arizona state board of nursing 1st...4 arizona state board of nursing regulatory journal changes...

VOL3 • NO1 • MAR 20081ST QUARTER

arizonaR E G U L A T O R Y J O U R N A L

STATE BOARD OF NURSING

TERCAP TM Edit ion: Taxonomy of Error, Root Cause Analysis Practice-Responsibility

IT TAKES A VILLAGE

Breakthrough Ideas for Evidenced BasedRegulation 2008

arizonaR E G U L A T O R Y J O U R N A L

PUBLISHED BYARIZONA STATE BOARD OF NURSING

4747 North 7th Street, Suite 200Phoenix, AZ 85014-3653Phone: 602.889.5150Main fax: 602.889.5155CANDO fax: 602.889.5238General e-mail: [email protected]: www.azbn.gov

GOVERNORThe Honorable Janet Napolitano

Joey Ridenour, RN, MN, FAANEXECUTIVE DIRECTOR

Judy Bontrager, RN, MNASSOCIATE DIRECTOR/OPERATIONS

Valerie Smith, RN, MS, FREASSOCIATE DIRECTOR/

INVESTIGATIONS/COMPLIANCE

Pamela Randolph, RN, MSASSOCIATE DIRECTOR/EDUCATION &

EVIDENCE BASED REGULATION

BOARD MEMBERSKaren Hodges Hardy, RN, MSNPRESIDENTTheresa Crawley, CRNA, MSHSAVICE PRESIDENTPatricia A. Johnson, LPNSECRETARYConstance Woulard, RN, MSNMEMBERDenise Link, RNP, DNS, FNAPMEMBERKathy Malloch, RN, MBA, PhD, FAANMEMBERSteven T. Robertson, LPN, CHPLNMEMBERKathryn L. Busby, J.D.PUBLIC MEMBERM. Hunter PerryPUBLIC MEMBER

CREATED BY:Virginia Robertson, [email protected] Concepts, Inc.14109 Taylor Loop Road Little Rock, AR 72223FOR ADVERTISINGINFORMATION:Steve [email protected] • 800.561.4686

34 Advanced Practice Corner

36 RN Test Observers Neededfor CNA Exam

37 Disciplinary Actions

44 Regulation Rundown

STATE BOARD OF NURSING

This magazine is mailed quarterly to over 90,000Arizona licensed nurses and reaches every nursingstudent, hospital administrator and nursing schooladministrator in the state

E D I T I O N 9

VOL 3• N O1 • MARCH 20081ST QUARTER

4 From the Executive Director:Discovering Evidence forEffective Regulation

6 Staff Directory

8 TERCAPTM Taxonomy of Error,Root Cause Analysis Practice-Responsibility

11TERCAP TM Data Col lect ionInstrument © Including GuidelinesFrom Protocol for Instrument Use

14 TERCAPTM Form

20 Nonpayment of Child Support

21 Controlled SubstanceMonitoring House Bill 2136- Enacted 2007

www.thinkaboutitnursing.com

23 New Law RequiresDocumentation for Licensure/Certification

28 Education Corner

31 Nursing Scholarship

32 MRSA Prevention: It’s in theNurses’ Hands

TERCAPTM used with permission NCSBN (c2007)

4 arizona STATE BOARD OF NURSING REGULATORY JOURNAL

Changes that appear to be sudden innursing regulation have been taking shapefor many years. The Three BreakthroughIdeas for Evidenced Based Regulation (EBR)captures transformations in various stagesof development. Among the change agentsare nurse leaders who are willing to watchbreakthrough ideas “sprout from seedlings”and continue to nurture until the new mod-els grow and multiply. Please know that thislist will be updated each year and we lookforward to your reactions.

1. Peer to Peer Networks or P2P (StanStalnaker, Harvard Business Review,February 2008)

National Council State Boards ofNursing Inc (NCSBN) held the first P2PLicensing & Operations Conference forboard of nursing staff to attend in person orby webinar in the fall of 2007. The peer topeer education is context specific and drawson the knowledge grown out of another’sindividual experience rather than broad-applicable advice. The licensing techs whoattended found a rich source of expert infor-mation previously not provided by othermeans.

The P2P Networking was also recentlyutilized when the sponsors of NurseRefresher Courses met in January 2008 atthe Board offices for their fourth annualmeeting. This annual meeting was startedafter the Board instituted a practice require-ment in 2004 that mandated a refreshercourse if nurses have not practiced for 960hours in the last five years. The sponsorssuddenly had an increased number ofapproximately 200 students with a curricu-lum that was not always felt to meet theneeds of the students. The attendees focuson issues such as student qualifications,clinical experiences/placements, successstories, lessons learned regarding develop-ing the competencies of students and evolv-ing changes in course requirements.

Certified Nursing Assistant Educatorshave been meeting annually for the pastfive years. Over 135 CNA educators sharedclassroom teaching strategies in January2008. Instead of drawing solely on the wis-

dom of experts, the CNA Educators find theP2P conversations provide strategies tomeet the educational needs of culturallydiverse students and learn new ways to pro-mote and reinforce professional behaviorsin students.

2. Practice Breakdown Research Usingthe TERCAP tm 2007. (Taxonomy ofError, Root Cause Analysis & PracticeResponsibility)

NCSBN has launched the TERCAP 2007project to help member boards find newways to collect and submit data to add tothe body of knowledge surrounding nursingerror to influence regulations that ensurepublic safety. Prior to TERCAP’s creation, nosystem existed for a board of nursing totransmit data into a central source to allowNCSBN to analyze casual relationships andsimilarities among instances of nurse prac-tice breakdown across states/jurisdictions.It is significant research and a technologicalmilestone in providing boards with the “evi-dence” to identify nurses and nursing situa-tions at risk. The research will provide a“new lens for regulators” according to Dr.Kathy Malloch and Dr. Kathy Scott. Bothhave contributed to this significant work inexamining nursing from a practice perspec-tive so we are collectively able to designmeasures to improve practice and developpatient safeguards. Dr. Malloch furtherstates that this breakthrough research willresult in a “new regulatory role to facilitateproactive regulation before harm occursrather than waiting for problems to bereported.”

This edition of the Journal provides addi-tional content regarding PracticeBreakdown. “It takes a village” beyond theBoard of Nursing to determine the rootcause of practice breakdown and encouragepersons submitting complaints regardingnurses who have violated the Nurse PracticeAct to complete this tool. The data will becollected in aggregate for the state, andspecific identifiable information concerningthe setting is purposely not asked in TER-CAP. We believe that the 15-20 minutesneeded to complete the information will

provide the research data to better protectthe public.

3. Controlled Substances PrescriptionMonitoring Programs (CSPMP)

Controlled Substances PrescriptionMonitoring Programs have been legislatedin many states. The legislation typicallyrequires the Board of Pharmacy to establisha computerized controlled substance moni-toring program. The CSPMP computerizeddatabase tracks prescribing, dispensing andconsumption of Schedule II, III, and IV con-trolled substances that are dispensed by apractitioner or by a pharmacy.

Dean Wright, Arizona’s PMP Director,states in this edition of the Journal, “CSPMPis not intended to interfere with the legiti-mate treatment of patients; however, theprogram will provide information if thepatients are receiving prescription fromother sources or if the prescriptions arebeing modified or forged. This informationwill facilitate and encourage the identifica-tion, intervention and treatment of individ-uals who become addicted to controlledsubstances.”

The number one challenge for theArizona State Board of Nursing continues tobe the early detection and prevention ofchemical dependency in nurses. The evi-dence shows that nurses who are not suc-cessful in staying in recovery not only con-tinue to place patients at risk, but progressin their disease and often times die at anearly age.

On February 5, 2008, a Google News Websearch for “nurse arrested” resulted in 485articles in the last month. The highest num-ber of arrests in over seven states related toprescription forgery, possession of illegalsubstances and theft of prescription drugs.

The notion of emerging breakthroughideas for evidenced based regulation “takesa village” for new models to grow and multi-ply as we collectively transform the way webetter protect the public.

From the Executive Director & StaffJOEY RIDENOUR, RN, MN, FAAN

Breakthrough Ideas for Evidenced Based Regulation 2008

Joey Ridenour, RN, MN, FAAN


STAFF DIRECTORY

ADMINISTRATIONJoey Ridenour, RN, MN, FAANExecutive [email protected]

Judy Bontrager RN, MNAssociate Director-Operations& Licensing [email protected]

Valerie Smith RN, MS, FREAssociate DirectorInvestigations/[email protected]

Pamela Randolph RN, MSAssociate Director Education& Evidenced Based Regulation [email protected]

Lila WiemannAdministrative Assistant to theExecutive Director [email protected]

Jene MartinezAssistant to Associate DirectorInvestigations/[email protected]

Cristina OatesAdministrative Assistant toAssociate DirectorOperations/[email protected]

ADVANCED PRACTICE

CANDO

Connie Linck, RN, MN,CNAA, BCNurse Consultant – [email protected]

Olga ZunigaAdministrative Secretary –Monitoring & [email protected]

EDUCATIONKaren GillilandAdministrative [email protected]

Karen Grady, MS, RN, FNP, BCNurse PracticeConsultant/[email protected]

Lila Van Cuyk Nurse PracticeConsultant/CNA Programs602.889.5176 [email protected]

FISCAL SERVICESRandi OrchardFiscal [email protected]

Norma SalterAdministrative AssistantAccounting [email protected]

HEARINGSSusan Barber, RN, MSNNurse Practice Consultant-Hearing [email protected]

Vicky DriverAdmin. Assistant-Hearing [email protected]

INVESTIGATIONSNURSE PRACTICE CONSULTANTSBetty Nelson, RN, MS602.889.5169 [email protected]

Jeanine Sage, RN, [email protected]

Mary Rappoport, RN, [email protected]

Nan Twigg, RN, [email protected]

Sister Rachel Torrez, RN, [email protected]

Stephanie Nelson, RN, [email protected]

Sydney Munger, RN, [email protected]

SENIOR INVESTIGATORSDoug [email protected]

Frank [email protected]

James [email protected]

Ron [email protected]

Kirk [email protected]

LEGAL SECRETARIESBarbara [email protected]

Dorothy [email protected]

Esther [email protected]

Trina [email protected]

INFORMATION TECHNOLOGYCory DavittNetwork Operations [email protected]

Adam HenriksenInformation TechnologyDirector/[email protected]

LICENSINGBecky MeltonRN/LPN [email protected]

Debbie KunkleRN/LPN [email protected]

Debbie [email protected]

Donna FryeFingerprints/[email protected]

Helen TayCNA Exam/[email protected]

Paula DelphyRN/LPN [email protected]

Rhonda [email protected]

MAILROOMDerek [email protected]

MONITORINGMichelle Mills, RN, MANurse Practice [email protected]

Dolores HurtadoLegal [email protected]

Brent SutterLegal SecretaryMonitoring & [email protected]

RECEPTIONISTSMarlane [email protected]

Nancy [email protected]

Susan [email protected]

RECORDSAnne [email protected]


Taxonomy of Error,Root Cause AnalysisPractice-Responsibility

The Arizona State Board of Nursing is aparticipating Member Board of theNational Council of State Boards ofNursing (NCSBN) TERCAP project. TheTERCAP project was implemented in1999 by NCSBN’s Board of Directorswho appointed a task force to developnew knowledge about the causes ofnursing practice breakdown.

In 2004, the following recommendationwas made in the Third Institute ofMedicine (IOM) Report on patient safetyentitled, Keeping Patients Safe,Transforming the Work Environments ofNurses (2004):

Recommendation 7.2: The NationalCouncil of State Boards of Nursing[NCSBN], in consultation with patientsafety experts and health care leaders,should undertake an initiative to designuniform processes across states for bet-ter distinguishing human errors fromwillful negligence and intentional mis-conduct, along with guidelines for theirapplicability by state boards of nursingand other state regulatory bodies (IOM,2004, p. 15).

TERCAP was designed as an intakeinstrument for capturing data from nurs-ing boards' discipline cases. It createsan opportunity for consistent data col-lection and future analysis of compileddata by NCSBN and Member Boards.

The Arizona State Board of Nursing mayrequest additional information for thepurpose of TERCAP.

What is the purpose of TERCAP?

The purpose of TERCAP is to provide aninstrument used by boards of nursing asan intake instrument for capturing datafrom discipline case files to feed into anational data set.

• Root cause of practice breakdown • Nurse characteristics • Patient characteristics • Types of nursing practice break-down

• System characteristics associatedwith the error

Why Use TERCAP?• Consistent and comprehensive datacollection • Track case elements and recurringthemes • Learn from the experience of nurs-es who have had episodes of prac-tice breakdown • Discover characteristics of nursesat risk

What might we learn?• How are errors identified? • When and where do errors occur? • Can errors be "recovered from" bycounteractions? • What are ways to trigger thosecounteractions? • Will changes in systems affecterror tolerance? • Could unintended side effects cre-ate new paths to failure? • Can we find deeper, more genericpatterns in failures? • How can we develop, prototypeand evaluate new approaches topatient safety? • Can we begin to anticipate newareas of concern?

TERCAP classifies breakdown into 10categories

• Patient Profile • Patient Outcome • Setting Where Practice BreakdownOccurred • System Issues • Health Care Team • Nurse Profile • Intentional Misconduct or CriminalBehavior • Practice Breakdown Category: SafeAdministration of Medication • Practice Breakdown Category:Documentation • Other Practice BreakdownCategories:

o Attentiveness/Surveillance o Clinical Reasoning o Prevention o Intervention

o Interpreting Authorized Providers'Orders o Professional Responsibility andPatient Advocacy

TERCAP Instrument

The TERCAP Electronic Form (PDF -1.27MB) can be downloaded fromwww.azbn.gov for use by any facility.This instrument can also supplementthe complaint form submitted to theArizona State Board of Nursing office.

TERCAP Data Collection InstrumentIncluding Guidelines From Protocol ForInstrument Use (PDF - 274KB) may alsobe downloaded from the board website: www.azbn.gov

FAQ: TERCAP

The following questions are frequentlyasked about TERCAP:

Q: What is “practice breakdown”?

A: Practice breakdown involves health-care situations when some aspects ofessential nursing practice expectationsare not met.

Q: On what kinds of cases should TER-CAP be used?

A: Cases that involve some aspect ofpractice breakdown.

Q: How can I get the TERCAP instru-ment?

A: Go to www.azbn.gov and click onTERCAP (PDF - 1.27MB)

Q: When did the Arizona State Board ofNursing start utilizing the TERCAPinstrument?

A: December 15, 2007

Q: Will you disclose my name andlicense number?

A: No, the identity of the nurse is notrevealed.

Relevant Articles

• TERCAP: Creating A NationalDatabase On Nursing Errors

• Nursing And Patient Outcomes:How Can Employers Provide TheRight Environment For Nurses ToDeliver High Quality Care?

TERCAP

arizona STATE BOARD OF NURSING REGULATORY JOURNAL 11

Taxonomy of Error, Root Cause Analysisand Practice- responsibility (TERCAP™)Instrument©

Electronic online TERCAP™ information

Purpose: TERCAP™ is a researchinstrument that can be used by boards ofnursing as an intake document that assistsin capturing data from discipline case filesto feed into a national data set. The TER-CAP™ instrument is copyright (c) 2006 byNCSBN. TERCAP is used to collect consis-tent and comprehensive discipline caseinformation.

Each TERCAP case should focus on onenurse and one practice breakdown. If mul-tiple nurses are involved in a practicebreakdown you are to complete a separateTERCAP for each nurse. Each practicebreakdown is a distinguishable occur-rence. Actions that are linked together inan unbroken chain of events would bereported as one practice breakdown. A sin-gle practice breakdown may have multiplecontributing factors. Fill out the form forthe one practice breakdown that triggeredthe report to the board. If more than onepatient is involved in the practice break-down, report on the patient with the mostserious harm.

Some questions specify only a singleresponse. Others ask you to check allanswers that apply. Many questions in theinstrument include the option"Unknown/None/Not Applicable." Thereare some items that ask for a yes or noanswer but also offer an "Unknown"option. You are provided specific direc-tions for each item.

There are tools to assist you in maneu-vering within the document:

• The Next and Back arrows at the bot-tom of each page allow you to move for-ward or go backwards in the document. • Be aware that the green backwardarrow on the Internet browser tool barwill take you out of the document. If thathappens, you will have to access thecase from the main TERCAP page, usingthe Case Identifier. • Throughout the document, there areblue question marks in brackets [?].

These are links to the TERCAP™ 2007Protocol, a resource to assist the user inmaking decisions about entry of caseelements. By clicking on a questionmark in a particular section in the TER-CAP, you will go directly to the relevantsection of the TERCAP™ 2007 Protocol. You must answer every question or you

will not be allowed to go to the next page. Executive Summary

This executive summary provides anoverview of the ten sections of the TER-CAP coding protocol. For detailed codinginformation, including examples for eachelement, see the full coding protocol.USING TERCAP

To begin a new case in the TERCAPinstrument, a Case Identifier must be cre-ated. The Case Identifier used to create acase should also be listed as the case IDin the TERCAP instrument. It is recom-mended that a consistent case identifica-tion system be used by all participatingmember boards. The recommended sys-tem will include: two or four memberboard (jurisdiction's) initials; four digitsfor the year the case was received by themember board; three initials for the per-son entering/inputting data into the TER-CAP instrument; and a number thatshould increase chronologically as eachperson (identified with the three initials)"opens" a TERCAP case. (ExamplesJJJJYYYYIII#, IL2005TAK1 orCAVN2006TCB1).

The name of the person who completesa TERCAP instrument for a discipline caseis listed as the reviewer. The reviewer iden-tifies the State Board of Nursing and Dateof the Incident. Then, the following sec-tions of datasets are collected:

Patient Profile Patient Outcome Setting System Issues Health Care Team Nurse Profile Intentional Misconduct or CriminalBehavior Eight different Practice BreakdownCategories

A summary of each section is providedbelow.

Section One — Patient Profile • This section describes the patientinvolved in the practice breakdown. • The patient's age and gender are to beidentified. • The reviewer is asked whether thepatient had family and / or friends inattendance at the time. • The reviewer is asked to check whetherthe patient exhibited characteristics (suchas cognitive impairment, sensory deficitsand other risk factors) that contributed tothe practice breakdown. • The reviewer is also asked to check diag-noses that contributed to the reported sit-uation.

Section Two — Patient Outcome • This section describes how the practicebreakdown affected the patient. • The reviewer is asked what happened tothe patient. • Harm is defined as temporary or perma-nent impairment of the physical, emotion-al or psychological functions or structureof the body and / or pain that requiresintervention. The reviewer is asked to identify thedegree, if any, of patient harm.

Section Three — Setting • This section describes the type of com-munity and setting where the reportedpractice breakdown occurred. • The reviewer is asked to identify the typeof community, the type of facility or envi-ronment, and size of the facility. • The reviewer identifies the type of med-ical; record documentation system used bythe facility/agency – such as electronic,paper, or some combination.

Section Four — System Issues • This section provides the opportunity toidentify system elements that contributedto the practice breakdown, which is oftenthe result of multiple influences • The transfer (or lack of transfer) ofpatient information is frequently cited inthe patient safety literature as a criticalelement in providing safe and effective

TERCAPTM Data Collection Instrument© Including Guidelines FromProtocol for Instrument Use

National Council of State Boards of Nursing October 2007

Copyright © 2002, 2004, 2006 National Council of State Boards of Nursing, Inc. (NCSBN) All rights reserved. The NCSBN logo, NCLEX®, NCLEX-RN® and NCLEX-PN® are regis-tered trademarks of NCSBN and may not be used or reproduced without written permission from NCSBN. No part of this publication may be reproduced, stored in a retrieval sys-tem or transmitted in any form by any means (electronic, mechanical, photocopying, recording, or otherwise now known or to be invented) without written permission from NCSBN.Address inquiries in writing to NCSBN Permissions, 111 E. Wacker Drive, Suite 2900, Chicago, IL 60601-4277


patient care. The reviewer chooses allcommunication factors that contributed tothe practice breakdown. • Leadership and management styles ofhealth care institutions impact the organi-zational culture. The reviewer chooses fac-tors related to management or leadership. • The reviewer is asked to identify whetherany plans were in place for unexpectedneeds. • The reviewer chooses environmental fac-tors of the practice setting that con-tributed to the practice breakdown.

Section Five — Health Care Team • This section provides an opportunity toidentify any other team members whoseactions or inactions contributed to thepractice breakdown. • The reviewer is asked to identify whatcategory of health team members wasinvolved. • The reviewer is asked to indicate whetherstaffing issues contributed to the practicebreakdown. • How the health care teams works togeth-er and the culture of the organization maycontribute to practice breakdown. The sec-tion provides an opportunity to identifywhether factors relating to how the staffinteracts contributed to the practice break-down or did not.

Section Six — Nurse Profile • This section of TERCAP tracks demo-graphic information about the nurseinvolved in the practice breakdown, includ-ing birth date, gender, nursing education,licensure and practice history. • This information provides a context forthe nurse's role at the time of the reportedpractice breakdown. • The reviewer indicates from which typeof nursing education program the nursegraduated and whether the subject nursereported any continued competence orprofessional development activities. • The reviewer is asked to identify the cur-rent licensure status, if English was thenurse's primary language, and if the nurseis an Advanced Practice Registered Nurse,what category of APRN. • The practice history of the nurse looks atthe amount of nursing experience, andhow long on the shift on the day the prac-tice breakdown occurred. • The practice history also tracks thelength of time in the primary role of thenurse at the time of the practice break-down, and whether the nurse was workingin some type of temporary capacity. • Additional information regarding the

nurse's workday – assignment, number ofpatients and staff the nurse was responsi-ble for, and how many days the nurse hadworked – are tracked to see if fatigue was afactor in the practice breakdown. • The reviewer is to ask the nurse and theemployer, separately, their perception offactors that contributed to the practicebreakdown. • The reviewer is asked to note whetherthe nurse had a history of disciplineaction, either with an employer or theboard of nursing, or a history of criminalconvictions. • The last question in this sectionaddresses the employment outcome. (TheBoard of Nursing Outcome is one of thelast questions in the instrument.)

Section Seven — Intentional Misconduct /Criminal Behaviors • This section addresses behaviors thatfall outside of nursing practice and involvedeliberate, illegal and / or unethical activi-ties. • Deliberate actions include changed orfalsified charting, or other actions to"cover-up" errors. • If "yes" is checked for this section, thereviewer is instructed to check the type ofintentional behaviors or misconductinvolved in the reported case. • Regardless of whether the practicebreakdown involved intentional or criminalactivity, the rest of the TERCAP instrumentis to be completed.

SECTIONS EIGHT THROUGH TEN —PRACTICE BREAKDOWN CATEGORIES • These important sections of TERCAPinstrument track various aspects of prac-tice breakdown. • Reviewers will analyze the events of thecase and identify the causes of the prac-tice breakdown. See below for the summa-ry of each section

Section Eight — Practice Breakdown: SafeMedication Administration • Because of the frequency of medicationerrors, this is a separate category. Thereviewer will complete this section if amedication error is part of the practicebreakdown. If a medication error did notoccur, the instrument will automaticallybring the reviewer to the next series ofquestions. • The exact name of the drug ordered,including dose, route, frequency, time, orother specifics should be included. • The exact name of the drug given (or"None"), including dose, route, frequency,time, or other specifics should be included.

• The type of medication error should bechosen. The reviewer should select allcontributing factors.

Section Nine — Practice Breakdown:Documentation

• Documentation is often a factor in prac-tice breakdown, whether associated with amedication error, a stand-alone error, orassociated with other types of practicebreakdown. It is also a separate category.The reviewer will complete this section ifdocumentation is part of the practicebreakdown.

• The reviewer chooses the type of docu-mentation error.

Section Ten — Practice Breakdown: OtherCategories

• There are six additional categories thatare included in an umbrella classificationof "Other Categories."

o Attentiveness / Surveillance o Clinical Reasoning o Prevention o Intervention o Interpretation of AuthorizedProvider's Orders o Professional Responsibility / PatientAdvocacy

• Each could be the underlying cause of amedication and / or documentation error.These errors may also stand-alone or com-bine with other categories.

Under the "other categories" classification,the reviewer is asked to go through the sixother categories and check all elementsthat apply to the practice breakdown.

The next TERCAP screen presents a sum-mary of the categories selected in ques-tions 54 through 59. The reviewer is thenasked to rank these categories. Though, allaspects of practice breakdown are interre-lated, the goal of TERCAP is to isolate theprecipitating cause. The reviewer choosesthe one primary category of error that isthe most relevant and direct cause of thepractice breakdown that occurred in thiscase. The reviewer then chooses a second-ary category of practice breakdown. This isoften the most difficult aspect of usingTERCAP, being asked to focus on one pri-mary and one secondary category of prac-tice breakdown. The reason for theseselections is to identify the root cause ofthe practice breakdown. The last practicerelated question addresses the Board ofNursing Outcome. The reviewer is to iden-tify what, if any, disciplinary action theboard took against the nurse's license.


Data Collection

Instrument© 10-9-07

TERCAP Case ID Number _________________________________________

1. Full Name of Reviewer ____________________________________________

2. State Board of Nursing ______________________ 3. Date of incident ____________________ or Unknown

4. Patient age _______ or Unknown

5. Patient gender Female Male or Unknown

6. Were the patient's family and/or friends present at the time of the practice breakdown? Yes No Unknown

7. Indicate whether the patient exhibited any of the following at the time of the practice breakdown Check all that apply.Agitation /Combativeness Altered level of consciousness Cognitive impairment

Communication /Language difficulty Depression / Anxiety Inadequate coping /stress management

Incontinence Insomnia Pain Management Sensory deficits (hearing, vision, touch)

8. Indicate the patient's diagnosis Check no more than two diagnoses, those that contributed to the reported situation. Alzheimer's disease and other dementias (confusion) Arthritis Asthma Back problems Cancer

Congestive heart failure Depression and anxiety disorders Diabetes Emphysema Fractures

Gall bladder disease Gastrointestinal disorders HIV / AIDS Hypertension Infections

Ischemic heart disease (CAD, MI) Nervous system disorders Pneumonia Pregnancy

Renal / urinary system disorders Skin disorders Stomach ulcers Stroke (CVA)

Unknown Other – please specify ______________________________

9. What happened to the patient? Check all that apply or your own variant. Patient fell Patient departed without authorization

Patient received wrong medication Patient received wrong treatment Patient received wrong therapy

Patient acquired nosocomial (hospital acquired) infection Patient suffered hemolytic transfusion reaction

Patient suffered severe allergic reaction / anaphylaxis Patient was abducted

Patient was assaulted Patient suicide Patient homicide

Unknown / not applicable (If you select this option, do not select any other choices.)

Other – please specify ______________________________

10. Patient harm Select only one No harm – An error occurred but with no harm to the patient

Harm – An error occurred which caused a minor negative change in the patient's condition.

Significant harm – Significant harm involves serious physical or psychological injury. Serious injury specifically includes

loss of function or limb.

Patient death – An error occurred that may have contributed to or resulted in patient death.

11. Type of community Select only oneRural (lowly populated, farm, ranch land communities 10,000 or less)

Suburban (towns, communities of 10,000 to 50,000) Urban (any city over 50,000) Unknown

12. Type of facility or environment Select only oneAmbulatory Care Assisted Living Behavioral Health Critical Access Hospital

Home Care Hospitals Long Term Care Office-based Surgery

Physician / Provider Office or Clinic Unknown Other – please specify _________________

Used with permission NCSBN (c2007) . This form is available on the AzBN website at www.azbn.gov under TERCAP (TM)


13. Facility size Select only one 5 or fewer beds 6-24 beds 25-49 beds 50-99 beds 100-199 beds

200-299 beds 300-399 beds 400-499 beds 500 or more beds Unknown / Not applicable

14. Medical record system Select only one Electronic documentation Electronic physician orders Electronic medication administration system

Combination paper / electronic record Paper documentation Unknown

15. Communication factors Check all that apply or your own variant Communication systems equipment failure Interdepartmental communication breakdown / conflict

Shift change (patient hand-offs) Patient transfer (hand-offs)

No adequate channels for resolving disagreements Preprinted orders inappropriately used (other than medications)

Medical record not accessible Patient name similar / same

Patient identification failure Computer system failure

Lack of or inadequate orientation / training Lack of ongoing education / training

None / Unknown / Not applicable (If you select this option, do not select any other choices.) Other – please specify _______________________________

16. Leadership / management factors Check all that apply or your own variant Poor supervision / support by others Unclear scope and limits of authority / responsibility

Inadequate / outdated policies / procedures Assignment or placement of inexperienced personnel

Nurse shortage, sustained, at institution level

Inadequate patient classification (acuity) system to support appropriate staff assignments

None / Unknown / Not applicable (If you select this option, do not select any other choices.)

Other – please specify _______________________________

17. Backup and support factors Check all that apply or your own variant Ineffective system for provider coverage Lack of adequate provider response

Lack of nursing expertise system for support Forced choice in critical circumstances

Lack of adequate response by lab / x-ray / pharmacy or other department



18. Environmental factors Check all that apply or your own variant Poor lighting Increased noise level Frequent interruptions / distractions

Lack of adequate supplies / equipment Equipment failure Physical hazards

Multiple emergency situations Similar / misleading labels (other than medications)

Code situation



19. Health team members involved in the practice breakdown Check all that apply or your own variant Supervisory nurse / personnel Physician (may be attending, resident or other)

Other prescribing provider Pharmacist

Staff nurse Floating / temporary staff

Other Health professional (e.g., PT, OT, RR) Health profession student

Medication assistant

Unlicensed Assistive Personnel (nurse aide, certified nursing assistant, CNA or other titles of non-nurses

who assist in performing nursing tasks)

Other support staff Patient Patient's Family / friends

Unknown / Not applicable (If you select this option, do not select any other choices.) Other – please specify ______________________________

20. Staffing issues contributed to the practice breakdown Check all that apply or your own variant Lack of supervisory / management support Lack of experienced nurses Lack of nursing support staff

Lack of clerical support Lack of other health care team support




21. Health care team Check all that apply or your own variant Intradepartmental conflict / non-supportive environment Breakdown of health care team communication

Lack of multidisciplinary care planning Intimidating / threatening behavior

Lack of patient involvement in plan of care

Care impeded by policies or unwritten norms that restrict communication

Majority of staff had not worked together previously Illegible handwriting

Lack of patient education Lack of family / caregiver education



22. Nurse's year of birth _________________ Unknown

23. Nurse gender Female Male Unknown

24. Where nurse received nursing education

Unknown U.S. Non-U.S., please list country _________________________

25. Indicate all degrees the nurse holds and list the year of graduation and year of initial licensure, if applicable Degree(s) Year of Graduation(s) Year of Initial Licensure(s) Unknown

________________ _____________________ _____________________

________________ _____________________ _____________________

________________ _____________________ _____________________

26. Current licensure status Check all license(s) active at the time of the reported practice breakdown LPN/VN RN APRN

27. Is English the nurse's primary language? Yes No Unknown

28. Did the nurse report completion of any continued competence activities or professional development activities in

the last five years? Yes No Unknown

29. Indicate the category of Advanced Practice Registered Nurse (APRN) Not applicable since not an APRN Nurse Practitioner Nurse Anesthetist Nurse Midwife

Clinical Nurse Specialist APRN Category unknown Other – please specify ___________

30. Work start and end times (based on a 24-hour clock) when the practice breakdown occurred Start time________ am pm End time________ am pm Time of incident________ am pm

31. Length of time nurse had worked for the organization where the practice breakdown occurred Less than one month One month to 12 months One to two years

Three to five years More than five years Unknown

32. Length of time nurse had worked in patient care location where the practice breakdown occurred Less than one month One month to 12 months One to two years


33. Length of time nurse had been in the specific nursing role at the time of the practice breakdown Less than one month One month to 12 months One to two years


34. Type of shift 8 hour 10 hour 12 hour On call Unknown Other – please specify _____________

35. Days worked in a row at the time of the practice breakdown (include all positions / employment) First day back after time off Two to three days Four to five days Six or more days Unknown

36. Was the nurse working in a temporary capacity? Yes No Unknown / Not applicable


37. Assignment of the nurse at time of the practice breakdown Direct patient care Team leader Charge nurse Nurse manager / supervisor

Combination patient care / leadership role Unknown

38. How many direct care patients were assigned to the nurse at the time of the practice breakdown?

Number of patients _________ Unknown

39. How many staff members was the nurse responsible for supervising at the time of the

practice breakdown?

Number of staff ___________ Unknown

40. How many patients was the nurse responsible for overall (counting direct care patients and the patients of the staff

the nurse was supervising at the time of the practice breakdown)?

Number of patients __________ Unknown

41. Nurse's reported perception of factors that contributed to the practice breakdown Check all that apply or your own variant Nurse's language barriers Nurse's cognitive impairment

Nurse's high work volume / stress Nurse's fatigue / lack of sleep

Nurse's drug / alcohol impairment / substance abuse Nurse's functional ability deficit

Nurse's inexperience (with clinical event, procedure, treatment or patient condition)

No rest breaks / meal breaks Nurse's lack of orientation / training

Nurse's overwhelming assignment(s) Nurse's lack of team support

Nurse's mental health issues Nurse's conflict with team members

Nurse's personal pain management Lack of adequate staff

Unknown / Not applicable (If you select this option, do not select any other choices.) Other – please specify ____________________________

42. Supervisor or employer's perception of factors that contributed to the practice breakdown Check all or your own variant Nurse's language barriers Nurse's cognitive impairment

Nurse's high work volume / stress Nurse's fatigue / lack of sleep

Nurse's drug / alcohol impairment / substance abuse Nurse's functional ability deficit

Nurse's inexperience (with clinical event, procedure, treatment or patient condition)

No rest breaks / meal breaks Nurse's lack of orientation / training

Nurse's overwhelming assignment(s) Nurse's lack of team support

Nurse's mental health issues Nurse's conflict with team members

Nurse's personal pain management Lack of adequate staff

Unknown / Not applicable (If you select this option, do not select any other choices.) Other – please specify ____________________________

43. Previous discipline history by current or previous employer(s) for practice issues Yes No Unknown

44. Terminated or resigned in lieu of termination from previous employment Yes No Unknown

45. Previous discipline by a board of nursing Yes No Unknown

Please provide the previous Case Identifier(s), if available, or any other information describing the type of practice

breakdown that resulted in previous discipline. Our goal is to be able to analyze cases in which a nurse had repeat / multiple practice breakdown issues.


46. Previous criminal convictions Yes No Unknown

47. Employment outcome Check all that apply or your own variant Employer retained nurse Nurse resigned Nurse resigned in lieu of termination

Employer terminated / dismissed nurse

Unknown / Not applicable (If you select this option, do not select any other choices.) Other – please specify _________________________

48. Did the reported incident involve intentional misconduct or criminal behavior? Check all that apply or your own variant

No

Yes: Changed or falsified charting Yes: Deliberately covering up error

Yes: Theft (including drug diversion) Yes: Fraud (including misrepresentation)

Yes: Patient abuse (verbal, physical, emotional or sexual) Yes: Criminal conviction

Yes: Other – please specify __________________________

49. Did the practice breakdown involve a medication error? Yes No If No, skip to question 53

50. Name of drug involved in the practice breakdown (Include complete medication order) Drug ordered ________________________ Drug actually given __________________________ Unknown

51. The type of medication error identifies the form or mode of the error, or how the error was manifested Drug prepared incorrectly Extra dose Improper dose / quantity Mislabeling Omission

Prescribing Unauthorized drug Wrong administration technique Wrong dosage form

Wrong drug Wrong patient Wrong route Wrong time

Wrong reason Abbreviations

Unknown / Not applicable (If you select this option, do not select any other choices.) Other – please specify ______________________________

52. Select contributing factors related to the medication error Check all that apply or your own variant Blanket orders Performance deficit Brand names look alike

Brand names sound alike Brand / generic drugs look alike Calculation error

Communication Computer entry Computerized prescriber order entry

Computer software Contra-indicated, drug allergy Contra-indicated, drug / drug

Contra-indicated in disease Contra-indicated in pregnancy / breastfeeding

Decimal point Dilutant wrong Dispensing device involved

Documentation inaccurate / lacking Dosage form confusion Drug devices

Drug distribution system Drug shortage Equipment design confusing / inadequate

Equipment (not pumps) failure / malfunction Fax / scanner involved Generic names look alike

Generic names sound alike Handwriting illegible / unclear Incorrect medication activation

Information management system Knowledge deficit Label – Manufacturer design

Label – Your facility's design Leading / missing zero Measuring device inaccurate / inappropriate

Monitoring inadequate / inappropriate Non-formulary drug Non-metric units used

Packaging / container design Patient identification failure Performance (human) deficit

Prefix / suffix misinterpreted Preprinted medication order form Procedure / protocol not followed

Pump: failure / malfunction Pump: improper use Reconciliation – Admission

Reconciliation – Discharge Reconciliation material confusing / inaccurate

Repackaging by your facility Repackaging by other facility Similar packaging / labeling

Similar products Storage proximity System safeguard(s) inadequate

Trailing / terminal zero Transcription inaccurate / omitted Verbal order

Written order Workflow disruption

Unknown / Not applicable (If you select this option, do not select any other choices.) Medication available as floor stock Other – please specify _____________________________

53. Did the practice breakdown involve a documentation error? Check all that apply or your own variant Yes No

If Yes, the practice breakdown documentation error involved: Pre-charting / untimely charting Incomplete or lack of charting

Charting incorrect information Charting on wrong patient record



TERCAP™ ROOT CAUSE ANALYSIS of the PRACTICE BREAKDOWN54. If attentiveness / surveillance was a factor in the practice breakdown Check all that apply or your own variant Patient not observed for an unsafe period of time Staff performance not observed for an unsafe period of time


55. If clinical reasoning was a factor in the practice breakdown Check all that apply or your own variant Clinical implications of patient signs, symptoms and/or responses to interventions not recognized

Clinical implications of patient signs, symptoms and/or interventions misinterpreted

Following orders, routine (rote system) without considering specific patient condition

Poor judgment in delegation and the supervision of other staff members

Inappropriate acceptance of assignment or accepting a delegated action beyond the nurse's knowledge and skills

Lack of knowledge Other – please specify _______________________________

56. If prevention was a factor in the practice breakdown Check all that apply or your own variant Preventive measure for patient well-being not taken

Breach of infection precautions

Did not conduct safety checks prior to use of equipment

Other – please specify ____________________________

57. If intervention was a factor in the practice breakdown Check all that apply or your own variant Did not intervene for patient Did not provide timely intervention Did not provide skillful intervention

Intervened on wrong patient Other – please specify ______________________________

58. If interpretation of authorized provider's orders was a factor in the practice breakdown Check all or your own variant Did not follow standard protocol / order Missed authorized provider's order

Unauthorized intervention (not ordered by an authorized provider)

Misinterpreted telephone or verbal order Misinterpreted authorized provider handwriting

Undetected authorized provider error resulting in execution of an inappropriate order


59. If professional responsibility / patient advocacy was a factor in the practice breakdown Check all or your own variant Nurse fails to advocate for patient safety and clinical stability

Nurse did not recognize limits of own knowledge and experience

Nurse does not refer patient to additional services as needed

Specific patient requests or concerns unattended

Lack of respect for patient / family concerns and dignity

Patient abandonment Boundary crossings / violations Breach of confidentiality

Nurse attributes responsibility to others Other – please specify ______________________________

Select which practice breakdown categories you selected above is most significant (Primary)

Attentiveness/surveillance

Clinical reasoning

Prevention

Intervention

Interpretation of provider's orders

Professional responsibility / patient advocacy

Select which of the practice breakdown categories you selected above is the second most significant (Secondary) Attentiveness/surveillance

Clinical reasoning

Prevention

Intervention

Interpretation of provider's orders

Professional responsibility / patient advocacy

60. Board of Nursing Outcomes Dismissed, no action

Referral to another oversight agency

Recommendations to the health care agency involved in the practice breakdown

Non-disciplinary action (e.g., letter of concern)

Alternative Program – The nurse was given the opportunity to participate in a non-discipline program to address

practice and / or impairment concerns

Board of nursing disciplinary action

Did the Instrument allow you to capture the essential elements of the practice breakdown? Yes No If No, explain:

_______________________________________________________________________________________________________ Provide any additional comments and feedback regarding the TERCAP Instrument:

______________________________________________________________________________________________

_______________________________________________________________________


Nonpayment ofChild SupportImplementation Arizona RevisedStatute 25-518 (D) (E)

Legislation was effective September20, 2007, requiring individuals who are atleast six months in arrears in making childsupport payments, periodic payments on asupport arrearage or periodic paymentspursuant to a court order of support, thetitle IV-D agency (Department ofEconomic Security/Division of ChildSupport Enforcement) may issue a noticeto the obligor that the obligor’s profes-sional or occupational license may besuspended or revoked.

If the obligor does not respond to thenotice or exhausts all remedies availablethrough the Department of EconomicSecurity/Division of Child SupportEnforcement and is still found to have will-fully not paid the child support, an adminis-trative order of non compliance will besent to the Arizona State Board of Nursingto order the suspension or revocation ofthe professional or occupational license.The function of the Board of Nursing isministerial. The Board will therefore com-ply with the directions given by theDepartment of Economic Security, Divisionof Child Support Enforcement.

Individuals who have a license suspendedor revoked will be required to submit astatement as to their current employment.The Board staff will notify the employer ofthe date of the suspension or revocation.In order for the suspension or revocationto be lifted and the license reinstated, theindividual must make arrangements withDepartment of Economic Security/Divisionof Child Support Enforcement and submitdocumentation to the Board regardingclearance of the non compliance. Thecurrent licensure status of the licensee maybe determined by accessing the Web sitewww.azbn.gov and verifying the status oflicensure.


The diversion of legitimate pre-scription drugs for personal abuseand for distribution to the illegiti-

mate street drug market remains a seri-ous problem in the state of Arizona, asit is across the country. Prescriptiondrug diversion occurs in a variety ofplaces, such as hospitals, pharmacies,and pharmaceutical wholesalers andmanufacturers. Diversion occurs at thecommunity pharmacy level throughrobberies or break-ins, employee theft,drug seeking patients or individualsattempting to obtain drugs illegally.Diversion also occurs through inappro-priate prescriptions written by compe-tent, well-meaning practitioners whoare duped by drug seeking individuals

or by impaired practitioners who areinappropriately prescribing for them-selves or others. However, document-ing the scope and breadth of theseproblems, and the ability to addressthem are limited in the absence of aneffective statewide monitoring program.

Of further concern to the state is thedata that has been generated by thePartnership for Drug Free America.Their 2005 Partnership AttitudeTracking Study (PATS) of teens ingrades 7 through 12 shows that teenshave a false perception of safety regard-ing prescription drugs, specifically 40percent believe the prescription drugsare “much safer to use than illegaldrugs,” 31 percent believe there is

“nothing wrong”with using pre-scription medicineswithout a prescription“once in a while,” and29 percent believe pre-scription pain relievers arenot addictive. The studyshows that among teens ingrades 7 through 12, the non-medicaluse of prescription drugs ranks secondonly to marijuana. It appears thatthese same attitudes are held by adultsas well. For example, non-medical useof prescription drugs among youngadults increased from 5.4 percent in2002 to 6.4 percent in 2006, due largelyto an increase in the non-medical use

CONTROLLED SUBSTANCE MONITORINGHOUSE BILL 2136- ENACTED 2007

By Dean Wright, RPh, Director Prescription Monitoring ProgramArizona State Board of Pharmacy


of pain relievers.Arizona has a population of just

over six million living in eight coun-ties served by approximately 1,200pharmacies and 5,200 pharmacists.The state has approximately 12,000physicians, 4,200 dentists, 3,000 nursepractitioners, 1,500 physician assis-tants, and 1800 veterinarians author-ized by their scope of practice in thestate to prescribe controlled sub-stances.

Arizona's Forty-eighth Legislaturepassed H.B. 2136 establishing aControlled Substances PrescriptionMonitoring Program (CSPMP). Thebill requires the Board of Pharmacy toestablish a controlled substances pre-scription monitoring program andrequires a medical practitioner whodispenses a controlled substance list-ed in Schedule II, III, or IV to a patientto report certain information to theBoard of Pharmacy on a weekly basis.The new statutes, Title 36, Chapter 28are available on the Board's Web site

under the "rules and statutes" link.Go to: www.azpharmacy.gov.

The CSPMP shall include a com-puterized central database trackingsystem to track the prescribing, dis-pensing, and consumption ofSchedule II, III, and IV controlled sub-stances that are dispensed by a med-ical practitioner or by a pharmacy thatholds a valid license or permit issued

pursuant to Title 32.The Board of Pharmacy may proac-

tively release data collected by theCSPMP to a medical practitioner reg-istered with the Board to assist inproviding individual pharmaceuticalcare to a patient or to evaluate apatient. The CSPMP is not intendedto interfere with the legitimate treat-ment of patients; however, the pro-gram will provide information totreating medical practitioners if theirpatients are receiving prescriptionsfrom other sources or if the prescrip-tions are being modified or forged.This information will facilitate andencourage the identification, interven-tion and treatment of individuals whobecome addicted to controlled sub-stances.

Once the system is operating, med-ical practitioners will receive instruc-tions on how to access the database.The program will allow a medicalpractitioner to access their patient'scontrolled substance prescriptioninformation to help treat an existingpatient or evaluate whether to treat apotential patient.

Any questions may be directed toDean Wright, PMP Director, at (602)771-2744 or [email protected],or Valerie Smith, RN, MSN, FRE,Associate Director, Arizona StateBoard of Nursing.

The bill requires the Board of Pharmacy toestablish a controlled substances

prescription monitoring program andrequires a medical practitioner who

dispenses a controlled substance listed inSchedule II, III, or IV to a patient to report

certain information to the Board ofPharmacy on a weekly basis.


New Law Requires Citizenship, Alien Status, Legal Residency orLawful Presence Documentation for Licensure/Certification

Judy Bontrager, RN, MN, Associate Director of Operations & Licensing

What are the citizenship requirementsfor licensure/certification?On January 2, 2008, ARS 1-504 (HB2467)was implemented by the Board requiringALL applicants to provide the Boardwith satisfactory documentationdemonstrating the applicants’ citizen-ship, alien status, legal residency or law-ful presence in the United States.

ALL Applicants Include:• RN/LPN/CNAs that are renewingtheir license/certification• RN/LPN/CNA applicants for licen-sure by Exam• RN/LPN/CNA applicants for licen-sure by Endorsement• Advance Practice Nurse(NP/CNS/CNM/CRNAs) applicants forAdvance Practice certifica-tion/Prescribing and DispensingAuthority or Prescribing Authorityonly.

• School Nurse applicants for initialcertification and renewal

Satisfactory Documentation IncludesTwo Parts:

• Responding to a question on theapplication regarding citizenship orother status demonstrating lawfulpresence in the United States.• Providing the Board with a copy ofacceptable documentation in demon-strating your citizenship, alien status,legal residency or lawful presence inthe United States.

Two lists have been provided, List A andList B, specifying which documents areacceptable. (These lists are found onpage 26 ) Do you know where your doc-uments are located? If not, begin thereplacement process now to have avail-able when you apply.

Will these requirements cause a delayin processing my application?:RN/LPNs renewing online will see anincrease in time from when you renewonline until you receive a license. Thisincreased delay is due to the fact thatthe Board will need to send you a defi-ciency notice notifying you that we havenot received documentation of citizen-ship/alien status/legal residency or law-ful presence in the United States. Whenyou mail in or scan your documentationto the board, it will need to be given tothe appropriate licensing tech for pro-cessing and scanning to merge with youronline renewal data. Approximately 75percent of the 13,000 renewals arereceived between May 1 and July 1 eachyear. Those who renew in the last fourweeks will experience a longer cycle timeto process the application than thosewho renew earlier in March or April.


Reducing Licensing/CertificationTurnaround Times:

• If your licenses lists “due for renew-al on 6/30/08”, You may renew NOW.Board policy allows applicants torenew six months prior to theirrenewal date. Your license will berenewed until 6/30/2012.• Mail in or scan and e-mail your citi-zen/lawful presence documentationwith the Board cover sheet the sameday you renew online. A cover sheetwill be attached to the e-mail con-firming you have renewed onlinewithin one to two minutes after youcomplete the process.• Encourage your colleagues to alsorenew early and avoid the last minutefrustrations that may lead to a delayin obtaining a current license andperhaps lost work time or wages.

What if I am a CNA and the renewalapplication for my certification is notonline?

Certified Nursing Assistant onlinerenewals will be available in the springof 2008. At that time, the process will bethe same as the RN/LPN onlinerenewals.

Until the online renewal service is avail-able, CNAs may go towww.azbn.gov/applications.aspx andprint out the paper application to com-plete.

CNAs may also renew up to six monthsbefore the expiration date shown on thecertificate.

Temporary extensions will not be grant-ed. Documentation must be submitted.

What will happen if I just walk in andask for my license/certificate to berenewed then?

Applicant “Walk Ins” at the Board Officehave experienced increased delays dueto confusion about correct documentsneeded to process the license/certificate.

If you hand-carry a paper application tothe Board, you will experience longerwait times for service. Since the law has

gone into effect, the average number ofwalk in customers has increased approx-imately 65 percent.

Please use the AzBN Web page atwww.azbn.gov and complete your renew-al online.If applying for licensure byexam or endorsement, go to the Webpage and print out the application, readthe instructions carefully, and submitrequired citizenship/lawful presence inthe United States documentation withyour application.

Applications are processed in the orderthey are received whether they are handcarried or mailed.

Find Answers on Web site & PreventPhone Waiting/Frustration

There may also be an increase in thetime it takes for Board Staff to respondto phone calls. Before the implementa-tion of the law, the Board received anaverage of approximately 220 calls perday. The Board is currently experiencingan average of 260 calls per day.

It is the Board’s goal to have informationavailable to you 24/7, and we are contin-uously updating information about thisnew requirement for licens-ing/certification.

To determine/verify the status of yourlicense, go to www.azbn.gov, access veri-fication and click on “TRY IT NOW, ITSFREE.” If it states “pending-citizenshipdocumentation” under license status,you will know that your paperwork hasnot yet been processed and your licensehas not been issued or renewed. Assoon as your license/certificate isprocessed/renewed, you will no longersee that status and a new expirationdate will be shown.

Board staff makes every effort to returnevery call received. If you place a calland get a recording, please remember toinclude the phone number that you maybe reached to return your call. We askthat you do not leave multiple messageson multiple extensions to prevent morethan one staff calling you back regardingthe same question.

Similar citizenship/lawful presence lawshave already been introduced in otherstates. National Conference of StateLegislatures reported there were 83 billsintroduced in 28 states that wouldrestrict the granting of licenses to citi-zens and legal immigrants only.

Education Sessions about requireddocumentation are planned for interest-ed employers, recruiters, and the public.Please consult www.azbn.gov for moreinformation. The one hour EducationalSessions will be held in the BoardConference Room on:

• March 17th at 10:00 a.m.• March 17th at 1:00 p.m.• March 18th at 1:00 p.m.

To ensure adequate space is available,please e-mail your RSVP to Cris Oates [email protected]. There is no charge forthese sessions.

Your patience and assistance is appreci-ated as we implement this new law.

ALL applicants are required toprovide the Board with

satisfactory documentationdemonstrating the applicants’citizenship, alien status, legalresidency or lawful presence

in the United States.

ARIZONA STATEMENTOF CITIZENSHIP &ALIEN STATUSAll applicants must answer questions on theapplication regarding citizenship. A copy of adocument that shows evidence of your citi-zenship or alien status MUST BE submittedwith your application for licensure or renewal.See List A or List B.

LIST A Evidence showing U.S. citizen or U.S.national status includes the following:a. Primary Evidence:(1) A birth certificate showing birth in one of

the 50 states, the District of Columbia,Puerto Rico (on or after January 13, 1941),Guam, the U.S. Virgin Islands (on or afterJanuary 17, 1917), American Samoa, or theNorthern Mariana Islands (on or afterNovember 4, 1986, Northern MarianaIslands local time) (unless the applicant wasborn to foreign diplomats residing in such ajurisdiction);

(2) United States passport; (3) Report of birth abroad of a U.S. citizen

(FS-240) (issued by the Department of Stateto U.S. citizens);

(4) Certificate of Birth (FS-545) (issued by aforeign service post) or Certification ofReport of Birth (DS-1350), copies of whichare available from the Department of State;

(5) Form N-550 or N-570, Certificate ofNaturalization (issued by the Servicethrough a Federal or State court, or throughadministrative naturalization after December1990 to individuals who are individually nat-uralized; the N-570 is a replacement certifi-cate issued when the N-550 has been lostor mutilated or the individual’s name haschanged);

(6) Form N-561, Certificate of Citizenship; (7) Form I-197, United States Citizen

Identification Card (issued by the Serviceuntil April 7, 1983 to U.S. citizens livingnear the Canadian or Mexican border whoneeded it for frequent border crossings)(formerly Form I-179, last issued inFebruary 1974);

(8) Form I-873 (or prior versions), NorthernMarianas Card (issued by the Service to acollectively naturalized U.S. citizen who wasborn in the Northern Mariana Islandsbefore November 3, 1986);

(9) Statement provided by a U.S. consularofficial certifying that the individual is a U.S.citizen (given to an individual born outsidethe United states who derives citizenship

through a parent but does not have a FS-240, FS-545, or DS-1350); or

(10) Form I-872 (or prior versions), AmericanIndian Card with a classification code “KIC”and a statement on the back identifying thebearer as a U.S. citizen (issued by theService to U.S. citizen members of theTexas Band of Kickapoos living near theU.S./Mexican border).

b. Secondary EvidenceIf the applicant cannot present one of the doc-uments listed in (a) above, the following maybe relied upon to establish U.S. citizenship orU.S. national status; (1) Religious record recorded in one of the 50

states, the District of Columbia, Puerto Rico(on or after January 13, 1941), Guam, theU.S. Virgin Islands (on or after January 17,1917), American Samoa, or the NorthernMariana Islands (on or after November 4,1986, Northern Mariana Islands local time)(unless the applicant was born to foreigndiplomats residing in such a jurisdiction)within three 3 months after birth showingthat the birth occurred in such jurisdictionand the date of birth or the individual’s ageat the time the record was made;

(2) Evidence of civil service employment bythe U.S. government before June 1, 1976;

(3) Early school records (preferably from thefirst school) showing the date of admissionto the school, the applicant’s date and U.S.place of birth, and the name(s) and place(s)of birth of the applicant’s parent(s);

(4) Census record showing name, U.S.nationality or a U.S. place of birth, andapplicant’s date of birth or age;

(5) Adoption finalization papers showing theapplicant’s name and place of birth in one ofthe 50 states, the District of Columbia,Puerto Rico (on or after January 13, 1941),Guam, the U.S. Virgin Islands (on or afterJanuary 17, 1917, American Samoa, or theNorthern Mariana Islands (on or afterNovember 4, 1986, Northern MarianIslands local time) (unless the applicant wasborn to foreign diplomats residing in such ajurisdiction), or, when the adoption is notfinalized and the state or other U.S. jurisdic-tion listed above will not release a birthcertificate prior to final adoption, a state-ment from a state or jurisdiction approvedadoption agency showing the applicant’sname and place of birth in one of such juris-dictions, and stating that the source of theinformation is an original birth certificate;

(6) Any other document that establishes aU.S. place of birth or otherwise indicatesU.S. nationality (e.g., a contemporaneoushospital record of birth in that hospital in

one of the 50 states, the District ofColumbia, Puerto Rico (on or after January13, 1941), Guam, the U.S. Virgin Islands(on or after January 17, 1917), AmericanSamoa, or the Northern Mariana Islands(on or after November 4, 1986, NorthernMariana Islands local time) (unless the appli-cant was born to foreign diplomats residingin such a jurisdiction);

c. Collective NaturalizationIf the applicant cannot present one of the doc-uments listed in (a) or (b) above, the followingwill establish U.S. citizenship for collectivelynaturalized individuals: Puerto Rico:

• Evidence of birth in Puerto Rico on orafter April 11, 1899 and the applicant’sstatement that he or she was residing in theU.S., a U.S. possession or Puerto Rico onJanuary 13, 1941; or • Evidence that the applicant was a PuertoRican citizen and the applicant’s statementthat he or she was residing in Puerto Ricoon March 1, 1917 and that he or she didnot take an oath of allegiance to Spain.

U.S. Virgin Islands: • Evidence of birth in the U.S. VirginIslands, and the applicant’s statement of res-idence in the U.S., a U.S. possession or theU.S. Virgin Islands on February 25, 1927; • The applicant’s statement indicating resi-dent in the U.S. Virgin Islands as a Danishcitizen on January 17, 1917 and residencein the U.S., a U.S. possession or the U.S.Virgin Islands on February 25, 1927, andthat he or she did not make a declaration tomaintain Danish citizenship; or • Evidence of birth in the U.S. Virgin Islandsand the applicant’s statement indicating resi-dence in the U.S., a U.S. possession or ter-ritory or the Canal Zone on June 28, 1932.

Northern Mariana Islands (NMI) (formerlypart of the Trust Territory of the PacificIslands (TTPI)):

• Evidence of birth in the NMI, TTPI citi-zenship and residence in the NMI, the U.S.,or a U.S. territory or possession onNovember 3, 1986 (NMI local time) andthe applicant’s statement that he or she didnot owe allegiance to a foreign state onNovember 4, 1986 (NMI local time); • Evidence of TTPI citizenship, continuousresidence in the NMI since beforeNovember 3, 1981 (NMI local time), voterregistration prior to January 1, 1975 and theapplicant’s statement that he or she did notowe allegiance to a foreign state onNovember 4, 1986 (NMI local time); or • Evidence of continuous domicile in theNMI since before January 1, 1974 and the



LIST B Qualified Aliens, Nonimmigrant, and aliensparoled into U.S. for less than one year.a. “Qualified Aliens”

Evidence of “Qualified Alien” status includesthe following:

Alien Lawfully admitted for PermanentResidence - *Form I-551 (Alien Registration ReceiptCard, commonly known as a “green card”); or - Unexpired Temporary I-551 stamp in foreignpassport or on *I Form I-94. Asylee - *Form I-94 annotated with stamp showinggrant of asylum under section 208 of the INA; - *Form I-688B (Employment AuthorizationCard) annotated “274a.12 (a) (5)”;- *Form I-766 (Employment Authorization

Document) annotated “A5”; - Grant letter from the Asylum Office of theU.S. Citizenship and immigration Service; or -Order of an immigration judge granting asylum. Refugee - *Form I-94 annotated with stamp showingadmission under § 207 of the INA;

- *Form I-688B (Employment AuthorizationCard) annotated “274a.12 (a) (3)”; - *Form I-766 (Employment AuthorizationDocument) annotated “A5”; Alien Paroled Into the U.S. for at Least OneYear- *Form I-94 with stamp showing admissionfor at least one year under section 212(d) (5)of the INA. (Applicant cannot aggregateperiods of admission for less than one year tomeet the one-year requirement.Alien Whose Deportation or Removal was

withheld - *Form I-688B (Employment AuthorizationCard) annotated “274a.12 (a) (10)”; - *Form I-766 (Employment AuthorizationDocument) annotated “A10”; or - Order from an immigration judge showingdeportation withheld under §243(h) of theINA as in effect prior to April 1, 1997, orremoval withheld under §241 (b) (3) of theINA. Alien Granted Conditional Entry- *Form I-94 with stamp showing admissionunder §203 (a) (7) of the INA; - *Form I-688B (Employment AuthorizationCard) annotated “274a.12 (a) (3)”; or

- *Form I-766 (Employment AuthorizationDocument) annotated “A3”. Cuban/Haitian Entrant- *Form I-551 (Alien Registration Receipt

Card, commonly known as a “green Card”)with the code CU6, CU7, or CH6. - Unexpired temporary I-551 stamp in foreignpassport or on *Form I-94 with the CodeCU6 or CU7; or - *Form I-94 with stamp showing parole as“Cuba/Haitian Entrant” under Section 212 (d)(5) of the INA. Alien who has been Declared a Battered Alienor Alien Subjected to Extreme Cruelty - U.S. Citizenship and Immigration Servicepetition and supporting documentation b. NonimmigrantEvidence of “Nonimmigrant” status includesthe following: - *Form I-94 with stamp showing authorizedadmission as nonimmigrant c. Alien Paroled into U.S. for less than Oneyear- *Form I-94 with stamp showing admissionfor less than one year under section 212 (d)(5) of the INA

applicant’s statement that he or she did notowe allegiance to a foreign state onNovember 4 1986 (NMI local time). Note:If a person entered the NMI as a nonimmi-grant and lived in the NMI since January 1,1974, this does not constitute continuousdomicile and the individual is not a U.S. citi-zen

d. Derivative CitizenshipIf the applicant cannot present one of the doc-uments listed in a or b above, the followingmay be used to make determination of deriva-tive U.S. citizenship: Applicant born abroad to two U.S. citizenparents: Evidence of the U.S. citizenship ofthe parents and the relationship of the appli-cant to the parents, and evidence that at leastone parent resided in the U.S. or an outlyingpassion prior to the applicant’s birth. Applicant born abroad to a U.S. citizen par-ent and a U.S. non-citizen national parent:Evidence that one parent is a U.S. citizen andthat the other is a U.S. non-citizen national,evidence of the relationship of the applicant tothe U.S. citizen parent, and evidence that theU.S. citizen parent resided in the U.S., a U.S.possession, American Samoa or Swain’s Islandfor a period of at least one year prior to theapplicant’s birth. Applicant born out of wedlock abroad to aU.S. citizen mother: Evidence of the U.S. citi-zenship of the mother, evidence of the rela-

tionship to the applicant and, for births on orbefore December 24, 1952, evidence that themother resided in the U.S. prior to the appli-cant’s birth or, for births after December 24,1952, evidence that the mother had resided,prior to the child’s birth, in the U.S. or a U.S.possession for a period of one year. Applicant born in the Canal Zone or theRepublic of Panama:

• A birth certificate showing birth in theCanal Zone on or after February 26, 1904and before October 1, 1979 and evidencethat one parent was a U.S. citizen at thetime of the applicant’s birth; or • A birth certificate showing birth in theRepublic of Panama on or after February26, 1904 and before October 1, 1979 andevidence that at least one parent was a U.S.citizen and employed by the U.S. govern-ment or the Panama Railroad Company orits successor in title.

In all other situations in which an applicantclaims to have a U.S. citizen parent and analien parent, or claims to fall within one of theabove categories, but is unable to present thelisted documentation:

• If the applicant is in the U.S., the applicantshould contact the local U.S. Citizenshipand Immigration Service office for determi-nation of U.S. citizenship; • If the applicant is outside the U.S., theapplicant should contact the State

Department for a U.S. citizenship determi-nation.

e. Adoption of Foreign-Born Child by U.S.Citizen

• If the birth certificate shows a foreignplace of birth and the applicant cannot bedetermined to be a naturalized citizenunder any of the above criteria, obtainother evidence of U.S. citizenship; • Because foreign-born adopted childrendo not automatically acquire U.S. citizenshipby virtue of adoption by U.S. citizens, theapplicant should contact the local U.S.Citizenship and Immigration Service officefor a determination of U.S. citizenship, if theapplicant provides no evidence of U.S. citi-zenship.

f. U.S. Citizenship By MarriageA woman acquired U.S. citizenship throughmarriage to a U.S. citizen before September22, 1922. Provide evidence of U.S. citizen-ship of the husband, and evidence showingthe marriage occurred before September 22,1922. Note: If the husband was an alien at thetime of the marriage, and became naturalizedbefore September 22, 1922, the wife alsoacquired naturalized citizenship. If the mar-riage terminated, the wife maintained her U.S.citizenship if she was residing in the U.S. atthat time and continued to reside in the U.S.


The Taxonomy of Error Root CauseAnalysis and Practice-Responsibility (TER-CAP) project undertaken by the NationalCouncil of State Boards of Nursing identi-fies eight categories of practice breakdown

related to nursing behaviors. Nursing pro-grams and students can apply these cate-gories to curriculum content, clinical per-formance evaluation measures, and reme-diation of potentially unsafe nursing prac-

tices. The categories and how they can beapplied to nursing education are listedbelow:

1. Safe medication administration: The nurse is the final safety feature of

a complex system of medication adminis-tration in health care facilities. Nursingstudents need to know the pharmacology,usual dosages, expected response of thepatient and the nursing care associatedwith every medication their patient isreceiving. The nursing student may makean error if he/she relies on the nurse toprovide knowledge of pharmacology or toverify orders. All orders should be veri-fied by both checking the original orderand seeking information from a reliablepharmacology reference regarding usualdose, route, delivery method, and nursingcare. Anecdotally, it has been reportedthat students make errors when relyingon staff nurses to verify the correct med-ication/dosage. Clinical instructors needto hold students strictly accountable forthis knowledge prior to administration ofany medication.

2. Documentation: One weakness identified by employers

of new graduates is the failure to applylegal principles in documenting anaccount of care. Failure to document canlead to inappropriate administration ofmedication or faulty treatment.Incomplete documentation does not pro-tect the nurse in the face of an adverseevent. The patient record is the commu-nication tool used between and amonghealth care providers. Nursing instruc-tors can assist students by criticallyexamining all student documentationbefore entry into the record. Students areaccountable for applying the principleslearned in the classroom to their care ofclients. Instructors can also role modelby applying the principles of documenta-tion to educational records related toindividual students and program evalua-

Education CornerPAMELA RANDOLPH RN, MSASSOCIATE DIRECTOR/EDUCATION AND EVIDENCE BASED REGULATION

APPLYING PRACTICEBREAKDOWNTERCAP CATEGORIES TO EDUCATION


tion. A frequently cited deficiency innursing programs is failure to record theresults of the systematic evaluationplan..

3. Attentiveness/Surveillance:The nurse must continually monitor

the patient in order to detect changes instatus. Lack of attentiveness con-tributes to patient mortality and mor-bidity as the patient deteriorates beforethe nurse notices a change in condition.Attentiveness requires that the nurselook for the unexpected response andconsider all possibilities in evaluating apatient’s response. Nursing studentsare expected to constantly monitor theirpatient’s condition. Nursing instructorsmust be attentive to student learningneeds. The attentive instructor roundsfrequently on students, anticipates theirlearning needs, looks for “teachablemoments” and gauges learning in theclassroom through frequent solicitationof student feedback.

4. Clinical Reasoning: This is also sometimes referred to as

critical thinking. It is the ability to “putthe pieces together” and form a hypoth-esis to explain patient observations. Italso requires that the nurse verify thehypothesis and act upon an assessmentof the situation. An observation ofnewly licensed nurses is that they gatherassessment data while the patient israpidly deteriorating. The new nurse orstudent may continue to take and docu-ment vital signs in the face of continu-ing hypotension without assigning ameaning to the data or taking action torescue the patient. Nursing studentsneed to be accountable for both theroutine care of the patient and themeaning of any observations made.Instructors can assist by role-modelingtheir own reasoning processes.

5. Prevention: Prevention includes instituting inter-

ventions that ensure patient safety andprevent further illness or mishaps to thepatient. Patient falls, skin breakdown,nosocomial infections, and wrong-sitesurgery have all been attributed to lackof prevention on the part of health carepersonnel. One of the most effective

and least practiced preventive measuresis hand washing. Students should beheld strictly accountable for this simpleact, yet many students seem to believethat once they have “checked out” onthis skill, it is no longer needed. Handwashing is a habit, not a skill.Instructors can assist their students byrole-modeling hand washing every timethey enter and leave a patient room.

6. Intervention: Errors in practice are also made by

faulty interventions. For example, anurse gave bolus of remainingchemotherapy medication when an IVpump failed. While this may not resultin patient harm for most drugs, it can belethal for toxic drugs. Nursing practicesneed to be based on evidence, not ritu-al, convenience, or “usual practice.”Students need to be well grounded inevidence based practice. Instructors canassist students to think of “the worstcase scenario” before engaging in aquestionable practice and apply evi-dence based methodologies to nursingpractices.

7. Interpretation of Provider Orders: Nurses may either implement a faulty

order or misinterpret a provider order.The chances for misinterpretation arelowered when the orders are typed andclearly follow best-practice guidelines.Disturbingly, some nurses will knowinglyimplement an unsafe order to avoidquestioning a physician. Nurses areaccountable for questioning providerorders that appear contrary to acceptedprocedures/practices. Nursing programscan assist students by providing themwith opportunities to talk with providersand role-play how to talk to a physician.

A rigorous nursing program with solidgrounding in evidence based practiceassists the student in gaining the knowl-edge to determine a deviation in practice.

8. ProfessionalResponsibility/Patient Advocacy:

This category is strongly related tothe concept of caring. A nursing stu-dent is the agent for the patient byvirtue of the knowledge gained in theprogram and the ability of the studentto “do” for the patient what the patientcannot do. Cheating, covering uperrors, failure to call a provider, bound-ary violations, and performing an actcontrary to the best interest of thepatient are all examples of breakdown inthis category. Nursing students areaccountable for adhering to the ethics ofthe nursing profession, including hon-esty, integrity, beneficence, and selfless-ness. Instructors may assist students byclearly stating the expected behaviorsand holding students accountable forbreaches of ethics. Instructors also canrole-model the ethics of the professionin their interactions with students.

The Board encourages nursing pro-grams to incorporate these practicebreakdown categories in curriculum con-tent and clinical evaluation tools.Nursing programs may wish to use theTERCAP tool as a documentationmethod for near misses and errors ofnursing students both in clinical and inclinical simulation. The TERCAP toolcan be found on the Board Web site:www.azbn.gov, or obtained by contactingthe author at [email protected].

Board Actions onEducation MattersNovember 2007

• Approved Yuma site for NorthernAZ University• Approved proposal for a practicalnursing program at RETS Tech Center• Approved proposal for a registerednursing program at RETS Tech Center• Continued approval of the nursingprogram at Eastern Arizona Collegewith a report in six months• Granted provisional approval toBSN program at Chamberlain College


University of Phoenix EstablishesMarch of Dimes Arizona Chapter

Nursing ScholarshipIn an on-going commitment to provide access to nursing education

opportunities and insure the future of quality healthcare in Arizona,the University of Phoenix, in partnership with March of DimesArizona Chapter, is offering one scholarship in either the degree ofLPN to BSN or MSN/Ed. The scholarship is for full tuition and feesfor one degree program.

Applications are available at www.marchofdimes.com/arizona.Complete applications and supporting documentation must be

received on or before March 31, 2008. Applications receivedafter the designated deadline date will not be considered. Foradditional scholarship information, please contact Sandy

LeClaire at [email protected].

Charlotte Saylors, Vice President of Strategic Development ofHealthcare for University of Phoenix, announced the establishment of

the continuing nursing education scholarship at the 4th annual March ofDimes “Arizona Nurses of the Year Awards” presented by Health Net

and the University of Phoenix, held Nov. 17 in Scottsdale.

with a Notice of Deficiency • Approved PN program at SouthWestSkill Center/Estrella MountainCommunity College for an additionalfour years (2011)• Dismissed self-report of rule viola-tion Northland Pioneer College• Dismissed self-report of rule viola-tion Northern AZ University

January 2007

• Received report on CNS portfolioproject outcomes• Approved CNS portfolio applicant forresubmission of competency #2• Extended provisional approval ofCoconino Community College Nursingprogram and issued a Notice ofDeficiency• Dismissed complaint against MetroTech High School CNA program• Approved CNA program at DirectCare Givers/Mountain View HighSchool• Approved recommended changes inCNA manual skills exam


Nurses play a critical role in preventinga multi-drug resistant organism like

Methicillin-resistant Staphylococcusaureus (MRSA). Not only are you responsi-ble for maintaining vigilant hygiene andsanitation protocols, you are also in chargeof coordinating communications and edu-cation for everyone involved with yourpatients’ care. That includes physicians,housekeeping staff members and familymembers.

MRSA FactsMRSA is a type of bacterial staph infec-

tion that is resistant to common antibi-otics. Although MRSA may be treated withother classes of antibiotics, it is more diffi-cult to manage than other types of staphinfections.

MRSA was first identified in the 1960s,when it was found in hospitals and nursinghomes. Within the past several years,there has been an increase in what isreferred to as community-associatedMRSA. While it’s certainly true that MRSAinfections may originate in healthcare set-tings, it’s even more likely that patientsmay be admitted to the hospital either col-onized or infected with MRSA, havingacquired it in the community or during aprevious stay in a healthcare facility.

When it comes to MRSA, there are twoequally important components – infectioncontrol and antibiotic stewardship. Bothare essential to keeping patients safe andto keeping MRSA where it belongs – undercontrol.

Infection ControlThe vast majority of hospitals in Arizona

are using contact precautions for infectionssuch as MRSA. This equates to patientisolation, signage on the door and gownand gloves for all who enter the room.When dealing with patients in isolation,remember this applies only to the physicalnature of caring for the patient, humancontact is paramount.

Hygiene and SanitationAs always, the number one precaution

to prevent the spread of MRSA infection isfrequent hand washing. Make sure to washyour hands before and after patient con-tact, either with soap and warm water orwith an alcohol-based hand sanitizer. Athorough hand washing should last 15 to30 seconds, with friction. If a patient saysthey haven’t seen you wash or sanitize yourhands, simply do it again. It is imperativethat patients feel empowered in their owncare and they know you are working hardto prevent the spread of MRSA and otherinfectious diseases.

Controlling the EnvironmentThe hospital is a high-touch environ-

ment. This makes disinfection a priority.Follow your hospital’s protocol for how andwhen to clean, but don’t assume its some-one else’s job. Remember -- teamwork iskey to preventing the spread of any infec-tion in the healthcare setting.

Environmental services will be in chargeof maintaining a clean patient care setting,but as the manager of your patients’ care,it is your responsibility to evaluate whatneeds to be cleaned and when. It can be achallenge to clean the room daily when apatient is in isolation, but make sure toalert housekeeping whenever there’s anopportunity. As you’re going about thebusiness of patient care, keep those disin-fectant wipes handy. Wipe down anyportable monitoring equipment andstethoscopes and don’t forget the patient’sbed rails, which can harbor a lot of germs.

Antibiotic StewardshipThe root cause of infections such as

MRSA is the use, abuse and overuse ofantibiotic therapy. Nurses play an impor-tant role here, too. You are in a primeposition to educate your patients and theirfamilies. Teach them about the impor-tance of taking antibiotics as directed andgetting them from the proper source. Thenumber one point to drive home is to fin-ish the entire course of antibiotics toensure that even the most resistant strainsof bad bacteria are eliminated.

Nurses are also typically the first toknow when a culture report is back fromthe lab. Why does it seem this alwaysoccurs after the physician has alreadymade rounds? Rather than letting it gountil the next day, take it upon yourself tocontact the physician’s office immediatelyso any necessary adjustments to thepatient’s antibiotic therapy may be maderight away.

Use Your ResourcesAs an infection control specialist, I can’t

pass up the opportunity to encourage youto consider us as a fellow team member.We can serve as consultants to help youunderstand policies and to educate yourpatients and other members of the health-care team about infection prevention,reduction and control.

Make sure to keep up with the latestinformation on any infectious disease,especially MRSA. The Arizona Hospitaland Healthcare Association (AzHHA), inpartnership with Blue Cross Blue Shield ofArizona, is launching a statewide initiativeto educate healthcare workers, patientsand the community at large about MRSA.This effort will be launched in May 2008,and you’ll be seeing more information onAzHHA’s Web site at www.azhha.org and inthe healthcare settings. Please continue toalso use the Centers for Disease Control asa resource. Visit www.cdc.org and do asearch for MRSA. These sources will pro-vide you with the most up-to-date informa-tion so you can serve as a knowledgeableresource for patients and others.

MRSA Prevention: It’s in the Nurse’s HandsPatty Gray, RN, BA, CIC, Scottsdale Healthcare-Infection Control Practitioner, Past PresidentArizona Association for Professionals in Infection Control & Epidemiology, Member, Arizona Hospital& Healthcare Association’s Patient Steering Committee


Approval ofSubstantive PolicyStatement – Allows ExpeditedTherapy Prescribingand Dispensing forNurse Practitioners

A substantive policy statement wasapproved by the Board on January 25,2008, to allow nurse practitioners withP&D authority to prescribe and dis-pense antimicrobials to personsbelieved to be at substantial risk as acontact of a patient they diagnosedwith a communicable disease. Thepolicy statement grants an exceptionto R4-19-511 (D) (5) that requires anexamination of a person before pre-scribing a medication except in cases

of emergency. In future rulemaking,this exception will be incorporatedinto R4-19-511 (D) (5). The text of the

Substantive Policy Statement appears

below:

This Substantive Policy Statement is

advisory only. A Substantive Policy

Statement does not include internal pro-

cedural documents that only affect the

internal procedures of the agency and

does not impose additional requirements

or penalties on the regulated parties or

include confidential information or rules

made in accordance with the Arizona

Administrative Procedures Act. If you

believe that this Substantive Policy

Statement does impose additional

requirements or penalties on regulated

parties, you may petition the agency under

Arizona Revised Statutes Section 41-1033

for a review of the statement. (ARS § 41-

1091)

Notwithstanding A.C.C. R4-19-511(D) (5), a registered nurse practitioner(RNP) with prescribing and dispensingprivileges may prescribe antimicro-bials to a person who is believed to beat substantial risk as a contact of apatient who has been examined anddiagnosed with a communicable dis-ease by the prescribing RNP.

Current language in R4-19-511 (D) (5)

requires an examination of a person

before prescribing a medication except in

cases of emergency. It is consistent withcurrent practice recommendations thatpersons at high risk for exposure tocertain communicable diseases suchas pertussis, meningitis, influenza,sexually transmitted diseases, scabies,plague, and Haemophilu influenzatype b, receive immediate preventativetreatment prior to a clinical diagnosisin order to prevent infection and ongo-

ADVANCED PRACTICE CORNERBY KAREN GRADY, MS, RN, FNP


ing transmission. Between 2004 and2006, there was a 36 percent increase inchlamydia, a 38 percent increase ingonorrhea, and a 240 percent increasein pertussis. This constitutes a publichealth emergency and consideration ofexceptions to the current rule.Expedited therapy can prevent majoroutbreaks of communicable diseases inpopulations and significant health mani-festations in individuals.

The RNP may prescribe for contactsof infected persons even if the contactis not in the population of the RNP’sspecialty area. For example, a pediatricnurse practitioner may prescribe foradult contacts of pertussis or a nursemidwife may prescribe to the male part-ner of an infected patient. However, theinfected patient must be within theRNPs scope of practice population forthe specialty area. All prescriptionsmust be issued in conformance withrecognized standards of care and in rec-ommended dosages.

RN TEST OBSERVERS NEEDED FOR C.N.A. EXAM

D & S Diversified is looking for RNs with one year long term care experi-ence interested in working a part-time, flexible schedule to administer thenurse aide test for the State of Arizona. The need is especially great in theShow Low area. To qualify to be an observer, you must be an RN in goodstanding with the Arizona State Board of Nursing.

Workshops will be held on Monday, March 10th in Mesa, Wednesday,March 12th in Flagstaff, and Thursday, March 13th in Payson. Those inter-ested in attending the workshops, please forward an updated resume toD&S, PO Box 418, Findlay, OH 45840 Attention: Director, or fax to 1-

419-422-8328. For more information, call 1-877-851-2355. Youmust pre-register thru D&S to attend this workshop.


CNA DISCIPLINARY ACTIONOCTOBER-NOVEMBER-DECEMBER 2007 EFFECTIVE DATE NAME CERTIFICATE DISCIPLINE VIOLATION(S)12/31/2007 Abeyta, Paige Z CNA1000004870 Revoked Unable to Practice Safely - Substance Abuse; Failure to Cooperate12/31/2007 Alexander, Veronica R CNA1000002990 Revoked Criminal Conviction; Failure to Cooperate10/12/2007 Allison, Travis M CNA Applicant Certificate Denied Criminal Conviction-Misdemeanor; Drug Related; Failure to Cooperate 12/31/2007 Alvarado, Rebecca A CNA999952736 Revoked Exploiting a Patient for Financial Gain; Breach of Confidentiality; Fraud/Deceit

- License/Credentials12/31/2007 Armstrong, Kecia CNA120471196 Revoked Criminal Conviction; Fraud - Failure to Cooperate12/31/2007 Ault, Wendy H CNA999993610 Revoked Violation/Failure to Comply Board Order; Unable to Practice Safely -

Substance Abuse; Failure to Cooperate12/5/2007 Brooks, Linda M CNA104993803 Stayed Suspension False Reports/Falsifying Records; Failure to Maintain Records11/5/2007 Chisler, Debbie L CNA870493803 Revoked Unable to Practice Safely - Substance Abuse; Patient Abandonment;

Violation/Failure to Comply Board Order12/31/2007 Christian, Benjamin O CNA1000001683 Revoked Fraud - Patient Abuse; Failure to Cooperate10/4/2007 Colinayo, Gilbert M CNA999989742 Civil Penalty Substandard or Inadequate Care; Patient Abuse11/7/2007 Conway, Laura A CNA Applicant Certificate Denied Criminal Conviction; Unable to Practice Safely - Substance Abuse; Failure to

Cooperate11/30/2007 Craig, Jason E CNA Applicant Certificate Denied Criminal Conviction; Unable to Practice Safely - Substance Abuse9/11/2007* Cummings, Lynne CNA825409326 Stayed Revocation Unable to Practice Safely - Substance Abuse1/29/2008 Curley, Janicia E CNA999951935 Revoked Violation/Failure to Comply Board Order12/24/2007 Durschmidt, Kristi L CNA254558457 Revoked Unable to Practice Safely - Violation/Failure to Comply Board Order12/31/2007 Dutcher, Cathy J CNA999995021 Revoked Criminal Conviction; Unable to Practice Safely - Substance Abuse; Failure to

Cooperate11/23/2007 Emswiler, Ryan C CNA Applicant Certificate Denied Criminal Conviction; Unable to Practice Safely - Substance Abuse11/15/2007 Encarnacion, Marianne R CNA1000010314 Revoked Violation/Failure to Comply Board Order12/31/2007 Escobedo, Maria S CNA417884353 Revoked Criminal Conviction; Exploiting a Patient for Financial Gain; Unprofessional

Conduct10/4/2007 Ferrato, Gina CNA1000005345 Stayed Suspension Criminal Conviction-Misdemeanor10/24/2007 Figueroa, Alex CNA Applicant Certificate Denied Criminal Conviction; Unable to Practice Safely - Substance Abuse11/19/2007 Garner, Linda C CNA808704103 Voluntary Surrender Unable to Practice Safely - Substance Abuse10/11/2007 Gutierrez, Emmanuelle M CNA1000001041 Voluntary Surrender Patient Abuse11/5/2007 Haas, Barbara M CNA1000000605 Revoked Patient Abuse; Criminal Conviction; Unable to Practice Safely - Substance

Abuse10/16/2007 Hall, Ossana CNA1000014063 Civil Penalty Criminal Conviction; Fraud/Deceit - Credentials11/30/2007 Hillyard, Jaime L CNA999952937 Stayed Revocation Criminal Conviction; Unable to Practice Safely - Substance Abuse12/31/2007 Hornyak, Jeannette CNA999948114 Revoked Violation/Failure to Comply Board Order; Failure to Cooperate12/3/2007 Hudson, Loni M CNA1000010694 Civil Penalty Patient Abandonment11/30/2007 Hyde, Jacob C CNA Applicant Certificate Denied Criminal Conviction; Unable to Practice Safely - Substance Abuse9/4/2007* Jackson, Deborah L CNA Applicant Certificate Denied Criminal Conviction9/5/2007* Jacobsen, Sharon L CNA Applicant Certificate Denied Criminal Conviction11/21/2007 Johnson, Freda L CNA913293803 Stayed Revocation Substandard or Inadequate Care; Patient Neglect12/31/2007 Jordan, Lisa A CNA806633270 Revoked Patient Abandonment; Violation/Failure to Comply Board Order;

Unprofessional Conduct 1/3/2008 Keller, Jacqueline CNA1000014787 Stayed Revocation Criminal Conviction; Unable to Practice Safely - Substance Abuse 11/12/2007 Kozie, Kylie L CNA1000001759 Civil Penalty Negligence 11/1/2007 Laker, Heather M CNA999994713 Stayed Revocation Criminal Conviction; Fraud/Deceit - Credentials; Violation of Fed/State

Statutes/Rules 12/31/2007 Lesnick, Ronald A CNA1000003878 Revoked Criminal Conviction; Dual Relationship/Boundaries; Unprofessional Conduct 12/31/2007 Luna, Krystal M CNA1000001930 Revoked Misappropriation of Property; Unprofessional Conduct; Failure to Cooperate 1/9/2008 Masch, Stacey A CNA Applicant Certificate Denied Misappropriation of Property; Criminal Conviction 12/31/2007 McDaniel, Richard A CNA1000001248 Revoked Unable to Practice Safely - Substance Abuse; Fraud - Patient Abandonment 11/29/2007 McNeil, Ivson T CNA1000003575 Civil Penalty Patient Neglect 11/16/2007 Mendoza, Bernardo P CNA1000009440 Voluntary Surrender Sexual Misconduct; Dual Relationship/Boundaries 11/5/2007 Mills, Ann N CNA999991935 Revoked Criminal Conviction; Fraud/Deceit - License/Credentials; Failure to Cooperate 10/2/2007 Modesitt, Barbara A CNA Applicant Certificate Denied Criminal Conviction-Against Person; Drug Related; Drug Abuse 10/17/2007 Moreno, Maria D CNA Applicant Certificate Denied Unprofessional Conduct; Failure to Cooperate

*Not reported in previous Newsletter

CNA DisciplineACTION CLEARED OCTOBER - NOVEMBER- DECEMBER 2007

EFFECTIVE DATE NAME LICENSE11/14/2007 Cutter, Marissa R. CNA100000994712/8/2007 Raderstorf, Karlette D. CNA999989680

10/9/2007 Mossman, Stephen B CNA Applicant Certificate Denied Criminal Conviction-Against Person; Failure to Cooperate 11/27/2007 Nez, Megan S CNA1000002042 Stayed Revocation Criminal Conviction 11/9/2007 Patch, Adam L CNA1000013440 Voluntary Surrender Violation/Failure to Comply Board Order 11/15/2007 Pena, Janet L CNA1000007490 Revoked Violation/Failure to Comply Board Order 12/31/2007 Penyak, Rita M CNA1000009452 Revoked Unprofessional Conduct; Failure to Cooperate 9/7/2007* Pina, Angela M CNA1000009219 Voluntary Surrender Unprofessional Conduct; Dual Relationship/Boundaries; Misappropriation of

Property 11/5/2007 Reyna, Angelica B CNA1000005215 Revoked Patient Abandonment; Unprofessional Conduct; Failure to Cooperate 10/22/2007 Rinehart, Bridget A CNA1000014277 Civil Penalty Criminal Conviction 12/31/2007 Rivera, Minnie M CNA489383103 Revoked Breach of Confidentiality; Practicing Beyond Scope; Unprofessional Conduct 10/30/2007 Rufer, Amanda R CNA1000002599 Civil Penalty Unable to Practice Safely - Substance Abuse 12/12/2007 Ryan, Michael W CNA Applicant Certificate Denied Criminal Conviction; Unable to Practice Safely - Substance Abuse; Failure to

Cooperate 12/7/2007 Sanford, Christine K CNA1000014647 Civil Penalty Fraud/Deceit - Credentials; Sexual Misconduct 12/31/2007 Santonocito, Lena CNA060253466 Revoked Criminal Conviction; Misappropriation of Property; Fraud 10/18/2007 Shah, Prince Rajin R CNA1000013587 Revoked Violation/Failure to Comply Board Order 12/3/2007 Singer, Paula J CNA1000014591 Civil Penalty Criminal Conviction; Patient Abandonment 11/12/2007 Solano, Toni S CNA1000014413 Stayed Revocation Criminal Conviction; Fraud/Deceit - Credentials; Failure to Cooperate 11/14/2007 Sova, Paul J CNA105208627 Stayed Revocation/ Unable to Practice Safely - Substance Abuse; Criminal Conviction

Stayed Suspension12/11/2007 Spangler, Pamela J CNA1000000543 Voluntary Surrender Negligence; False Reports/Falsifying Records; Unprofessional Conduct12/31/2007 Taylor, Kristy CNA182250641 Revoked Violation/Failure to Comply Board Order; Failure to Cooperate12/31/2007 Thompson, Rose H CNA852142803 Revoked Exploiting a Patient for Financial Gain; Unprofessional Conduct; Failure to

Cooperate10/22/2007 Tsosie, Bernita CNA801278353 Civil Penalty Fraud/Deceit - Credentials 11/30/2007 Twigg, Mary A CNA Applicant Certificate Denied Unable to Practice Safely - Substance Abuse12/4/2007 Van Ausdall, Patricia A CNA1000005689 Voluntary Surrender Violation/Failure to Comply Board Order10/11/2007 Vigueria, Rafael F CNA040141441 Voluntary Surrender Substandard or Inadequate Care; Incompetence9/27/2007* Wade, Maria C CNA999995091 Civil Penalty Fraud/Deceit - Credentials12/11/2007 Wade, Patti Ann CNA Applicant Certificate Denied Criminal Conviction; Unable to Practice Safely - Substance Abuse; Failure to

Cooperate 9/28/2007* Weaver, Michelle P CNA999987999 Revoked Unable to Practice Safely - Substance Abuse; Criminal Conviction; Fraud


CNA DISCIPLINARY ACTION CONTINUED *Not reported in previous Newsletter

EFFECTIVE DATE NAME CERTIFICATE DISCIPLINE VIOLATION(S)OCTOBER-NOVEMBER-DECEMBER 2007



EFFECTIVE DATE NAME LICENSE DISCIPLINE VIOLATION(S)11/14/2007 Acheson, Nancy M. LP024034 Probation Unprofessional Conduct9/28/2007* Adkison, Vandaline K. LP024545 Decree of Censure False Reports/Falsifying Records12/28/2007 Alexander, Catherine A. RN115414/LP035913 Decree of Censure Substance Abuse9/27/2007* Applin, Cecilia M. LP032345 Voluntary Surrender Unable to Practice Safely, Improper Delegation/Supervision9/30/2007 Arce, Mary N. RN057132/LP018713 Decree of Censure Patient Abuse8/30/2007* Ashfield, Heather A. RN096123 Probation with Limited Unable to Practice Safely

Licensure12/12/2007 Auler, Therese A. RN Endorsement License Denied Criminal Conviction, Fraud/Deceit - License/Credentials, Unable

to Practice – Substance Abuse12/28/2007 Baars, Terry L. LP039936 Revocation Violation/Failure to Comply Board Order, Failure to Cooperate

with Board10/31/2007 Barden, Robert C. RN113515 Decree of Censure Substance Abuse-Positive Drug Screen12/14/2007 Barton, Marvin RN124273 Stayed Revocation with Unable to Practice - Substance Abuse, Diversion of

Suspension Controlled Substance11/23/2007 Bergin, Bernadette M. RN090633/LP029045 Suspension/Indefinite Unable to Practice Safely, Substandard or Inadequate Care, Error

CNA201201189 in Administering Medication10/26/2007 Blanton, Suzanne D. RN053114/LP017009 Probation Monitored Use of Controlled Substances11/26/2007 Blumberg, LP018736 Voluntary Surrender Violation/Failure to Comply Board Order

Jacqueline M.10/18/2007 Braun, Betty L. LP036287 Decree of Censure Insurance Fraud (Medicare, Medicaid or Other Insurance)12/18/2007 Britt, Veretta L. RN112061 Voluntary Surrender Unable to Practice - Substance Abuse, Diversion of Controlled

Substance10/5/2007 Brooks, Katherine L. RN149036/LP043838 Probation with Civil Penalty Practicing Without Valid License, Narcotics Violation or Other

Violation of Drug Statutes11/2/2007 Brough, Patricia L. RN133259 Revocation Violation/Failure to Comply Board Order, Unable to Practice -

Substance Abuse, Failure to Cooperate with Board11/13/2007 Brown, Monica L. LP023682 Reinstatement: Stayed Unable to Practice - Substance Abuse

Revocation with Probation11/18/2007 Bustamante, Monica G. RN144525 Decree of Censure False Reports/Falsifying Records11/29/2007 Buzonik, Cindy L. RN080261 Decree of Censure Criminal Conviction12/19/2007 Cady, Troy K. RN122058 Stayed Revocation with Unable to Practice - Substance Abuse; Diversion of Controlled

Suspension Substance9/25/2007* Caldwell, Wanda Jo LP037689/ Voluntary Surrender Violation/Failure to Comply Board Order

CNA99998846011/1/2007 Canez, Amber A. E. RN138589/LP039721 Probation with Civil Penalty Practicing Beyond Scope, Submitting False Claims, Substandard

or Inadequate Care11/18/2007 Chanda, Shivcharan S. RN056567 Decree of Censure Substandard or Inadequate Care11/9/2007 Chanel, Chari LP Endorsement License Denied Practicing Without Valid License10/10/2007 Chavez, Anthony E. RN079637 Decree of Censure False Reports/Falsifying Records10/2/2007 Cockrell, Lisa V. RN129828 Decree of Censure Breach of Confidentiality11/23/2007 Cooper, Grant W. RN094171 Probation Practicing Beyond Scope, Unable to Practice Safely, 11/23/2007 Cooper, Grant W. AP851 Suspension Unauthorized Prescribing Medicine11/20/2007 Crandall, Lynette S. RN Endorsement License Denied Criminal Conviction, Unable to Practice - Substance Abuse,

Failure to Cooperate with Board11/5/2007 Davies, James C. LP039894 Probation Unprofessional Conduct, False Reports/Falsifying Records, Error

in Administering Medication8/28/2007* Dean, Jennifer A. RN127746 Probation Unable to Practice - Substance Abuse12/4/2007 Dignoti, John S. LP031508 Decree of Censure Unprofessional Conduct10/11/2007 Dooher, Denise E. RN149040/LP041612 Probation Dual Relationship/Boundaries11/14/2007 Drommond, Louise A. RN066851/LP021966 Suspension/Indefinite Unprofessional Conduct, Unable to Practice Safely11/15/2007 Dubois, Janet M. RN149094/AP02907 Civil Penalty Practicing Without Valid License12/9/2007 Durfield, Amber D. LP040482/ Probation Criminal Conviction

CNA9999974379/17/2007* Eischen, Tricia M. RN148615 Probation Criminal Conviction7/25/2007* Fairman, Penny L. RN038753 Voluntary Surrender Violation/Failure to Comply Board Order10/2/2007 Farnell, Elizabeth RN082173 Voluntary Surrender Violation/Failure to Comply Board Order, Improper

Delegation/Supervision, Unauthorized Dispensing of Medication

RN/LPN DISCIPLINARY ACTIONOCTOBER-NOVEMBER-DECEMBER 2007


EFFECTIVE DATE NAME LICENSE DISCIPLINE VIOLATION(S)


11/2/2007 Fike, Richard L. RN083836 Revocation False Reports/Falsifying Records, Failure to Maintain Records, Narcotics Violation or Other Violation of Drug Statutes

11/26/2007 Finefrock, Erica L. RN149703 Probation Disciplinary Action Taken by Any Licensing Authority12/10/2007 Galvan, Lois M. LP008627 Decree of Censure Substandard or Inadequate Care, Error in Administering

Medication12/28/2007 Gamel, Cassandra C. LP037309 Decree of Censure Practicing Beyond Scope11/2/2007 Garland, Pamela L. RN091820 Probation Unable to Practice - Substance Abuse8/23/2007* Gehl, Amy L. LP043428/ Stayed Suspension Diversion of Controlled Substance

CNA999987170 with Probation8/31/2007 Gibbons, Deborah P. RN062340/LP018215 Stayed Revocation Violation/Failure to Comply Board Order

with Probation12/28/2007 Gibbs, Laurie R. RN097546 Revocation False Reports/Falsifying Records, Unable to Practice Safely,

Failure to Maintain Records8/31/2007* Gregory, Julie L. RN133671/LP039776 Probation Failure to Maintain Records, Error in Administering Medication11/15/2007 Hadley, Jane F. RN115267/AP142 Civil Penalty Unauthorized Prescribing Medicine10/30/2007 Hairston, Andre J. RN149441 Civil Penalty Sexual Misconduct, Failure to Cooperate with Board8/24/2007* Hanks, Millicent L. RN118958 Suspension Violation/Failure to Comply Board Order9/28/2007* Harlan, Sherry A. RN102537 Stayed Revocation Unable to Practice - Substance Abuse,

with Suspension Narcotics Violation or Other Violation of Drug Statutes9/28/2007* Hart, Brenda M. RN117921 Voluntary Surrender Violation/Failure to Comply Board Order12/28/2007 Headrick, Doreen D. RN085428 Revocation Unprofessional Conduct, Unable to Practice Safely11/5/2007 Hill, Denise M. RN103152/AP1688 Probation Narcotics Violation or Other Violation of Drug Statutes11/30/2007 Hogen, Julie L. RN144582/AP2629 Civil Penalty Practicing Without Valid License, Unauthorized Prescribing

Medicine, Unauthorized Dispensing of Medication9/25/2007* Hogner, Lucinda L. RN032080 Voluntary Surrender Violation/Failure to Comply Board Order10/21/2007 Hopkins, Pamela S. RN062555 Decree of Censure with Practicing Without Valid License

Civil Penalty10/9/2007 Horn, Mary K. RN091454 Decree of Censure Substandard or Inadequate Care11/2/2007 Howell, Brenda L. RN064798 Revocation Unable to Practice - Psych/Mental, Failure to Cooperate with

Board9/12/2007* Hoy, Ann RN079222 Probation Unable to Practice - Substance Abuse10/11/2007 Ingram, Richard K. RN056745 Decree of Censure Failure to Maintain Records, Error in Administering Medication11/1/2007 Jackson, Elmer R. LP041306/ Probation Criminal Conviction, Unable to Practice -

CNA999950413 Substance Abuse10/20/2007 Jackson, Mary Ann RN125048 Decree of Censure with False Reports/Falsifying Records

Civil Penalty10/31/2007 Janis, Karen L. RN112545 Stayed Suspension Unable to Practice - Substance Abuse

with Probation11/20/2007 Johnson, Cheron K. RN128587 Suspension Unable to Practice - Substance Abuse, Incompetence, Diversion

of Controlled Substance11/23/2007 Johnson, Rebecca W. RN057760 Suspension Unprofessional Conduct, Substandard or Inadequate Care,

Negligence11/15/2007 Kelso, Theresa RN095337/AP2247 Civil Penalty Practicing Without Valid License, Unauthorized Prescribing

Medicine, Unauthorized Dispensing of Medication11/1/2007 Kirkwood, Lisa N. RN Endorsement License Denied Unable to Practice - Substance Abuse, Narcotics Violation or

Other Violation of Drug Statutes, Failure to Cooperate with Board9/27/2007* Kolly, Joseph A. RN051780 License Renewal Denied Sexual Misconduct, Failure to Cooperate with Board11/16/2007 Kontos, Jerome K. LP Endorsement, License Denied Not eligible to practice under any Compact State

Compact- LP, WI license, Disciplinary Action Taken by any Licensing Authority10/10/2007 Kramer Jr., Mike RN094894 Probation Unable to Practice - Substance Abuse, Failure to Maintain

Records11/19/2007 Light, Kelly A. RN114070/LP033966 Suspension/Indefinite Violation of Fed/State Statutes/Rules, Criminal Conviction, Failure

to Cooperate with Board9/6/2007* Lowe, Teresa B. LP006247 Probation Unable to Practice - Substance Abuse12/13/2007 Luxem, Dana P. RN135853 Suspension/Indefinite Fraud – Unable to Practice - Substance Abuse9/19/2007* MacMillan, Jessie P. RN148498 Probation Disciplinary Act Taken by any Licensing Authority12/16/2007 McCann, Karen D. RN118940 Probation Unable to Practice – Substance Abuse



EFFECTIVE DATE NAME LICENSE DISCIPLINE VIOLATION(S)10/2/2007 McClure, Cathleen K. RN Endorsement License Denied Criminal Conviction, Unable to Practice - Substance Abuse,

Failure to Cooperate with Board10/25/2007 McDonald-Selm, RN060673/ Probation Criminal Conviction

Carolyn W. LP01644811/30/2007 Menegay, Karen P. RN046037 Decree of Censure Substandard or Inadequate Care9/11/2007* Miller, Edith L. RN122146 Decree of Censure Substandard or Inadequate Care9/25/2007* Mohn, Judy A. LP028793 Voluntary Surrender Violation/Failure to Comply Board Order12/5/2007 Morales, Gilbert A. RN088538 Stayed Suspension Unable to Practice - Substance Abuse, Diversion of

with Probation Controlled Substance9/20/2007* Mountford, Lisa RN095120 Civil Penalty Practicing Without Valid License10/1/2007 Munoz, Edina Y. RN126056 Decree of Censure Breach of Confidentiality12/9/2007 Nelson, Crystal D. LP036472 Decree of Censure Practicing Beyond Scope, Failure to Maintain Records,

Unauthorized Administration of Medication11/14/2007 Niesen, Margaret A. RN086330 Probation False Reports/Falsifying Records11/12/2007 Nolan-Pendry, Linda P. RN096300 Decree of Censure Practicing Beyond Scope11/28/2007 Nyman, Shawn E. RN137730 Stayed Revocation Unable to Practice - Substance Abuse,

with Suspension Diversion of Controlled Substance12/10/2007 Paulowski, Jennifer M. RN077278 Decree of Censure Substance Abuse11/8/2007 Pettet, Donna L. RN112437 Probation Unable to Practice - Substance Abuse11/2/2007 Phillips, Tammy F. LP023895 Revocation Violation/Failure to Comply Board Order12/31/2007 Richardson, Tiffany J. RN114213/LP028341 Probation Violation of Fed/State Statutes/Rules; Criminal Conviction11/2/2007 Scott, Michael L. RN119781 Revocation Misrepresentation of Credentials, Unable to Practice - Substance

Abuse, Failure to Cooperate with Board11/9/2007 Shelton, Lameatria J. RN125095 Decree of Censure False Reports/Falsifying Records10/11/2007 Siglow, Janet B. LP017790 Voluntary Surrender Unable to Practice - Substance Abuse9/22/2007* Simmons, Irene P. LP036220 Decree of Censure Substandard or Inadequate Care, Error in Administering

Medication9/20/2007* Sims, Lisa F. RN092768/AP0856 Civil Penalty Practicing Without Valid License



EFFECTIVE DATE NAME LICENSE DISCIPLINE VIOLATION(S)


10/22/2007 Sipperley, Elsa C. RN087205/LP028366 Probation Unable to Practice - Substance Abuse, Failure to Maintain Records, Unauthorized Administration of Medication

11/15/2007 Smith, Vicki S. RN149010 Civil Penalty Practicing Without Valid License11/13/2007 Strickland, Bethany A. LP041149 Decree of Censure Narcotics Violation or Other Violation of Drug Statutes11/13/2007 Sullenger, Vivian C. LP005407 Decree of Censure Failure to Maintain Records8/13/2007* Sumpter Sage, Teresa A. LP012552 Decree of Censure Unauthorized Administration of Medication11/15/2007 Taylor-Piliae, Ruth E. RN149648 Civil Penalty Practicing Without Valid License12/24/2007 Tendoeschate, Julene T. RN131366 Stayed Suspension Unable to Practice – Substance Abuse

with Probation6/21/2007* Thomas, Rex W. RN089503 Probation Criminal Conviction, Substandard or Inadequate Care11/13/2007 Waggoner, Darlene M. RN098326 Decree of Censure Unprofessional Conduct9/26/2007* Wall, Jason E. LP040360 Suspension/Indefinite Immediate Threat to Health or Safety, Narcotics Violation or

Other Violation of Drug Statutes10/10/2007 Wayland, Karen S. RN105983/LP028758 Stayed Revocation Unable to Practice - Substance Abuse

with Suspension10/16/2007 Webster, Susan C. LP037228 Voluntary Surrender Unable to Practice Safely - Substance Abuse; Psych/Mental10/29/2007 Welty, Gwen J. RN108286 Stayed Revocation Unable to Practice - Substance Abuse,

with Suspension Diversion of Controlled Substance11/30/2007 Welty, Gwen J. RN108286 Revocation Violation/Failure to Comply Board Order11/5/2007 West, Karen A. RN064021/LP014768 Decree of Censure Unprofessional Conduct12/26/2007 Wohldmann, Wayne L. RN Endorsement License Denied Criminal Conviction, Unable to Practice - Substance Abuse10/18/2007 Yardley, Laurie K. RN102532 Voluntary Surrender Criminal Conviction, Unable to Practice - Substance Abuse,

Diversion of Controlled Substance


RN-LPN Discipline ACTIONCLEARED OCTOBER-NOVEMBER-DECEMBER 2007

EFFECTIVE DATE NAME LICENSE

12/26/2007 Blondell, Marissa J. RN127834/LP038560

11/19/2007 Bryant-Deconcini, Sara W. RN053547

10/6/2007 Burr, James J. RN142146

11/6/2007 James, Lori R. LP020565

11/3/2007 Lindsay, Kathy Sue RN042314

10/14/2007 Martino, Frank P. RN057440/LP018910

9/27/2007* Minnis, Linda K. RN124893

9/30/2007* Morris, Regina R. RN069228/LP021647

10/13/2007 Payne, Deborah A. RN113821/LP035496

10/3/2007 Perkins, Cameo M. RN142051

10/19/2007 Pickering, Margarita S. RN094281

12/28/2007 Rich, Angela RN142981

9/27/2007* Sjoberg, Thomas W. RN146134/LP042554

11/15/2007 Wayner, Christy RN058904

9/22/2007* Woods, Sandra RN083582

11/16/2007 Zawadzki, Walter RN054811/LP013179


RUNDOWN

Nurse Practice Act ChangesEvery five years, the Board considers

what changes may need to be made to

the statutes governing the Board of

Nursing. The Board is currently review-

ing the Nurse Practice Act (NPA) to

determine what changes are needed to

best position the Board to respond to

future health care needs. The Board has

decided to continue to work on a com-

prehensive overhaul of the NPA for the

2009 legislature. A draft of proposed

changes will be posted for public com-

ment and information following accept-

ance by the Board.

Due to the potential merger of the

Nursing Board with the Respiratory Care

Board, some NPA changes in Board

composition will be considered this year.

Specifically, if adopted by the legislature,

the Board will add three respiratory ther-

apist members. Another position for a

CNA or CNA educator is also being pro-

posed. This will bring the total number

of Board members from 9 to 13. In addi-

tion, the Board will be seeking authority

to conduct pilot studies.

Articles 1 and 4A preliminary draft is currently posted

on the Board Web site for general public

review and comment. A docket opening

has been filed with the Secretary of

State. The draft rules have been submit-

ted to the Governor’s Regulatory Review

Council (GRRC) for a courtesy review.

Changes will be made based on GRRC

feedback to improve clarity, understand-

ing, and consistency with existing

statutes and rules. Comments on the

preliminary draft are welcome.

The person to contact at the Board regardingregulation is:

Pamela RandolphAssociate Director Education andEvidence-based Regulation602-889-5209E-mail: [email protected]: 602-889-5155

Regulation by Pamela Randolph RN, MS ASSOCIATE DIRECTOR/EDUCATION AND EVIDENCE BASED REGULATION

arizona state board of nursing 1st...4 arizona state board of nursing regulatory journal changes...

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