The Official Publication of the Alaska Nurses Association Circulation 8,300 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska
Volume 63 • No. 1
March 2013
Focus on Safe Lifting Protects Nurses, Patients Dianne O’Connell Years of moving, lifting and handling patients of all sizes have left a significant percentage of Alaska’s nurses with chronic back, neck and shoulder problems and other spinal cord injuries, reported and unreported. In an eight-hour shift, the cumulative weight that a nurse lifts averages approximately 1.8 tons per day. Looking at the problem from a different angle, research shows that when a nurse or other healthcare worker lifts something or someone heavier than 35 pounds, that healthcare employee sustains a microscopic tear in his or her discs, inevitably leading to pain. Multiply this by the size of the average patient times hours of lifting and moving these individuals times the number of nurses – and quickly you’ll see the hospital’s budget line items for missed work time, medical leave-use, increased “lightduty” time and workmen’s compensation claims bulge like a ruptured disc. It is estimated that the healthcare industry spends more than $20 billion on costs related to occupational back injuries. Nursing staff, including aides and orderlies, report the most working days off due to work-related back pain – an estimated 750,000 days, according to a November 2012 newsletter published by the Premier Safety Institute. Inadequate solutions for patient lifting and movement can also result in harm to the patient due to falls, one of the Center for Medicare & Medicaid Services’ (CMS) preventable hospitalacquired conditions being monitored for reduced reimbursement, according to Premier. The Centers for Medicare & Medicaid Services (CMS) is an agency within the US Department of Health &
current resident or
Page 3
Nurses Go Red
Human Services responsible for administration of several key federal health care programs. In addition to Medicare (the federal health insurance program for seniors) and Medicaid (the federal needs-based program), CMS oversees the Children’s Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act (HIPAA) and the Clinical Laboratory Improvement Amendments (CLIA), among other services. Back in 1994, the National Institute for Occupational Safety and Health (NIOSH) developed a revised NIOSH lifting equation, an ergonomics assessment tool used to calculate the recommended weight limit for two-handed, manual-lifting tasks. In 2007, Thomas R. Waters, Ph.D., a research safety engineer at NIOSH, published an article in the American Journal of Nursing entitled “When is it safe to manually lift a patient?” Waters concluded that when the lifted weight exceeds 35 pounds (the typical size of a small child), assistive devices should be used. The 35-pound limit came from the Veterans Integrated Service Network 8 (VISN 8) Patient Safety Center of Inquiry, first funded in 1999 by the Department of Veterans Affairs in Tampa, Fla. VISN 8 developed algorithms for assessing patient-handling tasks to help healthcare workers differentiate between dependent patients who require nurses to lift more than 35 pounds in helping them and partially weight-bearing patients who will not force the nurse to lift more than 35 pounds. Continuing its pioneering work in the area, the Tampa hospital eventually converted its whole facility into a safe patient handling environment, including installing ceiling lift equipment in
Six nursing groups recently formally affiliated with the Alaska Nurses Association. Of the affiliate groups, some utilize AaNA’s meeting space and telephone conference lines while others share in common lobbying efforts. For 2013, the six affiliate groups are: The Alaska Nurse Practitioner Association, Alaska Association of Nurse Anesthetists, Alaska Affiliate of the American College of NurseMidwives, Alaska Home Care & Hospice Association, Alaska School Nurses Association, and Alaska Clinical Nurse Specialist Association. For close to 20 years, nursing groups in Alaska have come together to lobby for improved healthcare for Alaska’s residents and to promote the practice of nursing in Alaska. Over the years the AaNA and their affiliates have lobbied to prohibit mandatory overtime for nurses, increase
Focus on Safe Lifting continued on page 6
Six Groups Affiliate continued on page 7
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Permit #14 Princeton, MN 55371
Page 4
In Memoriam Arne Beltz MPH, MN, RN
Page 10
Six Groups Affiliate with the Alaska Nurses Association
Inside This Issue Note from the President . . . . . . . . . . . . . . . . . . . . . 2
Professional Practice Corner . . . . . . . . . . . . . . . . 11
A Note from a Fellow Nurse. . . . . . . . . . . . . . . . . . 2
Congratulations UAA Graduates . . . . . . . . . . . . . 12
Nurses Honored at Nurse of the Year Awards. . . . 3
White Paper: A Nurse’s Guide to the
Susan Walsh, Ketchikan Super Nurse. . . . . . . . . . 4
Use of Social Media. . . . . . . . . . . . . . . . . . . . . 13
Legislative Corner. . . . . . . . . . . . . . . . . . . . . . . . . . 5
Governor Parnell Announces Board of
Labor Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Nursing Appointments . . . . . . . . . . . . . . . . . . 15
Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . 10
Membership Application . . . . . . . . . . . . . . . . . . . 15
The AaNA Vision Empowering Alaska nurses to be dynamic leaders, powerful in both the health care and political communities.
Page 2 • Alaska Nurse
March 2013
Note from the President Susan Walsh, RN, Alaska Nurses Association President Ketichikan, Alaska I recently taught a childbirth class – a fairly large class for Ketchikan, with dozens of expectant faces reminding me of the impact nurses will have in their lives. I am not only referring to my comrades in labor, delivery and postpartum, but also Susan Walsh, RN our midwives and nurse anesthetists, who perform the intrathecals or spinals should a C-section become necessary. Should it be that a Caesarean section be needed for any of our patients, a nurse will be there to answer questions, hold their hands and deliver skilled assessments and care, as we all strive to do. There are numerous nursing specialties that families will come in contact with during a child’s lifetime: clinic, emergency room, pediatric, medicalsurgical, and, if they are fortunate enough, a school nurse, to name but a few. We as nurses have a great responsibility and opportunity to teach our patients. In that spirit, I attended a recent teleconference sponsored by Alaska Community Action on Toxics
(ACAT) titled, “Nurses in the Halls of Power: the Why, What and How of Nurse Advocacy for Safer Chemicals.” I have been interested in the environment since Earth Day made its debut many decades ago. That interest has only grown as I’ve become more aware of the environment and the issues surrounding it. The Alaska Nurses Association has passed resolutions regarding aerial pesticide spraying and supporting our firefighter’s efforts to ban the use of brominated flame retardants (BFRs). AaNA has also supported the American Nurses adoption of the Precautionary Principle, which in a nutshell, shifts the burden of proof to the proponent of an activity or product to be responsible for assessing its safety before it is undertaken or introduced. It also requires that alternative methods of accomplishing the same goal be considered in order to avoid causing undue harm to human health or ecosystems. There are many ways we can promote healthier hospitals, communities, environments and people; we can influence policy decisions within those settings, and I urge all to become involved and informed. I would like to recommend several websites with helpful information: Health Care without Harm (www. noharm.org), Green Guide for Health Care, (www. gghc.org), Safe Cosmetics (www.safecosmetics.org), and last but not least, Alaska Community Action on Toxics (www.akaction.org). Have a beautiful spring, everyone. I am off to plant some seeds.
A Note from a Fellow Nurse Kristin Fahey, RN, Secretary, AaNA Board of Directors
Kristin Fahey, RN
As a new nurse and professional, it has been an honor to be involved with the Alaska Nurses Association. Since my time with the AaNA, I have served as the Ketchikan Bargaining Unit vice president, negotiation team member, and as the secretary for the AaNA Board of Directors.
I recently joined the Alaska Nurses Association Legislative Committee and was able to participate in the AFL-CIO’s Legislative Fly-In in Juneau, providing me the opportunity to address several of our legislators. While I never expected nursing to result in my involvement with politics, I have found that real change in medicine occurs through many venues, including policy, whether at the organizational or state level. By participating in legislation and professional practice, I have the opportunity to voice healthcare practice concerns with the added benefit of continued mentorship from experienced nurses across our great state of Alaska. Interested parties are always welcome to join, as diversity is key! The AaNA represents the largest single group of registered nurses within the state of Alaska, and with that comes the responsibility to not only fairly
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represent members but to advocate for practice changes that will improve the quality of care our patients receive and ensure the safety of nurses at all levels. It is the mission of the AaNA to gather information and opinions from all practice levels and to provide the most current evidenced-based information to all concerned parties. Although my professional experience has been limited to acute care, our network gives us access to the expert opinions of Certified Registered Nurse Anesthetists, public health, school and advanced practice nurses, just to name a few. Having this established relationship with a wide array of nurses, I have been able to grow both as a nurse and as an individual and continue to build relationships with people I would otherwise probably never know. Without question, the thing that has helped me become the nurse I am today has been exposure to exceptional nurse mentors. I was blessed with excellent instructors in nursing school, RN preceptors immediately following graduation, and most recently for ICU training. I remember years ago being warned “nurses eat their young,” but I am glad to report I could not feel more supported by the professional nurses who have become my colleagues and friends. I wholeheartedly wish that all nurses receive the mentorship and support I have found in my practice and that they continue to “pay it forward” to ensure the future of excellent nursing care. Get involved, whether at your local organization or the state level. It’s never too early to jump in. If you find yourself slightly intimidated by something new, don’t hesitate to ask a question or two. Potential mentors are out there just waiting to lend a freshly sanitized helping hand.
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An official publication of the Alaska Nurses Association, 3701 East Tudor Rd., Ste. 208, Anchorage, AK 99507. Tel: 907/274-0827. Web site: http://www.aknurse.org. Published quarterly January, April, July, October. Materials may not be reproduced without permission from the Editoral Committee.
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Editorial Committee: Contact Janet Pasternak at editor@aknurse.org AaNA Board of Directors President: Susan Walsh, RN Vice President: Jane Erickson, RN, CCRN Secretary: Kristin Fahey, RN Treasurer: Jennifer Hazen, BSN, RN Directors: Rural Director: Greater Alaska Director: Colleen Bevans, RN Staff Nurse Director: Directors at Large: Shelley Burlison, RN-BC Janet Pasternak, BA, BSN, RN Labor Council (designee): Donna Phillips, BSN, RN Student Nurse Liaison: Past President: Mary Stackhouse (resigned) AaNA Labor Council Chair—Donna Phillips, BSN, RN Vice-Chair—Deni Callahan, BSN, RN Secretary—Susan Walsh, RN Treasurer—Colleen Bevans, RN Directors: Julie Eib, RN Lila Elliott, BSN, RN Janet Hilleary, RNC PAMC BU Rep.—Jennifer Hazen, BSN, RN Soldotna BU Rep.—Shelley Burlison, RN-RC Ketchikan BU Rep.—Susan Walsh, RN Affiliate Organizations: Alaska Affiliate of the American College of NurseMidwives Alaska Home Care & Hospice Association Alaska Association of Nurse Anesthetists Alaska Nurse Practitioner Association Alaska School Nurses Association Alaska Clinical Nurse Specialist Association
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 aknurse@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, Patricia Senner at aknurse@ aknurse.org.
March 2013
Alaska Nurse • Page 3
Save The Date May 6 & 7, 2013
Alaska Nurses Association Nurses Week Banquet Featuring Patty Wooten, RN, BSN, PHN and Legendary Nurse-Humorist
Nurses Honored at Nurse of the Year Awards By Andrea Nutty The Alaska March of Dimes Nurse of the Year Awards Banquet, held at Anchorage’s Egan Center on Nov. 16, 2012, honored 25 dedicated nurses from across the state. Honorees were recognized for providing exemplary personal and professional care to individuals and communities and for demonstrating an extraordinary level of patient care and compassion. Among the nurses honored was Jayme Schroeder, who received the Rising Star Nurse of the Year Award for his dedication to pediatric nursing. The Rising Star Award is presented each year to a registered nurse who displays exceptional leadership and professionalism within his or her first 18 months of practice. Schroeder’s colleagues applauded his positive attitude and aptitude for learning, citing his swift obtainment of all mandatory certifications for pediatric nurses, as well as certifications in Advanced Cardiovascular Life Support, Trauma Nursing Core Course, and the STABLE neonatal education program. Janet Froeschle, a certified nurse-midwife and vice president of the Alaska Affiliate of the American College of Nurse-Midwives, was honored with the Advanced Practice Nurse of the Year Award. An employee of Southcentral Foundation since 1990 and frequent traveler to rural villages, Janet has been caring for Alaskans for more than two decades. The Legend in Nursing Award was presented to Wilma Manual who began her nursing career in 1958. Manual worked as an RN during the 1964 earthquake, and she began working in Bethel in 1978 as a Public Health Nurse, a calling she continues to pursue to this day. Traveling every other week to remote villages of the Yukon Kuskokwim Delta, Manual works tirelessly to administer immunizations; screen children for early vision difficulties; promote sexually
transmitted infection screenings; and investigate tuberculosis outbreaks, often without running water. Manual is championed by her colleagues, friends and patients as a hero to the nursing world. All outstanding nurses honored: Felecia Baker – Maternal/Newborn BJ Bennedsen – Perioperative Amanda Bergeron – Advanced Practice, Military Greta Brewster – Nursing Management, Military Kristen Caldwell – NICU Pam Cook – Emergency/Flight Karin Evans – General Medical/Surgical Bonnie Ezell – Nursing Management Janet Johnson – Rehabilitation Catherine Jones – Pediatrics Teri Kiss – Legend in Nursing Brenda Lamont – Hospital Case Management Care Coordinator Natalie Portner – Critical Care, Adults Andra Rasmussen – Non-Hospital-Based Nurse Denise Scholze – Behavioral Health Sheron Smoyer, Friend of Nursing Professional Leslie Stephens – Community Case Management Care Coordinator Emily Stevens – Nursing Administration Brandi Swanson – Licensed Practical Nurse Carol Switzer – Friend of Nursing Ancillary Cary Van Dyke – Education Angeline Washington – Charge Nurse
Patty Wooten is a motivational keynote speaker and industry icon whose laughter, wit, and wisdom heal the hearts of audiences around the world. Patty is often called the “Queen of Jest” because she’s tickled the funny bones of thousands. The world understands more about the healing power of humor because of Patty’s lifelong work with leaders in the field – leading humor researchers and practitioners such as Norman Cousins; Vera Robinson, PhD, RN; Billy Fry, MD; Lee Berk, DrPH; and even Dr. Patch Adams! As the matriarch of the modern therapeutic humor movement, Patty is a founding member of the professional advisory board for the World Laughter Tour, and received the Lifetime Achievement Award for her work in the field of therapeutic humor.
This year’s event is planned for November 22nd. Check the March of Dimes/Alaska website to obtain an application to nominate an outstanding nurse colleague that you know. The AaNA will once again sponsor the Nurse Medallions that are given to each nurse nominated for an award. Please contact our office if you would like to attend the award dinner as a representative of the Alaska Nurses Association. Please email: Andrea@ aknurse.org
An icon within the therapeutic humor industry, Patty captivates, motivates, and energizes her audience. Patty has published three books and more than 50 articles about the therapeutic value of humor and laughter, and was a featured columnist for the Journal of Nursing Jocularity. Her research about humor and burnout was presented at the International Society of Humor Studies. Patty has appeared on numerous television shows including To Tell the Truth and her work has been featured in USA Today. Audiences who hear Patty are changed forever by the compassionate spirit of this fun-loving, caring, dynamic celebrity. She inspires hope and happiness in the hearts of all who share in a “Patty Moment.”
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The next class begins September 16, 2013. For more information contact: Dennis Murray, Senior Program Officer Alaska State Hospital and Nursing Home Association Email: dennis@ashnha.com • Phone: 907-646-1444 For more information on the class and Consortium partners, please visit our website: www.aksnc.net
Page 4 • Alaska Nurse
Susan Walsh, Ketchikan Super Nurse
Susan Walsh, RN and president of the Alaska Nurses Association Board of Directors shares her ride with one of her two beloved dogs, a large St. Bernard. Photo courtesy Susan Walsh Susan Walsh, RN and president of the Alaska Nurses Association Board of Directors, is often told she makes nursing look fun. That is not surprising, though, given that nearly every aspect of Susan Walsh’s life sounds fun. She was born in New York, raised in California, schooled in Montana and has spent most of her adult life as a proud resident of Ketchikan, where her twice-weekly commute to and from work includes a 30-minute boat ride on the skiff owned by her and her husband. The two are caretakers at a lodge off of the road system north of Ketchikan; and aside from their in-town home, they own a large homestead property on Gravina Island, where Walsh hosts an annual all-women summer solstice gathering, just for fun. Her husband, who helps transport the women to and from the island, is allowed to stay for dinner. But that’s about it. Walsh also owns two dogs, and even the 30 chickens that supply her family with all the fresh, flavorful eggs they need to have a pleasurable existence foraging on the beach and enjoying the outdoors. The chickens, of course, go hand in hand with Walsh’s large garden she hopes to one day turn into an edible landscape. To top it off, she works the night shift in the PeaceHealth Ketchikan Medical Center Labor and Delivery Unit. She has been delivering babies for 12 years, now working six days on and eight days off. With what seems to be never-ending excitement and new experiences, you can see why many think Walsh’s life is full of fun. The Seattle STD/HIV Prevention Training Center presents
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“It’s just like Christmas every day I come to work. I never know what I’m going to get,” Walsh said in an interview from her home in Ketchikan, while resting up from a night shift at the hospital. “Labor and Delivery is an art of nursing that gives me the ability to give comfort and relief to new families.” But behind all this fun is a woman, wife and mother who has dedicated her life – both work and play – to serving others. “That’s what I like about nursing. There are different avenues to pursue, and I don’t have to stay at the same spot,” she said. And that’s basically how she leads all aspects of her life. Walsh has been a nurse since 1976. Those 37 years of nursing were spent working in every medical field possible except surgery, as well as dedicating extra time to her involvement with the American Nurses Association; the Alaska Nurses Association Labor Program; the local school board in Ketchikan and the Tongass Conservation Society. On her days off, she works on renovating the family house in the city and cultivating a small P-Patch garden with a greenhouse that she plans to turn into a community garden for residents with less yard space to use to start their own vegetable plants. The end goal is to develop a local version of the Full Circle Farms produce box to feature only produce that has been grown in Alaska. Walsh’s involvement with AaNA began when the labor program started organizing at KGH in 1999. She assumed leadership roles essentially from the start. Today there are roughly 90 members of AaNA’s Ketchikan Nurses Bargaining Unit but only a small core group based in Ketchikan keeps the program going. To Walsh, nursing and immersion in the professional organization go hand in hand. “We are so scattered around the state, ‘United We Stand’ is true,” Walsh said of AaNA nurses slogan. “Nursing is repeatedly the most respected profession among American people surveys, and we have great responsibility to address health care issues. No matter what, health is our main focus professionally, and standing together and addressing those healthcare concern is a benefit for all – nurses and patients.” Aside from pushing for legislation and contract agreements, Walsh emphasized the importance of being involved in AaNA as a way to build bridges with other nurses and maintain contact with each other as life takes them in different directions. Interestingly, going into nursing wasn’t a calling for Walsh, and there was no moment of epiphany either. Walsh was one of six children with a mother who abhorred the site of blood; and, in Walsh’s words, “Someone had to do it.” She also knew a nurse who lived around the corner from her house. “She made nursing look fun,” Walsh said. And now Walsh is the one making nursing look fun.
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March 2013
Nurses Go Red On Sunday, February 10, the Alaska Nurses Association joined the Alaska Aces and the American Heart Association at “Hockey With Heart,” an event kicking off American Heart Month and designed to raise awareness about heart disease, stroke, and other cardiovascular diseases. The American Heart Association is the largest voluntary health organization working to prevent, treat, and defeat these diseases – the number one and number four killers – that claim more than 813,800 American lives each year.
Janet Pasternak, Jennifer Elledge and Eric Moulton participate in “Hockey With Heart.” The Alaska Nurses Association Labor Council has again elected to sponsor the American Heart Association Alaska Heart Run and Anchorage Heart & Stroke Walk. As a sponsor, we are invited to join all the events put on by the AHA. This provides the AaNA with multiple opportunities to show our support for the AHA and to participate in giving back to the community by offering free Blood Pressure checks and First Aid at events. We also have the opportunity to communicate what our organization strives to accomplish in our state for nurses and our community. Intermission activities included a testimonial from Alan Diamond, Head Athletic Trainer of the Alaska Aces, who underwent bypass surgery and entertainment by the AHA’s Jump Rope for Heart performance team. The AaNA booth shared the concourse with the AHA, the GO Red hair station, where attendees received temporary new ‘dos, and the CPR Anytime table, which gave both kids and adults the opportunity to learn the quick and fast community-level skills for chest compressions and calling for help in the event of heart attack or stroke. The Anchorage School District recently updated third-grade curriculum to include the CPR Anytime program. Kathy Bell, RN at Providence Alaska Medical Center and school nurse, and a member of the Alaska School Nurse Association and AaNA, helped introduce this program to children at Golden View Elementary School. The third-graders were given kits, which include an inflatable chest, and learned the skills to save lives. In return, the children were tasked to teach five other people. Using the material taught by this program, a seven-year-old saved her two-year-old brothers’ life last year. The Alaska Nurses Association will be sponsoring the 2013 Alaska Heart Run on April 27th at UAA and the 2013 Anchorage Heart & Stroke Walk on September 14th at the Delaney Park Strip. The 5K Heart Run is the largest footrace in Alaska and attracts participants from across the state. Strollers and children are welcome. Both events are designed to celebrate those who have made healthy-heart lifestyle changes and to raise awareness and funds to continue research and education. The AaNA will have a booth at both events and will have a TEAM at both events as well. Check out our website at www.aknurse.org to learn more and join the Alaska Nurses Association Heart Run or Heart Walk teams!
March 2013
Alaska Nurse • Page 5
Legislative Corner Editor’s Note: This article was written in early February. Bill content is current as of March 14, 2013 and may have changed by time of distribution.
Lobbyists Mark Hickey and Caren Robinson The 28th Legislature Session has begun and the Alaska Nurses Association is closely following two issues: House Bill 53 and the proposed budget for Medicaid funding. House Bill 53 HB 53 is an Act establishing a consultation requirement with respect to the prescription of opiates. This bill was introduced by Representative Keller, who sits on the Alaska Health Care Commission and the House Health and Social Services Committee. HB 53 would require health care providers, including advanced nurse practitioners, to consult with a pain management specialist if the provider is prescribing 120 mg or more of morphine equivalent or other opiate to a patient for longer than one week. The bill states that the State Board of Medicine and the Board of Nursing shall establish criteria and qualifications for
pain management specialists. A second and more controversial provision of the bill is the proposed requirement of all health care professionals to check the controlled substance prescription database operated by the Board of Pharmacy each time an opiate is prescribed. The goal of the bill is to attempt to ensure the appropriate management of patients with pain who are taking larger doses of opiates and to reduce instances of inappropriate opiate prescriptions. While agreeing with the goal of the bill, the Alaska Nurses Association has testified about several concerns. First, although currently working in this capacity, nurse anesthetists were excluded from the description as to who may qualify as a pain management specialist. Secondly, there is already a long waiting period for patients to be evaluated by the existing pain management specialists, most of whom are located in Anchorage. What is a nurse practitioner or nurse anesthetist to do if they cannot have their patient evaluated in a timely fashion? Will this be an added cost to the patient and or third party payer? The requirement of consulting the controlled substance prescription database for every opiate prescription is cumbersome. It was brought out at the hearing that funding for this database only lasts through August 2013. The database is not in real time, with pharmacies only being required to enter data on a monthly basis. If funding for the database continues in the future, the database may become a valuable tool for health care professionals trying to identify individuals who are seeking drugs from multiple providers. HB 53 highlights the need for the many nursing groups of Alaska to work together to get the definition of Advanced Nurse Practitioner changed in Alaska Statutes to Advanced Practice Registered Nurse, which would include nurse anesthetists, nurse midwives, and clinical nurse specialists in addition to nurse practitioners.
FY 2014 Proposed Budget for Alaska Medicaid Services Behavioral Health Medicaid Services
204,936,000
12%
Children’s Medicaid Services
13,937,400
1%
Adult Prev. Dental Medicaid Services
16,426,600
1%
Health Care Medicaid Services
906,500,200
55%
Senior/Disabilities Medicaid Services
520,838,800
31%
Total 1,662,639,000
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It also points to the need for the health care community as whole to work to improve efforts to control the pain experienced by patients. Medicaid Funding Alaska’s Medicaid budget has gone from $1.369 billion in FY 2012 to a projected total of $1.64 billion by the end of FY 2013. The annual growth in Medicaid spending is around 8% at a time when oil tax revenues are declining. William Streur, Commissioner of the Department of Health and Social Services, has been speaking with many health care related groups about this issue. The State of Alaska is the largest single payer for health care in Alaska. If you take State and Federal spending combined, the total is about 60% of the health care dollars spent in the Alaska. Medicaid is a huge part of this spending, with about 20% of the population receiving benefits through Medicaid (including Medicaid waivers) and Denali KidCare. Over the last few years, the average cost per recipient has dropped slightly, but the number of people served has continued to increase. Commissioner Streur has proposed several options for reducing the amount of money the State spends on health care. These include the creation of patient medical (nurses?) homes to return control of patient care to the primary care providers. The State is also looking at creating a managed care system for not only Medicaid recipients, but for State employees as well. They are discussing the possible creation of a disease case management system. The most controversial proposal the Commissioner has put forward is for identifying “centers of excellence” for certain types of surgeries or medical care and then sending patients out of state to these centers. The real goal of this proposal is to identify centers with costs lower than care providers in Alaska. This could have a huge financial impact for Alaska’s hospitals, which rely heavily on surgery and other treatments to fund operations. Since a huge amount of health care in Alaska is funded by the State, the Alaska Nurses Association will continue to follow this debate and try to make sure that nurses are involved in the discussion as to how to reduce costs and maintain access.
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Page 6 • Alaska Nurse
March 2013 Focus on Safe Lifting continued from page 1
2012 AaNA General Assembly November 11, 2012 Anchorage, Alaska RESOLUTION NO. 4 AaNA to Promote Safe Patient Handling and Avoiding Injuries to Workers Legislation Whereas nurses working in health care facilities perform patient handling tasks as part of their every day care responsibilities; and
virtually every room. A no manual lift policy was adopted and enforced. The hospital found that within three to five years, the cost of the equipment, installation and program were offset by the savings in work time lost. But does a hospital really have to purchase expensive equipment and re-tool their hospital rooms to accommodate it? One might ask, “Are there not cheaper ways, such as lift teams or good ergonomic body mechanics training, to provide a safe work environment for nurses as well as safe transfers for patients?”
Whereas if the patients are not lifted and repositioned properly it places them at risk of skin breakdown and injuries from falls; and Whereas there is no safe way to manually lift a physically dependent patient; and Whereas patients are tending to weigh more while the average age of nurses increases; and Whereas lift and transfer assistance devices exist but are not always readily available to nurses; and Whereas studies have shown that humans cannot lift and turn heavy patients over extended time periods without incurring back, shoulder and neck injuries; and Whereas nursing personnel are among the highest at risk for musculoskeletal disorders according to the Bureau of Labor Statistics, and worker’s compensation claims reveal that nursing personnel have the highest claim rates of any occupation or industry. Therefore be it resolved that the Alaska Nurses Association will work to draft legislation that will hasten the adoption of proven strategies – including lift devices – that assist healthcare workers to maneuver worker. The AaNA will work with their lobbyist and other interested parties to find sponsors for such legislation and work for its passage. Therefore be it further resolved that the Alaska Nurses Association will seek willing partners in this effort to include but not limited to the Alaska State Hospital and Nursing Home Association. ___x___Adopted _____Not Adopted
The answer is that lift teams are generally staffed with brawny men. But, when they lift and transfer people all day long, they are just as prone to injury as a smaller person. A lift team program just transfers the injury from the nurse to someone else. In addition, a nurse is less likely to call for a lift team for routine matters, such as putting a patient on a bedpan. They typically would proceed to do it themselves – and get injured. These assertions are supported by research done by Audrey Nelson, Ph.D., RN, associate chief of Nursing Service for Research at the James A. Haley Veterans Hospital in Tampa, and Andrea S. Baptiste, MA, CIE, Biomechanist/Ergonomist at the Patient Safety Center of Inquiry. The two researchers maintain that health care facilities must stop using outdated approaches, including manual patient lifting, classes in body mechanics, training in safe lifting techniques and back belts; these approaches have been proven to be ineffective in reducing caregiver injuries. So why are hospitals reluctant to implement no manual lift policies and opt for the ceiling lifts, slings and air transfer mats that would protect staff and patients alike? In a word: cost. Hospitals often only look at the initial, short term expense of purchasing equipment and implementing a program. Scott Sandager, the Alaska VA’s safe patient handling coordinator, views the Alaska VA’s safe patient handling program as a cost-effective investment in employee safety, since Alaska VA received national funding to implement it.
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Sandager works for the Veterans Administration in Alaska, which has the best, state-of-the-art Safe Patient Handling program and equipment in the state. The program was made possible through national funding of a nationwide VA safe patient handling program aimed at implementing a culture of safety through no manual patient handling by using safe patient equipment. “Some national programs are ahead of ours,” Sandager said. “But, here in Alaska, we’re the most developed.” The Veterans Administration has two major presences in Anchorage, with the Safe Patient Handling program being implemented at both. About two years ago, the VA opened its new OutPatient Service Center in the east side of town. The center is wholly managed and staffed by the VA. For in-patient services, the VA has a joint venture partnership with the Joint Base ElemdorfRichardson (JBER) 673rd Medical Group’s in-patient hospital adjacent to the VA clinic on the base. Sandager works out of an office in the hospital’s Intensive Care Unit. “Here at the JBER 673rd Medical Group/VA Joint Venture Hospital, we have nine out of 10 rooms equipped with ceiling lifts intensive care unit rooms, and 18 of 25 beds have ceiling lifts on the multi-service unit,” Sandager said. “We also use slings and hover mats (air transfer mats) in the outpatient operating room at the VA clinic. A deflated air transfer mat is placed under the patient before surgery, for instance. After surgery the mat is inflated, levitating the patient off the surgery table, enabling the nurse to lightly push the patient onto a recovery stretcher, and again into a waiting bed.” The first part of any safe patient handling program involves the proper equipment with the ultimate goal of 100 percent no manual patient handling of any kind. But, according to Sandager, of equal importance is the program itself: the policies, the training, the implementation and the compliance. “We have 100 percent compliance when a nurse is faced with a 300-pound patient,” Sandager explains, “but when the patient is a frail type it seems more efficient in the nurse’s mind to forgo the equipment and do it themselves.” According to the VA, other reasons staff are sometimes reluctant to use equipment can include time, availability, difficulty of use, space constraints and patient preferences. The key to any program’s success, according to Sandager, is a culture change brought on by moral support from a cadre of leaders and peers setting examples for others. This change is something that the Safe Patient Handling Committee and the coordinator work to develop together. “All VA clinic and JBER hospital in-patient staff have received training now, and the culture of safety will continue to develop and change over time,” Sandager predicts. Almost every country in Europe has mandated no manual lifting policies; and there is a growing movement across this country to do the same, as it has been demonstrated to be a cost efficient way to prevent occupational injuries. The Veterans Administration is a primary player but only one among many. The American Nurses Association has supported legislation on the national level for years. Two bills have been introduced in Congress, and several states have passed legislation. Separate bills (H.R. 2381 and S.B 1788) in the House and Senate would direct the Occupational Safety and Health Administration within one year to propose a rule, to the greatest extent feasible without compromising patient care, that would require hospitals to purchase and install safe patient lift devices; implement safe patient handling and injury prevention plans; track musculoskeletal injuries under a data system; train staff on safe patient handling policies and how to use the devices; and to evaluate these efforts. The legislation would also establish a $200 million grant program to assist health care facilities in purchasing the necessary lifting equipment. Nursing groups believe such legislation could reduce worker injuries and cut hospital costs for workers’ compensation. Dianne O’Connell retired from the Alaska Nurses Association in 2007 after working as the Labor Program Director for 9 years. Dianne also served as the Executive Director/ Program Director for the last 2 years with the AaNA. Dianne is now living in Washington and does freelance writing.
March 2013
Alaska Nurse • Page 7
Six Groups Affiliate continued from page 1 eligibility for Denali KidCare, and to increase the tax on tobacco and alcohol in order to discourage their use by younger generations. The association has worked to increase funding for public health nurses and has lobbied on bills to strengthen public health statutes covering state powers in times of disease outbreaks. The Alaska Nurses Association and its affiliates are always on the lookout to make sure that when there are statutes that reference healthcare providers, nurses are also considered and included. In 2012, AaNA and its dedicated members were able to include nurses in a tuition reimbursement bill. The advanced practice nurses were included in the Tier 1 level of reimbursement for every quarter they work in high need areas. This year, two dozen nurses flew to Juneau for the annual fly-in that took place Feb. 26-28. The fly-in is an opportunity for nurses to meet with their legislators and educate them on what nurses do for their communities. Nurses discussed changes in the work environments for nurses, nursing education and ways to provide quality nursing care for Alaskans. For the past six years, AaNA and its affiliates have been honored to have Caren Robinson and Mark Hickey as our lobbyists. The two share AaNA’s passion for making sure Alaskans receive the health care they need. Alaskan Clinical Nurse Specialists
Laura Sarcone, Alaskan Certified Nurse Midwife
April Charpentier, Alaskan Certified Registered Nurse Anesthetist
Alaskan Military Certified Nurse Midwives
Celebrate National Nurses Week May 6-12
Page 8 • Alaska Nurse
March 2013
Labor Lines Soldotna Nurses Bargaining Unit Reaches Contract Agreement with Central Peninsula General Hospital / Heritage Place Soldotna, Alaska—The Soldotna Nurses Bargaining Unit (RNs United), affiliates of the Alaska Nurses Association, recently ratified a three-year contract agreement with Central Peninsula General Hospital (CPH) and Heritage Place administrators. On Dec. 26, 2012, the RNs United negotiating team shared details of the proposed new contract with members and took a ratification vote. CPH Chief Executive Officer Rick Davis took his recommendations to the borough executive committee, which voted to officially ratify the contract Dec. 27. This new contract ensures nurses will receive a step wage increase that is competitive with nurses’ wages in Anchorage. The contract also specifies that nurses will receive 10 hours of rest time between regularly scheduled shifts. “Our top priority for negotiations of a new contract were patient and nurse safety as well as ensuring that our members receive proper benefits for their hard work,” said RNs United President Velinda Albrechta-East. “We feel that all of these objectives were met by this newly ratified contract with CPH.” Effective January 1, 2013, members of RNs United, began receiving their benefits from the successful contract negotiations. Nurses will receive time and a half of their base pay rate for any overtime hours if they are called back after the completion of a shift; team leaders and preceptor nurses will receive additional pay for their added responsibilities while on shift; and nurses will be given 10 hours of time to sleep between shifts to avoid burnout and fatigue. Additionally, the Professional Practice Committee will focus on advancing nursing standards of care at CPH. A new LaborManagement Committee was formed with the focus to assist in the development, evaluation and review of personnel policies, procedures that are “mandatory subjects of bargaining.” The labor program of the Alaska Nurses Association was established in 1974 to advance and support the profession of nursing in Alaska through its three bargaining units in Anchorage, Ketchikan and Soldotna. The Alaska Nurses Association works to improve health standards and access to healthcare services for Alaskans; fosters high standards and the professional development of nurses; advances the economic and general welfare of its members and empowers nurses to be dynamic leaders in healthcare and political communities.
Ketchikan Nurses Bargaining Unit Reaches Contract Agreement with PeaceHealth Ketchikan Medical Center KETCHIKAN, Alaska—The Ketchikan Nurses Bargaining Unit, part of the Alaska Nurses Association Labor Program, recently completed contract negotiations and reached a new agreement with PeaceHealth Ketchikan Medical Center administration. Rank-and-file members of the association in Ketchikan ratified the agreement in a vote that took place on Monday, Oct. 15. The two-year agreement guarantees two separate wage increases as well as scheduling changes that will better ensure patient safety. “We are extremely pleased that our Ketchikan nurses were successful in achieving this improved agreement that promotes patient safety and also supports the nurses’ general and economic welfare,” said Alaska Nurses Association Labor Council Chair Donna Phillips, BSN, RN. “A secure, collective bargaining agreement such as this promotes a trained and ready workforce for the community of Ketchikan and the surrounding areas.” Beginning December 2012, members of the Ketchikan Nurses Bargaining Unit will receive a 6 percent wage increase throughout the following 16 months. In addition, the bargaining unit secured a 1 to 3 percent annual step increase. Furthermore, the new agreement guarantees a slot on the schedule for an experienced night nurse who will float between hospital units to offer support and assistance, as needed, to fellow night shift nurses. Members of the Ketchikan Bargaining Unit who are responsible for these successful negotiations: Ketchikan Board Vice President Kristin Fahey, RN; Board Secretary Sarah Eichman, RN and Grievance Officer Syble Doyon, RN; and 2012 negotiation team members Sharon Clarkson, RN, Ann Fama, RN and Jen MacDonald, RN.
March 2013
Alaska Nurse • Page 9
Labor Lines
Alaska Nurses Association Members Attend Juneau AFL-CIO Legislative Fly-in Donna Phillips, BSN, RN, Labor Council Chair
Kristin Fahey, Jennifer Hazen and Lila Elliott stop for a photo before heading into the Capitol for appointments with legislators.
The Alaska Nurses Association Labor Program has been a member of the Alaska AFL-CIO since 1999. AaNA has always sent representatives to the Juneau meeting, and this year we were fortunate to have several members return for a second or third time. Attendees included Kristin Fahey, Ketchikan General Hospital Bargaining Unit vice-president and Board of Directors secretary; Lila Elliott, KGH health and safety officer and Labor Council member; Deni Callahan, PRN president and Labor Council vice-chair; Terra Colegrove, PRN negotiating team member 2012; Jennifer Hazen, AaNA Board of Directors treasurer and Labor Council member; and Jane Erickson, long-time AaNA member and new member of the Board of Directors. As the AaNA Labor Council chair and Board of Directors member, I, too, was able to enjoy this great event.
Seasoned leaders from the Ketchikan Registered Nurses (employed by Ketchikan General Hospital) and the Providence Registered Nurses (PRN) Bargaining Units joined other state union leaders Jan. 21-22, for the annual AFL-CIO legislative flyin. The annual Juneau gathering is an opportunity for union leaders to discuss issues of common interest, particularly those related to the economy and collective bargaining in the state.
While members of our group noticed that the work was a bit different this year (last year we were in the middle of working bills; this year we are just coming off an election), we all enjoyed the opportunity to meet with new legislators who were making their way through the first couple of weeks in their new positions. Some of our nurses met with their legislators and staff to make the important connection of putting a face with the constituent. Many of the legislators we knew from the previous session were very welcoming and open to hearing our opinions. We enjoyed the opportunity to thank all the legislators and their staff for all the hard work they do in a very short 90-day session. While AaNA is fortunate to be able to represent more than 1,200 nurses for collective bargaining, we enjoy meeting with other labor leaders who also represent registered nurses in Alaska. Many RNs, such as state workers at Alaska Psychiatric Institute (API), public health nurses and school nurses in the school districts, also enjoy the benefits of having a union behind them. This annual fly-in event is a great way to network with other unions in our state. We have received great support from the labor community when we needed it in the past. We are thankful for the long-standing relationship we have had with others in the labor community in Alaska and the many unions that represent nurses in our state. Thank you for the opportunity to serve our association in this very special way.
Senator Ellis and Anil Karia While in Juneau, our delegation met with the AaNA lobbyist team, Caren Robinson and Mark Hickey. Our lobbyists have represented the interests of Alaska nurses through our Alaska Nurses Association Legislative Committee for the past six years. The Legislative Committee works with AaNA affiliates and interested members. We appreciate all the hard work and dedication it takes to keep track of several bills that may affect our profession and our patients. Joelle Hall, Jennifer Hazen, Jane Erickson and Kristin Fahey
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Celebrating 25 Years of Service EMPLOYMENT OPPORTUNITIES
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Registered Nurses North Star is Alaska’s premier behavioral health provider that specializes in helping young people with life’s challenges. Our programs at North Star work with the family and the community to help facilitate optimal growth and nurturing throughout times of childhood adversity. Our goal is to help young people get on a track that leads to a life of youthfulness—the life that child and adolescents deserve. North Star is seeking registered nurses to join an outstanding nursing department. The registered nurse is responsible for delivering quality general and psychiatric nursing care to patients with emotional or psychiatric disorders; serves actively and constructively as a member of the multi-disciplinary treatment team, supporting the organization and program philosophy of care; ensuring the safety and well-being of each patient. Must be licensed as a Registered Nurse in the State of Alaska. Sign on bonuses currently offered for all Full-Time & Part-Time new hires
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To apply, please visit www.northstarbehavioral.com and go to the employment section. Follow the instructions to apply online.
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North Star Behavioral Health is an Equal Opportunity Employer.
Page 10 • Alaska Nurse
In Memoriam
Arne Beltz, MPH, MN, RN Arne Louise Bulkeley Beltz, 95, passed away at home on February 1, 2013. Arne was born, October 27, 1917 in Little Falls, New York. She graduated from Rhinebeck High School in 1934, Middlebury College in 1938 and the Yale School of Nursing in 1942. She worked in the Visiting Nurse Service in New York City and Georgia until 1944. Then she served as an Army Nurse in WWII stationed in the Philippines. She moved to Wrangell, Alaska in 1948 and lived and worked in various communities in Alaska: Kake and Angoon from 1950-1952, Fairbanks from 1952-1957, Unalakleet from 1957-1960 and finally to Anchorage in 1960. It was in Fairbanks that Arne married William Beltz on November 28, 1953. Both were interested in the welfare of the Alaskan people, he as a State Senator and she as a traveling public health nurse. They had four children, Mark, William, Kathy, and Axel. Upon her husband’s untimely death in 1960, Arne moved to Anchorage to raise her children. She worked in the Health Department and eventually became the Division Manager of Physical Health in Anchorage from 1981 to 1984 when she retired. Foremost among her many honors, the Health Department Building in downtown Anchorage was named for her in 1990. More recently she is an inductee into the Alaska Women’s Hall of Fame class of 2013. Arne was active in the Alaska Nurses Association since the 1950’s, serving as district president, and as AaNA State President from 1973 to 1975. She worked with AaNA to establish a multidisciplinary Health Summit to provide a forum for networking to benefit the citizens of Alaska. Arne was inducted into the AaNA Hall of Fame in 2003. She is remembered as a public health hero and nursing legend. Arne enjoyed gardening, reading, writing and being active in the community. She was proud to be a part of Citizens Against Nuclear War. She opened her home and heart to many people and many people think of her as their mother. Arne was admired for her grace, wit and strength. She is survived by her son William Beltz; granddaughters Stephanie Beltz and Bree Avellaneda (Ron); grandson David Beltz; great grandsons Marco and Leonardo Avellaneda; stepdaughters Wanda and Caroline Beltz; nephews Peter, David, and Jonathan Bulkeley; and niece Susan Daly. Arne is preceded in death by her sons Mark and Axel Beltz; daughter Katherine Beltz, brother Peter Bulkeley, sisters Judy Bulkeley, Grace Bulkeley and Marjorie Garwood; husband William Beltz; father Dr. Howard Sheldon Bulkeley; and mother Alice Maclean Bulkeley.
March 2013
Calendar of Events
AaNA Professional Practice Committee Third Monday of each month 5:00 to 6:00 pm
National Nurses Week! – May 6-12, 2013 AaNA District 1 Nurses Week Banquet - Anchorage May 6, 2013 Kincaid Park AaNA Nurses Week Banquet – Soldotna May 7, 2013 Kenai Senior Center Featuring Nurse-Humorist Patty Wooten!
AaNA Legislative Committee Contact for times: andrea@aknurse.org or 907-274-0827
Stay tuned for more exciting Nurses Week events! Tickets available online at www.aknurse.org or call (907) 274-0827
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AaNA Board of Directors Meeting Third Wednesday of each month 4:00 to 5:30 pm AaNA Labor Council Meeting Third Wednesday of each month 5:30 to 7:30 pm
Providence Registered Nurses Third Thursday of each month
4:00 to 6:00 pm
RN’s United of Central Peninsula Hospital Contact for times: 907-252-5276 KTN Ketchikan General Hospital Contact for times: 907-247-3828 ___________________________________________________________
Alaska State Board of Nursing – Upcoming Meetings April 3-5, 2013 Juneau agenda deadline March 13, 2013 July 10-12, 2013 Anchorage agenda deadline June 19, 2013 October 23-25, 2013 Fairbanks agenda deadline Oct. 3, 2013 January 22-24, 2014 Anchorage agenda deadline Dec. 30, 2013 The Alaska Board of Nursing has a listserv that is used to send out the latest information about upcoming meetings, agenda items, regulations being considered, and other topics of interest to nurses, employers, and the public. To sign up for this free service, visit www.nursing.alaska.gov Inquiries regarding meetings and appearing on the agenda can be directed to: Nancy Sanders, PhD RN, Executive Administrator Alaska State Board of Nursing 550 West 7th Ave, Ste 1500, Anchorage, AK 99501 Ph: 907-269-8161 Fax: 907-269-8196 Email: nancy.sanders@alaska.gov ___________________________________________________________
Alaska School Nurses Association 2013 Spring Conference “We’re Ready!” Emergency Nursing in the School Setting April 19-21, 2013 Settler’s Bay Lodge, Wasilla www.alaskasna.org/conferences.html ___________________________________________________________
International Council for Nurses 25th Quadrennial Congress May 18-23, 2013 Melbourne, Australia “Equity and Access to Health Care” www.icn2013.ch ___________________________________________________________
American Association of Critical-Care Nurses National Teaching Institute & Critical Care Exposition May 20-23, 2013 • Preconferences May 18-19, 2013 Boston, MA www.aacn.org/nti ___________________________________________________________
Seattle STD/HIV Prevention Training Center STD Update with Optional Clinical Practicum May 22-23, 2013 Anchorage seaptc@uw.edu ___________________________________________________________
AANP 28th National Conference June 19-23, 2013 – Las Vegas, NV Dr. Donna Shalala – IOM, The Future of Nursing Report The Venetian, The Palazzo & Sands Expo & Convention Center ___________________________________________________________
Award Opportunities for the Alaska Nurses Foundation, deadline August 1, 2013. Watch website www.aknurse.org for details.
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American Association of Nurse Anesthetists 2013 Annual Meeting August 10-13, 2013 – Las Vegas, NV www.aana.com ___________________________________________________________
Alaska Nurse Practitioner Association 30th Annual Conference September 12-14, 2013 – Anchorage Marriott www.anpa.enpnetwork.com
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Experience a New Model of Healthcare . . . Southcentral Foundation (SCF) is an Alaska Native owned, nonprofit healthcare organization located on the Alaska Native Health Campus. SCF is seeking dynamic Registered Nurses to act as Case Managers in (SCF) Primary Care Clinics. Experience the opportunity to practice in a customer centered case management position within the award winning “NUKA” system of care; a designated medical home. Work as part of our growing integrated care teams, caring for a panel of customer owners. Combining your knowledge of preventative and disease process, with passion for our customer’s care.
$10,000 Sign on Bonus for full time Primary Care RN positions Relocation assistance provided, excellent benefits package, and much more. This position is open to Public Health and Commission Corp Officers. If you are interested in becoming part of the nationally recognized Anchorage Facility please visit our website and apply at www.scf.cc or contact Tess Johnson at 907-729-5011/email tjohnson@scf.cc
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March 2013
Alaska Nurse • Page 11
Professional Practice Corner
Nurse Administration of Low-Dose Ketamine for Pain – Is It Safe? Patricia Senner MS, RN, ANP, Alaska Nurses Association Interim Professional Practice Director At the January 2013 Alaska Board of Nursing meeting, representatives from Central Peninsula Hospital approached the Board with a proposal to allow RNs in the hospital to administer lowdose intravenous Ketamine for the management of intractable or poorly controlled pain. This type of treatment is an off-label use for Ketamine, which is an anesthetic agent, generally administered by an anesthesiologist or a Certified Register Nurse Anesthetist (CRNA). This raises the question, “how safe is this practice and under what circumstances can the RN safely assume this responsibility?” Ketamine is a dissociative agent which causes a functional and electrophysiolgic dissociation in the brain leading to a trance-like state. The drug accomplishes this by noncompetitively inhibiting glutamate at the N-methy-D-aspartate (NMDA) receptors at the thalamocortical and limbic central nervous system (Sih et al., 2011). At lower doses, Ketamine also has analgesic properties. The downside of Ketamine is that in some individuals it causes psychomimetic adverse effects such as hallucination, nightmares, feeling light-headed, floating, delusions and/or delirium. In addition to these side-effects Ketamine increases heart rate and blood pressure. These side effects can occur up to several days after administration. Ketamine is metabolized via the cytochrome P450 3A4 pathway. In the 1970s, Ketamine began showing up in nightclubs and social settings as a recreational drug under the name “Special K.” Because of the potential for abuse it is a controlled substance and is categorized as a schedule III medication. Because of its analgesic properties, studies have been conducted to test whether the use of Ketamine enhances pain control in a number of different types of patients, including out-ofhospital trauma patients (Jennings et al., 2012), ED patients ( Richards & Rockford, 2012) patients with chronic pain (Hockings & Cousins, 2003), and patients receiving palliative care (Prommer, 2012).
Anesthesiologists specializing in pain control are prescribing low-dose Ketamine for postoperative pain, particularly in patients who have used opioids prior to surgery. In a review article of fifty-three randomized trials done on Ketamine use in postoperative pain Elia & Tramer (2005) concluded that administering Ketamine with morphine postoperatively decreased the pain intensity experienced by patients who completed a pain intensity visual analogue scale. The difference in pain scores between patients receiving Ketamine and morphine versus morphine alone was highest immediately postoperatively and then declined with time. There was a statistically significant decrease in morphine consumption with Ketamine, with morphine sparing ranging from 9% to 47%. Ketamine administered after surgery was as effective as Ketamine administered prior to surgery (Elia & Tramer, 2005). In these postoperative studies it was found that the risk of Ketamine induced hallucinations was minimal in anesthetized patients. In contrast, one in 35 non-anesthetized patients who received Ketamine had hallucinations which they would not have experienced without Ketamine (Elia& Tramer, 2004). The risk of hallucinations was highest in awake or sedated patients receiving Ketamine. At the Alaska Board of Nursing meeting, one of the main concerns expressed by board members was what would a nurse on a medicalsurgical unit with multiple patient responsibilities do if their patient receiving Ketamine started to hallucinate. With the nurses other patient responsibilities, it would be difficult for the nurse to take the time needed to respond to the disoriented patient. The New York State Board of Nursing (NYSBN) adopted a protocol for IV administration of Ketamine for Treatment of Pain in June of 2011 (http://www.op.nysed.gov/prof/nurse/nurse-ivketamine.htm). The NY Board’s policy states that, within the first 24 hours of initiation of low-dose Ketamine administration, RNs can administer and monitor patients on this regimen only to patients in recovery rooms, critical care, hospice, stepdown or palliative care areas, that is in patient
care units with low patient to nurse rations. After this time if the patient doesn’t show signs of troublesome side effects, they can be cared for in general patient units. There are other criteria set out by the NY Board of Nursing that provide good safeguards for the patient and nurse. In a phone call to the NYSBN, it was stated that there had been no reports of difficulties occurring when the protocols were followed. Using low-dose Ketamine postoperatively in the hospital setting has been shown to reduce the pain experienced by patients and reduces the need for opiates. If protocols like that developed by the NYSBN are used, there should be protections in place to make sure the nurse can adequately deal with any medication side effects their patients may experience. For a copy of the Alaska Board of Nursing’s advisory opinion of Registered Nurse administration of sedating and anesthetic agents go to http://www.dced.state.ak.us/occ/pub/ nur1809.pdf. References Elia, N. & Tramer, M.R. (2005) Ketamine and postoperative pain – a quantitative systematic review of randomized trials. Pain, 113 (2005), 6170. Hocking, G. & Cousins, M.J. (2003) Ketamine in chronic pain management: and evidence-based review. Anesth Analg, 97, 1730-1739. Jennings, P.A., Cameron, P., Bernar, S., Walker, T., Jolley, D., Fitzgerald, M., & Masci, K. (2012). Morphine and Ketamine is superior to morphine alone for out-of-hospital trauma analgesia: a randomized controlled trial. Annals of Emergency Medicine, Vol. 59 (6), 497-503. Richards, J.R. & Rockford, R.E. (2012). Lowdose ketamine analgesia: patient and physician experience in the ED. American Journal of Emergency Medicine). Article in press, accepted 27 July 2012. Sih, K., Campbell, S.G. , Tallon, J.M., Magee, K, & Zed, P.J. (2011). Ketamine in adult emergency medicine: controversies and recent advances. The Annals Pharmacotherapy, December, Vol.45, 15251534.
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Page 12 • Alaska Nurse
March 2013
Congratulations UAA Graduates
Baccalaureate Degree Program Graduates
Associate Degree Program Graduates from outreach programs across the state
Katie Ellsworth Tina Harness Darilynn Moses Karin Siebenmorgen Alisa Folsom Debra Nielsen Carrie Pleier Sara Savo Carder Adcock Lora Anderson Jane Atkinson Nicole Barker Sara Burley Elizabeth Doddridge Alisha Flieger Johnny Germann Caleb Nichols Rachel Piszczek Nicole Smathers Lisa Stevenson Leah Swasey Tristan Wagner Mira Wilhelm Susan Cobb Elizabeth Cristiano Desiree Dunn Ashley Franchino
Location Bethel Bethel Bethel Bethel Dillingham Dillingham Dillingham Dillingham Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Fairbanks Kenai Kenai Kenai Kenai
Laura Hatten Angela Hill Jeremy Hunter Jordan Ikerd Jacqueline Michels Ashley Myers Margaret Padgett Amanda Pugh Julie Roberts Kristie Stockton Elizabeth Tough Stephanne Bradbury Jennifer Doerksen Katelyn Gallaway Erin Howland Erin Simone Jessica Wheelhouse Jessica Mute Amber Ryan Sarah Weaver Lorraine Daly Ruth Evans Michelle Fleming Georgianna Foruria Ann-Marie Parker Trinna Wick
Location Kenai Kenai Kenai Kenai Kenai Kenai Kenai Kenai Kenai Kenai Kenai Kodiak Kodiak Kodiak Kodiak Kodiak Kodiak Nome Nome Nome Sitka Sitka Sitka Sitka Sitka Sitka
Ilsa Y Anderson
Ruby S McMahon
Caroline E Aulie
Isabel A Nay
Eva A Brink
James A Nicholson
Kyle A Chacho
Jori K Nicholson
Stlaay Cloud-Morrison
Jessica M Portlock
Hayley C Crow
Eva M Prieto
Evgeny V Degodyuk
Danya L Rowan
Sarah A del Rosario
Tina L Sargent
Hannah E Dompier
Sarah L Schieman
Earlene E Eaton
Danielle R Schinn
Ashley E Fairbanks
Meghan K Smith
Janaya R Hartman
Cheryl J Tatham
Charlene M Hill
Jonbert M Villamor
Holland E Kuper
Cara H Washburn
Wendy M Lewis
Patricia E Westbrook
Samantha A Martinez
Monica V Zakrzewski
Spirit of Nursing Award –
Awarded by faculty vote for the student they feel demonstrates the spirit of caring, science, love of learning, and compassion. BS – Ruby S McMahon
Peer Award –
Awarded by the senior class to a fellow classmate who has completed their nursing studies while balancing the daily demands of life. Sponsored by the AaNA. BS – Meghan K Smith
Directors Award –
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Alaska Nurse • Page 13
White Paper: A Nurse’s Guide to the Use of Social Media Reprinted with permission from National Council of State Boards of Nursing Introduction The use of social media and other electronic communication is increasing exponentially with growing numbers of social media outlets, platforms and applications, including blogs, social networking sites, video sites, and online chat rooms and forums. Nurses often use electronic media both personally and professionally. Instances of inappropriate use of electronic media by nurses have been reported to boards of nursing (BONs) and, in some cases, reported in nursing literature and the media. This document is intended to provide guidance to nurses using electronic media in a manner that maintains patient privacy and confidentiality. Social media can benefit health care in a variety of ways, including fostering professional connections, promoting timely communication with patients and family members, and educating and informing consumers and health care professionals. Nurses are increasingly using blogs, forums and social networking sites to share workplace experiences particularly events that have been challenging or emotionally charged. These outlets provide a venue for the nurse to express his or her feelings, and reflect or seek support from friends, colleagues, peers or virtually anyone on the Internet. Journaling and reflective practice have been identified as effective tools in nursing practice. The Internet provides an alternative media for nurses to engage in these helpful activities. Without a sense of caution, however, these understandable needs and potential benefits may result in the nurse disclosing too much information and violating patient privacy and confidentiality. Health care organizations that utilize electronic and social media typically have policies governing employee use of such media in the workplace. Components of such policies often address personal use of employer computers and equipment, and personal computing during work hours. The policies may address types of websites that may or may not be accessed from employer computers. Health care organizations also maintain careful control of websites maintained by or associated with the organization, limiting what may be posted to the site and by whom. The employer’s policies, however, typically do not address the nurse’s use of social media outside of the workplace. It is in this context that the nurse may face potentially serious consequences for inappropriate use of social media. Confidentiality and Privacy To understand the limits of appropriate use of social media, it is important to have an understanding of confidentiality and privacy in the health care context. Confidentiality and privacy are related, but distinct concepts. Any patient information learned by the nurse during the course of treatment must be safeguarded by that nurse. Such information may only be disclosed to other members of the health care team for health care purposes. Confidential information should be shared only with the patient’s informed consent, when legally required or where failure to disclose the information could result in significant harm. Beyond these very limited exceptions the nurse’s obligation to safeguard such confidential information is universal. Privacy relates to the patient’s expectation and right to be treated with dignity and respect. Effective nursepatient relationships are built on trust. The patient needs to be confident that their most personal information and their basic dignity will be protected by the nurse. Patients will be hesitant to disclose personal information if they fear it will be disseminated beyond those who have a legitimate “need to know.” Any breach of this trust, even inadvertent, damages the particular nursepatient relationship and the general trustworthiness of the profession of nursing. Federal law reinforces and further defines privacy through the Health Insurance Portability and Accountability Act (HIPAA). HIPAA regulations are intended to protect patient privacy by defining individually identifiable information and establishing how this information may be used, by whom and under what circumstances. The definition of individually identifiable information includes any information that relates to the past, present or future physical or mental health of an individual, or provides enough information that leads someone to believe the information could be used to identify an individual. Breaches of patient confidentiality or privacy can be intentional or inadvertent and can occur in a variety of ways. Nurses may breach confidentiality or privacy with information he or she posts via social media. Examples may include comments on social
networking sites in which a patient is described with sufficient detail to be identified, referring to patients in a degrading or demeaning manner, or posting video or photos of patients. Additional examples are included at the end of this document. Possible Consequences Potential consequences for inappropriate use of social and electronic media by a nurse are varied. The potential consequences will depend, in part, on the particular nature of the nurse’s conduct. BON Implications Instances of inappropriate use of social and electronic media may be reported to the BON. The laws outlining the basis for disciplinary action by a BON vary between jurisdictions. Depending on the laws of a jurisdiction, a BON may investigate reports of inappropriate disclosures on social media by a nurse on the grounds of: • Unprofessional conduct; • Unethical conduct; • Moral turpitude; • Mismanagement of patient records; • Revealing a privileged communication; and • Breach of confidentiality. If the allegations are found to be true, the nurse may face disciplinary action by the BON, including a reprimand or sanction, assessment of a monetary fine, or temporary or permanent loss of licensure. A 2010 survey of BONs conducted by NCSBN indicated an overwhelming majority of responding BONs (33 of the 46 respondents) reported receiving complaints of nurses who have violated patient privacy by posting photos or information about patients on social networking sites. The majority (26 of the 33) of BONs reported taking disciplinary actions based on these complaints. Actions taken by the BONs included censure of the nurse, issuing a letter of concern, placing conditions on the nurse’s license or suspension of the nurse’s license. Other Consequences Improper use of social media by nurses may violate state and federal laws established to protect patient privacy and confidentiality. Such violations may result in both civil and criminal penalties, including fines and possible jail time. A nurse may face personal liability. The nurse may be individually sued for defamation, invasion of privacy or harassment. Particularly flagrant misconduct on social media websites may also raise liability under state or federal regulations focused on preventing patient abuse or exploitation. If the nurse’s conduct violates the policies of the employer, the nurse may face employment consequences, including termination. Additionally, the actions of the nurse may damage the reputation of the health care organization, or subject the organization to a law suit or regulatory consequences. Another concern with the misuse of social media is its effect on team-based patient care. Online comments by a nurse regarding co-workers, even if posted from home during nonwork hours, may constitute as lateral violence. Lateral violence is receiving greater attention as more is learned about its impact on patient safety and quality clinical outcomes. Lateral violence includes disruptive behaviors of intimidation and bullying, which may be perpetuated in person or via the Internet, sometimes referred to as “cyber bullying.” Such activity is cause for concern for current and future employers and regulators because of the patient- safety ramifications. The line between speech protected by labor laws, the First Amendment and the ability of an employer to impose expectations on employees outside of work is still being determined. Nonetheless, such comments can be detrimental to a cohesive health care delivery team and may result in sanctions against the nurse. Common Myths and Misunderstandings of Social Media While instances of intentional or malicious misuse of social media have occurred, in most cases, the inappropriate disclosure or posting is unintentional. A number of factors may contribute to a nurse inadvertently violating patient privacy and confidentiality while using social media. These may include: • A mistaken belief that the communication or post is private and accessible only to the intended recipient. The nurse may fail to recognize that content once posted or sent can be disseminated to others. In fact, the terms of using a social media site may include an extremely broad
• •
•
•
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waiver of rights to limit use of content.1 The solitary use of the Internet, even while posting to a social media site, can create an illusion of privacy. A mistaken belief that content that has been deleted from a site is no longer accessible. A mistaken belief that it is harmless if private information about patients is disclosed if the communication is accessed only by the intended recipient. This is still a breach of confidentiality. A mistaken belief that it is acceptable to discuss or refer to patients if they are not identified by name, but referred to by a nickname, room number, diagnosis or condition. This too is a breach of confidentiality and demonstrates disrespect for patient privacy. Confusion between a patient’s right to disclose personal information about himself/herself (or a health care organization’s right to disclose otherwise protected information with a patient’s consent) and the need for health care providers to refrain from disclosing patient information without a care-related need for the disclosure. The ease of posting and commonplace nature of sharing information via social media may appear to blur the line between one’s personal and professional lives. The quick, easy and efficient technology enabling use of social media reduces the amount of time it takes to post content and simultaneously, the time to consider whether the post is appropriate and the ramifications of inappropriate content.
How to Avoid Problems It is important to recognize that instances of inappropriate use of social media can and do occur, but with awareness and caution, nurses can avoid inadvertently disclosing confidential or private information about patients. The following guidelines are intended to minimize the risks of using social media: • First and foremost, nurses must recognize that they have an ethical and legal obligation to maintain patient privacy and confidentiality at all times. • Nurses are strictly prohibited from transmitting by way of any electronic media any patientrelated image. In addition, nurses are restricted from transmitting any information that may be reasonably anticipated to violate patient rights to confidentiality or privacy, or otherwise degrade or embarrass the patient. • Do not share, post or otherwise disseminate any information, including images, about a patient or information gained in the nurse-patient relationship with anyone unless there is a patient care related need to disclose the information or other legal obligation to do so. • Do not identify patients by name or post or publish information that may lead to the identification of a patient. Limiting access to postings through privacy settings is not sufficient to ensure privacy. • Do not refer to patients in a disparaging manner, even if the patient is not identified. • Do not take photos or videos of patients on personal devices, including cell phones. Follow employer policies for taking photographs or video of patients for treatment or other legitimate purposes using employer-provided devices. • Maintain professional boundaries in the use of electronic media. Like in-person relationships, the nurse has the obligation to establish, communicate and enforce professional boundaries with patients in the online environment. Use caution when having online social contact with patients or former patients. Online contact with patients or former patients blurs the distinction between a professional and personal relationship. The fact that a patient may initiate contact with the nurse does not permit the nurse to engage in a personal relationship with the patient. • Consult employer policies or an appropriate leader within the organization for guidance regarding work related postings. • Promptly report any identified breach of confidentiality or privacy. • Be aware of and comply with employer policies regarding use of employer-owned computers, cameras and other electronic devices and use of personal devices in the work place. • Do not make disparaging remarks about employers or co-workers. Do not make
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Page 14 • Alaska Nurse Social Media continued from page 13 threatening, harassing, profane, obscene, sexually explicit, racially derogatory, homophobic or other offensive comments. • Do not post content or otherwise speak on behalf of the employer unless authorized to do so and follow all applicable policies of the employer. Conclusion Social and electronic media possess tremendous potential for strengthening personal relationships and providing valuable infor- mation to health care consumers. Nurses need to be aware of the potential ramifications of disclosing patient-related information via social media. Nurses should be mindful of employer policies, relevant state and federal laws, and professional standards re- garding patient privacy and confidentiality and its application to social and electronic media. By being careful and conscientious, nurses may enjoy the personal and professional benefits of social and electronic media without violating patient privacy and confidentiality. Illustrative Cases The following cases, based on events reported to BONs, depict inappropriate uses of social and electronic media. The outcomes will vary from jurisdiction to jurisdiction. SCENARIO 1 Bob, a licensed practical/vocational (LPN/VN) nurse with 20 years of experience used his personal cell phone to take photos of a resident in the group home where he worked. Prior to taking the photo, Bob asked the resident’s brother if it was okay for him to take the photo. The brother agreed. The resident was unable to give consent due to her mental and physical condition. That evening, Bob saw a former employee of the group home at a local bar and showed him the photo. Bob also discussed the resident’s condition with the former coworker. The administrator of the group home learned of Bob’s actions and terminated his employment. The matter was also reported to the BON. Bob told the BON he thought it was acceptable for him to take the resident’s photo because he had the consent of a family member. He also thought it was acceptable for him to discuss the resident’s condition because the former employee was now employed at another facility within the company and had worked with the resident. The nurse acknowledged he had no legitimate purpose for taking or showing the photo or discussing the resident’s condition. The BON imposed disciplinary action on Bob’s license requiring him to complete continuing education on patient privacy and confidentiality, ethics and professional boundaries. This case demonstrates the need to obtain valid consent before taking photographs of patients; the impropriety of using a personal device to take a patient’s photo; and that confidential information should not be disclosed to persons no longer involved in the care of a patient. SCENARIO 2 Sally, a nurse employed at a large long-term care facility arrived at work one morning and found a strange email on her laptop. She could not tell the source of the email, only that it was sent during the previous nightshift. Attached to the email was a photo of what appeared to be an elderly female wearing a gown with an exposed backside bending over near her bed. Sally asked the other dayshift staff about the email/photo and some confirmed they had received the same photo on their office computers. Nobody knew anything about the source of the email or the identity of the woman, although the background appeared to be a resident’s room at the facility. In an effort to find out whether any of the staff knew anything about the email, Sally forwarded it to the computers and cell phones of several staff members who said they had not received it. Some staff discussed the photo with an air of concern, but others were laughing about it as they found it amusing. Somebody on staff started an office betting pool to guess the identity of the resident. At least one staff member posted the photo on her blog. Although no staff member had bothered to bring it to the attention of a supervisor, by midday, the director of nursing and facility management had become aware of the photo and began an investigation as they were very concerned about the patient’s rights. The local media also became aware of the matter and law enforcement was called to investigate whether any crimes involving sexual exploitation had been committed. While the county prosecutor, after reviewing the police report, declined to prosecute, the story was heavily covered by local media and even made the national news. The facility’s management placed several staff members on administrative leave while they looked into violations of facility rules that emphasize patient rights, dignity and protection. Management reported the matter to the BON, which opened investigations to determine whether state or federal regulations against “exploitation of vulnerable adults” were violated. Although the originator of the photo was never discovered, nursing staff also faced potential liability for their willingness to electronically
March 2013 share the photo within and outside the facility, thus exacerbating the patient privacy violations, while at the same time, failing to bring it to management’s attention in accordance with facility policies and procedures. The patient in the photo was ultimately identified and her family threatened to sue the facility and all the staff involved. The BON’s complaint is pending and this matter was referred to the agency that oversees longterm care agencies. This scenario shows how important it is for nurses to carefully consider their actions. The nurses had a duty to immediately report the incident to their supervisor to protect patient privacy and maintain professionalism. Instead, the situation escalated to involving the BON, the county prosecutor and even the national media. Since the patient was ultimately identified, the family was embarrassed and the organization faced possible legal consequences. The organization was also embarrassed because of the national media focus. SCENARIO 3 A 20-year-old junior nursing student, Emily, was excited to be in her pediatrics rotation. She had always wanted to be a pediatric nurse. Emily was caring for Tommy, a three-year-old patient in a major academic medical center’s pediatric unit. Tommy was receiving chemotherapy for leukemia. He was a happy little guy who was doing quite well and Emily enjoyed caring for him. Emily knew he would likely be going home soon, so when his mom went to the cafeteria for a cup of coffee, Emily asked him if he minded if she took his picture. Tommy, a little “ham,” consented immediately. Emily took his picture with her cell phone as she wheeled him into his room because she wanted to remember his room number. When Emily got home that day she excitedly posted Tommy’s photo on her Facebook page so her fellow nursing students could see how lucky she was to be caring for such a cute little patient. Along with the photo, she commented, “This is my 3-year-old leukemia patient who is bravely receiving chemotherapy. I watched the nurse administer his chemotherapy today and it made me so proud to be a nurse.” In the photo, Room 324 of the pediatric unit was easily visible. Three days later, the dean of the nursing program called Emily into her office. A nurse from the hospital was browsing Facebook and found the photo Emily posted of Tommy. She reported it to hospital officials who promptly called the nursing program. While Emily never intended to breach the patient’s confidentiality, it didn’t matter. Not only was the patient’s privacy compromised, but the hospital faced a HIPAA violation. People were able to identify Tommy as a “cancer patient,” and the hospital was identified as well. The nursing program had a policy about breaching patient confidentiality and HIPAA violations. Following a hearing with the student, school officials and the student’s professor, Emily was expelled from the program. The nursing program was barred from using the pediatric unit for their students, which was very problematic because clinical sites for acute pediatrics are difficult to find. The hospital contacted federal officials about the HIPAA violation and began to institute more strict policies about use of cell phones at the hospital. This scenario highlights several points. First of all, even if the student had deleted the photo, it is still available. Therefore, it would still be discoverable in a court of law. Anything that exists on a server is there forever and could be resurrected later, even after deletion. Further, someone can access Facebook, take a screen shot and post it on a public website. Secondly, this scenario elucidates confidentiality and privacy breaches, which not only violate HIPAA and the nurse practice act in that state, but also could put the student, hospital and nursing program at risk for a lawsuit. It is clear in this situation that the student was well-intended, and yet the post was still inappropriate. While the patient was not identified by name, he and the hospital were still readily identifiable. SCENARIO 4 A BON received a complaint that a nurse had blogged on a local newspaper’s online chat room. The complaint noted that the nurse bragged about taking care of her “little handicapper.” Because they lived in a small town, the complainant could identify the nurse and the patient. The complainant stated that the nurse was violating “privacy laws” of the child and his family. It was also discovered that there appeared to be debate between the complainant and the nurse on the blog over local issues. These debates and disagreements resulted in the other blogger filing a complaint about the nurse. A check of the newspaper website confirmed that the nurse appeared to write affectionately about the handicapped child for whom she provided care. In addition to making notes about her “little handicapper,” there were comments about a wheelchair and the child’s age. The comments were not meant to be offensive, but did provide personal information about the patient. There was no specific identifying information found on the blog about the patient, but if you knew the nurse, the patient or the patient’s family, it would be possible to identify who was being discussed.
The board investigator contacted the nurse about the issue. The nurse admitted she is a frequent blogger on the local newspaper site; she explained that she does not have a television and blogging is what she does for entertainment. The investigator discussed that as a nurse, she must be careful not to provide any information about her home care patients in a public forum. The BON could have taken disciplinary action for the nurse failing to maintain the confidentiality of patient information. The BON decided a warning was sufficient and sent the nurse a letter advising her that further evidence of the release of personal information about patients will result in disciplinary action. This scenario illustrates that nurses need to be careful not to mention work issues in their private use of websites, including posting on blogs, discussion boards, etc. The site used by the nurse was not specifically associated with her like a personal blog is; nonetheless the nurse posted sufficient information to identify herself and the patient. SCENARIO 5 Nursing students at a local college had organized a group on Facebook that allowed the student nurses’ association to post announcements and where students could frequently blog, sharing day-to-day study tips and arranging study groups. A studentrelated clinical error occurred in a local facility and the student was dismissed from clinical for the day pending an evaluation of the error. That evening, the students blogged about the error, perceived fairness and unfairness of the discipline, and projected the student’s future. The clinical error was described, and since the college only utilized two facilities for clinical experiences, it was easy to discern where the error took place. The page and blog could be accessed by friends of the students, as well as the general public. The students in this scenario could face possible expulsion and discipline. These blogs can be accessed by the public and the patient could be identified because this is a small community. It is a myth that it can only be accessed by that small group, and as in Scenario 3, once posted, the information is available forever. Additionally, information can be quickly spread to a wide audience, so someone could have taken a screen shot of the situation and posted it on a public site. This is a violation of employee/university policies. SCENARIO 6 Chris Smith, the brother of nursing home resident Edward Smith, submitted a complaint to the BON. Chris was at a party when his friend, John, picked up his wife’s phone to read her a text message. The message noted that she was to “get a drug screen for resident Edward Smith.” The people at the party who heard the orders were immediately aware that Edward Smith was the quadriplegic brother of Chris. Chris did not want to get the nurse in trouble, but was angered that personal information about his brother’s medical information was released in front of others. The BON opened an investigation and learned that the physician had been texting orders to the personal phone number of nurses at the nursing home. This saved time because the nurses would get the orders directly and the physician would not have to dictate orders by phone. The use of cell phones also provided the ability for nurses to get orders while they worked with other residents. The practice was widely known within the facility, but was not the approved method of communicating orders. The BON learned that on the night of the party, the nurse had left the facility early. A couple hours prior to leaving her shift she had called the physician for new orders for Edward Smith. She passed this information onto the nurse who relieved her. She explained that the physician must not have gotten a text from her coworker before he texted her the orders. The BON contacted the nursing home and spoke to the director of nursing. The BON indicated that if the physician wanted to use cell phones to text orders, he or the facility would need to provide a dedicated cell phone to staff. The cell phone could remain in a secured, private area at the nursing home or with the nurse during her shift. The BON issued a warning to the nurse. In addition, the case information was passed along to the health board and medical board to follow up with the facility and physician. This scenario illustrates the need for nurses to question practices that may result in violations of confidentiality and privacy. Nurse managers should be aware of these situations and take steps to minimize such risks. SCENARIO 7 Jamie has been a nurse for 12 years, working in hospice for the last six years. One of Jamie’s current patients, Maria, maintained a hospital-sponsored communication page to keep friends and family updated on her battle with cancer. Jamie periodically read Maria’s postings, but had never left any online comments. One day, Maria posted about her depression and difficulty finding an effective combination of
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March 2013 Social Media continued from page 14 medications to relieve her pain without unbearable side effects. Jamie knew Maria had been struggling and wanted to provide support, so she wrote a comment in response to the post, stating, “I know the last week has been difficult. Hopefully the new happy pill will help, along with the increased dose of morphine. I will see you on Wednesday.” The site automatically listed the user’s name with each comment. The next day, Jamie was shopping at the local grocery store when a friend stopped her and said, “I didn’t know you were taking care of Maria. I saw your message to her on the communication page. I can tell you really care about her and I am glad she has you. She’s an old family friend, you know. We’ve been praying for her but it doesn’t look like a miracle is going to happen. How long do you think she has left?” Jamie was instantly horrified to realize her expression of concern on the webpage had been an inappropriate disclosure. She thanked her friend for being concerned, but said she couldn’t discuss Maria’s condition. She immediately went home and attempted to remove her comments, but that wasn’t possible. Further, others could have copied and pasted the comments elsewhere. At her next visit with Maria, Jamie explained what had happened and apologized for her actions. Maria accepted the apology, but asked Jamie not to post any further comments. Jamie self-reported to the BON and is awaiting the BON’s decision. This scenario emphasizes the importance for nurses to carefully consider the implications of posting any information about patients on any type of website. While this website was hospital sponsored, it was available to friends and family. In some contexts it is appropriate for a nurse to communicate empathy and support for patients, but they should be cautious not to disclose private information, such as types of medications the patient is taking. References 1 One such waiver states, “By posting user content to any part of the site, you automatically grant the company an irrevocable, perpetual, nonexclusive transferable, fully paid, worldwide license to use, copy, publicly perform, publicly display, reformat, translate, excerpt (in whole or in part), distribute such user content for any purpose.” Privacy Commission of Canada. (2007, November 7). Privacy and social networks [Video file]. Retrieved from http://www.youtube.com/watch?v=X7gWEgHeXcA Anderson, J., & Puckrin, K. (2011). Social network use: A test of self-regulation. Journal of Nursing Regulation, 2(1), 36-41. Barnes, S.B. (2006). A privacy paradox: Social networking in the United States. First Monday, 11(9). Retrieved from http:// firstmonday.org/htbin/cgiwrap/bin/ojs/index.php/fm/article/ view/1394/1312 College of Nurses of Ontario. (2009). Confidentiality and privacy — Personal health information (Pub. No. 41069).
Alaska Nurse • Page 15 Retrieved from http://www.cno.org/Global/docs/prac/41069_ privacy.pdf Royal College of Nursing. (2009). Legal advice for RCN members using the internet. Retrieved from http://www.rcn.org. uk/data/assets/pdf_file/0008/272195/003557.pdf Eysenbach, G. (2008). Medicine 2.0: Social networking, collaboration, participation, apomediation, and openness. Journal of Medical Internet Research, 10(3), e22. Retrieved from http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC2626430/. Gauthier, M. (2008). Technology and confidentiality. Nursing bc, 40(2), 11-12. Genova, G.L. (2009). No place to play: Current employee privacy rights in social networking sites. Business Communication Quarterly, 72, 97-101. Helliker, K. (2011, January 5). Odd facebook post leads to student’s ouster, suit. Wall Street Journal. Retrieved from http:// online. wsj.com HIPAA Administrative Simplification 45 C.F.R., Parts 160, 162 and 164 (2009). Retrieved from http://www.hhs.gov/ocr/privacy/ hipaa/administrative/privacyrule/adminsimpregtext.pdf Klich-Heartt, E.I., & Prion, S. (2010). Social networking and HIPAA: Ethical concerns for nurses. Nurse Leader, 8(2), 56-58. Lehavot, K. (2009). “My Space” or yours? The ethical dilemma of graduate students’ personal lives on the internet. Ethics and Behavior, 19(2), 129-141. McBride, D., & Cohen, E. (2009). Misuse of social networking may have ethical implications for nurses. ONS Connect, 24(17), 7. National Labor Relations Board. (2011). Settlement reached in case involving discharge for Facebook comments. Retrieved from http://www.nlrb.gov/news/settlement-reached-case-involvingdischarge-facebook-comments NCSBN. (2010). Summary of social networking survey to boards of nursing. Chicago: Author. Skiba, D.J., Connors, H.R., & Jeffries, P.R. (2008). Information technology and the transformation of nursing education. Nursing Outlook, 56(5), 225-230. Spector, N. (2010). Boundary violations via the internet. Leader to Leader. Retrieved from https://www.ncsbn.org/L2L_ Spring2010.pdf Winchester, A.M., & Maines, R.E. (2010, October 6). Harvesting text messages from the sea of text messages. Law Technology News. Retrieved from http://www.law.com/jsp/ lawtechnologynews/PubArticleLTN.jsp?id=1202472941212&slret urn=1&hbxlog in=1 Wink, D.M. (2010). Teaching with technology: Automatically receiving information from the internet and web. Nurse Educator, 35(4), 141-143. ©2011 The National Council of State Boards of Nursing (NCSBN) is a not-for-profit organization whose members include the boards of nursing in the 50 states, the District of Columbia and four U.S. territories—American Samoa, Guam, Northern Mariana Islands and the Virgin Islands. There are also nine associate members. Mission: NCSBN provides education, service and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection.
Governor Parnell Announces Board of Nursing Appointments Governor Parnell has announced one new appointment and one reappointment to the Alaska Board of Nursing. Hannah Espera, LPN from Anchorage was appointed to a term from 10/19/2012 to 03/01/2016. Thomas Hendrix PhD, RN from Eagle River was reappointed from 03/01/2013-03/01/2017. Hannah Espera is a licensed practical nurse who works at the Alaska Native Medical Center’s Internal Medicine Outpatient Clinic. She has also worked at Providence Extended Care Center and the Anchorage Fracture and Orthopedic Clinic. Hannah holds a bachelor’s degree in history and a practical nursing certificate, both from UAA. Hannah attended the January Board of Nursing meeting and is an outstanding addition to the Board. Thomas Hendrix PhD, RN is an Associate Professor of Nursing at UAA. He was previously a Teaching Research Assistant for the Air Force. Thomas is currently the Treasurer for Sigma Theta Tau International Nursing Honor Society. He holds a bachelor’s and master’s degree in nursing, a master’s degree in Health Services Administration, and a doctorate in Health Policy/ Health Economics. Congratulations to Hannah and Thomas and thank you for your willingness and dedication to work for the advancement of nursing and the protection of the Alaska public.
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2013 Nissan Pathfinder 2014 Mazda 6
*Offer available for active RN, LPN, ANP and CRNPA. Must show current, Alaska nursing license.
563-CARS International + Old Seward Anchorage, Alaska
or email c.babuscio@msrmc.com