Summer 2012 • Volume 6. No 2. Edition 12

“Bridging” from Home-Care Aide or Medical Assistant to Assistant Certified Page 10 Nurses as Second Victims: Supporting Our Colleagues Following an Adverse Event Page 14 The Process of Investigation: Fact v. Fiction Page 23

Official publication of the Washington State Nursing Care Quality Assurance Commission and the Washington State Department of Healthwashington Nursing Commission News 1 Every day is a journey of hope and compassion at Seattle Children’s.

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2 washington Nursing Commission News PRODUCTION ONLY 07/06/2012 1739684-PAPC75544 SEACHI 7.875” x 10” Jennifer Boyd v.3 SUMMER 2012 • Volume 6. No 2. Ed.12 Published by Washington State Nursing Care Quality The Washington Assurance Commission (NCQAC) Nursing P .O . Box 47864 Commission Olympia, WA 98504 Telephone: (360) 236-4700 News circulation FAX: (360) 236-4738 includes over http://www.doh.wa.gov/hsqa/ 100,000 licensed .nursing/default.htm nurses and Commission Members student nurses Susan Wong, MBA, MPA, RN in Washington. Chair Susan L. Woods, Ph .D ., RN, FAHA, FAAN Vice Chair Linda Batch, LPN Charlotte Foster, BSN, MHA, RN DOH Pub 669-256 William J. Hagens, MA Public Member Erica Benson-Hallock, MPPA Public Member Margaret E. Kelly, LPN Suellyn M. Masek, RN, MSN, CNOR Message from the Chair...... 4 My Personal Experience with a Complaint Against My License . . . Darrell A. Owens, DNP, ARNP Using Your Trust and Credibility 22 Gene I. Pingle, RN, BSN-BC, CEN to Protect Patient and Community Commission 2012 Meeting Dates. . 22 Health...... Diane Sanders, MN, BC, RN 6 The Process of Investigation: Fact v . Message From the Executive Fiction...... L. Susana Serna, RN, ARNP 23 Director...... 8 Should I Place My License Into Cass Tang, PMP Inactive Status or Let It Expire?. . . Public Member “Bridging” from Home-Care Aide 24 or Medical Assistant to Nursing Nursing in Washington Rhonda Taylor, MSN, RN Assistant Certified...... 10 State...... Laura Yockey, LPN 25 in the : Washington Health Professional The Nurse...... 12 Services...... 26 Created by Bullying in the Workplace: Washington’s Prescription Publishing Concepts, Inc. The Employer ...... 13 Monitoring Program...... Virginia Robertson, Publisher 26 [email protected] Ideas or Suggestions Welcome!. . . . 13 It Can’t Be That Easy, Can It?. . . . 27 14109 Taylor Loop Road Nurses as Second Victims: Addressing and Education Little Rock, AR 72223 Supporting Our Colleagues in Washington State: How 501.221.9986 Following an Adverse Event. . . . . For advertising information contact: 14 WCN is Implementing the IOM Michelle Forinash at 800.561.4686 ext.112 Recognizing and Helping the Recommendations ...... 28 [email protected] Nurse “Second Victim”...... 16 Washington State Advanced ThinkNurse.com Second Victim Trajectory...... 17 Practitioner Survey Results...... edition 12 Actions...... 18 29

The Washington State Nursing Care Quality Information published in the Washington Nursing Advertisements contained herein are not endorsed Assurance Commission regulates the competency Commission News is copyrighted but may be by the Washington State Nursing Care Quality and quality of licensed practical nurses, registered reproduced for education and purposes. Assurance nor the Department of Health . The nurses and advanced registered nurse practitioners The Nursing Commission would appreciate Washington State Nursing Care Quality Assurance by establishing, monitoring and enforcing qualifica- credit for the material used. Direct Washington Commission reserves the right to accept or reject tions for licensing, consistent standards of practice, Nursing Commission News questions or com- any and all advertisements in the publication . continuing competency mechanisms, and discipline . ments to: Editor, Nursing Care Quality Assurance Responsibility for errors is limited to corrections in The commission establishes standards for approval Commission, PO Box 47864, Olympia, WA a subsequent issue . and of nursing education programs . 98504-7864 or [email protected].

Executive Director The Department of Health is an equal opportunity agency . For persons with disabilities, this document is Paula R . Meyer, MSN, RN available on request in other formats . To submit a request, please call 1-800-525-0127 (TTY 1-800-833- Editor 6388) . For additional copies of this publication, call 1-800-521-0323 . This and other publications are Mindy Schaffner, PhD, MSN-CNS, RN available at http://www .doh .wa .gov/hsqa/ .

washington Nursing Commission News 3 Message from the Chair By Susan Wong, MBA, MPA, RN

At last…summer has finally arrived! Congratulations to all the newly graduated nurses in Washington State .

As you embark on your , you will encounter and touch many lives that will bring you joy and satisfaction . You will also feel compassion and sadness with difficult situations . Healthcare is hard work but definitely challenging and rewarding at the same time .

The nursing is full of challenging experiences . Nursing continues to change and evolve as research, science, and technology enhance nursing practice . At times, questions arise about new procedures and techniques, and you may wonder about your scope of practice . The Nursing Care Quality Assurance Commission Web site at http://www.doh.wa.gov/hsqa/Professions/ Nursing/default.htm provides information on various resources such as the Scope of Practice Decision Tree, the Nurse Practice Act, and Commission Advisory Opinions . The Web site also contains information on licensing, continuing competency, and discipline .

I encourage all nurses to read the articles in the commission newsletters . They contain a wealth of information including updates and anticipated changes related to our profession . Publication of the newsletter occurs twice a year . You can find current and older issues of the newsletter on commission’s Web site .

The commission holds business meetings six times a year to address issues related to our profession . Three meetings occur by videoconference at five different sites in the state . Commission members attend the other three meetings at the Department of Health in Tumwater . The public may attend all business meetings . I encourage you to attend .

As I look back on the years since first appointed to the commission, I have gained a wealth of knowledge in nursing regulation and a strong commitment for nursing excellence in the protection of public safety . I have enjoyed working with knowledgeable and expert commission members and staff from all walks of life . Serving as chair of the commission for the last three years has been a powerful experience of challenge and responsibility . I will treasure this experience as I embark on new challenges in the future .

Enjoy the Newsletter!

Susan Wong, Chair Nursing Care Quality Assurance Commission

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As a nurse, you’re one of the most im- We’ve been fortunate in the United States, where portant people in the health of your fam- ily, friends, and community . People trust we’ve had the benefit of vaccine protection for your advice for their health decisions . many decades. Yet too many people are skeptical With such an essential role, I often find myself asking for your help — and time or complacent and are putting our families and after time, you come through . communities at great risk. Last June, I asked all healthcare provid- ers in our state for help as we began imple- ing cough epidemic is a sobering reminder • Consider the diagnosis of pertussis, menting a new law we hoped would de- about how serious these diseases can be . even if the patient has been immunized crease exemptions for preschool and school It also shows that immunization is key in if they meet any of these conditions; immunizations . The law requires parents to protecting our community’s health . • Any respiratory symptoms in babies talk to a licensed health care provider about Across our state, we’re seeing far too under 12 months . the real benefits and potential risks of im- many infants and toddlers who are get- • Cough illness includes gagging, munizations before they can file a vaccine ting pertussis from adults and teens who a whoop, or any cough that lasts exemption form with their child’s school . weren’t up-to-date with their pertussis vac- more than two weeks (in patients of Less than a year later, we’ve already seen a cinations . Many adults — including health any age) . small, but important improvement in our care staff and new parents — may mistak- • Respiratory illness of any duration statewide immunization exemption rate . enly believe they’re protected . In fact, most in patients who’ve had contact with This is great news and shows that when par- teens and adults need a booster shot . We someone known to have pertussis . ents get accurate information from trusted already have more than 2,000 cases this • Report pertussis cases within 24 hours health care professionals it helps them make year and the disease continues to spread . to your local health agency as required . vaccine decisions based on facts . Thank you Sadly, we’re on track to have the highest Information for health professionals for the important work you do to combat number of cases in more than six decades and the public is on our 2012 Pertussis vaccine-preventable diseases . — since vaccine became widely used . Epidemic website . Posters, parent fact Unfortunately, the news isn’t all good You can help slow this epidemic by using sheets, and other materials about the dis- and we still have a lot of work to do to- your influence as a trusted health partner: ease are available in English and Spanish . gether . Although improving, our immuni- • Make sure you, your family, and your pa- You’ll find county-by-county weekly up- zation coverage is spotty . Several school tients are up-to-date on pertussis immuni- dates on reported cases . Call your local districts in the state have more than 10 zations . Use a single dose of Tdap for all health agency with questions or contact percent of their students with immuniza- adolescents and adults as recommended . the of Immunization and Child Pro- tion exemptions on file . Some individual • Give Tdap to all pregnant women af- file ([email protected]), 360-236-3595 . schools have more than 20 percent of their ter 20 weeks gestation, if they were We’ve been fortunate in the United children whose parents have exempted not previously vaccinated . Vaccina- States, where we’ve had the benefit of vac- them from vaccination, for non-medical tion during pregnancy is preferred, but cine protection for many decades . Yet too reasons . This leaves many children at risk post-partum vaccination is acceptable . many people are skeptical or complacent of catching and spreading preventable ill- • Recommend vaccination to household and are putting our families and commu- nesses . Some diseases, like measles, need members and other close contacts of nities at great risk . With your help, we can less than a 5 percent susceptible popula- infants . This disease is really hitting ba- turn the tide on pertussis and improve our tion to take off, and clearly, in some areas bies hard and the only way to protect immunization rates . Thank you for your we are at dangerous levels of vulnerability . them is to make sure that they’re sur- continued dedication to the health of your As you know, many diseases can spread rounded by people who are protected patients . They count on you — as I do — quickly in schools and the current whoop- through vaccine . and you come through .

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washington Nursing Commission News 7 Message from the Executive Director By Paula R. Meyer, MSN, RN, NCQAC Executive Director Legislative Report The 2012 legislature passed many bills toms, referral to treatment, and immediate steps to take related to nursing care in Washington . New laws affect to protect people . Mental health education currently the full spectrum of nursing care . This year’s new laws required in nursing education meets the new requirement . address such issues as delegation of nursing care, work- The law requires the Secretary of Health to conduct a ing with licensed midwives, and Washington pharma- study and submit a report to the legislature by December cies accepting out-of-state Advanced Registered Nurse 15, 2013 . The report must include: Practitioners’ (ARNP) prescriptions . This article sum- (a) Available research and literature regarding the rela- marizes the new laws with links to the full laws .* tionship between licensed health professionals com- House Bill 1486 allows Washington pharmacies to fill pleting training in suicide assessment, treatment, and prescriptions for controlled substances written by ARNPs management and patient suicide rates; licensed outside of Washington working up to their scope (b) An assessment of which licensed health professionals of practice . This law amended the Controlled Substances are best situated to influence positively the mental Act by adding ARNPs from any state to the list of practi- health behavior of individuals with suicidal ideation; tioners with prescriptive authority for controlled substances . (c) An evaluation of the impact of suicide assessment, ARNPs with prescriptive authority for controlled substances treatment, and management training on veterans from Idaho and Oregon write prescriptions for their patients with suicidal ideation; and who may reside in Washington or who may wish to have (d) A review of the curriculum of health profession their prescriptions filled in Washington . The new law allows programs offered at Washington state educational Washington pharmacies to fill these prescriptions for con- institutions regarding suicide prevention . trolled substances . The law is effective on June 7, 2012 . In conducting this report, the secretary from the House Bill 2186 added Licensed Midwives to the list of Department of Health may collaborate with other health professionals working with nurses . The new law amends profession disciplinary boards and commissions, profes- parts of the Nursing Practice Act to add licensed midwives . sional associations, and other interested parties . The For example, RCW 18 .79 .040(1)(e) now states “The secretary shall submit a report to the legislature no later executing of medical regimen as prescribed by a licensed than December 15, 2013 . The Nursing Commission will physician and surgeon, dentist, osteopathic physician assist in gathering information and drafting the report and surgeon, podiatric physician and surgeon, physician with the Secretary of Health . assistant, osteopathic physician assistant, or advanced House Bill 2247 expands the types of medications registered , or as directed by a licensed nurses in schools K-12 may delegate to unlicensed midwife within his or her scope of practice .” Hospital, school personnel . Currently, school nurses may delegate Pharmacy, Birthing Center, and Licensed Midwife laws oral medications . House Bill 2247 expands this practice and rules must be followed . to delegation of eye drops, eardrops, and topical medi- House Bill 2366 addresses the prevention of suicide in cations . The Nursing Commission will work with the Washington . The law recognizes the number of people in Office of the Superintendent of Public Instruction to our nation and state affected by suicide and requires cer- provide guidelines on implementing this bill . The nurse tain health professionals to receive education on preven- retains the responsibility to determine if the delegation tion . Advanced registered nurse practitioners, registered is safe and the person completing the task is competent . nurses, and licensed practical nurses receive education in Competency includes being willing to complete the task, psychiatric care, including assessing for suicidal symp- able to perform safely the task, and available to perform

8 washington Nursing Commission News the task as the student needs . Temporary Practice Permit until all licensing House Bill 2314 defines and describes requirements are met when military person- the certification of home care aides . Home nel relocate to Washington and their spouse care aides are certified long-term care work- holds a professional license in another state . ers . Under the amended definition in RCW The Nursing Commission quickly issues Message from the Executive Director 74 .39A .009(17(a) “Long term care workers temporary practice permits, usually within By Paula R. Meyer, MSN, RN, NCQAC include all persons who provide paid, hands- two days of receiving the application if the on care services for the elderly or persons license is in good standing from another with disabilities including but not limited to state . The temporary practice permit appears individual providers of home care services, on our Provider Credential Search as soon as direct care workers employed by home care granted . The Provider Credential Search pro- NursiNg agencies, providers of home care services vides primary source validation of a license . to persons with developmental disabilities Employers use the Provider Credential Search Program under Title 71A RCW, all direct care workers to verify the Temporary Practice Permit rN to BsN degree in state-licensed boarding homes, assisted liv- and licenses . Once the applicant meets all master of Nursing ing facilities, and adult family homes, respite the requirements, the Nursing Commission Course content relevant to your care providers, direct care workers employed issues a Washington nursing license . clinical practice. by community residential service businesses, Senate Bill 6237 creates a career pathway • Nursing classes 1 day/week and any other direct care worker providing for Medical Assistants . The law moves all • BSN in Bothell, Everett and Mt Vernon (minimum 4-5 quarters) home or community-based services to the registered health care assistants into a new • MN Friday classes (7 or 11 quarters) elderly or persons with functional disabilities category of medical professional, Medical or developmental disabilities .” Assistants . The law defines four catego- [email protected] This law defines the training, examina- ries: Medical Assistant, Registered; Medical 425.352.5000 | www.uwb.edu

Get tion, and certification requirements for home Assistant, Certified; Medical Assistant, Connected care aides . The law also allows nurses in Hemodialysis Technician; and, Medical community-based care settings to delegate Assistant, Phlebotomist . The law defines nursing tasks to certified home care aides . education, examination, registration, and You realized your nursing dream. The Nursing Commission will hold rules certification requirements for medical assis- writing workshops to implement this law . tants . The law also directs the Nursing Care Now Realize Your Be on the lookout for the announcements Quality Assurance Commission to “review of the workshop dates and locations on our and identify other specialty assistive person- POTENTIAL. nursing listserv . nel not included in this chapter and the tasks Earn your BSN or MSN Online. You’ve come a long way since your first day as an RN. Go House Bill 2473 allows certified nursing they perform . The department of health shall even further with one of Jacksonville University’s acclaimed assistants in nursing homes to administer compile the information from each disciplin- nursing programs, offered in a 100% online classroom. medications . The law requires the Nursing ing authority listed in this subsection and • RN to BSN – Now Offering Commission to write rules on the education, submit the compiled information to the leg- Scholarships! examination, and supervision that certified islature no later than December 15, 2012 ”. • MSN: Leadership in Healthcare Systems nursing assistants must complete before they These new laws demonstrate the wide • MSN: Clinical can receive this endorsement on their certifi- variety of professional relationships for JacksonvilleU.com/PC cation . The Nursing Commission will hold nurses and the varied settings for nursing Or, talk with a specialist: 800-571-4934 rules writing workshops to implement this practice . Please join the nursing listserv to 8-week classes | 6 sessions per year law . The announcements will be posted on receive information on rules workshops . our listserv . Please join our nursing listserv to You can assist the Nursing Care Quality receive information on dates and locations of Assurance Commission in developing the these very important workshops . regulations . Your input is very important . Senate Bill 5969 describes licensing *The on-line newsletter contains hyperlinks . If services for spouses of military person- you wish to look up these bills on the Washington Legislature’s Web site go to www.leg.wa.gov, click © 2012 All Rights Reserved. Made Available by University Alliance® nel . The law recognizes the contributions The Nation’s Leading Universities Online. SC: 191734ZJ1 | MCID: 2742 on Bill Information at the left under Inside the of our military personnel and their fami- Legislature and input the bill number where indi- One of America’s Best Colleges . The Nursing Commission may grant a cated under Search by Bill Number . U.S. News & World Report

washington Nursing Commission News 9 By Jacqueline Rowe, RN NCQAC Pro Tem Member “Bridging” from Home-Care Aide or Medical Assistant to Nursing Assistant Certified

Certified Home Care Aides (HCA) and Medical Assistants (MA) can now become Nursing Assistants Certified (NAC) without having to do the Nursing Assistant program in its entirety . The Alternative “Bridge” Training Program takes into account the skills that HCAs and MAs already possess and provides 24 hours of further training, to allow the transition to NAC . The alternative training program con- sists of 24 hours of training that will equip HCAs and MAs with the additional skills necessary to pass the NAC compe- tency exam . The program must meet the requirements of a state-approved nurse aide competency evaluation . In order to be eligible for the alterna- In 2010, the Washington State tive training program, the HCA must Legislature recognized the need for a meet the minimum training requirements more stabilized workforce to assure the listed in WAC 246-841-545 . The MA availability of trained personnel in health must meet the training requirements list- care facilities . ESSB 6582 was passed and ed in WAC 246-841-550 . If the HCA or signed by the governor on March 10, MA meet these requirements, the next 2010 . The bill provides a career advance- steps are as follows: ment track by which the HCA and MA • enroll and complete an alternative can obtain nursing assistant certifica- “bridge” training program tion . This opportunity creates a potential • complete a CPR course resource to meet the rising basic care • complete seven hours of Acquired needs of Washington’s aging population . Immune Deficiency Syndrome (AIDS) In addition, this strategy provides a training source of potential candidates • successfully pass the NA Competency to advance into licensed nursing practice, Test thereby increasing the number of available • apply through the Department of nurses to care for these more clinically com- Health to become certified . plex patients in our health care facilities . The increase in the elderly population Effective January 2012, school sites and the high of health care workers can apply to become an alternative train- in long-term care settings support the need ing program . Please see the Department of for alternative training programs . These Health Nursing Care Quality Assurance numbers create a challenge in meeting the Commission Web site for more informa- staffing needs in health care facilities . tion regarding alternative programs .

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washington Nursing Commission News 11 By Nancee Tardif, MSN, RN

Bullying in the Workplace: The Nurse

Bullying in the workplace is a topic that them . It undermines their work outcomes, allow the bully to undermine our confidence comes up frequently when talking with nurs- which can result in ineffective patient care, in our own abilities . es . We used to call it “eating our young” but make staff prone to mistakes, and make The bully frequently feels insecure and the prominent problem has changed from them feel on edge . actually feels threatened by the person hazing to bullying . This affects not only new As a forty-year veteran of our profession, being bullied . Realize you are not the nurses, but all nurses . Bullying may include I remember the way I was treated as a nov- source of the problem . Bullying is a control unwarranted criticism, swearing, exclusion, ice nurse . You can outgrow being a novice issue; not a performance one . Easy to say, , and blame without factual jus- but bullying continues like a virus . Having but harder to deal with when the bully tification . Additionally, covert types of bul- experienced bullying myself, I recognize how rallies others against you . The best defense lying, such as trivial criticism and isolated frustrated I felt . The criticism can come out is to learn effective direct communication actions between the nurse and the bully can of the blue and catch you unprepared lead- skills . Assertiveness training can certainly go unnoticed . ing you to an ineffective response or cause help the situation . Bullying is not harass- I processed a complaint filed against a you to walk away . Even though the criticism ment . The state of Washington has laws nurse by her peers because she bullied them . is unfounded, it will continue to eat away at against (RCW49 .60), but not It was the only way they felt they could get the victim . In part, this response stems from against bullying . The work environment to her to stop the behaviors . I can empathize the fact that nurses provide care and do not also needs to support you in making bul- with the way they felt about bullying . In take care of themselves . Sometimes, we work lying off limits . The next article deals with an already high-stress environment, victims long hours under difficult conditions . We ways the employer can approach bullying feel higher stress when the bully works with really do not need bullying . We should not in the workplace .

Jesuit learning for social justice.

12 washington Nursing Commission News By Nancee Tardif, MSN, RN Bullying in the Workplace: The Employer

Victims of bullying may experience sig- spots are on the table . Knowing that your Employer costs increase as nificant physical and mental health prob- supports you and will help or productivity dips, desire to lems . These manifest as phobias, sleep dis- refer you to employee assistance takes some meet organizational goals turbances, digestive problems, depression of the bite out of the bullying behavior . or self-blame and absence from work . Any However, be aware that overt bullying may dwindles, and staff or all of these affect performance . The bully become covert bullying, which is often the creativity is stifled . undermines . phase after the bullying is acknowledged by Healthcare increases . Transfer requests abound . Work management . A support system and com- can support individuals who life becomes more stressful . Morale drops . municating in a professional manner makes are bullied by recognizing Nurses resign . Teamwork suffers . Once a big difference in both your environmental trust breaks down in a team, nurses may fail culture and day-to-day work . that bullying does exist . to contribute their best work or not offer ideas for improvement of work processes . This situation also leads to less reporting of Example of an Australian workplace anti-bully policy: failures or mistakes and less honesty about Company name considers unacceptable and will not situations of questionable performance . tolerate it under any circumstances. Workplace bullying includes behavior Employer costs increase as produc- that harms, intimidates, offends, degrades, or humiliates an employee, tivity dips, desire to meet organizational possibly in front of other employees, clients, or customers. Workplace goals dwindles, and staff creativity is sti- bullying may cause the loss of trained and talented employees, reduce fled . Healthcare organizations can support productivity and morale, and create legal risks. individuals who are bullied by recognizing Company name believes all employees should be able to work in an that bullying does exist . Addressing bullying environment free of bullying. Managers and must ensure requires having a policy with consequences employees are not bullied. for bullying . Employee education on bully- Company name Unit has grievance and investigation procedures to ing, employee assistance programs, group deal with workplace bullying. Managers and supervisors must ensure classes on professional behavior, and com- employees are not bullied. munication and consistent enforcement of Company name Unit encourages all employees to report workplace policies can reduce bullying in the work bullying. Any reports of workplace bullying will be treated seriously and place . I needed to confront my bully . I did so investigated promptly, confidentially, and impartially. through my supervisor who got us together Company name encourages all employees to report workplace bullying. to talk about behaviors and perceptions . Managers and supervisors must ensure employees who make complaints Bullies lack insight about their behav- or witnesses are not victimized. Disciplinary action will be taken against iors . It is much easier to confront the behav- anyone who bullies a co-employee. ior when it happens again if those blind

Ideas or Suggestions Welcome! Do you have any ideas or suggestions for the next Washington Nursing Commission newsletter? Would you like more information on a specific nursing regulation or law? Is there something you think we should address or include in future issues? Please submit suggestions to: [email protected]

washington Nursing Commission News 13 By Ron Hofeldt, MD and Patricia I. McCotter, RN, JD, CPHRM, CPC

Nurses as Second Victims: Supporting Our Colleagues Following an Adverse Event

John Nance’s award-winning book, patient-related injury who becomes vic- Why Hospitals Should Fly: The Ultimate timized in the sense that the provider is Common second victim Flight Plan to Patient Safety and Quality traumatized by the event. Frequently, sec- symptoms include: Care, describes health care as a complex ond victims feel personally responsible for Physical symptoms system with potential for catastrophic con- the unexpected patient outcomes and feel • sleep disturbances sequences . Health care is a human enter- as though they have failed their patients, • difficulty concentrating prise—and as a result, it is imperfect . Any second-guessing their clinical skills and • eating disturbance process involving humans will be prone to knowledge base. • headache errors . We should recognize that it is not When an error occurs, nurses report • fatigue a matter of if, but when, because humans that they isolate themselves and withdraw • diarrhea will always make mistakes regardless of in shame . Some will scrupulously review • nausea or vomiting our training . In fact, most preventable the moments of the event countless times, • rapid heart rate harm done to patients is caused by unin- thinking “If only I would’ve…” They • rapid breathing tended human error and systems failures . will condemn themselves as being not • muscle tension According to Donald Berwick, MD, good enough, and second-guess other Psychological symptoms outgoing administrator of Center for clinical decisions . They will struggle to • isolation Medicare and Medicaid Services (CMS) concentrate and suffer a host of physical • frustration and former president and Chief Executive problems . Unfortunately, the risk of mak- • fear Officer (CEO) of the Institute for ing a subsequent error also grows when • grief and remorse Healthcare Improvement, few health care a health care provider experiences the • uncomfortable returning to work organizations use a systematic way of stress and symptoms of a second victim . • anger and irritability taking care of their clinicians who find Therefore, offering a warm hand of sup- • depression themselves involved in adverse events that port to an affected nurse is not just the • extreme sadness harm patients . Instinctively as clinicians ethical thing to do, it is the safest thing • self-doubt our hearts naturally go out to the injured to do . • flashbacks patient and family when something bad In 2007, a University of Missouri Source: University of Missouri happens . They are the first and most Health Care system survey reported that Health Care important victim . However, clinicians are one in seven caregivers (14 percent) had hurt too . Moreover, if we are really heal- experienced a patient safety event within ers, then we collectively have a job of heal- the past year that had caused personal Promoting a culture of ing them too . problems such as anxiety, depression, or caregiver support Nurses and other health care providers concerns about the ability to perform one’s Today too few nurses are supported dealing with the emotional aftermath of a job . By 2010, a follow-up survey showed adequately by their organizations fol- have been described in litera- the number had climbed to one of every lowing an adverse event . However, sev- ture as the “second victims .” Researcher three- caregivers (30 percent) . eral promising support models are being Susan Scott, RN, MSN, at University of Nurses are part of this vulnerable developed and implemented by Scott Missouri Health Care, developed this com- group . A study of nurses, physicians, and and by others . These programs raise monly used definition: pharmacists found that nurses were the awareness through all-staff education, A second victim is a health care pro- group most likely to report negative emo- and provide support from peers and vider involved in an unanticipated adverse tions and fear of disciplinary action or specially trained rapid-response team patient event, medical error and/or a punishment . members .

14 washington Nursing Commission News Washington Nursing Commission News 07/06/2012 1739917-PAPC75878 YAKREM 2.5” x 4.875” Jennifer Boyd v.6

Nurses and other health Registered care providers dealing Nurses with the emotional aftermath of a medical Reach Yakima Regional Medical and error have been described Cardiac Center and Toppenish in literature as the Community Hospital have a Recruit lot to offer RN’s at our hospitals. “second victims .” We are located in sunny Central Washington within the Yakima One example is a program at Retain Valley Wine Country and nationally University of Missouri Health Care, recognized recreational areas. Both

O 2. EDITION 12 • VOLUME 6. N forYOU, which provides 24/7 free, con- SUMMER 2012 hospitals provide state of the art fidential support to clinicians reacting nursing care at the highest acute Winter 2010 • Volume 4. n o 1. e dition 7 care levels. Learn about our nursing to a stressful event or outcome . Trained SUMMER 2009 • VolUME 3. No 2. EditioN 6

Fingerprint Cards for Endorsement Applicants Page 12 opportunities by visiting our websites Washington Health Professional peers from a range of disciplines support Services (WHPS): Recovery That Saves Lives Page 14 Washington Center at www.yakimaregional.com and for Nursing Update caregivers one-on-one, so the caregiver “Bridging” from Page 16 Clinical Nurse Home-Care Aide Specialist Survey or Medical Assistant www.toppenishhospital.com. Page 15 to Nursing Assistant Changing Times Promotes can explore normal reactions and feel- Continued Focus on Patient Safety Certified Page 10 Page 15 Patient Injury: It’s Not Just the Physician Being Sued Nurses as Second ings after adverse events . Additionally, Page 18 Victims: Supporting Our Yakima Regional Official publicatiOn Of Colleagues Following Official publicatiOn Of the WashingtOn state nursing care Quality the WashingtOn state nursing care Quality assurance cOmmissiOn and the WashingtOn an Adverse Event assurance cOmmissiOn and the WashingtOn state department Of health state department Of health Page 14 Human Resources The Process of forYOU educates co-workers and their Investigation: Fact v. Fiction 110 South 9th Avenue Page 23 families about the second victim phe- OFFICIAL PUBLICATION OF RE QUALITY 1 INGTON THE WASHINGTON STATE NURSING CA COMMISSION NEWS Yakima, Washington 98902 washington NURSING ASSURANCE COMMISSION AND THE WASH nomenon and prepares managers with STATE DEPARTMENT OF HEALTH tools to support second victims . Reaching over 100,000 As nurses, you can begin to promote this culture shift by advocating for Washington Nurses EEO/AA MFVD implementation of robust provider sup- Washington Nursing port programs in your . An excellent resource to help an organiza- Commission News tion get started is Medically Induced EASTERN STATE to reserve advertising space Trauma Support Services (MITSS), a HOSPITAL ARNP nonprofit organization that helps sup- contact Michele Forinash [email protected] Eastern State Hospital, the 287 port healing of patients, families, and bed state psychiatric hospital in eastern WA, clinicians affected by a medical trauma . is recruiting for an advanced practice RN Its Web site, at www.mitss.org, offers 1-800-561-4686 ext.112 (ARNP) to provide medical care on the Adult downloadable clinician-support tool- Psychiatric, Forensic or Geropsychiatric Unit kits and resources for organizations Our nursing journals are with a caseload of 30 patients. The ARNP would be part of the treatment team, which and individuals . Please feel free to con- mailed directly to over 1.5 million is comprised of the attending psychiatrist, tact the authors directly for additional nurses, healthcare professionals medical provider, social worker, RN, and resources, literature, and support . and educators nationwide. recreation therapist. The ARNP will treat As John Nance wrote, human mis- common medical conditions and refer the North Carolina Arizona patient for consultation to providers in the takes are inevitable . Nevertheless, when Arkansas North Dakota community for care that cannot be provided they occur, we as healers can help The District Ohio at ESH. ESH is twenty minutes southwest of alleviate our co-workers’ suffering, per- of Columbia Oregon Spokane. The ARNP is a member of the ESH haps as well as our own . Indiana South Carolina Kentucky South Dakota Medical Staff comprised of 30 psychiatrists, Mississippi StuNurse/Nationwide physicians, ARNPs, and physician assistants. Ron Hofeldt, MD, is Director of Physician Montana Tennessee ARNPs are credentialed and privileged. Affairs at Physicians Insurance. Patricia I. Nebraska Washington McCotter, RN, JD, CPHRM, CPC, is the Nevada West Virginia Director of Facility Risk Management and Contact Shirley Maike, 509.565.4352 Provider Support at Physicians Insurance. New Mexico Wyoming email: [email protected] She can be reached at [email protected] or Eastern State Hospital (206) 343-6511. More information may be PO Box 800 found at www.muhealth.org/secondvictim ThinkNurse.com Medical Lake, WA 99022-0800.

washington Nursing Commission News 15 Adapted from Scott, S., Hirschinger, L. and Cox, K. (2008). Sharing the load of a nurse “second victim.” RNWeb, 71(12): 38-43

Recognizing and Helping the Nurse “Second Victim” Common Second Victim Physical Symptoms • Uncontrolled crying/shaking • Increased blood pressure • Extreme fatigue/exhaustion • Abdominal discomfort • Sleep Disturbances • Nausea, vomiting, diarrhea • Muscle tension • Headaches

Key Phrases that Indicate Coping Difficulty • “…sickening realization of what has happened.” • “This will alter the way I work from now on.” • Fear of damage to professional life • “I don’t deserve to be a nurse .” • Excessive excitability • “This has been a career-changing event for me.” • Avoidance of patient care areas • “This event shook me to the core. I’ll never be the same.” • “This is a turning point in my career.” Key Words to Stimulate Conversation with • Other phrases post critical events. Second Victims • “Are you OK?” Key Actions for Supporting Individual • “I’ll help you work through this.” Peer/colleagues • “You are a good nurse working in a very complex • “Be there” – Practice active listening skills and allow the environment .” second victim to share his or her story . Offer support as you • “I believe in you.” deem appropriate . • “I’m glad that we work together.” • If you have experience with an adverse event or bad patient • “Please call me if you would like to talk about it again.” outcome yourself, share it . “War stories” are powerful • “I can’t imagine what that must have been like for you. Can healing words . we talk about it?” • If you don’t have experience with an adverse event or bad • “I’m here if you want to talk.” patient outcome, be supportive and predict the victim’s needs . • Avoid condemnation without knowing the story – it could Key Actions for Department Leaders have been you! • Talk with the employee as soon as you become aware of the • Let your peer know that you still have faith in his or her incident . abilities, and that he or she is a trusted member of your unit . • Reaffirm your confidence in him or her as a staff member. • Determine a way that you can make an individual difference. • Consider calling in flex staff to allow time to compose thoughts, prepare if an investigation is anticipated . Common Second Victim Psychosocial Symptoms • Keep the second victim informed of likely next steps in the • Extreme guilt, grief even of an investigation . • Repetitive, intrusive memories • Check on second victim regularly. • Difficulty concentrating • Be visible to all staff; physical presence during post-even • Loss of confidence, self doubt helps decrease anxiety and shows accessibility . • Return to work anxiety • Frustration, anger, depression Permission for use of this document provided by Susan Scott, Patient Safety • Second-guessing career Coordinator, University of Missouri Health Care

16 washington Nursing Commission News

Second Victim Trajectory

Staging Characteristics Common Questions Proposed Institutional Actions

Stage 1 Error realized/ event recognized. How did that happen? Identify second victims Tell someone  get help Why did that happen? Assess staff member(s) ability to Chaos & Stabilize/treat patient continue shift Accident May not be able to continue care of patient Activate” ForYOU Team” Response Distracted support as needed Experience a wave of emotions

Stage 2 Re-evaluate scenario What did I miss? Ensure “ForYOU Team” Self isolate Could this have been Response Intrusive Haunted re-enactments of event prevented? Observe for presence of Reflections Feelings of internal inadequacy lingering physical and/or psychosocial symptoms Provide management oversight of Stage 3 Acceptance among work/social structure What will others think? event. Managing /grapevine Will I ever be trusted again? Ensure incident report completion. Restoring Fear is prevalent How much trouble am I in? Manage unit/team‟s overall Personal How come I can‟t response-“rumor control” esp. Integrity concentrate? Evaluate if event debrief is indicated (Stages 1-3 may occur individually or simultaneously) Identify key individuals involved Stage 4 Realization of level of seriousness How do I document? in event Reiterate case scenario What happens next? Interview key individuals Enduring Respond to multiple “why‟s” about the event Who can I talk to? Develop understanding of what the Interact with many different „event‟ responders Will I lose my job/license? happened Begin answering „why‟ did it Inquisition Understanding event disclosure to patient/family How much trouble am I in? Litigation concerns emerge happen

Ensure emotional response plan in Stage 5 Seek personal/professional support Why did I respond in this progress if needed. Getting/receiving help/support manner? Obtaining What is wrong with me? Ensure Patient Safety/Risk Emotional Do I need help? Management representatives are First Aid Where can I turn for help? known to staff and available as needed.

Stage 6 Dropping Out Is this the profession I should Provide ongoing support of the Transfer to a different unit or facility be in? second victim. Consider quitting Can I handle this kind of Moving On Feelings of inadequacy work? Support second victim in search for alternative (One of Three options within institution. Trajectories Chosen)

Surviving How could I have prevented Provide ongoing support Coping, but still have intrusive thoughts this from happening? Maintain open dialogue Persistent sadness, trying to learn from event Why do I still feel so badly/guilty? Provide ongoing support Thriving What can I do to improve our Support second victim in Maintain life/work balance patient safety? „making a difference‟ for future. Gain insight/perspective What can I learn from this? Encourage participation in case Does not base practice/work on one event reviews involving event Advocates for patient safety initiatives Encourage staff feedback on practice modifications.

Throughout all stages individuals may experience physical and/or psychosocial symptoms. Triggering of symptoms and repetitive thoughts regarding the event can occur anytime during stages 2-6.

Permission for use of this document provided by Susan Scott, Patient Safety Coordinator, University of Missouri Health Care

washington Nursing Commission News 17 Licensure Actions “Many nurses are not aware that it is the NCQAC’s job to protect the public, not to provide support to the respondent (one against whom a complaint has been filed) ”. The Nursing Commission’s orders emphasize return to safe nursing practice . The following is a list of licensure actions taken between January 1, 2011, and December 31, 2011 .

Licensee Date of action Violation Action Bigley, Karla A., RN 01/05/11 Failure to comply with previous order Taylor, Christian F., LPN 01/07/11 Suspension Failure to comply with previous order Taylor, Christian F., RN 01/07/11 Suspension Failure to comply with previous order Stanley, Sharon J., RN 01/07/11 Suspension Failure to comply with previous order McClain, Angela L., RN 01/14/11 Suspension Sexual misconduct Kearns, Sylvia L., RN 01/18/11 Probation Alcohol and other substance ; Violation of federal or state statutes, regulations or rules Patton, Craig R., RN 01/31/11 Suspension Alcohol and other substance abuse; Violation of federal or state statutes, regulations or rules Guse, Debi D., LPN 02/01/11 Probation Violation of federal or state statutes, regulations or rules Ratcliff, Bob L., RN 02/01/11 Monitor License disciplinary action by a federal, state, or local licensing authority Barrett, Rosemary, LPN 02/01/11 Suspension Alcohol and other substance abuse; Criminal conviction; Violation of federal or state statutes, regulations or rules Reed, Gayle A., RN 02/01/11 Voluntary Surrender Misrepresentation of credentials Conahan, Megan A, RN 02/01/11 Suspension License disciplinary action by a federal, state, or local licensing authority; Violation of or failure to comply with licensing board order Kelly, David W., LPN 02/02/11 Suspension Incompetence; Practicing beyond the scope of practice; Violation of federal or state statutes, regulations or rules McClain, Deborah S., RN 02/02/11 Suspension Incompetence; Violation of federal or state statutes, regulations or rules Chandler, Tracy L., RN 02/03/11 Suspension License revocation by a federal, state, or local licensing authority Whittaker, Elizabeth A., RN 02/10/11 Monitor Violation of or failure to comply with licensing board order Howell, Penni H., RN 02/14/11 Suspension Failure to comply with previous order Eisenbeis, Debi R., LPN 02/15/11 Suspension Failure to comply with previous order Miller, Michael E., LPN 02/15/11 Suspension Failure to comply with previous order Barr, Margaret M., RN 02/17/11 Suspension Violation of or failure to comply with licensing board order Brown, Kelly L., RN 02/28/11 Suspension Criminal conviction; License disciplinary action by a federal, state, or local licensing authority Scheerens, Thomas P., RN 03/01/11 Monitor Violation of or failure to comply with licensing board order Werner, Donna E., RN 03/07/11 Suspension Failure to comply with previous order Muhammad, Yahya A. 03/07/11 LPN Licensure Denied Failure to meet initial requirements of a license; License disciplinary action by a federal, state, or local licensing authority Soliven, Rosalina C. 03/07/11 LPN Licensure Denied Failure to meet initial requirements of a license Bain, Sarah M., RN 03/08/11 Suspension Violation of or failure to comply with licensing board order Drury, Sasha, RN 03/08/11 Suspension License disciplinary action by a federal, state, or local licensing authority Robertson, Sean T., RN 03/09/11 Suspension Alcohol and other substance abuse; Violation of federal or state statutes, regulations or rules Christie, Sandra L., RN 03/10/11 Suspension Alcohol and other substance abuse Bethea, Vivian D., LPN 03/16/11 Suspension Incompetence; Violation of federal or state statutes, regulations or rules Marshall, Karen A., RN 03/21/11 Suspension Violation of or failure to comply with licensing board order Harding, Ann M., RN 03/22/11 Suspension License disciplinary action by a federal, state, or local licensing authority Scharf, Jessica A., RN 03/29/11 Suspension License disciplinary action by a federal, state, or local licensing authority Schiller, Sharon K., RN 04/04/11 Suspension License disciplinary action by a federal, state, or local licensing authority Leonce, Alain S. 04/06/11 LPN Licensure Denied Failure to meet initial requirements of a license Bodamer, Michael J., RN 04/06/11 Probation License disciplinary action by a federal, state, or local licensing authority Linville, Patrick I., RN 04/08/11 Suspension Diversion of controlled substance Edge, Brenda J., RN 04/13/11 Suspension License disciplinary action by a federal, state, or local licensing authority Taffer, Rhonda L., RN 04/13/11 Suspension License disciplinary action by a federal, state, or local licensing authority Hendershot, Joshua L., LPN 04/13/11 Licensure Denied License disciplinary action by a federal, state, or local licensing authority; Misrepresentation of credentials Kaluzny, Micah W., RN 04/14/11 Suspension Alcohol and other substance abuse; Failure to cooperate with the disciplining authority; Violation of federal or state statutes, regulations or rules Dyer, Gretchen G., LPN 04/15/11 Suspension Failure to comply with previous order Yost, Michelle A., LPN 04/18/11 Suspension Failure to comply with previous order Fuentes, Juan de Dios, RN 04/25/11 Suspension Sexual misconduct Westcott, Crystal A., RN 04/26/11 Suspension License disciplinary action by a federal, state, or local licensing authority Buechler, Hillary A., RN 04/26/11 Probation Alcohol and other substance abuse; Failure to meet initial requirements of a license; License disciplinary action by a federal, state, or local licensing authority; Practicing beyond the scope of practice Omohundro, Janice M., RN 04/27/11 Suspension Violation of or failure to comply with licensing board order Nolasco, Elsa J. P., RN 05/06/11 Probation License disciplinary action by a federal, state, or local licensing authority Snider, Amie M., RN 05/06/11 Monitor Alcohol and other substance abuse; Criminal conviction; License disciplinary action by a federal, state, or local licensing authority Boardman, Barbara A., ARNP 05/06/11 Suspension Alcohol and other substance abuse; Violation of federal or state statutes, regulations or rules Boardman, Barbara A., RN 05/06/11 Suspension Alcohol and other substance abuse; Violation of federal or state statutes, regulations or rules

18 washington Nursing Commission News Licensee Date of action Violation Action Spradling, Cindy D., RN 05/06/11 Suspension Alcohol and other substance abuse; Violation of federal or state statutes, regulations or rules Chesky, Jennifer M., RN 05/06/11 Suspension Alcohol and other substance abuse; License disciplinary action by a federal, state, or local licensing authority Long-Anderson, Ember R., LPN 05/06/11 Suspension Criminal conviction Zoleta, Carlito A., LPN 05/13/11 Suspension Failure to cooperate with the disciplining authority Dunthorn, Dottie L., LPN 05/18/11 Suspension Failure to comply with previous order Evans, Kathleen J., LPN 05/20/11 Suspension Violation of or failure to comply with licensing board order Vasquez, Rose M., ARNP 05/27/11 Suspension Violation of or failure to comply with licensing board order Vasquez, Rose M., RN 05/27/11 Suspension Violation of or failure to comply with licensing board order Olsen, Andrea M., RN 05/27/11 Suspension Failure to cooperate with the disciplining authority Palmer, Susanna T., RN 05/27/11 Suspension Alcohol and other substance abuse; Diversion of controlled substances, Violation of federal or state statutes, regulations or rules Albert, Allan J., LPN 05/31/11 Monitor Alcohol and other substance abuse; Criminal conviction King, Sara B., LPN 05/31/11 Monitor Narcotics violation; Violation of federal or state statutes, regulations or rules Stokke, Michele M., RN 05/31/11 Suspension Narcotics violation; Violation of federal or state statutes, regulations or rules Ryle, Tracie L., RN 05/31/11 Suspension Incompetence; License suspension by a federal, state, or local licensing authority; Narcotics violation; Violation of federal or state statutes, regulations or rules Jones, Jessica S., RN 05/31/11 Suspension Violation of or failure to comply with licensing board order Anderson, Sharon G., RN 05/31/11 Suspension Incompetence; Narcotics violation; Violation of federal or state statutes, regulations or rules Carroll, Michele, LPN 06/02/11 Suspension Alcohol and other substance abuse; Failure to cooperate with the disciplining authority Blansett, Monica D., LPN 06/06/11 Suspension Failure to comply with previous order Weiss, Beth M., RN 06/10/11 Probation License disciplinary action by a federal, state, or local licensing authority Jones, Belinda F., RN 06/15/11 Suspension License disciplinary action by a federal, state, or local licensing authority Givens, John J., RN 06/15/11 Suspension Violation of or failure to comply with licensing board order Barr, Larry D., LPN 06/23/11 Suspension License disciplinary action by a federal, state, or local licensing authority; Narcotics violation; Unable to practice safely by reason of alcohol or other substance abuse Bourbonnais, Travis A., LPN 06/23/11 Suspension License disciplinary action by a federal, state, or local licensing authority Stone, Betty M. 06/23/11 RN Licensure Denied Immediate threat to health or safety; License disciplinary action by a federal, state, or local licensing authority Hunter, Carmen L., RN 06/24/11 Suspension Failure to comply with previous order Huebner, Russell J., RN 07/12/11 Probation License disciplinary action by a federal, state, or local licensing authority Fischer, Andreas, RN 07/12/11 Probation License disciplinary action by a federal, state, or local licensing authority Paine, Jacqueline K, RN 07/13/11 Suspension Criminal conviction Gannaway, Kimberly R., RN 07/13/11 Suspension Violation of or failure to comply with licensing board order Daddio, Susan J., LPN 07/15/11 Suspension License disciplinary action by a federal, state, or local licensing authority Green, Jennifer A., RN 07/19/11 Probation Criminal conviction; Diversion of controlled substance; Narcotics violation or other violation of drug statutes; Unable to practice safely by reason of alcohol or other substance abuse; Violation of federal or state statutes, regulations or rules Dowty, Ruth D., RN 07/25/11 Suspension Alcohol and other substance abuse; Failure to cooperate with the disciplining authority Raymond, Carlyle, RN 07/25/11 Suspension Violation of or failure to comply with licensing board order Magwood, Bridget T., RN 07/29/11 Suspension Failure to comply with previous order Erickson, Eric T., RN 08/05/11 Suspension Alcohol and other substance abuse Jordan, Amber R., RN 08/10/11 Suspension License suspension by a federal, state, or local licensing authority Walgamott, Anne M., RN 08/11/11 Suspension Violation of or failure to comply with licensing board order Louissaint, Margaret 08/11/11 LPN Licensure Denied Failure to meet initial requirements of a license Thomas, Aleyamma, RN 08/11/11 Suspension License disciplinary action by a federal, state, or local licensing authority Martin, Colleen R., RN 08/12/11 Probation Negligence; Violation of federal or state statutes, regulations or rules Nekola, Kelly., RN 08/18/11 Suspension Violation of or failure to comply with licensing board order Reyes, Cielito A. 08/19/11 LPN Licensure Denied Failure to meet initial requirements of a license Baird, Jennifer L., RN 08/22/11 Suspension Violation of or failure to comply with licensing board order Smith, Anna C., RN 08/22/11 Suspension License disciplinary action by a federal, state, or local licensing authority; Violation of or failure to comply with licensing board order Wincewicz, Wendy L., RN 08/26/11 Probation Error in prescribing, dispensing or administering medication; Incompetence; Violation of federal or state statutes, regulations or rules Milstead, Julie A., LPN 08/26/11 Suspension Sexual misconduct; Violation of federal or state statutes, regulations or rules Brown, Dawn M., RN 08/26/11 Suspension Alcohol and other substance abuse Olsen, Jacqueline K., RN 08/26/11 Suspension Violation of or failure to comply with licensing board order Blake, Nancy D., RN 08/26/11 Suspension Diversion of controlled substance; Narcotics violation; Violation of federal or state statutes, regulations or rules Harris, Marcy C., RN 08/30/11 Probation Alcohol and other substance abuse; Violation of federal or state statutes, regulations or rules Rydberg, Jay W., RN 08/30/11 Probation Mental disorder Kertland, Warren B., RN 09/02/11 Suspension Alcohol and other substance abuse; Failure to cooperate with the disciplining authority; Narcotics violation or other violation of drug statutes Fournier, Perri E., RN 09/14/11 Suspension Violation of or failure to comply with licensing board order Weber, Mary C., ARNP 09/15/11 Monitor Alcohol and other substance abuse; Criminal conviction; License disciplinary action by a federal, state, or local licensing authority Weber, Mary C., RN 09/15/11 Monitor Alcohol and other substance abuse; Criminal conviction; License disciplinary action by a federal, state, or local licensing authority Pudil, Tanya S., RN 09/22/11 Suspension License disciplinary action by a federal, state, or local licensing authority Callicoat, Nicholas W., RN 09/23/11 Probation Violation of federal or state statutes, regulations or rules Smith, Angelica K, LPN 09/23/11 Suspension Narcotics violation; Violation of federal or state statutes, regulations or rules

washington Nursing Commission News 19 Licensee Date of action Violation Action Cusick, Tia, M., LPN 09/26/11 Suspension Violation of or failure to comply with licensing board order Sheldon, Melissa J., RN 09/28/11 Suspension License disciplinary action by a federal, state, or local licensing authority Anderson, Robin M., RN 09/30/11 Suspension Failure to comply with previous order Wrinkle, Amber M., LPN 10/03/11 Suspension Violation of or failure to comply with licensing board order Simmons, Jean A., RN 10/03/11 Suspension License disciplinary action by a federal, state, or local licensing authority McCaslin, Laura F., RN 10/04/11 Suspension License disciplinary action by a federal, state, or local licensing authority Chen, Fang 10/06/11 LPN Licensure Denied Failure to meet initial requirements of a license Pomerinke, Jerriann, RN 10/14/11 Suspension Alcohol and other substance abuse; Criminal conviction; Narcotics violation Radacina, Jenelia I., LPN 10/14/11 Suspension Unable to practice safely by reason of psychological impairment or mental disorder Wee, Li-Phing C. 10/14/11 RN Licensure Denied Failure to meet initial requirements of a license Ackerbauer, Kristen M., RN 10/20/11 Suspension License disciplinary action by a federal, state, or local licensing authority Yang, Liuqing 10/25/11 RN Licensure Denied Failure to meet initial requirements of a license Asrari, Deborah M., RN 10/27/11 Monitor Alcohol and other substance abuse; Violation of federal or state statutes, regulations or rules Breunig, Roxanne B., RN 10/27/11 Probation Error in prescribing, dispensing, or administering medication Weathers, Gina M., LPN 10/27/11 Suspension Narcotics violation; Violation of or failure to comply with licensing board order Swaffield, Gina R., RN 10/27/11 Suspension License disciplinary action by a federal, state, or local licensing authority Scheerens, Thomas P., RN 10/28/11 Suspension Failure to comply with previous order Ngurimu, Anthony K., LPN 10/31/11 Suspension License disciplinary action by a federal, state, or local licensing authority Holl, Melissa F., RN 11/01/11 Suspension License disciplinary action by a federal, state, or local licensing authority Patrick, Sherry A., RN 11/02/11 Suspension Failure to cooperate with the disciplining authority; Unauthorized dispensing of medication; Violation of federal or state statutes, regulations or rules Bliss, Julie A., RN 11/15/11 Monitor Diversion of controlled substance; Narcotics violation; Violation of federal or state statutes, regulations or rules Kemp, Kevan D., ARNP 11/15/11 Suspension Violation of or failure to comply with licensing board order Kemp, Kevan D., RN 11/15/11 Suspension Violation of or failure to comply with licensing board order Pithan, Gregory G., RN 11/15/11 Suspension License disciplinary action by a federal, state, or local licensing authority King, Sara B., LPN 11/16/11 Suspension Failure to comply with previous order Johnson, Ashley M., RN 11/16/11 Monitor License disciplinary action by a federal, state, or local licensing authority McSherry, Gordon E., RN 11/16/11 Suspension Alcohol and other substance abuse; Incompetence; Violation of federal or state statutes, regulations or rules Ratcliff, Bob L., RN 11/17/11 Suspension Failure to comply with previous order Anderson, Elizabeth M., RN 11/22/11 Suspension Unable to practice safely by reason of psychological impairment or mental disorder Petering, Laura A., RN 11/29/11 Suspension License disciplinary action by a federal, state, or local licensing authority Dhaliwal, Balwinder K. 11/29/11 LPN Licensure Denied Failure to meet initial requirements of a license Westby, Linda L., RN 11/30/11 Suspension Failure to comply with previous order Middleton, Judith K., LPN 11/30/11 Suspension Failure to comply with previous order Ayat, Janice C. 11/30/11 LPN Licensure Denied Failure to meet initial requirements of a license Haverty, Joseph D. 11/30/11 LPN Licensure Denied Failure to meet initial requirements of a license Freeman, Clarice C., LPN 12/21/11 Probation Alcohol and other substance abuse; Criminal conviction Gregory, Michael A., ARNP 12/22/11 Monitor Patient abuse; Sexual misconduct; Violation of federal or state statutes, regulations or rules Gregory, Michael A., RN 12/22/11 Monitor Patient abuse; Sexual misconduct; Violation of federal or state statutes, regulations or rules Thamert, Carol J., ARNP 12/22/11 Probation Mental disorder • Phlebotomy Thamert, Carol J., RN 12/22/11 Probation Mental disorder Gotelli, Christine A., RN 12/22/11 Probation License revocation by a federal, state, or local licensing authority Training Schreck, Carol A., RN 12/22/11 Probation Incompetence; Violation of federal or state statutes, regulations or rules• The “NEW” ICD-10 Everest College Waters, David B., RN 12/22/11 Monitor License disciplinary action Nursingby a federal, state, Networking or local licensing authority Henderson, NV Bailey, Brandon L., RN 12/22/11 Monitor Alcohol and other substance abuse;Classifieds Criminal conviction; (1.5” Violation wide of federal x 1” or state high) statutes, Certification RN program regulations or rules seeking applications for Ketcham, Donna J., RN 12/22/11 Suspension Narcotic violation; Violation of federal or Contactstate statutes, regulationsGreg Jones or rules at • EKG Training both PT and FT positions Harris, Sharon K., RN 12/22/11 Suspension Criminal conviction; License [email protected] action by a federal, state, or local licensing authority in all specialty areas Stewart, Kenya M., LPN 12/27/11 Suspension Criminal conviction Call Today NURSING FACULTY Picou, Nancy L., LPN 12/29/11 Probation Narcotics violation or other violation of drug1-800-561-4686 statutes ext. 105 702.645.7900 MSN preferred or BSN working on MSN Doering, Deborah L., RN 12/29/11 Suspension License disciplinary action by a federal, state, or local licensing authority Send & www.medicalskillsforlife.com CV/Resume to: [email protected] Thrive in Alaska! The Nurse ‑ New Hospital Opening 2012 ‑ Network ER & OB Nursing Opportunities The “NEW” in natural Northwest Alaska! Classifieds Contact FT Faculty Position NORTON SOUND HEALTH w/MSN Degree, Pharmacology Med/Surg experience Michele Forinash Rhonda Schneider, HR preferred. Great Benefits! Employment 148 Electronic Submission [email protected] Free Employer Accounts (877) 538-3142 or [email protected] application available online or email Renee Knapp Call for More Details 1-800-561-4686 ext.112 Visit www.nortonsoundhealth.org Human Resources [email protected]. [email protected] www.bdfingerprinting.com

20 washington Nursing Desert View Hospital in Pahrump Nevada is seeking Commission News exceptional per-diem RNs and LPNs to work in our 25-bed critical access hospital with openings in all departments. Our Surgical Services (OR) Department is currently seeking Full Time, Part time and Per Diem RNs. You could work anywhere. You’re called to work here.

Providence is calling.

We’re looking for At Providence, we believe that nursing is more than Registered Nurses just a great career. It’s a calling. Discover what makes to answer the call. Providence different.

Nursing positions available in the following areas: • Nursing Leadership • Nurse Practitioners • Experienced Staff Nurses in Acute Care, Clinics, Home Care, Hospice, and Long Term Care

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washington Nursing Commission News 21 By Donna Poole, ARNP NCQAC Pro Tem Member My Personal Experience with a Complaint Against My License

I cannot imagine what it would be like care, so when we cause pain or distress by you have somewhere to turn, you will to commit a serious clinical error, but I accident, we suffer as well . The idea of come out of the shadows . To cut down know what it is like to have a complaint second victim is somewhat new: on the secrecy and shame, I have person- filed against my nursing license . Second victims are health care provid- ally resolved to tell my story whenever Several years ago at a professional ers who are involved in an unantici- appropriate . organization retreat we discovered that pated adverse patient event, in a medical Many nurses are not aware that it is the over half of us in attendance had expe- error and/or a patient related injury and NCQAC’s job to protect the public, not rienced complaints against our nursing become victimized in the sense that the to provide support to the respondent (one licenses . Our group was made up of provider is traumatized by the event. against whom a complaint has been filed) . leaders, officers or former officers, and Frequently, these individuals feel person- However, the NCQAC can provide links award winners . If half of this group had ally responsible for the patient outcome. and connections so the respondent knows weathered a complaint, we speculated Many feel as though they have failed the where to turn for help . The NCQAC that a significant number of our general patient, second-guessing their clinical can partner with agencies and profes- members had also suffered this humilia- skills and knowledge base.1 sional associations to publicize supports tion . When one receives a complaint, the Whether a serious error has occurred and resources . I would even propose that response is feeling alone, disgraced, and or not, I would argue that any nurse who the NCQAC create a “Bill of Rights for guilty, whether a violation has been com- experiences a complaint feels failure and Respondents .” mitted or not . wonders what could have been done dif- We might wish there was no need As a pro tem member of the Nurs- ferently to satisfy the complainant . for the disciplinary process, but as long ing Care Quality Assurance Commission My experience has led me to reflect on as it exists it should be understandable (NCQAC) my primary responsibility is for how and who should provide support to and transparent . There is no shortage of the disciplinary process . I review investiga- nurses . Agencies that employ nurses cer- shame, guilt and humiliation when some- tor reports and make recommendations to tainly play a big role in providing support . thing goes wrong . All agencies and orga- a review panel based upon the standards My agency provided an attorney to help nizations must work together to avoid the of practice . However, nothing in my work me respond to the complaint, which pro- proliferation of second victims . on the NCQAC prepared me for being the vided me relief and guidance . Professional Reference: subject of a complaint . organizations are in an ideal position to 1SD Scott, LE Hirschinger, KR Cox, M McCoig, Every nurse’s nightmare is committing reach out to members . Individuals must J Brandt, and LW Hall . The natural history of recovery for the healthcare provider “second a serious error . Most of us go into nursing feel that they have the resources needed to victim” after adverse patient events . Qual Saf with the intent of providing comfort and ask for and receive support . If you know Health Care 2009:18 p . 326

Nursing Care Quality Assurance Commission Meeting Dates We invite you to attend! All business meetings and workshops are open to the public . We strongly DATES encourage nurses and students to attend meetings to learn about issues addressed by the commission . July 13, 2012 Two weeks prior to each meeting, we place an agenda and location sites on the Web site at September 14, 2012 http://www.doh.wa.gov/hsqa/Professions/Nursing/minutes.htm . Topics range from rules, advi- sory opinions and school approvals to subcommittee reports . Business meeting agendas include November 9, 2012 an opportunity for you to comment . Workshops include training opportunities for commission members . We hope to see you at a future meeting .

22 washington Nursing Commission News By Catherine Woodard, Chief Investigator, Nursing Care Quality Assurance Commission The Process of Investigation: Fact v. Fiction

So you come home from a long, demand- assigned health care investigator (of which with witnesses and gathered documents, or ing shift one day and there is a letter in your there are nine in the NCQAC unit, includ- may speak with the respondent early in the mailbox from the Department of Health, ing the chief investigator) begins the investi- investigation . At some point, usually after informing you that you are the subject of an gation by gathering documents and records a careful records review, the investigator investigation . Your heart sinks as you read related to the allegation(s) the complainant will contact the respondent with a detailed the words; you slump in your favorite chair made against the respondent . Depending letter of allegation and give the respondent and think, “What’s next?” on the allegation, the investigator may an opportunity to address the allegations RCW 18 130. defines the process and also contact witnesses, asking for written and tell their side of the story . This is most authority of the Nursing Care Quality statements that address specific issues . The often done by mail and written response, Assurance Commission (NCQAC), and you investigator does this by writing a letter of but could also be an in-person interview . can find the details of the 25 sections of cooperation to the witnesses, asking very The respondent also has 14 days to return conduct, acts, and conditions that constitute specific questions . Witnesses and facilities a statement . unprofessional conduct in RCW 18 .130 .180 . must submit the requested information Investigators encourage respondents to This includes the requirement for a licensee within 14 days . be thorough in their responses, as this to cooperate with the disciplining authority . Depending on the nature of the inves- is the respondent’s first opportunity to Investigators refer to the nurse under tigation, investigators may wait to contact inform the commission about the situa- investigation as the respondent . The the respondent until after they have spoken continued on page 24

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washington Nursing Commission News 23 tion . It is also appropriate to submit other dents must submit a letter of representation the case . The investigator is always willing documentation you have that supports to the investigator as soon as possible so to answer questions about the process to your statement . investigators may speak with the attorney concerned respondents, but cannot discuss At any time during the course of the about the case . the details of the investigation . investigation, the respondent has the right Finally, the investigator’s role is to gath- Once the case file leaves the investiga- to retain legal counsel at their expense . The er all the appropriate evidence and state- tions unit, a staff attorney and reviewing investigation is confidential and the law ments in an investigative file and describe commission member review the file to prohibits investigators from discussing the the evidence in a report . The investigator is determine next steps . Look for a sequel facts of the case with anyone not directly not a decision maker and cannot draw con- article about the rest of the process in a involved . Attorneys representing respon- clusions or make recommendations about future newsletter issue .

By Tom Bolender, Licensing Unit Should I Place My License Into Inactive Status or Let It Expire?

Washington Nursing Care Quality The nurse who takes a from work- Assurance Commission licensing staff mem- So which is the best ing in Washington for less than three years bers receive many calls every day with option? Should I place will find the inactive status a great option . this question: So which is the best option? my license into Inactive The same is true for a travel nurse who Should I place my license into Inactive sta- wants to come back to Washington within tus or let it expire? That is a question to status or let it expire? three years . Remember: the nurse completes ask yourself and be sure you understand the That is a question to a Reactivation application when a license consequences of each choice . ask yourself and be expires for more than one year, or is in Oftentimes a nurse feels she has worked sure you understand inactive status for more than three years . hard to achieve her status as a nurse and Starting in 2014, the requirements for has a hard time with the thought of letting the consequences of reactivating a license from either the inac- it expire . Many nurses moving out of state each choice . tive or expired status will change . At that believe they should never let their original time, any nurse in inactive status for any license expire . Some are only planning not legal to work as a nurse in the state of period of time, or in expired license status to be gone a short time, while others are Washington while in inactive status . for more than one year must complete a taking a break from the profession . The You have up to three years to renew continuing competency agreement with the travel nurses who work in our state, but your license by simply paying the full commission . This agreement requires the also may have an assignment out of state, renewal fee . If your license is in inactive nurse to sign a contract agreeing to accu- frequently do not want to pay for a license status, you must fill out a Reactivation mulate 177 practice hours and 15 hours of they are not going to use . Each of these application . If you wish to return to active within the first year situations is understandable . So what do practice from inactive status, you may do of renewal . If the nurse fails to accumulate you do? so for up to three years by simply paying the specified hours, a refresher course is For the nurse who does not want to the full renewal fee . You must also take a then required . Once those requirements let her license go, this is a very hard ques- refresher course if your license is in inactive have been met, the nurse can resume the tion . If you place your license into inactive status for more than three years, or has regular three year continuing competency status you will be required to renew your expired for more than one year . You can cycle of 531 practice hours and 45 continu- license each year at a reduced rate . The RN reactivate your license in your original state ing education hours every three years . inactive status renewal is $65 compared of licensure at some point in the future . In the end, the decision is yours . I hope to the regular license renewal amount of You must follow the reactivation require- the information you have received will help $101 . The LPN inactive status renewal fee ments by the laws of that state . . You are you make an informed decision . If not, is $45 annually compared to the regular not required to retake the National Council please feel free to call Tom Bolender at 360- license renewal amount of $96 . Note: it is Licensing Examination (NCLEX) . 236-4700 for more information .

24 washington Nursing Commission News By Usrah Claar-Peck, MSN, RN Mindy Schaffner, PhD, MSN, CNS, RN Nursing Education in Washington State Thirty-nine colleges and universities in the state of Washington education for care providers . The number of associate degree reg- offer nursing programs . Thirty of the nursing programs are istered nurses completing a bachelors degree in nursing increased nationally accredited; all are approved by the Nursing Care 115 percent over the last nine academic years . The number Quality Assurance Commission (NCQAC) . Even with budget of Advanced Registered Nurse Practitioner (ARNP) graduates reduction, public and private academic institutions have main- increased 41 percent over ten academic years . Non-ARNP mas- tained their commitment to nursing education . Over the last ten ter’s degree in nursing graduates over the same ten years increased academic years, the number of practical nursing graduates has 540 percent . The number of doctoral degrees awarded over the increased 48 percent . In the same ten academic years, associ- last six academic years increased 270 percent . (See Figure 2) ate degree registered nursing graduates increased 101 percent . Bachelor of Science and Graduate Entry registered nursing grad- Post‐Licensure Nursing Programs uates increased 116 percent over these ten years . (See Figure 1) . Graduates

450 400 Pre‐Licensure Nursing Programs 350 Graduates 300 1800 250 1600 200

1400 150 100 1200 50 1000 0 RNB MSN MSN/ARNP PhD/DNP 800 2001‐2002 25 157 600 2002‐2003 200 65 126

400 2003‐2004 195 93 120 2004‐2005 251 69 170 200 2005‐2006 209 136 177 10 0 2006‐2007 231 101 151 13 LPN AD‐RN BSN/GE 2001‐2002 552 799 374 2007‐2008 290 135 171 18 2002‐2003 558 853 432 2008‐2009 264 125 214 16 2003‐2004 661 922 453 2009‐2010 278 98 204 33 2004‐2005 759 1179 560 2005‐2006 505 1447 666 2010‐2011 429 160 228 37 2006‐2007 820 1615 745 2007‐2008 718 1605 809 2008‐2009 616 1668 827 Nursing programs do not have space for the number of quali- 2009‐2010 684 1516 885 2010‐2011 817 1603 808 fied applicants requesting entry . For the last two academic years, programs report admitting 40-60 percent of qualified applicants . One indicator of nursing education quality is pass rates on the Two factors continue to limit the size of nursing programs . national licensing exam . Average pass rates for Washington’s Programs have difficulty hiring nursing faculty, primarily because practical and registered nursing candidates consistently exceed academic are lower than health care facilities . Nursing the national average . faculty is leaving nursing education, either retiring or seeking Demographics among pre-licensure programs show that higher elsewhere . The other limiting factor is availability of practical nursing programs have more diversity . Less than clinical learning sites for students . Over half of nursing programs half of practical nursing students identify as white/Caucasian . report difficulty identifying adequate clinical sites . Approximately 70 percent of registered nurse students identify NCQAC publishes an annual summary of data from as white/Caucasian . Bachelor degree programs report an aver- Washington State nursing programs . These reports are avail- age student age of 25 years . Associate degree programs report able on our Web site: http://www.doh.wa.gov/hsqa/Professions/ an average student age of 32 years . All programs report 79-87 Nursing/NursingPrograms.htm percent of the students are women . For more information regarding this article contact Mindy The increasing complexity of health care demands continuing Schaffner at [email protected] .

washington Nursing Commission News 25 By John Furman PhD, MSN, Executive Director Washington Health Professional Services “I shall always be grateful that there was a program for me to be part of. Without this program I would have lost my nursing license, my livelihood and my future… I walk tall and hold my head high as a nurse and a woman in recovery.” Quote from a WHPS program participant.

I am excited to write this article as the The mission of WHPS is to ensure entry untary participation in the WHPS pro- Washington Health Professional Services into recovery for the impaired practitioner gram is fully confidential . (WHPS) executive director . With more while providing protection of the public’s • Alternative to Discipline: A licensing than 30 years of state service working in safety . It does this by: authority or the department may refer behavioral health, chemical dependency, • Protecting the public’s health and a health care professional to the WHPS and occupational health, WHPS provides safety from impaired practitioners; Program as an alternative to license the greatest opportunity for me to support • Retaining skilled, highly trained practi- discipline . public health and health care professions . tioners; • License Discipline: A licensing author- Nurses are valuable professionals, com- • Encouraging and promoting recovery; ity may refer a health care professional munity members, and individuals . The and through an order for monitoring . WHPS program provides an avenue for • Bringing the health care professional Confidentially is a key component of nurses who misused substances to re-enter safely back to practice . the WHPS program . Confidentiality of the work force as productive profession- WHPS uses diagnosis, treatment, and WHPS participants and records is pro- als . My goal is to apply my experience compliance monitoring to ensure struc- tected by state and federal law . It is as a nurse and manager to continue the ture and accountability of nurses with much more likely that nurses will seek and WHPS program’s history of excellence substance use disorders . Once the nurse engage in treatment when they feel secure . while at the same time being responsive to completes a chemical dependency evalua- the always changing health care landscape . tion, the case consultant team develops a Contact WHPS customized monitoring plan to ensure the We provide education and consulta- Washington Health Professional best opportunity to return safely to prac- tion services free of charge to employ- Services tice . In addition, we work closely with ers, schools and universities, and profes- WHPS is an abstinence-based monitor- employers to support continued employ- sional associations . WHPS staff is avail- ing program designed for nurses impacted ment and ensure patient safety . able to assist in planning and consultation by substance use disorders . The program for interventions with nurses who may focuses on early detection, referral to Program Participation be diverting drugs from the workplace treatment, and recovery monitoring . The WHPS currently monitors more than or coming to work impaired . You can American Nurses Association estimates 400 nurses . Nurses may enter the WHPS find more information about WHPS at that six to eight percent of nurses use alco- program several different ways: http://www.doh.wa.gov/hsqa/professions/ hol or drugs to the extent that is sufficient • Voluntary: We encourage self-referral. WHPS/default.htm or you may send ques- to impair professional performance . It speeds treatment and recovery . Vol- tions to [email protected]

By Chris Baumgartner, Director Washington State Prescription Monitoring Program Washington’s Prescription Monitoring Program

A new tool in patient care is now fully went live to providers on January 4, 2011 . have been dispensed to patients . Data col- operational and available for prescribers, The Washington State Department of lection began in October 2011 and as of pharmacists, and other licensed health pro- Health is very pleased to bring this new March 12, 2012 the system has more than fessionals to use . Prescription Review (the resource online . It provides important 5 .5 million records and more than 6,000 state Prescription Monitoring Program) information on controlled substances that providers have registered for and received

26 washington Nursing Commission News By Amanda Whipple, Licensing Unit access . Over 700 Advanced Registered Nurse Practitioners (ARNP) have already registered for and received access . Of the 3,540,188 records collected in It Can’t Be That Easy, 2011 more than 900,000 of them were for Can It? Hydrocodone Acetaminophen . This one drug accounted for a quantity of more than 49 mil- What is the secret to a quick lion pills . and painless licensing process in This lack of attention Between October 1, 2011 and February 29, Washington State, you ask? Drum- to detail poses an even 2012 more than 477,000 individuals in Wash- roll please . The secret is reading bigger problem when ington State received at least one prescription the License Requirements in the using recruiting agencies . for a II drug . During that same Endorsement Application packet . time period more than 713,000 individuals Yup, it’s really that easy . Endorsement The fingerprint-based background received at least one prescription for a sched- Application instructions and require- check may complicate the endorse- ule III drug . ments provide step-by-step guidelines ment process . Non-resident applicants Practitioners may request prescription his- to help nurses be proactive . I must must complete this requirement (no, tory reports for their patients from the pro- say, about 60 percent of these ques- it doesn’t matter if a nurse has been gram . The information is online 24 hours a tions I receive wouldn’t be asked if fingerprinted by the other 49 States) . day, seven days a week anywhere that a user the applicant read the instructions The Nursing Care Quality Assurance has Internet access . and requirements; which leads me Commission (NCQAC) mails a finger- To register to access the information… to assume instructions/requirements print packet to the nurse once an out-of- 1 .On or after December 12, 2011, visit the are oftentimes skimmed through (or state application comes into our office . following site (http://www.wapmp.org/ thrown out accidentally on purpose! Upon review of a complete application, practitioner/pharmacist/) to register by fol- Gasp!). This lack of attention to detail the Commission issues a temporary lowing the steps in the Training Guide for poses an even bigger problem when practice permit to the nurse who com- Practitioners and Pharmacists posted there . using recruiting agencies . pletes fingerprints . Temporary practice 2 . If you have a Washington State health care Many travel nurses hold multiple permits are active for six months only . provider license, fill out the online form state licenses making use of recruiting Let me do a quick summary of the and submit it . If you are an out-of-state agencies beneficial . However, nurses at highlights: practitioner or are unable to successfully times put 100 percent of the responsi- • Application: submit the form online, complete the form bility of licensing on recruiters, causing Pay correct application fee ◦ online, submit the information, print the communication wires to criss-cross . Answer all personal data ◦ form, have it notarized, and send it by mail Recruiting agencies and nurses should questions to: Washington PMP | P .O . Box 47852 | review license requirements together; Send in original application, not ◦ Olympia, WA 98504-7852 . keeping in mind that the Washington a photocopy 3 . If we approve your account online, the sys- State Nursing Commission cannot • Verification: tem will send you an e-mail containing your provide information to third parties . Original State regardless of status ◦ logon information . If you mail a notarized Nurses are solely responsible for the Nursys .com if your original ◦ form, we will send your logon information progress of their applications . state participates once we review and verify your information . All endorsement applicants must Verification form if your ◦ The department encourages providers to provide verification of their original state does not participate in use this new system to provide improved license regardless of status . Certain Nursys .com patient care and help us prevent prescription states do not participate in the national • Fingerprints: drug misuse . licensing and discipline database called Required for all non-residents ◦ The program Web site (www.doh.wa.gov/ Nursys . In these situations, the nurse’s Temporary license issued if the ◦ hsqa/PMP/default.htm) provides more infor- original must veri- previous two bullet points are met mation and an option to receive updates fy your nursing license in that state . Please read the application instruc- through a listserv . You can also contact PMP Please contact your respective board of tions and requirements . For more infor- Director Chris Baumgartner at 360-236-4806 nursing for verification fees and pro- mation on this topic contact amanda . (prescriptionmonitoring@doh .wa .gov) . cessing timeframe . [email protected]

washington Nursing Commission News 27 By Maddie Maloney Communications Manager, Washington Center for Nursing Addressing Diversity and Education in Washington State: How WCN is Implementing the IOM Recommendations.

For the past eight years, the Washington Center for Nursing (WCN) has worked to facilitate streamlining of nursing education, enhance nursing workforce diversity, and promote nurs- ing to K-12 students and second-career populations . We are changing the land- scape of nursing to increase the number of nurses and to reach the Institute of (IOM) national goal of a nurs- ing workforce with 80% baccalaureate degree or higher by 2020 . We are also helping to implement transition-to-prac- tice programs to provide full support of More Nurses Means More annual conference to clarify the need for new graduates . These are steps for the Education action . Students asked me how the IOM health of Washington . Under health care reform by 2014, recommendations are affecting the indus- approximately 300,000 new individuals try, their and educational choices, Increasing Diversity: Creating an will be eligible for health care coverage in and what steps they might take . Inclusive Nursing Environment the state of Washington . With the expected The National Research Council’s report, of many in our nursing work- The Promise of Nursing In the Nation’s Compelling Interest: Ensuring force, we are looking at a drastic nursing If you attended the Johnson and Johnson Diversity in the Health-Care Workforce, shortage of registered nurses as soon as Promise of Nursing for Washington gala shows health care disparities are reduced 2015 . It is a lack of capacity for applicants in 2006 or 2009, to raise money to fund when the health care workforce reflects rather than a lack of applicants that is our scholarships for nurses and nurse educa- the composition of the general population . problem . In order to teach more nursing tors, mark your calendar for October 20, WCN has reported on Washington’s nursing students, we need more nurse educators . 2012 for gala number three! More infor- workforce diversity and the nursing faculty . mation can be found at the WCN site . The data indicate we must bolster the diver- IOM Recommendations: www.WACenterforNursing.org sity of our nursing workforce to ensure our The Washington Nursing Action increasingly diverse population receives the Coalition (WNAC) is charged with ensur- WCN and Washington’s Future quality care it needs and wants . ing all IOM recommendations are imple- WCN recognizes that in order to cre- Last April, WCN welcomed Christine mented in our state . The four workgroups, ate change, you have to start at the roots . Espina DNP, MSN, RN as our Diversity education, practice, leadership and collab- One of our next projects focuses on intro- Network Director . Christine is helping oration, are beginning their work . To join ducing middle and high school students create a virtual online mentoring program a group or follow a group, email info@ to nursing via new media . We are excit- that supports minority/underrepresented wcnursing .org . ed about reaching a younger generation students by pairing them with experienced WCN has been educating current nurs- through multimedia such as our blog . nurses from like groups . The network will es and nursing students about the IOM Watch for more information at http://www. provide a safe space where experienced recommendations and the impact of these WACneterforNursing.org . We love hear- nurses can help nursing students and new recommendations . Ms . Tieman, Executive ing from you! Feedback, ideas, questions? graduates through their nursing programs Director of WCN, recently spoke at the Please contact Maddiem@wcnursing .org . and during their first jobs . Nursing Students of Washington State We look forward to working with you .

28 washington Nursing Commission News By Martha Worcester, PhD, ARNP ARNP Practice Advisor Washington State Advanced Registered Nurse Practitioner Survey Results

Background & Purpose: Survey Method and Description form advanced practice title in all states; The Nursing Care Quality Assurance The survey was launched at the October knowledge of the role and functions of Commission (NCQAC) recognizes three 27 to 29 Pacific Northwest 34th Annual our state nursing commission; and the designations of Advanced Registered National Conference: Advanced Practice prescriptive authority of advanced prac- Nurse Practitioner (ARNP) in Wash- in Primary and Acute Care Conference tice nurses under federal and state law . ington State . WAC 246-840-302(1) . (880 attended) . NCQAC made the survey The last question was open-ended giving These designations and numbers of available on-line on its Web site from respondents the opportunity to identify licensees are: October through December 2011 . what they considered the most pressing (1) Nurse practitioners (NP)-- 3,811; The survey included ten multiple-choice issues for advanced practice nurses in (2) Certified nurse midwives (CNM)--- questions and one open-ended question . Washington . 787; and (3) Certified registered nurse anesthetists Figure 1: Question: The APRN Consensus Model was: (CRNA)-- 359 . These three groups comprise the 4,957 licensed ARNPs in Washington . (Licensing statistics DOH, 2011) . ARNP titles, scope of practice, degree of independent practice, and state boards of nursing rules differ from state to state . This variation often makes it difficult to move from state to state or for advanced practice nurses to practice to the full extent of their educational preparation . The National Council of State Boards of Nursing (NCSBN) sought to address Figure 2: Question: In my opinion, the title for nurse this issue by working with 48 profes- practitioners should be: sional nursing groups to develop the Advanced Practice Registered Nurse (APRN) Consensus Model . Published in 2008, the goal of the APRN Consensus Model is to lower barriers to practice across state lines by providing a model for consistent titles, education, scope of practice, and legislation . Many states are now using the model to guide education and legislation toward conformity with the model, promoting consistency among states . In furtherance of this goal, a sur- vey was launched by NCQAC to deter- The survey asked respondents how long Results of the Survey mine how well Washington State ARNPs they had been licensed in Washington A total of 579 nurse practitioners understand the model and its origins, State and then surveyed their awareness responded to the survey . Incomplete sur- and to what extent they support selected of the APRN Consensus Model . The veys were set aside . This left 360 surveys elements of the model . survey also included questions on a uni- continued on page 30

washington Nursing Commission News 29 ing education conference of the year was helpful in launching the survey . We look forward to collaborating with ARNPs, • The main limitation of the study was advanced nursing practice associations, and other that it was designed to discard partially stakeholders to work toward accomplishing the goals completed surveys . Although 579 start- set forth in the APRN Consensus Model . ed the survey, only 360 were available for analysis, thus 219 surveys could not be included in the analysis . to use in the analysis . Statistics have been 28 percent reported 20-30 states rounded to the nearest whole number . The 24 percent reported more than 31 states . Implications of the Findings and results follow: “The most pressing issues for ARNPs in Recommendations for Action: Respondents’ Licensure History in Washington State are . . . ” The responses to the multiple-choice Washington State: 223 of the 360 completing the surveys questions highlighted the need to dissemi- • 11 percent had been licensed <1 year made comments . nate more information about both NCSBN • 25 percent had been licensed 1-5 years The most frequent comments by num- and NCQAC: Only 50% of those respond- • 17 percent had been licensed 6-10 years ber who commented on the item were: ing were familiar with the APRN Consensus • 47 percent had been licensed over 10 • 48 – The need for equal pay for equal Model . The preference for a uniform title years . work . for advanced practice nurses throughout the • 40 – The importance of maintaining their United States (91%) was strong . This finding The APRN Consensus Model (see Figure 1): scope of practice and independence . may support efforts to seek title congruence • 50 percent reported some knowledge • 38 – Education issues including: (a) with the APRN Consensus Model . of the APRN Consensus Model access to ; (b) clarity The open-ended questions shed light on • 50 percent reported they were not about the doctoral of nursing practice; key concerns of ARNPs in our state . While familiar with the model . (c) pain management information; (d) the percentage supporting title uniformity understanding regulations; and (e) con- was high, this will require legislation . The Preference Title Uniformity (see Figure 2) tinuing education reporting for renewal degree of concern about protection of the • 91 percent reported preferring a uni- related to the new RN requirements . current scope of practice and indepen- form title throughout the United States • 20 – Barriers to practice: (a) restriction dence in Washington is also strong . • 7 percent reported no opinion of full scope of practice in home health Other prominent concerns reported • 4 percent opined the title should vary and nursing home practice settings due included: (a) ; by state . to federal regulations; (b) limitations in (b) education issues; (c) informing other practice across state lines; and (c) limi- professionals about the advanced practice The questions asked: tations on scope of practice by agencies role; and (d) barriers to practice imposed Awareness of Role and Function of where they were employed . by federal legislation . The survey results Washington State Nursing Commission • 16 – Better education of the public and can assist the NCSBN and NCQAC as • 94 percent – To oversee licensure, disci- other disciplines about their role . they prioritize their goals and help devise pline, scope of practice, and education • 15 – The need for a consistent title, sev- successful strategies for working on issues regulations (Correct) eral mentioned “not too many initials .” of concern to advanced practice nurses . • 73 percent – To respond to inquiries that • 13 – Better access to care for those who In conclusion, the Web site was found to related to laws and rules governing ARNP cannot afford it . be effective in gathering data about ARNP practice in Washington State (Correct) • 9 – The need for respect and recognition viewpoints and can be a useful tool in fur- • 22 percent – To initiate all laws and compared to other professions . ther education and communication about rules that govern and regulate ARNP • 7 – ARNPs need to get together and issues both within the state and across state practice (Incorrect) communicate with one another . lines . NCQAC extends a special thanks to Knowledge of Number of States in all the ARNPs who took the time to respond which Advanced Practice Nurses Have Strengths and Limitations of the to the survey . We look forward to col- Independent Prescriptive Authority Survey: laborating with ARNPs, advanced nursing 18 percent reported 1-10 states • The strength of the study was that the on- practice associations, and other stakeholders 29 percent reported 11-20 states (the cor- line method brought a significant response . to work toward accomplishing the goals set rect answer) Advertising at the largest ARNP continu- forth in the APRN Consensus Model .

30 washington Nursing Commission News WHICH IS THE DOCTOR AND WHICH IS THE NURSE?

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For information, contact: TSgt Sonja Mariner, Health Professions Recruiter (253) 874-7931 or [email protected] • AIRFORCE.COM Washington State Nursing Care Quality Assurance Commission (NCQAC) P .O . Box 47864 Olympia, WA 98504

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