OREGON BOARD OF NURSING [ VO.39V ▬ NO.4 ▬ NOVEMBER 2020 ] Also in this issue Freedom Of Speech, Hate Speech, And The Nurse Practice Act AA REGULATORYREGULATORY RESPONSERESPONSE TOTO HEALTHCAREHEALTHCARE SERIALSERIAL KILLINGKILLING Advanced training for YOUR advance nursing caree All of ASU’s MS in Nursing graduates Take the next step in your nursing career and earn your MS in Nursing! The 100% online are prepared to address MS in Nursing program from Arizona three main objectives: State University develops the in-depth skills you need to excel in a wide variety Deliver comprehensive of nursing and health care settings. nursing care in partnership When you enroll with ASU, you expand your with individuals, families, nursing skills with a deeper understanding groups and communities, of evidence-based practice, leadership, 1 pathophysiology and how to meet workforce and populations. demands. This graduate program is ideal for anyone looking to upgrade their nursing career while building on their own education. Develop theoretical and practice-based nursing education across diverse 2 care settings. Demonstrate knowledge and skills needed to analyze, use and generate evidence for 3 application to practice. Edson College of Learn more at Nursing and Health Innovation nursingandhealth.asu.edu/msnonline TABLE OF CONTENTS Oregon State Board of Nursing 17938 SW Upper Boones Ferry Road Portland, OR 97224-7012 SENTINEL Phone: 971-673-0685 ▬ ▬ Fax: 971-673-0684 [VO.39 NO.4 NOVEMBER 2020] www.oregon.gov/OSBN contentstable of ÑġßáÊëñîï Monday - Friday 8:00 a.m. - 4:30 p.m. ÒäëêáÊëñîï A Regulatory Response To Healthcare ÒäëêáÊëñîïîáàñßáàâëîðäáàñîÝðåëê Serial Killing ........................4 ëâðäáÉëòáîêëîĊïÇôáßñðåòáÑîàáîëê Covid-19. Please see website for A New Look for OSBN Online ßñîîáêðäëñîï Licensing Services ................. 13 Board Members: Freedom Of Speech, Hate Speech, And Page 4 The Nurse Practice Act ............14 Kathleen Chinn, RN, FNP Board President Uncomfortable Truths And Annette Cole, RN Reportable Behavior ...............16 Adrienne Enghouse, RN Year of the Nurse ..................18 ÏåßäáèèáÅäÝñÎÒÐ Documentation: A Necessary Element Of Board Secretary Nursing Practice ..................19 Sheryl Oakes Caddy, JD, MSN, RN, CNE The Impact Of The Pandemic On Oregon Bobbie Turnipseed, RN Nursing Education ................20 ÌñàåðäÙëëàîñĞÌÆ Page 20 Public Member You Ask, We Answer ...............22 ÏåßäÝáèÙõêðáîÎåãäðâëëð Disciplinary Case Study: Public Member Boundary Violations ...............23 Aaron Green, CNA All Board Meetings, except Executive Sessions, Meet The Team ....................30 are open to the public. All meetings will be Ruby Jason, MSN, RN, NEA-BC held remotely for the duration of the Governor’s Executive Director Executive Order on Covid-19 ÄÝîÞÝîÝÊëèðîõ Communications Manager Editor of the Sentinel Created by Publishing Concepts, Inc. David Brown, President • 1-800-561-4686 ext.103 [email protected] Advertisements contained herein are For Advertising info contact Laura Wehner • 1-800-561-4686 24 2020-21 Board Meeting Dates not endorsed by the Oregon State Board [email protected] of Nursing. The Oregon State Board of 2020 Board Members Nursing reserves the right to accept or 25 reject advertisements in this publication. ÄëÝîàÆåïßåìèåêÝîõÃßðåëêï Responsibility for errors is limited to cor- 27 EDITION 48 rections in a subsequent issue. NURSING PRACTICE By Erin Tilley, BHSc, BScN, MN, RN, PMP, FRE; Catherine Devion, BA, MLS; Anne L. Coghlan, BScN, MScN, RN; and Kevin McCarthy, BScN, MPPAL, RN. Reprinted with permission. A REGULATORY RESPONSE TO HEALTHCARE SERIAL KILLING Healthcare serial killing is difficult to detect, which makes protecting patients from this insidious harm challenging. In 2016, Elizabeth Wettlaufer confessed to murdering eight long-term care residents, attempting to murder four others, and assaulting two more while working as a registered nurse in Ontario, Canada (R v. Wettlaufer, 2017). These events prompted the College of Nurses of Ontario (CNO), along with partners in the system, to question what can be learned from this tragedy so that the suffering of families and victims was not in vain. Can serial killers be detected and prevented? Where there are potential threats to patient safety, regulators must take action to reduce risk and prevent harm. Determined to learn from the horren- dous crimes and contribute to the learning of others, CNO began with an extensive literature review related to healthcare serial killers. From the literature review, this article describes common factors associated with healthcare serial killers, their victims, their crimes, and possible detection. Several recommendations based on the literature are proposed. In 2016, Elizabeth Wettlaufer confessed to murdering eight medical assessments, she was able to practice again in 1998. long-term care residents, attempting to murder four others, and Yet, she did not work as a nurse again until 2007 (Long-Term assaulting two more while working at a number of locations as a Care Homes Public Inquiry, 2018a). In 2014, CNO received a registered nurse in Ontario, Canada. According to the Agreed mandatory report from an employer for terminating the former Statement of Facts from her criminal trial (R v. Wettlaufer, nurse “due to a medication error which resulted in putting a 2017), the dates of the attacks spanned from 2007 to 2016 and resident at risk” (Long-Term Care Homes Public Inquiry, 2018a). took place in southwestern Ontario. Wettlaufer’s first 11 attacks Wettlaufer was required by CNO to perform remedial activities took place at a long-term care home between 2007 and 2014, including a review of standards related to professionalism and and a twelfth took place at a different long-term care facility in safe medication administration. September 2015. She carried out her thirteenth attack while Wettlaufer often worked the night shift, and at one facility employed as an agency nurse at a long-term care facility. The was responsible for up to 100 residents during her shift final attack for which she was convicted took place in 2016 in (Dubinski, 2018a). She was reported to have made colleagues a client’s private home while she was employed by a nursing uncomfortable due to bizarre and unprofessional behavior agency. She was caught after she confessed in 2016 to a physician (Dubinski, 2018b). She had shared with employers that she who was treating her for a mental health disorder (Long-Term had mental health disorders. A discharge notice following the Care Homes Public Inquiry, 2018a). care Wettlaufer received in 2016 indicated diagnoses of major Wettlaufer murdered and harmed her victims by injecting depressive disorder, alcohol use disorder, opioid use disorder, them with insulin. In some cases, she misappropriated insulin and borderline personality disorder as well as antisocial adult from the medication room at the facility where she worked, and behavior (Long-Term Care Homes Public Inquiry, 2018a). in one case, she admitted to stealing insulin from one patient to When Wettlaufer confessed to her crimes in 2016, nursing overdose another patient (R v. Wettlaufer, 2017). According to colleagues, administrators, families, residents, the government, court documents, the killer used her murders as a way to relieve and the public were shocked and horrified that she had pressure that was building from anger and frustration (R v. deliberately harmed residents. In the wake of this tragedy, Wettlaufer, 2017). the Government of Ontario established a public inquiry to probe the events and make recommendations to avoid similar Background occurrences. The inquiry is ongoing, and its mandate involves In 1995, Wettlaufer was required to participate in the several goals: College of Nurses of Ontario’s (CNO) process for nurses The Inquiry’s mandate is to inquire into the events that led with mental health disorders. After monitoring and meeting to the offences committed by Elizabeth Wettlaufer. Additionally, specified requirements set by CNO based on independent the Inquiry is directed to inquire into the circumstances and 4 ØÑ%¶ÐÑ ¶ÐÑØÇÏÄÇÔ OREGON STATE BOARD OF NURSING contributing factors allowing these events to occur, including murder,” “serial homicide,” “serial killer,” “health personnel,” the effect, if any, of relevant policies, procedures, practices “healthcare professionals,” and “nurse.” The literature search and accountability and oversight mechanisms. The Inquiry yielded 197 items, and from these, 35 abstracts were selected is also directed to inquire into other relevant matters that the that most closely addressed the topic of healthcare serial killers. Commissioner considers necessary to avoid similar tragedies. These were reviewed and assessed as to whether they met the (Long-Term Care Homes Public Inquiry, 2018b) previously described purpose. Only English articles were The public hearings explored four parts: (a) facilities and considered. Year of publication was not used as exclusionary agencies, (b) Office of the Chief Coroner and Ontario Forensic criteria given the limited number of articles. After the initial Pathology Service, (c) CNO as the nursing regulator, and (d) review, 18 articles were selected for full review. provincial government (the Ministry of Health and Long- Most of the articles reviewed described the authors’ Term Care). CNO continues to participate to support the observations and opinions. Regarding healthcare serial killers inquiry’s mandate. specifically, the search uncovered