Summer-Fall 2001 Bulletin

• New Chemical Dependency Video
• Looking for a Refresher Course?
• But They're "Practicing On My License..."
• Compact Update
• Top 5 Licensure Renewal Errors
• How to Participate in NCLEX Examination Item Development
• Discipline

Note: Please contact the Board office if you have in your employ or know the whereabouts of the following licensee: Janet L. Broz, R.N., Belgrade, ME

New Chemical Dependency Video

The National Council of State Boards of Nursing (NCSBN) just released its latest video and facilitation package entitled Breaking the Habit: When your Colleague is Chemically Dependent. This educational program focuses on the challenges of nurses working with chemically dependent colleagues.

The video includes narrative, expert opinions and dramatization of the issue. The video centers on the experience of one chemically dependent nurse and her colleagues. The viewer is presented with two scenarios with different outcomes. This story is used to illustrate the dilemmas of colleague nurses and helps make their decision to come forward about a chemically dependent colleague an easier one. This program is for every nurse in every practice setting at every level of practice.

The content covers:

• The three dimensions of addiction
• Warning signs
• Common narcotic discrepancies
• Risk factors
• Role of the colleague/manager
• Steps and phases of recovery
• Boards of nursing approaches: discipline vs. alternative programs

In addition to the video, the program contains valuable instructor tools: master overheads for projection; facilitator's notes; interactive learning exercises; and a detailed reference list. The complete package is priced at $279.00. An accompanying handbook for nurse managers is available for purchase separately for $34.95. This handbook contains vital information about identification, intervention, aftercare and return to work. The program and handbook can be purchased through Niche Communications, nichecom@home.com or (410) 335-2618. Sample clips from the video can be found online at National Council's Learning Extension, www.nclex.com.

Looking for a Refresher Course?

In addition to checking local nursing programs and medical centers, why not consider the Review for the NCLEX-RN Examination? You may work at your own time and pace on-line. While the course is designed to assist students in a review for the licensure examination, the course may benefit those nurses who have been out of practice for awhile and would like to pursue a review before returning to the practice arena. The course is available at www.nclex.com.

But They're "Practicing On My License..."

How many times have you heard someone say, "They're practicing on my license?" Many nurses believe that when they delegate a nursing task to a certified nursing assistant (CNA), that CNA or unlicensed person is "practicing on the nurse's license." This is NEVER true. No one practices on a nurse's license except the nurse to whom the license was issued. No one can practice on your license except you.

The Law Regulating the Practice of Nursing (Nurse Practice Act) authorizes the registered professional nurse (RN) to delegate selected nursing services to assistants to nurses who have completed or are currently enrolled in a course sponsored by a state approved facility or a facility licensed by the Department of Human Services (DHS). (This course must include a curriculum approved by the board) (32 M.R.S.A. Sec. 2102.2.D.)

By rule the Board has defined delegation as the transferring to a competent individual authority to perform a selected nursing task in a selected situation.

Delegation is a tactic to "get work done." Delegation is a management principle used to obtain desired results through the work of others, and is a legal concept used to empower one to act for another - as provided for in the Nurse Practice Act. Delegation is an independent function within the RN's scope of practice. Delegation provides a means to distribute the workload in order to better employ the time and skills of the licensed nurse. When used appropriately, delegation is a basic management tool that allows nurses to effectively utilize staff to provide safe nursing care for a group of patients.

Why then are nurses reluctant to delegate? In three words: "loss of control." Loss of control that is often accompanied by fears of liability and potential licensure action by the Board. These fears are primarily based on a misunderstanding about the duty of a nurse with regard to delegation and a blurring of the distinction between accountability and liability.

When a nurse delegates the performance of a nursing task or activity to a CNA the nurse has transferred authority to perform the task while remaining accountable or answerable for the outcome. This means the nurse is responsible for his/her own actions as well as the actions or inactions of the CNA in the context of delegation. The CNA is responsible for performing the task exactly as it was delegated. The nurse must justify the decision to delegate and his/her own actions in that process.

• Did the nurse first determine that the task or activity was within his/her scope of practice and also something he/she had the knowledge, skills and ability to perform?
• Was an adequate assessment performed to determine the patient's needs and any special circumstances associated with that patient?
• Did the nurse know whether the task or activity was something the unlicensed individual had the skills to perform?
• And finally, did the nurse provide adequate supervision and evaluation of the performance by the unlicensed individual?

Accountability means that the nurse must answer questions about certain decisions that were made regarding a decision to delegate as well as whether adequate supervision and evaluation were provided. When the nurse's answers to these questions reflect performance that is consistent with standards for delegation then the nurse has met his/her duty and will likely be able to successfully defend any malpractice action that might involve delegation issues.

Standards for delegation in the form of Board rules (Chapter 5) set forth the expectations nurses must meet when delegating to a CNA. In other words, these standards spell out the areas of responsibility for the licensed nurse.

While the nurse is accountable, that does not mean the nurse is "liable" in a legal sense. Although being named a defendant in a lawsuit is always a possibility, liability will arise only when a duty is breached resulting in harm and damages. A nurse can never avoid accountability. It is inherent in licensure; however, liability can be avoided by practicing in accordance with established standards of care.

Two-way communication is an essential component of safe delegation. The importance of providing clear expectations cannot be over emphasized. When a nurse delegates, he/she should provide directions to the CNA that establish the priority of the activity, expected timelines, guidelines for consulting with the nurse and guidelines for reporting back upon completion of the delegated task.

Supervision, as part of delegation, includes communicating directions and expectations for completion of the task, monitoring the performance of the activity, intervening if necessary, and assuring that appropriate documentation of the activity is completed. It is the nurse's role to assist and support the CNA in the accomplishment of the delegated activities. Evaluation, in the context of delegation, requires the nurse to provide feedback to the CNA, to consider the initial assessments, and alter the plan of care when needed.

Compact Update

There are now 13 states who are members of the Nurse Licensure Compact. They are:

• Arkansas
• Nebraska
• Delaware
• North Carolina
• Idaho
• South Dakota
• Iowa
• Texas
• Maine
• Utah
• Maryland
• Wisconsin
• Mississippi

Top 5 Licensure Renewal Errors:

5. Waiting until the last minute to mail in your renewal application and fee.

4. Failing to provide the Board office with you current, correct mailing address.

3. Failing to answer questions on renewal application.

2. Failing to sign the renewal application.

1. Failing to keep track of license expiration date (which is always on your birthday).

How to Participate in NCLEX Examination Item Development

The NCLEX-RN examination and NCLEX-PN examination are developed by hundreds of nursing professionals and testing specialists. There are three different panels:

• ITEM WRITERS - nurses that write the questions (items) with the assistance of the test service
• ITEM REVIEWERS - nurses that review the questions and answers submitted by the item writers
• PANEL OF JUDGES - nurses that recommend the passing standard to the Board of Directors

By participating as an NCLEX examination writer, item reviewer or panel judge, you will:

• Promote excellence in nursing
  
• Network with other nurses from across the country
  
• Learn how the licensure examinations are developed and have input into the process
  
• Have an excellent addition to your resume/curriculum vitae
• Have all of your expenses paid (airfare, airport transportation, hotel and meals)

Applying is easy! You may qualify to serve on an NCLEX Development Panel if you work in a clinical setting with newly licensed nurses or are a faculty member, and meet the academic requirements. All of the item development sessions take place in Princeton, NJ. The sessions are ongoing year round and last an average of three to five days. The item development panels are assembled one to two months before the session is to take place. Your application will remain active for two years from the date of approval.

To learn more about the NCLEX Development Panels or access an online application:

1. Go to the National Council of State Boards of Nursing (NCSBN) Web site at http://www.ncsbn.org
2. Choose NCLEX Examination from the scroll-down menu on the National Council's home page
3. Click the Section Contents link labeled Developing the NCLEX Examination
4. Click the link labeled Item Development Application

Discipline