PIERRE, S.D. (KELO) — Gloria Damgaard served all of her career in nursing, whether in the field or the classroom or helping oversee its practice in South Dakota.
“Nurses have held the number one spot for the most trusted profession in the country by the Gallup Poll for many years,” she said.
A few weeks ago, Damgaard retired as executive director for the South Dakota Board of Nursing. She answered questions about her career from KELOLAND News Capitol Bureau reporter Bob Mercer.
How long have you worked at the state Board of Nursing? What years were you in the various roles? What was your previous professional experience?
DAMGAARD: I worked for the Board of Nursing for 29 years. My work with the board actually began on a volunteer basis in the early 1980s, when Governor William Janklow appointed me to the board as a member. I served as a member until my term ended in 1985. In 1991, I was hired as the nursing education specialist for the board. In 2002, I was promoted to the position of executive director for the board, which I held until May 8, 2020.
My tenure as a nurse educator began at my alma mater, Presentation College in Aberdeen from 1978-80. This was a two-year associate degree nursing program. From 1980 to ’83, I served on the nursing faculty at the University of South Dakota in Vermillion while my husband attended law school. This too, was a two-year associate degree RN (registered nurse) program.
We relocated to Sioux Falls, in 1983, and I joined the nursing faculty at Sioux Valley Hospital School of Nursing, a three-year diploma program. Following the closure of the Sioux Valley Hospital School of Nursing program, I joined the nursing faculty at Augustana College, a four-year baccalaureate degree in nursing program. I served in this position until 1991, when I joined the staff at the South Dakota Board of Nursing as the nursing education specialist.
Other clinical nursing experience throughout my nursing career included positions at St. Luke’s Hospital in Aberdeen, St. Ansgar Hospital in Moorhead, Minnesota, Dakota Hospital in Vermillion, Rapid City Regional Hospital and Sioux Valley Hospital.
My formal education includes an associate degree in nursing from Presentation College, a bachelor degree in nursing from Moorhead State University, and a master of science, with a major in adult-health nursing, from South Dakota State University.
In a nutshell, what does the state Board of Nursing do?
DAMGAARD: The Board of Nursing is responsible for public protection in all aspects of the practice of nursing in our state. In a nutshell, the board is responsible for the approval of all nursing education programs, the licensing of all nurses either by examination or endorsement, and the handling of all complaints against nurses for practice or conduct violations.
How many nurses does the state board license in the various categories?
DAMGAARD: Registered nurses 18,537. Licensed practical nurses 2,597. Certified nurse midwives 37. Certified nurse practitioners 1,273. Certified registered nurse anesthetists 506. Clinical nurse specialists 60. We also register unlicensed assistive personnel such as medication aides, unlicensed diabetes aides and dialysis technicians.
The Legislature and the board set standards for nursing. What has been the general direction of regulation in South Dakota?
DAMGAARD: The general standards for nursing include the completion of an approved educational program for the preparation of the nursing role that is licensed, and successful completion of the initial licensing exams for RNs and LPNs and the certification exams for the advanced practice roles of CNP, CNM. CNS, and CRNA. The standards for nursing are found in the statutes and rules that govern the practice.
One direction of the board in decision making is to be risk managers rather than rule enforcers. Decisions are based on the risk of harm to the public. The board also utilizes a nursing theory-based decision model that is based on human dignity, both for the public that is served and the nurses that are the subject of nursing regulation.
The board is also focused on the mobility of nurses and the portability of their license across state lines. The board has been part of a nurse licensure compact for RNs and LPNs that allows them to be licensed in one state and have a privilege to practice in all states that are party to the compact. There are currently 34 states that participate in this model of licensure.
In terms of handling complaints against nurses, the direction of the board is to evaluate all cases using a ‘just culture’ approach, distinguishing human errors, system errors and recklessness, with guidelines to handle each situation.
In terms of the practice of nursing, the direction is that practice evolves over time and that nurses have the tools they need to determine which practice activities are in their licensed scope, especially if the statutes and rules neither permit or prohibit those practices. The board relies heavily on the best available evidence in making decisions.
Earlier you answered about the types of licenses the board issues. Tell us about how nursing has become more specialized, focusing on those types of licenses.
DAMGAARD: Nursing has become more specialized in the area of advanced practice nursing. In addition to LPN and RN practice, there are four advanced practice roles that include the certified registered nurse anesthetists (CRNA), certified nurse practitioners (CNP), clinical nurse specialists (CNS), and certified nurse midwives (CNM). The advanced practice nurses hold two licenses, one as a registered nurse and the second as an advanced practice nurse in one of the four roles.
Each advanced practice role requires a formal educational degree at least at the master’s level. Each role also requires a national certification examination to verify competence in the role. The numbers of CNPs are increasing in our state as they are able to provide primary care services, many serving in our rural communities where there is a shortage of providers.
CNPs, CNMs and CRNAs have prescriptive authority related to their respective roles, with the exception of the CNS. They are allowed to practice to the full extent of their educations and licensure.
One of the roles of the nursing board is disciplinary. Have the numbers of complaints changed? Have the types of complaints changed? How are complaints handled?
DAMGAARD: The disciplinary cases have increased in number over the years. On average the Board investigates approximately 150 cases per year. This is a very small number compared to the total number of nurses that are regulated by the board.
The majority of the cases are drug- and alcohol-related issues that interfere with the nurse’s ability to practice with skill and safety unless those issues are managed. Access to medications in the work environment is an occupational hazard for some nurses.
The board funds a program called the Health Professionals Assistance Program (HPAP) that case manages nurses with these types of issues. If the board refers nurses to HPAP, they must meet certain requirements in order to return to practice, including close monitoring. The board has the authority to remove nurses from practice if they pose a danger to the public.
There are also complaints of substandard practice that the board handles. The board is able to require remedial action in the case of poor practice issues.
Every complaint that is received is investigated and appropriate action is taken in accordance with statutes and rules. The entire board votes on the disciplinary actions that are taken. The board is required to hold a formal hearing in many cases where an agreed-upon disposition cannot be reached. Due process is paramount in the process. All disciplinary actions are made public and reported to the National Practitioner Database.
What are the academic requirements for the different types of nurse licenses in South Dakota? Are there additional steps?
DAMGAARD: All LPNs and RNs are required to complete approved programs for the preparation of these roles. LPNs are educated in our technical schools in Sioux Falls, Mitchell, Rapid City and Watertown. Additionally, we have two tribally based colleges that prepare LPNs. The technical schools in Sioux Falls and Watertown have LPN to associate degree RN programs in place. Rapid City and Mitchell technical institutes are preparing to offer these programs as well.
The two tribal colleges that prepare LPNs are located at Sinte Gleska University in Mission and Sisseton Wahpeton Community College in Sisseton.
The generic RN programs are conducted in our colleges and universities and require a bachelor’s degree. There are currently seven programs in South Dakota. These programs are: University of South Dakota, South Dakota State University, Augustana University, University of Sioux Falls, Mount Marty College, Dakota Wesleyan University and Presentation College.
Oglala Lakota College in Pine Ridge has a two year, associate degree program for RNs.
All graduates take a licensing exam prior to gaining a license.
Advanced practice nurses must complete an approved education program for the licensed role and obtain national certification in their area of practice. The formal education must be at least at the master level. Many programs are requiring a doctoral degree. All advanced practice nurses hold two licenses, the RN and an advanced practice license as a CRNA, CNP, CNS or CNM. CRNAs are required to have a minimum of two years of critical care experience prior to entering their programs.
SDSU, Mount Marty and Presentation College have programs that prepare CNPs. Mount Marty has the only CRNA program in the state. We do not have programs that prepare the CNS or CNM role.
What makes a good nurse?
DAMGAARD: A good nurse is one who is academically prepared to make sound clinical decisions related to their area of practice. A good nurse practices safely, skillfully and ethically as a member of the health care team. A good nurse honors the dignity of every person that is entrusted to his or her care and bears witness to the choices that people make in living out their health. A good nurse never stops learning. A good nurse understands the legal and policy implications of nursing practice.
Does South Dakota have enough nurses?
DAMGAARD: It depends somewhat on who you ask. We have one of the highest nurse to population ratios in the country, but that doesn’t tell the whole story. We have geographic shortages in some areas of our state because of our rural nature. In essence, we may experience more of a maldistribution of nurses than a true shortage. We always need to over-prepare nurses in our state to replace those that retire, relocate to other states or leave the practice for some reason.
Is there anything I should have asked that I didn’t?
DAMGAARD: The World Health Organization has named 2020 as the International Year of the Nurse and Midwife in honor of the two-hundredth birthday of Florence Nightingale on May 12, 2020.