OREGON BOARD OF NURSING

[ VO.39V ▬ NO.4 ▬ NOVEMBER 2020 ] Also in this issue Freedom Of Speech, Hate Speech, And The Nurse Practice Act

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Edson College of Learn more at Nursing and Health Innovation nursingandhealth.asu.edu/msnonline TABLE OF CONTENTS Oregon State Board of Nursing 17938 SW Upper Boones Ferry Road Portland, OR 97224-7012 SENTINEL Phone: 971-673-0685 ▬ ▬ Fax: 971-673-0684 [VO.39 NO.4 NOVEMBER 2020] www.oregon.gov/OSBN contentstable of ÑġßáÊëñîï Monday - Friday 8:00 a.m. - 4:30 p.m.

ÒäëêáÊëñîï A Regulatory Response To Healthcare ÒäëêáÊëñîïîáàñßáàâëîðäáàñîÝðåëê Serial Killing ...... 4 ëâðäáÉëòáîêëîĊïÇôáßñðåòáÑîàáîëê Covid-19. Please see website for A New Look for OSBN Online ßñîîáêðäëñîï Licensing Services ...... 13

Board Members: Freedom Of Speech, Hate Speech, And Page 4 The Nurse Practice Act ...... 14 Kathleen Chinn, RN, FNP Board President Uncomfortable Truths And Annette Cole, RN Reportable Behavior ...... 16

Adrienne Enghouse, RN Year of the Nurse ...... 18 ÏåßäáèèáÅäÝñÎÒÐ Documentation: A Necessary Element Of Board Secretary Nursing Practice ...... 19 Sheryl Oakes Caddy, JD, MSN, RN, CNE The Impact Of The Pandemic On Oregon Bobbie Turnipseed, RN Nursing Education ...... 20 ÌñàåðäÙëëàîñĞÌÆ Page 20 Public Member You Ask, We Answer ...... 22

ÏåßäÝáèÙõêðáî™Îåãäðâëëð Disciplinary Case Study: Public Member Boundary Violations ...... 23 Aaron Green, CNA All Board Meetings, except Executive Sessions, Meet The Team ...... 30 are open to the public. All meetings will be Ruby Jason, MSN, RN, NEA-BC held remotely for the duration of the Governor’s Executive Director Executive Order on Covid-19

ÄÝîÞÝîÝÊëèðîõ Communications Manager Editor of the Sentinel Created by Publishing Concepts, Inc. David Brown, President • 1-800-561-4686 ext.103 [email protected] Advertisements contained herein are For Advertising info contact Laura Wehner • 1-800-561-4686 24 2020-21 Board Meeting Dates not endorsed by the Oregon State Board [email protected] of Nursing. The Oregon State Board of 2020 Board Members Nursing reserves the right to accept or 25 reject advertisements in this publication. ÄëÝîàÆåïßåìèåêÝîõÃßðåëêï Responsibility for errors is limited to cor- 27 EDITION 48 rections in a subsequent issue. NURSING PRACTICE By Erin Tilley, BHSc, BScN, MN, RN, PMP, FRE; Catherine Devion, BA, MLS; Anne L. Coghlan, BScN, MScN, RN; and Kevin McCarthy, BScN, MPPAL, RN. Reprinted with permission. A REGULATORY RESPONSE TO HEALTHCARE SERIAL KILLING

Healthcare serial killing is difficult to detect, which makes protecting patients from this insidious harm challenging. In 2016, Elizabeth Wettlaufer confessed to murdering eight long-term care residents, attempting to murder four others, and assaulting two more while working as a registered nurse in Ontario, Canada (R v. Wettlaufer, 2017). These events prompted the College of Nurses of Ontario (CNO), along with partners in the system, to question what can be learned from this tragedy so that the suffering of families and victims was not in vain. Can serial killers be detected and prevented? Where there are potential threats to patient safety, regulators must take action to reduce risk and prevent harm. Determined to learn from the horren- dous crimes and contribute to the learning of others, CNO began with an extensive literature review related to healthcare serial killers. From the literature review, this article describes common factors associated with healthcare serial killers, their victims, their crimes, and possible detection. Several recommendations based on the literature are proposed.

In 2016, Elizabeth Wettlaufer confessed to murdering eight medical assessments, she was able to practice again in 1998. long-term care residents, attempting to murder four others, and Yet, she did not work as a nurse again until 2007 (Long-Term assaulting two more while working at a number of locations as a Care Homes Public Inquiry, 2018a). In 2014, CNO received a registered nurse in Ontario, Canada. According to the Agreed mandatory report from an employer for terminating the former Statement of Facts from her criminal trial (R v. Wettlaufer, nurse “due to a medication error which resulted in putting a 2017), the dates of the attacks spanned from 2007 to 2016 and resident at risk” (Long-Term Care Homes Public Inquiry, 2018a). took place in southwestern Ontario. Wettlaufer’s first 11 attacks Wettlaufer was required by CNO to perform remedial activities took place at a long-term care home between 2007 and 2014, including a review of standards related to professionalism and and a twelfth took place at a different long-term care facility in safe medication administration. September 2015. She carried out her thirteenth attack while Wettlaufer often worked the night shift, and at one facility employed as an agency nurse at a long-term care facility. The was responsible for up to 100 residents during her shift final attack for which she was convicted took place in 2016 in (Dubinski, 2018a). She was reported to have made colleagues a client’s private home while she was employed by a nursing uncomfortable due to bizarre and unprofessional behavior agency. She was caught after she confessed in 2016 to a physician (Dubinski, 2018b). She had shared with employers that she who was treating her for a mental health disorder (Long-Term had mental health disorders. A discharge notice following the Care Homes Public Inquiry, 2018a). care Wettlaufer received in 2016 indicated diagnoses of major Wettlaufer murdered and harmed her victims by injecting depressive disorder, alcohol use disorder, opioid use disorder, them with insulin. In some cases, she misappropriated insulin and borderline personality disorder as well as antisocial adult from the medication room at the facility where she worked, and behavior (Long-Term Care Homes Public Inquiry, 2018a). in one case, she admitted to stealing insulin from one patient to When Wettlaufer confessed to her crimes in 2016, nursing overdose another patient (R v. Wettlaufer, 2017). According to colleagues, administrators, families, residents, the government, court documents, the killer used her murders as a way to relieve and the public were shocked and horrified that she had pressure that was building from anger and frustration (R v. deliberately harmed residents. In the wake of this tragedy, Wettlaufer, 2017). the Government of Ontario established a public inquiry to probe the events and make recommendations to avoid similar Background occurrences. The inquiry is ongoing, and its mandate involves In 1995, Wettlaufer was required to participate in the several goals: College of Nurses of Ontario’s (CNO) process for nurses The Inquiry’s mandate is to inquire into the events that led with mental health disorders. After monitoring and meeting to the offences committed by Elizabeth Wettlaufer. Additionally, specified requirements set by CNO based on independent the Inquiry is directed to inquire into the circumstances and

4 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING contributing factors allowing these events to occur, including murder,” “serial homicide,” “serial killer,” “health personnel,” the effect, if any, of relevant policies, procedures, practices “healthcare professionals,” and “nurse.” The literature search and accountability and oversight mechanisms. The Inquiry yielded 197 items, and from these, 35 abstracts were selected is also directed to inquire into other relevant matters that the that most closely addressed the topic of healthcare serial killers. Commissioner considers necessary to avoid similar tragedies. These were reviewed and assessed as to whether they met the (Long-Term Care Homes Public Inquiry, 2018b) previously described purpose. Only English articles were The public hearings explored four parts: (a) facilities and considered. Year of publication was not used as exclusionary agencies, (b) Office of the Chief Coroner and Ontario Forensic criteria given the limited number of articles. After the initial Pathology Service, (c) CNO as the nursing regulator, and (d) review, 18 articles were selected for full review. provincial government (the Ministry of Health and Long- Most of the articles reviewed described the authors’ Term Care). CNO continues to participate to support the observations and opinions. Regarding healthcare serial killers inquiry’s mandate. specifically, the search uncovered four main scholarly sources that analyzed cases: Field and Pearson (2010); Lubaszka, Shon, CNO’s Response and Hinch (2014); Yardley and Wilson (2016); and Yorker et The sole mandate of a health profession’s regulator is al. (2006). A significant development was the emergence of to protect the public. Regulatory processes aim to ensure a checklist of 22 factors from Ramsland (2007) based on the professionals practice safely. Where there are potential threats work of earlier scholars. Depending on the eligibility criteria, to patient safety, regulators act to reduce risk and prevent these authors differed in terms of the number of healthcare future harm. But what about deliberate harm? How can this serial killers and the number of victims they identified. As be detected and prevented? Are there warning signs to identify one example, to give readers a sense of the number of potential individuals who pose a risk to patients? cases, Yorker et al. (2006) identified 90 cases of healthcare serial Confronted for the first time with a known healthcare serial killers from 1970-2006. Of these, 54 resulted in convictions with killer on its register (a 1980s suspected case of a healthcare 317 victims associated with these convictions. A further 2,113 serial killer in Ontario has remained unsolved [Lucy & Aitkin, possible victims are also associated with the 54 convictions. 2002]), CNO sought to understand this phenomenon. CNO was Given limited findings, the results should be considered determined to learn from this horrendous crime and identify in the context of what knowledge can be gained from the what actions could be taken to enhance safety in the healthcare best evidence available, rather than as conclusive answers. system. This article describes common factors associated with As Lubaszka and Shon (2013, p. 68) report, research about healthcare serial killers and possible detection. Stemming healthcare serial killers is in its infancy, and this continues to from the literature review findings, several recommendations be the case. Knoll (2006, p. 64) states, are proposed. There is no current theory that adequately explains the etiology of serial murder (Holmes et al., 2002). This is Literature Review and Findings primarily due to the fact that serial murder is an event with To learn more about the circumstances and behavior an extremely low base rate and therefore is difficult to study associated with healthcare serial killers, our work began with via rigorous scientific methods (Dietz, 1986). an extensive literature review. The question articulated by Furthermore, a review by Reid (2017) suggests, “the the Professional Standards Authority (2015a) in the United literature on serial murder is problematized by its large Kingdom was considered: “whether we can know enough about amount of assumptive reasoning and a relative lack of scientific the past (circumstances, behavior) and the future to predict the scrutiny” (p. 296). Limitations aside, the literature on this topic circumstances in which harm is likely to occur in the future – continues to grow and contains valuable information that could and to develop a regulatory response that reduces the likelihood potentially help protect patients from healthcare serial killers of it occurring” (p. 10). The purpose of the literature review was in the future. to understand the state of the science; identify patterns related to characteristics of healthcare serial killers, their victims, and Æáğêåðåëê their crimes; examine how healthcare serial killers are detected; Although not all authors agree, a definition commonly cited and determine what regulatory recommendations, if any, could in the literature is from the U.S. Federal Bureau of Investigation be derived from the findings. (FBI) (n.d.): “the unlawful killing of two or more victims by In 2018, searches were undertaken in the PsycINFO, the same offender(s), in separate events.” Furthermore, Reid PubMed, Scopus, CINAHL, and Google Scholar databases. (2017) puts forward several statements about serial killers Search terms included various permutations of “serial continued on page 6 >>

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that have reached some agreement in the literature (Table 1). addiction) (Esmail, 2005; Forrest, 1995; Rourke & Ward, Healthcare serial killers commit their crimes while working as 2017; Yardley & Wilson, 2016; Yorker, 1996; Yorker et al., healthcare providers. 2006). For example, Harold Shipman had a substance use disorder and depression (Esmail, 2005). In an analysis of 16 ÄÝîîåáîïåêÃààîáïïåêãÕáîåÝèÍåèèåêã cases, Yardley and Wilson (2016) found the appearance of The literature cites barriers in addressing serial killing. Kizer having a personality disorder was present in 50% of cases and Yorker (2010, p. 187) suggest that, given a perceived small and history of mental instability or depression was present number of known deaths, there may be a misperception that it is in 64% of cases. Factitious disorder imposed on another not a significant problem. Some see it solely as a law enforcement is a mental health disorder that is described by Yardley problem (Kizer and Yorker, 2010). These perceptions may result and Wilson (2016) as a “hero complex,” whereby the nurse in barriers to addressing the issue; yet, resources are warranted generates a health emergency in a patient. given the most grievous impact on patients. In addition, literature • Healthcare serial killers may make colleagues anxious suggests healthcare settings “form crucibles in which murder (Yardley & Wilson, 2016). For example, colleagues had serious can take place” (Field & Pearson, 2010). Healthcare providers concerns about nurse serial killer Niels Högel’s conduct, yet have access to potential victims and they have knowledge that the murders continued to go undetected (Klinkhammer, may enable them to carry out crimes (e.g., knowledge related 2015). According to a media report on his trial, “although to medications). The literature is a useful starting point for the high number of patients dying under Mr. Högel’s care identifying risk factors and therefore informing actions that can was noticed by other staff members in Oldenburg, no action be taken by regulators and other organizations to detect and was taken to understand why,” and he was transferred to possibly prevent healthcare serial killers from inflicting harm another unit (Eddy, 2017). At that unit, a doctor “told Mr. on patients. Högel that his services were no longer wanted, because he was always forcing himself into the spotlight when trying ÖäáéáïåêðäáÎåðáîÝðñîá to revive a patient” (Eddy, 2017). In this example and other The major themes from the literature review are presented cases, testimony from colleagues suggest that they harbored in the following paragraphs. These themes are grouped by suspicions about the serial killer before the healthcare perpetrator, victim, crime, and detection. Also, Table 2 describes provider was caught (Forrest, 1995; Kizer & Yorker, 2010; healthcare serial killers from the past 10 years (Yorker, 2018) Klinkhammer, 2015; Lubaszka et al., 2014; Lucy & Aitken, related to some of the patterns identified in the literature review. 2002; Rourke & Ward, 2017; Yardley & Wilson, 2016; Yorker, It is important to note that content in Table 2 relies on media 1996; Yorker et al., 2006), but these suspicions may not have reports and may be incomplete (e.g., original court documents necessarily been related to intentionally harming patients. were not found and/or original sources were in other languages). In some cases, colleagues may have had concerns about the individual’s nursing practice (e.g., not documenting Characteristics of Healthcare Serial Killers administration of medications, stealing from patients, In regard to understanding the traits of healthcare serial falsifying records or other information, difficult personal killers, it is important to note that these are not put forward as relationships, and manufacturing crises). Lubaszka et al. predictive factors. For example, Yorker is quoted as saying: “We (2014) cite another example whereby Joseph Michael Swango can’t do screening for predictive traits at this time – but that was observed by a nursing student giving a patient an might change” (as cited in Ramsland, 2007, p. 129). In addition, unauthorized intravenous injection that caused respiratory in a significant study, Field and Pearson (2010) suggest nothing in failure. The nursing student reported the event to her their study “pointed to any one profile of the nurse most likely to supervisor but nothing was done. murder patients” (p. 307). • Healthcare serial killers may possess unauthorized Notwithstanding these caveats, there are several sources medications or drugs at their home or in their workplace of literature that suggest potential characteristics of healthcare locker (Rourke & Ward, 2017; Yardley & Wilson, 2016). This serial killers: factor was observed in 50% of 16 cases analyzed by Yardley • As described above, Reid (2017) puts forward a number and Wilson (2016). of statements related to serial killers including that the • Healthcare serial killers may make employment changes. psychological state, whether noticeable or not, is abnormal. In some cases, there is evidence that the healthcare serial One theme in the literature review is that healthcare serial killers moved from one setting to another (within the same killers often have a mental health disorder (a variety are organization or to a different organization), or from one described in the literature including depression, personality jurisdiction to another (e.g., after suspicion was raised at their disorders, factitious disorder imposed on another, and place of employment) (Field & Pearson, 2010; Klinkhammer,

6 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING 2015; Ramsland & DeVito, 2007; Rourke & Ward, 2017; Victim Characteristics Yorker et al., 2006). For example, a physician, Joseph All patients are vulnerable and a potential target to a Michael Swango, was prosecuted for murders in New healthcare serial killer. Lubaszka et al., (2014) state that York, Illinois, and Zimbabwe (Yorker et al., 2006). Woods healthcare serial killers may select their victims based on (2000) offers the following account of the 30-year accessibility and availability. Yet the literature identifies career of Swango: that healthcare serial killers may target the most vulnerable Swango is thought to have first started killing patients patients (e.g., to go undetected): when he was a medical student at Southern Illinois • Many victims had attributes that made them especially University. After five patients under his care died vulnerable (e.g., elderly living alone, infants and children mysteriously, he became known as Double-O Swango— before speech has developed, adults in intensive care licensed to kill. Swango later worked at Ohio State units, patients who are not aware of their surroundings University where he had an internship. In 1986, he because they are sedated or disoriented) (Esmail, 2005; had his licence to practice medicine suspended when he Field & Pearson, 2010; Forrest, 1995; Kizer & Yorker, went to prison for attempting to poison his colleagues. 2010; Lubaszka & Shon, 2013; Lubaszka et al., 2014; Patel, On his release in 1987, however, he was able to enter a 2015; Rourke & Ward, 2017; Yardley & Wilson, 2016; residency in internal medicine in South Dakota. When Yorker, 1996; Yorker et al., 2006). For example, Harold his past caught up with him there, he went on to secure Shipman, a physician convicted in 2000 of murdering 15 a psychiatric residency in New York state, before fleeing of his patients, mostly killed elderly patients living alone to Zimbabwe, where he was again suspected of poisoning (Esmail, 2005). patients—and again dismissed. From there he moved on • Individuals who are terminally ill may be targeted, which to practice in Zambia, where he was suspected and fired facilitates the ability of a healthcare serial killer to go once again (p. 657). undetected (Esmail, 2015; Lucy & Aitken, 2002). Similarly, • The ability to move from one setting to another contributed to the number of victims. continued on page 8 >>

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a couple of articles indicate the rarity of autopsy after the Rosenbleeth, the authors state, “71.5% were captured because death of a sick or elderly patient may facilitate evasion of of the direct observations, descriptions and other information capture among healthcare serial killers (Lubaszka et al., provided by surviving victims, direct witnesses and even 2014; Ramsland & DeVito, 2007; Rourke & Ward, 2017). family members of serial killers” (p. 164). For healthcare serial killers, this is supported in a discursive analysis by Field and Factors Associated With the Crimes Pearson (2010) that asserts, “almost always these cases come The literature review yielded common factors that may be to light when a nurse eventually blows the whistle” (p. 307). associated with the nature of the crime: Similarly, in a study of 58 cases of healthcare serial killers, • There is some evidence that healthcare serial killers are Lubaszka et al., (2014) state the most common reason to initiate looking for opportunities – times when they are working an investigation is information from coworkers. alone (e.g., working in the community in an independent • Employees are usually the first to recognize deviant activities, role, working in a hospital on evening/night shift) (Esmail, but they do not always report these (Rogojan, 2009). Field 2005; Field & Pearson, 2010; Kizer & Yorker, 2010; Lucy and Pearson (2010) advocate for a culture that encourages & Aitken, 2002; Ramsland & DeVito, 2007; Yorker, 1996; reporting of concerns, combatting what they describe as Yorker et al., 2006). This was reportedly the case for Charles “silence of nurses when they know or suspect, or ought to Cullen, who worked night shifts (Pérez-Peña, Kocieniewski, know or suspect, that a colleague is killing patients that can & George, 2004). Also, in 38% of cases they assessed, Yardley patently contribute to the length of an individual nurse’s and Wilson (2016) identified that healthcare serial killers killing trajectory” (p. 304). Conversely, in some healthcare may prefer nightshifts when fewer colleagues are around. serial killer cases, concerns were reported by colleagues and Working in less supervised times and settings may enable action was not taken (Lubaszka et al., 2014). For example, crimes to go undetected. Lubaszka et al. (2014) describe how a nursing student • Most healthcare serial killers use injection into intravenous observed and reported that Joseph Michael Swango gave a lines to kill their patients, and some of these were non- patient an unauthorized intravenous injection that caused controlled medications (Kizer & Yorker, 2010; Lubaszka et respiratory failure and nothing resulted from this report. Both al., 2014; Yardley & Wilson, 2016; Yorker et al., 2006). A underreporting and not acting on concerns contributed to the recent analysis of 16 cases indicated the substances most length of time healthcare serial killers committed their crimes, commonly used are insulin, muscle relaxants, sedatives, thus increasing the number of victims. The following example opiates, epinephrine, potassium, and anesthetics (Yardley & illustrates missed opportunities and missed red flags, which, Wilson, 2016). if acted upon, could have prevented patient deaths. Charles • Some articles suggest most healthcare serial killers are Cullen was a registered nurse arrested for murder in 2003. employed in the hospital setting (Lubaszka et al., 2014; Once in custody, he confessed to killing 40 patients while Yorker et al., 2006). Conversely, other articles question working as a nurse (Yorker et al., 2006). In an analysis of the if deaths in other settings such as long-term care and case, Dahm (2007) wrote: the community are more likely to go unnoticed and are During his career as a nurse, Cullen worked for 10 different therefore underreported (Forrest, 1995; Lucy & Aitken, healthcare facilities, was fired from five of them, was questioned 2002). For example, some settings may have fewer resources about patient deaths four times, and was accused twice of and fewer checks and balances in place to detect suspicious improperly administering medications. He primarily worked circumstances surrounding a death. the night shift, and was employed at each facility for as few as 16 days and as long as five years; his short tenure at each Clues to Detection perhaps explains why Cullen had successfully avoided detection The literature provides some clues as to how serial killers by hospital authorities time and time again. (p.3) are detected: The failure to report, investigate, and/or address serious • Some healthcare serial killers are caught because an individual concerns enabled and increased patient harm. or a system detects increased cardiac events and/or deaths in Although there is no universally accepted, existing methodology a setting (Esmail, 2005; Guthrie, Love, Kaye, MacLeod, & for identifying a healthcare serial killer, the literature serves as a Chalmers, 2008; Lubaszka & Shon, 2013; Lucy & Aitken, 2002; useful starting point for identifying potential risk factors. Themes Ramsland & DeVito, 2007; Rourke & Ward, 2017; Tsang, 2013; identified in the literature both validated CNO’s existing risk Yardley & Wilson, 2016; Yorker, 1996). assessment factors and contributed to factors that now inform • In a 2011 study of 200 serial killers by White, Lester, Gentile, and CNO’s assessments.

8 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING DISCUSSION internally through a presentation and discussion with all teams CNO initiated the literature review determined to learn from that support regulatory functions (i.e., entry-to-practice, practice Wettlaufer’s horrendous crimes. Is there evidence that would standards, continuing competence, and professional conduct). support the detection and prevention of intentional patient harm? The challenge for staff was for them to consider how information Are there warning signs to identify individuals who pose a risk? about healthcare serial killers may give them a different lens so Although we found no algorithm for identifying a healthcare they can best protect the public in their role. serial killer, the literature review suggests there are warning signs. Reflective of this, one of CNO’s first changes to its processes was to ÕäÝîåêãËêâëîéÝðåëê establish a new lens of inquiry that integrates these warning signs. Regulators should have systems to facilitate sharing of When a report is received by CNO about a nurse’s practice information. Data sharing about the work histories of nurses or conduct, the information is assessed to identify immediate should be done at a national level (Lubaszka et al., 2014, p. 14; or potential risk of harm to patients. To support a new lens of Ramsland, 2007, p. 130). There should also be a clearinghouse inquiry, CNO staff who conduct these assessments received of information about healthcare serial killers to maintain data training and are using a new tool that integrates the findings from on incidence and details of deaths (Kizer & Yorker, 2010, p. 189). the healthcare serial literature review as well as other sources of evidence. For example, the tool integrates warning signs from ÇêäÝêßåêãÔáâáîáêßáÅäáßçï the literature review such as frequent changes in employment Enhancing reference checks for hiring healthcare settings, patterns of poor conduct, access to high-risk intravenous professionals is critical for sharing and acting on information medications, and concerns from colleague. The tool assists about poor practice (Kizer & Yorker, 2010, p. 189; Lubaszka & the assessor in determining what questions to ask and what Shon, 2013; Ramsland, 2007, p. 130; Yardley & Wilson, 2016, information to collect to support their assessment, and ultimately p. 53). For example, in the case of Charles Cullen, hospital the tool makes a recommendation for regulatory action. The administrators reported they were unaware Cullen had been goal is for CNO employees to be alert to the possibility of a serial investigated elsewhere. There were no red flags suggesting killer and aware of factors associated with healthcare serial killers practice issues when the hospital was hiring him (Ramsland & to identify cases that indicate potential risk and warrant further DeVito, 2007). Regulators can be one source of information for investigation. This process aligns with Kizer and Yorker (2010), employers (e.g., through an online register of members, with who suggested a review of professional licensure processes to help member employment history). Providing information about understand why current practices do not seem to cull healthcare employment history is one way stakeholders can contribute to serial killers and what can be improved (p. 190). safety in the system (i.e., sharing information despite fear of This example of a change to CNO process is one of several lawsuits, as described in Ramsland, 2007). changes being made. Reflective of findings in the literature review, there are seven key actions that can be taken by regulators, some ÔáßëãêåöåêãËêðáîòáêðåëêÑììëîðñêåðåáï in collaboration with other stakeholders such as employers and The literature suggests that individuals are not born serial other agencies. killers; rather, it is a process where they become serial killers (2015). Ramsland and DeVito (2007) state many nurse serial ÔÝåïåêãÃóÝîáêáïï killers transform into killers on the job. This implies that there Regulators can raise awareness about this phenomenon as may be an opportunity, in some cases, to intervene. Given the recommended in Kizer and Yorker (2010). For example, regulators link to mental health, it is important to identify individuals could work to raise awareness within hospitals, health systems, and who need support and treatment early. A white paper from other healthcare organizations. In the words of Field and Pearson the United Kingdom states there is a need for a system “that (2010), “the strongest message for nurses is that the profession has is better able to identify people early on who are struggling – to acknowledge that some nurses murder patients with malice perhaps with personal problems of mental health or addiction aforethought” (p. 306). They also state, “the inability to accept the – and supporting them” (The Secretary of State for Health by possibility of a nurse who murders patients is characterized as an Command of Her Majesty, 2007, p. 2). Related to this theme, one enabling factor” (p. 307). This increased awareness could result in of Elizabeth Wettlaufer’s victims made a closing statement to the stakeholders, including regulators and employers, looking at risk public inquiry: of harm with a different lens, such that the system would identify The same lack of compassion that allowed her fellow victims and deal with serious concerns to prevent further patient harm. to die in relative obscurity also harmed their confessed killer, As one example, CNO began by increasing awareness continued on page 10 >>

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 9 NURSING PRACTICE << continued from page 9 who told investigators about her long-standing struggles with reporting unsafe conditions to prevent harm, trusting that addiction and mental health issues. “She cried for help many other staff and leadership will act on the report, and taking times and none was given,” [the victim] told the inquiry. “She was personal responsibility for one’s actions). A challenging not paid attention to, and this is the aftermath of her journey.” balance for health professionals and regulators exists in that (McQuigge, 2018). “fear can be the enemy of improvement” while the “right kind A number of stakeholders, including employers and of fear” is necessary to drive us to be vigilant in recognizing regulators, can play a role in earlier intervention for struggling and acting on any signals of harm to patients (Macrae, 2014). health professionals. Flin, Bromiley, Buckle, and Reid (2013) suggest that “staff at every level share responsibility for safety.” This is perhaps ×ïåêãÏëîðÝèåðõÆÝðÝ the most fundamental, and perhaps most challenging, shift There needs to be a system that collects, analyses, and shares that could possibly help protect patients and residents from data related to increased cardiac arrests and/or mortality to healthcare serial killers. detect deviations from the norm (Lubaszka & Shon, 2013, p. 73; and Ramsland, 2007, p. 132). From Yardley and Wilson’s 2016 CONCLUSION study of 16 cases, the most prevalent red flag uncovered was Wettlaufer’s murders, attempted murders, and assaults “higher incidences of death on his/her shift” (p. 52), suggesting resulted in CNO exploring its role and processes through a tracking of mortality data as a method to detect healthcare new lens. The impact on the victims and their families was serial killers. However, as pointed out by Field and Pearson unspeakably devastating, and CNO wishes to acknowledge (2010), this method may only be useful after a high number of their suffering. This article described what CNO learned deaths or cardiac events occur, and patients require protection from a literature review related to healthcare serial killers. before this occurs (p. 306). In terms of the role of health Common factors associated with healthcare serial killers, regulators, information may be received through a variety of their victims, their crimes, and ways in which healthcare serial sources (e.g., an employer report, information from a coroner) killers have been detected are described. This article also puts about increases in mortality rates. Regulators would assess forward several recommendations for action stemming from that information and follow-up as needed to protect patients. the literature review. Although there is no algorithm for identifying a healthcare ÏëêåðëîåêãÏáàåßÝðåëêï serial killer, the patterns identified in the literature review Monitoring medications associated with killing patients is may assist regulators and other stakeholders in preventing recommended in the literature (Kizer & Yorker, 2010, p. 190; similar tragedies. CNO learned that there are warning signs Lubaszka et al., 2014, p. 15; Ramsland, 2007, p. 131; Yardley & for healthcare serial killers, and these have been integrated Wilson, 2016, p. 53). Organizations can have systems in place into our conduct processes. Other initiatives that CNO has to monitor drugs that are known to be used by healthcare serial undertaken, related to the recommendations previously killers to harm patients, so discrepancies can be identified early described, include the following: and investigated. In terms of the role of regulators, conduct • Through the literature review, CNO learned that a barrier matters involving drugs with a potential link to healthcare to addressing healthcare serial killing may be related to a serial killers should trigger careful assessment of patterns and misperception that this is infrequent and is not something potential risks. regulators can undertake. Thus, CNO is raising awareness of this phenomenon by sharing what it learned after Seeing Something, Saying Something Wettlaufer’s crimes including findings from the literature A culture shift across the entire system must occur. review described above. In many cases, colleagues were suspicious of the killer’s • CNO’s board is currently considering by-law changes that behaviour. They either did not bring their concerns forward would enable CNO to post nurse employment history or their concerns were not acted on. Individuals should be on its online nursing register in response to employers encouraged to bring issues forward, and these issues should reporting that they were unaware of some of Wettlaufer’s be explored to support safety in the system without fear of previous employers. retribution (e.g., whistleblower protection). Creating a safe • CNO’s board recently approved a new Code of Conduct environment to share, investigate, and act on concerns could for nurses, which explains to the public the behavior prevent patients being harmed or killed. For example, The and conduct to expect from a nurse when receiving care. Joint Commission (2018) recommends organizations create This document includes the expectation that nurses act and nurture a safety culture (e.g., through identifying and with integrity to maintain patients’ trust (e.g., by taking

10 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING Want to get away for a while to the beach? Do you just need a few days prompt action to prevent and protect management” (p. 9). Public protection is a week to be in a different patients from harm). a shared responsibility. In working with environment other than • To support reporting conduct other stakeholders, CNO hopes it can help matters, CNO has made changes prevent a similar tragedy by shining a your current workplace? to its reporting forms, including spotlight on potential risks and engaging clarification about the need to all stakeholders in the system as partners Nehalem Valley Care Center, located report all matters where there is a in ensuring patient safety. Rather than wait in Wheeler, Oregon, we are looking for serious concern about patient safety. for the recommendations from the inquiry, hardworking, reliable employees to • CNO established two employer CNO is acting now based on evidence join our team. We are currently offering part time and full time positions. reference groups who meet quarterly and feedback from stakeholders. Future We have benefits for full time with staff to enhance professional regulatory actions will be informed by employees and competitive wages. collaboration, improve education, recommendations from the inquiry, when and enable consultation related to published. Please call regulatory issues and accountability. 503-368-5171 ex. 3101 CNO’s work in developing and for more information or implementing change is just beginning. About the Authors: Erin Tilley, BHSc, BScN, MN, apply online at In its right-touch framework, the RN, PMP, FRE, is a Strategy Consultant, College www.nehalemcarecenter.com Professional Standards Authority (2015b) of Nurses of Ontario (CNO), Toronto. Catherine Hope to hear from you soon soon!! states, “right-touch regulation is about Devion, BA, MLS, is a Librarian, CNO. Anne L. sharing the responsibility for mitigating Coghlan, BScN, MScN, RN, is Executive Director and the risk of harm between the different CEO, CNO. Kevin McCarthy, BScN, MPPAL, RN, is Director, Strategy, CNO. organizations and people involved in its 280 Rowe Street/PO Box 45 - Wh ee ler, OR OR continued on page 12 >>

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SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 11 NURSING PRACTICE << continued from page 11 REFERENCES

25-year-old man blameworthy of killing. (2018, March 24). Legal Monitor Event Alert, 60. Retrieved from https://www.jointcommission.org/ on guilty plea). Exhibit 1 at Long-term care homes inquiry.Retrieved from Worldwide. sentinel_event_alert_60_developing_a_reporting_culture_ learning_ https://longtermcareinquiry.ca/en/exhibits/ from_close_calls_and_hazardous_conditions/ Belgian ‘deacon of death’ jailed for 27 years. (2018, February 1). Agence Ramsland, K. M. (2007). Inside the minds of healthcare serial killers: Why France Presse - English. Killer nurse jailed for life: Judge brands Victorino Chua ‘indescribably they kill. Westport, CT: Praeger Publishers. wicked’ as he sentences him to a minimum of 35 years for murdering and Dahm, L. L. (2007). Regulation of nurses: Should the NPDB be expanded? Ramsland, K., & DeVito, D. (2007). Nurses who kill. In P. W. Iyer (Ed.), poisoning patients. (2015, May 19). Daily Mail Online. Michigan State University Journal of Medicine and Law, 11(1), 33–69. Nursing Malpractice (3rd ed., pp. 909–923.). Tucson, AZ: Lawyers and Kizer, K. W., & Yorker, B. C. (2010). Health care serial murder: A patient Judges Press. Dean, M. M. (2013, May 14). Verdict: Gosnell guilty of murdering 3 babies. safety orphan. The Joint Commission Journal on Quality and Patient The Philadelphia Daily News. Reid, S. (2017). Compulsive criminal homicide: A new nosology for serial Safety, 36(4), 186–191. murder. Aggression and Violent Behavior, 34, 290–301. Dubinski, K. (2018a, June 11). Nursing home didn’t follow reporting Klinkhammer, G. (2015). Patient killing: How a carer became a killer. rules, Wettlaufer inquiry hears. CBC News. Retrieved from https:// Rogojan, P. (2009). Deviant workplace behavior in organizations: Deutsches Ärzteblatt, 112(43), A1774–A1775. 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Retrieved from http://www.upstate.edu/ https://www.cbc.ca/news/canada/london/ontario-long-term-care- viewarticle/884136 psych/pdf/education/fellowships/serial_murder.pdf public-inquiry-week-4-elizabeth-wettlaufer-1.4720545 Serial killer nursing aide sentenced to life behind bars: Angelo Stazzi Long-Term Care Homes Public Inquiry. (2018a). Overview Dye, J. (2016, December 16). Megan Haines jailed for 27 years for çåèèáàğòááèàáîèõìÝðåáêðïóåðäåêïñèåêœ ÏÝîßä ÃÐÕà report: The College of Nurses of Ontario. Retrieved from https:// murdering patients at nursing home. The Sydney Morning Herald. Retrieved from http://www.ansa.it/english/news/2014/03/31/serial- longtermcareinquiry. ca/en/exhibits/ killer-nursing-aide-sentenced-to-life-behind-bars_1921a6fc-06de- Eddy, M. (2017, August 28). German nurse is thought to have killed at Long-Term Care Homes Public Inquiry. (2018b). The public inquiry into 4378-add6-a5c2a0e3a980.html least 86. New York Times. Retrieved from lexisnexis.com the safety and security of residents in the long-term care homes system. The Secretary of State for Health by Command of Her Majesty. (2007). Esmail, A. (2005). Physician as serial killer—The Shipman case. New Retrieved from https://longtermcareinquiry.ca/en/ Trust, Assurance and Safety – The Regulation of Health Professionals England Journal of Medicine, 352(18), 1843–1844. Lubaszka, C. K., & Shon, P. C. (2013). Reconceptualizing the notion in the 21st Century. Retrieved from https://www.gov.uk/government/ Federal Bureau of Investigation. (n.d.) Serial murder: Multidisciplinary ëâòåßðåéïáèáßðåëêîåïçÝêàëĞáêàáîÞáäÝòåëîåêäáÝèðäßÝîáïáîåÝè publications/trust-assurance-and-safety-the-regulation-of-health- perspectives for investigators. Retrieved from https://www.fbi.gov/ murders. Journal of Criminal Psychology, 3(1), 65–78. professionals-in-the-21st-century stats- services/publications/serial-murder#two Lubaszka, C. K., Shon, P. C., & Hinch, R. (2014). Healthcare serial killers Starr, L. (2015). What can we learn from Quakers Hill? Australian Nursing Field, J., & Pearson, A. (2010). Caring to death: The murder of patients by ÝïßëêğàáêßáéáêÌëñîêÝèëâËêòáïðåãÝðåòáÒïõßäëèëãõÝêàÑĞáêàáî & Midwifery Journal, 22(11), 37–37. nurses. International Journal of Nursing Practice, 16(3), 301–309. Òîë™ğèåê㜝š$ Tsang, C. (2013). Patient safety in English general practice: the role Èåêêåïä êñîïá ãáðï èåâá âëî éñîàáîåêã ğòá ìÝðåáêðï œ ÆáßáéÞáî Lucy, D., & Aitken, C. (2002). A review of the role of roster data and of routinely collected data in detecting adverse events. (PhD Thesis). 22). The Telegraph. Retrieved from https://www.telegraph.co.uk/news/ evidence of attendance in cases of suspected excess deaths in a medical Retrieved from https://spiral.imperial.ac.uk/handle/10044/1/14712 worldnews/europe/finland/8220323/Finnish-nurse-gets-life-for- context. Law, Probability and Risk, 1(2), 141–160. Velliquette, B. (2012, June 5). Nurse pleads guilty to involuntary man- éñîàáîåêã™ğòá™ìÝðåáêðïäðéè Macrae, C. (2014). Early warnings, weak signals and learning from slaughter. Herald-Sun (Durham, North Carolina). Flin, R., Bromiley, M., Buckle, P., & Reid, J. (2013). Changing behaviour healthcare disasters. BMJ Quality & Safety, 23(6), 440–445. White, J. H., Lester, D., Gentile, M., & Rosenbleeth, J. (2011). The with a human factors approach. BMJ, 346, f1416. Marks, K. (2013, May 27). Nurse Roger Dean pleads guilty to Sydney ñðåèåöÝðåëêëââëîáêïåßïßåáêßáÝêàßîåéåêÝèìîëğèåêãâëîßÝìðñîåêãïáîåÝè Forrest, A. R. W. (1995). Nurses who systematically harm their nursing home deaths. The Independent. killers. Forensic Science International, 209(1-3), 160–165. patients. Medical Law International, 1(4), 411–421. https://doi. McQuigge, M. (2018). Victims’ families, survivor speak at Wettlaufer Williams, R. S. (2011). Report of the grand jury in re county investigating org/10.1177/096853329500100404 inquiry. The Globe and Mail. Retrieved from https://www.theglobe- grand jury XXIII. Retrieved from https://cdn.cnsnews.com/ documents/ Forsyth, C. J. (2015). Posing: The sociological routine of a serial killer. andmail.com/canada/article-victims-families-survivor-speak-at- Gosnell,%20Grand%20Jury%20Report.pdf American Journal of Criminal Justice, 40(4), 861–875. wettlaufer-inquiry/ Woods, D. (2000). US doctor may have killed 60. BMJ, 321(7262), 657– German midwife jailed for giving patients blood thinner. (2016, October Patel, M. (2015). Serial killer: Elderly victims of serial killers. International 657. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/ PMC1118552/ 28). The Canadian Press. Retrieved from lexisnexis.com Journal of Criminology & Sociological Theory, 8(1), 1–11. Worker at nursing home arrested for throwing old man from veranda. Grierson, J. (2015, May 19). Stepping Hill nurse Victorino Chua jailed Pérez-Peña, R., Kocieniewski, D., & George, J. (2004). Death on the night (2016, February 16). Japan Economic Newswire. for life. The Guardian. Retrieved from http://www.theguardian.com/ shift: 16 years, dozens of bodies; through gaps in system, nurse left Yardley, E., & Wilson, D. (2016). In Search of the ‘Angels of Death’: uk-news/2015/may/19/stepping-hill-nurse-victorino-chua-jailed- trail of grief. The New York Times. Retrieved from https:// www.nytimes. Conceptualising the Contemporary Nurse Healthcare Serial Killer. for-life com/2004/02/29/nyregion/death-night-shift-16-years-dozens- ÌëñîêÝè ëâ ËêòáïðåãÝðåòá Òïõßäëèëãõ Ýêà ÑĞáêàáî Òîëğèåêã  œ bodies-through-gaps-system-nurse-left-trail.html Guthrie, B., Love, T., Kaye, R., MacLeod, M., & Chalmers, J. (2008). 39–55. Routine mortality monitoring for detecting mass murder in UK general Professional Standards Authority. (2015a). The role of risk in regulatory Yorker, B.C. (1996). Hospital Epidemics of Factitious Disorder by Proxy. ìîÝßðåßáÖáïðëâáĞáßðåòáêáïïñïåêãéëàáèèåêãÄîåðåïäÌëñîêÝèëâ policy: A review of the literature. Retrieved from https://www.profession- In Marc D. Feldman & S. J. Eisendrath (Eds.), The Spectrum of Factitious General Practice, 58(550), 311–317. alstandards.org.uk/docs/default-source/publications/research-paper/ Disorders (pp. 157–174). Washington, DC: American Psychiatric Press. risk-in-regulatory-policy-2015 Hoerr, K. (2016, September 29). Nursing home worker found guilty of Yorker, B. C. (2018). Expert report of Professor Beatrice Crofts Yorker. murdering two residents. Australia Broadcasting Corporation News. Professional Standards Authority. (2015b). Right-touch regulation Exhibit 163 at Long-term care homes inquiry. Retrieved from https:// Retrieved from https://www.abc.net.au/news/2016-09-28/nursing- revised. Retrieved from https://www.professionalstandards.org. longtermcareinquiry.ca/en/exhibits/ home-employee-garry-davis-found-guilty-of-murder/7883704 uk/docs/default-source/publications/thought-paper/right-touch- regulation-2015.pdf Yorker, B., Kizer, K. W., Lampe, P., Forrest, A. R. W., Lannan, J. M., & The Joint Commission. (2018, December 10). Developing a reporting Russell, D. A. (2006). Serial Murder by Healthcare Professionals. Journal culture: Learning from close calls and hazardous conditions. Sentinel ÔòÙáððèÝñâáîœ#ÑÕÅÌÅëñîðğèá!ž#œÃãîááàïðÝðáéáêðëââÝßðï of Forensic Sciences, 51(6), 1362–1371.

12 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING NURSING PRACTICE By OSBN Licensing Manager Tracy Gerhardt and Communications Manager Barbara Holtry A New Look for OSBN Online Licensing Services

The Oregon State Board of Nursing • Supporting documents may be uploaded is pleased to announce the launch of our directly to the Board within the portal redesigned online licensing system. This instead of having to email or mail enhanced online services portal expands them separately. on the capabilities of the former platform • Payments are now processed in real- and improves the licensing experience time, instead of having to wait for the for applicants. It even allows licensees to nightly batch system, thus allowing for manage their own information whenever it speedier application processing. suits their schedule. Please note that all previously existing Although the OSBN has offered online online accounts have been deleted; users renewals since 2004, nearly every other will need to create a new user profile before application or change request required a logging in for the first time. paper form to be mailed or hand-delivered If you have any questions about the new to the OSBN offices. Processing hundreds OSBN licensing portal, please contact us at of paper applications and updates per day [email protected]. caused lengthy wait times and slow updates to licensee information. The new online system will streamline licensing processes considerably, increase access for licensees, and fully integrate with our database. OSBN staff worked with an outside vendor, Resource Data, to reinvent and Join Our develop the new online service portal. For nearly two years, staff conducted Nursing weekly cross-departmental meetings to discuss requirements and solve issues that Team arose. Many staff participated in testing the portal for usability and functionality before determining that it was ready for release. Some highlights of the new portal: Saint Alphonsus is a Catholic health system based in Oregon & Idaho • The new portal is compatible for featuring 4 hospitals, a large medical group and clinically integrated network. use with mobile devices as well as computers. KƉƉŽƌƚƵŶŝƟĞƐĂǀĂŝůĂďůĞŝŶ͗ • Nearly every application type is ƌŝƟĐĂůĂƌĞ|DĂŝŶKZ| ŵĞƌŐĞŶĐLJ| KƌƚŚŽͬDĞĚͬ^ƵƌŐ| >ĂďŽƌΘĞůŝǀĞƌLJ available in the portal, virtually eliminating paper applications. • License and certificate holders can log in at any time of the day or night to update their personal information, K/^| NAMPA | KEdZ/K | <Z/dz submit a name change, or manage their employment history. &KZDKZ/E&KZDd/KE WůĞĂƐĞĐŽŶƚĂĐƚŶĚLJƌŝŵŵĞƌĂƚ;ϮϬϴͿϯϲϳͲϳϳϵϳ Equal Opportunity ŶĚƌĞǁ͘ƌŝŵŵĞƌΛ^ĂŝŶƚůƉŚŽŶƐƵƐ͘ŽƌŐ Employer

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 13 NURSING PRACTICE By OSBN Executive Director Ruby Jason, MSN, RN, NEA-BC FREEDOM OF SPEECH, HATE SPEECH, AND THE NURSE PRACTICE ACT

In 2019, the Oregon legislature passed Senate Bill 577, which updated Oregon’s bias crime laws (formerly called intimidation), defined the new legal term “bias incidents,” created a victim-centered response hotline for reporting bias, requires law enforcement to refer all victims of bias incidents to support services, and streamlines data collection about bias occurring in Oregon. Visit the Oregon Department of Justice website for more information: https://www.doj.state.or.us/oregon-department-of-justice/bias-crimes/about-the-law/.

During this time of civil unrest, public. The role of the OSBN is to determine While the OSBN has authority over the pandemic, and uncertainty, the Oregon if the behavior of the nurse, outside of practice of nursing in the state of Oregon, State Board of Nursing (OSBN or “the their work as nurses, could have a “nexus” the Board does not act outside of federal Board”) has seen an increase in the number to how the nurse would practice in their or state laws, which would supersede the of complaints received citing that OSBN profession. A “nexus” is defined as a “causal practice act. This means that the Board licensees are displaying behavior that runs link” (Merriam-Webster online dictionary, is not authorized to write rule that is in counter to that expected from those in retrieved Sept 2020). In the case of nurses, violation of any federal or state law. the nursing profession. For the purposes a “nexus” would identify a predictor of Lately, there is much interest in the of this article and ease of reading, the how the behavior or actions of the nurse concepts of what constitutes “hate speech” term “nursing” and “nurses” applies to would influence the nurse’s practice. For and “freedom of speech,” and when is that all licensees and certificate holders of the example: If the nurse uses social media to line crossed? It is beyond the scope of this Board except when specifically identified to express a derogatory opinion regarding the article to dissect these concepts and parse be either nurses or nursing assistants. race or gender of individuals, would those what statements would be classified under These are a few examples of the types of opinions influence how the nurse provides either concept. (To learn more about hate complaints received: care for a patient of that race or gender in crimes, bias incidents, and hate speech • Nurses on social media platforms the course of their nursing practice. in Oregon, visit the Oregon Attorney with opinions about the COVID-19 Oregon Revised Statute (ORS) 678.111 General’s website: https://www.doj.state. pandemic that run counter to the authorizes the Board to discipline a license or or.us/oregon-department-of-justice/ opinion of the complainant or current certificate for “Conviction of the licensee of bias-crimes/about-the-law/.) Because state guidelines. crime where the crime bears demonstrable the Board is a regulating body, the Board • Nurses posting derogatory comments relationship to nursing.” A “demonstrable lives in the domain of legal interpretation on social media about specific groups relationship” is synonymous with “nexus.” of laws governing all citizens, regardless of individuals, usually related to The statute also allows possible discipline of possession of a professional license race or sexual orientation, which are for “conduct derogatory to the standards or certificate, and laws that direct the interpreted by the complainant to be of nursing.” Conduct derogatory to safe practice of nursing. The Board is “hate speech.” the practice of nursing and conduct not authorized to consider personal • Complaints about nurses unbecoming a nursing assistant applicable interpretations of what would constitute a participating in civil unrest activities. to those licensed or certified by the OSBN “nexus,” despite any insistence on the part • Nurses providing testimony or is described in Oregon Administrative of the complainant. social media posts regarding the Rules (OAR) 851-045-0070 and OAR 851- Hate speech in the United States is not effectiveness of vaccinations. 063-0090. The legislative authority given regulated due to the right of free speech The common theme in all these to the Board requires that any investigation found in the first amendment of the complaints is that the complainant (the and consideration for possible discipline Constitution. In case after case, the Supreme individual making the complaint) considers is based upon the language of the Nurse Court of the United States (SCOTUS) has these activities not in keeping with their Practice Act, not the opinion or perspective ruled that, “Speech that demeans on the expectation of how a nurse should act in of the complainant. basis of race, ethnicity, gender, religion,

14 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING age, disability, or any other similar ground record, to determine if there were any to the practice of nursing. The OSBN is hateful, but the proudest boast of our concerning behaviors at work that link to Triage Committee meets weekly to review free speech jurisprudence is that we protect the nurse’s non-work activities, or if the complaints that may fall outside of these the freedom to express “the thought we nurse was targeting a specific patient or parameters. The Board has authorized hate.” (United States V Schwimmer, 2017, patients in social network posts (targeting this committee to perform the initial written by Justice Samuel Alito). Because specific patients could establish a nurse- investigation into these complaints. Based SCOTUS rulings supersede those of the patient relationship). Each investigation on the findings of the Triage Committee, a state and the OSBN, hate speech, as defined, and fact pattern are viewed individually to complaint may be closed or forwarded for a is not considered conduct derogatory to the determine if the behavior of the licensee full investigation. practice of nursing. or certificate holder could influence The OSBN’s mission is public protection. What happens when hate speech turns their practice. However, a complainant’s personal opinion into actions that go beyond speech, such as Complainants will frequently express of what constitutes “appropriate behavior” a nurse participating in property damage to the Board outrage that their complaint of a nurse, might not fall into the Board’s associated with civil unrest? This action was not handled in a way they felt it should, jurisdiction. The Board uses federal and would go from freedom of speech to the or that the Board did not open a case on state laws (the Nurse Practice Act is a state violation of laws protecting property. This, their complaint, particularly when, as is regulatory law) as the criteria to determine in all probability, would result in an arrest present today, emotions and opinions are any possible sanctions against a licensee or and possible conviction. The Board would running high. The Board may only open certificate holder. It is the determination then need to determine if the information cases that are within its jurisdiction, have of jurisdiction and the preponderance of gathered during the investigation enough information available to proceed to evidence that drives the discussion and constitutes a violation of ORS 678.111. This investigation, and are (or could be) related decisions of the Board. is done through a case-by-case assessment of information that could show a “nexus” to the practice of nursing of a crime that happened outside the performance of nursing work. Because a license is an instrument that does not depend on the employment of a nurse or certificate holder to be in force, what occurs outside of the workplace could, based on the preponderance of information obtained during an investigation, establish a nexus to the safe practice of nursing. Only the OSBN has been granted legislative authority to make this determination. OAR 851-045-0070 (1) (a) states that it is conduct derogatory to the practice of nursing to demonstrate incidents of violence, abusive, neglectful, or reckless behavior, and (b) demonstrated incidents of dishonesty, misrepresentation, or fraud. These rules are mirrored in OAR 851- 063-0090 (1) and (8) (n) and (o) relating to Conduct Unbecoming a Nursing Assistant. These rules could apply to those nurses who attend protests or who post on social media debunking, for example, current COVID restrictions and guidelines. In determining if there is a “nexus,” the Board would look at factors such as the individual’s personnel

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 15 NURSING PRACTICE By OSBN Nurse Investigator Barbara Ju, RN, and OSBN Investigators Jeff Lamontand Dante Messina UNCOMFORTABLE TRUTHS AND REPORTABLE BEHAVIOR

The news articles are uncomfortably such as a client or customer. or threatening behavior towards a familiar: articles about teachers, coaches, Sexual harassment is unlawful when co-worker; or or other civic or religious leaders who have the behavior: (b) Engaging in violent, abusive, or been exposed as committing crimes of a 1. Becomes a condition of employment, threatening behavior that relates to the sexual nature. Such stories often describe or; performance of safe care to a person. how supervisors/administrators fired or 2. Is severe, or frequent, or pervasive OAR 851-045-0070 Conduct Derogatory to quietly transferred the offenders to another enough to create a work environment the Standards of Nursing Defined district, rather than report the behavior that a reasonable person would (6) Conduct related to co-workers and and risk bringing unfavorable attention on consider intimidating, hostile, health care team members: the facility. One profession that is just as abusive, or offensive, or; (a) Engaging in violent, abusive susceptible to these types of incidents, but 3. When it results in an adverse or threatening behavior towards a rarely makes the newspapers, is nursing. employment decision (such as the co-worker; or The Oregon State Board of Nursing victim being fired demoted, or passed (b) Engaging in violent, abusive, or (OSBN) has noted several sexual for promotion). threatening behavior that relates to the misconduct cases during the last year Sexual assault may take many different delivery of safe nursing services. that, if the licensees’ behavior had been forms. By definition, sexual assault is any Nursing licensees/certificate holders reported to the Board sooner, could have type of sexual encounter without a person’s who believe their fellow licensees/certificate prevented coworker and patient harm. In consent, including: holders have exhibited behavior—such this article, we will provide an overview • rape as sexual harassment—that falls into of sexual harassment, reporting, and our • attempted rape those categories have a duty to report that responsibilities as a licensee/certificate • inappropriate touching behavior to the Board. The following is a holder keeping in line with the Nurse • indecent exposure case study in which most of the observed Practice Act (NPA). • sexual harassment behavior was not reported. Sexual assault can happen to anyone. ÕÇÚ×ÃÎÊÃÔÃÕÕÏÇÐÖ No matter who a victim is – woman, child, ÅÃÕÇÕÖ×ÆÛÐ×ÔÕÇÚ ÃÐÆÃÕÕÃ×ÎÖ or man – sexual assault is never their In late 2017, a male RN (Nurse It is unlawful to harass a person because fault. No matter where or how it happens. X) inappropriately accessed patient of that person’s sex. Sexual harassment Anti-discrimination laws also provide information and then violated professional happens when one person uses sexual certain protections from retaliation for boundaries by contacting the patient via words, gestures, looks, or touches that may filing a complaint or participating in social media. The following month, Nurse X make another person feel uncomfortable or an investigation. resigned while under internal investigation unsafe. It can include unwelcome sexual Harassment or assault of coworkers, for this incident and subsequently admitted advances, requests for sexual favors, and other staff, or clients also is in direct violation that he had a non-professional relationship other verbal or physical harassment of a of the NPA. Per Oregon Administrative with another patient. The facility reported sexual nature. Rule (OAR), these specific elements the incident to the OSBN shortly after Nurse Both victim and the harasser can be any are applicable: X resigned. Following an investigation, the gender; the law applies equally if the victim OAR 851-063-0090 Conduct Board reprimanded Nurse X’s license. and harasser are the same sex. The harasser Unbecoming a Nursing Assistant At a second Oregon facility in mid- can be the victim’s supervisor, a supervisor (6) Conduct related to relationships with 2018, Nurse X asked a female CNA for in another area, a co-worker, or someone co-workers and health care team members: assistance in a patient’s bathroom. Once who is not an employee of the employer, (a) Engaging in violent, abusive, there, he grabbed the CNA’s shirt, kissed

16 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING her neck, and attempted to put his hand The facility reportedly conducted an Some takeaways from the above down her pants without consent. A internal investigation. This included OSBN investigations: co-worker (another CNA) walked by and speaking to a female CNA who reported 1. Facilities/nurse leaders failed to observed them at which point, Nurse X that Nurse X had held her hand against investigate appropriately or failed left. Nurse X began harassing the CNA via his genitals; she told him to stop, but he to document adequately their text; however, the CNA had never given later grabbed her buttock that same day investigations of reported allegations Nurse X her phone number. The co-worker without consent. Nurse X continued to that Nurse X sexually harassed reported the bathroom incident to human sexually harass the CNA via text message. co-workers. resources and the CNA subsequently did The CNA was subsequently approached by 2. Facilities/nurse leaders failed to take as well; however, the CNA indicated that a female patient who told her that Nurse X adequate action after employees she would not have come forward if the had inappropriately contacted her via text reported Nurse X’s sexual harassment co-worker hadn’t reported the matter. message; however, the patient didn’t know of co-workers. After the co-worker had observed Nurse how Nurse X had even obtained her phone 3. At no point did any of the above X sexually harass many of the female staff, number. The CNA indicated that she would parties ever file a complaint to OSBN she told him to stay away from her. Nurse not have come forward if other co-workers pertaining to Nurse X’s sexual X brought over the nurse manager and hadn’t first complained about Nurse X, harassment of co-workers. demanded the co-worker explain herself to as she was scared of him and didn’t think both of them. The co-worker did explain, she would be believed. Again, no one ÔÇÒÑÔÖËÐÉËÐÅËÆÇÐÖÕ and Nurse X began screaming in her face. reported the allegations to the OSBN at Behavior such as that displayed by Nurse Nurse X resigned in summer 2018 after the time. X is not appropriate and should be reported a patient reported to police that he had According to public court records, to the Board of Nursing, in addition to your inappropriately touched her leg. Nurse while Nurse X was working at a fifth organizational reporting structure. X’s personnel file from this second facility facility outside of Oregon in autumn 2019, As mentioned earlier, licensees have a contained no documentation of any these he allegedly administered Ativan to a duty to report as per the NPA: incidents. Neither the CNA, the co-worker, patient (Patient), blocked the room door, OAR 851-045-0090 Duty to Report the manager, nor the Chief Nursing Officer and raped and sodomized Patient. Patient (2) A licensee who has knowledge or reported these incidents to the OSBN at reported the incident to police that same concern that a nurse’s behavior or the time. month. Nurse X initially denied having practice presents a potential for, or actual In autumn 2018, a third Oregon facility sexual contact with Patient, and later told danger to, a client or to the public’s received a sexual harassment complaint police that it was consensual. Patient health, safety and welfare, shall initiate a against Nurse X two months after he then filed a lawsuit against both Nurse X report to be made to the Board. started there as supervisor. Three days and his employer for this incident. Both (6) The following shall always be reported later, the administrator documented that the other state’s board of nursing and the to the Board: Nurse X had a pattern of approaching OSBN were notified of this incident and (c) Dismissal from employment due to staff in an effort to develop a personal opened investigations. unsafe practice or conduct derogatory to relationship outside of work; however, they In winter 2019, Nurse X began working the standards of nursing. were unable to verify specific concerns at a sixth facility outside of Oregon; Reports to the OSBN may be made by listed the complaint. Five days later, the however, by spring 2020, that facility had visiting our website and clicking on “File facility received a second sexual harassment received multiple complaints of Nurse X a Complaint About a Licensee.” You may complaint against Nurse X. Three days being inappropriate with patients so he was also report to the following agencies: later, Nurse X was terminated for a pattern terminated that same month. • Employment Discrimination of inappropriate conduct of supervisory In summer 2020, Nurse X voluntarily Complaint Form: https://www. role. Again, no one reported the allegations surrendered and relinquished (respectively) oregon.gov/boli/workers/Pages/ to the OSBN at the time. his Oregon RN license and his RN license employment-discrimination- Soon after Nurse X began working issued by the state where the alleged rape/ questionnaire.aspx at a fourth Oregon facility, it came to the sodomy occurred. In spring 2020, Nurse • Filing Charge Discrimination: attention of their Chief Nursing Officer X was issued an RN license by a third state https://www.eeoc.gov/filing-charge- that multiple staff reported Nurse X that, as of this writing, is still active and discrimination inappropriately speaking to them and unencumbered. The civil lawsuits filed contacting them through social media. outside of Oregon are still pending. continued on page 18 >>

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 17 NURSING PRATICE << continued from page 17 • Equal Employment Opportunity Commission A VAMERE (EEOC) – within 180 days. • Oregon Bureau of Labor and Industry (BOLI) – A FAMILY OF COMPANIES within 1 year. • Local law enforcement. #WorkWithPurpose Find Your Calling ÊÇÎÒÈ×ÎÎËÐÍÕ • The OSBN Complaint Form: https://www. as a Nurse Report practice or oregon.gov/osbn/pages/complaint.aspx Bring your behavior issues to the • Oregon Department of Justice Crime Victim compassion for Oregon State Board of Nursing: seniors while we and Survivor Services (Assault): https://www. https://www.oregon.gov/osbn/ help support your doj.state.or.us/crime-victims/victims-resources/ professional growth. other-resources/rape-and-sexual-assault/ pages/complaint.aspx • Oregon DOJ Crime Victim and Survivor Services (Stalking): https://www.doj.state. or.us/crime-victims/victims-resources/other- resources/stalking/ CNA, LPN, • EEOC’s definition sex based discrimation: RN, & more https://www.eeoc.gov/sex-based-discrimination • EEOC’s definition of harassment: https://www. LEARN MORE AT eeoc.gov/harassment. TeamAvamere.com

YEAR OF THE NURSE

The nursing profession marks the Year of the Nurse is a perfect a milestone in 2020. The World time to honor all nurses as they Health Organization declared it continue to show courage and the International Year of the Nurse compassion under challenging and Midwife in recognition of the circumstances. Nurses’ vital contributions they make and in contributions impact the health honor of the 200th anniversary of and well-being of our communities the birth of Florence Nightingale. every day. As the world grapples with the History: Born on May 12, 1820, COVID-19 pandemic, the public Florence Nightingale became the respects and recognizes, more than founder of modern nursing and the ever, the value of nurses. For years, first woman to receive the Order of nurses have ranked as the most trusted of health care Merit. During the Crimean War, Nightingale was providers. Oregonians can see why. Whether they’re put in charge of nursing British and allied soldiers in on the front lines in hospitals, providing in-home Turkey. Her time in the wards, especially her night care, working in outpatient clinics or assisted living rounds, earned her the nickname “Lady of the Lamp” facilities, or educating the next generation of nurses, and helped her begin to formalize nursing education.

18 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING NURSING PRACTICE By OSBN RN/LPN Practice Policy Analyst Gretchen Koch, MSN, RN DOCUMENTATION: A NECESSARY ELEMENT OF NURSING PRACTICE

Documenting one’s engagement complete an act or action. Once the the plan, ongoing evaluation of in nursing practice is a fundamental action is completed, the responsibility the client and their outcomes, and responsibility held by each nurse. has been met. By contrast, being evaluation of the effectiveness of Chapter 851 Division 45 of the practice accountable requires the person who the plan. This is nursing practice act (OAR 851-045) identifies the nurse’s undertakes an action to provide an for the RN. responsibly to document nursing account of, reason and/or explanation • At the dependent LPN level of practice in a timely, accurate, thorough, for, the action taken. licensure, nursing practice occurs and clear manner. This concise legal But how is the nurse to memorialize within the parameters of a client’s practice standard applies to each nurse accountability for their actions? established plan of care. The LPN regardless of with whom nursing The answer may be found in one recognizes the client’s priority practice is engaged, one’s practice role seemingly succinct standard: Chapter condition at the time of a clinically and method of documentation. 851 Division 045, rule number 0040, directed intervention through The truth is that the documentation subsection (4), The licensee shall observation, monitoring, and of one’s nursing practice has become document nursing practice in a timely, reporting signs, symptoms, and synonymous with nursing practice accurate, thorough, and clear manner. changes in the client’s condition to itself. This means that failure of a Let’s tease this out. the RN or the licensed independent nurse to document one’s observations, practitioner directing their decisions, planned actions, and RESPONSIBILITY FOR NURSING practice. This is nursing practice outcomes implies failure to provide PRACTICE for the LPN. nursing care or services. Division 045’s documentation Documentation of the above This article will discuss application standard calls for the nurse to described nursing practice processes of Division 45’s documentation document nursing practice; a familiar necessitates the nurse to record standard in regards to a nurse’s term that is defined as, “the diagnoses an account of one’s observations, accountability for their individual and treatment of human responses to decisions, planned actions, and the actions and responsibility for their own actual or potential health problems.” outcomes of those actions. This is how nursing practice. • At the independent RN level the nurse memorializes accountability of licensure (including the within their nursing practice. Many ACCOUNTABILITY FOR advanced practice RN), nursing a licensee complaint made to the INDIVIDUAL ACTIONS practice occurs through the RN’s Board has been closed with no Each nurse is accountable for engagement in cognitive processes disciplinary action based on the nurse’s their own nursing practice and their to analyze client data against prudent documentation of nursing individual actions. By definition, being their own nursing knowledge and practice. accountable identifies a higher-level practice experience relative to a It’s important to note that undertaking than being responsible. clinical situation. Such cognitive the tangible content of a nurse’s At the most basic level, responsible processes result in a plan of care documented observations, decisions, means to hold the responsibility to for the client, implementation of continued on page 21 >>

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 19 NURSING EDUCATION By Oregon Center for Nursing Executive Director Jana R. Bitton, MPA, and OSBN Policy Analyst Debra K. Buck, MS, RN THE IMPACT OF THE PANDEMIC ON OREGON NURSING EDUCATION

Much has been written about how flexible enough to change quickly when in comparison to nurses in practice, have the COVID-19 pandemic has upended protocols change, adapting to limited taken pay cuts and are working with the nursing profession, and the impact clinical placements, increasing reliance less support staff due to lay-offs. With to nursing’s education programs on simulation, and preparing grads for more than 50 % of the nursing assistant have been no exception. In fact, the new realities. faculty in the high-risk category, the pandemic-related challenges facing need for qualified faculty is creating nursing education are pronounced ÅÑÐÕÖÃÐÖ ÅÊÃÐÉÇ ÃÐÆ more stress on an already challenged enough to cause concern nationwide for ÃÆÆËÖËÑÐÃÎÕÖÔÇÕÕ education system. the stability of the nursing pipeline. Nurse educators have shared the In response to the pandemic, the most challenging aspect of the pandemic ÎËÏËÖÇÆÅÎËÐËÅÃÎ Oregon Center for Nursing (OCN) is the constant shifting of priorities, ÇÚÒÇÔËÇÐÅÇÕ began hosting the “Friday Huddles,” guidelines, and recommendations. In addition to a lack of nurse faculty, a weekly check-in call with nursing Educators have reported all their energy the lack of clinical placements, due to leaders from across the state to share is consumed with the uncertainty. This both the increasing number of nursing obstacles and brainstorm solutions uncertainty is bringing a new level of programs and the additional workload to the challenge of the pandemic. At stress to nurse educators, a portion students place on healthcare providers, these huddles, nursing educators have of the nursing workforce already in has long been one of the main obstacles shared how COVID-19 has impacted danger of burnout due to low pay and to the growth of the nursing workforce. their students, faculty, and curriculum high workload. While clinical placements for as educators faced impossible questions. Colleges, universities, and nursing students was limited at the start How do you educate nursing students educational programs around the of the pandemic, many programs have with limited or no access to patients? state are reporting financial losses resumed clinical placements over the How do you conduct socially-distant because of lockdowns in the early summer and into the fall. However, classes and skills labs? How do you days of the pandemic and forecasts for most clinical sites have modified determine clinical competency of decreased enrollment. Nursing assistant their approach to placements due to nursing assistants if they have no little programs have had to reduce their safety concerns for students, staff and or no access to residents? cohort sizes to meet the physical patients and the need to preserve PPE For Oregon nursing programs, distancing requirements. for potential future surges. Clinical educating nurses and nursing assistants Nursing faculty, who are already placements in areas where students during the pandemic has meant being difficult to recruit because of low salaries have a high probability of exposure

20 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING to COVID-19 positive patients (e.g. experts are collaborating to identify workforce needs, and the role residency ICU, critical care units, ER) have been useful resources for Oregon faculty. The and mentoring programs may play in suspended indefinitely. Experiences use of simulation in Oregon nursing onboarding new staff. in long-term care facilities have been and nursing assistant education will be a suspended mid-placement if staff or topic of discussion at the November 2020 ÑÒÒÑÔÖ×ÐËÖËÇÕÈÑÔ residents test positive for COVID-19 Oregon State Board of Nursing meeting. ÅÑÎÎÃÄÑÔÃÖËÑÐ causing a disruption in the education for The pandemic has brought about many many students. ×ÖËÎËÖÛÑÈÔÇÕËÆÇÐÅÛ challenges for nursing education, and ÒÔÑÉÔÃÏÕ it has created space for innovation and ËÐÅÔÇÃÕÇÆ×ÕÇÑÈ As nursing and nursing assistant opportunity. Utilizing more technology ÕËÏ×ÎÃÖËÑÐ programs continue to adapt in real- for instruction and virtual simulation As campuses closed for in-person time to changes in healthcare and access prepares a new generation of nurses for instruction, nursing educators quickly to clinical experiences, healthcare the future of telemedicine, simulation, turned to online tools to deliver lecture organizations are compelled to examine e-learning, and even artificial intelligence. material, but the lack of access to clinical the preparedness and competency of As programs adapt and expand use of placements meant nursing and nursing individuals entering their workforce. these tools, capacity within nursing and assistant programs also had to replace Though some health carenursing assistant programs may expand. in-person clinicals with new simulated organizations have residency programs Nursing and nursing assistant students learning experiences. As schools increase for new graduates, many programs are living the value of public health and their use and reliance on simulation, decreased or delayed enrollment in infection control. Most importantly, faculty will need additional education and response to the COVID-19 crisis. As the pandemic has brought new chances resources to hone their simulation skills. the pandemic continues, organizations for partnerships, collaboration, and With OCN’s help, Oregon simulation are beginning to assess their long-term workforce transformation.

NURSING PRACTICE

<< Documentation: A Necessary Element of Nursing Practice continued from page 19

planned actions, and the outcomes of actions, and the outcomes when nursing practice documentation. actions will vary based on a multitude carrying out interventions within Does it consistently communicate of factors. Examples of these the RN’s plan of care for the your observations, your decisions and factors include: hospitalized labor and delivery planned actions, and the outcomes of • A nurse’s practice role with a client will be different from those those actions? Does it make sense given client. The documented account of generated when carrying out your practice role, your practice setting, an RN’s observations, decisions, interventions within the RN’s plan and the presenting needs of your planned actions, and the outcomes of care for a client who receives client(s)? Does it convey adherence to generated into the health record hospice services in their the legal standards of Division 45? of a client receiving hospital own home. Documentation is a necessary intensive care services will be • The client. The documented element of nursing practice. different depending on whether account of a RN’s observations, Understanding the proper application the RN’s practice role is to provide decisions, planned actions, and of Division 45’s documentation direct hands-on intensive care outcomes will communicate standard as well as one’s accountability for the client or to provide care far different content when the for individual actions facilitates a management services for RN’s client is a community or more prudent practice. Thoughtful the client. population verses an self-evaluation regarding one’s • A client’s plan of care. The individual person. documentation helps to identify documented account of an LPN’s As you reflect on the content strengths as well as areas where observations, decisions, planned of this article, self-reflect on your professional growth can be of benefit.

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 21 NURSING PRACTICE By OSBN RN/LPN Practice Policy Analyst Gretchen Koch, MSN, RN, YOU ASK, WE ANSWER

Q: Can an RN administer a flu I am not talking multipage nursing vaccine without a patient-specific assessment and plan of care documents. order? Our medical director has The standard is that nursing practice written and signed an order so that all (i.e., nursing assessment, reasoned staff can be vaccinated. The associated conclusions, goals, plan of care, et al.) policy requires the vaccination to be be documented by the RN in a timely, administered by an RN. Don’t we need accurate, thorough, and clear manner. a client-specific order to administer a For more on documentation, read the vaccination? article in this issue of the Sentinel titled Documentation: A Necessary Element of A: This question is about the ability Nursing Practice. of an RN to act upon an influenza vaccination order that has been scribed Q: I am requesting information for a population of persons instead of for in regard to any state restrictions one specific person. To this question, or out-of-state licensing needs the answer is yes; the RN may act upon required for registered nurses by such an order. the Oregon Board of Nursing for a Such a prescriber’s medical order video conference consulting service will typically contain inclusion criteria based outside of Oregon. We provide and exclusion criteria that are to be the general population with video applied to the individual member of The RN may accept and implement conference consulting services by the population who presents for the such a population-based order for the registered nurses offering restorative, vaccination. When a member of the person when the RN concludes that the supportive, and preventative health care population presents for the vaccination, individual person presenting for the recommendations to in-state and out- the RN who is responsible to administer vaccination meets inclusion criteria, does of-state clients. the vaccination would proceed to engage not present with any exclusion criteria, in nursing practice with the person. and the ordered vaccination is appropriate A: From this question, it’s apparent This means that the RN would collect, for the person. The RN’s plan of care that your services will require the RN validate and analyze data (conduct for the person would operationalize this to gather information, determine and an assessment) to arrive at a reasoned conclusion through interventions such analyze pertinent data, develop a reasoned conclusion regarding the safety of the as verifying the person has consented conclusion, and develop a plan of care for ordered influenza vaccination for the to receipt of the vaccination, education the client in order to address, educate, person. The RN’s assessment data on the vaccination and side effects, and counsel the client on their issues/ would include the vaccine’s ordered follow up instructions, administration of concerns. This constitutes the practice of route, dosage and ingredients; known the vaccination, and monitoring the nursing. Staff performing such work with contraindications for the specificperson’s response. a client located in Oregon would require vaccine; the order’s inclusion criteria The RN could decline to implement an Oregon registered nursing licensure. and exclusion criteria; client age, such a population-based order if any body temperature, allergy status, of the above criteria was not met. The Q: Can an individual reside in and past experience with influenza RN’s plan would reflect the decision not adult foster care with a PICC line for vaccinations; the client’s presence of or to administer as well as any counseling antibiotics? For some reason, I am lack of contraindications for the specific or instruction provided to the person on thinking that it is not allowed as a vaccine, the presence or lack of inclusion accessing other vaccination options. delegated task, but I don’t recall the criteria and exclusion criteria; etc. Before panic sets in, please note that specifics in the rule.

22 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING A: This specific question is not route for a client in a community based of the client’s ordered intervention is expressly answered by Oregon’s Nurse setting. The administration of antibiotics allowed - or is not expressly prohibited - Practice Act. The Board’s jurisdiction is through a peripherally inserted central by the rules governing the setting where over the individual licensed nurse. The catheter (PICC) would be a procedure the client is located. Board holds no jurisdiction over residency (i.e., nursing procedure) that only one of If the RN determines that delegation or admission requirements of any the aforementioned RNs could consider of the ordered intervention is not practice setting. for delegation to an unregulated assistive prohibited by the rules governing the Division 47 of the practice act (OAR person (UAP). setting, the RN could then proceed with 851-047) does grant the RN who is an The decision to proceed with delegation process. In proceeding, the employee of an Oregon Health Authority- delegation of this nursing procedure RN is then responsible to arrive at the certified home health (HH), home by the HH, HI, or HA RN would be up decision of whether delegation of the infusion (HI) or hospice agency (HA) the to the individual RN. In making such procedure’s performance to a specific authority to delegate the administration a decision, the RN’s first charge would UAP would be a safe care option for the of medications by the intravenous be to determine whether RN delegation specific client.

INVESTIGATIONS

By OSBN Investigator Jeff Lamont DISCIPLINARY CASE STUDY: ÄÑ×ÐÆÃÔÛØËÑÎÃÖËÑÐÕ

A Certified Nursing Assistant (CNA) was employed as a professional boundaries and admitted to acting on the proposal for Resident Assistant at a resident care facility. The Board received a a sexual relationship. report explaining the CNA had self-reported to the manager about At the conclusion of the investigation, law enforcement having an inappropriate sexual relationship with a resident that continued to investigate as it was learned the resident was not harmed the Resident. Initial reports indicated the CNA told the capable of giving consent due to diminished capacity. Given the manager about his inappropriate conduct the following day and egregious nature of the CNA’s actions and the vulnerability of the acknowledged what he had done to the resident was wrong. The client, and considering the cooperation of the CNA, the OSBN Manager then reported the incident to the Oregon State Board of Investigator discussed the option of a Stipulated Order for Voluntary Nursing (OSBN) and the Department of Human Services (DHS) Surrender with the CNA, with the understanding that if the CNA and local law enforcement. elected to sign it, the Board would consider the stipulation at their The CNA was interviewed by an OSBN Investigator regarding next meeting. The violations of the Nurse Practice Act included: the incident. The CNA admitted the behavior and acknowledged 1. Engaging in sexual misconduct with a client, being sexually inappropriate toward the resident. During 2. Engaging in sexual misconduct in the workplace, the interview, CNA agreed to sign an Interim Consent Order 3. Failing to maintain professional boundaries, and disallowing them from continuing to work as a CNA until further 4. Abusing a person. Order by the Board. The CNA agreed to sign the Stipulated Order for Voluntary The CNA cooperated fully with the OSBN investigation. The Surrender, and after discussing the merits of the case, the Board CNA explained to the Investigator that the resident had made issued the Final Stipulated Order for Voluntary Surrender of sexual advances toward him. The CNA admitted he did not set NA Certificate.

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 23 2020-21 OSBN BOARD MEETING DATES

November 17, 2020 6 6:30:30 pp.m..m. April 13, 2021 6:306:30 p.mp.m.. September 1414, 2021 6:30 p.m. Board Meeting Boardoardrdd MeMeetingMeetinM g Board Meeting

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Please visit the OSBN website meeting page at www.oregon.gov/osbn/Pages/board-meetings for agendas, materials, and logistical details.

OSBN EMAIL ADDRESSES Don’t Forget to Renew! ÐñîïåêãèåßáêïáïÝêàêñîïåêãÝïïåïðÝêð HAVE CHANGED ßáîðåğßÝðáïáôìåîááòáîõðóëõáÝîïëêõëñîÞåîðäàÝõ This means you need to renew—at the latest—the day The email domain for the Oregon State Board of Nursing has before your birthday; if you wait until your birthday to changed from @state.or.us to @osbn.oregon.gov. Please make renew, it will be too late. If you were born in an even the change in your address books or email rules so you can õáÝîõëñêááàðëîáêáóõëñîèåßáêïáëîßáîðåğßÝðáðäåï continue to receive email from the OSBN. year (if you haven’t already). And if you were born in ÝêëààõáÝîõëñóåèèêááàðëîáêáóõëñîèåßáêïáêáôð õáÝîÛëñéÝõßäáßçõëñîèåßáêïáïðÝðñïÝêàáôìåîÝðåëê àÝðáñïåêãðäáÄëÝîàĊïÎåßáêïáØáîåğßÝðåëêïõïðáé äððìžžëïÞêëîáãëêãëòžÑÕÄÐØáîåâåßÝðåëêžÆáâÝñèð aspx. Ëâ õëñî ßñîîáêð áéÝåè Ýààîáïï åï ëê ğèá óåðä ðäá ÄëÝîàëġßáõëñïäëñèàîáßáåòáÝßëñîðáïõîáéåêàáî ÞáâëîáõëñîèåßáêïááôìåîÝðåëêàÝðáðäáÞëÝîàïáêàï out email reminders at 90, 60, and 15 days prior to an áôìåîÝðåëêàÝðáÊëóáòáîåðåïñèðåéÝðáèõðäáèåßáêïááĊï îáïìëêïåÞåèåðõðëîáêáóäáîžäåïèåßáêïá ÆëêĊð îåïç ìëïïåÞèá ßåòåè ìáêÝèðåáï Þõ ìîÝßðåßåêã óåðäëñðÝèåßáêïá›îáêáóëêðåéá.

24 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING 2020 OSBN BOARD MEMBERS

ÏËÅÊÇÎÎÇÅÊÃ×ÎÒÐ ÕÊÇÔÛÎÑÃÍÇÕÅÃÆÆÛÌÆÏÕÐÔÐÅÐÇ BOARD SECRETARY ÖÇÔÏ°°$¬° ° ÖÇÔÏ°°%¬° ° ÏïÑÝçáï™ÅÝààõåïðäáÆáÝêëâÐñîïåêãÝðÏðÊëëà Ms. Chau is a Panel Manager for the Multnomah County Community College in Gresham, Ore. She has more than 30 ÊáÝèðäÆáìÝîðéáêðåêÒëîðèÝêàÑîáÕäáßëéìèáðáàäáî õáÝîïëâßèåêåßÝèêñîïåêãìîÝßðåßáÕäáîáßáåòáàäáîÃïïëßåÝðá ìîÝßðåßÝèêñîïåêãìîëãîÝéÝðÏðÊëëàÅëééñêåðõÅëèèáãá ëâÕßåáêßáåêÐñîïåêãâîëéÎåêê™ÄáêðëêÅëééñêåðõÅëèèáãá åêÉîáïäÝéÑîáÝêàäÝïÝÄÝßäáèëîëâÕßåáêßáàáãîááåê åêÃèÞÝêõÑîáäáîÄÝßäáèëîëâÕßåáêßáåêÐñîïåêãâîëé ÃàòÝêßáàÅäáéåïðîõÄåëèëãõÝêàÉáêáîÝèÕßåáêßáâîëé ÑîáãëêÊáÝèðäÕßåáêßáï×êåòáîïåðõåêÒëîðèÝêàÑîáäáî Oregon State University in Corvallis, Ore. She has 10 years ÏÝïðáîëâÕßåáêßáåêÐñîïåêãâîëéÙÝèàáê×êåòáîïåðõ ëâêñîïåêãáôìáîåáêßáÝêàïáîòáïåêðäáÎåßáêïáàÒîÝßðåßÝè ÄÝèðåéëîáÏàÝêàäáîÆëßðëîëâÌñîåïìîñàáêßáâîëé Nurse position on the Board. ÙåèèÝéáððá×êåòáîïåðõÕßäëëèëâÎÝóåêÕÝèáéÑîáÏï ÑÝçáïÅÝààõïáîòáïåêðäáÐñîïáÇàñßÝðëîìëïåðåëêëêðäá KATHLEEN CHINN, RN, FNP ÄëÝîàÝêàîáïåàáïåêÎáÞÝêëêÑîá BOARD PRESIDENT ÖÇÔÏÕ°°"¬° °$°°%¬° ° Ì×ÆËÖÊÙÑÑÆÔ×ÈÈÌÆ ÏïÅäåêêåïÝÈÝéåèõÐñîïáÒîÝßðåðåëêáîóåðäðäá PUBLIC MEMBER ÒáÝßáÊáÝèðäÕáêåëîÊáÝèðäÝêàÙáèèêáïïÅáêðáîåêÇñãáêá ÖÇÔÏ°°¬° ° ÑîáÕäáîáßáåòáàäáîÃïïëßåÝðáÆáãîááåêÐñîïåêãâîëé ÏïÙëëàîñĞîáßáåòáàäáîæñîåïàëßðëîÝðáâîëéðäá×êåòáîïåðõ ÎÝêáÅëééñêåðõÅëèèáãáåêÇñãáêáÑîáÝêàäáîÄÝßäáèëî ëâÑîáãëêÕßäëëèëâÎÝóÆñîåêãäáîèáãÝèßÝîááîïäáóëîçáà ëâÕßåáêßáåêÐñîïåêãÝêàÏÝïðáîĊïàáãîááïâîëéÑîáãëê as an Assistant Attorney General with the Oregon Department ÊáÝèðäÕßåáêßáï×êåòáîïåðõåêÒëîðèÝêàÑîáÕäáîáïåàáï ëâÌñïðåßáÝêàïáîòáàÝïÝêÃàéåêåïðîÝðåòáÎÝóÌñàãáÕäá in Eugene, Ore. ÝèïëóëîçáàåêìäåèÝêðäîëìõÝêàêëê™ìîëğðëîãÝêåöÝðåëêï åêßèñàåêãëòáîÝàáßÝàáóåðäðäáÐëîðäóáïðÊáÝèðäÈëñêàÝðåëê ANNETTE COLE, RN ÝïðäáÕáêåëîÒîëãîÝéÆåîáßðëîâëßñïáàëêäáÝèðäßÝîá ÒÔÇÕËÆÇÐÖ«ÇÎÇÅÖ óëîçâëîßáàáòáèëìéáêðÏïÙëëàîñĞïáîòáïÝïëêáëâðóë ÖÇÔÏ°°$¬° ° ìñÞèåßéáéÞáîïëêðäáÄëÝîàÝêàïäáîáïåàáïåêÒëîðèÝêàÑîá ÏïÅëèáåïðäáØåßáÒîáïåàáêðëâÒÝðåáêðÅÝîáÕáîòåßáï ÝêàÅäåáâÐñîïåêãÑġßáîÝðÕçõÎÝçáïÏáàåßÝèÅáêðáîåê ÏËÅÊÃÇÎÙÛÐÖÇÔ«ÎËÉÊÖÈÑÑÖ ÍèÝéÝðäÈÝèèïÝêàäÝï õáÝîïëâêñîïåêãáôìáîåáêßáÕäá PUBLIC MEMBER îáßáåòáàäáîÄÝßäáèëîïëâÕßåáêßáåêÐñîïåêãàáãîááâîëé ÖÇÔÏ° °¬° ° ðäáÑîáãëêËêïðåðñðáëâÖáßäêëèëãõåêÍèÝéÝðäÈÝèèïÑîá ÏîÙõêðáî™Îåãäðâëëðîáðåîáàåê%ÝâðáîïáòáêõáÝîï ÝêàäáîÏÝïðáîïëâÕßåáêßáåêÐñîïåêãÝêàÊáÝèðäÅÝîá ïáîòåêãÝïðäáÕðñàáêðÕñßßáïïÃàòëßÝðáâëîÒëîðèÝêàÒñÞèåß Administration degree from the University of Phoenix. Ms. ÕßäëëèïÊáîáßáåòáàäåïÃïïëßåÝðáëâÕßåáêßáàáãîááâîëé Cole serves in the Nurse Administrator position on the ÔëßçèÝêàÅëééñêåðõÅëèèáãáåêÕñĞáîêÐÛÏîÙõêðáî™ Board. She resides in Klamath Falls. ÎåãäðâëëðåïëêáëâðóëìñÞèåßéáéÞáîïëêðäáÄëÝîàÝêàäá resides in Milwaukie, Ore. ADRIENNE ENGHOUSE, RN ÖÇÔÏÕ°°"¬° °#°°$¬° ° ÏïÇêãäëñïáåïÝÕðÝĞÐñîïáÝðÍÝåïáîÕñêêõïåàá AARON GREEN, CNA ÏáàåßÝèÅáêðáîåêÅèÝßçÝéÝïÑîáÕäáïáîòáïåêëêáëâ ÖÇÔÏÕ°°¬° ° ðóëàåîáßð™ßÝîáÔÐìëïåðåëêïëêðäáÄëÝîàÕäáîáßáåòáà ÏîÉîááêåïÝÅÐÃÝðÏßÍáêöåáÙåèèÝéáððáÏáàåßÝèÅáêðáî äáîÃïïëßåÝðáÆáãîááåêÐñîïåêãâîëéÏëñêðÊëëà åêÕìîåêãğáèàÑîáÊáïáîòáïåêðäáÅÐÃìëïåðåëêëêðäá Community College in Gresham, Ore., and resides ÄëÝîàÊáäÝïáåãäðõáÝîïëâáôìáîåáêßáÝïÝÅÐÃÝêàîáïåàáï in Portland, Ore. åêÕìîåêãğáèà

ÄÑÄÄËÇÖ×ÔÐËÒÕÇÇÆÔÐ ÖÇÔÏÕ°°"¬° °#°°$¬° ° ÏïÖñîêåìïááàåïÝïðÝĞêñîïáÝðÕðÃèìäëêïñïÏáàåßÝèÅáêðáî åêÑêðÝîåëÝêàäÝïéëîáðäÝê õáÝîïëâêñîïåêãáôìáîåáêßá ÕäáîáßáåòáàäáîÃïïëßåÝðáÆáãîááåêÐñîïåêãâîëéÄëåïáÕðÝðá ×êåòáîïåðõåêÄëåïáËàÝäëÏïÖñîêåìïááàåïëêáëâðóëàåîáßð™ ìÝðåáêðßÝîáÔÐïëêðäáÄëÝîàÕäáîáïåàáïåêÑêðÝîåëÑîá

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 25 Save the Date!

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26 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING DISCIPLINARY ACTIONS Actions taken in July, August, and September 2020. Public documents for all disciplinary actions listed below are available on the OSBN website at www.oregon.gov/OSBN (click on ‘Look Up a Nurse or Nursing Assistant’). Name License Number Discipline Effective Date Violations

Laurie A. Adams RN Applicant Voluntary Withdrawal 9-9-20 Using intoxicants to the extent injurious to herself or others. Mary K. Allen 078041637RN Reprimand 7-8-20 Violating clients’ rights of privacy and confidentiality, and failing to conform to the essential standards of acceptable nursing practice. Steven M. Allen 200911425CNA Revocation 7-8-20 Demonstrated incidents of reckless behavior, leaving a nursing assignment without properly notifying supervisory personnel, and using intoxicants to the extent injurious to himself or others. Lois D. Ashe 087000316RN Voluntary Surrender 7-8-20 Violating the terms and conditions of a Board Order. Paul K. Baumgardner 200342320RN Reprimand 8-5-20 Failing to document nursing interventions in a timely manner, failing to take action to preserve client safety, and failing to conform to the essential standards of acceptable nursing practice. Tyler N. Berch 201906876RN Suspension/Probation 7-8-20 RN placed on immediate two-year probation. CRNA suspended for 12 months, followed by 12-month probation. 201907524CRNA Unauthorized removal of medications from the workplace, possessing unauthorized medications, and demonstrated incidents of reckless behavior. Denise M. Bertrand 201806552RN Revocation 7-8-20 Unauthorized removal of medications from the workplace, entering inaccurate documentation into a health record, and failing to report to the Board her arrest for a felony crime within 10 days of the arrest. Star S. Bilberry 078041695RN Reprimand 9-9-20 Failing to document nursing interventions, failing to take actions to promote client safety, and failing to conform to the essential standards of acceptable nursing practice. Misty J. Bingham 200141176RN Suspension 8-5-20 60-day suspension. Abusing a client, failing to take action to preserve client safety, and failing to conform to the essential standards of acceptable nursing practice. Stacey L. Boeholt 201242364RN Suspension 9-9-20 Minimum 14-day suspension. Failing to cooperate with the Board during an investigation. Laura K. Borud 097000421RN Probation 7-8-20 Six-month probation. Failing to take action to preserve client safety, and failing to conform to the essential standards of acceptable nursing practice. Nicholas A. Bower 201903744RN Revocation 7-8-20 Falsifying data in a client record, documenting services that were not provided, and using intoxicants to the extent injurious to himself or others. Neal A. Boyd 088003228RN Reprimand 7-8-20 Reprimand with conditions. Failing to take action to preserve client safety, failing to communicate client status information to members of the healthcare team, and failing to clinically supervise persons to whom an assignment was made. Jade E. Brannan 200342113RN Probation 9-9-20 24-month probation. Due to her previous use of intoxicants to the extent injurious to herself or others. Joel D. Brown 201041730RN Voluntary Surrender 9-9-20 Violating the terms and conditions of a Board Order. Zachary T. Cader 201803643CNA Revocation 8-5-20 Abusing a person, failing to respect the dignity and rights of a client, and failing to cooperate with the Board during the course of an investigation. Tanya L. Calvert 200312433CNA Revocation 7-8-20 Obtaining unauthorized drugs, using intoxicants to the extent injurious to herself or others, and failing to cooperate with the Board during an investigation. Santiago Campos Brambila 202001438CNA Voluntary Surrender 9-9-20 Demonstrated incidents of abusive behavior, engaging in sexual misconduct with a client in the workplace, failing to maintain professional boundaries, and failing to conform to the essential standards of acceptable CNA performance. Douglas M. Carty 200242896RN Suspension 7-8-20 30-day suspension. Falsifying data, documenting nursing practice implementation that did not occur, and failing to conform to the essential standards of acceptable nursing practice. Irena Chernish 201609883RN Revocation 9-9-20 Violating the terms and conditions of a Board Order. Cory A. Churner-Tisdale 201608584LPN Probation 9-9-20 36-month probation. Falsifying data, obtaining medications without authorization, failing to answer questions truthfully, and failing to conform to the essential standards of acceptable nursing practice. Amanda M. Ciraulo 201242934RN Voluntary Withdrawal 9-9-20 Due to her previous use of intoxicants to the extent injurious to herself or others. Robert M. Clements 200141854RN Suspension/Probation 7-8-20 30-day suspension, followed by 18-month probation. Threatening and abusive behavior towards coworkers, and failing to conform to the essential standards of acceptable nursing practice. Stephanie M. Conant 200542136RN Suspension/Probation 7-8-20 Nine month suspension, followed by three years of probation. Violating the terms and conditions of the Health Professionals’ Services Program, demonstrated incidents of dishonesty, and failing to cooperate with the Board during an investigation. Tiffany R. Cox 201050091NP Reprimand/Civil 7-8-20 $3,500 civil penalty. Failing to accurately document nursing interventions, failing to document information pertinent Penalty to a client’s care, and failing to conform to the essential standards of acceptable nursing practice. Sherri Lynn G. Crawford 200310388CNA/ Revocation 8-5-20 Violating the terms and conditions of a Board Order. 201507452CMA Melissa M. Davis 201143136RN Reprimand 9-9-20 Improperly delegating the performance of a nursing procedure to unlicensed assistive personnel, and failing to conform to the essential standards of acceptable nursing practice. Kate J. DeBruin 200341026RN Voluntary Surrender 7-8-20 Misrepresentation in applying for a license, conviction of a crime that bears a demonstrable relationship to nursing, and using intoxicants to the extent injurious to herself or others. Megan H. Donahue 201800682CNA Revocation 7-8-20 Failing to respect the dignity and rights of clients, failing to implement the plan of care developed by a RN, and failing to cooperate with the Board during an investigation. SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 27 Name License Number Discipline Effective Date Violations

Yvonne M. Elkins 087003076RN Reprimand 9-9-20 Unauthorized removal of a medication from the workplace, stealing property from a client, and failing to conform to the essential standards of acceptable nursing practice. Maria S. Faris 091006472RN Probation 8-5-20 12-month probation. Due to a previous license revocation. Elizabeth M. Fisher 201141408RN Civil Penalty 7-8-20 $2,500 civil penalty. Violating a person’s rights of privacy and confidentiality, and failing to conform to the essential standards of acceptable nursing practice. Nicole Lei P. Fonacier 201707659RN Civil Penalty 7-8-20 $500 civil penalty. Demonstrated incidents of dishonesty, and altering words or characters within an existing docu- ment to mislead the reader. Lorna A. Fortuna RN Applicant Application Denied 7-8-20 Failing to cooperate with the Board during an investigation. Jeffrey C. Goolsby 201604947RN Probation 7-8-20 12-month probation. Engaging in threatening behavior towards a coworker, and demonstrated incidents of intimidating and abusive behavior. Matthew S. Grove 200742451RN Probation 8-5-20 24-month probation, contingent on completing a re-entry program and other conditions. Due to previous discipline on his license. Linda A. Gruenwald 094000558RN/ Voluntary Surrender 9-9-20 Violating the terms and conditions of a Board Order. 200450037NP Tamika Hall Winter LPN Applicant Application Denied 9-9-20 Demonstrated incidents of dishonesty and failing to answer questions truthfully. Debora E. Halstead 084060670RN Reprimand 9-9-20 Improperly delegating the performance of a nursing procedure to unlicensed assistive personnel, and failing to conform to the essential standards of acceptable nursing practice. Lisel N. Ham 096007312RN Probation 7-8-20 24-month probation, contingent on three conditions. Practicing nursing while impaired. Amanda D. Hammond 201505186RN Probation 9-9-20 24-month probation. Failing to comply with the terms and conditions of the Health Professionals’ Services Program. Andrea K. Handforth 201042021RN Probation 7-8-20 24-month probation. Practicing while impaired and using intoxicants to the extent injurious to herself or others. Lacey E. Haney 201341434RN Reprimand 7-8-20 Violating a client’s rights of privacy and confidentiality. Krystle A. Herrera 200510386CNA/ Suspension 9-9-20 Minimum 14-day suspension. Failing to cooperate with the Board during the course of an investigation. 200720025CMA Micaela G. Horning 201507604LPN Suspension 8-5-20 Minimum 14-day suspension. Failing to cooperate with the Board during an investigation Taek Huh 201705261LPN Suspension/Probation 7-8-20 30-day suspension, followed by 18 months of probation. Documenting nursing practice that did not occur, falsifying data, and failing to conform to the essential standards of acceptable nursing practice. Martin L. Johnson 201404926RN Probation 7-8-20 24-month probation. Using intoxicants to the extent injurious to himself or others. Toni L. Johnson 201392952RN Suspension/Civil 7-8-20 60-day suspension. $1,500 civil penalty. Failing to reportincidents of abuse, failing to answer questions truthfully, Penalty and conviction of a crime that bears demonstrable relationship to nursing. Kjersti K. Johnston 201704386RN Reprimand 9-9-20 Failing to communicate client status information to members of the healthcare team, failing to take actions to promote client safety, and failing to conform to the essential standards of acceptable nursing practice. Peter A. Jones 201040419RN Voluntary Surrender 9-9-20 Failing to clinically supervise persons to whom an assignment had been made, failing to document nursing interventions, and failing to conform to the essential standards of acceptable nursing practice. Christine E. Laib 201503030CNA Revocation 9-9-20 Abusing a person, for using her role to solicit money for personal gain, failing to maintain professional boundaries, and failing to cooperate with the Board during an investigation. Amanda K. Lamberson CNA Applicant Voluntary Withdrawal 8-5-20 Due to a conviction for a crime that bears demonstrable relationship to CNA duties. Cayla R. Larkin 201806881CNA Suspension 9-9-20 Minimum 14-day suspension. Failing to cooperate with the Board during an investigation. Christene M. Lawrence 200313032CNA Suspension 8-5-20 Minimum 14-day suspension. Failing to cooperate with the Board during an investigation Leah M. Leming RN Applicant Application Denied 9-9-20 Failing to cooperate with the Board during the course of an investigation. Wendy M. Lohan 200242481RN Probation 7-8-20 24-month probation. Using intoxicants to the extent injurious to herself or others. Bobbi S. Marugg 201391804RN Suspension 7-8-20 14-day suspension. Falsifying data and failing to conform to the essential standards of acceptable nursing practice. Janet A. Matthews 077038880RN/ Revocation 9-9-20 Failing to maintain client records in a timely manner, and failing to conform to the essential standards of acceptable 200150137NP and prevailing nursing practice. Ashlee R. McKenzie CNA Applicant Application Denied 7-8-20 Failing to cooperate with the Board during an investigation. Katie M. McMullin 201803144RN Probation 8-5-20 24-month probation. Using intoxicants to the extent injurious to herself or others.

Nicodeme Nzisabira 202001087RN Suspension 8-5-20 Minimum 14-day suspension. Failing to cooperate with the Board during an investigation

Maureen O’Dea 201700239RN Reprimand/Civil 9-9-20 $1,500 civil penalty. Demonstrated incidents of abusive behavior. Penalty Patty J. Olson 202002727RN Voluntary Surrender 9-9-20 Demonstrated incidents of dishonesty, and failure to report the Board her felony arrest within 10 days. Bradley D. Patrick 200743831RN/ Revocation 9-9-20 Failing to take action to preserve client safety, failing to communicate client status information to the healthcare 200760034CRNA team, and failing to conform to the essential standards of acceptable nursing practice. Joanna L. Pelton 201600051RN Voluntary Surrender 9-9-20 Using intoxicants to the extent injurious to herself or others, and practicing while impaired.

Taylor L. Perkins 201340136RN/ Revocation 7-8-20 Performing acts beyond her authorized scope, prescribing drugs to an individual who is not her client, prescribing to 201350032NP an individual not within her scope of practice, and failing to answer questions truthfully.

28 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING Name License Number Discipline Effective Date Violations

Becky M. Poe 200540369RN Voluntary Surrender 7-8-20 Using intoxicants to the extent injurious to herself or others. Orion Poptean CNA Applicant Voluntary Withdrawal 7-8-20 Failing to cooperate with the Board during an investigation. Jennifer L. Quesada 200742059RN Application Denied 9-9-20 Due to a mental impairment. Tamara L. Ramsey 082011895RN Voluntary Withdrawal 7-8-20 Failing to answer questions truthfully.

Dawn S. Regier 200242628RN Voluntary Withdrawal 7-8-20 Mental impairment as evidenced by documented deterioration of functioning in the practice setting. Donna K. Reynolds 201230251LPN Reprimand 8-5-20 Failing to document nursing interventions, failing to take actions to promote client safety, and failing to conform to the essential standards of acceptable nursing practice. Amanda L. Rhodes 202008404CNA Probation 9-9-20 24-month probation. Demonstrated incidents of neglectful behavior, and previous possession of unauthorized drugs. Nicole Robustelli 200141391RN Probation 7-8-20 24-month probation, contingent on three conditions. Using Cheryl R. Russo 200640046RN Voluntary Surrender 7-8-20 Using intoxicants to the extent injurious to herself or others. Brandon Saada 201800657RN Revocation 7-8-20 Violating the terms and conditions of the Health Professionals’ Services Program. Carolyn M. Schoenfelder 200742872RN Suspension 8-5-20 Minimum 14-day suspension. Failing to cooperate with the Board during an investigation. Brandon J. Seward 201501006RN Probation 9-9-20 24-month probation. Demonstrated incidents of violent behavior, and using intoxicants to the extent injurious to himself or others. Brandae M. Shannon 201709546LPN Reprimand 8-5-20 Failing to document nursing interventions accurately, and failing to conform to the essential standards of acceptable nursing practice. Kimberlee Shoop-Lockett 201403761CNA Revocation 8-5-20 Violating the terms and conditions of a Board Order. Brandi S. Slaton 200612698CNA Revocation 9-9-20 Using intoxicants to the extent injurious to herself or others, possessing unauthorized drugs, and failing to answer questions truthfully. Eva A. Small 083039958RN Reprimand 8-5-20 Performing acts beyond her authorized scope, and assigning persons to perform functions for which they were not prepared to perform. Heather S. Spaulding 201010059CNA Probation 9-9-20 24-month probation. Demonstrated incidents of reckless behavior and using intoxicants to the extent injurious to herself or others. Christopher J. Stamulis 201703758RN Voluntary Surrender 8-5-20 Demonstrated incident of abusive behavior, engaging in sexual misconduct with a client in the workplace, engaging in threatening behavior towards a coworker, and failing to conform to the essential standards of acceptable nursing practice. Amy K. Stokes 201803669RN Probation 7-8-20 24-month probation. Practicing nursing while impaired and obtaining unauthorized medications. Tracey L. Tait 201605649RN Suspension 7-8-20 180-day suspension. Demonstrated incidents of dishonesty. Marcene L. Thomas 089006837RN Reprimand 7-8-20 Failing to document nursing interventions in a timely manner, failing to implement the plan of care, and failing to conform to the essential standards of acceptable nursing practice. Patricia D. Twombly 201402422LPN Probation 9-9-20 24-month probation. Failing to comply with the terms and conditions of the Health Professionals’ Services Program. Barbara A. Vinyard 000034486CNA/ Reprimand 9-9-20 Reprimand with conditions. Failing to respect the client’s dignity and rights, and failing to conform to the essential 201604592CMA standards of acceptable CNA performance. Denise M. Wagner 092003128LPN Reprimand 9-9-20 Engaging in threatening behavior towards a coworker. Ann M. Wakeman 000006287RN Suspension 8-5-20 Minimum 14-day suspension. Failing to cooperate with the Board during an investigation. Simon P. Walusimbi LPN Applicant Application Denied 7-8-20 Using intoxicants to the extent injurious to himself or others. Julie A. Watts 091007335RN Civil Penalty 8/28/20 $525 civil penalty. Practicing nursing without a current license. Timothy E. Wheeler 201230557LPN Voluntary Withdrawal 8-5-20 Demonstrated incidents of dishonesty, and failing to answer questions truthfully. Lyndon J. White 097006503RN Voluntary Surrender 7-8-20 Physical condition that prevents him from practicing safely. Crystal D. Whited 201243520RN Voluntary Surrender 9-9-20 Violating the terms and conditions of a Board Order. Sandra Young 201801688RN Reprimand/Civil 8-5-20 $500 civil penalty. Demonstrated incidents of dishonesty, and failing to conform to the essential standards of Penalty acceptable nursing practice. Ingrid A. Zeckser 201405939RN Voluntary Surrender 7-8-20 Violating the terms and conditions of a Board Order. Tina M. Zeeberg-Foote 200241551RN Reprimand 7-8-20 Violating the client’s rights of privacy and confidentiality.

BEING “CARDLESS” PROMOTES PUBLIC SAFETY ÖëìîëéëðáìñÞèåßïÝâáðõÝêàäáèììîáòáêðâîÝñàðäáâðÝêàéåïñïáëâêñîïåêã 2. ÑÕÄÐÝñðë™òáîåğßÝðåëêïõïðáéâëîèÝîãáêñéÞáîïëâèåßáêïáï èåßáêïáïðäáÑîáãëêÕðÝðáÄëÝîàëâÐñîïåêãêëèëêãáîåïïñáïìèÝïðåßèåßáêïá https://osbn.oregon.gov/OBNPortal/DesktopDefault. ßÝîàïÖäáîáÝîáïáòáîÝèóÝõïêñîïáïÝêàáéìèëõáîïßÝêèëëçñìèåßáêïá aspx?tabindex=0&tabid=5&utyp=5 êñéÞáîïÝêàòáîåâõðäáßñîîáêðïðÝðñïëâèåßáêïáï 3. ÐÝðåëêÝèÅëñêßåèâëîÕðÝðáÄëÝîàïëâÐñîïåêãÐ×ÔÕÛÕèåßáêïá 1. ÑÕÄÐëêèåêáòáîåğßÝðåëêïõïðáé òáîåğßÝðåëêÝêàǙÐÑÖËÈÛïõïðáéï äððìžžëïÞêëîáãëêãëòžÑÕÄÐØáîåğßÝðåëêžÆáâÝñèðÝïìô äððìïžžóóóêßïÞêëîãžèåßáêïá™òáîåğßÝðåëêäðé

SENTINEL ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ 29 STAFF PROFILES By OSBN Communications Manager Barbara Holtry MEETMEET THETHE TEAMTEAM The Oregon State Board of Nursing is much more than just, “that place where you get your license renewed every two years.” To achieve our mission of public protection, our team is hard at work approving educational and training programs, providing outreach presentations to employers and licensees, answering scope-of-practice questions, investigating possible violations of the Nurse Practice Act, maintaining our online systems, and, yes, issuing licenses. In each issue of the Sentinel, we’ll introduce you to a team member who makes everything work.

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Born and bred him to apply for the Clackamas County Inter-Agency Police Reserve in Oregon, OSBN Academy. He worked first as a volunteer for Clackamas County, and Investigator Chad Steele then as a fulltime officer in the Lake Oswego Police Department. thought he’d stay in the “It’s so hard to see people struggling and know there’s not much Northwest forever when you can do to help them,” he says. “So, we created a Food Box he graduated from Sam program. Officers would notice people who needed extra help, and Barlow High School in we’d provide them a free box of food. In addition to donations from Gresham. However, local businesses, we all donated food for the boxes. The people getting shortly after beginning the boxes were very appreciative, and it felt good to help them.” classes at Mt. Hood After he was injured in a training accident, police work was no Community College, he packed up and moved to Michigan. “There longer an option, so Steele joined the Oregon Medical Board in 2017 was a girl,” he explains with a laugh. as an Investigator. He was quickly promoted to Compliance Officer, Although his relationship didn’t last, the move presented him where he dealt with physicians on probation, but he didn’t care for with an interesting job opportunity as an investigator for Rite Aid. working in downtown Portland. “Law enforcement was always a direction for me,” he explains. “It’s “I was getting tired of the commute. Then I saw the opening at about problem solving and the feeling that you’re accomplishing the Board of Nursing in Tualatin and jumped at it.” Steele joined something. It was fulfilling.” At Rite Aid, he was part of a team the OSBN Investigations department in February 2020. Here, he that set up stings to expose internal and customer theft. “It was cool, investigates complaints to determine whether a Nurse Practice because we had to dress for the various areas of Michigan where we Act violation has occurred, and prepares a final report for Board were working, so we could blend into our surroundings. I never review and possible action. He says the most important part of his considered before how people in different communities in the same job gathering enough data—documents, witness statements, and state have different clothing styles.” records—so the Board can make an informed decision. “One of the After a couple years, Steele switched to a private investigation things that’s different here from other places I’ve been is that nurses firm that worked with major insurance companies to uncover fraud. are usually honest and come clean right away if they’ve committed a “I did visual surveillance, following people around. Every day violation. It’s refreshing,” he explains. was something different. For instance, this one person went to his Steele says he enjoys the blend of nurse investigators and non- medical appointment using a walker, but then went about the rest of nurse investigators at the OSBN. “It makes for great collaboration his day walking around just fine. It’s surprising the lengths to which and good opportunities to bounce ideas and questions off some people will go.” each other.” He eventually grew tired of Michigan’s “too hot and too cold” In his spare time, he enjoys the outdoors with his wife and two weather extremes and moved back to Oregon. While finishing his young daughters. “We recently moved to a rural area, and there’s a Associate of Arts degree at Clackamas Community College, he nature trail that’s great for biking and hiking. At night, we can hear went on a ride-along with a Clackamas County Sheriff, which led the coyotes talking to each other. It’s pretty cool.”

30 ØÑ %¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING Choose [More]. Choose NGHS.

A nursing career at Northeast Georgia Health System (NGHS) gives you more of what you want: more support, more opportunities, more innovation, more teamwork and more technology. It’s simply more than you expect. We listen to our nurses, and we make it easier for you to love what you do every day. With opportunities at all four of our Northeast Georgia Medical Center campuses – Gainesville, Braselton, Barrow and Lumpkin – in addition to more than 100 outpatient and physician practice locations, you’re sure to find the fit that’s right for you. Choose More. Choose NGHS.

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