The Alaska Nurse - Vol. 61 No. 4 - December 2011

The Official Publication of the Alaska Nurses Association Circulation 7,700 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska

Volume 61 • No. 4

December 2011

FYI— Health Reform Update

Page 3

Alaska Nurse Practitioner Association Names NP of the Year

Page 5

Members of the Alaska Nurses Association voting at the General Assembly chaired by Nancy Davis, President.

Quick Neuro Exam

Page 9

2011 AaNA General Assembly

by Donna Phillips, RN and Nancy Davis, RN Sunday, November 6th at the Alyeska Resort in Girdwood served as the venue for members of the Alaska Nurses Association (AaNA) to come together to debate changes to the AaNA bylaws and vote on resolutions that will guide the organization in 2012. We had beautiful fresh snow as the backdrop for the joining of nursing leaders, both new and seasoned, to express their opinions and offer direction to the incoming Board of Directors. There were nearly 40 members in attendance and we had over a dozen members attending via teleconference.

The General Assembly is the annual opportunity for conducting the business of the Alaska Nurses Association. The members attending have the opportunity to speak on bylaws changes and resolutions, and to celebrate the outcome of the annual elections for the Board of Directors and the Labor Council. The General Assembly is for the membership to set the direction for their Association for the coming year.

The bylaws debate this year was a great opportunity to educate members regarding the structure of the AaNA, which has a labor union inside the broader structure of the professional organization. The debate on bylaws changes was spirited and earnest as changes in Article VIII

governing the Labor Council within the AaNA were the most significant. The changes in Article VIII alter the previous structure of the Association providing more autonomy for the Labor Program.

Despite some complications the structure has brought to leaders, the desire to stay united remained steadfast. We are stronger together than as separate entities.

The bylaws committee was appointed by the Board of Directors to review the entire document.

The Labor Council had submitted changes to Article VIII in late August. Nancy Davis, Pam Embler, Donna Phillips and Debbie Thompson, Executive Director, met for a final review at the end of September. The document was then posted on the AaNA website, www.aknurse.org for all members to review prior to the debate at the General Assembly. Some great questions arose from the review by members. We were able to make some further necessary changes to enhance the document from the floor of the Assembly. The changes can be summarized as follows: • If a district nurses association is unable to maintain the necessary bylaws requirements, they can convert to a task force. They will then be required to have an annual event to benefit the nurses of that geographical area.

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2011 AaNA General Assembly continued on page 4

Update – RN to BS Program at UAA Elizabeth Campbell and Dianne Toebe

Did you know that an RN can get a BS degree in an all online program at UAA? Students take nursing courses online and participate weekly at times convenient to them. There are no formal, synchronous classes to attend in person or online.

The courses are asynchronous which means that at no time are students required to be online all at the same time. The courses require online participation in Discussion Boards where you post your response to readings and to other students’ posts. This is done whenever your time permits during the week that a module is available. There are quizzes that you take online over the material in the module. Each course has written assignments and sometimes PowerPoint presentations to give that help students to interact with the course material.

RN to BS Program continued on page 13

Inside This Issue President’s Message. . . . . . . . . . . . . . . . . 2 Home Emergency Preparedness . . . . . . . 3 ANF Grants Funds . . . . . . . . . . . . . . . . . 4 ANPA Annual Conference 2011 . . . . . . . 4 Alaska Drug Take-Back Program Total. . 4 Nurses in the News . . . . . . . . . . . . . . . . . 5

Heart of the Alaska Nurse . . . . . . . . . . . 6 JCAH Sentinel Event . . . . . . . . . . . . . . . 12 March of Dimes Awards . . . . . . . . . . . . 12 Resources . . . . . . . . . . . . . . . . . . . . . . . . 14 Upcoming Events. . . . . . . . . . . . . . . . . . 15 Letter to the Editor. . . . . . . . . . . . . . . . . 15

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

Page 2 • Alaska Nurse

December 2011

Author Guidelines for the Alaska Nurse The editorial committee welcomes original articles for publication. Preference is given to nursing and health related topics in Alaska.

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

Format and Submission Articles should be 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 jpg. 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. Photos should be provided with a caption and photo credit info and be high resolution. 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 lhartz@alaska. com. 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 to Editor, AK Nurse, Alaska Nurses Association, 3701 East Tudor Road Ste 208, Anchorage, AK 99507. If you have any questions email the Editor, Lynn Hartz at lhartz@alaska.com.

President’s Message Greetings! I am proud to be addressing all of you as your newly elected President of the Alaska Nurses Association. I am proud to be a leader in your organization together with some of the best nurse leaders in Alaska. To that end, I am pleased to announce two appointments to vacant seats on the board of directors. Mary Stackhouse has been appointed to Vice President and Julie Eib has been appointed to Director-at-Large. Both nurse leaders are also Labor Council members, with Mary being one of the original charter members. Collectively, your board of directors is a voice for all members.

I encourage you to visit the AaNA website for

a complete listing of board members and their contact information. Please contact any of us with your questions, items of interest or concern.

Remember, we are here to serve you, the nurses of Alaska.

I would like to explain to our members the process we used to seat your newly appointed members to the AaNA Board of Directors. The bylaws as stated do not outline a clear and distinct process. Arbitrarily seating persons by virtue of having a present board seat or reverting to a President’s Message continued on page 4

Wishing a n o p u star?

Finding meaning in your work is more than fate. It’s Providence.

An official publication of the Alaska Nurses Association, 3701 East Tudor Rd., Ste. 208, Anchorage, AK 99507. Tel: 907/274-0827. Web site: www.aknurse.org. Published quarterly every March, June, September and December.

Materials may not be reproduced permission from the Editor.

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Editor: Lynn E. Hartz, MSN, FNP lhartz@alaska.com AaNA Board of Directors President: Pam Embler, MSN, RN Vice President: Mary Stackhouse, RN Secretary: Michelle L. Marshall, MSN, RN Treasurer: LeMay Hupp, RN Directors: Labor Council (designee): Donna Phillips, BSN, RN Rural Director: Susan Walsh, RN Greater Alaska Director: Linda Worman, D.M., RN, PHN Staff Nurse Director: Jennifer Hazen, RN Directors at Large: Stacy Allen, RN Patricia Barker, BSN, RN Julie Eib, RN Rhonda Richtsmeier, RN, MN, NEA-BC Student Nurse Liaison: Sarah Van Abel AaNA Labor Council Chair—Donna Phillips, BSN, RN Vice-Chair—Deni Callahan, BSN, RN Secretary—Joe Peacott, RN Treasurer—Colleen Bevans, RN Directors: Julie Eib, RN Lila Elliott, BSN, RN Janet Hilleary, RNC Mary Stackhouse, RN PAMC BU Rep.—Joe Peacott, RN Soldotna BU Rep.—Velinda Albrechta-East, RN Ketchikan BU Rep.—Susan Walsh, RN Affiliate Organizations: Alaska Chapter of the American College of Nurse Midwives Alaska Home Health and Hospice Association Alaska Nurse Anesthetists Association Alaska Nurse Practitioner Association Alaska School Nurses Association Forensic Nurses Association, Alaska Chapter Executive Director: Debbie Thompson, BSN, RN, CNOR For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. 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.

Acceptance of advertising does not imply endorsement or approval by the Alaska Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. AaNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of AaNA or those of the national or local associations.

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December 2011

FYI - Health Reform Update

by Candice Hughes, RN, Contributing Editor

The Patient Protection and Affordable Care Act, also referred to as the Health Care Reform Law was signed by President Obama on March 23, 2010. The law will result in comprehensive health insurance reforms that began in 2010 but with most taking effect in 2014. Listed below are a few key changes that have already taken effect: • Expanded young adult coverage: Prior to the Affordable Care Act, insurance companies were able to remove enrolled children typically at the age of 19 or later if the child was enrolled in college.

Now if a person’s health insurance covers children, they may add or keep their children on their Candice Hughes insurance until they turn 26 years old even if they are married, do not live with their parents, are not financially dependent on their parents, and are eligible to enroll in their employer’s health insurance plan. The goal of this legislation is to make health insurance easier to obtain and more affordable for young adults. In 2011, an estimated 1.2 million young people gained health insurance under this provision.

• Free preventative care: The new law mandates that private health insurance plans are now required to cover evidence-based preventative services without charging a deductible, co-pay, or coinsurance. Examples of these services include regular well-baby and well-child visits from birth to age 21, routine vaccinations, cancer screenings such as mammograms and colonoscopies, and blood pressure, diabetes, and cholesterol tests. This provision applies only to people enrolled in job-related or individual health insurance policies created after March 23, 2010. Medicare recipients are also eligible for free preventative services with certain restrictions.

• Prescription drug discounts for Medicare recipients: Medicare recipients who reach the coverage gap (also referred to as the donut hole) will be eligible for a 50% discount when they purchase Part D covered brand-name prescription drugs and a 7% discount on generic prescription drugs. By 2020, the coverage gap will be closed with Medicare recipients receiving additional savings on both brand-name and generic drugs.

Twenty-seven states, including Alaska filed a lawsuit challenging the constitutionality of the law. So far it has been upheld by three out of four appellate courts and is scheduled to be reviewed by the Supreme Court in March of 2012. We will continue to report updates on this important issue. www.healthreform.kff.org www.healthcare.gov www.consumerreports.com

Alaska Nurse • Page 3

Home Emergency Preparedness for the New Year LeMay Hupp, R.N., Coordinator, ALASKA RESPOND As winter continues and the new year has arrived, it’s a great time to accomplish tasks in the home. Looking over your emergency supplies and your Home Preparedness Plan should be one of those jobs. It truly is a process of reviewing, revising and restocking. Have you considered taking time to program your cell phone? It could be an excellent safety tool.

• Do you have personal emergency contact numbers listed? ICE (In Case of Emergency) • Emergency daycare or school numbers • If found, please call...

• List medicines and / or medical conditions / allergies • Photos of loved ones and pets • Non emergency local numbers for police, fire • Meeting points near home, work or school • Shelter in place information Sharing all of this with your family is an excellent way to update everyone. If you need help, here are some good resources: 1. www.ak-prepared.com 2. www.ready.gov 3. www.alaskaredcross.org/disaster_services.php And for additional information on disaster planning and preparedness, you may want to consider joining the ALASKA RESPOND, the data registry for volunteer medical professionals. You will receive educational notices and training on related topics. Go to www.akrespond.alaska.gov to read more or sign up!

References

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Page 4 • Alaska Nurse President’s Message continued from page 2 person who held a seat in the past seriously limits potential exceptional nurse leader candidates for your organization. As President I outlined a fair, equitable, and majority agreed upon process for board appointment to vacant seats. I charged members of the board to solicit interested persons consenting to serve in the vacant positions and to provide a bio for contemplation. After a period of review by board members and at the close of discussion, the board members were called upon to submit, via secret ballot, their choice of candidate. We welcome our new members.

I encourage all of you as well to be a part of your organization whether you are one of the represented nurses or one like myself who is not part of the bargaining unit but who belongs to join my voice with other like-minded professional nurse voices. This is your nursing organization.

Join me, and come to board meetings held every second Tuesday of each month at 5:30pm at the AaNA office. Not local? No worries, join us via teleconference at 800.276.2576. Become a part of the Alaska Nurses Association and chart the future!

Best wishes in the New Year.

Thank you, Pam Embler, MSN

2011 AaNA General Assembly continued from page 1 • Changes to committee structure to make current with our practice • The Labor Council (collective bargaining arm) will now have autonomy for their staff.

• A member can now request a second ballot if they did not receive one in the mail. There are safeguards to assure no duplicate voting.

• The General Assembly will no longer need to be tied to the election of officers.

We had professionals to record minutes and Theta Pittman, a fabulous parliamentarian, that kept us on track as we had motions and amendments to motions to consider. General Counsel Chuck Dunnagan was present to address members questions on legal aspects of bylaws changes. We had speaker microphones that assured speakers could be heard throughout the meeting area. Our turnout was the best in many years in spite of the large snow fall. It is the hope that leaders will continue to engage members in this extremely important annual meeting that guides our organization.

General Assembly was preceded by a full day of lectures at the Fall Retreat Continuing Education Program on Saturday, November 5th at Alyeska Resort. Attendees were treated to a full day of interesting and stimulating topics and speakers that engaged the learners in interactive exercises and group discussion. Speakers included Lemay Hupp, Bethany Buchanan, Linda Nelson, and Debbie Thompson. The opportunity to learn with nurses from across the state was both valuable and fun. The topics included disaster preparedness, Vitamin D and new research, alternative therapies in women’s health, and moral distress for nurses.

Attendees went away wanting to learn more and filled with new ideas and information. The discussion on moral distress brought to light the impacts of the many human dramas nurses witness and experience in our demanding but rewarding profession.

A thank you goes out to Executive Director Debbie Thompson and Christine Ryan Eldridge, the Association Administrative Assistant, who arranged and organized an excellent meeting at Alyeska Resort for our 2011 General Assembly.

[Donna Phillips is the Chairperson of the AaNA Labor Council and Nancy Davis is the now past President of the Alaska Nurses Association as Pam Embler was announced as the new President at the meeting.]

December 2011

Alaska Nurses Foundation Grants Funds The Alaska Nurses Foundation funded two $500 grants in November 2011. Masayo Nishiyama received funding to partially defray costs associated with completing a Public Health Management Certificate Program through the University of Washington. A second grant was awarded to Pamela Embler to partially defray expenses associated with completing her dissertation research at the University of Tennessee; Ms. Embler will be conducting a study entitled Culture Care Expressions: Meanings, Patterns, and Practices Related to End of Life Care.

Both grant recipients have promised to eventually share some of their lessons learned through a future issue of the Alaska Nurse.

Grant awards were smaller than in previous years because the Foundation is still recovering from the stock market crisis of 2008. The Board has agreed that funds will not be withdrawn from

the investment account unless that fund holds $90,000 or more; on September 30, 2011, the fund contained only $84,971. However, that amount is nearly $25,000 more that the account had at the peak of the stock market crisis in March 2009.

Managing the investment account in this manner will ensure that the Foundation is able to fund small grants well into the future.

Awarding only a total of $1,000 in grants in 2011 did not require that any money be withdrawn from the investment account. The grants were only possible because of the generosity of Alaska nurses who joined or made monetary contributions to the Foundation. If you are interested in joining the Alaska Nurses Foundation, you can do so by sending your dues of $20/year to the Alaska Nurses Foundation, P.O. Box 244471, Anchorage, AK 99524.

Alaska Drug Take-Back Program Total (ANCHORAGE, Alaska, 11/4/11)—Just under 1,900 pounds of prescription medication was collected in Alaska during the third Drug Enforcement Administration (DEA) National Prescription Drug Take Back event in October 2011. Nationwide (188.5 tons) of drugs came out of homes and was turned over for proper destruction.

Last Take Back Day, April 2011, Alaskans turned over 1,603.6 pounds of prescription drugs.

Until a safe disposal process for prescription medications is established nationwide, the DEA will continue to partner with agencies like the Alaska State Troopers to hold Take Back Days every six months. The Alaska State Troopers would like to thank the DEA along with the Alaska National Guard Counterdrug Support Program, the U.S. Department of Justice, Anchorage PD, Joint Base Elmendorf-Richardson, Veterans Affairs Police, Juneau PD, Sitka PD, Petersburg PD, Valdez PD, North Pole PD, Craig PD, Skagway PD, Soldotna PD, Kenai PD, Hoonah PD, Seward PD and the Mayor of Juneau for their efforts. Also, a special thanks to Fred Meyer and to all the volunteers from across the state that stepped up to assist with collecting medications. The event wouldn’t have been possible or successful without the enormous effort put out by the volunteers and private agencies.

More than seven million Americans abuse prescription drugs, according to the 2009 Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health. Each day approximately 2,500 teens use prescription drugs to get high for the first time according to the Partnership for a Drug Free America. Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet.

Four days after DEA’s first Take-Back Day event September 25, 2010, Congress passed legislation amending the Controlled Substances Act to allow the DEA to develop a permanent process for people to safely and conveniently dispose of their prescription drugs. After President Obama signed the Safe and Secure Drug Disposal Act of 2010 on October 12, DEA immediately began developing regulations for a more permanent solution.

In all, there were 34 locations in 27 communities around Alaska who participated in the event during October 2011. Communities participating in the event were Anchorage, Aniak, Bethel, Dillingham, Emmonak, Fairbanks, Girdwood, Glennallen, Hoonah, Juneau, Ketchikan, Klawock, Kodiak, Kotzebue, McGrath, Nome, North Pole, Palmer, Petersburg, Seward, Skagway, Sitka, Soldotna, St. Mary’s, Talkeetna, Valdez and Wasilla.

To view the DEA’s national release on the Prescription Drug Take-Back Day, go to http:// www.justice.gov/dea/pubs/pressrel/pr110311.html (December 9) New Flash! There is now a prescription drug collection box in the lobby of the main police station in Anchorage at 4501 Elmore for your patients to dispose of their medications with plans for two additional sites in Anchorage in the near future. For sites outside of Anchorage, call the state troopers for information.

ANPA Annual Conference 2011 The Alaska Nurse Practitioner Association held their 28th Annual Conference at the Anchorage Marriott September 15-17, 2011. Some 150 nurse practitioners were in attendance. The keynote speaker was Mimi Secor who gave a motivating, entertaining and informative presentation about nurse practitioners in the media. Mimi is a very popular national speaker, clinician, consultant and also the host of radio show: Partners in Practice on Reach MD. Janet Selway, the current president of the American College of Nurse Practitioners offered a presentation "Federal Legislative Update for Nurse Practitioners" which provided valuable information about the role of nurse practitioners in national health care policy.

Janet was also able to enjoy some sightseeing during her first trip to Alaska and visit a nurse practitioner owned practice which she

has written about in the president's update for the next issue of "The Journal for Nurse Practitioners."

Nurse Practitioners from all across Alaska and a number of the lower 48 states also enjoyed presentations on primary health care, pediatric topics, women's health, psychiatric nursing and nurse practitioner practice in Alaska. Additionally workshops were offered in basic suturing and basic EKG reading. The conference offered a wonderful opportunity to update clinical knowledge and network with colleagues. We look forward to the 29th annual conference, September 20-22, 2012.

December 2011

Alaska Nurse • Page 5

Notice

Nurses in the News Alaska Nurse Practitioner Association Names NP of the Year

photo by Barbara Abair, RN, ANMC

From left: Frank Sacco, MD, Chief of Surgery, ANMC, Rachelle White, RN, Bethel, Donna Zeznock, RN, ANP, award recipient, and Nancy Sanders, Executive Administrator, Alaska Board of Nursing.

Donna Zeznock, RN, FNP-C, ANP was honored as the Northwest Wound Ostomy Continence Nurse of the Year at the September Northwest WOCN conference. Five states are in this organization: Washington, Oregon, Idaho, Montana and Alaska.

Ms. Zeznock was presented with a crystal vase.

The Wound, Ostomy and Continence Nurses Society™ (WOCN®) is a professional nursing society that supports its members by promoting educational, clinical, and research opportunities to advance the practice and guide the delivery of expert health care to individuals with wounds, ostomies, and incontinence.

At last September’s ANPA Conference in Anchorage, Lois Rockcastle received the 2011 Alaska Nurse Practitioner of the Year Award.

Lois received her B.S. from Alfred University and her M.S. as a family nurse practitioner from the University of Rochester. She has lived in Alaska since 1992, spending her first ten years in Bethel. For the last 19 years, she has worked for the Yukon-Kuskokwim Health Corporation. In addition, she currently works parttime at North Star Behavioral Health and is an adjunct clinical faculty member at the University of Alaska Anchorage.

Lois is a past president of the Alaska Nurse Practitioner Association and has participated on the conference committee for many years. From 2006 to 2010 she was a member of the board of directors for the American College of Nurse Practitioners. She resides in Eagle River, Alaska with her husband, Dr. Eric Noble and their two teenage children, three Icelandic horses, one cat and 16 dogs!!

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Governor Parnell appoints Lavern Valdez to the Board of Nursing News Release 11/19/11—Lavern Valdez, LPN, of Fairbanks, is the assistant administrator and nurse manager for Caring Bridges Assisted Living Home, where she has worked since 2004. Prior to that, she worked as a nurse for the Fairbanks Veterans Affairs clinic and as a nurse consultant for Developmental Disability Resource of Lakewood, Colorado. She earned her degree from Southern Colorado University and is appointed to the seat for a licensed practical nurse. Ms. Valdez’ name will be submitted to the legislature for confirmation.

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Juneau Assembly Appoints Davis to Hospital Board November 16—Nancy Davis, MSN, RN, most recently President of the Alaska Nurses Association, was appointed to the Bartlett Regional Hospital Board for a three-year term.

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Page 6 • Alaska Nurse

December 2011

Heart of the Alaska Nurse

By Marianne Schlegelmilch Who is the Alaska Nurse?

Underneath the titles and the hard won credentials, who is the person who makes up the Alaska Nurse?

In this series, Heart of the Alaska Nurse, we will meet some of the women and men—both young and old—working, retired, or still students— who form the unique and always interesting ranks of caregivers who are the Alaska Nurse.

Summer Cutting BSN, MSN, DNP Summer Cutting is a wife, a mother, an avid runner and a passionate gardener. She is also a humanitarian, a nurse and a doctor, having recently achieved the hard-won degree of Doctorate in Nursing Practice.

Cutting, far right, working at the Alaska Sudan Medical Project in Southern Sudan where she has volunteered with her husband since 2008.

Summer Cutting grew up in Eagle River, Alaska.

Inspired by Lila McEwen, one of the first nurse practitioners in the state (bearing the license number 10). As Summer tells it: For me, Lila was an inspiration. I saw a woman who loved what she did as she cared for people with a grace and love like my family had never experienced. Lila has now been a NP in Alaska for well over 30 years. Little did she know how she

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planted a seed in me, just by fulfilling her calling and giving our community her gifts of health.

As the seed for providing health care grew within Summer Cutting, she began to explore many aspects of the health care profession, ruling out becoming a physician early on. When a wise mentor asked her if she had ever considered becoming a nurse practitioner, she describes how a light within her was lit.

I changed my major to nursing and at 18 years old set lofty educational and career goals for myself that I refused to let anything discourage.

By 21 years old, I completed a Bachelor in Nursing and by 24, a Master in Nursing as a Family Nurse Practitioner.

In the course of her evolution as a nurse with a higher calling, Summer spent two summers on the North Slope of Alaska working with Alaska Native populations as a public health nurse and doing thesis research. She also works at the Alaska Native Medical Center in the Family Medicine Clinic.

For 10 years, she has been involved with the Alaska Nurse Practitioner Association and has advocated for nurse practitioners on a policy making level. In 2009, she was rewarded for her efforts by her colleagues when she was awarded the Nurse Practitioner of the year award—for her, an especially poignant recognition since many of those in the association had contributed to her own professional growth.

Summer spent two years in between having children and attending swimming and soccer lessons to obtain her latest degree—a Doctorate in Nursing Practice from Chatham University. Now approaching her mid-thirties, one can only wonder what else this highly motivated and accomplished woman can achieve, which takes us back to one of her basic passions—her garden. Summer is so passionate about gardening that she writes: Nothing gets me more excited than talking about food—growing food, local food, organic food and eating food . . . I love to talk about gardening and use my home and yard as a resource for educating people about how to feed their own families . . .

I am passionate about teaching people how to live healthy, balanced lives.

With this simple statement, it is easy to realize that the nurse in Summer Cutting is fully a part of who she is as a person. Perhaps that is why she, along with her husband, Andrew, have made numerous volunteer trips to Jonglei State, an extremely remote part of Southern Sudan long ravaged by war and disease. There they have been involved with the Alaska Sudan Medical project since 2008. The Project was founded by Jill Seaman, MD, in the early 1990’s after Doctor’s Without Borders had left the area. Seaman, a MacArthur Fellow, lives in Bethel half the year and in the Sudan the other half. It is here that Summer tries to make the biggest difference, where sometimes despite the best attempts under the worst conditions, the heartache of loss might deter many of us from facing such devastation again—a place where Summer displays an even greater passion than she does for fitness and gardening— passion for the basic survival of life. Summer writes: While in Sudan, I cared for a young boy, probably 6-7 years old, who was admitted to

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the clinic for high fevers. We had no idea upon admission what was causing his fevers, and he quickly began to deteriorate. Because we don’t have the option of laboratory work or radiology, treatment decisions are primarily based upon direct evaluation. Under the guidance of Dr. Jill Seaman, we treated him for Malaria, Kala Azar, Tuberculosis, Measles and multiple other endemic illnesses. I even drew blood from one of the doctors on our team and transfused it into the child, hoping to overcome his profound anemia. I cared for him for two weeks, and in my Western mind, had hope that as a young child he should recover. I found out shortly after I left that he died.

Cutting, in a red shirt, working in the Alaska Sudan Medical Project established by Jill Seaman, MD, from Bethel.

I was greatly moved by this experience because it occurred to me that with the most basic of preventative care—Measles immunization, Tuberculosis screening, and mosquito nets to prevent insect bites which lead to Malaria and Kala Azar, this child would likely never have become ill. It is horribly sad that we didn’t have the resources to treat his profound, acute illness, but even sadder that we could not provide the most basic of inexpensive preventative care that would have prevented his illness altogether.

Which again takes us back to Summer’s basic tenet of the importance of food, nutrition and activity as the foundation of life. In her words: The simple joy of seeing clean water pour out of a newly sunk well or providing immunizations to a small child to prevent death from Measles brings one back to the heart of nursing and the core of why we embrace its calling. In its purest form, nursing is about making a difference in the lives of people so they have hope for a better tomorrow.

Like most nurses, Summer Cutting has achieved excellence in nursing by following her passion, for nursing is not just a job or a career choice or a way to generate income. Like Summer Cutting, real nurses, true nurses—no matter what level of education they achieve, follow an inner need to help their fellow man—to make a difference by enhancing and preserving the quality of life of those entrusted to their care. As Summer points out, in Alaska, nurses—and nurse practitioners in particular—are a vanguard for the nation.

As nurses, and particularly as Nurse Practitioners, we are so privileged to live and work in Alaska, where we enjoy a broad scope of practice. That broad scope allows us to be at the forefront of advanced practice policy and scope nationally. As Alaska NPs, we have set a standard of care that has improved accessibility and choice in care, as well as proven safe and desirable to patients.

Throughout the country others look to our model as an example. With great privilege, comes great responsibility. We each need to stay informed and get involved in nursing issues, vehemently protecting those privileges so that in the next 30 years, there will be dozens more who will plow new paths and leave behind a legacy much like the one Lila did for all of us by finding her niche, following her calling, and by living out the heart of nursing.

It goes without saying, that Summer Cutting, BSN, MSN, DNP has taken up the torch and will be instrumental in carrying the already innovative and exciting field of Alaska nursing brightly into the future.

December 2011

Alaska Nurse • Page 7

Heart of the Alaska Nurse Continued

Donna Fenske FNP From providing public health care to the lower Kenai Peninsula for 32 years, to founding health fairs on the lower Kenai Peninsula that have now become international, to writing grants for village education of all ages—whenever the healthcare needs of Homer, Seldovia, Nanwalek, Port Graham, and all points in between are mentioned, the name Donna Fenske comes up. In looking at her resume, Donna Fenske has taught nursing, practiced nursing, increased her education incrementally in nursing, and by all accounts excelled in nursing.

If there were ever a category for super nurse, Donna would surely be a top contender. It seems that if there is an unmet need in health care, Donna is there to help get the need met. And in talking with her, getting any given need met means not only identifying it, but also assembling the key players who will be affected by the plan in order to write the best grant possible to cover their needs—a process she lovingly embraces as she considers cultural, economic and logistical matters at hand in her work with mostly Alaska Native populations.

Just keeping up with her travels by email has been exhausting, for Donna Fenske is the epitome of the “can do” person. It is almost as if she is a legend in her own time. No wonder that with each tidbit of information I learn about her, I eagerly await more.

Recently, I met with her and asked her a few questions designed to draw out her inner nurse.

Following are some of those questions and her answers. From these snippets of her life’s story, join me in getting to know this dedicated Alaska Nurse.

If one were to ask Donna Fenske what drives her need to excel in nursing, what would she say?

I’m very energetic. I don’t need much sleep. I’m always thinking. I’ll see a need and I’ll think, how can I make this happen? Helping others, caring, love of being a nurse and a need to keep current in order to improve and be a competent health care provider—each of these, her own words, drive her need to excel in nursing.

What is it that first lit the fire of excellence inside you? That made you want to keep learning and keep reaching out and keep trying new things.

As she tells it: I always enjoyed public health. When I got to Alaska, I wanted a job where I could fly. As a single mom, I drove up to Alaska in 1974 with my children, then ages 10, 5 and 2 in an old VW bus.

Seeking out work in public health seemed like the best way to both fly and do the kind of nursing I loved. I have loved the people and the village work since I started working with the State of Alaska Public Health Service in 1979. (Prior to that she worked at Alaska Native Medical Center, AaNA, AMU, and UAA).

When I made my first visits to the villages across Kachemak Bay, I knew this was where I was supposed to be. I have totally loved the people and the village work. To me, the village people are not just patients, they are my friends and I care for them like family. They are wonderful.

Eventually, Donna became co-owner of a Maule tail dragger plane. Its large balloon tires allowed her to land on beaches, gravel bars in rivers, at abandoned mines and canneries and other locations otherwise not easily accessible.

During our talk, I asked her to tell me some of the pioneering things (besides flying her own plane)

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that she has done in her role as a nurse and nurse practitioner?

I identify needs and then try to think of what works in the communities and for the age and for the people. For example, teen nights with pizza and dessert were extremely successful. There, colleagues would join me as we talked about disease prevention, and health promotion topics— presenting information that was relevant to them, educational games, as well as having fun while learning. I can’t remember all the classes I have developed and taught over the years—Lots!

In all the work I do, the basic philosophy of compassion, caring and going the extra mile has always been very important to me, as well as accepting people the way they are in their beliefs and lives. It is critical to always be positive, respectful, and culturally sensitive while helping others. I learned this beautiful, inspiring song by Brooke Medicine Eagle at a wellness class I took in Seldovia a few years ago:

Spirit lend me your voice, Teach me what I should know, Show me how I should live To walk the medicine way.

I would take every opportunity to find grants, in order to develop special projects, classes, or presentations, for all ages in the communities. For example, when developing parenting classes, I would involve elders, leaders, and parents in the planning to assure that cultural and traditional ways were integrated into the sessions. There were numerous grants that I wrote over the years to enhance health and wellness for the people that I serve.

I have also implemented health fairs and seen them grow internationally through Rotary. It started years ago in the Homer office of Dr. White where the first health fair was held, then it moved for two years to the Homer Methodist Church before being presented to and embraced by the Donna Fenske FNP continued on page 8

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Page 8 • Alaska Nurse

December 2011

Heart of the Alaska Nurse Continued Donna Fenske FNP continued from page 7 local chapter of Rotary. From there it has become both a local and an international success.

Indeed, the health fairs have become one of the crown jewels in the work done by Rotary both in Alaska and in Russia.

I am often asked by Rotary to do presentations on health, prevention, working in the Bush, etc. for visiting dignitaries—for example, a Russian delegation that visited Homer in 2011. The health fairs in the villages have been very successful and almost everyone attends. I implemented and now organize and coordinate the Ladies Gathering in Seldovia, which is in conjunction with the annual health fair (43 women in this small community of about 300 people attended last year, although about 15 of them were from other communities) I do a presentation as a radio announcer and we have great presenters, skits, and lots of fun and laughs.

And, one important legacy that Donna fails to mention is the institution of the CERP (now CEARP) program for nurses in Alaska and her role of being only the second nurse in Alaska to begin assessing the continuing education needs of nurses in Alaska—a role she took on from 10/1975-5/1976 [1] and during which she traveled throughout Alaska explaining the CE program, assessing the CE needs of Alaska nurses and starting a record keeping system for RNs throughout the state. And, she continues: My research with TRMA/TRADD was very rewarding.

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to pack her supplies and walk. She remembers carrying her things in a backpack during one of those times, along a mountain trail to get to the next village.

Actually, it was so peaceful (albeit challenging in places; Bonnie and I are going to walk it this summer).

You cannot pull a sled there, but can within Seldovia and other villages— usually I take a backpack. I travel with LOTS of stuff—just ask the pilots!

As I finish my talk with Donna, standing on the deck of her office overlooking Kachemak Bay, she once again pulls out the giant Valentine card given to her recently by the people in one of her villages. She smiles as she reads me the tender thoughts of those who love her like family, and tears form in her eyes as she describes her ongoing efforts to continue service to her people. She reads a few of the precious words written on the card by some of the families and individuals: Thank you very much for the love you’ve shown to the community.

Donna Fenske pictured overlooking Kachemak Bay in Homer.

Indeed, when talking to Donna about her research and work with the rare genetic condition known as Thiamine Responsive Anemia, Deafness, Diabetes (TRADD), one can clearly feel her commitment and passion for her work—something she undertook in her role as a FNP and inspired by her instructor, role model and mentor, Dr. Barb Berner.

She readily produces her ¾ inch thick thesis upon which she just as proudly places the giant Valentine card signed by all the residents in the small village where this rare autosomal variant occurs. The village has the largest number of people carrying this trait of the 70 known people on earth with the condition.

Donna Fenske is fully committed to her work and is undeterred by nuisance obstacles that keep her from her patients. As her friend, public health nurse Bonnie Betley points out, where she would turn around and go home because there is a power outage in a village, Donna Fenske will use a flashlight until the battery goes dead and then she will use her otoscope to provide enough light to see. Where plumbing conditions are sub-standard and cleanliness sub-optimal, Donna Fenske will get down on her hands and knees and clean, or she will improvise however she can.

It is not unheard of for her to answer the door to a villager while still in her pajamas because she has not yet had time to get up and get ready for work on some early morning during a village visit. If she needs to get from village to village and does not have a ride—such as conditions that do not allow planes to fly—she has been known

God grant you many years.

Without you my heart wouldn’t be beating. I love you always.

Thank you for all the wonderful things you have done for our village—you are a true angel.

And from an eight year old boy: Thank you for saving my life when I got a cut on my head and you stitched it up.

Donna describes the mutual trust, respect and caring between people in the villages and herself. There is no talk of retiring or even of slowing down. To the contrary, she shares her ideas for the future—new concepts, new questions, new problems to solve and new ways to solve the problems creating roadblocks to the as yet unanswered questions.

Suddenly, you want to hug her as if to give strength to her resolve. For a moment she waffles as if there is a smidgeon of doubt that she will figure out her next approach. Then she shrugs and you shrug and you both laugh, knowing full well that this woman named Donna Fenske is a nurse and if there’s one thing that nurses do well, it is to solve problems—not only solve them, but have the ability to first identify them and then take them on head first with all the heart of a true Alaska Nurse.

Reference: (1) AaNA History 1951-1976 (25 years Anchorage scrapbook) 1977-2003 (information gathered to add to scrapbook) General History/Membership/ Admission of Districts

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December 2011

Quick Neuro Exam

By Mary Margaret Hillstrand DNP, ANP The purpose of this article is to provide “pearls” for providers who need to perform a quick neuro exam.

This format is not intended for use with an unconscious patient. Many nurses and nurse practitioners start to twitch and tremble when faced with patients who have disorders of the central nervous system (CNS). A Mary Margaret common concern among Hillstrand providers trying to identify a central nervous system disorder is “What if I miss something?” One way to diminish uncertainty is to develop a pattern in your neurological examination and follow the same routine each time. You will be more likely to identify abnormal signs and symptoms after you have performed many normal exams.

The first item to determine is whether or not there is a neurologic problem. Patients may describe symptoms such as numbness, headache, tingling, weakness, coordination problems, tremor, dizziness, imbalance or visual disturbances that may be due to a metabolic or systemic problem. It is important to evaluate the individual’s basic health status first.

Diabetes, hypertension, cardiac, pulmonary and renal diseases are all issues that must be identified and addressed first.

Few interventions will be effective unless an individual maintains good sleep hygiene, regular eating patterns, adequate water intake and regular exercise. These health maintenance activities seem like common sense, however, many individuals do not incorporate these into their daily schedule. These four activities are important for general health and essential for brain health.

The brain cannot store “food” efficiently and when individuals skip meals they may be irritable, tired, tremulous, have near syncopal episodes or even pass out. The most common cause of headache is dehydration. Diabetes and excessive alcohol consumption are responsible for 80% of neuropathies.

Vitamin deficiencies such as B12 levels less than 400 pg/ml may cause peripheral neuropathy in some individuals. Recent research has been published regarding symptoms associated with Vitamin D deficiency. Individuals with vitamin D deficiency may have symptoms ranging from mood disorders to generalized pain. Pain is also common in individuals who do not maintain normal muscle tone such as with regular exercise. Memory problems, confusion and irritability can be caused by irregular or lack of restorative sleep.

HISTORY: Detailed descriptions of the patient’s signs and symptoms are an essential part of the history. Patients with physiologic or organic CNS disorders may have difficulty describing their symptoms because the patient’s sensations or abnormal movements do not always correspond to a specific organ system or body part. As always, the “chief complaint”—the patient’s primary concern— is documented first. This issue must be addressed throughout your report. Additionally, include any modalities that improve or worsen their symptoms.

Review medications or interventions the patient has already tried. Your diagnosis or impression and plan of care with follow-up must include actions that apply to the patient’s chief complaint. As the provider, you understand the physiology and it’s your responsibility to interpret the patient’s symptoms into actual physiological causes. Sometimes a patient may need prompting questions to clarify their signs and symptoms. Try to include any events that precipitated the problem. When did the symptoms begin and how have they progressed—improved or worsened—over time. Are there any associated symptoms? Has this ever happened before and if so how did it resolve?

Physical Exam: Nurses are skilled observers with knowledge of anatomy, physiology and pharmacokinetics. Starting at the top and working down is a simple way to progress through a neurology exam. You can assess the patients mental attendance, short and long term memory, and general fund of knowledge during your questioning for information about their medical history. The provider can evaluate whether the patient is oriented to person, place and time. Is their speech clear, goal directed with a normal rhythm and rate? Do they have facial symmetry or a facial droop? Can they hear and respond appropriately to your questions without paraphasic error or do they have difficulty relaying information? What about their emotional state of mind? Does the patient seem euthymic or are they subdued, anxious, depressed or inappropriately cheerful—“la belle a difference?” This information is available through observation or questioning of the patient and family members.

Observe the patient’s movements as they fill out paperwork for their office visit, as they walk, sit or stand during their time with you. Are their movements coordinated or does the patient demonstrate abnormal movements such as balance problems, tremor, ataxia or weakness? If you cannot name the specific sign or symptom demonstrated by the patient it is completely acceptable to describe what you see.

Before you begin your physical exam lay out all the items you will need to complete the exam. Consider including the following items: stethoscope, otoscope, cotton swab, tongue blade, tuning fork, and a reflex

Alaska Nurse • Page 9

hammer.

Cranial Nerves: Seated or standing in front of the patient you can easily check most of the cranial nerves.

CNI: Testing for the sense of smell is often omitted because it rarely provides significant pathology and abnormal findings may be confusing. If your patient is concerned about loss of smell, you can keep a small vial of coffee and one of an aromatic oil to use in your examination. Interestingly, individuals with early Parkinson’s disease will lose their sense of smell approximately 5 years before they have actual Parkinsonian symptoms. Sense of smell is diminished in smokers and in the elderly.

CNII: First check central vision. Check for far vision by using a Snellen test. Check for near vision by having the patient read a short paragraph from an office magazine or pamphlet. To check peripheral vision, have the patient cover one eye then point to the side with the “wiggling fingers.” Ask the patient to look towards your nose as you are a couple of feet directly in front of them. With your arms outstretched about 1½ to 2 feet apart, wiggle your fingers in 3 areas—low, middle and high—lateral and medial to the patient’s uncovered eye. Repeat this process with the other eye. Check pupillary response in each eye by shining the lighted otoscope in one eye as you observe pupillary constriction in the lighted eye as well as the other eye then switch.

This also covers visual accommodation.

CN III, IV & VI: Check extra ocular movements by having the patient hold their head still and follow your fingers with their eyes. Move your fingers—the focal point—up, down, left, right and then diagonally left to right and right to left. As you check ocular movement laterally observe the smoothness of visual pursuit from side to side. Expect a few beats of nystagmus laterally but if the nystagmus persists this is pathological and may provide a cue to the injured side of the brain.

CN V: A CNS lesion that affects this nerve will usually affect all 3 divisions. Simultaneously lightly touch both sides of the patient’s face. This will rule out CNS components of CN V. If a patient notices a sensory or motor change in their face, they will likely report this to during the history.

CN VII: Ask the patient to smile.

CN VIII: Rub your fingers together near each of their ears.

CN IX & X: Use the tongue blade to elicit a gag reflex and notice if the soft palate elevates symmetrically.

CN XI: Have the patient shrug their shoulders.

CNXII: Have the patient stick out their tongue. If there is weakness in their tongue, it will deviate to the left or right.

Quick Neuro Exam continued on page 10

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December 2011

Quick Neuro Exam continued from page 9 MOTOR EXAM: The goal is to determine if there is a brain stem or cerebrum lesion that has caused extremity weakness. The easiest way to do this is by checking for drift. Ask the patient to put their arms out in front of them with palms up and fingers wide. Ask them to shut their eyes and wait about 15 seconds. If there is pathology, the hand on the affected side will rotate inward. Check lower extremity strength by resistance against foot flexion and extension. If you suspect a problem with weakness in an extremity, start with the most peripheral aspect of the limb then you can continue checking that limb moving closer towards the trunk.

Motor strength is always measured on a scale of 0 to 5 with 0 being no strength—or flaccid—with 5 being normal. If a patient can only resist gravity you would report this as 3/5.

SENSORY EXAM: It is unnecessary to check each dermatome as patients will tell you in the history if they have altered or diminished sensation. You can quickly check sensory integrity by using 2 pointed implements such as safety pins or diagonally cut tongue blade. Apply the double sensation simultaneously to each hand and ask “dull or sharp?”

If the patient reports dull, then there is a sensory problem on that side and further exam is necessary PROPRIOCEPTION: While holding the patient’s great toe with your index and thumb on either side of the most peripheral joint demonstrate by moving the end of the toe “up” then “down.” Ask the patient whether their toe is being flexed up or down with 2-3 variations for each side, for example up-up-down or down-up-down while you manipulate the toes.

COORDINATION: The purpose of testing coordination is to evaluate cerebellar and basal ganglia function. Since these lesions can cause

unintended movement at rest you may see tremor chorea or ataxia. These unintentional movements are easily observed during most interactions with the patient. Check finger to nose and heel to shin maneuvers. Have the patient close their eyes, and hold their arms outstretched away from their body either forward or lateral. Ask the patient to touch their nose with their index finger. To check the lower extremities have the patient run the heel of one leg down from the knee to the ankle on the opposite leg. Repeat this on the other side. For the upper extremities you can have the patient rapidly open and close their hand or pat their fingers to the thumbs.

Another option is to have the patient pat their thigh alternating with palm down then palms up. If there is a problem with gait check, tandem walk. In this maneuver, the patient walks forward placing their heel of one foot directly in front of the toe of the opposite foot walking forward.

REFLEXES: Check the major reflexes of triceps, biceps, patellar, Achilles and Babinski. Reflexes should be symmetrical and are recorded as 2+ when they are normal.

That’s all there is to it. Of course, if you discover abnormal findings these must be evaluated more carefully. What to do with an abnormal finding is beyond the scope of this paper however, you will have a more precise idea of the location and extent of the central neurological problem than before you started and will be better able to describe and discuss your findings with a neurology provider or other consultant.

[Editor’s note: Ms. Hillstrand was born and raised in Anchorage, Alaska. Education: Bachelor of Sciences in Nursing from the University of Alaska Anchorage 1979. Master of Sciences in Health Care Administration from University of Alaska - Anchorage

1996, Master of Sciences from University of Alaska - Anchorage 1998, Doctorate of Nursing Practice from Vanderbilt University 2011. Currently has a privately owned NP general neurology practice: 3340 Providence Drive, Suite A-466, Anchorage, Alaska 99508, Phone 907-263-2200, Fax 907-276-0366] References: Goldberg, S. (1999). The four minute neurological exam. Miami: MedMaster.

Biller, J., Gruner, G. & Brazis, P. (2011). The neurologic examination: A programmed text. China: McGraw-Hill.

Guller, G. (2008). The neurological examination made easy. China: Churchill Livingston Elsevier.

Brazis, P., Masdeu, J., & Biller, J. (2011). Localization in clinical neurology. Philadelphia: Lippincott, Williams & Wilkins.

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Alaska Nurse • Page 11

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Page 12 • Alaska Nurse

2011 March of Dimes Nurse of the Year Winners

December 2011

The Joint Commission Sentinel Event Alert Health care worker fatigue and patient safety

On December 14, 2011, the Joint Commission, an organization that accredits health care organizations, issued a sentinel event alert regarding health care worker fatigue and patient safety.(1) The Joint Commission issues alerts to identify specific types of events, describe their underlying cause and suggest steps to prevent occurrences in the future. The issue is of importance to Alaskan nurses. In 2010 a bill prohibiting mandatory overtime for nurses became law in Alaska – see The Alaska Nurse, Vol. 61, no. 1. The June 2011 issue of The Alaska Nurse featured a CNE article on “Fitness for Duty,” which described some of the issues involved in nurses and fatigue.

In keeping with that theme, an update on the subject with evidence-based actions recommended by the Joint Commission seems appropriate The report listed the many documented studies indicating that the practice of extended work hours contributes to worker fatigue, decreased productivity and increases the risk of adverse events both to the patient and health care worker.

Study results of both nurses, attending physicians and medical residents were included. Nurses who worked over 12.5 hours were three times more likely to make errors in patient care. Shifts over 12 hours also led to more occupational injury. (2,3) Pictured are the nurses given awards by the Alaska March of Dimes in 2011 Since 2004, the Alaska chapter of the March of Dimes has honored nurses nominated from across the state and various specialties at a November gala.

This year the banquet was on November 18 at the Captain Cook Hotel and attended by over 300 people. Nurses are nominated by co-workers, patients, friends, businesses and organizations in twenty different categories from administration to Neonatal Intensive Care. The entrees are judged by a committee comprised of Chief Nursing Officers and nursing administration.

Listed below are the 2011 honorees. Congratulations and keep up the good work!

Emergency/Flight: Richard Janik, Airlift Northwest Juneau Critical Care Adults: Jacqueline Quantrille, Alaska Native Medical Center Pediatrics: Charlot Main, Alaska Native Medical Center Friend of Nursing Ancillary: Mike Lopez, Bartlett Regional Hospital Legend in Nursing: James Steven Reese, Bartlett Regional Hospital Maternal/Newborn: Joan Harvey, Bartlett Regional Hospital Military Nursing Administration: Caroline Broden, Bassett Army Hospital Friend of Nursing Professional: Leilani Sauer, Fairbanks Memorial Hospital Hospital Case Mgmt. Care Coordinating: Hannah Brice Smith, Fairbanks Memorial Hospital LPN: Eugeina Erickson, Fairbanks Memorial Hospital Nursing Administration: Gena Edmiston, Fairbanks Memorial Hospital Rising Star: Heather Cunningham, Fairbanks Memorial Hospital Military Advanced Practice: Valerie Trump, Joint Base ElmendorfRichardson (JBER) Military Nursing Management: Tambra Yates, Joint Base ElmendorfRichardson (JBER) Ambulatory Nursing: Lorrie Dreese, Mat Su Regional Medical Center Advanced Practice: Danette Schloeder, Providence AK Medical Center Behavioral Health: Ronald Strandberg, Providence AK Medical Center General Medical/Surgical: Angel Wallis, Providence AK Medical Center Legend in Nursing: Elizabeth Friesen, Providence AK Medical Center NICU: Lindsey Piatt, Providence AK Medical Center Nursing Management: Eva Berthiaume, Providence AK Medical Center Rehabilitation: Judy Elaine Fine, Providence Kodiak Island Medical Center Community Case Management Care Coordinator: Nora Herrera, Southcentral Foundation Friend of Nursing Ancillary: Jasmine Polk, Yukon Kuskokwim Health Corporation To find out more and to nominate nurses in your community for the 2012 awards, visit marchofdimes.com/alaska or contact Frank Blakeney at FBlakeney@marchofdimes.com.

• Nationally accredited • No campus visits • Competitive Tuition • Liberal Credit Transfers

Courses that fit your schedule. Enroll today!

Go to: http://bsn-linc.wisconsin.edu Toll Free: 1-877-656-1483

Recommendations by the Joint Commission for all organizations are: • Assessment of the organization for fatigue-related risks. This includes an assessment of off-shift hours and consecutive shift work, and a review of staffing and other relevant policies to ensure they address extended work shifts and hours.

• Since patient hand-offs are a time of high-risk—especially for fatigued staff—assess the organization’s hand-off processes and procedures to ensure that they adequately protect patients.

• Invite staff input into designing work schedules to minimize the potential for fatigue.

• Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue. These strategies can include: engaging in conversations with others (not just listening and nodding); doing something that involves physical action (even if it is just stretching); strategic caffeine consumption (don’t use caffeine when you’re already alert and avoid caffeine near bedtime); taking short naps (less than 45 minutes). These strategies are derived from studies conducted by NASA, which state that people can maximize their success by trying different combinations of countermeasures to find what works for them. The NASA studies stress that the only way to counteract the severe consequences of sleepiness is to sleep.

Strategies for determining shift durations and using caffeine to combat fatigue can be found in chapter 40 of “Patient Safety and Quality: An Evidence-Based Handbook for Nurses.” (4) • Educate staff about sleep hygiene and the effects of fatigue on patient safety. Sleep hygiene includes getting enough sleep and taking naps, practicing good sleep habits (for example, engaging in a relaxing presleep routine, such as yoga or reading), and avoiding food, alcohol or stimulants (such as caffeine) that can impact sleep.

Safety culture (for all organizations): • Provide opportunities for staff to express concerns about fatigue.

Support staff when appropriate concerns about fatigue are raised and take action to address those concerns.

• Encourage teamwork as a strategy to support staff who work extended work shifts or hours and to protect patients from potential harm. For example, use a system of independent second checks for critical tasks or complex patients.

• Consider fatigue as a potentially contributing factor when reviewing all adverse events.

To see the report go to the Joint Commission website and search under Sentinel Event and the date. In addition, the American Nurses Association has issued two position statements, Assuring Patient Safety: The Employer’s Role in Promoting Healthy Nursing Work Hours and Assuring Patient Safety: Registered Nurses’ Responsibility to Guard Against Working When Fatigued.

Sources: 1.

The Joint Commission Sentinel Event Alert, Health care worker and patient safety, Issue 48, December 14, 2011 2.

Rogers AE, et al: The working hours of hospital staff nurses and patient safety. Health Affairs, 2004; 23(4):202-212 3.

Trinkoff AM, et al: Work schedule, needle use, and needlestick injuries among registered nurses. Infection Control and Hospital Epidemiology, February 2007;28:156-164 4.

Agency for Healthcare Research and Quality: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 080043, April

December 2011

Alaska Nurse • Page 13 RN to BS Program continued from page 1

Membership Application

Integrity Professionalism ~ Advocacy Empowerment~ Representation

Membership Categories

AaNA Collective Bargaining Full Members (PAMC, CPH & KGH) contact AaNA (907)274-0827 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—62+ years or totally disabled (not employed)

Dues AaNA Only Anchorage Monthly (*EFT) & Fairbanks Yearly

Full

Reduced

Special

$17.50 $204.00

$9.00 $102.00

$4.75 $51.00

All Other Monthly (*EFT ) $16.87 $8.20 Locations Yearly $196.50 $98.25 For monthly credit card payments subtract $.50 per month

$4.10 $49.12

____________________________________________________________ Last Name/First Name/Middle Initial ____________________________________________________________ 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 Check—Please make checks payable to the Alaska Nurses Association MasterCard or Visa—available for:  Annual payment

 Monthly payment

_________________________________ _____/_____ $_______ ______________________________________ Card Number Expiration Amount Signature Monthly Electronic Dues Payment *EFT is the monthly Electronic Funds Transfer Plan Amount =Yearly dues / 12 months + $.50 per month service charge See EFT description - 1/12 of your yearly dues will be withdrawn from your checking account monthly along with a monthly service fee. Please: (1) read and sign the below authorization form and (2) enclose a check for the first month.

AUTHORIZATION to provide monthly electronic payments to the Alaska Nurses Association (AaNA): This is to authorize AaNA 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. AaNA is authorized to change the amount by giving the undersigned thirty (30) days written notice. The undersigned may cancel this authorization upon receipt by AaNA of written notification of termination twenty (20) days prior to the deduction date as designated above. AaNA will charge a $5 fee for any return drafts.

________________________________________

Signature for EFT Authorization

To get involved check off any of the boxes below: Name: ____________________________________ E-mail: ___________________________________ Informational E-mail ❏ Various Nursing Information—If you would like National, State and Local nursing information e-mails from AaNA on a weekly basis. ❏ Action Alerts—If you would like political action alerts for National and State legislative issues involving nursing and health care issues.

Taskforce Members Taskforce 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. ❏ Health and Safety Issues—Taskforces will consider safety and health issues of nurses and patients. ❏ 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. ❏ Other interest? Let us know what you would like to work on:______________ AaNA Committees ❏ 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 third Tuesday of the month. ❏ 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. ❏ 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. ❏ Professional Nursing Practice Issues— Members will consider issues relating to AaNA’s policy on RN practice and other professional issues.

Return Get Involved form, application and payment to: AaNA, 3701 E. Tudor, Suite 208, Anchorage, AK 99507 • Questions? (907) 274-0827 or (800) 811-2576

Elizabeth Campbell, RN, PhD, at 785-4578 at UAA is the RN to BS Program Coordinator. Dianne Toebe, RN, PhD at 786-4566 teaches in the RN to BS program.

At Central Peninsula Hospital, you can have the job of your dreams AND enjoy an active lifestyle!

We invite you to learn more about our organization at www.cpgh.org. Some of the highlights are: • State-of-the-art equipment • Education & professional support • Excellent pay with benefits • Outstanding lifestyle – work balance Click on “Careers” for more information and application or contact Debi Honer, Director of Human Resources at dhoner@cpgh.org Central Peninsula Hospital 250 Hospital Place Soldotna, Alaska 99669 (907) 714-4770 – (907) 714-4674 Fax Drug screening is required prior to employment. EOE

Photo taken by active CPH employee Alan Thye.

Advancing and Supporting the Profession of Nursing

The nursing courses take one year, plus part (first 7 weeks) of a summer session, after completing the prerequisite courses. The program starts in the Summer semester when students take an Informatics course as their introductory nursing course. Nursing Research and a nursing elective may also be taken in the first Summer. The Fall semester is a Health Assessment course and a Dimensions of Professional Nursing course. The physical assessment assignments in the Health Assessment course can be met in your home community with another RN supervising. Spring semester is the first Community Health course as well as a Nursing Management course for the RN. The final course is the capstone course and is the first part (7 weeks) of the second Summer semester.

This course is the Community Health II course that focuses on the health of populations and includes a Community Mental Health component.

RNs receive upper division nursing credits from their Associate Degrees that count toward the total credits needed to graduate from UAA with the BS degree. Thus, the nursing courses do not focus on the skills and knowledge gained in your AS program.

The courses for the returning RN can focus on areas of nursing that RNs probably did not have in their first nursing program.

Six credits of nursing elective are required. This can be met by taking any two of the 300 and 400 level nursing elective courses, which include an online ICU course and an online NICU course. A course in another discipline may be petitioned to serve as a nursing elective, when an RN gives a rationale for wanting to take the course. The elective requirement may also be met by current certification in a nursing specialty. Some RNs use certification to advance in their jobs, as well as for three credits of the nursing elective requirement at UAA. The instructor to student ratio is usually about 1 to 10 in online courses. All of the students in the course are RNs and usually go through their nursing courses as a cohort who gets to know each other fairly well through discussions and class projects. The faculty for the courses is the same faculty with the same required credentials as those who teach these courses to the pre-licensure nursing students. Many of the faculty say that teaching RN students and interacting with RN colleagues is a very satisfying experience.

The advisor to contact about having your transcripts evaluated, to learn about prerequisite classes, and about the admission process is Marie Samson, MEd. You may schedule an appointment to meet with her at 786-4550. Also, check out the School of Nursing web site at: http://www.uaa.alaska.edu/ schoolofnursing/rnjobs/index.cfm We would like to tell you about the RN to BS program and help make a plan of study for you to meet the University’s degree requirements and earn your BS degree.

Page 14 • Alaska Nurse

December 2011

Resources Scholarships/Funding/ Volunteer Opportunities/Nominations Alaska: Orsini Scholarship Alaska Nurses Association, District 4 District Four of the Alaska Nurses Association announces that funds are available for scholarships for nursing students who are Fairbanks area residents enrolled in a 4-year college program with a Nursing major or who are accepted for or enrolled in graduate study in an accredited university. Applicants who are enrolled in other programs will be considered on an individual basis.

The Scholarship Fund also supports Continuing Education in Nursing.

The Fund is supported by contributions from the general public as well as from the family and friends of Dixie Orsini, who was a registered nurse who resided and practiced in Fairbanks from 1953 until her death in 1984. The fund is no longer accepting contributions, but those who wish more information may contact Ruth Benson, R.N., Trustee, 1551 Farmers Loop, Fairbanks 99709. Nursing students who wish to apply for scholarship aid may write to the same address or phone 479-6912.

Applications are to be completed and returned

by March 31 for the 2011-12 academic year. More Info: Ruth Benson RN, Trustee, 907-4796912 **** The David E. Knox Memorial Nursing Fellowship Established at the Alaska Community Foundation, the fellowship supports outstanding candidates in the pursuit of registered nursing degrees and service to small Alaskan communities.

Ideal candidates will embody the same nurturing compassion, detailed organization, high technical standards, and devotion to healthcare for which David was known. The Fellowship provides awards of up to $2,500. In return, the recipient must agree to practice as a nurse/RN in a small community within the state of Alaska for a minimum of one year.

Want to have an adventure this summer?

Join the Camp Togowoods team and make the difference in the life of a girl.

Call 800-478-7448 or go to www.girlscoutsalaska.org for more information.

Knox moved to Alaska from California in 1973 to pursue a career in surgical nursing, after finishing service in the Army as a surgical technician in a Vietnam M.A.S.H. unit. Starting his work in Sitka in the Public Health Service surgical unit, Knox soon earned his RN degree through the University of Alaska Anchorage. After 10 years with PHS, he was hired to coordinate the surgical unit at Sitka Community Hospital and served there for more than 20 years. He brought a high level of leadership and expertise to Sitka’s surgical unit, developing it into one of Alaska’s leading rural heath units. The new surgical suite at SCH was dedicated in his honor and a plaque was erected that reads “a beloved husband, father, mentor and friend who selflessly served his community, patients, family and friends.”

Deadline for Applications: April 1, 2012.

For more information visit the Alaska Community Foundation – www.alaskacf.org, or contact us at 907-334-6700 or info@alaskacf.org **** Living Well Alaska: Better Choices, Better Health is a series of workshops that help people with chronic illnesses learn ways to self manage their condition and take charge of their life.

Living Well Alaska: Better Choices, Better Health workshops are held throughout Alaska for people with all kinds of chronic conditions, such as arthritis, diabetes and heart disease.

Upcoming 2012 Workshops • Kenai CDSMP Course Leader Training to be held at the Dena’ina Health Clinic in Kenai. Dates: January 16-19, 2012. To register, please contact Deborah: dnyquist@kenaitze. org or call 907-335-7320 • Eagle River A 6-week chronic disease selfmanagement workshop will be held at Saint Andrew’s Catholic Church in Eagle River.

Dates: April 9-May 14, 2012. To register call Marlise: 212-2053.

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This year, over 2,500 people in Alaska will be diagnosed with cancer.

Many of them will need support with their battle.

You can help save a life by volunteering your time & working with patients!

Become a volunteer driver. Volunteer drivers in the Road to Recovery program help patients get to the lifesaving treatment they need. Volunteer drivers donate their time and resources to take patients to treatment appointments and return them to their homes.

Become a mentor to breast cancer patients. The Reach to Recovery program provides one-on-one support to newly diagnosed breast cancer patients throughout their cancer journey. Volunteers are

DIVISION of JUVENILE JUSTICE

Join our team today Family Practice

McLaughlin Youth Center wants YOU! RN–Full time days working with teenagers in our Detention and Treatment Programs.

For complete job description go to:

equipped with information packets and gift items to provide to the patients they meet.

Become a volunteer patient navigator. Spend time Providence Cancer Center and help patients get the resources they need by providing brochures and pamphlets, program information and resource referral.

Become a general office volunteer. Help with the day-to-day and administrative tasks within the local office in Anchorage.

Interested in volunteering in other areas, such as fundraising or advocacy? Call for more information 907-273-2077.

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General: NIH releases updated cholesterol screening guidelines for children Children ages 9 to 11 years old should receive regular cholesterol screenings to identify early signs of heart disease, according to updated guidelines released by the NIH and endorsed by the American Academy of Pediatrics. The guidelines, which appear in the journal Pediatrics and on the website of the National Heart, Lung and Blood Institute, include suggestions for improving cardiovascular health, such as regular physical activity and protection from tobacco smoke. [source, AANP Smartbrief 11/14/11] Secondary Prevention Guidelines for Cardiovascular Events Released The American College of Cardiology Foundation and the American Heart Association released on Thursday their guidelines for the prevention of cardiovascular events. These guidelines, endorsed by the Preventive Cardiovascular Nurses Association, promote the use of comprehensive cardiac rehabilitation programs for all patients with a history of myocardial infarction, stroke, bypass surgery, heart-related chest pain or blockages in leg arteries. The new secondary prevention and risk reduction therapy guidelines also are endorsed by the World Heart Federation.

They will be published in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology. To download a PDF, visit http://bit.ly/t7yd4w. [source, AANP Smartbrief, 11/4/11] ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

CDC Endorses HPV Vaccine for Boys The CDC’s Advisory Committee on Immunization Practices has approved recommendations for routine human papillomavirus vaccination of boys ages 11 and 12 with three doses of HPV4 (Gardasil). The vaccine will protect males against certain HPV-related diseases and cancers and may also indirectly protect women from getting HPV, according to the committee. [AANP Smartbrief, 10/26/11] Websites of interest: For updated information on the Affordable Healthcare Act. www.healthcare.gov

Workplace Alaska or call for more information and to arrange a tour:

CHA Program Instructor/ Provider

LaVon Ausman, Nursing Supervisor McLaughlin Youth Center 2600 Providence Drive, Anchorage, AK 99508 Phone: 907-261-4313, fax: 907-261-4372

Emergency Medicine Psychiatric NP ANP - Cardiology Certified Nurse Midwife Loan Repayment Options Available

Simplify your nursing research... with access to over 10 years of nursing publications at your fingertips.

nursingALD.com

ANTHC Statewide Recruiting 1-800-528-6680 Fax: 1-907-729-3969 www.anthctoday.org/business/statewide.html

healthcare@anthc.org

Simply click on the Newsletter tab on the far right and enter your search term.

AUI is pleased to announce our new associate Zachary Posey, M.D.

December 2011

Alaska Nurse • Page 15

Upcoming Events

Letter to the Editor

Alaska State Board of Nursing— Upcoming Meetings Jan. 18-20, 2012 Anchorage agenda deadline April 2-4, 2012 Juneau agenda deadline July 25-27, 2012 Anchorage agenda deadline Oct. 24-26, 2012 Fairbanks agenda deadline Jan. 16-18, 2013 Anchorage agenda deadline

Dec. 28, 2011 March 14,2012 July 3, 2012 Oct. 3, 2012 Dec. 26, 2012

The Alaska Board of Nursing has a list-serve that is used to send out the latest information about upcoming meetings, agenda items, regulations being considered, and other topics of interest to nurses, employers and the public. To sign up for this free service, go to www.nursing. alaska.gov. Choose the “Subscribe Now” box, just above Board Staff information.

Inquiries regarding meetings and appearing on the agenda can be directed to: Nancy Sanders, PhD RN, Executive Administrator Alaska State Board of Nursing 550 West 7th Ave, Ste 1500, Anchorage, AK 99501 Ph: 907-269-8161, fax 907-269-8196 email nancy.sanders@alaska.gov To attend by audio conference call 907-269-8161 for access number.

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Ongoing Free CE The Division of Public Health provides notices of webinars and updates on women’s health, many of which provide continuing education credit.

To join the Alaska Women’s Health Program clinical network list go to this link: http://list. state.ak.us/soalists/AWHPclinicalnetwork/jl.htm If you have difficulty with the link, contact: Sherrell Holtshouser RN, MPH, Women’s & Reproductive Health Nurse Consultant 907-2693426

Registration is free, fast, confidential and easy! You will receive an e-mail when a new job posting matches your job search.

If you are interested in writing a letter to the Alaska Nurse, we are interested in printing it! Do you have comments, opinions or questions about nursing and health care in Alaska? Send your letter via email to lhartz@alaska.com. Letters should be limited to 500 words or less. They may be edited for length, clarity and grammar.

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.

Fairbanks Nurse Recommends Online Education October 26, 2011 I am a Registered Nurse in Fairbanks, Alaska and currently taking classes to get my certification in Wound Care. I am attending Wicks Education Program out of Harrisburg, Pennsylvania. How am I doing this you might ask? I am doing it on-line.

On-line education is an asset to those of us living in out-of-the-way places. When I complete this program, and pass the certification exam, I’ll be a

certified wound care nurse or CWCN. If I choose, I can also be certified in ostomy and incontinence care, which would make me CWOCN. In order to participate in this program, one needs to have a bachelor’s degree and be a Registered Nurse. Once certified, one will be able to develop a plan of care for wounds, and treat patients under the direction of a physician. There are currently 4 certified wound care nurses at the clinic where I work at Fairbanks Memorial Hospital. We see an average of 24 patients a day.

Responsibilities vary depending on the patients being seen, but developing a plan of care and following close with the physician are the two primary responsibilities.

If you have questions on this specialty, I can be reached at work, 907-458-5443, between the hours of 7 am and 6 pm Monday through Friday. I currently work every Saturday, as we have a heavy load of patients needing daily dressing changes.

Kathleen Senecal, RN Fairbanks Memorial Hospital

Page 16 • Alaska Nurse

December 2011

FAIRBANKS, ALASKA

Anchorage, Alaska is a vibrant, modern city that offers an exceptional array of leisure activities while surrounded by unsurpassed scenic beauty and recreational resources.

Located on the Alaska Native Medical Center campus, Southcentral Foundation (SCF) is a nonprofit Alaska Native healthcare organization that incorporates traditional Native values into western practices.

We are currently accepting applications for:

RN Case Managers

LPNs

If you are someone who welcomes adventure and are looking for a new challenge, come join our growing team and kindle your spirit!

For a complete list of jobs, job descriptions, and to apply online* go to www.scf.cc or contact Tess Johnson at (907) 729-5011 or tjohnson@scf.cc

*For an applicant to be added in to Southcentral Foundation’s job bank, an online application must be completed, including the criminal background section–visit www.scf.cc

At Banner Health, an award winning hospital system, we don’t take everyday activities for granted. We give you all the resources you need to be successful with your patients, career and life, and we strongly believe in making a difference in our employees’ lives so they can make a difference in the lives of others. We are committed to providing state-of-the-art facilities, leading-edge technology, and engaging environment and comprehensive benefits.

Fairbanks Memorial Hospital is located in the Golden Heart of Alaska in the second largest city in Alaska – the perfect jumping off point for exploring the state. We at Fairbanks put the patients first and remain steadfast in our commitment to providing the highest quality healthcare to our friends and family.

Opportunities available for Nurses!

For full-time, part-time and per diem opportunities available call 1-888-303-5402, or visit:

www.BannerHealth.com/careers Please reference keyword “Alaska Careers” when applying.