The Alaska Nurse - Vol. 59 No. 1 - February 2009

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

Volume 59 • No. 1

February 2009

Bills Banning Mandatory Overtime for Nurses Reintroduced Senator Bettye Davis (D), co-chair of the Senate HESS Committee, has prefiled SB 12, a bill that will limit mandatory overtime and excessive “call” for nurses in this upcoming legislative session. This bill is based on the bill that passed the Senate last year but died in the House Finance committee. Companion bills have been introduced in the House. Representative Berta Gardner (D) has introduced HB 51 and Representative Peggy Wilson (R) has introduced HB 50. For updates on the bills please go to aknurse.org.

Alaska is attempting to join 15 other states who prohibit the practice of imposing mandatory overtime. Twelve have legislation in place: Connecticut, Illinois, Maine, Maryland, Minnesota, New Jersey, New Hampshire, New

York, Oregon, Pennsylvania, Washington, and West Virginia. In California, Missouri and Texas, regulations restrict overtime hours.

Federal legislation has been proposed to prohibit mandatory overtime numerous times but it has not passed despite evidence showing that excessive work hours increase medical errors. Currently the Safe Nursing and Patient Care Act of 2007 is active in both the House (HR 2122) and Senate (S 1842). It would prohibit mandatory overtime except in cases of states of emergency. Our congressional delegation, Senator Murkowski and Congressman Young have signed on as co-sponsors in their respective houses.

The ANA has taken a position supporting all state and national legislation to ban mandatory overtime for nurses.

Nurses Building A Healthy America

Page 3

ADHSS’s Environmental Public Health Program

Page 9

Genetic Counseling at Providence Cancer Center

Page 10

[Source: American Nurse, Vol 3, No. 12 2008].

Providence RNs Force Reverse on Flu Ultimatum Providence Alaska Medical Center reversed a controversial policy that mandated flu shots for all employees at it's Anchorage hospital on Dec. 18 just ten days after issuing the ultimatum.

As originally stated, employees had to get a flu shot by Dec. 31, 2008 or would be terminated, according to news reports by the Anchorage Daily News on 12/8/08 and 12/19/08.

The Alaska Nurses Association Labor program, which represents Providence nurses, filed a grievance with the hospital soon after the new policy was announced.

Doctors on the hospitals' infection control committee unanimously supported the requirement, though as non-employees, physicians would be one of the few groups not required to get the vaccination.

Neither Alaska Regional Hospital nor the Alaska Native Medical requires all employees to get flu vaccines, but they strongly encourage it.

All Anchorage hospitals provide free flu shots to employees.

The CDC recommends all health care workers get flu shots to prevent spread of disease to vulnerable inpatient populations. Nevertheless, fewer than half of health care providers get flu shots.

According to the Anchorage Daily News more than half of employees at Alaska Regional have been vaccinated and nearly 3/4 of employees at the Alaska Native Tribal Health Consortium.

Before the policy was rescinded 75% of employees at Providence had been vaccinated.

The grievance brought by the Alaska Nurses Association against Providence stated, "Nurses felt their basic rights as United States Citizens were being infringed upon.” Nurses who had been vaccinated felt equally strongly as those who hadn’t that vaccination should be a matter of choice.

As union-represented nurses, the policy subjected nurses to a change in their wages, hours and working conditions, all of which are a right of collective bargaining.

Debbie Thompson, Executive Director of the Association says she hopes to work with the hospital in the future to increase vaccination rates on a voluntary basis and emphasize effective means of prevention of all virus transmission. “Our Mothers taught us to wash our hands after a sneeze or cough, before handling food and after using the restroom and to stay home when we were ill. With Providence Alaska Medical Center and the Alaska Nurses Association doing public service announcements reminding everyone in the community of these basic prevention methods we help prevent the spread of viruses during cold and flu season. When some one is sick, it is important to stay home. Do not visit the elderly, the very young, or those who are immunologically suppressed or those who are hospitalized. If you have been exposed to the flu or are recovering from the flu please follow these same simple rules.”

Inside This Issue From the Editor’s Desk. . . . . . . . . . . . . . . . . . . 2 Nurses Week 2009 . . . . . . . . . . . . . . . . . . . . . . 3 Safe, Competent Nursing Practice . . . . . . . . . 4 Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 AaNA President’s Report . . . . . . . . . . . . . . . . . 7 Nurses in the News . . . . . . . . . . . . . . . . . . . . . 8 Spotlight: ADHSS’s Environmental Public Health Program. . . . . . . . . . . . . . . . . . . . . . 9 Spotlight: Genetic Counseling at Providence Cancer Center . . . . . . . . . . . . 10 The Alaska Nurse Alert System in 2008 . . . 11 Nurses Caring for Their Community—Kenai . . . . . . . . . . . . . . . . . 11 Membership Application . . . . . . . . . . . . . . . . 12 UAA December 2008 Nursing Graduates . . . 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.

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Page 2 • Alaska Nurse

February 2009

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 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.

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: Nancy C. Davis, MSN, RN Vice President: Open Secretary: Diana Robinson, RN Treasurer: Donna Phillips, BSN, RN

From the Editor’s Desk Podcasting Board of Nursing Meetings Lynn Hartz MSN, FNP-BC First, let me introduce my desk mate, a nineteenyear-old Siamese cat who keeps me company working on every issue of The Alaska Nurse.

Second, a very early Happy Nurses week to you. We hope you will “Frosky,” supervises all have fun things to compilation of each do on nurses week and Alaska Nurse although perhaps send in a picture he usually ends up or two for us to put in the napping in the “In” tray. paper. (See Nurses Week page 3).

Third. You will see a very interesting article

by Cathy Giessel, MS, RN, FAANP, Chairperson of the Alaska State Board of Nursing in this issue

on Continued Competency for nurses on page 4; and Commentary on page 6. In the article on “Safe, Competent Nursing Practice: a Promise to Consumers,” Ms. Giessel notes that the BON will be reviewing the current regulations, apparently sometime this year. Review of Alaska's regulations on continued competency and any changes to those regulations will impact every registered nurse and licensed practical nurse in the state.

We are all "stakeholders" in the Board of Nursing's endeavor. Our state is large, travel is expensive and personally attending Board of Nursing meetings is simply not possible for most nurses even though the meetings are public and nurses are encouraged to attend. Audio-conferencing is available but with nurses’ work schedules this is also unworkable for many of us. The minutes of the meetings are available but usually only months later. We at the Alaska Nurses Association believe it is time to take advantage of improved technology to podcast the Board of Nursing meetings to be posted on the Board website. That way the entire audio portion of the meetings which are open to the pubic would be available to the public within one to two weeks. Nurses across the state could download the meeting and stay up to date on portions of the meeting crucial to their practice. When asked about podcasting meetings, Ms. Giessal said the board had not considered that; felt they had a big enough challenge keeping their website updated and “that the State IT staff has a lot to do and we are not the top priority.”

Rules and regulations affect lives; in this case, both nurses and their charges. Those whose lives will be affected by those rules should be given ample time for reflection and input during the review, revision and writing of the regulations.

Notification of proposed regulation changes when the changes are completed is rather late in the game. In the past, when approaching large or significant regulation projects, the Board of Nursing has made use of community expertise and sought input from stakeholders. In my own recollection this was done during the nurse practitioner regulation changes and again during the development of the delegation regulations for UAPs. Subcommittees were formed with one or two Boardmembers and included members of the community deemed to have expertise in the area of regulations being developed. We hope the Board will take a similar course when they begin their review of Continued Competency regulations for nurses.

In the interest of making BON meetings more accessible to the public, the AaNA plans to make formal requests to the state to podcast BON meetings. It is time, and maybe a request from us will help the BON get the technical help they would need. Meanwhile, the AaNA is investigating the feasibility of posting the audio portion of the BON meetings on their website, aknurse.org which could then be downloaded by anyone accessing the site. But, we need to hear from YOU!

Directors: Labor Council (designee): Susan Walsh, RN Greater Alaska Director: Shelley Burlison, RN Staff Nurse Director: Kathleen A. Gettys, BSN, BA, RN Rural Director: Jennifer Straight, RN Director at Large: Carolyn S. Adkins, MS, RN Paul T. Mordini, RN Shirley LaForge, RN Joe Peacott, RN Pat Senner, MS, RN, ANP AaNA Labor Council Chair—Donna Phillips, BSN, RN Vice-Chair—Mary Stackhouse, RN Secretary—Karen Friedl, MSN, RN Treasurer—Megan Orien, RN Directors—Joshua Meals, BSN, RN Directors—Kathleen Gettys, BSN, BA, RN PAMC BU Rep.—Cindy Price, RN Soldotna BU Rep.—Velinda Albrechta-East, RN Ketchikan BU Rep.—Susan Walsh, RN UAN Delegate—Joshua Meals, BSN, 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 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.

This is your space.

What do you think?

We want your opinion.

Is this important to you?

Please email editor@aknurse.org and answer this survey.

1. Do you feel the current Alaska license renewal continued competency requirements help you to stay competent to practice?

2. Would you like the public, audio portion of the Board of Nursing meetings to be posted on the Board website so that you could download them to listen to?

February 2009

Alaska Nurse • Page 3

Nurses Week 2009

Nurses Building a Healthy America National Nurses Week begins each year on May 6th and ends on May 12th, Florence Nightingale's birthday. 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 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. What better way to recognize nurses than to publish the March of Dimes Nurses of the Year for 2008. Congratulations to all these nurses building a healthy Alaska!

[Editors Note: Once again: 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.]

March of Dimes Nurses of the Year 2008 Back row Left to Right: Dave Arthen, Friend of Nursing, ANMC; Connie Lorenz, Ed/Research, AK Regional; Ryan Shercliffe, ER/Flight, Elmendorf AFB; Lesa Ancrews, Mat/Newborn, PAMC; Claire Lewis, APRN, YK Regional Hospital; Therese Thibodeau, Critical Care, Bartlett Regional; Wendy Moore, Case/Quality Mgt., Elmendorf AFB; Atoinette Shinn, Perioperative, Elmendorf, AFB; Robert McCurry, Nursing Adm/Mgt, Elmendorf AFB. Front row Left to Right: Faith Roberts, Pediatrics, PAMC; Denise Harro, Ambulatory Nursing, Central Penn.; Theresa Rodgers, Gen. Med/Surg, ANMC; Angela Ellis, Forensic Nursing, FMH; Donna Mills, Behavioral Health, PAMC; Gina Chegarnov, Rising Star, MSRMC; Julie Hanson, Women’s Health, Elmendorf AFB; Pamela Swanson, Rehab, Long-Term Care, PAMC, Wesley; Leslie Romero, NICU, PAMC.

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February 2009

Safe, Competent Nursing Practice: A Promise to Consumers Catherine Giessel, MS, RN, ANP, FAANP Chair, Alaska Board of Nursing December 2008 The public deserves healthcare that is provided safely, by competent professionals. In fact, they are demanding it. In order to fulfill this expectation, regulatory Boards establish levels of fundamental skills and knowledge needed to enter into a healthcare profession, and issue a license to persons who meet the defined minimum, entrylevel standards.

Knowledge and skills are perishable.

Technology and knowledge advances, faster now than ever before. To assure that healthcare professionals continue to be competent and safe, Boards establish criteria required to renew a license to practice.

Described by National Council of State Boards of Nursing (NCSBN), “Nursing regulation is the governmental oversight provided for nursing practice in each state. Nursing is regulated because it is one of the health professions that pose risk of harm to the public if practiced by someone who is unprepared and incompetent. The public may not have sufficient information and experience to identify an unqualified health care professional, and is vulnerable to unsafe and incompetent practitioners.” (www.ncsbn.org) Continued competency, during the professional life of the licensee, is fundamental to public safety. This concept has been endorsed by the Pew Health Professions Commission, Citizens Advocacy Center, Institute of Medicine (To Err is Human, 2002), National League for Nursing, Joint Commission of the Accreditation of Hospitals, International Council of Nursing and the President’s Advisory Council on Consumer Protection and Quality in the Health Care Industry.

The National Priorities Partnership identified the goals of its 28 national organization members.

The six goals include “improve the safety and

reliability of America’s healthcare system” through “…absolutely reliable care from healthcare professionals intolerant of defects or errors in care, and who constantly seek to improve, regardless of their current levels of safety and reliability.

(November 2008)” “The U.S. health care system is in crisis.

There are too many preventable medical errors and serious problems in the quality of care.

Assuring the continued competence of health care practitioners is an essential element to improve patient safety.” (2004, Citizens Advocacy Center) Measuring Continued Competence The methods used by Boards of Nursing to measure continued competency vary from state to state. Several states require continuing education credits. Some states add clinical practice hour requirements to the CE credits. Some states require nothing more to renew a license than a completed renewal application and payment of a fee. NCSBN Continued Competence Committee is developing a Continued Competence Regulatory Model that could be used by Member Boards, with the goal of standardizing the continued competency requirements among states.

In 2004, the National Council of State Boards of Nursing identified Continued Competency guiding principles and premises: • The primary responsibility of boards of nursing is to protect the public.

• Licensure is a privilege, not a right; therefore, each licensed nurse has responsibility to the licensing entity granting the authority to practice and to the public who receives nursing services.

• Boards have a role in assuring the public that licensed nurses meet minimum standards of competence throughout their professional lives.

• Regulatory approaches to continued competence, in order to be viable, must be: o Administratively feasible o Publicly credible o Professionally acceptable o Legally defensible and o Economically affordable • Attaining, maintaining, and advancing competence is a joint responsibility between the individual nurse, employer, licensing board, educator and profession.

In addition, other premises considered by NCSBN and Boards in developing continued competence models are: • The public expects safe and competent nursing care.

• The public expects Board of Nursing to regulate the practice and monitor the competence of nurses through their careers.

• The nurse is responsible for maintaining competence in nursing practice through the

Communicate with the Board of Nursing Get on the listserv: http://www.dced.state.ak.us/occ/pnur.htm Website: www.nursing.alaska.gov or find the link at www.aknurse.org Email: Nancy Sanders, PhD, RN Executive Administrator nancy.sanders@alaska.gov Phone: (907) 269-8161 Fax: (907) 269-8196 Next meeting: April 8-10, Juneau Alaska Call if you plan to attend or wish to join by audio conference 907-269-8161

process of life-long learning. It is an essential component of professional accountability.

• Professional accountability also requires nurses to recognize limitations and place themselves in settings and roles that allow them to function safely.

• Minimum, essential competence for safe practice includes elements such as critical thinking, interpersonal relations, basic nursing principles and aspects of jurisprudence/ethics.

• Continued competence requirements apply to endorsement, renewal and reinstatement of licensure.

• Re-entry into nursing practice following a significant period of absence from practice requires evidence of current knowledge, skills and abilities.

• What constitutes “minimal, essential” varies over time, just as advances in knowledge and technology vary over time.

• Excellence is desirable but is within the purview of the professional rather than the regulatory community. Collaboration between the professional and regulatory communities is both logical, and reasonable since growth and excellence are on a continuum with minimal, essential.

There are nearly 2.9 million nurses in the United States. There is tremendous diversity of practice for nurses, unlike other health professions whose practice is much more narrow and focused. Healthcare technology, and therefore the complexity of nursing, is increasing rapidly.

With the large number of nurses, monitoring continued competence is challenging and could be expensive.

In contrast, the airline industry has very high standards for competence. The pilots who Safe, Competent Nursing Practice continued on page 5

February 2009 Safe, Competent Nursing Practice continued from page 4 fly Alaskans on commercial airlines must, on a yearly basis, successfully complete simulator testing, demonstrating actual flying skills, as well as written testing. Failure to meet competence requirements means loss of a pilot’s license. Pilot age and health also affect their license status.

Use of alcohol or drugs while on duty results in immediate loss of a pilot’s license. These standards are considerably stricter than those for healthcare professionals, who prescribe medications and perform invasive procedures. Yet we would not want anything less from those who pilot large pieces of machinery, transporting hundreds of people, through our airways every day.

Many healthcare professions are beginning to use retesting as a measure of continued competence. Physician Assistants, emergency room physicians, pediatricians and family practice physicians are a few groups who now require periodic written retesting to validate competency.

Seventy-five percent of Boards of Nursing require some form of continued competence activity each relicensure period. Most require CEUs; 16 states require coursework be completed in specific topics, such as AIDS, end of life, pain, pharmacology, or ethics. Three boards require a competence test. Forty two percent require minimum clinical practice hours. Five states have a peer review requirement.

In 2006, the North Carolina Board of Nursing instituted a Reflective Practice model. Reflective Practice is defined as a process for the assessment of one’s own practice to identify deficiencies and seek learning opportunities to promote continuing competence. Inherent in this process is the evaluation and incorporation of this learning into one’s practice. This approach requires each nurse to carry out a self-evaluation and formulate a plan for maintaining competence at each license renewal time. (http://www.ncbon.com/content. aspx?id=664) In a 2003 study, Exploring the Value of Continuing Education Mandates, June Smith, PhD, RN, found that nurses consider work experience to be the greatest contributor to their current levels of ability. Nurses with CE mandated by the Board of Nursing attended more hours of CE unrelated to their work or interests. Those nurses with and without CE mandates estimate the same levels of growth in ability. Novice nurses are much more likely to know what they don’t know, be willing to ask more questions, and be motivated to learn more. Veteran nurses may be more isolated, stuck in the routine they have always used, or believe that there is nothing they don’t know.

The Institute of Medicine has stated its support for more reliable continued competence measures.

“Health care oversight agencies are challenged to abandon reliance on continuing education in favor of a more systematic approach requiring that

Alaska Nurse • Page 5 each practitioner’s competence be assessed and interventions be targeted to specific deficiencies.”

(2003, IOM) Alaska’s requirements—Do they make sense for assuring competence?

Alaska provides great latitude in continued competency validation.

Registered Nurses or Licensed Practical Nurses can choose two of three options. Those three options are: 320 hours of clinical practice, 30 hours of continuing education or 30 hours of “professional activities.” “Professional activities” are defined as uncompensated activities that use nursing knowledge and contribute to the health of individuals or the community.

Alaska requires two credentials for advanced practice Registered Nurses—an active Registered Nurse license and a second “authorization” as an advanced practice Registered Nurse. The only additional CE requirement is 8 hours of pharmacology.

Certified Nurse Aides (CNA) are required to complete 24 contact hours of continuing education in each two year certification period. They must be employed 160 hours during every certification period. If they are employed less than 160 hours, they must successfully complete a competency evaluation that is defined in regulation. If the CNA has not worked and their training program was completed more than two years ago, they must complete another CNA training program or its equivalent in order to renew their certificate.

The Registered Nurse and Licensed Practical Nurse continued education credits are defined by criteria and limitations: the courses must be approved by valid organizations defined by the board; the topics must be related to nursing and be of sufficient complexity to advance nursing knowledge; no more than 10 hours can be in the form of in-service education offered by a facility; basic life support (CPR) is not accepted for CE credit.

Do the continuing education requirements make you a better Registered Nurse or Licensed

Practical Nurse? Do you take course work that is challenging, and do you apply new knowledge to practice? Or is it just a hoop that you jump through to renew your license? Would you continue to make effort to learn if there was no requirement for continued education?

Nursing is a psychomotor profession. In other words, clinical judgment (developed through education and knowledge), coupled with skilled nursing functions brings hands-on proficiency, through clinical practice. Is 320 hours a valid threshold for maintaining those skills?

Registered Nurse and Licensed Practical Nurse “Professional Activities” is a very vague category. Only 30 hours is required. The activities could include publishing, presenting a nursing related talk, volunteering in a nursing role for an organization, or conducting nursing research. Each of these items could be very challenging, enriching endeavors. But… how was 30 hours arrived at for the threshold? How does this compare to 320 hours of clinical practice for maintaining competence?

Nursing—A Dynamic Profession The Alaska Board of Nursing is utilizing NCSBN research to define “best practices” concerning continued competence. Just as knowledge and skills become obsolete with time, so regulations must evolve to coincide with technological advances that change nursing practice. Based on NCSBN recommendations and its own research work, the Alaska Board will be reviewing the current Alaska continued competence regulations.

It is the Board’s responsibility to assure the continued competence requirements are relevant and defensible in terms of assuring the public that licensed nurses in Alaska are held to appropriate standards.

All regulation changes receive public notice for comment. The Alaska Board of Nursing offers an email list serve that communicates with interested parties who have registered to receive notices. You can find the link to sign up for the list serve on the Alaska Board of Nursing website at http://nursing. alaska.gov.

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February 2009

Commentary Development and Assessment of Continued Competency Models Must Be a Collaborative Effort

by Barbara Berner, EdD, FNP, FAANP Chairperson AaNA Professional Practice Committee The issues raised in the article by Ms. Giessel, Safe, competent nursing practice: A promise to consumers, are certainly timely and provocative. Clearly, there is a need to assure continued minimal competence levels of practice for all nurses, and the regulatory bodies are appropriately tasked with the need to oversee and implement sound measures to assure competence. Ms. Giessel makes many good points about the need to reevaluate our current regulations.

The difficulties in assuring professional competence are myriad and many of the health professions are struggling with these same issues.

However, because of the complexity of the nursing profession in terms of specialties and types of practices, a broad-brush approach is unlikely to produce the outcomes desired.

The documents this article has used as reference material provide additional information that is not contained in the article. I would encourage the readers to review these documents to obtain a more complete understanding of the work that has preceded the National Council of State Boards of Nursing’s current work on the Continued Competence Regulatory Model (APRN Consensus Work Group & NCSBN APRN Advisory Committee, 2008). These include: Meeting the Ongoing Challenge of Continued Competence (NCSBN, 2004), which is available on the NCSBN website, and Implementing Continuing Competency Requirements for Health Care Practitioners (Swankin, D., LeBuhn, R., & Morrison,

R., CAC, 2006), which is available on the Citizen Advocacy Center website.

The following are points that were not clearly evident in the article, which, I would suggest, need to be emphasized.

• Any approach used to develop and evaluate continued competency must be evidence-based.

It should not be based solely on popularity (i.e. on how many other states are using that approach). We need to do what is best for Alaska, not necessarily what works in other states.

• Because the nursing profession encompasses so many practice variables, no one approach is likely to “fit all.” Methods to evaluate and assess competence must also be variable and fit the needs of unique practices, but at the same time, be doable and cost and time effective.

• Decisions will need to be made on the definition of competency. o Will competency mean ability to continue to function as a generalist as is measured by the initial NCLEX exam for RNs? LPNs and certification exam for NPs/CNMs/APRNs? o Will competency also mean competency in the specialty area where the professional chooses to work? o Will competency also mean the acquisition of new information that is now considered essential for anyone in the profession?

• Development and assessment of continued competency models must be a collaborative effort that includes individual nurses, professional bodies, educators and employers in cooperation with regulatory bodies.

• Continuous quality improvement should also apply to any continued competency models that are developed.

• Competency models developed by professional certification bodies or employers that encompass the content of regulatory bodies’ requirements should suffice for demonstration of continuing competence.

• Practice hours as a measure of competence was presented with confounding information in the article. First, a finding in the 2003 study by Smith showed that work experience provided the greatest contribution to nurses’ perceived levels of abilities. However, this statement was followed by another statement that “veteran nurses may be more isolated, stuck in the routine they have always used, or believe that there is nothing they don’t know.” What is the importance of clinical practice as it relates to competence? Where is the research-based evidence that corroborates that clinical practice results in continued competence?

All of us have a stake in ensuring competent practitioners in nursing. All of us must have a strong voice and put our combined efforts into achieving this end. “Only governmental licensing boards have the authority to enforce change.” (NCSBN, 2004, p.10).

But, as the NCSBN so aptly put it, “Boards of nursing cannot go it alone. This has to be a collaborative effort. Nurses, employers, educators, nursing organizations, CE providers, consumers and boards of nursing are all stakeholders and have perspectives to share and expertise to offer.”

February 2009

Alaska Nurse • Page 7

AaNA President’s Report Debbie Thompson, BSN, RN, CNOR President, AaNA [as of January 2009, Executive Director of AaNA] It has been my distinct pleasure to represent the nurses of Alaska this year. I have been at national meetings, State Board of Nursing meetings, down to Juneau during the legislative session and at different national meetings and teleconferences.

What I found as a common thread at each of these functions is that with this ever-changing world; Nursing is changing at a faster pace than the rest of world. During these challenging times, we the working Nurses are challenged even further with new work standards. We are all working faster, longer and with less support than we have in the past. We are also working with regulations that are in fact impacting and changing totally at times how we are able to do our jobs. Knowing this and appreciating the work that each nurse does in his/ her specialty I would like to take a personal look at nursing.

This year I would like to talk to you, about nurses and what they mean to those that we serve.

This past March my Mother was diagnosed with terminal cancer. Not a journey that any of us would think that we would become thankful for, but I am here to tell you that this was a beautiful journey and it was made so by those of you who took direct care of my Mother, my family and of me.

From the time Mom was given her diagnosis and learned that she had a short window of time she directed her children and grandchildren that we were going to LIVE. We were not going to wait for her to die, but take the bunch of lemons, make lemonade and good memories and LIVE. This is how we chose to face each new day and we were supported by the Nurses to the fullest on each step of this path.

I observed nurses who had worked overtime and continued to smile and apologize for the time it took to get to her call light, care, and pain medication. My Mom always smiled and let them know that she understood. At times, I think that this made the nurses feel worse if that is possible and observed nurses with tears in their eyes trying to convince Mom it was not okay. As a Nurse, I wanted to be able to just give Mom her pain medication and not watch her suffer but neither my sister nor I could do that. Although, we did do all the personal care that we could and helped with emergencies that happened. It seemed so little when the need for assistance was so high. I wrote to supervisors, county officials, and business owners with my observations on how

an acuity system was failing the nurses at this facility. Funny they agree, but no changes have occurred as of yet.

I am in awe of the sacrifices that nurses give each time they arrive at their place of employment.

I am saddened by the load that they carry home with them after their shift ends. I am extremely angered that nurses feel the need to start their next shift apologizing for circumstances that they have no control over. These overworked and understaffed nurses return the next day believing that they can make a difference and feeling like they have let down their patients and patients families. Knowing that these shifts will more than likely be the same as, or God forbid, worse than the last one. I believe that this is the true meaning of dedication and more importantly hope and optimism.

I have always been proud of the nursing profession and have respected all aspects of nursing but I truly did not know or appreciate the depth of respect that I would come to give to nurses in all walks of practice. I worked with OR nurses, PACU nurses, ICU nurses, oncology nurses, infusion nurses, radiology nurses, end of life nurses, hospice nurses and home health nurses. I was totally humbled and in awe that each one of the nurses that I met with discussed treatment plans, made changes in the plans, discussed difficult end of life choices and then implemented those plans, always respecting my mother’s dignity. Each nurse gives so much of him/her self each day they go to work that we forget that each one of the working nurses in this country need to have a work life balance that allows them to rejuvenate and be able to go back to the public that we work for and give their all, all over again.

With these thoughts in mind, I would like to ask each nurse today to go back to your place of employment and recruit a new nurse to become involved at the state level. To become a strong single voice for working nurses and their patients, to become committed to the political process ensuring that nursing practice remains nursing and is not watered down or done away with. To ensure that nurses are doing nursing and not some technician that is hired to do parts of nursing at a lower cost and with less understanding and oversight.

I had the privilege to meet Gretta Styles, past president of ANA, an international nurse leader and here is a question she posed to nurses at different times during her life. “Imagine a world without persons who know what nurses know; who believe as nurses believe; who do what nurses do; who have the effect that nurses have upon

the health of individuals, families and nations; who enjoy the trust that nurses enjoy…..Imagine a world without nurses?”

I believe, if we do not use our combined voices, we may face a world that has drastically changed what nurses know and do. We will lose the impact that we have on the healthcare of individuals, families and nations. We will lose the trust that we now enjoy because we did not take the time to stand up for our patient’s safety and the wellbeing and safety for ourselves for our practice of nursing. I think that imagining a world like this is far more frightening than standing side-by-side and supporting nursing at all levels. What do you think and what do each of you want to do about it? Give time? Speak up not only for your patient’s well being, but for your own well being and that of your fellow nurses? What do you each feel you can do to protect the practice of nursing? If we don’t do something, we will continue to see an erosion of nursing practice and the loss of nursing colleagues from the profession.

I would like to thank each of you for your trust in me to represent you as a strong voice for nurses and our practice. I ask that each of you get on this bandwagon and protect the Profession that we all belong to. Together we make up the foundation for quality health care in the State of Alaska and can be a model for our Nation. During Nurses Week this year, we will be thinking of all of you. Thank you for all you do.

Page 8 • Alaska Nurse

February 2009

Nurses in the News New AaNA President and Executive Director Association to Executive Director. Stepping up to take her place was former Vice President Nancy Davis of Juneau. The two are planning a busy spring and plan to have messages to the membership in upcoming issues.

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Board of Directors President Nancy Davis, MSN pictured on the left with new Alaska Nurses Association Executive Director, Debbie Thompson, BSN, CNOR In January, Debbie Thompson moved from her position as President of the Alaska Nurses

General counsel for the Alaska Nurses Association, Charles A Dunnagan was selected for inclusion as “Super Lawyers 2008” for his work in Alaska employment and labor law. Only the top 5 percent of lawyers in the state are featured in the publication. Dunnagan is a partner in the law firm of Jermain, Dunnagan & Owens. [Anchorage Daily News, 1/19/09]

Alaska Native Tribal Health Consortium and Dr. Melany Cueva’s work, entitled “Developing Arts-Based Cancer Education with Alaska Native People.” Alaska Native cancer rates are the highest of any US ethnic group—34% higher than US Whites—and survival rates are 17% lower than for US Whites. The American Cancer Society has awarded a grant of over $600,000 to Dr. Melany Cueva, EdD, RN of the Alaska Native Tribal Health Consortium to change those numbers.

“Cancer is the top killer of Alaska Natives and we’re taking an innovative approach to change that,” said Alaska Native Tribal Health Consortium (ANTHC) Chairman and President Lincoln Bean.

The Consortium is developing arts-based cancer prevention educational tools for Alaska Native care providers and the people in their communities.

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(Anchorage, AK 10/08) The first American Cancer Society Cancer Research Grant awarded in 42 years in Alaska will go to support the

Dixie Orsini Nursing Scholarship Awarded Fairbanks District 4 Nurses Association awarded the Dixie Orsini Scholarships recently to Leah Johnson of Johns Hopkins University.

Ms. Johnson has completed the Bachelor of Science in Nursing and is beginning the Master of Science degree Program to become licensed as an Advanced Nurse Practitioner.

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

Dixie Orsini was an active member of the Fairbanks Nurses Association who worked at St. Joseph’s Hospital and as an office nurse for Dr. Schaible. Her family and friends established the scholarship fund after her death in 1984.

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

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

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February 2009

Alaska Nurse • Page 9

Spotlight ADHSS’s Environmental Public Health Program

by Nim Ha, MPH Consider these scenarios: 1) residents of a rural Alaska village question the safety of their traditional foods because of concerns about mercury and other contaminants; 2) a road built with mine tailings may be exposing residents to arsenic-laden dust; 3) state regulators want to know if levels of PCBs found in soil near a housing unit may cause adverse health effects; 4) members of a high school shooting team are found to have elevated blood lead levels; 5) a woman isn’t sure if she should stop eating fish now that she’s pregnant. Ever wonder who tackles these sorts of issues and questions for Alaska?

Within the Alaska Department of Health and Social Services, Division of Public Health, Section of Epidemiology there is a small but critical program called the Environmental Public Health Program. This program is responsible for evaluating the possible hazards to human health associated with toxic substances in the environment. Chemical contaminants can enter the environment from unplanned releases, hazardous waste disposal, global transport, local deposition and other sources.

The potential public health impact of these contaminants is evaluated by reviewing available environmental data or recommending data be collected; identifying ways people might come in contact with chemicals, such as through water, air, or soil; and determining if people are being exposed through inhalation, ingestion, or dermal contact at high enough levels to affect their health. The ultimate goal is to prevent or reduce the harmful effects caused by the exposure to hazardous substances.

The program is funded primarily by a cooperative agreement with a federal public health agency, the Agency for Toxic Substances and Diseases Registry. Alaska is one of 29 states that currently receive funding from this agency to respond to citizens’ inquiries about environmental exposure to hazardous substances. An essential component involves working directly with communities to address their concerns. The Environmental Public Health Program works directly with community members throughout the investigative process to understand their health concerns, determine the extent of exposure to contaminants, provide health education, and train healthcare providers, as needed.

Hair Mercury Biomonitoring Program Since 2002, the state of Alaska has offered free and confidential hair mercury testing to women in Alaska. Alaska is the only state in the nation to offer such a program to its residents free of charge.

The program was initiated to collect information about exposures to mercury among pregnant women because the growing fetus is the most vulnerable to the neurotoxic effects of mercury.

The program was later expanded to include all women of childbearing age from 15 to 45 years old. The environmental health program uses the mercury biomonitoring data to establish a baseline for ongoing monitoring purposes, and to assist in the development of fish consumption guidance for all Alaskans.

People are most commonly exposed to mercury through consumption of fish. Mercury is toxic to humans—too much can cause permanent damage to the brain and nervous system. However, numerous studies have shown the many health benefits of eating fish, so reducing or removing fish from the diet to avoid possible mercury exposure may do more harm than good. This is especially true for women of childbearing age. The omega-3 fatty acids found in fish are essential for optimal neurodevelopment in children. A study published in The Lancet (February 17, 2007, Vol. 369) by Hibbeln et al. found that mothers who ate little to no fish during pregnancy had children with lower IQ scores than those who ate more fish (over 340 grams per week) during pregnancy.

Fortunately, most of the fish that Alaskans eat

The environmental team: left to right. Chung Nim Ha, health educator, Rae Benedict, risk assessor, Lori Verbrugge, program manager, Mo Otto, administrative clerk, and Rachel Kossover, a two-year Public Health Prevention Specialist fellow through CDC. This team is responsible for several ongoing statewide programs. One of which is the Hair Mercury Biomonitoring Program. are low in mercury and other contaminants. In fact, all five species of Alaska salmon have some of the lowest mercury concentrations of any fish.

To date, the environmental health program has not found any cases of unsafe mercury levels in Alaskan women as a result of eating fish from Alaska waters. Nonetheless, having their hair tested allows individual Alaska women to assess their own mercury exposures, and to learn whether dietary changes may be needed.

Participation in this program can give women peace of mind that the fish they are eating is safe and healthy for them and their children.

As of December 31, 2008, a total of 689 women ages 15 to 45 years, including pregnant women, have participated in the Hair Mercury Biomonitoring Program. Tests have shown the median hair mercury level at 0.49 ppm (parts per million). Of the total enrolled, 386 or 56 percent, are women from rural areas of the state, with a median hair mercury level of 0.59 ppm. To put these values in perspective, the World Health Organization has established a level of 14 ppm for maternal hair mercury; two large epidemiological studies found no adverse health effects to the fetus below this level. However, to provide a margin of safety, the environmental health program conducts follow-up investigations on all participants whose hair mercury levels are above 5 ppm.

Collecting a hair sample for mercury testing.

Participation in the Hair Mercury Biomonitoring Program is very simple. All healthcare providers, including nurses, health aides, doctors and physician assistants, should encourage women of

childbearing age to participate in the program. If a woman in interested in getting her hair tested, she should talk to her healthcare provider, who can contact the environmental health program (see below) for free testing kits (includes instruction sheet, hair collection bag, envelope, and brochure).

Collecting the hair sample takes just a couple minutes. A small section of hair is cut from the back of the head near the scalp (see photo) and mailed to the environmental health program in a pre-stamped pre-addressed envelope. Results of the mercury test are typically mailed to the healthcare provider within a month.

• Questions about the Hair Mercury Biomonitoring Program and how to obtain testing kits can be directed to Rachel Kossover at (907) 269-8054 or rachel. kossover@alaska.gov.

• A more detailed summary of the hair mercury results is available in an Epidemiology Bulletin online at http://www. epi.hss.state.ak.us/bulletins/docs/b2002_29. pdf.

• More information on the Environmental Public Health Program, the Hair Mercury Biomonitoring Program, and the state’s fish consumption guidelines, as well as useful links to various materials and resources, can be found at http://www.epi.hss.state.ak.us/ eh/biom/default.htm.

Page 10 • Alaska Nurse

February 2009

Spotlight Genetic Counseling at Providence Cancer Center

Maggie Miller, MS, Certified Genetic Counselor at PAMC To understand the work I do, I always tell the story of how I came to do this in the first place.

I first became aware of this field when my sister saw a genetic counselor due to Advanced Maternal Age in her pregnancy with my nephew (who is now 8 and healthy). I was a sophomore in college at UAA and had always known I would work in health care. My oldest sister is an oncology nurse and has always been my role model; at the time I was in UAA’s pre-nursing program. When I heard the words ‘Genetic Counseling’ it was as though a light bulb came on. I love people, I love explaining things, and genetics was always one of my favorite subjects in school.

I immediately began researching the field,

shadowed Providence’s Genetic Counselor, and changed degree tracks to complete my undergraduate degree as soon as possible. The BS Psychology program was the best fit to complete the Genetic Counseling pre-requisites and to prepare me for understanding my patient’s thoughts and motivations. In 2003 I graduated UAA and was accepted to the Master’s program in Genetic Counseling at the University of Minnesota.

This is a two-year training program focused on genetics, clinical medicine, and psychology that included 40 weeks of clinical internship. My final ten-week rotation was in cancer genetics.

After 30 weeks of pre-natal, pediatric, neurologic, and hematologic genetics, cancer genetics was a breath of fresh air. In cancer genetics we have the opportunity to change a family’s perspective.

Through counseling and sometimes testing, family members can then understand their risk of cancer, make screening plans to detect it early, and occasionally to make choices that drastically reduce their chance of ever developing certain cancers. Most people who find out what I do say, “That sounds depressing” and I always explain that from my perspective it is empowering.

I began working as a genetic counselor at Providence in June of 2005, less than two months after I graduated with my master’s degree. The stars aligned, Providence was creating a Cancer Center, and for their Commission on Cancer, Community Cancer Center recognition, they needed to provide cancer genetic services. Over the past three and a half-years I have worked hard to create relationships with our physicians, nurse practitioners, PAs, nurses, and the community advocacy and support groups who are now my main sources of referral.

My services are available for free as a part of the BP Cancer Resource Center. I have been seeing patients for over three and a half-years and have seen my numbers rise from one patient my first month to a record 53 patient visits in December of 2008. Patients can self-refer, however they are encouraged to share our discussions with their clinician as any screening, management, and genetic testing would need to be ordered by a qualified provider. I typically encourage patients who call without a referral to contact their provider to request a referral prior to their visit.

When considering referrals I encourage you to think of the types of cancer diagnosed in the family; for example, breast and ovarian cancer often run together in families, as does colon and

uterine cancer, and colonic polyposis (100-1000’s # of polyps) with colon cancer. The age at diagnosis in a family, typically anyone diagnosed with cancer under 50 years of age should be flagged for further evaluation of family history with respect to cancer genetics. When looking at family history watch for Ashkenazi Jewish ancestry, multiple generations being diagnosed with cancer, people diagnosed with more than one cancer, and limited family structure (when many family members die young, have preventative surgery, or are not in contact).

Typically I spend between 45 minutes to twohours at an initial visit taking family health history, patient medical history, educating the patient on the signs and symptoms of hereditary cancer syndromes, and facilitating decision making and genetic testing when appropriate.

Many patients walk away with the contact information for our patient navigation team who can provide disease specific information, psychosocial support, counseling for children, financial aid options, and even medication management when the psychological stresses reach a necessary level. Results of most cancer genetic tests take 2-4 weeks to return. At their blood draw I make a contract with the patient to either share results in person or to call them by telephone with these results. Typically patients who have a positive result will meet with me again to discuss the implications and to create a plan for meeting with the appropriate providers. We often also meet if the patient has an ambiguous result, this includes Variants of Uncertain Significance and patients who have a very concerning family history with a negative test result. Some of these patients are referred to research studies, at this time many genetic cancer syndromes are poorly understood, through research we are able to better define the condition for these patients and their family members.

Starting February 5th, we plan to begin our Group for Hereditary Cancer, providing Education, Advocacy, and Support. The goal of this group will be to provide a place for patients who have hereditary cancer, have a risk of hereditary cancer, or who are concerned that their cancer (or the cancer in their family) might be hereditary to learn more, talk to others, and eventually raise community awareness of these syndromes.

Contact and Referral Information: • Cancer Genetic Counseling—Providence Cancer Center, Anchorage • Maggie Miller, MS, Certified Genetic Counselor • Tel 907-212-6874 • Fax 907-212-2735 • Margaret.dewhurst.miller@providence.org

February 2009

Alaska Nurse • Page 11

Nurses Caring for Their Community— Kenai

by Janet Hilleary RNC and Velinda Albrechta-East RNC

The Alaska Nurse Alert System in 2008

by LeMay Hupp We’ve grown and become a real “player” in disaster preparedness circles throughout the state this past year. In my dealings with other emergency personnel, we are viewed as a group of respected professional nurses that will be valuable personnel in the event of a crisis situation. There has not been a true emergency call-out this year, BUT on two different occasions our organization was considered for providing assistance if the need arose.

Our number of volunteers has increased to 428 (12/2008) which is up from 344 (9/2007). ANAS letters went out in LPN and RN renewal packets and I made 12 presentations on ANAS. There were 5 editions of the ANAS newsletter and discussions of the system in other materials including the Alaska Nurse.

Continuing Education remained popular and there were 7 offerings for 30.5 CEU’s (includes one day of disaster nursing at the October AaNA conference). We are exploring “live” video conferencing for future presentations.

Other miscellaneous projects that were put into effect this year were: 1. ID badge template completed utilizing digital pictures, neck lanyards with plastic pocket given for badge and nursing license and all volunteers encouraged to send digital pictures.

2. Exploring funding sources for supplies (gear bags, apparel, etc.)

3. Standardized letter completed to submit to smaller hospitals around state explaining ANAS and how to initiate system in time of need for their disaster response plans.

4. ANAS was included in 3 separate grants to provide various types of assistance. The Medical Emergency Preparedness Project— Pediatrics is supporting numerous types of continuing education that will be available to volunteers after the grant completion.

5. I am working with the National Disaster Life Support Foundation to complete Basic Disaster Life Support courses and make them available to volunteers and others and propose ANAS as the training party for these courses.

It's been a busy and rewarding year and I have thoroughly enjoyed getting to work with all of you. I'm looking forward to continued growth and activities in 2009!

As the economy continues to falter there may be more despair felt by the members of our community. The family of nurses at Central Peninsula Hospital and Heritage Place have helped answer the call. On December 9, 2008 Janet Hilleary RNC, President of RNs United, presented a $1,000.00 check to the Kenai Peninsula Food Bank on behalf of the Central Peninsula Hospital and Heritage Place registered nurses. This money was raised during the annual Arts & Craft Fair at Kenai Central High School just after the Thanksgiving Holiday. The delicious baked goods and wonderful crafts were all made and donated by the registered nurses and their families. Many nurses worked their shift and then came out to lend a hand with the sale.

The Central Peninsula Hospital and Heritage Place registered nurses also entered a float this year in the Kenai Chamber of Commerce Electric Light Parade. We were honored to be awarded first place in the organizational category. Walking the entire route of the parade receiving cheers from the crowd truly was incredible. Fun was had by all.

Left to right: Michelle Hanson, Amanda Taylor, Velinda Albrechta-East, Vice President, RNs United, Janet Hilleary, President RNs United and Janice Villegas.

By holding true to the Mission Statement of the Hospital, “We are a community-initiated and community-nurtured organization dedicated to promoting wellness and providing high quality healthcare that ensures the confidence and loyalty of our customers,” our hope is to help provide warm meals and Christmas cheer to many of our fellow community members that are in less fortunate circumstances than ourselves. We are all aware of the continuing needs in our community year-round, so this is why the registered nurses are planning to continue the spirit throughout the year. You will see us at bake sales and community activities, so we will be looking for your support as well. We are proud to be part of the family of loving, caring nurses that place the community needs above themselves everyday and answer this call. Together, we do make a difference.

Page 12 • Alaska Nurse

Notice to AaNA Members Has your address or email changed? If you have not been getting email updates and information from the Alaska Nurses Association, and you are a member, please contact Donna Phillips at Donna@aknurse. org.

Go to aknurse.org For online CE Nursing News Alaska nursing links And more!

February 2009

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

Membership Categories

Full Membership—Employed Full-time or Part-time Reduced Membership—Not Employed * 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 2009

Alaska Nurse • Page 13

UAA December 2008 Nursing Graduates The University of Alaska, Anchorage conferred degrees on the following students last December.

Additional honors were given to Autum Nicole Steward who received the Spirit of Nursing Award. This is an award by faculty vote for a student who best demonstrates the spirit of caring, science, love of learning and compassion. Ms. Steward was also given the Peer Award: determined by class vote for the colleague who best demonstrates the definition of nursing to them. The Directors Award for highest GPA was achieved by Brittany T. Hamilton in the BS program, Anchorage, and by Laura Buehler in the AAS program in Sitka.

Our sincere best wishes and congratulations to you all. Welcome to our profession!

Masters Program Graduates Kathleen C. Knutson, FNP—Chair Maureen O’Malley, PhD “Attention-Deficit/Hyperactivity Disorder: A Survey of Diagnosis and Treatment Practices” Lori Towson, PMH—Chair Fredricka Gilje, PhD “Perspectives of Teaching Friendship, Intimacy and Sexuality to Adult Psychiatric In-Patients” Denise B. Smith, HCA—Chair Jill Janke, PhD “Nursing Satisfaction and Attitudes with Computerized Software Implementation: A Quasi-Experimental Study ”

Baccalaureate Program Graduates Jaena M. Avey Mary Ann C. Batchelder Amy J. Breakfield Melanie E. Brown Kristie L. Clark Michelle R. Cooper Dezarae B. Cowles Lorayne M. Embretson, RN Danelle M. Estes, RN Keely J. Falcon Teresa J. Ferguson Heather M. Frank Annemarie E. Gerlach Brittany T. Hamilton Melissa I. Houston Rachel M. Knowles = Nursing Honor Society =Member SNA

Morgan M. McCourt Tiffany M. McEntire Aisha E. Merced Meriam C. Middaugh Colleen M. Raven Michelle L. Rudisill Jennifer R. Sandy Tabatha A. Schellenger Catherine Y. Schaffstall Autum Nicole Steward Toby A. Sursa Jacob J. Szajkowski Jennifer M. Tackitt Courtenay L. Taylor Cassie S. Welling Karla R. Wirkkala

Page 14 • Alaska Nurse

February 2009

Resources Volunteers Needed—American Cancer Society Your American Cancer Society is at work across Alaska to provide programs aimed at reducing the risk of cancer, detecting cancer as early a possible, ensuring proper treatment, and empowering people facing cancer to cope and maintain the highest possible quality of life. Volunteers play a critical role in the success of the society and its programs!

For more information, please call your American Cancer Society at 1-800-ACS-2345 or in Anchorage, Lea Anne McWhorter at 273-2077 or Amanda McDade at 273-2069.

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WhyNotTheBest.org: A New Resource for Health Care Providers, Researchers, and Other Professionals December 17, 2008—The Commonwealth Fund, a private philanthropic group founded in 1918, has launched a new web site that allows health care providers, researchers, and professionals to easily conduct side-by-side comparisons of 4,500 hospitals nationwide, track performance over time against numerous benchmarks, and download tools to improve health care quality. Go to WhyNotTheBest.org. [1/7/09 AANP Smartbrief]

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Volunteers Needed—March of Dimes The March of Dimes is seeking nurses as volunteers to assist us with our outreach in the outlying communities. We would love to be at all the health fairs, baby fairs, conferences, etc.; but resources restrict our travel budget. We are looking for volunteers who will represent the March of Dimes at these events. If you are interested please email Janie Odgers at jodgers@marchofdimes.com.

Remember: The March of Dimes has Continuing Education modules, for a free catalogue send your details to Janie Odgers at jodgers@marchofdimes. com.

March for Babies is right around the corner, we want to see more nurses forming teams and walking in our walks. Our first walk is March 28, Saturday, INDOORS at the AT&T Sports Center in Palmer. Then May 3 in Juneau and Ketchikan; May in Soldotna/Kenai; May in Anchorage and June 6 in Fairbanks. For more information contact Susan Churchill at schurchill@marchofdimes.com.

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CMS has ranked some 16,000 U.S. nursing homes and put the results online.

The scores—from one to five stars—are based on quality, staffing, inspections and overall operations. Acting Medicare Administrator Kerry Weems said the easy rating system could encourage improvements and "a national conversation about nursing home quality." USA TODAY (12/18), Google/The Associated Press [12/18/08—AP On the Net] • Medicare's Nursing Home Compare Web site: http://Medicare.gov/NHcompare

Consumermedsafety.org is a new site on medicine safety from the Institute for Safe Medication Practices, a nonprofit organization of pharmacists, nurses and physicians devoted entirely to safe medication practices. It has information for the public and professionals as well as helpful links. [1/7/09 AANP Smartbrief] ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

CDC's Newborn Screening CDC's Newborn Screening Quality Assurance Program has a new publication—Newborn Screening Laboratory Bulletin. This document highlights NSQAP's three-decade history of ensuring the quality of newborn screening tests in the U.S. and around the world. Resources about newborn screening can be found at www.cdc. gov/labstandards/nsqap.htm. If you would like to access the report online, please visit www.cdc.gov/ nbslabbulletin or call 770-488-7729. [1/7/09 AANP Smartbrief] ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

The U.S. Department of Health & Human Services has a new website on health-care associated infections including recommendations for Health Care Personnel Flu Vaccination. Go to www.hhs.gov/ophs/initiatives/hai/index.html.

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New Pediatric Emergency Nursing Certification Examination Launches January 2009 Chicago —The Board of Certification for Emergency Nursing (BCEN®) and the Pediatric Nursing Certification Board (PNCB®) today announced that exams for their new Certified

Pediatric Emergency Nurse (CPEN™) credential would begin on January 21, 2009. The CPEN is designed to validate extensive experience, knowledge and abilities in the field of pediatric emergency nursing.

The CPEN exam was developed and is delivered in equal partnership between BCEN and the PNCB. This unique exam was developed in response to the Institute of Medicine’s report (2006) identifying an urgent need for specialized nursing expertise in the management of the emergency healthcare needs of pediatric patients.

It is recommended that CPEN candidates have two years of full-time experience in pediatric emergency nursing care. This is defined by BCEN and PNCB as providing direct care, health care facilitation, education, and advocacy for pediatric emergency patients.

At minimum, CPEN candidates must be licensed to practice as a nurse in the United States (a nursing certificate equivalent to an RN license is also accepted) and have at least 1,000 hours of pediatric emergency nursing practice in the past 24 months. Those requirements can be met in a variety of ways. For more information on CPEN requirements, registration and the exam, see the CPEN Web site at http://www.ena.org/bcen/cpen/ about.asp or www.pncb.org/cpen.html.

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New AHRQ health care Web sites The Agency for Healthcare Research and Quality has developed a new page on the AHRQ Health Care Innovations Exchange Web site, Linking Clinical Practices and the Community for Health Promotion. The new page is designed to find new ways to work together to support patients in adopting healthy behaviors and managing their health, to create new ways to connect patients with services in primary care offices and community settings, and to increase accessibility to these services. Visitors to the new page can find profiles of innovations that have successfully integrated clinical, public health and community health services. Also available are tools to assist in developing partnerships and referral linkages.

Go to: www.innovations.ahrq.gov/learn_network/ resources-for-linking.aspx.

The Agency for Healthcare Research and Quality has launched Clinician-Consumer Health Advisory Information Network, a Web site that offers advice on emerging medical therapies.

The site, chainonline.org, connects users to new information about evidence-based medicine that is gathered from AHRQ's Centers for Education and Research on Therapeutics. [1/9/09 and 1/12/09 AANP Smartbrief] ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

ANA’s GeroNurseOnline Website is Back!

ANA has launched a re-designed web site for the care of older patients. The Gero Nurse Online site is designed to serve as a comprehensive, rich resource for nurses and the public they serve. GeroNurseOnline.org provides nurses with resources regarding clinical information, education and career certification instrumental in providing care for older adults, regardless of specialty.

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The Centers for Disease Control (CDC) has release the updated Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008. These guidelines presents evidence-based recommendations on the preferred methods for cleaning, disinfection and sterilization of patient-care medical devices and for cleaning and disinfecting the healthcare environment.

This document supercedes the relevant sections contained in the 1985 Centers for Disease Control (CDC) Guideline for Handwashing and Environmental Control. The pdf document can be downloaded at the CDC website.

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February 2009

Alaska Nurse • Page 15

Upcoming Events Relay For Life Of Anchorage 2009 TEAM REGISTRATION FEE: $150 per team (can be contributed by a team sponsor) Sponsor, the American Cancer Society WHEN: Friday, May 29, 2009 at 6:00 pm until Saturday, May 30, 2009 at 6:00 pm.

WHERE: The Anchorage Park Strip WHAT: Try to imagine a giant moving slumber party with 500 or more guests. Teams of 8-15 walkers from businesses, churches, schools, organizations, families, and neighborhoods join with the cancer survivors (the honored guests) and their families with altering “shifts.”

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2009 ANCC National Magnet Conference Louisville, Kentucky October 1-3, 2009 Explore nursing excellence in clinical practice, leadership and research through pre-conference seminars, concurrent sessions, posters, art, film, exhibits and networking with your nurse colleagues during three full days of programming.

Go to www.nursecredentialing.org and find the link to the conference.

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For more information on how to form a team or for sponsorship opportunities, please contact: Nicki Shinners at 273-2066 nicki.shinners@cancer.org Visit our website at www.anchoragerelay.org ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

AANP 24th National Conference June 17 to 21, 2009 Gaylord Opryland Nashville, Tenn.

Visit www.aanp.org for more information

Join AaNA Today!

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A Premier Dining Event for a Premier Cause LEAD CHEF JENS NANNESTAD

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Owner of Southside Bistro

Alaska Nurse Practitioner Association’s 26th Annual Conference

with his twins Max and Jaez

September 24, 25, and 26th, 2009 Anchorage Downtown Marriott Joel Weintraub, with a Master’s Degree in Physiology and a Degree in Health Education will be the motivational keynote speaker who will discuss the magical benefits of incorporating humor in our lives and will offer an additional presentation reviewing the new risk factors for heart disease. Back by popular demand are specialty tracks in psychiatry, pediatrics and women’s health. A new pharmacology track has been added to this year’s conference. The pharmacology track will include pharmacologic management of diabetes, hypertension, arrhythmias, congestive heart failure and dermatologic conditions. Join your colleagues from across Alaska and the lower 48 for continuing education, networking, and a good time. For complete conference brochure and registration information, go to: alaskanp.org

Event Objectives • Apply and share nursing knowledge and leadership skills in sustaining the health of the world's people.

• Explore diverse opportunities to promote collaboration for the advancement of nursing science, evidence-based practice, education, administration and policy development in the global community.

• Utilize new knowledge to create culturally sensitive practice.

• Examine interdisciplinary partnerships to promote the global nursing community.

Contact www.nursingsociety.org for more information.

Sheraton Anchorage Hotel October 9 6 - 9:30 pm

1st Annual Signature Chefs Auction For Babies For sponsorship & tickets info call March of Dimes 907-276-4111

Presenting our Signature Chefs from Anchorage’s Finest Restaurants Southside Bistro - Sheraton Anchorage Hotel Crow’s Nest - Double Musky Inn - Villa Nova Haute Quarter Grill - Kincaid Grill - Jens’ Restaurant Marx Brothers Café - Ginger - City Diner - Suite 100