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					                                                                                                                                    DRAFT
                                                              NEW HAMPSHIRE BOARD OF NURSING
                                                                         MINUTES
                                                                       March 16, 2006
Recorder: Kathryn Dickson, Executive Secretary

                TOPIC                                DISCUSSION                                       ACTION                        FOLLOW-UP
1.0   Call to Meeting                     Board welcomed nursing students from          Meeting called to order at 8:30 a.m. with
                                          Rivier.                                       T. Bloomquist, Chair (TB) presiding.
                                                                                        Board members present: R. Duhaime
                                          New Board member, Christine Naas, LPN,        (RD), G. Barba (GB), H. Featherston
                                          from Southern NH Medical Center was           (HF), M. Potter (MP), L. Morel (LM), B.
                                          introduced.                                   Howard (BH), S. Dyer (SD), K. A. Day
                                                                                        (KAD), M. Danderson (MD) and non-
                                                                                        voting member today, C. Naas, (CN).
                                                                                        Board staff present: M. Walker (MW), J.
                                                                                        Evans (JE), S. Goodness (SG), K. Dickson
                                                                                        (KD).
                                                                                        Absent: N. Patenaude, Investigator/
                                                                                        Prosecutor (NP) (MW presiding in NP’s
                                                                                        absence).

      1.1 Open Forum                      Deborah Lindberg, RN, BSN, MBA, from
                                          Dartmouth Hitchcock Medical Center
                                          requested clarification of Board’s decision
                                          that is it not within RN scope of practice
                                          to complete paracentesis procedure started
                                          by provider.

      1.2 Addendum
          1.2.1 Additions                                                               7.2.1    C. B. Settlement Agreement
                                                                                        10.1.1.1 Holden Health Career Training
                                                                                                 Center
                                                                                        11.1.1 Candidate for Membership on
                                                                                                 ARNP Liaison Committee
                                                                                        11.2.1 P & E Recommendations

         1.2.2   Deletions                None

         1.2.3   Appearances                                                            1.1    D. L.                   8:30 a.m.
                                                                                        10.1.3 First Choice           11:00 a.m.
                                                                                        8.1.1 C. B.                    1:00 a.m.
                                                                                                                                           Board Minutes
                                                                                                                                           March 16, 2006
                                                                                                                                             Page 1 of 12
               TOPIC                                   DISCUSSION                                   ACTION                              FOLLOW-UP
                                                                                       8.1.2 L. T. (Telephone)       1:15 p.m.
                                                                                       10.3.1 CareMed                2:00 p.m.
                                                                                       10.1.1 Holden Health Career   2:30 p.m.

7.0   Adjudicative (Investigator/
      Prosecutor)
      7.2 Consent Decree/Settlement
           Agreement/Voluntary
           Surrender/ Reciprocal
           Discipline
           7.2.1 C. B. RN                  Reviewed and discussed with C. B. and       M/HF, S/SD to accept proposed              MW to respond.
                                           her attorney, Michael Craig Settlement      Settlement Agreement as written.
                                           Agreement signed on March 13, 2006.         Yea: HF, SD, RD
                                                                                       Nay: LM, BH, MD, MP, GB, KAD
                                                                                       Motion fails. Proposed Settlement
                                                                                       Agreement denied.

                                                                                       M/RD, S/GB to move to executive session
                                                                                       at 8:55 a.m.
                                                                                       Unanimous.

                                                                                       M/RD, S/LM to reconvene public meeting
                                                                                       at 9:00 a.m.
                                                                                       Unanimous.

2.0   Approval of minutes
      2.1 February 16, 2006                Reviewed and discussed.                     M/HF, S/MP to accept minutes as written.
                                                                                       Unanimous (See approved February 16,
                                                                                       2006 minutes.)


3.0   Report of Chair/Members
      3.1 Nursing Compact Rules            Board held public hearing on February 16,   M/HF, S/LM to approve Nur 1000 rules as    MW to contact Attorney Mott-Smith to
                                           2006 for Nur 1000 Administrative Rules      written.                                   file document for Joint Legislative
                                           related to Nursing Compact. There have      Unanimous.                                 Committee on Administrative Rules
                                           been no comments received.                                                             review.

4.0   Report of Executive Director/Staff
      4.1.1 Expense Summary Budget
            (Through 3/6/06)
            7430, 7431, 7432               FYI.


                                                                                                                                                          Board Minutes
                                                                                                                                                          March 16, 2006
                                                                                                                                                            Page 2 of 12
                TOPIC                                   DISCUSSION                                      ACTION                              FOLLOW-UP
      4.1.2 Delivery of Prescriptions by   Reviewed and discussed letter received
            Visiting Nurse                 from Board of Pharmacy related to
                                           delivery of prescriptions by visiting
                                           nurses:

                                            “Provided that patient/client is unable to
                                           physically accept prescription medications
                                           mailed to his/her home address or for
                                           patients housed in skilled nursing facilities
                                           (or other public facilities) that do not
                                           accept delivery from public couriers, such
                                           prescription medications may be delivered
                                           to local VNA office and consequently
                                           delivered, by an agency nurse, directly to
                                           physical location of patient/client. Process
                                           is allowed only when patient/client
                                           specific prescription medications are being
                                           shipped from mail-order pharmacy, as
                                           defined in Ph 902.01(a), and authorized by
                                           Ph 907.01(e)(4) of NH Code of
                                           Administrative Rules. Delivery of
                                           prescription medications originating from
                                           local pharmacies must be made directly to
                                           patient’s/client’s physical location and
                                           does not allow for process described
                                           above.”

6.0   Report of Investigator/Prosecutor
      6.1   Open files                                                                     Discussion deferred until April meeting
                                                                                           when Investigator/Prosecutor is present.
7.0   Adjudicative (Investigator/
      Prosecutor)
      7.1 Hearings
           7.1.1 N. L.                     Reviewed and discussed request from             M/BH, S/MP to continue to April 20,        MW to respond.
                  Motion to Continue       Investigator/Prosecutor to continue N. L.       2006 meeting.
                                           matter until April 20, 2006 meeting.            Unanimous.


      7.2 Consent Decree/Settlement
          Agreement/Voluntary
          Surrender/Reciprocal
          Discipline

                                                                                                                                                        Board Minutes
                                                                                                                                                        March 16, 2006
                                                                                                                                                          Page 3 of 12
                TOPIC                                DISCUSSION                                        ACTION                              FOLLOW-UP
           7.2.2 K. C. (VS)               Reviewed and discussed Voluntary               M/GB, S/HF to accept Voluntary               MW to respond.
                                          Surrender.                                     Surrender as recommended.
                                                                                         Unanimous.

           7.2.3 V. W. (VS)               Reviewed and discussed Voluntary               M/GB, S/HF to accept Voluntary               MW to respond.
                                          Surrender.                                     Surrender as recommended.
                                                                                         Unanimous.

           7.2.4 C. C. (VS)               Reviewed and discussed Voluntary               M/GB, S/HF to accept Voluntary               MW to respond.
                                          Surrender.                                     Surrender as recommended.
                                                                                         Unanimous.

           7.2.5 K. C. (VS)               Reviewed and discussed Voluntary               M/GB, S/HF to accept Voluntary               MW to respond.
                                          Surrender.                                     Surrender upon receipt of signed
                                                                                         agreement.
                                                                                         Unanimous.

           7.2.6 J. U. (VS)               Reviewed and discussed Voluntary               M/GB, S/HF to accept Voluntary               MW to respond.
                                          Surrender.                                     Surrender upon receipt of signed
                                                                                         agreement.
                                                                                         Unanimous.

           7.2.7 K. S. (VS)               Reviewed and discussed Voluntary               M/GB, S/HF to accept Voluntary               MW to respond.
                                          Surrender.                                     Surrender upon receipt of signed
                                                                                         agreement.
                                                                                         Unanimous.

9.0   Licensure
      9.1 Credentialing Examination for   Reviewed and discussed memo describing         No action necessary.
           Psychiatric-Mental Health      result of investigation into psychiatric
           ARNPs                          clinical nurse specialist and advanced
                                          nurse practitioner credentialing
                                          examination. Recommendation is that
                                          instead of 2 exams, one for clinical nurse
                                          specialists and one for nurse practitioners,
                                          the exams be combined.

10.0 Education
     10.1 Continuing Approval
          10.1.1 Holden Health Career     JE reported on site visit on March 14,         Action deferred until representatives from
                 Center                   2006 to Holden Health Career Training          Holden Health Career appear at Board
                                          Center. Results of site visit are extremely    meeting at 2:30 p.m.

                                                                                                                                                       Board Minutes
                                                                                                                                                       March 16, 2006
                                                                                                                                                         Page 4 of 12
              TOPIC                                   DISCUSSION                                 ACTION                                 FOLLOW-UP
                                         positive and JE recommended that the
                                         status of Conditional Approval be
                                         maintained until scores show
                                         improvement while lifting restriction on
                                         new admissions.

4.0   Report of Chair/Members            Nursing students from Rivier College
                                         directed general questions regarding
                                         Board meeting to members of Board.

10.0 Education
     10.1 Continuing Approval
          10.1.2 Hearts and Minds        Reviewed corrections made to February      M/MP, S/RD to approve report as               MW to respond.
                 LNA Educational         site visit report.                         corrected and grant Continued Approval of
                 Program                                                            program and coordinator.
                                                                                    Unanimous.

          10.1.4 Crotched Mountain       Reviewed and discussed.                    SD recused.                                   MW to respond.
                 Rehabilitation Center                                              M/GB, S/RD to grant Continued Approval
                 LNA Educational                                                    of program and coordinator.
                 Program                                                            Unanimous.

          10.1.5 Crotched Mountain       Reviewed and discussed.                    SD recused.                                   MW to respond.
                 Rehabilitation Center                                              M/MP, S/BH to grant Continued Approval
                 MNA Educational                                                    of program and reviewer as recommended
                 Program                                                            with provision that site visit is necessary
                                                                                    prior to start of next class.
                                                                                    Unanimous.

          10.1.6 American Red Cross –    Reviewed and discussed.                    M/MP, S/HF to grant Continued Approval        MW to respond.
                 Greater Nashua &                                                   of program and coordinator.
                 Souhegan Valley                                                    Unanimous.
                 Chapter
                 LNA Educational
                 Program

          10.1.7 American Red Cross –    Reviewed corrections made to February      M/BH, S/HF to approve report as               MW to respond.
                 Great Bay Chapter       site visit report.                         corrected and grant Continued Approval of
                 LNA Educational                                                    program and coordinator.
                 Program                                                            Unanimous.

          10.1.8 Unicare                 Reviewed corrections made to February      M/MP, S/LM to approve report as               MW to respond.

                                                                                                                                                    Board Minutes
                                                                                                                                                    March 16, 2006
                                                                                                                                                      Page 5 of 12
         TOPIC                                    DISCUSSION                               ACTION                                 FOLLOW-UP
           MNA Educational         site visit report.                         corrected and grant Continued Approval of
           Program                                                            program and coordinator.
                                                                              Unanimous.

10.3 Education Issues
     10.3.2 Nurse Extern Program   Reviewed and discussed whether or not      M/GB, S/KAD to affirm that students          MW to respond, explaining that Board
                                   students enrolled in Excelsior College     enrolled in Excelsior College nursing        members plan to revise wording of Nur
                                   nursing program are eligible to be nurse   programs are not eligible to be nurse        605.04 (b) (2) to delete “in that program”
                                   externs. As rules are currently written,   externs as Administrative Rules are          and to replace with “beyond
                                   students are NOT eligible to be nurse      currently written.                           fundamentals”.
                                   externs since Excelsior does not include   Unanimous.
                                   clinical nursing courses.

    10.3.3 Multiple NCLEX          Reviewed and discussed suggestions of      M/MP, S/KAD to proceed with the              MW to respond.
           Retakes: Language in    wording in rules with regard to limiting   following in rule writing:
           the Rules               number of times applicant should be        Applicants who fail the licensing
                                   allowed to retake NCLEX.                   examination 3 consecutive times, or who
                                                                              have not passed the examination within 4
                                                                              years of graduation from an approved
                                                                              school of nursing or within 4 years of
                                                                              completing the CGFNS process shall
                                                                              submit to the Board a plan of remediation.
                                                                               The Board shall review and determine
                                                                                  whether or not to approve remediation
                                                                                  plan.
                                                                               The applicant shall submit evidence of
                                                                                  completion of the remediation plan
                                                                                  prior to be allowed to take the
                                                                                  examination.
                                                                               Remediation plan must be completed
                                                                                  within 1 year prior to taking the
                                                                                  examination.
                                                                               An applicant who has failed 3 times
                                                                                  and has completed remediation, may
                                                                                  retake the examination 1 additional
                                                                                  time.
                                                                              Unanimous.
                                   Are RN candidates who fail NCLEX-RN                                                     MW to respond.
                                                                              M/HF, S/BH to affirm that applicants
                                   and who choose to take NCLEX-PN,
                                                                              taking the NCLEX-PN based on
                                   allowed to take NCLEX-PN any number
                                                                              comparable education as described in
                                   of times?
                                                                              301.02(1)(3) may take the NCLEX-PN
                                                                                                                                                      Board Minutes
                                                                                                                                                      March 16, 2006
                                                                                                                                                        Page 6 of 12
                TOPIC                                  DISCUSSION                                    ACTION                             FOLLOW-UP
                                                                                        one time only.
                                                                                        Unanimous.

           10.3.4 Nursing Faculty         FYI.
                  Shortage

      10.1 Continuing Approval
           10.1.3 First Choice Training   Representatives from First Choice             M/MP, S/BH to remove Conditional          MW to respond.
                  Institute               Training Institute appeared at the Board to   Approval status and to return status
                                          discuss progress with recruitment and         designation to Initial Approval of
                                          organizational changes of LPN Program.        program. Program may admit new
                                          Present were:                                 students, but may not expand enrollment
                                          Magalie Ferdinand, Director                   beyond what is currently projected.
                                          Robert Ferdinand, Owner                       Unanimous.
                                          Robert Shepard, Attorney
                                          Richard Desautel, RN, LPN Program
                                          Director

11.0 Practice Inquiries and Practice
     Committee Reports
     11.1 Liaison Committee (MP)          MP reported on ARNP summit.

                                          Reviewed ARNP candidate at last meeting
                                          who was not approved based on lack of
                                          education.

                                          Lisa Sullivan, CRNA, has indicated            M/MP, S/GB to appoint Lisa Sullivan as    MW to respond.
                                          interest in being appointed to ARNP           member of ARNP Liaison Committee.
                                          Liaison Committee.                            Unanimous.

      11.2 P & E Committee                Reviewed and discussed P & E                  M/MP, S/KAD to accept
                                          recommendation to allow a 30-day public       recommendations of P & E.
                                          comment period and then make final            Unanimous.
                                          board decision on clinical practice
                                          inquiries. Further recommendation that
                                          board decisions shall be referred to as
                                          “NH Board of Nursing white paper” rather
                                          than Board advisory.

10.0 Education
     10.3 Education Issues
          10.3.6 Request for              Reviewed and discussed proposal of            M/MP, S/RD to have JE convene group of

                                                                                                                                                    Board Minutes
                                                                                                                                                    March 16, 2006
                                                                                                                                                      Page 7 of 12
                TOPIC                                  DISCUSSION                                     ACTION                                FOLLOW-UP
                  consideration of rule   student-faculty ratio be changed as           educators and directors for discussion of
                  change                  revision of draft rules.                      proposal of revision of draft rules.
                                                                                        Unanimous.

           10.3.5 Request for change in   Reviewed and discussed request submitted      M/RD, S/MD to include this request as         MW to respond.
                  faculty-student ratio   by Lynette Ament, Phd, RN, CNM,               part of discussion of task force              Recommendations from task force to be
                                          FACNM, Associate Professor and Chair,         collaborated by directors and educators in    forthcoming.
                                          UNH Department of Nursing for one-time        10.3.6.
                                          waiver of rule regarding the 8:1 faculty      Unanimous.
                                          student ratio. Request is to allow 9
                                          community health students to be overseen
                                          by 1 faculty member for one clinical
                                          experience.

11.0 Practice Inquiries and Practice
     Committee Reports
     11.2 P & E Committee                 RD reported that representatives from                                                       CMC and Elliot to contact Board to be
                                          Catholic Medical Center and Elliot                                                          placed on agenda.
                                          Hospital would like to come before Board
                                          to discuss Board’s determination that it is
                                          not within scope of practice of licensed
                                          nurse to administer bolus Astromorph or
                                          other neuroaxial narcotics.

                                                                                        SG excused at 12:00 noon.

8.0   Adjudicative
      8.1 Petition for Reinstatement of
          Practice Privileges/Return of
          Licensure/Annulment of
          Reprimand
          8.1.1 C. B.                     Reviewed and discussed with C. B.             M/MP, S/MD to reinstate RN license with       MW to respond.
                                          petition for reinstatement of RN license.     two-year probation and restrictions and
                                                                                        conditions pursuant to July 21, 2004
                                                                                        Settlement Agreement.
                                                                                        Unanimous.

          8.1.2 L. T.                     Discussion with L. T. via the telephone       S/MD M/SD, S/GB to reinstate license          MW to respond.
                Telephone:                regarding petition for reinstatement of       with no restrictions or conditions upon
                Reinstatement Request     LPN license.                                  receipt of four satisfactory responses from
                Meeting                                                                 references as provided by Mr. Tate.
                                                                                        Unanimous.

                                                                                                                                                               Board Minutes
                                                                                                                                                               March 16, 2006
                                                                                                                                                                 Page 8 of 12
               TOPIC                                  DISCUSSION                                   ACTION                              FOLLOW-UP

                                                                                     Board informed Mr. T. that it is his
                                                                                     responsibility to contact OIG’s office to
                                                                                     have his name removed from the list.

10.0 Education
     10.1 Continuing Approval
          10.1.1 Holden Health Career     Michele Douglas, MS, RN, LPN Program       M/GB, S/SD to maintain Conditional          MW to respond.
                 Center                   Director, Holden Health Career Center      Approval of program and director with no
                                          provided oral testimony regarding          restrictions on new admissions.
                                          organization’s plan to improve future      Unanimous.
                                          NCLEX success for graduates. Also
                                          present at meeting were Judy Readey, RN
                                          and Joann Monks, RN, members of
                                          faculty.

     10.3 Education Issues
          10.3.1 CareMed Educational      Discussion with owners and staff of        Board informed owners and staff that they   MW to respond.
                 Services                 CareMed (Sheryl and S. Jeffery Angus       must cease and desist all advertising of
                 LNA/LPN Educational      and Jennifer Washburn) related to          LNA and LPN programs and dismantle
                 Programs                 postcard received by MW at her home        website until Board approval has been
                                          advertising CareMed Educational Services   obtained. Programs will not be approved
                                          as private medical training company        until Board meets with Program Director,
                                          offering LNA and LPN programs before       Martha Aguiar.
                                          they obtained approval from NH Board of
                                          Nursing.

                                          Further, Board reviewed contents of
                                          CareMed website that does not fully
                                          inform public that they are not approved
                                          as educational program in NH.


                                                                                     GB left meeting at 2:35 p.m.

11.0 Practice Inquiries and Practice
     Committee Reports
     11.3 Request for Board advice re:
           11.3.1 LNA Scope of Practice   Reviewed and discussed whether or not it   M/MP, S/KAD to affirm that it is within     MW to respond.
                  to perform EKC,         is acceptable for LNA to perform EKC,      LNA scope of practice provided they have
                  bladder scan or         bladder scan, or Doppler on resident/      competence as outlined in Nur 305.01 (c)
                  Doppler                 patient if LNA has been instructed on      & (d).

                                                                                                                                                   Board Minutes
                                                                                                                                                   March 16, 2006
                                                                                                                                                     Page 9 of 12
              TOPIC                                      DISCUSSION                                    ACTION                                FOLLOW-UP
                                           policy and procedure by appropriate           Unanimous.
                                           licensed staff.

          11.3.2 Reconsideration of        Several requests of reconsideration were      M/MP, S/LM to have P & E research             MW to respond.
                 question re:              reviewed by Board with regard to Board’s      question and make further
                 Paracentesis              opinion that completion of paracentesis       recommendations to Board.
                                           procedure started by provider is not within   Unanimous.
                                           RN scope of practice.

          11.3.3 RN Scope of Practice:     Reviewed and discussed whether or not it      M/MP, S/RD to affirm that procedure is        MW to respond.
                 Performing carotid        is within scope of practice for licensed      within RN scope of practice provided they
                 massage                   school nurse (RN) to perform carotid          have competence as outlined in Nur
                                           massage for supraventricular tachycardia      305.01 (c) & (d).
                                           if ordered by student’s doctor.               Unanimous.

          11.3.4 Reconsideration of        Several comments and additional               M/MP, S/RD to reverse original decision       MW to respond.
                 question: Pharmacist      information were reviewed by the Board        and affirm that it is within RN scope of
                 clarification of orders   with regard to RN transcribing telephone      practice to accept a physician’s order that
                 for RN/LPN                orders from pharmacist.                       has been documented and clarified by
                                                                                         licensed pharmacist.
                                                                                         Unanimous.

          11.3.5 RN Scope of Practice:     Reviewed and discussed whether or not it      M/RD, S/HF to affirm that procedure is        MW to respond.
                 Flushing ICP catheter/    is within RN scope of practice to:            within RN scope of practice provided they
                 Aspirate sample of         Flush intraventricular (IC) catheter        have competence as outlined in Nur
                 CSF from catheter          Aspirate sample of CSF from catheter        305.01 (c) & (d).
                                                                                         Unanimous.

15.0 Old Business
     15.2 Board member attendance          Reviewed and discussed. KAD informed
                                           Board that she cannot attend April Board
                                           meeting.


12.0 Committee Reports and
     Recommendations
     12.1 HeM 1201 (MD)                    MD reported on February meeting.

     12.2 Day of Discussion
          12.2.1 RN/LPN Day of             JAE updated Board on plans for Day of
                 Discussion (JE)           Discussion.
                 Winnipesaukee Expo

                                                                                                                                                         Board Minutes
                                                                                                                                                         March 16, 2006
                                                                                                                                                          Page 10 of 12
               TOPIC                               DISCUSSION                            ACTION                      FOLLOW-UP
                 Center: Wednesday,
                 June 7, 2006


          12.2.2 LNA Day of            MW updated Board on plans for LNA
                 Discussion (LR)       Day.
                 Winnipesaukee Expo
                 Center: Wednesday,
                 May 24, 2006

     12.3 ADA (LM, SD, MD)             No applicants.

     12.4 Joint Health Council (MW)    MW reported on last meeting.

14.0 National Council                  MW reported on NCSBN Midyear
                                       Meeting in Chicago that she and RD
                                       attended.

15.0 Old Business
     15.1 ARNPs prescribing for self   Reviewed and discussed.              M/HF, S/SD to affirm that prescriptive
          and family members                                                practice is reserved for established
                                                                            provider/patient relationships.
                                                                            Unanimous.

16.0 Correspondence/Articles/FYIs
     16.1 News release from BON in     FYI.
          CA

     16.2 Conference on Disaster       FYI.
          Preparedness

     16.3 News Release from NCSBN      FYI.
          re: NCLEX testing sites

     16.4 NCSBN Board of Director’s    FYI.
          Meeting

17.0 Adjournment                                                            Meeting adjourned at 3:45 p.m.




                                                                                                                                 Board Minutes
                                                                                                                                 March 16, 2006
                                                                                                                                  Page 11 of 12
TOPIC             DISCUSSION                                ACTION               FOLLOW-UP




        Next meeting:
               April 20, 2006
               8:30 a.m.
               NH Board of Nursing
               Education Conference Room 100
               First Floor
               21 South Fruit St
               Concord, NH 03301
                                               Respectfully submitted,



                                               Margaret J. Walker, MBA, BS, RN
                                               Executive Director
                                               MJW/kd




                                                                                             Board Minutes
                                                                                             March 16, 2006
                                                                                              Page 12 of 12

				
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