Nurse Reporter Spring 2011 - Wyoming State Board of Nursing

Vol. 7
Nurse
Number 1 Spring 2011
R E P O R T E R
Wyoming
In Celebration of
Wyoming Nurses and
Nurses Week 2011
Cover Photo: Michelle
Mulberry cares for
wounded veterans
returning from combat

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Wyoming
Spring 2011 Vol. 7 Number 1
Editor
Mary Kay Goetter
Assistant Editor
Patti Gardner
Nurse R
T a b l e o f C o n t e n t s
“Serving and safeguarding the
people of Wyoming through the
regulation of nursing education and
practice”
E P O R T E R
Published by the
Wyoming State Board of Nursing
1810 Pioneer Ave.
Cheyenne, Wyoming 82002
Phone: 307-777-7601
Fax: 307-777-3519
Web Address: http://nursing.state.wy.us
Mission: To serve and safeguard the people of
Wyoming through the regulation of nursing education
and practice.
Vision Statement: Acknowledging the dynamic
nature of healthcare, provides the climate, collaboration
and regulatory framework for nurses to practice to the
fullest extent of their scope.
Values: Excellence, Ethics, Education, Safety and
Competence.
Executive Director
Mary Kay Goetter, PhD, RNC, NEA-BC
Assistant Executive Director,
Practice and Education Consultant
Todd Berger, MSN, ACNP-BC, ACNS-BC
Compliance Consultant
Patti Hefflin, BSN, RN
Financial and Human Resources Officer
Cindy Stillahn
Executive Assistant
Amanda Roberts
Licensing Coordinators
Maxine Hernandez
LaVelle Ojeda
Disciplinary Assistant
Debra Ball
Legal Assistant
Jan Ross
3 Editorial
5 President’s Message
6 Life are You Ready?
7 The Wyoming Center for Nursing and Health Care Partnerships Corner
9 Getting to Know Wyoming Nurses: Meet Michelle Mulberry
10 Returning to School: Is It Right for You?
12 First CNA II Training Class Held in Gillette
13 Inside Scoop
14 Getting to Know Wyoming Nurses: Meet Mariusz Pieczalski
16 Practice Questions Requiring Substantial Thought
20 Faith Community Nursing
21 Customer Service Corner
21 Getting to Know Wyoming Nursing Students: Meet Lilian Ogana
22 Getting to Know Wyoming Nursing Students: Meet Mallory Davis
22 Legislative Review
23 Delegation Statement
24 Disciplinary Actions
30 Pearls of Practice
Greetings
From Mary Kay Goetter
Executive Director
Board of Nursing Members
Kellie Clausen, FNP, WHCNP, RN President
Tracy Wasserburger, RN-C, APRN, NNP-BC
Vice President
Marguerite Herman Consumer Secretary
Lee Carruthers, RN--RN
Representative
Kim Williamson, LPN Expires February 2, 2011
Marcie Burr, RN, HSA, CCHP Member
Carrie Deselms, APRN, FNP-BC Member
Wyoming Nurse Reporter does not necessarily
endorse advertisements contained herein. The
publisher reserves the right to accept or reject
advertisements for Wyoming Nurse Reporter.
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Victor Horne
vhorne@pcipublishing.com
501.221.9986 or 800.561.4686 ext. 114
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EDITION 24
Spring is really coming!
It seems impossible to
believe, but in fact, the sun
is particularly warm today,
reminding me that spring
truly is just around the
corner! With the spring
seasonal change always
comes Nurses’ Week and
all the celebrations that
accompany it. We decided
here at WSBN to herald
Spring 2011 and Nurses’
Week with an issue
focusing on celebrating
nurses, both the people and
the profession as a whole.
There are so many
things to be grateful for in
nursing today, not the least
of which is a President
who is outspoken in his
support of nurses and their
role in healthcare reform.
But rather than discuss
politics in this forum, I
am going to share a story
that I believe captures the
essence of why being a
nurse today is a reason to
Continued on next page
pause and express gratitude
and humility. This is the
story of how one nurse
made all the difference to
one family.
My mother, Virginia,
lives in a suburb of
Milwaukee and despite
being 85 years of age
she works about 10-14
hours a week in church
volunteer activities. No
visit or phone call with her
is complete without her
regaling me with the latest
stories about her volunteer
work serving on the
parish council or making
regular rounds of hospital
Wyoming Nurse Reporter 3

visits to bring communion or just pray with
people. One family in particular has figured
prominently in her stories in the past several
years.
Tom and Erica, a married couple in their
40s, had two daughters and both of them were
affected by MELAS Syndrome: an incredibly
rare genetic disease that causes debilitation,
dementia and death, with symptoms usually
apparent in the teen years. It was especially
grievous to Erica that, although she herself
was not afflicted by the condition, she was
the carrier. The older of the two, Ashley,
was far more ill and had been confined to
a wheelchair since her mid-teens. She had
also become progressively blind, but retained
her mind’s ability to think and enjoy some
cognitive activities. Although diagnosed
with the same disease, the younger daughter,
Brittany, remained seemingly healthy. Tom
and Erica tried their best to care for Ashley
while allowing Brittany to have as normal of
a life as possible. My mother was part of a
parish ministry that went to their home to
help out and her task was to read aloud to
Ashley. Though in her 20s and completely
bedridden, Ashley still loved Nancy Drew
Mystery stories and my mother spent many
hours in the last year of Ashley’s life reading
Nancy’s adventures aloud to the young
woman. Ultimately, Ashley died at home at
age 24, in hospice care, surrounded by her
family.
For the next few years, Brittany continued
to do well. She had graduated from high
school, attended some college classes and was
employed in a job that she loved. She had
some symptoms, was painfully thin and often
fatigued, but her ability to finish school and
be employed encouraged Tom and Erica that
maybe this time, it would be different. Maybe
Brittany could defy the odds and survive with
a mild case of the disease. Everyone tried to
remain optimistic, despite the physicians’
sympathetic, though realistic prognosis of
premature debilitation and death.
Last October, Brittany reported to her
doctor’s office for a routine check-up and flu
shot. A few hours later, she felt terribly ill.
Thinking it was only a reaction to the flu
shot, she crawled into bed. By morning, she
was barely responsive and Tom and Erica
called an ambulance. She usually received
all her care at a regional medical center in
Milwaukee, but her condition was so grave,
she was taken to the Emergency Department
of the nearest community hospital, where she
was admitted to the Intensive Care Unit.
Brittany was already in respiratory failure
and soon needed to be intubated and placed
on mechanical ventilation. Less than 24 hours
after admission, despite vigilant medical and
nursing care, Brittany had a cardiac arrest. Tom
and Erica stood by, numb and helpless, while
they watched the resuscitation procedures
being done on their daughter. The physicians
had confirmed that her rapid deterioration was
related to MYLAS Syndrome and not the flu
shot or some other more treatable condition.
It seemed inconceivable that she could have
had such a reprieve from this disease, only to
be facing the dreaded outcome right now.
The resuscitation efforts were successful,
in that the healthcare providers were able
to stabilize Brittany’s heart rate and blood
pressure. However, as the next few days
unfolded, it was evident that Brittany would
not leave the hospital. She was mostly
unconscious, but now and then a glimmer of
responsiveness would shine through, sparking
hope in Tom and Erica. However, their fervent
wishes were denied when Brittany once again
showed signs of imminent decline. Brittany’s
caregivers gently broached the topic of endof-life
care with her distraught parents.
Her body was failing rapidly, they said.
But she was doing so well up until less than 2
weeks ago! The disease process is taking over,
they said. But, surely if we can buy her some
time she can recover enough to come home, at
least for a little while! The doctors and nurses
found themselves in the position of helping
this family hear and understand the most
heartbreaking information imaginable—Your
child will not recover. This position is not
unfamiliar to many of WNR’s readers.
After all of their questions were answered,
every “What if?” was brought out in the open,
after all the tears and prayers, the answer was
affirmative; Tom and Erica agreed to a “Do
not resuscitate” order for their 24-year old
daughter. Brittany would not after all, outlive
Ashley.
As so often happens after such a decision is
made, Brittany seemed to rally a bit. She still
responded to her mother’s voice and touch.
But it was short-lived. Brittany was near death
and the accoutrements of intensive care were
only prolonging her suffering. Their suffering.
The physician suggested that perhaps it would
be best for Brittany if they discontinued life
support.
Members of my mother’s church were
contacted to renew their prayers and support
for this family during these last difficult days
and hours. Erica agreed that it was futile to
allow Brittany to continue to suffer, but this
decision proved even more difficult than the
“Do not resuscitate” decision. It is one thing
to agree to a DNR order, but another matter
to say, go ahead and turn off the ventilator, go
ahead and extubate her. Erica did say OK, but
on one condition; I want to hold her in my
arms. I want her to leave this world the same
way she came into it—in my arms. I want to
hold my baby as she dies so she knows she is
not alone.
Afterwards, my mother went to visit Erica
and Tom at their home and just be with them.
Erica had been so distraught after Ashley’s
death, she could barely speak to anyone, but
it had seemed to help when church members
came and just sat with her and prayed with
her. But when my mother came after Brittnay
died, Erica wanted to talk. She wanted to
share the story of her daughter’s death much
like a new mother wants to share her birth
story to everyone who comes to see the new
baby.
“I told them I would only let them turn off
the machines if I could get in bed with her
and hold her. I thought they might argue with
me but they didn’t! Not at all! The nurses
were so wonderful to me, Virginia! They
lifted my baby so gently to the edge of the
bed, they arranged all the tubes and lines, and
moved everything aside. They made a spot for
me and helped me to hold her just so. And
then they turned off the machines and made
sure Brittany and I were as comfortable and
supported as could be. And Virginia, her nurse
stayed! She just stayed there long after her
shift was over. She just sat there and stayed
with us. I could not believe it. They weren’t
used to this kind of thing, not in an intensive
care unit. But she did everything she could to
make sure we could just be together and that
Brittany’s death could be peaceful. And she
cried! I could not believe it, Virginia, but the
nurse held me and cried with me afterwards. I
didn’t know a nurse would do that.”
I do know that a nurse would do that. I
think that, as nurses, we all know that most
of us would do just about anything possible
to relieve suffering, express compassion,
embrace new life, and when necessary, ease
the transition from life to death. I don’t know
any of the nurses in that intensive care unit
in Wisconsin, but I don’t believe they are
much different than nurses in Wyoming, or
anywhere else for that matter.
To all the nurses I do know, as well as the
ones I do not, I express my gratitude for being
in this profession. We are all honored to be
part of people’s lives on the journey from birth
to death and I am most honored to stand with
you as colleagues.
4 Wyoming Nurse Reporter

According to the Chinese Zodiac, the Year
of 2011 is the Year of the Golden Rabbit, which
begins on February
3, 2011 and ends on
January 22, 2012.
The Rabbit is the
fourth sign of the
Chinese Zodiac,
which consists of
12 animal signs.
The Rabbit is a
lucky sign. I readily
recognize that this
astrology is felt to relate to those who are born
this year, but my readings have also led me to
appreciate that this can also be applied to the
business world as well. I feel the Year of the
Rabbit is going to be lucky for me and in part it
is because I feel honored to be a member of the
Board of Nursing, serving you, the licensees, in
our fabulous state.
Last year, the Board put great effort in
establishing and implementing a strategic plan
for our organization. We have focused on some
key areas which include: Public relations-
A Message from Tracy Wasserburger
President of Wyoming State Board of Nursing
establish and authenticate the board’s mission
to the public; Policy Making - Establish wellorganized,
efficient and effective processes
and procedures; Service - Deliver a reliable
and consistent service to public and licensees;
Safety - Ensure public safety through all WSBN
processes; and Education - Sustain progressive
and dynamic standards of quality nursing
education. We know that we have a lot of work
to do in each of these areas, but we also know
that we have many opportunities as well. We
will work diligently to take these key areas of
focus and deliver the kind of support, assistance,
direction and service that you need from us. For
Board members and Board staff, it will serve as
a tool that will not be looked at just once a year,
but on a consistent basis so that we keep these
four key areas at the heart of what we do for you
and the public.
The forecast for those who are born this year
is said to be balanced in outlook and cautious
in approach. I feel that the Board of Nursing is
required to practice with these same attributes
to ensure safety of the public. Not unlike those
born this year who are said to be prone to having
the trait of being informed of all the facts before
making a judgment, we as a Board also have
made the same commitment in gaining as much
knowledge and education as feasible as we move
forward in decision or policy making. Chinese
astrology goes on to say that those who are
born in 2011 are likely to identify opportunity.
I feel that we have very strong and intelligent
members and staff who too are gifted with
identifying opportunity. We will work hard to
turn these opportunities in to advantages for
those we interact with.
According to Chinese tradition, the Rabbit
brings a year in which you can catch your breath
and calm your nerves. It is a time for negotiation.
It is a time not to force issues. One is suppose to
make it a goal to create a safe, peaceful lifestyle,
so you will be able to calmly deal with any
problem that may arise. Although I was born
in the Year of the Tiger, as Board President I will
try to adopt the attributes of the Rabbit so that
we at the WSBN, may do our greatest service
for those who rely on us most.
Tracy Wasserburger, RNC, MSN, NNP-BC
WYOMING HEALTH
MINISTRY SUMMIT
INVITES
Faith Community & Parish Nurses, Health Professionals,
Clergy & Faith Professionals and Laypersons to:
“INTEGRATING BODY, MIND, SPIRIT:
BUILDING THE FOUNDATION”
Friday, April 29, 2011
Faith Community & Parish Nurse Reception
Saturday, April 30, 2011
General Session & Presentations
Cheyenne, WY ~ Little America Hotel
Sponsored by:
Wyoming Health Council
Cheyenne Regional Medical Center
Visit: www.wyhc.org for
registration information
Month
January 10-14, 2011
February 1, 2011
April 4-8, 2011
April 26, 2011
July 4-8, 2011
July 25, 2011
October 3-7, 2011
October 25, 2011
January 9-13, 2012
Nurses are welcome!
WSBN Board Meeting
Schedule 2011-2012
Location
WSBN Office, 1810 Pioneer Ave, Cheyenne,
WY
Teleconference (Dial In 877-278-8686 Pin
517378)
Board of Medicine Office, 320 W. 25th St. 2nd
Floor Cheyenne, WY
Teleconference (Dial In 877-278-8686 Pin
517378)
TA Ranch Buffalo, WY
Teleconference (Dial In 877-278-8686 Pin
517378)
TBD
Teleconference (Dial In 877-278-8686 Pin
517378)
TBD
Wyoming Nurse Reporter 5

Life R U Ready? originated in Tucson,
Arizona and was originally called “Sex
R U Ready?” The name was changed to
“Life R U Ready?” when it was offered to
Campbell County students in Gillette,
Wyoming. Washakie County offers this real
life simulation to middle school students in
Worland and Ten Sleep, Wyoming.
The goals of “Life R U Ready?” are to
increase awareness of the consequences
of alcohol, tobacco, and other drug use;
to decrease the motivation to participate
in risk-taking behavior and provide
LIFE are YOU READY?
new opportunities for parent-teen
communication. This program is a real life
simulation where students find themselves
at a party with a variety of opportunity
to participate in risky behaviors. Each
behavior results in consequences, such as
jail, court trial, hospital emergency room,
morgue, pregnancy, disabilities, etc. The
event provides 6th, 7th, and 8th graders
with the opportunity to use the skills and
knowledge they have learned in simulated
situations where they can safely experience
the outcomes of their decisions.
Lori Schaal
Numerous agencies and community
volunteers are needed for this annual
event. As students attend this scenario and
experience its consequences, they interact
with law enforcement officials, judges,
nurses, doctors, EMTs, morticians and
counselors. Nurses participate from the
hospital, the clinic, the ambulance, Public
Health and Family Planning.
Lori L. Schaal RN, is the Washakie
County Public Health Nursing Manager.
VA Montana Health Care System
Offers Great Career Opportunities
Helena:
- Deputy Chief Nurse Executive
- Operating Room Nurse Manager
- Chief, Out-Patient Behavioral Health,
RN/NP
Nurse Practitioners – Various opportunities
state
LPNs – Various locations around the state
Visit www.usajobs.gov or contact
Human Resources at
(406)447-7933 EOE
Competitive Salaries!
Generous Benefit Packages!
Excellent Career Paths!
Weston County
Health Services
Seeks
Nurse Program Manager
Newcastle, WY
Great opportunity for a Nurse
Program Manager. Key
responsibilities include infection
control, employee health, disaster
planning, nurse in-service
education, worker’s compensation,
case management and physician
credentialing. Wyoming RN license
req with BSN preferred; 5 years
nursing management experience.
Competitive salary and benefits.
Send resume to
hgilliland@wchs-wy.org
or call 307-746-3707
6 Wyoming Nurse Reporter

Mary E. Burman and Matt Sholty
Nursing Accomplishments in Recruitment and Retention
The Wyoming Center for Nursing and
Health Care Partnerships Corner
In this issue of the Wyoming Nurse Reporter, the accomplishments of
Wyoming nurses are applauded and celebrated. In keeping with this theme,
the Wyoming Center for Nursing and Health Care Partnerships (WCNHCP)
would like to feature five pilot projects from around the state that highlight
the kind of accomplishments nurses can have when they address significant
issues, such as recruitment and retention of nurses.
In Fall of 2008, the WCNHCP put out a
call for proposals to address nurse recruitment,
training, and retention, especially in long-term
care. The Center received a number of proposals
and funded five projects that began in March
2009 and continued through Spring/Summer
of 2010. In this column, we’ll describe each
of the projects and offer recommendations for
successful recruitment and retention projects.
More information about the projects and their
evaluation is available on the WCNHCP’s
website.
Powell Valley Healthcare (PVHC) was
awarded funds to implement a CNA mentorship
project to enhance retention of CNAs. The
project was based on a successful program for
nurse mentoring, in which the implementation
of a mentoring program for nurses at PVHC
decreased the turnover rate from 66.7% to 0%
during the one year study (Blough, 2006). The
project is based on development of a mentoring
process in which an experienced expert CNA
acquaints a novice CNA to the customs, resources,
and values of the organization, while at the same
time serves as a role model. The desired outcomes
include turnover reduction, financial savings,
increased job satisfaction, enhanced quality of
care, and provide veteran CNA’s advancement
opportunities and recognition. The mentoring
program did decrease recruitment and turnover
costs and generated positive feedback from those
involved.
The Wyoming Nurses Association received
funding to develop a leadership institute, called
the Wyoming Nurse Leadership Institute
(WNLI). Leadership style and behaviors are
associated with staff nurse job satisfaction and
intent to stay and organizational commitment in
both the US and in other countries. In a study
by the Wyoming Department of Employment,
satisfaction with salary, interpersonal relations
Continued on page 8
Nursing
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Relocation Assistance
- Director of Emergency Services
- ER/ICU RNs
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Visit www.Riverton-Hospital.com
Great People. Great Benefits. Great Pay.
GREAT NURSING OPPORTUNITIES
Relocation Assistance is Available!
Wyoming Medical Center has openings for
Registered Nurses in the following departments:
• OR Nurse Manager • Progressive Care Unit
• Surgical Unit • Medical Unit • Neuro Unit
Contact: Sammie Stephens RN Nurse Recruiter
307.577.2669 • sstephens@wmcnet.org
1233 E. 2nd St., Casper, WY 82601
Equal Opportunity Employer
Visit us online to apply: www.wyomingmedicalcenter.com
Wyoming Nurse Reporter 7

and professional development opportunities are
strongly correlated to intent to stay/leave current
nursing positions for Wyoming nurses. WNLI
was developed to strengthen nursing leadership
in the state of Wyoming. The Institute involved
four face-to-face sessions addressing a variety of
topics including leadership competencies, nursing
and health care policy, quality and patient safety,
work with a mentor to provide support and
guidance during the program, and completion of
a leadership project. Six participants completed
the first institute, which has been continued for
another year.
Public Health Nursing in the Wyoming
Department of Health developed a statewide
recruitment, retention and succession plan for
Wyoming public health nursing. The projected
nursing shortage and the upcoming retirement
of PHNs was the major impetus for this project.
This plan is imperative for a competent PHN
workforce to promote and protect the health
of Wyoming citizens (Robert Woods Johnson
Foundation [RWJF], 2008). As part of the
project, two preceptor manuals were developed
to ensure that students had a meaningful and
structured experience in public health nursing
as a mechanism to recruit more graduates into
public health. In addition, a consultant was
hired to facilitate a retreat and the development
of a succession plan. PHNs from all levels
participated in the process used to development
the plan. The preceptor manuals lead to more
understanding of PHN by nursing faculty and
helped PHNs develop their skills as preceptors.
Wyoming Medical Center was funded to
lengthen their traditional nursing orientation
from three months to a yearlong graduate nurse
residency program. Nurse residency programs
are one of the “best practices” for recruitment
and retention of graduate nurses (Altier & Krsek,
2006). Graduate nurses participated in monthly
didactic courses, unit specific orientation, a
preceptor/mentor program, and interdisciplinary
rotations through the hospital. As part of the
project, preceptor education was enhanced
through basic and advanced preceptor classes in
order to enhance preceptor ability to stimulate
critical thinking, evaluation of graduate nurse
development and management of conflict. The
12 month residency was more appealing to
nurses applying to WMC and a majority of the
new graduates successfully made the transition
into their nursing roles at the hospital.
Finally, Campbell County Memorial Hospital
focused on improving preceptor education for
nurses in acute and long-term care settings in
northeastern Wyoming. The overall goal was
to increase satisfaction by nurses who serve as
preceptors and the pool of nurse preceptors
available for nursing students and/or graduate
nurses. The project staff worked with current
preceptors, nurse managers and nurse educators
to outline the knowledge and skills needed
for nurses to be effective preceptors. Based on
those competencies, a curriculum for preceptor
education was developed with the goal that the
education modules be available on-line. As a
result of the project, a network for preceptors in
northeastern Wyoming has been developed and
managers remain passionate and committed to
the project.
Each of the project directors submitted a
final evaluation report to the WCNHCP. In
addition, Laran Despain and Laura Feldman,
from the Wyoming Statistical & Analysis
Center (WYSAC), conducted a systematic
overall evaluation of the projects (available on
the WCNHCPs website). This is a rich analysis
and addresses outcomes related to recruitment,
training, retention and sustainability, as well as
describing the challenges faced by these nurses
in implementing their projects. Despain and
Feldman provide a number of recommendations
to enhance the success of recruitment and
retention projects. Overall, they conclude
that projects, such as these described in
this column, can improve recruitment and
decrease recruitment costs. In relation to
retention, job satisfaction can be increased
through professional development efforts,
such as through preceptor training, although
examining retention is challenging because not
all facilities had mechanisms to collect this kind
of data. To optimize training efforts, gathering
regular participant feedback, using consultants,
matching mentors and mentees, and facilitating
regular contact between mentors and mentees
are critical. To ensure sustainability of the
projects, it is important to garner administrative
support through ongoing participant feedback
and find other funding and resources.
Our congratulations to the nurses who
directed these projects! They are strong
examples of what nurses can do in this state to
enhance the nursing workforce and meet the
health needs of people in Wyoming.
The WCNHCP is the nursing workforce
center for the State of Wyoming. The mission
of the center is to strengthen the nursing
workforce through on-going collaboration,
communication, and consensus building
to meet the health needs of the people of
Wyoming. For further information, please visit
the WCNHCP’s webpage at
wynursing.org.
Join one of state’s top
healthcare teams in delivering
outstanding patient care
throughout south central
Wyoming. Our facilities
are state-of-the-art and our
commitment to nursing
excellence and positive patient
outcomes is unmatched!
Current opportunities:
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We deliver world class
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To apply, visit our website at
www.landerhospital.com
Lander Regional Hospital
1320 Bishop Randall Drive
Lander, WY 82520
307-335-6580
Fax 307-332-3548
EOE
8 Wyoming Nurse Reporter

Getting to Know Wyoming Nurses
Meet Michelle Mulberry
Patti Gardner
My name is Michelle Mulberry, RN, BSN.
I have been a nurse in Wyoming since 1999.
I decided to attend LCCC School of Nursing
after working as a paramedic for 5 years.
While going to nursing school, I worked
full time in the Emergency Department at
CRMC as an ER tech. I completed my LPN
in 1999. I continued to work full time as
an LPN in the ER while I finished school
and eventually graduated with my RN in
2000. I later went on to complete my BSN
through the University of Wyoming. I
worked in the Emergency Department at
CRMC in various nursing positions for
a total of 10 years prior to moving to the
Cheyenne VA Medical Center, where I
am currently the Mobile Telehealth Clinic
Coordinator. My role at the VA is to
facilitate providing primary care and mental
health to veterans in rural and highly rural
areas of Wyoming and Colorado. The clinic
travels to Sterling, Colorado, Wheatland,
Torrington, and Laramie, Wyoming and
conducts primary care and mental health
visits via Telehealth.
Working with our veterans is very near
and dear to my heart. I come from a very
military family. My father a retired Army
Colonel, my older sister, currently serving a
second tour in Iraq, is a Lieutenant Colonel,
and my younger sister is a Staff Sergeant
who, after completing a tour in Afghanistan,
completed her Law Degree in North Dakota,
and continues to serve in the North Dakota
Army National Guard. I am currently
a member of the Wyoming Air National
Guard and have been in the military for 21
years. I spent 10 years in the Army National
Guard both in North Dakota and Wyoming,
where I flew as a medic on Blackhawk
helicopters. Upon completion of my nursing
degree, I wanted to stay in the military and
stay flying, so I transferred to the Wyoming
Air National Guard in Sept of 2000, where
I began flying as a flight nurse on C-130s.
In 2004 I deployed to Al Udeid Air Base,
Qatar, where I flew Aeromedical Evacuation
(AE) missions in and around Iraq and
Kuwait. In 2007, I deployed to Bagram Air
Field, Afghanistan, where I again flew AE
missions in and around Afghanistan and on
occasion to Ramstein, Germany. In 2009 I
deployed to Andrews Air Force Base, MD,
flying AE missions up and down the coast,
returning the wounded to military bases as
close to their home station as possible. This
last year, I did my fourth deployment to
Ramstein Air Base, Germany, where I flew
into and out of Iraq, Kuwait, Afghanistan
and back to the United States. Between the
C-130, C-17 and KC-135, I have flown over
1000 hours, 468 of those are combat hours.
I am currently in an on-line Master’s
program for the military. I began the program
last year, and plan to have it completed by
April of 2012.
I am blessed with the most amazing family.
My husband Ron and I have been married
for almost 12 years. He is a Lieutenant
working for Cheyenne Fire and Rescue in
Cheyenne. I also have two wonderful step
children, Jessica, 19 and David, 16. They
have all been so supportive during all of my
deployments , school, etc. Ron and I live
on 11 acres NE of Cheyenne with our two
lab dogs, Libby and Oprah. A typical day at
the Mulberry’s starts at 0415, when Ron and
I get up and do an hour of P90X before we go
to work, and then we meet at the gym after
work for an hour of cardio. Fitness is very
important to both of us. With the jobs we
have we must be at the top of our fitness at
all times, so this is pretty much our routine
6 days a week. We are a very active family,
to say the least.
Being a nurse has offered me so many
opportunities in life I would not have
otherwise had. I always say being a flight
nurse in the military is the most rewarding
job I have ever had, and I truly mean that.
I have had the privilege of traveling all over
the world and meeting so many wonderful
people. Most importantly I have been
blessed and have had the honor of meeting
and transporting some true American hero’s,
our military men and women.
Wyoming Nurse Reporter 9

Returning to School: Is It Right for You?
Pamala D. Larsen
The kids need picked up from soccer
practice and ballet and you’re late, again. You
didn’t sleep that well during the morning and
then fell asleep hard around 1 p.m., making
you late for the soccer and ballet car pools.
Plus you need to be back at the hospital by
6:45 p.m. for your shift. Although you’d been
thinking about going back to school for your
BSN, on days like this, how in the world
could you ever fit it into your life? There
just isn’t enough time. It’s the start of a new
semester and a number of your colleagues
are taking classes. But you hesitate because
of the time commitment, family obligations,
work obligations, and for you, a primary issue
is….will my brain cells still work? Your brain
works fine at work, but writing a paper for
school, doing the readings, participating in
threaded discussions (whatever the heck
those are)?
The decision to go back to school is always
a tough one. You worry about the timing of
doing it now versus later. Will things just
fall into place and make sense? How much
financial support, if any, will I get from my
employer? And what could they possibly
teach me that I haven’t already learned from
my previous education and my experience?
Cullen and Asselin (2009) offer several
questions for prospective students to
consider. In addition, I’ve added my own
comments from various students I’ve talked
with over the years.
• Do you want to prepare for another
position in nursing? In your facility or
another one?
o Think hard…..what do you really want
to be when you ‘grow up’? Allow time to
think and daydream about ‘what if’?
• Do you need the degree for advancement
in your facility?
o Perhaps you need this degree for
certification in your area, or your facility is
on the Magnet journey and administration
is pushing everyone towards school?
• Do you like to study?
o Ok, perhaps that’s not a fair question, but
think about experiences on your unit. Do
you seek out learning opportunities? Are
you a staff member that is always looking
for the latest evidence on a clinical issue?
• How will you balance school, work and
your personal life?
o This is definitely the tricky part. Balance
is the key word. However, I think you
will find that you are more efficient with
your ‘time to study’ when you don’t have
much time. Many of your colleagues
have worked part-time or full-time while
pursuing a higher degree. Find that magic
time that is ‘all yours’ to study.
• Is the timing right for you to return to
school? Do you have support from family
and friends to return to school?
o This is a toughie that only you can answer.
Don’t expect the stars to be in alignment
and everything goes perfectly. That just
doesn’t happen. Most RN-BSN programs
encourage part-time study, and students
may take just 1 course/semester or even sit
out a semester when things are tough at
work and home.
• Will your peers at work be supportive?
o There are many working RNs that are
returning to school so I’m guessing that
finding a support group at work will
be relatively easy to do. However, be
prepared to field questions from some
peers such as…….who do you think you
are going back to school? They could be
jealous and want to do it as well. Do you
have the support of your unit’s manager/
head nurse//patient care coordinator, etc?
Are they willing to work with you and
your schedule? Are they willing to provide
some financial assistance?
(Cullen & Asselin, 2009, p. 33)
After making the decision to return to
school, determine the type of program that
is best for you. Obviously, I think UW’s
program is top-notch (if you’ve not been in
touch with the program within the last 3-4
years, give us a call. You will find that many
things have changed), but there are lots of
things to consider as you return to being a
student. The majority of RN-BSN programs
available across the country are on-line
programs. These programs are offered strictly
on the internet, and you don’t go to a campus
or classroom. On-line programs are great
for that reason, but the real issue is staying
focused to complete your work on-line and
making the time for it. On-line programs
aren’t any easier than face to face programs.
UW counsels students to plan on spending 3
hours a week for a 1 credit course, translating
into 9 hours a week for a standard 3 credit
hour course. However, the advantages of
working on the class when you have time
often outweighs the standard class times.
Students often ask the School of Nursing
to send information about our program. We
do not have standard written materials on
the program (or any of our programs). The
most up-to-date information is always on the
webpage (http://www.uwyo.edu/NURSING/
programs/RN-BSN%20Completion/index.
html) The School of Nursing has two fulltime
administrative staff that are always
available to answer questions for you as well
as any of our RN-BSN faculty (307-766-
3907 or email RN.BSN@uwyo.edu)
Finally, one of our current MS nurse
practitioner students, Corrie Carver, recently
posted a comment in one of her classes, and I
asked her permission to use it in this article.
Although she did not graduate from the
RN-BSN program at UW, she is a staunch
supporter of RN-BSN education. Corrie
writes, “Little did I know, that while in
the RN to BS program, I would learn how
to REALLY be a nurse. I was amazed at the
level of understanding I gained during that
extra year of instruction. I learned how to
better relate to and communicate with my
patients. Looking back I now realize that as
an ADN I understood the ‘physical’ aspect of
the profession, but it wasn’t until I became a
BSN that I started to understand the art and
‘mental’ side of the profession”.
If RN-BSN education is in your future,
please give us a call or email us at the Fay W.
Whitney School of Nursing at the University
of Wyoming. Good luck as you continue
your education!
Pamala D. Larsen, PhD, CRRN,
FNGNA
Associate Dean for Academic Affairs
Fay W. Whitney School of Nursing
University of Wyoming
Laramie, Wyoming
Source: Cullen, H.A., & Asselin, M.E.
(2009). Why go back for a baccalaureate
degree? American Nurse Today, 4(5),
33-34.
10 Wyoming Nurse Reporter

Fay W. Whitney
SCHOOL OF NURSING
On the Peak of Excellence!
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The Fay W. Whitney School of Nursing has an atmosphere
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Join an exciting and dynamic community where
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Fay W. Whitney School oF nurSing
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~ Dr. Mary E. Burman, Dean and Professor
· State-of-the-Art nursing school with Simulation
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· Offering three ways to obtain a baccalaureate
degree in nursing
· Offering two graduate degrees: Nurse Educator and
Nurse Practitioner (FNP or PMHNP)
· UW graduates are highly valued throughout Wyoming
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Accredited by the Commission on Collegiate
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Wyoming Nurse Reporter 11

Improving Patient Care
First CNA II Training Class Held in Gillette
The state’s first CNA II training class was
held January 17-21, 2011 at Campbell County
Memorial Hospital. Todd Berger, Practice and
Education Consultant, traveled to Gillette to
personally talk with the students and answer
questions about the program. Six CNAs
completed the one week training and then had
to verify competency in the hospital under the
supervision of other nursing staff.
This is the first CNA II program organized
after the approval of the changes to Chapter 7 of
the Certified Nursing Assistant Administrative
Rules and Regulations in July 2010. The CNA
II program allows CNAs who meet certain
requirements to take advanced training in specific
skills. These skills may include oxygen therapy,
sterile technique, wound care, oropharyngeal
suctioning, tracheostomy care for patients
with well established tracheostomies, urinary
catheter, PEG tubes, elimination procedures,
and responding to mental health needs. The
CNA II role was designed to improve patient
care by augmenting licensed nurses in providing
skilled care for STABLE patients. The goal of
Powell Valley Healthcare is a
facility
Powell
dedicated
Valley Healthcare
to improving
is a
facility
quality
dedicated
of life through
to improving
excellent
quality of
healthcare.
life through
We are
excellent
looking for
healthcare.
outstanding
team
We are
members
looking for
that
outstanding
want to
grow within our organization.
Powell Valley Healthcare is a
facility team dedicated members that to improving want to
quality of life through
Located
grow within
excellent
near
our
healthcare.
Yellowstone
organization.
Located near Yellowstone
We are looking for outstanding
team members that want to
grow by within our organization.
opportunity
mountains,
Located near
for
there
Yellowstone
outdoor
is ample
National recreation
opportunity
Park year
for
and around.
outdoor
surrounded
by recreation mountains, year there around. is ample
opportunity for outdoor
recreation year around.
National Park and surrounded
by
National
mountains,
Park
there
and surrounded
is ample
this new rule is to improve patient outcomes by
allowing designated CNAs to perform certain
routine nursing procedures, thereby freeing
the licensed nurse to focus on other aspects of
professional nursing care.
WSBN expects that with the success of
this training program we will be able to offer a
template to other facilities looking to provide
the training for CNA II advancement. Special
recognition goes to Susan Howard MSN, RN,
Clinical Education Supervisor at Campbell
County Memorial Hospital for her work
initiating the course and developing course
materials.
For more information on the CNA II
requirements and standards read Chapter 7,
sections 10-12 of the Rules and Regulations
found on WSBN website under information.
As information becomes available regarding
the pilot program of the CNA II course it will
be posted on the WSBN website. If you or
your facility are considering offering a CNA II
program, please contact Todd Berger at tberge@
wyo.gov for details.
Instructors and students of the first Wyoming
CNAII Class
Checking tube feeding
Practicing sterile technique
An experience with us includes:
•
An
Generous
experience
compensation
with
based
us
on
includes:
years of
•
experience
Generous compensation based on years of
• Career
experience
Ladder that recognizes achievements in
•
education,
Career Ladder
certification,
that recognizes
cross-training,
achievements
quality,
in
and
education,
mentorship
certification, cross-training, quality,
• Differential for evenings & nights
• Tuition Reimbursement
• Paid time off starting at 18 days
• Health insurance, including dental & vision
• Retirement plan
• Life & Disability insurance
• Extended Illness Plan
An experience with us includes:
• Generous
and mentorship
compensation based on years of
• experience Differential for evenings & nights
•
•
Career
Tuition
Ladder
Reimbursement
that recognizes achievements in
education, certification, cross-training, quality,
•
and
Paid
mentorship
time off starting at 18 days
• • Differential Health insurance, for evenings including & nights dental & vision
•
•
Tuition
Retirement
Reimbursement
plan
• Paid time off starting at 18 days
•
•
Health
Life &
insurance,
Disability insurance
including dental & vision
• • Retirement Extended plan Illness Plan
• Life & Disability insurance
• Extended Illness Plan
12 Wyoming Nurse Reporter

Inside Scoop
News, Requests, Updates
Board Staff Position
WSBN currently has a job opening for
the position of Compliance Consultant.
This full time position handles complaints
and investigations into disciplinary matters
for the board. Must have a minimum of
a Bachelor’s degree in nursing or closely
related field PLUS five years of professional
work experience as Registered Nurse (RN).
Must be licensed or eligible for licensure
as a Registered Nurse (RN) in the State of
Wyoming. For a full job description and
online application go to:http://statejobs.
state.wy.us/JobSearchDetail.aspx?ID=17886
Become a Nursing Leader
Interested in being involved in Board
Activities? Would you like to make your
thoughts known on a certain issue? Is there
a topic you want the board to consider? It is
easy to be involved with WSBN.
Are you aware of WSBN website listing
all board meetings?
Are you aware that all board meetings are
open to the public?
Would you attend a board meeting if it
was held near your home?
If you would be interested in more
information regarding these or any other
board matters please contact us at wynursing@
state.wy.us .
NCSBN Institute of Regulatory
Excellence
to developing administrative regulations and
supporting research that helps formulate
regulatory policy. WSBN has been involved
with the IRE for many years and Mary Beth
Stepans, the previous Education and Practice
Consultant, was a member of the IRE research
proposal review committee.
The Wyoming Nurse Reporter
wants you!
Are you doing something unique,
challenging, cutting-edge or newsworthy
in some way? Are you volunteering, did
you change your life, have you overcome
obstacles to get where you are? We want your
story! The Wyoming Nurse Reporter would
love to introduce you to nurses all over the
state! Email us about yourself or a colleague
@ WNREditor@aol.com. We want to hear
from you!
Getting to Know Wyoming Nursing
Students!
Wyoming State Board of
Nursing Updates
As we exit the renewal cycle, the licensing
department will be looking closely at all
processes. We are mapping out the tasks we
do on a daily basis to create efficiencies and
eliminate redundancies. We hope to improve
licensing time as we find ways to make the
licensing process more efficient.
Staff Member Spotlight
Maxine Hernandez has been with the
WSBN since May 2008. She works in the
licensing department and works primarily
with processing applications and issuing
new licenses. She has a great amount
of knowledge about the WSBN nursing
database and continues to streamline the
application process. Her expertise has
helped thousands of nurses and CNAs start
their careers.
Roseanne Colosimo, Nevada BON, Nancy
Spector NCSBN Director of Regulatory
Innovations, and Todd Berger, WSBN
Assistant Executive Director at the 2011
NCSBN Annual Institute of Regulatory
Excellence Conference in February. The IRE
focuses on evidence based practice as it applies
Know an up and coming Nursing Student
in Wyoming who deserves to be recognized?
Contact us at WNReditor@aol.com with
their name and contact information and
we’ll profile them in an upcoming issue of the
Wyoming Nurse Reporter. An easy way to
recognize excellence!
Debra Ball started working with the
WSBN in 2006. She previously served as
a Licensing Coordinator and has been the
WSBN Discipline Assistant since April,
2008. She assists the Compliance Consultants
with complaint investigations; investigating
applications with “yes” answers to the history
questions and she forwards applications
needing further review to the Application
Review Committee.
Wyoming Nurse Reporter 13

Getting to Know Wyoming Nurses
Meet Mariusz Pieczalski
Patti Gardner
My name is Mariusz
Pieczalski, I was born in
Poland and lived there for
the first 27 years of my life.
As many young people in
a communist country do, I
dreamed of living in a free
and democratic country,
with a lot of opportunities. I
graduated from nursing school
with a diploma in Nursing in
1982 and my destiny brought
me initially to Italy, where I
spent 3 years. I learned a new
language and began to pursue
my career in nursing. This
was my first time taking care
of elderly patients in various
While working with the elderly population I have
grown a lot professionally and personally. Their
gratitude and appreciation fueled my desire to work
and help patients and their families to heal and/or
deal with end of life issues.
settings; from hospitals to private homes. I surprised myself as I
found a lot of satisfaction working with this patient population in
a completely different culture from my own. Dealing with chronic
diseases and end of life issues helped me to gain a new prospective
on nursing and to develop a more multicultural approach to the
patient’s I cared for.
I had an opportunity to immigrate to South Africa, Canada or
Australia and eventually I decided to travel to Canada, to look at
nursing in a new way and maybe to even look at a different nursing
practice. I had to learn English and complete a Total Upgrading
Nursing Program to update my credentials and to be eligible to take
a Canadian Licensing Board Examination. I learned the language
and passed the exam with no difficulties and started my career in
the Canadian health care system. I worked in a Nursing home
mostly with an elderly Asian population. I gained another view
on practicing nursing and another exposure to yet another culture,
their approach to illness, healing and the rehabilitation process.
My wife was a physician and wanted to go to the United States
to pursue her professional career and I have followed her. It had
been a tough time for both of us; for me trying to prepare for the
CGFNS (Commission on Graduate of Foreign Nursing School--an
exam foreign nurses have to take in order to practice in the US)
exam with a 6month old son and for my wife who had to spend the
majority of her time in the hospital during residency. I have to
admit that was a most difficult exam to pass, however, I overcame
that obstacle as well.
With many opportunities in front of me, I decided to pursue my
professional career as a nurse at Acute Care for Elderly at University
of Texas in Galveston. This was a highly specialized unit with a team
of Geriatricians and board certified Geriatric Nurses with a widely
recognized Geriatric residency program that had a model approach
on Holistic Elderly Care. I joined the team and gained a lot of new
knowledge and experience and after some time there, I decided to
take the board certification exam in geriatric nursing..
While working with the elderly population I have grown a lot
professionally and personally. Their gratitude and appreciation
fueled my desire to work and help patients and their families to heal
and/or deal with end of life issues. Understanding health issues in the
geriatric population is a key issue in prevention as well as treatment
of many medical conditions . Polypharmacy and multiple chronic
illnesses often make diagnosis and treatment a very challenging
task. I am happy I can share my knowledge and experience with my
colleagues, patients and families to improve their health and lives.
Mariusz currently works as a charge nurse on the Transitional
Care Unit at Cheyenne Regional Medical Center at TCU Unit. He
is board certified in Geriatric Nursing.
14 Wyoming Nurse Reporter

LICENSE
TROUBLE?
SUSPENSION?
SEEKING
REINSTATEMENT?
Have you received a letter for
suspension or discipline? You worked
hard for your license so don’t make an
uninformed decision about the future
of your career. Remember you have
options and we can help.
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For training dates and locations, and for quick and easy online registration, simply visit
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To us,
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EOE
© 2011 NAS
(Media: delete copyright notice)
Wyoming State Board of Nursing
Wyoming Nurse Reporter 15

P Q R S T
(Practice Questions Requiring Substantial Thought)
Q & a
Q I am a new nurse working in Wyoming and
am wondering what the NPA (nurse practice
act) states regarding RNs and abnormal result
notifications (labs, rads, pathology).
A Your facility would have their own policy
regarding reporting of critical results. It is a
JCAHO requirement to address this issue.
WSBN regulates nursing practice, not facility
policy. As an RN you would be held accountable
for recognizing abnormal lab values, the effect
they would have on your patient, and taking
appropriate action for the patient’s care.
Q I am taking courses to get into the nursing
program in Casper. I am taking Medical
Terminology and Microbiology this fall. I was
wondering if they count as hours for CNA
continuing education?
A The prerequisite courses you list are not
integral to CNA practice and would not count
(also they would be in 2010 and the next 2
year renewal period starts in Jan 2011). If you
start a nursing program in the next 2 years one
of the first semester courses will be devoted to
basic patient care. That is generally accepted
as qualifying for education hours toward CNA
renewal. Academic semester credit hours equal
15 contact hours each and most of these courses
are 2-3 credit hours so you would be covered if
you get into a nursing program.
Q I am wondering if there has already been a
position statement written regarding trained
RN’s providing conservative sharp debridement
in the state of Wyoming.
If not, would the next step be to complete a
decision tree outline and submit it to Wyoming
State board of Nursing? I am developing a
policy for the facility that I work at to cover
me in doing SD.
A Nurses can become certified in wound care
and have greater authority to accept delegation of
certain tasks. Certification courses often include
debridement as part of their overall curricula.
Nurses should look for courses accredited by
the Wound Ostomy and Continence Nursing
Certification Board. My question for you is
did your Wound certification prepare you to do
debridement and are you competent to provide
this service? Does your facility allow you to
provide this service? Will you be providing this
service under a Doctor’s order or are you making
the wound management decisions as part of
your job? Although many previous opinions
have been eliminated in favor of utilizing the
Decision tree model to determine scope issues,
there is a WSBN opinion from 1997 (97-77)
that said in effect “that sharps debridement may
be considered a delegated function from the
surgeon to the registered nurse. Any registered
nurse accepting such delegation will need to be
appropriately educationally and experientially
prepared for this procedure and any such
delegation should be case specific, client specific,
and nurse specific.”
To determine your personal scope of practice
I refer you to the Decision Tree Model found
on our website under opinions. Work through
it and if you have questions you may submit it
to the board for an opinion. You might also
consider the acronym LACEE in your policy
statement; licensure / accreditation / certification
/ education / experience. This is a concept under
consideration in conjunction to the Decision
Tree Model. Each of these can provide weight
to the decision and ability to shape practice in a
specific area.
Q If someone suffering from a chronic pain
condition is taking a long term narcotic
prescription, will she be able to still receive a
CNA license through the state of Wyoming?
A Thanks for contacting the WSBN. First off,
let me correct one thing. The term narcotic
is often misused. Narcotic is not a class of
medication. It is a legal and law enforcement
term referring to many illegal substances and
has tremendous negative connotations. You
don’t get prescriptions for illegal medication.
The preferred term is opioids which are legal
controlled substances.
Now to answer your question: Does it impair
her ability to do her job or does it allow her to
function at the best of her ability? Opioids,
diabetic medications, seizure medications, antianxiety
medications, muscle relaxants, etc. and
the chronic medical conditions that require their
use all have the capability to impact a person’s
job performance. Their misuse or abuse can
have serious consequences related to licensure
or certification. A CNA applicant is asked to
reveal if they are taking any controlled substances
either by prescription or not. Each application
is reviewed individually. Simply taking a
controlled substance for a chronic condition is
not an automatic barrier to certification.
Q I need to know if a LPN who has an
“Advanced IV Certification” can change
dressings, access, and administer pre mixed/
labeled IV Medications for a central line.....a
groshong cath.
A While an IV certified LPN may administer
certain medications via a peripheral line Chapter
3,Section 3 (c)(iv) states:
(C) Assist the registered professional nurse in
16 Wyoming Nurse Reporter

the administration of midline or central venous
infusion of approved IV fluids by:
(I) Checking the flow rate;
(II) Maintaining patency by use of saline/heparin
flush;
(III) Changing the tubing(s) and site
dressing(s);
(IV) Administering TPN; and
(V) Obtaining a blood sample.
This would indicate that the central line IV
medication is not started by an LPN but may
be monitored by the LPN to assist the RN in
delivering the medication. If it were otherwise
it would state that an LPN may administer IV
medications via a central line. It does not say
that and allows an LPN to access Central lines
only to flush or obtain blood. They may change
central line dressings but administering premixed
IV medications is reserved for peripheral
lines. TPN is the only fluid identified for Central
line administration. I hope that helps with your
interpretation.
Q I am an RN working in LTC. I am looking
for information on caring for persons with
MRSA. Specifically, I want to know if once a
person has been treated for an active infection
what are the guidelines for safe contact. I
am concerned about keeping other residents
protected as well as the issue of continued
isolation for the resident with MRSA. The
information presented to our staff was that
once treated there is no longer an issue. Can
you answer this question or direct me to the
most current literature on the subject? Thank
you in advance,
A As a nurse, you need to be aware of evidence
based practice and the means to obtain such
evidence. You are responsible for seeking
knowledge to expand your practice and the
information base you provide your patients. A
one minute google search of “MRSA carrier
contagious” turned up a wealth of information.
This brief search found a PDF brochure prepared
by the Washington Board of Health called
Living with MRSA which provides answers to
your questions and many others you might have.
Your own search may turn up more information
you could share with everyone at your facility.
Your risk management or infection control
departments should have policies in place to
address this issue as well. I don’t agree that once
treated there is no longer an issue because many
people remain carriers for life although personally
exhibiting no symptoms. Some hospitals have
initiated standard nares swabbing on admission
to identify such carriers and initiate appropriate
transmission precautions. Find your evidence
based research and initiate a best practice
program. Let me know how it works out.
Q I have a question about a CNA splitting
her time at a clinic between a CNA and a
phlebotomist. I also would like some guidance
on what requirements a phlebotomist has for
Wyoming. A local phlebotomist stated that
there is no requirement for Wyoming but
I would rather be correct than to create a
problem
A Phlebotomy technicians are not licensed or
certified by any board authority that I am aware
of. They pass a skills training and are allowed
to practice under the policies determined by the
facility. A CNA may have phlebotomy training
but it would be outside their scope to perform such
acts when representing themselves as a CNA. It
can become very complicated to work with two
job titles and if the person were working as a
CNA could they refuse a request to draw blood
during that shift (or would they refuse). There is
a distinction to be drawn between being a CNA
and being a medical assistant or technician. A
CNA must work under the direction of an RN
and an RN would not delegate that to a CNA.
I hope that clarifies the issue.
Q I have had several questions from our
staff who are enrolled at UW in the nurse
practitioner program about whether an APRN
can practice as RN? Are they held to the
higher license? They’ve been getting conflict
messages from their professors.
A I am glad to try to provide some insight into
your question. As you may know, in Wyoming,
APRNs have an RN license with APRN
recognition. Therefore, an APRN is an RN
and will always have an RN license. The only
confusion that may arise from an APRN being
employed as an RN is one of accountability. An
APRN, despite their job title, may be held to a
greater expectation than an RN because of their
advanced training.
Hypothetically, consider a Certified Nurse
Midwife working as an RN on a labor & delivery
floor. A mother goes into labor. The doctor is
called but can’t be reached. The mother begins
progressing rapidly and the baby begins showing
signs of distress but there is still no doctor. The
CNM cannot claim to be only working as an
RN and not utilize her advanced knowledge and
training in protecting the safety of mother and
child.
Secondly is the issue of insurance. It may be
questionable whether a carrier would allow an
APRN to work below their scope or whether
they would be covered in the event of a claim
if they did not act to the full extent of their
license.
And third is the legal aspect. Many a jury
would look at the CNM and fully expect that
person to step in and perform because of their
training no matter what the regulation, facility
policy, or job title may say. Legal Eagle Eye (a
newsletter) often has examples of juries finding
that a nurse was expected to know something or
do something simply because of their education.
So, can an APRN work as an RN... absolutely,
they are licensed as an RN. Should they accept
employment as an RN is really the question and
the answer to that is full of variables. Personally,
after achieving my APRN I wouldn’t want to
accept anything less.
Q Can an RN place an external jugular vein
IV catheter with the proper training? Can an
RN place a chest decompression needle in the
case of pneumothorax?
A Every nurse has skills and abilities that range
from novice to expert on a variety of tasks. A
veteran nurse may be a novice in an area outside
their expertise. Please direct each nurse to the
Decision Tree model as found on our website
under opinions. WSBN does not issue scope
of practice decisions individually and prefers for
each nurse to study the algorithm to determine if
they are capable, competent and willing to take
responsibility for their actions. The answers to
your questions may also be found in your facility
policy which may be more restrictive than what
would be allowed by scope.
Questions you could ask yourself: Generally,
needle decompression would be a procedure
only initiated in an emergency where failure to
perform it could be fatal. In the ER there should
be someone trained in this procedure. With
proper training and continued competency
nurses do many invasive procedures. What
is the alternative to the RN not doing NDC?
Why do your RNs want to access an External
Jugular? Although it is considered peripheral
IV access, there are specific risks involved and
they are difficult to secure. Intraosseous infusion
is one of the quickest ways to establish access
for the rapid infusion of fluids, drugs and blood
products in emergency situations. Training in
these techniques may be more beneficial. If time
is not critical, a central line or PICC might be
an alternative providing more access ports and
greater infusion capacity than an EJ.
Q I am an RN in Wyoming. Because I work
in a rural area and in an industrial setting with
Continued on page 18
Wyoming Nurse Reporter 17

an ambulance transportation time of at least 45
minutes to the nearest hospital, I am looking
into improving my pre-hospital knowledge
and skills by taking a RN to Paramedic Bridge
Program. Are there any programs that are
recognized by the State of Wyoming? I am
specifically looking for programs that can be
mainly done on line with in class clinical, as I
work full time.
A It is a very intelligent decision to evaluate
your setting and look for ways to enhance your
training to fit the needs of your area. WSBN does
not evaluate RN to Paramedic programs because
they are not nursing based. Although they
have additional training and skills, paramedics
are considered unlicensed medical personnel
and certifying as such can create nightmares for
your scope of practice. Have you considered the
FCCS (Fundamental Critical Care Support)
classes or studying for and obtaining your CCRN
certification? FCCS classes are 2 day programs
designed for the stabilization and transport of
Critical patients in the first 24 hours and the
CCRN can be self studied and then test for
certification. These both give you advanced
insight and skills related to critical care treatment
and are designed for nurses. You probably want
to complement your RN license rather than
train for an unlicensed position. Talk to your
employer about supporting you in expanding
your skills. Perhaps they will send you to a
conference where you can obtain skills and take
preparation classes. Good Luck,
Q I work in an office where we do surgeries.
The Doctor would like the RN and LPN to do
the Pre-ops for Surgeries. Should we be doing
this? Also he would like us to numb areas
with 1% Xylocaine with Epi, prior to excision
of moles or lesions. Should we be doing this
as well?
A I am not sure what specifically you mean by
pre-ops. If your doctor is asking you to fill out
a form prior to surgery, you probably have the
skill to do so. However, if you are referring to
obtaining a History and Physical (H&P) and a
pre-op physical, that is a process taught in graduate
school to advanced practice nurses. Performing
a full H&P assessment requires graduate training
and is one of the defining features of an APRN
education. A nursing assessment is not designed
to take into consideration the factors required
to evaluate a patient for surgery. The H&P is
an evaluative process and therefore completely
outside the scope of an LPN whose scope is
defined by the collection of data. It could be
asked of you to do it, but as an RN you would
not want to take responsibility for missing
a medication incompatibility, an allergy, a
comorbid condition, or a physical inconsistency
that would put a person at risk in surgery. In the
end I do not believe the H&P is delegatable to
an RN.
Regarding giving sub-q injections, if you
have been given the training to competently
perform these tasks in the office setting it would
be in both your scopes to do this with a doctor’s
order. Providing injectable medication is taught
as a basic nursing skill and prepping an area for
excision would be a skill set you could acquire.
Please check the Decision tree model for advice
on how to evaluate your individual scope of
practice.
Q I’m a CNA and I work for two companies
in Rock Springs. I had a Med training class for
Nowcap and I read the state regulations for
CNA’s when assisting with meds. I was told by
a student nurse that CNA’s cannot assist with
meds. Is this true?
A Thank you for contacting the board of
nursing. What you were told is partially correct.
A CNA cannot administer medications but
Chapt.7, Section 7 (ii)(K) allows for “assisting
with the self-administration of medication” and
then defines the very limited scope of what that
includes. What you may have read is the inclusion
in Chapter 7 (Certified Nursing Assistants) of an
advanced level of nursing assistant, CNA II, who
is given additional training to provide a select set
of nursing skills primarily in a long term care or
nursing home environment. This was approved
in July of 2010. In addition to the CNA II is the
Medication Assistant certified (MA-C) which
requires 100 hours of instruction beyond the
CNA II. Although these levels of CNA are in
the regulations there currently are no programs
developed to train them at the present time and
no one is registered in the state in that capacity..
WSBN is working with several facilities to
approve these new courses and we hope to have
them more available later in the year.
Regarding your Med training with NOWCAP,
as a CNA you must verify that you are following
the scope of practice as defined in the Rules &
Regulations, Chapter 7. If you have questions,
your NOWCAP director should be able to
clarify the rules as they apply to this assistance
program.
Q I want to know if with the trouble I go
through for my CNA recertification every two
years if it would be worth my time and money
to go to college to be a LPN or RN? PLEASE
RESPOND
A If you feel that submitting a log of 24 in-services
every 2 years to renew a CNA certification is a
lot of trouble then perhaps going on to become a
nurse would not be worth it for you. Becoming a
nurse means a lifelong commitment to continuing
education and keeping your skills sharp. It means
a commitment to evidence based practice which
can only be developed by staying current with
latest knowledge and trends. It means hundreds
of hours of studying and classroom lectures. It
means accepting responsibility not only for
your actions, but for the actions of others. It
means long and stressful hours. And it means
developing the ability to reflect on your practice
and see where you need to improve and take
steps to achieve improvement.
Of course becoming a nurse also means having a
profession, not just a job. It means having a career
that is open ended with possibilities. It means
being able to travel and work almost anywhere
in the world. It means being a member of one of
the most respected groups in the nation. It means
helping others and having the opportunity to see
miracles happen. And it means that you have
made a wise choice. Money and time spent on
education is never wasted. Good luck on your
decision,
Q I am working with some of our physicians
trying to determine what would be the best rate
to run the IV solution with PCA infusions.
Currently, we use a TKO (to keep open) rate.
However, there has been much discussion
regarding if this rate allows the medication to be
effectively administered to the patient. We are
trying to decide if there should be a set rate for
all patients, or if the prescriber should choose
a rate based on the patient’s comorbidities.
How do you decide what the TKO rate is?
What rate do you run the IV solution in the
line infusing the PCA?
A Keep in mind that the Y-PCA tubing is
designed with an anti-backflow valve to have
a carrier solution. These safety devices prevent
opioid solutions from backing up into the
tubing if the patient access is blocked and then
inadvertently delivering a large bolus dose if the
obstruction clears. The carrier solution prevents
single doses from sitting in the line undelivered to
the patient. A direct line to the patient without
a carrier solution, if clotted, would prevent any
medication from reaching the patient. Also, the
carrier solution should be on pump, rather than
gravity feed, to alarm when the flow is obstructed
and prevent the accumulation of a bolus dose.
The rate should be consistent with the
volume of the extension set or tubing volume
between the PCA and the patient. If there is a
18 Wyoming Nurse Reporter

10ml tubing volume between the PCA and the
patient and the TKO (to keep open) is 20ml/
hr it would take 30 minutes for a PCA dose to
reach the patient. (These numbers are just for
example but do point out why it is discouraged
to use extension sets with PCA tubing).
TKO rates can also be based on the fluid
needs of the patient or the provider’s orders.
Q2 I agree with your analysis for the valve
and the TKO; could you provide me with the
evidence? Is the evidence from the company?
A2 Evidence generally flows from research
involving experimentation and testing.
What was stated is critical thinking. It is an
examination of the physical principles involved
and how they will impact the patient. You could
say the evidence is physics. There generally is no
argument in how to set up a PCA line.....connect
as close to the patient as possible, carrier solution
piggybacked above the backflow valve into the
y port of the PCA tubing. The only pushback I
have seen is when the patient is fluid overloaded
and the physician does not want any extra fluid
administered. At that point it becomes a safety
issue to maintain KVO (keep vein open) carrier
solution (maybe as little as 10cc ... but still on a
pump) vs. the danger of a opioid bolus impacting
respirations. It doesn’t need to be a clot to
obstruct the line. A positional IV or simply
laying or twisting the tubing can store up extra
doses in the line. That is why I always advocate
for an infusion pump with the carrier solution.
Sometimes it takes a sentinel event for some to
see the danger of not running a carrier line. A
bag of normal saline is much cheaper.
Q Just wondering if LPNs can triage in the
emergency department.
A Before answering I need to know what you
mean by triage. If you mean assessing and
evaluating a patient’s condition and need for
treatment then the answer is no.
Rules and Regulations Chapter 3, Section 3.
Standards of Nursing Practice for the Licensed
Practical Nurse says “The licensed practical
nurse shall:
(A) Contribute to the nursing assessment by:
(I) Collecting, reporting, and recording
objective and subjective data in an accurate
and timely manner. Data collection includes
observations about the condition or change in
condition of the client.
The LPN scope does not allow for assessment
and evaluation but does allow the LPN to gather
information to assist the RN in making the
evaluation and assessment.
If you can find a role for the LPN in ED triage
that meets that scope, then all right. Otherwise
the LPN should recognize the limitations of their
practice and inform you if the job requirements
exceed their scope.
For further information on determining
scope of practice please refer to the Decision
Tree located on our website under opinions.
The Decision Tree algorithm is designed to help
nurses determine scope of practice issues.
Q I am a psychiatric CNS, certified in adult
psychiatry. My question is at what age does the
WSBN consider it within my scope of practice
to begin treating. I get different answers from
the UW School of Nursing and what I had
been told verbally by a person at WSBN. Also
if a child or adolescent has been evaluated by a
physician or a Pediatric Psychiatric APN can
I then follow them. I would like something
in writing from the state board so that I am
clear. In the center of WY there is a paucity
of accessible psychiatric care for children and
adolescents. There is one psychiatrist in the
area who sees children and it takes at least 2
months for people to get in to see her. The
other two will not see children one until 13
and the other until 16. When UW graduates
this class in 2012 it will help, but until then
it is a problem. Thanks for considering this
issue.
A I have been presented with this question
before and I am glad to provide you an in-depth
answer.
First off -ANCC adult psychiatric mental
health nurse practitioner (PMHNP) certification
starts at 13 years of age on up through geriatrics.
I consulted with someone who has done both
programs and they do not believe that an adult
trained PMHNP is educated on how to manage
child psychiatric disorders. After the adult
program, this person completed an additional
500 hours to certify Family/Child Psych NP.
A child psych practitioner must consider the
presenting symptoms and then put the symptoms
into the context of child development normals
versus abnormals. This is not part of an adult
PMHNP program. Consider a 4 year old with
multiple foster care, fetal alcohol syndrome,
mental retardation, sexual acting out issues --
see how this does not fit into the scope of an
adult PMHNP? Childhood onset disorders in
the DSM would rarely be studied by and adult
PMHNP.
The way a child versus teen versus adult
presents with bipolar disorder differs. Many
many of the meds used for pediatric populations
are technically off label and that is not the case
for adult patients for the most part. There is a
learning curve to prescribing this way especially
since the lawsuit risk is greater with children
because of the lifelong responsibility for the
damages caused at an early age.
Family therapy and family systems therapy
are not part of an adult program. School
special education systems to include school
IEP (individual educational plans) are not in
adult programs. Adult programs do not cover
the national EBP and national guidelines on
pediatric psychiatry that a family PMHNP
program teaches.
The idea that an adult PMHNP could
take on a child that has been seen by a child
psych person does not take into account the
fact that children need much more titration
of medications than adult patients do so one
visit with a child psychiatrist would hardly be
adequate for effective care. Plus once you get it
just right, the child grows and you have to then
readjust once again.
There are Child/Pediatric PMHNPs available
and parents will drive considerable distances to
get the right care. A shortage of surgeons does
not indicate that internists need to take on liver
transplants. Just because there’s a shortage of
child psych practitioners doesn’t mean people
who aren’t qualified can start seeing populations
they haven’t been educationally prepared for.
In the end, the WSBN takes the stance
that Nurses determine their own scope by the
licensure, accreditation, certification, education,
and experience they possess. That is why we
adopted the decision tree model for determining
scope of practice. Located on our website under
information/opinions, it is an algorithm that will
help determine if you feel you have the training,
skill, ability, and are ready to accept responsibility
for your actions.
I hope that helps you in your deliberations.
Q I am a hospice RN and I am wondering if it
is standard practice to teach competent family
members to administer class II medications to
their terminally ill family member in the home
setting. This would include both PO and SC
morphine.
A Thank you so much for bringing this question
to the WSBN. Family members are exempt
from the requirements of nursing licensure. The
Nurse Practice Act specifies:
33-21-154. Exemptions.
(a) No provisions in this act ...prohibit:
(iii) The incidental health care by members of
the family and friends;
Consider, what would be the alternative?
Continued on page 20
Wyoming Nurse Reporter 19

That the family member endure the pain of a
terminal illness? Patients have a right to have
their pain managed in an appropriate manner. If
you determine that family assistance is necessary
for proper management then they should be
educated and utilized. I also believe you use
the correct terminology by saying “competent
family member” as this is an important aspect of
proper delegation. I wouldn’t turn the task over
to someone I felt might be a diversion or abuse
risk because, not only would you enable their
problem, but your patient might not receive the
necessary medication and suffer needlessly.
The real elephant in the room for this question
is what happens if the family gives a large dose
of medication and the patient expires? For
additional thoughts on the subject of providing
high dose opioids to terminally ill patients search
for articles on the Rule of Double Effect. It poses
interesting ethical questions that all Hospice and
Palliative Care nurses should be aware of.
Faith Community Nursing
Laura Mallett
What is Faith Community Nursing (FCN) (Parish Nursing)? Until
recently I was not sure either. At present I am learning about FCN through
the Wyoming Health Council and Cheyenne Regional Medical Center,
and the FCN’s in Wyoming. I started the basic training in January and
will attend classes or be online until April. I’m excited about starting this
aspect of nursing in my congregation after I have completed the course.
Laura Mallett, MSN, RN
A little background on FCN; it was
founded by Dr. Westberg, a Lutheran
minister, who had the idea of locating
clinics in church with physicians, nurses
and clergy, all working together to provide
holistic care to the members of the church.
This project connected nurses with hospitals
and churches in providing preventative care
to the congregation and the community
over the years. Research that has been done
revealed that preventative care reduced
hospital admissions, leaving hospital beds for
the very ill people that needed them.
As nurses we were taught in school to
address the mind, body and spirit of the
client and their families. With time restraints
over the years and the illnesses being more
complicated than in years past, we do not
always met the spiritual needs of the client
or their families in the institutional setting.
There is a need to make sure that we are
addressing the spiritual needs of clients and
their families to begin the healing process.
The FCN is that link for nursing practice;
the link to providing both spiritual and
preventative care at the community level.
In preparation of developing a practice in
FCN, I have started putting a bulletin insert
in the church bulletin on Sundays that deals
with preventative health care. I’m a member
of the Community of Christ Health Ministries
Association through the church that I
attend. After I finish the basic training, I will
develop a program with my Pastor to move
forward in the congregation and surrounding
community over time. I don’t know exactly
what my practice will look like within the
congregation yet, or what their needs are, but
working with them and the Pastor, I hope
to develop a relationship so that I can be a
resource person and educator for the church.
I can also use what I learn in my job at the
University of Wyoming to better prepare
nurses in assessing their clients spiritual
needs while they are students, emphasizing
the importance of mind, body, and spirit in
healing.
FCN is another way nursing can make a
positive impact on the health of Wyoming
citizens. It consists of working with resources
we have and developing a team approach
to make the citizens of Wyoming healthy
and make an impact in lowering the overall
health care cost without compromising
quality of care.
I would like to close this and address
the many nurses who feel their career in
nursing is a calling from God. I was called
to the profession of nursing several years
back. I really didn’t figure I would be called
to other aspects of nursing. I was also called
to teaching future nurses and treat every
aspect of my career as a blessing from God.
I have always felt that it is privilege to have
the ability and knowledge to care for God’s
children. I think this writing from James N.
Spurgeon says so much about the FCN:
Job or Ministry?
A job is at your choice.
A ministry is at Christ’s call.
In a job you are expected to receive
In a ministry you are expected to give.
In a job you give something for a return.
In a ministry you return something that
has already been received.
A job depends on your abilities;
A ministry depends on your availability
to God.
A job done well brings you praise,
A ministry done well brings honor to
Christ.
Laura Mallett, MSN, RN is Assistant
Lecturer at the Fay W. Whitney School of
Nursing at the University of Wyoming.
For more information about Faith Community
Nursing, please contact
Amanda Hubbard
Project Assistant
Faith Community & Parish Nursing Program
Wyoming Health Council
307.632.3640 Tel
www.wyhc.org
20 Wyoming Nurse Reporter

Customer Service Corner
With our first on-line renewal season over, we are getting back into
the swing of everyday work at the WSBN. Our licensing department
took over 3500 phone calls and assisted over 300 walk in customers
from the period of October 1, 2010 through December 31, 2010.
We are very pleased to say that over 90% of all license renewals
were processed on-line allowing for instantaneous licensure for many.
We look forward to using your input to improve the process for
2012.
Thank you to you and your employers for assisting us in our success
with paperless licensing! We continue to improve our processes in
order to ensure that all receive the information they need to be
successful.
Please feel free to contact Amanda Roberts at arober@wyo.gov for
your suggestions and feedback on customer service from WSBN.
“Completely unexpected” was the response to the flowers and
card received a few days before this issue went to print. Amanda
had taken a request from a VA Hospital to specify our website license
verification as primary source. After Board approval Amanda worked
with our programmer to get it online. “We always try to keep the web
Amanda Roberts, WSBN Executive Assistant
current, so it was quite a surprise when the flowers and heartfelt note
arrived. It really is nice to know people appreciate what you do. “
Patti Gardner
Getting to Know Wyoming Nursing Students
Meet Lilian Ogana
My name is Lilian Ogana and I am originally
from Kenya. I am currently enrolled as a full
time senior student in the nursing program
at the Fay W. Whitney School of Nursing
at the University of Wyoming. My husband
and I came to the United States in the fall
of 2003 after living in the United Kingdom
for a year. While my husband was pursuing
his education, I stayed home and offered
voluntary services from 2004 at the Nursing
and Spring Wind Assisted Living Homes
in Laramie. I perfected my communication
skills at these residences using my singing
talent to comfort and inspire the residents.
In addition, these services made me connect
not only with the residents but also with the
greater Laramie community.
In 2007, I started taking classes at Laramie
County Community College (LCCC), Albany
Campus, to pursue a nursing degree. It was
my hope that I could positively contribute
to humanity and society by helping and
supporting people who have health concerns
or different disabilities. Having been born
and raised in Kenya, I have seen fatalities
that would have otherwise been prevented
with proper health provision and care. This
has motivated and inspired me to pursue a
nursing career instead of other careers so that
I can get the expertise and experience that is
needed to promote better health services in
my country and the rest of the world.
While at LCCC, I was involved with
the international students’ body and did
advertisements for the college on television,
radio, newspaper, and school catalogs. After
finishing my prerequisites from LCCC, I
transferred to the University of Wyoming
and got accepted into the BSN nursing
program. My school journey has been rough
but through thick and thin I have persisted
despite the financial and health problems I
have incurred. I am grateful to my husband,
family, and friends for the support they have
given me. In addition, I thank the faculty,
staff, and all the donors for continued
support.
I am currently doing my senior residency
at McKee Hospital in Loveland, Colorado
and will finish the second half of residency
in Florida. I plan to graduate in the spring
of 2011. After completion of my education,
I will seek for employment in Florida where
my husband and I are planning to relocate to
gain experience and strengthen my career.
My ultimate goal is to use my degree to
help prevent and eradicate the spread of
diseases such as AIDS, tuberculosis, malaria,
and cholera that are currently annihilating
countries in the sub-Saharan region including
Kenya.
Wyoming Nurse Reporter 21

Patti Gardner
Getting to Know Wyoming Nursing Students
Meet Mallory Davis
Mallory Davis (left) and Friend
During the last four years, while I have
been in nursing school, I have found that I
had a great deal of time to think; not only
about which textbook would I over-highlight
next or what organizational meeting I might
attempt to make, but also about what career
plan I would choose to pursue once I earned
my degree. Of course many options have
come to my mind; public health in Wyoming
working with HIV/AIDS patients, an ICU
position on a Burn Unit in Colorado or Utah,
or specializing in the geriatrics field.
In order narrow down these possible
professional choices, I had to examine my past
and present interests within the academic
Legislative Review
WSBN is involved in all aspects of
nursing and nursing regulation. That
includes taking an active role in formulating
state policy and the legislative process that
relates to nursing practice or activities that
impact our licensees. This year, WSBN has
been working with two of our legislators,
Senator Leslie Nutting from Laramie County
and Representative Noreen Kasperik from
Campbell County, to advance bills favorable
to nursing regulation. Both Registered Nurses
in their own regard, Representative Kasperik
was the Interim Director of Gillette College
Nursing Program while Senator Nutting is
an Advanced Practice Nurse retired from
the Veterans Administration. WSBN is
fortunate to have such knowledgeable and
supportive legislators to advance our issues.
This year saw numerous bills submitted to
the legislature dealing with terminology used
to describe a Doctor of Nursing Practice,
field and to take under consideration my
extracurricular interests as well. During my
freshman and Sophomore years, I developed
a passion for public health nursing while
participating in an organization called
Face AIDS. As student members, we
raised awareness AND money for smaller
communities in Africa that were victims of
the growing HIV/AIDS epidemic. During
my experience with this group of people, I
became acquainted with professionals who
worked specifically with people in Wyoming
who suffered from AIDS.
Shortly thereafter, I began working
as a CNA during summer and winter breaks
on the Burn ICU at the University of
Colorado Hospital and my drive to work in
a critical care area grew. The intensity of the
unit as well as the overwhelming knowledge
the ICU nurses possessed was impressive and I
felt myself drawn to it. I wanted to be familiar
and comfortable in this critical care area so
that I could have input with residents and
surgeons about what I felt was the patient’s
best plan of care. In particular, I found that
I loved taking care of burn patients, and as
only two accredited burn centers were in my
granting APRNs admitting authority to
hospitals, recovery of fees by WSBN for
disciplinary costs, making it an offense
to violate a board order, and a change to
the student exemption allowing clinical
privileges for someone pursuing post licensure
education. Of special interest to WSBN are
surrounding vicinity, I would either have to
move to Colorado or Utah to chase such an
ambition. My interest in becoming a critical
care nurse has not completely evaporated,
but has been momentarily replaced by a
third, and final career interest: geriatrics.
During my first year of nursing school, we
were required to complete a geriatrics course
as well as help at local assisted living facilities.
The class census overall was not in favor of
this particular course as most students were
more drawn toward pediatrics or obstetrics. I
found that I enjoyed this course after growing
up with a mother who was a nurse that
cherished the older community and became a
hospice nurse. I found that as that particular
semester passed, I had found my niche within
the senior citizen community, always looking
forward to working with older clients.
In the end, despite my changing interests
and involvement in a wide array of nursing
specialties, I feel most drawn to care for the
Baby Boomers of the generations before
myself. The beautiful thing about the finality
of my decision for me, is that I can care for
these men and women anywhere in the
country, and especially in Wyoming!
SF90 and HB253 which at the time of this
publication deadline had both passed out
of their chamber of origin and were being
considered by the other chamber. Go to the
legislative website for details on the outcome
of these bills. http://legisweb.state.wy.us/
Board Consumer Member Marguerite
Herman has been busy meeting with legislators
as an advocate for the board’s mission of
public protection and following the progress
of many of these bills that could directly or
indirectly affect nurses in this state. Board
staff have testified in committee for several of
the bills up for consideration. The Wyoming
Nurses Association sponsored a legislative
day in January, bringing student nurse leaders
to Cheyenne to learn about the legislative
process and even mingle with legislators at a
reception. Political involvement is just one
more aspect of how WSBN serves the public
and all licensees.
22 Wyoming Nurse Reporter

WYOMING STATE BOARD OF NURSING
Delegation Statement
In the Spring 2010 issue of the Wyoming Nurse Reporter there
was an answer to a practice question regarding a registered nurse’s
authority to delegate to a medical assistant (MA). It stated that
it is not within the scope of practice of a nurse to delegate tasks
to medical assistants. It cited Rules & Regulations, Chapter 9
and stated, “nurses delegate to other nurses or CNAs.”
That is a common understanding and
statements like this reinforce that belief. Nurses
are taught to value evidence based practice,
proven methods and ideas backed by research.
There is a famous anonymous quote: “Evidence
is not the plural of Anecdote”. However, as
much as that delegation statement may seem
to be common practice, the evidence does not
back up the claim.
Careful reading of Chapter 9; Delegation and
Assignment finds the following specific wording.
First, Section 1 defines delegation as: “...the
transferring to a competent individual (italics for
emphasis) the authority to perform a specific
nursing task in a selected situation. The nurse
retains responsibility for the delegated tasks.”
It does not say ‘to another nurse or CNA’, but
merely identifies a “competent individual”.
Chapter 9, Section 3 utilizes a number of
terms to describe who a nurse may delegate
to and is not consistent in specifically naming
other nurses. Instead, it identifies “any nursing
assistant”, “members of the nursing team”, “other
health care worker”, “delegatee”, “staff to whom
the task is delegated”. Even when it names a
nursing assistant it is not clear that it is referring
to a Certified Nursing Assistant (CNA) or
simply to the person assisting the nurse.
Finally, Chapter 9, Section 8 outlines the
decision tree for delegation based on the joint
statement of the American Nurses Association
(ANA) and the National Council of State
Boards of Nursing (NCSBN). In wording
selected by these national agencies, the
delegation tree mentions CNAs specifically and
then reverts to using the term ‘nursing assistive
personnel’.
It should be clear that if the intent was to
limit RN delegation only to other nurses or
CNAs it could have used more consistent
language. The goal is always to provide for
the safety and care of the patient. A nurse can
imagine many instances where an RN might
be in a position to delegate specific tasks to a
‘competent individual’. A CNA, MA, PA,
RN, LPN, EMT, Surgical Tech, RT, Speech
therapist, PT, (to name a few) are all medical
staff and healthcare workers who are competent
to perform any number of tasks. Just as a family
member of a patient with specific training could
be given any number of nursing tasks, many of
these assistive personnel can possess skills that
Today’s nurses must combine expertise in
their field with an ability to lead. A degree
from the University of Mary will prepare
you to assume leadership positions in direct
patient care, management and education.
Programs focus on the application of knowledge
– you will understand not only what is needed,
but how that service is best provided.
make them competent to perform nursing tasks.
(Think of parents of Cystic Fibrosis
children who percuss, suction, and administer
tube feedings....all nursing functions.)
It is better for a nurse in a Physician’s office
to oversee and perhaps sharpen the skills of an
Medical Assistant (MA) than to refuse to interact
simply because “they are under a Physician’s
supervision and are not a nurse”. True, the MA
is by definition under the supervision of the MD
but that does not mean they will not interact
with nursing staff and could require direction
performing their duties. Does it not make more
sense for an APRN in an emergency room to
coordinate the care of a number of assistive
personnel during a crisis than wait to find an
available nurse for delegation? Nurses are not
part of a medical caste system. They function
in the best interests of the patient and as long
as nurses do not delegate the nursing process,
there are many interactions that can flow to
competent individuals.
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Wyoming Nurse Reporter 23

Disciplinary Actions
(C) Misappropriation or misuse of property; (D)
Abandonment; (E) Abuse, including emotional,
physical or sexual abuse; (F) Neglect, including
substandard care; (G) Violation of privacy or
confidentiality in any form, written, verbal or
technological; (H) Drug diversion-self/others;
(I) Sale, unauthorized use, or manufacturing of
controlled/illicit drugs; (J) Criminal conviction;
(K) Unprofessional conduct; (L) Boundary
violations, including sexual boundaries; (M)
Failure to comply with reasonable requests from
the board including, but not limited to: (I)
Responses to complaints; (II) Responses to formal
Grounds for discipline for Licensed Practical
Nurses and Registered Professional Nurses
are located in the Administrative Rules and
Regulations Chapter 3, pages 3-13 through 3-15
and Certified Nursing Assistants Chapter 7, pages
7-16 and 7-17 (July 2010).
Grounds for Discipline are: (i) engaging in
any act inconsistent with uniform and reasonable
standards of practice, including but not limited
to: (A) Fraud and deceit including, but not
limited to, omission of required information
or submission of false information written or
verbal; (B) Performance of unsafe client care;
pleadings such as notice of hearing and/or petition
and complaint; (III) Responses to requests
regarding application and/or renewal information;
(IV) Written response to request for explanation
for failure to disclose required information; (V)
Failure to appear at properly noticed hearings;
(N) Impairment. (I) Lack of nursing competence;
(II) Mental illness; (III) Physical illness including,
but not limited to, deterioration through the aging
process or loss of motor skills; or (IV) Chemical or
alcohol impairment/abuse. (ii) Failure to conform
to the standards of prevailing nursing practice, in
which case actual injury need not be established.
WENDY KING
RN 18437
LICENSE REINSTATED
JANUARY 11, 2011
Wyoming State Board of Nursing ordered full reinstatement
of license because of satisfactory compliance with the Board’s
previous order of conditional licensure dated 7/30/2010.
GWEN ANDREWS
LPN 3242
VOLUNTARY SURRENDER
Gwen Andrews, LPN, agreed to voluntarily surrender her
license on November 17, 2010. Ms. Andrews had been
issued a Conditional License on September 23, 2010, arising
from investigation of disciplinary complaint of alcohol and/
or chemical dependency. WSBN was informed in October
2010 that Ms. Andrews had been recently arrested for DUI,
which Ms. Andrews subsequently confirmed and explained
was due to her consumption of alcohol in combination
with a prescription sleep medication. Such conduct was
alleged to have failed to conform to nursing standards and
to constitute unprofessional conduct in nursing practice.
As a result, Ms. Andrews voluntarily surrendered her LPN
license.
ALFRED BALDES
CNA 20940
VOLUNTARY SURRENDER
Alfred Baldes, CNA, entered into a Settlement Agreement,
Stipulation and Order for Voluntary Surrender on January
11, 2011. A complaint was filed in February 2010 by
Mr. Baldes’ employer, Amedisys Home Care (“AHC”),
alleging sexual abuse violations and client abuse. Such
complaint alleged that while employed as a CNA at AHC,
complaints were filed on behalf of two male patients alleging
sexual abuse by Mr. Baldes. Mr. Baldes’ employment was
consequently terminated. On November 18, 2010, .
Baldes was found “Guilty” by jury verdict in the case
entitled The State of Wyoming vs. Alfred Lee Baldes, of
two counts of Sexual Assault in the Third Degree. Mr.
Baldes subsequently agreed to voluntarily surrender his
CNA certificate.
WENDY BEIGHLEy
LPN 7223
REVOCATION
On or about November 16, 2010, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Wendy Beighley, LPN. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter an
order of default based on the allegations in a petition and
complaint against a respondent/licensee who fails to appear
for a properly noticed hearing. Ms. Beighley was in prison at
the time of the scheduled hearing for criminal convictions
related to sexually abuse of a minor child. Accordingly,
WSBN revoked Ms. Beighley’s LPN license.
MARY ANNE BERGAN
RN 9649
CONDITIONAL LICENSE
Mary Anne Bergan, RN, entered into a Settlement
Agreement, Stipulation and Order for Conditional License
on December 6, 2010. In June 2009, a complaint was initiated
on grounds of substance abuse/chemical dependency. Such
complaint was based upon correspondence from Wyoming
Professional Assistance Program (“WPAP”) Executive
Director, George A. Vandel, NCAC II, CAP, dated June
1, 2009, that Ms. Bergan had self-reported a relapse on May
29, 2009. Ms. Bergan had previously executed a monitoring
agreement with WPAP on July 1, 2008. Mr. Vandel further
indicated that Ms. Bergan would be required to enter
residential treatment before returning to nurse practice.
On June 12, 2009, Ms. Bergan acknowledged her relapse to
alcohol on May 29, 2009, and stated that she had entered
a residential treatment program at Wyoming Recovery in
Casper, WY. Correspondence from the Wyoming Recovery
Program Director dated June 29, 2009, stated Ms. Bergan
had satisfactorily completed her treatment goals and would
be in a period of stabilization for approximately two months
while she became involved in her continuing care program.
On September 1, 2009, Ms. Bergan executed a modified
monitoring agreement with WPAP to add one more year
to the monitoring period. In January 2010 WSBN received
another report from WPAP advising that Ms. Bergan again
self-reported relapse on or about January 18, 2010. WPAP
anticipated further recommendations for evaluation and
treatment. The terms of the Conditional License include a
stayed suspension of six (6) months and require Ms. Bergan
to: (1) enroll in the Nurse Monitoring Program (“NMP”)
for not less than sixty (60) months; (2) submit to random
drug screens; (3) regularly attend AA or NA meetings, and
submit documentation of such attendance to the NMP; (4)
not sign out, dispense or administer controlled substances
without direct supervision for at least twenty-four (24)
months; (5) obtain a worksite monitor; (6) provide an
annual report of her progression and education in recovery;
(7) provide annual clinical substance abuse evaluations/
assessments; (8) complete courses in ethics, critical thinking
and professional accountability; and (9) provide the terms
of the Conditional License to present/future employers.
ERIC CANTRELL
RN 18706
CONDITIONAL LICENSE
Eric Cantrell, RN, entered into a Settlement Agreement,
Stipulation and Order for Conditional License on
November 18, 2010, following a positive drug test for Ethyl
Glucoronide on October 4, 2010. In October of 2007,
Mr. Cantrell was issued a Conditional License by WSBN
arising from incidents of chemical dependency and relapses
during monitoring by the Wyoming Professional Assistance
Program (“WPAP”) and which was a reinstatement of his
previously voluntarily surrendered license due to chemical
dependency issues. Mr. Cantrell also received a Notice
of Warning, issued on July 9, 2010, based upon violations
related to his (1) failure to notify WSBN of an application
for nursing license in the State of Utah following his
relocation to Utah; (2) misrepresentation of the status of
Utah application; and (3) failure to comply with WPAP
monitoring. The terms of the Conditional License include
a stayed suspension for six (6) months and require Mr.
Cantrell to: (1) enroll in the Nurse Monitoring Program
(“NMP”) for not less than thirty-six (36) months; (2) submit
to random drug screens; (3) regularly attend AA or NA
meetings, and submit documentation of such attendance
to the NMP; (4) not sign out, dispense or administer
controlled substances without direct supervision for at least
twelve (12) months; (5) obtain a worksite monitor; (6)
provide an annual report of his progression and education
in recovery; (7) provide annual clinical substance abuse
evaluation/assessment; (8) complete courses in ethics and
professional accountability; and (9) provide the terms of
the Conditional License to present/future employers.
VICTORIA COLE
CNA 3564
REVOCATION
On or about February 1, 2011, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Victoria Cole, CNA. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter an
order of default based on the allegations in a petition and
complaint against a respondent/licensee who fails to appear
for a properly noticed hearing. Ms. Cole failed to appear at
a properly noticed disciplinary hearing. Accordingly, based
on the petition and complaint which alleged violations of
the Nurse Practice Act through Ms. Cole’s actions related
to practice beyond the scope of her licensure, fraud and
deceit, and unprofessional conduct while employed at
Mountain Towers Healthcare and Rehabilitation Center,
in Cheyenne, Wyoming, WSBN revoked Ms. Cole’s CNA
certificate.
RACHEL CRUMP
CNA 18692
LETTER OF REPRIMAND
On or about February 1, 2011, WSBN entered an Order
of Default Judgment and an Order of Reprimand against
Rachel Crump, CNA. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter
an order of default based on the allegations in a petition
and complaint against a respondent/licensee who fails
to appear for a properly noticed hearing. Ms. Crump
failed to appear at a properly noticed disciplinary hearing.
Accordingly, based on the petition and complaint which
alleged violations of the Nurse Practice Act through Ms.
Crump’s actions related to criminal conviction, chemical
dependency, unprofessional conduct and failure to comply
with reasonable requests by the Board, WSBN reprimanded
Ms. Crump’s CNA certificate.
24 Wyoming Nurse Reporter

JULIANA CULP
LPN 6981
LETTER OF REPRIMAND
Juliana Culp, CNA, entered into a Settlement Agreement,
Stipulation and Order for Letter of Reprimand on November
17, 2010. A complaint was filed with WSBN by Ms. Culp’s
employer, Pioneer Manor (“PM”) in Gillette, Wyoming,
alleging unprofessional conduct and unsafe practice arising
from a February 2010 event, in which a PM resident
contacted 911 requesting assistance because she was being
ignored by medical personnel. The resident indicated that
she did not feel safe and was not receiving requested medical
treatment. During the internal investigation at PM, it was
determined that Ms. Culp had not properly assessed the
resident for medical treatment, administered medications
without appropriate authorizations and/or insufficiently
documented her activities and response to instructions
from the hospitalist. Investigation by WSBN revealed that
Ms. Culp had been disciplined previously on September
17, 2009, for failure to comply with PM policies and
procedures, including possible endangerment of different
resident due to incomplete assessment and documentation.
Ms. Culp also was terminated from employment at PM
for failing to follow policies and procedures. In light of
Ms. Culp’s cooperation with the investigation, and other
mitigating circumstances, WSBN agreed to issue a Letter
of Reprimand for her conduct. Additionally, Ms. Culp was
required to complete courses in ethics, critical thinking, and
professional accountability.
ERICA CURRY
RN 21954
SUMMARY SUSPENSION
Erica Curry, RN, stipulated to an Order for Summary
Suspension on December 7, 2010. On or about December
3, 2010, WSBN received a complaint from Ambulatory
Surgery Center (“ASC”) in Laramie, Wyoming, which was
based upon allegations of Ms. Curry’s admission to diversion
of controlled substances for her personal use following
determination of discrepancies in the controlled substance
log. This selfadmitted diversion led to a stipulation between
Ms. Curry and WSBN to summarily suspend her registered
nursing license pending further proceedings by WSBN.
ERICA CURRY
RN 21954
CONDITIONAL LICENSE
Erica Curry, RN, entered into a Settlement Agreement,
Stipulation and Order for Conditional License on January
13, 2011. The issuance of a Conditional Licensed followed
Ms. Curry’s previous self-admitted diversion of controlled
substances for personal use as a result of determination of
discrepancies in controlled substances log at Ambulatory
Surgery Center in Laramie, Wyoming, which resulted in a
Summary Suspension on December 7, 2010. The terms of
the Conditional License include a stayed suspension for six
(6) months and require Ms. Curry to: (1) enroll in the Nurse
Monitoring Program (“NMP”) for not less than sixty (60)
months; (2) submit to random drug screens; (3) regularly
attend AA or NA meetings, and submit documentation of
such attendance to the NMP; (4) not sign out, dispense or
administer controlled substances without direct supervision
for at least twelve (12) months; (5) obtain a worksite
monitor; (6) provide an annual report of her progression and
education in recovery; (7) provide annual clinical substance
abuse evaluations/assessments; (8) complete courses in
ethics, critical thinking and professional accountability;
and (9) provide the terms of the Conditional License to
present/future employers.
CHRISTY DOWNES
CNA 16318
REVOCATION
On or about February 4, 2011, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Christy Downes, CNA. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter
an order of default based on the allegations in a petition
and complaint against a respondent/licensee who fails
to appear for a properly noticed hearing. Ms. Downes
failed to appear at a properly noticed disciplinary hearing.
Accordingly, based on the petition and complaint which
alleged violations of the Nurse Practice Act through Ms.
Towns’ actions related to abandonment and unprofessional
conduct while employed at Shepherd of the Valley Care
Center, in Casper, Wyoming, WSBN revoked Ms. Downes’
CNA certificate.
AMY ELM
RN 21676
SUMMARY SUSPENSION
Amy Elm, RN, stipulated to an Order for Summary
Suspension on January 11, 2011. On or about December
15, 2010, WSBN received a complaint from Johnson
County Healthcare (“JCHC”) in Buffalo, Wyoming, which
was based upon allegations of Ms. Elm’s admission on
October 8, 2010, to diversion of controlled substances for
her personal use following determination of discrepancies
in controlled substances log and/or discovery of forgeries.
Ms. Elm subsequently entered residential treatment for
approximately three (3) weeks and was permitted to return
to work on November 1, subject to employer-imposed
restrictions and conditions. Ms. Elm also submitted to a
drug screen by blood but subsequently did not consent to
the test being confirmed or completed and also voluntarily
resigned from her nurse position at JCHC. This selfadmitted
diversion led to a stipulation between Ms. Elm and
WSBN to summarily suspend her registered nursing license
pending further proceedings by WSBN.
BARBARA EMERSON
LPN 6600
REVOCATION
On or about November 16, 2010, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Barbara Emerson, LPN. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter
an order of default based on the allegations in a petition
and complaint against a respondent/licensee who fails
to appear for a properly noticed hearing. Ms. Emerson
failed to appear at a properly noticed disciplinary hearing.
Accordingly, based on the petition and complaint which
alleged violations of the Nurse Practice Act through Ms.
Emerson’s actions related to substance abuse/chemical
dependency while employed at the Wyoming Retirement
Center in Basin, Wyoming, WSBN revoked Ms. Emerson’s
LPN license.
VIOLET FREOUF
CNA 16255
VOLUNTARY SURRENDER
Violet Freouf, CNA, entered into a Settlement Agreement,
Stipulation and Order for Voluntary Surrender on
November 18, 2010. It was alleged that Ms. Freouf failed to
comply with reasonable requests of the Board. Specifically,
Ms. Freouf provided an affirmative answer on her renewal
application for the 2009-2010 biennium to the question
whether in the past two years (2007-2008) “any disciplinary
action has been taken or is any pending against [her] by a
licensing authority,” without providing the documentation
of the same as required in the application. Subsequently,
Board compliance staff corresponded with Ms. Freouf
requesting that she respond to requests for a personal
statement or explanation regarding such disciplinary action
or actions and documentation of the same, as well as
confirmation of compliance with any orders. Ms. Freouf
never responded to such requests, and subsequently agreed
to voluntarily surrender her CNA certificate.
ANNA GALLARDo
CNA 19995
LETTER OF REPRIMAND
Anna Gallardo, CNA, entered into a Settlement
Agreement, Stipulation and Order for Letter of Reprimand
on November 17, 2010. On July 31, 2008, Ms. Gallardo
executed an application for certified nursing assistant and
answered in the negative the question whether she had been
“charged, arrested, cited or convicted for any criminal offense
(including DUI).” Ms. Gallardo was issued an unrestricted
certificate for certified nursing assistant on October 1,
2008. A subsequent investigation revealed a conviction
for DUI in 2003 in Scottsbluff, Nebraska. Such conduct is
alleged to have failed to conform to nursing standards and
to constitute unprofessional conduct as well as fraud and
deceit. WSBN agreed to issue a Letter of Reprimand to Ms.
Gallardo’s conduct, as well as require completion of courses
in ethics and professional accountability.
NANCY GILBERT
RN 14495
REVOCATION
On or about November 16, 2010, WSBN entered an
Order of Default Judgment and an Order of Revocation
against Nancy Gilbert, RN. Pursuant to WSBN Rules
and Regulations, Chapter 8, Section 7(a), WSBN may
enter an order of default based on the allegations in a
petition and complaint against a respondent/licensee who
fails to appear for a properly noticed hearing. Ms. Gilbert
failed to appear at a properly noticed disciplinary hearing.
Accordingly, based on the petition and complaint which
alleged violations of the Nurse Practice Act through Ms.
Gilbert’s actions related to substance abuse, neglect, unsafe
care, and physical/mental disability while employed at
the Indian Health Services in Fort Washakie, Wyoming,
WSBN revoked Ms. Gilbert’s license.
CARRIE GILLARD
CNA 11288
LETTER OF REPRIMAND
Carrie Gillard, CNA, entered into a Settlement Agreement,
Stipulation and Order for Letter of Reprimand on January
11, 2011. On or about December 28, 2009, the Board
office received a complaint filed by Ms. Gillard’s employer,
Wyoming State Hospital (“WSH”), alleging sexual
boundary violations and client abuse by Ms. Gillard.
Specifically, WSH had determined as the result of an
internal investigation or personnel action that Ms. Gillard
had taken provocative pictures of women from a magazine
and posted them on the headboard of a patient of WSH
as a joke when she was on duty in her employment with
WSH. Ms. Gillard admitted her actions when confronted
and also acknowledged that such actions prompted a
response by the patient, even though the patient is stated
to have cognitive limitations. In addition, Ms. Gillard
expressed remorse for her conduct. In light of the isolated
instance of the complaint and Ms. Gillard’s willingness to
remediate, WSBN agreed to issue a Letter of Reprimand
to her conduct. Additionally, Ms. Gillard was required to
complete courses in ethics and professional boundaries.
KRISTINA GOSSMAN
RN 25421
CONDITIONAL LICENSE
Kristina Gossman, RN, entered into a Settlement
Agreement, Stipulation and Order for Conditional License
on January 10, 2011. In April 2009 a complaint was
initiated with respect to Ms. Gossman, based upon a March
12, 2009, incident in which Ms. Gossman appeared to
be impaired while working by several other co-workers
at the West Park Hospital (“WPH”) in Cody, Wyoming.
Ms. Gossman was requested to submit to an alcohol
screen by urinalysis, which she refused. Ms. Gossman
also admitted the use of alcohol the previous evening
but denied being under the influence when she reported
to work. Ms. Gossman subsequently was terminated
from employment for violating WPH policy. Further
investigation by WSBN staff revealed: (a) Ms. Gossman
was the subject of a prior informal disciplinary action in the
December 2008 time frame, in which a patient at WPH had
reported suspicions of Ms. Gossman having alcohol on her
breath. No urinalysis was obtained at such time; and (b)
Witness letters provided to the Board with respect to the
events on March 12, 2009, confirmed, without exception,
observations that Ms. Gossman appeared impaired and/or
had the smell of alcohol on her breath. The terms of the
Conditional License include a stayed suspension of six (6)
months and require Ms. Gossman to: (1) enroll in the Nurse
Monitoring Program (“NMP”) for not less than sixty (60)
Continued on page 26
Wyoming Nurse Reporter 25

months; (2) submit to random drug screens; (3) regularly
attend AA or NA meetings, and submit documentation of
such attendance to the NMP; (4) not sign out, dispense or
administer controlled substances without direct supervision
for at least twenty-four (24) months; (5) obtain a worksite
monitor; (6) provide an annual report of her progression and
education in recovery; (7) provide annual clinical substance
abuse evaluations/assessments; (8) complete courses in
ethics, critical thinking and professional accountability;
and (9) provide the terms of the Conditional License to
present/future employers.
DIANA GUMM
RN 22394
CONDITIONAL LICENSE
Diana Gumm, RN, entered into a Settlement Agreement,
Stipulation and Order for Conditional License on November
18, 2010. Ms. Gumm was reported to have suffered a Level
III relapse in 2007 while in the Wyoming Professional
Assistance Program (“WPAP”), with subsequent admission
to residential treatment for opiod detox. Following
discharge from residential treatment, Ms. Gumm returned
to WPAP. The terms of the Conditional License include
a stayed suspension for six (6) months and require Ms.
Gumm to: (1) enroll in the Nurse Monitoring Program
(“NMP”) for not less than sixty (60) months; (2) submit
to random drug screens; (3) regularly attend AA or NA
meetings, and submit documentation of such attendance
to the NMP; (4) not sign out, dispense or administer
controlled substances without direct supervision for at least
twenty-four (24) months; (5) obtain a worksite monitor; (6)
provide an annual report of her progression and education
in recovery; (7) provide semi-annual clinical substance
abuse evaluations/assessments; (8) complete courses in
ethics, critical thinking and professional accountability; (9)
participate in regular mental health counseling; and (10)
provide the terms of the Conditional License to present/
future employers.
KATHERINE HALVORSEN
RN 17718
VOLUNTARY SURRENDER
Katherine Halvorsen, RN, entered into a Settlement
Agreement, Stipulation and Order for Voluntary Surrender
on November 17, 2010. Initially, Ms. Halvorsen was the
subject of a disciplinary complaint as the result of a WPAP
report of three (3) previous Level III relapses while she
was participating in the voluntary impaired nurse program
with WPAP. Respondent acknowledged her chemical
dependency and was issued a Conditional License for sixty
(60) months, subject to monitoring, 36-month restrictions
regarding dispensing of medication and other terms and
conditions that was approved by the Board on or about
January 12, 2005. Respondent was the subject of a further
disciplinary complaint prompted by the September 12, 2005
WPAP notification that Respondent had tested positive
for morphine on August 15, 2005. This relapse was noted
to have occurred only eight (8) months following the
approval of the 2005 Conditional License. Ms. Halvorsen
was issued a Conditional License on October 9, 2007,
arising from incidents of chemical dependency and relapses
during monitoring by Wyoming Professional Assistance
Program (“WPAP”). This Conditional License modified
the 2006 Conditional License, which also incorporated
the 2005 Conditional License terms and conditions. On
December 28, 2009, WPAP notified WSBN of a Level
III relapse by Ms. Halvorsen, in which she had tested
positive for alcohol and acknowledged the positive test
to WPAP representatives and, subsequently, to WSBN.
Subsequently, on March 12, 2010, WPAP notified WSBN
of another Level III relapse by Ms. Halvorsen. Since January
there were several drug screens indicated to be diluted, but
testing negative for drugs or alcohol. A hair specimen was
subsequently collected for testing and returned positive for
morphine and hydromorphone. Such conduct was alleged
to have failed to conform to nursing standards, constitute
unprofessional conduct, and to constitute unauthorized use
of a controlled substance. Ms. Halvorsen did not dispute
the findings of WSBN and, accordingly, Ms. Halvorsen
agreed to voluntarily surrender her RN license.
TRINA HEIDE
CNA 14087
REVOCATION
On or about November 16, 2010, WSBN entered an
Order of Default Judgment and an Order of Revocation
against Trina Heide, CNA. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter an
order of default based on the allegations in a petition and
complaint against a respondent/licensee who fails to appear
for a properly noticed hearing. Ms. Heide failed to appear at
a properly noticed disciplinary hearing. Accordingly, based
on the petition and complaint which alleged violations
of the Nurse Practice Act through Ms. Heide’s actions
related to alcohol abuse and unprofessional conduct while
employed at West Park Long Term Care Center and
voluntary admission to an inpatient treatment program for
an addiction to opiate pain medication noted in her 2009-
2010 certification renewal application, WSBN revoked Ms.
Heide’s CNA certificate.
TANIE HEITZ
CNA 11941
CONDITIONAL CERTIFICATE
Tanie Heitz, CNA, entered into a Settlement Agreement,
Stipulation and Order for Conditional Certificate on
January 13, 2011. In May 2010, Ms. Heitz’s employer,
Laramie Hospice (“LH”), submitted a complaint alleging
Ms. Heitz tested positive at work for alcohol on April 27,
2010. Specifically, the complaint alleged that Ms. Heitz’s
breath alcohol test was .020, and because she was in a
monitored treatment program, was required to test negative
on random tests. Ms. Heitz subsequently submitted a letter
of resignation to LH. Ms. Heitz acknowledged the substance
of the complaint and denied consumption of alcohol, but
instead taking Theraflu, which contained alcohol, as well
as summarizing her subsequent efforts toward treatment and
recovery to prior residential treatment and aftercare. Ms.
Heitz was admitted for residential treatment to Harmony
Foundation in Estes Park, Colorado (“Harmony”) on May
26, 2009 and was discharged on June 23, 2009. Further
communications from LH indicated that since residential
treatment, Ms. Heitz tested positive two of three times
for alcohol, which included the incident related to her
resignation, and her supervisor suspected alcohol odor
from Ms. Heitz at work, for which she had been previously
confronted. The terms of the Conditional Certificate shall
remain in place for not less than sixty (60) months and
require Ms. Heitz to: (1) abstain from all mind-altering
drugs or medications; (2) notify her designated worksite
monitor(s) within seventy-two hours of any prescriptions
or mood-altering substances; (3) obtain a worksite monitor;
(4) submit to random drug screens; (5) regularly attend
AA or NA meetings, and submit documentation of such
attendance to WSBN; (6) provide an annual report of
her progression and education in recovery; (7) provide
annual clinical substance abuse evaluations/assessments; (8)
complete a courses in ethics; and (9) provide the terms of
the Conditional Certificate to present/future employers.
KATHERINE HENDRICKS
RN 24794
VOLUNTARY SURRENDER
Katherine Hendricks, RN, entered into a Settlement
Agreement, Stipulation and Order for Voluntary Surrender
on November 16, 2010. It was alleged that Ms. Hendricks
was abusing medications, both nonprescription and
prescriptions for mental health conditions (bipolar disorder
and depression), as well as alcohol. WSBN investigation
subsequently confirmed that: (1) Ms. Hendricks had
entered into residential substance abuse treatment at
Transformations Wellness Center, of Klamath Falls, Oregon,
following which she participated in aftercare; and (2) On or
about February 11, 2009, according to National Practitioner
Data Bank/Healthcare Integrity Protection Data Bank
records regarding Ms. Hendricks, the Oregon State Board
of Nursing denied license renewal based upon, among other
things, misrepresentations of credentials, practicing without
a valid license and fraud, deceit or material omission in
obtaining license. Such conduct was alleged to have
failed to conform to nursing standards and to constitute
unprofessional conduct in nursing practice. Ms. Hendricks
subsequently advised she would not be continuing to
practice nursing due to medical issues and agreed to
voluntarily surrender her registered nursing license.
MICHELLE JACOBSEN
CNA 17499
LETTER OF REPRIMAND
Michelle Jacobsen, CNA, entered into a Settlement
Agreement, Stipulation and Order for Letter of Reprimand
on November 17, 2010. In April 2010, WSBN received
a complaint from Ms. Jacobsen’s employer, Shepherd of
the Valley Care Center in Casper, Wyoming (“SVCC”),
alleging patient abandonment, which also was reported to
the Wyoming Department of Health, Office of Healthcare
Licensing and Surveys (“OHLS”). Specifically, after
reporting for work, Ms. Jacobsen was seen to have left
the premises at SVCC, without returning or making
arrangements for continuing care of residents to whom
Ms. Jacobsen had been assigned. Ms. Jacobsen also did
not have prior knowledge or approval for her departure
from her superiors, and her actions resulted in employment
termination. Such conduct is alleged to have failed to
conform to nursing standards, as well as to constitute
abandonment and unprofessional conduct. WSBN agreed
to issue a Letter of Reprimand to Ms. Jacobsen’s conduct
and, additionally, require completion of courses in ethics
and professional accountability.
JAMES JUDD
LPN 6137
VOLUNTARY SURRENDER
James Judd, LPN, entered into a Settlement Agreement,
Stipulation and Order for Voluntary Surrender of License
on November 18, 2010. As of the date of this Agreement,
Mr. Judd’s license was a Conditional License per Settlement
Agreement, Stipulation and Order approved by the Board
on April 9, 2009, arising from an incident resulting in
criminal conviction for diversion of controlled substances.
In September 2010, Mr. Judd returned his nurse license card
for personal reasons and requested that the Board accept
his voluntary surrender of his LPN license. Although Mr.
Judd’s request did not constitute new violations of the NPA
or Board’s Rules, the underlying grounds and basis for the
2009 Conditional License have not been excused, and
the Board retains continuing jurisdiction over Mr. Judd.
Consequently, Mr. Judd’s voluntary surrender of his LPN
license was accepted by WSBN.
DEBORAH KETCHAM
RN 21161
CONDITIONAL LICENSE
Deborah Ketcham, RN, entered into a Settlement Agreement,
Stipulation and Order for Conditional License on November
18, 2010. Ms. Ketcham was alleged to have ordered an
excessive amount of Vicodin for a resident under her care,
raising suspicions of drug diversion. A patient prescription
profile relating to Ms. Ketcham obtained from the Wyoming
State Board of Pharmacy (“BOP”) covering the period July
2008 through May 2009 revealed numerous prescriptions
for opiod pain relief medication from multiple health care
providers, in addition to prescriptions for Suboxone beginning
in January 2009. In July 2009 it was reported by the WPAP
that Ms. Ketcham had suffered a Level III relapse, following
two positive tests for methadone in May 2009 accompanied by
two additional positive tests for methadone in June 2009. The
terms of the Conditional License include a stayed suspension
for six (6) months and require Ms. Ketcham to: (1) enroll in
the Nurse Monitoring Program (“NMP”) for not less than sixty
(60) months; (2) submit to random drug screens; (3) regularly
attend AA or NA meetings, and submit documentation of
such attendance to the NMP; (4) not sign out, dispense or
administer controlled substances without direct supervision
for at least twenty-four (24) months; (5) obtain a worksite
monitor; (6) provide an annual report of her progression and
education in recovery; (7) provide annual clinical substance
abuse evaluations/assessments; (8) complete courses in ethics
and professional accountability; and (9) provide the terms of
the Conditional License to present/future employers.
26 Wyoming Nurse Reporter

MARCELLA KNAUB
RN 20430
REVOCATION
On or about November 16, 2010, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Marcella Knaub, RN. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter an
order of default based on the allegations in a petition and
complaint against a respondent/licensee who fails to appear
for a properly noticed hearing. Ms. Knaub failed to appear at
a properly noticed disciplinary hearing. Accordingly, based
on the petition and complaint which alleged violations of
the Nurse Practice Act through Ms. Knaub’s actions related
to chemical dependency/substance abuse while employed at
Indian Health Services, Crow Agency, Montana, and which
rendered her unable to perform nursing duties, WSBN
revoked Ms. Knaub’s RN license.
SAMANTHA LITTLE
RN 28410
LETTER OF REPRIMAND
Samantha Little, RN, entered into a Settlement Agreement,
Stipulation and Order for Letter of Reprimand on January
11, 2011. In September 2010 a complaint was initiated
based upon Ms. Little’s self-report of DUI. On September
21, 2010, Ms. Little entered a plea of guilty to Driving While
Under the Influence-First Offense, which was suspended
pursuant to W.S. §7-13-301 and was placed on unsupervised
probation for a period of twelve (12) months. It is alleged
Ms. Little’s conduct failed to conform to standards of
nursing practice, as well as constituting criminal conviction,
unfitness due to use of drugs or other mind-altering chemical
and substance abuse/impairment. In light of Ms. Little’s
cooperation with the investigation, and other mitigating
circumstances, WSBN agreed to issue a Letter of Reprimand
to her conduct. Additionally, Ms. Little was required to
complete an ethics course.
KEVIN MADER
RN 24869
SUMMARY SUSPENSION
Kevin Mader, RN, stipulated to an Order for Summary
Suspension on January 11, 2011. On or about December
23, 2010, a complaint was submitted by Mr. Mader’s
employer, Powell Valley Healthcare (“PVH”) in Powell,
Wyoming. Such complaint was based upon allegations
of Mr. Mader’s diversion of controlled substances for his
personal use. Mr. Mader had presented at North Big
Horn Hospital (“NBHH”) emergency room, with a likely
benzodiazepine overdose as indicated by his own statement
that he had ingested three (3) Lorazepam tablets, which he
had obtained from his employer, PVH. This information
also was communicated by NBHH to PVH. Mr. Mader
was known to PVH as being monitored privately by the
Wyoming Professional Assistance Program (“WPAP”) and
that prior relapses or non-compliance had been suspected.
Other controlled substances believed to have been taken
from PVH were discovered at NBHH and on Mr. Mader’s
person including approximately sixty-two (62) tablets of
Tramadol. Further investigation would be undertaken
by PVH in an attempt to determine whether additional
amounts of controlled substances and other medications,
including Tramadol, may have been diverted by Mr. Mader.
This self-admitted diversion led to a stipulation between
Mr. Mader and WSBN to summarily suspend his registered
nursing license pending further proceedings by WSBN.
PAMELA MATTSON
CNA 18634
REVOCATION
On or about November 16, 2010, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Pamela Mattson, CNA. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter
an order of default based on the allegations in a petition
and complaint against a respondent/licensee who fails
to appear for a properly noticed hearing. Ms. Mattson
failed to appear at a properly noticed disciplinary hearing.
Accordingly, based on the petition and complaint which
alleged violations of the Nurse Practice Act through Ms.
Mattson’s actions related to alcohol impairment while
employed at Weston County Health Services of Newcastle,
Wyoming, WSBN revoked Ms. Mattson’s CNA certificate.
MARY MCBRIDE
RN 17887
LETTER OF REPRIMAND
Mary McBride, RN, entered into a Settlement Agreement,
Stipulation and Order for Letter of Reprimand on November
17, 2010. In June 2010, WSBN received a complaint from
Ms. McBride’s employer, Goshen Care Center (“GCC”) in
Torrington, Wyoming, which generally alleged abuse and
unprofessional conduct. Specifically, Ms. McBride allegedly
was abusive to two GCC residents. Ms. McBride allegedly
restrained one resident by holding their hands after the
patient was slapping their hands on the dinner table. In
addition, when another resident was verbally rude while in
the dining room, Ms. McBride placed the resident in the
sun room by herself where she was left for approximately
fifteen minutes. Such conduct is alleged to constitute
unsafe client care; abuse; neglect; unprofessional conduct;
and failure to conform to nursing standards. In light of Ms.
McBride’s cooperation with the investigation, and other
mitigating circumstances, WSBN agreed to issue a Letter of
Reprimand to her conduct. Additionally, Ms. McBride was
required to complete courses in ethics, critical thinking, and
professional accountability.
AMANDA NAPOLETANO
CNA 12470
LETTER OF REPRIMAND
Amanda Napoletano, CNA, entered into a Settlement
Agreement, Stipulation and Order for Letter of Reprimand
on January 11, 2011. On or about February 12, 2010,
the Board received a report from Wyoming Department
of Family Services (“DFS”) of alleged abuse towards a
male patient of the Wyoming State Hospital (“WSH”).
A complaint was initiated against Ms. Napoletano.
Subsequently, on February 24, 2010, the Board received a
complaint initiated by Donna Aspuria, Interim Director
of Nursing for the WSH in Evanston, Wyoming, alleging
acts of abuse, unprofessional conduct and sexual boundary
violations towards the same male patient, in which Ms.
Napoletano also was the subject. WSBN agreed to issue
a Letter of Reprimand to Ms. Napoletano’s conduct.
Additionally, Ms. Napoletano was required to complete
courses in ethics and professional boundaries, along with
reading “Games Criminals Play” by Juanita Allen and
completing an authorized test on said book.
ANDREW NEMEC
RN 27678
VOLUNTARY SURRENDER
Andrew Nemec, RN, entered into a Settlement Agreement,
Stipulation and Order for Voluntary Surrender on December
6, 2010. WSBN initiated a complaint based upon
disciplinary action relating to Mr. Nemec’s Illinois license,
as reflected by an Order dated July 19, 2010 (“Illinois
Order”), by the State of Illinois Department of Financial
and Professional Regulation. The Illinois Order reflected
that Mr. Nemec diverted Dilaudid during the period
December 6 through 8, 2009, and was subjected to a drug
screen which tested positive, while employed as a registered
nurse with Alexian Brothers Medical Center in Elk Grove
Village, Illinois (“ABMC”). Mr. Nemec admitted the
diversion and was terminated from employment at ABMC.
Mr. Nemec also held a Registered Nurse license in the state
of California, the status of which is “inactive” due to failure
to provide continuing education. Mr. Nemec subsequently
notified WSBN of his intent to let his Wyoming license
expire and agreed to voluntarily surrender his registered
nursing license.
DELORIS PARKER
RN 20501
LETTER OF REPRIMAND
Deloris Parker, RN, entered into a Settlement Agreement,
Stipulation and Order for Letter of Reprimand on January
11, 2011. In February 2009 Ms. Parker’s employer initiated
a complaint alleging inappropriate delegation, as well
as fraud and deceit. Specifically, on February 16, 2009,
a report was submitted of an incident on February 12,
2009, in which Ms. Parker, in violation of safety protocol
regarding medication administration, directed a first-year
nursing student to give an oral opiate medication without
the nursing instructor or a supervising preceptor nurse being
present. Although the medication was administered by the
nursing student, Ms. Parker documented that she herself
had administered the medication (hydrocodone). Internal
investigation at PVH also confirmed this report. Ms. Parker
subsequently confirmed the allegations, acknowledging
that she asked a nursing student to deliver medication to
a patient, whom she did not accompany because of other
nursing duties and fire alarm distractions at the time. It is
alleged this conduct violated standards of nursing practice
and constituted unprofessional conduct as well as fraud and
deceit in signing a report/record as a registered nurse. In
light of Ms. Parker’s cooperation with the investigation,
and other mitigating circumstances, WSBN agreed to issue
a Letter of Reprimand to her conduct. Additionally, Ms.
Parker was required to complete courses in ethics, effective
delegation, and detection and prevention of medication
errors.
JEANNE PAYTON
RN 16924
CONDITIONAL LICENSE
Jeanne Payton, RN, entered into a Settlement Agreement,
Stipulation and Order for Conditional License on November
17, 2010. Ms. Payton made a self-report of on-the-job
alcohol use on April 21, 2010, stemming from a report she
made to her employer, Cheyenne Regional Medical Center
(“CRMC”) in October 2009. Ms. Payton also reported a
relapse in March 2010 to WSBN, which she also reported
to CRMC. Ms. Payton immediately entered residential
treatment at Cedar Springs, after which she participated
in an Intensive Outpatient Program (“IOP”) provided by
CRMC until successful discharge on May 17, 2010. The
terms of the Conditional License include a stayed suspension
for ninety (90) days and require Ms. Payton to: (1) enroll
in the Nurse Monitoring Program (“NMP”) for not less
than sixty (60) months; (2) submit to random drug screens;
(3) regularly attend AA or NA meetings, and submit
documentation of such attendance to the NMP; (4) not sign
out, dispense or administer controlled substances without
direct supervision for at least twenty-four (24) months; (5)
obtain a worksite monitor; (6) provide an annual report
of her progression and education in recovery; (7) provide
annual clinical substance abuse evaluations/assessments; (8)
complete courses in ethics and professional accountability;
and (9) provide the terms of the Conditional License to
present/future employers.
LAURIE PENDERGRAFT
LPN 4315
VOLUNTARY SURRENDER
Laurie Pendergraft, LPN, entered into a Settlement
Agreement, Stipulation and Order for Voluntary Surrender
on January 11, 2011. In June 2010, a complaint was
submitted to WSBN by Ms. Pendergraft’s employer, Pioneer
Manor (“PM”), the long-term care unit of Campbell County
Memorial Hospital, located in Gillette, Wyoming. Such
complaint generally alleged alcohol or chemical impairment
and concerns regarding unsafe care. Specifically, Ms.
Pendergraft reported to work on May 29, 2010 with a blood
alcohol level of 117, which was reported by an outside lab
testing as showing blood alcohol content (“BAC”) of 0.092.
Ms. Pendergraft was subsequently terminated from her
employment with PM. It is alleged that Ms. Pendergraft’s
conduct failed to conform to standards of nursing practice
and constituted unfitness/incompetency due to use of drugs
or other mind-altering chemical, as well as unprofessional
Continued on page 28
Wyoming Nurse Reporter 27

conduct and impairment. WSBN agreed to accept Ms.
Pendergraft’s voluntary surrender of her LPN license.
SHARI (LONG) ROMERO
RN 21612
LETTER OF REPRIMAND/CONDITIONAL
LICENSE
On or about January 10, 2011, WSBN entered an Order
Issuing Letter of Reprimand and Issuing Conditional License
against Shari (Long) Romero, RN, following a contested
hearing held on September 21-22, 2010. It was generally
alleged that Ms. (Long) Romero had violated provisions of
the Nurse Practice Act related to unprofessional conduct,
disciplinary action in another jurisdiction, substance abuse/
chemical impairment and criminal convictions. Specifically,
it was alleged that Ms. (Long) Romero had failed to disclose
certain disciplinary information from another jurisdiction
to WSBN and had been twice arrested for driving while
under the influence. Further, it was alleged that Ms. (Long)
Romero had an on-going impairment related to substance/
chemical abuse. WSBN issued a reprimand for Ms. (Long)
Romero’s conduct in failing to disclose information on
the Board’s application documents. In addition, WSBN
issued a Conditional License to Ms. (Long) Romero with
the following conditions: (1) indefinite participation in
the Nurse Monitoring Program (NMP); (2) shall not work
as a registered nurse while taking a prescription for any
controlled substance, as defined in the Wyoming Controlled
Substances Act, and demonstrate to the NMP the proper
waste of any unused controlled substance; (3) administration
of any medication by any route, or participation in any
procedures, including PICC line placement, while employed
as a registered nurse shall be monitored by her worksite
monitor through direct supervision; (4) no duties that
allow exposure to medical waste containers without direct
supervision from her worksite monitor; and (5)submit to a
hair sample for drug screening purposes every six months,
beginning one month from the effective date of the order.
KRISTINE SCOTT
CNA 19728
REVOCATION
On or about November 16, 2010, WSBN entered an Order
of Revocation against Kristine Scott, CNA, following a
contested hearing held on September 21, 2010. It was
generally alleged that Ms. Scott had violated provisions
of the Act related to chemical impairment and criminal
violations. Specifically, it was alleged that Ms. Scott
had been terminated from her employment as a CNA
for being under the influence of methamphetamines at
work; had been criminally convicted of unauthorized use
of a controlled substance; and had subsequent relapses to
substances. Accordingly, following deliberations which
considered the evidence presented at the hearing, WSBN
revoked Ms. Scott’s CNA certificate.
WILLIAM STEWART
RN 22821
CONDITIONAL LICENSE
William Stewart, RN, entered into a Settlement Agreement,
Stipulation and Order for Conditional License on November
17, 2010. When Mr. Stewart submitted his application for
a registered professional nurse license by endorsement in
2005, he voluntarily revealed that he had been the subject
of prior disciplinary action by the Montana State Board
of Nursing on the basis of drug diversion and narcotics
addiction and had received treatment for addiction. Mr.
Stewart subsequently filed a self-complaint with WSBN in
August 2009, admitting drug diversion and substance abuse/
dependency. At that time, Mr. Stewart indicated that in
1998 he had developed a substance abuse problem when
working as a nurse in Montana and received treatment.
He also indicated that he was drug free until working in
Lander, WY, when he was prescribed medication for back
pain. He developed an addiction and began diverting
medication waste and abusing opioids. He further indicated
that he returned to treatment at Rimrock Foundation
Treatment Center in Montana on an in-patient basis. In
September2009, WSBN received a complaint from Lander
Regional Hospital (“LRH”), which reported that on August
25, 2009, Mr. Stewart was perceived to be impaired toward
the end of his shift in the ER. It was also reported at that
time the department in which Mr. Stewart was assigned had
been under investigation for drug diversion. On the basis of
an initiated internal complaint and preliminary investigation
by LRH, Mr. Stewart was drug tested, which yielded a
positive screen, as well as admissions of his involvement
in drug diversion in an interview with law enforcement
officers. Mr. Stewart was charged with 3 felony counts of
possession of a Schedule II controlled substance – Fentanyl
Citrate. Mr. Stewart admitted to law enforcement officers
to taking controlled substances and provided a statement
regarding his history of addiction to Tramadol, which led to
his diverting unused portions of controlled substance vials,
including Morphine, Demerol, and Dilaudid. Mr. Stewart
further admitted that his addiction was so strong that when
there was not waste, he began diverting these opioids from
the supply and using them, and that on August 25, 2009,
he injected himself with Morphine, Dilaudid and Fentanyl.
On April 13, 2010, two of three felony counts of possession
of a controlled substance were dismissed and Mr. Stewart’s
guilty plea for the remaining count was not accepted and
entry of conviction was deferred pursuant to Wyo. Stat. §
7-13-301, and he was placed on supervised probation for
a period of five (5) years, subject to indicated terms and
conditions. The terms of the Conditional License require
Mr. Stewart to: (1) enroll in the Nurse Monitoring Program
(“NMP”) for not less than sixty (60) months; (2) submit
to random drug screens; (3) regularly attend AA or NA
meetings, and submit documentation of such attendance
to the NMP; (4) not sign out, dispense or administer
controlled substances without direct supervision for at least
twenty-four (24) months; (5) obtain a worksite monitor; (6)
provide an annual report of his progression and education
in recovery; (7) provide annual clinical substance abuse
evaluations/assessments; (8) complete courses in ethics,
critical thinking and professional accountability; and (9)
provide the terms of the Conditional License to present/
future employers.
JESSE TAYLOR
CNA 18499
REPRIMAND/SUSPENSION
On or about February 1, 2011, WSBN entered an Order
of Default Judgment and an Order of Suspension and
Reprimand against Jesse Taylor, CNA. Pursuant to WSBN
Rules and Regulations, Chapter 8, Section 7(a), WSBN
may enter an order of default based on the allegations in
a petition and complaint against a respondent/licensee
who fails to appear for a properly noticed hearing. Ms.
Taylor failed to appear at a properly noticed disciplinary
hearing. Accordingly, based on the petition and complaint
which alleged violations of the Nurse Practice Act through
Ms. Taylor’s actions related to sexual boundary violations
and unprofessional conduct while employed at Wyoming
State Hospital, WSBN reprimanded Ms. Taylor’s CNA
certificate. Additionally, Ms. Taylor’s CNA certificate is
suspended pending completion of Board-approved ethics
and boundaries courses.
CARLENE THAYER
RN 19703
REPRIMAND
On or about February 1, 2011, WSBN entered an Order
of Default Judgment and an Order of Reprimand against
Carlene Thayer, RN. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter an
order of default based on the allegations in a petition and
complaint against a respondent/licensee who fails to appear
for a properly noticed hearing. Ms. Thayer failed to appear at
a properly noticed disciplinary hearing. Accordingly, based
on the petition and complaint which alleged violations of
the Nurse Practice Act through Ms. Thayer’s actions related
to fraud and deceit, and unprofessional conduct while
employed at Western Medical Associates, PC, in Casper,
Wyoming, WSBN reprimanded Ms. Thayer’s RN license.
LEA THOMPSON
RN 22822
REVOCATION
On or about February 1, 2011, WSBN entered an Order of
Default Judgment and an Order of Revocation against Lea
Thompson, RN. Pursuant to WSBN Rules and Regulations,
Chapter 8, Section 7(a), WSBN may enter an order of
default based on the allegations in a petition and complaint
against a respondent/licensee who fails to appear for a
properly noticed hearing. Ms. Thompson failed to appear at
a properly noticed disciplinary hearing. Accordingly, based
on the petition and complaint which alleged violations of
the Nurse Practice Act through Ms. Thompson’s actions
related to nurse license discipline in other jurisdictions,
fraud and deceit/failure to disclose, and unprofessional
conduct, WSBN revoked Ms. Thompson’s RN license.
KATRINA TOLBERT
LPN 6890
REVOCATION
On or about February 1, 2011, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Katrina Tolbert, LPN. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter an
order of default based on the allegations in a petition and
complaint against a respondent/licensee who fails to appear
for a properly noticed hearing. Ms. Tolbert failed to appear at
a properly noticed disciplinary hearing. Accordingly, based
on the petition and complaint which alleged violations of
the Nurse Practice Act through Ms. Tolbert’s actions
related to drug diversion and unprofessional conduct while
employed at Valley View Rehabilitation and Care Center
in Saratoga, Wyoming, WSBN revoked Ms. Tolbert’s LPN
license.
KORTNEY TOWNS
CNA 21290
REVOCATION
On or about February 4, 2011, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Kortney Towns, CNA. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter
an order of default based on the allegations in a petition
and complaint against a respondent/licensee who fails
to appear for a properly noticed hearing. Ms. Towns
failed to appear at a properly noticed disciplinary hearing.
Accordingly, based on the petition and complaint which
alleged violations of the Nurse Practice Act through Ms.
Towns’ actions related to abandonment and unprofessional
conduct while employed at the Wyoming Medical Center,
in Casper, Wyoming, WSBN revoked Ms. Towns’ CNA
certificate.
TRINA WATERMAN
RN 26297
REVOCATION
On or about November 16, 2010, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Trina Waterman, RN. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter
an order of default based on the allegations in a petition
and complaint against a respondent/licensee who fails to
appear for a properly noticed hearing. Ms. Waterman
failed to appear at a properly noticed disciplinary hearing.
Accordingly, based on the petition and complaint which
alleged violations of the Nurse Practice Act through Ms.
Waterman’s actions related to violation of the Medication
Administration Policy and improper wasting practices/drug
diversion while employed at Wyoming Medical Center in
Casper, Wyoming, WSBN revoked Ms. Waterman’s RN
license.
JAMEY LEA WEICKUM
CNA 4929
LETTER OF REPRIMAND
Jamey Lea Weickum, CNA, entered into a Settlement
Agreement, Stipulation and Order for Letter of Reprimand
on December 11, 2010. In July 2010, a complaint was
initiated based upon information obtained following Ms.
Weickum’s application for renewal of her CNA certificate,
28 Wyoming Nurse Reporter

which information was not disclosed in such application.
Ms. Weickum provided negative answers on her application
to the question whether in the past two years she had been
“charged, arrested, cited, or convicted for any criminal
offense (including DUI).” However, an investigation
disclosed that Ms. Weickum entered a plea of nolo
contendere to a felony charge of “Accessory after the Fact,”
pursuant to WYO. STAT. § 6-50202(a) & (b)(ii)(B),
which was deferred pursuant to WYO. STAT. § 7-13-301.
Such conduct is alleged to have failed to conform to nursing
standards and constitute unprofessional conduct. WSBN
agreed to issue a Letter of Reprimand to Ms. Weickum’s
conduct and, additionally, require completion of courses in
ethics and professional accountability.
CRISTINA WILLIAMS
RN 26995
REVOCATION
On or about November 16, 2010, WSBN entered an Order
of Default Judgment and an Order of Revocation against
Christina Williams, RN. Pursuant to WSBN Rules and
Regulations, Chapter 8, Section 7(a), WSBN may enter
an order of default based on the allegations in a petition
and complaint against a respondent/licensee who fails
to appear for a properly noticed hearing. Ms. Williams
failed to appear at a properly noticed disciplinary hearing.
Accordingly, based on the petition and complaint which
alleged violations of the Nurse Practice Act through Ms.
Williams’ actions: (1) reported by the Texas State Board of
Nursing in an Agreed Order dated June 3, 2009, indicating
numerous instances of drug diversion, falling asleep on
duty, presenting improper patient care, misappropriation
of narcotic medication for personal use, and a positive
drug screen for opiates, and chemical dependency; and
(2) of providing false information on her application for
a Wyoming registered nurse license, WSBN revoked Ms.
Williams’ RN license.
Denials of Applicants Seeking Licensure or Certification
The Nurse Practice Act, 33-21-146 identifies the following reasons that an application may be denied:
“(a) The board of nursing may refuse to issue or renew, or may suspend or revoke
the license, certificate or temporary permit of any person, or to otherwise discipline a
licensee, upon proof that the person:
(i) Has engaged in any act inconsistent with uniform and reasonable standards of
nursing practice as defined by board rules and regulations;
(ii) Has been found guilty by a court, has entered an Alford plea or has entered a plea
of nolo contendere to a misdemeanor or felony that relates adversely to the practice of
nursing or to the ability to practice nursing;
(iii) Has practiced fraud or deceit:
(A) In procuring or attempting to procure a license to practice nursing;
(B) In filing or reporting any health care information, including but not limited to client
documentation, agency records or other essential health documents;
(C) In signing any report or record as a registered nurse or as a licensed practical
nurse;
(D) In representing authority to practice nursing; or
(E) In submitting any information or record to the board. (iv) Is unfit or incompetent
to practice nursing by reason of negligence, habits or other causes including but not
limited to:
(A) Being unable to practice nursing with reasonable skill and safety to patients by
reason of physical or mental disability, or use of drugs, narcotics, chemicals or any other
mind-altering material; or
(B) Performance of unsafe nursing practice or failure to conform to the essential
standards of acceptable and prevailing nursing practice, in which case actual injury need
not be established.
(v) Has engaged in any unauthorized possession or unauthorized use of a controlled
substance as defined in the Wyoming Controlled Substances Act [§§ 35-7-1001 through
35-7-1057];
(vi) Has had a license to practice nursing or to practice in another health care discipline
in another jurisdiction, territory or possession of the United States denied, revoked,
suspended or otherwise restricted;
(vii) Has practiced nursing within this state without a valid current license or temporary
permit or as otherwise permitted under this act;
(viii) Has knowingly and willfully failed to report to the board any violation of this act
or of board rules and regulations;
(ix) Has been found by the board to have violated any of the provisions of this act or of
board rules and regulations; or
(x) Has knowingly engaged in an act which the licensee knew was beyond the scope of
the individual’s nursing practice prior to committing the act, or performed acts without
sufficient education, knowledge, or ability to apply nursing principles and skills; or
(xi) Has failed to submit to a mental, physical or medical competency examination
following a proper request by the board made pursuant to board rules and regulations and
the Wyoming Administrative Procedure Act.
(b) Upon receipt from the department of family services of a certified copy of an order
from a court to withhold, suspend or otherwise restrict a license issued by the board, the
board shall notify the party named in the court order of the withholding, suspension
or restriction of the license in accordance with the terms of the court order. No appeal
under the Wyoming Administrative Procedure Act shall be allowed for a license
withheld, suspended or restricted under this subsection” (pg 12-13 of 18).
DENIALS OF APPLICANTS SEEKING LICENSURE OR CERTIFICATION
BRITTANIA STONER CNA APPLICANT DISMISSAL
On or about February 1, 2011, WSBN entered an Order of Dismissal against Brittania Stoner, CNA Applicant. Ms. Stoner’s application for certification as a CNA was denied
by WSBN application review committee based upon information indicating a criminal history. Ms. Stoner notified WSBN she no longer wished to pursue her request for a
hearing. The preliminary denial is confirmed as a final denial of Ms. Stoner’s application, and the proceedings related thereto have been dismissed for failure to prosecute.
AMANDA STEPHENS CNA APPLICANT DISMISSAL
On or about February 1, 2011, WSBN entered an Order of Dismissal against Amanda Stephens, CNA Applicant. Ms. Stephens’ application for certification as a CNA was
denied by WSBN application review committee based upon information indicating a criminal history. Subsequent to filing her request for a hearing, Ms. Stephens failed to
appear at scheduled pre-hearing conferences or other pursue her request for a hearing. The preliminary denial is confirmed as a final denial of Ms. Stephens’ application, and
the proceedings related thereto have been dismissed for failure to prosecute.
WILLIAM CARSON
CNA APPLICANT
Mr. Carson’s application for certification as a CNA was denied by WSBN application review committee based upon information indicating a criminal history and impairment
issues.
KASSIDY FALKENBURG
CNA APPLICANT
Ms. Falkenburg’s application for certification as a CNA was denied by WSBN application review committee based upon information indicating a criminal history and related
impairment issues.
HOLLIE GUERRERo
CNA APPLICANT
Ms. Guerrero’s application for certification as a CNA was denied by WSBN application review committee due based upon information indicating a criminal history and related
impairment issues.
Wyoming Nurse Reporter 29

Gems Worth Sharing...
Pearls of Practice
Everyone has a nursing secret…..a special
method of doing something they learned
along the way from another nurse, a mentor,
a clinical instructor or by trial and error. It
might be evidence based practice or an old
“nurses” tale, but if it works and makes things
easier for you or your patient the WSBN is
interested in hearing from YOU. Any CNA,
LPN, RN, or APRN can submit. Share your
experience or creativity. Send in your Pearls
of Practice to wynursing@state.wy.us and if
selected for publication you will receive a
special gift.
This issue we feature Pearls from the
Board. We asked each board member to
submit their favorite Pearls.
NG tubes. Before inserting a salem NG,
try soaking it briefly in some very warm water.
This makes the tube softer and more flexible
and better able to snake through the sinuses
without tissue damage. Just don’t get it so
hot that it burns the nasal tissue.
Having trouble getting an NG to go down
the esophagus instead of the trachea? Just as
you use the natural curve of the tubing to go
through the sinus, when you pass it through
the back of the throat twist the tube 180
degrees so the natural curve of the tubing is
posterior. That will keep the tip of the NG
away from the windpipe and right down into
the stomach. (X-ray is still gold standard for
verifying placement).
When you enter a patient’s room for
the first time, take a moment to establish a
personal connection before launching into
your assessment routine. Try to establish eye
level communication rather than standing
over the patient. Sit on a stool or the edge
of the bed when you introduce yourself and
ask a few questions. This will humanize your
further interactions and help establish trust.
Remember your ABCs when interpreting
a chest X-ray.
A= airway (is the ET tube in the correct
position, any deviations of airway not related
to positioning)
B= bones (are the clavicles intact, correct
number of ribs, etc)
C= cardiac (what is the shape of the heart)
D= diaphragm (what’s the level, is it present
all the way across)
E/F= Equal lung Fields (are the fields
homogenous, hyperinflation vs.
hypoinflation)
G= gas pattern of bowels (is it present all the
way to colon, any abnormal dilation)
H= hardware (central lines and leads, is the
NG tube in the correct position)
NEXT ISSUE: What are your favorite
mnemonics?
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30 Wyoming Nurse Reporter

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Wyoming State Board of Nursing
1810 Pioneer Ave.
Cheyenne, Wyoming 82002
Presorted Standard
U.S. Postage Paid
Little Rock, AR
Permit No. 1884
TO OUR STATE’S WONDERFUL NURSING COMMUNITY:
THANKS FOR YOUR SERVICE
AND ALL THAT YOU DO!
Remember, wherever you work or volunteer as a nurse,
you can speak up about colorectal cancer.
Colorectal Cancer is the only cancer that is preventable
with screening!
Help us spread the word about prevention.
Save a life - one colon at a time!
Letha Buller, RN,
Patient Care Coordinator
Downtown Clinic, Laramie, WY
The Wyoming Colorectal Cancer
Screening Program would like
to express gratitude and
admiration for the state’s free
clinic nurses. You Make This
World A Better Place!
Not pictured:
Teton Free Clinic
Jackson, Wyoming
Margie Schauland, RN
Heart Mountain Volunteer Medical Clinic
Cody, Wyoming
Marty Kethman, LPN and Cyndy Rankin RN
Free Clinic of Sheridan County, Sheridan, WY
TO APPLY FOR A FREE COLONOSCOPY
Call 1-866-205-5292
or visit https://ccedp.health.wyo.gov
Sadie Hockenhull, RN
Heart Mountain Volunteer Medical Clinic
Powell, WY