Volume 9 Number 2 DISTRICTDISTRICT OFOF COLUMBIACOLUMBIA May 2012

NURSER e g u l at i o n E d u c at i o n P r a c t i c e

Happy National Nurses Week!

RN/APRN Renewals Have Begun (page 8) Government of the District of Columbia Licensed Practical Nurse Forum (pages 6) Vincent C. Gray, Mayor Two DC Nurses in Africa (pages 20-26) e-mail:Official [email protected] Publicati • o web:n of www.hpla.doh.dc.gov the District of Columbia Board of Nursing1 Kids will be kids at home again, thanks to you.

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HSC Home Care, LLC We are proud to be the only organization in the District of Columbia that provides dedicated home care services for special needs children. HSC Home Care, LLC is also honored to be a 2012 Member of “Select 50 Diversity Employers.” For immediate consideration, apply on-line or e-mail your resume to: [email protected] • RNs, PRN (IV certification or 2 District of Columbiaexperience Nurse: a plus) Regulation • Education • Practice

DC NURSE ECHO MAGAZINE HEASEF 5/1/2012 8” x 10” 3046719-WA20860 Veta Ifill-Martinez v.4 Districtof Columbia contents message from DOH Director 4

message from the Chair NURSEEdition 33 5 Director, Department of Health MOHAMMAD N. AKHTER, MD, MPH Regulation Board Members E. Rachael Mitzner, BSN, MS, RN Board of Nursing Update 6 Chairperson Mary Ellen R. Husted, RN, BSN, OCN Vice Chairperson RN/APRN Renewals Have Begun 8 Margaret Green, LPN Selena Howell LPN CE Non-compliance Notice 9 Rev. Mary E. Ivey, D-Min Ottamissiah Moore, LPN Mary Rockefeller, BSN, RN IN THE KNOW 10 Office Location Telephone Number COIN CONSULT 11 DC Board of Nursing 899 North Capitol St. NE Washington, D.C. 20002 E-mail: [email protected] Education Phone: (877) 672-2174 Phone: (202) 724-4900 Fax: (202) 724-8677 Panel Discussion on Direct Care Personnel (NAPs) 12 Web site: www.hpla.doh.dc.gov Office Hours Patient Care Tech Research 14 Monday thru Friday: 8:15 a.m.-4:45 p.m. Professional/Practical Nurse Programs 15 Board Staff Karen Scipio-Skinner, MSN, RN Executive Director NCLEX Myths 15 Concheeta Wright, BSN, RN Nurse Consultant/Practice Bonita Jenkins, EdD, RN, CNE Nurse Specialist Practice Donna Harris Health Licensing Specialist on Guard 16 Melondy Scott Health Licensing Specialist Gwyn Jackson Legal Aspects of Documentation 17 Health Licensing Specialist Nicole Scott Shadowing Nurses in Sierra Leone Health Licensing Specialist 20 Tanee Atwell Health Licensing Assistant Tropical Medicine Expedition to Tanzania 22 Nancy Kofie DC Nurse: REP Managing Editor Wound Care 27

Kudos! 29 Address Change? Name Change? Question? In order to continue uninterrupted delivery of this Board Disciplinary Actions 30 magazine, please notify the Board of any change to your name or address. Thank you. DC BON Mission Statement: “The mission of the Board of Nursing is to safeguard the public’s health Created by and well being by assuring safe quality care in the District of Columbia. This is achieved through Publishing Concepts, Inc. the regulation of nursing practice and education programs; and by the licensure, registration and Virginia Robertson, Publisher continuing education of nursing personnel.” [email protected] 14109 Taylor Loop Road • Little Rock, AR 72223 Circulation includes over 22,000 licensed nurses, nursing home For advertising information contact: administrators, and nurse staffing agencies in the District of Columbia. Tom Kennedy at 800.561.4686 or 501.221.9986 Feel free to e-mail your “Letters to the Editor” for our quarterly column: IN THE KNOW: Your opinion on [email protected] the issues, and our answers to your questions. E-mail your letters to [email protected]. (Lengthy letters ThinkNurse.com may be excerpted). e-mail: [email protected] • web: www.hpla.doh.dc.gov 3 Greetings from DOH Director Mohammad N. Akhter, MD, MPH HAPPY NATIONAL NURSES WEEK

To the Remarkable Nurses of the District,

The constant care and attention you provide to your patients cannot be measured. I want to thank you for your dedication to the field of nursing and for your commitment to your patients. The theme for National Nurses Week this year is “Nurses: Advocating, Leading, Caring.” This year’s DOH Director Mohammad N. Akhter, MD, MPH commemorative theme could not prove to be a more fitting description of the ambitious attributes needed to be a successful nurse. As the first line of care in a hospital, office, home-health care, public health or any other clinical settings—you play an essential role in helping to advocate for the sick, be a leader for those around you and show an unwavering level of care and compassion for those lives you work so hard to protect and improve.

In addition, I want each of you to know how much I value your expertise and ability to make quick and accurate assessments regarding patient care and safety. Often times, nurses carry the burden of working in strenuous environments that constantly challenge their decision making, as well as their physical and mental well-being. Without your support and devotion to the District of Columbia, our city would not have the type of top-notch, community-level care we are known for. I admire your resilience and want to thank you for all of your hard work, dedication and sacrifice.

Sincerely, Dr. Mohammad N. Akhter Director DC Department of Health

4 District of Columbia Nurse: Regulation • Education • Practice Message from the Chair

Each and every day nurses in the District of Columbia care for patients and communities, making a positive difference in the lives of many of our resi- dents. As compassionate and competent care givers, the nurses at every level of care, who contribute to the health of those residing in DC are a credit to the field of health care, and their efforts deserve recognition. The DC Board of Nursing would like to extend our thanks to all nurses whose dedication and achievements have contributed to the nursing profession.

National Nurses Week begins each year on May 6th and ends on May 12th, Florence Nightingale’s birthday. These permanent dates enhance plan- ning and position National Nurses Week as an established recognition event. As of 1998, May 8 was designated as National Student Nurses Day, to be celebrated annually. As of 2003, National School Nurse Day is celebrated on E. Rachael Mitzner, BSN, MS, RN the Wednesday within National Nurses Week (May 6-12) each year. Interna- tional Nurses Day is celebrated around the world on May 12th of each year. The theme for National Nurses Week in 2012 is “Nurses: Advocating, Leading, Caring.”

In mid-March three Board of Nursing members attended the National Council of State Boards of Nursing (NC- SBN) midyear meeting which, in many ways, reinforced this year’s National Nurses week theme of Advocating, Lead- ing and Caring.

A day was spent with Board Chairs and Executive Directors to enhance leadership and communication skills. When Board leaders become comfortable with each other’s expectations and work more closely as a team, the Board as a whole is more effective and efficient.

The second day was spent discussing the role of LPNs in more affordable, accessible and efficient health care. The LPN is utilized differently in various states, and in Canada, and it was interesting to discuss the possibilities for education and utilization of this important segment of our nursing community. As the Board looks at Regula- tions and scope of practice for the LPN community in DC, we need to ensure that we are allowing them to practice to their level of knowledge and skill, and we are encouraging them to continue their education and improve their skill sets through certification and/or upward mobility in the profession of nursing.

The last day of the meeting focused on disciplinary procedure. It covered how to ask questions to get accurate and truthful answers, to the procedure for running a formal hearing. The three days provided wonderful informa- tion for the Board members and staff who attended. Information which can be used by the Board to lead, advo- cate and care for our residents in DC and the nurses who work to keep our community healthy.

We will continue to provide educational programs to help our nurses in their role of advocate, leader and caregiver. We will continue to include our nurses in our discussions related to healthcare regulation, and we will consistently put the safety and protection of our residents first. We thank each of you for sharing and participating in our vision of healthcare in the District. Thanks for being a nurse; we need and appreciate each of you.

E. Rachael Mitzner, BSN, MS, RN Chairperson DC Board of Nursing

e-mail: [email protected] • web: www.hpla.doh.dc.gov 5 Regulation Board Update MARCH 7, 2012 BOARD HOLDS LICENSED PRACTICAL NURSE FORUM

The Board of Nursing has begun working on revising RN and LPNs in CLINICAL SETTING LPN regulations. In considering the LPN regulations, the Board • LPNs are cost-friendly to budgets of facilities. A mix of invited feedback from the nursing community regarding the RNs and LPNs is cost effective. future role of LPNs. • LPN jobs will grow due to aging population. Topics discussed at forum: • In the Midwest, there is more LPN utilization in all settings, including acute care. LPN EDUCATION • LPNs are particularly suited for practice in long term • What educational components are missing from LPN care, home care, and ambulatory centers. educational programs? • Better orientation for new hires is needed, especially • LPN educational programs cannot find acute care new graduates in long term care and home health facilities for clinicals. practice. • Participants discussed LPN-to-BSN articulation and the barriers to obtaining schooling while working full time. NURSING ASSISTIVE PERSONNEL (NAPs) It is especially difficult for LPNs to gain the general • Many participants expressed concern that Nursing education courses needed. Assistive Personnel (NAPs) are usurping the role of the LPN. One attendee stated that LPNs learn more theory

6 District of Columbia Nurse: Regulation • Education • Practice and critical thinking skills than NAPs. • Traditional LPN duties have been given to Patient Care Technicians, eroding the role of the LPN in acute care BOARD VACANCIES: LPN Member settings. and Consumer Member • LPNs function as the liaison between the RN and NAPs. ADDITIONAL LPN FUNCTIONS AND SKILLS TO CONSIDER The Board of Nursing is currently seeking to • IV Therapy fill Consumer member and LPN member Board • Infusion Therapy vacancies. If you are a resident of the District of • Central Line Columbia and interested in applying to serve on • Assessment the Board, please visit the website of the DC Office of Boards and Commissions at www.obc.dc.gov, Your feedback is welcomed. Please email to for application forms and for information on the [email protected]. n application process.

LPN STAKEHOLDERS: Nurse Managers and Nurse Educators share their views and concerns about LPN education and LPN scope-of-practice issues.

LPN STAKEHOLDERS: Nurse Managers and Nurse Educators share their views and concerns about LPN LPN Board Member Ottamissiah Moore education and LPN scope-of-practice issues.

e-mail: [email protected] • web: www.hpla.doh.dc.gov 7 RN Renewal 2012 RN/APRN Renewals Have Begun Licenses Expire June 30, 2012

RN/APRN RENEWAL TIPS http://hrla.doh.dc.gov/pcd or contact MorphoTrust for a CBC will pay the TO AVOID DELAY the Health Professional Licensing $50.00 fee to L-1 directly for this RN/APRN renewals began Administration to obtain a copy of service. April 1, 2012. Licenses will expire the application at 1-877-672-2174. June 30, 2012. Here are a few tips to Note that if your primary requisite avoid delay, now and in the future. license is placed on hold for any Applicants have two options Renew first and then get reason, you will be unable to renew to schedule fingerprinting CBC: Please renew your license your controlled substance registration appointments with L-1 Enrollment/ prior to completing your Criminal until the hold is released. MorphoTrust. Background Check (CBC) 1. On-line Live-Scan Scheduling: requirements: workforce Survey Available 24 hours a day, 7 days a Renew online: RN/APRNs can Please be reminded that week renew their licenses by accessing the beginning with the RN/APRN • Go to www.L1ENROLLMENT.com HPLA website at: renewal, the Board of Nursing will • Click on the map link to DC https://app.hpla.doh.dc.gov/ ask its RN and APRN licensees to • Choose Online Scheduling; enter mylicense/ respond to survey questions to required information; select desired Web Browser: To renew online, assess the DC nurse workforce. appointment location and date you must use Internet Explorer web 2. Call Center Scheduling: browser. CBC Fingerprinting: Available Monday - Friday, 9am – Contact information: It is L-1 Enrollment/MorphoTrust 5pm EST at (877) 783-4187 important to keep your contact In addition to Criminal • Operators will collect required information up-to-date. Please Background Check services provided information and schedule your notify us, in writing, of any name or by the District of Columbia appointment. address changes. These can be sent Metropolitan Police Department, • Applicants who are physically via e-mail to [email protected], health professionals applying for unable to go to a location to faxed to 202.727.8471 or mailed licensure or renewing their license be fingerprinted may use L-1/ to the Board of Nursing at 899 in DC can now also receive live scan MorphoTrust’s Card Scan North Capitol Street NE, First Floor, Criminal Background Check services Processing Program. This program Washington, DC 20002. with L-1 Enrollment Services, utilizes advanced scanning Controlled Substance which is now operating under a technology to convert a traditional Registration: APRNs, if you also new name—MorphoTrust USA. The fingerprint card (hard card) into possess a controlled substance company, which was purchased an electronic fingerprint record. registration, your registration is due in 2011 by the French-owned Applicants must go online to the for renewal. The fee for renewal company Safran, is still in the L-1 Enrollment website www. for your controlled substance process of converting the company l1enrollment.com or call registration is $130.00. brand from L-1 Enrollment to 1-877-783-4187. n You may renew online after you MorphoTrust. MorphoTrust remains renew your primary requisite license. a U.S. controlled entity, with all If you choose to use the paper-based business under the control of U.S. renewal method, you may download citizens working for MorphoTrust. an application from the website Applicants who choose to use L-1/

8 District of Columbia Nurse: Regulation • Education • Practice Licensed Practical Nurse Continuing Education Members of the public Non-compliance Notice are invited Licensed Practical Nurse The Board of Nursing’s Continuing Education (CE) Audit to attend... for Licensed Practical Nurses began October 2011 for LPNs renewing their license during the 2011 renewal period. The letter sent from the Board stated: Our records indicate that you recently renewed your license to practice BOARD OF as an LPN in the District of Columbia. You indicated on your licensure NURSING application that ‘Yes’ you, have acquired the required 18 continuing MEETINGS education hours for LPNs at the time that you submitted your application. At this time, the District of Columbia Health Professional Licensing Date: First Wednesday of Administration is conducting an audit to verify your compliance with the month. the continuing education requirements. Two notices have been mailed to the persons listed below. At the time this publication went to press, we had not received a response to the Board’s request. If your name Time: appears on the list below please submit evidence of having completed 18 hours of 9:30 a.m - 11:30 a.m. continuing education. Failure to submit proof of compliance with a Board of Nursing regulatory requirement will result in a fine up to $500.00 and/or a disciplinary action Location: against your license to practice as an LPN in the District of Columbia. 2nd Floor Board Room If you have any questions or need additional information please feel free to send an 899 North Capitol St NE email to Gwyn Jackson at [email protected] or call (202) 442-4764. Washington, D.C. 20002 Transportation: Closest iNDiViDuals WHo HaVE Not rEsPoNDED to cE auDit Metro station is Union Hirut Abraham LPN1004675 Station. Martin Adamu LPN1003494 Adeshola Adewale LPN1004049 To confirm meeting Cynthia Anoma LPN1003224 date and time, call Nnamdi Chukwuocha LPN966856 (202) 724-8800.

Cynthia Devenish LPN966066 Saudatu Dumbuya LPN1003544 June 6, 2012 Carlyle Fletcher LPN962984 Solange Hangou LPN1004426 July 11, 2012 Charlene Harley LPN4439 Althea Isaac LPN966977 August - no meeting Lorine Jackson LPN5656 September 5, 2012 Sunday Jolaoso LPN8381 Adaku Kalu LPN1004858 October 3, 2012 Japhet Mutanga LPN1003738 Paula Neal LPN1003786 November 7, 2012 Emergencia Njekam-Bodog LPN1004438 December 5, 2012 Georgina Ofori-Atta LPN1004694 Bose Otugalu LPN1004537 Deen Sesay LPN1004776 Vijaykumar Shirsat LPN7670 Maria Taylor LPN6167

Please note: If you have misplaced your continuing education verification certificate, contact your Continuing Education provider to request a duplicate. n

e-mail: [email protected] • web: www.hpla.doh.dc.gov 9 RN Renewal 2012 IN THE KNOW The Board of Nursing has established the “In The Know” column in response to the many phone calls and e-mails the Board receives regarding licensure and other issues. The Board often receives multiple inquiries regarding the same topic. Please share this column with your colleagues and urge them to read it. The more nurses are aware of the answers to these frequently asked questions, the less our resources will have to be used to address duplicate questions.

TMEs Criminal Background Check : Do the nurses have the ability to : Are Trained Medication (CBC) Qreceive a copy of their background QEmployees (TME) able to float : If a nurse has recently had a CBC check? among community residential facilities to Qfor another facility or board of : No, the CBC results that come to administer medications? nursing, will they still have to redo it to Athe Board are the property of the : No. TMEs are not allowed to renew their license? Board. We cannot share the reports with Afloat. Allowing TMEs or nurses to : If they completed a CBC for the the licensee. go to multiple residences to administer Apurposes of licensure in DC, they medication will result in a medication will not be required to complete another : Will the CBC be required for error—untimely administration of CBC. However, if they did it for another Qevery renewal year from now on? medication. Further, leaving the facility entity, including a hospital or another : No. The law requires the CBC after administering the medication board of nursing, they will have to do Abe completed every four (4) years. does not allow the medication giver an another CBC. Results of the CBC can only We are working to have a “wrap-back” opportunity to observe the resident’s be shared with the entity requesting the program. This will allow persons arrested reaction to the medication. CBC. or convicted to be automatically reported to the Board. If we are able to implement RN License Needed? : Does DC require a state this, we will not require CBCs after the : If a Quality Improvement Qbackground check of permanent initial one has been completed. QManager is employed by a facility residence along with the FBI check in and is a Registered Nurse but does not order for a license to be issued? If the : If a traveler submits fingerprints give any direct resident care, does this state does not offer the ability to request Qthrough L1 Enrollment (Morpho person need to have a DC RN license? is the FBI sufficient? Trust), do they still receive the results in : Yes. If they are using nursing : We require state/DC and FBI CBCs. the mail and send to the DC BON? Aknowledge and the RN title, they AIf the state does not offer the ability : The results will come to us directly need to be licensed as a nurse in the to provide a state CBC, a state CBC will Afrom L1 Enrollment. District. not be required. Website Compliments Mandatory HIV/AIDS CE : I’ve received notification that my Dear Board of Nursing: I just wanted : Regarding DC Councilman Qfingerprints were rejected. What do to commend you on your nursing license QCatania’s plan to require HIV/AIDS I do now? renewal website. Very easy. Since I am a continuing education for license renewal: : If you have received notification travel nurse, I have spent a few hours here Has it been passed? I would like to Athat your fingerprints were rejected, going to the websites of different states respond to this proposed requirement. you will need to be fingerprinted again. to renew and by far, yours is the easiest. : The hearing regarding this bill When you schedule your appointment, Thank you, very much. n Ahas been held and the comment be sure to note that you have received a period has ended. But if you wish you rejection notice and this is your second can still send comments to the Council’s time being fingerprinted. With this Committee on Health. The Board of rejection notification, you will not have Nursing supported the bill. to pay for fingerprinting the second time.

10 District of Columbia Nurse: Regulation • Education • Practice COIN CONSULT nurses did not seek appropriate medical care and physicians (Chappel, 1992: Grover A Resource for Impaired Nurses for self-diagnosed health problems; instead, & Floyd, 1998). Often, other healthcare they obtained prescriptions from physician professionals hold the most negative views friends without adequate workups (Solari- of colleagues with substance use disorders Workplace Risk Factors Twadell, 1988). (Howard & Chung, 2000a: Howard & By Kate Driscoll Malliarakis, RN, MSM, CNP Stress: Nursing is a highly stressful Chung, 2000b). occupation. In fact, nurses reported more Darbro (2005) interviewed many nurses The prevalence of substance abuse on-the-job stress than any other group who identified a lack of education and a and addiction among nurses and other of healthcare professionals (Wolfgang, culture of mistreatment in their workplace. healthcare professionals is no higher than 1988). Long shifts, extra shifts, staffing Thus, as the adage goes, “ignorance breeds the prevalence in the general population shortages,and shift rotation contribute to contempt,” producing a work environment (Storr, Trinkoff & Hughes, 2000). However, increased stress. Trinkoff and Storr (1998b) in which nurses with substance use the prevalence of prescription drug misuse examined the relationship between work disorders may take even greater pains to is 6.9% among nurses compared with 3.2% schedule characteristics and substance use conceal their abuse, thereby increasing the among white females (SAMHSA*, 1998a). and found that in general, the more adverse risk of harm to all. Thus, many nurses with substance abuse the schedule characteristics, the greater the Attitude: Five attitudes can increase the disorders not only provide patient care while likelihood of substance abuse. The schedule odds of substance use problems in nurses impaired, they also divert their patients’ characteristic most strongly associated (Clark & Farnsworth, 2006). First, nurses prescribed medications, risking patient with substance use was a combination of may see substance use as an acceptable harm. The top four risk factors for nurses shift rotation and long shifts. Shift work, means of coping with life’s problems and a in the workplace are access, stress, lack of and long work hours also lead to fatigue, way of promoting enjoyment, comfort, and education, and attitude. sleep deprivation, circadian rhythm the ability to get along. Second, because of Access: The ready availability of drugs disruption and other psychophysiological their training and daily observations, nurses is an occupational hazard, especially consequences (Geiger-Brown and Trinkoff, may develop a faith in drugs as a means of when combined with a poorly managed in press). In a longitudinal study, adverse promoting healing. This pharmacological administration of controlled substances in work schedules, including long work hours optimism is a profound belief. The third healthcare facilities (Trinkoff, Storr, Wall, and limited time off to recover, were related attitude is a sense of entitlement that focuses 1999). Sullivan, Bissell, & Leffler (1990) to musculoskeletal injury, pain, and needle on the nurse’s need to continue working surveyed 300 nurses enrolled in treatment sticks (Trinkoff et al.2006; 2007). and rationalizations regarding drug use. The programs and learned that one-sixth Self-medication for pain is always a fourth attitude deals with the special status changed worksites (usually by internal concern among nurses. Bugle (1996) of healthcare providers as being invulnerable hospital transfer) to have easier access to compared a group of nurses disciplined to the illnesses of their patients; healthcare drugs in the workplace. On the other hand, for substance abuse (n = 79) with a group providers see themselves as caregivers, not Kenna found that reduced workplace access of nurses not disciplined for substance care receivers. Fifth, professional training was related to a greater likelihood of using use (n = 124). The findings: 40% of involving powerful drugs leads to an illicit substances among nursing students disciplined nurses used prescription drugs acceptance of self-diagnosing and self- (Kenna & Wood, 2004b) and that access is to control chronic pain compared with medicating for physical pain and stress. an important feature promoting substance 20% of undisciplined nurses, and 42.5% Article adapted from Darbro, N. & use among health professionals (Kenna & of disciplined nurses used substances for Malliarakis, K. (2012, April). Substance abuse: Wood, 2004a). emotional problems compared with 6.5% Risks factors and protective factors. Journal of The ongoing lack of institutional controls of undisciplined nurses. Nursing Regulation (in press). n and oversight in the storing and distribution Lack of Education: The lack of education *********************************** of narcotics facilitates diversion and its on the addictive process and its signs Contact the Committee On Impaired Nurses concealment. Loose prescribing practices and symptoms remains one of the more (COIN): for one’s friends or family is another risk profound—and overlooked—risk factors for Phone: (202) 724-8870 factor and reflects society’s tolerance for nurses. This lack of education contributes (202) 724-8818 taking drugs and expectation of receiving to the negative stereotypes of those with Email: [email protected] prescriptions from office visits. In one study, substance use disorders, especially nurses **********************************

*The Substance Abuse and Mental Health Services Administration

e-mail: [email protected] • web: www.hpla.doh.dc.gov 11 Education

Panel Discussion on Direct to address concerns Karen Scipio-Skinner, RN, MSN, DC Care Personnel (NAPs) about locating NAP Board of Nursing: workers and ensuring • The District passed NAP legislation that there are standards in 2009 allowing the Board of in their education and Nursing to regulate NAP practice and job titling. “Consumers educational programs. can be confused by the • The Board worked with the DC Long terms,” Ms. Levy said. Term Care Coalition, a coalition of “And some health care stakeholders from a wide variety of professionals don’t clinical settings as well as nursing understand, either.” Right education programs to develop now there are no national an NAP regulatory model. In or regional standards for developing the model, it became L. to R.: Brenda G. Krohn, RN, MS; Pamela Ambush-Burris, RN, MSN; Karen Scipio-Skinner, RN, MSN; and Beverly their education or job clear that part of the confusion also Lunsford, PhD, RN. titling, and “certified” may is that there is a major overlap of not mean “credentialed.” A roles with NAP and licensed practical The direct-care workforce (Nursing certification issued through a national or nurses. The Board is attempting to Assistive Personnel or “NAPs”) will play industry-recognized body certifies that make the role deliniation more clear. a critical role in health care as America’s [the person] is qualified to perform a • Unless the federal government Baby Boomers age in place at home, defined job, Ms. Levy told attendees. “It comes up with titling and or enter Assisted Living and Long Term also means that others can rely on this regulations, we will not have Care (LTC) facilities. A panel discussion, proof of your qualifications. It is a type of consistency state to state. entitled “Quality Jobs/Quality Care: credential.” But every certificate is not a • Stakeholders in the DC community Building a Regional Direct Care Workforce credential, however. “Any organization can indicate a need for a CNA-to-LPN – Barriers and Opportunities” was recently award a certificate. Not all certificates prove educational program. held at the Meyer Foundation. Among that the recipient has reached a certain • The DC Board is communicating the top issues discussed were NAP job standard (of performance or education).” with other nursing boards as they titles, credentialing, education and career draft NAP regulations to work mobility. Fluid Borders: The District is part of towards consistent education and a region with fluid borders. People travel practice requirements. Job Titles and Credentials: Speaker back and forth between Virginia, Maryland Judith Levy, Coordinator of the DC Long and DC; however, each jurisdiction has its Brenda G. Krohn, RN, MS, Deputy Term Care Coalition, told attendees that own criteria for who can use the CNA title. Executive Director of the Virginia Board job titles for direct care workers vary from To be a CNA in Washington you need 120 of Nursing: state to state, and that obtaining accurate training hours/45 clinical, in Maryland • We regulate CNAs. Many Assisted data about the workforce can be difficult. 100 hours/40 clinical and in Virginia 120 Living facilities (AFLs) have no To catalog these positions for labor hours/40 clinical. Increased training is RNs or LPNs on staff, and the ALFs statistics can be daunting, she said. Direct- necessary. Federal training minimums for pushed for legislation requiring care job titles include Home Health Aide, CNAs and Home Health Aides have not CNAs to be regulated by the Virginia Home Care Aide, Homemaker Health changed in 20 years and may have less Board of Nursing and for more Aide, Personal Care Aide, Chore Aide, training requirements than dog groomers, training because there were so many Nurse’s Aide, Certified Nursing Assistant cosmetologists and crossing guards, Ms. medication errors. (CNA), Geriatric Nursing Assistant (GNA), Levy said. “We need them [NAPs]. They • The VA board regulates CNA schools Patient Care Technician (PCT), Medical are a very important part of our workforce. as well as Home Health Aide (HHA) Care Technician and Consumer-Directed There will never be enough nurses or educational programs. However, Support Professional. doctors to serve the aging population.” HHA practice is not regulated. Now is the opportune time for us • A lot of CNAs become LPNs.

12 District of Columbia Nurse: Regulation • Education • Practice • Regarding our CBC requirements for NAPs, we look at convictions on an individual basis. How long ago were they convicted? Candidates with crimes of moral Speaker Judith Levy turpitude—lying, cheating, • We have a high acuity-level of stealing—must come and talk to the people at home. In Maryland, board. you must be a CNA first before you in LTC; they must be a Geriatric • Virginia’s current Governor can be a Home Health Aide. Nursing Assistant (GNA). Maryland is moving toward decreasing • Some trade associations will fight GNAs receive training beyond that regulations. against increased regulation if it of a Maryland CNA. A GNA in increases their costs. That is one of Maryland has the same training and Pamela Ambush-Burris, RN, MSN, our major obstacles. certification requirements as a CNA Director of Nursing Licensure, Maryland • Input from the community indicates in the District of Columbia. Board of Nursing: that stakeholders are looking for • We have had a problem with direct care workers with a good work The program was moderated by Beverly companies offering fraudulent ethic—a good attitude, punctual, Lunsford, PhD, RN, Associate Research courses—courses that start on who will call if they cannot come Professor at the School of Nursing at The Monday and graduate on Friday. to work, who can work as part George Washington University Medical Such courses are “cash cow” courses, of a team and who have good Center, and director of the Washington but do not provide adequate communication skills. DC Area Geriatric Education Center training. • In Maryland, a CNA cannot work Consortium. n

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Unity Health Care is an Equal Opportunity Employer

e-mail: [email protected] • web: www.hpla.doh.dc.gov 13 Education Patient Care Tech Research

In February, the Board of Nursing held a breakfast briefing on the “DC Metropolitan Region Patient Care Technician Research Project.” After a welcome from Board Executive Director Karen Scipio Skinner, MSN, RN, participants were given an overview of the project concerning the Patient Care Technician (PCT) position and the duties currently being carried out by PCTs.

School of Nursing Enroll in the Nursing Education program right for you! Dr. Bonita Jenkins Bachelor of Science in Nursing Traditional and Accelerated program schedules RN-to-BSN (live broadcast, live videostream, and online options) Board staff member Nurse Specialist Dr. Bonita Jenkins, serves as the principal Master of Science in Nursing investigator (PI) of project. Co-PI of Nurse Anesthesia (full-time, campus-based) Adult Gerontology CNS/Nurse Educator (online)* Beginning Fall 2012 the project is former Board of Nursing Nurse Administrator/Nurse Executive (online, multiple entry options)* Family Nurse Practitioner (online with live broadcasts)* Women’s Health Nurse Practitioner (online with live broadcasts)* Nurse Midwifery (in partnership with Shenandoah University)

*Post-Masters certificate programs available

Doctor of Nursing Practice DNP Advanced Practice (online post-masters program) DNP Nursing Executive-Beginning in January 2012

Dr. JoAnne Joyner

The RN > BSN curriculum is designed to accommodate adult learners: chairperson, Dr. JoAnne Joyner, who Learn from nationally recognized faculty is an Adjunct Professor at Trinity University. Research will be gathered Contemporary curriculum prepares the RN for admission to MSN. (RN > BSN from acute care institutions that employ option) and Doctoral programs Nursing Assistive Personnel in our region until late in 2012. Fall and Spring admissions available Contact Dr. Bonita Jenkins if your facility is interested in participating in For more information about a nursing education program, call or visit: this study at email address 1-800-483-2781 dl.odu.edu/ODU-Nursing [email protected].

14 District of Columbia Nurse: Regulation • Education • Practice NCLEX MYTHS National Council Licensure Examination

Myth: If a candidate receives candidate’s ability estimate based on the NCLEX test plan requirements. a “Select all that apply” (multiple all the responses including the most The examination continues in this response) item and answers recent response. Next, the item bank way until a pass or fail decision can incorrectly, the computer will is searched to find an item in the be made. There is no established continue to give the candidate appropriate test plan category that percentage of items with alternate those types of questions until best matches the candidate’s ability formats that will be administered to it determines the candidate can (i.e., difficulty level). This could candidates. The NCLEX is computer proficiently answer them. be any type of item, standard or adaptive and items are based on alternate. The item selected is only the candidate’s ability. There are Fact: With computerized adaptive based on the test plan content area alternate item types in all areas of testing, each candidate’s test is and difficulty level, not item type. the test plan, across all difficulty assembled interactively as the This process is repeated each time levels. As with standard multiple- individual takes the exam. When an item is administered, creating choice items, alternate items are the candidate answers an item, an examination tailored to the scored either right or wrong. n the computer recalculates the individual’s ability while fulfilling

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Patricia McMullen, PhD, JD, CNS, CRNP, Mary H. Hill, DSN, RN, Associate Dean, Nancie Pardue Bruce PhD, RN, Director of Susie Cato, MSN, MASS, RN, Director of Dean, Catholic University School of Nursing Howard University College of Nursing Nursing, School of Professional Studies, Trinity Nursing, Associate Degree Nursing Program, 620 Michigan Avenue, N.E. 2400 6th St. N.W. Nursing Program, Trinity University Community College of the District of Columbia Washington, DC 20017 Washington, DC 20059 125 Michigan Avenue, N.E. Building 53 [email protected] [email protected] Washington, D.C. 20017 801 North Capitol Street NE PH: (202) 319-5400 PH: (202) 806-7456 [email protected] Washington, DC 20002 FAX: (202) 319-6485 FAX: (202) 806-5958 PH: (202) 884-9207X9672 Ph: (202) 274-5914 CONDITIONAL CONDITIONAL PH: (202) 884-9245 FAX: (202) 274-5952 FAX: (202) 884-9308 CONDITIONAL Jeanne Matthews, PhD, RN, Chair, Department India M. Medley, MSN, RN, CPNP, Dean of CONDITIONAL of Nursing, Associate Professor & Program School of Nursing, Radians College Ellen Dawson, Ph.D., ANP, Professor and Director for Nursing Education, Georgetown 1025 Vermont Avenue, NW; Suite 200 Senior Associate Dean for Academic Affairs, University School of Nursing & Health Studies Washington, DC 20005 George Washington University 3700 Reservoir Road N.W. [email protected] Advanced Practice Nursing Program Washington, DC 20007 PH: (202) 291-9020 900 23rd Street, NW [email protected] FAX: (202) 829-9192 Washington, DC 20037 PH: (202)687-0754 FULL APPROVAL FULL APPROVAL FULL APPROVAL

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Michael Adedokun, PhD, MSN, RN, Director of Nursing, India M. Medley, MSN, RN, CPNP, Dean of School of Nursing, Jonas Nguh, PhD, MSN, MHSA, RN Comprehensive Health Academy Radians College Practical Nursing Program, Community College of the District School of Practice Nursing 1025 Vermont Avenue, NW; Suite 200 of Columbia, Bertie Campus-Nursing Certificate Programs 1106 Bladensburg Road, N.E. Washington, DC 20005 5171 South Dakota Avenue NE Washington, DC 20002-2512 [email protected] Washington, DC. 20017 [email protected] PH: (202) 291-9020 [email protected] PH: (202) 388-5500 FAX: (202) 829-9192 PH: (202) 274-6950 FAX: (202) 388-9588 FULL APPROVAL FAX: (202) 274-6509 FULL APPROVAL CONDITIONAL e-mail: [email protected] • web: www.hpla.doh.dc.gov 15 Nursing Practice

particular nursing specialty or boards of nursing receive against nurses are On Guard healthcare work setting. those related to drug and alcohol addiction, Protect Your License—Read and Specialty nursing associations develop Apple says. Nurses need to recognize the Understand your Nurse Practice Act standards of practice and care for their areas symptoms of addiction and its enabling of expertise. If you are a psychiatric mental behaviors so they can tell if they are working By Janet Boivin, RN health nurse, for example, you need to know with a nurse who is impaired. For example, Examples of serious violations of the the standards of care for mental health agreeing to sign off to wastage of a narcotic Nurse Practice Act (NPA) include being nursing, Apple says. that you did not witness is putting your license impaired by drugs or alcohol while working; at risk and is possibly illegal, Apple says. Many stealing from a patient/client, including Always question assignments states have mandatory reporting laws requiring medications; providing treatment or care you believe are not within your nurses to report unsafe or incompetent that should be provided only by a physician scope of practice. behavior in other nurses, Apple says. or APRN; falsifying records; and boundary A nursing license gives you authorization issues, including abusing a patient physically to practice within a defined scope. If a Understand the concept of or sexually. physician asks you to do something you have professional boundaries. Nurses study and work hard to obtain their not done before and you believe is not within Boundary violations occur when nurses nursing education and licensure, says Kathy your scope of practice, you must say no. You have inappropriate involvement in a patient’s Apple, RN, MS, FAAN, CEO of the National can find out by asking your direct supervisor, personal relationships. Boundary violations Council of State Boards of Nursing, based Apple says. “You need to ask the question,” can be extremely complex, ambiguous and in Chicago. They also need to be aware of she says. difficult to evaluate. Nurses should be aware whether they are acting in ways that can put of their feelings and behaviors toward their their licenses at risk. Apple says nurses can take Know what to do if someone patients and always act in the best interest of the following steps to protect their licenses: files a complaint against you patients. as a nurse. Read and understand your While licensure and nursing regulation Ensure that your state board state’s NPA. were established to protect the public from of nursing has your current Licensure is a privilege, not a right, and harm, nurses who have been accused of address. with it comes obligations and responsibilities violating their NPAs for any reason have Apple says that sometimes nurses do not that are spelled out in NPAs, Apple says. Each certain rights, Apple says. Every state has an renew their licenses, either by choice or by state has its own NPA that spells out the administrative procedures act that guides oversight. If the state board of nursing does rules and regulations governing how nurses the conduct of a state’s regulatory agency not have your correct address, then you will practice. The basic legal concept in all NPAs when processing a complaint. If you have not receive notification of licensure renewal. is that nurses must be competent in the area a complaint filed against you, you should Nurses who fail to renew and continue to in which they are practicing. Whether you are contact your state board of nursing and practice are committing a serious violation in competent to practice is your responsibility in ask about your rights in the process. Some most states. relation to maintaining your license in good of those rights usually include the right to standing, not your employer’s, Apple says. see the complaint and know who has filed Periodically check your state For example, if you have applied to a a complaint against you, the right to legal board of nursing’s website. hospital as a med/surg nurse, but the hospital representation, the right to a hearing in front Most state boards of nursing have websites wants to hire you in pediatrics, it is your of the board and the right of appeal. You can where nurses can keep current on changes to responsibility to tell the recruiter you are not protect your license by understanding the NPAs, Apple says. competent in this area. The hospital can then complaint process and knowing what those DC Board website: www.hpla.doh.dc.gov. make the appropriate arrangements, whether rights include. For more information, visit the National training you in the specialty area or hiring Council of State Boards of Nursing online at you in a different unit, Apple says. Understand the disease of www.ncsbn.org. addiction and how to recognize Janet Boivin, RN, is a freelance writer. © Know the professional it in yourself and co-workers. 2011 Gannett Healthcare Group. All Rights standards of care for your Among the most frequent complaints Reserved. n

16 District of Columbia Nurse: Regulation • Education • Practice Continuing Education Update Article and Photos by Nancy Kofie LEGAL ASPECTS OF DOCUMENTATION

The Board of Nursing sponsored a continuing education program at the Washington Center for Aging Services on the “Legal Aspects of Documentation.” According to speaker Izu I. Ahaghotu, RN, Esq., in a court of law, there are four elements involved in proving malpractice. To stand up in court, all four elements in a malpractice case must be present. However, if only the first two elements of the following are present, the nurse may be called before the Board of Nursing.

Four Elements in Malpractice: • Duty to the patient (Your duty to the patient according to a reasonable prudent standard—your peers in this area of practice nationwide). L. to R.: Mary Sklencar, Mark Donatelli, Missy Moore and Izu I. Ahaghotu, Esq. • Breach of Duty • Causation (The patient was injured with your ability to give the care you error in documentation. Never use and, but for the defendant’s actions, have charted. Charting care that has white out! the plaintiff’s injury would not have not been completed is considered • Ask yourself: Would your facility’s occurred) fraud. legal team, a survey team, or a • Damages (The patient suffered a • Documentation should reflect the client’s attorney find documentation loss, such as needing additional individual patient status, i.e. patient that is clear, concise, timely and medical treatment or more needs, problems, limitations, etc. complete? medication) • Show continuity of care, • Do not alter a patient’s record—this interventions made, and responses is a criminal offense. Documentation: Your documentation from patient. represents you. Do not write with sloppy • The SOAP format is a great guide (S Nurse Practice Act: Ms. Ahaghotu penmanship. Be mindful of spelling, = subjective data, O = objective data, urged attendees to read the DC Nurse grammar and penmanship. “In one A = assessment, P = plan). Practice Act (in the Health Occupations malpractice case, a nurse’s handwriting was • Read your note after you write it. Revision Act–HORA). “It is very, very so illegible, they thought she was impaired. • If you make a mistake in writing, important for you to read. It is your She was not,” Ms. Ahaghotu said. Here are put a line through it and write— responsibility to know it.” The DC Nurse some more tips from Ms. Ahaghotu: “mistaken entry”. After you have put Practice Act can be accessed online at • Read the entire chart. Do you have a line through the mistaken entry, http://www.hpla.doh.dc.gov/hpla/lib/ the right chart? sign your signature. hpla/nursing/nurse_practice_act.pdf. • Talk to the patient. • Do NOT write “error”! A lawyer • Do not document BEFORE you have could interpret “error” as a completed a task. Document AFTER. confession that you made a mistake Something could happen to interfere in your actions, rather than just an Continued on page 18

e-mail: [email protected] • web: www.hpla.doh.dc.gov 17 Nursing Practice

Continued from page 17 the MAR [medication administration record] Malpractice Trends: According is complete,” Mr. to Ms. Ahaghotu, “The frequency of Donatelli said. He claims involving RNs, for malpractice told participants about or disciplinary defense, are highest a case in which an in adult med-surg, followed closely employer notified the by gerontology. Claims are most Board that it terminated frequently concerning allegations related an RN for failing to to treatment and care management, properly document the followed by medication administration, administration and then by assessment. DC is a federal wasting of fentanyl territory, and therefore conduct is subject in its post-anesthesia to federal law and the implications associated with a federal crime.“

Malpractice Insurance: “You need Division and he has to have malpractice insurance. You conducted investigations have to have it. At a cost of ninety for all of the major boards dollars a year, malpractice insurance including Nursing, Medicine, can provide coverage up to a million Dentistry, Podiatry, dollars. It covers disciplinary defense Psychology, Pharmacy, Social charges.” When a malpractice case Work, Optometry, and is brought, lawyers will go after the Physical Therapy. facility and the nurse. If the case is lost, the hospital has a right to come Clarity: Speaker after the nurse’s assets. In addition, Mary Sklencar, RN, clients are more likely to settle out of care unit: “The RN removed fentanyl made it abundantly clear that your court if you have malpractice insurance, on six different occasions and failed documentation must be abundantly Ms. Ahaghotu said. A case is more likely to document the administration and/ clear: “Your documentation should to be taken to criminal court if the or wasting of fentanyl on six different be clear 250 years from now, like the patient was from a prominent family, occasions.” Mr. Donatelli noted the Egyptian hieroglyphs. It must make or if the family is very angry, or if the possible violations of the Health sense. If what we write does not nurse’s actions against the patient were Occupations Revision Act associated communicate, then we have failed in our clearly, extremely willful. You will be with this case. “We established that there professional and legal responsibilities,” held accountable, she said. were documentation errors, however we said Ms. Sklencar, who is a member did not establish that she was taking the of the HPLA Compliance and Quality Ms. Ahaghotu established her law firm drug.” Assurance Unit. in 2005 and dedicates a portion of her practice to providing disciplinary defense Documentation Tips: Use proper Completeness: Ms. Sklencar says that before the DC and Maryland boards of medical abbreviations (not your own); families often complain that residents nursing. She also practices as a hospice accurately date-and-time stamp the in LTC facilities did not get all the nurse on a per diem basis. entry; fill out all required sections (do attention they were due. Often, however, not take shortcuts); never replace or the staff did provide complete care, but Speaker Mark Donatelli discard an original record. they did not document all that they did is an investigator for the DC for the resident. Your care plan should Health Professional Licensing Mr. Donatelli is currently the Senior include all interventions. Be sure to put Administration. “Please be sure that Investigator for the HPLA Enforcement something in the record.

18 District of Columbia Nurse: Regulation • Education • Practice Conform to Policies: “Cultural diversity is wonderful,” Ms. Sklencar said, however, your documentation NATURAL should not reflect your own individual or your cultural style. It should conform MINERALS to the policies and procedures of your facility. Your life is busy. Mineral make up is healthy When indicating the patient or for your skin, quick and easy to use. You can resident’s name, please put their first name even sleep in it without clogging your pores. first, and last name last. Do not switch the names. “And when you sign your name, Enjoy beautiful healthy skin with please do not include all the flourishes, botanical easy to use Mineral ruffles and curlicues,” Ms. Sklencar said. Make up from Jordan Essentials. “Don’t sign it that way in the record.”

Profusion of Pronouns: Do not get lost in pronouns. If you are documentating and it is littered with “he did this”, “she said that,” “he said this” and “she did that,” is the person reading it going to be able to tell who you are talking about? Be clear, write legibly and spell correctly. Do not write “Ability” when you mean “Abilify”, Ms. Sklencar said. Do not make up your own abbreviations: “What is ‘BBB’? Bed, Bath and Beyond?”

No Fighting: Do not use the documentation as a method of airing your grievances; do not give an opinion, fight or lay blame in your documentation. A PORTION OF YOUR PURCHASES HELP EDUCATE NURSES. Visit our web site for monthly specials and to Be precise: Do not write: “The wound find your perfect shade today at Myjestore.com/11668. was large”; specify size, color, etc., record the date, time and content of phone calls; To order other high quality home spa products do not chart a symptom without charting from Jordan Essentials, go to www.jordanrep. an intervention. com/11668 or www.jordanessentials.com and choose consultant #11668 for purchase. Por- Ms. Sklencar has been teaching, tions of the proceeds coaching and working with surveyors and go to Think About It providers for almost 20 years through the Nursing Scholarship Fund. All products are hinkNurse DOH Health Regulation and Licensing Scholarship Fund Administration. Ms. Sklencar’s duties made in America! include investigating incidents and complaints generated from the Long Term WWW.JORDANESSENTIALS.COM Care community. n

e-mail: [email protected] • web: www.hpla.doh.dc.gov 19 Nursing Practice Shadowing Nurses in Sierra Leone Photos & Captions by Olivia Pessima, RN, MBA, MS

April 2011 marked the 50th year I visited the University of Sierra Connaught Hospital in Freetown, of independence for Sierra Leone, a Leone’s Faculty College of Nursing, where I shadowed members of the country located on the gold coast of where I spoke to an administrator, nursing staff. Special thanks to Western Africa. I took a break from but I was unable to gain access to a Matrons Massaquoi and Momoh for vacationing to experience a day in the class or the clinical area. Fortunately, allowing me to visit and shadow a few life of a nurse in Sierra Leone. Initially, I was able to make a connection at of the nurses on the surgical ward.

University of Sierra Leone’s Faculty College Connaught Hospital, Freetown, Sierra Leone of Nursing, College of Medicine, and Allied Health Sciences, in Freetown, Sierra Leone

Registered nurse standing in front of patient’s bed under mosquito netting. Seen here in a mounted position, mosquito netting is used as a preventive measure in reducing the acquisition of malaria. During times in which patients are resting or asleep, the netting is lowered and covers the full body of the Nurse with surgical ward inpatient attempting to initiate an intravenous catheter. patient.

Public health nurse completing documentation Staff nurse completing documentation. Clinical nursing student assessing the upon transfer to the pulse of an inpatient on the surgical ward. surgical ward.

20 District of Columbia Nurse: Regulation • Education • Practice Monthly census data for January to July (year-to-date of photo). Notes admissions, deaths, and discharges.

Nursing students, in uniform, conversing on the surgical Supplies (gloves and safety needles) used in nursing ward. clinical practice.

Far left: Illustrations posted showing uniforms of the ward head nurse (green belt) and ward charge nurse (red belt). Graduate nurses (gray uniform) have completed all coursework, however are anticipating testing eligibility to enter the nursing field. Nursing ancillary staff wear green or pink.

At left: Nursing staff member pictured with two graduate nurses in the offi ce of the head matrons at Connaught Hospital.

View of the mountains from Sussex beach.

Olivia Pessima, RN, MBA, MS is an Infection Control Nurse for the Department of Defense and completed a DC Board of Nursing internship under the supervision of Karen Skinner, Executive Director for the Board. Ms. Pessima completed a Master of Science degree in Nursing and Business Leadership from The Washington Adventist University in May 2011, and is currently pursuing doctoral studies at The George Washington University. Ms. Pessima ultimately plans to direct her focus toward health policy and international health. n

e-mail: [email protected] • web: www.hpla.doh.dc.gov 21 Nursing Practice Tropical Medicine Expedition to Tanzania

By Erin J. Bagshaw, NP

This was an expedition led by February 20, 2011 - We are thirteen up is difficult for the doctors and a well-known tropical medicine medical providers from Germany, US, keeping the patients on the needed specialist out of Germany named Caribbean and Japan. Everyone has medications. The wards are crowded Dr. Kay Schaefer. He takes a small varied experience and expertise. We sometimes more than 10 patients per group of international health care were briefed on safety and told never room. There is no isolation room, providers into Africa for clinical to take pictures of crowds, bridges, hands on experience with tropical banks or of policemen. We were diseases at both the bed side and advised to always travel as a group in field excursions, as well as to and not to leave our compound. We learn the health care resources were to be up in just a few hours to available in Tanzania. I chose to begin our hospital rounds in Arusha. do this expedition for a few reasons. In Tanzania, although many speak First, since our practice provides English, the official language is comprehensive primary care AND Swahili. travel medicine we were beginning to see more travelers return to our February 21 - We began our day primary care side with tropical with rounds at St. Elisabeth’s hospital. Rounds in Mnazi Moja Hospital. diseases, creating more overlap of Approximately 30% of the hospital is HIV positive. We learn that close to one million tuberculosis (an infection spread by orphans are living with respiratory droplets through the air) HIV. Many do not tell their patients are placed by the windows. families of their disease or There are no masks, sinks or standard seek testing as there is still infection control measures in place. a stigma associated with this diagnosis. For this and February 22 - Today we traveled other reasons many patients through an extremely impoverished are not seen in the clinic area of Arusha. The poverty level is or the hospital until they difficult to describe. Most Americans are considered Stage 3 or will never see this level of poverty. 4 in their disease, this is Even the internship I completed in extremely advanced. We see rural Appalachia does not compare. Rounds in Father Babu Hospital. tuberculosis, cryptococcal No modern conveniences exist and meningitis, severe malaria one realizes very quickly why even needs, i.e. it is changing the questions and dysentery. clean water may not be found. We we need to ask and the diagnoses we The hospital is funded mostly are rounding today on a pediatric need to consider. Second, most health by grants, much of the treatment ward. There are many of the Massai care providers in the U.S. have not had is covered, but some patients must tribe here and in this area they are the opportunity to see these diseases pay for their medications and many becoming fractured, kids living with and I wanted this experience. It has cannot afford treatment. Patients grandparents, many single moms been my dream to travel to Africa and or their families often times bring and severe malnutrition. The Massai understand why everybody says, “It is in their own bed sheets and food as are hard to describe as they vary a amazing.” this service is not provided. Follow- bit in region. The Massai will eat

22 District of Columbia Nurse: Regulation • Education • Practice there is an underlying Today feels like we have traveled back disorder, but we are in time. limited in ability to make any difference here other February 23 - This morning we than discussion for we are listened to a fabulous lecture on not their treating provider malaria by our expedition leader and testing capability is and tropical medicine specialist, limited. There is a pecking Dr. Kay Schaefer. There is treatment order for meals and who for all forms of malaria (take your eats first in the family prophylaxis though and you have -husband, older men, a 90% chance of not getting it!). The Flying Medical Service. wives and lastly children. Treatment of malaria in children We visited the ICU presents more challenge. Between beef or lamb but no chicken or eggs. (Intensive Care Unit), 1 and 3 million die annually, the They wear traditional clothing, and it was eerily quiet as there are no majority are children and live in depending what region you are in alarms or sounds because there are no Africa. still carry spears and knives to hunt machines, no oxygen, no ventilators We then traveled to the Meserani and gather. We saw a 2 year old who and still no gloves or standard Snake Park in Arusha. Here we met weighed 11 pounds. We attempt to infection control precautions. We see “B.J.”, the owner of the park and the give our opinion on a 5 year old who other diseases but the malnutrition at clinic. He provides free anti-venom weighs 23 pounds, most of us believe this level overshadows the experience. treatment. Each vial costs $200 and

Continued on page 24 Saint Michael College of Allied Health

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e-mail: [email protected] • web: www.hpla.doh.dc.gov 23 Nursing Practice

Continued from page 23 and HIV. I still don’t see much use of if they kill a lion they are seen as a gloves, masks, or gowns. Everything hero amongst the village. There are runs very slow, the rounds, the around 100 lion bites a year according work-up of patients, and the doctors to the Doctor at this hospital. The whisper the cases which makes it very hospital has an x-ray machine and hard to hear and move through the some surgical capabilities. They exist rounds. In Tanzania in some areas it here on donation. We see cases of is considered more polite to speak in Brucellosis. This disease is caused by a quiet tone. a gram negative bacillus. It is usually We then went to Tarangire National Park to view Tsetse Flies and Tsetse traps. This type of fly can carry Treatment for a Puff Adder snake bite. African Trypanosomiasis, also known as “African Sleeping Sickness.” Once for some bites, like a neurotoxic bite bitten the parasite can eventually from a black mamba, the patient can move to the brain if left untreated require up to 7 vials for stabilization. and cause meningoencephalitis, the There are neurotoxic and cytotoxic appearance may mimic dementia as types of bites and treatment and symptoms vary depending on the bite. Most of the bites are from puff An operating room. adders and mambas but they also have spitting cobras and pythons seen as an occupational disease of here. We saw a young Massai woman those who work with cattle. However, with a snake bite of her hand. Many here you see it through the ingestion Tanzanian women give birth at home. of unpasteurized milk. The Massai She was giving birth alone on the still drink the blood and milk directly floor of her home (these homes are from the cow. It causes fever, lymph made in a traditional way with cow node involvement and severe arthritis, dung, sticks and dirt) and while she Massai girl with author Erin Bagshaw. but complications can vary. Although was delivering her own baby she was the Massai are educated to boil the bitten on the hand by a snake. It is the disease can take months to years milk often times this does not happen. believed to be a puff adder but she to progress. Measures to control the It is hard to describe the environment, did not see it as it was nighttime. The flies have involved “traps.” The flies it is easy to say, “Just boil it,” but baby is about 2 days old; the Massai are drawn to the colors dark blue and this tribe lives day to day dealing at times will walk for miles to be seen. black and actual movement. These with getting enough food and not They will both be okay. traps are impregnated to stop the fly succumbing to animals hunting them from breeding. We did see these flies as hyenas, lions and other animals February 24 - We rounded this and the bite hurts. compete for food in this region. morning at a private hospital in Hyenas are particularly vicious as they Arusha. For 10,000 Tanzanian February 25 - The Massai here hunt in packs and will go into their shillings you can see a specialist, ($1 hunt and gather for their food. They homes attacking them as they sleep. USD equals 1,500 shillings). For a walk miles and miles for food, water Medications are limited and pain medical visit it is 5,000 shillings. The or medical treatment. Often the control is not always available even in hospital is cleaner; there is even a young children are tending to the cases with children. This is one of my “VIP” room with a TV. We still see lots cattle with no adult in sight. The hardest days as I watch a young burn of malaria, tuberculosis, pneumonia Massai warriors antagonize the lion, victim being treated.

24 District of Columbia Nurse: Regulation • Education • Practice We next visited the Olduvai establish the hospital (You Gorge also known as the “Cradle of can see a video of the work Mankind”. This is one of the best they are doing on You known archeological sites. The oldest Tube by visiting their web known human footprints were found site www.fameafrica.org). here in the 1970’s and were dated to They are really making a be 3.75 million years old. One of the difference and I find them most famous skulls, a 1.8 million the most inspiring for their year old ape skull was found in 1959 passion for their work and by Mary Leakey. It’s a unique area as care. almost 2 million years ago volcanic Next we visited the ash was laid down in a sequential last tribal medicine group order allowing the preservation of known as the “Hadzabe.” many of these fossils. The tribe has only around 1,200 tribesmen left. They Nurses who run the Kizimkazi/Dimbani Health Center. February 26 - Today we visited move in small groups still the F.A.M.E (Foundation for African hunting and gathering for We were awoken this morning by the Medicine and Education) hospital. food and to live off the land. We Muslim prayer in the distance. We This is one of the most organized learn how they get to water by digging went to visit the largest hospital in and functioning hospitals. It was put holes and what they are using for Zanzibar. It is government run and together by an American named “Dr. herbal medicine to treat colic, fever, now having seen private, non-profit Frank,” a pediatric cardiac anesthetist malaria. They speak a kind of “cluck” and government hospitals, it is clear and his wife. He had attempted to language. Their highest mortality rate that the government hospital is not climb Kilimanjaro years ago with is under the age of five, there is a high as well organized or efficient. The his wife and developed pulmonary rate of miscarriage. There is a strong female doctor in charge is young and edema - a high altitude induced possibility that they will disappear impressive. We rounded through some medical emergency. He was treated sometime in the next decade. very crowded wards, sometimes 25 in Tanzania. After hearing how much people to a room. We see typhoid and they needed doctors, he and his wife February 27 - We make it to a many issues of overlapping dysentery sold everything and moved here to government hospital that is treating and HIV. There is one ventilator for African Trypanosomiasis, or the entire island, let me repeat that “African Sleeping Sickness.” one! We completed our rounds and We rounded on a few patients went to see the Spice Farm. Zanzibar with this disease and learn is known for their spices such as about the treatment and curry, nutmeg and cinnamon. We tour complications that can occur. through and learned what spices treat It is a rare disease amongst certain conditions. short term travelers to game parks or safaris. The treatment March 1 - Today we visited is dependent on the stage a Muslim school of almost 900 of the disease and can be children. They scream for us as if we complicated. are celebrities. We ask why and we are told they were hoping the Mazungos February 28 - Zanzibar (white people) were bringing them is predominantly Muslim. pens. Yes, just simple pens to write. There are approximately 1.2 We are introduced as “doktores” and million people on this island. unfortunately we are here looking Visiting with Hadzabe people.

e-mail: [email protected] • web: www.hpla.doh.dc.gov 25 Nursing Practice

Continued from page 25

for schistosomiasis, a water born March 3 - Today we had a parasite. This school has a high rate lecture on lymphatic filariasis, of infection. There is a stream nearby some know this disease and the children bathe and urinate as elephantitis. There are in the water there perpetuating the three species of this worm. cycle. In order for this parasite to Transmission occurs via the bite live it must have a fresh water (slow of a mosquito to the human moving) stream, snails and a human. and it moves into the lymphatic The snail is the host until the human system causing lymphoedema, arrives, then it penetrates human skin here usually in a limb such as and eventually makes it way to the Boys submitting urine samples for testing. a leg. We drive south of the liver. It matures here into adult worms island to the Kizimkazi/Dimbani and eventually migrates to other areas March 2 - This morning we Health Center. Here two nurses including the bladder. Symptoms can returned to the government hospital in run this center and they concentrate vary based on the infection from rash, Zanzibar for dermatology rounds. We on treatment for this disease as well fever, diarrhea to blood in the urine. see many cases of tinea, also known as leprosy. We see both types of Screening for blood in the urine is the as fungus. Fungus is common around patients and I am so impressed on first step in looking for the disease in the world but likely more prominent their assessment, documentation and these children. here due to the weather/heat, lack of treatment records of cases. resources and other infections. March 4 - Africa is a contrast in so many ways. Between the most amazing landscapes I have ever seen to the poverty and disease to the resilience of the people and joy of the children in the smallest of things. I leave Africa with the hope of returning one day; my clinical knowledge of tropical medicine improved but even better my soul more fulfilled. Africa is truly amazing.

About the Author: Erin J. Bagshaw, NP is the owner of Northwest Nurse Practitioner Associates, the first primary care Nurse Practitioner practice in Washington, DC. Their practice currently cares for approximately 4,000 patients as their primary care provider and they are also certified in travel health. If you would like to read more about the expedition or their practice you can check out their web site www. NWNursePractitioners.com. n

26 District of Columbia Nurse: Regulation • Education • Practice Continuing Education Update WOUND CARE

Article and Photos by Nancy Kofie “For pressure ulcers, it is At a wound care conference sponsored important to determine if by the Board of Nursing, speaker Diane the ulcer may be (i) healable Krasner, PhD, RN, CWCN, CWS, within an individual’s life expectancy, different. Dr. Krasner noted one case at MAPWCA, FAAN, began her talk on (ii) maintained, or (iii) non-healable or her facility where the family and physician Skin Changes at Life’s End (SCALE) by palliative. If you are offering palliative care, opted for above-the-knee amputation for a acknowledging that some wounds/pressure do not send the patient for debridement resident who habitually crossed her ankles ulcers are not healable, due to the dying every week. Debridement could bring more and the wound created was down to the process and the body’s shunting of blood pain. Focus on symptom management. tendon; it was irritated and painful. The to vital organs: “You can do everything Aggressive modalities for symptom amputation increased her quality of life— right,” Dr. Krasner said, “but some wounds management reduce pain. no pain. “It was the best outcome for her.” may be unhealable due to co-morbidities.” Show the Family: “The family needs to Documentation is crucial: “Lawsuits Three Pathways: Dr. Krasner delineated understand that the wound is present and come three, four, five years later. The only three major pathways for wound care: what we are doing about it,” Dr. Krasner thing you have to rely on is the record.” said. “Invite families in to see the wounds,” Documentation should include a wound she said. After one resident passed away, description, measurement and wound her daughter complained “They hid the care treatments as well as documentation wound from me. When they did wound of pressure redistribution devices and care they put me out [of the room].” Show techniques, including support surfaces and the family. turning schedules (Source: Legal Issues in the Care of Pressure Ulcer Patients). Each Case is Different: Dr. Krasner told attendees: “A comprehensive, Dr. Krasner is a board certified wound Left to right: RN Cindy Sylvia with Dr. individualized plan of care should not specialist who served as a member of the Expert Diane L. Krasner only address the patient’s skin changes and Panel for the SCALE (Skin Changes At Life’s co-morbidities, but any patient concerns End), an 18-month project with 18 panel (1) Aggressive, (2) Maintenance, and (3) that impact quality of life including member including physicians, nurses and legal Palliative. Look at every case individually, psychological and emotional issues.” experts. Dr. Krasner is a wound and skin care Dr. Krasner said. “Patient centered concerns SCALE statement #7 says, in part: “A total consultant and works part-time as the WOCN/ should be addressed—including pain skin assessment should be performed Special Projects and activities of daily living. The family regularly and document all areas of concern Nurse. of patient may be confused as to why consistent with the wishes and condition you chose a particular level of treatment. of the patient. Pay special attention to Speaker and Communicate to the family that you bony prominences and skin areas with wound care “diva” are addressing the pain. Dr. Krasner underlying cartilage.” Nancy Morgan, shared the SCALE project’s statement The goals of care should be considered; RN, BSN, #5: “Expectations around the patient’s SCALE Statement #9 provides a listing MBA, WOCN, end of life goals and concerns should be of 5 P’s to be considered for determining WCC, DWC, communicated among the members of the appropriate intervention strategies: showed nurses interprofessional team and the patient’s Prevention, Prescription, Preservation, in attendance a Nancy Morgan, RN circle of care.” Palliation, and Preference. Each case is Continued on page 28

e-mail: [email protected] • web: www.hpla.doh.dc.gov 27 Nursing Practice

Continued from page 27 ulcers, and diabetic (neuropathic) ulcers. Care and a National Pressure Ulcer Advisory Ms. Morgan, a Certified Wound Care Panel member. photograph of a huge pile of coffee beans. Nurse, has an extensive background in wound “Look closely,” she said. Eventually the care education and wound management Speaker Sue Petros, RN, BSN, CWOCN, audience members realized that one of the program development. a Senior Clinical Nurse Educator with 3M coffee beans was actually a small image Health Care, of a man’s face. Ms. Morgan used the Support Surfaces: Speaker Gail Rogers reviewed skin photo to illustrate the importance of close Hebert, RN, MS, WCC, CWCN, LNHA, anatomy and inspection when assessing wounds. “Do participated spoke about the detective work. Proper and accurate wound in research levels of tissue assessment will help determine wound conducted by the injury (partial type and etiology.” Wound care greatly National Pressure thickness and impacts our health care system. “In the US, Ulcer Advisory full-thickness more than 5 million patients have chronic Panel (NPUAP) wounds). wounds, and it costs $40,000 to treat the to formulate She shared average leg ulcer.” standardized terms Sue Petros, RN photographic When documenting wound and definitions examples of a characteristics, be thorough, Ms. Morgan for wound care. wound base said, “Document what the wound looks Gail Rogers Hebert, RN (See website with slough (nonviable tissue) or eschar like, as if you were explaining to a blind www.npuap. (necrotic tissue). She reviewed the person.” Characteristics to document: org). Ms. Hebert spoke about therapeutic methods of cleansing and debridement  Note tissue type – presence of eschar, support surfaces. She urged participants (mechanical, autolysis, biologic). Ms. Petros slough (wet stringy, note color); to anticipate the questions of the Joint also reviewed types of dressing—from granulation; epithelial tissue, muscle, Commission: What type of support surface traditional gauze and tape, to composite tendon, bone. are you using for your patient? Where is dressings, transparent film, acrylic dressing,  Describe surrounding tissue it documented? How does it benefit the hydrocolloids, foam, absorbent wound (periwound tissue) patient? How does it redistribute pressure? fillers (alginates), hydrogel.  Explain wound’s characteristics – Why did you pick this surface – any Drainage amount? Bleeding? Tissue particular benefits over another surface? Tips for cleansing: destruction? Mushy like pudding? Did you change the surface based on • Cleanse wounds at each dressing Hypergranulation? Wet? Dry? Cool or changes in patient condition? Are surfaces change warm? Color? addressed in the care plan? How old is • Cleansing doesn’t require  Use diagnostic tools such as the the surface you are using? (if facility owns antiseptics, normal saline is effective Ankle Brachial Index (ABI) to the surface) How do you assure that it is when delivered at 8-12 psi (19g compare the systolic blood pressure functioning properly? needle with 30 ml syringe) of the ankle to that of the arm • Chronic wound cleansers designed (brachial). Basic Wound Care: to deliver appropriate psi.  In your documentation note patient • ALWAYS turn and reposition your • Preserve the peri-wound skin education. Address pain level in patients. integrity: cleanse surrounding skin, documentation. use non-adherent dressings, alcohol  Look at the wound location • Lift, don’t drag. free barrier film, moisture barriers, (document using proper anatomical • Use maximum inflation for patient solid barrier wafers. location) and its shape (is it round? care activities. jagged edges? irregular shape?). • A loose sheet underneath patient is Wound Care Basics: preferable to a fitted sheet. • If the wound is infected, treat it. Ms. Morgan reviewed the specific • If the wound is dry, add moisture. characteristics of diabetic and arterial Ms. Hebert has been a registered nurse for • If the wound is wet, absorb it. wounds,. She also provided specific 35 years, and is a member of the Certification • If wound is necrotic, debride it. charting guidance for venous ulcers, arterial Committee for the National Alliance of Wound • Fill dead space with alginates, gauze,

28 District of Columbia Nurse: Regulation • Education • Practice or hydrogels. Invest in gaining this • Protect the peri-wound skin. expertise; conducting a focused wound Wound Assessment: Speaker Donna B. assessment is a skill and Johnson, BSN, requires training, she said. RN provided “This refers to a insights collection of data on wound that characterizes the assessment. status of the wound “You need to and the peri-wound know what type skin,” Ms. Johnson told of wound you participants. Data to • amount and type of exudates are assessing— document: • odor pressure • anatomic location of wound • wound edges wound, vascular Donna B. Johnson, RN • extent of tissue loss (i.e., stage if • peri-wound skin wound, venous pressure) • presence or absence of local signs of leg wound or diabetic wound. Use your • characteristics of wound base infection, and detective skills. Try to discover what caused • type of tissue observed • wound pain. the wound and determine how long the • percentage of wound containing wound has been present. Try to ascertain each type of tissue observed Ms. Johnson has been an RN for over 30 what types of treatments have been used in • dimensions of wound in cm years. She has been employed as a Wound, the past.” Always assess the WHOLE patient, (length, width, depth, tunneling, Ostomy Continence Nurse Specialist at Greater not just the HOLE in the patient, she said. undermining) Southeast Hospital for 20 years. n

and Bachelor of Science degree from the Medical Universities of America. Ms. KudOs! Moore has verifications in wound care, IV therapy, gerontology, and hospice and staff Congratulations to Board member development in Long Term Care. Ms. Moore Ottamissiah “Missy” Moore, LPN, BS, is a Life Time Member of the National Black WCC, CLNI, CHPLN, GC, CSD-LTC, who Nurses Association. She is also a member was been named the 2012 Black Nurse of of the Association of Hospice and Palliative the Year by the Black Nurses Association Nurses, Infusion Nursing Society, the of the Greater Washington DC Area. Ms. Ottamissiah “Missy” Moore with her father, Hookup for Black Women and National Moore is the first Licensed Practical Nurse Elder Stanford A. Moore. Baptist Convention. honored with this award. Ms. Moore has been a member of the National Federation of Licensed Congratulations the DC Board of Nursing since 2005. She Practical Nurses since 2008. NFLPN has to Kate Malliarakis, has served on the 2011 PN NCLEX Item a membership of 7,000 LPNs and LPN RN, MSM, CNP who Selection Committee of the National students. Ms. Moore speaks at the national was honored with the Council of State Boards of Nursing and level on nursing topics such as wound care, Medical Professional on the LPN Standards Committee of the hospice care of the aging, IV therapy and Award by the Caron Commission of Graduates of Foreign scope and regulation of practical nursing, Foundation at its 7th Kate Malliarakis Nursing Schools, from 2007-2011. Ms. and she has organized numerous continuing Annual Washington Moore has served as a Staff Development education programs for nurses in the District Metropolitan Area Community Service Specialist for the Washington Center for of Columbia. Awards Breakfast. Ms. Malliarakis was Aging Services since 2011. Ms. Moore holds an LPN degree selected for “making a difference” for those Ms. Moore has been President of from Atlantic County Vocational School suffering from the disease of addiction.

e-mail: [email protected] • web: www.hpla.doh.dc.gov 29 Board Disciplinary Actions

NAME LICENSE # ACTION None

Names and license numbers are published as a means of protecting the public safety, health and welfare. Only Final Decisions are published. Final Orders and the Certified Nurse Aide Abuse Registry can be assessed by going to www.hpla.doh.gov.

Non-Public Disciplinary Actions: Public vs. Non-Public Discipline

Notices of Intent to Discipline 5 Public Discipline: Disciplinary actions Referrals to COIN 1 that are reported to Nursys, National Practitioner’s Data Bank and viewed in Consent Orders 4 DC NURSE and at http://app.hpla.doh. dc.gov/weblookup/. Requests to Withdraw Application 0 Requests to Surrender License 1 Non-Public Discipline: Disciplinary actions that constitute an agreement Letters of Concern 1 between the Board and the licensee and, if complied, are not made public. Licensure Denied 1 Targeted Networking A member of Nurses Service Organization (NSO**) **NSO may cover most of your attor ney fees. The “NEW” Classifieds (1.5” wide x 1” high) Reach every nurse in Washington, D.C., Izu I. Ahaghotu,RN, JD for as little as $225. RESERVE Contact Tom Kennedy A TTORNEY A T L A W YOUR SPACE [email protected] NOW! 1-800-561-4686

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