arizona VOL1 • NO2 • MAY 2006 2ND QUARTER STATE BOARD OF NURSING REGULATORY JOURNAL Arizona State Board of Nursing 85th Anniversary Celebration June 9, 1921-2006 Celebration Luncheon: Governor’s Task Force on the Nursing Shortage REDUCING HARM: Common Signs of Substance Abuse & Impaired Practice PUBLISHED BY ARIZONA STATE BOARD OF NURSING 4747 North 7th Street, Suite 200 Phoenix, AZ 85014-3653 Phone: 602.889.5150 Main fax: 602.889.5155 CANDO fax: 602.889.5238 General e-mail: arizona@azbn.gov Website: www.azbn.gov GOVERNOR The Honorable Janet Napolitano Joey Ridenour, RN, MN EXECUTIVE DIRECTOR Sue Hanauer, VP Patient Care Services, John C. Lincoln Hospital North VO L 1 • N O 2 • M AY 2 0 0 6 2 N D Q UA R T E R 4 f reoxme ctuhtei v e d i r e c t o r 6 from the president 9 staff directory 10 e d u c a t i o n c o r n e r Judy Bontrager, RN, MN ASSOCIATE DIRECTOR/OPERATIONS 12 O p e n L e t t e r t o B o a r d Valerie Smith, RN, MS ASSOCIATE DIRECTOR/INVESTIGATIONS Members and Staff BOARD MEMBERS 14 R e d u c i n g H a r m 18 We l c o m e Tw o N e w Board Members 19 R e g u l a t i o n Kathy Malloch, PhD., MBA, RN, FAAN, PRESIDENT Theresa Crawley, CRNA, MSHSA VICE PRESIDENT Karen Hodges Hardy, RN, MSN SECRETARY Trista Campbell, RN, BSN MEMBER Rundown Patricia A. Johnson, LPN MEMBER Judith F. Rich, RN, MSN MEMBER Steven T. Robertson, LPN, CHPLN MEMBER Above: Commissioned in 1995 by Joey Ridenour for the 75th anniversary of AzBN. The Oil Painting resides in the front lobby of the Board Office. The artist is R. Elaine Davis. Kathryn L. Busby, J.D. PUBLIC MEMBER 22 Celebration Luncheon: M. Hunter Perry PUBLIC MEMBER arizona Governor’s Task Force on the Nursing Shortage EDITION 2 STATE BOARD OF NURSING CREATED BY: REGULATORY JOURNAL Virginia Robertson, PRESIDENT vrobertson@pcipublishing.com Publishing Concepts, Inc. 14109 Taylor Loop Road Little Rock, AR 72223 FOR ADVERTISING INFORMATION: Steve McPherson smcpherson@pcipublishing.com 501.221.9986 • 800.561.4686 Arizona Student Nurse 28 S c o p e o f P r a c t i c e Committee Report 29 Nurse Imposter Alert 30 D i s c i p l i n a r y Actions from the executive director JOEY RIDENOUR, RN, MN FOURTEEN PRINCIPLES of Nursing Regulation I had the pleasure of attending the March 2006 National Council of State Boards of Nursing Midyear Meeting. For the “first time ever”, 20 Executive Directors of Boards of Medicine and 45 Executive Officers of Boards of Nursing spent the day collectively discussing how we should “Ensure Safe Practitioners Through Collaboration & Regulatory Excellence.” Barbara Safriet, Associate Dean, Yale Law School moderated the process as well as presented her thoughts and reflections on the future of health care regulation. As the Arizona State Board of Nursing nears its 85th Anniversary, I believe that the shared principles provided at the meeting are timeless and will be “guiding principles” for nursing regulation for the near future and perhaps decades to come. Dean Safriet provided the following General Principles of Regulation: 1.) Do the least possible required in statute/rules to achieve the goal identified. 2.) Don’t create general statutes/rules for specific problems. When you create a general solution to a specific problem you create more problems. 3.) Gather, share and analyze information with other health professions. Understand the origins & contexts of the problems or issues. Analyze and connect the dots for knowledge. 4.) Explain what the problem is and how this regulatory change will work to address the issue. 5.) Be thoughtful about minimizing unintended consequences. When changing scopes of practice, be aware of other health professional roles and anticipate problems that could create consumer issues. 6.) Don’t decrease access and increase costs when planning to change educational requirements. 7.) Be more active in testifying before the legislature on patient safety issues. 8.) As regulatory boards, demonstrate three key competencies: information, cooperation and respect. 9.) Mind the store, identify priorities and don’t get distracted. 10.) Promote best practices related to safe patient care. 11.) Be active but not manic. 12.) Protect and promote the public interest. 13.) When educating others on scope of practice issues get beyond “us and them” and get to “we”. 14.) Be mindful of the actions of others that would diminish the Boards ability to regulate. Finally, know that the recent office move to our new space at 4747 N. 7th Street, Phoenix, Arizona may have created disruption in services to you. By now the old office space on 1651 E Morten will be have been “bladed” to ready the grounds for a new development. Those attempting to access the prior address will not have the traditional building notification that AzBN has moved. Your assistance in getting information to your employees is appreciated. Joey Ridenour, RN, MN EXECUTIVE DIRECTOR 4 arizona STATE BOARD OF NURSING REGULATORY JOURNAL REACH RECRUIT RETAIN arizona . 1 VOLUME 1 • NO STATE BOARD OF NURSIN G JOURNAL REGULATORY Regulation RUNDOWN ation is Critical CASE STUDY: License Verific THE ARIZONA STATE BOARD OF NURSING MAGAZINE SCHEDULE • August 2006 • November 2006 • February 2007 to reserve advertising space smcpherson@pcipublishing.com 1-800-561-4686 Our State Board magazines are directly mailed to every licensed nurse in the following states–one million and growing! • Arizona • Arkansas • The District of Columbia • Indiana • Kentucky • Nebraska • Nevada • • • • • • • • New Mexico North Carolina North Dakota Ohio South Carolina South Dakota Tennessee Wyoming www.thinkaboutitnursing.com 6 from the president KATHY MALLOCH PHD, MBA, RN It gives me great pleasure to welcome our two new board members, Steve Robertson LPN member and Hunter Perry, public member. Steve and Hunter joined us for their first meeting in March and now bring the board to its full 9-member compliment. Both bring unique skills and experiences that will certainly enrich the quality of the board’s decision making process in assuring public protection. As most of you know, the board and staff continue to work aggressively to assure timely management of complaints (average time from complaint to board meeting is now 6.4 months!) as well as continuing to examine issues related to the overall regulatory processes. Recently, two issues have generated significant dialogue and differing opinions; the National Council of State Boards of Nursing (NCSBN) Draft Advanced Practice Vision paper and the issuance of a notice of deficiency to Excelsior College. NCSBN Draft Advanced Practice Vision Paper • One issue that is being vigorously debated and examined is the NCSBN Advanced Practice Vision paper. This document, released in February 2006 by the board of directors of NCSBN as recommended by the Advanced Practice committee, presents a vision for nurse practitioners, certified registered nurse anesthetists, midwives, and clinical nurse specialists. The document was presented after three years of study, debate and dialogue by the NCSBN Advanced Practice Committee. The anticipated next phase of the process is to gather input, evidence, and recommendations to continue the debate at the NSCBN Delegate Assembly meeting in August 1-4, 2006 in Salt Lake City, Utah. At the March 2006 meeting, the Arizona State Board of Nursing referred the document to the Advanced Practice Committee for review of the substance of the paper, review of comments from nurses in Arizona and other national organizations and to make recommendations to the board at its May 2006 meeting. A link on the Arizona board website to elicit comments and recommendations will also be created to allow nurses from across the state to share their opinions. Excelsior College • As many of you are aware, Excelsior College is an external degree program that does not offer classroom or clinical instruction. The college awards credit by transfer from a regionally accredited institution or testing. To address the need for clinical instruction, Excelsior requires that applicants have a healthcare background which could include LPN, foreign physician, paramedic, respiratory therapist or military corpsman. To obtain clinical experience applicants are urged to practice in their present job role and seek an RN mentor to observe. Excelsior does not help students obtain a mentor. Students are tested on clinical skills during a two and a half day exam CPNE (Clinical Practice in Nursing Exam). The student is not tested in all areas of nursing in the CPNE. The Arizona board approved Excelsior College (then Regents) to conduct clinical testing at Maricopa Medical Center in the 1990s. In 1997, the Arizona Board of Nursing Education committee requested Regents/Excelsior to address concerns related to the clinical instruction in their program and apparent lack of clinical arizona STATE BOARD OF NURSING REGULATORY JOURNAL continued on Page 8 continued from Page 6 skills in some graduates investigated for unprofessional conduct. In 2004, Excelsior lost their contract with Maricopa and obtained a contract with Banner Desert Medical Center. Staff at Banner Desert requested that Excelsior provide proof that it was a board-approved program. Excelsior presented a request to the Education Committee to conduct clinical testing at Banner Desert February 2005. The committee found that the Excelsior program did not meet rule requirements for nursing programs in Arizona and requested Excelsior work with the board to meet the intent of the current rules. Given the lack of progress in resolution of the lack of clinical experience, the board issued a notice of deficiency to Excelsior College at its January 2006 meeting. Discussions continue with Excelsior College and the Education Committee to review a proposed preceptor program. Six other states (Colorado, Kansas, Oklahoma, Washington, Georgia, and Louisiana) have taken action to limit the ability of Excelsior graduates to obtain licensure. Most recently the California Board of Registered Nursing prevailed in a state Court of Appeal decision that Excelsior College graduates, like other out-of-state programs, must fulfill all California licensing requirements, including supervised clinical practice, in order to qualify for licensure as a registered nurse in California. Clinical hour requirement is 810 hours in California. The work of the board is to assure that registered nurses are competent to enter the workforce and continue to ask the hard questions: What is the appropriate number or range of student clinical hours and in which specialties should they occur? Note: Hours of clinical experience vary widely in programs across Arizona. Are there other innovative processes to gain the experiences that are believed essential to practice competence? Is the evidence provided by Excelsior for clinical competence specific to student competence following graduation generalizable to all nursing students? What are we missing? Excellence, Excelsior and My Golf Game • On a personal note, as I ponder the Excelsior issue, I find myself reflecting on the game of golf—my much loved pastime. To become a somewhat competent golfer, I did several things—read the books about golf and learned as much as I could about techniques, players, equipment, and golf courses. Next, I went to the driving range in a controlled environment and simulated the golf swing for short, medium and long shots, practiced putting and hitting from sand traps. Finally, I began the real work of learning to play the game in all kinds of conditions and situations. I moved to the real world of the golf course with an experienced golfer and began to apply the knowledge and simulation experiences to the golf course. It was the beginning of my lifelong journey to develop competence and become a competent golfer. I share this because I believe that the Excelsior program has provided the instruction and simulation in some cases but has not assured that students are competent to manage the course through integration and application of principles learned. To be sure, issues of this magnitude continually present challenges to both board members and board committee members. The issues of timeliness in responding, equity in decision-making, patient safety, consideration of available evidence to support decisions, and the ever present mandate to protect the public are regularly debated before decisions are made. While these issues are fraught with varying amounts of emotion and evidence, our challenge as a board of nursing is to understand both the emotional and objective issues and then integrate them into policy that is based on evidence from research, the experience of experts, and the needs of the citizens of Arizona. We welcome your input and dialogue. Kathy Malloch, President ARIZONA STATE BOARD OF NURSING 8 arizona STATE BOARD OF NURSING REGULATORY JOURNAL ADMINISTRATION Joey Ridenour, RN, MN Executive Director 602.889.5200 jridenour@azbn.gov EDUCATION Pamela Randolph RN, MS Education Consultant/Educational Programs RN/LPN 602.889.5209 prandolph@azbn.gov Judy Bontrager RN, MN Associate Director-Operations & Licensing 602.889.5204 jbontrager@azbn.gov Rose Wilcox, RN Education Programs CNA 602.889.5176 rwilcox.@azbn.gov Valerie Smith RN, MS Associate Director-Nursing Practice, Complaints & Investigations 602.889.5206 vsmith@azbn.gov FISCAL SERVICES Norma Salter Accounting Technician 602.889.5211 nsalter@azbn.gov STAFF DIRECTORY Lila Wiemann Administrative Assistant to the Executive Director 602.889.5292 lwiemann@azbn.gov Dolores Hurtado Assistant to Associate Director/Nursing Practice, Complaints & Investigations 602.889.5158 dhurtado@azbn.gov Thereasa Huff Assistant to Associate Director/Nursing Practice, Complaints & Investigations 602.889.5208 thuff@azbn.gov Mary Palmer Administrative Assistant to Associate Director/Operations & Licensing 602.889.5205 mpalmer@azbn.gov ADVANCED PRACTICE Karen Grady, MS, RN, FNP, BC Advanced Practice/RN/LPN 602.889.5182 kgrady@azbn.gov CANDO Suanne Smith, RN, MS Nurse Consultant - CANDO 602.889.5156 ssmith@azbn.gov Olga Zuniga Administrative Secretary – Monitoring & CANDO 602.889.5157 ozuniga@azbn.gov Barry Harris Business Manager 602.889.5210 bharris@azbn.gov HEARINGS Susan Barber, RN, MSN Nurse Practice ConsultantHearing Dept 602.889.5151 sbarber@azbn.gov Debra Blake Legal Assistant 602.889.5183 dblake@azbn.gov Vicky Driver Admin. Assistant-Hearing Dept 602.889.5162 vdriver@azbn.gov INVESTIGATIONS NURSE PRACTICE CONSULTANTS Betty Nelson, RN, MS 602.889.5169 bnelson@azbn.gov Jeanine Sage, RN, MSN 602.889.5174 jsage@azbn.gov Mary Rappoport, RN, MN 602.889.5184 mrappoport@azbn.gov Nan Twigg, RN, MSN 520.615.4945 ntwigg@azbn.gov Pat Midkiff, RN, MN 602.889.5179 pmidkiff@azbn.gov Sister Rachel Torrez, RN, MS 602.889.5180 srachel@azbn.gov Sydney Munger, RN, MS 602.889.5186 smunger@azbn.gov SENIOR INVESTIGATORS Duncan “Cory” Polak 602.889.5172 cpolak@azbn.gov James Williams 602.889.5167 jwilliams@azbn.gov Jeanne Bauer 602.889.5178 jbauer@azbn.gov Kirk Olson 602.889.5171 kolson@azbn.gov Ronald “Ron” Lester 602.889.5159 rlester@azbn.gov LEGAL SECRETARIES Barbara Ritenour 602.889.5193 britenour@azbn.gov Dorothy Lindsey 602.889.5177 dlindsey@azbn.gov Esther Garcia 602.889.5173 egarcia@azbn.gov Karen Gilliland 602.889.5187 kgilliland@azbn.gov Trina Smith 602.889.5175 tsmith@azbn.gov INFORMATION TECHNOLOGY Cory Davitt Network Operations Director 602.889.5213 cdavitt@azbn.gov Adam Henriksen Information Technology Director/Webmaster 602.889.5231 ahenriksen@azbn.gov LICENSING Becky Melton RN/LPN Exam 602.889.5190 baranyos@azbn.gov Debbie Kunkle RN/LPN Renewals 602.889.5195 dkunkle@azbn.gov Cristina Oates RN/LPN Endorsements 602.889.5191 coates@azbn.gov Donna Frye Advance Practice – School Nurses 602.889.5194 dfrye@azbn.gov Helen Tay CNA Exam/Endorsements 602.889.5189 htay@azbn.gov Paula Delphy RN/LPN Endorsements 602.889.5192 pdelphy@azbn.gov Rhonda Rogers CNA.Renewals 602.889.5188 rrogers@azbn.gov MAILROOM Rita Kelly.Sierra 602.889.5215 rkelly@azbn.gov MONITORING Erica Bailey Senior Investigator 602.889.5160 ebailey@azbn.gov Pamm Wiggin, RN, JD Nurse Consultant 602.889.5170 pwiggin@azbn.gov Brent Sutter Legal Secretary Monitoring & CANDO 602.889.5168 bsutter@azbn.gov RECEPTIONISTS Athena Santos 602.889.5196 asantos@azbn.gov Marlane Brosseau 602.889.5199 mbrosseau@azbn.gov Susan Kingsland 602.889.5224 skingsland@azbn.gov RECORDS Charlotte Seechoma Records Room 602.889.5217 cseechoma@azbn.gov arizona STATE BOARD OF NURSING REGULATORY JOURNAL 9 education corner PAMELA RANDOLPH RN, MS EDUCATION CONSULTANT Essential Elements of Nursing Education The National Council of State Boards of Nursing (NCSBN) has been exploring evidence based indicators of quality nursing education as part of a large project where evidence based elements of education from published literature will be identified. The Elements of Education Study by Dr. Suling Li explored the relationship of the characteristics of a graduate’s nursing program, practice, and transition program to the graduate’s perception of preparedness and difficulty with client assignments. Graduates had an increased perception of preparedness and/or less difficulty with assignments when their programs: Teach specialty knowledge as independent courses (pediatric, medical-surgical, women’s health, psychiatric/mental health, critical care) Integrate critical thinking, pathophysiology, the use of information technology, and evidence based practice throughout the curriculum Use the same faculty to teach both the didactic and clinical courses Have faculty who are highly available to students during both clinical and didactic Utilize faculty to demonstrate and assist with skills in clinical activities and require students to demonstrate skills before performing them on patients Require students to analyze multiple types of data when making client decisions Provide transition to practice programs of sufficient length and that focus on specialty knowledge of the patient population. English Language Proficiency for Graduates of International Nursing Programs The Board is considering changing the minimum scores for English language proficiency examinations in Article 3 (R4-19-301), based on research from National Council of State Boards of Nursing. Thomas O’Neill PhD, Associate Director of NCLEX Examinations at National Council of State Boards of Nursing will address the Education Committee and interested members of the public on the recommended cut scores for English language proficiency examinations on June 9th 2006. The Committee invites all interested members of the public to attend. Please see the Board website for 10 arizona STATE BOARD OF NURSING REGULATORY JOURNAL location and exact times of the June 9 Education Committee meeting. Students Attend Board Meeting Several Glendale Community College students attended the March Board meeting with the assignment to “role play” some aspect of the Board meeting. When talking with their instructor about the Board meeting, they reported that they were impressed by how well the Board worked together, how focused they were, the fairness of the proceedings, and how “student friendly” the Board was. Students and all members of the public are welcome to attend Board and Committee meetings. Please visit the Board website for dates and location of meetings. BOARD ACTIONS ON EDUCATION MATTERS January 2006 Dismissed complaint against Pima Medical Institute Approved Maricopa Community College District Nursing Program to decrease the length of the program Released Northland Pioneer College from probation and approved request to increase enrollment Approved CNA Curriculum and CNA Minimum Competencies as a resource for CNA programs and the public Issued a Notice of Deficiency with 12 months to correct to Excelsior College for lack of instructed clinical experiences March 2006 Renewed full approval of Grand Canyon University Granted final approval of SouthWest Skill Center/Estrella Mountain CC PN program for 3 years with a site visit in 1 year and dismissed complaint (with a letter of concern) Approved new site for Maricopa Community College Nursing Program at Estrella Mountain CC Approved change in mission and goals at Northern Arizona University Nursing Program Approved new site and increase in enrollment at Baptist Health System Nursing Program Approved application of Consolidated Learning Services Refresher Program Approved University of Mary for clinical preceptorships in Arizona in Spring 06 only. Open Letter to Board Members and Staff Staff note: Portions of a letter written by a licensee and read to the Board during their March Meeting is being published with his permission. The letter describes some of the classic symptoms of addiction including the inability to predict and control one’s use while mistakenly believing that control is possible; the preoccupation with using or not being able to use; the use of the substance despite the potential for negative consequences; the losses and chaos that substance abuse and addiction often causes in a person’s life, and often years before being identified in the professional environment. Valerie Smith, MS, RN MEMBERS OF THE BOARD: I want to thank you for giving me the opportunity to explain how I got here today, how the events and circumstances of my life have led me to this point. I am here as a direct result of having tested positive for marijuana while on a mandated random drug screening program, ordered by the this board as part of my conditions of probation from an incident about a 1 year ago, also related to marijuana use. The fact is, I have smoked pot, on and off, for about 24 years. I’ve never smoked every day, but have friends who smoke and I and enjoy getting high in the company of those friends. I worked construction for 16 years prior to nursing, and would never use before or during work. I’ve been married almost 19 years. My wife is against drug use of any kind, and neither of us smoke cigarettes, and only drink occasionally. My pot use has always been a source of friction between us, but she was able to tolerate it, as long as I didn’t have it around the house or seemed to be using too often. I honestly believed my smoking pot was not a problem. I have always been a loving husband, a hard worker, and a good provider. After my son was born I realized that I should stop. I would never want him to smoke. I told myself I would stop soon, but soon never came. My life has changed in many ways since he was born, almost 10 years ago now. I went back to school, obtained my nursing degree, and have worked as an ER nurse now for 7 years. It was one of the best things I have ever done. I am dedicated and passionate about my work, extremely satisfied with my career choice, and love the fact that I continue to learn and grow with each shift. But, I still maintain ties with my old friends, and once in a while, I still smoke put. 12 arizona STATE BOARD OF NURSING REGULATORY JOURNAL A year ago, I was busted smoking pot while fishing in a public park. I could have been arrested, could have lost my job, and almost wrecked my marriage. I was so lucky. This board, my employer, and my wife all gave me another chance. I tried to be honest about my drug use, promised to quit completely, but in reality, I wasn’t being honest with myself the only change I made was not smoking. I was resentful that I could no longer smoke, and continued to hang around my old friends and continued to be tempted. It was only a matter of time. It finally happened. While over at a friend’s house, I smoked again. It had been 11 months since my prior incident, 11 months without getting high. Knowing I was on probation, knowing my wife would be devastated, knowing my career was on the line, I did it anyway. Eight days later, my next urine drug screen was positive for marijuana. “I have received overwhelming support, and I realize now that the help I needed was right there all the time, all I had to do was ask.” When I went to see Erica Bailey she was unforgiving, tough, and told it to me straight. I had seriously screwed up, and maybe I wasn’t meant to be a nurse at all. Maybe I should just give up my nursing license and continue to be a stoner, seems that was what I really wanted. I’d lost my job, my marriage was in serious trouble, and I’d thrown away everything just to get high. I knew how bad this was, but I also knew I loved my wife and my son more then anything else in this world. I loved the life we had built together, and I knew that being an ER nurse was much more than just a job to me, it was who I am. I realized this was much more than just liking to get high once in a while, this was a serious addiction, and I needed help. At Erica’s urging, I contacted Valley Hope and enrolled in an intensive outpatient drug treatment program. The counselors there helped me realize I needed to stop minimizing my problems, that I needed to face the fact that I am indeed an addict, and will always be an addict, and that no one can beat a drug addiction until you recognize it for what it is. Notice of Address Change from the Arizona State Board of Nursing I’ve learned a tremendous amount about the nature of addiction, and have met many others who have suffered like I have and many others much worse off. I realize now the power that pot has had over me that all these years I was struggling to manage my addiction, when in fact, it was managing me. I’ve learned that I could never beat this until I admitted to myself that I am powerless over my addiction, and need to reach out beyond myself to get the strength I would need to overcome my problems with marijuana, my family, and my life. In addition, my wife and I are seeing a personal counselor to help us become a strong family unit again, and to be able to support each other and begin to repair the damage that this, that I, have done to our marriage, and to her ability to trust me again. Although I have smoked pot for many years, in reality I was ashamed of it, and I have never told my parents or friends about my problem. Very few people actually knew the truth. Well, all that has changed. It was tremendously difficult to come clean to my parents, close friends and co-workers. I was embarrassed and ashamed, and thought they would turn their back on me, tell me I got what I deserved. Instead, I have received overwhelming support, and I realize now that the help I needed was right there all the time, all I had to do was ask. Regardless of the outcome of this hearing today, I am confident I will never go back to smoking pot ever again, that I can find the strength to completely change, to no longer associate with my user friends, to learn to use the support system I have when I feel cravings or resentment, to not be afraid to communicate my fears and my needs, to realize that I will be a recovering addict for the rest of my life. Authors Name Withheld The Arizona State Board of Nursing has moved to a new location. All contact numbers and email addresses have remained the same. The new address is listed below. 4747 North 7th Street, Suite 200 Phoenix, AZ 85014 Phone: 602.889.5150 • Main fax: 602.889.5155 arizona@azbn.gov • www.azbn.gov arizona STATE BOARD OF NURSING REGULATORY JOURNAL 13 CANDO corner VALERIE SMITH, MS, RN ASSOCIATE DIRECTOR, COMPLAINTS AND INVESTIGATIONS SUANNE SMITH, RN, MS CANDO NURSE PRACTICE CONSULTANT REDUCING HARM: Common Signs of Substance Abuse & Impaired Practice It is estimated that dependence on or abuse of alcohol or illicit drugs among persons aged 12 or older is approximately 10 percent, with alcohol being the most prevalent drug of abuse. While nurses’ use of alcohol and drugs is about the same rate as the general population, a nurse’s dependence on or abuse of alcohol or drugs may lead to unsafe practice and harm to patients as well as cause other potential serious medical complications. If left untreated, ultimately death occurs. Early recognition of addiction, treatment and monitoring of ongoing recovery and sobriety status is essential in minimizing the risk of harm to patients and to promoting the well being of the nurse suffering from the disease of addiction. attentive to the patient. When a nurse is unable to or fails to provide care according to standards of nursing practice or disregards the policies and procedures of the facility, the safety of the patient may be threatened. The workplace is often the last place for the signs and symptoms of substance abuse and addiction to be evident. By the time the symptoms do become recognizable in the workplace, the nurse typically has developed a significant substance abuse problem that may have already impacted other areas of the nurse’s life. While there are numerous signs and symptoms indicative of a substance abuse problem, none of the symptoms alone is conclusive evidence of a substance abuse problem. Likewise, Addiction is a chronic progressive disease characterized by increased tolerance, inability to predict and control one’s use, and the preoccupation with securing or using the drug or alcohol. Addiction is a chronic progressive disease characterized by increased tolerance, inability to predict and control one’s use, and the preoccupation with securing or using the drug or alcohol. It involves the inappropriate, compulsive use of the drug or alcohol and despite a high potential for negative consequences. In nurses, substance abuse and addiction impairs the nurse’s practice by affecting the nurse’s communication, assessment, technical and decision-making ability, and ability to be present and 14 there are times when there are no obvious symptoms until an acute event occurs such as overt symptoms of active impairment on duty or indications of narcotic diversion are identified. It is imperative that administrators, managers and fellow nurses increase their knowledge about the problems and patient harm that substance abuse can cause and how to identify common signs that may be seen in nurses who abuse drugs and/or alcohol. All nurses have a legal and ethical responsibility to protect arizona STATE BOARD OF NURSING REGULATORY JOURNAL patients from harm and a duty to respond to and report concerns about impaired practice. Failure to do so may facilitate the nurse moving from facility to facility and continue to endanger the safety of patients. Behavioral indicators: • emotionally labile, mood swings, inappropriate verbal or emotional responses • diminished alertness, nodding off or sleeping on duty • confusion or memory lapses • absence from the unit • frequenting the restroom after accessing drugs • defensiveness, suspiciousness, secretiveness, lying • elaborate implausible excuses for behavior • isolation from peers and others • neglect of commitments and obligations Time and attendance indicators: • excessive use of sick time or absent from work, particularly if drug of choice is accessed and used outside of the work environment (alcohol, marijuana, …) • late to work • frequent or unexplained absences from the unit • works excessive hours, particularly if drug of choice is accessed through the work environment (narcotic and controlled drug diversion) • appears on the unit on days off Physical indicators: • odor of alcohol • tremors or shakiness • unsteady gait • slurred speech • constricted pupils Job performance indicators: • increasing difficulty in meeting deadlines • requests for assignments that increases access to drugs • medication “errors”, documentation “errors”, sloppy or illogical documentation • poor judgment, errors in cognition, disorganization and difficulty prioritizing • unreasonable excuses for poor performance • gradual deterioration in job performance (commonly not identified until late in the disease and addiction process) Drug diversion is symptomatic of the compulsion to use, loss of control, and continued use despite negative or high potential for negative consequences. It involves impulsive and compulsive thinking and behaviors and unfortunately, is not uncommon in nurses with the disease of addiction. Workplace indicators of drug diversion include: • discrepancies involving incorrect, altered or missing controlled drug records • high volume of narcotic removal • discrepancies between nursing notes, medication records and controlled drug records • narcotics signed out to patients who do not have an order, are not on the unit or who report they did not receive the medication • inconsistencies with medications required from shift to shift • drugs signed out to patients after discharge or transfer • drugs signed out to patients outside his/her assignment arizona STATE BOARD OF NURSING REGULATORY JOURNAL 15 • patients report not receiving medications or not attaining pain relief from medications they reportedly received unwitnessed or excessive waste of controlled drugs • tampered with drugs, vials or containers • defensiveness when questioned about medications missing, administered, picked up, or delivered It is usually a combination of several of the above signs that are noticed by a nurse manager or the other nursing staff and often requires an extensive process of gathering and reviewing multiple documents and interviewing others. The documents may include narcotic dispensing records, patients’ medical records and personnel records. Gathering facts to confirm or substantiate observations and concerns about a nurse would also be necessary. Once information and documentation has been gathered and analyzed, and the nurse is identified as potentially engaging in substance abuse, an intervention should be done as soon as possible so that the nurse’s harmful behaviors can be stopped. During the meeting, the nurse should be presented with information regarding available resources and the Arizona State Board of Nursing’s Chemically Addicted Nurses Diversion Option (CANDO) program. On our website, www.azbn.gov, under the heading of Resources select CANDO, there is the “Frequently Asked Questions” about the CANDO program. The nurse should be encouraged to call the Board’s CANDO program at 602-889-5156 and speak with the CANDO Nurse Practice Consultant. Whether or not the nurse contacts the CANDO program, the employer or others with information are required to notify the Board of Nursing. The Nurse Practice Act under A.R.S. §32-1664 (B) states: A licensee, a certificate holder and a health care institution as defined in section 36-401 shall, and any other person may, report to the board any information the licensee, certificate holder, health care institution or individual may have that appears to show that a licensee or certifi16 arizona STATE BOARD OF NURSING REGULATORY JOURNAL cate holder is, was or may be a threat to the public health or safety. Failure to report such information to the Board of Nursing may be grounds for the Board to take disciplinary action against the license or certificate of those who had knowledge but failed to report. A.R.S. §321601 (16) (k) defines unprofessional conduct in part, as: Failing to report to the board any evidence that a professional or practical nurse or a nursing assistant is or may be: (i) Incompetent to practice. (ii) Guilty of unprofessional conduct (iii) Mentally or physically unable to safely practice nursing or to perform nursing related duties. A nurse who is providing therapeutic counseling for a nurse who is in a drug rehabilitation program is required to report that nurse only if the nurse providing therapeutic counseling has personal knowledge that patient safety is being jeopardized. CANDO is an alternative to discipline program, available to eligible nurses with substance abuse and addiction and who Save the Date! The Arizona State Board of Nursing Invites You to Attend the: Arizona Nurse Practitioner Summit Maintaining Scope of PracticeExpanding Competencies Location: Rio Salado College Conference Center September 29, 2006 Information & Registration: www.azbn.gov The workplace is often the last place for the signs and symptoms of substance abuse and addiction to be evident... are licensed by the Arizona State Board of Nursing. It is a voluntary program and is confidential to the general public as long as the nurse remains in compliance with the CANDO stipulated agreement. CANDO enhances protection of the public by providing earlier identification, intervention, monitoring and treatment of eligible nurses, and with a goal of returning the recovering nurse to safe nursing practice. Nurses, who are eligible, must voluntarily agree to continued on Page 24 arizona STATE BOARD OF NURSING REGULATORY JOURNAL 17 WELCOME TWO New Board Members M. Hunter Perry Mr. M. Hunter Perry is Business Development Manager for Sonora Quest Laboratories specializing in services for the geriatric and long term care community. His background in the area of aging also includes experience in neurodegenerative disease research. Hunter has been a healthcare professional for over 20 years, and is a graduate of U.S. Naval Health Sciences in San Diego. He is an active Business Affiliate Member of the Arizona Health Care Association and serves on the AHCA Public Policy Committee. Mr. Perry’s term expires June 30, 2010. Steve Robertson Mr. Steve Robertson has been employed with Hospice of the Valley in Peoria for the past nine years. Steve has been a LPN for 28 years. He is currently a member of Hospice and Palliative Nurses Association. Mr. Robertson’s terms expires June 30, 2008 Arizona Student Nurse with Instructor 18 arizona STATE BOARD OF NURSING REGULATORY JOURNAL by Pamela Randolph RN, MS Regulation RUNDOWN Rulemaking R4-19-215; R4-19-301; R4-19-302; R4-19-505; R4-19-506; and R4-19-507. These individual rules need revisions to address issues that have arisen since their adoption. A rulemaking docket was filed and published on the Administrative Register on March 3rd, 2006. Amendments to Article 2 (R4-19215) will incorporate a process for rescinding the approval of an out-ofstate nursing program that does not substantially meet Board standards. Other Amendments to Article 3 (R4-19302) will give the Board discretion to prescribe additional licensure requirements for an individual who graduates from a revoked nursing program. The Board is also considering changing the minimum scores for English language proficiency examinations in Article 3 (R4-19-301) based on research from National Council of State Boards of Nursing. Please see the announcement in Education Corner regarding an opportunity to hear Dr. Thomas O’Neill, Associate Director of NCLEX Examinations at National Council of State Boards of Nursing, address the Education Committee and interested members of the public regarding recommended English language proficiency scores. Amendments to Article 5 (R419-505) will extend the waiver of certification for clinical nurse specialists practicing in the area of maternal/infant health or women’s health until a certification exam is developed. The other rules were opened to make technical and grammatical changes to improve clarity and internal consistency (R4-19506; R4-19-507). Future Rulemakings Extensive revisions of Articles 4 (Regulation) and 1 (Definitions and Time-frames) are planned. Please watch the Board website for more information. The person to contact at the Board regarding rules is: Pamela Randolph Nurse Practice Consultant 602-889-5209 e-mail: prandolph@azbn.gov Fax: 602-889-5155 arizona STATE BOARD OF NURSING REGULATORY JOURNAL 19 advertisement Nurse Leadership When is it window dressing and when it is real? Nurse leadership is a well-worn notion these days, ful of innovative hospitals in the region that are bene- often turning up alongside phrases like “supportive fiting from nurse guidance on everything from environment!” and “work/life balance!” But take a employment policies to clinical practice. look inside most major hospitals you find authentic nurse leadership is still a rare thing—more common as Case in point: Phoenix Children’s Hospital (PCH), talking point than reality. No surprise; instituting real which has been turning heads since its Nursing nurse leadership means shaking up the status quo, Practice Council was instituted in 2004. This dynamic way and influential self-governance body identifies issues things are done, even and creates solutions, involving managers and direc- handing over some tors in a consultative role where needed. The council power, which isn’t includes representatives from each care area or always easy. department. (Each care area has its own self-gover- changing the nance, called a Unit Based Council—also initiated by The rewards are rich, the Nursing Practice Council—to work on solutions however, judging specific to that care area. When an issue requires hand- housewide attention, the representative brings it to from the the Nursing Practice Council or vice versa.) The council was behind the move to develop a clinical ladder (dubbed the ‘REFLECT Program’), a career track for bedside nurses resulting in increased pay and professional prestige as nurses advance from the Clinical Nurse I designation to Clinical Nurse IV. The REFLECT program, now being finalized, is slated to roll out by early summer. 20 arizona STATE BOARD OF NURSING REGULATORY JOURNAL 2005 Nursing Excellence Awards, Phoenix Children’s Hospital (award recipients and excerpts from their nominations) Excellence in Practice: Britt Olson, PNP Center for Cancer and Blood Disorders Last year, nurses on the council kicked off Nursing Grand Rounds as part of Nurse’s Week Celebration. These nurse-driven educational programs bring in clinical nurse specialists and other experts to speak on topics of interest to PCH nurses such as childhood obesity or childhood asthma. Now a popular and successful resource, Nursing Grand Rounds continues today; a check of the PCH website showed such intriguing Grand Rounds topics as “Adolescent Thoughts Involving Choices with Risk: Do They Differ When Asthma Symptoms are Involved?” and “The New T-Tube Tracheostomy: A Lesson in Patient Education.” This Nurse’s Week brought the Second Annual "Over the past year Britt has developed a new program for our patients. Our 'Late Effects of Cancer Therapy Clinic' is staffed by a multidisciplinary team including a physician, nurse coordinator (Britt), a social worker, an endocrinologist, and a nutritionist…this approach to patients previously treated for cancer has led to a new level of patient education and satisfaction." Excellence in Leadership & Mentorship: Laurie Meenan, RN Care Area 1, General Pediatrics "I saw her inspire everyone around her, including me, to be better as a nurse and as a human being. She believes in nursing - not just the science, but the art, the presence of a human being reaching out to help another. That is what she has done for me, and that is what she has precepted me to do for others." Excellence in Patient & Family Education: Penny Overgaard, RN Airway/Tracheotomy Unit "Penny has taken the initiative to apply evidence-based practice to tracheostomy care, collaborating with nurses in the Emily Center to ensure the teaching materials in the library reflect current practice and research. She not only teaches families to care for their children's trachs but teaches staff how to care for their trachs and how to teach families to do so, too." Nursing Excellence Awards, another brainchild of Heart of Nursing: PCH’s Nursing Practice Council. (See awards and Marcia Dern, RN Clinical Coordinator, General Pediatrics Clinic award winners listed in the sidebar.) Ultimately, it’s this impressive group that reminds us of the true importance of nurse lead- "The nicest thing about Marcia is her willingness to give you the immediate attention you need....She is very conscientious, reliable and cares about what she does for others…She goes the extra mile to give the kids the nurturing and care they deserve." ership. Yes, it’s critical for nurses to have the power to address nuts and bolts problems and start new initiatives. But in the end, nurse leadership is so much more: it’s about creating the conditions for the best patient care possible by supporting nurses to do truly excellent work. Learn more at www.phoenixchildrenshospital.com/ professionals/nursingexcellence Pursuit of Excellence: Peggy Daily, RN Newborn Intensive Care Unit "Peggy has mastered her clinical expertise in the CCN environment where the goal is to support families so that they transition successfully to the home environment. She takes every opportunity to help parents feel confident and knowledgeable; she is flexible and creative in her approach so that the teaching is specific to that family. She doesn't have to convince anyone that she loves her job - it is reflected in how she cares for the families of the patients." arizona STATE BOARD OF NURSING REGULATORY JOURNAL 21 Celebration Luncheon: Governor’s Task Force on the Nursing Shortage February 14, 2006 Pictured Above: (From left to right) back row- Margaret Taylor, Barbara Weber-Averyt, Sandy Hughes, Bernadette Melynk, Daniel Chafetz, Ray Kronebitter, Judith Seller, Charlie Kelly, Marla Weston, Rose Conner, Bertha Sepulveda middle row - Jayne Wilkins, Linda Maschner, Doris Milton, Marty Enriquez, Julie Ward, Fran Roberts, Marjorie Isenberg, Kathy Scott seated - Patt Rehn, Governor Janet Napolitano, Pat Harris, Joey Ridenour Reports from the Governor’s Task Force on the Nursing Shortage are available on the Arizona State Board of Nursing website: www.azbn.gov 22 arizona STATE BOARD OF NURSING REGULATORY JOURNAL Arizona Nurse - Heidi 24 arizona STATE BOARD OF NURSING REGULATORY JOURNAL continued from Page 17 participate and enter into CANDO stipulated agreement before the initiation of a complaint investigation. They may be accepted into CANDO following their self-report to the CANDO program or following the receipt of a complaint to the Board in which a nurse admits to using and/or abusing drugs or alcohol and prior to the initiation of the investigation. If a nurse is not eligible for CANDO or otherwise declines entering into CANDO, an investigation is initiated and the confidential, non-disciplinary option of CANDO, by statute, is no longer available. The CANDO program is a three-year monitoring program that requires attendance at a Board-approved chemical dependency treatment program. Intensive treatment is then followed by attendance at weekly aftercare meetings for a minimum of six months. Other requirements are attendance at 12Step meetings, such as Alcoholics Anonymous, Narcotics Anonymous, and Pills Anonymous; random drug screens at least monthly; weekly attendance at nurse recovery support group meetings, performance evaluations by the nurse’s employer, involvement of the nurse’s medical provider; and completion of self-report forms by the nurse. Once a nurse enters the CANDO program, the information received to develop the rehabilitation plan and all other information is confidential and not subject to the public disclosure. The nurse’s entry into the program remains confidential even after the nurse successfully completes the program. However, the nurse is required to notify any and all nursing employers of their involvement in CANDO while participating in the program. Hiding an addiction to drugs and alcohol will put the care of patients at risk as well as risk the life of the person afflicted with the disease. Appropriate, effective intervention, treatment and monitoring can save a life, a license, and a career. For further information on CANDO, please call Suanne Smith, RN, MS, CANDO Nurse Practice Consultant at 602-889-5156. By Judy Bontrager, RN, MN, Associate Director of Operations NOTICE TO ALL CNAS CNA’S AND CNA EMPLOYERS: Proof of Employment Changes July 1, 2006 The rules for Certified Nursing Assistants were recently amended. Effective July 1, 2006 Certified Nursing Assistants will be required to show proof of employment for a minimum of 160 hours within the previous two years, when applying for renewal of their certification. Currently the requirement is to show proof of working 8 hours in the previous two years. Renewing Online You can renew your CNA certificate on –line by accessing the AzBN website at www.azbn.gov Print out the proof of employment 26 form, complete your section of the form and have your supervisor complete the form and sign. Mail or fax the completed form 602889-5155 Please note: The renewal process will not be will be finalized until one of the following has been received at the Board 1.) the signed proof of employment form, OR 2.) a copy of a paycheck stub which includes the employer’s name, your name and /or social security number and date OR arizona STATE BOARD OF NURSING REGULATORY JOURNAL 3.) a copy of your W-2 form. Renewing Through Mail If you do not choose to renew online and prefer to send you application through the mail, access the Board website at HYPERLINK "http://www.azbn.gov" www.azbn.gov , click on resources, and then click on applications. Scroll down to Certified Nursing Assistant Renewal application and print out the application packet. Complete the application, have your supervisor complete/sign the proof of employment form and mail them both to Arizona State Board of Nursing. When Your License Or Certificate Is Due for Renewal… Post cards will no longer be sent to licensees/certificate holders reminding them of their renewal date. We will however continue to publish reminders in the Arizona State Board of Nursing’s Journal. If you have provided the Board with a valid email address, you will receive an email reminder 2-3 months before your date of renewal. UPDATE your email address and/or other demographic information by following the instructions provided. All RNs/LPNs/CNAs can renew on line except a person with a status of inactive, lapsed, probation, suspended, or revoked license/certificate. • To update your email address and/or other demographic information go to www.azbn.gov. Failure to notify the board within 30 days of a change of residence address will result in a $5 address fine. • Under My Services, click on the STAR to get started • Enter your license/certificate number followed by your PIN code **If you do not remember your Username or PIN code Use the Retrieval tool supplied for you. • After entering your User Name & PIN code, click on LOGIN • Following the instructions to update your personal information Scope of Practice Committee R E P O R T Board Members Co Chairs: Trista Campbell RN BSN & Pat Johnson, LPN Judy Bontrager, RN, MN, Associate Director of Operations At the March 22, 2006 Board Meeting, the Board approved the Advisory Opinions listed below. ALL Advisory Opinions may be viewed and/or download from our website at ww.azbn.gov under the Resources menu. New Advisory Opinion Suture/Staple Removal – Role of the LPN Updated Advisory Opinions Supervision of Unlicensed Nurse Externs by Registered Nurses Orders: Accepting, Transcribing, Signing-off Orders Injection of Lidocaine: Local Infiltration for Femoral Sheath Removal Death, Assessment of Intra-Aortic Balloon Removal Intra-Osseous Cannulation Medication, Carrying by Licensed Nurses Suture Mediated Closure Devices Amniotomy Lumbar Puncture Abandonment of Patients Foley Catheter: Use of Instrumentation to Deflate Malfunctioning Foley Cath Balloon Insertion (and removal) of Laminaria Sponge Pacemaker Wires Intrauterine Pressure Catheters 28 arizona STATE BOARD OF NURSING REGULATORY JOURNAL NURSE IMPOSTER ALERT by Valerie Smith, Associate Director – Nursing Practice, Complaints & Investigations The following individual has either applied for a nursing position or has been employed as a nurse in Arizona without evidence of a valid nursing license. • Patricia Vincent. Nurse Imposter. A cease and desist letter was issued March 15, 2006. The Board of Nursing received information that Vincent had been represented as a “school nurse” while employed at Fort Mohave Elementary School to students, parents and others. There is no record at the Arizona Board of Nursing that validates Vincent completed an approved program of study or holds a valid license to practice nursing in Arizona. A complete list of imposters can be found by visiting our website at www.azbn.gov. For questions regarding imposters or to report an imposter, please contact Valerie Smith, RN, MS, Associate Director at vsmith@azbn.org (602) 889-5206 or Thereasa Huff, Assistant to Associate Director/Investigations at thuff@azbn.gov 602) 889-5208. arizona STATE BOARD OF NURSING REGULATORY JOURNAL 29 *Not reported in previous Newsletter CNA DISCIPLINARY ACTION JANUARY - FEBRUARY - MARCH 2006 (NEWSLETTER MAY/JUNE/JULY 2006) EFFECTIVE DATE 2/23/2006 Allison, Connie J. 1/9/2006 Barthelemy, Carlo 2/17/2006 Big, Lanova 3/13/2006 Brown, Amy K. NAME CNA Applicant CNA Applicant CNA1000008496 CNA Applicant 12/27/2005* 1/19/2006 1/3/2006 11/9/2005* 3/13/2006 1/20/2006 Bullock, Lori I. Bunfill, Darice L. Chapetti, Sara G. Chew, Jeremy B. Christopher, Gordon W. Dejaynes, Sherry M. CNA Applicant CNA608063103 CNA657248103 CNA1000007857 CNA Applicant CNA999990391 1/12/2006 2/10/2006 9/21/2005* 2/9/2006 3/13/2006 Dockery, George T. Duvall, Kelly M. Fields, Hassan K. Flores, Martha A. Ford, Charity R. CNA Applicant CNA1000008503 CNA Applicant CNA999993591 CNA Applicant 2/8/2006 Gustafson, Lisa A. CNA090432533 2/23/2006 3/15/2006 3/13/2006 Harris, Zonya M. Hernandez, Sylvia O. Hoftender, Nancy J. CNA1000008550 CNA999951510 CNA Applicant 11/1/2005* 2/21/2006 2/8/2006 12/15/2005* CNA999951367 CNA1000008505 CNA545593803 CNA999991924 12/27/2005* 1/4/2006 2/22/2006 1/4/2006 12/19/2005* 1/9/2006 Holland, Angelica C. Iudean, Jennifer C. Jones, Edna L. Leatherwood, Stephanie M. Lerma-Trillo, Franciso Marshall, Che M. Martinez, Celia McFadden, Shawn E. McRae, Jose A. Meadows, Shamona R. DISCIPLINEVIOLATION(S) Criminal Conviction-Misdemeanor; Drug Related Theft - Client; Misconduct; Failure to Cooperate Criminal Conviction-Misdemeanor; Alcohol Abuse Criminal Conviction-Misdemeanor; Drug Related; Failure to Cooperate Certificate Denied Criminal Conviction-Misdemeanor; Voluntary Surrender Sex with Client; Sexual Abuse Stayed Suspension Failure to Maintain Minimal Standards; Verbal Abuse Civil Penalty Criminal Conviction-Misdemeanor; Against Person Certificate Denied Criminal Conviction-Misdemeanor; Failure to Cooperate Voluntary Surrender Criminal Conviction-Drug Related; Failure to Maintain Minimal Standards; Drug Abuse Certificate Denied Sexual Misconduct; Drug Related; Failure to Cooperate Stayed Revocation Criminal Conviction-Misdemeanor Certificate Denied Criminal Conviction-Felony Civil Penalty Obtaining Certificate by Fraud Certificate Denied Criminal Conviction-Misdemeanor; Unsafe Practice; Failure to Cooperate Civil Penalty Failure to Follow Orders; Documentation Errors; Practicing Beyond Scope Civil Penalty Criminal Conviction-Misdemeanor Revocation/Non-voluntary Violating Board Order Certificate Denied Criminal Conviction-Misdemeanor; Alcohol Abuse; Failure to Cooperate Voluntary Surrender Practicing Beyond Scope Civil Penalty Criminal Conviction-Misdemeanor Civil Penalty Mental Abuse; Verbal Abuse Stayed Suspension Practicing Beyond Scope CNA Applicant CNA999952275 CNA1000008504 CNA602791033 CNA1000007845 CNA999994266 Certificate Denied Revocation/Non-voluntary Civil Penalty Revocation/Non-voluntary Civil Penalty Stayed Suspension 12/22/2005* 3/2/2006 10/21/2005* 3/15/2006 11/30/2005* Mellone, Carrie L. Mitchell, Bridgette I. Nave, Randi M. Norton, Rosario A. Norton, Rosario A. CNA1000007940 CNA999990182 CNA Applicant CNA531830641 CNA531830641 3/3/2006 12/21/2005* 1/23/2006 11/16/2005* 3/3/2006 2/15/2006 1/4/2006 Parks, Robert D. Parra, Pearl M. Prempeh, George K. Puhr, Lorelei M. Quinn, Jamie L. Riley, Sherry A. Rivenburgh, Robin L. CNA Applicant CNA999999540 CNA999997813 CNA Applicant CNA Applicant CNA999999980 CNA Applicant 1/4/2006 Rodriquez, Ruben CNA771951619 30 CERTIFICATE Certificate Denied Certificate Denied Suspension/Indefinite Certificate Denied Failure to Follow Orders; Leaving Duty Station Failure to Maintain Minimal Standards; Drug Abuse Criminal Conviction-Misdemeanor Leaving Duty Station; Verbal Abuse; Failure to Cooperate Criminal Conviction-Misdemeanor Failure to Follow Orders; Unprofessional Conduct; Leaving Duty Station Civil Penalty Criminal Conviction-Misdemeanor Civil Penalty Misconduct Certificate Denied Criminal Conviction-Misdemeanor Revocation/Non-voluntary Violating Board Order Stayed Revocation Failure to Maintain Minimal Standards; Verbal Abuse; Violating Board Order Certificate Denied Criminal Conviction-Felony; Against Person Civil Penalty Failure to Follow Orders Voluntary Surrender Failure to Follow Orders; Sexual Misconduct Certificate Denied Criminal Conviction-Felony Certificate Denied Criminal Conviction-Felony; Drug Related; Drug Related Stayed Revocation Physical Abuse Certificate Denied Drug Abuse; Criminal Conviction-Misdemeanor; Inability to practice safely; Alcohol Abuse Revocation/Non-voluntary Criminal Conviction-Felony; Misdemeanor; Boundaries; Obtaining Certificate by Fraud; arizona STATE BOARD OF NURSING REGULATORY JOURNAL *Not reported in previous Newsletter CNA DISCIPLINARY ACTION JANUARY - FEBRUARY - MARCH 2006 (NEWSLETTER MAY/JUNE/JULY 2006) EFFECTIVE DATE 1/3/2006 Rojas, Anna c. 10/14/2005* Schmidt, Keri L. 1/4/2006 Steward, Ruth A. 12/19/2005* Taylor, Jacqueline 1/4/2006 Timmer, Barbara E. NAME CNA Applicant CNA Applicant CNA999952555 CNA308673580 CNA835278103 3/13/2006 1/25/2006 2/3/2006 3/7/2006 2/14/2006 CNA Applicant CNA999994297 CNA948680103 CNA975080803 CNA1000001076 Torres, Eddy Trawally, Amy C. Trimmer, Michele Valencia, Elma V. Villanueva, Ana D. CERTIFICATE Certificate Denied Certificate Denied Revocation/Non-voluntary Stayed Suspension Revocation/Non-voluntary DISCIPLINEVIOLATION(S) Criminal Conviction-Misdemeanor; Failure to Cooperate Criminal Conviction-Misdemeanor; Drug Related; Drug Abuse Verbal Abuse; Violating Board Order Failure to Maintain Minimal Standards; Neglect Criminal Conviction-Misdemeanor; Failure to Report Violations; Failure to Cooperate Certificate Denied Criminal Conviction-Misdemeanor; Failure to Cooperate Civil Penalty Unprofessional Conduct; False Documentation Civil Penalty Practicing Beyond Scope; False Documentation Revocation/Non-voluntary Violating Board Order Voluntary Surrender Unprofessional Conduct; Physical Abuse; Verbal Abuse RN/LPN DISCIPLINARY ACTION JANUARY - FEBRUARY - MARCH 2006 (NEWSLETTER MAY/JUNE/JULY 2006) EFFECTIVE DATE 1/16/2006** NAME Alderson, Margaret A. LICENSE RN073411 2/28/2006 2/2/2006 2/7/2006 12/26/2005* 12/27/2005* 1/1/2006 Alvarado, Jennifer T. Amity, Frank R. Bartholomay, Sandra L. Bartholomay, Sandra L. Bernot, Joanne L. Bidgood, Roberta A. LP034986 RN115594/LP033324 RN071937/LP019179 RN071937/LP019179 LP034146 LP015862 9/7/2005* Boggs, Sharron L. Multi State License-MD 1/26/2006 3/20/2006 Booker, Tina L. Boyd, Anne P. LP038999 RN088106 3/1/2006 2/14/2006 1/4/2006 Brazier, Mary J. Bristol, Kenneth H. Brown, Charmaine M. RN039180 RN130075 LP032552 1/19/2006 Brunelle, Elizabeth M. LP032299 2/16/2006 1/25/2006 Capriotti, Teresa L. Carrillo, Carol D. RN092105 LP037206 1/5/2006 LP036261 1/4/2006 Chamberlain, Kimberly D. Choate, Donald D. VIOLATION(S) Failure to maintain minimal standards; Failure to Follow Orders, Documentation Voluntary Surrender Violating Board Order Decree of Censure Documentation Errors, Practicing Beyond Scope Revocation/Non-Voluntary Alcohol Abuse, Violating Board Order Stayed Revocation w/Probation Alcohol Abuse Decree of Censure Practicing Beyond Scope Stayed Suspension w/Probation Unsafe Practice, Drug Diversion, Inability to Practice Safely Revocation-Privilege to Practice Documentation Errors, Medication Errors, Alcohol Abuse Decree of Censure Positive Drug Screen Probation Failure to Maintain Minimal Standards, Failure to Follow Orders, Medication Errors Voluntary Surrender Unsafe Practice, Practicing Beyond Scope Voluntary Surrender Incompetent Practice, Failure to Follow Orders Revocation/Non-Voluntary Criminal Conviction-Misdemeanor, Fraud, DeceitObtaining License Voluntary Surrender Unsafe Practice, Failure to Follow Orders, Medication Errors Decree of Censure Failure to Supervise, Unprofessional Conduct Revocation/Non-Voluntary Criminal Conviction-Misdemeanor, Misconduct-Theft – Employer, Fraudulent Billing Revocation/Non-Voluntary Violating Board Order RN130952 Revocation/Non-Voluntary 3/3/2006 Connell, Nicole L. Voluntary Surrender 1/9/2006 2/6/2006 3/20/2006 Cruz, Rhodora B. Day, Kristie M. Demattia, Arlene C. LP031853/ CNA780087103 RN106055 RN120453 LP037609 2/28/2006 1/25/2006 3/29/2006 Deptula, Shannon L. RN120655 Dominguez, Rose Mary RN045549 Donovan, Denise L. RN129105 Voluntary Surrender Probation Voluntary Surrender 12/19/2005* 11/18/2005* 1/5/2006 Drake, Susan J. Fitch, James C. Frost, Jason J. Decree of Censure Court Ordered Revocation License Denied LP034210 LP038949 RN Endorsement Applicant ** Correction to prior violation as listed in March 2006 First quarter journal DISCIPLINE Probation Probation Revocation/Non-Voluntary Probation Drug Abuse, Drug Diversion, Action in Another Jurisdiction Drug Diversion, Unsafe Practice, Action in Another Jurisdiction Unsafe Practice Violating Board Order Failure to Maintain Minimal Standards, Documentation Errors, Medication Errors Action in Another Jurisdiction Drug Abuse, Failure to Cooperate with Board Fraud, Deceit-Obtaining License, Action in Another Jurisdiction Inappropriate Delegation Criminal Conviction-Felony Drug Abuse, Fraud, Deceit-Obtaining License, Action in Another Jurisdiction arizona STATE BOARD OF NURSING REGULATORY JOURNAL 31 RN/LPN DISCIPLINARY ACTION JANUARY - FEBRUARY - MARCH 2006 (NEWSLETTER MAY/JUNE/JULY 2006) EFFECTIVE DATE 3/20/2006 NAME Gallagher, Kathleen LICENSE LP036276 1/4/2006 Garoulis, Jeana A. LP040115 1/25/2006 Gebhardt, Pamela G. RN030942 2/23/2006 Gillespie, Karen L. LP Exam Applicant 3/8/2006 12/6/2005* Gray, Delores F. Gray, Kimberly C. LP011483 RN108798 2/21/2006 Greer, Juliana LP033724 3/9/2006 3/20/2006 3/9/2006 Grignon, Janet L. Hagen, Robin L. Hallier, Charles R. 12/8/2005 Hauser, Susanne M. RN072948 LP032674 LP031511/ CNA732360803 RN098514 1/4/2006 1/4/2006 3/7/2006 Heron, John D. Hogan, Keitha R. Hunter, Russia T. 1/25/2006 Iwunze, Eunice C. 1/25/2006 2/28/2006 1/25/2006 Jocque, Monica L. Johnson, Norma J. Jones, Sandra M. 1/4/2006 1/4/2006 12/14/2005* 1/12/2006 1/4/2006 1/19/2006 Kettner, Ruth A. Kilbourne, Cherise P. Knowlton, Lisa M. Lauber, Jane K. Lause, Carol A. Light, Kelly A. 1/17/2006 Lubinski, Sandra M. 12/15/2005* 3/20/2006 1/4/2006 12/14/2005* 2/9/2006 3/14/2006 MacMaster, Robert P. Marsh, Audrey L. McKay, Barbara A. Medford, Wendy Miller, Angela M. Miranda, David F. 1/4/2006 Molina, Georgina A. 3/9/2006 1/12/2006 Morgan, Tina L. Nash, Jacqueline P. 1/4/2006 3/20/2006 Neal, Mary E. Nopp, Kelly A. 3/20/2006 2/3/2006 Opuroku, Ezekiel T. Parke, Todd S. 2/3/2006 1/25/2006 1/12/2006 Pierson, Lynette D. Powers, Tammy S. Preuss, Sonia R. 3/20/2006 3/21/2006 Rebel, Karen L. Robb, Diane L. 32 *Not reported in previous Newsletter DISCIPLINE Decree of Censure VIOLATION(S) Failure to Maintain Minimal Standards, Unsafe Practice Revocation/Non-Voluntary Positive Drug Screen, Failure to Cooperate with Board Stayed Revocation w/Probation Failure to Comply with Requirements of Impaired Nurse Program License Denied Criminal Conviction-Misdemeanor, Alcohol Related, Failure to Cooperate with Board Decree of Censure Misconduct-Physical Abuse, Verbal Abuse Probation Criminal Conviction-Misdemeanor, Violating Board Order, Failure to Cooperate with Board Voluntary Surrender Failure to Maintain Minimal Standards, Unsafe Practice Voluntary Surrender Violating Board Order Probation Criminal Conviction-Misdemeanor, Alcohol Abuse Voluntary Surrender Drug Use on Duty, Drug Diversion Decree of Censure with Fine Unsafe Practice, Failure to Intervene, MisconductLeaving Duty Station Violating Board Order Violating Board Order Action in Another Jurisdiction LP034472 Revocation/Non-Voluntary LP026375 Revocation/Non-Voluntary LP Endorsement License Denied ApplicantLETTER MAY/JUNE/JULY 2006) LP032436 Stayed Suspension w/Probation Criminal Conviction-Misdemeanor, MisconductVerbal Abuse, Failure to Cooperate with Board RN100895/LP032473 Voluntary Surrender Violating Board Order RN061775 Voluntary Surrender Violating Board Order LP031384 Stayed Revocation w/Probation Criminal Conviction-Misdemeanor, Drug RelatedPositive Drug Screen, Violating State/Federal Statutes/Rules LP030743 Revocation/Non-Voluntary Violating Board Order RN075265 Revocation/Non-Voluntary Violating Board Order RN111439 Decree of Censure Positive Drug Screen RN098052 Voluntary Surrender Criminal Conviction-Felony, Alcohol Abuse LP036145 Revocation/Non-Voluntary Failure to Maintain Minimal Standards, Drug Abuse RN114070/LP033966 Decree of Censure Failure to Follow Orders, Documentation Errors, Medication Errors RN116696 Probation Documentation Errors, Practicing Beyond Scope, Drug Abuse RN107531 Probation Positive Drug Screen RN085435 Stayed Revocation w/Suspension Violating Board Order LP032205 Revocation/Non-Voluntary Drug Abuse, Drug Use on Duty, Drug Diversion RN115980 Probation Medication Errors RN114201/LP035304 Probation Failure to Maintain Minimal Standards RN Endorsement License Denied Criminal Conviction-Misdemeanor, Unprofessional Applicant Conduct, Drug Abuse LP038438/ Revocation/Non-Voluntary Criminal Conviction-Felony, Misdemeanor CNA999992367 Misconduct-Leaving Duty Station RN115990 Stayed Revocation w/Probation Misconduct-False Documentation, Drug Diversion RN106317 Voluntary Surrender Alcohol Abuse, Failure to Comply with Requirements of Impaired Nurse Program LP030527 Revocation/Non-Voluntary Drug Abuse, Positive Drug Screen LP028917/ Summary Suspension Failure to Maintain Minimal Standards, MisconductCNA498965933 Theft – Employer, Drug Diversion LP036460 Probation Documentation Errors, Positive Drug Screen LP033596/ Revocation/Non-Voluntary Violating Board Order CNA999947954 TLP041676 Probation Action in Another Jurisdiction RN124448 Voluntary Surrender Violating Board Order RN074406 Voluntary Surrender Failure to Maintain Minimal Standards, Alcohol Abuse, Inability to Practice Safely RN078320/LP024669 Stayed Revocation w/Probation Violating Board Order RN127554 Decree of Censure Positive Drug Screen arizona STATE BOARD OF NURSING REGULATORY JOURNAL RN/LPN DISCIPLINARY ACTION JANUARY - FEBRUARY - MARCH 2006 (NEWSLETTER MAY/JUNE/JULY 2006) EFFECTIVE DATE 1/24/2006 3/1/2006 1/4/2006 NAME Robertson, Sherry L. Sharp, Christina E. Shields, Felicia R. LICENSE RN127274 RN127552 RN096212 1/25/2006 3/9/2006 1/4/2006 Songer, Denise J. Stanley, Juanita L. Stephenson, Kendall RN107519 RN078472 RN092605 12/8/2005* 1/12/2006 1/20/2006 Strackbein, Nancy L. Suggs, Forrest M. Tatum, Donna C. 1/25/2006 Tosh, Ann Marie RN130805 RN073691 LP Endorsement Applicant RN087259 1/26/2006 3/15/2006 2/6/2006 Trakes, Tara M. Truman, Melissa M. Wagner, Cindy A. RN122291 RN107102 LP007420 12/27/2005* 01/30/2005* 1/4/2006 Walker, Judith A. RN129503 Welsh, Jason C. LP039920 Whitmore, Katharine M. RN122964 1/19/2006 1/4/2006 Williams, Kathy B. LP028430 Worthington III, Frank B. RN048087 *Not reported in previous Newsletter DISCIPLINE Revocation/Non-Voluntary Probation Revocation/Non-Voluntary VIOLATION(S) Drug Abuse, Violating Board Order Drug Abuse, Positive Drug Screen Criminal Conviction-Misdemeanor, MisconductLeaving Duty Station, Failure to Report Violations Probation Inability To Practice Safely Voluntary Surrender Violating Board Order Stayed Revocation w/Suspension Failure to Maintain Minimal Standards, Inability to Practice Safely, Action in Another Jurisdiction Decree of Censure Documentation Errors, Medication Errors Voluntary Surrender Drug Diversion License Denied` Criminal Conviction-Misdemeanor, Failure to Maintain Minimal Standards, Unsafe Practice Probation w/Limited Licensure Violating Board Order, Misconduct-False Documentation Decree of Censure Practicing Beyond Scope Revocation/Non-Voluntary Violating Board Order Decree of Censure Failure to Maintain Minimal Standards, Practicing Beyond Scope Probation Alcohol Abuse Probation Drug Abuse Revocation/Non-Voluntary Failure to Follow Orders, Alcohol Abuse, Violating Board Order Voluntary Surrender Violating Board Order Revocation/Non-Voluntary Failure to Comply with Requirements of Impaired Nurse Program Termination of Board Agreement/Order for CNAs EFFECTIVE DATE 2/14/2006 3/21/2006 1/26/2006 1/25/2006 3/28/2006 NAME Collins, Sr., Raymond Bungay, Lydia N. Gantala, Mary E. Tenequer, Adrianna Ball, Jamie CERTIFICATE CNA1000003963 CNA809248219 CNA546613420 CNA9999988247 CNA1000005416 DISCIPLINE VIOLATION(S) Cleared / Stayed Revocation Cleared / Stayed Suspension Cleared / Stayed Suspension Cleared / Stayed Suspension Cleared / Suspension Termination of Board Agreements/Orders for RNs/LPNs EFFECTIVE DATE 3/21/2006 3/21/2006 1/25/2006 3/21/2006 1/25/2006 1/25/2006 3/21/2006 3/21/2006 1/25/2006 3/21/2006 1/25/2006 3/30/2006 3/21/2006 1/25/2006 1/25/2006 1/30/2006 3/21/2006 34 NAME Bolton, Ryan W. Brown, Cindy M. Brown, Shellee E. Cowan, Cheryl L. Davis, Melissa Dempsey, Elaine M. Iannoli, Jess E. Igo, Charlotte E. Kelly, Laura L. Lyons, Scott W. Nagy, Jeri E. Reed, Zulema I. Torres, Nikki D. Velasquez, Jo Ann L. Vomaska, Suzanne M. Welsh, Jason C. Wheat, Jon M. arizona STATE BOARD OF NURSING REGULATORY JOURNAL LICENSE RN106954/LP032632 RN087150 RN129452/LP039947 RN123412 RN102422/AP1193 RN067283 RN115489/LP036052 RN115692 RN033549 RN129737 LP038858 LP036794 RN132551 LP027939 RN131114 LP039920 RN120488 Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Probation Completed Arizona State Board of Nursing TOTAL ACTIVE AZ LICENSES IN ALL STATES RN 42266 46207 47451 50486 52939 56722 58657 6/30/1999* 6/30/2000* 6/30/2001* 6/30/2002* 6/30/2003** 6/30/2004** 6/30/2005** 5/2/2006 Daily Real Time Data 60,079 LPN 8812 9271 9389 9160 10302 11074 11221 TOTAL 51078 55478 56840 59646 63241 67796 69878 11,917 71,996 * NCSBN Report ** Monthly Stat Report Fiscal Year Time Frame Data Reports NUMBER OF APPLICATIONS RECEIVED YEAR 1999 Exam Endorsement Renewal 2000 Exam Endorsement Renewal 2001Exam Endorsement Renewal 2002 Exam Endorsement Renewal 2003 Exam Endorsement Renewal 2004 Exam Endorsement Renewal 2005 Exam Endorsement Renewal 36 arizona STATE BOARD OF NURSING REGULATORY JOURNAL RN 470 2268 18945 1855 1522 15657 610 803 19636 1236 622 18858 1483 2628 9937 1725 3627 9938 1925 4129 10639 LPN 248 391 3754 702 212 2989 249 111 3654 486 88 3443 615 346 1643 742 438 1769 673 618 1722 TOTAL 718 2659 22699 2557 1734 18646 859 914 23290 1722 710 41159 2098 2974 11580 2467 4065 11707 2598 4747 12361 Arizona Pediatric Nurse Practitioner arizona STATE BOARD OF NURSING REGULATORY JOURNAL 37 18th Annual Southwestern Regional Nurse Practitioner Clinical Symposium 38 T he Arizona Nurses Association and the Nurse Practitioner Council are sponsoring the 18th Annual Southwestern Regional Nurse Practitioner Clinical Symposium on July 28 - 30 2006, at the Scottsdale Hilton Resort & Villas, 6333 N. Scottsdale Road, in Scottsdale, Arizona. This conference provides nurse practitioners who practice in a variety of settings with current practice and pharmacological knowledge as well as the opportunity for professional networking. Margaret A. Fitzgerald, MS, APRN, BC, NP-C, FAANP, CSP, President and Principle Lecturer with arizona STATE BOARD OF NURSING REGULATORY JOURNAL Fitzgerald Health Education Associates will provide the keynote presentation "Entrepreneur or Intrapreneur, the future of NP Practice". Registration information will be posted at www.aznurse.org on the calendar of events page. This program is approved for continuing education by the Arizona Nurses Association accredited by the American Nurses Credentialing Center. In addition, Fitzgerald Health Education Associates will provide a Nurse Practitioner Certification Practice Preparation seminar starting July 27. Register at www.aznurse.org on the calendar of events page.