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FALL 2016 VOLUME 13 {NO 1} EDITION 37 www.ncbon.com WHAT COULD HAPPEN: The Consequences of “Practice Drift”... Is It Worth the Risk? – page 6 Publication of the North Carolina State Board of Nursing . FALL 2016 BULLETIN N NC BOARD OF NURSING Nursing Bulletin is the official C publication of the North Table of Carolina Board of Nursing. CONTENTS Office Location 4516 Lake Boone Trail O Raleigh, NC 27607 VOLUME 13 {N 1} EDITION 37 Mailing Address P.O. Box 2129 Raleigh, NC 27602 Telephone (919) 782-3211 Fax 6 WHAT COULD HAPPEN: The Consequences (919) 781-9461 of “Practice Drift... Is It Worth the Risk? Website www.ncbon.com Office Hours 14 LPN-BSN ACADEMIC PROGRESSION 8 a.m. to 5 p.m., IN NORTH CAROLINA: Challenges and Monday through Friday Board Chair Recommendations Report Martha Ann Harrell Executive Director Julia L. George, RN, MSN, FRE 16 TELEHEALTH/TELENURSING: Editor Position Statement for RN and LPN Practice David Kalbacker Managing Editor Elizabeth Langdon 18 COMPLEMENTARY THERAPIES: Photography Position Statement for RN and LPN Practice DayMeetsNight Media Services Mission Statement 20 Election Results for 2016 The mission of the North Carolina Board of Nursing is to protect the public by regulating the Executive Director Nationally Recognized practice of nursing. 21 with Highest Award in Nursing Regulation Advertisements contained herein are not necessarily endorsed by the North Carolina Board of 22 LITERATURE REVIEW: Nursing. The publisher reserves the Nurse Fatigue Related to Shift Length right to accept or reject advertise- ments for the Nursing Bulletin. All art (photos, paintings, draw- ings, etc.) contained in this pub- lication is used under contractual agreement. 150,000 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 employer. DEPARTMENTS: 4 From the Editor 20 pcipublishing.com Summary of Activities Created by Publishing Concepts, Inc. 30 Classifieds $ % !"( % #! For Advertising info contact " ( &" NURSING $ #! ThinkNurse.com BULLETIN . 3 NC from the EDITOR Eyeing that slippery slope I first want to congratulate new Board members, Lisa Hallman and Glenda Parker on their election efforts and the re-election of Sharon Moore to the 2017 Board of Nursing. I also want to thank departing Board members, Jennifer Kaylor, Cheryl Duke and Margaret Conklin for their hours of dedicated service on behalf of the Board. To read more about our incoming Board members see the article on Page 20. The CE cover story on Page 6 highlights the issue of “Practice Drift.” In it, author Kathy Chastain, RN does a great job describing the “slippery slope” that licensees are known to take that eventually leads them to appear before the Board. I assure you this is NOT a work of fiction. We hear licensees describe these practices all the time — in defense of their actions. The article is a compelling read and will definitely help you identify problem areas where drift might occur. Also in this issue is a short article, on Page 14, about the Foundation for Nursing Excellence (FFNE) and their efforts to report on steps that might be taken to address academic progression for LPNS. We have included a link to the report. As 2016 comes to a close, I am already looking toward the future and a long session of the 2017 North Carolina General Assembly. I will keep you posted on Board of Nursing issues in the legislature. David Kalbacker Editor, NC Board of Nursing URSING 4 N N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } . MASTER’S IN NURSING Earn your MSN Online in as little as 15 months! Visit ecpi.edu/college-of-nursing or call 877-959-1142 Don’t forget ECPI University also offers: BS 2 BSN*, RN 2 BSN, & Nursing (RN) For more information about our graduation rates, the median debt of students who have completed the program, and other important information, please visit our website at ECPI.EDU/FASTFACTS Programs vary by location. Talk to an admissions advisor to inquire about institutional requirements. *Prerequisite courses are required. 5 WHATREQUIREMENT COULD HAPPEN: vs. PROFESSIONALISM The Consequences of “Practice Drift”... Is It Worth the Risk? Kathy Chastain, MN, RN, FRE and Linda Burhans, PhD, RN, FRE Purpose: To assist nurses in under- standing and identifying practice drift and how to eliminate/mitigate effects. Objective: 1. Explain “practice drift.” 2. Recognize factors that contribute to the occur- rence of “practice drift.” 3. Discuss the impact of “practice drift,” 4. Create a plan to eliminate and decrease “practice drift.” Have you ever… because you were pressed for T failed to scan the bar code on a 1. Deviated from the procedure for safe time and/or you were trying to medication because the scanner medication administration? save a few steps; wasn’t working; T administered a medication prior to T carried medications in your T made assumptions when orders obtaining an order from a provider pocket and wasted them at the were incomplete or were illegible because you “knew” what the end of the shift because there because you didn’t want to bother physician would order; wasn’t anyone available at the the provider; or, T borrowed a medication from time to serve as a witness; T hidden away unused medications another patient or used STAT T signed as a witness to a narcotic from discharged patients for orders to override the system as medication waste you did not administration to other patients if a workaround to bypass slow observe because you trusted your needed in the future to avoid delays. pharmacy services; co-worker; 2. Neglected a patient? T administered a pain medica- T left a patient’s medications on T failed to perform an assessment or tion without completing a pain the bedside table because he/she treatment because the patient was assessment because you were was on the phone; sleeping; in a hurry; T failed to check 2 identifiers when T silenced a piece of equipment (bed T prepared medications simultane- administering medication because alarm, IV pump, cardiac monitor, ously for more than one patient you were in a rush; etc.) because it kept alarming for URSING 6 N N ORTH CAROLINA BULLETIN {Official Publication of the Board of Nursing } . no apparent reason and you felt it change because you were busy was disturbing the patients; or, with another patient; or, N T failed to complete the “time out” T allowed unlicensed personnel to in surgery because the surgeon was make assignments and delegate C upset with how long it took to set patient care tasks to others. up for his/her patient. 7. Accepted an assignment when you of the risk attached to everyday behaviors, 3. Failed to maintain an accurate knew you were not fit for duty? or to mistakenly believe the risks taken patient medical record? T worked while so fatigued that you to be justified. Decisions about what is T pre-documented an assessment were nodding off to sleep because important on a daily list of tasks are based or care delivered to save time you agreed to work an extra shift on the immediate desired outcomes and because the information was at the request of your manager; or, over time, as perceptions of risk fade away, always the same; T worked an early shift while still individuals try to do more with less and T pre-documented medication “hung over” from a party that take shortcuts, drifting away from behav- administration because you knew ended only a few hours before. iors they know are safer (ISMP, June 2012). you would not have time later; or, Articles published by the Just Culture T waited until the end of the shift to Chances are you have done some Community, have identified “at-risk” document all assessments and care of these yourself, or if not, you have behaviors as the most common of the rendered because you didn’t have worked with someone who has! The 3 types of errors (human, at-risk, reck- time during the shift to get it done. multiple “at-risk” behaviors listed less). Marx of Outcome Engineering 4. Breached a patient’s confidentiality? above all describe “practice drift.” The (2005) explains, T out of curiosity, looked up infor- term “practice drift” is another way of “We all tend to lose perception of the mation on a patient you were describing a “work- around,” “shortcut,” risk attached to everyday activities, or not assigned to provide care; or “rule-bending” done in order to mistakenly believe in some situations a T posted pictures or comments accomplish an immediate goal, to meet a risk is justified. Often our decisions to about patients or family members perceived expectation of another, and/or circumvent an evident or perceived on social media; to promote efficiency (Collins, 2003). workflow hindrance are based on T discussed patient information in All of these incidents are types of immediate outcomes (time saver) in a public setting (e.g., elevator or practice violations which the NC Board order to meet a goal or to achieve it cafeteria) or commented on a of Nursing has investigated. Thankfully more readily and do not consider the patient’s condition to another the vast majority of these incidents did potential or uncertain consequence patient or family member. not result in serious negative patient (patient harm) which is more remote.” 5. Exceeded scope of nursing practice? outcomes but each incident represents a Studies have shown that once you T acted outside your scope of “drift” from the standard of care and has have bent the rules and had a favorable practice by writing “verbal orders” the potential to jeopardize patient safety.

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