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Agenda Item #1.1 Prepared by: Katherine Thomas

Meeting Date: October 26-27, 2017

REPORT OF THE EXECUTIVE DIRECTOR NATIONAL AND INTERNATIONAL NEWS 26 States Enact the Enhanced Nurse Licensure Compact: Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wyoming joined the enhanced NLC in 2016. The eNLC will go into effect on January 19, 2018. See Board item 7.14 for further information on implementation of the new compact. https://www.nursecompact.com/ NCSBN e-Notify Service: This service delivers real-time notification to employers about nurses in their employ. The system provides licensure and publicly available discipline data directly as the information is entered into the Nursys database by boards of nursing. Employers can chose the types and frequency of notifications such as expiration of license and discipline on a license. National Council of State Boards of Nursing (NCSBN) permits individual nurses to enroll as well. Currently there are 1,015 Texas nursing employers and 163,540 Texas nurses enrolled in e-Notify. Tri-Regulator Collaborative Release Position Statements Addressing Electronic Health Records, Practitioner Burnout: The Tri Regulator Collaborative is comprised of organizations representing medical, pharmacy and nursing professional licensing boards. These organizations share a common mission of protecting the public. “The Collaborative meets periodically to discuss issues of mutual concern, exchange ideas, and share resources to better protect patients and improve the quality of care.” The Tri-Regulator Collaborative governing Boards approved two position statements --- “Tri-Regulator Collaborative Position Statement on Electronic Health Records (EHRs) calls for improving interoperability and uniformity of use, declaring that the seamless transfer of this data is essential to the delivery of high-quality health care and to patient safety. The Collaborative is urging that steps be taken by all stakeholders to bring uniformity and interoperability to EHRs across all practice settings.” “Tri-Regulator Collaborative Position Statement on Practitioner Wellness expresses its commitment to identifying and preventing practitioner burnout. Today, knowledge overload, numerous technology innovations, social media pressures, and a rapidly changing practice environment create numerous challenges. More needs to be done to provide practitioners with the wellness strategies and assistance they need to deal with the stress of these challenges, which often leads to practitioner burnout and/or unhealthy responses.” (NCSBN) https://www.ncsbn.org/11356.htm https://www.ncsbn.org/11355.htm National Quality Forum (NQF) Launches New Opioid Stewardship Initiative: The NQF recently launched a new opioid stewardship initiative aimed to lower opioid overprescribing rates and patient addiction risks. The initiative creates an opioid stewardship action team of 25 NQF members that will develop a playbook to help health care providers better manage their patients’ pain while reducing the risk of opioid addiction. The team “will identify strategies and tactics for managing the care of individuals who are at high risk of becoming dependent on opioids and will advance quality measures that support providers and the care of patients with chronic pain.” http://www.qualityforum.org/New_NQF_Initiative_Focuses_on_Opioid_Prescribing.aspx

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Department of Health and Human Services (HHS) Announces $195 Million to Fund Expansion of Substance Abuse and Mental Health Services: HHS is providing $195 million in new funding to community health centers in all U.S. states, territories and the District of Columbia to expand access to mental health and substance abuse services focusing on the treatment, prevention and awareness of opioid abuse. https://www.hhs.gov/about/news/2017/06/26/hhs-announced-195-million-funding-to-expand-mental-health-and-substance-abuse-service-access.html New Centers for Disease Control and Prevention (CDC) Report Shows Opioid Prescriptions Decreased, But Still Remains High: According to a new CDC report, the number of opioid prescriptions written by health care providers peaked in 2010 and then decreased each year through 2015, but remains at high levels and varies in the U.S. from county to county. The CDC states that prescriptions for highly addictive painkillers dropped 13.1 percent between 2012 and 2015, from 81.2 per 100 people to 70.6. The report notes that six times more opioids per resident were dispensed in the highest-prescribing counties than in the lowest-prescribing counties, suggesting inconsistent prescribing practices among health care providers. https://www.cdc.gov/media/releases/2017/p0706-opioid.html New National Academies of Sciences, Engineering and Medicine (NASEM) Report Includes Strategy to Reduce Opioid Epidemic: According to a recent report from the NASEM, “Years of sustained and coordinated efforts will be required to contain and reverse the harmful societal effects of the prescription and illicit opioid epidemics, which are intertwined and getting worse.” The report calls for regulators to overhaul opioid policies and weigh the societal impacts of opioids when approving or recalling drugs. The report includes recommended actions that the U.S. Food and Drug Administration, other federal agencies, state and local governments and health-related organizations should take to reduce the opioid epidemic, including: • Promoting more judicious prescribing of opioids; • Expanding access to treatment for opioid use disorder; • Preventing more overdose deaths; • Weighing societal impacts in opioid-related regulatory decisions; • Investing in research to better understand the nature of pain and develop non-addictive

alternatives; and • Enhancing education for both health professionals and the general public.

Richard J. Bonnie, report committee chair, stated, “This report provides an action plan directed particularly at the health professions and government agencies responsible for regulating them. This plan aims to help the millions of people who suffer from chronic pain while reducing unnecessary opioid prescribing.”

http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24781 Study Examines the Return on Investment (ROI) of New Graduate Registered Nurse (RN) Transition to Practice Programs: A study published in Nursing Economics reports the ROI results from NCSBN’s Transition to Practice study. According to the ROI study, “Many health care organizations have been reluctant to implement evidence-based transition to practice programs due to concerns about costs.” Researchers conducted the study to demonstrate the monetary value for providing a structured transition to practice program for new graduate RNs. Study findings show a positive ROI and provide “nursing practice leaders with evidence of cost savings considering investment associated with implementing a transition to practice program” in hospitals to decrease new graduate RN turnover. Additionally, study results suggest “the immediate investment in a new graduate RN transition to practice program has a financial benefit that accrues relatively quickly due to higher nurse retention rates.” https://www.nursingeconomics.net/necfiles/2017/MJ17/110.pdf

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White House Announces Telehealth Initiatives Designed to Provide Greater Access to Veterans: The White House recently announced a set of initiatives developed by the Veterans Health Administration designed to expand access to health care for veterans through mobile and other telehealth services. The initiatives provide Veterans Affairs (VA) health care providers with tools that will make it easier to see patients off-site and will eliminate a licensing requirement that has prevented VA providers from providing remote consultations to out-of-state patients. The initiatives will expand VA’s telehealth capability in three areas: • The Anywhere to Anywhere VA Health Care initiative will explicitly authorize VA providers,

using telehealth technologies, to serve veterans wherever the provider or the veteran is located;

• The VA Video Connect application will provide a secure and web-enabled video service to make it easier for veterans to connect with their VA providers by video or their own mobile phone or personal computer; and

• The Veteran Appointment Request application will allow veterans to use their smartphones, tablet or computer to schedule or modify appointments at VA facilities.

http://www.blogs.va.gov/VAntage/40113/president-va-secretary-announce-veteran-telehealth-initiatives-providing-greater-access-care/ STATE NEWS Texas Facilities Commission Space and Hobby Building Issues: Staff have received an approved a plan for the Texas Facilities Commission (TFC) to complete construction on the 4th floor to adapt to nursing, enforcement and legal space needs. The construction is scheduled to start this month. Discussions continue with TFC on sanitation, safety and security issues in the Hobby Building. Health Professions Council: The Health Professions Council (HPC) met on September 18, 2017. The Laserfiche system used by the Board of Nursing (BON) to store scanned documents will have software upgraded this year. Board member and staff training on anti-trust issues was conducted by the Office of the Attorney General on October 2nd, 1:30 p.m. Chris Kloeris (Optometry Board) was elected Chair and Kelly Parker (Dental Board) was elected Vice Chair at this meeting. Since the Podiatry Board has been transferred to the Texas Department of Licensing and Regulation (TDLR), the agency will no longer be a member of HPC and funding will be re-distributed among the remaining agencies. BOARD NEWS TCNWS FY17 Expenditure Report: The Texas Center for Nursing Workforce Studies (TCNWS) is funded by nurse licensure fees. The Board has an Interagency Contract to enable transfer of funding and assure deliverables. The FY 2017 Annual Financial Report is attached to this report. (See Appendix A) BON Bulletin Articles : The October issue of the Board of Nursing Bulletin contains the following articles: 1.) BON Response to Hurricane Harvey, including an FAQ for nurses; 2.) 8th Legislative Session Summary report; 3.) Implementation of the eNLC; and 4.) Customer Service Survey Results. Board Retreat: A board retreat will be held on Wednesday, October 25, 2017. This session will be a review of the 85th Legislative Session and status of statutory implementation.

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AGENCY NEWS Staff News: Since the hiring freeze was lifted at the end of FY 17, staff has interviewed and filled several positions: NURSING

Calyn Hughes, MSN, RN, CPNP-PC, has been hired as a Nurse Consultant for Practice. Calyn began her nursing career as a registered nurse in 2002 at Children’s Hospital of Austin, then as the lead RN for a pediatric surgical practice from 2006-2011. Since completing her MSN in 2012, she has been practicing as a pediatric nurse practitioner at pediatric clinics in the Austin area.

ENFORCEMENT Denise Benbow has transferred from Nursing to the Enforcement Department where she is

now an Enforcement Nursing Consultant. Denise will be reviewing all contested cases before formal charges are filed. She will also continue to represent the Board on the TPAPN Advisory Committee.

ELIGIBILITY Jeffrey Morales, Investigator II – Education includes Associates Degree Fire Science from

Columbia Southern, AL; Bachelor’s Degree Criminal Justice from St. Edwards, Austin; Master’s Degree Human Resources from Columbia Southern AL. Jeffrey is an Army Veteran who participated in Operation Desert Freedom, deployed to Iraq and Afghanistan and was in Africa Command/ He was most recently Administrator of Compliance with the Texas Funeral Commission

COMPLIANCE Tosha Rocquemore-Coleman, Case Manager. Her previous state employment includes the

Office of the Attorney General, Texas Department of Family & Protective Services, and Texas Department of Public Safety.

Melanie “Faith” Hunter, Case Manager. She holds a Bachelor’s Degree in Sociology/Psychology from The University of Texas, Austin, Texas, in 1995 and a Master of Arts Degree in Professional Counseling from Texas State University, San Marcos in 2001. Her previous state employment includes the Texas Juvenile Justice Department, the Texas Comptroller of Public Accounts and the Texas Youth Commission.

Gina Lawson, Case Manager. She holds a Bachelor’s Degree in International Studies/Business Degree from Texas State University, San Marcos in 1996. Her previous state employment that includes Texas A & M Health Science Center and the Department of State Health Services.

NURSE INVESTIGATORS Lucinda French, MSN, RN, Investigator. Lucinda completed her MSN in Nursing

Leadership & Management in March 2014 after having completed a BSN in 2013 and her ADN in 2007. Her nursing background includes experience in acute care Mother/Baby, Neuro, Med-Surg, Ortho, Oncology, and Orthopedic Units. Prior to entering the nursing profession, Lucinda also completed a Baccalaureate Degree in Computer Science and had a career as a computer software engineer.

Julie Rhone, BSN, RN, Investigator. Julie completed her BSN in 2008 and her ADN in 2000. Julie is Board Certified as a Nurse Executive and is currently working toward completing an MBA in Healthcare Management in July 2018. Initially licensed as a RN in Kansas in 2000, Julie began her nursing career in a Surgical ICU in Kansas followed by a Neuro ICU in England. After relocating to Texas in January 2017, Julie became the Director of Nursing for Critical Care Services at a local acute care facility. Julie’s previous nursing experience includes being a Rotor Wing Flight Nurse, a staff nurse and unit educator in a Surgical Trauma ICU, an L&D nurse, a unit manager for a Surgical ICU-Bariatric Services-Telemetry Unit, and an Adjunct Clinical Faculty with an ADN program in South Carolina. Prior to becoming a nurse, Julie was an undercover drug investigator police woman in the Royal Air Force.

Deirdre (Dee) George, BSN, RN, Investigator. Dee completed her BSN in 1993 and completed her MBA in Healthcare Administration in 2016. Initially becoming licensed as a RN in Florida, Dee’s nursing experience includes L&D both as a staff nurse and manager as

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well as NICU and case management. Dee was employed as an L&D Manager in Ocala, Florida, before relocating to Texas in June of this year.

Nursing Jurisprudence Examination: The Jurisprudence examination required for initial licensure by Texas Occupations Code Section 301.252, License Application, was implemented in September 2008. Those applying for initial licensure by exam or endorsement after September 1, 2008 must pass the Jurisprudence Exam in order to be eligible for licensure. In addition, nurses who have not been current in Texas for four or more years, must complete the Jurisprudence Examination prior to reinstatement. Attached are statistics for Jurisprudence exam takers for past 3 fiscal years including through the fourth quarter of Fiscal Year 2017. (See Attachment B). Updates to the examination questions were made and incorporated during the first quarter of 2017. Department of Public Safety Audit: On June 14, 2017 the Texas Department of Public Safety (DPS) completed on an on-site audit designed to review the BON’s access, use, dissemination, storage, security and destruction of criminal history information (CHI) and BON Compliance with federal and state laws. On August 4, 2017, pursuant to the findings outlined in the audit, the BON outlined its plan to implement several changes to the CHI processes. These include the following:

BON no longer utilizes name based searches through DPS secure website; BON will unsubscribe to rap-back data for any licensee whose license is not active; BON will communicate with applicants regarding CHI only through secure mail; BON will no longer share CHI results with schools; BON will increase security associated with use of CHI such as increases in staff training, and

implementation of stronger IT solutions for continuous security; and BON has begun to limit hard copy use of CHI, and for all physical media will verify and

document destruction. These measures are designed to answer all DPS identified concerns. National Council of State Boards of Nursing (NCSBN) Projects: Staff continue the BON on- boarding process for the new NCSBN data base system, Optimal Regulatory Board System (ORBS). Launch of ORBS 2.0 will include licensing processes, complaint intake processes, investigations and enhanced functionality. This project continues to involve Intensive effort by the staff. Launch will take place in 2018. Information Technology Updates: This quarter the IT department has focused on end of year equipment/software orders. Configurations for new device that allows agency users to remote into their desktops (telework) was completed. The agency is making progress towards WordPerfect migration to Word. IT developed a new document to generate letters on a new Doc-Gen application. This application was used to generate 1575 permits during the Hurricane Harvey licensing efforts. The team continues to work with the ORBs team to develop a data migration strategy. Work continues on the BON eNLC system in anticipation of implementation. IT is assisting NCSBN with the testing phase of the Nursys 3.0 which begins in November. Staff will be finishing a hyper-convergence (network system/equipment/software) project that allows agency better internal network system functionality and better disaster recovery/business continuity functionality. Website: Google Analytics of user information on our website shows that there were 6,569,830 page views during the 90 day period from July to October 2017. Please note that the Hurricane Harvey page had 69,194 views during this period. (See Attachment C) Facebook: The Texas Board of Nursing page can be found at: https://www.facebook.com/Texas-Board-of-Nursing-1498436920404832/ The agency posts at least weekly.

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Key Meetings and Presentations: by the Executive Director and Staff since the last Board meeting. (Does not include internal meetings with staff). Executive Director Meeting: Interagency Prescription Monitoring Program Work Group, July 24, 2017, Austin Conference: Tri-Regulator Symposium, July 25-26, 2017, Chicago Presentation: Federal Trade Commission Roundtable - Streamlining Licensing Across State Lines: Initiatives to Enhance Occupational License Portability presented on webinar, July 27, 2017, Washington, D.C. Meeting: Texas Nurses Association staff, July 31, 2017, Austin Conference Call: Interstate Commission of Nurse Licensure Compact Administrators (ICNLCA) meeting, August 3, 2017 Webinar: NCSBN nursys.com Changes for clarity to the public, August 10, 2017 Meeting: E&D Advisory Committee Meeting, August 11, 2017 Meeting: Nurse Licensure Compact Administrators (NLCA) and ICNLCA Meetings, August 15, 2017, Chicago Meeting: NCSBN Annual Meeting, August 16-18, 2017, Chicago Meeting: Texas Nurses Association staff, August 24, 2017, Austin Conference Call: Texas ORBS Implementation, August 30, 2017 Conference Call: KSTAR Team Call, August 30, 2017 Meeting: Tri Regulator Leadership Meeting, September 6, 2017, Prospect, IL Meeting: CGFNS Leadership Meeting, September 8, 2017, Philadelphia Conference Call: TPAPN Program, September 13, 2017 Meeting: Indonesian Consulate General Staff, September 14, 2017, Austin Meeting: Eligibility & Disciplinary (E&D) Advisory Committee Meeting, September 15, 2017 Meeting: NCSBN Board of Directors, September 18-20, 2017, Chicago Meeting: Federal Nursing Leadership, September 21, 2017, Bethesda, MD Meeting: Nursing Tri Council, September 22, 2017, Washington, D.C. Presentation: 85th Legislative Session BON Update, Texas Nurses Association Leadership Conference, September 28-29, 2017, Georgetown, TX Training: Antitrust Issues for Regulators, Health Professions Council, October 2, 1017 Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, October 4, 2017

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General Counsel Conference Call: Recovery Trek Drug Screening, July 6, 2017 Meeting: Interagency Prescription Monitoring Program Work Group, July 24, 2017, Austin Meeting: ACE Meeting, July 25, 2017 Conference: Essential Cybersecurity Law, July 28, 2017 Conference: 12th Annual Advance Texas Administrative Law, August 24-25, 2017 Conference Call: KSTAR Team Call, August 30, 2017 Conference: Government Law and Liability Conference, September 6 and 7, 2017 Meeting: Meeting with Office of the Attorney General regarding Opioid Enforcement Issues, September 14, 2017, Austin Meeting: E&D Advisory Committee Meeting, September 15, 2017 Meeting: NPAC Meeting regarding Minor Incident Charge, September 21, 2017 Meeting: KSTAR Meeting, September 25, 2017 Meeting: Meeting with Sunset Staff, September 29, 2017, Austin Training: Antitrust Issues for Regulators, Health Professions Council, October 2, 1017 Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, October 4, 2017 Director of Operations Meeting: Dept. of Information Resources Customer Advisory Committee, July 26, 2017 Meeting: NCSBN 2017 Delegate Assemble Meeting, August 15 – 18, 2017, Chicago Meeting: Indonesia Consulate and Staff, September 7, 2017 Meeting: Health Professions Council, September 18, 2017 Meeting: New Deans and Directors, September 22, 2017 Conference: NCSBN Leadership and Public Policy Conference, October 11, 12, 2017, New Orleans Meeting: Texas Association of Deans and Directors of Professional Nursing Programs, October 13, 2017 Meeting: Dept. of Information Resources Customer Advisory Committee, October 16, 2017 Meeting: Texas Association of Vocational Nurse Educators, October 27, 2017 Director of Enforcement Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, July 21, 2017, Austin

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Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, July 28, 2017, Austin Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, July 26, 2017 Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, August 11, 2017, Austin Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, August 25, 2017, Austin Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, September 1, 2017, Austin Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, September 8, 2017, Austin Conference: Council on Licensure, Enforcement and Regulation, September 12-15, Denver, CO Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, September 22, 2017, Austin Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, September 29, 2017, Austin Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, October 4, 2017 Meeting: TPAPN 3rd Party Referral Reviews with TPAPN staff, October 5, 2017, Austin Director of Nursing and Nursing Consultants Meeting: Advisory Committee on Education, July 25, 2017, Austin Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, July 26, 2017 Conference Call: Texas Higher Education Coordinating Board and Academy of Nursing Education, July 27, 2017 Workshop: NCLEX Regional Workshop, July 28, 2017, Austin Meeting: Prescription Monitoring Program Work Group, July, 31, 2017, Austin Presentation: St. David’s Education Summit, July 28, 2017, Austin Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, May 3, 2017 Meeting: NCSBN Education Outcomes and Metrics Committee, August 1-2, 2018, Chicago, IL Conference: Nurse Tim Nuts and Bolts for Nurse Educators, August 4-5, 2017, Minneapolis, MN Meeting: NPR: Minor Incidents, August 4, 2017, Austin Presentation: Geriatric Symposium, August 7, 2017, Austin Meeting: Eligibility and Discipline Advisory Committee Meeting, August 8, 2017, Austin Conference Call: NCSBN Policy Network Knowledge Call, August 9, 2017 Webinar: NURSYS, August 11, 2017 Meeting: NCSBN Annual Meeting, August 15-18, 2017, Chicago, IL

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Presentation: Army Faculty Event, August 22, 2017, San Antonio Presentation: Protecting Your Patients and Your Practice, Nursing Jurisprudence and Ethics, August 23, 2017, Houston Conference Call: NCSBN Practice Knowledge Network Call, August 24, 2017 Meeting: Joint Nursing Research Committee, August 24-25, 2017, Chicago, IL Conference Call: Texas Team Advancing Education Committee, August 28, 2017 Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, August 30, 2017 Conference Call: Community College BSN’s, August 31, 2017 Conference Call: NCSBN Committee Chair Orientation Call, September1, 2017 Meeting: TPAPN Advisory Committee Meeting, September 1, 2017, Austin Meeting: Texas Department of Health and Human Services, September 1, 2017, Austin Conference Call: Texas Children’s Hospital APRN Scope of Practice, September 12, 2017 Conference Call: NCSBN Leadership Succession Committee, September 13, 2017 Presentation: A Collaborative Approach to Address Nursing Practice Breakdown, Doctors of Nursing Practice Annual Meeting, September 13-14, 2017, New Orleans, LA Meeting: Texas Medical Association Stakeholder Meeting on Infection Control Prevention in Long Term Care, September 14, 2017, Austin Meeting: TDLR Advisory Board on Cosmetology- Audit, September 18, 2017 Presentation: Austin Community College, September 20, 2017, Austin Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, September 20, 2017 Meeting: Nursing Practice Advisory Committee, September 21, 2017, Austin Presentation: New Deans, Directors, and Coordinators Orientation, September 22, 2017, Austin Meeting: Advisory Committee on Education, September 25, 2017, Austin Conference Call: Texas Team Advancing Education Committee, September 25, 2017 Meeting: NCSBN Leadership Succession Committee, September 25-26, 2017, Chicago, IL Meeting: TMB Stakeholder Meeting, Nurses Performing Radiological Procedures, September 28, 2017, Austin Conference: Texas Nurses Association Leadership, September 28-29, 2017, Austin Meeting: HHSC eHealth Advisory Committee, September 29, 2017, Austin

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Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, October 4, 2017 Presentation: Education Informal Information Session, October 10, 2017, Austin Conference: NCSBN Public Policy & Leadership, October 11-13, 2017, New Orleans, LA Meeting: Texas Association of Deans and Directors of Professional Nursing Programs, October 13, 2017, Austin Meeting: Texas Team, October 17-18, 2017, Austin Conference Call: Texas A&M College of Nursing/RCHI/ BON KSTAR Nursing Pilot, October 18, 2017 Conference Call: Texas Team Advancing Education Committee, October 23, 2017 Conference: Texas Association of Vocational Nurse Educators, October 26-27, 2017, Austin

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Quarterly Statistics Where Executive Director Closed Cases in Compliance with Board Policy:

Case Resolution Report

June 1, 2017 through August 31, 2017

Type of Action Total

No Jurisdiction 9

No Violation 5

No Action 287

Insufficient Evidence 140

Admonish 14

Without Prejudice 1587

TPAPN Referrals 80

EEP Referrals 9

Corrective Actions 33

Totals 2,164

Temporary Suspension Case Resolution Report June 1, 2017, through August 31, 2017

Type of Action

Total

Voluntary Surrender

2

Enforced TPAPN

2

Voluntary Surrender/Enforced Suspension (Surrender of APN/Suspension of RN)

1

Suspend Probate

2

Totals 7

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Quarterly Statistics Where Executive Director Ratified Requests for Exception

in Compliance with Board Policy:

REQUESTS FOR EXCEPTION TO A PREVIOUSLY ISSUED AGREED ORDER June 1, 2017 through August 31, 2017

Total Number of Requests Received 30

Number of Requests Resolved 36

Number of Requests Granted by Executive Director

16

Number of Requests Granted by Eligibility and Disciplinary Committee

17

Number of Requests Denied by Eligibility and Disciplinary Committee

1

Number of Requests Denied Pursuant to Board’s Guidelines for Exceptions to Existing Board Orders

2

Number of Requests Pending 31*

*Seven (7) requests on November 14, 2017 E&D.

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Cases Where Executive Director Offered and Entered Ordered Orders in Compliance with Board Policy:

LVN DISCIPLINARY ORDERS Time frame: June 1, 2017, through August 31, 2017

DISCIPLINARY

8 1 1 1 2 1 1 1

FINE AND REMEDIAL EDUCATION Inappropriately submitted thirty-three (33) blank and/or incomplete home health visit notes Verbally abused a patient by saying “I’m gonna beat your fucking ass,” and subsequently flipped him off with her middle finger Inaccurately documented the wastage of Diazepam on the narcotic tracking count log Practiced as a Vocational Nurse without a valid license Verbally abused a resident by telling him if he was “not a full code” she would let him die and then subsequently referred to him as a “sorry son of a bitch” and flipped him off Left her nursing assignment without notifying the appropriate personnel Failed to follow the facilities poly and procedure for wastage of unused portions of medications, instead transferred the medications between two county jails to administer to other patients

9 1 1 1 1 1 1 1 1 1

TPAPN CONFIDENTIAL BOARD ORDEREngaged in the intemperate use of Morphine, Codeine, and Marijuana Was found unresponsive and admitted into Memorial Hermann Hospital for a drug overdose Engaged in the intemperate use of cocaine Admitted to the emergency room where a specimen was collected and tested positive for Opiates, Amphetamine, Barbiturates and Benzodiazepines Signed a three (3) year participation contract with the Texas Peer Assistance Program PUBLIC TPAPAN BOARD ORDER Diverted Morphine and Dilaudid; intemperate use of Opiates TPAPN ENFORCED SUPSENSION BOARD ORDER Non-compliance with prior TPAPN participation agreement Misappropriation of five syringes of Dilaudid 2mg and five vials of Ativan 2mg, Fentanyl and Midazolam Diagnosed with Opiod Use Disorder

5 1 1 1 1 1

REMEDIAL EDUCATION Provided a falsified Health Statement/Release Form to the agency Abandoned nurse station 3 without assessing the residents and reporting to the oncoming nurse Left nursing assignment before the end of shift, failing to wait for the oncoming nurse to arrive Failed to administer or document the administration of scheduled medications, feeding and saline flushes Failed to report the suspected abuse of the patient’s sister, a minor, to a law enforcement agency

14 2 1 1 1 1 1 1 1 1 4

VOLUNTARY SURRENDER Non-compliance with previous Board Order Convicted of second degree felony Intoxication Manslaughter Deferred judgment for third degree felony Credit Card or Debit Card Abuse Elderly Deferred judgment for state jail felony Possession of a Controlled Substance and Third degree felony Debit Card Abuse Against Elderly Individual Failed to ensure emergency equipment was available; patient subsequently expired Violated professional boundaries by assaulting patient in a sexual manner Falsely documented pain assessments for multiple patients; incorrectly entered a verbal physician’s order for Dilaudid instead of Demerol Failed to timely administer morning medications and falsely documented the time medication given Submitted a statement voluntarily surrendering their license to practice nursing

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LVN CORRECTIVE ACTION ORDERS Time frame: June 1, 2017, through August 31, 2017

16 1 7 1 1 1 1 2 1 1

LVN CORRECTIVE ACTION Failed to complete and submit required nursing documentation for multiple patients Practiced as a Vocational Nurse without a valid license Failed to document an assessment, including a pain assessment Misread medication label for a student subsequently administering 40mg Propranolol instead of 10mg Failed to accurately document in medical record the Situation-Background-Assessment-Request form Inaccurately documented in the Medical Necessity and Level of Care Assessment that patient had renal failure Was made aware of an inappropriate video of a resident taken by the aides and failed to report it Incorrectly documented the administration of Xifaxin in a patient’s medical record Withdrew three tabs of Hydrocodone 10mg but failed to document the administration

0 ENDORSEMENT CORRECTIVE ACTION 0 APPLICANT/PETITIONER CORRECTIVE ACTION

LVN DEFERRED DISCIPLINE ORDERS Time frame: June 1, 2017, through August 31, 2017

1 1

REMEDIAL EDUCATION – DEFERRED DISCIPLINE Failed to document the patient’s physician was notified of the patients elevating blood sugar

0 FINE W/ REMEDIAL EDUCATION – DEFERRED DISCIPLINE

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LVN ENDORSEMENT/PETITIONER DISCIPLINE ORDERS Time frame: June 1, 2017, through August 31, 2017

384 1 1 1 1 1 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 5 1 1 3 346

APPLICANTS/PETITIONERS DISICPLINE ORDER Convicted of felony Possession of a Controlled Substance PG, Namely Methamphetamine Submitted Fraudulent and falsified nursing services/patient care Convicted of felony Theft $1500 - $20,000 Deferred judgment for felony Possession of a Controlled Substance; and misdemeanor Theft – Retail and Theft Control Intent <$500 Deferred judgment for felony Secure Execution of Document by Deception >=$1500 < $20K Completed treatment for substance abuse Convicted of felony Forgery; misdemeanor Fail to Identify Fugitive Intent Give False Info. Deferred judgment for misdemeanor Fail to identify Fugitive from Justice and Possession of Marijuana Under two ounces Convicted of misdemeanor Theft by Shoplifting, Disturbing the Peace and Marijuana – Possess Deferred judgment for felony Theft of Property >=$1500 <$20K Convicted of felony Forgery Government Instrument/Money/Securities and misdemeanor Theft by Check Deferred judgment for felony Credit Card Abuse and Unauthorized Use of a Motor Vehicle Deferred judgment for felony Aggravated Assault Convicted of misdemeanor two counts of Driving While Intoxicated/Open Alcohol Container; deferred judgment for three counts of misdemeanor Possession of a Controlled Substance Deferred judgment for misdemeanor Theft Diagnosed with mental health disorder Disciplinary Action taken by another Licensing Authority Convicted of misdemeanor Possession of a Controlled Substance and use Under Influence CS Deferred judgment for felony Tampering with Government Record, and Evading Arrest/Detention/ Vehicle; convicted of misdemeanor Criminal Attempt and Assault – Simple Deferred judgment for felony Welfare Fraud $1,500 - $20,000 and misdemeanor Theft Convicted of misdemeanor six counts of Theft by Check Convicted of felony Conspiracy to Possess with Intent to Distribute a Controlled Substance Deferred judgment for felony offense of Possession of a Controlled Substance Convicted of misdemeanor Possession of Marijuana 0-2 oz, Theft $50 - $500 and Assault – Bodily Injury; deferred judgment for misdemeanor Interference With Peace officer and Resisting Arrest Deferred judgment for felony Forgery and misdemeanor Possession of Marijuana Under 2 oz Deferred judgment for misdemeanor Theft – Aggregation Prior Board Order during petition process Deferred judgment for two counts of felony Forgery Financial Instrument Conviction of felony Welfare Fraud $1,500 - $20,000 and misdemeanor Shoplifting and Theft by Check of Property $20 - $500 Denial of Licensure No Grounds for Denial

57 1 1 3 52

ENDORSEMENT DISCIPLINE ORDER Convicted of misdemeanor Falsely Reporting a Crime Convicted of felony Burglary and misdemeanor Theft by Check $20 Disciplinary Action taken by another Licensing Authority No Grounds for Denial

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Cases Where Executive Director Offered and Entered Ordered Orders in Compliance with Board Policy:

RN DISCIPLINARY ORDERS Time frame: June 1, 2017, through August 31, 2017

DISCIPLINARY

4 1 1 1 1

FINE AND REMEDIAL EDUCATIONInappropriately accessed patient medical record approximately seven times without a valid reason Provided false and misleading information when she submitted online applications for renewal Practiced Professional Nursing without a valid license Documented and submitted skilled nursing visit notes

9 1 1 1 1 1 1 3

REMEDIAL EDUCATION Submitted inaccurate documentation for a visit with a patient that did not occur on the date in question Withdrew a total of 4mg of Morphine, three (3) tablets of Norco, and 18mg of Dilaudid in excess of physician’s order Failed to monitor and supervise the nursing care and performance of tasks by her nursing staff Inappropriately restrained a patient with four limb, soft restraints and tied the patient’s mittens to the bed when patient was only ordered to have two limb, soft restrains Misappropriated four tablets of Hydrocodone Withdrew one tablet of Norco without a physician’s order and failed to document the administration or follow proper wastage procedures; misappropriation of Norco Disciplinary action taken by another Licensing Authority

22 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

TPAPN CONFIDENTIAL BOARD ORDERIntemperate use of Hydromorphone Intemperate use of Morphine and Oxycodone Lacked fitness to practice by exhibiting signs of impaired behavior while on duty Failed to verify the dosage of a medication prior to administration; removed hydromorphone but failed to follow policy and procedures for proper wastage Deferred judgment for felony Driving Under Influence of Alcohol Intemperate use of Codeine, Hydrocodone, Hydromorphone, and Midazolam Misappropriation of four syringes of Hydromorphone, one syringe of Fentanyl and one syringe of Morphine, admitted to having a substance abuse problem Intemperate use of Hydromorphone Intemperate use of Norco PUBLIC TPAPAN BOARD ORDER Intemperate use of Cocaine Intemperate use of Opiates Non-compliance with prior TPAPN self-referral Intemperate use of Alcohol Misappropriated Meperidine, Hydrocodone, Hydromorphone Alprazolam, Temazepam, Tylenol 3, Diazepam and Lorazepam Self-referred to Texas Peer Assistance Program for Nurses Diagnosed and treated for Alcohol Use Disorder TPAPN ENFORCED SUPSENSION BOARD ORDER Deferred judgment for state jail felony Divert Controlled Substance for Personal Use Misappropriation of Hydromorphone, Falsely documented the administration of pain medication; intemperate use of Morphine Defaulted on Texas Guaranteed Student Loans Misappropriation and Intemperate use of Hydromorphone Failed to follow procedures for the management of controlled substances, failed to take precautions to prevent the misappropriation of Demerol; misappropriation of Fentanyl and Midazolam Non-compliance with prior TPAPN Board Order

17

30 5 1 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

VOLUNTARY SURRENDER Non-compliance with previous Board Order Disciplinary action taken by another licensing authority Submitted a statement voluntarily surrendering their license to practice nursing Convicted of Driving While Intoxicated; Assault of a Public Servant and Public Intoxication Diversion of Dilaudid; falsely documented pain assessments for multiple patients; incorrectly entered a verbal physician’s order for Dilaudid instead of Demerol Intemperate use of alcohol by consuming alcohol prior to reporting to duty Inappropriately touched one patient on 2 occasions in that he moved his hands across her breasts and another patient on 3 occasions by inserting his fingers inside her vagina Practiced fell below the minimum standards by engaging in non-therapeutic prescribing practices Misappropriation of 3cc syringes with full needles, 10cc syringes, Propofol and supplies Received treatment for detoxification, suicidal ideation, mood disorder, and opiod dependence Misappropriation of 22 vials of Dilaudid and eight vials of Morphine for personal use; intemperate use of Dilaudid and Morphine Engaged in non-therapeutic prescribing practices by prescribing prescriptions without conducting appropriate assessments Convicted of Second degree felony Intoxication Manslaughter Removed patients confidential personal health information without authorization; convicted of felony Wrongful Disclosure of Individually Identifiable Health Information Issued prescriptions for six patients without conducting appropriate assessments Falsified start and end times on the home health visit notes for multiple patients Observed and photographed sleeping while on duty; failed to ensure emergency equipment was available; patient subsequently expired Misappropriation of thirty-four injections of Meperidine

18

RN CORRECTIVE ACTION ORDERS Time frame: June 1, 2017, through August 31, 2017

15

3 1 1 1 1 1 1 1 1 1 1 1 1

RN CORRECTIVE ACTION Practiced nursing without a valid nursing license Failed to complete and submit required nursing documentation for multiple patients Failed to completely document the events surrounding the care and transfer of a patient o a higher acuity floor Failed to assess and/or document the symptoms when his BP was reported to be 87/47 Administered doses of liquid Tylenol; to multiple patients from her own personal supply Exceeded authorized scope of practice by suturing a patient’s finger Designated as the facility’s abuse coordinator was made aware of an inappropriate video of a resident taken by the aides and failed to report it Incorrectly documented that she administered Xifaxin in a patient’s medical record Accessed patient medical record without written authorization and without being assigned to provide patient care Failed to document a lumber puncture procedure which she assisted Provided inaccurate and misleading information by not disclosing disciplinary action against Chiropractic license Failed to ensure the facility’s policy for “Nursing Peer Review Plan / Safe Harbor Request” Failed to verify the name of a patient on the bag of intravenous Potassium chloride and administered the bag of IV Potassium Chloride to a patient in error

0 ENDORSEMENT CORRECTIVE ACTION 0 APPLICANT/PETITIONER CORRECTIVE ACTION

RN DEFERRED DISCIPLINE ORDERS Time frame: June 1, 2017, through August 31, 2017

3

1 1 1

REMEDIAL EDUCATION – DEFERRED DISCIPLINE Failed to document administration of medication Mistakenly documented that the set-up equipment was ready to be used if needed during the first endoscopy procedure Failed to document the patient’s physician was notified of the patients elevating blood sugar

0 FINE W/ REMEDIAL EDUCATION – DEFERRED DISCIPLINE

19

RN ENDORSEMENT/PETITIONER DISCIPLINE ORDERS Time frame: June 1, 2017, through August 31, 2017

239

20 1 3 1 1 1 4 208

ENDORSEMENT DISCIPLINE ORDERDisciplinary Action taken by another Licensing Authority Deferred judgment for felony Possession of a Controlled Substance of less than one gram namely: Methamphetamine Non-disclosure of criminal history or disciplinary action on application for licensure by Endorsement Diagnosed with Opiod Use Disorder, Sever, History of Opiod Withdrawal and Alcohol Use Disorder Practiced as a Registered Nurse in violation of the Nurse Licensure Compact Petitioner is treatment for substance abuse through working the 12-Step program Denial of Licensure No Grounds for Denial

742 1 1 3 1 1 1 1 1 1 6 1 1 1 1 3 1 1 4 1 1 3 707

APPLICANTS/PETITIONERS DISICPLINE ORDERDeferred judgment for felony Possession of Cocaine Less Than One Gram; conviction of misdemeanor Possession of Marijuana Article 15 military non-disciplinary action Deferred judgment for felony Theft $1500 - $20,000 Provided false, deceptive information in that she indicated that she would graduate from University of Texas-Arlington Deferred judgment for felony Aggravated Robbery Failed to provide required wound care treatments while practicing as a vocational nurse Pre-Trial Diversion for misdemeanor Possession of a Deadly Weapon; convicted of felony Grand and Theft by Employee Failed to ensure timely Cardio Pulmonary Resuscitation was initiated Administered 11 medications which had been refused by one resident to another who did not have a physician’s order for 7 of the 11 medications administered Entered treatment for substance use/abuse Failed to manually ventilate as ordered when the patient was not being properly Oxygenated Convicted of felony Injury to a Child 14 years or Younger Convicted of felony Tamper with Physician Evidence; misdemeanor Possession of Marijuana and Driving While Intoxicated Deferred judgment for misdemeanor Possession of Marijuana and Assault Causes Bodily Injury Deferred judgment for felony Credit/Debit Card Abuse Deferred judgment for felony Possession of Marijuana 4 oz – 5 lbs Deferred judgment for misdemeanor Possession of Marijuana; convicted of misdemeanor Resisting Arrest and two counts of Driving While Intoxicated Deferred judgment for felony Possession of a Controlled Substance Convicted of felony Forgery and Possession of Prohibited Weapon Denial of Licensure Prior Board Order during petition process No Grounds for Denial

TO: Ms. Kathy Thomas, MN, RN, FAAN, Executive Director, Texas Board of Nursing FROM: Pamela Lauer, Program Director, Texas Center for Nursing Workforce Studies DATE: 09/30/2017 SUBJECT: Texas Center for Nursing Workforce Studies, Center for Health Statistics

Expenditure of Funds Obtained from the Texas Board of Nursing – FY 2017 Annual Financial Report. HB 3126, the bill that established the TCNWS, requires the center to present an annual financial report to the SHCC and the Texas Board of Nursing (BON). The Texas Board of Nursing collects $3 per Registered Nurse and $2 per Licensed Vocational Nurse per 2 year licensing cycle to help fund the Texas Center for Nursing Workforce Studies. This report provides an accounting of how TCNWS funds were spent FY 2017. See Attachment 1. Deliverables. During FY 2017, the following nursing workforce projects were completed. These projects and reports represent the most current and comprehensive picture of the nursing workforce in Texas.

Reports Published during FY 2017: 2016 Reports on Professional Nursing Education Programs in Texas:

o Professional Nursing Program Characteristics o Student Admission, Enrollment and Graduation Trends o Faculty Demographics o Student Demographics

2016 Reports on Advanced Practice Nursing (APRN) Education Programs in Texas: o APRN Program Characteristics o Student Admission, Enrollment and Graduation Trends in APRN Programs o Faculty Demographics in APRN Programs o Update on Student Demographics in APRN Programs

TEXAS DEPARTMENT OF STATE HEALTH SERVICES

JOHN HELLERSTEDT, M.D. COMMISSIONER

P.O. Box 149347Austin, Texas 78714-9347

1-888-963-7111TTY: 1-800-735-2989

www.dshs.state.tx.us

2016 Reports on Vocational Nursing (VN) Education Programs in Texas: o Vocational Nursing Program Characteristics o Student Admission, Enrollment and Graduation Trends o Student Demographics in VN Programs o Faculty Demographics in VN Programs

Reports from the 2016 Hospital Nurse Staffing Study

o Design and Methods o Agency Characteristics o Staffing o Vacancy and Turnover o Hiring Practices o Recruitment and Retention o Appendices

Reports from the 2016 Long Term Care Nurse Staffing Study

o Design and Methods o Agency Characteristics o Staffing o Vacancy and Turnover o Hiring Practices o Recruitment and Retention o Appendices

Texas Nurse Supply and Demand Projections, 2015-2030

Workplace Violence Against Nurses in Texas Report

For further information about this financial report, please contact Pamela Lauer at the Texas Center for Nursing Workforce Studies by phone at (512)776-6723 or via e-mail at pamela.lauer@dshs.texas.gov

Attachment 1 TCNWS Budget Summary:

Disposition of Funds Received from the Board of Nursing – FY 2017

Budget Major Categories 

Budget Category  Budget Detail  FY 2017 1 

 Budgeted Amount    2017 APPROPRIATION + Unexpended Balance Carried Forward from FY 16  $466,168.412 

Salary and Wages  1001 Salary and wages for 1 Program Specialist VI, 2 Program Specialist IV, 1 Research Specialist IV, 1 Research Specialist II  $272,731.47 

Other Personnel Costs  1002A  Longevity Pay, Additional Retirement Contributions, Merit Bonus  $8,385.52 

Agency Payroll Contribution  2009A  Payroll Health Insurance Contribution  $2,727.43 

Fringe  9999 Employee Benefits (FICA Employer Matching, Employee Insurance Payments Employer Contribution, Employee Retirement State Contribution)  $84,361.08 

Professional Services and Fees  2001  Software training  $8,956.00 

Consumable Supplies  2003  Office Supply Orders  $56.78 

Telecommunication Parts and Supplies  2004  Headsets  $661.12 

In‐State Travel  2005  To: Texas Public Health Association Conference   $2,188.25 

Out‐of‐State Travel  2005A  To: National Forum of State Nursing Workforce Centers Annual Conference  $3,795.13 

Rent  2006 Conference Exhibits: Texas Public Health Association, Texas Hospital Association, Texas Organization of Nurse Executives  $8,450.00 

Other Operating Expenses  2009 Survey Software, Membership dues, Office Supplies, Publications and Printing Services, Registration Fees, Promotional Items, and Staff Training  $39,460.673 

Total Expenses    $431,773.45

1 Fiscal Year 2017 began September 1, 2016 and ended on August 31, 2017. 2 In FY 2017, TCNWS received $411,550 from the Texas BON. 3 In FY 2017, TCNWS made in-kind contributions to the Center for Health Statistics in exchange for the payment made in FY 2016 to cover the outstanding balance on the IHS Supply and Demand Projections contract. Approximately $27,000 were paid in-kind.

5 Education Statistics5.1 Nursing Jurisprudence Exam Statistics Totals FY'14 Totals FY'15 Totals FY'16 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Running FY 2017

5.1.1 Total Nursing Jurisprudence Exam taken 46,193 41,696 34,988 9001 7,618 10997 8665 36281

5.1.1.1 Exam Not Completed (total) 14,324 6,553 853 316 233 330 285 1164

5.1.1.2 Percentage Not Completed 27.6625 15.14 2.48 3.51 3.06 3.00 3.29 3.22

5.1.1.3 Did Not Pass the Exam (total) 3,910 5,529 5,435 1439 1546 1918 1967 6870

5.1.1.4 Percentage Did Not Pass Exam 7.45 13.855 15.66 15.99 20.29 17.44 22.70 19.10

5.1.1.5 Exam Passed (Total) 27,960 28,814 28,700 7246 5,839 8749 6413 28247

5.1.1.6 Percentage Exam Passed 64.885 71.00 81.86 80.50 76.65 79.59 74.01 77.69

5.1.2 LVN-Candidate 8,632 7,846 6,530 1477 1,333 1541 2263 6614

5.1.2.1 Exam Not Completed 2,217 1,007 105 44 43 42 50 179

5.1.2.3 Did Not Pass the Exam 1,201 1,667 1,520 362 395 425 607 1789

5.1.2.5 Exam passed 5,214 5,172 4,905 1071 895 1074 1606 4646

5.1.3 LVN-Endorsement 2,604 2,212 1,917 419 414 417 481 1731

5.1.3.1 Exam Not Completed 958 433 43 22 16 13 29 80

5.1.3.3 Did Not Pass the Exam 415 559 588 114 135 128 172 549

5.1.3.5 Exam passed 1,231 1,220 1,286 283 263 276 280 1102

5.1.4 RN-Candidate 18,694 15,334 14,406 4170 3,120 5918 2896 16104

5.1.4.1 Exam Not Completed 5,459 2,218 386 155 106 189 105 555

5.1.4.3 Did Not Pass the Exam 1,108 1,415 1,705 523 544 831 717 2615

5.1.4.5 Exam passed 12,128 11,701 12,315 3492 2,470 4898 2074 12934

5.1.5 RN-Endorsement 15,000 14,464 11,276 2752 2,563 2878 2845 11038

5.1.5.1 Exam Not Completed 5,220 2,699 308 90 66 76 96 328

5.1.5.3 Did Not Pass the Exam 1,138 1,821 1,545 419 453 498 455 1825

5.1.5.5 Exam passed 8,642 9,944 9,423 2243 2,044 2304 2294 8885

5.1.6 Refresher Course/Renewal Requirements 1,262 1,040 859 183 188 243 180 794

5.1.6.1 Exam Not Completed 470 196 11 5 2 10 5 22

5.1.6.3 Did Not Pass the Exam 48 67 77 21 19 36 16 92

5.1.6.5 Exam passed 744 777 771 157 167 197 159 680

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