Thursday, July 24, 2008

Nursing Jurisprudence Exam

The Board's current newsletter lists the following information about the upcoming Jurisprudence Exam:

The Texas Board of Nursing (BON) will begin administering the Nursing Jurisprudence Examination (NJE) to all initial nursing licensure applicants by examination and endorsement who apply on or after September 1, 2008. A passing score on the NJE will be a new licensure requirement for LVN and RN students seeking licensure through the applicable NCLEX examination, as well as licensed nurses (including advanced practice nurses) seeking licensure by endorsement from out-of-state and from foreign countries. The NJE will be psychometrically validated and will consist of a minimum of 50 multiple-choice questions. The examination will be administered on-line, and accessible from most Internet-capable computers with an applicant’s unique sign-on code. Applicants who fail the jurisprudence exam will be allowed to retest.

License renewal

The Board of Nursing is going paperless. As seen in the current newsletter:

Reminder: No More Paper Licenses Upon Renewal After
September 1, 2008
The Board of Nursing (BON) will discontinue issuing wallet-sized paper licenses for nurses renewing their licenses beginning September 1, 2008. The BON will continue to issue paper license certificates for:

* Graduate nurses who pass the NCLEX® exam and obtain their initial nurse
license in Texas;
* Nurses who hold licenses in other states and are obtaining a Texas nurse license for the first time; and
* Nurses who receive full authorization to practice as advanced practice nurses.

After September 1, 2008 Nurses and nurse employers should go to the agency website at and to verify a license online. The verification, once printed, will resemble a license and will allow the nurse to have the document laminated for the purpose of carrying with them. Also, after September 1, 2008, the Texas BON will no longer issue duplicate or replacement licenses. The Texas Board of Nursing strongly suggest that licensed nurses provide a copy of this article to their employer, director of nursing and/or human resource department.

Friday, July 11, 2008

Minor Criminal Crimes and the BON

At the January 2008 full Board meeting, the Board staff presented a list of one-time only crimes that the Board staff had chosen as those that the explanation for the conduct had no relation to patient care and thus, no action would be taken by the Board. This issue is being revisited at the July 17-18, 2008 Board meeting. This is because the Board members had recommendations and comments when the report was presented at the January meeting:

After review of this report, Staff was instructed to revisit the propriety of declining (by policy) whether to investigate or take action on these crimes. For example, it was noted by Board members that DUI/DWI crimes and Public Intoxication Crimes, even if isolated, should be examined to determine whether a person is safe to practice given this nature of the criminal behavior and it potential impact on nursing practice. Similarly, isolated crime involving domestic/family violence may justify further scrutiny before a person is licensed without stipulations.

The revised recommendation to the Board by staff is now as follows:

Staff’s Recommendation:
As a result of the discussions, Staff has reviewed its processes and intends to implement the following procedures for single incident criminal behavior. Each positive hit for criminal behavior will not be closed until such time as the applicant/petitioner has provided a copy of the underlying court documents or an explanation as to why the documents are not available. The applicant/petitioner must provide a letter of explanation regarding the criminal charge along with any other material to verify the minor nature of the conduct or the lack of nexus to nursing practice. Before a matter is closed without further investigation or action, Staff will review the documents, information and explanation. From a cumulative review, the matter will not be closed unless it is established;
1. There appear to be no material omissions or misrepresentations.
2. The incident is isolated or minor
3. No recency of conduct or other evidence of failure to rehabilitate; and
4. No reasonable basis to conclude the behavior will effect applicant’s ability to practice nursing safely.

What this will ultimately mean is further delays in processing these types of cases and further increase in workload for the Board. Furthermore, nurses will have to be very careful to provide all required information to the Board in order to show "the minor nature of the conduct or the lack of nexus to nursing practice." Seems like for every step forward, there are 3 steps back.

Dangers of Telephone Orders

The Institute for Safe Medication's (ISMP) newsletter Nurse Advise-ERR has some interesting information and cases regarding telephone orders in the July 2008 newsletter. They give warnings about several cases where fraudulent telephone orders were given and then follow with helpful hints for nurses getting telephone orders.

My favorite is a teenager who worked at the hospital who had aspirations to be a physician began answering pages to on-call residents. As an employee, the teenager could access the paging system. His actions of issuing orders for 6 patients (lab tests, oxygen orders, heparin orders) were not caught right away because the orders were medically appropriate!!!

The ISMP points out that telephone orders are only in emergent or urgent cases and that nurses should be suspicious if anything seems unusual or if you don't recognize the caller. They then detail steps that can be taken to verify the caller's identity.

Be sure to sign up for the monthly newsletter because it has helpful hints and they give examples of medication errors that have arisen. There is one in the July issue involving a handwriting problem that could have led to a medication error. There is also a link to a web seminar titled "Physical Design and Workflow of an Organization to Support Patient Safety." This webinar will discuss how design can help patient safety.