VOLUME 9, ISSUE 4 · JANUARY 2019 SUPPLEMENT THE OFFICIAL JOURNAL OF THE NATIONAL COUNCIL OF STATE BOARDS OF NURSING JOURNAL OFNURSING REGULATION Advancing Nursing Excellence for Public Protection The NCSBN 2019 Environmental Scan: 40th Anniversary Edition National Council of State Boards of Nursing JOURNAL OFNURSING REGULATION Official publication of the National Council of State Boards of Nursing Editor-in-Chief Editorial Advisory Board Maryann Alexander, PhD, RN, FAAN Mohammed Arsiwala, MD Patty Knecht, PhD, RN, ANEF Chief Officer, Nursing Regulation President Vice President, Integration Services National Council of State Boards of Nursing Michigan Urgent Care ATI Nursing Education/Ascend Learning Chicago, Illinois Livonia, Michigan Leawood, Kansas Chief Executive Officer Kathy Bettinardi-Angres, MT Meadows, DNP, RN, MS, MBA David C. Benton, RGN, PhD, FFNF, FRCN, APN-BC, MS, RN, CADC Director of Professional Practice, AONE FAAN Professional Assessment Coordinator, Executive Director, AONE Foundation Research Editors Positive Sobriety Institute Chicago, Illinois Allison Squires, PhD, RN, FAAN Adjunct Faculty, Rush University Brendan Martin, PhD Department of Nursing Paula R. Meyer, MSN, RN Chicago, Illinois Executive Director NCSBN Board of Directors Washington State Department of President Shirley A. Brekken, MS, RN, FAAN Health Nursing Care Quality Julia George, MSN, RN, FRE Executive Director Assurance Commission President-elect Minnesota Board of Nursing Olympia, Washington Jim Cleghorn, MA Minneapolis, Minnesota Treasurer Barbara Morvant, MN, RN Gloria Damgaard, MS, RN, FRE Nancy J. Brent, MS, JD, RN Regulatory Policy Consultant Area I Director Attorney At Law Baton Rouge, Louisiana Cynthia LaBonde, MN, RN Wilmette, Illinois Area II Director Ann L. O’Sullivan, PhD, CRNP, FAAN Adrian Guerrero, CPM Sean Clarke, RN, PhD, FAAN Professor of Primary Care Nursing Area III Director Professor and Associate Dean, Dr. Hildegarde Reynolds Endowed Term Jay P. Douglas, MSM, RN, CSAC, FRE Undergraduate Program Professor of Primary Care Nursing Area IV Director William F. Connell School of Nursing University of Pennsylvania Valerie J. Fuller, PhD, DNP, AGACNP-BC, Boston College Philadelphia, Pennsylvania FNP-BC, FAANP, FNAP Chestnut Hill, Massachusetts Director-at-Large Pamela J. Para, RN, MPH, Elizabeth Lund, MSN, RN Anne Coghlan, MScN, RN CPHRM, ARM, DFASHRM Director-at-Large Executive Director and Chief Risk and Regulatory Specialist Cathy Borris-Hale, RN, MHA Executive Officer Chicago, Illinois Director-at-Large College of Nurses of Ontario Mark Majek, MA, PHR, SHRM-CP Toronto, Ontario, Canada Carolyn Reed RN, MA, FCNA Director-at-Large Chief Executive/Registrar Lori Scheidt, MBA-HCM Sandra Evans, MA Ed, RN Nursing Council of New Zealand Executive Director Wellington, New Zealand The Journal of Nursing Regulation is a quarterly, peer-reviewed professional journal published by Elsevier and supported by the National Idaho Board of Nursing Council of State Boards of Nursing (NCSBN), a not-for-profit Boise, Idaho Carol A. Romano, PhD, RN, organization. NCSBN can be contacted at: 111 East Wacker Drive, Suite 2900 FACMI, FAAN Chicago, IL 60601-4277 Suzanne Feetham, PhD, RN, FAAN Dean and Professor Telephone: 1-312-525-3600 Fax: 1-312-279-1032 Nursing Research Consultant Uniformed Services University of the https://www.ncsbn.org Children’s National Medical Center Health Sciences, Daniel K. Inouye Copyright © 2019. Produced and printed in the USA. All rights reserved. Washington, DC Graduate School of Nursing No part of this publication may be reproduced or transmitted in any form, whole or in part, without the permission of the copyright holder, Visiting Professor Bethesda, Maryland the National Council of State Boards of Nursing. University of Wisconsin Disclaimer The Journal of Nursing Regulation is a peer-reviewed journal. Milwaukee, Wisconsin Linda R. Rounds, PhD, RN, FNP, FAANP Statements, views, and opinions are solely those of the authors and Professor/Betty Lee Evans Distinguished persons quoted. Such views do not necessarily reflect those of the publisher. The publisher disclaims all responsibility for any errors or Professor of Nursing University of Texas any injuries to persons or properties resulting from the use of information Medical Branch School of Nursing or advertisements contained in the journal. Galveston, Texas Subscription, advertising, reprints Go to www.journalofnursingregulation.com or [email protected]. ISSN 2155-8256 Supplement The NCSBN 2019 Environmental Scan: 40th Anniversary Edition National Council of State Boards of Nursing CONTENTS January 2019 • Volume 9 • Issue 4 Supplement The U.S. Nursing Workforce . S3 Registered Nurses and Licensed Practical Nurses/Licensed Vocational Nurses . S3 The 2017 National Nursing Workforce Survey. S5 Aging of the Workforce. S5 Gender, Race, and Ethnic Diversity. S6 Education. S6 Employment Settings and Salary. S6 Telehealth. S6 Advanced Practice Registered Nurses . .S6 Certified Nurse Practitioners. S6 Certified Nurse Specialists. S7 Certified Registered Nurse Anesthetists . S7 Certified Nurse Midwives . S7 HRSA Projections for the U.S. Nursing Workforce. S7 Advancing nursing excellence Regulatory Implications . S8 Nursing Education. S8 for public protection Growing Education Trends. S9 New Graduates . S9 Employment trends . .S10 Private, Public, and For-Profit Programs. .S11 Changes to Nursing Education. S12 Education Program Outcomes . S12 Clinical Experience. S12 Clinical Reasoning. S13 Apprenticeships . .S13 Graduate Nursing Education. S14 Faculty Shortage. S14 Regulatory Implications . S15 Healthcare Delivery . S15 Telehealth . .S16 Remote Patient Monitoring . .S17 Emerging Technology . .S17 Artificial Intelligence-Assisted Diagnosis. .S17 Personalized Technology . S17 Shared Ledger Technology (Blockchain) . S18 Regulatory Implications . S19 Legislation and Policy Issues. S19 Mission The Nurse Licensure Compact. S19 The Journal of Nursing Regulation provides a The Consensus Model for APRN Licensure, Accreditation, Certification and Education: An Update. S20 worldwide forum for sharing research, Removing Barriers for Veterans . .S20 evidence-based practice, and innovative From Soldier to Nurse . S20 strategies and solutions related to nursing Occupational Licensure: Barrier or Public Safety Defender . .S21 regulation, with the ultimate goal of State Occupational Licensure Measures. S21 safeguarding the public. The journal North Carolina State Board of Dental Examiners v. Federal Trade Commission . S21 maintains and promotes National Council Federal Action Related to Licensure Reform . S22 of State Boards of Nursing’s (NCSBN’s) values of integrity, accountability, quality, Student Loan Defaults . S22 vision, and collaboration in meeting readers’ SUPPORT for Patients and Communities Act . S23 knowledge needs. Regulatory Implications . S23 Social Issues Affecting Nursing and Regulation . S23 Manuscript Information Update on the Opioid Epidemic . S23 The Journal of Nursing Regulation accepts Initiatives Addressing the Opioid Epidemic . S24 timely articles that may advance the science of nursing regulation, promote the mission Medical and Recreational Marijuana Use. S25 and vision of NCSBN, and enhance com- Nurse Ambassadors . .S26 munication and collaboration among nurse Nurses and #MeToo and TIME’S UP Movements . S26 regulators, educators, practitioners, and the Regulatory Implications . S26 scientific community. Manuscripts must be International Issues . S27 original and must not have been nor will be The 2018 Ebola Outbreak . .S27 submitted elsewhere for publication. See www.journalofnursingregulaton.com for Summary and Conclusions. S27 author guidelines and manuscript submis- References . S29 sion information. Appendix A: Board of Nursing Position and Advisory Statements . S36 Letters to the Editor Send to Maryann Alexander at Appendix B: 2018 Center for Regulatory Excellence Research Grants. S40 [email protected]. S2 Journal of Nursing Regulation The NCSBN 2019 Environmental Scan: 40th Anniversary Edition n 2018, the National Council of State Boards of Nursing (NCSBN) commemorated 40 years since its founding in 1978. This milestone was more than just an opportunity to celebrate, it was an opportunity to measure the impact, outcomes, and progress Imade as an organization. It was also an opportune time to determine the organization’s influence and effectiveness, and reflect on the safety of nursing care and the daily vigilance of boards of nursing (BONs). In its mission to assist BONs, NCSBN publishes an annual environmental scan to help BONs strategically plan, anticipate, and prepare for new challenges on the horizon. The scan describes the state of the workforce, nursing education, healthcare delivery, tech- nological advancements, and policy and legislation. It also describes social, emerging regulatory, and international issues impacting regulators and summarizes the actions of BONs around the country. This environmental scan commemorates 40 years of NCSBN’s work with BONs. Glimpses of the past are scattered throughout to remind us of the regulatory environment in 1978 and how much nursing and healthcare have changed, and stayed the same, since then. The U.S. Nursing Workforce Registered Nurses and Licensed Practical Nurses/Licensed Vocational Nurses It was a different workforce 40 years ago. In 1978, there were approximately 1,112,000 registered nurses (RNs) and 509 employed RNs per 100,000 population (U.S. Department of Health and Human Services, 1980), which