Having trouble viewing this email? View it as a Web page.

DATE: November 25, 2019

You are receiving this update as a licensee of the Wisconsin Board of Nursing and/or as a subscriber to this communication.

Chairs Corner

By Peter Kallio, DNP, CRNA, APNP      We have been busy in the last several months addressing the changes in leadership within our board, DSPS, and converting to the new nursing compact. Our meetings have been well attended and we are continuing with our role of public protection. In that role we have a continual task of: Reviewing cases against nurses to determine if public safety is at risk. (discipline or educate as needed) Monitor those in drug and alcohol state monitoring programs. Review and approve new schools of nursing. Monitor NCLEX pass rates for schools of nursing. Update current rules around the nurse practice act through our Legislation and Rules Committee headed by Luann Skarlupka. Educate our own board members on their duties and responsibilities. Review PDMP data for prescribers.      This year we sent board members to the NCSBN Annual Meeting in Chicago. This is a great networking meeting to get regulation education and to see how other state boards conduct business. On that same note, Jim Puente of the NCSBN came to Madison for a 2-day training event for our board on the new nursing compact and the regulations that surround it.      As the Chairperson for the Wisconsin Board of Nursing, I would like to acknowledge and thank Lillian Nolan for her many years of service as a public member of our board. Her time on the board has expired and she will be missed. Personally, I will miss her levelheadedness and concern for the nurses of Wisconsin. She was a great mentor to me when I first came to the board. She was supportive and will be missed by her colleagues on the board. We wish her the best of luck moving forward.      As our Board of Nursing moves forward, we will always have the public safety at heart as we work to serve all nurses in Wisconsin. We look forward to continuing updates in rules language, moving forward with the new e-compact for nursing, being a resource as we approve new schools of nursing and providing input to proposed legislation and solutions to the opioid crisis.

Discharge and Discharge Planning Tips for Nursing in the Opioid Epidemic

     In 2015 the Wisconsin Act 269 granted authority to the Board of Nursing to issue guidelines regarding best practices in prescribing controlled substances for persons credentialed by the Board of Nursing who are authorized to prescribe controlled substances. The purpose of these guidelines is to provide guidance to advanced practice nurse prescribers for prescribing controlled substances. These guidelines are intended to supplement and not replace the individual advanced practice nurse prescriber’s clinical judgment. The guidelines are not intended to address prescribing practices related to patients who are in active cancer treatment, palliative care, or end-of-life care. https://dsps.wi.gov/Documents/BoardCouncils/NUR/BONGuidelinesV1.pdf

     I would like to address how these new guidelines might affect nurses who are involved with discharge and discharge planning of patients in this new environment of opioid reduction. Patients being discharged on opioids must be informed of the serious risks of opioid dependence especially if they already have risk factors for dependence or complications. These risk factors include previous or current addictions (including alcohol), mental health conditions (depression or anxiety), sleep apnea, pregnancy, concurrent benzodiazepine use. These are highlighted in the CDC recommendations from 2016. http://dx.doi.org/10.15585/mmwr.rr6501e1

     According to the American Hospital Association (AHA), patient education is a key component to a successful discharge.

     Conversations with patients regarding post-operative expectations are already happening in operating rooms, EDs and inpatient settings. No longer are we telling them that we will take care of all of their pain. Some pain may be expected. New recommendations (CDC 2016) discuss a multimodal approach to pain management. No longer should the focus be on opioids alone in the treatment of pain. This is where nursing can have a big impact on patient satisfaction. We as nurses are already the main educators of patients and this crisis is no different. We as nurses should be working hard to prevent the next opioid dependent patient. Education on the risks of opioids and on the benefits of a multimodal approach to pain management is needed in all discharge education and planning. Patients must also be educated to realistic expectations.

     Recent studies are finding that ED providers had little change in their prescribing habits even with access to the Prescription Drug Monitoring Program (PDMP). We must realize that even for patients with no previous opioid exposure, initial short use of opioids can put them at risk for withdrawal and even dependence. The state of Wisconsin has made steady improvement in provider education and PDMP use. https://www.healthit.gov/sites/default/files/resources/pdmp_pilot_studies_summary.pdf

     It is now upon nursing to help in this crisis by doing what we do best. As patient advocates, we need to assist in this crisis by ensuring our patients know all of the risks and patient modalities for pain management upon discharge. This is where all nurses can be effective in this crisis.

There are patient education tools available:

1. AHA Quality advisory Patient education resource:

          http://www.aha.org/content/16/opiodneedtoknow.pdf

1. CDC Patient information

          https://www.cdc.gov/drugoverdose/patients/index.html

References:

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1

Why Opioid Addiction Will Persist Until Physicians Have A Panoramic View Of Opioid Exposure, " Health Affairs Blog, October 4, 2018.DOI: 10.1377/hblog20180928.934819

https://www.healthaffairs.org/do/10.1377/hblog20180928.934819/full/

Legislation and Rules Committee Continues Review of Certified Nurse Midwives Administrative Rule N 4

By Luann Skarlupka, Legislative Liaison and Public Member      The Legislation and Rules Committee of the Board of Nursing is continuing its review of Chapter N 4 of the Administrative Rules which governs the practice of Certified Nurse Midwives.  The Committee is grateful for the dedicated Certified Nurse Midwives and other stakeholders who have attended the committee meetings to provide insight and input.  The Board reviews all Administrative Code on a regular basis to ensure the rules reflect and support current practice.  Chapter N 4 has not been formally reviewed in more than a decade.       Committee meetings typically occur before the regularly scheduled full board meeting.  Meetings are held in Madison at the Department of Safety and Professional Services building, 4822 Madison Yards Way, Second Floor Conference Room N208.  Future Committee meeting dates and times can be found at https://dsps.wi.gov/Pages/BoardsCouncils/Nursing/Meetings.aspx. If you cannot attend the meeting but would like to provide insight, please contact the Board's Administrative Rules Coordinator, Dale Kleven at Dale2.Kleven@wisconsin.gov.

Wisconsin Report from Inside the
2019 NCSBN Annual Meeting

Elizabeth Houskamp served as Wisconsin's voting delegate at the 2019 NCSBN Annual Meeting in Chicago, IL.

By Debra Sybell, Executive Director

      Delegates of nursing regulatory bodies from across the nation gathered in Chicago August 21-23 for the 2019 Annual Meeting of the National Council of State Boards of Nursing (NCSBN).  It was a time to reflect, collaborate, and take care of NCSBN business with Beth Smith-Houskamp, PhD, RN representing the Wisconsin Board of Nursing.

     NCSBN Board of Directors President Julia George kicked off the meeting by highlighting the organization’s activities, progress, and collaborative efforts over the past year which include establishing an APRN Task Force, advancing the Nurse Licensure Compact, and participating in the Tri-Regulator Collaborative along with the Federation of State Medical Boards and the National Association of Boards of Pharmacy.

     Annual meeting attendees engaged the NCSBN Board of Directors on a variety of topics including the Nurse Licensure Compact; APRN education, scope and variability of full practice authority; occupational licensing reform; Next Generation NCLEX; admission criteria for nurse education programs; and how technology may impact regulations in the future. 

     At the end of the day, the NCSBN Delegate Assembly approved the Strategic Initiatives for 2020-2022 and adopted the 2020 NCLEX-PN Test Plan.  Ultimately, NCSBN punted on taking up the APRN Compact, citing the complexity of finding a solution that will garner support given the variation in state progress towards the APRN Consensus Model.

     Keynote speaker Erik Wahl closed out the annual meeting with a crowd-pleasing presentation that combined music, live painting, video imagery and his own version of Let’s Make a Deal to challenge attendees to explore, innovate, and create.

New Member Introductions

By Lisa Pisney, NP      I am currently employed as a Nurse Practitioner in the division of GI/Hepatology at Gundersen Health in La Crosse. I have worked as a Registered Nurse since my graduation from the University of South Carolina in 1993. I worked as a RN, primarily in surgery and ICU settings, for 10 years prior to getting my Master of Science in Nursing and my certification as an Adult Nurse Practitioner at the University of Colorado at Colorado Springs. I have been an Adult Nurse Practitioner for the past 15 years and have spent most of those years working in Gastroenterology and Hepatology.      My husband was in the Army for 20 years and my career has followed him to many different states and positions. We are originally from the Midwest and returned here after he retired. I have been able to experience differences is health care across the United States and have personally seen the disparity of health care that exists. I have worked for both the VA healthcare system and the private sector. I feel that this has given me a great ability to be able to speak from a background of great depth of experience in nursing.

By Emily Zentz, RN-BSN      I am a new member on the board since April 2019. I am also an Alumni of the University of Wisconsin Madison School of Nursing and currently work as a staff nurse in the Emergency Department at the William S. Middleton Memorial Veteran Hospital and UW Health at the American Center in Madison.      My path to Nursing was not a traditional one as I spent twelve years in the Biotech industry working in Molecular Biology, Genomics, and Microbiology prior to becoming a Registered Nurse in 2016. It is an honor to be on the board and I look forward to serving the State of Wisconsin and acting as a resource for RNs throughout the state.

Continuing the Vision: Future of Nursing 2020-2030

By Barbara Nichols, Wisconsin Center for Nursing      On March 20, 2019, The National Academy of Medicine (NAM) launched a new study on the future of nursing. The goal of the new Committee on the Future of Nursing 2020-2030 is to extend the original vision and chart a course for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the U.S. population in the 21st century.      Nearly 10 years ago, NAM published the forward-thinking report: The Future of Nursing: Leading Change, Advancing Health, which included recommendations to improve access to safe and high-quality patient care through nursing. The landmark report called for action to build the capacity of the nursing workforce by: Fostering interprofessional collaboration, Improving diversity by making it a workforce priority, Increasing the proportion of baccalaureate-prepared nurses by 2020, Doubling the number of doctorally-prepared nurses by 2020, Utilizing advanced practice RNs (APRNs) to the full extent of their education and training, Ensuring that healthcare leadership positions are available to and filled by nurses.      During 2020, the Committee on the Future of Nursing 2020-2030 will highlight the unprecedented progress made, including recommendations leading to the context for the second report. 2018 Wisconsin RN Workforce Survey Report      Wisconsin is facing an impending primary care workforce shortage. Wisconsin’s 90,143 registered nurses (RNs) are uniquely positioned to help meet the growing demand for effective primary care.      The 2018 Wisconsin RN Workforce Survey is required by Wisconsin State Statute. The survey is conducted by the Wisconsin Department of Safety and Professional Services, the Wisconsin Department of Workforce Development, and the Wisconsin Center for Nursing. This report offers recommendations for regional variation in nursing practice, education, and policy. It also includes evidence-based analysis by the research team from the University of Wisconsin – Madison, School of Nursing, and the Wisconsin Center for Nursing.      Through the data analysis, the researchers found the shift in health care reform and delivery suggests that health care organizations, in partnership with schools of nursing and communities, should emphasize recruitment, retention, and succession planning for optimum RN utilization. Read the full report at www.wicenterfornursing.org

Board of Nursing Quick Links

Statute and Rules
BON Annual Reports
Agenda Materials/ Meeting Dates
Nursing School Information
BON Best Practices for Prescribing Controlled Substances Guidelines
Prescription Drug Monitoring Program (PDMP) Website

Board of Nursing Membership and Staff Assignments

The Board of Nursing consists of 9 members. The members are appointed by the Governor and confirmed by the Senate.

Board Members:

Peter Kallio, Chairperson - Registered Nurse Member (Muskego)
Pamela White, Vice Chairperson - Registered Nurse Member (Eau Claire)
Luann Skarlupka, Secretary - Public Member (De Pere)
Rosemary Dolatowski, Registered Nurse Member (Burlington)
Jennifer Eklof, Licensed Practical Nurse Member (Madison)
Lisa Pisney, Registered Nurse Member (Onalaska)
Elizabeth Smith Houskamp, Registered Nurse Member (Onalaska)
Emily Zentz, Registered Nurse Member (Madison)
Vacant, Public Member

Information on how to apply for appointment to the Wisconsin Board of Nursing can be found through the Office of the Governor using the link below: https://evers.wi.gov/Pages/Application_Process.aspx

Enforcement Actions of the Board of Nursing

The Board of Nursing, with help from staff at the Department of Safety and Professional Services, can take action against nurses licensed in the state to help protect the profession and the citizens of Wisconsin. You may search for any of the Board Orders listed below on the Department’s website by using this link:

Board Order Search: https://dsps.wi.gov/Pages/SelfService/OrdersDisciplinaryActions.aspx

Disciplinary options available to the Board

Reprimand: A public warning of the licensee for a violation.

Limitation of License: Imposes conditions and requirements upon the licensee, imposes restrictions on the scope of practice, or both.

Suspension: Completely and absolutely withdraws and withholds for a period of time all rights, privileges and authority previously conferred by the credential.

Revocation: To completely and absolutely terminate the credential and all rights, privileges and authority previously conferred by the credential.

Non-disciplinary options available to the Board

Administrative Warning: Issued if violation is of a minor nature, a first occurrence and the warning will adequately protect the public. The issuance of an Administrative Warning is public information, however the reason for issuance is not.

Remedial Education Order: Issued when there is reason to believe that the deficiency can be corrected with remedial education, while sufficiently protecting the public.

Board Orders

June 2019 - October 2019

A wealth of useful information is available on the Department of Safety and Professional Services website at: https://dsps.wi.gov/pages/Home.aspx

Do you have a change of name or address?

Licensees can update name or address information on the Department website at: https://dsps.wi.gov/Pages/SelfService/Default.aspx. Please note that confirmation of change is not automatically provided. Legal notices will be sent to a licensee’s address of record with the Department.

Telephone Directory:

Call the Department of Safety and Professional Services toll-free (877) 617-1565, or (608) 266-2112 in the Madison area to connect to the service you need.

CONTACT US

Email: dsps@wisconsin.gov  |  Phone: (608) 266-2112  |  Office Hours: 7:45 a.m.- 4:30 p.m.

The mission of the Department of Safety and Professional Services is to promote economic growth and stability while protecting the citizens of Wisconsin as designated by statute.