WEBVTT 00:00:05.346 --> 00:00:11.426 position:50% align:middle - [Nicole] So between now and lunch, we are going to have a panel titled, 00:00:11.426 --> 00:00:16.196 position:50% align:middle "Interdisciplinary Regulation: Strength in Numbers." 00:00:16.196 --> 00:00:23.826 position:50% align:middle So the goal of this panel with these esteemed panelists is to demonstrate how regulatory boards can work 00:00:23.826 --> 00:00:26.696 position:50% align:middle together to achieve policy goals. 00:00:26.696 --> 00:00:32.765 position:50% align:middle So I think here to connect it to Jefferson, we can think about Lewis and Clark and all the 00:00:32.765 --> 00:00:39.305 position:50% align:middle individuals that had to play their specific roles in order to achieve an outcome. 00:00:39.305 --> 00:00:45.095 position:50% align:middle And so it's really what we're hoping to highlight here is how you can work together with other regulatory 00:00:45.095 --> 00:00:52.745 position:50% align:middle boards in your jurisdiction to achieve policy goals or to stop a policy initiative that you believe will 00:00:52.745 --> 00:00:54.585 position:50% align:middle harm the public. 00:00:54.585 --> 00:00:58.805 position:50% align:middle So in order to accomplish this goal, we have with us David Brown, 00:00:58.805 --> 00:01:03.759 position:50% align:middle who you may recognize from yesterday, who has served as the director of the Virginia 00:01:03.759 --> 00:01:09.079 position:50% align:middle Department of Health Professions under three Virginia Governors overseeing the work of Virginia's 13 00:01:09.079 --> 00:01:12.589 position:50% align:middle health regulatory boards. 00:01:12.589 --> 00:01:17.909 position:50% align:middle And David was also a member of the Virginia Board of Medicine and the past president of the Federation 00:01:17.909 --> 00:01:19.949 position:50% align:middle of Chiropractic Licensing Boards. 00:01:19.949 --> 00:01:28.909 position:50% align:middle So obviously a lot of collaboration going on within David's tenure working at DHP and prior to that on the 00:01:28.909 --> 00:01:30.574 position:50% align:middle Board of Medicine. 00:01:30.574 --> 00:01:34.444 position:50% align:middle We then have Kelly Jenkins, who is the executive director of the Kentucky 00:01:34.444 --> 00:01:35.814 position:50% align:middle Board of Nursing. 00:01:35.814 --> 00:01:41.434 position:50% align:middle And prior to her role as executive director, Kelly previously served on the Kentucky Board 00:01:41.434 --> 00:01:47.214 position:50% align:middle of Nursing for seven years and was both president and vice president of the Kentucky Board. 00:01:47.214 --> 00:01:50.514 position:50% align:middle And then last but not least, we have Phyllis Polk Johnson, 00:01:50.514 --> 00:01:55.214 position:50% align:middle who is the CEO and Executive Director of the Mississippi Board of Nursing, 00:01:55.214 --> 00:01:59.134 position:50% align:middle and currently serves as president of NCSBN. 00:01:59.134 --> 00:02:04.936 position:50% align:middle So we welcome our panelists here to talk about this important issue, and we hope that the audience will 00:02:04.936 --> 00:02:10.936 position:50% align:middle have some takeaways, some lessons, some thoughts on how you can work with other 00:02:10.936 --> 00:02:17.716 position:50% align:middle professional regulatory boards in your jurisdiction to achieve public policy and advocacy goals. 00:02:17.716 --> 00:02:21.926 position:50% align:middle So I'm going to start off with a prompt, and I'm going to start with you Phyllis, 00:02:21.926 --> 00:02:29.066 position:50% align:middle and then work our way this way towards David, just talking about and telling us about a time when you 00:02:29.066 --> 00:02:34.104 position:50% align:middle worked with other regulatory boards to affect policy change. 00:02:34.104 --> 00:02:37.253 position:50% align:middle - [Dr. Johnson] Well, first of all, I want to say thank you to NCSBN for allowing me to be 00:02:37.253 --> 00:02:40.673 position:50% align:middle a part of this panel and be with these esteemed guests up here. 00:02:40.673 --> 00:02:45.363 position:50% align:middle I feel very honored and privileged to be sitting with the historian David there. 00:02:45.363 --> 00:02:50.493 position:50% align:middle And I know we had met briefly prior to his presentation, which was a great presentation. 00:02:50.493 --> 00:02:56.503 position:50% align:middle So I'm excited to speak to you just shortly about a time when we've worked in Mississippi. 00:02:56.503 --> 00:03:01.289 position:50% align:middle I am from Mississippi, so many of you probably have contacted me about the 00:03:01.289 --> 00:03:02.869 position:50% align:middle IV hydration issues. 00:03:02.869 --> 00:03:05.549 position:50% align:middle I know there are a couple of states that have. 00:03:05.549 --> 00:03:12.209 position:50% align:middle That is one of the issues that we talked about and did some things with our regulatory entities. 00:03:12.209 --> 00:03:15.279 position:50% align:middle Another one is the mileage restriction. 00:03:15.279 --> 00:03:21.679 position:50% align:middle Prior to me becoming the executive director, I was the director of Advanced Practice and Licensure 00:03:21.679 --> 00:03:23.369 position:50% align:middle for the Mississippi Board of Nursing. 00:03:23.369 --> 00:03:28.299 position:50% align:middle One of the issues was the mileage restriction of 25 to 30 miles. 00:03:28.299 --> 00:03:30.482 position:50% align:middle And we are a collaborative state. 00:03:30.482 --> 00:03:38.362 position:50% align:middle So that was an issue that basically was in the Board of Medical Licensure's rules and regulations. 00:03:38.362 --> 00:03:40.362 position:50% align:middle We reviewed our rules and regulations. 00:03:40.362 --> 00:03:45.232 position:50% align:middle We did not have a mileage restriction, but because we were a collaborative state, 00:03:45.232 --> 00:03:49.922 position:50% align:middle we had to work with the Board of Medical Licensure to get that rule changed. 00:03:49.922 --> 00:03:54.582 position:50% align:middle So that was one of the things that we worked with initially with the regulatory board. 00:03:54.582 --> 00:03:57.112 position:50% align:middle And just let me be clear. 00:03:57.112 --> 00:04:03.458 position:50% align:middle There was not a good relationship between the Board of Medical Licensure and the Board of Nursing. 00:04:03.458 --> 00:04:10.428 position:50% align:middle When I say not a good relationship, there was mistrust quite naturally, mistrust. 00:04:10.428 --> 00:04:18.028 position:50% align:middle They had control of how basically the nurse practitioners or the APRNs could practice in our state 00:04:18.028 --> 00:04:20.608 position:50% align:middle because we were a collaborative state. 00:04:20.608 --> 00:04:22.908 position:50% align:middle It required us to have a physician. 00:04:22.908 --> 00:04:26.908 position:50% align:middle So there were some barriers that need to be broken down at that point. 00:04:26.908 --> 00:04:32.268 position:50% align:middle One of the things that assisted with that was a change in leadership at the Board of Medical Licensure 00:04:32.268 --> 00:04:33.658 position:50% align:middle during my tenure. 00:04:33.658 --> 00:04:38.728 position:50% align:middle And that has continued now with being in the executive director role. 00:04:38.728 --> 00:04:43.838 position:50% align:middle We developed a good working relationship with the new executive director who was willing to reach out and 00:04:43.838 --> 00:04:45.698 position:50% align:middle cross the aisle. 00:04:45.698 --> 00:04:54.938 position:50% align:middle And as I think our last speaker, Larry, I believe, talked about how politics is dirty, 00:04:54.938 --> 00:05:01.351 position:50% align:middle but politics is the driving force in almost everything we do in the regulatory arena. 00:05:01.351 --> 00:05:03.771 position:50% align:middle So that was one of the things. 00:05:03.771 --> 00:05:09.811 position:50% align:middle Another major component, I know we have a time limit, another major item that we dealt with in addition 00:05:09.811 --> 00:05:18.661 position:50% align:middle to the IV hydration was the Mississippi Community College Board who legislated at that a couple 00:05:18.661 --> 00:05:24.431 position:50% align:middle of years ago, about three years ago now, to bring the Practical Nursing Education Program 00:05:24.431 --> 00:05:26.381 position:50% align:middle under the Board of Nursing. 00:05:26.381 --> 00:05:27.851 position:50% align:middle That happened during my tenure. 00:05:27.851 --> 00:05:29.061 position:50% align:middle That was... 00:05:29.061 --> 00:05:34.236 position:50% align:middle They had tried before and it failed, but this time they approached us, 00:05:34.236 --> 00:05:38.166 position:50% align:middle and by working together, we were able to get the Practical Nursing Education 00:05:38.166 --> 00:05:40.416 position:50% align:middle program on the Board of Nursing. 00:05:40.416 --> 00:05:44.766 position:50% align:middle So more to come on that, and I can give you more specifics of how we did that 00:05:44.766 --> 00:05:46.316 position:50% align:middle once everyone else speaks. 00:05:46.316 --> 00:05:52.326 position:50% align:middle But those are three things that we have worked with other boards to affect policy change. 00:05:52.326 --> 00:05:55.426 position:50% align:middle And policy change was affected in each one of those areas. 00:05:58.626 --> 00:05:59.732 position:50% align:middle - Kelly? 00:05:59.732 --> 00:06:01.053 position:50% align:middle - [Kelly J.] Okay. 00:06:01.053 --> 00:06:06.013 position:50% align:middle So what I'm going to talk about is what I kind of consider a perfect storm that happened in Kentucky. 00:06:06.013 --> 00:06:11.653 position:50% align:middle So we also have done the IV hydration and a few other things that Phyllis had mentioned. 00:06:11.653 --> 00:06:16.223 position:50% align:middle But one of the nuances that we had, problems, and complaints was 00:06:16.223 --> 00:06:18.263 position:50% align:middle regarding certified medication aides. 00:06:18.263 --> 00:06:24.083 position:50% align:middle And I'm not sure how many of you all provide oversight for them, but we had complaints that were coming 00:06:24.083 --> 00:06:29.583 position:50% align:middle in from constituents that there were not enough classes to become certified medication aides. 00:06:29.583 --> 00:06:33.657 position:50% align:middle So all of our long-term skilled facilities required that. 00:06:33.657 --> 00:06:37.517 position:50% align:middle And what we found out was that we only had one sole provider in the state, 00:06:37.517 --> 00:06:40.497 position:50% align:middle and that was through our community college system. 00:06:40.497 --> 00:06:45.507 position:50% align:middle The community college system was facing a staffing shortage of faculty members, 00:06:45.507 --> 00:06:48.817 position:50% align:middle as you all probably can realize that. 00:06:48.817 --> 00:06:54.627 position:50% align:middle And so they were pulling the courses that usually would be taught for the certified medication aides. 00:06:54.627 --> 00:06:57.727 position:50% align:middle They were having to take that faculty and teach programs of nursing. 00:06:57.727 --> 00:07:03.100 position:50% align:middle So they were only scheduling the classes for certified medication aides whenever they had a class 00:07:03.100 --> 00:07:04.150 position:50% align:middle that was full. 00:07:04.150 --> 00:07:09.680 position:50% align:middle So you can imagine the skilled facility centers who needed staffing and they could not afford to wait. 00:07:09.680 --> 00:07:16.300 position:50% align:middle We also had an ask from the long-term care facilities for certified medication aides to be able 00:07:16.300 --> 00:07:19.240 position:50% align:middle to administer insulin injections. 00:07:19.240 --> 00:07:27.630 position:50% align:middle So again, over 60% of their population are diabetics, and they were having a nursing shortage as well. 00:07:27.630 --> 00:07:29.700 position:50% align:middle So that was one of the ask that came to us. 00:07:29.700 --> 00:07:32.851 position:50% align:middle So we then in turn developed a work group. 00:07:32.851 --> 00:07:36.211 position:50% align:middle So our work group consisted of the pharmacy board. 00:07:36.211 --> 00:07:41.671 position:50% align:middle We had members from the Licensed Diabetes Educator Board, which is a separate board in Kentucky. 00:07:41.671 --> 00:07:45.921 position:50% align:middle We had KCTCS members who is our community college system. 00:07:45.921 --> 00:07:48.051 position:50% align:middle We had the Cabinet for Health and Family Services. 00:07:48.051 --> 00:07:50.741 position:50% align:middle And the agency is called the OIG in Kentucky. 00:07:50.741 --> 00:07:53.711 position:50% align:middle It's not the federal OIG, but we do refer to them as the Office 00:07:53.711 --> 00:07:54.721 position:50% align:middle of Inspector General. 00:07:54.721 --> 00:07:58.561 position:50% align:middle So we even had a state representative who served on our work group. 00:07:58.561 --> 00:08:05.348 position:50% align:middle So when we learned all about these, you know, issues, we developed a plan. 00:08:05.348 --> 00:08:07.848 position:50% align:middle So we did get a bill. 00:08:07.848 --> 00:08:10.268 position:50% align:middle So we drafted a bill, we had a bill sponsor. 00:08:10.268 --> 00:08:11.608 position:50% align:middle Actually, there was three of them. 00:08:11.608 --> 00:08:16.688 position:50% align:middle And it helped to have the co-chairs of the Health and Family Services Committee. 00:08:16.688 --> 00:08:23.068 position:50% align:middle So we have Senator Meredith, who used to be a CEO for like 30 years. 00:08:23.068 --> 00:08:27.228 position:50% align:middle And then we have Representative Moser who is a registered nurse. 00:08:27.228 --> 00:08:31.366 position:50% align:middle So that kind of helped along the way with the bill sponsor. 00:08:31.366 --> 00:08:37.136 position:50% align:middle So what we realized is when we got into the work group, we didn't have a formal data registry 00:08:37.136 --> 00:08:39.166 position:50% align:middle for certified medication aides. 00:08:39.166 --> 00:08:46.076 position:50% align:middle What the college system had was an Excel spreadsheet that started in 1991 that had over 10,000 names on it. 00:08:46.076 --> 00:08:52.696 position:50% align:middle So we had no idea how many were active, how many were non-active. 00:08:52.696 --> 00:08:58.066 position:50% align:middle So along the way of the bill drafting, we certainly recognized that we needed to set standards 00:08:58.066 --> 00:09:05.116 position:50% align:middle for the application and renewal process and have some educational requirements for the renewal process. 00:09:05.116 --> 00:09:10.276 position:50% align:middle So we developed the training program standards for Certified Medication Aide I, 00:09:10.276 --> 00:09:13.316 position:50% align:middle which were just the oral and topical medications. 00:09:13.316 --> 00:09:19.646 position:50% align:middle And then we also created standards for Certified Medication Aide II, which would be allowed to give 00:09:19.646 --> 00:09:24.016 position:50% align:middle insulin by prefilled insulin injections. 00:09:24.016 --> 00:09:30.523 position:50% align:middle So what we learned from this is, you know, you definitely have to have everybody on board. 00:09:30.523 --> 00:09:33.973 position:50% align:middle So you wouldn't want pharmacy board opposing your bill. 00:09:33.973 --> 00:09:37.653 position:50% align:middle You wouldn't want the OIG opposing your bill. 00:09:37.653 --> 00:09:45.443 position:50% align:middle So it takes everybody working together collaboratively to set the tone before you take a bill 00:09:45.443 --> 00:09:47.093 position:50% align:middle to your legislators. 00:09:47.093 --> 00:09:53.873 position:50% align:middle Because we all sat at the table when we testified, there were no questions asked really by our 00:09:53.873 --> 00:09:55.633 position:50% align:middle legislators at all. 00:09:55.633 --> 00:09:58.933 position:50% align:middle I can tell you it was a great bill. 00:09:58.933 --> 00:09:59.863 position:50% align:middle We now have... 00:09:59.863 --> 00:10:01.876 position:50% align:middle We just started taking the applications. 00:10:01.876 --> 00:10:07.236 position:50% align:middle We already have 809 certified medication aides now. 00:10:07.236 --> 00:10:12.496 position:50% align:middle We have about 15 training programs that have already been approved in Kentucky. 00:10:12.496 --> 00:10:20.056 position:50% align:middle We also now are utilizing the MACE exam, which is offered through the National Council of State 00:10:20.056 --> 00:10:22.136 position:50% align:middle Boards of Nursing through Credentia. 00:10:22.136 --> 00:10:26.796 position:50% align:middle So that is just now getting ready to go up on our website within the next two weeks. 00:10:26.796 --> 00:10:34.006 position:50% align:middle So we're very...we've had very good results from this. 00:10:34.006 --> 00:10:39.396 position:50% align:middle And I also, just another caveat, I think it's important for the regulator executive 00:10:39.396 --> 00:10:45.246 position:50% align:middle director to be involved with professional organizations that speak to these entities. 00:10:45.246 --> 00:10:48.786 position:50% align:middle So we have, like, leading age and we have some other... 00:10:48.786 --> 00:10:50.166 position:50% align:middle We have a couple other organizations. 00:10:50.166 --> 00:10:56.146 position:50% align:middle And so I'm invited to be an annual speaker at those events so that I'm able to give them Kentucky Board 00:10:56.146 --> 00:10:58.766 position:50% align:middle of Nursing updates so that it keeps them current. 00:10:58.766 --> 00:11:02.834 position:50% align:middle It also relaxes them, and they realize that they can come to us and ask 00:11:02.834 --> 00:11:06.514 position:50% align:middle questions so that we can ensure they're doing the right things. 00:11:06.514 --> 00:11:06.874 position:50% align:middle So... 00:11:06.874 --> 00:11:09.284 position:50% align:middle - Thank you, Kelly. 00:11:09.284 --> 00:11:09.634 position:50% align:middle David? 00:11:09.634 --> 00:11:11.754 position:50% align:middle - [David] Sure. 00:11:11.754 --> 00:11:14.324 position:50% align:middle You know, there's a number of directions I could go on this. 00:11:14.324 --> 00:11:22.164 position:50% align:middle Obviously, Virginia having a very comprehensive agency with all the boards under one roof, 00:11:22.164 --> 00:11:24.124 position:50% align:middle there's a lot of examples of collaboration. 00:11:24.124 --> 00:11:28.544 position:50% align:middle But I wanted to start 30 years ago. 00:11:28.544 --> 00:11:36.015 position:50% align:middle And 30 years ago, I had just gotten on the board of the Federation of Chiropractic Licensing Boards. 00:11:36.015 --> 00:11:48.175 position:50% align:middle And in 1995, the Pew Health Professions Commission task force on healthcare workforce regulation issued a 00:11:48.175 --> 00:11:57.295 position:50% align:middle well-publicized report on how health professional regulation should be reformed. 00:11:57.295 --> 00:12:06.594 position:50% align:middle Now I'm pretty sure that I was attending either a FARB conference or a CLEAR conference that a group of us who 00:12:06.594 --> 00:12:10.494 position:50% align:middle were attending from different professions kind of started talking about this. 00:12:10.494 --> 00:12:17.434 position:50% align:middle It has just come out and it had some recommendations that we all could kind of agree on, the need for... 00:12:17.434 --> 00:12:24.064 position:50% align:middle Is there some way to standardize among the states the language that we use, 00:12:24.064 --> 00:12:25.994 position:50% align:middle certification, registration, licensure? 00:12:25.994 --> 00:12:30.812 position:50% align:middle Can we standardize those terms and standardize the categories? 00:12:30.812 --> 00:12:33.642 position:50% align:middle So it's apples to apples in all jurisdictions. 00:12:33.642 --> 00:12:36.952 position:50% align:middle Well, a noble goal, not necessarily easy. 00:12:36.952 --> 00:12:42.672 position:50% align:middle Another recommendation they had, collect workforce data using state boards. 00:12:42.672 --> 00:12:45.182 position:50% align:middle Well, okay, we can agree on that one. 00:12:45.182 --> 00:12:51.272 position:50% align:middle But some of the recommendations, especially back then, were pretty on the edge. 00:12:51.272 --> 00:13:00.585 position:50% align:middle For example, the Pew Commission recommended that entry to practice in all health professions to be based only 00:13:00.585 --> 00:13:07.525 position:50% align:middle on demonstrated competence, nothing else, because they wanted to improve mobility, 00:13:07.525 --> 00:13:11.075 position:50% align:middle make it easy for people to get licensed in one state go somewhere else. 00:13:11.075 --> 00:13:18.625 position:50% align:middle Continued licensure, according to the Pew Commission, also would depend on periodic competence assessments. 00:13:18.625 --> 00:13:21.555 position:50% align:middle So we're kind of going, "Uh-oh." 00:13:21.555 --> 00:13:31.978 position:50% align:middle They also recommended developing in each state an oversight board with the majority of citizen members 00:13:31.978 --> 00:13:39.478 position:50% align:middle who could amend or overturn regulations by individual boards. 00:13:39.478 --> 00:13:45.428 position:50% align:middle So this is kind of worrisome stuff. 00:13:45.428 --> 00:13:52.688 position:50% align:middle The National Council of State Boards of Nursing at the meeting where we started talking about this, 00:13:52.688 --> 00:13:55.448 position:50% align:middle got all the professions together. 00:13:55.448 --> 00:13:58.818 position:50% align:middle Now, of course, there was one profession that didn't choose to participate. 00:13:58.818 --> 00:14:00.842 position:50% align:middle Can you guess? 00:14:00.842 --> 00:14:02.912 position:50% align:middle Medicine. 00:14:02.912 --> 00:14:05.282 position:50% align:middle Well, anyway, I won't go there too far. 00:14:05.282 --> 00:14:08.442 position:50% align:middle But we all get together. 00:14:08.442 --> 00:14:14.202 position:50% align:middle And it was a great thing that the National Council did for the smaller professions, 00:14:14.202 --> 00:14:19.842 position:50% align:middle the Federation of Chiropractic Licensing Board, for example, because we have limited resources, 00:14:19.842 --> 00:14:24.892 position:50% align:middle we have limited real experience, and we got to work at the table. 00:14:24.892 --> 00:14:28.032 position:50% align:middle So we all understood what all of our concerns were. 00:14:28.032 --> 00:14:30.757 position:50% align:middle We met a number of times in Chicago. 00:14:30.757 --> 00:14:35.627 position:50% align:middle It was led by a nurse at the National Council. 00:14:35.627 --> 00:14:41.307 position:50% align:middle I mean, the...yes, Jennifer Bosma. 00:14:41.307 --> 00:14:43.757 position:50% align:middle I don't know if any of you knew her. 00:14:43.757 --> 00:14:45.767 position:50% align:middle She was fabulous. 00:14:45.767 --> 00:14:53.187 position:50% align:middle And then at the end of this, the National Council put out a very detailed and 00:14:53.187 --> 00:14:58.517 position:50% align:middle specific response to the Pew Commission's report. 00:14:58.517 --> 00:15:00.416 position:50% align:middle I don't know that other... 00:15:00.416 --> 00:15:05.226 position:50% align:middle We didn't, the Federation of Chiropractic Licensing Boards. 00:15:05.226 --> 00:15:08.886 position:50% align:middle But what we did do was we had knowledge of it. 00:15:08.886 --> 00:15:10.496 position:50% align:middle We talked about it at our conferences. 00:15:10.496 --> 00:15:16.516 position:50% align:middle It was on our radar and we understood from our annual meeting and district meetings of the federation what 00:15:16.516 --> 00:15:20.956 position:50% align:middle the problems were in case these things came up in our states. 00:15:20.956 --> 00:15:27.136 position:50% align:middle I will say the one thing I'm curious about because I can't find a direct link, 00:15:27.136 --> 00:15:37.808 position:50% align:middle but a lot of the recommendations of the Pew Commission were about mobility of healthcare practitioners. 00:15:37.808 --> 00:15:47.038 position:50% align:middle 1996 is when our groups are meeting and coming up with ideas, and it's around that time that their interstate 00:15:47.038 --> 00:15:49.558 position:50% align:middle compact in nursing starts. 00:15:49.558 --> 00:15:51.428 position:50% align:middle And so, I don't know, I don't necessarily... 00:15:51.428 --> 00:15:56.578 position:50% align:middle I didn't see it being a direct response, but I think it was a reason to respond, yes, 00:15:56.578 --> 00:15:57.908 position:50% align:middle there is a problem. 00:15:57.908 --> 00:16:00.058 position:50% align:middle Let's see what we can do to fix it. 00:16:00.058 --> 00:16:02.232 position:50% align:middle And so I'll stop there. 00:16:02.232 --> 00:16:03.102 position:50% align:middle - Thank you. 00:16:03.102 --> 00:16:03.732 position:50% align:middle Thank you so much. 00:16:03.732 --> 00:16:09.162 position:50% align:middle And David, I think what you just spoke to there in part is talking about a formal structure that was in place. 00:16:09.162 --> 00:16:15.332 position:50% align:middle NCSBN brought together different professions, some small, some large to come together and really, 00:16:15.332 --> 00:16:22.452 position:50% align:middle you know, face the challenge and come up with solutions or a response that would hopefully be able to guide any 00:16:22.452 --> 00:16:24.382 position:50% align:middle policy changes moving forward. 00:16:24.382 --> 00:16:29.712 position:50% align:middle But Phyllis and Kelly, I want to ask you about any formal or informal 00:16:29.712 --> 00:16:35.094 position:50% align:middle structures in place for regulators in your jurisdictions to interact. 00:16:35.094 --> 00:16:40.354 position:50% align:middle And also, you know, as executive officers, are those structures in place so that you can 00:16:40.354 --> 00:16:42.394 position:50% align:middle communicate with other board heads? 00:16:42.394 --> 00:16:45.024 position:50% align:middle But also, what about for board members? 00:16:45.024 --> 00:16:52.724 position:50% align:middle - So in Kentucky, executive directors from all of our licensing boards that report through the 00:16:52.724 --> 00:16:56.754 position:50% align:middle Governor's office, we meet on a quarterly basis. 00:16:56.754 --> 00:17:01.552 position:50% align:middle So we actually meet in person and have a lunch meeting. 00:17:01.552 --> 00:17:07.662 position:50% align:middle And so I think, you know, having that collective voice whenever you go forth 00:17:07.662 --> 00:17:12.932 position:50% align:middle with a bill or whatever you're proposing, you know, definitely has more influence on your policymakers 00:17:12.932 --> 00:17:16.942 position:50% align:middle because if you're all sitting at the table, you're all in agreeance. 00:17:16.942 --> 00:17:20.182 position:50% align:middle You know, it's harder for them to ignore your recommendations. 00:17:20.182 --> 00:17:26.112 position:50% align:middle I'm fortunate also that we are across the parking lot from the Board of Medical Licensure. 00:17:26.112 --> 00:17:30.630 position:50% align:middle So that makes it kind of convenient for myself and our staff attorneys. 00:17:30.630 --> 00:17:40.140 position:50% align:middle They write a lot of documents together whenever we put out any type of kind of, like, the IV hydration. 00:17:40.140 --> 00:17:44.320 position:50% align:middle You know, we did a unified response to that between the pharmacy, the Board of Medical Licensure, 00:17:44.320 --> 00:17:45.520 position:50% align:middle and the Board of Nursing. 00:17:45.520 --> 00:17:48.450 position:50% align:middle So our three attorneys, I'm not going to take the credit for all that 00:17:48.450 --> 00:17:53.220 position:50% align:middle elegant writing, you know, they put out that joint statement together. 00:17:53.220 --> 00:18:00.390 position:50% align:middle So our board members, now my board president is here, but it's hard for them, I think, 00:18:00.390 --> 00:18:05.690 position:50% align:middle to get in a room with the other board members just because our meetings are on different dates, 00:18:05.690 --> 00:18:07.840 position:50% align:middle on different days of the week. 00:18:07.840 --> 00:18:11.410 position:50% align:middle And, you know, our board members, you know, they have other commitments, other jobs. 00:18:11.410 --> 00:18:18.230 position:50% align:middle So although I do think it might be beneficial maybe to sponsor maybe an event, we could certainly do that. 00:18:18.230 --> 00:18:19.130 position:50% align:middle It'd be interesting. 00:18:19.130 --> 00:18:24.350 position:50% align:middle But in Kentucky, I'm fortunate because we get along with all of our other executive directors. 00:18:24.350 --> 00:18:29.820 position:50% align:middle I'm in the same building as dentistry, physical therapy, the barbering board is 00:18:29.820 --> 00:18:30.654 position:50% align:middle right beside me. 00:18:30.654 --> 00:18:35.104 position:50% align:middle So there's a lot of uniqueness, but a lot of things that are similar and a lot 00:18:35.104 --> 00:18:36.794 position:50% align:middle of things that are not. 00:18:36.794 --> 00:18:40.684 position:50% align:middle But essentially, we try to share our expertise. 00:18:40.684 --> 00:18:47.044 position:50% align:middle For example, my administration, CFO has been there for decades and she assists other 00:18:47.044 --> 00:18:50.474 position:50% align:middle licensing boards all the time on questions. 00:18:50.474 --> 00:18:55.744 position:50% align:middle My staff attorney, again one of those have been there for a long time. 00:18:55.744 --> 00:18:57.404 position:50% align:middle She assists the other boards. 00:18:57.404 --> 00:18:59.864 position:50% align:middle You know, they reach out to her whenever they have questions. 00:18:59.864 --> 00:19:06.535 position:50% align:middle So I think just collaborating, you know, building those relationships are vitally important. 00:19:06.535 --> 00:19:17.265 position:50% align:middle - So to echo some of what Kelly was saying, do we have a formal or informal structure? 00:19:17.265 --> 00:19:19.965 position:50% align:middle I'm not aware of a formal structure. 00:19:19.965 --> 00:19:28.335 position:50% align:middle However, we do have several informal structures in which we in Mississippi collaborate with the other 00:19:28.335 --> 00:19:30.625 position:50% align:middle regulatory entities now. 00:19:30.625 --> 00:19:35.989 position:50% align:middle I think Virginia is like an umbrella board, and is Kentucky an umbrella... 00:19:35.989 --> 00:19:36.409 position:50% align:middle Independent. 00:19:36.409 --> 00:19:39.889 position:50% align:middle So we are similar in that we're not an umbrella board. 00:19:39.889 --> 00:19:42.789 position:50% align:middle And I will acknowledge my president is here also. 00:19:42.789 --> 00:19:52.299 position:50% align:middle And our board members don't necessarily get a chance to interact as the staff does because of the availability, 00:19:52.299 --> 00:19:53.339 position:50% align:middle you know, of the staff. 00:19:53.339 --> 00:19:56.709 position:50% align:middle This is our job every single day to do that. 00:19:56.709 --> 00:19:58.649 position:50% align:middle But no, there's not an opportunity. 00:19:58.649 --> 00:20:01.495 position:50% align:middle There may be opportunities, but they don't...that's not a formal structure where 00:20:01.495 --> 00:20:02.845 position:50% align:middle they can do that. 00:20:02.845 --> 00:20:06.855 position:50% align:middle Let me tell you what we do have in Mississippi. 00:20:06.855 --> 00:20:12.995 position:50% align:middle We have a regulatory leadership meeting with the Board of Medicine, the Board of Pharmacy, 00:20:12.995 --> 00:20:17.695 position:50% align:middle the Board of Dentistry, the Mississippi State Department of Health 00:20:17.695 --> 00:20:23.195 position:50% align:middle medical officer, chief medical officer, and us. 00:20:23.195 --> 00:20:25.755 position:50% align:middle And we do that on a periodic basis. 00:20:25.755 --> 00:20:27.305 position:50% align:middle It's every other month. 00:20:27.305 --> 00:20:34.766 position:50% align:middle These meetings were developed to discuss issues and concerns that affect the practice of our licensees and 00:20:34.766 --> 00:20:42.576 position:50% align:middle to develop our legislative agendas to address any concerns prior to the legislative session starting. 00:20:42.576 --> 00:20:46.386 position:50% align:middle Now, our session starts in January, but we start... 00:20:46.386 --> 00:20:48.796 position:50% align:middle These meetings are continuous through the year. 00:20:48.796 --> 00:21:00.912 position:50% align:middle And so this has allowed us to have one unified voice when legislative issues arise that we can go as a 00:21:00.912 --> 00:21:05.492 position:50% align:middle unified front and say, "All of these regulatory entities support 00:21:05.492 --> 00:21:06.412 position:50% align:middle this one cause." 00:21:06.412 --> 00:21:09.172 position:50% align:middle That has somewhat been beneficial. 00:21:09.172 --> 00:21:12.602 position:50% align:middle A few years ago, it probably would not have happened. 00:21:12.602 --> 00:21:20.522 position:50% align:middle But that is an evolution of how collaboration works and when you're willing to reach across the aisle and start 00:21:20.522 --> 00:21:25.672 position:50% align:middle things that affect all of our license needs because we're all about public health and the protection 00:21:25.672 --> 00:21:26.462 position:50% align:middle of public health. 00:21:26.462 --> 00:21:27.852 position:50% align:middle So that was one of the entities. 00:21:27.852 --> 00:21:32.995 position:50% align:middle So we have developed a good working relationship with those entities. 00:21:32.995 --> 00:21:38.025 position:50% align:middle And when you look at the benefits of what that does is the achievement of common goals. 00:21:38.025 --> 00:21:39.135 position:50% align:middle We all have common goals. 00:21:39.135 --> 00:21:40.975 position:50% align:middle So achieving of common goals. 00:21:40.975 --> 00:21:43.235 position:50% align:middle We respect each other. 00:21:43.235 --> 00:21:49.375 position:50% align:middle And we had to develop that respect because there was a lack of respect among those regulatory entities. 00:21:49.375 --> 00:21:53.835 position:50% align:middle Resolution of interest, safeguarding the contributions that each member makes 00:21:53.835 --> 00:21:57.315 position:50% align:middle to achieve the optimal goal of what? 00:21:57.315 --> 00:21:58.915 position:50% align:middle Public safety. 00:21:58.915 --> 00:22:00.005 position:50% align:middle That's what it's all about. 00:22:00.005 --> 00:22:05.178 position:50% align:middle And so I always, and those entities always bring back what is our purpose? 00:22:05.178 --> 00:22:06.458 position:50% align:middle What is our role? 00:22:06.458 --> 00:22:12.458 position:50% align:middle Public safety, to protect the safety and the welfare of the citizens that receive the care which we render 00:22:12.458 --> 00:22:14.488 position:50% align:middle in our respective states. 00:22:14.488 --> 00:22:19.748 position:50% align:middle So it's been beneficial to us, but that probably wouldn't have been something that 00:22:19.748 --> 00:22:22.118 position:50% align:middle happened a few years ago. 00:22:22.118 --> 00:22:26.148 position:50% align:middle And not only that, we bring industry into those decision made. 00:22:26.148 --> 00:22:31.226 position:50% align:middle Our stakeholders are involved in those collaborative efforts as well. 00:22:31.226 --> 00:22:33.346 position:50% align:middle The industry, the educators. 00:22:33.346 --> 00:22:35.356 position:50% align:middle I'm also... 00:22:35.356 --> 00:22:40.236 position:50% align:middle It's also nice to have the director of nursing education from the institutions of higher learning 00:22:40.236 --> 00:22:43.576 position:50% align:middle at this meeting today from Mississippi, Dr. Melissa Temple. 00:22:43.576 --> 00:22:44.726 position:50% align:middle My board president is Ms. 00:22:44.726 --> 00:22:46.136 position:50% align:middle Sandra Culpepper. 00:22:46.136 --> 00:22:53.106 position:50% align:middle And so we have to work with IHL because we are one of probably two states that don't control the 00:22:53.106 --> 00:22:54.606 position:50% align:middle RN education, the programs. 00:22:54.606 --> 00:22:57.066 position:50% align:middle A lot of your other boards of nursing do that. 00:22:57.066 --> 00:22:58.036 position:50% align:middle So we don't. 00:22:58.036 --> 00:23:00.156 position:50% align:middle We do have the practical nursing education. 00:23:00.156 --> 00:23:03.390 position:50% align:middle So Dr. Temple is great to work with. 00:23:03.390 --> 00:23:05.420 position:50% align:middle Dr. Temple, wave your hand if you're in the room. 00:23:05.420 --> 00:23:07.070 position:50% align:middle There she is in the back. 00:23:07.070 --> 00:23:08.460 position:50% align:middle She told me she was coming. 00:23:08.460 --> 00:23:13.690 position:50% align:middle She has been a godsend, and she is very easy to work with because they have 00:23:13.690 --> 00:23:18.640 position:50% align:middle their own standards and policies, but they affect what we do in regulation. 00:23:18.640 --> 00:23:19.950 position:50% align:middle So we have to work together. 00:23:19.950 --> 00:23:21.470 position:50% align:middle So that has worked well for us. 00:23:21.470 --> 00:23:28.750 position:50% align:middle That's another example of collaboration and how you develop those relationships and partnerships that are 00:23:28.750 --> 00:23:32.813 position:50% align:middle beneficial for the common good. 00:23:32.813 --> 00:23:39.063 position:50% align:middle - I wanted to just kind of echo what I heard Kelly say, and then I heard Phyllis say, 00:23:39.063 --> 00:23:46.783 position:50% align:middle which is how important the collaboration is among the staff, you know, the executive directors and other 00:23:46.783 --> 00:23:51.383 position:50% align:middle staff of the different professions when it's feasible. 00:23:51.383 --> 00:23:53.243 position:50% align:middle Virginia kind of has both. 00:23:53.243 --> 00:23:59.053 position:50% align:middle We have the Board of Health Professions, which has a member from each of our licensing board, 00:23:59.053 --> 00:24:03.810 position:50% align:middle a member of the board, but then we also have the building where all of our 00:24:03.810 --> 00:24:08.710 position:50% align:middle boards are together and the executive directors rub shoulders every day. 00:24:08.710 --> 00:24:13.170 position:50% align:middle And I will say, I like to remind sometimes some of the board members when they need it, 00:24:13.170 --> 00:24:22.030 position:50% align:middle is rely on your executive director and the other staff because they do this work all day, every day, 00:24:22.030 --> 00:24:26.870 position:50% align:middle as opposed to board members who often come in with fairly limited knowledge. 00:24:26.870 --> 00:24:30.360 position:50% align:middle And so to me, if it's a... 00:24:30.360 --> 00:24:37.340 position:50% align:middle Efforts and collaborations really should come by establishing ties at the staff level. 00:24:37.340 --> 00:24:39.018 position:50% align:middle - Thank you so much for those comments. 00:24:39.018 --> 00:24:44.888 position:50% align:middle And Kelly, you had talked about a specific, you know, instance where you worked with other boards and variety 00:24:44.888 --> 00:24:46.408 position:50% align:middle of stakeholders outside of boards. 00:24:46.408 --> 00:24:52.098 position:50% align:middle As we've learned, so important to work with the professions as well and work with stakeholders 00:24:52.098 --> 00:24:54.008 position:50% align:middle across the board on an issue. 00:24:54.008 --> 00:24:56.478 position:50% align:middle Phyllis, can you talk about an example of... 00:24:56.478 --> 00:24:59.248 position:50% align:middle I know you brought up IV hydration and others about... 00:24:59.248 --> 00:25:05.440 position:50% align:middle Sort of what was the problem that you as regulatory boards in Mississippi came together on? 00:25:05.440 --> 00:25:07.810 position:50% align:middle Who was involved in that effort? 00:25:07.810 --> 00:25:09.530 position:50% align:middle And what has come from it? 00:25:09.530 --> 00:25:14.800 position:50% align:middle How have you seen the strength and numbers affect, you know, play out? 00:25:14.800 --> 00:25:20.570 position:50% align:middle - So I would probably say, well, there are two, and I mentioned two at the beginning. 00:25:20.570 --> 00:25:25.830 position:50% align:middle But the number one would probably be the IV hydration because it was such an issue. 00:25:25.830 --> 00:25:34.636 position:50% align:middle And what happened was, you know, we have statutes, even different regulatory agencies have 00:25:34.636 --> 00:25:35.756 position:50% align:middle their own statutes. 00:25:35.756 --> 00:25:41.206 position:50% align:middle So what we looked at, what we saw when this became an issue in Mississippi 00:25:41.206 --> 00:25:49.416 position:50% align:middle was that some of the statutes did not overlap, and some statutes had more power than the other, 00:25:49.416 --> 00:25:51.646 position:50% align:middle if that makes sense. 00:25:51.646 --> 00:26:02.749 position:50% align:middle So it made it even more rational for us to work together because the Nurse Practice Act, statute, 00:26:02.749 --> 00:26:08.429 position:50% align:middle may allow us to do a lot of things that the Board of Medicine could not do because they're not over nurses 00:26:08.429 --> 00:26:10.059 position:50% align:middle but by working together. 00:26:10.059 --> 00:26:15.329 position:50% align:middle And then the Pharmacy Board, there were things that the Pharmacy Board could not do, 00:26:15.329 --> 00:26:17.349 position:50% align:middle but our statute would allow us to do. 00:26:17.349 --> 00:26:26.809 position:50% align:middle So it made more sense for us to work together to come up with a plan of how best to tackle this issue from a 00:26:26.809 --> 00:26:30.535 position:50% align:middle regulatory standpoint and from statutory law. 00:26:30.535 --> 00:26:34.805 position:50% align:middle So we were able to join forces and go out together. 00:26:34.805 --> 00:26:39.805 position:50% align:middle We go out on all investigations together, the Board of Medicine, the Board of Pharmacy, 00:26:39.805 --> 00:26:43.155 position:50% align:middle Board of Nursing on any IV hydration issue. 00:26:43.155 --> 00:26:46.915 position:50% align:middle Pharmacy deals with IV and medications. 00:26:46.915 --> 00:26:48.375 position:50% align:middle We are a collaborative state. 00:26:48.375 --> 00:26:52.435 position:50% align:middle There's a physician involved somewhere at some point with our APRN. 00:26:52.435 --> 00:26:58.515 position:50% align:middle So the Board of Medicine has statutes that address what that physician is doing or is not doing. 00:26:58.515 --> 00:27:03.858 position:50% align:middle Then the Board of Nursing can do a lot of things in their statute. 00:27:03.858 --> 00:27:11.078 position:50% align:middle And the other regulatory entities realize, hmm, it makes sense for us to partner together because then 00:27:11.078 --> 00:27:12.748 position:50% align:middle our laws can overlap. 00:27:12.748 --> 00:27:16.978 position:50% align:middle What this person can't do by this person being there, they can do. 00:27:16.978 --> 00:27:19.768 position:50% align:middle They can get all the information they need while they're sitting there. 00:27:19.768 --> 00:27:22.498 position:50% align:middle Board of Medicine We send a subpoena. 00:27:22.498 --> 00:27:25.118 position:50% align:middle They have subpoena power right there, and they give it to them and they have to give 00:27:25.118 --> 00:27:25.678 position:50% align:middle them the record. 00:27:25.678 --> 00:27:27.898 position:50% align:middle So we can get everything we need in one swoop. 00:27:27.898 --> 00:27:31.805 position:50% align:middle So it made more sense for us to work together. 00:27:31.805 --> 00:27:39.405 position:50% align:middle That's just one example of how I can say it all came together and it made more sense to work together. 00:27:39.405 --> 00:27:43.905 position:50% align:middle The other one is the acquisition of the Practical Nursing Education program from the Mississippi 00:27:43.905 --> 00:27:45.485 position:50% align:middle Community College Board. 00:27:45.485 --> 00:27:46.475 position:50% align:middle They approached us. 00:27:46.475 --> 00:27:49.835 position:50% align:middle They said, "We don't have a nurse over here that's running this program. 00:27:49.835 --> 00:27:50.645 position:50% align:middle You're nursing. 00:27:50.645 --> 00:27:59.845 position:50% align:middle It makes more sense for you guys to be able to have the accreditation, the standards, the education of nurses." 00:27:59.845 --> 00:28:01.222 position:50% align:middle Makes sense, doesn't it? 00:28:01.222 --> 00:28:03.312 position:50% align:middle Makes sense to me. 00:28:03.312 --> 00:28:10.842 position:50% align:middle So they started this process of...and this was a large collaborative effort. 00:28:10.842 --> 00:28:20.372 position:50% align:middle It involved multiple stakeholders, the PN council, the educators across the state, nursing education. 00:28:20.372 --> 00:28:26.682 position:50% align:middle It involved our legislators, it involved industry, the professional associations. 00:28:26.682 --> 00:28:35.255 position:50% align:middle So it was a gamut of people working together to achieve this particular component of, you know, 00:28:35.255 --> 00:28:40.735 position:50% align:middle obtaining the practical nursing education system under the Board of Nursing. 00:28:40.735 --> 00:28:45.475 position:50% align:middle And it has shown that it was a great choice. 00:28:45.475 --> 00:28:49.971 position:50% align:middle We've had it now since 2019, I believe. 00:28:49.971 --> 00:28:56.335 position:50% align:middle And I have a great director, Dr. Priscilla Burks, who was in the community college board system who is 00:28:56.335 --> 00:29:04.125 position:50% align:middle now the director of that program and doing miraculous things, and evolving practical nursing education in the 00:29:04.125 --> 00:29:05.025 position:50% align:middle state of Mississippi. 00:29:05.025 --> 00:29:06.695 position:50% align:middle So that's worked well. 00:29:06.695 --> 00:29:08.775 position:50% align:middle Those are just a couple of examples. 00:29:08.775 --> 00:29:09.355 position:50% align:middle - Wonderful. 00:29:09.355 --> 00:29:10.915 position:50% align:middle Thank you so much. 00:29:10.915 --> 00:29:17.535 position:50% align:middle So we've talked a lot about working together in sort of that kumbaya, but the reality is that sometimes working 00:29:17.535 --> 00:29:22.465 position:50% align:middle with other regulatory boards, you may disagree on a policy issue. 00:29:22.465 --> 00:29:27.865 position:50% align:middle And although it's important to think about how you can plan ahead for what issues may arise, 00:29:27.865 --> 00:29:32.595 position:50% align:middle especially during the legislative session, we know lawmakers can create problems like that. 00:29:32.595 --> 00:29:35.825 position:50% align:middle A filed bill comes out and you had no idea. 00:29:35.825 --> 00:29:41.115 position:50% align:middle In fact, your colleagues through these professional or through these informal or formal structures had no idea 00:29:41.115 --> 00:29:42.435 position:50% align:middle that it was coming. 00:29:42.435 --> 00:29:45.245 position:50% align:middle And so you have issues arise quickly. 00:29:45.245 --> 00:29:50.855 position:50% align:middle I want to specifically focus on those moments where your boards that you've developed these 00:29:50.855 --> 00:29:54.995 position:50% align:middle relationships with, you disagree on a policy issue. 00:29:54.995 --> 00:29:56.625 position:50% align:middle Can you give an example? 00:29:56.625 --> 00:30:02.205 position:50% align:middle And David, I think from your perspective of overseeing some boards that may disagree with one another on a 00:30:02.205 --> 00:30:05.955 position:50% align:middle policy issue, that's going to be fascinating to hear about. 00:30:05.955 --> 00:30:11.605 position:50% align:middle Can you give examples or talk about how you navigate through those situations, in your case, you know, 00:30:11.605 --> 00:30:12.955 position:50% align:middle as a leader? 00:30:12.955 --> 00:30:14.815 position:50% align:middle - Well, that's a great question. 00:30:14.815 --> 00:30:16.005 position:50% align:middle And it does arise. 00:30:16.005 --> 00:30:22.595 position:50% align:middle You know, it certainly arises in our state between the Board of Medicine and the Board of Nursing, 00:30:22.595 --> 00:30:29.715 position:50% align:middle given the fact that we still have a joint board doing regulation of nurses. 00:30:29.715 --> 00:30:34.284 position:50% align:middle And even though there've been recommendations to kind of move away from that, 00:30:34.284 --> 00:30:37.174 position:50% align:middle we're one of the only states that still has that structure. 00:30:37.174 --> 00:30:40.974 position:50% align:middle But we have it in other boards as well. 00:30:40.974 --> 00:30:47.864 position:50% align:middle And, you know, for an example, the ability of physical therapist to do dried needling 00:30:47.864 --> 00:30:49.004 position:50% align:middle as a treatment for pain. 00:30:49.004 --> 00:30:51.914 position:50% align:middle Well, that's opposed by the acupuncturist. 00:30:51.914 --> 00:30:55.474 position:50% align:middle The acupuncturist have an advisory board underneath the Board of Medicine. 00:30:55.474 --> 00:31:03.733 position:50% align:middle You know, navigating that, in my opinion, is less a matter of at the board level because I think 00:31:03.733 --> 00:31:07.103 position:50% align:middle at the board level, you know, you certainly have something where there's respect, 00:31:07.103 --> 00:31:10.803 position:50% align:middle mutual respect, people that know how to get along. 00:31:10.803 --> 00:31:16.933 position:50% align:middle It's really the legislative level is where the issues really come to fore. 00:31:16.933 --> 00:31:26.163 position:50% align:middle And that's why it's so important to have established relationships with the other boards so you get a 00:31:26.163 --> 00:31:35.470 position:50% align:middle heads-up on what legislation may be coming that impacts your board that may come in with a lot of legislative 00:31:35.470 --> 00:31:38.960 position:50% align:middle support because it's a controversial issue. 00:31:38.960 --> 00:31:44.680 position:50% align:middle And just one short example of that, the optometrists in Virginia last year or two 00:31:44.680 --> 00:31:48.940 position:50% align:middle years ago, got the ability to do laser surgery. 00:31:48.940 --> 00:31:53.430 position:50% align:middle Well, the Board of Medicine and the medical profession was completely opposed to this. 00:31:53.430 --> 00:31:59.240 position:50% align:middle But the way they got it through, they didn't let anyone know they were doing this bill 00:31:59.240 --> 00:32:03.541 position:50% align:middle except for when they went to meet with legislators at events. 00:32:03.541 --> 00:32:09.041 position:50% align:middle And so they had done their homework and gotten commitments of support before the other professions 00:32:09.041 --> 00:32:11.731 position:50% align:middle even knew what the bill was going to say. 00:32:11.731 --> 00:32:18.081 position:50% align:middle And so having a heads up legislatively, either contact with legislators or contacts with other 00:32:18.081 --> 00:32:24.901 position:50% align:middle boards so you know what's coming and can prepare for it because the legislature is where these conflicts 00:32:24.901 --> 00:32:26.451 position:50% align:middle really arise, in my opinion. 00:32:26.451 --> 00:32:28.141 position:50% align:middle - Thank you. 00:32:28.141 --> 00:32:29.201 position:50% align:middle Kelly or Phyllis? 00:32:29.201 --> 00:32:32.338 position:50% align:middle - I mean, we have had those sneaky bills. 00:32:32.338 --> 00:32:37.148 position:50% align:middle I mean, the last day of session, somebody slides in something, 00:32:37.148 --> 00:32:38.638 position:50% align:middle and that is actually hell. 00:32:38.638 --> 00:32:40.198 position:50% align:middle And it's kind of funny. 00:32:40.198 --> 00:32:47.168 position:50% align:middle And so with the certified medication aides, we have a group of now they're classified all long-term 00:32:47.168 --> 00:32:51.808 position:50% align:middle care facilities, but at one point in time, the assisted living homes were classified 00:32:51.808 --> 00:32:56.078 position:50% align:middle under something else, okay, like a different social model. 00:32:56.078 --> 00:33:04.080 position:50% align:middle But years ago, one of the ring leaders who was a lobbyist, very connected with these assisted 00:33:04.080 --> 00:33:06.960 position:50% align:middle living homes, he slid in the bill. 00:33:06.960 --> 00:33:14.570 position:50% align:middle That's how they were able to have non-licensed or non-credentialed people passing medications in these 00:33:14.570 --> 00:33:15.520 position:50% align:middle assisted living homes. 00:33:15.520 --> 00:33:18.850 position:50% align:middle And it was slid under a bill that wasn't even health-related. 00:33:18.850 --> 00:33:22.580 position:50% align:middle And so whenever we started this journey and I was setting... 00:33:22.580 --> 00:33:27.820 position:50% align:middle We had a meeting in Frankfurt with key legislators that were going to be tied to this because again, 00:33:27.820 --> 00:33:33.331 position:50% align:middle we've got the Office of Inspector General for all of health and family services at the table. 00:33:33.331 --> 00:33:37.211 position:50% align:middle And I kind of sat in the back row, and they've all been through this with me, 00:33:37.211 --> 00:33:40.371 position:50% align:middle with Senate Bill 10, which is a whole nother story that I adopted when 00:33:40.371 --> 00:33:41.121 position:50% align:middle I first came. 00:33:41.121 --> 00:33:43.061 position:50% align:middle And it was terrible for nursing. 00:33:43.061 --> 00:33:43.691 position:50% align:middle Very terrible. 00:33:43.691 --> 00:33:47.181 position:50% align:middle I had a lot of negotiations through that bill. 00:33:47.181 --> 00:33:48.811 position:50% align:middle Lowered our standards for faculty. 00:33:48.811 --> 00:33:52.211 position:50% align:middle It did a lot of bad things in Kentucky. 00:33:52.211 --> 00:33:55.701 position:50% align:middle So anyway, they sit, they do all this talking and then they lean back and 00:33:55.701 --> 00:33:57.281 position:50% align:middle they're like, "Well, what do you think, Kelly?" 00:33:57.281 --> 00:34:01.727 position:50% align:middle And I said, "I don't know who slid this in, but you all know that was dirty. 00:34:01.727 --> 00:34:08.807 position:50% align:middle You know that no Board of Nursing would have ever approved somebody not having formal training for our 00:34:08.807 --> 00:34:12.107 position:50% align:middle nurses to delegate to that individual to pass their medications. 00:34:12.107 --> 00:34:13.077 position:50% align:middle You all know that." 00:34:13.077 --> 00:34:14.507 position:50% align:middle They all got silent. 00:34:14.507 --> 00:34:16.787 position:50% align:middle They said, "We're going to proceed on with this work group though. 00:34:16.787 --> 00:34:18.627 position:50% align:middle And Kelly's got the CMA." 00:34:18.627 --> 00:34:21.617 position:50% align:middle So, you know, you learn that respect though. 00:34:21.617 --> 00:34:28.457 position:50% align:middle But I had a lot of negotiations that I think helped me gain respect through Senate Bill 10, 00:34:28.457 --> 00:34:33.801 position:50% align:middle which was something that was pushed through at the time through Kentucky Hospital Association, 00:34:33.801 --> 00:34:35.531 position:50% align:middle which I could not fathom. 00:34:35.531 --> 00:34:39.301 position:50% align:middle I worked in acute care hospital for 32 years, or 30 years. 00:34:39.301 --> 00:34:41.581 position:50% align:middle So I'm like, "Why did you all do this? 00:34:41.581 --> 00:34:42.611 position:50% align:middle What were you all thinking?" 00:34:42.611 --> 00:34:43.771 position:50% align:middle And it was just... 00:34:43.771 --> 00:34:48.611 position:50% align:middle They were just so coming out of COVID, they really didn't know what to do. 00:34:48.611 --> 00:34:50.031 position:50% align:middle They were just so short-staffed. 00:34:50.031 --> 00:34:52.251 position:50% align:middle They were just grasping at straws. 00:34:52.251 --> 00:34:57.151 position:50% align:middle And they paired up with somebody who wrote this bill, and it did a lot of crazy things. 00:34:57.151 --> 00:35:01.098 position:50% align:middle At one point in time, they wanted a nurse to have a provisional license 00:35:01.098 --> 00:35:02.588 position:50% align:middle in our state. 00:35:02.588 --> 00:35:06.578 position:50% align:middle That's somebody who has not passed their boards for 12 months. 00:35:06.578 --> 00:35:09.378 position:50% align:middle That would have allowed them to fail the NCLEX, like, eight times. 00:35:09.378 --> 00:35:15.818 position:50% align:middle And I had to negotiate down and we got one failure. 00:35:15.818 --> 00:35:21.428 position:50% align:middle They could remain in a provisional status if the employer wanted to continue to employ them under a 00:35:21.428 --> 00:35:24.568 position:50% align:middle provisional license, which at least meant they were still supervised and we 00:35:24.568 --> 00:35:26.818 position:50% align:middle at least had a cap to six months. 00:35:26.818 --> 00:35:31.854 position:50% align:middle But that was the original language in the bill was 12 months for a provisional. 00:35:31.854 --> 00:35:32.894 position:50% align:middle So we had a lot of... 00:35:32.894 --> 00:35:37.944 position:50% align:middle I learned the hard way my very first year to negotiate, negotiate, negotiate. 00:35:37.944 --> 00:35:39.554 position:50% align:middle So, yeah. 00:35:39.554 --> 00:35:50.944 position:50% align:middle - So I was sitting listening to David, and he's so right in that the relationship building is 00:35:50.944 --> 00:35:58.554 position:50% align:middle such a big component of how you get things accomplished in the legislature. 00:35:58.554 --> 00:36:02.603 position:50% align:middle We are fortunate to have a lobbyist, and I'm not sure how many other boards of nursing 00:36:02.603 --> 00:36:03.443 position:50% align:middle have a lobbyist. 00:36:03.443 --> 00:36:08.743 position:50% align:middle We have a lobbyist that works on our behalf in addition to very competent staff. 00:36:08.743 --> 00:36:14.283 position:50% align:middle We are really involved on the legislative session, even during the non-legislative session. 00:36:14.283 --> 00:36:21.513 position:50% align:middle And building those relationships, those partnerships, understanding who the key people are, 00:36:21.513 --> 00:36:29.523 position:50% align:middle and then making sure that we develop that relationship with those key individuals about prospective bills that 00:36:29.523 --> 00:36:36.936 position:50% align:middle may be coming up that may affect our agency and our licensees in general. 00:36:36.936 --> 00:36:43.516 position:50% align:middle During the legislative session, I know my CFO, myself, and I think one of the legal individuals, 00:36:43.516 --> 00:36:46.236 position:50% align:middle we get anything with nurse in it. 00:36:46.236 --> 00:36:51.406 position:50% align:middle We get an email, we get a notification of, "This is coming up in legislation," and we read all 00:36:51.406 --> 00:36:52.136 position:50% align:middle of those bills. 00:36:52.136 --> 00:36:56.596 position:50% align:middle I spend the majority of my time doing the legislative session, reading every line. 00:36:56.596 --> 00:36:59.096 position:50% align:middle And then my staff will tell you, "She's going to read every line." 00:36:59.096 --> 00:37:04.171 position:50% align:middle I don't care if it's 500 pages.If we have to divide it up because they slipped stuff in, 00:37:04.171 --> 00:37:11.381 position:50% align:middle we're dealing with an issue now that was slipped in at the 12th hour that deals with our appropriations. 00:37:11.381 --> 00:37:20.051 position:50% align:middle And so I get a notification on my way up here that the legislative budget office needs a draft of what that 00:37:20.051 --> 00:37:24.551 position:50% align:middle bill had asked us for that somebody slipped in last year in our appropriations bill and we're not going 00:37:24.551 --> 00:37:24.991 position:50% align:middle to get our money. 00:37:24.991 --> 00:37:28.191 position:50% align:middle And I had to have it in today. 00:37:28.191 --> 00:37:35.199 position:50% align:middle Needless to say, we had already had it done because we'd been meeting with these individuals but they... 00:37:35.199 --> 00:37:40.099 position:50% align:middle And when I get back home and meet with that particular person I had this relationship with, 00:37:40.099 --> 00:37:45.429 position:50% align:middle I'm going to tell him, "That was dirty, sneaky, and low-down and underhanded," what he did. 00:37:45.429 --> 00:37:49.999 position:50% align:middle And I will have that conversation with him because that was low-down and dirty. 00:37:49.999 --> 00:37:52.159 position:50% align:middle And politics is so dirty and low-down. 00:37:52.159 --> 00:37:53.399 position:50% align:middle That's just the way it is. 00:37:53.399 --> 00:37:57.729 position:50% align:middle And so, you know, I don't appreciate that, but that's the way they do stuff. 00:37:57.729 --> 00:38:00.469 position:50% align:middle So you have to stay on top of things. 00:38:00.469 --> 00:38:02.769 position:50% align:middle You have to stay abreast of what's going on. 00:38:02.769 --> 00:38:04.429 position:50% align:middle You have to have those relationships. 00:38:04.429 --> 00:38:05.979 position:50% align:middle You have to have those partnerships. 00:38:05.979 --> 00:38:07.169 position:50% align:middle Good, bad, indifferent. 00:38:07.169 --> 00:38:11.879 position:50% align:middle I ain't got to like you because I don't have to sleep with you, but we got to work together. 00:38:11.879 --> 00:38:12.729 position:50% align:middle We got to work together. 00:38:12.729 --> 00:38:13.559 position:50% align:middle So it's important. 00:38:13.559 --> 00:38:16.139 position:50% align:middle Those key relationships are so, so important. 00:38:16.139 --> 00:38:20.999 position:50% align:middle - And Phyllis mentioned that, and I think we've all mentioned how things can just get 00:38:20.999 --> 00:38:24.489 position:50% align:middle slipped into bills, even bills with different subject matters. 00:38:24.489 --> 00:38:26.419 position:50% align:middle But in Mississippi, she's not lying. 00:38:26.419 --> 00:38:33.160 position:50% align:middle All you have to do in Mississippi in order to delete an entire chapter of law is put two asterisks and you have 00:38:33.160 --> 00:38:35.270 position:50% align:middle no idea what's being deleted. 00:38:35.270 --> 00:38:40.030 position:50% align:middle It could be a word, could be a sentence, a section, or an entire chapter. 00:38:40.030 --> 00:38:45.520 position:50% align:middle And so Tom knows this from analyzing Mississippi bills that come across our desk. 00:38:45.520 --> 00:38:52.230 position:50% align:middle They're either just striking out "shall" and putting "must" or they're deleting the entire, you know, 00:38:52.230 --> 00:38:55.250 position:50% align:middle Advanced Practice section of law. 00:38:55.250 --> 00:38:59.860 position:50% align:middle And so definitely in Mississippi, I can see where it's very important to stay on top 00:38:59.860 --> 00:39:04.847 position:50% align:middle of that because even the bills are not transparently written at all. 00:39:04.847 --> 00:39:08.557 position:50% align:middle So I think you talked about just there about relationship building. 00:39:08.557 --> 00:39:14.517 position:50% align:middle So I wonder if you have advice for our audience, any of you, about how to engage 00:39:14.517 --> 00:39:20.497 position:50% align:middle in relationship-building with other regulators if they do not even have informal structures in place. 00:39:20.497 --> 00:39:26.027 position:50% align:middle What advice would you give about how to go about creating those networks? 00:39:26.027 --> 00:39:29.307 position:50% align:middle - I mean, I think you have to... 00:39:29.307 --> 00:39:33.522 position:50% align:middle Sometimes if you have to take the initiative, you know, do it, it's worth it. 00:39:33.522 --> 00:39:38.702 position:50% align:middle We meet a lot of legislators or we meet a lot of the other boards at legislative committees through the 00:39:38.702 --> 00:39:43.762 position:50% align:middle summer months because a lot of the bills, they won't hear it unless it's been heard through the 00:39:43.762 --> 00:39:47.152 position:50% align:middle joint committee meetings that we have during the summer in Kentucky. 00:39:47.152 --> 00:39:51.142 position:50% align:middle And so, you know, we stand out in the halls, we talk to everybody. 00:39:51.142 --> 00:39:59.252 position:50% align:middle I think it's great for the legislators to see that all of our staff, it's usually the executive director and 00:39:59.252 --> 00:40:03.696 position:50% align:middle one of their legal representatives from each of the boards usually show up at these committee meetings. 00:40:03.696 --> 00:40:06.426 position:50% align:middle And I think it's good for us. 00:40:06.426 --> 00:40:11.046 position:50% align:middle And if sometimes, like, you have those executive directors who maybe 00:40:11.046 --> 00:40:17.216 position:50% align:middle are...maybe they think their board's the most important, I'll put it that way, 00:40:17.216 --> 00:40:19.286 position:50% align:middle just let them think that. 00:40:19.286 --> 00:40:20.806 position:50% align:middle You know what I mean? 00:40:20.806 --> 00:40:22.136 position:50% align:middle Just let them think that. 00:40:22.136 --> 00:40:26.436 position:50% align:middle You know, thank goodness, like, I've worked with doctors all my life and so, you know, 00:40:26.436 --> 00:40:29.666 position:50% align:middle sometimes you just have to let them think they came up with the idea. 00:40:29.666 --> 00:40:31.393 position:50% align:middle Let them think it. 00:40:31.393 --> 00:40:34.303 position:50% align:middle You know they didn't, but just let them think that because it makes them feel 00:40:34.303 --> 00:40:35.293 position:50% align:middle good about themselves. 00:40:35.293 --> 00:40:36.523 position:50% align:middle And then you just roll on. 00:40:36.523 --> 00:40:40.323 position:50% align:middle It's a much smoother shift than, you know, whenever you have issues. 00:40:40.323 --> 00:40:44.683 position:50% align:middle And I learned that the hard way a long time ago as house supervisor on the, you know, 00:40:44.683 --> 00:40:47.473 position:50% align:middle night shift for years when I was a brand new nurse. 00:40:47.473 --> 00:40:52.083 position:50% align:middle You know, but you gain that respect over time. 00:40:52.083 --> 00:40:52.843 position:50% align:middle So don't argue. 00:40:52.843 --> 00:40:53.883 position:50% align:middle Pick your battles. 00:40:53.883 --> 00:40:59.483 position:50% align:middle You know, you're here for a reason, and that's to represent your board and 00:40:59.483 --> 00:41:00.587 position:50% align:middle to protect the public. 00:41:00.587 --> 00:41:02.647 position:50% align:middle And you have to always keep that in hindsight. 00:41:02.647 --> 00:41:06.537 position:50% align:middle You don't have to be the center of attention in a room. 00:41:06.537 --> 00:41:11.897 position:50% align:middle If you think that, you're probably not going to make it very tenured years through this because you have to be 00:41:11.897 --> 00:41:16.767 position:50% align:middle willing to negotiate, and you have to be willing to take the back seat. 00:41:16.767 --> 00:41:18.137 position:50% align:middle You know what I mean? 00:41:18.137 --> 00:41:20.847 position:50% align:middle I think that's the most important thing for me anyway. 00:41:20.847 --> 00:41:21.777 position:50% align:middle - Okay. 00:41:21.777 --> 00:41:33.655 position:50% align:middle Well, and I'll just quickly add that in the same way that the National Board back in the '90s took the lead 00:41:33.655 --> 00:41:42.045 position:50% align:middle in reaching out to the other regulatory groups, I think the boards of nursing, 00:41:42.045 --> 00:41:48.965 position:50% align:middle which are generally better resourced than a lot of the smaller boards and are probably aware of bills that not 00:41:48.965 --> 00:41:54.585 position:50% align:middle only affect nursing but affect other professions, should just reach out and say, 00:41:54.585 --> 00:41:58.155 position:50% align:middle "I don't know if you saw this bill, but I wanted to call it to your attention because it's 00:41:58.155 --> 00:42:00.448 position:50% align:middle actually going to affect you more than it will us." 00:42:00.448 --> 00:42:06.138 position:50% align:middle And so I think there's a great opportunity for boards of nursing to really establish those relationships 00:42:06.138 --> 00:42:09.368 position:50% align:middle because you don't have to wait for them to come to you. 00:42:09.368 --> 00:42:09.548 position:50% align:middle - Yeah. 00:42:09.548 --> 00:42:13.238 position:50% align:middle Very important part, David, because that now is what the Board of Medicine 00:42:13.238 --> 00:42:14.748 position:50% align:middle does with me. 00:42:14.748 --> 00:42:20.208 position:50% align:middle They will reach out to me and keep me abreast of something that is on their radar that may affect me, 00:42:20.208 --> 00:42:21.038 position:50% align:middle and they will reach out. 00:42:21.038 --> 00:42:24.478 position:50% align:middle The executive director will reach out and say, "Hey, Phyllis," this is coming up. 00:42:24.478 --> 00:42:26.188 position:50% align:middle What are your thoughts?" 00:42:26.188 --> 00:42:30.148 position:50% align:middle That never would have happened in the field a few years ago. 00:42:30.148 --> 00:42:34.143 position:50% align:middle Never, never, never, never. 00:42:34.143 --> 00:42:37.143 position:50% align:middle But now, because we have developed that relationship...and I'm just... 00:42:37.143 --> 00:42:41.363 position:50% align:middle You know, I can't remember what you said. 00:42:41.363 --> 00:42:44.153 position:50% align:middle I almost wrote it down about, you know, let them think they're right. 00:42:44.153 --> 00:42:45.413 position:50% align:middle I just tell them they're wrong. 00:42:45.413 --> 00:42:47.883 position:50% align:middle I just tell them, "You're wrong, you're wrong." 00:42:47.883 --> 00:42:51.653 position:50% align:middle And this is the way it should be done because we have to work together. 00:42:51.653 --> 00:42:58.723 position:50% align:middle But I think the most important part is even though we're different boards and we have different statutes, 00:42:58.723 --> 00:43:00.974 position:50% align:middle we're alike in a lot of ways. 00:43:00.974 --> 00:43:05.164 position:50% align:middle So my advice would be start the conversation. 00:43:05.164 --> 00:43:11.684 position:50% align:middle Start the conversation, develop that relationship, even if you don't think you can move the needle. 00:43:11.684 --> 00:43:18.994 position:50% align:middle You will move the needle because we were able to move the needle under new leadership in those boards and 00:43:18.994 --> 00:43:25.134 position:50% align:middle change that mileage restriction that our APRNs, nurse practitioners, if they're in primary care, 00:43:25.134 --> 00:43:31.304 position:50% align:middle there is no mileage restriction at the Board of Medicine anymore, which has allowed greater access 00:43:31.304 --> 00:43:33.634 position:50% align:middle to care for our patients. 00:43:33.634 --> 00:43:39.514 position:50% align:middle And the bottom line is patient care, access to that. 00:43:39.514 --> 00:43:47.774 position:50% align:middle So we were able to do that by moving the needle a little bit each year until we crossed the finish line. 00:43:47.774 --> 00:43:51.454 position:50% align:middle So start the conversation and develop a relationship. 00:43:51.454 --> 00:43:54.584 position:50% align:middle And just remember, there's a lot of overlap, whether you believe it or not. 00:43:54.584 --> 00:43:56.174 position:50% align:middle There's a lot of common ground. 00:43:56.174 --> 00:44:00.854 position:50% align:middle And so if we can get that common ground, you can get things achieved that way. 00:44:00.854 --> 00:44:07.764 position:50% align:middle - And I think that it's important that now that we live in a legislative environment where we're seeing bills, 00:44:07.764 --> 00:44:13.384 position:50% align:middle pardon me, come across, you know, our desk that are these one-size-fits-all 00:44:13.384 --> 00:44:14.004 position:50% align:middle type of bills. 00:44:14.004 --> 00:44:20.154 position:50% align:middle So they talked about how, at the end of the day, there's a lot of commonalities in how your statutes may 00:44:20.154 --> 00:44:22.604 position:50% align:middle read and how your processes may play out. 00:44:22.604 --> 00:44:29.204 position:50% align:middle It's more commonalities probably than differences among regulatory boards, both small and large. 00:44:29.204 --> 00:44:34.202 position:50% align:middle And so one of the opportunities I would challenge you with is when there is one of these one-size-fits-all 00:44:34.202 --> 00:44:38.352 position:50% align:middle bills that comes across, hopefully before it's introduced, but reality, 00:44:38.352 --> 00:44:44.432 position:50% align:middle sometimes it's once it's introduced and maybe even headed towards a committee hearing, a formal hearing, 00:44:44.432 --> 00:44:51.432 position:50% align:middle is to use that as an opportunity to reach out to colleagues across different disciplines and 00:44:51.432 --> 00:44:53.522 position:50% align:middle different regulatory boards. 00:44:53.522 --> 00:44:57.062 position:50% align:middle And, you know, we're talking about that from board-to-board relationships, 00:44:57.062 --> 00:45:02.018 position:50% align:middle but also with stakeholders and outside groups as well, to ask them what their thoughts are, 00:45:02.018 --> 00:45:04.838 position:50% align:middle what they're hearing, what can we do together? 00:45:04.838 --> 00:45:06.378 position:50% align:middle Who knows who? 00:45:06.378 --> 00:45:06.748 position:50% align:middle Right? 00:45:06.748 --> 00:45:09.548 position:50% align:middle Because a lot of this is about who knows who. 00:45:09.548 --> 00:45:14.868 position:50% align:middle And if you know that the head of the medical board has a really great relationship with the sponsor, 00:45:14.868 --> 00:45:21.558 position:50% align:middle then the sponsor may be very much more interested in hearing from their colleague who they have a 00:45:21.558 --> 00:45:26.888 position:50% align:middle relationship with perspective than yours, and you may not have yet developed that relationship 00:45:26.888 --> 00:45:27.798 position:50% align:middle with that individual. 00:45:27.798 --> 00:45:33.349 position:50% align:middle So really, strength in numbers is about utilizing different talents, different relationships 00:45:33.349 --> 00:45:34.819 position:50% align:middle to work together. 00:45:34.819 --> 00:45:42.549 position:50% align:middle I will tell you that one of the...or whenever a board comes to our group, state affairs, and asks us, 00:45:42.549 --> 00:45:44.399 position:50% align:middle you know, "What should I do about this bill? 00:45:44.399 --> 00:45:46.199 position:50% align:middle We want to testify against this bill. 00:45:46.199 --> 00:45:49.329 position:50% align:middle We really believe that it's going to harm the public." 00:45:49.329 --> 00:45:50.229 position:50% align:middle I'll give you an example. 00:45:50.229 --> 00:45:54.409 position:50% align:middle In Maryland this past year, there was a bill that would have limited what criminal 00:45:54.409 --> 00:46:00.319 position:50% align:middle history the board might have been able to take into account when licensing an individual, 00:46:00.319 --> 00:46:05.413 position:50% align:middle including around whether or not they were participating in an alternative program in another jurisdiction 00:46:05.413 --> 00:46:07.373 position:50% align:middle or within Maryland. 00:46:07.373 --> 00:46:09.263 position:50% align:middle It impacted every board. 00:46:09.263 --> 00:46:16.413 position:50% align:middle So the last thing I wanted to advise the Board of Nursing on as they wanted to testify against the bill, 00:46:16.413 --> 00:46:19.953 position:50% align:middle was to be the only one up there at the table doing that. 00:46:19.953 --> 00:46:23.343 position:50% align:middle Because you're also putting a spotlight on nursing. 00:46:23.343 --> 00:46:28.183 position:50% align:middle And in that moment, in that instance, the sponsor of the bill felt like he was reducing 00:46:28.183 --> 00:46:30.991 position:50% align:middle barriers to get to work in Maryland. 00:46:30.991 --> 00:46:37.181 position:50% align:middle So you don't want only the Board of Nursing sitting there testifying against this individual's bill, 00:46:37.181 --> 00:46:41.981 position:50% align:middle especially if they're an individual who holds political power, might be on a key committee, etc. 00:46:41.981 --> 00:46:48.581 position:50% align:middle So to the extent that you can work with colleagues, maybe even do a joint statement may not be possible, 00:46:48.581 --> 00:46:56.031 position:50% align:middle or invite your colleagues to also share their views, their shared views on this issue with the legislature, 00:46:56.031 --> 00:46:59.401 position:50% align:middle whether that be in a committee setting or outside of that process. 00:46:59.401 --> 00:47:05.360 position:50% align:middle I think that those bills are a great opportunity to build relationships. 00:47:05.360 --> 00:47:10.490 position:50% align:middle So the last question that I will ask this group before we'll open it up for a couple of questions before we 00:47:10.490 --> 00:47:15.530 position:50% align:middle head to lunch is to challenge, you know, you all have relationships with these boards. 00:47:15.530 --> 00:47:17.550 position:50% align:middle You've talked about them here. 00:47:17.550 --> 00:47:26.610 position:50% align:middle What is one regulatory board or agency relationship that you hope to strengthen, and why? 00:47:26.610 --> 00:47:32.165 position:50% align:middle - So I'll speak, because Nancy is here in the room and she knows that I'm dealing with this 00:47:32.165 --> 00:47:33.415 position:50% align:middle in Kentucky right now. 00:47:33.415 --> 00:47:36.765 position:50% align:middle So post-secondary education has started a big... 00:47:36.765 --> 00:47:43.615 position:50% align:middle Well, they're trying to do a little media push of heroes to...I can't even think of now what 00:47:43.615 --> 00:47:44.565 position:50% align:middle it is, healers. 00:47:44.565 --> 00:47:45.545 position:50% align:middle Heroes to healers. 00:47:45.545 --> 00:47:47.355 position:50% align:middle And they're trying to have... 00:47:47.355 --> 00:47:53.225 position:50% align:middle Well, they started with a push to have military medics be equivalent to an LPN from the get-go. 00:47:53.225 --> 00:47:56.655 position:50% align:middle Like, go straight to an NCLEX. 00:47:56.655 --> 00:48:00.641 position:50% align:middle And so we have negotiated down. 00:48:00.641 --> 00:48:02.361 position:50% align:middle We're really trying hard to work with them. 00:48:02.361 --> 00:48:09.321 position:50% align:middle And the good thing is that one of the bills, well, the bill sponsors I have worked with with the CMA group 00:48:09.321 --> 00:48:10.811 position:50% align:middle and some other things. 00:48:10.811 --> 00:48:12.581 position:50% align:middle So they keep saying, "Just go talk to Kelly. 00:48:12.581 --> 00:48:14.331 position:50% align:middle She's reasonable, she'll talk to you." 00:48:14.331 --> 00:48:17.381 position:50% align:middle So now they're kind of coming around. 00:48:17.381 --> 00:48:23.961 position:50% align:middle They do understand that they are going to need more didactic education before they can just go straight 00:48:23.961 --> 00:48:24.981 position:50% align:middle for the NCLEX. 00:48:24.981 --> 00:48:31.137 position:50% align:middle But we are definitely trying to still continue to strengthen that relationship 00:48:31.137 --> 00:48:32.667 position:50% align:middle with post-secondary education. 00:48:32.667 --> 00:48:36.067 position:50% align:middle And I will tell you, they carry a big stick with some of the legislators, 00:48:36.067 --> 00:48:39.937 position:50% align:middle not so much in Health and Family Services Committee, which is where I'm at all the time, 00:48:39.937 --> 00:48:44.367 position:50% align:middle but in other licensing board or committees. 00:48:44.367 --> 00:48:46.547 position:50% align:middle So that's probably the biggest one. 00:48:46.547 --> 00:48:54.257 position:50% align:middle And I encourage you to rely on your NCSBN experts because they've been through this probably 00:48:54.257 --> 00:48:55.447 position:50% align:middle with another state. 00:48:55.447 --> 00:49:02.397 position:50% align:middle And so I have reached out to Nicole before on issues that we were having with our APRNs and now with Nancy's 00:49:02.397 --> 00:49:07.357 position:50% align:middle group on this military-to-medic crosswalk, so to speak. 00:49:07.357 --> 00:49:09.447 position:50% align:middle So... 00:49:09.447 --> 00:49:14.427 position:50% align:middle - Well, I'll offer a brief comment even though I'm actually not actively involved, 00:49:14.427 --> 00:49:23.617 position:50% align:middle but it really does disappoint me that in Virginia we still have, as I mentioned earlier, 00:49:23.617 --> 00:49:32.907 position:50% align:middle this joint regulation of advanced practice nurses and that we have the Board of Medicine, you know, 00:49:32.907 --> 00:49:39.617 position:50% align:middle really the board members themselves really not on board with the idea that nurse practitioners and other 00:49:39.617 --> 00:49:44.087 position:50% align:middle advanced practice nurses have the skills to practice independently. 00:49:44.087 --> 00:49:49.877 position:50% align:middle And I think that if I could do something, that's the direction I would like to see it go. 00:49:49.877 --> 00:49:57.547 position:50% align:middle One of the ways I've tried to help that happen that I think is a good strategy is to make sure legislators 00:49:57.547 --> 00:50:00.669 position:50% align:middle have access to the documents that help them inform their decision. 00:50:00.669 --> 00:50:04.169 position:50% align:middle And that's advice I could give anyone, is one way of reaching out, 00:50:04.169 --> 00:50:07.959 position:50% align:middle getting to know legislators is send them a report. 00:50:07.959 --> 00:50:11.909 position:50% align:middle Say, "I don't know if you're aware of this report, but I thought you might be interested in it." 00:50:11.909 --> 00:50:19.279 position:50% align:middle And it's a good way of meeting and making relationships, but also in a subtle fashion influencing 00:50:19.279 --> 00:50:19.749 position:50% align:middle what they do. 00:50:19.749 --> 00:50:28.889 position:50% align:middle - So I agree with David and Kelly on that about strengthening, like, 00:50:28.889 --> 00:50:33.474 position:50% align:middle the Board of Medical Licensure and making sure legislators have the information. 00:50:33.474 --> 00:50:37.474 position:50% align:middle We continue to educate them over and over and over on the same thing every year. 00:50:37.474 --> 00:50:42.874 position:50% align:middle So I'm not sure what educational institution they attended that they can't comprehend. 00:50:42.874 --> 00:50:48.674 position:50% align:middle However, and Nicole can attest to that before practice authority, we educate, educate, 00:50:48.674 --> 00:50:50.444 position:50% align:middle but you have to educate them over and over. 00:50:50.444 --> 00:50:58.424 position:50% align:middle I do believe that being visible as the executive officer for your agency, 00:50:58.424 --> 00:51:03.875 position:50% align:middle doing the legislative session so that they know who you are, they see you all the time, 00:51:03.875 --> 00:51:05.985 position:50% align:middle they know you're concerned. 00:51:05.985 --> 00:51:11.295 position:50% align:middle It sticks with them when you show up, not only you but your staff that are involved in the 00:51:11.295 --> 00:51:14.525 position:50% align:middle legislative components of what goes on. 00:51:14.525 --> 00:51:19.615 position:50% align:middle We have a lobbyist, but we show up, we are there, they see us, our board members show 00:51:19.615 --> 00:51:21.635 position:50% align:middle up and they're there. 00:51:21.635 --> 00:51:25.715 position:50% align:middle So they see us and that gives us a certain amount. 00:51:25.715 --> 00:51:30.085 position:50% align:middle We've earned a certain amount of respect, and that the board knows what they're talking about, 00:51:30.085 --> 00:51:33.729 position:50% align:middle but we have to continue to educate and educate and educate. 00:51:33.729 --> 00:51:34.999 position:50% align:middle So that's important. 00:51:34.999 --> 00:51:42.459 position:50% align:middle Also, I think just continuing to strengthen the relationship with the Board of Medical Licensure 00:51:42.459 --> 00:51:48.849 position:50% align:middle because the medical association is so powerful and they appoint a lot of people to the Board of Medicine. 00:51:48.849 --> 00:51:55.289 position:50% align:middle So continuing to build on what we've already established and continuing to strengthen that 00:51:55.289 --> 00:51:57.629 position:50% align:middle relationship is so, so important. 00:51:57.629 --> 00:52:02.698 position:50% align:middle But last but not least, the most important, and it's not a regulatory board, 00:52:02.698 --> 00:52:11.628 position:50% align:middle but it is a agency relationship, we are regulation, we regulate. 00:52:11.628 --> 00:52:18.088 position:50% align:middle And I have to always remind that we are not a professional association. 00:52:18.088 --> 00:52:26.248 position:50% align:middle And so our professional associations sometimes are our biggest enemies, and that I would like to see us all 00:52:26.248 --> 00:52:34.155 position:50% align:middle get on one accord and have one unified voice and stop tearing each other down when legislation comes forward. 00:52:34.155 --> 00:52:42.395 position:50% align:middle Because sometimes it's just one group that will tear our bill up because they don't like one little 00:52:42.395 --> 00:52:45.065 position:50% align:middle component in there. 00:52:45.065 --> 00:52:51.465 position:50% align:middle And if we could all just work together and stop fighting when it comes in trying to advance the 00:52:51.465 --> 00:52:58.475 position:50% align:middle profession and the cause, you may not get it this time, but you may be included the next time. 00:52:58.475 --> 00:53:07.840 position:50% align:middle But as for what can we do right now to get across the finish line, and then once we get across the 00:53:07.840 --> 00:53:10.420 position:50% align:middle finish line, we can bring everybody else on board. 00:53:10.420 --> 00:53:15.020 position:50% align:middle That's the thing that I see, the discord within the profession that prevents us 00:53:15.020 --> 00:53:17.080 position:50% align:middle from getting some legislative things done. 00:53:17.080 --> 00:53:21.310 position:50% align:middle - Thank you so much, and thank you to you, all. 00:53:21.310 --> 00:53:23.100 position:50% align:middle Does anyone have any questions? 00:53:23.100 --> 00:53:30.379 position:50% align:middle Please come up to a mic and ask or share an experience from working with boards in your jurisdiction. 00:53:30.379 --> 00:53:33.069 position:50% align:middle - [Kelly H.] Hi, I'm Kelly Hoffman from the Pennsylvania Board of Nursing. 00:53:33.069 --> 00:53:34.299 position:50% align:middle I'm a nursing education advisor. 00:53:34.299 --> 00:53:35.249 position:50% align:middle I have two questions. 00:53:35.249 --> 00:53:38.649 position:50% align:middle I'm not trying to hold up lunch, but the first is for Dr. Johnson. 00:53:38.649 --> 00:53:46.739 position:50% align:middle If you don't mind speaking to the timeframe in which it took to kind of acquire that PN education 00:53:46.739 --> 00:53:48.229 position:50% align:middle under your board. 00:53:48.229 --> 00:53:54.469 position:50% align:middle - I think we started working on it one year, and I think the legislation went forth the next year. 00:53:54.469 --> 00:54:00.189 position:50% align:middle So it was a one-year process of meetings, continuous meetings, 00:54:00.189 --> 00:54:03.655 position:50% align:middle great debate, stakeholder involvement. 00:54:03.655 --> 00:54:13.375 position:50% align:middle And I think that next year the bill went forward and it passed without any opposition to us obtaining the 00:54:13.375 --> 00:54:14.535 position:50% align:middle PN education program. 00:54:14.535 --> 00:54:21.055 position:50% align:middle And I mentioned that Dr. Temple was in the room, who was over the RN educational programs in the state. 00:54:21.055 --> 00:54:28.235 position:50% align:middle And they were instrumental also because, you know, we had to kind of work together to make sure that we 00:54:28.235 --> 00:54:33.728 position:50% align:middle were not infringing upon their rules and regulations and standards, but it was the PN educational program so 00:54:33.728 --> 00:54:36.408 position:50% align:middle it was a joint effort with all the stakeholders involved. 00:54:36.408 --> 00:54:38.178 position:50% align:middle But it took about a year, I guess. 00:54:38.178 --> 00:54:39.748 position:50% align:middle - That's impressive collaboration then. 00:54:39.748 --> 00:54:40.738 position:50% align:middle Thank you. 00:54:40.738 --> 00:54:42.488 position:50% align:middle My next question is for Ms. Jenkins. 00:54:42.488 --> 00:54:48.758 position:50% align:middle Can you speak to the level of detail that your, you know, collaborative groups really dealt 00:54:48.758 --> 00:54:53.368 position:50% align:middle with in that certified medical assistant piece? 00:54:53.368 --> 00:54:57.328 position:50% align:middle As far as the curriculum, was there a standardized curriculum that was developed, 00:54:57.328 --> 00:54:58.718 position:50% align:middle and is that now mandatory? 00:54:58.718 --> 00:55:04.101 position:50% align:middle - Yes, it's even written in our regulation, the exact standards that are required for that 00:55:04.101 --> 00:55:07.301 position:50% align:middle certified medication aide, the one and the two. 00:55:07.301 --> 00:55:12.421 position:50% align:middle So I do not know the exact research study use. 00:55:12.421 --> 00:55:17.761 position:50% align:middle I know that we reached out to other multiple boards that prepare for the MACE exam. 00:55:17.761 --> 00:55:23.041 position:50% align:middle We had also the Kentucky Community College System. 00:55:23.041 --> 00:55:26.731 position:50% align:middle They referred to their training program as Kentucky Medication Aides. 00:55:26.731 --> 00:55:29.641 position:50% align:middle It was actually written in statute like that. 00:55:29.641 --> 00:55:34.177 position:50% align:middle The Kentucky Board of Nursing, when that was created back in 1990s, 00:55:34.177 --> 00:55:39.427 position:50% align:middle the Board of Nursing education consultants were really involved in that development of that 00:55:39.427 --> 00:55:40.597 position:50% align:middle curriculum as well. 00:55:40.597 --> 00:55:42.587 position:50% align:middle So we basically took that curriculum. 00:55:42.587 --> 00:55:47.977 position:50% align:middle We looked at current curriculum through some other boards that I reached out to, 00:55:47.977 --> 00:55:50.197 position:50% align:middle and then they developed those standards. 00:55:50.197 --> 00:55:53.017 position:50% align:middle So they're actually written in our regulation. 00:55:53.017 --> 00:55:56.647 position:50% align:middle - So now your board then has oversight of that curriculum as well? 00:55:56.647 --> 00:55:57.147 position:50% align:middle - Correct. 00:55:57.147 --> 00:55:57.437 position:50% align:middle - Okay. 00:55:57.437 --> 00:56:00.822 position:50% align:middle - We approve the training programs in Kentucky. 00:56:00.822 --> 00:56:01.462 position:50% align:middle - Thank you. 00:56:01.462 --> 00:56:02.222 position:50% align:middle Thank you, both. 00:56:02.222 --> 00:56:03.172 position:50% align:middle - All right. 00:56:03.172 --> 00:56:05.682 position:50% align:middle I realize that we are right up to lunch. 00:56:05.682 --> 00:56:07.112 position:50% align:middle I have one announcement. 00:56:07.112 --> 00:56:08.822 position:50% align:middle Well, first of all, please thank the panel [inaudible 00:56:09.341]. 00:56:08.822 --> 00:56:11.286 position:50% align:middle - Thank you.