ursing nevada state board ofnewsepubs.nsla.nv.gov/statepubs/epubs/620964-2006-3.pdf · nevada state...

NURSINGNEWSNURSINGNEWSNevada State Board ofNevada State Board of

March 2006

ProfessionalBoundaries

What are they and how can

you stay within them?

Meet the Staff

GovernorAppointsNew LPNBoardMember

Betty McKay

7 0 2 . 3 8 3 . 2 0 0 0 w w w . u m c s n . c o m

I n o n e p r e c i s e m o m e n t

Something happens when you puteleven centers of excellence in one hospital:Every moment is charged with meaning.And miracles are all part of a day’s work.

the symbol of excellence

a mother holds her first child

a stroke survivor takes a step on her own

a heart patient is flown in by chopper

and a doctor says, “she’s going to be fine.”

3Nevada State Board of Nursing ■ Toll-Free 1-888-590-6726 ■ www.nursingboard.state.nv.us

The mission of the NevadaState Board of Nursing is toprotect the public’s health,safety and welfare througheffective regulation of nursing.

Debra Scott, MS, RN, APN Executive Director

Cindy Kimball, EditorPublic Information Officer

5011 Meadowood Mall Way,Suite 201Reno, NV [email protected]

The Nevada State Board ofNursing News publishesnews and information aboutBoard actions, regulations, andactivities. Articles may bereprinted without permission;attribution is appreciated.

NEVADA STATE BOARDOF NURSING5011 Meadowood Mall Way,Suite 201Reno, NV 89502-6547phone—888-590-6726 fax—775-688-2628 [email protected]

2500 W. Sahara Ave., Suite 207Las Vegas, NV 89102-4392phone—888-590-6726fax—[email protected]

WORLD WIDE WEBwww.nursingboard.state.nv.us

6Governor Appoints New LPNBoard Member Betty McKay

Wear Your Name Tag—It’s the Law

Professional Boundaries

4

7Renew Your License or Certificate On Line

Look for the postcard in the mail 8

9Meet the Staff: Patty

Towler and Linda Aure 13

Created by Publishing Concepts, Inc.Virginia Robertson, President • [email protected] • 14109 Taylor Loop Road • Little Rock, AR 72223 / 501.221.9986

For advertising information contact: Jane Coker at 800.561.4686 • [email protected] our website www.thinkaboutitnursing.com

C O N TA C T

If you’re reading a friend’s magazine, it’s probably becauseyou didn’t notify the Board ofyour correct address.You may do so by visiting our website and clicking on the“Address Change” link.See page 18 for details.

Edition 9

contentspage 6

page 13

Nevadans help developNCLEX items

page 9

Board and Advisory Committee Meetings 4

You’re in Good Company 4

Board Members 14

Moving? Now you can change your address on line! 18

Disciplinary Actions 20

Use Website To Verify Active License/Certificate 21

Staff Directory 22

On the Cover: New LPN Boardmember Betty McKay. Photo by Doreen Begley

Circulation includes more than 30,000 nurses,nursing assistants and student nurses.

page 13

4 Nevada State Board of Nursing ■ Toll-Free 1-888-590-6726 ■ www.nursingboard.state.nv.us

The openings (listed in parentheses)will occur in the next six months. Allmeetings will be held via videoconfer-ence in Reno and Las Vegas, exceptfor the Disability Advisory Committee.

Advanced Practice AdvisoryCommittee (one)

May 9, 2006August 16, 2006November 7, 2006

CNA Advisory Committee (two)Recent appointment: Kathie Wilcox, LPNMay 4, 2006August 17, 2006November 2, 2006

Disability Advisory Committee (three)April 21, 2006 - Las VegasOctober 20, 2006 - Reno

Education Advisory Committee (five)Recent appointments: Frances Brown, MSN,BSN, RN; Margaret Covelli, MHA, BSN,RN; Madelon Lawson, BSN, RN, CAPAMay 12, 2006August 11, 2006November 3, 2006

Nursing Practice Advisory Committee (four)April 4, 2006June 6, 2006August 8, 2006October 3, 2006December 5, 2006

B O A R D TA L K

BOARD MEETINGSA seven-member board appointed by thegovernor, the Nevada State Board ofNursing consists of four registered nurs-es, one practical nurse, one certifiednursing assistant and one consumermember. Its meetings are open to thepublic; agendas are posted on theBoard’s web site and at community sites.

BOARD MEETING DATESMarch 29-31, 2006 - Reno(April 26, 2006)May 17-19, 2006 - Las Vegas(June 21, 2006)July 19-21 (annual business meeting) - Elko(August 23, 2006)September 20-22, 2006 - Las Vegas(October 18, 2006)November 15-17, 2006 - Reno(December 13, 2006)(Meetings may be held on dates and inlocations in parentheses, depending onBoard business.)

COMMITTEE MEETINGDATES AND OPENINGS

COME TALK TO THE BOARDDuring each regularly scheduled meeting of the Nevada State Board of Nursing,Board members hold a Public Comment period for people to talk to them on nurs-ing-related issues.

If you want to speak during the Public Comment period, just check the meetingagenda for the date and time it will be held. Usually, the Board president opensthe first day of each meeting by inviting Public Comment. Time is divided equallyamong those who wish to speak.

For more detailed information regarding the Public Comment period, please callthe Reno office.

WE’LL COME TALK TO YOUBoard staff will come speak to your organization on a range of nursing-relatedtopics, including delegation, the impaired nurse, licensure and discipline process-es, and the Nurse Practice Act.

ADVISORY COMMITTEESThe Nevada State Board of Nursing isadvised by and appoints members to fivestanding advisory committees. Committeemeetings are open to the public; agendasare posted on the Board’s website and atcommunity sites. If you are interested inapplying for appointment to fill anupcoming opening, please visit theBoard’s website or call the Reno office foran application.

Local nurses serve on national panels

Nevadans help developNCLEX items

The National Council of StateBoards of Nursing (NCSBN)recently recognized Nevada regis-tered nurse Connie Uy Liao forserving as an item reviewer for theNCLEX-RN Examination. It alsorecognized two Nevadans whoserved as alternates: Fatima Judsonfor the NCLEX-RN Item WritingPanel and Ashley Brooks for theNCLEX-RN Item Review Panel.

If you would like to participatein the review or development ofitems for the national nursinglicensure exam, you can learn moreby going to the National Council’swebsite at www.ncsbn.org, andclicking on Item Development On-line Application under the headingTesting Services Announcements. Ifyou don’t have web access, call312-525-3775.

YOU’RE IN GOODC O M P A N Y

Active Nevadalicenses/certificates on

January 23, 2006

RN • 21,468LPN • 3,097CNA • 6,060


REACHRECRUITRETAIN

THE NEVADA BOARDOF NURSING

MAGAZINE SCHEDULE• June 2006• September 2006• December 2006• March 2007

to reserve advertising [email protected]

1-800-561-4686

www.thinkaboutitnursing.com

Our State Board magazines are direct mailed to everylicensed nurse in the followingstates–one million and growing!

Governor ReappointsBoard MemberJoseph Cortez

2005 RN SurveyResults Released

Board Member David Burgio EarnsNational Recognition


Governor ReappointsBoard MemberJoseph Cortez

2005 RN SurveyResults Released

Board Member David Burgio EarnsNational Recognition

December 2005


March 2006

ProfessionalBoundaries

What are they and how can

you stay within them?

Meet the Staff

GovernorAppointsNew LPNBoardMember Betty McKay

• Arizona• Arkansas• The District of

Columbia• Indiana• Kentucky• Nebraska• Nevada

• New Mexico• North Carolina• North Dakota• Ohio• South Carolina• South Dakota• Tennessee• Wyoming

For Advertising InformationContact Jane Coker at 1-800-561-4686

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RECRUIT NURSES. www.thinkaboutitnursing.com


Gov. Kenny Guinn recently appointed Betty McKay,LPN, to the Nevada State Board of Nursing. An LPNhealth technician for the Dayton School System, LyonCounty School District, McKay replaces licensed practicalnurse and veteran Board member Patricia Shutt, whose sec-ond four-year term expired in October.

The Board's newest member has more than30 years experience as an LPN, with a focus onschool nursing, long-term geriatric care, and thedevelopmentally disabled/mentally retarded pop-ulation.

In her current position, McKay provides nurs-ing services for about 600 elementary school chil-dren. In addition, she works part time forEducare, an Intermediate Care Facility for theMentally Retarded in Carson City, and for GoingPlaces, a Supported Living Arrangement compa-ny, also located in Carson City.

As a licensed residential facility administra-tor, she owned and operated Valley View CareHome, an assisted living facility in Minden,Nevada, from 1991 to 2000. During that time,McKay served as state secretary and then presi-dent of the Nevada Adult Care Association.

Her work experience includes two stints over-seas. At Clark Air Force Base in the Philippines,she worked as a staff nurse for the Red Cross. InGiessen, Germany, McKay was a consumeradvocate/social services specialist with the Department ofDefense, serving 5,000 military personnel and their families.She also ran the community's emergency food bank.

In the time between the Philippines and Germany, shevolunteered to work in the FISH (Friends In ServiceHelping) Thrift Shop in Carson City, Nevada, and soonfound herself the manager of five FISH thrift shops.

McKay’s nursing experience includes a unique position forthe State of Nevada's Cervical Cancer Screening program,where she and an RN traveled throughout the state in an oldWWII-type ambulance and set up women's clinics. The pro-gram ended with the loss of federal funding.

The new Board member’s long and varied career alsoincludes a position as a communications specialist for the

United States Air Force's Presidential Airways. From 1968 to1970, she worked at Andrews Air Force Base nearWashington, D.C., handling communications to and fromAir Force One, a position which required a Top SecretClearance. She later served in the Nevada Air NationalGuard from 1979 to 1984.

McKay earned her diploma in practical nursing from DelMar College in 1972, and is now attending ColoradoTechnical University to complete her degree in businessadministration with a major in health facility management.

A current member of the Nevada Classified SchoolEmployees Association, she has served as the state boardsecretary and state representative.

When asked why she volunteered for yet anotherdemanding role—serving as the LPN member of the NevadaState Board of Nursing—McKay explained, "I have a pas-sion for giving back. After living abroad and traveling allover the world, I am just so appreciative of how special ourcountry is. I truly believe we each have a responsibility tomake our community a better place in our own unique way."

Governor Appoints New LPN Board MemberBetty McKay replaces Patricia Shutt

New LPN member Betty McKay confers with RN member Mary AnnLambert during the January 25-27 Board meeting in Las Vegas.


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As you’re getting ready for work and whileyou’re at work, please remember—the NursePractice Act (NAC 632.249) requires:1. Each registered nurse, licensed practical nurse,certified nursing assistant, nursing student andnurse certified in an advanced specialty shall identify himself by his appropriate title:

(a) When recording information on a record;(b) When introducing himself to a client,

patient or prospective patient; and(c) On a name tag which:

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All you need to renew your Nevadalicense or certificate is a MasterCard™,Visa™ or Discover™ debit or credit card,and access to the internet. If you are aCNA, you will also need the full nameand license number of your supervisingRN or LPN.

Instead of receiving a renewal appli-cation in the mail, you’ll be mailed ablue (nurse/advanced practitioner) oryellow (nursing assistant) postcard witha Personal Identification Number (PIN)and instructions to access the Board’swebsite at www.nursingboard.state.nv.usfor on line renewal. (The postcards aremailed to your address of record abouttwo months before your license/certifi-cate expires.) Once you’ve successfullycompleted the process, your license orcertificate will be renewed within onebusiness day. Your hard card will followin the mail.

If you don’t have a MasterCard™,Visa™ or Discover™ debit or credit card,the postcard will direct you to completeand print a renewal application from theBoard’s website or call for an applicationto be mailed to you. Or you can come toeither Board office and renew your certifi-cate using the lobby computer set up justfor you!

So, make sure the Board has yourcorrect address—and don’t throw awaythat postcard! If it’s less than twomonths before your license/certificateexpires, and you haven’t received yourpostcard—or if you have any questionsregarding the on line renewal process—please call the Board.


Look for the postcard in the mail

RENEW YourLicense or Certificate

On Line


As nurses and nursing assistantsincreasingly find themselves providingcare in patient homes or involved inlong-term care giving roles with thechronically ill, the opportunities to “talkabout their troubles” or accept that “lit-tle gift” seem to occur innocently andnaturally.

But beware–those behaviors couldrepresent inappropriate involvement ina patient’s personal life and constitute“boundary violations” that can haveharmful consequences for the patientand ultimately for the nurse.

For the patient, inappropriate rela-tionships with caregivers can disrupt theability of the nurse or nursing assistantto respond objectively to the patient’shealth care needs. It may also leave thepatient feeling confused, betrayed, anddistrustful of the profession.

For the nurse or nursing assistant, itcan result in disciplinary action by the

Nevada State Board of Nursing.According to Nevada law, engaging inconduct “outside professional bound-aries” with a patient is a violation of theNurse Practice Act [NAC 632.890 (38)].

■ It’s about power and vulnerabilityProfessional boundaries are defined as

the space between the nurse’s or CNA’spower and the client’s vulnerability. Thepower of the nurse and nursing assistantcomes from the professional position andthe access to private knowledge aboutthe patient. By virtue of their controlover life-sustaining therapies and com-plex equipment, nurses hold subtle buttremendous influence over theirpatients’ behaviors.

This power, which is an essential ele-ment in the nurse/patient relationship,enables the nurse or nursing assistant topositively influence the patient’s healthstatus. However, if the extent of that

power is not limited through the estab-lishment of appropriate professionalboundaries, the patient is subjected tounacceptable risks that could ultimatelynegatively affect the patient’s physicaland emotional health. Defining andmaintaining these professional bound-aries are responsibilities of the nurse andnursing assistant, not the patient.

Meeting these responsibilities can bechallenging, particularly in today’shealthcare environment.

■ Where exactly are the boundaries?Boundaries and professionalism may

be defined differently by members of thesame staff. What some consider casualconversation may actually be excessivepersonal disclosure when more thanmundane personal information is sharedwith a patient. Joking and camaraderiemay be seen as contributing to a pleas-ant atmosphere in some circumstances,but may lead to boundary violations inothers, particularly if the jovial atmos-

Professional BoundariesWhat are they and how can you stay within them?

Have you ever

• shared your personal problemswith a patient?

• given a patient a gift?

• complained to a patient about aco-worker or about being “shortstaffed”?

• socialized with a patient outside ofyour professional capacity?

• flirted with a patient or engaged insexual banter “all in good fun”?

• accepted a gift of more than mini-mal value from a grateful patientor family member?

you may have crossed the line

10

phere is not counter-balanced by a solidunderstanding of professionalism. Thesame activity engaged in by one nurse ornursing assistant may fall within appro-priate boundaries when the clear intentbehind the activity is therapeutic, yetfall outside that line when done byanother who has a more personal motivefor the behavior.

Consider, for example, the nurse whogives a young female patient a compactdisc featuring a favorite pop singer. Themusic is intended to provide a welcomedistraction during strenuousrehabilitation exercises.

Conversely, anothernurse gives the same patientthe same gift but does itsecretly, indicating that thegift reflects how special thepatient is to the nurse. Onenurse has a therapeuticmotive for the gift while theother is trying to be friends.One has crossed a profes-sional boundary, the otherhas not.

■ Always consider your motivationWhen providing “special” privileges

to a patient, always consider the motivebehind the action. Was it done openlyas encouragement or as a reward forefforts to comply with the care plan, orwas it to gain approval and acceptancefrom the patient? Interactions that arewell-intended can become boundary vio-lations when nurses or nursing assistantsmeet their own needs at the expense oftheir clients.

Many boundary violations arise out ofthe helpful, nurturing personality thatmotivates people to become nurses andCNAs in the first place. Avoiding inap-propriate involvement with patientsdoes not mean sacrificing that helpingnature. Instead, helpfulness must becarefully centered along a so-called con-tinuum of professional behavior. Over-involvement with a patient, whichoccurs when nurses and nursing assis-tants engage in excessive personal dis-closure, secrecy, or even role reversal is

at one end of the continuum whileunder involvement (distancing, disinter-est and neglect) is at the other. Thereare no definite lines separating the zoneof helpfulness from either end of thecontinuum; instead, it is a gradual transi-tion or melding.

■ Even well-meaning involvementcan have bad consequences

Dealing with these issues is furthercomplicated because the concept ofboundary violations is often poorly

understood and resisted. Many nursesand CNAs find it difficult to analyzetheir own motives and fail to see whentheir well-meaning involvement withtheir patients could have dire conse-quences.

Take for example the nursing assis-tant who needs a car for his teenage sonand knows that his patient has a car tosell. The CNA buys the car at fair mar-ket value and all seems well. But severaldays later the car stops running. Howwill that situation affect the ability of

the nursing assistant tocontinue to provide care tohis patient?

Or what about the nursein the nursing home whofrequently takes a lonelypatient home with her forthe weekend? The nursedecides to accept a new joband leaves the facility andher patient behind. Will thepatient be able to acceptthe sudden loss of her week-end excursions with her

“friend” without feeling abandoned? Finally, what about the home-health

nurse whose husband has lost his joband whose three-year-old son needsintensive speech therapy that is not cov-ered under the nurse’s health insurance?One day the nurse shares her problemswith her patient who then offers to loanher money to take care of all of herfinancial obligations. The nurse acceptsthe loan fully intending to repay themoney. How will this financial arrange-ment affect the ability of the nurse to be

Excessive self-disclosureThe nurse/CNA discusses personalproblems or aspects of his or her inti-mate life with the patient, or discuss-es feelings of sexual attraction.

Secretive behaviorThe nurse/CNA keeps secrets withthe client and/or becomes guardedor defensive when someone ques-tions their interaction.

“Super nurse/CNA”behaviorThe nurse/CNA believes that he orshe is immune from fostering a non-therapeutic relationship and that onlyhe or she understands and can meetthe specific client’s needs.

Singled-out patient The nurse/CNA spends inappropriateamounts of time with a particularpatient, visits the patient when offduty or trades assignments to be withthe patient. This may also bereversed, with the patient paying spe-cial attention to the nurse/CNA, suchas giving the nurse/CNA gifts.

Selective communicationThe nurse/CNA fails to explainactions and aspects of care, reportsonly some aspects of the patient’sbehavior, or gives “double mes-sages.” In the reverse, the patientturns repeatedly to the nurse/CNAbecause other staff members are“too busy.”

FlirtationThe nurse/CNA communicates in aflirtatious manner, perhaps employingsexual innuendo, off-color jokes, oroffensive language.

“You and me against theworld” behaviorThe nurse/CNA views the patient in aprotective manner as his or herpatient, tends not to accept thepatient as merely a patient or sideswith the patient’s position regardlessof the situation.

Failure to protect the patientThe nurse/CNA fails to recognizefeelings of sexual attraction to thepatient, consult with supervisor or col-league, or transfer care of the patientwhen needed to support boundaries.

Does client consent make a sexualrelationship acceptable? The Nurse Practice Act specifically prohibits nurses and nursing assistants fromengaging in sexual conduct with a patient or client [NAC632.890 (29)]. If thepatient accepts or even initiates the sexual contact, a sexual relationship is stillconsidered sexual misconduct for the healthcare professional. It is an abuse ofthe nurse-client relationship that puts the nurse’s needs first. It is always theresponsibility of the healthcare professional to establish appropriate boundarieswith present and former clients.

WARNINGSIGNS

11

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Visit our website at: http://nursing.unlv.edu or call Dr. Patricia T. Alpert at(702) 895-3810

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12 Nevada State Board of Nursing ■ Las Vegas 486-5800 or Toll-Free 1-888-590-6726 ■ www.nursingboard.state.nv.us

Actual Cases from Board Files(The names and some of the details have been changed.)

RN took personal photographs of patients RN Joseph took photographs of patients’ body parts and genitalia without the

patients’ or the hospital’s knowledge or consent. He took the photos with his per-sonal digital camera, transferred them to his personal computer, and uploadedthem to his personal web site.

RN Joseph originally said it was common practice to take photos for use bythe surgeon and for a book kept in the facility. The facility said it did maintain abook of photos for educational purposes only, and that while surgeons frequentlyask staff to take pictures for them, staff are only allowed to do so with the hospitalcamera.

The Board found RN Joseph guilty of violating the Nurse Practice Act, fined him$2,500, and ordered him to complete legal ethics and critical thinking courses.

LPN removed a resident from a facility because he asked her to take him home

LPN Janice removed a resident from a long-term facility without authorization ororders. She didn’t notify the treating physician or facility staff. She drove the resi-dent to his neighborhood and left him at the clubhouse. Later, neighbors found theman standing outside his car, lost, and looking for his house. They drove him tohis house, where the front door was standing wide open. There was no power inthe house and it was filled with boxes. The neighbors called the police, who tookthe resident back to the facility.

LPN Janice said the resident was outside waiting for her when she got offwork, showed her some papers, and told her that he had signed out AgainstMedical Advice (AMA) from the facility. She added that the resident had been inthe facility for two weeks and she did not know why he was there. She said thatthe resident dressed himself, and walked with a walker to the dining room.

The Board’s investigation revealed that while the resident had the AMA processexplained to him in the past, and he had AMA papers, they were not signed. Thefacility was working with social services to get a public guardian for the resident.

The Board found LPN Janice guilty of violating the Nurse Practice Act, publiclyreprimanded her; fined her $100; ordered her to take courses on critical thinking,legal ethics, and the Nurse Practice Act; and restricted her from working in long-term and home health care for one year.

CNA solicits extra business from home health care clientsWhile CNA Martha performed home health care for clients, she would also

mention she could repair their clocks for a fee. Several of her clients took her upon the offer; a few relatives expressed their unease with the situation to the homehealth agency. One client gave CNA Martha food items in exchange for vacuum-ing his house. Another client paid her to shovel the snow and ice off her drivewayand sidewalk.

CNA Martha originally said she gave her clients business cards in case herclients needed to call her for help, not to solicit business. She said that a coupleof her patients asked her to repair their clocks, and she picked those clocks upduring times she was not working as a CNA. She later admitted that she did infact solicit business from clients and receive gifts from clients for non-CNA workthat she performed while on duty as a CNA.

The Board found CNA Martha guilty of violating the Nurse Practice Act,placed her on a two-year probation, and ordered her to take legal ethics andprofessional boundaries courses.

an objective, effective caregiver, even ifthe money is eventually repaid?

■ Your employer can helpWhen a relationship is strictly profes-

sional, it has checks and balances thathelp prevent patients from getting upsetwith staff interactions. Helping staff tounderstand this very complex issue andto appreciate the importance of profes-sional checks and balances is a challengefaced by most supervisors and managers.

Employers can help by developingpolicies and guidelines specific for theirown institutional circumstances thatdefine a caring, professional relationshipand discourage or forbid inappropriatepersonal friendships with patients.

To be effective, these policies mustreflect the sorts of care relationships thatare commonplace in the particular setting.For example, nurses and CNAs in acutecare typically do not have the same rela-tionship issues as nurses and CNAs inlong-term care settings who see the samepatients for prolonged periods of time.

Employers should be sensitive toboundary issues and offer timely adviceor counseling when it appears that anurse or nursing assistant may be riskingover-involvement with a patient. Inthose settings especially at risk forboundary violations, staff orientationshould deal with the issue proactively,and there should be ongoing in-servicepresentations on the topic.

■ Awareness is the keyWhat can the individual nurse do to

assure boundary violations do not occur?Awareness is the key. Nurses and nursingassistants who are clear about their ownneeds and the needs of their patients, andwho can separate the personal from theprofessional, will find themselves acting inthe best interest of their patients. It is pos-sible to maintain a caring professionalrelationship with a patient without sacri-ficing the patient’s autonomy or dignity.

Patients come to nurses and CNAsbecause they need professional health-care, not because they need a friend.Being that professional caregiver is reallywhat nursing is all about.

(Adapted with permission from an articlein Momentum, the Ohio Board ofNursing’s Newsletter, and ProfessionalBoundaries, a National Council of StateBoards of Nursing publication.)

Meet the Staff


Linda AureLinda Aure says, “The most important

part of my job, and sometimes, the mostdifficult, is to maintain an open mind.”Her job is to investigatecomplaints against nursesand nursing assistants. Sheexplains, “Allegations arejust that until they areproven. No matter howawful they sound at first,you cannot make judg-ments.”

As a nurse investiga-tor, Aure is assigned com-plaints that contain alle-gations that a nurse ornursing assistant has vio-lated the Nurse PracticeAct. Her job is to gatherand review a variety ofdocuments (includingany information provided by the personnamed in the complaint), interview wit-nesses, and present the evidence forreview. “I act as an independent fact-gatherer whose position is to obtain asmuch information regarding the com-plaint allegations as possible. It is not myjob to prove anyone guilty or innocent,but rather to collect information and evi-dence regarding the allegations.”

Another part of Aure’s position is toanswer questions about the NursePractice Act. It’s one of the things shelikes most about her job. “I like talking tonurses, nursing assistants, and facilitystaff, “ she says. “It helps me keep up withwhat is happening in nursing when I amdoing all the research necessary for com-plaint investigations.”

The senior investigator began hercareer with the Board after 23 years ofclinical experience, which included posi-tions as a medical corpsman, nursing assis-tant, licensed practical nurse, and regis-tered nurse. Aure’s work experienceincludes staff and management positionsin acute and long-term care facilities.Before joining the Board as nurse investi-gator in 1997, she served as assistant direc-

tor of nursing with Physicians’ Hospital forExtended Care, then Manor Care NursingFacility in Reno. “Working in long-termcare was one of the most important expe-riences I’ve had in my life,” Aure recalls.

“I was so lucky to workwith and learn from theresidents—and the nurs-ing staff who cared somuch and worked sohard. ”

Learning from othershas been a key factor inher professional growth,she emphasizes. “I havebeen fortunate to havementors who excelled inteaching. The lessons Ilearned from theminclude: listen to thepatient; trust your ownjudgment; call and givethe doctors information

so they have an opportunity to do some-thing even if they get upset or it’sunpleasant; keep familiesinformed; if somethinglooks wrong, it probablyis; patients know whenthey are getting worse ordying; patients have aright to refuse care; fami-lies have a right to ques-tion everything you do;and remember why anurse is a nurse.”

Aure, who earned herassociate’s degree fromLos Angeles ValleyCollege in 1980 and herbachelor’s degree fromCalifornia StateUniversity, DominguezHills, in 1988, has specialty certificationsin gerentological nursing, public healthnursing, and staff development. And likeall Board nurse investigators, she has suc-cessfully completed both the basic andadvanced National CertifiedInvestigator/Inspector Training sponsoredby the Council on Licensure,Enforcement and Regulation.

Asked if there was one thing shewanted Nevada nurses and CNAs toknow about her job, Aure replied, “Ifyou have a question about whether youshould do something, ask first. I’dmuch rather prevent a problem thaninvestigate one.”

Patty TowlerPatty Towler joined the Board as a

licensure specialist 12 years ago. Oneyear later, in 1995, she became a certifi-cation specialist. In 2005, she was pro-moted to senior certification specialist.In that capacity, she processes initialand renewal applications for individualCNAs, CNA instructors, and CNAtraining programs. She also completesout-of-state certificate verifications,answers email correspondence for theLicensure/Certification Department,and assists with licensure activities.

Towler says one of the most reward-ing aspects of her position is helping

CNAs become certifiedin Nevada: “I feel thatwhat I do and how I doit makes a difference. Iunderstand the stress ofnot having a certificateto work. I explain theprocess to them andgive them a contactperson for future helpand assistance.”

The long-timeemployee enjoys sharingher wealth of knowledgeand experience, withstaff and customers alike.“I work with wonderfulpeople at the Board. We

have lots of work, and we have lots offun.” When it comes to customers,Towler says, “Call me. If I don’t have theanswers, I’ll get them for you.”

During her free time, you’ll find thesenior certification specialist traveling,reading, shooting pool, throwing darts,and spending time outdoors at the lakeor in the mountains.

Meet the StaffPatty Towler and Linda Aure

Patty Towler, Senior CertificationSpecialist, Licensure/CertificationDepartment

Linda Aure, BSN, RN, C, SeniorInvestigator, Investigations andMonitoring Department


Helen Vos, MS, RN

President, RN Member

10/31/2008

David Burgio, MS, RN, APN

Vice President, RN Member

10/31/2007

Dorothy Perkins, CNA

Secretary, CNA Member

10/31/2007

Doreen Begley, MS, RN

RN Member

10/31/2008

Joseph Cortez

Consumer Member

10/31/2009

Mary Ann Lambert, MSN, RN

RN Member

10/31/2008

Betty McKay, LPN

LPN Member

10/31/2009

BOARD MEMBERSThe Nevada State Board of Nursing is a seven-member boardappointed by the governor of Nevada consisting of four registerednurses, one licensed practical nurse, one certified nursing assistant,and one consumer member.

If you wish to contact a Board member, please write c/o NevadaState Board of Nursing, 5011 Meadowood Mall Way #201, Reno,NV 89502-6547; call1-888-590-6726; or [email protected]

BOARDAUTHORITYThe Board has authorityonly over its licenseesand certificate holdersand not over the facilitiesin which these individu-als practice. The Boardenforces the NursePractice Act (the law reg-ulating nursing practice),with funding for all of itsactivities coming solelyfrom the fees paid to theBoard by licensees andcertificate holders. TheBoard does not haveauthority to take actionon issues that are of anemployment nature, orthose that relate to thenursing profession as awhole. These matters arebest dealt with by thestate labor commissioner,nursing associations,labor unions, or othersimilar entities.

15

The 2006 American Academy of

Pediatrics report3 on optimizing

bone health supports dairy’s role

in the bone health of children and

adolescents.

Talk to your patients about

including three servings of dairy a

day (milk,cheese or yogurt) to help

build stronger bones.

• Assess Calcium Intake:

The AAP suggests periodically assessing

calcium intake and risk factors for sub-

optimal bone health at 2 or 3 years of

age, after the infant is no longer taking

human milk or formula; during preadoles-

cence (8-9 years of age); and during early

adolescence, when peak accumulation of

calcium occurs. Refer to the AAP report,

“Optimizing Bone Health and Calcium

Intakes of Infants, Children, and

Adolescents” for an assessment

questionnaire.

• Share Bone Building Tips:

Most people can achieve the

recommended dietary intake of calcium by

eating three servings of milk, cheese, or

yogurt each day. Low-fat and fat-free

versions are encouraged.3 Non-dairy food

sources and supplements are an alterna-

tive, but these products do not offer the

same nutrient benefits of dairy foods.

• Model Healthy Habits:

All family members should evaluate their

calcium intake and consider three serv-

ings of dairy a day (4 for adolescents) for

building stronger bones.

• Be Active:

Encourage physical activity, primarily

weight-bearing exercise as part of an

overall healthy bone program.

Age

1-3 years

4-8 years

9-18 years

CalciumIntake,mg/day2

500

800

1300

Servings of Dairy perDay3

3*

3**

4**

* Age-appropriate servings

** One serving equals 8 ounces of milk or milk equivalent

Kids/Adolescents

1 US Department of Agriculture, Agricultural Research Service. Data tables: results from USDA’s 1994-96 continuing survey of food intakes by individuals and 1994-96 diet and knowledge survey. Riverdale, MD: US Department of

Agriculture; 1999; (data for males and females ages 12-19 years).2 Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997.3 American Academy of Pediatrics, Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics, 117 (2):578-585; February, 2006.

3aday.orgHave you had your 3 today?

Visit www.nationaldairycouncil.org

to download a calcuim assessment

questionnaire for use with patients and

www.aap.org for additional resources.

Recommendations for Adequate Dietary Calcium

Intake (mg/day) and Servings of Dairy per Day in

the United States

Copyright ©2006 NATIONAL DAIRY COUNCIL®

7 out of 10 boys and

9 out of 10 girlsdon’t get the calcium

they need.1, 2

Pediatricians Call for Calcium Check-up

7 0 2 . 3 8 3 . 2 0 0 0 w w w . u m c s n . c o m

I n o n e p r e c i s e m o m e n t

the symbol of excellence

UMC salutes the people who provide the most caring part of healthcare. Congratulations – and thank you – to all of our nurses.

the 11:30 rounds begin

a patient finds healing in a friendly smile

and a nurse changes yet another life

Now you canchange your

address on line!The law requires you toinform the Board whenyou change addresses

You’re required by law to inform theBoard, in writing, of any address change,including a zip code change. The easiestand fastest way for you to make youraddress change is to go to the Board’swebsite and click on the Address Changelink. You may also send an email to [email protected], call the Boardand request an address change form, ormail a signed letter to the Las Vegasoffice. Remember to include your name,license or certificate type and number, for-mer address, current address, social secu-rity number, and date of birth.


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Change of address formName (Last, First, Middle)________________________________________Type of License________________________________________License Number________________________________________Date of Birth________________________________________Social Security #________________________________________Former Address________________________________________City, State, Zip Code________________________________________Current Address________________________________________City, State, Zip Code________________________________________Telephone#_______________________________________Signature________________________________________Mail to: Nevada State Board of Nursing

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20

The following are disciplinary andlicensure/certification actions taken bythe Nevada State Board of Nursing forthe period of September 17, 2005through November 18, 2005. Pleasenote that this list does not include someoutcomes of the November 16-18, 2005Board meeting due to legal noticerequirements. Those outcomes will bereported in a future disciplinaryactions list. This list does include someoutcomes of previous Board meetingsthat were not reported earlier due tolegal notice requirements

Settlement Agreements and/orHearing OutcomesCage, Tina, LPN06097 Order of Probation Extension for violationof NRS 632.320 (14) failing to complywith Board order. Cilley, Eric, RN41221 Reprimand and Probation Extension orviolation of NRS 632.320 (14) failing tocomply with Board order.Cusick, Nancy, CNA 016123Agreement for Reprimand for violation ofNRS 632.320 (7) unprofessional conduct,and NAC 632.890 (2) practicing beyondscope of practice and (38) professionalboundaries. Downing, Joseph, RN43544Reprimand and Probation Extension forviolation of NRS 632.320 (14) failing tocomply with Board order. Drury, Debra, RN25633Voluntary Surrender of License in Lieu ofOther Disciplinary Action for violation ofNRS 632.320 (7) unprofessional conductand (14) failing to comply with Board order,and NAC 632.890 (35) failing to comply.

Eshelman, Terry, LPN09797Agreement for Reprimand for violation ofNRS 632.320 (1) fraudulent application. Gardner, Todd, LPN12840Reprimand and Probation Extension forviolation of NRS 632.320 (14) failing tocomply with Board order. Grimes, Linda, RN16355Agreement for Probation for violation ofNRS 632.320 (2) criminal conviction and(5) controlled substances and/or alcohol. Grosso, Michelle, CNA016867Certificate revoked for violation of NRS632.320 (7) unprofessional conduct, andNAC 632.890 (22) patient abandonmentand (27) customary standards. Harris, Catherine, LPN12598Voluntary Surrender of License in Lieu ofOther Disciplinary Action for violation ofNRS 632.320 (7) unprofessional conduct,and NAC 632.890 (9) impaired practiceand (27) customary standards of practice. Johnson, Tonya, CNA016542Voluntary Surrender of Certificate in Lieuof Other Disciplinary Action for violationof NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (27) customarystandards of practice and (38) professionalboundaries. Jones, Sandra, RN32701Reprimand and Probation Extension forviolation of NRS 632.320 (14) failing tocomply with Board order.Koyen, Scott, RN43010Agreement for Probation for violation ofNRS 632.320 (5) controlled substancesand/or alcohol and (7) unprofessional con-duct, and NAC 632.890 (18) diversion ofequipment or drugs.Montgomery, Laura, CNA015438Voluntary Surrender of Certificate in Lieuof Other Disciplinary Action for violationof NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (29) sexual con-

tact with a patient and (38) professionalboundaries. Orozco, Rhonda, CNA010125Agreement for Reprimand for violation ofNRS 632.320 (7) unprofessional conduct,and NAC 632.890 (27) customary stan-dards of practice and (28) causing harm toa patient. Pelzer, Volana, CNA014298Certificate revoked for violation of NRS632.320 (14) failing to comply withBoard order. Schooley, Laura, RN4382Agreement for Reprimand for violation ofNRS 632.320 (7) unprofessional conduct,and NAC 632.890 (24) failing to collabo-rate with health care team and (27) cus-tomary standards of practice. Schultz, Joy, RN29541Agreement for Reprimand for violation ofNRS 632.320 (7) unprofessional conduct,and NAC 632.890 (27) customary stan-dards of practice. Smith, Elizabeth, CNA017803Voluntary Surrender of Certificate in Lieuof Other Disciplinary Action for violationof NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (28) causingharm to a patient and (38) professionalboundaries. Stribling, Nicole, CNA018440Voluntary Surrender of Certificate in Lieuof Other Disciplinary Action for violationof NRS 632.320 (7) unprofessional con-duct, and NAC 632.890 (33) abuse/neg-lect of patient. Stricklin, Annette, RN4133Voluntary Surrender of license in Lieu ofOther Disciplinary Action for violation ofNRS 632.320 (5) controlled substances. Taylor, Mary, RN46023Reprimand and Probation Extension forviolation of NRS 632.320 (14) failing tocomply with Board order. Winder, Lindsay, CNA017215Agreement for Reprimand for violation ofNRS 632.320 (7) unprofessional conduct,and NAC 632.890 (27) customary stan-dards of practice.

Please do not use this list of disciplinary actions for verifyinglicensure or certification status. Other action may have takenplace between the time the discipline was imposed and the timeof publication. To verify licensure or certification status, pleasevisit our website or call the Las Vegas or Reno office.

ABBREVIATIONSNRS Nevada Revised StatutesNAC Nevada Administrative Code

Disciplinary ActionsBefore disciplinary action is taken, the Board ensures the nurse or nursing assistant is given due process

21

Denials of Applications forLicensure or Certification Jones, Sasha, CNA applicantHanif-Greene, Lillian, CNA applicantCooper, Tammi, LPN applicantApplications denied for violation of NRS632.320 (2) is guilty of a felony or anyoffense (a) involving moral turpitude; or(b) related to the qualifications, functionsor duties of a licensee or holder of a cer-tificate, in such case the record of convic-tion is conclusive evidence thereof.

Wandera, Sam, CNA applicantMercene, Chona, CNA applicantEisele, Lisa, CNA013946Applications denied for violation of NRS632.320 (1) is guilty of fraud or deceit inprocuring or attempting to procure alicense or certificate pursuant to this chapter.

Shaw, Galina, CNA014107, renewalapplicant Application denied for violation of NRS632.320 (7) unprofessional conduct, andNAC 632.890(20) inaccurate recording,falsifying, (38) professional boundaries

Findings of Guilt for Abuse,Neglect or MisappropriationPlaced on the Certified NursingAssistant Registry by the NevadaState Health Division’s Bureau ofLicensure and Certification

Whiting, Michal, CNA014367Misappropriation of property

Citation for Practicing Without A Certificate

Agdamag, AbrahamAlbaciete, ArielAlexander, KathyannAmante, ElizabethArapece, Ma JoharaCabili, LourdesitaCalara, PeteCotton, LouisCua, AileenCuenta, GraceDel Pina, LornaDela Pena, LornaDelacruz, DarylnmayDelos Santos, PamelaKotico, HettieLewis, DithraLim, EstefaniaLumanas, FlorizelMabanta, HeraldMacducdoc, DennisMcleod, CynthiaMesias, ReynaldoMorgan, DeneseNontsikelelo, PietersenPiedad, GraceRadcliff, AndreaReyes, RowenaSimbulan, LuciaTan, Ma EuniceTan, MarieThompson, ElidoraValencia, DoloresVidad, GraceVirtudazo, MinviluzZuasula, Juanito

Who can I call if I have questions about the complaint or discipli-nary process? The Board encourages you to call any time you havea question about the disciplinary process or what constitutes a vio-lation of the Nurse Practice Act. Just call the Board and ask for oneof the nurse investigators or the director of operations.

What are common types of disciplinary actions?When considering what kind of disciplinary action itshould take, the Board always asks itself, “What isneeded to make this person safe to practice?” Theanswer depends on the nature of the violation, andcan range from reprimanding an individual andordering the person to attend a remedial class torevoking the person’s license or certificate. All disci-plinary action is reported to national disciplinarydata banks. Outlined in the Nurse Practice Act, NRS632.325, disciplinary actions available to theBoard include:

Denial of ApplicationIf the Board denies an application for licensure orcertification, it has determined that the individualviolated the Nurse Practice Act. In most cases, thedenial is due to criminal convictions and/or submit-ting a fraudulent application.

Reprimand and/or FineIf the Board reprimands or fines a nurse or CNA, ithas determined that the individual violated theNurse Practice Act. This action does not prohibit orrestrict the individual’s practice.

ProbationIf the Board puts an individual on probation, itmeans the nurse or CNA may work, but will beworking on a restricted license or certificate andmonitored by the Board for a specific time period.The probation may also include practice and/orsetting restrictions and requirements like classes orrandom drug tests.

SuspensionIf the Board suspends a license or certificate, itmeans the nurse or CNA is prohibited from practic-ing for a designated time period.

Voluntary SurrenderThis means the nurse or CNA has agreed to volun-tarily surrender his or her license or certificate andcannot practice in Nevada. If the person applies forreinstatement, the Board weighs evidence of reha-bilitation and remediation when considering theapplication.

RevocationIf the Board revokes a license or certificate, itmeans the nurse or CNA cannot practice in Nevadafrom a minimum of one to a maximum of 10years. After that time, the nurse or CNA may applyfor reinstatement if all the requirements in theorder of revocation have been met. The Boardweighs evidence of rehabilitation and remediationwhen considering the application.

Employers—when you’re verifying that someone hasan active license or certificate, the Board encourages you touse our website verification system. It’s quick, convenient,and it’s updated within one business day of renewal or initialissuance. You can also call the Board for verification at 888-590-6726. Both methods ensure you have the most up-to-date information about the license or certificate status ofyour employees and potential employees.

Use Website To Verify Active License/Certificate

22

Debra Scott, MS, RN, APN, Executive DirectorStatewide Liaison and SpokespersonOrganizational and Public ManagementFiscal and Human Resource ManagementLegislative and Governmental RelationsAPN Advisory Committee ChairNursing Practice Advisory Committee Chair

Chris Sansom, RN, Director of Operations Program ManagementCNA Advisory Committee Co-Chair

Donna Cowling, MSN, RN, Education ConsultantNursing Education ProgramsCNA Training ProgramsCNA Advisory Committee Co-ChairContinuing Education ProgramsEducation Advisory Committee Chair

Fred Olmstead, General CounselLegal Counsel

Dean Estes, Accountant/Technology OfficerBudget, Accounting and PayrollExpense ReportsTechnology Support

Cindy Kimball, Public Information OfficerPublic Information and EducationConsumer RelationsNews Magazine, Web Site, Publications

Teri Troke, Executive AssistantAssistant to the Executive Director SchedulingBoard Meeting Agenda and Arrangements Nurse Practice Act Publication

Administration5011 Meadowood Mall Way, Suite 201, Reno, NV 89502, 888-590-6726

Investigations and MonitoringLinda Aure, BSN, RN, C, Senior Investigator

Complaint InvestigationsNursing Practice Questions

Lark Muncy, RN, Investigator Complaint InvestigationsNursing Practice Questions

Robert Buck, BSN, RN, ApplicationCoordinator

Application ReviewFraudulent Application ScreeningAPN CertificationReinstatement Applications

Kathleen Reynolds, BHS, RN, ComplianceCoordinator Disability Advisory Committee ChairDisability Advisory Committee SchedulingProbation and Alternative Program Monitoring

Licensure/CertificationSarah Long, Licensure Specialist

Licensure Eligibility QuestionsRenewal ApplicationsEndorsement and Examination ApplicationsContinuing Education ProvidersForeign Nurse Graduates and Licensure Issues

Patty Towler, Senior Certification Specialist CNA Registry MaintenanceCNA Certification and RenewalsCNA Program and Instructor Approvals

Molly Echandy, Licensure/Certification Clerk Licensure Eligibility QuestionsRenewal ApplicationsEndorsement and Examination ApplicationsContinuing Education ProvidersForeign Nurse Graduates and Licensure IssuesCNA Certification and Renewals

SupportSherrie Frederick, Fingerprint Specialist

Endorsement FormsFingerprint ProcessingFingerprint Report Screening

Malinda Baldridge, Management Assistant Assistant to the Director of OperationsDiscipline Investigative SupportCompliance SupportBoard Meeting PreparationDisability Advisory Committee Scheduling

Shannon Siner, Management Assistant Discipline Investigative SupportYes Answer and Fraudulent Application ProcessingBoard Meeting Preparation NURsys Data Entry

Christie Daliposon, Receptionist Renewal ApplicationsProgram SupportInquiries, Information and ReferralsLicensure and Certification ApplicationsNursing Personnel Lists

Adela Smith, Receptionist Program SupportInquiries, Information and ReferralsLicensure and Certification ApplicationsSpanish-Speaking Services for Consumers

Program Staff 5011 Meadowood Mall Way, Suite 201, Reno, NV 89502, 888-590-67262500 W. Sahara Ave., Suite 207, Las Vegas, NV 89102, 888-590-6726

Have a question? Give us a call. NURSINGNevada State Board of

• CVOR• ER • Float Pool: ICU & Med/Surg/Tele • ICU • L & D • Level II Nursery • Med/Surg/Tele • PACU • Post-Partum • Progressive Care Unit • Respiratory Therapist • Unit Secretary Monitor Tech

What’s in it for you at HCA: Competitive compensation

and benefits practices including benefit eligibility on

your 31st day; medical/dental/life/LTD; childcare subsidy;

401(k); discounted Employee Stock Purchase Plan; relo-

cation assistance program; and ability to transfer to

other HCA affiliated hospitals.

Please send your resume to: MountainView Hospital Care of Human Resources, 3100 N.Tenaya Way, Las Vegas, NV 89128.Jobline: (702) 255-5135 • Call Natalie Gardner, RN: (702) 562-5508

Fax: (702) 233-5301 www.MountainView-Hospital.comA drug test and background investigaton are required as part of our pre-employment process. EOE M/V/F/D HCA is a registered

service mark of HCA Inc., Nashville,TN.

MountainView Hospital is a provider of compassionate, quality health care in the heart of Northwest LasVegas. Our 235 bed, full-service facility is big enough to serve the needs of a rapidly-growing community,but small enough for your contributions to have a definite impact. MountainView is more than a hospital.It’s the place our friends and neighbors turn in time of need. We’ve earned their trust. Let us earn yours.Right now, we have incredible opportunities in our Nursing Departments.

You’re part of a community.

You’re not just partof a hospital...You’re not just partof a hospital...

You’re part of a community.

Nevada State Board of Nursing5011 Meadowood Mall Way, Suite 201Reno, NV 89502-6547

PRESORTEDSTANDARD

U.S. POSTAGE

P A I DLITTLE ROCK, ARPERMIT NO. 1884

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