Candidate for President-elect

Paula Meyer, MSN, RN, FRE
Executive Director, Washington State Nursing Care Quality Assurance Commission

President-elect Responsibilities:

  1. Assists the president and performs the duties of the president in the president’s absence
  2. Assumes the office of the president at the conclusion of the president’s term and fills any vacancy in the office of the president
  3. The President-elect shall have served NCSBN as either a delegate, a committee member, a director or an officer before being elected to the office of President-elect

Describe all relevant professional, regulatory, and community experience.

I have 20 years experience as the executive director of the WA State Nursing Commission. I included some of the highlights below. Advanced Practice: In 1998, Advanced Registered Nurse Practitioners (ARNP) in WA had independent practice with prescriptive authority for Schedule V and legend drugs. Legislation passed allowing ARNPs prescriptive authority for Schedule II through IV drugs under a collaborative agreement. The legislation directed the Medical Commission, Board of Osteopathic Medicine and Nursing Commission to collaboratively write the rules. I lead the session and the draft rules were adopted without questions or comments. One year later, ARNPs presented research to the legislature demonstrating no increase in disciplinary cases and increased patient satisfaction. The legislature overwhelming passed removal of the collaborative agreement giving ARNPs full, independent prescriptive authority and practice. The Nursing Commission recently recognized Clinical Nurse Specialists as ARNPs. Washington is now fully compliant with the Consensus Model by including Nurse Practitioners, Certified Nurse Anesthetists, Certified Nurse Midwives and Clinical Nurse Specialists. The educational requirements listed in the Consensus Model mirror the requirements for advanced practice in Washington State. The Nursing Commission is currently developing rules for Opioid Prescribing with members of the Medical Commission, Board of Osteopathic Medicine, Dental Commission and Board of Podiatrists. Model rules have been drafted for each individual board to consider adopting in September, 2018.

Registered Nurses and Licensing Practical Nurses. In 2008, rules were adopted for continuing competency. The rules required active practice and continuing education for an active license. Washington now has a much clearer number of the nurses working in nursing. On January 1, 2018, the rules for collection of demographic data became required for active licensure. Each nurse must complete a two part survey: one question collecting ethnic data specific to Washington state; the second survey uses the E-notify registration and profile to collect data. At the end of 2018, Washington will have a full data set to use for its supply data. Increased Authority for the Nursing Commission: Using CORE data and state performance measures, the Nursing Commission was granted additional budget and personnel authority. Working in an umbrella agency, this significant increase in authority lead to increased independence. The project and report was the basis for my Fellowship in Regulatory Excellence.

What is your perspective regarding the following issues affecting nursing regulation?

  1. Borderless health care delivery
    Large, multistate health care organizations now require multistate practice. Large medical centers have provided multistate care to people in large regions for decades. School nurses accompany students on field trips across the United States and even to countries beyond our national borders. States along our national borders cooperate to provide medical care in the face of natural disasters. This glimpse of multistate practice confirms the necessity for nursing licenses to be portable. This portability demands a system allowing the nurse to provide care to patients regardless of location. The regulatory system needs to assure patient safety in the case of a poor outcome. The Enhanced Nurse Licensure Compact meets these requirements.

  2. Regulation of nursing education
    Nursing Education must meet the demands of our ever changing health care delivery system. Nurse Educators, nurse regulators and health care industry representatives must work together to identify knowledge and competencies necessary to prepare new nurses to provide fundamental nursing care. Educators, regulators and industry representatives need to work together to identify resources needed to address the shortage of faculty and cooperative solutions. Educators, regulators and industry representatives must work together on projecting health care demands of the near future to assure nurses continue their education to respond to patients’ needs. Multistate health care organizations provide care across the continuum. Initial and continuing nursing education needs to be inclusive of care settings beyond acute care.

  3. The role of regulation in evolving scopes of practice
    Nursing care continues to evolve and meet the ever changing demands of patient care. As regulators, we need to assure safe patient care. Regulators need to allow nursing practice to expand and not place barriers that may limit safe nursing practice. The Scope of Practice decision tree, used by many state boards of nursing, places the responsibility for professional nursing practice with the individual nurse to determine possession of necessary knowledge and competencies to safely perform nursing functions. The nurse determines if there are prohibitions in law or professional standards. The nurse determines if they are competent and safe to perform the intervention. The nurse must also possess the confidence necessary to say no if they do not possess the knowledge and competency to perform the interventions.

Please describe a strategy or activity to increase participation in the leadership of the organization.

Early engagement of new members nurtures new leaders. Twenty potential leaders are now new executive officers! Each year, there are new board presidents, each holding competencies necessary to provide leadership in our organization. Members express concern about the time needed to be a leader in our organization. While there is a considerable amount of time needed to invest in being leaders, the multiple rewards outweigh the investment of the time. Members possess competencies in leading meetings, recruiting and assessing stakeholder input, and conducting research to provide evidence to support regulatory decisions. Engagement includes encouraging new members to serve on committees, participate in knowledge networks, and come to meetings.

Executive officers (EO) are the key to early engagement by encouraging and recruiting new leaders. EOs recognize talent and abilities in each other, in their staff and board members. NCSBN announces opportunities for service on committees each year. EOs need to identify peers, staff and board members possessing the competencies necessary to serve. EOs need to encourage people to serve and provide the resources to allow service: time, finances, and access to learning. Finances are available through NCSBN resource funds. NCSBN also financially supports the expenses for people to attend committee meetings. If time is the issue, EOs may need to communicate with board members and employers and influence them to invest in their board members and employees. The EO can also find resources to fill in for staff so they can participate in events. This allows new staff to step up and provides career progression.

EOs need to be comfortable recruiting new leaders. Recruiting takes time to build a relationship, assess skills and abilities, and begin to match the emerging leader with opportunities. Recruiting requires the EO to work through anxieties expressed by the emerging leader. The new leader may just need the encouragement to serve or access to information.