2 • Colorado Nurse | May 2018 The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association CNA President continued from page 1 A violation of the NPA is serious and can result in a complaint being filed with the BON. Some examples of violations of NPA are negligence, impaired practice by drugs or alcohol or a mental health condition, stealing from a patient/client, including medications, providing treatment or care that should be provided only by a physician or APRN, falsifying records, boundary issues, including abusing a patient physically or sexually and involvement in criminal conduct. This is not an exclusive list. The BON utilizes its authority to decide whether misconduct or safe practice has occurred and what action should be taken. Violations are taken very seriously since they can put patients at risk. This is why every nurse is responsible for understanding his/her scope of practice and other requirements outlined in the law. Nurse Practice acts in each state are laws that define relationships of the nurse and “scope of practice.” The range of activities and services as well as the qualifications for practice. The acts are intended to protect patients from harm as a result of unsafe or incompetent practice, or unqualified nurses. When was the last time you read your NPA? I’m guessing you were given a copy of the Act when you started nursing school. Be honest now, did you ever read it? I would guess that most of you did not see a need. After all, it’s not like it’s particularly fun or easy to read all that legal jargon. There are 127 pages of rules and regulations attached to the Nurse Practice Act in Colorado. But the truth is, if you are going to be successful as a nurse, (and one that others look to as an example) you’ll need to know what is your NPA. Did you know that there are now two states that requires jurisprudence examinations prior to licensure? That’s at least one way to get people to read and understand their Nurse Practice Act. Wondering if you live in one of the two states? See the answer below! Come Join our Amazing Team! Great Benefits! Now Hiring Full Time RNs & LPNs & CNAs Apply @ careers-junipercommunities.icims.com CALL US @ 303-458-1112 (Ask for Kristen) In addition to Scope of Practice, a NPA details information about licensure requirements, including initial licensures, renewing or reestablishment of licenses. Most nursing students and some nurses are surprised to learn the purpose of the NPA is to protect the public. So, compassion and knowledge go hand in hand. If you think about it, if someone calls him or herself a nurse, then she/he would have the education and training required to perform the requirement associated with being “a nurse.” To shine on the job, it’s critical to know how to prevent and navigate disciplinary issues. And, this gets significant attention in any NPA. • Grounds for discipline – Did you know that forgetting to renew your license on time or defaulting on a student loan are grounds for discipline? • Investigating a complaint filed against a nurse. Did you know that anyone can file a complaint against a nurse? • Board hearing process – Did you know that a nurse who is the subject of a complaint is provided the opportunity for due process (which is guaranteed by the U.S. Constitution? The first person who said, “ignorance is bliss” was probably not a nurse because not knowing information in your Nurse Practice Act can result in disciplinarian action against your license, ranging from reprimand to suspension, or even revocation. So, are you ready to read your NPA? Don’t know how to find your NPA? Of course, you can locate at the Colorado Department of Regulatory Affairs website under Nursing (https://www.colorado.gov/dora). Another way is to go to the National Council of State Boards of Nursing (NCSBN) site (https://www.ncsbn.org/npa.htm) which has a map with contact information (LINK) for every Board of Nursing (BON); use the BON website to locate your Nurse Practice Act and to find information about Colorado’s. Your scope of practice is governed by the state in which your patient lives, if you do telehealth. Answer to question in first paragraph: Texas and Kentucky law now require taking (and passing) a nurse jurisprudence examination prior to licensure. Nurses in Colorado are among the best in the country and work hard to practice safely and competently. Your BON is working diligently to support nurses in this effort. The next Colorado Nurse will talk about the upcoming Sunset Review of the NPA. COLORADO NURSE (ISSN-8750-846X) is published 4 times annually, February, May, August, and November, by the Arthur L. Davis Publishing Agency, Inc. for the Colorado Nurses Foundation, 2851 South Parker Rd, Ste 1210, Aurora, CO 80014; Mailing: P.O. Box 3406, Englewood, CO 80155-3406. Subscription may be purchased for per year, /2 years, per year for foreign addresses. For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, firstname.lastname@example.org. CNF and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement. Acceptance of advertising does not imply endorsement or approval by the Colorado Nurses Foundation of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. CNF and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of CNF or those of the national or local associations. Colorado Nurses Foundation wants to hear from you and welcomes letter to the editors. Correspondence may be sent to Colorado Nurses Foundation, 2851 South Parker Rd, Ste 1210, Aurora, CO 80014; Mailing: P.O. Box 3406, Englewood, CO 80155-3406; email, info@ coloradonursesfoundation.com. To submit an article for publication, please consider the following guidelines. 1. Topic is current and relevant to RN practice. 2. 500 word limit 3. Individuals may submit articles for consideration by emailing http://www.coloradonurses.org/publication/. Material is copyrighted 2015 by the Colorado Nurses Foundation and may not be reprinted without written permission from CNF. Co-Editors: Eve Hoygaard, MS, RN, WHNP (30) M. Colleen Casper, RN, MS, DNP (16) CNA Executive Director: Colleen Casper, RN, MS, DNP COLORADO NURSES FOUNDATION EXECUTIVE COMMITTEE President: Sara Jarrett Vice President: Margaret Mulhall Secretary: Carol O’Meara Treasurer: Carol Brookshire BOARD MEMBERS Lola Fehr, Eve Hoygaard, Judith Burke, Linda Satkowiak, Norma Tubman COLORADO NURSES ASSOCIATION EXECUTIVE COMMITTEE President: Donna Strickland (31) Vice President: Susan Moyer (20) President-Elect: Secretary: Carol O’Meara (30) Treasurer: Linda Stroup (20) BOARD OF DIRECTORS Region I Director: Region I Director: Laura Rosenthal (30) Kathy Shaw (30) Region II Director: Region II Director: Hilary St. John (3) Lori Rae Hamilton (4) Region III Director: Region III Director: Sandie Nadelson Mary Ciambelli (31) Director-At-Large: Director-At-Large: Ingrid Johnson (16) Jody DeStigter (9) SIG #2: DNA #3: DNA #4: DNA #5: DNA #6: DNA #7: DNA #9: New Graduate Director: Adam Diesi (16) DNA PRESIDENTS Colleen Casper (Liaison) Anne Zobec, Colorado Springs Kathryn Carpenter, Model, CO Contact Sandi Nadelson at email@example.com Charlotte LeDonne, Alamosa, CO Contact Colleen Casper at firstname.lastname@example.org for additional information DNA #12: Contact Colleen Casper at email@example.com for additional information DNA #16: Christine Schmidt, Denver, CO DNA #20: Annette Cannon, Lakewood, CO DNA #23: Contact Colleen Casper at firstname.lastname@example.org for additional information SIG #30: SIG #31: Afton Williamson, Denver, CO Karen Lyda, DNP, PMHNP, RN To contact any person listed above, please use the CNA/CNF office numbers/address/email address. CNA Contact Information: Ph: 720-457-1194 • Fax: 303-200-7099 Email: email@example.com CNF Contact Information: Ph: 720-457-1004 Email: firstname.lastname@example.org www.coloradonurses.org
The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association May 2018 | Colorado Nurse • 3 Executive Director's Column Story of Advocacy in Action Colleen Casper, DNP, RN, MS At the 2017 Annual DNA 16 Sponsored Legislative Dinner, Colorado State Senator Irene Aguilar (District 32) announced an interest in talking with any RN’s who are willing to work with her on nursing workforce and staffing issues in critical care. Senator Aguilar shared that constituents of hers had brought to her concerns of critical care nurses not having enough staff to consistently deliver the surveillance and interventions required for safe patient care. In follow up, in May of 2017, myself as Executive Director of Colorado Nurses Association (CNA) and as a previous critical care nurse and hospital administrator, partnered with a current critical care RN member of CNA, and the CNA lobbyist Gil Romero to meet with Senator Aguilar. What followed was a yearlong series of meetings with the above-mentioned individuals along with representatives from Colorado Hospital Association (CHA) and the Colorado Department of Public Health and Environment (CDPHE). CHA represents Colorado hospitals and health care systems, and CDPHE licenses facilities that provide acute, long term, assisted living, and home based care. Initially, we explored the potential of a legislative approach, i.e. a nurse-staffing bill. We were cognizant of many factors that could influence the success of that effort. Some of those included known workforce shortages, particularly in rural areas, and, Colorado’s history of resisting mandated nurse:patient ratios, including a stakeholder based process in the 2008 Legislative session. Those efforts resulted in a pilot study to understand how hospital based RN providers define “involvement in staffing decisions” and the correlation of that process with patient and staff outcomes (Houser, et al, 2012, JONA, 42:7/8,pp375-382). We determined that this was not a good time for a successful Colorado legislative bill regarding staffing. Yet, we persisted. CNA recognizes that nurse staffing is not a one size fits all. We also recognize the critical role RN’s play in assuring effective monitoring and early detection of real or potential complications, as well as timely coordination of essential care provided at the bedside (critical care, home care, nursing home care, medical surgical care). For many years, we have said there is not enough evidence to support mandating nurse staffing and now we know better. We know that patient morbidity, mortality, and hospital economic success is dependent on competent and adequate RN staffing. CNA is interested in assuring that the conversation of safe staffing in Colorado remains current and includes RN’s who are closest to the patient as well as administrative and regulatory leaders. As we reviewed the key wins from the 2008 efforts, we were reminded of the legislative mandate (SB08- 196) for the Hospital Quality Report Card that was to include standardized reporting of nationally recognized Nurse Sensitive Indicators. (See article in this issue by Elizabeth Adle) We knew we needed useful data to support meaningful conversation and solutions. Recently, CNA, CHA, and CDPHE met at the Colorado State Capitol with Senator Aguilar to discuss the possibility of care providers of all disciplines being able to report “near misses” in care delivery related to quality and safe staffing. We had a shared knowledge of the CDPHE “complaint line.” Our discussion highlighted that, in fact, there is currently a method to confidentially report staffing, or any work environment, related concerns that put patients at risk. CDPHE leadership recommended that we collaborate on a strong and formal communication of the available existing systems. Further, CDPHE shared their plan to then report those complaint trends annually to the CDPHE governing board, the Colorado Board of Health. CNA would like to thank Senator Aguilar, CHA staff Gail Finely, CDPHE staff Randy Kuykendahl and Larry Wolk, MD, MSPH, and Gil Romero in advising, supporting and advancing this conversation. Where we started in this process is different from where we ended, not uncommon in the world of policy and politics. The outcomes achieved are the result of persistent and collaborative efforts to work towards a solution. We insisted on achieving a change that was focused on patient safety and would support increasing awareness and action for responsible RN staffing. Please watch for more detailed communication from the Colorado Department of Public Health and Environment regarding the utilization of the “near miss” reporting line. In the event you want to make a report, please do so at this link: https://www.colorado.gov/pacific/cdphe/ health-facilities-complaints. CNF President continued from page 1 As the profession looks to its future, I would like to offer the following points for consideration. First, we should consider the focus and mission of organizations to include advocacy and professional citizenship, clinical practice and certification, education and accreditation, and workforce issues. Second, how do we best engage members of the profession for involvement and work in multiple geographic areas: international, national, state and local? Third, the economics related to professional organizations – the cost of membership for individuals and the expense to run a viable organization. Fourth, the profession and its groups must also consider how to best use social media in any re-organizational activities. Additional information of significance is to Join Our Experienced, CLOSE-KNIT TEAM! acknowledge the sheer size of this profession in the US – over 3 million. (Most of the other health professions in the US are below the one million mark.) The questions now before us include: How and where do we start? What should be the process? Who should provide a plan? How do we best communicate to the entire community of nurses in the US? There are a lot of dots to be connected…I hope that we (the profession) can find our way through the maze of complexity to some new and updated approaches to this topic. 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