NEW YORK NURSE: October/November 2008
by Barbara Zittel, RN, PhD, Executive Secretary
Thank you for this opportunity to provide a brief summary that reflects the efforts of the New York State Education Department (SED) and the State Board for Nursing (SBFN) in the areas of licensure, discipline, and scope of practice determinations during the last year.
As of Jan. 1, 2008, New York State Education Department statistics reveal that there are 256,055 individuals licensed and registered to practice professional nursing. That statistic continues to reflect an upward trend in the total number of individuals licensed to practice as registered professional nurses (RNs) in New York.
The department issued 13,456 new RN licenses in 2007, fewer than in 2006. That decline may reflect normal variations in number sets, it may result from federal mandates that have reduced the number of work visas available to international nurses, or it may be consequent to schools of nursing having reached their maximum capacity for admissions and graduations. Further longitudinal study is required before we can determine the probable cause of this finding.
New York State continues to have slightly more than 13,000 nurse practitioners (NPs) practicing in more than 16 specialties. More than 800 master’s-prepared nurse practitioners were added to New York’s licensure data banks in 2007.
As of January 1, 2008, there were 70,675 licensed practical nurses (LPNs) in the state. The 4,330 new licenses issued in 2007 reflected a slight decrease from the previous year.
Disciplinary and moral character charges require considerable time commitments for SBFN members. As the largest profession of the 47 disciplines regulated by the State Education Department, nursing also has the largest caseload of discipline. In 2007, 1,410 cases were opened against RNs, 116 against NPs, and 780 against LPNs.
Negligence/incompetence is the most frequent category of charge against licensees, no matter what their title. As reported to you for several years, the category of Conviction of a Crime remains the second most frequent category of charge, thus outranking Substance Abuse, which has traditionally been in that second slot. This trend remains especially alarming among LPNs.
Another disquieting trend that needs to be brought to your attention is that of cheating on the national licensure exam, the NCLEX-RN/LPN. When a determination is made of cheating on the exam, the resultant charges are reflected within the department’s disciplinary statistics in the “moral character before licensure” category. The cases in that category have doubled since 2000.
I seek your assistance in addressing this issue. Examinees are required to complete an attestation form before they sit for the exam, affirming that they will maintain strict confidentiality of all test questions. If you work with new graduates, do not tempt them to violate this oath by inquiring about exam items. If you are faculty, resist the temptation to gently interrogate them about the exam. Please remind new graduates who are about to take the exam of the importance of maintaining this confidentiality and that no study materials can be brought into the test center.
In 2007 the SBFN office handled more than 19,000 telephone calls and 5,000 e-mail messages. Each year a significant number of those inquiries relate to scope of practice questions. The answers to the most frequently asked questions are placed on our website.
The SBFN’s position on the administration of propofol needs to be brought to your attention again. Propofol cannot be administered by RNs unless they are Certified Registered Nurse Anesthetists (CRNAs). The one exception occurs in a critical care setting, with a patient-specific medical order, on an intubated, ventilated patient, where RNs who have been deemed competent in the procedure through education and experience may administer this anesthetic agent.
Last year I reported to you about the SBFN’s collaboration with the Department of Health (DOH) Wadsworth Center’s division of Blood and Tissue Resources that resulted in joint policies permitting LPNs to participate in the administration of blood components given certain conditions. That collaboration has continued and this year yielded two documents: Guidelines for Monitoring Transfusion Recipients and Transfusion Reaction Response Guide that provide instructive resources on signs and symptoms related to transfusion reactions and guidance on immediate actions to safeguard patients. Both documents can be found on the State Board for Nursing website.
NYSNA is to be congratulated on passage of legislation that limits mandatory overtime for nurses. There is, however, one provision of the bill which caused concern for the Board for Nursing in that it permits nurses to voluntarily work beyond their normally scheduled hours in a situation that is not a declared emergency.
Research is abundant, from professions and occupations as varied as airplane pilots, medical interns, and truck drivers, that competencies of individuals who work beyond 12 hours can mimic persons with alcohol intoxication. Nursing research also has clearly demonstrated the positive relationship between number of hours worked and patient errors. Based on that evidence, the Board for Nursing has taken the position that voluntarily working beyond 16 hours in a 24-hour time period will be considered as a factor in determining the willful disregard of patient safety and subject to a potential charge of unprofessional conduct.
We have updated the Nursing Guide to Practice, which includes frequently asked scope of practice questions, the full text of statutes, regulations and rules related to nursing, the ANA code of ethics, and ways to contact the Office of the Professions including the SBFN Office and all of the regional Professional Discipline offices.
All of the information in the Nursing Guide to Practice is also available on the Board for Nursing’s website, www.op.nysed.gov/nurse, where information can be reviewed on the latest practice standards, current activities to address the nursing shortage, licensure statistics by county, and much more.