NURSE Volume 10 Number 3 DISTRICT OF COLUMBIA September 2013 R e g u l at i o n E d u c at i o n P r a c t i c e CE: Physical Assessment Update Government of the Communication Skills for CNAs District of Columbia Vincent C. Gray, Mayor eO -mf afi il c ia : h p ll a . dPo u h@ v •i owne bo bdlc i. gcoat : fh t tt p h: e/ / dDo histrict . d c . g o v / b o n of C olumbia B oard of N ursin g1  There’s more than enough food in America for every child who struggles with hunger. Help get kids the food they need by supporting Feeding America, anationwidenetworkoffoodbanks. VisitFeedingAmerica.org 2 District of Columbia Nurse: Regulation • Education • Practice Districtof c o n t e n t s Columbia NURSE Director, Department of Health Edition 38 Message from the Chair R e g ulation 4 Joxel Garcia, MD, MBA LPN and RN Continuing Education Audits 5 B oard M embers Mary Ellen R. Husted, RN, BSN, OCN Trained Medication Employee (TME) Recertification 5 Chairperson Cathy A. Borris-Hale, RN, MHA, BSN Home Health Aides Update 6 Vice Chairperson Toni A. Eason, DNP, MS, APHN-BC, COHN-S Rev. Mary E. Ivey, D-Min Midwives Speak to Board 7 Vera Waltman Mayer, JD IN THE KNOW 8 Ottamissiah Moore, BS, LPN, WCC, CLNI, GC, CHPLN Chioma Nwachukwu, DNP, PHNCNS-BC, RN Sukhjit “Simmy” Randhawa DNP, MBA, MS, RN, NE-BC, CPN Criminal Background Check Results For RNs/APRNs/LPNs/TMEs 9 Winslow B. Woodland, RN, MSN COIN CONSULT 11 O ffice L ocation T ele p hone N umber DC Board of Nursing 899 North Capitol St. NE Washington, D.C. 20002 E ducation E-mail: [email protected] ANA Hails Iowa Court Ruling 12 Phone: (877) 672-2174 Phone: (202) 724-4900 Fax: (202) 724-8677 Web site: http://doh.dc.gov/bon Professional Nursing Schools & Practical Nurse Programs 12 O ffice H ours Monday thru Friday: Nursing Schools and Hepatitis B Discrimination 13 8:15 a.m.-4:45 p.m. B oard S taff NCSBN launches a mobile site 13 Karen Scipio-Skinner, MSN, RN Executive Director Concheeta Wright, BSN, RN Nurse Consultant/Practice/COIN Practice Bonita Jenkins, EdD, RN, CNE Nurse Specialist/Education The Patient Protection Act of 2013 (B20-101): Pro & Con 14 Felicia Stokes, BSN, JD Nurse Consultant/Discipline Continuing Education Update: Physical Assessment 18 Health Licensing Specialists: Donna Harris, BSHA Continuing Education Update: Communication Skills for CNAs 22 Melondy Scott Gwyn Jackson Nicole Scott Kudos! 28 Tanee Atwell, BS Angela Braxton Board Disciplinary Actions 30 Nancy Kofie DC Nurse: REP Managing Editor Address Change? Name Change? Question? In order to continue uninterrupted delivery of this magazine, please notify the Board of any change to your name or address. Thank you. DC BON Mission Statement: “The mission of the Board of Nursing is to safeguard the public’s health and well being by assuring safe quality care in the District of Columbia. This is achieved through the regulation of nursing practice and education programs; and by the licensure, registration and continuing education of nursing personnel.” pcipublishing.com Circulation includes over 22,000 licensed nurses, nursing home Created by Publishing Concepts, Inc. David Brown, President • [email protected] administrators, and nurse staffing agencies in the District of Columbia. For Advertising info contact Tom Kennedy • 1-800-561-4686 Feel free to e-mail your “Letters to the Editor” for our quarterly column: IN THE KNOW: Your opinion on [email protected] the issues, and our answers to your questions. E-mail your letters to [email protected]. (Lengthy letters ThinkNurse.com may be excerpted.) e-mail: [email protected] • web: http://doh.dc.gov/bon 3 Message from the Chair I hope you have been enjoying your input from the full Board. In the back of summer, and staying cool. Although DC Nurse you will see both public and you may not have seen the Board as private board disciplinary actions in each often, due to our full-board meetings issue. convening every other month, the Board Our Practice/Legislative Committee has been hard at work. I am pleased to [chaired by Simmy Randhawa] drafted tell you that the implementation of our four advisory opinions to date, including Mary Ellen R. Husted, RN, BSN, OCN subcommittees (Discipline, Practice/ suprapubic catheter replacement, staple Legislative, Regulation, and Education) removal, ear lavage, and Isoflurane has been very successful, as you will see for Status Asthmaticus. The drafts will been a huge undertaking and we are below.

The subcommittees are comprised be considered by the full-Board at the grateful to all who have helped. of three board members, one of which is September Board meeting. The committee The Education Committee [chaired the committee chairperson, and at least will also submit a new format for these by Toni Eason] met with two continuing one staff member. These smaller meetings opinions, for board approval. Once education providers who are interested have enabled board members to lend approved the advisory opinions will be in creating continuing education courses their expertise on the committee where it on our website. In addition to considering based on the Board’s suggested topics. We is best utilized. The full board reviews the practice issues this Committee has been have also met with the nursing education subcommittee’s recommendations and charged with responding to legislation community to discuss proposed major are better able to focus of the key issues impacting the practice of nursing. We changes to Nursing School regulations. brought before it by the subcommittee. have reviewed and prepared comments Input at this time is extremely helpful as it This change in structure has increased the regarding the Patient Protection Act (see reduces extra work when the regulations board’s productivity. Pro and Con opinions on page 14) and are out for public comment. We have also The Discipline Committee [chaired drafted recommendation for the Medispa reviewed comments to the RN regulations by Mary Ellen Husted] has been given and Telemedicine draft legislation and and made revisions as appropriate. the authority to make disciplinary comments regarding the Prescription And we have provided the Regulation decisions on behalf of the Board. Since Drug Monitoring bill. Committee with recommendations for its inception, the Discipline Committee The Regulation Committee [chaired revising the training requirements in the has had met with nurses for a number by Winslow Woodland] continues to Nursing Assistive Personnel regulations. of reasons --- they have been suspended review public comments regarding During this time, the committee has also by the board and asking to have their the Nursing Assistive Personnel addressed complaints from consumers license reinstated, they have a disciplinary Omnibus Regulations from hospitals, regarding nursing schools and has action pending before the Board and dialysis centers, the disability provider reviewed Adult Protective Services as part of the disciplinary process they community, and assisted living providers. mandatory curriculum.

 have asked for a settlement conference Omnibus regulations include proposed We could not have accomplished all with the Board, in lieu of a hearing. The Dialysis Technician, Medication Aide, and of this without the wonderful support Committee has also reviewed a number Certified Nursing Assistant/Patient Care of our Board of Nursing staff and the of criminal background checks (see page Technician Regulations. The Committee encouragement we have received from 9) The Board is fortunate to have the has completed reviewing all of the our public members who join us at our Committee on Impaired Nurses as a comments. The full-board has reviewed meetings and take time to provide written resource. A number of persons are referred our recommendations regarding the comments regarding our proposed to COIN to determine whether or not Dialysis Technician and Medication Aide regulations. Our work is not done, and the persons need to be monitored due to regulations. we will need this continued support. substance abuse and/or mental illness. At the next full-Board meeting in Thank you so much and we look The Discipline Committee has been September, Committee’s recommended forward to seeing you at our open authorized by the Board to make final amendments to the Certified Nursing sessions. n discipline decisions, or refer to the full Assistant/Patient Care Technician Mary Ellen R. Husted, RN, BSN, OCN board, if they deem necessary for broader regulations will be discussed. This has Chairperson, DC Board of Nursing 4 District of Columbia Nurse: Regulation • Education • Practice Regulation LPN Continuing RN Continuing Education Audit Education Audit The LPN CE audit concluded December 31, The RN CE audit has been concluded. Negotiated settlement 2012. Any nurse who was not compliant with the agreements will be sent to those nurses selected for the audit, negotiated settlement agreement was not able to but did not meet CE compliance or did not respond. Non- renew their license until the settlement agreement compliance with the negotiated settlement will mean that was fulfilled. registered nurses, and APRNs will not be able to renew their license in 2014. LPNs Negotiated Settlement Agreement: $500, Ethics Course, 18 hours of continuing education required RNs Negotiated Settlement Agreement: $500, Ethics Course, to be submitted prior to licensure renewal. 24 hours of continuing education required to be submitted prior to licensure renewal. Trained Medication Employee (TME) Recertification TMEs please be reminded that your certification will expire October 30, 2013 To renew online: Go to the HPLA website at www.hpla.doh.dc.gov (Web browser must be Internet Explorer or Firefox) Requirements for re-certification: Submit completed application along with application fee Following the renewal period you may be selected for audit. If selected you will be asked to provide the following information: Verification of continued adequacy of performance: Skills check list signed by supervising nurse Evidence of continued competency: Successful completion of twelve (12) hours of board approved in-service training. Do not submit this information until you receive a letter from the DC Board of Nursing requesting that it be submitted. BOARD OF NURSING MEETINGS Members of the public are invited to attend... Date: *First Wednesday of every other month. Transportation: Closest Metro station is Union Station. Time: 9:30 a.m - 11:30 a.m. To confirm meeting date and time, call (202) 724-8800. Location: 2nd Floor Board Room September 4, 2013 899 North Capitol St NE November 6, 2013 Washington, D.C. 20002 *Please note new schedule e-mail: [email protected] • web: http://doh.dc.gov/bon 5  Re g u l a t i o n HOME HEALTH AIDES Update Thus far, we have approved processing and approving other licensure CBCs are reviewed and considered on a approximately 6,000 HHA applications categories that come under the auspices case-by-case basis. with approximately 3,000 pending. All of the Board of Nursing (RN, APRN, LPN, It takes a considerable amount of time applications submitted have been entered TME) as well as Nurse Staffing Agencies. to review these reports and determine into our licensure system. HHA waiver Additionally we have just completed our whether or not we can approve the applications should either be “Active” LPN Renewal period and are making applications. In some instances, staff may or “Pending.” HHA exam applications plans for the TME Renewal (pg 5). need to contact the applicant asking that should either read “Active” or “Pending they submit records from the court to Exam.” Some of the applications that determine their current disposition and I have submitted have been to have a better understanding regarding What does “pending” mean? approved while others have the seriousness of the reported crime. In It means that the application has been not and they were submitted addition to speaking with the applicant, submitted and it is in the queue to be at the same time. Why are they staff may also be in contact with their reviewed for approval of certification. all not approved at the same probation officer or others who can As noted above we have approximately time? better help staff determine the applicant’s 3,000 pending review and approval. Applications are delayed for many ability to practice safely. reasons such as discrepancies or The Board is fortunate to have the Why is it taking so long? inconsistencies in the information Committee on Impaired Nurses (COIN) We have received approximately provided or due to a positive criminal as a referral resource. Persons with arrests 10,000 HHA applications in less than background check. Discrepancies and or convictions such as DWIs/DUIs or a year. Staff are still responsible for inconsistencies may be due to the with drug trafficking are referred to COIN fact that the information provided by by the Board to determine whether or not the applicant is not the same as the they are safe to practice. You realized your nursing dream. information provided by the employer, Now Realize Your such as HHA training program and Is it too late for persons poteNtial. dates of employment. Or the school the applicant attended may not be an missing the HHA waiver deadline to apply? Earn your BSN or MSN Online. approved HHA program. It is too late for persons to apply You’ve come a long way since your first day as an RN. Go Reviewing of positive CBCs takes for HHA certification by waiver of even further with one of Jacksonville University’s acclaimed nursing programs, offered in a 100% online classroom. a considerable amount of time. The examination but the Board has agreed • RN to BSN – Now Offering initial FBI or State CBC reports provided to allow persons practicing as HHAs to Scholarships! to staff only indicate that the CBC is take the HHA examination. They will • MSN: Leadership in Healthcare positive; the reason for the positive CBC need to submit an application for HHA Systems is not provided. It may be positive as certification by examination and provide • MSN: Clinical Nurse Educator a result of an arrest or a conviction or evidence of having completed a board JacksonvilleU.com/onlineprogram Or, talk with a specialist: it may be positive due to a bad check approved HHA training program. They 800-571-4934 8-week classes | 6 sessions per year or immigration issues (see graph on will not be able to work as an HHA pg 9). Although the incident may have until they pass the examination and are occurred a number of years ago, when approved for certification. we receive a positive CBC we don’t know the disposition until we obtain access *CHECK WWW.HPLA.DOH.DC.GOV to the full CBC report. Applicants with --- Licensee search to determine the status arrests or convictions occurring more of a HHA application. n © 2012 All Rights Reserved. Made Available by University Alliance® The Nation’s Leading Universities Online. SC: 191734ZJ1 | MCID: 13186 than seven years ago may be approved for certification. The deciding factor is One of America’s Best Colleges the seriousness of the crime. All positive U.S. News & World Report 6 District of Columbia Nurse: Regulation • Education • Practice  Midwives Speak to Board Whitney Pinger, Certified Nurse Midwife, and Nicole Jolley, Certified Professional Midwife, appeared before the Board to ask for their support in regulating the practice of Direct Entry Midwives in the District. Currently, certified nurse midwives are regulated but others practicing in the District as midwives are not. CNMC Request: Isoflurane Therapy in PICU Krista Cato, RN, and Jeannette M. Mitchell, RN Children’s National Medical Center appeared before the Board to request the utilization of Isoflurane therapy for life threatening asthma in Children’s Pediatric Intensive Care Unit (PICU) by RNs. e-mail: [email protected] • web: http://doh.dc.gov/bon 7  Re g u l a t i o n IN THE KNOW The Board of Nursing has established the “In The Know” column in response to the many phone calls and e-mails the Board receives regarding licensure and other issues. The Board often receives multiple inquiries regarding the same topic. Please share this column with your colleagues and urge them to read it. The more nurses are aware of the answers to these frequently asked questions, the less our resources will have to be used to address duplicate questions. Fee for License in the middle of is terminated for a practice related issue you 2-year cycle Q : I am starting my application process for a DC RN license. are required to report the termination to the appropriate board. We are working with other agencies Q : Once the license packet is received with fingerprints, which department does it go to initially? All licenses expire on June 30th of even numbered years, if I apply this year does this mean the $230 fee will only be good for one to assure that the appropriate agencies such as, the Office of the Inspector General, Medicaid, Health Regulations A : All applications are initially received by our processing unit. Once the completed application and year for me? Administration, receive information sent to required documents, and CBC results are A : You are correct. You will be licensed for one year. All RN licenses expire June 30, 2014. us regarding complaints, when appropriate. CBCs received, the application is submitted to Board staff for review and approval. HHAs Agency: I have some names of aides that Q : If an applicant walks into the DC Board of Nursing with his fingerprints or has completed the Q : Typically how long does it take for a license to be issued? [our agency] wants to turn in to the Board of Nursing. What is the process? Who do we MorphoTrust process in DC, can his or her license be issued the same day? A : We recommend having applicants submit their application at least 2 submit the information to? Board: You can find the complaint form A : No, they will not be licensed the same day. MorphoTrust has to have weeks prior to their expected start date. online at http://doh.dc.gov/node/145702. Have we certified the persons named in the time to send us the results. Q : If an applicant marked “yes” for any felonies/criminal history, is complaint? Agency: Yes, two of them are certified— both terminated. One for fraud, and one for Q : Are licenses issued after the fingerprint results are back or after DC Board of Nursing has received them? there an additional waiting period on this? A : Yes. We need to review the arrest/ conviction record. attempting to commit fraud. Board: Have they been reported to Medicaid or the OIG for Medicaid fraud (if A : All applications are initially received by our processing unit. Once the fee, all required documents and Q : Can a clinician get a permanent license with fingerprints pending? that is what it is)? If not, we can forward the complaint. Agency: We have paid back the money notification that a CBC has been completed, the application is submitted to Board staff for review and approval. A : A permanent license is not issued until the results of the fingerprinting are received. to Medicaid, but we have not notified the other agencies. I am going to write these up and send them to you because it was my understanding that we must submit Q cleared? : If MorphoTrust is done, how long does it take for fingerprints to be Q : If a clinician resides outside of DC and they opt for the fingerprints to be done with the the names of any employee that has been terminated, even if it is not fraud-involved. Is that correct? Please advise because I don’t A : In most cases it takes MorphoTrust 24-48 hours to provide us with the results of the criminal background check. MorphoTrust, does that take more time? Or would it be faster to complete this portion of the license in DC for quicker processing? want to overwhelm the stressed system unnecessarily. Board: You are correct. If a person If the prints are unreadable or if the state requires additional documentation prior to processing the fingerprints, the time period A : Background checks for DC must be done via MorphoTrust. Applications will not be considered licensed or certified by a health care board will be longer. Continued on page 10 8 District of Columbia Nurse: Regulation • Education • Practice CRIMINAL BACKGROUND CHECK RESULTS FOR RNs/APRNs/LPNs/TMEs Dear Readers: The members of the Board of Nursing staff are often asked about the results of our criminal background checks. The graphs below provide the percentages regarding the types of offenses that have been found on our applicants’ records. n e-mail: [email protected] • web: http://doh.dc.gov/bon 9  Re g u l a t i o n Continued from page 9 REGISTERED NURSE SCOPE OF PRACTICE “(17) “Practice of registered nursing” means the performance of the full complete and eligible for review by Board scope of nursing services, with or without compensation, designed to promote staff until the CBC results are received. and maintain health, prevent illness and injury, and provide care to all patients in The fingerprinting process is quicker if all settings based on standards established or recognized by the Board of Nursing. they have their fingerprinting done by The practice of registered nursing includes: one of the fingerprinting venues in DC or Maryland. But, this does not mean “(A) Providing comprehensive nursing assessment of the health status of that they will be licensed immediately patients, individuals, families, and groups; after they have completed their CBC. We “(B) Addressing anticipated changes in a patient’s condition as well as average 400 RN/LPN/APRN applications emerging changes in a patient’s health status; a month. Applicants residing outside “(C) Recognizing alterations of previous physiologic patient conditions; of DC can contact MorphoTrust for “(D) Synthesizing biological, psychological, spiritual and social nursing directions for mailing their fingerprints diagnoses; for processing. If they have submitted a “(E) Planning nursing interventions, and evaluating the need for different complete application and we receive their interventions and the need for communication and consultation with CBC results, they may be licensed before other health care team members; their start date. “(F) Collaborating with health care team members to develop an integrated client-centered health care plan as well as providing direct and indirect NON-NURSING SUPERVISORS nursing services of a therapeutic, preventive, and restorative nature in Q : We had a question arise about RNs reporting to non-nursing supervisors. We have had for years nurses response to an assessment of the patient’s requirements; “(G) Developing a strategy of nursing care for integration within the patient- centered health plan that establishes nursing diagnoses, sets goals to working out of the quality office who do meet identified health care needs, determines nursing interventions, and data abstraction, core measure reporting implements nursing care through the execution of independent nursing etc. and who report to the Chief Medical strategies and regimens requested, ordered or prescribed by authorized Officer. Is this a violation of DC Municipal health care providers; Regulations for RNs? I reviewed the “(H) Performing services such as: regulation myself, but did not see any “(i) Counseling; reference to that. “(ii) Educating for safety, comfort, and personal hygiene; A : The Health Occupations Revision Act states the “Practice of Registered Nursing means.... (N) “(iii) Preventing disease and injury; and “(iv) Promoting the health of individuals, families, and communities; “(I) Delegating and assigning interventions to implement a plan of care; Managing, supervising, and evaluating “(J) Administering nursing services within a health care facility, including the the practice of nursing;” Thus, the scope delegation and supervision of direct nursing functions and the evaluation of nursing practice requires that RNs be of the performance of these functions; supervised by RNs. Administrative duties “(K) Delegating and assigning nursing interventions in the implementation of can be supervised by persons who are not a plan of care along with evaluation of the delegated interventions; RNs. n “(L) Providing for the maintenance of safe and effective nursing care rendered directly or indirectly as well as educating and training persons in the direct nursing care of patients; “(M) Engaging in nursing research to improve methods of practice; “(N) Managing, supervising, and evaluating the practice of nursing; “(O) Teaching the theory and practice of nursing; and “(P) Participating in the development of policies, procedures, and systems to support the patient.” 10 District of Columbia Nurse: Regulation • Education • Practice  COIN CONSULT A Resource for Impaired Nurses When a CBC Reveals Driving Under the Influence (DUI) By Kate Driscoll Malliarakis, PhD, CNP, MAC Last month, DC Nurse featured one of our “success” stories—a nurse who came into the Committee on Impaired Nurses (COIN) program and used the structure of the program to regain a life worth living. We love those success stories!! The new background checks instituted by the Board of Nursing have brought the COIN many new participants. Nurses are surprised when a DUI or DWI shows up on their background check and often respond “but it’s only one DUI!!!” White and Gasperin (2007) offer the following facts about DUIs: Between 40-70% of first-time DUI offenders have prior alcohol- or drug-related criminal offenses. A driver would have to commit between 200 and 2000 repetitions of impaired driving violations to statistically generate one arrest. More than 80% of DUI offenders have a significant problem in their relationship with alcohol and/or other drugs. Reading that data, it is difficult to simply ignore a DUI or DWI. They are serious charges. COIN looks upon DUIs and drug diversion as opportunities to help you examine your relationship with drugs and alcohol, and if need be, assist you in developing a recovery program that works for you. COIN can also assist you in assistance for your mental health issues. Sometimes, issues such as depression, anxiety, bipolar, ADHD can affect the way you are able to practice. COIN works with you and your healthcare provider to ensure that you have a safe nursing practice while grappling with mental health issues. The goal of COIN is to preserve the nurse while protecting the public. If you have any questions, you can contact Concheeta Wright, Clinical Nurse II, Nurse Manager of COIN, ([email protected]) or call her at (202) 724-8870. References White, W. & Gasperin, D. (2007). The “hard core drinking driver:” Identification, treatment and community management. Alcoholism Treatment Quarterly, 25(3), 113-132. e-mail: [email protected] • web: http://doh.dc.gov/bon 11  Education ANA Hails Iowa Court Ruling The American Nurses Association Law. Fluoroscopy is a real-time (ANA) hailed the Iowa Supreme X-ray imaging technique used to Court decision affirming Advanced guide a variety of diagnostic and Registered Nurse Practitioners’ interventional procedures. The legal (ARNPs) ability to supervise a issue involves “scope of practice” certain high-tech X-ray and imaging – the range of services that nurses procedure as a victory for Iowa are educated and licensed and/or residents, who will benefit from certified to provide. having broader access and choice “We believe the district court erred health care for rural Iowans and in obtaining important health care in second-guessing the department helps lower costs.” services. of public health and nursing board The Iowa Nurses Association The appeal to Iowa’s highest court on the adequacy of ARNP training (INA) had initially intervened in the by three nursing organizations was to supervise fluoroscopy,” the Iowa case along with the Iowa Association spurred by an Iowa District Court Supreme Court wrote. “The record of Nurse Anesthetists on the side of judge’s ruling that supervision of affirmatively shows ARNPs have the Iowa Board of Nursing, which fluoroscopy was not “recognized by been safely supervising fluoroscopy defended its regulation against the medical…profession as proper and are adequately trained to do claims of illegality by the Iowa to be performed by the registered so…[A]llowing ARNP supervision Society of Anesthesiologists and the nurse,” as required by Iowa Nursing of fluoroscopy improves access to Iowa Medical Society. n Professional Nursing Schools Patricia McMullen, PhD, JD, CNS, CRNP, Mary H. Hill, DSN, RN, Associate Dean, Teresa L. Panniers, PhD, RN Susie Cato MSN, MASS, RN, Director of Dean, Catholic University School of Nursing Howard University College of Nursing Associate Dean for Nursing and Health Associate Degree Nursing Program, University of 620 Michigan Avenue, N.E. 2400 6th St. N.W. Professions District of Columbia Community College Washington, DC 20017 Washington, DC 20059 Chief Nursing Officer Associate Degree Nursing Program [email protected] [email protected] Trinity Washington University 801 North Capitol Street NE Room 812 PH: (202) 319-5400 PH: (202) 806-7456 125 Michigan Avenue, N.E. Washington, DC 20002 FAX: (202) 319-6485 FAX: (202) 806-5958 Washington, D.C. 20017 [email protected] CONDITIONAL CONDITIONAL [email protected] PH: (202) 274-5914 • FAX: (202) 274-5952 PH: (202) 884-9207 X9672 CONDITIONAL Jeanne Matthews, PhD, RN, Chair, Department India M. Medley, MSN, RN, CPNP, Dean of PH: (202) 884-9245 of Nursing, Associate Professor & Program School of Nursing, Radians College FAX: (202) 884-9308 Stephanie Wright Ph.D., CRNP, Senior Director for Nursing Education, Georgetown 1025 Vermont Avenue, NW; Suite 200 CONDITIONAL Associate Dean for Academic Affairs, The University School of Nursing & Health Studies Washington, DC 20005 George Washington University Graduate School 3700 Reservoir Road N.W. [email protected] of Nursing Washington, DC 20007 PH: (202) 291-9020 900 23rd St. NW, Suite 6167 B [email protected] FAX: (202) 829-9192 Washington, DC 20037 PH: (202) 687-0754 FULL APPROVAL [email protected] FULL APPROVAL PH: (202) 994-5192 • FAX: (202) 994-2777 FULL APPROVAL PRACTICAL NURSE PROGRAMS Michael Adedokun, PhD, MSN, RN, Director of Nursing, India M. Medley, MSN, RN, CPNP, Dean of School of Nursing, Susie Cato, MSN, MASS, RN Interim Director Comprehensive Health Academy Radians College University of the District of Columbia Community College School of Practice Nursing 1025 Vermont Avenue, NW; Suite 200 Nursing Certificate Programs 1106 Bladensburg Road, N.E. Washington, DC 20005 5171 South Dakota Avenue NE Washington, DC 20002-2512 [email protected] Washington, DC. 20017 [email protected] PH: (202) 291-9020 [email protected] PH: (202) 388-5500 FAX: (202) 829-9192 PH: (202) 274-6950 FAX: (202) 388-9588 FULL APPROVAL FAX: (202) 274-6509 FULL APPROVAL CONDITIONAL 12 District of Columbia Nurse: Regulation • Education • Practice Nursing Schools and Hepatitis B Discrimination The Department of Justice, the Approximately 800,000 to 1.4 infection, in itself, should not preclude Department of Education, and the million people in the United States have the study or practice of medicine, surgery, Department of Health and Human hepatitis B. Asians, Native Hawaiians, dentistry, or allied health professions. Services sent a joint letter to the nation’s and Pacific Islanders make up roughly The Departments of Justice, Education, medical schools, dental schools, nursing 4.5 percent of the U.S. population, but and Health and Human Services share schools, and other health-related schools represent 50 percent of the persons with responsibility for protecting the rights of regarding hepatitis B discrimination. hepatitis B in the United States. The students and applicants with disabilities, The departments expressed concern that letter cites to a March 2013 settlement including those with hepatitis B, in some health-related schools may be agreement that the Justice Department schools of higher education by enforcing making enrollment decisions based on an reached with a medical school and a titles II and III of the Americans with incorrect understanding of the hepatitis B school of osteopathic medicine resolving Disabilities Act and Section 504 of the virus, resulting in discrimination. allegations that the schools violated Rehabilitation Act. The Departments The letter updates schools on the the Americans with Disabilities Act by of Justice, Education, and Health and latest recommendations from the Centers excluding previously-accepted applicants Human Services also enforce Title VI for Disease Control and Prevention with hepatitis B from their programs. of the Civil Rights Act, which prohibits (CDC). The letter also emphasizes the The updated CDC recommendations discrimination on the basis of race, importance of CDC’s recommendations, dispel many myths associated with color, or national origin in programs especially as they relate to the schools’ hepatitis B and provide guidance to and activities receiving federal financial obligation to comply with federal laws health-related schools on managing assistance, including those of health- prohibiting discrimination on the basis students with the virus. Among other related schools. n of disability, race, color, and national recommendations, the CDC recommends origin. that chronic hepatitis B virus NCSBN launches a mobile site The National Council of State Boards which utilizes mobile user experience act and counsel together on matters of of Nursing Inc. (NCSBN) announces design best practices. With an eye toward common interest. NCSBN’s membership the launch of its new mobile website, maximizing the mobile user experience, is comprised of the BONs in the 50 m.ncsbn.org, to optimize the experience m.ncsbn.org features the most popular states, the District of Columbia, and of smartphone and tablet users. content from the site, including NCLEX four U.S. territories — American Samoa, NCSBN’s website hosts more than Exams, Nurse Licensure Compact, nurse Guam, Northern Mariana Islands 4.5 million visits a year; 12 percent of license verification and board of nursing and the Virgin Islands. There are also all visits are with a mobile device. This contact details. 12 associate members that are either represents 192 percent increase in such In the future geo-location services nursing regulatory bodies or empowered visits over the last year. Regardless of the will also be available. Ultimately, a regulatory authorities from other platform used, NCSBN is committed single site that will be responsive to both countries or territories. to providing the best possible website desktop and mobile screen sizes will be NCSBN Member Boards protect visitor experience and that goal moved developed, eliminating the need for a the public by ensuring that safe and the organization to accommodate the separate mobile version. competent nursing care is provided by needs of mobile users with this new site. Founded March 15, 1978, as an licensed nurses. These BONs regulate NCSBN’s mobile website is independent not-for-profit organization, more than 3 million licensed nurses, specifically designed to increase NCSBN was created to lessen the the second largest group of licensed accessibility to users on the go with burdens of state governments and bring professionals in the U.S. an easy to browse and simple layout, together boards of nursing (BONs) to e-mail: [email protected] • web: http://doh.dc.gov/bon 13  Nursing Practice The Patient Protection Act of 2013 (B20-101) The introduction this year of the “Patient Protection Act” has resulted in heated debates in the District’s health care community. Below you will find “Pro and Con” positions regarding this legislation. Where do you stand? Your feedback is welcomed send to [email protected] By Judy Alba MA, CAPA, RN “I think this bill is today’s version of the eight-hour day— something that we will see business resist but, on the other hand, makes good sense and leads to quality care”—Phil Mendelson on February 5, 2013, introducing the Patient Protection Bill of 2013 in the District of Columbia City Council. With the sponsorship of the national average on most indicators O’Grady & Malloch, 2011). In Chairman of the City Council, and for patient satisfaction, and patient addition, the bill bans mandatory nine other members, DC nurses from safety. overtime, which many hospitals use across the city under the umbrella Fundamentally, the bill seeks to fill their staffing shortages, in organization National Nurses United to establish minimum ratios that excess of what is safe. It also provides (NNU), which represents over 4,000 are safe for each specialty unit in for whistle blowing protection for registered nurses in the District, have hospitals at all times (including meal hospital nurses that expose patient introduced The Patient Protection Act break times). The bill also institutes safety violations. of 2013. With a few differences, this unit-based committees composed of What makes this bill controversial, bill was modeled after California’s 50% direct care RNs, which would and also has provoked the reaction law of 1999, to address a persistent serve to correct staffing according to of the American Hospital Association patient safety crisis that exists in DC’s patient acuity. These committees can to spend millions of dollars to hospitals. As it is reported yearly by provide the flexibility that is needed lobby against this kind of legislation the Hospital Consumer Assessment for the 20% of unpredictability that around the country, is the regulatory of Healthcare and Systems, District commonly exists in hospitals with aspect of the bill with a strong of Columbia hospitals fall below the regards to patient acuity (Porter reinforcing safeguard: It includes 14 District of Columbia Nurse: Regulation • Education • Practice  a $25,000.00 fine for each day 2007); Nurse-to-patient ratios are turnover, less need for temporary that a violation occurs. In fact, the directly related with urinary tract and traveling nurses. Investment in same day the Patient Protection Act infections and surgical site infection additional nursing care hours better was introduced, Councilwoman (Cimiotti, Aiken, Sloane & Wu, prepares patients for discharge, Mary Cheh presented a different 2012). which results in less readmissions version of the bill which also Understaffing, and unsafe (Weiss, Yakushua & Bobay, 2011). calls for the establishment of workloads, are the most important Adding 133,000 RNs to acute-care staffing committees, but includes causes of nurse burnout and hospitals nationally would result in no consequences for violations. dissatisfaction among nurses (Van an estimated $6.1 billion in reduced NNU representatives call it “the den Heede, et al, 2013; Aiken et al, patient care costs, and an additional do nothing bill,” as it basically 2010). Chronic RN understaffing, $231 million per year when nurses maintains the status quo. In and eroding patient safety was help patients to recover more practice, hospitals continually expressed by the majority of District quickly reducing hospitalization violate their own staffing policies of Columbia nurses in a survey days (Dall, Chen, Seifert, Maddox and District regulations in the conducted by NNU in 2012. Eighty & Hogan, 2009). Reducing the high absence of enforcement legislation. seven percent of the 857 nurses that RN turnover rate, estimated at 18.5 Since this same legislation answered the survey responded that percent nationally (Washington took effect in California in 2003, mandatory RN-to-patient ratios are DC’s is 20 percent), could save numerous studies have been a necessary measure to improve the about $20 billion every year based conducted that give mounting situation. Focused group discussions on a 2007 inflation-adjusted evidence of the close link that of RNs conducted by NNU in 2012, turnover cost of $82,000 to $88,000 exists between patient outcomes and testimonies expressed at the per RN (Jones, 2008). and nurse-to-patient ratios. It has City Council, have revealed that The choice to support The Patient been documented, for example, hospitals frequently do not follow Protection Act is becoming clear that improving nurse workloads their own staffing policies and for most bedside care nurses and and staffing can prevent 30 day matrixes. The opinion of the nurses, unit supervisors, even as hospital readmissions for heart failure, and that of some experts is that executives recite many of the acute myocardial infarction, and in the absence of mandatory ratios same arguments that were used to pneumonia (McHugh & Ma, 2013); legislation, hospital corporations oppose the California legislation. or that higher nurse staffing levels are not inclined to maintain They generally cite overwhelming protect postoperative cardiac minimum safe staffing, as their economic burden to hospitals, surgery patients from unplanned priority is mainly focused on saving reduction of the skill mix to care for readmissions to the intensive care labor costs (Aiken, Clarke & Sloan, patients and subsequent reduction unit or the operating room, as well 2001). of the ancillary work force, as well as from in-hospital mortality (Diya, Mounting evidence of the past as lack of evidence of the difference Van den Heede, Sermeus & Lesaffre, 10 years strongly suggest that RN- that the legislation makes in patient 2012). Other studies find that for to-patient ratios is a cost effective outcomes. The ten years since the every additional patient assigned solution for hospitals and could implementation of the legislation to an RN there is a 7% increase produce billions in reduced in California, and the production in the risk of hospital acquired patient care costs on a number of numerous studies in this same pneumonia, a 53% increase in of different fronts, such as fewer respiratory failure, a 17% increase complications, less litigation, in medical complications (Kane, shorter patient hospitalization Shamliyan, Mueller, Duval & Wilt, stays, fewer readmissions, less nurse Continued on page 16 e-mail: [email protected] • web: http://doh.dc.gov/bon 15  Nursing Practice Continued from page 15 opportunities to participate in the systematic review and metaanalysis. period (more than can be cited in coming activities at the City Council Medical Care , 45 (12), 1195-1204. this short article), have contradicted please contact most of those arguments (Mchugh, [email protected] or McHugh, M., & Ma, C. (2013). Kelly, Sloane & Aiken, 2011; call 240-235-2000. Hospital nursing and 30-day Weiss, Yakusheva & Bobay, 2011). readmissions among medicare Today there is increased certainty References patients with heart failure, acute that the regulation is not only a myiocardial infarction, and common sense measure to improve Aiken, L., Clarke, S., & Sloane, D. pneumonia. Medical Care , 51 (1), oppressive workloads, but it would (2001). Hospital Restructuring: 54-59. also reduce mortality and injury to does it adversely affect care and patients. outcomes. Journal of Health and Mchugh, M., Brooks-Carthon, M., Most acute care hospital nurses in Human Services Administration , 23 Sloan, D., Wu, E., Kelly, L., & Aiken, the District of Columbia experience (4), 416-442. L. (2012). Impact of nursing staffing the frustration of not having time mandates on safety-net hospitals: to care adequately for all patients Aiken, L., Sloane, D., Cimiotti, lessons from California. Milbank assigned to them. I have been a J., Clarke, S., Linda, F., Seago, J., Quaterly , 90 (1), 160-187. nurse for thirty years, and like most et al. (2010). Implications of the of my experienced colleagues, can California nurse staffing mandate Mchugh, M., Kelly, L., Sloane, D., testify that our work environments for other states. Health Services & Aiken, L. (2011). Contradicting have deteriorated significantly in Research , 45 (4), 904-921. fears: California’s nurse-to-patient terms of understaffing since the mandate did not reduce the skill 1990’s when most hospitals in the Dall, T., Chen, Y., Seifert, R., level of the nursing workforce in District changed ownership to large Maddox, P., & Hogan, P. (202009). hospitals. Health Affairs , 30 (7), corporations. Very often we have The economic value of nursing. 1299-1306. to work in constant fear that our Medical Care , 47 (1), 1473-1494. patients may suffer some kind of Porter-O’Grady, T., & Malloch, harm, or that our licenses to nurse Diya, L., Van den Heede, K., K. (2011). Quantum Leadership. patients and earn our livelihoods & Sermeus, W. &. (2012). The Sudbury: Jones & Bartlett Learning. maybe at risk. Nurses have the relationship between in-hospital right and the mandated duty to mortality, readmission into the Van den Heede, K., Florquin, M., advocate for their patient’s wellbeing intensive care nursing unit and/or Bruyneel, L., Aiken, L., Lesaffre, unhindered, and un-encumbered by operating theater and nurse staffing E., & Sermeus, W. (2013). Effective poor working conditions. levels. Journal of Advanced Nursing , strategies for nurse retention in The struggle to pass this 68 (5), 1073-1081. acute hospitals: a mixed method legislation takes advocacy for study. International Journal of patients and for the nursing Jones, C. (2008). Revisiting Nursing Studies , 50 (2), 185-194. profession to a new level of activism nurse turnover costs: adjusting among DC nurses. It also has the for inflation. Journal of Nursing Weiss, M., Yakushua, O., & Bobay, potential to transform the present Administration , 38 (1), 11-18. K. (2011). Quality and costs patient care crisis in the District of analysis of nurse staffing, discharge Columbia in a matter of a few years Kane, R., Shamliyan, T., Christine, preparation, and postdischarge if the bill passes. M., Duval, S., & Wilt, T. (2007). utilization. Health Services Research , For any information about The association of registered nurse 46 (5), 1473-1494. n The Patient Protection Act, and staffing and patient outcomes: 16 District of Columbia Nurse: Regulation • Education • Practice  A Letter to the DC Board of Nursing By Delores Clair, RN, MHA, CNAA,BC President, DC Organization of Nurse Executives (ONE) We write to you today asking you to oppose B20-101, the Patient Protection Act of 2013, which would result in mandated staffing quotas at all District of Columbia hospitals. Although this legislation is being positioned as a “Standards of Care” bill, the reality is that the bill’s provisions have little to do with establishing standards to improve the care we provide our When emergencies like this year’s flu takes place between nurse leaders, staff patients. As Chief Nursing Officers from epidemic caused an influx in emergency nurses and other members of the care across the District, we’re concerned rooms, we take advantage of our cross- team. It is a complex and dynamic process with the unintended yet predictable trained staff of caregivers. By utilizing our that requires intense knowledge of staff consequences of this legislation. This entire staff rosters, we are able to care for capabilities, patient care and the ongoing legislation would increase patient, the emergency victims and other critical change in needs of the patient population. taxpayer and hospital costs without care patients. If this bill were to become We urge you to keep staffing decisions advancing patient safety or quality. It is a law, our ability to provide care would be with the people who know their hospital’s solution in search of a problem. limited. needs best: nurses and care teams at local Scheduling staff for a hospital is Successful patient care comes from hospitals. We would welcome the chance unlike staffing other work places. It is a team of healthcare providers. It is to speak with you about this issue. n extremely challenging to try to foresee about doctors, advanced· practice nurses, or plan for the emergencies that will registered nurses, licensed practical nurses, inevitably affect the needs of the patient nurse assistants, and others working Link to the DC Patient Protection Act population. As Chief Nursing Officers, together to provide patients with the 2013 we work with care teams at our local best quality care. A rigid quota from http://dcclims1.dccouncil.us/ hospitals to determine staffing. We the government would restrict us from images/00001/20130207134956.pdf have to consider individual patient needs providing patients with our staff’s highest along with the training, experience and level of expertise. ANA- Nurse Staffing Plans & Ratios capabilities of the whole care team We look to nurses to use their critical http://www.nursingworld.org/ when scheduling shifts. Circumstances thinking skills to provide patients with MainMenuCategories/Policy-Advocacy/ in a hospital can change at a moment’s the best care. They know when to call on State/Legislative-Agenda-Reports/State- notice and we need the flexibility to other team members and when to request StaffingPlansRatios properly care for the people involved in more staff. Hospitals in the District those emergencies. This legislation would provide the high quality care we do in AONE- Policy Statement on Mandated deprive local hospitals of the flexibility large part because of the high quality staff Staffing Ratios needed to make the best staffing decisions we attract and retain. http://www.aone.org/resources/ for our patients. Staffing is a collaborative effort that leadership%20tools/PDFs/ps_ratios.pdf e-mail: [email protected] • web: http://doh.dc.gov/bon 17  Nursing Practice Continuing Education Update Physical Assessment Assessment skills are essential to subjective and objective data that should Avoid Writing “Normal”: Dr. excellence in nursing practice. “If a be obtained from the six systems; Jenkins cautioned nurses against writing nurse cannot assess—everything else explained the normal findings for the “normal” as part of assessment. “Nurses is just following orders,” according six systems; and provided samples of like to write ‘normal’ in documentation,” to the Board’s Nurse Specialist for appropriate documentation for the six she said. However, your assessment Education Bonita Jenkins, EdD, RN, systems. should state what you have found more CNE, who addressed the topic of physical “Assessment is extremely important specifically. “If you cannot define assessment recently at a Board-sponsored in this day and time,” Dr. Jenkins normal, do not document normal,” Dr. continuing education program. Dr. said. “A nurse is only as good as her/ Miller told attendees. Jenkins was joined at the podium by his assessment skills and ability to colleague Elizabeth Miller, DNP, RN, document findings.” CCM, who is an Assistant Professor in Initial Observations: Your assessment Copycat Syndrome: Do not the Department of Nursing at Bowie State should begin before you speak with the document what the nurse before you University. patient. Watch and observe patient’s wrote, just for the sake of expediency. You The speakers described assessment height, stature, gait, fat distribution, level may be the only member of the nursing techniques for Integumentary, of nutrition, facial features—do you note staff conducting an accurate assessment. Cardiovascular, Musculoskeletal, any distress or trauma? Write what you Respiratory, Gastrointestinal, and observe. Are the patient’s word choices Neurological systems; discussed the and ideas clear? Frequent Flyers: Dr. Miller indicated that some patients may feign symptoms. Someone having a seizure cannot speak and is unaware of their surroundings. Be cognizant of this fact if patient tells you, “I am having a seizure.” Integumentary Assessment – Skin, Hair and Nails Do a quick general survey looking head to toe, looking for obvious lesions, then start head to toe examining lesions with a penlight and gently palpating after inspection. For skin lesions, note the color, size, location, drainage, wound bed, peri-wound tissue, and treatment. The various types of lesions and the classifications of pressure ulcers were discussed. Elizabeth Miller, DNP, RN, CCM 18 District of Columbia Nurse: Regulation • Education • Practice Sample Documentation of skin assessment Skin: Dark brown, soft, dry, warm, DOCTOR OF turgor resilient; no edema, odor or NURSING excess perspiration; freckling over cheeks and nose; 2 cm scar over left PRACTICE scapula; 4 mm round brown nevi on left thigh; no other lesions; Hair: coarse, curly, black with few gray, male distribution pattern thinning at crown, no infestations. Nails: smooth, hard, uniform, no clubbing or spooning, nail folds without redness, swelling or lesions. CARDIOVASCULAR ASSESSMENT Dr. Jenkins reviewed the anatomy of the heart and great vessels and discussed the cardiac cycle as it relates to EKG and heart sounds. She also provided a list of subjective data that should be collected, such as chest pain, cough, cardiac history, personal habits, as well as objective data through assessment. Inspect – Neck for Jugular Vein Distention (JVD), and point of maximum Department of Mental Health impulse (PMI) Psychiatric Nurses, are you looking for a new challenge? We need to hire Palpate – chest wall for lesions experienced Psychiatric Nurses and Nurse Managers immediately and this could be beneath the skin and PMI, palpate the perfect challenge for you! peripheral arteries bilaterally, except Saint Elizabeths Hospital relies on its’ Psychiatric Nurses to provide leadership and input into all aspects of healthcare carotids (Never palpate both carotid delivery for Hospital patients. As a Psychiatric Nurse and frontline caregiver at Saint Elizabeths you will have daily arteries at the same time) opportunities to influence the quality of healthcare provided at the Hospital. The Hospital’s new 450,000 square foot, state-of-the-art facility which replaced the 150-year old Hospital in April 2010, will allow you to provide high quality Auscultate – carotid using bell of nursing services in a therapeutic environment specifically designed to maximize the talents of staff members. stethoscope, auscultate chest (supine, left latera) recumbent, and then sitting We are seeking experienced registered nurses who are licensed (or can become licensed) in the District of Columbia with appropriate experience for Psychiatric Nurse (RN) positions. Psychiatric nursing experience is required and a for rate and rhythm. Use the diaphragm, BSN strongly preferred. Nurse Manager and Nurse Educator positions are also available. We offer competitive then the bell, in the order: salaries, a great benefits package, stable employment with opportunities to grow, flexible work hours, and enhanced educational opportunities plus free parking. Qualified applicants will receive a job interview within five business days Aortic of receipt of application. For a complete list of current vacancies, visit www.dchr.dc.gov and click on employment Pulmonic opportunities or send your resume to: Erb’s Point Tricuspid RN Jobs Saint Elizabeths Hospital, 1100Alabama Ave. SE Mitral Rm 205, Washington, DC 20032, PHONE: 202-299-5347 E-mail: [email protected] Take this opportunity to move your nursing career to the next level and join us now! Continued on page 20 e-mail: [email protected] • web: http://doh.dc.gov/bon 19  Nursing Practice Bonita Jenkins, EdD, RN, CNE Continued from page 19 RESPIRATORY ASSESSMENT Sample Documentation of Dr. Miller presented assessment of Respiratory Assessment Dr. Jenkins stated that you can the respiratory system. She indicated, Patient sitting upright during remember the order of heart assessment ”begin by inspecting the thoracic cage- assessment, Anteroposterior to lateral by the saying: “All People Enjoy Time anteroposterior and lateral dimensions. diameter is 1:2 and breathing is easy Magazine.” Inspect the skin over the chest and back, and unlabored. Color is consistent noting the color and condition. Note the with genetic background. No lesions client sitting position and work involved noted in anterior or posterior chest Sample Documentation of when breathing; as well as the respiratory wall. Tactile fremitus noted to be Cardiovascular Assessment rate. equal bilaterally over posterior wall. PMI not seen on precordium “Next is palpation. Palpate posterior Chest expansion is symmetrical. No inspection, Regular rhythm S1 and chest wall for symmetric expansion and percussion performed. Vesicular breath S2 present, rate 86 bpm no extra or tactile fremitus.” sounds are clear throughout periphery. abnormal sounds heard in apex or “Percussion would be next if done, in base. No pulse deficit. No bruits. PMI most cases, nurses do not percuss.“ palpated at 4th intercostal space L. “Then, auscultate, the passage of air ABDOMINAL ASSESSMENT mid-clavicular line. Carotid arteries through tracheobronchial tree creates Dr. Miller provided information palpable, no bruit. JVD absent at 45o a characteristic set of noises that are on abdominal assessment. There is a angle. All peripheral pulses palpable audible through the chest wall. These specific order for assessment of the bilaterally 3+, capillary refill < 3 sec in sounds may be modified by obstruction abdomen. It is inspection, auscultation, upper and lower extremities. No edema within respiratory passageways or by percussion, and palpation. noted in extremities. changes in lung tissue, the pleura, or Inspect the abdomen for contour, chest wall.” symmetry, the position of umbilicus, the condition of the skin. In addition the 20 District of Columbia Nurse: Regulation • Education • Practice nurse should inspect for pulsation in the involves the techniques of inspection and Cranial Nerve VII – facial muscle abdomen. palpation only. movement, droop, is the face symmetrical. Auscultation of the abdomen begins Inspect then Palpate, Upper Cranial Nerves IX, X, XII - Ability to in RLQ at ileocecal valve area because extremities then lower. swallow, protrude tongue midline, gag bowel sounds are normally always ROM and test for strength at each reflex. present there, then proceed clockwise to major joint comparing side to side. Cranial Nerve XI – Shoulder muscle the RUQ, LUQ, and LLQ. Use diaphragm Head and neck. strength – resistance. of stethoscope. Note character and Upper: shoulders, elbows, wrists, frequency of bowel sounds. Depending fingers. on time elapsed since eating, a wide Lower: hips, knees, ankles, toes. Consciousness: One participant range of normal sounds can occur. Finally, Inspect and Palpate Spine: asked about declaring a patient to be Bowel sounds are high pitched, gurgling, Check ROM and curvature of spine by unconscious. The long term care facility cascading sounds, occurring irregularly asking to bend and touch toes. called 911 and the EMT personnel wanted anywhere from 5 to 30 times per minute; to know if the resident was conscious or do not bother to count them. Use the Observe patient in motion. Gather unconscious. Dr. Jenkins said that your bell of stethoscope to listen over aorta subjective data such as occupational assessment doesn’t have to conform to hazards and functional deficits. and renal arteries for bruit. the either/or thinking of others. “We try Percuss to assess relative density of to make things simple, when they are abdominal contents, to locate organs, not simple,” Dr. Jenkins said. “There and to screen for abnormal fluid or Sample Documentation are various states of consciousness. masses. Dull sounds are heard over of Musculoskeletal The choices go beyond conscious and organs tympany should predominate Assessment unconscious. You call the patient’s Head straight and erect on neck. because air in intestines rises to surface name and they are not responsive. They Active ROM to all joints with full joint when person is supine. movement, no pain or discomfort, No could be unconscious, semi-conscious, Palpate surface and deep areas. Begin redness, swelling or deformity of joints. in a state of slumber, somnolence, in with light and then deep palpation. With Bilateral strength grade 5 in upper and a stupor, or unconscious.” If you see first four fingers close together, depress lower extremities, Able to oppose force the resident’s eyes moving while they skin about 1 cm. Make gentle rotary in two directions in upper and lower are unresponsive, you will probably be extremities. Gait steady. Spine is straight. motion, sliding fingers and skin together. hesitant to automatically classify them as Then lift fingers (do not drag them) and unconscious. move clockwise to next location around abdomen. NEUROLOGICAL ASSESSMENT LPNs also need to know assessment. Dr. Miller presented neurological RNs do the initial head-to-toe assessment, focusing on assessment of the assessment, but LPNs do focused and Sample Documentation of 12 cranial nerves. ongoing assessment. Abdominal Assessment Consciousness: Eyes open Dr. Jenkins informed participants Skin over abdomen is consistent spontaneously to name. about the IOM’s 2010 report which in color, no lesions. Noted pulsation Motor response - Have patient squeeze proposes that 80% of the nursing over aorta in mid - lower abdomen. your fingers and push against your workforce have baccalaureate degrees in Contour is flat. Bowel sounds present hand like a gas pedal and document the nursing by 2020. She stated, “I encourage with normal rate in all four quadrants. response. you to go back to school if you do not No bruit heard over aorta or renal Verbal response. have the bachelor’s degree in nursing. arteries. No percussion. Light palpation Communication. Baccalaureate programs require students revealed no tenderness. Cranial Nerve II, III, IV and VI - Pupil to complete a three –credit, 45-hours size in mm and reaction, movement right physical assessment course.” MUSCULOSKELETAL ASSESSMENT and left, any ptosis (drooping eyelid), This continuing education program Dr. Jenkins presented assessment Cranial Nerve V - Muscle strength jaw, was held in February 2013 at United of the musculoskeletal system, which Sensation. Medical Center. n e-mail: [email protected] • web: http://doh.dc.gov/bon 21  Nursing Practice Continuing Education Update Communication Skills for CNAs by Nancy Kofie “There are 19 nursing homes in the District of Columbia, and CNAs are my pride and joy,” DOH Compliance Nurse Specialist Mary Sklencar told the Certified Nursing Assistants (CNAs) who attended a Board of Nursing continuing education program on mastering CNA communications skills. Ms. Skencar is not a surveyor, but rather “I am the one that asks you questions about what happened when there is a complaint or an incident is reported. Don’t be afraid of me. Tell me the truth because I will eventually find it anyway.” CNAs must be master communicators. They must be able to communicate effectively with residents, LPNs, RNs, and with DC Department of Health investigators. Ms. Sklencar brought a unique perspective to the topic of CNA communications: “I have been a CNA. I have been kicked, hit, spit at, cussed at and told that I hurt somebody.” Mary Sklencar, RN, with DOH Compliance Supervisor Gregory Scurlock. Your Resident Has a Backstory Culture/Family/Personal There is a Reason: Reactions to The challenge of communicating Experiences the Past with residents is that they come with a “You come to work with a whole set People behave that way for a reason. different life experience than yours. Can of experiences,” Ms. Sklencar said. “The They are not acting this way against you, a 35 year old CNA (from the US or who resident has a totally different set of CNA, as a person; they are acting based on has immigrated to the US) communicate experiences. When two people talk, the their personal history and experience. Think effectively with an 85 year old resident messages are interpreted through their about where the resident is coming from. with dementia who was raised in the experiences. Communication can be If you are a smoker, and I tell you to stop Washington, D.C., of the 1930s? Yes. But affected by the speaker’s and listener’s smoking this very moment, will you? NO. it may take strategies and mindfulness. age, culture, country of origin, experience, There was a whole life of smoking prior to Layered on top of the resident’s culture, anger issues, dementia, hearing abilities. my request. There is a reason you can’t just personal history and personality, is the The onus is on the CNA to learn how to stop. Ms. Sklencar shared a few anecdotes. fact that they are residents in the facility communicate with the resident. You are • Resident A was from an African because they need 24-hour care. the professional—the onus is on you. country. She fell and broke her 22 District of Columbia Nurse: Regulation • Education • Practice  hip. She would not go with EMS to over anything, except his food. He the first thing you say to the resident in hospital. Everyone stood around her had moved in with his brother, but the morning sets the tone for the whole shouting that she should go to the then his brother died two weeks day.” Be eager to acknowledge something hospital. In her home country, when later. This is not the time to push positive about the person. Take a positive people come in the middle of the him. Before you judge him, think of approach. night, wearing uniforms, they take where he’s coming from. you and kill you. You’re Not the Residents’ They Need Care Boss • Resident B had been a farmer, born “When you attempt to communicate “I have noticed when a resident and bred in the USA. When he was with residents, keep in mind that you are doesn’t understand, some CNAs speak younger, he only took a bath once a dealing with someone who is NOT WELL. louder,” Ms. Sklencar said. “Do you think year. Now he is worried: What is going You are not seeing them in their best light, that is going to help? ‘Mr. Smith, it is time to happen to my crops if I take a bath? for a variety of reasons,” Ms. Sklencar told to get up. MR. SMITH IT’S TIME TO GET the CNAs. “Residents may be: angry, proud, UP!!’ It is a troubling trend I see—CNAs • Resident C was from Asia. She would and/or have dementia or psychological thinking they have authority over the not speak with her CNA because they issues; the younger residents may be former residents.” You should not be raising had not been formally introduced. or current drug users.” your voice and speaking with authority. You should be asking instead of telling. • Resident D had been the president Set the Tone CNAs should respond cheerfully, not of a university. He demanded a “When I said ‘Good Morning’ to you resentfully. Ask “How can I help you?” double portion of food! He has at the registration table, you said ‘hello’ rather than “What do you want?” The lost everything. He had no control back. I set the tone. Keep in mind that resident is the client. Be professional. It is not personal unless you make it personal.” Find the Words That Work Words mean different things to different people, Ms. Sklencar said. “Let’s run away” can mean let’s get married or let’s elude the police. “Nothing works all the time,” Ms. Sklencar said. Use gentle experimentation to gain residents’ trust. US versus THEM Do not unknowingly create a hostile atmosphere. Don’t form a little CNA social session with a co-worker, talking in hushed tones about your date last night, your child’s bout with the flu, about who won the election in your home country, CNAs participating in CE program exercise. Continued on page 24 e-mail: [email protected] • web: http://doh.dc.gov/bon 23  Nursing Practice Continued from page 23 First initial, Last name, CNA (example: your joy or make you angry except you. or if Delores slept with John. Secret D. Smith, CNA). Ms. Sklencar asked Don’t argue with a resident. Don’t “feel conversations turn into ammunition attendees to sign legibly—no loopy important” at the risk of the resident. If for the resident. You cannot tell the curlicue signatures. An illegible signature a resident is nasty, arguing, and angry, resident, “This is not your business. could be interpreted that you are hiding his or her goal may be just to release the This is personal business. This doesn’t something, she said. anger. It is not personal. If you are having involve you.” A resident can say, “that difficulty, seek help. Ask another CNA, a CNA was rude to me.” Yes, residents can Speak Their Language nurse, or a member of the housekeeping be paranoid. If you abruptly stop talking Is English the resident’s second staff. Sometimes the housekeeper may be when a resident approaches, he may language? Residents may greatly able to communicate better, in a certain think you are talking about him. CNA appreciate it if you say something in situation, than you or any other health success means creating an atmosphere of their native language: “When I travel, I care professional in town. trust. gravitate to the persons who at least try to speak some English. If you can say a few Part of the Art Professionalism Basics words, it opens up a passageway of trust,” CNAs have a very difficult job. You “You chose this profession,” Ms. Ms. Sklencar said. do a wonderful job, given the task ahead Sklencar reminded participants. You of you! Continue to attend educational chose this profession, this town, this Coping with Conflict programs and improve yourselves. Seek country, this facility. You must abide by CNAs must remain calm and keep to improve communications with your the rules. When you sign your name, put their cool. Remember—no one can steal supervisor and co-workers, as well as residents. “You are part of the Art of Nursing,” Ms. Sklencar said. “The goal is to get things done while keeping the resident happy.” n Perspective Residents are not your buddies; Residents are your clients. Put up the wall called Professionalism. DO THIS • Speak softer; if the Resident is hard of hearing, speak closer to their ear rather than yell • Slow down and speak with clarity • Use a Strategy rather than assume a Tone of Authority 24 District of Columbia Nurse: Regulation • Education • Practice DO NOT DO THIS Foundation of Trust • Yell Resident Non-Compliance • Eye Contact: Look at person you • Talk Fast are talking to and smile. • A resident cannot be “non- • Speak as if You Have Authority over compliant.” • Touch: When you touch a Resident resident, let them know you are • There is a Reason why the going to touch them ahead of • Roll Your Eyes or Sigh Resident is acting this way. time. • Fold Your Arms across your Chest • Rise to the challenge. • Tone of Voice: Don’t bark orders, Acknowledge what is ask “How can I help you?” or • Put Your Hands on Your Hips important to them. “How do you want me to help you?” • Whisper to Co-workers • Acknowledging their values opens a pathway to • Don’t Alarm Resident: Nobody • Stop Talking Abruptly when Resident communication. likes surprises. Don’t grab for the Approaches resident because they don’t know what you want. • Speak in Another Language • Reset Trust: When a resident has Winning Strategies For dementia, you have to reestablish Communicating trust every day. • Simplify your language Are You a CNA “Ugly Betty” or “Simon LeGree”? • Clarify your statements Tools of the Trade • Shuts the Residents Out • Validate that the Resident heard what • Words you meant to say • Becomes “deaf” when he or she doesn’t want to deal • Tone of Voice • Validate who your Residents are as with a resident individuals. • Gestures • Points at the dinner plate Validate with Creativity (an example) and yells “Here’s your ENTER THE STAGE Issue: dinner! Eat it!” • Resident has dementia. Before you enter your facility, • Alienates residents—and know yourself: Are you angry • Resident is a former federal employee, once words are spoken, about something? Did you get a and attempts to leave the building you can’t take them back. speeding ticket? In a fight with your saying “I have to go to work.” spouse? • If you cannot say When you cross the threshold, • Use a creative strategy to get the something nice, don’t say be centered. If not, any little thing desired result. Tell the resident, anything. will set you off. “There is no work today. The office is If you enter angry, who will get closed.” the brunt of it? The resident! Continued on page 26 e-mail: [email protected] • web: http://doh.dc.gov/bon 25  Nursing Practice Continued from page 25 CROSSING THE THRESHOLD • A CNA is an Actress or Actor on a Stage • You set the tone for the whole day • Be a Professional, focused on providing care for the client (resident) BLOW OFF SOME STEAM Feel you are about to verbally explode? Take 5 minutes in the bathroom. If you don’t, when someone tells you that you didn’t get Ms. Jones a bath, you may explode! What are some causes of Residents becoming violent? • Dementia • Psychiatric issues • “Street survival” mode CNA asks a question during CE program. You Better Tell Somebody Hard of Hearing? • Get help from the Charge nurse, Unit Manager or Director of Nursing. They Family Members If a resident is hard of hearing, can be a buffer. do not yell. Talk closer to the ear. • Be respectful and polite A visitor may mistake the situation • The more information you can give when speaking to Resident’s and think you are yelling at the the charge nurse the better. family members. resident in anger. Being yelled at feels denigrating and looks to • Ask yourself “What is important to • Chanel discussion to the visitors like abuse. the resident? What could be the root Charge nurse. cause of the anger?” • DO NOT give them Anticipate Problems • You can’t just start yelling; no information that you are not resident likes to be berated. Get sure of. When you know that you will not the charge nurse or remain silent be on duty the next day, assure your momentarily. It takes two to fight. • Whatever you say, the family resident that he will be okay with members take it as gospel. another CNA: “Beverly will be here • Accept resident where they are. You tomorrow. Would you let Beverly take can lead a horse to water, but you care of you? She is really good.” can’t make him drink. 26 District of Columbia Nurse: Regulation • Education • Practice Do Not Creative Strategies! Rule #1 • yell Problem: resident frequently falls. Solution: Give the resident You are the professional. • chat in a CNA social clique something to do. If the resident does not Example: We put a bible in her lap understand your message, it’s your • grab the resident and asked “Do you know Matthew 15?” fault. or “Oh, Millie, What is John 3:16?” She Be prepared for the challenges • approach from behind never fell again. Keep them occupied with professionalism and a creative with a newspaper, bible, baby doll. approach to communications! Solutions Duct taping to wheelchair is not a Fear: A resident may be resistant to solution it is patient abuse. walk because they fear falling. CALM YOURSELF DOWN. Solution: That resident’s fear may Abuse disappear with support from two According to DOH Compliance REMEMBER, STRESSED SPELLED people at each side. Supervisor Greg Scurlock, “if you BACKWARDS IS ‘DESSERTS’! Words: Words not working? say something negative about a Solution: Change it up. Change resident within earshot, that is the words you are using. Say “prayer” abuse.” Motive #1: instead of “chapel.” A different word Abusive behavior is reported to may get desired results! the Board of Nursing for discipline. Provide Residents with the Best Care e d u c a t i o n / e m p l o y m e n t nationwide April 2009 How can you improve the big picture of healthcare? Maximize your talents in an innovative setting, and make the world a healthier place, with Healthways. As the largest independent global provider of well-being solutions, we use the science of behavior change to produce nationwide l o y m e n t positive change. Join us, and see the big difference you can make. o n / e m p e d u c a t i MAKE YOU RUREDU CATION JO NEY SMAR COM Thinking AL Outside the Box: TBINING CARING AND TECHNOLOG Local Care Coordinators – RN OPO P FOR NURSING HL AW Y Full-Time Opportunities in MD, DC and VA DEGREE HOLDERSRS WEST EDITION E D I T I O Reaching every It’s one thing to work with a healthcare provider that treats symptoms. But it’s quite another to work directly with individuals in your community to help improve their N 1 2 nursing student/school in America health, and create lasting solutions. This is a unique position—and a rare opportunity The Art and Science of Crafts to offer the patient education, care management, and care coordination others will SICAL TREATMENT OF PHYBILITIES AND COGNITIVE DISA need to learn in order to maintain healthier habits—and build longer, happier lives. ol Ninu rAmeric a 1 nursing studenwt/scho ww.Stu se.com ER 2009 Reaching every SEPTEMB T I O N 1 E D I 3 Working remotely from your home and in the field, you will travel locally approximately 50-60% of the week. Dedicated to educating our participants, Free Subscription to you will develop and coordinate care plans with physicians, patients, and Allied Health professionals to provide engaging, cost-efficient, quality care to StuNurse magazine! the highest-risk health plan members in your community. The ideal candidate will possess a minimum of 3 years of RN Do you know someone who is a experience, RN licensure, case management/care coordination experience, the ability to collaborate with physicians for student nurse, or someone successful program outcomes, and keyboarding/computer considering a nursing career? Then proficiency. let them know about the StuNurse Our competitive pay and benefits package, fitness programs, magazine. A subscription to the professional and personal development, and community volunteer opportunities encourage balance, helping you StuNurse digital magazine is FREE and stay emotionally and socially fit. can be reserved by visiting www.StuNurse.com and clicking on Please contact us at 866-754-1884 the Subscribe button at the upper or apply online at right corner. Educators... let your www.healthways.com/careers students know they can subscribe free of charge! Equal Opportunity Employer M/F/D/V e-mail: [email protected] • web: http://doh.dc.gov/bon 27  Nursing Practice Congratulations to Ottamissiah “Missy” Moore on the publication of her article “A KudOs! Reflective Look at Practical Nursing” which was published last spring in a special issue of the National Black Nurses Association News entitled THE FUTURE OF NURSING. Reprinted below with permission from the National Black Nurses Association, from the NBNA News special issue THE FUTURE OF NURSING, published in celebration of National Nurses Week, May 6-12, 2013. A Reflective Look at Practical Nursing by Ottamissiah Moore, BS, LPN, WCC, CLNI, GC, CHPLN Over 26 years ago, I stood with a group and act on behalf of the occupational of my peers in a crisp white uniform, group. It is the only organization in the holding a nightingale lamp. It was my United States governed entirely by LP/VNs graduation from License Practical Nursing for LP/VNs. NFL PN is recognized by the (LPN) school and my entrance into the other national nursing organizations as the nursing profession. Armed with my new official voice of LP/VNs. license, a new nursing venture and a great mentor, I was preparing myself for best The Present career of my life. The discussion about the “phasing out” practical nurses has been going on for more The past than 26 years. Although the conversation is When I look at the history of practical quietly spoken, practical nurses are slowly nurses, some contend it began in 1897, leaving areas they have practiced in for with the programs at Massachusetts many years. Licensed Practical/Vocational General Hospital in Boston, and New Nurses across the county are voicing their Haven Hospital in Connecticut which concern over several issues as discussed opened around 1873. Others believe “Practicals” were licensed through waivers below. LPN practice started with the programs and different States had different ways. The underutilization of practical nurses, established in New York. These “trained” Some required a letter of recommendation in some states and workplaces, prohibits nursing schools were Bellevue Hospital in from a physician, a supervisor, etc., and practical nurses to perform tasks that they New York City, the Ballard School in New the nurse had to have worked as a practical have been taught, and show knowledge, York (1893) (Anderson, 2001, p. 17); and nurse for at least five years immediately skill and competency to perform. LP/VNs a training program for practical/vocational prior to application. State-by-State, they are being replaced by unlicensed assistive nurses developed by the American Red were waived into nursing. Their licenses personnel. During periods of nursing Cross (1892) at the Young Women’s had a “W” on it and for many of them it shortage, LP/VNs are often recruited for Christian Association in New York City. was a stigma until they actually took the positions which were originally RN jobs After the turn of the century, LPN education licensure exam. By 1945, 19 states and one and assistive personnel are often recruited and licensure became more formalized territory had licensure laws. One state was for jobs traditionally held by LP/VNs. with the opening of the Thompson permissive licensing. While they can assist with tasks Practical Nursing School in Vermont in The National Federation of License associated with the maintenance and 1907 and the Household Nursing School in Practical Nurses (NFL PN) was organized support of the aged, they do not and Boston in 1918 (White & Duncan, 2001). in 1949 to provide a structure at the cannot replace the LP/VN at the bedside. World War II brought the need for national level through which LPNs and While we may not be able to conduct additional nurses, which focused attention LVNs (Licensed Vocational Nurses) could comprehensive assessments of the patient, on the contributions of the LPN/LVN. The promote better patient care and to speak we do understand patient response, we 28 District of Columbia Nurse: Regulation • Education • Practice have been taught how to conduct general These questions and others about the outside the hospital? Retrieved assessments and able to accurately convey issues are endless. July 12, 2012, from http://www. patient status, care concerns and needs in Leadership in nursing must take a nursezone.com/nursing-news-events/more- a manner unknown to unlicensed assistive look at what part LP/VNs have in nursing news/Are-LPN-Jobs-Moving-Outside-the- personnel. history, bedside nursing, patient outcomes Hospital_26658.aspx LP/VN students are not receiving and work together to carve out a role and Magnet Doesn’t Attract Everyone the education and career opportunities practice specifically for LP/VNs now and for found at http://www.afscme.org/ previously afforded the profession. Clinical the future. Leadership must be creative in publications/4194.cfm experience has always been an integral our thinking to assist LP/VNs to transition Lafer, G. & Moss, H. (2007). The LPN: part of nursing education. It prepares to the role of an RN. The nightingale A practical way to alleviate the nursing student nurses to be able to perform as light of LP/VNs is still shining. Given the shortage. Labor Education and Research well as have knowledge about the clinical opportunity, LP/VNs will prove the value of Center, University of Oregon, for the principles in practice. Clinical practice practical nursing in the primary, preventive United Nurses of America. Retrieved July stimulates students to use their critical and long-term care settings. We only need 12, 2012, from http://www.afscme.org/ thinking skills for problem solving. There to have our light shine brighter. news/publications/health-care/the-lpn- is a strong demand for high-quality, cost a-practical-way-to-alleviate-the-nursing- effective clinical education experiences that References shortage facilitate student learning in the clinical Blegen, M., Vaughn, T., Vojir, C. Spector, N. (2005). Practical Nurse setting. The clinical learning environment (2007). Nurse staffing levels: Impact of Scope of Practice White Paper. National (CLE) is the interactive network of forces organizational characteristics and registered Council of State Boards of Nursing. within the clinical setting that influence nurse supply. Health Services Research, Available at: https://www.ncsbn.org/ the students’ clinical learning outcomes. 43(1), 154-173. Final_11_05_Practical_Nurse_Scope_ We believe clinical experiences would Larson, J. (2008). Are LPN jobs moving Practice_White_Paper.pdf. n improve the knowledge, skills and abilities of LP/VNs. We have heard about problems existing with students obtaining Marymount University clinical experiences, preceptorships, and job placement. No studies have been Arlington, Virginia Nursing Programs conducted on this issue. Concerns about lack of clinical experiences for LP/VN students may be one of the barriers to the NCLE X pass rate and employment Master of Science in Nursing opportunities. Family Nurse Practitioner (post-master’s certificate option) The Future of practical nursing Doctor of Nursing Practice It appears there are more questions than answers. The practice, the market and Nursing scholarships available the education of LP/VNs is changing every single day. The questions are… How will LP/LVN become educated? Who will offer clinical sites to LP/LVN students? What will the skill set of an LP/VN look Information Luncheon • September 20, noon like over the next 10 years? MU’s Ballston Center, 1000 North Glebe Road How will practical nurses transition to RSVP: (703) 284-5902 or marymountinfosessions.com another position if the market does not utilize them? Who will precept LP/VNs new to www.marymount.edu practice? e-mail: [email protected] • web: http://doh.dc.gov/bon 29  Board Disciplinary Actions NAME LICENSE # ACTION Nursing Staffing Vitalis Kemakolam RN1019635 Fine Agencies Rosaline Carter RN66684 Suspension Order terminated Aburro Staffing - Revoked Uline Atongnong LPN1005891 Suspension Order terminated Stephanie Thompson NA364249 Revoked AEF Comfort Nursing Care - Revoked Dominic Atabongakeng NA807355 Summarily Suspended Franka Blossom - Revoked Denise Bain RN1025455 Suspended Raymonia Foreman LPN1007361 License Denied Dedicated Care - Revoked Names and license numbers are published as a means of protecting the public safety, health and welfare. Only Final Decisions are published. Final Orders and the Certified Prime Consulting - Revoked Nurse Aide Abuse Registry can be assessed by going to http://doh.dc.gov. Non-Public Disciplinary Actions: Public vs. Non-Public Discipline Public Discipline: Disciplinary actions that are reported to Nursys, National Referrals to COIN 9 Practitioner’s Data Bank and viewed in DC NURSE and at http://app.hpla.doh.dc.gov/ Consent Orders 24 weblookup/. Requests to Withdraw 10 Requests to Surrender 3 Non-Public Discipline: Disciplinary actions that constitute an agreement between the Letters of Concern 3 Board and the licensee and, if complied, are not made public. License denied 1 A m e m b e r o f N u r s e s S e r v i c e O r g a n i z a t i o n ( N S O**) Targeted Networking ** N S O m a y c o v e r m o s t o f y o u r a t t o r n e y f e e s . The “NEW” Classifieds (1.5” wide x 1” high) Reach every nurse in Washington, D.C., Izu I. Ahaghotu, RN, JD R E SE RV E for as little as $225. Contact Tom Kennedy A T T O R N E Y A T L A W YOU R SPAC E [email protected] NOW ! 1-800-561-4686 Thrive as a Legal Nurse Consultant! LNCs are in demand and can earn $80 to $150 per hour analyzing medical cases for attorneys. Classified Legal Nurse Consulting, Inc.'s dynamic, self-paced LNC training program prepares you for ASLNC certification - ads for from the privacy of your own home or attend class starting November 1 Baltimore, MD as low Put your clinical experience to If you or a colleague is in need of an Attorney to represent you before the D.C. as $225 work in the exciting legal arena... take that first step today. Board of Nursing or FOR ANY OTHER LEGAL MATTER, Call a Nurse Attorney Call 8888-888-4560 Today! for a confidential consultation. Visit www.LNCcenter.com Please contact Izu I. Ahaghotu, RN, Esquire directly: Office: 202.726.4171 DIRECT 202.361.6909 www.IZUAHAGHOTU.com Email: [email protected] 7211 Georgia Avenue, NW Washington, DC 20012 30 District of Columbia Nurse: Regulation • Education • Practice  Free Subscription to Reach StuNurse magazine! e d u c a t i nationwide o n / e m p l o y m e n t April 2009 Do you know someone who is a student nurse, or Recruit PUBLISHING CONCEPTS INC. nationwide KAI011971B 1 8/1/2013 e d u c a t i o n / e m p l o y m e n t someone considering a nursing career? Then let them 5.125 x 7.5 cationa l Thinking Outs ide the Box: know about the StuNurse magazine. KHOWARD A subscription K Make you r edu COm Bining Caring Jou rney SMartand TeC hnOlOgy Retain æ Opp Ortunities for NursiNg in Hea ltH law Degree to the StuNurse digital magazine is FREE DCand can be Nurse HolDers WEST EDITION E D I T I O N 1 2 Reaching every nursing student/school in America reserved by visiting www.StuNurse.com and clicking on Crafts the Subscribe button at the upper right corner. The Art and Science of SiCAl TreATmenT of PhybiliTieS And CogniTive diSA 3 Educators…let your students know NURSE Volume 9 Number August 2012 COLU MB IA DISTR ICT OF ol inu rAmeric a 1 nursing studenwt/scho ww.Stu N se.com Reaching every they can subscribe free of charge! Septemb er 2009 3 T I O N 1 E D I d u c at i o n PRactic e R e g u l at i o n e SOC IAL MED IA & YOU R LICE NSE Are You On Facebook, Twi : tter? I build ON THE POSITIVE My unique skills and knowledge give me the confidence and enthusiasm to face new INSIGHTS FOR challenges—in my career and beyond. At Kaiser Permanente, I work in an environment (CNAs) ING ASSISTANTS of the CERTIFIED NURS Government District of Columbia (See page 20) R S I N g1 Vincent C. Gray, Mayor B IA BOA RD OF NU g oTv cI.C OF COLUM that encourages me to reach my potential. With the support of my colleagues and the pD h .R l aI. dSoT d v •i Owne bo t hw e : fw w .h oat bdlc i. gc i a a . dPo u p ll h@ eO -mf afi il c : h organization, I am able to push myself to greater heights and grow in new ways every Mailed to every nurse in day. Being the best I can be motivates me to set and achieve new goals. Which is Washington, D.C. – over 25,000. something I pass on to our members. If you believe in discovering your own limitless potential, join us at Kaiser Permanente. The Washington, D.C. Board of Nursing Journal to reserve advertising space, contact Tom Kennedy at [email protected] 1-800-561-4686 ext. 104 Our nursing journals are direct mailed to over 1.5 million nurses, healthcare professionals and educators nationwide. The nation’s leading not-for-profit integrated health plan, Kaiser For more information Permanente is a recognized health advocate in the communities about these and other in which it resides. Here, in the Mid-Atlantic, we provide quality opportunities, and to Arizona North Carolina health care to our more than 500,000 members in Maryland, the view complete Arkansas North Dakota District of Columbia, and Northern Virginia. Ready to advance qualifications and job The District Ohio your skills with us? Consider the following opportunities: submission details, of Columbia Oregon please visit our website. ➞ Clinical Educator (Emergency) - MD, VA, DC Indiana South Carolina jobs.kp.org ➞ Clinical RNs – Various Specialties – MD, VA, DC Kentucky South Dakota ➞ Clinical RNs – ER and Critical Care – Capitol Hill, DC Mississippi StuNurse/Nationwide and Tyson's Corner, VA Montana Tennessee ➞ Perioperative Educators – Tyson's Corner, VA/Capitol Hill, DC, Nebraska Washington and Largo/South Baltimore, MD Nevada West Virginia ➞ Psychiatric Advanced Practice Nurse – Largo, MD New Mexico Wyoming ➞ RN First Assistant – South Baltimore, MD ➞ Wound Care RN – Largo, MD ThinkNurse.com © 2013 KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. PRINCIPALS ONLY. DRUG-FREE WORKPLACE. EEO/AA EMPLOYER. e-mail: [email protected] • web: http://doh.dc.gov/bon 31 DC Board of Nursing 899 North Capitol Street NE Presorted Standard First Floor U.S. Postage Paid Little Rock, AR Washington, DC 20002 Permit No. 1884 MedStar Georgetown University Hospital Nurse Practitioners MedStar Georgetown University Hospital, a 609-bed academic hospital, is one of the nation’s leading teaching and research hospitals. As Washington, DC’s first Magnet® hospital and one of the few hospitals to receive Magnet re-designation, MedStar Georgetown University Hospital is deeply committed to your professional development. MedStar Georgetown has unique opportunities for exceptional advanced practice nurses. Nurse Practitioner positions are available in the following areas: • Neonatology • Internal Medicine • Transplant, Adult Small Bowel • Gastroenterology • Transplant, Inpatient Kidney • Occupational Health • Transplant, Liver • Vascular Surgery • Hematology/Oncology • Orthopedics • Breast Health • Pediatric Endocrinology, • OB/GYN Part-Time For details on how to join our Magnet nursing team and to apply online, please visit www.medstargeorgetown.jobs/ NursePractitioners EOE