Division 1 of the Oregon Nurse Practice Act is for Everyone - Professional Boundaries in Healthcare: Be Aware of These Red Flags Delegate or ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
O R E G O N B OA R D O F N U R S I N G [ VO.41 • NO 3 • SUMMER 2022 ] Division 1 of the Oregon Nurse Practice Act is for Everyone Also in this issue Professional Boundaries in Healthcare: Be Aware of These Red Flags Delegate or Assign: What is the Difference?
We take care of you, so that you
can take care of our community.
JOIN THE GOOD SHEPHERD FAMILY!
Home Health Nurses — Hospice Nurses
n No call
n Career development
n Continuing education support
n Flexible scheduling
n Sign on bonus up to 20k
n Additional certification pay
Apply today at www.gshealth.org/careers
TABLE OF CONTENTS
SENTINEL
Oregon State Board of Nursing
17938 SW Upper Boones Ferry Road
Portland, OR 97224-7012
Business Hours:
Monday-Friday
[ VO.41 • NO. 3 • SUMMER 2022 ]
8:00 am – 5:00 pm
table of
FAX: 971-673-0684
www.oregon.gov/OSBN contents
Staff are available to assist you during
Division 1 of the Oregon Nurse Practice
business hours via email:
Act is for Everyone . . . . . . . . . . . . . . . . . . . 4
oregon.bn.info@osbn.oregon.gov.
Please allow up to 48 hours for a response. Professional Boundaries in Healthcare:
Page 6
Be Aware of These Red Flags . . . . . . . . . . 6
Delegate Or Assign:
What is the Difference? . . . . . . . . . . . . . . . 8
Board Members:
Judith Woodruff, JD Is it Time for Oregon to Embrace the APRN
Board President, Public Member Nurse Licensure Compact? . . . . . . . . . 12
Aaron Green, CNA RN Well-Being Project Illuminates
President-Elect Nursing Workplace Needs . . . . . . . . . . 14
Page 8
Sheryl Oakes Caddy, JD, MSN, RN, CNE
Board Secretary Board Votes to Implement New Public
Hearing Process . . . . . . . . . . . . . . . . . . . 16
Sarah Horn, RN
Disciplinary Case Study:
Michael Wynter-Lightfoot
Public Member
Boundary Violations . . . . . . . . . . . . . . . 18
Michelle Chau, LPN You Ask, We Answer . . . . . . . . . . . . . . . 20
Angela Powell, RN Faith Community Nursing-
Devorah Bianchi, RN is it Right for You? . . . . . . . . . . . . . . . . . 22
Page 12
Yvonne Duan, RN, FNP Verification Subscribers Will Soon
All Board Meetings, except Executive Switch To E-Notify . . . . . . . . . . . . . . . . 25
Sessions, are open to the public.
Ruby Jason, MSN, RN, NEA-BC
Executive Director
Barbara Holtry
Communications Manager
Editor of the Sentinel Created by Publishing Concepts, Inc.
David Brown, President • 1-800-561-4686 ext.103
dbrown@pcipublishing.com
Advertisements contained herein are not
endorsed by the Oregon State Board of Nursing.
For Advertising info contact
Jesseca Youngblood • 1-800-561-4686 ext. 115
jyoungblood@pcipublishing.com
26 2022 Board Members
The Oregon State Board of Nursing reserves the
right to accept or reject advertisements in this
28 Board Disciplinary Actions
publication. Responsibility for errors is limited to
corrections in a subsequent issue.
30 2022 Board Meeting Dates
EDITION 55
NURSING PRACTICE
By OSBN Executive Director Ruby Jason, MSN, RN, NEA-BC
DIVISION 1 OF THE
OREGON NURSE
PRACTICE ACT IS FOR
EVERYONE
There are currently 17 divisions in the Oregon Nurse Practice 851-001-0008 – Agency Representation at Hearings: For
Act (NPA) . Each division is dedicated to a specific license type civil penalties not exceeding $2,900 for a nurse working in the
describing the education requirements, licensing requirements state of Oregon without a valid license, Oregon statute allows
and the legal standards of practice . Frequently overlooked is the OSBN staff to represent the OSBN in a settlement hearing .
Division 851-001, which contains information applicable In all other situations, an Assistant Attorney General from the
to all those licensed or certified by the Oregon State Board Office of the Attorney General represents the OSBN .
of Nursing (OSBN) . This article is intended to provide the
*851-001-0009 – Imposition of Civil Penalties authorizes
reader with a brief synopsis of information found in each of the
the OSBN to levy monetary penalties in addition to discipline
sections that comprise OAR 851-001 . This article describes all
sanctions on a license or certificate . This describes the
sections of 851-001, but those sections of particular interest are
minimum and maximum fines per occurrence the OSBN is
marked with an asterisk (*) .
allowed to impose .
851-001-0000 – Notice of Proposed Rule Making: The
OSBN has legislative authority to write administrative rule *851-001-0010 – Notification Procedure identifies the
to implement statute . This section describes the timeline entities receiving copies of final OSBN sanctions and notifies
requirements the OSBN must meet for notifying the public of the public of where public disciplines will be posted .
the rule hearing . *851-001-0030- Social Security Numbers (SSN) are
851-001-0005 – Model Rules of Procedure: Requires the required for licensure or certification . This section describes
OSBN to adopt the Attorney General Model Rules during a the entities with whom the OSBN is authorized to send your
contested case . “Contested Case” refers to the process a licensee SSN, if needed . The OSBN will not share your SSN unless there
or certificate holder uses when they disagree with the OSBNs is a need to do so . This section also describes the documents
determination of the disciplinary sanction against their license required if the applicant does not have an SSN . It is not legal to
or certificate due to a violation of the practice act . In Oregon, make up an SSN or borrow an SSN; if the OSBN discovers an
the license is considered a property right and as such, before attempt to do so, the OSBN is obligated to report the applicant to
the OSBN can impose a final determination, the licensee or the Social Security Administration . Submitting an application
certificate holder has the right to contest the OSBN’s decision . to the OSBN gives permission to share your SSN, if needed,
with the listed entities and for the describes uses .
*851-001-0007 – Hearing Request: Provides information
regarding timelines the license holder must meet to successfully 851-001-0100- Delegation of Signature Authority allows
file a hearing request to contest the OSBN determined sanction . the executive director or designee to sign certain forms in lieu
4 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N G
of the OSBN president . This authority is only granted to OSBN violate the Governor’s emergency declaration . Since this is
staff by rule and delegation of the OSBN . in rule, if the OSBN receives a complaint regarding a licensee
*851-001-0115 – Criminal Background Checks for engaging in any of these activities, the OSBN is obligated to
Licensure or Certification by the OSBN including Initial, open an investigation and, based upon the preponderance of
Renewal, Reactivations, Reinstatements or Endorsements. evidence, the licensee could face OSBN sanctions .
Identifies what criteria the OSBN will utilize when evaluating *851-001-0160-Compliance with the Oregon Health
past criminal convictions and egregious arrests to determine Authority’s (OHA) COVID-19 Requirements. This is
a fitness to practice nursing . For initial, reactivation, another rule generated by the Governor’s and OHA’s response
reinstatements, and endorsement application the background to COVID-19 . All healthcare licensing boards were required
check consists of a national fingerprint check, whereas renewal to write rule describing that violating the OHA vaccine rules
are done by using an Oregon State database only . would be considered conduct derogatory to the practice of
851-001-0122 – Criminal Background Checks for nursing or conduct unbecoming a nursing assistant . The
employees of, those seeking to be employed by, or providing OSBN has no authority to inspect or independently locate
services or seeking to provide services as a contractor any licensee or certificate holder violating this requirement .
or volunteer for the OSBN describes the process used to All OSBN investigations are instigated based on receipt of a
determine the fitness of employees and vendors doing business complaint .
with the OSBN . The criteria differ slightly from applicants; *851-001-0170 – Health Care Interpreters. This is the
therefore, it has its own section . newest rule in this division, passed during the June 2022 OSBN
851-001-0125 – Appealing a Fitness Determination for meeting as temporary rule . Temporary rule is what state
employees of, for those seeking be employed by, or providing agencies use to implement a rule without a public hearing to
services or seeking to provide services as a contractor or meet legislative timelines . These rules are legal for a maximum
volunteer for the OSBN. If an applicant is denied a license of 180 days . Prior to 180 days, the OSBN must hold a public
based on the OSBN’s review of the criminal background hearing and vote if the rules will be made permanent or be
information, the applicant is allowed to follow the contested allowed to expire . This rule implements HB 2359 that affects
case process previously mentioned . If the denial of employment all healthcare providers who accept public funds (usually
or contract was the result of a criminal background check this Medicaid/Medicare) for services . This is not only applicable
section explains the procedure to be used . to nurse entrepreneurs who own their own business and bill
under their own number, but also those licensees and certificate
*851-001-0135 – Record Keeping and Confidentiality holders who work for organizations who accept public funds
identifies the OSBNs obligation to keep all criminal background for payment . This rule requires, with a few exceptions, that
information confidential . This section also describes how an those licensed or certified by the OSBN must consult with the
applicant may view their own criminal background results if healthcare interpreter registry administered by the Oregon
they wish to review information on which an OSBN fitness Health Authority when communicating with a patient who
determination was made . The OSBN does not permanently prefers to communicate in a language other than English or
retain these documents . They are destroyed according to a who communicates in a signed language . Please familiarize
Federal Bureau of Investigation (FBI) requirement . yourself with this rule, which takes language directly from the
*851-001-0145- Emergency Declaration Response HB 2359 document . As with any other rule, the OSBN only
describes the OSBN’s authority to adapt licensing procedures has the authority to open an investigation if a complaint is
if an emergency declaration, such as the Governor’s COVID- submitted regarding violation of this rule .
19 declaration, is issued . This is where criteria for emergency Check the OSBN website
authorizations and exemptions for some educational programs The entire Nurse Practice Act is available on the OSBN
are described . website (www .oregon .gov/osbn) . The OSBN hopes that this
*851-001-0150-Violations of Declared Governor’s article has provided you with enough information to appreciate
Emergency Declaration. Based upon direction from the the importance of this division to the practice of all licensees
Governor’s office, this section describes activities that would and certificate holders .
SENTINEL VO.41 • NO. 3 • SUMMER 2022 5
NURSING PRACTICE
By OSBN Investigations Manager Jacy Gamble
PROFESSIONAL BOUNDARIES IN HEALTHCARE:
BE AWARE OF
THESE RED FLAGS
National surveys have repeatedly to use to ensure they are maintaining a vehicle, renting a room to a patient,
shown that nursing remains the most professional patient relationship . helping a patient move, etc .),
respected and trusted of professions . Boundary violations can be described • sharing confidential information
That trust is essential and the relationship as the gap between the healthcare about a patient,
between nurses and nursing assistants provider’s power and the patient’s • making derogatory remarks about
with patients must be one based on vulnerability . Due to a CNA or nurse’s a patient on their social media .
mutual respect, with the needs of the access to sensitive personal information
patient being the primary objective . It and the patient themselves, the provider Red Flags
is the expectation that the nurse or CNA is in a position of power over the patient . When an investigation related to
will use their professional knowledge, The Oregon State Board of Nursing alleged boundary violations is conducted
skills, and abilities to act in the best (OSBN) frequently receives complaints by an OSBN investigator, there are
interest of the patient . Maintaining related to alleged boundary violations usually red flags that were present prior
professional boundaries is essential to by nurses . The complaints consist of to the actual violations . It is important
ensure a therapeutic patient relationship allegations such as: that nurses and nursing assistants know
and failing to do so can be a considered • a nurse or nursing assistant how to identify and pay attention to
conduct derogatory to the standards of accepting money or other things of those red flags . Some of the red flags that
nursing and is a violation of the Oregon value from a patient, may indicate a provider is engaged in,
Nurse Practice Act (NPA) . This article • sexual or intimate relationships or is at risk of engaging in a violation of
will explore some ways in which nurses between a provider and patient, professional boundaries include:
and nursing assistants violate professional • personal friendships, • Engaging in behaviors that could
boundaries, how they can identify red • sharing personal or sensitive be considered “flirting”
flags in their practice, strategies they can information with a patient, or becoming overinvolved with
use to evaluate a situation that might lead • entering into a business a patient .
to a boundary violation, and methods relationship with patients (buying a • Showing favoritism or preferential
6 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N G
"Maintaining professional boundaries is essential to
ensure a therapeutic patient relationship and failing
to do so can be a considered conduct derogatory to the
standards of nursing and is a violation of the Oregon
Nurse Practice Act (NPA)."
treatment or spending more • Is the relationship potentially
time than necessary with a harmful in any way to
patient . the patient?
• Keeping secrets with a patient Investigations of potential
or having “inside jokes .” boundary violations and interviews
• Sharing personal or intimate with nurses and nursing assistants
information about yourself . have revealed various motivations
• Speaking negatively about other for conduct that led to boundary
employees or managers . violations, such as feeling sorry for
• Meeting a patient outside of the a patient or empathizing with their
healthcare setting . situation, wanting to help patients,
So, what if a nurse runs into providers experiencing strong
a former patient outside of the personal or intimate feelings toward
healthcare setting and the nurse a patient, or intentionally engaging
and former patient are interested in violations that can lead to personal
in exploring a personal or intimate gain for the nurse or nursing assistant .
relationship? Does maintaining
professional boundaries mean that Be Self-Aware
a nurse can never date or become It is vital that nurses and nursing
friends with a former patient? In assistants are knowledgeable about
this scenario, there are several factors professional boundaries and ensure
that a nurse should consider when that they pay attention to potential red
determining whether a personal flags before they become violations of
relationship with a former patient is the Nurse Practice Act . Additional
appropriate . examples of boundary violations
Those factors include: can be found in the case studies on
• The nature of the nurse-patient page 18 . Nurses and nursing
relationship and type of care assistants must be familiar with the
provided (a one-time treatment reporting requirements of
versus ongoing care for chronic their employer as well as their
illnesses) . responsibilities under the Nurse
• The length of time since the Practice Act . Recognizing red flags
care was provided . and having the courage to report and
• Does the nurse have continued redirect the behavior is essential to
access to the patient’s health the delivery of safe, patient-centered
information, and could that care, and maintaining a professional
information create problems and therapeutic patient relationship .
that can affect the relationship?
SENTINEL VO.41 • NO. 3 • SUMMER 2022 7
NURSING PRACTICE
By OSBN RN/LPN Policy Analyst Gretchen Koch, MSN, RN
DELEGATE OR ASSIGN:
WHAT IS THE DIFFERENCE?
The Board has received reports about it is the process utilized by an RN to related procedure (nursing procedure)
confusion regarding two very separate authorize an unregulated assistive person that the client is unable to perform for
and distinct nursing practice authorities: (UAP) to perform a nursing procedure themselves .
delegation process and assignment . While for their client for which the RN retains Standards for community-based
it is understood that both present as an accountability for the outcome . The RN delegation are in OAR 851-047 and
option for the RN when implementing the licensed practical nurse (LPN) cannot may only be applied by an RN when
plan of care, there is expressed confusion delegate as they are not authorized by the practice occurs in a community-based
related to 1) the practice settings in NPA to do an independent assessment of setting . Pursuant to OAR 851-006-
which either activity many occur, and 2) the client . 37, a community-based setting means
the accountability held by the registered Proper understanding of delegation a setting that does not exist primarily
nurse (RN) who delegates and by the RN process requires one to know the meaning for the purposes of providing nursing
and the LPN who assigns . of the term nursing procedure . Pursuant or medical services, but where nursing
This article presents the two practice to OAR 851-006-101, nursing procedure services could be required intermittently .
authorities, and licensee accountability means a health-related procedure These settings include, but are not limited
for each authority, based on Oregon’s identified within the RN’s plan of care that to, private homes, foster homes, assisted
Nurse Practice Act (NPA) . is commonly taught in nursing education living facilities, schools and twenty-four-
programs and normally performed by the hour residential care facilities; most any
Delegation Process RN or LPN when implementing the plan environment where people live, engage
Delegation process has a specific of care . Delegation process can present in recreational activities, attend school or
meaning in Oregon’s NPA . As defined as an option for the RN when the plan work .
in Oregon Administrative Rule (OAR) of care for their community-based client Conversely, this means that delegation
Chapter 851 Division 006 (851-006-45), includes the performance of a health- process does not occur in the acute care or
8 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N G
ambulatory care setting, or in any health the nursing procedure for the client for a delegates; however, at the end of the day
care facility where nursing care is provided limited period . the UAP is working “under the license” of
24-hours a day seven days a week (such as a In addition to meeting OAR 851-045 the RN .
hospital or nursing facility) . nursing practice responsibilities with
Delegation process requires the RN to their client, the RN who delegates remains Assignment
observe and assess their client’s presenting responsible to provide ongoing assessment The term assign has a specific meaning
situation and arrive at clinical judgments of their client and ongoing observation of in Oregon’s NPA . Pursuant to OAR
specific to: the client’s condition and the UAP’s performance of the procedure 851-006-20, assign means directing
needed frequency for ongoing assessment, on the client at the frequency determined and distributing, within a given work
the nursing procedure, the individual during the delegation process - or more period, the work that each health care
UAP, and the environment of care where frequently if their client’s status changes . team member is already authorized by
the nursing procedure would be performed Note: In any practice role, the RN is license or certification and organizational
by the UAP . The RN who determines that accountable for their actions . The RN position description to perform . Making
their client’s situation meets the conditions who authorizes a UAP’s performance of a prudent assignment requires the RN to
for delegation pursuant to OAR 851-047 a nursing procedure through delegation be knowledgeable of their co-workers’
standards, and who validates the UAP’s process retains accountability for the respective scope of practice authorities,
safe performance of the nursing procedure outcome of that action . Oregon Revised authorized duties, and job responsibilities
by the UAP on the client, holds the Statue 678 .036(3) does provide civil in the practice setting .
authority to authorize the UAP to perform liability protections for the RN who continued on page 10 >>
Now hiring nurses in all areas
Experience a career of excellence in the recreation capital of Montana!
logan.org/careers
SENTINEL VO.41 • NO. 3 • SUMMER 2022 9
NURSING PRACTICE
Get to know your patients,
help them get well, and
see them return to a
meaningful life.
OSHJOBS.COM Check out our competitive
wages and benefits!
Salem
Junction City
Call a recruiter: 503-945-2815 Two campuses, unlimited possibilities
Oregon Department of Corrections
Uniting Talent with Opportunity
• Nurse Practitioners
- Psychiatric/Adult/Family
• Registered Nurses
• Primary Care Physicians & Psychiatrists
Create your future with us!
Apply today
odocjobs.com
odocjobs@doc.oregon.gov
The state offers one of the most comprehensive
benefit packages available anywhere!
SENTINEL VO.41 • NO. 3 • SUMMER 2022 11ADVANCED PRACTICE
By OSBN APRN Practice & Education Policy Analyst Sarah Wickenhagen, DNP, FNP-C, RN
IS IT TIME FOR
OREGON TO EMBRACE
THE APRN NURSE
LICENSURE COMPACT?
Healthcare regulation in the US, since the early 18th century Delaware in August 2021, and most recently Utah in March
has always taken place at the state level . Health care licensing 2022 . New York and Maryland have bills that are not yet enacted .
boards in individual states make decisions about their unique An important distinction about the ARPN compact is that it will
licensing requirements and scope of practice restrictions for only become active when a minimum of seven states adopt the
nursing in order to provide public protection for their citizens . model legislation .
With numerous technological advances and the explosion of It should be stated that the APRN nurse compact is not
telehealth services in response to the pandemic, it is getting without controversy . National and state professional advocacy
increasingly difficult for patients, nursing and regulators to organizations like the American Association of Nurse
use 18th century healthcare regulatory rational in a 21st Practitioners (AANP), the National Association of Pediatric
century reality . Nurse Practitioners (NAPNAP), Nurse Practitioners of Oregon
In many ways, state boundaries in Oregon are more figurative (NPO), and ARNPs United have all stated publicly their concern
than literal particularly in areas like Portland-Vancouver (OR/ about these model rules being a potential step backwards and
WA border) and Ontario-Fruitland (OR/ID border) . So how more restrictive for APRN practice . On the other hand, there
do health regulatory boards across the country provide patient are several other professional organizations—the American
protection and allow for freedom of movement for nurses in a Organization for Nursing Leadership (AONL), the American
healthcare shortage? Telemedicine Association (ATA), and the Alliance for Connected
The National Council of State Boards of Nursing (NCSBN) Care (ACC), amongst others —that feel the compact is the path
responded to this call for action with their multistate licensure forward for the profession and an incredible opportunity to
APRN nurse compact . Basically, the compact would allow an expand access to care in other states where our colleagues are
APRN who holds a multistate license from one of the compact currently restricted in their scope .
states to work in any of the compact states on the same license . So, what is the controversy?
Holding a multistate license is optional; APRNs could choose
to hold only a single state license . But if they hold a multistate Concern 1
license, they could work in any compact state and only pay for The APRN compact requires 2,080 practice hours to be eligible
one license . to participate in a multistate license . This number of hours is a
Separate from the compact for RNs and LPNs, the APRN legislative compromise with stakeholders for those states who do
compact was initially introduced in 2002, revised in 2015, not have independent practice authority for their APRNs . At the
and again updated in 2020 . This model legislation includes time the compact model legislation was agreed upon, those at
eleven individual articles that identify the purpose, general the table felt it a necessary stipulation to get the legislation fully
provisions, application process, coordination, administration, adopted across the country . This is difficult for Oregon APRNs
and rulemaking authority . To date, three states have passed to understand, as we have had no such practice requirement or
this legislation: North Dakota, the first to adopt in April 2021, restrictions here . Of note, Delaware, which recently adopted
12 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N Gthis legislation, additionally introduced a companion bill that So, is it time to consider adoption of the APRN compact
removed the 2080-hour requirement from that state’s statute in in Oregon?
the belief the hour requirement was not necessary . In previous discussions, the Oregon Board of Nursing
has stated that this legislation was not ready for adoption nor
Concern 2 necessary here in Oregon . If professional advocacy organizations
The administration of the compact itself is handled by NCSBN or health systems decide to pursue this path, they would need to
and state licensure board appointees/representatives . Not all introduce a bill to the Oregon Legislature for potential adoption .
state’s licensing boards have administrators who are themselves For more information, please see
APRNs . A potential solution to address this concern, suggested • About the Compact | APRN Compact https://www .
by AANP and NAPNAP, is to appoint APRN consultants to aprncompact .com/about .htm
advise NCSBN administrators . • APRN Compact Licensure (aanp .org)
Concern 3
The multi-state licensee will have only one home state, their References
Mullangi, S., Agrawal, M., & Schulman, K. (2021). The COVID-
state of residence, which is the one claimed for tax purposes . 19 pandemic—An opportune time to update medical
Only the licensing rules of the home state need to be maintained licensing. JAMA Internal Medicine, 181(3), 307–308. https://
to keep a multi-state license . Many states require very specific doi.org/10.1001/jamainternmed.2020.8710
continuing education (CE) to address specific issues in that state . National Council State Boards of Nursing Website.
A multi-state licensee will not be required to complete these 1pager_APRNCompact_2022.pdf
CEs if not required by their home state . This may impact their Kaplan, L. (2021). Should NPs Advocate for the APRN
knowledge, when working somewhere other than their home Compact? The Nurse Practitioner, 46 (10), 14-15.
state, of how a state addresses specific healthcare needs for their NCSBN, Ibid.
population . Ibid.
We’re Growing and Hiring
Medical Staff
Valley View Health Center is one of the fastest growing
community health centers in SW Washington.
We offer the following:
• Sign On Bonus • Loan Forgiveness • Weekdays/Day Shift only
• Career Development
Apply now by sending your resume
to HR@VVHC.org
SENTINEL VO.41 • NO. 3 • SUMMER 2022 13NURSING PRACTICE
By Oregon Center for Nursing Executive Director Jana R. Bitton, MPA
RN WELL-BEING PROJECT
ILLUMINATES NURSING
WORKPLACE NEEDS
A statewide survey conducted by the The survey and infographic make clear
Oregon Center for Nursing (OCN) detailed that even as health experts start retiring the
the workplace interventions that nurses feel word “pandemic” in favor of “endemic,” the
are necessary to improve their mental and strains on the nursing workforce remain as
emotional well-being . severe as ever . Regardless of coronavirus,
Aiding workplaces in developing an overstressed and understaffed nursing
those interventions is the central goal workforce presents a public health concern .
of OCN’s RN Well-Being Project, which “Honestly, if we don’t have the workforce
launched last year and has garnered to care for our patients, then that’s a crisis,”
national attention for the important work Schoenthal emphasized . “We have sick
it’s doing . people that are going to continue to get sick . We have an aging
With assistance from the Oregon State Board of Nursing, population and we have very little staff to care for them . That’s
OCN sent an anonymous online survey to about 80,000 why this is important – so that patients, as they get sick, there
licensed nurses . More than 4,300 RNs completed the survey, will be someone there for them .”
said Rick Allgeyer, research director at OCN .
Some of the initial takeaways were striking, according OCN’s latest infographic can be downloaded
to OCN Program Director Dawne Schoenthal . “There were on the RN Well-Being Project page at
some responses that were uniform, regardless of the setting of www .oregoncenterfornursing .org .
the nurse, and that speaks volumes,” she says . Scan to view
By and large, the infographic reflects nurses’ near-
universal desire for changes to their work environments OCN is a nonprofit organization created by nursing leaders in
to support their well-being, including dedicated paid time 2002. OCN facilitates research and collaboration for Oregon’s
for learning, additional supervisor support, revisions to nursing workforce to support informed, well-prepared, diverse,
policies and procedures, and emotional health resources, and exceptional nursing professionals. Recognized by the
Allgeyer said . Oregon state legislature as a state advisor for nursing workforce
OCN created an infographic, designed to be printed and issues, OCN fulfills its mission through nurse workforce
distributed, with the hope that its messages make it onto the research, building partnerships, and promoting nursing and
desks of decision-makers . healthcare. For more information about OCN, please visit
www.oregoncenterfornursing.org.
14 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N GHOW ARE
OREGON’S NURSES?
The pandemic has impacted the well-being of registered nurses in
Oregon. More than 5,000 nurses responded to the RN Well-Being
Project survey to tell us how they were doing at the start of year.
EMOTIONAL
Fact: FEELINGS SUPPORT
Oregon nurses are not ok. 83%
Stress* AT WORK
YES 33%
Individual accounts and 80%
Frustration
research have shown that our 68%
Anxiety, exhaustion, and burnout
Being overwhelmed and undervalued NO 49%
nursing workforce is under 62%
Being unappreciated
more strain than ever before. 60%
*The highest reports of stress were reported in LTC,
UNSURE 18%
Home Health/Hospice, and Hospital settings.
SYMPTOMS Nurses reporting a
emotional
exhaustion
trouble
WORK-RELATED
STRESSOR 97%
sleeping
Fact:
questioning TOP WORK
Healthcare workers showed career path work-related
dread STRESSORS 1 heavy or increased
workload
about five times higher rate of compassion physical symptoms
uncertainty about when
2
fatigue such as headache,
symptoms than the estimated stomach ache, etc. things will settle down
prevalence of PTSD in the physical
exhaustion 3 burnout
general population.
95:100 Nurses feel their WORK ENVIRONMENTS
can CHANGE to support their well-being.
NURSES NEED… NURSES WANT...
Fact: RNs
32% 30%
It takes years to create More Nurses
a qualified, educated, More
Support Staff
Dedicated paid time to learn More supervisor support
experienced registered nurse. 26% 25%
There is a very real need to More Meaningful
Recognition
protect and retain our current Revisions to policy/procedures Emotional health resources
nursing workforce. Source:
Oregon Center for Nursing. RN Well-Being Mental Health Survey, April 2022.
© 2022 Oregon Center for Nursing
oregoncenterfornursing.org
SENTINEL VO.41 • NO. 3 • SUMMER 2022 15RULEMAKING
By OSBN Executive Director Ruby Jason, MSN, RN, NEA-BC
BOARD VOTES TO
IMPLEMENT NEW PUBLIC
HEARING PROCESS
Oregon Revised Statute (ORS) For the purposes of this article, which testimony may be given regarding
678 .150 (6) (a) authorizes the Oregon OSBN will refer to the nine individuals the proposed draft rules . Per Oregon
State Board of Nursing (OSBN) to appointed by the Governor that Public Meeting Law, before any rule is
exercise general supervision over the comprise the Board of Nursing . Rule approved by the OSBN, the public and
practice of nursing in this state . ORS writing begins with the OSBN voting profession can provide testimony in
678 .442 (1) authorizes the Board to to open specific rules based upon need support of or opposition to the proposed
establish standards for certifying a for revision to current rules, update rule . It is this rule hearing procedure has
nursing assistant (CNA) and discipline rules, or adopt new rules in response recently been revamped by the OSBN .
those CNAs practicing outside those to legislative changes or changes to In the past, rule hearings were held
standards . The method used to define federal laws . The OSBN directs board on Tuesday nights with the nine OSBN
the supervision and standards for those staff to begin work on rules and the members present to hear testimony . The
licensed and certified by the OSBN is rule writing is assigned to specific OSBN would then vote on the draft rules
called “rulemaking .” Statute gives the staff members . Often, a Rule Advisory two days later (Thursday) during a public
OSBN the authority to write the rules all Committee (RAC) is convened through board meeting . For a rule to become
individuals licensed and certified by the a public announcement . Licensees, part of the practice act, the OSBN must
OSBN must follow to continue holding certificate holders, and the public are vote during a public meeting .
a license or certification to practice all eligible to be members of the RAC . As nursing and the influence of
in Oregon . The board staff selects RAC members nursing on public safety has increased,
The legislative statutes and rules based on the requirement of diverse so has the complexity of rulemaking . It
written by the OSBN make up the Oregon membership . The RAC will review draft was clear to the OSBN that thoughtful
Nurse Practice Act (NPA) . The OSBN rules and provide feedback to board consideration of the draft rules and the
primary focus is to assure the public staff regarding their perception if the submitted testimony would require more
that individuals licensed or certified by rule (1) meets the standards of public than two days, particularly if the OSBN
the Board meet the minimum education safety, and (2) does not place barriers to was engaged in an all-day executive
and competency standards . The NPA the practitioners in implementation that session meeting on the intervening
defines for the public and for licensees/ would negatively impact practice . The Wednesday .
certificate holders the rules regarding primary consideration for rule writing The OSBN directed board staff
education, licensure, standards of is public safety, not the profession . to develop a new process . Presented
practice and describes behaviors and Once rule writing is completed, the February 2022, the OSBN voted to adopt
actions that are below the accepted board staff member will present the a new process as follows:
public safety standards . Therefore, “rule proposed draft rules to the OSBN . The 1 . The OSBN directs staff to schedule
writing” is an essential function of the OSBN will vote on either sending the a rulemaking hearing .
Board in communicating the laws of rules back to the RAC for rework, or 2 . The scheduled hearing is posted in
practice for licensees and the public . vote to schedule a public hearing, during a public notice as required by the
16 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N GSecretary of State (SoS) and public months after the rules gov/osbn; on the front-page there is
meeting laws . were adopted . a section entitled “OSBN Proposed
3 . Public notice provides Licensees, certificate holders, and Administrative Rules .” This will provide
instructions and deadlines for members of the public are encouraged information regarding proposed rule
'
those wishing to provide either to participate in the revision, adoption, changes and other information to help
oral or written testimony . and additions to the NPA . Please access you stay informed on the activities of
4 . The board Rule Hearings Officer, the Board’s website at www .oregon . the OSBN .
a member of core values of Sacred Tr
board staff, presides icipation,
over the hearing . The hearing is
eative Vitality and Team rsonalized
RE conducted without the nine OSBN
“
memberscare that
being lies at the heart of o
present .
5 . All written and recorded
testimony is collected and sent Our core values of
Center, a large
OPPORTUNITIES
history and directly to the OSBN members Sacred Trust, Personal
are committed to review no later than one
for their Reverence, Thoughtful
e in the community Evenvote
month before the public though
to San Juan Regional Medical Center
of our employees that has modern technology and a stunning facility Anticipation, Creative
adopt the rule language
ovide the best care,
is held .
designed to serve San Juan County and the Vitality and Team
This vote is usually scheduled
m nursing, support Four Corners for region into the future, it's t
trive to provide
the our in-personcompassionate, and innov •
Thursday of the talented, Accountability enable
in February, who make our ho •
healthy work OSBN meetings heldprofessionals us to provide
ndependence, personalized
April, June, September, November,care
portunities for growth the personalized care
and December . However, the
sional support,
vote can be scheduled for one of
ur compassionate
the virtual
ant's heart, like the meetings held in the
“
that lies at the heart
of our mission.
Careers
of San Juan remaining
Regional months if there is a
better is our deadline
mission. for specific legislative
rule implementation .
6 . If the OSBN, based on testimony,
votes to not adopt the draft at San Juan Regional Medical Center Check out
rules, the OSBN will request our opportunities!
staff to consider how concerns OUR CULTURE
presented during testimony San Juan Regional Medical Center, a large nonprofit hospital in Farmington, NM, has a rich
should be or can be addressed history and reputation of excellence. We are committed to providing the best healthcare in
the community that we serve. We strive to provide our employees with a safe and healthy
based on the premise of public work environment that cultivates independence, teamwork, initiative, and opportunities
safety . If new draft language is for growth through personal and professional support, training, and development. Our
prepared, then the RAC will have compassionate employees come with a servant’s heart, like the many previous generations
of SJRMC. This is why better is our mission.
another opportunity to review the
View our
language prior to being presented OPPORTUNITIES benefits today!
again to the OSBN . Steps one Whether you are a new graduate, an experienced nurse, or looking for a new career path,
through 6 are repeated until the we have a role for you. Ranked 3rd in the nation for best state for nurses to work, we are
committed to giving our employees the best opportunities including:
OSBN votes to adopt the rule
• Robust benefits package
language .
• Career advancement opportunities
7 . Once the rule language is adopted,
• Quality work life balance
the rules are filed with the SoS .
• Continuing education
Rules are not considered effective
until they are posted on the SoS
website, which may come several
Sign On Bonus of up to $21,000 for some positions
-- SAN JUAN REGIONAL
MEDICAL CENTER
SENTINEL VO.41 • NO. 3 • SUMMER 2022 17INVESTIGATIONS
By OSBN Chief Investigator Nakeita West and Investigator Chad Steele
DISCIPLINARY CASE STUDY:
BOUNDARY VIOLATIONS
Although disciplinary action taken by the Board is a matter of public record, the identity of the nurses referenced in this article
will remain confidential.
Case Study #1 had relapsed with alcohol and drugs . was terminated from employment after
This case study involves a complaint The Board found that the RN violated the investigation by the employer .
received by the Board regarding a the Nurse Practice Act (NPA) by engaging The Board opened an investigation into
Registered Nurse (RN) who had in conduct derogatory to the standards the allegations . During the investigation,
befriended a resident of the care facility of nursing by failing to establish and the RN reported meeting the patient at
where she was employed . The complaint maintain professional boundaries with her workplace and beginning a personal
alleged that upon discharge, the resident a client and for practicing nursing when relationship with the patient . The RN
moved into the home of the RN . physical or mental ability to practice is and patient moved in together after
An investigation was opened and impaired . The Board issued a Notice of several months . The investigation found
during an interview with the RN Proposed Revocation . The RN did not that while they were living together, the
conducted by Board staff, the RN request a hearing and a Final Order of patient continued to see their pain doctor
admitted that she became close with the Revocation by Default was issued . All and the RN (who was still employed at
resident, moved the resident into her Final Orders of Revocation require that that time) monthly for prescription refills,
home upon the resident’s discharge and licensees must wait at least 3 years before which included random drug screens to
began receiving rental payments from re-applying for their license . ensure compliance with the patient’s pain
the resident in the amount of $600 per contract . Review of the patient’s medical
month . The RN said that they allowed Case Study #2 records revealed that the RN continued
the resident to live with them because This case study involves a complaint treating the patient and signed off on
the resident has recently lost her husband received by the Board regarding a several of the patient’s rapid drug screen
and the RN felt bad for her . It was also Registered Nurse (RN) who was alleged to results while they were living together
found during the investigation that the have engaged in an intimate relationship and before the employer was aware of the
RN was suffering from substance use with a patient and had forged COVID-19 allegations . The RN refused to discuss
and mental health issues . The RN had vaccine cards . The RN worked at a pain the allegations of fraudulent Covid-19
previously completed probation with the clinic and the employer investigation cards with Board staff .
Board for substance use issues, and the revealed an intimate relationship The RN elected to sign a Stipulated
current investigation revealed the RN between the RN and the patient . The RN Order for Voluntary Surrender of
their RN license for violations of the
Nurse Practice Act related to conduct
derogatory to the standards of nursing by
failing to fully cooperate with the Board’s
investigation and failing to establish or
maintain professional boundaries with a
client . The Board accepted the Voluntary
Surrender which requires the RN wait
three years to re-apply for their license .
18 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N GLooking for
AT FIRST
I WAS EMBARRASSED.
ME, A CAT, LIVING WITH
EXCEPTIONAL NURSES ...
A SINGLE GUY. BUT WHEN Northern Nevada Medical Center offers progressive employee programs including
I WATCH HIM PICK SOMETHING a culture of Service Excellence that honors outstanding employee efforts at
UP WITH HIS HANDS AND EAT IT, every level. We provide a generous benefits/compensation package and tuition
I CAN’T HELP BUT LOVE HIM. reimbursement. You’ll enjoy the innovative approaches to personalized health care
— MARU in our 125-bed acute care hospital located on a scenic hillside over looking the
adopted 01-10-10 Truckee Meadow in Sparks, NV.
For more information and a
tour, please call Leah Webb
at 775-356-4085 or visit
2375 E. Prater Way, Sparks, NV 89434 www.nnmc.com/careers.
Join our team in
Southeast Washington
Enjoy all the benefits of a large health system, working with the best and
brightest in Walla Walla.
Providence St. Mary Medical Center is a regional leader with top technology and
staff. Known for its award-winning wineries, Walla Walla charms with all the
best of a small town—historic homes, public art, shops, restaurants, and more.
Sign-on bonuses up to $20,000 are available!
wamt.providence.jobs
SENTINEL VO.41 • NO. 3 • SUMMER 2022 19NURSING PRACTICE
By OSBN Practice & Evaluation Policy Analyst Gretchen Koch, MSN, RN and
OSBN APRN Practice & Education Policy Analyst Sarah Wickenhagen, DNP, FNP-C, RN
YOU ASK, WE ANSWER
COMMON QUESTIONS REGARDING THE
OREGON NURSE PRACTICE ACT
Q: I would like to know if it is within A: You are! In a community-based care
the scope of practice of the RN in setting, such as a public school, the RN
Oregon to administer propofol either holds the scope of practice authority
through IV push or on a medication to teach the administration of non-
pump in the non-intubated patient for injectable medications to unregulated
the purposes of therapeutic sedation. assistive personnel which would include
These patients would not be in a the administration of prn medications
procedure, would not be intubated, such as rectal Diastat or nasal Versed .
and would be in an ICU setting. I This RN practice authority is codified in
have always understood that the Oregon Administrative Rule Chapter 851
administration of propofol in the Division 045 .
non-intubated patient was outside of
an RN’s scope. Q: I thought there used to be Board
A: It depends . Oregon’s Nurse Practice advisory guidelines that talked about
Act does not contain a one-size-fits-all scope of practice for infusion therapies.
list of activities, interventions or roles I can’t find it, and I want to know if an
authorized for performance by all RNs . LPN can administer intravenous (IV)
The answer must be arrived at by the medications.
individual RN through use of the A: The Oregon State Board of Nursing has
Oregon State Board of Nursing Scope of retired its advisory guidelines on infusion
Practice Decision Making-Framework . therapy . Because an individual nurse’s
This Interpretive Statement provides content and citations specific to the use of engagement in any activity, intervention,
a standardized, decision-making sedation in patient care . or role far exceeds the role, intervention,
framework for all licensed nurses in all or activity alone, nurses are directed
settings with respect to their education, Q: I was recently hired by a school district to access the Board’s Scope-of-Practice
role, function, and accountability and part of my responsibilities include Decision-Making Framework Interpretive
within the scope of nursing practice . teaching district staff/teachers how to Statement . The statement is available on
The Board’s Interpretive Statements administer medications to students. A the OSBN Practice Statements and FAQs
may be accessed via the OSBN Practice few of my students have prn orders for webpage .
Statements and FAQs webpage . It will medications like rectal Diastat and nasal
behoove you to access both the original Versed to be administered in the event Q: If I am following a prescriber’s
Scope of Practice Decision-Making the student experiences prolonged seizure standing order, is my nursing license
Framework and the Interpretive activity. It is my understanding that this protected?
Statement link titled Use of Sedation is something that I have the authority to A: Oregon’s Nurse Practice Act (NPA)
and Anesthetic Agents . The former teach to the staff and teachers. However, makes no expressed “protections” for a
presents the decision-making in talking with another RN who works nurse’s license in any practice situation .
framework; the latter contains the here, she states that she “delegates” these The NPA exists for the protection of the
decision-making framework with types of medications. Who is right? public .
20 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N GThe individual licensed nurse is always Before doing this, I wanted to verify that and boards of nursing exist to protect
accountable for their actions and it is now in our scope to do so. the public, and state government has
responsible for the safety of their client . A: Yes, you are correct NPs, CRNAs jurisdiction only over the “public” located
The legal practice standards on the and CNSs were all added to the list of within their borders (even if they are just
nurse’s responsibilities when accepting recognized “attending providers .” APRNs visiting) .
and implementing any order are located must review patient medical records at the Traveling is a grey area . There are clients
in OAR Chapter 851 Division 045 of the client’s request, complete a physical exam, who are gone for weeks and months at a
NPA . along with a follow up care plan, all of time and that is difficult to navigate for
which need to be document in the patient’s providers and regulatory authorities . In
Q: I am an Oregon-licensed RN and treatment record . To recommend OMMP, the event the client needed a prescription,
want to know if there are any restrictions the APRN must determine if the client’s it is also dependent on state regulations .
on my ability to continue to provide medical condition meets qualifying Many pharmacies will honor prescriptions
telehealth nursing visits for clients who criteria . For complete information please from out of state providers when their
reside in California now that we are no see the OMMP Attending Provider rules, patients are traveling, but some will not .
longer under a public health emergency. located on the Oregon Health Authority Many states are looking for solutions
A: This question can only be answered (OHA) website as it falls under their to address these unique situations that
by the California Board of Registered jurisdiction, which is why it is not listed include telehealth licensing options or
Nursing (CBRN) . The legal jurisdiction on our website . multistate licensure compacts . Please see
over the practice of nursing has always article in this issue (page 12) .
been held by the state where the client/ Q: Do CRNA’s have prescriptive
patient is physically located . authority by default just by having an
It is important to know that during the Oregon CRNA license, or does it have to
nationally declared COVID-19 public be applied for separately?
health emergency, the U .S . Department A: Since 2013, prescriptive authority
of Health & Human Services (HHS) is optional for CRNAs in Oregon per
Centers for Medicare & Medicaid Services regulatory statute . It remains optional
Furtsiunrg e
(CMS) enacted policy changes specific to as not all CRNAs want to independently
The
telehealth provider billing only . The CMS prescribe medications . If you would like
policy changes did not annul any state- to obtain prescriptive privileges, you
based health practitioner licensure laws . will need to complete the CRNA-PP
While virtually all states enacted laws application available on our website .
or policies to expedite the practice of Additionally, you will need to review the
of Nu
Starts Here
qualified out-of-state health practitioners OSBN APRN Prescriptive and Dispensing
with their citizens, each state’s actions Authority presentation on the OSBN
occurred based on their own laws and website and print out your certificate as
rules meaning the requirements put in part of the application .
place by each state differed . Per the CBRN USD Nursing offers multiple online
website, California’s Emergency Medical Q: May APRNs provide advice/care options for you to stay local, but go
Services Authority’s out of state medical to Oregon patients who are traveling far. Check out our online RN to
personnel authorization approvals ended outside Oregon or the United States? BSN, MSN and DNP options.
on June 30, 2022 . A: The Nurse Practice Act is silent on this
issue . The jurisdiction over practice is
Q: Regarding House Bill 3369. Effective determined by the state where the patient
Jan 2022. The new OMMP form, and is located . Telehealth and telemedicine fall
their website, imply that NP’s can now under the same licensure rules in every
recommend medical marijuana and sign jurisdiction, meaning that you must be
the form. However, I do not see anything licensed in the state where the patient is
on the OSBN website regarding this. located . The legal reason is that licensing nursing@usd.edu • usd.edu/nursing
SENTINEL VO.41 • NO. 3 • SUMMER 2022 21NURSING PRACTICE
By Guest Authors Deb Fell-Carlson, BSN, RN, MSPH and
Marcy Shanks, MSN, RN, MSEd, from Faith Community Health Network
FAITH COMMUNITY NURSING–
IS IT RIGHT FOR YOU?
Are you a Registered Nurse (RN) setting with a focus on intentional care nursing expertise directly to the people in
feeling a nudge to use your nursing of the spirit . The Robert Wood Johnson their community where it is so desperately
expertise in service to your faith Foundation says it well; Faith Community needed to improve healthcare access,
community? Have you heard about Faith Nursing is listed as one of their “What equity, and literacy . This could be in the
Community Nursing and are curious works for health” strategies: form of health education or coaching,
about this little-known practice specialty? “Faith community nurses (FCNs) are advocacy, counseling, health navigation,
Are you familiar with Faith Community registered nurses positioned within a or spiritual support . FCNs might
Nursing and are seeking information on faith community or working in a health also come alongside faith community
how you can become a Faith Community care system and serving as a liaison to leadership to provide spiritual support
Nurse (FCN) in Oregon? congregations . FCNs focus largely on and the gift of presence to hospitalized and
health promotion, managing chronic homebound faith community members .
Faith Community Nursing as disease, and injury prevention, but also FCNs often serve as health advisors to
a Community Health Improvement often function as health counselors, patient faith community leaders, a role which
Strategy navigators, and advocates . FCNs support has emerged as essential in recent years,
A Faith Community Nurse is not the physical, psychological, and spiritual especially in large congregations .
simply an RN who happens to be a well-being of their patients . FCNs, also
member of a faith community . Faith known as parish or congregational Nursing Process is Fundamental to
Community Nursing, sometimes called nurses, are usually members of the faith Faith Community Nursing
Congregational Nursing or Parish communities they serve; FCNs may also As with any nursing practice, the
Nursing, is a growing nursing practice provide care to patients from the broader nursing process is fundamental to faith
specialty recognized by the American community . Faith community nursing community nursing practice . FCNs may
Nurses Association (ANA) and defined is common in Christian denominations, engage with individuals in their faith
by the ANA Faith Community Nursing though FCNs also support temples, community, but most often they are
Scope and Standards of Practice . Faith synagogues, mosques, and faith-based applying the nursing process steps to
Community Nursing emphasizes a holistic community agencies .” the faith community as a population; in
approach to nursing in a faith community Faith Community Nursing brings essence, the faith community becomes the
22 VO.41 • NO.3 • SUMMER 2022 O RE GO N S T A T E BO A RD O F N U R SI N GYou can also read
