inside...linda stroup, ph.d., rn greetings to all colorado nurses! my name is linda stroup, and i am...

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From the Desk ofthe CNF President

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association

NURSEVolume 119 • No. 4 • November 2019

Quarterly publication direct mailed to approximately 84,000 RNs and LPNs in Colorado

100 Nurses for 100 Legislators . . . . . . . . . . . . . . 2Executive Director’s Column . . . . . . . . . . . . . . . . 3Government Affairs & Public Policy Committee . . . 4Peer Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . 5Boomers Leading Change: Building a Movement to Transform Aging . . . . . . . . . . . 6CNA Honors Outstanding Members . . . . . . . . . . 7

CNA Membership Assembly Highlights . . . . . .8-9District & Special Interest Group Reports . . . . . 10Combat Drug Abuse, Misuse and Diversion . . . 12Malpractice 101 . . . . . . . . . . . . . . . . . . . . . . . . . 14Re-Thinking Shared Governance:How Does the Profession Engage Itself? . . . . . 16Strengthening Workplace Violence Prevention . . . 19

INSIDE

Linda Stroup, Ph.D., RN

Greetings to all Colorado Nurses! My name is Linda Stroup, and I am your new President of the Colorado Nurses Association (CNA). I am excited to be in this role with CNA, the professional organization representing all of Colorado’s Registered Nurses. I would like to extend my thanks to past President Donna Strickland, Executive Director Colleen Casper, and the CNA Board of Directors for their leadership and commitment. By way of introduction, I’d like to tell you a little about my professional background.

My career in nursing began as a staff nurse in medical-surgical and critical care nursing. While working as a staff nurse, I began a career pathway in nursing education. I have taught in four different nursing programs, most recently at Metropolitan State University of Denver. I have been the director of two nursing programs in metro Denver. I have had the opportunity to be involved with a number of professional nursing organizations, including the National League for Nursing and Sigma Theta Tau. My involvement with CNA includes Treasurer of DNA 20 for a little over ten years, and serving as a member of the Colorado Nurses Association Board of Directors for several years including a term as Treasurer.

The coming year promises to be a very busy one for CNA, with the Colorado Nurse Practice Act a priority issue. We look forward to continued collaboration with our partners to complete this important piece of legislation. Together we can advance the mission of the Colorado Nurses Association: Strong together to advance the profession of nursing to improve health for all.

Linda Stroup

Save the Date• Nurses Day at the Capitol and Legislative Dinner February 20, 2020

• Nurses & Healthcare Appreciation Day at the Colorado Rockies May 8, 2020

• Colorado Nurses Association Annual Membership Assembly September 18 & 19, 2020

Looking Ahead – The Next Decade and Beyond

Our profession has helped set in motion the continuation of the work and goals of the Institute of Medicine’s 2010 report. Ten years ago, this now well-known report on the future of nursing was released. With it came recommendations for action and change for the upcoming decade. This report was widely distributed and used for both discussion and planning for positive growth and development of the profession for the new decade that began in 2010. As we approach the beginning of the new decade we must evaluate the past work and plan for the future. It is an exciting time for nursing as we embrace the evaluative results and the proposed actions for the future of nursing in 2020 to 2030. The next report (see below) will guide continued discussion.

Some of the current details and work are found at this site:The Future of nursing 2020 to 2030. Health Care Workforce, Quality and Patient

Safety, Select Populations and Health Equity are some the topics presented to help us frame the activities, structure, and philosophical base for the next 10 years. Additional details of this report can be found at on the IOM website: http://www.nationalacademies.org/hmd/Activities/Workforce/futureofnursing2030.aspx

Where and how do we start a process of evaluation and action planning based upon the recommendations and information found in this new report? The answers to the question above are a professional responsibility of each and every member of the profession. It falls under the expectations of what it means to be a good “Citizen” of the profession. We are challenged to continue the journey of professional development and change. How will this be done in Colorado?

Collaboration, cooperation, and action will be essential if we are to truly committed to the responsibility of professional growth and change. I look forward to hearing from you about your personal involvement as a member of the profession of nursing.

More Information can be found at the website below:Future of Nursing 2030 Study Email: [email protected] Future of Nursing 2020-2030 is a consensus study from the National

Academy of Medicine.

Sara Jarrett

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association2 • Colorado Nurse | November 2019

COLORADO NURSE (ISSN-8750-846X) is published 4 times annually, February, May, August, and November, by the Arthur L. Davis Publishing Agency, Inc. for the Colorado Nurses Foundation, 2851 South Parker Rd, Ste 1210, Aurora, CO 80014; Mailing: P.O. Box 3406, Englewood, CO 80155-3406.

Subscription may be purchased for $20 per year, $35/2 years, $25 per year for foreign addresses.

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, [email protected]. CNF 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 Colorado Nurses Foundation of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. CNF 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 CNF or those of the national or local associations.

Colorado Nurses Foundation wants to hear from you and welcomes letter to the editors. Correspondence may be sent to Colorado Nurses Foundation, 2851 South Parker Rd, Ste 1210, Aurora, CO 80014; Mailing: P.O. Box 3406, Englewood, CO 80155-3406; email, [email protected].

To submit an article for publication, please consider the following guidelines.

1. Topic is current and relevant to RN practice.2. 500 word limit3. Individuals may submit articles for consideration by emailing

http://www.coloradonurses.org/publication/.

Material is copyrighted 2015 by the Colorado Nurses Foundation and may not be reprinted without written permission from CNF.

Co-Editors: Eve Hoygaard, MS, RN, WHNP (30) M. Colleen Casper, RN, MS, DNP (16)

CNA Executive Director: Colleen Casper, RN, MS, DNP

COLORADO NURSES FOUNDATION

EXECUTIVE COMMITTEEPresident: Sara Jarrett

Vice President: Margaret MulhallSecretary: Carol O’Meara

Treasurer: Carol Brookshire

BOARD MEMBERSLola Fehr, Eve Hoygaard, Judith Burke,

Linda Satkowiak, Norma Tubman

COLORADO NURSES ASSOCIATION

EXECUTIVE COMMITTEEPresident: Linda Stroup (DNA 20)

Vice President: Laura Rosenthal (DNA 30)Secretary: Nan Morgan (DNA 16)

Treasurer (Interim): Carol O’Meara

BOARD OF DIRECTORS

DNA PRESIDENTS

To contact any person listed above, please use the CNA/CNF office numbers/address/email address.

CNA Contact Information:Ph: 720-457-1194 • Fax: 303-200-7099

Email: [email protected]

CNF Contact Information: Ph: 720-457-1004Email: [email protected]

www.coloradonurses.org

Region 1 Director (DNA 8 & 9):

Brenda Tousley (DNA 8)

Region I Director:Rebecca Sposato (DNA 16)

Region II Director:Amanda Clerkin (DNA 4)

Region 2 Director (DNA 3, 12, 16, 20, 23):Shawn Elliott (DNA 16)

Region III Director:Mary Ciambelli (SIG 31)

Region 3 Director (DNA 4):Mel Vinney (DNA 4)

Region 4 Director (DNA 6):Vacant

Region 5 Director (DNA 7):Nora Flucke (DNA 7)

Region 6 Director (DNA 5):Ann Cox (DNA 5)

Director At Large (SIGs):Karen Lyda (SIG 30)

Director At Large (SIGs):V. Sean Mitchell (SIG 31)

Director Recent Graduate:Dylan Chodos (DNA 16)

SIG #2: Colleen Casper (Liaison)

DNA #3: Anne Zobec Colorado Springs

DNA #4: Kathryn Carpenter Model, CO

DNA #5: Holly Covington

DNA #6: Charlotte LeDonne Alamosa, CO

DNA #7:

DNA #9: Colleen Casper


DNA #16: Christine Schmidt Denver, CO

DNA #20: Annette Cannon Lakewood, CO


SIG #30: Jennifer Rogers Denver, CO

SIG #31: Karen Lyda, DNP, PMHNP, RN

Laura Rosenthal and Mary Ciambelli

Although every legislative session is important for Colorado nurses, the upcoming 2020 legislative session (January through May) is a crucial one. Every ten years all regulatory agencies in the state of Colorado must be re-evaluated to determine whether they should continue to exist for the good of the public. The Colorado Office of Policy, Research, and Regulatory Reform (COPRRR) reviewed the Colorado Nurse Practice Act to make recommendations to the Colorado legislature for the upcoming 2020 legislative session.

When a review is conducted, input from all stakeholders in Colorado is welcomed and assessed. Information was gathered from agency officials, associations, literature, task forces, other state programs, and consumer advocacy groups, to name a few. Opportunities for stakeholder input were closed in May, 2019. COPRRR is finishing the review currently and will report findings and recommendations to the legislature this month (October, 2019).

COPRRR collects all data and then makes a recommendation to the Colorado legislature to continue the Board of Nursing and the Nurse Practice Act, or to eliminate the Board of Nursing, and hence regulation of nursing in Colorado. It is called a sunset, as the sun will set on this practice act if not reapproved by the legislature for the next 10 year period. This vote will occur in the 2020 legislative season.

Colorado Nurses Association (CNA) anticipates support for continuation of licensure and oversight of LPN/LVNs, RNs, APRNs, and Certified Nurse Assistants (CNAs) by the Colorado State Board of Nursing. The General Assembly (legislature) will vote to continue the Colorado Nurse Practice Act or to eliminate it. If the General Assembly does not pass this bill, the Board of Nursing will dissolve and there will be no regulation of nursing in the State of Colorado. This is very dangerous to both the public and to nurses in Colorado. If the General Assembly passes the bill to continue with the Nurse Practice Act, the Board of Nursing will continue and the next sunset review will occur in 2030.

In order to provide a strong voice for nurses to practice at their full scope in Colorado, leadership from the Colorado Nurses Association and the Government Affairs and Public Policy Committee (GAPP) have

been deeply involved in the process since July, 2018. CNA has also partnered with over 300 RNs and LPNs State wide as part of a Colorado Professional Nurse Association coalition to advise on modernization language for the Colorado Nurses Practice Act. To continue this great work and broaden the message of providing quality care to all citizens in the state of Colorado, the CNA Board of Directors developed the 100 for 100 Initiative.

The Colorado Senate consists of 35 members and the House of Representatives contains 65 members. Senators and representatives must remain well informed of the presence of nurses and their scope of practice in the state of Colorado. As constituents of elected officials, nurses have the power to educate and apprise legislators about the care, and increased access to cost-effective care, that nurses provide citizens, including those individuals in the rural and frontier populations of Colorado.

The importance of interacting with Colorado legislators cannot be understated. The Colorado Nurses Association is recruiting 100 volunteer members of the Colorado Nurses Association to serve as personal liaisons to each Colorado senator and representative. Volunteers will be paired with the senator or representative within their voting district in order to provide each legislator with updated and accurate information regarding the practice of nursing in Colorado. CNA will provide a toolkit, information session, and additional resources, including key talking points, to volunteers to promote successful interactions and facilitate positive relationships. The message is clear; Nurses provide increased access to quality, cost-effective health care to all citizens of Colorado, encompassing the underserved and those with all manners of diagnoses, including mental health and substance use disorders.

Please consider volunteering for this valuable initiative. If you have questions or would like to volunteer, please contact by email at [email protected] or by phone at 855-848-8970.

To identify your legislator: https://leg.colorado.gov/findmylegislator.

For more information on COPRRR and sunset in general: https://www.colorado.gov/pacific/dora-oprrr/node/143226/.

for 100 Legislators100 NursesColorado Nurses Association to Launch New Initiative:

http://careers.mhcd.org

The Official Publication of the Colorado Nurses Foundation in partnership with the Colorado Nurses Association November 2019 | Colorado Nurse • 3

Executive Director's Column

Colorado Nurse Publication Article

Submission

• January 1 for February Issue• April 1 for May Issue

• July 1 for August Issue• October 1 for November Issue

Colorado Nurses Association in partnership with the Colorado Nurses Foundation seeks your regular reports

and any content you feel would be informative for Colorado Nurses.

Submit to: https://civicamanagement.wufoo.com/forms/m10eei4p1ds8okp/

Colleen Casper, DNP, RN, MSExecutive Director

Colorado Nurses Association (CNA) has worked diligently for the past three years on building accountability for safe work environments for nurses in Colorado. We have engaged with representatives of the Colorado Hospital Association (CHA), the member association representing Colorado’s hospital and health systems. CHA and CNA have also worked with Colorado Department of Public Health and Environment Health Facilities Division that authors the rules and regulations for licensure of health care provider facilities in Colorado. The outcomes of this work included revisions to the public reporting of Quality and Nursing Sensitive Quality Measures Report by Hospitals as mandated by 2008 Senate Bill 08-196. This data is publically available via

the CHA website at https://cha.com/colorado-hospitals/report-card/. Efforts to keep the data current and accurate continue to be the focus of our work.

The recent release of the ANA Principles of Nurse Staffing (2019) recognizes the strong and consistent relationships between nursing work environments and patient outcomes. Growing evidence clarifies the association of more direct nursing care hours per patient day with fewer adverse outcomes, in particular, mortality and failure to rescue. The RN role in patient surveillance, early detection and prevention of adverse outcomes, though poorly understood by non-nurses, is the central argument to assuring adequate nurse staffing.

Other organizational variables have an impact on patient safety as well. Those variables include staff turnover, nurse competency and experience, availability, type and quality of equipment, team dynamics and

communication norms, and, reliable processes of care, or better stated, systems that are designed to assure timely patient care. The call to action is not to avoid the conversation of safe staffing, rather, it is to engage in honest dialogue about investing in all the components of safe work environments to reduce nurse turnover, the critical workforce for safe patient care. Additional work is necessary to monitor the data (Quality Measures Report Card) and match that with the evidence of essential organizational elements that have been associated with improved and effective nurse staffing.

Join us in this important conversation.

For ANA Principles of Nurse Staffing 3rd Edition (https://www.nursingworld.org/practice-policy/nurse-staffing/staffing-principles/)

Facing Patient Safety in the Face

of ShortagesDavid Hollander, RN, BSNDirector of Patient Care

Medical/TelemetrySwedish Medical Center

How are the nurse leaders of today prepared to tackle patient safety in the face of a growing nursing shortage? A recent study by the Colombia School of Nursing showed a correlation between nurse understaffing, and Hospital Acquired Infections (HAI). When it comes to patient safety, look beyond staffing for answers to reducing HAI’s. As a nurse leader I struggle with the challenges of staffing, employee engagement, patient satisfaction, and patient safety. I don’t think it’s really possible to put an emphasis on one of the above, without losing ground in another area. Where do we, as nurse leaders, put our focus?

Start with the nurses that you have. Build your culture from the top down. Be present, and round on your nurses monthly. Be open and honest about your vision, and have a plan for reduction of HAI’s at the unit level. In “Transitions in Nursing: Preparing for Professional Practice” the authors talk about creating a culture that promotes empowerment and develops learning. Get buy-in from your high performers that has trickle-down effect on the rest. Developing culture will positively impact patient safety.

Colorado Nurses Association Efforts to Advance Safe Practice

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Government Affairs & Public Policy Committee

When Nurses Speak: Advocacy DescribedPatricia Abbott, RN, PhD

Nurses Can and Should Leverage Their Expertise to Inform and Influence Healthcare Policy

All Registered Nurse (RN) licensees have immense insight on healthcare and a voice to use that expertise to inform and influence healthcare policy. As of September 2019, there were over 85,000 active RN licenses in Colorado (BON). According to the American Nurses Association (ANA, 2019) there are approximately four million nurses in the United States (US), the largest part of the US healthcare workforce. Now is the time for the nursing profession to use its strength in numbers, it’s expertise from their frontline roles and use their voices to positively influence healthcare policy.

Nurses are at the very center of healthcare, and what the nursing profession says matters to policy makers at all levels. Registered nurses by the nature of their education/training have well developed advocacy skills and with every patient a nurse encounters, they advocate for patients. Research confirms NPs are adept at advocating for patients and patients value this advocacy. It is essential that nurses also use these advocacy skills to inform and influence healthcare policy that directly affects what they do as healthcare providers and the care they provide.

There are three levels of advocacy where nurses can impact healthcare: (1) direct care, (2) organizational,

and (3) policymaking. As a profession nurses have made strides to positively influence direct care and organizational policy, but there remains a perceived reluctance to inform policy makers at the state and federal levels, thought to be due to lack of knowledge and confidence. Nurse advocates need to become more politically astute and pay more attention to health-related politics. To do so, nurses must have the will and energy to be “players” in the political arena to determine strategic action with a unified voice.

Nurses can influence policy only if they share their expertise and wisdom by using their voices. Where does the busy nurse begin?

How to Inform and Influence 1. Have confidence – You can positively influence

healthcare; value the expertise you have.2. Join professional organizations – There is greater

influence in numbers and a unified message.3. Interact with policy makers at all levels – Educate

them on barriers and issues that face nurses and patients. Tell them your personal stories from the frontline of healthcare.

4. Know your legislators – They want your vote & need your insight and wisdom.

5. Policy/legislative websites – Become familiar with these websites which provide information on current trends and bills.

6. Make your voice heard – Provide expert testimony at public hearings, give presentations, write editorials/articles/policy briefs.

Conclusions • Nurses offer a unique perspective that influences

every aspect of the healthcare system. It is time to share that perspective to influence healthcare policy.

• Now is the time for the nursing profession to use it’s strength in numbers, it’s expertise from their frontline roles and use their voices to positively inform healthcare policy

• By speaking through a unified voice on healthcare issues and supporting all nurses to work to the full extent of their licenses and education, nurses will improve healthcare for all (ANA website) https://www.nursingworld.org/practice-policy/

• This future of quality healthcare is dependent on RNs using their voices to inform and influence healthcare.

Nightingale Luminary NominationsWill Open in October

DENVER - Nominations for the 2020 Colorado Nightingale Luminary Awards opened on Oct. 1, 2019 and will close on or about January 15, 2020 (some regions may vary) according to the event’s administrator, the Colorado Nurses Foundation.

Next year is the 35th installment of the awards, which culminates in the statewide Nightingale Luminary Awards & Gala on Saturday, May 9, 2020. The event will be held at the CU South Denver, 10035 S. Peoria Street, Lone Tree, CO 80134.

Please refer to the foundation’s website at www.coloradonursesfoundation.com for up-to-the-minute details.

Colorado RNs working in both clinical and non-traditional settings are recognized for their

achievement in one of three categories: advocacy, innovation and leadership.

Local Area Health Education Centers and independent Nightingale Committees in 10 regions of the state designate up to 60 nurses as Luminaries. A state selection committee selects up to 12 of the Luminaries as recipients of the Colorado Nightingale Award, Colorado nursing’s highest honor.

In 2019, 255 nominations were received, with 52 nurses designated as Luminaries. The awards are named for Florence Nightingale, English social reformer and statistician, and the founder of modern nursing. The 2020 edition of the awards falls on the 200th anniversary of Nightingale’s birth. They also fall during National Nurses Week in the U.S.

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Peer AssistanceNote: Many thanks to Dr. Mary Weber for contributing this column on the

important role for nurses in the care of those with Opioid Use Disorder. Given the continuing opioid crisis, PAS thought it timely to reprint this article.

Medication Assisted Treatment for Opioid Use Disorder: Advanced Practice Nurses can help increase access to care.

Author: Dr. Mary Weber,PhD, PMHNP-BC, FAANP, FAAN

ProfessorEndowed Professor in Psychiatric NursingUniversity of Colorado College of Nursing

From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999 (CDC http://wonder.cdc.gov). Opioids, mainly synthetic opioids, are currently the main driver of drug overdose deaths. Opioids were involved in 47,600 overdose deaths in 2017, equaling 67.8% of all drug overdose deaths (CDC https://www.cdc.gov/drugoverdose/data/statedeaths.html). Since the 1990s, when the amount of opioids prescribed to patients increased, the number of overdoses and deaths from prescription opioids escalated. The amount of opioids prescribed and sold for pain has increased, yet the amount of pain that Americans report has not similarly changed.

Unfortunately, Opioid Use Disorder (OUD) is not a new phenomenon, and attention to the rising number of deaths from prescription opioids has only highlighted what many of us in Nursing have known, that access to treatment has been an ongoing problem for decades. Although research has been limited, there are evidence-based options for treatment other than abstinence, what is referred to as medication-assisted treatment (MAT). These options include methadone that can only be prescribed from a federally qualified opioid treatment program (OTP); as well as buprenorphine and naltrexone that can be prescribed from a primary or integrated care setting, an OTP, or a substance treatment program. Unfortunately, most people with OUD do not receive MAT, despite evidence that MAT reduces mortality, high-risk behaviors that can lead to HIV and Hepatitis C, and levels of crime (Connock, 2007).

The purpose of MAT is to block the euphoric and sedating effects of opioids, reduce the craving for opioids, and/or mitigate the symptoms of opioid withdrawal. MAT also includes psychosocial interventions that have shown to promote recovery and retention in care. These interventions can save lives. Unfortunately, there has been a shortage of physicians who prescribe buprenorphine as well as a lack of understanding among clinicians as to what MAT is and why this is such an important option.

On July 22, 2016, President Obama signed the Comprehensive Addiction and Recovery Act (CARA) in to law. This law expands prescribing privileges to Nurse Practitioners (NP) and Physician Assistants (PA) for five years (until October 1, 2021) to prescribe buprenorphine. It is believed that this law will expand access to MAT in rural and urban settings as well as in primary care settings. It is hoped that more and more NP’s and PA’s will take this opportunity to learn how to treat OUD and help reduce overdose deaths and increase access to treatment.

What are the steps for you to be able to prescribe buprenorphine? Nurse Practitioners and PA’s must obtain a “waiver” from the Drug Enforcement Administration (DEA). This “waiver” permits you to legally prescribe buprenorphine products for OUD with a designation on your DEA license. Here are the steps:

Step 1: Check your eligibility. To qualify for a waiver, NPs and PAs must:• Be licensed under state law to prescribe Schedule III, IV, or V medications for

pain• Through other training or experience, demonstrate the ability to treat and

manage OUD and have a valid and active DEA number• If required by state law, be supervised or work in collaboration with a

qualifying physician (physician must be waivered) to prescribe medications for the treatment of OUD

Step 2:Take 24 hours of required courseworkThe American Psychiatric Nurses Association, in conjunction with the Providers

Clinical Support System for MAT (PCSS-MAT), offers the FREE required 24 hours of MAT waiver training. The American Association of Nurse Practitioners (AANP), in conjunction with the American Society of Addiction Medicine (ASAM) also offers the FREE required 24 hours of MAT waiver training. Both groups give continuing education credit.

Step 3:Complete your Notice of Intent Form (NOI) to prescribe buprenorphineOnce you have finished the 24 hours of training, complete the NOI form online

and submit it to the Substance Abuse and Mental Health Services Administration (SAMHSA) for review.

Step 4:Forward your Certificates of Completion to SAMHSAWhen you complete the 24-hour trainings, email your certificates of completion

to [email protected] or fax them to 301-576-5237. You will receive notice from SAMHSA as well as a letter from the DEA with a special identification number.

Important websites:• https://www.cdc.gov/drugoverdose/ retrieved September 12, 2019• https://aanp.inreachce.com/Details?groupId=714cb0a9-73b2-4daf-8382-27cbdb70ef5a• https://www.apna.org/i4a/pages/index.cfm?pageid=6197• https://www.samhsa.gov/medication-assisted-treatment/training-

materials-resources/apply-for-practitioner-waiver • https://www.effectivehealthcare.ahrq.gov/ehc/products/636/2350/

opioid-use-disorder-report-161123.pdf

Additional References: Connock et al., (2007). Methadone and buprenorphine for the management of opioid

dependence: a systematic review and economic evaluation. Health Technology Assessment, 11(9); 1-171, iii-iv.

American Society of Addiction Medicine (ASAM), (2015). The ASAM National Practice Guidelines for the use of medications in the treatment of addiction involving opioid use.

Peer Assistance Services Inc. provides the statewide Nurses Peer Health Assistance program through a contract with the Colorado Board of Nursing. If you have any questions regarding the Program or for more information contact: Katherine Garcia, MA, LAC, MAC, Clinical Services Manager. [email protected].

Office locations: 2170 South Parker Road, Suite 229Denver, CO 80231303 369-0039

200 Grand Avenue, Suite 270 Grand Junction, CO 81501970 291-3209

24 hour information Line: 720 291-3209

SBIRT Training Available Online at No Cost

www.PeerAssistanceServices.org [email protected] • 303.369.0039 x245

See Peer Assistance Column on

Earn CNE credits!Screening, brief intervention and referral to treatment (SBIRT) training is now available online. Learn to screen patients for alcohol and drug use and practice motivational interviewing.

Training Includes:– SBIRT overview

– Interactive simulations to practice motivational interviewing skills with adolescents and/or adults

To access online training visit: www.SBIRTColorado.org/online-training

http://www.denvercollegeofnursing.edu

http://www.hlccommission.org

http://www.denvercollegeofnursing.edu


Boomers Leading Change:Building a Movement to Transform Aging

Lynette Reiling

Moving into life’s second half requires us to create a new collection of thoughts, beliefs and activities that are important for continued well-being. Older adults have a strong desire to contribute to their communities well beyond what was once the traditional “retirement” age. As a nurse, you have chosen a path focused on service, and you possess a lifetime of knowledge and tools. How can you repurpose these assets for greater good?

Volunteerism is an answer to creating a fulfilling second half that supports the physical, mental and emotional wellbeing as we grow older. It provides a heightened sense of purpose, usefulness, continued growth and competence. Service to others is an antidote to ageism, isolation, loneliness and age discrimination that is commonly experienced by older adults.

Research shows that volunteer engagement is associated with longevity, vitality, and productivity…. ingredients needed for successful aging. It can counter the harmful narrative of aging as decline/diminishment by reducing cognitive decline, heart attacks, depression and by delaying physical disability. Individuals with positive self-perception of their own aging, fueled by an enhanced sense of self-worth, live up to 7.5 years longer than those with less positive perceptions. Now that sounds like an amazing “health insurance policy!”

Boomers Leading Change (BLC) is here to underwrite this amazing “health insurance policy” by empowering adults age 50+ to utilize their talents,

strengths, wisdom and experience for lasting social good. We are here to model a new narrative of aging that highlights meaning and purpose through renewed engagement.

Experience EngAGEd, a new BLC initiative, is a service program designed for individuals who are ready to take a deep dive into volunteerism, providing year-long fellowships that engage individuals in organized efforts to provide access to health care, help older people age in place, and increase food security. Although not the primary purpose of the program, some Fellows use this year long experience and training to transition to an encore career.

Boomer Volunteers share their skills and talents with more than 40 host organizations across metro Denver in high impact volunteer roles ranging from three to six hours per week. Nonprofit host partners have been selected to reflect a wide range of issues and needs that help insure the satisfying placements that reflect the volunteers’ interests and passions.

Interested in learning something new, meeting like-minded folks, and having opportunities to socialize? BLC offers monthly educational opportunities that feature experts in their fields relating to both personal growth and career development topics.

The future of aging is in our hands – both how we age individually, and how we shape a society that more effectively utilizes the experience and skills that older adults can contribute. If you would like to be part of this thriving movement, find out more about us at boomersleadingchange.org or call 303-426-6637.

Colorado Center for Nursing Excellence

News BriefCallie Anne Bittner, MS, RN, Coach-CTI

www.coloradonursingcenter.org

ALL nurses are leaders, and ALL leaders require life-long development!

The Nursing Leadership Connection (NLC) is the national blueprint for professional development for emerging nurse leaders, and you, too, can be a part of this innovative community!

Quarterly networking events are held at various breweries, wineries, and other fun venues around the metro area. They include food & beverage, networking, and a celebration of ALL that comes with being an emerging leader (the good and the big learning moments). A one-hour presentation on pertinent leadership topics is offered (1 contact hour is awarded) and participants leave feeling supported, empowered, and connected. Over 65% of participants to each event are attending for the first time!

2020 is sure to be an exciting year as NLC rolls out two new programs that will reach both metro and rural Colorado leaders: N.U.R.S.E Talks (Nurses Unapologetically Recognizing Self-Empowerment) and a program for all nurse leaders to gain experience coaching as a leadership skill.

Mark your calendars for future networking events on February 11th, 2020 & the annual full-day Conference May 15th, 2020.

Contact [email protected] to join (it’s free!), and “like” the Center Facebook and LinkedIn pages to see upcoming events for NLC and all other Center offerings.

2851 S Parker Rd | Aurora, CO [email protected] | 720-457-1194

Colorado Nurses AssociationANCC Accredited Approver for Continuing Nursing Education

For more information go to:Colorado Nurses Association

www.coloradonurses.org

Education Links:Please note Calendar of Scheduled

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Colorado Nurses Association Honors Outstanding Members

Colleen Casper and Carol O’Meara

At a Gala Reception at the Colorado Nurses Association (CNA) Annual Conference, several members were recognized for their contributions to the association and to nursing in Colorado.

CNA Emerging Leader Award to recognize an individual who has been a nurse for no more than 10 years who is emerging as a leader in CNA or a DNA/SIG - Kyle Mullica, DNA 23

Kyle was initially licensed in 2018 as a RN. He is a Colorado native who began his career in finance and real estate following his studies as a Daniel’s Scholar at University of Denver. Kyle quickly found a passion for the non-profit sector and more specifically homelessness. Kyle determined that a return to school to study nursing was a match for him. Kyle has served on the Northglenn City Council and in 2018 he was elected to the Colorado House of Representatives for House District 34. Colorado Nurses Association has had the opportunity to work closely with Representative Mullica on many issues in the 2019 Legislative Session including legislation to allow APRN’s Level I Accreditation in Colorado Workers’ Compensation system, improving transparency and accountability for health care costs, improving vaccination rates, and advancing extreme risk protection orders. Representative Mullica practices nursing in the Emergency Department of Presbyterian-Saint Luke’s Medical Center in Denver. We look forward to a long relationship with Representative Mullica advancing issues central to nursing as well as the voice of nursing in Colorado.

Sara Jarrett Award for a CNA member who has contributed to nursing practice and health policy through political and legislative activity - Laura Mehringer, SIG 31

Laura’s contributions to CNA Government Affairs and Public Policy Committee work dates back many years. Laura consistently brings thoughtful feedback on all legislative bills and frequently brings attention to areas that could be missed, without her thorough review. Laura is always willing to put in the work required to assist committee members in determining a position of support or opposition to legislative bills. In addition, Laura’s leadership with the Nurses for Political Action in Colorado consistently demonstrates Laura’s commitment to building and maintaining strong working relationships with Colorado Legislators. CNA certainly benefits from Laura’s passion and diligence.

Dr. Margie Ball-Cook Award for a CNA member who has advanced equal opportunities in nursing for members of minority groups - Amanda Quintana DNA 12

Amanda’s work with the Colorado Center for Nursing Excellence as Project Manager for the Mentoring Program for Diverse Students has both facilitated growth in the diversity of Colorado’s

nursing workforce, and highlighted the tremendous need for greater structure and processes to assure that the nursing workforce of tomorrow matches with our patients and families that we serve. Amanda has shepherded both the mentoring program for students as well as the mentoring program for clinical nurses - coordinating academic and professional practice mentoring. On behalf of CNA, we congratulate and thank you, Amanda, for your groundbreaking work in building a strong, diverse workforce in Colorado.

Carol O’Meara Award for a CNA member who has made sustained contributions to CNA - Christine Schmidt, DNA 16

Christine has served in multiple leadership roles with CNA and most recently has served as President for DNA 16. Recognizing DNA 16’s long success of engaged volunteers, and knowing that this is a reflection of the “DNA 16 village of volunteers,” CNA recognizes the leadership of Christine Schmidt in always putting members first. The most recent example of this is the decision of DNA 16 Board of Directors to use the member dues and revenues from their multiple successful events to offer discounts to DNA 16 members to attend the CNA annual conference and membership assembly. CNA appreciates and recognizes Christine’s ability to coalesce volunteers and strengthen the voice of nursing in Colorado.

CNA Leadership Award for a member who has served as a leader in CNA through service on the Board of Directors or on a Committee or Task Force-Donna Strickland, DNA 31.

Donna is the outgoing President of CNA. She served as President Elect prior to her very successful two year presidency. She was previously Vice President of DNA 31. Known for her style and humor, Donna strived to bring “lightness of being” to the CNA Board, reflecting her belief that we need to spend more time talking about the joys and beauty of our profession. Under Donna’s leadership, CNA has done considerable work in preparing for the Sunset of the Nurse Practice act and she leaves her Presidency with us well positioned for the year ahead. We thank Donna for all of her contributions.

In addition to these State Level Awards, two DNA’s recognized a member as their DNA Nurse of the Year. DNA 16 recognized Nan Morgan for her coordination of a successful volunteer evening at Project Cure, her collaboration on the DNA Bylaws amendments and her service on the Nominating Committee. DNA 20 honored long time DNA leader Linda Stroup. Linda served as the DNA 20 Treasurer for over 10 years. She also served on the CNA Board of Directors, as CNA Treasurer and as CNA President Elect. She becomes CNA President at the close of the 2019 Membership Assembly Meeting.

Congratulations to all of these outstanding CNA Members!

CNA Emerging Leader AwardRepresentative Kyle Mullica

Sara Jarrett AwardLaura Mehringer

Dr. Margie Ball-Cook AwardAmanda Quintana

Carol OMeara AwardChristine Schmidt

2019 CNA Leadership AwardPresident Donna Strickland

DNA 16 Member of the YearNan Morgan

DNA 20 Nurse of YearCNA President Linda Stroup


Carol O’Meara

The Colorado Nurses Association (CNA) Membership Assembly meeting held on September 21, 2019 provided members from around the state with a wealth of information regarding their practice and the association. The highlight of the meeting was an update on CNA’s activities regarding the Sunset of the Nurse Practice Act by Colleen Casper, CNA Executive Director; Gil Romero, CNA Lobbyist; and Linda Siderius, CNA Regulatory Attorney. The panel provided information on the Sunset Process, CNA activities to date and plans going forward. All Registered Nurses and LPN/LVN’s in the state need to be aware of the Sunset Process and how it could impact nursing practice.

Membership Assembly attendees also received informational reports on the 100 Nurses for 100 Legislators Initiative, the ANA Dues Policy and the revised CNA Strategic Plan. Election results were announced and the following members were elected:

Secretary Nan MorganRegion 1 Director Brenda TousleyRegion 2 Director Shawn ElliotRegion 3 Director Melvin VinneyRegion 5 Director Nora FluckeRegion 6 Director Ann CoxDirector at LargeRecent Graduate Dylan ChodosDirectors at LargeSpecial Interest Groups Karen Lyda Vera Sean MitchellNominating Committee Elizabeth Welch-CarreANA MembershipAssembly Representatives Mary Ciambelli Jennifer Chrisman Alternate Carol O’Meara

Congratulations to all of those newly elected and thanks for your willingness to serve CNA.

Visit coloradonurses.org for more information about CNA.

CNA Membership Assembly Highlights

Amanda Quintana

CPDMP Jo and Justin

CCNE 2019 CNA Membership Assembly

DNA 20 always present

CNA Membership Assembly 2019

General Session 2019

Thank you to our Vendors

CNA Membership Assembly Meeting a Wealth of Information

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CNA Membership Assembly Highlights

Keynote, Jack Cochran, MD, Healer Partner Leader

Story Catchers, Kate Hoffman Presenter

Nightingale Pledge

Sunset Update

Sarah Moultrie

Christine Schmidt Sustaining CNA Leader

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Public Health, speak on the national, state and county measles outbreak. In addition she spoke on what Colorado is doing to increase HPV vaccination rates and about the Hepatitis A outbreak in the state. Gwyn stressed that despite the measles outbreak ending, the need for immunizations against communicable diseases has not decreased. Our October speaker Lee Shaughnessy, Director of Program, Rocky Mountain Children’s Health Foundation presented on how the Foundation works to support children and families through its four major programs – Patient and Family Assistance, The Stink Bug Project, The Mother’s Milk Bank, and The Best Start Program. The Foundation was the recipient of diapers donated by DNA 20 members for its 2018 holiday project so members appreciated hearing more about the Foundation’s work. In November we will return to Front Range Community College School of Nursing to present on the benefits of belonging to the American Nurses Association. We will close out 2019 with a holiday potluck at St. Anthony’s Hospital with members and guests sharing information on health care in foreign countries that they have visited. The Hispanic Nurses Association has been invited to join us.

Congratulations to Linda Stroup, incoming CNA President, who is the DNA 20 Nurse of the Year. From 2008-2019 Linda served as DNA 20 Treasurer and served on the CNA Board of Directors in various positions from 2014 to current. In addition to her contributions to CNA, Linda represented nursing in the community by serving on numerous other nursing association boards and through her career in academia. Linda was awarded Professor Emeritus-Nursing status in May 2019 by the Metropolitan State University Board of Trustees. A number of DNA 20 members were at the CNA Awards Reception to see Linda honored. At the Continuing Education Sessions of the conference, attendees had the opportunity to hear Annette Cannon, DNA 20 President and Jefferson County Coroner, be one of three presenters on a panel discussion on The Opioid Epidemic – The Colorado Experience. Annette and Jean Schroeder served on the CNA Conference Planning Committee which deserves credit for its excellent continuing education sessions. Recognition also goes to Jean Schroeder, DNA 20 Vice-President, who passed the National League of Nursing exam to become a Certified Nurse Educator in June 2019. Jean has worked as a nurse educator for over 10 years and currently teaches in the graduate and undergraduate programs at Regis University Loretto Heights School of Nursing.

For information on DNA 20 meetings and speakers, contact President Annette Cannon at [email protected] or see the CNA website (www.coloradonurses.org).

District & Special Interest Group Reports

DNA 5

DNA 20 (West Metro Area)

SIG 30

DNA 16

Ann Cox, PMHNP-BCHolly Covington, RN, PhD, PMHNP-BC, FNP-BC

Evie Kellogg, RN

In the past year, Colorado Nurses Association (CNA) Board of Directors and the general membership voted to reorganize the regions to reach nurses in the rural settings. Dr. Ann Cox, PMHNP-BC, who lives and works in Grand Junction, has recently been elected by the membership to serve on the DNA 5, Region 6 Director to the CNA Board. As we begin to reach out to nurses on the western slope, there is increased interest in re-vitalizing District 5. An organizational meeting was held Wednesday, October 16th at 6:30 pm. We are planning for regular scheduled meetings and would appreciate hearing from DNA 5 members and non-members as to idea times to meet.

For more details, contact [email protected].

Christine Schmidt, RN, MSPresident DNA 16

DNA 16 kicked off the new meeting year on August 20 with a meet and greet barbecue and swim party at the clubhouse of Mary Kershner. In between dining and swimming we held a brief business meeting and reported on approval of our by-laws revision and election of new officers. Over the summer Nan Morgan and Christine Schmidt updated district by-laws to be in alignment with current CNA by-laws as well as make officer elections and terms more flexible. We are pleased to announce our new officers:

Vice-President–Rebecca Sposato, Treasurer–CJ Culllinan, Board Members–Emily Brower and Nan Morgan. Congrats to all and thanks to Rebecca and Nan for continuing to serve.

We then drafted a calendar for our next year:• September 13, 2019 – Healthcare Worker

Appreciation Rockies vs San Diego Game package that included insulated mugs with a percentage of tickets donated to Colorado Nurses Foundation for the newly named “Nurses Night at the Rockies” scholarship. There were 165 health care workers cheering on the Rockies as they beat the San Diego Padres 10-8!

• September 20-21: 2019 Colorado Nurses Association Annual Conference & Membership Assembly – Officers, board members, and then the first 20 members to register received a district supported discount for registration. Nan Morgan was selected as our DNA Nurse of the Year for her leadership and outstanding support by continuously holding offices of president and board member over the past ten years, coordinating our annual volunteer night at Project Cure, and taking on numerous special projects, most recently helping update our by-laws.

• October 8, 6:00-8:00pm – “Become a Homeowner with Habitat for Humanity.” (Adams, Douglas, Arapahoe and Denver Counties). Speaker: Jessica Albright, BSW, Family Services Coordinator, Habitat for Humanity of Metro Denver, www.habitatmetrodenver.org

• November 12 – Stop the Bleed speaker on trauma education to be arranged by Emily Brower.

• December 3 – Holiday celebration hosted by Carol and Alan Brautigam, thank you!

• December 5 – Mary Kershner volunteered to assist in reviewing student scholarships with CO Nursing Foundation. DNA 16 continues their annual Eleanor Bent Scholarship contribution with criteria of it being for a male nursing student. The amount awarded for 2020 is $1500.

• January 25, 2020 – 9:00-11:00am Brunch Meeting at Morning Story restaurant, Leetsdale and Holly. Final preparations for Leg Dinner and other brief business will be discussed over great food!

• February 18, 2020 – plan to attend the 20th Annual Nurse Legislator Connection Dinner with Legislative Day – CJ Cullinan will continue to serve on the planning committee.

• March 10, 2020 – program ideas proposed are either a pediatric topic update or Center for Nursing Excellence rural “Grow Your Own” project presentation.

• April or May TBA, Volunteer Night at Project Cure – Nan Morgan will arrange again.

• May 8, 2020 Healthcare Appreciation Night at the Rockies – Mary Kershner will again coordinate.

DNA 16 also confirmed plans to incorporate a community event, such as Project Cure volunteerism, and a fundraising walk, on an annual basis, and set criteria for making donations to local not for profit organizations.

Watch the CNA website and your e-mail for more details, hope you can join us!

Norma Tubman, MScN, RNDNA 20 Board Member At Large

DNA 20’s first meeting of 2019-20 at St. Anthony’s Hospital, Lakewood on Sept. 19 heard Gwyn Rodman-Rice, Supervisor, Clinical Services, Jefferson County

Rae Ann Raisor, ARNPSecretary

SIG 30 is looking forward to the 2020 legislative dinner with a contribution towards the dinner and intend to send 25 SIG 30 members to represent APNs in Colorado. The University of Colorado Health Leadership Conference was on 9/27/19 and SIG 30 sponsored a booth. We would like to send a big thanks to Eric Rodgers for attending as our representative. We have an upcoming unsponsored meeting in November where we plan to have the CNA Executive Director, Colleen Casper speaking, as well as Gil Romero, CNA lobbyist, and Laura Rosenthal, from CNA Board of Directors and Regional Representative of AANP. Nurse Practitioner week is approaching in November, and efforts are being made to join the Northern Colorado Nurse Practitioner group to put in a proclamation to Polis’ office to recognize and promote the awareness of NPs in Colorado. We will be posting more information to the website to notify SIG 30 how they can participate.

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www.coloradonurses.orgTO JOIN VISIT:

Join an association that advocates for, engages with and advances the professional practice of nursing through;

• Leadership Development• Evidence Based Practice• Education• Research• Membership Growth• Health Policy

MEMBERBECOME A

OF COLORADO NURSES ASSOCIATION

In MemoryEve Hoygaard, MS, RN, WHNP,

Co-Editor, Colorado Nurse

We have received information regarding the following nurses honored in this column. All of them have lived in, worked in and/or were educated in Colorado. We appreciate your assistance in sharing this information with us about RN’s and LPN’s who have passed away.

Ambrose, Karen, RN a graduate of St. Luke’s Hospital, Denver, passed away in July 2019. She spent her career working in Labor & Delivery at several area hospitals. She was very active in NAACOG/AWHONN.

Cobb, Mary, RN passed away in Littleton, CO in September 2019 at age 85. She completed her BSN from Baylor School of Medicine, Arkansas Baptist Hospital.

Dawson, Rita “Anette,” RN passed away in Denver in July 2019 at age 75. She graduated from Iowa Methodist Hospital School of Nursing, then practiced in Kansas City, Missouri. She retired in 2002.

Elliott, Cornelia, RN passed away in Denver at age 75 in July 2019. She completed her RN program and Midwifery education in the Netherlands. She practiced in Canada.

Franklin. Priscilla, RN was 82 when she passed away in Santa Cruz, CA in July 2019. She was a graduate of St. Luke’s Hospital School of Nursing in Racine, Wisconsin. Her long career included practice in Chicago, St. Louis and Denver. In Colorado she worked at General Rose, Swedish, Porter’s, St Luke’s and St. Joseph hospitals and at Aspen Siesta Nursing Home.

Pieter, Elizabeth, RN, BSN passed away at age 102 in July 2019. She graduated from Mary Lanning Memorial Hospital School of Nursing in Hastings, Nebraska in 1936. In 1969, she graduated with her BSN at the University of Colorado School of Nursing in Denver. Her 40 year nursing career included caring for polio patients, thoracic, surgical and private duty nursing. She was a member of ANA & CNA, as well as Beta Sigma Phi.

Reeves, Jeanne Varian, RN was 97 when she passed away in Denver in 2019. A graduate of the Colorado Training School for Nurses. She worked at St. Luke’s Hospital in Denver. She was a Past President of Friends of Nursing.

Roch, Hazel, RN passed away at age 91 in Denver. She was a graduate of Oak Park Hospital School of Nursing and later graduate work at Chicago Laying in Hospital. Her career included work for CARE and Medico, in Algeria and in Hondorus. She retired from Lutheran Hospital in 1980 after 20 years of Colorado experience.

Russo, Marilyn, RN passed away in March 2019 in Colorado Springs at age 74. She was a BSN graduate of the the University of Massachusetts, received her MSN from Walden University and a MS in Health Service’s Administration, College of St Francis–Joliet IL. She taught nursing and was also the Director of CNA Programs at Pike’s Peak Community College in Colorado Springs. She was honored as the 2010 Faculty Member of the year. She was an active member of ANA-CNA in Colorado Springs.

Valentine-Werthan, Vanessa, RN, BSN a graduate of the University of Colorado, Denver, her career focus was in Womens Health

We reserve the right to edit material submitted and endeavor to verify all information included in this column. If you note an error, please advise us and a correction will be published. Your assistance with this column will be greatly appreciated. For more information, please contact Eve Hoygaard ([email protected]).

Behavioral Health & Wellness CenterA Campus of The Medical Center of Aurora

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To register, visit colorado.pmpaware.net and follow the “Create an Account” linkFirst, enter an email address and create a passwordNext, select the “Prescriber Delegate – Unlicensed” Role, found under the

“Healthcare Professional” section:

Next, enter the required personal information and enter your supervisor’s PMP AWARE login email address at the bottom of the page, and submit your registration. Your supervisor will receive an email notification that your registration is pending approval. Your supervisor will need to approve you as their delegate before you can search the PDMP on their behalf.

Colorado PDMP Delegate Access FAQs

Can a prescriber authorize a delegate to access the PDMP database for a patient?Yes, prescribers can authorize up to three delegates to access the PDMP

database on behalf of the prescriber.

Who can be a delegate?If you are a prescriber, you may authorize a delegate who is sufficiently

competent in the use of the PDMP, whom you either employ or have under contract with your practice.

Where does a delegate sign up?Visit colorado.pmpaware.net/login to create an account.

What information does the delegate need to provide?Delegate will need to know their supervising prescriber’s PMP AWARE

login email address before registering. They also will need to add personal information, including first and last name, date of birth, address, etc.

How long will it take to sign up as a delegate?The registration only takes a couple of minutes. However, delegates must be

approved by their supervisor before they can search on their supervisor’s behalf. The supervising prescriber will receive an email notification regarding an approved delegate’s registration and will ask the prescriber to log in to PMP AWARE and approve the delegate.

Can one person be a delegate for more than one prescriber or pharmacist?Yes, as long as the delegate is sufficiently competent in the use of the PDMP and

is either employed by, or under contract with, the prescriber or the same practice.

Colorado PDMP Delegate Registration InstructionsDelegates should first obtain permission from their supervisor to register as a

delegate, and will need to know the supervisor’s PMP AWARE login email address before registering.

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What are the statutory requirements concerning the PDMP?

A requirement to register and maintain an account has been the law since Jan. 1, 2015 for those prescribers who have controlled substance prescriptive authority - a personal DEA license. All pharmacists licensed in Colorado are required to register and maintain a user account with the Colorado PDMP. All licensees who have gone through the renewal process in the past two years have attested that he or she has a PDMP account.

What does the PDMP do?1. It can be searched for any current patient.

2. Prescribers can review their own substance prescription history through the “My Rx” tool in PMP Aware.

3. It is a clinical decision-making tool for prescribers to make sure he or she has a complete controlled substance record. It’s putting information into a prescriber’s hands to allow for better decision-making.

4. It helps prevent prescribing of dangerous combinations of medications that can lead to overdoses.

5. It helps prevent doctor shopping, and the diversion of drugs to the black market.

6. The PDMP can examine how utilization reduces high-risk prescribing behaviors.

7. Prescribers and dispensers need to know that even when opioids aren’t being prescribed, but they are prescribing another controlled substance, it is recommended they query the PDMP.

When do I need to check the PDMP?A law passed in 2018 (SB 18-22) places limits upon

initial opioid prescriptions for opioid-naive patients and requires prescribers to check the PDMP in certain circumstances. Initial fills of opioids are limited to a seven-day supply with the requirement to check the PDMP before authorizing a second fill for an opioid, though the law has exceptions for cancer pain, post-surgical pain, hospice or palliative care, chronic pain, and other diagnoses. There are no exceptions to the requirement except in these instances.

What if I have a personal DEA number and I don’t have a PDMP account?

Colorado will increase enforcement of the PDMP registration requirement in the near future, so the prescribing and dispensing Boards are asking those prescribers who don’t have a user account to create an account as soon as possible. The goal is increased utilization and not potential Board action. And the intent is that all prescribers receive important information about their prescribing habits via prescriber reports.

I have a DEA number but my profile either is incomplete, including a missing or incomplete specialty listing, or has not been set up. What do I do?

Prescription Drug Monitoring Program: Q&ASet up can be accomplished in five minutes by

providing basic personal information, such as name, date of birth, license number and DEA number through Colorado.pmpaware.net.

I’m not sure I have an account. What do I do?You may call the state’s PDMP vendor, Appriss, at

1-855-263-6403, 24 hours a day.

I can’t log-in to my PDMP account, what do I do?If you aren’t sure whether you have an account, it’s

likely you probably created an account at some point in the past but don’t know your login credentials. Again you can contact Colorado’s PDMP Vendor, Appriss, through their 24/7 support line at 1-855-263-6403 to see whether you have an account.

How often do I need to reset my password?The requirement has changed to once per 12

months.

How do I know whether the prescribers in my organization have PDMP accounts?

Please contact the state’s PDMP administrator with any general questions at [email protected].

What do prescriber reports do?If you prescribe opioids and haven’t received a

prescriber report, your profile is incomplete. Prescriber reporters compare you to your peers and to Centers for Disease Control guidelines for pain management and will provide an indication as to whether you are compliant with standards of practice and the law. These reports are tailored to your area of practice but only work if your correct specialty is listed in order to compare to your peers.

How do I get a direct connection to the PDMP through EHRs to avoid the web portal?

Your organization’s administration and/or IT team should contact either your EHR vendor, or the state administrator at [email protected] to let them know you would like to develop the integrated connection. The state can provide additional resources for those interested in integrating. There would be some ongoing subscription costs for this tool that would need to be paid by the healthcare organization.

How do I change my specialty in my profile or make sure that the correct specialty is listed?

The effectiveness of prescriber reports is dependent on prescribers creating a PDMP account in PMP AWARE and having the right specialty selected in their profile. Prescribers can review the full list of Specialties in the PMPAWARE.net portal in the “My Profile” section.

I practice in another state and use that state’s PDMP. Do I still need to register in Colorado?

Colorado statute requires all prescribers with a Colorado license who hold a personal DEA license to register and maintain an account with the Colorado PDMP. Statute does not have any exceptions for those with a Colorado license who practice out of state.

I am no longer prescribing, do I need to participate in the PDMP?

All prescribers who hold an active Colorado license and who have controlled substance prescriptive authority are required by statute to register and maintain an account. If you do not have a DEA number you are not required or able to register. If your DEA license or your state physician license goes inactive, you would not be required to maintain your account.

How does the PDMP interact with other states?Colorado shares data with 28 other state PDMPs.

Colorado will continue to initiate data-sharing agreements with other states in the future. You can select from a list of other states when searching in PMP AWARE. You would want to discuss with the patient in which states they previously received care to know which states to search.

Are Veterans Administration physicians exempt from PDMP usage?

The VA reports controlled substance data to the PDMP in the state which the patient resides. The Military Health System operates its own PDMP for active duty military. It is treated as another state’s PDMP for our purposes. With regard to VA prescribers, Colorado only has jurisdiction over its licensees. If a VA prescriber doesn’t have a Colorado license, we would not have jurisdiction over that prescriber, with the prescriber subject to VA requirements.

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Lynn Pierce, BSN, RN, CPHRM,Risk Control Consulting Director for CNA

Reprinted from Tennessee Nurse September 2019

Most nursing professionals have only seen professional malpractice lawsuits in dramatized plots on television shows. However, if a nurse inadvertently commits an error and a patient is injured, a real-life malpractice claim can be brought against them.

In this article, we’ll discuss what nursing professionals need to know about professional malpractice and offer some risk management recommendations on how to reduce the chance of being in a lawsuit.

What is Malpractice?When you pass your licensing exams, your state

board of nursing provides you with a professional license that certifies you have the knowledge necessary to provide treatment and care in your state.

Professional malpractice is the failure to provide the degree of care required under the scope of your license that results in an injury. Legally, four elements must exist for malpractice to occur:

1. Duty: A nurse-patient relationship is present. The nurse has the duty to treat their patient according to the standards of care recognized by the nursing profession.

2. Breach: A breach of that standard has been established.

Examples: Failure to notify the attending physician of a change in the patient’s condition.

Failure to properly complete a patient assessment. Failure to administer the correct dose of a medication.

Malpractice 1013. Cause: The patient sustained an injury caused by

the nurse’s error.4. Harm: The injury resulted in damages, such as

pain, medical bills, loss of income, etc.

Patients tend to define malpractice more loosely. They may initiate a lawsuit because of the perception of wrongdoing. Real or perceived, win or lose, an allegation of professional malpractice can be devastating and typically results in an investigation by the state board of nursing. Depending on the outcome of that investigation, action may be taken against your license.

Who can Allege Malpractice?The injured patient can allege malpractice, their

legal counsel, or in the case of a minor, it could be their parents or guardian. In the event of a death claim, it could be the estate of the deceased party.

Examples of damagesWhen a malpractice lawsuit is initiated, the injured

party will seek damages to “make them whole.” Tangible losses are called economic damages. Intangible losses are called non-economic damages.

Economic Damages Non-Economic Damages• Medical expenses • Mental anguish• Loss of income • Pain and suffering• Funeral expenses • Loss of consortium

Reporting IncidentsReport any patient incident to your supervisor,

employer’s risk manager, and to your professional liability insurance carrier. If a patient sustained an injury as a result of any of the following scenarios, report it immediately and document it according to your facility’s policies and procedures. Such scenarios include:

• Slip and fall accidents

Lynn Pierce

• Treatment-related injuries such as burns or fractures

• Complaints about unusual pain or discomfort• Concerns over adverse treatment results• Medication-related injuries

Malpractice Claim Do’s and Don’ts Do• Contact your manager or supervisor• Contact your organization’s risk manager • Contact your malpractice liability insurer

Don’t• Add or delete information in the patient’s chart• Try to resolve the situation on your own • Discuss the matter with anyone other than your

defense attorney or your insurer

Nurse Practice ActTo understand the standard of care required, know

the Nurse Practice Act in your state. You can find your state’s Nurse Practice Act and keep abreast of changes to the law by visiting the National Council of State Boards of Nursing website at: www.ncsbn.org/npa.

The Importance of Good DocumentationGood and thorough documentation is a key

component of successfully defending a malpractice claim. A patient’s record is a legal document. Your documentation can provide evidence of the treatment provided, as well as acts against any miscommunication with that care.

As a general rule, if it wasn’t documented, it wasn’t done. Your legal team can prove you provided specific treatment and care if it is found in the patient’s record.

• Document your patient care assessments, observations, communications, and actions in a timely, accurate, and complete manner.

• Never alter a record for any reason unless it is necessary for the patient’s care.

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• If it is essential to add information to the record, properly label the delayed entry.

• Never add any documentation to a record for any reason after a claim has been made.

Do’s and Don’ts of DocumentationDo• Read and act upon progress notes of previous

shift• Be specific and objective when you document

your observations• Document complete assessment data• Document interventions and status of patient

following any intervention• Communicate any changes in the patient’s

condition in a timely manner

Don’t• Use vague expressions• Record a symptom without including what you

did about it• Use shorthand or abbreviations unless they are

approved• Give excuses• Record for someone else• Record care ahead of time

Policies and ProceduresWherever you work, the facility will be engaged

in patient safety measures. Make sure you know and understand your facility’s policies and procedures for preventing errors and ensuring positive outcomes.

Learn the documentation standard in your facility for how to chart, correct errors, make late entries, and for copying/pasting in the electronic record.

Should a malpractice claim occur, your defense team will analyze your documentation, and if the documentation is thorough, it can build a strong defense. However, poor, inaccurate or missing, documentation may weaken a defense. This is especially if changes or additions to the healthcare record are made after an incident has occurred, lawsuit has been filed, and/or if they don’t follow your facility’s formal documentation policies and procedures.

Key Takeaways for Protecting Your Career• Know and comply with your state scope of

practice requirements, Nurse Practice Act, and facility policies, procedures, and protocols.

• Follow documentation standards established by nurse professional organizations and comply with your employer’s standards.

• Develop, maintain, and practice professional written and spoken communication skills.

• Emphasize ongoing patient assessment and monitoring.

• Maintain clinical competencies aligned with the relevant patient population and healthcare specialty.

• Invoke the chain of command when necessary to focus attention on the patient’s status and/or any change in condition.

While no healthcare professional is immune from a malpractice lawsuit being filed against them, implementing good risk management techniques in your daily practice is the best defense.

*Nurse Professional Liability Exposures: 2015 Claim Report Update, NSO & CNA, www.nso.com, October 2015.

Lynn Pierce, BSN, RN, CPHRM, is a Risk Control Consulting Director for CNA the underwriters for the Nurses Service Organization in the Healthcare division of Affinity Insurance Services, Inc. With more than 20 years’ experience in the healthcare risk management, Lynn is dedicated to educating healthcare professionals on professional liability risks and offering strategies to mitigate those risks. The CNA/NSO Professional Liability Insurance Program provides malpractice insurance and license protection coverage to over 550,000 nursing professionals.

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Re-Thinking Shared Governance:How Does the Profession Engage Itself?

Sheena M. Ferguson, MSN, RN, Doctoral Student

Reprinted with permission from New Mexico Nurse October 2019 issue

Our chosen profession of nursing can be defined as a profession because of the presence of several required elements:

1. A distinct body of knowledge which defines the profession;

2. A specific educational curriculum taught within a college that conveys skills to practice;

3. A written code of professional ethics advocated by a national organization (ANA);

4. Autonomy over professional practice; and5. Oversite of professional members by a state

licensing board (BON) for professional standards.

Interested readers may pursue research back to the middle ages where there were only three “true” professions: law, divinity and medicine. However, by the late 1800’s and early 1900’s, additional professions which met the required elements included social work, pharmacy, psychology, and yes, nursing (among others in health care).

The numbers within the profession continue to grow at a critical pace to meet the health care demands of the population, the advancement of the science, and the need for a delivery system that ensures quality outcomes. Now more than ever the professional requirements are essential to solidly frame “what is nursing.” Yet not all within the profession have embraced the requirements for Nursing’s status as a profession. In other words, some nurses don’t understand their role in maintaining and advancing the profession. Re-read the five elements above. Exactly what is the profession doing to refine, expand and validate what is distinctly nursing knowledge? Is there a deliberate plan to ensure a quality curriculum taught by qualified educators? How many nurses don’t belong to the ANA or NMNA and therefore have no voice in the discussion? How is autonomy within the profession being maintained and expanded? And what is a nurse’s role in ensuring that fellow members of the profession are adhering to professional standards, protecting patients as well as the integrity of the profession?

Some key components within nursing departments are foundational as conversations about the profession of nursing are considered. Typically, there is a Professional Practice Model (PPM) for nursing. There are five subsystems within the PPM:

1) a delivery of patient care model: such as the roles of nurses, teams and case management;

2) a management team structure: such as decentralized decision-making and support for changes in clinical practice;

3) values of the nursing department: such as autonomy, accountability, quality care outcomes, professional development, and professional values;

4) interprofessional relationships structure: such as collaboration and teamwork; and

5) nursing clinical ladder describing benefits, and compensation: such as tuition assistance, certification and growth.

Think about the current PPM at your organization. The model is further defined by ensuring that care is delivered within the scope of professional nursing practice. However, if nurses don’t know what the Professional Practice Model or PPM is (informed autonomy), or nurses don’t know what the unit’s patient safety gaps are (just culture), and nurses haven’t participated in the conversations around practice standards or quality outcomes (participating in peer review), or nurses haven’t shared with their educators what is needed professionally (demonstrated competence), then we start to see erosion in the integrity of our profession.

Professional participation is not optional, and it is here where the discussions of Shared Governance are often misunderstood. It is not about the voice of the few, nor is it the voice of the management team. It is about the membership of the profession engaging in professional practice decisions. The literature is replete with impassioned discussions about Shared Governance. A re-emerging term is simply Professional Governance. Why? Because within the required elements of a profession is the requirement that the membership must actually manage the profession. Nurses own their profession, it is not owned by another profession, nor a single segment within the profession. There is a requirement for accountability by nurses for the profession as a whole. Now look

at your Shared Governance model. What are your thoughts about how well it works?

Do you embrace it? Does it make sense? Does it assist you in addressing your professional practice issues? Your nursing department probably has and should have documents providing guidance on each of the sub-systems. Other critical guidance about Peer Review, Just Culture, and Safe Harbor should assist Shared Governance in the same way as the PPM, and Delivery of Care Model documents.

Let’s look at professional practice thru another lens. For example, if we look at our physician partners, we can see that medical professional autonomy exists within a physician’s practice. Physicians direct medical care, assess, diagnose, perform interventions, write orders, and create a plan of care that requires ongoing evaluation. Sound familiar? However, there also exist medical staff by-laws that are policies and procedures and guidelines as a framework for that autonomous professional practice. Physicians must ensure that the professional integrity of medicine is maintained. Those medical staff by-laws are presented to a clinic or hospital board of directors for approval with ongoing review and evaluation of the impact on quality outcomes. Gaps in quality outcomes or patient care may result in an individual physician’s practice being closely reviewed. To assist the physician in meeting standards of care, support and assistance would be given being to re-validate competency, participating in additional review of care (peer review), or another remediation action (just culture). Autonomy doesn’t mean a lack of accountability or erosion of standards of care. Physicians are also required to maintain regulatory competency and expectations as determined by the Department of Health or The Joint Commission. Medical board intervention may also be warranted in some cases of severe gaps in care standards.

So then, most health care professions are dealing with many of the same difficult issues in the membership managing their profession. That includes resources and budgets that may be shrinking due to decreased reimbursements. It is an exceptional opportunity to partner between disciplines to achieve creative solutions to mutual opportunities (see Porter-O’Grady, T. 2009. Interdisciplinary shared governance. Jones & Bartlett Learning Publishers: New York). How do we address barriers to optimal patient care outcomes, including resource shortages, threats to nurse’s well-being, and threats to our profession? Use the gifts that come from being a profession: science, education, ethics, autonomy and professional standards.

Sheena M. Ferguson’s favorite title of self is “Nursologist.” She has been selected to enter the American Nurse Advocacy Institute fellowship program and will be working closely with NMNA.

Selected Resources: Latta, L. & Davis-Kirsch, S. (2011). Developing a robust

professional practice model using a shared governance approach. Journal of Pediatric Nursing, 26(6), p. 580-585.

Porter-O’Grady, T. (2017). A Response to the Question of Professional Governance Versus Shared Governance. Journal of Nursing Administration, 47(2), 69-71.

O’May, F. & Buchan, J. (1999). Shared Governance: A literature review. International Journal of Nursing Studies, 36(4), 281-300.

Slatyer, S., Coventry, L., Twigg, D., & Davis, S. (2015). Professional practice models for nursing: a review of the literature and synthesis of key components. Journal of Nursing Management, 24(2), p. 139-150.

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NURSES VOTE

2020The American Nurses Association recently

launched its new and improved #NursesVote website. Thousands of nurses engaged with ANA’s #NursesVote Action Center in 2018, ensuring that they had all the information nurse advocates need to cast their vote and make their voices heard.

With ANA’s recent decision at its 2019 Membership Assembly to move away from endorsing a candidate in the presidential election, nurse-advocates can utilize the new website to get out the vote, educate themselves on how each presidential candidate has worked to advance the nursing profession, and volunteer and advocate for the candidate of their choice. ANA highly encourages all nurse-advocates to become politically engaged at all levels of government.

As #NursesVote makes clear, every candidate hoping to be on the ballot next November understands and values the importance of nurses to the American healthcare system. ANA is heartened to know it will have a partner to work with in the White House regardless of this election’s outcome.

Also included are sections on the most pressing federal advocacy priorities impacting nursing, as well as a newly released comprehensive guide for those looking to engage with the presidential campaigns – as a volunteer or simply as a concerned citizen and nurse-advocate.

ANA looks forward to hearing how the new website helps members and nurses everywhere further their advocacy between now and next November.

The Ethical Oath of Advocacy:A Nurse’s Promise

Karen Kiefer, APN, NP-C, RN-BC

Reprinted with permission fromNew Jersey Nurse October 2019 issue

As nurses we see and assist people during the most vulnerable and private times in their lives. We are physically and emotionally present often feeling the burden, honor and spirit of walking them through painful and frightening experiences. We guide them through understanding, acceptance and participation in their healthcare (Sommaruga, et al. 2016). The impact we (knowingly or unknowingly) impart does not end with the transition of patient to home, other health facilities or even death. We can do so much more for ourselves, our patients and families.

I challenge you to join public advocacy groups and use your experience, knowledge and desire that you choose and continue to work in nursing. Nurses are one of the most trusted professions interacting with the public (Sommaruga et al., 2016). The American Nurses Association Code of Ethics addresses advocacy, education and affects change in public policy and legislation (ANA, 2019). Participation includes public advocacy organizations, professional organizations, participation in public hearings regarding health issues and national work groups for healthcare issues (Taylor, 2016). Nurses can and do lead on boards of public advocacy organizations and Nightingale, continuing through the present day. A contemporary example is NJ Assemblywoman Nancy Munoz who is impacting healthcare policy and legislation.

I challenge nurses to become involved in public concerns that are present and concrete. Examples include the opioid epidemic, chronic diseases, the rise of elderly population and access to insurance and healthcare (Office of Disease Prevention and Promotion, 2019). There is a need to assist the public in understanding the impact of chronic conditions with actions of education, and inclusion within the healthcare team resulting in increased daily function and decreased hospitalizations (MacLeod et al., 2017). I have chosen to become involved in groups such as

the American Pain Foundation and the pain community (thepaincommunity.org) It provides an opportunity for professional and personal growth honoring the oath for education, advocacy and the inferred promise of disruptive change to advance health, promote comfort, and provide emotional support (CDC, 2019) The non-profit website provides virtual support groups, education, an opportunity for expression via blogs, research and tools for patients and caregivers. The information provided increases healthcare literacy, patient centered care using research and credible information. As a board member I implore you to look at public advocacy organizations and find your place, and impact many people who benefit from your experience, knowledge and vocational mission.

ReferencesAmerican Nurses Association. Code of Ethics for Nurses with

Interpretive Statements (View only for members and non-members). Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/ on July 14, 2019.

Centers for Disease Control and Prevention. Health Literacy. Retrieved from https://www.cdc.gov/healthliteracy/learn/index.html on July 14, 2019.

MacLeod, S., Musich, S., Gulyas, S., Cheng, Y., Tkatch, R., Cempellin, D., Bhattari, G., Hawkins, K. & C. Yeh (2017). The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults. Geriatric Nursing, 1-7. http://dx.doi.org/10.1016/j.gerinurse.2016.12.003

Office of Disease Prevention and Health Promotion. HealthyPeople.gov. Access to Health Services. Retrieved from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Access-to-Health-Services on July 14, 2019.

Sommaruga, M., Casu, G., Giaquinto, F. & P. Gremigni. (2016). Self-perceived provision of patient centered care by healthcare professionals: The role of emotional intelligence and general self-efficacy. Patient Education and Counseling, 1-7. http://dx.doi.org/10.1016/j.pec.2016.12.002

Taylor, M. (2016). Impact of Advocacy. Initiatives on Nurses’ Motivation to Sustain Momentum in Public Policy Advocacy. Journal of Professional Nursing, 32(3), 235-245 http://dx.doi.org/10.1016/jprofnurs.2015.10.010.

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Strengthening Workplace Violence PreventionDonna M. Fountain, RN, PhD

Reprinted with permission fromNew Jersey Nurse October 2019 issue

In 2018, the Joint Commission acknowledged the seriousness of physical and verbal violence against healthcare employees, particularly among nurses, and other health care workers as a Sentinel Event (TJC). Federal policy against workplace violence is vital. However, dependency on legislative action alone is not enough. A dynamic leadership presence across patient-care units is needed to enforce efforts to prevent violence. Typically, sources of violent behavior against nurses vary from patients and family, visitors, and other colleagues. The nursing profession desperately needs stronger policy guidelines to identify, prevent, and mediate all forms of violence at work. Studies have shown that violence against hospital nurses reduces their:

• job satisfaction

• self-esteem

• health and well being

• engagement levels

• retention rates

• ability to provide optimal levels of patient-centered care

The American Nurses Association (ANA, 2015) Position Statement on Incivility, Bullying and

Workplace Violence has driven the charge among nurses to increase their awareness of the problem of violence in health care settings and to devise effective strategies on a system-level (2015, 2018). Since health care organizations respectively create their unique set of policies against employee violence, also referred to as “Zero-tolerance” or “Anti-Workplace Violence” policies, this continues to pose a challenge for researchers. In a recent ANA Workplace Violence webinar (2019, June 6) presenters, Fountain and Zankowski asked nurse participants to respond to the following two-part poll question “Does your organization have a workplace violence policy in place?” Reporting yes were 68.3% of nurses who had a workplace violence policy at work; 9.9% reported No policy, and 21.8% indicated that they were Unsure. Moreover, for the participants who reported Yes to having a violence policy in place, when asked if they perceived it to be effective, 28.1% indicated Yes; while 42% indicated No; and 29.9% indicated that they were Unsure.

The ANA End Nurse Abuse Professional Panel (2019) recommends a system-level approach to prevent workplace violence using the three levels of prevention:

1. Primary prevention through education and prompt identification of the occurrence of workplace violence, such as a Zero-tolerance employee education program.

2. Secondary prevention by screening, ongoing surveillance, and treatment of employees of workplace violence incidents with swift interventions to mitigate the potential negative consequences; such as a reporting and a systematic improvement program.

3. Tertiary prevention to provide rehabilitative services and employee assistance to minimize the long term post-violence employee limitations; such as Employee Assistance Programs and After-care.

More research is needed to cultivate and sustain effective strategies to improve healthy work environments for all healthcare providers, particularly for nurses. Health care managers and staff should align to ensure daily efforts are made to prevent workplace violence through the use of realistic policies and ongoing monitoring of violent incidences and prompt remediation.

References:American Nurses Association. (2019). ANA Professional

Issues Panel, END RN ABUSE: Issue Brief: Reporting Incidents of Workplace Violence, Silver Spring, MD.

American Nurses Association. (2015). ANA Professional Issues Panel, Position Statement: Incivility, Bullying, and Workplace Violence, Silver Spring, MD. Retrieved from https://www.nursingworld.org/practice-policy/work-environment/violence-incivility-bullying/

Free Live Webinar: American Nurses Association ANA Webinar. (2019, June 13). Presenters: Fountain, D. M & Zankowski, D. L. What Every Nurse Needs to Know – and Do- about Workplace Violence. Silver Spring, MD.

Stockwell, S. (2018). Joint Commission Issues Alert Addressing Violence Against Health Care Workers. AJN The American Journal of Nursing: July 2018, 118(7): 14. doi: 10.1097/01.NAJ.0000541417.67605.8f In the News.

The Joint Commission. (2018). Addressing violence against health care workers. Sentinel Event Alert, Issue 59. Retrieved from https://www.jointcommission.org/sea_issue_59/

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