WIXLIB

Page 4November, December 2010, January 2011Virginia Nurses Todaywww.VirginiaNurses.com26th Annual Nurses Day at theGeneral AssemblyWednesday, February 2, 2011Richmond Marriott Hotel Downtown7-7:30 AMRegistration & Continental Breakfast7:30WelcomeShirley Gibson, MSHA, RN, FACHE,President, Virginia Nurses Association8:00AMMeet at State Capitol—Taking the Message to theLegislature8:30-9:00 AMGreetings from Governor McDonnell (invited)Photo opportunities on the Capitol steps9:05-10: 30 AMIndividual visits with Legislators9:15-10:00 AMPlenary Session: How to approach and talk to yourLegislator—Helpful hints for your visit to the Capitol10:00 AMBreak and Exhibitors at the Marriott Hotel11:30-1:00 PMLunch and the Annual Emily Couric Addresswith Dr. William Hazel, Secretary of Health and HumanServices (invited)1PMPlenary Session: TBA2PMAdjourn

www.VirginiaNurses.comVirginia Nurses TodayNovember, December 2010, January 2011Page 526th Annual Nurses Day at the General AssemblyNurses Day at theGeneral Assembly—Hotel AccommodationsRoom Reservations for the Richmond Marriott HotelDowntown, may be made by calling 804-643-3400.The VNA has a block of rooms reserved for the eventat a special rate, so please indicate when you callthat it is for the Virginia Nurses Association’s NursesDay at the General Assembly.Deadline for room reservations is January 5th,2011. Registration FormTHE STATE OF NURSING IN VIRGINIA26th Annual Nurses Day at the General AssemblyFebruary 2, 2011; 8:00 am-4:30 pmThe Richmond Marriott, 500 E. Broad Street, Richmond, VAName—Please Type or Print Clearly—this will be printed on your nametag.Permanent AddressCityStateZip CodeE-mail AddressHome PhoneWork PhoneRegistration FeeMail To:Virginia Nurses Association7113 Three Chopt Road, Suite 204Richmond, VA 23226 VNA Member . . . .VNA Non-MemberRetiree (Age 62 ) .Student . . . . . . . .Students:.Make checks & money orders payable to VNA Legislative DayFee includes: materials, legislative packet, coffee and lunch. Itdoes NOT include parking fees- which must be paid separately. 75. 95. 65. 49Will Graduate in May, 2011.Will Graduate in May, 2012.We accept DISCOVER, MASTERCARD and VISA; (Circle One).Credit Card NumberExpiration DateSignature for credit card authorizationREGISTER EARLYON-SITE REGISTRATION MAY NOT BE AVAILABLE; LAST YEAR WE REACHED A CAPACITY LEVEL.If on-site registration is available, it will NOT include lunch.On-line registration will be cut-off on Monday, January 31, 2011.Inclement weather will not affect the day’s events.There are no refunds available due to bad weather.LATE FEE - After January 18, add 20.00. Refund Policy--- NO REFUNDS AFTER JANUARY 29, 2011.Full refund minus a 25% administration fee if canceled by Jan. 28, 2010.Registration forms can also be downloaded from www.VirginiaNurses.comYou may fax this form to the VNA or register on-line if you preferVNA Fax number is: 804-282-4916.

Page 6November, December 2010, January 2011Virginia Nurses Todaywww.VirginiaNurses.comPractice InformationAANP Awards for ExcellenceEvery year the American Academy of NursePractitioners (AANP) awards a nurse practitioner anda nurse practitioner advocate with an award in eachstate. This year the winner of the Virginia NP StateAward for Excellence was Carola Bruflat. SandraWhitley Ryals, Former Chief Deputy Director,Virginia Department of Health Professions, was therecipient of the NP Advocate award. The awardswere presented at the annual AANP conference inPhoenix, Arizona in June.State award for NP ExcellenceCarola Bruflat is a women’s health and familyNP, currently practicing in an OB/GYN practicein Northern Virginia. Carola has been a leader inthe state of Virginia, serving as President of theVirginia Council of Nurse Practitioners, NationalLegislative Liaison/lobbyist for the National PerinatalAssociation and chair of the legislative committee forAWHONN. In 2000, she received the AWHONN Awardof Excellence for Advocacy. She is a member of theAdvisory Committee to the Joint Boards of Nursing& Medicine. She also serves as a member of the ANACongress on Nursing Practice and Economics. Shehas been active in legislative and advocacy issuesin Virginia for her entire career, lobbying to removebarriers to nurse practitioner practice and increaseaccess to care for all VirginiansState award for NP AdvocateSandra Whitley Ryals has been a tirelessproponent of Virginia nurse practitioners, workingto reduce barriers to nurse practitioner scope ofpractice while creating greater awareness throughoutthe Commonwealth regarding the important role ofnurse practitioners. In the summer of 2008, Ms Ryalswas instrumental in bringing leaders of Virginia’sphysician and nurse practitioner groups together toengage in an unprecedented level of dialogue withthe hope of furthering the goals of the Governor’sHealth Reform Commission to remove barriers to NPscope of practice. Her efforts led to the establishmentof greater communication between the physician andnurse practitioner groups, and mutual partnershipson medical malpractice and other health relatedlegislation. Carola Bruflat, 2nd from left is honored with theAmerican Academy of Nurse Practitioners awardin Phoenix, AZ.Understanding the Complaint Processby Michele SatterlundWhile it’s an unpleasant experience to learn thata complaint has been filed against you, it’s importantto remember that you do have options. The complaintprocess is not necessarily an attack on you, but it isa process that ensures the protection of both youand the public.In Virginia, complaints against nurses aresubmitted to the Virginia Department of HealthProfessions (DHP) in writing, by telephone, fax,email, or in person. The complaint can be made byanyone who is concerned that a nurse’s practice isin violation of the laws and regulations pertainingto health care practitioners. The person making thecomplaint (the complainant) could be your employer,a colleague, a patient, a patient’s family member, oreven someone who wishes to remain anonymous. Thecomplainant, however, must provide the DHP withthe basis for the complaint and provide informationdetailing the sequence of events surrounding thereason for concern.Once received, a complaint is referred to a CaseIntake Analyst who determines whether DHPactually has jurisdiction over the person or subjectof the complaint. If DHP has authority and there issufficient information to justify an investigation, aninvestigator is assigned to the case. The investigatorforwards a summary of the findings and evidencerelated to the case to the appropriate board for adetermination. In the case of nurses, that board ismost often the Virginia Board of Nursing.Once the Virginia Board of Nursing receives theinvestigator’s report, a preliminary review determineswhether there is enough evidence that a violation ofa law or regulation occurred. If there is not enoughevidence, the Board of Nursing closes the case andno further action is taken.It’s important to remember that even if apractitioner’s action may be considered improper,it may not always be in violation of law. The boardmust find sufficient evidence that a violation oflaw has occurred before an informal conference isscheduled.At an informal conference, a committee of theboard meets with the nurse. Informal conferencesare open to the public and the person making thecomplaint will be notified as well, although thecomplainant rarely testifies.At the informal conference, the board committeedevelops a recommendation that includes one of thefollowing: 1) close the case with a finding that noviolation of the law has occurred; 2) offer an order inwhich the licensee consents to be sanctioned; or 3)send the case to the full board for further review.In making a recommendation for disciplinaryaction, the committee looks at the severity of thealleged actions, and takes into account factorssuch as the practitioner’s experience, the practiceenvironment, the practitioner’s understandingof the action, and whether the practitioner hastaken steps to correct the reason for the complaint.In making a recommendation for disciplinaryaction, the committee may recommend a monetarypenalty, a reprimand, probation, limitation onpractice privileges, remedial or corrective action, orsuspension or revocation of the practitioner’s license.A formal hearing may also occur, but only ifthe practitioner against whom the complaint hasbeen made requests it, the informal committeerecommends it or if the sanction is quite serious,such as the suspension or revocation of a license. Aformal hearing is more like a trial, and evidence canbe introduced, and witnesses can be called.The complaint process is always easier ifthe practitioner has acted proactively to ensurecompliance with Virginia’s laws and regulations.Once a complaint is initiated, the investigatorverifies whether the practitioner’s license is current,and determines whether the necessary forms anddocuments are up-to-date and properly filed. Stayingcurrent with licensing requirements is important—an investigation is not the time a practitioner wantsto discover he or she forgot to file a required practicedocument with the board.While the complaint process can be intimidating,it’s helpful to remember that the board is there foryou. The Board of Nursing website has many helpfulresources, including legal references, practiceregulations, and guidance documents that canhelp you better understand your specific practicerequirements. The board wants to ensure thatVirginia’s citizens are served by quality health careprofessionals, and they are willing to work with youto help ensure you are the best nurse you can be. Michele Satterlund is an attorney with Macaulay& Burtch, P.C. in Richmond, Virginia. She can bereached by telephone at 804-649-8847 or by email atmsatterlund@macbur.com.Reimbursement of Nurse PractitionersDiane Walker RN, MSN, FNP-BCImmediate Past PresidentVirginia Council of Nurse PractitionersReimbursement of nursepractitioners is an importantandcomplexissue.Howservices are being billed mayhave a direct effect on accessto care. It creates a logisticalnightmare for those doing thebilling for nurse practitionerswith each company creatingdifferent policies for how theywill or will not reimburse nursepractitioners.TheamountDiane Walkerthat nurse practitioners arereimbursed for their servicesto patients often directly impacts both salary andbonuses.When seeing patients in an office setting, a decisionneeds to be made as to whether you will be billing“incident to,” or billing under your own numbers, whenthis is possible. What does “incident to” billing mean?“Incident to a physician’s professional service” isa concept that originated in the Medicare system.It requires that the physician be physically presentin the office suite, though not in the exam room. Itfurther requires that the physician has established adiagnosis and plan of care for that particular patientand problem. More information about this may befound at the Centers for Medicare and MedicaidServices website at: pdf.The financial advantage to the practice for billing“incident to” in the case of a Medicare patient is ahigher rate of reimbursement. The practice will bereimbursed at 100% of the allowable charges whena nurse practitioner bills “incident to.” Medicarereimburses nurse practitioners 85% of the physician’sfee schedule if billed under his or her own Medicarenumber.There are important aspects of billing “incidentto” that nurse practitioners need to be aware of.The physician must personally perform an initialservice and remain actively involved in the course oftreatment.Medicaid reimburses nurse practitioners at 100%of the allowable rate in Virginia, with the exception ofpsychiatric nurse practitioners, who are reimbursedat a lower rate. This is not the case for managedMedicaid.Private insurers each have their own policiesand fee schedules for how nurse practitioners arereimbursed which vary. Some companies will directlyreimburse nurse practitioners and others will not. Thisfurther complicates things when a Medicare patienthas managed Medicare or a secondary payer.A good example of the complexity of the paymentdifferences between companies may be found in thestate to state reference at the American Academy ofPhysician Assistants website: s/reimbursement/private-payers/623.The Institute of Medicine, in a report released inOctober, 2010 on the Future of Nursing, has justpublished recommendations that Medicare andMedicaid reimburse advanced practice nurses atthe same rate as physicians for performing the samework.Though the Commonwealth of Virginia law clearlystates that we may see new patients and currentpatients with new problems, “incident to” billing addsadditional levels of restrictions, as do many privateinsurers. It is important that nurse practitionersunderstand the constraints of “incident to” billing,as well as those being placed by private insurers.Reimbursement constraints ultimately affect accessto care. Nurse practitioners need to understand theseissues and work together to change them.

www.VirginiaNurses.comVirginia Nurses TodayNovember, December 2010, January 2011Page 7Practice InformationTaming the Beast of Lateral Violence Among Nursesby members of the VNA Ethics & Human RightsCommittee: Diane Brothers, RN, BS, MA,Esther Condon, RN, PhD, Barbara A. Cross, RN,PhD, Kathryn M. Ganske, RN, PhD,and Erica Lewis, MS, RNLateral violence among nurses has been a topicof ongoing concern for several years. Its lingeringinfluence is reflected in the continuing publication ofarticles and position statements in nursing journalsand professional nursing organizations’ documents.The American Nurses Association (ANA) House ofDelegates reaffirmed its position on hostility, abuseand bullying in the workplace. The 2010 House ofDelegates resolved that the ANA will fully supportthe existing principles of the 2006 resolution relatedto workplace abuse and harassment of nursesand the Texas Nurses Association statements onviolence and bullying in the workplace, whichstate that lateral violence can negatively affect thedelivery of healthcare services, have financial andorganizational effects on the employer, may affect theefficiency, accuracy, safety and outcomes of care, andhinder recruitment and retention of nurses (ANA,2010). This article will address the background andcurrent status of lateral violence as a concern fornurses.BackgroundLateral violence is defined as “any inappropriatebehavior, confrontation or conflict-ranging fromverbal abuse to physical and/or sexual harassment“(Rowell, 2007). Other researchers have labeled it“horizontal hostility” (Thomas, 2003; Bartholomew,2006) and “horizontal violence” (Farrell, 1997; Hastie,2002; Dunn, 2003; Longo & Sherman, 2007). Lateralviolence also encompasses bullying in the workplace,which is repeated inappropriate behavior, direct orindirect, verbal, physical or otherwise, perpetuatedby one or more persons against another in the courseof employment, which could reasonably underminean individuals’ right to dignity at work (Task Forceon the Prevention of Workplace Bullying, 2001;Murray, 2009). In addition, bullying is differentiatedfrom peer lateral violence by the existence of a realor perceived power differential between perpetratorsand victims of bullying (Center for American Nurses,2007; Vessey, Demarco, Gaffney, Budin, 2009;Murray, 2009).A theory of oppressed group behavior thatdescribes group self-hatred, low self-esteem, andself-loathing, has been used to explain lateralviolence among nurses (Roberts, 1983; Woelfe &McCaffrey, 2007). Longo & Sherman (2007) alsocite low self esteem in addition to lack of respect forothers as factors in lateral violence among nurses.Environmental factors such as patient and familyto nurse violence that is not addressed withinpractice settings have been identified by the NationalAdvisory Council on Nursing Education and Practice[NACNEP] as influencing the potential for lateral bysuggesting to nurses that violence is something to becontended with. (NACNEP, 2007). Stanley Dulaney,& Martin (2007) identified that the “ebb and flow”of lateral violence is associated with reorganizationof institutions, the nursing shortage, the pressuresassociated with producing high quality patient carewith minimal staff and budgets.Organizational Culture and EnvironmentalImpact on Lateral ViolenceOrganizational culture, defined as commonlyheld values, beliefs, and attitudes by members ofthe organization (Boan, 2006) has been linkedto lateral violence. If the meanings inherent inthe values, beliefs, and attitudes of a culture arestrongly held, widely shared, and deeply embedded,they will be strongly influential in either positiveor negative ways; meaning within a culture may betaken for granted and thus not easily changed byconsensus (Staber, 2003). Therefore, organizationalculture or climate can create changes in nurse-to -nurse behaviors simply because the culturesupports them whether they are negative or positive.Unless established processes are in place to stop orcorrect negative behaviors, they may quietly growuntil the culture not only supports such behaviors,but expects them. A culture of tolerance for lateralviolence may grow

Bon Secours Virginia Centra Health Inc. Owens & Minor University of Virginia Health System Virginia Commonwealth University Health System Hall of Fame INOVA Health System HCA-Virginia Health System Winchester Medical Center Caring Contributors Arthur L. Davis Publishing Agency Carilion Clinic George Mason University SON Martha Jefferson Hospital