NEW YORK NURSE: October 2011
by Barbara Zittel, RN, PhD, former Executive Secretary
New York State Education Department statistics reveal there were 270,959 individuals licensed and registered to practice professional nursing as of Jan. 1, 2011. That statistic reflects a slightly downward trend (1,157 fewer licenses than in 2010) in the total number of individuals licensed to practice as registered professional nurses (RNs) in New York. The department issued 13,572 new RN licenses in 2010. This represents 571 fewer licenses issued than in 2009 and it is the second year that we have witnessed this negative trend.
New York state has slightly more than 16,031 Nurse Practitioners (NPs) practicing in more than 16 specialties. Almost 750 new master’s prepared nurse practitioners were added to New York’s licensure data banks in 2010.
As of Jan. 1, 2010, there were 71,136 licensed practical nurses (LPNs) in the state, an increase of more than 1,200 from the previous year. During 2010, 4,479 new LPN licenses were issued, which represents almost 500 more than in 2009.
State Board for Nursing members are kept extremely busy with the highest caseload of disciplinary and moral character charges among the 47 professions licensed by the State Education Department. In 2010, 1,630 cases were opened against RNs, 116 against NPs, and 797 against LPNs, which represents almost 300 more cases than in the previous year.
“Negligence/incompetence” remains the most frequent category of charge against nurses no matter what their title. As in 2009, “conviction of a crime” remained as the second most frequent category of charge for RNs and LPNs.
In 2010, the Nursing Board office handled more than 23,971 telephone calls, an increase of 6,000 over the previous year and 5,135 e-mail messages. After questions about licensure, the majority of inquiries relate to scope of practice. Critical issues identified and dealt with by the board include the following:
Many schools have reported to us that students and faculty are barred from clinical practice during accreditation site visits. Not only does this policy have a negative impact on the number of student clinical hours, but students also do not have the opportunity to participate in this “teachable moment” and thus will be less prepared when experiencing such an event when they do become employed. Additionally, by excluding student nurses, facilities are not providing a true picture of routine daily activities to the accreditation team.
A second major concern voiced by nursing programs is the inability of students and in some cases faculty to access the electronic health record (EHR). This results in students not having access to crucial patient information and prevents them from documenting their patient care. Additionally, students are unable to ‘sign off’ on the electronic medication record for medications given. Not only does this situation negatively impact on student learning, it also compromises the accuracy of documentation of patient care. We are collaborating with the Council of Associate Degree Nursing in New York State as well as the New York Organization of Nurse Executives on this issue.
Social networking has taken on new a meaning in the 21st century with such new phrases as tweeting, Facebook, and texting. What once was whispered between two persons is now broadcast for many to read – and with that arise issues of violations of professional confidentiality, slander, and other code of ethics insults. Counsel to the State Education Department has opined that for students in nursing programs, posted statements that may cause harm or injury to another or to the agency shall be grounds for dismissal.
This rule, which relates to the administration of medication, was instituted in February 2011, by the Centers for Medicare and Medicaid Services, in spite of advice to the contrary from all levels of nursing leaders including two letters from the Board for Nursing. The rule requires an ordered medication to be administered within 30 minutes before or after the noted time. The unrealistic policy is likely to result in unhealthy “work arounds” by nurses, difficulty in implementation with students, who traditionally take a longer time than seasoned RNs to administer medications, and difficulty with implementation with resistant toddlers, the mentally ill patient, the geriatric patient, etc. The American Nurses Association is attempting to abolish or alter the rule. In the meantime, board members were cautioned to be particularly watchful for disciplinary charges around this issue. Board members have the right to deny a disciplinary complaint that is exclusively related to an unrealistic time limit when that is the only charge.
It has been brought to the attention of the board that for some years emergency medical technicians and paramedics have utilized the services of RNs in emergency departments to document the wasting of narcotics partially used in the field. RNs are cautioned about complying with this policy if there is any question about the substance being wasted. Facilities should contact the State Bureau of Narcotic Control to determine a policy that will assure that narcotic reconciliation is actually taking place.
The State Board received several questions from the field about whether RNs can refill an implanted medication pump in intrathecal pain management. A complicating factor in this procedure is the existence of two ports, one which leads to a reservoir and the other which, if accessed could inadvertently deliver a bolus amount of medication to the patient with potential lethal results. It was determined that this function is within the scope of practice of RNs with competency training. The completed guideline is posted on the board’s website.
Questions continue to arise regarding appropriate utilization of medical assistants and other unlicensed persons in clinical settings and private medical offices. We were able to write a joint memorandum between the New York State Department of Health and the State Education Department’s Board for Nursing that states that emergence from anesthesia/sedation requires extreme vigilance and constant, total care provided by physicians and registered nurses. Staffing in recovery areas should minimally include a physician or registered nurse competent in the care of patients recovering from anesthesia/sedation plus at least one other caregiver to provide assistance with delegated tasks and/or seek assistance if required. Access to anesthesia and surgical care should be available at all times.
Responsibilities assigned to medical assistants and other competent unlicensed personnel should be limited to activities not requiring licensure such as vital signs, provision of comfort measures, assistance with moving patients and getting them out of bed upon the direction of the registered nurse or physician.
Patient readiness for discharge must be authorized by a physician or other licensed independent practitioner.
Answers to nursing issues addressed by the board are posted on our nursing website at: www.op.nysed.gov/prof/nurse/ under the category heading “Practice Alerts and Guidelines.”
The New York State Education Department has adopted the National Council of State Boards of Nursing’s NURSYS system. This electronic data record system includes disciplinary and licensure statistics related not only to all New York state RNs and LPNs, but also data from 44 other states. Benefits of entering this system include participation in what may soon be a national body of information on nursing licensure, facilitation of mobility for nurses as they seek licensure in other states, rapid accessibility to disciplinary data, the ability of New York’s healthcare facilities to check New York state nurse registration information in batch format instead of on an individual basis, and a significant decrease in labor intensive responsibilities of the Office of the Professions related to the verification of nurses’ licenses.
In order to fully implement the system, staff is currently in the process of correcting errors in our system including names with hyphens, apostrophes and double surnames. The reward for this labor intensive endeavor is that New York will be receiving a systematically corrected body of names of all licensees since the beginning of the licensure process in New York. It is anticipated that New York’s participation will encourage the few remaining states not yet included in NURSYS to enter the system thus creating a national data base of nurse licensure information.
Information on these issues is available on our website: www.op.nysed.gov/prof/nurse/.
The site features: