Texas Nursing Magazine - Winter 2018

texa s nu r s e s .o rg

TEXASNURSING M A G A Z I N E THE TEXAS PEER ASSISTANCE PROGRAM FOR NURSES (TPAPN) Unlocking Hope for Maintaining and Regaining Safe Nursing Practice HIGH CONSEQUENCE INFECTIOUS DISEASE WHAT NURSES NEED TO KNOW

HANDLING A BON COMPLAINT CONSIDERATIONS AND FIRST STEPS

T N A : E m p o w e r i n g Te x a s N u r s e s t o a d v a n c e t h e p r o f e s s i o n | W I N T E R 2 0 1 8

WINTER 2018 Volume 92, Number 1 EDITOR-IN-CHIEF: Cindy Zolnierek, PhD, RN 8501 North MoPac Expressway, Suite 400, Austin, TX 78759-1292 P: 800.TNA.2022 or 512.452.0645; F: 512.452.0648 tna@texasnurses.org | texasnurses.org

MISSION Empowering Texas Nurses to advance the profession

BOARD of DIRECTORS OFFICERS:

Jeff Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN, President

Kim Belcik, PhD, RN-BC, CNE, Vice President

Kleanthe Caruso, RN, MSN, NEA-BC, Secretary

Gayle Dasher, RN, PhD, ANP-BC, Treasurer DIRECTORS:

Rhonda Winegar, DNP, RN, FNP-BC, CCRN, CPN

Tamara “Tammy” Eades, DNP, MSN, RN

Pam Greene, PhD, RN

Patricia Freier, MSN, RN-BC, RCIS

Shakyryn Napier, DHSc, MSN, RN, CPN EXECUTIVE DIRECTOR:

Cindy Zolnierek, PhD, RN

TNA DISTRICT AND PRESIDENT

VISION Nurses Transforming Health TEXAS NURSING (ISSN 0095-36X) is published quarterly — Winter, Spring, Summer, Fall — by the Texas Nurses Association, 8501 N. MoPac Expy., Ste 400, Austin, TX 78759-8396 Periodical postage is paid in Austin, Texas.

One-year subscriptions: $25 (nursing schools, libraries, hospitals, non-nurses, out-of-state nurses) foreign, $30; single copy, $2.50.

Subscription is not available to non-member Texas nurses.

Some back issues may be viewed online at texasnurses.org.

PUBLISHING PARTNER Monarch Media & Consulting, Inc. P: 512.680.3989 or 512.293.9277; F: 866.328.7199 monarchmediainc.com | chellie@monarchmediainc.com Advertising inquiries call Chellie Thompson at 512.293.9277.

TEXAS NURSING is indexed in The Cumulative Index to Nursing and Allied Health Literature and in the International Nursing Index.

16mm, 35mm microfilm, 105mm microfiche, article copies available from University Microfilms International: 1.800.521.3044 Statements of fact and opinion are made on the responsibility of the authors alone and do not imply an opinion on the part of the officers or the membership of TNA. POSTMASTER Send address changes to TEXAS NURSING, 8501 North MoPac Expy., Suite 400, Austin, TX 78759-8396 ARE YOU MOVING? Need to change your address? If so, provide it quickly and easily in the Members Only section of the TNA web site, texasnurses.org. Or mail us your new address —at least six weeks prior to your move—to Texas Nurses Association headquarters. We’ll make sure your TEXAS NURSING makes the move with you.

Dist.1:

Dist. 4: Jackie Michael, michaels@uta.edu, District office: Pat Pollock, P.O. Box 764468, Dallas, TX 75376; 972.435.2216; d4tna@flash.net; tnad4.org Dist. 5: El Burley, president.tnad5@gmail.com Dist. 7: Patricia Phelps, psphelps1993@gmail.com, District office: P.O. Box 1482, Belton, TX 76513 Dist. 8: Linda Juenke, 830-739-7028, ljsoaringeagle3@gmail.com Dist. 9: Lisa Boss, lisa.boss@uth.tmc.edu, District office: Melanie Truong, 7324 Southwest Freeway, Suite 2-1453, Houston, TX 77074; 713.523.3619; tna9@tnadistrict9.com; tnadistrict9.com Dist. 11: Paula Parks, 940.224.3533, wfparksdept@gmail.com Dist. 12: Heidi Wolf, 409.853.5900, HWolf@iasishealthcare.com Dist. 13: Nannette Kelley, nannettekelley@msn.com Dist. 15: Andrea Kerley, 325.670.4230, akerley@hendrickhealth.org Dist. 17: Cindy Keese, 361.332.1643, cakeese@aol.com Dist. 18: Darla Smith, darla.smith3@stjoe.org Dist. 19: Colleen Marzilli, cmarzilli@uttyler.edu Dist. 21: Jessica Tully, 432.254.1949, jessica.tully@midland-memorial.com Dist. 22: Toni McDonald, 936.544.8823, t.mcdonald323@yahoo.com Dist. 35: Chrystal Brown, 903.434.8302, cbrown@ntcc.edu Dist. 40: Contact TNA, 800.862.2022, ext. 129, brichey@texasnurses.org.

Printed on Recycled Paper

FEEDBACK EMAIL OR LETTER GUIDELINES TEXAS NURSING will select emails/letters on the basis of readership interest and relevance to current nursing/health care events. TEXAS NURSING reserves the right to edit all letters. Guide: Limit to 200 words; focus on single issue; include writer’s name, mailing address, and daytime phone. Send to: editor@texasnurses.org.

Copyright 2018 © Texas Nurses Association

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

Paula Meagher, pmeagher@epcc.edu

Dist. 3: Linda Dunn, ladynurse101@aol.com, District office: 817-249-5071, tna3@usapathway.com, tna3.org

PAGE 2

THE TEXAS PEER ASSISTANCE PROGRAM FOR NURSES (TPAPN) A Voluntary Program Playing a Key Role in Maintaining and Regaining Safe Nursing Practice

What Do You Mean There’s a Complaint?!

8

What is the first step?

Should I hire an attorney?

HIGH CONSEQUENCE INFECTIOUS DISEASE

14

20

Contents 5 PRESIDENT’S NOTES Coming Full Circle

6

TNA MEMBER NEWS Appointments, Partnerships, and Special Events

11 WHY SHOULD EMPLOYERS SUPPORT NURSE PARTICIPATION IN THE TPAPN PROGRAM? TPAPN Work Agreements

12 NURSING REGULATION AND THE IMPACT OF ADVOCACY ON NURSING PRACTICE

16 EMPOWERED NURSES ADVANCING THE PROFESSION Save the Date April 13-14, 2018

19

22

POLICY POSITION DEVELOPMENT UPDATE

TNA'S NEW ON-DEMAND CNE PROGRAM

What Can I do to Help?

Learning Curve

23 NURSE ADVOCACY IN ACTION

BON Sunset Review

Coming Together to Support T-21

PAGE 3

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

THE UNIVERSITY OF

NURSING DEGREES, ON A NURSE’S SCHEDULE. Study for your BSN or MSN wherever you are, whenever your schedule allows. Earn your degree at WGU, named a Center of Excellence™ by The National League for Nursing for visionary leadership in nursing education and professional development.

texas.wgu.edu © 2017 Western Governors University. All Rights Reserved.

Guest Columnist, Gayle Dasher, RN, PhD, ANP-BC Treasurer, TNA Board of Directors

B:11”

T:10.75”

S:9.75”

President’s Notes

BY THE TIME I was in eighth grade at St. Martin Hall in San Antonio, every Sister teaching in the school knew I wanted to be a nurse. There must have been some tacit agreement among them to nurture that desire. Whenever one of the younger children would scrape a knee on the playground, one of the Sisters would find me, hand me the keys to the office and ask me to get the first aid kit to take care of the injury. The sense of urgency was incredible! I had everything I needed — Band-Aids and methiolate (remember, this was the 60s). I painted smiley faces on knees, wrapped Band-Aids around cut fingers and wiped tears. I couldn’t wait to tell my mom that I had been the “school nurse” that day.

Those days were long forgotten as my career started in neuro-critical care in the Army Nurse Corps and then transitioned to practice as a clinical nurse specialist, CNO, clinical director and adult nurse practitioner. That is, until three years ago, when my supervising physician and I walked into McCullough Hall, the retirement community for those same Sisters. I had a momentary flashback to blue plaid skirts and black saddle oxfords when I realized that my new case load would include some of those same Sisters who nurtured my budding nursing career. During the ensuing weeks and months, my weekly visits became more than just the routine monthly follow-up for the residents. My “reason for being a nurse,” had, in many respects, come full circle.

We’ve all been asked the question, “Why did you become a nurse?” Inevitably, the answer has something to do with helping others. Many of us had experiences with nurses when we were

COMING FULL CIRCLE Who Set the Stage for Your Career in Nursing?

We aspire to care for more complex patients, in settings rich with cutting-edge technology. But the most powerful factor that brings us to nursing, and keeps us there, remains the people we serve. We all come full circle. growing up, whether because of some childhood illness or while being inspired by someone’s compassion when caring for a family member. No matter the triggering event, that desire to bring comfort to people forms the foundation for virtually all our career decisions. As we progress on a professional path, our life experiences add layer upon layer of influencing factors, shifting our focus to different practice settings or clinical specialties. We aspire to care for more complex patients, in settings rich with cutting-edge technology. But the most powerful factor that brings us to nursing, and keeps us there, remains the people we serve. We all come full circle.

I continue to learn more and more about these Sisters. They have led lives richly entrenched in service — building missions and establishing schools in South America, serving indigent families in Appalachia, and leading academic institutions in a variety of states. When I think back now to what I learned from them through 12 years, it wasn’t so much about the English literature or biology or geometry — it was about the nature of caring and compassion that we owe one another. They may not have been nurses but they sure knew a lot about what it takes to be one.

Every Friday afternoon, I leave my “real job” to spend a few hours with the Sisters at the retirement facility to follow up on

PAGE 5

new issues and complete routine monthly visits. Those few hours reaffirm my love for nursing. Despite varying stages of cognition, I am met with smiles from the minute I enter the facility. I smile to myself, with more than just a little pride, when a new resident asks another, “Who is that?” and I hear the answer, “That’s Gayle. She’s a nurse practitioner. She went to St. Martin Hall!”

As a nurse practitioner, my visits with the Sisters are intended to preserve their health and quality of life, and in some cases, support their decisions to simply remain comfortable. As I get ready to leave a Sister’s room, I might get a hug, I will always have my hand grasped, and I will always be told, “God bless you.”

And I can’t count the number of times I have been told, “Thank you. We are so lucky to have you to take care of us.” But how do you thank the people who really gave you so much, those who helped set the stage for a career dedicated to meeting the needs of people who need care? For me, I’ve been blessed to have the opportunity to do that — by coming full circle. i Dr. Dasher is currently clinical director at Christus Santa Rosa Health System in San Antonio. An inaugural member of TNA's Policy Council, former president of District 8 and former TNA Finance Committee member, she was elected as TNA treasurer in 2017.

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

TEX AS NURS ES AS SOCIATION

TNA MEMBER NEWS SPOTLIGHT ON YOU APPOINTMENTS Two TNA members have been appointed to the American Nurses Association (ANA) Connected Health/ Telehealth Professional Issues Panel Steering Committee. Congratulations to Kristi Henderson, DNP, APRN, ACNP-BC, FNP-BC, FAAN, FAEN, who will serve as the co-chair and Jing Wang, PhD, MPH, MSN, RN, FAAN. In addition, Mary Tietze, PhD, RN-BC, FHIMSS, co-chair of the TNATONE Health Information Technology Committee, was appointed to the Professional Issues Panel that will be working with the ANA Connected Health steering committee as they update the current principles.

TNA PARTNERS WITH TEXAS ORGANIZATION OF NURSE EXECUTIVES Adequate staffing to support optimum patient outcomes continues to be a hot topic for nurses across the continuum of care. It is vital that nurses in all roles from direct care to senior leadership positions collaborate to develop innovative solutions to staffing conundrums.

Fostering this collaboration, TNA was pleased to partner with Texas Organization of Nurse Executives (TONE) and offered a preconference, "Optimal Staffing: Advocating with a Business Case and Innovation" on February 22, which

preceded the TONE Annual Conference on February 23.

"DEFINING HOPE" MOVIE SCREENINGS

The featured speaker was Seun Ross, DNP, CRNP-F, NP-C, NEA-BC, director of Nursing Practice and Work Environment for the American Nurses Association.

She addressed the national staffing trends, benchmarking, promising staffing models, and the importance of making the business case for staffing in the era of changing reimbursement models. The preconference was held at the Fogelson Auditorium at Texas Health Presbyterian Hospital in Dallas.

More than 20 TNA members across the state worked to facilitate the successful launch of "Defining Hope" bringing premier screenings to nine cities across Texas and involving more than 650 participants! Thank you TNA members for your advocacy work on behalf of Texans!

SHARE YOUR STORY The American Nurses Association (ANA) has declared 2018 as the Year of Advocacy and will be sharing stories about how nurses have used their leadership to initiate change at the beside and beyond. Tell us your stories!

TNA GAC member Patricia Phelps' story of advocacy is being featured by ANA this quarter at http://ana.aristotle.com/ SitePages/YearOfAdvocacy.aspx.

In case you missed it, TNA members will be eligible for a one-time discount towards the community screening licensing fee during the month of April in support of National Healthcare Decisions Day, Monday, April 16.

To organize a screening in a local movie theater, please visit: http://hope.film/ theatrical-on-demand/. To organize a community screening in a venue of your own choosing, including educational settings, please contact Estelle Grosso at egrosso@kinolorber.com and be sure to let her know you are a TNA member.

If you are a Texas Nurses Association member and you’ve changed employers, been promoted, received an award, or been elected or appointed to a board or community organization, we’d like to hear from you. Notices printed in the TNA Member News section are limited to members of the Texas Nurses Association and are printed at no cost. Information must be submitted in writing, is subject to editing, and will be printed as space is available.

The TNA News section does not include information on papers, speeches (unless they are of national stature), CNE presentations, or political announcements. Announcements for TNA News should include all pertinent information including employer name, email, and contact numbers. Photos are welcome, but must be 300 dpi (high resolution) at a size of at least 3” x 4”. Send submissions to editor@texasnurses.org.

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

PAGE 6

A nursing degree you can be proud of!

100% ONLINE | 11 PROGRAMS | 7 CERTIFICATE OPTIONS SCHOLARSHIPS AVAILABLE! Advance your practice at UTA Our affordable online programs are designed to meet the educational needs of working professionals. We offer accelerated online coursework with multiple start dates.

Online Nursing Programs

• BSN • RN to BSN • RN to MSN • MSN – 7 program options • DNP • Post Baccalaureate and Post Master’s

Certificate Options

Get started today!

Center of Excellence in Nursing Education

The UTA College of Nursing and Health Innovation has been named a Center of Excellence by the NLN

UTA is the #1 public college of nursing in the country for enrollments and graduates (AACN)

UTA’s online nursing programs are fully accredited by the Commission on Collegiate Nursing Education (CCNE)

UTANURSE.COM | 866-489-2810

THE TEXAS PEER ASSISTANCE PROGRAM FOR NURSES (TPAPN) A Voluntary Program Playing a Key Role in Maintaining and Regaining Safe Nursing Practice

TPAPN's mission is to help nurses thereby helping to protect the public.

THE TEXAS PEER ASSISTANCE PROGRAM for Nurses (TPAPN) is a voluntary program that promotes, facilitates, and supports recovery1 from behavioral health (substance use and mental health) conditions to help nurses (APRNs, RNs, and LVNs) of Texas maintain and/or regain safe nursing practice. TPAPN provides individualized comprehensive case management services (guidance, support, and monitoring) to: 1. Facilitate participants’ recovery from behavioral health (substance use and mental health) conditions; and

TPAPN is a program of the Texas Nurses Foundation, the nonprofit charitable organization of the Texas Nurses Association (TNA). TPAPN shares office space with TNA located in Austin. TPAPN is funded by and works closely with the BON. The BON’s mission “is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse is the State of Texas is competent to practice safely” (www.bon.texas.gov/about_mission _and_values.asp). TPAPN’s mission is to help nurses thereby helping to protect the public.

2.

Nurses are referred to TPAPN in one of three ways: 1. Self-referral;

Assist participants to demonstrate sobriety and mental fitness.

TPAPN organizes its services among five separate tracks designed to meet different participation needs (see TPAPN Track Description Table on the following page).

Additionally, TPAPN volunteer Nurse Advocates provide social peer support for some TPAPN participants. For many nurses, TPAPN provides an alternative to Texas Board of Nursing (BON) discipline.

2.

Referral by a third party (employer, coworker, friend, family member, etc.); and/or

3.

Referral or order by the BON.

It is unusual for a nurse to refer him/herself without a third-party referral also in process. Nurses are required to report

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

PAGE 8

nurses whose practice is believed to be impaired due to substance use. This requirement may be met through a written, signed report to TPAPN or the BON. Written referrals can be completed on the TPAPN referral form and/or on a BON Complaint Form. TPAPN accepts BON Complaint forms and the BON accepts TPAPN referral forms. A TPAPN referral form can be found on TPAPN’s website at www.tpapn.org. BON complaint forms can be found on the BON’s website at www.bon.texas.gov/discipline_and_ complaints_ policies_and_guidelines_ filecomplaint.asp. If a practice violation has occurred, the nurse must be reported directly to the BON. Though reporting a peer is difficult, reporting can help nurses to get help sooner as well as protect patients from harm. Reporting may instigate recovery — a lifesaving process. According to the American Society of Addiction Medicine’s definition of addiction, “Without treatment or engagement in recovery activities, addiction is progressive and

can result in disability or premature death” (www.asam.org/resources/ definition-of-addiction).

covery support services (mutual aid groups [AA, NA, etc.]);

drug testing (urine, hair, nail, blood). Abstinence from all abusable drugs, including alcohol, is generally required for TPAPN participation. Participants are responsible for expenses which may include an evaluation(s), treatment, recovery support services, mutual aid groups, drug testing, and miscellaneous fee(s).

When TPAPN receives an eligible referral, TPAPN mails the potential participant information about enrolling. Participation is voluntary and may potentially be an alternative to BON discipline.

Eligibility is based on numerous factors, including but not limited to, the number of previous participations, the referral reason and details, direction from the BON, etc. The enrollment process, definitive track placement, and detailed individualized participation requirements are determined, in most cases, after a comprehensive toxicology test and the completion of a comprehensive behavioral health (substance use and mental health) evaluation by a TPAPN approved evaluator. TPAPN case managers help potential participants throughout the process.

As an abstinence-based program, TPAPN participants are expected to remain free of all mood-altering, controlled, and/or addictive substances including alcohol, over-the-counter drugs and prescription drugs. TPAPN does not determine the appropriate pharmacologic regimen for a participant.

However, if a prescribing professional determines that mood-altering and/ or potentially addictive substances are necessary for treatment, the individual may not be appropriate for the TPAPN program.

Obtaining a behavioral health evaluation or reevaluation (when applicable);

Obtaining an initial diagnostic toxicology test (drug test);

Obtaining, participating in, and/or completing treatment;

Participating in, and/or utilizing, re-

Obtaining, maintaining, and/or demonstrating sobriety and/or mental fitness;

Completing TPAPN participation requirements including communicating regularly with TPAPN, submitting required reports, and random drug testing; and

Practicing nursing safely.

TPAPN participants who are non-adherent with TPAPN participation requirements may be required to: Obtain a new and/or updated comprehensive behavioral health (substance use and mental health) assessment/evaluation;

Participant requirements are individualized and may include: Obtaining and/or maintaining recovery from substance use and/or mental health conditions;

Specific participation requirements are determined by a participant’s case manager in collaboration with the participant’s provider(s), evaluator(s), treatment provider(s), employer, the BON, etc. TPAPN participation requirements are tailored considering referral details, participant’s evaluation(s), diagnosis and diagnostic severity, the need for nursing practice monitoring, BON direction, TPAPN participation adherence, recovery progress, etc. TPAPN participant requirements are modifiable and may include random

Participate longer;

Be drug tested more frequently;

Obtain additional treatment;

Utilize additional recovery support services; and

Be discharged from TPAPN and/or referred to the BON.

Randomized toxicology screens (drug tests) are required for most TPAPN participants. Drug testing is used as a tool for supporting recovery and is useful to deter the inappropriate use of substances and facilitate the maintenance, demonstration, and documentation of sobriety. Urine drug screens (UDS) are the standard test utilized.

TPAPN TRACK DESCRIPTIONS

BOARD OF NURSING (BON) APPROVAL REQUIRED

BEHAVIORAL HEALTH CONDITIONS

SOBRIETY AND MENTAL FITNESS

(Tracks 1 & 2)

(Track 3 & 4)

Recovery focused (practice monitoring required)

Support and monitoring focused (practice monitoring not required)

Helping nurses recovery from substance use and/or mental health conditions.

Helping nurses maintain and demonstrate sobriety and/or mental fitness.

Track 1 Substance Use Disorder-­‐ Dual Diagnosis (SUD-­‐DUAL)

Two sub-­‐tracks: a) SUD For nurses with only a substance use disorder. b) Dual (DUAL) For nurses with both a SUD and mental health condition(s).

Track 2 Mental Health Monitoring (MHM)

For nurses with either a mental health condition or a history of a mental health condition.

Track 3 Mental Health Support (MHS)

For nurses who have disclosed a mental health diagnosis, are stable and do not have nursing practice violation(s) or a criminal history.

Track 4 Extended Evaluation (EE)

For nurses who have had a one-­‐time substance-­‐ related incident, and do not have nursing practice violation(s) or a criminal history.

PAGE 9

FOR NURSES WHOSE CASE HAS BEEN REFERRED TO THE BON

POST-­‐TPAPN NON-­‐ADHERENCE (Track 5)

Recovery focused (continued) (practice monitoring usually required)

Continued help for nurses whose TPAPN cases have been referred to the BON

Track 5 Interim Monitoring (IM)

For nurses who have been non-­‐adherent with TPAPN track requirements, and become disqualified from continued participation in that track. With BON approval, nurses may continue to be monitored by TPAPN while the BON investigates and makes their determination.

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

ADVOCATE COMMENTS ABOUT TPAPN Fall 2018 Advocate Workshop The role of advocate is an important way to serve nurses of Texas. It has broadened my compassion. TPAPN is an invaluable resource for great nurses in Texas.

—Beth Hultquist Value and importance of being an advocate: 1) Way to give back 2) Resource to HR 3) Resource to employers —Sabita Singh Being a participant gave a chance at life. I was suicidal with a plan to end my life so my insurance would benefit my family. I have been 18 years clean and sober because TPAPN helped restore my life.

—Jan M. Value and importance of being a participant: 1) Provides support 2) Accountability 3) Teaches coping skills —Sabita Singh The accountability provided

by TPAPN is essential to recovery.

—Unknown PARTICIPANT: Having a support system that is knowledgeable about the ups and downs of addiction.

—Unknown ADVOCATE: Having support to other nurses at a time when they need a friendly face or ear.

—Unknown

I think the value and importance of being an advocate is: »» Another tool to keep me clean. »» To give back to my profession after I feel that I took so much from. »» Making living amends. »» The value of one addict helping another addict is beyond parallel. »» Meet wonderful people, an advocate stood by me. »» The value and importance of being a participant is: 1) Allow me to be able to keep my career and those things dear to me.

2) Stop using drugs and find a new way to live.

3) Not be afraid and know there are others like me.

4) New people, places, and things.

—Unknown I became a TPAPN advocate after going through addiction recovery with my adolescent son. I am so thankful to be able to help other nurses who are dealing with substance abuse and mental health issues that could impact their ability to practice safely and maintain their license.

The greatest joy for me is when a participant says to me, “I am so glad I can talk to you, you are a nurse. You understand.”

—Cynthia Hawks BSN, RN, CNOR

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

PAGE 10

TPAPN may require, and randomly utilizes, other types of toxicology screening including blood, hair, and nail testing.

The frequency of screens varies.

Many participants benefit from the social peer support of TPAPN Volunteer Advocates. Advocates are an integral part of TPAPN, TPAPN’s recovery support services, and TPAPN participants’ recovery. Advocates may also serve as educational resources to employers, schools of nursing, and to the public. Advocates meet and/or speak with their assigned participants on a regular basis and communicate regularly with their assigned participants’ case managers. Advocates may, or may not, be in recovery themselves. Advocate training workshops are held twice a year. Please consider helping a fellow nurse by becoming a TPAPN Advocate.

TPAPN can be reached Monday-Friday 8 a.m. - 5 p.m. at 512.467.7027 or by email at tpapn@texasnurses.org. The preferred way for participants to communicate with their TPAPN case manager is through TPAPN’s online participant portal. TPAPN’s after-hours support staff can be reached for urgent TPPAN matters at 512.467.7027, extension 6. i TPAPN Texas Peer Assistance Program for Nurses c/o Texas Nurses Foundation/Association 8501 N. MoPac Expy., Ste. 400 Austin, TX 78759 Phone: 512.467.7027 Fax: 512.467.2620 tpapn@texasnurses.org www.tpapn.org Office Hours: 8:00 a.m. to 5:00 p.m.

Monday-Friday FOOTNOTE 1. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” (https://blog.samhsa.gov/2012/03/23/ defintion-of-recovery-updated)

WHY SHOULD EMPLOYERS SUPPORT NURSE PARTICIPATION IN THE TPAPN PROGRAM?

By Dr. Sally Gillam, DNP, MAHS, RN, NEA-BC, Advisory Committee Chair 2017 NURSING IS CONSISTENTLY RANKED as the most trusted profession. Trust is imperative for nurses to provide safe and effective patient care. But what happens when caregivers need care for substance use or mental health concerns? The American Nurses Association estimates these issues impact 6 to 8 percent of nursing professionals. According to the Texas Board of Nursing (BON), there were more than 415,000 currently licensed RNs and LVNs in the State of Texas during 2017. Applying the 6-percent figure to this total indicates nearly 25,000 currently licensed nurses in Texas may exhibit impaired professional performance because of substance use or mental health issues.

The structure of the TPAPN program and its partnership with employers provides participants with the structure needed for successful transition back into practice.

To ensure patient safety and continue to earn public trust for our profession, it is vital to identify potentially impaired nurses when professional practice issues arise — such issues must be reported to the BON. Board actions in severe cases can preclude employment because of license suspension or revocation; actions may also include reporting of suspected criminal activity to law enforcement.

When referral to the TPAPN program occurs and eligibility is confirmed, participants are assigned a case manager. Case managers provide approved work agreements for participants.

TPAPN work agreements include restrictions on practice, while employers provide supervision according to the terms of the work agreement. Advocates and volunteers are also available to support nurses as they complete the program. TPAPN programs involve individualized treatment plans, self-help groups, monitoring, and reporting to ensure participants fulfill conditions of their agreements. TPAPN monitors the nurse’s practice for a minimum period of one year.

The Texas Peer Assistance Program for Nurses (TPAPN), operated by the Texas Nurses Foundation through a contract with the BON, offers licensed nurses with practice impairment related to substance use or mental health conditions with an alternative to disciplinary action. The goals for such nurses are retention, recovery, and re-entry into safe professional practice. Early identification and referral are key elements of success. Referral to the TPAPN program may be initiated by individuals and/or employers.

The considerable proportion of nurses afflicted by substance misuse and/or emotional health issues calls for integrated environments, so participants can fully address attitudes and behaviors which adversely impact patient care. The structure of the TPAPN program and its partnership with employers provides participants with the structure needed for successful transition back into practice. For more information regarding the TPAPN program, please visit: http://www.texasnurses. org/?page=TPAPN. i

Protect Your License!!

T EX A S PEER ASSISTANCE

If you have received:

PROGRAM FOR NURSES

Letter of Investigation from the Texas Board of Nursing Notice of Peer Review Call today, delay is not an option!

VOLUNTEER NURSE ADVOCATES NEEDED HELP* SUPPORT TX NURSES WHO HAVE SUBSTANCE USE AND/OR MENTAL HEALTH CONDITIONS

If you cannot hire an attorney, please visit

www.nursingcomplaint.com

512.467.7027 Monday-Friday 8 a.m. - 5 p.m. tpapn@texasnurses.org • www.tpapn.org

for suggestions, sample documents and information about the Investigation Process.

TPAPN is a voluntary program funded by nurses’ licensure fees though the Texas Board of Nursing.

Joyce Stamp Lilly RN JD Registered Nurse and Attorney

*The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

See https://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated.

713.759.6430 jslilly@me.com www.nurse-lawyer.com

PAGE 11

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

TEX AS NURS ES AS SOCIATION

The BON Sunset review process provides an exemplar of how regulation is influenced by nurse advocacy throughout the process.

NURSING REGULATION and the Impact of Advocacy on Nursing Practice

By Ellen Martin, PhD, RN, CPHQ

IN TEXAS, nursing is regulated by the Board of Nursing, and nurses have input into the regulations that govern their practice.

The American Nurses Association has designated 2018 as the Year of Advocacy. The BON Sunset review process provides an exemplar of how regulation is influenced by nurse advocacy throughout the process.

WHAT IS SUNSET? Sunset is a periodic review process for all state agencies by the Sunset Commission. The Commission has 12 members, five senators, five representatives, and two members of the public who are appointed by the lieutenant governor and the speaker of the house each biennium. The process begins with a self-study prepared by the agency and includes an intensive evaluation of all aspects of the agency. Both confidential and public comments are solicited from stakeholders by Sunset Commission staff, state employees, to inform the evaluation process.

This is an opportunity for nurses to advocate for themselves and their profession. The agency review culminates in a report to the Sunset Commission that includes recommendations for the continuation of the agency and changes the agency should make to improve performance.

As a key stakeholder in the Sunset process, TNA staff met with the Sunset Commission staff and provided formal comments for consideration in the final report. Members serving on the TNA Regulation Committee were instrumental in discussing the Sunset review of the BON and providing guidance to TNA staff.

As a key stakeholder in the Sunset process, TNA staff met with the Sunset Commission staff and provided formal comments for consideration in the final report. Members serving on the TNA Regulation Committee were instrumental in discussing the Sunset review of the BON and providing guidance to TNA staff.

SUNSET REPORT RECOMMENDATIONS There were seven Sunset recommendations and the final statute made the following changes to nursing regulation.

1.

The most significant recommendation was that the BON continue to regulate nursing. A dedicated nursing board is very important to Texas nurses.

2.

The BON was directed to create a pathway to licensure for students of out-of-state nursing educational programs which are not substantially equivalent to Texas programs.

The expiration for the existing such program, Excelsior College, was removed.

3.

Recommendations related to the licensure of nurses and disciplinary action included the requirement that the BON demonstrate a connection between the nurse’s conduct and the practice of nursing. Past disciplinary action for

More than 60 people provided public comments to the Sunset Commission. All the relevant documents and public comments can be viewed at www.sunset.texas.gov.

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

PAGE 12

many nurses must be removed from the BON and NURSYS websites. Further, the BON is no longer able to pass along costs associated with an administrative hearing to the nurse nor change the administrative judge’s findings of fact or conclusions of law.

4.

The BON was directed to ensure that its peer assistance program (TPAPN: Texas Peer Assistance Program for Nurses) implement flexible program requirements that are individualized to participant needs.

5.

Advance practice registered nurses will be required to check the Prescription Monitoring Program (PMP) database before prescribing some controlled substances. The Sunset legislation also directs the BON to develop guidelines for responsible prescribing and provide licensee information to the pharmacy board, so they can enroll APRNs in the PMP database. APRNs will also be able to sign death certificates of patients who received hospice or palliative care.

6.

Nurses advocate for their profession as the BON works to implement Sunset statute. Nurses, including TNA representatives, participated on various BON committees which met over the summer and fall of 2017.

TNA REPRESENTATIVES ON BON ADVISORY COMMITTEES IMPLEMENTING SUNSET STATUTE Advisory Committee on Education: Stephanie Woods, PhD, RN Nursing Practice Advisory Committee: Donna Richardson, DNP, RN

The statute adopted the enhanced Nurse Licensure Compact which allows nurses to practice under a multistate license with other states in the new enhanced Nurse Licensure Compact.

Licensure, Eligibility and Licensure Advisory Committee: Lolly Lockhart, PhD, RN APRN Committee: Stan Harmon, MSN, RN, FNP (has not yet convened)

IMPLEMENTING RECOMMENDATIONS Nurses advocate for their profession as the BON works to implement Sunset statute. Nurses, including TNA representatives, participated on various BON committees which met over the summer and fall of 2017. Much of this work will be reduced to administrative rules. Proposed rules are reviewed by the BON advisory committees and revisions considered. Final recommendations are presented to the BON for approval. The BON quarterly meeting has a dedicated agenda item for public comment and nurses can address the board at that time. Once approved by the BON, the draft rules are published in the Texas Register for

public comment, giving nurses a final opportunity to advocate.

Once the comment period is over, final rules are prepared, published, and become practice regulations.

Throughout 2018, nurses can participate in the Year of Advocacy by engaging on local, regional, state, and national issues of importance to nurses. i

Representing nurses and healthcare professionals who have dedicated their life to helping people.

Be a Leader Advance YOUR Career

Earn your RN to BSN or MSN www.tarleton.edu/nursing

PAGE 13

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

HIGH CONSEQUENCE INFECTIOUS DISEASE:

WHAT NURSES NEED TO KNOW

By Toby Hatton, MA, RN, BSN, BS, CHSP and Ellen Martin, PhD, RN, CPHQ

NURSES AT THE SHARP END of healthcare are at increased risk during an infectious disease outbreak. As we learned during the Ebola outbreak three years ago, the stakes are highest when the infectious disease is lethal. High consequence infectious diseases (HCID) are defined by the Centers for Disease Control and Prevention (CDC) as those diseases that have epidemic or pandemic potential, have the potential to spread rapidly through a population, or have a high mortality rate.

The Texas Department of State Health Services (DSHS) defines HCID as diseases that: “presents an immediate threat, poses a high risk of death or serious long-term disability to a large number of people; and creates a substantial risk of public exposure because of the disease’s high level of contagion or the method by which the disease is transmitted.” This definition is closely tied to the Texas Health and Safety Code definition of a public health disaster.

HCID PREPAREDNESS The potential severity of HCID makes preparedness and response planning a vital public health priority with significant policy implications at the federal, state,

The federal priority is mitigating the effects of HCID through training, preparedness, response, investigation, monitoring, and controlling so that a constant state of readiness exists within both public health and healthcare delivery systems. health system, and facility level.

The federal priority is mitigating the effects of HCID through training, preparedness, response, investigation, monitoring, and controlling so that a constant state of readiness exists within both public health and healthcare delivery systems.

In response to the Ebola outbreak in 2014, Texas received $13.3 M in new state funds and $15.5 M in one-time federal funding to support high consequence infectious disease projects.

The Texas Department of State Health Services and the Health and Human Services Commission address HCID in their strategic plans. The two main priorities are to develop and sustain an HCID response system and build an infrastructure within the existing healthcare delivery system of hospitals and Emergency Medical Services (EMS) to ensure facilities and healthcare providers are prepared to safely transport and treat patients with HCID.

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

PAGE 14

Hospital priorities include development of internal processes and procedures so that staff can safely receive and treat patients with HCID. Nurses will provide direct care to the patient with a HCID until they can be safely transferred to a CDCapproved HCID Treatment Center.

From a public health perspective, collaboration is the priority as all entities work together to build a stronger and better prepared community. This includes providing education, monitoring, and supporting the HCID response. The CDC and Center for Health Security at the Johns Hopkins Bloomberg School of Public Health have developed resources including a health sector resilience checklist to help support public health preparedness and response efforts.

HCID RESPONSE In Texas, we have a system of disaster responders known as the Emergency Medical Task Force (EMTF). The EMTF is broken

Texas is pioneering a highly specialized and highly trained Infectious Disease Response Unit (IDRU) within the Emergency Medical Task Force. This IDRU consists of two components, hospital augmentation teams and prehospital/inter-facility transport teams. into eight regions that encompass the entirety of Texas. These EMTF teams are further broken down in to unique and specialized disaster response components such as Mobile Medical Units, Nurse Strike Teams, Ambulance Strike Teams, Mass Casualty Ambulance Buses, and more.

Additionally, Texas is pioneering a highly specialized and highly trained Infectious Disease Response Unit (IDRU) within the EMTF. This IDRU consists of two components, hospital augmentation teams and pre-hospital/inter-facility transport teams. The Hospital augmentation teams will consist of specially trained nurses who will provide direct patient care to HCID patients in the hospital setting. The nurses serving on this elite team will receive in-depth

training and would be paid through the hospital or agency they normally work for, and that agency, in turn, is reimbursed by the State of Texas for personnel costs.

WANT TO GET INVOLVED? Nurses are now being recruited for the Infectious Disease Response Unit. If you are interested in trying out for this unique team, or want to learn more about the criteria, please visit the IDRU website at www.txidru.org.

In exchange for their participation, selected nurses will receive specialized training at no cost that will allow them to help their community and be part of the Emergency Medical Task Force in Texas. i

Toby Hatton is the regional emergency management officer for MedxcelFM, a subsidiary of Ascension Health, responsible for emergency management in more than 13 hospitals and countless clinics and doctor’s offices. He has extensive experience and content knowledge in disaster nursing and chairs the Hospital Committee of the Texas Infectious Disease Response Unit.

TRANSFORMATIVE EXPERIENCES IN NURSING Master of Science in Nursing – Family Nurse Practitioner Program · Online format · 46 credit hours with 720 clinical hours Registered Nurse to Bachelor of Science in Nursing Program · Online format · Designed to complete in one calendar year Pre-licensure Bachelor of Science in Nursing Program · On-campus format · Excellent NCLEX-RN, graduation and job placement rates

SFASU.EDU/NURSING

For more information, email nursing@sfasu.edu, or call 936-468-7700.

PAGE 15

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

Save the date

APRIL 13-14, 2018

ADVANCING THE PROFESSION FindADVANCING Out HOW

by Participating in ThisTHEAnnual Event!

THE PROFESSION ADVANCING PROFESSION 2018 POLICY SUMMIT

2018 LEGACY BANQUET

TNA’s Policy Council is tasked with presenting the Board of Directors with well-thought-out policy positions for the next biennium. This is your opportunity to advocate for TNA policy initiatives!

Attendees will consider work to date as committee chairpersons report on their work related to APRN issues, Education, Workplace Advocacy, Regulation, End of Life Issues, Maternal Morbidity and Mortality, and Mental Health. Breakout sessions will enable dialogue so that participant feedback can be considered and final recommendations are made.

Janet Haebler, MSN, RN senior associate director, ANA State Government Affairs will provide a keynote address on state ADVANCING THE policy initiatives across thePROFESSION nation.

Leaders and Legends of Texas Nursing

2018 HOUSE OF DELEGATES

POSTHUMOUS HONOREES

7:00 p.m. – 9:00 p.m.

TNA members advance policy through association leadership. At the HOD, attendees will enjoy a morning of updates from the TNA president and staff as well as a discussion of proposed bylaws and resolutions. This informal session will be followed by TNA Board and Nominating Committee candidate presentations on their platforms and vision to advance the association. During the lunch break, delegates will cast votes and all attendees will enjoy a networking opportunity. The afternoon will include TNA’s official business session and installation of officers.

Brigadier General Lillian Dunlap, USA

Shirley Finn, PhD, RN

LEGACY BANQUET ($125 per person/$1,250 table sponsor for 10, includes reception and dinner)

Mildred Hogstel, PhD, RN

We are able to focus on current policy initiatives because of the many who paved the way to this point. This event — often referred to as the Legacy Banquet — is an opportunity to recognize members of Texas Nurses Association who have personified TNA’s mission. These nurses advocated for and advanced the profession through their life’s work and it is our privilege to recognize their contributions.

In 2018 we willl be honoring:

EMPOWERED NURSES

ADVANCING THE PROFESSION LOCATION: Doubletree Arlington DFW South A block of rooms has been reserved at a rate of $115 per night plus tax and fees.

APRIL 13 7:30 a.m. – 4:00 p.m.

Carolyn Gunning, PhD, RN

Lucy Norris, MSN, RN

TNA POLICY SUMMIT ($150 TNA Members/$200 Non-Members – includes breakfast & lunch)

Elizabeth Sjoberg, JD, RN

6:00 p.m. – 7:00 p.m.

Patricia S. Yoder-Wise, EdD, RN, NEA-BC, ANEF, FAAN

LEADERS & LEGENDS OF TEXAS NURSING SIGN-IN/RECEPTION/SILENT AUCTION

Sponsored by the Texas Nurses Foundation, all proceeds benefit this charitable, professional, and scholarly arm of TNA. Individual tickets are available for cocktail hour and dinner through the event registration. If you’re interested in sponsoring a table of 10, please contact Staci Vines, 1.800.862.2022 ext. 133 or svines@texasnurses.org. i

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

PAGE 16

APRIL 14 7:30 a.m. – 3:00 p.m.

TNA HOUSE OF DELEGATES ($60 for official delegates/$100 for observers - includes breakfast & lunch)

REGISTER: Visit texasnurses.org for a full schedule and to register for events.

BECOME AN AGGIE NURSE

Advance your career with RN to BSN • Flexible Online • Comprehensive • Affordable

nursing.tamhsc.edu

POLICY POSITION DEVELOPMENT UPDATE

By Andrew Cates, JD

WHAT CAN I DO? Even if you are not a committee member, you can still play a vital role in our policy development process.

REGULATORY Use of technology and the future of the profession

Expert advisors are members of TNA who receive the agenda before each policy council committee meeting and have the opportunity to email questions, suggestions, comments, or concerns for committee consideration.

Telehealth Disciplinary rules of the Board of Nursing Full practice authority for all healthcare providers

These submissions are extremely important to the development of the discussion around the issues.

WORKPLACE Safe staffing Nurse fatigue

Expert advisors help to ensure that we have a well-rounded conversation with all viewpoints and opinions considered.

Last year, TNA engaged over 400 nurses as expert advisors to our inaugural Policy Council. This year we would like to reach 500.

Workplace violence Opioid crisis/substance misuse

APRN APRN preceptor shortage Full practice authority for APRNs THE TEXAS NURSES ASSOCIATION Policy Council began work in earnest on policy position development this fall and will continue into late spring 2018.

Policy work is completed by each of the seven substantive policy committees throughout the year covering a broad range of policy areas.

Help us reach that goal by signing up to be an expert advisor using the form under the Policy Council section of www. texasnurses.org.

Access and quality of care by APRNs in women’s health

EDUCATION Nursing shortage and budgetary Issues Faculty shortage and budgetary Issues

Supported decision-making for persons with intellectual disability

Each committee meets once a month to discuss a different issue that relates to the topic area.

Community college baccalaureate programs BSN in 10 legislation in New York

Opioid crisis/substance misuse

A number of DNP students will be serving as policy fellows, assisting in the research and writing process as part of their coursework.

Graduate nursing education funding

Guns in community mental health centers

Do Not Resuscitate Orders

Texas Peer Assistance Program for Nurses

This year TNA is also introducing a Policy Summit prior to the House of Delegates in April. This one-day summit on Friday, April 13th in Arlington provides all Texas nurses with an opportunity to have their voice heard in the development of policy positions! (See announcement for April event on page 16.)

Medical Power of Attorney

Access to care − budget/beds

Texas recognition of Medical Orders for Scope of Treatment (National POLST paradigm)

MATERNAL MORTALITY

Medicaid funding for advance care planning discussions with patients and families

Education of nurses on postpartum risks

Issues that the committees are currently researching and discussing include:

END OF LIFE

State funding for a state repository for advance directives

PAGE 19

MENTAL HEALTH

Alignment of postpartum discharge instructions Texas AIM Maternal Bundle Support of State Maternal Mortality and Morbidity Task Force i

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

TEX AS NURS ES AS SOCIATION

What Do You Mean There’s a Complaint?!

By Taralynn R. Mackay, RN, JD NOTE: “he” or “she” designations are used interchangeably throughout the article.

THE MAIL BRINGS A LETTER from the Texas Board of Nursing (BON): a complaint has been filed against you. You may be expecting the letter because of an incident which occurred, or it may be a complete shock.

No matter if you were expecting a letter or not, you can expect to go through many different emotions — anger, guilt, worry, and sadness. There can also be physical manifestations. The most important thing to remember is a good nurse can get reported to the board, and a good nurse can end up with a disciplinary order on his or her nursing license.

FIRST STEPS It’s important to keep your address current with the BON because it sends all correspondence to the last known address on file with the board. If a nurse moves and does not inform the BON, the complaint letter may never reach the nurse. That means the investigation continues without the knowledge or input from the nurse. A nurse could lose her nursing license because she did not inform the BON of her new address.

A common reaction is for the nurse to fear losing his license based on what he has read in the newsletter or heard from other nurses. A quick review of previous disciplinary orders only serves to scare the nurse more. It is important to realize the BON’s typical reaction to allegations is to allow the nurse to remediate and keep his license. The revocations are for various reasons (discussed later) but the BON is typically judicious in issuing revocations.

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

Just because the nurse received a BON complaint letter

does not mean the BON believes the allegations against the nurse. The complaint notice letter is typically sent before the BON investigator has received the records involved.

The letter is worded based on the information contained in the complaint form sent to the BON. The complaint can come from patients, patients’ families, co-workers, or even the nurse’s own family or friends, but the majority of complaints arise from employers. Complaints can be filed voluntarily or be required reporting by law.

The BON investigator assigned to the case subpoenas records such as the nurse’s personnel file, departmental records, policy and procedures at the place of work, payroll records, pharmacy records, and — of course — the medical records.

The investigator may request affidavits from witnesses in certain cases. In criminal offense cases, the investigator may request court records and police records.

BON investigations tend to be record or document reviews and not in-person interviews or fact finding. The assumption is the investigator will go to the place the incident occurred, interview all witnesses and review the original documents. This does not typically occur.

Because the investigation is typically a review of the documents pertinent to the case, it is critically important the nurse respond to the allegations. The investigation process is detailed in a flow chart on the BON’s website under the Discipline and Complaint section.

CONSIDERATIONS There are several considerations or hints when dealing with a BON complaint: Do Not Ignore it. A nurse should not ignore a notice letter from the BON. When

PAGE 20

the BON tells the nurse they have an opportunity to respond, what they mean is the nurse shall respond or suffer the consequences of not responding.

Some nurses believe there is no need to respond because the investigation will show there was no violation of the laws, but this is not true. When a nurse fails to respond to the BON, the case is put on a revocation track because the nurse is not responding to his licensing board.

Not responding can result in the filing of formal charges or even a harsher order or ultimately a revocation if the nurse never responds.

Do Not Share. Resist sharing the news of the complaint. Sometimes co-workers, employers, and even friends become distrustful of the nurse’s capabilities or shun the nurse entirely.

Consider Contacting an Attorney.

When the nurse is first informed of the complaint is the best time for a nurse to contact an attorney for assistance before the BON. A nurse can harm his case by disclosing information that is not required to be disclosed, and a lawyer can help to protect the nurse.

Hiring an attorney does not make a nurse appear guilty. Not only can an attorney provide legal advice, the attorney is able to look at the case objectively.

When you are busy working, it is difficult to find the time to research the laws involved with the complaint and it takes a while to figure out the ins and outs of an investigation. Too often a nurse seeks legal advice after submitting a written response, calling the investigator, or even signing an agreed disciplinary order and the further along the nurse is with the case, the less an attorney can do to protect the nurse.

Once an agreed disciplinary order is signed and ratified by the BON, it is too late to argue the facts in the case.

Hire an Experienced Lawyer. An experienced attorney means someone who works extensively with the BON. For example, in the same manner that it would not be prudent to have a general practitioner perform brain surgery, the nurse should not have a family law or

DISCIPLINE FACTS Although regulation of nursing practice is an important topic to nurses, did you know that very few nurses are reported to the Board of Nursing each year and of those only a small percentage result in discipline? In fiscal year 2017:

95.06% of RNs selected for a pre-renewal CE Audit were compliant.

98.7% of RNs had no recent violations (past three years).

8.2 complaints per 1,000 licensees, of these 15.9% result in discipline.

83.5% of complaints are resolved within six months.

The Quarterly Statistical Report is published on the BON website under board meetings in the meeting agenda.

criminal law attorney represent him before the BON. Furthermore, the “experience” needs to come from working with the BON, not just experience representing nurses in some type of legal case. For example, just because an attorney is experienced representing a nurse in a malpractice case does not mean that attorney is experienced with the BON. Carefully Consider Anything You Put in Writing. Anything put in writing or told to the BON can be used against the nurse later. A nurse needs to cooperate with the BON but remain cautious. It is best to have an attorney review all statements before the statements are sent to the Board. If you are going to hire a lawyer, do not call or put anything in writing to the BON. Contact Your Malpractice Insurance Provider. If you have malpractice insurance, contact your insurance carrier immediately. The carrier will provide you with an attorney or tell you how they will reimburse you for your expenses in hiring an attorney on your own.

If you don’t have an insurance carrier and you are covered under your employer’s insurance, realize most employer insurance companies do not cover professional license defense.

Read Up on the Rules. Read employee handbooks/contracts/policy and procedure to determine if you are required to

PAGE 21

report the investigation to your employer. While a nurse is not required by the BON to inform an employer there is an open investigation, the nurse may face repercussions from their employer by not telling them.

Do Not Copy the Patient’s Medical Record.

To do so would be a violation of privacy and a HIPAA violation. Even reviewing the record contained in your employer’s files would be a violation. The records can legally be obtained from the BON. Do Not Alter the Patient’s Medical Record. To add, destroy, rewrite, deliberately document inaccurate information, or omit significant facts in a medical record is fraud. Do not attempt to correct or add to the medical record, even if what you are documenting is a true reflection of what occurred. If you do so, allegations of tampering with the record or fraudulent documentation will also arise.

Open Investigations Take Time. The nurse should remember the investigation is active unless the nurse receives written confirmation from the BON that the case has been closed/dismissed. An investigation can take months to complete, and the amount of time is determined by when the complaint comes in, what priority level it is placed at, how quickly the records can be obtained, and the caseload of the investigator. continued on page 22

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

TEX AS NURS ES AS SOCIATION

TNA’S NEW ON-DEMAND CNE PROGRAM CONTINUING NURSING EDUCATION — ANYTIME. ANYWHERE! NURSING CONTINUING EDUCATION is now accessible anytime, anywhere!

The Texas Nurses Association is proud to announce the launch of the TNA Learning Curve, an on-demand source for continuing nursing education activities. Whether you’re at your house at midnight, on the beach in another time zone, at a coffee shop, or on break at work, you can access these education programs at any time. Even if you don’t have a full hour to watch, you can stop and come back later.

TNA Learning Curve will maintain a library of nursing education. Initially, it will feature the three topics required by the Texas Board of Nursing:

Jurisprudence and Ethics; Forensics; and Geriatrics.

The required topics will be followed by Incident-based and Safe Harbor Nursing Peer Review.

The catalog will continue to expand, including additional modules on nursing peer review, suicide screening and intervention, and health information technology. In addition, TNA will continue to identify the most pressing needs for nursing continuing education. Many of the topics will only be available on TNA Learning Curve. TNA is dedicated to supporting your professional growth and de-

velopment and your journey of life-long learning with evidence-based, best practice information designed to improve and enhance your nursing practice.

You do not have to view the entire activity at once. You can stop in the middle, pick up later, and still receive credit.

TNA Learning Curve is open to both members and non-members of TNA, with members receiving a special member pricing. When you visit TNA’s website at TexasNurses.org, click on On-Demand CNE. It will take you to a page explaining the process to sign-in. All users (members and non-members) must sign-in prior to exploring TNA Learning Curve.

When you successfully complete, receive your certificate of successful completion instantaneously.

Because the Texas Nurses Association/Foundation Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation, the contact hours that are awarded are nationally accepted.

WHY CHOOSE TNA LEARNING CURVE?

The activities are developed for nurses by nurses and presented by experts in their fields.

Provides activities that meet license renewal and continuing education requirements.

View CNE in any location at any time of day.

All TNA Learning Curve topics will be of interest to nurses and the nursing profession to support the mission — Empowering Texas nurses to advance the profession — and vision — of the Texas Nurses Association. i

COMPLAINT continued from page 21 NOTICE: This article has been prepared for the information of TNA members. It is not intended for use as legal advice. Please consult an experienced attorney for legal advice. Finally, the opinions expressed in this article are the authors’ and are not necessarily the opinions of the TNA. Taralynn R. Mackay, RN, JD McDonald, Mackay, Porter & Weitz, LLP 1411 West Avenue, Ste. 200, Austin, TX 78701 512.281.5999 direct

Mackay@healthlicensedefense.com www.healthlicensedefense.com Board Certified in administrative law by the Texas Board of Legal Specialization.

Taralynn R. Mackay, RN, JD, is a founding partner in the law firm of McDonald, Mackay, Porter & Weitz, LLP where her practice focus since 1997 has been administrative/regulatory law, health care law, and professional licensing issues with a primary focus on representing

T E X A S N U R S I N G M AGA Z I N E | W I N T E R 2 018

PAGE 22

nurses before the Texas Board of Nursing.

Previously, Mackay worked as an assistant general counsel and staff attorney for the Texas State Board of Medical Examiners and the Texas State Board of Physician Assistant Examiners. She received her BSN with honors from the University of Texas Medical Branch, practiced nursing in ICU, CCU, and Transplant ICU. Mackay received her doctor of jurisprudence from the University of Texas School of Law. i

NURSE ADVOCACY IN ACTION! Tobacco-21 (T-21) increases the legal age for tobacco purchases from 18 to 21.

TNA IS A LONGSTANDING MEMBER of the Texas Public Health Coalition (TPHC) — a coalition of healthcare organizations and health-focused organizations dedicated to disease prevention and health promotion. Every legislative session the TPHC identifies policy priorities to pursue. Requiring tobacco purchasers to be 21 years of age was a coalition initiative strongly backed

by TPHC member the American Heart Association (AHA) that failed. AHA is now working to advance this policy initiative in local communities and reached out to TNA to support its initiative in San Antonio. With only two days’ notice, TNA District 8 responded in full force! TNA and District 8 sent a joint letter to the San Antonio City Council and TNA members Joyce Borgfeld, Cindy Strzelecki, Karen Weis, and Jennifer Cook testified at the meeting forum and spoke in support of T-21 at the City Council hearing on January 11, 2018. The initiative passed, coincidentally on the anniversary of the Surgeon General’s 1964 report alerting the nation to the health risks of smoking. i

District 8 members Joyce Borgfeld, Jennifer Cook (front, center), Karen Weis and Cindy Strzelecki (back, center) along with representatives of San Antonio American Heart Association, M D Anderson, and members of the Campaign for Tobacco-Free Kids.

Come to Work...

Where your work makes a difference!

RNs and LVNs

W

e offer predictable work schedules, set case loads, and an excellent benefits package, including: n Competitive salaries n Health and retirement benefits n Paid vacation leave n Up to 15 paid holidays annually n Shift differential pay Contact: Laura Hunter atof Aging Texas Department and Disability Services laura.hunter@hhsc.state.tx.us

Exciting and challenging job opportunities await you at a state supported living center!

877-738-2213

Various nursing positions are available at 12 facilities around Texas.

Apply online: www.dads.state.tx.us/employment/sslcs/

Our Austin office is located blocks from the Board of Nursing

BERTOLINO LLP PAGE 23

www.BertolinoLaw.com

W I N T E R 2 018 | T E X A S N U R S I N G M AGA Z I N E

8501 North MoPac Expressway Suite 400 Austin, TX 78759-8396

REYNOLDS & FRANKE, PC CERTIFIED PUBLIC ACCOUNTANTS REPORT OF INDEPENDENT AUDITORS OPINION: In our opinion, the financial statements referred to in the audit present fairly, in all material respects, the financial position of the Texas Nurses Association General Fund as of June 30, 2017, and the changes in its net assets and its cash flow for the fiscal year then ended in accordance with accounting principles generally accepted in the United States of America.

Current members may login and view the audit at http://www.texasnurses.org/page/Member1

Harris College of Nursing & Health Sciences Fully Online Graduate Nursing Programs n MSN for Clinical Nurse Leader, Nursing Administration and

Leadership, and Nurse Educator n Post-master’s DNP for APRNs and Nurse Administrators n BSN to DNP for Family Nurse Practitioner and Clinical

Nurse Specialist n Post-master’s certificates for all programs n Oncology specialization available

Why TCU? n Outstanding faculty credentialed specifically for online education n Largest Nurse Faculty Loan Program participant in Texas n A Collaborating Center of the Joanna Briggs Institute n The Master’s and DNP programs at Texas Christian University

are accredited by the Commission on Collegiate Nursing Education (One Dupont Circle, NW, Suite 530, Washington, DC 20036, 202-887- 6791)

https://nursing.tcu.edu/graduate TEXAS CHRISTIAN UNIVERSITY