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Future of Nursing West Virginia
Update
Page 3
Basics of Nursing Practice and
Licensure
Page 7
AppreciationCelebration
Page 8
The official publication of the West Virginia Nurses Association
Volume 19 • No. 3August, September, October 2016
“Nurses working together for a healthy West Virginia”Quarterly publication direct mailed to approximately 37,000 RNs and LPNs in West Virginia.
President’s MessageBeth Baldwin, APRN, PNP, BC
WVNA President AANP WV State Rep
Fellow WV Nurses, The sunny days of
summer shine upon West Virginia and our State Nu r s e s A s s o c i a t i o n , WVNA. It is a great time to sit back, relax and enjoy the beauty of our state and the company of our family and friends. WVNA has done just that this summer with a kick off celebration in June for our champions, friends and members cheering the sparkling successes of the association’s 2016 legislative session. A GREAT time was had by all and I hope you were able to join in the festivities in Charleston. WVNA had a chance to thank our champions and partners for supporting efforts to pave the way for WV Nurses to practice to the top of their license and training. These advances expand WV nurses’ abilities to provide top quality evidence based healthcare to WV citizens. Once fully implemented WV citizens will have enhanced choices of fully qualified healthcare providers.
Passing this historic legislation for WV was WVNAs first hurdle to updating state codes and modernizing nursing regulations within the state. The next step of this code change is for WVNA to provide comment on the proposed rule and await the Board of Nursing’s final rules recommendations to section 8 prescriptive authority. Nurses will need to remain engaged and follow up with further support and comments about the benefit of the modernized regulatory rules changes. It will be up the WV
Beth Baldwin
board of nursing to assure the rules complete the improvements and implement the legislative intent. Although, many of the changes in code section 30-17-5 for APRN did not require any additional rules changes and became effective June 10. These include the global signatures of documents as an example; with only additional training required for signing death certificates. This training is online at the WV Board of Register Nurse Professional’s website and is ready for review and completion. The board of nursing has also submitted their recommendation for the APRN candidates for the Joint Advisory Council to the governor. The intent of the council is to review and recommend best prescribing practice in the country for WV. The goals would continue to advance WV to the nationally recommended levels of providing advanced healthcare prescribing practices. They will also help the board to review applications for APRNs that wish to prescribe autonomously without a written regulatory collaborative agreement in West Virginia to implement the legislative intent of HB4334.
WVNA has been busy this summer on the national front also. The officers have attended the American Nurses Association convention in Washington DC. WVNA will represent and join with the American Nurses Association in promoting national policy movements. At the top of the list is the national campaign for federal changes to safe staffing H.R. 2083/S. 1132 “utilizes direct care nursing experiences to establish staffing plans.” WVNA will be discussing the implementation of those national recommendations at the WVNA retreat in August. This retreat is held annually to discuss and revise the Health Policy and legislative initiatives of the association. It also is a time to reflect on success and prepare for future policy projects. If you would like to attend with
fresh thoughts, concerns and ideas, all nurse members are welcome. To attend please contact the central office for RSVP. The future direction of our professional nurses’ association depends on every WV nurse’s voice speaking up to improve WV’s healthcare delivery systems.
In closing it is my opinion that increasing membership in our professional nurses association is the key to meeting the needs of West Virginia’s ever changing healthcare demands. Nurses must be at the table as a united professional voice. WVNA plans to continue to promote all nurses practicing to the top of their education and train to be full partners in health care changes and improvements. WVNA stays involved with nurses in multiple initiatives, like the health workforce initiative, work place safety and violence prevention. WVNA is involved in the newest solutions to treating and preventing opioid addiction and over prescribing, we know the solution must include nurses. WVNA will remain engaged in the implementation of the future of nursing initiatives with advancement of best practice recommendation from the future of nursing WV. WVNA supports advancing the nursing profession through lifelong learning and continued credited education of our nursing work force. WVNA acknowledges that improved transition from the bedside into the community for WV citizens is imperative to promote health within our state and prevent the number 3 killer in the US, medical errors, for this nurses must be involved. Join Nurses with your front line knowledge, input and voice by being a member of the West Virginia Nurses Association and letting us know what matters to you as a professional. Nurses are the first line to promote a sparkling healthy West Virginia.
PLEASE JOIN US TODAY!!!!!
Seems as if it’s always time for an election. National, state and WVNA. This year WVNA will be electing a new association president, vice-president
and treasurer. Nominations are being accepted.
Duties for each as listed in the WVNA By-Laws which can be found on WVNA’s website http://www.wvnurses.org/Functional-Category/About-Us/Bylaws.pdf
If you are interested in an office and you would like more information please contact the office via email [email protected] or call 304-342-1169.
Election Time!
Page 2 West Virginia Nurse August, September, October 2016
West Virginia Nurse Official Publication of the
West Virginia Nurses Association
2306 1/2 Kanawha Blvd. EastCharleston, WV 25311
Phone: 304.342.1169 or 800.400.1226Fax: 304.414.3369
Email: [email protected]
Webpage: www.wvnurses.org
Published quarterly every February, May, August and November for the West Virginia Nurses Association, a
constituent member of the American Nurses Association.
The opinions contained herein are those of the individual authors and do not necessarily reflect the views of the
Association.
WV Nurse reserves the right to edit all materials to its style and space requirements and to clarify presentations.
WVNA Mission StatementThe mission of WVNA is to empower the diverse voice of nurses in all settings toward unified focus of nursing knowledge, skill and ability to promote the health & well-being of all West Virginians, through education, legislation and health policy.
Executive BoardBeth Baldwin, President: [email protected]
Brenda Keefer, 1st Vice President: [email protected] Wilson, 2nd Vice President: [email protected]
Toni DiChiacchio, Treasurer: [email protected] Booton, Secretary: [email protected]
Aila Accad, Immediate Past President: [email protected] Williams, Approver Chair: [email protected]
Joyce Egnor, Approver Co-Chair: [email protected] Hermosilla, District 5: [email protected]
Shelia Kyle, District 9: [email protected] Cotton, WVN-PAC Chair: [email protected]
Jennifer Westfall, APRN Congress: [email protected] Collins, Membership Committee Chair:
WVNA StaffLori Chaffins, Executive Director
WV Nurse StaffRuth Blevins, Managing Editor
West Virginia Nurse Copy Submission GuidelinesAll WVNA members are encouraged to submit material for publication that is of interest to nurses (especially in the following sections: Nightingale Tribute and Members in the News). The material will be reviewed and may be edited for publication. There is no payment for articles published in the West Virginia Nurse.Article submission is preferred in Word Perfect or MS Word format. When sending pictures, please remember to label pictures clearly since the editors have no way of knowing who persons in the photos might be.Copy Submission via email: Only use MS Word for text submission. Please do not embed photos in Word files, send photos as separate jpg files.Approximately 1,600 words equal a full page in the paper. This does not account for headlines, photos, special graphics, pull quotes, etc.
Submit material to:West Virginia Nurse
PO Box 1946, Charleston, WV 25327 or Email: [email protected]
For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. WVNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the West Virginia Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. WVNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of WVNA or those of the national or local associations.
Published by:Arthur L. Davis
Publishing Agency, Inc.
www.wvnurses.org
2016 Meetings– The weekend of August 13th and
14th, there will be a WVNA Retreat/Conference – meeting time and location to be announced.
– There will be a WVNA General Assembly meeting on October 22nd at 9:00am in Charleston – location to be announced.
Members We Shall MissIf your name appears on this list and
you believe it is in error please contact [email protected] or call 304-342-1169 for more information.
Stacey Haynes Archer
Carla Renee Isble Bane
Lashonda Bare
Rebecca M. Bowe
Janet Chapin
Jennifer Cook
Ashley Nicole Davis
Tashawna Davis-Lilly
Pamela M. Deiriggi
John Robertson Gaskins
Carolyn Gibson
Stacy Groom
Patricia A. Hackney
Kathryn Kahler
Betsy Kanakanui
Rebecca J. King
Rachel Knotts
Delores Lucky
June R. Lunney
Tara McCormick
Judith Patricia McGill
Diane Nally
Amanda Nicola
Constance J. Oates
Hillary Elaine Parcell
Bessie Raines
Melissa Ann Roach
Lydia Smith
LeAnn Snead
Martha Snider
Kathy Lynn Stahl
Lisa G. Walker
Cheryl L. White
Angelita (Angy) NixonAmerican Certified Nurse Midwives
2016 Public Policy Award
For work in WVA to achieve Full Practice Authority!
Angy was also induced into the Fellowship of ACNM adding to her list of achievements. WVNA congratulates her for her outstanding contributions to nursing for the state of West Virginia.
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Browse our online databaseof articles and content.
Find events for nursing professionals in your area.
Your always-on resource for nursing jobs, research, and events.
www.nursingALD.com
August, September, October 2016 West Virginia Nurse Page 3
Future of Nursing WV UpdateAila Accad, MSN, RN, Executive Director
The Future of Nursing WV is an action coalition of nurses and non-nurses working together for a healthier WV through strengthening nursing practice, education, & leadership. Here is an update on our progress.
GalaTickets and sponsoring opportunities are
now available for the first Annual Future of Nursing Recognition Gala to be held at the University of Charleston, Ballroom on Saturday, August 27th. We will be recognizing our volunteers and organizations who have contributed to the success of our Team Projects. This is an exciting time for Nursing and we would like to see you there to celebrate, network, and join fellow colleagues and leaders from a variety of nursing and nursing champion organizations. We have a special Master of Ceremonies who will dazzle you and make the evening a memorable and fun time. We hope to see you there! Get your tickets now on the website at www.futureofnursingwv.org. Some of our gala team planners are pictured with this update.
Online Transition to Practice & Leadership ProjectThe project is now complete and open for enrollment by new
graduate nurses and nurses moving into leadership roles in their organization. Instructions for enrolling are on the website: http://www.futureofnursingwv.org.
Transition to Practice Course Classes Delegation, Communication, Time Management, Pain Management,
Staff Support at End of Life, Less Stress-More Power, Precepting
Leadership Academy Management Classes Coaching and Developing Employees, Safety, Regulatory Management,
Ethics, Planning and Goal Setting, Teamwork and Collaboration, Budgeting, Staffing, Mentoring
Education Team Survey The WV Board for Professional Nursing partnered with the Education
Team to conduct an online survey of Barriers to Advancing Nursing Education in WV. Results of the survey are published on the www.futureofnursingwv.org website
New team members are always welcomed to join our teams! Contact Aila if you are interested in participating in these exciting initiatives.
Join Us!You can also keep up with FONWV updates on the national website at
www.campaignforaction.org.If you are interested in becoming a member of the WV Action
Coalition, learning more, or joining a team or if your organization would like to become an organizational member, contact Aila Accad at [email protected] or sign up on the website at http://www.FutureofNursingWV.org.
Also, join us on our social media sites:Facebook – look for Future of Nursing WVLinkedIn.com/in/FONWVTwitter.com/FONWV
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Page 4 West Virginia Nurse August, September, October 2016
Unity DayUnity Day 2016 Summary of Posters and Purpose
Fanning, MaryS u s t a i n i n g M a g n e t ® : O u t c o m e s
Demonstrating Nursing Excellence. Describe examples of evidence demonstrating return on investment in facilities that possess Magnet characteristics, discuss examples of structure and process that can lead to outcomes that meet or exceed national benchmarks, list outcomes in areas of nurse recruitment and retention, access to care, workplace safety, clinical service and patient safety that demonstrate nursing excellence._______________________________________________
Strakal, MavisStaff nurse at WVU medicine Neuroscience
unit. Identify sources of stress specific to neuroscience nurses, implement relief strategies for symptoms of burnout, list symptoms of burnout._______________________________________________
Spencer, BarbaraEvaluating Ef fectiveness of Pain
Management Education for Hospice Nurses. Recognize the unacceptable level of management of pain, discuss the public health challenge that unrelieved pain places on the health care system, list methods of nurses’ evaluation of pain as well as documentation and follow-up, and recognize the need for pain management education in all levels of nursing curricula._______________________________________________
Gray, Donna; Smith, Ashley; Braley, Susan; Hazlett, Jessica; Mullins, Laura
The Effect of Drugs on the Fetus. Discuss the effects of drugs on a developing fetus, review the prevalence of drug abuse in pregnant women in WV, and recommend policy changes related to drug abuse in the pregnant woman._______________________________________________
Burke, Sarah; Casey, Aaron; Latimer, Frank; Spurlock, Mallori; Welch, Shannon
Medication-Assisted Treatment of Substance Abuse. Review prevalence of drug abuse in WV, discuss how nurses can reduce opiate dependence, and make policy recommendations on the use of medication-assisted treatment for substance abuse._______________________________________________
Boggess, Kenny; Graley, Roy; Martin, Jessica; Ogden, Jesse; Willis, Casi
Assessment of the Cardiac Patient. Review the impact of heart disease on population health, and recommend techniques for the nurse to complete a thorough cardiac assessment._______________________________________________
Estepp, Mikael; Darst, Brittany; Burford, Chelse; Wilkes, Andrea; Holley, Leanne
Chronic Obstructive Pulmonary Disease (COPD.) Review the pathophysiology of COPD, discuss the impact COPD symptoms have on patient quality of life, and recommend nursing interventions on lifestyle decisions and symptom management for patients suffering with COPD._______________________________________________
Gunnoe, Anita; Raines, Jennifer; Hudson, Amber; White, Amanda; Wright, Samantha; Taylor, Kayla
Nutritional Change in Elementary Schools of WV. Review prevalence of obesity in the youth of WV, review prevalence of chronic diseases in WV associated with obesity, recommend interventions directed at elementary school children in WV to reduce childhood obesity._______________________________________________
Vargo, Amanda; Remo, Heinz; Mufti, Nefisa; Ceballos, Noel, VanBibber, Whitney
Health Promotion and Childhood Obesity. Describe dietary interventions that prevent weight gain, review impact of obesity on other chronic diseases, recommend strategies to reduce childhood obesity._______________________________________________
Klenk, BrianImproving Testing Rates for Hepatitis C
in the US Veteran Population. Review CDC guidelines on Hepatitis C screening, discuss risk factors for Hepatitis C, improve education to veterans on Hepatitis C screening._______________________________________________
Sheaves, CrystalPolicy for Modifiable Social Determinants
of Health in West Virginia. Describe how social determinants impact health quality of life and identifiy specific policies that could influence social determinants of health in WV._______________________________________________
Fowler, Jessica; Everly, JacquelineImmunizations: The impact of personal
belief exemptions on public health. Explore the impact of personal belief exemption from mandatory childhood immunizations, review the immunization exemption law in WV, and review best policy practices relating to childhood immunizations._______________________________________________
Barker, KendraTreating Diabetes with Folk Medicine:
The Facts on Herbals. Healthcare professionals face challenges in providing evidence-based healthcare for topics on which the evidence base is limited. Using herbal treatments for patients with diabetes is an area of complementary and alternative medicine, and has been less widely explored for therapies in the provision of EBP and diabetes management as compared to mainstream medicine. Patients in WV may utilize herbals for folk medicine, and exploring these therapies is important to evaluate the impact on diabetes._______________________________________________
West, LaurenChildhood Obesity: What We Can Do.
Examine childhood obesity in the US and WV, explore nurses responsibility in prevention and treatment of childhood obesity, recommend methods of decreasing childhood obesity._______________________________________________
Unmussig, JessicaNewborn Screening Policy. Promote
awareness and understanding of newborn screening policy in WV, discuss needs for parents, public and nurse education with newborn screening, and bring attention to benefits and issues with mandatory screening._______________________________________________
Kerling, NicoleEducation on Organ Donation. Review
organ donation statistics, identify ways to improve education of healthcare professionals on the matter of organ donation, discuss methods of updating nursing curriculum to facilitate learning of organ donation._______________________________________________
Davis, AmyExploring the Mature Minor Doctrine.
Examine the Mature Minor Doctrine, investigate the significance the issue plays in healthcare and discuss recommendations for improving this policy._______________________________________________
Cropper, BrookeImpact of Healthcare Policies on Nurse
Practitioners Providing Primary Healthcare. Evaluate the modern role of NPs in primary care and impact of the Affordable Care Act on healthcare workforce, examine quality of care provided by NPs, and review implications for scope of practice regulations._______________________________________________
Cropper, RachelCare of the Transgender Youth: Ethical
and Legal Factors. Review the ethical and legal patient care issues for transgender youth population and make recommendations for nursing care of this population._______________________________________________
Mickinac, Philip; Royek, AnnaThe early introduction of education
on advance directives to community populations. Examine methods of increasing awareness and utilization of advance directives and the nursing role in completion of advance directives, review the components of advance directives and barriers to completion, present a resolution made to the National Student Nurses Association regarding increasing education of nursing students on the completion of advance directives._______________________________________________
McCutcheon, BrandonDrug Diversion in Health Care. Provide
healthcare professionals with the baseline understanding of drug diversion, the nursing role in preventing drug diversion, and the proper disposal of narcotics._______________________________________________
Calebaugh, KristinLack of Parity between Mental Health and
Physical Health in Primary Care. Examine the disparity between care for mental health compared to physicial health, review the underlying reasons for such disparity, recommend policy changes to increase mental health care provision in primary care settings._______________________________________________
Whilte, MeghanProviding Foot Care Education to
Individuals with Diabetes. A prevalent issue in persons with diabetes is the occurrence of foot complications, a theoretically preventable problem. Ten percent of those with diabetes have at least one or two risk factors for developing foot ulcers at the time of their diagnosis and a 15% risk over their lifetime. The purpose of this poster is to educate healthcare providers on the standards of foot care for persons with diabetes._______________________________________________
Pinto, SusanPerceptions of Asthma QOL in Child-Parent
Dyads in two Rural Counties in West Virginia. Present results of study examining perceived quality of life of children with asthma and their parents from two schools in rural WV._______________________________________________
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experience required.
Qualified individuals may apply online at: [email protected]
by mail or in person to: Westbrook Health Services
Human Resources, 2121 7th Street Parkersburg, WV 26101
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Advanced Practice Registered Nurse
August, September, October 2016 West Virginia Nurse Page 5
APRN Congress NewsJennifer Westfall, APRN-BC
Hello everyone! I am Jennifer Westfall and am the newly elected chair of the APRN Congress. For those of you that don’t know me I have been an advanced practice nurse for 10 years and am certified in both family and geriatrics. My primary care focus over my career has been cardiology in the acute care setting. Like many of you, I reluctantly admit to a previous lack of involvement with the WVNA, ANA and any politics in general. What a mistake! Over the last year I have seen a concerted effort trying to prevent progress in the role of advanced practice nurses. I have had many of my colleagues say to me “I don’t do politics.” Again, what a mistake! If we don’t stand together and protect ourselves, no one else will. If we all joined and stood together, what an impact we could make on our profession. So I would like to start by encouraging every person that reads this to please join the WVNA and ANA. If you are advanced practice, please join the APRN congress. I recognize that this is an added expense in a time when we are all short on money, but I truly believe that this should be considered a necessary cost of doing business as a nurse. Please join us; we need each and every one of you if we are going to make our voices count!
On the same note, we had some hard fought success this year in legislative terms with the passage of House Bill 4334. This bill would allow an advanced practice nurse that has practiced for at least three years under a collaborative practice agreement, licensed in good standing, and who has submitted appropriate paperwork to the board of nursing to practice without a collaborative agreement. It would change the requirement on schedule III drugs from 72 hours to 30 days with no refills. It also grants the ability to sign certain documents, such as DNR forms, handicap hunting
certificates, utility company forms requiring maintenance of utilities regardless of ability to pay and death certificates, (with specific training). An advanced practice nurse would not be able to sign a certificate of merit for a medical malpractice claim against a physician. While it is not the complete autonomy we hoped for, it is certainly a step in the right direction. The law does require that APRNs complete death certificate training prior to signing a death certificate. The training program is available at http://www.wvrnboard.wv.gov/education/Pages/Death-Certificates.aspx. Once you complete the program you will be required to complete an evaluation attestation statement related to completion of the training. You will receive a “Thank you” certificate which you will want to keep as evidence of completing the program should you be audited. A list of those completing the program will also be available on the Boards website for verification purposes. If you have any problems with the program email [email protected]. The nursing board is currently working on revisions to WV19CSR8 Limited Prescriptive Authority to reflect the changes in the law. The bill also created a joint advisory council on limited prescriptive
authority composed of 13 members: (2) allopathic physicians who are in collaborative relationship with advanced practice nurses (2) osteopathic physicians who are in an active collaborative relationship with an advanced practice nurses (6) APRNs appointed by the WV RN Board whom have at least 3 years full time practice experience at least (1) nurse practitioner (1) nurse midwife (1) CRNA all of whom actively prescribe drugs (1) licensed pharmacist (1) consumer representative (1) representative from school of public health each serving a 3 year term. The purpose of this council would be to review and evaluate applications of APRNs asking to prescribe without collaborative agreement, assist those trying to enter into collaborative agreements with advice, advise board on developing rules, review and advise complaints against APRNs, develop pilot projects and foster communication between professionals. The entire bill is available online for your review, WV HB 4334. Please do take time to look at it, and remember those legislators’ names that supported us in our endeavors, so we can support them at election time.
I look forward to the coming year and am grateful for the opportunity.
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Page 6 West Virginia Nurse August, September, October 2016
APRN Education on Advance Care Planning: Completing the POST
Dr. Lori Constantine, DNP, APRN, FNP-BC and Dr. Alvin Moss, MD, FACP, FAAHPM
During the past legislative session, Governor Earl Ray Tomblin signed HB 4334 giving Advanced Practice Registered Nurses (APRNs) in West Virginia the authority to sign Death Certificates, Do Not Resuscitate (DNR) cards and Physician Orders for Scope of Treatment (POST) forms. The POST program which oversees the distribution and use of POST forms is West Virginia’s version of the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program which is now in use or being developed in 44 of the 50 states (www.polst.org, 2016). This legislation went into effect June 10, 2016. The POST form is a medical order form for patients with serious illness. Typically, if you can answer “No” to the “surprise” question (Would I be surprised if my patient died in the next year?), this form should be completed (Moss et al., 2008; Moss et al, 2010). Completion of the POST should follow an in-depth discussion with the patient or incapacitated patient’s medical power of attorney representative or health care surrogate regarding treatment preferences, and is reimbursed by Medicare and other private insurers. Once completed, in order to be valid, the APRN or physician must sign the form. With the patient’s permission the form is submitted to the WV e-Directive Registry where it is available to treating
health care providers 24 hours a day, 7 days a week. Access to the registry, POST forms, and other advance care planning resources are available at the WV Center for End-of-Life website, wvendoflife.org, or by calling 1-877-209-8086.
Currently, WV is one of three states in the country that has a mature POLST/POST program (www.polst.org, 2016). The use of the POST form, particularly when comfort measures orders are initiated, has been shown to reduce unwanted in-hospital deaths (Pedraza, Culp, Falkenstine, & Moss 2016). In an effort to provide APRNs with relevant education for completion of the POST forms, a webinar, Advanced Care Planning: Completing the POST, will be available for review on July 1, 2016. The webinar will explain why insurers have begun to pay for and how APRNs can bill for advance care planning. Additionally, APRNs will learn how to apply a step-by-step process for advance care planning with patients and trusted family members or friends, identify the advantages of the POST form for seriously ill patients, and create an advance care plan to ensure patients’ wishes are respected in medical orders using the POST form as appropriate. A video demonstrating how to conduct a POST form conversation is also included in the webinar. The webinar fee is $25 including CE credit and will be available for review on July 1, 2016 at the WV Network of Ethics Committees website, wvnec.org, or by calling l-877-209-8086. This continuing education activity was approved by WVU School of Nursing Charleston Division for 1.4 contact hours and is co-presented by Lori Constantine, DNP, APRN, FNP-BC and Alvin Moss, MD, FACP, FAAHPM. Dr. Constantine is a Clinical Assistant Professor at WVU School of Nursing and is a palliative care nurse practitioner at WVU Medicine in Morgantown, WV. Dr. Moss is a Professor of Medicine at WVU School for Medicine, a palliative care physician at WVU Medicine, also in Morgantown, and is the Director of the WV Center for End-of-Life Care.
ReferencesPOLST: Physician Orders for life-Sustaining Treatments paradigm (2016). Available
at: www.polst.orgMoss et al. (2008). Utility of the “surprise” question to identify dialysis patients with
high mortality. Clinical Journal of the American Society of Nephrology, 3: 1379-1384.
Moss et al. (2010). Prognostic significance of the “surprise” question in cancer patients. Journal of Palliative Medicine, 13: 837-840.
Pedraza, S., Culp, S., Falkenstine, E., & Moss, A. (2016). POST Forms More than Advance Directives Associated with Out of Hospital Death: Insights From a State Registry. Journal of Pain and Symptom Management, 51: 240-246.
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August, September, October 2016 West Virginia Nurse Page 7
Basics of Nursing Practice and LicensureFrom Triage to Trial – WV Nurses and the Law
Lisa L. Lilly, BSN, RN, JD
The majority of my practice involves the defense of nurses and other licensed healthcare professionals in civil malpractice cases and in administrative actions before their licensing boards. In the upcoming series of articles, I will provide general legal information relevant to nursing practice in West Virginia, particularly in practice areas where actions are becoming more prolific. These articles are intended to provide basic guidance to all West Virginia nurses, from students/graduate nurses to our more experienced LPNs, RNs and Practitioners. These articles are not intended to take the place of an attorney’s advice, but hopefully they can provide tools to aid the understanding of the legal responsibilities of being a West Virginia licensed nurse and allow you to practice more safely and defensively.
First and foremost, all West Virginia licensed Nurses are governed by statutes enacted by the Legislature (“laws” or “West Virginia Code”) and the “rules” and “regulations” subsequently promulgated (formal administrative process of drafting and approving) and enforced by their respective Nursing Boards. The purpose of the West Virginia Board of Registered Professional Nurses and the West Virginia Board of Licensed Practical Nurses (jointly referred to as “Boards”) is, in a nutshell, to safeguard the life and health of the citizens of this State FROM their nurse licensees (a.k.a. YOU). Specifically, the Boards are lawfully created State agencies, established by the Legislature and empowered “to promote and protect public health, safety and welfare” through licensing and regulation of nursing practice throughout West Virginia.
The Boards take on this complicated and difficult duty, primarily through their rules and regulations. Through these, the Boards can address their multifaceted responsibilities to regulate the nursing profession. More importantly, at least for the purposes of this article, the Boards are also tasked with the enforcement of West Virginia nursing laws, rules and regulations. In this regard and as a simplified analogy with due respect, the Boards essentially act as the “nursing practice police,” enforcing nursing laws, rules and regulations. The Boards’ role is similar to that of a local
police officer who acts to enforce statutory and regulatory traffic laws. If necessary, a nurse can bring her case to hearing before the Board and then challenge the Board’s decision via appeal through State Court.
As in traffic court, once a nurse is accused of a violation by her licensing Board, the Board advises that the nurse can hire an attorney. When hiring an attorney, it is important to hire someone experienced in the particular practice area involved, whether in traffic court or before a licensing board, to provide guidance and ease navigation throughout the process.
It cannot be emphasized strongly enough that the Boards, the Board Members, their agents and their employees, to put it quite simply and directly, are not a nurse’s friend, nor are they a nurse’s advocate. They do not exist to: “make your job easier,” to “help you out,” or, to “give you a break” as their nurse licensee. They are instead charged with the difficult job of regulating the entire body of nurse licensees, including both education and practice, again with the Boards’ purpose being to protect the public’s “health, safety and welfare.” The above statements are not intended as a criticism of the Boards, but instead are made with respect to their role, under law, and the enormity of the responsibilities the Boards must undertake to govern virtually all aspects of nursing practice in West Virginia.
To understand the nurses’ roles and legal responsibilities in day-to-day practice, most nurses understand that by being a licensee, they have a defined “Scope of Practice,” adopted by their Boards (sometimes referred to as the “Purple Book”). The Scope of Practice sets forth perimeters, definitions and the structure that allows APRNs, RNs and LPNs to provide a much greater breadth and depth of nursing care than a non-licensed healthcare worker could provide. However, with this increase in duties and abilities, comes additional obligations and responsibilities, not required of a non-licensed healthcare worker.
To protect professional nursing licenses, every nurse is responsible for educating themselves as to the legal requirements their Board places upon them as licensees and then conform their practice to be in compliance with those legal requirements. Nurses must be familiar with each and every legal requirement that
has been promulgated or otherwise adopted by their licensing board, including, but not limited to: statutes, rules, regulations, position statements, and guidelines. The nurse must also understand the application of each of these legal requirements to the specifics of their day-to-day nursing practice. It is the responsibility of every licensed nurse to practice in compliance with their Board’s legal requirements. Unfortunately, failing to abide by any of a Board’s requirements and later claiming not to know of a particular statute, rule, regulation, position statement, or guideline is generally NOT a viable legal defense in the prosecution of a licensee.
If a licensee of a Board fails to follow the applicable statute, rule, regulation, position statement, or guideline, the nursing Board can and/or will take disciplinary action against that licensee. Thus, the Boards also promulgate “disciplinary” rules, which are used in conjunction with other legislative and administrative provisions that govern discipline of a licensed nurse. These rules and regulations allow a Nurse to be disciplined for a variety of offenses, arising from a nurse’s professional practice, whether the act is intentional or unintentional. Unfortunately, these rules do not limit prosecution to the workplace. A licensee may also be prosecuted for certain activities in a nurse’s personal life, even if the nurse’s conduct is outside of the workplace. The only way for nurses to protect their licenses is to educate themselves regarding the requirements of their Board’s statutes, rules, regulations, position statements, and guidelines that apply to their nursing practice.
To find these statutes and agency position papers, rules and regulations: Registered Nurses, Midwives and Advanced Practice Registered Nurses should visit the website for the West Virginia Board of Registered Professional Nurses (http://www.wvrnboard.wv.gov). Once on their home page, click the “Law/Scope” which will provide directions to the subject documents. Licensed Practical Nurses should visit the website for the West Virginia Board of Licensed Practical Nurses (http://www.lpnboard.state.wv.us) and select the “Our Goals and Services” title and review the information under each subheading.
Basics continued on page 8
Page 8 West Virginia Nurse August, September, October 2016
Appreciation Celebration CONVENTIONAL LEGAL WISDOM Whenever someone advises that you have the
option to consult with an attorney, there is usually a reason… so, you should probably go ahead and hire counsel.
HOT TIP: MALPRACTICE INSURANCE COVERAGEEvery practicing nurse should confirm that
they have adequate malpractice insurance that provides legal representation by their own attorney, if requested, and provides coverage for administrative and licensure issues. Many nurses believe that their employers provide them with adequate malpractice insurance; however, this coverage usually EXCLUDES coverage for administrative/licensure actions. When complaints are filed against uninsured nurses, the nurse must pay out-of-pocket for attorney fees, just to protect their reputation and their ability to support their family. While many times complaints may ultimately be found meritless, legal costs can be several thousand dollars. If an employer’s malpractice policy does not provide coverage for these types of claims, a nurse should ask their employer to provide coverage or just buy their own policy. The costs for these policies are incredibly reasonable, generally around $100 per year.
SPOTLIGHT ISSUE: PHOTOGRAPHSMany healthcare facilities have policies
prohibiting all staff from taking photographs or videos while on site. These policies vary but many are “no tolerance” policies. If a nurse works at a no-tolerance facility and takes a photo while on the job, even in the breakroom, that nurse can/will be disciplined by the employer and possibly their licensing board. Worse yet, you and your employer must also report that you have been “disciplined” to the Nursing Board. The nursing board will, in turn, likely undertake its own investigation.
Example 1: A Nurse gets flowers delivered to her workplace, specifically to her nursing station in a “no tolerance” hospital. The Nurse is excited and takes a picture of the flowers and shares with her friends on Facebook. Unfortunately for this nurse, a corner of a patient’s test results was visible in the background of her photo. This nurse was disciplined by the employer and reported to her Board.
Example 2: A nurse works on the oncology unit in a “no tolerance” hospital. Her patient was feeling much better after a rough round of chemo and radiation treatments. Patient’s husband asked the nurse if she could take a photo of he and his wife with her personal phone because his phone battery was dead. He then asked the nurse to email him the photo so he could post the photo on the patient’s Facebook page. This Nurse was also disciplined by her employer and reported to her Board.
BOTTOM LINE: Never use a camera, including your phone, while on the job or working in a healthcare facility. If circumstances arise, where a nurse is requested to take a photo of a patient (i.e., wound care), the nurse must first: review the facility’s policies addressing photography, use the employer’s camera, and confirm there is a properly signed photography release in the chart. If asked to photograph your fellow nurses while on the job, just decline. The photos involved generally do not involve an intentional violation of patient’s privacy, but rather are innocent looking group shots of patients in LTCs or selfies taken at staff parties, all of which seem to get posted online.
Lisa L. Lilly, BSN, RN, JD is a founding member of the law firm of Francis & Lilly, PLLC located in Charleston, WV. She has over 25 years of experience representing nurses and other healthcare providers.
Basics continued from page 7
A bit of conversation before
the festivities begin
WNA President Beth Baldwin and Vice-President Brenda Keefer
Senator Kent Leonhardt
talking with Sam Cotton
WVNA President Beth Baldwin
with Delegate Amy Summers, RN,
District 49, Taylor County
Members of WVNA and guests mingle
On June 9th at the Charleston Embassy Suites WVNA hosted the first annual Appreciation Celebration for its members and supporters. The night kicked off with music by Acme Sound of Huntington providing DJ services which kept our guests entertained. As our guests arrived they were met by WVNA members to welcome them and express our appreciation of the support WVNA was given this past legislative session. A good time was had by all.
ATTENTION RNs & LPNsMaxim is searching for RNs & LPNs to join our
team! Positions currently available in: private duty nursing, pediatrics and adults, local and travel staffing opportunities in West Virginia!
Competitive Pay and Comprehensive Benefits!
Contact us today!
313 MacCorkle Ave SW Suite 200South Charleston, WV 25303
Phone: 681-313-4759 Fax 844-800-3954Email: [email protected]
EOE
Stonerise Healthcare strives to be the best employer and provider of senior care solutions in every community we serve. We enrich the lives of those with whom we work and serve through principles, passion and purpose.
View all available positions for our 15 locations and 2 home health agencies at:
stonerisehealthcare.com
Now recruiting for RNs & LPNsFull-time | Part-time | PRN
August, September, October 2016 West Virginia Nurse Page 9
Being Mortal Comes to
West VirginiaChris Zinn, RN, MSc, CHPN
Executive Director of the Hospice Council of West Virginia
This April, Hospice of the Panhandle was the first in the nation to host a screening and discussion of the PBS FRONTLINE documentary Being Mortal: Medicine and What Matters in the End in partnership with WVU Medicine University Healthcare, WVU Health Sciences Center and the Hospice Foundation of America. Other screenings are planned around the state and this is an opportunity for nurses and other clinicians to engage with the public about the importance of talking about end-of-life preferences.
The John and Wauna Harman Foundation, an underwriter of the FRONTLINE film, has selected the Hospice Foundation of America to sponsor and coordinate a public awareness campaign around advance care planning. Being Mortal first aired in February 2015 and is being repeated June 21st this year. The documentary follows physician Atul Gawande as he thinks about death and dying in the context of being a healer. The renowned writer and Boston surgeon shares stories about experiences at the end of life from patients and his own family. Dr. Gawande published a national bestselling book by the same name.
The screenings of the documentary will be followed by a guided discussion with a panel of local experts. Hospice of the Panhandle is planning more community events due to the success of the first. Charleston Area Medical Center is partnering with HospiceCare to host this event as a mini medical school at the WVU Auditorium on the Memorial campus in Charleston on October 20th. United Hospital Center is hosting an event on October 6th in Bridgeport. An event is being planned in Morgantown and there should be opportunities to participate in many areas of the state.
This comes to West Virginia at a time when Senator Shelley Moore Capito and Senator Richard Blumenthal have introduced The Compassionate Care Act. This bipartisan legislation is designed to improve end-of-life care for Americans. Both Senators have spoken about the importance of communication at the end of life and this legislation empowers health professionals to start talking about end-of-life care and supports more education on how to do this.
West Virginia ranks first in the nation in the numbers of residents who have completed advance directives and much has been accomplished by the WV Center for End-of-Life Care. However, many people complete forms without having discussions with their family about their personal values and what matters most. Being Mortal will highlight the complexity of medical decision-making at end-of-life and the importance of these conversations. As Dr. Gawande says, “Hope is not a plan.”
For more information about the film, visit http://www.pbs.org/wgbh/pages/frontline/being-mortal and to find out about screenings, visit www.hospicefoundation.org.
(Bluefield)—Sandra Wynn, Director of the Bluefield State College Associate Degree Nursing program, has accepted appointment to the West Virginia Rural Health Association (WVRHA) Board of Directors.
WVRHA advocates for empowering all West Virginians to advance their quality of life, well-being, and access to excellence in rural health care. The 16-member Board will hold six regularly-scheduled meetings in 2016, in addition to executive committee and policy committee meetings.
After obtaining a Master of Science in Nursing degree from Radford University, Wynn joined the BSC nursing faculty since 2002 and has served as program director of the Associate Degree Nursing and Accelerated LPN-RN programs since 2005. A BSC alumna, she has also worked as a Registered Nurse in the Emergency Department at Princeton Community Hospital and is a Certified Family Nurse Practitioner at Mercer Charitable Clinic. She is currently pursuing a Doctoral Degree in Higher Education Leadership from Liberty University.
Wynn holds membership in numerous nursing organizations, including the American Nurses Association, the National League for Nurses, and the West Virginia League for Nurses. Her community engagement includes participation in the American Diabetes Walk and membership on the planning committee for the Mercer County Walk to End Alzheimer’s Disease. She received BSC’s “William D. Goodman Faculty Service Leadership Award” in 2013.
For Additional Information, Contact Jim Nelson/Media Relations(304) 327-4103, [email protected]
BSC Nursing Educator/Administrator Appointed to the WV Rural Health
Association Board of Directors
Explore Your Career Opportunities at UHCBENEFITS United Hospital Center offers a comprehensive benefits program including a competitive salary, health and life insurance, retirement and TSA plans, vacation and ill time, tuition reimbursement, and a Clinical Ladder for advancement.
Please apply online at www.uhcemployment.com
Bridgeport, WV | Be a part of Something Great.
facebook.com/UHCHR
This IsWhere It Begins
PRINCETON HEALTH CARE CENTERis seeking qualified candidates for the following position:
Registered Nurse and Licensed Practical Nurses able to work 12 hour shifts
Applicants must be able to work all shifts and have a valid WV nursing license to be
considered.
We also offer a payroll package option that pays more than $2.00 per hour above the
average wage in lieu of benefits.
Interested parties should apply at Princeton Health Care Center, 315 Courthouse Road, Princeton, WV from 8:00am-4:00pm M-F.
Applications require full addresses and phone numbers for all professional and personal
references in order to be submitted to Human Resources.
NO PHONE CALLS PLEASE.
PHCC is an Equal Opportunity Employer. PHCC is a drug free workplace.
1090372182
Continuing Education Courses and OSHA Courses
Courses can also be conducted at your location for your group
Contact us at 304-293-7527800-626-4748
See our course schedule:www.trainingcentertechnologies.com/wvu
www.safetyandhealth.ext.wvu.edu
Page 10 West Virginia Nurse August, September, October 2016
On June 8th and 9th WVNA hosted Pam Dickerson of the American Nurses Credentialing Center (ANCC) during a workshop for nurse reviewers and primary nurse planners of its Approved Provider Unit. WVNA’s Approver Unit is one of 26 in the nation that approves providers of nursing contact hours accredited by ANCC. ANCC contact hours are essential towards certification for specialty nursing areas with many providers being West Virginia hospitals and medical centers. Once approved as a provider of ANCC contact hours the provider may offer unlimited contact hours and also must adhere to quality standards required by ANCC. The cost of a provider unit is substantially less than hospitals or medical centers sending their nurses to specialty conferences to obtain ANCC contact hours for certification.
Certifications for nurses range from Advance Practice and Clinical Nurse Specialists (adult, geriatric, pediatric and others) to certifications for cardiac, emergency room to school nursing. A total of 49 unique certifications exist for nurses. WVNA/ANA members receive a discount on their certifications. For more information contact [email protected] or call the office 304-342-1169.
ANCC WorkshopWVNA’s Advance Practice Registered
Nurse Council experienced a ground breaking milestone this past year in the removal of collaborative agreements for prescriptive authority. It shows that working together to achieve a common goal works for nursing law
Staff Nurse Councilchanges. There are many changes that need to be made in regards to patient to nurse ratios, safe staffing, safe work environments and other important measures. How can this come about? First we need a combined effort from nurses who are working with these issues, second these nurses will need to work with WVNA to obtain the needed change. With the example of the APRN accomplishment WVNA would like to offer staff nurses and nurses working in primary care the opportunity to join WVNA’s Staff Nurse Council.
Staff Nurse Council will be a part of WVNA made up of members who are committed to working together for needed changes that will benefit nurses. In making these changes not only will nurses have better working experiences but their patients will also have a safer environment. ANA is promoting a Culture of Safety that had its kick off during National Nurses Week in May that ties into many of these needed reforms.
If you are willing to be a part of this movement please contact WVNA at the office 304-342-1169 or email [email protected] and talk with someone about the Staff Nurse Council.
Job OpportunitiesHopemont Hospital
Full-time positions available:
RNs | LPNs | HEALTH SERVICE WORKERS (CNAs)
Great benefits include:• Health insurance • 18 sick days• Retirement • Paid vacation• Life insurance • Education expense• 12+ holidays reimbursement and• Shift differential leave program
Applications accepted in person or online at www.personnel.wv.gov. Those applying online can search for a particular position by job title.
150 Hopemont DriveTerra Alta, WV 26764
304-789-2411
The State of West Virginia is an Equal Opportunity Employer.
Please contact Jen Utzig
to learn more:800-903-3616 X313 or
Wexford Health has the following opportunities available at the Northern Regional Jail and Correctional Center in Moundsville, WV:
Full Time & Per Diem Licensed Practical Nurses
Make a Difference in the Lives of Your Patients!
Cornerstone Hospital is a Long-Term Acute Care Hospital (LTAC) designed for extended
stay patients with chronic conditions.We provide a multidisciplinary approach to care that is individualized and resource intensive.
Medically Complex • Complex Wound ManagementInfections/lnfectious Disease • Ventilator Weaning
Post Surgical Complications • Cardiovascular ConditionsPulmonary/Respiratory Conditions • Renal Dialysis • Amputation • Brain Injury
A JCAHO Accredited Hospital
A local team of physicians from multiple specialties and sub specialties such as: Pulmonology, Internal Medicine, Nephrology, Urology, Cardiology
2900 1st Avenue, 2 East, Huntington, WV 25702 (304) 399·2661
August, September, October 2016 West Virginia Nurse Page 11
Membership News
Please complete and return to:West Virginia Nurses Association | PO Box 1946 | Charleston, West Virginia 25327 | (f) 304-414-3369
WVNA/ANA Membership Application
Contact Information
Payment Plans
PAYMENT DETAILS
$24.50
RN’s who work or live in $151.00 Transfer*
Employed Full/Part Time $288.00 Transfer*
$288.00 (Full) $149.00 (State Only)
New WVNA MembersWVNA would like to welcome new members.
Shanna AkersDana Sue Dragonir
Ellen Margaret EllisonIda M. Evans
Ashley Dawn FunkhouserMarjory Jan Gentry
Erin HuppCarmen M. KingKasey Erin KirkAmy Lynn MaustAlisha McKitrickMary Beth MilroyJennifer Powers
Jessica RiceKristi L. ShislerJenna Simmons
Michelle Deanne StreetsCallie TierneyMary D. Uraco
Priscilla Lynn VanceValerie Veal
Cheryl Ann Frank VegaTera Wallis
Barbara Boyle WeanerJerilyn WeikleDoreen Willis
Barbara J. WrightHannah Yetzer
Dynamic Career Opportunity
Mildred Mitchell-Bateman Hospital is a 110-bed acute care mental health facility operated by the West Virginia
Department of Health and Human Resources. We are seeking qualified staff to fill permanent and temporary positions.
• RNs • LPNs • Health Service Workers (CNA)• Interpreters for the Deaf
Some of the benefits you will enjoy:• Paid holidays with incentive for working Thanksgiving,
Christmas, and New Year’s Day• Accrued sick leave
• Accrued annual leave• Shift differential for evenings and night shifts• Education assistance (tuition reimbursement)• Annual increment pay after 3 years of service
• Public Employees Retirement System• Comprehensive health insurance plans, including PEIA
• Prescription drug plan and optional dental and vision coverage
Temporary positions do not include benefits.Interested individuals should contact:
Patricia G. Hamilton, RN, BC Chief Nurse Executive [email protected]
1530 Norway Avenue, Huntington, WV 25709Phone: 304-525-7801 x734 • Fax: 304-529-6399
www.batemanhospital.org
Mildred Mitchell-Bateman Hospital is a Drug Free Workplace.Minorities are encouraged to apply. Equal Opportunity Employer.
Experienced RNs and Nurse Leaders
Full-time, Part-time, PRN, and Flexible scheduling options.
We offer an excellent benefit package. We are an EOE.
Learn more: visit our website at: williamsonmemorialhospital.net or call
Human Resources at 304-899-6321
Our nurses have a strong work ethic, enjoy team work, and appreciate a workplace thatputs patient safety first. If you have these quali-ties, we want to hear from you!
Page 12 West Virginia Nurse August, September, October 2016
Are you seeking a nursing opportunity with a dynamic and progressive healthcare organization? Then explore a future with Mon General Hospital.
*$10,000 RN Sign-on BonusRegistered Nurse opportunities are available in:
Mon General Hospital offers an outstanding benefits package, on-site childcare, tuition reimbursement, and much more. Visit the Mon General Careers website to learn more about our Nursing opportunities at www.mongeneral.com/RN and apply directly online. EOE
*Call HR at 304-598-1485 for additional information on the Sign-on Bonus
• CCU/ICU
• CriticalCareFloat
• EmergencyDepartment
• InfusionCenter
• Medicine
• Oncology
• OrthoSurgeryPeds
• StepDownUnit
• SurgicalServices
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