NEW YORK NURSE: October/November 2007
by Barbara Zittel, PhD, RN, Executive Secretary
As of Jan. 1, 2007, New York State Education Department statistics reveal that there are 252,662 individuals licensed and registered to practice professional nursing. That statistic continues to reflect an upward trend in the total number of individuals licensed to practice as Registered Professional Nurses (RNs) in New York.
The total number of new RN licenses issued by the department in 2006 approached 14,000, approximately 2,000 more licenses than last year. Almost half of these new licensees were from out of state, which includes internationally educated nurses. Approximately 7,000 of newly licensed RNs were educated in New York State nursing programs.
New York State nursing programs continue to report an increase in the number of graduations. Unfortunately, the number of qualified applicants who are being denied admission to these nursing programs continues to escalate. In 2006, that number approached 4,000. Since 2000, the department has issued licenses to almost 70,000 new applicants. During that same time period, however, the net gain in licensed individuals was only 15,000. In our opinion, the major reason for this apparent discrepancy is the number of nurses retiring from the profession.
New York State has slightly more than 13,000 nurse practitioners (NPs) practicing in over 16 specialties. That figure continues to have leveled out with 900 new licenses issued in 2006.
As of Jan. 1, 2007, New York State had 68,729 licensed practical nurses (LPNs) licensed to practice, which represents an increase of less than 500 persons from the previous year. The 4,500 new licenses issued in 2006 reflect a slight increase from the previous year.
State Board for Nursing members were kept extremely busy with the highest caseload of disciplinary and moral character charges among the 47 professions licensed by the State Education Department. In 2006, 1,361 cases were opened against RNs, 99 against NPs, and 923 against LPNs. The disproportionately higher number of actions brought against LPNs than RNs continues. LPNs have almost a 250% higher probability of having disciplinary charges brought against them than RNs.
Negligence/incompetence is the most common category of charge against nurse licensees, no matter what their title. However, as I reported to you last year, conviction of a crime remains the second-most common category of charges, outranking substance abuse, which traditionally had been in that second slot. This trend is especially alarming among LPNs.
We can take slight comfort in that when disciplinary charges are rank-ordered by profession, based on the total number of complaints by the number of registrants (with the lowest rank representing the highest discipline), LPNs rank 19, RNs 30.5, and NPs 33.5.
In June, the department eliminated a provision, termed the 2EQ, which permitted students who had not completed RN programs to obtain licensure as LPNs. This change was supported by the New York State Nurses Association, the New York Organization of Nurse Executives (NYONE), and nursing faculty in both LPN and RN programs. This option for licensure was eliminated because it had been abused and because the Board’s evaluation determined that there is no longer “substantial equivalence” between an LPN program and three semesters of an RN program.
After two years of collaboration with the Department of Health (DOH) Wadsworth Center’s division of Blood and Tissue Resources, we have completed policies to permit LPNs to participate in the administration of blood components given the following conditions:
Sept. 15, 2007, marked the final elimination of a regulation that had permitted a nurse practitioner who was certified to practice in one specialty to become certified in another specialty by completing 60 hours of continuing education and on-the-job training from a physician.
The elimination of this provision, the “alternative criteria for NP certification,” received support from NYSNA, the Nurse Practitioners Association, NYONE, and, as might be expected, faculty in NP programs. This provision had been appropriate during the early years of NP licensure, due to the low number of NP programs available at the time. However, almost 20 years after the statutory establishment of nurse practitioners, there is no longer a need for such an option.
The Board has taken positions on several major practice questions, many of which are posted on the Board’s web site: www.op.nysed.gov/nurse. I’ll elaborate on only two:
The first relates to mental health services that can be provided by NPs who are certified in a specialty other than psychiatry. Nurse practitioners are permitted to practice only within the specialty in which they are licensed. In most areas of practice, this differentiation is clear. For example, pediatric nurse practitioners are prohibited from caring for patients who are 55 years old and acute care nurse practitioners are prohibited from serving as family primary care providers.
The major area in which this becomes murky is psychiatric care. For example, pediatric NPs are educated to provide care to children with attention deficit disorders and geriatric NPs may provide care to elderly patients with dementia, even though attention deficit disorders and dementia fall within the scope of psychiatric nurse practitioner practice.
The Board’s position is that situational and minor mental health issues may be cared for initially by NPs who are competent by education and experience, along with proper patient surveillance and referral if treatment goals are not met. This interpretation does not, however, confer authority on a non-psychiatric NP to be employed as a primary provider in a psychiatric diagnostic and treatment facility or agency.
The second position relates to the administration of IV anesthetic agents by non-anesthetist registered nurses for the purpose of sedation and anesthesia. In general, RNs may not administer drugs such as propofol, ketamine, etomidate, methohexital, and thiopental for the purpose of sedation and anesthesia unless they are qualified and competent to administer them. In most instances, RNs obtain such competence through the completion of a certified registered nurse anesthetist (CRNA) program.
As members of NYSNA, you can be rightfully proud of the association’s efforts to obtain passage of a state law that limits use of the title “nurse” to persons who are duly licensed by the State Education Department. The Governor’s signature on this bill last year finally ensured title protection of the word “nurse.”
Two weeks after the bill’s effective date in July 2007, the Education Department took action to support its provisions. We were informed of advertisements for “baby nurse training” in the Bronx. We sent two undercover “operatives” to be enrolled in the unlicensed school and then confronted the owner, who was required to return all student fees, cease training of enrolled students, and stop using the term “nurse.” If you witness examples of abuse of this now protected term, I encourage you to work within your systems to make corrections and to take every opportunity to inform the world of this change.
For several years now, NYSNA has collaborated with the Department of Health, the State Board for Nursing, and other stakeholders, to develop processes that would ensure the most efficient use of volunteer licensed professionals in the event of a disaster.
The Department of Health has informed us that in all but the most critical situations, simultaneous unaffiliated volunteers (SUVs) will not be permitted access to disaster areas. DOH is encouraging licensees to volunteer to be part of a corps that will receive training and preparation to better ensure a coordinated response. Please consider joining the NurseResponse team – a cadre of volunteers who are known to the Department of Health – who can be contacted in the event of a disaster and who are better prepared to participate in such an event through completion of continuing education.
Joining NurseResponse is fairly simple: just click onto NYSNA’s web site at www.nysna.org, scroll down to “Announcements” and click on “Are you registered? Join NurseResponse.” If you are no longer clinically active, NurseResponse can still use you. It’s estimated that for each clinician, 10 support staff are needed. Please join and be prepared to respond.
I am pleased to announce that online registration renewal is now available for licensees renewing their registrations for the period beginning Jan. 1, 2008. Phased in over the next three years, the online process will provide a timely and secure alternative to the paper registration applications used for many years. When registering online, the registration fees can be paid using a credit card. There will be no additional charge for this convenience.
To register online, you must:
More information will be sent to each licensee at the time of registration renewal. Licensees will not be able to participate in online renewal until they are notified and given a PIN. Please see www.op.nysed.gov/renewalinfo.htm for more information about online renewals and how to log in to the application.
Please access the Board for Nursing’s website for information on the latest practice standards, current activities to address the nursing shortage, licensure statistics by county, and much more.