I Volume 12 I Number 3 I Summer 2014 I
The Nurse Licensure Compact: Virtual Nursing Care for School The Latest Information Children with Diabetes
NORTH and SOUTH DAKOTA STATE BOARDS of NURSING Redefining health care
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SUMMER 2014 EDITION 47 14 Professionals In Recovery Together
Substance Abuse Epidemic Reaches Deep into the 16 Health Care Provider Community
Virtual Nursing Care for School 20 Children with Diabetes SOUTH DAKOTA HIGHLIGHTS NORTH DAKOTA HIGHLIGHTS 4 Message from the Executive Director 5 Message from the Executive Director 19 16th Biennial International Conference 7 North Dakota Board Highlights
Virtual Nursing Care for School Children 2012-2013 Nursing Education 20 with Diabetes 10 Annual Report
2013 Continuing 13 Education Audit
The Nurse Licensure Compact: 15 The Latest Information
Dakota Nurse Connection circulation includes over 28,000 licensed nurses, hospital executives and nursing school administrators in North and South Dakota.
The Dakota Nurse Connection is published by the South Dakota and North Dakota Boards of Nursing. Direct Dakota Nurse Connection questions or comments to:
South Dakota Board of Nursing, 4-PVJTF"WF 4VJUF 4JPVY'BMMT 4PVUI%BLPUBt pcipublishing.com North Dakota Board of Nursing, Created by Publishing Concepts, Inc. 4UI4USFFU 4VJUF #JTNBSDL /PSUI%BLPUBt $AVID "ROWN 0RESIDENT s DBROWN PCIPUBLISHINGCOM For Advertising info contact 6ICTOR (ORNE s VHORNE PCIPUBLISHINGCOM ThinkNurse.com DAKOTA NURSE CONNECTION ■ 3 SOUTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
A message from the Executive Director Gloria Damgaard, RN, MS, FRE South Dakota Board of Nursing
Dear Readers, response to change. Specifically, the experienced throughout the process Welcome to the summer edition authors identify five categories of of changing the administrative rules of the Dakota Nurse Connection. responders to change. First are the to allow for the delegation of insulin As I write this message, the trees Champions, the people that are out administration. The goal of our work outside my window are bending and in front and run with an idea. They over the past few years has been to swaying in the wind and the weather make up about 5-10% of the total. ensure that our citizens living with forecasters have started using the They are few in number but own diabetes have access to the safest “polar vortex” phrase again. It is a whatever happens. Next are the care possible, especially when a nurse reminder that change is ever present Chasers, who don’t respond to a new is not present to deliver that care. in our lives. idea in a positive way immediately, One would think that everyone would On behalf of the Board of Nursing, but need more time to reflect on who stand up and cheer for that goal. I am happy to announce that the else might be in favor. They can In conclusion, I would like to Board’s proposed rule changes will be see the advantages of the change. extend our gratitude and sincere final as of July 28, 2014. These rules This group is larger in number and appreciation to everyone involved allow for the delegation of insulin represent about 15-20% of the with the “Virtual Nursing Care” project. administration to trained unlicensed total. Converts are the third group of Our champions are the virtual nurses assistive personnel by qualified RNs responders and represent the largest and the trained unlicensed assistive in accordance with a written protocol. group. These responders require solid personnel that provided many hours The rule change is supported by evidence in order to favor the change. of safe nursing care to children in evidence from the “Virtual Nursing The fourth group identified by Ross the school setting. The SD Diabetes Care for Children with Diabetes in the and Segal are the Challengers. They Coalition is now championing School Setting” project. In this edition ask the tough questions. They resist the sustainability of this model of of the DNC, we reprinted the results or challenge the change from the care in our state. It has been a of this research project that appeared very start. It is very important to source of professional pride and in the January 2014 edition of the listen to the challengers as they are accomplishment for the Board of Journal of Nursing Regulation. the ones that need to be convinced Nursing to design and implement a Arriving at this change was an that a change is needed. Once they research study that would answer the interesting process. I thought I are convinced, they stop opposing questions of the Challengers, Converts would share with you one of the the change. Lastly, are the Change- and Chasers. We are better informed many things that I personally learned Phobics. They represent about 5-10% because of the role that you played about the change process through of the responders and you will in the process. Lastly, to the Change- this experience. Authors Bernard never get them to change. These Phobics, we will assist you with this Ross and Clare Segal write about responders usually have a stake in change to the best of our ability. responses to change in their book the outcome and will attempt to derail I will be in touch with you again in titled: Breakthrough Thinking for your change. They are essentially the Fall edition of the DNC. Nonprofit Organizations: Creative immovable. Ross and Segal offer Sincerely, Strategies for Extraordinary Results. suggestions on managing change They answer the question: “Why and dealing with all five categories. didn’t they all stand up and cheer?” The authors helped me put into To answer this question, Ross and perspective, many of the positive Gloria Damgaard, RN, MS Segal (2002) describe The 5 C’s of and negative encounters that we Executive Director
4 ■ DAKOTA NURSE CONNECTION NORTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
A message from the Executive Director Constance Kalanek, Ph.D., RN, FRE North Dakota Board of Nursing
Greetings, and welcome to and to inspect and accredit The board said farewell to the Dakota Nurse Connection, schools of nursing. A change Julie Traynor RN and Melisa the official publication of the in legislation in 1939 (S. Frank LPN. We thank them for North Dakota Board of Nursing. L. 1939, Ch. 187) required their service to nursing regulation This magazine is another way, Board members to have in our state. At the same time, in addition to our website, to five years of experience the board will be welcoming keep consumers and licensees in nursing education or two new board members in July apprised of the changes and related experiences. The or shortly thereafter. Melissa news events occurring at the Board hired a registered Hanson RN has been appointed North Dakota Board of Nursing. and qualified nurse as an as an RN Board Member with The Board just recently rolled inspector of the schools. The expertise in nursing education. out a new website- visit the inspector could also serve We await the appointment of an site at www.ndbon.org . It has as a member of the Board LPN member. a totally new look highlighting (S. L. 1939, Ch. 187). The The Board continues to strive the ND landscape. We have Board accredited a school to proactively regulate the tried to make the information after inspection, collected practice of nursing by providing easily accessible and useful, a fee for accreditation, and timely information that gives so let us know your thoughts set requirements for the registered nurses, licensed or if you have suggestions for schools. The Board also practical nurses, unlicensed improvements to the site. determined the qualifications assistive persons and medication The North Dakota Board of for applicants of the nursing assistants the knowledge they Nursing will be celebrating 100 schools.” The sources for this need to remain compliant with years of nursing regulation and information are the Gray, the laws and rules. Let us know licensure in 2015. The board David P. Guide to the North what you think! Please feel free has partnered with the North Dakota State Archives, 1985. to use the “Contact Us” on the Dakota Center for Nursing to website or call the office direct. plan the celebration. This event So mark your calendars for The Board will be in touch marks an exciting year in nursing May 21, 2015. A conference will with you again in the Fall regulation in our state. The be held to mark this occasion publication. Remember as Board’s purpose changed as at the ND Heritage Center, caretakers, we need to take time each decade passed. This is the Bismarck, ND. The title of the out for ourselves and relax and historical highlight for this issue. conference is: Celebrating 100 enjoy life. Hope you are having Enjoy! years of Nursing Excellence- a great summer! Past, Present and Future. The “In 1939, the purpose of initial plans indicate a one- Best Regards, the Board was to provide for day conference with a keynote exams, to grant and issue speaker and a celebration to Constance B. Kalanek PhD, certificates of registration, follow. RN, FRE
DAKOTA NURSE CONNECTION ■ 5 OFFICIAL PUBLICATION NORTH DAKOTA BOARD OF NURSING Mission The mission of the North Dakota Board of Nursing is to assure North Dakota citizens quality nursing care through the regulation of standards for nursing education, licensure and practice. Telephone Lines Busy? Use E-mail! North Dakota Board of Nursing Officers and Members You can contact anyone at the Board of Nursing by e-mail. PRESIDENT Daniel Rustvang, RN, Grand Forks BOARD STAFF E-MAIL ADDRESSES
VICE PRESIDENT Constance Kalanek, Ph.D., RN, FRE, Executive Director [email protected] Jane Christianson, RN, Bismarck Karla Bitz, Ph.D., RN, FRE, Associate Director [email protected] TREASURER Clara Sue Price, Public Member, Minot Patricia Hill, BSN, RN, Assistant Director – Practice and Discipline [email protected]
Charlene Christianson, RN, Carrington Stacey Pfenning, DNP, APRN, Associate Director, [email protected] RN, Bismarck Melissa Hanson, Education and Advanced Practice Janelle Holth, RN, Grand Forks Bonny Mayer, LPN, Minot Julie Schwan, Administrative Services Coordinator [email protected] Paula Schmalz, APRN, Fargo Gail Rossman, Technology Specialist [email protected]
Sally Bohmbach, Administrative Assistant [email protected]
Kathy Zahn, Administrative Assistant [email protected]
NORTH DAKOTA BOARD OF PROVISION of HIGH QUALITY NURSING CARE NURSING 2014 BOARD MEETING DATES A series of Educational Presentations Sponsored by the North Dakota Board of Nursing July 17, 2014 Annual Meeting PURPOSE: To provide an opportunity for students, registrants, and licensees to keep current on regulatory September 24, 2014 Board Retreat issues in the nursing profession. September 25, 2014 AVAILABLE TOPICS: BENEFITS: November 20, 2014 * Delegating Effectively * Cost effective – we’ll come to you * Nurse Practices Act (NPA) * Individualized – to meet your needs January 15, 2015 * Violations of NPA * Current and up-to-date information
March 19, 2015 * Emerging Issues in Nursing * CE credits with every presentation * Standards of Practice & Code of Ethics May 22, 2015 PRESENTERS: July 16, 2015 Annual Meeting Constance Kalanek, Ph.D., RN, FRE As a service to the citizens of North Dakota, the Board Karla Bitz, Ph.D., RN, FRE of Nursing provides a PUBLIC FORUM during each Patricia Hill, RN, BSN board meeting. This is a time when anyone may Stacey Pfenning, DNP, APRN address the board about any issue regarding nursing. Prior notification is not necessary. Individuals will be Length of Presentation(s): 60 minutes each. Fee: $100 per presentation plus mileage. recognized in the order of their signature on a roster available at the board meeting. The time of the Public Contact Hours: One contact hour each, except Standards of Practice and Code of Ethics is 2.3 contact hours. Forum for the 2014-2015 board meetings is 11:00 a.m. Approved by the North Dakota Board of Nursing. of the first day of each board meeting.
NORTH DAKOTA BOARD OF NURSING NURSES Have you “CARDLESS” FOR PUBLIC LICENSURE VERIFICATION moved recently? SAFETY North Dakota License Verification Options Wallet licensure cards are no The North Dakota Board of Nursing provides the following longer issued for: options for individuals attempting to verify a ND nursing license: Update your address on the s .ORTH $AKOTA "OARD OF .URSING 7EBSITE n GO TO WWW N.D. Board of Nursing RN & LPN Renewal ndbon.org. and choose “Verify.” License by Examination s .URSYS¸ .URSES 6ERIlCATION &OR PARTICIPATING STATES GO TO Web site: www.ndbon.org License by Endorsement www.nursys.com. Choose Licensure QuickConfirm. Click on: UAP/Technician/Medication Assistant III s % NOTIFY n DATABASE FOR VERIlCATION OF LICENSURE AT [email protected] Name/Address Update www.ndbon.org
6 ■ DAKOTA NURSE CONNECTION 3 TH 3T 3UITE s "ISMARCK .$ s 0HONE NORTH DAKOTA BOARD HIGHLIGHTS May 2014
• Continue the requirement for 500 from the ND Board of Nursing and the program has full approval hours of Nursing Practice per year the programmatic changes are in from the ND Board of Nursing and while under a board order for compliance with NDAC 54-03.2-06-02. the programmatic changes are in encumbrance. compliance with NDAC 54-03.2-06-02. • Accepted notification of the name • Found Turtle Mountain Community change of Sanford College of Nursing • Affirmed the nurse refresher course College Associate of Applied Science to ND State University at Sanford policy and requirement of 120 hours Practical Nurse (AASPN) program Health; and the report on the plan of clinical experience for ND programs. in substantial compliance with ND for storage of the academic records administrative code 54-03.2; and according 54-03.2-01-04 upon • Approved the guidelines for successful acquisition June 30th, 2014. recognition of distance education • Placed Turtle Mountain Community nurse refresher course requirements College AASPN program on full • Approved the request to extend the according to NDAC 54-02-05-05 as approval status May 2014 through Practical Nurse Program at Lake programs are board approved within May 2016; and Region State College, partner in Dakota the state the program is headquartered Nursing Program, to Grand Forks, with a minimum of 80 clinical hours. • Turtle Mountain Community College ND in Fall 2014, admitting no more AASPN program may not admit than 16 students, as the program • Accepted certificates of completion more than 12 students per Cohort. has full approval from the ND Board from board approved nurse refresher Program may request to the board to of Nursing and the programmatic courses with a minimum of 80 clinical expand enrollment if faculty resource changes are in compliance with NDAC hours that meet requirements of the requirements are met and evaluation 54-03.2-06-02. board’s guidelines. plan is in place. • Approved the Dickinson State • Accepted the continuing education • The Turtle Mountain Community University’s notification of major audit results report College AASPN Program Administrator programmatic changes for the AASPN must submit the 2013-2014 annual and BSN completion program as • Direct staff to review the policy report by October 15, 2014; in the programs have full approval addressing continuing education addition, a compliance report will from the ND Board of Nursing and providers request to be displayed on be submitted by May of 2015 the programmatic changes are in ND Board of Nursing web site and addressing the deficiencies of the “non- compliance with NDAC 54-03.2-06-02. report back at the July 2014 board compliance” 54-03.2-02-05 Nursing meeting. Program evaluation and “partial- • Approved the University of Mary’s compliance” 54-03.2-04-01 faculty notification of major programmatic • Direct staff to notify nurses regarding responsibilities standards for Nursing changes for the LPN to BSN (RN) the exemption in NDCC 43-48-03 (2) Program approval as cited in this program as the program has full that allows nurses to complete waived survey report. approval from the ND Board of laboratory tests, i.e. whole blood Nursing and the programmatic glucose; and that the waived tests • Approved the request from Sanford changes are in compliance with NDAC cannot be delegated to unlicensed College of Nursing BSN Program 54-03.2-06-02. personnel. for voluntary closure effective June 30, 2014 as they have met the • Approved the Minot State University’s • Establish a task force to study the requirements according to NDAC major programmatic change for the practice questions posed by the 54-03.2-09-02 pending successful BSN program as the program has aesthetic nurses and review the current acquisition June 30, 2014. full approval from the ND Board practice statements related to aesthetic of Nursing and the programmatic nursing and report back at the July • Recommended the board approve changes are in compliance with NDAC board meeting. the ND State University major 54-03.2-06-02. O programmatic changes of the BSN • Interpret NDAC 54-05-01-08 (10): program related to the acquisition/ • Approved the ND State University’s health teaching of clients and their merger with Sanford College of Nursing Fargo campus major programmatic as the program has full approval changes for the BSN program as continued on page 8
DAKOTA NURSE CONNECTION ■ 7 NORTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
continued from page 7 disciplinary statistics/case activity and guidelines for web-streaming as a documents and related agenda items charge for the technology committee families may be implemented by the to be congruent with the revised for FY 2014-2015 LPN utilizing an established teaching administrative rules that took effect plan/protocol as assigned by the RN, April 1, 2014. • Approved Dr. Karla Bitz as co-chair of APRN, or licensed practitioner. The the joint planning committee of the LPN is participating in health teaching • Approved the proposed position North Dakota Board of Nursing and to promote, attain, and maintain the descriptions for board president, vice North Dakota Center for Nursing for optimum health level of clients. president and treasurer. 100th year celebration which is to include a conference and gala. • Approved the changes to the • Approved development of policies • Approved the following dates for Board Meetings in 2014-2015:
Nursing Opportunities July 17, 2014 September 24, 2014 board retreat September 25, 2014 Visit www.trinityhealth.org for employment opportunities; find information about our benefits packages, and more. Whether you are a new graduate or November 20, 2014 an experienced RN, Trinity Health offers the resources, benefits, and January 15, 2015 opportunities for you to enjoy your career and take it to the next level. From March 19, 2015 exciting medical surgical nursing to flight nursing, we have it all. Our goal May 22, 2015 (CFN/BON conference during our orientation classes is to introduce both new and experienced nurses to nursing practice standards and our electronic health record. Clinical date May 21) Nurse Educators are available on every unit to help guide you and answer July 16, 2015 annual meeting questions. Visit our website or contact our Nurse Recruiter at 701-857-5126. • We offer a competitive salary and benefits package, to include a SIGN ON BONUS. Approved Char Christianson RN, Apply online at www.trinityhealth.org or contact the Nurse Recruiter at 701-857-5126. board member & Patricia Hill RN, staff Trinity Health is an Equal Opportunity Employer as the representatives of the board of nursing to the community paramedic pilot project.
• Approved $27,000 fixed assets for FY 2014-2015 be taken from reserve funds. Behavioral Health Care • Approved $25,000 from reserve Excellent Benefits th Making a difference funds for the NDBON 100 Leading Edge Technology anniversary celebration. in the lives of Diverse Career Paths patients and their families • Direct staff to review the current and The Fargo VA Health Care System proposed contract with Pearson Vue and Community-Based Outpatient and NDDOH for NNAAP testing. Clinics seek RNs and LPNs who will thrive in a challenging and cutting • Approved the proposed 2014-2015 edge organization, delivering health budget of $1,350,065 projected Join the team of amazing nurses at Prairie St. John’s care to veterans. We are a general income and $1,418,420 budgeted medical, surgical, and psychiatric Nursing Opportunities expenses, which includes $77,000 facility with a restorative designated for nursing education 6tXGent Loan 5eSa\ment 3Oan care unit and vast clinical areas. loans and $259,800 designated for &ontLnXLnJ (GXFatLon %ene¿tV the ND Center for Nursing. 5eLmEXrVement Ior LLFenVe )eeV View current career opportunities at ([FeOOent 3a\ anG %ene¿tV www.usajobs.gov • Elected by unanimous ballot: or contact Learn more at prairie-stjohns.com President- Dan Rustvang RN Jennifer Kraiter, Nurse Recruiter, Vice President – Jane (701) 239-3700 ext. 93570 Christianson RN An Equal Opportunity Employer Clara Sue Price - Treasurer
prairie-stjohns.com | Fargo, ND
8 ■ DAKOTA NURSE CONNECTION 3 TH 3T 3UITE s "ISMARCK .$ s 0HONE Knowledge is power— take some for yourself! Wound Care Education Institute (WCEI®) is a dedicated center of education designed curriculum designed to motivate and re-energize you. While you learn, you can take to provide students with comprehensive training programs. Being certified can make advantage of networking and career support opportunities. The National Certification a distinct difference in your patient’s life, but it could change yours, too. In just a few Exams are sponsored by the National Alliance of Wound Care and OstomyTM. In some days with our professional instructors, you can develop specialized clinical skills in a cases, tuition for WCEI programs may be covered by your employer. Courses available for: RNs / LPNs / LVNs / PTs / PTAs / OTs / OTA / MDs / DOs / DPMs / PAs
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DAKOTA NURSE CONNECTION ■ 9 NORTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
2012-2013 NURSING EDUCATION ANNUAL REPORT Executive Summary Nursing Education Programs in North Community College Associate issues and requested to bring evidence Dakota: of Applied Science Practical of compliance to the July 2013 In fiscal year 2012-13, nineteen Nurse (AASPN) program in board meeting for reconsideration of nursing education programs held continued partial compliance recommendation #4 which mandated approval by the North Dakota Board with ND Administrative Code no admittance of a Fall 2013 cohort. of Nursing. There were three graduate 54-03.2; and level nursing education programs 2. Place Turtle Mountain Board of Nursing Program Approval designed to educate for advanced Community College AASPN and Accreditation: practice registered nursing (APRN) program on conditional The NDBON developed a table to licensure. There were eight approved approval status until January describe the approval and accreditation baccalaureate nursing education 30, 2014, at which time the status of ND nursing education programs and two associate degree ND Board of Nursing will programs. Information obtained nursing education programs designed determine whether stated from program surveys and the CCNE to prepare individuals for registered deficiencies have been and NLNAC websites revealed 9 ND nurse (RN) licensure. Additionally, there sufficiently corrected; and programs with CCNE accreditation and were five approved associate degree 3. If a level of substantial 6 programs with ACEN accreditation programs and one certificate program compliance is not (formerly NLNAC). providing educational preparation for demonstrated by January 30, practical nurse (PN) licensure. 2014, the ND Board of Nursing Admissions: will determine a course of As national authorities struggle Nursing Program Approvals action, which will include to capture admissions information In fiscal year 2012-13, the ND withdrawal of board approval with precision, a mechanism for Board of Nursing conducted onsite and the setting of a date to acquiring this data accurately certainly surveys and approved the following discontinue the program; and continues to be challenging here in recommendations for these existing 4. Turtle Mountain Community North Dakota as well. As with any programs: College AASPN program summation of admissions data, the • Sitting Bull College ASPN program may not admit a new cohort following summary must be viewed 1. Find the Sitting Bull College of AASPN students until with a degree of caution, and the Associate of Science Practical the program has achieved reader must remain cognizant that the Nursing Program in substantial substantial compliance. A date report does not account for applicants compliance with North for further admission of AASPN who have applied for admission at Dakota Administrative Code students must be mutually multiple programs. However, the 54-03.2 Standards for Nursing agreed upon by the ND Board continues to acknowledge the Education Programs; and Board of Nursing and Turtle importance of this somewhat elusive 2. Continue full approval of Mountain Community College. information. the Sitting Bull College ASPN 5. The Turtle Mountain For FY 2012-13, the baccalaureate program through November Community College AASPN programs reported 451 slots for 2015; and program administrator must admission, which is 71 less than 3. Require an addendum to submit the 2012-13 Annual reported in FY 2011-12. Admissions accompany the FY 2012-13 Report by October 15, 2013. to baccalaureate nursing programs Nursing Education Annual In addition, a compliance designed as preparation for RN Report, verifying: a) the report will be submitted licensure totaled 503, which was 23 presence of adequate and by December 13, 2013 less than last year. The two associate dedicated clerical/assistive addressing the deficiencies degree nursing (ADN) programs for support for the Sitting Bull of the “non-compliance,” RN licensure, which are structured via College Division of Nursing; “partial-compliance,” and “met the ladder concept, reported 137 slots and b) incorporation of progressing” standards for for the program. Of the 191 basic and additional adjunct nursing Nursing Program Approval as advanced standing applicants, 132 faculty as deemed appropriate cited in this survey report. qualified for admission. Of the 121 and necessary. applicants accepted, 115 enrolled. • Turtle Mountain Community The TMCC representatives requested Essentially, 87% of the qualified Technical College AASPN Program reconsideration upon meeting applicants proceeded to enrollment, 1. Find Turtle Mountain noncompliance and partial compliance depicting a 2% increase over FY 2011-
10 ■ DAKOTA NURSE CONNECTION 3 TH 3T 3UITE s "ISMARCK .$ s 0HONE
12. In total, admissions to educational a substantial decrease (19%). Practical Seven minority students were enrolled programs which qualify graduates for RN nurse (PN) programs’ enrollment in ADN programs, comprising 9% licensure was 578, which is a decrease decreased by 64 students. The nursing of the students (down from 16% FY of 22 students. programs for RN licensure saw an 2011-12). The 123 minority students The Associate in Science Practical enrollment increase of 2 students in in baccalaureate programs accounted Nursing (ASPN), Associate in Applied FY 2012-13. The enrollment numbers for 10% of the enrollees, similar to last Science in Practical Nursing (AASPN) in pre-licensure master’s degree FY. The 26 minority students in the and Certificate Practical Nurse programs programs decreased from 639 in FY graduate programs represented 10% reported 272 available admission slots, 2011-12 to 239 in FY 2012-13. A of the student population. 26 less than last FY. The programs report from one master’s program Male students (n=17) constituted reported 607 basic applicants, 55 less stated that data from previous FYs was 6% of the students enrolled in PN than last fiscal year. Of the applicants, inclusive of all programs (including the programs (up 1% from 2011-12 404 (67%) were qualified for admission. nurse education and administration FY). The ADN programs had 1 male Of those individuals who were qualified programs) which contributed to enrolled, which represented only 1% for admission, 303 were accepted and the abrupt decrease in enrollment of the students (down from 10% in the 241 proceeded to enrollment. The total numbers. There were 33 doctorate of 2011-12 FY). Baccalaureate program number of applicants admitted (n=241) nursing practice students enrolled in enrollment of males (n=149) comprised represents a decrease of 25 from last North Dakota programs, which is one 12% of the student population (same fiscal year. student more than last year. as 2010-11 and 2011-12 FY). Male Similar to the past fiscal year student numbers (n = 39) in graduate- Enrollment: reports, non-minority females level programs reflected 14% of the FY 2012-13 marked a grand total comprised the majority of students total graduate program enrollment (an enrollment in all programs of 1,948, enrolled in all types of nursing increase of 6%). which is 461 students less than FY programs. There were 74 minority 2011-12. Enrollment trends from 2008- students reported in PN programs, 2012 reflected increases in each year; thereby making up 24% of the continued on page 12 however, FY 2012-13 demonstrated students (up 2% from 2011-12 FY).
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DAKOTA NURSE CONNECTION ■ 11 NORTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
continued from page 11 Faculty: Graduates: In FY 2012-13, the state’s nursing Faculty demographic data was There was a total of 206 graduates education programs employed 153 initiated FY 2010-11. The FY 2012- from the state’s PN programs, an full-time and 180.39 part-time faculty 13 data indicated 286 female and increase of 25 students from the with a total calculated FTE of 242.84. 15 male faculty serving the state’s previous year. The only certificate PN In FY 2011-12, total FTE’s equaled nursing education programs. Data program, offered through a consortium 189.28. Of the FY 2012-13 totals, the on age range of faculty were also of five academic institutions, graduated following figures represent the highest collected. The 51-60 age range a class of 109, which reflected 23 more level of academic preparation: accounted for the highest percent graduates than the previous year. • 42.14 FTE’s are prepared at the (34%) of nursing faculty. The 61 A total of 125 ADN students bachelors level (33.27 FTE’s in FY and above age range accounted graduated, thus qualifying for RN 2011-12) for 11%; 41-50 accounted for license by examination. An additional • 131.61 FTE’s are prepared at the 28%; 31-40 accounted for 22%; 479 individuals graduated from master’s in nursing level (108.16 25-30 accounted for 6%, and the baccalaureate programs (65 more than FTE’s in FY 2011-12) 24 and below accounted for 0% of 2011-12 FY), creating a combined 604 • 1.00 FTE’s are prepared at the faculty. Nursing programs reported graduates from all programs preparing non-nursing master’s level (00.75 faculty in North Dakota as almost for RN licensure. FTE’s in FY 2011-12) exclusively Caucasian (98%), with 5 The most prominent age group • 40.26 FTE’s are prepared at the Native American faculty individuals. represented in all the undergraduate doctorate in nursing level (24.86 programs consisted of those aged FTE’s in FY 2011-12) Distance Nursing Education 24 and below (50%). The basic • 27.83 FTE’s are prepared at the Program Recognition baccalaureate programs provided the non-nursing doctoral level (22.24 The ND Board of Nursing largest numbers of graduates in the age FTE’s in FY 2011-12) continues to collaborate with 24 and below group (72%), in contrast pre-licensure distance nursing to the age 41 and above group (2%). Faculty position openings, education programs seeking to Within the PN graduate group (n=206), reported as the total of all ND Nursing place students in ND facilities for the 24 and below age group was Education Programs as of December clinical experiences. In FY 2012- calculated at 44% and the 25-30 age 2013, are listed as follows: 13, the board recognized 25 group was at 28%. Age trends are not • Number of openings = 14.09 distance programs with a total reported for graduates of the master’s (was 15.5 December 2012) of 709 placements of students in or doctoral level programs. Master’s • Total vacancies being actively clinical settings in ND throughout program graduate data decreased from recruited as of December 2013 the academic year. The distance 264 in FY 2011-12 to 84 in FY 2012- = 9.67 nursing education students from 13. Again, this decrease is partially PN programs represented 73.9% contributed to the reported information Nursing education programs of student placements in ND from one master’s program which was continue to be highly committed to facilities. The ADN/ASN programs inclusive of all programs (education and the advancement of their faculty accounted for 11.9% of the student administration. The doctorate of nursing within their respective graduate placements. In Fall 2012, there practice programs decreased graduates programs, in an effort to increase the were 301 distance education by 4 as compared to the previous year. percentage of academically qualified student placements in ND facilities. faculty. The Faculty Developmental In Spring 2013, there were 295 NCLEX® Examination Pass Rates for Program (NDAC 54-03.2-04-08.1) student placements in ND. In First-Time Candidates: provides the ND Board of Nursing Summer 2013, there were 113 The overall FY 2012-13 North with an ongoing mechanism for student placements in ND facilities. Dakota NCLEX-PN® pass rates were tracking the progress of faculty The ND facilities included various 87.36%, which portrays a decrease of individuals. The following information clinical, hospital, and long term care 7.67% from last fiscal year. The ND reported by the programs is reflective settings in Bismarck, Fargo, Minot, pass rates were 2.85% higher than of the progress of faculty in the Valley City, Harvey, Grand Forks, national average. development program. and Langdon and other rural areas. The overall FY 2012-13 North • Total faculty FTE’s filled by Dakota NCLEX–RN® pass rates were academically unqualified Summary compiled by: 88.05%, which portrays a decrease of individuals: Stacey Pfenning, DNP, APRN, 1.4% from last fiscal year. The ND pass o FY 2012-13 = 9.63 FTE Associate Director of Education and rates were 1.02% higher than national o FY 2011-12 = 4.75 FTE APRN Practice average. o FY 2010-11 = 26.4 FTE o FY 2009-10 = 19 FTE
12 ■ DAKOTA NURSE CONNECTION 3 TH 3T 3UITE s "ISMARCK .$ s 0HONE
2013 CONTINUING EDUCATION AUDIT
2013 – 2014 Licensure Cycle
LPN RN APRN APRN (RX) TOTAL Experience Natural Northwest Alaska! Number Audited 48 133 4 7 192 Norton Sound Health Corporation’s new hospital was recently ranked among the Top 20 Most Beautiful Hospitals in the Continuing education was mandated in 2003 for license renewal in North U.S.! Our state-of-the-art facility serves Dakota. Nurses are randomly selected for audit annually. During the 2013 the people of the Seward Peninsula and renewal period, a request for audit was generated through the online renewal Bering Straits region of Northwest Alaska, process to obtain a random sample of 192 nurses who renewed for the some of the most breathtaking scenery 2014 – 2015 licensure period and verified completion of 12 contact hours of you will ever see. Rolling mountains, continuing education. The 192 nurses were asked to submit documents to rivers and lakes offer excellent fishing, hunting, hiking and beach acess. verify completion of the required contact hours for the previous 2 years by furnishing a copy of the verification of attendance for the earned contact hours. We are seeking RNs – This number also reflected several license by examination renewal applicants. The majority of nurses chose to meet the continuing education requirements by ER and OB! obtaining the appropriate number of contact hours. The table above illustrates Contact: Rhonda Schnieder, HR the compliance of the North Dakota nurses with the CE requirement. One (877) 538-3142 [email protected] hundred and ninety-one fully met the requirements. Visit www.nortonsoundhealth.org NSHC is an equal opportunity employer affording native preference under PL93-638. AA/M/F/D. We are a Drug Free Workplace and background checks are required for all positions.
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DAKOTA NURSE CONNECTION ■ 13 NORTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
14 ■ DAKOTA NURSE CONNECTION 3 TH 3T 3UITE s "ISMARCK .$ s 0HONE
The Nurse Licensure Compact: The Latest Information
Start Your Nursing Career in The Nurse Licensure Compact Nursing implemented the compact 16 Months* with Augustana's allows a nurse to have one license January 1, 2005. Twenty-four Accelerated Nursing Program in his/her state of residency and states have implemented the This competitively priced, post-baccalau- to practice electronically and compact. The nurses must become reate accelerated option is a full-time plan of physically in other states that familiar with the requirement study designed for students who have a have enacted the Compact. Under of the Compact. An excellent college degree and have completed the prerequisite courses. the Compact license the nurse resource is the National Council Begin your career in nursing, a field that is may practice across state lines State Board of Nursing website at projected to grow by 19 percent between unless restricted by the state of www.ncsbn.org. Click on Nurse 2012 and 2022 — faster than the average of residence. Licensure Compact (Lower right all occupations in the U.S.** Learn more and apply at The Nurse Licensure Compact section) under Nursing Regulation www.augie.edu/fasttrack includes registered nurses (RN) in the U.S. There are many fact * The 16-month Accelerated Nursing Program begins after students and licensed practical nurses sheets and helpful resources at have met the required prerequisites. (LPN). The North Dakota Board of https://www.ncsbn.org/nlc.htm. ** (U.S. Department of Labor, Bureau of Labor Statistics, Jan. 8, 2014)
Prairie Travelers The Premier Healthcare Staffing Solution Outstanding ATTENTION!! Nursing Opportunities MONTANA, NORTH DAKOTA Devils Lake, North Dakota & SOUTH DAKOTA RNs, LPNs, CNAs & Mercy Hospital is part of Catholic Health Initiatives a faith based national health care system with hospitals located in ND and MN. We are a 25-bed critical access hospital located in Devils Lake, ND. We offer a professional Certified Medical Assistants environment with leaders committed to nursing excellence.
Prairie Travelers has provided RN, LPN, Sign On Bonus CNA and Medication Aide travelers to FT OR-RN/Surgery health care facilities in Montana, North Previous OR experience preferred, but not required. Dakota and South Dakota since 2000. Staff $5,000 Sign On Bonus chooses the shifts, dates and locations they ER-RN prefer! Work can vary from single-day, Previous ER experience required. multiple-day or 13-week assignments. Sign On Bonus Prairie Travelers offers: Labor & Delivery – RN Competitive Wages Previous OB experience preferred, but not required Flexible Scheduling 9 Competitive salary and benefit package Expense Reimbursement 9 Relocation assistance Bonus Programs 9 Retirement and 401(k) Plans Varied Work Settings For info, contact: For an application or more information, Human Resources please call 406-228-9541 or visit (701) 662-9717 Mercy Hospital, 1031 7th St. NE www.prairietravelers.com Devils Lake, ND 58301 www.mercyhospitaldl.com [email protected]
DAKOTA NURSE CONNECTION ■ 15 NORTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
Substance Abuse Epidemic Reaches Deep into the Health Care Provider Community
Across the U.S., more than 100,000 regulatory agencies or law enforcement cases involving practitioners stealing health care providers and other health if they catch employees diverting or drugs for personal use. A USA TODAY care professionals struggle with drug abusing drugs. As a result, disciplinary analysis of the National Practitioner abuse, mostly involving narcotics action for drug abuse by health care Data Bank indicated that, from 2010 such as oxycodone and fentanyl. providers, such as suspension of a to 2013, only about 750 physicians Approximately 8,000 people in license to practice, often does not occur nationwide lost hospital privileges or eight states were tested for hepatitis until a practitioner has committed had their licenses restricted for drug or after David Kwiatkowski, a medical multiple transgressions. Although alcohol abuse related misconduct. technician, was found injecting himself there are national databases to track The latest data released by the U.S. with patients’ pain medicine and misconduct by doctors and nurses, Substance Abuse and Mental Health refilling syringes with saline. He infected there is no national database to track Services Administration in 2007 at least 46 patients. This hepatitis misconduct by medical technicians, as indicated that an average of 103,000 outbreak was the third since 2009 in David Kwiatkowski’s case. doctors, nurses, and other health care linked to a health care worker using Health care practitioners engaging in professionals a year were abusing or patients’ syringes (the others were in drug diversion rarely are prosecuted. dependent on illicit drugs. The USA Colorado and Florida). USA TODAY reviewed more than 200 TODAY authors indicate that various Many states do not yet have federal and state prosecutions since other studies suggest the number could mandatory reporting requirements 2008 for drug diversion by health care be far higher. to ensure that medical facilities alert providers, finding just 15 percent of Some states offer special rehabilitation programs for health care practitioners, typically run under the auspices of state licensing boards or medical professional societies. These programs typically aim to enroll 1 to 3 percent of the state’s health care practitioners, but data suggest that these programs are not reaching the minimal Join the estimates of the populations needing assistance. Many addiction experts and policymakers believe Resource Pool that immediate progress could be A rare opportunity to become made by addressing the health care a part of Nursing Excellence practitioner community’s substance abuse problem by better educating • Low nurse-to-patient ratios practitioners on preventing addiction • State-of-the-art facilities and detecting potential impairment • An emphasis on balancing in colleagues. work and life
Copyright © 2014 NCSBN, All rights WE OFFER reserved. a competitive salary based on previous experience NCSBN ADDITIONAL 15% 111 E. Wacker Drive, Suite 2900 added to your base pay to join the Resource Pool. Chicago, Illinois 60601 (This doesn’t include night and weekend differentials.) 312.525.3600 For more information visit http://www.ncsbn.org/ International Calls: +1.312.525.3600 cheyenneregional.org/resource-pool
16 ■ DAKOTA NURSE CONNECTION 3 TH 3T 3UITE s "ISMARCK .$ s 0HONE Ninth NURSING 2014 NCLEX-PN Test Plan and New NCLEX- Annual CONTINUING PN Passing Standard Are Now Effective EDUCATION The 2014 NCLEX-PN Test Plan, based Further information about how the Cruise on the results of the 2012 PN Practice BOD determines the passing standard Analysis, is now in effect. The new PN test can be found on the NCSBN website. plan went into effect April 1, 2014. The *A logit is defined as a unit of test plan, available in a basic format, as measurement to report relative well as detailed formats for candidates and differences between candidate abilities educators, can be accessed on the NCLEX estimates and item difficulties. Test Plans page of ncsbn.org. In conjunction with the release of the Copyright © 2014 NCSBN, All rights new PN test plan, the new NCLEX-PN reserved. passing standard also went into effect April 12-19, 2015 on April 1, 2014. In December 2013, NCSBN
kNurse.c the NCSBN Board of Directors (BOD) 111 E. Wacker Drive, Suite 2900 in o h m re-evaluated the PN passing standard and Chicago, Illinois 60601 T CE determined that safe and effective entry- CRUISE Th in om level licensed practical/vocational nurse Add us to your address book kNurse.c (LPN/VN) practice requires a greater level Day Port Arrive Depart of knowledge, skills, and abilities than was 312.525.3600 Sun New Orleans, LA 4:00 PM required in 2010. The passing standard has http://www.ncsbn.org/ Mon Fun Day At Sea been revised from -0.27 to -0.21 logits*. International Calls: +1.312.525.3600 Tue Cozumel, Mexico 8:00 AM 6:00 PM Wed Belize 8:00 AM 5:00 PM Thu Mahogany Bay, Isla Roatan 9:00 AM 5:00 PM Fri Fun Day At Sea Sat Fun Day At Sea Sun New Orleans, LA 8:00 AM Who says Continuing Education can’t be fun?
Join ThinkNurse and Poe Travel for our 9th Annual CE Cruise. Cruise the Caribbean on Carnival’s Dream (.,&5%).-5R5,!) while you earn your annual CE credits and write the trip off on your taxes! Prices for this cruise and conference are based on double occupancy (bring Exceptional your spouse, significant other, or friend) and start at only $838 per person (not including airfare to New Orleans) A $250 non-refundable per-person deposit patient care is required to secure your reservations. Please ask from the bedside up about our Cruise LayAway Plan! South Central Accreditation Program (SCAP) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Our two locations in Mandan and Fargo have various shift For more information about the cruise and opportunities for Nursing Supervisors, RNs, LPN and CNAs! the curriculum (to be determined by Aug. Be part of a team that is passionate about excellence. 30, 2014) please log on to our Web site at ThinkNurse.com or call Teresa Grace at Please visit www.vibracareers.com and select “Career Opportunities” or contact: Poe Travel Toll-free at 800.727.1960. Ann Draper Talent Acquisition Partner 717-713-7892 [email protected]
DAKOTA NURSE CONNECTION ■ 17 OFFICIAL PUBLICATION SOUTH DAKOTA BOARD OF NURSING
Board Staff Directory Gloria Damgaard, MS, RN, FRE %XECUTIVE $IRECTOR [email protected] / (605) 362-2765 MISSION STATEMENT To safeguard life, health, and the public welfare, and to protect citi- Stephanie Orth, MS, RN zens from unauthorized, unqualified, Nursing Program Specialist [email protected] and improper application of nursing 2EGARDING .URSING %DUCATION .URSE !IDE 4RAINING (605) 642-1388 Med Aide Training education programs and nursing practices, in accordance with SDCL Linda Young, MS, RN, FRE, BC 36-9 and SDCL 36-9A. Nursing Program Specialist [email protected] Regarding Advanced Practice Nursing, Scope of (605) 362-2772 0RACTICE AND .URSING 7ORKFORCE #ENTER South Dakota Board of Nursing Francie Miller, RN, BSN, MBA Officers and Members [email protected] Nursing Program Specialist (605) 362-3545 Diana Berkland #OMPLIANCE %NFORCEMENT $ISCIPLINE President, RN Member, Sioux Falls Erin Matthies [email protected] June Larson Licensure Operations Manager (605) 362-3546 Vice-President, RN Member, Vermillion Robert Garrigan, Business Manager [email protected] Christine Callaghan 2EGARDING .#,%8 %XAMINATION (605) 362-2766 LPN Member, Yankton Adrian Mohr Winora Robles [email protected] Public Member, Sioux Falls Program Assistant (605) 362-3525 Nancy Nelson Lois Steensma, Secretary [email protected] RN Member, Sturgis Regarding licensure verification, renewal, name (605) 362-2760 changes, duplicate licenses, and inactive status. Sharon Neuharth LPN Member, Burke Jill Vanderbush [email protected] Betty Oldenkamp Licensure Specialist (605) 362-2769 Public Member, Sioux Falls Kristin Possehl RN Member, Brookings Mary Schmidt LPN Member, Sioux Falls Licensure Information Jean Murphy RN Member, Sioux Falls License Verification Licensure status for all nursing professions can be verified online, https://www.sdbon.org/verify/ Darlene Bergeleen Registry status for Certified Nurse Aides can be verified online, https://ifmc.sd.gov/lookup.php 2. -EMBER 7ESSINGTON 3PRINGS The verification report generated is considered primary source verification from the South Dakota Board of Nursing.
Criminal Background Checks Required Next scheduled Board of Nursing Criminal background checks (CBC) must be submitted to the SD Board of Nursing Meetings, to be held in Sioux for all new applications for licensure by examination or endorsement on the South Falls, South Dakota: Dakota Board of Nursing cards. Please note: Cards from other agencies are not accepted.
September 11-12, 2014 Verification of Employment: *Agenda items due The Board will periodically audit and request a completed employment verification August 27th, 2014 form.
All licensure forms, the Nurse Practice Act and contact information is available on the South Dakota Board of Nursing Website at www.sdnursing.gov
18 ■ DAKOTA NURSE CONNECTION 3 ,OUISE !VE 3UITE s 3IOUX &ALLS 3$ s 0HONE s &AX
'* LIVING QUALITY (*#(+"(&') ! "
This conference offers nurses and other participants an opportunity to network and learn from local and international scholars on the Humanbecoming School of Thought.
Join us for this unique opportunity to hear keynote speaker, and well known theorist, Dr. Rosemarie Rizzo Parse, share her expertise and reflections on the Humanbecoming Paradigm and Living Quality.
Dr. Rosemarie Rizzo Parse is a vibrant leader with a strong vision to advance the discipline of nursing. Her humanbecoming school of thought focuses on living quality and human dignity from the perspective of patients, families, and communities. She is the author of numerous books including The Humanbecoming Paradigm: A Transformational Worldview released in 2014.
Contact Deb Letcher [email protected] to request the full brochure with full agenda, hotel information, fees, and registration information, or call 605-328-6306.
DAKOTA NURSE CONNECTION ■ 19 SOUTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION Virtual Nursing Care for School Children with Diabetes
Gloria Damgaard, MS, RN, FRE, and Linda Young, MS, RN, FRE, BC regarding less-than adequate care have been cited by parents of children with diabetes attending schools where a “Reprinted with permission from the Journal of Nursing Regulation”. nurse is not present. Parents reported Citation: Damgaard, G. & Young, L. (2014). Virtual nursing care for that some school children have been school children with diabetes. Journal of Nursing Regulation (4),4, 15-24. transported to nursing homes for insulin administration during the school day. Other reports indicated that some Access to safe health care when personnel by licensed nurses in South schools required a parent to come to a nurse is not present is a public Dakota (South Dakota Legislature, the school to administer insulin. Given protection issue facing many boards 2013). The literature shows several the rural nature of South Dakota, of nursing. This is especially true in critical factors that influence the this requirement presented several schools where a nurse is not present to effectiveness of nursing delegation. challenges for parents. In one instance, provide care for children with diabetes. Boards of nursing (BONs) have school officials administered insulin This study examined the safety and jurisdiction over licensed nurses and to children, citing their authority as an effectiveness of a model of care that the nursing care they provide, including exemption to the NPA for gratuitous linked trained unlicensed school the care they delegate (Mueller & care of family and friends. These personnel to registered nurses (RNs) via Vogelsmeier, 2013). Nurse practice acts concerns as well as proposed legislation telehealth technology to delegate and (NPAs) define the legal limits of nursing allowing unlicensed personnel to supervise diabetes care tasks, including practice and, in most jurisdictions, administer insulin were the basis for insulin administration. The study took NPAs or administrative rules refer the South Dakota BON to examine the place from December 2010 to May to delegation, though not all NPAs delegation of diabetes care in schools. 2013, and 5,568 doses of insulin were authorize delegation by registered In 2008, a state bill (HB 1152) administered safely by unlicensed nurses (RNs) (Corazzini et al., 2011). was drafted to provide diabetes personnel. Surveys taken before and The RN’s obligation to provide management and treatment for school after implementation measured the safe, quality care creates distinct children (South Dakota Legislature, perceptions of parents and school challenges when delegating care to 2008). The bill stated that in the personnel regarding the safety unlicensed personnel. These challenges absence of a school nurse, trained and efficacy of the model of care. are amplified for school nurses by diabetes personnel could administer Statistical results showed large degrees budgetary constraints, the lack of insulin and perform other diabetes care. of effectiveness. This study provides qualified nurses, and the increased use The School Nurses Association in South preliminary evidence supporting of unlicensed personnel (Gordon & Dakota strongly opposed allowing regulatory changes for the delegation Barry, 2009). Compounding the issue unlicensed personnel to administer of insulin administration and other are federal and state requirements insulin, while the South Dakota Diabetes diabetes care tasks by RNs. of the Individuals with Disabilities Educators Association strongly Education Act that mandate school supported the proposed legislation The Virtual Nursing Care for Children services for complex student health and formally requested that the BON with Diabetes in the School Setting needs as well as state and school support it. The sponsoring legislator project is a model for having a virtual administrators’ directives requiring did not introduce the bill in committee nurse presence in settings where a nurse school nurses to delegate to unlicensed because of the lack of consensus in the is not present or needs help to meet the personnel (Resha, 2010). Thus, nursing community. The BON agreed health care needs of the population. delegation to unlicensed personnel in the issue would be studied and methods The Virtual Nurse project was inspired schools has become a necessary and for meeting the needs of children by three major concerns for the citizens challenging practice, and school nurses with diabetes in the schools would be of South Dakota: access to care for struggle to meet the expectations of examined. individuals with diabetes in settings their role, maintain their standards, At the same time, assisted living where a nurse is not always present, and comply with their NPAs and other centers and residential care facilities legal barriers to the delegation and regulatory statutes. were seeking ways to help those with supervision of insulin administration, diabetes receive care when a nurse and the cost of sustaining the current School Children with Diabetes was not present. Clients who could not model of care. South Dakota, like many other states, administer their own insulin had to The model was based on the has been examining the management be admitted to a skilled nursing facility. nursing principles of delegation and and treatment of children with diabetes One client was taken to the emergency supervision of trained unlicensed in schools. Numerous concerns department of a local hospital to
20 ■ DAKOTA NURSE CONNECTION 3 ,OUISE !VE 3UITE s 3IOUX &ALLS 3$ s 0HONE s &AX
receive insulin because a nurse was not underserved, meaning these areas what extent is a model of nursing care present. These methods were neither cannot support sufficient health care utilizing a virtual RN linked to a trained desirable nor economically sustainable. services. This represents 71% of the unlicensed provider through telehealth As a result, the BON was challenged to counties (HHS, 2013a). Because of South technology safe and effective in the care of find ways to overcome barriers to the Dakota’s rural nature, nurses cannot be school children with diabetes, including insulin provision of diabetes care in settings present 24 hours a day in all settings administration?” The study objectives where a nurse is not always present. where people with diabetes need were as follows: In response to these challenges, assistance. s Implement and test a model of the BON and the South Dakota virtual nursing delegation to and Center for Nursing Workforce hosted Testing the Model supervision of trained unlicensed conversations on diabetes care The current study was intended to providers caring for school children in two locations. Key stakeholders determine whether diabetes care tasks with diabetes, including insulin participating in the conversations including insulin administration could administration. were school administrators, policy be safely delegated to trained unlicensed s Develop evidence-based makers, physicians, diabetes clinical personnel by a virtual RN. The study quality indicators of safety for nurse specialists, school nurses, and received approval from the Avera Health virtually managed care of school concerned parents. The overall question Institutional Review Board. RNs certified children with diabetes through was: “What possibilities exist to enhance in diabetes education were linked with the evaluation of clinical case diabetes management when a nurse is unlicensed personnel via telehealth management records. not present?” The findings of these two technology to implement the diabetes s Measure the difference in perceived conversations were used to convene medical management plan. The virtual levels of satisfaction, timeliness, a task force to begin planning a pilot RNs could clearly see and speak to the communication patterns, project. What emerged was a model unlicensed personnel and the school responsiveness, and use of linking trained unlicensed personnel with children by means of the technology. technology in the care of school a virtual RN by means of technology to The main purpose of the study was children with diabetes before and manage the care of school children with to answer the following question: “To diabetes. continued on page 22
South Dakota Demographics The geography of South Dakota lends itself to a model of care using NURSES virtual RNs. South Dakota is a large St. Alexius Medical Center in state with an estimated population of Bismarck invites you to share 833,354 (U.S. Census Bureau, 2012). Of in our passion for delivering the 38 counties in western South Dakota, high-quality healthcare by joining 33 are considered frontier (having fewer our team. than 7 people per square mile). South Dakota is one of the least urbanized Nursing Compensation states with more than 50% of South Opportunities Dakotans living in rural areas. Only four counties have more than 30,000 Competitive Salary people. Continuing (ducation Bene¿ts Though South Dakota has the highest Comprehensive Bene¿ts RN-to-resident ratio in the country, Package 1,247.7 RNs per 100,000 residents (U.S. Department of Health and Human 5elocation Assistance Services [HHS], 2013b), most of the 1ursing 2rientation Program state’s rural and frontier counties are /oZ 1urse to Patient 5atio experiencing shortages of nurses and other health care professionals. According to the Health Resources St. Alexius and Services Administration (HRSA), PrimeCare 55 of South Dakota’s 66 counties (83%) are listed as primary care health professional shortage areas. To apply, visit st.alexius.org and click on careers. Furthermore, 47 entire counties are St. Alexius is an equal opportunity employer. considered by HRSA to be medically
DAKOTA NURSE CONNECTION ■ 21 SOUTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
continued from page 21 South Dakota Department of Health, FIGURE 1 after model implementation. and South Dakota Nurses Association. Student Demographics s Formulate a resource guide for The role of the advisory panel was to 15 school nurses, administrators, guide and assist the investigators in and unlicensed providers who the implementation of the project 12 deliver care to school children with and to identify and support policy 9 diabetes. recommendations for regulatory
s Discover the implications of virtual changes to the BON. 6 nursing care delivery for regulatory infrastructure expansion through Participants 3 analysis of research data. A convenience sample was 0 utilized for the study. In the first year, Young Child: Child: Teen: Method administrators of public and private 5 to 7 years 8 to 12 years 13 to 18 years An exploratory pilot project was schools in the central, northeast, and Female = 11 Male = 20 performed in which clinical data southeast regions of South Dakota were collected and a survey was were sent a letter of invitation to conducted before and after model participate. Administrators interested appropriate technology to connect implementation. The project was in participating contacted the principal to the virtual RN. implemented from December 1, investigators, and face-to-face s The school must be able to identify 2010, through May 31, 2013. The meetings were conducted. an unlicensed person who can sample population included school A second method of recruiting partner with the virtual RN for the administrators, parents or guardians of participants was used for the management of students with children with diabetes, virtual RNs, and remainder of the study. The certified diabetes during the school day. trained unlicensed personnel. Survey diabetes educators invited parents of s Informed consent must be obtained tools were designed to measure multiple children who were their clients and from the student and his or variables, including satisfaction, safety, who met study inclusion criteria to her parents or guardian before timeliness, communication patterns, participate. At the start of the study, participation in the project. responsiveness, and technological the principal investigators were proficiency. Clinical diabetes outcome contacted by other parents and school Parents and guardians of children measures were collected by the virtual administrators to request participation. meeting the inclusion criteria received RNs and analyzed by the primary In some cases, administrators were the consent form, and the children investigators. willing to participate, and the parents received an age-appropriate assent were not interested. In other cases, form. By signing the document, the Advisory Council parents wanted their children to parents or guardians voluntarily A core consultant panel, including participate, but the schools declined to consented to their children’s the principal investigators, a clinical participate. participation. nurse specialist certified diabetes A total of 31 students participated: educator, technology experts, school 20 males and 11 females. (See Figure 1.) Measures nurses, and a research consultant Six students were ages 5 to 7; 21 were The measures used to evaluate provided the expertise for project ages 8 to 12; and 4 were ages 13 to18. the safety and effectiveness of the implementation. This panel met nursing model of care were insulin monthly. Additionally, an advisory Inclusion Criteria administration, blood glucose stakeholder council was appointed by The following criteria were monitoring, carbohydrate counting, the investigators. established for inclusion in the study: activity monitoring, and the survey The advisory council met face-to- s The school in South Dakota must before and after implementation. face three times during the course of have students diagnosed with The trained unlicensed personnel the project: initially, at the midpoint, and type 1 or type 2 insulin-dependent documented the care provided in a at the conclusion. The council consisted diabetes. weekly diabetes care log. The logs were of the core consultants of the project; s The student must require insulin submitted to the virtual RNs at the end parents or guardians of children with administration by injection or pump of each week and were the basis for diabetes; primary care providers; school on a regularly scheduled or sliding- clinical data collection for the study. administrators; nursing administrators; scale basis during the school day. Virtual RNs calculated the total and representatives of the South s The school must not have a number of insulin doses administered Dakota Diabetes Coalition, South licensed nurse present every day to by unlicensed personnel and the Dakota Certified Diabetes Educators assist children with diabetes during number administered correctly Association, South Dakota School lunch time. according to the six rights of medication Nurses Association, South Dakota BON, s The school must have the administration (Potter & Perry, 2005).
22 ■ DAKOTA NURSE CONNECTION 3 ,OUISE !VE 3UITE s 3IOUX &ALLS 3$ s 0HONE s &AX
Unlicensed personnel recorded care of children with diabetes. the dates, times, and results of blood s Experience a level of satisfaction that glucose monitoring tests. These records the best care is provided to children were evaluated by the virtual RNs to with diabetes. determine if the times and results of the routine tests were recorded. The virtual Additionally, respondents were Impacting RNs also evaluated the extra blood asked to identify personal goals for the glucose monitoring tests performed and Virtual Nursing Care project. Health Care the actions taken in response to the Nursing at SDSU. results. Procedure The documentation of carbohydrate Essential components of the study counting by unlicensed personnel was included the technology, the virtual Consider a Career in evaluated by the virtual RNs for accuracy. RNs, diabetes education for unlicensed Teaching & Research Virtual RNs also determined whether personnel, clinical interventions, and the Assistant professor and instructor unlicensed personnel performed the task survey. positions now available. independently or needed assistance from a virtual RN. Technology The College of Nursing is seeking full- Activity monitoring was evaluated Each school that met the inclusion time assistant professor and instructor positions. SDSU is a land-grant institution based on blood glucose testing before criteria was evaluated by technology and the state’s largest institution of and after physical education classes or consultants for sufficient network higher education with an enrollment other physical activity as directed by the access and equipment. It was of approximately 12,500 students. diabetes medical management plan anticipated that most schools would The College of Nursing includes CCNE (DMMP). meet the technology demands accredited undergraduate standard, The survey tool measured because a statewide project in the accelerated, RN Upward Mobility and graduate programs with more than 900 participants’ perceptions about safety, 1990s provided Internet access and students at multiple sites. For a closer satisfaction, timeliness, communication computer capability to all public school look, visit our website: www.sdstate.edu/ patterns, responsiveness, and the use districts. Unfortunately, almost all the nurs/index.cfm. of technology for the virtual care of schools were at capacity with network For a full list of qualifications and to school children with diabetes before and utilization, and broadband width was apply, visit: http://yourfuture.sdbor.edu. after implementation. The surveys were not available for the required clarity of Applications will be screened as received developed by the research consultant, the virtual RN connections. Therefore, and will continue to be accepted until and the content was validated by separate Internet connections were positions are filled. the diabetes clinical nurse specialist installed. The technology consultants For more information contact: consultant. Each parent was asked to ordered and installed identical hardware Nancy Fahrenwald, Ph.D., RN, APHN-BC rate the school’s level of ability to care and software for the schools and virtual Dean & Professor for his or her child with diabetes; school RNs. The technology included desktop College of Nursing administrators were asked to rate the video units, laptop computers, Logitech Box 2275 school’s ability; and unlicensed school Quickcam Pro 9000, Polycom PVX v8.0 South Dakota State University Brookings, SD 57007 personnel were asked to rate their own Conferencing Application, Cisco VPN, ability to provide care to the children. and VPN Appliance. Call: (Toll Free) 1-888-216-9806 Email: Respondents rated their ability according The software ensured a secure [email protected] to a five-point Likert scale with 1 as internet connection to the virtual RN SDSU is committed to affirmative action, equal opportunity and the diversity of its faculty, staff and “not at all” and 5 as “very well” in seven at the hub site. The hardware and students. Women and minorities are encouraged to categories: software were designated for exclusive apply. Arrangements for accommodations required by disabilities can be made at TTY (605) 688-4394. s Provide safe, quality care. use with this study, and computers s Obtain immediate assistance if a were locked, so no other access was child experiences complications allowed. Training on the use of the or conditions calling for instant hardware and software was provided decisions. to the virtual RNs and unlicensed s Communicate with an RN who will personnel by the technology supervise medication administration. consultants. Mock calls were conducted s Respond appropriately to questions between the virtual RNs and the schools about diabetes care. to test the technology and network s Make sound evidence-based connections. Backup protocols were decisions in a timely fashion within established in case the technology policies, procedures, and standards. did not work as intended. A help desk s Use technology to assist with the continued on page 24
DAKOTA NURSE CONNECTION ■ 23 SOUTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION
continued from page 23 FIGURE 2 and injecting insulin via syringes, dialing was available for troubleshooting Number of Insulin Doses Administered by and injecting insulin via an insulin pen, technology-related issues. The virtual Injection and Pump and assisting with entering data and RNs could clearly see and speak to the delivering insulin via an insulin pump. unlicensed personnel and the children Virtual RNs conducted the competence by means of the technology. evaluations either in person or through the virtual technology units. In addition, Virtual RNs each unlicensed person received a Injection Insulin Pump The project had six virtual RNs. 2,167 3,402 resource manual entitled Helping the All six were certified as diabetes (39%) (61%) Student with Diabetes Succeed: A Guide educators. Four held a bachelor of for School Personnel produced by the nursing degree, and two were licensed National Diabetes Education Program as clinical nurse specialists and held (2011). a master of nursing degree. All six were employed in two hospitals that Clinical Interventions served as the virtual RN hub sites. A DMMP was completed for each During the project, the virtual RNs a weekly basis. Virtual RNs were student participating in the project. The were contracted and paid to provide available to unlicensed personnel by DMMP detailed the specific needs of the a total of 2,636 hours for their telephone and in weekly telehealth child and formed an agreement among services. Services included training and consultations. the student’s health care team, parent competency evaluation, delegation or guardian, and school personnel to and supervision of diabetes care Diabetes Education for Unlicensed meet the child’s needs. All schools that tasks including insulin administration, Personnel received federal funds were required assisting with the development of Each school in the project selected to have a written plan for children the DMMPs for all 31 students, and one or more unlicensed persons with special health needs according to evaluation of clinical outcomes on to participate. Personnel included Section 504 of the Rehabilitation Act of teachers, school administrators, and 1973 (ADA, 2003). The DMMP form for administrative assistants who agreed this project was similar to the example to be responsible for assisting with the provided by the ADA. The unlicensed management of children with diabetes. personnel were responsible for The American Diabetes Association’s implementing diabetes care tasks (ADA) standardized curriculum in based on the DMMP in consultation Diabetes Care Tasks at School: What Key with the virtual RN. Virtual consultation Personnel Need to Know (ADA, 2008) dates and times were arranged by Advance Your Career provided the basis for the education the virtual RNs and the unlicensed of the unlicensed personnel. The personnel, and consultations took Avera St. Mary’s Hospital and curriculum was developed and place once a week or more frequently if Maryhouse Long Term Care in reviewed by a team of ADA expert necessary. The amount of consultation Pierre, South Dakota are now volunteers and staff. and supervision needed for each offering outstanding career The didactic portion was 10 hours unlicensed person was determined opportunities for New Graduates and taught by the clinical nurse by the virtual RN. The virtual RN and Experienced Registered specialist, certified diabetes educator Nurses and Licensed who served as the clinical expert for the FIGURE 3 Practical Nurses. project. The entire 10-hour program Number of Insulin Doses Administered: 5,569 3428 was video and audio recorded, and 3500 View available positions and unlicensed personnel received a 3000 apply online at: DVD copy and a training manual. 2500
1968 averastmarys.org Additionally, each unlicensed person 2000 1677 received a kit of diabetes supplies to 1460 1500 use in developing competence in (605)224-3279 970 1000 carbohydrate counting and insulin 707 464 464 Avera Values: administration by vial and syringe and 500 0 Compassion by insulin pen. Before implementation, 0 Young Child: Child: Teen: Hospitality one-to-one competency evaluations 5—7 years 8—12 years 13—18 years Stewardship and return demonstrations were Total Doses Administered = 5,569 conducted with each unlicensed person Injection/Pen = 2,167 Insulin Pump = 3,402 EOE/AA Employer M/F/D/V on carbohydrate counting, preparing
24 ■ DAKOTA NURSE CONNECTION 3 ,OUISE !VE 3UITE s 3IOUX &ALLS 3$ s 0HONE s &AX
determined the amount of supervision Survey of Parents and School Personnel based on an assessment of the child’s Parents were mailed a survey health status, diabetes management and consent form before their needs, and the unlicensed person’s level children participated in the project. Reach of comfort and proficiency in providing When the project was completed care. The virtual RN was available or a child withdrew from the study, during the school day by phone and parents received a second survey. Recruit virtual meeting if an unanticipated Nonresponding parents received a consultation was needed. Calls made second mailing. to the virtual RNs outside the routine School personnel received the Retain consultations were recorded in the survey before the study at their school
Winter 2013 I Number 1 I clinical care record, which was submitted addresses. Because the investigators I Volume 11 I to the virtual RNs weekly. The trained then obtained the e-mail addresses of unlicensed personnel also recorded the school personnel, the survey following number of calls made to parents. These the study was e-mailed. A second calls were made in compliance with request was e-mailed to nonresponders. elements of the DMMP. Clinical Data Results Insulin Administration Clinical data and the survey were : Handle with Care Over the course of the project, 5,569 analyzed to evaluate the effectiveness North Dakota Nursing Education Fostering Medically Fragile Children Annual Report
doses of insulin were administered of the model. The clinical data included DS of NURSING SOUTH DAKOTA STATE BOAR subcutaneously by trained unlicensed (61.6%) were administered to children NORTH and personnel to children enrolled in the ages 8 to 12 (Figure 3). Of these Mailed to every nurse project. (See Figures 2 and 3.) The insulin 3,428 doses, 1,968 (57.4%) were was administered by pen, syringe and administered by insulin pump, and in North and South Dakota – over 28,000. vial, or pump and was based on the 1,460 (42.6%) were administered child’s DMMP. The unlicensed personnel by insulin pen. Children ages 5 to 7 The North and South Dakota entered the grams of carbohydrates received 1,677 (30.1%) of the total Board of Nursing consumed into the pumps, and the doses in the study. Of these doses, pumps calculated and administered 970 (58%) were administered by JOURNAL the programmed doses of insulin. insulin pump, and 707 (42.2%) were Unlicensed personnel also administered administered by insulin pen or syringe. To reserve advertising space insulin by dialing the dose on an insulin Only 464 (8.3%) of the total doses were contact Victor Horne pen and by drawing up insulin from vials administered to children ages 13 to 18. into syringes. The virtual RNs reported All were administered by insulin pump. [email protected] the vast majority of students used either Only one administration error an insulin pump or insulin pen, not the (wrong dose) was reported; it 1-800-561-4686 ext.114 syringe and vial method. resulted from the wrong number of Diabetes care tasks implemented and carbohydrates being programmed Our nursing journals reach over 1.5 recorded by the unlicensed personnel into an insulin pump. This error million nurses, healthcare professionals included insulin administration, blood was discovered by the unlicensed and educators nationwide each quarter. glucose monitoring, carbohydrate person who then called the virtual counting, activity monitoring, RN. Appropriate actions were taken, Arizona North Carolina hypoglycemic recognition and and the error did not cause a negative Arkansas North Dakota treatment, emergency glucagon outcome. The District Ohio administration, and hyperglycemic During the course of the project, of Columbia Oregon recognition. The unlicensed personnel emergency glucagon was not Georgia South Carolina documented each of the clinical administered, and no calls were made Indiana South Dakota elements and provided the information to emergency medical services. The Kentucky StuNurse/Nationwide to the virtual RNs weekly. Data were records indicated that 59 calls were Mississippi Tennessee analyzed to determine the safety made to parents during the project. Montana Washington and efficacy of the care provided. A total of 265 calls were made to the Nebraska West Virginia Of particular concern to the primary virtual RNs outside of the prearranged Nevada Wyoming investigators was the safety of consultations. New Mexico delegating insulin administration to unlicensed personnel. continued on page 26 ThinkNurse.com
DAKOTA NURSE CONNECTION ■ 25 SOUTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION continued from page 25 those episodes, 703 (99%) were treated FIGURE 4 Performance of Delegated Tasks by Blood Glucose Monitoring accurately based on the DMMP. In less Unlicensed Personnel 0.7% 0.2% 100 Blood glucose monitoring was than 1% of the cases, either the episode 7.5% 30.0% 19.0% 25.0% performed according to the DMMP, and was not treated according to the DMMP, 80 the weekly records submitted to the or the unlicensed person did not enter virtual RNs indicated that monitoring the data in the weekly log. Unlicensed 60 92.5% 70.0%81.0% 75.0% 99.3% 99.8% was completed accurately 92.5% of personnel recorded 415 episodes of 40 the time. Records showed that 7.5% of hyperglycemia. Nearly all (99.8%) the time the unlicensed personnel did were recorded as accurately treated 20 before and after PE Blood Glucose Tests Performed Glucose Testing Accurate Episodes per DMMP Hypoglycemic Responded to Episodes per DMMP Hyperglycemic Responded to 0 without Assistance Counted CHO not record blood glucose monitoring according to the DMMP. CHO Counting Performed Accurate accurately or documentation was missing. The weekly logs also Carbohydrate Counting tracked the number of blood glucose The virtual RNs reported that 81% monitoring tests beyond those required of the time unlicensed personnel No Yes by the DMMP. An additional 1,737 tests performed carbohydrate counting were recorded. accurately, and 19% of the time Episodes of hypoglycemia and they did not. Of the unlicensed education, sports, and other times as hyperglycemia were also recorded. personnel, 70% indicated that specified on the child’s DMMP. The Each child’s primary care provider carbohydrate counting was completed virtual RNs reported that blood glucose identified specific indications of a independently, and 30% indicated that monitoring was performed by the hypoglycemic or hyperglycemic they needed assistance from the virtual unlicensed personnel 75% of the time. episode for the child on the DMMP. The RN. The investigators believe that activity provider also listed appropriate actions monitoring was not completed and to take in response to the episodes. Activity Monitoring recorded 100% of the time because it The unlicensed personnel recorded The child’s blood glucose level was was not required for all children in their 708 episodes of hypoglycemia. Of monitored before and after physical DMMPs.
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26 ■ DAKOTA NURSE CONNECTION 3 ,OUISE !VE 3UITE s 3IOUX &ALLS 3$ s 0HONE s &AX
Overview of Clinical Data Results in the study. After the study, 28 surveys = .111. However, these items had large Figure 4 represents the results of the were returned for a 56% response (d =1.04) and medium (d = .77) effect clinical findings with the exception of rate. Parents were asked to rate their sizes. Regarding the technology item, insulin administration. perceived level of ability to trust the the unlicensed personnel and virtual Findings from the clinical measures school with care of their children with RNs were the primary users of the revealed 5,568 doses of insulin over a diabetes before and after the study. technology. Regarding the immediate 21/2 year period were administered School personnel were asked to rate assistance item, the absence of a safely by unlicensed personnel. Of their perceived level of ability to provide significant difference in parent responses these doses, 61% were administered safe care of a child with diabetes in the before and after the study should be by insulin pump. Administration by school. The questions on the surveys explored further, though it must be noted pen or syringe and vial accounted for were identical for both groups. that no emergency situations arose 39% of the doses. Only 69 doses were A series of paired-samples t-tests during the study. administered by the syringe and vial were conducted to examine differences Results of the before and after surveys method. in responses before and after the study. completed by school personnel indicated The performance on carbohydrate Only participants who completed both statistically significant differences for counting by unlicensed personnel was surveys were included in the analyses. all survey items. Effect sizes were large of more concern to the investigators Effect sizes indicated large differences in (d >.80) for most survey items. Every than the delegation of insulin responses before and after the study. (See measure for the parent group indicated administration. Carbohydrate counting Table 1.) a large effect size with the exception of is a complex task and is closely Despite a small sample size, results of make sound evidence-based decisions in a connected to insulin administration the before and after surveys completed timely fashion, which had a medium effect because the grams of carbohydrates by parents indicated statistically size (d = .78). For the school personnel, consumed often determine the amount significant differences for all items obtaining immediate assistance if a child of insulin administered. It is clear except the ability to use technology, experiences complications also had a from the clinical outcome measures t(8) = 2.05, p = .074; and the ability medium effect size (d = .71). that trained unlicensed personnel had to obtain immediate assistance if a child the most difficulty with carbohydrate experiences complications, t (8) = 1.79, p continued on page 28 counting, which is a diabetes care task that nurses may delegate in South Dakota. Online RN-to-BSN In the opinion of the investigators, trained unlicensed personnel should have access to an RN for assistance Take the Next Step in Your Nursing Career. with all aspects of diabetes care. Such If you’re a registered nurse wanting to complete a access may require new models of care Bachelor of Science in Nursing, we have an ONLINE program for you. to enhance the presence of the nurse in settings where a nurse is not routinely Classes start in the fall and spring. present. Overall, the clinical data results You can take one or several courses each semester. suggest that RNs can safely delegate and supervise insulin administration after The curriculum builds on previous nursing education. unlicensed personnel complete diabetes We’re affordable! Our tuition is comparable to or less than education training and competency other online RN-to-BSN programs. validation. For more information or to apply: Survey Results Before the study, 31 surveys were usiouxfalls.edu/nursing 605-331-6697 sent to the parent group, and all were [email protected] returned. Completion of this survey was required to enroll a child in the study. After the study, surveys were distributed to parents with two follow-up requests; the response rate was 32.3% (N = 10). Before the study, 50 surveys were sent to the school personnel group, which included administrators and trained unlicensed providers. Completion of this survey was required for inclusion
DAKOTA NURSE CONNECTION ■ 27 SOUTH DAKOTA BOARD OF NURSING OFFICIAL PUBLICATION continued from page 27
TABLE 1 Overall, survey results showed large Results of Paired-Samples t-test: Survey Responses of Parents and School Personnel Before changes in parents’ perceptions of the and After the Study school’s ability to provide safe care for their children and in unlicensed Before After personnel’s perception of their ability Parents to provide safe care for children Item M (SD) M (SD) t(df) p Cohen’s d with diabetes. The survey findings Provide safe, quality care. 3.56 (1.13) 4.56 (.73) 2.68 (8) .028 1.05 complement the clinical outcome Obtain immediate assistance if a child experiences complica- 3.67 (1.22) 4.44 (.73) 1.79 (8) .111 .77 data and lend support to the safety tions or fast-paced conditions calling for instant decisions. and efficacy of RNs delegating and Communicate with registered nurse (RN) to supervise medica- 2.70 (1.83) 4.30 (1.25) 2.85 (9) .019 1.02 supervising diabetes clinical care tasks, tion administration. including insulin administration, to Respond appropriately to parent’s or teacher’s questions about 3.30 (1.70) 4.60 (.70) 2.51 (9) .033 1.00 trained unlicensed personnel using the diabetes care.
Virtual Nursing Care for Children with Make sound evidence-based decisions in a timely fashion with- 3.30 (1.64) 4.60 (.70) 2.62 (9) .028 1.03 Diabetes in the School Setting model of in policies, procedures, and standards. care. Use technology to assist with the care of children with diabetes. 3.33 (1.50) 4.56 (.73) 2.05 (8) .074 1.04
Experience a level of satisfaction that I am doing my best in 3.70 (1.16) 4.60 (.70) 2.38 (9) .041 .94 Limitations of the Study caring for children with diabetes. One of the limitations of this study Rate the extent to which this project met your expectations. -- 4.71 (.49) was the small sample size of students School Personnel with diabetes. The investigators intended the sample size to be Provide safe, quality care. 3.61 (1.13) 4.54 (.58) 3.55 (27) .002 1.04 between 30 and 32 students to make Obtain immediate assistance if a child experiences complica- 3.78 (1.25) 4.52 (.80) 2.39 (26) .024 .71 tions or fast-paced conditions calling for instant decisions. the project feasible given the human and financial resources available. Communicate with RN to supervise medication administration. 3.36 (1.47) 4.50 (.92) 3.32 (27) .003 .93 Safety was also a consideration in Respond appropriately to parent’s or teacher’s questions about 3.32 (1.28) 4.39 (.63) 3.81 (27) .001 1.06 diabetes care. keeping the sample size small. A second limitation was the lack of Make sound evidence-based decisions in a timely fashion with- 3.50 (1.14) 4.25 (.75) 2.63 (27) .014 .78 in policies, procedures, and standards. survey data from the virtual RNs. Despite the limitations, the Use technology to assist with the care of children with diabetes. 3.00 (1.41) 4.18 (.90) 3.45 (27) .002 1.00 investigators believe that valuable Experience a level of satisfaction that I am doing my best in 3.50 (1.20) 4.64 (.68) 3.83 (27) .001 1.17 caring for children with diabetes. information was obtained for Rate the extent to which this project met your expectations. -- 4.21 (.92) evidence-based decision making by nursing regulators.
Implications for Nursing Regulation Access to care in the safest manner What key personnel need to know. The clinical outcome data and possible is a public protection issue Retrieved from www.diabetes. org/ survey results support the Virtual RN for BONs. In this study, virtual nursing living-with-diabetes/parents-and-kids/ model as safe and effective. The study practice, including coordination diabetes-care-at-school/school-staff- also provides preliminary evidence of care, education and training, trainings/diabetes-care-tasks.html for BONs to support policy changes delegation and supervision, and American Diabetes Association. regarding the delegation of insulin evaluation of outcomes was safely (2003). Diabetes medical management administration and diabetes care tasks and successfully implemented. The plan. Retrieved from www.diabetes. in the school setting. investigators believe RN involvement org/living-with-diabetes/ parents- Additional investigation in the is necessary to assure the public that and-kids/diabetes-care-at-school/ area of handling complications and safe diabetes care is being provided. written-care-plans/ diabetes-medical- conditions that call for immediate Nursing regulators need to be open to management.html assistance is needed based on the the exploration of new models of care Corazzini, K., Anderson, R. responses of parents and school that maximize the knowledge, skills, A., Mueller, C., McConnell, E. S., personnel. Carbohydrate counting and abilities of RNs and reduce the Landerman, L., Thorpe, J., & Short, N. also needs more study because it legal barriers to the delegation and M. (2011). Regulation of LPN scope required more-than-anticipated supervision of nursing tasks. of practice in long-term care. Journal assistance from the virtual RN. of Nursing Regulation, 2(2), 30-36. Diabetes training programs may need References Retrieved from http://jnr.metapress. to ensure unlicensed personnel are American Diabetes Association. com/content/e8577q70274200n2/ competent in this task. (2008). Diabetes care tasks at school: Gordon, S. C., & Barry, C. D. (2009).
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Delegation guided by school nursing Gloria Damgaard, MS, RN, FRE, CDE; Gayle Bates, RN; Sheila Freed, RN; values: comprehensive knowledge, is the Executive Director of the South Molly Satter, RN; Marge Hegge, EdD, trust, and empowerment. Journal Dakota Board of Nursing. Linda Young, RN; Casey Bialas; Marilyn Penticoff; Dee of School Nursing, 25(5), 352–360. MS, RN, FRE, BC, is the Nursing Practice Schlotterbach; DanVanroekel; and Erin Retrieved from www.ncbi.nlm.nih.gov/ Specialist for the South Dakota Board of Matthies. pubmed/19553354 Nursing. The authors wish to recognize Mueller, C., & Vogelsmeier, the following individuals for their This article was funded through grants A. (2013). Effective delegation: participation and assistance with this from the National Council of State Boards of Understanding responsibility, authority, study: Rhonda Jensen, CNS, MS, RN, Nursing’s Center for Research Excellence and and accountability. Journal of Nursing CDE; Mary Lobb Oyos, CNS, MS, RN, the South Dakota Department of Health. Regulation, 4(3), 20–25. National Diabetes Education Program. (2011). Helping the student with diabetes succeed: A guide for school personnel. Retrieved from http://ndep.nih.gov/ publications/PublicationDetail. aspx?PubId=97#main Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis, MO: Elsevier Mosby. Resha, C. (2010). Delegation in the school setting: Is it a safe practice? Online Journal of Issues in Nursing, 15(2). doi:10.3912/ OJIN. Vol15No02Man05 South Dakota Legislature (2013). Administrative rule. Delegation of nursing tasks. Retrieved from http:// legis.state.sd.us/rules/ DisplayRule. aspx?Rule=20:48:04.01 South Dakota Legislature. (2008). Legislative session. An act to provide for diabetes management and treatment in schools. Retrieved from http://legis. state.sd.us/sessions/2008/1152.htm U.S. Census Bureau. (2012). Annual estimates of the resident population: April 1, 2010 to July 1, 2012. Retrieved from http://factfinder2.census.gov/ bkmk/table/1.0/en/PEP/2012/ PEPANNRES/0400000US46.05000 U.S. Department of Health and Human Services. (2013a). Medically underserved areas/populations. Retrieved from www.hrsa.gov/ shortage/find.html U.S. Department of Health and Human Services. (2013b). The U.S. nursing workforce: Trends in supply and education. Retrieved from http://bhpr. hrsa.gov/healthworkforce1/reports/ nursing-workforce/index.html A video demonstration of a virtual RN consultation is available on the South Dakota Board of Nursing’s website www. nursing.sd.gov.
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