Page 8 • DNA Reporter May, June, July 2018 Delaware Legislative Involvement and Priorities Gary W. Alderson, RN, Esq. See Guest Editor for complete bio on page 1 This article is a call to political action for all nurses. There are so many critical issues to address in our nation and state, thus it has never been more important for nurses to step up and speak out as the voices of reason, credibility and civility for the good of our profession, patients, and clients. According to the Gallup Poll results on honesty and ethics survey for 15 years running, the public considers nurses members of the most trusted profession (American Nurses Association [ANA], 2017a). In fact, the ANA stated that when nurses speak, politicians in Washington listen. However, so many issues that directly affect nurses originate at the state level. Thus, it is imperative that when Delaware nurses speak – with a unified voice – legislators listen. The Delaware Nurses Association (DNA) provides that single voice for the almost 8,000 registered nurses licensed in our state. Nurses must be heard whenever new statutes or regulations, or changes to existing statutes or regulations affecting our profession are conceived, debated, passed, and implemented. Nurses must be involved in the oversight of these regulations or Gary W. Alderson Attorney At Law, Registered Nurse Malpractice Defense & Board Complaint Defense Personal Injury, Wills, Guardianships, General Litigation Elzufon Austin & Mondell, P.A. 300 Delaware Ave., Suite 1700 | Wilmington, DE 19801 302-504-3231 | GALDERSON@ELZUFON.COM Cape Henlopen School District Lewes, Delaware Vacancies Nurse Substitutes Must complete online application at: http://www.applitrack.com/chsd/onlineapp/ Contact: Office of Human Resources (302) 645-6686 A satisfactory criminal background check, DE child protection registry check, health exam, and TB test are required for all new employees. EOE statutes in order to initiate change in those laws and regulations when necessary. It is important, however, that nurses’ influence is not diluted, and for that reason, efforts should be focused on just a few key issues for maximum impact. Therefore, I have identified two issues to discuss for the current session of the Delaware legislature; first, to amend the Nurse Practice Act to remove “permanently revoke;” and second, to clarify the criminal law for assaulting a nurse. Delaware regulates 41 professions and occupations, ranging from physicians and nurses to adult entertainment operators (Del. Code Ann., Title 24 (2018)). All but one of those regulated vocations address license revocation, but only one – nursing – has permanent revocation as its sole option for revocation. The Board of Nursing and the Superior Court interpret this statutory language to mean that regardless of future circumstances, including a pardon from the Governor, a nurse whose license was once revoked can never again hold a license. That interpretation is currently on appeal to the Delaware Supreme Court. Regardless, the law must be changed to clarify that it was never the intent of our legislature to treat nurses differently from other professions and vocations. The statutes for the other 15 regulated “healing arts” vocations and professions use only the word “revoke;” meaning that the Boards for those other 15 vocations have a degree of latitude and discretion not given to our Board of Nursing (Del. Code Ann., Title 24, §§ 516(a)(5), 711(e) (6), 1129(a)(5), 1735(a), 2017(e), 2115(a)(7), 2516(a)(5), 2616(a)(9), 3011(d), 3516(a)(7), 3716(a)(7), 3811(b)(6), 3916(f), 5218(a)(5), and 5315(f). (2018)). The Board of Nursing is a highly dedicated group of professional and lay members who take their responsibility to protect the public very seriously. Removal of the word “permanently” before “revoke” in the statute would give the Board the same discretion afforded their peers on those other boards to view an applicant seeking reversal of revocation on her or his individual merits on a case-by-case basis. The unspeakable depravity of former Lewes pediatrician Earl Bradley a few years ago created a horrible situation. In response, Delaware now has a provision in all healthcare practice acts (except for pharmacists, dieticians, nutritionists, and nursing home administrators) for mandatory and permanent license revocation for any licensee convicted of a felony sexual offense (Del. Code Ann., Title 24 §§516(a)(7), 711(e)(7), 1129(a)(8), 1731(a), 2017(e), 2115(a)(7), 2616(a)(9), 3011(d), 3716(a)(7), 3916(f), and 5315(f)(2108)). That provision was also added to the Nurse Practice Act (Del. Code Ann., Title 24 § 1922(a) (2018)), and would not be affected by removing the word “permanent” from the statute elsewhere. Enactment of the “Bradley provision” provided the perfect opportunity for “permanent” revocation to be amended to simple revocation, but nursing was not at the table to make that request. Nurses and DNA in particular, should be vigilant to never again allow such an opportunity for positive change to the laws affecting nurses to pass us by. The second issue for the DNA to address with the legislature is clarification of the laws regarding assault upon a nurse. According to Campbell (2017), there has been a 110% increase in the number of violent incidents reported against healthcare workers in the past decade. According to the ANA (2017b), one in four nurses was assaulted at work, and the likelihood of healthcare workers being exposed to violence is higher than for prison guards or police officers. Currently, one who assaults an EMT, LPN, RN, paramedic, or physician in Delaware while such person is performing “a work-related duty” is guilty of a class D felony, whereas, if the assault were “while such person is rendering emergency care,” the assailant would be guilty of a class B felony (Del. Code Ann., Title 11 §§612(a)(4), 613(a)(6)(2018)). The differences between those felony classes is the sentencing. The sentence for assaulting a nurse who is “on-duty” (class D felony) is from zero to eight years of incarceration in state prison. Whereas, the sentence for assaulting that same nurse who is “rendering emergency care” (class B felony) is “not less than two years up to 25 years” of incarceration (Del. Code Ann., Title 11 §§4205(b)(4), (2)(2018)). A reasonable interpretation of “rendering emergency care,” which is presently codified as a higherlevel felony than assault upon the same nurse in a clinical or occupational setting, means outside one of those settings, such as in a bystander or Good Samaritan role. The law should reflect that assault upon a nurse, in any setting, is a very serious offense. Thus, any assault upon a nurse should be codified as a serious class B felony and punished accordingly. DNA intends to work hard towards passage of these two legislative changes and welcomes – and needs – the involvement of all nurses in the political and legislative process right here in Delaware. References: American Nurses Association (2017a). ANA Homepage. Retrieved from: http://ana.aristotle.com/sitepages/ homepage.aspx American Nurses Association (2017b). Stop the abuse: Take the pledge. Retrieved from: http://p2a.co/DQPJlDH Campbell, Alexia Fernandez (2017). Why violence against Nurses has spiked in the last decade. The Atlantic. Retrieved from: https://www.theatlantic.com/business/ archive/2016/12/violence-against-nurses/509309/
May, June, July 2018 DNA Reporter • Page 9 Continuing Education Q & A Question: How should the joint providership be advertised on the website of the joint provider? Answer: The name of the Individual Activity applicant as the PROVIDER should be displayed on the website of the joint provider when advertising the activity. It should be very clear who is providing the activity and awarding the contact hours. Question: Are broad yes/no questions acceptable learner outcome and professional improvement measures? Examples of yes/no evaluation questions: • Do you feel you can achieve the learner outcomes stated in the activity? • Do you feel participating in this activity will improve your performance in your profession? What makes life worth living? How do we cope with serious illness? Nurses have a unique perspective on these questions. In touch with life, death, pain, and joy on a daily basis; nurses experience the most intense extremes of our existence and yet – they continue to devote their lives to providing dignity to anyone in need of care. With the support of the American Nurses Foundation, award-winning filmmaker Carolyn Jones has brought these insights to life in ‘Defining HOPE,’ a feature-length documentary that tells the story of patients with life-threatening illnesses, and the nurses who share their journey. Defining HOPE Month, with a special showing in Washington, D.C., on November 2. To fully showcase the nursing excellence in the documentary, the Foundation has invested in educational resources to accompany the work. Our study guide highlights 16 brief vignettes, covering a range of topics, and profound talking points. Explore the guide with your clinician(s) or students, to promote vital dialogue on how nurses can work together and continue to keep hope alive. Through the film and the use of the American Nurses Foundation’s guide, viewers will be able to: 1. Discuss key factors that affect patient and family decision making about end-of-life care. Answer: This method of assessment is considered acceptable to meet ANCC criteria so long as the question being asked is written in measurable terms, the level of educational need is evaluated, and the professional practice gaps are identified. When asking yes/no questions, hold the learner accountable to improve, change and/or enhance their practice based on the stated outcomes related to the professional practice gap that was identified. The yes/no questions need to be action oriented and the learner outcomes must be achievable. It may be beneficial to expand the question and ask, ‘if yes, why’ or ‘if no, why’. This type of evaluation may provide more detailed information than simply asking yes/no. Individual Educational Activity Applicants may have evaluation templates/forms that takes a ‘one size fits all approach’ for all activities. This will not work. The Nurse Planner should develop individualized evaluations that meet the needs of each activity. Question: What data are Approved Providers required to enter into the ANCC NARS system to open or close an activity? Answer: The following fields are required to establish or ‘open’ an activity in NARS: • Activity Type (e.g. course, Regularly Scheduled Series (RSS), Enduring Materials, etc.) • Activity Title • Activity Date The significance of hope The Foundation has supported the documentary to raise public awareness on the impact of nursing; and the light that nurses can bring to the darkest of times. Through exploring what matters most at the fragile junctures in life, the film follows patients making choices about how they want to live, how much medical technology they can accept, what they hope for – and how that hope evolves when life is threatened. Learn from the movie The feature was released on November 1, 2017, in honor of National Hospice and Palliative Care 2. Differentiate between hospice and palliative care. 3. Compare and contrast the terms sympathy and empathy. 4. Discuss internal conflicts that people may encounter when making decisions about whether to pursue aggressive treatment for life threatening illnesses. 5. Describe the role of the nurse in palliative care/hospice settings. 6. Discuss how family members play a significant role in decision making surrounding care choices. For additional information, visit https://www. nursingworld.org/foundation/programs/defining-hope • Activity Location (Courses and RSS only) • Reporting Year The following fields are required to complete or ‘close’ an activity in NARS: • Providership (Direct or Joint) • Hours of Instruction • Designed to change (competence, performance, or patient outcomes) • Changes in (competence, performance, or patient outcomes) evaluated • Number of nurses who participated in the activity • Number of other learners who participated in the activity • Commercial support received (Y/N) • If yes, total monetary of commercial support received and/or nature of in-kind commercial support received • Competencies addressed • Name(s) of Joint Providers, if applicable • Name(s) of commercial supporter(s) and monetary amount/nature of in-kind support received from each supporter • Number of contact hours awarded Why are Nurses Suing the EPA? How is it that our shampoo can contain carcinogens and our floor cleaner reproductive toxicants? For over a decade nurses have been working with a wide range of partners, including other health professionals, environmentalists, and health-affected groups, to up-date the nation’s chemical safety policy. Written in 1976, the Toxic Substance Control Act was an ineffectual safety net for people and the environment from exposures to toxic chemicals in our air, water, food, and products. It did not require companies to do any sort of pre-market testing of their products for toxicity or potential harm. Worse, it established that any chemicals that were already in the market place (some 80,000 chemicals) were “generally regarded as safe” without any evidence about their safety or harm to confirm this assumption. This was a way in which to “grandfather” a host of toxic chemicals and thus protect them from new requirements for safety testing. Additionally, the burden of proof regarding toxicity was the responsibility of the public and the Environmental Protection Agency, rather than requiring manufacturers to prove that a chemical or product is safe before letting us use the product in our homes, schools, or workplaces. In every instant in which the EPA tried to prove that a chemical was dangerous, the industry prevailed in keeping it on the market. An example of the challenges under the original law, the EPA could not even ban asbestos – a know carcinogen with unquestionable evidence of harm. In 2016, after making significant and debilitating compromises, we (nurses and others) helped to usher in a new chemical law, passed by a Republican Congress and signed by President Obama that replaced the 1976 law. The biggest and most important compromise of the new federal law is the fact that it pre-empts states from passing chemical safety laws that are more effective than the new federal law once a chemical is under review by the EPA. Historically, we have looked to progressive states to pass legislation on health and safety before federal laws have made their way through Congress and to the President. This exception flies in the face of Republican calls for increasing state’s rights over federal mandates. Instead, we now have states incapacitated from further protecting their citizens from toxic chemicals, even if their citizens overwhelmingly want the added protection. Another problematic issue with the new chemical safety law is the time line that was created for reviewing potentially, and often known, toxic chemicals. Only 10 new chemicals are required to be reviewed in the first year and then by 2019 twenty chemicals need to be under review at any given time. The Registry for Toxic Effects of Chemicals includes over 150,000 chemicals for which there is Why are Nurses Suing the EPA? continued on page 10
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