WYOMING STATE BOARD OF NURSING
BOARD MEETING MINUTES
July 9, 10, 1998
PUBLIC SESSION
The Wyoming State Board of Nursing held its regularly scheduled meeting on July 9th & 10th, 8:00 a.m. -5:00 p.m. at the Best Western Motel Conference Room, Pinedale, WY.
CALL TO ORDER 1. CALL TO ORDER
The meeting of the Wyoming State Board of Nursing was called to order at 8:00 a.m. on July 9, 1998 and at 8:30 a.m. on July 10, 1998, by President Janice McCoy.
ROLL CALL 1.1. ROLL CALL
The President took the Roll Call. The following Board Members were present: (July 9 & 10, 1998)
Janice McCoy, RN, President, Lander
Veronica Taylor, RN, Vice President, Gillette
Karla Roich, LPN, Secretary, Rock Springs
Patricia Ellis, LPN, Pinedale
Beth Evans, Consumer Board Member, Cheyenne
Judith Knight, RN, Board Member, Laramie
Michael McCleery, RN, Board Member, Thermopolis
Staff Present: (July 9 & 10, 1998)
Mary Schaper, Interim Executive Director
Susan Blaney, Compliance Consultant
Fran Hawkins, Management Service Officer
John Burbridge, Attorney General's Office
Visitors Present: (July 9, 1998)
Linda Hayward, RN, DON, Sublette County Retirement Center
Sharon Tusing, LPN, Sublette County Retirement Center
Visitors Present: (July 10, 1998)
Leslie Rozier, RN, APN
DECLARATION OF 1.2. DECLARATION OF QUORUM
QUORUM
President McCoy declared a quorum present.
REORDERING OF THE 2. REORDERING OF THE AGENDA
AGENDA
By consensus, the agenda was accepted with flexibility.
BOARD MEETING 3. APPROVAL OF MEETING MINUTES
MINUTES
3.1. MINUTES OF THE April 29-30, 1998 BOARD MEETING
By consensus, the minutes of the April 29-30, 1998 Board Meeting approved as amended.
Beth Evans, Consumer Member, commended staff for an improvement in the preparation of materials mailed to the Board prior to the meeting.
ADMINISTRATIVE 4. ADMINISTRATIVE ISSUES
ISSUES
4.1. ETHICS FILM (Item was acted upon July 10, 1998)
The film explaining the Governor's Executive Order on Ethics was viewed by the entire Board.
4.2. BUDGET (Items were acted upon July 9, 1998)
Karla Roich, Board Member, confirmed with Board staff that one of the larger expenditures since the last meeting was a payout for time accrued by the departing Executive Director.
A question was raised regarding the annual expenditure for a security maintenance system. As the US Bank Building, where the BON offices are housed, has its own security system, the security system that was being leased by the Board office has been returned to the leasing company.
President McCoy asked which budget items were paid from the 1999-2001 budget allocation. Board staff stated that the National Council State Board of Nursing dues and June's postage bill were paid from the 1999 monies.
4.2.1. COMPARISON OF CNA REVENUE AND EXPENSE STATEMENTS
Fran Hawkins, Board staff, reported that it was past practice to account for all monies in the Administrative 100 Series Account. She proposed that monies generated by CNA activities be accounted for in the Nurse Aide 300 Series Account. She forecast that as monies are deposited into the 300 Series Account, by September 1998, expenses related to CNA activities will also be paid from said account. Statistics provided by Ms Hawkins:
Period covered = 7/1/96 - 6/30/98
Revenue:
Examination fees $ 95,000
Certification, Verification,
and Renewal fees 116,000
Health Department 120,000
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Total Revenue Collected $331,000
Expenditures:
Budgeted Spent
Salaries $80,000 $84,000
Support Services 51,000 44,000
Testing 55,000 58,00
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Totals $186,00 $186,000
Salaries included Exam Coordinator and Practice Consultant until the account was depleted and it was necessary to fund these salaries from the main budget.
Expenses for support services were mixed, in that monies were paid for nursing assistant expenses and non-nursing assistant expenses from both the nursing assistant account and the main account.
Testing only includes fees paid to the coordinators, examiners, raters, and actors.
Susan Blaney, Board staff, reported on CNA and DCI fingerprint check statistics. In 1996 and 1997, CNAs accounted for approximately 50% of the disciplinary cases. To date, in 1998, CNAs account for approximately 61% of disciplinary cases.
CNA applicants generating cases were approximately 3% of total CNA applications in 1996 and 2% of total CNA applications in 1997. The Board requested that these statistics be maintained over time and be collected for RNs and LPNs as well.
DCI background checks positive for criminal activity result in approximately 5% of the total background checks done. Cases have been generated from approximately 46% of these positive results, which is approximately 2% of the total DCI background checks done.
4.2.2 COMPARISON OF FINGERPRINTING REVENUE & EXPENSE
STATEMENTS
This agenda item was deferred to the October 1998 Board meeting, before which time research will be conducted as to the use of the National Practitioner Data Bank.
4.2.3. RENEWAL UPDATE
The question was raised as to all and/or any of the statistical questions on the renewal application cards. The conclusion was to research what is required for statistics and what methods other states employ to decrease labor-intensiveness of the duties associated with renewing licenses/certificates. Renewal statistics to date were reported:
Beginning in 1998, there were:
RNs 4950
LPNs 1120
CNAs 4750
As of June 30, 1998:
Renewals Inactive
RN 2313 137
LPN 425 21
CNA 1441
The BON has paid approximately $600 in credit card fees and has collected approximately $750 in charges.
About 2 checks per month are returned for insufficient funds.
4.3. WPAP
President McCoy reported that she has spoken with Dr. Hogarty of the Wyoming Professional Assistance Program, regarding the Board's participation in this program. Mary Schaper stated that she had also discussed the Board's participation with Mr. Bob Kidd of the Wyoming Hospital Association.
Discussion proceeded upon the Board's use of the resources offered by WPAP, how to publicize WPAP's availability to Wyoming nurses, and the approximate cost per nurse to participate in the program.
Ms McCoy stated she would contact Dr. Hogarty and inform him of the Board's continued interest in the WPAP program.
4.4. BON/BOM UPDATE
John Burbridge, Assistant Attorney General reported that the Board of Medicine did not sign the proposed Memorandum of Understanding with the Board of Nursing and gave no indication to their reasoning in writing. Consequently, this Board has no Memorandum of Understanding with the Board of Medicine at this time.
4.5. LETTER FROM BOM RE: PROPOSED REGULATION OF PHYSICIANS COLLABORATING WITH APNS
John Burbridge, Assistant Attorney General, reported that the Board of Medicine voted unanimously to promulgate the rules developed by the Ad Hoc Committee in November, 1997. There will be a public meeting regarding these proposed rules September 9, 1998. Neither the Board office nor the Attorney General's office has a copy of the proposed rules at this time.
Leslie Rozier, RN, APN, reported to the Board that APN's are now being asked to submit their collaborative plans to the Board of Medicine as the collaborating physician(s) renews his/her license. Discussion followed regarding the necessity of the existence of a collaborative plan.
Fran Hawkins, Board staff, called the BOM during this meeting and a copy of the proposed rules were faxed to the Board. These proposed rules were reviewed and it was concluded that these are the same rules previously proposed by the Board of Medicine.
President McCoy requested a shared meeting date be set with the Board of Medicine for October 2, 1998.
John Burbridge, Assistant Attorney General, urged the Board to comment on the BOMs proposed rules during the 45 day public comment period.
4.6. NCSBN ANNUAL MEETING
By consensus, the Board determined that Veronica Taylor and Mary Schaper would be the voting delegates at the National Council State Board of Nursing meeting in Albuquerque, New Mexico, in August 1998. Discussion followed regarding which Board members will attend educational sessions -vs- disciplinary sessions, and travel arrangements.
The Board allowed that, if flight arrangements could be made at a comparable cost to ground travel, the alternative would be discussed by President McCoy and Ms. Schaper for possible approval.
Ms. Schaper stated that the Business Book of Materials is now available on the National Council's web site.
The final copy of the Multi State Licensure Compact has been sent to President McCoy , who requested that all Board members review the Compact before the August NCSBN meeting.
4.7. REPRESENTATIVE FOR MEETING WITH DOC & LICENSING BOARDS
The meeting regarding the reorganization of the Department of Commerce will occur August 3, 1998. Beth Evans, Board Member, and Fran Hawkins, Board staff, will represent the Board. Discussion centered around the available options: independent agency, professional licensing authority, A&I, or the Secretary of State's office. By consensus, the Board stated their preferences: #1 to remain in the Department of Commerce and #2 A&I.
4.8. CITIZENS ADVOCACY CENTER
The Board approved sending Beth Evans, Consumer Member, to the Citizen's Advocacy Center's annual meeting in Austin, TX, November 5-7, 1998.
PRACTICE 5. SCOPE OF PRACTICE
5.1. APN APPLICATION/COLLABORATIVE PLAN
Proposed guidelines for the standardization of the format of the APN collaborative plan were discussed. Discussion centered around the definitions/relationships between consultation, referral, and collaboration. The guidelines were approved with revision.
The Board recognized the need for revision of Chapter IV of the Administrative Rules and Regulations. Judith Knight, Board member, will initiate a review of past proposed changes to Chapter IV and the definitions and APN letters to the Board. Her remarks will be forwarded to President McCoy and Veronica Taylor, for future presentation. The Board also recognized that the October joint meeting with the Board of Medicine may generate proposed changes to Chapter IV.
5.1.1. APN CONFERENCE REPORT
Judith Knight, Board member, reported on the meeting of the American Academy of Advanced Practice Nurses in Phoenix, AZ. She reinforced that many states across the nation are addressing the issue of the relationship between advanced practice nurses and physicians, and attempts by Boards of Medicine to regulate APN practice.
5.2.1. IV SYSTEMS WITH PRE-LOADED CASSETTES
Patricia Ellis, Board member, posed the question: In the case of a terminally ill patient receiving palliative care, may an LPN change a pre-loaded narcotic cassette in an IV system delivering the drug? No tubing is being primed and the LPN has received pharmacy inservicing on the use of the IV unit.
By consensus, the Board stated that, in this patient- specific case, the LPN may replace the cassette as a delegated procedure. The Board counselled that the Delegation Model must be referenced in deciding such cases, as each case is patient - and/or situation - specific.
5.2.2. PERIPHERAL IV LINES
Ms. Ellis posed the question: May an appropriately educated LPN insert subclavicular and/or midline IV lines, as both are considered peripheral lines by definition?
By consensus, the Board declared that an LPN with advanced certification in IV therapy may insert a mid-line catheter as defined by the Intravenous Nurses Association. However, under no circumstances could an LPN insert a subclavicular or midclavicular line.
DISCIPLINARY ISSUES 6. DISCIPLINARY ISSUES
6.1. REVIEW & AFFIRMATION OF DC ACTION (Items were acted upon July 10, 1998)
President McCoy closed the meeting to the public, and directed that the Disciplinary Committee present their findings and recommendations. In addition, the Committee reported that the Office of the Attorney General had concurred in writing with their recommendations. At the completion of the presentation, the Board deliberated on the recommendations. The Board came out of Executive Session and the President declared the meeting open to the public and voted on the following decisions.
6.1.1. DISMISSAL
The Board voted to affirm the Disciplinary Committee's recommendation to dismiss the allegations against:
Mxxxxxx Cxxx, CNA
Mxxxx Ixxxxxxxx, CNA
Lxxx Mxxxx, LPN
Lxxx Nxxxxxxx,RN
The vote on the above decision was 5-0-2. The members
of the Disciplinary Committee were absent from voting in accordance with Board Rules and Regulations.
6.1.2. DISMISS & TAG FILE
The Board voted to affirm the Disciplinary Committee's recommendation to dismiss the complaint and tag the file of:
Txxxxxx Rxxxxxxxxx, CNA
The vote on the above decision was 4-0-3. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations. There was one abstention.
6.1.3. FULL CERTIFICATION WITH ADVISORY LETTER
The Board voted to affirm the Disciplinary Committee's Recommendation to issue full certification with an advisory letter to Bxxxxxxxxx Bxxxxx, CNA applicant.
The vote on the above decision was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.1.4. ADVISORY LETTER
The Board voted to affirm the Disciplinary Committee's Recommendation to dismiss the following cases with an advisory letter:
Sxxxxxx Cxxxx, CNA
Jxxxxxxx Bxxxxx, RN
Pxxxxxxx Mxxxxx, RN
Pxxxxxx Mxxxxxx, CNA
Rxxxxx Sxxxxxxx, CNA
The vote on the above decision was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.1.5. RELICENSE WITH ADVISORY LETTER
The Board voted to affirm the Disciplinary Committee's recommendation to issue a license as a registered professional nurse with an advisory letter to Bxxxxxx Exxxxxx.
The vote on the above decision was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.1.6. AMENDED STIPULATED AGREEMENT
The Board voted to affirm the Disciplinary Committee's recommendation to grant the request of Nancy Flury, RN, to pass schedule II medications.
The Board voted to affirm the Disciplinary Committee's recommendation to deny the request of Larry Chaney, LPN, to discontinue the reporting of his counseling and 12-step meeting attendance (self-reporting).
The vote on the above decisions was 5-0-2. The members of the Disciplinary Committee were absent from voting.
6.1.7. LETTER OF REPRIMAND
The Board voted to affirm the Disciplinary Committee's recommendation to issue a letter of reprimand to:
Cxxxx Bxxxx, LPN
Jxxxxx Sxxxxxxxxx,LPN [Docket # 97-98]
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.1.8. STIPULATED AGREEMENT/IMPAIRED NURSE PROGRAM
The Board voted to affirm the Disciplinary Committee's recommendation to enter into a stipulated agreement/Impaired Nurse Program with:
Cynthia Andre, RN
Becki Dawson, RN
Dxxxx Lxxxx, RN Re-applicant [Docket # 98-31]
Pxxxxxxx Pxxxx, LPN [Docket # 97-91]
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.1.9. NOTICE OF INTENT TO REVOKE
The Board voted to affirm the Disciplinary Committee's recommendation to send a notice of intent to revoke the certificates of:
Roxanne Karsky, CNA
Suzanna Millhouse, CNA
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.1.10. TAG & FILE
The Board voted to affirm the Disciplinary Committee's recommendation to tag the files of:
Mxxxxx Dxxxxx, RN
Dxxxxxx Dxxxxx, CNA
Kxxxxxx Fxxxxxx, RN
Wxxxxx Fxxxxxx, RN
Axxxxxx Gxx, CNA
Jxxxx Hxxxxx, RN
Kxxxxx Kxxxxx, CNA
Mxxxxx Txxxxx, RN
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.1.11. NON-SUFFICIENT FUNDS
The Board voted to affirm the disposition of the cases of:
Caroline Dicks, CNA
Judith Widdop, RN
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.1.12. FULL REINSTATEMENT OF LICENSURE
The Board accepted the Disciplinary Committee's recommendation to give full reinstatement of licensure to Diane Johnson, RN.
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
HEARINGS 6.2. HEARINGS TO SHOW CAUSE (Hearings occurred July 9, 1998)
6.2.1. Ora Charging HEARING TO SHOW CAUSE WHY HER CERTIFICATION AS A NURSING ASSISTANT SHOULD NOT BE DENIED
Ms. Charging did not appear at the hearing.
The Board heard the testimony and reviewed the evidence presented.
As a result of the administrative hearing, a motion was made and seconded to revoke the certificate of Ora Charging, CNA # 8762 for violation of W.S. § 33-21-146(a)(iv)(B) and by default according to Chapter VIII, Section 6 of the Administrative Rules and Regulations.
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.2.2. Catherine Banks HEARING TO SHOW CAUSE WHY SHE SHOULD BE GRANTED CERTIFICATION AS A NURSING ASSISTANT
Ms. Banks appeared in person without the benefit of counsel.
The Board heard the testimony and reviewed the evidence presented.
As a result of the administrative hearing, a motion was made and seconded to offer Catherine Banks a stipulated agreement/conditional certificate as a certified nursing assistant for violation of W.S. § 33-21-146(a)(ii) and Chapter VII, Section 11(b)(vii) of the Administrative Rules and Regulations.
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.2.3. James Heddeman HEARING TO SHOW CAUSE WHY HIS LICENSE AS A REGISTERED PROFESSIONAL NURSE SHOULD NOT BE REVOKED
Mr. Heddeman did not appear at the hearing.
The Board heard the testimony and reviewed the evidence presented.
As a result of the administrative hearing, a motion was made and seconded to revoke the licensure of James Heddeman, RN # 16371 for violation of W.S. § 33-21-146(a)(vi) and by default according to Chapter VIII, Section 6 of the Administrative Rules and Regulations.
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.2.4. Sherie Lee Payne HEARING TO SHOW CAUSE WHY HER LICENSE AS A LICENSED PRACTICAL NURSE SHOULD NOT BE REVOKED
Ms. Payne did not appear at the hearing.
The Board heard the testimony and reviewed the evidence presented.
As a result of the administrative hearing, a motion was made and seconded to revoke the license of Sherie Lee Payne, LPN # 4943 for violation of W.S. § 33-21-146(a)(i) and Board Rules and Regulations Chapter III, Section 1(a)(iv)(A), Section 3(a)(i)(A)(I), Section 3(a)(i)(C)(I),(IV), and(VII) and Section 3(b)(i)(B),(D),(E), and (U), and W.S. § 33-21-146(iii)(B) and W.S. § 33-21-146(iv)(B) and by default according to Chapter VIII, Section 6 of the Administrative Rules and Regulations.
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.3.1. FULL LICENSURE (Item was acted upon July 10, 1998)
This matter came to be reviewed by the Board upon Joseph Gautsch's application for reinstatement of full RN licensure (LIC.NO 14416) to practice professional nursing in Wyoming. The Board heard Mr. Gautsch's personal testimony and reviewed the evidence presented. After its review and in accordance with WS § 33-21-148, the Board ordered full licensure for Joseph Gautsch RN because of his satisfactory compliance with the Board's previous order.
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
6.3.2. FULL LICENSURE (Item was acted upon July 10, 1998)
This matter came to be reviewed by the Board upon Margaret Martinez's application for reinstatement of full RN licensure (LIC.NO 16084) to practice professional nursing in Wyoming. The Board heard Ms. Martinez's personal testimony and reviewed the evidence presented. After its review and in accordance with WS § 33-21-148, the Board ordered full licensure for Margaret Martinez RN because of her satisfactory compliance with the Board's previous order.
The vote on the above matter was 5-0-2. The members of the Disciplinary Committee were absent from voting in accordance with the Board Rules and Regulations.
DC 6.4. DC ITEMS (Items were acted upon July 10, 1998)
6.4.1. APPLICATIONS VS DISCIPLINARY CASES
The Disciplinary Committee requested that application reviews of those with "yes" answers be separated from the review of disciplinary cases, in an effort to balance the workload. The Board concurred that these applications would be sent to the Board members, not the Disciplinary Committee, on a rotating basis for review for licensure.
6.4.2. DCI CHECKS
Karla Roich asked if there was any procedural way to speed the return of the criminal background check results by encouraging students to apply for licensure/certification earlier. John Burbridge, Assistant Attorney General, reiterated that the DCI information was to be used to discover serious past conduct relating to nursing and not necessarily for use of non-disclosure.
6.4.3. APPLICANTS WITH HISTORIES OF IMPAIRMENT AND/OR FELONIES
The Board reiterated that each application showing a history of drug impairment and/or felony conviction is decided upon an individual basis and that the Board reserves the right to decide what conduct relates to the practice of nursing.
APPLICATION REVIEWS 6.5. APPLICATION REVIEWS
John Burbridge, Assistant Attorney General, recommended that Board staff begin to obtain the prosecutor's statement as part of the requested documentation that accompanies applications for persons with criminal backgrounds, in order to provide more information upon which to base a decision.
6.5.1. JUANITA MARTINEZ, RN APPLICANT
Upon review of her application, and after discussion, the Board voted to issue full registered professional nurse licensure to Juanita Martinez, registered professional nurse applicant.
The vote on the above matter was 5-2-0.
6.5.2. JUDITH VERONICA CHRISTOPHERSON, CNA APPLICANT
Upon review of her application, and after discussion, the Board voted to issue full nurse aide certification, with an advisory letter, to Judith Veronica Christopherson, certified nurse aide applicant.
The vote on the above matter was 7-0-0.
6.5.3. PENNY TAMBURELLI, RN APPLICANT
Upon review of her application, and after discussion, the Board voted to deny registered professional nurse licensure to Penny Tamburelli, registered professional nurse applicant. Ms Tamburelli will have thirty (30) days after official notification in which to request a hearing before the Board.
The vote on the above matter was 7-0-0.
6.5.4. KELLY WEGNER, LPN APPLICANT
Upon review of her application, and after discussion, the Board voted to deny licensed practical nurse licensure to Kelly Wegner, licensed practical nurse applicant. Ms Wegner will have thirty (30) days after official notification in which to request a hearing before the Board.
The vote on the above matter was 7-0-0.
EXECUTIVE SESSION 7.0 EXECUTIVE SESSION (Item was acted upon July 10, 1998)
President McCoy declared an Executive Session to discuss personnel matters. This session lasted a half hour.
ANNUAL REPORTS 8.0 ANNUAL REPORTS FOR NURSING EDUCATION PROGRAMS (Items were acted upon July 10, 1998)
8.1. CWC ANNUAL REPORT (Agenda item was acted upon July 10, 1998)
The Board reviewed the Annual Report submitted for the Associate Degree Program by Central Wyoming College at Riverton. As a result of that review, the Board accepted the report and directed that it be placed on file.
8.2. U OF W ANNUAL REPORT (Agenda item was acted upon July 10, 1998)
The Board reviewed the Annual Report submitted for the Bachelor of Science in Nursing Program at the University of Wyoming, Laramie. The Board noted that the pass rate was lower than the national average, but was within the guidelines specified in Chapter 6, Section 4 of the Administrative Rules and Regulations. As a result of that review, the Board accepted the report and directed that it be placed on file.
ADJOURNMENT ADJOURNMENT
Having no further business to come before the Board, the meeting was adjourned by President McCoy at 5:00 p.m..
Submitted by:
Mary K. Schaper, RN, Interim Executive Director
Janice McCoy, RN, President
Veronica Taylor, RN, Vice President
Karla Roich, LPN, Secretary