The Alaska Nurse - Vol. 61 No. 2 - June 2011

The Official Publication of the Alaska Nurses Association Circulation 7,400 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska

Volume 61 • No. 2

June 2011

Heart of Alaska Nurse

Pages 6 & 7

Fab Five Honored in Juneau Legislators and Staff Receive AaNA Awards

by Lynn Hartz Wrangell Representative Peggy Wilson on left and Senator Bettye Davis of Anchorage with AaNA awards recognizing their contributions to the profession of nursing in Alaska.

The AaNA legislative committee organizes the annual Fly-In. Members from each affiliate group are invited to have a member on the committee so that the broadest spectrum of nurses are represented. This spring, the committee voted to make the Juneau Nurse Fly-In dates to occur annually on the third week of February. So, next year’s dates will be February 14-15. Come join the fun!

On March 16, three state legislators and two of their staff-members were honored with awards from the Alaska Nurses Association during a reception in Juneau. Senator Bettye Davis, Representative Peggy Wilson and Representative Bill Stolze were recognized for their work and dedication in advancing and supporting the profession of nursing in Alaska. Senator Davis and Rep. Wilson sponsored SB12 and HB 50, bills limiting mandatory overtime. HB 50 passed and is now in state statute. Rep. Stoltze’s support was crucial in the eventual passage of the bill.

Rep. Wilson’s Chief of Staff, Rebecca Rooney and Thomas Obermeyer, legislative aide for Sen. Davis, were also honored for their hard work and hours spent on the legislation.

The ‘Fabulous Five’ were honored at the annual reception hosted by the AaNA in Juneau, part of the annual nurse Fly-In. Nurses flew in from around Alaska to educate and be educated by legislators. In addition, this year nurses met with Karen Perdue, President and CEO of the Alaska State Hospital and Nursing Home Association (ASHNA) as well as Jason Hooley, Director of Boards and Commissions in the Governor’s Office and Jeff Jessee, CEO of the Alaska Mental Health Trust Authority.

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Fitness for Duty Includes Getting Your ZZZZs

Pages 10-12

Labor Lines— Seasoned Leader at the Helm

Page 13

Representative Peggy Wilson on left with her Chief of Staff, Rebecca Rooney.

Alaska Reports Highest Rate of Chlamydia in the US

Second Highest Rate of Gonorrhea

by Donna J. Cecere, BA STD Program Coordinator

AaNA lobbyist Mark Hickey on left with Eagle River/Chugiak Rep. Bill Stolze.

A press release and associated Bulletins were released by the Section of Epidemiology (SOE) on May 3rd, announcing continued increases in both chlamydia1 and gonorrhea2 for 2010. In fact, the 2010 disease rates of 849 chlamydia and 179 gonorrhea cases per 100,000 Alaskans, respectively, ranks Alaska first for chlamydia and second for gonorrhea in the nation.

Alaska has ranked first and second for chlamydia rates since the year 2000. Gonorrhea rates have not been this high since 1988. The Southwest region of Alaska has experienced the highest increase in GC cases and rates since Alaska Reports continued on page 17

Inside This Issue President’s Message. . . . . . . . . . . . . . . . . . . . . . . . . 2

Note from Alaska Nurse Alert System. . . . . . . . . 14

Nurses in the News. . . . . . . . . . . . . . . . . . . . . . . . . 4

Alaska State Board of Nursing Update. . . . . . . . . 15

Coping Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . 4

Book Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Congratulations UAA Graduates . . . . . . . . . . . . . . 8

In Memory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Legislative Update from Juneau . . . . . . . . . . . . . . 9

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Call for Grant Proposals . . . . . . . . . . . . . . . . . . . . . 9

Letter to the Editor. . . . . . . . . . . . . . . . . . . . . . . . . 17

Membership Application . . . . . . . . . . . . . . . . . . . 14

Upcoming Events. . . . . . . . . . . . . . . . . . . . . . . . . . 18

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

Page 2 • Alaska Nurse

June 2011

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

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

Format and Submission Articles should be Word documents in 10 or 12 point font, single or double spaced.

There is currently no limit on the length of the article. Include the title of the article and headings if applicable. Author’s name should be placed after the title with credentials, organization and/or employer and contact information. Authors must identify potential conflicts of interest, whether of financial or other nature and identify any commercial affiliation if applicable.

All references should be listed at the end of the article. Pictures in black and white or color are encouraged and may be sent

as a jpg. file, as an email attachment or on disc. Photographs sent to the Alaska Nurse will become property of the AaNA. We hope that we will be sent copies, not originals and prefer emailed files. Photos should be provided with a caption and photo credit info and be high resolution. Be sure to spell check, grammar check and second check the article, any website addresses, references or phone numbers. It is recommended you have a colleague review your article before submission.

Prepare the article as a WORD document and attach it to an email to lhartz@alaska. com. If you do not have WORD, try pasting the text of the article directly into the body of the email. You may also mail the article on disc to Editor, AK Nurse, Alaska Nurses Association, 3701 East Tudor Road Ste 208, Anchorage, AK 99507. If you have any questions email the Editor, Lynn Hartz at lhartz@alaska.com.

President’s Message

by Nancy Davis, RN, MS, President, Alaska Nurses Association “Rather, ten times, die in the surf, heralding the way to a new world, than stand idly on the shore” —Florence Nightingale As I write, we are just finishing the celebration of Nurses Week, culminating on May 12th with the birthday of Florence Nightingale. We celebrate Nurses Week not because the greeting card companies tell us to with their marketing, but because of our commitment and regard for our profession.

Others who love or care about us wish us well during Nurses Week because, whether they truly understand what we do or not, they have a sense that being a nurse is a special kind of work.

It would be hard to believe there is anyone in this country who has not encountered a nurse during their life—from the premature infant, to the pregnant mom, to the school child, to teens and young adults, to those who are middle aged and in the workforce, to the elderly who are well and active, to the homebound who may be ill or disabled, and to those facing the end of their life either at a hospital, skilled nursing facility or in their own home. NURSES ARE EVERYWHERE. The opportunity to make a difference surrounds us daily in our work. Small things that seem routine or huge events filled with drama make up the daily work of a nurse. Sometimes I wonder if what I do as a nurse makes any impact at all…. problems I thought I solved rear their heads to be solved all over again. The hours and the tasks before me eat the day and at its end I ask ‘Did I even make a dent, did I have any influence or impact with my work today?’

And yet I believe I did and I try again the next day. I believe that however small or seemingly insignificant it was, for that moment or hour, the patient and family had my undivided attention, listening to their concerns, offering information, support, cheerleading, asking the right questions, clarifying the treatment and medications, advocating and reassuring them with my knowledge and sometimes merely by being there with them. I cannot measure my influence or impact in the hours and minutes and the list of tasks but only in the impact I have on the patient and family outcomes.

And that is what Florence Nightingale made famous about nursing. It is inspiring to read about her thought processes and how she analyzed patient conditions and considered the potentials for harm and crafted solutions to the care needs she saw before her. If that was not courageous enough, she went on to share that knowledge and teach and inspire others to take the same

chances she did; to learn and perform and care for the patients using sound and well-researched ideas about health and patient care. And she did this in the 1800’s when women were not as well regarded as nurses are today. Whew!!!! She was one impressive nurse.

When I look around today, at modern professional nursing, I am equally struck by how far our profession has come since Florence’s days.

Bright and energetic, nurses with credentials demonstrating their expertise, nurses caring for patients so much more complex than even 25 years ago, applying reasoning and judgment that is backed by evidence through research, being a true collaborative partner with other health disciplines to achieve the best outcome for the patient. The way nurses now influence patient outcomes and have positive impacts on patient care would make Florence proud and glad to be a nurse.

All this brings me to the topic of professional advocacy. One nursing blog by Tim Porter O’Grady especially spoke to me about caring for the nursing profession. O’Grady asserts that if we claim to be advocates for the patient—and we all do—then we must also be advocates for the nursing profession as well. Nurses achieve great patient outcomes because they influence and impact the patient’s care. Nurses can enlarge the impact they have on patient care by assuring that the profession has their strong advocacy as well.

Advocating for the profession means stepping up to the plate to assure our professional standards are upheld. It means supporting those who are new to the nursing profession. It means being active in the socio-political arena where issues important to nursing are discussed and debated.

It means developing new nursing knowledge through research. It means a lifetime of learning and progressing in professional knowledge.

Being a professional carries both rights and responsibilities. Our professional responsibilities mean more than just taking care of our patients.

The Nursing Department at our local hospital is launching its shared governance plan. It is exciting to see nurses at all levels of care in the facility learning and exploring the opportunities that shared governance can bring. Being part of the decision structure as a nurse is advocating for the patient and the profession. Shared governance brings a commitment from all aspects of nursing— staff, specialists, managers and administrators—to share in both the rights and responsibilities and to be accountable for nursing care in their facility.

Another opportunity to advocate for the nursing profession is to participate in your nursing organization. Of course the Alaska Nurses Association would love for every nurse in Alaska to be a member and multiply the strength of nursing’s voice in our state and nation. Speaking out for nursing is an obvious way to advocate for your profession and as a result you advocate for your patients.

Many opportunities exist for you to exercise your leadership skills, to practice your advocacy,

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

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Editor: Lynn E. Hartz, MSN, FNP lhartz@alaska.com AaNA Board of Directors President: Nancy C. Davis, MS, RN Vice President: Pam Embler, MSN, RN Secretary: Michelle L. Marshall, MSN, RN Treasurer: Donna Phillips, BSN, RN Directors: Labor Council (designee): Susan Walsh, RN Rural Director: Shelley Burlison, RN Greater Alaska Director: Linda Worman, D.M., RN, PHN Staff Nurse Director: Mary Stackhouse, RNC, CLNC Directors at Large: Stacy Allen, RN Patricia Barker, BSN, RN Helena Jermalovic, MSN, RN Rhonda Richtsmeier, RN, MN, NEA-BC Carol Widman, RN, BA, BSN Student Nurse Liaison: Sarah Van Abel AaNA Labor Council Chair—Mary Stackhouse, RNC, CLNC Vice-Chair—Donna Phillips, BSN, RN Secretary—Joe Peacott, RN Treasurer—Sharie Morton, RN Directors: Colleen Bevans, RN Deni Callahan, RN Lila Elliott, BSN, RN Janet Hilleary, RNC PAMC BU Rep.—Joe Peacott, RN Soldotna BU Rep.—Velinda Albrechta-East, RN Ketchikan BU Rep.—Susan Walsh, RN Affiliate Organizations: Alaska Chapter of the American College of Nurse Midwives Alaska Home Health and Hospice Association Alaska Nurse Anesthetists Association Alaska Nurse Practitioner Association Alaska School Nurses Association Forensic Nurses Association, Alaska Chapter Executive Director: Debbie Thompson, BSN, RN, CNOR For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, sales@aldpub.com. AaNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

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

and to support your profession. In this issue of AKNurse is a Call for Nominations for the Alaska Nurses Association. This Fall we will be electing the President, Treasurer and several Director seats. Having a full slate of great candidates for the membership to choose from is important to the advocacy efforts of nursing and the Alaska Nurses Association. Both the President and the Treasurer positions are open without incumbent candidates.

Help nursing in Alaska by putting your name on the ballot. Realize new opportunities to advocate for nursing.

As Ms. Nightingale would say, Step into the surf and herald the way to a new world for nursing— don’t stand idly on the shore. NURSING NEEDS YOU!

June 2011

Alaska Nurse • Page 3

District 1 Nurses Week Banquet

Shared Governance Kicks Off at Bartlett Regional Hospital

Vice-Chair of AaNA Labor Council, Donna Phillips, in period RN uniform in honor of Nurses Week.

Left to right: Susan Thompson, RN (Co-Chair), Dr. Victoria George, VMG Consulting, Nancy Davis, Pres. Alaska Nurses Assoc., Marjorie Fisher, RN,(Co-Chair).

Over one hundred nurses from across District 1 gathered to celebrate Nurses’ Week on May 6th at a classy affair at Anchorage’s Egan Center. Attendee’s enjoyed a full evening. Stuart Robertshaw, aka Dr. Humor, presented “The Healing Power of Humor.”

Attendees received 1.5 contact hours. Denise Marten (hammered dulcimer) and Jim Kerr (guitar) entertained the crowd with lively Irish tunes. RN Donna Phillips donned a nursing uniform of days gone by to pass out door prizes. Special thanks go to the hard-working Committee who planned and executed this delightful celebration: Donna Phillips, LeMay Hupp, Linda Gonzales, Virginia Walker, Michelle Marshall, Pam Embler, Ly Tibayan, Donna Zeznock, Debbie Thompson, Kay Lahdenpera and Robin Klinger.

Bartlett Regional Hospital Shared Governance Development Team hosted the “Shared Governance Kick-off” on May 12th, Florence Nightingale’s birthday, with an evening of fun, food, prizes and more! Dr. Victoria George, CEO of VMG Consulting and former ANCC Magnet System Appraiser, shared her knowledge and experiences with the Bartlett Nursing staff about the process and challenges of implementing Shared Governance in a hospital nursing system. Nancy Davis, President of the Alaska Nurses Association, was also present to provide encouragement for the project. “This is an exciting time for our nursing staff!” says Cathy Carter, Chief Nursing Officer. “I can’t wait to see the progress during the next year! Our Nursing staff have grown as professionals in an amazing

way during the development process. I am so proud to be associated with them and to be part of the process. Our community is very fortunate to have these nurse advocates for health care.”

Members of the Shared Governance Team represent all nursing patient care units at Bartlett Hospital in Juneau. The team was chartered in April 2010 and has been preparing for the model and implementation of Shared Governance through research and education over the past year. RN team members include Co-Chairs Susan Thompson and Marjorie Fisher, Corinne Austin, Hannah Mendelsohn, Cecelia Brenner, Brian Tennant, William Gardner, Alicia Gillis, Gail Moorehead, Sarah Hargraves and Cathy Carter.

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June 2011

Coping Mechanisms:

Nurses in the News R.N., C.E.N., Soldotna—“In recognition of his dedication and contributions to Central Peninsula Hospital, his community, and his patients, and for promoting positive change and providing the highest standard of patient care.” The Melissa Ann Peters Memorial Award, “is given in memory of a young nurse whose untimely death prompted her family and friends to remember her by honoring other nurses who have contributed in a special way to the encouragement of EMS skills, efforts and education.”

Nominations for this award are encouraged yearly and throughout the state. For more information go to: http://www.ems.alaska.gov/ ACEMS/awards/default.htm ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

Betty Miller, 2011 School Nurse of the Year holding her plaque while Luann Fogels, President of the Alaska School Nurses Association looks on.

Betty Miller RN, MS, of the Kenai Peninsula Borough School District is this year’s School Nurse of the Year (affectionately known as SNOTY). The announcement was made at the spring conference of the Alaska School Nurses Association held at Chena Hot Springs. Ms. Miller has been a nurse for 35 years. ASNA writes, “Betty was directly responsible for initiating, developing and writing the original health curriculum for the Kenai Peninsula Borough School District before the Alaska and national health curriculums were ever in place. She also served on the committee that wrote the State of Alaska Health Curriculum.

After the state mandated teacher training in child abuse reporting and FAS training, Betty wrote both curricula for the Kenai Peninsula Borough School District.”

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The Governor’s Annual Awards for Emergency Medical Services, sponsored by the Alaska Council on Emergency Medical Services, were announced at the State Emergency Medical Services Symposium on Nov. 12, 2010. The Melissa Ann Peters Memorial Award went to Shayne Pond,

Scholarship awarded in honor of Sitka nurse David Knox ANCHORAGE, AK.—Michelle Fleming of Sitka is the recipient of this year’s David E. Knox Memorial Nursing Fellowship, administered by The Alaska Community Foundation. The award, worth $2,500, is awarded once a year to a strong student dedicated to serving rural communities.

Fleming, a student at the University of Alaska Anchorage School of Nursing program in Sitka, is a strong student and a dedicated worker who has spent years working toward her degree by taking a class or two at a time. This scholarship award will help her realize her goal of becoming a nurse while keeping her costs down.

David Knox was a well respected Sitka nurse who died unexpectedly in 2005. The scholarship was set up in his honor to support outstanding candidates in pursuit of nursing degrees and who are dedicated to serving communities in rural Alaska. This scholarship is administered by the Alaska Community Foundation, which serves the state with more than 200 charitable funds, including over 30 scholarships.

Since 1996, ACF has built successful partnerships with donors and nonprofits to connect people who care with causes that matter.

Each year, ACF receives gifts from thousands of generous individuals and families who wish to leave a lasting impact on the state they love. Last year alone, ACF awarded more than $6.3 million in grants to a broad range of nonprofit organizations in the state. ACF offers a range of charitable funds, allowing donors to advance a cause, support an individual organization or provide flexible support for community needs.

Upcoming AaNA Election, This Could Be You! Come be a part of Alaska nurses making a difference! Join your nurse colleagues in representing your district and your profession as we address critical nursing issues that face us today. The Alaska Nurses Association will allow you to hone your leadership skills and network with nurses across the state.

Open state offices on the AaNA Board of Directors are: • President • Treasurer • Rural Alaska Director • Staff Nurse Director • Director at large (2) • Nominating Committee (4) All offices are for a two year term.

Contact the AaNA office for information, nomination forms 907-274-0827.

Descriptions of responsibilities are at aknurse. org; click Bylaws; see page 11 under Bylaws.

The good, the bad, and the ugly— Part 1

by Martha Herriott, PhD, ANP Have you ever encountered someone who frequently complains or requests help, then invariably rejects the suggestions, help, or advice offered by others?

The frustration of such a situation brought “Sue,” a middle-aged RN to me for therapy. Sue’s mother, a cancer survivor with Herriott lingering health issues, on a daily basis telephones Sue with a myriad of physical complaints, emotional problems, and mini-crises. Being very practical, Sue usually has ideas for resolving the problem, which her mother promptly rejects. Sue feels frustrated, angry and guilty with this interaction, which repeats itself over and over.

Sue was amazed to learn through therapy that her mother’s behavior has a name, “helprejecting complaining” and is considered to be a psychological coping (or defense) mechanism.

In psychiatry/mental health terminology, the terms coping mechanisms and defense mechanisms are used interchangeably; “defense mechanism” is the more clinical of the terms. A defense mechanism is a relatively unconscious process which we deploy to cope with conflict and stress. This automatic reaction allows us to survive psychologically, in a way analogous to the automatic reaction of the immune system.

Sigmund Freud, who first wrote about defense mechanisms, considered them to be pathological.

This view has evolved to the current perspective —defense mechanisms are more often healthy than unhealthy. Healthy, or “mature,” defenses are considered adaptive in adult life, while “immature” defenses are viewed as maladaptive.

The DSM IV, the diagnostic manual in psychiatry, lists a hierarchy of defenses, from mature to immature. Over time, an individual’s defenses can evolve toward greater maturity.

Humor is an example of a mature defense. Using humor, the individual deals with stress or conflict by emphasizing the amusing or ironic aspects of the situation. An example is the “black” humor sometimes heard in an ER or trauma center.

The help-rejecting complaining that occurred with Sue’s mother is considered an immature coping mechanism. Here, the individual deals with emotional stressors by complaining or making repetitive requests for help that disguise feelings of hostility. These hostile feelings are then expressed by rejecting the advice or help offered by others. The object of hostility may be someone other than the person offering the help. In our work together, Sue recognized that her mother, fighting a terminal illness, was also struggling with disappointment over an unhappy marriage. Sue and I surmised that her mother’s marital problems were too much to deal with at this time in her life, and hence her defenses were directed, not toward her husband, but toward her very loving daughter. With this perspective, Sue learned to calmly and empathetically step back when her mother started complaining, replace suggestions with empathetic listening, and work to build positive experiences with her mother.

In Part 2 of this article, I will discuss defense mechanisms that lead to psychological resilience, as well as further examples of immature defense from my clinical experience.

[Dr. Martha Herriott is in private practice specializing in Psychiatry/Mental Health. Her practice is at 821 “N” Street, Anchorage, ph. 907279-8111.]

June 2011

Alaska Nurse • Page 5

Page 6 • Alaska Nurse

June 2011

Heart of the Alaska Nurse

by Marianne Schlegelmilch Who is the Alaska Nurse?

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

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

Kathy Ingallinera, FNP

Ingallinera caring for an injured eagle at the Sitka Alaska Raptor Center.

FNP Kathy Ingallinera has been taking care of people for her entire life, beginning when she was a young girl of eight in Connecticut when she started going upstairs on weekends to help cook, clean and prepare baths for her grandmother who was cared for during the week by her regular nurse, and who would stubbornly respond only to her young granddaughter’s instructions on the weekends. For Kathy, she would even take her medicines. Kathy attributes that formative time in her life with lighting the fire that led her to a career in nursing.

Later, while still in grade school and throughout high school, Kathy would help her father, who suffered several heart attacks and who ultimately died when she was only twenty. She remembers helping him with his meds and waiting with him for

the ambulance during one of his many bouts with congestive heart failure.

Once in college, greatly inspired by those times, she would go on to become an EMT and work on the local rescue squad, becoming a member of the first rescue squad run entirely by college students at her school of Virginia Tech. Although she studied forestry and health education, after four years she decided to go to nursing school. As she tells it, “I guess I finally listened to my inner voice.” She has now been a working nurse for over twenty-seven years.

Over the span of her career, Kathy has worked only three jobs, which she describes here in her own words: My first job out of school was as an RN on the medical floor of a small community hospital in Wallingford, Connecticut. I worked evening shift for a year and learned some good organizational and medication administration skills. But I longed for the drama and really sick patients I had taken care of as a nursing student at a 1000 bed teaching hospital.

Also, during nursing school I worked as a nursing assistant in the busy ER, which had a surgical/ trauma ER, a medical ER, a pediatric ER, and a nonacute surgical ER. As a student, I took part in many codes, cracking chests for open chest massage, major traumas, drug overdoses, psychiatric emergencies, heart attacks, strokes, poisonings, stabbings, shootings, etc. It was quite exciting to go to class all week and then work each Saturday and Sunday on the 3-11 shift and see all of it in real life.

I also worked full time during the summer between my first and second year of nursing school.

I often think I passed my boards by remembering patients from the ER who fit the scenarios in the questions!

So, back to my first job—I missed the excitement of the Medical College of Virginia at Richmond, so I applied for a job in the Medical ICU there. I had always liked the medical patients in the ER—GI bleeds, bad asthma, overdoses, chest pain, etc.

Later, for a span of approximately twelve years, Kathy would work in her second job in the Medical Respiratory ICU at the Medical College of Virginia.

She writes: It was a 12 bed unit and we took care of all sorts of medical patients: asthma, diabetes, overdoses, hypoand hyperthermia, pneumonia, complications of all sorts of cancers and bone marrow transplants, AIDS, GI bleeds, renal failure, severe OB complications, sepsis and multi-system organ failure, and we did liver transplants. I am sure I have forgotten many types of patients, but you get the gist.

I was there twelve years and became a Clinician III and was involved in our ethics and bereavement committees, and supervised several nurses. I was also a Care Coordinator for the last several years I worked there, working a month at a time every four months to oversee care for the whole unit. As a teaching hospital, we had a new batch of interns and residents each month who needed to learn the ropes.

I also oriented many new and experienced nurses to the ICU. I went back to graduate school full time for the last two years of my working there to get my MSN and primary care degree.

By the time Kathy arrived in Alaska, it is easy to see that she had acquired the full range of clinical skills along with the significant educational experience that would make her a wonderful fit for her job as a nurse practitioner at the SEARHC Community Health Aide Training Center in Sitka.

There she provides primary care in the outpatient departments, teaches in the classroom, and oversees the providing of skills lab material to students from all over the state. She explains: In Alaska, Community Health Aides play a vital role in the care of injured and sick Native Alaskans in bush communities throughout the state where there are often no doctors, nurses or other providers.

Community Health Aides are unique to Alaska and there are no similar roles for health care providers in any other state. These lay primary health care providers are trained over a period of two years to provide a range of health care services including preventative, emergency, urgent and chronic health care services for their community members.

At the training center, Kathy sees patients with her students in clinic and helps them learn to develop their skills at history taking, physical exam, patient assessment, and the completion of care plans.

Because of the ground level work that she does, Alaska Native villages are supplied with the best possible primary health care skills through the work of Community Health Aides working in the remote and underserved areas of Alaska.

Kathy feels fortunate to have found work in Sitka, a place where she—like so many others—has learned there are seldom job openings. Also, like so many who come to Alaska, she accepted her job there after only a phone interview and without benefit of first visiting the community, thus displaying that pioneering spirit so prevalent in Alaska nurses.

Like others have done before her, she packed up everything that mattered and moved here, arriving in 1996 with her personal belongings packed in a U-Haul trailer, driving first, across country and then taking a ferry to the remote community of Sitka, located on Baranof Island on the far outer reaches Heart of the Alaska Nurse continued on page 7

June 2011 Heart of the Alaska Nurse continued from page 6 of the Alexander Archipelago in the panhandle of Alaska also known by locals as “Southeast.”

Unlike some, she and her husband had already visited several parts of Alaska once and knew Alaska was where they wanted to be. It was after that twomonth sojourn to the “last Frontier” that she first decided to pursue her education to become a nurse practitioner so that she would have marketable skills when they arrived. As time has shown, Alaska is a better place because she did.

Kathy Ingallinera is first and foremost a nurse, but to both her students and her patients she is a caring and dedicated individual. Along with work in training Community Health Aides, she is also a dedicated volunteer at the Alaska Raptor Center in Sitka. There she performs an array of support functions in caring for injured eagles, ravens, owls and other birds— doing such things as performing lab testing and x-rays, giving IV fluids, dressing wounds and cleaning cages.

She and her husband have also provided a loving home to several rescue dogs, including a wolf hybrid and her wonderful husky mix, Sassy who she recently lost to cancer. Recently, Kathy and her husband added a young husky mix to their household that she describes as, “he’s quite a trip, let me tell you.”

When listening to Kathy talk about her Alaska life, it is easy to see that she is a compassionate person who goes the extra mile for her students, her patients and the animals and birds she cares for.

Who of us who own dogs would not agree that they would readily aspire to live with someone as caring as Kathy Ingallinera as she stays up to till 2 a.m. making chicken balls as special treats for her dogs?

How many of us have the fortitude, stamina, and commitment to help the local veterinarians piece back together injured birds after working long hours caring for people?

Alaska is a better place because nurses like Kathy Ingallinera live here. In addition to re-certifying CHA’s who travel to Sitka from the villages like Kake, Angoon, Klawock and Tenakee Springs, Kathy sometimes provides debriefing support for EMS staff.

She recalls one incident in which classmates saw a child from Kake swept away in a river and drowned.

Kathy visited the school and talked with and supported the elementary school children who had watched the tragedy unfold. Until the last year or so and until there was no longer a need, she taught EMT classes in Sitka. She also once traveled to Kotzebue to re-certify four CHA’s from that area and she has occasionally worked for one-week intervals in several villages in Southeast Alaska.

Kathy is that special breed of adventurous and dedicated person who so often find their way to Alaska. Her story is similar to that of so many other Alaska nurses in its uniqueness, leaving us to surely agree that Kathy Ingallinera is a living, working example of the “Heart of the Alaska Nurse.”

Alaska Nurse • Page 7 Kathy Ingallinera received her RN and BSN in 1983 and her MSN and FNP certification in 1996 from Virginia Commonwealth University (VCU) Richmond, Virginia.

A Diploma nurse, Marianne Schlegelmilch has spent more than forty years working as a registered nurse.

Although she is the author of six books of Alaska fiction (Solo Flite, Coho Waterboy, Raven’s Light, Gaston’s Crow’s Nest, and Feather From Schlegelmilch a Stranger and Two Tickets and a Feather), she says that she will “always first and foremost be a nurse.” The series, “Heart of the Alaska Nurse” is her tribute to her chosen profession of nursing expressed in her chosen art form of writing. If you feel there is any student, active or retired nurse you know who personifies the heart of the Alaska nurse, please contact lhartz@alaska.com and your story may be one that is featured in this exciting new series.

Your Story Wanted— Heart of the Alaska Nurse to Become Book Marianne Schlegelmilch, RN, author of six published books and the series Heart of the Alaska Nurse, is compiling her profiles of nurses to be used in a book. She is donating her work and writing in an effort to honor nurses and stimulate interest in nursing. Profits from the book will go to benefit nurses.

In this collection of stories based on interviews with Alaskan nurses, Schlegelmilch will describe the reality and challenge of practicing nursing in an Arctic environment. A “living history” of nursing in the 49th state, the book will include recollections from the 1940’s through the current decade. Collaborator Lynn Hartz, will open each chapter with historic narrative from diaries and archives to set the stage. Commissioned by the Alaska Nurses Association to commemorate its 60th year in 2013, Heart of the Alaska Nurse is planned for publication in 2012.

Schlegelmilch is trying to gather stories from as large a variety of nurses as possible—LPNs, RNs, FNPs, student nurses, rural and urban nurses, village and remote nurses—all kinds and every kind of nurse out there to represent a cross-section of the Alaska nurse.

To share your story and find out details, requirements and deadlines, contact the editor at lhartz@alaska.com.

Page 8 • Alaska Nurse

June 2011

Congratulations April 2011 UAA Graduates!

The University of Alaska, Anchorage conferred degrees on the following students in April.

Additional honors were bestowed on these graduates: Spirit of Nursing Award—Awarded by faculty vote for the student they feel demonstrates the spirit of caring, science, love of learning, and compassion.

Pam Talton Jessica Walsh

Spirit of Nursing Spirit of Nursing

AAS BS

Peer Award—Awarded by the senior class to a fellow classmate who has completed their nursing studies while balancing the daily demands of life.

Megan Ferguson Kyle Colburn

Peer award Peer award

AAS BS

Directors Award—Awarded to the student with the highest GPA Melissa Dawley Kristen Ludwig

Directors Award Directors award

AAS BS

AAS Graduates Sarah E. Allegrucci, LPN Sarah R. Ballard Heather L. Barndt Barbara A. Berl Sandra A. Brown Amber L. Burzinski Amy M. Connaker, LPN Johnelle S. Cooper Jasmine Crandall, LPN Junalyn V. Daguro Melissa A. Dawley, LPN Ksenia Deishl-Gaines Erika L. Descutner Marianne N. Dingman Jennifer R. Estabrook, LPN Megan T. Ferguson Sandra J. Fox Tiffany D. Griffin, LPN Jamie L. Heffner Hannah J. Henderson Elexis D. Hinds Lori J. Keel

Jesse F. Kirgis Jennifer S. Kjerstad Daphne C. Kopperud Erika D. Maakestad Karrie V. Malone Katie R. McKee Karla K. Murray Tauna A. Norman, LPN Luigie B. Padron Melissa H. Papasodora Monica L. Pereira Lisa L. Poston Katia Pronzati Gina R. Robinson Jessica A. Schroeder Leona L. Schroeder, LPN Brenn C. Shumway, LPN Leonora Spencer, LPN Pamela M. Talton Nicole M. Votaw Claudia A. Rodriguez-Zinn

BS Graduates Kristina M. Aurigue Ivy A. Baisch Rosecelie D. Benigno Elise C. Blomfield Erica L. Carr Rene A. Castro Kyle D. Colburn Tessa V. Dominick Ellie M. Farmer Brenda L. Feaster Rena R. Graciani Belinda K. Green Tapia B. Hansen Laura-Jean G. Hughes Victoria V. Konaeva Sarah M. Kruse

Stephanie D. Lord Kristen P. Ludwig Gared Lukoskie Holly M. McCune Maria “Cristy” C. Murray Asia A. Nichols Cherlyn R. Peralta Janette I. Pollock David S. Sanner Oksana V. Sprecher Rebecca Wabule Jessica M. Walsh Shanda W. Walton Jessie E. Westin Michelle A. Wilson Lisa R. Wood

MS Graduates Thesis Leah M. Coffman, RN Family Nurse Practitioner Chair, Jill Janke, PhD “Breastfeeding Support in the WIC Population: Workplace Barriers.”

Angela J. Strommer, RN Family Nurse Practitioner Chair, Susan Modlin, PhD “Compassion Fatigue and Compassion Satisfaction in Emergency Nurses in Alaska.”

photo courtesy of Lisa J. Seifert /lisa@seifertphoto.com

photo courtesy of Lisa J. Seifert /lisa@seifertphoto.com

Kyle Colburn receives Peer Award from Debbie Thompson, E.D., AaNA.

Melissa Dawley after receiving the Director’s Award from Barbara Berner, Interim Director, UAA School of Nursing.

Rachael D. Carlson, RN Family Nurse Practitioner Chair, Elizabeth Campbell, PhD “Burnout in Baccalaureate Degree Nursing Students in a University in the Northwest United States.”

Project Liberty Joy, RN Nursing Education Chair, Barbara Berner, EdD “Evaluating the Implementation of Online Clinical Log System for Family Nurse Practitioner Students” Jill M. Montague, RN Nursing Education Chair, Maureen O’Malley, PhD “Delirium Assessment in the Critical Care Patient” Carol ‘Lynn’ Senette, RN Nursing Education Chair, Maureen O’Malley, PhD “Passing the Baton: Using Simulation to Develop Nursing and Paramedic Student Collaboration”

Notice

Audio CD’s of recent Alaska Board of Nursing Meetings Now Available at the AaNA Office Call 907-274-0827 for copies and information Brought to you by the Alaska Nurses Association

June 2011

Alaska Nurse • Page 9

Legislative Update from Juneau

Denali Kid Care Fails in Senate The first session of the 27th Alaska State Legislature ended on time, but without all of the work completed. Governor Parnell, responding to requests by the House and Senate, adjourned the regular session and called them back in immediately into special session.

The legislature approved HB 126, which extended the Board of Nursing, as well as other boards listed in the legislation to June 30, 2019.

Governor Parnell vetoed the bill on June 17, 2011.

As of June 19, there was no letter or announcement available on the Governor’s website explaining the veto. Without the extension, the Board of Nursing is due to sunset on July 1, 2012. [see related story, page 15].

Following Parnell’s veto last year of the bill to raise the income eligibility for children and pregnant women from 175% to 200% of the federal poverty line, Senator Bettye Davis re-introduced SB 5 this session. The bill moved through the Senate quickly, but failed on the Senate floor by a vote of 10 to 10. SB 5 is back in Senate Rules.

Governor Parnell continues to oppose this measure because the measure may increase the number of abortions funded under Denali Kid Care.

HB 28 by Representatives Bill Thomas, Bob Herron and Eric Feige allows a military spouse to obtain a temporary license in their field of practice as long as they meet professional standards required by law or regulation. The temporary

licenses are valid for six months. This measure passed the legislature.

HB 78 sponsored by Representative Bob Herron establishes a loan repayment and employment incentive program for certain health care professionals in Alaska. The bill has been placed into a subcommittee of House Finance to allow interim work on the proposal. One change was adopted to use the correct terminology to describe an advanced nurse practitioner. Other changes are under consideration relating to the correct tier classification for nurse practitioners when educational requirements change in the future and the treatment of other types of advance practice nursing professions.

Other bills of interest include HB 122 relating to the practice of naturopaths and creation of its own board, SB 8 changing the permission requirements for student surveys, and SB 14 allowing health care providers to object to provision of services.

HB 122 by Representative Kathy Munoz remains in its first committee of referral and is facing stiff opposition from physician groups. SB 8 by Senator Davis passed the Senate, but is opposed by key House leaders and the governor. SB 14 by Senators Fred Dyson and John Coghill was heard once and held in its first committee of referral.

For information during the interim between sessions, check out the AaNA website at www. aknurse.org.

Governor Parnell Vetoes HB 126

Senator Giessel, MS, ANP, FAANP represents Anchorage District P. She previously served two terms on the state Board of Nursing.

The following text was sent by Senator Giessel to AaNA. At press-time, the Governor had not made a public statement regarding his veto.

You may hear that the Governor has vetoed the renewal of the Board of Nursing. This is not exactly true. Here’s the story…

HB 126 was a simple bill that renewed the Board of Nursing, the Board of Dental Examiners and the Board of Barbers and

Hairdressers. These three boards were due to sunset on June 30, 2012. All three of these Boards passed their audit review and were recommended to be renewed until 2019.

In addition, the Alcoholic Beverage Control Board renewal was included in this bill. This Board was only recommended for renewal for one year.

In Senate Finance, a provision was added that states: “A person convicted of a felony may not serve on a board or commission of the state government unless the conviction has been overturned on appeal or otherwise set aside.”

I have talked with the Governor’s office. I am told that when the bill came to the Governor, he believed that the ban on felons serving on boards and commissions represented an infringement of civil rights. Because of the provision related to felons, in an otherwise simple board renewal bill, the Governor vetoed the bill.

The Governor’s office has told me that it is not the Governor’s intention that any of the four boards sunset (discontinue). I am told that the Governor hopes that the Legislature will pass a simple renewal bill for the boards early in the next session, which he can sign into law.

I have been advised that the Governor supports the continued function of the boards in this bill.

I am personally committed to working on this issue and doing everything in my power to get the renewal of the boards passed quickly. I believe that this is a glitch that we can, and will, fix.

Happy Summer from the Alaska Nurse Practitioner Association!

Karen Niedermier, Secretary Alaska Nurse Practitioner Association Change is in the air at ANPA! A new slate of executive committee members will be elected at our annual meeting this September. Contact secretary@alaskanp.org to nominate yourself or your colleagues for the following positions: Treasurer, Secretary, and President-Elect. We’d love to have you join our merry crew!

Mark your calendars for our annual fall educational conference. This top-notch conference will take place at the Anchorage Downtown Marriott September 16-18, 2011. Many hands make light work: if you would like to help out prior to or during the conference, please contact the conference planning chair at pres-elect@alaskanp. org.

As conference time approaches, you’ll be able to register online at www.alaskanp.org. While you’re there, you can also apply for or renew your membership, update your listing in our online directory, find a nurse practitioner, or contact personnel directly online.

Have a beautiful summer, and we look forward to seeing you in the fall!

Call For Grant Proposals

By Alaska Nurses Foundation Nurses interested in carrying out a community or clinical project, conducting a research project, or completing a continuing education activity are invited to apply for grant funding from the Alaska Nurses Foundation. Grant applications can be accessed on the Alaska Nurses Foundation section of the Alaska Nurses Association website (www.aknurse.org).

Technical support is available and applicants are strongly encouraged to take advantage of such advice in advance of the submission date. Applications, with all attachments, must be submitted electronically by August 1, 2011.

In recent years, the Foundation has funded a research project designed to examine access to and utilization of child care services in Juneau and to identify the needs of underserved children in Juneau. Another grant provided partial funding to cover expenses associated with becoming certified as a Professional in Healthcare Quality.

And recently, the Foundation funded a distance delivered prenatal education program to moms in interior Alaska. So if you have an idea in search of funding, check out the Alaska Nurses Foundation small grants program.

Page 10 • Alaska Nurse

June 2011

Fitness for Duty Includes Getting Your ZZZZs

It is unusual for the Alaska Nurse to reprint articles from other states but this article covers a subject made timely after the passage last year of a bill prohibiting mandatory overtime for nurses. According to Debbie Thompson, Executive Director of AaNA, “ Every nurse needs to know they are ultimately held accountable for fitness for duty and that part of that responsibility is coming to work rested.”

can contribute to errors. This article reviews the limitations of human performance as it influences fitness for duty and impacts the nurse’s ability to practice safely.

Reprinted with permission from Texas Nursing Voice Jan-Mar 2010. For CE credit, go to www. texasnurses.org and click on ‘Education’ then ‘Online TNA CNE courses.’

Anatomy of an Error Anatomy is the science of structure. We all completed an anatomy course early in our nursing education to learn about the structure Error: those occasions of the human when a planned activity body, but most of fails to achieve the us have probably intended outcome not considered the (Reason, 1990). anatomy of an error until we are faced with the consequences of an error. It’s at that point that we ask, “How did this happen? I was so careful!” The obvious answer is that we are human and ‘to err is human.’ But, there’s more…

Errors can be broken down into two types.

Active errors occur by the person doing the activity, for example, when a nurse gives the patient a wrong medication. Latent errors occur farther away from the action, that is, away from the bedside. An example might be lookalike medications stored in adjacent bins in the medication cart or new equipment to which staff have not been oriented. Essentially, these are errors waiting to happen.

Because human error is inevitable, prevention is directed at the design of systems that can prevent errors – mechanisms that don’t allow you to make a mistake. For “We cannot change the instance, you human condition, but we can cannot fill your change the conditions under car’s unleaded which humans work.” gas tank with James Reason leaded gasoline because the gas receptacle for no-lead gasoline tanks has been designed smaller than a leaded nozzle. The two don’t fit, thus preventing an error.

There are many examples of this approach in health care as well: pre-filled syringes prevent dosage errors, programmed infusion pumps prevent certain infusion errors, and bar coding has prevented some identification errors.

However, health care is extremely complex and it is impossible to design potential errors out of all processes. Consider the design of the work environment, staffing and scheduling practices, and communication processes—has any health care system perfected these designs to eliminate error? Though improvements have been made, nurses continue to be left at the “sharp end” where latent errors become active. Therefore, the nurse often represents the final opportunity to prevent a latent error from becoming an active error—the last safety net so to speak.

How to Earn Continuing Nursing Education Credit

1. The article, Fitness for Duty Includes Getting Your ZZZZs, is presented as information only in this issue of Alaska Nurse. It is also presented online with an opportunity to earn continuing nursing education credit. To receive a certificate of successful completion for 1.0 contact hour, visit www.texasnurses.org and follow the online prompts.

2. Once you complete the registration form, you may use your Visa® or MasterCard® to pay the processing fee.

• $10 for TNA members • $15 for non-members 3. Once payment is made, you will receive a confirmation that will allow access to the online activity.

4. Read the article.

5. Take the post-test. To successfully complete the post-test, you must achieve a score of 80% or better.

6. Complete the evaluation tool.

7. You will then be able to print your Certificate of Successful Completion for 1.0 contact hour.

Accreditation Statement

The Texas Nurses Association/Foundation Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Disclosure to Participants

1. Requirements for successful completion: To receive credit for this continuing nursing education activity, the reader must: • Read the activity (either in Alaska Nurse or online at texasnurses.org).

• Complete the registration form online.

• Pay the appropriate processing fee online.

• Complete the activity evaluation tool online.

• Achieve a score of 80% on the post-test.

• Once successful completion has been verified, a “Certificate of Successful Completion” will be awarded for 1.0 contact hours 2. Conflict of interest: A conflict of interest occurs when an individual has an opportunity to affect or impact educational contents with which he or she may

by Debora Simmons, PhD(c), RN, CCRN, CCNS and Cindy Zolnierek, MSN, RN

About the authors

Debora Simmons, PhD(c), RN, CCRN, CCNS is associate director, Patient Safety Education Project, and research scientist at Texas A&M University Health Science Center Rural and Community Health Institute.

Cindy Zolnierek, MSN, RN, is director of practice for Texas Nurses Association, a frequent contributor to TEXAS NURSING Voice.

Introduction In 2006, Wisconsin registered nurse Julie Thao faced criminal prosecution for "neglect of a patient causing great bodily harm" following a medication error that resulted in a patient’s death. Nurse Thao had slept at the hospital the night before after a 16-hour shift. It was the July 4th holiday, and she had agreed to work a double shift (7:00 a.m. to midnight) in order to help provide adequate staff coverage for the Labor and Delivery unit in which she was employed. Nurse Thao mistakenly infused an epidural anesthetic intravenously, thinking

have a commercial interest or financial relationship. All planning committee members and the author(s) are required to disclose any potential or actual conflict of interest with any commercial entity that may have an interest in the activity’s educational contents. The planners and the one author (Zolnierek) of this CNE activity would like to disclose that they are employed by the Texas Nurses Association.

3. Commercial support: This educational activity did not receive any commercial support.

4. Non-endorsement of products: TNA/F’s ANCC accreditation status refers to the continuing nursing education activity only, and does not imply either TNA/F’s or ANCC’s real or implied endorsement of any product, service or company referred to in this educational activity.

5. Off-label product use: This education activity does not include any information about off-label use of a product for a purpose other than that for which it is approved by the U.S. Food and Drug Administration (FDA).

6. Expiration date: This activity expires January 19, 2012.

Questions

E-mail any questions to: CNE@texasnurses. org or phone 512-452-0645 extension 3. (If you experience technical difficulty, please use extension “0” to get help.)

Educational learning goal/purpose statement

The purpose of this educational activity is to enhance the knowledge base and practice of the registered nurse by outlining the limitations of human performance as it influences fitness for duty and the nurse’s ability to practice safely.

Learning objectives

1. Explain the “anatomy of an error” in health care.

2. Identify human performance limitations, such as emotional, cognitive and physical factors, that can contribute to errors.

3. Relate fatigue to a nurse’s fitness for duty and risk for error.

4. Review the nurse’s responsibility for ensuring fitness for duty under the Standards for Nursing Practice. [include whose standards? Is this Texas Standards for Nursing Practice or BON?]

the drug was an antibiotic prescribed for a strep infection the patient had. Both infusion bags had been placed next to each other on a counter in the patient’s room. The patient died within the hour, although her newborn son survived (Error, 2006).

Was nurse Thao guilty as charged? Or was nurse Thao, who had an impeccable record prior to this incident, a good nurse who made a mistake with disastrous consequences? Most nurses will make medication errors at some point in their careers, and most of their patients will be “lucky” enough not to suffer serious consequences from their mistakes. How does the fact that nurse Thao had worked a double shift the day before and slept at the hospital play into the error equation?

Nurses are frequently asked to “work over” to cover an unexpected absence of a co-worker or to cover a chronically short-staffed area. Despite the availability of extra hours and the temptation of additional income, the professional accountability of nursing carries a responsibility to be in a safe condition to care for patients. “Fitness for duty” is used to describe this condition. Nurses may not be aware of what factors influence fitness for duty and how easily human performance limitations— emotional, cognitive, and physical components—

Human Performance Factors Humans are imperfect. Human factors confound performance and risk for error (see sidebar, Some Human Factors Some Human Factors Affecting Performance).

Affecting Performance Many of these factors involve our interaction Distraction with the environment, Fatigue for example, when Pressure/Stress we’re faced with Norms unfamiliar equipment, poor lighting in a Lack of communication patient’s room, a noisy Lack of knowledge/skills Lack of teamwork nurses’ station, or a Lack of resources difficult physician.

Environmental distractions are a well documented factor in medical errors. When reduced, performance improves. Recently, several San Francisco hospitals were successful in reducing their medication errors by 88 per cent by reducing the interruptions (distractions) nurses experienced when administering medications (San Francisco Chronicle, 10/28/09).

Other human factors are internal. Fatigue is an internal human factor that crosses both our emotional state and physical abilities. Performance ability considers the relationship of the nurse’s work capacity to workplace demands and can be referred to as “fitness for duty.” We often think of impaired practice due to alcohol or other Fitness for Duty continued on page 11

June 2011 Fitness for Duty continued from page 10 substance use when we hear the term “fitness for duty,” but fitness for duty is actually a broader concept that encompasses any factor that may affect the nurse’s ability to perform competently and safely. Fatigue is one such factor that has been studied thoroughly in other industries, but only recently applied to health care.

Fatigue as a Factor in Fitness for Duty Fatigue is defined as “an overwhelming sense of tiredness, lack of energy, and a feeling of exhaustion associated with impaired physical and/or cognitive functioning. Sleepiness and fatigue often co-exist as a consequence of sleep deprivation.” (Rogers, 2008, p.2-509). Fatigue may result from circadian Any factor affecting the rhythm effects, sleep nurse’s ability to perform deprivation and competently and safely continuous fatigue influences the nurse’s effects, and “time-onfitness for duty. task” effects.

Our sleep-wake cycle is regulated biologically by two factors and their interaction: a homeostatic system and circadian rhythm. Circadian rhythm is a “biological clock” which regulates our periods of sleepiness and wakefulness during the day.

It functions in response to light signals which stimulate the release of hormones such as cortisol in the morning light and melatonin in evening.

We respond with fluctuations in attentiveness during the day. Most of us experience our greatest sleepiness in the early morning hours (2:00-4:00 a.m.) and a lesser period in the early afternoon (1:00-3:00 p.m.). Circadian rhythms can only be shifted one to two hours in either direction and can be influenced by our sleeping and waking behaviors. For example, if we normally work early in the morning, but stay up late and sleep in over the weekend, we experience greater than usual sleepiness on Monday morning as our body adjusts to the change in sleep pattern. Disturbances in circadian rhythm, such as when traveling across time zones, also interrupt our normal sleep patterns and force our body to adjust—we experience this as “jet lag”. Night shift workers are especially challenged to manage disruptions to circadian rhythms.

Sleep deprivation may result in: * lapses in attention and inability to stay focused * reduced motivation * compromised problem-solving * confusion or bewilderment * irritability or hostility * unusual tenseness or anxiety * memory lapses (particularly in short-term memory) * impaired communication * faulty information processing and judgment * diminished ability to detect and recognize the significance of subtle changes in a patient’s health * diminished reaction time * slowed information processing * inability to deal with the unexpected * indifference and loss of empathy Sleep/wake homeostasis is a second biological component that interacts with our circadian rhythm to help us to maintain adequate sleep.

While circadian rhythm regulates the timing of sleepiness, sleep-wake homeostasis is concerned with the duration and intensity of sleep. While awake, we accumulate a need for sleep. When we get adequate quality sleep, we are able to replenish this sleep deficit. When we don’t, our homeostasis or balance is upset and we become sleep deprived.

Most adults require seven to eight hours of sleep per day. Sleep deprivation occurs when we don’t get required sleep or when we are awake longer than 16 hours. Lack of an uninterrupted sleep interval, such as when breaking up sleep into several naps, can also contribute to sleep deprivation (as any mother of an infant can attest!).

A sleep deficit is cumulative over time and may require more than one replenishing normal sleep cycle to remedy.

Time-on-task is an industrial concept that refers to fatigue that accumulates during the work period. Prolonged concentration while reviewing and noting physician orders may be an example of

Alaska Nurse • Page 11 time-on-task that may result in fatigue. Generally, fatigue increases and performance diminishes with sustained task effort.

How Fatigue Affects Fitness for Duty Imagine… you are on your way to Hawaii to begin your dream vacation. As you board your airplane you are greeted by a red-eyed pilot carrying a large “energy drink” and overhear her comments to the flight attendant that she only had time for a four-hour nap between flights so was feeling a bit tired. Sound frightening? Would you board the plane?

What if you knew that in a safety study conducted by the National Transportation Safety Board (NTSB) of U.S. major carrier accidents from 1978 to 1990, it was concluded: Half the captains for whom data were available had been awake for more than 12 hours prior to their accidents. Half of the first officers had been awake for more than 11 hours. Crews comprising captains and first officers whose time since awake was above the others made more errors overall and significantly more procedural and tactical decision errors (1994).

How confident are you of the pilot’s fitness for duty?

Insufficient sleep is associated with cognitive problems, mood alteration, reduced job performance, reduced To reduce errormotivation, increased producing fatigue, state safety risks, and p h y s i o l o g i c a l regulatory bodies should prohibit nursing staff c h a n g e s ( R o g e r s, from providing patient 20 08). Fe de r a l care in any combination regulators recognize of scheduled shifts, t h e a d v e r s e mandatory overtime, effects of fatigue or voluntary overtime on safety and in excess of 12 hours require the airline in any given 24-hour industry (along with period and in excess trucking and nuclear of 60 hours per 7-day industries) to directly period. manage fitness IOM, 2004 for duty of airline crew members— specifically the number of consecutive hours that can be worked and the number of hours required between work periods for adequate rest.

Patients in hospital beds are more likely to be greeted by a sleepy nurse than airline passengers are a sleepy pilot. Knowing that this sleepy nurse has a significantly greater risk of making an error that will affect your care, and perhaps your recovery, how safe do you feel now?

Despite recommendations from the Institute of Medicine in 2004, and recent attention to hours worked by medical residents, hours worked by nurses remain, for the most part, unchallenged.

In a recent survey conducted by the Texas Nurses Association, 60 per cent of hospital chief nursing officers reported having a fitness for duty policy, yet only 4 percent of those reported considering fatigue as a component of this policy.

Nurses are not immune to fatigue or related effects on performance. A landmark study of 393 staff nurses over 5317 work shifts documented the significant effects of work duration, overtime, and number of hours worked on errors: • The likelihood of making an error increased with longer work hours and was three times higher when nurses worked shifts lasting 12.5 hours or more.

• Working overtime increased the odds of making at least one error, regardless of how long the shift was originally scheduled.

• There (was) a trend for increasing risks when nurses work overtime after longer shifts, with the risks being significantly elevated for overtime following a 12-hour shift.

• Working more than 40 hours per week and more than fifty hours per week significantly increased the risk of making an error.

• Results were somewhat similar for near errors (Rogers et al., 2004, p. 207).

Why are nurses at risk for fatigue?

There are a number of professional and personal factors that contribute to nurse fatigue.

The unpredictable nature of the health care environment—emergencies, fluctuating census patterns, changes in patient conditions, physician practice patterns—contributes to changing needs for nursing staff. Although organizations have strategies for anticipating patient care needs and scheduling staff appropriately to meet those needs,

it is often a “best guess” and must be adjusted. This creates gaps in staffing needs Professional —some days more On-call hours nurses than those Required overtime hours scheduled will be Total # hours worked per needed, requiring week addit iona l work Length and sequencing hours and possible of shifts overtime. An Rotating shifts or g a n i z at ion t h at Chronic short staffing has vacancies Working when sick faces even greater challenges in Personal meeting its staffing Working extra jobs needs without Voluntary overtime requiring additional Additional home/family hours from nurses. responsibilities Cha racteristics Overall physical/mental of a 24-hour, 7-dayhealth a -w e e k op e r a t io n also contribute (Nursing Organizations to a nurse’s risk for Alliance, 2006) fatigue. Night shift hours predispose individuals to sleep deprivation due to their circadian rhythm and likely interruption in sleeping schedule on days off. Twelve-hour shifts are popular with nurses, but they easily lead to fatigue at the end of the work day, or at the completion of a few shifts in a row. On-call often interrupts sleep as well as requires nurses to work hours exceeding the recommended daily limit.

As human beings, nurses will have personal factors affecting risk for fatigue. Nurses who report social duties and caretaking roles outside of work often report higher levels of stress both at work and at home. A nurse may be the caretaker for elderly family, young children, or ill partners.

Concerns about one setting (e.g., the home) are frequently reported to interfere with performance in the second arena (work) (Scott et al., 2006). Our physical and mental health—aging, dehydration, depression, anxiety and stress—also affects our experience of fatigue and related performance.

Factors Related to Nurse Fatigue

Nurse’s responsibility for fitness for duty Just as you wouldn’t go to work under the influence of alcohol, you shouldn’t go to work under the influence of fatigue—whatever the reason (personal or professional factors). Vigilance is not enough. Individuals are poor judges of their impairment from fatigue or sleep deprivation and alertness cannot be willed.

The nurse has a primary duty to his/her patient that supersedes any facility policy or physician order. The Code of Ethics for Nurses (ANA, 2001) clearly outlines the nurse’s responsibility for safe patient care: • “The nurse’s primary commitment is to the… patient…” (Provision 2) • “The nurse is responsible and accountable for individual nursing practice… “(Provision 4) Further, the Texas Board of Nursing Standards of Practice state that the nurse shall: • “Implement measures to promote a safe environment for clients and others” (Rule 217.11(1)(B)); and • “Accept only those nursing assignments that take into consideration client safety and that are commensurate with the nurse’s educational preparation, experience, knowledge, and physical and emotional ability” (Rule 217.11(1)(T)).

Sleep Hygiene DO

• Establish a regular schedule: wake up and go to bed at the same time every day • Practice a relaxing bedtime routine • Create a sleep friendly environment • Exercise! But not right before bed.

DON’T

• Go to bed if you aren’t sleepy • Consume alcohol, caffeine, heavy/ spicy/sugary food 4-6 hours before bed • Go to bed hungry • Exercise vigorously before bed • Read, write, eat, watch TV, etc. in bed

Fitness for Duty continued on page 12

Page 12 • Alaska Nurse Fitness for Duty continued from page 11 The nurse has a duty to always act in the best interest of the patient. This duty to the patient includes being physically and emotionally “fit” to provide safe patient care. Therefore, nurses providing direct patient care have a professional responsibility to ensure they are adequately rested and not fatigued when accepting a patient assignment. Likewise, a nurse making an assignment (or staffing a unit) must consider the “physical and emotional ability of the person to whom the assignment is made” [Rule 217(1)(S)] and is therefore responsible for considering the nurse’s fatigue and patient’s safety in making an assignment, a work schedule, or setting policies (e.g. on-call hours).

Individual Safety Practices Despite the evidence, nurses are frequently faced with either voluntary or required work schedules that may put them at risk for fatigue.

How can nurses protect themselves and their patients when they may be at risk for fatigue? A number of countermeasures, preventative and operational strategies (Rosekind et al., 1996), can assist in maintaining alertness and on-the-job performance. However, these strategies should be applied with caution—they do not eliminate the safety risks of working when fatigued.

Evidence-Based Practice Recommendations • • • •

Get 7-8 hours of sleep per 24-hour period Do not work > 48 hours in a 7-day period Do not schedule/work 12-hour shifts If you must work 12-hour shifts: • Do not work more than 3 shifts without a day off • Take breaks free from patient care responsibilities (10 minutes/2 hours and a 30 minute meal break) • Take 10-12 hours off between shifts to obtain adequate sleep • Use caffeine therapeutically • Do not consume caffeine outside of work hours • Only consume caffeine at the beginning of the shift or between 3:00 a.m. and 5:00 a.m.

• If you work nights, take a nap prior to your shift • Take a nap during the shift (allow a wake up period after the nap before resuming patient care) Rogers, 2008

A primary, preventative countermeasure is to minimize sleep loss by using days off to “catch up” or “stock up” in anticipation of sleep debt.

Good sleep habits, or sleep hygiene (see inset), can improve sleep quality. However, despite the quality of sleep, several sleep cycles are required to fully recover from a sleep deficit and sleep cannot be effectively “stored” to accommodate for a future lack of sleep.

Operational strategies include those things you can do while on the job to mitigate fatigue.

Social interaction and conversation can assist in maintaining alertness; physical exercise

June 2011 combats sleepiness, however may leave one more fatigued later. Strategic use of caffeine can improve alertness. Nutritional snacks and planned breaks, including naps, can assist the nurse in maintaining energy (see inset: Evidence-Based Practice Recommendations).

The nurse has a primary duty to the patient.

Texas nurses who believe that this duty may be violated by accepting an assignment when too tired to work safely, have the option of evoking Safe Harbor Nursing Peer Review. Safe Harbor is a process that protects the nurse when the nurse makes a good faith request for nursing peer review of an assignment because the nurse believes that accepting the assignment would violate the nurse’s duty to the patient. The nurse has the right to refuse the assignment while awaiting the Nursing Peer Review Committee’s determination. The decision to refuse the assignment must be based upon the belief that no reasonable nurse would accept the assignment. A nurse requesting Safe Harbor is protected from retaliation.

Organizational Safety Practices Health care has traditionally valued nurses who never call in, who pick up extra shifts when needed, and who never seem to need a break— yet, this valuing allows fatigue and its dangers to permeate the organizational culture. Current evidence and recommendations challenge organizations to shift their culture toward one respectful of the deleterious effects of fatigue on the patient, the nurse, and the organization.

A number of organizational practices can be implemented to fight fatigue in the workplace.

First, organizations can work to understand current practices that may contribute to fatigue by conducting an assessment of staffing and scheduling, use of overtime and breaks, nurse satisfaction measures, and patient incident and employee accident reports. This information can assist organizations in identifying their risks related to potential fatigue, prioritizing issues, and developing a fatigue management plan to incorporate evidence-based recommendations.

Recent legislation passed in Texas, the Hospital Safe Staffing Law, prohibits hospitals from requiring nurses to work hours or shifts in addition to hours or shifts previously scheduled.

This prohibition on mandatory overtime is a first step in supporting nurses’ efforts to ensure they are rested prior to accepting additional shifts.

Conclusion The fallibility of human beings, limitations of human performance, and importance of fitness for duty are well established. The health care industry has not yet incorporated this knowledge into its systems to effectively design out errors or “mistake proof” care. It is incumbent on the nurse to assume responsibility for safe patient care. That responsibility includes ensuring personal fitness for duty when accepting an assignment.

References American Nurses Association (2001). Code of Ethics for Nurses with Interpretive Statements.

Washington D. C.: Author.

Hughes, R. G. & Rogers, A. E. (2004). First do no harm. American Journal of Nursing. 104(3), 36-38.

Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: Author.

Nursing Organizations Alliance (2006).

Principles of fatigue that impact safe nursing practice. Retrieved 12/03/09 from http://www. nursing-alliance.org/ Reason, J. (1990). Human Error. Cambridge: Cambridge University Press.

Rogers, A. E. (2008). Chapter 40: the effects of fatigue and sleepiness on nurse performance and patient safety. In Hughes, R. G., editor, Patient Safety and Quality: An Evidence-Based Handbook for Nurses (Volume 2). Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.

Rogers, A., Hwang, W., Scott, L., Aiken, L. & Dinges, D. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212.

Rosekind, M. R.; Gander, P. H.; Gregory, K. B.; Smith, R. M.; Miller, D. L.; Oyung, R.; Webbon, L. L.; Johnson, J. M. (1996). Managing fatigue in operational settings 1: physiological considerations and countermeasures. Behavioral Medicine, 21, 157-165.

Error and Punishment. Retrieved on 12/03/09 from http://www.nursingadvocacy.org/news/2006/ nov/20_captimes.html Evoking Safe Harbor Nursing Peer Review in Texas This process applies for LVNs when an entity employs, hires or contracts for the services of 10 or more nurses, and for RNs when at least 5 of those 10 or more nurses are RNs. A nurse may evoke safe harbor by making a written initial request to the supervisor. The initial request must include: • The nurse’s name and his/her signature • The date and time of request • The location of where the assignment is to be completed • The name of the person making the assignment • A brief explanation of why safe harbor is being requested The initial request must be followed by a comprehensive request, completed in writing before leaving the work setting at the end of the work period. The comprehensive written request must include: • The conduct assigned or requested, including the name and the title of the person making the assignment; • A description of the practice setting (the nurse’s responsibilities, resources available, extenuating or contributing circumstances impacting the situation); • A detailed description of how the requested conduct or assignment would have violated the nurse’s duty to the patient (specific section of the Texas Nursing Practice Act or Board of Nursing rules if possible); • If applicable, the nurse’s rationale for not engaging in the requested conduct or assignment awaiting the nursing peer review committee’s determination • Copies of any other pertinent documentation • The nurse’s name, title, and relationship to the supervisor making the assignment or request.

When duty to keep patients safe is threatened by fatigue…

Jennie began her day of scheduled on-call at 3:30 p.m. when her 8-hour OR shift concluded. After arriving home at 4:30 p.m., she had something to eat and then took a 2-hour nap. At 10:30 p.m. she was called in for a trauma. She completed two emergency cases that night and was particularly disturbed by one patient, a young woman who died during surgery.

She returned home at 4:30 a.m. but had difficulty falling asleep. Feeling exhausted, she called the charge nurse at 5:00 a.m. to let her know that she felt too tired to work after taking call that night. The charge nurse told her she was expected to come in to work and coming in on-call was no excuse for missing work. Despite grabbing a double Expresso on the way to work, Jennie found herself having difficulty staying awake while driving. When she arrived at work, she told her manager that she felt too tired to practice safely, could not accept the

assignment, and requested safe harbor (completed the quick request form).

Jennie’s manager then met with her to see if they could collaborate and reach agreement on an acceptable assignment. Jennie thought that if she could use the sleep room until noon, she would be rested enough to assist with afternoon cases. The manager arranged for this and asked Jennie if she would withdraw her Safe Harbor request. Even though the immediate situation was remedied, Jennie elected to have the Nursing Peer Review Committee consider her request because scheduled shifts immediately following an on-call shift was not an unusual practice at her facility. She completed the comprehensive form, and gave it to her manager before going to the sleep room.

Jennie also voiced her concerns about fatigue, oncall, and scheduled shifts to the nurse representing perioperative services on the Nurse Staffing Committee so that they could evaluate the issue.

June 2011

Alaska Nurse • Page 13

Labor Lines - AaNA Labor Council News

Seasoned Leader At The Helm Anchorage—Mary Stackhouse, longtime member of the Alaska Nurses Association, and seasoned nurse leader has taken the reigns as Chair of the AaNA Labor Council.

The Labor Council directs the business of the three bargaining units across Stackhouse the state—RN’s United of Central Peninsula Hospital in Soldotna (RNU), the Ketchikan Bargaining Unit (KGBU) at Ketchikan General Hospital, and the Providence Registered Nurses (PRN) from Providence Alaska Medical Center. In all, the bargaining units comprise nearly 1,300 RN’s.

Stackhouse was elected by unanimous vote December 18, 2010 at the annual meeting of the Labor Council.

Now, a little about Mary Stackhouse and why she is such a great choice. Stackhouse has credibility. She can speak first hand about the differences a labor union has made in her work and for the RN’s at Providence Hospital because she was there on the front line back when it all began. Recently, I interviewed Stackhouse and she had these things to say about the pre-union days at Providence. “Things had been going down hill.

Patient safety wasn’t where it should be and we (nurses) all knew it.”

“The Providence RN’s pulled together in 1997 and formed the PRN. I was the founding president.

We fought for ten years to get a union and contract.

Those were tough times. There were retaliations, but we all put our feet to the pavement. We did not strike for money, although our wages lagged behind. Our mantra was ‘nurses must have a say in staffing.’ It took ten years of blood, sweat and tears and fighting off a legal challenge from the hospital that was appealed to the 9th Circuit Court of Appeals.

At the end, we came through victorious. We went out on strike April 15, 1999 for over thirty days. In May 1999, we achieved our first contract.

We were very proud of our success, for we had won by keeping to the high road. Even in the strike, the focus was always ‘patient safety and safe working conditions.’

There were many nurses active in the ten-year struggle. “Some of the early activists are still around today,” Stackhouse related. “B” Bolin, Carol Claussen, Rosie Debnem, Arminda Doggett, Connie Federmann, Kelly Foreman, Kathleen Gettys, Wanda Katinzsky, Peggy Ormsby Tipton, Bev Sullivan, Mary Luken, Esther Petrie, Donna Phillips, Doyle Stewart, Debbie Thompson, Ginny Weisman, and Ronnie Zeigler. Have you heard these names? Do you know these nurses? If you see them, thank them for the sacrifices they made to get us as far as we are today.”

“My very first job was at a twenty-six bed rural hospital. There was one RN and one CNA per shift and the average census was fifteen to eighteen patients. There was no unit dosing. We mixed our own drugs, no IV pumps—we counted drops.

We also did respiratory treatments, post-ops, and delivered babies, sent out volunteer rescue squads.

Don’t get me wrong. In ways, this was good for a new nurse. We learned to prioritize and triage.

But can I say it was the safest way to practice nursing? No, I can not. I remember one particular harrowing night as my most challenging. There was an ice storm and eighteen victims in ER. There were three post-ops, two cardio patients on telemetry, and one cardiac arrest—he coded at 7:00 AM. During this shift, I delivered two singletons, followed by one set of triplets, to a Vietnamese couple who did not know English and did not know they would deliver three babies. There was no doctor in the house. But we made do, the one CNA and I.” So next, I asked Stackhouse, “After 22 years in the union, what can you say about unions now?”

Stackhouse was quick with her answer and also very passionate. “The Patient is the center of the universe when it comes to healthcare. Patients have the best outcomes when nurses say ‘enough is enough.’ Nurses must stand at the bedside with the freedom to say ‘no.’ Nurses must have breaks and reasonable hours to do critical thinking.

No overwhelming assignments, no working outside the scope of practice. You get these things through a union. But I want to see more nurses representing nurses, (not long shore men and teamsters) to keep the focus where it should be, with the patient. Only a nurse understands what it really takes to have safe patient care and safe working conditions.”

In addition to founding president of the PRN, Stackhouse has been a Labor Council member and Labor Council Vice-Chair. She has served on every PRN bargaining team except one. I asked Stackhouse whether new leaders are stepping up.

“They are,” stated Stackhouse. “This work takes a toll over time. The work and vision must be shared. Sometimes, you have to step back and take a break from it. We have new members who have stepped up to leadership and are doing wonderful things. These nurses are the present and future of the AaNA Labor Program. In the beginning, I think some of the younger and newer nurses thought the battle had been fought and the stress was lower and pay better. But now, after what happened in Wisconsin and what has happened right here in

Anchorage with labor contracts not being honored, many nurses have begun to recognize that things could change literally overnight. And, nurses are engaging with more than a desire for status quo, but with the hope of how much better it can be.”

As our interview drew to a close, I asked Stackhouse of her specific goals for nurses in Alaska in the immediate years to come. “We just cannot lose ground. We need the best nurses and conditions at the bedside. We need more people involved and we need more nurses in the hierarchy. We must organize other areas in the state so nurses are represented by other nurses. We must support nurses in the bush. We need better staffing at the bedside. That is my big deal. We need patient advocacy. That is my focus.”

Labor Council Chair Mary Stackhouse is not content to sit on past accomplishments. And she is not unclear about the future. Stackhouse has a definite progressive nursing agenda and we are all the better for it.

■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

Wrangell—The Alaska Nurses Association (AaNA) is hopeful it will be representing RN’s at the Wrangell Medical Center (WMC) by years end. A majority of WMC’s RN’s contacted the Association in January and expressed the strong desire to be represented by the AaNA. Program Director Debbie Thompson and Labor Specialist TK Kleiner met with WMC nurses and collected cards from over two thirds of them. Based on the strong showing, the AaNA Labor Council voted unanimously to pursue representation.

On February 2nd, Kleiner filed a representation petition with the Alaska Labor Relations Agency (ALRA). The WMC filed a timely petition in opposition. Per statute, an ALRA hearing was convened, May 3rd and 4th at the Nolan Center in Wrangell, Alaska. Attorney Chuck Dunnagan represented the Association. The Hearing Examiner will issue an opinion in August. If the Association prevails, the ALRA will conduct an election, and with a 51% yes vote of those RN’s voting, the Wrangell nurses will comprise the Association’s fourth nurse bargaining unit. The AaNA looks hopefully ahead to welcoming the Wrangell RN’s on board. Stay tuned.

[TK Kleiner, Labor Specialist for the AaNA will be reporting on news from the ‘labor front’ in Alaska in this new section of the Alaska Nurse. To contact Ms. Kleiner email TKleiner@aknurse.org or call 907-317-2799].

Page 14 • Alaska Nurse

A Final Note from Alaska Nurse Alert System

June 2011

Membership Application

by LeMay Hupp, RN, Coordinator

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

Membership Categories

AaNA Collective Bargaining Full Members (PAMC, CPH & KGH) contact AaNA (907)274-0827 Full Membership—Employed Full-time or Part-time Reduced Membership—Not Employed

Full time student

New graduate from basic Nursing Education program, within first six

months after graduation (first year only), or

62 years of age or over and not earning more than Social Security allows.

Special Membership—62+ years or totally disabled (not employed)

As this newsletter goes to print, the Alaska Nurse Alert System will be transitioning into the Emergency System Advanced Registration of Volunteer Health Professionals (ESAR-VHP) program. After 9/11, the National Disaster Medical System was formed. ESAR-VHP is a national network of state-based systems, which verifies the identity and credentials of health professionals so that they can more readily volunteer for disaster, public health and medical emergencies.

By registering through an ESAR-VHP program, volunteers’ identities, licenses, credentials, accreditations, and hospital privileges are all verified in advance of an emergency. The program is administered by the Health and Human Services/Office of the Assistant Secretary for Preparedness and Response (ASPR).

All of the Alaska Nurse Alert System volunteers will be automatically enrolled into the new ESAR-VHP program. Other licensed health care professionals that will be included are; Behavioral health professionals (marriage and family therapists, clinical social workers, psychologists, and mental health counselors), Dentists, Paramedics, Pharmacists, PAs, Physicians, Respiratory therapists and Veterinarians. With this system change, there will new opportunities such as a professional data registry with automatic email/telephone messages and additional monies for training.

More information will be distributed to volunteers over the next few months and a web site is being developed for online registration. If you are interested in joining this new system, please call 274-0827 for more information.

“Emergency preparedness is a team sport!”

Eric Whitaker

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

Full

Reduced

Special

$17.50 $204.00

$9.00 $102.00

$4.75 $51.00

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

$4.10 $49.12

____________________________________________________________ Last Name/First Name/Middle Initial ____________________________________________________________ Street or PO Box City/State/Zip

______________________________ Home Phone

____________________________________________________________ Employer Name Unit City/State/Zip

______________________________ Work Phone

_____________________________ RN License Number/State

___________________________ FAX Number

_______________________________ E-mail Address

Payment Method—see above for categories and amounts Check—Please make checks payable to the Alaska Nurses Association MasterCard or Visa—available for:  Annual payment

 Monthly payment

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

AUTHORIZATION to provide monthly electronic payments to the Alaska Nurses Association (AaNA): This is to authorize AaNA to withdraw 1/12 of my annual dues and any additional service fees from my checking account designated by the enclosed check for the first month’s payment. AaNA is authorized to change the amount by giving the undersigned thirty (30) days written notice. The undersigned may cancel this authorization upon receipt by AaNA of written notification of termination twenty (20) days prior to the deduction date as designated above. AaNA will charge a $5 fee for any return drafts.

________________________________________

Signature for EFT Authorization

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

Taskforce Members Taskforce members will receive requests to work on a variety of projects on nursing issues, and may choose to participate in only the projects that interest them. ❏ Health and Safety Issues—Taskforces will consider safety and health issues of nurses and patients. ❏ AaNA Event Planning—Taskforces will plan events such as the AaNA Fall Retreat, open house events, AaNA General Assembly, or other events for AaNA members. ❏ Other interest? Let us know what you would like to work on:______________ AaNA Committees ❏ Legislative Committee—Actively involved in reviewing and coordinating strategy and testimony for legislative issues related to health and nursing. Works closely with the AaNA Lobbyist. Usually meets on the third Tuesday of the month. ❏ Conference Planning Team—Participates help plan the Alaska Statewide Nurses Conference. Roles include working with program planning, marketing, vendor and sponsor recruitment and onsite assistance. ❏ Alaska Nurse Newsletter Editorial Board— Members work with the editor to recruit articles and pictures for the quarterly newsletter. The current editor is Lynn Hartz. ❏ Professional Nursing Practice Issues— Members will consider issues relating to AaNA’s policy on RN practice and other professional issues.

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

June 2011

Book Review Skloot, R. (2010). The Immortal Life of Henrietta Lacks. New York: Crown Publishers.

by Dianne Toebe, RN, PhD, ANP This book is about the true story of how cervical cells infected with Human Papillomavirus (HPV) were cultured and used worldwide in research labs, beginning in the 1950’s at Johns Hopkins Hospital. The cells were taken from Henrietta Lacks and named HeLa cells after the first letters in her name, without her knowledge or consent.

These cells have become ‘immortal’ as they were robust cells that successfully reproduced for use in research studies, long after Henrietta died of cervical cancer.

The ethics of using the HeLa cells when neither the patient nor the family knew or consented are well explored in the book. The family eventually discovered the existence of the ubiquitous HeLa cells and they feel betrayed and shocked. Even with legal assistance, the family was never compensated in any way. There is a discussion in the book about who owns or controls cells or parts of our bodies that are removed.

The author thoroughly describes the events that led to the lack of informed consent from the perspective of Henrietta, her family, and the researchers. Henrietta Lacks was poor, uneducated, and African-American. Her cells are still being used in medical experiments. The context within which these events occurred makes for a read that is perfect for nurses. Nurses would be fascinated by the laboratory and medical information on the HPV cells. Nurses would also be stunned and outraged at the social injustices, the misinformation, and the inhumane treatment of Henrietta and her family.

This book was published in 2010 and was a New York Times bestseller. Rebecca Sloot, the author, spent many years tracking down the actual details around the discovery and use of the HeLa cells. She also interviewed Henrietta’s survivors and provides the reader with their perceptions of the situation and their belief that Henrietta is immortal. The character of each person in the book is well described and the person comes alive to the reader. The impact of what we do in the nursing profession working with human beings is poignantly seen in the context of these peoples’ lives and humanity.

[Dianne Toebe is a Professor of Nursing at UAA. If you have books of interest to nurses that you think are outstanding, write a book review! Send it to the editor at lhartz@alaska.com.]

Alaska Nurse • Page 15

Alaska State Board of Nursing Update

New Boardmembers Confirmed

Board of Nursing members pictured during a break at their April meeting in Juneau. Left to Right— Tom Hendrix, Erin Pringle, Beth Farnstrom, Denise Ekstrom, Julie Gillette and Kevin Dougherty The Legislature approved Beth Farnstrom, RN, BSN, for her second 4 year term on the Board of Nursing. Erin Pringle, RN. MS and Julie Gillette, Public Member, were approved for their first 4 year term. The LPN position remains vacant as of May.

Visit aknurse.org Online CE Nursing News “Alaska Nurse” on the web Alaska nursing links Job Listings And More!

Page 16 • Alaska Nurse

In Memory Carolyn Bromley Oct. 23, 1940-May 5, 2011 Carolyn Jean Bromley, age 70, of Eagle River, passed away May 5, 2011 in an automobile accident. Carol was retired from the Alaska Native Hospital in Anchorage where she had worked for many years as the infection-control coordinator.

During her career Carol initiated the formation of the Alaska Infection Control Association and continued to be active in the program until her death. She also served on the Board of Directors of the AaNA and the Alaska Nurses Foundation.

Carol earned her nursing certificate from Good Samaritan Hospital in Dayton, Ohio, her BS from the University of Dayton and her graduate degree in hospital management from the University of LaVerne. She was an Air Force nurse during Viet Nam and was proud of her service in the 805th Medical Group.

In lieu of flowers and other gifts, memorial donations are suggested to St. Andrew’s Catholic Church, 16300 Domain Lane, Eagle River, 99577, or Covenant House (a crisis youth center), 609 F St., Anchorage 99501.

[Source: Anchorage Daily News 5/11/11]

June 2011

Resources Scholarships/Funding/ Volunteer Opportunities Alaska

Award Nomination: The Melissa Ann Peters Memorial Award, “is given in memory of a young nurse whose untimely death prompted her family and friends to remember her by honoring other nurses who have contributed in a special way to the encouragement of EMS skills, efforts and education.”

Nominations for this award are encouraged yearly and throughout the state. For more information go to: http://www.ems.alaska.gov/ ACEMS/awards/default.htm Vaccines: Those interested in subscribing to the Alaska Section of Epidemiology Bulletins including information on vaccines can subscribe at: http://www.epi.alaska.gov/bulletins/subscribe.htm Volunteers for Students: Romig Middle School is trying to offer free Sport Physicals, Health

Screenings, Dental Screenings, and Vision Screenings during registration this coming August 2, 3, and 4th. We would love to get your assistance in providing these valuable services to students prior to the beginning of school. If you are interested in assisting with this effort, please contact Mark Johannes as soon as possible (I am done with my teaching job on May 20) so that I can coordinate with you to make this a valuable experience for everyone involved. It is our intent to extend this offer to community members as well, but students would get priority preference.

By offering these services, students will be ready to fully participate in all aspects of school on the first day.

If you have any questions, please feel free to contact Mark Johannes, Romig liaison, #742-5226 or our school nurse, Kathy Estes 742-5201.

General Websites of Interest: www.kff.org—The Kaiser Family Foundation has information on health care generally and the Affordable Health Care Act specifically. www.ahrq.gov/news/socialmedia.htm—USDHHS Agency for Healthcare Research and Quality. This site accesses email updates, podcasts and online videos for up to date information on health care research.

■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

Federal government rolls out vaccine website The federal government has introduced its Vaccines.gov website, which includes content from HHS agencies. The site features information on recommended vaccines, the diseases they prevent and how they work, as well as provides links to other vaccine-related websites and states’ vaccination standards to attend school and day care centers. [ANA Smartbrief 3/30/11] ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

FDA approves shingles vaccine Zostavax for those in their 50s The FDA approved Merck & Co.’s vaccine Zostavax to prevent shingles in patients ages 50 to 59. The expanded approval is based on clinical data indicating that Zostavax reduces this age group’s risk by 70%. The drug was initially approved in 2006 for patients age 60 and older.

[ANA Smartbrief, 3/28/11] ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

Pediatric NPs Join Call for Heightened Pertussis Vaccination A coalition of nine health organizations, including a group of pediatric nurse practitioners, issued an advisory letter encouraging health care providers to get vaccinated against pertussis and to utilize a dosing guide for vaccine types and schedules for specific groups. Health care providers should promote pertussis immunization to anyone who has contact with newborns and infants, according to the letter. [AANP Smartbrief, 3/28/11)

Happy 4th of July

June 2011 Alaska Reports continued from page 1 2007 followed closely by the Northern and Interior regions. In comparison, the US rates have decreased somewhat over the same time period [Figure 1].

Figure 1. Gonococcal Case Rates by Alaska Regions and the United States, 2006–2010*

Alaska Nurse • Page 17 Control and Prevention on strategies to control these epidemics. Earlier this year the program published recommendations to health care providers on treating exposed sexual partners through Expedited Partner Therapy (EPT).4 A tool to augment partner notification activities, EPT is the clinical practice of treating people exposed to a sexually transmitted disease without a provider first examining the person. EPT may be an effective strategy when traditional partner management strategies are unavailable, impractical, or unlikely to be effective. For resources on EPT, visit the SOE website at: http:// www.epi.hss.state.ak.us/hivstd/ept/default.htm.

Partner Services Training.

The next available Partner Services training, Fundamentals of STD Intervention (FSTDI), will be held here in Anchorage, October 25-28. FSTDI, a training program designed for health care workers who conduct STD Partner Management for gonorrhea and chlamydia, is a skills-building course that covers STD Partner Management from the initial interview, through the investigative process and to the successful testing and treatment of the partners. This is a no-cost course and Nursing CE contact hours are free. To register, go to http://stdhivtraining.org/class_calender.html and click on the course you wish to attend.

*The 2010 U.S. case rate is preliminary The Southwest region of Alaska experienced the greatest increase in GC case rates from 2006 to 2010. Second was the Northern region followed by the Interior.

STD data now available online in new format.

An interactive STD data display is now available on the SOE website at: http://www.epi.

The hss.state.ak.us/hivstd/std2010/atlas.html.3 display features CT and GC data depicted through maps, charts and tables and distributed according to Alaska Native Epi Regions corresponding with the service areas of the Alaska native health corporations. The staff at the HIV/STD Program worked closely with the Alaska Native Tribal Health Consortium (ANTHC) STD Program to match population data to these regions. The data are displayed by age-adjusted rates from 2001 to 2010. Tables of statewide counts by gender, age and race are viewable by clicking on an icon “for more detailed case data.”

The HIV/STD Program has been working collaboratively with public and private health care partners and the Centers for Disease

Last note on treatment.

CDC’s new GC treatment guidelines increase the dosage of Ceftriaxone from 125 mg to 250 mg IM, and include Azithromycin 1 g PO as cotreatment for possible CT infection and to hinder the development of antimicrobial-resistant N. gonorrhoeae.5 Alaska Section of Epidemiology. Chlamydia Infection Update – Alaska, 2010. Bulletin No. 10, May 3, 2011.

Available at: http://www.epi.hss.state.ak.us/bulletins/docs/ b2011_10.pdf 2 Alaska Section of Epidemiology. Gonorrhea Infection Update – Alaska, 2010. Bulletin No. 11, May 3, 2011.

Available at: http://www.epi.hss.state.ak.us/bulletins/docs/ b2011_11.pdf 3 Chlamydia and Gonorrhea Rates, by Alaska Native Health Corporation Service Region – Alaska, 2001-2010.

March 30, 2011. Available at: http://www.epi.hss.state. ak.us/hivstd/std2010/atlas.html 4 Alaska Section of Epidemiology. Expedited Partner Therapy Recommendations for Alaska Providers. Bulletin No. 1, January 12, 2011. Available at: http://www.epi.hss. state.ak.us/bulletins/docs/b2011_01.pdf 5 Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59 (RR-12). Available at: http://www.cdc.gov/std/ treatment/2010/STD-Treatment-2010-RR5912.pdf 1

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

Remember, the AK Nurse is published every three months so be careful about sending time-sensitive material. Be sure to include your name and contact information.

May 2, 2011 YOU HAVE BREAST CANCER! This year more than 400 women in our state will sit across from their oncologist and hear the words: “You have breast cancer.” It will be a moment where their lives will go from the usual daily concerns of home and career to the very real fears of a possible surgery, what treatments are available, how it will affect their family and marriage, and finally, how will they ever meet the growing mountain of bills that will surely follow?

That is why the American Cancer Society has developed its Reach to Recovery program. Reach to Recovery is a free program where volunteer breast cancer survivors provide one-on-one support, inspiration and information to assist women who are newly diagnosed with the disease. As breast cancer survivors themselves, the volunteers know exactly what the women are feeling as they meet with them in person or over the phone; after all, they have already heard their own diagnosis and have walked a mile in their shoes.

A diagnosis of breast cancer is a frightening ordeal, but you don’t have to go through it alone.

For those women in our community who are newly diagnosed and are looking for someone to talk to, I strongly encourage all of you to call the American Cancer Society to learn more about our Reach to Recovery program and schedule a lowkey, confidential meeting with one of our caring and compassionate volunteers. If you are a breast cancer survivor and would like to be a role model during the journey of other people with breast cancer please call 907/276-8610.

Mary Whalen 907/276-8610 Quality of Life Manager American Cancer Society, Anchorage

Page 18 • Alaska Nurse

June 2011

Upcoming Events Alaska State Board of Nursing—Upcoming Meetings July 20-22, 2011 Anchorage agenda deadline Oct. 19-21, 2011 Fairbanks agenda deadline Jan. 18-20, 2012 Anchorage agenda deadline

June 22 Sept. 28 Dec. 28, 2011

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

Inquiries regarding meetings and appearing on the agenda can be directed to:

Save the Date Alaska Nurse Practitioner Association’s 28th Annual Conference September 15-17, 2011 Anchorage Downtown Marriott www.alaskanp.org or 907-222-6847 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

6th Annual Asthma & Allergy Conference Wheezin’ Sneezin’ and Itchin’ September 23-24, 2011 Alyeska Resort – Girdwood Up to 15 CEU’s For info call 907-349-0637 or 1-800-651-4914 Or, aafaalaska@gci.net ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

Nancy Sanders, PhD RN, Executive Administrator Alaska State Board of Nursing 550 West 7th Ave, Ste 1500, Anchorage, AK 99501 Ph: 907-269-8161, fax 907-269-8196 email nancy.sanders@alaska.gov To attend by audio conference call 907-269-8161 for access number.

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Sigma Theta Tau International 41st Biennial Convention Grapevine, Texas, 29 October-2 November 2011 Registration is open through 26 October 2011, but attendees can take advantage of the early registration discount by registering before 31 August 2011.

The Biennial Convention will feature keynote speakers Karen H. Morin, DSN, RN, ANEF and president of STTI and Kim Bouldin-Jones, an internationally recognized educator specializing in HIV, STDs and global disease prevention. The convention will also include the presentation of STTI’s International Awards.

For additional information on the 41st Biennial Convention and http://www.nursingsociety.org

2011 AaNA Fall Retreat Enjoy this ultimate getaway in a place surrounded by stunning mountain views!

Alyeska Resort-Girdwood October 15-16, 2011 6 hrs CE Call for more information 274-0827

Alaska Healthy Nurses Mind, Body & Soul

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What is the Alaska Nurses Association?

[For those of you who are not members yet, here is information on the organization that sends you The Alaska Nurse as well as an invitation to join.]

AaNA is the professional association representing Registered Nurses in Alaska. It is supported through membership dues. The AaNA was incorporated in 1953 and has been actively involved with nursing issues in Alaska ever since.

The AaNA is your organization. We exist to serve your professional needs and ensure that nurses: …influence the laws that affect your profession.

AaNA Legislative Committee Members lobby, educate and advocate for the nursing profession, and our full time lobbyist acts on our legislative concerns and agenda. …inform and impact the regulations that affect your practice. AaNA staff and members monitor the Board of Nursing in order to protect nursing practice, provide information to the Board to enhance nursing practice while protecting the public, and inform AaNA members of changes in regulations that affect your practice. AaNA has recently provided input, information, and monitoring on the following topics:  New regulation which addresses administering dietary supplements  Participation in orientation of EMTs & paramedics by Registered Nurses  Information regarding volunteer nursing hours as CEU for re-licensure  Competency criteria for original as well as re-licensure for nursing  Input on re-licensure question regarding depression and use of anti-depressants …have a voice on trends, issues, and changes in the profession. AaNA Professional Practice Committee considers issues in the nursing profession and makes recommendations on how to address them. …promote the profession. Nursing is a strong profession when nurses at all levels work to develop and promote it. AaNA members promote nursing in their practice and to the public in order

to recruit new professionals and continue to raise awareness of and respect for the profession of nursing. …direct Continuing Education. AaNA approves CE programs according to ANCC standards using volunteer approvers to ensure excellence in the CE programs available to nurses in the state. …develop their leadership abilities. Our elected leaders power our association and active members—RNs just like you. AaNA Leaders represent the Association in meetings, trainings and at conventions.

How Would YOU Like to Participate?

Committees and task forces do the majority of the work, help to keep you active in, and informed about your profession. Let us know how you would like to participate. If you are not sure, or have interests that are not listed, please speak with Debbie Thompson, Executive Director, and she would be delighted to find a way to use your talents to benefit the association and the profession.

What if I Don’t Have Time to be Active?

Then your membership is supporting your profession by being a paying member of AaNA— even if you cannot join another committee today, your membership lends strength to AaNA’s representation of nurses and nursing on the state and national levels. You will be kept informed about the current issues and activities. Your dues will fund all the above projects and much, much more. Paying members make it possible for us to go further in protecting and promoting the profession.

Questions about Membership Status or Benefits?

Please call the office anytime with any question that you may have. In Anchorage 274-0827 or across the state call toll free at (800) 811-2576.

Office Hours Monday – Friday

8 am – 5 pm

We recognize that nurses work a variety of shifts and have busy lives. If you need the staff to be available at an alternative time, please request an appointment.

Through your membership to AaNA you are securing the future of your profession of nursing in Alaska, the United States and throughout the World. Consider adding your support by becoming a member of AaNA. Sincerely,

Nancy Davis, RN, MS Alaska Nurses Association President AaNA Leadership Contact Information President, Nancy Davis, RN, MS davisn_rn@ yahoo.com Vice President, Pam Embler, MSN, RN pamembler@yahoo.com Secretary, Michelle Marshall, MSN, RN mlmrn@ acsalaska.net Treasurer, Donna Phillips, RN donnaphill@ acsalaska.net AaNA Staff Contact Information Executive Director, Debbie Thompson, RN, BSN debbie@aknurse.org Continuing Education Director, Michelle Marshall, MSN, RN mlmrn@acsalaska.net ~ “Why the big A, little a?”

Because AaNA was incorporated when Alaska was still a territory and the initials for the territory were Aa. It is now part of our history, so we keep AaNA as the symbol for the Alaska Nurses Association as an acknowledgement of our beginning, instead of changing to the official state initials, AK.