Spring 2021

NCSBN’s CEO David Benton Reflects on 2020 and Beyond

Inside this Issue: Workforce Survey Reveals Noteworthy Trends Next Generation NCLEX Update Nurses and Students Volunteer in Vaccination Effort Managing Editor and Writer Spring 2021

Michael Grossenbacher | [email protected]

Contributing Editor and Writer In This Issue

Dawn Kappel | [email protected]

A Portrait Emerges...... 4 Designer NCSBN’s 2020 National Workforce Kalona Owens | [email protected] Survey Reveals Noteworthy Trends

Rounding the Corner...... 8 Founded March 15, 1978, as an independent not-for-profit organization, NCSBN was initially created to lessen the Nurses and Students Participate in Nationwide burdens of state governments and bring together nursing regulatory bodies (NRBs) to act and counsel together on Vaccinator Effort matters of common interest. It has evolved into one of the leading voices of regulation across the world. ® NCSBN’s membership is comprised of the NRBs in the 50 Next Generation NCLEX states, the District of Columbia, and four U.S. territories — American Samoa, Guam, Northern Mariana Islands and the Advances Toward Launch...... 12 Virgin Islands. There are three exam user members. There are also 27 associate members that are either NRBs or empowered regulatory authorities from other countries or territories. NCSBN’s CEO David Benton

Mission: NCSBN empowers and supports nursing regulators in Reflects on 2020 and Beyond...... 14 their mandate to protect the public. The statements and opinions expressed are those of NCSBN Impact in Action: Nurses Share their and not the individual member state or territorial boards of nursing. 12 NLC Stories...... 20

Copyright ©2021 National Council of State Boards of Nursing, North to the Future: the NLC would Benefit Alaskan Inc. (NCSBN) All rights reserved. This document may not be used, reproduced or disseminated to any third party without Nurses and their Patients written permission from NCSBN.

Reducing Barriers and Filling a Need: Nevada and Address inquiries in writing to NCSBN Permissions, 111 E. Wacker Drive, Suite 2900, Chicago, IL 60601-4277. the U.S. as a Whole would Benefit from the NLC 312.525.3600 | www.ncsbn.org | [email protected]

News & Notes...... 26 4 8 Speed Round...... 13 For this reason alone, it is than 5 million registered nurses imperative that accurate, (RNs) and licensed practical up-to-date data on the nurses/licensed vocational nursing workforce be Since 2012, NCSBN and the National Forum of nurses (LPNs/LVNs) currently State Nursing Workforce Centers have conducted available to predict potential a biennial nursing workforce study. licensed in the U.S. The nurses A PORTRAIT EMERGES shortages and assist in the are sent a survey which allocation of resources, program development asks questions about demographics, education, NCSBN’s 2020 National Nursing Workforce and recruitment efforts in the and employment status, practice setting and licensure. education sectors. The need to know more about In the most recent survey, data were collected Survey Reveals Noteworthy Trends the characteristics of the nursing workforce is from 42,021 RN respondents and 39,765 critical to understanding the supply of nurses in LPN/LVN respondents between Feb. 19, 2020 the country. Without knowing what the nursing here was never a time when nurses were more in the spotlight than they were and June 30, 2020. workforce looks like now and uncovering emerging in 2020. The pandemic brought to the forefront what most in the health care trends in demographics, the health care system One of the more alarming trends uncovered is system already knew, the value of nurses is almost immeasurable. Along with could be brought to its knees in another pandemic that one-fifth of nurses surveyed plan to retire articles rightly lauding the contributions of nurses grew the recognition that if we don’t prepare adequately now. or leave the profession over the next five years. theT nursing workforce is aging and rapidly approaching retirement age, foreshadowing The survey found that the median age of RNs was Since 2012, NCSBN and the National Forum of potential future shortages. Nurses were the backbone of the health care system in 52 years. The median age of the workforce has State Nursing Workforce Centers have conducted battling COVID-19, but the question arises — what could happen in a future crisis where remained approximately the same since 2013 but a biennial nursing workforce study. These surveys there are even fewer nurses to call into the system? the age distribution of the workforce has changed draw a nationally representative sample of more

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Table of Contents 4 | In Focus Spring 2021 | 5 Table of Contents continued from page 5 substantially. Nurses who are aged 65 years or traumatized by the workload and emotional turmoil nurses in any other group younger than 60 years, followed by adult health (8.3%). older account for 19% of the RN workforce and brought on by caring for COVID-19 patients. It and higher than the proportion of white nurses in The use of telehealth by nurses has remained comprise the largest age category. The proportion remains to be seen whether those nurses and the RN workforce as a whole (80.7%). almost unchanged since 2017 with about 50% of nurses aged 65 years or older increased by others like them will return to bedside nursing, or Results from the survey also show that the of RNs and LPNs/LVNs reporting that they have 5.1 percentage points from 2013 and by 4.4 to the profession in another capacity. nursing workforce is becoming increasingly more utilized telehealth technologies when providing percentage points from 2017. Depatures due to retirement and burnout will have educated with approximately 42% of nurses in nursing services. It is important to note that the This potential exodous of 20% of the nursing repercussions on the workforce and the health 2020 reporting a baccalaureate nursing degree as period that this survey was conducted (February workforce has serious implications for the care care system but it is unknown how detrimental their first U.S. nursing license, an increase of 5.8 – June 2020) included the months just prior to of an aging population plaugued by chronic these changes will be long term. percentage points from 2013. The most common the declaration of the global pandemic and during diseases and comorbidities. Combined with nurse highest level of nursing education achieved is a the early months of the crisis. It bears watching Although there have been some small changes in retirement, nurses leaving practice and an aging baccalaureate degree across all groups (65.2% of to see what the trend will be in nurse utilization of gender, race and ethnicity statistics, it is evident population is the fact that there are not enough RNs), which increased by 7.8 percentage points telehealth technologies due to the shift made by that the nursing workforce does not reflect the new nurses entering the health care system to between 2013 and 2020. The number of RNs who the health care system to deploy more telehealth diversity of the U.S. population. Males account meet the demand. According to the American indicated that a doctorate of nursing practice services. for 9.4% of the RN workforce, an increase of 0.3 Association of Colleges of Nursing (AACN), a (DNP) was their highest level of nursing education percentage points since 2017. For LPNs/LVNs, This study presents a portrait of the nursing 2019 study found that there was 5.1% enrollment increased by a full percentage point from 0.4% in males account for 8.1% of the population, an workforce in 2020. The data collected including increase in entry-level baccalaureate programs in 2013 to 1.4% in 2020. increase of 0.4 percentage points since 2017. For nurse demographics, educational attainment, nursing, but this increase is insufficient to meet the first time in 2020, a third gender response While 81.5% of LPN/LVN respondents in 2020 employment, practice characteristics as the demand. Additionally, AACN’s report on 2019– option of “other” was added to the survey and was reported a vocational/practical certificate for their well as emerging trends provides evidence- 2020 Enrollment and Graduations in Baccalaureate selected by 0.1% of respondents. first nursing license, the proportion of LPNs/LVNs based research. This sound research is what and Graduate Programs in Nursing, states, “U.S. with an associate or baccalaureate degree policymakers and leaders in nursing education nursing schools turned away 80,407 qualified Most nurses in the survey reported being white increased over the years, the number of those and health care practice can use when making applicants from baccalaureate and graduate (81% of RNs and 69.5% of LPNs/LVNs). For RNs, qualifying with a vocational/practical certificate decisions that will impact nursing and the health nursing programs in 2019 due to insufficient the next largest racial group was Asian, accounting and diploma has decreased. The highest level and the welfare of patients in the future. number of faculty, clinical sites, classroom for 7.2% of the workforce. Black/African American of nursing education achieved as reported by space, and clinical preceptors, as well as budget RNs increased from 6.0 % in 2013 to 6.7 % in This study “The 2020 National Nursing Workforce LPNs/LVNs were vocational/practical certificate constraints.” 2020. The proportion of RNs reporting being Survey” was published as a special supplement (72%), diploma (12.2%), associate degree (12.7%), Hispanic/Latinx was 5.6%, an increase of 0.3 of the Journal of Nursing Regulation and can be What is yet unknown is whether COVID-19 has and baccalaureate degree (3.1%). percentage points compared to 2017. accessed free of charge. or will cause more nurses to leave the profession.

The majority of respondents, both RNs and

Even pre-pandemic, burnout and stress were The proportion of LPNs/LVNs who reported being REGULATION NURSING OF JOURNAL LPN/LVNs, reported that they were actively VOLUME 12 · APRIL 2021 SUPPLEMENT cited as reasons why nurses left the workforce. Black/African American was 17.2%. Those who THE OFFICIAL JOURNAL OF THE NATIONAL COUNCIL OF STATE BOARDS OF NURSING involved in the practice of nursing either full or part A study published in JAMA, “Prevalence of and report being Hispanic/Latinx account for 10.0% time. For RNs, a was the primary practice Factors Associated With Nurse Burnout in the of the workforce, an increase of 2.6 percentage setting selected by 54.8% of respondents which US,” measured the rate of nurse burnout and points since 2017.

is a decrease of 0.9 percentage points from 2017. 12 Volume JOURNAL • examined factors that caused nurses to leave or Supplement OF

While what younger nurses report as their race Ambulatory care was the second most frequently NURSING

• consider leaving employment. Among nurses who 2021 April reveals greater diversity as a group than their older selected response at 9.7%. For LPN/LVNs, 26.6% REGULATION reported leaving their job due to burnout, “a high Advancing Nursing Excellence for Public Protection counterparts, the youngest RNs in the survey selected geriatric/gerontology as the employment proportion reported a stressful work environment.” The 2020 National Nursing Workforce Survey (aged 19 to 29 years) are actually less diverse than Richard A. Smiley, MS, MA; Clark Ruttinger, MPA, MBA; Carrie M. Oliveira, PhD; specialty that most closely corresponded to their Laura R. Hudson, MSN, RN; Richard Allgeyer, PhD; Kyrani A. Reneau, MA; Ancedotally, during the height of the pandemic, Josephine H. Silvestre, MSN, RN; Maryann Alexander, PhD, RN, FAAN RNs aged between 30 and 49 years. The number primary nursing practice position, down from JOURNAL numerous news articles highlighted stories of nurses aged 19-29 years who identify as white OF

30.5% in 2017. Home health was the second most S1–S96 Pages of nurses who left the profession after being NURSING (84.1%) is higher than the proportion of white frequently selected employment specialty (8.4%) REGULATION

Table of Contents 6 | In Focus Spring 2021 | 7 Table of Contents At right: Lewis University nursing student Rachel Bingenheimer vaccine administration site for adults with special administers a vaccine to student Going Where They are Most Needed: Michael Babich. Lewis University Nursing Students needs and those who care for young children Volunteer as Vaccinators with special needs. Nursing students are planning this event with students in other disciplines such Unknown to most, nursing students at Lewis as occupational therapy, special education and University in Illinois have been busy with the speech therapy. Additionally, nursing students COVID-19 vaccine administration effort since will be involved in helping to vaccinate those in stepping up in December 2020. Due to the underserved areas through local churches. Rounding the Corner university’s ongoing relationship with the Will Read the full Lewis University story here. Nurses and Students Participate in County Health Department, students and faculty completed Centers for Disease Control and An Historic Moment for Nationwide Vaccinator Effort Prevention COVID-19 Vaccine Training Modules Nursing Students and administered more than 500 doses in the last week of 2020. These experiences help to replace The pandemic has presented many As the U.S. moved into the vaccine some of the clinical experiences that students lost out on due to COVID-19. challenges to nursing phase of the COVID-19 pandemic, it education, particularly created an unprecedented and urgent “Because of the pandemic, clinical rotations were related to providing need for qualified personnel across sometimes not open to students and they were quality clinical justifiably disappointed,” says Julia Koklys, DNP, experiences because the country to safety administer the I’m going to tell you, going there is a good “ APRN, FNP-BC, chair, Department of Nursing, many clinical facilities COVID-19 vaccines. Many medical break from an emergency department Lewis University, College of Nursing and Health closed their doors or a critical care situation. It’s a feel-good professionals have stepped up to Science. “When we explained that many of to nursing students. feeling, doing your part, being a part of However, it has volunteer their skills and expertise. history and turning this virus around.. the units were turned into ICUs and the nurses reassigned, understanding dawned in their eyes presented many Karly Schmitz, prelicensure student at UIC College of Nursing, Springfield campus — Michael D. Jackson, MSN, RN, CEN about what was really going on.” opportunities as well. Now that we have effective COVID-19 vaccines, nursing students have been participating in the Suit Up Jackson is no stranger to service. Over the years, Long-term, I wonder whether this exposure massive, national public health vaccination effort. he has volunteered professionally and in his ” “ “It’s a sigh of relief for them.” will change their minds and lead them in community. He also served his country in Desert a different direction than they could have The Western Kentucky University (WKU) School That’s how Michael D. Jackson, Shield and Desert Storm as an active duty U.S. imagined before they had this experience. of Nursing has provided their nursing students MSN, RN, CEN, describes the Marine. “The call was put out to employees to with an unprecedented opportunity to administer way patients and members of his come in and assist with the vaccination effort — Julia Koklys, DNP, APRN, FNP-BC, chair, Department of Nursing, vaccinations to the public during this pandemic. Lewis University, College of Nursing and Health Science own family have responded to because we had already been vaccinated,” he Their clinic vaccinates from 800–1,200 people receiving the COVID-19 vaccine. explains. “I live in a city that borders another daily, seven days a week, from 7:00 am to 7:00 pm. Jackson is a seasoned clinical nurse country and we have a huge immigrant In another part of the country, prelicensure in the Department of Emergency Medicine at population. Some people are suspicious of Lewis nursing students have administered the ” nursing students at the Springfield campus of the the University of California, San Diego (UCSD) getting the vaccine. I think it’s important for me vaccine to school bus drivers, emergency medical University of Illinois, Chicago (UIC), gave some of Medical Center and immediate past president to be out there so people can see that I’ve had services personnel and people on the autism the first COVID-19 vaccinations in the city at HSHS of the California Board of Registered Nursing. this shot, I’ve studied the science, and it’s going spectrum. Generally, Lewis students administer St. John’s Hospital. The UIC students vaccinated He and his wife Arlene, an intensive care unit to be safe for our community.” from 200 to 1,000 vaccine doses per week. Soon, nearly 600 people on Jan. 28, 2021, including nurse, have volunteered as vaccinators through a in partnership with major pharmacy chain in the Read Michael D. Jackson’s full story here. front-line workers at HSHS St. John’s Hospital partnership between UCSD Medical Center and Chicago metro area, the Lewis campus will serve as and people from the community who were 65 or San Diego County. continued on page 10

Table of Contents 8 | In Focus Spring 2021 | 9 Table of Contents continued from page 9 Questions about ? This has really pulled our community together, showing that we are all “ interconnected. I am so proud of our students, faculty and nurses at WKU! NCSBN’s new Nurse Licensure Guidance — Tracy Jenkins, DNP, RN, CNE, faculty, Western Kentucky University School of Nursing tool provides resources and direction on becoming a licensed nurse in the U.S.

There are several steps in the process of older. Their clinical instructor, Jennie Van Nurses at NCSBN are also helping with the ” obtaining (RN) or licensed Schyndel, PhD, RN, said, “Students were vaccination effort! practical/vocational nurse (LPN/VN) able to see how much effort it is for a “As a volunteer nurse licensure in the U.S. Our Nurse Licensure health care organization to organize and vaccinator, I am grateful for Guidance tool helps international nurses and efficiently carry out mass vaccination the opportunity to help my domestic nurses learn more about state- clinics. They saw how hospital managers community and neighbors. specific licensure requirements based on volunteered their time to be there and their selections of where they want to live Let’s stop this virus by all of support the efforts. They interacted and practice in the U.S. us getting vaccinated!” with senior citizens who came on a cold Try out the Nurse Licensure and icy day — many who thought they — Nadja James, PhD, MSN, MHA, senior content associate, Guidance tool today! had won the lottery by being able to Nursing Regulation, NCSBN get their first dose.” Van Schyndel also noted that students gained valuable clinical experience in the vaccination “I feel so honored to participate clinic, interacting with older adults, in the COVID-19 vaccination educating them on the vaccine, making administration process. People appointments, assessing them post- are grateful for the vaccine, and vaccination, and listening to their health surprised that it doesn’t hurt histories and medications. much!” Register for the Read the full version of this story here. — Kathleen Russell, JD, MN, RN, associate director, Nursing 2021 Virtual Regulation, NCSBN ® NCLEX NCSBN has issued a policy brief that recommends what personnel should administer Conference the vaccine in order to protect the public. The brief specifically states, “COVID-19 vaccines can be safely administered by licensed practical nurses/vocational nurses Thursday, Sept. 30, 2021 (LPNs/VNs), registered nurses (RNs) and advanced practice registered nurses (APRNs), in addition to other licensed health care providers such as physicians, physician assistants and pharmacists.” This one-day, educational conference provides educators with Next Nursing regulatory bodies are assuring that there is a supply of licensed nurses who Generation NCLEX (NGN) NCSBN Clinical Judgment Measurement are safe and competent to administer these vaccines. Additionally, the formation of Model (NCJMM) updates and techniques for applying the NCJMM in Register Today partnerships with nursing education programs where the services of student nurses the classroom. Live question and answer sessions will be available can be employed to administer the vaccines under the supervision of faculty or other after each session. The conference will also feature a variety of video qualified, licensed personnel, is also vital. resources about the NCLEX.

Table of Contents 10 | In Focus Spring 2021 | 11 Table of Contents Beyond the collection of data, which initially was an important check on the efficacy of new item types and Speed Round now provides useful information on Get to know NCSBN staff:

individual items and case studies, there is still a significant amount of Josephine H. Silvestre, work to do prior to the launch of the MSN, RN NGN. Senior Associate, Regulatory Innovations With the “Measurement/Research” phase ongoing, we are now working with Pearson VUE to ensure that all technology systems can support What do you do? the new NGN item types, scoring I assist on multiple projects related to nursing education, methods and data structures. including the following: 1) the Safe Student Reports study designed to collect nursing student error and near miss data Advances Toward Launch This includes significant software from participating nursing programs; 2) the Prelicensure RN development as well as numerous Cohort study designed to assess the impact of COVID-19 on levels of validation subsumed nursing education programs; and 3) the annual reports project, Just over a year ago, NCSBN temporarily halted However, we did know that prolonged suspension under the “alpha testing” and “beta which is assisting boards of nursing to collect core nursing NCLEX® testing in response to the rapid spread of the Special Research Section would present testing” headings. Importantly, education program data. of COVID-19 across the U.S., Canada, and other challenges to an on-time launch of the NGN. NCSBN is also providing timely countries where Pearson VUE maintains testing and accurate information about Just over six months later, with our highest volume What are the best and most challenging aspects sites. When we were able to resume testing, the NGN to stakeholders through testing months behind us and a multitude of safety of your job? though limited and with a lengthy list of expanded webinars, research papers, quarterly and capacity mitigations in place, we reinstated the I have many opportunities to work with various research-related health and safety protocols, the exam itself newsletters and other information NCLEX Special Research Section on Oct. 1, 2020. projects. When I joined NCSBN, I was hired to manage the had changed as well. To reduce overall testing resources. daily activities of a two-part, multisite study of transition to This milestone not only marked the continuation time, which minimized risk to candidates, we practice in hospital and nonhospital settings. Since then, I’ve of the NCLEX-RN Special Research Section, Testing candidates safely during removed our Next Generation NCLEX (NGN) had the opportunity and pleasure to work on several studies. I but included its debut on the NCLEX-PN exam. the pandemic while keeping the enjoy working with teams that contribute new knowledge and Special Research Section as well as our standard Though the research sections have always been NGN launch on track was by no provide the foundation to inform future research and nursing experimental optional, we means easy or a given this past program policy. The primary challenge of my job is navigating (or “pretest”) are pleased to year. However, we are pleased to the sometimes competing priorities and deadlines of the various items. At see that a large report that all systems indeed point studies and projects. the time the Develop Clinical Item Item Item percentage of to “go” for a successful launch as Judgment Prototypes Usability Data decision was Measurement Development Testing Collection Model candidates are we turn the corner into the final If you weren’t working at NCSBN, what would made, the completing the 24 months of the project. There is your dream job be? duration of still substantial work to do, but it My dream job would be to volunteer full time for a nonprofit that Technology items, providing the changes Build NCSBN with appears the most significant hurdles, provides health and social services to marginalized populations. (as with Since my early 20s, I volunteered for multiple organizations in Measurement Alpha/Beta the data expected and unexpected, have now all things Research Tests various programs (such as Howard Brown Health Center, Lesbian Launch required to been cleared, perhaps not only with pandemic- Community Cancer Project, Center on Halsted HIV Resources) keep the launch the exam but with the pandemic assisting the LGBT+ population in various capacities. I would love related) of the new itself. Stay safe, stay healthy and get to continue this important work addressing disparities in health was uncertain. The NGN consists of several phases of research, which are delineated in the model above. If the evidence during any individual step indicates that potential innovations will not support exam on schedule. ready for NGN! and social services in the LGBT+ community. the rigor and quality of the NCLEX, the project will be reexamined at all levels.

Table of Contents 12 | In Focus Spring 2021 | 13 Table of Contents NCSBN’s CEO David Benton Reflects on 2020

and Beyond One who gains strength by overcoming obstacles possesses the only “ “ strength which can overcome adversity. — Albert Schweitzer

In the midst of a crisis, it can be difficult to see the path forward. Those with perseverance and ingenuity can conceive the end of the journey and take steps to overcome the obstacles. NCSBN embarked on a journey, along with the rest of the “ It’s like the air that we world, when the World Health Organization declared COVID-19 a global pandemic on March 11, 2020. The organization was braced for what might happen and had breathe … regulation the forethought to imagine what contingencies might come into play, but NCSBN protects us in ways still had to deal with “curve balls” that no one saw coming. Its ability to perform with

that most people don’t flexibility, adaptability and creativity — coupled with previously conducted evidence- “ based research — allowed it to weather the pandemic with inventive solutions to even think about. seemingly insurmountable problems.

We are now more than one year into the “There have been a lot of regulatory lessons — David Benton pandemic. In Focus interviewed NCSBN CEO learned,” Benton notes. “The first one, which David Benton, RGN, PhD, FFNF, FRCN, FAAN, we should be proud of, is that we have been to discuss the lessons learned, how NCSBN able to change systems at a pace which, for dealt with the challenges that arose and how the regulatory community, is unprecedented. the organization will use the innovations that As problems arose, we worked with our resulted from the crisis as a springboard for members to get fresh ideas, convened future transformation. small groups to work on them, and came up with solutions, which were both borne from necessity but also addressed the critical elements that we needed to concentrate on to move forward.”

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Spring 2021 | 15 Table of Contents continued from page 15

Benton knows that open lines of that I was asking people to do things they communications were, and remain, essential. wouldn’t perhaps normally be asked to do, He remembers sending an email to NCSBN and worried I was overloading individuals. It staff on a Saturday evening because he was the combined effect of all of the issues wanted them to have the message in their that was perhaps the biggest challenge. We inbox first thing Monday morning, “I wanted could not do this in a nice, linear fashion. We to communicate the fact that I knew that actually had to embrace multiple things all at things were going to be tough, that we weren’t once. Sorting out access to the exam sectors, going to be working business as normal, and coming up with new metrics, managing media that, at times, I might be placing demands on communication, getting an understanding staff that I wouldn’t normally ask. I would be from our members of what was keeping them reaching out to them on the weekend or in the up at night, and then responding to it in real- evening,” Benton recalls. time. We’re a high-performing organization. We can deal with this. But doing multiple tasks It was also crucial to have ongoing, open all at once in a compressed time scale, that dialogues with NCSBN members, nursing was the biggest challenge!” regulatory bodies (NRBs) in the U.S., Canada and across the world, that were also enduring The COVID-19 pandemic was a worldwide VIDEO: David Benton on the importance of nursing regulation: “We do need to strengthen our communication with this crisis with their own challenges. What cataclysmic event that impacted every the public so that they inform us about the things that are really important to them.” each NRB had to contend with varied widely single segment of society. Although it is dependent on how much they were impacted sometimes hard to find a silver lining in One of the biggest hurdles NCSBN faced came focused to one which was about a single by the pandemic at a given time. To assist what was experienced, opportunities arose when the Pearson VUE Testing Centers were organization with multiple contributions — put them, NCSBN set in place a system in which in its obstacles and adversity for increased closed on March 16, 2020. NCSBN immediately us in a very strong position for moving forward they could immediately connect with staff and communications and partnerships between took action to ensure that NCLEX® testing during the pandemic. We recognized before the NRB executive officers. countries, allied health professions and could resume as soon as possible. The steps the pandemic that different parts of the associations, and regulation and government. NCSBN took to resume testing by March organization were not connected in the way NCSBN’s Board of Directors (BOD) had Reaching the one-year anniversary of the 25, 2020, as well as the other challenges to that they should be, or they didn’t come into confidence that leadership and staff were well pandemic gives rise to asking how NCSBN testing throughout the year, are detailed in the the equation early enough on in the process. equipped to handle the crisis. Benton notes overcame the difficulties it faced? What was Summer 2020 issue of In Focus. “We identified That can be problematic because you miss that this empowered them to be nimble and learned during that process that could propel that getting nurses into the system was an opportunity to produce an even better adaptable, and to do what was necessary to it forward as an organization? What positives essential. We petitioned the state governors product.” function at peak efficiency. “Knowing that can be taken away from this crisis? to make sure that that was recognized,” people trust you to get on with what it is truly comments Benton. Benton acknowledges that technology had a important is a very liberating thing that really Benton relates that during his conversations role to play. “We were, by good luck, renovating helps us do the job.” with the NCSBN BOD, the NCSBN When asked about the qualities that enabled our office. And as a result of that, we had leadership team and counterparts at other NCSBN to pivot in the dramatic way it did, equipped staff with the technology to work off- When asked about the greatest challenge organizations, they recognized the need to Benton remarks, “On a staff basis, I actually site. So when the decision was taken to move the organization faced, Benton says it is understand the enormity of the things that think we were well-prepared. The fact that to remote working, it wasn’t really a change. difficult to identify one single greatest were accomplished in a compressed time we had already made a commitment as an It was already in play. And therefore, we didn’t challenge. “We were multitasking a lot of scale and to use that as an opportunity for organization to change our culture — from have the problems that other organizations the time. I was always conscious of the fact future lessons. He notes, “I think one of the one which was functionally based and project- experienced.”

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things that regulators are often criticized boundaries. I believe that the pandemic has government can do for regulators. It’s what VIDEO: David Benton on borderless health care: “I for is that they move at a pace which is actually set us on a trajectory for much closer regulators can do for society. If we embrace believe that the pandemic has actually set us on insufficient for the rate of change within the collaboration across jurisdictions.” that concept, it lives up to our vision of a trajectory for much closer collaboration across jurisdictions.” environment. When you look at the history of leading regulatory excellence worldwide, this organization, it does make big and bold The pandemic necessitated modifications because staying still is going back. We have steps in a way that prepares a pathway to the in the way that health care was delivered to move forward.” future. The decision NCSBN’s founders made in nonemergent circumstances. Telehealth to create the organization in the first place expanded exponentially, but its use brings a Benton also asserts that NCSBN had a unique was very much dealing with the issues of the new set of regulatory challenges as care is role in the pandemic by providing up-to-the- day more than 40 years ago, but it was also often being delegated to practitioners across minute data that no one else had, as well as a about the vision for the future. Making sure the country and around the world. Regulatory public safety perspective that examined how that we are not solving yesterday’s problems frameworks need to be in place that do not legislative changes could negatively impact or even today’s, but positioning ourselves for inhibit new modes of health care delivery real-world situations. “We were able to not the future is an important lens that we need but still safeguard the patient. Additionally, talk in abstract terms but talk actual numbers to look through as we do move forward “ because technology is moving so quickly, and give information on where people were if regulators are not part of the discussion and how we might tap into their expertise. Some of the changes made during the surrounding the proliferation of these modes Having discussions with the White House and pandemic uncovered gaps in the public safety of health care delivery, they are going to the U.S. Department of Health and Human arena that will need to be addressed. There be in the unfortunate position of trying to Services (HHS) and being able to give real- were also adjustments and alternations made retrofit solutions to problems that they were time data are invaluable assets that we were to policies and procedures that merit being unaware would even occur. able to bring to the table that no one else made permanent. On a national level the work could,” adds Benton. done toward advancing the Nurse Licensure When queried about the role that nursing Compact is an example of a potential solution regulation played in the pandemic and how Benton concludes, “I think part of what we that benefits both nurses and patients with he would like the public to view it, Benton were able to demonstrate is that if we have increased access to care, greater mobility states, “Regulation is a bit like the air that resources that are fit for the moment, then and developing modes of service delivery like we breathe. It’s all around us, and it sustains we should have the courage to apply those . NCSBN is also working with the us in a way that most people don’t even resources in a way that benefit the wider International Nurse Regulator Collaborative think about. Without regulation, health care stakeholder group. The work that we did with to see how to facilitate public safety across delivery cannot be held to account. The the Tri-Council for Nursing was an important not just state boundaries but national public needs to know that we’re there and lesson for all of us because we were able borders. that we’re there for them. We also need to to take the very best strengths of each strengthen our communication with the organization and apply them in a way that Another positive arising out the pandemic is public so that they inform us about the things perhaps we wouldn’t have done normally, increased partnership across borders, Benton that are important to them.” because we all knew the pandemics was the explains, “On the international stage, whether largest threat facing humanity in over 100 “ Viruses do not

you are a regulator in downtown Chicago Further articulating on the role of regulation years. We all had to play our part. And as

or in rural America or in a conflict-torn in society, Benton evokes President John F. such, we fulfilled what is the essence of our respect jurisdictional country in Africa or the Middle East, many of Kennedy in his inaugural address, Ask not profession, the profession of nursing: doing “ the challenges we’ve faced have been the what your country can do for you – ask what the right thing for the right person at the boundaries. same. Viruses do not respect jurisdictional you can do for your country. “It’s not what right point in time. Taking those bold steps is important.” — David Benton

Table of Contents 18 | In Focus Spring 2021 | 19 Table of Contents wanting to stay due to the weather or being so far Because Alaska is a very small community, the The (NLC) is becoming ever away from family for long periods of time,” says board was very busy hiring travelers into the state. more vital to nurses and those who employ them. The Paxton. “Being part of the NLC would allow people I was delayed almost two months in getting my NLC helps remove barriers or unnecessary burdens to come to the state, start practicing and stay as Alaska nursing license.” to borderless practice and increases access to care. long as they can.” It also helps address and reduce workforce shortages COVID-19 has been the greatest public health and enhances disaster preparedness. Paxton has experienced the delays of obtaining emergency in generations. If every state was in licensure firsthand. Before joining Providence the NLC, costs to health care facilities, providers Over the past year, NCSBN has shared compelling Alaska in November 2020, she served as chief and state government could have been reduced, NLC Stories to show how the compact can positively impact nurses and their patients. When the COVID-19 nursing officer at Providence Saint Joseph Medical and treatment could have been provided more pandemic hit, the ability of nurses to move quickly Center in Burbank, California. Previously, she quickly to areas where it is needed most. Nearly where they are needed became more important than worked as a Newborn Intensive Care Unit staff every state – Alaska included -- issued emergency ever. The common thread running throughout these nurse at Children’s Hospital of Alabama before declarations and lifted state licensure regulations stories is that these individuals have experienced moving to Indiana. in 2020. firsthand the value of the NLC, and its impact on patient care. “Indiana is a compact state, and California and “Because we are small and very remote, getting Alaska are not,” says Paxton. “When I moved from people in as quickly as we can is imperative during Indiana to California, it took four months to get my a disaster like a pandemic,” says Paxton. “If we had California license. I had to pay for fingerprinting not had that emergency declaration, I don’t know and licensing fees which delayed my start with that we would have received the help we needed. Providence by about two months. When I moved I think being part of the NLC could certainly help. from California to Alaska, I had to apply for my Again, it creates one standard -- if you’re a nurse license, go through all the fingerprinting again and and you’re licensed in one state, you’re licensed in present my CEUs. This happened during COVID. any state.” continued on page 22

North to the Future: the Nurse Licensure Compact would Benefit Skyline of Anchorage, Alaska from Alaskan Nurses and their Patients Earthquake Park at sunset

Alaska’s motto of “North to the Future,” adopted for our patients,” says Paxton. “This in turn protects in 1967 for the Alaska Purchase Centennial, the community and our patients, as well as our suggested a land of promise. This optimistic caregivers, to ensure that we’re all practicing at the statement could also apply to efforts by lawmakers highest standards.” This would also go further to create and nurses in the state to enact the Nurse While Alaska is the largest U.S. state Licensure Compact (NLC). A December 2019 unity among nursing, and it would geographically, its population is less than 800,000, survey of Alaska-licensed nurses, conducted by the about one resident per square mile. Nearly a “make us more of a united profession. Alaska and NCSBN, revealed that quarter of the population live in areas that are 92% of Alaska’s licensed nurses are in favor of the — Elizabeth Paxton only accessible by plane or boat. Many residents state joining the NLC. live in communities of fewer than 1,000 people. One nurse leader who supports enacting the NLC Health care is Alaska’s largest private-sector in Alaska is Elizabeth Paxton, MSN, RN, NE-BC, employer. Providence Health & Services, Paxton’s chief nursing officer, Providence Health & Services employer, operates the largest medical center in ” Alaska. Paxton is responsible for all nursing the state, and three critical access in rural practice for the Providence Alaska Region. communities. “The NLC would create one standard that ensures “We have a bit of a recruiting problem here in that we’re all practicing at the highest level of care Alaska, because of our remoteness and people not

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Paxton feels the NLC would help health care the NCLEX. Every state also requires background seen as a more welcoming state to nurses. Travel required to meet the same standards, including employers recruit because people like to come checks. I don’t know that people are asking for nurses often bypass us because we’re not in the submission to federal and state fingerprint-based to the state seasonally. “I’ve heard from travelers. different things, but creating the compact can compact. Being in the NLC would also reduce the criminal background checks. onboarding process time of checking with each If they don’t start early enough, they miss the ensure that everyone’s standards are the same, so Located in Reno in Northwest Nevada, Northern individual state.” season because they haven’t gotten their license,” that we are providing the safest care that we can to Nevada Medical Center is just 20 miles from the she explains. “They have to do a lot of proactive our patients.” A nurse with primary residency in an NLC state California border and just a two-hour drive from its planning ahead if they want to come to Alaska. But The Gallup poll that has ranked nursing as the has the authority to practice in person or via capital in Sacramento. Adams’s colleague Teresa if you are a traveler in the Midwest for instance, most trusted profession for 19 years in a row is a telehealth in all compact states. In the event of Whitfield, MS, RN, is director of medical/telemetry you can go from state to state without any break nationwide poll, from respondents of every state. a crisis, nurses from multiple states can quickly at NNMC. Whitfield recently relocated from between contracts because you’re already licensed In a time where technology’s reach and power and easily respond. The compact can reduce California, where she lived 40 miles from Paradise, in those states; the bulk of the compact states are are quickly removing boundaries and opening complexity, decrease cost and provide an equal a town destroyed by wildfires in 2018. in the middle of the country. If Alaska was in the or even higher level of protection to the public. up avenues to care, nurses need to be able to go “The fires that came through Paradise took out compact, it would make them more mobile when Licensure requirements are aligned in NLC states, quickly and fluidly to where they are needed most. their hospital and destroyed the homes of their they start up with the travel company.” and all nurses applying for a multistate license are For Paxton, the future is now. Joining the NLC hospital staff,” says Whitfield. “If we all were As the NLC has evolved, some states are still would benefit Alaskans and the nurses who care compact states, nurses who work for the health reluctant to join. One concern, related to the safety for them. system in Paradise – who knew their system -- of patients, is due to a misunderstanding about “This would also go further to create unity among Collaboration with the other compact could have come in to help. In that sense, I see a the licensure standards to be an NLC member nursing, and it would make us more of a united benefit in compact states allowing nurses within state. On this subject, Paxton says, “from a safety states would make a statement about profession, if you will, because we are all ensuring the same health system to cross borders to help perspective, there are standards that we’re practicing at the same level and “Nevada — we would be seen as a more their work colleagues, no matter what state they’re across the board. And when you graduate, you take responding to things the same way.” welcoming state to nurses. in. If there are hurricanes for example, nurses in the same system could travel south to help. It would be Reducing Barriers and Filling a Need: — Carla Adams more seamless, and you would have help faster in Nevada and the U.S. as a Whole would Benefit from the NLC times of disaster.” continued on page 24 What would it look like if every U.S. state was a our neighboring California hospitals. It could allow member of the NLC? While advocates for the NLC more nurses to practice physically in Nevada. But have faced strong opposition in a number of states, as we move more electronic, nurses from other Pictured left to right: Adams,” Pistone, Whitfield we are also living in an unprecedented time. The states would also be able to help us locally via Reno, Nev. COVID-19 pandemic has shown that during a crisis telehealth.” or disaster, nurses must be able to move quickly For now, Adams is focused on how Nevada and the and fluidly to where they are needed most. entire U.S. would benefit from the NLC. “Between There are currently 34 states and one U.S. territory the growing and the baby that have enacted the NLC, and legislation to enact boomer generation’s retirement, the new needs the NLC is now pending in 12 states and one U.S. are astronomical,” she says. “From a recruitment territory. standpoint, employers would win with faster hiring. Nurses would win because they wouldn’t have to “If every state were an NLC state, it would open up wait to start their employment, and application avenues that are currently hard for us to imagine,” and license renewal costs would be reduced. says Carla Adams, MSN, RN, chief nursing officer, Collaboration with the other compact states would Northern Nevada Medical Center (NNMC). “The make a statement about Nevada — we would be barriers would be reduced, and I think it would help

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The unprecedented number of patients affected ensuring that agreed upon standards were met. Whitfield also thinks that by COVID-19 and the overwhelming effect it had Each state would have enforcement authority removing barriers to interstate on health care providers resulted in all states, when a nurse from another NLC state practiced practice is appealing to young Save the Date territories and the District of Columbia issuing in its jurisdiction, and expiration of executive people starting their nursing emergency declarations and lifting state licensure orders and nurses’ authority to practice would be careers. “They work to live,” 2021 NCSBN regulations in 2020. In some cases, emergency nonissues. she says. “I think they would license waivers were issued to allow nurses love it because they live more One argument that groups opposed to the NLC licensed in other states to accelerate their ability to in the moment. They have a often suggest is that the safety of patients could Annual Meeting practice and assist with disaster relief. desire to experience as much be compromised when an influx of nurses trained as they can; there’s a little more “I found that having that red tape removed was and educated in other states come to practice. wanderlust. The opportunity to incredibly helpful,” says Lisa Pistone, MBA, RN, Whitfield says this claim doesn’t square with Virtual | Aug. 18–19, 2021 travel and experience different CNML, director of the Medical Surgical unit at her experience. “The unit I direct brings in new cultures across the U.S. is very NMCC. “Our state board was good about moving graduates and new graduate-nurses,” she explains. appealing to them. And they’re forward with temporary licenses. But when you’re “No matter what state a new graduate-nurse has Featuring keynote speaker excellent nurses. They’ve grown looking for a nurse, whether for a posted position trained in, when they start it’s their work ethic, Doris Kearns-Goodwin, up with technology. They’re very or a traveler, you’re looking for a need now so personality and drive that determines patient world-renowned presidential adaptable and they’re all very that you’re not putting strain on your team. That safety. I can teach a new graduate anything they bright.” historian and Pulitzer process can normally take a solid month. When need to know if they have a willing, open attitude. the restrictions were lifted, that process sped up There are nurses who practice the utmost of On Feb. 16, 2021, Assembly Prize-winning author significantly. As soon as a traveler was ready, they patient safety in their practice every day across the Bill 142 was introduced in the were able to walk through the door.” U.S., and there are some who do not. I don’t think Nevada legislature. While this it’s dependent on whether they are from a compact legislation was defeated, these If the NLC was expanded to all 50 states, all nurses state or not.” nurse leaders in Nevada are would meet uniform licensure requirements, hopeful that compact licensure will eventually prevail. “I see it as having much more synergy among nurses,” explains Adams. The NLC allows a nurse to practice in “We’re already a well-loved person or via telehealth in all compact group of professions. Why not states. This fosters greater nurse have us unite more?” mobility and public protection. In the event of a crisis like COVID-19, nurses For more information about the Nurse Licensure from multiple states can quickly and Compact, contact easily respond. [email protected] or visit www.nlc.gov. Make your voice heard. Tell your legislators you support the NLC and improving access to care. More information will be shared in the coming months.

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Disque Honored with Women of Distinction Award

Laura Disque, MSN, CGRN, assistant chief nursing officer, HCA Rio Grande Regional Hospital (RGRH), will be honored June 9 with the Women of Distinction 2021 Award in the Health category by the Rio Grande Valley Hispanic Chamber of Commerce. Disque, a Texas Board of Nursing board member, is a certified GI nurse and has served her community as a registered nurse for more than 25 years. She worked as a bedside nurse for the first 10 years of her career, and in multiple leadership roles the last 15 years, Pictured from left to right: Kindall, Moffatt and Wiggins including transplant administrator in 2016 at Doctors Hospital at Renaissance where she was instrumental in opening the only adult kidney transplant center in the Rio Grande Valley (RGV). In December 2019, Kindall, Moffatt and Wiggins Elected as New Officers Disque transitioned to RGRH as assistant chief nursing officer, where she was awarded a Commitment to at Louisiana State Board of Nursing Excellence in Organ Donation in the RGV by the Texas Organ Sharing Alliance, for her transplant and organ donation work throughout the years. Disque is currently pursuing her doctorate of nursing practice at The The Louisiana State Board of Nursing has elected new officers University of Texas in Arlington. for the 2021-2022 biennium. The president of the board is Tavell Kindall, PhD, DNP, APRN, FNP, family and APRN representative; the vice president of the board is Baker Begins New Role at Glymph Selected for Tracey Moffatt, MHA, RN, system chief nursing officer (CNO) the Bureau of Health Care Induction in the 2021 and vice president for quality at Ochsner Health System Practitioner Regulation Fellows of the American and nursing service administrator representative; and the with Florida Department of Academy of Nurse alternate officer is Jamie Wiggins, MBA, RN, FACHE, senior vice Health Anesthetists (FAANA) president and CNO for Children’s Hospital in New Orleans and nursing service administrator representative. Florida Board of Nursing The Fellows of the American Executive Officer Joe Baker, Jr., is also now serving Association of Nurse Anesthetists (AANA) Selection as Acting Chief of General Operations for the Committee has selected Derrick C. Glymph, DNAP, Bureau of Health Care Practitioner Regulation CRNA, APRN, RN, as a candidate for induction in News & Notes highlights within the Florida Department of Health. In this role, the Inaugural 2021 Fellows of the AANA. Glymph is Baker supervises the management of six other enrollment and global initiatives coordinator and a NCSBN member achievements regulatory board offices which are responsible clinical associate professor in the Graduate Nursing and updates as well as for 22 boards, four councils, and 10 department- Department at the Nicole Wertheim College of regulated professions/facilities. The bureau has Nursing and Health Science. He is an RN member individual leadership and staff oversight of more than 1.3 million licensed health of the Florida Board of Nursing. He will be inducted accomplishments. care practitioners in Florida. in August 2021, during the AANA Annual Congress in Austin, Texas. He joins a group of leaders whose achievements and forward-thinking contributions Have news to share? have had meaningful impact on the nurse profession and the role of CRNAs. Send your News & Notes submissions via email.

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“ Nursing is a progressive art such that to stand still is to go backwards. “

— Florence Nightingale

Thank you to all our health care heroes.