Page 6 • RN Idaho May, June, July 2018 Idaho Board of Nursing Update Sandra Evans, M.A.Ed., RN, Executive Director Sandra.Evans@ibn.idaho.gov By the time you read this “Update from the Board of Nursing,” the Second Regular Session of the 64th Idaho Legislature will very likely have adjourned “sine die” (Latin for “without day,” or “without a fixed day for further meeting or action.”) The Board’s pending rules, having been approved by the Legislature early in the Session, will become final on adjournment. These adopted changes to the Administrative Rules serve to clarify processes for enrollment in the Program for Recovering Nurses (PRN) and requirements for nursing program faculty and administrators—changes necessary to keep nursing regulation in Idaho relevant and responsive to changes in nursing regulation. The Administrative Rules of the Idaho Board undergo some form of revision nearly every year, for example: • In 2017, rule revisions 1) allowed for MD and PA preceptors for APRN students, thereby expanding clinical opportunities; and 2) authorized the use of electronic addresses for purposes of Board communication with licensees; • In 2016, rule revisions 1) implemented the requirement for demonstrated continued professional development for LPN and RN license renewal beginning with the 2018 LPN renewal; and 2) amended requirements for RNs practicing in a specialty area; • In 2015, rule revisions clarified what constitutes sexual misconduct as grounds for disciplinary action against a nurse’s license; • In 2014, rule revisions 1) provided for interfaces other than delegation in which licensed nurses engage; e.g. teaching, guiding, consulting, advising; and 2) deleting the list of specific tasks that should not be delegated by a licensed nurse to unlicensed assistive personnel; • In 2013, rule revisions amended the titles and abbreviations for registered nurses (formerly “licensed professional nurse” abbreviated “RN”) and advanced practice registered nurses (formerly “advanced practice professional nurse” abbreviated “APPN”) for full alignment with the national Consensus Model for APRN Regulation. In addition to reviewing/revising its rules, the Board of Nursing continually assesses the relevance of Idaho’s nursing laws to assure they remain responsive to emerging trends and changes in the regulatory environment. In fact, since its creation in 1911, the Idaho Nursing Practice Act (NPA) has been amended no less than 30 separate times. At the writing of this “Update,” it’s too early to know if the Board’s 2018 proposed changes to the Nursing Practice Act will have been adopted by the Legislature. However, if so, criteria for RN members of the Board will have been amended to be more consistent with those for LPNs and APRNs—specifically, all licensed nurse candidates must be US and Idaho citizens, must live in and be licensed in Idaho, and be actively practicing nursing in Idaho at the time of appointment to the Board. Recent significant changes to the Idaho Nursing Practice Act include: • Revision of the definition of “Practice of Nursing” in 2016 to clarify that practice occurs at the location of the recipient of services and includes “a broad continuum of services delivered in healthcare and non-healthcare environments for remuneration or as volunteer service,” • Adoption of the “enhanced” Nurse Licensure Compact and APRN Compact in 2016 to be implemented when the respective thresholds are met (NOTE: the Nurse Licensure Compact [NLC] was implemented on 1/19/2018, replacing its predecessor NLC); • Granting the Board authority in 2013 to share investigative information with other regulatory boards and law enforcement; and • Granting the Board authority in 2012 to 1) administer an alternative to discipline for practice remediation and 2) use dedicated funds to support workforce–related initiatives. Although the outcome is not yet known for 2018 legislation that might impact the Board, including bills introduced by the Board as well as bills introduced by others, one thing is certain...in Idaho, change is inevitable. Consistent with its “Philosophy of Governance,” the Board strives to initiate change that most effectively upholds its Mission of public protection and ensures major decisions and day-to-day activities are guided by core values and beliefs. In a nutshell, the Idaho Board continually pursues innovation and best practices in nursing regulation. In concert with each annual legislative session, the nine appointed members of the Idaho Board of Nursing meet at least quarterly for the conduct of regular business. Current Board members include Vicki Allen, RN, Pocatello, Chair; Carrie Nutsch, LPN, Jerome, Vice Chair; Jennifer Hines- Josephson, RN, Rathdrum; Whitney Hunter, Consumer, Boise; Jan Moseley, RN, Coeur d’Alene; Rebecca Reese, LPN, Post Falls; Clay Sanders, APRN, CRNA, Boise; Merrilee Stevenson, RN, Wendell; and Reneé Watson, RN, Boise. Business of the Board centers around responsibilities related to licensure, practice, education, discipline and alternatives to discipline, communication, governance and organization. At their meeting on January 18-19, 2018, Board members: • Reviewed correspondence and reports of external meetings attended by both members and staff; • Adopted proposed revisions to existing Board policies related to the Board’s Code of Ethics and Conduct, and requirements for a U.S. Social Security Number and declared primary state of residence by applicant’s for Idaho nurse licensure; • Took action to recognize APRN national certifying organizations that meet criteria as defined by the National Council of State Boards of Nursing for purposes of APRN certification related to role and population focus, a requirement for APRN licensure in Idaho; • Accepted reports and recommendations from the Board’s APRN and PRN Advisory Committees; • Finalized plans for the 2018 Board Business Retreat to be held May 18th in Boise; and • Took action to: • Revoke an LPN license for violations of standards of practice and conduct; • Deny a petition for early release from monitoring through the Program for Recovering Nurses (PRN); • Authorize continuation in the PRN under original terms and conditions with a “reset” of the 5-year period of monitoring for a nurse following a single incident of non-compliance; and • Fully reinstate a previously disciplined LPN license having determined the applicant’s successful completion of requirements for reinstatement defined in the original discipline order. The Board wishes to encourage nurses to complete a brief, anonymous on-line survey accessible on the Board’s website at https://ibn.idaho.gov/IBNPortal/ before May 1, 2018 to assist the Board in complying with Lieutenant Governor Brad Little’s Executive Order No. 2017-06, requiring a review of Idaho’s occupational licensing requirements (available at https://www.ibsp.idaho.gov/ EO%202017-06.pdf). Results of the survey will be reported in the aggregate as part of the Board’s report to Lieutenant Governor Little this coming spring. As always, the Board invites the public to attend scheduled Board meetings and participate in the Open Forum held on the second day of each meeting. The Open Forum provides the opportunity to dialogue with the Board on issues of interest that are not necessarily included on the published agenda. The Board will not take action on issues introduced during the Forum, but may choose to address them at a later scheduled Board meeting. The next meetings of the Board are tentatively scheduled for July 26-27 and November 1-2, 2018 in Boise at a location to be determined. For further information, visit the Board’s website or contact the Board office at 208.577.2476.
May, June, July 2018 RN Idaho • Page 7 IALN Update Ominous Future for the Idaho Nursing Workforce Randall Hudspeth, PhD, APRN-CNP, FRE, FAANP Executive Director, IALN and NLI email@example.com Idaho nurses have seen many shortages come and go with varying predictions of a gloomy future each time. History is helpful to teach us the causes and remedies of each shortage as it happened in its own era, but the common response throughout time to solve a shortage has been to increase the production of new nurses. Three things have been both a blessing and a curse for nursing: disease, war and shortage. Each resulted in more attention to an insufficient nursing manpower supply and called for additional funding in terms of scholarship, academic opportunity and salary. The first statewide nursing shortage was documented in 1918 when each state was asked to submit an inventory of trained nurses for the WWI effort. There was no way to determine how many nurses lived in Idaho because licensure was voluntary at that time. Immediately after the war, returning soldiers and a more mobile population brought the Spanish flu to Idaho and many nurses died and others declined work for fear of catching it. No community was hit harder than Lewiston, where seven Catholic nursing sisters died depleting the hospital nursing staff. To keep the hospital open it started a nursing program. A 1918 Idaho Statesman headline stated “Idaho Nurses in Big Demand” (Charting Idaho Nursing History, 2009, pp. 39-40). History repeated itself in WWII when many Idaho schools affiliated with the Cadet Nurse Corps began paying students who then joined the military. After the war nurses came home, many got married, raised families and did not work. The national polio epidemic happened soon after and nurses again resisted returning to work for fear of taking polio home to their children. A 1947 Idaho Statesman headline read “St. Luke’s to Close 10 Beds Due to Nurse Shortage” (Charting Idaho Nursing History, 2009, pp. 86-98). In 2002, the federal government’s national nursing workforce eight year projection alerted us to an impending 2010 shortage. The 2008 economic downturn helped delay that shortage alarm. Now, both nationally and in Idaho, there is a growing awareness that we have a big nursing workforce crisis in our near future that will negatively impact the healthcare of Idaho citizens. There are multiple reasons why this is happening again and the Idaho Nursing Workforce Center, housed at IALN, is taking action to help mitigate shortage issues. In February, 45 stakeholders representing nursing education, long term care, large hospital systems, critical access hospitals, Idaho Hospital Association, Board of Nursing, and Idaho Department of Labor, met in Boise to review the current status of Idaho’s nursing workforce. The primary reasons for Idaho’s impending shortage are the demand for nursing care by an increasingly sick and elderly state population, the aging Idaho nursing workforce, and the lack of nurses migrating into Idaho to fill vacancies. The Federal Bureau of Labor Statistics projects nursing to be the most needed profession by 2022 (only 4 years from now) with 525,700 replacement nurses needed to maintain the 3.2 million national nursing workforce (2018). On December 20, 2017, a National Census Bureau report identified Idaho as the nation’s fastest growing state with a more than 2% population increase in one year, mostly in the Treasure Valley (U.S. Census Bureau, 2017). The influx of new Idaho residents are commonly older than 55 years, have limited years of employment left in their careers, and are coming from more heavily populated states with a future plan to retire in Idaho. Because of their numbers and ages we can project increasing demands on Idaho’s healthcare services. Workforce impact has two parts: (1) the supply of nurses to work, and (2) the number of jobs to be filled. According to the Idaho Department of Labor (2017), Idaho’s supply of LPNs has remained constant for almost 20 years with 3,268 reported in 1997 and 3,650 reported in 2017. The supply of RNs has grown by about 670 each year from 9,489 in 1997 to 23,046 in 2017. However, the RN supply number has a skew because of nurses who live in states that do not participate in the nurse license compact, such as Washington, Oregon and California. Because these nurses provide remote nursing services, such as case management or telemedicine, to patients living in Idaho, these out-of-Idaho nurses must have a single state Idaho license to provide these services. For workforce inclusion purposes, they do not physically reside in Idaho and are not available to work in Idaho unless they move to Idaho. Thus, the actual resident RN workforce in 2017 was 17,411 versus the 23,046 total licensed. Of the 17,411 only 16,402 reported they were employed. That leaves an effective available employment pool of nearly 1,000 RNs, recognizing that these nurses may retain their license and yet have no plans to work in traditional nursing roles (Idaho Department of Labor, 2017). Age evaluation for both LPNs and RNs is a good indicator of future workforce capacity. Both LPN and RN groups have significant older age groups that are similar. The report on nursing by the Idaho Department of Labor states that for LPNs, 34.8%, or 1,270 of 3,650 currently licensed are 55 years or older (2017). For RNs, 34.6%, or 6,024 of 17,411 currently licensed are 55 years or older. Even more concerning for the RN population, 12.6%, or 2,193 of 17,411 are age 65 or older and can be expected to retire when they reach full retirement age of 66 years (Idaho Department of Labor, 2017). How is the need for nurses determined? There is a national standard ratio that calls for 10.35 full-time working RNs per 1,000 population. Idaho has a population of 1,654,930 and 16,402 working nurses, which yields a nurse ratio of 9.91 per 1,000 population. To meet the standard for this population, Idaho needs 17,128 RNs working full time. Based on currently reported numbers Idaho is short by 726 RNs, and the need may be higher due to the inability to determine the number of part-time employed nurses (Bureau of Labor Statistics, 2018; Idaho Department of Labor, 2017). Using the population based need factor with projected census increases and applying an exponential decay methodology for retirements between 2018 and 2024 to gauge an annual impact, two determinations can be made. They are (1) how many nurses Idaho needs to produce or recruit into Idaho to replace retirements, and (2) how many additional nurses Idaho needs in order to provide care to an increasing and aging population. The results of these two calculations show that 4,393 RN’s will retire in the next 6 years, leaving a 12,009 incumbent RN workforce; while the demand from census growth calls for a total RN workforce of 19,665. Thus, there is a total replacement need of 7,656 RN over the next 6 years or a yearly demand of 1,276 nursing replacements (Idaho Department of Labor, 2017). Historically, the 10 Idaho RN nursing schools graduate an average of 800 students yearly. Based on nurse migration history, we cannot count on in-migration of nurses to Idaho to meet the need and we must look at increasing nursing school graduations. This poses a significant challenge in that each school will need to increase graduates by 47 students on average annually (Idaho Department of Labor, 2017). What are Idaho’s risks to meeting this need? (1) There are some Idaho nursing school graduates who are outof-state residents and who came to Idaho only to attend college. This graduate group commonly has no plan to reside in Idaho permanently. (2) All of the surrounding states currently report similar census growth and need Intermountain Hospital is recruiting for our Psychiatric Nursing Team Come be a part of the RN team at Intermountain, a behavioral healthcare facility in beautiful Boise, ID. Bachelors/Associates degree Please go to our website to review and apply online for our job openings. www.intermountainhospital.com Ask about our sign-on bonus & student loan repayment programs for FT positions. for nurses. Washington and Oregon combined predict a nursing shortage of up to 6,000 nurses during this same time (Bureau of Labor Statistics, 2018). (3) All of the surrounding states report nursing salaries that are greater than Idaho pays (Idaho Labor Department, 2017). (4) Over the past 10 years we have evidence of a nurse graduate outmigration from Idaho of about 250 each year (Bureau of Labor Statistics, 2018). (5) Idaho continues to experience a long standing mal-distribution of the nursing workforce with rural and critical access hospitals facing difficult recruitment and retention issues (Idaho Labor Department, 2017). (6) Clinical experience sites are limited, making it difficult for nursing schools to accommodate more students. (7) Nursing faculty salaries are low, making recruitment of qualified educators difficult. Qualified nurses often choose not to teach because they have significantly higher salaries working for hospitals and agencies (Idaho Labor Department, 2017). (8) Faculty are nearing retirement age and will retire sooner and in greater numbers than the general nursing workforce, resulting in a loss of experienced educators that will not be easy to replace (Idaho Labor Department, 2017). (9) Idaho also faces a provider shortage, and nurses seeking graduate degrees most commonly become nurse practitioners, helping meet the provider shortage versus the nursing shortage. Resolution of these issues will not be easy. There are sufficient qualified student applications to fill the vacancies so focusing on encouraging students to consider nursing as a career is not needed. In fact, some schools report up to 10 well qualified applicants for each available position. The issues of finding and increasing clinical space for training opportunities, recruiting qualified nurses to work as clinical faculty, paying nursing faculty adequate salaries to prevent them from leaving teaching for higher paid clinical jobs, and increasing staff nurse salaries to compete with surrounding states are all key issues that need to be addressed in order to successfully secure the nursing workforce for the future of Idaho. References: Bureau of Labor Statistics, U.S. Department of Labor. (2018). Occupational Outlook Handbook, Registered Nurses. Retrieved from: https://www.bls.gov/ooh/healthcare/ registered-nurses.htm Idaho Department of Labor. (2017). Idaho Nursing Overview: An interim report. Idaho Department of Labor Communications & Research. Retrieved from: https://labor. idaho.gov/publications/NursingOverview2017.pdf Kaiser, V., & Hudspeth, R. (2009). Charting Idaho Nursing History. (pp. 39-40, 86-98). Boise, Idaho: VKRHPubs, LLC. United States Census Bureau Reports. (2017). Idaho is Nation’s Fastest-Growing State, Census Bureau Reports. Retrieved from: https://www.census.gov/newsroom/press-releases/2017/ estimates-idaho.html Boise, Idaho BE A PART OF A GREAT TEAM! Idaho State University’s School of Nursing Temporary Simulation Technology Specialist For more information or to apply, email your resume to firstname.lastname@example.org Part-Time, Temporary position, no benefits, RN licence required ISU is an equal opportunity/affirmative action employer. We have an institution-wide commitment to inclusion and diversity and encourage all qualified individuals to apply. Veterans’ preference. 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