arizona STATE BOARD OF NURSING VOL 13 • NO1 APRIL 2017 REGULATORY JOURNAL We see the HONOR in you. Because you truly QT[JUJTUQJ Because you treat each patient \NYMHTRUFXXNTSFSIJRUFYM^ <*8:554799-* HONOR.3>4: At HonorHealth, Nursing excellence is central to everything we do and everything we are. As Arizona’s only healthcare system to achieve Magnet® recognition LQHDFKRIRXUğYHKRVSLWDOVZHłUH a leader in medical innovation, talent and technology with a genuine commitment to nursing. (VSHFLDOO\GXULQJ1DWLRQDO Nurses Week, we thank our Nurses - and all Nurses - for the work you do every day. We honor your commitment to \RXUSDWLHQWVDQGGHGLFDWLRQ WRLPSURYLQJWKHLUKHDOWKDQG well being. <*è7**=(.9*)94 HONOR>4: /HDUQPRUHDERXWSURYLGLQJ care in a Magnet HQYLURQPHQW where Nurses are encouraged to do ZKDWłVEHVWIRU\RXU SDWLHQWand best for the team you work with. HonorHealthJobs.com HonorHealth is an equal opportunity employer. >> 4 arizona STATE BOARD OF NURSING REGULATORY JOURNAL  ICU, CATH, LABOR & DELIVERY AND PERIOPERATIVE SERVICES RN’S WANTED!! $10,000.00 SIGN ON BONUS PLUS RELOCATION ASSISTANCE* Canyon Vista Medical Center is a new technologically advanced, 100-bed hospital serving Southeastern Arizona and Cochise County. Nestled at the base of the Huachuca Mountains, the community of Sierra Vista holds the perfect year round climate.  Ê&RPSHWLWLYH3D\DQG%HQHILWVÊ  For more information or to apply, Visit www.canyonvistamedicalcenter.com      6LJQRQERQXVIRU51·VZLWKPLQLPXPWZR\HDUH[SHULHQFHLQ,&8&DWK/DERUDQG'HOLYHU\DQG Periop areas. *Two year commitment is required. * Former CVMC employees who left within two years not eligible for sign on bonus and relocation. The following link provides a detailed discussion of the clinical judgement model: http://www.jattjournal.com/index. php/atp/article/view/89187). NCSBN research, literature review and pilot studies identified the following important elements of nursing clinical judgment: a. Cue recognition b. Hypotheses generation c. Hypotheses evaluation d. Taking actions e. Evaluating outcome The Examinations Department is currently conducting the NGN research project to assess the ability of current and potential innovative items to assess clinical judgement. Beginning in July, 2017, NCSBN will present a Special Research Section as part of the NCLEX-RN administration. The Special Research Section will be given to select candidates taking the NCLEX-RN and will take approximately 30 minutes to complete. This section will be administered following a candidate’s regular NCLEX exam and will not count as part of their NCLEX score. Information about the Special Research Section will be made available to NCLEX candidates in early April via the NCSBN and Pearson VUE websites. Included in this edition of Arizona Board of Nursing Regulatory Journal are two resources that have been developed specifically for the boards of nursing/regulatory bodies in regards to the NGN project. The first document is the NGN Project Summary and the second document is FAQs regarding the Special Research Section given at the Midyear meeting. Joey Ridenour, RN, MN, FAAN Work Where You are Valued and Honored Memorial has been serving the healthcare needs of our neighbors for more than 60 years. Healthcare has changed, and so has Memorial Medical Center. Today, Memorial is fast becoming the regional healthcare referral system for all of southern New Mexico, with high quality Ɖ ƉŚLJƐŝĐŝĂŶƐ͕ŶƵƌƐĞƐĂŶĚƐƚĂīǁŚŽĂƌĞĨŽĐƵƐĞĚŽŶĚĞůŝǀĞƌŝŶŐƚŚĞ ƌŝŐŚƚ ŚƚĐĂƌĞ͕ĂƚƚŚĞƌŝŐŚƚƟŵĞǁŝƚŚĐŽŶǀĞŶŝĞŶĐĞĂŶĚĐŽŵƉĂƐƐŝŽŶ͘ Memorial is currently hiring talented health care professionals to join our dynamic team. These include physicians, nurses, therapists, social workers and a variety of ŽƚŚĞƌƉŽƐŝƟŽŶƐ͘ƉƉůLJƚŽĚĂLJƚŽǁŽƌŬǁŚĞƌĞ you are valued and honored. Visit us at MMCLC.org and apply online. For more information call or email our Nurse Recruiter, Ernest Perez, RN 575-635-7101 X Ernest.Perez@LPNT.net 2450 S. Telshor Blvd, Las Cruces, NM 88011 6 arizona STATE BOARD OF NURSING REGULATORY JOURNAL X MMCLC.org  EDUCATION BUILT FOR Life Advance your nursing career with an RN-BSN degree • 100% online program Ŏ‚;m7=†ѴѴঞl;our-u|ঞl; • 8-week classes Ŏ bmbv_bm-vѴb‚Ѵ;-vom;‹;-u Ŏoru;u;t†bvb|;vu;t†bu;7 Ŏ  11u;7b|;7 We are currently seeking RNs for these positions: Clinical Nurses - Operating Room Director of Surgical Services Supervisory Clinical Nurse – Med/Surg Unit Clinical Nurses – Med/Surg Clinical Nurses – Emergency Services Clinical Nurses – ICU Public Health Nurse ALL NURSING and Certified Nursing Assistant positions: Contact, Cynthia Soria, HR Specialist at (928)283-2432 or cynthia.soria@tchealth.org. RNBS N PROGR AM 1601 W. Main St., Mesa, AZ – 480.461.6790 UIU.EDU/MesaNursing For more information visit www.tchealth.org or contact Human Resources at (928) 283-2432 or tcrhcchr@tchealth.org. Final candidates selected will be subject to a favorable adjudicated background investigation. arizona STATE BOARD OF NURSING REGULATORY JOURNAL 7 111 E. Wacker Drive, Suite 2900 Chicago, IL 60601-4277 312.525.3600 www.ncsbn.org Next Generation NCLEX Project Summary 1. 2. 3. 4. 8 At the request of NCSBN’s NCLEX Examination Committee, the examination staff began research to ensure the NCLEX continued to measure the knowledge, skills, and abilities necessary for ensuring safe nurse practice in the evolving nursing practice environment. This research identified the need for a high-stakes nursing licensure exam with a focus on clinical judgment. The findings of the research were substantiated by the inclusion of critical thinking and decision-making skills as an essential component of entry-level nursing education and the findings of the 2013-2014 NCSBN practice analysis confirming the importance of sound clinical judgment skills to a significant number of tasks performed by entry-level nurses. Based on these initial findings, additional research has been conducted and presented at scientific meetings (NCME, AERA, Scientific Symposium, Sigma Theta Tau International). A comprehensive clinical judgment assessment model has also been published in the Journal Applied Testing Technology, 2016. Clinical judgment is defined as the observed outcome of critical thinking and decision-making. It is an iterative process that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care. NCSBN research identified a list of contextual factors that play a role in the quality of nursing clinical judgment (Dickison et al, 2016). These factors may be divided into conditions that are internal (education, experience, knowledge, communication, consequences/risk, emotions/ perceptions, professional orientation) or external arizona STATE BOARD OF NURSING REGULATORY JOURNAL 5. 6. 7. (task complexity, time pressures, distractions, interruptions, professional autonomy) to the nurse. NCSBN research, literature review and pilot studies identified the following important elements of nursing clinical judgment: a. Cue recognition b. Hypotheses generation c. Hypotheses evaluation d. Taking actions e. Evaluating outcome A pilot study was conducted in 2016 (cite Muntean et al. 2016 AERA presentation) to ascertain whether clinical judgment is more than just possessing nursing knowledge. The results of the pilot study indicated that while knowledge is necessary for safe nursing practice it is not sufficient to confirm the clinical judgment essential to safe nursing practice. The same study also suggested that the average ability of a nurse to demonstrate the different steps in the clinical judgment process (cue recognition, hypothesis generation, hypothesis evaluation, taking actions, and evaluating outcomes) is progressive. This finding indicates that simply recognizing cues and developing hypotheses does not guarantee the nurse’s ability to evaluate a hypothesis nor does having appropriate ability to take actions guarantee the ability to evaluate the outcomes of the action taken. No single element of clinical judgement adequately predicts a nurse’s clinical judgment ability, rather it is the combination of all the elements that add validity and reliability to the measurement of a nurse’s clinical judgment ability. Based on the assessment model presented by Dickison et al (2016), task models may be constructed to generate items and clinical scenarios Constructs by using an Information-Processing Framework, Vol. for use in nursing educational curricula and nursing 17(1). Retrieved from http://www.jattjournal.com/index.php/atp/ high stakes licensure examinations that reflect real-life article/view/89187. nursing clinical judgement situations. Muntean, W., Lindsay, M., Betts, J., Kim, D., Woo, A., 8. An internal analysis of current NCLEX items indicated Dickison, P. (2016, April). Separating Assessment of Subject that while nursing clinical judgment is measured in Matter Knowledge from Assessment of Higher-Order Cognitive the current NCLEX, items with higher fidelity that Constructs. Paper presented at American Educational Research directly assess this construct are needed to keep up with Association Annual Meeting, Washington, D.C. the evolving nursing profession and nursing’s role in protecting the public. 9. NCSBN examinations is currently conducting a research project to assess the ability of current and potential innovative items to assess clinical judgement. The research project consists of the following The Southwest Region Indian Health Service is seeking steps: Registered Nurses in multiple specialties including Medical/Surgical, ER, OB/L&D and Leadership Roles. Bring a. Develop item prototypes to your innovative spirit to improve the health status of our assess clinical judgment tasks Native American population. b. Research the usability of the Recruitment and Relocation Bonus available. prototypes c. Collect data on the prototypes Why Nurses Choose IHS: d. Determine which items • Loan Repayment Program – accurately measure clinical Up to $20,000 annually judgement, are usable and • Competitive Salaries provide useful data that can • 10% evening/night differential help measure a candidate’s • 25% weekend differential nursing competence. • 26 vacation days e. Conduct a pilot using selected • 13 sick days, 10 Federal holidays items. • Numerous health plans to choose; continue 10. A project communication plan is in retirement in development. The project team • Outstanding Federal Retirement Plan, and intends on providing regular updates much more to the NCSBN Board of Directors • Transfer opportunities–1 license/50 states and the NCLEX Examination Our nursing career opportunities are available Committee as well as an update at in rural and urban locations throughout the each midyear and annual meeting. states of Arizona, Nevada and Utah. The Southwest Region also has the largest In addition, the plan includes Medical Center in the Indian Health Service communication to external located in central Phoenix. audiences throughout various phases of the project. Nurses interested in a rewarding career, please contact Southwest Region Indian Health Service References Dickison, P., Luo, X., Kim, D., Woo, A. (2016). Assessing Higher-Order Cognitive Kevin Long at 602-364-5178, or email Kevin at Kevin.long@ihs.gov. I hope we’ll talk soon. Your Southwest adventure awaits you. arizona STATE BOARD OF NURSING REGULATORY JOURNAL 9 STAFF DIRECTORY ADMINISTRATION Joey Ridenour, MN, RN, FAAN Executive Director 602.771.7801 jridenour@azbn.gov Janeen Dahn, PhD, RN, FNP-C Associate Director Complaints & Investigations 602.771.7814 jdahn@azbn.gov Kathy Malloch, PhD, MBA, RN, FAAN Associate Director Education & Evidence Based Regulation 602.771.7803 kmalloch@azbn.gov Robert Ellis, BSIT, MBA, MPM Associate Director of Operations 602-771-7889 rellis@azbn.gov Valerie Smith, MS, RN, FRE Associate Director Hearings 602.771.7804 vsmith@azbn.gov Judy Bontrager, MN, RN Scope of Practice Expert 602.771.7802 jbontrager@azbn.gov Dolores Hurtado, Senior Investigator & Assistant to the Associate Director of Complaints/ Investigations - Intake Triage Coordinator 602.771.7845 dhurtado@azbn.gov Dolores Hurtado, Senior Investigator Complaints-Intake Triage Coordinator 602.771.7845 dhurtado@azbn.gov Lynette Drafton Senior Investigator Complaints-Intake Triage Coordinator 602.771.7827 ldrafton@azbn.gov Shawna Bonner, BSN, RN Nurse Practice Consultant 602.771.7833 sbonner@azbn.gov Stephanie Chambers, MN, RN Nurse Practice Consultant 602.771.7818 schambers@azbn.gov SENIOR INVESTIGATORS Ronda Doolen, MSN, BSN, RN Education Program Administrator 602.771.7877 rdoolen@azbn.gov Bonnie Richter, MSW Senior Investigator 602.771.7828 brichter@azbn.gov Cindy George, BSN, RN Nurse Practice Consultant 602.771.7857 cgeorge@azbn.gov David Elson, III Senior Investigator 602.771.7851 delson@azbn.gov Lyn Ledbetter Administrative Assistant 602.771.7856 lledbetter@azbn.gov FISCAL SERVICES Robert Digan B.B.A Accounting Manager 602-771-7809 rdigan@azbn.gov Eric Blake Jr, BS Accountant eblake@azbn.gov HEARINGS Trina Smith Legal Assistant 602.771.7852 tsmith@azbn.gov Tran Tran, BBA Management Analyst III 602.771.7825 ttran@azbn.gov INVESTIGATIONS CANDO Ruth Kish, MN, RN Nurse Practice Consultant 602.771.7823 rkish@azbn.gov EDUCATION Susie Flores Administrative Assistant to the Executive Director 602.771.7806 sflores@azbn.gov Lila Wiemann Administrative Assistant 602.771.7890 lwiemann@azbn.gov 10 COMPLAINTS-INTAKE Kathy Watson, DNP, RN, CPNP Advanced Practice Nurse Consultant 602.771.7819 kwatson@azbn.gov Kristi Hunter, MSN, FNP-C Advanced Practice Nurse Consultant 602.771.7854 khunter@azbn.gov Frank Curatola Senior Investigator 602.771.7822 fcuratola@azbn.gov Jennifer Ingram Senior Investigator 602.771.7835 jingram@azbn.gov Regine Mussotte, MHA, BS Licensing Administrator 602.771.7862 rmussotte@azbn.gov Becky Melton RN/LPN Exams 602.771.7830 bmelton@azbn.gov Donna Frye Advance Practice Certifications dfrye@azbn.gov Heather Reed RN/LPN Endorsements 602.771.0209 hreed@azbn.gov Helen Tay CNA Exam/Endorsements 602.771.7832 htay@azbn.gov Monica Ortiz Imaging Technician 602.771.7831 mortiz@azbn.gov Stephanie Cruz RN/LPN 602.771.7837 scruz@azbn.gov MAILROOM Kirk Olson Senior Investigator 602.771.7824 kolson@azbn.gov Karen Johnson 602.771.7876 kjohnson@azbn.gov Michelle Morton Senior Investigator 602.771.7850 mmorton@azbn.gov MONITORING Kathleen Harrington, MSN-INF, RN Nurse Practice Consultant 602.771.7811 kharrington@azbn.gov Pam Millben Senior Investigator 602.771.7866 pmillben@azbn.gov LEGAL SECRETARIES Lynette Drafton Senior Investigator 602.772.7827 ldrafton@azbn.gov Brent Sutter Legal Assistant 602.771.7860 bsutter@azbn.gov Naira Kutnerian Legal Assistant 602.771.7861 nkutnerian@azbn.gov Gari Carrol Legal Secretary 602.771.7841 gcarrol@azbn.gov CUSTOMER SERVICE Richard Carr Legal Secretary 602.771.7852 rcarr@azbn.gov Nancy Davis 602.771.7872 ndavis@azbn.gov INFORMATION TECHNOLOGY Susan Kingsland 602.771.7873 skingsland@azbn.gov Janet (Jan) Kerrigan, BSN, RN Nurse Practice Consultant 602.771.7864 jkerrigan@azbn.gov Cindy Mand, MSN, RN Nurse Practice Consultant 602.771.7815 cmand@azbn.gov Susan Bushong, B.A. Senior Investigator/Case Manager 602.771.7821 sbushong@azbn.gov Kevin Rapkoch, BSN, RN Nurse Practice Consultant 602.771.7867 krapkoch@azbn.gov Olga Zuniga Administrative Secretary 602.771.7865 ozuniga@azbn.gov Michael Pilder, MSN, RN Nurse Practice Consultant 602.771.7816 mpilder@azbn.gov Kevin Castleman MCP, MCDST Senior Network Administrator 602-771-7808 kcastleman@azbn.gov Pat Midkiff, MN, RN Nurse Practice Consultant 602.771.7826 pmidkiff@azbn.gov Chien-Chieh Kuan BSIT, MIT SQL Database Developer 602-771-7807 cckuan@azbn.gov arizona STATE BOARD OF NURSING REGULATORY JOURNAL LICENSING Jamie Fivecoat 602.771.7871 jfivecoat@azbn.gov RECORDS Glen Cook, MLIS, BA 602.771.7875 gcook@azbn.gov 111 E. Wacker Drive, Suite 2900 Chicago, IL 60601-4277 312.525.3600 www.ncsbn.org Highlights of the 2017 ENVIRONMENTAL SCAN As 2017 begins, researchers, governments, and international organizations are examining how technological developments may have far-reaching consequences for the future of various professions. As the White House explores the future of artificial intelligence and the United Nations focuses on sustainable development, boards of nursing may see the profession of nursing itself transformed by technological innovation. The Nursing Workforce As of September 2016, a total of 3,880,565 registered nurses (RNs) and 913,453 licensed practical nurses and licensed vocational nurses (LPN/VNs) in the United States (NCSBN, 2016). The most recent Occupational Employment Statistics data indicate that 2,687,310 RNs and 695,610 LPN/VNs were employed in the United States as of May 2015 (U.S. Bureau of Labor Statistics, 2016). These statistics show that 2015 had the largest number of employed nurses in more than a decade; however, the LPN/VN population has actually seen a decrease (See Figure 1). More than 250,000 advanced practice registered nurses (APRNs) are in the United States, categorized into four distinct roles: the certified nurse practitioner, the certified registered nurse anesthetist (CRNA), the certified nurse midwife (CNM), and the clinical nurse specialist. Certified nurse practitioners constitute nearly 70% of the total number of APRNs, with nurse practitioners reportedly numbered at 222,000 in 2014 (American Association of Nurse Practitioners, 2016). The CRNA accounts for approximately 20% of total APRNs. The American Midwifery Certification Board reported a total of 11,210 CNMs in 2015, approximately 3% to 4% of the total APRNs (AMCB, 2015). Clinical nurse specialist numbers are a bit more difficult to estimate, as they have not been recognized in some states until fairly recently and still are not recognized in a few (Newland, 2016). The trend for new graduates finding employment has improved each year since 2012 (See Table 1). In 2012, only 51% of new graduates had a job in less than 1 month after graduation. In 2016, 75% did. After 6 months, 97% had jobs compared with 86% in 2012 (National Student Nurses’ Association [NSNA], 2016). The employment rate upon graduation did vary across regions, with the South having the highest number of employment opportunities (77% of new graduates were employed), and the West having the lowest (66% of new graduates employed) (American Association of Colleges of Nursing, 2016). Graduates of Bachelor of Science in nursing (BSN) programs continue to be employed as RNs at a greater percentage (92.73%) than those of associate degree in nursing, or ADN, programs (89.59%) or accelerated BSN programs (86.08%) (NSNA, 2016). Deans of baccalaureate programs (n = 576) reported that 54% of hospitals and other health care settings require new hires to have a BSN degree, a 6.6% increase from 2015. The full article may be accessed at www.journalofnursingregulation.com/article/S2155-8256(17)30042-X/pdf arizona STATE BOARD OF NURSING REGULATORY JOURNAL 11 111 E. Wacker Drive, Suite 2900 Chicago, IL 60601-4277 312.525.3600 www.ncsbn.org Next Generation NCLEX Special Research Section Questions and Answers 1. What is the special research section for? The special research section is intended to collect data on new item types that could expand or enhance the measurement of entry-level nursing competence including clinical judgment. 2. What are the new item types that students can expect to see? NCSBN is researching several item types, including: extended multiple response items, extended drag and drop items, CLOZE items, enhanced hot-spot items, dynamic exhibit items, and constructed response items. 3. What kind of information will be collected in the special research section? The special research section will collect data on developing scoring rules, provide evidence of item characteristics and determine how much time candidates spend on each item. 12 factors determine whether or not a candidate will be given the special research section (e.g., the time remaining in their NCLEX appointment). 6. Will my performance on the special research section effect my NCLEX result? No. Data derived from the research section will not be used to determine the candidate’s result. 7. Will more information about the special research section come out soon? Yes. Language informing candidates about the special research section is included in the regular correspondence to NCLEX candidates, on the NCSBN and Pearson VUE websites and provided via the NCSBN social media sites. 8. How long will the special research section take? The special research section should take approximately 30 minutes to complete. 4. How long will this research be conducted? The first phase of the special research section is slated to occur between July and September 2017. Further special research sections may be included in future testing quarters depending on research needs. 9. Is there a place that I can make comments regarding the new item type? Please contact nclexinfo@ncsbn.org or 1.866.293.9600 for comments regarding the special research section. 5. What kind of candidates will be selected for the special research section? Only NCLEX-RN candidates may be selected to 10. How will the items be scored (e.g., partial credit, full credit, etc.)? The special research section items will not be scored. participate in the special research section. A number of One of the purposes of the special research section arizona STATE BOARD OF NURSING REGULATORY JOURNAL is to gather the data needed to determine scoring methods for the new item types. 11. What resources/who created the new type of questions? Expert nurses and psychometricians at NCSBN and Pearson VUE created the new item types based on the steps of the clinical judgement model. The content was validated with approved nursing references and by NCSBN subject matter expert reviewers. the data gathered from the special research section will inform which item types are able to go through to further research steps. 15. Is the NCLEX going to change? The new item types are still in the research and development phase, the results of which will inform whether the items are appropriate for the measurement of entry-level nursing competence. More research data is required before it can be determined whether or not the NCLEX will change. 12. What research has been conducted to validate the new item types? Focus group studies, usability studies, and cognitive labs studies are either well underway or planned for future portions of this research project. The data from the special research section will be another step to collect important empirical evidence to validate new item types. 13. How can nursing schools incorporate the clinical judgement model into their curriculum? The communication plan for this research project will include early communication between NCSBN and the nursing education community to ensure effective integration of the clinical judgement model into nursing education programs. 14. When will the new item types go into effect on the exam? The new item types are still in the research and development phase and arizona STATE BOARD OF NURSING REGULATORY JOURNAL 13 Michael Pilder, MSN, RN, Nurse Practice Consultant Arizona State Board of Nursing CASE STUDIES Case Study Number 1 Background: According to the Board’s Advisory Opinion on Abandonment, the following requirements define patient abandonment: (1) The nurse must have first accepted the patient assignment, thus establishing a nurse-patient relationship. Accepting a patient assignment varies from setting to setting and requires a clear understanding of workload and agreement to provide care, and then (2) disengaged from the nurse-patient relationship without giving reasonable notice and report to the qualified person (e.g. supervisor, nurse) so that arrangements can be made for continuation of nursing care. Transfer of patient care requires reporting the condition, circumstances, and needs of all patients under the nurses’ care, in oral or written form, to another nurse who acknowledges receipt and understanding of the report. Case Facts: The Board received a complaint from a staffing supervisor at a skilled nursing facility, alleging a nurse accepted a 12-hour night shift through the nurse’s employer, a local staffing agency. When the nurse arrived at the facility for the shift, the nurse told staff that he did not have his computer login information and did not feel comfortable working at this facility. Respondent stated he was going to leave the facility. Respondent left the facility and the staffing supervisor reported the behavior to the Board as possible abandonment. According to the Complainant, the nurse had “accepted” the shift through the nurse’s employer, the staffing agency, and then refused to work, which therefore constituted abandonment. Respondent said that he did not have his login information, and even when the login information was provided, Respondent refused to accept report and never began the shift. Further, according to the complaint, Respondent left the facility before the night supervisor could find a replacement for RN coverage. The nurse stated that the staffing agency notified him that the skilled nursing facility was looking for a nurse for a night shift, where Respondent had worked shifts during the previous summer. 14 arizona STATE BOARD OF NURSING REGULATORY JOURNAL Respondent said that he would accept that shift since he worked there previously. Two hours prior to the start of the shift, the agency called the nurse again and notified him that there had been a change, and the nurse would be working in a different area within the facility. Respondent notified his employer that he had not worked in this area and at the very least would require an orientation to the unit. The employer informed him that everything had been taken care of and confirmed the nurse would receive an orientation on the unit. When the nurse arrived at the facility, he was informed that he would receive report, and would be the only nurse on duty that shift. Respondent informed the day shift nurse that he would not take report and requested to speak to a supervisor. The nurse informed the staffing office that he had not been there for at least two months, and they had changed their computer system since he had last been there. The nurse informed the supervisor that he was assured by his employer that he would be oriented to the unit prior to taking the shift. The nurse also told the supervisor that he had not yet taken report, and would not do so until he received a proper orientation. Board Decision/Outcome: Respondent did not accept the patient assignment and there was RN personnel already within the facility. The Board dismissed the case. Case Study Number 2 Background: According to the Arizona Nurse Practice Act, all certified or licensed personnel are to maintain confidentiality of the patient health record. The confidentiality of the record cannot be breached for personal reasons, or reasons other than involving the direct care of the patient. Patient confidentiality is regulated in the Arizona Nurse Practice Act and also in the Health Insurance Portability and Accountability Act (HIPAA). Case Facts: The Board received a complaint from the nurses former family member alleging the nurse, while on duty as a LPN in a hospital, saw and confronted a relative from a family member’s previous relationship (“Patient A”), who was visiting a relative recovering from surgery.” The nurse allegedly used her employment status to access the hospital’s computerized medical records system. The family filed a complaint with the hospital, and following the facility investigation, the nurse’s employment was terminated for misuse of company property, and violating patient confidentiality. The nurse repeatedly denied that she accessed Patient As record. Investigators presented the screen shots of the nurse accessing this particular record, using her login. Board Outcome: The Board voted to offer a Civil Penalty (a form of a disciplinary action with a monetary fee) for violating facility/employer policy, accessing patient information. Case Study Number 3 Background: The Arizona Nurse Practice act allows discipline of a nursing license if the licensee is unfit or incompetent due to the use of alcohol, or is addicted to the use of habit-forming drugs and exhibits a pattern of using or being under the influence of alcohol, drugs, or a similar substance to the extent that judgment may be impaired and nursing practice detrimentally affected, or while on duty in any health care facility, school, institution, or other work location. had demonstrated frequent mood changes. Interviews with other witness’s revealed coworkers had become concerned that the nurse may have a substance use disorder. The coworkers’ concerns related to the nurses attendance issues and also noticed needle “tracks” on one or both arms. The nurse would frequently ask coworkers if they needed help administering medications, including controlled substances, and would sign the drugs out under other nurse’s names. Management received intermittent complaints from staff that Respondent would sleep while on duty and leave the unit for extended periods. Over the following months, it was reported that the nurse’s absenteeism increased and during a meeting with management, disclosed that she used an illegal substance. It was not until after the nurse received a suspension notice that the nurse subsequently resigned in lieu of termination from the hospital. Board Outcome: The Board issued an order to summarily suspend Respondent’s nursing licensure, which ultimately led to revocation of the nurse’s license. Case Facts: The Board received a complaint from hospital personnel alleging that the nurse was possibly under the influence of substances while on-duty and taking care of patients. Complainant said that the nurse came to work looking disheveled, odor of alcohol, evasive, shivering, at times would be hostile and argumentative, would disappear for extended amounts of time, and had dark marks on her upper arms. Complainant stated when she started working on the unit she was a “good nurse” and as time progressed, her appearance changed. The nurse was frequently tardy (up to several hours) and on one occasion left work before her shift ended. Complainant asserted that the nurse created an “unsafe hostile work environment,” such as raising her voice when questioned and arizona STATE BOARD OF NURSING REGULATORY JOURNAL 15 TOP 10 PATIENT SAFETY CONCERNS for Healthcare Organizations 2017 16 Why We Create This List ECRI Institute creates this annual list of Top 10 patient safety concerns to support healthcare organizations in their efforts to achieve the following: • Proactively identify potential threats to patient safety • Improve patient safety by addressing concerns This report offers perspectives from some of our many experts, as well as links to further guidance on addressing these issues. The process synthesized data from these varied sources: • Routine review of events in the PSO database • PSO members’ root-cause analyses and research requests • A survey of Healthcare Risk Control (HRC) members regarding their top patient safety concerns • Topics reflected in weekly HRC Alerts • Voting by a panel of experts from inside and outside ECRI Institute How the Concerns Were Identified In selecting this year’s list, ECRI Institute relied both on data regarding events and concerns and on expert judgment. Since 2009, when our patient safety organization (PSO), ECRI Institute PSO, began collecting patient safety events, we and our partner PSOs have received more than 1.5 million event reports. That means that the 10 patient safety concerns on this list are very real. They are causing harm — often serious harm — to real people. But this is not an exercise in simple tabulation. The list does not necessarily represent the issues that occur most frequently or are most severe. Most organizations already know what their high-frequency, high severity challenges are. Rather, this list identifies concerns that might be high priorities for other reasons, such as new risks, existing concerns that are changing because of new technology or care delivery models, and persistent issues that need focused attention or pose new opportunities for intervention. arizona STATE BOARD OF NURSING REGULATORY JOURNAL How to Use This List Use this list as a starting point for conducting patient safety discussions and setting priorities. This list is not meant to dictate which issues an organization should address. Rather, it’s intended to serve as a catalyst for discussion about the top patient safety issues faced by the organization. Determine whether your organization faces similar issues that should be targeted for improvement. Organizations can investigate whether they are experiencing problems with these or related concerns — and whether they have processes and systems in place to address them. Develop strategies to address concerns. The full report on the top 10 patient safety concerns discusses key strategies for each issue, and other ECRI Institute resources provide more in-depth guidance on individual topics. See page 14 for more information. Consider applications across care settings. Although not all patient safety concerns on this list apply to all healthcare organizations, many are relevant to a range of settings across the continuum of care. 1 Information Management in EHRs Healthcare providers have troves of information to manage, and the advent of electronic health records (EHRs) has brought this challenge to the forefront. “But the object is still for people to have the information that they need to make the best clinical decision,” says Lorraine B. Possanza, DPM, JD, MBE, senior patient safety risk safety, risk, and quality analyst and health information technology (IT) patient safety liaison, ECRI Institute. Healthcare organizations must approach health IT safety holistically. One key step is integrating health information management professionals, IT professionals, and clinical engineers into patient safety, quality, and risk management programs programs. Other strategies include ensuring that users understand the system’s capabilities and potential problems, encouraging users to report concerns and investigating those concerns, engaging patients in information management, and harnessing the power of EHRs to enhance patient safety. Unrecognized Patient Deterioration Over the past few decades, concerted efforts have enabled speedier recognition of and response to stroke and heart attack. Certain other conditions—including sepsis, some maternal conditions, and serious postsurgical complications — “need the same type of prompt recognition and attention in order for the patient to have a 3 good outcome,” says Patricia N. Neumann, RN, MS, senior patient safety analyst and consultant, ECRI Institute. Organizations must cultivate staff competencies in rapidly identifying conditions of concern. Practice (e.g., in simulations) and the use of tools (e.g., early-warning criteria) may aid speedy recognition. 2 Clinicians can proactively assess patients’ risk, plan for appropriate care and monitoring, educate at-risk patients, and supplement with technological monitoring. Organizations can develop condition specific protocols for an organized and speedy response and analyze work systems and processes to identify and address barriers. Implementation and Use of Clinical Decision Support Clinci cial al dec ecis isio is ion io n supportt (C (CDS DS)) encompasses “tools tha hatt we use to en e su surre tha hatt th he ri r ght information is pre ressent n ed d at th t e right time me wit ithin the workflow,” explainss Robert C. Gianni nini ni, NH NHA, A, CHT HTS-IM/CP, well as disruption of clinical workflows an nd provider frustration—could result. Healthcare organizations must design gn CDS systems judi CD dici ciou ousl sly; y; res esou ourc rces aree rc availa l bl blee fr f om HealthIT.go govv, ECR CRI Instittut u e, roless and role an nd re resp resp spon onsi on ns bi bili liti li ties ies e , aan nd ha h ve accesss to supportt structures ess. On an ongoing basis, organizations s ou sh ould ld mon onit itor or the eff ffec ecti tive vene ness ss and d app ppro ro-ro pria pr iate tene ness ss of CD CDS S al aler erts ts, ev eval alua uate te the im- patient safety analyst and nd consultant, ECR CRII Institute. But if use is suboptimall, opp ppor ortunities may be missed. Patient harm—as and others. A multid and idis isci cipl plinary team sho houl uldd have overs rsig ight h . End users mustt be trrai aine nedd in the he pro rope perr us usee of CDS DS, as welll as as the heir ir pact on wo pact work rkflo flow, w, and rev evie iew w st staf afff re resp spon onse se to ale lert rts. s. The too ooll sh shou ould ld be re rede desi sign gned ed as ne nece cess ssar ary. y aarizona rizona STA STATE TE BOA BOARD RD OF NURSIN NURSIN NUR NG REG REGULATORY EG E G ULA U LA UL AT AT TOR OR Y JOUR O J JOURNAL OURNAL OUR NAL 17 4 Test Result Reporting and Follow-Up Testing is a com ompl plex pl ex process. When inadequately managed, this com ompl p exity can pl contribute to fragmentation. “Sometimes as clinicians we become very task oriented— labs ordered, blood drawn and sent; imaging ordered, x-ray completed—and we lose sight of the big picture,” says Kelly C. Graham, RN, patient safety analyst an nd cco onsul nsul ulta taant nt, t ECRI Institute te. “C te “Cri riiti tica c l ca th hin nkiingg an ndd teamwork get lost whe hen n you’ yo you’ u’re fooccus usin ingg ju in ustt on your assig igne ned task.” .” Orga Or g niza ga niiza z ti tioon ons sh shou ou uld analyyze the heir test ressu resu re ult rep epor orti rtiing syste teems and mon nitorr the h ir effe ef fect fe fect ctiv iven iv enes en esss in es i tri rigg gger gg erin ingg appropriate followin up. Po P licies and procedu d res should clearly designate accountability for acting on test resu su ults. To help l cloose the looop, organizat atio ions ns can n facilita tate two o-way conveersations am mong he h althcare profe f ssionaals inv voollvveed in i trea eaatment and those in i vo olv lved e in di diaag agn gnosttic testing. Patient enga gage ga age g me ment ntt an nd healt lth lt h li lite teracy te strategies can be us used to teach patients what to do—and why it is important. Antimicrobial Stewardship Toda daay, d ru d rugg ch chooiiccees fo for treati ting ng maa ny bac acte t ri riall i nf nfe fec ections are becomi ect ming ng increassing nggly n l lim imiited ed and expensive— and in som me ca case s s, s, nonexistent.. Inappropri riat a e prescribbin at ingg is a key facto or. r. “If prescribing habi bits ts do no not chan nge, more people will die from infecttio ion ns for which there is no treatment,” says Sharon Bradley, RN, CIC, senior iin n fe fect ctio ion pprrev ion io rev eve ven enti tion on a na naly aly lyst yst s , EC ECRI RII R In uteee.. Institut Heallth t hcaa re r orrggan a nizat i zattiio iz ons n s may ay decid eccid id e tto o hol oldd pr pres esccr cribbeerr s ac acco co coun ouun nttaabl ablle foor aad d he herenc ncce to t re n reat at m meentt g uiiddeeeli llii nees. s. A ph hys ysic icia ic ian ia n ad dvoca cate can a n lea eadd th he ef e fo fort rt an nd ta t lkk to oth ot her ph hys y ic i ia i ns a s a pe p eerr. O rga gani niza zati t on n s caa n all so s educa duuca c tee pati t entss, faa mi m ly mem e be b rrss, an a nd tth he 6 Patient Indentification Alth A Al lth thou ough ou gh h the he majjor o itt y of th hee 7,6613 even ev een ntss ana n ly lyze zedd fo or EC ECRI Inssti titu tuute te PSO’ PS O’s De Deep ep Div ivee:: Patient Ideenttiifi ive: fica cati t on ti were caugh ht be befo befo forre re they caussedd paattie ient nt harm, abou b ut 9% resullteed iin n pat atie ient ie ntt n injury, includingg tw two deaths. “T “The he report brought natio i na nall at atte tent n ion to an issue that most healthcare providers recognize as a significant problem,” 18 says Wil says illi liam am M. Ma Mare r ll re lla, a, MBA BA,, MM MMI, I, exec ex ecut uuttiivve di dire rect ctor orr, PS P O op operrat atio ions io n a ndd ns an anal nal a ytic ytics, yt s ECR RI IIn nsttit ituut ute. ute. e L aad Le der erss caa n st star artt by ar by f ullly sup uppo port rtin i ng p ti pa tien entt id en den nti tific ficattion ficat fic io on in nit i iati iati ia tive ves— ve s by s— by prio pr iori rriitiiziingg the iss s uuee, en nga gaggiing ng cli lini n caal andd no n nc n li l ni nica cal st s af aff,f,f and nd ask skin kin ing st staf taaff f to ide d ntif ifyy ba barr barr rrie ieers r to safe saafe ide dent ntifica nt ifi fica cati ttiion o practices, for example. arizona STATE BOARD OF NURSING REGULATORY JOURNAL 5 gene nera ne rall puubl bliic about an ntiimicrobiiall steew st wards d hi hip andd th thee re r ason on n s bbeehi h nd d it. t. T he Ce Th The C nt nterss fo forr Di Diseea se Coontro nt rool an nt a nd and P eev Pr ven e ti tioon n ha s outli uttli li ne ned co core re eleeme mentt s for anti for fo a nti an tibi biot otic ic stewa waa rdsh rd d sh hip ip for hos ospi pita tals l, ls nuu rs n rsiin n ngg h hoome mes an mes, nd outpa nd ut pa patti tien ent settings. Too ide T den ntifyy ga g ps ps, or o gaa ni ni zaati tions can use the ch th c ec eckkliis i stss i nc nclu l de dedd in each set of core elemeents. co ntt s. Reedu dund nddant processes for patien n nt iden id enti en tiific tific ficat a io at ion ca c n incrrea ease ase the liikkeeli eliho lliiho hood od of pr prev ev even venti een nting ttiing n pat atie ient ie nt mix ix-ups. up s. Eleme lem le meentts ssuuch uch c as el eleecctr elec t onic displays a d pa an patiien nt iidden enti tiific ficat ficat atiioon band baan s may be staan st nda dard rddiz ized ed. Wh When en n use sed aass int nten ende ded, d, barr--co barba code d sys de ysteems ms a nd nd oth the her er tec echn ch ologies caa n al can also so sup upppo ortt saffe pa pati ttiient een nt i entificattio id ion. n. 7 Opioid Administration and Monitoring in Acute Care In ana n ly na lyzi zing zi ngg event n veent n s fo or its its up it upco comi co ming mi ng Deep epp Dive ivve on n oppiioi oidd sa s fety, ECRI Inst s itut u e PS PSO O noted problems with opioid administration and patient monitoring. “We’re seeing the same issues with administration that you see with other medications,” says Gail Horvath, MSN, RN, CNOR, CRCST, patient safety analyst and consultant, ECRI Institute. However, “unlike with some of these othe ot the her me her medi ddiica c tiion ons, s, opiioids oids oi ds can an hav ave catastrophic con nseequ quen ence en c s.” The organiza zattion za n mayy wissh to evaluate and add ddre ress re ss wor ork ssyystem sttem m a nd n process factors th that mayy con ntr tribute to opioid administration errors, such as organizational culture and workload. Best practices can be implemented for processes including patient identification, medication purchasing, labeling, ddiisp disp spen ensi en sing si ngg, us u e off bar a -ccode od de me medi dicaatiion a mi ad m niistra sttrati rati ra t on syste yssteems, an andd in nde d pe pend n ent dooub uble checkks. uble Staf afff mu m st carefullyy ass s es ess ss patients ts b fore andd after adminisstr be trattion trat ioon—using an opioid-indu duce ced sedation o sca on cale, for example. For certain in pat atie ients, ie capnography or minute vent ntil ilat il a io at ion n monitoring can supplement nurs rse rs monitoring. Behavioral Health Issues in Non-Behavioral-Health Settings Healthcare organizations do not always recognize when a patient has behavioral health needs—and the patient’s needs may therefore go unmet. Some unmet behavioral health needs can cause hostile or aggressive behavior, whicch can n fr frig ighten or frustratte staff,, especiallyy if they lack ck tra rain inin in i g or support. Patients and staff can be injured, 9 sometimes seriously. “We’re very reactive, and that’s part of the problem,” says Nancy Napolitano, patient safety analyst and consultant, ECRI Institute. Comprehensively assessing all patients can heelp pro rovi vide ders rs pro roac acti tive ti v ly detter ve ermi m ne mi patients’ be b havioral healt ealt lth h ne n edds. All staff shou sh ould ld be trained to rec eccoggni nize ze ear a ly ly sig igns ig n ns 8 or cues of behavioral health needs, use nonoffensive techniques, and de-escalate a situation and participate in frequent drills. Behavioral emergency response teams, which staff can call when a patient patient’ss beha be havi vioor bec ecom om mes agi gita tate ta tedd or o threateni niing ng, ng, c n be implemeent ca n ed e to su supp pppor ortt eaarl rlyy asse as sess se sssmeent n and res espo p nse. po e Management of New Oral Anticoagulants Since 2010, four new ew ora ral anticoagulant medications have been approved ed. In an analysis of ECRI Institute PSO events involving these agents, almost 34% of events for which a harm score was off the agentts; it’ t s not ‘o ‘onee siz ize fit ize fitss al a l’ l and yo you’ u re r done,”” says ys Steph han nie Usees, s, Phar Ph a mD, MJ, JD JD, pa patien nt sa safe feety fety ty ana n ly lyst st and conssul ulta tant nt,, ECRI Institutee. Standardized order set etss sh should ldd spe peci cify fy of the hera rapy py and nd trraack c resppo ponsee to o ale lertss. A multidisci cipl plin in naryy te team am should develo lo op pllan ans fo for reverssaall of an anticogulant the herappy, an nd reversal agents sh houldd be re read adilly acceess ssible. Co oll llecti t on n and nd analy lysi sis of provided resulted in patient harm, ranging from temporary injuries to death. “We need more awareness of the proper use doses for the different medication ons based on indication. Organizations can use CDS to alert practitioners to duplication events ts inv nvol olvvin ving ng new e oral anticoagulants can help orgaan aniz izat atio ions ns identify de furtthe herr prev even enti tion strraatteg egiie ies. ies arizona STATE BOARD OF NURSING REGULATORY JOURNAL 19 10 Inadequate Organization Systems or Processes to Improve Safety and Quality Numerous studies show a link between error prevention and a culture of safety. Nevertheless, healthcare organizations have been slow to adopt all the necessary features of a high-reliability organization. Root-cause analyses are vital, but Elizabeth Drozd, MS, MT(ASCP), CPPS, patient safety analyst and consultant, ECRI Institute, also recommends 20 that organizations “be proactive rather than waiting until a patient is harmed.” Proactive strategies can be used to examine processes, identify what can go wrong, and make the process less vulnerable to error before mistakes can occur. Strong preventive strategies, such as standardization and automation, should be explored. arizona STATE BOARD OF NURSING REGULATORY JOURNAL Leaders should support a “just culture” that emphasizes learning rather than blaming. Individual accountability must be balanced with organizational responsibility to design and improve systems to ensure safe care. Finally, all organizations should have an actionable quality and patient safety plan with high-level approval. 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RN Opportunities include: Clinical Nurses, Senior Clinical Nurse, Clinical Care Coordinators, Public Health Nursing, Family Nurse Practitioners The community has a say in our direction and we provide services based on their needs. We are beholden to this community. - Maureen “Mimi” Warwick Coomler, RN,  ½½"# /,-#(! q, View all available positions at jobs.tmcaz.com Visiit us todday att www.wihcc.com andd applly onlline. *Not reported in previous Journal CNA DISCIPLINARY ACTION OCTOBER – NOVEMBER – DECEMBER 2016 / JANUARY – FEBRUARY – MARCH 2017 EFFECTIVE DATE NAME CERTIFICATE DISCIPLINE 3/31/2017 Aguiniga Cervantes, Maria G. CNA999989241 Decree of Censure 12/29/2016 Alari, Jennifer M. CNA999996207 Revoked 3/8/2017 Anderly, Jessica J. CNA1000031558 Revoked 3/21/2017 Anderson, Brendon J. CNA Applicant Certificate Denied 10/24/2016 Barlow, Oskar CNA Applicant Certificate Denied 3/14/2017 Berg, Tina A. CNA Applicant Certificate Denied 3/8/2017 Burns, Todd D. CNA1000021667 Revoked 2/10/2017 Campos, Guadalupe K. CNA1000028389 Voluntary Surrender 1/27/2017 Cheeseman, John K. CNA Applicant Certificate Denied 10/26/2016 Clayton, Ronald J. CNA1000034224 Revoked *2/8/2016 Cota, Michelle A. CNA1000009139 Decree of Censure 11/21/2016 Curd, Nicholas D. CNA Applicant Certificate Denied 1/4/2017 Eakin, Susan L. CNA157193803 Revoked 1/30/2017 Eggen, Tara L. CNA1000012368 Voluntary Surrender 2/14/2017 Erwin, Audrey J. CNA1000039373 Voluntary Surrender 3/6/2017 Estrada, Socorro CNA1000008487 Revoked 1/26/2017 Fenner, Shina D. LNA1000017357 Revoked 1/23/2017 Fredericks, Tiffani A. CNA1000009988 Stayed Suspension 3/8/2017 Fuller, Paula L. CNA239233103 Revoked 3/6/2017 Gamboa, Amanda D. CNA1000028183 Revoked 1/4/2017 Geer, Tracy S. CNA1000005163 Revoked 1/19/2017 Gupta, Rebekah L. CNA Applicant Certificate Denied 3/7/2017 Hayes, Genevieve M. CNA1000026578 Revoked 3/14/2017 Heacox, Julie D. CNA Applicant Certificate Denied 10/3/2016 Hendrix, Tiffany R. CNA Applicant Certificate Denied 12/2/2016 Hill, Carlisa M. CNA Applicant Certificate Denied 10/26/2016 Ijams, Ben T. CNA999996590 Revoked 11/28/2016 Jackson, Erika E. CNA Applicant Certificate Denied 2/16/2017 Johnson, Kimberly R. CNA563102641 Reinstatement Denied 12/20/2016 Johnson, Matilda A. CNA461686803 Decree of Censure 2/23/2017 Julian, Brian A. CNA1000042419 Decree of Censure 10/11/2016 Kaisand, Kimberly A. CNA1000053063 Decree of Censure 1/20/2017 Kamara, Mamayan CNA Applicant Certificate Denied 1/4/2017 Keams, Marguerite M. CNA805562803 Revoked 11/21/2016 Kormos, Kevin J. CNA Applicant Certificate Denied 12/27/2016 Kuyateh, Mickey M. CNA1000000495 Revoked 1/19/2017 Larussa, Karen L. CNA Applicant Certificate Denied 11/21/2016 Lee, Gilmore CNA Applicant Certificate Denied 11/3/2016 Lee, Yvette C. CNA Applicant Certificate Denied 10/24/2016 Lenoir, Lakisha A. CNA Applicant Certificate Denied 12/14/2016 Levene, Adrianna M. CNA1000045813 Voluntary Surrender arizona STATE BOARD OF NURSING REGULATORY JOURNAL 23 *Not reported in previous Journal CNA DISCIPLINARY ACTION OCTOBER – NOVEMBER – DECEMBER 2016 / JANUARY – FEBRUARY – MARCH 2017 EFFECTIVE DATE NAME CERTIFICATE DISCIPLINE 10/3/2016 Limon, Eliza Y. CNA Applicant Certificate Denied 3/6/2017 Lino, Joan M. CNA999988803 Revoked 3/7/2017 Listo, Colleen G. CNA999948305 Revoked *9/6/2016 Lobina, Whitney T. CNA Applicant Certificate Denied 3/24/2017 Lucien, Felix G. CNA1000027847 Revoked 12/8/2016 Matthews, Chanae C. CNA1000053723 Decree of Censure 3/7/2017 Mcbeth, Latonia A. CNA1000002630 Reinstatement Denied 10/26/2016 Mchardy, Shannon L. CNA Applicant Certificate Denied 11/25/2016 Medlin, Marcella A. CNA Applicant Certificate Denied 11/25/2016 Mickey, Ciera N. CNA Applicant Certificate Denied 3/16/2017 Monroe, Amanda K. CNA999993257 Decree of Censure 1/20/2017 Montijo, Brian J. CNA1000054246 Revoked 3/14/2017 Moreno, Rosa O. CNA Applicant Certificate Denied 2/6/2017 Murphey, Scott J. CNA Applicant Certificate Denied 12/2/2016 Nez, Ranae M. CNA Applicant Certificate Denied 1/3/2017 Ojeda, Elizabeth H. CNA1000034885 Revoked 3/8/2017 Owens, Cecilia E. CNA1000016896 Revoked 12/27/2016 Padilla, Bambi C. CNA1000033056 Revoked 1/6/2017 Parades Cifuentes, Leslie L. CNA Applicant Certificate Denied 11/9/2016 Porter, Latrice N. CNA Applicant Certificate Denied 3/21/2017 Price, Marquerita N. CNA Applicant Certificate Denied 10/26/2016 Quintero, Brian A. CNA1000036831 Revoked 2/24/2017 Reed, Nathania J. CNA1000009965 Voluntary Surrender 10/20/2016 Riggs, Candace C. CNA Applicant Certificate Denied 11/28/2016 Rincon, Robert M. CNA1000041010 Decree of Censure 12/7/2016 Roberts, Sylvan N. CNA1000053645 Civil Penalty 10/3/2016 Salazar-Rojas, Joel I. CNA Applicant Certificate Denied 10/21/2016 Sanchez, Gloria CNA193620213 Renewal Denied 1/23/2017 Sartin, Amanda J. CNA1000044173 Voluntary Surrender 3/20/2017 Sepulveda, Mary Helen CNA Applicant Certificate Denied 11/18/2016 Silver, Chelsey A. CNA Applicant Certificate Denied 10/27/2016 Sterling, Latricia V. CNA Applicant Certificate Denied 11/21/2016 Thomas, Makesha M. CNA Applicant Certificate Denied 10/26/2016 Thompson, Charles S. CNA1000041782 Revoked 11/21/2016 Toms, Tamara S. CNA Applicant Certificate Denied 3/7/2017 Vyamungu, Venant CNA1000034782 Revoked 10/3/2016 Walden Celaya, Enedina D. CNA Applicant Certificate Denied 3/6/2017 Willess, Jordan M. CNA1000049611 Voluntary Surrender 2/23/2017 Williams, Delores M. CNA999998039 Voluntary Surrender *9/16/2016 Woody, Delphina CNA1000013225 Stayed Suspension 24 arizona STATE BOARD OF NURSING REGULATORY JOURNAL *Not reported in previous Journal RN/LPN DISCIPLINARY ACTION OCTOBER – NOVEMBER – DECEMBER 2016 / JANUARY – FEBRUARY – MARCH 2017 EFFECTIVE DATE NAME LICENSE DISCIPLINE 10/3/2016 Ajeakwa, Comfort A. RN Exam License Denied 2/8/2017 Alexander, Robert T. RN159971/AP3870/AP10014 Decree of Censure 10/26/2016 Allen, Roger G. RN169677/CNA1000017600 Revocation 12/6/2016 Amick, Kelsie R. RN186922 Voluntary Surrender 1/3/2017 Anchondo, Brandy N. LP049817 Decree of Censure 3/20/2017 Anderson, Debra L. RN041529 Voluntary Surrender 1/20/2017 Anderson-Cole, Dawn M. LP043396 Voluntary Surrender 11/17/2016 Anderson-Cole, Dawn M. LP043396 Summary Suspension 11/17/2016 Armstrong, Carrie S. TRN204637 Stayed Revocation with Probation 3/21/2017 Arnett, Aaron RN171155 Voluntary Surrender 10/26/2016 Arnold, Jacqueline LP045182 Revocation 12/20/2016 Ayoub, Sultan Y. RN138359/AP3529 Summary Suspension 12/20/2016 Baty, Joshua J. LP051774/CNA1000030505 Summary Suspension 3/6/2017 Baty, Joshua J. LP051774/CNA1000030505 Voluntary Surrender 2/15/2017 Beck, Mindy L. TRN206229 Limited Licensure 10/7/2016 Bennett, Carrie A. Compact - IA RN115934 Voluntary Surrender-Privilege to Practice 2/27/2017 Bianco, Megan M. RN157099 Stayed Revocation with Suspension 12/30/2016 Bishop, Melissa R. RN142926 Voluntary Surrender 10/13/2016 Bonvillain, Rita S. LP044275 Reissuance Denied 10/3/2016 Bowen, Kristy A. RN162464 Voluntary Surrender 10/25/2016 Boyle, Rebecca L. RN114982 Revocation 12/21/2016 Bracamonte, Elisa R. RN038748 Stayed Revocation with Probation 10/26/2016 Brenner, Jeanne RN096503 Revocation 1/27/2017 Burtman, Svetlana RN133876/AP4511 Decree of Censure 3/14/2017 Campos Salinas, Jessica Y. LP049077 Decree of Censure 3/20/2017 Cline, Kelli D. LP040707 Decree of Censure 10/24/2016 Coenen, Amy L. RN170880 Voluntary Surrender 2/22/2017 Coleman, Tana L. RN102493 Voluntary Surrender 12/7/2016 Datingaling, Josefina G. RN063058 Probation 1/3/2017 Delaney, Kathryn L. LP021963 Voluntary Surrender 1/3/2017 Delashmit, Sarah A. RN182674 Revocation 11/30/2016 Disner, Paul M. RN094413 Voluntary Surrender 2/2/2017 Donley, Patricia J. RN184407 Voluntary Surrender 1/19/2017 Dooley, Jenna A. RN174038 Voluntary Surrender 1/3/2017 Dovgan, Lori S. RN066495 Revocation 10/26/2016 Dumas, David G. RN179325 Revocation 3/25/2017 Ebereonwu, Laura C. RN170503 Stayed Revocation with Suspension 10/14/2016 Egnash, Brandi M. RN183854 Revocation arizona STATE BOARD OF NURSING REGULATORY JOURNAL 25 *Not reported in previous Journal RN/LPN DISCIPLINARY ACTION OCTOBER – NOVEMBER – DECEMBER 2016 / JANUARY – FEBRUARY – MARCH 2017 EFFECTIVE DATE NAME LICENSE DISCIPLINE 2/28/2017 Ekereuke, Catherine O. RN112447 Decree of Censure 10/16/2016 Esparza, Rachel M. RN159484/LP044593 Voluntary Surrender 3/13/2017 Fairchild, Tabitha A. LP046733 Voluntary Surrender 3/24/2017 Fisher, Elliott E. LP035306/CNA280101339 Revocation 1/19/2017 Flores, Tania M. LP049386 Stayed Suspension with Probation 10/21/2016 Francis-Lindsay, Christina Reissuance Applicant Reissuance Denied 3/2/2017 Garcia, Davina B. RN166106 Decree of Censure 1/3/2017 Garman, Montsho RN159778 Revocation 11/15/2016 Gay, Loretta M. RN160976 Voluntary Surrender 1/26/2017 Gorsuch, Jasmine E. LP045725 Summary Suspension 12/19/2016 Graven, Mara J. RN204458 Decree of Censure 11/15/2016 Grizer, Bruce E. RN Endorsement License Denied 11/18/2016 Gyles, Thomas S. RN180698 Stayed Revocation with Probation 3/10/2017 Hackl, Rachel E. RN094663/AP1413 Decree of Censure 11/17/2016 Hackman, Felix RN145614 Decree of Censure 3/8/2017 Hall, Joseph D. RN165503 Revocation 12/19/2016 Hamilton, Jennifer L. RN162294 Stayed Revocation with Probation 12/27/2016 Harlan, Sherry A. RN102537 Reissuance Denied 1/27/2017 Harmer, Brian J. RN152301 Probation 3/6/2017 Hasson, Michelle L. LP045510 Decree of Censure 1/3/2017 Headlee, Stacey L. RN155349 Revocation 10/25/2016 Heard, Lee A. RN094404 Revocation 3/1/2017 Henao, Dario E. RN164718 Probation 10/26/2016 Henley, Nicole L. RN164826 Probation 10/26/2016 Hensley, Melissa E. RN152796 Revocation 12/15/2016 Hernandez, Annelle M. RN145607 Civil Penalty 10/25/2016 Hiller, Jill M. RN085361 Voluntary Surrender 3/20/2017 Hines, Andrea L. LP048200/CNA1000013278 Voluntary Surrender 12/14/2016 Hoeft, Cassandra A. LP053407 Probation 10/11/2016 Holliday, Lee RN039226/AP0099 Decree of Censure 10/26/2016 Hollingsworth, Mary G. RN090421/LP029017 Revocation 3/8/2017 Honaker, Erin K. LP044685 Revocation 1/19/2017 Hoy, Ann V. RN079222 Voluntary Surrender 12/27/2016 Hughes, Sukanlaya RN151776/AP4387/SN1019/LP042913 Revocation 12/2/2016 Iannoli, Gina E. RN147241 Decree of Censure 12/20/2016 Johnson, Cora M. RN124360 Probation 3/21/2017 Johnson, Jenny L. RN Endorsement License Denied 10/31/2016 Johnson, Matthew RN150245/CNA1000008748 Stayed Revocation with Suspension 1/4/2017 Jones, Jennifer L. RN131539 Revocation 10/21/2016 Jones, Linette M. RN Endorsement License Denied 26 arizona STATE BOARD OF NURSING REGULATORY JOURNAL RN/LPN DISCIPLINARY ACTION *Not reported in previous Journal OCTOBER – NOVEMBER – DECEMBER 2016 / JANUARY – FEBRUARY – MARCH 2017 EFFECTIVE DATE NAME LICENSE DISCIPLINE 11/23/2016 Kaymen, John C. RN156179/LP044073 Voluntary Surrender 3/24/2017 Kearney, Robert A. RN161218 Decree of Censure 11/21/2016 Knapp, Michelle M. RN Endorsement License Denied 3/7/2017 Kochheiser, Dana E. RN076433 Revocation 10/26/2016 Lange, Karen C. LP020675 Revocation 3/16/2017 Lawlyes, Tyler J. RN199340 Stayed Revocation with Suspension 1/4/2017 Lawson, Marylin L. RN140278 Revocation 10/26/2016 Lewis, Jonathan M. RN132908 Probation 11/7/2016 Liu, Qing RN178970 Voluntary Surrender 12/14/2016 Llacuna, Kira L. TRN095176 Reissuance Stayed Revocation with Probation 2/16/2017 Lonergan, Sophia E. RN157092/AP3346 Decree of Censure 10/21/2016 Long, Sandra K. RN079849//AP2928 Revocation 11/1/2016 Lopez, Tamara R. LP037918/CNA999990763 Probation 12/30/2016 Lott, Paige E. RN169981/SN1088 Decree of Censure 12/27/2016 Ludwig, David E. RN153178 Revocation 10/26/2016 Lynn, Paula W. RN154886 Revocation 03/21/2017 Martin, Betty LP966304 Voluntary Surrender 3/23/2017 Marzley, Michael A. RN147571 Stayed Revocation with Suspension 2/23/2017 Mayes, Jocelyn R. RN141319 Decree of Censure 1/27/2017 Mazur, Dennis P. RN122325 Probation 12/6/2016 McCarthy, Mary J. LP022531 Voluntary Surrender 2/17/2017 McConnell, Matthew J. RN118329/AP3837 Probation 11/17/2016 McEntire, Paula A. RN165738/LP041680 Decree of Censure 11/3/2016 Mendoza, Emilia F. LP044153 Probation 12/27/2016 Menendez, Miguel RN184986 Revocation 10/3/2016 Meyer, Jean H. RN042915 Stayed Revocation with Probation 3/3/2017 Miller, Cindy J. RN Exam License Denied 10/26/2016 Miller, Judy E. RN175254 Revocation 1/3/2017 Mills, Leonard C. RN140911 Revocation 1/3/2017 Mims, Raphael I. LP049984 Revocation 1/25/2017 Moctezuma, Christine L. LP042684 Voluntary Surrender 11/17/2016 Mohammed, Camille Angeli V. RN189942 Stayed Suspension with Probation 10/25/2016 Mollenhauer, Sarah A. LPN Endorsement License Denied 3/7/2017 Momon, Debra LP024121 Revocation 11/17/2016 Moran, Jaime RN204408 Decree of Censure 12/12/2016 Morgan, Kim L. RN167965/LP041400 Decree of Censure 3/9/2017 Mortensen, Laurie J. RN098399 Voluntary Surrender 1/6/2017 Mueller, Brita L. RN171349 Voluntary Surrender 11/7/2016 Nelson, Brandee M. LP041405 Voluntary Surrender 2/9/2017 Obrien, Robert W. RN125649 Stayed Revocation with Probation arizona STATE BOARD OF NURSING REGULATORY JOURNAL 27 RN/LPN DISCIPLINARY ACTION *Not reported in previous Journal OCTOBER – NOVEMBER – DECEMBER 2016 / JANUARY – FEBRUARY – MARCH 2017 EFFECTIVE DATE NAME LICENSE DISCIPLINE 12/19/2016 Obrien, Terrence C. LP024743 Decree of Censure 2/2/2017 Odongo, Joyce R. RN170219 Decree of Censure 11/17/2016 Palmer, Mauda K. RN094532 Summary Suspension 10/11/2016 Parsons, Elizabeth RN157544 Voluntary Surrender 3/8/2017 Patterson, Rochelle A. RN101879 Revocation 10/11/2016 Penne, Kay L. RN203378 Probation 11/17/2016 Perez Canez, Felicia LP047645 Civil Penalty 11/16/2016 Perotti, Shawn C. RN167275 Civil Penalty 3/15/2017 Pius, Pfon T. LP045093 Decree of Censure 10/3/2016 Poe-Ami, Delores RN088587 Decree of Censure 2/2/2017 Ponwith, Vincent G. RN075299 Voluntary Surrender 1/4/2017 Port, Kerin C. RN129303 Revocation 3/7/2017 Pratt, Jillian M. RN153478 Revocation 1/27/2017 Raichert, Jayme L. RN140707 Probation 1/27/2017 Ramsey, Prudence A. RN169503 Voluntary Surrender 1/12/2016 Randall, Jeffrey S. LP044667 Voluntary Surrender 12/12/2016 Randhawa, Jasmine K. RN165766 Civil Penalty 1/26/2017 Rangel, Shannon M. LP041945 Summary Suspension 12/16/2016 Robinson, Dawn R. RN174550 Stayed Suspension with Probation 10/12/2016 Rodriguez, Amy L. RN134521 Revocation 10/20/2016 Rodriguez, Cheryl M. LP038152 Decree of Censure 3/23/2017 Romo, Patricia G. RN056655/AP2342 Decree of Censure 11/9/2016 Russell, Chauncy M. RN159130/CNA1000008877 Stayed Revocation with Probation 1/4/2017 Sabala, Hillary A. LP041714 Revocation 2/14/2017 Sanchez, Ryan M. LP049668 Voluntary Surrender 11/29/2016 Santos, Judith RN098132 Probation 11/3/2016 Scalmato, Rose RN126372 Voluntary Surrender 1/3/2017 Schilt, Blanche K. RN201369/CRNA1215 Voluntary Surrender 1/4/2017 Schmieg, Gerald L. RN118265 Revocation 1/4/2017 Sedita, Allison J. RN150879 Revocation 11/14/2016 Silva, Michelle A. LPN Endorsement License Denied 1/4/2017 Skinner, Kathy A. RN163557 Revocation 10/14/2016 Smith, Mary K. RN140579 Voluntary Surrender 10/21/2016 Sotelo, Rebecca Reissuance Reissuance Denied 3/15/2017 Spinuzzi, Jodi G. LP043771 Decree of Censure 2/21/2017 Stanford, Mary B. RN076792 Revocation 2/3/2016 Starkey, Alana M. RN175676 Voluntary Surrender 1/6/2017 Talboy, Patricia J. RN179821/LP048655 Civil Penalty 1/3/2017 Theut, Olivia J. RN195373 Stayed Revocation with Probation 10/28/2016 Thomas, Kimberly A. LP033839/CNA177805510 Voluntary Surrender 28 arizona STATE BOARD OF NURSING REGULATORY JOURNAL RN/LPN DISCIPLINARY ACTION *Not reported in previous Journal OCTOBER – NOVEMBER – DECEMBER 2016 / JANUARY – FEBRUARY – MARCH 2017 EFFECTIVE DATE NAME LICENSE DISCIPLINE 11/17/2016 Thompson, Jilaine Compact Nurse-VA Summary Suspension of Nurse Multi-State Licensure Privilege g 3/2/2017 / / Thompson, p , Michael G. RN085632 Voluntaryy Surrender 3/24/2017 / / Todd,, Amber C. LP044168/CNA1000008127 / Stayed y Revocation with Suspension p 1/4/2017 / / Todd,, Nicole T. RN174751/LP047951 / Revocation 1/19/2017 / / Torres,, Teresa S. RN035464 Voluntaryy Surrender 1/30/2017 / / Villa,, Crystal y M. RN195179 Voluntaryy Surrender 2/14/2014 / / Villarreal,, Kellyy N. RN205843 Probation 11/30/2016 / / Vlasic,, Andrea T. RN144982 Stayed y Revocation with Suspension p 3/9/2017 / / Weigand, g , Linda RN128658 Stayed y Revocation with Suspension p 12/20/2016 / / Whiteaker,, Brett A. RN168273 Summaryy Suspension p 3/1/2017 / / Williams,, Debourne A. RN206425 Probation 3/8/2017 / / Williams,, Terri L. LP Endorsement License Denied 11/2/2016 / / Wright, g , Preston A. RN191098 Probation 10/31/2016 / / Young, g, Angela g D. RN176855 Voluntaryy Surrender 12/23/2016 / / Young, g, Courtneyy L. RN112461 Decree of Censure / / 10/6/2016 Zielsdorf,, Lee M. RN203380 Probation Summit Healthcare Regional Medical Center Trusted to Deliver Exceptional, Compassionate care close to home Come to Arizona’s cool, beautiful White Mountains where the quality of life soars as high as the tall pines! Sign on bonus / Relocation Assistance / Excellent Benefits / 403(b) Retirement / Tuition Reimbursement Current Employment Opportunities Free Subscription to StuNurse magazine! Do you know someone who is a student nurse, or someone considering a nursing career? Then let them know about the StuNurse magazine. A subscription to the StuNurse digital magazine is FREE and can be reserved by visiting www.StuNurse.com and clicking on the Subscribe button at the upper right corner. Educators… let your students know they can subscribe free of charge! And Ƃnd us on Facebook. f RN Labor & Delivery f RN ICU f RN ER f RN Med Surg Tele f RN Home Health f RN Case Manager f RN Surgery f Perioperative Manager / Educator f New Grad RN's for Nurse Residency Program (Opening June 1st) To learn more about our Career opportunities T visit www.summithealthcare.net or call to speak with the Nurse Recruiter, Stevie Burnside at 928-537-6367 email sburnside@summithealthcare.net Show Low Ariz i ona has ffour beautiful,l mild seasons — a perfect f place fo f r outdoor adventures year-round! Summit Healthcare Regional Medical Center 2200 E. Show Low Lake Rd. • Show Low, AZ 85901 arizona STATE BOARD OF NURSING REGULATORY JOURNAL 29 Serve on a Board? MAKE IT COUNT arizona STATE BOARD OF NURSING REGULATORY JOURNAL Visit nursesonboardscoalition.org g to be recogniized d and d counted d. Our College of Nursing and Health Care Professions has been providing an outstanding health care education for over 30 years. The College prides itself on the ability to create degree programs based on the demand for highly qualified health care professionals. Correctional Care. Committed Careers. We're hiring! Registered Nurse Mental Health RN Nurse Practitioner Mental Health NP Licensed Practical Nurse We currently have openings for Full-Time Faculty positions available at our main campus in Phoenix, Arizona. In addition, we are also hiring Adjunct Faculty for both online and campus courses. We currently have openings in the following areas: Full time Faculty • Lab Skills and Simulation • MPH – Master of Public Health • MSN Public Health Please check our career website as new openings could become available in various specialties. Founded in 1949, GCU is a private, Christian university serving nearly 15,473 students on our main campus in Phoenix, Arizona and an online student population of more than 59,600. HOW TO APPLY Please apply online by visiting jobs.gcu.edu CorizonJobs.com | Follow Corizon Health Careers Contact Nancy James Nancy.James@CorizonHealth.com | Nurse Network The “NEW” Classifieds (1.5” wide x 1” high) Reach every nurse in Arizona for as little as $290. R E SE RV E YOU R SPAC E NOW ! Contact Laura Wehner 30 480.897.9515 X 2504 EXPERIENCED NURSE –ATTORNEY NURSE ADVOCATE Teressa M. Sanzio, RN, JD Get the representation you deserve when you need it most. FREE lwehner@pcipublishing.com Phone Consultation 1- 800 -561- 4686 ext. 117 Tsanziolaw@gmail.com arizona STATE BOARD OF NURSING REGULATORY JOURNAL 602-993-3215 With facilities across the West, there is something for everyone at Banner Health, from the bustling urban medical center to the friendly rural hospital. As one of the largest nonprofit health systems in the country, Banner Health has both the stability that comes with success and the values you can be proud to represent. Help define the future of health care. Learn more at: BannerHealth.com/careers 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 MIHS… It’s Who I Am “When I tell peop ple where I work and what I do, I do it with pride. We are that slice of the community that people can depend on.” At Maricopa Integrated Health System, we wear this badge with pride. Like Greg, our staff is dedicated to providing a high quality integrated system of care for patie ents and families. We’re all committed to continuous teaching, learning and improveme ent. That’s the power of an environment drive en by values like respect, leadership, and d education. Join MIHS as a Registtered Nurse and enjoy: s (IGHLY COMPETITIVE WA AGES s !RIZONA 3TATE 2ETIREM MENT 3YSTEM Plan with a lifelong pe ension upon retirement s 'ENEROUS 04/  holidays per year s 4HE 0UBLIC 3ERVICE Loan Forgiveness (PSLF) Program s 3ATISFYING .URSE TO Patient ratio Connect with us att: JOBS.MIHS.ORG MARICOPA INTEGRATED HEALTH SYSTEM Maricopa County Special Health Care District Greg Scaggs McDowell Healthcare Center Clinical Manager