NEW YORK NURSE: November 2010
By Barbara Zittel, RN, PhD, Executive Secretary
According to the New York State Education Department, 272,116 individuals were licensed and registered to practice professional nursing in New York as of Jan. 1, 2010. This continues to reflect an upward trend. The Department issued 14,143 new RN licenses in 2009. While this represents 300 fewer licenses issued than in 2008, we need to wait an additional year before determining if this is the initiation of a trend or normal, random fluctuations.
New York State has slightly more than 15,300 nurse practitioners (NPs) practicing in over 16 specialties. Almost 800 new master’s prepared NPs were added in 2009. As of Jan. 1, 2010, there were 69,902 licensed practical nurses (LPNs), a decrease of over 1,600 from 2009. While 4,009 new LPN licenses were issued during this time frame, this is only 100 more than in 2008.
Among the 47 licensed professions, the State Board for Nursing has the highest caseload of disciplinary and moral character charges. In 2009, 1,397 cases were opened against RNs, 92 against NPs, and 784 against LPNs. Negligence/incompetence remains the most frequent category for all titles. For RNs and LPNs, “conviction of a crime” increased more in 2009 than any other category.
One finds a significant difference when comparing disciplinary cases opened against RNs and LPNs, using a common metric. On average, in each year between 2001 and 2009, for each 1,000 nurses, there were 11 disciplinary/moral character cases against LPNs, compared to 4 cases against RNs.
To help understand this discrepancy, the board will start using a new data collection instrument called “Taxonomy of Error, Root Cause Analysis and Practice-responsibility” (TERCAP). The instrument was developed by regulators nationwide, under the National Council of State Boards for Nursing, led by Patricia Benner, RN, PhD, of the Carnegie Foundation for the Advancement of Teaching. It attempts to address the nuances of nursing practice breakdowns. By using this nurse-developed instrument, the Board hopes to have a comprehensive analysis of errors from which to recommend changes in areas such as environment, education, or management.
In 2009, the board office handled over 17,459 telephone calls and 5,054 e-mails. The majority were related to scope of practice. Answers to nursing issues are posted on our website under “Practice Alerts and Guidelines.” Major guidelines added this year include:
Medical assistants – It has come to the attention of the Office of the Professions that a significant number of physicians’ offices are utilizing medical assistants or other unlicensed persons to assist in the care of patients. Section 6530 (11) of Education Law states that “permitting, aiding or abetting an unlicensed person to perform activities requiring a license” constitutes unprofessional conduct. Medical tasks may only be delegated to persons authorized by law to perform that task — for instance, medication administration, starting IVs, taking an X-ray, and making a diagnosis.
The fact that an unlicensed person may be “competent” to perform a task does not confer legal authorization to engage in an activity restricted to licensed persons. Licensed professionals, including physicians, who knowingly delegate a medical task to a person who is not legally authorized are guilty of professional misconduct.
The state boards for nursing and medicine developed a list of tasks that can and cannot be performed by “medical assistants” or other unlicensed persons. The lists include tasks frequently mentioned by practitioners in queries to board offices. It is not an exhaustive list. Practitioners may be called upon to make judgments about whether certain tasks, not mentioned in the list, may be delegated.
Practitioners with authority to order or delegate medical tasks should be guided by the principle that tasks requiring an exercise of medical judgment and assessment, or tasks specifically restricted to licensed professionals, may not be delegated to medical assistants or unauthorized persons.
Such tasks must be performed by licensed persons who, by their education and licensure, are presumed to possess the level of professional judgment and assessment skills to ensure safe practice. Tasks that can be performed by medical assistants or unlicensed persons include secretarial work, such as assembling charts or assisting with billing; measuring vital signs; performing ECGs; drawing blood work; and assisting an authorized practitioner, under their direct and personal supervision, to carry out a specific task, as a “second set of hands.”
For example, an authorized practitioner, after positioning a limb, asks the medical assistant to maintain the limb in the position while a bandage is applied or sutures removed. The assistant could not independently position the patient.
Tasks that cannot be performed by medical assistants or unlicensed persons include triage; administering medications; administering contrast dyes or injections; placing or removing sutures; taking or independently positioning patients for x-rays; applying casts; and first-assisting in surgical procedures.
Unlicensed assistive personnel and waived tests – The board received numerous inquiries on the role of unlicensed assistive personnel (UAPs) in performing waived tests in acute care settings – bedside tests such as glucose monitoring, which have been performed by UAPs for many years. With the passage of the bill licensing clinical laboratory technicians, such practice was restricted for several years.
A resolution was reached by the Department of Health (DOH) that waived tests may be performed by UAPs in acute care settings if the facility has obtained a permit from DOH for a limited service laboratory. The hospital’s clinical laboratory director must also be in charge of the laboratory. The clinical laboratory director, not nursing management, must ensure personnel are trained and equipment is appropriate and tested.
Prefilling medication boxes in homecare settings – In December 2009, the Governor signed into law Chapter 503, permitting RNs and LPNs functioning under RN supervision to prefill medication boxes for up to a 15-day supply.
As mandated by the law, a guideline of “best practice” was developed by the state boards for nursing and pharmacy. Highlights include:
After an initial assessment of the patient by an RN and under the supervision of an RN, an LPN may be permitted to prefill medication boxes, provided:
Effective July 1, 2010, Chapter 56, Part B of the Laws of 2010, provides immunity for training, drills and response activities for all affiliated volunteers. This includes Medical Reserve Corps and Citizen Corps volunteers who are specifically referenced in a county’s Emergency Management Plan, have clearly defined roles, and are activated by the county chief executive or designee. This is in addition to the defense and indemnification provided by a county through Public Officer’s Law 18.
Information on these issues is available on our web site:www.op.nysed.gov/prof/nurse/.