cathy boden presentation
DESCRIPTION
TRANSCRIPT
Standards of Nursing Practice Standards of Nursing Practice ForFor
2009 ALAA Fall Conference2009 ALAA Fall Conference
Presented byPresented byCathy Boden, MSN, RNCathy Boden, MSN, RN
Nurse Consultant for Legal DivisionNurse Consultant for Legal DivisionAlabama Board of NursingAlabama Board of Nursing
September 2009September 2009
ObjectivesObjectives
Identify factors that determine what a Identify factors that determine what a nurse can do once they are hired by an nurse can do once they are hired by an employer.employer.
Discuss standards of nursing practice.Discuss standards of nursing practice. Recognize and report substandard Recognize and report substandard
nursing practice. nursing practice.
Who is the Alabama Board Who is the Alabama Board of Nursing?of Nursing?
What is the mission of the What is the mission of the ABN?ABN?
Alabama Board of NursingAlabama Board of Nursing
Legislature passed first law Legislature passed first law establishing Board in 1915establishing Board in 1915
Initial approach was to standardize Initial approach was to standardize nursing education requirementsnursing education requirements
Voluntary registrationVoluntary registration Practical nurses first came into being Practical nurses first came into being
after World War IIafter World War II
Composition of the ABNComposition of the ABN
Established by The Alabama Nurse Established by The Alabama Nurse Practice Act Practice Act
13 members - as of July 2009, one 13 members - as of July 2009, one RN nursing education position was RN nursing education position was vacantvacant
Appointed by the Governor for 4 year Appointed by the Governor for 4 year terms – max of 2 consecutive terms terms – max of 2 consecutive terms or 8 consecutive yearsor 8 consecutive years
Composition of the ABN Composition of the ABN Cont’dCont’d 8 RN Positions8 RN Positions
3 (Three) must be from practice or administration 3 (Three) must be from practice or administration 3 (Three) must be from nursing education3 (Three) must be from nursing education 2 (Two) must be advance practice nurses2 (Two) must be advance practice nurses
4 LPN Positions4 LPN Positions 2 Nominated by Licensed Practical Nurses 2 Nominated by Licensed Practical Nurses Association of Alabama (LPNAA)Association of Alabama (LPNAA) 2 Nominated by Alabama Federation of 2 Nominated by Alabama Federation of Licensed Practical Nurses (AFLPN)Licensed Practical Nurses (AFLPN)
1 Consumer1 Consumer No financial gain from health care and not No financial gain from health care and not
previouslypreviously a health care professionala health care professional
Nurse Consultants of ABN Nurse Consultants of ABN under Executive Officer, under Executive Officer,
Genell LeeGenell LeeLegal Division Legal Division VDAPVDAP
EducationEducation Advanced Advanced PracticePractice
Continuing Education/Practice Continuing Education/Practice
Mission of the ABNMission of the ABN
The mission of the Alabama Board of The mission of the Alabama Board of Nursing is Nursing is public protection public protection through the regulation of through the regulation of
nursing educationnursing education nursing practicenursing practice
Who does the ABN work/advocate Who does the ABN work/advocate for?for?
Board InformationBoard Information
www.abn.state.al.uswww.abn.state.al.us
ABN Attorney & InvestigatorsABN Attorney & Investigators
ABN Attorney is a Deputy Attorney ABN Attorney is a Deputy Attorney GeneralGeneral
Investigators have law enforcement Investigators have law enforcement background, no power to arrestbackground, no power to arrest
Who does the ABN Who does the ABN work/advocate for?work/advocate for?
Patients?Patients? Nurses?Nurses?
Professional AssociationsProfessional Associations American Nurses Association (ANA)American Nurses Association (ANA)
– – ASNA (Alabama State Nurses Association)ASNA (Alabama State Nurses Association) Specialty Associations (Incomplete list)Specialty Associations (Incomplete list)
AACNAACN AORN (Association of Peri-Operative Nurses)AORN (Association of Peri-Operative Nurses) ENS (Emergency Nurses Association)ENS (Emergency Nurses Association) Infusion Nurses SocietyInfusion Nurses Society American Gastroenterology Association American Gastroenterology Association WOCN (Wound Ostomy & Continence Nurses WOCN (Wound Ostomy & Continence Nurses
Society)Society) Nephrology Nursing AssociationNephrology Nursing Association
Who do the Associations Who do the Associations work/advocate for?work/advocate for?
Patients?Patients? Nurses?Nurses?
Is it true that “A nurse is a Is it true that “A nurse is a nurse is a nurse…..”?nurse is a nurse…..”?
What determines What determines differences?differences?
Is it the nurse’s education program?Is it the nurse’s education program?Is it what the nurse wears to work?Is it what the nurse wears to work?Is it the facility where the nurse Is it the facility where the nurse works?works?Is it the license the nurse holds?Is it the license the nurse holds?
Differences determined Differences determined by….by….
Educational preparationEducational preparation
Licensure Licensure
Roles & Scope of PracticeRoles & Scope of Practice
Nursing ExperiencesNursing Experiences
CompetencyCompetency
Differences in Differences in BasicBasic Educational Educational PreparationPreparation
LPNLPN 1 Year1 Year
RNRN ADN = 2 yearsADN = 2 years
BSN = 4 yearsBSN = 4 years
Begin with type of Nursing Education Begin with type of Nursing Education ProgramProgram
Additional Factors of Additional Factors of BasicBasic Nursing Education Nursing Education
Including but not limited toIncluding but not limited to Clinical experiences available in schoolClinical experiences available in school
Expertise of InstructorsExpertise of Instructors
Student motivation/reason for entering Student motivation/reason for entering programprogram
Basic Education for Nursing Basic Education for Nursing ProgramsPrograms
Practices/Procedures/Treatments taught in the Practices/Procedures/Treatments taught in the nurse’s basic educational program (RN & LPN).nurse’s basic educational program (RN & LPN).
Vital Signs*Vital Signs* Make a BedMake a Bed Bed BathsBed Baths Comfort CareComfort Care Administer MedicationsAdminister Medications
-- Oral Oral -- Topical - InhalationTopical - Inhalation Perform InjectionsPerform Injections
- IM - SQ - Intradermal- IM - SQ - Intradermal - Z track- Z track
Basic Nursing Education RN & LPNBasic Nursing Education RN & LPN Cont’dCont’d
Insert Foley CathetersInsert Foley Catheters FemalesFemales Maybe MalesMaybe Males
Change basic dressingsChange basic dressings Basic Infection ControlBasic Infection Control
Sterile glovingSterile gloving Sterile field: create & maintain Sterile field: create & maintain
Biohazard waste disposalBiohazard waste disposal
Additional Basic Nursing Education Additional Basic Nursing Education
for the RN for the RN (incomplete listing)(incomplete listing) Cardiovascular Alterations - Hemodynamic Cardiovascular Alterations - Hemodynamic
MonitoringMonitoring Respiratory AlterationsRespiratory Alterations
Endotracheal Tube ManagementEndotracheal Tube Management Tracheostomy ManagementTracheostomy Management Ventilator MonitoringVentilator Monitoring
Neurological AlterationsNeurological Alterations Glascow Coma ScaleGlascow Coma Scale Intracranial Pressure MonitoringIntracranial Pressure Monitoring
Management & PrioritizingManagement & Prioritizing Nursing Leadership & ManagementNursing Leadership & Management
Specifics of LPN EducationSpecifics of LPN Education Until 2005/2006, Basic IV Therapy was not Until 2005/2006, Basic IV Therapy was not
in curriculumin curriculum
Until August 2008, Body Structure & Until August 2008, Body Structure & Function is in the curriculum instead of Function is in the curriculum instead of Anatomy & Physiology with corresponding Anatomy & Physiology with corresponding lablab
Curriculum does not include Curriculum does not include MicrobiologyMicrobiology ChemistryChemistry
Clinical many times does not includeClinical many times does not include Psychiatric NursingPsychiatric Nursing
ADMISSION TO PRACTICEADMISSION TO PRACTICE
LicensureLicensure
LicensureLicensure
RepresentsRepresents Specialized knowledgeSpecialized knowledge
Independent judgmentIndependent judgment
Fitness and Capacity to PracticeFitness and Capacity to Practice
RequiredRequired to practice nursing in the to practice nursing in the state of Alabamastate of Alabama
LicensureLicensure
Alabama is NOT part of the licensure Alabama is NOT part of the licensure compact at this time.compact at this time.
Temporary PermitTemporary Permit
New graduates may request a New graduates may request a nonrenewable temporary permit to nonrenewable temporary permit to practice nursing that is valid untilpractice nursing that is valid until The applicantThe applicant fails fails the licensing the licensing
examination.examination. The The expiration dateexpiration date on the permit is on the permit is
reached.reached. A A licenselicense is issued. is issued. The applicant is The applicant is denieddenied licensure. licensure.
Temporary PermitTemporary PermitAdministrative CodeAdministrative Code § 610-X-4-.07 § 610-X-4-.07
Signatures:Signatures: Practical Nurse (PN) Program = NG-PNPPractical Nurse (PN) Program = NG-PNP RN Program = NG-RNPRN Program = NG-RNP
Restrictions: The Nursing GraduateRestrictions: The Nursing Graduate Must function under Must function under DIRECTDIRECT Supervision of a Supervision of a
currently licensed currently licensed Registered NurseRegistered Nurse Shall not assume nor be assigned charge Shall not assume nor be assigned charge
responsibilitiesresponsibilities
Licensure RenewalLicensure Renewal
LPN’s - odd numbered yearsLPN’s - odd numbered years December 31, 2009December 31, 2009
RN’s - even numbered yearsRN’s - even numbered years December 31, 2010December 31, 2010
Continuing education is required for Continuing education is required for renewalrenewal
License RenewalLicense Renewal
““The licensed nurse shall have the The licensed nurse shall have the active license renewal card available active license renewal card available for employer inspection by January 1 for employer inspection by January 1 of the new license period.”of the new license period.”
Administrative CodeAdministrative Code § 610-X-4-.08(4) § 610-X-4-.08(4)
License LookupLicense Lookup This application is for LICENSE LOOKUP.This application is for LICENSE LOOKUP. Updated daily by 8:00 am.Updated daily by 8:00 am. Search by entering the license number or Search by entering the license number or
the entire last and first name or by the entire last and first name or by portions of last and first nameportions of last and first name..
License LookupLicense Lookup
GROUP ONLINE LICENSE GROUP ONLINE LICENSE VERIFICATION BY VERIFICATION BY SUBSCRIPTION SUBSCRIPTION
You can subscribe annually and once you You can subscribe annually and once you input the license numbers of the nurses input the license numbers of the nurses employed in your facility/agency, you employed in your facility/agency, you will receive electronic notification at any will receive electronic notification at any time the license status of your nursing time the license status of your nursing employees changes, including renewal. employees changes, including renewal.
Why should I subscribe? Why should I subscribe?
Provides license verification information Provides license verification information without phone calls or written requests. without phone calls or written requests.
PUSH technology will notify you within 24-PUSH technology will notify you within 24-48 hours if the license status changes. 48 hours if the license status changes.
Reduces the risk of individuals working Reduces the risk of individuals working without proper authorization from the without proper authorization from the Board of Nursing. Board of Nursing.
Provides information to employer about Provides information to employer about the individual nurse. the individual nurse.
LEVEL ONE: Subscription fee of LEVEL ONE: Subscription fee of $100 annually$100 annually
PUSH technology PUSH technology Name of licensee Name of licensee License Number License Number License status (including temporary permits) License status (including temporary permits) Expiration date of license Expiration date of license Original date of licensure Original date of licensure
LEVEL TWO: Subscription fee of $750 annuallyLEVEL TWO: Subscription fee of $750 annually LEVEL THREE: Subscription fee of $1500 annually LEVEL THREE: Subscription fee of $1500 annually
Legal Foundation of Legal Foundation of NursingNursing
Nurse Practice ActNurse Practice ActAndAnd
Administrative CodeAdministrative Code
Nurse Practice Act
And
ABN Administrative Code
Legal Foundation of Nursing Legal Foundation of Nursing PracticePractice
Nurse Practice Act:Nurse Practice Act: statutes passed by statutes passed by legislature; broad language; provides legislature; broad language; provides authority for Board to pass regulationsauthority for Board to pass regulations
ABN ABN Administrative CodeAdministrative Code:: regulations regulations passed by Board to clarify, amplify, and passed by Board to clarify, amplify, and explain the statutesexplain the statutes Proposed rules posted on Board’s web siteProposed rules posted on Board’s web site Requires 35 day public notice and comment Requires 35 day public notice and comment
periodperiod If Board approves, rules become effective in If Board approves, rules become effective in
another 35 days after filinganother 35 days after filing
Definition of RN in StatuteDefinition of RN in Statute PRACTICE OF PROFESSIONAL NURSING. The PRACTICE OF PROFESSIONAL NURSING. The performance, for performance, for
compensation,compensation, of any act in the care and counseling of persons of any act in the care and counseling of persons or in the promotion and maintenance of health and prevention of or in the promotion and maintenance of health and prevention of illness and injury based upon the nursing process which includes illness and injury based upon the nursing process which includes systematic data gathering, systematic data gathering, assessmentassessment, appropriate nursing , appropriate nursing judgment and evaluation of human responses to actual or judgment and evaluation of human responses to actual or potential health problems through such services as case finding, potential health problems through such services as case finding, health teaching, health counseling; provision of care supportive health teaching, health counseling; provision of care supportive to or restorative of life and well-being; and executing medical to or restorative of life and well-being; and executing medical regimens including administering medications and treatments regimens including administering medications and treatments prescribed by a licensed or otherwise legally authorized prescribed by a licensed or otherwise legally authorized physician or dentist. physician or dentist. A nursing regimen shall be consistent A nursing regimen shall be consistent with and shall not vary any existing medical regimenwith and shall not vary any existing medical regimen. . Additional acts requiring appropriate education and training Additional acts requiring appropriate education and training designed to maintain access to a level of health care for the designed to maintain access to a level of health care for the consumer may be performed under emergency or other consumer may be performed under emergency or other conditions which are recognized by the nursing and medical conditions which are recognized by the nursing and medical professions as proper to be performed by a registered nurse.professions as proper to be performed by a registered nurse.
Code of Ala., 1975, Code of Ala., 1975, §34-21-1(3)(a)§34-21-1(3)(a)
Practice of Professional NursingPractice of Professional Nursing(Registered Nurse)(Registered Nurse)
The performance, for The performance, for compensation,compensation, of any act in the of any act in the Care and counseling Care and counseling Promotion and maintenance of healthPromotion and maintenance of health Prevention of illness and injuryPrevention of illness and injury
Practice of Professional Practice of Professional Nursing Nursing Cont’dCont’d
Based upon the nursing process includingBased upon the nursing process including Systematic data gatheringSystematic data gathering AssessmentAssessment Appropriate nursing judgment and Appropriate nursing judgment and
evaluation of human responseevaluation of human response Case findingCase finding Health TeachingHealth Teaching Health counselingHealth counseling
Practice of Professional Practice of Professional Nursing Nursing Cont’dCont’d
Provision of care supportive to or Provision of care supportive to or restorative of life and well-beingrestorative of life and well-being
Executing Executing medical regimensmedical regimens including administering medications including administering medications and treatments and treatments prescribed byprescribed by a a licensed…..physician or dentistlicensed…..physician or dentist
Definition of LPN in Definition of LPN in StatuteStatute
PRACTICE OF PRACTICAL NURSING. The performance, PRACTICE OF PRACTICAL NURSING. The performance, for for compensationcompensation, of acts designed to promote and maintain , of acts designed to promote and maintain health, prevent illness and injury and provide care utilizing health, prevent illness and injury and provide care utilizing standardized procedures and the nursing process, including standardized procedures and the nursing process, including administering medications and treatments, administering medications and treatments, under the under the direction of a licensed professional nurse or a licensed direction of a licensed professional nurse or a licensed or otherwise legally authorized physician or dentistor otherwise legally authorized physician or dentist. . Such practice requires basic knowledge of the biological, Such practice requires basic knowledge of the biological, physical and behavioral sciences and of nursing skills but physical and behavioral sciences and of nursing skills but does not require the substantial specialized skill, does not require the substantial specialized skill, independent judgment and knowledge required in the independent judgment and knowledge required in the practice of professional nursing.practice of professional nursing. Additional acts Additional acts requiring appropriate education and training may be requiring appropriate education and training may be performed under emergency or other conditions which are performed under emergency or other conditions which are recognized by the nursing and medical professions as proper recognized by the nursing and medical professions as proper to be performed by a licensed practical nurse.to be performed by a licensed practical nurse.
Code of Al., 1975, Code of Al., 1975, § 34-21-1(3)(b)§ 34-21-1(3)(b)
Practice of Practical NursingPractice of Practical Nursing(Licensed Practical Nurse)(Licensed Practical Nurse)
The performance, for The performance, for compensationcompensation, of acts designed to, of acts designed to Promote and maintain healthPromote and maintain health Prevent illness and injuryPrevent illness and injury Provide care utilizing standardized Provide care utilizing standardized
procedures and the nursing processprocedures and the nursing process Including administering medications and Including administering medications and
treatmentstreatments
Practice of Practical Nursing Practice of Practical Nursing Cont’dCont’d
Under the Under the directiondirection of a of a Licensed professional nurseLicensed professional nurse Licensed or otherwise legally authorized Licensed or otherwise legally authorized
physicianphysician
OrOr Licensed or otherwise legally authorized Licensed or otherwise legally authorized
dentistdentist
Practice of Practical Nursing Practice of Practical Nursing Cont’dCont’d
Such practice requires basic knowledge of Such practice requires basic knowledge of the biological, physical and behavioral the biological, physical and behavioral sciences and of nursing skills butsciences and of nursing skills but
does not require does not require the substantial specialized skill, the substantial specialized skill, independent judgment and independent judgment and knowledgeknowledge
required in the practice of professionalrequired in the practice of professional
nursingnursing
RegulationRegulation
ABN ABN Administrative CodeAdministrative Code: : regulations passed by Board to regulations passed by Board to clarify, amplify and explain the clarify, amplify and explain the statutesstatutes
Examples of RegulationsExamples of RegulationsChapter 610-X-6, Standards of Nursing Chapter 610-X-6, Standards of Nursing
PracticePractice
-.02: Conduct and Accountability-.02: Conduct and Accountability (2) (2) Function within the legal scope of Function within the legal scope of
nursing practice.nursing practice.
Examples of RegulationsExamples of RegulationsChapter 610-X-6, Standards of Nursing Chapter 610-X-6, Standards of Nursing
PracticePractice
-.02: Conduct and Accountability-.02: Conduct and Accountability (9) (9) Respect dignity and rights of patients Respect dignity and rights of patients
and their significant others including, but and their significant others including, but not limited to: not limited to: (a) (a) Privacy; Privacy; (b) (b) Protection Protection of confidential information, unless of confidential information, unless disclosure is required by law; disclosure is required by law; (c) (c) freedom freedom from exploitation of physical, mental, from exploitation of physical, mental, sexual, or financial boundaries; and sexual, or financial boundaries; and (d) (d) protection of real and personal property.protection of real and personal property.
Examples of RegulationsExamples of Regulations Chapter 610-X-6, Standards of Nursing PracticeChapter 610-X-6, Standards of Nursing Practice
-.03(2) and -.04(2) Competence…shall include, -.03(2) and -.04(2) Competence…shall include, but is not limited to:but is not limited to:(e) Delegation of selected nursing functions to (e) Delegation of selected nursing functions to others in accordance with the education and others in accordance with the education and demonstrated competence of the persons. demonstrated competence of the persons. Tasks delegated to unlicensed assistive Tasks delegated to unlicensed assistive personnel shall not require the exercise of personnel shall not require the exercise of independent nursing judgment or intervention. independent nursing judgment or intervention. Selected nursing functions that may not be Selected nursing functions that may not be delegated include but are not limited to delegated include but are not limited to performance of invasive or sterile procedures performance of invasive or sterile procedures or administration of medications except as or administration of medications except as provided in Rule 610-X-6-.06, -.07.provided in Rule 610-X-6-.06, -.07.
How do you access the How do you access the Alabama Nurse Practice Act Alabama Nurse Practice Act and and Administrative CodeAdministrative Code??
www.abn.state.al.uswww.abn.state.al.usNurse Practice ActNurse Practice Act
Administrative CodeAdministrative CodeDeclaratory RulingsDeclaratory Rulings
Proposed Rule ChangesProposed Rule Changes
What are Standards of What are Standards of Practice?Practice?
Level of performance that is Level of performance that is Desired andDesired and AchievableAchievable
Expectation for nurses’ conduct and Expectation for nurses’ conduct and practice practice
Where do standards come Where do standards come from?from?
Laws and RegulationsLaws and Regulations Nurse Practice ActNurse Practice Act ABN ABN Administrative CodeAdministrative Code
Agency/Facility Policies & ProceduresAgency/Facility Policies & Procedures
Nursing EducationNursing Education
Professional AssociationsProfessional Associations
Example of Example of a Nursing Standard a Nursing Standard
SEVEN Rights of Medication AdministrationSEVEN Rights of Medication Administration Right Patient Right Patient Right MedicationRight Medication Right TimeRight Time Right DoseRight Dose Right RouteRight Route Right ReasonRight Reason Right DocumentationRight Documentation
Documentation StandardDocumentation Standard
If you didn’t chart it, it wasn’t done.If you didn’t chart it, it wasn’t done.
Care StandardsCare Standards
Knock before enteringKnock before entering
Tell the patient what you areTell the patient what you are going to do BEFORE you do itgoing to do BEFORE you do it
Care Standards Care Standards Cont’dCont’d
Introduce self to patientIntroduce self to patient
Wear a name tag that can be seen & Wear a name tag that can be seen & readread
Care StandardsCare Standards Cont’dCont’d
Provide for Hand Provide for Hand Hygiene before Hygiene before mealsmeals
Straighten sheets, Straighten sheets, particularly for particularly for bedbound patientsbedbound patients
What is it called when a nurse’s What is it called when a nurse’s practice is undesirable or practice is undesirable or
unacceptable?unacceptable?
Top Substandard Practice Violations
0
10
20
30
40
04 05 06 07 08
NEGLIGENCECombined*
Diversion/Theft
Scope of Practice
Documentation
UnprofessionalBehavior/Conduct
Additional Additional Substandard Substandard PracticePractice Violations Violations
AbandonmentAbandonment
Boundary violationsBoundary violations
Confidentiality Confidentiality breachbreach
Improper Improper DelegationDelegation
Improper Improper SupervisionSupervision
Substandard Violations
01020304050
Age
at
Vio
latio
n
Yrs
as
Nur
se
Age
beca
me
Nur
se
Pre
v LP
N
Pre
vD
isci
plin
e
FY 04
FY 05
FY 06
FY07
FY08
ADJUDICATION OF ADJUDICATION OF DISCIPLINEDISCIPLINE
Discipline,Discipline,
Removal from Practice Removal from Practice
andand
Readmission to PracticeReadmission to Practice
Complaints to ABNComplaints to ABN
Must be in writingMust be in writing Email ([email protected])Email ([email protected]) LetterLetter Form (website under Forms & Other Form (website under Forms & Other
Information) Information) Employers Report of Possible Violation Employers Report of Possible Violation
FormForm Consumers Report of Possible Violation Consumers Report of Possible Violation
FormForm
ComplaintsComplaints Cont’dCont’d
Can be anonymousCan be anonymous
Must contain sufficient information to Must contain sufficient information to identify the nurse who is being identify the nurse who is being reported and what the nurse is reported and what the nurse is alleged to have done wrongalleged to have done wrong
ProcessProcess
Docketed in databaseDocketed in database Reviewed by Executive OfficerReviewed by Executive Officer Notice of Investigation sent to NurseNotice of Investigation sent to Nurse Acknowledgment sent to Acknowledgment sent to
ComplainantComplainant Subpoena(s) issuedSubpoena(s) issued InvestigatedInvestigated
NON-Discipline OptionsNON-Discipline Options
No violation: letter of closureNo violation: letter of closure No provable violation but reported No provable violation but reported
conduct inappropriate: Letter of conduct inappropriate: Letter of AdmonishmentAdmonishment
VDAPVDAP Drugs/Alcohol abuse & dependencyDrugs/Alcohol abuse & dependency Mental IllnessMental Illness Physical ImpairmentPhysical Impairment
Discipline Option: Discipline Option: Board must be able to prove Board must be able to prove
violationviolation Informal vs. Formal DispositionInformal vs. Formal Disposition
Informal: Informal: Consent OrderConsent Order Voluntary Surrender (self-revocation by Voluntary Surrender (self-revocation by
nurse)nurse) Formal: Administrative HearingFormal: Administrative Hearing
Types of DisciplineTypes of Discipline
ReprimandReprimand
Reprimand and FineReprimand and Fine
Probation Probation FineFine Until conditions metUntil conditions met Specific time period (1-5 years)Specific time period (1-5 years)
Types of Discipline Types of Discipline Cont’dCont’d
Suspension:Suspension: FineFine Until conditions metUntil conditions met Certain time periodCertain time period May be followed by a period of ProbationMay be followed by a period of Probation One year: automatic revocation clause One year: automatic revocation clause
in order if suspension extends beyond in order if suspension extends beyond 12 months12 months
Revocation Revocation Voluntary Surrender: Self-revocationVoluntary Surrender: Self-revocation
NURSE PRACTICE ACT&
ADMINISTRATIVE CODE
Federal LawsHIPAA, ADA, EMTALA, CLIA, OSHA, Civil Rights, etc.
Board of Medical
Examiners
Board of Pharmacy
Accrediting Bodies
Other Professional Boards/Rules
Physical Therapy, Speech Therapy, etc
Facility/Agency Policies & Procedures
Federal Laws Specific to
Facility Type
Rules/Laws of State Agencies (Departments)ADEM, ADPH, etc
Other Laws, Rules and Regulations can NOT weaken Other Laws, Rules and Regulations can NOT weaken the Nurse Practice Act and the Nurse Practice Act and Administrative CodeAdministrative Code but do but do
influence Nursing Practiceinfluence Nursing Practice
Non-Inclusive List
Conduct and AccountabilityConduct and AccountabilityAdministrative CodeAdministrative Code §§ 610-X-6-.02 610-X-6-.02
What is Accountability?What is Accountability? Answerable or responsible for actionsAnswerable or responsible for actions
What is Responsibility?What is Responsibility?
The charge to do something that is expected The charge to do something that is expected performance.performance.
Shall = mandatoryShall = mandatory
Administrative CodeAdministrative Code § 610-X-2-.06 (4) § 610-X-2-.06 (4)
Conduct and AccountabilityConduct and AccountabilityAdministrative CodeAdministrative Code § 610-X- § 610-X-
6-.02(6)6-.02(6)
The RN and LPN shallThe RN and LPN shall
Accept individual responsibility and Accept individual responsibility and accountability for judgments, actions accountability for judgments, actions and nursing competency.and nursing competency.
Substandard PracticeSubstandard PracticeFailure to interveneFailure to intervene
Resident lying on floor, had large amount of Resident lying on floor, had large amount of feces on herself after she lost her feces on herself after she lost her step/blacked out while attempting to get to step/blacked out while attempting to get to the bathroomthe bathroom
Nurse allowed the resident to be assisted to Nurse allowed the resident to be assisted to the shower prior to assessing the resident for the shower prior to assessing the resident for injuriesinjuries
Medical evaluation the next day-fracture of Medical evaluation the next day-fracture of left proximal humerusleft proximal humerus
Probation for 12 months, $300 fine, courses Probation for 12 months, $300 fine, courses on critical thinking, patient assessment, and on critical thinking, patient assessment, and professional accountabilityprofessional accountability
Limestone Lodge Assisted LivingLimestone Lodge Assisted Living
Medication ErrorMedication Error
RN administered Morphine 40 mg IV push RN administered Morphine 40 mg IV push instead of ordered 4 mginstead of ordered 4 mg
RN administered Morphine 50 mg IV push RN administered Morphine 50 mg IV push instead of ordered D50W for treatment of instead of ordered D50W for treatment of hypoglycemia hypoglycemia
Medication ErrorMedication Error ContCont
LPN administered LPN administered Tetanus Tetanus intradermally instead of PPDintradermally instead of PPD
LPN administered multiple oral LPN administered multiple oral medications in errormedications in error
RN administered 4 Restoril tablets instead RN administered 4 Restoril tablets instead of of
4 Lyrica tablets 4 Lyrica tablets
Patient Care OrdersPatient Care Orders
Administrative CodeAdministrative Code §§ 610-X-6-.09 610-X-6-.09
Patient Care Orders and the Patient Care Orders and the Definition of Professional Definition of Professional
NursingNursing
...executing medical regimens ...executing medical regimens including administering medications including administering medications and treatments prescribed by a and treatments prescribed by a licensed or otherwise legally licensed or otherwise legally authorized physician or dentist.authorized physician or dentist.
Code of Alabama, 1975 § 34-21-1(3a)Code of Alabama, 1975 § 34-21-1(3a)
Patient Care Orders and the Patient Care Orders and the Definition of Practical NursingDefinition of Practical Nursing
... including administering ... including administering medications and treatments, under medications and treatments, under the direction of a licensed the direction of a licensed professional nurse or a licensed or professional nurse or a licensed or otherwise legally authorized otherwise legally authorized physician or dentist.physician or dentist.
Code of Alabama, 1975 § 34-21-1(3)(b)Code of Alabama, 1975 § 34-21-1(3)(b)
Patient Care OrdersPatient Care Orders Administrative CodeAdministrative Code § 610-X-6-.09 § 610-X-6-.09
““Authorized prescriber”Authorized prescriber” Licensed physician or dentistLicensed physician or dentist CRNP (Nurse Practitioner)CRNP (Nurse Practitioner) CNM (Nurse Midwife)CNM (Nurse Midwife) LICENSEDLICENSED Physician’s Assistant or Surgical Physician’s Assistant or Surgical
AssistantAssistant Lawful orderLawful order CRNPs & CNM may CRNPs & CNM may NOTNOT order narcotic order narcotic
medicationsmedications
Verbal Orders Verbal Orders Administrative CodeAdministrative Code § 610-X-6-.09(2) § 610-X-6-.09(2)
RN or LPN may receive verbal orders RN or LPN may receive verbal orders from an authorized prescriber relayed from an authorized prescriber relayed by by another licensed or registered health care another licensed or registered health care
professional or professional or CERTIFIEDCERTIFIED medical assistant medical assistant
Implement standing orders at the Implement standing orders at the direction of an authorized prescriberdirection of an authorized prescriber
Telecommunication for Telecommunication for Pronouncement of Patient Pronouncement of Patient
DeathDeathAdministrative CodeAdministrative Code § 610-X- § 610-X-
6-.106-.10
The RN or LPN may receive a The RN or LPN may receive a pronouncement of a patient’s death from a pronouncement of a patient’s death from a physician via telecommunication without a physician via telecommunication without a physical examination of the patient by that physical examination of the patient by that physician. A standardized procedure shall physician. A standardized procedure shall specify the permissible patient conditions specify the permissible patient conditions for which the RN or LPN in a specific health for which the RN or LPN in a specific health care facility or agency may receive the care facility or agency may receive the pronouncement of a patient’s death by pronouncement of a patient’s death by telecommunications. telecommunications.
Substandard PracticeSubstandard PracticeLack of MD OrderLack of MD Order
Scope of PracticeScope of Practice Gave another Gave another
employee an employee an injection of injection of Rocephin with no Rocephin with no MD order.MD order.
How does the nurse record How does the nurse record pertinent patient data as proof pertinent patient data as proof
of the quality of care of the quality of care provided?provided?
Tips on ChartingTips on Charting
Write legibly in INKWrite legibly in INK
Be accurateBe accurate Date & TimeDate & Time NO Block Charting (7-3 Resting NO Block Charting (7-3 Resting
quietly)quietly) Late EntriesLate Entries
AbbreviationsAbbreviations Use Use approvedapproved abbreviations abbreviations
Accepted Standards vs specialty Accepted Standards vs specialty practice termspractice terms VAD VAD
Vascular Access DeviceVascular Access Device Ventricular Assist DeviceVentricular Assist Device
JCAHO Patient Safety ProgramJCAHO Patient Safety Program Hazardous abbreviations in Hazardous abbreviations in
medication ordersmedication orders
Tips on Charting Tips on Charting Cont’dCont’d
Descriptive TerminologyDescriptive Terminology ““Punch” colored (what flavor punch?)Punch” colored (what flavor punch?)
Be conciseBe concise Be objective; Write facts, not opinionsBe objective; Write facts, not opinions Assessment/interpretationAssessment/interpretation
BehaviorBehavior “ “Resting comfortably” (Says who?)Resting comfortably” (Says who?) “ “Confused” (Says who?)Confused” (Says who?)
Grounds for Disciplinary Action Grounds for Disciplinary Action regarding Documentationregarding Documentation
Failure to make entriesFailure to make entries (NEVER discard pages (NEVER discard pages
from PERMANENT patient record)from PERMANENT patient record)
Destroying or altering entries Destroying or altering entries (Recopy, for (Recopy, for legibility, and label the page: keep old and legibility, and label the page: keep old and new pages together)new pages together)
Pre-charting - Pre-charting - Charting BEFORE assessment or Charting BEFORE assessment or delivery of caredelivery of care MedicationMedication TreatmentTreatment Assessment Assessment
Administrative CodeAdministrative Code § 610-X-8-.03(6)(g) and (h) § 610-X-8-.03(6)(g) and (h)
Traditional Standard of Traditional Standard of Documentation……Documentation……
If you didn’t chart it, it wasn’t done.If you didn’t chart it, it wasn’t done.
ABN added…..ABN added…..
If you didn’t do it, DON’T chart it!If you didn’t do it, DON’T chart it!
Substandard PracticeSubstandard PracticeFalse DocumentationFalse Documentation
Documented the administration of Percocet Documented the administration of Percocet and Lortab for which there was no record of and Lortab for which there was no record of sign out on the controlled drug recordsign out on the controlled drug record boundary violation - accepted and cashed checks made out boundary violation - accepted and cashed checks made out
to her by a residentto her by a resident exceeded LPN scope of practice - supervised all aspects of exceeded LPN scope of practice - supervised all aspects of
resident care provided by licensed and non-licensed staff resident care provided by licensed and non-licensed staff and provided care without the direction of a Registered and provided care without the direction of a Registered NurseNurse
Suspension until payment of $500 fine and Suspension until payment of $500 fine and courses on documentation, professional courses on documentation, professional accountability, and chemical dependency accountability, and chemical dependency followed by probation for 12 monthsfollowed by probation for 12 months
Mature Options Senior Services–Seasons of Talladega, Mature Options Senior Services–Seasons of Talladega, Autumn Trace, & Summer PlaceAutumn Trace, & Summer Place
Conduct and AccountabilityConduct and Accountability Administrative CodeAdministrative Code § 610-X-6-.02(3) § 610-X-6-.02(3)
The RN and LPN shallThe RN and LPN shall
Be responsible and Be responsible and accountableaccountable for the for the QUALITYQUALITY of nursing care delivered to of nursing care delivered to patientspatients
based on and LIMITED to based on and LIMITED to scope of scope of educationeducation, , demonstrated demonstrated competencecompetence, and , and nursing nursing experienceexperience..
Conduct and AccountabilityConduct and Accountability(Cont’d) (Cont’d) Administrative CodeAdministrative Code § 610-X-6-.02 § 610-X-6-.02
Respect the dignity and rights of patients and their Respect the dignity and rights of patients and their significant others including, but not limited to:significant others including, but not limited to:
PrivacyPrivacy; protection of confidential information, ; protection of confidential information, unless disclosure is required by law;unless disclosure is required by law;
Freedom from exploitationFreedom from exploitation of physical, mental, of physical, mental, sexual, or financial boundaries; andsexual, or financial boundaries; and
Protection of real and personal property.Protection of real and personal property.
AbuseAbuse
““Intentionally or negligently Intentionally or negligently causing or permitting physical, causing or permitting physical,
sexual, emotional or verbal abuse sexual, emotional or verbal abuse of a patient, willfully harassing or of a patient, willfully harassing or
intimidating a patient.”intimidating a patient.”
Administrative CodeAdministrative Code 610-X-8-.03(6)(o) 610-X-8-.03(6)(o)
Substandard PracticeSubstandard PracticePatient AbusePatient Abuse
Repeatedly sprayed Repeatedly sprayed wound cleanser in wound cleanser in the face of a the face of a quadriplegic resident quadriplegic resident during the resident’s during the resident’s care.care.
Subsequently Subsequently disciplined on two disciplined on two other occasionsother occasions
Substandard PracticeSubstandard PracticePatient AbusePatient Abuse
Tied the resident in Tied the resident in the wheelchair with the wheelchair with a bed sheet.a bed sheet.
Substandard PracticeSubstandard PracticePatient AbusePatient Abuse
Verbally abused and used Verbally abused and used profanity with a patient in an profanity with a patient in an attempt to get the patient to attempt to get the patient to return to the other side of the return to the other side of the patient’s semi-private room.patient’s semi-private room.
Scope of PracticeScope of PracticeAdministrative CodeAdministrative Code § 610-X-6-.03 and § 610-X-6-.03 and -.04-.04
……includes but is not limited to:includes but is not limited to: (a) Educational preparation, initial and (a) Educational preparation, initial and
continued;continued; (b) License status, including Board approval (b) License status, including Board approval
for advanced practice nursing;for advanced practice nursing; (c) State and federal statutes, and regulations;(c) State and federal statutes, and regulations; (d) State and national standards appropriate (d) State and national standards appropriate
to the type of practice;to the type of practice; (e) Nursing experience;(e) Nursing experience; (f) Demonstrated competence; and(f) Demonstrated competence; and (g) Knowledge, skills, and ability to manage (g) Knowledge, skills, and ability to manage
risks and potential complications. risks and potential complications.
Practice Beyond ScopePractice Beyond ScopeIllegal PracticeIllegal Practice
Practiced as RN supervisor for Practiced as RN supervisor for compensation while her license was compensation while her license was lapsedlapsed
Public reprimand and payment of $600 Public reprimand and payment of $600 finefine
St. Martins in the PinesSt. Martins in the Pines
Please Identify….Please Identify….
Any basic NURSING program that Any basic NURSING program that taught a student how to use a scalpeltaught a student how to use a scalpel
Substandard PracticeSubstandard PracticeExceeded Scope of PracticeExceeded Scope of Practice Nurse performed sharp debridement Nurse performed sharp debridement
on a patient’s heelon a patient’s heel
Conduct and AccountabilityConduct and Accountability Administrative CodeAdministrative Code § 610-X-6-.02(4) § 610-X-6-.02(4)
The RN or LPN shallThe RN or LPN shall
Be responsible and accountable for the Be responsible and accountable for the quality of nursing care deliveredquality of nursing care delivered to to patients by nursing personnel patients by nursing personnel under under the individual nurse’s supervisionthe individual nurse’s supervision
Responsibility & Responsibility & AccountabilityAccountability
RN supervisesRN supervises Other RNsOther RNs LPNSLPNS Nursing AssistantsNursing Assistants
LPN supervisesLPN supervises Other LPNsOther LPNs Nursing AssistantsNursing Assistants
DelegationDelegation
The act of authorizing a The act of authorizing a competent competent individual to individual to
perform acts perform acts supportivesupportive to to RNs or LPNs in selected RNs or LPNs in selected
situations.situations.
Administrative CodeAdministrative Code § 610-X-6-.03 (2e) & .04(2e) § 610-X-6-.03 (2e) & .04(2e)
DelegationDelegationAdministrative CodeAdministrative Code §§ 610-X-6-.03 (2e) & 610-X-6-.04(2e) 610-X-6-.03 (2e) & 610-X-6-.04(2e)
Tasks delegated to UNLICENSED personnel Tasks delegated to UNLICENSED personnel shall involveshall involve NO tasks or functions that require NO tasks or functions that require
independent nursing judgmentindependent nursing judgment or or interventionintervention
NO invasive or sterile proceduresNO invasive or sterile procedures NO administration of medicationsNO administration of medications
DelegationDelegation Administrative CodeAdministrative Code §§ 610-X-6-.03 (2)(e) & 610-X-610-X-6-.03 (2)(e) & 610-X-
6-.04(2)(e)6-.04(2)(e)
Consistent with Consistent with
education ANDeducation AND
demonstrated competence of the demonstrated competence of the PERSON to whom the task is PERSON to whom the task is delegateddelegated
Substandard PracticeSubstandard PracticeImproper Improper
Delegation/supervisionDelegation/supervision Allowed unlicensed staff to Allowed unlicensed staff to
administer medications to residentsadminister medications to residents Acknowledged that she prepared the Acknowledged that she prepared the
medications and signed the MAR to medications and signed the MAR to reflect that the medication was givenreflect that the medication was given
Public reprimand and payment of Public reprimand and payment of $300 fine$300 fine
TLC Assisted Living HomeTLC Assisted Living Home
AbandonmentAbandonment
AcceptanceAcceptance of a patient assignment, of a patient assignment, thus thus
establishing a nurse-patient relationship, establishing a nurse-patient relationship, and and
then then EndingEnding the nurse-patient the nurse-patient relationship relationship
Without Giving Reasonable NoticeWithout Giving Reasonable Notice toto
supervisory personnel so that supervisory personnel so that others can makeothers can make
arrangements for continuation of arrangements for continuation of nursing care.nursing care.
Substandard PracticeSubstandard PracticeAbandonmentAbandonment
Abandoned her assignment without notice Abandoned her assignment without notice to supervisory personnel so that others to supervisory personnel so that others could make arrangements for continuation could make arrangements for continuation of nursing careof nursing care Fraud/deceit - falsified time card Fraud/deceit - falsified time card False documentation – falsified resident’s MARFalse documentation – falsified resident’s MAR
Probation for 12 months, payment of $300 Probation for 12 months, payment of $300 fine and courses on professional fine and courses on professional accountability, documentation, and accountability, documentation, and legal/ethical aspects of nursinglegal/ethical aspects of nursing
Cedar Hill Assisted Living FacilityCedar Hill Assisted Living Facility
Unprofessional Unprofessional Behavior/ConductBehavior/Conduct
Nursing behaviors Nursing behaviors (acts, knowledge & practices) (acts, knowledge & practices)
failing to meet the failing to meet the minimalminimal standards of acceptable and standards of acceptable and prevailing nursing practice, prevailing nursing practice,
which could jeopardize the health, which could jeopardize the health, safety and welfare of the publicsafety and welfare of the public
Substandard PracticeSubstandard PracticeUnprofessional ConductUnprofessional Conduct
Completed terms of an Order (Probation until Completed terms of an Order (Probation until completion of course on legal/ethical aspects of nursing completion of course on legal/ethical aspects of nursing and payment of $250 fine) due to unprofessional and payment of $250 fine) due to unprofessional conduct, THENconduct, THEN
Failed to observe that medications were administered Failed to observe that medications were administered as documented; left medication on a table; excessive as documented; left medication on a table; excessive amount of medication on hand when compared to MAR amount of medication on hand when compared to MAR and date medication dispensedand date medication dispensed
Same conduct at a Nursing HomeSame conduct at a Nursing Home Suspension until payment of $1000 fine and completion Suspension until payment of $1000 fine and completion
of pharmacology course followed by probation for 24 of pharmacology course followed by probation for 24 monthsmonths
Ashton Gables in Riverchase and Ashton Gables in Riverchase and Lakeview Estates Assisted LivingLakeview Estates Assisted Living
Substandard PracticeSubstandard PracticeUnprofessional ConductUnprofessional Conduct
Involved in Involved in altercation and altercation and assaulted PCT by assaulted PCT by slapping PCT in the slapping PCT in the face twiceface twice
Frequent Misconceptions often Frequent Misconceptions often resulting in Disciplinary Actionresulting in Disciplinary Action
From the NurseFrom the Nurse ““Because a doctor told me to do a Because a doctor told me to do a
procedure/give a medication, it is OK.”procedure/give a medication, it is OK.”
From the PhysicianFrom the Physician ““Because I told the nurse toBecause I told the nurse to
do a procedure/give a medication,do a procedure/give a medication,
it is OK”it is OK”
Conduct and AccountabilityConduct and AccountabilityAdministrative CodeAdministrative Code § 610-X-6-.02 § 610-X-6-.02
Collaborate WITH other members of the Collaborate WITH other members of the health care team.health care team.
Practice WITHOUT discriminationPractice WITHOUT discrimination on on the basis of age, race, religion, gender, the basis of age, race, religion, gender, national origin, sexual orientation, patient national origin, sexual orientation, patient diagnosis or disability.diagnosis or disability.
Professional BoundaryProfessional Boundary
Administrative CodeAdministrative Code § 610-X-8-.03(6p) § 610-X-8-.03(6p)
Grounds for disciplinary Grounds for disciplinary action related to Professional action related to Professional
Boundary ViolationBoundary ViolationAdministrative CodeAdministrative Code § 610-X-8-.03(6)(p)(i), (ii), and (iii) § 610-X-8-.03(6)(p)(i), (ii), and (iii)
Sexual or Intimate ConductSexual or Intimate Conduct Emotional or Financial ExploitationEmotional or Financial Exploitation Inappropriate DisclosureInappropriate Disclosure
With/ to a patient, patient’s With/ to a patient, patient’s immediate family member(s) or immediate family member(s) or significant other(s)significant other(s)
Individual Nurse’s ResponsibilityIndividual Nurse’s Responsibility
Accept Accept individualindividual responsibility and responsibility and accountability for timely reporting of accountability for timely reporting of illegal, illegal, substandard, substandard, unethical, unethical, unsafe, or unsafe, or incompetent nursing practice incompetent nursing practice
DIRECTLYDIRECTLY to the Board of Nursing. to the Board of Nursing.
Administrative CodeAdministrative Code § 610-X-6-.02(10) § 610-X-6-.02(10)
CompetenceCompetence
Administrative Code Administrative Code §§ 610-X-6-.03(2) 610-X-6-.03(2)
Administrative CodeAdministrative Code §§ 610-X-6-.04(2) 610-X-6-.04(2)
Competence in the Practice of Competence in the Practice of NursingNursing Administrative CodeAdministrative Code §§ 610-X-6-.03(2) & .04(2) 610-X-6-.03(2) & .04(2)
Includes but is not limited to:Includes but is not limited to: Knowledge and compliance with:Knowledge and compliance with:
Applicable statutes and regulationsApplicable statutes and regulations Standards of nursing practiceStandards of nursing practice Standardized procedures for nursing Standardized procedures for nursing
practicepractice
Competency Competency Cont’dCont’dAdministrative CodeAdministrative Code § 610-X-6-.02(6) § 610-X-6-.02(6)
The RN and LPN shallThe RN and LPN shall
AcceptAccept individual individual responsibility responsibility and accountability for judgments, and accountability for judgments, actions and nursing COMPETENCY.actions and nursing COMPETENCY.
““Competence….shall Competence….shall include….”include….”
Administrative CodeAdministrative Code § 610-X-6-.03(2b) § 610-X-6-.03(2b)
““Maintenance of knowledge and skills Maintenance of knowledge and skills in the area of practice.”in the area of practice.”
Continuing Education Continuing Education for renewal of licensefor renewal of license
Administrative CodeAdministrative Code § 610-X-4-.08(3)(b) and (c) § 610-X-4-.08(3)(b) and (c) A registered nurse and licensed practical A registered nurse and licensed practical
nurse shall earn in each earning period not nurse shall earn in each earning period not less than 24 contact hours of Board-less than 24 contact hours of Board-approved or Board-recognized continuing approved or Board-recognized continuing education as a condition for renewal of education as a condition for renewal of license for the subsequent license period. license for the subsequent license period.
Failure to meet the continuing education Failure to meet the continuing education requirement shall be cause for the license requirement shall be cause for the license to lapse. to lapse.
Grounds for Disciplinary Action Grounds for Disciplinary Action related to Continuing related to Continuing
EducationEducationAdministrative CodeAdministrative Code § § 610-X-10-.02(4)610-X-10-.02(4)
Failure to comply with continuing Failure to comply with continuing education requirements may result in education requirements may result in disciplinary action by the Board. disciplinary action by the Board.
Alabama Nurse’sAlabama Nurse’s
FY 2008 - 68,145 nurse’sFY 2008 - 68,145 nurse’s 50, 184 RN’s50, 184 RN’s 17, 961 LPN’s17, 961 LPN’s
As of June 2009As of June 2009 325 nurse’s monitored in VDAP325 nurse’s monitored in VDAP 317 nurse’s with license status of 317 nurse’s with license status of
Active/ProbationActive/Probation 218 RN’s218 RN’s 94 LPN’s94 LPN’s 3 CRNA’s3 CRNA’s 2 CRNP’s2 CRNP’s
Nursing Education ProgramsNursing Education ProgramsJuly 2009July 2009
43 RN Programs43 RN Programs 27 ADN 27 ADN 1 ADN mobility (LPN to RN)1 ADN mobility (LPN to RN) 15 BSN15 BSN
24 PN Programs24 PN Programs
What’s newWhat’s newJuly 2009July 2009
New Rules New Rules Continuing Education 610-X-2-.10 and 610-X-Continuing Education 610-X-2-.10 and 610-X-
10 10 eliminated the distinction between independent eliminated the distinction between independent
study and attended CEstudy and attended CE Licensure 610-X-4-.07, -.08 and -.10 Licensure 610-X-4-.07, -.08 and -.10
incorporated new CE rulesincorporated new CE rules
Rules under revisionRules under revision Standards of Practice 610-X-6 and -7Standards of Practice 610-X-6 and -7 Discipline 610-X-8Discipline 610-X-8
Board Vacancies as of Jan 1, Board Vacancies as of Jan 1, 20102010
RN Nursing Practice Position (1)RN Nursing Practice Position (1) RN Nursing Education Position (1)RN Nursing Education Position (1) Advanced Practice Nursing Position (1)Advanced Practice Nursing Position (1) LPN Position through LPNAA (1)LPN Position through LPNAA (1)
The position is nominated by LPNAA. Ms. The position is nominated by LPNAA. Ms. Hopkins is eligible for reappointment. Hopkins is eligible for reappointment.
Consumer Position (1)Consumer Position (1) The consumer position is not nominated by any The consumer position is not nominated by any
particular group and is appointed by the particular group and is appointed by the Governor. Mr. Harry I. Brown, Jr. is eligible for Governor. Mr. Harry I. Brown, Jr. is eligible for reappointment. reappointment.
