kbn ed50 PROOF9 · administration because you knew you would not have time later; or, • waited until the end of the shift to document all assessments and care rendered because you

KBNCONNECTION 17Winter 2017

• Felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.

For a complete list, and more details about permissive and mandatory exclusions, see 42 U.S.C.A.§1320a-7. For more information about the OIG Exclusion list, visit the Office of Inspector General’s website (https://oig.hhs.gov/faqs/exclusions-faq.asp).

Bottom line: for physicians, nurse practitioners, and other health care providers facing disciplinary charges by their state medical or nursing board, or those healthcare providers facing potential criminal charges, it is important to know that licensure discipline and criminal charges, among other things, could land a provider on the OIG Exclusion list, and lead to an even steeper uphill battle back to the practice of medicine or nursing. For employers, it is impor-tant to know that an entity can face severe penalties for attempts to recover payment from the federal government for patient care performed by an individ-ual on the OIG exclusion list. I recommend that employers check the Exclusions Database prior to hiring new health care providers to determine if potential hires fall on this list, and to avoid potential liability for the organization. If a provider is currently on the OIG exclusion list, he or she can apply for reinstatement to participate in Federal health programs once the specified period of exclusion ends.

18 KBNCONNECTION Winter 2017

Purpose: To assist nurses in under-standing and identifying prac-tice drift and how to eliminate/mitigate effects.

Objective: 1. Explain “practice drift.”2. Recognize factors that con- tribute to the occurrence of “practice drift.”3. Discuss the impact of “practice drift,”4. Create a plan to eliminate and decrease “practice drift.”—————————————————HAVE YOU EVER…1. Deviated from the procedure for safe medication administration?• administered a medication prior to obtaining an order from a provider because you “knew” what the physician would order;• borrowed a medication from another patient or used STAT orders to override the system as a workaround to bypass slow pharmacy services; • administered a pain medication without completing a pain assessment because you were in a hurry; • prepared medications simulta- neously for more than one patient because you were pressed for time and/or you were trying to save a few steps;• carried medications in your pocket and wasted them at the end of the shift because there wasn’t anyone available at the time to serve as a witness; • signed as a witness to a narcotic medication waste you did not observe because you trusted your co-worker;

• left a patient’s medications on the bedside table because he/ she was on the phone; • failed to check 2 identifiers when administering medication because you were in a rush; • failed to scan the bar code on a medication because the scanner wasn’t working; • made assumptions when orders were incomplete or were illegi- ble because you didn’t want to bother the provider; or, • hidden away unused medications from discharged patients for administration to other

patients if needed in the future to avoid delays.2. Neglected a patient?• failed to perform an assessment or treatment because the patient was sleeping; • silenced a piece of equipment (bed alarm, IV pump, cardiac monitor, etc.) because it kept alarming for no apparent reason and you felt it was disturb- ing the patients; or,• failed to complete the “time out” in surgery because the surgeon was upset with how long it took to set up for his/her patient.

WHAT COULD HAPPEN: THE CONSEQUENCES OF “PRACTICE DRIFT”... IS IT WORTH THE RISK?

by Kathy Chastain, MN, RN, FRE and Linda Burhans, PhD, RN, FRE

Reprinted with permission from the North Carolina

Board of Nursing (NC BONNursing Bulletin, Fall 2016)


3. Failed to maintain an accurate patient medical record?• pre-documented an assessment or care delivered to save time because the information was always the same; • pre-documented medication administration because you knew you would not have time later; or,• waited until the end of the shift to document all assessments and care rendered because you didn’t have time during the shift to get it done.4. Breached a patient’s confidentiality? • out of curiosity, looked up information on a patient you were not assigned to provide care;• posted pictures or comments about patients or family members on social media;• discussed patient information in a public setting (e.g., elevator or cafeteria) or commented on a patient’s condition to another patient or family member.5. Exceeded scope of nursing practice? • acted outside your scope of practice by writing “verbal orders” without actually speaking with the provider, believing they would be signed off at next rounds; or,• performed a procedure that was outside your scope of practice (e.g., rupturing mem- branes to induce labor) because the provider instructed you to do so. 6. Inappropriately delegated a task to an unlicensed staff member? • directed a nurse aide (not appropriately educated and validated competent) to admin- ister a medication or perform a simple dressing change because you were busy with another patient; or,• allowed unlicensed personnel to make assignments and delegate patient care tasks to others. 7. Accepted an assignment when you knew you were not fit for duty?

• worked while so fatigued that you were nodding off to sleep because you agreed to work an extra shift at the request of your manager; or,• worked an early shift while still “hung over” from a party that ended only a few hours before.

Chances are you have done some of these yourself, or if not, you have worked with someone who has! The multiple “at-risk” behaviors listed above all describe “practice drift.” The term “practice drift” is another way of describing a “workaround,” “shortcut,” or “rule-bending” done in order to accomplish an immediate goal, to meet a perceived expectation of another, and/or to promote effi-ciency (Collins, 2003). All of these incidents are types of practice violations which the NC Board of Nursing (as well as the Kentucky Board of Nursing), has investigated. Thankfully, the vast majority of these incidents did not result in serious negative patient outcomes but each incident represents a “drift” from the standard of care and has the potential to jeopardize patient safety.

STOP READING: Make a list of work-arounds, shortcuts, and rule-bending in your practice set-ting. What variations from stan-dards of practice or policies and procedures have you witnessed? Which variations have you used? How often does “practice drift” occur in your practice and that of your co-workers?

Behavioral research has shown that all humans are mentally pro-gramed to drift into unsafe habits, to lose perception of the risk attached to everyday behaviors, or to mistakenly believe the risks taken to be justified. Decisions about what is important on a daily list of tasks are based on the immediate desired outcomes and over time, as perceptions of risk fade away, individuals try to do

more with less and take shortcuts, drifting away from behaviors they know are safer (ISMP, June 2012). Articles published by the Just Culture Community, have identi-fied “at-risk” behaviors as the most common of the 3 types of errors (human, at-risk, reckless). Marx of Outcome Engineering (2005) explains, “We all tend to lose perception of the risk attached to everyday activi-ties, or mistakenly believe in some situations a risk is justified. Often our decisions to circumvent an evident or perceived workflow hin-drance are based on immediate out-comes (time saver) in order to meet a goal or to achieve it more readily and do not consider the potential or uncertain consequence (patient harm) which is more remote.” Studies have shown that once you have bent the rules and had a favorable outcome and/or a posi-tive response from your peers and supervisors, you are likely to be tempted to do it again (Collins, 2003). If left unquestioned, the rule-bending action then tacitly becomes acceptable practice not only by that individual but may be adopted by others in the unit or facility and many times leads to what is referred to as a “cultural norm.” However, work-arounds and rule-bending are often just temporary fixes for bigger prob-lems in the system and do not pro-mote an environment supportive of safe patient outcomes.

STOP READING: Go back to your “practice drift” list. For each variation, list the reason(s) for those variations. Why do you and your co-workers use these work-arounds and shortcuts and bend established rules? What are you trying to achieve? What prob-lems in the system or environ-ment make it seem necessary to use these approaches?

Consider the following scenario: Megan, a newly-employed Registered Nurse in the Operating


Room of a small rural hospital, was assigned to circulate with another experienced nurse on a surgical case for Dr. S, a very impatient surgeon. The set up for the procedure was taking longer than expected because a specific piece of equipment that had been requested the day before could not be located. Dr. S voiced his frustration and threatened that he would cancel the surgery and “start taking his surgeries elsewhere” as they were never ready and always caused him to be behind in his schedule. The nurses rushed to fin-ish the set up and due to the delays the experienced nurse instructed Megan that they would forgo doing the required “time out” to verify the patient, procedure, site, allergies, and antibiotics administered. Megan voiced concerns but was assured this was “common practice” for this surgeon to keep him happy as you never wanted to be on his bad side. This example demonstrates how “practice drift” became a “cultural norm” for this facility. Based on extensive studies and the patient safety literature, the risk severity potential of omitting the “time out” procedure was high, but the proba-bility of incident was incorrectly perceived by the nurses to be low as there had been no reports of wrong patient or wrong site sur-geries in this hospital. The decision drivers to “work-around” the rule included the intimidation the nurses felt due to the surgeon’s threats, the nurses’ desire to make up for lost time, and the time delay caused by the lack of preparedness in failing to verify the day before that the equipment was available. As described in this example, it is likely that this cultural norm will be perpetuated by the new nurse for whom this was identified as acceptable behavior. In addition, this cultural norm was reinforced again for all the nurses by the lack of untoward outcomes in this case.

STOP READING: Go back to your “practice drift” list. High-light those variations that have

become “cultural norms” in your setting. Is this “practice drift” so common that it is used routinely by all nurses? Is it used only by some of the nurses? If so, why do the other nurses not use these approaches?

Dr. Van Sell (2012), noted that nurses will engage in a reasoned, intentional rule bending behavior to solve an immediate problem and not realize the potential nega-tive consequences. Factors such as staffing levels, patient acuity, work-load, time constraints, interrup-tions/emergencies, lack of access to providers, lack of input in design of workflow and procedures, famil-iarity and trusting relationships with providers, and lack of proper working equipment/supplies/medi-cations are just some of the chal-lenges nurses face every day when trying to do what needs to be done to provide effective patient care. Work-arounds develop in response to factors that:• are perceived to prevent or undermine nurses’ care for their patients; • are not considered in the best interests of the patient; • make performance of their job difficult; or • potentially threaten professional relationships. Now, can you identify “practice drift” in the following scenario? Cindy, a Licensed Practical Nurse, has worked on the evening shift in a long term care skilled nursing facility for a number of years. The facility does not have an on-site pharmacy; therefore, all ordered resident medications are obtained from a pharmacy in a neighboring town. On the date of this incident, a new resident was transferred from the hospital to Cindy’s unit. They were under-staffed, which was not an uncom-mon occurrence on that unit. That evening Cindy was falling behind with all the tasks she was assigned to complete. She completed the admission assessment but failed to

review the orders. The Unit Secre-tary transcribed all the medication orders onto the Medication Admin-istration Record (MAR) for Cindy to verify. Cindy was preparing to do her first medication pass for the shift. She took the Medication Administration Record (MAR) without verifying the orders because she had no doubts that it was accurate. She proceeded to pre-pour all scheduled medications for all residents for the entire shift and place them into individual baggies which she labeled with the residents’ room numbers. At the same time, she documented that all medications poured had been administered at the times noted in the MAR. She believed these prac-tices to be safe. She had worked with these residents for a long time and knew who they were as well as what medications they took. Throughout the shift, she com-pleted the medication passes which she had pre-poured and pre-documented. The new resident had an order for an oral antibiotic which had not been delivered. Cindy knew another resident on the unit was taking this same medication so she “borrowed” one dose because she didn’t have time to wait on the pharmacy. She failed to check the new resident’s allergies, thus fail-ing to see that there was a docu-mented allergy to the antibiotic she had administered. The resident had an allergic reaction resulting in the resident having to be trans-ferred back to the hospital. While trying to take care of the transfer arrangements for the above resident, a nursing assistant (who is currently in nursing school) informed her that another resident was requesting her pain medication. Cindy reviewed the MAR and noticed the medica-tion was ES-Tylenol. She poured the medication and handed it to the nursing assistant directing her to take it to the resident. In addition, a nurse arrived at 8:30pm to assist with medication


administration but left and went back to her own unit when she reviewed the MAR and saw all medications had already been administered through 10:00pm doses. The relief nurse reported to the supervisor that there was a discrepancy related to medica-tion administration. The above scenario involved multiple “practice drifts.” How many did you find? • Insufficient staff on the unit contributed to Cindy’s decisions to “cut corners.” She did not request assistance because she “knew” it would not be available, leaving the supervisor unaware of the unit status. • She rationalized that she did not have to check the orders and MAR because she trusted the secretary and believed she would not make an error in transcribing. • She failed to consider that the unit secretary was not educated in clinical nursing and pharma- cology and would not likely identify the problem between the resident’s allergies and the medication ordered. • In her rush to complete the medication pass, she omitted the safety check of reviewing the allergies as well. • Instead of waiting on the pharmacy or calling to see why the resident’s medications had not been delivered, Cindy decided to bypass policy and borrow the medication from another resident. Had she called the pharmacy she would have been informed that there was a question regarding the order. This third safety mechanism would have prevented an error. • Cindy believed that pre-pouring all the medications at once would save her time and be more efficient. Because she knew the patients, she believed that she could label the baggies with room numbers only. She chose to ignore all patient safety policies and procedures.

• Cindy’s decision to pre-document all the medications that were scheduled to be administered on her shift ultimately resulted in confusion as to what medications had been administered when another nurse came to assist. Notification of the supervisor resulted in an internal investigation into Cindy’s medication administration practices

and resulted in a report to the Board. As a result of this action, Cindy’s credibility was called into question causing her em- ployer to question if she falsi- fied patient records routinely.• Finally, Cindy inappropriately delegated medication administration to an unlicensed nursing assistant. This, too, was a viola- tion reported to the Board.


Ultimately, Cindy’s actions on this shift demonstrated extreme “practice drift.” Her overall intent was to provide the best care possible with limited resources. However, the time Cindy thought she was saving by using shortcuts, bending rules, and implementing work-arounds, resulted in com-promised patient care, damage to her professional reputation and credibility, a potential loss of her job, and a potential sanction of her nursing license. It is not uncommon for any one of us, when faced with hav-ing to do more with less or when pushed for time, to find ways to use work-arounds and take short-cuts. In a busy work environment, particularly one that is under-staffed, rule-bending may seem like the only solution. But none of these influence substantive change and they only provide a temporary fix when what is needed is a change in the under-lying condition that made work-arounds, short-cuts or rule bending necessary. “Practice drifts” operate as adaptions to inefficiencies and have the potential to both subvert and augment patient safety. Occa-sionally, workarounds operate as localized acts of resilience, are at times crucial to the delivery of services, place the patient’s best interests at the forefront, operate as adaptions to inefficiencies, and provide opportunities for improvement. When operating in this manner, they are used as unique, short-term solutions and the opportunities for im-provement are immediately addressed. More frequently, however, because rule-bending, work-arounds, and shortcuts circumvent safety blocks, mask environmental and operational deficiencies, and undermine standardization they have the potential to jeopardize patient safety as well as your career. When a patient is injured because you deviated from the standard

of care, there is little defense to be found (HPSO, 2016). Rules: we can’t live without them, but there is probably not a day goes by when we don’t break or bend one. Rule-bending, work-arounds, and shortcuts are all reflective of the “practice drift” used to achieve specific outcomes. They often seem like the only solu-tion to fixing what is wrong. They become part of the culture and the need to identify and address the root cause of the issue is hidden. We fail to see that we have institu-tionalized a temporary, inadequate fix. In many cases, it is not until an adverse event requires deeper examination that the underlying conditions that led to unsafe “practice drift” are identified. Nurses, according to the Gallup Poll, have ranked as the most trusted profession for the last 14 years (ANA, 2015). Nurses strive to do a good job and to provide safe, effective care. We strive to identify more efficient ways to accomplish effective outcomes. Unfortunately, once we get com-fortable in doing something, our practice may begin to drift in an attempt to find ways to accomplish more with less or to do something “faster” or “better.” We lose sight of the risk inherent in the result-ing deviations from established standards of care, policies, and procedures. We assume that risk through the behavioral choices we make. When a patient is injured because we deviated from the standard of care, we bear that responsibility. The NC and KY Nursing Practice Acts (Laws) and Rules provide clear direction concerning the variables that determine the responsibilities or assignments that can be safely accepted by an RN or LPN. Likewise, specific criteria designate considerations when assigning or delegating to others. Nurse manager and admin-istrator responsibilities for staff, unit environment, and nursing systems are also spelled out.

STOP READING: Explore the KY Nursing Practice Act KRS 314 (http://kbn.ky.gov/Legal_Opinions/Pages/Laws.aspx) and Kentucky Administration Regulations Chapter 20 to identify sections relevant to this discussion.

All nurses must strive to un-cover and address the underlying causes of rule-bending, workarounds, and shortcuts to affect substantive change. Nurses, nurse managers, and administrators must work together to identify and address the underlying issues in each work environment – both chronic and acute – which influence “practice drift.” Nurses must speak out to identify the “practice drift” they and their peers are using; specifi-cally identify the underlying rea-sons: short staffing, inadequate supplies, unresponsive pharmacy services, inadequate education, etc.; and collaborate with manag-ers and administrators to identify effective, evidence-based solutions. It is essential that safe solutions to underlying problems be imple-mented. Patient safety and well-being is the ultimate shared goal.

NOW: Go back to your “prac-tice drift” list and make a plan to address at least one variation! How will you alter your own practice to move away from at-risk behavior? How will you communicate the risks of “prac-tice drift” to your co-workers? How will you address the under-lying system changes with your manager and administrator?

IN THE FUTURE: Prioritize your “practice drift” list and address one at a time. Enlist support and involvement from your co-workers and manager. Patient safety and well-being is your ultimate shared goal!

REFERENCES: American Nurses Associa-tion (2015, December). Nurses rank as most honest, ethical

profession for 14th straight year. News release, 12/21/15. Silver springs, MD: Author.

Collins, S.E. (2003, July). Legally speaking: The problem with breaking the rules. RN Magazine.

Debono, D.S., et al. (2013). Nurses’ workarounds in acute healthcare settings: A scoping review. BMC Heath Services Research; BioMed Central Ltd.

HPSO. (2016). The Risks of bending the rules. Available at: www.hpso.com/risk-education/individuals/articles/

Hutchinson, S.A. (1990). Responsible Subversion: A study of rule bending among nurses. Sch Inq Nurs Pract, 4(1), 3.

Institute for Safe Medication Practices (IMSP). (2012, May). Just culture and its critical link to patient safety (Part 1). ISMP Medication Safety Alert! (First published 2006.)

Institute for Safe Medication Practices (IMSP). (2012, June). Our long journey towards a safety-minded just culture: Where we are going (Part 2). ISMP Medication Safety Alert! (First published Sept. 2006.)

Marx D, Comden SC, Sexhus Z, eds. (2005, Nov/Dec). Repeti-tive at-risk behavior - what to do when everyone is doing it. Just Culture Community News Views, 1, 5-6.

Outcome Engineering. (2005). An Introduction to Just Culture. Dallas, Tex: Outcome Engineering, Inc. Available at: www.justculture.org/downloads/jc_overview.pdf.

Outcome Engineering. (2005, March). The Just Culture Algorithm-version 1.0. Dallas, Tex: Outcome Engineering, Inc. Available at: www.justculture.org/downloads/jc.algorithm05.pdf

Van Sell, S. (2012, Dec 8). What are the implications of breaking a nursing law? Texas Woman’s University. Available at: www.researchgate.net/post/What_are_the_implications


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Chicago — The National Council of State Boards of Nursing (NCSBN) Board of Directors (BOD) voted to provide NCSBN courses “Understanding Substance Use Disorder in Nursing” and “Nurse Manager Guidelines for Substance Use Disorder” free of charge for all nurses and nursing students. NCSBN BOD President Katherine Thomas, MN, RN, FAAN, executive director, Texas Board of Nursing, comments, “The chronic and complex disease of substance use disorder (SUD) is an issue of importance to U.S.

boards of nursing because of the potential harm to patient welfare. Cognizant of the opioid crisis and substance use disorder’s societal impact, NCSBN is responding to the American Public Health Asso-ciation’s call to action to imple-ment evidence-based provider training programs in substance use disorder.” NCSBN’s SUD toolkit, which includes brochures, posters, a book and two continuing education (CE) courses, was developed to assure that nurses are armed with knowl-edge to help identify the warning

signs of SUD in patients, nurses and the general public and provide guidelines for prevention, educa-tion and intervention. Now all of these resources are available free of charge from www.ncsbn.org. Both CE courses award contact hours upon success-ful completion. Register for the courses at www.learningext.com. In addition, the toolkit includes the “Substance Use Disorder in Nursing” resource manual, the “Substance Use Disorder in Nursing” video, prevention-focused posters for health care


facilities and two brochures, “What You Need to Know About Substance Use Disorder in Nursing” and “A Nurse Manager’s Guide to Substance Use Disorder in Nursing.” About NCSBN Founded March 15, 1978, as an independent not-for- profit organization, NCSBN was created to lessen the burdens of state governments and bring together boards of nursing (BONs) to act and counsel together on matters of common interest. NCSBN’s membership is comprised of the BONs in the 50 states, the District of Columbia, and four U.S. territories — American Samoa, Guam, Northern Mariana Islands and the Virgin Islands. There are also 27 associate members that are either nursing regu-latory bodies or empowered regulatory authorities from other countries or territories. NCSBN Member Boards protect the public by ensur-ing that safe and competent nursing care is provided by licensed nurses. These BONs regulate more than 4.5 million licensed nurses. Mission: NCSBN provides education, service and research through collabora-tive leadership to promote evidence-based regulatory excellence for patient safety and public protection. The statements and opinions expressed are those of NCSBN and not the individual member state or territorial boards of nursing.

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HIGHLIGHTS OF BOARD ACTIONSKENTUCKY BOARD OF NURSING SUMMARY OF MAJOR ACTIONSBoard MeetingOctober 20, 2016

PRESIDENT’S REPORTBoard members and staff provided updates from the 2016 National Council of State Board of Nursing General Assembly; overviews of the Citizens Advocacy Center (CAC) conference; Council of Licensure, Enforcement and Regulation (CLEAR) conference; and the NCSBN 2016 International Nurse Regulator Collaborative Symposium.

FINANCIAL OFFICER’S REPORTThe Financial Officer report was discussed and accepted.

EXECUTIVE DIRECTOR’SREPORTThe written Report of the Executive Director was presented and included information on Administrative Staff; Office Suite Update; Legal Memo-randum – Performance of Program of Nursing Site Visit and Investigation of Complaints; Council on Licensure, Enforcement and Regulation Con-ference; Citizens Advocacy Center 2016 Annual Meeting; 2017 ENLC Cohort Meeting; Legal Matters; Ad-ministrative Regulation Information; License Renewal Update; Registration and Credential Statistical Reports; Investigation Data; Compliance Data; Sex Offender Registry; Presentations and Conferences Report; Approved Agreed Orders, Consent Decrees, and Removals from Probation.

Nathan Goldman has been re-appointed to the National Council of State Boards of Nursing Board of Directors.

EDUCATION COMMITTEEThe Education Committee Meeting was held September 8, 2016. The Board accepted the Report and the following actions were taken:• Approved the 2016-2017 Edu-

cation Committee Objectives.

• Directed that the October 2016 Gateway CTC (Associate Degree Nursing Program, Edgewood, KY) Site Visit be delayed and require a report to come forward from Gateway CTC to the Education Committee in March 2017. The Education Committee will review and determine the date of the next Site Visit.

Galen College of Nursing, Associate Degree Nursing Program, Louisville, KY, Proposal for Secondary Site - Hazard, KY• Approved the proposal, dated

July 26, 2016, from Galen College of Nursing, Louisville, KY, to establish a secondary associate degree nursing site in Hazard, KY.

• Granted Developmental Approval Status to the Galen College of Nursing, Louisville, KY, secondary site in Hazard, KY.

ATA College, Louisville, KY, Letter of Intent to Establish an Associate Degree Nursing Program• Accepted The Letter of Intent,

dated July 11, 2016, submitted by ATA College, Louisville, KY, to establish an associate degree nursing program in Louisville, KY.

• Directed ATA College, Louisville, KY, to proceed to the proposal phase to meet the requirements of 201 KAR 20:280 Section 4.

201 KAR 20:215 Continuing Competency Requirements• Approved the proposed revision

to 201 KAR 20:215 Continuing Competency Requirements.

201 KAR 20: 220 Nursing Continuing Education Provider Approval• Approved the proposed revision to

201 KAR 20:220 Nursing Continu-ing Education Provider Approval.

PRACTICE COMMITTEEThe Practice Committee Meeting was held September 9, 2016. The Board accepted the Report and the following actions were taken:

Committee Objectives – Proposed• Approved the 2016-2017 Practice

Committee Objectives.

AOS #21 – Roles of Nurses and Technicians in Dialysis – Proposed Editorial Revision• Approved the editorial revision to

AOS #21, Roles of Nurses and Technicians in Dialysis.

AOS #29 – Cardiopulmonary/Respiratory Nursing Practice – Proposed Editorial Revision• Approved the editorial revision

to AOS #29, Cardiopulmonary/Respiratory Nursing Practice.

CREDENTIALSREVIEW PANELThe Report of the Credentials Review Panel Meetings held September 9, 2016 and October 19, 2016 were presented. The Board accepted the Report and no actions were taken.

GOVERNANCE COMMITTEEThe Governance Committee Meeting was held September 8, 2016. The Board accepted the Report and the following actions were taken:

Review Proposed Legislation for 2017 • Approved the proposed legislation

for the 2017 General Assembly and directed the staff to proceed with its introduction of legislative language.

KBN 2016 Retreat Agenda• Approved the proposed agenda.• Approved the Customer Service

Satisfaction Survey Proposal.

DISCIPLINARY ACTION• Approved 14 (fourteen) Recom-

mended Orders, as written, and received reports on the approval of 51 (fifty-one) Agreed Orders, 79 (seventy-nine) Consent Decrees, and 10 (ten) Removal of Licenses from Probation.



Since the publication of the Summer edition of the KBN Connection, the Board has taken the following actions related to disciplinary matters as authorized by the Kentucky Nursing Laws. A report that contains a more extensive list of disciplinary actions is available on the KBN website (http://kbn.ky.gov/conprotect/investdiscp/disciplinary.htm). If you need additional information, contact KBN’s Consumer Protection Branch at 502-429-3300.

COPIES OF INDIVIDUAL NURSE’S DISCIPLINARY ORDERS CAN BE VIEWED OR OBTAINED AT THE WEBSITE: nursys.com

DISCIPLINARYActions

CEASE AND DESIST NOTICES ISSUEDHowland, Haley Murray, KY Eff. ............. 10/6/16 IMMEDIATE TEMPORARY SUSPENSION OF LICENSE/CREDENTIAL Bartley, Jaime J LPN License 2037832 Pikeville, KY Eff. ........... 10/18/16Battaglia, Chelsea M LPN License 2039575 Hebron, KY Eff. ............. 10/3/16Beckner, Melissa Jo Bailey LPN License 2036062 Louisville, KY Eff. ........... 10/28/16Bremer, Amy Lynn RN License 1120874 Middletown, KY Eff ............ 12/22/16Browning, Amanda Jane Flowers RN License 1091536; Glasgow, KY Eff. ........... 10/27/16 APRN License 3007614 Carpenter, Marita LPN License 2042092 Nicholasville, KY Eff. ........... 10/27/16Church, Amy Hay LPN License 2045543 Ashland, KY Eff. ........... 10/27/16Duff, Jami Allese Lee RN License 1140515 Beaver Dam, KY Eff. ........... 10/27/16Edwards, Richard Lee RN License 1135904 Lexington, KY Eff. ............. 11/4/16Forrest, Orville Brenton LPN License 2040414 Lexington, KY Eff. ........... 10/27/16Gauze, Janice Aileen Alewine RN License 1085715 Louisa, KY Eff. ........... 10/25/16Hogan, Phyllis Jean Shirley RN License 1091544; Bowling Green, KY Eff. ........... 10/24/16 LPN License 2023764 Kaufman, Andrea Deneea LPN License 2040546 Louisville, KY Eff. ........... 10/27/16Langford, Katherine Elizabeth LPN License 2044494 Tompkinsville, KY Eff. ........... 10/31/16Lengfellner, Patricia Ulrike Ham LPN License 2042891 Murray, KY Eff. ........... 10/27/16Malone, Lois B LPN License 2039594 Jamestown, KY Eff. ........... 10/12/16Martin, Janice K Lansdale LPN License 2022938 Mount Sterling, KY Eff. ........... 10/28/16McWilliams, Helen F White LPN License 2039817 Morgantown, KY Eff. ........... 10/27/16Miles, Rebecca LPN License 2036497 Pinetop, KY Eff. ........... 10/12/16Miller, Timothy Shayne LPN License 2048298 Louisville, KY Eff .............. 12/7/16Mollette, Sandra Gwen Dixon RN License 1091573 Inez, KY Eff. ........... 10/27/16Nourse, Carrie Beth LPN License 2039459 Independence, KY Eff. ........... 10/27/16Pitcock, Jessica Leigh Ann RN License 1098925 Burkesville, KY Eff. ........... 10/28/16Price, Beverly Gribbins LPN License 2028443 Lebanon, KY Eff. ........... 10/31/16Puckett, Joann RN License 1118647 Union, KY Eff. ........... 10/27/16Reid, Keziah Yolanda RN License 1119434; Radcliff, KY Eff. ............. 11/3/16 LPN License 2037488 Smith, Tony Nathaniel LPN License 2033409 Jeffersonville, IN Eff. ........... 10/27/16Stapleton, Joann Watts LPN License 2044803 Ashland, KY Eff. ........... 10/27/16Steward, Christopher Dale RN License 1118301; Cave City, KY Eff. ........... 10/28/16 APRN License 3006036 Taylor, Ruth Helms RN License 1084980; Cumberland, MD Eff. ............. 10/3/16 APRN License 3003775 Threets, Kenya Kyreen RN License 1129925; Jeffersonville, IN Eff. ........... 10/27/16 LPN License 2041651 White, Lillian Denise Long LPN License 2028918 Richmond, KY Eff. ............. 10/4/16 IMMEDIATE TEMPORARY SUSPENSION OF PRIVILEGE TO PRACTICEBass, Kristi Leigh MO RN License 2007021904 Dexter, MO Eff. ............. 10/3/16Therault, Patricia M TN RN License 209580 Murfreesboro, TN Eff. ........... 10/28/16

LICENSE/CREDENTIAL SUSPENDEDGeorge, Kimberly Sue RN License 1128494 Paducah, KY Eff .............. 12/8/16Massey, Gloria Denise RN License 1103897 Jeffersonville, KY Eff. ........... 10/27/16Shepherd, Angela Kay Callahan LPN License 2031930 Wooton, KY Eff. ........... 10/20/16 LICENSE/CREDENTIAL CONTINUED ON SUSPENSIONBlakeman, Kimberly Jo Wade RN License 1098664 Elizabethtown, KY Eff .............. 12/8/16 Crocker, Terrie Jane Embry RN License 1096920 Henderson, KY Eff .............. 12/8/16 Davis, Amy LPN License 2044792 Burlington, KY Eff ............ 10/20/16 Gordon, Christina Joy Tussey RN License 1124043 Richmond, KY Eff ............ 10/20/16 Huff, Larry B RN License 1101180 Middlesboro, KY Eff .............. 12/8/16 Lovett, Shea Ashley White RN License 1140329 Lexington, KY Eff .............. 12/8/16 Miller, Laura Katherine LPN License 2051285 Almo, KY Eff ............ 10/20/16 Petty, Corina Michelle Moore LPN License 2035743 Shepherdsville, KY Eff .............. 12/8/16 Rennecker, Allison Danielle RN License 1128964 Georgetown, KY Eff .............. 12/8/16 Riley, Jeffrey Edward RN License 11330931 Elizabeth, IN Eff .............. 12/8/16Robinson, Elisha Renee Hampton RN License 1106377 Robinson Creek, KY Eff .............. 12/8/16 PRIVILEGE TO PRACTICE CONTINUED ON SUSPENSION Pyle, Cody Andrew TX RN License 786992 Houston, TX Eff. ........... 10/20/16Winn-Francisco, Rachel A CO RN License 47277 Aurora, CO Eff. ........... 10/20/16 LICENSE/CREDENTIAL IMMEDIATELY SUSPENDED OR DENIED REINSTATEMENT FOR FAILURE TO COMPLY WITH BOARD ORDER; STAYED SUSPENSION IMPLEMENTED OR TERMINATION FROM KARE PROGRAM Barrowman, Elizabeth June Slone RN License 1081345 Elkhorn City, KY Eff. ............. 10/3/16Bowles, Symantha Eve Daniels LPN License 2046220 Louisville, KY Eff. ............. 11/2/16Mills, Ann Marie Miller RN License 1111078 Ashland, KY Eff. ............. 10/3/16


Cambridge Place provides resident directed care and respects resident choices. Our residents enjoy a clean, sociable and comfortable environment. If you honor this type of environ-ment then Cambridge Place may be the right fit for you in making your next career move. We have active employee appreciation programs and our caregivers interact daily with our residents. In other words ... we are family here. Ask a resident about our lovely facility or ask a caregiver. Now is a great time to join our team.

RN/LPN• We offer a wide array of flexible schedules.

• Our nurses are gracious, caring and inspiring caregivers.• Visit us and feel the difference.

The facility accepts applications for all departments, M-F, 8am-5pm

[email protected]

RN/LPN• We offer a wide array of flexible schedules• Ask about Sign-On Bonuses • Weekend

Differential • Our nurses are gracious, caring and inspiring caregivers.• Visit us and feel the difference.

The facility accepts applications for alldepartments, M-F, 8am-5pm

Apply at: 2020 Cambridge Drive,Lexington, KY 40504

email: [email protected]

Cambridge Place provides resident directed care and respects resident choices. Our residents enjoy a clean, sociable and comfortable environment. If you honor this type of environment then Cambridge Place may be the right fit for you in making your next career move. We have active employee appreciation programs and our caregivers interact constantly with our residents. In other words ... we are family here. Ask a resident about our lovely facility or ask a caregiver. Now is a great time to join our team.


Pendergrast, Nia Faerron LPN License 2020991 Jeffersonville, IN Eff. ............. 10/3/16Pugh, Christina Marie Eberenz RN License 1085912 Lexington, KY Eff ............ 11/29/16

LICENSE/CREDENTIAL DENIED OR DENIED REINSTATEMENT Birney, Melissa Carol LPN License 2038367 Danville, KY Eff .............. 12/8/16Cazzell, Stephanie Dawn Bloomingdale RN License 1143057 Fairborn, OH Eff. ........... 10/20/16Dryden, Nancy Carol LPN License 2026038 Seaman, OH Eff .............. 12/8/16Farley, Crystal Renee Johnson LPN License 2050298 Lewisburg, KY Eff .............. 12/8/16 Hagan, Matthew Blane Carl RN License 1112088 Louisville, KY Eff ............ 11/21/16Hicks, Tanya Ellen Hall LPN License 2041989 Paducah, KY Eff. ........... 10/20/16Howard, Danita Ulery White RN License 1098008 Englewood, FL Eff. ........... 10/20/16Hunter, Barbara Lea Reed LPN License 2035120 Lancaster, KY Eff .............. 12/8/16Lavender, L. Annette Rogers RN License 1027474; Hebron, KY Eff. ........... 10/20/16 APRN License 3005530 Lingar, Cindy M. Tuttle RN License 1111463 Barbourville, KY Eff. ........... 10/20/16Montgomery, Carranetta Lynn RN License 1088946 Louisville, KY Eff. ........... 10/28/16O’Hara, Kieran Tully LPN License 2047875 Louisville, KY Eff .............. 12/8/16 Rhodes, Felivia Mae LPN License 2049940 Indianapolis, IN Eff .............. 12/8/16 Snider, Christina Faye Jones RN License 1136494 Lexington, KY Eff ............ 11/21/16 Wenthe, Robin S Blackwell LPN License 2040049 Hopkinsville, KY Eff .............. 12/8/16

LICENSE/CREDENTIAL VOLUNTARILY SURRENDERED Carlton, Rachel Susanne Baird TN RN License 141253; Lebanon, TN Eff ............ 11/16/16 APRN License 3009624Dennison, Amy Carol Foushee RN License 1083649 Louisville, KY Eff. ........... 10/18/16

LICENSE/CREDENTIAL TO BE REINSTATED ON LIMITATION/PROBATION OR ADMITTED TO KARE PROGRAMCook, Marsha Land Evans RN License 1065479 Beattyville, KY Eff ............ 12/19/16 Donahue, Patrick Owen RN License 1111865 Louisville, KY Eff ............ 10/18/16 Eberling, Karen Stober RN License 1073845 Louisville, KY Eff ............ 12/19/16McAlister, Melissa Ann Ayres RN License 1104220 Lexington, KY Eff. ............. 10/6/16McCarthy, Jeri Lynn RN License 1086790 Owensboro, KY Eff ............ 11/16/16Ridener, Symmi Karl Thompson RN License 1108363 Georgetown, KY Eff .............. 10/6/16Tanweer, Rehana Kausar RN License 1119747 Lexington, KY Eff. ........... 10/20/16Wooton, Tonya Denise Schenk RN License 1087365 Cox’s Creek, KY Eff. ........... 10/20/16

LICENSE/CREDENTIAL PLACED ON LIMITATION/PROBATION Coulter, Douglas Tyler RN Applicant/Examination Bardstown, KY Eff. ............. 10/6/16Hudnall, Brandy Lynn Buckman RN License 1133454 Henderson, KY Eff ............ 12/19/16Walker, Renette Rachel LPN License 2046342 Carollton, KY Eff ............ 10/18/16

LICENSE/CREDENTIAL REPRIMANDED Ard, Dorothy RN Applicant/Examination California, KY Eff. ............. 10/6/16Brown, Anne-Margaret Bryant LPN License 2047615 Lexington, KY Eff ............ 12/19/16Fannin, Cairee Ann RN License 1138227 Vanceburg, KY Eff ............ 11/16/16Field, Mary Nell Boggs RN License 1104479 Wooton, KY Eff. ............. 10/6/16Golden, Mark Anthony RN License 1096606; Corbin, KY Eff. ............. 10/6/16 APRN License 3004618 Johnson, Stephanie Danielle Conner RN License 1118284 Jackson, KY Eff ............ 12/19/16Miller, Tiffany N RN License 1101263; Frankfort, KY Eff. ........... 10/18/16 APRN License 3007192 Penn, Aquelia Breanna Caven RN License 1125110 Mannsville, KY Eff ............ 12/19/16Pfohl, Melissa Elizabeth RN License 1091858 Louisville, KY Eff. ............. 10/6/16Showalter, Angelita Haynes RN License 1124400 Kevil, KY Eff ............ 12/19/16 Sidebottom, Laura Danielle RN License 1123409 Bardstown, KY Eff ............ 12/16/16 Simpson, Michele Howard RN License 1079761; Henderson, KY Eff ............ 11/16/16 APRN License 3006861 Williams, Temika L LPN License 2038062 Louisville, KY Eff ............ 12/19/16

LICENSE CLEARED FROM DISCIPLINARY ACTION Ball, Paula Rae Blaylock LPN License 2041281 Wallins, KY Eff. .......... 10/11/16Brooks, Holly Beth Schug LPN License 2039983 Ironton, OH Eff ............ 11/18/16Calvert, Robert Everett LPN License 2051491 Park City, KY Eff. ........... 10/27/16Collins, Lequita Denise RN License 1141725; Cincinnatti, OH Eff. ........... 10/25/16 LPN License 2042683 Compton, Tracy R RN License 1092229 Elizabethtown, KY Eff ............ 11/28/16Douglas, Julliette MO LPN 2002003886 Imperial, MO Eff. ........... 10/27/16Edson, Jeffrey Wyatt RN License 1115289 Severn, MD Eff ............ 11/21/16Golden, Mark Anthony RN License 1096606; Corbin, KY Eff. ........... 10/26/16 APRN License 3004618 Gray, Amy Nicole Trevathan DT Credential 8000078 Benton, KY Eff. ........... 10/31/16Hagan, Glenn William RN License 1087937 LaGrange, KY Eff ............ 12/21/16Martin, Brandon RN License 1121933 Nancy, KY Eff. ............. 10/6/16O’Bryan, Timothy Eugene RN License 1092106 Owensboro, KY Eff ............ 11/18/16 Pelfrey, Rocky V RN License 1074481 Clay City, KY Eff ............ 12/12/16Sizemore, Alayna Ann RN License 1141665 Louisville, KY Eff ............ 12/15/16

CONSENT DECREES ENTERED FISCAL YEAR TO DATE Imposition of civil penalty for practice without a current active license or temporary work permit .................................................................................... 8Imposition of civil penalty for falsification of an application for licensure ........................................................................................................................... 45Imposition of civil penalty for failure to meet mandatory continuing education requirement ............................................................................................ 14Imposition of civil penalty for a positive drug screen ................................................................................................................................................................ 7Imposition of civil penalty for a practice issue ........................................................................................................................................................................ 19

Kentucky Board of Nursing312 Whittington Pky., Ste 300Louisville 40222-5172

PRESORTED STANDARD

U.S. POSTAGE PAID

LITTLE ROCK, ARPERMIT NO. 1884

Documents

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