dragonheart

Please go to the Nurse Practice Act and /or call the appropriate Board of Nursing. In the course of conducting facility licensure and investigations, I have had to contact the Board. The Board has also conducted training for nurses conducting healthcare facility surveys with respect to this question . If one elects to no longer hold an active RN/LPN license, then there is no restricton on electing to seek employment as a CNA/CMT. Yes, there is the requirement to hold active certification. DesiDani already answered question posed about persons practicing as nurses who were doctors in other countries.

In accordance with the Nurse Practice Act, you cannot perform duties below your level current licensure. If you no longer hold an active nursing license then you can seek employment as a CNA. There are some previous RNs who are currently working as CNA/CMT

Is there an area of specialization in nursing for regulatory compliance in Assisted Living setting in each state? yes, Health Facility Nurse Surveyors, common title across state lines What is the focus of these RNs during surveys ( pre-licensure, re-licensure. complaint investigation)? Healthcare and Life Safety of population served inclusive of licensed professional compliance with their Board's generally accepted standards of care / practice (MD, pharmacy, RN/CRNP/LPN and certified staff (GNA/CNA/CMT), Social Work, PT/OT...) Critical mass question:: Has the process to initiate regulatory follow through specific to the healthcare, life safety, and client advocacy been done, inclusive of filing complaints with local Ombudsman and Dept of Aging (client advocate focus), and state licensing agency and if you believe it should happen now as opposed to after licensing body conducts its investigation . then the state governor's office who will also request investigation and a report of findings. There is a lot of encouragement to quit... There has been at least one encouragement to whether you stay or go report the identified/firsthand knowledge problem(s) in a manner that will yield advocacy results for current and future residents and staff . As nurses we use the nursing process to identify problems, develop plans of care which include individualized, realistic, and measurable long and short term goals to address those problems. Through our use of the nursing process we implement , evaluate,and re-evaluate our plans of care. We incorporate assessment and collaboration skills to develop goals and measure outcomes of those goals. We use prudent judgement to determine if tje plan is working and if additional resources ( interdisciplinary, equipment, supplies,...)are needed to support client achieving those goals related to improving health, maintaining individualized, realistic baseline of function /health or support during aging in place process or palliative care. In this case you have used data to make a professional assessment about general conditions and impact on healthcare and life safety in your capacity as a professional nurse. What is the identifed plan and how do you propose to implement that plan to achieve the goal of resident /staff advocacy? Do you need additional and external agency support/resources to accomplish the goal of patient / staff advocacy? First plan of action was posting here. What is your next step in your action/care plan.?

There are elder support/care options in every state. The question is how do elderly/representatives8 who need /require those services learn about/access them? I didn't learn about these options and how ro access them until I started working in the elder care regulatory setting. Information is often available at grocery store and library entrances and yes, on each state website. Marketing and knowldege are a research challenge at best How is no ti know that local county/city resources are a phone call away: ombudsman, hospital social worker/discharge planners , place of worship wellness aministry teams ... Opinion: Ressarch and outreach opportunities abound -The need is for increased awareness programs in areas where those who need the information can hear/learn about Assisted Living, Adult Medical Day Care, PACE, Medicaid Waiver, religious based community outreach support .... Ideal: Nursing schools would expand intern/practicum experiences to include these sett!ings , advanced degree( masters, doctoral) research in elder care settings (Assisted Living , Adult Medical Day Programs since these are the programs already in plac e to serve people like the woman described in this communication - to decrease isolation, increase socialization, and maintain ability to live in community setting There has little research to date to follow up on how these programs are working , is access a problem/concern, initial vs current nursing care needs, medication management/errors related to staff education, transition to / lack of electronic health re cord and timely access to hospital, clinic, home health/hospice reports .....interdisciplinary collaboration/commumication challenges, ....medication reconciliation, verification, quality assurance specific to these settings to name a few leading edge opportunities for nursing in the area of elder/senior/geriatric care, including what message does the verbiage we use convey to prospective clients/residents/participants in these state regulated programs Argentum/ National Association for Assisted Living a and Adult Medical Day Care are beginning to collaborate with Universities and colleges recognizing that we are on the leading . bleeding edge of health and life safety evidence based practice opportunities presented by the continuum of aging in place( at home, in Continuing Care Residential communiities [CCRC], Assisted Living Facities [ALF], supplemented by Adult Medical Day [AMDC]....

It would be interesting to research and share sativa and or indica treatment for ailments during that time period

ANCC World Certification ANCC Certification Center and Stat Pearls StatPearls

From an evidence based perspective, the steps in this research process to determine if there are situations of regulatory non-compliance at the facilities mentioned in this topic are to : If the state has a licensing requirement then the facility is required to conspicuously post: the license which identifies bed capacity and authorized level of care the most recent re-licensure survey (often maintained in the library or at the lobby/foyer complaint procedure which includes phone number of state licensing agency OR Visit the state website and search for Assisted Living programs (Assisted Living Programs are regulated by the states) OR The Assisted Living Federation of America lists the specific regulations for each state. Call the help desk and ask how to access most recent re-licensure and /or to speak with a nurse surveyor or file a complaint specifying concerns (anonymous or by name) Ask the question of concern to the nurse who will respond or research the question and get back to you Generally: Assisted Living Programs mean that a residential or facility based program provides housing and supportive services or a combination of these services in a way that promotes optimum dignity and independence. Health Care practitioners complete resident assessment tools (preadmission assessment, level of care scoring tool, functional assessment, 45 day RN assessment, quality assurance plan and meeting minutes) to determine the level of care (low :1 to high:3) and whether or not the prospective/current resident is a candidate for residing at the facility Fire Drills and Disaster Drills are required components of surveys and require documentation and random staff interviews that identify a plan that has been practiced i.e. on a quarterly/monthly basis (fire drills) biannual (disaster drills) that addresses transport of level 2-3 residents to safety and evacuation routes Reference for article The History of Assisted Living (AL) - The Who, What, Where, When & Why of Assisted Living

Boy Scouts of America (BSA) store camp log has everything in one permanent bound register, complete with directions on how to best use the tool, if you do not have a corporate one to use.

I learned to join the Association of Camp Nurses(ACN) for reliable information, resource and reference guide for each state and the District of Columbia. Association of Camp Nurses - ACN

State surveyors use the federal/state regulations for licensing to determine compliance. Recommendation: If the Regulations for LTC, Assisted Living, Hospitals, Hospice .... are not readily accessible then use the search engine of choice (Google, Yahoo....) and look up the regulations. You will see what the regulations are. The survey is not supposed to be/intended to be a mysterious experience. They are conducted for the purpose of determining compliance with the federal/state regulations or Conditions of Participation. The surveyor team follows a process of survey activities to make objective determinations specific to regulatory compliance. This survey process includes interviewing new employees and a sampling of different staff types which includes CNAs. It is typically unannounced so that the observations are based on a snapshot of actual day to day facility practices. Some facilities have a mock in house survey team. These teams conduct internal surveys and provide their own internal findings to departments. If your facility has an internal survey team, you might request to become member. All surveys are public documents,and available upon request or if you are willing to research where they posted for review. You could go on- line and review a few to determine what the completed survey process looks like in final form for your facility.

Research the state licensure surveys for facilities within the area you are looking at as prospective employers. Each state survey becomes available via public record after the survey responses are submitted by the facility to the state. Facilities are required to share them upon request or have them posted in a easily accessible location (facility lobby/library) for easy access by interested parties. So the question is- What is the agency that posts the surveys on-line? You can ask the state where to look if you do not want to ask the facility. Then you review the survey(s) and draw objective conclusions about the facility by categories that are addressed and the documented plan of correction responses.

The question is-what area of specialization do you want to explore/pursue? If you like the Long Term Care (LTC) population then you will have great experience working with them and be a great mentor. If you determine that something other than the population served is the concern or issue, then your gained experience will allow for greater relocation and career move opportunities for you. I like this site because it serves as a great reference and touchpoint. It helps me with informed decision-making. I appreciate the honest and thoughtful responses provided in a networking environment.

Depending on the camp setting, some state first aiders/nurses are using a medication log similar to the the one Boy Scouts of America(BSA) sale in their stores(or adopted the BSA log since it meets legal requirements related to documentation). The BSA log provides guidance for how to use the log and prompts for documentation by using the following headers: name of camper/staff, time and date of first aid station visit, reason for visit, medication /first aid care, follow up( isolate, contact parents for pickup, call parents and advise of need for MD visit emergent/non-emergent) and signature of person completing the documentation. GSUSA has offered guidance first aiders which follows training requirements. The basis of that guidance is that First Aiders must hold current certification and then follow that training guidance. The RN/LPN functions according the Nurse Practice Act in regards to medication administration, management , first aid support, and advising camp director. Nurses functioning in the camp setting are advised to review their state nursing regulations specific to nurse practice . Generally, the Nurse Practice Act does not allow for prescriptive authority, unless the RN is advanced practice (i.e. CRNP, midwife...) Because by definition nurses do not prescribe. Doctors (MD) prescribe. Based on that information if a camp does not have MD prescriptive authority(written blanket order to administer medication within the camp setting) then there is no authorization to "dispense meds" in the traditional sense of store meds brought from home in first aid setting,pour, and administer the medication, which includes OTC(over the counter)meds (i.e. suntan lotion, antibacterial ointments....) Doctors, in general, have moved away from prescriptive authority for "patients they have not conducted assessment and have a clinical baseline from which to grant authority to administer medications. The reason has been the increase and allergic responses/reactions to an ever increasing range of foods and medications ( peanut butter, gluten, suntan lotion, antibacterials, and medical conditions that more campers are presenting for camp experience. Approaches that I have experienced are : 1. Have campers continue bring meds in original packaging. The medications are held in first aid setting to ensure temperature control and the camper is observed to take the medication, at the prescribed time on the packaging and that is what is documented. The distinct difference is that the camper is taking medication. 2. Meds are retained by campers and if used in camper unit setting that is reported by unit leader to first aider/nurse who documents occurrence. 3. Inhalers are retained by campers who have had patient discharge teaching specific to inhaler use. 4. Family MD writes order that camp nurse can dispense medications to individual camper Summary, depends on : prescriptive authority state nurse practice act type of setting primitive, community center, school, day, resident camp are all volunteers functioning under the position description/role of first aiders and nurses serving in first aid capacity as level II first aiders Recommendation: American Camp Nurses has been helpful , current, and state specific reference

Alzheimer Association of America in your local area would be a great start. They teach courses to nurses , Assisted Living managers and others which results in certification and focused training specific to dementia.

The best reference for what is happening, to get involved in decision making/support as well as what direction camp nurse practice is heading is http://www.aca.org http://www.campnurse.org ACA acredits over 2,400 camps and works closely with other youth-serving organizations i.e. American Cancer Society, American Red Cross, American Academy of Pediatrics, Boy Scouts of America, Girl Scouts of America, Camp Fire USA to name a few .... I have found that I can get answers specific to the areas for which I serve as a consultant in a single location The state regulations database is easily accessed from this site Each state regulations are what is needed. The comments and opinions I find supportive and informative but when I needed to know regulations this was the source Public Policy committees are active in researching and advising change in practice at the national, state and local level . These committees are composed or RNs, MDs, legislators, insurance companies, national organizations representing specific illnesses i.e asthma The Healthy Research Study 2006-2010 is ongoing and new camp participation is welcomed sample finding : injuries are more likely to occur midweek(Wednesday and Thursday) and between the hours of 12N-6PM Camp research is used to : enhance the quality of the camp experience, understand, the importance of the camp experience, connect and collaborate, and improve camp business operations some of the findings that have supported and helped me understand changes has been are posted in the ACA Compass Point magazine : December 2007 Best Practices for Medication Management by Day and Resident Camps Recommendations for Managing Asthma at Camp -based on the NAEPP-National Association of Asthma Education and Prevention Program June 2008 Camper Medications and Medical Issues (excerpt) ...more than 71% of camp directors report that campers who are taking medications have increased over the past three years campers are taking more medications and there is grater variety in the types of medication brought to camp I first logged onto Allnurses in hopes to find out what was going on in terms of prescriptive authority . I found support and encouragement What I have learned from ACA web site research, attending local new regulations forums offered by the states and District is that due to the ever increasing complexity of medications and camper history physicians in general are less willing to give blanket consent to medicate someone sight unseen . The insurance companies are advising us(MD and RN alike ) to take a risk aversion position ... thus it is becoming more common than not . The result has been that the camper's physician is asked to provide individual camper specific prescriptive authority . This takes us to the health history when giving any OTC medication (commonly used over the counter medications such as (Ibuprofen, Tylenol, Benadryl, Neosporin) Looking at mediation administration of any kind from this approach, it makes sense to ensure that we do the patient no unintentional harm by giving a medication that we can have no way of knowing adverse reaction based on medication or history we are unaware of at the camp site level The state regulations take us back to nursing practice in terms of what delegated prescriptive authority means at the camp level i.e. this includes camps that use first aiders who are not certified EMT, military medics, .... I rely on Allnurses for peer support and barometer of what are emerging or current issues/concerns.. I use ACA for research based informed decision making re: camp first aid practice /intervention First hand experience I have found that as a camp nurse is often more important in terms of bee stings, especially multiple to know about baking soda paste and ice water than to have permission to administer benadryl This comes from having been int he situation where a camper was allergic to benadryl and one who was not. Both suffering multiple bee stings and were brought to first aid. I mixed the baking soda paste places it on all sting areas let it dry scraped it off with handle of plastic spoon placed ice water in baggies and large handkerchiefs girls are asked to bring to camp to dry hands etc Since I could not offer benadryl to one camper I got to see the outcome of this impromptu, situation -driven study Both girls felt better after about 20 minutes . Both physicians commented to parents that the comfort issue was definitely addressed best by the baking soda because the stings were no longer inflammed. Neither physician had ever heard of that intervention, neither had ever been camp physicians or knew of anyone stung at camp ..... Of course toxin release can occur again in heat related conditions(camp) so Benadryl was prescribed for one the other girl was prescribed a different medication