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Nurses’ competency: Will new program verify it better?

RNs in Georgia are facing new licensure requirements.

RNs in Georgia are facing new licensure requirements.

In a development that was years in the making, mandatory “continuing competency” tracking is beginning this week for Georgia’s more than 9,000 registered nurses.

The new system has long been discussed and even now continues to be debated.

Before the new law took effect, RN renewal was a matter of filing a timely request every two years. Advanced practice nurses, however, did have educational requirements based on their specialty.

Now, nurses have five options for meeting their individual competency requirements.

Debbie Bartlett

Debbie Bartlett

The law takes effect for license renewals for the year beginning Jan. 1, 2016. It applies to all licensed registered nurses. For licensed practical nurses, the competency tracking process will begin in 2017.

In some states, getting more hours of educational credits after completing one’s degree — commonly known as continuing education, or CE — remains the only way for RNs to verify competency. But the Georgia Nurses Association successfully lobbied for multiple ways to verify competency, says Debbie Bartlett, CEO of the association.

“It is important for all registered nurses in Georgia to realize that for the 2016 licensure renewal cycle and for all future renewal cycles, the law requires nurses to verify their continued competency,” says Bartlett.

“Nursing was the only health profession [in Georgia] that did not have a continuing competency requirement for license renewal,’’ she says. “Other Georgia health providers were using that void against the advancement of the nursing profession.”

Details about the new competency program were revealed during this summer’s Board of Nursing mailing to every licensed nurse in Georgia, and there were some differences of opinion.


Skepticism about the results


Critics say the change will accomplish little.

Lisa Eichelberger

Lisa Eichelberger

“The problem with this new law is that is does not in any way ensure ‘continued competency,’ ” says Lisa Wright Eichelberger, dean of the College of Health at Clayton State University.

“I believe the enactment of this rule will be costly and ineffective,” she says. “It is basically bureaucratic window dressing or ‘feel-good’ legislation that does nothing more than help continuing education providers, and we [Georgia nurses] can say we require CEs” just as other licensed organizations do.

“To my knowledge, after implementing mandatory continuing education requirements for re-licensure, no improvements in practice or decreases in disciplinary actions have been shown” in other states, says Eichelberger.  “I [had hoped] we would base what we do on evidence, outcomes and results.”

Others, however, are looking forward to the change.


Software company says it’s ready


Partnering with a Jacksonville, Fla., company, CE Broker, the Georgia Board of Nursing says it’s confident the program will succeed.

“Lifelong learning is an essential component of professional nursing practice,” says Jim Cleghorn, the board’s executive director.

In his quarterly letter to nurses, Cleghorn said, “License renewal season is fast approaching.”

Brian Solano

Brian Solano

CE Broker’s CEO, Brian Solano, says his company is committed to simplifying the competency reporting process as well as tracking maintenance for Georgia nurses and its regulators.

“The software is built, and we are on schedule,” he says. “Our role is to empower the state regulators and keep the system easy to use for all.”

According to CE Broker’s website, it already provides the continuing education tracking systems for the Florida Department of Health, the Ohio Board of Speech, and other regulating agencies in the country.

“As a company, we have been handling health care CEs for Florida since 2003,” says Solano. He adds that there have been three renewed contracts. The company also serves District of Columbia nurses.

Information about the registration process with CE Broker can be found at the Georgia Board of Nursing website.


What are a nurse’s options?


The new Georgia law “is all about competency,” says Carole Jakeway, chief nurse and director of district and county operations at Georgia’s Department of Public Health.

“Continuing education is one of five options for measuring competency” that the state uses, says Jakeway.

The additional four options are:

clipboard**  Maintenance of certification or recertification by a national certifying body recognized by the board

** Completion of an accredited academic study in nursing or a related field as recognized by the board

** Verification of competency by a licensed health care facility or entity, or by a physician’s office that is part of a health system, verifying at least 500 hours of practice that has been approved by the board

** Completion of a board-approved re-entry program or graduation from a nursing education program

“Every nurse in Georgia has an account and can use the basic system free of charge,” says Solano. More service-oriented systems are also available, but there is a fee.

CE Broker’s goal, says Solano, is to simplify continuing education audits for Georgia’s nurses and board staff. The board will use CE Broker to ensure renewal requirements are met.

“The Georgia Board of Nursing’s position is to be supportive of all learning activities that increase knowledge and enable nurses to practice with the highest degree of skill and safety,” says Cleghorn.



Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.




Unusual dental clinic is a boon for the developmentally disabled

The Dentistry for the Developmentally Disabled Foundation treats more than 4,000 patients annually.

The DDD Foundation treats more than 4,000 patients annually.


Recently, outside a dental clinic in Atlanta, two men in lavender-colored scrubs could be seen escorting a woman in a wheelchair to a car.

To a passer-by, that might have looked like an unusual level of service to be given a dental patient. But this is not a typical dentist’s practice. It’s the Georgia office of the DDD Foundation (Dentistry for the Developmentally Disabled Foundation).

The patient, 49, is developmentally disabled and lives at a personal care home. Earlier that morning, she had been dropped off by staffers from the home for a check-up on how she was healing after oral surgery. Now she was set to begin her trip home.

The DDD Foundation clinic, which opened in 2002, is exclusively for treatment of the developmentally disabled population.

Some of these people would not get much dental care otherwise. While several Georgia dentists specialize in treating the developmentally disabled, many others don’t feel equipped to do so. Most dentists in the state, in fact, do not accept patients who are severely developmentally disabled.


Hard cases to handle


A dental visit can be stressful for anyone, but patients of the DDD Foundation often find it especially difficult. And that, in turn, can cause challenges for clinic staffers.

“Sometimes you open up the car door, and the patient takes off running,” says Sheri Lynch, the director of development at the DDD Foundation, explaining the necessity of a private parking lot for the clinic.

Each day, the clinic receives about 20 patients, both children and adults. Different methods and procedures are employed for each individual patient, requiring extensive time. The full-time staff includes two dentists, a dental hygienist and three dental assistants.

More than 40 percent of the patients seen at the clinic have autism spectrum disorder; others have intellectual delays, cerebral palsy and Down syndrome.

Developmental disabilities can keep people from performing simple tasks, including basic oral health measures like brushing and flossing the teeth. In severe cases, individuals are wholly dependent on caregivers. It’s easy for dental care to be neglected entirely.

Treating such patients is “not the kind of thing most dentists want to do,” notes Lynch. There are practical reasons for that.

Developmentally disabled individuals often are unable to communicate when they are having dental problems. Consequently, behavioral issues can emerge.

“These individuals will act out when really trying to say, ‘My mouth hurts,’ ” says Eric Jacobson, the executive director of the Georgia Council on Developmental Disabilities.

The average dental residency teaches procedures that assume a dentist’s ability to communicate with a patient and to maintain reasonable control of the treatment situation. Most dentists are not prepared for uncontrolled behavior by patients, which may include screaming, scratching or even running away.

The two dentists at the DDD Foundation clinic, Dr. Deidra Rondeno and Dr. Willie  Oliver, completed two of the few general practice residencies nationwide that include training for treating developmentally disabled patients — the Illinois Masonic Medical Center and Ohio State University, respectively.

While patients with developmental disabilities can pose problems, there is also a sense of satisfaction in helping such vulnerable people. “You enjoy it. Otherwise you wouldn’t be able to do it,” says Dr. Roy Brooks, the dental director at Georgia Regional Hospital in Atlanta, when he speaks of treating such patients.

At the DDD Foundation, multiple dental staff often work together with a single patient at any given time. Some patients require more than two assistants.

Lynch recalls a time when one patient — who was about 6 feet 3 inches tall and weighed about 300 pounds — required the assistance of almost every member of the clinic staff.

“He thrashed and kicked like he was fighting for his life,” recalls Lynch.

The clinic’s head dentist, Rondeno, is only 5 feet tall. Lynch adds, “This makes the job physically demanding.”


Dental care is essential, not incidental


The oral health of people depends a lot on their hygienic routine. Patients from personal care homes often skip their bi-annual dental appointments to avoid the costs of care, which results in severe dental decay and periodontal disease. That can cause tooth loss and further infection.

In such cases, “these appointments can take hours,” says Lynch.

It’s well known that dental health affects overall health and well-being, but Jacobson says public policy groups have failed to recognize this reality.

Eric Jacobson

Eric Jacobson

Dental service “is always cut first when cutting dollars,” says Jacobson.

Many private health insurance plans do not include dental coverage, and most dentists in Georgia do not accept patients covered by Medicaid, a government program for the poor and disabled.

“The DDD Foundation are angels for serving a population that predominantly relies on Medicaid,” says Dr. David Kurtzman, a Georgia dentist who treats developmentally disabled patients who need hospitalization for dental care.

The foundation treats 4,200 patients with developmental disabilities annually, yet the estimated number of potential clients in need of special services is higher. The clinic is currently under renovation to expand into a neighboring building.

“Dental services cannot be seen as this extra service,” says Jacobson. “It has to be seen as just as important as other medical or social services.”

Editor’s note: The first version of this story contained errors relating to dental procedures. Georgia Health News apologizes for those errors.


The maternal death tragedy: Facts come into better focus

African-American women have a higher rate of maternal mortality than other women in Georgia. (This is a stock photo)

African-American women have a higher rate of maternal mortality.   (This is a stock photo)

“Maternal mortality” is a chilling phrase. And it’s a term that has haunted Georgia public health and medical officials for years.

Also known as death related to pregnancy, maternal mortality is defined as the death of a woman while she is pregnant or within one year after the end of her pregnancy, from any cause related to or aggravated by the pregnancy or its management.

A few years ago, a report surfaced that Georgia had the highest rate of maternal mortality in the nation. It came as jarring news.

The state was reported to have reached 28.7 maternal deaths per 100,000 live births in 2011, up from an average of 20.2 in the period 2001 to 2006.

The Georgia General Assembly, alarmed by those numbers, passed a law last year that laid the foundation for a committee to review such deaths.

Dr. Michael Lindsay

Dr. Michael Lindsay

Recently the committee produced its first report, analyzing cases from 2012.

Surprisingly, the panel determined that the original shocking statistics were not completely reliable. At the same time, the panel found some key trends in the Georgia deaths studied.

First the numbers: The maternal mortality panel leaders discovered that some Georgia deaths listed as related to or associated with pregnancy did not belong in those categories. The deaths had been wrongly classified.

“We found a lot of patients [who had died] had not been pregnant within a year,’’ Dr. Michael Lindsay, an Atlanta ob/gyn and chairman of the review panel, said recently.

The committee concluded that there’s no way to say whether Georgia – or some other state – has the worst record on maternal mortality. Because of the uncertainty involved with available statistics, it’s impossible to compare states on maternal mortality. “Only about 25 states do a formal maternal mortality review,’’  said Lindsay, associate professor in the division of gynecology and obstetrics at the Emory School of Medicine.

But the Peach State can’t take too much satisfaction in shedding that infamous No. 1 label. Lindsay said the panel also concluded that Georgia, in fact, has “among the highest rates”  of maternal mortality.


Breaking down the numbers


The panel’s report identified 85 maternal deaths. Of those, 25 were classified as “pregnancy-related.” The other 60 occurred while the woman was pregnant or within one year of the end of the pregnancy, but were not necessarily related to the pregnancy. The panel called these deaths “pregnancy-associated.”

Other findings included:

** Sixty percent of the maternal deaths were of women 29 or younger

** African-Americans were the predominant racial/ethnic group among the cases reviewed

** Obesity was a compounding factor in many cases

pregnant-mother-sonThe mortality report noted that chronic medical conditions increase risks during pregnancy. Pregnant or postpartum women often lack access to mental health services, and lack of access to care was cited as a potential problem.

The maternal mortality review effort came as a collaboration with the CDC, the Georgia Department of Public Health and the Georgia OBGyn Society.

Sen. Dean Burke (R-Bainbridge), a physician who sponsored legislation to create the state review panel, said Thursday that the obesity factor “surprised me the most – how much influence it has on maternal mortality.”

Of the deaths from pregnancy-related reasons, the most common cause was hemorrhage, followed by cardiac disorders, embolism and seizure disorders. Among the deaths listed as pregnancy-associated, the leading causes were motor vehicle crashes, homicide and suicide.

“The results of our first year of work provided some excellent information on efforts that can be made in the medical community to decrease maternal deaths,’’ said Pat Cota, executive director of the Georgia OBGyn Society. “We have already begun education campaigns in a number of areas.”

“One of the key findings,” Cota added, “is that women need to be healthier before they become pregnant, through efforts such as weight management and hypertension control, so the pregnancy does not put undue stress on their bodies.”

Lindsay noted that the South generally has a higher rate of maternal mortality, and that minorities account for a much higher percentages of these deaths than do whites.


Much more to learn


The Georgia data are preliminary in terms of making recommendations, Lindsay cautioned.

“Our goal is to make the information widely available,’’ he said. “We need to recognize . . . [maternal mortality] as a problem. It’s a matter of educating health care providers and the lay public that this is a public health problem.”

Sen. Burke, an ob/gyn who is now a Bainbridge hospital’s chief medical officer, pointed out that many hospitals in rural areas of Georgia have shut down their obstetrical services due to financial losses. “We’ve got to stabilize that and stop the deterioration in the number of [obstetrics] units and providers,’’ he said.

230px-PregnantWomanHigher pay will help. The state budget, Burke noted, has increased reimbursements for ob/gyns under the Medicaid program, which covers the majority of childbirths in the state.

Burke said he believes physicians will give a lot of consideration to the report’s findings. “Doctors respond to data very well. It’s very critical that the committee continue to do the work it’s doing.”

The Department of  Public Health, meanwhile, is collaborating with the Association of Women’s Health, Obstetric and Neonatal Nurses and Merck for Mothers to improve clinical practice and reduce errors related to postpartum hemorrhage, the leading cause of maternal death.

Public Health has joined other states to strengthen and enhance state maternal mortality surveillance systems. The agency has distributed maternal mortality education materials to ob/gyns and hospitals throughout the state, along with information about the use of antidepressant medications in pregnancy.

Georgia birth certificates have been adjusted to reflect information about previous poor pregnancy outcomes and risk factors during the pregnancy being recorded, among other data. And DPH is also reviewing changes to Georgia death certificates to more accurately identify maternal deaths.

The maternal mortality committee is already looking at possible pregnancy-related deaths from 2013.

“Our goal,” said Lindsay, “is to hopefully uncover information that will lead to lower mortality.”




Acupuncture: A different way to deal with pain

2Atlanta Acupuncture

In 1996, the FDA approved the acupuncture needle as a medical device.

Sara Hewitt Kupelian is not your typical medical-surgical nurse. What makes her stand out is that she is also a licensed acupuncturist.

“Learning Chinese medicine and acupuncture takes real dedication and devotion,” says Kupelian, a registered nurse for 23 years.  She estimates that she logged about 10,000 hours in class and studied for more than four years to prepare for the national certification exam.

Kupelian, who practices in Atlanta,  started her training in Georgia, but later moved to Colorado to complete her master’s degree from the Colorado School of Traditional Chinese Medicine in Denver.

She decided to study acupuncture after her mother, who later died from complications of cancer, found relief from pain and nausea through acupuncture.

“In my mother’s case,” Kupelian says, “she was able to tolerate the side effects of medications better with acupuncture. It enabled her to reduce the amount of medications needed and to offset side effects with far more relief than anticipated.”

Kupelian comes from a family of RNs, including her mother.


What’s old is new


The National Center for Complementary and Integrative Health defines acupuncture as “a technique in which practitioners stimulate specific points on the body — most often by inserting thin needles through the skin.”

Sara Hewitt Kupelian, an RN, has been practicing acupuncture for eight years.

Sara Hewitt Kupelian, an RN, has been practicing acupuncture for eight years.


According to experts in Chinese medicine, acupuncture can be traced back about 2,500 years. It has been practiced in the United States for perhaps 200 years. But not until the 1970s — when U.S. interest in China increased and Asian immigration surged — did acupuncture become widely known to the average American.

In 1996, the FDA approved the acupuncture needle as a medical device.

Outcomes of acupuncture vary, but the aim is decreased pain, as well as improved control of chronic pain.

In Georgia, the General Assembly has made acupuncture the subject of regulation and control under the Georgia Composite Medical Board. There are more than 200 licensed acupuncturists in the state.


Relief of sensory loss


“My [acupuncture] experience was a great one,” says Margretta Milburn of Sandy Springs, a recent client.

Margretta Milburn

Margretta Milburn

In her 80s, she says she was looking for something to help her with certain types of sensory loss that seemed to come with aging. She turned to Kupelian for guidance.

“I’m open to trying new things,” Milburn says. She explains that for her treatments, the small needles were placed on her head and around her ears.

It was not painful, she adds.

Milburn was able to regain some of the senses  that had slowly disappeared. Kupelian says in some cases, a loss of the senses of taste and smell can be restored using acupuncture.


Is it economical?


Some insurance companies may cover the costs of acupuncture, while others may not.

Medicare does not cover acupuncture treatments for older Americans. Some Medicare Advantage plans may offer coverage for varying types of alternative treatments, but only if they are considered medically necessary and provided by a health care professional who participates within the plan.

Mark Lewinter

Mark Lewinter

According to Atlanta licensed acupuncturist Mark Lewinter, initial consultations, which are typically about 90 minutes long, can cost approximately $100 to $200, and follow-up visits can cost from $75 to $150 and typically last about an hour.

“At Metro Acupuncture, we focus on symptoms, of course, but also preventive care and lifestyle choices, especially nutrition,” says Lewinter, who works with Dr. Anna Kelly, also a  licensed acupuncturist.

Lewinter’s interest in studying Oriental Medicine started at age 13, when he was diagnosed with cancer. While undergoing chemotherapy, he also received alternative medicine to facilitate his recovery.


Increasingly important


A 2007 survey found that U.S. adults in the previous 12 months spent an estimated $33.9 billion out of pocket on complementary health approaches, which can include massage therapy and yoga.

Ann Gill Taylor, a professor at the University of Virginia’s School of Nursing, says she finds that “practitioners who use acupuncture view the human body as an ecosystem.”

clipboardTaylor suggests that acupuncture is among the most researched and documented complementary health-enhancing practices.

“An estimated 137 plus randomized clinical trials on 10 painful conditions have been reported, which provide evidence, although not statistically conclusive, of the efficacy of acupuncture in painful conditions,” says Taylor.

Acupuncturists and other experts suggest not seeking acupuncture help without first consulting a health care professional for any pain problems.

In addition, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) reminds all patients seeking help for pain that most states, including Georgia, require a license to practice acupuncture.

NCCAOM adds that certification, or a license, doesn’t [always] guarantee quality of care, but it does indicate the practitioner “meets certain standards regarding the knowledge and use of acupuncture.”

Kupelian says she has seen health benefits of acupuncture, including relieving acute and chronic pain among patients. She has practiced acupuncture for eight years.

“Acupuncture practice has been professionally and personally rewarding,” she says.




** If you decide to visit an acupuncturist, check his or her credentials. Most states require a license, certification, or registration to practice acupuncture; however, education and training standards and requirements for obtaining these vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture. Most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine for licensing.

** Some conventional medical practitioners — including physicians and dentists — practice acupuncture. In addition, national acupuncture organizations (which can be found through libraries or by searching the Internet) may provide referrals to acupuncturists.

** When considering practitioners, ask about their training and experience. Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost.

** For information about insurance coverage for acupuncture, see NCCIH’s fact sheet Paying for Complementary Health Approaches.


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.



A study in gratitude: Former patient helps out at free dental clinic

A free dental clinic last weekend in Perry treated more than 2,000 patients.

A free dental clinic last weekend in Perry treated more than 2,000 patients. Photos courtesy of the Georgia Dental Association.

Doug Taffe of Fort Lauderdale, Fla., traveled hundreds of miles north to central Georgia over the weekend to work as a volunteer at a free dental clinic.

His volunteer stint at the event in Perry was a form of repayment.

Two years ago, Taffe was in a motorcycle accident and sustained severe damage to his teeth. He couldn’t afford the extensive repairs. He heard about a Georgia Dental Association free clinic in Norcross, and traveled to the Atlanta suburb to see if he could get some work done.

“I looked like a homeless person,’’ he told GHN. “I couldn’t smile, had difficulty eating.”

GDADentists at the clinic pulled about a dozen of his teeth and gave him a denture.

So, out of gratitude, Taffe joined the volunteers in Perry delivering dental care to more than 2,000 people Friday and Saturday.

The Georgia Mission of Mercy is an outreach program of the Georgia Dental Association and its Foundation for Oral Health. It’s held every two years.

This was the first time the clinic was held in Perry. Previous ones were in metro Atlanta.

“We’re trying to move it around the state’’ to reach more people, said Frank Capaldo, executive director of the Dental Association. One big plus for Perry is that it’s near the geographic center of Georgia.


A lack of dental coverage


The services provided at the temporary clinic included cleanings, fillings and extractions. More than 600 dentists volunteered, along with 1,200 health care providers and community volunteers, including dental hygienists, lab technicians, pharmacists and local residents. And there were more than 100 dental chairs in use.

Each patient got a basic health check-up before being moved into one of the chairs.


Taffe’s volunteer work consisted of briefing and advising the patients who were getting partial dentures. “I explain to patients how to care for dentures, what you can and can’t do,” he said Saturday.

Chris Harris, a 40-year-old man from coastal Georgia, had to have 11 teeth pulled and was fitted Friday with a temporary, partial denture, the Macon Telegraph reported.

When he looked at his reflection and his new smile, Harris said, it almost brought tears to his eyes, according to the Telegraph.

Roughly 20 percent of Georgians have no health insurance at all. But a much higher percentage, including those who do have some insurance, lack dental coverage. It’s increasingly common for health insurance coverage not to include dental care.

Frank Capaldo

Frank Capaldo

Oral health, however, is not just a medical side issue. Many people who skip the dental work they need will eventually wind up in a hospital emergency room.

In 2007, there were about 60,000 visits to Georgia emergency rooms for “non-traumatic” dental problems — oral health issues not caused by injuries. That cost more than $23 million.

The problem is not a lack of capacity in the system. Capaldo emphasized that most dentists in Georgia have the ability to see more patients in their regular practices.

Barriers to patients getting needed work, he said,  include lack of money, lack of transportation, an inability to get time off from work, and the Medicaid program not covering regular dental care for adults.

“We have people calling in, asking for free care,’’ he said. “We’re trying to get that messaging out.”

“The need for a dental home [for more patients] is great — no question about it.”

The Georgia Dental Association has a toll-free number for patients to call, 1-800-432-4357. GDA also provides a list of charitable clinics offering care: charitable-clinics.html

Patients can also inquire here to find a dentist: a-dentist.




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