Action Taken by any Licensing Authority, Failure to Comply Board Order, Fraud 8/22/2008 Stayed Revocation Unable to Practice - Substance Abuse, Unauthorized Administration w/ Suspension of Medication, Diversion of Controlled Substance 9/22/2008 Voluntary Surrender Failure to Comply Board Order 34 Noyes, Terri M. Nyman, Shawn E. RN118730/LP025229 RN137730 arizona STATE BOARD OF NURSING Regulatory Journal RN/LPN Disciplinary Action *Not reported in previous Journal JULY - AUG - SEPT 2008 effective date name LICENSE discipline violation(s) 9/19/2008 Oden, Remitha K. LP040622 Probation Substance Abuse 8/24/2008 Oleksy, Roxann E. RN088056 Decree of Censure Practicing Beyond Scope 8/28/2008 Ortiz, Denise M. RN134601 Voluntary Surrender Immediate Threat to Health or Safety, Unable to Practice - Substance Abuse 7/28/2008 Page, Brenda L. RN152333 Civil Penalty Practicing Without Valid License 9/5/2008 Pauquette, Karen M. RN Endorsement License Denied Disciplinary Action Taken by any Licensing Authority, Unable to Practice - Substance Abuse, Failure to Cooperate with Board 9/12/2008 Immediate Threat to Health or Safety, Unable to Practice Safely, Failure Peltier, Debra J. RN116186 Revocation to Cooperate with Board 9/17/2008 Pence, Shannon M. LP044919 Civil Penalty Practicing Without Valid License 6/17/2008* Penwell, Justin RN Endorsement License Denied Criminal Conviction, Unprofessional Conduct 7/10/2008 Petersen, Theresa K. RN Endorsement License Denied Criminal Conviction, Unprofessional Conduct, Fraud/Deceit - License/ Credentials 6/10/2008* Pierce, Donald L. RN087054/AP0638 Decree of Censure w/ Civil Penalty False Reports/Falsifying Records 8/18/2008 Pogue, Stephanie J. LP037769 Decree of Censure Practicing Beyond Scope 9/5/2008 Ponikvar, Joseph F. RN Endorsement License Denied Unable to Practice Safely, Substandard or Inadequate Skill Level, 7/8/2008 Pratt, Robin L. RN095139 Incompetence Voluntary Surrender Failure to Consult or Delay in Seeking Consultation with Supervisor/ Proctor, Improper Delegation/Supervision 9/24/2008 Unable to Practice - Substance Abuse, Failure to Maintain Records, Pryor, Terrie L. RN128910 Voluntary Surrender Diversion of Controlled Substance 8/29/2008 Rasdall, Kathleen M. Substance Abuse 7/30/2008 Reumann-Linam, Sharon K. RN110535 Revocation Failure to Comply Board Order 8/19/2008 Richardson, Joan LP034919 Voluntary Surrender Fraud/Deceit - License/Credentials 9/16/2008 Richins, Anita RN Endorsement License Denied Criminal Conviction, Failure to Cooperate with Board Unprofessional Conduct, Fraud/Deceit - License/Credentials LP041343 Decree of Censure 8/20/2008 Ricker, Cynthia A. RN049353 Probation 9/19/2008 Robbins, Cathy C. RN065672 Probation Substance Abuse 7/28/2008 Rodie, Sondra S. RN079561 Decree of Censure Unauthorized Dispensing of Medication, Error in Administering Medication 8/13/2008 Substandard or Inadequate Care, Failure to Maintain Records, Error in Rodriguez, Frank RN096120 Decree of Censure Administering Medication 9/12/2008 Royalty, Michelle D. LP037430 Revocation Criminal Conviction, Fraud, Failure to Cooperate with Board 8/20/2008 Samson, MaryAnn D. T. RN138279 Decree of Censure Failure to Maintain Records, Narcotics Violation or Other Violation of 9/4/2008 Sanders, Ruth D. Drug Statutes RN063927/AP1151/ AP328 Probation Failure to Maintain Records, Narcotics Violation or Other Violation of LP011147 Drug Statutes, Diversion of Controlled Substance 9/5/2008 RN Endorsement Unable to Practice - Substance Abuse, Unable to Practice Safely, Santillo, Lynn M. License Denied Substandard or Inadequate Care 8/19/2008 Schmid, Douglas I. RN065880 Voluntary Surrender Violation of Fed/State Statutes/Rules, Criminal Conviction 8/21/2008 Seeman, Virginia S. RN031648/AP0023 Decree of Censure Unauthorized Prescribing Medicine w/ Civil Penalty 9/18/2008 Shockley, Linda L. RN041667 Revocation Unable to Practice - Substance Abuse, Failure to Cooperate with Board 9/2/2008 Smith, Holly K. LP043727 Probation Substance Abuse 9/21/2008 Smith, Natalie A. RN154643 Civil Penalty Criminal Conviction 11/6/2007* Sobel, Daren B. RN Endorsement License Denied Criminal Conviction, Unable to Practice - Substance Abuse, Diversion of Controlled Substance 7/9/2008 Soch, Susan M. RN149279 Voluntary Surrender Substandard or Inadequate Care 8/13/2008 Stafford, Bobbie R. RN120515/SN0970/ Voluntary Surrender Unable to Practice - Substance Abuse, Diversion of Controlled LP037222 Substance 8/5/2008 RN103958 Substandard or Inadequate Care 36 Stanley-Holsten, Joan Decree of Censure arizona STATE BOARD OF NURSING Regulatory Journal RN/LPN Disciplinary Action *Not reported in previous Journal JULY - AUG - SEPT 2008 effective date name LICENSE discipline violation(s) 9/8/2008 Stevens, Dorothea B. RN035543 Probation Criminal Conviction, Unprofessional Conduct 9/12/2008 Stewart, Stacey L. TRN109576/ Revocation Unable to Practice - Substance Abuse, Failure to Cooperate with Board Criminal Conviction CNA742646641 8/29/2008 Studi, Melyssa J. LP039066 Civil Penalty 7/28/2008 Stump, Virginia RN109792 Probation Unprofessional Conduct, Unable to Practice Safely, Error in Administering Medication 7/2/2008 Stayed Revocation Unable to Practice - Substance Abuse, Diversion of Controlled Tawzer, Jeff G. RN134222 w/ Suspension Substance 7/28/2008 Teets, Pamela R. TRN107237/LP031467 Stayed Revocation w/ Suspension Unable to Practice - Substance Abuse, Failure to Maintain Records 8/8/2008 Tipton, Leona B. LP024898 Decree of Censure Practicing Beyond Scope 7/31/2008 Tosh, Ann Marie RN087259 Revocation Failure to Comply Board Order 9/17/2008 Van Keulen, Anna A. RN154024 Civil Penalty Practicing Without Valid License 7/29/2008 Van Vactor, Janeen D. RN152250 Civil Penalty Practicing Without Valid License 7/29/2008 Webb, Michael J. RN152274 Civil Penalty Practicing Without Valid License 9/26/2008 Weldon, Diane E. LP041884 Decree of Censure False Reports/Falsifying Records 6/20/2008* Wilkins, Gregory RN128674 Civil Penalty Violation of Fed/State Statutes/Rules, Unprofessional Conduct 9/12/2008 Williams, Carol E. RN10375/LP033133 Decree of Censure Practicing Beyond Scope 9/5/2008 Wilson, Dwayne L. RN051411 License Renewal Denied Disciplinary Action Taken by any Licensing Authority, Fraud/Deceit - License/Credentials, Unable to Practice Safely 9/17/2008 Unprofessional Conduct, Substandard or Inadequate Care, Substandard Winikates, David M. RN117796 Probation or Inadequate Skill Level 9/2/2008 Woodall, Kristin A. RN119409 Revocation Failure to Comply Board Order, Criminal Conviction 9/12/2008 Woodard, Shelia Mae RN126757 Revocation False Reports/Falsifying Records, Unable to Practice Safely, Failure to Cooperate with Board 7/28/2008 Immediate Threat to Health or Safety, Narcotics Violation or Other Yenglin, Jonathan A. RN141351 Summary Suspension Violation of Drug Statutes, Diversion of Controlled Substance 9/4/2008 Immediate Threat to Health or Safety, Narcotics Violation or Other Yenglin, Jonathan A. RN141351 Voluntary Surrender Violation of Drug Statutes, Diversion of Controlled Substance UPDATED LICENCURE STATUS RN-LPN SUBJECT TO A BOARD ORDER/CONSENT AGREEMENT JULY - AUG - SEPT 2008 effective date name LICENSE 8/20/2008 LP037609 DeMattia, Arlene C. Stayed Revocation w/ Probation Completed terms of the Stayed Revocation Suspension, converted license to Stayed Revocation Probation 8/20/2008 Completed terms of Indefinite Suspension, converted Milliken, Cynthia G. RN148429 Stayed Revocation w/ Probation license to Stayed Revocation Probation 8/22/2008 Completed terms of Indefinite Suspension, converted Mytczynsky, Megan S. RN123625 Stayed Suspension w/ Probation license to Stayed Suspension Probation 9/8/2008 Completed terms of Indefinite Suspension, converted Paccioni, Taryn W. RN083610 Stayed Revocation w/ Probation license to Stayed Revocation Probation arizona STATE BOARD OF NURSING Regulatory Journal 37 RN-LPN Discipline ACTION CLEARED JULY - AUG - SEPT 2008 38 effective date name LICENSE 9/8/2008 Carden, Betsy RN120373 9/18/2008 Castillo, James RN093848 7/29/2008 Fiocchi, Julio F. LP043267 7/21/2008 Helmrich, Anne F. RN047458 9/5/2008 Johnson, Aileen N. RN042448 9/6/2008 Kish, Suzanne M. RN112540 7/29/2008 Lind, Shari A. RN080709 9/11/2008 Luedke, Shea A. LP028484 8/26/2008 Medford, Wendy RN115980 8/13/2008 Nelch, Bruce F. RN131549/LP039292 8/3/2008 Pranke, Kristi A. RN071157 9/21/2008 Robison, Amy T. RN135542/LP039398 8/26/2008 Shoemaker, Kimberly A. LP036554 8/22/2008 Sokolowski, Paul S. RN135203 8/14/2008 Whitson, Leah S. RN104266 arizona STATE BOARD OF NURSING Regulatory Journal