September 2004 Bulletin

• Board Meetings - Fiscal year 2005
• In Appreciation
• Board Appointment
• Homeland Security Extends Deadline for Screening of Certain Healthcare Workers in U.S.
• ATTENTION!
• Attention Nurse Practitioners and Nurse Midwives!
• More on Going Forward with Paperless Licensure
• Disciplinary Action
  

Board Meetings - Fiscal year 2005

All Board meetings are held in the Board office in Augusta.

October 6-7, 2004
December 8-9, 2004
March 2-3, 2005
June 1-2, 2005

In between the scheduled Board meetings, adjudicatory hearings (requiring a quorum of the Board) and informal conferences (using a subcommittee) are held. These meetings are scheduled according to need and availability of Board members.

In Appreciation

The Board extends sincere appreciation to Jeanne B. Delicata, R.N.C., who served on the Board from December, 1998 through May, 2004. Jeanne's commitment and dedication to the public welfare greatly enhanced the work of the Board.

The Board also extends appreciation to Carol B. Card, R.N., who served on the Board from March, 2003 through October, 2003. Carol resigned her position due to a move out of state. In the short time Carol served, she contributed greatly to the work of the Board. Richard L. Sheehan, M.S, R.N. was appointed in April, 2004 to complete Carol's unexpired term.

Board Appointment

In May, 2004, Diane L. Dalton, R.N.C., was appointed to the Board of Nursing by Governor Baldacci. She fills the vacancy reserved for a registered professional nurse who is active in long term care nursing. Diane is Director of Nursing Services at the Maine Veterans Home in Scarborough.

For information on how to become a Board member, you are invited to look at the July, 2003 edition of the Maine State Board of Nursing Bulletin on its web site at: www.maine.gov/boardofnursing.

There is currently one available seat for someone actively engaged in nursing practice as defined in the article referenced above.

Homeland Security Extends Deadline for Screening of Certain Healthcare Workers in U.S.

In July, 2004, the U.S. Department of Homeland Security (DHS) decided to extend the deadline for Canadian and Mexican healthcare workers to obtain a special visa certification to deliver patient care and services in the U.S. The new deadline will be July 25, 2005. The extension applies ONLY to Canadian and Mexican citizens who were licensed and employed BEFORE September 23, 2003, in one of seven specific health care occupations, including nursing, and who previously were exempt under the North American Free Trade Agreement (NAFTA). These trade NAFTA (TN) healthcare workers would have been required for the first time to obtain the special visa certification if they entered the U.S. after July 26, 2004.

If this information applies to you or to one of your employees, please do not wait for the proverbial last minute: be diligent in following the visa certification process as experience over the last year has showed us that this is sometimes complicated and time consuming.

ATTENTION!

Please contact the Board office if you have in your employ or know the whereabouts of the following licensees:

Jeffrey T. Skelton, LPN; last known address was in Portland, Maine,
Freya Matheson, RN; last known address was in Portland, Maine.

Attention Nurse Practitioners and Nurse Midwives

Delegated Performance of Services

The Law Regulating The Practice of Nursing, Section 2205-B(3) Delegated performance of services states that a certified nurse midwife (CNM) or certified nurse practitioner (NP) who is approved by the board as an advanced practice registered nurse "may choose to perform medical diagnosis or prescribe therapeutic or corrective measures when these services are delegated by a licensed physician." This requires a formal registration by the physician and CNM or NP with the Board of Licensure in Medicine. A physician and nurse practitioner cannot register a relationship with the Board of Licensure in Medicine until the nurse practitioner has met the twenty four month physician supervision requirement based on a full time work week; provided this information to the Board of Nursing; and has received a letter of approval reflecting the NP's current status in recognition of the 24 month period of supervision having been met.

Documentation of Completion of Physician Supervision

A retrospective review of 180 nurse practitioners who had been approved to practice between May 1999 and July 2002 was recently conducted. These individuals had also received reminders about providing evidence of completion of the 24 month supervisory requirement. 90 of the 180 nurse practitioners submitted the required documentation. Of the remaining 90, 4 had lapsed licenses; 3 were inactive; and, 83 never responded.

It is the responsibility of the nurse practitioner to ensure the physician submits documentation of completion of the supervision requirement. This supervisory period is based on full time. If the nurse practitioner works part time, the supervisory period must be extended until the equivalent of 24 months of full time employment is met.

Supervising Physician

Nurse practitioners must be supervised by physicians in their same practice category. Two examples of inappropriate supervisory relationships are the nurse practitioner approved to practice in primary care supervised by a licensed psychiatrist and a psychiatric and mental health nurse practitioner supervised by a licensed primary care physician.

There must be a formal relationship between the supervising physician and the nurse practitioner. A nurse practitioner cannot privately employ a physician to supervise him/her or arrange for oversight by a physician in the community.

A nurse practitioner must submit a physician supervision letter to the Board prior to beginning new employment and prior to any organizational change in physician supervisors.

Drug Enforcement Agency (DEA) Numbers

Nurse practitioners and nurse-midwives may not apply for a DEA number until they have received full approval. Full approval to practice is obtained after successful completion of the national certification examination.

Prescriptive Authority

The nurse practitioner and nurse-midwife may only prescribe the categories of narcotics listed on their DEA certificate issued by the DEA office. If a nurse practitioner or nurse-midwife has not updated his/her DEA certificate to include schedule II narcotics, he/she must do so and receive a new DEA certificate prior to prescribing schedule II narcotics.

A nurse practitioner or nurse-midwife is not required to request authority to prescribe schedule II narcotics from the DEA. It is the individual's decision whether or not he or she wants to prescribe narcotics.

If a physician has registered a nurse practitioner or nurse-midwife delegation relationship with the Board of Licensure in Medicine, the physician cannot delegate to the nurse practitioner or nurse-midwife the authority to prescribe schedule II narcotics even if the DEA certificate includes schedule IIs. The physician is prohibited from this delegation by the Board of Licensure in Medicine's regulations contained in its Chapter 3 Physician Supervision of the Advanced Practice Nurse under Medical Delegation.

If nurse practitioners begin employment in a community it would be prudent to introduce themselves to local pharmacists who often call asking about DEA status on specific nurse practitioners and nurse-midwives. Pharmacists do not want to fill prescriptions, particularly narcotics; unless they are assured the providers have the authority to prescribe.

ALL APRNS

Continuing Education

Advance practice registered nurses who renew their initial approval to practice within a less than 2 year cycle are not expected to have completed the full 75 continuing education hours as part of the renewal process. They should simply answer "No" on the renewal application; indicate the date they were initially approved to practice; and note how many continuing education credits they have accrued to date. The documentation of credits is than filed and a new cycle of continuing education begins.

Contact: virginia.e.delorimier@maine.gov

More on Going Forward with Paperless Licensure

After the featured article in the Board's April/May 2004 Bulletin, The Art of Licensing and Going Paperless in the 21st Century, the Board received many positive kudos and one letter expressing concern and asking that the "Board not take away the license." The Board has no intention of removing the requirement and process for licensure. What the Board intends is simply to go paperless. The evidence of the licensure will be found on the web site. Since the publication of the April/May Bulletin, the State of Texas has also begun the paperless initiative.

When an individual decides to practice nursing, there are certain requirements to be met in order to safeguard the life and health of the people in Maine. Individuals who for compensation, practice or offer to practice professional or practical nursing in Maine must provide evidence that they are qualified to practice and be licensed.

How can a person know if an individual is in fact licensed to practice as a nurse? In order to show that a nurse is licensed, an individual is provided a wallet card or wall certificate indicating that the Maine State Board of Nursing has reviewed the evidence the person submitted upon application and determined that nurse licensure requirements were met. This card or certificate serves as the proof that permission has been granted to practice as a nurse.

In May, 2002, the Board of Nursing established on its website (www.maine.gov/boardofnursing ) a mechanism for the public to determine if an individual is licensed as a registered professional nurse, licensed practical nurse or approved as an advanced practice registered nurse (and in what category). This serves as evidence that the person has permission to practice and reveals the current status of that permission (such as whether the license is active, lapsed, inactive, suspended, revoked). Since that time there have been more than "hits" on the verification of licensure feature.

Verification of licensure should include multiple steps to determine the identity and licensure status of a nurse. These include viewing a government photo identification card or driver's license or other verifiable form of identification and verifying licensure status through the Board's web site - license verification feature. The Board's goal is to move to a paperless proof of licensure system. What this means in practical terms is that an individual will receive an official document upon initial licensure in Maine and then upon renewal, simply have that proof of permission to practice posted on the Board's web site. Wallet cards will no longer be need and will no longer be issued.

These are exciting times. This revolution will take place in the near future. Many advantages exist to going paperless: the status of a license may be verified at any time anywhere online; there is no loss of a wallet card either through theft, loss, destruction or misplacement. Identity theft is minimized. Also, since the board updates discipline information routinely, the public, particularly employers, would be able to access public protection information in a more efficient manner.

Disciplinary Action

Licensees fined from 04/15/04 - 08/31/04 for practicing during lapsed license status: 39

Complaints Dismissed from 04/15/04 - 08/31/04: 37