Licensure Issues Research Articles

Telehealth as a Tool to Transform Pediatric Care: Views from Stakeholders.

Background and Objectives: The 2020 COVID-19 pandemic generated rapid telehealth expansion. Most prior telehealth studies focus on a single program or health condition, leaving a knowledge gap regarding the most appropriate and effective means of allocating telehealth services and funding. This research seeks to evaluate a wide range of perspectives to inform pediatric telehealth policy and practice. Methods: In 2017, the Center for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation (Innovation Center) issued a Request for Information to inform the Integrated Care for Kids model. Researchers identified 55 of 186 responses that addressed telehealth and analyzed them based on grounded theory principles overlaid with a constructivist approach to contextualize Medicaid policies, respondent characteristics, and implications for specific populations. Results: Respondents noted several health equity issues that telehealth could help to remedy, including timely care access, specialist shortages, transportation and distance barriers, provider-to-provider communication, and patient and family engagement. Implementation barriers reported by commenters included reimbursement restrictions, licensure issues, and costs of initial infrastructure. Respondents raised savings, care integration, accountability, and increased access to care as potential benefits. Discussion and Conclusions: The pandemic demonstrated that the health system can implement telehealth rapidly, although telehealth cannot be used to provide every aspect of pediatric care such as vaccinations. Respondents highlighted the promise of telehealth, which is heightened if telehealth supports health care transformation rather than replicating how in-office care is currently provided. Telehealth also offers the potential to increase health equity for some populations of pediatric patients.

Telehealth Providers: Begin Planning Now for End of COVID-19 PHE

Telehealth Providers: Begin Planning Now for End of COVID-19 PHE

Conceptualizing stress associated with clinical experiences of Korean counseling repatriates

AbstractThis study explored stress associated with clinical experiences of Korean counseling repatriates who returned to South Korea after obtaining their doctoral degree in the United States. Concept mapping revealed six major clusters of stressors: difficulties associated with language and communication, cultural differences between therapists and clients, clients’ attitudes toward and expectations regarding therapy, lack of ethical standards and licensure issues, hierarchical collectivistic working culture, and mental health system not being well‐established.

Mr. Watson, come here-I want to see you: One rural residency program’s rapid pivot to telemedicine during the pandemic

Telemedicine has been used for over a generation, but application has been limited in rural areas by lack of payment, licensure issues, cumbersome video equipment, and challenges with digital communications. Early in the COVID-19 pandemic, our rural family medicine residency made a rapid shift to all telemedicine services for our patients.

PH Professional Network: The Benefits and Challenges in Delivering Telehealth in Pediatric Pulmonary Hypertension

PH Professional Network: The Benefits and Challenges in Delivering Telehealth in Pediatric Pulmonary Hypertension

Clinical Practice and Clinical Supervision: Building a Firm Foundation

In this paper, the authors report on the “Foregrounding Clinical Practice and Clinical Supervision” working group of the Canadian Counselling Psychology Conference held on October 26 to 28, 2018, at the University of Calgary. Of the 12 working group participants, nine self-identified as students and three identified as licensed practitioners (two of the practitioners also held academic positions). This group of mostly early-career professionals identified an overarching theme of building a firm foundation for their future practice. Working group members identified three important contributors: the development of a strong, multi-faceted professional identity, including issues of licensure and certification, the interplay between counselling and clinical psychology, and the place of career psychology; the importance of clinical supervision, including the perceived variable quality of supervision and the apparent shortage of practicum placements; and professional role models. The authors provide their perspectives on the issue the working group raised and offer recommendations for counsellor educators and practice leaders.

Acting in the Public Interest: Learnings and Commentary on the Occupational Licensure Literature

There is increased interest in reforming the way occupations are licensed. However, most of the current dialogue focuses on the rapid growth in the number of people who need a license to pursue their chosen occupation. Consequently, significant questions are being raised as to the appropriateness of such requirements for groups that do not appear to present any tangible threat to public safety. Recent research has demonstrated that health professions have failed to articulate the need and value for licensure and how health regulators are addressing the many concerns being raised by the current debate. This study identifies dimensions or aspects of nurse licensure congruent with acting in the public interest and starts to curate (ie, to select, organize, and present) evidence related to each dimension, thereby identifying the current impact and highlighting opportunities for further research. This study utilizes a mixed-methods approach that combines documentary analysis, focus group discussion, and related literature associated with the various dimensions of acting in the public interest to highlight how nurse licensure addresses the current drivers for regulatory reform. A total of 99 documentary sources (ie, papers, articles, reports, and opinion editorials) were uploaded to NVivo 11 Plus for analysis. The analysis generated four overarching themes: (a) licensure reform, (b) impact of occupational associations, (c) occupational licensure issues, and (d) contemporary issues. Associated with these themes, 22 subthemes were also identified. The findings demonstrate there is clear evidence to support the fact that nurse regulators are acting in the public interest. However, further research is needed to provide definitive evidence to inform best practices in regulation and to offer direction for improved nurse regulatory reform. Furthermore, it is suggested that nurse regulators create and effectively maintain a global community capable of learning from one another and driving continuous improvement to better serve the public.

Prevalence rates of substantiated and adjudicated ethics violations

Summary This exploratory study examined the ethics violation data from one state’s licensing agency over a 28-year period, from 1985 through 2013. This study used descriptive statistics and chi-square analysis of the data to determine occurrence and prevalence rates in 592 cases. Violations were grouped into seven categories, and days before a license complaint was filed were also examined: dates ranged from 8 years before a license was issued (fraud on license application) to 28 years after being licensed. There were 389 females and 203 males in the sample, with 430 holding a social work license, 160 professional counselors, and 2 marriage and family therapists. Findings Of the 592 substantiated and adjudicated cases, 221 related to violations involving licensure, with 169 of those failure to comply with continuing education requirements, and most of those by professionals who have been licensed 10 or more years. Additionally, 156 violations involved boundary crossings, only of which 36 involved sexual boundary violations. Of those involving sexual contact, 22 were by female professionals and 14 by males. An additional 12 cases involved inappropriate sexual relations, but these were unrelated to professional practice. Overall, sexually involved cases represented a little over 8% of the cases, while licensure issues represented 38% of the cases. Applications Understanding which violations occur with more frequency enables social work educators to incorporate understanding the ethics of the social work into academic curriculum. Further study enables the profession to look at both what occurs and how that impacts clients, workers, and the public trust.

In Debt and Out of Work

Over the past few years, occupational licensure issues made headlines across media and policy organizations and appeared at the top of key lawmakers’ agendas. The majority of the articles focus on evaluating the necessity of licensure for certain professions and highlight the growth of licensure over the past 60 years, often citing the fact that one in four professions in the United States now requires a license ( Hultin, 2018 Hultin S. The National Occupational Licensing Database: Executive summary. National Council of State Legislatures. 2018, January 10; (Retrieved from)http://www.ncsl.org/research/labor-and-employment/occupational-licensing-statute-database.aspx Google Scholar ). These articles examine laws requiring the licensure of hair braiders, equestrian massage therapists, florists, interior designers, and others to highlight the debate over whether licensure is in fact an effective mechanism for ensuring public protection. Nicole Livanos, JD, MPP, is State Advocacy Associate, Nursing Regulation, National Council of State Boards of Nursing, Chicago, IL. Conflict of Interest Compliance Article 2Journal of Nursing Regulation Vol. 12Issue 2PreviewAs is standard in scholarly publishing, NCSBN’s Journal of Nursing Regulation (JNR) requires its authors to disclose any potential conflicts of interest (COI). Although COI information has always been collected by our staff in order to support editors’ review of the paper, it was not our standard practice to publish COI statements in each article. In this issue, JNR is retrospectively publishing the COI statements, which were collected with the below papers at submission, in order to make potential COI’s transparent to readers, as well as editors. Full-Text PDF

Regulatory and licensure issues derived from the summit on master’s training in psychological practice.

Regulatory and licensure issues derived from the summit on master’s training in psychological practice.

Don’t Take Away Our Licenses!

Don’t Take Away Our Licenses!

The Licensure Issue in I-O Psychology: A Canadian Perspective

The issue of registration/licensure as it is currently being discussed in North America is one that is near and dear to many of us involved with industrial-organizational (I-O) psychology in Canada. The consequences of any potential regulatory changes could be profound, and Canadian regulatory authorities, like any others, may be cued by other jurisdictions, including those within the United States, concerning standards and requirements.

The Licensure Issue in I-O Psychology: Are We Trying to Police the Police?

Many industrial and organizational (I-O) and consulting psychologists who engage in practice of their profession, for example as “management consultants,” compete against consultants with a wide array of backgrounds and disciplinary degrees. Indeed, in consulting work, one of us has competed against practitioners with backgrounds in fields ranging from accounting (CPAs) to sociology, communication, anthropology, business administration, and even those with degrees in divinity.

The Licensure Issue in Consulting and I-O Psychology: A Discussion Paper

The Licensure of Consulting and Industrial–Organizational (I-O) Psychologists (LCIOP) Joint Task Force has been examining the controversial issue of licensing I-O and consulting psychologists since 2014. We argue that constructive engagement with licensure is important for setting the future direction of the laws and regulations that govern professional psychology. We review relevant background information, current pressures on regulators, and recent developments in this area. We outline recommendations for jurisdictions’ regulators as well the I-O and consulting psychology communities to consider, discuss, and possibly act on. Others are invited to join the constructive, sometimes vigorous discussions we have enjoyed within the LCIOP Joint Task Force.

Future of Tele-echocardiography

AbstractTelemedicine is defined as the ‘delivery of health care and sharing of medical knowledge over a distance using telecommunication systems’. Echocardiography is often used to diagnose and exclude important cardiac diagnoses in adults and children. Evolving telemedicine technology has boosted access to echocardiography and has created a network that offers many possibilities for clinical, research and teaching activities. The two primary modes of telemedicine practise are ‘ store and forward’ and ‘real time’ videoconferencing. Using these technologies, relevant, up-to-date scientific information is instantly available for analysis and interaction. Studies have also shown these to be accurate, cost effective, improves patient care, enhances echocardiography quality and sonographer proficiency and promotes practice expansion.The growing use of technology such as smart phones, laptops and computer tablets as well as newer technologies like cloud computing, picture archiving computer systems (PACS) and the standardization of medical images (DICOM) has fuelled the now accelerating specific demands for tele-echocardiography. However, all these are not without challenges and obstacles. Some of these include lack of standardization of telemedicine components, confusing medico-legal and licensure issues, privacy/confidentiality, poor reimbursement, training issues as well as attitude and acceptance.These issues need to be addressed by all those involved in medical practice. Clinicians must work with sonographers, medical IT experts, hospital management and hospital physicists as well as manufacturers and insurance companies to ensure that the new system is integrated as an extra function within ultrasound consoles. National and international societies such as the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) could play a role in bringing everyone together and define the necessary training programmes. In conclusion, the revolution in digital technology is rapidly changing the world of telecommunications. Tele-echocardiography has a bright future to become an integrated part of our clinical available echocardiographic tool set – in a matter of time.

Balancing Tribal Sovereignty and the Role of Interjurisdictional Partnerships in Oklahoma.

Oklahoma has a history of strong partnerships with their tribal health leaders and tribal communities. In 2012, the Oklahoma State Department of Health (OSDH) established the Office of the Tribal Liaison, as Oklahoma has 39 tribal nations in the state, of which 38 are federally recognized. The Office of the Tribal Liaison is responsible for promoting relationships with Oklahoma Tribal Nations and implementing the OSDH Tribal Consultation policy. The strength of the partnership between the OSDH and the Tribal Nations enabled a new collaboration during an event hosted by a tribal casino event center that brought tattoo artists to provide tattoos to patrons over 3 days. Licensure issues that crossed the jurisdiction boundaries of the OSDH emerged before the event, which required the OSDH, Indian Health Service, and the Tribal Nation to work together to protect the public's health. The 3 jurisdictions drew upon their previously established partnership, OSDH's tribal consultation policy, and their open and trusting relationship to come together quickly to protect the public's health. This event and interjurisdictional partnership highlighted the importance of adopting the "Spectrum of Processes for Collaboration and Consensus-Building" model as outlined by Orenstein et al to help guide and support state, tribal, and federal collaborations. This case example highlights the opportunities for collaboration between different regulatory public health and tribal bodies to improve the communities' health.

AMA Approves Recommendations for Telemedicine

AMA Approves Recommendations for Telemedicine

Telemedicine in Ophthalmology: Promise and Pitfalls

An ophthalmologist in Iowa receives a phone call from a physician in Illinois about a case and provides treatment suggestions. Is the Iowa physician practicingmedicine in Illinois? Was his contact sufficient to establish a physicianepatient relationship with the Illinois patient? Does it matter if he receives an electronic copy of the patient’s record or if the physician seeking the consult is an internist? What if the Illinois patient joins in the phone call to answer some questions? These issues arise frequently and have existed since the advent of the telephone and the origins of medical licensure. Telemedicine uses electronic communications between a physician in “one location and a patient in another with or without an intervening health care provider” to provide expert opinion and care in a confidential patient-specific electronic exchange. Cybermedicine and e-medicine are more inclusive terms that address all aspects of physicians’ electronic communications; however, most laws and regulations apply only to telecommunications that are patient-specific, that is, telemedicine. Ohio’s statutory definition is typical: Telemedicine is “the practice ofmedicine. by a physician located outside. (the) state.” The linchpin for state regulation is the definition ofmedical practice; the laws of the state inwhich the physician is located and the laws of the state in which the patient is located are both relevant. The Federation of State Medical Boards maintains a listing of licensure requirements for telemedicine in each state. In addition, as of September 9, 2013, there were 146 bills pending in state legislatures addressing telemedicine and telehealth, clear recognition of their emergence as essential for medical care. The rush to regulate and the plethora of regulations create a morass for physicians practicing across state boundaries and impede widespread access to healthcare via telemedicine. Ophthalmology relies heavily on visual images for screening, diagnosis, treatment, and monitoring of disease, which frequently can be accomplished through digital imaging and telemedicine. It is not surprising that ophthalmologists have adapted quickly to the changing cyberlandscape and employ telemedicine to expand patient access to advanced care. Telemedicine has been particularly effective in the diagnosis and monitoring of retinopathy of prematurity (ROP) and diabetic retinopathy.

Lessons from the Trenches: Adopting Medication Technology Within Agencies Serving Older Adults

In 2009, a California-based technology and aging-focused non-profit implemented a medication optimization diffusion grants program, awarding grants to five health service organizations to develop technology-based projects to improve medication use by older adults. The project looked at the diffusion of innovation, in this case the technologies used, within the five organizations. “Diffusion of innovation” refers to the spread or dissemination of an idea, concept, or product throughout a group, such as a society or organization (Rogers 2003). The purpose of this study was two-fold. The first aim was to determine factors that served as challenges and facilitators in implementing and adopting medication optimization technology by community-based programs serving older adults. The second aim was to gather information to inform grant makers of how their grant making structure could better support agencies adopting new medication technologies. A semi-structured questionnaire was administered to the project investigators at each of the five organizations and one clinical site in late 2010 to identify the challenges and facilitators encountered when implementing medication management technology for older adults. Qualitative analysis revealed specific challenges, including time, funding, staff, licensing, scope of practice, reimbursement, and technology issues. Facilitators included presence of a site champion, information technology and other staff, organization mission and structure, and technology. In addition, project investigators discussed implementation and policy issues and lessons learned. Outreach, education, and hands-on training were considered essential to prepare staff to ensure their buy-in and project success. An on-site champion was particularly important. Most clinicians and their older patients—including those with severe chronic conditions—found the technology simple and easy to use. Reimbursement for the technology was inconsistent and licensure issues, problematic. Some providers believe licensure issues can be resolved through a cooperative regional approach (Cwiek et al. Telemedicine and e-Health 13(2):141–147, 2007). This study provides new information for agencies aiming to implement or adapt new medication technologies as well as grant makers seeking to fund the development of these technologies.

Criminal charges not necessarily criminalization of medication error

A lethal error in making injectable colchicine has resulted in federal criminal charges against a Texas pharmacy and its pharmacist-in-charge. The error, according to an early public statement by the pharmacist-in-charge, was a “breach in protocol” that “apparently resulted in the batch being more potent than was indicated on the label.” The deaths occurred in Oregon and Washington, several states away from the pharmacy where the colchicine injection had been made. Criminalization of an error in health care? In January, the National Coordinating Council for Medication Error Reporting and Prevention revised its eight-month-old position statement opposing the criminalization of errors in health care. The revision gives more prominence to the sentence “Criminal acts and patient harm related to competency and/or licensure issues are not addressed in this statement as they are beyond the Council’s purview.” As to the criminal case in Texas, Council Chair Manisha Shah in an e-mail said the role of the group does not include commenting on individual events.