September 2006 - Nevadaepubs.nsla.nv.gov/statepubs/epubs/620964-2006-9.pdf · school setting. The...

Board AdoptsNew Regulations

Epidural CatheterDecision Revised

Board RevisesSchool Nurse

Advisory Opinion

September 2006September 2006

Board RevisesSchool Nurse

Advisory Opinion

Board AdoptsNew Regulations

Epidural CatheterDecision Revised

7 0 2 . 3 8 3 . 2 0 0 0 w w w . u m c s n . c o m

I n o n e p r e c i s e m o m e n t

Something happens when you puteleven centers of excellence in one hospital:Every moment is charged with meaning.And miracles are all part of a day’s work.

the symbol of excellence

a mother holds her first child

a stroke survivor takes a step on her own

a heart patient is flown in by chopper

and a doctor says, “she’s going to be fine.”

3Nevada State Board of Nursing ■ Toll-Free 1-888-590-6726 ■ www.nursingboard.state.nv.us

The mission of the NevadaState Board of Nursing is toprotect the public’s health,safety and welfare througheffective regulation of nursing.

Debra Scott, MS, RN, APN Executive Director

Cindy Kimball, EditorPublic Information Officer

5011 Meadowood Mall Way,Suite 201Reno, NV [email protected]

The Nevada State Board ofNursing News publishesnews and information quarterlyabout Board actions, regulations,and activities. Articles may bereprinted without permission;attribution is appreciated.

NEVADA STATE BOARDOF NURSING5011 Meadowood Mall Way,Suite 201Reno, NV 89502-6547phone—888-590-6726 fax—775-688-2628 [email protected]

2500 W. Sahara Ave., Suite 207Las Vegas, NV 89102-4392phone—888-590-6726fax—[email protected]

WORLD WIDE WEBwww.nursingboard.state.nv.us

7Board Revises School Nurse Advisory Opinion

Board Revises Epidural CatheterRemoval Practice Decision

Board Adopts Regulations inPublic Workshop, Hearing

4

12

14Board Member Receives Local Award,

Named to National Committee 17Meet the Staff

Chris Sansom and Teri Troke 19

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For advertising information contact: Jane Coker at 800.561.4686 • [email protected] our website www.thinkaboutitnursing.com

C O N TA C T

Edition 11

contentspage 17

page 19

Finding Your Passion

page 7

Board and Advisory Committee Meetings 6

You’re in Good Company 6

Board Members 16

Disciplinary Actions 20

Staff Directory 22

Circulation includes more than 30,000 nurses, nursing assistants and student nurses.

page 19

The caption for this photo of the members of theBoard’s Disability Advisory Committee thatappeared on the cover of the June 2006 issue ofNSBN News inadvertently omitted the name ofcommittee member Susan O’Day, who is stand-ing, second from the right. Here is the correctcaption: Standing: Doreen Begley (Board liaison),Mary Culbert, Judith Vogel, Virginia Deleon, JanBrethauer, Susan O’Day, Sandra Hotchkiss;Seated on chairs: Roseann Colosimo, PhyllisErichsen, Judith Slaney, Alice Adams; Seated onfloor: Kathleen Reynolds (committee chair andcompliance coordinator) and Cookie Bible.

When the editor proposed articles for the next two issuesof the NSBN News, I realized two of them cover specialtiesin nursing which affected my choice to enter our profession.If you have ever attended one of my presentations, you prob-ably have heard me say that I decided to go to nursing schoolwhen I was “old”—what that means is that I started nursingschool when I was 30. My life had been spent raising twowonderful kids and working part time in quasi-nursing posi-tions. When we lived in Hawaii, I worked as a school healthaide, under the supervision of a school nurse. I loved theposition and quietly thought that someday I might be able togo to college and actually become a real school nurse. In fact,when we moved back to California, I began a position as ateacher’s aide in special education. I was able to sit in on IEP(Individual Education Plan) meetings and saw the schoolnurse working in her practice setting. Now, I was hooked!

I began my prerequisites in the community college in asmall rural town in California’s San Joaquin Valley, and thentransferred to a BSN program at University of California,Fresno in 1981. While in my nursing program, it becameclear that psychiatric nursing came relatively easy to me, andI felt that I truly had found my niche in nursing. So, in1985, after graduating, getting licensed, and working thatmost important year in medical surgical nursing, I started mylong career in adolescent psychiatric nursing.

In 1993, when I moved to Nevada, I had been in clinicaldirector positions in two different free-standing psychiatrichospitals. I spent my first two years in Nevada as the clinicaldirector in a residential center for adolescents and children.I learned of an opportunity to work on one of the NevadaState Board of Nursing’s advisory committees, and applied tobe on the Board’s Disability Advisory Committee (DAC).I thought my experience in psychiatric nursing and the relat-ed field of chemical dependency, not to mention my mastersof science—clinical specialization in psychiatry, might be ofvalue to the Board. They thought so too, and so began myinvolvement in nursing regulation.

School nurses direct and provide school health services.The school nurse (RN) is responsible to develop, implement,evaluate, and revise the plan of health care for each studentwith special health care needs under her supervision. Schoolnurses are the only RNs in Nevada who may delegate specific

nursing procedures to unlicensed, qualified individuals in theschool setting. The Board has specific regulations (NAC632.226) and an advisory opinion (practice decision) whichguide the school nurse in her expanded role. What an excit-ing responsibility! See the article on page 7 for more infor-mation on the role of the school nurse and the newly revisedadvisory opinion.

When I began working for the Board in 1996 as the asso-ciate executive director for nursing practice, one of myassignments was to chair the Disability Advisory Committee(DAC). I had never had the honor to work with such a spe-cial group of nurses who were willing to volunteer endlesshours and give overwhelming energy to support nurses whoare afflicted with the disease of chemical dependency, thosewho have been diagnosed with a psychiatric illness, or whohave the dual diagnosis of both disorders. Some of the DACmembers were already “conceptual members” meaning thatthey continued to work in this capacity even though theyhad completed both of their three-year terms on the entirelyvolunteer committee.

Regulation (NAC 632.210) gives the legal parameters forthe Disability Advisory Committee. The members must benurses who are knowledgeable concerning any conditions,diagnoses, or addictions that may negatively impact the safepractice of nursing. The DAC members are among theheroes who give freely of their time, their expertise, and theirhearts in this very important work. Look for the article onour Alternative Program for Chemically Dependent Nursesin the December issue of NSBN News for more informationabout DAC.

So, when I was a senior in high school and I wrote anessay on “What I Want to be When I Grow Up,” I got mywish. At that time, I couldn’t settle on a teacher or a psy-chologist, but I was lucky enough to be able to do both—as aregistered nurse. Isn’t that one of the wonderful aspects of ourprofession? Finding our passion in whatever we choose to do.

Debra Scott, MS, RN, APNExecutive Director

Finding Your PassionA message from the executive director

4 Nevada State Board of Nursing ■ Toll-Free 1-888-590-6726 ■ www.nursingboard.state.nv.us


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Board SeeksEducationConsultantThe Nevada State Board ofNursing is looking for the rightperson to serve as its educationconsultant, either as an employ-ee or as a contractor. The indi-vidual selected for the positionwill be responsible for conduct-ing Board surveys of nursingeducation and nursing assistanttraining programs, as outlinedby the requirements of theNevada Nurse Practice Act. Thequalified person will have amaster’s degree in nursing andrelevant experience. For moreinformation on the position,please contact ExecutiveDirector Debra Scott, MS, RN,APN, at 888-590-6726.

Board Seeks ApplicationCoordinatorThe Nevada State Board ofNursing is looking for a regis-tered nurse with a bachelor’sdegree and five years nursingexperience to serve as an appli-cation coordinator. This is a full-time position in the Reno officeof the Board. The position willbe responsible for reviewingand processing advanced prac-tice applications, and applica-tions for licensure/certificationwith affirmative answers toscreening questions, positivecriminal backgrounds, andapplications that are fraudulent.Interested individuals may fax aresume to Chris Sansom, BSN,RN, Director of Operations at775-688-2628.


MEETINGS AND OPENINGSThe openings (listed in parentheses)will occur in the next six months. Allmeetings will be held via videoconfer-ence in Reno and Las Vegas, exceptfor the Disability Advisory Committee..

Advanced Practice AdvisoryCommittee (one)

Recent appointment: Susan VanBeuge,

MSN, RN, APN

November 7, 2006

CNA Advisory Committee (four)November 2, 2006

Disability Advisory Committee (one)October 20, 2006 - Reno

Education Advisory Committee (four)Recent appointments: Robert Rowe, Jr.,

MSN, RN, and Mable H. Smith, PhD, JD, RN

November 3, 2006

Nursing Practice Advisory Committee (none)Recent reappointments: Cheryl McKinney,

RN, and Karen Winter, RN. Recent

appointments: Carolyn Copeland, RN,

and Joseph Rosich, RN

October 10, 2006

December 5, 2006

B O A R D TA L K

BOARD MEETINGSA seven-member board appointed by thegovernor, the Nevada State Board ofNursing consists of four registered nurs-es, one practical nurse, one certifiednursing assistant and one consumermember. Its meetings are open to thepublic; agendas are posted on theBoard’s web site and at community sites.

BOARD MEETING DATESSeptember 20-22, 2006 - Las Vegas

(October 18, 2006)

November 15-17, 2006 - Reno

(December 13, 2006)

(Meetings may be held on dates and inlocations in parentheses, depending onBoard business.)

ADVISORY COMMITTEESThe Nevada State Board of Nursing isadvised by and appoints members tofive standing advisory committees.Committee meetings are open to the pub-lic; agendas are posted on the Board’swebsite and at community sites. If youare interested in applying for appoint-ment to fill an upcoming opening, pleasevisit the Board’s website or call the Renooffice for an application.

COME TALK TO THE BOARDDuring each regularly scheduled meeting of the Nevada State Board of Nursing,Board members hold a Public Comment period for people to talk to them on nurs-ing-related issues.

If you want to speak during the Public Comment period, just check the meetingagenda for the date and time it will be held. Usually, the Board president opensthe first day of the meeting by inviting Public Comment. Time is divided equallyamong those who wish to speak.

For more detailed information regarding the Public Comment period, please callthe Board.

WE’LL COME TALK TO YOUBoard staff will come speak to your organization on a range of nursing-relatedtopics, including delegation, the impaired nurse, licensure and discipline process-es, and the Nurse Practice Act.

The Board conductsrandom audits

Don’t Forget to KeepCopies ofYour CECertificates

As it states on your renewalapplication, you must keep copies ofyour continuing training/educationcertificates for four years, in case youare selected for random audit. If youcannot prove you met the renewalrequirements for nurses (30 continu-ing education credits for nurses and 24hours of continuing education/train-ing for CNAs), you may be subjectto disciplinary action.

Nurses: the Board is also audit-ing for compliance with the one-time renewal requirement for a four-hour bioterrorism course. For moreinformation on the bioterrorism CErequirement for renewing nurses,visit the Board’s website or call theBoard office.

YOU’RE IN GOODCOMPANYActive Nevada

licenses/certificates on August 1, 2006

RN • 22,576LPN • 3,137

CNA • 6,174

SCHOOL NURSES are the only RNs inNevada who may delegate specific nurs-ing procedures to unlicensed, qualifiedindividuals. The school nurse is respon-sible to develop, implement, evaluate,and revise the plan of health care foreach student with special health care

needs under his or her supervision. TheBoard has a specific regulation (NAC632.226) and an advisory opinion(practice decision) that guide theschool nurse in this expanded role. Atits annual meeting in July, the Boardaccepted the recommendation of its

Nursing Practice AdvisoryCommittee to revise theadvisory opinion to reflectmore clearly its originalintent and to provideclearer direction for theschool nurses who workunder its guidance.

The Board’s NursingPractice AdvisoryCommittee made the rec-ommendation after receiv-

ing a request for revision from DanaBalchunas, BSN, MEd, RN, director ofstudent health services for the WashoeCounty School District. At its regular,public meeting in June, the committeeheard and considered testimony regard-ing the section of the opinion thatdefined a family member/friend desig-nated by the parent or legal guardian as“a qualified person” to whom nursingcare could be delegated. This, it wasargued, implied the school nurse mustensure that parents or their designeesare willing, competent providers, andprovide supervision and training of theparents or designees. After discussion,the committee agreed to recommend arevision that removed that implication,because the Board does not require the


Board Revises School NurseAdvisory OpinionChange clarifies role of nurse as it relates to parents or designees

Zofia Figiel, BSN, RN, is preparing to give student Ryan Harmon atube feeding in the health office at John F Miller School in LasVegas, a school for students with specialized needs. Photographby Michele Nelson, photographer, Clark County School DistrictCommunications Office.

Jacqueline Arnold, BSN, RN, gives a near-vision examination to Estela Vasquez in thehealth office at CC Ronnow Elementary School in Las Vegas. Photograph by MicheleNelson, photographer, Clark County School District, Communications Office.

nurse delegate care to parents and theirdesignees. It also added a clarifyingstatement (see section 4) that a familymember/friend is exempt from the pro-visions of the Nurse Practice Act.

“As school nurses, we rely heavilyupon the regulation and advisory opin-ion to guide our practice, especially inthe area of delegation,”Balchunas said. “We are pleasedthe committee and the Boardshared our concern that theoriginal opinion might causeconfusion regarding the role ofthe school nurse.”

Betty McKay, the Boardmember liaison to the NursingPractice Advisory Committeeand an LPN health technicianwith the Dayton School System,

presented the committee’s recommenda-tion to the Board. She said the adop-tion of the revision “helps clarify thatthe Board never intended to require theschool nurse to delegate care to a parentor designee.” She added that a student’sfamily is an integral part of the teamthat provides health care to students in

the school setting. “But they do not fallunder the requirements of the NursePractice Act,” she explained, “nor dothey require supervision or training bythe school nurse.”

The director of health services forthe Clark County School District saidshe appreciated the Board’s clarification

to “the framework of ourapproach to the provision of pro-cedures.” Diana Taylor, MA,BSN, RN, added, “We’re veryglad to have the advisory opinion.We follow it exactly. It keeps uson track legally, and it providesthe information schools need asfar as why certain tasks are dele-gated and why others are not.”

See related articles on following pages


Jacqueline Arnold, BSN, RN, who is about to give Jose Alvarado a hearing test at CCRonnow Elementary School in Las Vegas, explains that Jose should raise his hand everytime he hears the beep. Photograph by Michele Nelson, photographer, Clark CountySchool District Communications Office.

COVER PHOTO: Alison Simcox, BSN, RN, takes Brenda Delgado’s bloodpressure. Delgado, who is five years old, was a participant in the pre-Ksummer program at Sparks High School. Photograph by Val Martino, publications specialist, Washoe County School District.


For me, school nursing has

proven to be the best practice

of nursing. It is everything in

nursing rolled into one.

—Diana Taylor

What are thequalifications fora school nurse?

In Nevada, at a minimum, aschool nurse needs a bachelor of sci-ence in nursing degree, an RNlicense, and a license issued by theNevada State Board of Education towork as a school nurse in Nevada.Other qualifications may includeclinical nursing experience in pedi-atrics, maternal-child health, emer-gency nursing, or public health. Ifyou’re interested in school nursing,check with your local county schooldistrict’s health services departmentfor more information.

What do schoolnurses do?DIANA TAYLOR, MA, BSN, RN,director of health services, ClarkCounty School District: “The stereo-typical portrait of a school nurse put-ting a Band-Aid on a scraped kneereally fits the aide, not the nurse.School nurses use everything welearned in school and more—theyneed clinical, technical, psychological,and organizational skills. School nurs-ing covers the specialties of pediatrics,psychiatric, emergency, and medical-surgical nursing. We educate ourpatients, their parents, their teachers,and the staff. The Clark CountySchool District is the largest schooldistrict in the nation and we havethousands of medically fragile students.We perform a high number of proce-dures, including tube feedings,catheterizations, and insulin injec-tions. School nurses also care for stu-dents with tracheostomies, portableventilators, and central IV lines.”

ALISON SIMCOX, BSN, RN,school nurse, Washoe CountySchool District: I think it’s importantthat people know we deal with a lot ofstudents with serious health problemswho are still entitled to come toschool and participate as fully as theycan, just as other students do. Our

level of nursing is always on theupswing--there are always new proce-dures, and there are always new stu-dents who require the kind of specialcare, that in the past, might have pre-vented them from being in a schoolsetting—now we just make it happen.Our goal is to help that child remainin school so he can learn. While abid-ing by all the guidelines, there is roomto be creative in finding a solution toa student’s problem, so he can be inclass, not in the clinic. As a schoolnurse, I work a lot to help studentsbecome as independent as possible inparticipating in their own care. I pro-vide all different levels of training—tothe student, other staff members, clin-ical aides, teachers, teacher aides, fieldtrip aides—based on the person’s will-ingness to learn and participate. It isnothing but a help to be able to dele-gate the things I can, so the studentsget the help they need, and I’m free todo something that is not delegable.”

Why do peoplebecome schoolnurses?DANA BALCHUNAS, BSN, MEd,RN, director of student health serv-ices, Washoe County SchoolDistrict: In one word, I’d say auton-omy. A lot of veteran nurses desiremore autonomy in practice, the abili-ty to make the decisions that are bestfor a particular situation. We offerthat. At the same time, it is collabo-rative. Even though school nursesdon’t spend time every day withanother school nurse, they are verymuch in touch, continually usingeach others’ expertise, looking at thestandard of care. While it is inde-pendent practice, it is also supportivepractice. People who are school nurs-es find it professionally rewardingbecause it takes a high level of skill—it requires every tool in your nursingbox to deal with a spectrum of situa-tions that can range from a child witha severe chronic illness, to a studentwith a tracheostomy, to training peo-ple to provide care, to treating kidsthat just need well visits.

When I recruit nurses, I tell themit’s a great part-time job with full-timebenefits. With a 185-day contract,and a seven-hour day, if you dividethe hours into the salary, we’re notthat far from the prevailing hourlywage. Plus, you never work eveningsor nights, and in addition to schoolbreaks, you always have weekends andall federal holidays off. The environ-ment we work in is by and large veryupbeat. In general, a school is a happyplace to work, the kids are funny andinteresting, and they’re well enoughto come to school.

ZOFIA FIGIEL, BSN, RN, schoolnurse, Clark County School District:I like the flexibility, independence,and variety—as a school nurse, youdon’t have to do the same thing overand over. It’s a big responsibility—youreally need to know how to delegate.You’re very independent, and reallyhave to be on top of things, especiallyduring an emergency. Also, it’s sorewarding working with the students,it’s unbelievable. Sometimes, we reallydon’t realize the impact we have onthe kids. I see a lot of great kids, andworking with them, you get really getclose to them, and they trust you.They know you’re there for them.

JACQUELINE ARNOLD, BSN,RN, school nurse, Clark CountySchool District: The most rewardingthing about being a school nurse is,of course, working with the childrenand being able to make a differencein their lives. The children come upand hug you and thank you, and sodo the parents. We provide free glass-es, free dental care, and we helpthem get the health care servicesthey need. I do a lot of referrals, andhelp parents access resources theydon’t even know are available tothem, like Nevada Check Up andMedicaid. I’m an integral part of thespecial education team, and helpwrite IEPs (Individual EducationPlans). On top of that, being aschool nurse means I can make agood living, and at the same time,have time off to spend my own chil-dren. It’s wonderful! This is the bestjob . . . this is my home.


Nevada State Board of NursingAdvisory Opinion Regarding Roles and Responsibilities of the School Nurse

All students in public school districts deserve tohave their health care needs met to enhance optimumlearning. In addition, the Individual's With DisabilitiesEducation Act (IDEA), mandates that all disabled chil-dren be provided an education in the least restrictiveenvironment and the special health care needs of chil-dren shall be met. An increasing number of childrenwith exceptional health care requirements are current-ly being mainstreamed into the school system. It is theBoard of Nursing's recommendation that registerednurses knowledgeable in school nursing should directand provide school health services. School Districtsneed to arrange for adequate personnel to providecare.

The role, duty, responsibility, and employment ofthe School Nurse, who is a Registered Nurse, mustcomply with the Nurse Practice Act (NRS Chapter 632and NAC 632) and NRS Chapter 391.207, 391.208,and 392.420.

The School Nurse (RN) is responsible to develop,implement, evaluate and revise the individualizedhealth care plan for each student with special healthcare needs under his/her supervision.A. Input for the individualized health care plan is

gathered from a multidisciplinary health team toinclude, but not limited to, the following:1. The student's primary physician2. The student's parent/guardian3. The student, when able to communicate4. Primary RN coordinating student's home care5. Social worker, if involved6. Designated school representative (per IDEA

requirement)7. Student's teacher, school counselor and school

psychologist8. Health care providers (example: Occupational

or Physical Therapist, Vision ImpairedSpecialist, Hearing Impaired Specialist, MentalHealth Counselor, etc.)

B. The individualized health care plan is based onthe evaluation of a number of variables specificto each student and includes, but is not limited to,the following:1. The stability of the student's medical condition

including diagnosis, symptomatology, specialalerts, emergent factors and educational impli-cations for the student. Consideration shouldbe given to the questions, "can the student'sstability change dramatically to life-threaten-ing within a few minutes/seconds?"

2. List of medications: type, dosage, interactions,toxicity, adverse reactions and route of admin-istration the child receives, as prescribed by alicensed prescribing practitioner in the State ofNevada.

3. Utilization of PRN medications and over thecounter medications.

4. The nature, frequency and complexity of pre-scribed treatments the child requires andassessment for PRN treatments.

5. The complexity and acuteness of the observa-

tions and judgements the care giver mustmake.

6. The specific student's ability to participate inthe plan of care and communicate his/herneeds to the caregiver.

7. Environment: To include physical plant andeducational staff and alternate health careproviders and any adaptations that are need-ed to accommodate the student because of thehealth care needs.

8. Level of preparation and experience of thedesignated direct care giver.

C. The individualized health care plan should includewritten policies and procedures addressing possi-ble medical emergencies the student may experi-ence while in the school setting. These policiesand procedures should include:1. Definition of a medical emergency for the spe-

cific student;2. Designation of individuals to be notified when

the emergency occurs;3. Identification of person who will initiate and

direct the action to be taken;4. Specific action to be taken in this emergency;5. Transport specifications (internal and exter-

nal), who will provide it and to where; and6. Format for documentation of actions taken in

medical emergency.D. Delegation

1. The Registered Nurse determines when it isappropriate to delegate or assign any portionof the provision of care. Thisdelegation/assignment must occur in accor-dance with the standards of practice outlinedin the Nurse Practice Act and the guidelines ofthis Advisory Opinion.

2. The Registered Nurse School Nurse is solelyresponsible for the determination of when it isappropriate to delegate or assign nursing careto a qualified person. A "qualified person" is:a. A person whose license/certification author-

izes his/her practice, orb. A willing person whom the RN School Nurse

has determined has acquired and/or main-tained knowledge, skill and ability to per-form the care in a safe and effective man-ner required by the child.

3. This definition precludes the automatic utiliza-tion of the office manager, secretary orteacher as a qualified person. Only the SchoolNurse may delegate or assign nursing care.The School Administrator cannot legally dele-gate or assign nursing care. A LicensedPractical Nurse providing nursing care in aschool may not delegate or assign nursing careprocedures to school personnel.

4. A family member/friend, designated or identi-fied by the student's parent or legal guardian,is exempt from the regulations of the NursePractice Act and, without delegation, trainingor supervision by the school nurse, may per-form required care for the student unlessemployed by the school district.

This advisory opinion (practice decision) is on theBoard’s website under the link Nurse Practice Actand Practice Decisions.

Nevada State Board of Nursing Advisory Opinion for Provision of Nursing Care by Licensed Nurses and Qualified Personnel in Schools

QUALIFIED QUALIFIED LICENSED

NURSING PROCEDURE PERSON NURSEDevelopment of procedures/emergency protocols RN onlyDevelopment of individualized student health care plan RN onlyNasogastric feedings XTube insertion or removal RN onlyGastrostomy feedings XMechanical pump feedings XClean intermittent catheterization X XIndwelling catheter insertion XSterile intermittent catheterization X

Care of external equipment only (leg bags, straighten tubing, etc.) X X

Crede X XCare of decubitus ulcer XReinforce external dressings (underpads) X XPhrenic nerve stimulator XPostural drainage X XChest percussion X XSuctioning pharynx XLight oral suctioning Emergency XSuctioning pharynx w/bulb Emergency XSuctioning bronchial Emergency XTracheal suctioning, trach care & tube replacement Emergency XGlucose levels-blood/urine X XColostomy/ileostomy/urostomy care X

Emptying devices/skin care X XCast care X XMechanical ventilator RN onlyIntravenous therapy: X

Intermittent XContinuous XPump devices XChemotherapy RN onlyInvestigational drugs RN onlyImplanted devices RN onlyCentral venous access devices RN only

Screening procedure:Vision/hearing X XOrthopaedic screening XSpinal screening RN onlyDental screening X XLice screening X XRescreening/referral to physician X

MedicationsTo administer medications, the School Nurse must have written permission from

parent/guardian, and medication must have been prescribed by licensed prescribingpractitioner, labeled and dispensed by licensed dispensing practitioner/pharmacist.Administration must be accompanied by a reliable tracking system.

The Nevada State Board of Nursing recognizes the administration/assistance withmedication is an issue of primary concern in school districts. School Nurses/SchoolDistricts are referred to the State Board of Pharmacy to work out a suitable mecha-nism for the accomplishment of this task. Any medication procedure developed mustmeet the standard requirement for the safe administration/assistance of medications.

QUALIFIED QUALIFIED LICENSED

NURSING PROCEDURE PERSON NURSEOxygen, continuous/intermittent X X Adjust nasal prongs X X Oral X X Topical therapeutic X X Injections XAdministration of glucagon injection kit in emergent situation X XCalculation of insulin dosage via pump, pen, or syringefor student self-administration X XVerification of insulin dosage via pump, pen, or syringe for student self-administration X XInhalation X X Bladder RN onlyRectal XNasogastric or gastrostomy tube X Automatic devices for fixed dosage injection X X Topical therapeutic X X


11

• Autonomy/Independence in specialized practice area• Case management of students with health care needs• Supervision and training of school-based personnel• Participation with educational staff on the student

assistance team• Excellent benefits/ 7.5 hours per day with evenings,

weekend, holidays and summers offApplications and job description are availableonline at: www.washoe.k12.nv.us

FOR INQUIRIES, call 775-353-5966 Or email Dana Balchunas, Director of Student Health [email protected] Tina Cotter, Nursing [email protected] is an equal opportunity employer

Full andPart TimeSchoolNursePositionsWashoeCounty(Reno Area) Nevadafor 2006/2007 School Year (BSN required)

Comprehensive Cancer Centers of Nevada (CCCN) is growing and iscurrently accepting applications including the following positions:

• Nurse Supervisor• Registered Nurse – Pediatric Oncology• Registered Nurse – Adult Oncology

CCCN is the premier provider of oncology and hematology care in the Las Vegas Valley.With six clinic sites, we offer exceptional opportunities for career growth. We providea competitive salary and outstanding benefits package, which includes medical, vision,dental, life and disability insurance, 401 K contributions, holiday and vacation pay,tuition assistance, and referral bonuses. OCN bonus available.

Bi-lingual a plus. Visit our website at cccnevada.com.If you are interested in joining our team of professionals, please forward yourresume and salary requirements to:

Comprehensive CancerCenters of NevadaAttn: Human ResourcesFax: 702-952-3368CCCN is an Equal Opportunity Employer. Pre-employment drug testing is a condition of employment

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Upon the recommendation of its Nursing PracticeAdvisory Committee, the Board at its annual meetingadopted a revision to its practice decision regarding theremoval of epidural catheters by RNs. The revisiondeleted the 72-hour in situ timeframe within which RNswere allowed to remove epidural catheters. It also clari-fied that RNs may remove percutaneously insertedepidural catheters, but may not remove tunneled epidur-al catheters. Finally, it deleted the requirement for aqualified nurse to have completed his/her probationaryperiod before being allowed to perform the procedure.

The Nursing Practice Advisory Committee made therecommendation after considering a request at its regu-

lar, public meeting in June by Dr. Kevin Lasko of theAssociated Anesthesiologists of Reno. In an email tothe committee, Dr. Lasko wrote, “There is no clinicalreason or increased risk that I am aware of that wouldmake removal of a catheter in place more than 72 hoursmore difficult. The current policy creates a problem inpatient care because we are not always available to pullcatheters in a timely manner.”

In addition to input by the committee members whowork with these devices, the committee also consideredresearch provided by Noel Kerr, a clinical nurse special-ist in medical-surgical nursing with Washoe MedicalCenter in Reno.

Board Revises Epidural CatheterRemoval Practice DecisionRevision deletes 72-hour limit

Opinion Question:Can a Registered Nurse with the appropriate trainingremove an epidural catheter (as defined)?

Recommendation:The Nevada State Board of Nursing has determined

that a Registered Nurse, who has completed theappropriate training and follows all applicable compe-tency regulations under NAC 632, may be authorizedto perform the task of removing an epidural catheter,as defined, post surgery/procedure, with a physicianor CRNA order. Only nylon/silastic or derivatives ofnon/silastic catheters may be removed by a qualifiedregistered Nurse.

The following epidural catheters may not beremoved by a Registered Nurse:

1. Metal or spring epidural catheters.2. Any tunneled epidural catheter.3. Spinal cord stimulators placed in the epidural

space.

Consumer Safety:Safety is assured by following all the recommenda-

tions of this opinion which includes a specific trainingprogram and annual competency skill validation whena qualified Registered Nurse removes an epiduralcatheter (as defined), that has been placed by anAnesthesiologist or a Certified Registered Nurse

Anesthetist (CRNA). This practice would be comparableto removal of femoral sheath catheters, removal ofarterial line catheters and removal of PICC lines whichis currently within the scope of practice of aRegistered Nurse.

Removal of an epidural catheter will be the respon-sibility of the qualified Registered Nurse only afterappropriate training and documentation of catheterintegrity and site integrity. Consumer safety may bedocumented through Quality Assurance/InfectionControl monitors.

For consumer safety the qualified Registered Nursemay remove percutaneously inserted epiduralcatheters.

Intervention and documentation with a patientshould include site care and cleanliness, removal ofprotective barriers, hygiene, indications of infectionand fluid leakage.

Public Interest:The removal of an epidural catheter by a

Registered Nurse allows the patient to have a broaderoption for elective epidural pain management whilemaintaining a safe environment for the patient.Continued or additional epidural pain management isnot always a choice when a physician is responsiblefor removing the catheter at the completion of a caseor procedure.

Practitioner Safety:Only Registered Nurses with the appropriate didac-

tic and clinical return demonstration skills training, incollaboration with the facility policies and proceduralsupport, may participate in the removal of epiduralcatheters. The didactic portion of the education pro-gram should include but is not limited to, anatomy,physiology, related pharmacology, assessment, con-traindications, exceptions, emergency preparednessand intervention.

Competency Mechanisms:A specified number of return demonstrations must

be completed at the end of the initial training. Annualskills validation must be demonstrated and document-ed as part of each facilities education program. Eachnurse must meet all the competency requirements asset forth in NAC 632.

Nursing Process:Removal of an epidural catheter may be considered

within the scope of practice of the Registered Nurse andonly performed following the completion of didacticand clinical training. A policy and procedure should bedeveloped specifically for the practice, and implement-ed in each facility following the nursing process.

This procedure can be performed in any relevantdepartment of each facility by a qualified RegisteredNurse. The areas impacted by this practice change

Practice Decision Regarding Removal of an Epidural Catheter

would include obstetrical and surgical services, postanesthesia recovery units, outpatient services, ambu-latory surgical centers, critical care and medical-surgi-cal units.

Annual documentation of competency and skillswill be monitored by the Chief Nurse in accor-dance with NAC 632.224 and 632.225. Infectioncontrol monitors may be employed to measureinfection rates.

Literature Search:Included in the literature search is a position state-

ment form the American Nurses Association. This posi-tion statement was written in collaboration withDelaware Board of Nursing (6/90), Louisiana Boardof Nursing (1/90); Ohio board of Nursing (3/92);Oklahoma Board of Nursing (Fall/92); Wyomingboard of Nursing (Spring/1993); and, South CarolinaBoard of Nursing (3/93).

Additional references for revision on July 19, 2006:Hayek, S.M., Paige, B., Kapural, L., Stanton-Hicks, M.

& Mekhail, N. Complications of Tunneled EpiduralCatheters in Non-Cancer Patients with RegionalPain, Anesthesiology 2003; 99: A1111

Aram, L, Krane, E.J. Kosloski, L.J. & Yaster, M.Tunneled epidural catheters for prolonged analge-sia in pediatric patients, Anesth Analg. 2001 June:92 (6): 1432 –1438

Epidural Administration of Medication (24867) PublishDate: 9/26/2005

Pain: Clinical Manual, page 236.Copyright 1999,Mosby, Inc.

Standardization Procedures:The standard of practice is found in the position

statements noted above.

Impact: Fiscal/Manpower:Removal of epidural catheters by qualified

Registered Nurses will decrease cost to the patient byeliminating the additional visit by the physician orCRNA.

The impact on manpower will increase the continu-ity of patient nursing care. The Registered Nurse willhave the ability to assess the patient’s pain levelsprior to the removal of the epidural catheter, and withspecific physician orders, administer additional painmanagement medications through the epiduralcatheter in a more timely manner, if necessary.

Type of function:The qualified Registered Nurse will work as a team

member with the attending physician, consultingAnesthesiologist, or CRNA.

Application to Past Decision:Currently, qualified nurses in the state of Nevada

may:a. remove mediastinal drainage tubes (11/86)b. insert and remove PICC lines (12/92)

c. remove arterial linesd. remove femoral sheathse. instill reversible opioid agonists, via an epidural

catheter.

Definition of Terms:1. Epidural Catheter: Catheter placed within the

epidural space, the space is bordered anteriorly bythe duramater and posteriorly by the ligamentumflavum and that which envelops the duramaterand its contents from the foramen magnum supe-riorly to the sacrococcygeal membrane inferiorly.

2. Intrathecal Catheter: Catheter placed within thesubarachnoid space (usually at the lumbar level),the space within the dura and arachnoid layerssurrounding the spinal cord which contains spinalfluid.

3. Epidural or Spinal Analgesia: Terms applied to thepain relief produced by the administration of nar-cotics and/or dilute local anesthetic solutions intothe epidural or intrathecal space or treatment orrelief of pre-surgery pain (e.g., labor pain), post-surgery acute pain, cancer pain, chronic backpain, post-trauma pain, or for acute medical con-ditions, which may include corticosteroid treat-ments.

4. Epidural or Spinal Anesthesia: Terms applied tothe production of surgical anesthesia by local

anesthetics, sometimes in combination with nar-cotics, in which the epidural or intrathecal solutionis concentrated enough to provide a completeanesthetic for specific surgical or therapeutic (e.g.,lithotripsy) procedures within an operating room.

5. Intrapleural Catheter: Catheter placed with theintrapleural space.

6. Peripheral Nerve Infusion Device: Catheter insert-ed to block or ease pain related to specific periph-eral nerves (i.e., brachial plexus).

7. Bolus Dosing: A concentrated mass of medicationadministered at one time, in a specified time peri-od, through an intravenous and/or specializedcatheter access route via syringe, i.e. push.

8. Regulated Medication Administration DeliverySystem: An implantable devise or external elec-tronic pump designed to control, over a period oftime, the administration of the medication inorder to maintain a constant, consistent medica-tion level. This system should include a securitymethod/device which would prevent bolus dos-ing/test, i.e., PAC pump.

9. Tunneled Epidural Catheter: A catheter placed inthe epidural space and tunneled subcutaneouslyresulting in an exit site some distance away fromthe insertion site, usually the patient’s abdomen.

This practice decision is on the Board’s website underthe link Nurse Practice Act and Practice Decisions.


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Regulation revisions, many of which were recom-mended by the Board’s advisory committees, wereadopted by the Board in May, and went into effect June28, 2006. Below are highlights of some of the majorchanges. You may access the full text of the regulationsby visiting our website at www.nursingboard.state.nv.us,clicking Nurse Practice Act, then clicking on the newregulations link.

The Board first considered the concept and wordingof the regulations during its regular Board meeting inMarch. To solicit comments from the public, it thenheld a public workshop on April 27, 2006 via videocon-ference in Reno and Las Vegas, followed by a publichearing on May 17, 2006 at its regular Board meeting inLas Vegas. There were no comments received in opposi-tion to the regulations.

Board Adopts Regulations in Public Workshop, HearingRegulations involve temporary licenses, APN practice, CRNA certification requirements, CNA recording and reporting

Extend the time temporary licenses and temporary certificates validfrom four to six months. The Board issues a temporary license or certificate toapplicants who endorse into Nevada from another state while it awaits receipt ofother required documents, including fingerprint results. The Board requires appli-cants to submit fingerprints to the Nevada State Department of Public Safety (DPS)for examination and also for forwarding to the Federal Bureau of Investigation forreview. Today, the length of time it takes for DPS and the FBI to review the finger-prints is often longer than four months, and occasionally, longer than six months.This regulation change lets otherwise qualified APNs, CRNAs, RNs, LPNs, and CNAscontinue to practice while their fingerprints are being reviewed by Nevada and theFBI up to a maximum of six months (NAC 632.175, 632.195).

Clarifies that CNAs are allowed to document the care they give.Specifically, NAC 632.746 now requires nursing assistant trainees to receive class-room instruction and clinical practice in observing, reporting and recording changesin condition, abnormal signs and symptoms, as well as reporting and recording inci-dents, and reporting and recording patient care provided.

Allow APNs to perform practices which are taught to them by physi-cians or other APNS which are identified as being within their scope of practicein the Cumulative Index to Nursing and Allied Health Literature (CINAHL) that wasmost recently approved by the Board (NAC 632.255).

Clarify that an APN’s protocol must reflect the ongoing collaborativerelationship between the APN and the physician, rather than one that isdocumented only at the time of renewal (NAC 632.2555).

Replace the physician’s review of a representative sample of an APN’srecords with a more comprehensive review of the APN’s records based on a systemof quality assurance (NAC 632.256).

Remove barriers and streamline the collaborative relationshipbetween the physician and APN by deleting the requirement for a drug list(NAC 632.259). In practice, medications are not listed individually in APN proto-cols, but rather referred to in terms of classes of drugs. Drug lists are no longerrequired due to the ongoing development of new drugs.

Make the practice requirement of APNs the same as for RNs—practicewithin the last five years (NAC 632.293). In addition, the revision gives the spe-cific number of hours (800) that an APN must practice under supervision of aphysician or another APN if the APN has not practiced in the previous five years.

Define “nurse midwife.” “Nurse midwife” means a registered professionalnurse who has completed an organized formal program of training in the area ofpregnancy, childbirth, the post partum period, care of the newborn, and the fami-ly planning and gynecological needs of women. (New section, NAC Chapter 632)

Clarify that clinical nurse specialists may seek recognition as an APNif they meet the requirements for a certification of recognition by the Board pur-suant to NAC 632.260 and 632.300.

Simplify the language related to when a CRNA certificate lapses. Now,a CRNA certificate lapses automatically whenever there is a lapse in national certi-fication (NAC 632.545).

Include testing of person’s hair in the list of tests allowed to determinewhether or not a nurse or CNA has alcohol, a controlled substance, or dangerousdrug present in their body (NAC 632.890).

Major Highlights of Regulations Adopted by BoardThe regulations:

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Helen Vos, MS, RN

President, RN Member

Term expires 10/31/2008

David Burgio, MS, RN, APN

Vice President, RN Member


Dorothy Perkins, CNA

Secretary, CNA Member


Doreen Begley, MS, RN

RN Member


Joseph Cortez

Consumer Member


Mary Ann Lambert, MSN, RN

RN Member


Betty McKay, LPN

LPN Member


BOARD MEMBERSThe Nevada State Board of Nursing is a seven-member boardappointed by the governor of Nevada consisting of four registerednurses, one licensed practical nurse, one certified nursing assistant,and one consumer member.

If you wish to contact a Board member, please write c/o NevadaState Board of Nursing, 5011 Meadowood Mall Way #201, Reno,NV 89502-6547; call1-888-590-6726; or [email protected]

BOARDAUTHORITYThe Board has authorityonly over its licenseesand certificate holdersand not over the facilitiesin which these individu-als practice. The Boardenforces the NursePractice Act (the law reg-ulating nursing practice),with funding for all of itsactivities coming solelyfrom the fees paid to theBoard by licensees andcertificate holders. TheBoard does not haveauthority to take actionon issues that are of anemployment nature, orthose that relate to thenursing profession as awhole. These matters arebest dealt with by thestate labor commissioner,nursing associations,labor unions, or othersimilar entities.


In May, Board member DoreenBegley, MS, RN, was recognized as aNorthern Nevada Nurse ofAchievement in the Patient Advocacycategory. Begley, who is director ofthe University of Nevada’s OrvisNursing Clinic, was selected from 140nominations in the 13 availableaward categories.

In July, Begley was appointed to theNational Council of State Boards ofNursing (NCSBN) ResolutionsCommittee. The NCSBN is a not-for-profit organization whose membershipcomprises the boards of nursing in the50 states, the District of Columbia, andfive United States territories—American

Samoa, Guam, Northern MarianaIslands, Puerto Rico, and the VirginIslands. Its purpose is to provide anorganization through which boards ofnursing act and counsel together on mat-ters of common interest and concernaffecting the public health, safety andwelfare, including the development oflicensing examinations in nursing.

In her role as a member of theResolutions Committee, Begley will helpNCSBN identify issues, recommendpolicy directions, and make sugges-tions for change. Resolutions are pre-sented and voted upon at the NCSBNAnnual Meeting, which is attended bydelegates from all member boards.

Board Member Receives Local Award,Named to National Committee

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Meet the Staff

Chris Sansom Chris Sansom, BSN, RN, has a big

job. As director of operations, she isresponsible for manag-ing the Board’s licen-sure, certification,investigation, disci-pline, and complianceprograms. She super-vises a staff of 14,whose responsibilitiesrange from processingapplications to issuinglicenses and certifi-cates to investigatingcomplaints to answer-ing practice questionsfrom nurses andCNAs.

“I am told that thedisciplinary actionslisted in the magazineare the first area manynurses review to ‘see ifthey know anyone,’” Sansom said.“Disciplinary action taken by the Boardis critical in public protection, but theBoard does so much more than disci-pline. I would like to invite everyone toa Board or committee meeting to experi-ence for themselves the issues the Boardis involved in. All meetings are open tothe public and agendas and locations areposted on our website. The most com-mon comment I hear from someone whoattends a Board meeting for the firsttime is, ‘I had no idea you did all that!’”

Sansom joined the Board in 1994 as anurse investigator, was named associatedirector for practice in 2002, and direc-tor of operations in 2005. After earningher associate degree in nursing fromMount San Antonio CommunityCollege in Walnut, California, in 1982,she began her nursing career as a med-ical-surgical nurse in San DimasCommunity Hospital. Beginning in1984, she began working in dialysis, afield she remained in for 10 years, first asa dialysis nurse, then as a nurse manager.

Looking back on her career, Sansomreflected, “I never dreamed that one dayI would work for a board of nursing, orbecome so familiar with laws and regula-

tions. Boards werealways some far-offentity that issued mylicense.” She addedthat after almost 12years, she’s still gladshe made the choiceto work for the Board.“I am still challengedevery day, I learnsomething new nearlyevery day, I have theopportunity to be edu-cated and current onnational nursing issuesand share that infor-mation with others,and what I do makes adifference.”

In addition to han-dling her responsibili-

ties at the Board, Sansom decided to goback to school to earnher Bachelor ofScience in Nursing.Her hard work wasrecently rewarded: shenot only graduated inMay from theUniversity of Nevada,Reno’s Orvis Schoolof Nursing, she wasgiven the Arthur andMae Orvis Outstand-ing RN-BaccalaureateStudent Award.

Sansom downplaysher accomplishment,but is clearly proud ofher chosen profession:“My decision tobecome a registerednurse so many yearsago has awarded me with experiencesand opportunities I don’t think I wouldhave had in another field. I love thisprofession.”

Teri TrokeTeri Troke spends most of her time

“behind the scenes.” As executive assis-tant to Debra Scott, MS, RN, APN,the Board’s executive director, Troke isthe one who makes sure that Board andcommittee meetings run smoothly. Inaddition to making meeting roomarrangements and scheduling travel,she assembles the huge stacks of docu-ments that the Board and committeemembers review before their meetingsand helps compile and distribute agen-das and minutes.

Aside from meeting preparation, shehandles all other travel arrangements forBoard and staff; manages the executivedirector’s calendar; processes proposedregulations and bill drafts; updates,revises and maintains policy and proce-dure manuals and the employee hand-book; produces the print version of theNurse Practice Act; and serves as a liai-son among the staff, Board members,executive director, and the public.

“I really enjoy thediversity of tasks I do,”Troke said. “I’m alwayslearning new things.”

Troke joined theBoard in 2002 as amanagement assistantin the disciplinedepartment, and a yearlater, was named exec-utive assistant. Herexperience includespositions as officemanager for SouthernAir in Las Vegas;satellite operationsmanager for EquinoxInternational, also in Las Vegas; andassistant manager for Chinon America

in Torrance, California.Married to Tim, she resides in Reno

and she has three children: Whitney,Jordan, and Destiny.

Meet the StaffChris Sansom and Teri Troke

Chris Sansom, BSN, RNDirector of Operations

Teri TrokeExecutive Assistant

The following are disciplinary andlicensure/certification actions taken by theNevada State Board of Nursing for the peri-od of April 1 through May 19, 2006.Pleasenote that this list does not include some out-comes of the May 17-19, 2006, Board meet-ing due to legal notice requirements. Thoseoutcomes will be reported in a future disci-plinary actions list. This list does includesome outcomes of previous Board meetingsthat were not reported earlier due to legalnotice requirements.

Settlement Agreements and/orHearing OutcomesBaldwin, Donnell, CNA011747 Certificate revoked for violation of NRS632.320 (1) fraudulent application.

Bayless, Sherman, LPN08194 Order of Probation for violation of NRS632.320 (14) failure to comply with Boardorder.

Becerra, Manuel, CNA018060 Certificate revoked for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (33) abusing a patient.

Bell, Roberta, RN28479 Agreement for Fine of $200.00 for violation ofNRS 632.320 (7) unprofessional conduct, andNAC 632.890 (36) practicing without activelicense.

Brazier, Brenda, CNA014061 Agreement for Probation for violation of NRS632.320 (5) controlled substances.

Carroll, Mike, CNA017343 Voluntary Surrender of Certificate in Lieu ofOther Disciplinary Action for violation of NRS

632.320 (7) unprofessional conduct and (14)failing to comply with Board order and NAC632.890 (27) customary standards, (35) failingto comply, and (38) professional boundaries.

Conklin, Marie, RN37410 Agreement for Reprimand for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (35) failing to comply.

Cordle, Crystal, CNA013522 Certificate revoked for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (22) patient abandonment and (36)practicing without an active certificate.

Edney, Sally, RN25785, APN00284 Agreement for Fine of $200.00 for violation ofNRS 632.320 (7) unprofessional conduct, andNAC 632.890 (36) practicing without activelicense/certificate.

Fredrick, Diane, RN13653 Agreement for Probation for violation of NRS632.320 (5) controlled substances and (7)unprofessional conduct, and NAC 632.890 (9)impaired practice and (10) positive drug screenwhile on duty.

Glueckert, Ron, RN applicant Agreement for Probation for violation of NRS632.320 (2) criminal conviction and (12)action in another state.

Humphrey, Edna, CNA003127 Agreement for Reprimand for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (20) inaccurate recording, falsifying.

Hutchinson, Marceline, RN47507 Agreement for Probation for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (25) failing to observe/report and (27)customary standards of practice.

Kelly, Melanie, RN26608 Agreement for Probation for violation of NRS632.320 (7) unprofessional conduct, and NAC

632.890 (24) failing to collaborate with healthcare team, (25) failing to observe/report, (28)causing harm to a patient and (33) abuse orneglect of patient.

Kingas, Penelope, LPN10521 Agreement for Fine in the amount of $200.00for violation of NRS 632.320 (7) unprofession-al conduct, and NAC 632.890 (36) practicingwithout active license.

Linehan, Dana, RN25746 Voluntary Surrender of License in Lieu ofOther Disciplinary Action by the Board forviolation of NRS 632.320 (5) controlled sub-stances and/or alcohol, (7) unprofessional con-duct and (14) failing to comply with Boardorder, and NAC 632.890 (9) impaired practice,(10) positive drug screen while on duty, (18)diversion of equipment or drugs, (21) obtain,possess, furnish prescription drugs withoutauthorization, (22) patient abandonment, and(35) failing to comply.

Marchewski, Mark, RN29589 Agreement for Probation for violation of NRS632.320 (5) controlled substances and/or alco-hol and (7) unprofessional conduct, and NAC632.890 (18) diversion of equipment or drugs.

Marinelli, Anita, CNA applicantAgreement for Probation for violation of NRS632.320 (2) criminal conviction and (5) con-trolled substance and/or alcohol.

Pajari-Joseph, Sherry-Anne, RN37380 Voluntary Surrender of License in Lieu ofOther Disciplinary Action for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (27) customary standards.

Palacios, Michelle, CNA017407Agreement for Reprimand for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (22) patient abandonment.

Parra, Susana, LPN11416 Agreement for Reprimand for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (2) practicing beyond scope, (6) inap-propriate assignment/delegation, (27) custom-ary standards of practice, and (28) causingharm to patient.

Pharris, Sheree, RN24557,APN000696Order of Fine of $200.00 and class for violationof NRS 632.320 (7) unprofessional conduct,and NAC 632.890 (36) practicing without anactive license/certificate.

Roark, David, RN41470 Voluntary Surrender of License in Lieu ofOther Disciplinary Action for violation of NRS632.320 (7) unprofessional conduct, and NAC

ABBREVIATIONSNRS Nevada Revised StatutesNAC Nevada Administrative Code

Disciplinary ActionsBefore disciplinary action is taken, the Board ensures the nurse or nursing assistant is given due process

20

Please do not use this list of disciplinary actions for verifyinglicensure or certification status. Other action may have takenplace between the time the discipline was imposed and the timeof publication. To verify licensure or certification status, pleasevisit our website or call the Board.

632.890 (18) diversion of equipment or drugs.

Schneider, Jocelyn, RN applicantAgreement for Probation for violation of NRS632.320 (2) criminal conviction.

Simmons, Victoria, LPN08121 Agreement for Extension of Probation for vio-lation of NRS 632.320 (14) failing to complywith Board order.

St. Pierre, Kimberlie, CNA01895Voluntary Surrender of Certificate in Lieu ofOther Disciplinary Action for violation ofNRS 632.320 (5) controlled substances and/oralcohol and (7) unprofessional conduct, andNAC 632.890 (10) positive drug screen whileon duty.

Turner, Kristin, RN46453Agreement for Reprimand for violation ofNRS 632.320 (7) unprofessional conduct, andNAC 632.890 (13) confidentiality violationand (18) diversion of equipment or drugs.

Turner, Michael, CNA016511Certificate revoked for violation of NRS632.320 (7) unprofessional conduct, and NAC632.890 (27) customary standards of practiceand (28) causing harm to a patient.

Wilkes, Jennifer, RN44469Agreement for Probation for violation of NRS632.320 (2) criminal conviction, and (12)action in another state.

Yu, Roselyn, RN36198Agreement for Probation for violation of NRS632.320 (2) unprofessional conduct, and NAC632.890 (20) inaccurate recording, falsifying,(24) failing to collaborate with health careteam, and (27) customary standards of practice.

Denials of Applications forLicensure or Certification Aquino, Soledad, RN applicantApplication denied for violation of NRS632.320 (7) unprofessional conduct, andNAC 632.890 (36) practicing without activelicense.

Candilenia, Glenn, RN applicant Application denied for violation of NRS632.320 (1) fraudulent application and (12)action in another state.

Cherry, James, RN applicant Application denied for violation of NRS632.320 (1) fraudulent application, (5) con-trolled substances and (7) unprofessionalconduct, and NAC 632.890 (16) failing toproperly document controlled substances and(18) diversion of drugs.

Riggs, Jennifer, RN applicant Application denied for violation of NRS632.140 (2) qualifications and fee for appli-cants for license

Vivar, Joseph, CNA applicantApplication denied for violation of NRS632.320 (7) unprofessional conduct, andNAC 632.890 (27) customary standards and(33) abuse/neglect of patient

Perkins, Doris, RN35022 Application denied for violation of NRS632.320 (12) action in another state

Beagle, Lisa, CNA applicantCao, Ginger, LPN applicantHilliard-Maxie, Lisa, LPN applicant Williams, Colleen, LPN applicant Above applications denied for violation ofNRS 632.320 (1) is guilty of fraud or deceitin procuring or attempting to procure alicense or certificate pursuant to this chapter.

Green-Guinan, Marilyn, CNA013620Halili, Criselda, CNA applicantHarris, Erica, CNA012163Khan, Sherry, RN37884 Rainey, Shmyra, CNA013759 Sherman, Tisha, LPN applicantAbove applications denied for violation ofNRS 632.320 (2) is guilty of a felony or anyoffense (a) involving moral turpitude; or (b)related to the qualifications, functions orduties of a licensee or holder of a certificate,in such case the record of conviction is con-clusive evidence thereof.

Citation for Practicing Without A CertificateWhite, LindseyMartinez, Nicole Maria (aka ShannaPatterson and Shanna Martinez)

Findings of Guilt for Abuse,Neglect or MisappropriationPlaced on the Certified NursingAssistant Registry by the NevadaState Health Division’s Bureau ofLicensure and Certification Smith, Elizabeth, CNA 017803Verbal Abuse/Neglect

Stribling, Nicole, CNA 018440Verbal Abuse

Who can I call if I have questions about the complaint or discipli-nary process? The Board encourages you to call any time youhave a question about the disciplinary process or what constitutesa violation of the Nurse Practice Act. Just call the Board and askfor one of the nurse investigators or the director of operations.

What are common types of disciplinary actions?When considering what kind of disciplinary action itshould take, the Board always asks itself, “What isneeded to make this person safe to practice?” Theanswer depends on the nature of the violation, andcan range from reprimanding an individual andordering the person to attend a remedial class torevoking the person’s license or certificate. All disci-plinary action is reported to national disciplinarydata banks. Outlined in the Nurse Practice Act, NRS632.325, disciplinary actions available to theBoard include:

Denial of ApplicationIf the Board denies an application for licensure orcertification, it has determined that the individualviolated the Nurse Practice Act. In most cases, thedenial is due to criminal convictions and/or submit-ting a fraudulent application.

Reprimand and/or FineIf the Board reprimands or fines a nurse or CNA, ithas determined that the individual violated theNurse Practice Act. This action does not prohibit orrestrict the individual’s practice.

ProbationIf the Board puts an individual on probation, itmeans the nurse or CNA may work, but will beworking on a restricted license or certificate andmonitored by the Board for a specific time period.The probation may also include practice and/orsetting restrictions and requirements like classes orrandom drug tests.

SuspensionIf the Board suspends a license or certificate, itmeans the nurse or CNA is prohibited from practic-ing for a designated time period.

Voluntary SurrenderThis means the nurse or CNA has agreed to volun-tarily surrender his or her license or certificate andcannot practice in Nevada. If the person applies forreinstatement, the Board weighs evidence of reha-bilitation and remediation when considering theapplication.

RevocationIf the Board revokes a license or certificate, itmeans the nurse or CNA cannot practice in Nevadafor a minimum of one to a maximum of 10 years.After that time, the nurse or CNA may apply forreinstatement if all the requirements in the orderof revocation have been met. The Board weighsevidence of rehabilitation and remediation whenconsidering the application.

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Debra Scott, MS, RN, APN, Executive DirectorStatewide Liaison and SpokespersonOrganizational and Public ManagementFiscal and Human Resource ManagementLegislative and Governmental RelationsAPN Advisory Committee ChairNursing Practice Advisory Committee Chair

Chris Sansom, BSN, RN, Director of Operations Program Management

Patty Shutt, LPN, Site Operations SupervisorLas Vegas Site Supervision

Donna Cowling, MSN, RN, Education ConsultantNursing Education ProgramsCNA Training ProgramsCNA Advisory Committee ChairContinuing Education ProgramsEducation Advisory Committee Chair

Fred Olmstead, General CounselLegal Counsel

Dean Estes, Accountant/Technology OfficerBudget, Accounting and PayrollProgrammingTechnology Support

Cindy Kimball, Public Information OfficerPublic Information and EducationConsumer RelationsNews Magazine, Web Site, Publications

Teri Troke, Executive AssistantAssistant to the Executive Director SchedulingBoard Meeting Agenda and Arrangements Nurse Practice Act Publication

Administration5011 Meadowood Mall Way, Suite 201, Reno, NV 89502, 888-590-6726

[email protected]

Investigations and MonitoringLinda Aure, BSN, RN, C, Senior Investigator

Complaint InvestigationsNursing Practice Questions

Lark Muncy, RN, Investigator Complaint InvestigationsNursing Practice Questions

Kathleen Reynolds, BHS, RN, ComplianceCoordinator Disability Advisory Committee ChairDisability Advisory Committee SchedulingProbation and Alternative Program Monitoring

Licensure/CertificationSarah Bowen, Licensure Specialist

Licensure Eligibility QuestionsRenewal ApplicationsEndorsement and Examination ApplicationsContinuing Education ProvidersForeign Nurse Graduates and Licensure Issues

Patty Towler, Senior Certification Specialist CNA Registry MaintenanceCNA Certification and RenewalsCNA Program and Instructor Approvals

Molly Echandy, Licensure/Certification Clerk Licensure Eligibility QuestionsRenewal ApplicationsEndorsement and Examination ApplicationsContinuing Education ProvidersForeign Nurse Graduates and Licensure IssuesCNA Certification and Renewals

SupportSherrie Frederick, Fingerprint Specialist

Endorsement FormsFingerprint ProcessingFingerprint Report Screening

Christie Daliposon, Management Assistant Assistant to the Director of OperationsDiscipline Investigative SupportCompliance SupportBoard Meeting PreparationDisability Advisory Committee Scheduling

Cyndie Souza, Management Assistant Discipline Investigative SupportYes Answer and Fraudulent Application ProcessingBoard Meeting Preparation NURsys Data Entry

Mallory Goodrich, Kelly Narte, Receptionists Renewal ApplicationsProgram SupportInquiries, Information and ReferralsLicensure and Certification ApplicationsNursing Personnel Lists

Adela Smith, Receptionist Program SupportInquiries, Information and ReferralsLicensure and Certification ApplicationsSpanish-Speaking Services for Consumers

Program Staff 5011 Meadowood Mall Way, Suite 201, Reno, NV 89502, 888-590-67262500 W. Sahara Ave., Suite 207, Las Vegas, NV 89102, 888-590-6726

[email protected]

Have a question? Give us a call. NURSINGNevada State Board of

What’s in it for you at HCA: Competitive

compensation and benefits practices including benefit

eligibility on your 31st day; medical/dental/life/LTD;

childcare subsidy; 401(k); discounted Employee Stock

Purchase Plan; relocation assistance program; and

ability to transfer to other HCA affiliated hospitals.

Please send your resume to: MountainView Hospital Care of Human Resources, 3100 N.Tenaya Way, Las Vegas, NV 89128.Jobline: (702) 255-5135 • Call Natalie Gardner, RN: (702) 562-5508

Fax: (702) 233-5301 www.MountainView-Hospital.comA drug test and background investigaton are required as part of our pre-employment process. EOE M/V/F/D HCA is a registered

service mark of HCA Inc., Nashville,TN.

MountainView Hospital is a provider of compassionate, quality health care in the heart of Northwest LasVegas. Our 235 bed, full-service facility is big enough to serve the needs of a rapidly-growing community,but small enough for your contributions to have a definite impact. MountainView is more than a hospital.It’s the place our friends and neighbors turn in time of need. We’ve earned their trust. Let us earn yours.Right now, we have incredible opportunities in our Nursing Departments.

You’re part of a community.

You’re not just partof a hospital...You’re not just partof a hospital...

You’re part of a community.

• Case Mgm (per diem)

• ER

• Float Pool: ICU &Med/Surg/Tele

• ICU

• Infection ControlNurse

• L&D

• Medical Imaging

• Med/Surg/Tele

• Nursery (per diem)

• Nursery Level II (per diem)

• Observation Unit

• PACU

• Post-Partum

• Progressive Care Unit

• Surgery

Nevada State Board of Nursing5011 Meadowood Mall Way, Suite 201Reno, NV 89502-6547

PRESORTEDSTANDARD

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P A I DLITTLE ROCK, ARPERMIT NO. 1884

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