The Alaska Nurse - Vol. 56 No. 4 - November 2006

The Alaska Nurse Circulation 8,000 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska Volume 56 No. 4

The Official Publication of the Alaska Nurses Association

Nurse Leaders Gather for AaNA General Assembly

by Dianne O’Connell, M.Div. AaNA ED/PD

which is to hear reports on the activities of the previous year and to chart the course for the organization’s program for the coming Nurses gathered from Kotzebue to year.

Ketchikan, from North Pole to Juneau, President Debbie Thompson, BSN, RN, a throughout the Matanuska-Susitna Valley surgical services nurse at Providence Alaska and from downtown Medical Center, presided.

Anchorage and Fairbanks.

Resolution No. 2 set the There was even one from Legislative Priorities for the Girdwood itself. coming Session as: There were staff nurses 1. protecting the public’s and nurse practitioners, health including disaster university professors and preparedness; nurse administrators, public 2. working to pass health nurses and nurses in legislation banning private practice, intensive mandatory overtime; care nurses, surgical nurses, 3. working to find ways to mental health nurses, encourage the progressive care nurses, acceptance of devices to women’s health nurses, reduce the lifting and pediatric nurses and geriatric turning of patients in nurses, retired nurses, health care facilities; infection control nurses and Alaska Nurses Association 4. maintaining the President Debbie Thompson even an infomatics nurse. independence of the The nurses came together presides over AaNA General practice of nursing; and for the annual Alaska Nurses Assembly, October 1, 2006 at maintaining an adequate Prince Hotel, Association General Alyeska nursing force in Alaska.

Assembly, the purpose of Girdwood, Alaska.

Continued on page 3

November 2006

Arctic Thunder 2006 Page 4

Editorials: Advanced Nurse Practitioners Pages 6-9

Spotlight Kodiak: Future Nurses of America Page 13

Inside This Issue Nurse Leaders Gather for AaNA General Assembly . . . . . . . . . . . . . . . . . . . . . 1

Confessions of a Blunt Needle User

by An Anonymous Nurse I’ve spent half my career unlearning the bad habits I picked up in my first six months as a nurse. (Flashback: Wow, that nurse held the needle cap in her mouth and pulled the syringe free! How cool. It must be the best way to uncap a needle!) On this day, though, all of that unlearning couldn’t have been farther from my mind.

I’d settled into my patient care assignment: two critically ill patients, both on ventilators.

One had unexpectedly required extra time at the beginning of the shift, so I was hurrying through my assessment on my second patient in order to catch up. Finally, it was time to administer the last of the scheduled medications—one that required aspirating liquid from a capsule so it could be administered via the feeding tube.

Like patient care units everywhere, this critical care unit had adopted engineering controls aimed at reducing the risk for injury.

Blunt needles had been substituted for sharp needles to reduce the risk of needlesticks at the bedside. I was full of confidence as I grabbed a blunt needle to perform the task of aspirating the medication from the capsule, a task I had performed many, many times before.

Hmmm, I thought. This capsule is quite a bit stiffer than I expected, and, as I pushed the blunt needle a little harder, there was a sudden shock of pain in my thumb. Yikes! I must have

stuck that needle into my thumb! Yep—there was that telltale sign of fresh bleeding, and I immediately grabbed a gauze pad to apply pressure. Whoa—there’s something red on the other side of my thumb . . . oh no! That blunt needle must’ve gone all the way through and out the other side of my thumb!

Panic!

I applied pressure and more pressure, but it didn’t seem like the bleeding was slowing down much. Wait—hold the hand up in the air, above the heart!

Thankfully, the bleeding did stop, and, though my thumb was throbbing, it wasn’t damaged as much as my dignity as I filled out an Unusual Occurrence Report. How embarrassing to have to report that I’d pretty much performed a thumb biopsy with a blunt needle!

Weeks later, my thumb was healed, and all was well. I’d just about forgotten about the whole incident when I received a note to make an appointment in the employee health office. To my chagrin, it turned out that OSHA was interested in whether the blunt needle device needed to be evaluated for possible removal from the worksite. My co-workers were worried. Remove the blunt needles? What would take its place? I promised to do my best to craft a response that showed the Continued on page 2

Confessions of a Blunt Needle User . . . . . . . . . 1 Arctic Thunder 2006 . . . . . . . . . . . . . . . . . . . . . 4 President’s Message . . . . . . . . . . . . . . . . . . . . . . 5 Editorials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9 Alaska Nurses in the News . . . . . . . . . . . . . . . 10 Membership Application. . . . . . . . . . . . . . . . . 11 Board of Nursing News . . . . . . . . . . . . . . . . . . 12 Spotlight Kodiak . . . . . . . . . . . . . . . . . . . . . . . 13 AaNA/ANA News . . . . . . . . . . . . . . . . . . . . . . 14

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

Presort Standard US Postage

PAID Permit #14 Princeton, MN 55371

Page 2—Alaska Nurse—November 2006

Confessions Continued Continued from Page 1 injury to be a result of operator error, and not device failure.

Much to my relief, the interviewer was sympathetic, and the blunt needles remained in the unit. Since then, however, better engineering controls have been implemented so that even blunt needles are no longer needed for most bedside tasks.

Though I’ve told and re-told my sad story with humor, needlestick injuries are serious. Up to 1 million needlestick injuries happen in the U.S. every year, and many nurses contract serious illnesses as a result: Hepatitis B and C, HIV, malaria, tuberculosis, herpes, and syphilis.

The ANA has taken the lead with the Safe Needles Save Lives campaign. In Alaska, we’re fortunate that the AaNA and the collective bargaining units spearheaded the effort to adopt needlestick prevention legislation, now in statute.

I count myself as one of the very luckiest persons who has ever sustained a needlestick injury. I’m more committed than ever to do whatever I can to promote the safest worksite possible, and I hope that everyone who reads this article will do the same. Visit the Safe Needles Save Lives campaign website (www.needlestick.org) to find out how you can be involved!

[Editor’s Note: This story is ‘anonymously’ by Patti Hong, Professor Emerita of the UAA School of Nursing]

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. 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. Photographs sent to the Alaska Nurse will become property of the AaNA. We hope that we will be sent copies, not originals and prefer emailed files. 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, 3701 East Tudor Road Ste 208, Anchorage, AK 99507. If you have any questions call Lynn Hartz 907-248-4877 or email lhartz@alaska.com.

An official publication of the Alaska Nurses Association, 3701 East Tudor Rd., Ste. 208, Anchorage, AK 99507. Tel: 907/2740827. Web site: www.aknurse.org. Published quarterly.

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 AaNA Board of Directors President: Debbie Thompson BSN, RN, CNOR Vice President: Nancy C. Davis, RN, MSN Secretary: Michelle Murphy, RN Treasurer: Martha Clinehens, RN Directors: Labor Council Chair: Donna Phillips, BSN, RN Greater Alaska Director: Sara M. Harvison, RN, BSN Staff Nurse Director: Kathleen A. Gettys, RN, BSN, BA Rural Director: Jane A. Conard, RN Director at Large: Lynn E. Hartz, MSN, ANP Carolyn S. Adkins, RN, MS, COHN-S, CM, COHC Paul T. Mordini, RN Dara M. Whalen, RN, MS AaNA Labor Council Chair—Donna Phillips, RN, BSN Joseph Peacott, RN, OCN Sheri Whitethorn, BSN, RN, CCRN Deni Callahan, RN Jenni Hancock, RN Julie Torres, RN UAN Rep.—Kathleen A. Gettys, RN, BSN, BA PAMC BU Rep.—Marlene Brehmer, RN Soldotna BU Rep.—Steve Baumgardner, RN Ketchikan BU Rep.—Susan Walsh, RN Affiliate Organizations: Alaska Chapter of the American College of Nurse Midwives Alaska Nurse Anesthetists Association Alaska Nurse Practitioner Association Alaska School Nurses Association Forensic Nurses Association, Alaska Chapter Executive Director: 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.

Errata In the last issue of the Alaska Nurse, the story on the U.S. Public Health Service Commissioned Corps (USPHS) repeatedly and mistakenly dropped the “s” in Corps. We regret the error.

Those of you who may be interested in the USPHS can obtain more information at their website http://www.usphs.gov.

November 2006—Alaska Nurse—Page 3

Nurse Leaders Gather – Continued Continued from Page 1 Ms. Benson’s contributions to the health of Alaskans, the nursing profession, and AaNA have been substantial and include being: • a pioneer nurse at the University of Alaska Fairbanks Student Health Center; • president of the Alaska Nurses Association; • perennial chair and/or member of the AaNA Bylaws Committee; and • the only AaNA member elected to the American Nurses Association Board of Directors.

One resolution mandated that the Ruth Benson, retired nurse Association explore funding practitioner from Fairbanks, opportunities for a media campaign to was designated an “AaNA promote membership of RNs in the Nursing Legend.”

Association.

Another resolution directed the association to work with both state and federal legislators to fine a way to maintain and expand the Denali Kidcare program, a program providing health insurance for lower income children.

Still another resolution directed the AaNA Professional Practices Committee to develop a white paper on the issue of Alaska participating in an intra-state licensure compact. The paper will be delivered at the 2007 Alaska General Assembly.

Workplace abuse and harassment of nurses was the topic of another resolution and the association was directed to explore the possibility and advisability of organizing some groups of employees for collective bargaining who are not nurses.

Election results were announced by Teller Joe Peacott, RN. Elected to the AaNA Board of Directors were: • Nancy Davis, RN, MS, Juneau, vice president; • Michelle Murphy, RN, Providence/Anchorage, secretary; • Kathleen Gettys, RN, BSN, BA, Providence/Eagle River, staff nurse representative; • Jane Conard, RN, Matanuska-Susitna Valley, rural representative; • Carolyn Adkins, RN, MS, COHN-S, CM, COHC, North Pole, director-at-large; • Paul Mordini, RN, Alaska Psychiatric Institute/Eagle River, director-at-large; and • Dara Whalen, RN, MS, Kotzebue, director-at-large.

Those persons going off the Board and thanked for their service were Pauline Stubberud, Alaska Native Medical Center; Gail Holtzman, University of Alaska Anchorage; Julie Torres, Providence; Geri BradyKelly, traveler based out of Ketchikan; and Lonnie Hosley, Alaska Psychiatric Institute.

Minutes of the General Assembly, including full text of the resolutions, can be found at: www.aknurse.org.

New Governor Sarah Palin and Alaska Nurses’ Association President Debbie Thompson at the April 2006 Alaska Statewide Nurses Conference. Candidate Palin returned a 2006 Gubernatorial Candidate Questionnaire to the Alaska Nurses Association Political Action Committee (PAC), which is still available for viewing at aknurse.org.

Page 4—Alaska Nurse—November 2006

Arctic Thunder 2006

by Captain M. Edouard, USAF The Alaska Air Show (Arctic Thunder) 2006 was a two-day event that included fighter jets streaking across the skies, simulated assaults, parachute drops and aerobatic aircraft, making it by far the most popular spectator event in Alaska. Last year it drew more than 150,000 people, according to the international council of air shows.

This year was my first Air Show; I had listened to the local weather before heading out to get an idea of the prospect for a great show. Although August 12, 2006 started out with it’s share of rain; I didn’t let weather dissuade me from attending the show. I quickly learned that shows will work around the weather and there are many acts that continue in overcast skies or light rain. So, I packed an umbrella alongside my camera, ear protection, and off I went.

I was looking to capture images of the aircraft on static display, so I arrived as soon as the gates opened to avoid people milling through my shots.

Another fascinating demonstration; the F-15 an all-weather, extremely maneuverable tactical fighter designed to permit the Air Force to gain and maintain air superiority in aerial combat. The weapons and flight control systems are designed so one person can safely and effectively perform air-to-air combat

[From Artic Thunder website] The Air Show also displayed an array of vendors from t-shirts, sunglasses, toy jets to military display from different branches; Air Force, Navy, Nation Guard to name a few. A variety of foods and beverages were sold at concession stands

The featured demonstrations included dozens of acts, a favorite by far were the Blue Angels. The Blue Angels flight demonstration exhibits choreographed refinements of skills possessed by all naval aviators. It included polished classic maneuvers of the four-plane Diamond Formation, in recital with the fastpaced, high precision maneuvers of its two Solo Pilots. The Blue Angles team illustrates the pinnacle of accuracy flying, performing maneuvers locked as a unit in the renowned, six-jet Delta Formation.

Bleacher seating was available for the general public. Guests were advised to bring blankets and folding chairs. Seating was provided for special guests and distinguished visitors who had been extended invitations from commanders.

[From the Artic Thunder website]

[Captain M. Edouard, is a Nurse Practitioner in the Air Force and can be reached via editor@aknurse.org if you have questions]

November 2006—Alaska Nurse—Page 5

large magnitude earthquake. I believe that this is the grass roots to being prepared for any emergent crisis that may occur.

AaNA members and RNs in general have the responsibility to take a stand and help to educate the people of each of our neighborhoods, communities and the state as part of a fundamental belief that all people should have access to reasonable health care. I believe that as the Association that represents nurses for the State of Alaska, we need

by Debbie Thompson BSN, RN to be at the forefront of education for all people of our state. There are AaNA President now emergency preparedness lists available from the Red Cross and some companies are starting to sell emergency first aid kits as well as There was an Influenza summit meeting held in emergency food kits and kits that will have battery operated radios, Anchorage on April 13th of this year. The meeting flash lights etc. was convened by ex-Governor Murkowski’s office As nurses we need start at our family level, move to our and attended by numerous Federal agencies, as neighborhoods and then to the municipal level to help educate and well as state and municipal representatives. There prepare members of each of our communities. We need to make sure were public, businesses, education, medical and that we reach out and volunteer to sit on councils that are popping up local government representatives on hand for the in our communities to address the problems that have been identified day’s events. in the Katrina aftermath and make sure that we are ahead of the these The day started with the members in attendance problems and at the forefront of preparedness rather than sitting in the from National government and councils talking back seat of need when the crisis arises. We as nurses need to start about the trouble we as neighbors, communities, volunteering to help organize a plan and set practice sessions and Debbie Thompson municipalities and a state would face in an evaluations of such practices in motion, we need to step forward doing emergency crisis situation. With Katrina in the forefront of all our public service messages for our local and state level. We need to be the minds, we were shown that the federal government is not always going voice available to answer questions and give directions, act as a to be able to get to the area affected by disaster and bring the offer of clearing house for that medical aid that comes to the state, and when help that would be necessary on that initial response to a disaster or needed find answers and help disperse volunteers. endemic crisis situation.

Nursing is one of the most trusted professions and we need to take With this in mind the conference started setting the stage for how the responsibility that this carries very seriously. We need to be best to prepare for a catastrophic event. Where do we start to prepare available for public service announcements and to meet with different for an event of the magnitude of Katrina? Are we ready for such a organizations, groups, families etc. to help educate on that initial disaster to hit the state of Alaska, to invade our neighborhoods, response. My hope is that each one of you will connect with your municipalities and family members, our state? It became n e i g h b o r s , apparent that the Information on one type of emergency, the flu pandemic may be found at c o m m u n i t i e s , focus was not limited municipalities and to Influenza but http://www.cdc.gov/flu/pandemic/healthprofessional.htm state leaders and start should have a much making those grass broader stroke and roots plans on how to just become an emergent response discussion that would prepare all of account for each other, where and how to meet up and set in motion us for whatever kind of disaster were to occur. As more representatives basic emergency plans and use this emergency plan as the foundation of the Federal and State government spoke it became quite clear that to build a plan for the state and national level. the way to plan was on a local front, starting with each individual, to Carry on as we move forward towards emergency preparedness. each family, to each neighborhood, to the municipal level, reaching the state level, moving to a regional level and then reaching the national level.

The concerns were how to reach out to all people and then how to train, practice and be ready for any type of disaster that should befall us. We have had numerous drills for preparedness within the state and local government and this is a start to being ready. We all have had to look at some sort of emergency preparedness for the possibility of a

President’s Message Are We Prepared for a Disaster?

Page 6—Alaska Nurse—November 2006

Editorial [Editors note: The next two articles are in response to a letter by the Alaska State Medical Board written in September, 2006 on another matter, in which a side note stated the Medical Board’s opinion that “advanced nurse practitioners are practicing medicine and, therefore regulation of that profession should fall under the regulation of the medical board.”]

Query: Do Nurse Practitioners Practice Medicine?

Answer: No, they practice Nursing

by Lynn Hartz MSN, ANP Advanced Nurse Practitioners (ANPs) are not practicing medicine.

This was the opinion of the Alaska state legislature when it passed enabling legislation and the Alaska State Board of Nursing when it adopted regulations instituting independent practice for nurse practitioners in 1984. Advanced Nurse Practitioners are practicing within their state nursing license and within their Advanced Nurse Practitioner authorization which puts them under the exclusionary language of Alaska Medical Statutes Sec. 08.64.360 & Sec 08.64.170, just as it does so many other health professionals whose practice overlaps with that of medicine. The practice areas of the nurse practitioner may in some cases overlap with medical practice just as physician practice will at times overlap into what traditionally has been seen as nursing practice. (“Cure” is not the exclusive domain of medicine nor is “Care” the exclusive domain of nursing) This does not mean either the nurse practitioner or physician is practicing outside their competency.

The definition of what lies within and without the scope of the practice of nursing at any given time must rely upon a set of criteria, rather than a set list of tasks, if there is any hope to remain current.

Many nursing leaders today apply the scope of practice principles used by the Board of Nursing when they developed regulations for advanced nurse practitioners: these principles are the following: Guiding Principles 1. The scope of practice in health care disciplines overlap.

2. The scope of practice in health care professions rapidly changes 3. A determination of whether a particular practice or technique falls within the practice of nursing must therefore rely on qualitative criteria rather than a set list of tasks as any particular list would rapidly be out of date.

4. The profession of nursing is impacted and defined by four main institutions: Nursing education curricula Professional Societies: state & national professional nursing association standards; scope of practice statements and certification/accreditation bodies State nurse practice acts Workplace job requirements In times of rapid growth or change in the health care system, it is not unusual for one institution to advance and create a temporary lack of agreement on what is or is not within the practice of nursing.

The creation of the role of nurse practitioner is an example of a temporary lack of symmetry between institutions as to what is and is not within the practice of nursing. In 1965 an educational institution in Colorado headed by Loretta Ford EdD, FAAN and the late Dr. Henry Silver created a curricula and new role for the registered nurse prior to there being any state nursing board approval, professional scope of practice statement, or job description. These features came later as the other entities caught up. Yet forty years later, the role of nurse practitioner functionally is falling well within nursing practice as each institution: education, state practice act, professional association and workplace job description now place the practice of nurse practitioner as being within the scope of nursing. This is not unique to nurse practitioners or even nursing and can probably be found in many other arenas.

Definitions Medicine: The practice of Medicine or osteopathy is defined in Alaska as “. . . to diagnose, treat, operate on, prescribe for or administer to any human ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other mental or physical conditions;” [source: Alaska Statute (AS) 08.64.380 (6)] As this definition is broad, a number of health care professionals licensed in Alaska could be said to be performing acts that fall within the practice of medicine as defined by Alaskan statute. These include: Acupuncturists, Audiologists, Speech Pathologists, Chiropractors, Dentists, Dieticians, Nutritionists, Midwives, Nurses, Optometrists, Physical Therapists, Occupational Therapy, Psychologists and Psychological Associates [source med statute, list] Sec. 08.64.360 in the Alaska Medical Statutes recognizes the problem and exempts “. . . a person licensed or authorized under another chapter of this title who engages in practices for which that person is licensed

Continued on page 7

November 2006—Alaska Nurse—Page 7

Editorial continued Do Nurse Practitioners Practice Medicine?

Continued from Page 6 or authorized under that chapter . . .” And again in Sec. 08.64.170 where the medical statute states a person may not practice medicine in the state unless licensed under “this chapter, except that” (3) “a person who is licensed or authorized under another chapter of this title may engage in a practice that is authorized under that chapter.” The plain language of these statues recognize the potential for overlap between practice areas and clearly indicate that an individual practicing within their own license and authorization is not practicing medicine and does not fall under jurisdiction of the medical board.

Advanced nurse practitioner Sec. AS 08.68.410. Definitions. In this chapter (1) “advanced nurse practitioner” means a registered nurse authorized to practice in the state who, because of specialized education and experience, is certified to perform acts of medical diagnosis and the prescription and dispensing of medical, therapeutic, or corrective measures under regulations adopted by the board;.”

It should be pointed out that although the statute does state advanced nurse practitioners can “perform acts of medical diagnosis”: one act does not a practice make. The practice of nursing is more than a list of tasks or techniques. One would assume that physicians feel the same is the true of the practice of medicine. The practice of nursing is the culmination of years of education, experience, group process, and the integration of a professional identity. The educational foundation, clinical practice and collegial relationships that comprise the practice of nursing can incorporate techniques that are also performed by physicians (such as prescription of medications, physical exams and advanced technical skills such as biopsies, etc.) without diminishing medical practice or turning the practice of nursing into medical practice.

Integrating new skills into nursing practice is not new. Years ago, intramuscular injection (IM) was considered a skill solely within the province of medical practice.

Few physicians today would consider the technique of IM injection exclusive to the practice to medicine. Likewise, techniques previously performed solely by nurses are now being done by licensed practical nurses and in some cases, by certified medical assistants.

As long as the Advanced Nurse Practitioner is practicing within her RN license and ANP authorization to practice, he/she is conducting nursing practice regardless of whether it overlaps with the practice of medicine. It is irrelevant that a physician doing a similar task would be practicing medicine. The Alaska Medical Statutes reflect the reality that there are going to be grey areas in the boundaries between professions. If the ANP is performing a task outside their competence or in an unsafe manner they should be reported to the Board of Nursing and prosecuted accordingly; just as unprofessional or incompetent practice by a physician or any other health care professional should be reported.

SummaryAn Advanced Nurse Practitioner, educated in an accredited nursing program, licensed as a registered nurse, authorized to practice by a board of nursing as nurse practitioner, credentialed as a nurse practitioner by a national nursing organization who has an advanced nursing degree, practicing within his/her scope of nursing practice and under that nursing license, functionally defined, cannot possibly be said to be practicing medicine.

[Lynn Hartz MSN, ANP is currently editor of the Alaska Nurse, a member of the AaNA Board of Directors and secretary of the Alaska Nurse Practitioner Association. She has been in a private GYN practice for 16 years, has practiced in Alaska since 1978 and served two terms on the Alaska Board of Nursing once 1984 and again in 1999.]

Page 8—Alaska Nurse—November 2006

Editorial

Alaska Advanced Nurse Practitioner Regulation

by Cathy Giessel, MS, RN, APRN-BC, FAANP Chair, Alaska Board of Nursing Practice of Nursing and Practice of Medicine in Alaska To begin this discussion, I will review Alaska statutes; this is the law in Alaska governing nurse practitioner practice and that of our colleagues in medicine. As a basis of understanding, Title 08 covers professions in healthcare. Chapter 64 is Medicine. Chapter 68 is Nursing.

Alaska Statute (AS) 08.68.410 (1) “Advanced Nurse Practitioner” means a registered nurse authorized to practice in the state who, because of specialized education and experience, is certified to perform acts of medical diagnosis and the prescription and dispensing of medical, therapeutic, or corrective measures under regulations adopted by the board (of nursing).

Alaska Statute (AS) 08.64.380 (6) “Practice of medicine” or “practice of osteopathy” means: (A) for a fee, donation or other consideration, to diagnose, treat, operate on, prescribe for, or administer to, any human ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other mental or physical condition; or to attempt to perform or represent that a person is authorized to perform any of the acts set out in this subparagraph. Alaska Statute (AS) 08.64.170 (a) A person may not practice medicine, podiatry, or osteopathy, in the state unless the person is licensed under this chapter, except that (3) a person who is license or authorized under another chapter of this title may engage in a practice that is authorized under that chapter.

Do Advanced Nurse Practitioners practice medicine?

Advanced Nurse Practitioner is the Alaska statutory title for Nurse Practitioners. For the purposes of this article, however, I am going to use an abbreviation that is being used nationally, that of “NP.” NPs have had independent practice in Alaska since 1984. The Alaska Board of Nursing, established in 1941, has always been the state regulatory entity overseeing NP practice. Prior to 1984, NPs in Alaska were under collaborative practice requirements. Kay Lahdenpera can tell you about hiring one of the first NPs for the Municipal Health Department in Anchorage in 1970. Lila McEwen will be writing her memoirs about the original work, establishing NP practice in Alaska. NPs in Alaska, as in every other state, must hold a Registered Nurse license first.

Therefore, NPs are nurses, first and foremost.

NPs practice from a foundational basis of nursing, they are instructed in graduate schools by other nurses and they integrate nursing into all that they do.

Medical approaches to healthcare are integrated into NP care. As you can see from the Alaska definition of “medicine,” there are many people who incorporate the “practice of medicine” into their professional work.

However, the integration of medical care into a profession’s work does not define a profession, but it is the entire scope of practice that defines any profession. The skill set of medicine is not unique and finite to the physician but is a shared skill set among many professions.

This fact is acknowledged in the Alaska law, when, under the definition of “practice of

medicine,” reference is made to except professionals licensed under another part of the law. The activities described in the definition of the “practice of medicine” are within the scope of practice described in the statutes for physicians, nurses, osteopaths and dentists when they practice medicine, nursing, osteopathy, and dentistry.

NPs integrate nursing and medicine into the provision of services that can be broadly referred to as primary healthcare. “Primary healthcare is that which occurs when a consumer makes contact with a healthcare provider who assumes responsibility and accountability for the continuity of health care regardless of the presence or absence of disease” (California Advisory Opinion on RN and NP Scope of Practice). So, to answer the question “Do NPs in Alaska practice medicine?” the answer is “No.” Who is best qualified to regulate NPs in Alaska?

Boards of Nursing are comprised of nursing professionals from all levels, as well as members of the public. Forty-four states, including Alaska, have elected to not involve the Board of Medicine in regulating NP practice, and two states regulate NPs through their own, separate Advanced Practice Board.

NPs are nurses, licensed as Registered Nurses, practicing nursing. Therefore, Boards of Nursing are the most appropriate state regulatory oversight agencies for their practice.

Are NPs being regulated effectively in Alaska?

The first and foremost purpose of the Board of Nursing is to protect the health, safety, and welfare of the public through the regulation of safe nursing practice. The Board of Nursing is authorized by law to perform a number of duties that define nursing practice. The complete list of duties can be found in AS 08.68.100 and include adopting regulations pertaining to practice, approving education programs, governing licenses, defining requirements for competence, developing reasonable and uniform standards of practice and publishing advisory opinions pertaining to the acceptable standards of nursing practice.

The Board of Nursing mandate is not to advocate for the profession of nursing, but to advocate for the public safety. The Board of Nursing provides the public with some assurance that nurses licensed in this state are competent and safe to practice.

Furthermore, the public can expect the Board to discipline individuals who fail to meet licensure and practice standards.

The Board must assure that the more than 600 NPs and more than 120 CRNAs who are licensed in Alaska have been properly educated and trained, they have successfully completed a national certifying board examination in their specialty and are maintaining their competency to practice safely. The authority of the Board is given in state law. The Nurse Practice Act refers to the Alaska Statutes in 08.68. Regulations are promulgated by the Board to define the application of the Statutes. In other words, they flesh out how the statutes are applied.

This is a complex process and the Board is assisted by Regulations Specialists and an Assistant Attorney General assigned to the Board.

In Alaska the Board of Nursing works very hard, through staff in the office, to review all Continued on page 9

November 2006—Alaska Nurse—Page 9

Editorial continued Alaska Advanced Nurse Practitioner Regulation Continued from Page 8 license applications and renewals. The Board has investigators who work for the Department of Law, assigned to investigate any Board of Nursing cases. The Assistant Attorney General acts as the Board of Nursing prosecutor for any cases brought against a nursing licensee. The Board of Nursing itself reviews all of this work.

Some of the authority of the Board is delegated to the Executive Administrator to act on the Board’s behalf between Board meetings.

In Alaska, between 1990–2005, only 3 NPs have had license actions taken against them that resulted in filings in the National Practitioner Data Bank (NPDB). The NPDB is an information clearinghouse of data related to professional competence and conduct of physicians, dentists, nurses and other healthcare practitioners. In Alaska it is extremely rare to have cases brought against NPs that result in license action. (As a point of reference, there have been 482 filings in the NPDB for Alaska DOs and MDs between1990 to 2005.)

The Board of Nursing has consistently done an excellent job regulating NP practice over the past 36 + years.

National issues related to Scope of Practice The American Medical Association House of Delegates adopted Resolution 814 in November 2005. This resolution created the Scope of Practice Partnership, a committee of the AMA made up of members from interested state medical associations. The purpose of this SOPP is to study the qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of other “nonphysician” practitioners in their states. It is anticipated that the Western states will be the most closely scrutinized by the AMA and that NPs will be one of the first “nonphysician” groups examined due to the independent practice authorization in the Nurse Practice Acts. There are many nursing professional organizations collaborating to respond to the SOPP. One such organization is the Coalition for Patient Rights (CPR) who states “Physician organizations are not in the best or most objective position to conduct a balanced and fair assessment of education and training standards for other licensed healthcare professions.

A balanced study of healthcare professions would include an evaluation of physician scope of practice and consider whether physician scope of practice is overbroad.” The National Council of State Boards of Nursing (NCSBN) is participating in another coalition to address scope of practice issues also. As scope of practice issues are considered, an

objective approach must be incorporated that remove the emotional responses related to a profession’s “turf” preservation. A coalition of six national regulatory board associations, which includes NCSBN, has identified four foundational objective measures to assess scope of practice. Those objective measures include, but are not limited to, the historical basis of the evolution of the profession, the education and training that assures competent and safe practice, the evidence of public need, and the appropriate regulatory oversight.

Public safety is the top priority in any scope of practice deliberation. Changes in scope of practice are inherent as healthcare evolves.

Collaboration between all healthcare providers should be the norm. No profession “owns” a skill or activity but overlap is expected. Nurse practice acts must require demonstration of training and competence to provide new services as well as maintenance of all skills and knowledge.

Conclusion This has been a very brief and broad overview but I hope it serves to enlighten the issues currently facing NPs in Alaska and nationwide. NPs need to be active members of Nurse Practitioner professional associations in their state and nationally. They need to be informed about the roles of professional associations and their Board of Nursing, so that they comprehend and appreciate the separate roles of each.

Page 10—Alaska Nurse—November 2006

Alaska Nurses in the News DIXIE ORSINI NURSING SCHOLARSHIPS AWARDED Fairbanks District 4 Nurses Association awarded the Dixie Orsini Scholarships recently to four local students. The recipients are Heidi Harris, UAA; Katherine Sanders, UNLV; Leah Johnson, BS, Johns Hopkins University; and Carolyn Adkins RN BSN MS, U of Phoenix and Walden University. All four recipients presented outstanding credentials to the scholarship committee.

Ms. Johnson is enrolled in a joint Bachelor of Science in Nursing/Master of Science degree to become licensed as an Advanced Nurse

Practitioner, and Ms. Adkins in an on-line program leading to a Master of Nursing Science Nurse Practitioner qualification.

Both Ms. Sanders and Ms. Harris are enrolled in accelerated BSN programs headed toward graduation in December, 2006.

Scholarships have been awarded every year since 1990. Previous awardees are now employed in nursing at Fairbanks Memorial Hospital and other local health care agencies, including the Fairbanks Health Center.

Dixie Orsini was an active member of the Fairbanks Nurses Association who worked at St. Joseph’s Hospital and as an office nurse for

Dr. Schaible. The scholarship fund was established by her family and friends after her death in 1984.

The scholarship board gives special consideration to applicants who may not meet criteria for other nursing scholarship programs.

Anyone wishing to donate to the scholarship fund, or requiring more information, may contact Ruth Benson RN, Fund Trustee, at 4796912.

Dr. Dan Kiley, DDS was recognized by the American Academy of Nurse Practitioners as Nurse Practitioner Advocate 2006. Dr. Kiley frequently acknowledges the numerous ways that Advanced Nurse Practitioners are making a significant impact on Dr. Dan Kiley healthcare quality and access in Alaska. Dr. Kiley recently completed a Masters in Public Health and has a private dental practice in Anchorage. The award was presented to Dr. Kiley at the Alaska Nurse Practitioner Association Annual Conference in Anchorage on October 6.

Cathy J. Johnson, MSN, MHA, FACHE, Advanced Nurse Practitioner, was recognized as Alaska’s Nurse Practitioner of Excellence 2006 by the American Academy of Nurse Practitioners at its annual conference in June in Dallas, TX. ANP Johnson is a Psychiatric Mental Health Nurse Cathy J. Johnson Practitioner with the Fairbanks Veterans Administration Clinic in Fairbanks. She retired from the US Army Nurse Corps in 2003 at Fort Wainwright, AK at the rank of Colonel.

The award was presented to ANP Johnson at the Alaska Nurse Practitioner Association Annual Conference in Anchorage on October 6.

November 2006—Alaska Nurse—Page 11

Membership Application Advancing and Supporting the Profession of Nursing Integrity Professionalism ~ Advocacy Empowerment ~ Representation

Membership Categories

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

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

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

Integrity ~ Advocacy Professionalism Empowerment Representation

Share your Expertise!

Get Informed! >>check off and return form to AaNA

A Benefit of Membership: AaNA Member Name: ________________ E-mail:

____________________________ Informational E-mail

Dues Anchorage & Fairbanks

Monthly (*EDPP) Yearly

Full $28.00 $330.00

Reduced $14.25 $165.00

Special $7.38 $82.50

All Other Locations

Yearly Monthly (*EDPP)

$322.50 $27.38

$161.25 $13.94

$80.62 $7.21

__________________________________________________ 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!

Check—Please make checks payable to the American Nurses Association MasterCard or Visa—(available for annual payment only) ____________________________________ Card Number

_____/_____ $_______ Expiration Amount

Return application and payment to: AaNA 3701 E. Tudor, Suite 208, Anchorage, AK 99507

____________________________ Signature

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 Various Nursing Information—If you would like National, State and Local nursing information e-mails from AaNA on a weekly basis.

K Action Alerts—If you would like political action alerts for National and State legislative issues involving nursing and health care issues.

Taskforce E-mail Pools Taskforce E-mail Pool members will receive requests to work on a variety of projects on nursing issues, and may choose to participate in only the projects that interest them.

K Professional Nursing Practice Issues— Taskforces will consider issues relating to AaNA’s policy on RN practice and other professional issues.

K Health and Safety Issues—Taskforces will consider safety and health issues of nurses and patients.

K AaNA Event Planning—Taskforces will plan events such as the AaNA Fall Retreat, open house events, AaNA General Assembly, or other events for AaNA members.

K Other interest? Let us know what you would like to work on:______________

AaNA Committees

K Legislative Committee—Actively involved in reviewing and coordinating strategy and testimony for legislative issues related to health and nursing. Works closely with the AaNA Lobbyist. Usually meets on the second Monday of the month. Current Chair is Pat Senner.

K Conference Planning Team—Participates help plan the Alaska Statewide Nurses Conference.

Roles include working with program planning, marketing, vendor and sponsor recruitment and onsite assistance.

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

K Alaska Nurse Newsletter Editorial Board— Members work with the editor to recruit articles and pictures for the quarterly newsletter. The current editor is Lynn Hartz.

Return to: AaNA, 3701 E. Tudor, Suite 208, Anchorage, AK 99507 or fax (907) 272-0292 or e-mail aknurse@aknurse.org and tell us your selection.

Page 12—Alaska Nurse—November 2006

Board of Nursing News Alaska Board of Nursing Summary of 2006 Accomplishments Submitted by Board Chair, Cathy Giessel, MS, RN, ANP, FAANP The Board of Nursing issues annual reports every June, summarizing its work over the previous year. Here is a brief summary of highlights from the 2006 Annual Report.

• All Licensed Practical Nurse and Registered Nurse licensees can renew online.

• Fingerprint checks are now required for all new and reinstated licensees.

• Foreign educated Licensed Practical Nurse applicants must submit verification of passing an English proficiency examination.

• “Appendix C: Position Statement: Registered Nurse and Advanced Practitioner Scopes of Practice” was reviewed and re-adopted • Advisory Opinions were adopted entitled “Administration of Anesthesia by Registered Nurses” and “The Use of Controlled Substances for the Treatment of Pain by Advanced Nurse Practitioners” • Several facilities and nurse licensee individuals requested

additional scope of practice delineation. These were approved by the Board of Nursing based on review of credentials and training criteria established by the Board.

• The Board applied a standard of 80% NCLEX pass rate for educational programs, based on year-end figures published by National Council of State Boards of Nursing. The effective date was March 06 and was applied to first time candidates.

• Development and implementation of a listserve to communicate Board of Nursing information to interested parties was completed.

The Board of Nursing website is http://www.dced.state.ak.us/ occ/pnur.htm. At this website anyone can join the listserve, designed to disseminate information about meetings and agendas, as well as other news, for the Board of Nursing. Meeting minutes and other tools, such as Advisory Opinions, are also posted on the website. The Alaska Board of Nursing publishes Advisory Opinions regarding safe nursing practice, in accordance with AS 08.68.100(a)(9), for the purpose of giving guidance for nursing practice.

The Board recently completed interviews for a new Executive Administrator. Dorothy Fulton, Executive Administrator for more than 15 years, will be retiring at the end of December. We will miss her very much but she has promised to remain available to the new Executive Administrator for consultation.

ALASKA BOARD OF NURSING Nurse Consultant I The Alaska Board of Nursing is recruiting for the position of Nurse Consultant I, to serve as a specialist on chemical dependency issues, responsible for oversight of the Certified Nurse Aide registry program, and Associate to the Executive Administrator of the Board of Nursing. This position is located in Anchorage, AK. Requires excellent written and verbal communication skills, superior organizational and analytical skills. Must have AK RN license. BSN required—MSN preferred.

Apply online through the State of Alaska’s Workplace Alaska program.

November 2006—Alaska Nurse—Page 13

Spotlight Kodiak: Future Nurses of America

by Katherine Pascua (FNOA Secretary, 2005-2006) Kodiak High School These young enthusiastic high school students are members of the Future Nurses of America (FNOA) at Kodiak High School (KHS) in Kodiak, Alaska. The FNOA club is led by school nurse, Christy Kinter. FNOA provides high school students with opportunities to explore nursing and other health care professions and promotes student leadership. While members have the opportunity to explore the diverse career options in health care, FNOA members also complete and receive their CPR and First Aid cards. Upon joining the club, all members volunteer within different areas of the community meeting different healthcare professionals at the hospital and clinics.

FNOA helped the Kodiak Hospital Auxiliary raise money for their Scholarship Fund by selling angels at KHS. Angels were sold for in memory or in honor of someone special, and placed on a tree with their name. The FNOA tree was displayed in the KHS library with about 50 angels that the members had made themselves. This is an annual event sponsored by the Hospital Auxiliary during the Christmas holidays with their trees displayed at the hospital.

FNOA members were able to go to a local clinic and meet a visiting ENT physician to learn more about his profession. To raise awareness about Diabetes, the FNOA started the first annual School Walk for Diabetes at KHS, with all money proceeded to the American Diabetes Association. FNOA participated in putting together the first “Celebrating Kodiak’s Nurses” for Nurses Week in May. This was to honor all nurses within the Kodiak community who put their time and effort in helping others.

To raise money for FNOA, members had rummage sales through out the school year. Although FNOA has been an ongoing organization at KHS for only two years, it has become an asset to both KHS and to the Kodiak community. As the FNOA motto says, “Alone we can do so little; together we can do so much.” (Helen Keller)

Pictured here, Top, from left to right: Ralph Pasana, Angela Harris, Rosemary Martin, Stephanie Pasana, Katherine Pascua, Chassidy Dingus; Bottom from left to right: Manuel Rodas, Jennifer Albano. Not pictured: Charlene Navales, Jackielyn Valdez, and sponsor, Christy Kinter.

Page 14—Alaska Nurse—November 2006

AaNA/ANA News District I AaNA Update A planning meeting was held on October 11, 2006 to discuss the future direction of District I of the AaNA. District I is presently a formal group operating under the by-law structure.

Current open leadership positions include President, Treasurer, two Board Members and two Nominating Committee Members. AaNA members living in the Anchorage area are automatically voting members of District I. The question at hand is whether we should continue as a formal group with specific bylaws or transition to a less formal task force structure. A task force typically focuses on specific projects which are usually time limited. For example, such projects could include the Annual May Banquet, a new community service oriented project, or activities associated with the annual AaNA “Voices in Unity Conference.”

A survey is scheduled to be mailed soon to all District I members in order to obtain your input on this question. If you do not receive your survey copy, please contact the AaNA office. When completing your survey, please be sure to update your email address so we can notify you of District I future activities in a timely manner. We look forward to your input.

Survey results will be presented at the District I Action Meeting scheduled for January 16, 2007 at 5:00 pm at the AaNA Office.

Impaired Nurses: ANA has added to its website a new page to help impaired nurses.

The Impaired Nurses Resource Center page offers assistance not only to those nurses who have chemical dependencies, but to those who wonder if they might. It provides ethical guidance for the individual, regarding obligations not only to the patient, but also the duty one has to one’s self, as well. It offers

ethical guidelines, also, for co-workers who suspect a colleague of impaired practice.

Links are provided to ANA’s constituent member associations, many of which offer “peer assistance” or “alternative to discipline” programs in conjunction with the state boards of nursing, to which we also offer links. We have also included some of the exemplary programs offered by nursing specialties, with more to be added. Lastly, the new webpage offers dozens of links to resources for impaired nurses, including those organizations specializing in addiction and recovery, emphasizing programs for nurses. (www. nursingworld.org/impaired) October 3, 2006 American Nurses Credentialing Center (ANCC) Announces Introduction of New Specialty Exams The American Nurses Credentialing Center (ANCC) Commission on Certification (COC) will take a new approach toward developing specialty exams. Findings from recent role delineation studies revealed that there were not significant differences in the tasks and activities performed by the nurses, based on their initial educational preparation.

This means that one exam will be offered for nurses at the specialty level regardless of the nursing preparation. This approach will affect the following exams: • Cardiac/Vascular Nurse • Gerontological Nurse • Medical-Surgical Nurse • Pediatric Nurse • Psychiatric and Mental Health Nurse Role delineation studies are conducted at regular intervals in order to preserve the integrity of certification exams. Study findings provide objective, evidence-based assessment of the knowledge, skills and abilities required to practice competently in the specialty. A benefit of the current findings is that applicants will experience a streamlined process; this change will facilitate nurses’ application and eligibility process for specialty nursing exams, because only a valid RN license will be required to document completion of a nursing education program. There is no change

in any of the other eligibility requirements.

The first of the new specialty exams to be introduced will be the Medical-Surgical exam, January 1, 2007, with others being introduced according to a schedule to be determined. In addition to being introduced in the new form, the Medical-Surgical exam will also move from paper and pencil to computer-based testing format. This change will allow nurses to test year-round for medical-surgical certification, rather than waiting for the paper and pencil exams’ two testing windows in May and October each year.

The American Nurses Credentialing Center is a subsidiary of the American Nurses Association (ANA). Its web site can be found at www.nursecredentialing.org.

ANCC Announces Next Generation Nursing Certification Credentials The ANCC Commission on Certification (COC) announces the next generation certification credentials in concert with introduction of new specialty exams. (See attached communiqué: ANCC Announces Introduction of New Specialty Exams.)

Beginning today, all ANCC-certified specialty nurses will receive the credential RN-BC, defined as Registered Nurse, Board Certified; this replaces a differentiation between the RN,C and RN,BC credentials.

The next generation credential will be reflected on new certifications and renewals.

Effective immediately, all ANCC-certified specialty nurses may use the new credential for their professional documentation; however previously issued certificates remain valid and will not be replaced until renewal. The new credentials, signifying that all ANCC-certified nurses are board-certified, are meant to simplify, clarify and unify professional credentials. The decision to announce next generation certification credentials was based in part on feedback received from nearly 3,000 ANCC-certified nurses who participated in a survey, in which over 75% approved this change.

With the introduction of the new credential, there will no longer be a difference in credentials based on education. Now, all specialty-certified nurses will receive the RNBC credential. ANCC Director of Certification Mary Smolenski, EdD, APRN,BC, FAANP, CAE, said “The key message is that, as in other health care professions, you are either board certified or not. Consistency in titling contributes to building uniformity across health care professions, based on a common understanding of board certification.”

This communiqué is part of an on ongoing effort to review the credentials used in nursing certification. Studies are in progress on titling of ANCC-certified clinical nurse specialists and nurse practitioners.