NEW YORK NURSE: November 2009

Annual Report from the New York State Board for Nursing

By Barbara Zittel, RN, PhD, Executive Secretary

As of Jan. 1, 2009, there were 262,593 individuals licensed and registered to practice professional nursing in New York State. That statistic reflects an upward trend in the total number of individuals licensed to practice as registered professional nurses (RNs) in New York. The Department issued 14,496 new RN licenses in 2008, an increase of more than 1,000 from 2007.

New York State has slightly more than 14,000 nurse practitioners (NPs) practicing in over 16 specialties. Almost 1,000 master’s-prepared nurse practitioners were added to New York’s licensure data banks in 2008. On Jan. 1 there were 71,505 licensed practical nurses (LPNs) in the State. The 3,903 new licenses issued in 2008 is a decrease of almost 500 from the previous year.

Disciplinary actions

The State Board for Nursing (SBFN) was kept extremely busy in 2008, with 1,296 disciplinary cases opened against RNs, 106 against NPs, and 714 against LPNs.

Negligence/incompetence charges were the most common among all three titles. In 2008, despite a decrease in the total number of disciplinary charges, the categories of “Conviction of a Crime” and “Substance Abuse” remained the same or increased from 2007.

Practice Issues

In 2008 the SBFN office handled over 17,500 telephone calls and 4,500 e-mail messages. A significant number of those inquiries were related to scope of practice questions.

The board took the position that registered professional nurses can legally manage Coumadin® (warfarin) dosing based on a patient-specific order and a written protocol. The Board’s guidance document includes requirements for training and determination of RN competency. Mandated elements of the protocol include:

an algorithm that includes the formula for the initial dose, the formula for changing dosage if the International Normalized Ratio (INR) is either subtherapeutic or above therapeutic range, when to withhold the drug, and when it is appropriate to administer vitamin K and at what dosage
therapeutic ranges for clinical problems such as atrial fibrillation, deep vein thrombosis, congestive heart failure, stroke, etc.
identification of how the INR will be measured – an INR calculated from a venipuncture sample is more accurate than some finger-stick methods
frequency of supplementary diagnostic tests to assess bleeding such as hemoglobin and hematocrit, urinalysis, fecal occult blood
frequency of follow-up visits, initially and when stabilized
type of visit (office, telephone, or both)
criteria for hospital admission
patient education

The board’s position on the administration of IV monoclonal antibodies was refined to permit home infusion by an RN after administration of the initial dose in the presence of the prescribing practitioner. The guidance document, among other stipulations, requires a written, institutionally developed policy and procedure, RN education, RN competency evaluation, and a full patient assessment prior to each administration of the medication.

Regarding the use of laser and ultrasound therapy for wound care, the board determined that RNs may provide such care with a patient-specific order, a written facility policy and procedure, documentation of RN education and ongoing competency evaluations, and a complete patient assessment prior to the administration of each treatment.

The board decided that RNs can use ultrasound technology in the insertion of intravenous catheters with a patient-specific order, a written policy and procedure, and continuing education and competency assessments.

Finally, the board ruled that RNs may apply a magnet to temporarily disable an Automatic Implanted Cardioverter Defibrillator (AICD) during colonoscopy procedures, given the following conditions:

A patient-specific order must be written by a physician for use of the magnet,
A physician must be in attendance the entire time that the magnet is attached to the patient,
Cardiac monitoring must be performed continuously throughout the procedure,
An emergency code cart must be immediately available,
The facility must provide education and skill training, with input from the Cardiology Department, to RNs providing this procedure,
The facility must have a written institutional policy and procedure, with input from the Cardiology Department/cardiologist, describing the role of the RN in this procedure,
The RN must be able to document the completion of appropriate education and clinical competence in the procedure,
The facility must provide competency assessment of each RN’s ability to provide this procedure. Such assessment must be documented in the personnel file of each RN and updated annually,
A complete nursing assessment must be performed and documented prior to each treatment,
Prior to discharge, the patient’s AICD must be evaluated by the facility’s cardiac electrophysiology lab/cardiologist.

Mandatory overtime ban in effect

Section 167 of the Labor Law, which prohibits health care employers from mandating overtime for nurses, took effect on July 1. The New York State Department of Labor (DOL) is responsible for enforcement of this law and has posted information on its website, including emergency enabling regulations.

This new law permits voluntary overtime without restriction, but given the evidence of the correlation between high levels of overtime and reduced job function, the SBFN has taken the following position on voluntary overtime:

Nurses who voluntarily work beyond their normally scheduled hours in a situation which is not a declared emergency, must be able to demonstrate that they are competent to perform their professional responsibilities. Voluntarily working beyond 16 hours in a 24-hour time period will be considered as a factor in determining the willful disregard of patient safety by nurses and will be subject to a potential charge of unprofessional conduct.

Visit the website

Be sure to visit the SBFN website at www.op.nysed.gov/nurse.htm. You’ll find licensure statistics, license application forms, and the state laws and regulations related to nursing. You can take an online test to measure your knowledge of the law.

We’ve posted the questions asked most frequently by nurses calling the board office and the practice guidelines and position statements adopted by the SBFN.