Board News

25 Pages·2016·0.96 MB·English

Massachusetts Board of Registration in Nursing

Board News
Fiscal Year 2016
August 2016 Volume 11 | Number 1
Mission Table of Contents
The mission of the Board of Registration in New Law in Fight Against Opioid
Nursing is to protect the health, safety and Overdose Epidemic: Implications for
welfare of the citizens of the Commonwealth APRN Prescribers. . . . . . . . . . . . . . . . . . . 2
through the fair and consistent application of Board Appoints New Executive and
the statutes and regulations governing nursing Deputy Executive Directors. . . . . . . . . . . . 4
practice and nursing education. Nursing Board Elects FY2017 Officers . . . .5
Board Members Extend Their
Fiscal Year 2016 Board Members
Appreciation to Outgoing Members . . . . . .6
Katherine Gehly, MS, CNP, Chairperson
Governor Appoints New Board Members . .6
Patricia Gales, RN, MS, Vice Chairperson
Sara Abbott, Consumer (appointed Oct. 2015) Board Member Vacancies . . . . . . . . . . . . .6
Anthony Alley, RN (until Feb. 2016) Updates on Nursing Practice Laws
Margaret Beal, PhD, CNM and Regulations . . . . . . . . . . . . . . . . . . . .7
Jackie Fantes, MD (appointed April 2016)
Nursing Practice Updates . . . . . . . . . . . . .9
Lori Keough, PhD, CNP (appointed May 2016)
Pre-Licensure Nursing Education. . . . . . . . 11
Joan Killion, LPN
Complaint Resolution and Patient Safety. . . 14
Colleen LaBelle, BSN, RN (appointed Nov. 2015)
Barbara Levin, RN, BSN (excluding Nov. 2015 to Substance Abuse Rehabilitation Program . .16
Feb. 2016)
Massachusetts Nurse Workforce. . . . . . . . 18
Ann-Marie Peckham, RN, MSN/MBA
Massachusetts Nurse Licensure. . . . . . . . . 19
E. Richard Rothmund, Consumer (until Jan. 2016)
Nursing Board (BRN) and Division of
Catherine L. Simonian, RPh, PharmD
Health Professions Licensure (DHPL) Staff. . 23
Susan Taylor, MSN, RN (until April 2016)
Christine Tebaldi, MS, CNP BORN Quick Links . . . . . . . . . . . . . . . . . .24
Cheryl Urena, LPN Contacting the Board . . . . . . . . . . . . . . . .25
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Board News August 2016 | Volume 11 | Number 1
New Law in Fight
Against Opioid
Overdose Epidemic:
Implications for
7 Day Restriction on Supply of
Prescribed Opioids
APRN Prescribers
Effective immediately, the new law establishes
Data available from the MA Department a maximum seven day supply on opioid
of Public Health indicates the number of prescriptions when issued to an adult for the
confirmed unintentional opioid deaths for first time. It also limits an opioid prescription
2015 (n=1531) represents an 18% increase for minors to a maximum seven day supply. A
over 2014 (n-1294) while the number of prescriber may issue a prescription for more
confirmed unintentional opioid deaths in than a seven day supply of an opioid to adult
2014 represents a 41% increase over cases or minor patients if, in the prescriber’s medical
in 2013 (n=918)1. Sadly, the estimated rate of judgment, a greater supply is necessary to
unintentional opioid-related overdose deaths treat an acute medical condition, chronic pain,
was 24.6 deaths per 100,000 residents in pain associated with a cancer diagnosis or for
2015 representing a 23% increase from the palliative care. In such a case, the condition
rate of 20 deaths per 100,000 residents must be documented in the patient’s medical
in 20142. record and the prescriber must indicate that
a non-opioid alternative was not appropriate
The data also indicates an alarming link to address the medical condition. The new law
between fentanyl and opioid-related deaths. does not apply to opioid medications that are
Among the 1319 opioid-related deaths in designed for the treatment of substance abuse
2015 in which a toxicology screen was also or opioid dependence.
available, over 50% had a positive screen for
fentanyl3, the synthetic opioid prescription Additionally, the law enables patients to direct
pain killer with effects similar to heroin. pharmacies to dispense less than the fully
prescribed quantity of an opioid. Whenever
In response to this growing epidemic, a prescriber issues a Schedule II opioid, the
Governor Charlie Baker signed landmark prescriber must:
legislation into law in March 2016 to address
the Commonwealth’s opioid crisis. Chapter 1. consult with the patient regarding the
52 of the Acts of 2016 represents a multi- quantity of the opioid prescribed and the
pronged approach in the fight against patient’s option to request the prescription
this devastating epidemic by focusing on be filled in a reduced quantity; and
prevention, education, treatment and
recovery. The Board of Registration in Nursing 2. inform the patient of the risks associated
takes this opportunity to highlight three of with the opioid. If dispensed in a lesser
the statutory requirements designed to curb amount, the prescription is void as to the
opioid misuse. unfilled quantity.
continued on page 3
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Board News August 2016 | Volume 11 | Number 1
New Law in Fight against Opioid Overdose
Epidemic: Implications for APRN Prescribers,
continued from page 2
Online PMP Check Required for • identification of patients at risk for
Each Schedule II and III Prescription substance use disorders;
Beginning October 15, 2016
• counseling patients about the side effects,
Effective October 15, 2016, prescribers will be addictive nature and proper storage and
required to use the Massachusetts Prescription disposal of prescription medications;
Awareness Tool (MassPAT), the new online
PMP, each time the prescriber issues a • appropriate prescription quantities for
prescription for a narcotic drug contained in prescription medications that have an
Schedules II and III. Prescribers must also check increased risk of abuse; and
MassPAT when prescribing a benzodiazepine
or DPH designated drugs in Schedule IV • opioid antagonists, overdose prevention
through VI for the first time (Gabapentin and treatments and instances in which a
its chemical equivalents are designated as patient may be advised on both the use of
“additional drugs” pursuant to chapter 52 of and ways to access opioid antagonists and
the acts of 2016). overdose prevention treatments.
The MassPAT will go live August 22, 2016. This new continuing education requirement
Online registration for MassPAT is now open must be fulfilled as a prerequisite to initial
(users will not be able to conduct patient application for a MA Controlled Substance
searches in MassPAT until August 22, 2016). Registration and subsequently during each
APRN license renewal period, and it must be
For more information, including how to consistent with 244 CMR 5.00: Continuing
access MassPAT, visit the Prescription Education. The APRN prescriber will be
Monitoring Program website at required to attest under the penalties of
www.mass.gov/dph/dcp/pmp. perjury to complying with M.G.L. c. 94C,
§ 18(e) when signing the Massachusetts
Additional Mandatory Prescriber Controlled Substance Registration form
Education Requirement and the nursing license/APRN authorization
renewal form.
All APRN prescribers are now required to
complete education related to: References
• effective pain management; 1. MA Department of Public Health. Data Brief: Opioid-
related Overdose Deaths among Massachusetts
• the risks of abuse and addiction Residents. Posted August 2016.
associated with opioid medication; 2. Ibid.
3. Ibid.
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Board News August 2016 | Volume 11 | Number 1
Board Appoints New
Executive and Deputy
Executive Directors
The Board of Registration in Nursing (Board) The Board has also appointed Claire
has appointed Lorena Silva, MSN-L, MBA, MacDonald, MSN, DNP, RN, to the position
DNP, RN, as its new Executive Director. of Deputy Executive Director.
Executive Director Lorena Silva. Deputy Executive Director
Claire MacDonald.
An accomplished nurse executive and
educator, Dr. Silva brings a national Dr. MacDonald has served in several
perspective to her new role having served in leadership roles in academia and acute care in
leadership positions in Arizona, California and the Commonwealth. Prior to her appointment,
North Carolina. Most recently, she was the she was a Professional Development Specialist
Chief Operating Officer and Chief Nursing of a large academic medical center.
Officer at a large healthcare network.
Dr. MacDonald will assist the Executive
As its Chief Executive Officer, Dr. Silva Director in managing the Board’s
will oversee and direct the Board’s daily daily operations.
operations related to:
Both Drs. Silva and MacDonald began their
• the licensure of over 120,000 Licensed positions in January 2016.
Practical Nurses, Registered Nurses and
Advanced Practice Registered Nurses;
• the administration of the Board’s Substance
Abuse Rehabilitation Program; and
• the regulation of nursing practice and
education including the approval of 75
Registered Nurse and Licensed Practical
Nurse education programs.
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Board News August 2016 | Volume 11 | Number 1
Nursing Board
Elects Fiscal Year
2017 Officers
Members of the Board of Registration in Nursing (Board) elected their Fiscal Year 2017 officers
during the Board’s June 8, 2016, meeting. Associate Degree-RN educator, Katherine Gehly, MS,
CNP, was re-elected as the Board’s Chairperson. Ms. Gehly is the Assistant Division Dean for
Nursing at community college and a certified Pediatric Nurse Practitioner. Barbara Levin, BSN,
RN, was elected Vice-Chairperson. She is a Registered Nurse in the Orthopedic Trauma Unit of an
academic medical center.
Lorena Silva, Executive Director (far right), congratulates Katherine Gehly (center right), on her re-election
as Board Chairperson as Deputy Executive Director, Claire MacDonald (far left) and newly elected Vice-
Chairperson, Barbara Levin (center left) look on.
For a list of the Fiscal Year 2017 meeting dates, visit the Board’s website at
www.mass.gov/dph/boards/rn, click on “About the Board of Registration in Nursing” and then on
the link to the BORN calendar. Minutes of the Board’s regularly scheduled monthly meetings are
published on the Minutes and Agendas of Previous Board Meetings webpage.
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Board News August 2016 | Volume 11 | Number 1
Board Members Governor
Extend Their Appoints New
Appreciation to Board Members
Outgoing Members
Governor Baker recently appointed three
new members to the Board of Registration
During Fiscal Year 2016, members and in Nursing (Board). The Board is pleased to
staff of the Board of Registration in Nursing welcome Jackie Fantes, MD, FAAFP (Physician),
extended their sincere appreciation to Chief Medical Officer of a metro Boston
outgoing Board members, Anthony Alley community health center; Lori Keough, PhD,
(RN - Direct Care), E. Richard Rothmund CNP (Advanced Practice RN), who practices
(Consumer) and Susan Taylor (Educator, in a substance use disorder treatment center;
Hospital-Based Diploma Program) for their and Gail Dufault, LPN, a Transitional Healthcare
service on behalf of the residents of Coordinator for a law enforcement agency. The
the Commonwealth. Governor has also reappointed former member,
Barbara Levin, BSN, RN, (RN - Direct Care).
Board Member Vacancies
The composition of the 17-member Board is established at M.G.L., Chapter 13, §13, and includes a
total of nine Registered Nurses, four Licensed Practical Nurses, one physician, one pharmacist and
two public members. Both the Registered Nurse and Licensed Practical Nurse members are required
to include representation from long-term care, acute care, and community health practice settings.
Additionally, among the nine Registered Nurses, there must be:
• one representative from each level of nursing education whose graduates are eligible to
write nursing licensure examinations (baccalaureate and higher degree programs are
considered be considered one level);
• two Registered Nurses in advanced practice, at least one of whom is employed providing
direct patient care at the time of appointment;
• one Registered Nurse who is currently employed as a nursing service administrator and
who is responsible for agency or service wide policy development and implementation; and
• two Registered Nurses not authorized in advanced nursing practice and who provide
direct patient care.
The statute also specifies that the consumer board member must be knowledgeable in consumer health
concerns and have no current or prior association, directly or indirectly, with the provision of health care.
continued on page 7
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Board News August 2016 | Volume 11 | Number 1
Updates on
Board Member Vacancies
continued from page 6
Nursing Practice Laws
and Regulations
Currently, there are three vacant seats on the Executive Order 562 Regulatory Review
Board: Licensed Practical Nurse; Educator
representing Hospital-Based Diploma Issued by Governor Baker on March 31,
Education; and Consumer. To be eligible for a 2015, Executive Order 562 charged all
Board appointment, potential members must state agencies to undertake a review of
meet criteria established at M.G.L., Chapter each regulation currently published in the
13, §13 which include residency in the Code of Massachusetts Regulations under
Commonwealth. Nurse members must: its jurisdiction. It further calls for the sunset
of a regulation through rescission, revision
• hold current licensure as a Registered or simplification unless the regulation is
Nurse or Licensed Practical Nurse; mandated by law or essential to the health,
safety, environment or welfare of the
• possess at least eight years of nursing Commonwealth’s residents. In response,
practice experience in the ten years the Board of Registration in Nursing (Board)
immediately preceding appointment; and began a multi-step process to review its
regulations published at 244 CMR 3.00
• be employed in the Commonwealth as through 9.00.
a nurse.
The resulting proposed revisions to
Appointments to the Board are made by the 244 CMR were approved by the Board at
Governor for a three-year term; members may its December 2015 meeting when it also
serve no more than two consecutive terms or authorized the submission of the revisions
until a successor is appointed. All members are for approval by the Executive Office of
subject to the State Conflict of Interest and Health and Human Services (EOHHS) and
Ethics Law in accordance with M.G.L. Part IV, the Executive Office of Administration and
Title I, c. 268A. Finance (ANF) in compliance with Executive
Order 562. The proposed revisions are
Individuals who are interested in an appointment intended to incorporate:
to the Board should submit a letter of intent and
current resume to: • Extensive and substantive updates to
the regulations proposed by Board-
James Lavery, Director appointed task forces including 244
Division of Health Professions Licensure CMR 3.00 with respect to delegation to
239 Causeway Street unlicensed persons and 244 CMR 6.00
Boston, MA 02114. designed to modernize standards and
streamline the process for the approval
of Registered Nurse and Practical Nurse
education programs;
continued on page 8
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Board News August 2016 | Volume 11 | Number 1
Updates on Nursing Practice Laws
and Regulations
continued from page 7
• Recent changes to statutes that impose 10.00 and a public hearing has been scheduled
conditions on nurse licensure such as St. for October 4, 2016. Details regarding the
2010, c. 283, An Act Adding Safeguards to hearing’s time and location will be posted on
the Prescription Monitoring Program and the Board’s website when available and will
Furthering Substance Abuse Education also be published at least 21 days before the
and Prevention which added M.L.G. C. hearing in selected daily newspapers with
94C, §18(e) requiring Advanced Practice broad distribution.
Registered Nurses who prescribe to
complete training in topics relating to The Board will review all of the comments
pain management, substance abuse it receives at the hearing during a regularly
and counseling and the new mandatory scheduled open meeting and based on
domestic violence training requirement the public’s feedback, it may make further
specified at M.G.L. c. 260, §9 of the Acts revisions to the regulations.
of 2014 (see following article);
Domestic Violence Training
• Technical corrections to 244 CMR 4.00 Requirement for Licensure
concerning provisions applicable to
the practice of certified registered M.G.L. c. 112, § 264 requires the boards of
nurse anesthetists; registration in nursing, medicine, nursing home
administrators, physician assistants, social
• Codification of licensee and applicant workers, psychologists and allied mental health
responsibilities with respect to license and human services to promulgate regulations
renewal and the information submitted establishing standards that require training on
to the Board in connection with the issue of domestic and sexual violence as a
any application; condition of licensure and license renewal.
• A newly created chapter of “definitions” to The Board’s proposed regulations are
promote internal consistency within 244 currently progressing through the
CMR; and administrative review process. Once this
process is completed, the Board will convene
• Greater efficiency and consistency in the a hearing at which the public may submit
initiation, investigation and handling of oral and written comments on the proposed
complaints across all boards within the regulations. Information about the hearing will
Division of Health Professions Licensure. be posted on the Board’s website as soon as it
is available. Nurses are encouraged to consult
As of this writing, the Board has received the Board’s website regularly to stay abreast
EOHHS and ANF approval for the proposed of further developments.
revisions at 244 CMR 3.00, 6.00, 7.00 and
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Board News August 2016 | Volume 11 | Number 1
Nursing Practice
Updates
During Fiscal Year 2016, the Board of when renewing their APRN authorization. To
Registration in Nursing (Board) responded to avoid delays in authorization renewal, be sure
1858 inquiries from nurses, employers and to provide the certification number only (do not
health care organizations related to scope provide the Registered Nurse license number in
and standards of nursing practice, advanced lieu of the APRN certification number).
nursing practice, continuing education,
statutes and regulations governing nursing, Should an APRN’s certification lapse for any
and trends in health care delivery. reason, the APRN must inform the Board
by completing a Request to remove APRN
authorization form and cease APRN practice
until such time that certification becomes
Practice scope
current (there is no “grace period”). Once
APRN practice
Licensing/GMC the re-certification process is successfully
Complaint completed, the APRN can complete a Request
CE to reinstate APRN authorization. Upon
Regulations receipt of the form, the Board will verify the
Duty to report
certification as current and will update the
Employment P/P
Board’s license verification website, and the
Other
APRN may return to practice. It is an APRN
professional responsibility to meet the initial
Figure 1: FY 2016 Practice Inquiries by Type and continued certification requirements of the
Board approved certifying organization. APRNs
APRN Certification Collected with should contact their certifying organization for
Authorization Renewal additional certification information.
In order to maintain the Board’s authorization Board Issues Revised Advisory Rulings
to engage in advanced nursing practice, an
Advanced Practice Registered Nurse (APRN) Authorized at M.G.L. c. 30A, § 8, the Board
must hold current APRN certification from a may issue an Advisory Ruling with respect
Board-approved certifying organization to the applicability of a statute or regulation
[ref: 244 CMR 9.04(4) and 244 CMR 4.05]. that it enforces or administers. The Board’s
Nursing Practice Advisory Panel reviews each
As a result, APRNs are required to inform the advisory at three-year intervals to ensure it
Board of their current certification including reflects evidence-based standards of practice
the name of their Board-recognized APRN and makes recommendations to the Board.
certification agency (i.e. ANCC, AANP, NCC, During Fiscal Year 2016, the Board updated
PNCB, AACN, AMCB, NBCRNA), certification the following Advisory Rulings in accordance
number and expiration date (mm/dd/year) with its systematic review schedule:
continued on page 10
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Board News August 2016 | Volume 11 | Number 1
Nursing Practice Updates
continued from page 9
• 0801: Withholding Initiation of CPR in Massachusetts nurse licensure. The Board of
Long Term Care Facilities Registration in Nursing reminds all nurses that it
is unlawful for an RN or LPN student employed
• 9401: The Role of the Licensed Nurse As Trainer as an unlicensed assistive person (UAP) to
or Consultant for the DPH MAP Program perform nursing activities requiring a nursing
license such as medication administration when
• 0201: Nurse Practitioner as First the student is functioning as an UAP.
Assistant in Cardiac Catheterization
Nursys E-Notify Available Free-of-
• 9802: Licensed Practical Nurse as Charge to Nurses and Employers
Charge Nurse/Nurse Supervisor
The National Council of State Boards of
• 9801: Holistic Nursing and Nursing now provides automatic license status
Complementary/Alternative Modalities notifications free of charge to LPNs, RNs and
APRNS who enroll through Nursys e-Notify.
• 0802: The Use of a Vagal Nerve Nurses can self-enroll in Nursys e-Notify to
Stimulator Magnet receive license status updates, track license
verifications, and create and manage multiple
• 9804: Administration of Immunizing license expiration reminders.
Agents or Vaccines
Nursys E-Notify also automatically provides
In each of its advisories, the Board affirms licensure, discipline and publicly available
that the licensed nurse is responsible and notifications to enrolled institutions that
accountable for acquiring and maintaining the employ nurses. The e-Notify system alerts
knowledge, skills and abilities (i.e. competencies) subscribers when a modification is made to
necessary to practice in accordance with a nurse’s record including changes to license
accepted standards. The Board’s Advisory status, license expiration, license renewal and
Rulings on Nursing Practice can be found in the public disciplinary action/resolution and alerts.
Nursing Practice section of the Board’s website. If a nurse’s license is about to expire, the system
will notify the institution of the expiration date.
Reminder Related to RN and LPN It will also inform the institution if a nurse is
Students Employed as Unlicensed disciplined by a board of nursing.
Assistive Personnel
M.G.L. c. 112, § 80B, exempts pre-licensure
nursing students enrolled in a clinical course of an
approved Registered Nurse (RN) and Licensed To learn more about the Nursys e-Notify and
Practical Nurse (LPN) education program from to enroll, visit www.nursys.com/e-notify.
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