Mississippi Board of Nursing

1. Mississippi Board of Nursing Lynn Langley, DNP, FNP-BC, ANP-BC, CPHQ Interim Executive Director Mississippi Board of Nursing llangley@msbn.ms.gov Phone (601) 957-6289

2. Objectives • 1. Explain role and function of the Mississippi Board of Nursing. • 2. Understand the function of the Nurse Recovery Program and the Office of Nursing Workforce. • 3. Identify grounds for disciplinary actions and duty to report.

3. Mississippi Nurse Practice Law Mississippi Board of Nursing • Legally charged to protect the public by Regulating the practice of Nursing. • Mississippi Nurse Practice Law defines the practice of nursing; (73-15-5)

4. Administrative CodeMississippi Board of Nursing Mississippi Administrative Code Title 30: Professions and Occupations Parts 2801 – 2900 • The authority of the Mississippi Board of Nursing is to promulgate rules and regulations for the licensure of registered nurses, advanced practice registered nurses, licensed practical nurses, expanded role licensed nurses and certified hemodialysis technicians as provided for in the laws of the Miss. Code Ann. Sections 73-15-17 (a), &73-15-101.

5. Purpose and Function • The Mississippi Board of Nursing is authorized by Miss. Code Ann., 1972 Chapter 15, to protect the public through the process of licensure and regulation of nursing practice.

6. Functions of the Board • Establish standards of nursing practice through rules and regulations. • Regulate the practice of nursing. • Approve applicants for licensure examinations. • License qualified applicants. • Certify qualified applicants to function in the expanded role. • Discipline those associated with practice violations. • Support effective relationships within the healthcare community. • Provide educational resources relative to licensure and practice. • Consider public opinion, responses and relationships.

7. Composition of the Board • There shall be at least one (1) board member from each congressional district in the state. • However the physician member, consumer representative member and one (1) registered nurse shall be at large always.

8. Composition of the Board • Thirteen (13) members • Two (2) nurse educations • Three (3) registered nurses in clinical practice • Two (2) associate or diploma degree • One (1) basic nursing preparation a baccalaureate degree • One (1) registered nurse at large • Four (4) licensed practical nurses • One (1) licensed physician who is member of the State Board of Medical Licensure • One (1) consumer of health services

9. Appointment of Members • Members (exception of the physician) is appointed by the Governor with advice and consent of the Senate from lists of nominees submitted by any Mississippi nursing organization and/or association. • Mississippi Nursing Practice Law ~73-15-9 (1), (2), & (3)

10. Qualifications of Members • Citizen of the United States and resident of the State of Mississippi

11. Qualifications - Registered Nurse • Graduation from an approved educational program. • At least five (5) years of nursing experience. • Employed for at least the past three (3) years. • Currently registered to practice in Mississippi.

12. Qualifications - Licensed Practical Nurse • Graduation from an approved educational program. • At least five (5) years of nursing experience. • Employed for at least the past three (3) years. • Currently registered to practice in Mississippi.

13. Accountability – Each Member Shall • Possess a current, active and unencumbered Mississippi nursing license. • Protect the public. • Make responsible and educated decisions and be accountable for such decisions. • Maintain the integrity of the board. • Participate actively in business meetings, assigned hearing panels and committees. • Collaborate with other board members.

14. Accountability: Each Member Shall Not • Disclose confidential information gained by reason of his/her official position or authority on the board. • Use his/her official position on the board to secure unwarranted privileges or exemptions for self or others. • Use confidential information for private or public gain. • Incur more than two consecutive absences from meetings.

15. Terms • Members are appointed in staggered terms for four (4) years. • No member may serve more than two (2) consecutive full terms.

16. Officers • President • Secretary • Treasurer • Mississippi Nursing Practice Law ~~73-15-11 (1)

17. President’s Duties • Preside over all meetings of the board. • Make decisions for the board, between meetings, which require immediate action. • Gain consent and appoint all members of ad hoc and standing committees.. • Remove any member not fulfilling obligation to a committee. • Oversee presentation of board’s annual budget… • Present to Personnel Board any changes in status of executive director • Serve as the board’s official representative to legislative groups… • Retain the right to vote on all board issues • Sign appropriate legal documents… • Serve as counselor and advisor to executive director • Serve as ex-officio member of all standing and special committees. • Oversee presentation of executive director’s annual evaluation… • Prepare and present report at annual meeting.

18. Secretary’s Duties • Preside and make decisions for the board, between meetings in absence of president…. • Sign all board minutes. • Keep the official tally of all board actions. • Prepare and present report at annual meeting.

19. Treasurer’s Duties • Work with executive director and accountant on budgetary matters. • Assist with board’s annual budget presentation to appropriate commissions and committees. • Present report at annual meeting. • Perform secretarial duties in absence of secretary.

20. Meetings • At least once every four (4) months for the purpose of transacting business. • Disciplinary hearings and business meetings are open to the public.

21. Quorum • Of the thirteen (13) board members, seven (7) members including at least three (3) registered nurses and two (2) licensed practical nurses shall constitute a quorum. • Mississippi Practice Law ~~73-15-11 (4)

22. Standing Committees • Executive Committee • Nominating Committee • Nursing Practice Committee • Advanced Practice Committee • Compliance Committee • Other Committees

23. Parliamentary Procedure • Published February 1876 by then U.S. ArmyColonelHenry Martyn Robert (1837–1923) with the short title Robert's Rules of Order placed on its cover.

24. Robert’s Rules of Order, Newly Revised • Governs the board, published 2011

25. Programs Under the Auspice of MS Board of Nursing • Nurse Recovery Program • Office of Nursing Workforce

26. Nurse Recovery Program • Operates within the Board of Nursing • Approximately workload annually …. • 318 participants signed 5 year monitoring affidavits. • 50% of those completed the five year program with no relapse or non-compliance. • 10% relapsed or engaged in noncompliance necessitating a second affidavit. • 40% were unable to maintain sobriety and were referred to the disciplinary division for further action. • Recidivism • Out of the 60 percent who successfully completed the program, 7.5 % of them violated following completion.

27. RN AND LPN Patterns of Abuse • Cases involving RN’s and LPN’s most often involve the diversion of wastes of opiate medications. • Pre-charting and excessive administration of controlled substances. • Doctor shopping to obtain more medication than prescribed. • Prescription forgery.

28. APRN Patterns of Abuse • Writing and filling prescriptions for self administration using patients or family member’s names. • Doctor shopping to obtain excessive amounts of medications. • Use of anesthesia agents. • Diversion of fentynal, versed and other anesthesia medications.

29. SIGNS AND SYMPTOMS OF IMPAIRMENT OBVIOUS SUBTLE Slurred speech Sleeping while on duty Lack of coordination Unexplained absences from the unit Frequent bathroom breaks Smelling of alcohol Glassy red eyes, or pinpoint dilated pupils Pulling and administering more controlled medications than other nurses. Patients complaining of untreated pain. Preferring night shifts or unsupervised settings Never wasting with a witness Never taking vacation Visiting home health patients when not on duty

30. THE IMPAIRED NURSE

31. Board Intervention • The MS Board of Nursing intervenes on a nurses practice when that nurse’s addiction has caused violations of the nursing practice law and administrative code to occur. • Investigative cases that involve diversion, doctor shopping, prescription forgery, and other drug related offenses are referred to the Recovering Nurse Program.

32. Nurses Monitoring Programs • 1982 International Conference on the Addicted Nurse launched a call to action to all states to create board based programs for substance dependent nurses. • The resolution was grounded on research showing that having programs specifically for nurses resulted in earlier identification of the disease, timely removal from the work place, appropriate monitoring and safer return to practice.

33. Nurses Monitoring Programs • The National Council of State Boards of Nursing took up the cause and began promoting the formation of advocacy programs to the boards of nursing. • Mississippi created the RNP in 1982, the RNP is a disciplinary program that results in action similar to an administrative felony. While many of the other states created programs based on a non-disciplinary model, the Board in Mississippi felt that diversion and similar violations of the NPL needed to be recognizable and did not want impaired untreated nurses moving from state to state anonymously.

34. Components of Monitoring • Professional assessment conducted by a master’s or doctorate level individual utilizing collateral information provided by supervisors, co-workers, and family members. • A substance dependency diagnosis. • Admission by the nurse of violation of the nursing practice law and administrative code as well as an expressed desire to receive help.

35. Components of Monitoring • Prompt removal from the workplace. • Referral and admission to the correct treatment modality. • Signing a monitoring affidavit with the board. • Return to work agreement • Monitoring with random drug screens, reports, prescription use and medical treatment documentation. • Aftercare treatment to include groups, counseling and medication management where appropriate.

36. Components of Monitoring • Participation in 12 step groups and recovery activities. • Routine group meetings with RNP staff. • Accountability • Repetition • Five year monitoring agreement

37. Office of Nursing Workforce Provides: • Educational programs. • Determine continuing education needs of nursing workforce. • Promote and coordinate schools of nursing opportunities. • Apply for grants for development • Data collections on adequate nurses in Mississippi.

38. Office of Nursing Workforce • The Mississippi Office of Nursing Workforce (ONW) is dedicated to furthering research and analysis of solutions to nursing workforce issues for purposes of public information. • Mississippi Code 1972, 75-15-18

39. Duty to Report • Failure to report to the Board facts known regarding incompetent or illegal practice of any RN or LPN

40. Filing a Complaint • Source of information will be kept confidential. • Report suspected problems at once to your immediate supervisor. • Do not discuss your suspicions with others. • Write a comprehensive report as soon as possible. • If you are not certain it has been reported to the Board, you can make a report yourself directly to the Board.

41. Conspiracy to and illegally dispensing and distributing controlled substances • MD, age 76, of Metairie, LA, pled guilty in federal court to four counts of dispensing Schedule III and Schedule IV controlled substances outside the scope of professional practice and not for legitimate medical purposes; and one count of conspiracy to illegally dispense and distribute Schedule III and Schedule IV controlled substances and mixtures of Schedule III and Schedule IV controlled substances outside the scope of professional practice and not for legitimate medical purposes. • MD was employed by Advanced Pain Management at clinics located in Metairie, Slidell, and Gretna, LA. During his employment, MD knowingly used his DEA registration to issue controlled substance prescriptions that were not medically necessary or were issued for overlapping treatment periods for the same medical condition. • Sentenced to ten months in federal prison followed by three years of supervised release and ordered to pay a fine of $40,000 and an assessment of $500.00.

42. Misprision (concealment) of a felony • According to court documents, MD was employed by Advanced Pain Management at clinics located in Metairie, Slidell, and Gretna, LA. During her employment, MD was aware of the clinics’ operations and practices including the issuance of controlled substance prescriptions without medical necessity or not in the course of usual medical practice and the scheduling and treatment of hundreds of patients per day, often seen by one doctor, and the clinics’ failure to comply with medical standards applicable to pain management. • Despite this knowledge, MD failed to notify any authorities or to disclose the information in meetings with agents of the Drug Enforcement Administration. • MD was sentenced to six months in federal prison followed by one year of supervised release and ordered to pay a fine of $5,000 and an assessment of $100.00.

43. Grounds for Disciplinary Action • Possessing, obtaining, furnishing or administering drugs to any person, including self, except as legally directed. • Failure to report to the Board facts known regarding incompetent or illegal practice of any RN or LPN.

44. Grounds for Disciplinary Action • Had disciplinary action in another jurisdiction • Failed to meet generally accepted standards of practice • Violated order of the board • Falsified or failed to make essential entries on records • Addicted to habit-forming drugs/alcohol • Misappropriated any medication

45. Grounds for Disciplinary Action • Physical, mental, or emotional disability that renders licensee unable to perform nursing with reasonable skill and safety • Engaged in conduct that constitutes a crime • Engages in conduct likely to deceive, defraud or harm the public • Engages in unprofessional conduct • Violated any provision of the nurse practice law

46. Grounds for Disciplinary Action • Unprofessional conduct • Violating confidentiality • Willful alteration of medications • Obtaining controlled substances by unauthorized means • Forging a prescription for medication • Passing a forged prescription • Selling a controlled substance

47. Questions??? • How far we have come.