4/28/16 - progressive surgical solutions

4/28/16

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Brought to you by Progressive A webinar series that keeps you in the know

Roles of Clinical Staff in the ASC Debra Stinchcomb, RN, BSN, MBA, CASC

Progressive Half Time

April 29, 2016

Objectives

•  Identify issues that can affect clinical staffing levels

•  Understand the importance of the scope of practice of clinical staff in your ASC

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KNOW YOUR STATE SCOPES OF PRACTICE FOR ALL CLINICAL

POSITIONS

ASC Staff

•  All staff positions require a job description

•  All staff must demonstrate competency

•  All staff must work within their scope of practice, licensure, &/or certification

•  All staff must have periodic evaluations of their job performance

Staffing Variables

•  Utilization of staff positions •  Administrator may be BOM or Clinical Director

•  Working managers

•  Charge Nurses or Supervisors

•  Assistants for Perioperative Nursing Staff

•  Delegation of job responsibilities

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Staffing Variables

•  Utilization of staff positions •  Materials Coordinator or someone delegated to

manage materials

•  Surgical Technologist/Instrument Technologist

Staffing Variables

•  Variables affecting required staff positions •  Case volume and size of facility

•  # of surgical specialties

•  Patient acuity (bariatric/pain/pediatric)

•  Overnight cases

•  Procedure time

•  Technology utilized

Staff Positions

•  Administrator

•  Clinical Director

•  Perioperative Nursing Staff

•  Assistants to Perioperative Nursing Staff

•  Ancillary Staff (RT, XRT)

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Administrator

•  Qualifications •  Nursing or business background

•  College degree

•  History of working at an ASC

•  Demonstration of previous success

•  Responsibilities •  Has been delegated clinical and fiscal responsibility from the

Governing Body for day to day operations of the ASC

Administrator

•  Job duties •  Fiscal Management

•  Contracts Management

•  Business Management

•  Clinical Management

•  Facility Management

•  Staff Development

•  Facility Promotion

Clinical Staff

•  RN must be in charge of nursing service (416.46)

•  “Sufficient nursing staff with appropriate qualifications to assure the nursing needs of all ASC patients are met” (416.46)

•  “Number and type of staff needed will depend on the volume and types of surgery the ASC performs” (416.46)

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Clinical Staff

•  “Nursing services must be provided in accordance with recognized standards of practice” (416.46(a)) •  State laws for nursing practice (BRN Scope of practice)

•  Medical Board

•  Professional Organizations (AORN, ANA)

Clinical Staff

•  “There must be a registered nurse available for emergency treatment whenever there is a patient in the ASC” (416.46(a)) •  “on the premises and sufficiently free from other duties that the

nurse is able to respond rapidly in emergency situations”

•  Staff must work within their scope of licensure or scope of practice

Clinical Director

•  Qualifications •  RN •  BSN or MSN/MBA preferred? •  Previous ASC experience? •  Previous management experience?

•  Responsibilities •  Patient Care •  Develops and implements nursing policies/procedures •  Manages resources and inventory •  Management of facility and staff •  Directs QAPI process •  Fiscal management •  Professional Development

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Available on Progressive eSupport

•  Compliance/Policy&Procedure Update/Human Resources

How do you determine staffing needs?

•  Identify needs based on caseload, types of cases, ages of patients, technical demands, and anesthesia provided

•  Perioperative staffing policy should include the minimum requirements required

•  Staffing should be cost-effective and efficient without compromising quality or safety of care

•  Provision should be made for late schedules, add on cases or emergent procedures

Operating Room Staffing

•  Two staff members required in the OR/PR. One RN circulator and one scrub •  The scrub position role can be filled by an RN or surgical

technologist

•  Complex surgical procedures may require an additional RN circulator and/or scrub person

•  In some circumstances, a scrub person may not be required (Yag laser procedure)

•  If IVCS is being administered by an RN—1 RN must be dedicated to monitoring the patient

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PACU Staffing

•  Phase I Recovery •  Class 1:2 – 1 nurse to 2 patients who are:

•  1 unconscious, stable, without artificial airway, and over the age of 8 years; and 1 conscious, stable, and free of complications

•  2 conscious, stable, and free of complications

•  2 conscious, stable, 8 years of age and under, with family or competent support staff member present

PACU Staffing

•  Class 1:1 – 1 nurse to 1 patient

•  At the time of admission, until the critical elements are met

•  Unstable airway

•  Any unconscious patient 8 years of age and under

•  A 2nd nurse must be available to assist as necessary

•  Class 2:1 – h2 nurses to 1 patient

•  1 critically ill, unstable, complicated patient

PACU Staffing

•  Phase II Recovery •  Class 1:3 – 1 nurse to 3 patients

•  Over the age of 8

•  8 years of age and under with family present

•  Class 1:2 – 1 nurse to 2 patients

•  8 years of age and under without family or support staff member present

•  Initial admission of patient postprocedure

•  Class 1:1 – 1 nurse to 1 patient

•  Unstable patient of any age requiring transfer

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Extended Recovery

•  Extended observation level of care •  Class 1:3/5 – 1 nurse to 3 to 5 patients

•  Patients awaiting transportation home

•  Patients in extended recovery/overnight care (ie, potential risk for bleeding, pain management, postoperative nausea, vomiting)

•  Additional staff members may include support staff

•  Refer to your state laws

Perioperative RN

•  Qualifications •  RN license

•  BSN preferred, as applicable

•  Previous ASC experience

•  Previous ER, ICU or PACU experience

•  Responsibilities •  Patient Care

•  Delegations of QAPI Tasks

RN Circulator: Patient Safety

•  Patient Advocate

•  RN Circulators improve patient safety and outcomes by leading the team in preventing: •  Surgical site infections

•  medication errors

•  wrong-site/wrong-patient/wrong-procedure surgeries

•  retained surgical items

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RN Circulator: Patient Safety

•  Examples of tasks within scope •  Verification of pre-operative assessment

•  Positioning the patient for surgery

•  Initiating the surgical “Time Out” before surgery

•  Documenting the nursing care during the procedure

•  Monitoring and maintaining the sterile field to prevent surgical site infections

•  Confirming the medications and blood products that are given to the patient

•  Supervising ancillary personnel

•  Making certain all equipment is functioning properly

•  Communicating with PACU

RN Circulator: State Laws

•  26 states have laws or regulations addressing the importance of the role of the registered nurse circulator in operating room safety in the ASC

•  24 states ASC licensing laws and regulations are silent on the role of the RN circulator

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Who is the RN Circulator? video

RNs and Conscious Sedation

•  Conscious sedation/analgesia: drug-induced, mild depression of consciousness achieved by the administration of sedatives or a combination of sedatives and analgesic medications

•  Delivered intravenously or by inhalation


Practitioners who administer moderate sedation should be able to rescue patients who enter deep sedation/analgesia

•  Depth of sedation occurs across a continuum

•  Patient response is unpredictable

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RNs administering moderate/conscious sedation must practice within the scope of nursing practice as defined by the state.

•  Each state’s board of nursing regulates which medications may be within the RN scope of practice (eg, Ketamine, Propofol, Nitrous Oxide, Fentanyl, etc.)

•  Consult with state board of nursing for rulings and other guidelines relating to RN’s role as a provider of moderate sedation


The perioperative RN administering moderate sedation should continuously care for the patient throughout the procedure.

•  Conscious sedation/analgesia = high risk for respiratory complications (hypoxia, hypercapnia, impaired airway reflexes, loss of airway patency, airway obstruction, respiratory depression)

•  Continuous monitoring = early detection

RNs and Moderate/Conscious Sedation

The RN administering/monitoring the patient receiving moderate sedation/analgesia should have no competing responsibilities.

•  Immediate response to any adverse reaction or complication

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Available on Progressive eSupport

•  Compliance/Policy&Procedure Update/Anesthesia

Staffing in Pain and Yag Laser Cases

•  Circulating RN •  May be state mandated

•  Must be a person who is able to document care within their scope of licensure or practice

•  Time out

•  Use of safe surgical checklist

•  Monitoring RN, if needed for sedation

•  Ancillary staff, as needed

RN Scope of Practice Issues

•  Informed Consent

•  Concurrently circulating and monitoring

•  Physician Orders •  Do not “check” off orders for physicians

•  Ensure orders are signed/dated/timed prior to notation and implementation

•  MD documentation (H&P, op report)

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RN Scope of Practice Issues

•  Delegations of duties •  Medication administration (Medical Assistant or Nursing

Assistant administering eye drops)

•  LPN/LVN not directly supervised

•  LPN/LVN not practicing within scope of licensure

•  COA or COT functioning outside of scope

LVN/LPN

•  Qualifications •  Current State License

•  History of work experience

•  Responsibilities •  Scrub Role

•  Delegated Tasks from RN

•  Focused assessment (ex VS, weight, BS) to provide to RN for comprehensive assessment

•  Typically able to administer medications

LVN/LPN

•  Responsibilities •  Delegated Tasks from RN

•  May be able to assist with IVs

•  Example: Texas allows IV start/med administration following class with the exception of PICC lines

•  Typically not involved with patient education

•  Example: Kentucky allows “educational activities for clients based upon established written guidelines as delineated in a plan/strategy of care

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LVN/LPN

•  Requires supervision by an RN

•  RN supervision can be direct, indirect or available •  Direct supervision is on site and immediately available •  Indirect is on site and available within 5-10 minutes, such as “2

halls away” •  Available is off-site but available by phone and within 30

minutes away from the setting

LVN/LPN

•  Supervision required depends on the type of facility •  Ex: SNF may be indirect

•  ASCs requires higher level of assessment and response due to the nature of surgery: Direct

•  Cannot substitute a LVN/LPN for an RN

NFLPN

•  National Federation of Licensed Practical Nurses http://www.nflpn.org/contact.htm •  LP/VN needs to be aware of the scope of licensure within their

state

•  Practice is applicable to the setting

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Surgical Technologist

•  Qualifications •  HS Diploma or GED

•  Completion of Certification Program

•  Certification or proof of training (proof of competency)


•  Certified •  Texas: must receive education from an accredited

school and maintain certification. Grandfathered if employed before September 1, 2009

•  Illinois: •  National Surgical Assistant Association on the

Certification of Surgical Assistants

•  Liaison Council on Certification for the Surgical Technologist as a certified first assistant

•  American Board of Surgical Assisting


•  Responsibilities •  Competence in use of instruments and equipment

•  Follows policies and procedures applicable to job (counts, equipment malfunction, time out)

•  Demonstrates ability to create and maintain a sterile field

•  Often cross trained for instrument processing

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State CitationRegistration/ Certification Definition of Surgical Technologist

Colorado Colorado Revised Statutes

Title 12: Professions and Occupations

Article 43.2: Surgical Assistants and

Surgical Technologists

12-43.2-101

Registration A person who performs certain duties, including:

(a) Preparation of the operating or procedure room and the sterile field for surgical procedures by

sterilizing supplies, instruments, and equipment;

(b) Preparation of the operating room or procedure room for surgical procedures by ensuring that surgical

equipment is functioning properly and safely; and

(c) Passing instruments, equipment, or supplies to a surgeon; sponging or suctioning an operative site;

preparing and cutting suture material; holding retractors; transferring but not administering fluids or

drugs; assisting in counting sponges, needles, supplies, and instruments; and performing other similar

duties as directed during a surgical procedure.

Illinois Illinois Compiled Statutes

Chapter 225: Professions and

Occupations

225 ILCS 130: Registered Surgical

Assistant and Registered Surgical

Technologist Title Protection Act.

Registration "Registered surgical technologist" means a person who (i) is not a physician licensed to practice medicine

in all of its branches, (ii) is certified by the Liaison Council on Certification for the Surgical Technologist, (iii)

performs duties under direct supervision, (iv) provides services in a licensed hospital, ambulatory

treatment center, or office of a physician licensed to practice medicine in all its branches, and (v) is

registered under this Act.

Indiana Indiana Code

IC 25-36.1: Certified Surgical

Technologists

Certification "Surgical technology" means intraoperative surgical patient care that involves the following:

(1) Preparing the operating room for surgical procedures by:

(A) ensuring that surgical equipment is functioning properly and safely; and

(B) preparing sterile supplies, instruments, and equipment using sterile technique.

(2) Anticipating the needs of the surgical team based on knowledge of human anatomy and

pathophysiology relating to the surgical patient and the patient's surgical procedure.

(3) Performing tasks in an operating room setting in the sterile field, including the following:

(A) Passing supplies, equipment, or instruments.

(B) Suctioning or sponging an operative site.

(C) Preparing and cutting suture material

(D) Transferring and irrigating with fluids.

(E) Transferring, without administering, drugs within the sterile field.

(F) Handling specimens.

(G) Holding retractors.

(H) Assisting in counting sponges, needles, supplies, and instruments with an operating room circulator as

allowed.

State Registration and Certification Requirements for Surgical Technologists

Massachusetts Massachusetts code: S.2058. An Act regulating surgical technology. Chapter 371 of the Acts of 2012

Certification “Surgical technologist”, any person who provides surgical technology services but is not a health care practitioner.

“Surgical technology”, surgical patient care including, but not limited to, 1 or more of the following:

(i) collaboration with an operating room circulator prior to a surgical procedure to carry out the plan of care by preparing the operating room, gathering and preparing sterile supplies, instruments and equipment, preparing and maintaining the sterile field using sterile and aseptic technique and ensuring that surgical equipment is functioning properly and safely;

(ii) intraoperative anticipation and response to the needs of a surgeon and other team members by monitoring the sterile field and providing the required instruments or supplies;

(iii) performance of tasks at the sterile field, as directed in an operating room setting, including: (1) passing supplies, equipment or instruments; (2) sponging or suctioning an operative site; (3) preparing and cutting suture material; (4) transferring and irrigating with fluids; (5) transferring, but not administering, drugs within the sterile field; (6) handling specimens; (7) holding retractors; and (8) assisting in counting sponges, needles, supplies and instruments with an operating room circulator.

(b) A surgical facility shall not employ or otherwise retain the services of any person to perform surgical

New York New York Code Article 28: 2824 Certification (b) "Surgical technologist" means a person who performs surgical technology other than in the course of

practicing as a healthcare professional.

(c) "Surgical technology" means the following surgery related tasks and functions:

(i) assisting healthcare professionals to prepare the operating room and sterile field for surgical

procedures, including assisting healthcare professionals to set up sterile supplies, instruments and

equipment using sterile technique and ensuring that surgical equipment function properly and safely;

(ii) assisting healthcare professionals to move and position patients for surgery;

(iii) assisting healthcare professionals to perform non-invasive prepping of the skin's surface and draping

patients for surgery;

(iv) assisting the surgeon's provision of hemostasis during surgery by handing instruments;

(v) holding a retractor after placement by a healthcare professional;

(vi) anticipating instrument needs of a surgeon; and

(vii) other tasks incidental to surgery that do not fall within the scope of practice of a licensed profession,

as directed by the surgeon. Services that fall within the practice of licensed professions include, but are not

limited to:

(A) retracting tissue to expose the operating field during a surgical procedure;

(B) administering any medication by any route, including local and topical medications;

(C) placing hemostatic instruments or devices or applying cautery or tying off bleeders;

(D) applying sutures or assisting with or performing wound closure;

(E) assisting the surgeon in identifying structures that should not be ligated; and

New Jersey New Jersey Permanent StatutesTitle 26: Health and Vital Statistics26:2H-12.62

Certification "Surgical technologist" means a person who is authorized to practice surgical technology pursuant to the provisions of this act."Surgical technology" means surgical patient care that includes, but is not limited to, the following tasks or functions:(1) preparing the operating room for surgical procedures by ensuring that surgical equipment is functioning properly and safely;(2) preparing the operating room and the sterile field for surgical procedures by preparing sterile supplies, instruments, and equipment using sterile technique;(3) anticipating the needs of the surgical team based on knowledge of human anatomy and pathophysiology and how they relate to the surgical patient and the patient's surgical procedure; and(4) as directed, performing tasks at the sterile field including: (b) sponging or suctioning an operative site;(c) preparing and cutting suture material(d) transferring and irrigating with fluids;(e) transferring and administering drugs within the sterile field, according to applicable law;(f) handling specimens;(g) holding retractors and other instruments(h) applying electrocautery to clamps on bleeders;(i) connecting drains to suction apparatus;(j) applying dressings to closed wounds; and(k) performing sponge, needle, supply and instrument counts with the registered nurse circulator.

South Carolina South Carolina Code of LawsTitle 44: HealthChapter 7: Hospitals, Tuberculosis Camps and Health Services Districts44-7-380

Certification "Surgical technology" means intraoperative surgical patient care that involves:(1) preparing the operating room for surgical procedures by ensuring that surgical equipment is functioning properly and safely;(2) preparing the operating room and the sterile field for surgical procedures by preparing sterile supplies, instruments, and equipment using sterile technique;(3) anticipating the needs of the surgical team based on knowledge of human anatomy and pathophysiology and how they relate to the surgical patient and the patient's surgical procedure; and(4) as directed within the sterile field in an operating room setting, performing tasks including:(a) passing supplies, equipment or instruments;(b) sponging or suctioning an operative site;(c) preparing and cutting suture materials;(d) transferring fluids or drugs;(e) holding retractors; and(f) assisting in counting sponges, needles, supplies, and instruments.

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Tennessee Tennessee Code AnnotatedTitle 68 Health, Safety and Environmental Protection HealthChapter 57 Surgical TechnologistsTCA 68-57-101

Certification "Surgical technologist" means one who works under supervision to facilitate the safe and effective conduct of invasive surgical procedures. This individual is usually employed by a hospital, medical office, or surgical center and supervised during the surgical procedure according to institutional policy and procedure to assist in providing a safe operating room environment that maximizes patient safety by performing certain tasks, including, but not limited to:(1) Preparation of the operating room and the sterile field for surgical procedures by preparing sterile supplies, instruments, and equipment using sterile technique;(2) Preparation of the operating room for surgical procedures by ensuring that surgical equipment is functioning properly and safely; and(3) Passing instruments, equipment, or supplies to a surgeon, sponging or suctioning an operative site, preparing and cutting suture material, holding retractors, transferring but not administering fluids or drugs, assisting in counting sponges, needles, supplies, and instruments, and performing other similar tasks as directed during a surgical procedure.

Texas Texas Health and Safety CodeTitle 4. Health FacilitiesSubtitle B. Licensing of Health FacilitiesChapter 259: Surgical Technologists

Certification "Surgical technologist" means a person who practices surgical technology."Surgical technology" means intraoperative surgical patient care as follows:(A) preparing the operating room for surgical procedures by ensuring that surgical equipment is functioning properly and safely;(B) preparing the operating room and sterile field for surgical procedures by preparing sterile supplies, instruments, and equipment using sterile technique;(C) anticipating the needs of the surgical team based on knowledge of human anatomy and pathophysiology and how they relate to the surgical patient and the patient's surgical procedure;(D) as directed in an operating room setting, performing the following tasks at the sterile field:(i) passing supplies, equipment, or instruments;(ii) sponging or suctioning an operative site;(iii) preparing and cutting suture material;(iv) transferring and pouring irrigation fluids;(v) transferring but not administering drugs within the sterile field;(vi) handling specimens;(vii) holding retractors and other instruments;(viii) applying electrocautery to clamps on bleeders;(ix) connecting drains to suction apparatus;(x) applying dressings to closed wounds; and(xi) assisting in counting sponges, needles, supplies, and instruments with the registered nurse circulator;(E) cleaning and preparing instruments for sterilization on completion of the surgery; and (F) assisting the surgical team with cleaning of the operating room on completion of the surgery

Virginia Code of Virginia sections numbered

54.1-2956.12 and 54.1-2956.13

Registration "Surgical technologist" means an individual who has met the requirements of the Board for certification as a surgical

technologist and who works under the supervision of a licensed health care provider

.§ 54.1-2956.12. Registered surgical technologist; use of title; registration.

A. No person shall use or assume the title "registered surgical technologist" unless such person is registered with the

Board.

B. The Board shall register as a registered surgical technologist any applicant who presents satisfactory evidence that

he (i) holds a current credential as a certified surgical technologist from the National Board of Surgical Technology and

Surgical Assisting or its successor, (ii) has successfully completed a surgical technologist training program during the

person's service as a member of any branch of the armed forces of the United States, or (iii) has practiced as a surgical

technologist at any time in the six months prior to July 1, 2014, provided he registers with the Board by July 1, 2015.

§ 54.1-2956.13. Certification of surgical technologist; application.

A. It shall be unlawful for any person to engage in the practice of surgical technology or to hold himself out as a surgical

technologist unless he is certified as a surgical technologist by the Board.

B. An applicant for certification as a surgical technologist shall submit evidence satisfactory to the Board that he (i)

holds a current credential as a certified surgical technologist from the National Board of Surgical Technology and

Surgical Assisting or its successor, (ii) has successfully completed a surgical technologist training program during the

applicant's service as a member of any branch of the armed forces of the United States, or (iii) has practiced as a

surgical technologist at any time in the six months prior to July 1, 2014.

C. Notwithstanding the provisions of subsection B, any individual who has successfully completed a surgical

technologist training program by July 1, 2015, may practice as a surgical technologist for a period of 12 months

following the date on which he completed such program without obtaining a certificate from the Board. Thereafter,

such individual shall be required to be certified by the Board.

D. The following shall not constitute the practice of surgical technology:

�

Washington Revised Code of Washington Title 18 Businesses and Professions RCW 18.215: Surgical Technologists

Registration Surgical technologist means a person, regardless of title, who is supervised in the surgical setting under the delegation of authority of a health care practitioner acting within the scope of his or her license and under the laws of this state.

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Available on eSupport

•  Compliance/Policy&Procedure Update/Human Resources

Instrument Technician



•  Certification or proof of training (proof of competency)

•  Responsibilities •  Decontamination and cleaning of instruments

•  Sterilization process

Nursing Assistant


•  Completion of Certification Program, if applicable in your state

•  Responsibilities •  Perform tasks delegated by an RN within their scope

•  VS, weight, donning gown, report observations, transportation assist

•  Cannot administer medications, assess patients or provide education

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Medical Assistant



•  Responsibilities •  Same functions as a Nursing Assistant

•  NY State Office of the Professions

Medical Assistant

•  Can perform •  secretarial work such as assembling charts or assisting with

billing,

•  measuring vital signs,

•  performing ECGs,

•  taking laboratory specimens including blood work

Medical Assistant

•  Can perform •  assisting an authorized practitioner, under the direct and

personal supervision of said practitioner, to carry out a specific task, as a "second set of hands" (e.g. authorized practitioner, after positioning a limb, asks the medical assistant to maintain the limb in the position while a bandage is applied or sutures removed. Medical assistant could not independently position the patient.)

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Medical Assistant

•  Cannot perform •  triage

•  administering medications through any route

•  administering contrast dyes or injections of any kind

•  placing or removing sutures

•  taking x-rays or independently positioning patients for x-rays

•  applying casts

•  first assisting in surgical procedures

COA (Certified Ophthalmic Assistant) COT (Certified Ophthalmic Technician)

•  Qualifications •  HS diploma or GED

•  Clinical Training Program with or without work experience

•  Certification

COA (Certified Ophthalmic Assistant) COT (Certified Ophthalmic Technician)

•  Responsibilities •  In MD office:

•  Gathering medical records and patient information

•  Taking ocular measurements, both anatomical and functional

•  Administering or preparing medications

•  Providing eye care and contact lens information to the patient

•  Maintaining and cleaning ophthalmic instruments

•  Assisting the ophthalmologist in basic procedures

•  In ASC:

•  Same responsibilities as a nurse assistant

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Radiology Technician vs. X-ray Technician

•  Scope of Duties •  Radiologic technicians are legally capable of performing any

diagnostic imaging procedure

•  XRT are procedure or area specific

Radiology Technician

•  Qualifications •  Two-year program based in hospitals, earning a

certificate upon graduation

•  Two-year program at community colleges or technical schools, earning an associate degree

•  Four-year program at universities and colleges, graduating with a bachelor’s degree

•  Current certification with the American Registry of Radiologic Technologists (AART).

•  May require licensure (41 states require this)

Radiology Technician

•  Responsibilities •  Conduct imaging tests such as x-rays, CT scans,

mammograms, sonograms, and many other procedures

•  Perform radiation therapy in a health care setting

•  Able to start IVs in most states

•  According to the American Society of Radiologic Technologists, "They are educated in anatomy, patient positioning, examination techniques, equipment protocols, radiation safety, radiation protection and basic patient care.”

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X-ray Technicians

•  Qualifications •  Completion of educational program

•  Educational programs range from nine months and two years, depending on the program.

•  Licensure/Certification/Registration may be required

•  Different States require different exams

•  CA: three limited permit categories: Chest, Extremities, and Torso-skeletal.

•  Responsibilities •  An x-ray technician is a limited based on the state of

practice

Resources

•  www.AORN.org

•  AORN Position Statement on Perioperative Safe Staffing and On-Call Practices

•  ASPAN Recommendations 2015 - 2017

•  https://www.bon.texas.gov/practice_bon_position_statements_content.asp#15.27

•  http://www.op.nysed.gov/prof/nurse/nurse-medical-assistants.htm

•  http://www.nursingassistants.net/educational-articles/observation-skills-for-cnas/

Resources

•  Linda Patterson, Nurse Consultant with the Washington State Nursing Commission

•  http://work.chron.com/differences-between-radiologic-technicians-xray-techs-25424.html

•  http://www.jcahpo.org/certification/

•  http://www.asrt.org/main/standards-regulations/practice-standards/practice-standards-faq

•  https://www.sdms.org/pdf/2015SDMSScopeofPracticeandClinicalStandards.pdf

•  Progressive Surgical Solutions

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Questions??

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[email protected]

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•  For questions, please contact Courtney Leonis: [email protected]

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