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STATE BOARD
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REGULATORY JOURNAL

Nurse Fatigue Six Countermeasures:

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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
Nikki R. Austin, JD, RN
ASSOCIATE DIRECTOR/INVESTIGATIONS &
COMPLIANCE
Pamela Randolph, RN, MS, FRE
ASSOCIATE DIRECTOR/EDUCATION &
EVIDENCE BASED REGULATION

VOL 9 t N O 3tSEPTEMBER 2013

4
6

From the Executive Director

Literature Review:
Nurse Fatigue Related to
Shift Length

10
12

BOARD MEMBERS
Randy Quinn, MSN, CRNA
PRESIDENT
Carolyn Jo McCormies, RN, MSN, FNP-BC
VICE PRESIDENT
Theresa (Terri) Berrigan, LPN
SECRETARY
Leslie Dalton, MSN, RN
MEMBER
Lori A. Gutierrez, BS, RN-C, RAC-CT, CBN
MEMBER
M. Shawn Harrell, MS, RN
MEMBER
Patricia (Pat) Johnson, LPN
MEMBER
Kimberly (Kim) Post, DNP, MBA/HCM, RN, NEA-BC
MEMBER
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MEMBER
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PUBLIC MEMBER

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Staff Directory
The Implications of
Nurse Fatigue

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F ro m th e E xe c u t iv e D ir e c t o r
JOEY RIDENOUR, RN, MN, FAAN

More Evidence Regarding Extended
Work Hours: Too Tired To Be Safe?
In this September 2013 edition of the Arizona State Board of Nursing Regulatory Journal the
focus is on the emerging evidence demonstrating a relationship of nurse fatigue to patient
safety. Guest author Debra J. Martin, MBA, MSN, RN, NE-BC, FACHE wrote the article entitled
Literature Review: Nurse Fatigue Related to Shift Length. Martin states “the evidence is compelling that long shift lengths are correlated with negative outcomes for both patients and nurses.”
The second article was written as a result of the 2011 Nurse Action Proposal by the Arizona
Nurse’s Association Professional Steering Committee. Susan Phillips MSN, RN, PMHCNS-BC
and Carol Moffett, PhD., FNP-BC, CDE authored The Implications of Nurse Fatigue and share
their Nurse Fatigue Survey responses from 1,004 Arizona RN’s. Phillips and Moffett opine that
“Eighty percent (80%) of the respondents recognized their inability to concentrate at work and
driving on the road was compromised when fatigued.” The authors also describe symptoms of
fatigue and performance impairment as well as countermeasures to be implemented.
Too tired to be safe? According to U.S. Army studies, staying awake 17 hours is functionally
equivalent to having a blood alcohol level concentration (BAC) of 0.05%; staying awake 24 hours
equivalent to BAC of 0.10%. In Arizona (as in most states) it is illegal to drive with a BAC of
0.08% or higher.
Special thanks to Debra Martin, Susan Phillips and Carol Moffett for providing recent evidence
to better understand the effects of fatigue and patient safety.

Joey Ridenour RN MN FAAN

4

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

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arizona STATE BOARD OF NURSING REGULATORY JOURNAL

5

DEBORAH J. MARTIN, MBA MSN, RN, NE-BC, FACHE
SENIOR DIRECTOR, PROFESSIONAL PRACTICE BANNER HEALTH

LIT ER AT URE RE VIE W:
Nurse Fatigue Related to Shift Length
The issue of nurse fatigue is of increasing concern
to nurses and healthcare organizations. Evidence to
document the fatigue issue continues to emerge and
provide more specific data and insights for the healthcare
community. The relationship of fatigue to patient safety
and risk of self-injury is documented in several sources.
The purpose of this literature review is to present the most
recent evidence and recommendations specific to nurse
fatigue for nurses and their managers in understanding
these relationships.
Symptoms of fatigue include, but are not limited to
decreased alertness, irritability and sleepiness. The
Occupational Safety and Health Administration (OSHA)1
cautions against working more than 8-hour shifts as
longer shifts may result in reduced alertness. Fatigue is
correlated to nurse performance and chronic fatigue is
related to the number of hours worked.2
Health care workers are not alone in shift work and
working long hours. The Department of Transportation
regulates the number of hours of service for those in
aviation, highway, rail and nautical professions.3 Not only
are shift times regulated; some have restrictions on weekly
and monthly work allotments. Sleep and rest are noted
to be important for those in the rail industry,4 airline
industry,5 and the forest industry.6
Long working hours may have an impact on errors as
well as near errors,7 and decrease the nurse’s vigilance
in critical care.8 Research conducted by Barker and
Nussbaum (2011) found that acute fatigue resulted
from long hours of work, and that fatigue was negatively
correlated with performance.
It was identified that an increased number of shifts
worked by nurses in the prior 72 hours were significantly
associated with hypoglycemic events in ICU patients
receiving insulin infusions.9 Documentation of patient
care can also be impacted by working longer hours; there
were 26 percent less charting errors with fewer call hours
in the surgical setting.10
In addition to patient clinical outcomes, a correlation
exists between hospitals where nurses worked 13 hours
in length or longer and patient dissatisfaction with
communication, pain control and help when they wanted
it.11 Nurses working long shifts were more likely to be
burned out, dissatisfied with their job and intended to
leave their job within the year.11, 12 Shifts scheduled for 12
hours often exceed that timeframe, as many as 40% of the
work shifts logged for their study exceeded 12 hours.7

6

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

Nurse’s personal safety related to longer worked hours
is also a concern. Extended work hours are a contributing
factor in needle stick injuries among nurses,13 and rates
of nurses driving drowsy doubled when they worked more
than 12.5 hours.14 In a study that examined the impact
of a 9-hour shift compared to an 8-hour shift, the nurses
working the 9-hour shift had more health issues, were
not as satisfied and had more fatigue.15 In variables
associated with worker injury, those working 12-hour
shifts had a higher medical cost per injury than those
who worked 8-hour shifts.16 Findings in a simulated
environment demonstrated older people were not able
to perform as well as younger people.17 This is important
for the health care industry to consider as the nursing

workforce ages and there is a need to retain them
through improved job attributes.18
If shorter shifts are not available, planning to
decrease the effects of fatigue can include regular and
frequent breaks,1, 7, 19, 20 meal breaks,1, 7, 19 staff getting
enough sleep or naps21, 22, 19, 23, limiting caffeine19, 23 eating
well and exercising19 and limit the number of shifts
worked in a row.20 Additional options include avoiding
double back shifts such as an evening shift followed
by a day shift with less than eight hours between, limit
on-call hours, and allow sleeping during the night shift.
Implementation of a formal fatigue countermeasures
program for nurses has provided evidence of
improvement in nurse fatigue.24. With consecutive
12-hour shifts, nurses were not able to recover between
shifts and used caffeine as a possible mechanism to
improve alertness.25
It is a legal and ethical obligation to educate the
nursing staff about the effects of long work hours. 26 It
is important for senior management to be aware of
the impact of working longer shifts.27 The Institute of
Medicine (IOM)28 recommends limiting the number
of hours worked in a day by nurses as a patient safety
precaution. They find the evidence to be “very
strong” (p. 236) related to prolonged work
hours and worker fatigue. Recommendations
are that health care organizations establish
policies and practices to limit hours worked in
a shift as well as the number of hours worked
in a week11, 28 that the “routine use of twelvehour shifts should be curtailed”7 (p. 210), and
that overtime after a 12-hour shift should
be eliminated7. Another recommendation
is to decrease shift length to allow recovery
time between shifts29. Health care workers in
the United States often work 12-hour shifts
prompting Lockley30 to state “hours routinely
worked by health care providers in the United
States are unsafe” (p. 14). The American
Nurses Association31 notes that in addition
to employee accountability regarding fatigue,
employers are obligated to provide adequate
staffing to care for patients. It is not the
individual nurse’s responsibility to cover all
shifts by working extra hours.
The evidence is compelling that long shift
lengths are correlated with negative outcomes
for both patients and nurses. Patients are
impacted by errors in their care and are more
dissatisfied when nurses work longer shifts.
For the nurse, the outcomes of working longer
shifts can be injury to self and intent to leave
their job. Injuries may happen on the job
such as needle sticks or strains; or on the way
home if in an accident caused by driving while
drowsy.

A literature review reveled that shift length has been
correlated with nurse fatigue and has become a growing
concern in the United States with the routine shift
length of 12 hours. Outcomes correlated to shift length
and fatigue includes errors or near errors in patient
care. In addition to concerns in patient care outcomes,
the impact of fatigue on the nurse is also noted.
Nursing is a profession, and as a profession, we need
to be self-regulating. If we are not able to mitigate the
impact of fatigue, it could become regulated as with
other industries such as transportation, logging and
nuclear power workers.
Acknowledgement: A special ‘thank you’ to Kathy
Malloch, PhD, MBA, RN, FAAN who encouraged me
to take the leap and go back to school for a DNP in
Innovation Leadership at ASU and for recognizing the
importance of this topic to the nursing profession.
Author: Deborah Maust Martin received her Master’s
degrees in nursing and business administration from
West Virginia University and is currently employed by
Banner Health as the System Director of Professional
Practice. She has served on various local and national
boards in an effort to strengthen the profession of
nursing. One of these was the Congress on Nursing
Practice and Economics with the American Nurses
Association where she contributed to the Scope and
Standards of Practice (2010) and the Principles for
Nurse Staffing (2012). Deborah is currently enrolled in a
doctoral program at Arizona State University.

1

2

3

4

5

6

References
Occupational Safety and Health Administration.
(n.d.) Frequently Asked Questions. Retrieved from http://
www.osha.gov/OshDoc/data_Hurricane_Facts/faq_
longhours.html
Barker, L. M., & Nussbaum, M. A. (2011). Fatigue,
performance and the work environment: a survey of
registered nurses. Journal of Advanced Nursing, 67(6),
1370-1382. doi: 10.1111/j.1365-2648.2010.05597.x
National Transportation Safety Board Safety report
NTSB/SR-99/01. (1999). Evaluation of U.S. Department
of Transportation Efforts in the 1990s to Address Operator
Fatigue. Washington DC: National Transportation
Safety Board. Retrieved from http://www.ntsb.gov/
doclib/reports/1999/SR9901.pdf
Dorrian, J., Baulk, S. D., & Dawson, D. (2011). Work
hours, workload, sleep and fatigue in Australian
Rail Industry employees. Applied Ergonomics,
42(2), 202-209. doi: http://dx.doi.org/10.1016/j.
apergo.2010.06.009
Roach, G. D., Petrilli, R. M., Dawson, D. & Lamond,
N. (2012). Impact of layover length on sleep,
subjective fatigue levels, and sustained attention
of long-haul airline pilots. Chronobiology International,
29(5), 580-586.
Lilley, R., Feyer, A., Kirk, P., & Gander, P. (2002). A

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

7

7

8

9

10

11

12

13

14

15

16

17

18

8

survey of forest workers in New Zealand: Do hours of
work, rest, and recovery play a role in accidents and
injury? Journal of Safety Research, 33(1), 53-71. doi: http://
dx.doi.org/10.1016/S0022-4375(02)00003-8
Rogers, A. E., Hwang, W., Scott, L. D., Aiken, L. H., &
Dinges, D. F. (2004). The working hours of hospital staff
nurses and patient safety: both errors and near errors
are more likely to occur when hospital staff nurses
work twelve or more hours at a stretch. Health Affairs,
23(4), 202-212.
Scott, L. D., Rogers, A. E., Hwang, W., & Zhang, Y.
(2006). Effects of critical care nurses’ work hours on
vigilance and patients’ safety. American Journal of Critical
Care, 15(1), 30-37.
Louie, K., Cheema, R., Dodek, P., Wong, H., Wilmer,
A., Grubisic, M., . . . Ayas, N. T. (2010). Intensive
nursing work schedules and the risk of hypoglycaemia
in critically ill patients who are receiving intravenous
insulin. Quality & Safety in Health Care, 19(6), e42. doi:
10.1136/qshc.2009.036020
Warren, A., & Tart, R. C. (2008). Fatigue and charting
errors: the benefit of a reduced call schedule. AORN
Journal, 88(1), 88. doi: http://dx.doi.org/10.1016/j.
aorn.2008.03.016
Stimpfel, A. W., Sloane, D., & Aiken, L. (2012). The
Longer The Shifts For Hospital Nurses, The Higher The
Levels Of Burnout And Patient Dissatisfaction. Health
Affairs, 31(11), 2501-2509. doi: http://dx.doi.org/10.1377/
hlthaff.2011.1377
Stimpfel, A. W., Lake, E., Barton, S., Gorman, K.C. and
Aiken. (2013). How differing shift lengths relate to
quality outcomes in pediatircs. The Journal of Nursing
Administration. 43(2), 95-100.
Trinkoff, A. M., Le, R., Geiger-Brown, J., & Lipscomb,
J. (2007). Work schedule, needle use, and needlestick
injuries among registered nurses. Infection Control &
Hospital Epidemiology, 28(2), 156-164.
Scott, L. D., Hwang, W., Rogers, A. E., Nysse, T., Dean,
G. E., & Dinges, D. F. (2007). The relationship between
nurse work schedules, sleep duration, and drowsy
driving. Sleep, 30(12), 1801-1807.
Josten, E. J., Ng-A-Tham, A., Tham J. E., & Thierry, H.
(2003). The effects of extended workdays on fatigue,
health, performance and satisfaction in nursing. Journal
of Advanced Nursing, 44(6), 643-652.
Brown, N., & Thomas, N. (2003). Exploring variables
among medical center employees with injuries:
developing interventions and strategies. American
Association of Occupational Health Nurses Journal, 51(11),
470-481.
Reid, K., & Dawson, D. (2001). Comparing performance
on a simulated 12 hour shift rotation in young and
older subjects. Occupational and Environmental Medicine,
58(1), 58-62. doi: 10.1136/oem.58.1.58
Letvak, S. (2005). Health and safety of older

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

19

20

21

22

23

24

25

26

27

28

29

30

31

nurses. Nursing Outlook, 53(2), 66-72. doi: 10.1016/j.
outlook.2004.09.005
Hughes, R. G., & Rogers, A. E. (2004). First, do no
harm. Are you tired? Sleep deprivation compromises
nurses’ health -- and jeopardizes patients. American
Journal of Nursing, 104(3), 36-38.
McGettrick, K. S., & O’Neill, M. A. (2006). Critical care
nurses--perceptions of 12-h shifts. Nursing in Critical
Care, 11(4), 188-197.
Caruso, C. & Hitchcock, E. (2010). Strategies for
nurses to prevent sleep-related injuries and errors.
Rehabilitation Nursing, (35)5, 192-197.
Dean, G. E., Scott, L. D., & Rogers, A. E. (2006). Infants
at risk: when nurse fatigue jeopardizes quality care.
Advances in Neonatal Care, 6(3), 120-126. doi: 10.1016/j.
adnc.2006.02.001
Witkoski, A., & Dickson, V. V. (2010). Hospital staff
nurses’ work hours, meal periods, and rest breaks: a
review from an occupational health nurse perspective.
AAOHN Journal, 58(11), 489-497. doi: http://dx.doi.
org/10.3928/08910162-20101027-02
Scott, L. D., Hofmeister, N., Rogness, N., & Rogers, A.
E. (2010). An interventional approach for patient and
nurse safety: A fatigue countermeasures feasibility
study. Nursing Research, 59(4), 250-258. doi: http://dx.doi.
org/10.1097/NNR.0b013e3181de9116
Geiger-Brown, J., Rogers, V. E., Trinkoff, A. M., Kane,
R. L., Bausell, R. B., & Scharf, S. M. (2012). Sleep,
sleepiness, fatigue, and performance of 12-hour-shift
nurses. Chronobiology International, 29(2), 211-219. doi:
10.3109/07420528.2011.645752
Miller, J. A. (2011). When time isn’t on your side:
12-hour shifts. Nursing Management, 42(6), 38-43. doi:
http://dx.doi.org/10.1097/01.NUMA.0000395197.70014.
a5
Keller, S. M. (2009). Effects of extended work shifts
and shift work on patient safety, productivity, and
employee health. AAOHN Journal, 57(12), 497-502; quiz
503-494. doi: 10.3928/08910162-20091124-05
Page, A. (Ed.) (2004). Keeping patients safe: Transforming
the work environment of nurses. Washington, DC: National
Academies Press.
Blouin, A. S. (2013, March). “Short on sleep”: Preventing
staff and patient consequences. Presented at the American
Association of Nurse Executives annual meeting,
Denver, CO.
Lockley, S. W., Barger, L. K., Ayas, N. T., Rothschild, J.
M., Czeisler, C. A., & Landrigan, C. P. (2007). Effects of
health care provider work hours and sleep deprivation
on safety and performance. Joint Commission Journal on
Quality & Patient Safety, 33(11), 7-18.
American Nurses Association (2007). Inside ANA –
Issues up close: ANA position statements call for RNs
and employers to prevent working fatigued. American
Nurse Today, April, 44-45.

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arizona STATE BOARD OF NURSING REGULATORY JOURNAL

9

STAFF DIRECTORY
ADMINISTRATION
Joey Ridenour, RN, MN, FAAN
Executive Director
602.771.7801
jridenour@azbn.gov

Michael Pilder, MSN, RN, CNS,
APHN-BC
Nurse Practice Consultant
602.771.7816
mpilder@azbn.gov

COMPLAINTS-INTAKE

Opal Wagner, RN, BSN
Nurse Practice Consultant
602.771.7818
owagner@azbn.gov

Judy Bontrager RN, MN
Associate Director, Operations
& Licensing
602.771.7802
jbontrager@azbn.gov

Dolores Hurtado, Senior
Investigator
Complaints-Intake Triage
Coordinator
602.771.7845
dhurtado@azbn.gov

Nikki R. Austin, JD, RN
Associate Director, Investigations
& Compliance
602.771.7819
naustin@azbn.gov

Dirk VandenBerg, Sr.
Administrative Assistant
Applicant Triage
602.771.7821
dvandenberg@azbn.gov

Tamara Greabell, MA, BSN, RN
Nurse Practice Consultant
602.771.7813
tgreabell@azbn.gov

EDUCATION

SENIOR INVESTIGATORS

Ronda Doolen, RN, BSN, MSN
Education Program Administrator
602.771.7877
rdoolen@azbn.gov

Bonnie Richter
Senior Investigator
602.771.7828
brichter@azbn.gov

Frannie Breed, RN, BSN
Nurse Practice Consultant/CNA
Programs
602.771.7857
fbreed@azbn.gov

Frederick Arias
Senior Investigator
602.771.7822
farias@azbn.gov

Pamela Randolph RN, MS, FRE
Associate Director Education &
Evidenced Based Regulation
602.771.7803
prandolph@azbn.gov
Valerie Smith RN, MS, FRE
Consultant to Executive Director
602.771.7804
vsmith@azbn.gov
Kirk Olson
Lead Senior Investigator
602.771.7824
kolson@azbn.gov
Dolores Hurtado, Senior
Investigator to the Executive
Director/Associate Director
Investigations/Compliance
Complaints - Intake Triage
Coordinator
Susie Flores
Administrative Assistant to the
Executive Director
602.771.7806
sflores@azbn.gov
Becky Melton
Administrative Assistant to Associate
Director Operations/RN-LPN
Exams
602.771.7805
bmelton@azbn.gov

Helen Turner-Epple, BS
Administrative Assistant
602.771.7856
hturner@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 Consultant
602.771.7851
sbarber@azbn.gov

Lisa Youtsey
Administrative Assistant /CNA
Renewals/CMA Applications
602.771.7836
lyoutsey@azbn.gov

Trina Smith
Legal Assistant
602.771.7852
tsmith@azbn.gov

Dirk VandenBerg, Sr.
Administrative Assistant
Applicant Triage
602.771.7821
dvandenberg@azbn.gov

INVESTIGATIONS

Lila Wiemann
Administrative Assistant
lwiemann@azbn.gov
CANDO
Janet (Jan) Kerrigan, RN, BSN
Nurse Consultant - CANDO
602.771.7864
jkerrigan@azbn.gov

10

Olga Zuniga
Administrative Secretary –
CANDO & Monitoring
602.771.7865
ozuniga@azbn.gov

Janeen Dahn, MSN, FNP-C
Advanced Practice Nurse Consultant
602.771.7814
jdahn@azbn.gov
Kristen Wilson, RN, MSN, CNS,
PMHNP, BC
Nurse Practice Consultant
602.771.7811
kwilson@azbn.gov
Kristi Hunter, MSN, FNP-C
Advanced Practice Nurse Consultant
602.771.7854
khunter@azbn.gov

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

Ruth Kish, RN, MN
Nurse Practice Consultant
602.771.7823
rkish@azbn.gov

Jennifer McWilliams
Legal Assistant
602.771.7835
jmcwilliams@azbn.gov
Linda Monas
Senior Investigator
602.771.7826
lmonas@azbn.gov
Max Barker
Senior Investigator
602.771.7812
mbarker@azbn.gov

Claudia Deines
Scanning/Verifying
602.771.7805
cdeines@azbn.gov
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RN/LPN Renewals
602.771.7833
dfrye@azbn.gov
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CNA Exam
602.771.7832
htay@azbn.gov
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Advanced Practice Certifications
602.771.7843
lhubbard@azbn.gov
Monica Ortiz
RN/LPN Endorsements
602.771.7831
mortiz@azbn.gov
Naira Kutnerian
RN/LPN Endorsements
602.771.7834
nkutnerian@azbn.gov
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Exam Tech
coates@azbn.gov
MAILROOM
Debra Kunkle
602.771.7876
dkunkle@azbn.gov
MONITORING
Diva Galan, JD
Senior Investigator
602.771.7862
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602.771.7850
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Legal Assistant
Monitoring & CANDO
602.771.7860
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LEGAL SECRETARIES

RECEPTIONISTS

Lynette Lohsandt
Legal Secretary
602.772.7827
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Legal Secretary
602.771.7852
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INFORMATION
TECHNOLOGY
Adam Henriksen
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Barbara Melberg
Legal Secretary - CNA
Endorsements
602.771.7840
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Nancy Davis
602.771.7872
ndavis@azbn.gov
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602.771.7873
skingsland@azbn.gov
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Anne Parlin
602.771.7875
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arizona STATE BOARD OF NURSING REGULATORY JOURNAL

11

THE IMPLICATIONS OF NURSE FATIGUE
SUSAN A. PHILLIPS MSN, RN, PMHCNS-BC
CAROL MOFFETT, PH.D., FNP-BC, CDE
Nurse Fatigue
It is estimated that approximately
38% of the U.S. workforce is fatigued
and more than 40 million Americans
suffer from some type of sleep disorder.
Over 85 sleep disorders have been
identified and some of those include:
acute or chronic insomnia; restless leg
syndrome; narcolepsy; sleep apnea;
and shift work syndrome. The fatigued
worker is often lacking in self-awareness
of the level of impairment they are
experiencing (Zhou, 2011). Workers who
experience continuous wakefulness of
21 hours or more have functional scores
that are similar to a blood alcohol
concentration of 0.08% (Arnedt, 2001).

in significant emotional pain and
physical distress (Figley, 1995). Stress is a
condition or feeling experienced when a
person perceives that demands exceed
the personal and social resources the
individual is able to mobilize (Stress
Management – Start Here!, 2013). Burnout
is a special type of job stress consisting
of a state of physical, emotional or
mental exhaustion combined with doubts
about competence and the value of
one’s work (Job burnout: How to Spot
It and Take Action, 2012). Nurse fatigue
can be described as fatigue affecting
the nurse population that may result
from the following contributing factors:
working long shifts in the health care

while fatigued and the benefits of coming
to work well rested. Strategies can be
established in the workplace to identify
a fatigued nurse and to mitigate the
consequences for the organization and
the nurse.
Evidence from the nursing literature
emphasizes the detrimental effect
fatigue has on the well-being of nurses
and patient outcomes. Nurse fatigue
may lead to a variety of adverse medical
problems, burnout, errors, and patient
dissatisfaction. Worker fatigue studies are
more prevalent in the aviation, trucking,
manufacturing, military, medical, and
nuclear power plant industries (Hursh,
2004; Lerman et al., 2012). The nursing

It is estimated that approximately 38% of the U.S. workforce is
fatigued and more than 40 million Americans suffer from some
type of sleep disorder. Over 85 sleep disorders have been identified
and some of those include: acute or chronic insomnia; restless leg
syndrome; narcolepsy; sleep apnea; and shift work syndrome.

Nurses experience fatigue and physical
exhaustion, which can be exacerbated
by working nights and 12-hour shifts. It
is not uncommon for nurses and other
night shift workers to fall asleep while on
the job (Rogers, 2008).

workplace; obtaining insufficient sleep
between scheduled shifts; a disturbance
in circadian rhythms; and attempting to
balance demanding personal, familial,
and social obligations in addition to the
work schedule.

Definitions
Fatigue is a feeling of weariness,
tiredness, or lack of energy (Lerman,
Flower, Gerson, & Hursh, 2012).
Sleepiness, a tendency to fall asleep,
often coexists with fatigue (Rogers,
2008). Nurse fatigue must not be
confused with compassion fatigue, which
is defined as a combination of physical,
emotional, and spiritual depletion
associated with caring for patients

Background
Nurse Fatigue is especially concerning
for health care organizations because
it can result in unsafe or hazardous
conditions that may jeopardize patient
safety, as well as the safety of the
nurse, especially when driving (Rogers,
2008). However, nurse fatigue can be
managed like many other types of risk
factors. Nurses and employers need to
be educated on the hazards of working

12

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

profession can benefit from these
research findings as each of these
industries have 24/7 operations. There is
a need for more nursing research to fully
explore the implications of nurse fatigue.
Arizona Nurses Association Action
Proposal
Nurse Fatigue was identified by the
membership of the Arizona Nurses
Association (AzNA) in 2011 as an issue
for concern and was developed into
an action proposal. According to the
findings at the time the proposal was
written:
1. The likelihood of making an error
is three times higher with >12.5
consecutive hours of nursing

2.

3.
4.

5.
6.

7.

practice (Rogers, 2008).
Errors are increased with overtime or
working over 40 hours per week (ANA
Policy Mandatory Overtime, n.d.).
Less than 50% of work breaks are
away from patient care (AHRQ, 2005).
Night shift workers may have
difficulty staying awake due to
disturbance in circadian rhythms
(Dagan, 2002).
The majority of errors from fatigue
are medication errors (Rogers, 2008).
Sleep deprivation is linked to
increased deviation from standard
practice and unintentional sleep at
work (Scott, 2006).
Drowsiness while driving is related
to inadequate sleep, night shift work,
and difficulty with wakefulness at
work (Rogers, 2008).

The Professional Issues Steering
Committee (PISC), a task force of elected
AzNA members, was assigned to address
the action proposal. The committee
decided to administer an electronic
survey to assess members’ fatigue-related
concerns and the survey was distributed
via email in December 2012.

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Nurse Fatigue Survey
The Nurse Fatigue Survey was
administered as a confidential, electronic
survey that included a demographics
section and 17 items for response. The
survey was active for three weeks and
closed on January 15, 2013. There were
1,004 Arizona registered nurses (RNs) who
responded. The targeted audience was
RNs whose primary responsibility was
direct patient care.
The majority of respondents were
Baby Boomers (47%) and 42% were BSN
prepared. The majority of nurses worked
on the day shift (71%), 37% had greater
than 20 years of nursing experience,
and 69% worked 12-hour shifts. Eighty
percent (80%) of respondents recognized
their inability to concentrate at work and
driving on the road was compromised
when fatigued. They feared making
mistakes and acknowledged drowsiness
while driving; 28% experienced
drowsiness behind the wheel at all times.
The number of hours of sleep varied
and 52% were concerned or seriously
concerned about the number of hours
they slept; 62% slept 6-7 hours and 33%

reported sleeping 4-5 hours between
shifts. In addition to quantity of sleep, the
quality of sleep was also problematic; 33%
of nurses reported sleep quality as poor
or very poor and 33% used some form
of prescription medication or over-thecounter preparation as a sleep aid most
days of the week. Additional survey results
are detailed in Table 1 and Table 2:
Fatigue Risk Model
The Moore-Ede fatigue risk model
was used as a framework to understand
the fundamentals of a fatigue risk
management system. According to MooreEde (2009), there are five defenses that
need to be managed:
1. Workload-staffing balance
2. Shift scheduling
3. Employee fatigue training and sleep
disorder management
4. Workplace environment design
5. Fatigue monitoring and alertness for
duty.
The model features a feedback loop to
help analyze fatigue-related errors and
strengthen defenses to ensure continuous
improvement. Use of a fatigue risk
management system is considered a best
practice (Lerman et al., 2012).

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arizona STATE BOARD OF NURSING REGULATORY JOURNAL

13

Symptoms of Fatigue and
Performance Impairment
Fatigue can produce a variety of
physiological, cognitive, and emotional
symptoms that may be detrimental
to quality of life, well-being, and
performance on the job.
Physiological symptoms.
Physiological symptoms of fatigue may
include excessive yawning, drooping
eyelids, rubbing of the eyes, head
dropping, and finally succumbing
to uncontrollable sleep in the form
of microsleep, naps, or longer sleep
episodes. Physical symptoms may
also include digestive problems and
speech effects affecting the rate and
content of speech. Manual dexterity
may also be reduced affecting activities
such as key-punch entry and switch
selection resulting in errors. Some of
the symptoms are easy to recognize in
oneself or others; however, cognitive
and emotional symptoms are less easily
recognized.
Cognitive symptoms. Cognitive
signs of fatigue may include difficulty
concentrating on tasks, lapses in
attention, difficulty remembering
tasks being performed, and failing to
communicate important information.
Nurses who are fatigued may fail to
anticipate events or actions. They may
accidentally take the wrong action or
inadvertently fail to do the right thing.
Reaction time may be compromised
and the fatigued nurse may respond
slowly or fail to respond at all to
normal, abnormal, or emergency
stimuli. These symptoms are linked
to performance impairment and often
there is a lack of awareness of a decline
in cognitive functioning. The impaired
employee may not anticipate danger
and display decreased vigilance. Logic
may become flawed, the individual
may have problems with cognitive
processing tasks such as mathematics,
or there may be a failure to accurately
interpret a situation. Additionally, there
may be poor judgment of distance,
speed, and time.

14

Emotional symptoms. Emotional
symptoms may be manifested by an
unusually quiet or withdrawn demeanor,
or a lack of energy and or motivation to
perform tasks. Mood may be affected
and others may notice the nurse is less
conversant than normal, irritable, or
apathetic, especially about performing
low-demand tasks. Attitude may also
be affected and may be manifested by
a willingness to take risks or ignoring
normal safety checks or procedures.
Long-term disorders. Chronic
conditions associated with fatigue are:
chronic fatigue syndrome; fibromyalgia;
sleep apnea; anxiety; depression;
irritable bowel syndrome; obesity;
metabolic syndrome; diabetes; and
cancer.
Countermeasures
A number of countermeasures or
interventions have been implemented
to mitigate worker fatigue and could be
considered as having potential benefit
for nurses in the health care industry.
Countermeasures can include: bright
lighting; cool temperature; social

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

interactions; physical activity; and
strategic use of caffeine. When possible,
a short nap break can significantly
improve function. A prophylactic nap
lasting 2-8 hours taken during the day
prior to working at night combined
with strategic use of caffeine 200 mg. at
crucial times of 1:30 a.m. and 7:30 a.m.
further enhances performance (Bonnet,
1994).
Screening for sleep disorders.
Sleep disorders are common among
shift workers. Mechanisms to manage
sleep disorders begin with screening
techniques. This could include a
questionnaire such as the Epworth
Sleepiness Scale (Johns, 1991) or the
use of a device such as an actigraph
worn on the wrist with computer-based
computational support for calculating
fatigue levels and determining fitness
for work. One such tool was developed
with the Department of Defense and
is known as the Fatigue Avoidance
Scheduling Tool (FAST). FAST
calculates five fatigue factors: 1) chronic
sleep debt; 2) recent sleep in the past
24 hours; 3) time since awakening; 4)

ends at the set alarm time. This
application also saves sleep data
and offers a detailed sleep graph and
accompanying statistics to analyze
sleep issues with a sleep specialist.
Another application plays relaxing
sounds of nature or ambient music
and can combine them all at different
volumes. This application also offers
a customizable option to combine
personal music with existing sounds or
interactive photographs to enhance the
experience on sleepless nights. Other
applications provide audio content
consisting of relaxation sleep sessions
or comforting words and relaxing,
guided meditations by hypnotherapists
designed to de-stress and discover an
inner calm that is conducive to sleep.
time of day; and 5) circadian rhythm
desynchronization at any point in
a schedule that contributes to the
predicted performance score. The tool
also provides a scale that gives an
equivalent to blood alcohol levels of
0.05%-0.08% (Hursh, 2004).
Sleep studies. Some sleep disorders
require assessment and treatment by
a health care provider. If disordered
sleep is determined to be problematic,
a sleep study is warranted. A sleep
study can identify narcolepsy, restless
leg syndrome, and sleep apnea as
well as other sleep-related problems.
With the sleep problem identified,
interventions can be targeted to
improve the quantity and quality of
sleep. For the individual experiencing
disordered sleep, adhering to the use
of intervention modalities sometimes
requires support and monitoring.
Sleep apnea treatment with
Continuous Positive Airway Pressure
(CPAP) machines can be monitored by
periodically downloading information
collected from the device (Lerman et
al., 2012). The wrist-worn actigraph
with FAST software is another tool
for determining fatigue management
success.
Sleep hygiene. One of the best ways
to prevent fatigue is by practicing good
sleep hygiene measures. Most people
require seven to nine hours of sleep

each day so it is essential that nurses
allow sufficient time for sleep. Avoiding
heavy meals and alcohol before sleep,
reducing caffeine intake, and limiting
other stimulants several hours before
bedtime should make it easier to fall
asleep. The sleep environment should
be very dark, comfortable, quiet, and
cool to facilitate falling asleep quickly
and staying asleep. A daily exercise
routine that provides regular physical
activity will improve sleep, help with
stress management, and promote
general health.
Insomnia applications for
smartphones. Advanced technology
now offers a number of insomnia
applications available for purchase
for smartphones that may be helpful
for individuals having difficulty
falling asleep or staying asleep. Sleep
proceeds through stages from light
to deep sleep forming cycles lasting
90-120 minutes. These cycles repeat
approximately five times lasting
90-120 minutes. The phase of sleep
an individual is in when their alarm
goes off significantly impacts how
tired he or she feels when awakening.
Individuals move differently through
the stages of sleep. One application
tracks movement during sleep
and determines which phase the
individual is in to determine the
best time to waken the individual
during a 30-minute time frame that

Lighting. Workplace lighting needs
are different during the day and night
shifts because of the sensitivity of the
human circadian system to nocturnal
light. The need for lighting during
the night shift is more complex than
during the day. Recent research has
demonstrated that many of the adverse
effects are due to the narrow band of
the light spectrum between 470 and
480 nm. The human visual spectrum
ranges from violet (380 nm.) to red
(700 nm.). There is mounting evidence
that exposure to light at night when
combined with frequent circadian
rhythm disruption can be a risk factor
for adverse health effects such as
cancer, heart disease, and metabolic
disturbances (Lerman et al., 2012).
Special eyeglasses were found to have
beneficial effects in nurses when the
sub-480 nm. light wavelength was
filtered out improving alertness, sleep,
and mood (Lerman et al., 2012).
Chemical Sleep Aid Use Requires
Caution
Chemical sleep aids may include
over the counter preparations such as
diphenhydramine, melatonin, or cold
and flu remedies. These preparations
may be perceived as benign; however,
they have adverse effects and some
can be especially dangerous when
combined with alcohol or other CNS
depressants due to their sedative

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

15

or antihistaminic effect. Others may
have abuse potential. Prescription
medications for sleep may include
sleeping pills, some of which are
associated with serious reactions such
as hallucinations and abnormal dreams.
Other prescription medications such as
benzodiazepines, antihistamines, and
tricyclic antidepressants may produce
sedation but they also have adverse
effects. Addiction potential should
always be considered before initiating
certain medications.
Employer Role in Promoting Healthy
Nursing Work Hours
The responsibility for fatigue risk
management is shared by employers
and the individual employee (Lerman
et al., 2012). The American Nurses
Association (2006) published a
position statement that recommended
employers of RNs should ensure
sufficient resources to provide a
work schedule that offers time for
adequate rest and recuperation
between scheduled shifts. Employers
can provide the opportunity for short
naps in quiet secluded areas adopting
a strategy employed by the airline
industry to assure alert pilots for long
haul flights. Additionally, sufficient
compensation and appropriate staffing
systems are needed that foster a safe
and healthful environment in which
RNs do not feel compelled to seek
supplemental income through overtime,
extra shifts, and other practices that
contribute to worker fatigue. Employers
can encourage nurses to provide
caring vigilance of co-workers helping
to identify behaviors or symptoms
that indicate fatigue and could place
themselves and others at risk. Nurses
need to have each other’s back.
Nurse Responsibility and Role in
Avoiding Fatigue
According to the ANA Code of Ethics
for Nurses (2001), the nurse’s primary
responsibility is to the patient whether
it is an individual, a family, a group, or
the community. The nurse promotes,
advocates for, and strives to protect the
health, safety, and rights of the patient.
The nurse’s obligation extends to his
or her own decision-making and that of
other members of the health care team.
16

There is mounting
evidence to suggest
that 12-hour shifts
and working over
40 hours per week
contributes to fatigue
and drowsiness.
This has a direct
impact on nurse
performance and
patient safety

The nurse must consider when fatigue
is impacting professional judgment and
decision-making of any member of the
health care team and whether fatigue
may possibly be placing the patient at
risk.
Regulatory Statements on Health
Care Worker Fatigue
The Joint Commission issued
Sentinel Event Alert 48 in 2011 and
brought recognition to the dangers of
extended work hours emphasizing that
the health care industry has been slow
to adopt changes, particularly with
regard to nursing. The Joint Commission
(2011) recommends the creation
and implementation of a fatigue
management plan with strategies such
as:
1. Actively engaging in conversations
with others
2. Doing something that involves
physical action (e.g. stretching)

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

3.
4.
5.
6.

Consuming caffeine
Taking short naps less than 45
minutes in length
Maximizing success by trying
different combinations of strategies
Counteracting severe consequences
by obtaining adequate sleep

Summary
As a result of the 2011 Nurse Fatigue
Action Proposal, AzNA generated a
nurse fatigue survey and disseminated
the findings through presentations,
publication of articles, and a continuing
education module for contact hours
that will be posted on the AzNA
website this year. Fatigue is pervasive
among nurses who work on all shifts
resulting in serious consequences for
the safety of patients and the safety
and well-being of nurses. There is
mounting evidence to suggest that 12hour shifts and working over 40 hours
per week contributes to fatigue and

drowsiness. This has a direct impact
on nurse performance and patient
safety (Rogers, 2008). As a result, it
is strongly recommended that nurses
protect their sleep time between shifts
and strive to achieve a minimum of
seven to eight hours per 24 hours.
Nurses must also be vigilant of their
co-workers who demonstrate signs of
fatigue and intervene when necessary.
An organizational culture of safety that
supports the physiological needs for
rest among health care providers will
enhance performance and improve
patient safety. One recommendation
for employers is creating opportunities
for rest breaks in a quiet space for
nurses. Education and awareness
about the dangers of nurse fatigue
for nurse leaders and RNs in hospital
organizations will contribute to a
healthier work environment and a safer
environment of care for patients.
References
Agency for Healthcare Research and
Quality. (March 2005). Skipping
meals or breaks may contribute
to nurse burnout and jeopardize
nurses’ health. Archive. Available
at:http://archive.ahrq.gov/research/
mar05/0305RA4.htm. Accessed
August 16, 2012.
American Nurses Association. (2006).
Assuring patient safety: Registered
nurses responsibility in all roles and
settings to guard against working
when fatigued. Position Statement.
Available at: http://ana.nursingworld.
org/MainMenuCategories/
ThePracticeofProfessionalNursing/
workforce/NurseShortageStaffing/
NurseFatigue/Fatigue.aspx. Accessed
August 10, 2013.
American Nurses Association. (2006).
Assuring patient safety: The
employers’ role in promoting
healthy nursing work hours for
registered nurses in all roles and
settings. Position Statement.
Available at: http://ana.nursingworld.
org/MainMenuCategories/
ThePracticeofProfessionalNursing/
workforce/NurseShortage/
NurseFatigue/EmployersRole.aspx.
Accessed August 10, 2013.
American Nurses Association.
Mandatory overtime. Position Statement.

Available at: http://nursingworld.
org/MainMenuCategories/PolicyAdvocacy/State/Legislative-AgendaReports/MandatoryOvertime.
Accessed August 26, 2013.
American Nurses Association.
(2001). Code of ethics for
nurses. Nursing World. Available
at: http://www.nursingworld.
org/MainMenuCategories/
Ethicsstandards/
CodeofEthicsforNurses/
Code-of-Ethics.pdf. Accessed August
15, 2013.
Arnedt, J. T., Wilde, G. J., Munt, P. W.,
& MacLean, A. W. (2001). How do
prolonged wakefulness and alcohol
compare in the decrements they
produce on a simulated driving task?
Accidental Anal Preview, 33(3), 337-344.
Available at:
http://ac.els-cdn.com/
S0001457500000476/1-s2.0S0001457500000476-main.pdf?
_Tid=30e51e5e-ff84-11e2-b0e200000aab0f27&acdnat=1375895579_
bc1a0ca5aedddd5137dac39a26b8cc30.
Accessed August 10, 2013.
Bonnet, M., & Arand, D. (1994). The use
of the prophylactic naps and caffeine
to maintain performance during
continuous operation. Ergonomics,
37(6) 1009-1020.
Caldwell, J. L. (2002). Efficacy of
napping strategies to counter the
effects of sleep deprivation.
Lecture. Available at: http://
www.dtic.mil/cgi-bin/
GetTRDoc?AD=ADP013765. Accessed
August 27, 2013.
Dagan, Y. (2002). “Circadian rhythm
sleep disorders (CRSD)” (Abstract).
Sleep Medicine Reviews (Elsevier) 6(1):
45–54. doi:10.1053/smrv.2001.0190.
PMID 12531141. Available at: http://
www.smrv-journal.com/article/S10870792(01)90190-X/pdf. Accessed
August 26, 2013.
Figley, C. (1995). Compassion fatigue: Coping
with secondary traumatic stress disorder in
those who treat the traumatized. New York,
NY: Brunner-Routledge.
Hursh, S., Redmond, D., Johnson, M.,
Thorne, C., Belenky, G., Balkin, T.,
Storm, W., Miller, J., & Eddy, D. (2004).
Fatigue models for applied research
in warfighting. Aviation Space
Environmental Medicine, 75(3 suppl.),

A44-53.
Johns, M. (1991). A new method for
measuring daytime sleepiness: The
Epworth sleepiness scale. Sleep 14(6),
540-545. PMID 1798888.
Lerman, S. E., Flower, D. J., Gerson,
B., & Hursh, S. R. (2012). ACOEM
guidance statement: Fatigue risk
management in the workplace. Journal
of Environmental Medicine, 54(2), 231258.
Mayo Clinic. (2012). Job burnout: How
to spot it and take action. Available
at: www.mayoclinicl.com/health/
burnout/WL00062. Accessed August
6, 2013.
Mind Tools. (2013). Stress management
– start here! Available at: www.
mindtools.com/pages/article/
newTCS_00.htm. Accessed August 6,
2013.
Moore-Ede, M. (2009). Evolution of
fatigue risk management systems:
The “tipping point” of employee
fatigue mitigation. CIRCADIAN White
Papers. Available at: www.circadian.
com/pages/157_white_papers.cfm.
Accessed August 6, 2013.
Rogers, A. E. (2008). The effects of
fatigue and sleepiness on nurse
performance and patient safety. In:
Hughes, RG, editor. Patient Safety and
Quality: An Evidence-Based Handbook
for Nurses. Rockville, MD: Agency for
Healthcare Research and Quality
(U.S.). April. Chapter 40. Available at:
http://www.ncbi.nlm.nih.gov/books/
NBK2645/ Accessed August 15, 2013.
Scott L. D, Rogers, A. E., Hwang, W. T.,
& Zhang, Y. (2006). Effects of critical
care nurses’ work hours on vigilance
and patients’ safety. American Journal
of Critical Care, 15(1), 30-37. Available
at: http://ajcc.aacnjournals.org/
content/15/1/30.long. Accessed
August 8, 2013.
The Joint Commission Sentinel Event
Alert. (2011). Health care worker
fatigue and patient safety. The Joint
Commission. Issue 48.
Zhou, X., Ferguson, S., Mathews, R.,
Sargent, C., Darwent, D., Kennaway,
D., & Roach, G (2011). Mismatch
between subjective alertness
and objective performance under
sleep restriction is greatest during
biological night. European Sleep
Research Society, 40-49.

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

17

PAMELA RANDOLPH, RN, MS, FRE, ASSOCIATE DIRECTOR
ROBIN SCHAEFFER MSN, RN, CNE, AZNA EXECUTIVE DIRECTOR

ARIZONA ACTION COALITION LAUNCHES
On June 21, 2013 the Arizona Action
Coalition (AzAC) held their official launch
at the Saguaro Hotel in Scottsdale.
Nationally recognized nursing leader,
Susan Hassmiller, Senior Advisor at
Robert Wood Johnson Foundation, spoke
to over 91 community and nursing leaders
on the recommendations contained
in the Institute of Medicine’s (IOM)
landmark report, The Future of Nursing:
Leading Change, Advancing Health.
Hassmiller emphasized that future
health care needs will not be met by our
current health care system, which, when
compared to other highly developed
nations, is the most expensive with the
poorest outcomes on every indicator of
health.
Nurses, the largest healthcare
workforce in the country, have the
potential to help improve the health

for the purpose of elevating nurses or
making them feel good, but to improve
the health of the nation.
The first session of the launch
included Senator John McComish and
representatives from the Arizona Medical
Association, Community Health Centers,
St Lukes Health Initiatives and Arizona
Public Health Association in addition to
lobbyists that focus on healthcare issues.
Health facility leaders representing 16
hospitals across the state attended the
second session. Community leaders had
a chance to dialogue with Hassmiller
on their issues and concerns in a small
group setting during the third session.
Over 70 nursing leaders, including nursing
students, attended the last session and
heard Hassmiller’s call to action. During
each session, AzAC workgroups reported
on their progress in meeting the IOM

and publishing an extensive selfstudy of Arizona’s status in regard to
the IOM recommendations. That was
completed in July 2011 and is currently
on the official website of the AzAC: www.
futureofnursingaz.com
Under the leadership of Robin
Schaeffer (Arizona Nurses Association),
Pamela Randolph (Arizona State Board of
Nursing), Laurie Liles (Arizona Hospital
and Healthcare Association) and Tony
Mollica (United Healthcare, Optum
Health), the exploratory committee
applied to be an Action Coalition with the
Center to Champion Nursing in America.
They were awarded Action Coalition
status in 2012 and have since recruited
over 90 members. Current leadership
includes Schaeffer, Randolph, Greg
Vigdor (Arizona Hospital and Healthcare
Association) and Marie Fredette (Arizona

Nurses, the largest healthcare workforce in the country, have the
potential to help improve the health of all citizens. The report
contains four key recommendations designed to position nurses to
improve health and health care in the United States
of all citizens. The report contains
four key recommendations designed
to position nurses to improve health
and health care in the United States.
These recommendations are: 1) Nurses
should practice to the full extent of their
education and training; 2) Nurses should
achieve higher levels of education and
training through an improved education
system that promotes seamless academic
progression; 3) Nurses should be full
partners, with physicians and other
health care professionals, in redesigning
health care in the United States; and 4)
Effective workforce planning and policy
making require better data. Hassmiller
emphasized that the report was not
18

goals. One significant accomplishment
reported by the Education workgroup,
was the formation of the EducationPractice Collaborative (EPC). Their goal
is to adopt Arizona Future of Nursing
competencies and ensure safe passage
of new graduates to the workplace. Over
90 individuals have been active in the
collaborative representing numerous
nursing programs and health care
facilities.
The Arizona Action Coalition, (AzAC)
originally formed as a state-based
exploratory group in 2010, when the
IOM report and recommendations were
introduced to the nation. The initial
goal included collecting information

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

Association for Homecare). A special
thanks goes out to Marie Fredette for
helping us on the business end; (i.e.
bylaws, incorporation, etc).
Current workgroup leaders include:
Practice: Denise Link, Randy Quinn;
Leadership: Rayette Vaughn, Lamont
Yoder; Education: Paulette Compton,
Roni Kerns, Workforce: Carla Clark, Tanie
Sherman.
Thank-you to the many nurses and
friends of nursing who have taken the
time to attend meetings whether in
person or virtual. Please consider joining
AzAC as a member if you have not already
at www.futureofnursingaz.com

e d u c a t i
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l o y m e n
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arizona STATE BOARD OF NURSING REGULATORY JOURNAL

19

CNA CORNER

FRANNIE BREED RN, BSN,
NURSE PRACTICE CONSULTANT, CNA PROGRAMS

CERTIFIED NURSING ASSISTANT RESPONSIBILITIES
Frequently, Board staff receives phone calls and e-mails
from health-care providers requesting clarification of
the tasks and responsibilities that can be delegated to a
certified nursing assistant (CNA). While basic information
can be located in the Nurse Practice Act, Article 8 R4-19-813,
this article will attempt to clarify this issue and apply it to
your work environment. First, both nurses and CNA’s may
need to review the criteria to be met when delegating and
accepting delegation. This criteria is found in R4-19-813.
A CNA may perform:
4ASKS THAT THE NURSING ASSISTANT HAS BEEN TRAINED FOR IN
the basic curriculum of the CNA program
s 4ASKS LEARNED THROUGH IN SERVICE OR EDUCATIONAL TRAINING
if the task meets the following criteria and the nursing
assistant has demonstrated competence performing the
task:
o The task can be safely performed according to clear,
exact, and unchanging directions;
o The task poses minimal risk to the patient or resident
and the consequences of performing the task
improperly are not life-threatening or irreversible;
o The results of the task are reasonably predictable;
and
o Assessment, interpretation, or decision-making is not
required during the performance or at the completion
of the task. (R4-19-813(1)(2)(a-d)
s

When a nurse delegates a task to a CNA, the nurse must
confirm that the task and the circumstances are right for the
task that is being delegated. The nurse is also responsible
for providing the CNA with guidance, direction, and
supervision. While it is the CNA’s responsibility to complete
the task correctly, ultimately the nurse is responsible for the
patient’s care. CNAs must also be aware of delegated tasks
they should not accept based on either their education, the
condition of the patient, or scope of practice. Assessment
and evaluation can never be delegated to CNAs or other
unlicensed personnel. The CNA should recognize and
communicate with the delegating nurse the limits of their
own personal knowledge, skills, and abilities prior to
accepting a task. In determining these personal limits, the
CNA may reflect upon:
s 7HETHER THE TASK WAS TAUGHT IN THE TRAINING PROGRAM
s $O ) KNOW HOW TO DO THE TASK
s )S THERE SUPERVISION AVAILABLE
s )S THE RIGHT EQUIPMENT AVAILABLE
s $O ) KNOW WHAT TO OBSERVE REPORT AND RECORD
If a CNA is unsure how to perform a task, they should

20

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

talk to the nurse and ask for assistance. Patient safety is of
the highest concern. It is a CNA’s responsibility to perform
all required actions when completing a task, including
ensuring patient or resident safety and comfort, reporting
observations to the nurse, and documenting according to
facility policy. It is essential that the CNA understands that
once a task is delegated to them, they cannot re-delegate
the task to someone else. The CNA must always keep in
mind that at all times they must follow the Residents’ Rights,
protect the residents’ privacy and dignity, and adhere to the
Nurse Practice Act.
The Arizona State Board of Nursing has established
a process for addressing questions relating to the scope
of practice. The Board no longer responds to telephonic
inquiries and all scope of practice questions must be
submitted in writing via email to scopeofpractice@azbn.gov.

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

21

Conference Registration
2014 11th Annual CNA Educators’ Retreat Friday January 10th
We want to make the process as easy as possible.You will need to complete a separate
registration form for each individual attending.
If you have any question about registration, please email Helen Turner at hturner@azbn.gov.
Contact Information
Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address
Meals
All Full Conference Registration fees include the following meals:
Continental breakfast and buffet lunch
Previous Attendee
Yes
No

Registration Fees
Submit Completed Registration Form with payment, by Check, Money Order or Credit/Debit
card to Arizona State Board of Nursing - 4747 North 7th St., Suite 200, Phoenix, AZ 85014
If paying by credit/debit card, please submit the completed Payment Card Authorization form
below. Please note, payment by credit/debit card includes a $3.00 processing fee.

Purchase Orders ARE NOT accepted in lieu of payment.
___
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General - $90 Due on or before 12/13/13
Late - $95 after 12/13/13
On-Site - $100 space permitted
Thumbdrive - $20 While available

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of hearing attendees. This technology is comprised of a wire within the building that transmits
an audio signal directly to a hearing aid, eliminating background noise thus creating clear
communication with speakers. Check the box if you would like to try one.

Where
Glendale Civic Center
5750 West Glenn Drive, Glendale AZ 85301
22

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

Collaboration

EducationInnovation
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ide the Box:
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let them know about the StuNurse
magazine. A subscription to the
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can be reserved by visiting
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right corner. Educators... let your
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arizona STATE BOARD OF NURSING REGULATORY JOURNAL

23

PAYMENT CARD AUTHORIZATION FORM
PLEASE RETURN COMPLETED FORM WITH YOUR APPLICATION
ONLY VISA OR MASTERCARD IS ACCEPTED
PLEASE CLEARLY PRINT ALL INFORMATION EXCEPT WHERE A SIGNATURE IS REQUIRED

NAME OF PERSON
REGISTERING:
(REQUIRED)

AUTHORIZATION INFORMATION:

TOTAL AUTHORIZED AMOUNT:

+ $3.00 =
(TOTAL FOR REGISTRATION Plus S3.00 PROCESSING FEE)

TYPE OF CARD:
VISA

MASTERCARD

CARD NUMBER:
(REQUIRED)

CVN #

EXPIRATION DATE:
(REQUIRED)

(REQUIRED)

BILLING INFORMATION:
CARD HOLDER NAME:
(REQUIRED)

BILLING/MAILING ADDRESS:

PHONE NUMBER:
(REQUIRED)

EMAIL ADDRESS:

SIGNATURE OF CARDHOLDER:
(REQUIRED)

24

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

Dignity is:
unparalleled
opportunity
Dignity Health is one of the nation’s leading hospital
networks. Our Arizona region is comprised of
Chandler Regional Medical Center, Mercy Gilbert
Medical Center and St. Joseph’s Hospital and Medical
Center. Within each of these facilities, we provide
numerous opportunities for you to strengthen your

We offer unparalleled opportunity in a
variety of nursing specialties:
, Operating Room/Surgery
, Intensive Care Unit
Learn more about Dignity Health in Arizona and apply to
the facility of your choice:

clinical skills and move forward in your career.
http://careersatdignityhealth.com/StJoseph2

We’re expanding in 2014!

http://careersatdignityhealth.com/Chandler2

, St. Joseph’s Westgate Medical Center in Glendale
Opening in Early 2014

Follow us on Twitter at @dignityhealthaz. EOE.

http://careersatdignityhealth.com/Mercy2

, Chandler Regional Medical Center’s 200-bed
expansion Fall 2014

continued >>>

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

25

*Not reported in previous Journal

CNA DISCIPLINARY ACTION
FEBRUARY, MARCH, APRIL, MAY 2013

EFFECTIVE DATE

NAME

CERTIFICATE

DISCIPLINE

3/21/2013

Acosta, Jennifer R.

CNA Applicant

Certificate Denied

2/18/2013

Alverson, Linda S.

CNA1000037071

Civil Penalty

3/19/2013

Anderson, Marc A.

CNA1000029828

Revoked

5/20/2013

Anderson, Martin S.

CNA1000026949

Decree of Censure

3/26/2013

Bell, Willie C.

CNA1000019500

Suspension

2/13/2013

Bilko, Larry

CNA1000011863

Decree of Censure

5/30/2013

Branham, Tracy L.

CNA Applicant

Certificate Denied

4/8/2013

Brown, Yvonne M.

CNA1000038944

Civil Penalty

2/17/2013

Burma, Sophia

CNA1000037345

Decree of Censure

5/15/2013

Byassee, Stacey L.

CNA999997175

Voluntary Surrender

5/22/2013

Caballes, Domingo S.

CNA455357061

Voluntary Surrender

5/6/2013

Carry, Carla Y.

CNA Applicant

Certificate Denied

3/21/2013

Carter, Arthur R.

CNA Applicant

Certificate Denied

3/4/2013

Corona, Briana M.

CNA1000006041

Suspension

5/20/2013

Cracknell, Steven R.

CNA Applicant

Certificate Denied

5/10/2013

Currie, Victoria L.

CNA Applicant

Certificate Denied

5/31/2013

Daley, Serrina L.

CNA1000038198

Decree of Censure

2/11/2013

Downs, Sandy C.

CNA1000021684

Decree of Censure

5/10/2013

Dukes, Lori L.

CNA1000012665

Revoked

5/21/2013

Edge, David L.

CNA Applicant

Certificate Denied

2/14/2013

Elam , Wilbert W.

CNA1000037109

Civil Penalty

5/23/2013

Faultner, Cherri A.

CNA677297803

Decree of Censure

2/6/2013

Felix, Allessandra L.

CNA1000037191

Stayed Suspension

2/19/2013

Felix, Esperanza

CNA128361103

Decree of Censure

3/19/2013

Goseyun, Cynthia I.

CNA1000009160

Revoked

3/15/2013

Graham, Alice F.

CNA Applicant

Certificate Denied

4/17/2013

Guyette, Ashley L.

CNA1000016247

Revoked

3/14/2013

Hatcher, Suzette M.

CNA Applicant

Certificate Denied

2/19/2013

Henke, Mindy A.

CNA Applicant

Certificate Denied

3/19/2013

Holdren, Tara L.

CNA999991946

Revoked

2/14/2013

Holland, Steven J.

CNA1000000181

Voluntary Surrender

2/28/2013

Irving, Tamisha L.

CNA1000030489

Decree of Censure

3/20/2013

Jacobi, Kachyto

CNA1000034548

Revoked

5/13/2013

Johnson, Esther E.

CNA Applicant Exam

Certificate Denied
Certificate Denied

3/21/2013

Lafevre, Toni A.

CNA Applicant

3/1/2013

Lennander, Alison N.

CNA999997156

Decree of Censure

5/7/2013

Manuel, Michael C.

CNA1000033843

Decree of Censure

3/11/2013

Mariner, Carol L.

CNA Applicant

Certificate Denied

3/4/2013

Martinez, Brittney O.

CNA1000038122

Decree of Censure

5/16/2013

Martinez, Sara E.

CNA Applicant

Certificate Denied

3/19/2013

Moore, Sonya G.

CNA999999248

Revoked

3/25/2013

Mueller, Mark C.

CNA1000037481

Stayed Revocation

3/11/2013

Natsyn, Charles A.

CNA Applicant

Certificate Denied

3/28/2013

Nelson, Lisa L.

CNA Applicant

Certificate Denied

4/3/2013

Nocki, Erin

CNA1000012626

Revoked

2/22/2013

Oberly, Trenton J.

CNA1000037206

Decree of Censure

4/12/2013

Owens, Adrianna D.

CNA1000031267

Decree of Censure

3/14/2013

Pappas, Tatiana E.

CNA Applicant

Certificate Denied

3/4/2013

Portillo, Sandra

CNA1000037211

Stayed Suspension

5/10/2013

Ramos, Gilbert A.

CNA999996202

Revoked

3/19/2013

Rangel, Aliya F.

CNA1000000045

Revoked

26

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

CNA DISCIPLINARY ACTION

*Not reported in previous Journal

OCTOBER, NOVEMBER, DECEMBER 2012 & JANUARY 2013
5/2/2013

Riggs, Andrew J.

CNA Applicant Exam

Certificate Denied

2/21/2013

Runge, Alyssa M.

CNA1000025777

Decree of Censure

2/14/2013

Saberon, Reniel M.

CNA1000004405

Decree of Censure

5/14/2013

Salazar, Maria A.

CNA Applicant

Certificate Denied

3/19/2013

Sandbank, Joshua A.

CNA1000027556

Revoked

5/21/2013

Sarmiento, Julie B.

CNA1000003901

Suspension

5/30/2013

Shabazz, Myra R.

CNA Applicant Exam

Certificate Denied

3/21/2013

Swanson, Yoko R.

CNA Applicant

Certificate Denied

5/17/2013

Taylor, Travis K.

CNA Applicant

Certificate Denied

2/1/2013

Tayon, Brittany E.

CNA Applicant Exam

Certificate Denied

3/19/2013

Tsosie, Bernita

CNA801278353

Revoked

2/6/2013

Tsosie, Tammy J.

CNA1000022948

Revoked

3/21/2013

Velez, Jose J.

CNA Applicant

Certificate Denied

3/11/2013

Vidal Noriega, Alma A.

CNA Applicant

Certificate Denied

3/18/2013

Villegas, Jesus R.

CNA Applicant

Certificate Denied

5/5/2013

West, Mae

CNA593575803

Decree of Censure

2/13/2013

Wilson, Geri S.

CNA Applicant Exam

Certificate Denied

3/11/2013

Windler, Randi R.

CNA1000030580

Decree of Censure

2/25/2013

Wooley Ii, John S.

CNA Applicant

Certificate Denied

5/21/2013

Yazzie, Raquel L.

CNA Applicant Exam

Certificate Denied

3/19/2013

Yescas, Leticia

CNA999991352

Certificate Denied

*Not reported in previous Journal

RN/LPN DISCIPLINARY ACTION
FEBRUARY, MARCH, APRIL & MAY 2013
EFFECTIVE DATE

NAME

LICENSE

DISCIPLINE

3/19/2013

Abruzzese, Nicole D.

LP041598

Revocation

5/3/2013

Allen, Christopher J.

RN140096

Revocation

5/10/2013

Atkinson, Eric C.

RN174601/LP048157

Voluntary Surrender

3/19/2013

Aubert, Rose M.0

RN08817

Revocation

3/1/2013

Baquial, Eugenio L.

RN148681

Voluntary Surrender

3/11/2013

Barrott, Christopher

RN Endorsement

License Denied

3/12/2013

Barr, Rosalinda

RN082548

Probation

4/9/2013

Bartram, Elizabeth M

RN057874

Probation

3/1/2013

Basil, Candace B.

RN137253

Stayed Suspension with Probation

5/17/2013

Bergstrom, Mia D.

Compact, TX RN

Voluntary Surrender-Privilege to Practice

5/20/2013

Biron, Robin D.

RN115664/SN0560

Stayed Revocation with Suspension

2/22/2013

Blandford, Katrina R.

RN151591

Civil Penalty

5/10/2013

Blocker, Mark D.

RN130134

Revocation

5/3/2013

Boyer, Shannon J.

RN154660

Probation

5/14/2013

Boyes, John G.

RN071172/AP0149

Voluntary Surrender

3/19/2013

Brandenburg, Kristella

LP047481

Voluntary Surrender

4/16/2013

Brunton, David W.

RN148454

Decree of Censure

5/10/2013

Buresh, Kara J.

RN121495

Revocation

5/14/2013

Burnett, Christina N.

LP Endorsement

License Denied

2/25/2013

Cala, Maria C.

RN158827

Suspension

3/11/2013

Camp, Shari

RN Endorsement

License Denied

5/20/2013

Carroll, Rachel J.

RN164962

Civil Penalty

3/7/2013

Clinton, Joanne C.

RN139323

Voluntary Surrender

4/2/2013

Cohen, Jennifer R.

RN 50027 (Compact - RI)

Voluntary Surrender - Privilege to Practice

continued >>>

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

27

RN/LPN DISCIPLINARY ACTION

*Not reported in previous Journal

CONTINUED

FEBRUARY, MARCH, APRIL & MAY 2013
EFFECTIVE DATE

NAME

LICENSE

DISCIPLINE

3/12/2013

Collier, Colleen P.

RN153439

Voluntary Surrender

2/19/2013

Cox, Carmen L.

RN155922

Decree of Censure

3/8/2013

Croft, Rachael A.

RN141776

Voluntary Surrender

4/30/2013

Curry, Lenard

LP026896/CNA602403839

Voluntary Surrender

5/21/2013

Dechenne, Jennifer S.

RN Endorsement

License Denied

3/8/2013

Deist, Kathryn E.

RN115035

Probation

2/8/2013

Dickehage, Gary A.

RN059116/LP012757

Voluntary Surrender

5/22/2013

Dudun, Sherri W.

LP037879

Voluntary Surrender

3/19/2013

Eaton, Susan B.

RN025042

Revocation

3/5/2013

Erickson, Patricia J.

LP022630

Decree of Censure

3/19/2013

Evernham, Christa N.

RN094726

Voluntary Surrender

2/26/2013

Fannon, Kimberly J.

RN118375

Voluntary Surrender

4/16/2013

Farley, Goldie J.

RN133251

Voluntary Surrender

2/26/2013

Finch, Lynn R.

RN178629

Decree of Censure

3/29/2013

Flores, Kelly L.

RN137531/AP4946

Probation

3/19/2013

Garcia, Christina R.

LP045178/CNA1000006240

Revocation

3/19/2013

Giacomelli, Tanya A.

LP031451/CNA644073674

Revocation

4/9/2013

Giacomello, Mariateresa

RN095337/AP2247

Revocation

3/6/2013

Glynn, Lauren K.

RN165661

Voluntary Surrender

3/19/2013

Goelz, Mary J.

LP047045

Revocation

5/3/2013

Grijalva, Thea

RN140479

Revocation

3/11/2013

Hall, Mara L.

RN102731

Probation

5/1/2013

Harbor, Patrice M.

RN179321

Probation

2/10/2013

Harrison, Richard E.

LP040618/CNA1000001849

Decree of Censure

3/25/2013

Hartley-Cobb, Holli

RN052454

Revocation

3/7/2013

Heimlich, Schuyler P.

RN158525

Voluntary Surrender

3/10/2013

Herbold, Debra C.

LP019299

Decree of Censure

5/20/2013

Herd, Debra A.

RN155907

Decree of Censure

3/26/2013

Hollatz, Audrey L.

TRN085435

Reissuance Stayed Revocation with Probation

2/26/2013

Hubbell, Karen K.

RN Endorsement

License Denied

3/19/2013

Hughes, Michael F.

RN Endorsement

License Denied

5/31/2013

Jamora, Rachel J.

RN170367

Suspension

3/19/2013

Jensen, Margaret E.

RN121160

Decree of Censure

2/6/2013

Jones, Ivan Q.

RN167319/LP036297

Probation

5/3/2013

Kause, Pamela M.

RN130944

Revocation

5/8/2013

Kay, Lisa R.

RN162097

Stayed Suspension with Probation

3/14/2013

Kewenvoyouma, Kristie B.

RN150850

Stayed Revocation with Suspension

2/1/2013

Kropczynski, Raymond M.

RN169604

Voluntary Surrender

3/19/2013

Kuhns, Susan L.

RN077077

Voluntary Surrender

3/19/2013

Lange, Lynette

RN096593

Revocation

3/11/2013

Lawler, Susan L.

LP038471

Suspension

5/2/2013

Lee, Annie R.

LP025985

Decree of Censure

4/11/2013

Lemieux,Michelle R.

RN179035

Probation

3/18/2013

Lentine, Shirley J.

RN019979/SN0739

Voluntary Surrender

3/27/2013

Leonard, Jeremy C.

RN178865

Stayed Revocation with Suspension

5/6/2013

Lunt, Melissa

RN070036/LP022340

Decree of Censure

3/22/2013

MacMaster, Robert P.

RN107531

Probation

3/22/2013

Maguire, Hollie J.

RN160227

Voluntary Surrender

5/10/2013

Mangum, Raheem W.

RN124389

Revocation

3/19/2013

Martinez, Linda M.

RN054132

Revocation

28

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

*Not reported in previous Journal

RN/LPN DISCIPLINARY ACTION
FEBRUARY, MARCH, APRIL & MAY 2013
EFFECTIVE DATE

NAME

LICENSE

DISCIPLINE

5/14/2013

Martinez, Patricia A.

RN069641

Revocation

3/26/2013

McLeod, Connie S.

RN079900/LP025152

Civil Penalty

3/6/2013

Mendiola, Primitivo G.

RN128286/LP038442

Stayed Revocation with Probation

5/1/2013

Mestas, Heidi J.

RN158613

Voluntary Surrender

3/11/2013

Michael, Laura D.

RN113397

Revocation

3/18/2013

Mills, Patrice R.

LP04918

Probation

3/26/2013

Miranda, Alexis B.

RN102584

Probation

3/14/2013

Moskop, Janet E.

RN158174

Probation

3/26/2013

Murray, Gary W.

RN132399

Probation

5/3/2013

Murray, Janel J.

RN134111/CNA999993040

Revocation

5/21/2013

Nwaohia, Nwadiuto J.

LP046735

Summary Suspension

2/20/2013

Obrien, Frances A.

LP009229

Voluntary Surrender

5/7/2013

Okoromkwo, Paul O.

LP043311

Decree of Censure

5/21/2013

Olson, Melissa B.

RN143665

Summary Suspension

4/24/2013

Peterson, James A.

RN058234

Voluntary Surrender

5/14/2013

Plotado, Aurea A.

LP044818

Decree of Censure

5/21/2013

Ramos, Ethel Jane M.

RN154614

Decree of Censure

2/01/2013

Ramussen, Kelly M.

LPN Endorsement

License Denied

5/10/2013

Reese, Gwen R.

LP031894

Revocation

4/23/2013

Renner, Brandon D.

RN166061/CNA1000015919

Voluntary Surrender

4/5/2013

Richards, Toby D.

RN151742/AP3005

Decree of Censure

5/14/2013

Richey-Smith, Jana D.

LP048912/CNA1000013610

Revocation

5/15/2013

Riviotta, Nancy L.

RN095171/LP030644

Voluntary Surrender

5/20/2013

Roth, Kelli A.

RN159519

Probation

5/4/2013

Sabin, Christina A.

RN157329/LP044401

Decree of Censure

5/10/2013

Schlener, Martha M.

LP040222

Revocation

3/26/2013

Shooter, Elisabeth L.

LP040397

Suspension

5/3/2013

Shores, Charlotte D.

RN151076

Voluntary Surrender

5/16/2013

Sirinek, Justin L.

TRN176783

Voluntary Surrender

5/1/2013

Smith, Virginia H.

RN083810/LP027324

Decree of Censure

5/24/2013

Spayde, Barbara D.

LP021745

Decree of Censure

4/5/2013

Stamps, Toni D.

RN116652

Stayed Revocation with Suspension

3/4/2013

Steimer, Jenna M.

RN Exam

Probation

3/5/2013

Szelepski, Jennifer E.

RN152290

Decree of Censure

5/8/2013

Taylor, Billie C.

RN173830

Voluntary Surrender

5/20/2013

Terrazas, Shelly L.

RN120428/CNA999988740

Stayed Revocation with Suspension

3/19/2013

Thompson, Misty M.

RN153496

Revocation

2/11/2013

Tomassoni, Linda E.

RN055089

Decree of Censure

5/10/2013

Toyama, Barbara K.

RN068761

Revocation

4/9/2013

Valdez, Elizabeth A.

RN116299

Revocation

3/19/2013

Watson, Katie L.

LP044042

Revocation

5/10/2013

Weisz, Sheree N.

RN061958

Revocation

3/22/2013

West, Amy J.

RN167750/LP027464

Probation

3/25/2013

Wikan, Chad

RN103990/AP4499

Voluntary Surrender

3/15/2013

Williams, Shoko

RN120940

Probation

5/21/2013

Witek, Dawn E.

RN 177125 (Compact-WI)

Stayed Revocation with Suspension of Muli-state
Licensure Privilege

5/10/2013

Wronko, Sandal F.

RN057533/LP018953

3/11/2013

Zack, Michelle A.

LP043948

Revocation
Revocation

5/10/2013

Zimpleman, Marla J.

RN149737

Voluntary Surrender

arizona STATE BOARD OF NURSING REGULATORY JOURNAL

29

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arizona STATE BOARD OF NURSING REGULATORY JOURNAL

31

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