The Alaska Nurse - Vol. 58 No. 1 - February 2008

The Official Publication of the Alaska Nurses Association Circulation 10,000 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska

Volume 58 • No. 1

-Statewide Plan Addresses Health Care Issues

Executive Summary The Council interpreted its charge from Governor Palin broadly, to focus on the overall goal of improving the health of Alaskans. Within that broad charge, the Council considered health care to be an important component in improving the health of Alaskans. According to the Council, health care is a broadly defined term, relating to the prevention, treatment and management of

Page 4

February 2008

AHCSP Council Publishes Final Report

In 2007, Governor Sarah Palin established The Alaska Health Care Strategies Planning Council (AHCSPC). The purpose of the Council “was to build the foundation for developing a statewide plan to identify both short-term and long-term strategies that effectively address issues related to access, cost and quality of health care for Alaskans.” Three nurses were appointed to the council; Donna Fenske, MSN, FNP Cathy Giessel, MSN, FNP and Thomas Hendrix, PhD, RN. What follows is an abbreviated summary of the Council’s final report published January 16, 2008.The final report was presented to the Governor and the legislature. The complete report can be found at www. hss.state.ak.us/ hspc/ or do a Google search. Following the report are comments by Dr. Hendrix.

Nurses Week 2008

illness, preserving mental, behavioral, physical health, and dealing with chemical dependency.

In accordance with the order, the Council reviewed and synthesized the extensive body of existing research on the subject, agreed upon the most salient facts, and identified the most significant health care issues in the state. Based on seven overarching healthcare challenges identified by the Council, members articulated the following seven comprehensive health care policy goals: • Personal responsibility and prevention in health care will be top priorities for government, the private sector, tribal entities, communities, families, and individuals; • Health care costs for all Alaskans will consistently be below the national average; • Alaska will have a sustainable health care workforce; • All Alaskan communities will have access to clean and safe water and wastewater systems; • Quality health care will be accessible to all Alaskans to meet their health care needs;

Continued on page 5

Mountain-Pacific Quality Health: A Resource for Nurses

Page 9

Alaska Nurse Alert

Page 13

Inside This Issue Nurse Week Message . . . . . . . . . . . . . . . . . . . . 3 Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Update from the Board of Nursing . . . . . . . . . 9 Nurses in the News . . . . . . . . . . . . . . . . . . . . 10 December 2007 Nursing Graduates . . . . . . . . 11 Congratulations New Graduates . . . . . . . . . . 11

Local Nurse Practitioner Nets State and National Awards December 2007 marked the completion of a banner year for Dorothy Hight, Family Nurse Practitioner at Alaska Native Tribal Health Consortium. For 27 years she has provided health services to the beneficiaries of the Indian Health Service, and has taught villagers in the Community Health Program how to provide primary care. In 2007 she was recognized for her efforts with both a local and a national award.

The Anchorage YWCA in partnership with BP Alaska awarded her one of the 10 “Women of Achievement Awards” for 2007, which was presented at a ceremony at the Egan Center December 12. Within 24 hrs of receiving that award, Hight also received a prestigious Indian Health Service National Director’s Individual Award in Bethesda Maryland. Both awards celebrated the successful culmination of a multi-year project to develop and deliver health aide education at a distance, where they live and work.Through partnership with Eastern Aleutian Tribes and her colleague in developing this course, Nurse Practitioner Kas Healy, community health aides were, for the first time able to take their training from home via web site and videoconferencing.

Membership Application . . . . . . . . . . . . . . . . 12 Ketchikan Nurses Retreat and Nurse Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Spotlight: CRNAs . . . . . . . . . . . . . . . . . . . . . . 13 Case Management Chapter Planned . . . . . . . 13 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Upcoming Events . . . . . . . . . . . . . . . . . . . . . . 15

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

Presort Standard US Postage

PAID

Dorothy Hight receives YWCA Woman of Achievement Award from Channel Two’s Maria Downey. Photo credit: Photo Arts by Janna

Continued on page 2

Permit #14 Princeton, MN 55371

Page 2—Alaska Nurse—February 2008

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. 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 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.

Local Nurse Practitioner Continued from page 1 The Anchorage award was broader in scope however. Each year for the last 15 years, the “Y” has selected a group of women to honor whose significant community contributions would ordinarily have gone unmentioned. Women from all fields of personal and professional service have been recipients of this award, from politicians to physicians, to community organizers. This award recognized her long time contributions a educator and practitioner, while also honoring her unique community service.

Her nomination for the Anchorage award read in part: “Dorothy has acted as team leader, as contributor, as ‘shaper’ of [the Community Health Aide Program] over the years. She is a ...teacher, historian, an a dynamic communicator who possesses the gift of being able to make complex subjects understandable. Most recently she has made the difficult transition from her role as classroom presenter to distance learning

facilitator, mounting a steep learning curve in distance education technology, and maintaining tenacity in the face of limiting systems. ...She is in the vanguard of educators who are preparing a workforce for Alaska’s delivery of health care.”

As part of her contributions to the native health system, Dorothy has been a member of the CHAP Certification Board since its inception, and most recently its chair. This is a federal board charged with the responsibility to review credentials and training standards for Community Health Aides and Practitioners throughout the state. Most recently it has been involved in the development and certification of Dental Health Aides.

Recognized also were her contributions in community service as well. She is a founding member of the local vocal group Bel Canto, and volunteers her vocal talents for naturalization ceremonies and local charities. She has been a frequent soloist for the yearly productions in Anchorage and the Mat-Su valley of Handel’s Messiah, and has performed with Anchorage Opera, Anchorage Concert Chorus, Mat-Su College Community Chorus and Alaska Chamber Singers.

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.

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 Vice President: Nancy C. Davis, MSN Secretary: Michelle Murphy, RN Treasurer: Donna Phillips, BSN Directors: Labor Council Chair: Susan Walsh, RN Greater Alaska Director: Jane Conrad, RN Staff Nurse Director: Kathleen A. Gettys, BSN, BA Rural Director: Dara Whalen, MS Director at Large: Carolyn S. Adkins, MS Paul T. Mordini, RN Shirley LaForge, RN Martha Clinehens, RN Jennifer Straight, RN AaNA Labor Council Chair—Donna Phillips, BSN Joshua Meals, ADN Jenni Hancock, RN Mary Stackhouse, RN UAN Rep.—Kathleen A. Gettys, RN, BSN, BA PAMC BU Rep.—Cindy Price, 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: Tom Renkes, RN, MS 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.

Wanted: Alaskan Photos The publishers have designed a beautiful new masthead for The Alaska Nurse for this first issue of 2008 featuring a northern landscape as a backdrop. They have assured us that if you send in landscape photos of Alaska in high quality jpg format, we can feature your photo as the new background for The Alaska Nurse masthead! So, amateur photographers out there, send in your photos to lhartz@alaska.com.

February 2008—Alaska Nurse—Page 3

Nurses Week 2008

National Nurses Week begins each year on May 6th and ends on May 12th, Florence Nightingale's birthday. These permanent dates enhance planning and position National Nurses Week as an established recognition event. As of 1998, May 8 was designated as National Student Nurses Day, to be celebrated annually. And as of 2003, National School Nurse Day is celebrated on the Wednesday within National Nurses Week (May 6-12) each year. The nursing profession has been supported and promoted by the American Nurses Association (ANA) since 1897. Each of ANA's state and territorial nurses associations promotes the nursing profession at the state and regional levels. Each conducts celebrations on these dates to recognize the contributions that nurses and nursing make to the community. [Editors Note: This is my annual apology to the readership for an article on this event two months early, but with only a quarterly edition, this is as close as we can get. Be sure to check out the AaNA website aknurse.org for up to date information on Nurses Week events. Featured on this page are some of the nurses honored by the March of Dimes in 2007.]

March of Dimes Maternal/Newborn Nurse of the Year Janet Jones of the 3rd Medical Group, Elmendorf AFB.

March of Dimes Perioperative Nurse of the Year is Kathi Rappuhn of Mat-Su Regional Medical Center.

March of Dimes Home Health/Hospice Nurse of the Year, Barbara Mistler from Mat-Su Regional Medical Center.

March of Dimes Administration/ Management Nurse of the Year, Cindy Alkire of Providence Alaska Medical Center.

March of Dimes Neonatal Intensive Care Unit Nurse of the Year, Mary Diel, from Providence Alaska Medical Center.

March of Dimes Pediatrics Nurse of the Year, Jean Lorentzen from Providence Alaska Medical Center.

Page 4—Alaska Nurse—February 2008

Nurses Week Message

- Tom Renkes, AaNA Executive Director As we reflect on our profession, I find it interesting that no matter how many doors open for us on our life journey, there is always that direct care experience we all share. I wrote the following piece just before my father died. He was the one who filled me with stories from his days in Alaska’s wilds, and kept the heat going so my diaper wouldn’t keep freezing to the wall at night. I was his hospice caregiver. To this day, my ethereal, soulful self is thankful for the experience and it creeps into my character daily. I have never shared this with anyone, except recently with my family, so they didn’t see it from someone else first. Thanks for letting me share, and thanks for being the professional you are.

A Dying Father

by Tom Renkes September 1997 The breathing; It looks so labored.

Like the body’s automatic pilot working on a low battery.

Up. Down. Nothing. Up. Down. Up. Up. Up. Down.

Nothing.

Start, okay, really breath! Please?

Okay. That’s better.

How tired the body gets.

The mouth looks sad.

In between sleep and wake; it just smiles to a happy thought or joke we share.

Up. Down. Up. Up. Up. Down.

The chest looks like there’s a huge weight on it.

Will the heart last?

Can’t the mind just fix everything?

So much of the brain we don’t know about.

Why can’t it make it all better?

Up. Up. Up. Down. Nothing. Up. The legs lay motionless.

The arms move slowly; sometimes the hands grasping at something that we can’t see.

The strength that used to be there just disappeared.

Does the spirit keep it?

Do we measure the soul by the size of a muscle?

Down. Down. Up. Down.

No tears.

No appetite.

How long can the spirit sustain an engine with no fuel?

You wonder if there’s supposed to be magical words.

Any last statements or declarations?

Will Dante and Virgil help decide where you go?

Does God watch?

Can you feel him?

Up. Down. Up. Down.

Are you scared?

We are.

What will we do without you?

Who will do all the little things we take for granted?

Who will I call to brag about the kids?

Who will I call when I’m fixing something and can’t figure it out?

I hope I learned everything I should have.

For so many years, I watched and listened.

For so many years, I didn’t say I love you enough.

Are you proud of me?

Did I fulfill your dreams?

Up. Down. Down. Up. Nothing.

I always thought you’d be there.

I hope I feel you after you go.

I’ve never seen you be rude to anyone.

I hope I can always be nice to people.

I hope I can be like you.

I hope my son is there for me.

I tell him I love him every day.

Up. Down. Up. Up. When will it stop?

Will you just not wake up?

I know there’s no pain.

I’m glad it’s easy to sleep.

I’m glad I can help and be here when you need me.

Never be a company man you use to say.

I’m not.

I set my own standards and direct my future.

Because you told me that, I can be here to talk.

To watch.

To help.

To never forget.

Up. Down. Up. Down.

Thanks Dad. I love you.

AHCSP Council Continued from page 1

• Develop and foster the statewide leadership necessary to support a comprehensive statewide health care policy; • Increase the number of Alaskans covered by health insurance and encourage employers to offer a range of health insurance options.

Because of its short time frame, the Council was unable to address the Administrative Order’s directive to present fiscal information to accompany each of the short- and long-term strategies.

Unfortunately, with only 24 hours of face-to-face meeting time, identifying the fiscal impact of recommendations remains unaddressed, and must be a top priority in future consideration by this or subsequent bodies.

The Council’s Vision and Long-term Goal At its inaugural meeting on June 11, 2007, Council members articulated an overall vision of health care in Alaska—that “Alaskans are the healthiest people in the nation.” This vision led to development of a concrete mission statement describing the ultimate outcome of the Council’s work: “To develop strategies, including performance measures, to provide health care access to all Alaskans by 2014.”

Alaska’s Health Care Challenges: A Strategic Plan for the Future In the opinion of the Council, there are seven challenges requiring immediate and comprehensive attention in Alaska’s health care system: • Prevention and personal responsibility don’t play big enough roles in the health and health care of Alaskans; • Receiving quality health care in Alaska is expensive, well above the national average, and increasing; • There are significant shortages in the health care workforce across the state; • Water and wastewater systems in many rural communities lead to health problems; • Quality health care is difficult to access for many Alaskans, urban and rural; • There must be consistent and focused state and local leadership to improve the health of Alaskans, and build a comprehensive health care system in Alaska; • Health insurance is an important if as yet misunderstood part of comprehensive health and health care.

Based on the vision of a healthy Alaska, a one-page “Alaska Health Care Action Plan” was developed by the Council. The plan appears in the following section, and includes a combination of long-term and short-term goals. Where applicable, the short-term strategies appear at the beginning of the relevant goals.

Alaska’s Health Care Action Plan: “Making Alaskans the healthiest people in the nation.”

Long-Term Goals and Strategic Directions (2008–2014) Goal One: Health costs for all Alaskans will consistently be below the national average.

• Increase the place of consumerism in health care purchasing by giving people control over their health care dollar—the foundations are accessible, transparent, evidence-based price/ quality information about providers and services (short-term) • Create an easily accessible and constantly updated website containing evidence-based price and quality information about health care providers and services (short-term) • Increase community-based health care services, both public and private sector • Stabilize the costs of health care by reducing the rate of increase relative to other states (national increase is 6%, decrease Alaskan rate to 4% annual increase) Goal Two: Alaska will have a sustainable health care workforce.

• Increase WWAMI seats to 50 per year, and increase seats in UA Nursing and Nurse Practitioner programs (short-term) • Develop policies and systems to alleviate the health care worker shortage, and prevent it from recurring • Implement a doctoral-level nursing program at the University of Alaska to meet the 2015

deadline for Nurse Practitioner education requirements Goal Three: All Alaskan communities will have clean and safe water and wastewater systems.

• Improve adherence to the state’s existing water and wastewater treatment “plan,” through the Village Safe Water Program Goal Four: Quality health care will be accessible to all Alaskans to meet their health care needs.

• Expand tele-health and electronic health record systems, taking the lead in pursuing matching FCC grant funds (short-term) • Increase presence of the public health system, particularly public health nurses, especially in rural communities (short-term) • Increase access of Alaskans to a primary care provider and behavioral health provider when they are needed • Decrease the likelihood that Alaskans will use emergency rooms for primary care • Reduce the impact of existing barriers to health care accessibility by exploring private enterprise incentives • Improve primary and long-term health care options for elders, particularly with regard to Medicaid and Medicare Goal Five: Personal responsibility and prevention in health care will be top priorities for government, the private sector, tribal entities, communities, families, and individuals.

• Decrease the impact of obesity, smoking, substance abuse and other lifestyle factors on the health of Alaskans, through intense public education with public and private partners (short-term) • Improve the likelihood that every Alaskan will choose to live a healthy lifestyle and make healthy lifestyle choices • Increase the place of personal responsibility in health care decision making for all Alaskans Goal Six: Develop and foster the statewide leadership necessary to develop and support a comprehensive statewide health and health care policy.

• Create an ongoing, quasi-independent, nonpartisan, volunteer “Alaska Health Care Commission” in statute (short-term) • Elevate the discussion of health care to a statewide audience Goal Seven: Increase the number of Alaskans covered by health insurance • Raise the eligibility criteria for Denali KidCare from the current 175% to 200% of federal poverty limits (short-term) • Reduce potential for financial impact from catastrophic loss by supporting new and innovative approaches to insurance for individuals, which would be consumer-owned, portable, and purchased with pre-tax dollars • All Alaskans have at least a catastrophic, incentive-based insurance option (i.e., high deductible coverage)

February 2008—Alaska Nurse—Page 5

• Encourage employers, through varied incentives, to offer a range of insurance options/choices to employees—to include at a minimum, high deductible plans Alaska’s Health Care Challenges: Discussion and Recommendations The Council engaged in lengthy discussion of the seven main challenges facing Alaska’s health care system, and generated the following discussion points related to each.

• Defining the specific problem or problems • Why addressing them through comprehensive state action is important • What should be done about it—in other words, identifying desired outcomes Goal One: The High Cost of Health Care in Alaska What’s the problem? The costs of producing quality health care are high, and therefore it is quite expensive to be a consumer of that care. The costs of health care in Alaska are already well above the national average, and like the rest of the nation, are increasing.

Why this is important: A new approach to this problem must be embraced if there is to be long-term, positive reform in Alaska’s health care system. If Alaska continues along the same path, the results will remain unchanged. Reducing the rate of increase in the costs of health care is a “must do” priority, and Alaskans need to get the best value for health care dollars spent. Every health care dollar must be spent wisely. Broadly stated, the high cost of health care is a barrier to many Alaskans getting the health care they need. The present system supports the high and increasing costs of health care and inefficient utilization of health care dollars.

What should be done about it: Decreasing the rate of growth in health care costs in Alaska will require development of a highquality health care system that is evidencebased, consumer driven and market-responsive.

With respect to lowering costs, insurance that is portable and consumer-owned plays a central role, and requires much more discussion at the state level. Overall, giving people more control over their health care dollar is a central component, as is providing appropriate, accessible, transparent, and evidence-based cost and quality information about health care providers and services. In the short-term, one of the most important goals should be state creation of an easily accessible and up-to-date website providing health care cost and quality information to Alaskans. These strategies alone are not sufficient to reduce the overall cost of health care in Alaska, nor to reduce the rate of growth. Closely related are the subjects of personal responsibility, access to health care, increasing the number of health care providers, and insurance.

Continued on page 6

Page 6—Alaska Nurse—February 2008

AHCSP Council

Continued from page 5

Goal Two: The Health Care Workforce What’s the problem? There are significant shortages in the health care workforce across the state.

Alaska needs more health care workers throughout the system, at all levels.

Why this is important: Without ample health care workers, the system will continue to falter —it is already showing signs of strain. Lack of a sustainable health care workforce is a primary factor in the increasing costs of health care, and also in the decreasing access of health care for Alaskans. In addition, significant access issues exist in both urban and rural areas, which will likely require expansion of the health care workforce.

What should be done: Statewide policy should enable the creation of a sustainable health care workforce that alleviates the current shortage and prevents it from recurring. A good start is to “grow more of our own” within Alaska, by presenting health care professions more prominently as viable career options, with students continually encouraged to build the skills and the interests necessary to pursue health care careers. In the short-term, to increase primary care providers in the state, the number of WWAMI seats should be increased to meet the projected need of 50 per year in the next decade. In concert with that, the University of Alaska nursing doctorate degree should be implemented as well. The number of resident positions in the Family Practice Residency Program should be increased, as should the number of graduates in both the UA Nursing and Nurse Practitioner Programs.

Goal Three: Sustainable Wastewater Systems

Rural

Water

and

What’s the problem: Water and wastewater systems in many rural communities are inadequate, unsafe, or non-existent, and can be a major cause of health problems within those communities.

Why this is important: There is a strong correlation between the health of Alaska’s rural residents, and water and wastewater safety.

Building and operating clean drinking water and wastewater disposal systems is one of the most effective means for improving the health and wellness of rural Alaskans and rural communities.

What should be done: There is an active state program in place to bring sustainable and safe drinking water and wastewater disposal systems to all of Alaska’s rural communities—the Village Safe Water Program. However, the real success of that program depends on the recognition by state policy makers that there is no “one size fits all” approach to bringing those systems to rural Alaska. What works in one community may not work in another. Efforts to provide infrastructure that the community can support in the future should continue. The state’s long-term health care policy, therefore, should improve and ensure the state’s adherence to the “plan” for bringing sustainable and appropriate safe water and wastewater systems to every Alaskan community.

Goal Four: Access to Health Care What’s the problem? Accessing quality health care is difficult for many Alaskans, both urban and rural. There is little consistency of access to health care for all Alaskans—some have it all the time, some have it some times, and some have it hardly at all. In Alaska’s urban areas there is a lack of access to necessary specialized care and efficient “same-day” primary care. In rural communities, there is often no access at all to health care because of a variety of barriers, including costs, geography, transportation challenges, lack of providers and much more.

Why this is important? The lack of access to quality health care contributes to Alaskans’ wellness challenges. Being able to guarantee timely access to primary care, in particular, presents significant challenges; but appropriate primary care is one of the most effective means for keeping Alaskans healthy. There was considerable discussion among members about the positive impact of Community Health Centers, and the state’s public health nurses, in providing greater access to health and health care opportunities.

There was agreement among Council members on two major points relevant to health care access. First, Community Health Centers (CHCs) are a valuable part of the “health care safety net” for Alaskans. Second, the state’s public health nursing structure is one of the most important mechanisms for affording greater access to a wider range of health care. The problem with CHCs and public health nursing is that both programs are under-funded. Community Health Centers are federally funded, and most states provide supplemental financial assistance because CHCs are viewed as an important part of the overall health care system in those states.

Partly due to the provision of health care services to the under-insured and uninsured, CHCs consistently face budgetary challenges. In Alaska, CHCs receive virtually no funding from the state.

Similarly, the state’s public health nursing system has been chronically under-funded for years.

Ever-decreasing state dollars for the Public Health Division has meant that fewer and fewer public health nurses are able to do their important work improving the health of Alaskans.

What should be done: Accessing health care should not be difficult for Alaskans, and broad policies that improve access to primary care and behavioral health care should be the focus of any state health care policy. Strategies should include: 1) the state becoming more actively engaged as an active investor in the Community Health Center system through supplemental funding and regulatory relief; 2) appropriate funding for and utilization of the state’s Public Health Division, in particular the Public Health Nursing program; 3) building monetary and other incentives into the health care system which encourage Alaskans to more effectively utilize primary care opportunities; 4) leveraging information technologies such as tele-health and electronic health record systems which can improve access while reducing costs; and 5) reducing barriers to private clinicians practicing in underserved areas.

In the very short term, the state could take the lead in guaranteeing that the required “match” associated with the current $10 million Federal Communications Commission tele-health grant is made.

Continued on page 7

AHCSP Council Continued from page 6

Goal Five: Prevention and Personal Responsibility What’s the problem: Prevention and personal responsibility play too small a role in health care, including maintaining and improving health.

While Alaskans may understand the connection between their lifestyle choices and their individual health, for the most part they do not make a connection between personal choices, having a personal stake in their health, and the cost of their health care. Alaskans are not optimally encouraged and equipped to make the kinds of choices that improve health and subsequently decrease health care costs.

Why this is important: More healthy Alaskans translates into fewer sick Alaskans, and improved quality of life with resultant cost savings. A clear understanding of the role of personal choice in individual health status and the impact on health care costs, as well as the central role of government in supporting health choices, are critical components in developing long-term strategic health and health care policies.

What should be done about it: Solving this problem requires a two-pronged approach. First, Alaskans must be encouraged to play a much greater role in their own wellness by having both a personal and financial “stake” in their own health. Having a “stake” in their own health is the product of a personal investment in wellness, and realizing the financial benefits of saved dollars by maintaining healthy lifestyles. In the opinion of the Council, the most effective mechanism for increasing the personal health investment of Alaskans is incentivizing and supporting positive change.

Second, governments, school districts, tribal entities and other employers are uniquely situated to be catalysts for positive change. These entities have the influence to help Alaskans understand and make healthy choices, while at the same time avoiding those lifestyle decisions that contribute to poor health.

Goal Six: Statewide Leadership What’s the problem: A lack of consistent statewide leadership makes development of comprehensive statewide health and health care policy challenging.

Why this is important: Public leaders have a pivotal role as catalysts for positive change.

Commitment at the executive and legislative levels to comprehensive and lasting change will effect health and health care in Alaska.

What should be done about it: The Council believes that government has an obligation to “jump start” healthy choices through incentives, and in addition build the necessary incentive structures for the future. Positive change will be the result of a concerted effort by the governor and the legislature, through partnering with local communities, in a long-term commitment to maintain positive momentum. The key is elevating the discussion of health and health care to the statewide level.

One of the most effective mechanisms for solidifying that long-term commitment to bringing positive change to Alaska’s health care system is to establish through statute a quasi-independent “Alaska Health Care Commission,” which would seek to provide advice on innovative solutions, and act as a catalyst for positive change. The Commission would be responsible for advising state leaders on incentivizing positive lifestyle choices; fostering ongoing research; controlling health care costs; improving access, and ensuring a sustainable health care workforce.

Goal Seven: Health Insurance What’s the problem: Over 100,000 Alaskans— including more than 14,000 children—are without health insurance at some time during any given year. When insurance is made available, there is often a misconception that it should cover everything, from routine and predictable events to catastrophic occurrences and long-term care; this misconception increases the cost of health insurance beyond the reach of many Alaskans.

Why this is important: Having access to health insurance coverage is one of the most significant determinants of access to appropriate health care. Alaskans who do not have health insurance are often unable to get the services they need to become healthy, and to maintain wellness.

When uninsured Alaskans do seek health and health care services, it is often for expensive chronic conditions which could possibly have been avoided if they had had health insurance coverage, or access to appropriate primary care. When Alaskans who may not be eligible for Medicaid and Denali KidCare do access health care, they are often unable to pay and often seek care in a hospital emergency room, which is the most expensive and inefficient mechanism for receiving primary care. The costs of such access are borne across the whole health care system, which raises the overall costs of health care in Alaska. When the uninsured who are not eligible for Medicaid and Denali KidCare do pay for health and health care services, they often do so at significant personal and family financial impact.

Not having insurance is only part of the problem, and simply providing insurance under the current structure is not the answer. With the exception of preventative health services, comprehensive health insurance is not an efficient way to pay for routine and predictable care, such as the common cold, ear infections, hang nails, and sprained ankles.

Whereas health insurance IS the most important tool for protecting people from unplanned catastrophic health events, it is an inefficient way to pay for routine expenditures. Therefore, the current system, which relies on insurance to pay for routine and predictable health care expenses, raises the costs of premiums above the reach of many Alaskans.

What should be done about it: More Alaskans need to be covered by efficient health insurance plans. Increasing the number of Alaskans covered by efficient health insurance will be the result of several specific actions. In the short-term, the Council recommends that the state immediately pursue and support change in the Denali KidCare program to make Alaskan children in families at 200% of the federal poverty level eligible for coverage. While there was a majority vote among Council members regarding this expansion of Denali KidCare coverage, the role of that program within an efficient and effective system of health care coverage is worthy of continued debate at the statewide level, through the recommended “Alaska Health Care Commission.”

To most effectively cover the adults and remaining children without health insurance, bringing consumerism to the forefront of Alaska’s health insurance structure is important. Alaskans should have access to choices, through a wide range of health insurance options, including at the very least high deductible coverage with a strong prevention component. Whereas some uninsured Alaskans are not working, most are working for employers who would like to, but cannot necessarily afford to, provide health insurance coverage for their employees. Therefore, through incentives, Alaskan employers should be encouraged to offer a wide range of coverage choices, to include at a minimum, high deductible coverage.

Consumerism is an essential component of bringing rationality to the health insurance structure in Alaska, and extending coverage to as many Alaskans as possible. The key to success is insurance that at least covers catastrophic care, so no Alaskan suffers from the extreme financial burden of catastrophic or unanticipated health events. In addition, insurance must be consumerowned, market-responsive and portable; this recommendation has received attention elsewhere in this report. Coverage options debated in the Council’s discussions, which are by no means exhaustive, include Health Savings Accounts, Health Opportunity Accounts, and high-deductible plans with a strong prevention component. This list provides a solid foundation from which to continue the ongoing discussion about expanding health care coverage for all Alaskans.

February 2008—Alaska Nurse—Page 7

Summary and Conclusions Resolving the health and health care issues in Alaska will not be the result of a single solution.

Instead, bringing real and lasting change means working together in partnership. Many of the solutions presented within this report fall squarely within the purview of state government. But no matter how committed state government is, solutions will not be forthcoming without involving all stakeholders as partners for change —from individual Alaskans to families, nonprofit organizations and private sector employers and employees, communities and local governments, tribal entities, state government, the governor, the legislature, and the federal government.

The Council has deliberately not prioritized solutions for solving the problems it has identified with the health and health care system in Alaska.

Indeed, all of the problems must be addressed concurrently if real, long-term change is to take place. Having said that, within those identified by the Council, one is definitely the larger-order problem, meaning if we can solve it, many of the other problems will be alleviated. That problem is the lack of prevention and personal responsibility.

By improving the place of prevention and personal responsibility in the health and health care decision-making rubric of Alaskans, costs of health care could be lower than they otherwise would be.

With concentration on a wellness model of health care, as well as state support for the Community Health Center system and a robust public nursing program, the current access problems could be significantly reduced. Most Alaskans will have both the motivation and the means to maintain their own wellness. And with greater wellness, the composition of the health care workforce will likely change, decreasing the dependence on health care professionals who are the most difficult and most expensive to attract and retain.

Becoming the healthiest people in the nation is indeed a grand vision—but it is real and achievable.

Respectfully Submitted, The Alaska Health Care Strategies Planning Council December 23, 2007

Page 8—Alaska Nurse—February 2008

Commentary: Initiating Market Forces in Alaskan Health Care

by Thomas J. Hendrix, PhD, RN In any debate over policy matters, there are foundational or “first” principles from which policy flows. For example, the Council did not believe there was a “right” to health care in the manner that we think of freedom of speech or religion. That is, one can exercise their right to speech or religion without infringing or reducing the rights of others. If the Council had Dr. Thomas wrongly concluded that there Hendrix; was a “right” to healthcare, appointed by policies would certainly follow Governor Sarah that would have come at the Palin to the expense of the property rights AHCSP Council of those paying the bill. From in 2007. this first principle it therefore follows that public expenditures for healthcare are finite and open to debate and must be justified to those paying the bill. That said, though not a

“right”, health care is indeed a “public good” and we (the citizens) should strive to provide access to quality healthcare at an efficient price to as many citizens as possible. To this end, the Council made some excellent recommendations that, if followed, could help provide an avenue to reach this goal.

The Council stressed in many ways the need to increase market forces in the health care system; that people should have some financial “skin in the game” which, in turn, would provide incentives for better lifestyle choices based on cost savings for care. The current system, which leans heavily on comprehensive private insurance or “free” government programs, provides little or no incentive for consumers to be cognizant of the cost of services they receive. After all, why should they? Once covered by comprehensive private insurance the incentive to shop wisely based on price is gone and, if covered by a public program, healthcare is effectively free. The current system must change to allow the “invisible hand” of the market to begin to work its magic on a system that currently has few market forces.

The Council concluded that health insurance is a very inefficient way to pay for routine and

predictable health care services and that the routing of these services through an insurance product increases overall cost by 12 to 15%. Auto insurance doesn’t pay for routine oil changes and homeowners insurance doesn’t cover predictable upkeep. If they did, the premiums charged would be much higher. Likewise, routine and predictable health care expenditures should be paid for directly by consumers through the use of a vehicle like a Health Savings account.

The use of these accounts would provide direct financial incentives for consumers to shop wisely because every dollar saved can be kept. The Council recommended creating and expanding consumer accounts. However, market shopping for routine and predictable care is difficult, if not impossible, unless each consumer is easily able to access quality and price information prior to making health care shopping decisions. To address this need, the Council recommended a statewide website that would allow consumers quick and easy access to up-to-date quality and cost information for healthcare products and services. This would make comparison shopping a possibility which, in turn, should put downward pressure on prices over time as providers would have to finally compete based on price.

Though the Council made many important recommendations, including the expansion of nursing education, none offer more hope for positive, market-based structural change than the direct purchase of health care services by incentivized consumers armed with accurate price and quality information.

[Dr. Thomas Hendrix is an Assistant Professor at the UAA School of Nursing. He has a Master’s degree in Health Services Administration, a Master’s degree in Adult Health Nursing and a PhD in Health Policy & Administration with an emphasis in Health Economics.]

February 2008—Alaska Nurse—Page 9

Update from the Board of Nursing Frequently Asked Questions Delegation by Nurses to Unlicensed Assistive Personnel (UAPs) Where are the regulations related to delegation to unlicensed assistive personnel (UAPs) located?

The specific regulations 12 AAC 44.950-975 pertain to Standards for Delegation of Nursing Duties to Other Persons (unlicensed assistive personnel). You can find a copy of the statutes and regulations on the website www.nursing.alaska.gov or a copy can be requested from the Board of Nursing office (907-269-8161).

Nancy Sanders, PhD, RN, Executive Administrator, Board of Nursing

Who are UAPs??

CMAs, CNAs, PCTs, PCAs, school secretaries, etc. Anyone not licensed as a health care provider.

To whom can nurses delegate the administration of medication?

Home and community based services providers and residential supported living services providers.

I’m a CMA in a physician’s office. The nurse gave me a pill to take to the patient. Can I do that?

No, this practice does not fall under home or community based settings (AAC 44.965 (b)(1)&(2))

Can nurses delegate injections to unlicensed assistive personnel (UAPs)?

No, 12 AAC 44.970 (13) states that the administration of injectable medications cannot be delegated to UAPs.

I am a nurse and have delegated obtaining blood glucose levels on Mrs. Evans to the UAP. The UAP took the reading and charted it, but did not tell me the reading was 250. Who is responsible?

The nurse is ultimately responsible for the tasks delegated to the UAP (12 AAC 44.950 (d). Also, if the patient is not stable and predictable, the task should not have been delegated (12 AAC 44.950 (a)(3) & 12 AAC 44.970 (10)).

Can a nurse delegate insulin injections to a UAP? NO. Injections cannot be delegated.

I work in a physician’s office as an appointment clerk. The nurse wants me to give out medication samples. Is this legal?

No, that is considered dispensing which falls under the realm of Advanced Nurse Practitioner practice (12 AAC 44.447).

Mountain-Pacific Quality Health: A Resource for Nurses

by Carol Kopec As an Alaska nurse, you probably know about most of the state’s many professional and health advocacy organizations that provide resources to professionals like yourself. Mountain-Pacific Quality Health joined this constellation of resource providers in 2005, and because of its relatively recent appearance on the scene, you might not be aware of exactly what it is or has to offer you.

In Alaska, Mountain-Pacific functions as the state’s Medicare quality improvement organization (QIO). Working under a contract with the Centers for Medicare & Medicaid Services, it provides quality improvement support to hospitals, physician offices, nursing homes and home health agencies. With an eye to protecting the health of Medicare beneficiaries, it also distributes preventive health care information to seniors and is the place they can turn with questions or concerns about the care they’ve received under Medicare. In addition, Mountain-Pacific assists hospital coders with common and difficult coding issues and case managers in following Medicare regulations.

Mountain-Pacific focuses on specific areas of patient care. It partners with hospitals working to improve perisurgical patient safety and the care of heart attack, heart failure and pneumonia patients.

In the area of home health, it promotes telehealth and assists agencies, hospital staff and physicians committed to keeping hospital discharges from ending up back in the hospital.

If you work in a nursing home, you may have seen the Nursing Home Insider newsletter or attended a workshop or teleconference on pain or staff immunizations. Other areas of focus are pressure ulcer and physical restraint reduction. In doctor’s offices, Mountain-Pacific helps practitioners implement new health information technologies and improve communication across cultural barriers. In all health care settings, Mountain-Pacific provides free tools, resources, education and consulting services.

A recent survey showed that Alaska providers find Mountain-Pacific to be a valuable resource (with value scores from various types of providers ranging from 88 to 99 percent). Their satisfaction may come not only from Mountain-Pacific’s professionalism and expertise, but also because the times are right for the kind of help it offers.

Health care is changing. Nursing homes are moving away from institutional, medical models toward more homelike and person-centered environments. Technology is now allowing for better monitoring of patients by agencies and physicians.

And as has always been true, providers, including nurses, want to use tools and systems that produce the best possible outcomes or try new ones when that doesn’t happen. Mountain-Pacific can help in

Can nurses delegate the administration of PRN controlled substances to a UAP? No, PRN controlled substances are not delegatable under the regulation 12 AAC 44.964(e).

The physician employs a CMA and wants the nurse to supervise the CMA starting an IV and giving IV push medications. Is this a proper role for the nurse?

No, this nursing duty is not delegatable by the nurse to a UAP. The nurse cannot be involved in supervising this activity. The delegation and supervision has to be by the physician. This includes ANPs; they can not delegate this task or supervise the CMA. But the physician ordered it.

It does not matter. The delegation including supervision of the CMA performing this IV start and IV push by the RN or ANP violates the nurse practice act.

Further questions can be directed to: Nancy Sanders, PhD, RN Executive Administrator, Board of Nursing nancy.sanders@alaska.gov

Here CEO Janice Connors and Alaska Hospital Project Lead Kathy Boulton present Susan Childers, chief operating officer of Alaska Native Medical Center with one of three 2007 MountainPacific Hospital Quality Awards given to Alaska hospitals. these situations, bringing news and training from successful practices and practitioners.

Mountain-Pacific’s Alaska office is in Anchorage (907-561-3202 or 877-561-3202, toll-free), where Director Sharon Stiassny and Medical Director Dr. Jerome List welcome inquiries. Mountain-Pacific’s corporate headquarters are in Helena, Montana, where staff support Alaska projects if needed. Besides serving the states of Alaska, Montana, Wyoming and Hawaii in the role of QIO, Mountain-Pacific also provides health care utilization review to private and public agencies.

[Carol Kopec is a Communications Officer with Mountain-Pacific Quality Health.]

Page 10—Alaska Nurse—February 2008

Nurses in the News Wanted: News items about Alaska Nurses.

If you want to publish awards or announcements regarding Alaska nurses please email editor@aknurse.org.

Cindy Nimmo, FNP has opened the Sterling Clinic in Sterling, Alaska. She has been seeing patients since December and has found the community very supportive.” I have had many people donate time and efforts and help with remodeling. We have one member of our community that has donated his snow plow and back hoe to keep my parking lot cleared during the winter!” As far as she knows, NP Nimmo is the only health care provider between Girdwood and Soldotna. Phone 907-260-7729

experience and dedication. Kitty exemplified the standards of nursing and a wonderful advocate to all patients at all times.

“She was my mentor and friend, and in 2006 she retired and moved to Pascoe, Washington. As her last supervisor I felt she deserved to receive this award and had already started the process when we received word that she had died. The staff of Internal Medicine decided to submit the nomination in her memory.

She will be greatly missed, however her accomplishments during her lifetime career in nursing will stand as a living tribute in the memory of those who knew and loved her.

I am proud to nominate Kitty for this award.”

Captain Cindy L. Wilson, RN, BC, MPH, MSN In addition to LPN Cloud and the nurses pictured on page 3, the March of Dimes honored a number of other nurses in the state. The following nurses were recognized for offering an exemplary standard of care within their specialty, elevating the status of nursing and serving as agents for change within their work force or community.

Jill Barnes, past president of the Alaska Nurse Practitioner Association left Alaska in January for Washington DC to work for the United States State Department. From there she will go to Albania (yes, Albania!) to provide care for State Department employees. She has promised email updates. *******************************************

Newly opened health clinic owned by Cindy Nimmo, MNSc, FNP-BC *******************************************

March of Dimes 2007 Nurse of the Year Awards Legend of Nursing Award—Kathleen (Kitty) Cloud, Retired LPN, Alaska Native Medical Center Kitty Cloud was nominated for the 2007 Alaska March of Dimes “Legends of Nursing Award” posthumously for her commitment to nursing practice and the strict standards that she adhered to , her professional performance, enhancement of the image of nursing and work as a leader, mentor and change agent during her twenty-two years of practice at the Alaska Native Medical Center.

As role model and mentor she was instrumental in convincing several high school students and interns that nursing was the profession of choice.

A leader who constantly studied how business was performed, making suggestions for improvement and watched as they were implemented, she coordinated efforts to define and write–up policies and procedures to improve care.

Always cheerful, quick to provide encouragement and praise, self-effacing, impressing new nurses with her immense

1. Advanced Practice Julie Ostrand, of 3rd Medical Group, Elmendorf AFB 2. Ambulatory: Wendy Beal of the 3rd Medical Group, Elmendorf Air Force Base 3. Behavioral Health Nurse is Kathy Nussbaum of Providence Kodiak Island Counseling Center 4. Case/Quality Management, Managed Care Nurse is Gwendolyn Carlson of Southcentral Foundation 5. Community/Public Health Nurse is Colleen Barry of Meadow Lakes Elementary School 6. Critical Care, Adults Nurse is Dee West of Alaska Native Medical Center 7. Education/Research Nurse is Cindy Roleff of Alaska Native Medical Center 8. Emergency Nurse of the Year is Dianne Dalen of Fairbanks Memorial Hospital 9. 2007 Friend of Nursing is Kris Green of Providence Alaska Medical Center 10. General Medical/Surgical Nurse is Linda Harrington of Alaska Native Medical Center 11. Rising Star is Ellen Reeder of Providence Alaska Medical Center 12. Women’s Health Nurse is Charlotta Leader of 3rd Medical Group, Elmendorf AFB ******************************************* ANPA Elects 2007-2008 Officers The Alaska Nurse Practitioner Association elected the following officers for 2007-2008; Dianne Tarrant, President; Martha Herriott, President-Elect; Kathryn Sexson, Secretary, and Maggie Fitzgerald, Treasurer.

Dianne Tarrant, Family Nurse Practitioner

Marty Herriott, Psychiatric Nurse Practitioner

Kathryn Sexson, Family Nurse Practitioner

Maggie Fitzgerald, Family Nurse Practitioner

February 2008—Alaska Nurse—Page 11

December 2007 Nursing Graduates AAS Nursing Graduates Fairbanks Berg, Wendy L. Callahan, Jamie M. Carpenter, Robert L. Cordova, Jacqueline D. Duran, Maribel Hampey, Jessica A. Helfenstein, Vikki E. Humphrey, Caleb G. Karras, Brenda L. Phifer, Jeralyn K. Robinson, Cassidy S. Schmidt, Brenda M. Vanderpool, Arlene G. Wolcott, Stephanie L. Ybarra-Oberrecht, Orlanda C. Homer Belieu, Marjorie A. Christiansen, Amy L. Ferman, Cristina J. Hyman, Marianne James, Jessica R. Sealman, Amy L. McHenry, Heather R. Rothenberger, Heather L. Juneau Browne, Deanna M. Farabee, Lincoln C. Hirsch, Oran K. Koski, Heidi J. Peterson, Kimberly C. Reifenstein, Amy L. Shepherd, Barbara L.

Ketchikan Avila, Emily D. Blanks, Leanne M. Grass, Thomas J. Hasibar, Mary F. Hinkle, Brett W. Kelly, Sherity L. Lyshol, Christine M. McGhee, Vanessa M. Mergenthal, Rosa L. Singer, Sandra L. Kotzebue Baker, Gloria D. Mat-Su—AAS Churchill, Letitia A. Houser, Gerald M. Kolberg, Julie A. Koslo, Heidi A. McLellan, Ami D. Martinez, Kimberly P. Mayfield, Lorie A. Van Thiel, Marissa J. BS Nursing Graduates Broderick, Doreen C. Brown, Lindsey E. Byrd, Romy C. Cathey, Leah J. Easley, Kathleen A. Edmondson, Anna C. Elmer, Larenda K. Gallardo, Jarrett E. Gourley, Cassandra B. Gross, Sarah E. Harris, Heidie M.

Congratulations New Graduates!

In December of 2008, the following students received nursing degrees from the University of Alaska. In addition to their degrees several students were honored with awards: 1. The Director’s Award: given to the student with the top GPA in the class.

2. The Spirit of Nursing: awarded by the faculty to the student who they feel demonstrates the spirit of caring, compassion and love of learning and science.

3. The Peer Award: given by the senior class to a fellow classmate who has completed their nursing studies while balancing the daily demands of life.

Welcome new graduates and well done!

Awards BSN Program Director’s Award: Doreen C. Broderick Spirit of Nursing: Rachel Rhodes Peer Award: Larenda Elmer PN Program Anchorage Director’s Award: Raegen Mundy Spirit of Nursing: Amanda Fisher Peer Award: Diane DeNio PN Program Fairbanks Director’s Award: Eun Jung Moore Spirit of Nursing: Elizabeth Wiedmaier Peer Award: Katrina Mailloux

Heller, Jackie L. Herron, Holly K. James-Liberty, LaVonna S. Jang, InYoung Kim, Hyona Lee, Mary R. Lewis, Tina M. Luvsandagva, Narangerel McIntyre, Rachelle A. Murrell, Amy A. Nicholas, Virginia L. Palmer, Jessica L. Powell, Jessica L. Rhodes, Rachel D. Rottman, Sara C. San Miguel, Ivy Lauren Schneider, Brian E. Stone, China K. Suydam, Myriah L. Swain, Zelda C. Sykes, Genevieve M. Teninty, Melissa A. Waggood, Rhianne E. Weber, Samantha L. Williams, Amanda L. Wright, Callie M. MS Graduate Weatherby, Eileen V. (2nd Master’s) Dara M. Whalen PN Graduates—Anchorage Cooper, Dessie N. DeNio, Diane N. Endecott, JoAnna L.

Felix, Hannah G. Fellman, Rhonda L. Fisher, Amanda R. Johnson, Eileen C. Knapp, Casy L. Mundy, Raegen R. Oliver, Erica Y. Polushkin, Agripina I. Richardson, Dacia E. Savage, Vivian D. Torrence, Theresa L. PN Graduates—Fairbanks Alexander, Sherlyn M. Bergner, Cara C. Cressley, Crystal M. Leslie-Wood, Evelyn V. Mailloux, Katrina M. Moore, EunJung Rachel Petty, Christine M. Thompson, Tamara L. Wiedmaier, Elizabeth J.

Page 12—Alaska Nurse—February 2008

Ketchikan Nurses Retreat and Nurse Awards

Membership Application

Submitted by Rebecca Bolling, FNP Nearly 80 nurses gathered together for massages, pedicures, manicures and dinner in October for the 4th Biannual Nurses Retreat in Ketchikan. The Ketchikan Nurses Association (KNA) organized the event but local businesses, organizations, the medical community and individual donors donated funds and gifts for the nurses who attended the event. This year the KNA raised over $5000 which provided community nurses with both the day’s activities and a prime rib dinner.

Yoga sessions and jewelry making workshops were also offered. Following an afternoon of retreat activities, the Nurse of the Year and the Spirit of Nursing Awards were presented to Ann Fama, RN and Linda Gilson, ANP respectively for their contributions to nursing and to the community of Ketchikan. Judy Glasspool, RN shared poetry she had written over the years about nursing, including a poem she wrote 41 years ago as a new graduate nurse called Nurse Pride. She also shared one written more recently called Forty One and Counting, as well as one she wrote especially for the Nurses Retreat entitled Retreat of the Nurses.

During dinner, Margie Gilmon, ANP, provided a presentation on Nursing Without A Paycheck, which highlighted a trip she had made to Moldova to provide health care services to indigent people in this region of Eastern Europe. She offered information about her experiences and tips on what to keep in mind if one is interested in being a nurse volunteer to needy populations in foreign countries.

This year’s event was the largest since the inception of the Nurses Retreat in 2001. This year’s attendees included 66 RNs, 10 CNAs, 2 LPNs and 2 student nurses. A great time was had by all and many nurses shared how appreciated the felt by the community of Ketchikan. A big thank you to all the sponsors of this years event for their generosity and appreciation of the nurses in their community.

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 * EDPP is the monthly Electronic Dues Full time student Payment Plan Amount New graduate from basic Nursing Education program, within first six = Yearly dues/12 months after graduation (first year only), or months + $.50 per 62 years of age or over and not earning more than Social Security allows. month service charge Special Membership—Not employed and 62+ years or totally disabled

Dues

Anchorage Monthly (*EDPP) & Fairbanks Yearly

Full $28.00 $330.00

Reduced $14.25 $165.00

Special $7.38 $82.50

All Other Locations

$322.50 $27.38

$161.25 $13.94

$80.62 $7.21

Yearly Monthly (*EDPP)

______________________________________ 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

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

_____/_____ $_______ _______________________________ Expiration Amount 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

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.

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 ❏ 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 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. ❏ Professional Nursing Practice Issues— Taskforces will consider issues relating to AaNA’s policy on RN practice and other professional issues. ❏ 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 second Monday of the month. Current Chair is Pat Senner. ❏ 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. ❏ 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. ❏ 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.

February 2008—Alaska Nurse—Page 13

Case Management Chapter Planned Join Alaska case managers in forming a Chapter of Case Management Society of America. CMSA’s mission is to positively impact and improve patient wellbeing and patient healthcare outcomes.

Network with other case managers, have ready access the multiple resources and educational opportunities available to members both on-line and locally. Improve your knowledge, skills and ability to advocate for Alaska’s patients. Call or e-mail Patricia Ennenga to be added to the mailing list for upcoming meetings, teleconferences and events. psennenga@scf.cc 907-729-3302. Visit www.cmsa.org to learn more.

Alaska Nurse Alert If you are signed up as a volunteer in the ALASKA NURSE ALERT SYSTEM (ANAS), you are part of a valuable group of 355 nurses throughout our state.

In 2007, you had access to or received: ~~ 9.75 FREE continuing education units on topics ranging from Pandemic Influenza to the Anchorage CDC Quarantine Station ~~ A brochure describing what a disaster call out may be like and what items you should bring along ~~ Six e-newsletters on many topics related to disaster preparedness and response ~~ An invite to be a “volunteer patient” in an Anchorage city wide drill to get the feel of what it would be like to be moulaged, triaged, transported and treated at one of the hospitals ~~ Information on assisting around the state to vaccinate our population with Flu vaccine and learn how mass immunization clinics set up and operate ~~ Further continuing education (some for ce credit) on pertinent information regarding topics such as the Incident Command System, Principles of Emergency Management, etc. ~~ The feeling of being part of a group of valuable and knowledgeable volunteers!

Our organization is growing and expanding! We are being included in disaster response plans at the local and state levels. If you are already signed up in the Alaska Nurse Alert System, THANK YOU! If you want to become a member of ANAS or have questions, please call LeMay Hupp at 274-0827 or go to the web site: www.nursealert.org or email at: info@nursealert.org

Spotlight—CRNAs Nurse Anesthetists Bring Better Care to Neighborhoods and Communities For Certified Registered Nurse Anesthetists (CRNAs) it's all about being there. During the ninth annual National Nurse Anesthetists Week, January 20-26, 2008, CRNAs were celebrating more than a century of providing safe, high quality anesthesia care to patients in urban and rural communities across America.

"CRNAs play a critical role in any surgical procedure, which is why we never leave the patient's side during surgery, said Wanda Wilson, CRNA, PhD, MSN, president of the 36,000-member American Association of Nurse Anesthetists (AANA). "We know from our education and experience that whether it's a small town hospital, or the trauma center in a metropolitan city, access to anesthesia care is important to any thriving community. That's why CRNAs practice in every setting where anesthesia care is delivered, and are the sole anesthesia providers in nearly 100 percent of rural hospitals."

National Nurse Anesthetists Week was established in 2000 to allow CRNAs and the AANA to educate the public about anesthesia, the education and qualifications necessary to become a nurse anesthetist, and what questions the patients should ask prior to surgery. Nurse anesthetist have been around since World War I, and have provided anesthesia care in every military conflict since that time.

While patients are asleep the majority of the time that they are under the care of a nurse anesthetist, many associate their anesthesia experience with the fading of surrounding noises and sounds, to later find themselves awakening in a recovery room. When in actuality, CRNAs are with the patient during the entire procedure inducing sleep, monitoring vital

signs adjusting anesthetic levels and safely reviving a patient after surgery is complete.

"In the end, it's important that patients know they are in the hands of a qualified anesthesia provider that is there to make their surgical procedure more comfortable every step of the way. A great deal of the public are unaware of who we are and what we do, despite the fact that nurse anesthetists deliver approximately 27 million anesthetics each year," added Wilson.

As a result of adhering to high practice standards, in last 20 years, the number of patient deaths related to anesthesia has declined from approximately two for every 10,000 to approximately one for every 240,000 anesthetics administered. Other attributions to this improvement include the advancement of monitoring technology, anesthetic drugs, provider education and the involvement of CRNAs in most of the anesthesia care provided in the United States each year.

About the American Association of Nurse Anesthetists (AANA) Founded in 1931 and located in Park Ridge, Ill., the AANA is the professional organization for more than 90 percent of the nation's CRNAs. As advanced practice nurses, CRNAs administer approximately 27 million anesthetics in the United States each year.

CRNAs practice in every setting where anesthesia is available and are the sole anesthesia providers in more than two-thirds of all rural hospitals.

Additional information about the AANA is available on the internet at www.aana.com.

Source: Armentia D. Snyder, BA American Association of Nurse Anesthetists

Page 14—Alaska Nurse—February 2008

Resources WGU Future of Nursing Scholarships Western Governors University is pleased to offer the WGU Future of Nursing Scholarships to eligible candidates. These scholarships are designed to help working nurses attend college online to become educators, managers, and leaders in the vital healthcare field. Each scholarship is valued up to $5,000. The scholarship will be credited to the recipient’s account at the rate of $1,000 per six-month term for up to five terms.

Tuition for a six-month term is $3,250, less the $1,000 per term scholarship.

Scholarships are awarded based upon a candidate’s academic record, readiness for online study, financial need, and current competency, plus other considerations. The scholarship awards are based on a reasonable experience of five sixmonth terms to complete a program, but may be completed sooner depending on the incoming student’s prior experience, academic background, and time commitment to study.

Who Should Apply Unencumbered

(not

under

suspension,

revocation or investigation) licensed RNs who hold a Bachelor of Science in Nursing degree and individuals interested in one of the following master’s degrees: Master’s of Nursing-Education and Master’s of Nursing-Leadership and Management should apply as soon as possible.

These are competitive, needs-based scholarships. Apply now and if all your admissions information is completed in a timely fashion, and you are awarded a scholarship, you could start as early as the first of the following month. All WGU students begin classes on the first of each month, for every degree program. For detailed information about eligibility requirements and application, go to: http://www.wgu.edu/msnscholarship or call toll-free 1-866-225-5948, extension 1693. ******************************************* Robert Wood Johnson Foundation Funds Center To Champion Nursing SILVER SPRING, MD—The American Nurses Association (ANA) applauds the Robert Wood Johnson Foundation (RWJF) in addressing the 1.1 million-nurse workforce shortage that is currently

poised to strike America’s health care system by 2020, by creating the Center to Champion Nursing in America.

The newly created Center to Champion Nursing in America will work to improve patient care for all Americans by pursuing an aggressive agenda to elevate the visibility of the nursing shortage while identifying actionable solutions to improve the quality of patient care. The Center is made possible by a $10-million grant to the AARP Foundation from RWJF. [ANA news release 12/11/07] ******************************************* Let ANA Nurse's Career Center work for you Too busy to look for a job? Need to recruit but don't have time? Let ANA Nurse's Career Center do the work for you. Sign up for Job Alerts, instant e-mail notifications of new job postings that meet your criteria. Employers with job postings can receive Resume Alerts, instant e-mail notification of new resume postings that meet your criteria.

Sign up today at www.nursescareercenter.com.

The National Diabetes Education Program (NDEP) has developed a free series of tip sheets to encourage teens with diabetes to reach out and get support from others and take action to manage the disease. The Tips for Teens with Diabetes tip sheet series are helpful for anyone who has diabetes and his or her loved ones and also includes a tip sheet to help teens lower their risk for type 2 diabetes.

Lower Your Risk for Type 2 Diabetes provides advice about how to reach a healthy weight and lead an active lifestyle. These free tip sheets can be downloaded or ordered by visiting www.

YourDiabetesInfo.org or calling 1-888-693-NDEP.

February 2008—Alaska Nurse—Page 15

Upcoming Events 5 ( * , 6 7 ( 5 1 2:

******************************************* 2008 Nurse Leadership in Native Care Conference May 12-15, 2008

49&0-' ,)%08, 2967)7 '32*)6)2') %TVMP ˆ ,SXIP 'ETXEMR 'SSO %RGLSVEKI %/

4VSQSXMRK 4YFPMG ,IEPXL 7XVEXIKMIW JSV E 2I[ )VE ˆ )RZMVSRQIRXEP ,IEPXL 0M^ &PEGOFYVR ERH &EVFEVE 7EXXPIV ˆ 7SGMEP .YWXMGI &IXX] &IOIQIMIV ˆ 'SQTIXIRGMIW MR 4,2 4VEGXMGI /VMWXMRI +IFFMI ˆ %XXIRHIIW JVSQ EVSYRH %PEWOE 4EGM½G 2SVXL[IWX ERH ;IWXIVR 'EREHE ˆ 'IPIFVEXI 4YFPMG ,IEPXL 2YVWMRK ˆ 4VSYH XS FI SJJIVMRK E +VIIR 1IIXMRK ˆ ')9´W [MPP FI EZEMPEFPI ˆ 0IEVR QSVI ERH VIKMWXIV RS[ EX

[[[ WMKRYT GSQ 4,2 *SV QSVI MRJSVQEXMSR TPIEWI GSRXEGX :MWMSRW 1IIXMRK )ZIRX 1EREKIQIRX 4LSRI ˆ ) QEMP VSF]R PERKPMI$ZMWMSRWYW GSQ

******************************************* ATTENTION - SPECIAL OPPORTUNITY!!

WHO: Effie PY Chow, PhD, RN, L.Ac, Dipl.Ac (NCCAOM), Qigong Grandmaster WHAT: Chow Medical Qigong System—100 Hour Course Certification—CEUs for nurses which provides an opportunity to obtain needed credits for up-coming re-licensure 11/08 WHERE: Providence Health Systems new Cancer Center WHEN: Three Week-end Sessions: 4/18/08 -4/20/08, 5/16/08-5/18/08 and 9/12/08-9/14/08.

WHY: To expand your understanding of energetics of Chow Medical Qigong, Traditional Chinese Medicine, and mind/body/spirit wellbeing in regard to health promotion and disease prevention.

NOTE: This will offer you an opportunity to use Chow Medical Qigong to promote your own health, as well as, the health of your family members, friends, co-workers, clients and patients. Contact Debbie Thompson @ (907) 278-1070 & email @ thodebbie@gmail.com and/or Kay Lahdenpera @ (907) 243-9502 & email @ vklahdenpera@aol.com— for further information.

COST OF THE 100 HOUR COURSE: A special rate of $1990. is to be paid in full by 3/17/08.After 3/17/08 registration increases to $2250. 500 deposit will not be refunded. Refunds will occur in the case of a hardship, such as, a death or unexpected illness, which needs to be accompanied by a health care providers note). ________________________________________

New Directions in the New Frontier: Education, Evidence and Empowerment Anchorage, Alaska Jointly sponsored by the Alaska Native Medical Center, the Indian Health Service (IHS) Division of Nursing and the IHS National Nurse Leadership Council.

Hotel Captain Cook 939 West 5th Avenue, Anchorage, AK 99501 (907) 276-6000 www.captaincook.com AUDIENCE Designed for nurse administrators, directors of public health nursing, nurses, public health nurses, and advanced practice nurses working for Indian health programs. This CE seminar provides an opportunity to network with peers/colleagues on nursing issues of common concern, update knowledge of current nursing trends/issues and enhance nursing practice to improve patient care, as well as receive accredited continuing nursing education.

CURRICULUM The agenda will include plenary and concurrent workshop sessions and poster presentations on a variety of clinical and public heath nursing topics focused on leadership, education, evidence-based practice and best practices. On Tuesday afternoon, conference participants will be transported to Alaska Native Medical Center to tour the Magnet Hospital which houses the largest collection of Alaska Native artwork in the world as well as network with staff nurses as they share evidencebased practice projects, shared governance experiences, and other innovative programs.

On-line access to the agenda and registration materials will be available in late March. Visit the NCONA Conference Website: http://www.ihs.gov/ MedicalPrograms/ncona/ncona-conferences.asp.

ACCREDITED SPONSOR Alaska Native Medical Center is an approved provider of continuing education by the Alaska Nurses Association, an accredited approver by

the American Nurses Association Credentialing Center’s Commission on Accreditation. Provider Number AP-06-002.

LODGING A block of rooms has been reserved at the Hotel Captain Cook in Anchorage with a special group rate of $105 + tax single or double occupancy per night. Note: for those wishing to see some of Alaska, this rate is good for three days before and three days after the conference, on a space available basis. ******************************************* American Academy of Nurse Practitioners 2008 National Convention June 26–July 1, 2008 Gaylord National on the Potomac in National Harbor, Maryland www.aanp.org ***************************************

Alaska Nurse Practitioner Association’s 25th Annual Conference September 25, 26, and 27th, 2008 Anchorage Downtown Marriott Alaskanp.org *************************************** Call for Abstracts American Assembly for Men in Nursing Conference American Assembly for Men in Nursing ** 33rd Annual Conference October 24th and 25th, 2008—New Orleans Louisiana Men in Nursing: Another Way of Caring The American Assembly for Men in Nursing is currently accepting submissions for oral and poster presentations for its annual conference, hosted by the Louisiana State University Health Sciences Center School of Nursing. AAMN is seeking submissions from a variety of Disciplines as well as Nursing to present in New Orleans.

Deadline for Submissions: April 30, 2008. For more information go to aamn.org/