What Nurses Need to Know About Informatics, Social Media and Security! – Page 6

FALL 2017 VOLUME 14 {NO1} EDITION 40 www.ncbon.com NURSING BBULLETINULLETIN

What Nurses Need to Know about Informatics, Social Media and Security! – page 6

Publication of the North Carolina State Board of Nursing

. . . FALL. . . . 2017 . . . BULLETIN...... N NC BOARD OF NURSING Nursing Bulletin is the ofﬁcial C publication of the North Table of Carolina Board of Nursing. Office Location CONTENTS 4516 Lake Boone Trail Raleigh, NC 27607 VOLUME 14 {NO 1} EDITION 40 Mailing Address P.O. Box 2129 6 What Nurses Need to Know about Raleigh, NC 27602 Informatics, Social Media, and Security! Telephone (919) 782-3211 Substance Use Disorder: Fax 12 (919) 781-9461 Timely Information for Your Practice Website www.ncbon.com 14 Updated Legislation Provides Benefit to Active Duty Office Hours Military & Spouses 8 a.m. to 5 p.m., Monday through Friday 15 NCBON Staff Nationally & Regionally Recognized Board Chair Pat Campbell The Enhanced Nurse Licensure Compact (eNLC): Chief Executive Officer 16 Julia L. George, RN, MSN, FRE Unlocking Access to Nursing Care Across the Nation Editor David Kalbacker 20 Role of the Registered Nurse in North Carolina— Managing Editor Is It Limited? Elizabeth Langdon

Mission Statement 26 NCBON Nurse Gateway—Update Your Information The mission of the North Carolina Board of Nursing is to protect the public by regulating the 27 Tribute to Duke Life Flight Team practice of nursing. 28 CE Opportunities 2018 Advertisements contained herein are not necessarily endorsed by the North Carolina Board of 29 Nomination Form Nursing. The publisher reserves the right to accept or reject advertisements for the Nursing Bulletin. 30 NCBON Launches New Website All art (photos, paintings, draw- ings, etc.) contained in this publication is used under contractual Election Results for 2017 agreement. 36 157,000 copies of this document were printed and mailed for a cost of $0.22 per copy. The North Carolina Board of Nursing is an equal opportunity DEPARTMENTS: employer. 4 From the Managing Editor pcipublishing.com 15 BON Calendar Created by Publishing Concepts, Inc. David Brown, President • [email protected] 32 Summary of Activities For Advertising info contact 38 Victor Horne • 800.561.4686 ext 114 NURSING Classifieds [email protected] BULLETIN ThinkNurse.com ...... 3 NC from the MANAGING EDITOR

The approaching fall season reminds us that the onlynly constantcons is change. The fading summer and impending cooler weathereather reremind us that the world and our surroundings are always changingng and evolving.ev Unfortunately, the prevalence of tragedy and natural disasterssters lately,latel has reminded us of the same. But it’s in these times of crisis thatt we’rew reminded of the selfless and heroic acts of first responders, includingding nurses and other healthcare professionals. For that, we thank you. The NC Board of Nursing is also experiencing change, as we have a host of announcements and information to share with you. First, I’d like to welcome our newest Board Members, Pamela Edwards, RN and Lori Lewis, LPN who were elected to serve the state of North Carolina, with terms beginning in January 2018. Additionally, Ashley Dixon, a local Raleigh real estate professional, was appointed by the NC Senate to serve as one of your three public members. As of the end of September, the NC Board of Nursing has a newly redesigned website that will facilitate easier navigation to resources and a user-friendly content structure for nurses and the public. In addition to our new website, the NCBON will be launching its own Facebook page at the end of October. This will allow us to connect with nurses across the state and keep you up to date on important meetings, regulatory information and rule changes that may impact your practice. Finally, we’d like to thank our legislative sponsors, especially Representative John Szoka for his hard work and dedication to getting the Enhanced Nurse Licensure Compact legislation passed and signed into law. This updated version of the Nurse Licensure Compact will facilitate greater access to nursing care across the nation. For more information on possible effects to your nursing license, please read the eNLC article on page 16.

Sincerely, Elizabeth Langdon Managing Editor, NC Nursing Bulletin

Attention Nursing Program Directors and Nursing Faculty Save the Date—April 9, 2018 SPEAKER: The keynote speaker is Carol Durham, EdD, RN, ANEF, NCBON 15th Annual FAAN, who will present on the topic of simulation. Education Summit Carol Durham is the Professor and Director of Education- Innovation-Simulation Learning Environment at the University The Friday Center, Chapel Hill • Cost $100 of North Carolina at Chapel Hill School of Nursing.

URSING 4 NURSING N O RTH C AROLIN A BULLETIN { Official Publication of the Board of Nursing } ...... 5 But all I did was share a photo of my patient’s wound with one friend... you couldn’t even see his face! What Nurses Need to Know about Informatics, Social Media, and Security!

Denise Hirst, RN, MSN

on the internet may be seen by roughly for information management into almost Purpose: nine out of ten adults. all aspects of life. In healthcare, infor- Advances in technology, telehealth, As technology continues to evolve matics provides advantages and poses risks. and an increasing global focus have and advance, it is critical that nurses had major impacts on the health care understand technology’s impact on Advantages workforce. The purpose of this article healthcare delivery. With the wide • Wellness and fitness information is is to provide information about variety of entertainment, educational, readily available. current trends related to electronic and information-technology advances, • Disease and illness information can information use and social network- it is essential that we keep in mind be found through a simple web search. ing as related to nursing practice. ethical, legal, and security issues when • Electronic health records provide a considering use of these technologies. method for documentation of care Outcome: The opportunity to use a wide variety and treatment. Recognize healthcare informa- of web-based programs, including social • Electronic health information is tion security advantages and risks. media, to provide education and resources available across health care systems Identify appropriate and inappro- to the public and healthcare profession- and individual healthcare providers. priate use of social media. als is an impactful use of technology • Patients have easy access to personal advances. However, as we use these health information (PHI) and direct tools, it is important to recognize the communication to their health- Advances in technology have regulatory and legal implications. care providers. changed the way in which healthcare is delivered. These advances have made Healthcare and Informatics Risks significant impacts on how nurses deliver Historical Perspective • Internet information may be mis- and document patient care and commu- Informatics is an enigma to some and leading or inaccurate. nicate nursing issues (National Council a way of life to others. The term infor- • Disease and illness information of State Boards of Nursing Regulator matics is simply defined as “the collection, retrieved from the internet may be Staff, 2015). The Pew Research Center classification, storage, retrieval and misunderstood, misinterpreted, or reports that 88% of people in the United dissemination of recorded knowledge” put to erroneous use. States use some form of internet-based (Merriam-Webster, 2017) and can be • PHI can be compromised due to social media (Pew Center, 2017). Ninety- broadly described as the practice of unauthorized access. four percent of respondents between the creating, storing, finding, manipulating, • Healthcare system data breaches pose ages of 18 to 64 years, use social media. and sharing information. From as early a threat to health and personal data Further, respondents age 65 years or as 1937 with the introduction of the first of all system participants. older reported a lower, yet significant computer, a Model K Adder, to 1971, with J. Weaver (2017) reported that 80 utilization of social media at 64% (Pew the implementation of personal comput- percent of Americans who use the Center, 2017). These data provide clear ing (Computer History Museum, 2017); internet have searched for health-related evidence that the information we place society has integrated the use of technology topics. Nurses, aware of this evidence

URSING 6 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... should develop and implement strategies Patient Trust and Confidentiality PHI. Nurses and other healthcare that will have a positive impact. In According to the January 2017 providers should follow these policies addition to directly providing healthcare Gallup poll, nursing continues to be and procedures as they plan and education and information via electronic ranked the most trusted profession in implement patient education, sharing means, nurses can provide much-needed the United States (The Advisory Board of information, and networking. education and guidance with regards to Company, 2017). Protecting those who the public’s use of healthcare informa- entrust us with their healthcare and Social Media tion retrieved from the internet. Nurses safety is not only a nurse’s professional American adults have increased can implement strategies to provide safe responsibility, it is a required by the their use of social media from 5% in evidence-based care and reduce risk of North Carolina (NC) law and rules 2005 to 69% in 2016 (Pew Research, PHI compromise, by: which regulate nursing practice. Ensuring 2017, January). One might assume that 1. identifying and anticipating risks, that today’s nurses remain competent the information posted online is private 2. develop policies and procedures in this responsibility in our modern era because most sites require a personal which provide for consistent elec- requires knowledge and understanding login and password. Unfortunately, tronic patient education practices and correct application of evolving personal privacy settings on social 3. close monitoring and assessment technologies used in healthcare. media provide a false sense of security. for existing and emerging risks. As the information age continues to Anything posted online on social Protection and security of healthcare evolve, a multitude of electronic devices media accounts has the potential to information in the electronic environ- and software applications are available. be viewed by the public. For example, ment requires ongoing assessment, Preserving our patient’s trust and con- posts shared with a friend may end up continuous monitoring and improve- fidentiality can sometimes be a challenge. being viewed. As nurses, we have an ment of safeguards and security prac- The “Health Insurance Portability and ethical responsibility to self-regulate tices. The model shown in FIGURE A, Accountability Act (HIPAA) and the that which we post on social media developed by the Department of Health privacy and security rules outline how accounts. These accounts have unlim- and Human Services (n.d.) demon- individuals, including nurses, at covered ited potential as a communications strates a cycle of monitoring to promote entities should collect, use and handle tool to help us educate our clients and security and reduction of risks for breach protected health information” (Borten, share reliable healthcare information of confidentiality, integrity and avail- 2017). This federal law and rules have resources. However, caution should be ability of private information. prompted those covered healthcare the rule, whenever posting anything agencies and services to develop and work related to social media or else- Figure A utilize policies and procedures to protect where on the internet.

...... 7 The National Council of State MYTH: Communication or post is Minimize Risk when using Boards of Nursing (NCSBN) and the private and accessible only to the Social Networking American Nurses Association (ANA) intended recipient. The American Nurses Association developed guidelines for upholding FACT: The nurse may fail to recognize (ANA) has developed guidelines for professional boundaries with regards to that content once posted or sent can using social media and a social network- social media. The NCSBN provides several be disseminated to others. ing principles toolkit (American Nurses resources for download free of charge at Association, 2017). The ANA’s prin- https://www.ncsbn.org/3739.htm. These MYTH: Content deleted from a site ciples for social networking are: resources provide information to guide is no longer accessible. Nurses nurses in the use of social media. They FACT: The moment something is • must not transmit or place online provide tips for using social media posted, it lives on a server that can individually identifiable patient appropriately while avoiding disclosure always be discoverable by others, information; of confidential information. Although including in a court of law. • must observe ethically prescribed there are cases of intentional abuse and professional patient-nurse boundaries; malicious intent with social media, most MYTH: It is harmless if private • should understand that patients, often the exposure of private and/or con- information about patients is disclosed colleagues, institutions, and fidential information is unintentional. if the communication is accessed only employers may view postings; Nurses must remember that there is an by the intended recipient. • should take advantage of privacy opportunity for confusion between a FACT: This is still a breach of settings and seek to separate patient’s right to disclose personal confidentiality. personal and professional infor- information about themselves and the mation online; need for healthcare providers not to MYTH: It is acceptable to discuss • should bring content that could harm reveal or share client information with- or refer to patients if they are not a patient’s privacy, rights, or welfare out a care-related need for the disclosure. identified by name, but referred to to the attention of appropriate The NCSBN has summarized the by a nickname, room number, authorities; and, following list of common myths and diagnosis or condition. • should participate in developing misunderstandings of Social Media to FACT: This, too, is a breach of institutional policies governing heighten awareness of risk related to confidentiality and demonstrates online conduct. false beliefs (NCSBN, 2011). disrespect for patient privacy. (American Nurses Association, 2017)

URSING 8 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... Consequences for Nurses to highlight risky situations that could comments. An anonymous call reported Whether intentional or unintentional, be avoided. the incident to hospital administration. the potential consequences for the The nurses admitted that they had nurse’s inappropriate use of electronic Public Debriefing indeed taken photos of the x-ray but social media and networking can be A nurse takes a picture of a patient denied that it was posted to social severe. The consequences are variable room and posts it on a popular social media. The nurses’ employment was and dependent on the specific details media site along with a detailed account terminated by the hospital. The nurse of each incident or event. NCSBN of his workday experiences caring for a accused of posting the photo removed (Spector, Kappel, 2012) reports that a challenging patient. The hospital room her account from the internet site. Board of Nursing (BON) may investi- includes soiled linens with the hospital Police were not able to acquire enough gate the nurse if a reported event or logo clearly visible, several personal evidence to prove a violation of state incident includes: patient items, and papers with printed law. However, the case has been referred • Unprofessional conduct; type on a bedside table. The nurse’s to federal authority to investigate for • Unethical conduct; account of the day is posted under federal law violations; specifically, • Moral turpitude (a malicious way the photo and includes the patient’s HIPAA and patient rights violation of behaving); diagnosis and prognosis along with (WISN-TV, ABC Milwaukee, 2009). • Management of patient records; descriptions of an incontinence event Intentional or unintentional • Revealing a privileged communi- and subsequent bathing. The photo was breaches of patient confidentiality cation; and, noticed by a friend of the patient due to and private health information is a • Breach of confidentiality. the personal items on the bedside table. violation of Federal HIPAA regulations. If the NCBON finds the allegations They were able to enlarge the photo and If the information provides enough to be true, the nurse may receive identify the patient’s name on the papers detail or could be used to identify an disciplinary action. Disciplinary actions on the bedside table. A complaint was individual, HIPAA rule is violated. by the BON can range from a letter made to the healthcare agency regard- HIPAA rules outline how protected of concern, to a reprimand, or up to ing the breach of confidentiality and information should be collected, sanctions that result in loss of licensure disclosure of personal health informa- used, and provides detailed guidance privileges. Additionally, if employment tion. In addition, the comments regarding handling of any information policy and/or regulations are not followed, regarding the incontinence event were that relates to past, present or future the employer may take disciplinary action considered humiliating and demeaning. physical or mental health information or termination. In March 2012, the The nurse was identified by the health- (Thacker, 2003). NCSBN conducted a survey of execu- care agency and terminated immedi- tive officers and of the 30 respondents, ately. Further, the nurse’s actions were Conclusion 63% reported that they had received reported to the Board of Nursing. As technology evolves and expands, complaints against nurses for inappropri- After an investigation by the Board nurses and the public will need to ate use of social media. Of the 63% who of Nursing, the Board found that the remain diligent in accessing and using reported complaints, 64% reported that nurse had violated the confidentiality information retrieved and communi- they had disciplined the nurses (Spector, requirements of the Nursing Practice cated via the internet. Educating Kappel, 2012). In addition to violation Act. The nurse received a disciplinary patients about the reliability and use of the Nurse Practice Act for failing to action that will be permanently noted of healthcare information located on maintain patient confidentiality and on their nurse license records. the internet will contribute to limit- safety, the nurse who discloses confiden- ing opportunity for misinterpretation. tial or personal health information may Photographic Disclosure It is essential that nurses follow policy be subject to prosecution by state and/or Two nurses working in an emergency and procedure when interacting with federal law enforcement. room used their cell phones to take a and contributing to personal health picture of an x-ray from a patient with a information records. Always remember, Illustrative Stories: foreign body lodged in the rectum. One if you post images or comments in an The following illustrative stories of the nurses then posted the picture online media site, they can be viewed (based on actual cases) are intended on her personal social media page with by the public.

...... 9 References Center Internet and Technology: Retrieved September 2017, from 1. American Nurses Association. (2017). http://www.pewinternet.org/fact- http://www.wisn.com/article/ Socal Networking Principles Toolkit. sheet/social-media/ nurses-fired-over-cell-phone-photos- Retrieved August 2017 , from ANA: 10. Spector, N., Kappel, D. (2012, of-patient/6291966 http://nursingworld.org/Functional September). Guidelines for Using MenuCategories/AboutANA/ Electronic and Social Media: The Additional Resources Social-Media/Social-Networking- Regulatory Perspective. Retrieved 16. American College of Healthcare Principles-Toolkit August 2017, from The Online Executives. (2016, November). 2. Borten, K. (2016, August). The Role Journal of Issues in Nursing: http:// Health Information Confidentiality. of Nurses in HIPAA Compliance, www.nursingworld.org/MainMenu Retrieved 2017, from ACHE: https:// Healthcare Security. Health IT Categories/ANAMarketplace/ANA www.ache.org/policy/hiconf.cfm Security Newsletter. Retrieved Periodicals/OJIN/TableofContents/ 17. Barry, M. (2017, September). Social August 2017, from https://health Vol-17-2012/No3-Sept-2012/ Media: Proceed with caution. (A. N. itsecurity.com/ Guidelines-for-Electronic-and- Association, Ed.) Retrieved Septem- 3. Computer History Museum. (2017). Social-Media.html ber 2017, from The American Nurse: Timeline of Computer History. 11. Thacker, S. (2003, April). HIPAA http://www.theamericannurse.org/ Retrieved from Computer History: Privacy Rule and Public Health: 2014/01/02/social-media-proceed- http://www.computerhistory.org/ Guidance from CDC and US Depart- with-caution/ timeline/computers/ ment of Health and Human Servies. 18. Health Information Technology. 4. Merriam-Webster. (2017). Medical Retrieved August 2017, from CDC (2014, October). Health Information Dictionary. Retrieved from Merriam- MMWR Epidemiology Program Office: Privacy Law and Policy. Retrieved Webster: https://www.merriam- https://www.cdc.gov/mmwr/preview/ August 2017, from Patient Consent webster.com/dictionary/informatics mmwrhtml/m2e411a1.htm for eHIE: https://www.healthit.gov/ 5. National Council of State Boards of 12. The Advisory Board Company. providers-professionals/patient- Nursing. (2011). A Nurse’s Guide to (2017, January). Nursing is America’s consent-electronic-health-information- the Use of Social Media. Retrieved most trusted profession yet again, exchange/health-information-privacy- August 2017, from NCSBN: https:// Gallup finds. Retrieved August law-policy www.ncsbn.org/3739.htm 2017, from The Advisory Board 19. Independence Hall Association. 6. National Council of State Boards of Daily Briefing: https://www.advisory. (2017). 60 d. Living in the Informa- Nursing. (2011, December). A Nurse’s com/daily-briefing/2017/01/03/ tion Age. Retrieved 2017, from US Guide to Use of Social Media. nurse-trusted-profession History: Pre-Columbian to the New Retrieved May 2017, from NCSBN: 13. US Department of Health and Millenium: http://www.ushistory. https://www.ncsbn.org/NCSBN_ Human Services. (n.d.). Reassessing org/us/60d.asp SocialMedia.pdf Your Security Practices in a Health 20. National Council of State Boards of 7. NCSBN. (2011, November). A IT Environment. Retrieved August Nursing Regulator Staff. (2015, Nurse’s Guide to the Use of Social 2017, from US Department of January). The 2015 Regulatory Media. Retrieved August 2017 , Health and Human Services: https:// Environment: Execultive Summary. from https://www.ncsbn.org/ www.hhs.gov/sites/default/files/ Journal of Nursing Regulation, 5(4), NCSBN_SocialMedia.pdf small-practice-security-guide-1.pdf 39-48. doi:http://dx.doi.org/10.1016/ 8. Pew Research Center. (2017). 14. Weaver, J. (2017, July). More people S2155-8256(15)30039-9 Internet/Broadband Fact Sheet. search for health online. Retrieved 21. North Carolina Office of Adminis- Retrieved August 2017, from Pew August 2017, from Telemedicine on trative Hearings. (2017, June). 21 Research Center Internet and Tech- NBC News: http://www.nbcnews.com/ NCAC 36.0217 Investigations; nology: http://www.pewinternet.org/ id/3077086/t/more-people-search- Disciplinary Hearings. Retrieved fact-sheet/internet-broadband/ health-online#.Wbp35rpFxaQ August 2017 , from NCAC Rules: 9. Pew Research Center. (2017, January). 15. WISN-TV, ABC Milwaukee. (2009, http://reports.oah.state.nc.us/ncac/ Social Media Fact Sheet. Retrieved February 26). Nurses Fired Over title%2021%20-%20occupational August 2017, from Pew Research Cell Phone Photos of Patient. %20licensing%20boards%20and

10 NURSING BULLETIN ...... %20commissions/chapter%2036% 23. Tillman, C. (2013, Fall). Social 2017, from Health Information 20-%20nursing/21%20ncac%20 Networking and Nurses, Archived Privacy: https://www.hhs.gov/hipaa/ 36%20.0217.pdf Nursing Bulletins. Retrieved May for-professionals/breach-notification/ 22. Office for Civil Rights. (2013, July). 2017, from NC Board of Nursing: index.html HHS.gov: Summary of the HIPAA http://www.ncbon.com/dcp/i/news- 25. US Department of Health and Human Security Rule. Retrieved August resources-publications-archived- Services. (2017, June). HIPAA for 2017, from Health Information nursing-bulletins Professionals. Retrieved 2017 Privacy: https://www.hhs.gov/hipaa/ 24. US Department of Health and August, from Health Information for-professionals/security/laws- Human Services. (2013, July). Breach Privacy: https://www.hhs.gov/hipaa/ regulations/index.html Notification Rule. Retrieved August for-professionals/index.html

EARN CE CREDIT “But all I did was share a photo of my patient’s wound with one friend—you couldn’t even see his face! … What Nurses Need to Know about Informatics, Social Media, and Security!” (1.9 CHs)

Read the article and the Chapter 36 (consolidated) Admin- Offerings,” scroll down to the link, “What Nurses Need to istrative Code Rules which guide the work of the NCBON and Know about Informatics, Social Media, and Security!” reflect on the following situations for reflection. Chapter 36 Register, be sure to write down your confirmation number, (consolidated) is located at http://reports.oah.state.nc.us/ncac/ complete and submit the evaluation, and print your certificate title%2021%20-%20occupational%20licensing%20boards%20 immediately. and%20commissions/chapter%2036%20-%20nursing/chap- If you experience issues with printing your CE certificate, ter%2036%20rules.pdf. please email [email protected]. In the email, please provide your full name and the name of the CE offering (What Nurses SITUATIONS FOR REFLECTION Need to Know about Informatics, Social Media, and Security!). 1. The mother of a pediatric patient has asked the nurse to Registration deadline is 7-01-2018. snap a photo and post it to the internet so that she can download it when she gets home. What is the best response PROVIDER ACCREDITATION or action for the nurse in this situation? If the nurse com- The North Carolina Board of Nursing will award 1.9 plies with the request, what are the potential consequences contact hours for this continuing nursing education activity. with regard to NC law and rules? The North Carolina Board of Nursing is an approved 2. The nurse keeps an online personal journal/blog. After one provider of continuing nursing education by the North especially rough shift, the nurse decides to debrief in the Carolina Nurses Association, an accredited approver by the blog. As long as there is no mention of patient name or American Nurses Credentialing Center’s Commission on identification, is it ok to write about the challenges of the Accreditation. day that one experienced at work? If the information is posted to the internet, are there potential consequences NCBON CNE CONTACT HOUR ACTIVITY with regard to NC law and rules? DISCLOSURE STATEMENT 3. A patient and nurse have developed a close relationship The following disclosure applies to the NCBON continu- during a long recovery period. The patient asks the nurse to ing nursing education article entitled “What Nurses Need to be a “friend” on a social media site. This would make it pos- Know about Informatics, Social Media, and Security!” sible for them to talk when the nurse is not on duty and share Participants must read the CE article and additional photos. What is the best response or action for the nurse in reading(s) listed (if applicable) in order to be awarded CNE this situation? What are the implications for the nurse should contact hours. Verification of participation will be noted by they choose to engage in an off-duty internet relationship? online registration. No financial relationships or commercial There is not a test requirement, although reading for com- support have been disclosed by planners or writers which prehension and self-assessment of knowledge is encouraged. would influence the planning of learning outcomes and content of the article. There is no endorsement of any product RECEIVE CONTACT HOUR CERTIFICATE by NCNA or ANCC associated with the article. No article Go to www.ncbon.com and scroll over “Education;” under information relates to products governed by the Food and “Continuing Education” select “Board Sponsored Bulletin Drug Administration.

11 Substance Use Disorder Timely Information for Your Practice

Bobby Lowery, Ph.D, MN, FNP-BC, FAANP, FANAI; Kathleen Privette RN, MSN, NEA-BC, FRE; North Carolina Board of Nursing

The North Carolina Board of Nursing (NCBON) has a long history of nursing leadership as the ﬁrst Board of Nursing in the nation, established in 1903 to protect the public through the regulation of nursing practice in all settings. (Toney, 2013). The NCBON is empowered to administer the State of North Carolina Nursing Practice Act (NPA) and its regulations and to issue its interpretations of this Act. (G.S. 90, Article 9A). Licensed nurses practice in a variety of settings where pain management involving the use of opioid and other pain management strategies are Substance Use Disorder (SUD) NCBON, 2017b). Optimal utilization utilized to manage pain in the delivery occurs when the recurrent use of alcohol of the knowledge and skills of every of nursing care (NCBON, 2014). and/or drugs causes clinically and sector of the healthcare workforce is This recurring column will inform functionally signiﬁcant impairment, essential to impact this deadly trend. nurses about the latest regulatory and such as health problems, disability, and Nurses are key leaders, comprising the practice updates on SUD and opioid man- failure to meet major responsibilities largest segment of the healthcare work- agement, emerging trends, management at work, school, or home (SAMHSA, force (U.S. Department of Health and recommendations and evidence-based 2015). The National Institute on Drug Human Services, Health Resources and resources available to address these issues. Abuse reported that the abuse of tobacco, Services Administration, National Center A series of informative columns will alcohol, and illicit drugs is costly to our for Health Workforce Analysis, 2014). address topics relevant to all nurses on Nation, exacting more than $740 billion Nursing leadership is essential to the optimal issues related to pain management both annually as noted in Table 1 (National Interprofessional management of pain, through the administration of prescribed Institute on Drug Abuse, 2017). North SUD and impacting the opioid epidemic. or ordered medications and through Carolina has four of the top 25 cities with the highest incidence of Opioid abuse in the country. Additionally, drug Table 1: Economic Burden of Substance Use (National Institute on Drug Abuse, 2017) poisoning has overtaken motor vehicle accidents as the number one cause of Healthcare Overall Year Estimate death in 2012, as noted in Table 2 Based On (Proescholdbell, 2017). The data on Tobacco $168 Billion $300 Billion 2010 SUD, including opioid abuse transcends Alcohol $27 Billion $249 Billion 2010 racial, geographic and social boundaries, Illicit Drugs impacting nurses and other professionals $11 Billion $193 Billion 2007 at rates mirroring the general public Prescription Opioids $26 Billion $78.5 Billion 2013

URSING 12 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... Table 2: Death Rates for Three Selected Causes of Death (Proescholdbell, 2017)

use of non-pharmaceutical approaches. • Strengthen Opioid Misuse Prevention of-care-for-opioid-prescribing ) The following resources on opioid (STOP ACT) External resources on Opioid prescribing and pain management may • FAQ - Controlled Substance Safety/SUD: be found under the Advanced Practice • Pre-authorization for Medicaid • National Council of State Boards of Registered Nurse link on the NCBON web- Opioid Prescriptions Nursing Opioid Tool Kit (https:// site at www.ncbon.com (NCBON, 2017a). • Opioid Treatment Programs (http:// www.ncsbn.org/opioid-toolkit.htm). • 21 NCAC 36 .0809 - Prescribing www.ncbon.com/vDownloads/ • Community Care of North Carolina Authority Position-Statements-Decision-Trees/ Opioid Safety (https://www. • DEA Online Renewal Application opioid-treatment-programs.pdf ) communitycarenc.org/population- Update • Standards of Care for Opioid Pre- management/opioid-safety/) • Controlled Substances Reporting scribing: What Every Advanced • Pathways to Safer Opioid Use System (CSRS) Practice Registered Nurse Prescriber (https://health.gov/hcq/training- • Policy for the Use of Opiates for the and Investigator Need to Know (http:// pathways.asp) Treatment of Pain (Updated, 3/29/2017) www.ncbon.com/practice-advanced- • This web-based training allows • Pain Management in End-of-Life Care practice-registered-nurse-standards- you to assume the role of 4

...... 13 playable characters who make programs. Retrieved from http:// SG1QRVU/view decisions—controlled by you— www.ncbon.com/practice-position- 6. SAMHSA. (2015). Substance use dis- about preventing opioid-related statements-decisions-trees orders. Retrieved from https://www. adverse drug events (ADEs). The 3. NCBON. (2017a). Controlled samhsa.gov/disorders/substance-use characters represent the following substance prescribing information. 7. Toney, S. (2013). The advanced roles: primary care physician, Retrieved from http://www.ncbon. practice registered nurse and transi- nurse, pharmacist, and patient. com/practice-advanced-practice- tions: Expanding the role of nursing. • Educational opportunities for registered-nurse-controlled- First in nursing. A journey of regula- meeting the requirements to apply for substance-prescribing-information tory excellence: The North Carolina a medication-assisted therapy waiver 4. NCBON. (2017b). Manager Hand- board of nursing 1903-2013 (pp. • SAMHSA for a Medication book: Resource for nurse administrators 68-71) NC Board of Nursing. Assisted Therapy waiver employing nurses participating in 8. U.S. Department of Health and • The Society of Addiction Medicine drug monitoring programs with the Human Services, Health Resources • American Association of Nurse North Carolina board of nursing. and Services Administration, Practitioners Retrieved from http://www.ncbon. National Center for Health Work- com/discipline-compliance-drug- force Analysis. (2014). The future of References monitoring-forms-manager-handbook the nursing workforce: National- and 1. National Institute on Drug Abuse. 5. Proescholdbell, S. (2017). Medica- state-level projections, 2012-2025. (). (2017). Trends & statistics. Retrieved tion and drug overdoses in North Rockville, MD: DHHS. Retrieved from https://www.drugabuse.gov/ Carolina: Data update. Retrieved from https://bhw.hrsa.gov/sites/ related-topics/trends-statistics from https://drive.google.com/ﬁle/ default/ﬁles/bhw/nchwa/projections/ 2. NCBON. (2014). Opioid treatment d/0B9NAvIvnEGfGTlRIMTNZ nursingprojections.pdf

Updated Legislation Provides Benefit to Active Duty Military & Spouses

The North Carolina BoardB of NurNursing announces waived request the Northorth Carolina Board of Nursing issue a non- initial licensing fees to all activetive dutduty military and their renewable temporary license (TL) valid for up to six months. spouses, who are registered or licenslicensed practical/vocational If eligible, this process usually takes 2 to 3 weeks. The TL nurses. The standard Endorsementsement application fee of $150.00 allows the applicant to begin employment while awaiting will be waived for all initiall applicaapplications of those active duty processing of additional required documents, to include members and spouses who have or/aor/are planning to relocate to criminal background results. North Carolina. Please keep in mind, if you are planning to practice nursing In June 2017, G.S. 93B-15.1(k)5.1(k) wawas signed into law stating; anywhere other than in a federal facility in North Carolina, “an occupational licensing boardoard shall not charge a military- you are required to have a North Carolina nursing license trained applicant or a military spouse an initial application fee OR a compact licenselice which allows you to practice on your for a license, certiﬁcation, registration,ration, or tetemporary practice privilege underder theth Nurse Licensure Compact agreement. permit issued pursuant to this section…on…” However,er, advancedadvanc practice registered nurses (APRN) are All licensure requirements must be met prior to NC issuing not covered underu the compact and are required to apply for a permanent license, to include the completionon of a criminalcrim approvalapprov to practice prior to practicing in North Carolina. background check. The applicant will be responsible for the cost For more guidance on APRN approval to practice or any of the criminal background check. Additionally, the nurse can licensure information visit www.ncbon.com.

URSING 14 NURSINGG N O RTH C AROLINA BULLETINN {Official Publication of the Board of Nursing } ...... NCBON Staff Nationally & Regionally Recognized

Congratulations to the following North Carolina Board of Nursing staff members!

Linda Burhans, Associate Execu- Crystal Tillman, Director Education Jennifer Lewis, Education & tive Ofﬁcer, was awarded the & Practice, completed the NCSBN Practice Consultant, was awarded Meritorious Service Award — an Institute of Regulatory Excellence the Overall Excellence Award in award granted to a member of (IRE) program and was awarded Nursing Research at the North National Council State Boards of Fellow status. Carolina Organization of Nurse Nursing (NCSBN) for signiﬁcant Leaders Annual Conference — contributions to the mission and May 11, 2017. vision of NCSBN — a prestigious honor indeed!

NORTH CAROLINA BOARD OF NURSING CALENDAR

Board Meeting: Hearing Committee: January 19, 2018 October 21, 2017; January 25, 2018 Administrative Hearings: November 30, 2017; Licensure Review Panel: February 22, 2018 November 9, 2017; December 14, 2017; Education/Practice Committee: January 11, 2018; November 29, 2017 February 8, 2018

...... 15 The Enhanced Nurse Licensure Compact (eNLC) Unlocking Access to Nursing Care Across the Nation

A new era of nursing licensure was ushered in on July 20, 2017, when Governor Roy Cooper signed enhanced Nurse Licensure Compact (eNLC) legislation into law, making North Carolina the 26th state necessary for eNLC enactment. The Interstate Commission

ID WY

HAWAII UT CO

AZ NM

GUAM

MARIANA ISLANDS (MP) AMERICAN SAMOA (AS)

URSING 16 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... of Nurse Licensure Compact Administrators, the governing license are required to meet the same licensing require- body of the eNLC, set the date of January 19, 2018, for ments, which include federal and state criminal back- eNLC implementation. ground checks. On Jan. 19, 2018, nurses with eNLC multistate licenses So What Does This Mean For You? may begin practicing in the 26 eNLC states, listed below. The eNLC, which is an updated version of the original In original NLC states that have enacted eNLC legislation Nurse Licensure Compact (NLC), allows for registered like North Carolina, a nurse who holds a multistate license nurses (RNs) and licensed practical/vocational nurses on or before July 20, 2017, will be grandfathered into the (LPN/VNs) to have one multi-state license, with the ability eNLC and will be able to practice in other eNLC states to practice in person or via telehealth in both their home beginning on the implementation date. You do not need state and other eNLC states. All applicants for a multistate to take any action unless you move to another state. If you do move to another state that is a member of the eNLC, you will need to apply for licensure and meet the Uniform

ND ME SD WI NH IA NE RI MO WV DE KY VA MD OK TN NC AR DC SC MS GA TX VIRGIN ISLANDS

eNLC States FL NLC States

...... 17 Licensure Requirements (ULRs) in A nurse residing in a state that is new Florida, Georgia, Idaho, Iowa, Kentucky, order to obtain a multistate license. to the eNLC will be able to practice in Maine, Maryland, Mississippi, Missouri, Likewise, all nurses applying for licen- other eNLC states contingent upon Montana, Nebraska, New Hampshire, sure and declaring North Carolina their that board of nursing issuing the nurse North Carolina, North Dakota, home state will need to meet the ULRs. a multistate license. Oklahoma, South Carolina, South The ULRs may be found at https:// The current states in the eNLC Dakota, Tennessee, Texas, Utah, www.ncsbn.org/eNLC-ULRs_082917.pdf include: Arizona, Arkansas, Delaware, Virginia, West Virginia and Wyoming. Work will continue toward the ulti- mate goal of having all 50 states in the compact. Additionally, beginning January 19, 2018, a nurse with a multistate North Carolina license will no longer have multistate privileges in Colorado, New Mexico, Rhode Island and Wiscon- sin. Also, if you are a North Carolina licensee who was issued a single state license, or if you have any stipulation on your license which limits your practice to North Carolina only, you will not be eligible for a multistate license or multistate licensure privileges. You must keep in mind that your nursing practice takes place where the patient is located. If the patient is located in another state, you need to be licensed to practice in that state. A multistate license helps to facilitate that, but you must still adhere to the laws and regulations of the state in which you are practicing, whether that be in person or via telehealth. The practice of nursing is not limited to patient care and does include all nursing practice, as deﬁned by state practice laws of the state in which the patient/client is located. If you need to practice in a state that is not a member of the eNLC, you will need a single-state license, issued from that state regardless of whether you hold a multistate license. Additional information about the eNLC can be found at https://www. ncsbn.org/enhanced-nlc-implementation.htm or www.nursecompact.com. For the latest information, follow the eNLC on Twitter or Facebook.

URSING 18 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... 19 Role of the Registered Nurse in North Carolina... Is It Limited?

• Why doesn’t the Board increase the scope of practice for the RN? • Why is the scope of practice for RNs in NC so limited? • Why can’t RNs in NC do …?

The North Carolina Board of Nursing (NCBON) frequently receives questions like these from nurses, managers, administrators, and nurse educators from across the state. These individuals may not be aware that the NC Registered the Position Statements explain nursing dependent and directed. LPN practice Nurse (RN) scope of practice is actually role and responsibility issues about requires assignment or delegation by and very broadly defined and already allows which the NCBON receives many performance under the supervision, RNs to practice to the full scope of their questions. Reading these position orders, or directions of an RN, physi- educational preparation, experience, and statements and the related rules together cian, dentist, or other person authorized competence. Many of the limitations provides detail helpful to RNs, LPNs, by State law to provide LPN supervision. addressed in questions such as these are employers, and educators. RN Practice encompasses the full based on misperceptions of NC nursing Basic RN education prepares nurses scope of nursing and includes caring for laws and rules; other more restrictive laws as generalists with basic competencies to all clients in all settings. Specific work and rules governing entities other than deliver nursing care. Throughout each responsibilities will vary from one RN to the NCBON; or employing agency nurse’s career increased competencies the next. An RN’s duties and title are policies that are more restrictive than are achieved through further education, often determined by their work setting laws and rules. The purpose of this article experience, and certifications. The nurse or patient population served. The RN is to clarify the practice potential and considering accepting a specific assign- scope of practice in all steps of the breadth of RN scope of practice in NC. ment or responsibility is responsible nursing process is independent and The Nursing Practice Act (Law), for assuring that he/she possesses the comprehensive. RN practice does not G.S. 90-171.20(7) and North Carolina appropriate knowledge, skill, ability, require assignment or supervision by Administrative Code (Rules), 21 and validated competence to accept a higher-level health care provider. NCAC 36.0224 govern RN practice in that assignment or responsibility. An RN scope of practice is not defined by North Carolina. These documents are assignment or activity may well be specific activities or tasks but rather accessible on the NCBON website at within RN scope of practice but an by the professional, competent use of www.ncbon.com under the laws and individual nurse may not be prepared the nursing process in delivering safe, rules tab. At the practice tab on this and competent to accept an assignment effective nursing care and services in same website, you are able to locate RN or perform an activity without prior dynamic and evolving practice settings. and Licensed Practical Nurse (LPN) education and competence validation. The practice of nursing is constantly Scope of Practice Position Statements. This article does not address LPN evolving as new and changing technol- While the RN and LPN legally-defined scope of practice in detail. LPN practice ogy and therapies are introduced. The scopes of practice apply at all times, is more limited and focused. LPN scope NC Nursing Practice Act and Rules regardless of specific practice setting, of practice, in contrast to RN scope, is allow for this ongoing evolution.

URSING 20 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... • Example A: Originally, only • Example B: Hospital ABC, due to procedures and pharmaceutical agents physicians were able to measure liability concerns, has established a to any and all clients presenting for blood pressure using a mercury policy that only a select group of 10 treatment even if they have not been manometer or sphygmomanometer. specially-trained RNs are approved evaluated by the physician. The • Evolution of Example A: Most to administer certain chemothera- physician tells the nurse that he/she blood pressure measurement is now peutic drugs. The other hospital had no liability because he/she is done with electronic devices. A wide nurses believe this activity is no administering medications and range of licensed and unlicensed longer within their scope of practice. treatments under delegation of the personnel are able to perform this • Reality of Example B: Administration physician who retains all responsibility. measurement. Licensed health care of these medications is still within scope • Legal Realities of Example C: professionals remain responsible and of practice for all other RNs employed Medical diagnosis and treatment is accountable for the interpretation of by Hospital ABC (if educated and beyond the RN’s scope of practice. those measurements. It is currently competent). Only their practice in this Medical diagnosis and treatment is common practice for RNs in critical specific hospital is limited or restricted restricted by law to physicians, nurse care units to measure arterial and by this policy. If hired by another hos- practitioners, and physician assistants. venous pressures through indwelling pital, administration of chemotherapy The NC Medical Board requires that catheters with the use of complex might be an expectation of all RNs. clients be evaluated by a physician, equipment. The evolution in levels • Example C: An RN is employed by a nurse practitioner, or physician of responsibility is clear. physician in a Medi-Spa. The physician assistant prior to the administration RN Components of Practice defined “authorizes” the RN to determine the of cosmetic procedures. Once the in nursing law and rules include: accept- need for, and to administer per the RNs client is medically assessed and ing an assignment; assessment; planning; own assessment, a variety of cosmetic diagnosed, it is within the RN scope implementation; evaluation; collaboration; reporting and recording client status and data; teaching and counseling clients; supervising, teaching, and evaluating those who perform nursing functions; and accepting responsibility for self for individual nursing actions, competence, and behavior. The appropriate and effective RN assignment of nursing care to other RNs and LPNs and the delegation of nursing activities to Unlicensed Assistive Personnel (UAP) is an essential element in assuring safe client care. The RN, while considering the input of LPNs, UAP, and others involved in the care of the client, main- tains overall responsibility for all aspects of client nursing care delivery at all times. Each agency/employer is responsible for developing policies/procedures/standards of practice and ensuring competency of the nursing staff. An agency or employer, including authorized licensed health care providers, may restrict but never expand the nurse’s practice beyond the legal scope as defined in law and rules.

...... 21 of practice to implement those providing nursing care. The RN admin- under which the nurse may act to carry cosmetic procedures for which she/he isters nursing services through the out specific orders for a client or client is educated and competent according identification, development, and updating population presenting with symptoms or to patient specific orders and/or of standards, policies, and procedures needs addressed in the standing orders. standing orders. In addition, physi- related to the delivery of nursing care; They outline the assessment and inter- cian delegation cannot ever expand implementation of the identified standards, ventions that a licensed nurse may perform RN (or LPN) scope of practice nor policies, and procedures to promote safe or deliver. While it is not within the alleviate liability of licensed person- and effective nursing care for clients; nurse’s scope of practice to make a medical nel. Licensed nurses are fully respon- and planning for and evaluation of the diagnosis, identify medical problems, sible and accountable for their own nursing care delivery system. develop medical treatment plans, or actions and this cannot be transferred Standing Orders are a valuable tool declare someone “free” of illness, the to a delegating person in any situation. in supporting the broad scope of RN nurse can provide assessment and imple- RN Components of Practice also practice. Standing orders allow for the ment standing orders to facilitate client include nursing management and admin- facilitation of timely interventions and care. (See details in Standing Orders istration. The RN manages the delivery the removal of barriers to care for various Position Statement at www.ncbon.com) of nursing care through the on-going patient populations in both outpatient • Example D: The physicians, nurse supervision, teaching, and evaluation and inpatient settings. Standing orders practitioners, and physician assistants of nursing personnel and through the are the signed instructions of a provider in an outpatient setting are over- direct observation and care of clients authorized by state law to prescribe/order whelmed with the sheer volume of and the evaluation of nursing care given. a medical treatment and/or pharmaceu- clients presenting for care. The wait- Only the RN may validate the compe- tical regimen. Standing orders describe ing list for appointments has grown to tency of licensed and unlicensed staff the parameters of specified situations unmanageable levels and clients are

URSING 22 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... waiting for 8 weeks for an appointment or are being referred to urgent care settings resulting in decreased continuity of care, client satisfaction and revenue loss for the practice. • Potential Solution for Example D: Implement an RN-staffed assessment center within the practice! The RN scope of practice enables the RN to: perform a history and physical; triage the need for immediate care; determine need for timely referral to provider; prioritize waiting list place- ment in collaboration with schedul- ing staff; implement standing orders for indicated laboratory studies and x-ray examinations; review test results and report to provider; and implement other medical treatment/pharmaceutical regimen as indicated by standing orders. This will improve the care of clients in need of immediate care or referral, increase client satisfaction, improve ofﬁce ﬂow, and retain practice revenue.

What if I am not sure about my scope of practice in a specific situation? Under NC Law and Rules, the NCBON defines and interprets scopes of practice for all levels of providers of nursing care. That legally-defined scope remains unchanged regardless of setting. If you are unsure, take the following steps: 1. Review the Position Statements available on the Board website as noted below under resources. These provide guidance for nurses faced with issues of frequent concern. 2. If not addressed in a Position State- ment, use the NCBON Scope of Practice Decision Tree for the RN and LPN also available on the Board website. This decision tree walks you through each step required to determine if a specific activity is within your scope. 3. If still unsure, NCBON Education- Practice Consultants are available to respond to or clarify your concerns

...... 23 at [email protected] or at licensing laws and rules) are the reasons the RN and LPN 919-782-3211 extension 242. for some limitations. It is also possible • RN Scope of Practice – Clarification: that a limitation is perceived but not real. Position Statement for RN Practice So, let’s re-examine the questions posed • LPN Scope of Practice – Clarification: at the beginning of this article in light of Why can’t RNs in NC do …? Position Statement for LPN Practice the information you have acquired: It is likely that, given the appropriate • RN and LPN Scope of Practice Com- education, competence validation, and ponents of Nursing Comparison Chart Why doesn’t the Board increase the employer policies, the RN in NC IS able • Decision Tree for Delegation to UAP scope of practice for the RN? to do… unless otherwise prohibited by law • Delegation and Assignment of The RN scope of practice in NC is very or employer policy. The NCBON Scope Nursing Activities broadly defined. It already allows RNs to of Practice Decision Tree for the RN • Delegation of Medication Adminis- practice to the full scope of their educational and LPN provides the needed guidance tration to UAP preparation, experience, and competence. to change “can’t” to “can” in most cases. Available at www.ncbon.com—select Why is the scope of practice for RNs NCBON Resources Law & Rules tab—select Nursing Prac- in NC so limited? Available at www.ncbon.com—select tice Act and Administrative Code (Rules): The RN scope of practice in NC is Practice tab—select Position Statements • Nursing Practice Act (NPA) - G.S. not limited—it is defined as being & Decision Trees: 90-171.20(7) – Law governing RN independent and comprehensive. It is • Accepting Assignments Scope of Practice possible that, in some cases, employer • History and Physical Examination • Administrative Code (NCAC) - 21 policies or laws other than nursing laws • Standing Orders NCAC 36.0224 – Rules Governing (such as other occupational or facility • Scope of Practice Decision Tree for RN Scope of Practice

URSING 24 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... NURSING OPPORTUNITIES!

Dosher Memorial places high value on the role of nursing. We have the following openings:

• Clinical Informatics Nurse RN with EHR experience required, FT

• Patient Care Unit RN 36 hours Night & PRN positions available

• Emergency Department RN 36 hours Midday and Night night positions

To view detailed position descriptions and apply, visit www.dosher.org and select “CAREERS” at the top of page. You may also contact: [email protected] or (910) 457-3801 Human Resources 924 N. Howe St. Southport, NC 28461 EEO

...... 25 NCBON Nurse Gateway— Update Your Information

Are you and your nursingnursi colleaguesolleague via “snail” mail postcard and is receiving emails and “snail”“sna mail diredirectly also sent electronically to your emailil from the NCBON? address on file. If not, the NCBON NURSERSE GAGATE- • Nurse Member Election— WAY is your key! Annually, voting information and The NC Board of Nursingng commcommuni- reminders are sent via email to cates directly with licensees,, using vavarious facilitate your participation in methods and for a variety off reasons: electing RN and LPN Board Members. • Nursing Bulletinn—The NNursing • Other Announcements—Special Bulletin is mailed to your phyhysical and urgent Board announcements address on file 3 times a year. MissedM are frequently sent via email. an issue? Both current and backk If you are not receiving these com-com issues are available on the Board munications, your address and e-mail as it changes. It is important to note website at www.ncbon.com. information on the Nurse GatewayGatew that using your employment email • License Renewal—Your biennial may be outdated.ddIi It is each nurse’s legal address frequently results in blocked license renewal reminder is sent responsibility to update this information NCBON emails, therefore causing Board notifications to not reach you. Please use your home address and personal email address on the Gateway to ensure that Board communications reach you directly. The NCBON Nurse Gateway provides all Nurses and Nurse Aide II’s an interactive portal to manage licenses and listings; allows access to printable documents; change of address forms; and many more features. The Nurse Gateway is used to submit all license and listing applications including Advance Practice approvals and registrations. Accessing the Nurse Gateway is easy! At www.ncbon.com, simply select “LOG IN” on the homepage GATEWAY icon to access your portal. Select “Learn More” to discover what your portal gives you access to. If you or your colleagues are not receiving NCBON communications; have moved; or have changed your phone number or email address, log onto the Nurse Gateway NOW and update all of your contact information, including your current personal “snail” mail and email addresses!

URSING 26 NURSING N O RTH C AROLIN A BULLETIN { Official Publication of the Board of Nursing } ...... Tribute to Duke Life Flight Team

Our condolences go outou too the DuDuke Health Team, friends, the gloomiest days, that she believed in everyone, and that and family for the tragic losss of nursnurses Kris Harrison, RN, she is the reason many new team members felt welcome. Flight Nurse, Crystal Sollinger,ger, RNRN, Flight Nurse, Jeff Burke, Kris started with Duke Life Flight in 1999, after his service at Pilot, and patient, Mary Bartlettrtlett dudue to a helicopter crash on WakeMed. His colleagues knew him as a “doer”—interested September 8th. in everything, and an avid sportsman who enjoyed hunting, As nurses, Kris and Crystaltal devotdevoted their careers to helping fishing and football. He was an amazing father and husband others, accompanying and caring for critically ill patients and was looked to by his family and community. Kris and from several states, on their journey to lifesaving treatments Crystal will be remembered as exemplary nurses who per- at Duke. Even as they put themselvesmselves at risk every day, our sonified Duke Health’sHea values and who leave behind lasting nurses never hesitated to enter unknown ssituations and use legacies of caring.ring. Crystal is survived by her husband. Kris is their skills, experience and multiplele professionprofessional certifications survived by his wifewi and two daughters. to bring comfort and healing to those in need. Duke Life FlightFli is a CAMTS accredited Critical Care Crystal started at Duke University Hospitalpital in the CCU in and EmergencyEmerg Air and Ground transport agency in 1992, and transferred to Duke Life Flight in 2001. Colleaguesll Durham, NC, providing services to North Carolina and have said that her beautiful smile showed through even on its surrounding states.

...... 27 NURSING BULLETIN NOMINATION FORM FOR 2018 ELECTION Although we just completed a succesful Board of Nursing election, we are already getting other Board-related information. You also may contact Chandra, Administrative Coordinator, at ready for our next election. In 2018, the Board will have three openings: Nurse Educator: ADN/ [email protected] or (919) 782-3211, ext. 232. After careful review of the information packet, Diploma, Staff Nurse, LPN. This form is for you to tear out and use. This nomination form must you must complete the nomination form and submit it to the Board office by April 1, 2018. be completed on or before April 1, 2018. Read the nomination instructions and make sure the candidate(s) meet all the requirements. Guidelines for Nomination 1. RNs can petition only for RN nominations and LPNs can petition only for LPN nominations. Instructions 2. Only petitions submitted on the nomination form will be considered. Photocopies or faxes are Nominations for both RN and LPN positions shall be made by submitting a completed petition not acceptable signed by no fewer than 10 RNs (for an RN nominee) or 10 LPNs (for an LPN nominee) eligible 3. The certificate number of the nominee and each petitioner must be listed on the form. to vote in the election. The minimum requirements for an RN or an LPN to seek election to the 4. Names and certificate numbers (for each petitioner) must be legible and accurate. Board and to maintain membership on it are as follows: 5. Each petition shall be verified with the records of the Board to validate that each nominee 1. Hold a current unencumbered license to practice in North Carolina and petitioner holds appropriate North Carolina licensure. 2. Be a resident of North Carolina 6. If the license of the nominee is not current, the petition shall be declared invalid. 3. Have a minimum of five years experience in nursing 7. If the license of any petitioner listed on the nomination form is not current, and that finding 44. HaveHave beenbeen engagedengaged contcontinuouslyinuously iinn a positionposition tthathat meets tthehe crcriteriaiteria for the specified Board decreases the number of petitioners to fewer than ten, the petition shall be declared invalid. position, for at least three years immediately preceding the election.. 8. The envelope containing the petition must be postmarked on or before April 1, 2018, for the Minimum ongoing-emmplployoymementnt reqequirements for both RNs and LPNP s shall include nominee to be considered for candidacy. Petitions received before the April 1, 2018, deadline continuous employment eequal to or grreeater than 50% of a full-time position that meets the will be processed on receipt. criteria for the specified BoBoarard memembmbeer position, except for the RN at-laarge position. 9. Elections will be held between July 1 and August 15, 2018. Those elected will begin their terms of office in January 2019. If you are interested in being a cana didate for one of the positions, visit our website at Please complete and return nomination forms to 2018 Board Election, North Carolina Board wwww.w.ncncbobon.n.cocom for additional inforrmmaatit ono , including a Board Member Job Description and of Nursing, P.O. Box 2129, Raleigh NC 27602-2129.

Nomination of Candidate for Membership on the North Carolina Board of Nursing for 2018

We, the undersigned currently licensed nurses, do hereby petition for the name of , NurseN Educator: Ed t ADN/Diploma/ ADN/Dipl / Staff St ff Nurse N / LPN (circle one), whose Certiﬁcated Number is , to be placed in nomination as a Member of the N.C. Board of Nursing in the category of (check one): Nurse Educator: ADN/Diploma Staff Nurse LPN Address of Nominee: Telephone Number: (Home) (Work) E-mail Address:

PETITIONER - (At least 10 petitioners per candidate required. Only RNs may petition for RN nominations). TO BE POSTMARKED ON OR BEFORE APRIL 1, 2018 NAME SIGNATURE CERTIFICATE NUMBER

Please complete and return nomination forms to 2018 Board Election, North Carolina Board of Nursing, P.O. Box 2129, Raleigh, NC 27602-2129.

...... 29 NCBON Launches New Website Lonzellnzell FogFogle, IT Business Analyst

The North Carolina Board B d of Nursing (NCBON) launcheded a completely redesigned webssite, www.NCBON.com, in Sep-- tember. The new site featurres enhanced navigation and a user-friendly content structurure— designed to improve the qualitity of visitor interactions, creatingg a more meaningful and valuable user experience. Last year, www.ncbon.com received more than 1.1 million visits and 4.2 million page views, therefore, we concentrated on understanding visitor behavior and needs through website analytics and feedback method- ologies. Attention was given to how our content was organized, structured and labeled. Our goal was to ensure that the user interface was easy to access, understand and helped facilitate the users needs. What you’ll love about the new website: • Homepage—at a glance, Nurse Gateway, upcoming events, recent NCBON news, licensure Statistics and quick links to get you where you want to go with one click •Department Overview Pages—provides a gateway to our content by giving users a quick guide around the available content on a speciﬁc subject, featured topic or publication • Topics of Interest—each diverse group (Nurses, Nursing Students, Program Directors and consumers) will have their own unique section of the website that offers resources, materials and serves as a gateway to additional content • Widgets—access to Google translate, AccuWeather and the “I want to…” dropdown which contains quick links to things you can do on the website We hope you ﬁnd the new website refreshing and modern, user-friendly with easy to access pertinent information. We will continuously expand our online content to bring you updated and relevant information. We appreciate your valued feedback and suggestions—your input is extremely important to us.

URSING 30 NURSING N O RTH C AROLIN A BULLETIN { Official Publication of the Board of Nursing } ...... 31 SUMMARY of ACTIVITIES

Administrative Matters Ratiﬁcation to Approvepp the Following g Expansi p ons in Enrollment: • Approved designation of funds • Cape Fear Community College – ADN, increase of 20 for a • Approved proposed Strategic Plan for 2018 – 2021 total of 200 beginning August 1, 2017 • Approved ﬁnal report for 21 NAC 36, Board of Nursing and • Daviv dson Community College – LPN, increase of 10 for a total directed staff to proceed with next steps in the periodic of 30 beginning August 17, 2017 review of rules • Garddner-Webb University – BSN, increase of 30 for a total of • Approved appointment to Midwifery Joint Committee 150 beginning May 1, 2017

Education Matters Notiﬁcation of Alternate Schedulinng Opptit ons: Ratiﬁcation of Continued Full Appprovp al Status: • Cape Fear Commmuunnity CoCollleegge – LPL N tot ADN Opttioi n • Bladen Community College – ADN and PN • Edgeeccommbbe CCoommm uunitty Coolll eegge – LPLPN tot ADNDN Optioon • Central Carolina Community College – ADN and PN • Forsyth Communnitity College – LPN ttoo BSSN RIBBN Option • Foothills Community College – ADN • Haliifaf x CoC mmm unity CColll egege – LPN too ADDN Option • Isothermal Community College – PN • GGarddnen r-Webb Univeerrssitity – ABBSNSN Prooggrramam Optptiion • RoR wan-Cabarrus Community College – PN • PfP eifferr Unin verssitty – LPN toto BSNN Prorogram Optioi n • Winston-Salem State University – BSN • StS ananlyy Commumuninityy Collllegge – LPPNN to ADDN OpOpttiiono

URSING 32 NURSING N O RTH C A R O LIN A BULLETIN { Official Publication of the Board of Nursing } ...... 33

...... 35. Election Results for 2017

New Members • PamelaPa Edwards, EducatorEdu tor at DuDuke University School of Nursing, from Willow Spring, NC was elected asa RN – At Large to the NC Board of Nursing. Mrs. Edwards has served as a nurnurse executive and nurse educator and has previously served on the NC BoBoard of Nursing, in her 38 years of practice. • Lori Lewis, of Fayetteville,ille, NC, currently works at the Fayetteville VA Medical Center and was elected in the LPLPN position to the NC Board of Nursing. Mrs. Lewis has been working as an LPN since 2002. • Ashley Dixon, of Raleigh,h, NC, waswa appointed to the NC Board of Nursing, as a public member in July 2017.17. Mrs. DDixon is a realtor in the Raleigh area, looking forward to serving thehe public in her new role as Board Member.

Chair & Vice Chair Elections • Pat Campbell, public member and 20177 Chair, was re-elected to Chair the Board for 2018. • Frank DeMarco, RN-Nurse Administrator- Hospital/Hospital System, was elected as Vice-Chair for 2018.

URSING 36 NURSINGG N O RTH C AROLINA BULLETINN {Official Publication of the Board of Nursing } ...... 37 Nurse Network Reach every nurse in North Carolina for as little as $500. Economical Classiﬁeds (1.5” wide x 2” high) RESERVE YOUR SPACE NOW! CONTACT VICTOR HORNE: [email protected] 800-561-4686, ext. 114

URSING 38 NURSING N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } ...... 39 Presorted Standard U.S. Postage Paid Little Rock, AR P.O. Box 2129 Permit No. 1884 Raleigh, NC 27602-2129