Orientation for New Nurse Leaders

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Orientation for New Nurse Leaders

  1. 1. New Hampshire Board of NursingNew Hampshire Board of Nursing Everything You Ever WantedEverything You Ever Wanted to Know about Licensing andto Know about Licensing and Practice RegulationsPractice Regulations Welcome!Welcome! January 2010January 2010
  2. 2. New Hampshire Board of Nursing2 PART 1PART 1 Mission of the BoardMission of the Board Structure and FunctionStructure and Function Nurse Practice ActNurse Practice Act Administrative RulesAdministrative Rules
  3. 3. New Hampshire Board of Nursing3 Board StaffBoard Staff Margaret Walker, Executive DirectorMargaret Walker, Executive Director Norma Blake, Assistant DirectorNorma Blake, Assistant Director Patricia Orzano, Assistant DirectorPatricia Orzano, Assistant Director Lori Tetreault, Program Specialist IVLori Tetreault, Program Specialist IV Susan Goodness, AdministrativeSusan Goodness, Administrative SupervisorSupervisor Attorney Laurel O’Connor, ProsecutingAttorney Laurel O’Connor, Prosecuting Attorney contracted by the BoardAttorney contracted by the Board
  4. 4. New Hampshire Board of Nursing4 Board StaffBoard Staff Professional nursing staffProfessional nursing staff Licensing clerks and secretarial staffLicensing clerks and secretarial staff Responsible for implementing the rules,Responsible for implementing the rules, including:including: – Licensing applicants,Licensing applicants, – Surveying education programsSurveying education programs – Conveying the Board’s decisions aboutConveying the Board’s decisions about practice issues to the publicpractice issues to the public
  5. 5. New Hampshire Board of Nursing5 Board MembersBoard Members Have the responsibility of regulatingHave the responsibility of regulating practicepractice 11 members11 members appointed by the governor for a 3 year termappointed by the governor for a 3 year term 5 RNs, one of which must be an ARNP5 RNs, one of which must be an ARNP 2 LPNs2 LPNs 2 LNA’s, one which should be a MNA if2 LNA’s, one which should be a MNA if possiblepossible 2 public members2 public members
  6. 6. New Hampshire Board of Nursing6 Board PurposeBoard Purpose Defined in RSA 326-B:1, aka theDefined in RSA 326-B:1, aka the Nurse Practice ActNurse Practice Act Safeguard the public from…..Safeguard the public from….. – UnauthorizedUnauthorized – UnqualifiedUnqualified – Improper practice of nursingImproper practice of nursing
  7. 7. New Hampshire Board of Nursing7 How does the Board protect theHow does the Board protect the public?public? Licenses nurse and nursing assistantsLicenses nurse and nursing assistants Defines the scope of nursing and nursingDefines the scope of nursing and nursing assistant practiceassistant practice Enforces rules and governs practice andEnforces rules and governs practice and educationeducation Reviews and approves schools of nursingReviews and approves schools of nursing Sanctions licensees who violate the lawSanctions licensees who violate the law
  8. 8. New Hampshire Board of Nursing8 Board Meeting ScheduleBoard Meeting Schedule 3rd Thursday of every month3rd Thursday of every month 8:30 - 4:00 PM at the Board office at8:30 - 4:00 PM at the Board office at 21 South Fruit Street, Concord, NH21 South Fruit Street, Concord, NH Board meetings are open to theBoard meetings are open to the public!public! We strongly encourage you toWe strongly encourage you to attend!attend!
  9. 9. New Hampshire Board of Nursing9 Committees of the BoardCommittees of the Board Practice & Education CommitteePractice & Education Committee – reviews and recommends to the Boardreviews and recommends to the Board changes and clarification to scope of practicechanges and clarification to scope of practice for all license categoriesfor all license categories ARNP Liaison CommitteeARNP Liaison Committee – reviews ARNP license applicants andreviews ARNP license applicants and recommends to the Board and makesrecommends to the Board and makes recommendations about ARNP practicerecommendations about ARNP practice issuesissues Education AdvisoryEducation Advisory – makes recommendations to the Boardmakes recommendations to the Board regarding education standardsregarding education standards
  10. 10. New Hampshire Board of Nursing10 Nurse Practice ActNurse Practice Act TheThe Nurse Practice Act (NPA)Nurse Practice Act (NPA) is also knownis also known asas:: – RSA 326-B orRSA 326-B or – Statute, LawStatute, Law Revised Nurse Practice Act signed by theRevised Nurse Practice Act signed by the Governor in Summer 2005Governor in Summer 2005 The NPA must be voted on by the legislatureThe NPA must be voted on by the legislature and signed/ not signed/ vetoed by the Governorand signed/ not signed/ vetoed by the Governor Revisions of laws may take years!Revisions of laws may take years!
  11. 11. New Hampshire Board of Nursing11 Nurse Practice Act:Nurse Practice Act: Legislative IssuesLegislative Issues Any one can propose new legislationAny one can propose new legislation about nursing!about nursing! Changes to the NPA are madeChanges to the NPA are made through the legislative process:through the legislative process: – Amendments to the Nurse Practice ActAmendments to the Nurse Practice Act – Amendments to other House or SenateAmendments to other House or Senate BillsBills Practice acts from other disciplinesPractice acts from other disciplines may affect nursing practicemay affect nursing practice
  12. 12. New Hampshire Board of Nursing12 Administrative RulesAdministrative Rules The board makes necessary revisions onThe board makes necessary revisions on an ongoing basis.an ongoing basis. The board appears before the JointThe board appears before the Joint Legislative Committee on AdministrativeLegislative Committee on Administrative Rules for any and all changes.Rules for any and all changes.
  13. 13. New Hampshire Board of Nursing13 Administrative RulesAdministrative Rules Chapter 100: Organization of the BoardChapter 100: Organization of the Board Chapter 200: General Board ProceduresChapter 200: General Board Procedures Chapter 300: Licensing RequirementsChapter 300: Licensing Requirements Chapter 400: Continuing Status, DelegationChapter 400: Continuing Status, Delegation Chapter 500: Ethical StandardsChapter 500: Ethical Standards Chapter 600: EducationChapter 600: Education Chapter 700: Nursing AssistantsChapter 700: Nursing Assistants Chapter 800: Medication NursingChapter 800: Medication Nursing AssistantsAssistants
  14. 14. New Hampshire Board of Nursing14 Monitoring legislation:Monitoring legislation: www.nh.govwww.nh.gov www.nh.gov/nursingwww.nh.gov/nursing Nurse Practice Act: Legislative IssuesNurse Practice Act: Legislative Issues
  15. 15. New Hampshire Board of Nursing15 PART 2PART 2 Licensure Requirements for RNs and LPNsLicensure Requirements for RNs and LPNs Mutual Recognition Licensure: The CompactMutual Recognition Licensure: The Compact Examinations, Endorsements and TemporaryExaminations, Endorsements and Temporary LicensesLicenses Foreign educated nursesForeign educated nurses Scope of Practice for RNs and LPNsScope of Practice for RNs and LPNs Understanding “404.12”Understanding “404.12” Reentry for RNs and PNsReentry for RNs and PNs LPN IV Therapy RulesLPN IV Therapy Rules
  16. 16. New Hampshire Board of Nursing16 RN & LPN Licensing RequirementsRN & LPN Licensing Requirements No nurse may work in any capacityNo nurse may work in any capacity without a temporary or permanentwithout a temporary or permanent active NH license or multi-stateactive NH license or multi-state license issued by another compactlicense issued by another compact statestate License by Examination orLicense by Examination or EndorsementEndorsement 2 status categories: active/ inactive2 status categories: active/ inactive Continuing competence requirementsContinuing competence requirements – 400 hours active in practice - 4 years400 hours active in practice - 4 years – 30 continuing education hours - 2 years30 continuing education hours - 2 years
  17. 17. New Hampshire Board of Nursing17 What is mutual recognition?What is mutual recognition? Allows a nurse to practice in multipleAllows a nurse to practice in multiple states with one licensestates with one license Nurse maintains a “home state” a.k.a.Nurse maintains a “home state” a.k.a. “Primary residence”“Primary residence” Nurse can practice in other compactNurse can practice in other compact states as long as license is in “goodstates as long as license is in “good standing”standing” Also known as Nurse LicensureAlso known as Nurse Licensure Compact (NLC) or “Compact”Compact (NLC) or “Compact”
  18. 18. New Hampshire Board of Nursing18 When did NH implement the Compact?When did NH implement the Compact? The Compact was enacted through theThe Compact was enacted through the state governmentstate government The Compact in NH is part of the NurseThe Compact in NH is part of the Nurse Practice ActPractice Act The Governor signed the Nurse PracticeThe Governor signed the Nurse Practice Act (SB 170) into law on July 25, 2005Act (SB 170) into law on July 25, 2005 Implementation of the compact in NewImplementation of the compact in New Hampshire was on January 1, 2006Hampshire was on January 1, 2006
  19. 19. New Hampshire Board of Nursing19 How does the Compact work?How does the Compact work? License to practice is issued by the stateLicense to practice is issued by the state in which you legally reside.in which you legally reside. Allows a nurse to practice in any otherAllows a nurse to practice in any other compact statecompact state If a nurse moves to another compactIf a nurse moves to another compact state, the nurse must apply for a multi-state, the nurse must apply for a multi- state license in the newly adopted statestate license in the newly adopted state and surrender the multi-state license fromand surrender the multi-state license from the former state.the former state.
  20. 20. New Hampshire Board of Nursing20 How do I know which states belongHow do I know which states belong to the Nurse Licensure Compact?to the Nurse Licensure Compact? Go toGo to www.ncsbn.comwww.ncsbn.com for a current listingfor a current listing of the statesof the states Arizona, Arkansas, Colorado, Delaware,Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland,Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Nebraska,Mississippi, Nebraska, New HampshireNew Hampshire,, New Mexico, North Carolina, North Dakota,New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota,Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, &Tennessee, Texas, Utah, Virginia, & Wisconsin currently belong to the compactWisconsin currently belong to the compact with Missouri entering June 2010with Missouri entering June 2010..
  21. 21. New Hampshire Board of Nursing21 How is primary residenceHow is primary residence determined?determined? A nurse can have only one primaryA nurse can have only one primary residence!residence! Documentation establishing primaryDocumentation establishing primary residency includes:residency includes: –Driver’s licenseDriver’s license –Federal income tax returnFederal income tax return –Voter registrationVoter registration
  22. 22. New Hampshire Board of Nursing22 What happened to the licenseWhat happened to the license of a nurse whoof a nurse who lives in NH aslives in NH as of January 1, 2006of January 1, 2006?? Current license became a multi-state licenseCurrent license became a multi-state license issued by NH (with a few exceptions)issued by NH (with a few exceptions) The nurse may practice nursing in NH or inThe nurse may practice nursing in NH or in another compact state without having to applyanother compact state without having to apply for a license in that compact statefor a license in that compact state
  23. 23. New Hampshire Board of Nursing23 What happens to the license of aWhat happens to the license of a nurse who wasnurse who was NOTNOT a residenta resident ofof New Hampshire on Jan. 1,New Hampshire on Jan. 1, 2006?2006? IfIf the nurse lived inthe nurse lived in another compact stateanother compact state (such as(such as Maine):Maine): – The NH license became inactive on January 1,The NH license became inactive on January 1, 2006!2006! – If the nurse wished to continue to practice as aIf the nurse wished to continue to practice as a nurse in NH, s/he had to apply for a multi-statenurse in NH, s/he had to apply for a multi-state license in the state of residence.license in the state of residence.
  24. 24. New Hampshire Board of Nursing24 What happens to theWhat happens to the license oflicense of a nurse who wasa nurse who was NOTNOT aa resident of NH on Jan. 1,resident of NH on Jan. 1, 2006?2006? If the nurse lives in aIf the nurse lives in a non-compact statenon-compact state (such as(such as Massachusetts or Vermont)Massachusetts or Vermont) – NH license became a “single state license” as ofNH license became a “single state license” as of January 1, 2006January 1, 2006 – A single state license in NH will allows the nurseA single state license in NH will allows the nurse to practiceto practice onlyonly in NH. The nurse may NOTin NH. The nurse may NOT practice in other compact statespractice in other compact states
  25. 25. New Hampshire Board of Nursing25 Does the compact changeDoes the compact change licensing requirementslicensing requirements in NH?in NH? NO!!NO!! Everything stays the same for nursesEverything stays the same for nurses who live in NH and have a NH multi-who live in NH and have a NH multi- state license or a NH single statestate license or a NH single state license!license! – Continuing education - 30 hours in 2 yearsContinuing education - 30 hours in 2 years – ““Active in practice” – 400 hours in 4 yearsActive in practice” – 400 hours in 4 years – Criminal background check requiredCriminal background check required
  26. 26. New Hampshire Board of Nursing26 What about scope of practice?What about scope of practice? You must comply with the practiceYou must comply with the practice regulations of the state in which theregulations of the state in which the care is provided!care is provided! Nursing practice is not limited toNursing practice is not limited to patient carepatient care
  27. 27. New Hampshire Board of Nursing27 Who is included in theWho is included in the compact?compact? Only RNs and LPNs are includedOnly RNs and LPNs are included LNAs and MNAs areLNAs and MNAs are NOTNOT includedincluded ARNPs areARNPs are NOTNOT includedincluded
  28. 28. New Hampshire Board of Nursing28 What if you are an ARNP?What if you are an ARNP? New Hampshire is not part of the ARNPNew Hampshire is not part of the ARNP nursing compact.nursing compact. A nurse practitioner must have a valid RNA nurse practitioner must have a valid RN license which is in good standing. It doeslicense which is in good standing. It does not need to be a NH-RN license whennot need to be a NH-RN license when applying to NH for a ARNP license.applying to NH for a ARNP license.
  29. 29. New Hampshire Board of Nursing29 ARNPs who live in NHARNPs who live in NH No changes to current licensingNo changes to current licensing You must maintain both your NH RN andYou must maintain both your NH RN and your NH ARNP licensesyour NH ARNP licenses
  30. 30. New Hampshire Board of Nursing30 ARNPs who live in anotherARNPs who live in another statestate Living in anotherLiving in another compactcompact state:state: – Obtain / maintain RN license in compactObtain / maintain RN license in compact statestate – Obtain / maintain NH ARNP licenseObtain / maintain NH ARNP license – Comply with NH ARNP licensingComply with NH ARNP licensing requirementsrequirements
  31. 31. New Hampshire Board of Nursing31 ARNPs who live in anotherARNPs who live in another statestate Living in aLiving in a non-compactnon-compact state:state: – Obtain / maintain NH RN single stateObtain / maintain NH RN single state licenselicense – Obtain / maintain NH ARNP licenseObtain / maintain NH ARNP license – Comply with NH RN and NH ARNPComply with NH RN and NH ARNP licensing requirementslicensing requirements
  32. 32. New Hampshire Board of Nursing32 Will NH continue to issueWill NH continue to issue temporary licenses?temporary licenses? Yes, NH issues temporary licenses to newYes, NH issues temporary licenses to new graduates and to applicants for license bygraduates and to applicants for license by endorsementendorsement As of January 1, 2006, all temporaryAs of January 1, 2006, all temporary licenses are single-state NH licenses onlylicenses are single-state NH licenses only When the licensing process is completeWhen the licensing process is complete and a permanent license is issued to a NHand a permanent license is issued to a NH resident, it is a multi-state licenseresident, it is a multi-state license
  33. 33. New Hampshire Board of Nursing33 How can an employer verify anHow can an employer verify an employee’s license?employee’s license? To verify a New Hampshire license:To verify a New Hampshire license: – www.nh.gov/nursingwww.nh.gov/nursing - on-line verification- on-line verification To verify a non-resident multi-stateTo verify a non-resident multi-state license:license: – www.nursys.comwww.nursys.com (free)(free) NurNursyssys® Licensure QuickConfirm® Licensure QuickConfirm I am an employer or recruiterI am an employer or recruiter who needs towho needs to verify the license of a nurse.verify the license of a nurse.
  34. 34. New Hampshire Board of Nursing34 On-Line VerificationOn-Line Verification Licensee Details:Licensee Details: Person InformationPerson Information Name: Margaret J. WalkerName: Margaret J. Walker License InformationLicense Information License No: 018445-21License No: 018445-21 Profession: Nursing License Type: Registered NurseProfession: Nursing License Type: Registered Nurse License Status: ActiveLicense Status: Active Issue Date: 8/28/1975Issue Date: 8/28/1975 Expiration Date: 2/26/12Expiration Date: 2/26/12 Discipline InformationDiscipline Information No Discipline InformationNo Discipline Information
  35. 35. New Hampshire Board of Nursing35 Licensing by Examination NCLEXLicensing by Examination NCLEX Required by all RN & LPN licenseesRequired by all RN & LPN licensees Given 12 months/ yearGiven 12 months/ year Computerized examComputerized exam Applicant can access on-line verificationApplicant can access on-line verification for license statusfor license status Limitation on number of times taken areLimitation on number of times taken are noted in the Administrative Rules, 45 daynoted in the Administrative Rules, 45 day waiting periodwaiting period
  36. 36. New Hampshire Board of Nursing36 2008 Rules re: NCLEX2008 Rules re: NCLEX May take 3 timesMay take 3 times Must take and pass within 4 years ofMust take and pass within 4 years of graduation or completion of CGFNSgraduation or completion of CGFNS processprocess After 3 failures, must completeAfter 3 failures, must complete remediation planremediation plan May take one additional time afterMay take one additional time after remediationremediation NCLEX-PN for comparable education mayNCLEX-PN for comparable education may be taken one time onlybe taken one time only
  37. 37. New Hampshire Board of Nursing37 Temporary Licenses - for newTemporary Licenses - for new graduatesgraduates New graduates are eligible forNew graduates are eligible for ONEONE temporary license before they take NCLEXtemporary license before they take NCLEX Valid for 120 days or until NCLEX takenValid for 120 days or until NCLEX taken Revoked if applicant fails NCLEXRevoked if applicant fails NCLEX Must be supervised by a RNMust be supervised by a RN Work within the scope of practice of theWork within the scope of practice of the license categorylicense category Title is Graduate Nurse (GN) or GraduateTitle is Graduate Nurse (GN) or Graduate Practice Nurse (GPN)Practice Nurse (GPN) May work only in New Hampshire – not inMay work only in New Hampshire – not in other compact statesother compact states
  38. 38. New Hampshire Board of Nursing38 EndorsementsEndorsements Nurse from another compact state mustNurse from another compact state must apply for a NH if s/he moves to NHapply for a NH if s/he moves to NH Require verification from original stateRequire verification from original state May apply for a temporary license toMay apply for a temporary license to bridge time before verification completebridge time before verification complete Must meet all licensing requirements:Must meet all licensing requirements: – active in practiceactive in practice – continuing educationcontinuing education
  39. 39. New Hampshire Board of Nursing39 Temporary Licenses –Temporary Licenses – for endorsementsfor endorsements Eligible forEligible for ONEONE temporary licensetemporary license MustMust have (and maintain)have (and maintain) an active license inan active license in another state if endorsing from a non-compactanother state if endorsing from a non-compact statestate Valid for 120 days or until permanent licenseValid for 120 days or until permanent license issuedissued Work within the scope of practice of the licenseWork within the scope of practice of the license categorycategory May work only in New Hampshire – not in otherMay work only in New Hampshire – not in other compact statescompact states
  40. 40. New Hampshire Board of Nursing40 Nurses Educated in a Foreign CountryNurses Educated in a Foreign Country Foreign educated (except Canada)Foreign educated (except Canada) – Must complete CGFNS process (credentialsMust complete CGFNS process (credentials review, English exam, predictor exam)review, English exam, predictor exam) – Must take NCLEXMust take NCLEX – May apply for a temporary licenseMay apply for a temporary license Canadian educated on TN Visa (NAFTA)Canadian educated on TN Visa (NAFTA) – Have been able to use Canadian examHave been able to use Canadian exam – Now must take NCLEX (Immigration ServicesNow must take NCLEX (Immigration Services requirement)requirement)
  41. 41. New Hampshire Board of Nursing41 License RenewalLicense Renewal Must meet continuing competenceMust meet continuing competence requirements: continuing education andrequirements: continuing education and active in practiceactive in practice License must be renewed by midnight ofLicense must be renewed by midnight of the birthday of the renewal yearthe birthday of the renewal year License status can be checked 24-7 onLicense status can be checked 24-7 on the on-line verification sitethe on-line verification site
  42. 42. New Hampshire Board of Nursing42 Reentry for RNs & LPNsReentry for RNs & LPNs Board approved refresher course (theory andBoard approved refresher course (theory and clinical)clinical) OROR Approved self-study option (theory andApproved self-study option (theory and clinical)clinical) OROR NCLEXNCLEX OROR Specified Excelsior College ExamsSpecified Excelsior College Exams
  43. 43. New Hampshire Board of Nursing43 Scope of Practice for RN’s 326-BScope of Practice for RN’s 326-B The law intent: “The law intent: “Registered nursingRegistered nursing”” meansmeans the application of nursing knowledge, judgmentthe application of nursing knowledge, judgment and skill drawn from broad in-depth education inand skill drawn from broad in-depth education in the biological, psychological, social, and physicalthe biological, psychological, social, and physical sciences in assessing, diagnosing, planning,sciences in assessing, diagnosing, planning, implementing, and evaluating care whichimplementing, and evaluating care which promotes optimum health, wellness, andpromotes optimum health, wellness, and independence of the individual, family and/orindependence of the individual, family and/or communitycommunity
  44. 44. New Hampshire Board of Nursing44 Scope of Practice forScope of Practice for LPN’s 326-BLPN’s 326-B The law intentThe law intent: “: “Practical nursingPractical nursing”” means a scope ofmeans a scope of practice,practice, directed by a RN, ARNP, dentist, or MDdirected by a RN, ARNP, dentist, or MD, by, by an LPN who is prepared to function as a member ofan LPN who is prepared to function as a member of the health care team by exercising sound nursingthe health care team by exercising sound nursing judgment based on preparation, knowledge, skills,judgment based on preparation, knowledge, skills, understanding, and past nursing experience.understanding, and past nursing experience. Practical nursing by a LPNPractical nursing by a LPN contributes to thecontributes to the assessment, planning, implementation and evaluationassessment, planning, implementation and evaluation of the patient careof the patient care. Practical nursing includes the. Practical nursing includes the delegation of nursing tasks that may be performed bydelegation of nursing tasks that may be performed by others..... (paraphrased)others..... (paraphrased)
  45. 45. New Hampshire Board of Nursing45 LPN IV RulesLPN IV Rules Administrative RulesAdministrative Rules Clients who weigh > 32 KgClients who weigh > 32 Kg Central linesCentral lines notnot prohibitedprohibited RN does not have to give the first doseRN does not have to give the first dose IV push, concentration, intermittent infusionIV push, concentration, intermittent infusion No blood, no blood productsNo blood, no blood products No IV oncology medications or research medicationsNo IV oncology medications or research medications
  46. 46. New Hampshire Board of Nursing46 Interpreting Scope of PracticeInterpreting Scope of Practice Practice is dynamicPractice is dynamic The Board determines practiceThe Board determines practice parameters within the confines of theparameters within the confines of the Nurse Practice Act and the AdministrativeNurse Practice Act and the Administrative RulesRules
  47. 47. New Hampshire Board of Nursing47 Clinical Practice Opinion Has Been Rendered by the Board Permitted – Under scope of practice of licensee Contact Board of Nursing staff Clinical Practice question presented to Board of Nursing Board consideration of Nurse Practice Act, National Standards Prohibited Not within scope of practice of licensee Stop In compliance with Nur 305.01 Yes Comply with Nur 305.01 Permitted No Yes -Allowed within scope of practice Opinion Has Not Been Rendered by the Board No -Prohibited not within scope of practice of licensee Stop
  48. 48. New Hampshire Board of Nursing48 Nur 404.12Nur 404.12 Guidelines for implementing additionalGuidelines for implementing additional nursing interventions:nursing interventions: describe thedescribe the education preparation andeducation preparation and practice historypractice history of the nurse (assistant)of the nurse (assistant) authorized to perform the activityauthorized to perform the activity develop adevelop a policy and procedurepolicy and procedure write a plan for attaining and maintainingwrite a plan for attaining and maintaining competencecompetence keep akeep a list of nurses authorized to performlist of nurses authorized to perform update at least yearlyupdate at least yearly
  49. 49. New Hampshire Board of Nursing49 PART 3PART 3 Delegation RulesDelegation Rules Licensing Requirements for LNAsLicensing Requirements for LNAs Scope of Practice of Licensed NursingScope of Practice of Licensed Nursing AssistantsAssistants Medication Nursing AssistantsMedication Nursing Assistants Paid Feeding AssistantsPaid Feeding Assistants LNA-Medication CertifiedLNA-Medication Certified
  50. 50. New Hampshire Board of Nursing50 Nursing DelegationNursing Delegation Pertains to delegation among licensees asPertains to delegation among licensees as well as to delegation to unlicensed assistivewell as to delegation to unlicensed assistive personnelpersonnel Must be in keeping with Nur 404Must be in keeping with Nur 404 RSA-B:29 II “No person may coerce aRSA-B:29 II “No person may coerce a licensed nurse into compromising clientlicensed nurse into compromising client safety by requiring the nurse to delegate asafety by requiring the nurse to delegate a nursing activity or task when the nursenursing activity or task when the nurse determines that it is inappropriate to dodetermines that it is inappropriate to do so…….”so…….”
  51. 51. New Hampshire Board of Nursing51 What is Delegation?What is Delegation? Nur 401.01(f):Nur 401.01(f): The transfer,The transfer, at theat the discretion of the nursediscretion of the nurse,, ofof authority for the performance of aauthority for the performance of a task of client care from the licensedtask of client care from the licensed nurse with the authority to performnurse with the authority to perform the task to someone who does notthe task to someone who does not otherwise have such authorityotherwise have such authority
  52. 52. New Hampshire Board of Nursing52 Nursing Delegation: Nur 404Nursing Delegation: Nur 404 Nurse must determine:Nurse must determine: – Client stability, whether client’s nursing needs areClient stability, whether client’s nursing needs are changingchanging – Delegate’s level of competencyDelegate’s level of competency – Complexity of taskComplexity of task – Familiarity of the delegate with the environmentFamiliarity of the delegate with the environment – Level of supervision neededLevel of supervision needed – On-going competencyOn-going competency – Need to rescind if the delegate proves unwilling orNeed to rescind if the delegate proves unwilling or incompetent, client objects, or nurse cannot provideincompetent, client objects, or nurse cannot provide adequate supervisionadequate supervision
  53. 53. New Hampshire Board of Nursing53 Delegation……. Do it Right!Delegation……. Do it Right! Right taskRight task Right circumstanceRight circumstance Right personRight person Right communication/ directionRight communication/ direction Right supervision and evaluationRight supervision and evaluation
  54. 54. New Hampshire Board of Nursing54 What does it mean.....What does it mean..... responsibility =responsibility = a two-way process thata two-way process that must be allocated and acceptedmust be allocated and accepted authority =authority = the right to act in areas onethe right to act in areas one is given and accepts responsibilityis given and accepts responsibility accountability =accountability = reviewing judgementsreviewing judgements and decisions, evaluating effectiveness,and decisions, evaluating effectiveness, and directing future effortsand directing future efforts YOU CAN’T GIVE AWAYYOU CAN’T GIVE AWAY ACCOUNTABILITY!ACCOUNTABILITY! MANTHEY & MILLER 1994MANTHEY & MILLER 1994
  55. 55. New Hampshire Board of Nursing55 Levels of AuthorityLevels of Authority Level 1Level 1 - Data gathering- Data gathering Level 2Level 2 - Data gathering + recommendations- Data gathering + recommendations Level 3Level 3 - Data + recommendation (pause) +- Data + recommendation (pause) + actact Level 4Level 4 - Act and inform others after taking- Act and inform others after taking actionaction LEVEL DEPENDS ON THE TASK, NOT THELEVEL DEPENDS ON THE TASK, NOT THE LEVEL OF THE LICENSEELEVEL OF THE LICENSEE!! MANTHEY & MILLER 1994MANTHEY & MILLER 1994
  56. 56. New Hampshire Board of Nursing56 Licensed Nursing AssistantsLicensed Nursing Assistants (LNA)(LNA) Education and Licensing Requirements:Education and Licensing Requirements: Nur 700Nur 700 – Based on Federal StandardsBased on Federal Standards – Educational Programs are approved by the BON:Educational Programs are approved by the BON: after program completion, apply for licensureafter program completion, apply for licensure – Must work under the supervision (direct or indirect)Must work under the supervision (direct or indirect) of a licensed nurseof a licensed nurse – Must maintain 12 hrs of continuing education eachMust maintain 12 hrs of continuing education each year, 200 hrs/2 years active in practiceyear, 200 hrs/2 years active in practice
  57. 57. New Hampshire Board of Nursing57 LNA Scope of PracticeLNA Scope of Practice Based on activities taught during initial educationalBased on activities taught during initial educational programprogram Additional activities may be added based on specificAdditional activities may be added based on specific BON approval, Nur 404.12 such as: .BON approval, Nur 404.12 such as: . Straight urinary catheters, foley irrigations, bladder scanStraight urinary catheters, foley irrigations, bladder scan or doppler, application of TENS unit, feeding tubes,or doppler, application of TENS unit, feeding tubes, phlebotomy, wound care, vagus nerve stimulation, pulsephlebotomy, wound care, vagus nerve stimulation, pulse oximetry, incentive spirometry, oral suctioning, oxygenoximetry, incentive spirometry, oral suctioning, oxygen mask placement/cannula placement, chestmask placement/cannula placement, chest physiotherapy, peripheral vein IV removal, colostomyphysiotherapy, peripheral vein IV removal, colostomy irrigations, medicated lotions, ointments and creams,irrigations, medicated lotions, ointments and creams, blood glucose monitoring, fingerstick PT/INR testing,blood glucose monitoring, fingerstick PT/INR testing, reminding clients to take their medications andreminding clients to take their medications and transcribing medical orders.transcribing medical orders. This list should not be considered all inclusiveThis list should not be considered all inclusive
  58. 58. New Hampshire Board of Nursing58 LNA Scope of PracticeLNA Scope of Practice The LNA may also assist in oxygen as a treatmentThe LNA may also assist in oxygen as a treatment therapy and change the collar that holds atherapy and change the collar that holds a tracheostomy tube in place as delegated by thetracheostomy tube in place as delegated by the nurse.nurse. It isIt is notnot within the scope of practicewithin the scope of practice for afor a Licensed Nursing Assistant to engage in theLicensed Nursing Assistant to engage in the following activities:following activities: – Insertion of intravenous catheters,Insertion of intravenous catheters, – Calling in Prescribing Practitioner orders to theCalling in Prescribing Practitioner orders to the PharmacyPharmacy – Insertion of indwelling cathetersInsertion of indwelling catheters
  59. 59. New Hampshire Board of Nursing59 Nursing Assistant RegistryNursing Assistant Registry Federal RequirementFederal Requirement Pertains to Nursing Assistants who arePertains to Nursing Assistants who are suspected of abuse, neglect,suspected of abuse, neglect, exploitation or misappropriationexploitation or misappropriation In collaboration with the Office of LongIn collaboration with the Office of Long Term Care, DEAS, OLTCO, BHFATerm Care, DEAS, OLTCO, BHFA BON may, in some cases, pursueBON may, in some cases, pursue additional disciplinary action against theadditional disciplinary action against the Nursing Assistant’s LicenseNursing Assistant’s License
  60. 60. New Hampshire Board of Nursing60 Medication Nursing AssistantsMedication Nursing Assistants A Medication Nursing Assistant (MNA) isA Medication Nursing Assistant (MNA) is a Licensed Nursing Assistant (LNA) with aa Licensed Nursing Assistant (LNA) with a NH Board Approved Certificate toNH Board Approved Certificate to administer medications under theadminister medications under the supervision of a RN/LPN to “stable”supervision of a RN/LPN to “stable” clients.clients.
  61. 61. New Hampshire Board of Nursing61 Why was this new role developed?Why was this new role developed? To provide safe medicationTo provide safe medication administration toadministration to stablestable clients living inclients living in facilities and in the community.facilities and in the community. The client whose health status is underThe client whose health status is under control and raises no expectations thatcontrol and raises no expectations that the client’s symptoms, vital signs orthe client’s symptoms, vital signs or reactions to medications will suddenlyreactions to medications will suddenly change.change. There are predictable outcomes to care.There are predictable outcomes to care.
  62. 62. New Hampshire Board of Nursing62 Nur 405.02Nur 405.02 A MNA shallA MNA shall NOTNOT perform a task involving theperform a task involving the administration of medication if:administration of medication if: -the task requires the determination of the-the task requires the determination of the client’s need for the medication, the calculation ofclient’s need for the medication, the calculation of the dosage or the conversion of the dosage;the dosage or the conversion of the dosage; -the delegating nurse is unavailable to monitor-the delegating nurse is unavailable to monitor the progress of the client and the effect of thethe progress of the client and the effect of the medication;medication; -the client is not stable or has changing needs.-the client is not stable or has changing needs.
  63. 63. New Hampshire Board of Nursing63 MNA CertificationMNA Certification Selection of candidatesSelection of candidates -- Five years as a LNA in good standing or 2 years full timeFive years as a LNA in good standing or 2 years full time - Two employer letters of reference- Two employer letters of reference - One letter of intent- One letter of intent Course requirementsCourse requirements - 30 hours of clinical/30 hours of theory- 30 hours of clinical/30 hours of theory - Final exam 90% or greater- Final exam 90% or greater Maintain the certificateMaintain the certificate - Renewed with LNA licensure- Renewed with LNA licensure - 4 of 12 CEs must be in medication administration topic- 4 of 12 CEs must be in medication administration topic
  64. 64. New Hampshire Board of Nursing64 If the MNA makes a mistake,If the MNA makes a mistake, is the RN’s license at risk?is the RN’s license at risk? A licensee who delegates or hasA licensee who delegates or has delegated a specific nursing activity ordelegated a specific nursing activity or task in compliance with this chapter (RSAtask in compliance with this chapter (RSA 326)326) shall notshall not be subject to disciplinarybe subject to disciplinary action because of the performance of theaction because of the performance of the person to whom the nursing activity orperson to whom the nursing activity or task is or was delegated.task is or was delegated.
  65. 65. New Hampshire Board of Nursing65 Paid Feeding AssistantsPaid Feeding Assistants Paid Feeding Assistants are individuals whoPaid Feeding Assistants are individuals who have been trained to provide feedinghave been trained to provide feeding assistance to residents of Long Term Careassistance to residents of Long Term Care FacilitiesFacilities under the supervisionunder the supervision of the RN orof the RN or LPN.LPN. The 8 hour NH BON approved training courseThe 8 hour NH BON approved training course is taught by Registered Nurses, Dieticians,is taught by Registered Nurses, Dieticians, Physical Therapists, Occupational Therapists,Physical Therapists, Occupational Therapists, Speech TherapistsSpeech Therapists OROR Licensed PracticalLicensed Practical Nurses.Nurses.
  66. 66. New Hampshire Board of Nursing66 Licensed Nursing AssistantLicensed Nursing Assistant Medication CertifiedMedication Certified This role is designed to allow nursingThis role is designed to allow nursing assistants with additional education toassistants with additional education to observe and document medicationobserve and document medication consumed by residents living in theirconsumed by residents living in their homes or residential care settings.homes or residential care settings. Facilities and agencies provide board-Facilities and agencies provide board- approved education to their employeesapproved education to their employees
  67. 67. New Hampshire Board of Nursing67 PART 4PART 4 Criminal Background ChecksCriminal Background Checks The Complaint ProcessThe Complaint Process Discipline ProcessDiscipline Process Nursing Assistant RegistryNursing Assistant Registry
  68. 68. New Hampshire Board of Nursing68 Criminal Background ChecksCriminal Background Checks required as of 9/1/2007required as of 9/1/2007 Renewals and Reinstatement applicationsRenewals and Reinstatement applications no longer require CBC. All new NHno longer require CBC. All new NH licensees are required to complete a CBClicensees are required to complete a CBC which includes FBI finger print technology.which includes FBI finger print technology. See applications for directionsSee applications for directions..
  69. 69. New Hampshire Board of Nursing69 Bars to Licensing for CertainBars to Licensing for Certain FeloniesFelonies MurderMurder Aggravated RobberyAggravated Robbery Felonious AssaultFelonious Assault Sexual Crimes Involving ChildrenSexual Crimes Involving Children KidnappingKidnapping Criminal Mistreatment of ChildrenCriminal Mistreatment of Children Aggravated Robbery or Vulnerable AdultsAggravated Robbery or Vulnerable Adults Exploitation of Vulnerable IndividualsExploitation of Vulnerable Individuals
  70. 70. New Hampshire Board of Nursing70 The Complaint Process:The Complaint Process: Factors to Consider:Factors to Consider: Does the act or omission violate theDoes the act or omission violate the NPA or the rules?NPA or the rules? Evaluate cause of incident:Evaluate cause of incident: – Licensee knowledge deficiencyLicensee knowledge deficiency – Licensee behavior problemLicensee behavior problem – Systems issues (or a combination of causes)Systems issues (or a combination of causes)
  71. 71. New Hampshire Board of Nursing71 The Complaint Process:The Complaint Process: Factors to ConsiderFactors to Consider Is there objective evidence that theIs there objective evidence that the incident actually occurred?incident actually occurred? Is there evidence that the licensee wasIs there evidence that the licensee was responsible?responsible? Was it a one-time incident or is there aWas it a one-time incident or is there a pattern of behavior?pattern of behavior?
  72. 72. New Hampshire Board of Nursing72 The Complaint Process:The Complaint Process: Factors to ConsiderFactors to Consider Do any of the witnesses have personalDo any of the witnesses have personal motives for reporting the incident?motives for reporting the incident? Would counseling, employmentWould counseling, employment suspension, education or other measuressuspension, education or other measures be more appropriate than sanctioning orbe more appropriate than sanctioning or restricting the license?restricting the license?
  73. 73. New Hampshire Board of Nursing73 The Complaint Process:The Complaint Process: Factors to ConsiderFactors to Consider Is it an employment/HR issue?Is it an employment/HR issue? Is it a concern that should be reported toIs it a concern that should be reported to the Ombudsman/Division of Elderly andthe Ombudsman/Division of Elderly and Adult Services?Adult Services? If you are not sure, call the BON toIf you are not sure, call the BON to discuss the incident.discuss the incident.
  74. 74. New Hampshire Board of Nursing74 Filing a Complaint –Filing a Complaint – what happens next:what happens next: DismissalDismissal Dismissal with letter of concernDismissal with letter of concern Settlement agreementSettlement agreement HearingHearing
  75. 75. New Hampshire Board of Nursing75 Possible Board ActionsPossible Board Actions Letter of concernLetter of concern ReprimandReprimand ProbationProbation SuspensionSuspension RevocationRevocation Monetary fineMonetary fine
  76. 76. New Hampshire Board of Nursing76 If a license has beenIf a license has been suspended…….suspended……. At end of suspended time, licenseeAt end of suspended time, licensee appeals to the Board for reinstatementappeals to the Board for reinstatement Reinstatement may be granted withReinstatement may be granted with restrictions & conditions (stipulations)restrictions & conditions (stipulations) Licensee may later request removal ofLicensee may later request removal of restrictions & conditionsrestrictions & conditions
  77. 77. New Hampshire Board of Nursing77 What if you hire someone who hasWhat if you hire someone who has a history of Board discipline?a history of Board discipline? Go to the website verification page atGo to the website verification page at www.state.nh.us/nursingwww.state.nh.us/nursing (located in quick link(located in quick link section of home page) for all disciplinarysection of home page) for all disciplinary documents (located in discipline section ofdocuments (located in discipline section of license verification)license verification) The licensee will provide you with documentsThe licensee will provide you with documents from the Board which outline anyfrom the Board which outline any restrictions/stipulations they must adhere to.restrictions/stipulations they must adhere to.
  78. 78. New Hampshire Board of Nursing78 Examples of Stipulations...Examples of Stipulations... –Quarterly performance reportsQuarterly performance reports –Random drug screeningRandom drug screening –Limitation on hours worked, nightLimitation on hours worked, night shift work and the ability to float.shift work and the ability to float. –Regular attendance with AA, NA,Regular attendance with AA, NA, –CounselingCounseling
  79. 79. New Hampshire Board of Nursing79 First Lab, IncFirst Lab, Inc NH Board of Nursing has contracted withNH Board of Nursing has contracted with First Lab, Inc., an organization used byFirst Lab, Inc., an organization used by many boards in the U. S. They providemany boards in the U. S. They provide services and contact with the licensee whoservices and contact with the licensee who has stipulations from the Board for drughas stipulations from the Board for drug screening. This company reports to thescreening. This company reports to the board on a daily basis.board on a daily basis.
  80. 80. New Hampshire Board of Nursing80 Drug Diversion in your facilityDrug Diversion in your facility Your facility realizes there is a problem…Your facility realizes there is a problem… what can you do to prove diversion? Whowhat can you do to prove diversion? Who to call?to call? The Department of Justice has the abilityThe Department of Justice has the ability to assist with this investigation.to assist with this investigation. Call James Brown, Investigator at 271-Call James Brown, Investigator at 271- 1246 to discuss your facility problem.1246 to discuss your facility problem.
  81. 81. New Hampshire Board of Nursing81 Board program to assistBoard program to assist impaired nursesimpaired nurses Road to Recovery has been in place sinceRoad to Recovery has been in place since December 2004. This program isDecember 2004. This program is designed to assist nurses with problems ofdesigned to assist nurses with problems of chemical dependency, physical disorders,chemical dependency, physical disorders, psychiatric impairments.psychiatric impairments. The purpose of this program ensuresThe purpose of this program ensures public health and safety while providingpublic health and safety while providing assistance and support to the licensee.assistance and support to the licensee.
  82. 82. New Hampshire Board of Nursing82 What Constitutes ClientWhat Constitutes Client Abandonment?Abandonment? ABANDONMENTABANDONMENT = "Leaving an assignment= "Leaving an assignment without notifying the appropriate authority,without notifying the appropriate authority, whereby such departure endangers the health,whereby such departure endangers the health, safety and welfare of those individuals entrusted tosafety and welfare of those individuals entrusted to the licensee's care;…" [Nur 215.01(B)(2)]the licensee's care;…" [Nur 215.01(B)(2)] Refusal to accept an assignment or refusal to workRefusal to accept an assignment or refusal to work overtimeovertime does notdoes not constitute client abandonmentconstitute client abandonment
  83. 83. New Hampshire Board of Nursing83 PART 5PART 5 Advanced Registered Nurse PracticeAdvanced Registered Nurse Practice License RequirementsLicense Requirements ARNP Practice IssuesARNP Practice Issues
  84. 84. New Hampshire Board of Nursing84 ARNP License RequirementsARNP License Requirements Complete advanced education programComplete advanced education program Certification in specialtyCertification in specialty Continuing competenceContinuing competence – active in practice - 400 hours in 4 yearsactive in practice - 400 hours in 4 years – continuing education - 60 hours in 2 yearscontinuing education - 60 hours in 2 years (certification counts for 30 hours) including(certification counts for 30 hours) including 5 hours in pharmacology5 hours in pharmacology – No endorsementNo endorsement – ARNPs are not in the compactARNPs are not in the compact
  85. 85. New Hampshire Board of Nursing85 ARNP Active in PracticeARNP Active in Practice Must work in advanced roleMust work in advanced role Does not include undergraduate facultyDoes not include undergraduate faculty rolerole New graduatesNew graduates – must apply for initial licensure within 2must apply for initial licensure within 2 years of graduation, or must completeyears of graduation, or must complete reentry programreentry program
  86. 86. New Hampshire Board of Nursing86 ARNP Scope of PracticeARNP Scope of Practice practice independentlypractice independently – history and physicalhistory and physical – initiate diagnostic testsinitiate diagnostic tests – formulate diagnosesformulate diagnoses – ID health problems and learning needsID health problems and learning needs – plan, teach, promote healthplan, teach, promote health – arrange referralsarrange referrals – emergency careemergency care – administer, dispense, procure and prescribeadminister, dispense, procure and prescribe medicationsmedications
  87. 87. New Hampshire Board of Nursing87 General FormularyGeneral Formulary exclusionary formularyexclusionary formulary ARNPs may prescribe drugsARNPs may prescribe drugs NOTNOT in thein the formularyformulary ARNPs must follow restrictions asARNPs must follow restrictions as described for drugs in the formularydescribed for drugs in the formulary Joint Health Council reviews medicationsJoint Health Council reviews medications quarterlyquarterly
  88. 88. Part 6Part 6 What does theWhat does the future hold?future hold?
  89. 89. New Hampshire Board of Nursing89 Nationally…….Nationally……. More states initiating mandatory criminalMore states initiating mandatory criminal background checks, particularly national FBI checksbackground checks, particularly national FBI checks More focus on continuing competency requirementsMore focus on continuing competency requirements to ensure safe practitionersto ensure safe practitioners Increased collaboration with health care agencies toIncreased collaboration with health care agencies to increase patient safetyincrease patient safety Increasing interest in licensing NA’s in all statesIncreasing interest in licensing NA’s in all states Spotlight on ARNP practiceSpotlight on ARNP practice More states joining the compactMore states joining the compact
  90. 90. New Hampshire Board of Nursing90 In New Hampshire…..In New Hampshire….. The board is studying the nursingThe board is studying the nursing workforce and making recommendationsworkforce and making recommendations to ease the shortage. A demographicto ease the shortage. A demographic survey is required with each licensesurvey is required with each license renewal to collect workforce datarenewal to collect workforce data Board committees continue to studyBoard committees continue to study national standards of practicenational standards of practice
  91. 91. New Hampshire Board of Nursing91 Contact us........Contact us........ telephone: 271-2323 or 271-6282telephone: 271-2323 or 271-6282 mwalker@nursing.state.nh.usmwalker@nursing.state.nh.us Norma.Blake@nursing.state.nh.usNorma.Blake@nursing.state.nh.us Patricia.orzano@nursing.state.nh.usPatricia.orzano@nursing.state.nh.us Lori.tetreault@nursing.state.nh.usLori.tetreault@nursing.state.nh.us web site:web site: www. state.nh.us/nursingwww. state.nh.us/nursing email:email: boardquestions@nursing.state.nh.usboardquestions@nursing.state.nh.us
  92. 92. New Hampshire Board of Nursing92 Conclusions...... Wrap-upConclusions...... Wrap-up Questions????????Questions???????? Please complete the evaluationPlease complete the evaluation form and return it to us.....form and return it to us..... Congratulations! You’ve just earnedCongratulations! You’ve just earned contact hours!contact hours!

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