The Alaska Nurse - Vol. 54 No. 4 - November 2004

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The Alaska Nurse Circulation 7,000 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska Volume 54 No. 4

The Official Publication of the Alaska Nurses Association

The New Federal Overtime Exemption What The New Rules Mean For Nurses

by Charles A. Dunnagan, JD of Jermain, Dunnagan & Owens SUMMARY On August 23, 2004, new regulations under the federal Fair Labor Standards Act (FLSA) took effect. The new regulations clarify and change the rules under which employees can be exempt from the requirement that employers pay them overtime. However, the new FLSA exemption regulations do not change the historic treatment of nurses. Also, compensation in the AaNA bargaining units is governed by collective bargaining agreements (CBAs), so any change in federal law is irrelevant during the term of the CBA. The CBAs typically provide for compensation in excess of the minimum requirements of state or federal law and the terms are settled, at least for the duration of the CBA. But, the new regulations make it much easier for employers to create salaried positions, and AaNA may begin seeing employers move in that direction in future contract negotiations.

DISCUSSION The Fair Labor Standards Act was enacted

AaNA Dues Update The membership approved two changes to the AaNA dues to begin on January 1, 2005. First, for the ANA (national) portion of the dues the membership approved an automatic increase every three years based on the following formula which was adopted by the ANA House of Delegates in June 2004 as an official policy. The formula is calculated yearly based on the Consumer Price Index. The national increase is primarily to compensate for inflation, but will also increase funds for ANA to better support the local work of the state associations. ° Cost of Living increase calculated yearly by ANA, but will be • No lower than 0% and • No higher than 2% of the ANA portion of the dues, per year ° The calculated increase will be implemented every three years starting January 1, 2005, then January 1, 2008, etc.

The AaNA (state) Portion of the Dues is also increased as of January 1, 2005, but on the condition of no additional dues increases until January 1, 2008, and then only if approved. This will put the state portion of dues on cycle with the ANA Continued on page 9

to establish minimum standards for wage and overtime pay for employees. States, such as Alaska, have always been able to enact their own minimum pay rules, but only to the extent that those rules exceeded the minimum requirements set out in the federal FLSA. Under the federal Fair Labor Standards Act, employees are entitled to overtime compensation at one and one-half times their regular rate of pay when they work longer than 40 hours in a standard work week. 29 USC § 207(a)(1). Alaska law is somewhat better for employees. In Alaska, an employer must pay overtime not only for hours in excess of 40 in a week, but also when an employee works more than 8 hours in a day. However, hospital employees who provide medical services are not protected under Alaska overtime law. AS 23.10.060(12).

On March 31, 2003, the United States Department of Labor proposed new regulations under the Fair Labor Standards Act that would clarify, and to some extent redefine, which employees could be exempt from FLSA coverage. Three months later the Department of Labor had received over 75,000 Continued on page 4

2004 AaNA General Assembly Resolutions October 24, 2004 Patient Protection and Nurse Retention WHEREAS, patient care and patient safety is the focus of all persons and agencies involved in the delivery of heath care to Alaskans, and WHEREAS, the health and safety of the Registered Nurse cannot be separated from the health and safety of the patient, and WHEREAS, a substantial number of Registered Nurses in the State of Alaska are leaving direct patient care nursing due exhaustion, personal injuries, lack of long term security in the form of retirement benefits, and concern for the quality of patient care they are able to deliver under adverse working conditions, THEREFORE, BE IT RESOLVED, that the Alaska Nurses Association General Assembly go on record as supporting legislation which would: • promote safe staffing, • prohibit non-emergency mandatory overtime, • assure workday breaks, • establish safe patient handling policies in health care facilities, Continued on page 16

November 2004

Alaska Statewide Nursing Conference Page 8

Leadership Training Page 18

ANP Recognized Page 3

Inside This Issue The New Federal Overtime Exemption . . . . . . 1 2004 AaNA General Assembly Resolutions . . . 1 AaNA Dues Update . . . . . . . . . . . . . . . . . . . . . . 9 President’s Message . . . . . . . . . . . . . . . . . . . . . . 2 Letters to the Editor . . . . . . . . . . . . . . . . . . . . . . 2 ANP Recognized for Leadership and Excellence. . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Carole Edwards Receives Oncology Nursing Society Excellence . . . . . . . . . . . . . 3 Forensic Nursing . . . . . . . . . . . . . . . . . . . . . . . . 6 Herbal/Nutritional/Dietary Supplements and the Nurse . . . . . . . . . . . . . . . . . . . . . . . . 7 Alaska Statewide Nursing Conference . . . . . . . 8 Conference Thank You . . . . . . . . . . . . . . . . . . . 9 CE Information . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Membership Application. . . . . . . . . . . . . . . . . 10 AaNA Committees . . . . . . . . . . . . . . . . . . . . . . 10 University of Alaska Anchorage Student Health Center . . . . . . . . . . . . . . . . 11 University of Alaska Fairbanks Center for Health and Counseling. . . . . . . 12 Board of Nursing . . . . . . . . . . . . . . . . . . . . . . . 13 AaNA Leadership Bios . . . . . . . . . . . . . . . . . . 14 2004 General Assembly AaNA Bylaws Amendments . . . . . . . . . . . 15 Alaska Nurse Alert System . . . . . . . . . . . . . . . 17 Leadership Training . . . . . . . . . . . . . . . . . . . . . 18 Volunteers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Working With Your Older Patent . . . . . . . . . . 18

The AaNA Vision Empowering Alaska nurses to be dynamic leaders, powerful in both the health care and political communities.

Page 2—Alaska Nurse—November 2004

President’s Message Making a Difference to Nurses

by Rebecca Bolling, BSN, RN It has been an exciting year as your President from “a-far.” As most of you know, I hail from Ketchikan and so it has been somewhat of a geographical challenge to be the AaNA President. But, for any “true Alaskan” geographical challenges are meant to be overcome. Thank you all for your patience and flexibility this past year and thank you for your continued support and encouragement for the upcoming year.

On reflection over this past year, we have worked hard to be more geographically relevant and visible to nurses all over the state.

A few years ago at General Assembly we passed a resolution to make a concerted effort to expand our presence throughout the state and to ensure greater geographical representation on the AaNA Board of Directors. We currently have two board

Author Guidelines for the Alaska Nurse The editorial committee welcomes original articles related to nursing for publication.

Authors are not required to be members of the Alaska Nurses Association.

Format and Submission Articles should be word-processed as Word documents in 10 or 12 point font, single or double spaced. There is currently no limit on the length of the article. Include the title of the article and headings if applicable. Author’s name should be placed after the title with credentials, organization/and or employer and contact information. Authors must identify potential conflicts of interest, whether of financial or other nature and identify any commercial affiliation if applicable.

All references should be listed at the end of the article. Pictures in black and white or color are encouraged and may be sent as a jpeg. file, as an email attachment or on disc. Be sure to spell check, grammar check and second check the article, any website addresses, references or phone numbers. It is recommended you have a colleague review your article before submission.

Prepare the article as a WORD document and attach it to an email to editor@aknurse.org. If you do not have WORD, try pasting the text of the article directly into the body of the email. You may also mail the article on disc in a Word document to Editor, AK Nurse, Alaska Nurses Association, 2201 East Tudor Road Ste 34, Anchorage, AK 99503. If you have any questions call Lynn Hartz 907-248-4877 or email lhartz@alaska.com.

Introducing Letters to the Editor

Rebecca Bolling, AaNA President, with new Board Member Lynn Hartz.

Continued on page 4

An official publication of the Alaska Nurses Association, 2201 East Tudor Rd., Ste. 34, Anchorage, AK 99503. Tel: 907/2740827. Web site: www.aknurse.org. Published quarterly: an official publication of the Alaska Nurses Association.

Materials may not be reproduced without written permission from the Editor. Views stated may not necessarily represent those of the Alaska Nurses Association.

Editor: Lynn E. Hartz, MSN, FNP lhartz@alaska.com Editorial Committee: Naomi Kirkwood Foody, RN, Kodiak and Jodi Stack, RN, Fairbanks AaNA Board of Directors President: Rebecca Bolling, RN, BS Vice President: J. Pauline Stubberud, BSN, MBA Secretary: Gail M. Holtzman, MSN, CCRN Treasurer: Dianne M. Toebe, PhD, RN Directors: Labor Council Chair: Donna Phillips, BSN, RN Greater Alaska Director: Sara M. Harvison, RN, BSN Director at Large: (currently vacant—previously Pauline Stubberud) Director at Large: Deborah M. Amos, RN, MN, CCRN Staff Nurse Director: Geri Brady Kelly, RNC Director at Large: Robin K. Burrell, RN Rural Director: Carole S. Edwards, RN, BSN Director at Large: Lynn E. Hartz, MSN, ANP AaNA Labor Council Chair—Donna Phillips, RN, BSN Secretary—Joe Peacott, RN, OCN UAN Rep.—Kathleen A. Gettys, RN, BSN, BA Carol Clausson, RN-C Sheri Whitethorn, BSN, RN, CCRN Deni Callahan, RN Ray Southwell, RN PAMC BU Rep.—Michelle Murphy, RN Soldotna BU Rep.—Janet Hilleary Ketchikan BU Rep.—Julie Sherrill, RN

A message from the Editor

ANA Delegates: Rebecca Bolling, Kathleen Gettys, Jackie Pflaum, Donna Phillips, Pat Senner

Dear fellow nurses, If you are interested in writing a letter to the Alaska Nurse, we are interested in printing it!

We would like to introduce a Letters to the Editor section with the next issue of the Alaska Nurse. This would be an informal way to foster communication and networking in a forum available to all nurses in the state. Do you have comments, opinions or questions about nursing and health care in Alaska? Send your letter as an email to editor@aknurse.org.

Short letters are best. Remember, the AK Nurse is published every three months so be careful about sending time sensitive material. Be sure to include your name and contact information.

Lynn Hartz, MSN, ANP Editor AaNA Board Member

ANA Alternate: Debbie Thompson Executive Director: Camille Soleil, JD Director of Labor Program: Dianne O’ Connell, M.Div Advertising Rates Contact—Arthur L. Davis Publishing Agency, Inc., 517 Washington St., P.O. Box 216, Cedar Falls, IA 50613, 800-626-4081.

AaNA 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.

November 2004—Alaska Nurse—Page 3

Carole Edwards, RN, BSN, Receives Oncology Nursing Society Excellence in Oncology Nursing Health Policy and Advocacy Award

Janice Stables, ANP, caring for her patients in Fairbanks.

ANP Recognized for Leadership and Excellence Janice Stables, Advanced Nurse Practitioner, was recipient of the 2004 Nurse Practitioner of the Year award. This award is made annually by the Alaska Nurse Practitioner Association to one of its members who demonstrates leadership and excellence in professional practice as a nurse practitioner and is a role model for other nurse practitioners, has contributed to raising the standard of care to a higher level for individual clients, families and/or communities, incorporates current research into practice to raise the standard of care, and promotes the growth of the profession of nurse practitioner. The award was presented at the annual conference of the Alaska Nurse Practitioner Association in Anchorage on Spetember 17, 2004.

Ms. Stables currently provides healthcare to the Fairbanks community in her clinic, ANP Family Care, on Airport Road, which she opened in January of 2003. For nearly 8 years prior to opening her own clinic, Ms. Stables provided primary healthcare services at Fairbanks Urgent Care Clinic, Fort Wainwright, and in Central, Alaska. She is a Fellow in the American Academy of Pain Management. She has served as adjunct faculty in the School of Nursing, University of Alaska Anchorage, and regional instructor in the Community Health Aide program with the Tanana Chiefs Conference, Inc. Ms. Stables is the president of the Fairbanks Chapter of the Alaska Nurse Practitioner Association.

PITTSBURGH, PA—September 20, 2004— Carole Edwards, RN, BSN, of Juneau, Alaska, understands that having your opinion heard by elected leaders can make a difference in the lives of patients with cancer. For her efforts, she is the first recipient of the Oncology Nursing Society (ONS) Excellence in Oncology Nursing Health Policy and Advocacy Award.

“I was never particularly interested in health policy and certainly not politics,” said Edwards. “But I have come to be a real enthusiast and love the challenge. I am very honored and proud to receive this award. To be recognized by my peers is an honor that is most meaningful.”

ONS established the award this year to acknowledge the efforts of the many oncology nurses who participate as state health policy liaisons. ONS is very active in cancer care advocacy at the state and federal level. “Our vision is to lead the transformation of cancer care, and to accomplish that, we must work closely with elected officials to keep them informed of what is best for our patients,” said Pearl Moore, RN, MN, FAAN, chief executive officer of ONS. Edwards is active in health policy in the legislature on a state and national level and gives presentations on health policy. She assisted one of her state senators in urging the Alaska State legislature to pass legislation mandating insurance coverage for prostatespecific antigen screening and Pap smears according to the American Cancer Society guidelines.

In addition, this year she testified for the “Five Wishes Bill” that clarifies healthcare laws for those Alaskans approaching the end of life. The Bill was passed in June, 2004.

Since Edwards’ retirement from Bartlett Regional Hospital in Juneau, she has continued to work at the facility on a casual basis and as the clinic nurse for a visiting oncologist. Juneau is a community of 29,000, surrounded by mountains and water with access only by plane or boat. The nearest oncologist is more than 700 miles away.

She is the ONS health policy liaison for the state of Alaska; a former member of the ONS Board of Directors; a member of the ONS Fatigue Focus Group, the Alaska Denali Chapter of ONS, the Alaska Nurses Association Legislative Committee, and the Alaska Nurses Association Board of Directors; and group facilitator for the Cancer Connection Cancer Support Group. She received her bachelor of science in nursing degree from the University of Alaska in Anchorage.

ONS is a national organization of more than 30,000 oncology nurses and other healthcare professionals dedicated to excellence in

Carole Edwards, RN, with legislative staffer Linda Sylvester in Juneau. patient care, education, research, and administration in oncology nursing. The largest professional oncology association in the world, ONS maintains a Web site at www.ons.org.

Carole Edwards is a member of the AaNA Board of Directors and we are proud to have her wonderful work in Alaska acknowledged by a national organization, of which she is also a member.

Page 4—Alaska Nurse—November 2004

President’s Message

New Federal Overtime Exemption

Continued from Page 2

Continued from Page 1

members from Ketchikan, one from Juneau and one from Fairbanks. We have also broadened our distribution of the AK Nurse newsletter and it now reaches all nurses statewide and not just those who are professional members of the Association. Mailing the AK Nurse to all nurses in all of Alaska has been a wonderful way to share what it is the Alaska Nurses Association is doing for nurses and the nursing profession in Alaska. It is also a great way for nurses to stay informed about the happenings and what other nurses are involved in their communities.

In this past year as we have continued to grow and reach out to more and more nurses, we find that we face new challenges as an Association. The Alaska Nurses Association is changing, and while change is good, it also challenges us to think and act in new ways. As a Board we are focusing our attention this year on refining our processes and infrastructure to support the changes and growing pains of the Association. We are looking to focus our efforts on a few critical goals rather than a long list of legitimate but not necessarily feasible ones.

Basically, we want to be sure we have “our ducks in a row” to support the growth and changes that surely lie ahead of us.

We have also strengthened connections throughout the nursing community, shared our resources, our strengths and our vision to advance the practice of nursing in Alaska. And we have had some incredible successes in the legislature “making a difference” for nurses and patients throughout the state. We look to a future that shows promise of continued AaNA growth and stability. A future we can be proud to be a part of and have worked very hard to ensure!

comments and the new regulations were embroiled in controversy. None the less, a final rule was announced April 20, 2004, and despite continued controversy the new regulations took affect August 23, 2004. Even now, the controversy rages as evidenced by the following: “On the day that John Kerry is sworn in as your next president we will reverse this overtime rule that this administration put into place.”

Senator John Edwards, Vice Presidential Candidate September 14, 2004.

The accusation being made against the new regulations is that they will allow employers to exempt more employees from receiving overtime pay. However, even before the new regulations, nurses could qualify as exempt employees, and employers could have put nurses into exempt salaried positions. The new rules just make it easier to establish exempt positions. As AaNA contracts expire, employers may be tempted to begin proposing more salaried positions for various bargaining unit members than in the past.

For a job position to be legally exempt from overtime requirements, the employer has to meet two tests: the duties test and the salary basis test. The duties test deals with established categories of employees. The test is whether the employee’s background and job duties meet the criteria for one of the exemptions. If the duties test is met, then there is a salary basis test which means that the position has to be paid on a bona fide salary basis. Only when a position meets both tests is the position exempt from overtime requirements.

For decades it was well established that RNs could satisfy the duties test under the “learned professional” exemption under the FLSA. In other words, RNs were considered “learned employees” and therefore met the duties test and were eligible for exemption under FLSA. Clem v. County of Santa Clara, California, 208

F.3d 1085 (9th Cir. 2000), Brock v. Superior Care, Inc., 840 F.2d 1054 (2nd Cir. 1988), Fazekas v. Cleveland Clinic Foundation Health Care Venture, Inc., 204 F.3d 673 (6th Cir. 2000).

Under the old rules the duties test for nurses was based on evaluating factors such as their education and job duties which led to the conclusion that nurses met the requirements for exemption. What has changed under the revised rules is that nurses now have their own specific exemption. 29 C.F.R. § 541.301 (e) (2).

The exemptions states as follows: (2) Nurses. Registered nurses who are registered by the appropriate State Examining Board generally meet the duty requirements for the learned professional exemption. Licensed practical nurses and other similar health care employees, however, generally do not qualify as exempt learned professionals because possession of a specialized advanced academic degree is not a standard prerequisite for entry into such occupations.

The language used by the exemption establishes a rebuttal presumption. Registered nurses “generally meet” the requirements of the exemption. That means that the NLRB or the courts could conceivably consider unusual situations in which the circumstances of a particular registered nurse might not meet the learned professional exemption but the burden of proof is clearly on those who would challenge the exempt status of registered nurses.

Although nurses generally meet the requirements of the learned professional exemption, their positions must also meet the salary basis test before the positions can be exempt from overtime requirements. The new regulations have simplified the salary basis test and make it both easier and safer for employer to create salaried positions without the danger of inadvertent overtime violations. Under the old rules, if an employer created a position and did not correctly administer the salary, the employer could be liable not only for the employee’s salary, but could also be liable for overtime in addition to the salary. That may explain why employers were hesitant to create salaried positions at the bargaining unit level.

Here generally are the new salary criteria Continued on page 5

NCLEX® Item Writers

Are you ready for the challenge?

National Council of State Boards of Nursing (NCSBN) needs staff nurses, charge nurses, clinical nurse specialists, clinical nurse managers and preceptors to serve on a NCLEX® examination item development panel.

Item writers create questions (“items”) that are used for the NCLEX examination, with the assistance of NCSBN’s test service. Item reviewers check items for currency, accuracy, job relatedness and appropriateness for the entry-level nurse.

You may access the item development panel application by visiting NCSBN’s Web site, www.ncsbn.org, and using the “Item Development Online Application” link.

If you do not have access to the Web, please call NCSBN at 1.312.525.3775.

November 2004—Alaska Nurse—Page 5

New Federal Overtime Exemption Continued from Page 1 which an employer must meet when creating an exempt nurse position: —Minimum salary is $455 per week —Deductions for disciplinary reasons can occur in full day increments (under the old rules, disciplinary deductions had to be an entire work week) —Some practices previously questioned by the courts are now expressly permitted, including deductions from leave accounts, recording and tracking hours, requiring specific work schedules, and overtime pay.

Also, under new § 541.604, the exemption is no longer lost if an employee who meets the minimum salary guarantee also receives additional compensation based on hours worked beyond the normal work week.

Interestingly, the additional compensation can be paid on any basis including straight time or on a formula bonus.

—Finally, the new rules make it harder for a position to lose its exempt status because of improper payroll practices. For example, if an employer makes improper deductions, a position can lose its exempt status, but only if they are willful. See § 541.603(c) and (d).

CONCLUSION For the time being, the new FLSA regulations do not affect AaNA nurses covered

by collective bargaining contracts. However, the regulations make salaried positions easier and safer for employers to implement, and we may see employers moving in the future to establish more bargaining unit positions that are paid on a salaried basis. Although salary basis compensation carries with it the potential for abuse by an employer, there may also be potential advantages for employees, especially in jobs where the time commitments vary seasonally or with other factors. Still, the hourly compensation rules are well understood, basically fair, and so totally engrained into the system that this writer doubts that there will be a wholesale move towards salary basis compensation in AaNA bargaining units.

Editor’s Note: Mr. Dunnagan is the general counsel for AaNA and has been honored in the annual publication, The Best Lawyers In America, every year from 1997 to the present, and the firm, Jermain, Dunnagan and Owens, enjoys an AV rating, the highest possible for both ethics and legal work, from the Martindale Hubbell Law Directory.

Tax Deductible Percentage for 2004 Based on 2003 taxes

By Bruce Restad, CPA and auditor, Lockitch, Clements and Rice on 9/13/04 Tax deductible percentage of AaNA Membership dues for 2004 taxes is 80%

Why Do You Have My Address?

Please know that the Alaska Nurses Association does not sell addresses. In fact, for this publication, AaNA purchases a list of all nurses licensed in Alaska from a commercial company.

As a licensed individual in Alaska, information provided on license applications is public information. Therefore, to keep home addresses private, a nurse would have to use a PO Box or other address as their official address for the Board of Nursing.

Join AaNA Today!

Page 6—Alaska Nurse—November 2004

Forensic Nursing Tara Henry RN, SANE-A Forensic Nurse Services Forensic nursing is the application of forensic science combined with the biopsycho-social education of the registered nurse, in the scientific investigation, evidence collection and preservation, analysis, prevention and treatment of trauma and/or death related medical-legal issues. This specialty area of nursing represents an era of nursing practice that has evolved in direct response to the sequelae of criminal and interpersonal violence (Lynch, 1995). The scientific knowledge base of forensic nursing comes from theories in nursing, forensic science, criminal justice, police sciences, and legal studies. Forensic nurses have become a critical link in the administration of justice for victims of sexual assault, domestic violence, elder abuse, and child physical and sexual abuse.

A forensic patient is one who has injuries or conditions that have a criminal or civil medical-forensic implication that may require involvement of the legal system. Victims and perpetrators of sexual assault, domestic violence, gunshot and stab wounds, and motor vehicle related trauma are examples of a forensic patient.

Forensic patients have both health and justice needs that forensic nurses must meet.

Nurses have many opportunities to play a major role in the identification, evaluation, and treatment of patients whose care involves forensic issues.

Many forensic patients initiating health care present with a complaint other than the actual problem of physical, sexual, or emotional abuse. This is especially true with victims of domestic violence. A trained forensic nurse will usually be able to identify the underlying problem of abuse while assessing the patient’s presenting complaint.

Although violent crime is currently on a decline in the country today, acts of child abuse, elder abuse, neglect, domestic violence, and sexual assault are at epidemic levels.

According to the World Health Organization’s Global Report (2002), the death and disability caused by violence make it one of the leading public health issues of our time. Violence is among the leading causes of death for people between the ages of fifteen and forty-four.

Almost half of the women who die due to homicide, are killed by their current or former husbands or boyfriends. Women face the

greatest risk for violence at home and in familiar settings.

Nurses do not generally receive education in providing care for patients with regard to forensic issues unless they seek further training in this area on their own. A forensically untrained nurse can easily overlook and destroy forensic evidence in the course of providing patient care. When this happens, information that may be of critical significance to criminal and civil proceedings is lost. When a forensic nurse is involved in the comprehensive evaluation of a crime victim, it improves the quality of care and treatment the patient receives for the physical, emotional, and psychological aspects of the traumatic event.

Forensic nurses identify and collect forensic evidence, perform physical assessments, provide the patients with referrals, and testify as expert witnesses in court when needed.

To identify forensic evidence, a nurse must know what it is. Forensic evidence is any physical or trace evidence that can be scientifically matched to a known person or item. Blood, semen, fingerprints, hairs, fibers, glass particles, etc. are examples of forensic evidence. Locard’s Exchange Principle is that whenever two objects come into contact there is always a transfer of material. This means a person at the scene when a crime is committed will leave something behind and take something with. Interpersonal violence cases such as sexual assault, domestic violence, and child abuse have three crime scenes. The physical scene where the incident occurred, the victim’s body, and the suspect’s body are all considered crime scenes.

Nurses must also have an understanding of why forensic evidence identification and collection is important. Not only does forensic evidence identify a person or item, it also assists in establishing an element of the crime, assists in reconstructing the crime, provides guidance to investigations, and most importantly helps convict the guilty and exonerate the innocent.

Physical assessments of crime victims and perpetrators should include assessing their demeanor, emotional response, non-genital and genital injuries, and making sure necessary lab work is ordered such as blood alcohol and urine drug screens. The patient’s medical-forensic evaluation should be detailed and documentation should be comprehensive.

Comprehensive documentation is narrative, diagrammatic, and photographic. Injuries should be measured and drawn on body traumagrams and photographed for preservation. Due to time constraints, it is difficult to document verbatim the history provided by the forensic patient, but whenever possible, it is important to do so.

Documentation in the medical records of specific statements made about what

happened, who did it, any threats made, weapons used, etc. are invaluable for future legal proceedings because of the medical exception to the HEARSAY RULE. Hearsay is a statement, other than one made by the declarant while testifying at the trial or hearing, offered in evidence to prove the truth of the matter asserted.

According to Alaska Rules of Evidence, Rule 802 HEARSAY RULE, hearsay is not admissible except as provided by this rule, or other rules prescribed by the Alaska Supreme Court or by enactment of the Alaska Legislature.

An exception to this hearsay rule is the medical exception. This is statements made for purposes of medical diagnosis or treatment and describing medical history, or past or present symptoms, pain, or sensations, or the inception or general character of the cause or external source thereof insofar as reasonably pertinent to diagnosis or treatment.

This exception allows the health care provider to testify to what the patient says during the history and examination.

Because of the specialized training forensic nurses receive in sexual assault, domestic violence, and child physical and sexual abuse, they are able to provide patient teaching specific to the crime the forensic patient encountered. Having a nurse who is knowledgeable and comfortable talking about these unspeakable crimes is more effective in providing patient education and referrals that will assist in the patient’s recovery process and hopefully prevent secondary injury or illness as a result of the crime incident.

Unlike other specialty areas in nursing, forensic nurses receive training in the criminal justice process and courtroom procedures.

When providing care for victims or perpetrators of crime, testifying in court is inevitable. To provide effective testimony, one must have a clear understanding of courtroom procedures and the nurse should have the knowledge, skills and experience in forensic nursing required to provide expert testimony.

The testimony must be objective and scientifically based.

The Forensic Nurses Association of Alaska (FNAA) was established in 1997 to meet the medical, forensic, legal, and educational needs of individuals and communities throughout Alaska. FNAA also develops, promotes and disseminates information about the science of forensic nursing locally and participates in the communication of this information nationally and internationally. More information about forensic nursing in Alaska can be found at www.alaskaforensicnurse.com and nationally at www.forensicnurse.org.

References Forensic Nurses Association of Alaska. (n.d.) [brochure]. Anchorage, AK: Author.

IAFN & ANA (1997). Scope and standards of forensic nursing practice. International Association of Forensic Nurses.

Lynch. V.A. (1995). Clinical forensic nursing: A new perspective in the management of crime victims from trauma to trial. Critical Care Nursing Clinics of North America. 7(3), 489-507.

Olshaker, J.S., Jackson, M.C., & Smock, W.S. (Eds.). (2001). Forensic Emergency Medicine.

Philadelphia: Lippincott Williams & Wilkins.

Palenik, S. (1988).

Microscopy and microchemistry of physical evidence. In R. Saferstein (Ed.), Forensic Science Handbook (2nd ed.) (pp. 162-163). Englewood Cliffs, NJ: Prentice Hall.

World Health Organization. (2002). World report on violence and health. Retrieved October 17, 2002, from http://www.who.int/violence_injury_ prevention/violence/world_report/en/full_en.pdf.

November 2004—Alaska Nurse—Page 7

Herbal /Nutritional /Dietary Supplements and the Nurse

by Lynn Hartz MSN, ANP Anchorage Did you know...

The majority of dietary supplements in the United States do not require proof of safety, are not required to meet any standards of manufacturing, do not need to have any proof of efficacy; do not need to notify the FDA in cases of harm they may have caused to consumers and have actually been shown repeatedly to contain ingredients that are not on the label. If you were unaware of this then you are among the majority of consumers (Consumer reports, 5/04 p.12-17) The issue of supplements is really two issues: One; is the supplement effective for what it is being taken for? Two; can you trust what is on the supplement label to reflect what is actually in the bottle?

Definition of Dietary Supplement In the United States, a federal law defined dietary supplements in 1994: “A dietary supplement is a product taken by mouth that contains a dietary ingredient intended to supplement the diet. The dietary ingredients in these products may include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissue, glandulars and metabolites”— Dietary Supplement Health and Educational Act , 1994 (DSHEA).

This legal definition is pretty broad and puts products such as vitamin C and Chinese herbs in the same category. Products defined as dietary supplements fall under the authority of the DSHEA rather than the stricter regulations that govern products defined as “drugs.”

Vitamins and Minerals Even though vitamins fall under the DSHEA, most of them meet the manufacturing standards of the United States Pharmacopoeia (USP), which also reviews drug-manufacturing standards. The nurse or consumer can tell which vitamins meet those standards by checking the vitamin label; it should have the initials USP on it.

Herbals, botanicals, etc.

It is increasingly easy to find good information on herbals, botanicals, amino acids, enzymes and the other substances considered dietary supplements. Mainstream sources such as Physicians’ Desk Reference (PDR) have published references for dietary supplements. Internet sites from the government as well as some private laboratories can provide study data and information, or detail the lack of it to help make decisions on use of supplements (see resource list).

The lack of regulatory oversight remains problematic. An extreme example of the problem is reported in the Consumer Reports May 2004 issue. Aristolochic acid (aka birthwort, snakeroot, snakeweed, sangree root, sangrel, serpentary, serpentaria, asarum canadense, wild ginger) is found in a variety of products available to the consumer. It occurs naturally in a species of Aristolochia vines that grow wild in parts of the world and has appeared as contaminants in some Chinese herbs. Aristolochic acid is a potent human carcinogen and can cause kidney failure. The FDA put out a warning to consumers in April 2001 and banned further imports of the herb.

Nevertheless, Consumer Reports found that it is still available online and notes that there are

professional must not only have access to general information on glucosamine/ chondroitin (that is the easy part); you must determine which brand is standardized and safe before you can safely recommend it. If the more than 100 products online that have supplement does not have USP or DVSP on the botanical ingredients listed by the FDA as label you will have to get information on the known or suspected to contain aristolochic analysis of the supplement yourself. This can acid. A consumer may be ingesting aristolochic be researched on the internet at sites that acid unknowingly when they take an herbal publish independent laboratory analysis of product because it is present as a contaminant supplements. Anything less than that diligence and so not listed on the label. on your part ignores the potential risk to the A more common example of what nurses patient of following your advice and taking a might run into is glucosamine and chondroitin supplement that has unknown ingredients in sulfate. These substances occur naturally in the it. Contrast that to giving advice to patients body and look quite promising as supplements about over the counter (OTC) drugs. If you that can slow the progression and reduce the recommend acetaminophen to a patient for pain of osteoarthritis. They are frequently relief of fever, you can ask the standard combined into one tablet. The literature questions on allergies and other drugs the supports use of Glucosamine 500mg TID and patient is taking as well as check the Chondroitin 400mg TID. Knowing that is not recommended dose and frequency of dosing. enough. One product You do not have to go the analyzed by extra step of checking Web resources consumerlab.com which brand to get since Dietary Supplement Health and acetaminophen listed on the label that is it contained “500 mg. Educational Act; www.cfsan.fda.gov/ standardized. Because of Independent laboratory analysis; being regulated under the of chondroitin sulfate www.consumerlab.com complex” when it only FDA, you can be fairly National Institutes of Health Office of sure that a Tylenol 325 contained 90mg of chondroitin per tab. Dietary Supplements; http://dietary- mg. will be the same as Taking this product supplements.info.nih.gov/health_inform Safeway brand might not be ation/ibids.aspx acetaminophen 325 mg.

United States Pharmacopoeia (USP) This article has been an dangerous to a patient, and links to USP’s Dietary Supplement attempt to illuminate but they are not getting Verification Program; www.usp.org, some of the problems what they paid for in http://www.pdr.com/ terms of money spent with use of dietary and efficacy. supplements in the United States. Other countries, such as Dietary Supplement Verification Program Germany do regulate supplements, which (DSVP) make life a lot simpler for clinicians wanting to There is hope for the future. The United States include them in their therapeutic arsenal. In Pharmacopoeia, which has been overseeing drug summary, many dietary supplements are standards for years, has instituted a voluntary extremely effective and general information on program for supplement manufacturers. USP will dietary supplements is increasingly available analyze and inspect manufacturers for com- to the nurse. Unfortunately, with the current pliance with standards for quality, purity and lack of regulatory safeguards in the United composition. Products that meet this standard States it is impossible to trust what is on the will have the USP- verified mark on the label. supplement label, and in the absence of USP or Herbal supplements may become like some DSVP certification, the nurse must do vitamin supplements that already carry USP on additional research on which brand is safe. the label if they meet quality standards. USP on the label will just help ensure the product’s ingredients, potency, purity and bioavailability; it will not get into the issue of efficacy. So far, Kirkland signature brand available at Costco stores and Nature Made brand are taking part in this program. The USP website carries information on what stores carry the Nature Made brand.

What does the Board of Nursing Say? In September of 2002 the Alaska Board of Nursing passed a motion regarding supplements which stated,” The Board of Nursing having considered the current lack of regulatory oversight of dietary supplements in regard to ingredients, potency and contaminants view dietary supplement administration as incurring unknown risks to clients, therefore the Board does not support nurse administration of dietary supplements at this time.”

What is a nurse to do?

Whether you are considering prescribing, administering or just giving advice to your neighbor on supplements, do your homework.

When you are acting in your professional capacity as a nurse, your responsibility is to do no harm, therefore it would not be advisable to recommend a particular herb or supplement to a patient if neither you nor the patient knew what was in the bottle. In other words, it is not simply enough to tell a patient to take glucosamine and chondroitin for management and prevention of osteoarthritis. You as the

Page 8—Alaska Nurse—November 2004

Alaska Statewide Nursing Conference— Another Success!

The fourth Alaska Statewide Nurses Conference was held October 21-24, 2004 at the Hotel Captain Cook in Anchorage.

Named Voices in Unity, the conference has been the effort of nurses from the Alaska Nurses Association, the Emergency Nurses Association, Alaska State Council and the Fairbanks North Star Chapter of the American Association of Critical Care Nurses. Alaskan nurses from across the state came to enjoy three days packed with a variety of continuing education sessions, networking and time with exhibitors.

LaTonia Wright, RN, JD, was the featured speaker for the event, presenting a number of sessions on legal issues related to nursing including Patient Safety Issues in Nursing and Nursing Documentation. Special Guest presenters were John F. Elder, CCEMT-P and Chuck Skinner, BS, AAS, CCPM, who presented sessions such as The Anatomy of a Tragedy: The Science behind the Grief which tied in the biological reactions occurring during an emergency.

In addition to these national talents, a number of very talented Alaskan speakers presented on a wide variety of clinical and nursing topics. Kitty Wellman, MSN, FNP, PNP, ANP presented Child Abuse in Alaska, Judith Minderler, RN, MS, offered Performance Improvement— Implementation Strategies, Eileen Weatherby RN, CCRN, MBA, presented When Your Adult Patient Can’t Say “Ouch”! (Using EBP to evaluate pain in the non-verbal adult), Cathy J. Johnson RN, PNP. MHA offered Post Traumatic Stress Disorder (PTSD) and B.J. Coopes, MD, offered several sessions including CPR from Hell: Beyond PALS. One of the highlights for the Conference attendees was Nurses Night Out! With the theme “Laughter is the Best Medicine” nurses got to enjoy a night of fun. Shelly Inda coordinated a silent auction (which was highly

Nurses Night Out participants Rebecca Bolling (left), Donna Phillips (middle), and Kathleen Gettys (right). This is what happens when they get out!

Latonia Wright, Featured Speaker

competitive) to benefit the continuation of the conference, while John Bitney and his sidekick Robbie, provided music which kept the gathering dancing. Sharon Merchant, the brains behind the fun, challenged nurses to bring forward their best hoola hooping skills and bubble blowing talents. Food included a chocolate dipping fountain and a mashed potato bar, which served up the meal in martini glasses.

Thank you to the conference planning team that made it all possible: Shelly Deering, Conference Chair, Teri Kiss Program Chair, Millie Tucillo, Exhibitor Chair, Shelly Inda, Sharon Merchant, Camille Soleil, Edie Forest, on the ground coordinator, and the Visionettes, the highly professional team from Visions Meeting and Event Management.

Please stay tuned to the Alaska Nurses Association website at www.aknurse.org and the Alaska Nurse for information about the 2006 Alaska Statewide Nurses Conference—it is still to be determined if it will be in Spring or Fall of 2006.

For your CE and networking needs in 2005, please join AaNA for our Fall Retreat and General Assembly—information will also be announced in the AK Nurse and on the website.

Patti Hong competing for the hoola hoop championship.

Conference photos by Michelle Murphy, RN

John Bitney, AaNA Lobbyist speaking with nurses.

Sheri Whitehorn, conference attendee, sharing her thoughts.

Nurses Night Out Coordinator Sharon Merchant (right) and assistant Christine Anderson (in the big purple hat!).

November 2004—Alaska Nurse—Page 9

Thank You Alaska Statewide Nurses Conference Would like to thank our Sponsors!

Premiere Conference Sponsors

Denali Center Fairbanks Memorial Hospital Community Owned

Tote Bag Sponsor

Nurses Night Out Sponsor

Lunch Sponsors

Educational Grant Ketchikan General Hospital

ANA Dues Update Continued from Page1 portion so that the membership will not see multiple increases, but a single increase.

With these two increases implemented, AaNA Full Membership Dues will increase by $9.82 per year or $0.82 per month as of January 1, 2005 with no further actions until January 1, 2008. Special and Reduced membership dues will be increased proportionately.

CE Information Information about Continuing Education opportunities is available on the AaNA website at www.aknurse.org. There you will find sessions listed which are offered in Alaska, outside, online and by self study.

Page 10—Alaska Nurse—November 2004

Membership Application AaNA Committees

Nursing Professionals— Promoting and Protecting the Profession Thank You!!!!

Membership Categories * EDPP is the monthly Electronic Dues Payment Plan Amount = Yearly dues/12 months + $.50 per month service charge

K Full Membership—Employed Full-time or Part-time K Reduced Membership—Not Employed K Full time student K New graduate from basic Nursing Education program, within first six months after graduation (first year only), or K 62 years of age or over and not earning more than Social Security allows.

K Special Membership—Not employed and 62+ years or totally disabled

Dues Anchorage & Fairbanks

Monthly (*EDPP) Yearly

Full $28 $330

All Other Locations

Yearly Monthly (*EDPP)

$322.50 $27.38

Reduced $14.25 $165

Special $7.38 $82.50

$161.25 $13.94

$80.62 $7.21

Note: All memberships include $7.50 for the subscription to The American Nurse, $14 for subscription to the American Journal of Nursing, $7 for subscription to the Alaska Nurse newsletter.

__________________________________________________ Last Name/First Name/ Middle Initial

______________________________________ Social Security Number

__________________________________________________ Street or PO Box City/State /Zip

______________________________________ Home Phone

__________________________________________________ Employer Name Unit City/State/Zip

______________________________________ Work Phone

________________________________ RN License Number/ State

________________________ FAX Number

______________________________ E-mail Address

Payment Method—see above for categories and amounts Apply Online at www.nursingworld.org—Join Today! Alaska!

K Check—Please make checks payable to the American Nurses Association

K MasterCard or Visa—(available for annual payment only)

____________________________________ Card Number

_____/_____ $_______ Expiration Amount

Return application and payment to: AaNA 2207 E. Tudor, Suite 34, Anchorage 99507

____________________________ Signature

K Monthly Electronic Dues Payment Please (1) read and sign the below authorization form and (2) enclose a check for the first month.

1/12 of your yearly dues will be withdrawn from your checking account monthly along with a monthly service fee.

AUTHORIZATION to provide monthly electronic payments to the American Nurses Association (ANA): This is to authorize ANA to withdraw 1/12 of my annual dues and any additional service fees from my checking account designated by the enclosed check for the first month’s payment. ANA is authorized to change the amount by giving the undersigned thirty (30) days written notice. The undersigned may cancel this authorization upon receipt by ANA of written notification of termination twenty (20) days prior to the deduction date as designated above. ANA will charge a $5 fee for any return drafts. ______________________________________________ Signature for EDPP Authorization

K Legislative Committee Actively involved in reviewing all legislative issues, which may relate to health and nursing. Reviews bills and testifies before senate and house committees on the AaNA position. Works closely with the AaNA Lobbyist. Usually meets monthly on the fourth Monday of the month. Current Chair is Pat Senner.

K Continuing Education Committee Reviews applications for continuing education approval based on the established guidelines of the American Nurses Credentialing Center and in coordination with the CE Director. Makes recommendation for improvements in the application process. The current CE Director is Norma Monsen.

K Alaska Nurse Newsletter Committee Committee members work with the editor and recruit articles for the quarterly newsletter. The current editor is Lynn Hartz.

K Membership Recruitment, Retention and Marketing Committee Responsible for addressing the needs of all current members, fostering membership in the association through sound marking strategies, and coordinating the annual Nurses Week activities. The Chair is appointed annually by the Board of Directors and the committee meets monthly.

K Professional Nursing Practice Committee Fosters understanding and acceptance of nursing as a professional practice by: a) promoting adherence to standards of nursing practice, b) receiving and taking appropriate action upon complaints and related problems in nursing practice from the pubic and profession, and c) establishing working relationships to correlate professional needs and practices with economic and political aspects of nursing practice.

K Awards Committee Solicits nominations for the various awards offered by the ANA and AaNA. Reviews these nominations and forwards recommendations of award recipients to the appropriate body.

The current chair is Pauline Stubberud.

K Conference Planning Committee Participates on the planning committee for the Alaska Statewide Nurses Conference, or Unity Conference. Roles include working with program planning, marketing, vendor and sponsor recruitment and onsite assistance.

K Health and Safety Committee Members work on addressing health and safety issues facing members in their workplace.

K Other interest? Let us know what you would like to work on: ____________________________________ Name ______________________________ e-mail ______________________________

November 2004—Alaska Nurse—Page 11

UAA—University of Alaska Anchorage Student Health Center 3211 Providence Drive BEB 120 Anchorage, AK 99508 907 786-4040 The mission of the Student Health Center is to empower students to make educated decisions regarding their health care needs, health status, life choices, and facilitate educational progress, thereby improving their quality of life.

The UAA Student Health Center provides services for students currently enrolled in six (6) or more academic credits and who have paid the SHC fee. These services include physical and psychiatric-mental health services, campus wide immunization programs, health education programs, classroom lectures, programmatic health requirements and policies; public health interventions, work in the residence halls, crisis intervention and ongoing assessment of the health needs of the campus.

The Student Health Center offers a wide range of health services similar to any family practice office. There is no charge for an office visit. This is an automatic saving of $75-125.

Physical examination and tuberculosis skin tests and HIV screens are free. All lab, x-ray and procedures are provided at greatly reduced cost. Services include family planning, PAPs (Women’s Annual Exam), STDs, immunizations, and a wide variety of other services.

Comparison of the SHC Fees for Services Service

SHC

Office Visit -0Strep Throat Screen $8 Pregnancy Test $8 Metabolic Profile $6 Lipid Profile $6 Wmn’s Annual Exam $49 Birth Control Pills $6 Physical Exam -0Hepatitis B $32 Immunize Mental Health Cnsl $10

Community $75-150 $18-25 $18-25 $25+ $25+ $95-150 $25+ $35+ $68+ $90-150

Appointments Appointments are encouraged to save students time. Walk-ins are seen on a first come first served basis.

Students with Health Insurance Individuals with health insurance or military benefits find that they save a considerable amount of money when they use the SHC. The out of pocket expense is minimized due to the fact that there is no charge for an office visit and other costs are low.

The Student Health Center is a preferred provider for Blue Cross-Blue Shield of Alaska.

Student Health Center Facts and Accomplishments ­ 26 weekly health education seminars on timely health topics. ­ Emergency Food Cache for students. ­ Student friendly and safe environment. ­ 77% of students seen at the SHC do not have health insurance. ­ SHC is a preferred provider for Blue Cross-Blue Shield of Alaska. ­ Widely publicized and successful “DriveIn Flu Shots” and campus-wide flu shot campaign. ­Immunizations for traveling abroad. ­ A “safe haven” for acutely ill students with physical and mental health problems.

­ Cost comparison for health services at the SHC and community show a considerable cost savings. ­ Usually same day appointments are available and walk-in patients are seen in a timely manner. ­ Individual counseling and psychotherapy provide students with a health supportive and therapeutic environment.

­ Student evaluation of services continues to indicate excellence of service.

The Student Health Center provides prompt accessible quality health care and helps to keep the campus healthy and minimizes lost classroom or workdays related to illness. Whether it is treating strep throat, flu, headaches, providing flu shots, immunization for hepatitis A or B, HIV screening, treating sexually transmitted diseases, providing mental health counseling or promoting health through education or programs, the campus community benefits.

UAA Student Health Center Staff

Page 12—Alaska Nurse—November 2004

University of Alaska Fairbanks Center for Health and Counseling Donna Patrick, MSN, APRN, BC The University of Alaska Fairbanks Center for Health and Counseling is an outpatient clinic available to all enrolled students. The Center assists students in acquiring the knowledge, skills and behaviors necessary to recover, build and maintain healthy balanced lifestyles. The clinic offers several different types of services, which include health care, counseling and disability

UAF Student Health Center Staff services. It also provides alcohol and other drug assessment and intervention, health education and coordination of the student health insurance

plan. In addition to direct services, consultation and education in the form of outreach programs to the campus are provided to help maintain a safe and healthy college community.

The medical staff at the Center for Health and Counseling, available Monday thru Friday, is comprised of a Family Practice Physician, three Nurse Practitioners and two Medical Assistants.

They provide high quality, cost effective care to students during health and illness. Services provided include primary care as well as preventive services. Students taking 6-9 credits may choose to pay the health center fee in order to utilize our services.

The medical staff at the health center provides diagnosis and management for acute and chronic illness. Acute care services include diagnosis and the provision of treatment for illnesses such as upper and lower respiratory tract infections, gastroenteritis, urinary tract infections, sexually transmitted infections and muscular skeletal injuries. Laboratory and diagnostic tests are ordered, performed and interpreted. Chronic disorders such as diabetes, hypertension, hyperlipidemia, thyroid disorders, musculoskeletal disorders and asthma are also managed by the health care providers.

The center also offers preventative and health maintenance services. These services include GYN exams with Pap smears, sports physicals and screening for hyperlipidemia and sexually transmitted diseases. Written as well as verbal education in all health areas is provided.

Family planning services are offered by the Center. The Center offers pregnancy tests and counseling, emergency contraception, oral contraceptive pills, the Ortho Evra patch, Nuva Ring, Depo-Provera injections and diaphragms.

IUD’s for women meeting eligibility criteria are inserted at the clinic. We also promote positive health behaviors and self care skills through education and counseling for sexual health.

Counseling services are available to students to assist them in making adjustments to college life, making personal and interpersonal changes and for other illnesses such as depression, anxiety, suicidal ideation, substance abuse, eating disorders, problems arising from abusive families and relationship difficulties. The center emphasizes short-term counseling and the Health Center fee covers four sessions per year. There is a small charge for additional counseling sessions.

Mental illness such as depression and anxiety are also managed medically. All of the students using medical support for these illnesses are strongly encouraged to utilize the Center’s counseling services as well. We work closely with the counseling staff to ensure optimal benefit of medical and psychological care by referring patients to and conferring with the counselors.

Disability services are provided to students who may need academic accommodations under the Americans with Disabilities Act. There is no charge for any enrolled UAF student. Some of the services include determination of eligibility under the ADA and arrangements for accommodations.

Located on the UAF campus, The Center for Health and Counseling can be found on the Continued on page 13

November 2004—Alaska Nurse—Page 13

UAF . . .

Continued from Page 12 second floor of the Whitaker Building. On the corner of Yukon Drive and Chandalar Drive, it is across from the Wood Center and next to the Fire department. There are parking spaces available for one-hour use at the East side of the Whitaker building. Hours of service are Monday through Thursday 8:00-4:30 and Friday from 9:30 to 4:30 pm. Service hours apply during the academic year only. No services are provided after hours or on weekends. The Center is open during the summer for primarily administrative services but some refills of medications and referrals may be made at this time. The telephone number is: 907 474-4043 (voice) and 907 474 7045 (TTY). Please e-mail the Center at: fyheaco@uaf.edu with questions or comments. For additional information please visit the Center on the Web at: www.uaf.edu/chc.

Dorothy Fulton, BON Executive Administer (left) with Karl Sanford of Fairbanks Memorial Hospital and Mary Weymiller, BON Chair.

Board of Nursing September 22–24, 2004, Fairbanks As a licensed individual in Alaska, information provided on license applications is public information. Therefore, to keep home addresses private, a nurse would have to use a PO Box or other address as their official address for the Board of Nursing.

Regulations about Delegating to Unlicensed Assistive Personnel went to the Lt. Governor in September, and will go into effect 30 days after he has signed them. Please check the Board of Nursing website at www.dced.state.ak.us/occ/ to determine when they went into effect and print off a copy.

Chemical Dependency Just a reminder to help prevent diversion of controlled substance and substance abuse: It is unprofessional conduct to “sign a record as a witness to wastage of a controlled substance that you did not witness.” 12 AAC 44.770 Unprofessional Conduct, subsection (20). And you, as an RN, are required to report suspected

abuse and are protected as long as you are reporting, in good faith.

The Alaska BON is joining NURSYS—The only national database for verification of nurse licensure, discipline and practice privileges for RNs and LPNs—allowing faster confirmation of critical information for applicants.

The Board of Nursing is interested in meeting in facilities rather than state buildings to allow greater access to the Board and its deliberation. Please keep an eye out for Board meetings in your area, or even your facility, and attend.

Upcoming Board of Nursing Meetings December 8–10, 2004, Anchorage March 9–11, 2005, Juneau June 15–17, 2005, Anchorage September 21–23, 2005, Fairbanks December 7–9, 2005, Anchorage

Alaska Board of Nursing Expanded Roles for RNs Program Approval Facility Application Checklist TITLE______________________________ ________Proposal Introduction ________Program Objectives ________Position Statement from National Professional/Certifyin Organization ________Facility Policy & Procedure ________Curriculum Vita’s of Staff Providers ________Outline of Proposed Training ________Location of Education/Training ________Competency Record (for participant) Includes Testing and Observation for Continuing Competency ________Healthcare Provider Support

Summer 2004 Graduates

OTHER SUPPORTING DOCUMENTS ________Position Statements

AaNA would like to congratulate the 2004 UAA School of Nursing Graduates!

Crystal Rhonda Anna Carly Natalie Jaime Kent Margaret Sarah Catherine Ericka Rosemary Bree William Amber Heather Peggy Megan Helen

Allen Beam Boutwell Byrne Cordy Criswell Curzon Dalpes Doughty Ducasse Freeman Gonzales Hays Henderson Hewitt Holvoet Kalamarides Lang Love

Leigh Jacob Amber Nicole Matti Solveig Christopher Sarah Rebecca Kelly L. Peggy

Luczak-Peck Malouf Mattson McCune Munson Olson Sanborn Spencer Welsh Williams** Willman

Masters Graduates: Ms. Karen MacClain, HCA, Dianne Toebe, PhD, Chair “The Experience of Parents Providing Care to their Children with Autism” Jyll K. LaMar, FNP, Mary Logan, PhD, Chair “Outcomes After Gastric Bypass Surgery” Angelia C. Zinsli, ACN, Mary Logan, PhD, Chair “Feminine Hygiene Practices of Women Attending a Public Reproductive Health Clinic in the Pacific Northwest”

________Practice Decisions ________Literature Review

Page 14—Alaska Nurse—November 2004

AaNA Leadership Bios AaNA Leadership is a diverse and committed group of RNs who have stepped forward to make sure that RNs continue to define their profession, advocate for their patients and make the profession of nursing as strong as it can be. They advocate for nurses and nursing with the legislature, Board of Nursing, in their workplaces and in our union.

They bring excellence and professionalism to the many facets of their lives. We are proud of our leaders and we want you to meet them. In following issues you will find additional AaNA Leadership Bios spread throughout the Alaska Nurse.

Lynn E Hartz MSN, ANP AaNA Director at Large Lynn started working as a nurse’s aide in 1969.

After deciding that nursing was the profession for her, she graduated with an ADN, returned to college for a BSN and finally got an MSN at the University of Lynn Hartz Texas Health Science Center in Houston in 1988. Certified as a Family Nurse Practitioner, she has worked in California, Texas and Alaska specializing in women’s health care. Favorite experiences in her working history include; working in a traveling planned parenthood clinic setting up for GYN exams in the kitchen of a church and boiling big pans of water to warm the place up and, at the request of a NASA contractor at the Johnson Space Center, surveying her fellow

graduate students on menstrual hygiene practices to determine requirements for the space station.

After moving to Alaska in 1978, Lynn worked for the Municipal Family Planning Clinic until 1984 when she was dragged to Texas due to her husband’s job transfer. The family moved back to Alaska in 1988. Lynn developed and managed the Municipality’s Reproductive Health Clinic Colposcopy Project, a cervical cancer prevention program during the 90’s. The project continues and has served as a national model in research and practice for colposcopy clinics, training nurses and physicians while providing services to at risk women. Lynn is currently practicing with George Stransky, MD specializing in women’s health care.

Lynn has been a member of the Alaska Nurses’ Association since 1978 and the Alaska Nurse Practitioner Association since shortly thereafter. She has served twice on the Alaska Board of Nursing, once in 1984 and most recently in 2003.

Married, with one son in law school, Lynn enjoys backpacking, skiing and reading.

“Alaska is the best place to be for nurses. We have the most opportunity here to fully practice our skills whether they are in acute care or primary care. When I came to Alaska in 1978, I was fortunate to mentor with nurses who believed that the ultimate goal was the best health care for the patient and that all of Alaska nurses should be united in supporting and trusting one another as they work toward that end. “ Geri Kelly, RN, AaNA Staff Nurse Director When Geri Kelly moved to Alaska in 1977, she planned to stay only two years. But the remote beauty of Ketchikan, an island nestled Geri Kelly just north of the Canadian border, gradually drew her in, and she never left. Kelly built a career as a nurse and began working at Ketchikan General Hospital five years ago.

Though she found helping patients fulfilling, dealing with management’s scattered staffing policies was not so satisfying. “We had 60 nurses with 60 different agreements,” says Kelly. “There was no pay scale. If one nurse asked for a dollar more an hour, she got it, but the nurse next to her didn’t.”

Scheduling was similarly arbitrary. In a twist on typical nurse staffing problems in which too few nurses are assigned to care for too many patients, at the Ketchikan hospital nurses were arbitrarily penalized when patients were few—

managers would send nurses home with no pay.

The workers formed a union with United American Nurses and won their first contract in March. “We have more input on staffing,” says Kelly, who along with other union members meets with managers every two weeks to design staffing procedures that work for everyone. One solution they’ve negotiated addresses rational staffing levels and helps nurses build their skills. Today, nurses receive 30 hours a year of cross training as a result of their union contract. Kelly, a medical surgical nurse, now has the expertise to provide support in the intensive care unit, as well as in the newborn nursery and ambulatory care, among other units. “We don’t have to stay home without pay, and we have become more well-rounded nurses,” she says. Union membership built solidarity among the workers at the hospital, Kelly says. “We think about how things affect all of us, and we’re more cohesive,” she says. “This is a cool thing.”

J. Pauline Stubberud, RN, BSN, MBA AaNA Vice President Ms. Stubberud is currently the Nurse Executive for Southcentral Foundation. One of her projects included participation on an Alaska Native Medical Center team on Work Force Development with the Institute for H e a l t h c a r e Improvement.

Ms. Stubberud received her BSN in 1985 from Montana J. Pauline Stubberud State University, and her MBA in 2001 from Kennedy-Western University. She has varied clinical experience including ER, L&D, medical-surgical and pediatrics. She worked for Indian Health Service since high school, in a work-study program, and went on to work in Shiprock, New Mexico on the Navajo reservation for 14 years. She moved to Alaska to work for Southcentral Foundation in 2002 and is a Commissioned Officer in the Public Health Service.

Dianne Toebe, RN, PhD AaNA Treasurer Dianne has been a professor at the University of Alaska Anchorage School of Nursing since 1980. She has taught informatics, management, and graduate health care administration courses Dianne Toebe at the university. Dianne recently retired after 28 years as an Army and Air Force nurse. She came to Alaska from Michigan as a camp nurse for Camp Fire Inc. and continues to serve on the Camp Fire board.

Dianne also serves on the March of Dimes board and is the AaNA representative to the Alaska Telehealth Advisory Committee.

November 2004—Alaska Nurse—Page 15

2004 General Assembly AaNA Bylaws Amendments Bylaws Amendment #1—Dues by secret ballot and Dues to ANA until disaffiliation.

Article III. Membership, Section 5. Dues a. Dues for AaNA shall be: i. The amount established by the AaNA Membership by secret ballot and shall include dues to be paid by AaNA to ANA in accordance with policies adopted by the ANA House of Delegates. ii. AaNA shall continue to pay dues to ANA pursuant the ANA bylaws and ANA House of Delegates policy until such time as two-thirds (2/3) of the entire AaNA membership votes to disaffiliate from the ANA. iii. Membership rights shall be forfeited upon failure to pay dues as required by current policy.

Bylaws Amendment #2—Creation of an Honorary Member for Hall of Fame Recipients.

Article III. Membership, Section 5. Dues, b.

Membership Categories v. Honorary Members (complementary membership): RNs or former RNs who have been inducted into the AaNA Hall of Fame.

Bylaws Amendment #3—Limit Labor Council and Labor Program participation to the AaNA Members who are represented by AaNA for Collective Bargaining.

Article VIII. Labor Council, Section 1. Purpose b. The program shall be administered by the AaNA Executive Director through the Labor Program Director within the policies established by the Labor Council which is elected by AaNA bargaining unit

members to deal with issues related to the economic and professional security of individual registered nurses or groups of nurses through the process of collective bargaining and other related activities. c. “Bargaining Unit Members” shall be defined as the RNs who are members of AaNA and their AaNA Local Bargaining Unit.

Below sections are current language with eligible (struck) and AaNA inserted in accordance with the above Amendment.

Section 4. Labor Council Composition a. The Council shall be composed of AaNA bargaining unit members Section 5. Qualifications a. Members of the Labor Council must be members of the Alaska Nurses Association and the AaNA local bargaining unit. b. The representative from the local bargaining unit(s) must be a member of the AaNA and of that local bargaining unit.

Section 9. Business Meetings a. The Council will conduct separate business meetings at times to be determined by the Labor Council. b. Only AaNA bargaining unit members and AaNA staff may attend the business meetings unless invited by the Labor Council.

Bylaws Amendment #4—Labor Council Nominations and Elections to be limited to AaNA Bargaining Unit Members only.

Article VIII. Labor Council, Section 4. Labor Council Composition

e. A Labor Council Nominating Subcommittee shall be elected every two (2) years, and be made up of three (3) bargaining unit members.

Section 6. Nominations and Elections a. Nominations and Elections for members of the AaNA Labor Council will be conducted in accordance with local and federal labor laws, and the provisions Article 3.0, Composition and Qualifications for Labor Council Membership, of the Labor Council Policies and Procedures Manual. b. The Labor Council Nominations Subcommittee is responsible for the call for nominations, checking the qualifications and determining the names to be placed on the Labor Council ballot. c. Only AaNA members who are in AaNA collective bargaining units may vote for Council members.

Proposed Amendment #5—ANA Membership Language Clarification Article XI. Relationship with the American Nurses Association Section 1. Membership a. AaNA is a constituent member of the American Nurses Association. b. AaNA shall continue pay dues to ANA in accordance with the ANA bylaws and policies adopted by the ANA House of Delegates until such time as two-thirds (2/3) of the entire AaNA membership votes to disaffiliate from the ANA. c. A vote for disaffiliation from ANA must be by secret ballot, mailed to each AaNA member’s last known residence. To disaffiliate two-thirds (2/3) of the entire membership must vote for disaffiliation by return ballot.

Page 16—Alaska Nurse—November 2004

Resolutions Adopted Continued from Page 1 • protect overtime pay for RNs, • include retired Registered Nurses in a state employee retirement program, and • guarantee that Registered Nurses NOT be forced to work outside of their Scope of Practice, and FURTHER BE IT RESOLVED, that the Alaska Nurses Association Legislative Committee, in collaboration with the Health and Safety Committee, Professional Practice Committee and Labor Council, investigate the development and introduction of legislation.

Resolution Concerning Use of Narcotic Pain Medications Whereas, Alaskan nurses have been on the forefront of efforts to ensure that patients receive adequate control of the pain they experience and; Whereas, Alaska ranks in the top ten states in per capita prescription of controlled pain medications such as oxycontin and methadone and; Whereas, there is concern about abuse and diversion of prescription pain medications which is resulting in legislation being proposed on the state and federal level; Therefore, be it resolved, that the Alaska Nurses Association, through the Professional Practice and Legislative Committees, will work with the other nursing groups and other health care groups in Alaska to investigate the possibility of holding a summit on this topic and that the professional practice committee and legislative committee monitor and lobby on any proposed legislation.

Therefore, be it also resolved that AaNA will retain its commitment to the patient’s right and ability to have adequate pain control.

Resolution on Principles to Guide Evaluation of Proposed Changes in Scopes of Practice of Health Care Providers Whereas, the techniques for evaluating and treating illnesses and injuries are constantly evolving and; Whereas, existing health care provider groups and individuals are constantly seeking

to change their scope of practice by regulation and legislations and; Therefore, be it resolved that the Alaska Nurses Association will use the following five principles when evaluating proposed changes in scope of practice; 1. The individual or group seeking to change their scope of practice have formal training by accredited individuals or institutions, including hands on experience, in the areas they are proposing to expand their practice into; 2. The individual or group have an exam, developed by a recognized examining entity, which covers the area of practice covered in the proposed expansion; 3. That the health care providers are regulated by an Alaska regulatory board which includes members of the public and; 4. That the individual or group seeking expansion have a requirement for continued education/competency in their area they are expanding into and; 5. That the proposed expansion of practice is not being driven by efforts to reduce the scope of practice of nurses or negatively impact their income.

Resolution Concerning Nurses Working Overtime Whereas, because of the nursing shortage nurses are under pressure to work overtime and; Whereas, studies show that working various types of overtime (hours per day, days per week, number of shifts in a row) increases the likelihood that a nurse will make an error in providing patient care and; Whereas, studies also show that working long hours contributes to back and other injuries; Therefore, be it resolved, that the Alaska Nurses Association will educate nurses about the hazards of working extended hours, will work to maintain overtime pay as a way to discourage employers from requiring workers to work extended hours, and will use a variety of methods to prohibit mandatory overtime.

Resolution Concerning the Prevention Of Exposure to Blood borne Pathogens From Sharps Whereas, accidental injuries from contaminated sharps have been reduced by 80% since implementation of State and Federal Needlestick legislation and; Whereas, the risk of contracting a blood borne disease by health care workers is increasing due to the increase number of individual infected with these disease; Therefore, be it resolved, that the Alaska Nurses Association, through its Labor Council, its Workplace Safety Committee, and its Legislative Committee, will work to ensure that strong Alaska laws regulating medical sharps will remain in place, that nurses are educated about evolving technology to prevent sharps

injuries, and that nurses will continue to work with employers to find ways to reduce the likelihood of health care workers experiencing a sharps injury.

Resolution Concerning Maintenance of Proper Funding For Health Care Services Whereas, State and Federal funding for health care services is vital for the provision of quality health care in Alaska and; Whereas, funding for health care constitutes a large percentage of State and Federal budgets and; Whereas, both State and Federal governments are experiencing budget shortfalls; Therefore, be it resolved, that the Alaska Nurses Association will continue to advocate for sufficient funds for health care for all Alaskans and that nurses are involved in the development of strategies for making sure that funds available are being utilized and in an efficient and proper manner.

Resolution Regarding Safe Patient Handling And Reduction of Injuries to Nurses Whereas, nursing had been one of the top professions for on-the-job injuries for the past three decades and; Whereas, the average nurse lifts, moves and turns 1.2 tons a day and; Whereas, improper handling of patients can lead to the patient experiencing skin breakdown, pain, and injury, and; Whereas, nurses are caring for patients who are increasingly heavy, and; Whereas, the nursing workforce is aging and it is imperative that we take measures to prolong a nurse’s career as long as possible; Whereas, the health and safety of the nurse cannot be separated from the health and safety of the patient; Therefore, be it resolved, that the Alaska Nurses Association will encourage research on safe patient handling, will educate nurses about the technology available to handle patients safely, and will look at ways, including legislation, for encouraging utilization of this technology in the work setting.

Resolution Concerning Funding for Birthing Centers Whereas, birthing centers operated by certified nurse midwives offer a safe alternative to hospital deliveries and; Whereas, the cost of delivering a baby in a birthing center is less than in a hospital and; Whereas, certified nurse midwives currently cannot receive Medicaid reimbursement for births that occur in birthing centers; Therefore, be it resolved that the Alaska Nurses Association, through the Legislative Committee, will support certified nurse midwives efforts to obtain licensure and Medicaid reimbursement for births occurring in centers they operate.

Resolution Concerning the Education of the Public About the Five Wishes Bill and End of Life Decisions Whereas the Alaska population is aging and an increasing number of individuals and families will be faced with making end of life decisions and; Whereas nurses are frequently the healthcare providers most directly involved in assisting individuals and families in making these decisions and; Whereas Alaska has passed a model law to help individuals make their decisions be known about their care towards end of their life; Therefore, be it resolved, that the Alaska Nurses Association will work with other interested parties in supporting a public education campaign based on five wishes legislations.

November 2004—Alaska Nurse—Page 17

Alaska Nurse Alert System (ANAS) The Alaska Nurses Association has partnered with Alaska Chapter of the American Red Cross, the Section of Public Health Nursing/Alaska Division of Public Health, the Anchorage Medical Reserve Corps Department of Health and Human Services, and the Alaska Board of Nursing to create The Alaska Nurse Alert System (ANAS).

What is ANAS?—The goal of ANAS is to establish a network of volunteer nurses who will prepare for and be able to respond to, natural and manmade disasters or emergencies, including acts of terror, bioterrorism, earthquakes, and other unforeseen events in Alaska. ANAS will work with state and local agencies to identify volunteer opportunities and to match volunteers with experiences that fit their interests and skills.

Trainings—Volunteers will be offered information about training opportunities across the state, which will be designed based on current needs. See the attached materials and keep your eye on the website for additional training information.

What Can I Do as a Volunteer?—Volunteers may currently participate by signing up to work with three different partners, depending on the way in which they wish to participate.

Please see the attached description sheets for additional information.

Red Cross Well Population Shelters—The

American Red Cross will be providing training to volunteers who agree to work in shelters. All volunteers will be asked to participate in a basic disaster preparedness training and take or show competency in basic first aid training and CPR. Section of Public Health Nursing—Mass Immunization/Prophylaxis—Volunteers will participate in providing immunizations and/or prophylactic medications to susceptible persons in times of contagious disease outbreak or bioterrorism attack. Duties may include intake, history taking/screening, education, and/or administration of immunizations/medications.

Anchorage Medical Reserve Corps—A variety of response opportunities, including immunization, in the Anchorage area. Please see attached sheet.

ANAS Volunteer Coordinator(s)— Volunteers would provide assistance to the ANAS system, such as verifying licenses, coordinating phone trees, or organizing information packets.

Future plans for volunteers—keep your eyes out for these options! In the future, ANAS also hopes to provide additional ways to volunteer. AaNA is seeking to allow nurses to sign-up on ANAS to supplement their local hospital facility personnel should a crisis create a demand for such assistance. In addition, we would like to have the ability to

activate nurses to serve in field trauma units if the hospital facilities were not available for some reason. Finally, while the American Red Cross runs well population shelters, we hope to determine a way to use volunteers in special needs population shelters as well.

How do I sign up?—AaNA is the sign-up and informational site for all validly licensed RNs, as well as LPNs and Nurse Practitioners who wish to participate in ANAS. You may sign up on the AaNA website, under the ANAS subheading at www.aknurse.org, or fax or mail in the informational sheet included in this packet. The ANAS Partners want to offer a way for nurses to volunteer to serve their communities in time of need. Think about what you are willing to do, sign up to volunteer and/or stay informed, participate in the trainings and spread the word about the Alaska Nurse Alert System. Keep your eyes on the website www.aknurse.org, or your e-mail, for additional information.

Page 18—Alaska Nurse—November 2004

Leadership Training

by Carole Edwards, AaNA Board Member AaNA held a two-day leadership training for nurses including the AaNA Board of Directors, Labor Council and nurses from other organizations on Oct 19 and 20 in Anchorage prior to the start of the Alaska Statewide Nurses Conference.

On Day One Dean Gingrich from the Foraker Group in Anchorage gave a day long presentation of Effective Boards in Nursing Organizations. Topics included Board Importance, Board Types, Roles and Responsibilities, the 5 Major Principles of Highly Effective Boards, High Performing Board Meetings, Recruiting, Training and Motivation New Board Members, Why Boards Matter, and 5 Tools for Leadership.

Mr. Gingrich is widely trained in board work with personal experience on several boards.

He referenced the Carver model and Covey principles in his presentation. The attendees did several exercises to determine core values, board skills, team behavior (how we work together). This was an extremely valuable experience for the members of the AaNA Board. We were given many pointers on how we can work more effectively to provide better service to our members and meet their needs.

We plan to incorporate many of the concepts presented into the work of the Board this coming year. Among our expectations are to refine the job description of the board, analyze the skills of each board member so that we will be able to fill any gaps that exist with future board members. We hope to provide you with a more efficient board that will fine tune the organization to improve our ability to meet the needs of you—our members.

Join AaNA Today!

Patti Bemis of Central Peninsula, Judy Lundamo of Ketchikan and Michelle Murphy of Providence networking at the AaNA Leadership Training.

On Day Two we had presentations from attorney Chuck Dunnagan on the complex realities for a professional nursing association and a union. Hot Issues in Nursing were discussed by presented by a variety of leaders: Michelle Murphy, AaNA Labor Council Member spoke on the latest in workplace safety, Jackie Pflaum, Interim Director of UAA School of Nursing spoke about their expansion and latest programs, Dianne O’Connell, AaNA Labor Program Director presented AaNA’s work on health care coverage for retired nurses, and Camille Soleil, Executive Director, presented information on latest studies about RN staffing and fatigue, changes in federal overtime regulations, the Nursing Reinvestment Act and Nursing Magnet Status.

John Bitney, AaNA lobbyist, and Patricia Senner, AaNA Legislative Committee Chair, gave a presentation on structure of the state legislature and upcoming issues for the new legislature. We expect to see bills about a prescriber’s database for drugs; qualifying licensed birthing centers for Medicaid, needle stick legislation to conform to federal law, safe patient handling, prescriptive authority for naturopaths and medical malpractice tort reform.

The 2 day session ended with the board feeling optimistic about the future and enthused to use this new information for improved your organization.

Volunteers 200 Short-Term Volunteer Healthcare Providers Needed to Improve the Quality of Care Provided to over 500,000 HIV Patients in Developing Countries: The International Center for Equal Healthcare Access (ICEHA) is recruiting experienced physicians and nurses to volunteer for 6-12 weeks in developing countries. Using clinical mentoring techniques, volunteers provide HIV bed-side training to local healthcare providers.

ICEHA is a network of physicians and nurses who volunteer technical assistance on HIV care and infectious diseases to clinics in developing countries. ICEHA’s clinical mentoring program was developed specifically for the rapid scale-up of skills of the local healthcare staff, strengthening the quality of healthcare delivered in developing countries so that countries can fight the HIV epidemic from within. More information, including a volunteer application, is available online at www.iceha.org or by emailing Katie GravesAbe at kgravesabe@iceha.org.

NEW! From the National Institute on Aging

Working with Your Older Patient: A Clinician’s Handbook Do you want to be able to better understand and communicate with your older patients?

This newly revised guide offers tips and strategies for clinicians—physicians, nurses, physician assistants, and other health professionals—seeking to build relationships and bridge communication gaps with older patients.

Working with Your older Patient addresses difficult-to-discuss issues, provides practical tips to promote adherence to treatment, and lists resources for more information.

Useful for primary care providers and health professionals working with seniors in outpatient settings, and as a training tool for students and new practitioners. FREE. Topic areas include: • Encouraging prevention wellness • Talking about sensitive subjects: Driving Abuse End-of-life care Incontinence Sexuality . . . and more • Supporting patients with chronic conditions • Breaking bad news • Working with diverse older patients, families and caregivers • Talking about cognitive problems To request your FREE copy of Working with Your Older Patient Order online at www.niapublications.org or Call the NIA Information Center toll-free at 1-800-222-2225 AaNA 2207 E Tudor Rd, Suite 34, Anchorage, AK 99507 907-274-0827