OR EGON BOA R D OF N U R S I NG SENTINEL [VO.38 NO.1 FEBRUARY 2019]

Evidence-Based Practice: Are You Working at the Top of Your License?

SENTINEL VO.37 • NO.1 • FEBRUARY 2018 1

TABLETABL OF CONTENTSNTENENT

Oregon State Board of 17938 SW Upper Boones Ferry Road Portland, OR 97224-7012 SENTINEL Phone: 971-673-0685 [VO.38VVOO 3838 NO.1NNO.NO O 1FEBRUARY211FEBRUARY20 F FEBRUARYEBRU 202201901 ] Fax: 971-673-0684 WhyW the Practice Act Does NotNo www.oregon.gov/OSBN ContainCoC a List of Easy Answers...... Answswers...... 4

EvidenEEvidvidence-Basedvidenidence-Basedce Based Practice:PracticePracactice:tic Office Hours: AreArre YouYoYWouo WorkingW rk g att the hehf Top To of Monday - Friday Yourur Liceicense?icc nse?..se? ...... 6 7:30 a.m. - 4:30 p.m. DivisionDiD visionisioniissi iioono 48: 48 RNs RNRNsN Teaching TTeachinTeacTeaeachchinc hih ngg a 10 Board Members: DesignatedDesigignatedgnatednatnaatteeed CarCCare eeP Provider ProvidPProProvideovivideidderr ......

Kathleen Chinn, RN, FNP DisciplinaryDiD ip inary CaseCase Studies...... Studiesdii ..... 11

Annette Cole, RN I ReceivedR ddAS A SubpSubpoenaSu b from theh OSBNOSBN: WhatW Wh Doesoes Adrienne Enghouse, RN ThatThhat Mean? MMean ...... 12 Michelle Chau, LPN You AskAsk, We AAnswer...... swer...... 14 Colin Hunter, JD, Public Member 2019201 LegislativeLegisla e SessioSession Update....te...... 16 Sheryl Oakes Caddy, JD, MSN, RN, CNE RedesignedR gned OSBNN WebsiteWe table of Debuts...... Debuts 17 Bobbie Turnipseed, RN, CONTENTS Board President APRNs: Information You Can Use...... 18 Ryan Wayman, Public Member 22 Board Disciplinary Actions William Youngren, CNA, Board 26 2019 Board Meeting Dates Meet the Team...... 20 Secretary 27 2019 Board Members NA/MA Certification Rule Ruby Jason, MSN, RN, NEA-BC Changes Delayed Until Executive Director August 1...... 26 Barbara Holtry Tips to Help Your Application Communications Manager Process...... 28 Editor of the Sentinel

pcipublishing.com Changes to Oregon Health Plan Advertisements contained herein are Created by Publishing Concepts, Inc. (OHP) Prescriber Enrollment David Brown, not endorsed by the Oregon State 0RESIDENTsDBROWN PCIPUBLISHINGCOM Implementation – For Advertising info contact Board of Nursing. The Oregon State ,AURA7EHNERs    Action Required...... 29 Board of Nursing reserves the right LWEHNER PCIPUBLISHINGCOM ThinkNurse.com to accept or reject advertisements Strong Demand for Nurses in this publication. Responsibility for EDITION 41 Continues in Oregon...... 30 errors is limited to corrections in a SENTINELsubsequent issue. VO.38 • NO.1 • FEBRUARY 2019 3 NURSING PRACTICPRRACTICERACTICRA CEE

Byy OSBN ExecutiveExecucuti Director Ruby Jason, MSN, RN, NEA-BC WHY THE PRACTICE ACT DOES NOT CONTAIN A LIST OF EASY ANSWERS

TheThhBe BBoBoaBoardoardard ddr rrecereceivesreecceiveivei ves alaalmalmost lmostmomososttdt dailydai ilily inquiriesiinnqunqqu iiirii iees ofoof“Isitinof, ff“I, “Is“II it in i carecaare supportivesup ortiveive to, oro restorativere of, life and well-being, and my scope to dod XYZ,” or,r, “M“MyMyM employere pllo expectsxp c mme to includinginc ddi the performanceperforma of additional services requiring doo XYZ,X Z,Z, andandIdon’tthinandIdon’tthink dId I don’tdon ’’tth t think h itttisinmyscope”tis is is in nmyscope”n my y scope.” scscopescoopppe. educationed ati n andnd trainintraintrainingng that are recognized by the nursing NursesNu sessesareoftenconfu are oftenoffdbhfhff confusedconfuusededdbd by by the tthhhe purpose puppurpurpururposeposeppoossese offh thet professionp ofess n as proper too beb performed by nurses licensed under NurseNu se PracticeAct(NPA)IftheactdoesnotlistitemsPPracticePtiAt(NPA)PiA(NPA)ctic tice Act Actt( t(NPA)Ifth (NPA). (NPA)N . Iff thehhe e actaca ttd doesdod oeeess notnnoototlit tlitit listli l sttit itemsite ite ORS 678.01078.0100toO to ORSORRS 678.410 and that are recognized by withinwithiiith n thehfh scopescopeofanursethencopeofanursethenwhatpurposed offthfhf a nurse, thenh hhd whatwha hthat purposepurp u p ddoesdoeoe it rulesrul of the Board.” TheTh rules of the Board are identified in serve?rve? When does a nurseu se knowkknnoww whenwhen theythe t have vviolated OregonO egon AdministAdministrativetra Rules (ORS) Chapter 851. theth prapracticet ce act?act? So, what doesdoees that mean? The practice of nursing is To understandund r tand thee pypracticeractice acttf fullfullyfully, ll there mumustt firstrst not associatedd withw defined tasks. Nursing practice is be an understandingerstandding offhl the legal ldfi defindefinitionsdefi regregardingard ng the the analysiss of the response the individual has to their practicece of nursing,rsining,g, aandnd how theth language l inn thethep practice current statestatate of health that brought them into contact act reflectss those definitionsfinit ons andddd describesescr bes the actions of withh thethhe nurse.n This requires the nurse to have her/his nursesn to implement legal practice.cti ThisT understandingunder ownwn asassessment and plan of care for the patient, which is basbased upon: can include interventions authorized by a Licensed 1. Whileile nursesses undergondergo educationducatio and ttesting to Independent Practitioner (LIP) whose practice focuses becomeme a nurse, the actual act l ability abilit for an individualindividuind on diagnosisg . However, the LIP plan is separate from to call themselveselves a “nurse”” is a legall l title authorized the nursing plan of care. The nurse is required, under the by the state in which the individual is licensed based requirements of the practice act, to have their own plan on the legislatively authorized duties and authority of for the patient’s overall response. the state Board of Nursing. In Oregon, this authority To illustrate, consider the following example: is found in Oregon Revised Statute (ORS) 678.150. A 36-year-old woman with four children, all under the 2. Achieving nursing education and successful age of 10, has just been given a terminal diagnosis. While completion of the NCLEX examination do not the woman is undergoing treatment authorized by the guarantee that the legal title of “nurse” will be offered LIP, the nurse reviews the woman’s human response and to an applicant for licensure. The Oregon State prioritizes her care, focusing on support of the woman’s Board of Nursing (OSBN) has the authority to deny priorities regarding her current state of health. Is the licensure to any candidate not meeting the standard woman able to focus on her own care needs when she is of being a “duly qualified” candidate. more concerned about what will happen to her children 3. It is through this legal titling—and only through this when she dies? Is her priority caring for her own needs or titling—that an individual may practice nursing and those of her children? It is the nurse who assesses these call herself/himself a nurse. Removal of this titling by issues, and plans the care and the intervention. the OSBN, or failure to renew the license, prohibits Now let’s look at how the NPA describes the legal an individual from the practice of nursing, seeking practice of nursing in this situation by some examples of employment as a nurse, and using the title “nurse.” statements found in the practice act: ORS 678.010 (8) states that the practice of nursing ORS 851-045-0060(2)(a): The RN shall base RN means “diagnosing and treating human responses to practice on current and evolving nursing science, other actual or potential health problems through such services sciences, and the humanities. as identification thereof, health counseling, and providing ORS 851-045-0060(3)(c)(G): Evaluating the data

4 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING NURSING PRACTICE

from the comprehensive assessment to identify problems or cist must gather information regarding the context of care risks presented by the client. Develop reasoned conclusions in which nurses work in the facility to identify the prob- that identify the client’s problems or risks, develop a client- lems and risks associated with the plan for informatics centered plan of care based on analysis of the client’s implementation, evaluate the plan and then modify the problems of risks that establishes priorities in the plan of plan as the needs of the client change or if the system is not care, identifies measureable outcomes, and that includes workable in the context of care. nursing interventions prioritized reasoned conclusions. ORS 851-045-0060(5): The Nurse Informaticist ORS 851-045-0060(5): Advocate for the client’s right is accountable to communicate the needs of the client to receive appropriate care, including client-centered care to those responsible for the overall system. The Nurse and end-of-life care that is respectful of the client’s needs, Informaticist is accountable to respect the practice of choices, and dignity. Communicate the client’s choices, nursing and assure that the needs of the nurses with concerns, and special needs to other members of the health regard to their ability to care for their patients in developed care team. within the implementation plan. There is not the need to As shown by these examples, the NPA describes address every concern, however, the Nurse Informaticist how the nurse shall implement the legal definition is accountable for knowing that the system works in each of nursing. The practice act also has a statement context of care in which it is used, including the appropriate describing the expectations of nurses with regard to education. Each individual nurse is accountable for being co-workers, the use of social media, working with able to utilize the informatics technology within their own Certified Nursing Assistants and unregulated support context of care, but it is the nurse informaticist who shall staff, and the required communications with other be held accountable under the practice act to provide the members of the healthcare team. documentation that they abided by the practice act in the The bottom line is that because nurses work in a wide implementation of the system or the Board has the legal variety of clinical settings and non-clinical settings, authority to take the same sanctions against the license the practice act must be applicable to all nurses in all of the Nurse Informaticist as the nurse providing direct settings. This is known as the “context of care.” The patient care. context of care refers to the environment in which the Clearly, if the practice act was a “laundry list” of nurse works, the nurse’s role within that environment, tasks, these could not be applicable to all the contexts the regulations governing the practice setting, and of care in which nursing has a role. Although many the abilities of the client. The same statements in the nurses do not provide direct care, all nursing practice is practice act apply to every nurse, in every setting, in related in some way, directly or indirectly, to the safety every role. No nurse with an Oregon license is exempt of the public. In our examples, the nurse caring for from the practice act, even if she/he never directly the 36-year-old is accountable for her safe care, and the care for or encounter a patient in their practice. Note Nurse Informaticist is accountable to assure the nurse that the NPA is written with the term “client” rather has informatics systems that aide in communicating than patient. For a staff nurse, the client is the patient. the care provided through the practice of nursing. For a Chief Nursing Officer the client is the nursing So how does a nurse determine if a task, role, delivery system in their facility. For a nurse working in or intervention is within scope? Each nurse has informatics, the client is the nurse at the bedside who is a different scope-of-practice based upon their using the informatics system to deliver care. knowledge, skills, abilities, and competencies. To Let’s review the same statements in our patient example determine your scope please access our interac- above and relate those statements to a nurse working in tive Scope-of-Practice Decision Making Tree at informatics: https://osbn.oregon.gov/OSBNScopeTree/Choice1. ORS 851-045-0060 (2) (a). The Nurse Informaticist aspx. must apply current knowledge of the practice of nursing In the next edition of the Sentinel, we will review the and the technology of the system used by nurses to assure statements in the Nurse Practice Act that provide the that the nurses are able to implement their practice. legal situations when a nurse is not practicing within ORS 851-045-0060(3)(c)(G): The Nurse Informati- the practice act.

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 5 NURSING PRACTICE

By OSBN RN/LPN Education Policy Analyst Nancy Irland, DNP, NMNP, CNM EVIDENCE-BASED PRACTICE: ARE YOU WORKING AT THE TOP OF YOUR LICENSE?

Do you remember your first impression of nursing? evidence, and clinical expertise (Stevens, 2013). Today, Perhaps it was placing a hand on a fevered brow, or a crisp, nurses are valued members of interdisciplinary teams. white uniform and black-ribboned cap. Maybe it was a Regulatory bodies expect nurses to go beyond being doctor’s “handmaiden.” Has it ever been a professional kind and caring. The opinion of the Oregon State whose trusted decisions are guided by research? Board of Nursing is that a nurse who works at the top Previously, nurses didn’t make decisions based on of her or his license is a nurse whose trusted decisions research (Polit & Beck, 2006). Very little nursing are guided and validated by research and evidence. research was available. In addition, getting our hands In this article we’ll take a look at the way things on any research was often a futile effort that included used to be before EBP. We’ll review the history of a drive to the closest university to search the card this approach to patient care, define what we mean catalog hoping to find something useful. Then, we by EBP, and consider the benefits of EBP to us both would pay a fee to photocopy the article, take it back professionally and personally. Finally, we’ll look at to the manager, and hope he or she would consider ways to incorporate EBP into nursing practice in spite the change. Of course, it needed physician approval, of limits on time and energy and perhaps see the too. As you can imagine, validation of good ideas did concept with new eyes. not seem worth the effort. The way we’d always done things worked just fine and was based on trusted, The Way Things Used to Be authoritative opinions. Where do we get the courage to do what we do? Over time, everything changed. White uniforms, As nurses, we’re asked to do things to people that caps, and the handmaiden role were out; nursing most others wouldn’t think of doing: stick things research and accessibility to it on the internet were into their bodies, push powerful drugs into their in. The public began demanding accountability for veins that could stop their hearts, and so forth. Why safety and quality in . With that came the aren’t we scared to do that? (Okay, sometimes we are phrase, “evidence-based medicine,” which has been a little scared). Those of you who have come into the implemented in nursing as, “evidence-based practice.” profession in the last 20 years have had the benefit Evidence-based practice (EBP) has changed the field of of grounding your practice on a growing body of nursing. It marks a shift among healthcare professionals evidence that didn’t exist years ago. Before EBP, I from a traditional emphasis on authoritative opinions was often scared; after EBP I felt more confident to an emphasis on data extracted from prior research in what I was doing. I could carefully evaluate and studies as well as patient preference. No more research to confirm that the practices I was asked doing something because doctor X said so. to do had been validated as beneficial by research In spite of the benefits, the mention of EBP makes studies. Putting babies to sleep on their backs many nurses raise their eyebrows in disdain. This was one of those changes that seemed intuitively could be because of a misunderstanding that EBP wrong (wouldn’t they choke on mucus at the back requires bedside nurses to generate new research of their throats?), but the research was powerfully in addition to everything else they must do. It is in its favor. important to recognize that EBP is not the generation Until the US Department of Health and Human of research. Instead, it is our standardization of Services established the National Institute of Nursing healthcare practices by basing them on science, best Research in 1993, standards of care were based

6 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING NURSINGNNURSING PRACTICE PPRACTICE

primarily on tradition or the establishededd practicespra epidemiologistpidemiologistti in theththUitdKiheh UnitedUniU itedd Kingdom namname named of a more renowned hospital down thehee road. OurO ArchieAhiChi Cochrane Cchranech hraanane was w s becomingbecomibe becoomi iingavocalcriticoftg a vocvocal l critic itifthiti of f theth main sources of evidence included whateverwhatever wew factct that most medicaldidicalcaltreatmentswal l treatments tretreeaatmtm were w not basbased learned in school, textbooks in the hospitalhoospitalpital library,libralib y onn a systematicy reviereviewvi of clinical evidence. For the recommendations from our moreree experienexperiexperienceded obviousbviousbvviouousouus reasonsrea asoasonsons citedtee above, even physiciansans didn’t colleagues, or providers’ opinions.s. Withouttho the havehavethetimeorthereshavve tththehhee timetimimemmeeo oror ththee resourcesres to review an adequatedtt internet, we weren’t likely to validateate theth reliabilityreliabilitility numbernuumbber o off researchreeseaarcharchh articlesartia articleticles to inform theirth practicepractice.p ct of our practice if nothing “bad” was haphapphappeningin Mr.Mr.CochranemadethedecisionthatacolleMChMrMr.. CochraneCochCocC chrachhdhdhllhhrananene mademadmmaaddthddde dthdiithte theheheedecis decisiondeci ththathatt a collection cocollectcollecollectio ll tition because of it. We had confidence inn thehe status quoquo. offfs systematicsystetemmattic reviewseviiewws shouldshs houldhouldbecreatedh ulduldd beb e created—oncreated—one-stop- atttedd—— ne-stop-p As such, because many changes or innovationinnovationsnnovat s in shoppingppingpgping for reseresearchresear thatthahathahatat wouldwwowouul guideg d besbestb beest ppractipracticespractices.ti . practice came only by word of mouth,uth,, it wawas ooftenen WithW hhthattheCochrahh thtthat,hat,at t, theth hCe Cochrane CCochrac h neeeCollaborationwas CollaborationCllbCollCCollab oollabll bborborrationatation tittiononn was wawass born.born terrifying to adopt them, though wee ddidid.d ThisThisisnottosaythatcurrentmedicineconsidersThiThisisnottosaytha iisittth not tt too says y thattha that tttdii currentcuurrentrrreent t medicinemedicinme didiicinecinecin iinneece considconsidersconccoonside ideerss the t I still remember an event that happenedapppened befobefore evidencevidenceencee while hl traditional d all medicinemedi m dddddicinecine ddidid iidd notnnot.tP ProvPProvideProviderss we obstetrical nurses were providedd withw formal haveh e beenn using evidencevidenncef foror mmedmedicalica decision-madecisiodecision-makingng neonatal resuscitation classes. I wass the nurse for manymanynynyyearsWhathas yearsyearsWhathaschangedistheearsrs Whathatattth hashhh ass changedchangechha a ged i is theth availabilityavai abilitbility assigned to assist a pediatrician with a planned of moremomor evidence.e. This reduces d ththe need for educatedducauc resuscitation for a baby whose mother wass havingh guessesessan and annd putsp thehbl responsibility responsibilitresponsibi on us too knowkknnow about an emergency cesarean section for fetal distresstresess (an thee evidencence andan to incorporate it iintoto practicepra whwhen old term). The pediatrician was new to our hospitalospitpital indicated.ted. Cochraneran ReviewsRReviewi s providep ovid meta-analysesmeta-a and just out of residency. Because the cesarean was that do the timtime-consumingi work of assessing and emergent, he had raced in from his office; there was comparing a broadbr d swathswat of studiesstu s aroundaroun the world,world no time to discuss our resuscitation ahead of time. too helpelp determineerm ne the strengthength andd reliabilityreli ofo thet The surgeon placed the purple baby on the researchh andd associatedasso itd outcomes.tcome warmer. She was floppy like a fish, with glazed eyes. Between chest compressions performed by another Defining Evidence Based Practice nurse, the pediatrician quickly inserted an airway So, let’s get back to defining evidence-based practice. into the apparently lifeless baby. I had drawn up As we’ve said, it marks a shift from a traditional some epinephrine and was ready to inject it. The reliance on authoritative opinions to an emphasis on pediatrician said, “Pour it into the tube.” data from prior research and studies. We’ve noted I was speechless. We traditionally gave epineph- that EBP is not the generation of new knowledge; it rine as an injection. But, the only time we were is the application of research. EBP blends research supposed to question a doctor’s order was if an evidence with clinical expertise and encourages ordered medication was on a patient’s allergy list. individualization of care by including patient With my heart pounding, I did as he asked, hoping I preferences when indicated. Too often, allowing for was not killing this already-stressed newborn. individualization of care is overlooked, although that You know the rest of the story: the baby turned is one of the fundamental pillars of EBP. pink and cried loudly. I had just witnessed evidence Evidence-based practice has been traditionally that epinephrine in an ET tube worked without conceptualized as a three-legged stool (Sackett, drowning the baby. When I asked the physician for Rosenberg, Gray, Haynes, & Richardson, 1996) a physiological explanation, he was kind enough to that depends on: 1) the best clinical evidence; 2) explain, and it all made sense. Still, I would have professional expertise and decision-making; and, 3) preferred to see the literature for myself before doing client preferences. Like all stools, however, the floor on it. Later, when we began taking official neonatal which the stool is placed determines whether or not resuscitation classes I saw the evidence. we feel safe sitting on it. Clearly, not everything we do in healthcare is quantifiable or researchable. Albert History of Evidence-Based Practice Einstein is credited as saying, “Not everything that At about the same time, around 1971, a visionary counts can be counted, and not everything that can be

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 7 NURSING PRACTICEPR TICETICCEC

countedcoun edd counts.”ountsunts.” ” ThisT is wherewhewhere the Benefitsts ofo Evidence-Basednce- d Incorporating Evidence on a Daily levelslevelselss of evidence come me in. inn.nResen Research eseearchrch Practice Basis evidence is notnotbit binary;bina y; iit iti isisn’tsnn ’tt eithereitheitither ith Our patientspatienpatient benefitefit best whenwhw Why, then, do so many nurses “evidence-based”evidence-id ased”or“non-evidence-ased”d orr “non-evidence-““non-evidencennon-onn--evidence-evievvidddenenncc wew practicece withwwi theesu support ofo resist the push to incorporate based.”baased.” There’s a continuumc of science and shareshshare the evidencevidenevidencece evidence-based practice in their “stronger”tronger”roonggeger” andd “weaker”“weaker“weake evidence with them.hem. ThisThThis alsoalso benefitsbenefitbenefits work? Two of the top barriers cited thathathatt validatesvaalialiddatetes whetherwwh whethhethher or not a us perpersonallyersonallyy EvidenceE v dence reducesre s are, “not having enough authority treatmenttreatmentiseffectivetreeeaatmtmmennttis is efeffeceffective.ctivective fearf arranduncer andd unceunceruncertaintyt n inn botboth to change patient care procedures,” QuestionsQtibtthQQuueststiotiionsio s aboutabou ut thetth hlihequali qualityqual qqliquuaaal li thethh patientp tit and ana d in ourselves.urselves and, “having insufficient time on off theth heree researcresearch,eseearceare rchchh worwoworordingordind ngg of o theth hhe ItIiIt iinincreancccrerreasesases con conficonfidence.fidenc Evidenceviden the job to implement new ideas,” researchr rch question,q, anand thethhe ooutcomesutcomut m can coonfirmnfirm oouru inintuitionuitionon and (Griffiths, et al, 2001). ofo theeresearchmustallbeeeresearchmustallb reresearcheaa hhll mustm stt all bbeblde evaeevaluated evaluatevaluaaluaaaluatedtted giveggiviveveve usu the h supportsu p too makemake Evidence-based practice is a withwitith otherotherresearchontherhh research o on ththethehe sassamemee needednneneedeeeeeddeddeddh changechachanges.hhananges Itth helpsps us accepacceptacce t practice based on knowing. It’s topicpic beforebefofdidforeforeorewedecideto,orewedecidorewedecidet we decideddd to,t o,o “sit“si“sitton onon changchhhaanngenggegean and kekeeppim improvingproving care.care. working intentionally, confirming theth stool,”sto l” and trusttrust theth evidence.evidence. It helhhelpsl devdevelopeloplop a standard oof that your beliefs and decisions CochraneCocCochrane reviewsviewsdothatforus.ewsdothatfo do thattthhathahatttforu forffooor us. uss. care. EvidenceEEvidence givesves us a defensedefeen about patient care are grounded OurO r clinicalc nical reasoningeasoningoningningiild includeincludes for our actiactionscti s if questionequestioned.ed A in research. I would suggest that individualizingindiv ual ing ththehe science wiwith nursenurse whwhosee practice is vavalidatedalid a nurse can incorporate EBP every whathat thisthi patientpatient wantsts and d what w withwith solidolid research dedevelopseve a day by bringing a questioning might be best ini thishis situation,situituuationo afteraftafte a r stellarellar reputation as somssomeone to approach to her practice, validating the patient learns the pros andan cons. be trutrusted. her practice with applicable research, sharing those findings with patients and colleagues, and perhaps changing hospital policies when necessary. The Cochrane reviews can confirm the strength of the evidence to determine if one’s standards of practice are scientifically supported by the three-legged stool of EBP. Imagine how powerful it would be if each nurse on your unit adopted one protocol or practice per year, to validate. A protocol without a good answer for whyy it was done could be either: 1) validated without needing change; 2) improved and tracked for better outcomes; or, 3) discarded as not helpful, and replaced with a new protocol, with the support of evidence. All of this, of course, requires the support of management. Sometimes the support of providers is also necessary.

8 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING NURSING PRACTICE

Summary REFERENCES Griffiths, J.M., Closs, S.J, Bryar, R.M, Hostick, T., Kelly, S., & Cooke, J. (2001). Barriers to The ancient phrase, “dare to research implementation by community nurses. Br J Community Nurs. 2001;6(10):501–510 know,” was first used by the Roman Polit, D. F., & Beck, C. T. (2006). Essentials of : Methods, appraisal, and utilization. (6th ed.). Philadelphia: Lippincott Williams & Wilkins poet Horace in 20 BCE. It is even Sackett, D. L., Rosenberg, W.M., Gray, J. A., Haynes, R. B., & Richardson, W.S. (1996). more important now, with patients Evidence based medicine: What it is and what it isn’t. BMJ. 312(7023):71–2. doi: 10.1136/ demanding that we know why we bmj.312.7023.71. Stevens, K. R., (2013). The impact of evidence-based practice in nursing and the next big ideas. do what we do. The information and OJIN, 18(2). Retrieved 12-12-2018 from http://ojin.nursingworld.org/MainMenuCategories/ evidence is at our fingertips. If you ANAMarketplace/ANAPeriodicals/OJIN/ don’t know the evidence behind the TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html treatments or standards you follow, look them up. Patients should be able to trust that the decisions we make are supported by the best research and scientific evidence available. More importantly, each nurse should take pride that he or she is working at the top of his or her license. Be that kind of nurse.

Dare to Know. Suggested Research Data Bases Cochrane Library: http://www.update-software. com/publications/cochrane/

Pubmed: http://www.ncbi.nlm.nih.gov/ entrez/query.fcgi?DB=pubmed

UpToDate: http://www.utdol.com

eMedicine: http://www.emedicine.com

National Guideline Clearinghouse: http://www.guidelines.gov

Clinical Evidence: http://www.clinicalevidence.com/ ceweb/index.jsp

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 9 NURSING PRACTICE

By OSBN RN/LPN Practice Policy Analyst Gretchen Koch, MSN, RN DIVISION 48: RNS TEACHING A DESIGNATED CARE PROVIDER

The use of designated care providers was driven by receive or accept monetary or other compensation for the emerging human immunodeficiency virus (HIV) executing the medical order. epidemic and related acquired immunodeficiencyy syndrome (AIDS) epidemic of the 1980s andnd 1990s.90s. The New Rule CChangeChang s resulting in-home care provided to personsersonsns diagnodiadiagnosedgnosed withth A mendmentmentsts s to DivisionDi 48 of the Nurse Practice Act HIV and/or AIDS was most oftenftenn provpprovidedd by a ssamee-e (Oregon Administrativetrativetive RuRules Chapter 851, Division sex partner or by a close friend.iend.nd. It is importantrtant to note 48) became effectivetive on JanuaryJJanunuary 1, 2019. Those familiar that during this time in OreOregon,regon, same-sex marriage was withw Division 48 will noteno thathat thet rule language has constitutionally banned.ed. SamSame-sexS domesticc partnershippartnep beenbeb streamlistreamlinedreaml ned anddh shortenedtened byb reremoving redundant status would not becomecomme legal untilu FebruarFebrruaryruaruauaryaryy2008 20082008. language.language.anguage In aadditaddiaddition,dd on, rulesles that ccontacontainedtain standards for The changes mademadade to OregonOrego lalaww ((OregonOregonegon Revised Re careca providers oviders and ana praprpracticetice settingsettin werewerre removedr as the Statute 678) inn 19971997 createdeat a llegal meanseans for thethe BoardBoaBoardrd hholdss no jurisdictiojurisdictjurisdictionalnal authorityhority oveovover either. home health nursenuurserse andan the hospice nursee toto enengageengage ge AllAllRNpractice-relateAAllRNpracll RN practice-relatedpractice-relate standardstandardsdards weweree rreworked to with a client’st’s same-sexame-sex papartner,er,,s signifisignificantantttht other,tthheerrr, oror directlyddirdireiirecrectlyctt identifyiden thehe RN’sRN s rresponsibilityponsibilitysibi to: friend, in thehe exact mannermanner asa they would a member • Adhere to Division 45 as thehe foundationfoufounnd for of the client’snt’ss immediateimmed family.fammiily.y. ThisThT hishhiis 1997 19997 statutorystatuto t nursing practicectice wwhwhenhen tteachingeachinghing a deddesignated change wass the culminculminationculm tii n of yearsyeearsars ofofkdbf workwoorkrkk donedodoneon by care provider;provideide the Oregonn Associationat for HomHomeHoommeme Ca CareCare.aree.. • EnsureEns competencycomompetencypyy in i one’sone’ne’s own executexecexecutionio of the Today, withw thh acuteacu e healthheaheal thh managementmanagem anaganagemg mentttoc occurring occurrincurringingg medicaldicalcalorderpriortld order o prpprior toto teachingteaceachingg its performancepeperffo outside off traditionalcaresettingsadvancementstraditionatraditiotraditional cacarcaree settings,settingssetettttintttiniinnggsg , advanceme aadvddvavananncencemmentsentntst totothecareprtot thehehd care ree prprovider; provider; in technologiesloogiesie bringingbring ggt thehe deliveryeliliifd ofofpr procedurduresurress • Verifyfyy that hat ththe hhe person person fforrw whomom theh ordorderer is writt- and treatmentsmentsnts to theth homehome setting,tting,ttingtingg, and shiftshifting shishiftinngg ten hash s ddirdirerectlyrectlytly choschosen h en theirthei designatedsignated cacaregiver; populationn demographiddemographics,emographics,emogra hCh851D48, CChapterhap rr851Division48 8518 D Divisioniv s 4 4848— oro for or the ththe ssituationituationtuation whenwh w en thet e designationesignation hash been the rules govgoverningverningerningRNswhoteachdesignatedcareerning RNRNs whwhoo teachteach designateddd carcarere mademmaaadedede byb aathir thirdththiirird d partypa y on behalfhalf of thet person providers—is—is as relevant assw whenw en ititwasfirstaddedttw wasassfirstaddedsfirstaddedto firstfifitdddt added tto requiringrreeqququiringuuiirinngn ththe th ororder,der, determineete mine that the ththird party the Nurse Practiceracctice Act. holdsho ds theh llegal autauthorityhoritorit to make the ddedesignation; • InformInf thethe careca e providerp vider that theythhey may not What It Does teachttea anothernother personpe on how to executeexeccut the order, Division 48 identifiesdenentifies levels of safefe andand acceptableacceptablebl mayy not transferransans their authorityy tto execute the practice for the registeredegigistered nurse (R(RN)RN) wwhoo teachteacheseacheses orderr too anothera ther person, andd mmay not receive the person designateded by,b or on behalf ofof, the pepersonrson or aacceptcce t monetary or otherotheher compensation for requiring care, how to executeexexecute the medical orderorder.d executing the medical ordorder;order Division 48 rules are commonlyommmmonly used byy theth RN in • GenerateGenera and providede rretrievable step-by-step the private home when an immediatemmediediate familyly member,m mber instructionsnstruct offhow howow tthe medical order is to be such as a parent, grandparent,nt, spospousespouse,se, partner,artner, performederformmedd on the person requiring care; child, or sibling, may not be availablele to executeexecut a • DetermineDetermetermine thet need for future evaluation of the medical order for another family member. Innsuch such care situation based on nursing judgment; and a situation, a friend or neighbor who is chosen by • Fulfill all mandatory reporting responsibilities. the person requiring care may be taught by the RN to perform the ordered procedure as if they were a To access a copy of Division 48, visit the OSBN’s family member. The qualifying factor is that the RN website at www.oregon.gov/OSBN and click on “Nurse must verify that the designated care provider does not Practice Act.”

10 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING NURSING PRACTICE

By OSBN Investigations Manager Jacy Gamble, Investigator Karen Russell, and Nurse Investigator Heather Johnson, BSN, RN DISCIPLINARY CASE STUDIES

Although disciplinary action taken by the Board is a matter of public record, the identity of the nurses referenced in this article will remain confidential. CASE STUDY #1 liters of oxygen. According to the chart notes, the Certified Medication Aide (CMA) was employed as resident’s oxygen saturation increased to 93 percent a medication aide in a care facility. The Board received with the oxygen. a report that CMA failed to apply a resident’s Fentanyl Board staff asked Nurse A to compose a written patch as ordered, but documented that the patch had statement detailing the allegation. When Board staff been applied. CMA stated she was withdrawing the reviewed the statement there were discrepancies patch from the medication cart when she was asked to between the statement and the chart notes. Board give another resident his pain medication and forgot to staff requested Nurse A attend a personal interview to follow up on the Fentanyl patch. CMA reported she review the discrepancies. had told one of two charge nurses that she may have When Board staff discussed the details with Nurse documented a medication not administered, however, A, it became clear that the nurse did not complete the neither could corroborate her statement. proper documentation surrounding the event. Nurse According to her personnel records, CMA had been A stated that a full respiratory assessment was done; previously counseled and disciplined by her employer however, there was no documentation to substantiate several times over the last few years for issues related the nurse auscultated the resident’s lungs before or to documenting a task not completed and failure to after oxygen was initiated. In addition, there were follow care plans. During the investigative interview, no chart notes stating the physician was contacted CMA acknowledged the Board’s concerns that there regarding a change in condition, or that the nurse appeared to be a pattern of poor practice habits. obtained valid orders to start the resident on oxygen. The Board determined that CMA’s actions violated Nurse A discussed with the patient whether she the Nurse Practice Act and that public discipline would like to be transferred to the Emergency Room was warranted. CMA agreed that she had engaged to be assessed; the resident declined, but this also in conduct unbecoming a nursing assistant related to was not charted. In addition, Nurse A failed to put dishonesty, failure to follow care plans, jeopardizing the resident on alert charting, per facility policy, for client safety, documenting care not provided, a change in condition. entering inaccurate data, and failing to communicate Nurse A admitted the shift was very busy, and he information to the supervising nurse. The Board had minimally charted in order to finish his shift on accepted CMA’s Stipulated Order for Probation with time and continue to care for the other residents he Conditions, which included the requirement to take was assigned to. Nurse A was educated by Board staff education courses relevant to the violations. that if you do not document all of the interventions you have completed, the Board considers that said CASE STUDY #2 interventions were not completed. Nurse A was employed as a A agreed that he had violated the Nurse Nurse at a nursing home in a temporary charge nurse Practice Act by failing to document the assessment of position. It was alleged that Nurse A had failed to the resident, failing to notify the resident’s provider, assess a resident who was experiencing shortness of failing to obtain an order for interventions prior to breath during the night shift. According to Nurse implementing them, and for misrepresenting the facts A’s documentation, the resident was assessed for of the event in a written statement to Board staff. shortness of breath at approximately 0400. At the The Board accepted a signed Stipulated Order for time of assessment, the resident’s oxygen saturation Reprimand from Nurse A, who took accountability was 84 percent and the resident was placed on two for his Nurse Practice Act violations.

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 11 NURSING PRACTICE

By OSBN Investigations Manager Jacy Gamble I RECEIVED A SUBPOENA FROM THE OSBN: WHAT DOES THAT MEAN?

When the Oregon State Board of Nursing (OSBN) citation granting the Board the authority to issue a conducts an investigation, Board staff use many tools subpoena. The subpoenas are legally enforceable, during the investigative process. One of the most which means that failure to produce the requested common resources at the Board’s disposal is the records or to request an extension by the deadline authority to issue subpoenas for various records. can result in the Oregon Department of Justice When a Board investigator determines that taking action to compel the recipient to produce the records are needed to conduct the investigation, they requested documents. can issue a subpoena. The subpoena is directing The OSBN is a HIPAA-exempt entity, so there is you (either the custodian of records, a supervisor, or no need to redact any information in the documents. Human Resources staff) to provide specific records, It is important to remember that the subpoenas are which can be personnel records, patient records, for documents only. You do not need to appear internal investigative documents, or many other personally. Please pay attention to the due date for types of information. Please read the subpoena the requested records. closely to ensure that you provide all of the requested All investigations conducted by the OSBN are information. Each subpoena contains the legal confidential. With every subpoena issued, the Board

12 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING includes a cover letter that describes the methods available to submit the documents. The cover letter also requests the recipient to keep the subpoena confidential—do not discuss them with other members of your staff. There are several reasons that the receipt of a subpoena should be kept confidential: • The issuance of a subpoena does not mean thatthe licensee or certificate-holder identified on the subpoena has done anything wrong, or has or will receive discipline from the Board. • Unless there is a restriction on the license or certificate listed on the OSBN website, the receipt of a subpoena itself does not mean that they are restricted from practicing nursing or are a danger to the public. • The integrity of the investigation can be compromised if the recipient of the subpoena shares that information with other staff. • Revealing the existence of a subpoena can also cause worry and stress to the licensee or certificate-holder in question, or promote the spread of rumors amongst other staff if they find out that the Board is asking for records related to them or their co-workers. If you receive a subpoena and have any questions about it, the name and contact information of the assigned investigator is located on the subpoena and cover letter.

SENTINEL VO.38 • NO.1VO.35 • FEBRUARY • NO.2 • MAY 2019 2016 13 NURSING PRACTICE

By OSBN RN/LPN Practice Policy Analyst Gretchen Koch, MSN, RN YOU ASK, WE ANSWER

QUESTION: I am an RN who practices at an assisted intervention is supported by facility policy. living facility. Is changing a colostomy bag a taught task • The RN assigns the intervention to an LPN who or a delegation? possesses competencies to safely perform the intervention. Again, this could occur for the client ANSWER: The answer may be neither – and before we with a fresh post-op colostomy where a focused have that discussion, know that the NPA does not of the surgical wound/stoma regulate procedures. The NPA regulates the licensed is indicated. This could also occur for the client nurse’s engagement in nursing practice in all settings who presents with an injury or trauma to an where nursing practice may happen. established stoma. It is also important to know that the concept of • The RN teaches the client how to perform “delegated task or a taught task” is flawed. The manner their own maintenance colostomy care, how to in which a RN incorporates any given intervention recognize problems with the stoma and bowel into a client’s nursing plan of care, and who the RN activity, and what to do if problems arise. The chooses to perform said intervention, depends on far RN ensures that clear instructions were accessible more than the intervention itself. and available for reference. The RN’s clinical decision regarding who will • The RN teaches a family member how to perform an intervention within the nursing plan of perform maintenance colostomy care, how to care will occur with the safety and well-being of the recognize problems with the stoma and bowel client being front and center. The decision will be activity and actions to take when problems arise grounded in the RN’s comprehensive assessment of (if allowed in the setting). The RN ensures that the client and will be shaped by the context of care clear instructions were accessible and available of the setting. for reference. As a refresher, the RN-level comprehensive • The RN teaches the client’s designated care assessment is the collection and in-depth analysis provider (per Division 48 of the NPA) to perform and synthesis of client data from which the RN: maintenance colostomy care, how to recognize 1) identifies and prioritizes client problems/risks, problems with the stoma and the client’s bowel and 2) identifies expected outcomes related to activity and actions to take when problems arise the respective identified problems/risks. The RN’s (if allowed in the setting). The RN ensures that prioritized client problems/risks and their respective clear instructions were accessible and available outcomes are then presented in the RN’s a plan of for reference. care where specific interventions designed to address, • The RN teaches an unlicensed assistive person mitigate, or prevent the identified problems/risks are how to provide maintenance colostomy care communicated. (i.e., emptying the colostomy bag, cleaning of The RN has several options for implementation of the ostomy site, and changing the bag that does interventions based on the assessed not adhere to the skin). When RN determines needs of the client and what is allowed in the practice the UAP to be safe in their performance of setting. Options include: the intervention(s), the RN may then assign • The RN Implements the intervention directly performance of the maintenance colostomy for the client. This would occur for the client care to the UAP. The RN ensures that clear with a fresh post-op or new colostomy as nursing instructions were accessible and available for assessment of the client and their surgical wound/ reference. stoma is indicated. This would also occur for the The RN’s plan of care would indicate who is client who presents with an injury or trauma to responsible for performance of the intervention. an established stoma (or related bowel area). The While delegation process is an RN practice privilege RN ensures that the engagement in the activity/ that can occur in community based setting (such as

14 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING NURSING PRACTICE

assisted living facility), it doesn’t fit with maintenance Most MAs have received formal medical assistant colostomy care. Delegation is a care delivery option training and have graduated from a training program for the performance of a nursing procedure. Colostomy that meets nationally accepted standards. Some care is considered a regular function of personal MAs pursue national certification and/or registration grooming, hygiene, toileting, and elimination (i.e., an through private certification and registration activity of daily living). organizations. Those who do so successfully carry With the above discussion, you can see why the the title of certified medical assistant or registered answer to the question “Is changing a colostomy bag a medical assistant. As you know, attaining certification taught task or a delegation?” could be neither. in one’s area of focus communicates to peers and the public that one has pursued additional education and QUESTION: Who regulates certified medical assistants in has met nationally accepted standards. Oregon? Are they under the Oregon Medical Board? MAs functions under their own job description and carry out the work that is assigned to them by ANSWER: In Oregon, there is no state agency or health- the physician, the , and possibly related licensing Board that regulates medical assistants the RN. The scope of the RN’s practice when (MA). This means that the MA is an unregulated working with an MA, and the standards of care the health worker and there are no legally regulated RN must adhere to when working with the MA, training requirements or competencies for the person are those identified for working with the unlicensed who uses the title of medical assistant, certified assistive person. This means when assigning and medical assistant or registered medical assistant. The supervising MA work, the RN must adhere to those Medical Practice act does not cover certified medical specific standards contained within Division 45 of assistants; this is a common misconception. the Nurse Practice Act.

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 15 LEGISLATION By OSBN Communications Manager Barbara Holtry 2019 LEGISLATIVE SESSION UPDATE

Since the 2019 Legislative Session began January 22, several bills have been introduced that could affect nurses or other health care practitioners. The following is a brief description of several other bills (either House Bills or Senate Bills) that affect licensees, the Board itself, or healthcare in general:

• HB 2188 & SB 128—Allows the Board of Medical relicensed as CNMs. The new CNMs will be able Imaging to issue a permit to supervise fluoroscopy to hold prescriptive privileges; they will practice to qualified advanced practice registered nurses. nursing as they do now as NPs, just under a dif- • HB 2230—Limits the amount of overtime ferent license type. The change will bring Oregon nursing staff who work in correctional facilities into alignment with the rest of the country. Ore- may be required to work. gon is currently the only state that doesn’t license • HB 2303—Deletes the requirement that pseu- CNMs. doephedrine be classified as a Schedule III • SB 66—Removes barriers to LPN licensure by controlled substance. allowing applicants who have graduated from • HB 2698 and SB 136—Removes the 10-day the US Air Force Licensed Vocational Nurse pro- supply limitation on prescriptions for certain gram (and are so designated on the DD214 form) controlled substances issued by CRNAs. to take the NCLEX-PN exam. The change will • HB 2722—Includes nurse practitioners, physician also apply to endorsement applicants who were assistants, and naturopathic physicians in the licensed in other states based on recognition of definition of “attending provider” who has military education. primary responsibility for treatment of person • SB 67—Since ambulatory surgical centers are diagnosed with a debilitating medical condition. defined elsewhere in statute, the bill removes it as • SB 64—Changes several sections of the Nurse a definition from the Nurse Practice Act. It also Practice Act (found in ORS chapter 678) to reflect changes the term ‘conscious sedation’ to ‘mod- that the Oregon State Board of Nursing (OSBN) erate sedation’ and ‘’ to ‘general anes- licenses nurse practitioners and clinical nurse thesia.’ The language changes were developed in specialists, rather than certifies them. The change collaboration with the Oregon Health Authority, will help differentiate between state licensure and the OSBN, and various stakeholders. national certification for advanced practice nurses. • SB 130—Authorizes school nurses associated The bill also changes several sections of ORS 678 with school-based health center to engage in the to reflect that the Board approves nursing educa- practice of telehealth. tion programs, rather than accredits them. The • SB 5523—This bill appropriates the Board of term “accredited” is reserved for those organiza- Nursing’s budget for the 2019-21 biennium. tions approved by the state to accredit institutions Although the Board is an Other Funded agency of higher education. The Board is authorized only (funded through licensing fees and not the state’s to measure a school’s nursing education program’s General Fund), it needs Legislative approval on ability to meet the standards developed in Board how to spend its funds. rule, not to certify the quality of the school itself. The session is scheduled to end by June 21, 2019, • SB 65—Based on requests from nurse midwives, although that date could be extended. To learn more the OSBN submitted this bill to create a stand- about the above bills or bills that have been introduced alone advanced practice license type entitled since press time, visit the Legislature’s website certified (CNM). All currently (www.leg.state.or.us/bills_laws) or contact your licensed nurse midwife nurse practitioners will be district legislators.

16 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING TECHNOLOGY Byy OSBOSBNOSBN CommunicationsCommunicationsmunicaicationscations ManagManagerMananaga Barbarara HoltryHolHooltr /OS/OSSBNSBSBNBN Redesigned OSBN WebsiteWbitDbWeWebebsitebsbsibbisitesisiteiittete DebutDebuts DDe ut ts

After months of hard work and testing with AlthoughAlthouA h thehehbithe webswebsitew eb iitee address adaddddressddddrdre remains remreremaineemmainsainsins thethe hundreds of licensees and students, the Oregon same,me,m the lookok is entirelytirelyirelyelyellThhly newnew.new.ew.w. TheTThhhee new nneewew homephomepagehom paag State Board of Nursing (OSBN) is pleased to is didividedivided intontofour“buckets”ofinfornto four “buckets”“bbuuucckkekets”ettt”s” ofo f information:informiinfnffoformo ati announce the launch of its newly designed website: Applicants,liccants, Licensees,i ensees,eses, Resources,RResResouResource ResourcResourcesRdEdesourceurceces, andan d EdEducation.Education duuca n www.oregon.gov/OSBN. Links withinw thosehosossee bucketsbuckeucketkt have beenbeb en placedpla As of February 12, users will notice the site is accordingng to userer preference.ppreferfererence.e. more intuitive and accessible, as well as being easier to The redesignesignsigngnn of ththe OSOSBN website is the firfirstfirs navigate and find the information they need. The new step: a new onlineline licensingcens ng ssystem interfacinterfinterface is site design also includes a site-specific search engine, planned this summer thathat will l incorporate incorpincorpor almost so users have more information at their fingertips. all applications for licensure or certification and In addition, the site design is in accordance with the make the application process easier for everyone. latest State of Oregon website standards, using plain Watch future issues of Sentinell for more language and mobile-device friendly templates. information.

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 17 ADVANCED PRACTICE

By OSBN Executive Director Ruby Jason, MSN, RN, NEA-BC APRNS: INFORMATION YOU CAN USE

Practice Act Revisions for Advanced Practice • Eliminate Division 56, since all APRN license Nurses: Work continues on revising the three existing types now have the ability for prescriptive rule divisions pertaining to each advanced practice authority, and incorporate those requirements nursing (APRN) license type and prescriptive authority and standards into the new licensing and scope- (OAR 851, Divisions 50, 52, 54, and 56). The goal is of-practice/standards-of-practice divisions. to prevent redundancy and/or discrepancies in language • Providing timeline for the attainment of the and practice standards. An advisory task force has met DNP as the entry-level education for licensure five times since the Board authorized this change to the as a Nurse Practitioner. NPA in June 2018. While only the members of the task There is no timeline for completion of the force may consider the content of the rules, the meeting complex work. is open to the public, and there is time on the agenda for Material Risk Form: Per OAR 851-056-0026 (6) comments from non-task force members. The major (b)(B), a Material Risk Notice is to be provided to recommendations of the task force thus far are: and signed by patients before treatment of intractable • Create new divisions based on subject instead pain commences. During the review process of the of license type. The three new divisions APRN divisions, it was noted that this is not required would address the approval of education by Oregon Statute based upon the passage of SB programs, licensing, and scope-of-Practice/ 800A by the legislature in 2007. The statute does Standards-of-Practice. require that the clinician should discuss with the

18 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING ADVANCED PRACTICE

patient the known risks and realistic practice for RNFAs is linked to the attestation as required in OAR 851- benefits of opioid therapy, and the license as the , not 031-0088. While the APRN may patient and clinician responsibilities the Advanced Practice license as an manage the patient at the advanced for managing therapy. Although NP, CNS, or CRNA. The role of the practice level pre- and post-surgical the specific form is not required, RNFA is not covered in advanced procedure, the role of the RNFA the content of the discussion and practice education to the extent may only be practiced by adherence documentation of such remains the required by the Board. Although to the rules of the Board. same. The form that is currently historically Nurse Practitioner Oregon Acute Opioid Prescribing available on the Oregon Medical Nurse Midwives have scrubbed in to Guidelines: These guidelines were Board website addresses all the assist in surgical procedures and this published in October 2018 and issues to be covered between the is covered in the basic Midwifery endorsed by the Board of Nursing. patient and the clinician providing education, this educational These guidelines can be accessed on the clinician with assurance that all exposure is not the equivalent of the OSBN website at https://www. the required discussion parameters the education as an RNFA. If the oregon.gov/OSBN/pages/advanced_ have been covered. While it is APRN or the RN wishes to bill or practice.aspx. This link also advisable to continue using this be identified in the patient’s chart as provides information for advanced form, it is not required by Oregon an RNFA, the rules of division 45 practice nurse regarding the DEA, statute, and even though Div apply and the Board must receive Buprenorphine FAQs, and various 56 remains unchanged for now, the appropriate forms and education other topics of interest to the APRNs. statutes supersede the rules of the Board. The APRN Advisory Task Force will review this language with an eye toward accurately reflecting current Oregon law. Advanced Nurse Practitioners Working as Registered Nurse First Assists (RNFA): Oregon Revised Statute 678.366 required the Board of Nursing to adopt rules establishing procedures for the recognition of registered nurses to become RNFAs by receiving additional certification through nationally recognized professional organizations. The rules for obtaining an RFNA certification recognized by the Board are listed in OAR 851-045- 0060(12) under the Scope and Standards for Registered Nurses and Licensed Practical Nurses. The Board has provided further information on the OSBN website with the Interpretive Statement entitled, “APRNs in the Role of Registered Nurse First Assists.” In both statute and rule, the level of

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 19 STAFF PROFILES

By OSBN Communications Manager Barbara Holtry MEETMEET THETHE TEAMTEAM The Oregon State Board of Nursing is much more than just, “that place where you get your license renewed every two years.” To achieve our mission of public protection, our team is hard at work approving educational and training programs, providing outreach presentations to employers and licensees, answering scope-of-practice questions, investigating possible violations of the Nurse Practice Act, maintaining our online systems, and, yes, issuing licenses. In each issue of the Sentinel, we’ll introduce you to two of the team members who make everything work

DEENAD WHITEHURST of 2018. “It’s been a huge culture shock to work for OSBN Licensing Technician the state instead of private industry, but I like it. I have Deena Whitehurst has a very supportive manager and co-workers,” she says. worked in healthcare- As a licensing tech, she focuses on advanced practice related occupations almost nurse and prescriptive authority applications—new her whole adult life. “I can’t applications and renewals. She is also a backup for seem to stay away from it!” reactivation application processing. “There are a lot of An Oregonian since age requirements for advanced practice nurses, and I like to five, Whitehurst grew up help them navigate the process.” in Turner the oldest of She says she enjoys the team approach in her five kkids. “They called me ‘Miss department and the collaborative focus on the agency’s Mature’ in my family,” she says with a laugh. “But, I was mission of public safety. “It’s all about the people we’re voted the Class Flirt in high school, so go figure!” serving, which includes the public.” After working at Salem Hospital as a nutrition Whitehurst is an avid hiker and takes four to six specialist for a few years, she became the Events and hikes a year throughout the state. “Jefferson Park is my Demonstration Coordinator at Waremart (now called favorite—absolutely beautiful. South Sisters is my next WinCo). She coordinated charity and holiday events goal.” She also loves gardening and spending time with with music and costumed employees for eight years, and her family, which includes attending her granddaughters’ worked extensively with the public and her coworkers. sporting events. “They always try to wear me out, but I “It was probably my most enjoyable job ever. The staff wear them out! I’m lucky to have everyone so close by.” was happy all the time. It was a great experience.” Whitehurst returned to Salem Hospital as a NAKEITA WEST Pharmacy Tech for seven years, and managed to attain “When I saw the job listingg, her Associate’s Degree in business from the University I thought, ‘Let’s try it!’ Whyy of Phoenix while working 50 hours a week. Wanting not, right?” says Delaware to try something a little different, she moved to native Nakeita West about Performance Health Technology, as a medical claims her cross-country move processor. She quickly became a software trainer for to join the Oregon State medical providers’ office staff and spent several years Board of Nursing as an on the IT side of healthcare. Whitehurst did desktop Investigator in 2016. support and provider relations while based in Salem, While growing up and then helped Bend Memorial Clinic implement their in Laurel, Del., West EPIC medical charting system. always wanted to become a Her four granddaughters brought her back to the doctor. But when she attendedddDl Delaware State S west side of the state, and she joined the OSBN in April University for pre-med and nursing, she decided that

20 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING STAFF PROFILES wasn’t the right path for her. “When We were stationed in state buildings, the investigations. Best of both worlds. And I re-considered how long I’d have to capitol, and the governor’s mansion,” she we have a great group of people here.” be in school and the debts I’d have to explains. For a time, she was assigned As an investigator, West receives incur, I decided it just wasn’t practical. to the Court Division, and toured cases regarding potential violations of But I was still interested in healthcare.” cour thouses across the state. She also did the Nurse Practice Act, and gathers She enrolled instead with Delaware a lot of motivational speaking. “I loved it. information to determine what Technical Community College and I never had to fight anyone; I was always happened. “It’s about keeping the studied to become a paramedic. able to talk people down. Everybody public safe and increasing their trust “I loved riding along in ambulances makes bad choices sometimes. You just in us, but also about helping licensees on calls,” she recalls. “I liked the fast have to learn from them.” become better practitioners,” she pace, but ultimately decided that wasn’t After West was injured on the job explains. “We’re not here to get people for me, either.” in 2011, she was on light duty until she in trouble. The more important part of She worked for a few years as a retired a year later and switched to the my job is preserving trust between the technician in a doctor’s office and as a Delaware Bank Commissioner’s office licensees and the public.” CNA in Milford Memorial Hospital’s as an investigator. Shortly thereafter, Until last year, her daughters used to Labor and Delivery department. At she decided it was time to take another be involved in competitive cheerleading, that point, pregnant with her first child, leap, this time to Oregon with her which meant not a lot of free time. she decided to take a very different husband and four children. “We were always traveling from one turn—she joined the Delaware Capitol “I like this because there’s always competition to the next,” she says. Police, went to the police academy, and something different, and I learn “Now, we have more time to explore served as an officer for almost 11 years. something new every day. It combines Oregon a bit. We need to see Crater “It’s separate from the state patrol. my original love of healthcare with Lake this summer.”

SENTINEL VO.36 VO.38 • •NO.3 NO.1 • • AUGUST FEBRUARY 2017 2019 21 DISCIPLINARY ACTIONS Actions taken in October, November, and December 2018. Public documents for all disciplinary actions listed below are available on the OSBN website at www.oregon.gov/OSBN (click on ‘Look Up a Nurse or Nursing Assistant’).

Effective Name License Number Discipline Date Violations Heather A. Agee 200541538RN Revocation 11-14-18 Using intoxicants to the extent injurious to herself or others,and failing to answer questions truthfully. Sara A. Arnholtz 200242813RN Voluntary 12-12-18 Violating a person’s rights to privacy and confidentiality,and failing to answer Surrender questions truthfully. Zoey D. Berggren 201041669RN Probation 12-12-18 12-month probation. Failing to accurately document nursing interventions in a timely manner, entering inaccurate documentation into a health record, and failing to conform to the essential standards of acceptable nursing practice. Donald L. Bons 200742846RN/ Probation 12-12-18 Six-month probation. Violating a person’s rights to privacy and confidentiality, failing 201391732NP-PP to maintain professional boundaries, and failing to conform to the essential standards of acceptable nursing practice. Debora N. Bowden 093006290RN Probation 11-14-18 12-month probation. Obtaining unauthorized medications Allen R. Brewer- 000034579CNA Revocation 12-12-18 Using intoxicants to the extent injurious to himself or others, and failing to cooperate Nielsen with the Board during the course of an investigation. Natalie N. Brizuela 201407784RN Probation 11-14-18 12-month probation. Inaccurate recordkeeping, entering late information into the record, and failing to conform to the essential standards of acceptable nursing practice. Danitra R. Brown 200942023RN Probation 10-10-18 24-month probation. Failing to conform to the essential standards of acceptable nursing practice and using intoxicants to the extent or in a manner injurious to herself or others. Heather T. Brown 200842210RN Probation 11-14-18 24-month probation. Practicing nursing while impaired, and using intoxicants to the extent or in a manner injurious to herself or others. Kristen K. Buckner Nurse Imposter Civil Penalty 11-14-18 $5,000 civil penalty. Practicing nursing without a license. Kelly S. Carey 201602397LPN Suspension 10-10-18 Minimum of 14-day suspension. Failing to cooperate with the Board during the course of an investigation. Mary J. Carlsen 094006957RN Probation 11-14-18 24-month probation. Failing to conform to the essential standards of acceptable nursing practice, and failing to document nursing interventions accurately and in a timely manner. Niamh Charles 083040591RN/ Voluntary 12-12-18 Failing to take action to preserve client safety based on nursing assessment and 200850151NP Surrender judgment, and failing to answer questions truthfully. Shawn C. Clark 200930226LPN Reprimand 11-14-18 Incomplete recordkeeping, performing acts beyond his authorized scope, and failing to conform to the essential standards of acceptable nursing practice. Sueann M. Coe 201505653CNA Revocation 10-10-18 Violating the terms and conditions of a Board Order. Kristina A. Crellin 201210150CNA/ Revocation 10-10-18 Entering inaccurate documentation into a health record, falsifying data, and failing to 201220109CMA document medications as administered. Cody L. Crow 201408709RN Revocation 12-12-18 Using intoxicants to the extent injurious to himself or others, unauthorized removal of drugs from the workplace, using his role as a nurse to defraud a person of their personal property, and failing to answer questions truthfully. Molly C. Dahlen 201242555RN Probation 11-14-18 24-month probation. Failing to document client care information, falsifying data, obtaining unauthorized medications, and failing to conform to the essential standards of acceptable nursing practice. Betty L. Dahnke 089006165RN Reprimand 11-14-18 Failing to maintain professional boundaries, and failing to conform to the essential standards of acceptable nursing practice. Victoria D. Deeks 079011396RN/ Suspension/ 11-14-18 One-year suspension, followed by 36-month probation Using intoxicants to the extent 079011396N3 Probation injurious to herself or others. Gretchen L. Dennison 090005158LPN Voluntary 10-10-18 Performing acts beyond her authorized scope and beyond the level of nursing for which Surrender she is licensed. Martha M. Desantis 000012280CNA Voluntary 10-10-18 Engaging in abusive behavior toward coworkers, entering inaccurate information into a Surrender health record, and failing to implement the plan of care developed by the RN. Melissa A. Dixon 201391083CNA Voluntary 11-14-18 Impairment. Surrender Margaret L. Doyle 201601074LPN Suspension 12-12-18 Minimum of 14-day suspension. Failing to cooperate with the Board during the course of an investigation.

22 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING Effective Name License Number Discipline Date Violations Warren E. Duncan 201810340CNA Probation 11-14-18 12-month probation. Misrepresentation during the certification process, using intoxicants to the extent injurious to himself or others, and failing to conform to the essential standards of acceptable CNA performance. Donna Emley- 079011393RN Civil Penalty 10-12-18 $2,500 civil penalty. Practicing nursing without a current license. Blackmore Carmen M. 201810339CNA Probation 11-14-18 24-month probation. Using intoxicants to the extent or in a manner injurious to Engelhardt herself or others. Natasha A. Fletcher 201503042CMA Probation 11-14-18 12-month probation. Failing to administer medications as ordered by a LIP, falsifying medication administration records, and documenting the provision of services that were not provided. Jennifer J. Gill 201408596CNA Suspension 10-10-18 Minimum of 14-day suspension. Failing to cooperate with the Board during the course of an investigation. Christopher J. 201408406CNA Voluntary 11-14-18 Using intoxicants to the extent injurious to himself or others. Gillespie Surrender Wendi S. Gonzales 201394807RN Voluntary 12-12-18 Resorting to fraud during the application process for licensure. Surrender Elizabeth L. Graham 201701535CNA Reprimand 10-10-18 Engaging in abusive or threatening behavior toward a co-worker and engaging in unacceptable behavior towards clients. Destony M. CNA Applicant Application 11-14-18 Failing to cooperate with the Board during an investigation. Hammond Denied Mindy R. Hanna 201402014LPN Revocation 10-10-18 Entering inaccurate information into a health record, the unauthorized removal of medications from the workplace, demonstrated incidents of dishonesty, and failing to cooperate with the Board during the course of an investigation. Mindy R. Hanna 201402014LPN/ Application 12-12-18 Unauthorized removal of medications from the workplace, and failing to answer RN Applicant Denied questions truthfully. RN Applicant Patricia S. Hanna RN Applicant Voluntary 11-14-18 Using intoxicants to the extent injurious to herself or others. Withdrawal Dustin J. Harris 201130039LPN Reprimand 11-14-18 Demonstrated incidents of dishonesty and failing to conform to the essential standards of acceptable nursing practice. Jennifer N. Hilley 201607646LPN Probation 12-12-18 24-month probation. Practicing while impaired, and using intoxicants to the extent or in a manner injurious to herself or others. Claudia D. Hudson 201402509CNA Revocation 12-12-18 Violating the terms and conditions of a Board Order, using intoxicants to the extent injurious to the CNA or others, and failing to answer questions truthfully. Danielle T. Jones 201243365RN Probation 11-14-18 12-month probation. Failing to dispense medications, failing to document, and failing to conform to the essential standards of acceptable nursing practice. Rowena R. Jones 201130001LPN Reprimand 11-14-18 Performing acts beyond her authorized scope, failing to take action to preserve client safety, and failing to conform to the essential standards of acceptable nursing practice. Lucille D. Judish 085075395RN Probation 11-14-18 24-month probation. Falsifying data, failing to clinically supervise person to whom an assignment has been made, and failing to conform to the essential standards of acceptable nursing practice. Dee A. Karl 200511846CNA Reprimand 11-14-18 Failing to respect a client’s dignity and rights, and failing to conform to the essential standards of acceptable CNA duties. Johannan E. Kelly 200943299RN Voluntary 12-12-18 Practicing when unable due to a mental impairment. Surrender Kevina L. Kemp 000044666CNA/ Revocation 11-14-18 Willful misrepresentation during the certification process, and abusing a person. 201020107CMA Tiffany S. King Nurse Imposter Civil Penalty 11-14-18 $5,000 civil penalty. Practicing nursing without a license. Jaimi L. Labonte 201402009LPN Probation 12-12-18 24-month probation. Abusing a client, and engaging in other unacceptable behavior towards clients. Matthew A. Langley 201600505CNA Probation 12-12-18 12-month probation. Demonstrated incidents of reckless behavior, and using intoxicants to the extent or in a manner injurious to himself or others. Kathrine C. Larsen Nurse Imposter Civil Penalty 11-14-18 $2,500 civil penalty. Practicing nursing without a license.

Sarah A. Little 200212724CNA Revocation 10-10-18 Violating a person’s rights of privacy and confidentiality, abusing a person, and failing to provide documents requested by the Board. Franki L. Lewis 201130115LPN Revocation 10-10-18 Inaccurate recordkeeping, and obtaining unauthorized controlled drugs. Nicole L. Lillie 200930353LPN Reprimand 11-14-18 Failing to take action to preserve client safety, and failing to conform to the essential standards of acceptable nursing practice. Richard C. Lucero 200642185RN Voluntary 10-10-18 Failing to take action to preserve client safety and failing to implement the plan of care. Surrender

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 23 Effective Name License Number Discipline Date Violations Janet A. Matthews 077038880RN/ Revocation 10-10-18 Inaccurate recordkeeping, developing standards of nursing care that jeopardize 200150137NP/ patient safety, practicing nursing while impaired, and failing to conform to the 200680014DP essential standards of acceptable nursing practice. Kristy M. McCarter 201130509LPN Voluntary 11-14-18 Unauthorized removal of drugs from the workplace, and using intoxicants to the Surrender extent injurious to herself or others. Sara M. McDermott 201603883LPN Voluntary 11-14-18 Physical condition that prevents her from safely practicing nursing. Surrender Gina V. Merritt 201811159LPN Civil Penalty 12-12-18 $1,750 civil penalty. Practicing nursing prior to obtaining an active Oregon license. Jelene S. Minnick 081001471RN Voluntary 12-12-18 Violating the terms and conditions of a Board Order. Surrender Brigitte A. 200242798RN Reprimand 10-10-18 Failing to conform to the essential standards of acceptable nursing practice. Montgomery Molly L. Morrison 200830011LPN Voluntary 10-10-18 Obtaining unauthorized controlled medications. Surrender Michael S. Murphy 201390480RN Revocation 10-10-18 Inaccurate recordkeeping, practicing nursing while impaired, and failing to cooperate with the Board during the course of an investigation. Kristin Olson RN Applicant Application 11-14-18 Misrepresentation during the licensure process, and failing to cooperate with the Denied Board during an investigation. Robert J. Parrish 200410455CNA Application 10-10-18 Conviction of a crime that bears demonstrable relationship to CNA duties and using Denied intoxicants to the extent injurious to himself or others. Kerry L. Patterson 201042207RN Probation 11-14-18 24-month probation. Practicing while impaired, and using intoxicants to the extent or in a manner injurious to herself or others. Emunah G. Pearl 201211534CNA Voluntary 12-12-18 Conviction of crimes that bear demonstrable relationship to the duties of a CNA. CMA Applicant Surrender Voluntary 12-12-18 Withdrawal Wendy Pepper 201702017RN Suspension 12-12-18 Minimum of 14-day suspension. Failing to cooperate with the Board during the course of an investigation. Brenda C. Price 099007611RN Probation 11-14-18 12-month probation. Obtaining unauthorized medications, entering inaccurate documentation into a health record, and failing to conform to the essential standards of acceptable nursing practice. Amal Rabadi 201608964RN Suspension 10-10-18 Minimum of 14-day suspension. Failing to cooperate with the Board during the course of an investigation. Nicole K. Rempel 200112300CNA Revocation 12-12-18 Failing to maintain professional boundaries, unauthorized removal of money from a person, and using her role as a CNA to solicit money for personal gain. James M. Rohde 200942282RN Revocation 10-10-18 Engaging in sexual contact with a client and failing to maintain professional boundaries with a client. Megan A. Ross 201707008LPN Probation 11-14-18 24-month probation. Unauthorized removal of supplies from the workplace, and using intoxicants to the extent or in a manner injurious to herself or others. Michael S. Russo 201508321CNA/ Voluntary 11-14-18 Obtaining unauthorized drugs, and failing to cooperate with the Board during an 201607855CMA Surrender investigation. Theresa M. Saunders 200441115RN Voluntary 11-14-18 Violating the terms and conditions of a Board Order. Surrender Dorinda L. Schaper 095003006RN Suspension/ 11-14-18 30-day suspension, followed by 24-month probation. Documenting the provision of Probation services that were not provided, the unauthorized removal of medications from the workplace, and using intoxicants to the extent or in a manner injurious to herself or others. Joseph N. Schneider 201404489LPN Revocation 10-10-18 Violating the terms and conditions of a Board Order. Cynthia V. Sewell 200941908RN Probation 11-14-18 24-month probation. Practicing while impaired, and failing to comply with the terms and conditions of the Health Professionals’ Services Program.

Jennifer L. Sizer 200640155RN Suspension/ 10-10-18 30-day suspension, followed by 24-month probation. Violating client’s rights to privacy Probation and confidentiality and implementing standards of nursing care that jeopardize patient safety. Marian K. Smith RN Applicant Voluntary 11-14-18 Misrepresentation during the licensure process and failing to answer questions Withdrawal truthfully. Rion J. Smith RN Applicant Voluntary 10-10-18 Misrepresentation during the licensure process. Withdrawal Joy S. Squires- 095003074RN Application 12-12-18 Violating the terms and conditions of a Board Order, and failing to provide documents Jensen Denied requested by the Board.

24 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING Effective Name License Number Discipline Date Violations Caroleanne Stalcup 085069868LPN Voluntary 12-12-18 Abusing and neglecting a client, and implementing policies that jeopardize client Surrender safety. Christopher J. 201703758RN Reprimand 11-14-18 Failing to maintain professional boundaries, and violating a person’s rights of privacy Stamulis and confidentiality. Andrea Sun 201243463RN Voluntary 10-10-18 Violating the terms and conditions of a Board Order. Surrender Brianna L. Sutton 201502089CNA Reprimand 12-12-18 Violating a person’s rights of privacy and confidentiality. Breanna M. Swars 200912475CNA Voluntary 11-14-18 Demonstrated incidents of dishonesty, failing to maintain professional boundaries, Surrender the unauthorized attempted removal of drugs from any setting, and using intoxicants to the extent injurious to herself or others. Virginia L. Tan 200942916RN Application 12-12-18 Using intoxicants to the extent injurious to herself or others, and willful Denied misrepresentation during the licensure process. Amber M. Thompson 201806868CNA Voluntary 10-10-18 Violating the terms and conditions of a Board Order. Surrender Debra L. Thompson 200830365LPN Voluntary 12-12-18 Gross incompetence. Surrender Victoria W. 201111561CNA/ Application 12-12-18 Conviction of a crime that bears demonstrable relationship to the duties of a CNA, and Thompson 201111561CMA Denied failing to cooperate with the Board during an investigation. Erica Trent 201806869CNA Voluntary 11-14-18 Violating the terms and conditions of a Board Order. Surrender Trudy E. Urban 091007006RN Probation 10-10-18 24-month probation. Using intoxicants to the extent injurious to herself or others, and practicing nursing while impaired. Kathy P. Vuong 201142153RN Reprimand 12-12-18 Performing acts beyond her authorized scope, unauthorized removal of supplies from the workplace, and failing to conform to the essential standards of acceptable CNA duties. Serena L. Watson 200940087RN Suspension 11-14-18 Minimum of 14-day suspension. Failing to cooperate with the Board during the course of an investigation. Mallory H. Wright 201042567RN Voluntary 11-14-18 Failing to document nursing interventions in a timely and accurate manner, and failing to Surrender dispense medications in a lawful manner. Carmen R. Woodell 201407484CNA Revocation 10-10-18 Demonstrated incidents of violent behavior and using intoxicants to the extent injurious to herself or others.

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 25 NURSING ASSISTANTS NA/MA CERTIFICATION RULE CHANGES DELAYED UNTIL AUGUST 1

Clearer, better-organized parameters for how to obtain a nursing assistant or medication aide certificate is the goal of the OSBN’s current work on Division 62 of the Oregon Nurse Practice Act. Although the Board of Nursing approved some revisions during the November 2018 board meeting, subsequent efforts to implement the rules revealed more opportunities to improve the division. To that end, implementation of the November • Addition of testing requirement for student nurses changes has been paused, and a new draft will be and graduates of nursing programs to obtain a CNA 1. presented to the Board during the April 2019 board • Establishment of CNA 2 as a separate certification. meeting for review and potential approval to proceed • Explanation of CNA and CMA nurse supervision with rulemaking in June. and monitoring to meet the paid employment requirement. Future changes to Division 62 include: • Provision for an individual whose prior unencum- • Clarification on when an individual can be hired bered Oregon CNA 1 has been expired for over two to perform nursing assistant duties in a licensed years, to reactivate their Oregon CNA 1 if they have nursing facility. worked in another US state or jurisdiction with active • Unlimited attempts on the CNA or CMA state certification at least 400 hours in the last two years competency exam within one year of completion doing CNA authorized duties under nurse supervi- of the training program. sion or monitoring. • Reduction from two years to one year from training • Similar process for a student nurse in the US to program completion for CNA state competency obtain an Oregon CNA and CMA. exam eligibility. For more information, visit the OSBN online meeting calendar at www.oregon.gov/meetings.aspx.

2019 OSBN BOARD MEETING DATES

February 12, 2019 6:30 p.m. June 11, 2019 6:30 p.m. September 13, 2019 8:30 a.m. OSBN Board Meeting Board Meeting Board Work Session

February 13, 2019 8:30 a.m. June 12, 2019 8:30 a.m. October 9, 2019 4:30 p.m. OSBN Board Meeting Board Meeting Board Meeting via Teleconference (Primarily Executive Session) (Primarily Executive Session) (Primarily Executive Session)

February 14, 2019 8:30 a.m. June 13, 2019 8:30 a.m. November 12, 2019 6:30 p.m. OSBN Board Meeting Board Meeting Board Meeting

Mach 13, 2019 4:304:30 p.m.pp.mm. July 1010,1 2019 4:30 p.m. November 13, 2019 8:30 a.m. OSBN Board Meeting via TeTeleconferenceeleconlec nfnferenceerencerenrreeennc BoardBoBoardard MeetingM via Teleconference Board Meeting (Primarily Executive Session)onon)) (Primarily(P imarilmarily Executive Session) (Primarily Executive Session)

April 9, 2019 6:30 p.m. August 14, 2019 4:30 p.m. December 18, 2019 4:30 p.m. OSBN Board Meeting Board Meeting via Teleconference Board Meeting via Teleconference (Primarily Executive Session) (Primarily Executive Session) April 10, 2019 8:308:3:30 a.a.m.m. OSBN Board Meeting SeptemberS 10, 2019 6:30 p.m. (Primarily Executive Session) Board Meeting All Board Meetings, except April 11, 2019 8:30 a.m. September 11, 2019 8:30 a.m. Executive Sessions, are open to the public. OSBN Board Meeting Board Meeting (Primarily Executive Session) All meetings are located at the OSBN Office May 8, 2019 4:30 p.m. 17938 SW Upper Boones Ferry Rd, Portland. OSBN Board Meeting via Teleconference September 12, 2019 8:30 a.m. (Primarily Executive Session) Board Meeting

26 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING 2019 OSBN BOARD MEMBERS

MICHELLE CHAU, LPN COLIN HUNTER, JD Term: 1/1/19 – 12/31/21 PUBLIC MEMBER Ms. Chau is a Panel Manager for the Multnomah Terms: 10/1/15 – 12/31/15, 1/1/16 – 12/31/18 County Health Department in Portland, Ore. She Mr. Hunter is an attorney with the Angeli Law Group in completed her practical nursing program at Mt. Hood Portland, Ore. He received his Bachelor’s degree from Community College in Gresham, Ore., and has a BS Claremont McKenna College in Claremont, Calif., and his degree in Advanced Chemistry, Biology, and General juris doctorate from the University of California, Berkeley, Science from Oregon State University in Corvallis, Ore. She has 10 years of School of Law. Mr. Hunter resides in Portland, Ore nursing experience, and serves in the Licensed Practical Nurse position on the Board. SHERYL OAKES CADDY, JD, MSN, RN, CNE Term: 1/1/18 – 12/31/20 KATHLEEN CHINN, RN, FNP Ms. Oakes Caddy is Director of the Nursing PRESIDENT-ELECT Department at Linn-Benton Community College Terms: 1/1/16 – 12/31/18, 1/1/19 – 12/31/21 in Albany and has more than 30 years of nursing Ms. Chinn is a Family Nurse Practitioner with the experience. She received her Associate of Science PeaceHealth Senior Health and Wellness Center in in Nursing from Linn-Benton Community College Eugene, Ore. She received her Associate Degree in in Albany, Ore., her Bachelor of Science in Nursing from Oregon Health Nursing from Lane Community College in Eugene, Sciences University in Portland, Ore., her Master of Science in Nursing Ore., and her Bachelor of Science in Nursing and Master’s degrees from from Walden University, Baltimore, Md., and her Doctor of Jurisprudence Oregon Health Sciences University in Portland, Ore. She resides in from Willamette University School of Law in Salem, Ore. Ms. Oakes Eugene, Ore. Caddy serves in the position on the Board and resides in Lebanon, Ore. ANNETTE COLE, RN Term: 1/1/18 – 12/31/20 BOBBIE TURNIPSEED, RN Ms. Cole is the Vice President of Patient Care BOARD PRESIDENT Services and Chief Nursing Officer at Sky Lakes Terms: 1/1/16 – 12/31/17, 1/1/18 – 12/31/20 Medical Center in Klamath Falls and has 30 years of Ms. Turnipseed is a staff nurse at St. Alphonsus nursing experience. She received her Bachelors of Medical Center in Ontario and has more than 30 years Science in Nursing degree from the Oregon Institute of nursing experience. She received her Associate of Technology in Klamath Falls, Ore., and her Masters of Science in Degree in Nursing from Boise State University in Nursing and Health Care Administration degree from the University of Boise, Idaho. Ms. Turnipseed is one of two direct-patient care RNs on the Phoenix. Ms. Cole serves in the Nurse Administrator position on the Board. She resides in Ontario, Ore. Board. She resides in Klamath Falls. RYAN WAYMAN ADRIENNE ENGHOUSE, RN PUBLICPUBLIC MEMBERMBE Terms: 1/1/16 – 12/31/17, 1/1/18 – 12/31/20 Terms:T ms:s: 4/1/13312/31/1513 – 12/31/12/31/15,1 15,5 11/1/161/ – 12/31/1812 31/18 Ms. Enghouse is a Staff Nurse at Kaiser Sunnyside Mr.. WaymanWiftbliy is onene ofo twoo public memmembmemberssonth ono the Medical Center in Clackamas, Ore. She serves in Board. HHe iss theththhee WestW st RegionReReegioion Vice PresidentPresidPresidePre nt aat AXA one of two direct-care RN positions on the Board. Advisorsdvvisoisosoorsororsr aanand residesesidesdiPtless ininPn PPorPortland.orrttlt She received her Associate Degree in Nursing from Mount Hood Community College in Gresham, Ore., and resides in Portland, Ore. WILLIAM YOUNGREN, CNA BOARDBBOBOAROAOARDARRDD SECRSSE SECRETARYCRETARYRERETARYETAARARRYY Terms:TeTererms:rmrms:ms:s 6/1/1666/16/1///166 – 12/31/18,1212/31 12/31/182/31/18,2/32/31/11 1/1/191 1/1//1//1919 – 12/12/312/31/212/3331/21 Mr.MrYoungrenisaUnitClerkatLegacyMr. Youngrenungrennggren iss a UnUnitUnititittC Clerk CClClererkeerrkk at at LegacyLegacygacy EmanuelEEm annuel MedicaledicalCenterinPortlandandhasbeenanursiedical CCenternntter in PPoPortlandPortlanoortlrtlrt anndd andananddhadhasbd hashaass been bebbeen a nursingurssing assistantassistanttanta t sincesin i2012Hncee 2012.201220 2. HeH received receive ve hishi s Bachelor’sBa heloor’s Degreeegegree innEnglishfn EnglisEnglishEngnglishsh ffrfrom Portlandt d StateState University andannd his nursingngg assistantt trainingt in ng fromfro Portland nd CoCommunitymmu College.Col Mr. Youngrenen residesre des in PorPortland,ndd OrOre.

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 27 LICENSING By OSBN Licensing and Fiscal Manager John Etherington TIPS TO HELP YOUR APPLICATION PROCESS

As we move into a new year, the Oregon Board of Nursing (OSBN) licensing department would like to share some tips about Oregon state licensing processes. Every year we experience application delays because of required items to complete an application were not given to OSBN. In our ongoing education outreach, OSBN would like to share some top licensing procedures and tips to help you with the licensing process. • All new users and renewal licensees will be required disclosure questions on your application. Even to “register” in order to access the online application if you have been advised by an attorney that you system. Registration is a two-step process; the first do not have to disclose, or if your offense was as step is creating an online account with a valid email a juvenile, you should disclose the information on address. After an account is created, our system will your application. If information is found during send you a verification email to the email address your national and state fingerprint background you provided on your account. You will then need check that was not disclosed on the application, to go into your email account, open the verification your application will be placed in a background email, and click on the link in that email to finish review process. The background review process setting up your verified account (don’t forget to will add additional time in order for us to approve check your email spam and junk folders for the your application. verification email). Once an account is set up and • If you are required to provide documentation of verified, then you can start your online application. citizenship, court documents, or other information • Apply early: There are many factors to application and required by the application, then please provide the processing time is not predictable. Waiting until a those with the application. few days before your license expires or accepting a job • OSBN cannot use fingerprints taken for other offer without being licensed are not recommended. state agencies or educational institutions. You will OSBN does not expedite applications (except for need to have fingerprints taken based on OSBN active military spouses or partners). directions and policies. • Use OSBN application tutorials: OSBN has online • Check the Status of Your Application: You may tutorials to help explain the licensing process. go to the OSBN application status wizard https:// Tutorials are available for CNA1 exam applications, app2.osbn.oregon.gov/OSBNAppStatus/Search. as well as RN/LPN Exam, RN/LPN Endorsement, aspx to check your application status. Once a and RN/LPN Reactivation applications. Please licensing technician is able to review and approve check out our forms page https://www.oregon.gov/ the application documents, the various process OSBN/Pages/forms.aspx to see if your application steps will be checked off on the wizard. Just type has a tutorial. because the OSBN has received a document does • Incomplete applications will not be accepted by the not mean it has been approved, so make sure to system. If all required documents are not provided, allow some time for review of documents. then the application is incomplete. An incomplete • Applicants may use a computer in the Board office application will not be processed until proper if needed, on business weekdays between 7:30 am information is received. and 4 pm. We recommend a local library or other • Fees must be paid in order for the application to be computer source if you are outside the Portland started. If the fee is not paid when you submit your metro area and cannot travel to our Board office. application, the application will be incomplete and Please check out the OSBN website at www.oregon. will not be processed until proper fee amounts are gov/OSBN to find additional resources and information. received and processed. If you are unable to find the answer to your questions, • Disclosure Questions and Background Check: It then you may call our licensing department at is required that you truthfully answer all of the 971-673-0652, ext. 2, from 9 am–3:00 pm.

28 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING Changes to Oregon Health Plan (OHP) Prescriber Enrollment Implementation – ACTION REQUIRED

The Oregon Health Authority (OHA) has postponed implementation of the prescriberp enrollment requirementqgpp for fee-for-service Oregon Health Plan prescription claims from November 13, 2018 to March 1, 2019. • Too many prescribers have not enrolled at this time, which would disrupt the care of OHP members. OHA is expanding its provider outreach strategies to get more prescribers enrolled to avoid interruptions to members’ prescription therapy. • To help us with this plan, please share this requirement with your colleagues and encourage prescribing providers and pharmacies to verifyyyg that OHA’s system recognizescognizesg thethem as an Oregon g Medicaid pprovider (https://www.or-medicaid.gov/ProdPortal/Validate%20NPI/tabid/125/Default. aspxx). • If they aren’t recognized as Oregon Medicaid providers, theyhey need to enrollnrolloll withwit OHAOH or their localloca coordinated care organization (CCO) as soon as possible.siblblee. Providing services is voluntary; enrollment does not requirequiuireire a providerp oviderer to o serve all lll Oregon OOreOrregongon HealthHealt HeaHHeHeal PlanP (OHP) members. It does ensure your prescriptions to OHPOHP membersmemm mbbbersersrs willw bebe coveredcovered.cco covooververerededdd.

HOW TO ENROLL To enroll with OHA, prescribing providers can enrollollll usingusin thethhhe OHPOOHHPHP3113P31P3P 311331131113111313 fforformform.rmm.m Pharmacies andnd otherotthherr providers seeking direct reimbursement from OHAA willneedtocompleteapacketoffourenrollmwillll nneneeded d too completeomp leteettee a packetppackpaacketacketckketetetoffourenrollmt ofo fourfourr enrollmenrollmeenrenrollmenten lment forms. To learn which forms to complete and submit, visitsit OHA’sOHAs ProviderProovidervidideriddEdererrEnrol Enrol EnrollmEEnEnrollEnrorolrollllllmentllm lmentmenmementmeentntt page: ppapageage:g : https://www.oregon.gov/oha/HSD/OHP/Pages/Provider-Enroll.aspx. To enroll with a CCO, contact the CCO: https://www.oregon.gov/oha/HSD/OHP/Pages/Coordinated-Care-Organizations.aspx.

QUESTIONS? • About prescriber enrollment: Contact Provider Enrollmentntt at 80800-336-60160-33 66001 (Option( 6) or provider. [email protected]. • About fee-for-service prescription claims: Contact the Pharmacyy CalllC Centerter aat 888-20888-202-2888-202-2126. This number is for providers only. • About coordinated care organization (CCO) claims: Contact the CCO (https://www.oregon.gov/ oha/HSD/OHP/Pages/Coordinated-Care-Organizations.aspxx).

SENTINEL VO.38 • NO.1 • FEBRUARY 2019 29 STRONG DEMAND FOR NURSES CONTINUES IN OREGON

Nursing Professionals in Oregon, state advisory for nursing workforce is available to download on the issues, OCN fulfills its mission Publications page of the OCN through nurse workforce research, website. Interactive data charts are building partnerships, and promoting also available on the site, as well nursing and healthcare. For more as a recorded webinar with report information about OCN, please visit Employers in Oregon continue author, Dr. Rick Allgeyer. www.oregoncenterfornursing.orgg. to report a strong demand, or OCN is a nonprofit organization need, for nurses according to The created by nursing leaders in Demand for Nursing Professionals 2002. OCN facilitates research in Oregon - 2018, a new report and collaboration for Oregon’s released by the Oregon Center for nursing workforce to support informed, Nursing (OCN). well-prepared, diverse, and exceptional “Employers report difficulties nursing professionals. Recognized in recruiting, hiring, and retaining by the Oregon state legislature as a nurses across the spectrum of health care,” said Jana R. Bitton, OCN’s Executive Director. “While hospitals seem to be using contract labor to help reduce the number of open positions, vacancy rates for long term care, home health/hospice and public health have continued to climb.” OCN conducted its research by contacting hospitals and health systems, skilled nursing facilities, home health and hospice agencies, and public health departments across Oregon to ask about current and projected hiring needs for nurses. “The demand for nurses in Oregon isn’t lessening,” Bitton said. “Our hope is this updated information will help inform employers, policymakers, and schools as they work to ensure Oregonians have access to health care and quality nursing professionals.” The full study, The Demand for

30 VO.38 • NO.1 • FEBRUARY 2019 OREGON STATE BOARD OF NURSING

Oregon State Board of Nursing PRESORTED STANDARD 17938 SW Upper Boones Ferry Road U.S. POSTAGE Portland, OR 97224-7012 PAID LITTLE ROCK, AR PERMIT NO. 1884