New Title - Nevadaepubs.nsla.nv.gov/statepubs/epubs/620964-2007-6.pdf · 2009-03-27 · and...

Nevada State Board ofNevada State Board of

June 2007

LPNs and IVs

Caring for the Elderly

Your Questions, Our Answers

An Alternativeto ImpairmentHelp for the Healers

7 0 2 . 3 8 3 . 2 0 0 0 w w w . u m c s n . c o m

I n o n e p r e c i s e m o m e n t

Something happens when you puteleven centers of excellence in one hospital:Every moment is charged with meaning.And miracles are all part of a day’s work.

the symbol of excellence

a mother holds her first child

a stroke survivor takes a step on her own

a heart patient is flown in by chopper

and a doctor says, “she’s going to be fine.”

3Nevada State Board of Nursing l Toll-Free 1-888-590-6726 l www.nursingboard.state.nv.us

6Caring for the Elderly?


LPNs May Per formIntravenous Therapy

4

713

Meet the Staff 15An Alternative to Impairment 18

Disciplinary Versus Alternative Program Process 22

You Want to Hire a Nurse or CNA? 24

contents

page 15

Professional Accountability—It’s a Choice

page 13

Board and Advisory Committee Meetings 6

Nurse Practice Act 11

But I Don’t Even Have a Child! 25

Emailing the Board? 25

Toll-Free Consumer Hot Line 25

Change of Address Form 26

Board Members 27

Disciplinary Actions 28

Staff Directory 30

Circulation includes more than 34,000 nurses, nursing assistants and student nurses.

page 15

On the CoverOriginal artwork by DerrickChow, courtesy of YoungPeople’s Press.

The mission of the NevadaState Board of Nursing is toprotect the public’s health,safety and welfare througheffective regulation of nursing.

Debra Scott, MSN, RN, APN Executive Director

Cindy Kimball, EditorPublic Information Officer

5011 Meadowood Mall Way,Suite 300Reno, NV [email protected]

The Nevada State Board ofNursing News publishesnews and information quarterlyabout Board actions, regulations,and activities. Articles may bereprinted without permission;attribution is appreciated.

NEVADA STATE BOARDOF NURSING5011 Meadowood Mall Way,Suite 300Reno, NV 89502-6547phone—888-590-6726 fax—775-688-2628 [email protected]

2500 W. Sahara Ave., Suite 207Las Vegas, NV 89102-4392phone—888-590-6726fax—[email protected]

WORLD WIDE WEB

www.nursingboard.state.nv.us

C O N T A C T

The Board extends a big THANK

YOU to our advertisers. Because

of your support, we are able to

provide this magazine at no

cost to every Nevada licensee

and certificate holder.

For Advertising information contactJane Saunders atOffice Phone: 501.776.2563Mobile: 501.909.9810email: [email protected] 2: [email protected]

page 18

Nevada State Board of Nursing staff members are invited tomake presentations to nursing schools, community groups, in var-ious types of facilities, and for numerous nursing associations.Oftentimes, we are asked to speak on The Role and Responsibility ofthe Professional Nurse, sometimes on Delegation, other times onThe Nurse Practice Act and You. We appreciate the opportunity toeducate nurses regarding the law that regulates our practice; it isour attempt to prevent future misconduct by providing resourcesand information on nursing regulation in Nevada. It is our desirethat no nurse should ever experience the discomfort, confusion,and sometimes pain that occurs when our practice is being inves-tigated.

I believe that nurses, by nature, want to do the right thing in anysituation that confronts us—in our practice, in our professionaldevelopment, and as it relates even to our everyday lives. When Ispeak to nursing students, I talk about having to give up “dancingon tables” when I became a nurse—not to mention after becomingthe executive director of our Board. I talk about nurses being held toa higher standard just for the fact that we are nurses.

So within that context, what is our professional responsibilitywhen it comes to our conduct? When does our professional account-ability end? If I get convicted of driving under the influence and I’mnot on my way to work, does the nursing board have jurisdictionover my behavior? If I give medical advice to my neighbor when herchild is sick and the child ends up in the emergency departmentwith an allergic reaction to the leftover antibiotics that I gave herthat had been prescribed for my son six months ago, does the nurs-ing board have the authority to discipline my license? And . . .if Iswear on my renewal application that l have completed my continu-ing education requirement for renewal of my license and, in truth, Ihave not, is that grounds for discipline of my license?

When considering whether a nurse’s misconduct merits a disci-plinary response by the Board, there are levels of so-called “wrong-doing.” The levels include human error, at-risk behavior (negligentconduct), reckless behavior, and intentional rule violation. In gener-al, the Board does not respond to human error with discipline.

Human error is when there is a slip, a lapse, or a mistake—aninadvertent action like, even after following all policies and proce-dures for bathing infants, the nurse drops an infant while givinghim a bath in the newborn nursery.

At-risk behavior, or negligence, is when a nurse deviates fromthe established and customary standards of care to the degree thatthe Board believes that the nurse had a conscious or overt disre-gard or indifference for the health, safety, well-being or welfare of a

patient. Oftentimes, this occurs when nurses do “work arounds” ormakes shortcuts while practicing. In the example of the nursedropping the baby, the nurse’s behavior could be deemed negligentif she didn’t report the incident to the physician and completedocumentation of the incident including her assessment and anyintervention needed.

Reckless conduct occurs when a nurse makes a behavioralchoice to consciously disregard a substantial and unjustifiablerisk—almost an “I don’t care how this will affect my patient, I’mgoing to do it anyway” attitude. In the example of the nurse givingmedical advice and leftover antibiotics to the neighbor’s son, thenurse knew that it was out of her scope to diagnose and illegal todispense the leftover medication, yet she took the risk anyway,with harmful consequences.

A nurse intentionally violates the rules by choosing to do some-thing which is in direct conflict with the law—like driving whileunder the influence of alcohol or drugs, or making false statementsin documenting patient care, or even on documents submitted to agovernmental agency, for example, the IRS or the Board.

The Board received 486 complaints during FY 2005/2006. Themajority of the complaints alleged conduct which fit into humanerror and at-risk behaviors. Some reckless behavior and intention-al rule violation was alleged, but generally these situations involvednurses with chemical dependency or mental health issues.

However, we are now noticing a curious trend that I can’texplain. During the last quarter of 2006, Board staff increased tofive percent per month the number of audits for renewal applica-tion requirements. Approximately 40 percent of those auditedwere not able to demonstrate that they had met the renewalrequirements, and 24 licensees and certificate holders are on theBoard’s May agenda, subject to possible disciplinary action.

Into what level of misconduct does this fall? Signing an officialdocument and swearing that renewal requirements have been metwhile knowing that is not true is an intentional violation of therule—the law. What does this say about a nurse’s practice? Can weassume a nurse lacks accountability for her practice when sheswears to an untruth on her renewal application? I’m not sure, butthe trend is troubling.

4 Nevada State Board of Nursing l Toll-Free 1-888-590-6726 l www.nursingboard.state.nv.us

Professional Accountability—It’s a ChoiceA message from the executive director

Debra Scott, MSN, RN, APNExecutive Director

EOEEOE


MEETINGS AND OPENINGSThe openings (listed in parentheses)will occur in the next six months. Allmeetings will be held via videoconfer-ence in Reno and Las Vegas, exceptfor the Disability AdvisoryCommittee.

Advanced Practice AdvisoryCommittee (none)

August 28, 2007

November 13, 2007

CNA Advisory Committee (one)Recent reappointment and appointments:Terri Shoemaker, CNA; Cheryl Becerra, RN;Carla Wright, RN

August 2, 2007

November 1, 2007

Disability Advisory Committee (two)October 19, 2007 - Reno

Education Advisory Committee (two)Recent reappointment and appointment:Connie Carpenter, EdD, RN; Judith Cordia,EdD, RN

August 3, 2007

November 2, 2007

Nursing Practice Advisory Committee (two)Recent appointment: Kellie Benway, RN

June 5, 2007

August 14, 2007

October 2, 2007

December 4, 2007

B O A R D TA L K

BOARD MEETINGS

A seven-member board appointed by

the governor, the Nevada State

Board of Nursing consists of four reg-

istered nurses, one practical nurse,

one cer tified nursing assistant and

one consumer member. Its meetings

are open to the public; agendas are

posted on the Board’s web site and

at community sites.

BOARD MEETING DATES

July 11-13, 2007 - Annual Business

Meeting - Zephyr Cove

September 12-14, 2007 - Las Vegas

November 7-9, 2007 - Reno

ADVISORY COMMITTEESThe Nevada State Board of Nursing is

advised by and appoints members to

five standing advisory committees.

Committee meetings are open to the

public; agendas are posted on the

Board’s website and at community

sites. If you are interested in apply-

ing for appointment to fill an upcom-

ing opening, please visit the Board’s

website or call the Reno office for an

application.

COME TALK TO THE BOARD

During each regularly scheduled meeting of the Nevada State Board ofNursing, Board members hold a Public Comment period for people to talk tothem on nursing-related issues.

If you want to speak during the Public Comment period, just check the meet-ing agenda for the date and time it will be held. Usually, the Board presidentopens the first day of the meeting by inviting Public Comment. Time is dividedequally among those who wish to speak. For more detailed information regard-ing the Public Comment period, please call the Board.

WE’LL COME TALK TO YOUBoard staff will come speak to your organization on a range of nursing-relatedtopics, including delegation, the impaired nurse, licensure and disciplineprocesses, and the Nurse Practice Act.

Make sure to keepyour skills sharpthrough continuingeducation

Caring for the Elderly?

The Board believes that nurses shouldbe free to meet the continuing educationrequirements for license renewal bychoosing courses that increase theirknowledge, skills, and ability in areasthey deem necessary for their profession-al competence. That’s why it routinelytestifies in opposition to legislativeefforts to mandate the specific type ofcontinuing education nurses should take.

However, the Board also believes it isimportant to remind nurses that it istheir professional and legal obligation toimprove their skills and ensure theircompetence, especially when it comes tocaring for the most vulnerable popula-tions in our society.

That is why we periodically publishthis reminder for those who care for theelderly, and also why the legislature putthis statement of “encouragement” intothe Nurse Practice Act in 2005:

NRS 632.343 (4) The Board shallencourage each licensee who treats or caresfor persons who are more than 60 years ofage to receive, as a portion of their continu-ing education, education in geriatrics andgerontology, including such topics as:

(a) The skills and knowledge that thelicensee needs to address agingissues;

(b) Approaches to providing health careto older persons, including bothdidactic and clinical approaches;

(c) The biological, behavioral, social andemotional aspects of the agingprocess; and

(d) The importance of maintenance offunction and independence for olderpersons.

For more information on how tomake sure a continuing education coursein geriatrics and gerontology is offered byan approved provider, visit the Board’swebsite.


Q&AQ&A

Every day, the Board receives manycalls and emails regarding scope of prac-tice, asking questions that range from whocan administer flu shots to how to refusean unsafe assignment.

While the Nurse Practice Act and theBoard’s practice decisions do specificallyaddress some of these question, there is noone “list” of acceptable procedures.

The Nurse Practice Act defines nursingin terms of applying the nursing process,teaching health care practices, and manag-ing the practice of nursing.

To determine if providing a specificservice or procedure is acceptable practice,both the specific circumstances involvingthe patient’s condition and the competen-cy of the nurse must be considered.

Published inside the Nurse Practice Act(revised January 2007) is a list of specificpractice decisions (pages 92-105) and aguideline and decision tree for determiningscope of practice (pages 106-107). (Thisinformation is also on the Board’s website.)

The guideline lists basic questions youshould ask if you’re trying to determinewhether a practice is within your scope. Ifyou can answer yes to all the questions,and other state or federal laws and regula-tions don’t prohibit it, the practice is prob-ably within your scope.

Here are answers to some of the scopeof practice questions the Board is frequent-ly asked.

Q Can an LPN administer flu shotsin a clinic? How about nursing students?

A They may be able to do so, underappropriate conditions. LPNs and nursingstudents have supervisory requirementsthat must be in place, and each must havedocumented competency to perform thenursing task.

Per NRS 632.017, an LPN must prac-tice under the direction of a registered pro-fessional nurse, an advanced practitionerof nursing, a licensed physician, a licensedphysician assistant, a licensed dentist or alicensed podiatric physician. Therefore, anLPN must have an order and directionfrom one of these practitioners. If anyassessment of the client is required prior toadministering the injections, an LPN isnot qualified to perform this nursing func-tion and would need to refer the client tothe appropriate person.

Per NAC 632.252, a nursing studentmay administer injections if working in thecapacity of an apprentice nurse in a healthcare facility, or a community health clinic,and working under the direction of a regis-tered nurse who is present at the site.Nursing Students may only perform thosetasks that they have successfully demon-strated in their program of education.

Q May a CNA supervise anotherCNA?

A No. Per NRS 632.0166, CNAs workunder the direction (supervision) of alicensed nurse. A CNA may orient anoth-er CNA to an assignment, but supervisionremains the responsibility of the licensednurse.

Q May an LPN supervise an RN?

A No. Per NRS 632.017, LPNs workunder the direction (supervision) of a reg-istered nurse, an advanced practitioner ofnursing, a licensed physician, a licensedphysician assistant, a licensed dentist or alicensed podiatric physician. LPNs are notqualified, nor is it in their scope of prac-tice, to supervise RNs.

Q May an LPN serve as the chiefnurse and supervise RNs?

A The answer lies both in the NursePractice Act and in facility regulations.Per NRS 632.240, nursing services must besupervised by a chief administrative nurse,who must be a registered nurse. Also,LPNs work under the direction of a regis-tered nurse, not the other way around (seeNRS 632.017).

Facility regulation (NAC 449.74517),enforced by the Nevada State HealthDivision’s Bureau of Licensure andCertification, allows an LPN to work as thecharge nurse in a facility for skilled nursing,but not as the chief administrative nurse.Here is the relevant text of that regulation:

NAC 449.74517 Nursing Staff.(2) A facility for skilled nursing shall employ afull-time registered nurse to act as the chiefadministrative nurse. The chief administrativenurse must have:

(a) At least 3 years of experience pro-viding nursing care in a hospital orfacility for long-term care; and

(b) Experience supervising otheremployees.

Q Can LPNs do assessments in long-term care settings?

A They can contribute to the assess-ment, just as they can in any setting,according to “Nursing Roles andResponsibilities” (pages 108-112 of theNurse Practice Act, revised January 2007).At the direction of an RN, APN, licensedphysician, licensed physician assistant, orlicensed dentist, an LPN can contribute toassessments of health status by (1) collect-ing, reporting, and recording objective and

Your Questions, Our Answers Answers to some frequently asked questions

Q&A


subjective data, (2) observation of condi-tions or change in condition, and (3) signsand symptoms of deviation from normalhealth status.

Q May licensed nurses perform atask or duty beyond their scope of prac-tice if the physician has given themdirection to do so and has indicated theyare “working under his license?”

A Licensed nurses may only performthose duties and tasks that are withintheir scope of practice as defined by theNevada Nurse Practice Act. Licensednurses never work “under” anyone else’slicense.

Q Can an individual work as anapprentice nurse work after graduation?

A No. A student’s eligibility to partici-pate in the Apprentice Nurse Programends upon graduation from the nursingprogram. At that time, the studentbecomes a graduate nurse and must possessan Interim Permit to practice nursing. It isthe responsibility of the director of nursingto ensure that after graduation, the studentno longer practices nursing as an appren-tice nurse. It is also the responsibility ofthe director of nursing to ensure that allgraduate nurses have active InterimPermits authorizing the practice of nursing.

Q Can apprentice nurses or graduatenurses work without RN supervision?

A No. Apprentice nurses must work under the

supervision of a registered nurse.According to NAC 632.252 (1) (a):

The nursing student works as an apprenticenurse in a licensed hospital for acute care, alicensed hospital for long-term care, a com-munity health clinic or a health mainte-nance organization and works under thesupervision of a registered nurse who is atthe site where care is provided.In addition to supervision by a regis-

tered nurse, apprentice nurses and theiremployers must meet several other legalrequirements. Please see the NursePractice Act and visit the Board’s websitefor more information.

Graduate nurses must work under thesupervision of a registered nurse.According to NAC 632.057, “Graduatenurse” means a person who:

1. Has graduated from a nursing programapproved by the board;

2. Holds an interim permit:3. Is awaiting the results of the examina-

tion for licensure; and4. Works under the supervision of a regis-

tered nurse who is at the site where careis provided.

Q How can I refuse an assignmentthat is unsafe without losing my licenseand my job?

A The Board receives many calls fromnurses who feel they are being asked toplace their patients at risk or their licensesin jeopardy. Many think they have nochoice but to accept assignments they are

Q&AQ&A

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YOU’RE IN GOODCOMPANYActive Nevada

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RN • 24,254LPN • 3,189CNA • 6,316

unable to safely manage, to perform actsthey aren’t qualified to do, or to worklonger hours than they believe they canphysically or mentally endure and still pro-vide safe patient care.

Often, refusing an assignment doesnot seem an option for these nurses whobelieve either the patients would beendangered or they would lose their jobsif they simply said “No.” Some blamepoor staffing due to economic motiva-tions, others point to nursing administra-tion’s failure to advocate for staff nurses,and sometimes the situation seems a fac-tor of the nursing shortage or the ruralnature of our state.

Yet, all licensed nurses in Nevada aresubject to the Nurse Practice Act thatholds nurses responsible and accountablefor nursing judgments, actions and compe-tence and requires the nurse to safeguardthe patient. Accepting an assignment thatthe nurse knows she is not qualified for,and/or accepting an assignment that places

a patient in jeopardy, are violations of theNurse Practice Act and may result in disci-plinary action.

How can nurses protect their patients,protect their licenses, and still maintaintheir jobs in the “real world”?

Prevention and early intervention arealways a place to start. Nurses should knowthe laws and regulations that govern theirpractice and clearly understand what con-stitutes a violation of the Nurse PracticeAct. For example, nurses may be told thatrefusing to accept an assignment is“wrongful abandonment,” but in fact, theNurse Practice Act cites three conditionsthat must exist before such an actionwould be considered abandonment by theBoard. Specifically, according to NAC632.895(6):

An act of patient abandonment occurs if:(a) A licensee or holder of a certificate hasbeen assigned and accepted a duty of care to apatient; (b) The licensee or holder of a certifi-cate departed from the site of the assignment

without ensuring that the patient was ade-quately cared for; and (c) As a result of thedeparture, the patient was in potential harm oractually harmed.

Evidence of all three conditions mustbe shown before the Board may considerdisciplinary action against a nurse forpatient abandonment.

However, it should be noted that theBoard has no jurisdiction over employ-ment or contract issues.

Until unsafe conditions are corrected,well-intentioned nurses may feel likethey’re in a “Catch 22,” where if theypractice in accordance with the law, theywill keep their licenses but lose their jobs.Unfortunately, sometimes leaving a posi-tion is the only option. Here are somethings to consider—• Place patient safety and well-being

first. Act in good faith.• Know the laws and regulations that

govern your practice.• Build a defense for why an action (or

Q&AQ&A

act of omission) was unavoidable.Document carefully. Be able to demon-strate that the course of action waswhat would have been provided in asimilar situation by a reasonable andprudent nurse with similar educationand experience.

• Continue to advocate for safe nursingcare for patients.

If you believe that a situation is truly arisk for the public, please do not hesitateto call the Board and discuss your con-cerns.

Q Am I responsible for tasks I assignto other nurses, CNAs or unlicensedpersonnel?

A The short answer is yes. According to NAC 632.222(4), “A

registered nurse who delegates nursing careto another nurse or assigns duties relating

to that care to other personnel is responsi-ble for the actions taken by those personsin carrying out the duties delegated orassigned.”

The 2001 American NursesAssociation Code of Ethics states, “Sincethe nurse is accountable for the quality ofnursing care given to patients, nurses areaccountable for the assignment of nursingresponsibilities to other nurses and the del-egation of nursing care activities to otherhealth care workers.”

Both the Nurse Practice Act (NAC632.222 and 632.224) and the ANA Codeof Ethics (Section 4.4) address how toproperly delegate nursing responsibilities orassign nursing care activities.

They both require the nurse to evalu-ate the knowledge, skills, and experienceof the individual to whom the care isassigned, the complexity of the assignedtasks, and the health status of the

patient. The nurse is also responsible formonitoring the activities of these indi-viduals and evaluating the quality of thecare provided.

According to the ANA Code of Ethics,“the nurse must not knowingly assign ordelegate to any member of the nursingteam a task for which that person is notprepared or qualified.”

If the nurse assigns or delegates “func-tions, tasks or responsibilities of licensed orcertified persons to unqualified persons,” orfails “to supervise a person to whom func-tions of nursing are delegated or assigned,if responsible for supervising that person,”the Board may consider the nurse guilty ofunprofessional conduct, according to theprovisions of NAC 632.890(6)(7).

If you’d like more information, pleaseread the Nurse Practice Act or call theBoard. The ANA Code of Ethics is on theweb at nursingworld.org/ethics/ecode.htm.


Board staff also receive many calls and emails regarding licensure and certification.Here are the answers to a few of the most common questions.

Q&AQ&A

Q I just moved here. Can I work in Nevadaon my out-of-state license/certificate?

A No, you may not work as an APN,CRNA, EMS-RN, RN, LPN, or CNA in Nevadaon an out-of-state license/certificate. If theBoard finds you have done so, it will issueyou a citation for practicing without a Nevadalicense/certificate.

Q If I have an out-of-state license/certifi-cate and I apply for a Nevada license/certifi-cate by endorsement, how long does it taketo get one?

A As it states on the application instruc-tions, as processing of your application isdependent on receiving documents fromoutside sources, the Board is unable to pro-vide specific time frames for processing.However, if your application is complete andmeets the criteria for issuance of alicense/certificate, the Board can generallyissue your (temporary or permanent)license/certificate within one week of receiptof your application.

Q How many continuing education unitsmust I earn to renew my license/certificate?

A RNs and LPNs are required to com-

plete 30 contact hours of continuing educa-tion during each renewal period. A contacthour is equal to 50 clock minutes. Newgraduates may use their nursing courseworkin lieu of continuing education hours fortheir first renewal period, except for therequired, one-time four-hour bioterrorismcourse all nurses must complete for theirfirst renewal. (See the Board’s website formore information on the bioterrorismrequirement). CNAs must complete 24hours of inservice training during eachrenewal period.

Q How often do I renew my license/cer-tificate?

A Every second birthday. Please note:your first renewal may not be a full twoyears, depending on when your birthday fallsand when your license/certificate is issued.

Q What happens if I’m selected for arandom CE audit?

A If you swear you completed CEs, youmust be able to prove you did if you’re audit-ed. As it states on your renewal application,you must keep copies of your continuingtraining/education certificates for four years,in case you are selected for random audit. If

you cannot prove you met the renewalrequirements for nurses (30 continuing edu-cation credits) or CNAs (24 hours of contin-uing/training education), your application willbe considered fraudulent and you may besubject to disciplinary action. Nurses: theBoard is also auditing for compliance withthe one-time renewal requirement for a four-hour bioterrorism course. You must keep acopy of your bioterrorism certificate of com-pletion indefinitely.

Q What happens if I have not worked asa CNA for two years or more?

A If you did not work as a CNA withinthe two years since your last renewal, youwill not need continuing education/trainingbecause you will not be eligible for renewal.To become recertified, you must complete atraining program and submit a new applica-tion, including fingerprints.

Q If I have not worked as a nurse formore than five years, how do I reactivate ormaintain my license?

A If you haven’t worked as a nurseduring the previous five years, you musttake a refresher course. Call the Boardfor more information.


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DO YOU HAVE A QUESTION?If you have questions regardingnursing practice, the first placeto look is inside your NursePractice Act. If after reading it,you still have questions, call theBoard. If it is an issue that needsfur ther definition, you mayrequest the Board issue a prac-tice decision. The Board will thenask its Nursing Advisory PracticeCommittee to research the issueand make a recommendation.

FOR MORE ANSWERS—GET INTO THE ACTThe Nevada Nurse Practice Act isa 5-1/2” by 8-1/2” booklet. It’sjust $5 if you buy it at the Renoor Las Vegas office, and $8 bymail (make check or money orderpayable to the Nevada StateBoard of Nursing).

THE ACT IS ON THE WEB The Board’s website www.nursing-board.state.nv.us has a link to thestate laws (NRS), regulations(NAC), and practice decisionswhich make up the Nurse PracticeAct. It also contains a separatesection on practice information,including guidelines for determin-ing scope of practice.

LEARN ABOUT THE ACTAND EARN TWO CEsTake the Nurse Practice Act(Nevada) continuing educationcourse at www.learningext.com.For only $12, you will learn aboutthe role of the Board and yourlegal responsibilities as a nurse orCNA, and earn two contact hoursof continuing education.


w w w . s i e r r a h e a l t h . c o m

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Fornursing resourcesand connections• • •information for and about nurses• • •nurse associations• • •boards of nursing

www.thinknurse.com


More than three years ago, the Boardamended regulations regarding the dele-gation of intravenous therapy by RNs toLPNs. The amendments deleted therequirement for 1,500 hours of clinicalexperience in nursing after receiving ini-tial LPN licensure and deleted the one-year experience in nursing requirementbefore LPNs are allowed to begin a certi-fication class in IV therapy. They alsoallowed IV-certified LPNs to administersteroids, to flush locks, and to assist theRN in administering blood and bloodproducts.

While the Board has widely publishedthese changes, including extensive arti-cles in the February 2004 issue of thismagazine and in subsequent “Questionand Answer” magazine articles, we’restill getting a lot of calls on the subject.Therefore, we thought it would be help-ful to reprint here the entire text of theregulations, which can also be found inthe Nurse Practice Act and on theBoard’s website.

NAC 632.450 Procedures delegable tolicensed practical nurses. (NRS 632.120)1. A licensed practical nurse who hascompleted a course in intravenous therapyapproved by the Board pursuant to NAC632.242 and who acts pursuant to a writ-ten order of a physician and under theimmediate supervision of a physician,physician assistant or registered nurse may:

(a) Start peripheral intravenous therapyusing devices which act like needlesand are not longer than 3 inches;

(b) Introduce one or more solutions ofelectrolytes, nutrients or vitamins;

(c) Piggyback solutions of electrolytes,nutrients and vitamins;

(d) Administer any of the followingmedications by adding a solution bypiggyback:(1) Antibiotics;(2) Steroids; and(3) Histamine H2 receptor antago-

nists;(e) Administer fluid from a container

which is properly labeled and con-tains antibiotics, steroids or histamine

H2 receptor antagonists that wereadded by a pharmacist or a registerednurse designated by the pharmacist;

(f) Flush locks;(g) Except as otherwise provided in

paragraph (h), administer fluid bycontinuous or intermittent infusionthrough a peripheral device whichuses a mechanism to control theflow;

(h) Administer fluid to a patient with atemporary central venous catheterby continuous or intermittent infu-sion through a peripheral devicewhich uses an electronic mechanismto control the flow;

(i) Discontinue peripheral intravenouscatheters which are not longer than3 inches; and

(j) Change a central venous catheterdressing.

2. In addition to the procedures set forth insubsection 1, a licensed practical nurse whohas completed a course in intravenoustherapy approved by the Board pursuant toNAC 632.242 and who acts pursuant to awritten order of a physician and under thedirect supervision of a registered nurse mayassist the registered nurse in the intra-

venous administration of blood and bloodproducts by collecting data and performingsimple nursing tasks related to that admin-istration of blood or blood products.

NAC 632.455 Procedures not delegableto licensed practical nurses. (NRS632.120) A licensed practical nurse maynot administer intravenously:1. Any drug other than an antibiotic,

steroid or histamine H2 receptor antag-onist;

2. Any drug which is under investigationby the United States Food and DrugAdministration, is an experimentaldrug or is being used in an experimen-tal method;

3. Any antineoplastic medications;4. Colloid therapy, including hyperalimen-

tation;5. Any medication administered by intra-

venous push.

NAC 632.460 Labeling required on con-tainers. (NRS 632.120) The followinginformation must be on a container beforeits contents may be administered by alicensed practical nurse:1. The name of the patient for whom the

contents are intended;2. An identification of the contents;3. The dosage;4. The rate at which the contents are to

be administered;5. The date and time when the container

and its contents were prepared;6. The expiration date and time of the

contents;7. The name or initials of the person who

prepared the container and its con-tents; and

8. The name or initials of the person whosuperimposed the container, if applicable.

NAC 632.465 Course on intravenoustherapy: Compliance with requirementsin NAC 632.475. (NRS 632.120) Anycourse on intravenous therapy must com-ply with the requirements set forth inNAC 632.475 before it is offered tolicensed practical nurses for the purpose ofcomplying with the requirements of NAC632.450 to 632.475, inclusive.

LPNs May Perform Intravenous TherapyRegulations outline requirements


NAC 632.470 Course on intravenoustherapy: Place of instruction; faculty.(NRS 632.120)1. The course must be taught in an edu-

cational institution or a licensedhealth and care facility as defined inNRS 449.0151.

2. The course must be taught by a regis-tered nurse who has had, during the 2-year period before the course is taught:(a) At least 6 months’ experience as a

member of a team which performedintravenous therapy in a licensedhealth and carefacility;

(b) At least 6months’ experi-ence, whichincluded startingand superimpos-ing fluids, in aclinical area witha high volume ofintravenous ther-apy; or

(c) Experience inteaching coursesin intravenoustherapy.

3. The ratio of faculty members to stu-dents in the laboratory or in an areaused for clinical practice in the coursemust not be more than 1 to 10.

NAC 632.475 Course on intravenoustherapy: Subjects and hours required;improvement of skills. (NRS 632.120)1. The course must include the following

subjects:(a) The current regulation concerning

licensed practical nurses and intra-venous therapy;

(b) The anatomy, physiology andphysics related to intravenous ther-apy;

(c) Identifying the purposes of intra-venous therapy;

(d) Identifying the major routes forfluid replacement;

(e) Locating and naming the commonintravenous sites;

(f) Identifying the types of fluids usedin intravenous therapy;

(g) Preparing patients for intravenoustherapy;

(h) Administering intravenous thera-py, including:

(1) Setting up equipment for intra-venous therapy;

(2) Inserting devices that act likeneedles in the periphery, whichare not longer than 3 inches;

(3) Inserting tubing into bottles ofadditives;

(4) Calculating drops per minute;(5) Regulating intravenous flow

according to calculation;(6) Using electronic regulating

mechanisms;(7) Superimposing and piggyback-

ing containers of solutions;(8) Discontinuing peripheral intra-

venous devices that act like nee-dles which are not longer than 3inches; and

(9) Recording intravenous therapy;(i) Identifying possible complications

from intravenous therapy;(j) The management of intravenous

therapy;(k) The pharmacology of medications

and solutions used in intravenoustherapy; and

(l) The appropriate technique forchanging a sterile dressing on aperipheral and central venous site.

2. The course must include at least 20hours of instruction and 10 hours ofclinical practice. The clinical practicemust include three successfulvenipunctures on live subjects.

3. A licensed practical nurse shall pro-vide evidence of the maintenance orimprovement of his knowledge andskills required to perform venipunctureand intravenous therapy to hisemployer or the Board, or both, uponrequest.

Nevada State Board ofNevada State Board of

June 2007

LPNs and IVsCaring for the Elderly


An Alternativeto ImpairmentHelp for the Healers

Nevada StateBoard of

NURSINGNEWS

MagazineScheduleADVERTISING

(COPY) DEADLINES

PUBLISHING DATE AD DEADLINE

August 25 ............August 1

November 25 .......November 1

February 25..........February 1

May 25 .................May 1

For advertising informationcontact Jane Saunders at

Office Phone: 501.776.2563Mobile: 501.909.9810

email: [email protected]

email 2: [email protected]

Patty Shutt, LPNOne might think that after volunteer-

ing a total of 11 years of service as theBoard’s LPN member, Patty Shutt wouldhave had enough of the Nevada StateBoard of Nursing. Instead, she is nowhappily working as a staff member, super-vising the Las Vegas site operations.

“As a Board member, I knew the staffwas caring and competent,” Shutt says.“Now that I’m part of the staff, I find itrewarding to work in an environmentwhere people are always willing to helptheir coworkers improve customer serv-ice and meet the public protection mis-sion of the Board.”

She adds that providing that personalcustomer service—to applicants whohave questions about endorsing theirlicenses into Nevadafrom another state, andto students who areabout to graduate andapply for their licensesby examination—is oneof the things she likesmost about her job.

Shutt was firstappointed to the Boardby Gov. Richard Bryanfor one term, beginningin 1987. A decade later,Gov. Kenny Guinnappointed her to twofull terms (1997-2005).During her most recenttenure as a Board mem-ber, Shutt served threeyears as secretary, two years as vice presi-dent, and three years as president.

In 2001, she was among a handful ofnursing board members nationwide cho-sen to serve on one of the NationalCouncil of State Boards of Nursing fewstanding committees—the NCLEX PN-Item Review Subcommittee. In that role,she reviewed the items that appear onthe national test all practical nurses mustpass before they can become licensed.

Her testing experience also spans

decades. “I was a proctorback in the days whenwe had paper and pencilexams,” Shutt remem-bers. “The test wasgiven only two times ayear, on the same twodays in Reno and LasVegas, and it lasted twofull days for RNs, oneday for PNs. Proctorswould walk around theroom and collect theexams from students asthey finished. The testswere then securelyshipped to the testingservice, where they were graded byScantron. We’ve come a long way sincethen. Students can take the computer-

ized NCLEX just aboutany time they want, andit takes four hours, nottwo days. But the levelof security is still high.”

Shutt joined theBoard’s staff after 15years with the SouthernNevada Health District,where her positionsincluded field LPN,addiction treatmentclinic staff member, andimmunization projectspecialist.

A graduate of theMercedian School ofPractical Nursing inScranton, Pennsylvania,

Shutt’s 40 years of nursing experiencealso includes working in hospitals andhome health.

In her spare time, she enjoys cookingand reading. Shutt has one son,Michael, and was married to the lateWilliam W. Shutt.

Christie DaliposonIn her role as a management assis-

tant, Christie Daliposon has a wide

variety of responsibili-ties. She supports thework of two nurseinvestigators, thecompliance coordina-tor, the legal counsel,and the director ofoperations. She alsopitches in to help thereceptionists answerthe Board’s busy tele-phone lines—a jobshe held when shefirst came to work forthe Board in January2006.

Daliposon, who waspromoted to management assistant inApril 2006, generates correspondence;opens, organizes, closes and storesinvestigative files; prepares statistics;and orders supplies. She also assists thecompliance coordinator by schedulingappointments with the DisabilityAdvisory Committee (DAC), helpingkeep the DAC manual up-to-date, andmaking arrangements for DAC meet-ings, which occur monthly, in bothnorthern and southern Nevada.

Three to four weeks before a Boardmeeting, Daliposon spends a great dealof time in front of the copy machine—reproducing the materials the investiga-tors, compliance coordinator, director ofoperations, and legal counsel have pre-pared for the cases the Board memberswill be considering at the meeting.

“Even though I’m behind the scenes,I’m proud of the part I play in providingthe Board members the informationthey need to make fair and just deci-sions,” Daliposon says.

When she’s not at work, or attend-ing classes at Truckee MeadowsCommunity College, you can find herspending time with her family. Her hus-band, Steve, and their three children—twin four-year-olds (son and daughter)and an eight-year-old son—enjoy paint-ball, camping, barbecuing, and CubScout activities.

Meet the Staff Patty Shutt and Christie Daliposon

Patty Shutt, LPNLas Vegas Site Operations

Supervisor

Christie DaliposonManagement Assistant

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18

An Alternative to Impairment


IF YOU OR SOMEONE YOU KNOW has anaddiction, the Nevada State Board of Nursing canhelp. It runs a successful program for nurses and nurs-ing assistants whose practice may be impaired due tochemical dependency.

The goal of the Alternative Program forChemically Dependent Nurses is to protect the pub-lic by identifying impaired individuals, providingintervention and education, and requiring treatment.

It helps heal the healers, giving them the oppor-tunity to take personal responsibility for recoverywhile being closely monitored through a nonpublicagreement.

How do people get into the program?

STEP 1. Self report—Nurses and nursing assistantswho are willing to admit that their impairment hasled to a violation of the Nurse Practice Act and whoare willing to go into treatment may enter the pro-gram by reporting their problem directly to theNevada State Board of Nursing.

STEP 2. Temporary surrender of license—Nursesand nursing assistants must agree to temporarily sur-render their licenses or certificates until they haveestablished stable recovery and met their treatmentrequirements of 180 hours of treatment in a Board-approved chemical dependency program, and 90Alcoholics Anonymous/Narcotics Anonymous meet-ings in 90 days.

STEP 3. Monitoring—After they complete theirtreatment requirements, participants must agree toabide by the terms of a nonpublic monitoring agree-ment, which includes working under an unmarked,conditional license while complying with an agree-

ment designed to closely monitor their practice whilein recovery.

Who is eligible?

Nurses or nursing assistants who ■ report themselves to the nursing board before,

rather than after, a complaint is filed, ■ are licensed or certified in Nevada, ■ abuse alcohol or drugs to the extent their nursing

practice has been affected, ■ have had no more than one previous treatment

episode, and ■ who sign a voluntary agreement to follow all com-

ponents of the program.

Who is not eligible?

A nurse or nursing assistant ■ who has had previous disciplinary action related to

impairment from chemical dependency, ■ who, evidence shows, has a long history of divert-

ing drugs, or ■ who has a complaint pending against him or her

regarding diversion or impaired practice.

What services does the program provide?

For the public■ immediate intervention to protect the public as an

alternative to a longer disciplinary process ■ coordination and consultation with employers to

assure patient safety

For the nurse or nursing assistant ■ the ability to continue to work as a nurse or nurs-

ing assistant ■ consultation about entering the program

Impairment can cost you your job and your license.Don’t wait to be reported.

Ask for help.


■ monitoring and ongoing assessment of their per-sonal recovery

■ random drug and alcohol testing ■ information regarding local professional and sup-

port services ■ encouragement, support and guidance in recovery

as an effective alternative to disciplinary action ■ removal from monitoring when the program is

successfully completed

Is the program successful?

Yes! The majority of participants successfully completethe program. To do so, they must follow all of the stip-

ulations contained in a signed agreement, completetreatment in a Board-approved program, and demon-strate a change in lifestyle that supports continuingrecovery. Participants who violate their agreements aresubject to disciplinary action by the Board.

How do people get more information?

How do people get more information?■ Call toll free 888-590-6726 ■ Write 5011 Meadowood Mall Way, Suite 300,

Reno, NV 89502-6547 ■ Refer to NRS 632.307 of the Nevada Nurse

Practice Act

Active members

Kathleen Reynolds, BHS, RN - Chair Doreen Begley, MS, RN - Board Liaison Cookie Bible, BSN, RNC, APN - Zephyr Cove,

November 2007*Peggy Cullum, RN - Las Vegas, September 2007*Virginia Deleon, RN – Henderson, September 2007*Phyllis Erichsen, RNC, CCM – Reno, May 2009Mattie Harris, RN - Las Vegas, May 2009*Deborah E. Martz, RN - Las Vegas, November 2006*Judith Slaney, RN, LADAC - Las Vegas, May 2007*Ann Testolin, EdD, MS, BS, RN – Reno, March 2009*

Active conceptual members**

Jan Brethauer, RN - Yerington Roseann Colosimo, PhD, MSN, RN - Las Vegas Mary Culbert, MS, RN - Reno Darlene Cunningham, MS, RN, CCRN, APN - Reno John Malek, PhD, MSN, APN - Yerington Susan O’Day, BS, RN, CPAN - Reno Karienne Rimer, RN - HendersonChris Veach, MS, RN - Reno Judith Vogel, BSN, RN - Boulder City Rilo Weisner, MS, RN, C - Las Vegas

* Indicates first-term

** Conceptual members are nurses who have servedtwo terms but desire to remain available to theBoard for their historical expertise.

Who runs the Alternative Program? The Board’s compliance coordi-nator chairs the Board’sDisability Advisory Committee,which administers theAlternative Program forChemically Dependent Nurses.Committee members includeprofessional substance abuseand mental health nurses andnurses who are in recoveryfrom alcohol or drug addictionor have had other life experi-ences around addictions. Thecommittee

■ evaluates whether chemicaldependence is impairing aperson’s nursing practice

■ submits recommendations tothe Nevada State Board ofNursing, which may beaccepted, amended, orrejected

■ monitors recovery progressthrough scheduled interviewswith the nurse or nursingassistant and regular reportsfrom employers, treatmentproviders, and the nursesthemselves.


Chemical Dependency in Nurses and NursingAssistants

Under Nevada law, nurses and CNAsmust report potential violations of theNurse Practice Act. Practicing whileimpaired is a violation of NRS 632.320 (5)and NAC 632.890 (9).

Chemical dependency is one cause ofimpairment. The Board’s Disability AdvisoryCommittee has put together this fact sheet to helpyou identify impairment on the job. If you suspectsomeone is impaired, urge the individual to seek help. Ifthey refuse, report your suspicions to your supervisors. Itmay be a difficult decision, but if you do not make it,you will be endangering the health of the patients andthe impaired nurse or CNA.

Possible indications of nurse or CNAimpairment on the job include• Absent or late for work, especially following several

days off. However, the drug-addicted nurse or CNAmay never be absent and may “hang around” whennot on duty. Because the hospital is the source of sup-ply, the nurse or CNA may volunteer to work doubleshifts, overtime, holidays, days off, etc.

• Odor of alcohol on the breath. Any nurse or CNAwho would report for duty after drinking is assuming aterrible risk and in doing so is evidencing his/her lossof control and need for the drug.

• Odor of mouthwash and breath mints. These may beused to mask the odor of alcohol.

• Fine tremors of the hands. This symptom occurs withwithdrawal from the drug. The alcoholic nurse or CNAwill sometimes begin to use tranquilizers to mask signsof withdrawal and thus may develop cross dependency.

• Emotional instability. The nurse or CNA may changefrom being irritable and tense to being mellow andcalm. There may be inappropriate anger or crying.

• Returns late from lunch break. • May be sleepy or may doze off while on duty. • Shuns interaction with others and tends to withdraw. • Makes frequent trips to the bathroom. The female

alcoholic/drug addict may carry a purse with her. • Deterioration in personal appearance. • Frequent bruises or cigarette burns. Bruises over ante-

cubital fossa and on wrists or hands. These injuries arethe result of crashing into furniture, falling while

intoxicated, dozing off with a lighted cigarette,or the recent injection of a drug. • Job performance may be affected withsloppy or illegible handwriting, errors incharting, and errors in patient care.

• Lapses in memory or confusion. Theremay be euphoric recall of events.

• Shunning of job assignment or job shrink-age. The nurse or CNA is apt to drop out of profes-

sional activities.

The nurse who is diverting drugs from the unit may• always volunteer to give medications. • medicate another nurse’s patient. • use the maximum PRN dosage when other nurses use

less, or the maximum PRN dosage may always be usedon one shift but not on another (the PRN medica-tions afford the greatest opportunity for the nurse tosupply his/her habit).

• have responsibility for patients who complain thatmedication given on one shift is not as effective as onothers, or that they did not receive medication whenthe record shows they did.

• have frequent wastage, such as spillage of drugs ordrawing blood in the syringe.

• work on a unit where drugs are disappearing or sealshave been tampered with.

• always offer to count narcotics to make sure the countis correct.

• have pinpoint pupils, shaky hands, could be sleepy orhyper while on duty.

Keep in mind that no indicator, orgroup of indicators, is unique tochemical dependency.

However, if there is a drop off in the work perform-ance of a previously good employee, the supervisor shouldconsider the possibility of a problem if several indicatorsare present.

See Disciplinary Versus Alternative Program Process Chart on next page


Disciplinary Process Alternative Program Process

Someone makes a complaint alleging you violated the Nurse Practice Act.

The allegations are reviewed by Board staff to determine if the information is sufficient to require an investigation.

A complaint is opened and assigned to a nurse investigator.

A complaint is not opened because the information submitted, at face value, does not identify a potential violation of the Nurse Practice Act.

You receive a notification by certified letter, containing the allegations submitted against you.

A nurse investigator gathers and reviews documents (including any information you provide), interviews witnesses, and presents the evidence for review.

The complaint is closed. The evidence obtained is not sufficient to support a violation of the Nurse Practice Act. You are notified by letter.

You have a formal hearing before the Board.

Depending on the nature of the violation, you may agree to receive disciplinary action ranging from a public reprimand to a voluntary surrender of your license or certificate.

You enter into a settlement agreement.

The Board takes disciplinary action against you, ranging from a public reprimand to revocation of your license or certificate.

The Board closes or dismisses your complaint.

The Board accepts the settlement agreement.

The Board renegotiates the settlement agreement.

The disciplinary action is published on the list of disciplinary actions taken by the Board and reported to national databanks.

Nurse signs Contract for Temporary Voluntary Surrender and surrenders license to Board staff.

Nurse admits self into chemical dependency treatment (180 hours in Board-approved program).

Nurse begins 90 AA/NA meetings in 90 days.

Contract for Temporary Voluntary Surrender accepted by Board at next Board meeting.

Board staff offer nurse Tem-porary Voluntary Surrender.

Complaint is opened.

Nurse schedules evaluation with Disability Advisory Committee (DAC) to be evaluated for return to work. If DAC recommends return to work, nurse is offered Five-Year Agreement for Monitoring (nonpublic).

Board accepts Agreement.

Nurse signs Agreement for Monitoring.

Nurse returns to work on Agreement (license is unmarked).

Nonpublic action is not reported to national databanks.

Nurse makes self-report to the Board for diversion and/or impairment.

Disciplinary Versus Alternative Program Process


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Need more options? We have an excellent in-house Travel and Registry program. To find out more,visit our website and enter keyword: Travelers.

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32nd NATIONAL PRIMARY CARE

NURSE PRACTITIONER SYMPOSIUM

July 12 - 15, 2007Keystone Resort

Contact:UCDHSC

Nurse Practitioner Symposium OfficePO Box 6508 Mail Stop F 541

Aurora, CO 80045-0508Phone: 303 724-0600 Fax: 303 724-0957

E-mail: [email protected]:

Colorado

http://www.uchsc.edu/nursing/nps.htm

• Extensive selection of practice and issues sessions

• Hands-on clinical workshops

• Pharmacology content in numerous sessions

Board staff often hears com-plaints from employers that it’staking too long to issue a licenseor certificate to a potentialemployee. Unless the applicanthas given formal authorization torelease information to employers,the Board cannot discuss anindividual’s application with

anyone but the individual. However, we can tell you

that if an application is com-plete and meets the criteria forissuance of a license/certificate,we can generally issue a (tempo-rary or permanent) license/cer-tificate within one week ofreceipt of the application.

There are many reasons that it may takethe Board longer than a week to issue thelicense/certificate. The list below (which isincluded in the application instructions)describes the most common reasons. ■ an unresolved “Yes answer” to the

Eligibility Screening Questions ■ a pending complaint investigation or a

Board disciplinary action against alicense/certificate

■ an unresolved issue pertaining to theChild Support Information section

■ applicant did not graduate from anapproved school of nursing with a nurs-ing certificate (LPN), degree or diplo-ma (RN), or completed an approvedCNA training program

■ applicant has not submitted a copy ofnursing education program transcript,diploma, or certificate

■ applicant did not pass the SBTPE orNCLEX licensing examination, or theCNA competency examination

■ applicant does not hold a current, per-manent license from another state

■ applicant has not submitted a U.S.Social Security number

■ applicant has not completed or submit-ted fingerprint cards, or delayed sub-mitting cards

■ applicant did not follow the finger-print instructions *

■ the Board has not received and clearedthe official fingerprint reports Please note: while an individual’s

application process with the Board is con-fidential, we are happy to answer any ques-tions or concerns you may have regardingour general processes.

* The Nevada Department of Public Safety(DPS), which is the state agency thatprocesses the fingerprint cards and pro-vides the results to the Board, returns atleast 100 cards to the Board every monthbecause of applicants’ failure to follow theinstructions enclosed with the application.The Board then must send the returned fin-gerprint cards to the applicant, with furtherinstructions regarding how to resubmitthem correctly. A majority of the cards arereturned because the applicant enclosed apersonal check rather than the moneyorder required by DPS—a requirementclearly stated in the fingerprint instructions.


You Want to Hire a Nurse or CNA What are some of the things that can hold up a license/certificate?

American HeartAssociation Training Center

• Advanced Cardiac Life Support (ACLS)

• Pediatric Advanced LifeSupport (PALS)

• Basic Life Support (BLS/CPR)

Certification and renewal offered weekly and/or monthly

For more information please contact:

Sara Williams

[email protected]

702-651-4770

ContinuingEducationCourses• Basic EKG

• LPN IV Certification

• The Latest & Greateston IV Therapy

• NRP—NeonatalResuscitationProvider

• PICC—PeripherallyInserted CentralCatheters

• TNCC—TraumaNursing Core Course

• Certified Caregiver(New! Certificate Only)

• Customized Trainingto meet the individualneeds of HealthcareAgencies

COMMUNITY COLLEGEof SOUTHERN NEVADA

Division of Workforce and Economic Development


TOLL-FREE CONSUMER HOT LINE

CALL 888 -590-6726

The Nevada State Board of Nursinghas a hot line to help consumerswho have questions or concernsabout the nursing care they or theirloved ones are receiving. Pleaseencourage your friends, familiesand patients to call the hot line ifthey have concerns about nursingcare. And remember, if you or any-one else wishes to file a complaintagainst a nursing assistant ornurse, it must be done in writing.Complaint forms can be requestedby calling the hot line or can beobtained by visiting the Board’swebsite.

We often hear this lamentfrom people whose applicationshave been returned to thembecause they didn’t think thechild support section applied to them.

But we don’t have a choice.It’s federal law that requiresapplicants to complete the childsupport section, even if theydon’t have children.

Your application will not beprocessed if you do not answerboth questions in the child sup-port section of the application.

But I don’teven have a child! Before you email the Board, make

sure you add us to your “safe list”and/or have given your emailprovider permission to receive mes-sages from email addresses endingwith @nsbn.state.nv.us. We respondpromptly to every email inquiry, butoften, our responses are rejected.Sometimes, they’re returned as“undeliverable” or they are mistakenfor spam. Other times, we’re askedto sign in and provide a password toan email screening service, which isagainst Board policy.

So, if you’re wondering why theBoard doesn’t answer your emails,check to see whether you’vescreened us out. We want to hearfrom you and we want you to hearfrom us!

Emailing the Board?Add us to your “safe list” first

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2007 Western Regional Preparedness Conference:

Strengthening Interstate Communication and Collaboration

July 9 – 11, 2007MGM GRAND HOTELLAS VEGAS, NV

This conference is intended for:

- Homeland Security Personnel

- Emergency Management Professionals- First Responders

- Health Care Professionals - Mental Health Professionals- Exercise Development and Training Personnel - Government Personnel- Public Health Personnel

To download registration forms or for more information, please visit our website:

www.snahec.org

For more information, please contact: Emergency Preparedness and Response Education Program Conference Coordinator at(702) 318-8452 ext. 262 or fax to (702) 212-8458.

Sponsord by:

This conference is supported by Grant #T01HP0697 from the Assistant Secretary of Preparedness and Response (ASPR).

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*Available CEUs for healthcare, EMS personell and nurses.


Now you canchange your

address on line!The law requires you toinform the Board whenyou change addresses

You’re required by law to inform theBoard, in writing, of any address change,including a zip code change. The easiestand fastest way for you to make youraddress change is to go to the Board’swebsite and click on the Address Changelink. You may also send an email to [email protected], call the Boardand request an address change form, ormail a signed letter to the Las Vegasoffice. Remember to include your name,license or certificate type and number, for-mer address, current address, social secu-rity number, and date of birth.

Change of address formName (Last, First, Middle)________________________________________Type of License________________________________________License Number________________________________________Date of Birth________________________________________Social Security #________________________________________Former Address________________________________________City, State, Zip Code________________________________________Current Address________________________________________City, State, Zip Code________________________________________Telephone#_______________________________________Signature________________________________________Mail to: Nevada State Board of Nursing

2500 W. Sahara Ave. #207Las Vegas, NV 89102-4392

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Helen Vos, MS, RN

President, RN Member

Term expires 10/31/2008

David Burgio, MS, RN, APN

Vice President, RN Member


Dorothy Perkins, CNA

Secretary, CNA Member


Doreen Begley, MS, RN

RN Member


Joseph Cortez

Consumer Member


Mary Ann Lambert, MSN, RN

RN Member


Betty McKay, LPN

LPN Member


BOARD MEMBERSThe Nevada State Board of Nursing is a seven-member board

appointed by the governor of Nevada consisting of four regis-

tered nurses, one licensed practical nurse, one certified nursing

assistant, and one consumer member.

If you wish to contact a Board member, please write c/o Nevada

State Board of Nursing, 5011 Meadowood Mall Way, Suite 300,

Reno, NV 89502-6547; call1-888-590-6726; or email

[email protected]

BOARDAUTHORITYThe Board has authority

only over its licensees and

certificate holders and not

over the facilities in which

these individuals practice.

The Board enforces the

Nurse Practice Act (the

law regulating nursing

practice), with funding for

all of its activities coming

solely from the fees paid to

the Board by licensees and

certificate holders. The

Board does not have

authority to take action on

issues that are of an

employment nature, or

those that relate to the

nursing profession as a

whole. These matters are

best dealt with by the state

labor commissioner, nursing

associations, labor unions,

or other similar entities.


The following are disciplinary andlicensure/certification actions taken by theNevada State Board of Nursing for the periodof November 17, 2006 through January 25,2007. Please note that this list does notinclude some outcomes of the January 24-25,2007, Board meeting due to legal noticerequirements. Those outcomes will be reportedin a future disciplinary actions list. This listdoes include some outcomes of previous Boardmeetings that were not reported earlier due tolegal notice requirements.

Settlement Agreements and/orHearing OutcomesBartley, Tanjara, LPN10747 Agreement forReprimand for violation of NRS 632.320 (1) fraudu-lent application.Burrows, Beth, CNA applicant Agreement forProbation for violation of NRS 632.320 (2) criminalconvictions.Chand, Erica, CNA019218 Certificate revoked forviolation of NRS 632.320 (7) unprofessional conduct,and NAC 632.890 (22) patient abandonment, and(27) customary standards of practice. Cunin, Chental, RN46042 Voluntary Surrender ofLicense in Lieu of Other Disciplinary Action pur-suant to NRS 632.320 (7) unprofessional conduct,and NAC 632.890 (35) failing to comply.Del Rosario, Yolanda, RN27848 Agreement forProbation for violation of NRS 632.320 (2) criminalconviction, and (13) deceive, defraud or endanger apatient or the general public.Dela Cruz, Darlyn May, RN46951 Agreement forReprimand for violation of NRS 632.320 (1) fraudu-lent application.Francisco, Amy, CNA019287 Agreement forReprimand for violation of NRS 632.320 (7) unpro-fessional conduct, and NAC 632.890 (2) practicingbeyond scope.

Glickman, Rebecca, RN47126 License revoked forviolation of NRS 632.320 (7) unprofessional conduct,and NAC 632.890 (16) failing to properly documentcontrolled substances, and (18) diversion of equip-ment or drugs. Hall, Lori, RN50507 Agreement for ExtendingProbation with Public Reprimand for violating NRS632.320 (7) unprofessional conduct and, NAC632.890 (35) failing to comply with Board order.Kahoa, Beverly, RN43708 Agreement for Probationfor violation of NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (11) positive drug screen ascondition of employment.Kapadia, Jayshree, CNA009506 Agreement forReprimand for violation of NRS 632.320 (7) unpro-fessional conduct, and NAC 632.890 (18) diversionof equipment or drugs.Lanzaro, Elizabeth, RN08496 Agreement forProbation for violation of NRS 632.320 (2) criminalconvictions. Lemich, Boja, RN14845, APN000550 APN certifi-cate revoked and RN Probation extended for viola-tion of NRS 632.320 (7) unprofessional conduct, and(14) failing to comply with Board order, and NAC632.295 unprofessional conduct, and NAC 632.890(2) practicing beyond scope, and (26) violation ofstate/federal nursing law/regulation. Maestrejuan, Tina, RN28766 Agreement forReprimand and Fine of $1,200.00 for violation ofNRS 632.320 (7) unprofessional conduct, and NAC632.890 (36) practicing without active license.Maldonado, Ingrid, CNA013310 Certificaterevoked for violation of NRS 632.320 (7) unprofes-sional conduct, and NAC 632.890 (11) positive drugscreen as condition of employment. McDaniel, Michelle, RN17055 Agreement forReprimand for violation of NRS 632.320 (7) unpro-fessional conduct, and (13) deceive, defraud or endan-ger a patient, and NAC 632.890 (20) inaccuraterecording, falsifying, (27) failing to perform nursingfunctions in a manner consistent with established orcustomary standards, and (38) professional boundaries.Metzinger, Connie, CNA009318 Certificaterevoked for violation of NRS 632.320 (7) unprofes-sional conduct, and NAC 632.890 (9) impaired prac-tice. Ozer, Debra, RN46238 License revoked for viola-tion of NRS 632.320 (7) unprofessional conduct, andNAC 632.890 (16) failing to properly document con-trolled substances. Palacios, Michelle, CNA017407 Agreement forReprimand for violation of NRS 632.320 (14) failingto comply with Board order.Rodgers, Rosemary, LPN12545 Agreement for Fineof $200.00 for violation of NRS 632.320 (7) unpro-fessional conduct, and NAC 632.890 (36) practicingwithout active license.Rojas, Marrilyn, LPN11740 Agreement forReprimand for violation of NRS 632.320 (7) unpro-fessional conduct, and NAC 632.890 (20) inaccuraterecording, falsifying. Ruiz, Dorothy, LPN03426 Agreement forReprimand for violation of NRS 632.320 (1)fraudulent application.

Salas, Michelle, LPN12076 Agreement forReprimand for violation of NRS 632.320 (7) unpro-fessional conduct, and NAC 632.890 (13) confiden-tiality violation.Stahlberger, Elizabeth, LPN08051 Agreement forExtending Probation with Public Reprimand for vio-lating NRS 632.320 (7) unprofessional conduct and,NAC 632.890 (35) failing to comply with Boardorder.Torres, Francis, CNA015111 Agreement forProbation for violation of NRS 632.320 (7) unprofes-sional conduct, and NAC 632.890 (22) patient aban-donment.

Denials of Applications forLicensure or CertificationCruze, Jacob, RN28627Kulikowski, Nadine, RN applicant Popovich, Sandra, RN applicant Riley, Linda, RN applicant Szafarek, Mary, RN applicant Taylor, Alia, CNA applicantWilliams, Kimberly, CNA applicant Wiscombe, Gary, RN/CRNA applicantApplications denied for violation of NRS 632.320 (1)fraudulent application.

Conway, Shamil, CNA applicantGray, Sarah, CNA applicantFaw, Linda, RN18865Applications denied for violation of NRS 632.320 (2)criminal conviction.

Fatta, Daniel, CNA applicant Zirot, Michael, CNA applicantApplications denied for violation of NRS 632.320(12) action in another state.

Citations for Practice Without ALicense/CertificateWilliams, Shanta

Findings of Guilt for Abuse,Neglect or MisappropriationPlaced on the Certified NursingAssistant Registry by the NevadaState Health Division’s Bureau ofLicensure and CertificationJohnson, Tonya, CNA016542Verbal abuse

Please do not use this listof disciplinary actions forverifying licensure orcertification status.

Other action may have takenplace between the time thediscipline was imposed andthe time of publication. Toverify licensure or certificationstatus, please visit ourwebsite or call the Board.

ABBREVIATIONSNRS Nevada Revised StatutesNAC Nevada Administrative Code

Disciplinary and Licensure/Certification ActionsBefore disciplinary action is taken, the Board ensures the nurse or nursing assistant is given due process


What are common types of disciplinary actions?When considering what kind of disciplinaryaction it should take, the Board alwaysasks itself, “What is needed to make thisperson safe to practice?” The answerdepends on the nature of the violation, andcan range from reprimanding an individualand ordering the person to attend a remedi-al class to revoking the person’s license orcertificate. All disciplinary action is report-ed to national disciplinary data banks.Outlined in the Nurse Practice Act, NRS632.325, disciplinary actions available tothe Board include:

Denial of ApplicationIf the Board denies an application for licen-sure or certification, it has determined thatthe individual violated the Nurse PracticeAct. In most cases, the denial is due tocriminal convictions and/or submitting afraudulent application.

Reprimand and/or FineIf the Board reprimands or fines a nurse orCNA, it has determined that the individualviolated the Nurse Practice Act. This actiondoes not prohibit or restrict the individual’spractice.

ProbationIf the Board puts an individual on probation,it means the nurse or CNA may work, butwill be working on a restricted license orcertificate and monitored by the Board fora specific time period. The probation mayalso include practice and/or setting restric-tions and requirements like classes or ran-dom drug tests.

SuspensionIf the Board suspends a license or certifi-cate, it means the nurse or CNA is prohibit-ed from practicing for a designated timeperiod.

Voluntary SurrenderThis means the nurse or CNA has agreed tovoluntarily surrender his or her license or cer-tificate and cannot practice in Nevada. If theperson applies for reinstatement, the Boardweighs evidence of rehabilitation and remedi-ation when considering the application.

RevocationIf the Board revokes a license or certifi-cate, it means the nurse or CNA cannotpractice in Nevada for a minimum of one toa maximum of 10 years. After that time,the nurse or CNA may apply for reinstate-ment if all the requirements in the order ofrevocation have been met. The Boardweighs evidence of rehabilitation and reme-diation when considering the application.

The following are disciplinary and licensure/cer-tification actions taken by the Nevada StateBoard of Nursing for the period of January 26through March 15, 2007. Please note that thislist does not include some outcomes of theMarch 14-15, 2007, Board meeting due to legalnotice requirements. Those outcomes will bereported in a future disciplinary actions list. Thislist does include some outcomes of previousBoard meetings that were not reported earlierdue to legal notice requirements.

Settlement Agreements and/orHearing OutcomesAlcaraz, Michelle, CNA013701 Agreement forReprimand for violation of NRS 632.320 (1) fraudu-lent application.Avalos, Jaime, RN36667 Agreement for Reprimandfor violation of NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (11) positive drug screen ascondition of employment.Bales, Mary, CNA018912 Agreement for Probationfor violation of NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (27) customary standards ofpractice and (28) causing harm to a patient.Bogle Skelton, Jennifer, CNA019216 Agreementfor Probation for violation of NRS 632.320 (7) unpro-fessional conduct, and NAC 632.890 (27) customarystandards and (28) causing harm to a patient. Byers, Helen, RN27434 Agreement for Reprimandfor violation of NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (22) patient abandonment.Byrd, Brent, CNA019172 Agreement for Probationfor violation of NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (27) customary standards and(28) causing harm to a patient. Corona, Roger, LPN11291 Agreement for Suspensionfor violation of NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (9) impaired practice.Dibartolomeo, Hope, RN54441 Voluntary Surrenderof License in Lieu of Other Disciplinary Action forviolation of NRS 632.320 (7) unprofessional conduct,and NAC 632.890 (11) positive drug screen as condi-tion of employment.Gonzales, Rebecca, RN33173 Agreement for Fine inthe amount of $300.00 for violation of NRS 632.320(7) unprofessional conduct, and NAC 632.890 (36)practicing without active license.Gustafson, Janet, RN07890 Order of Probation forviolation of NRS 632.320 (2) criminal convictions. Kerner, Emilda, CNA014917 Agreement forProbation for violation of NRS 632.320 (7) unprofes-

sional conduct, and NAC 632.890 (27) customarystandards and (28) causing harm to a patient.Lubic, Ross, RN applicant Agreement for Probationfor violation of NRS 632.320 (2) criminal convictionsand (7) unprofessional conduct, and NAC 632.890(35) failure to comply. Narito, Stanley, RN43913 Agreement for Probationfor violation of NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (22) patient abandonmentand (38) professional boundaries. Tatsuo, Jacqueline, CNA015417 Agreement forReprimand for violation of NRS 632.320 (7) unpro-fessional conduct, and NAC 632.890 (22) patientabandonment and (27) customary standards. Tuomy, Georgia, RN49520 Order of ProbationExtension and Reprimand for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (35) failing to comply with Board order. Wallis, Charlotte, RN19366 Agreement forReprimand for violation of NRS 632.320 (7) unpro-fessional conduct, and NAC 632.890 (2) practicingbeyond scope and (25) failing to observe/report.Williams, Aisha, LPN13067 Order of Reprimandand Probation Extension for violation of NRS632.320 (7) unprofessional conduct and NAC632.890 (35) failing to comply with Board order.Williams, Lynette, RN27316 Agreement forProbation for violation of NRS 632.320 (5) con-trolled substances and/or alcohol and (7) unprofes-sional conduct, and NAC 632.890 (16) failing toproperly document controlled substances and (18)diversion of equipment or drugs.

Denials of Applications forLicensure or CertificationClanton, Karen, RN applicantMoore, Deborah, LPN applicantMorgan, Doris, RN applicantApplications denied for violation of NRS 632.320(1)fraudulent application.

Rainey, Shmyra, CNA013759 Rollings, Robert, CNA applicantApplication denied for violation of NRS 632.320 (2)criminal convictions.

Jackson, Carolyn, RN applicant Application denied for violation of NRS 632.320 (1)fraudulent application and (12) action in another state.

Failure to Provide Evidence ofContinuing Education/TrainingWhen AuditedLawson, Freda, CNA002171 Leach, Kathryn, CNA018895 Renewal applications denied for violation of NRS632.320 (7) unprofessional conduct, and NAC632.415 (1) failure to provide continuing education.

Citations for Practice Without ALicense/CertificateHosseini, Magda

Findings of Guilt for Abuse,Neglect or MisappropriationPlaced on the Certified NursingAssistant Registry by the NevadaState Health Division’s Bureau ofLicensure and Certification Turner, Michael, CNA016511Verbal abuse

Who can I call if I have questions about the complaintor disciplinary process?

The Board encourages you to callany time you have a questionabout the disciplinary process orwhat constitutes a violation of theNurse Practice Act. Just call theBoard and ask for one of thenurse investigators or the directorof operations.


Have a question? Give us a call.

Debra Scott, MSN, RN, APN, Executive DirectorStatewide Liaison and SpokespersonOrganizational and Public ManagementFiscal and Human Resource ManagementLegislative and Governmental RelationsAPN Advisory Committee ChairNursing Practice Advisory Committee Chair

Chris Sansom, BSN, RN, Director of Operations Program ManagementCNA Advisory Committee Chair

Patty Shutt, LPN, Site Operations SupervisorLas Vegas Site Supervision

Roseann Colosimo, PhD, MSN, RN,Education Consultant

Nursing Education ProgramsCNA Training ProgramsContinuing Education ProgramsEducation Advisory Committee Chair

Fred Olmstead, General CounselLegal Counsel

Dean Estes, Accountant/Technology OfficerBudget, Accounting and PayrollProgrammingTechnology Support

Cindy Kimball, Public Information OfficerPublic Information and EducationConsumer RelationsNews Magazine, Web Site, Publications

Marianne Kadlic, Executive AssistantAssistant to the Executive Director SchedulingBoard Meeting Agenda and Arrangements Nurse Practice Act Publication

ADMINISTRATION5011 Meadowood Mall Way, Suite 300, Reno, NV 89502, 888-590-6726

[email protected]

Investigations and MonitoringLinda Aure, BSN, RN, C, Senior Investigator

Complaint InvestigationsNursing Practice Questions

Lark Muncy, RN, Investigator Complaint InvestigationsNursing Practice Questions

Marilyn Schmit, RN, Application Coordinator Application Review Fraudulent Application Screening

Kathleen Reynolds, BHS, RN, Compliance Coordinator Disability Advisory Committee ChairDisability Advisory Committee SchedulingProbation and Alternative Program MonitoringReinstatement Applications

Licensure/CertificationSarah Bowen, Licensure Specialist

Licensure Eligibility QuestionsRenewal ApplicationsEndorsement and Examination ApplicationsContinuing Education ProvidersForeign Nurse Graduates and Licensure Issues

Patty Towler, Senior Certification Specialist CNA Registry MaintenanceCNA Certification and RenewalsCNA Program and Instructor Approvals

Molly Echandy, Licensure/Certification Clerk Licensure Eligibility QuestionsRenewal ApplicationsEndorsement and Examination ApplicationsContinuing Education ProvidersForeign Nurse Graduates and Licensure IssuesCNA Certification and Renewals

SupportSherrie Frederick, Fingerprint Specialist

Endorsement FormsFingerprint ProcessingFingerprint Report Screening

Christie Daliposon, Management Assistant Assistant to the Director of OperationsDiscipline Investigative SupportCompliance SupportBoard Meeting PreparationDisability Advisory Committee Scheduling

Cyndie Souza, Management Assistant Discipline Investigative SupportYes Answer and Fraudulent Application ProcessingBoard Meeting Preparation NURsys Data Entry

Kimberly Roth, ReceptionistKiley Smith, Receptionist

Renewal ApplicationsProgram SupportInquiries, Information and ReferralsLicensure and Certification ApplicationsNursing Personnel Lists

Adela Smith, Receptionist Program SupportInquiries, Information and ReferralsLicensure and Certification ApplicationsSpanish-Speaking Services for Consumers

PROGRAM STAFF 5011 Meadowood Mall Way, Suite 300, Reno, NV 89502, 888-590-67262500 W. Sahara Ave., Suite 207, Las Vegas, NV 89102, 888-590-6726

[email protected]

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