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T H E O F F I C I A L P U B L I C A T I O N O F T H E M O N T A N A N U R S E S A S S O C I A T I O N

VOL. 52 • NO. 3 Fall 2015

Quarterly publication direct mailed to approximately 17,000 RNs and LPNs in Montana.

Executive Director Report

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Supporting the Work and Growth of YOUR Professional Organization

Please visit MNA’s constantly updated website!

www.mtnurses.orgEnjoy a user friendly layout and access to more information, including membership material, labor resources, Independent Study Library, a

new Career Center for Job Seekers & Employers, and more downloadable information.

Vicky Byrd, BA, RN, OCNExecutive Director

MNA is the recognized leader and advocate for the professional nurse in Montana. The professional organization has not had a significant dues increase in more than a decade. So our first ask will be for a ten dollar bill across the board from all members, collective bargaining or not. This

money will go to support the work and growth of MNA as a professional organization.  

Growing our Membership• Reaching out to APRN’s, engaging them in

CAP (Council on Advanced Practice), relevantlegislation to continue to support independent practice and supporting achievement of continuing education requirements related to pharmacology prescribing education.

• Encouraging people to become members anddeveloping our plan to reach out to district leaders and facilitate growth of activities at the district level (this includes all nurses,not just labor) – so they could be activelyinvolved in our councils and other work of the professional nurses association

• We’ve responded to the call for help andorganized 4 new local units in 2 years in Lewistown, Bozeman, and Missoula. Those contracts are being negotiated and we are helping to build the local unit structure and election of officers

• We’ve laid the foundation for more effectiveinternal organizing so more nurses that are covered by a union contract are choosing union membership and are full dues paying members than ever before

• We’re about to launch a new effort toincrease the membership of our professional organization and communicate with all new

nurses within the first few months following their graduation

Expanding our Services• We’ve added one additional Labor

Representativetoourstaffandhaveincreasedthe response time and quality of our representation and organizing capacity.

• We added an additional Nurse Educator toour staff to assist in the robust growth of our Continuing Education Department that is now serving over 32 states and 3 countries.

• CE department supports all membersthrough webinars, independent studies, and opportunities for nurses to engage in distance learning as well as “real time” interactions and our provider updates that enhance the professional development of nurses in all of our approved provider units in 6 states

• We’re empowering nurses with more qualityeducation directly through our provider services (APRN conf, annual Labor Retreat,annual convention, and Transition to practice) and through our national affiliateswhich includes nursing education as well as workplace advocacy.

• Wehave assistedmore professional nurses infacing workplace issues and challenges to their license than ever before whether they are a member or not.

Leading the Healthcare Industry• MNAis“leadingthehealthcareindustry”by:

1. Staff and member engagement in national nursing and interprofessional associations.

2. Staff and members who facilitate the work of international accreditation through serving on the Commission on Accreditation and as an Accreditation appraiser.

3. Facilitating publication of articles by members and nurses engaged with MNA activities.

Vicky Byrd,BA, RN, OCN

Executive Director continued on page 3

National News – Janet Ivers

Page 15

Montana Nurses Association 103rd Annual Convention

Page 7

A View from Chicago: One Nurses Perspective as a Delegate for NFN and

Professional Labor Academy

Page 11

Page 2 Montana Nurses Association Pulse August, September, October 2015

CONTACT MNAMontana Nurses Association

20 Old Montana State Highway, Clancy, MT 59634Phone (406) 442-6710 Fax (406) 442-1841

Email: info@mtnurses.orgWebsite: www.mtnurses.org

Office Hours: 8:00 a.m.-4:30 p.m. Monday through Friday

VOICE OF NURSES IN MONTANAMNA is a non-profit, membership organization that advocates for nurse competency, scope of practice, patient safety, continuing education, and improved healthcare delivery and access. MNA members serve on the following Councils and other committees to achieve our mission:• CouncilonPractice&GovernmentAffairs(CPGA)• CouncilonEconomic&GeneralWelfare(E&GW)• CouncilonContinuingEducation(CCE)• CouncilonAdvancedPractice(CAP)

MISSION STATEMENTThe Montana Nurses Association promotes professional nursing practice,

standards and education; represents professional nurses; and provides nursing leadership in promoting high quality health care.

CONTINUING EDUCATIONMontana Nurses Association is accredited as an approver of

continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Montana Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s

Commission on Accreditation.

MNABoard of Directors

Executive Committee: President Lucy Ednie, RN-BC Vice President Rayna Joshu, RN, MSN Secretary Brenda Donaldson, RN Treasurer Lorri Bennett, RN

Directors at Large:

Council Representatives: Advanced Practice Arlys Williams, APRN, FNP-BC CCE Deborah Lee, BSN, RN-BC CPGA JohnHonsky,APRN E&GW DaylynPorter,BAN,RNC

Editorial Board: Chair–Barbara Prescott Schaff, APRN, DNP, FNP-BC Mary Pappas, RN, EdD Kate Eby, APRN, MN, FNP-C

MNA Staff: VickyByrd,BA,RN,OCN,ExecutiveDirector PamDickerson,PhD,RN-BC,FAAN,DirectorofContinuingEducation Mary Thomas, BA, RN, OCN, RN, Continuing Education Specialist Kathy Schaefer, Continuing Education Specialist Robin Haux, Labor Program Director Amy Hauschild, BSN, RN, Labor Representative Caroline Baughman, Labor Representative SandiLuckey,LaborRepresentative KimberlyKralicek,Administrative&MarketingSpecialist JillHindoien,Membership&FinanceSpecialist

Questions about your nursing license?Contact Montana Board of Nursing at: www.nurse.mt.gov

PUBLISHER INFORMATION & AD RATESCirculation 18,000. Provided to every registered nurse, licensed practical nurse, nursing student and nurse-related employer in Montana. The Pulse is published quarterly each February, May, August and November by the Arthur L. Davis Publishing Agency, Inc. for Montana Nurses Association,

20 Old Montana State Highway, Clancy, MT 59634, a constituent member of the American Nurses Association.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. MNA and the Arthur L.

Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next

issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Montana Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising iswithoutmerit,orthatthemanufacturerlacksintegrity,orthatthisassociationdisapproves of the product or its use. MNA and the Arthur L. Davis Publishing

Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or

membership of MNA or those of the national or local associations.

WRITER’S GUIDELINES:MNA welcomes the submission of articles and editorials related to nursing or about Montana nurses for publication in The PULSE. Please limit word size between 500-1000 words and provide resources and references. MNA has the right to accept,

edit or reject proposed material. Please send articles to: kim@mtnurses.org.

PULSE SUBMISSIONS

We are gathering articles that are relevant and appealing to YOU as a nurse. What is happening in your world today? Is there information we can provide that would be helpful to you? The Pulse is YOUR

publication, and we want to present you with content that pertains to your interests.

Please submit your ideas and suggestions to Kim.

kim@mtnurses.org

Published by:Arthur L. Davis

Publishing Agency, Inc.

www.mtnurses.org

Notice of Proposed MNA Bylaw Changes

Brenda Donaldson, RNMNA Bylaws Chair

There are several proposed changes to the MNA Bylaws that will be presented to the 2015 House of Delegates. The Bylaws Committee is in the process of finalizing the proposed changes which will be posted on the website upon completion.

Proposed changes include:1.Article IX. Council on Continuing Education:

Minor changes will be proposed that relate directly to MNA’s transition from ApprovedProvidertoAccreditedstatus.

2. Article X. Council on Economic and General Welfare. Section 7. (f.): The current languagerestricts the CBA to voting by secret mailed or electronic voting. Changes will be proposed which will also allow on site secret voting as this has been past practice.

3. Article II. Membership and Dues Section 2. Qualifications (a.): Revisions will need to bemade in defining the qualifications for MNA membership. Currently licensure to practice must be granted by the Montana Board of Nursing as a requirement for MNA membership.

During the 2015 legislative Session, Compact Licensure was passed. This allows RN’s fromother compact states to practice in Montana utilizing their multi-state compact license which would not be granted specifically from the Montana Board of Nursing.

4. Article II. Membership and Dues Section 2. Qualifications (d.): MNA is in the process ofevaluating and defining an affiliate organization membership. Current language will be reviewed to ensure compliance and to clarify how dues are set for an affiliate organization.

If you have any questions regarding Bylaw changes, please email MNABOD@mtnurses.org.

Call forNominations 2015

Brenda Donaldson, RNMNA Secretary

All members are eagerly encouraged to consider involvement in MNA by consenting to serve and accepting nomination to any of the open positions. Seasoned nurses and new graduates alike who hold membership in MNA are welcome. Service in a position is a wonderful way to gain knowledge of MNA, provide valuable input into the future of our organization, represent nurses throughout the state and develop leadership skills. If you are a new member to MNA or have ever considered serving in a position, there are many veteran members who are willing to mentor you.

General Ballot1. President2. VicePresident3. Secretary 4. CAPReptoBOD5. CPGARepto

BOD 6. Nominations

Committee7. GPGACouncil8. CE Council9. ANA Membership 10. Elections

Committee

CAP Ballot1. Member at Large 2. Secretary 3. Chair Elect

Collective Bargaining Ballot

1.E&GWCouncil2. AFT Convention

Delegates

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August, September, October 2015 Montana Nurses Association Pulse Page 3

• We’re keeping a high profile meeting regularly with the Governor andkey cabinet members so the nurses of MNA have a voice in policy and legislation that impacts healthcare and their ability to meet the highest standards of care with the freedom to advocate for that care without inappropriate repercussions.

• Wemeet regularlywith theBoardofNursing to collaborateonprojectsthat improve healthcare and public safety as well as provide input to the fairest processes for nurses that find themselves in the review process.

• Nationallywehavedirect input fromMNA staff andourmemberswithANA, NFN and AFT Nurses and Healthcare professionals!

• We are planning to launch a campaign to raise awareness of Violenceagainst healthcare workers focusing on nurse assaults that we hope willhelppassinthe2017LegislativeSession.Ourgoalisfortheassaulton a nurse while on duty to become a felony as is supported by our membership. The campaign is called “Your Nurse Wears Combat Boots” and is the first campaign of its kind to be spearheaded by MNA.

This chart is a comparison of our yearly dues and broken down by cost per month. I compared them to our MNA staff employed here at the association. It helps with perspective and if we want to continue to grow and provide increasing services. Also, here are examples of our 2 sister states who also have similar nursing wages as MT and with their resources are able to employ morestaffandimplementprogramstosupporttheirmember’sneeds.Oregonand Ohio are similar to Montana as they have blended memberships as well.

MNA 2015 • CollectiveBargainingdues $513.50yearly $42.80monthly• NonCollectiveBargainingdues $471.50yearly $39.29monthly

MNA Staff 2015 Liuna 1686 Yearly Monthly• Admin/MarketingSpecialist $580.44 $48.37• Finance/MembershipSpecialist $658.20 $54.85• CESpecialist $787.44 $65.62• LaborSpecialist $867.84 $72.32

Oregon Nurses Association 2015 (ONA)• CollectiveBargainingduescurrently $658.00yearly $54.83monthly• IncreasingduetoAFTaffiliation $975.00yearly $81.2monthly (tobegin2016)

Ohio Nurses Association 2015 (ONA) • CollectiveBargainingduesrangefrom $597.00-$790.00yearly $49.16-$65.83monthly• ONA—2015newgraduaterate$26.00/hour,annualsalary$58,080

Washington Nurses Association 2014 (WSNA)• CollectiveBargainingDuesrangefrom $892.80-$923.28yearly(Thisdoesnotincludedistrictdues) $74.40-$76.94monthly• WSNA—2015 wage average for their contracts is $32.94/hour, annual

salaryof$68,548

Amazingly Montana is competitive on their wage scales compared to our sister union states and I understand cost of living is different in different areas across all our states…MNA has heard from the members and they want more support in Education, Labor and Legislation and this dues increase assists us in that endeavor!!!

Wewillcontinue toupdate thesebulletpointsasother informationcomesin……

Executive Director continued from page 1 In Memory…MechelleSommerfeldwasthefirstPresidentofMNALocalUnit#6in

Bozeman. She was a fearless leader and was a tireless union advocate. She knew there was a better way for she and her co-workers and was unwavering in her support for their collective action. The following are somewordsfromherco-workers–

M. Mechelle Sommerfield passed away on July 5th, 2015, surrounded by her family. Mechelle was an RN at the Fresenius Dialysis Clinic in Bozeman, Montana. Her joi d’vivre will be greatly missed by coworkers and clients alike.

Mechelle didn’t grow up dreaming she would be a nurse some day. Mechelle enjoyed her life as a bartender. She loved learning to ride a Harley Davidson motorcycle and then teaching others how to ride. One year she took a trip to Mexico. When she got home she felt a bit unwell, the feeling hung on so eventually she went to a doctor. She learned that she had kidney failure. No one ever figured out why she had kidney failure, she was not diabetic or hypertensive, she didn’t have any of the other diseases associated with development of kidney failure. She submitted to hemodialysis. During that time she became an administrative assistant at the dialysis clinic, a post she really enjoyed as she got to use all those cool office supplies she loved. However, she felt like she could do more for the patients and so she went to school to become a registered nurse.

On one glorious New Year’s Eve, Mechelle got the call that there was a kidney available to her. She lived with that transplanted kidney for 14 years before it failed and she again reviewed her options, this time choosing peritoneal dialysis.

Mechelle and her husband moved to Montana in 2011, a place that truly felt like home to both of them. Mechelle’s personal experience of hemodialysis, transplant and peritoneal dialysis informed her every professional interaction. Her spirit lightened us all. “Thanks for a great day” was her last remark as she left work each day. Thank you, Mechelle.

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Page 4 Montana Nurses Association Pulse August, September, October 2015

Labor Reports and News

What IS the Collective Bargaining Assembly (CBA)Robin Haux, Labor Program Director

WHAT IS THE MNA Collective Bargaining Assembly (CBA)?

The MNA Collective Bargaining Assembly is comprised of two elected members from each local bargaining unit (LBU)represented by MNA. The CBA determines the direction for the Economic and General Welfare (E&GW) programand reviews its policies and budget for the MNA’s

collective bargaining activities. It is essentially the House of Delegates exclusively for the collective bargaining members.

The CBA meets annually at the MNA Convention. At this annual meeting, it is the business of the CBA to accept nominations made by the collective bargaining membership for the followingelectedpositons:

1.E&GWCouncilMembersandE&GWCouncilBoard of Director Member;

2.National Federation of Nurses (NFN)NationalExecutiveBoard(NEB)Director;

3. NFN delegates;4. AFL-CIO Cope Convention delegates;5. AFL-CIO Constitutional delegates; and6. AFT Convention delegates.

Each year prior to the CBA, a ‘call for nominations’ shall be provided to the collectivebargaining members a minimum of 15 days prior to the scheduled start of the CBA. Only nominated candidates shall be forwarded to the collective bargaining members to be voted on by secret ballot and each candidate must complete a consent to serve form.

All elected CBA members IN-ATTENDANCE at the annual meeting of the CBA are eligible to vote on business presented to the CBA. At the annual CBA meeting, the CBA may propose additional revenue for the collective bargaining program. Any increase in dues or assessments must be approved by a majority of the CBA who vote by secret mailed or electronic ballot. For this upcoming CBA meeting, this will include an electronic vote on a potential dues increase of $10.00 to $15.00, for a dues assessment for ourAFT affiliation. If you have not modified your local unit bylaws to contain the elections of the two members to the CBA, please contact your MNA representative immediately for assistance with the process. It is very important that all LocalBargainingUnitshavetheirvoiceandvoteat the 2015 CBA.

YOUR MNA Economic and General Welfare Council (E&GW)

Outside of the annual CBA meeting, your elected members of the Economic and General Welfare (E&GW) Council have the duty toprovide for implementation of CBA policies and procedures approved by the CBA. Additionally, theyhavethefollowingresponsibilities:

1. Establish goals; 2. Establish policies and procedures to conduct

the business and direction of the collective bargaining program;

3. Approve use of mobilization funds from the MNA mobilization fund in accordance with direction from the CBA;

4. Arrange for the annual meeting of the CBA to coincide with the annual MNA convention; continue providing a labor retreat specifically designed for our collective bargaining members and

5. Annually, in conjunction with the Labor Program Director, develop and submit abudget to the Finance Committee;

6.The E&GW Council shall have all powersof the CBA to transact business between CBA meetings in accordance with rules established by the CBA.

Withourmembersvotingonbothanincreasein dues and a new AFT Affiliation Assessment dues increase at both the annual convention and CBA, it is more important than ever that all members be educated and encouraged to run as a convention delegate and CBA delegate. Visit the MNA website for a current flyer with information and the rationale on the dues increases. Additionally, keep checking the website as we will be updating it frequently.

Our work as your State Advocate continues and grows every day! We need your help tosustain this growth and to build new programs to bring awareness to nursing issues in Montana.

Robin HauxLabor Program

Director

Montana AFL-CIO Convention Delegates Adopt Resolution Against Violence Against

Healthcare WorkersAmy Hauschild, BSN, RN

Labor Representative,Montana Nurses Association

District 7 Representative,AFL-CIO Executive Board

Delegates to the 59th Annual Montana AFL-CIO Constitutional Convention unanimously passed a resolution supporting legislation which criminalizes violence against first responders and healthcare workers.Theresolutionreadsasfollows:

Whereas, death and injury from workplaceviolence in healthcare settings are a significant occupational hazard that also threatens patient safety and well- being; and

Whereas, according to the Department ofLabor’s Bureau of Labor Statistics, healthcareworkers suffer injuries associated with workplace violence at almost twice the rate of all other private sector workers; and

W he r e a s , r e s e a r c hindicates that work-re l a t ed a s sau l t s and injuries associated with violence in the field and healthcare settings are often discouraged from reporting assaults or threats of violence; and

Whereas, MT AFO-CIO members have been assaulted on the job in the field and in healthcare facilities:

NOWBEITTHEREFORERESOLVED that MT AFL-

CIO support state legislation which criminalizes violence against first responders and healthcare workers.

Amy Hauschild, RN, BSN

Labor Representative

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August, September, October 2015 Montana Nurses Association Pulse Page 5

Labor Reports and News

Communication is KEY

Robin Haux, Labor Program Director

Over the past few months, your MNA Labor Department has learned of some topics we need to expand upon and develop. MNA is a member driven organization and when our members provide us with a need, our job is to find a way to meet that need. As a result of learning of new challenges, we researched more locals by reaching out to other leaders to gauge how to address these desires. Through our research, we have begun to make some changes at MNA in how we can make information more available to you.

What are we going to do differently?1.EMAIL ADDRESSES: Your MNA Board of

Directors has approved new email addresses for all our elected Council and Board members.Wewillprovidetheseaddressesviaour website and we should have these up and running before summertime.

2.CONTRACTS DATABASE: The MNA E&GW(Economic and General Welfare) Council andBoard of Directors have approved the new MNA Contracts Database. Our website will soon host an area where you can search and print all the current MNA contracts.

3. EDUCATION: Your MNA Labor Departmenthas started brainstorming new ideas to better provide our members with more relevant education.Workingwith our CEDepartment,we are hoping to provide more webinars that can be more easily accessible to our members. Improved ideas for training are Officer training, treasurer training, grievance training, UnfairLaborPractices,andADO’s.Ifyouhavean idea of something your local has an interest in or something you think would benefit our members, please email me at robin@ mtnurses.org.

Your MNA Labor Team strives to empower our locals! We are stronger together and as ourcommunication needs change, we look forward to bringing new ideas and improved methods as our Association grows.

Congratulations to RNs at Montana Mental

Health Nursing Care Center (MMHNCC)!

Amy Hauschild, BSN, RNLabor Representative

On May 20th, 2015 the Montana Board of PersonnelAppeals(BOPA)certifiedarepresentationelection in which the RNs chose Montana NursesAssociation as their bargaining agent. MMHNCC is located in Lewistown MT. The nurses voted by secret mail ballot and their message was strong! By a large margin the nurses chose MNA to represent their interests in the workplace. MNA Local #9 nurses are electing local unit leadership,adopting bylaws and along with their MNA representatives, are working on securing their first collective bargaining agreement with the state. CongratulationsMMHNCCRNs!

MNA Local #6Dialysis Nurses

Bargaining First ContractAmy Hauschild, BSN, RN

Labor Representative

MNA #6 in Bozeman won their representationelection in March 2015. First contract negotiations are underway. Additional sessions are planned for early August and early September 2015. Bargaining is never easy, though the interactions thus far have notbeencontentiousorespeciallydifficult.Local#6RNs are well on their way to achieving their firstcollective bargaining agreement.Go Local #6, staystrong!

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Page 6 Montana Nurses Association Pulse August, September, October 2015

Continuing Education

Displaying Your CredentialsPam Dickerson, PhD, RN-BC, FAAN

What “initials” do youhave after your name? How do you write them? What’sthe sequence that should be followed? Does it matter?

Yes – it does! How wedisplay our credentials is a mark of professionalism and designates our academic and professional status. Here are the guidelines:

1. First, list your highest academic degree (examples:BSN,MSN,PhD)

2. Next, list your licensure (example:RN)

3.Third, any state designations (examples:APRN,CNP,CNS,CNM,CRNA)

4. Next, provide the correct designation for national certification (examples: BC, OCN,CCRN,CPHQ)

5.Finally, include awards and honors (example:FAAN)

There is a reason for this specific sequence. The educational credential is permanent – once youhave earned it, it’s yours for life. Therefore, it hasfirst place in your listing. The licensure credentials (license+anystatedesignations)havebeenearnedas evidence of your ability to practice. They can be taken away for violations of state practice laws

and rules, so they are listed next. Finally, national certification and awards/honors are voluntary, sothey are listed last.

If you have achieved increasingly higher levels of academic degrees, it is not necessary to list all of those credentials. Typically, the highest degree is the one listed – Mary White, PhD, RN,or Sam Green, EdD, RN. However, if you havedifferent types of degrees, you may choose to list them. As an example, if Marion Martin has a baccalaureate degree in nursing and a master’sin business administration, she may choose to list her credentials as MBA, BSN, RN. When listing acombination of nursing and non-nursing degrees, the non-nursing degree is listed first.

Whendoyouusewhichcredentials? Itdependson the purpose. In clinical practice settings, typically only the licensure designation is used – Jonathan Jacobs, RN, or Becky Thompson,CNP. Be sure to know and follow the policy andprocedure for proper use of your credentials on patient medical records and other facility-specific documents.Whenwritingarticlesforpublicationorusing your credentials for a presentation, all of your credentials should be provided, in the order listed above.

Use your credentials with pride! They meansomething to you, to other healthcare providers, and to the public. Standardizing the way credentials are displayed helps people understand our education, expertise, and professionalism.

Reference: American Nurses CredentialingCenter. (2013). How to display your credentials.Retrieved from http://www.nursecredentialing.org/DisplayCredentials-Brochure.pdf.

Pam Dickerson, PhD, RN-BC, FAANDirector, Continuing

Education

APRN CORNERKeven Comer, APRN, MSN, FNP-BC

(This is a new additionto the PULSE. I will betrying to bring relevant issues and concerns quarterlytoAPRNs.)

Over70APRNsattendedMNA’s Annual APRNPharmacology conferenceheld in Helena March 13 and 14th. A total of 16.5 CE credits and 11.5 Pharmacology credits wereavailable over the 2 day conference. If you would be interested in giving

a lecture or know someone you think would be a valuable asset, please let the MNA staff know. Mark your calendar for next year’s conferenceMarch 4-5, 2016 in Helena. The conference is always a wonderful time to reconnect with fellow APRNsandmeetnewAPRNs.Wehadaneveningdiscussion about upcoming state and national legislative bills and discussed barriers to practice around the state.

MNA staff, Executive Director and Lobbyist, Vicky Byrd, and many MNA members spent tireless days and nights with the MNA legislative agenda. Vicky made sure APRN voices were heard, andno detrimental rules were put in place. Our full practice authority is intact.

OnTuesday,April14, theUSSenatevoted92-8in favorof (H.R.2) theMedicare Access and CHIP Reauthorization Act of 2015, legislation which repealed the Sustainable Growth Rate (SGR). TheHousepassed thebillonMarch26, andPresidentObama signed the bill into law on Thursday, April 16.

As you may recall, H.R. 2 includes NPs in thefirst year of the Merit-based Incentive PaymentSystem (MIPS), and NP-led Patient CenteredMedical Homes are eligible to receive incentive payments for the management of patients with chronic disease. The legislation also removes a current barrier to practice for NPs by authorizingthem to document the face-to-face encounters they conduct with their Medicare patients when orderingcertaindurablemedicalequipment(DME).Additionally,thebillreauthorizesCHIP,whichwillensure access to care is preserved for millions of children.

TheAmericanAssociationofNursePractitionersachieved unprecedented levels of support for this bill. During the recent AANP Health PolicyConference, more than 250 NPs met with thestaff of 96 Senators and over 150 House Members asking them to support this important legislation. Additionally, more than 3,900 NPs wrote over14,000 emails to their Members of Congress over the past month, asking them to support this important legislation. This is an incredible effort andisanillustrationofthepowerNPshavewhenwe come together to support provider neutral legislation that puts our patients first.

If there are any issues or news worthy information, please contact me at keven.comer@gmail.com so I can get them in the PULSE. ThePULSE goes to all APRNs and RNs and LPNslicensed in the state of Montana.

Keven Comer, APRN, MSN,

FNP-BC

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August, September, October 2015 Montana Nurses Association Pulse Page 7

Continuing Education

Montana Nurses Association103rd Annual Convention

September 30, Wednesday – October 2, Friday 2015Helena, MT

Best Western Premier Helena Great Northern Hotel

*21/2daysofContinuingEducation* House of Delegates

* Movie Night “The American Nurse”* Council Meetings

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Register online at www.mtnurses.org

Nurses

The Heart of Healthcare

PamelaF.Cipriano,PhD,RN,NEA-BC,FAANPresident,AmericanNursesAssociationSeptember 30, 20159:00am-10:00am

JeannineBrant,PhD,APRN-CNS,AOCN,FAANOncology Clinical Nurse SpecialistOctober 1, 20159:00am-10:00am

You’re Never Too BusyTo LEARN

Mary Thomas, BA, RN, OCNRN Continuing Education Specialist

We are all familiar with Nurses being the patientadvocate. MNA could be an acronym for My Nurse Advocate. Let me explain further. I have been an MNA member since 1985. I was a busy mother of 3 boys, a wifeandanRN. Ihad receivedmybachelor’sdegreein nursing from Carroll College. I served on the Labor Negotiations Team twice, as a voice for the hospital nurses and worked diligently to increase the quality of patient care and conditions of employment. As a busy young mother, nurse and wife, I thought I was way too busy to attend conferences outside of the hospital. However, to cope with changes and to keep a positive attitude, studies have shown that attention to lifelong learning will benefit the nurse emotionally

and physically! It is all about the benefits and the opportunities! I have come to realize that to be a more effective nurse and professional leader in quality patientcareIshouldembraceMNA’sContinuingEducationdepartment inmycareer!

I recently was hired as the RN Continuing Education Specialist at MNA.The Montana Nurses Association” promotes professional nursing practice, standards and education; represents professional nurses; and provides nursing leadership in promoting high quality health care.” What MNA also promotesis increased morale and excitement to practice more efficiently and effectively. I have been surrounded by enthusiasm and the extraordinary commitment of many professional nurses and staff to provide and promote higher education for our nurses. Some are volunteers! These professionals are empowering and constantly striving for perfection. These nurse educators should be wearing capes, as they are real super-heroes. Many have doctorates and have great experience to share.

Personally, networkingwithmy colleagues is somuchmore engaging forme than obtaining contact hours from various articles available. It is like having a face-to-face conversation vs texting on the phone. One is a media communication means only, the other takes in the non-verbal and verbal communication of the participant, the smiles, the frowns, the nodding of the head in agreement. Constructive criticism can be delivered more amicably personally than in a text.My point being: utilize the Conferences andMNAConvention! Network with your fellow nurses! Sharing is a great morale booster! Encouragement is like a vitamin infusion! As we work our busy schedules, we need to know that we are not alone and that other nurses are committed to the same standards as we are! Support your ProfessionalAssociation! There is strength in numbers! There is no “I” in team! Education is a building block to morale, professionalism and leadership. Be the professional! Support your professional association. Attend MNA Convention, conferences,webinarsandyou’llelevateyourjobtoawholenewlevel.

Mary Thomas, BA, RN, OCN

Page 8 Montana Nurses Association Pulse August, September, October 2015

Continuing Education

Montana Nurses Association Approved Providers

Milestones in MNAContinuing Education

Pam Dickerson, PhD, RN-BC, FAAN

Two important milestones were achieved by MNA’s Continuing EducationDepartment this spring: AccreditationwithDistinction for our ProviderUnit,and receiving the ANCC Premier Award for our Approver Unit. These are atestament to the knowledge, skill, energy, enthusiasm, and commitment of our entireMNAteam.Workingtogether,weidentifyopportunitiestoenhancetheprofessional development of our members and other nurses, and we adhere to international accreditation standards in assuring that our work is based on highqualityandbestavailableevidence.ReceivingthesedesignationsfromtheAmericanNursesCredentialingCenter’sCommissiononAccreditationissimilartoreceivingMagnetDesignationasahospital–itisevidenceofexcellenceinmeeting quality standards and achieving outcomes that improve the practice of nursing and the provision of patient care.

HereistheletterfromANCCinformingusofthePremierAward:

March 24, 2015PamelaS.Dickerson,PhD,RN-BC,FAANMontanaNursesAssociationApproverUnit20 Old Montana State HighwayMontana City, Montana 59634

DearPam,

I am very pleased to inform you that the Montana Nurses Association Approver Unit is the recipient of the 2015 American Nurses CredentialingCenter(ANCC)AccreditationProgram’sPremierAward.

The Premier Program Award recognizes accredited organizations thatexcel in approving organizations and/or individuals to develop high qualitycontinuing nursing education activities. Organizations receiving the PremierProgram Award demonstrate excellence in leadership ability and promotingthe use of innovative and creative education strategies to meet the needs of learners. The effectiveness of continuing nursing education activities approved by Premier Program Award recipients is continually evaluated to achieveoptimal professional nursing and patient care outcomes.

The Montana Nurses Association Approver Unit willbe recognized on the ANCC Accreditation web site, at the annual Continuing Nursing Education Symposium, and to all accredited organizations via a press release. In addition, the Montana Nurses Association Approver UnitwillreceiveaPremierProgramAwardtrophyandiseligible touse thePremierProgramAward logo.Finally,up to three members of the Montana Nurses Association ApproverUnitwillreceivefreeregistrationattheannualContinuing Nursing Education Symposium.

Congratulations on achieving this prestigious designation!

JannBalmer,PhD,MSN KathyChappell,PhD,RNChair,CommissiononAccreditation VP,AccreditationProgramandInstitute forCredentialingResearch

St. Vincent HealthcareBillings, MT

Alaska Native Medical CenterAnchorage,AK

KalispellRegionalMedicalCenterKalispell,MT

Fairbanks Memorial HospitalAlaska

Benefis Healthcare SystemsGreat Falls, MT

CentralPeninsulaGeneralHospitalSoldotna,AK

St.Peter’sHospitalHelena, MT

WrangellMedicalCenterWrangell,Alaska

Community Medical CenterMissoula, MT

Montana Health NetworkMiles City, MT

Bozeman Deaconess HospitalBozeman, MT

Livingston HealthcareLivingston, MT

ProvidenceSt.PatrickHospitalMissoula, MT

Alaska Nurses AssociationAnchorage,AK

Billings ClinicBillings, MT

North Valley HospitalWhitefish,MT

MT Geriatric Education CenterMissoula, MT

South Dakota Nurses AssociationPierre,SD

St. James HealthcareButte, MT

PartnershipHealthCenterMissoula, MT

ProvidenceAlaskaMedicalCenterAnchorage,AK

MountainPacificQualityHealthMT

SouthPeninsulaHospitalHomer,AK

Alzheimer’sResourceofAlaskaAnchorage,AK

BartlettRegionalHospitalJuneau,AK

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August, September, October 2015 Montana Nurses Association Pulse Page 9

Continuing Education

Integrating Social Media into Nursing EducationDebra Rapaport, RN, MSN

Helena College Nursing Faculty

Nurses are taught the importance of confidentiality from the first day of nursing school. It is clearly understood that nurses will not share personal patient information. Nursing students learn to avoid discussion of patient information in public arenas. Technology, particularly smart phones and social media sites like Facebook,TM Twitter,TM and InstagramTM have added an additional layer to the confidentiality and privacy equation.

Hospital administrators and managers, fearing inappropriate use of social media sites by employees, impose strict regulations on social media activities andinteractions.NewYorknurseKatieDukewasfiredafterpostingapictureofanemptytraumabaytitled“Manvs.6train.”Whileneitherthepatientnorany other identifying patient information was visible, she was terminated for beinginsensitive(Li,2014).

Today’s technology-focused generation of nursing students and nursesmay appropriately use their smart phones to research health and medical information. Rather than limit the use of socialmedia sites, nurse educatorsshould address appropriate use of these sites and help students properly utilize social media technologies (Bristow, 2013; Schmitt, Sims-Giddens, & Booth,2012). Incorporating social media education into nursing course work givesthe students an expanded framework for hands-on learning. These skills will prepare nursing students to better utilize these constructive technologies.

Policy AwarenessA key step for appropriate use of social media in nursing education is

knowledge of policy. Students must have education and understanding about patient privacy and confidentiality. These concepts are presented in beginning nursing courses and should be reviewed along with information about using social media. The student must be clearly aware of the institution’s policyon social media (#iAMaNurse, 2015; Schmitt, Sims-Giddens, & Booth, 2012).Institutional social media policies usually restrict texts, tweets, posts, and conversations. Violations may include disciplinary action including dismissal. Nursing students and all nurses must recognize that patients, peers, facility administrators and instructors can potentially view information posted on social media sites. It is important to understand that comments made on a personal Facebook page can impact future job or academic opportunities (Lachman,2013).

Many benefits exist with the use of social media. Schmitt, Sim-Gidens, andBooth (2012)note that socialmedia is transforming theway informationis distributed, and as such can facilitate the way nursing students learn about communication, nursing roles, policies, and ethical considerations. Nursing faculty can promote understanding of appropriate uses of social media in healthcare and offer the student an opportunity to practice with social media in a controlled environment.

Social Media: Helena College NursingHelena College Nursing program sought to increase opportunities for the

three nursing cohorts to interact and engage in the peer-mentoring program. In order to minimize scheduling conflicts among students, a current-student FacebookTM group page was created. This private and secret group was only

open to current Helena College nursing students and faculty by invitation. Students could post questions, words of encouragement, or arrange study or mentoring sessions. Nursing Faculty was represented and available to respond to issues individually or address the entire group.

In addition to the private Facebook page, students in the Fundamentals courses used their phones and tablets to film skills return demonstrations, uploading the video for grading. This provided the students an opportunity to utilize technology, as well as fine-tune their nursing skills prior to instructor review. In the RN Management classes, podcasts and YouTube videos wereincorporated into the didactic course. Topics included ethics, lateral violence and other current topics such as Vaccines: Public Health and the Measlesoutbreak; Ebola; and High cost medications. These videos and podcasts provided a foundation for the class discussion on the topics, allowing students to prepare and review current issues. Similarly, students were assigned to listen to a podcast and then post their discussion points on the private Facebook page. Assignment included discussion and peer responses via the online classroom platform.

Future applications of social media technologies at Helena College will include the extension of nursing classes designed to address geographically diverse nursing students. These platforms will allow students an opportunity to come together to view a podcast, discuss current trends, upload a presentation, or demonstrate a skill through virtual technology.

ConclusionNursing educators must take an active role in instructing students in

appropriate and acceptable uses of social media. Social media offers a way to lessen the confines of distance and time restrictions of the traditional classroom setting, offering a viable option for interacting with distance students(Schmitt,Sims-Giddens,&Booth,2012),whilealsoaffordingstudentsand nurses accessibility to current trends and up to date information.

Teaching the nursing student how to use social media technologies with respect to patient privacy and confidentiality is a clear and present responsibility of all nursing educators. Participation in social media helpsnursing students collaborate with peers and engage in thoughtful discussions on current health topics, promoting learning and critical thinking. Social media can be effectively and appropriately incorporated into nursing education with attention to policy, support from administration and creativity of nurse educators.

ReferencesBristow, T. (2013). Hybrid classrooms: Mix match magic. Nurse Tim Webinar.

#iAMaNURSEinaSocialMediaWorld.(2015,videofile).Retrievedfromhttps://youtu.be/9qRdzdK93Rc

Lachman,V.D. (2013). Socialmedia:Managing the ethical issues.MEDSURG Nursing, 22(5),326-329.

Li,D.K. (2014).NewYorkMedNurse fired for ‘insensitive’ Instagramshot.New York Post. Retrieved from http://nypost.com/2014/07/08/new-york-med-nurse-katie-duke-fired-for-insensitive-instagram-shot/

Schmitt, T., Sims-Giddens, S., & Booth, R. (2012). Social media use in nursingeducation. OJIN: The Online Journal of Issues in Nursing, 17(3)Manuscript2.

Nurses – Welcome to Wyoming!

Wyoming Behavioral Institute has been accredited by The Joint Commission (TJC) and is licensed by the State of Wyoming’s Department of Health.

Wyoming Behavioral Institute is owned, managed and operated by a subsidiary of Universal Health Services, Inc., one of the largest providers of high-quality healthcare in the nation.

Wyoming Behavioral Institute, an 85-bed acute care psychiatric hospital is now recruiting in Casper, Wyoming.

Wyoming Behavioral Institute is the premier leader in providing behavioral health services and treatment in

Wyoming and the Rocky Mountain West.

We pride ourselves in providing the highest quality of nursing care. If you are an experienced nurse, or a recent graduate, and have a commitment to service excellence we look forward to hearing from you and

having you join our team today.

We offer excellent compensation and full benefits package. Interested applicants please

visit our website and apply online.

RNs • LPNs • New Grads Welcome!

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Page 10 Montana Nurses Association Pulse August, September, October 2015

Membership

Join Your Professional

Association TODAY!Jill Hindoien

Membership & Finance Specialist

The Montana Nurses Association is not only a collective bargaining union, we are your professional association. Many RNsbelieve that they need to be a collective bargaining member in order to be a member of MNA. This is not the case. Any RN;managers, supervisors, directors, PRNs, PDRs,relief, Advanced PracticeRegistered Nurses, andstaff RNs in non-collective

bargaining organizations can belong to their professional association. Membership in MNA automatically provides membership in the American NursesAssociation(ANA).

MNA is provider and approver accredited. With membership you can enjoy discounts forcontinuing nursing education activities provided by MNA. Activities include, but are not limited to; independent studies, webinars, and 3-day conferences. MNA can help you get contact hours for an individual activity you would like to offer at your facility or can help your facility become an approved provider to offer numerous continuing education activities at your workplace. Members receive discounts on application fees. Contact hours earned through the ANCC Accreditation System help you maintain licensure and attain/maintaincertification.

Ifyouwouldlikemoreinformation,pleasedon’thesitatetocontactmeat406-442-6710.

Jill HindoienMembership &

Finance

MEMBERSHIPMATTERS!

Montana Nurses Association would like to invite you to join us today!

BENEFITS INCLUDE:•EMPOWERINGRNsTOUSETHEIR

VOICESINTHEWORKPLACE•IMPROVINGPATIENTCARE

•HAVINGINPUTREGARDINGWAGES&BENEFITS

•CONTINUINGEDUCATIONOPPORTUNITIES

•LEGISLATIVEREPRESENTATION

Call or email todayjill@mtnurses.org(406) 442-6710

Applications also available onour website.

mtnurses.org

Has your contact information changed?

New name? New address?New phone number?New email address?

To update your contact information, please emailorcallMontanaNursesAssociation:

jill@mtnurses.orgor406-442-6710

Finding cervical cancer early can help you fight it.

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Laurel Health & Rehabilitation Center

Seeking RNs & MDS CoordinatorContact us for current openings

820 3rd Ave.Laurel, MT 59044e-mail: Phone: 406-628-8251apowell1@empres.com Fax: 406-628-8253

August, September, October 2015 Montana Nurses Association Pulse Page 11

h o p e f u l l y inspire you like it did me. Together we can make a difference. Vicky Byrd, our MNA E x e c u t i v e D i r e c t o r , like always, was leading the way. Her d e d i c a t i o n and devotion to our nursing profession is genuinely astounding.

So I returned h o m e w i t h m a n y g r e a t memories and an extra 10 pounds.It’struethat Chicago deep dish is to die for, I feel like I am dying daily trying to lose these extra 10 pounds. It was all worth it in the end…lots

oflaughswerehadandnewfriendsweremade.I’msure to be in Butte soon enough to catch up with my newfriend,ifshedoesn’tkillmeforwritingthis!

before profits. It was during all of this that it became so much clearer to me that how “big” the picture truly is. The “Union”is spoken so many times as a separate entity, but what it truly is, is all of us. We(the nurses) arethe Union, we represent the voice of the nurses,thepatient advocate! It’s abig jobespeciallywhenyou start to look at patients before profits, and trying to streamline medical billing. Then you try to look at things from a little smaller perspective, your local level and educating not only your nurses, but patients, and community. How do we do this in today’s ever changing work environments andfast paced lives? Keeping people motivated andinterested is a challenge that is formidable. If we are to succeed and to change what is happening to us, our patients, and healthcare system, let us use our voices and our resources to overcome these obstacles.

At NFN I got to see one of our own, Daylyn Porter, get elected to Treasurer! All in all, it wasa great trip and I encourage all of you to try and attend at some point in your career. It will

Student News

Flight NursingJason Hall

WalkingacrossthetarmacoftheMissoulaAirporttowards the gray hangar that holds the aircraft and offices of the Northwest MedStar Critical Care Transport Service, I wondered if I was in the right place. The tall building was old, its tall painted sides a flat gray on the cloudy afternoon. There was yellow-grey insulation showing around the edges of the large rolling door that ran almost the entire widthofthewall.Itdidn’t looklikeanyhospitalordoctor’sofficeI’deverseen.

I met my guide for the tour of the aircraft and hangarattheairfieldgate.LarryPetermanhasbeena flight nurse for 25 years, and it was evident in the way he seemed completely at home in and around the aircraft. A fit looking older man, he wore a neatly trimmed gray beard below his bright, friendly blue eyes. His navy blue flight suit appeared comfortable but functional, covered in pockets full of medical supplies and trimmed in bright yellow and reflective tapes. On helicopter flights they wear an additional reflective vest with even more pockets. Describing the purpose for all the pockets, Larry said “I can get an IV started with just what I have on me at [an accident] scene. I can be talking to a patient and gathering information, but at least be getting that done.”

The first thing we did was tour the two aircraft. Weclimbedupthefoldoutstairsintothebackoftheairplane and each sat down in a seat in the back. My first thought was that it was tight, but actually not as cramped as I had expected. I had also expected to see a lot more equipment than was evident in the treatment area, but that impression was based on what I’ve seen in hospital rooms. Although thetwo environments share similar purposes, there are several key differences.

First of all, the aircraft only has to hold enough equipment and supplies for one patient at a time, the rest are stored in the hangar. Also, many of the same machines you’d see in the hospital room arealso present in the aircraft, just in a smaller size. My favorite was the portable ventilator, a machine that breathes for a patient who has a breathing tube inserted into their trachea. I thought that such a vital piece of equipment would take up more space, but this portable ventilator was no bigger than my Xbox at home. I decided I need to give medical device engineers a little more credit.

In both aircraft, the patient lays on a cot and is inside a bright orange sleeping bag called “Dr. Down.” The name mostly comes from the down insulation inside the bag, but Larry said the bag could also help secure individuals who are confused and uncooperative due to injury or illness. The bag also serves another purpose by containing blood, urine, or other bodily fluids that would otherwise get onto the floor. I had an impression that trauma victims in particular might come in spraying blood all over the place, but Larry brought me back to reality in his usual calm and confident manner, “The blood isn’t as big a deal as I thought it’d be.” Hesaid the bleeding is controlled as much as possible as part of stabilizing a patient for transfer. And when occasionally things do happen in flight, the disposable absorptive liner of Dr. Down does a good job keeping the mess under control.

The final difference between a hospital room and the aircraft is that patients spend a long time in hospital rooms until they’re significantly better, butthe transport is always accomplished in as little time aspossible.“We’renottryingtocuretheminflight,”said Larry. “We’re just looking at their vital signsand trying to make them a little bit better, a little bit better,” until they can get to the higher level of care.

Finally, I sat down with Larry to talk about his owncareer.HecamefromasimilarsituationthatI’min now. He started nursing as a second career and from the start he was interested in being a flight nurse. He talked about enjoying the variety and intensity of cases that he sees, and the satisfaction of handling one case at a time. I could also see an aspect of his personality that I recognized from my timeinthemilitary:hewasmostanimatedwhenhetalked about the challenges the teams face in their jobs. He grinned while describing the frustration of radio issues when the flight team is orbiting a site butcan’tmakeradiocontactwiththerescueworkersbelow, a rare but incredibly frustrating occurrence. His grin wasn’t cynical, and he wasn’t treating theproblem flippantly. It was an appreciation that overcoming such obstacles is what makes the job exciting, and that the hardest times always make the beststoriesonceyou’rethroughthem.

I finished my tour with great regret that I had to leave. The fascinating subjects and Larry’s friendlymanner were things I could have enjoyed for much longer. I was, perhaps morbidly, disappointed that I hadn’tseenthemrespondtoacall,butIthinkIgota good idea of the nature of the business. And my visit had caused a slight change in my perspective of medical treatment. Treatment is not the building that it is practiced in; it isn’t a hospital or a clinic or aroom full of monitors and IV drips. It is a process, conducted with sophisticated tools, by highly trained people in a calm and determined manner to heal a sick or injured patient. I left that hangar with a strengthened desire to be a part of such an impressive team, capable of bringing life-saving care to wherever the patient may be.

Works CitedPeterman,Larry.PersonalInterview.10February2015

Statewide Nursing News

Jen Taylor, CCRN

As I arrived in Chicago and waited for my Butte roommate in the airport, I knew it would be a good trip, I was surrounded by fifty priests (this had tobe a good omen)! I had toadmit I was a little nervous about the roommate thing, meeting new people is great, but getting to know someone up close and personal is another matter.

According to my trip planner, my roommate came withaCPAP,soIwaspreparedforthewholeDarthVader experience. But, to my surprise I never even noticed it and met a lifelong friend in the process! I guess those Butte gals are fun! Katie andI had a great time learning lots and even got to explore Chicago some!

At the Professional Labor Academy we got achance to network with nurses from all over the U.S. anddiscuss challenges that all ofus face,notjust locally, but on a national level. It was here that AFT announced their campaign of patients

A View from Chicago: One Nurses Perspective as a Delegate for NFN and Professional Labor Academy

Jen Taylor, CCRN

From left to right:Susan E. Jacobsen of Oregon,

Jacinta Tucker of Ohio,Daylyn Porter, BA, RN, OCN

Jen Taylor and Katie Haxby

From left to right:Paula Anderson of Ohio;

Katie Haxby, RN;Jen Taylor, CCRN,

Vicky Byrd, BA, RN, OCN

From left to right:Vicky Byrd, BA, RN, OCN, MNA Executive Director; Jen Taylor,

CCRN; Sandi Luckey, MNA Labor Representative

Page 12 Montana Nurses Association Pulse August, September, October 2015

Statewide Nursing News

“Reclaim the Promise”Katie Haxby, RN

As I boarded the plane heading for Chicago, I had no idea what was in store. I knew that I would be meeting new people, and that always can be intimidating and nerve racking to me. What Iexperienced in this week away from my family and colleagues was self-growth, problem solving skills, and confidence in my career. The hotel we stayed at, PalmerHouseHiltonHotel,wasbeautiful,elegantanda historic point of the district. The food served, the kind helpful employees, and beauty of the hotel left me speechless.

At the conference for AFT and NFN, we addressed, and were educated, on new updates and important

care for continuing to “Reclaim the Promise” of quality healthcare here inMontana. I will stand tall and be that voice that will speak loud and proud stating “patients before profits.” One workshop that truly left me inspired was Compassion and Choices. This session allowed the views of individuals not wanting to die, but to live their final days with love and support from their family, friends, and caregivers regarding their final wishes.

This trip and conference workshops allowed me to grow in my leadership skills and reminded me that we truly are all professionals wanting to provide safe,effective,qualitycare.We,attimes,failtorememberthateventhoughwehave “been there, done that”, the patients and families may not have, leaving a gap in our communications.

Special thanks to Vicky Byrd for taking extra care of her Montana girls.

Katie Haxby

Jennifer Miller, RN

When I arrived at the ANA Code of Ethics conference in Baltimore,anxious is the best word to describe how I felt. I was one of at least 300 people. As I perused the brochure about the variety of classes offered, I was awestruck by the diversity of presenters, their educational background and the number of letters after their name! I was pleasantly surprised at the immediate sense of camaraderie and feeling of unity in the room. As we completed sessions and introductions were made, I came to realize that there was no hierarchy here. This was a fabulous group of multifaceted nurses that each brought dynamic and different ideas from their life and work experiences to this symposium. Despite the difference in letters following our names we were all aligned in our dedication to nursing.

There was so much take away from this conference but these are the highlights. Ethical concerns affect us all; from rural, critical access hospitals, to 1100 bed inner city hospitals with a competing hospital 2 blocks away. It is important that we all purchase the Code of Ethics for Nurses with Interpretive Statements. The changes that were made to the code of ethics were the first changes made in 14 years. This code needs to become the bar by which we set our standards of care, for our patients, ourcoworkers,andmostofallourselves.Weneed toreconnectwithourconscience, be responsible for our actions, and our inactions. In order to have moral courage, we have to be willing to ask the hard questions and act.Weneedtomakeethicalpracticeroutine.Whereyoulive,shouldnotdetermine how long you live, or the standard of treatment you receive. The movement towards greater patient access to medical records may also present new ethical challenges. In summation, the Code of Ethics is our contract with the public. It is imperative to learn and grow as nurses and keep ethics as a part of our day to day practice. Thank you National Federation of Nurses for sponsoring my all-expense paid trip, it was an invaluable experience.

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August, September, October 2015 Montana Nurses Association Pulse Page 13

National News

Sleep and WorkClaire Caruso, PhD, RN, and Roger R. Rosa, PhD

Reprinted from CDC NIOSH Science Blog with permission of Claire Caruso, PhD, RN

Weknow that sleep is important. Theneed forsleep is biologically similar to the need to eat and drink, and it is critical for maintaining life and healthandforworkingsafely.Sleeping7to8hoursa night is linked with a wide range of better health and safety outcomes. NIOSH has been actively involved in research to protect workers, workers’families, employers, and the community from the hazards linked to long work hours and shift work. In honor of National Sleep Awareness Week, wehave summarized the sleep and work issue below and, in a companion blog tomorrow, will highlight NIOSH research in this area.

A growing number of American workers are not getting enough sleep. Research shows an increasefrom 24% in the 1980s to 30% in the 2000s in the percentage of American civilian workers reporting 6 orfewerhoursofsleepperday—alevelconsideredbysleepexpertstobetooshort(Luckhaupt,Tak,&Calvert2009).

Why are more Americans getting less sleep?Workdemandsareonefactor.Thetimingofashiftcan strain a worker’s ability to get enough sleep.Working at night or during irregular hours goesagainst the human body’s biology, which is hard-wired to sleep during the night and be awake and active during the day. Still, society needs certain workers around the clock to provide vital services in public safety, healthcare, utilities, food services, manufacturing, transportation, and others. The resulting shift work—any shift outside the normaldaylight hours of 7 a.m. to 6 p.m.—is linked topoorer sleep, circadian rhythm disturbances, and strains on family and social life. It is not possible to eliminate shift work altogether, so the challenge is to develop strategies to make critical services available while keeping workers healthy and everyone around them safe. In addition to shift work, some data suggest that a growing number of employees are being asked to work long hours on a regular basis. Every extra hour on the job is one less spent attending to the person’s off-the-job responsibilities.When theday is too full to fiteverything in, it is often sleep that gets the short shrift.

What are the risks of long work hours and shift work?

Risks for Workers:• Sleepdeprivation• Lackofadequatetimetorecoverfromwork• Decline in mental function and physical

ability, including emotional fatigue and a decline in the functionof thebody’s immunesystem

• Higher rates of depression, occupationalinjury, and poor perceived health

• Higher prevalence of insomnia among shiftworkers with low social support

• Increasedriskofillnessandinjury• Strain on personal relationships, such as

marriage and family life• Increasedriskoflong-termhealtheffects,such

as heart disease, gastrointestinal disorders, mood disturbances, and cancer

Risks for Employers:• Reducedproductivity• Increaseinerrors• Absenteeism and presenteeism (present at

work but not fully functioning because of healthproblemsorpersonalissues)

• Increased health care and workercompensation costs

• Workforceattritionduetodisability,death,ormoving to jobs with less demanding schedules

Risks to the Community:• Potentialincreaseinerrorsbyworkersleading

to:o Medical errorso Vehicle crasheso Industrial disasters

Research indicates that the effect of long workhours and shift work may be more complex than a simple direct relationship between a certain high number of work hours or shift schedule and risks. The effects appear to be influenced by a variety of factors including characteristics of the worker and the job, worker control, pay, non-work responsibilities, and other characteristics of the work schedule.

Both workers and employers share in the responsibility of reducing risks connected to poor sleep. Therefore, it is important for both workers and managers to make sleep a priority in their personal life and in the assignment of work.

What can employers do to address this issue?• Regular Rest: Establish at least 10 consecutive

hours per day of protected time off-duty in orderforworkerstoobtain7-8hoursofsleep.

• Rest Breaks: Frequent brief rest breaks (e.g.,every 1-2 hours) during demanding workare more effective against fatigue than a few longer breaks. Allow longer breaks for meals.

• Shift Lengths: Five 8-hour shifts or four 10-hour shifts per week are usually tolerable. Depending on the workload, twelve-hour days may be tolerable with more frequent interspersed rest days. Shorter shifts (e.g.,8 hours), during the evening and night, arebetter tolerated than longer shifts.

• Workload: Examine work demands with respect to shift length. Twelve-hour shifts are more tolerable for “lighter” tasks (e.g., deskwork).

• Rest Days: Plan one or two full days of restto follow five consecutive 8-hour shifts or four 10-hour shifts. Consider two rest days after three consecutive 12-hour shifts.

• Training: Provide training tomake sure thatworkers are aware of the ups and downs of shiftwork and that they know what resources are available to them to help with any difficulties they are having with the work schedule.

• Incident Analysis: Examine near misses and incidents to determine the role, if any, of fatigue as a root cause or contributing cause to the incident.

What can workers do to address this issue?• Make sure you give yourself enough time to

sleep after working your shift.• Avoidheavyfoodsandalcoholbeforesleeping

and reduce intake of caffeine and other stimulants several hours beforehand since these can make it difficult to get quality sleep.

• Exercise routinely, as keeping physically fitcan help you manage stress, stay healthy, and improve your sleep.

• Choose tosleepsomeplacedark,comfortable,quiet, and cool so you can fall asleep quickly and stay asleep.

• Seekassistancefromanappropriatehealthcareprovider if you are having difficulties sleeping.

What does the future hold?NIOSH is working on several projects to reduce

the risks associated with long working hours and shiftwork.Ourcurrentresearchincludes:

• Studyingnewmethodstobettermeasureworkhours

• Surveillancetobetterunderstandtheextentofthe problem

• Studies to estimate risks to workers andemployers

• Traininginterventions

—ClaireCaruso,PhD,RN,andRogerR.Rosa,PhDDr. Caruso is a research health scientist in the

NIOSH Division of Applied Research and Technology.Dr. Rosa is the NIOSH Deputy Associate Director for

Science.

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Page 14 Montana Nurses Association Pulse August, September, October 2015

National News

If You See Something, Say SomethingJennifer Flynn, BA

Manager, Healthcare Risk ManagementNurses Service Organization (NSO)

On a busy day with short staff and high-acuity patients, a nurse fails to notify the physician of an abnormal clotting time for her patient. Not knowing theresult, thephysicianordersthepatient’sheparinto be restarted. The nurse mistakenly overlooks the abnormal lab tests and implements the order. Subsequently, the patient suffers significant brain hemorrhage and permanent disability.

In this situation, you might think it was the physician’s, not the nurse’s, responsibility to checkthe clotting time before restarting the heparin. But in a similar case, a nurse was held liable for failing to notify the physician. The case illustrates the important responsibility of nurses to notify others of a significant change in a patient’s condition,including results of lab tests. Failure to do so can leave you open to legal action by patients or families. Here is what you need to know to ensure you are following correct procedures for notification.

A common problem Allegations related to patient assessment

monitoring, treatment, and care—three main areaswhere notification plays an important role—arerelatively common and can be quite costly, according to the CNA/NSO claim study Understanding Nurse Liability, 2006–2010: A Three-part Approach. From January 2006 through December 2010, assessment allegations accounted for 12.6 percent of closed claims with a paid indemnity greater than $10,000,monitoring accounted for 6.8 percent, and treatment and care accounted for 58.5 percent. The average paid indemnity was $228,737 for assessment,$223,282 formonitoring, and$156,857 for treatmentand care. So how can you lower your risks for being named in a lawsuit as a result of not notifying practitioners?

Monitor the patient It seems self-evident that you should monitor your

patients, but claim studies show that this doesn’talways happen. Base your monitoring on practitioner orders and your professional judgment. For example, if your patient is having neurologic checks every 2 hours and develops altered cognition, perform a complete neurologic assessment.

Common areas to assess include vital signs, blood glucose, lab and diagnostic test results, clinical signs

of bleeding, effectiveness of pain management, signs of infection or inflammation, nutritional intake, oral andI.V.fluidintakeandoutput,outputs(e.g.,urine,stool, wound drainage), wound status, behaviors,cognition, patient concerns, response to treatment, and patient safety.

Make the patient your ally. Tell him or her to report any problempromptly. Keeping patients andfamilies informed will make it more likely they will speak up promptly. If there is a change in your patient’s condition, you’ll need to communicate itquickly.

Communicate effectively Think before you speak with the practitioner so

you can provide the information in a way that will get results. A commonly used tool is SBAR, whichstaff at Kaiser Permanente created based on a toolfromtheU.S.Navy.HereisanexampleadaptedfrommaterialfromKaiser:

• Situation. Give a concise statement of the problem. “Dr. Jones, I’m calling about JackWilson, a 55-year-old man who is pale,diaphoretic, and complaining of chest pressure.”

• Background. Give pertinent, but brief, information related to the situation. “He has a history of hypertension and was admitted yesterday for GI bleeding. He received two units of RBCs yesterday, and his hematocrit 2hoursagowas32.Hisbloodpressure is90/50and pulse 120.”

• Assessment.Providewhat you foundandwhatyou think about the situation. “I think he is bleeding again, and we can’t rule out an MI,butwedon’thavearecentH&Hortroponin.”

• Recommendation. Request or recommend anaction. “I’d like to get an ECG and labs, andhave you evaluate him right away.”

To make your communication more effective, use the practitioner’s name to get his or her attentionand state the problem clearly and concisely. If you are talking in person, make eye contact. Minimize background noise, particularly when you are on the phone, and avoid multitasking. Some hospitals have RapidResponseTeams that you can call if you feelthesituationwarrantsmoreimmediateattention.Usethem if you need them.

Overcoming resistance What if you feel the practitioner isn’t listening

to you or doesn’t plan to take appropriate action?According to TeamSTEPPS, a tool for enhancingpatient safety that you can obtain at no cost from theAgencyforHealthcareResearchandQuality, it’syour responsibility to assertively voice your concern at least two times to ensure it has been heard. If the outcomeisstillnotacceptable,you’llneedtocontactyour supervisororgoup thepractitioner’s chainofcommand.

Remember that your goal is not just to notifysomeone—you want to ensure proper action istaken. Following the chain of command is important from a liability perspective, too. According to the Understanding Nurse Liability claims study, claims involving the failure to invoke the chain of command represented 5.6 percent of the treatment and care closed claims and had one of the highest average paidindemnities($350,558).

Don’t forget to document It’s easy to forget to document your efforts to

contact the practitioner, particularly if the patient’scondition is declining rapidly. However, that documentation is what will protect you should a claim occur. Date and time each entry and include detailed information about the patient’s conditionbased on your assessment, who you notified, and actions taken. If you need to follow up with someone higher in the chain of command, note that as well. Other areas to document include reporting abnormal lab values and diagnostic tests.

Remember documentation basics: Follow yourorganization’s protocols and guidelines from yourprofessional association. Don’t alter the medicalrecord and comply with the policy for correcting errors.

Notifying practitioners These actions will help ensure you properly

notify practitioner of a change in a patient’scondition:

• Frequently monitor the clinical situation ofyour patients so you detect problems early. Follow practitioner orders, but also use your judgment about when to conduct additional assessments.

• Listen to what the patient says. It can betempting to dismiss another complaint from a “difficult”patient.Don’t.

• Assess and document, at a minimum, thefollowing when there is a change in the patient’s condition: presenting problem(s),comorbidities affecting the patient’s status,mobility status, medications, behaviors, cognition, vital signs, and lab values.

• Notify appropriate practitioners of yourassessment results.

• Document the results of specific patient-monitoring activities according to the practitioner’s orders and as indicated by thepatient’s condition, including vital signs andother relevant information.

• Document all patient treatment and care,including timely implementation of practitioner orders, patient/family education, supervisionof nonprofessional caregivers, tracking of test results/consultationreports,follow-upofdelaysand issues in obtaining tests or test results, and reporting of any patient incident (injuryoradverseoutcomeandsubsequenttreatment/response).

• Document the actions you took to notify thepractitioner and the response.

• If you do not receive a response in areasonable time frame, seek assistance elsewhere and document your actions.

The bottom line As a nurse, you are responsible to promptly notify

practitioners of a change in a patient’s condition.The bottom line is that if you see something, say something—anddocumentit.

RESOURCES Agency for Healthcare Research and Quality. Pocket

Guide: TeamSTEPPS. Publication number #06-0020-2. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.html.

CNA, NSO. Understanding Nurse Liability, 2006-2010: A Three-part Approach. www.nso.com/nurseclaimreport2011.

Kaiser Permanente. SBAR toolkit. http://www.ihi.org/resources/Pages/Tools/SBARToolkit.aspx.

This risk management information was provided by Nurses Service Organization (NSO), the nation’slargest provider of nurses’ professional liabilityinsurance coverage for over 650,000 nurses since 1976.The individual professional liability insurance policy is administered through NSO and underwritten by AmericanCasualtyCompanyofReading,Pennsylvania,aCNA company. Reproduction without permission of thepublisher is prohibited. For questions, send an e-mail to service@nso.comorcall1-800-247-1500.www.nso.com.

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August, September, October 2015 Montana Nurses Association Pulse Page 15

Janet Ivers

I have finished my final lecture in Infection PreventiononFriday,andonThursdayIstartedtheEmergencyRoomTV series to help theMalawianswith their English. Yep, I was awarded a grant to fund this item. The students seemed to enjoy the pilot, but we didn’t have enough time to discussit. I try to discuss certain terms, but I forget they are only first year students, so it may be confusing. Slowly, slowly.

The students are on holiday for this coming week. Then they start clinicals the week after. I willbeworkingwiththeICUstudentsandTheater(surgery)students.IamsureIwill findprojects tokeep me busy.

Inmid-MaytherewasInternationalNurses’Day.Wewent to anearby town to celebrate.Wegot toNtheu just as it was starting at 1000. We rode bybus to the start of the parade. Then walked in the sun and heat for about two hours. There were nurses from all over Malawi. I took videos of the nurses dancing along the route, flat-bed trucks carrying nurses and friends I met along the way.

One particular friend is R.,who was one of my favorites while I was orienting. She was marching/dancing along in the parade, too. R. is the headof Out PatientD e p a r t m e n t (OPD) at thelocal tertiary hospital here in our town, and I really like her.

There were only two or three other nurses fromKCN, and theywere trying to showme howto dance in a traditional Malawian way to the entertainment of the other nurses in the parade. Finally N. said, “Madame, we have been dancing like this since we were five. If you try to dance like us you will probably break a bone.” She calls me “old white woman” and I call her “young black whippersnapper.”We laughateachother trying tostumptheotherwithnames.Welikeeachothertoomuch to seriously insult each other.

At the end of the parade we went to this big field where there were chairs for about1/3ofus.Variouspeople were introduced, some groups put on skits, and awards were handed out. One of the most adorable skits was a group of children all dressed up like nurses. The nurse read ascript,whichstarted like this,“Whenmymothergave birth to me, and I was delivered without problems, I realized...” and the children said, “I want to be a nurse.” The script went through the

life with the children stating “I want to be a nurse” as the chorus. It really was adorable. And I got a photoofoneof thechildren. Isn’t sheanadorablefuture nurse? She is the one speaking into the microphone in the group photo.

The majority of the ceremony was in Chichewa, which I do not understand. Then S., who was sitting nexttome,said,“Thereisyourfriend.”R.hadjustgotten an award. She went up to get her award and I met as she was coming back. I ran up to her and gave her a big hug. Being the only “old white woman” in a group of about three hundred nurses, I am sure I did not stand out. Much.

We got something to eat (cookies and Fanta)before we headed home. On the way home N. bought mice on a stick, and I actually got close enough to takeaphoto.YUK.However,ofall thisthings to be done with a mouse, this seems the most appropriate. Skewer and roast and sell.

That same week we were invited to the village of L., C.’s (my housemate)counterpart. It was about an hour drive on paved road, then gravel road, then dirt road, then straddling a foot path. The home site was absolutely beautiful. They raise their own vegetables, pigeons, corn and fruits.

I worked on this email over the weekend. Sunday night I was eating leftovers from Sunday lunch. I was muching on a piece of toast and the crown and part of my tooth decided to fracture from the root. I said a few choice words, dug the crown with tooth bits out of the partically masticated soggy bread, and said more choice words. Then I texted the dentist.

I had met this dentist at book club, and she cleaned my teeth in December. When I went toLilongwe for my extension checkup I requested that she perform the checkup and cleaning instead of going to a new dentist in Lilongwe. That was fine. SoIhadseenher(Dr.S.) lastweekforacheck-upand x-rays. And another cleaning. The water here in nycityreallystainsmyteeth.WearenowFacebookfriends. She is from Scotland, has an adorable Scottish accent, is about 6’3” and very thin. Andvery gentle in the dental area. And very busy.

Since I was not in pain, I went to bed. The next morning I called her office at 0803 and requested anappointment.Theygotmeinat230(getit?Two-thirty is close to tooth-hurty). Shehadgoodnews.She can do a post and core to give the crown, which had broken off at gum level, something to attach to. I was very glad to hear that. Of course I have a vacation coming up-leaving Blantyre on 13June,sowehaveatimecrunch.BUT,shecouldfit me in the very next day to get the prelim done. More good news-the whole procedure was 40,000 Kwacha-about $100.USDollars.And I get to keepmy tooth. And I get it done before vacation so I don’thavetoeatmashedpotatoesuntilmid-July.

After many phone calls and texts and messaging, we resolved the tooth issue and I got my approval throughWashingtonDC. Ifallgoeswell, Iwillberepaired (cored, posted and cemented) by Friday.Just in time to leave for South Africa.

Since I will be in South Africa next week and on vacation with my soulmate the two weeks after that, IwillprobablywritesometimeinSeptember.BUT,Idid get an opportunity to visit a clinic in the village withanewfriendfromtheUK.Mynextinstallmentwill start there.

National News

A banana tree

Papayas on a papaya tree

Tangerines...almost ripeA teenaged orange

Two immature pineapple plants

Ourhostfamily:Lefttoright:F.(C.’srecentnewbestfriend),C.,L.(C.’scounterpart),M.(thedaughter of L.), and G. (the husband of L.).

G just broke open a (fresh!) coconut

Selfie: R. and me during the parade

Montana to Malawi – 3rd Installment

Page 16 Montana Nurses Association Pulse August, September, October 2015

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