Orientation for New Nurse Leaders

New Hampshire Board of NursingNew Hampshire Board of Nursing

Everything You Ever Wanted Everything You Ever Wanted to Know about Licensing and to Know about Licensing and Practice RegulationsPractice Regulations

Welcome!Welcome! January 2010January 2010

New Hampshire Board of NursingNew Hampshire Board of Nursing 22

PART 1PART 1Mission of the BoardMission of the Board

Structure and FunctionStructure and Function

Nurse Practice ActNurse Practice Act

Administrative RulesAdministrative Rules


Board StaffBoard Staff

Margaret Walker, Executive DirectorMargaret Walker, Executive DirectorNorma Blake, Assistant DirectorNorma Blake, Assistant DirectorPatricia Orzano, Assistant DirectorPatricia Orzano, Assistant DirectorLori Tetreault, Program Specialist IVLori Tetreault, Program Specialist IVSusan Goodness, Administrative Susan Goodness, Administrative SupervisorSupervisor

Attorney Laurel O’Connor, Prosecuting Attorney Laurel O’Connor, Prosecuting Attorney contracted by the BoardAttorney contracted by the Board


Board StaffBoard Staff

Professional nursing staffProfessional nursing staff

Licensing clerks and secretarial staffLicensing clerks and secretarial staff

Responsible for implementing the rules, Responsible for implementing the rules,

including:including:– Licensing applicants,Licensing applicants,– Surveying education programsSurveying education programs– Conveying the Board’s decisions about Conveying the Board’s decisions about

practice issues to the publicpractice issues to the public


Board MembersBoard Members

Have the responsibility of regulating Have the responsibility of regulating practice practice 11 members11 members

appointed by the governor for a 3 year termappointed by the governor for a 3 year term

5 RNs, one of which must be an ARNP5 RNs, one of which must be an ARNP

2 LPNs2 LPNs

2 LNA’s, one which should be a MNA if 2 LNA’s, one which should be a MNA if possiblepossible

2 public members2 public members


Board PurposeBoard Purpose

Defined in RSA 326-B:1, aka the Defined in RSA 326-B:1, aka the Nurse Practice ActNurse Practice Act

Safeguard the public from…..Safeguard the public from…..– UnauthorizedUnauthorized

– UnqualifiedUnqualified

– Improper practice of nursingImproper practice of nursing


How does the Board protect the How does the Board protect the public?public?

Licenses nurse and nursing assistantsLicenses nurse and nursing assistants

Defines the scope of nursing and nursing Defines the scope of nursing and nursing assistant practiceassistant practice

Enforces rules and governs practice and Enforces rules and governs practice and educationeducation

Reviews and approves schools of nursingReviews and approves schools of nursing

Sanctions licensees who violate the lawSanctions licensees who violate the law


Board Meeting ScheduleBoard Meeting Schedule

3rd Thursday of every month3rd Thursday of every month

8:30 - 4:00 PM at the Board office at 8:30 - 4:00 PM at the Board office at

21 South Fruit Street, Concord, NH21 South Fruit Street, Concord, NH

Board meetings are open to the public!Board meetings are open to the public!

We strongly encourage you to attend!We strongly encourage you to attend!


Committees of the BoardCommittees of the Board

Practice & Education CommitteePractice & Education Committee– reviews and recommends to the Board changes reviews and recommends to the Board changes

and clarification to scope of practice for all and clarification to scope of practice for all license categorieslicense categories

ARNP Liaison CommitteeARNP Liaison Committee– reviews ARNP license applicants and reviews ARNP license applicants and

recommends to the Board and makes recommends to the Board and makes recommendations about ARNP practice issuesrecommendations about ARNP practice issues

Education Advisory Education Advisory – makes recommendations to the Board regarding makes recommendations to the Board regarding

education standardseducation standards


Nurse Practice ActNurse Practice Act

The The Nurse Practice Act (NPA)Nurse Practice Act (NPA) is also known as is also known as::

– RSA 326-B orRSA 326-B or– Statute, Law Statute, Law

Revised Nurse Practice Act signed by the Revised Nurse Practice Act signed by the Governor in Summer 2005Governor in Summer 2005

The NPA must be voted on by the legislature and The NPA must be voted on by the legislature and signed/ not signed/ vetoed by the Governorsigned/ not signed/ vetoed by the Governor

Revisions of laws may take years!Revisions of laws may take years!


Nurse Practice Act: Nurse Practice Act: Legislative IssuesLegislative Issues

Any one can propose new legislation Any one can propose new legislation about nursing!about nursing!

Changes to the NPA are made through Changes to the NPA are made through the legislative process:the legislative process:– Amendments to the Nurse Practice ActAmendments to the Nurse Practice Act– Amendments to other House or Senate Amendments to other House or Senate

BillsBills

Practice acts from other disciplines Practice acts from other disciplines may affect nursing practicemay affect nursing practice



The board makes necessary revisions on The board makes necessary revisions on an ongoing basis.an ongoing basis.

The board appears before the Joint The board appears before the Joint Legislative Committee on Administrative Legislative Committee on Administrative Rules for any and all changes.Rules for any and all changes.



Chapter 100: Organization of the BoardChapter 100: Organization of the Board

Chapter 200: General Board ProceduresChapter 200: General Board Procedures

Chapter 300: Licensing RequirementsChapter 300: Licensing Requirements

Chapter 400: Continuing Status, DelegationChapter 400: Continuing Status, Delegation

Chapter 500: Ethical StandardsChapter 500: Ethical Standards

Chapter 600: EducationChapter 600: Education

Chapter 700: Nursing AssistantsChapter 700: Nursing Assistants

Chapter 800: Medication Nursing Chapter 800: Medication Nursing

AssistantsAssistants


Monitoring legislation:Monitoring legislation:

www.nh.govwww.nh.gov

www.nh.gov/nursingwww.nh.gov/nursing

Nurse Practice Act: Legislative IssuesNurse Practice Act: Legislative Issues


PART 2PART 2Licensure Requirements for RNs and LPNsLicensure Requirements for RNs and LPNs

Mutual Recognition Licensure: The Compact Mutual Recognition Licensure: The Compact

Examinations, Endorsements and Temporary Examinations, Endorsements and Temporary LicensesLicenses

Foreign educated nursesForeign educated nurses

Scope of Practice for RNs and LPNsScope of Practice for RNs and LPNs

Understanding “404.12”Understanding “404.12”

Reentry for RNs and PNsReentry for RNs and PNs

LPN IV Therapy RulesLPN IV Therapy Rules


RN & LPN Licensing RequirementsRN & LPN Licensing Requirements

No nurse may work in any capacity No nurse may work in any capacity without a temporary or permanent without a temporary or permanent active NH license or multi-state license active NH license or multi-state license issued by another compact stateissued by another compact stateLicense by Examination or EndorsementLicense by Examination or Endorsement2 status categories: active/ inactive2 status categories: active/ inactiveContinuing competence requirementsContinuing competence requirements– 400 hours active in practice - 4 years400 hours active in practice - 4 years– 30 continuing education hours - 2 years30 continuing education hours - 2 years


What is mutual recognition?What is mutual recognition?

Allows a nurse to practice in multiple Allows a nurse to practice in multiple states with one license states with one license Nurse maintains a “home state” a.k.a. Nurse maintains a “home state” a.k.a. “Primary residence” “Primary residence” Nurse can practice in other compact Nurse can practice in other compact states as long as license is in “good states as long as license is in “good standing” standing” Also known as Nurse Licensure Also known as Nurse Licensure Compact (NLC) or “Compact” Compact (NLC) or “Compact”


When did NH implement the Compact?When did NH implement the Compact?

The Compact was enacted through the The Compact was enacted through the state governmentstate government

The Compact in NH is part of the Nurse The Compact in NH is part of the Nurse Practice ActPractice Act

The Governor signed the Nurse Practice The Governor signed the Nurse Practice Act (SB 170) into law on July 25, 2005Act (SB 170) into law on July 25, 2005

Implementation of the compact in New Implementation of the compact in New Hampshire was on January 1, 2006Hampshire was on January 1, 2006


How does the Compact work?How does the Compact work?

License to practice is issued by the state License to practice is issued by the state in which you legally reside. in which you legally reside. Allows a nurse to practice in any other Allows a nurse to practice in any other compact statecompact stateIf a nurse moves to another compact state, If a nurse moves to another compact state, the nurse must apply for a multi-state the nurse must apply for a multi-state license in the newly adopted state and license in the newly adopted state and surrender the multi-state license from the surrender the multi-state license from the former state.former state.


How do I know which states belong How do I know which states belong to the Nurse Licensure Compact?to the Nurse Licensure Compact?Go to Go to www.ncsbn.comwww.ncsbn.com for a current listing for a current listing of the statesof the statesArizona, Arkansas, Colorado, Delaware, Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Nebraska, Mississippi, Nebraska, New HampshireNew Hampshire, , New Mexico, North Carolina, North Dakota, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, & Tennessee, Texas, Utah, Virginia, & Wisconsin currently belong to the compact Wisconsin currently belong to the compact with Missouri entering June 2010with Missouri entering June 2010..


How is primary residence How is primary residence determined?determined?

A nurse can have only one primary A nurse can have only one primary residence!residence!

Documentation establishing primary Documentation establishing primary residency includes:residency includes:–Driver’s licenseDriver’s license–Federal income tax returnFederal income tax return–Voter registrationVoter registration


What happened to the license What happened to the license of a nurse who of a nurse who lives in NH as lives in NH as

of January 1, 2006of January 1, 2006??Current license became a multi-state license Current license became a multi-state license issued by NH (with a few exceptions)issued by NH (with a few exceptions)

The nurse may practice nursing in NH or in The nurse may practice nursing in NH or in another compact state without having to apply another compact state without having to apply for a license in that compact statefor a license in that compact state


What happens to the license of a What happens to the license of a nurse who was nurse who was NOTNOT a resident a resident

of of New Hampshire on Jan. 1, New Hampshire on Jan. 1,

2006?2006?If If the nurse lived in the nurse lived in another compact stateanother compact state (such as (such as Maine): Maine): – The NH license became inactive on January 1, The NH license became inactive on January 1,

2006!2006!

– If the nurse wished to continue to practice as a If the nurse wished to continue to practice as a nurse in NH, s/he had to apply for a multi-state nurse in NH, s/he had to apply for a multi-state license in the state of residence.license in the state of residence.


What happens to the What happens to the license of license of a nurse who was a nurse who was NOTNOT a a

resident of NH on Jan. 1, resident of NH on Jan. 1, 2006?2006?

If the nurse lives in a If the nurse lives in a non-compact statenon-compact state (such as (such as Massachusetts or Vermont)Massachusetts or Vermont)– NH license became a “single state license” as of NH license became a “single state license” as of

January 1, 2006January 1, 2006

– A single state license in NH will allows the nurse A single state license in NH will allows the nurse to practice to practice onlyonly in NH. The nurse may NOT in NH. The nurse may NOT practice in other compact statespractice in other compact states


Does the compact change Does the compact change licensing requirements licensing requirements

in NH?in NH?NO!!NO!!

Everything stays the same for nurses Everything stays the same for nurses who live in NH and have a NH multi-state who live in NH and have a NH multi-state license or a NH single state license!license or a NH single state license!– Continuing education - 30 hours in 2 yearsContinuing education - 30 hours in 2 years– ““Active in practice” – 400 hours in 4 yearsActive in practice” – 400 hours in 4 years– Criminal background check required Criminal background check required


What about scope of practice?What about scope of practice?

You must comply with the practice You must comply with the practice regulations of the state in which the regulations of the state in which the care is provided!care is provided!

Nursing practice is not limited to Nursing practice is not limited to patient carepatient care


Who is included in the Who is included in the compact?compact?

Only RNs and LPNs are includedOnly RNs and LPNs are included

LNAs and MNAs are LNAs and MNAs are NOTNOT included included

ARNPs are ARNPs are NOT NOT included included


What if you are an ARNP?What if you are an ARNP?

New Hampshire is not part of the ARNP New Hampshire is not part of the ARNP nursing compact.nursing compact.

A nurse practitioner must have a valid RN A nurse practitioner must have a valid RN license which is in good standing. It does license which is in good standing. It does not need to be a NH-RN license when not need to be a NH-RN license when applying to NH for a ARNP license. applying to NH for a ARNP license.


ARNPs who live in NHARNPs who live in NH

No changes to current licensingNo changes to current licensing

You must maintain both your NH RN and You must maintain both your NH RN and your NH ARNP licensesyour NH ARNP licenses


ARNPs who live in another ARNPs who live in another statestate

Living in another Living in another compact compact state:state:

– Obtain / maintain RN license in compact Obtain / maintain RN license in compact statestate

– Obtain / maintain NH ARNP licenseObtain / maintain NH ARNP license

– Comply with NH ARNP licensing Comply with NH ARNP licensing requirementsrequirements


ARNPs who live in another ARNPs who live in another statestate

Living in a Living in a non-compactnon-compact state: state:

– Obtain / maintain NH RN single state Obtain / maintain NH RN single state licenselicense

– Obtain / maintain NH ARNP licenseObtain / maintain NH ARNP license

– Comply with NH RN and NH ARNP Comply with NH RN and NH ARNP licensing requirementslicensing requirements


Will NH continue to issue Will NH continue to issue temporary licenses?temporary licenses?

Yes, NH issues temporary licenses to new Yes, NH issues temporary licenses to new graduates and to applicants for license by graduates and to applicants for license by endorsementendorsement

As of January 1, 2006, all temporary As of January 1, 2006, all temporary licenses are single-state NH licenses only licenses are single-state NH licenses only

When the licensing process is complete When the licensing process is complete and a permanent license is issued to a NH and a permanent license is issued to a NH resident, it is a multi-state licenseresident, it is a multi-state license


How can an employer verify an How can an employer verify an employee’s license?employee’s license?

To verify a New Hampshire license:To verify a New Hampshire license:– www.nh.gov/nursingwww.nh.gov/nursing - on-line verification - on-line verification

To verify a non-resident multi-state To verify a non-resident multi-state license:license:– www.nursys.comwww.nursys.com (free) (free)

NurNursyssys® Licensure QuickConfirm® Licensure QuickConfirmI am an employer or recruiterI am an employer or recruiter who needs to who needs to verify the license of a nurse. verify the license of a nurse.


On-Line VerificationOn-Line Verification

Licensee Details: Licensee Details: Person Information Person Information Name: Margaret J. WalkerName: Margaret J. Walker

License InformationLicense Information License No: 018445-21License No: 018445-21

Profession: Nursing License Type: Registered NurseProfession: Nursing License Type: Registered Nurse

License Status: ActiveLicense Status: Active Issue Date: 8/28/1975 Issue Date: 8/28/1975

Expiration Date: 2/26/12Expiration Date: 2/26/12

Discipline InformationDiscipline Information

No Discipline InformationNo Discipline Information


Licensing by Examination NCLEXLicensing by Examination NCLEX

Required by all RN & LPN licenseesRequired by all RN & LPN licensees

Given 12 months/ yearGiven 12 months/ year

Computerized examComputerized exam

Applicant can access on-line verification Applicant can access on-line verification for license statusfor license status

Limitation on number of times taken are Limitation on number of times taken are noted in the Administrative Rules, 45 day noted in the Administrative Rules, 45 day waiting period waiting period


2008 Rules re: NCLEX2008 Rules re: NCLEX

May take 3 timesMay take 3 timesMust take and pass within 4 years of Must take and pass within 4 years of graduation or completion of CGFNS processgraduation or completion of CGFNS processAfter 3 failures, must complete remediation After 3 failures, must complete remediation planplanMay take one additional time after May take one additional time after remediationremediationNCLEX-PN for comparable education may NCLEX-PN for comparable education may be taken one time onlybe taken one time only


Temporary Licenses - for new Temporary Licenses - for new graduatesgraduates

New graduates are eligible for New graduates are eligible for ONEONE temporary license before they take NCLEXtemporary license before they take NCLEXValid for 120 days or until NCLEX takenValid for 120 days or until NCLEX takenRevoked if applicant fails NCLEXRevoked if applicant fails NCLEXMust be supervised by a RNMust be supervised by a RNWork within the scope of practice of the Work within the scope of practice of the license categorylicense categoryTitle is Graduate Nurse (GN) or Graduate Title is Graduate Nurse (GN) or Graduate Practice Nurse (GPN)Practice Nurse (GPN)May work only in New Hampshire – not in May work only in New Hampshire – not in other compact statesother compact states


EndorsementsEndorsements

Nurse from another compact state must Nurse from another compact state must apply for a NH if s/he moves to NHapply for a NH if s/he moves to NH

Require verification from original stateRequire verification from original state

May apply for a temporary license to May apply for a temporary license to bridge time before verification completebridge time before verification complete

Must meet all licensing requirements:Must meet all licensing requirements:– active in practiceactive in practice– continuing educationcontinuing education


Temporary Licenses – Temporary Licenses – for endorsementsfor endorsements

Eligible for Eligible for ONEONE temporary license temporary licenseMustMust have (and maintain)have (and maintain) an active license in an active license in another state if endorsing from a non-compact another state if endorsing from a non-compact statestateValid for 120 days or until permanent license Valid for 120 days or until permanent license issuedissuedWork within the scope of practice of the license Work within the scope of practice of the license categorycategoryMay work only in New Hampshire – not in other May work only in New Hampshire – not in other compact statescompact states


Nurses Educated in a Foreign CountryNurses Educated in a Foreign Country

Foreign educated (except Canada)Foreign educated (except Canada)– Must complete CGFNS process (credentials Must complete CGFNS process (credentials

review, English exam, predictor exam)review, English exam, predictor exam)– Must take NCLEXMust take NCLEX– May apply for a temporary licenseMay apply for a temporary license

Canadian educated on TN Visa (NAFTA)Canadian educated on TN Visa (NAFTA)– Have been able to use Canadian examHave been able to use Canadian exam– Now must take NCLEX (Immigration Services Now must take NCLEX (Immigration Services

requirement)requirement)


License RenewalLicense Renewal

Must meet continuing competence Must meet continuing competence requirements: continuing education and requirements: continuing education and active in practiceactive in practice

License must be renewed by midnight of License must be renewed by midnight of the birthday of the renewal yearthe birthday of the renewal year

License status can be checked 24-7 on License status can be checked 24-7 on the on-line verification sitethe on-line verification site


Reentry for RNs & LPNsReentry for RNs & LPNs

Board approved refresher course (theory and Board approved refresher course (theory and clinical) clinical)

ORORApproved self-study option (theory and Approved self-study option (theory and clinical)clinical)

ORORNCLEXNCLEX

ORORSpecified Excelsior College ExamsSpecified Excelsior College Exams


Scope of Practice for RN’s 326-BScope of Practice for RN’s 326-B

The law intent: “The law intent: “Registered nursingRegistered nursing”” means means the application of nursing knowledge, judgment the application of nursing knowledge, judgment and skill drawn from broad in-depth education in and skill drawn from broad in-depth education in the biological, psychological, social, and the biological, psychological, social, and physical sciences in assessing, diagnosing, physical sciences in assessing, diagnosing, planning, implementing, and evaluating care planning, implementing, and evaluating care which promotes optimum health, wellness, and which promotes optimum health, wellness, and independence of the individual, family and/or independence of the individual, family and/or communitycommunity


Scope of Practice for Scope of Practice for LPN’s 326-BLPN’s 326-B

The law intentThe law intent: “: “Practical nursingPractical nursing”” means a scope of means a scope of practice, practice, directed by a RN, ARNP, dentist, or MDdirected by a RN, ARNP, dentist, or MD, by , by an LPN who is prepared to function as a member of an LPN who is prepared to function as a member of the health care team by exercising sound nursing the health care team by exercising sound nursing judgment based on preparation, knowledge, skills, judgment based on preparation, knowledge, skills, understanding, and past nursing experience. understanding, and past nursing experience. Practical nursing by a LPN Practical nursing by a LPN contributes to the contributes to the assessment, planning, implementation and evaluation assessment, planning, implementation and evaluation of the patient careof the patient care. Practical nursing includes the . Practical nursing includes the delegation of nursing tasks that may be performed by delegation of nursing tasks that may be performed by others..... (paraphrased)others..... (paraphrased)


LPN IV RulesLPN IV Rules

Administrative RulesAdministrative RulesClients who weigh > 32 KgClients who weigh > 32 KgCentral lines Central lines notnot prohibited prohibited

RN does not have to give the first doseRN does not have to give the first dose

IV push, concentration, intermittent infusionIV push, concentration, intermittent infusionNo blood, no blood productsNo blood, no blood productsNo IV oncology medications or research medicationsNo IV oncology medications or research medications


Interpreting Scope of PracticeInterpreting Scope of Practice

Practice is dynamicPractice is dynamic

The Board determines practice The Board determines practice parameters within the confines of the parameters within the confines of the Nurse Practice Act and the Administrative Nurse Practice Act and the Administrative RulesRules


Clinical Practice

Opinion Has Been Rendered by the Board

Permitted – Under scope of

practice of licensee

Contact Board of Nursing staff

Clinical Practice question presented to Board of Nursing

Board consideration of Nurse Practice Act, National Standards

Prohibited Not within

scope of practice of

licensee

Stop

In compliance with Nur 305.01

Yes

Comply with

Nur 305.01 Permitted

No

Yes -Allowed within scope of

practice

Opinion Has Not Been Rendered by the Board

No -Prohibited not within scope of

practice of licensee

Stop


Nur 404.12 Nur 404.12

Guidelines for implementing additional Guidelines for implementing additional nursing interventions: nursing interventions:

describe the describe the education preparation and education preparation and practice historypractice history of the nurse (assistant) of the nurse (assistant) authorized to perform the activityauthorized to perform the activity

develop a develop a policy and procedurepolicy and procedure

write a plan for attaining and maintaining write a plan for attaining and maintaining competencecompetence

keep a keep a list of nurses authorized to performlist of nurses authorized to perform

update at least yearlyupdate at least yearly


PART 3PART 3Delegation RulesDelegation Rules

Licensing Requirements for LNAsLicensing Requirements for LNAs

Scope of Practice of Licensed Nursing Scope of Practice of Licensed Nursing AssistantsAssistants

Medication Nursing AssistantsMedication Nursing Assistants

Paid Feeding AssistantsPaid Feeding Assistants

LNA-Medication CertifiedLNA-Medication Certified


Nursing DelegationNursing Delegation

Pertains to delegation among licensees as Pertains to delegation among licensees as well as to delegation to unlicensed assistive well as to delegation to unlicensed assistive personnelpersonnel

Must be in keeping with Nur 404Must be in keeping with Nur 404

RSA-B:29 II “No person may coerce a RSA-B:29 II “No person may coerce a licensed nurse into compromising client licensed nurse into compromising client safety by requiring the nurse to delegate a safety by requiring the nurse to delegate a nursing activity or task when the nurse nursing activity or task when the nurse determines that it is inappropriate to do determines that it is inappropriate to do so…….”so…….”


What is Delegation?What is Delegation?

Nur 401.01(f):Nur 401.01(f): The transfer, The transfer, at the at the discretion of the nursediscretion of the nurse,, of of authority for the performance of a authority for the performance of a task of client care from the licensed task of client care from the licensed nurse with the authority to perform nurse with the authority to perform the task to someone who does not the task to someone who does not otherwise have such authorityotherwise have such authority


Nursing Delegation: Nur 404Nursing Delegation: Nur 404Nurse must determine:Nurse must determine:– Client stability, whether client’s nursing needs are Client stability, whether client’s nursing needs are

changingchanging– Delegate’s level of competencyDelegate’s level of competency– Complexity of taskComplexity of task– Familiarity of the delegate with the environmentFamiliarity of the delegate with the environment– Level of supervision neededLevel of supervision needed– On-going competencyOn-going competency– Need to rescind if the delegate proves unwilling or Need to rescind if the delegate proves unwilling or

incompetent, client objects, or nurse cannot provide incompetent, client objects, or nurse cannot provide adequate supervisionadequate supervision


Delegation……. Do it Right!Delegation……. Do it Right!

Right taskRight task

Right circumstanceRight circumstance

Right personRight person

Right communication/ directionRight communication/ direction

Right supervision and evaluationRight supervision and evaluation


What does it mean.....What does it mean.....responsibility =responsibility = a two-way process that a two-way process that must be allocated and acceptedmust be allocated and accepted

authority =authority = the right to act in areas one is the right to act in areas one is given and accepts responsibilitygiven and accepts responsibility

accountability = accountability = reviewing judgements and reviewing judgements and decisions, evaluating effectiveness, and decisions, evaluating effectiveness, and directing future effortsdirecting future efforts

YOU CAN’T GIVE AWAY ACCOUNTABILITY!YOU CAN’T GIVE AWAY ACCOUNTABILITY! MANTHEY & MILLER 1994MANTHEY & MILLER 1994


Levels of AuthorityLevels of Authority

Level 1Level 1 - Data gathering - Data gathering

Level 2Level 2 - Data gathering + recommendations - Data gathering + recommendations

Level 3Level 3 - Data + recommendation (pause) + - Data + recommendation (pause) + actact

Level 4Level 4 - Act and inform others after taking - Act and inform others after taking actionaction

LEVEL DEPENDS ON THE TASK, NOT THE LEVEL DEPENDS ON THE TASK, NOT THE LEVEL OF THE LICENSEELEVEL OF THE LICENSEE! ! MANTHEY & MILLER 1994MANTHEY & MILLER 1994


Licensed Nursing Assistants Licensed Nursing Assistants (LNA)(LNA)

Education and Licensing Requirements: Education and Licensing Requirements:

Nur 700Nur 700– Based on Federal StandardsBased on Federal Standards– Educational Programs are approved by the BON: Educational Programs are approved by the BON:

after program completion, apply for licensureafter program completion, apply for licensure– Must work under the supervision (direct or indirect) Must work under the supervision (direct or indirect)

of a licensed nurseof a licensed nurse– Must maintain 12 hrs of continuing education each Must maintain 12 hrs of continuing education each

year, 200 hrs/2 years active in practiceyear, 200 hrs/2 years active in practice


LNA Scope of PracticeLNA Scope of PracticeBased on activities taught during initial educational Based on activities taught during initial educational programprogramAdditional activities may be added based on specific Additional activities may be added based on specific BON approval, Nur 404.12 such as: .BON approval, Nur 404.12 such as: . Straight urinary catheters, foley irrigations, bladder scan Straight urinary catheters, foley irrigations, bladder scan

or doppler, application of TENS unit, feeding tubes, or doppler, application of TENS unit, feeding tubes, phlebotomy, wound care, vagus nerve stimulation, pulse phlebotomy, wound care, vagus nerve stimulation, pulse oximetry, incentive spirometry, oral suctioning, oxygen oximetry, incentive spirometry, oral suctioning, oxygen mask placement/cannula placement, chest mask placement/cannula placement, chest physiotherapy, peripheral vein IV removal, colostomy physiotherapy, peripheral vein IV removal, colostomy irrigations, medicated lotions, ointments and creams, irrigations, medicated lotions, ointments and creams, blood glucose monitoring, fingerstick PT/INR testing, blood glucose monitoring, fingerstick PT/INR testing, reminding clients to take their medications and reminding clients to take their medications and transcribing medical orders. transcribing medical orders.

This list should not be considered all inclusiveThis list should not be considered all inclusive


LNA Scope of PracticeLNA Scope of Practice

The LNA may also assist in oxygen as a treatment The LNA may also assist in oxygen as a treatment therapy and change the collar that holds a therapy and change the collar that holds a tracheostomy tube in place as delegated by the tracheostomy tube in place as delegated by the nurse.nurse.

It is It is notnot within the scope of practice within the scope of practice for a for a Licensed Nursing Assistant to engage in the Licensed Nursing Assistant to engage in the following activities: following activities: – Insertion of intravenous catheters, Insertion of intravenous catheters,

– Calling in Prescribing Practitioner orders to the Calling in Prescribing Practitioner orders to the Pharmacy Pharmacy

– Insertion of indwelling cathetersInsertion of indwelling catheters


Nursing Assistant RegistryNursing Assistant Registry

Federal RequirementFederal Requirement

Pertains to Nursing Assistants who are Pertains to Nursing Assistants who are suspected of abuse, neglect, exploitation suspected of abuse, neglect, exploitation or misappropriation or misappropriation

In collaboration with the Office of Long In collaboration with the Office of Long Term Care, DEAS, OLTCO, BHFATerm Care, DEAS, OLTCO, BHFA

BON may, in some cases, pursue BON may, in some cases, pursue additional disciplinary action against the additional disciplinary action against the Nursing Assistant’s LicenseNursing Assistant’s License


Medication Nursing AssistantsMedication Nursing Assistants

A Medication Nursing Assistant (MNA) is A Medication Nursing Assistant (MNA) is a Licensed Nursing Assistant (LNA) with a a Licensed Nursing Assistant (LNA) with a NH Board Approved Certificate to NH Board Approved Certificate to administer medications under the administer medications under the supervision of a RN/LPN to “stable” supervision of a RN/LPN to “stable” clients.clients.


Why was this new role developed?Why was this new role developed?

To provide safe medication administration To provide safe medication administration to to stablestable clients living in facilities and in clients living in facilities and in the community. the community.

The client whose health status is under The client whose health status is under control and raises no expectations that the control and raises no expectations that the client’s symptoms, vital signs or reactions client’s symptoms, vital signs or reactions to medications will suddenly change.to medications will suddenly change.

There are predictable outcomes to care.There are predictable outcomes to care.


Nur 405.02Nur 405.02

A MNA shall A MNA shall NOTNOT perform a task involving the perform a task involving the administration of medication if:administration of medication if:

-the task requires the determination of the -the task requires the determination of the client’s need for the medication, the calculation of client’s need for the medication, the calculation of the dosage or the conversion of the dosage;the dosage or the conversion of the dosage;

-the delegating nurse is unavailable to monitor -the delegating nurse is unavailable to monitor the progress of the client and the effect of the the progress of the client and the effect of the medication;medication;

-the client is not stable or has changing -the client is not stable or has changing needs.needs.


MNA CertificationMNA CertificationSelection of candidatesSelection of candidates- - Five years as a LNA in good standing or 2 years full time Five years as a LNA in good standing or 2 years full time - Two employer letters of reference- Two employer letters of reference- One letter of intent- One letter of intent

Course requirementsCourse requirements- 30 hours of clinical/30 hours of theory- 30 hours of clinical/30 hours of theory- Final exam 90% or greater- Final exam 90% or greater

Maintain the certificateMaintain the certificate- Renewed with LNA licensure- Renewed with LNA licensure- 4 of 12 CEs must be in medication administration topic- 4 of 12 CEs must be in medication administration topic


If the MNA makes a mistake, If the MNA makes a mistake, is the RN’s license at risk?is the RN’s license at risk?

A licensee who delegates or has A licensee who delegates or has delegated a specific nursing activity or delegated a specific nursing activity or task in compliance with this chapter (RSA task in compliance with this chapter (RSA 326) 326) shall notshall not be subject to disciplinary be subject to disciplinary action because of the performance of the action because of the performance of the person to whom the nursing activity or task person to whom the nursing activity or task is or was delegated.is or was delegated.


Paid Feeding AssistantsPaid Feeding Assistants

Paid Feeding Assistants are individuals who Paid Feeding Assistants are individuals who have been trained to provide feeding have been trained to provide feeding assistance to residents of Long Term Care assistance to residents of Long Term Care Facilities Facilities under the supervisionunder the supervision of the RN or of the RN or LPN.LPN.

The 8 hour NH BON approved training course The 8 hour NH BON approved training course is taught by Registered Nurses, Dieticians, is taught by Registered Nurses, Dieticians, Physical Therapists, Occupational Therapists, Physical Therapists, Occupational Therapists, Speech Therapists Speech Therapists OROR Licensed Practical Licensed Practical Nurses.Nurses.


Licensed Nursing Assistant Licensed Nursing Assistant Medication CertifiedMedication Certified

This role is designed to allow nursing This role is designed to allow nursing assistants with additional education to assistants with additional education to observe and document medication observe and document medication consumed by residents living in their consumed by residents living in their homes or residential care settings.homes or residential care settings.

Facilities and agencies provide board-Facilities and agencies provide board-approved education to their employeesapproved education to their employees


PART 4PART 4Criminal Background ChecksCriminal Background Checks

The Complaint ProcessThe Complaint Process

Discipline ProcessDiscipline Process

Nursing Assistant Registry Nursing Assistant Registry


Criminal Background ChecksCriminal Background Checks

required as of 9/1/2007required as of 9/1/2007

Renewals and Reinstatement applications Renewals and Reinstatement applications no longer require CBC. All new NH no longer require CBC. All new NH licensees are required to complete a CBC licensees are required to complete a CBC which includes FBI finger print technology. which includes FBI finger print technology. See applications for directionsSee applications for directions..


Bars to Licensing for Certain Bars to Licensing for Certain FeloniesFelonies

Murder Murder

Aggravated Robbery Aggravated Robbery

Felonious Assault Felonious Assault

Sexual Crimes Involving Children Sexual Crimes Involving Children

Kidnapping Kidnapping

Criminal Mistreatment of Children Criminal Mistreatment of Children

Aggravated Robbery or Vulnerable Adults Aggravated Robbery or Vulnerable Adults

Exploitation of Vulnerable Individuals Exploitation of Vulnerable Individuals


The Complaint Process:The Complaint Process:

Factors to Consider: Factors to Consider:

Does the act or omission violate the Does the act or omission violate the NPA or the rules?NPA or the rules?

Evaluate cause of incident:Evaluate cause of incident:– Licensee knowledge deficiencyLicensee knowledge deficiency– Licensee behavior problemLicensee behavior problem– Systems issues (or a combination of causes)Systems issues (or a combination of causes)



Factors to ConsiderFactors to Consider

Is there objective evidence that the Is there objective evidence that the incident actually occurred?incident actually occurred?

Is there evidence that the licensee was Is there evidence that the licensee was responsible?responsible?

Was it a one-time incident or is there a Was it a one-time incident or is there a pattern of behavior?pattern of behavior?




Do any of the witnesses have personal Do any of the witnesses have personal motives for reporting the incident?motives for reporting the incident?

Would counseling, employment Would counseling, employment suspension, education or other measures suspension, education or other measures be more appropriate than sanctioning or be more appropriate than sanctioning or restricting the license?restricting the license?




Is it an employment/HR issue?Is it an employment/HR issue?

Is it a concern that should be reported to Is it a concern that should be reported to the Ombudsman/Division of Elderly and the Ombudsman/Division of Elderly and Adult Services?Adult Services?

If you are not sure, call the BON to If you are not sure, call the BON to discuss the incident. discuss the incident.


Filing a Complaint – Filing a Complaint – what happens next:what happens next:

DismissalDismissal

Dismissal with letter of concernDismissal with letter of concern

Settlement agreementSettlement agreement

HearingHearing


Possible Board ActionsPossible Board Actions

Letter of concernLetter of concern

ReprimandReprimand

ProbationProbation

SuspensionSuspension

RevocationRevocation

Monetary fineMonetary fine


If a license has been If a license has been suspended…….suspended…….

At end of suspended time, licensee At end of suspended time, licensee appeals to the Board for reinstatementappeals to the Board for reinstatement

Reinstatement may be granted with Reinstatement may be granted with restrictions & conditions (stipulations)restrictions & conditions (stipulations)

Licensee may later request removal of Licensee may later request removal of restrictions & conditionsrestrictions & conditions


What if you hire someone who hasWhat if you hire someone who has a history of Board discipline? a history of Board discipline?

Go to the website verification page at Go to the website verification page at www.state.nh.us/nursingwww.state.nh.us/nursing (located in quick link (located in quick link section of home page) for all disciplinary section of home page) for all disciplinary documents (located in discipline section of documents (located in discipline section of license verification)license verification)

The licensee will provide you with documents The licensee will provide you with documents from the Board which outline any from the Board which outline any restrictions/stipulations they must adhere to.restrictions/stipulations they must adhere to.


Examples of Stipulations...Examples of Stipulations...

–Quarterly performance reportsQuarterly performance reports

–Random drug screeningRandom drug screening

–Limitation on hours worked, night Limitation on hours worked, night shift work and the ability to float.shift work and the ability to float.

–Regular attendance with AA, NA, Regular attendance with AA, NA,

–CounselingCounseling


First Lab, IncFirst Lab, Inc

NH Board of Nursing has contracted with NH Board of Nursing has contracted with First Lab, Inc., an organization used by First Lab, Inc., an organization used by many boards in the U. S. They provide many boards in the U. S. They provide services and contact with the licensee who services and contact with the licensee who has stipulations from the Board for drug has stipulations from the Board for drug screening. This company reports to the screening. This company reports to the board on a daily basis.board on a daily basis.


Drug Diversion in your facilityDrug Diversion in your facility

Your facility realizes there is a problem…Your facility realizes there is a problem…what can you do to prove diversion? Who what can you do to prove diversion? Who to call?to call?

The Department of Justice has the ability The Department of Justice has the ability to assist with this investigation.to assist with this investigation.

Call James Brown, Investigator at 271-Call James Brown, Investigator at 271-1246 to discuss your facility problem.1246 to discuss your facility problem.


Board program to assist Board program to assist impaired nursesimpaired nurses

Road to Recovery has been in place since Road to Recovery has been in place since December 2004. This program is designed December 2004. This program is designed to assist nurses with problems of chemical to assist nurses with problems of chemical dependency, physical disorders, dependency, physical disorders, psychiatric impairments.psychiatric impairments.

The purpose of this program ensures The purpose of this program ensures public health and safety while providing public health and safety while providing assistance and support to the licensee.assistance and support to the licensee.


What Constitutes Client What Constitutes Client Abandonment?Abandonment?

ABANDONMENTABANDONMENT = "Leaving an assignment = "Leaving an assignment without notifying the appropriate authority, without notifying the appropriate authority, whereby such departure endangers the health, whereby such departure endangers the health, safety and welfare of those individuals entrusted to safety and welfare of those individuals entrusted to the licensee's care;…" [Nur 215.01(B)(2)]the licensee's care;…" [Nur 215.01(B)(2)]

Refusal to accept an assignment or refusal to work Refusal to accept an assignment or refusal to work overtime overtime does notdoes not constitute client abandonment constitute client abandonment


PART 5PART 5

Advanced Registered Nurse PracticeAdvanced Registered Nurse Practice

License RequirementsLicense Requirements

ARNP Practice IssuesARNP Practice Issues


ARNP License RequirementsARNP License Requirements

Complete advanced education program Complete advanced education program

Certification in specialtyCertification in specialty

Continuing competenceContinuing competence– active in practice - 400 hours in 4 yearsactive in practice - 400 hours in 4 years– continuing education - 60 hours in 2 years continuing education - 60 hours in 2 years

(certification counts for 30 hours) including (certification counts for 30 hours) including 5 hours in pharmacology 5 hours in pharmacology

– No endorsement No endorsement – ARNPs are not in the compactARNPs are not in the compact


ARNP Active in PracticeARNP Active in Practice

Must work in advanced roleMust work in advanced role

Does not include undergraduate faculty Does not include undergraduate faculty rolerole

New graduatesNew graduates– must apply for initial licensure within 2 must apply for initial licensure within 2

years of graduation, or must complete years of graduation, or must complete reentry programreentry program


ARNP Scope of PracticeARNP Scope of Practice

practice independentlypractice independently– history and physicalhistory and physical– initiate diagnostic testsinitiate diagnostic tests– formulate diagnosesformulate diagnoses– ID health problems and learning needsID health problems and learning needs– plan, teach, promote healthplan, teach, promote health– arrange referralsarrange referrals– emergency careemergency care– administer, dispense, procure and prescribe administer, dispense, procure and prescribe

medicationsmedications


General FormularyGeneral Formulary

exclusionary formularyexclusionary formulary

ARNPs may prescribe drugs ARNPs may prescribe drugs NOTNOT in the in the formularyformulary

ARNPs must follow restrictions as ARNPs must follow restrictions as described for drugs in the formularydescribed for drugs in the formulary

Joint Health Council reviews medications Joint Health Council reviews medications quarterlyquarterly

Part 6Part 6

What does the What does the future hold?future hold?


Nationally…….Nationally…….

More states initiating mandatory criminal More states initiating mandatory criminal background checks, particularly national FBI checksbackground checks, particularly national FBI checksMore focus on continuing competency requirements More focus on continuing competency requirements to ensure safe practitionersto ensure safe practitionersIncreased collaboration with health care agencies to Increased collaboration with health care agencies to increase patient safetyincrease patient safetyIncreasing interest in licensing NA’s in all statesIncreasing interest in licensing NA’s in all statesSpotlight on ARNP practiceSpotlight on ARNP practiceMore states joining the compactMore states joining the compact


In New Hampshire…..In New Hampshire…..

The board is studying the nursing The board is studying the nursing workforce and making recommendations workforce and making recommendations to ease the shortage. A demographic to ease the shortage. A demographic survey is required with each license survey is required with each license renewal to collect workforce datarenewal to collect workforce data

Board committees continue to study Board committees continue to study national standards of practice national standards of practice


Contact us........Contact us........

telephone: 271-2323 or 271-6282telephone: 271-2323 or 271-6282

[email protected]@nursing.state.nh.us




web site: web site: www. state.nh.us/nursing www. state.nh.us/nursing

email: email: [email protected]@nursing.state.nh.us


Conclusions...... Wrap-upConclusions...... Wrap-up

Questions????????Questions????????

Please complete the evaluation Please complete the evaluation

form and return it to us..... form and return it to us.....

Congratulations! You’ve just earned Congratulations! You’ve just earned contact hours!contact hours!

Orientation for New Nurse Leaders

Documents

Transcript of Orientation for New Nurse Leaders