INA's Esther Huston was quoted in an article titled "Iowans spar on proposed SNAP and Medicaid changes that could cut thousands of recipients" on Tuesday, April 4, 2023. INA is proud of you for representing INA public policy interests so well, Esther! Thank you!

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Jennifer Mensik Kennedy, PhD, MBA, RN, the new president of the American Nurses Association, also weighed in. "The accusation that personnel at once-accredited nursing schools allegedly participated in this scheme is simply deplorable. These unlawful and unethical acts disparage the reputation of actual nurses everywhere who have rightfully earned [their titles] through their education, hard work, dedication and time."

The false degrees and transcripts were issued by three once-accredited and now-shuttered nursing schools in South Florida: Palm Beach School of Nursing, Sacred Heart International Institute, and Sienna College.

The alleged co-conspirators reportedly made $114 million from the scheme, which dates back to 2016, according to several news reports. Each defendant faces up to 20 years in prison.

Most LPN programs charge $10,000 to $15,000 to complete a program, Robert Rosseter, a spokesperson for the American Association of Colleges of Nursing (AACN), told Medscape Medical News.

None were AACN members, and none were accredited by the Commission on Collegiate Nursing Education, which is AACN's autonomous accrediting agency, Rosseter said. AACN membership is voluntary and is open to schools offering baccalaureate or higher degrees, he explained.

"What is disturbing about this investigation is that there are over 7600 people around the country with fraudulent nursing credentials who are potentially in critical health care roles treating patients," Chad Yarbrough, acting special agent in charge for the FBI in Miami, said in the federal justice department release.

"Operation Nightingale" Based on Tip

The federal action, dubbed "Operation Nightingale" after the nursing pioneer Florence Nightingale, began in 2019. It was based on a tip related to a case in Maryland, according to Nurse.org.

That case ensnared Palm Beach School of Nursing owner Johanah Napoleon, who reportedly was selling fake degrees for $6000 to $18000 each to two individuals in Maryland and Virginia. Napoleon was charged in 2021 and eventually pled guilty. The Florida Board of Nursing shut down the Palm Beach school in 2017 owing to its students' low passing rate on the national licensing exam.

Two participants in the bigger scheme who had also worked with Napoleon, Geralda Adrien and Woosvelt Predestin, were indicted in 2021. Adrien owned private education companies for people who at aspired to be nurses, and Predestin was an employee. They were sentenced to 27 months in prison last year and helped the federal officials build the larger case.

The 25 individuals who were charged January 25 operated in Delaware, New York, New Jersey, Texas, and Florida.

In the scheme involving Siena College, some of the individuals acted as recruiters to direct nurses who were looking for employment to the school, where they allegedly would then pay for an RN or LPN/VN degree. The recipients of the false documents then used them to obtain jobs, including at a hospital in Georgia and a Veterans Affairs medical center in Maryland, according to one indictment. The president of Siena and her co-conspirators sold more than 2000 fake diplomas, according to charging documents.

At the Palm Beach College of Nursing, individuals at various nursing prep and education programs allegedly helped others obtain fake degrees and transcripts, which were then used to pass RN and LPN/VN licensing exams in states that included Massachusetts, New Jersey, New York, and Ohio, according to the indictment.

Some individuals then secured employment with a nursing home in Ohio, a home health agency for pediatric patients in Massachusetts, and skilled nursing facilities in New York and New Jersey.

Prosecutors allege that the president of Sacred Heart International Institute and two other co-conspirators sold 588 fake diplomas.

The FBI said that some of the aspiring nurses who were talked into buying the degrees were LPNs who wanted to become RNs and that most of those lured into the scheme were from South Florida's Haitian American immigrant community, Nurse.org reported.

Telehealth rules in Chapters 6 and 7 became effective on June 22, 2022, and the purpose is to provide guidance to licensed practical nurses, registered nurses, and APRNs on the practitioner provider relationship, consent to telehealth visits, the use of technology, record keeping, and follow-up care. In essence, the rules provide additional guidance on the effective and safe use of telehealth technology.

According to the literature, telehealth is the use of digital information and communication technologies to access health care services remotely and manage the health care of a patient (ATA, 2019; Kruse et al., 2017; NONPF, 2018). Technologies can include computers and mobile devices, such as tablets and smartphones. This may be technology the patient use from home.

In addition, a nurse or other health care professional may provide telehealth from a primary care office or federally qualified health center, such as in rural areas. Telehealth can also be technology that the health care provider uses to improve or support health care services.

Per Iowa Administrative Code, Chapter 7.9(5), Prior to providing services through telehealth, the licensee shall first establish a practitioner-patient relationship. A practitioner-patient relationship is established when:

- The person with a health-related matter seeks assistance from the licensee

- The licensee agrees to provide services

- The person agrees to be treated, or the person’s legal guardian or legal representative agrees to the person’s being treated, by the licensee regardless of whether there has been a previous in-person encounter between the licensee and the person.

In addition, a practitioner-patient relationship can be established through an in-person encounter, consultation with another licensee or health care provider, or telehealth encounter. Some services may be provided through telehealth without first establishing a practitioner-patient relationship in the following settings or circumstances:

- Institutional settings

- Licensed or certified nursing facilities, residential care facilities, intermediate care facilities, assisted living facilities, and hospice settings

- In response to an emergency or disaster

- Informal consultations with another health care provider performed by a licensee outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation

- Episodic consultations by a specialist located in another jurisdiction who provides consultation services upon request to a licensee

- A substitute licensee acting on behalf and at the designation of an absent licensee or other health care provider in the same specialty on an on-call or cross-coverage basis; -· when a sexually transmitted disease has been diagnosed in a patient, a licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention.

A licensee who provides services through telehealth shall be held to the same standard of care as is applicable to in-person settings. A licensee shall not perform any service via telehealth unless the same standard of care can be achieved as if the service was performed in person. Prior to initiating contact with a patient for the purpose of providing services to the patient using telehealth, a licensee shall:

- Review the patient’s history and all relevant medical records

- Determine as to each unique patient encounter whether the licensee will be able to provide the same standard of care using telehealth as would be provided if the services were provided in person.

Additionally, prior to providing services via telehealth, the licensee shall obtain consent from the patient, or the patient’s legal guardian or legal representative, to receive services via telehealth.

Lastly, a licensee who provides services through telehealth to a patient physically located in Iowa must be licensed by the Iowa board of nursing. A licensee who provides services through telehealth to a patient physically located in another state shall be subject to the laws and jurisdiction of the state where the patient is physically located.

Telehealth rules and regulations may be reviewed in the following web links:

https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.6.4.pdf

https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.7.9.pdf

References:

American Telemedicine Association. (ATA). (2019). Telehealth basics. Retrieved from https://www.americantelemed.org/resource/why-telemedicine/.

Iowa Administrative Code. (IAC). (2022). 6.4(152) Telehealth. Retrieved from https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.6.4.pdf

Iowa Administrative Code. (IAC). (2022). 7.9(152) Standards of practice for telehealth. Retrieved from https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.7.9.pdf

Kruse C. S., Krowski N., Rodriguez B., Tran L., Vela J., Brooks M. (2017). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 7, e016242.

In May of 2022, the United States Surgeon General released an advisory statement informing the public of the urgent issue of health worker burnout. This statement is a call to action to strengthen the nations public health infrastructure by addressing health worker burnout and to build a thriving workforce.

Themes of this statement include: 

- A safe and inclusive health care environment

- Investing in a diverse and empowered health workforce

- Human centered technology

- A culture of healing, community, and connection

- Organizational values and leadership commitment to health workers needs

- Reducing administrative burdens during care delivery

- Community partnerships 

- Accessible mental health and substance use care for all including health workers

As we look for solutions to health worker burnout, we must learn from the past and focus on the changes that we can make for a brighter future. 

If you would like to read more: https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html

If you would like to learn about actions that can be taken: https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html#action

On January 1, the American Nurses Association (ANA), the premier association representing the interests of the nation’s more than 4.4 million registered nurses, welcomed its newest president, Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN. She brings more than 25 years of nursing experience to the ANA presidency and has devoted more than a decade of service to ANA, providing leadership in high-profile positions such as ANA Committee Treasurer and service on ANA’s Board of Directors while maintaining membership with the Oregon Nurses Association. Dr. Mensik Kennedy is ready to address the most pressing issues facing nurses: racism in nursing, the health and well-being of nurses, full practice authority for advanced practice registered nurses (APRNs), and nurse staffing.

“It is a tremendous honor to be elected to serve as the president of the American Nurses Association and as the national, leading advocate for nurses during these unprecedent times in nursing history. The COVID-19 pandemic brought significant challenges to the nursing profession, with workforce issues making national headlines despite decades of existence. I am committed to maintaining this visibility and more importantly, the momentum made to call for real solutions that address safe staffing concerns, workplace violence, and burnout to ensure nurses receive the support they so desperately deserve. I will also ensure that ANA’s work with the National Commission to Address Racism in Nursing and journey of racial reconciliation continues.

Nursing is truly my passion and calling. In addition to tackling the hard issues, I’m simply excited to connect with my fellow nurses across the country. I want to hear their challenges, but I also want to celebrate their vast contributions to society, education, public health, science, research and so much more. Working together, we can support our profession and make health care delivery the best experience it can be for our patients and communities,” said ANA president Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN.

Dr. Mensik Kennedy most recently served as the division director of care management at Oregon Health and Science University in Portland, Oregon as well as an instructor for Arizona State University College of Nursing and Health Innovation. She is the proud mother of six children, and in her spare time enjoys camping and traveling with her family. To read the complete profile on ANA’s newest president visit American Nurse to read the President’s Column feature.

Dr. Mensik Kennedy is available for press briefings to discuss timely and critical health care and nursing topics and issues. Interested members of the media should email newsroom@ana.org.

About the American Nurses Association
The American Nurses Association (ANA) is the premier organization representing the interests of the nation's 4.4 million registered nurses. ANA advances the profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. ANA is at the forefront of improving the quality of health care for all. For more information, visit www.nursingworld.org.

As a licensed nurse, you are responsible for following the laws, rules, and regulations which govern your profession. The following are reminders of what you need to do to retain your license and suggestions on how to involve yourself in the nursing profession.

RN Reminders:

1. Routinely check the IBON Online Verification System to determine your license expiration date.

2. Remember the Board of Nursing no longer issues paper nursing licenses.

3. A licensee may renew a license beginning 60 days prior to the license expiration date on the wallet card.

4. At the time of renewal make sure you have completed your continuing education requirements.

5. For renewal of a three year license, the requirement is 36 contact hours.

6. For renewal of a license that has been issued for less than three years, the requirement is 36 contact hours.

7. Maintain records of the continuing education you have received in your licensing cycle.

8. If you are chosen for a random audit of your continuing education, complete the audit following the directions.

9. If you regularly examine, attend, counsel or treat dependent adults or children in Iowa, have you completed the Mandatory Training course for dependent adults and the Mandatory Training course for children within the last 3 years? These courses must be completed every 3 years.

10. At the time of initial licensure or renewal answer all questions honestly, specifically relating to your continuing education and criminal history.

11. Does the board office have your current address on file? If not, submit your current address in writing to the board office or submit by email.

12. Do you know the address for the Iowa Board of Nursing’s website? www.nursing.iowa.gov Mark it as a favorite and refer to it often!

13. Do you know where to find the Iowa Administrative Rules for nursing, 655IAC? They can be found on the IBON Website!

14. Do you know who your legislator is?

15. Have you explored the option of joining a professional nursing organization and asked yourself how you can become involved in your profession?

16. Board staff is here to help answer your questions, it is always better to ask then to assume you have the correct answer. The main number to the board office is 515-281-3255.

Specific to the Advanced Registered Nurse Practitioner (ARNP):

1. ARNPs must hold an active RN license.

2. For an Iowa ARNP license you must submit a copy of your current certification card from the applicable national certifying body and documentation of your RN license if from another compact state.

3. The continuing education required by the national certifying body is deemed to meet the

continuing education requirement mandated by Iowa law for license renewal. Documentation of current certification in itself verifies compliance.

4. ARNP’s who regularly examine, attend, counsel or treat children or adults in Iowa are required to complete the Mandatory Training course for dependent adults and the Mandatory Training course for children every 3 years.

Council Bluffs, Iowa – The Iowa Board of Regents approved a proposal from the University of Northern Iowa to proceed with the planning, development and implementation of a Bachelor of Science in Nursing (BSN) program on Thursday. According to UNI President Mark Nook, campus leadership will work to develop the appropriate programming and curriculum in anticipation of a Fall 2024 launch.

“Based on figures from the Iowa Board of Nursing, nearly 80% of employers in the state indicate that it is difficult or very difficult to recruit nurses,” Nook said. “Finding qualified health care professionals is becoming exceedingly challenging, particularly in rural areas and in long-term care facilities.

“Long-term projections by Iowa Workforce Development indicate that registered nurses represent the top employment need in the state that will require a four-year baccalaureate degree,” Nook continued. “Research also indicates that health care, and specifically nursing, is the most in-demand field of study among Iowa students seeking a four-year degree. We believe UNI is uniquely positioned to provide the combination of hands-on experience and curriculum necessary to serve the students and residents of our state.”

Additional data from the Iowa Board of Nursing indicates that over 20% of current nurses in Iowa are currently eligible for retirement, while 35% of open nursing positions in the state take over three months to fill. These statistics point to the urgency of getting more students enrolled in health care education programs. In addition, data from the American Association of Colleges of Nursing indicates that over 8,000 qualified applicants for nursing programs in the Midwest were denied entry last year.
 
"This may be the most significant thing to come out of this meeting," Regent David Barker indicated. 

"This is not a one or a three-month decision, but a thought-out decision," added Regent Sherry Bates.

Nook indicated that UNI anticipates formally introducing an executive director of nursing and chief academic nurse administrator (CANA) in the very near future as the university launches its first stand-alone nursing program. This individual will play a strategic role in developing a cutting-edge curriculum and assisting the university in obtaining state and national accreditation. In addition, this leader will figure prominently in developing strategic community partnerships with clinical experience providers and future employers of program graduates. 

The University of Northern Iowa will join its fellow Iowa Regent institutions at the University of Iowa and Iowa State to offer a Bachelor of Science in Nursing degree. According to Nook, the objective of UNI’s initiative is to provide access to more seats at public school tuition to students who seek to pursue a nursing career and ultimately increase the number of working nurses in the state of Iowa, and not to draw candidates away from existing programs. The University of Northern Iowa anticipates that its initial cohort of undergraduate students enrolling in its BSN program in Fall 2024 will consist of approximately 24 students.

In addition to engaging with its fellow Regent institutions in Iowa to provide more access to nursing education, UNI also plans to continue its collaborative relationship with Allen College in Waterloo. Current UNI students taking their general education coursework may still complete their clinical training at Allen. UNI and Allen are discussing potential models to improve and expand their existing relationship in an effort to train additional nurses for the Iowa workforce.

Contact:
Pete Moris, director, University Relations, pete.moris@uni.edu, 319-273-2761.

by Dawn M. Bowker, PhD, ARNP-BC, CNE

America is changing and we are experiencing more diversity than ever before. With this diversity, we are creating mosaic of cultures that add a richness to our communities however; it can also create challenges in providing culturally appropriate care to patients. To achieve the best outcomes, we must respect the fact that our patient’s culture shapes their concept of health, illness, and health practices. To be an effective partner in their health journey, we need employ cultural humility and be cognizant of our own ethnocentrism.

As nurses care for patients and families with diverse backgrounds, preferences, and cultures, we experience cross-cultural experiences. Culture influences people’s health status and it shapes our concept of health, illness, and health practices. Impact of and meaning ascribed to an illness by a patient could be in conflict with the meaning ascribed to the illness by the nurse. This difference can result in a cultural misunderstanding that can negatively impact the health outcome for the patient.

Nurses need to develop cultural humility so they can bridge the gap between the patient and the health care system. Cultural humility is recognizing and being cognizant of ethnocentrism so we do not make false assumptions. A nurse who possesses cultural humility recognizes the limitations of their cultural perspective and works towards overcoming their perspective in order to provide better nursing care to all patients. Cultural humility addresses the power imbalance between the nurse and the patient. A nurse who recognizes their own unconscious bias is more likely to maintain an open mind and be respectful of all people and not act as if their way was the only way or the best way to proceed. Cultural humility entails working collaboratively with clients and embracing difference. Cultural humility comes from a position not as experts but from a perspective of learning and understanding. It forces us to step back and realize this person is an expert on their culture, background, and experiences.

The American Nurses Associations (ANA) Code of Ethics states that nurses must practice “with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (ANA, 2015).”

Cultural humility is a lifelong journey of self-reflection and works in apposition with cultural competence to improve health outcomes and decrease disparities. Cultural humility, along with an understanding of the impact of social determinants of health (SDOH) improve health outcomes and reduce health inequities. SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH can be grouped into five domains: economic stability, education access and quality, health care access and quality, neighborhood- built environment, and social and community context (Healthy People 2030). One of Healthy People 2030 overarching goals specifically related to SDOH is to “Create social, physical, and economic environments that promote attaining the full potential for health and well Being for all.” Reducing health inequity is a clear social mandate for nursing in the 21st century, and will require nursing care that is more acutely focused on the SDOH (Thorton & Persaud, 2018).

SDOH require knowledge of and include, but not limited to, the concepts of advocacy, ethics, clinical judgement, communication, compassionate care, diversity, equity, inclusion, evidenced based practice, quality and safety, and professionalism. It is important to specifically address the concepts of diversity, inclusion, and equity. The definitions of these concepts vary in the literature.

Diversity addresses potential differences in individuals and groups. Diversity encompasses differences in race, age, gender identity, religion, culture, language, sexual orientation, and socioeconomic class of individual persons. Inclusion is creating, fostering, and sustaining practices and conditions that encourage and allow each of us to be fully ourselves—with our differences from and similarities to those around us—as we work together (Jagoo, 2021). Inclusion refers to the act or practice of including and accommodating people who have historically been excluded because of their race, gender, sexuality or ability (Jagoo, 2021). Diversity focuses on representation, whereas inclusivity focuses on how to help the group feel like they belong.

Equity examines the fairness by which persons of diverse backgrounds are able to access information, health care, higher education, and other resources that help them to advance and fully contribute to society. A common image differentiating equality and equity is three different persons with different physical characteristics. Equality is providing all three people with three identical bicycles. Equity is providing each individual with a bicycle that is appropriate for their use. In this analogy, a young child would receive a smaller bicycle than a person who is six feet tall or a person with physical limitations. With equity, each would receive a bicycle to accommodate their physical structure, strengths, and limitations.

Similarly, the definitions of race and ethnicity are often used synonymously. Race represents the physical characteristics. Race is biological, describing physical traits inherited from your parents. A person may identify as belonging to one or more race such as White, Black or African American, Asian, American Indian or Alaska Native, or Native Hawaiian or Pacific Islander. Ethnicity reflects cultural identification. Cultural identity, chosen or learned from your culture and family. Commonalities such as national origin, tribal heritage, religion, language, and culture can describe someone’s ethnicity.

As nurses, we cannot overemphasize the significant impact cultural humility, SDOH, diversity, equity and inclusion have on the health outcomes of our patients. When we understand and employ these concepts, we can bridge the gap between the patient and the health care system and provide the best possible care for our patients.

References
American Nurses Association. (2015). Code of ethics for nurses. American Nurses Publishing.
Dayer-Berenson, L. (2013) Cultural competencies for nurses: Impact on health and illness (2nd
ed.). Sudbury, MA: Jones and Barlett

DeChesnay, M. & Andersin, B.A. (2020). Caring for the vulnerable: Perspectives in nursing
theory, practice, and research (5th ed.). Sudbury, MA: Jones and Barlett
Jagoo, K. (2021) What is inclusion? Retrieved from https://www.verywellmind.com/what-is-
inclusion-5076061

James, T. (2020). What Is Upstream Healthcare? An approach to care that examines and
addresses root causes rather than symptoms can improve long-term outcomes and
decrease healthcare costs. Retrieved from https://healthcity.bmc.org/population-
health/upstream-healthcare-sdoh-root causes#:~:text=Simply%20put%2C%20upstream%20healthcare%20is%20any%20approa
ch%20to,we%20can%20change%20the%20corollaries%20in%20health%20outcomes.

Manchanda, R. (2016). What is an “Upstreamist” in Health Care? Retrieved from
https://video.search.yahoo.com/yhs/search?fr=yhs-trp-001&ei=UTF-8&hsimp=yhs-
001&hspart=trp&p=Upstream+health+care&type=Y167_F163_202037_102020#id=21&vid=b5800de74a3f0cbaeb6d17aa78001afc&action=view

Office of Disease Prevention and Health Promotion. (n.d.). Social determinants of health.
Healthy People 2030. U.S. Department of Health and Human Services.
https://health.gov/healthypeople/objectives-and-data/social-determinants-health
Purnell, L.D. (2014). Guide to culturally competent health care (3rd ed.). Philadelphia, PA: F.A.
Davis Company

Thornton, M., & Persaud, S. (2018). Preparing Today’s Nurses: Social Determinants of Health and Nursing Education. OJIN: The Online Journal of Issues in Nursing.
University at Buffalo, School of Social Work (2019). Conversations about culture: Video and
lesson plan. Retrieved from http://socialwork.buffalo.edu/resources/conversations-
about-culture.html

At a gubernatorial debate hosted by Iowa PBS' Iowa Press on October 17, 2022, Governor Kim Reynolds made a comment about nurses and their educational backgrounds.

While debating the student loan repayment/forgiveness announcement shared by the Biden administration, Governor Reynolds said, "If you are that truck driver or machinist or a nurse, a person that decided not to seek a college education, why should you be responsible in paying someone else's off, especially when they often make more than you do?"

As the representative for nurses in Iowa, INA knows Iowa nurses work hard to obtain an education, complete clinical hours, pass the NCLEX to earn a nursing license, and then maintain their license and continue their education for the duration of their careers.

View the Press Release

Join us in educating the Governor, so we can help her understand that nurses are actually highly educated, trained and licensed members of the health care community!

Register an Opinion

Register an Opinion at Governor Reynolds' office, or call her staff at 515-281-5211, Monday through Friday, 8 am - 4:30 pm. Don't hesitate to leave a message if you get a voicemail.

It can also be effective to send your comments in writing. To do so, send a letter to the following address:

Office of the Governor
Iowa State Capitol 1007 East Grand Avenue
Des Moines, IA 50319

Together, we can change the incorrect perspective and opinion. We can remind the public once again that nursing remains the most trusted profession.

Watch the full debate

*Governor Reynolds' comment about nurses not being college educated is at the 40:08 minute mark.