arizona vol 6 • No1 march 2011 state board of nursing RegulatoRy JouRnal ? Continuing Education, Competency & Evidence Based Regulation: Searching for a Rational Approach MandatoRy Continuing eduCation: agReeMents & disagReeMents arizona STATE BOARD OF NURSING RegulatoRy JouRnal 1 It’s an honor … Phoenix Children’s Hospital is proud to be among the first organizations to receive an Arizona’s Most Admired Companies Award from Best Companies AZ and Arizona Business Magazine. Proud because our employees played a pivotal role in earning us this distinction, and because our culture continues to make us a great place to care and work! ...and a privilege. Join us in transforming Phoenix Children’s Hospital into a world class medical campus that will set a new standard in children’s health care. We are currently the only free standing specialty children’s hospital in Arizona, and our $588 million expansion will put us on track to become one of the foremost pediatric hospitals in the nation. If you’re a dedicated professional with a desire to be the best, we invite you to help shape the future of a growing, thriving organization where opportunities for personal and professional development will continue for years to come! Phoenix Children’s Hospital offers outstanding benefits effective the first of the month after your start date, as well as excellent salaries. EOE. 2 arizona STATE BOARD OF NURSING RegulatoRy JouRnal For a complete list of our open positions, please visit our website: Published by ARIzONA STATE BOARD OF NURSING 4747 North 7th Street, Suite 200 Phoenix, Az 85014-3655 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 v OL 6 • N O 1• MARCH 2010 4 6 8 From the executive director Continuing education, Competency, and Regulation: searching for a rational approach staff directory Valerie Smith, RN, MS, FRE AssOciAtE DiREctOR/ iNVEstiGAtiONs/ cOmpliANcE 9 Pamela Randolph, RN, MS AssOciAtE DiREctOR/EDucAtiON & EViDENcE BAsED REGulAtiON 12 boaRd MeMbeRs Kathy Scott, RN, MPA, PhD, FACHE pREsiDENt Kathy Malloch, PhD, MBA, RN, FAAN VicE pREsiDENt Patricia (Pat) Johnson, LPN sEcREtARy Theresa (Terri) Berrigan, LPN mEmBER Leslie Dalton, MSN, RN mEmBER Lori A. Gutierrez, BS, RN-C, RAC-CT, CBN mEmBER Denise Link, RNP, PhD, CNE, FNAP mEmBER Randy Quinn, MSN, CRNA mEmBER Charleen Snider, BSN, RN mEmBER Kathryn L. Busby, JD puBlic mEmBER M. Hunter Perry puBlic mEmBER EDITION 21 14 17 19 Continuing education and Continuing Competency: What’s the difference? house of Representatives house bill 2091 scope of Practice Committee Report Cna Corner title Protection for advanced Practice arizona 20 Registered nurse Practitioner (RnP) Practicing in an acute Care setting 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: Greg Jones gjones@pcipublishing.com 501.221.9986 • 800.561.4686 ext. 105 ThinkNurse.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. 23 25 27 Cna exam Changes Cna disciplinary actions Rn/lPn disciplinary actions arizona STATE BOARD OF NURSING RegulatoRy JouRnal 3 F rom the e x e c uti v e d ire cto r JOEy RIDENOUR, RN, MN, FAAN Mandatory Continuing Education: Agreements & DisAgreements The overall trend during the 1970’s, 1980’s, 1990’s and early 2000’s had been towards a passage of mandatory continuing education (CEU) in most states. Mandatory continuing professional education is by no means a universally applauded concept as evidenced by two recent reports: 1.) Institute of Medicine Report (2010): The Future of Nursing – Leading Change, Advancing Health and 2.) Patricia Benner, et al Education nurses: A call for radical transformation (2010). Mandatory continuing education for health professionals refers to the regulatory requirement that professionals show evidence of participation in a given number of units of continuing education. Queeny & English (1994) definition of mandatory continuing education: “Education required for a professional practitioner to maintain the right to practice; use a professional title or to earn/maintain specialty certification.” State CEU legislation first appeared in 1971, when the state of New Mexico mandated continuing professional education as a licensing requirement for physicians (Young, 1980). During the 1980’s there began a more concerted effort to link continuing education with competency (Queeny & English 1994) House Bill 2091 mandating continuing education for nurses was introduced this legislative session as found on page 12. Proponents of mandatory continuing education argue: 1. Expecting voluntary participation is unrealistic. Those who need it most may be least likely to participate. 2. Mandates are necessary to protect the public from incompetent or out-of-date practitioners. 3. Although imperfect, it is better than such alternatives as retesting through examination or practice review. 4. By choosing a profession, professionals submit to its norms. A license to practice implies consent to be governed by the rules of the profession and legislature. 5. Some public policy makers assert “it is counter intuitive to not believe that mandatory continuing education is not a public protection issue.” Opponents of mandatory continuing education offer the following arguments: 4 arizona STATE BOARD OF NURSING RegulatoRy JouRnal 1. It violates lifelong learning principles, such as voluntary participation, the informal nature of adult education, and adult self-direction. 2. By definition, professionals are supposed to be autonomous, self-managed, and responsible for lifelong mastery of knowledge. 3. Evidence for improved practice is scant or lacking. All that is mandated is “seat time” or attendance, which will not necessarily change attitudes, motivation, determination to practice responsibly, or ability to learn to enhance practice. 4. Many continuing education units lack relevance to practitioner needs 5. Professionals should be accountable for safe/effective performance, not participation. 6. There are economic motives behind the provision of CEU’s as may be perceived as a “cash cow.” In summary, those opposing legislation mandating mandatory continuing education raise objections to its implementation and regulatory effectiveness in relation to continued competency. Opinions on the pro side run equally ardent, with proponents staunchly defend the need for and rationale behind mandatory continued education, even while at the same time admitting the need for reform. Finally, it should be noted that proponents and opponents of mandatory continuing education agree on two major points: 1. professional knowledge faces rapid obsolescence and 2.) all health professionals must commit to lifelong learning. This edition of the AzBN Regulatory Journal will provide an update on the issues related to mandatory continued education and outline the work of the AzBN Education Subcommittee on Continued Competence. Our collective role as nurses, professional organizations, nurse executives and educational leaders is to work with legislative leaders to continually evaluate and search for the best public policy based on continuing competence evidence before making legislative changes. Queeny, D., English, J. (1994). Mandatory Continuing Education: a status report. Information series n. 357. Columbus, OH: ERIC Clearinghouse on Adult, Career & Vocational Education, 1-15. Young, W. (1980) Mandatory continuing education: the bright side of the picture. Setting the Pace, 1 (1), 12-15. arizona STATE BOARD OF NURSING RegulatoRy JouRnal 5 By PAMELA RANDOLPH RN, MS KATHy MALLOCH, PH.D. MBA, RN, FAAN Continuing EduCation, CompEtEnCy, and REgulation: Searching for a rational approach Background: In 2002 the Board was given the statutory mandate to “adopt rules to establish competency standards for obtaining and maintaining a license” (A.R.S. §32-1606(B) (21). In implementing this requirement, the Board examined existing literature relying heavily on Smith’s (2003) report that nurses in states that require continuing education and those that do not receive equivalent amounts of continuing education related to their nursing role/ job. While nurses in states mandating continuing education may have engaged in more continuing education overall, the relationship to the continued competency of the nurse in his/her work was not known or identified. In fact the excess education was in areas not related to their current work (Smith, 2003). Smith (2003) further asked nurses to rate various factors that contributed to their current competency. Experienced nurses rated actual work experience highest when compared to continued education, mentoring, self study and basic nursing preparation. Reflecting that evidence, in 2004 the Board adopted A.A.C. R4-19-312 requiring nurses renewing a license to have practiced 960 hours in the past 5 years or complete a Board approved refresher course. Since that time the Board has continued to explore effective ways to measure and reasonably ensure the competency of licensed nurses. Recently the Board was challenged in its decision not to require continuing education as a condition of renewal. It was opined by some that continuing education is a “hallmark of a profession”. The Board agreed to reexamine the literature and work towards 6 an effective regulatory solution to the competency issue. Under the leadership of Board President, Kathy Scott, the Board established the Continued Competence Subcommittee as part of the Education Advisory Committee. The committee charter includes the following: • Review current criteria for competency, as well as recent literature related to continued competency assessment of healthcare professionals and other professionals working in high-risk industries. • Develop recommendations for determining and regulating continued competency of nurses in Arizona for the State Board of Nursing to review that include: o Periodic evaluation of nursing practice competency; o Nurse accountability for lifelong learning; o A focus on patient safety; and o Financial implications. o Legislative language, rules and recommendations for Board review and approval The subcommittee has extensively explored the concepts of both continuing education and competency. Both of these concepts have provided insight to the nature of determining continuing competence to practice in nursing. At the national level Interestingly, National Council of State Boards of Nursing (NCSBN) is also struggling with the demonstration of continuing competence for licensure. This topic has been studied over the last five years intensively. Solutions from requiring a re-testing exam every 3-5 arizona STATE BOARD OF NURSING RegulatoRy JouRnal years to certifications to documenting continuing education hours have been debated extensively for their validity and relationship to nurse competence and patient safety and outcomes. It is hoped that recommendations will be available in 2011. Continuing Education While a CE event may contribute to competency Forestland, et.al. (2009) in an extensive review of 81 trials of educational meetings concluded that: “Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviors.” (abstract) Regehr and Myopolous (2009) extensively examined professional continuing education models. Current continuing education models rely heavily on the professional’s ability to self assess performance for flaws. However research does not support this assumption. Humans tend to justify poor performance in ways that enhance self-esteem. A classic example of this is the gambler’s report of losses as “near wins”. Regehr and Myopolous (2009) further contend that even when a practitioner knows their gaps in knowledge, left to their own devices, the practitioner will tend to attend educational events that reinforce current knowledge rather than address gaps in competency. The author’s state that this should not be surprising as learning one’s areas of weakness is inherently difficult with less perceived benefit. Regehr and Myopolous also report, similar to Forsetlund et.al. (2009), that even when knowledge is gained, actual changes in practice do not necessarily result from attendance at an educational event. Competency The AZBN Continued Competence Subcommittee reviewed 29 studies and reports and developed the following definition of competency: “Competency ‘is an expected level of performance that integrates knowledge, skills, abilities and judgment’ (A.N.A., 2010). Acquiring and maintaining competence is a dynamic process that requires on-going re-definition within the context of nursing practice. It is reflected in and best assessed by actual performance. Competency is supported when the nurse acquires, enhances and maintains knowledge, skills, attitudes, and abilities that promote sound nursing judgment.” This definition recognizes the dynamic properties of competency as reflected in practice and assessed in practice. Competency is complex and reflected in behavior. Cognitive knowledge of the behavior as measured by NCLEX, skill exams and teacher made tests are a necessary foundation for competency, but not an assurance of competency. For example, all nurses in every single nursing program for the past 50 years have been taught the importance of hand-washing. They have been required to demonstrate this skill on numerous occasions, yet lack of appropriate hand hygiene is still a major public health threat. In fact, health care agencies have delegated the regulatory role of ensuring hand hygiene to patients and family members by posting signs encouraging patients and visitors to remind health care providers to wash their hands. For the past year, the Board has partnered with Scottsdale Community College and Arizona State University on a project entitled “ Measuring Competency with Simulation” sponsored by National Council of State Boards of Nursing. Review of 63 videos of nurses performing simple medical-surgical simulations reveals that consistent areas of low competency in both new and experienced nurses are infection control and documentation. There are extensive educational efforts in both these areas in nursing programs. Reghr and Myopolous (2009) suggest that competency can be effectively developed in the workplace. Most practitioners do not reflect on practice when patient progress is proceeding normally, however clinical challenges and problems in practice provide opportunities for practice improvements through reflection, problem solving, learning, and broad application of the solution for improved patient outcomes. The authors describe the process as effort intensive but a fruitful avenue for practice improvement through practice. Progress of the Arizona State Board of Nursing Continued Competency Subcommittee The Continued Competence Subcommittee has met 3 times and is scheduled to meet this month to continue its work. The committee has explored the following ideas: • Certifications—There is an identified need to link certification with improved patient safety/outcomes. The literature validates that such studies have not been done. Certification involves passing an exam which verifies knowledge and to some extent, skill. Re-certification is tied mostly to continuing education in the field. It was decided that certification might be one way some nurses could validate competency coupled with practice related to the area of certification. Due to varying requirements however, it will not fit for all nurses. • Mentorship—Members agreed that the literature was interesting and mentorship appeared valuable from the nurse’s career and self-fulfillment potential, however there are no studies tying mentorship directly to improved outcomes. • BSN Preparation—Literature linking a high percentage of BSN staff to improved outcomes is compelling. The NY initiative “BSN in 10” was also reviewed. The Committee noted that completing an advanced nursing degree may be a valid measure of competence. Most RN/BSN programs in AZ are nationally accredited and follow broad standards/essentials established by accrediting bodies relating to excellence in education but not necessarily linked to patient outcomes. However, there are significant differences in accredited programs. For example only 2 of 5 accredited BSN completion programs in AZ require clinical experience as part of the program. There are also non-accredited programs. The Board does not have jurisdiction over BSN completion programs. • Partnering with Employers: It was opined that a fruitful avenue to explore might be jointly developed guidelines by AZBN and industry representatives for an employee competency program incorporating formal opportunities for reflective practice in addition to continuing education opportunities and development of evidence for practice improvement. For further information on this issue, please contact Pamela Randolph at prandolph@azbn.gov. References: American Nurses Association. (2010). Nursing: Scope and Standards of Practice, 2nd Edition. Washington, DC: Authors. (Specifically Chapter 8, Education). Forsetlund L., Bjørndal A., Rashidian A., Jamtvedt, G., O’Brien, M., Wolf, F., Davis, D., OdgaardJensen, J., & Oxman, A. (2009). Continuing education meetings and workshops: effects on professional practice and health care outcomes (Review). The Cochrane Library. 2009, Issue 4. Regehr, G., & Mylopoulos, M. (2008). Maintaining competence in the field: Learning about practice, through practice, in practice. Journal of Continuing Education in Health Professions. 28 (1), 19-23. Smith, J. (2003). Exploring the effectiveness of continuing education mandates. NCSBN Research Brief. 6 Retrieved on 8/25/10 from https://www.ncsbn.org/CEStudy.pdf arizona STATE BOARD OF NURSING RegulatoRy JouRnal 7 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 Judy Pendergast, RN, JD Nurse Consultant – CANDO 602.771.7864 jpendergast@azbn.gov Olga zuniga Administrative Secretary – Monitoring & CANDO 602.771.7865 ozuniga@azbn.gov COMPLAINTS-INTAKE Dolores Hurtado, Senior Investigator Complaints-Intake Triage Coordinator Nurse Consultant 602.771.7845 dhurtado@azbn.gov Jennifer McWilliams Legal Assistant 602.771.7831 jmcwilliams@azbn.gov EDUCATION Debra McGinty, RN, PhD Education Program Administrator 602.771.7877 dmcginty@azbn.gov 8 Lila van Cuyk, RN, BSN Nurse Practice Consultant/ CNA Programs 602.771.7857 lvancuyk@azbn.gov Karen Gilliland Administrative Assistant 602.771.7856 kgilliland@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 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 Deborah Richards, JD Senior Investigator 602.771.7850 drichards@azbn.gov INvESTIGATIONS NURSE PRACTICE CONSULTANTS Angela Hill, RN, BSN 602.771.7811 ahill@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 Karen Grady, MS, RN, FNP, BC 602.771.7821 kgrady@azbn.gov Mary Rappoport, RN, MN 602.771.7816 mrappoport@azbn.gov Sister Rachel Torrez, RN, MS 602.771.7818 srachel@azbn.gov Stephanie Nelson, RN, MS 602.771.7819 snelson@azbn.gov v. Ann Schettler, RN, MHL, CLNC 602.771.7812 aschettler@azbn.gov arizona STATE BOARD OF NURSING RegulatoRy JouRnal SENIOR INvESTIGATORS Bonnie Richter 602.771.7828 brichter@azbn.gov Paula Delphy RN/LPN Endorsements 602.771.7834 pdelphy@azbn.gov Doug Parlin 602.771.7822 dparlin@azbn.gov Lisa youtsey Exam Tech 602.771.7835 lyoutsey@azbn.gov Kirk Olson 602.771.7824 kolson@azbn.gov Ron Lester 602.771.7825 rlester@azbn.gov Linda Monas 602.771.7826 lmonas@azbn.gov Lynda Hemann 602.771.7827 lhemann@azbn.gov LEGAL SECRETARIES Barbara Melberg 602.771.7840 bmelberg@azbn.gov Dorothy Lindsey 602.771.7841 dlindsey@azbn.gov Trina Smith 602.771.7844 tsmith@azbn.gov INFORMATION TECHNOLOGy Cory Davitt Network Operations Director 602.771.7808 cdavitt@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 RN/LPN Renewals 602.771.7833 dfrye@azbn.gov Erica Hernandez CNA Renewals 602.771.7836 ehernandez@azbn.gov Helen Tay CNA Exam/Endorsements 602.771.7832 htay@azbn.gov MAILROOM Debra Kunkle 602.771.7876 dkunkle@azbn.gov MONITORING Tammi Bymers, RN, MSN Nurse Practice Consultant 602.771.7862 tbymers@azbn.gov Esther Garcia Legal Assistant 602.771.7861 egarcia@azbn.gov Brent Sutter Legal Secretary Monitoring & CANDO 602.771.7860 bsutter@azbn.gov RECEPTIONISTS Madelyn Emerson 602.771.7871 memerson@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 By DEBRA MCGINTy, RN PhD EDucAtiON pROGRAm ADmiNistRAtOR Continuing EduCation and Continuing CompEtEnCy: WhAt’S thE DiffERENCE? Continuing education (CE) encompasses specific learning activities for the purpose of enabling healthcare professionals to maintain knowledge and skills and stay current with new developments following initial licensure. It has generally been thought that mandatory attendance at continuing education events encourages the best possible care, improves patient outcomes, and protects patient safety. Continuing education is often acquired by attendance at formal conferences and completion of academic courses. While many health professions have adopted these methods to assess a health care professional’s continued competency, there is little evidence these activities have any effect on professional behaviors or health-based outcomes (IOM, 2009). The Institute of Medicine committee appointed to study current continuing education models in health professions cited significant flaws in the way continuing education was conducted, financed, regulated and evaluated. They found the scientific evidence to support current models for continuing education programs was “fragmented and undeveloped”. It was evident from their research that most health professionals utilized continuing education to meet regulatory requirements rather than identify personal knowledge gaps and find programs to address particular learning needs. The committee expressed concern about the extent to which pharmaceutical and medical device companies have developed and financed continuing education opportunities, which raised questions about conflict of interest and the use of CE to increase market share. The Institute concluded the problems with continuing education could not be “remedied by anything short of a coordinated, national effort”. The committee’s report concluded with a recommendation to create a privatepublic entity to engage all stakeholders in the delivery of health care and regulation of continuing education. According to the National Council of State Boards of Nursing (2010), continuing education is required in 36 states with wide variation in the number and types of required continuing education courses from state to state. Fifteen states require specific subject matter to maintain nursing licensure. While one state might require a course in law and rules, another requires courses focusing on end of life, AIDS, domestic violence, child abuse, pain management and pharmacology. The IOM committee determined such wide variations in CE regulation lead to “inconsistent learning and conflict with efforts to achieve high levels of competence and practice”. The committee could find no clear link between continuing education and patient outcomes or protection of patient safety. In 2002, the State Board of Nursing considered imposing continuing education requirements for continued licensure but shared similar concerns and instead established a minimum practice requirement of 960 minimum practice hours per renewal period. More recently the Board has explored a profession-wide movement away from continuing education and toward continuing competence. The foundations of continuing competence embrace a more holistic view of the individual nurse participating in collaboration with education, industry, regulation and the professional nursing organizations. Continuing competence supports the ethic that each nurse has a responsibility to demonstrate continuing competence through acquisition of new knowledge and skill and appropriate, safe application of sound nursing principles in practice. Continuing competence assumes a culture that holds nursing accountable for lifelong learning, supports focused improvements in nursing practice and values periodic evaluations (NCSBN, 2005). Continuing competence is a value shared among healthcare providers to assure evidence-based practice and safeguard patient safety. The concept of continuing competence is discussed in the more recent recommendations of the Institute of Medicine report on The Future of Nursing (2011). Recommendation 6 specifically challenges the profession to ensure that nurses engage in lifelong learning. The committee envisions health care continued >>> NORTHERN ARIZONA UNIVERSITY College of Health and Human Services salaries are Competitive The School of Nursing at NAU seeks innovative, enthusiastic individuals who have a passion for nursing and a desire to build strong nursing education programs. Our vacancies are: ✓ 1 Full-time Assistant Clinical Professor – Flagstaff Campus ✓ 2 Full-time Tenure Track Assistant or Associate Professor positions on Flagstaff Campus ✓ 1 Full-time Assistant Clinical Professor with primary teaching responsibilities in the American Indian Program located in st. Michaels (Window Rock), Arizona ✓ 1 Full-time 12 month Assistant Clinical Professor – clinical simulation coordination for students – Flagstaff Campus ✓ 1 Part-time Assistant Clinical Professor – Flagstaff Campus ✓ 1 Full-time Assistant or Associate Clinical Professor – tucson ✓ 1 Full-time Assistant Clinical Professor – yuma The nursing programs include traditional, accelerated, RN to BSN and American Indian Reservation based students as well as master’s degree programs with specialty in Family Nurse Practitioner, Nursing Education, and Nurse Generalist. Faculty will have the opportunity to address health care challenges of diverse populations in rural settings. The faculty position will support baccalaureate level students in the classroom, clinical teaching and/or in graduate courses in family health (NP) and nursing education. Teaching assignments are contingent upon qualifications and experience and are commensurate with rank. Northern Arizona University is a 25,000-student institution with its main campus in Flagstaff, a four-season community of about 62,000 at the base of the majestic San Francisco Peaks. NAU’s emphasis on undergraduate education is enhanced by its graduate programs and research as well as distance learning. The university is committed to a diverse and civil working and learning environment. Please visit the NAU recruitment website at http://hr.nau.edu. arizona STATE BOARD OF NURSING RegulatoRy JouRnal 9 <<< continued from previous page continuing education (cE) encompasses specific learning activities for the purpose of enabling healthcare professionals to maintain knowledge and skills and stay current with new developments following initial licensure. organizations, health care disciplines, and schools of nursing coming together to provide interprofessional continuing competency programs. These professional development collaborations would necessarily move the “classroom” closer to the point of care. Already, the development and prioritization of core competencies is currently under construction as six professional accreditation agencies together articulate definitions of competency: the Association of American Medical Colleges; the American Association of Colleges of Osteopathic Medicine; the American Dental Education Association; the American Association of College of Pharmacy; the Association of Schools of Public Health; and the American Association of Colleges of Nursing (AACN). Providing core, interprofessional competencies will allow each discipline to identify specific objectives and goals and tailor the learning process to curricular needs. In this new vision, control of learning shifts to the individual practitioners to be the architects of their own learning process. Reaching across the multidisciplinary spectrum of healthcare, continuing competency may provide evidence-based practices and offer interprofessional, collaborative learning opportunities to more readily address patient safety issues and lead to improved patient care outcomes. To be competent, nurses must obtain and maintain a particular level of skill which could be periodically verified to assure the health care professional’s ability to deliver care reflecting indicators of safe, competent practice. The key difference between continuing competence and current continuing education methods is the interaction of multiple healthcare disciplines and incorporation of evaluation methods to assure continuing competence. The mission of the Arizona State Board of Nursing is to protect the public health, safety and welfare through the safe and competent practice of nurses and nursing assistants. Intended to build the capacity for lifelong learning, continuing competence as it is currently being conceived and formulated may provide the mechanism by which competence is assured. 10 References: Recommended Reading: Institute of Medicine. (2009). Redesigning continuing education in the health professions. Washington, D.C.: National Academy of Sciences. Retrieved from http://books.npa.edu/catalog/12704.html Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, D.C.: National Academy of Sciences. Retrieved from http://www. nap.edu/catalog.php?record_id=12956 National Council of State Boards of Nursing. (2005). Continued Competence Concept Paper. Chicago, IL: Author. Retrieved from https://www.ncsbn.org/ Continued_Comp_Paper_TestingServices.pdf National Council of State Boards of Nursing. (2010). Member board profiles: Continued competence/Assistive personnel/Scope of Practice. Retrieved from https://www. ncsbn.org/2010_Continued_Competence_Assistive_ Personnel_Scope_of_Practice.pdf Allen, P., Lauchner, K., Bridges, R. A., FrancisJohnson, P. McBride, S. G., and Olivarez, A. (2008). Evaluating continuing competency: A challenge for nursing. The Journal of Continuing Education in Nursing, 39(2), 81-5. Cusack, L., and Smith, M. (2010). Power inequalities in the assessment of nursing competency within the workplace: Implications for nursing management. The Journal of Continuing Education in Nursing, 41(9), 408-412. Jordan, C., Thomas, M. B., Evans, M. L., and Green, A. (2008). Public policy on competency: How will nursing address this complex issue? The Journal of Continuing Education in Nursing, 39(2), 86-91. Tilley, D. D. S. (2008). Competency in nursing: A concept analysis. The Journal of Continuing Education in Nursing, 39(2), 58-64. Exciting Opportunities! 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Health Temp, Arizona’s largest and most respected agency offers: • Top Wages • Block Assignments • Daily Pay • Local Assignments • Sign On Bonus • Statewide Assignments • Direct Deposit • Priority Contract • Credit Union • Individual Insurance All RN Areas Available. Call 602-234-1944, 520-577-9088 or 800-486-8367 for additional info. NURSING RegulatoRy JouRnal w w w . h e a l t harizona t e mSTATE p BOARD . c oOFm 11 Fiftieth Legislature - First Regular Session Senate House change session | printer friendly version Email a Member | Email Webmaster Legislative Council JLBC More Agencies Bills Committees Calendars/News HOUSE OF REPRESENTATIVES HB 2091 nurses; continuing education Sponsor: Representative Heinz X Committee on Health and Human Services Caucus and COW House Engrossed OVERVIEW HB 2091 requires continuing education as part of the license renewal process, and establishes criteria regarding that process. Summary of Proposed Strike-Everything Amendment to HB 2091 HB 2091 requires continuing education as part of the license renewal process, and establishes criteria regarding that process. HISTORY The State Board of Nursing (Board) was established on June 9, 1921, through House Bill 32, and in 1952 the Nurse Practice Act was rewritten to include the qualifications of Board members. The Board consists of nine members all of whom are appointed for five year terms beginning and ending on June 30. The Board assures that standards of practice are met and that persons engaged in the practice of nursing are competent. It approves individuals for licensure, registration and certification, approves educational programs for nurses and nursing assistants, investigates complaints, and determines and administers disciplinary actions. PROVISIONS Requires, beginning April 1, 2013, an affidavit to be filed for a renewal application that states the licensee has completed at least sixty hours of continuing education (CE) for a registered or practical nurse, a clinical nurse specialist, or a registered nurse practitioner. Allows an extension by the Board for a licensee to complete the requirements for a renewal application if a written request is submitted with the renewal application. Allows any of the following to provide CE courses:  A nursing program recognized by the Board or other state board of nursing.    An entity approved or certified by an organization recognized by the Board, and specifies that if the entity is not approved or certified, the licensee may only claim six hours per year from that entity. Any CE provider recognized by any state board of nursing. A regionally or nationally accredited postsecondary school. Requires the Board to recognize CE units as follows: One semester credit is equivalent to fifteen CE hours.    12 One quarter credit is equivalent to ten CE hours. One hour of employer sponsored or continuing education provider sponsored education is the equivalent of arizona STATE BOARD OF NURSING RegulatoRy JouRnal one CE hour. Requires the licensee to maintain CE records for five years. Exempts a licensee from CE for two years immediately following initial licensure by the Board. Provides that CE requirements do not apply to a licensee who, during the renewal cycle:        Has been placed on inactive status. Demonstrates that the licensee has been employed outside the U.S. for at least one year. Is employed by a federal agency outside of the state. Is serving in the U.S. armed forces outside the state. Has suffered from a total physical disability for at least one year. Has had total responsibility for an immediate family member who suffers from a total disability for at least one year. Has shown good cause to the Board for exemption. Requires the Board to submit a report to the Governor, the President, the Speaker, and a copy to the Secretary of the State, regarding the effect and benefits of the CE requirements. Requires the Board to prorate the CE requirements to reflect the number of months remaining before licensure renewal following the effective date of this act. Repeals this section from and after December 31, 2020 Defines, for the purposes of this section, continuing education. Fiftieth Legislature First Regular Session 2 February 10, 2011 ©2007 Arizona State Legislature. privacy statment Making a Difference By Serving Those Who Serve NOW Hiring RNs For The Following! CM Supervisor ECHO Program Health Coach-Behavioral Health (Depression/Anxiety) Clinical Communicator (Technical writing) Quality Study Coordinator Quality Management For details please see our website at www.triwest.com TriWest Healthcare Alliance provides access to quality health care for 2.7 million members of America’s military family in the 21-state TRICARE West Region. Visit the website for a company overview and highlights of our benefits. We are proud to be an Equal Opportunity Employer providing a smoke-free, drug-free environment. Applicants must be able to pass a drug test and a DoD-mandated background investigation. www.triwest.com U R AC NURSING FACULTY NURSING FACULTY POSITIONS POSITIONS AVAILABLE AVAILABLE Nursing Faculty Positions Available The University Arizona, College of Nursing is seeking clinical TheofUniversity of Arizona, College of scholars to support our educational mission. Nursing is seeking candidates to support Visit www.uacareertrack.com for additional information, our educational mission. Faculty will minimum qualifications and to apply. provide nursing instruction in clinical and classroom settings to nursing students. To apply go to: www.uacareertrack.com andVisit refer to job number 46896, 46551, www.uacareertrack.com for additional information, minimum qualifi cations and 46381, 45437 and 45412. The University Arizona, College to apply (see job of numbers 44212, 45049,of 45053 and 45054). Reviews ofNursing applications will continue until positions is seeking clinical scholarsare filled. Reviews of applications will continue until positions are filled. to support our educational mission. The University of Arizona is an EEO/AA Employer – M/W/D/V. University of Arizona is an EEO/AA Employer - M/W/D/V Visit Thewww.uacareertrack.com for arizona STATE BOARD OF NURSINGminimum RegulatoRy JouRnal additional information, 13 You are invited to the 2011 NCSBN Long-term Care Conference: A Regulatory Perspective and Future Implications at the Swissôtel Chicago. This conference will provide a forum where participants will hear speakers present key issues in long-term care today and what the future may bring. There will be an emphasis on regulatory implications in long-term care, including the promotion of patient safety with effective communication across the workforce, a discussion of delegation and a panel discussion on issues in education consistency. There will also be time for participants to dialogue about issues, such as scope of practice, education consistency and testing, and building teams in longterm care. Objectives: 1. Explore the present and future regulatory implications in long-term care; 2. Discuss pertinent education issues related to unlicensed assistive personnel (UAPs), medication aides/assistants (MAs), licensed practical/vocational nurses (LPN/ VNs) and registered nurses (RNs) who work in long-term care; and 3. Identify a preferred future for long-term care and how we might get there. Who should attend: Educators of UAPs, MAs, LPN/VNs and RNs who work in long-term care; Longterm care/nursing home administrators; State and federal administrative agency staff; and UAPs, MAs, LPN/VNs and RNs who work in long-term care. CE provider number/expiration date: ABNP1046, October 2014 Accommodations for the 2011 NCSBN Longterm Care Conference are provided by the Swissôtel Chicago in Chicago, Ill. When Tuesday, August 23, 2011 8:00 am - Wednesday, August 24, 2011 4:00 pm Central Time Where Swissôtel Chicago 323 E. Wacker Drive Chicago, IL 60601 Fees View Event Summary View Event Agenda RSVP Friday, August 12, 2011 cO chAiRs: KAthy scOtt, RN, mpA, phD, FAchE & pAt JOhNsON, lpN stAFF: JuDy BONtRAGER, RN, mN & tAmmi BymERs, RN, msN SCoPE of PRACtiCE CommittEE REpoRt to the initial assessment of wounds through the gathering and recording of assessment data, and to perform basic and advanced wound care in collaboration with the RN or Licensed Independent Practitioner (LIP). The General requirements clearly state it is the RN or LIP who is responsible for the assessment of the patient and develops the initial and ongoing plan of treatment performed by the LPN. The advisory opinion also defines the instruction required for LPN’s to do basic wound care, advanced wound care and sharp wound debridement. At the January, 2011 Board meeting, the Board approved the following advisory opinions. New Advisory Opinions • Wound Care: The Role of the LPN – This advisory opinion states that it is within the scope of practice for an LPN to contribute 14 • Flouride Varnish: Oral Health Screening – This advisory opinion states that it is within the scope of practice for an RN to perform oral health screening/ assessments and apply fluoride varnish under the supervision of a Licensed Independent provider (LIP) who possesses specific knowledge, skills arizona STATE BOARD OF NURSING RegulatoRy JouRnal and abilities in oral health screening/ assessment and fluoride varnish application procedures. It is also within the scope of practice of the LPN to apply fluoride varnish under the supervision of an RN. The advisory opinion also defines the instruction that is required for this procedure. Updated Advisory Opinions • Assessing Patient-Client Conditions: The Role of the RN • Intubation: Endotracheal, and the Use of Advanced Airway Devices: The Role of the RN • Ventilator Care by LPN’s • Blood Cell Salvage: The Role of the RN • Intravenous Administration of Radiologic Contrast Media Please review all the advisory opinions on the Board’s Web site at www.azbn.gov, under Resources tab. Share your unique vision with us. You Dreamed of Being a Nurse. At University Medical Center, we provide our nurses with an array of professional advantages to allow them to practice the true art of nursing. With your specialized skill, passion for excellence and compassion for others, you can help us give our patients a brighter future. With our commitment to professional development, advanced technology and low nurse-to-patient ratios, you’ll have the support and time you need for an inspirational nursing career. • Case Manager • NP – Pain Managment • NP – Trauma Now Become the Nurse You Dreamed of Being. • RN – OR • RN – Critical Care • RN - IMC/MS Earn Your RN to BSN Online! To learn more about our rewarding career opportunities and the unique advantages that we offer, please visit us online at www.umcarizona.org or send an email to nurserecruitment@umcaz.edu. If you would like to speak with a recruiter, please call 800-524-5929. We are an Equal Opportunity Employer. www.umcarizona.org RNs: Get 30 Credits Free! Call 800-571-4934 JacksonvilleU.com/PC One of “America’s Best Colleges” U.S. News & World Report © 2009 All Rights Reserved. Made Available by University Alliance® – The Nation’s Leading Universities Online. SC: 191734zj1 | MCID: 2742 You can pursue your passion in paradise zona State Board of Nursing Newsletter 31/2011 53670-PHPC40060 NIMEC 25” x 4.875” rianna Pasquale v.1 Our 181-bed facility is home to advanced healthcare technology and a full range of specialized treatment options. If you share our passion for community-focused caring, consider a career with our facility as a: Registered Nurse—Full Time & Seasonal Havasu Regional Medical Center offers opportunities in all aspect of nursing. We also excellent compensation and benefits package, health, dental, vision, life insurance, 401K and a vacation plan. excellent offer an including generous For further details regarding job opportunities or to apply, visit our website www.havasuregional.com. We support a drug-free environment, EOE. 101 Civic Center Lane, Lake Havasu City, Arizona 86403 arizona STATE BOARD OF NURSING RegulatoRy JouRnal 15 BSN or MSN. Three initials that can make the difference. RNs can prepare to advance their education and their careers while working with our online options: RN to BSN Online Degree Completion Program, RN-BSN to MSN Online Bridge Option and Master of Science in Nursing (MSN) Degree Program. With over 120 years of history in providing excellence in nursing education, Chamberlain College of Nursing offers a proven education model with degree options to take you to the next step. Keep moving forward. Online. On your time. chamberlain.edu 888.556.8226 National Management Offices | 3005 Highland Parkway | Downers Grove, IL 60515 Accreditation: Chamberlain College of Nursing is certified to operate by the State Council of Higher Education for Virginia, 101 N. 14th Street, Richmond, Virginia 23219, 804-225-2600. The VA Board of Nursing has provided Chamberlain College of Nursing with the authority to advertise the program and to admit students to its Arlington campus location. Arlington Campus: 2450 Crystal Drive, Arlington, VA 22202 Chamberlain College of Nursing is accredited by The Higher Learning Commission (HLC) of the North Central Association of Colleges and Schools, www.ncahlc.org, one of the six regional agencies that accredit U.S. colleges and universities at the institutional level. The bachelor of science in nursing degree program at the Addison, Columbus, Jacksonville, Phoenix, and St. Louis campuses and the master of science in nursing degree program are accredited by the Commission on Collegiate Nursing Education (CCNE, One Dupont Circle, NW, Suite 530, Washington, DC 20036, 202-887-6791). The bachelor of science in nursing degree program at the St. Louis and Columbus campuses and the associate degree in nursing program are accredited by the National League for Nursing Accrediting Commission (NLNAC). The bachelor of science in nursing degree programs at the Phoenix and the Addison campuses are candidates for accreditation by NLNAC. Candidacy is the first step toward NLNAC accreditation. (NLNAC, 3343 Peachtree Road NE, Suite 500, Atlanta, Georgia 30326, 404-975-5000) The Arlington and Chicago campuses are pursuing programmatic accreditation for the bachelor of science in nursing degree program on their respective campuses. Accreditation provides assurance to the public and to 16 prospective students STATE BOARD OF NURSING JouRnal that standards of qualityRegulatoRy have been met. Program availability varies by location. AC0103. ©2010 Chamberlain College of Nursing, LLC. All rights reserved. arizona eduCation CoRneR DEBRA MCGINTy RN, PhD. EducatioN Program admiNistrator innovative Directions to Narrow the Education – Practice Gap While all appears calm to the unsuspecting observer, there is a veritable flurry of activity behind the scenes amongst members of the Education Advisory Committee. Recent publications and local presentations this past fall by Patricia Benner (2010) and Linda Burnes Bolton (Institute of Medicine [IOM], 2010) launched critical discussions and calls to action around the state. Members of the Education Committee are participating in focused discussions to evaluate everything from current theory underlying the formation and sustainability of nursing competency to implementation of IOM recommendations. Members of the Committee and the Education Department are examining the Board’s advisory opinion regarding preceptorships, and the use of simulation to measure competency. Competency Model This subcommittee retrieved the Board’s competency model from the archives and updated the structure, concepts and outcomes. Fortuitously, the National League for Nursing (2010) just spent the better part of two years creating a systems model to demonstrate the progression of competency from LPN to DNP. Developed by leaders from both education and practice, the framework provided an excellent springboard to adjust for consistency and add the certified nursing assistant and certified medication assistant roles. Look for the revised model on our website this spring under the education section. A special thank you goes to committee members Dr. Sally Doshier (Northern AZ University), Ms. Carolyn McCormies (Eastern AZ College), Mr. Brian Stewart (Pima Community College), and Dr. Brenda Morris (Arizona State University), for their investment of time and energy into this project. Continued Competence With renewed interest to seek continuing education requirements at the legislature, a subcommittee formed to examine indicators of continued competence (advanced degrees, certifications, and research). Discussions have centered on the diverse roles of nurses and workplace centered competency programs. This subcommittee is tasked with defining competency and reviewing evidence that ties competency to patient outcomes. institute of Medicine A volunteer group has formed to conduct a statewide assessment of Arizona’s current status in relation to the 8 recommendations of the IOM report, The Future of Nursing: Leading Change, Advancing Health. The group is also developing plans to form a Regional Action Coalition (RAC) as part of a national effort to reform nursing and health care for the future. The group’s work will be disseminated on a Board of Nursing sponsored website. Check for updates this spring. Volunteer members represent education, industry and regulation. The group is currently seeking a non-nurse partner. For more information contact Pamela Randolph at prandolph@ azbn.gov. Preceptorship Advisory opinion Review During its December meeting, Education continued on page 18 >>> Come join our Nurse Practitioner teams in Arizona! We invite you to explore the rewarding opportunities with one of the largest NP group practices in the state of Arizona. INSPIRIS employs over 50 full time and part time nurse practitioners in a variety of clinical settings. The INSPIRIS clinical model is built around proactive, preventative care; early, aggressive care in the appropriate location; and Advance Care Planning that identifies and supports patient centered care. Our patients are the chronically ill --- those with complex medical needs. Clinical settings include nursing homes, assisted living centers, group homes, and individual homes. You will have the unique experience of having a panel of patients assigned to you yet working with a team of nurse practitioners and nurse care managers under the supervision of another very experienced nurse practitioner. INSPIRIS offers autonomy in your practice, flexibility in your work week, and clinical challenges that will help you grow in your expertise as a nurse practitioner. “The practice you had in mind all along” We provide competitive pay, generous benefits including medical, dental, vision, life and long-term disability insurance, three weeks of vacation, 9 paid holidays, 401K plan, mileage reimbursement and continuing education reimbursement. Certified nurse practitioner, Masters Degree required; FNP, ANP or GNP; Active, unencumbered nursing license. To learn more about our opportunities direct inquiries and resumes to: Kathy Rudman / 310-903-3460 / kathy.rudman@inspiris.com www.inspiris.com arizona STATE BOARD OF NURSING RegulatoRy JouRnal 17 with very encouraging findings. This joint venture between Arizona State University, Scottsdale Community College and the Arizona State Board of Nursing was funded by the National Council of State Boards of Nursing through its Center for Regulatory Excellence. The project team developed and established initial reliability and validity of a Nursing Performance Profile tool to be used in simulation scenarios. The team will be seeking to publish their result in the Journal of Regulatory Excellence and is applying for Phase II of the grant. Team members from Scottsdale Community College include Janine Hinton, Nick DeFalco You’ve arrived. Committee members discussed specific objectives for preceptorships associated with capstone experiences. Members asked if the current advisory opinion relates to all programs as different models are evident. Observations regarding continuity and quality of the student experience were shared. Members agreed there was a need for data to support the model and to identify specific problems as finding placement for students is becoming increasingly difficult. There is a need to articulate how the preceptorship model prepares students for practice and supports the transition from education to practice. The group will review the preceptorship advisory opinion, identify concerns, and offer recommendations to nursing programs and healthcare facilities. Measuring Competency with Simulation Phase I of Measuring Competency with Simulation has been completed 18 You’ve put years of hard work, education and training into establishing a great career for yourself. Your compassion and commitment to quality caring have placed you among the best in the profession. Now it’s time to enjoy the incomparable rewards of a career with Yavapai Regional Medical Center in Prescott, Arizona. The acuity and advanced technology are just what you’re used to. But living here is far beyond the expected. Please apply now for future openings in: •Cath Lab/Angio Suite •Perinatal/Gyn Services •Emergency Department •ICU, CVICU, CVOR •Med/Surg/Tele •Surgical Services arizona STATE BOARD OF NURSING RegulatoRy JouRnal To take the first step, visit us online at: www.yrmc.org. If you are a qualified candidate for any of these positions, please apply online or e-mail resumes to VIPCareerNetwork@yrmc.org. For further information, contact our recruiter at 877-976-9762. Two great hospitals. One caring spirit. and Kathy Miller; team members from ASU include Debra Hagler, Ruth Brooks, Beatrice Kastenbaum and Dan Weberg. Mary Mays, formerly from ASU, is providing statistical expertise. Pamela Randolph is the Board representative. It’s an exciting time to be (or become!) a nurse educator in Arizona! All around the state discussions about developing, improving, and sustaining nursing competencies are taking place. Taken together, these efforts will offer new directions to better prepare and sustain our nursing workforce. For additional information contact Debra McGinty at dmcginty@azbn.gov. Recommended Reading: Benner, P. Sutphen, M., Leonard, V., & Day, L. (2010). Education nurses: A call for radical transformation. San Francisco, CA: JosseyBass. Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, D.C.: National Academies Press. Retrieved from http:// thefutureofnursing.org/IOM-Report National League for Nursing. (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master’s, practice doctorate, and research doctorate programs in nursing. New York, NY: Author. Robert Wood Johnson Foundation. (2011). Initiative on the future of nursing: Campaign for action. Retrieved from http:// thefutureofnursing.org/content/regionalaction-coalitions Community College. • Accepted Plan of Correction for Cactus Wren Nursing Assistant Training Program. • Accepted Terms of Probation as implemented and deficiencies corrected at Star Canyon Nursing Assistant Training Program. Board Actions – Educational Programs November 2010 • Granted provisional approval to BrownMackie College Tucson LPN Program with a report 12 months after admission of students. • Granted provisional approval to East Valley Institute of Technology LPN Program under probationary terms with a report 12 months after admission of students. • Renewed approval of the CNS, FNP, and ACNP Programs at Grand Canyon College. • Approved program change at Central Arizona College RN Program. • Approved change from current Second Degree Accelerated BSN track to a Masters Entry into Practice track at The University of Arizona. • Issued Notice of Deficiency to ITT Technical Institute. • Issued Notice of Deficiency to Mohave January 2011 • Deferred decision for Mohave Community College Proposal for LPN Program until remedies for current RN program deficiencies are approved. • Approved changed in length of Mohave Community College RN Program. • Renewed approval of all NP Programs at Arizona State University. • Adopted Licensure Subscription Service for Employers/Educational Institutions to track licensure changes. • Renewed approval of University of Phoenix LPN to BSN program. • Accepted Plan of Correction as being satisfactorily implemented and deficiencies corrected at Scottsdale Community College Nursing Assistant Training Program. • Approved changes to Certified Nursing Assistant Testing effective March 1, 2011. TiTle PROTecTiOn fOR ADVANCED PRACTICE NURSES In 2005 the Board amended its administrative rules to place title protection for advanced practice nurses in rule (R4-19-510). Four years later, in 2009, nearly identical title protection for advanced practice rules was placed in statute (A.R.S. § 32-1636). The Board is required to review agency administrative rules every 5 years to determine if they are still effective and enforced and submit the review to the Governor’s Regulatory Review Council (GRRC) for approval. Agencies can also elect not to review a rule in order to let an obsolete rule expire. In an amended 5 year rule review report, the Board is electing not to review R4-19-510 and allow it to expire. This is based on the advice of GRRC and recommended by the Advanced Practice Advisory Committee. This rule is replaced and trumped by ARS §32-1636. Below is a comparison of the rule and statute. Statute A.R.S. §32-1636 Use of titles or abbreviations Rule R4-19-510 Use of Title C. Only a person who holds a valid and current certificate issued pursuant to this chapter to practice as a registered nurse practitioner in this state may use the title “nurse practitioner”, “registered nurse practitioner” or “nurse midwife”, if applicable, or use any words or letters to indicate the person is a registered nurse practitioner. A person who is certified as a registered nurse practitioner shall indicate by title or initials the specialty area of certification. D. Only a person who holds a valid and current certificate issued pursuant to this chapter to practice as a clinical nurse specialist may use the title “clinical nurse specialist” or use any words or letters to indicate the person is a clinical nurse specialist. A person who is certified as a clinical nurse specialist shall indicate by title or initials the specialty area of certification. Under A.R.S. § 32-1666, a person shall not practice as a registered nurse practitioner, also known as a nurse practitioner, a certified nurse midwife, also known as nurse midwife or a clinical nurse specialist, or use any words or letters to indicate the person is a registered nurse practitioner, nurse practitioner, certified nurse midwife, nurse midwife, or clinical nurse specialist unless certified by the Board. Pamela Randolph at prandolph@azbn.gov may be contacted for further information. arizona STATE BOARD OF NURSING RegulatoRy JouRnal 19 REgiStEREd nuRSE pRaCtitionER (Rnp) PRACTICING IN AN ACUTE CARE SETTING Background Registered nurse practitioner (RNP) education has progressed beyond the apprentice model of “see one, do one, teach one.”(Swenson, 2006). It is no longer acceptable to substitute registered nursing experience and physician oversight for a formal nurse practitioner program consisting of didactic and clinical study informed by national standards. Authority to practice does not flow from a physician’s license (Swenson, 2006) but from a rigorous credentialing process that includes verification of appropriate educational preparation including supervised clinical practice and competency testing at the advanced practice level. Similar to other professions, the scope of registered nurse practitioner practice is based upon the didactic and clinical education obtained in a basic RNP program (Klein, 2008). RNP Education Registered nurse practitioner education has evolved into a system consisting of advanced core and focused specialty courses. This educational model prepares graduates for advanced nursing practice as direct care providers within a focused population of care (also known as specialty area). RNP education does not follow the medical model therefore RNPs do not readily fit into the process used by facilities to credential physicians and medical residents. Care must be taken in credentialing the RNP to ensure full utilization of scope of practice based on the RNP’s training, practice setting and education (Kleinpell, Hrvanak and Hinch, 2008). Administrators are challenged with ensuring that appropriate mechanisms exist to credential and privilege RNPs within the institution appropriate to their scope of practice (Kleinpell, Hravnak and Hinch, 2008). The primary component of the RNP ability to practice is their licensure and recognition through national certification in an established population area of practice (Klein 2008). In Arizona prior to July 1, 2004, not all nurse practitioners were required to hold national certification, but all have been through a review of their education for consistency with their assigned specialty population as part of the qualification for state board certification; state board certification is required for practice in Arizona. Population is not only defined by 20 diagnosis, gender, and age, but also by acuity and type of care needed. There are 2 broad categories of RNP preparation: primary care with didactic and clinical education focused on health promotion, disease prevention and treatment of patients primarily in ambulatory and community settings; and acute care with didactic and clinical education focused on the management of patients with complex acute, critical and chronic health conditions primarily in acute care (hospital) settings (NONPF 2002, 2004). Within primary care, RNP practice is further specialized to a population of care (Pediatric, Adult, Gerontology, Family, Women’s Health, etc). Journey to a place where caring comes naturally. With facilities in Cottonwood, Flagstaff and Sedona, Northern Arizona Healthcare is the largest healthcare provider in Northern and Central Arizona. We are dedicated to providing our communities with the highest quality care available. We achieve this mission by utilizing the most advanced technology to assist our staff and encouraging our patients to take an active role in their treatment. Flagstaff Medical Center is currently seeking: • Clinical Manager- CCU • Clinical Manager- CVICU • Clinical Manager- Med/Surg • RN- CVICU • RN- PICU Verde Valley Medical Center is currently seeking: • Clinical Manager- Cath Lab • Director, Perinatal Services • Neonatal Nurse Practitioner Employees of NAH enjoy a generous benefits package that includes competitive salaries, free core medical insurance, wellness programs, a new hire on-boarding program, weekend differentials, tuition reimbursement and much more! To learn more about opportunities at NAH and the communities that we serve, please visit www.nahealth.com/careers. Patients Are Our Purpose arizona STATE BOARD OF NURSING RegulatoRy JouRnal Acute care RNP specialties are currently limited to neonatal, pediatric and adult. Additional nurse practitioner specialty areas of preparation include Adult or Family Psychiatric and Mental Health Nurse Practitioner and Certified Nurse Midwife. The educational preparation and practice in these populations of care include management of clients in both primary and acute care settings. Additional Competencies and overlapping Scopes of Practice An individual RNP may enhance their competencies by learning additional skills/ procedures within their scope of practice through additional didactic education and supervised clinical practice as specified in A.A.C. R4-19-208 (C). For example, since primary care of infants is within their scope of practice, a pediatric or family nurse practitioner could perform a circumcision after obtaining and demonstrating this competency through completion of a formal didactic and clinical instruction course. In contrast, an adult RNP, even after completion of the same course, could not perform circumcisions because care of infants is outside the scope of adult nurse practitioner practice. While the Board recognizes that there is some overlap in scopes of practice between specialties, an individual may not expand scope to a different specialty without completing a basic NP program in that specialty. For example a pediatric nurse practitioner may be qualified to follow some patients into young adulthood before transitioning their care to an adult or family practitioner, overlapping with Adult/FNP scope; and a family nurse practitioner may be qualified to treat common, self-limited depression or anxiety, overlapping with psychiatric nurse practitioner scope; but neither is qualified to practice within the full scope of the others’ specialty area. RNP’s in Acute Care Settings Due to recent limits regarding the use of physician residents, acute care facilities have sought to hire nurse practitioners to fill “hospitalist” roles with scant attention as to whether the educational preparation of the NP is consistent with the role. For example, an FNP with some pediatric ICU experience as an RN was believed to be qualified to take an acute care pediatric NP position in the pediatric intensive care unit. While the Board does not limit the employment setting of the NP, the role within that setting must be consistent with the formal education and scope of the NP’s education, certification and specialty. “An RNP shall only provide health care services within the nurse practitioner’s scope of practice for which the RNP is educationally prepared and for which competency has been established and maintained” (A.A.C. R4-19-508 C) . According the National Organization of Nurse Practitioner Faculties (2004), the acute care RNP “practices in any setting in which patient care requirements include complex monitoring and therapies, high intensity nursing intervention, or continuous nursing vigilance within the range of high acuity care” (pg. 13). Acute care nurse practitioners receive “highly focused education that includes psychomotor skill assessment and evaluation in many complex procedures. They are prepared to manage complex unstable patients similar to those managed by hospitalists” (Klein, 2008, pg 277).Therefore it is the position of the Board that an RNP who provides acute care services cannot exceed the limits of the advanced practice specialty area. Sole and independent management of the care of complex unstable patients in an acute care setting, including but not limited to an intensive care unit, is in the exclusive domain of the nurse practitioner who has completed an approved acute care nurse practitioner program. A primary care nurse practitioner may have a role in assisting or directing management of the acute care patient as long as the aspect of care is within the limits of their specialty and role of nurse practitioner certification. Role of Primary Care RNPs in Acute Care Settings There is a role for the primary care NP in an acute care facility if the role is consistent with the educational preparation and certification of the NP. The primary care NP may admit his/her own patients and manage referrals to appropriate specialties, as it is within scope for a primary care NP to facilitate transitions between health care settings and to provide continuity of care for individuals and family members. Patients admitted to an acute care facility will benefit from the inclusion of a primary care RNP on the health care team to assist in the management of some aspects of care consistent with the primary care RNPs scope of practice. Primary care RNP preparation focuses on management of health promotion, disease prevention, and ongoing care of individuals and families (Klein, 2008). The National Organization of Nurse Practitioner Faculties (2002) describe the primary nurse practitioner role in managing and negotiating health care delivery systems as one of “overseeing and directing the delivery of clinical services within an integrated system of health care” (pg. 20, 24 28, 33, 38). A hospital-based primary care RNP could coordinate care between specialty physicians; plan the patient’s discharge; order and review results of diagnostic tests; initiate referrals; advocate for the patient; and monitor the patient’s progress through the system. An acute exacerbation of a chronic illness could be managed by a primary care NP if the nature of the person’s exacerbation is manageable in an ambulatory setting. If an exacerbation of a chronic illness is such that the person is unstable or critically ill, then that person’s care team should include someone with acute care credentials, at least until the situation is under control and stable. Summary In summary the RNP is expected to utilize appropriate judgment to determine if a specific role or procedure within a patient care situation is within the scope of practice that he or she is educationally prepared to provide. “Recognizing the limits of the nurse’s knowledge and experience, planning for situations beyond the nurse’s knowledge and expertise and consulting with or referring clients to other health care providers when appropriate,” (ARS § 32-1606 (17) (d)(vi)) are part of the legal scope and responsibilities of all registered nurse practitioners. Experience as an RN, on-the-job training, having a physician sign off orders, and the personal comfort of the RNP are not a sound basis for accepting an assignment or role beyond the RNP’s scope of practice. Questions and Answers 1. can a primary care nurse practitioner treat hospital patients as long as they are not in the icU? The primary care RNP’s role in any setting must be within their scope of practice consistent with their educational preparation. An oft-quoted caveat is that the RNP can treat any condition in an acute care setting that they could treat in an office setting. While this may have some practical applicability, it will not cover the RNP for practicing outside his/her scope. The condition that led to the patient’s hospital admission may influence the treatment of even the simplest condition. For example, an RNP may be very competent at treating urinary tract infections (UTI) in an office setting. However, when a patient is admitted to the hospital with a diagnosis of dehydration, diarrhea and acute renal failure and subsequently develops a UTI, that patient needs a different treatment approach than an ambulatory client with an episodic illness. The primary care RNP’s continued on page 22 >>> arizona STATE BOARD OF NURSING RegulatoRy JouRnal 21 <<< continued from page 21 educational preparation and supervised clinical practice did not include this content. Therefore, absent additional formal training, independent management of this particular patient’s UTI would be considered outside the scope of primary care nurse practitioner practice. 2. How does my experience as an Rn expand my RnP scope of practice? Your experience as an RN may give you some familiarity with a particular patient population but does not determine your scope of practice as a nurse practitioner. Your RNP scope is based on the didactic education and clinical practice obtained in your RNP program. 3. can a primary care RnP write hospital orders? The Nurse Practice Act allows for primary care RNPs to write orders for hospitalized patients within their scope and limits of the specialty area. Employers may choose to be more restrictive than the nurse practice act, they cannot be less restrictive. RNPs who choose to practice in those more restrictive environments must discuss any concerns they have about practice policies that are more restrictive than the NPA with the facility administration. 4. can a primary care RnP perform invasive procedures? The Board does not maintain a list of approved procedures. In general, primary care RNPs may only perform primary care procedures within the limits of their scope and the demonstrated and evaluated competency of the RNP. First and foremost, the patient and procedure must be appropriate to the RNP scope of practice. The condition necessitating the procedure must be one that the RNP is educationally and experientially prepared to manage. The RNP must have demonstrated and evaluated competency in the procedure. Consistent with A.A.C. R4-19-508 (C), education should consist of formal didactic learning and supervised documented clinical practice as prescribed by an accrediting body, accredited university, or professional association. Finally the RNP must be able to recognize and manage complications including emergencies that would result from the procedure. If the patient’s acuity level requires an invasive procedure and management in an acute care setting this suggests that the sole management of the patient is beyond the scope of practice of the FNP. 5. if a procedure is illegal in AZ, but legal in other states, is it within the scope of practice for an RnP to perform the procedure in AZ? 22 No, the Board’s authority to regulate nursing practice comes from legislatively enacted statutes. The broad scope of RNP practice is contained in the statutory definition of registered nurse practitioner (see ARS § 32-1606 (15) below). If the legislature subsequently prohibits an RNP from performing an activity, for whatever reason, that activity is clearly outside the legal scope of practice. 6. Does scope of practice change based on the scarcity of acute care RnP programs and graduates in AZ? No. Scope of practice is based on formal education and supervised clinical practice within the basic RNP program. The scarcity of appropriate programs for training acute care nurse practitioners does not allow others without that training to assume the role. 7. can a primary care RnP who successfully completes life-support education (AclS, PAlS or nRP) run a code in a hospital? An RN (including NP) may provide care consistent with the recognized guidelines of the organization offering the life-support course. The provider with the highest level of training and proficiency in resuscitative procedures should direct the code. 8. i completed an acute care nurse practitioner program before there was a recognized specialty or exam so was certified as an adult nP. What is my scope of practice? The Board recognizes that with emerging specialty populations, there is often confusion and occasionally inconsistent certification due to lack of a certification exam or approval of the specialty. RNP scope of practice is based on the didactic and clinical education obtained in the basic RNP program. Prior to the emergence of the acute care specialty, some Pediatric NP programs may have contained both a primary and acute care focus, and some Adult NP programs may have included either a primary or acute care track. Graduates of programs that included an acute care focus or track may qualify for acute care certification, and their educational preparation would support acute care practice. For consistency the Board would advise that graduates pass the acute care national certifying exam (if qualified) and seek additional Board certification. The Board recognizes that not all graduates of these programs will qualify for the exam, especially if the program was not part of a graduate degree program. Applicable Regulations ARS § 32-1606 Definitions 15. “Registered nurse practitioner” means a professional nurse who: arizona STATE BOARD OF NURSING RegulatoRy JouRnal (a) Is certified by the board. (b) Has completed a nurse practitioner education program approved or recognized by the board. (c) If applying for certification after July 1, 2004, holds national certification from a national certifying body recognized by the board or provides proof of competence if a certifying examine is not available. (d) Has an expanded scope of practice within a specialty area that includes: (i) Assessing clients, synthesizing and analyzing data and understanding and applying principles of health care at an advanced level. (ii) Managing the physical and psychosocial health status of clients. (iii) Analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health care problem and selecting, implementing and evaluating appropriate treatment. (iv) Making independent decisions in solving complex client care problems. (v) Diagnosing, performing diagnostic and therapeutic procedures, prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances within the scope of registered nurse practitioner practice on meeting the requirements established by the board. (vi) Recognizing the limits of the nurse’s knowledge and experience, planning for situations beyond the nurse’s knowledge and expertise and consulting with or referring clients to other health care providers when appropriate. (vii) Delegating to a medical assistant pursuant to section 32-1456. (viii) Performing additional acts that require education and training as prescribed by the Board and that are recognized by the nursing profession as proper to be performed by a nurse practitioner. ARS § 32-1606 B. The board shall: 12. Adopt rules establishing those acts that may be performed by a registered nurse practitioner in collaboration with a licensed physician. R4-19-508. Scope of Practice of a Registered Nurse Practitioner A. An RNP shall refer a patient to a physician or another health care provider if the referral will protect the health and welfare of the patient and consult with a physician and other health care providers if a situation continued >>> B. 1. 2. a. b. c. 3. or condition occurs in a patient that is beyond the RNP’s knowledge and experience. In addition to the scope of practice permitted a registered nurse, a registered nurse practitioner, under A.R.S. §§ 32-1601(15) and 32-1606(B) (12), may perform the following acts within the limits of the specialty area of certification: Examine a patient and establish a medical diagnosis by client history, physical examination, and other criteria; For a patient who requires the services of a health care facility: Admit the patient to the facility, Manage the care the patient receives in the facility, and Discharge the patient from the facility; Order and interpret laboratory, radiographic, and other diagnostic tests, and perform those tests that the RNP is qualified to perform; 4. Identify, develop, implement, and evaluate a plan of care for a patient to promote, maintain, and restore health; 5. Perform therapeutic procedures that the RNP is qualified to perform; 6. Prescribe treatments; 7. If authorized under R4-19-511, prescribe and dispense drugs and devices; and 8. Perform additional acts that the RNP is qualified to perform. C. An RNP shall only provide health care services within the nurse practitioner’s scope of practice for which the RNP is educationally prepared and for which competency has been established and maintained. Educational preparation means academic coursework or continuing education activities that include both theory and supervised clinical practice. References Klein, T. (2008) Credentialing the nurse practitioner in your workplace: Evaluating scope for safe practice. Nursing Administration Quarterly. 52 (4) 273-278. Kleinpell, R., Hravnak, M., & Hinch, B. (2008) Developing an advanced practice nursing credentialing model for acute care facilities. Nursing Administration Quarterly. 52 (4) 279-287. Swenson, D. (2006) Advanced registered nurse practitioners: Standards of care and the law. Journal of legal nurse consulting. 17 (4) 3-6. The National Organization of Nurse Practitioner Faculties (2002). Nurse Practitioner Primary Care Competencies in Specialty Areas; Adult, Family, Gerontological, Pediatric, and Women’s Health. Available at www.nonpf.org. Accessed July 2, 2009. The National Organization of Nurse Practitioner Faculties (2004). Acute Care Nurse Competencies. Available at www. nonpf.org. Accessed July 7, 2009. Cna eXaM CHanges aRiZona StatE BoaRd oF nuRSing BOARD APPROVED ON JANUARY 26, 2011 test adVisorY PaneL The Test Advisory Panel (TAP) members meet every year to review both the written and manual skills test for C.N.A. Certification. The panel is composed of volunteers from throughout the state representing private and public programs and industry. The panel met on January 12, 2011 and made their recommendations which were presented to the participants in the C.N.A. Educator’s Retreat on January 14, 2011 with positive feedback. On January 26th, 2011 the Board of Nursing approved the following recommendations. Written exam Changes The TAP reviewed 221 new written test items and retained 141 for use on AZ candidates. The TAP also recommended the addition of 3 items in the category of “Role and Responsibility”. This increases the items in the category from the current 4 to 7 and increases the total written test items from 72 to 75. skills exam Changes Eliminate Skill # 11 “Handwashing” as a separate skill and embed appropriate hand involves tactile/kinesthetic learning which occurs only with repeated consistent practice. It is currently problematic that there is the potential for programs to practice these skills according to the steps in the manual which requires verbalization of hand hygiene rather than performance. hygiene into all skills that currently require verbalization of handwashing o Rationale: Skill demonstration tests need to authentically reflect the practice environment and actual skill set expected. The less pretending, the more valid the test (Jefferies, 2005). Hand hygiene is of critical importance to infection control and to allow verbalization instead of actually cleaning hands negates the importance of this activity. Hand hygiene is a habit that needs constant reinforcement and Changes in the Handwashing steps include: • Requiring a minimum of 20 seconds of washing. Rationale: per CDC Guidelines • Eliminating the specification that only 2 towels be used. Rationale: it is not incorrect to use more than 2 paper towels • Clarifying that contamination means touching the sink or faucet during/ after the procedure. Rationale: some observers have been overzealous in failing candidates for “recontamination” if they touch anything after washing their hands—this is overreaching for a clean technique. • Recontamination is not a key step. continued on page 24 >>> arizona STATE BOARD OF NURSING RegulatoRy JouRnal 23 <<< continued from page 23 Rationale: if hand hygiene is performed frequently as recommended, a one-time minor recontamination is unlikely to place a resident in jeopardy. It will be scored as a procedural error however. All candidates will have either Skill #4 “Bedpan and Output” or #15 “Perineal Care Female”. • Within these scenarios, candidates will be required to demonstrate hand hygiene with sanitizer prior to the task and hand washing with soap and water at the end of the scenario consistent with CDC Guidelines Rationale: Provides all candidates with an authentic opportunity to wash hands with soap and water. Tests the appropriate use of hand sanitizer within the skill. These are frequently performed CNA activities so it is appropriate that all be tested on one or the other. Add Skill: “Putting on isolation gown and gloves”. Rationale: this was a suggestion from the community and was viewed as important by committee members. It supports the increased emphasis on infection control in health care facilities. It is commonly performed in LTC facilities. Change effective date from April 1 to March 1 • For this year and in the future meet in early fall so changes can be communicated to the Board and CNA Community for a January 1 effective date. ○Rationale: High school programs have nearly completed all instruction by April 1. A March 1 effective date would allow for instruction earlier when the students are still in the classroom. In the future, an even earlier date is suggested. To accommodate this request, the TAP meeting will be uncoupled from the CNA Retreat can occur earlier. CHANGES IN INDIVIDUAL SKILLS Skill #6 “Blood Pressure” o ○ If candidate makes more that 2 attempts, it will be counted against their score. Rationale: multiple BP readings on an actor is a comfort/ safety issue; CNAs should be able to reliably measure BP in two attempts—if unable this skill needs more practice in the program. FYI: one student took 8 readings in an exam. Skill # 7 “Denture care” o Add to step # 10: “Cleans and dries equipment and returns to storage”. Rationale: failure to dry equipment encourages the proliferation of microorganisms. Skill #8 “Dressing the Bedridden Patient” o Eliminate step #5 “Resident always remains lying in bed” Rationale: due to variances in interpretation, some test observers and instructors are teaching that the CNA cannot lean the person forward to put a shirt on. This is contrary to standard dressing procedures in textbooks. The original intent of placing this step in the test was that the CNA should not sit the resident at the bedside. The instructions will be modified to include that the CNA not sit the resident at the bedside for demonstration of this skill. Skill #12 “Mouthcare—Brushing Teeth” o Eliminate optional use of toothettes for this. Rationale: it would be inappropriate to apply toothpaste to a toothette, which is a required step so this option will not authentically test teeth brushing. This option was added last year to provide for comfort for the actor; to decrease discomfort associated with multiple tooth brushing, it will be suggested that actors/observers provide a very soft toothbrush. Skill #13 “Mouthcare Comatose Patient” o Add 2 additional steps: “Maintains respectful, courteous interpersonal interactions and all times”; and “leaves call light or signaling device and water within easy reach”. Rationale: standards of care for comatose patients support appropriate provider interactions and communication; Call lights need to be available to every resident regardless of neurological status—lack of a call bell within reach of a comatose resident is a violation of DHS standards for LTC facilities. Skill # 15 “Perineal Care Female” o Eliminate from step #3, “asks resident if they would like a third party present”. Rationale: this is not a practice in the long term care facility; changes of diapers and pericare occur many times a day and LTC facilities lack available personnel to routinely chaperone this activity. Nurses Nurse Managers What Magnet means to us… …it’s a feeling of pride and accomplishment every day. …it’s peace of mind, knowing we can count on patient ratios that let us deliver the kind of patient care we became nurses for. …it’s the voice we have with shared governance; our Unit-Based Patient Care Councils truly allow us to drive our practice. …it means knowing the full strength of SHC’s leadership is behind us as we go above and beyond - in world-class patient care and professional growth. …it’s confidence that no matter what, SHC won’t budge on their commitments to great nursing through Magnet status. Join us! Nationally renowned Scottsdale Healthcare (SHC) is a leader in medical innovation, talent and technology — and deeply committed to the nurse Magnet program. We are committed to our core strategy of being the best place to work for talented staff. Explore opportunities at www.shc.org Text RNJobs to 447363 [HireMe] for exclusive employment messages. REFERENCES Jeffries, P. R. (2005). A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96-103. EOE/AA/M/F/D/V 24 arizona STATE BOARD OF NURSING RegulatoRy JouRnal Cna disCiplinaRy aCtion OCTOBER-NOvEMBER- DECEMBER 2010, JANUARy 2011 effective date 12/5/2010 11/10/2010 10/29/2010 name alexander, Heather m. ali, sadia m. Bailey, vicki l. certificate cna1000011827 cna999999715 cna999948995 discipline civil penalty voluntary surrender summary suspension violation(s) filing false reports or falsifying records patient abuse; patient neglect failure to cooperate With Board investigation; criminal conviction; fraud 12/27/2010 11/5/2010 1/4/2010* 12/21/2010 10/7/2010 1/20/2011 Banks, simmenett e. Bilal, amir H. Brent, John t. Brown, stephanie l. Brummett, Brandy l. Burke, deloros cna750712070 cna1000007747 cna999950704 cna999998880 cna1000013598 cna applicant civil penalty revoked civil penalty civil penalty civil penalty certificate denied 12/9/2010 Burkhardt, Bianca B. cna1000013677 civil penalty 10/25/2010 12/17/2010 1/31/2011 7/6/2010* 10/21/2010 Burney, rose m. Butler, ramona c. carley, elisa l. carusillo, anthony H. chapman, Joanne m. cna1000013473 cna1000027232 cna1000027628 cna999994704 cna1000026429 civil penalty civil penalty civil penalty voluntary surrender stayed revocation 9/1/2010* chase, ashley r. cna applicant certificate denied 12/31/2010 11/18/2010 12/14/2010 11/17/2010 1/19/2011 chee, leander chintankwa, tamina d. cruz, roberta a. diaz, michael dilyou, regina a. cna999992480 cna999950485 cna999996389 cna applicant cna643067803 civil penalty civil penalty civil penalty certificate denied renewal denied 11/5/2010 1/14/2011 dixon, elizabeth a. ellisor, christy l. cna1000010077 cna1000018682 revoked voluntary surrender 11/5/2010 engel, Jon a. cna552005863 revoked 10/28/2010 escobar, carolyn r. cna applicant certificate denied 1/12/2011 12/22/2010 1/20/2011 11/24/2010 1/20/2011 falcon, carolyn J. finley, nekocher l. fraiberg, alexandria J. fulton, James a. Galberth, stephanie l. cna552913677 cna applicant cna1000023340 cna applicant cna applicant revoked certificate denied revoked certificate denied certificate denied 12/9/2010 1/13/2011 Gambold, Kristina l. Garcia, albert J. cna999948569 cna applicant decree of censure certificate denied 12/7/2010 1/6/2011 12/15/2010 10/27/2010 Gearhart, Brittney m. Gibbons, Beatrice m. Gibbs, Joseph W. Gibson, lanny r. cna applicant cna1000008113 cna1000027089 cna applicant civil penalty renewal denied stayed revocation certificate denied 12/17/2010 Glamuzina, debra J. cna999996110 decree of censure 1/26/2011 11/29/2010 7/29/2010* Grabner, William d. Haggmana, tesfai Hampton, tanya m. cna727526103 cna999990453 cna1000025005 voluntary surrender decree of censure civil penalty drug screening violation patient abuse; sexual misconduct; Unable to practice safely patient abuse; patient neglect criminal conviction criminal conviction; failure to cooperate With Board investigation criminal conviction; failure to cooperate With Board investigation; narcotics violation or other violation of drug statutes violation of federal or state statutes, regulation or rules; criminal conviction; failure to cooperate With Board investigation non-sexual dual relationship or Boundary violation criminal conviction criminal conviction patient abuse; abusive conduct toward staff alcohol or other substance abuse; criminal conviction; failure to cooperate With Board investigation failure to cooperate With Board investigation; failure to meet licensing Board reporting requirements; criminal conviction criminal conviction patient abuse criminal conviction criminal conviction criminal conviction; misrepresentation of credentials; failure to cooperate With Board investigation criminal conviction; failure to cooperate With Board investigation failure to cooperate With Board investigation; misappropriation of patient property or other property patient abuse; criminal conviction; failure to comply with Health & safety requirements criminal conviction; failure to disclose; failure to cooperate With Board investigation violation of or failure to comply with licensing Board order criminal conviction violation of or failure to comply with licensing Board order criminal conviction; failure to cooperate With Board investigation criminal conviction; failure to cooperate With Board investigation; narcotics violation or other violation of drug statutes patient abuse fraud/deceit or material omission in obtaining license or credentials; violation of federal or state statutes, regulation or rules; failure to cooperate With Board investigation criminal conviction; failure to cooperate With Board investigation criminal conviction criminal conviction criminal conviction; fraud/deceit or material omission in obtaining license or credentials; failure to cooperate With Board investigation Breach of confidentiality; sexual misconduct; other Unprofessional conduct disruptive conduct; abusive conduct toward staff abusive conduct toward staff; filing false reports or falsifying records criminal conviction; misappropriation of patient property or other property; violation of federal or state statutes, regulation or rules 12/3/2010 11/26/2010 12/4/2010 11/24/2010 Hargarten, tinna K. Hartung, Kurt Hays, Wayne a. Henegar, Hannah m. cna1000027043 cna applicant cna1000027042 cna applicant civil penalty certificate denied civil penalty certificate denied 10/27/2010 9/30/2010* 12/29/2010 Hernandez, Brian K. Herrera, christina Hill, enika c. cna1000026558 cna860264441 cna999951121 civil penalty revoked suspension failure to cooperate With Board investigation criminal conviction; failure to cooperate With Board investigation criminal conviction; failure to cooperate With Board investigation failure to cooperate With Board investigation; criminal conviction; violation of federal or state statutes, regulation or rules criminal conviction misappropriation of patient property or other property violation of or failure to comply with licensing Board order 11/16/2010 Hilleary, cassidy e. cna applicant certificate denied criminal conviction; narcotics violation or other violation of drug statutes 1/13/2011 10/27/2010 Howard, ruby l. Hubler, lynda m. cna applicant cna applicant certificate denied certificate denied 1/6/2011 Hunt, Jarhett r. cna applicant certificate denied 9/30/2010* 11/23/2010 iloh, Ben U. James Jr, charles B. cna999991655 cna1000027226 civil penalty stayed revocation 10/21/2010 12/16/2010 10/6/2010 James, Whitney J. Johnson, Jermyn J. Jordan, redessa p. cna applicant cna1000028002 cna1000005119 certificate denied stayed revocation stayed revocation 1/12/2011 11/1/2010 10/21/2010 10/12/2010 11/17/2010 Jordan, redessa p. Kleppel, trisha a. landolfi, niki n. lekol, Baribuma J. lewis Jr, samuel n. cna1000005119 cna1000018628 cna applicant cna1000021205 cna applicant revoked decree of censure certificate denied civil penalty certificate denied criminal conviction; failure to cooperate With Board investigation alcohol or other substance abuse; criminal conviction; failure to cooperate With Board investigation failure to meet the initial requirements of certification; failure to cooperate With Board investigation; criminal conviction filing false reports or falsifying records criminal conviction; failure to cooperate With Board investigation; alcohol or other substance abuse criminal conviction; narcotics violation or other violation of drug statutes criminal conviction abusive conduct toward staff; Unable to practice safely; substandard or inadequate care violation of or failure to comply with licensing Board order substandard or inadequate care; filing false reports or falsifying records criminal conviction; failure to cooperate With Board investigation failure to comply with Health & safety requirements; patient abuse criminal conviction; fraud/deceit or material omission in obtaining license or credentials arizona STATE BOARD OF NURSING RegulatoRy JouRnal 25 Cna disCiplinaRy aCtion *not reported in previous Journal Continued OCTOBER-NOvEMBER-DECEMBER 2010, JANUARy 2011 effective date name certificate discipline violation(s) 10/14/2010 liska, Kimberly l. cna999999576 civil penalty 11/9/2010 livingston, ashley m. cna1000007754 1/5/2011 11/30/2010 lodwig, daniel a. lopez, mario a. cna1000000538 cna1000000094 stayed revocation w/suspension civil penalty civil penalty failure to meet licensing Board reporting requirements; criminal conviction violation of or failure to comply with licensing Board order 11/5/2010 manoogian, ron l. cna716273759 revoked 11/5/2010 mata, margarita cna999993116 revoked 7/20/2010* mcmullin, annmarie m. cna1000000734 voluntary surrender 1/10/2011 merkley, Bryce G. cna applicant certificate denied 11/9/2010 12/9/2010 11/5/2010 12/14/2010 12/22/2010 10/30/2010 miller, dawn m. mullane, Kim l. myers, rhonda m. myles, tonja m. nathan, ona d. nelson, emma J. cna applicant cna999995830 cna applicant cna applicant cna applicant cna applicant certificate denied civil penalty certificate denied decree of censure certificate denied stayed revocation 11/22/2010 12/22/2010 9/9/2010* 1/17/2011 10/6/2010 nelson, renata J. oliver-nez, christopher J. orosco, olivia p. padia, chelsea r. parker, amy c. cna999949901 cna applicant cna360414913 cna1000023839 cna999989677 stayed suspension certificate denied voluntary surrender stayed revocation voluntary surrender 1/27/2011 1/20/2011 paul, Ketlie c. pennington, rhonda K. cna1000003034 cna applicant voluntary surrender certificate denied 11/24/2010 1/13/2011 12/10/2010 10/27/2010 pickett, cindy l. radke, tara r. richardson, rosalind m. rodriguez, sarah e. cna621608177 cna applicant cna1000010295 cna825394441 voluntary surrender certificate denied civil penalty reinstatement denied 8/26/2010* 10/27/2010 rojas, Gabriela romero, Jaysi l. cna1000005515 cna applicant civil penalty certificate denied 1/3/2011 rud, donna l. cna applicant certificate denied 1/21/2011 10/1/2010 1/10/2011 schaller, donna m. schmuecker, megan e. shi, aifang cna1000007597 cna1000022579 cna1000005894 voluntary surrender decree of censure revoked 10/5/2010 11/5/2010 1/28/2011 smith, lynn m. solis, veronica sommerfeld, Kelly J. cna999950263 cna1000018754 cna1000007595 renewal denied revoked revoked 1/27/2011 11/17/2010 tataru, ana v. tewawina, effie d. cna1000012080 cna applicant decree of censure certificate denied 10/15/2010 12/12/2010 11/9/2010 thompson, marcy K. Waddell, andrea l. Warner, Jeffrey m. cna1000026428 cna753238803 cna applicant civil penalty suspension certificate denied 12/10/2010 10/8/2010 12/29/2010 12/7/2010 12/13/2010 Weaver, terri l. Wells, laura J. Wells, laura J. Wilhelm, daryl r. Williams, delores m. cna applicant cna410147824 cna410147824 cna1000026989 cna999998039 certificate denied civil penalty suspension stayed revocation civil penalty 12/23/2010 7/6/2010* Williams, reba K. Willie, ardith m. cna1000027245 cna1000015095 civil penalty decree of censure 11/17/2010 10/20/2010 Yaw, ariana m. cna applicant Yerge-Briggles, deborah l. cna applicant certificate denied certificate denied drug screening violation criminal conviction; violation of federal or state statutes, regulation or rules drug screening violation; non-sexual dual relationship or Boundary violation fraud/deceit or material omission in obtaining license or credentials; violation of federal or state statutes, regulation or rules; failure to meet the initial requirements of certification substandard or inadequate care; failure to cooperate With Board investigation other Unprofessional conduct; failure to cooperate With Board investigation; criminal conviction criminal conviction; failure to cooperate With Board investigation criminal conviction criminal conviction criminal conviction criminal conviction; misappropriation of patient property or other property deferred adjudication; narcotics violation or other violation of drug statutes criminal conviction; alcohol or other substance abuse failure to cooperate With Board investigation; criminal conviction exploiting a patient for financial Gain drug screening violation criminal conviction; failure to cooperate With Board investigation; violation of federal or state statutes, regulation or rules patient abuse; patient neglect violation of federal or state statutes, regulation or rules; failure to cooperate With Board investigation; fraud/deceit or material omission in obtaining license or credentials alcohol or other substance abuse criminal conviction; narcotics violation or other violation of drug statutes patient abuse license revocation, suspension or otr discl action taken by a fed, state or local licensing authority; failure to meet the initial requirements of certification criminal conviction; patient abuse criminal conviction; violation of federal or state statutes, regulation or rules; alcohol or other substance abuse failure to cooperate With Board investigation; criminal conviction; substandard or inadequate care criminal conviction substandard or inadequate care; patient abuse practicing Beyond the scope of practice; Unable to practice safely; failure to consult or delay in seeking consultation with supervisor/proctor failure to meet licensing Board reporting requirements; criminal conviction patient abuse; alcohol or other substance abuse criminal conviction; fraud/deceit or material omission in obtaining license or credentials; violation of federal or state statutes, regulation or rules practicing Beyond the scope of practice criminal conviction; failure to meet the initial requirements of certification; failure to cooperate With Board investigation criminal conviction patient abuse criminal conviction; failure to cooperate With Board investigation; filing false reports or falsifying records criminal conviction failure to comply with Health & safety requirements; negligence violation of or failure to comply with licensing Board order criminal conviction; failure to cooperate With Board investigation failure to maintain adequate or accurate records; filing false reports or falsifying records; patient abandonment criminal conviction criminal conviction; violation of federal or state statutes, regulation or rules criminal conviction; failure to cooperate With Board investigation criminal conviction; failure to cooperate With Board investigation; misrepresentation of credentials Cna discipline - ACTION CLEARED OCTOBER, NOvEMBER, DECEMBER 2010, JANUARy 2011 effective dAte 11/1/2010 26 nAme Bejar, martha a. LicenSe cna1000009963 arizona STATE BOARD OF NURSING RegulatoRy JouRnal Rn/lpn disCiplinaRy aCtion *not reported in previous Journal OCTOBER – NOvEMBER - DECEMBER 2010 - JANUARy 2011 effective date name 11/29/2010 9/30/2010* 10/27/2010 abbuhl, carolyn d. acosta, annette l. adams, Glenn s. license rn024917 rn085264 lp exam discipline violation(s) probation revocation license denied 10/5/2010 adams, Jason c. lp041170 voluntary surrender 10/20/2010 12/27/2010 alexander, lacretia r. allen, troy l. lp028449 rn129097/lp033835/ cna513778857 civil penalty decree of censure 11/29/2010 ayiyi, osaginwen K. rn156071 decree of censure 10/6/2010 Baltz, Karissa m. rn132162 suspension 1/27/2011 Bass, John a. rn157887/lp043971 suspension/indefinite 10/22/2010 Bates, Gordon a. civil penalty 10/4/2010 Beard, Jennifer l. lp042008/ cna250030803 rn148464 suspension/indefinite 12/30/2010 10/19/2010 Beaumont, Julie Behnke, audrey l. rn086492/lp028393 rn148250 revocation voluntary surrender 11/30/2010 Benson, Barbara o. rn033085/ap0160 suspension 10/22/2010 Bernal, esmeralda decree of censure 1/7/2011 12/7/2010 11/30/2010 10/13/2010 Best, charlotte a. Bickle, Jessica a. Bonham, alexis c. Bowers, Kimberly s. lp041440/ cna751958233 rn156195 lp045211 rn166087 rn062562 10/7/2010 Braat, sheryl l. rn143215 1/14/2011 1/18/2011 11/5/2010 1/4/2011 10/20/2010 Brandt, dashiell i. Brant, Gloria r. Brice, sandra W. Brown, rebecca l. Byron, Barbara s. rn049069 lp036750 rn020683 rn endorsement lp038813/ cna371486903 revocation reinstatement denied voluntary surrender license denied decree of censure 11/29/2010 cake, pauline m. rn111837/ cna999948686 probation decree of censure voluntary surrender license denied probation revocation Unable to practice safely by reason of physical illness or impairment failure to comply with licensing Board order failure to meet the initial requirements of a license, failure to cooperate With Board investigation, license revocation, suspension or other disciplinary action taken by a federal, state or local licensing authority criminal conviction, failure to disclose, failure to maintain records or provide medical, financial or other required information criminal conviction drug screening violation1/11/2011 arguelles, marissa G. rn106736 civil penalty filing false reports or falsifying records, substandard or inadequate care failure to cooperate With Board investigation, criminal conviction, Unprofessional conduct failure to comply with licensing Board order drug screening violation, Unable to practice safely by reason of alcohol or other substance abuse, Unauthorized prescribing medicine violation of federal or state statutes, regulation or rules Unable to practice safely by reason of alcohol or other substance abuse, failure to maintain adequate or accurate records, diversion of controlled substance failure to comply with licensing Board order, drug screening violation failure to comply with licensing Board order, drug screening violation, failure to maintain adequate or accurate records substandard or inadequate care, narcotics violation or other violation of drug statutes, Unauthorized prescribing medicine error in prescribing, dispensing or administering medication diversion of controlled substance 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 revocation voluntary surrender civil penalty stayed revocation with suspension decree of censure failure to maintain records or provide medical, financial or other required information failure to comply with licensing Board order, drug screening violation failure to meet the initial requirements of a license substandard or inadequate care criminal conviction failure to maintain records or provide medical, financial or other required information, Unauthorized dispensing of medication failure to maintain adequate or accurate records, Unprofessional conductfailure to consult or delay in seeking consultation with supervisor/proctor filing false reports or falsifying records, failure to comply with Health & safety requirements substandard or inadequate care Unable to practice safely by reason of physical illness or impairment criminal conviction, failure to cooperate With Board investigation narcotics violation or other violation of drug statutes 11/5/2010 campbell, Jo anne W. 12/19/2010 12/29/2010 10/19/2010 11/5/2010 carter, martha e. caruso, issemathe B. casuse, raquel catani, cynthia a. 11/4/2010 cavanary, susan p. rn110917/lp031069/ cna141548387 rn109681 rn158322 rn exam lp046985/ cna999990830 rn128269 voluntary surrender 11/30/2010 chadwick, sunshine a. rn119575/lp033382 probation 8/31/2010 10/16/2010 christianson, tammy l. collins, amy J. rn132358 rn071683 civil penalty decree of censure 12/5/2010 cooper, Kathy a. rn134587 suspension 10/21/2010 10/13/2010 1/10/2011 crilly, Jean crofton, Juanita l. daly, anastasia l. decree of censure voluntary surrender probation 11/4/2010 dampf, marcia rn124252 rn062095 rn109974/lp034045/ cna912961010 rn165509 decree of censure 10/20/2010 dejaynes, margo J. 1/26/2011 delgado, Joyce a. rn140955/ cna1000000574 lp025990 stayed revocation with suspension summary suspension 1/19/2011 downing, Bethany a. rn161114 11/4/2010 1/28/2011 10/29/2010 10/13/2010 doyle, lisa K. dunn, steven s. eller, elizabeth a. ely, Kelly K. rn089295 rn107235 trn165490 rn063864 10/23/2010 evans, shari l. lp040410 stayed revocation with probation revocation probation suspension stayed suspension with probation probation 10/6/2010 1/5/2011 11/12/2010 fleck, denise c. flores, priscilla a. foulke, michelle l. rn151954 rn161110 lp038066 decree of censure civil penalty probation 10/25/2010 11/12/2010 Gibson, Bruce J. Gilbert, Jennifer K. rn endorsement rn153436 probation probation continued >>> failure to cooperate With Board investigation, license revocation, suspension or other disciplinary action taken by a federal, state or local licensing authority substandard or inadequate care, failure to provide medically reasonable and/ or necessary items or services criminal conviction practicing Beyond the scope of practice, failure to comply with Health & safety requirements Unable to practice safely by reason of psychological impairment or mental disorder, substandard or inadequate care practicing Beyond the scope of practice Unable to practice safely by reason of physical illness or impairment substandard or inadequate care practicing Without a license, error in prescribing, dispensing or administering medication Unable to practice safely by reason of alcohol or other substance abuse Unable to practice safely by reason of psychological impairment or mental disorder failure to comply with licensing Board order failure to comply with licensing Board order drug screening violation Unable to practice safely by reason of physical illness or impairment, substance abuse; diversion of controlled substance Unauthorized prescribing medicine,H1narcotics violation or other violation of drug statutes substandard or inadequate care criminal conviction substandard or inadequate care, failure to maintain adequate or accurate records practicing Without valid license, criminal conviction failure to maintain adequate or accurate records arizona STATE BOARD OF NURSING RegulatoRy JouRnal 27 Rn/lpn disCiplinaRy aCtion *not reported in previous Journal Continued OCTOBER - NOvEMBER - DECEMBER 2010- JANUARy 2011 effective date name license discipline 10/7/2010 1/7/2011 Glynn (noblin), lauren K. Haines, deborah c. rn165661 rn114470/sn0504 probation revocation 1/10/2011 Harker, lorraine K. stayed suspension with probation 1/18/2011 11/29/2010 Harris, marie a. Henely, richard J. rn153660/ lp043908/ cna1000007735 rn118277 rn046579 12/20/2010 12/22/2010 Hughes, Julie a. Hyatt, James l. rn121518 rn109959 decree of censure decree of censure revocation decree of censure 10/29/2010 Jackson, carmen r. rn124350 voluntary surrender 1/6/2011 Kappeler, ramona e. civil penalty 1/27/2011 11/1/2010 Keats, Kristi l. Keener, Wanda d. 11/29/2010 11/29/2010 12/14/2010 10/20/2010 King, Karen m. King, Karen m. lassiter, cheryl e. lassiter, cheryl e. lp046541/ cna1000010587 rn examination lp036302/ cna343651389 rn106795/ap2526 rn106795/ap2526 rn069175/lp022396 rn069175/lp022396 10/21/2010 lavender, delores m. lp038126 12/14/2010 11/10/2010 1/26/2011 lee, adonis c. legg, peggy a. lemert, donna e. rn166242 lp036663 rn046827 1/5/2011 lucero, traci l. 9/29/2010* luck, shonna l. lp035697/ cna174565103 rn120022 probation 11/30/2010 mackin, deborah l. rn107956 summary suspension 11/4/2010 magwood, Bridget t. rn151468 revocation stayed revocation with suspension decree of censure revocation civil penalty revocation civil penalty civil penalty probation civil penalty civil penalty revocation stayed revocation with suspension stayed revocation with probation civil penalty civil penalty probation voluntary surrender 10/11/2010 maloney, Jeffrey r. rn095109 11/3/2010 11/4/2010 12/27/2010 1/20/2011 10/29/2010 martin, colby d. martinez, Gina i. mcGlothin, monica mcmillan, susan e. meshirer, Kathlene e. lp042452 rn063113 rn166360 rn097099 rn132135 10/20/2010 11/29/2010 mochal, Karen r. moniz, taressa m. rn157610 lp038103 1/14/2011 muckerheide, Bonnie G. rn115153 10/4/2010 nelson, Janice W. rn045858 12/13/2010 nicholson, neika s. 12/29/2010 12/31/2010 9/30/2010* norman, frances J. nuffer, rebekah a. ott, shannon m. lp047073/ cna1000000063 rn046670 lp044628 rn118591 voluntary surrender decree of censure decree of censure 1/25/2011 11/30/2010 oyler, martha c. paglierani, Judith a. rn043144/ap0061 lp042596 decree of censure voluntary surrender 12/29/2010 palmer, melissa a. lp047094 12/21/2010 11/4/2010 passaretti, Barbara l. peek, tina m. rn159289 rn144913 stayed revocation with probation decree of censure revocation 11/22/2010 pemberton, Heather K. rn138871 voluntary surrender 11/1/2010 pennington, Jennifer f. rn148653 probation 12/6/2010 10/28/2010 11/4/2010 pierson, lynette d. pittaway, carol l. porras, debra m. lp041676 rn046335 lp032125 decree of censure decree of censure revocation 10/4/2010 pradia, vincent p. lp046914/ cna999994339 civil penalty 11/30/2010 ratcliffe, ophelia K. lp037371 probation 1/18/2011 11/4/2010 riley, sandra e. robbins, cathy c. trn059279 rn065672 suspension revocation 28 voluntary surrender decree of censure with fine voluntary surrender stayed revocation with probation civil penalty arizona STATE BOARD OF NURSING RegulatoRy JouRnal violation(s) criminal conviction Unable to practice safely by reason of physical illness or impairment, immediate threat to Health or safety substance abuse failure to comply with licensing Board order Unprofessional conduct-failure to maintain adequate or accurate records; filing false reports or falsifying records substandard or inadequate care failure to maintain records or provide medical, financial or other required information Unable to practice safely by reason of alcohol or other substance abuse, diversion of controlled substance misrepresentation of credentials criminal conviction error in prescribing, dispensing or administering medication, failure to maintain adequate or accurate records, f6substandard or inadequate care filing false reports or falsifying records filing false reports or falsifying records failure to comply with licensing Board order Unable to practice safely by reason of alcohol or other substance abuse license revocation, suspension or other disciplinary action taken by a federal, state or local licensing authority, substance abuse criminal conviction criminal conviction practicing Beyond the scope of practice, violation of federal or state statutes, regulation or rules, fraud failure to comply with licensing Board order Unable to practice safely by reason of physical illness or impairment, failure to maintain records or provide medical, financial or other required information criminal conviction, Unable to practice safely by reason of alcohol or other substance abuse license revocation, suspension or other disciplinary action taken by a federal, state or local licensing authority, failure to cooperate With Board investigation Unable to practice safely by reason of alcohol or other substance abuse patient abandonment failure to comply with licensing Board order criminal conviction violation of or failure to comply with licensing Board order violation of federal or state statutes, regulation or rules, criminal conviction, failure to cooperate With Board investigation failure to disclose, drug screening violation, criminal conviction disruptive conduct, criminal conviction criminal conviction, violation of federal or state statutes, regulation or rules, filing false reports or falsifying records substance abuse criminal conviction substandard or inadequate care substandard or inadequate care criminal conviction, violation of federal or state statutes, regulation or rules, non-sexual dual relationship or Boundary violation substandard or inadequate care Unable to practice safely by reason of alcohol or other substance abuse, Unable to practice safely by reason of psychological impairment or mental disorder criminal conviction practicing Beyond the scope of practice license revocation, suspension or other disciplinary action taken by a federal, state or local licensing authority, Unable to practice safely, substandard or inadequate care violation of federal or state statutes, regulation or rules, deferred adjudication Unable to practice safely, failure to maintain records or provide medical, financial or other required information practicing Beyond the scope of practice practicing Beyond the scope of practice failure to cooperate With Board investigation, license revocation, suspension or other disciplinary action taken by a federal, state or local licensing authority, Unprofessional conduct violation of federal or state statutes, regulation or rules, narcotics violation or other violation of drug statutes substandard or inadequate care, failure to consult or delay in seeking consultation with supervisor/proctor, sleeping on duty failure to comply with licensing Board order failure to comply with licensing Board order, drug screening violation Rn/lpn disCiplinaRy aCtion *not reported in previous Journal Continued OCTOBER - NOvEMBER - DECEMBER 2010- JANUARy 2011 effective date name license discipline violation(s) 11/29/2010 10/14/2010 lp026432 rn094835/ap1618 substandard or inadequate care license revocation, suspension or other disciplinary action taken by a federal, state or local licensing authority rockney, susan a. rodman, annie m. 12/3/2010 rosnizeck, eileen l. rn133573/lp037150 probation reissuance with stayed revocation probation revocation 12/9/2010 rucker, mary s. rn122100/lp037684 decree of censure 10/19/2010 1/16/2011 savage, Wendy s. schmidt, sherill a. lp027760 rn098931 10/18/2010 11/8/2010 scoggin, patricia a. simmons, Kristy K. 12/6/2010 10/31/2010 smithberger, megan e. spencer, Kathleen J. rn063442 rn133727/ cna999999369 rn149566 rn159533 voluntary surrender stayed revocation with probation decree of censure probation civil penalty probation 12/8/2010 11/4/2010 starr, virginia i. steffe, Brian m. rn143748/lp038337 rn127702 civil penalty revocation 10/25/2010 10/6/2010 11/5/2010 11/19/2010 1/1/2011 1/10/2011 stewart, trishuana a. stone, Betty m. taffer, rhonda l. tiessen, Kathleen d. timmerman, leslie a. tooker, erica m. lp040950 rn154103 rn156985 rn135006 rn120405 rn155388 suspension decree of censure revocation voluntary surrender probation revocation 12/18/2010 Wall, Jason e. lp040360 10/13/2010 Walz, lisa a. 11/5/2010 Warder, stephanie l. rn143104/lp040789/ cna1000000230 rn112134 stayed revocation with probation voluntary surrender Unable to practice safely by reason of alcohol or other substance abuse, diversion of controlled substance drug screening violation Unable to practice safely by reason of alcohol or other substance abuse failure to comply with licensing Board order substandard or inadequate care failure to maintain adequate or accurate records, diversion of controlled substance criminal conviction substandard or inadequate skill level, error in prescribing, dispensing or administering medication Unprofessional conduct Unable to practice safely by reason of psychological impairment or mental disorder failure to comply with licensing Board order inadequate or improper infection control practices drug screening violation, failure to cooperate With Board investigation Unable to practice safely by reason of physical illness or impairment criminal conviction Unable to practice safely by reason of alcohol or other substance abuse, failure to disclose, diversion of controlled substance failure to comply with licensing Board order failure to comply with licensing Board order 11/3/2010 Wemimo, Kayode J. lp045219 stayed suspension w/probation probation substance abuse, violation of federal or state statutes, regulation or rules 11/5/2010 11/8/2010 11/4/2010 10/19/2010 10/29/2010 Wilcut, matthew l. Williams, Kelly l. Wood, laura a. Woods-pierce, carolyn a. Yandell, Julie d. rn endorsement rn160817 rn151818 rn136476 trn165059 civil penalty probation revocation decree of censure summary suspension 12/9/2010 Zack, michelle a. lp043948 probation practicing Beyond the scope of practice, Unauthorized administration of medication, failure to maintain adequate or accurate records criminal conviction criminal conviction failure to comply with licensing Board order practicing Beyond the scope of practice criminal conviction, Unable to practice safely by reason of alcohol or other substance abuse, sexual misconduct failure to comply with licensing Board order, failure to maintain adequate or accurate records, substandard or inadequate care rn-LPn - UPDATED LICENSURE STATUS effective dAte nAme LicenSe 12/2/2010 Brookman, pamela r. lp042515 completed terms of suspension, converted license to probation with terms and conditions 1/11/2010 david, sandra, K. rn100893 reinstatement with terms and conditions 10/29/2010 montgomery, Janet l. rn079671/lp026003 reissuance of rn license, conditional upon completion of rn refresher course program 1/4/2011 mullany, rose trn085183 reinstatement with terms and conditions rn-LPn - ACTION CLEARED effective dAte 1/27/2011 nAme armijo, randi l. 10/29/2010 10/22/2010 10/19/2010 10/31/2010 12/7/2010 10/17/2010 11/15/2010 Hammarbeck, michelle l. Howard, curt B. Hoy, ann v. Janis, Karen l. Kirkpatrick, carrie l. Kuk, James m. mitoff, Jeffrey s. LicenSe rn146421/lp042646/ cna1000003391 rn157243 rn112908 rn079222 rn112545 rn144135 rn154979 rn108447 OCTOBER, NOvEMBER, DECEMBER 2010, JANUARy 2011 diScipLine probation reissuance with stayed revocation probation reissuance with probation reissuance with stayed revocation probation OCTOBER, NOvEMBER, DECEMBER 2010, JANUARy 2011 12/16/2010 1/6/2011 10/27/2010 11/8/2010 12/17/2010 1/28/2011 1/14/2011 12/1/2010 12/1/2010 morales, Gilbert a. nugent (liston), stacey d. nwankwo, Jude i. pettet-Bishop, donna l. stewart, trishuana a. taras, christopher J. Williams, Bobbie e. Williamson, Karen K. Wright, paulette d. rn088538 rn103334/lp032167 lp040048 rn112437 lp040950 rn094548 rn119038 rn069359 rn124982/ap1846 arizona STATE BOARD OF NURSING RegulatoRy JouRnal 29 Complaints and discipline matters Over 30 years experience 33% OFF RETAIL FOURTH QTR - 2010 ONLY ZOLL MEDICAL PRODUCTS PHILLIPS HEALTHCARE PRODUCTS PAR EDUCATIONAL SYSTEMS 602-510-3292 American Heart Association BLS ACLS PALS NRP CNA PAR EDUCATIONAL SYSTEMS LLC Simple- Effective learning! New 2010 Guidelines www.Pareducation.com 602.510.3292 Terry F. Hall, Attorney at Law 817 North Second Street Phoenix, AZ 85004 602 258 1771 602 258 1779 fax Terry.Hall@azbar.org RISK MANAGERS / ADMINISTRATORS REDUCE LIABILITY NURSING BOARD COMPLAINT? Reduce Liability/ Become AHA Training Site Now Simple ASHI- TO -AHA Instructor Conversion BLS-ACLS-PALS-NRP-CNA Certifications EXPERIENCED, AGGRESSIVE TRIAL LAWYER New 2010 Guidelines www.Pareducation. com Kelly J. McDonald, RN, JD REPRESENTING AZ NURSES SINCE 1998 FREE CONSULT FLAT FEES 480-922-1010 kelly@aznurselaw.com Go to www.aznurselaw.com to learn more about your rights at the State Board of Nursing Board Complaint/Questionnaire? Call For Help. “Leading the Way” in “Changing Lives One Student at a Time” COURSE OFFERING: Nursing Assistant Classes Phlebotomy technician Caregiver training CPR and First Aid IV certification for LPN’s Caregiver CEU’s and Manager CEU’s Registration online is now Available 10640 N. 28th Dr., Bldg C-107 and A-103 Phoenix, AZ 85029 Tel: 602-741-5526, 602-633-2730 Teressa Sanzio, RN, MPA, JD Experienced Nurse–Attorney Nurse Advocate 602-993-3215 TSanzio@aol.com WWW.CACTUSWRENHOMECARE.COM D. Jay Ryan, AB, JD Former Board Attorney & Administrative Law Judge 623-937-3737 Lisa Gervase, BS, JD Former Agency Attorney & Administrative Law Judge 480-515-4801 LGervase@gervaselaw.com Each has over 10 yrs. nursing board experience Go to www.arizonanurselawyers.com for more information City North • 5415 E. High St., #200 • Phoenix, AZ 85054 JOIN OUR TEAM! EXPERIENCED Excellent Compensation and Benefits AT T O R N E Y    Representing Nurse Practitioners, RNs, LPNs and CNAs in Nursing Board Investigations. Administrative Nurse Director of Nursing Registered Nurses To apply, go to www.azstatejobs.gov, click on “Search for Jobs” button, type in keyword DES and click on “Search” Anne Fulton-Cavett For more information, contact Richard Lopez, Division of Developmental Disabilities at 602-542-6814 DES is an Equal Opportunity Employer. Persons with a disability may request a reasonable accommodation. Call the Human Resources Administration at 602-771-2870 to arrange an accommodation or request alternative format; TTY/TDD 7-1-1. 30 arizona STATE BOARD OF NURSING RegulatoRy JouRnal When a complaint has been filed against you, your license is on the line. Don’t wait until it is too late. (520) 733-0100 anne@cavettandfulton.com 6035 East Grant Road / Tucson, Arizona 85712 C H W C A R E E R S . O R G / A R I Z O N A Experience a truly fulfilling career. At CHW, our commitment to employee satisfaction is unwavering. We work hard to ensure our employees have the support they need to live their lives to the fullest — both professionally and personally. And by creating an environment that inspires them to perform at their best every day, we’re able to continuously deliver the extraordinary care our patients have come to expect. We’re CHW Arizona, comprised of Chandler Regional Medical Center, Mercy Gilbert Medical Center, and St. Joseph’s Hospital and Medical Center. Our focus on employee satisfaction has helped us earn recognition as: • A “Best Place to Work in the Valley” by the Business Journal, Phoenix • One of “Arizona’s Most Admired Companies” by the Best Companies AZ • One of the “Top 100 Best Places to Work in Healthcare 2010” by Modern Healthcare magazine (second year in a row) • One of the “Top 25 Best Places to Work for Women 2011” by AZ Magazine • One of the “Valley’s Healthiest Employers 2011” by the Business Journal, Phoenix Find us on Facebook and follow us on Twitter: CHWAzCareers Come and experience the many opportunities we give you to learn, grow and achieve. Whatever it is you’re looking for in a career, you can find it at CHW Arizona. For more information, visit chwcareers.org/Arizona. EOE. © 2011 Catholic Healthcare West Arizona arizona STATE BOARD OF NURSING RegulatoRy JouRnal 31 ARIzONA STATE BOARD OF NURSING 4747 North 7th Street, Suite 200 Phoenix, Az 85014-3655 Presorted standard U.s. Postage PaId LIttLe rock, ar Permit No. 1884 Stories of Life. Stories of Hope. Every day, every hour, our stories of life and hope occur. It’s why we’re here. Cancer Treatment Centers of America® is seeking Exceptional Nurses at our Goodyear (Phoenix), AZ location! Start your story today! As our organization continues to grow and expand, our need for exceptional nurses will do the same. Our nurses are able to offer: • Individualized, whole person treatment options • Different clinical settings and environments • Our new universal bed care model • A fully-digital cancer treatment environment • The nation’s leading cancer technology at your fingertips We have a competitive compensation offering including: “We make an impact here because we understand the voice of the patient and what is important to them, and it makes it very special for us. We never lose sight of why we’re here.” — Anne, CTCA • An attractive benefits package • Medical, dental and vision • 401(k) with matching • And much more! Best of all, you’ll know that you are using your skills in the service of an inspiring cause — helping patients win the fight against cancer. Explore nursing opportunities at azjobs.cancercenter.com