arizona vol4 • No3 • SEPT 2009 3rd Quarter state board of nursing Regulatory Journal The Importance of HIPAA for Nurses New and Old Public Policy Changes Impacting Arizona Nurses Summary of Changes to Arizona Nursearizona Practice Act: Senate Bill 1105 STATE BOARD OF NURSING Regulatory Journal 1 vol 4 • N o 3 • SEPT 2009 3rd Quarter Published by Arizona State Board of Nursing 4747 North 7th Street, Suite 200 Phoenix, AZ 85014-3653 Phone: 602.771.7800 Main fax: 602.771.7888 CANDO fax: 602.771.7882 General e-mail: arizona@azbn.gov Website: www.azbn.gov GOVERNOR The Honorable Janice K. Brewer Joey Ridenour, RN, MN, FAAN Executive Director Judy Bontrager, RN, MN Associate Director/Operations Valerie Smith, RN, MS, FRE Associate Director/ Investigations/ Compliance Pamela Randolph, RN, MS Associate Director/Education & Evidence Based Regulation BOARD MEMBERS Kathy Malloch, RN, MBA, PhD, FAAN President Patricia A. Johnson, LPN Vice-President M. Hunter Perry Secretary Denise Link, RNP, PhD, CNE, FNAP Member Karen Hodges Hardy, RN, MSN Member Kathy Scott, RN, MPA, PhD, FACHE Member Steven T. Robertson, LPN, CHPLN Member Kathryn L. Busby, J.D. PUBLIC Member 4 From the Executive Director: New and Old Public Policy Changes Impacting Arizona Nurses 6 From the Board President: Evidence: Firm Grounding in Turbulent Times 9 Summary of Changes to Arizona Nurse Practice Act: Senate Bill 1105 14 The Importance of HIPPA for Nurses 16 Education Corner: Program Complaint/ Investigation Process arizona 19 edition 1 5 2010 Seventh Annual CNA Education Retreat state board of nursing Regulatory Journal 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 20 22 24 CNA Corner CNA Disciplinary Actions RN/LPN Disciplinary Actions arizona STATE BOARD OF NURSING Regulatory Journal 3 F r om the Ex e c uti v e Di recto r Joey Ridenour, RN, MN, FAAN New and Old Public Policy Changes Impacting Arizona Nurses As many of you are aware, the Arizona State Board of Nursing Omnibus Legislation sponsored by Sen. Carolyn Allen, was signed into law on July 13, 2009. Sen. Allen, Greg Harris, the governor’s office and the Nurse Practice Act Steering Committee are to be recognized for their leadership and perseverance in successfully having this legislation passed during a turbulent 2009 legislative session. The healthcare community has a deep respect and appreciation for the patient advocacy role Sen. Allen has played in Arizona over the many years and extends special thanks for her leadership in ensuring health policy is relevant to the needs of Arizona citizens in the 21 st century. Implementation of Senate Bill 1105 will go into effect 90 days from the time of the signing of the bill. As shared with you in the Jan. 2009, edition of the AzBN Regulatory Journal, there are basically 14 substantive public policy changes as found on page 9. Three examples are: 1. Increased board members from nine to 11 to allow representation by two regulated groups not previously represented on the board: advanced practice nurses and certified nursing assistants. 2. Expanded executive director delegated duties to include closure of investigative cases that are without merit thus reducing the cycle time of low risk or no risk cases. 3. Allows the Board to conduct pilot programs to collect research to support evidenced based regulation and informed policy changes. The other area of public policy interest that impacts you relates to the passage of the Health Insurance Portability & Accountability Act (HIPAA) enacted by Congress in 1996 and formally implemented in 2003 by the Department of Health & Human Resources. The Los Angeles Times last year reported HIPAA violations when health care workers accessed the electronic medical records of celebrities Britney Spears and Farrah Fawcett out of curiosity without any legitimate purpose. A number of employees were terminated when it was determined they did not need to know the confidential information. In July 2009, three employees of St. Vincent Medical Center, Little Rock, Ark., pled guilty to misdemeanor federal charges when they inappropriately accessed the medical records of a television anchor that was slain in Oct. 2008. The physician stated he was at home and logged in to determine if the news reports were accurate. 4 arizona STATE BOARD OF NURSING Regulatory Journal Another employee logged in up to 12 times without legitimate purpose. Each faces a maximum penalty of one year in prison and fine up to $50,000 or both. Penalties for HIPAA violations in some instances may include fines up to $250,000 and imprisonment up to 10 years for knowing misuse of individual identifiable health information. According to author Ann W. Latner, JD in an Oct. 2008, article downloaded from http://www.renalandurologynew. com, “more than 34,000 complaints of privacy violation have been filed. About 80 percent were resolved and simply dismissed due to the corrective actions taken.” According to Latner, about 400 unresolved cases have been referred to the federal Department of Justice and a handful been prosecuted.” She further states that the low prosecution rate is likely to change as violations are taken more seriously and the government gears up for these types of cases. Latner also referenced a staff nurse who faces jail time for HIPAA violations when she accessed a patients medical records, gathered information and provided that information to someone else, knowing that it would be used in a way that would be harmful to the patient. The Board staff was recently asked: “What are the HIPAA violations in regards to patient identifiers?” Please be aware of your facilities HIPAA policies. According to one privacy officer, examples of HIPAA patient identifiers are: account numbers, name (s), certificate/license numbers, device identifiers, medical record numbers, birth date, photographs and images of patients, postal address, e-mail address, social security number, fax numbers, telephone numbers, health plan numbers, vehicle identifiers, IP address numbers, web URL’s and any other unique identifying number, characteristic or code. Nursing Regulation Cases Studies related to misuse of confidential patient information can be found on page 14. Sister Rachel Torrez, AzBN Nurse Consultant, shares with you HIPAA provisions, the importance of patient privacy and cited violations of the Nurse Practice Act for each investigative case. Learn to protect not only the patients but yourself by understanding both the “new and old public policy changes”. Joey Ridenour, RN, MN, FAAN F r om the Boa r d Pr e si de nt Kathy Malloch, PhD, MBA, RN, FAAN Evidence: Firm Grounding in Turbulent Times The intense and far reaching economic challenges have further heightened the judicious use of resources. Over the last 10 years, nurses have increasingly engaged in the advancement of evidence-based practice as the most effective way in which to achieve the best patient outcome at the lowest cost. Having good rationale or evidence to make decisions is now more critical than ever in order to create and sustain value whether it is about patient care, nursing leadership or nursing regulation. Having access to the best evidence is the first step in an evidence-based practice model. Also essential are knowledge of the patient values and competence of the nurse as the caregiver using the evidence. Evidence-based practice considers all three elements as the means to optimize outcomes and use resources efficiently. It is the integration of these three essential elements; evidence, the values of the patient and the skills of the caregiver that supports effective and sustainable patient care. Nursing professionals work diligently every day to provide patient care based on the best clinical evidence available, the needs and values of each patient and the resources available in the environment. These same elements or considerations apply to nursing regulation as well; research evidence, community needs and values and the skills of the members of the board of nursing. Using an evidence-driven approach is especially important in times of economic crisis when resources are severely limited. Once the state of Arizona achieved consensus on the 2009 budget, we were fortunate to have Senate Bill 1150 sponsored by Sen. Carolyn Allen, passed by the legislature. SB 1150 supports more effective and evidence-based regulatory practices. The evidence for nursing regulation is emerging from the analysis of the outcomes and processes of other boards of nursing, best practices identified by their constituencies and rigorous research studies. Increasingly, boards of nursing, supported by funding from the National Council of State of Boards of Nursing, are designing and conducting research studies to identify the most effective models for discipline, the impact of clinical simulation in the preparation of nurses, optimal nursing board structures and licensing processes. To be sure, the results of these studies provide only the first level of information for boards of nursing and the public they serve, the research evidence. The next step is to determine if and how this evidence is linked to the Arizona community and then if the evidence can be implemented within the resources available in the state. It is about taking reliable data and turning it into information to make decisions. For example, if research identifies optimal remediation practices that require significant number of additional staff, these practices might not be possible. Or a modified version of the evidence-based recommendation might be the best that can occur. Or efforts might need to acquire the needed resources to engage in the best practice for remediation. Several options exist as to how best to use research evidence. Members of the Arizona State Board of Nursing, in open session, regularly examine new evidence, recommendations from the community and comments from individual licensees. In the past year, the board has considered: • The number of members and representation for the board of nursing and determined that representation was needed from those regulated over the past 20-40 years such as the advanced practice community and the nursing assistant community. These recommendations were supported and passed in SB 1150 in June. • The value of pilot programs to consider and advance innovative ideas. The Arizona nursing community has many innovative ideas that require testing and validation. SB 1150 now allows for pilot programs through the board of nursing such as the Pilot Study Medication Technician in Long Term Care, in an effort to generate and validate regulatory evidence to change public policy. • Recommendations from community members were made to consider changing the scheduling of cases and agendizing potential discipline prior to the meeting similar to the practices of the Arizona Medical Board. The recommendations were examined and believed to decrease the licensee or certificate holder’s opportunity to address the board during the initial “probable cause” component of the investigation. • Elimination of dialogue with licensees specific to their case at board meetings was recommended by community members as they believed the dialogue with the board mirrored the hearing process. No evidence was found to support this model. Members of the board believed licensees and certificate holders should have the opportunity to briefly address the board and declined to adopt this recommendation. As a result of this discussion, those addressing the board are informed that they are not required to address the board. The members of the Arizona State Board of Nursing encourage the members of the Arizona community to continue to share their comments and ideas to advance evidence-based regulation practices. We believe this is the best way to protect and serve the public of Arizona. Kathy Malloch, PhD, MBA, RN, FAAN Board President 6 arizona STATE BOARD OF NURSING Regulatory Journal Staff Directory ADMINISTRATION Joey Ridenour, RN, MN, FAAN Executive Director 602.771.7801 jridenour@azbn.gov Judy Bontrager RN, MN Associate Director-Operations & Licensing 602.771.7802 jbontrager@azbn.gov Valerie Smith RN, MS, FRE Associate Director Investigations/Compliance 602.771.7804 vsmith@azbn.gov Pamela Randolph RN, MS Associate Director Education & Evidenced Based Regulation 602.771.7803 prandolph@azbn.gov Lila Wiemann Administrative Assistant to the Executive Director and Associate Director Investigations/Compliance 602.771.7806 lwiemann@azbn.gov Cristina Oates Administrative Assistant to Associate Director Operations/Licensing 602.771.7805 coates@azbn.gov CANDO Connie Linck, RN, MN Nurse Consultant – CANDO 602.771.7864 clinck@azbn.gov Olga Zuniga Administrative Secretary – Monitoring & CANDO 602.771.7865 ozuniga@azbn.gov Complaints-Intake Karen Grady, MS, RN, FNP, BC Complaints-Intake Triage Coordinator - Advanced Practice Nurse Consultant 602.771.7821 kgrady@azbn.gov Jene Martinez Triage Secretary 602.771.7829 jmartinez@azbn.gov EDUCATION Karen Gilliland Administrative Assistant 602.771.7856 kgilliland@azbn.gov 8 Lila Van Cuyk, RN, BSN Nurse Practice Consultant/ CNA Programs 602.771.7857 lvancuyk@azbn.gov FISCAL SERVICES Randi Orchard Fiscal Services Manager 602.771.7810 rorchard@azbn.gov Norma Salter Accounting Technician 602.771.7809 nsalter@azbn.gov HEARINGS Amy Foster, JD Senior Investigator 602.771.7850 afoster@azbn.gov Susan Barber, RN, MSN Nurse Practice ConsultantHearing Dept 602.771.7851 sbarber@azbn.gov Vicky Driver Admin. Assistant-Hearing Dept 602.771.7852 vdriver@azbn.gov INVESTIGATIONS NURSE PRACTICE CONSULTANTS Angela Hill, RN, BSN 602.771.7811 ahill@azbn.gov Betty Nelson, RN, MS 602.771.7813 bnelson@azbn.gov Janeen Dahn, MS, FNP-C Advanced Practice Nurse Consultant 602.771.7814 jdahn@azbn.gov Jeanine Sage, RN, MSN 602.771.7815 jsage@azbn.gov Mary Rappoport, RN, MN 602.771.7816 mrappoport@azbn.gov Nan Twigg, RN, MSN 520.615.4945 ntwigg@azbn.gov Pat Midkiff, RN, MN 602.771.7827 pmidkiff@azbn.gov Sister Rachel Torrez, RN, MS 602.771.7818 srachel@azbn.gov Stephanie Nelson, RN, MS 602.771.7819 snelson@azbn.gov arizona STATE BOARD OF NURSING Regulatory Journal Tammi Bymers, RN, MSN 602.771.7820 tbymers@azbn.gov V. Ann Schettler, RN, MHL, CLNC 602.771.7812 aschettler@azbn.gov SENIOR INVESTIGATORS Doug Parlin 602.771.7822 dparlin@azbn.gov Frank Curatola 602.771.7823 fcuratola@azbn.gov Kirk Olson 602.771.7824 kolson@azbn.gov Ron Lester 602.771.7825 rlester@azbn.gov Stoney Blair 602.771.7826 sblair@azbn.gov LEGAL SECRETARIES Barbara Melberg 602.771.7840 bmelberg@azbn.gov Dorothy Lindsey 602.771.7841 dlindsey@azbn.gov Esther Garcia 602.771.7842 egarcia@azbn.gov Helen Tay CNA Exam/Endorsements 602.771.7832 htay@azbn.gov Jennifer McWilliams RN/LPN Renewals 602.771.7833 jmcwilliams@azbn.gov Paula Delphy RN/LPN Endorsements 602.771.7834 pdelphy@azbn.gov Rhonda Rogers CNA Renewals 602.771.7835 rrogers@azbn.gov Xheni Ndreu 602.771.7836 xndreu@azbn.gov MAILROOM Debra Kunkle 602.771.7876 dkunkle@azbn.gov MONITORING Michelle Mills, RN, MA Nurse Practice Consultant 602.771.7862 mmills@azbn.gov Dolores Hurtado Legal Assistant 602.771.7861 dhurtado@azbn.gov Trina Smith 602.771.7844 tsmith@azbn.gov Brent Sutter Legal Secretary Monitoring & CANDO 602.771.7860 bsutter@azbn.gov INFORMATION TECHNOLOGY Cory Davitt Network Operations Director 602.771.7808 cdavitt@azbn.gov RECEPTIONISTS Hazel Degrate 602.771.7870 hdegrate@azbn.gov Adam Henriksen Information Technology Director/ Webmaster 602.771.7807 ahenriksen@azbn.gov LICENSING Becky Melton RN/LPN Exam 602.771.7830 bmelton@azbn.gov Donna Frye Fingerprints/Endorsements 602.771.7831 dfrye@azbn.gov Marlane Brosseau 602.771.7871 mbrosseau@azbn.gov Nancy Davis 602.771.7872 ndavis@azbn.gov Susan Kingsland 602.771.7873 skingsland@azbn.gov RECORDS Anne Parlin 602.771.7875 aparlin@azbn.gov Summary of Changes to Arizona Nurse Practice Act: SENATE BILL 1105 A. Law/Section/Proposed Changes B. Rationale/Evidence Supporting Change C. Expected Outcome/Impact Patient Safety D. Potential Unintended Consequences Board Members 32-1602 Board of Nursing; Board Members & Terms; Includes adding two new board members to the current nine member board: one registered nurse practitioner or clinical nurse specialist and one member being a nursing assistant or nursing assistant instructor. AzBN has been regulating nurse practitioners for approximately 40 years and certified nursing assistants since 1991. Therefore, the addition of two members provides for representation of disciplines currently regulated. The two new members will add depth/ breadth to the board regarding standards of practice and standards of patient care in the regulation of approximately 100,000 APRNs/ RNs/LPNs/CNAs. Board member terms automatic terms were not previously stated. The average size of most boards of nursing is 11 members. Additional members will enhance and promote diversity as well as multiple perspectives when debating issues and making decisions regarding patient safety. Adding two new board members will increase the expense of annual meetings by approximately $10,000. Executive Director 32-1605.1 Executive Director; powers; duties; Changes to 32-1605.1 allows the Executive Director to: *issue and renew licenses, certificates and prescribing or dispensing; *approve nursing assistant programs. Based on board approved substantive policy statement and requirement to be reported out at the next board meeting: * dismiss complaints if there is not evidence substantiating the complaint; * enter into stipulated agreements for those admitting to chemical dependency; * close complaints resolved through board approved settlement; * issue letters of concern; *.in lieu of summary suspension hearing and if respondent agrees, enter into consent agreement if there is sufficient evidence to warrant emergency action The legislation streamlines the Executive Director’s (ED) authority to facilitate more timely decision making on issues of licensing and investigations. Specifically the ED will have delegated authority to: *take action on specific types of license applications previously referred for board action and the case has typically closed without discipline. *reduce the cycle time on meritless complaints through earlier closure as well as closing out those non discipline cases resolved through a letter of concern *facilitate the consent agreement process for those admitting to chemical dependency * in cases when emergency action is required and the person admits to the findings of fact and conclusion of law without a summary suspension being held, the ED will have the authority to accept the consent agreement which would be reported out at the next meeting Nurses and nursing assistants who have low risk/harm issues and concerns will have licensing/certifying decision making processes facilitated thereby reducing the investigative cycle time to close the case and therefore enter the workforce. Also, individuals who have complaints submitted and are found to be without merit or low risk will have earlier closure of their investigative case. The protection of the public will be improved through earlier case closure to facilitate nurses and nursing assistants being employed and being available to provide care. Some members of the public may expect the board to review each and every case submitted to the board even if the case is without merit. Any member of the public may specifically request the board hear a case and therefore the delegated authority would be voided or would not apply. continued on page 10 arizona STATE BOARD OF NURSING Regulatory Journal 9 Retirement Status: RN/LPN There could potentially become confusion as to the role of the “Retired RN or LPN”. A. Law Section/Proposed Changes ARS 32-1606 Powers and duties of board; changes allows retirement status on request to retired nurses who are or were licensed under this chapter, who have no open complaint or investigation pending against them, and who are not subject to discipline. ARS 32-1636 Use of titles or abbreviations; changes to 32-1636 (E) states a nurse who is granted retirement status shall not practice nursing but may use the title :Registered Nurse-Retired” or “RN-Retired” or “Licensed Practical Nurse-Retired” or “LPN-Retired”, as applicable. 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). 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. Nurses who are no longer practicing can still use their nursing license credential, retired, and continue to identify with the profession. Board Accepting Monies/Services ARS 32-1606 Powers and duties of the board; changes to 32-1606 (a) (11) allows the Board to accept monies and services to assist in the implementation or enforcement of activities the board is required to conduct relating to chapter 15. This will allow the Board to apply for and accept funding to more fully engage in research studies related to its mission and function. Research such as the effectiveness and safety of medication aides or ways to enhance the measurement of clinical competency are examples of research studies which could have a positive impact on patient care. Research is costly but essential to provide evidence based - informed regulation Research outcomes are sometimes not supported in changes in public policy Pilot Programs 32-1606 Powers and duties of the board; Changes to 32-1606 (9) allow the Board adopt rules for conducting pilot programs to implement innovations in nursing practice, education or regulation. Currently innovations in education, practice or regulation are bound by existing statutes and rules. Members of the nursing community have approached the Board asking for an exemption to regulation to implement a rational scientific-based innovation. Currently the Board has no mechanism to grant such an exemption. Rulemaking will establish rigorous standards for granting exemptions to regulation for the purposes of innovation and improvement of health care delivery, nursing education, and regulation. Rulemaking is a lengthy process and some stakeholders may be frustrated with the time commitment and resources required. Board resources will need to be expended both in the rulemaking and in the evaluation/ monitoring of pilot programs. Workforce Data 32-1606 Powers and duties of the board; Changes to 32-1606 include adding provision to enhance the Board’s role and authority in the collection of workforce data The Nursing Board is in an ideal position to collect information on the nursing workforce. Though strategic partnerships with service and other governmental agencies, the Board can transmit such data in aggregate to allow for workforce planning to meet future health care needs. Collection and dissemination of such data is critical to meeting health care needs of Arizona. Accurate data regarding licensed nurses and CNAs with ability to forecast and compare from year to year Collection of such data requires time and effort on the part of Board staff as well as an upto-date information technology infrastructure. There may be budgetary consequences and/ or diversion of staff from other projects. 10 arizona STATE BOARD OF NURSING Regulatory Journal This will have no impact on patient safety and will support those nurses who wish to use this designation. Exemptions To Licensure/ Certification 32-1631 Acts and persons not affected by this chapter; Subsections 8 and 9 were added to exempt nurses licensed in another state from Arizona licensure if they are teaching electronically or in person as long as the practice does not include patient care supervision or direct patient care and does not exceed six consecutive months. These exemptions to licensure involve low-risk, short term situations where the program or facility engages in short-term employment with faculty who may not be licensed in Arizona. Requiring Arizona licensure for such practice is seen as a barrier to accessing faculty or effective instruction. Enactment of this provision will result in increased access to out-of-state faculty/experts for teaching and less expense for nurses and schools who fit these criteria. There may be a rare instance where a nurse licensed in another state, and practicing here under this exemption, does not meet Arizona qualifications for licensure. Examination Security ARS 32-1633 Examination of Registered Nurses; ARS 32-1633 (D) was added to allow the board, if on review of credible evidence, believes that the security of a licensure examination has been compromised and that the credibility of examination results is in questions. The board may require retesting of a registered nurse applicant. ARS 32-1634.01 (C) Allows the board to require retesting of an international registered nurse exam applicant if the board believes the international licensure examination has been compromised and the credibility of the examination results is in question. Cheating on many types of high stakes tests used for licensure or certification domestically or internationally is as widespread and deeply troubling to health care regulators. Cheaters may earn passing scores without actually acquiring the knowledge and skills measured by the test. Licenses or credentials signify that an “individual has demonstrated a significant and safe level of competence in specified domains. The cheaters credential provides no such assurance. Cheating is particularly important given the trends that show cheating has increased dramatically over the past 30 years. To increase assurance that test takers earn passing scores based on their knowledge and skills. Applicants who challenge the Board’s decision to require them to retest, and request a hearing could have a financial impact on the Board’s budget. Nurse Practitioners & Clinical Nurse Specialists 32-1635.01 Temporary nurse practitioner and clinical nurse specialist certification; Changes allow the Board to grant temporary prescribing and dispensing privileges to nurse practitioners who are awaiting confirmation of requirements for permanent licensure. 32-1636. Use of titles or abbreviations; Changes to 32-1636 (C) and (D) provide statutory title protection for nurse practitioners and clinical nurse specialists and requires them to indicate their specialty area of certification when using the title. Granting of temporary prescribing & dispensing authority allows qualified nurse practitioners to fully practice while awaiting confirmation of their qualifications. Current rules limit the granting of temporary prescribing and dispensing to nurse practitioners who have passed a national certifying exam and are current in practice. This would encompass nurse practitioners endorsing into Arizona. Title protection is currently in rule for nurse practitioners and clinical nurse specialists. It is more consistent with health care regulation to place title protection in statute. Title protection ensures that all persons using these titles are competent and qualified and protects the consumer from unqualified health care providers. The provision that nurse practitioners and clinical nurse specialists indicate their specialty area also protects consumers because the increased scope of practice granted to these practitioners is limited to their specialty population. There will be fewer barriers to full practice by endorsing nurse practitioners with the ability to grant temporary prescribing and dispensing privileges. Title protection will result in less confusion on the part of health care consumers and allow for consistent use of titles and specialty areas. There may be a need for ongoing education regarding approved specialty areas of nurse practitioner and clinical nurse specialist practice. Examination of Practical Nurses ARS 32-1638 (D) was added to mirror the RN requirements that, if on review of credible evidence the board may require retesting of practical nurse applicants if the board believes that the security of a licensure examination has been compromised and that the credibility of examination results is in question. ARS 32-1639.01 (C) was added to allow the board, on review of credible evidence, the board may require retesting of an applicant if the board believes that the security of an international licensure examination has been compromised and that the credibility of the exam results is in question. Cheating on many types of high stakes tests used for licensure or certification domestically or internationally is widespread & is deeply troubling to health care regulators. Cheaters may earn passing scores without actually acquiring the knowledge and skills measured by the test. Licenses or credentials signify that an “individual has demonstrated a significant and safe level of competence in specified domains. To increase assurance that test takers earn passing scores based on their knowledge and skills. Applicants who challenge the Board’s decision to require them to retest, and request a hearing could have a financial impact on the Board’s budget. Changes In Licensure Renewal Dates ARS 32-1642 Renewal of license; Changes the “due for renewal” date for RN/LPN licenses from June 30, 20XX to March 30, 20XX. The dates of the statute were changed to accommodate cash flow and thereby preventing an increase in licensing fees. Ninety-five percent of the Boards’ revenue stream is generated during the RN/LPN license renewal, which currently takes place in June at the end of a fiscal year. For some months of the year, the revenue collected does not support operating expenditures. The agency must rely on the cash reserve in the fund balance to cover the costs when revenues are low. By moving the renewal period forward three months from July 1 to April 1, revenue would be available earlier to support the operating expenditures for the fiscal year. The collection of revenues earlier in the fiscal year would resolve the cash flow issues and prevent an increase in licensing fees. This change would not have any impact on patient safety. This change could result in some confusion for RNs & LPNs who have previously renewed their license in June and would now need to renew in March. This change would result in the nurses needing to renew their license three months earlier than previously in the four year period; the three month difference is $9.38 per license. continued on page 12 arizona STATE BOARD OF NURSING Regulatory Journal 11 Fee Determination ARS 1643 Fees; penalties. 1. Changes allows the board to vote at their annual meeting to establish fees, but does not mandate it be the November meeting. 2. Registered Nurse Practitioner and Clinical Nurse Specialist were added to clarify extended nursing practice. 3. “Reinstatement” was changed to “Reissuance” for additional clarification. 4. Fee for failure to notify the board of a change in address is no longer specific to their “residence” address, but simply states “their address”. No anticipate unintended consequences are anticipated. 1. Budgetary needs do not always correlate with the “November” board meeting. This change allows the board to review the fee schedule at a time other than the November board meeting. 2. Title specifications were added to clarify broader categories currently stated. 3. Recommendation from GRRC to rename reinstatement to reissuance. 4. Currently the applications request a temporary, mailing, home, and work address. The intent is for the board to have current address as applicable and not just at a residence. None of these changes should impact patient safety. 1. Will allow the Board more flexibility for establishing fees. 4. This change will increase the ability of the board to contact licensed nurses and certified nursing assistants’ at a current address. Deleting “resident” and just stating the fee for failing to notify the board of a change of address should not have had unintended consequences. 2. Clarifying language will increase understanding. 3. None. CNA Education 32-1647 Examination of Nursing Assistants; Changes to 32-1647 (C) include deleting the required re-training of nursing assistant applicants that fail the competency exam three times and adding the requirement that an applicant must pass the qualifying exam within two years of program completion or re-train. This provision mirrors requirements for RN and LPN licensure already prescribed in rule and changed in statue. There are very few applicants who fail the test three times and many more who, for whatever reason, fail to register and take the test. The test must be passed in proximity to the education to demonstrate competency to practice and serve as an evaluative component for program improvement. While there may be multiple reasons for repeated failure, the person who fails to pass the exam within two years of program completion is a risk to public welfare and has either been practicing without demonstration of competency or not practiced at all with consequent loss of knowledge and skills There is expected to be increased consistency in certifying nursing assistants and increased public protection. There may be some nursing assistants working in settings that do not require certification and have never taken the exam who will need retraining. Education of the public and providers of nursing assistant education of the need to take the exam within two years should minimize this risk. Investigation of Complaint; Hearing; Notice 32-1664 Investigations; hearing; notice Changes to 32-1664 clarifies the Board’s authority and process for obtaining documents, medical records and other evidence in connection with an investigation. Similar to other Boards who regulate independent providers of healthcare, it provides the authority for investigative personnel to enter a premise at reasonable times to inspect or copy materials. The proposed changes also clarifies the statutory authority, criteria and process for the Board to delegate to the Executive Director, the authority to obtain personal medical records of the regulated party. Many advanced practice nurses and some RNs practice in independent settings where they may be the solo practioner and the custodian of records. Having the authority to enter, inspect and copy records provides less opportunity for the records and evidence to be modified or altered and better preserves the evidence of what did or did not happen in cases where the documentation is critical to establishing whether or not the practice was within the standard of care. Additionally, it would allow the Board to facilitate communication to and the transfer of care of patients in situations where the NP is unable to safely practice and notification needs to be made to assure continuity of patient care. At times in an investigation, to validate that a statute or rule has or has not been violated or, for the Board to reasonably evaluate whether or not a licensee is safe to practice, there is a need to obtain the personal medical records of the respondent. This may include records from their treating provider(s), pharmacy profiles or other health records. Although it is always preferable to obtain authorization or consent from the respondent to access the necessary records, in some cases such as allegations of recent/current substance abuse/misuse, it is not uncommon for the respondent to decline authorizing access. In other cases, the respondent may not be responsive in the investigation and thus there needs to be alternative mechanisms to obtain records necessary to the complaint investigation and the evaluation of safeness to practice. 1. Improved and timely access to patient care records that are necessary in a complaint investigation 2. Ability to facilitate communication or transfer of care in cases where the Nurse Practitioner is no longer able to safely practice 3. Standardized guidelines and process for obtaining patient records 4. Provides clarification to the recipient of a subpoena for records, the Board’s statutory authority to request and receive the records There may still be nurses or attorneys who do not believe that the board has the authority to review personal medical records even is the evidence demonstrates unsafe practice and therefore additional board resources will be needed to access the records through the courts. 12 arizona STATE BOARD OF NURSING Regulatory Journal arizona STATE BOARD OF NURSING Regulatory Journal 13 CASE STUDIES: Sister M. Rachel Torrez RN, MS, Nurse Practice Consultant The Importance of HIPAA for Nurses In 1996 Congress passed the Health Insurance Portability and Accountability Act (HIPAA). The act mandated the establishment of federal standards for the privacy of individually identifiable health information. The Privacy Rules establish safeguards to protect the confidentiality of patient medical information and all health care providers are bound by the privacy standards. The introduction of the electronic medical record has resulted in a great deal of efficiency. The ease of communication and the speed in obtaining laboratory and other testing results occurs in record time. The efficient use of computer access to data has also posed concerns that the patient information may now be too easily accessible and visible by individuals who should not have access to the information. Patient authorization and consent to access personal and protected medical data is required. Patient information must remain confidential in all health care settings and not be accessed by or accessible to others not directly involved in the care of the patient. Patient information should not be visible in the form of “white boards”, patients lists, computer screens or printouts. Employers have been diligent in establishing facility policies related to the employees responsibility regarding HIPAA. Only authorized employees may access patient records and many employers have established mechanisms to determine if unauthorized persons have accessed the electronic medical record. The Board of Nursing has investigated complaints regarding HIPAA violations. The following are a few examples of cases reported to the Board that resulted in discipline imposed by the Board of Nursing. Nurse A • Nurse A accessed the medical record of a coworker who was a patient in a clinic setting where both individuals were employed. Nurse A wanted to learn how she could advise her co-workers in dealing with the individual in the work setting. Nurse A did not have any assigned responsibility to the co-worker, nor did she have any authority to access the co-workers medical record. Nurse A was terminated. Nurse B • Nurse B accessed a number of patient medical records over a period of months. Nurse B was counseled and informed she needed to refrain from accessing records for patients that were not assigned to her care. 14 arizona STATE BOARD OF NURSING Regulatory Journal Nurse B stated she was sure someone was using her password without her permission. Her password was changed. There was improvement for a period of time, but several months later it was discovered that Nurse B had continued to access numerous medical records for patients not assigned to her care. Nurse B was terminated. Nurse C • Nurse C accessed the medical record of a coworker who had been admitted to the ER for treatment. Both individuals were employees at the facility. Nurse C was not assigned to the care of the co-worker and when asked why she had accessed the medical record she said she was curious as to why the individual was being treated in the ER. Nurse C was terminated. Nurse D • Nurse D made entries into the medical record of a family member. Nurse D worked in the department where the family member was a patient. Nurse D was not assigned to the care of the family member, nor was she on duty at the time she accessed the medical record and made the nursing note entries. Nurse E • Nurse E accessed the electronic medical record of a family member. Nurse E was not assigned to the care of the family member. Nurse E also copied portions on the medical record of the family member and removed the documents from the facility because she said she had the Power of Attorney (POA) for the family member. Nurse E was employed at the hospital where the family member was a patient. Nurse E was terminated. Nurse F • Nurse F a member of the health team was in the operating room participating in a procedure to remove a foreign object from a patient’s vagina. An x-ray of the foreign object was taken and available to the health team in the operating room. Nurse F used his cell phone to take a picture of the foreign object visualized in the x-ray. Nurse F shared the picture from his cell phone with other members of the team who were participating in the procedure. Nurse F stated the picture was taken for educational purposes. Nurse F said he was not aware of a hospital policy prohibiting the use of cell phones with camera capabilities. When the case was presented to the Board discipline was imposed because taking pictures of patients or sharing unauthorized medical information is a violation of HIPAA. Lessons to be learned: • Follow facility policies related to accessing medical records. • Do not share your password related to accessing the medical record with other persons. • Permission from appropriate persons is required if medical record information is needed. • Unauthorized access to patient medical information is a violation of federal law. Health Insurance Portability and Accountability Act of 1996 (HIPAA) The following are the potential violations related to HIPAA. A.R.S. § 32-1663(D) AS DEFINED IN A.R.S. §32-1601 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. (g) Willfully or repeatedly violating a provision of this chapter or a rule adopted by pursuant to this chapter (j) Violating a rule that is adopted by the Board pursuant to this chapter. POTENTIAL VIOLATION OF RULES: A.A.C. § R4-19-403 For purposes of A.R.S. § 32-1601(16)(d), any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public includes one or more of the following: 9. Failing to take appropriate action to safeguard a patient’s welfare or follow policies and procedures of the nurse’s employer designed to safeguard the patient. 16. Removing, without authorization, a narcotic, drug, controlled substance, supply, equipment, or medical record from any health care facility, school, institution or other work place location. 31. Practicing in any other manner that gives the Board reasonable cause to believe the health of a patient or the public may be harmed. arizona STATE BOARD OF NURSING Regulatory Journal 15 EDUCATION CORNER By Pamela Randolph RN, MS Associate Director Education and Evidence Based Regulation Program Complaint/Investigation Process While most nurses are somewhat familiar with complaints on a nursing license, few are aware that the Board also investigates complaints about nursing programs. While 16 Arizona has many excellent program programs, there are occasional complaints alleging that a program falls below the standards of the Board. There are several arizona STATE BOARD OF NURSING Regulatory Journal aspects to the complaint process that should be understood. Jurisdiction The Board can only investigate nursing programs over which it has regulatory authority as permitted in the Nurse Practice Act. Generally, these are programs that lead to licensure or certification by the Board. The Board has jurisdiction over certified nursing assistant (CNA), licensed practical nurse (LPN), registered nurse (RN), nurse practitioner (NP) and clinical nurse specialist (CNS) programs. The Board also has jurisdiction over nurse refresher programs as this is the basis for renewing the licenses of inactive nurses. The Board does not have jurisdiction over patient care technician (PCT), medical assistant (MA), caregiver, dialysis technician, RN to BSN, or other (non-advanced practice) nursing master’s and doctoral programs. Types of Complaints Not all complaints warrant an investigation. The complaint must relate to a violation of rule or statute for the particular type of program. Rules related to programs are found in the Rules of the Board (www.azbn.gov) Article 2 for RN, LPN and nurse refresher programs; Article 5 for NP and CNS programs; and Article 8 for CNA programs. The Board routinely receives calls from disgruntled students regarding unfair treatment or grade disputes. These are not violations of rule, per se. However, each program must have an internal grievance process in place for students to address these issues. If the program has failed to make the grievance process accessible to a student, that omission could form the basis of a complaint investigation. Complaints that are investigated usually involve poor instruction, insufficient resources, unqualified faculty or lack of administrative support. The investigation of the initial complaint may uncover additional information leading to other possible rule violations. Complainants typically come from either current or former nursing students, but occasionally faculty, practicing nurses or administrators file program complaints. Complainants may request to remain anonymous but sometimes the nature of the allegations leads program personnel to accurately surmise the identity of the complainant. Investigation Process Once a complaint is received and it is determined that an investigation is needed, the nursing program administrator is notified. On rare occasions, the notification occurs in Once the program has determined that it has remedied the deficiency, evidence is reviewed by Board staff and a site visit to verify program compliance is conducted, if needed. an unannounced site visit. More typically, the director is informed via telephone or e-mail and asked for his/her response to the allegations. If the response and other evidence is not sufficient to close or dismiss the complaint or the response indicates that there may be additional violations, an investigative site visit or further investigative interviews are conducted. The investigation continues until all sides are heard and the evidence gathered is sufficient to either substantiate or refute the allegations. During the investigative phase, all viewpoints and available evidence is considered and compiled into an investigative report that is presented to the Board during their meeting. Program personnel are notified of the findings, the likely outcome and the Board date and time. The complainant is also notified of the meeting and given an opportunity to be present. During the Board meeting program representatives and the complainant may address the Board. Outcomes If the allegations are not substantiated, the complaint is presented to the Board for dismissal. If the allegations are substantiated but subsequently remedied by the program, the complaint is also set for dismissal. This is because Arizona law gives nursing programs an opportunity to remedy potential violations before the Board can place any restrictions on the program. If the program immediately recognizes and remedies a potential violation, the Board generally takes no additional action. If the original complaint or a different potential violation is substantiated and the program is unable to correct in a timely manner, the Board may issue an official “Notice of Deficiency” to the program. This type of deficiency is different from the application deficiency notice routinely sent to applicants because of insufficient information to grant a license (e.g. passing NCLEX). This “Notice of Deficiency” is an official Board action providing formal notice to the program that they are in violation of law. The Board may grant up to 18 months to continued on page 19 arizona STATE BOARD OF NURSING Regulatory Journal 17 18 arizona STATE BOARD OF NURSING Regulatory Journal correct the deficiency for RN, LPN, NP, CNS and refresher programs and three months for CNA programs. After service of the “notice”, the program has 30 days to request an administrative hearing to refute the findings. If the program does not request a hearing, they must respond with a plan of correction. Failure to correct the deficiency within the time-frame will result in either the program being unable to admit students or revocation of the program’s approval, closing the program. Occasionally the Board will extend the notice for an additional period if the program demonstrates significant progress toward remedying the deficiency. In addition to a complaint investigation, a program may also, and more typically, receive a “Notice of Deficiency” as a result of evidence submitted or gathered as part of a routine site visit or in monitoring NCLEX pass rates. Notices of Deficiency are reported in this column and on the list of programs on the Board Web site. Once the program has determined that it has remedied the deficiency, evidence is reviewed by Board staff and a site visit to verify program compliance is conducted, if needed. Some deficiencies, such as faculty qualifications can be verified with document review. Others, such as deficiencies in resources, curriculum and administrative support would require a site visit to verify compliance. Once the deficiency is remedied, the Board lifts the deficiency status from the program. For questions about the program complaint process, please contact Pamela Randolph RN, MS at prandolph@azbn.gov or 602-771-7803. Registration Fees 2010 Seventh Annual CNA Educators Retreat Nuts and Bolts of Education Friday, January 15, 2010 The Black Canyon Conference Center, Phoenix, AZ Registration FORM Purchase Orders WILL NOT be accepted in lieu of payment. Please Use One Form Per Registrant and Print Clearly/ Type All Information (*Required Field) *Name: General $80.00 (On/Before December 15th) Late $90.00 (After December 15th) On-site $100.00 (Space permitted) Fees include meals and conference materials. (as you would like it to appear on Badge) *Degree/ Credentials: * Affiliation/Agency: Title/Position: * Address: City/State/Zip: Telephone Numbers: O; C * Email Address(es): REGISTRATION CONFIRMATION SENT BY E-MAIL ONLY Contact hours for this continuing nursing education activity will be submitted to the Arizona Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accrediation. Vendors on Site Sponsored by SEVEN Healthcare Academy. Exhibits open during scheduled breaks. Submit completed registration form and payment to: Arizona State Board of Nursing 4747 N. 7th Street, Suite 200, Pheonix, Arizona 85014 | 602-771-7800, 602-771-7888 fax; www.azbn.gov Board Actions on Education Matters June 2009 • Approved the development of a consortium under the Education Committee consisting of educators, service, nursing organizations and policy makers to develop a plan for rational growth of nursing programs to meet AZ health care needs in the future • Re-approved the RN refresher program at Northland Pioneer College • Affirmed that Copper Mountain Inn, Globe, remains a site for the Pilot Study Medication Technician Project despite sanction by DHS • Granted extension of approval of the refresher program at Mohave Community College • Dismissed complaints on Emmanuel School of Nursing CNA Program and Grace Institute CNA program arizona STATE BOARD OF NURSING Regulatory Journal 19 CNA CORNER By Lila Van Cuyk, RN, BSN Nurse Practice Consultant/ CNA Programs As nursing assistant training programs enter the new 2009 school year, I would like to reflect and share potential future changes. Early this year, suggestions and ideas to increase the pass rates were sent to programs that had a minimum of 10 students take the D&S State CNA test in 2008. These programs had a first time pass rate of 10 percent or more below the statewide first time pass rate for written test of 92 percent and the skills test of 78 percent. I am pleased to find in recent visits, a number of ideas have been implemented to improve the pass rates. These have included: initiating a pre-entry test to assess reading and math ability. The nursing assistant texts vary in their level of reading ability, but most require about an eighth grade reading level. Candidates who do not meet criteria are encouraged to get remediation prior to taking the course. One high school program decided to take only seniors this coming year. After they reviewed their scores, they determined that the younger students were not as ready to enter health care. Some programs have added extra hours to their program, especially in laboratory skills and clinical training. Many programs have taken the opportunity to test their students at their training site. Many instructors have also attended the D&S Instructor training workshops. These have helped new instructors in preparing their students for the competency exam. I also have seen more use of the evaluations by students and the testing profiles to help determine areas that need improvement. Since most of these changes are new or yet to be implemented, the D&S testing scores have not shown improvement to date in response to these many efforts. During the first six months of 2009, 2,618 candidates took the written test with a first time pass rate of 86 percent. This was down six percent from 2008. Also, 2,738 candidates took the skills test with a first time pass rate of 76 percent. This was down two percent from 2008. At the test writing session in May 2009, over 200 new questions were written, which will be evaluated and added to the test pool. One thing to note is that some these were 20 arizona STATE BOARD OF NURSING Regulatory Journal math questions which reflect the math skills needed in the skill scenarios: weighing, intake and output and pulse. In this way all students will have assessment of their math abilities, even if they do not get math related skills in their five skill scenarios. Reminder: All requests for approval of coordinators and instructors, including ongoing coordinators and instructors at program renewal time will need to complete the Coordinator/Instructor Application which is available at the AZBN Web site. During the first six months of 2009, 2,618 candidates took the written test with a first time pass rate of 86 percent. This was down six percent from 2008. The CNA Educator Retreat looks like it will be another very beneficial day for our programs. The 2010 program is titled “Nuts and Bolts of Education”. It will focus on teaching strategies and how to address several of the more difficult concerns facing many programs: English as a second language and cheating in the classroom. Save the day (Friday, Jan. 15, 2010)! Send in your registration early. Program information and the application are available online. arizona STATE BOARD OF NURSING Regulatory Journal 21 *Not reported in previous Newsletter CNA Disciplinary Action April-May-June 2009 effective date name certificate discipline violation(s) 5/28/2009 Alcala, Rachael A. CNA Applicant Certificate Denied 5/11/2009 Awumah, Mavis CNA999988793 Revoked 5/26/2009 Bailey, Nancy Y. CNA Applicant Certificate Denied 5/1/2009 Barnhill, Gayla L. CNA Applicant Certificate Denied 4/1/2009 Briones, Judy M. CNA1000007905 Civil Penalty 4/30/2009 Brown, Steven V. CNA1000011723 Stayed Revocation w/Suspension 6/8/2009 Camacho, Kayla A. CNA1000017212 Revoked 6/17/2009 Campbell, Qiana L. CNA1000020218 Civil Penalty 5/11/2009 Carranza, Louie R. CNA999951622 Revoked 5/26/2009 Charleston, Noreen J. CNA Applicant Certificate Denied 5/5/2009 Clement, Christine R. CNA Applicant Certificate Denied 6/24/2009 Debrew, Cynthia M. CNA827962103 Stayed Revocation 5/26/2009 Donaldson, Jennifer A. CNA Applicant Certificate Denied 5/11/2009 Evans, Sylvia D. CNA711386103 Revoked 5/11/2009 Fields, Peter S. CNA1000011690 Revoked 2/20/2009* Fortin, Barbara A. CNA1000019065 Civil Penalty 4/21/2009 Guzman, Jennifer L. CNA Applicant Certificate Denied 5/28/2009 Hamner-Scott, Christopher M. CNA Applicant Certificate Denied 4/2/2009 Heaberlin, Jeffrey L. CNA Applicant Certificate Denied 4/29/2009 Hibbard, Jayme L. CNA Applicant Certificate Denied 4/13/2009 Hill, Kimberly A. CNA1000019606 Civil Penalty 5/26/2009 Hill, Lavella L. CNA Applicant Certificate Denied 5/28/2009 Hooks, Shavona R. CNA1000016498 Voluntary Surrender 4/9/2009 Jones, Peter E. CNA1000015606 Revoked 6/16/2009 Keller, Nicole M. CNA1000020371 Civil Penalty 4/13/2009 Kerley, Greg CNA1000004326 Voluntary Surrender 3/17/2009* Loftus, Juanita S. CNA Applicant Certificate Denied 4/29/2009 Lopez, Marisela CNA1000019751 Stayed Suspension 2/10/2009* Lynch, Robin R. CNA591967803 Civil Penalty 1/5/2009* Madison, Lenard E. CNA534767873 Revoked 4/24/2009 Mason, Donald A. CNA1000009005 Stayed Revocation 5/4/2009 Mcafee, Latonya CNA Applicant Certificate Denied 5/11/2009 Mcallister, Rashad CNA1000009143 Revoked 5/26/2009 Mcaninch, Samantha C. CNA Applicant Certificate Denied 4/21/2009 Mccoy, Patricia A. CNA Applicant Certificate Denied 3/4/2009* Mcknight, Delena CNA1000019063 Civil Penalty 5/11/2009 Mendoza, Melissa CNA1000006520 Revoked 5/26/2009 Mitchell, Titania F. CNA Applicant Certificate Denied 5/14/2009 Moore, Christine E. CNA1000000656 Stayed Revocation 5/13/2009 Navarro Jr, Victor M. CNA999989146 Revoked 3/21/2009* Nevarez, Vanessa N. CNA1000005749 Civil Penalty 4/9/2009 Nolen, Victoria J. CNA1000009764 Civil Penalty 5/26/2009 Oghenejabor, Favour C. CNA Applicant Certificate Denied 4/3/2009 Park, Matthew T. CNA Applicant Certificate Denied 6/14/2009 Patzke, Stephanie C. CNA1000020388 Civil Penalty 4/21/2009 Petersen, Christopher W. CNA1000010023 Voluntary Surrender 6/9/2009 Platt, Cassandra L. CNA1000005859 Voluntary Surrender 6/9/2009 Pokuta, Christopher CNA Applicant Certificate Denied 6/10/2009 Pozzi, Cathlena S. CNA999999389 Revoked 4/25/2009 Reyes, Jessica J. CNA999997496 Stayed Revocation w/Civil Penalty 6/4/2009 Robles, Angela A. CNA614792103 Renewal Denied 4/4/2009 Rose, Kimberly S. CNA1000019965 Civil Penalty 5/6/2009 Ross, Nadine R. CNA Applicant Certificate Denied 4/3/2009 Ryan, Crystal A. CNA Applicant Certificate Denied 6/29/2009 Salazar, Dorsey M. CNA1000008470 Stayed Revocation 4/3/2009 Sanders-Lara, Lydia CNA208245103 Civil Penalty 4/3/2009 Sandoval, Samantha G. CNA Applicant Certificate Denied 5/27/2009 Schlepp, Matthew B. CNA Applicant Certificate Denied 4/21/2009 Scrivano, Karen M. CNA999953351 Revoked 5/6/2009 Siew, Olivia Y. CNA Applicant Certificate Denied 5/11/2009 Simon, Christina L. CNA1000011667 Revoked 4/24/2009 Smith, Michelle J. CNA590261803 Civil Penalty 5/6/2009 Stevens, Garrett N. CNA Applicant Certificate Denied 5/11/2009 Sullivan, Megan N. CNA1000013435 Revoked 4/24/2009 Symmonds, David L. CNA Applicant Certificate Denied 22 arizona STATE BOARD OF NURSING Regulatory Journal Criminal Conviction; Failure to Cooperate Unable to Practice Safely - Substance Abuse; Violation of Fed/State Statutes/Rules; Fraud Failure to Meet Licensing Board Reporting Requirements; Criminal Conviction Failure to Meet the Initial Requirements of Certification; Criminal Conviction Patient Neglect; Patient Abuse Misrepresentation of Credentials Failure to Comply Board Order Criminal Conviction Sexual Misconduct; Failure to Comply Board Order Violation of Fed/State Statutes/Rules; Criminal Conviction Criminal Conviction; Failure to Cooperate Criminal Conviction; Substance Abuse; Narcotics Violation or Other Violation of Drug Statutes Criminal Conviction; Narcotics Violation or Other Violation of Drug Statutes Misappropriation of Property; Failure to Comply Board Order; Unprofessional Conduct False Reports/Falsifying Records; Patient Neglect; Substandard or Inadequate Care Criminal Conviction Criminal Conviction; Failure to Cooperate Criminal Conviction; Fraud/Deceit; Failure to Cooperate Failure to Cooperate; Unprofessional Conduct Criminal Conviction; Unable to Practice Safely - Substance Abuse Criminal Conviction Criminal Conviction; Narcotics Violation or Other Violation of Drug Statutes Failure to Comply Board Order Failure to Comply Board Order Criminal Conviction; Fraud/Deceit Sexual Misconduct; Practicing Beyond Scope; Failure to Comply Board Order Criminal Conviction Criminal Conviction Violation of Fed/State Statutes/Rules; Criminal Conviction; Failure to Cooperate Criminal Conviction; Violation of Fed/State Statutes/Rules; Failure to Cooperate Substance Abuse Failure to Meet the Initial Requirements of Certification; Criminal Conviction Patient Abuse; Substandard or Inadequate Care; Patient Neglect Criminal Conviction Criminal Conviction; Failure to Cooperate Criminal Conviction Patient Abuse; Unprofessional Conduct Criminal Conviction; Substandard or Inadequate Care Criminal Conviction; Substance Abuse Failure to Comply Board Order Unprofessional Conduct; Patient Abuse Violation of Fed/State Statutes Regulation or Rules; Fraud-Unspecified Criminal Conviction Criminal Conviction Violation of Fed/State Statutes/Rules; Criminal Conviction Sexual Misconduct Unable to Practice Safely Criminal Conviction; Failure to Cooperate Failure to Comply Board Order Patient Abuse Criminal Conviction; Failure to Cooperate Criminal Conviction Criminal Conviction; Failure to Cooperate Criminal Conviction Substance Abuse Practicing Beyond Scope Criminal Conviction Violation of Fed/State Statutes/Rules; Unable to Practice Safely - Substance Abuse; Failure to Cooperate Failure to Comply Board Order Failure to Cooperate Practicing Beyond Scope; Failure to Cooperate Patient Abuse Criminal Conviction; Failure to Cooperate Patient Abandonment; Failure to Cooperate Criminal Conviction; Unable to Practice Safely - Substance Abuse arizona STATE BOARD OF NURSING Regulatory Journal 23 *Not reported in previous Newsletter CNA Disciplinary Action April-May-June 2009 effective date name certificate discipline violation(s) 4/30/2009 Tabor, Ricky V. CNA999952539 Revoked 4/6/2009 Taylor, Tammy D. CNA162255403 Civil Penalty 6/12/2009 Tewayguna, Sonia K. CNA999993734 Revoked 5/24/2009 Vega Sanchez, Pamela D. CNA1000008915 Civil Penalty 6/27/2009 Villalobos, Maria D. CNA Applicant Civil Penalty 6/26/2009 Wade, Maria C. CNA Applicant Civil Penalty 6/15/2009 Wales Jr., Mark A. CNA1000003427 Revoked 12/30/2008* Wall, Carmen M. CNA703712897 Stayed Revocation w/Civil Penalty 5/11/2009 Washington, Cynthia O. CNA611599103 Revoked 3/2/2009* Whindleton-Pineda, CNA1000019066 Civil Penalty Samantha R. 5/26/2009 Woodruff, Ashley C. CNA Applicant Certificate Denied Failure to Comply Board Order Criminal Conviction; Narcotics Violation or Other Violation of Drug Statutes Failure to Comply Board Order Breach of Confidentiality; Dual Relationship/Boundaries Violation of Fed/State Statutes/Rules; Criminal Conviction; Narcotics Violation or Other Violation of Drug Statutes Criminal Conviction; Narcotics Violation or Other Violation of Drug Statutes Failure to Comply Board Order Patient Abuse; Negligence Patient Abuse; Unprofessional Conduct; Failure to Comply Board Order Criminal Conviction Criminal Conviction; Failure to Cooperate CNA Discipline ACTION CLEARED April-May-June 2009 effective date name 4/4/2009 Ferrato, Gina M. 5/13/2009 Polingyumptewa, Calandra 6/3/2009 Rivera, Iran R. 5/5/2009 Sawyer, Evelyn J. 5/15/2009 Solano, Toni S. 5/12/2009 Treat, Ryan M. LICENSE CNA1000005345 CNA1000012330 CNA1000008757 CNA1000012654 CNA1000014413 CNA1000015896 RN/LPN Disciplinary Action April-May-june 2009 effective date name LICENSE discipline violation(s) 6/3/2009 Agboola, Althea M. LP038729 Probation 4/16/2009 Ashby, Matthew T. RN104324 Civil Penalty 4/26/2009 Bannon, Leanne E. RN000099193 Stayed Revocation w/Probation 5/21/2009 Barnhart, Brittney N. LP043030 Probation 6/17/2009 Beaver, Debra D. TRN159033 Probation 6/18/2009 Bennett, Charles A. RN109600 Suspension 6/5/2009 Bishop, Deborah L. RN157782 Decree of Censure 6/14/2009 Blake, Diane G. RN146156 Suspension 5/21/2009 Boaz, Jesvin J. RN140453 Decree of Censure 5/28/2009 Bohm, Connie Jo LPN Endorsement License Denied 5/5/2009 Bolton, Pamela S. RN154233 Stayed Revocation w/Probation 4/30/2009 Brady-Beetham, Cassandra RN091519 Probation 5/7/2009 Brazil, Yvette A. RN Endorsement License Denied 4/29/2009 Bridges Jr., Talmadge L. RN081485 Voluntary Surrender 6/26/2009 Brown, Anthony S. RN085307 Voluntary Surrender 6/1/2009 Burns, Abigale D. RN090598 Revocation 6/12/2009 Cardona, Cynthia L. TRN158058 Stayed Revocation w/Probation 6/14/2009 Carter, Bryce E. LP045675 Probation 4/3/2009 Carter, Christopher A. LP045454 Probation 4/11/2009 Cary, Donna M. LP041992 Decree of Censure 6/1/2009 Castellucci, Dawn D. RN099858 Stayed Revocation w/Suspension 24 arizona STATE BOARD OF NURSING Regulatory Journal Substance Abuse Criminal Conviction Failure to Comply w/Licensing Board Order, Substance Abuse Failure to Comply w/Licensing Board Order, Unable to Practice Safely License Revocation, Suspension or Other Disciplinary Action Taken by a Federal, State or Local Licensing Authority, Substance Abuse Failure to Maintain Records or Provide Medical, Financial or Other Required Information, Unauthorized Administration of Medication, Diversion of Controlled Substance Narcotics Violation or Other Violation of Drug Statutes Failure to Maintain Records or Provide Medical, Financial or Other Required Information, Substandard or Inadequate Care Substandard or Inadequate Care Criminal Conviction, Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse, Failure to Cooperate with Board Failure to Comply w/Licensing Board Order, Substance Abuse Failure to Maintain Records or Provide Medical, Financial or Other Required Information Failure to Cooperate with Board, Narcotics Violation or Other Violation of Drug Statutes Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse, Narcotics Violation or Other Violation of Drug Statutes Failure to Comply with Health and Safety Requirements, Filing False Reports or Falsifying Records, Diversion of Controlled Substance Failure to Comply w/Licensing Board Order Failure to Meet the Initial Requirements of a License, License Revocation, Suspension or Other Disciplinary Action Taken by a Federal, State or Local Licensing Authority, Substance Abuse Criminal Conviction Violation of Federal/State Statutes, Regulations or Rules, Criminal Conviction, Substance Abuse Filing False Reports or Falsifying Records Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse, Unauthorized Dispensing of Medication, Diversion of Controlled Substance arizona STATE BOARD OF NURSING Regulatory Journal 25 RN/LPN Disciplinary Action April-May-june 2009 effective date name LICENSE discipline violation(s) 6/4/2009 Cauwet, Julianne C. RN157798 Probation 6/26/2009 Chandler, Carol L. RN130840 Voluntary Surrender 4/24/2009 Chaney, Arlana B. RN Endorsement License Denied 5/20/2009 Cifelli, Carol A. RN053355/LP017203 Decree of Censure 6/10/2009 Clark, Phillip W. RN075107/LP024164 Decree of Censure w/Civil Penalty 6/11/2009 Cleveland, Linda M. RN158624/LP027000 Civil Penalty 5/15/2009 Collazo, Linda C. LP043667/CNA100009092 Probation w/Civil Penalty 6/24/2009 Compton, Farleigh E. RN000099205/LP031615 Stayed Revocation w/Probation 5/15/2009 Cooper, Gena R. RN094888 Probation 6/4/2009 Crow, Julie E. RN158158 Civil Penalty 4/17/2009 De Vries, Darlene R. RN063590 Voluntary Surrender 6/1/2009 Demattia, Arlene C. LP037609 Revocation 5/5/2009 Dennis, Betty S. LP041760 Voluntary Surrender 6/3/2009 Derousse, Kimberly J. LP035868 Suspension 5/8/2009 Diaz, Judith C. RN119896/LP036581 Revocation 6/3/2009 Distefano, Julie D. LP039767 Stayed Suspension w/Probation 4/7/2009 English, Sheri D. RN137072/AP3329/ LP040402 Civil Penalty 5/28/2009 Esho-Bakare, Oluwatoyin RN Endorsement License Denied 6/15/2009 Eskeets, Laura J. RN070982 Voluntary Surrender 6/16/2009 Evans, Karen L. RN074803/SN0589 Revocation 4/13/2009 Faulx, Lori A. RN153031 Probation 6/3/2009 Frankley, Alison E. RN150331 Revocation 6/4/2009 Garner, Roger A. RN100288 Decree of Censure 4/2/2009 Gavin, Stephanie L. RN Endorsement License Denied 5/4/2009 Gesswein, Patricia A. RN022323 Stayed Revocation w/Probation 4/22/2009 Gray, Delores F. LP011483 Decree of Censure 6/4/2009 Hadley, Frank J. LP036210 Voluntary Surrender 26 arizona STATE BOARD OF NURSING Regulatory Journal Criminal Conviction Violation of Federal/State Statutes Regulation or Rules, Criminal Conviction Practicing Without Valid License, Unprofessional Conduct Failure to Comply w/Health & Safety Requirements, Failure to Maintain Records or Provide Medical, Financial or Other Required Information Failure to Comply w/Licensing Board Order, Unprofessional Conduct, Error in Prescribing Dispensing or Administering Medication Failure to Meet Licensing Board Reporting Requirements, Criminal Conviction, Fraud Filing False Reports or Falsifying Records Failure to Maintain Records or Provide Medical, Financial or Other Required Information, Diversion of Controlled Substance Narcotics Violation or Other Violation of Drug Statutes Practicing Without Valid License Failure to Comply w/Licensing Board Order Failure to Comply w/Licensing Board Order Patient Abuse Failure to Comply w/Licensing Board Order, Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse Fraud, Deceit or Material Omission in Obtaining License or Credentials, Failure to Cooperate with Board Criminal Conviction, Substance Abuse Fraud Criminal Conviction, Fraud, Failure to Cooperate with Board Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse Failure to Comply w/Licensing Board Order Criminal Conviction, Substance Abuse Failure to Comply w/Licensing Board Order, Substandard or Inadequate Care Substance Abuse Criminal Conviction, Failure to Cooperate with Board Failure to Maintain Records or Provide Medical, Financial or Other Required Information Substandard or Inadequate Care, Unauthorized Administration of Medication Failure to Comply w/Licensing Board Order *Not reported in previous Newsletter RN/LPN Disciplinary Action April-May-june 2009 effective date name LICENSE discipline violation(s) 6/10/2009 Hamlin, Sheril E. RN080199 Revocation 5/5/2009 Harris, Kelly H. RN069119 Stayed Revocation w/Suspension 6/10/2009 Harris, Kelly H. RN069119 Revocation 4/23/2009 Harris, Linda M. RN058140 Probation 6/4/2009 Harris, William V. RN157068/CRNA0504 Civil Penalty 5/5/2009 Heim, Patricia J. LP032014 Probation 4/1/2009 Hurst, Rebecca M. RN121847 Voluntary Surrender 6/1/2009 Iler, Connie D. RN134996 Revocation 5/12/2009 Jackson, Lorrie M. LP026634/CNA355978363 Suspension 6/14/2009 Jeffrey, MaryEllen RN079790/LP023755 Stayed Revocation w/Suspension 4/9/2009 Johnston, Tracy L. RN133783 Revocation 6/16/2009 Jorgensen, Karen RN131691 Probation 5/15/2009 Kamens, Gregory D. RN128911 Voluntary Surrender 6/10/2009 Karcher, Shelby L. RN140110/CNA766784641 Voluntary Surrender 5/27/2009 Kinder, Michael C. RN106172 Probation 4/1/2009 Kirkendall, Mark A. RN121540 Voluntary Surrender 4/22/2009 Kirkpatrick, Ian R. LP042491 Decree of Censure 6/27/2009 Kuntz, Danny J. RN083436/LP026094 Decree of Censure 4/28/2009 Lammert, Shannon L. LP043068 Revocation 6/24/2009 Landa, Stephanie L. RN090090 Probation 6/11/2009 Lapinska, Christina M. RN Endorsement Stayed Revocation w/Probation & Limited Licensure 6/3/2009 Lembert, Delya E. RN030184 Probation Failure to Comply w/Licensing Board Order Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse Failure to Comply w/Licensing Board Order Violation of Federal/State Statues Regulation or Rules, Criminal Conviction, Substance Abuse Practicing Without Valid License/Certificate Substance Abuse Violation of Federal/State Statutes/Rules, Criminal Conviction, Sexual Misconduct Failure to Comply w/Licensing Board Order Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse, Unable to Practice Safely by Reason of Psychological Impairment or Mental Disorder, Error in Prescribing, Dispensing or Administering Medication Failure to Comply w/Licensing Board Order, Failure to Maintain Records or Provide Medical, Financial or Other Required Information Failure to Comply w/Licensing Board Order Failure to Maintain Records or Provide Medical, Financial or Other Required Information, Unprofessional Conduct Failure to Comply w/Licensing Board Order, Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse Criminal Conviction, Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse, Unauthorized Prescribing Medicine (APRN) Unprofessional Conduct, Failure to Cooperate with Board Violation of Federal/State Statutes Regulation or Rules, Criminal Conviction, Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse Patient Abuse, Fraud, Substandard or Inadequate Care Practicing Beyond the Scope of Practice Failure to Comply w/Licensing Board Order Criminal Conviction, Substance Abuse License Revocation, Suspension or Other Disciplinary Action Taken by a Federal, State or Local Licensing Authority Failure to Comply w/Health & Safety Requirements, Failure to Maintain Records or Provide Medical, Financial or Other Required Information, Substandard or Inadequate Skill Level arizona STATE BOARD OF NURSING Regulatory Journal 27 28 arizona STATE BOARD OF NURSING Regulatory Journal *Not reported in previous Newsletter RN/LPN Disciplinary Action April-May-june 2009 effective date name LICENSE discipline violation(s) 4/22/2009 Lovesy, Jason D. RN098343 Reissuance with Stayed Revocation w/Probation 5/28/2009 Lovett, Jennifer N. RN Endorsement License Denied 6/1/2009 Manuel, Karen M. RN026418 Revocation 4/2/2009 Matthews, Joseph W. LPN Endorsement License Denied 4/2/2009 McConnaughey, Jennifer E. RN Endorsement License Denied 6/23/2009 McKeown, Kathy RN037649 Revocation 4/27/2009 Merrill, Amy R. RN115430/LP035988 Probation 4/8/2009 Miller, David M. LP045463 Probation 5/13/2009 Mochal, Karen R. RN157610 Probation 5/26/2009 Muoebonam, Gladys C. RN122547 Probation 5/1/2009 Naughton, Shirley C. LP012311 Decree of Censure 5/20/2009 Niemeyer, Laura P. LP027755 Voluntary Surrender 6/3/2009 Nwankwo, Jude I. LP040048 Probation 4/6/2009 Palko, Amanda J. RN140617 Revocation 4/7/2009 Pallanes, Tiffani R. RN157443 Civil Penalty 4/3/2009 Pawlowski, Regina D. LP032074 Decree of Censure 6/22/2009 Pearce, Albert E. RN128254 Decree of Censure 4/13/2009 Peck, Jeremiah R. RN132289 Voluntary Surrender 5/5/2009 Peplinski, Deanna H. RN045787 Voluntary Surrender 5/8/2009 Petsinger, Christine C. RN124402 Revocation 4/7/2009 Peuser, Phillip A. RN136288 Decree of Censure 5/8/2009 Purvis, Edward A. LP023385 Revocation Rademacher, Tracey A. RN139037 Revocation 6/3/2009 4/30/2009 Ratliff, Helen J. RN049961 Decree of Censure 4/7/2009 Robinson, Anna C. RN157280 Civil Penalty 6/20/2009 Roland, Dawn M. LP045676 Civil Penalty 4/17/2009 Rood, Tristan L. RN114875 Decree of Censure 5/8/2009 Rosset, Lorrie L. RN114964 Revocation 5/28/2009 Roth, Nancy A. RN Endorsement License Denied 5/6/2009 Silva, Marta A. RN063948/AP0186 Probation w/Civil Penalty 4/22/2009 Somers, Colleen M. LP034313 Stayed Revocation w/Suspension 4/28/2009 Spence, Candy L. RN116153 Revocation 4/30/2009 Tawzer, Jeff G. RN134222 Revocation 6/26/2009 Tkach, Mary Ann RN125002 Reissuance w/Probation 4/23/2009 Turner, Louis C. RN112365 Probation 6/26/2009 Tysz, Deborah J. RN112913 Voluntary Surrender 4/30/2009 Valdez, Rosaria A. RN098766/LP031777 Probation 5/15/2009 Van Lanen, Denise L. RN108326/SN0471 Probation 5/15/2009 Wagner, Todd M. RN145082 Probation 4/9/2009 Wall, Jason E. LP040360 Suspension 6/18/2009 Wilkinson, William E. RN070664 Probation 6/30/2009 Willison, Keri R. RN125492 Probation 6/19/2009 Young, Amy M. RN158165/CNA1000002161 Civil Penalty Failure to Comply w/Licensing Board Order, Substance Abuse Criminal Conviction, Failure to Cooperate with Board Failure to Comply w/Licensing Board Order Criminal Conviction, Failure to Cooperate with Board Criminal Conviction, Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse, Failure to Cooperate with Board Failure to Comply w/Licensing Board Order Substance Abuse, Substandard or Inadequate Care, Narcotic Violation or Other Violation of Drug Statutes Criminal Conviction, Substance Abuse Unprofessional Conduct, Substance Abuse, Diversion of Controlled Substance Substandard or Inadequate Care, Failure to Provide Medically Reasonable and/or Necessary Items of Services Patient Abuse License Revocation, Suspension or Other Disciplinary Action Taken by a Federal, State or Local Licensing Authority, Fraud, Deceit or Material Omission in Obtaining License or Credentials, Unable to Practice Safely by Reason of Alcohol of Other Substance Abuse Failure to Maintain Records or Provide Medical, Financial or Other Required Information, Error in Prescribing, Dispensing or Administering Medication Failure to Comply w/Licensing Board Order Fraud Diversion of Controlled Substance Substance Abuse Criminal Conviction, Narcotics Violation or Other Violation of Drug Statutes Failure to Maintain Records or Provide Medical, Financial or Other Required Information, Unprofessional Conduct Unable to Practice Safely, Substandard or Inadequate Care, Failure to Cooperate with Board Criminal Conviction Failure to Meet Licensing Board Reporting Requirements, Violation of Fed/ State Statutes Regulation or Rules, Criminal Conviction Failure to Comply w/Licensing Board Order Failure to Comply w/Health & Safety Requirements, Negligence Criminal Conviction Criminal Conviction, Fraud, Deceit or Material Omission in Obtaining License or Credentials, Substance Abuse Substance Abuse Failure to Comply w/Licensing Board Order Criminal Conviction, Fraud, Deceit or Material Omission in Obtaining License or Credentials, Failure to Cooperate with Board Failure to Maintain Records or Provide Medical, Financial or Other Required Information, Substandard or Inadequate Skill Level Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse, Diversion of Controlled Substance Failure to Comply w/Licensing Board Order Failure to Comply w/Licensing Board Order, Unable to Practice Safely by Reason of Alcohol or Other Substance Abuse Failure to Meet Licensing Board Reporting Requirements, Substance Abuse Violation of Federal/State Statutes Regulation or Rules, Criminal Conviction; Substance Abuse Failure to Comply w/Licensing Board Order Unsafe Practice Unprofessional Conduct Criminal Conviction Failure to Comply w/Licensing Board Order Substandard or Inadequate Care, Substandard or Inadequate Skill Level, Patient Abandonment Substance Abuse Violation of Federal/State Statues Regulation or Rules, Criminal Conviction UPDATED LICENCURE STATUS RN-LPN SUBJECT TO A BOARD ORDER/CONSENT AGREEMENT April-May-june 2009 effective date name LICENSE discipline violation(s) 6/5/2009 RN114042/LP033131 Hua, Chyi Jen Probation Completed terms of the Suspension, converted license to Probation arizona STATE BOARD OF NURSING Regulatory Journal 29 RN-LPN Discipline ACTION CLEARED April-may-june 2009 effective date name 6/3/2009 Bray, April 5/1/2009 Brown Jr., Garry L. 4/10/2009 Duick, Jennifer A. 6/9/2009 Gillcoatt, James P. 6/3/2009 Hill, Denise M. 5/27/2009 Ireland, Sheron J. 6/9/2009 Jennings, Marvin K. 6/3/2009 Johnson, Veronica E. 4/1/2009 Lopez, Mary F. 6/3/2009 Noriega, Nancy Y. 6/3/2009 Ross Feeley, Suzanne P. 5/15/2009 Tambi, Kennedy C. 6/19/2009 Thomas, Sandra C. 6/3/2009 Wright, Kenneth T. LICENSE LP044417 LP000032935 RN141230 RN089620 RN103152/AP1688 RN034303 RN098694 RN076109 RN119733 RN040222 RN071694 RN129381 RN105564 LP037077 RETRACTION In VOL 4, No 1, Feb 2009 1st Quarter of the Arizona State Board of Nursing’s Regulatory Journal Disciplinary Violations for Jennifer A. Kreger, LP045102 were incorrectly identified. The correct violation is Failure to Comply with Board Order. Arizona State Board of Nursing 4747 North 7th Street, Suite 200 Phoenix, AZ 85014-3653 Presorted Standard U.S. Postage PAID Little Rock, AR Permit No. 1884