The Alaska Nurse - Vol. 58 No. 3 - August 2008

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

Volume 58 • No. 3

August 2008

Providence May Miss Magnet Status with Mandatory Overtime

Page 5

Young, Murkowski Sign On To Nurse Legislation

by Dianne O’Connell Alaska’s Congressional delegation is mightily aware of issues facing Registered Nurses in Alaska and the rest of the nation thanks to the lobbying efforts of nurse leaders such as Donna Phillips, Kathleen Gettys, Jackie Pflaum, Patricia Senner and Jennifer Straight.

The work of these leaders recently paid Dianne high dividends when O’Connell, M.Div. Congressman Don Young AaNA Executive signed on as a co-sponsor Director, Ret. of H.R. 2123—Legislation to Ensure Appropriate Acute Care Staffing, and H.R. 2122/S.1842—Legislation to Strictly Limit Mandatory Overtime.

U.S. Senator Lisa Murkowski also signed on as a co-sponsor of the Mandatory Overtime bill (S. 1842) on the Senate side. At the moment there is no companion bill on the senate side dealing with staffing.

“We saw Congressman Young and Senator

Page 6

District 1 May Banquet

Page 11

Meeting in Senator Lisa Murkowski’s office with the Senator and her trophy salmon are Donna Phillips RN, on the left and Kathleen Gettys, RN on the right who sit on the United American Nurses Executive council.

Murkowski in May during the United American Nurses (UAN) Labor Cabinet meeting,” explains Ms. Phillips. “On that occasion, it was Kathleen and I who met with them. They were very

Continued on page 4

Alaska Nurse Practitioners A History of Firsts

by Lynn Hartz MSN, FNP This year the Alaska Nurse Practitioner Association (ANPA) will celebrate the 25th year of independent practice for Advanced Nurse Practitioners (ANPs) in Alaska. It is also the 25th anniversary of ANPA providing continuing education conferences for the nurse practitioners in the state. To commemorate these landmarks the association has delved into the record books to honor “firsts” for nurse practitioners in Alaska: times, places and people.

In 1980 when nurse practitioners (NPs) were first authorized to practice in Alaska there were twenty-seven listed: there are now over 600.

Alaska was one of the first states in the nation to have independent practice for nurse practitioners and independent prescriptive privileges. Many, many people contributed to the achievements of the ANPA even though only a few are mentioned by name in this article. Also from the beginning, the strength of the ANPA, even its existence, came from its close connection with the Alaska

Terri Lynn Kiss Wins 2008 Tina De Lapp Professional Excellence Award

Inside This Issue From the Desk of the AaNA Executive Director . . . . . . . . . . . . . . . . . . . 2 Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Alaska Nurses in the News . . . . . . . . . . . . . . . 6 ANP Finds Mission at SAFE Campus . . . . . . 7 Update from the Board of Nursing . . . . . . . . . 7 State of Alaska 2008 Recommendations for the Management of Diabetes Type 2 . . 8 Thoughts at the AaNA Office . . . . . . . . . . . . 10 District 1 May Banquet . . . . . . . . . . . . . . . . . 11 Membership Application . . . . . . . . . . . . . . . . 12 Welcome Nursing Graduates . . . . . . . . . . . . . 13 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Upcoming Events . . . . . . . . . . . . . . . . . . . . . . 15

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

1976—In this old newsletter photo at a AaNA convention luncheon, practitioners spearheading the PEER group are first meeting. From left to right Jo Ann Gladden, Betty Kuffel, Julie Sprott and Lila McEwen.

Nurses Association. The Professionals Engaged in Expanded Roles (PEER) group, later to become the ANPA, started as an

Continued on page 3

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Page 2—Alaska Nurse—August 2008

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

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

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

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

All references should be listed at the end of the article. Pictures in black and white

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

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

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

Materials may not be reproduced without written permission from the Editor. Views stated may not necessarily represent those of the Alaska Nurses Association.

Editor: Lynn E. Hartz, MSN, FNP lhartz@alaska.com AaNA Board of Directors President: Debbie Thompson BSN, RN Vice President: Nancy C. Davis, MSN, RN Secretary: Michelle Murphy, RN Treasurer: Donna Phillips, BSN, RN

From the Desk of the AaNA Executive Director

The First Year

by Tom Renkes, RN Well, the first year has come and gone and somebody told me it would slow down. It has only gotten busier. We’ve welcomed the Heritage Place group into the fold down in Soldotna after they voted to be represented

by AaNA. There have been visits to Ketchikan, Fairbanks, Valdez, Homer, Wasilla, Juneau, and everywhere in between.

I’ve even been flattered by UAA by being asked to do their Tom Renkes, RN commencement address for the nursing graduates in August.

What I truly appreciate is the kindness and sincerity with which I have been accepted and made to feel at home. So many times in our life we face daily negativity and anger with no place to hide.

Each group I’ve met has a healthy attitude about work, family, and what is real in life. After being so many places, I now know that is the pleasure of being in Alaska. If we don’t have a “safe place” or hobby or dream, the world just crumbles around us; no one benefits from that least yourself.

In many places, we are attempting to engage a

more positive work place; a more positive approach to each other, but most of all to explore dreams and methods of solving problems that may never have been explored. If this all sounds somewhat ethereal, let me put it in black and white terms: it’s time for the Alaska Nurses Association to be THE group every nurse in the state of Alaska wants to be a part of.

The visibility of the Association and how a positive, proactive approach to all functions of practice, legislation, and community may work does take time.

Often it’s a two to five year change process. I can tell you as of this writing, we’re ahead of schedule.

As events or needs come to your health care community, please let us know how we can help.

Our door is always open and the phone is always on.

I share another poem that I wrote recently upon my arrival in Alaska. It is actually attached to a sketch I made several years ago while driving through farm and field on my way to visit this Great Land.

Thanks for allowing me to be here. I thank you all.

Tom “Analogy to a Busy Life” by Tom Renkes I saw this fence so long ago.

Kansas I think; No. It was Montana; Perhaps Alberta.

I’ve been so many places and have seen so many faces, But I bet this fence is still there.

I wish I could remember where.

Directors: Labor Council (designee): Susan Walsh, RN Greater Alaska Director: Open Staff Nurse Director: Kathleen A. Gettys, BSN, BA, RN Rural Director: Open Director at Large: Carolyn S. Adkins, MS Paul T. Mordini, RN Shirley LaForge, RN Martha Clinehens, RN Jennifer Straight, RN AaNA Labor Council Chair—Donna Phillips, BSN, RN Vice-Chair—Kathleen Gettys, BSN, BA, RN Secretary—Karen Friedl, MSN, RN Treasurer—Jenni Hancock, RN Directors—Joshua Meals, RN Directors—Mary Stackhouse, RN PAMC BU Rep.—Cindy Price, 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: Tom Renkes, RN, MS Advertising Rates Contact—Arthur L. Davis Publishing Agency, Inc., 517 Washington St., P.O. Box 216, Cedar Falls, IA 50613, 800-626-4081. AaNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Corrections The Alaska Statewide Nurses Conference dates and location given in the last issue have been changed. The conference is October 10-11 with members’ General Assembly on the 12th at the Captain Cook Hotel.

August 2008—Alaska Nurse—Page 3

Alaska Nurse Practitioners Continued from page 1

interest group at an Alaska Nurses Association convention in August of 1976.

Below is a list of “Firsts.” If you are interested in celebrating with the ANPA at their 25th conference there is still time. The conference dates are September 25, 26 & 27 at the Anchorage Marriott.

For more information go to www.AlaskaNP.org.

• 1976 September 20—First meeting of PEER group at the Alaska Clinic chaired by Julie Sprott, NP. The PEER group later becomes the Alaska Nurse Practitioner Association (ANPA). (1) • 1980 “Advanced Nurse Practitioners” (ANPs) are authorized to practice in Alaska under a mandatory, signed collaborative agreement with a physician. The plan must be approved by the Alaska Medical Board as well as the Board of Nursing (BON). Jean Frank, is the first ANP authorized to practice in Alaska.

• 1981 Leila McEwen, FNP establishes the first nurse practitioner private office practice in Eagle River. (2) 1982—Connie Trollan, FNP was one of three Juneaubased nurses who used their proximity to the legislature to help get Senate Bill 238 passed; a critical factor that lead to eventual independent practice for ANPs. • 1982 Senate Bill 238 passes giving the Board of Nursing statutory power to repeal regulations adopted jointly by the BON and Medical Board. Connie Trollan, FNP,

Margaret Crawford CNM in Juneau along with Gail McGuill RN, Executive Administrator, and Sammye Rink, RN on the BON work as a team to get this passed. This gives the BON the power to unilaterally rewrite the nurse practitioner regulations. (3)

1983—Lynn Hartz, FNP is appointed to the Board of Nursing and in concert with the PEER group works to revise the ANP regulations. After hours of public hearings, multiple revisions and despite negative reactions and threats from the Medical and Pharmacy Boards, the new regulations are adopted and become effective in 1984.

• 1983 Governor Bill Sheffield appoints the first ANP, Lynn Hartz, to the Board of Nursing.

• 1984 September—First continuing education conference sponsored by PEER group is given.

Organized by Julie Sprott NP and Barb Berner FNP, the workshop is on over-the-counter medications and attended by 28 people. (4)

• 1984 December 1—New regulations become effective that institute independent practice for nurse practitioners with independent prescriptive privileges for legend drugs.

The regulations abolish the mandatory collaborative agreement with a physician.

• 1987 November—New regulations give ANPs independent authority to prescribe controlled drugs Schedule II-IV (5) • 1988—Senate Bill 315 passes requiring third party payers, such as insurance companies to cover the services of ANPs. Lead practitioners in this effort were Barb Berner and Norma Lundy. (6) • 1989—PEER group changes its’ name to Alaska Nurse Practitioner Association (ANPA) (7) 1994—Gail McGuill RN, Executive Administrator for the Board of Nursing (BON) addresses the ANPA conference.

Ms. McGuill either initiated or provided critical support to every landmark made by the nurse practitioners in Alaska during her term on the BON. 1. “The PEER Group Meets,” The Alaska Nurse, November (1976), Vol. 26, no 2.

2. Verbal communication, Leila McEwen, FNP. 3. Verbal communication, Connie Trollan, FNP. 4. “Pharmacy Workshop a Success,” PEER News, Sept/ Oct 1984 5. “Prescription Authority for Controlled Substances,” PEER News, Jan/Feb, 1988.

6. Anchorage Daily News, May 2, 1988, Legislative News.

7. ANPA special mailing, 1989.

Page 4—Alaska Nurse—August 2008

Young, Murkowski Sign On Continued from page 1 friendly and eager to work with us on these issues.” Gettys sits on the UAN Executive Council as a Director At-Large and Phillips attends by virtue of her position as chair of the Alaska Nurses Association Labor Council. Originally appointed to the Director At-Large position, Gettys recently won a full term of her own.

“Our second opportunity to meet with the delegation came in June during the American Nurses Association House of Delegates meeting,” Phillips continued, “Pat Senner, Jackie Pflaum, and Jennifer Straight were with us then. We talked with Congressman Young and Senator Murkowski’s legislative assistant, Amanda Makki about funding of Medicare and several issues of particular importance to nurses. They are completely on board with us.”

House Resolution 2122 and Senate Bill 1842 Unlike many other major industries where public safety is a concern, health care is exempt from regulations that limit the use of overtime as a staffing tool. Mandatory overtime, as most nurses recognize, puts patients and nurses themselves at risk for medical errors, as well drives registered nurses out of patient care.

Congressman Pete Stark (D-CA) and Senator Ted Kennedy (D-MA) introduced the “Safe Nursing and Patient Care Act of 2007,” which would set strict federal limits on the ability of health facilities to require mandatory overtime from nurses. Nurses would use their own professional judgment in deciding to volunteer for overtime, but, forced overtime would only be allowed when an official state of emergency was declared by federal, state or local government.

The Alaska Nurses Association has worked diligently over the past three years to address the

issue of mandatory overtime through the Alaska Legislature, so far to no avail. Nurse leaders believe that by working at both the national and state levels, as well as through the bargaining process, they will eventually bring the relief nurses must have in order to remain in the profession and to deliver the level of care necessary for their patients.

House Resolution 2123 On May 3, 2007, Representative Janice Schakowsky (D-IL) introduced the “Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 (H.R. 2123).” This legislation would establish federally mandated minimum safe registered nurse-to-patient ratios to protect patients and staff. The Schakowsky legislation would provide the following minimum direct-care ratios: • One nurse to one patient in operating room and trauma emergency units; • One nurse to two patients in all critical care units, including emergency critical care and all intensive care units, labor and delivery units and post anesthesia units; • One nurse to three patients in antepartum, emergency room, pediatrics, step-down, and telemetry units; • One nurse to five patients in rehabilitation units; and • One nurse to five patients in postpartum (three couplets) and well-baby nursery units.

HR378 Safe Patient Handling Legislation On January 10, 2007, Congressman John Conyers introduced the “Nurse and Patient Safety and Protection Act” (HR378). This legislation

would require OSHA to develop and implement a standard that will eliminate manual lifting of patients by direct-care registered nurses through the use of mechanical devises, except during a declared state of emergency. The legislation also requires hospitals to develop a plan to comply with the standard (with input from RNs), provides protection for RNs through refusal of assignment and whistleblower provisions, and requires regular audits.

RESPECT Act In addition to the above, the United American Nurses has worked with the Alaskan congressional delegation on the RESPECT Act, (the Re-Empowerment of Skilled and Professional Employees and Construction Tradeworkers Act.) The RESPECT Act (S. 969 and H.R. 1644) introduced in March would restore the freedom to form unions to workers harmed by the recent National Labor Relations Board NLRB’s ruling impacting the rights of charge nurses and others, in some instances, from organizing and becoming members of unions.

Congressional supporters believe that employers shouldn’t be able to take away someone’s rights under the guise of giving them a promotion. The RESPECT Act will protects worker and ensure livable wages, comprehensive benefits and decent working conditions.

“We should remember that Congressman Young was an original sponsor of this legislation,” Ms. Phillips recalls. “We also met with Senator Ted Stevens (R-AK) on the bill and have his support.”

(Nurses who want copies of any of the legislation mentioned in this article, should contact the Alaska Nurses Association office, 274-0827, and copies will be either e-mailed or mailed to you.)

August 2008—Alaska Nurse—Page 5

Editorial

Providence May Miss Magnet Status with Mandatory Overtime

by Joshua Meals RN My name is Joshua Meals and I’m a registered nurse working at Providence Hospital in Anchorage, Alaska. Every week on our intranet, employees are able to write messages and receive answers on “Al’s Action Line” from our Chief Executive Officer, Al Parrish. In light of Senate Bill 28, the upcoming Alaskan House and Senate election, Senator Lisa Murkowski’s support of senate bill 1842, and more recently, Al Parrish’s acceptance as chair of the Alaska State Hospital and Nursing Home Association (ASHNHA), I thought it was crucial that I spread this message to all registered nurses across Alaska, and wherever else this paper finds a reader. What you are about to read is what I submitted to ‘Al’s Action Line’ at the beginning of June. I have yet to get an answer, and quite frankly, really don’t expect one. I have photo copied the letter below and have spread it around to various nurses and physicians within Providence, but decided that it needed to be seen by a much more wider audience. This information is not new in the sense that it happened overnight.

Many of us are aware of this information already.

Please don’t get me wrong. I do enjoy my job and work on a great orthopedic unit surrounded by dedicated and hard working registered nurses and staff…but there is always room for improvement.

I strongly believe that the more of us that take responsibility to advocate for what is right for our profession and our patients can only bring about a crystal clear examination that is void of smoke and mirrors. It’s time to stop being afraid of retaliation and uphold what it was that we became registered nurses for.

Dear Al, I'm confused. I was surfing the net the other day at home and I came across the Alaska State Hospital and Nursing Home Associations web site and ran across this: "Nurse Overtime Legislation Stopped April 2008" SB 28—Limiting Facilities’ Use of Mandatory Nurse Overtime ASHNHA successfully stopped SB 28 literally in the final hours of the Session. Nursing advocates put on a full court press throughout the final days to move this bill to the House floor for a vote. House Finance Co-chair Representative Kevin Meyer proved a key figure in preventing a House floor vote from occurring. Rep Meyer faced incredible pressure all weekend to bring the bill up. We were able to show Representative Meyer that ASHNHA had the votes in the Finance Committee to stop the bill. This gave him the 'high ground' to take the position that there was no point in spending Finance Committee time on the bill. Another key factor in our success was the strong support received from Alaska Native health care leaders who refused to accept an exemption from the nurse overtime limits in return for their support of the bill (Betit, 2008).

I just finished reading your 6/13/08 Action Line Response message board and you mentioned, "This is why I agreed to serve as chair of the Alaska State Hospital and Nursing Home Association this year; through that organization Providence is very

Joshua Meals hiking at Alyeska. directly engaged in advocating for health care policy reforms As you can see Al, I'm confused. As I was surfing a little more I ran across the American Nurses Association (ANA) web site. Since this facility is applying for Magnet status awarded by a nursing organization it seemed the ANA’s philosophy on mandatory overtime might be important. I found this on the ANA web site: "The Magnet Recognition Program® was developed by the American Nurses Credentialing Center (ANCC) to recognize health care organizations that provide the very best in nursing care and uphold the tradition within nursing of professional nursing practice. Currently there are 261 facilities receiving Magnet Designation (American Nurses Association, 2007).

Digging a little more and wanting to see what the American Nurses Association stance on mandatory overtime was, I found this:

Background "Mandatory overtime is a difficult problem for RNs and health care facilities. Overtime is defined as the hours worked in excess of an agreed upon, predetermined, regularly scheduled full or part time work schedule, as determined by contract , established work scheduling practices, policies or procedures. Because of inadequate RN staffing, employers have used mandatory overtime to staff facilities. Concern for the long term effects of overtime include impact on the care-givers health as well as the potential for errors or near misses from fatigue and diminished quality of care provided. Research indicates that risks of making an error are significantly increased when work shifts are longer than 12 hours, when nurses worked overtime, or when they worked more than 40 hours per week.[1] The American Nurses Association (ANA) has take the position that regardless of the number of hours worked, each registered nurse has an ethical responsibility to carefully consider his/ her level of fatigue when deciding to accept any assignment extending beyond the regularly scheduled work day or week, including mandatory or voluntary overtime assignment. To help nurses make the case against working when fatigued, the ANA has added this issue to its’ Nationwide State Legislative Agenda supporting the enactment of mandatory overtime legislation in state legislatures and regulatory agencies. ANA is also pursuing the enactment of federal legislation to prohibit mandatory overtime (American Nurses Association, 2008).

My question then is this: How can you be the chair of an association that supports mandatory overtime and be the Chief Executive Officer of a hospital that is a attempting to attain Magnet status from an organization (ANCC) that is closely associated with one (ANA) that wants to prohibit it?

Resources: American Nurses Association. (2008). Mandatory overtime. www.nursingworld.org.

Retrieved June 6, 2008 from http://www.nursingworld.org/ M a i n MenuC ate gor ie s/A NA Pol it ic a l Powe r/St ate/ StateLegislativeAgenda/MandatoryOvertime.aspx American Nurses Association. (2007). ANCC magnet designation. www.nursingworld.org. Retrieved June 6, 2008 from http://www.nursingworld.org/ HomepageCategory/NursingInsider/Archive_1/2007/ Oct07NI/ANCCMagnetDesignationOctober2007.aspx) Betit, R. (2008). Presidents report. www.ashnha.org.

Retrieved June 6, 2008 from (http://www.ashnha.org/ UserFiles/File/2008%20presidents%20report/April%20 14%202008.pdf)

Page 6—Alaska Nurse—August 2008

Alaska Nurses in the News

AANP Leaders Visit WA DC

Left to Right American Academy of Nurse Practitioners (AANP) Alaska Representative Cathy Giessel; Senator Lisa Murkowski; AANP Regional Director Deb Kiley and Alaska Nurse Practitioner Association President Dianne Tarrant visited WA. DC. in April and met with Alaska’s congressional representatives to discuss health issues. The AANP held it’s annual conference in WA. DC. this June.

Terri Lynn Kiss Wins 2008 Tina De Lapp Professional Excellence Award Teri Lynn Kiss MSN, RN is the recipient of the 2008 Tina DeLapp Theta Omicron Professional Excellence Award. The award was established in 1995 to recognize individuals for a career that personifies professional excellence.

Students lucky enough to benefit from her expertise as a nurse and as an educator call her “inspirational” and have characterized her teaching as encouraging them to “strive for excellence and fostering…a true passion for the art of nursing.” Ms. Kiss has demonstrated professional excellence beyond her current educator role. As a staff nurse in the ICU at Fairbanks Memorial Hospital (FMH), she was described by colleagues as consistently role modeled patient advocacy and adherence to high standards of practice; her effectiveness is clear when one hears colleagues say that she motivates them to provide higher quality care.

Ms. Kiss’ excellence has been evident away from the bedside as well. Described as a change agent at FMH, she has headed several performance improvement projects, among them on reducing the occurrence of ventilator-associated pneumonias and another on promoting evidence based practice.

Currently she remains a leader of the FMH nursing research committee and is actively involved in it’s journey toward Magnet status.

A leader in the Fairbanks professional Nursing community, Ms. Kiss served as President of the Fairbanks chapter of the American Association of Critical Care Nurses (AACN), leading the chapter to participate in a diverse array of community activities such as immunization clinics and youth education programs regarding nursing careers. In addition, Ms. Kiss has been heavily involved in organizing the annual Interior Region Emergency

Currently Assistant Professor of Nursing at UAA, Ms. Kiss teaches in the AAS Program from the Fairbanks site.

Medical Systems symposium for a number of years.

At a national level, Ms. Kiss has been both active and praised. In recent years she participated in speaker selection for the National Teaching Institute (NTI), and currently she holds an elected position on the AACN Nominating Committee.

In 2004 she was the recipient of the 2004 AACN Excellence in Leadership Award.

Over time, Terri L. Kiss has impacted the lives of current and future nurses in a manner that has and will continue to affect the quality of nursing care of Alaskans. It was for this reason that she was selected as the 2008 recipient of the 2008 Tina DeLapp Theta Omicron Professional Excellence Award.

August 2008—Alaska Nurse—Page 7

ANP Finds Mission at SAFE Campus

by Christine Sagan, MSN, FNP I am part of a book club and recently finished reading, “Three Cups of Tea.” I highly recommend it. Its message will speak to people differently.

At our discussion people commented about how profoundly one person can impact lives. They also commented about how they might not necessarily be able to be as remarkable as Greg Mortensonbut brainstormed ways they can make impact on others lives.

Through a course of interesting life events I have been shown a need in our community and want to provide a needed service. My friend reminds me, “Each one should use whatever gift he has received to serve others.” I am inviting the nursing/medical community to come together as volunteers to make change happen.

Salvation Army has a SAFE campus here in Anchorage that has the only homeless shelter for families in the state. They also have Cares for Kids program that serves as a safe haven for children who have been taken from their homes or need foster or adoptive parents. Salvation Army does a lot for our community, including running Clitheroe and providing Meals on Wheels for the seniors and disabled in Anchorage.

Salvation Army relies on the community to support their mission. The newest shelter was recently opened and a room is dedicated for a small health care office. People at the shelter lack health care and there are long waits to get into Anchorage Neighborhood Health Clinic. There is little funding for their health care needs in this population. The Salvation Army has to pay to bring tenants to the doctors, buy their medication and pay for the visits.

These families are transitioning into housing and jobs with staff support. There is a strong need for well-child exams in the Cares for Kids program. Many families also have acute illnesses or unidentified chronic diseases, and they need counsel on where to obtain services when they are out of the shelter.

The shelter houses 16 families and the children’s center houses 12 children. I would like to open a free clinic at the shelter once a week to address their needs. Providence has donated supplies and is willing to donate mobile laboratory services.

I am asking for volunteers to donate whatever time they have to see patients. I hope to open it once a week for 8 hours and ask people to donate 2-4 hour shifts. We can use nurses to help with intakes and vitals. I am open to all ideas. The clinic will be open to serve the tenants only, and it’s meant to be simple. However simple, the lives it touches will be grand! Any help or suggestions are appreciated!

Thanks, Christine Sagan, FNP saganfnp@gmail.com

Update from the Board of Nursing Time to renew your nursing license!

LPN renewals are well underway with a deadline of September 30, 2008. RN license renewals start October 1, 2008 with a November 30, 2008 deadline.

Good News!! The renewal fee continues to be $215 for 2008-2010.

Renewal information will be “in the mail” in a colorful postcard format. We are trying to save money and rapidly renew your license.

Remember that you cannot work until your license is renewed.

How to do it: Choose one (1) of the following three methods: 1) Renew on-line at www. nursing.alaska.gov. Select the appropriate link and complete your renewal in a matter of minutes.

2) Print the appropriate renewal forms from www.nursing.alaska.gov. Fill them out and send them with the renewal fee by mail to Board of Nursing, 550 W. 7th Ave., Suite 1500, Anchorage, AK 99501. Do this

ASAP to get the renewal forms to the office before the deadline.

3) Request “hard copy” renewal forms from the Board of Nursing by mail, fax (907269-8196), or by calling 907-269-8161 (then select 0). Do this immediately so that you can receive the forms in time to fill them out and send them by mail with the fee. Note this change. You will not get a hard copy renewal form unless you print it out or request it.

Did you know that for the 20062008 renewal period 48% of the LPNs and nearly 70% of the RNs renewed on-line? This year let’s make it 100%!!** **Nurse Practitioners and CRNAs can renew their RN licenses on-line, too!

Continuing competency requirements apply. To renew you need to be able to certify you have completed two (2) of the following three (3) options since 12/1/2006: 1) 320 compensated hours of employment, 2) 30 contact hours of continuing education, 3) 30 hours of uncompensated professional activities.

Page 8—Alaska Nurse—August 2008

State of Alaska 2008 Recommendations for the Management of Diabetes Type 2

by Barbara Stillwater PhD, RN The State of Alaska recently published 2008 Recommendations for the Management of Diabetes Type 2 in Adults. Available as a laminated 11”x17” poster, the Recommendations reflect national and state evidence-based guidelines for diabetes care.

The Recommendations are released bi-annually by the State of Alaska Diabetes Prevention and Control Program (AK DPCP) to help providers keep current with the diabetes standards of care.1 It is recommended that everyone with diabetes have the following exams at least once a year: • a dental exam; • a dilated eye exam, and • a diabetic foot exam.

In addition, people with diabetes should have each year at least: • two glycosylated hemoglobin (A1c) tests; • a fasting lipid panel; • a serum creatinine test (to estimate the glomerular filtration rate): • a urinalysis/microalbuminuria test: and • a flu immunization.

And they should have: • a pneumococcal immunization every six years, as well as • at least one diabetes education class in their lifetime.

The AKDPCP uses the Alaska Behavioral Risk Factor Surveillance System (AK BRFSS) to get data on Alaskans with diabetes. These data include information on how many persons with diabetes report receiving these recommended services.

Table 1: Percentages of Alaskans with diabetes that had recommended diabetes care from the 2000-2002 and 2005-2007 AK BRFSS 2000-2002 2005-2007 Reported at least 2 health care provider visits for diabetes care

74%

71%

Reported at least 1 visit for diabetes care

90%

86%

At least two A1c tests

67%

64%

A foot exam

70%

67%

A dilated eye exam

74%

62%

A flu immunization

52%

61%

A pneumococcal shot

47%

55%

A diabetes education class

51%

59%

Reported receiving in the past year:

Reported ever having had:

More Alaskans with diabetes. One reason for the low percentages could be that demand for diabetes care has increased substantially. The estimated number of Alaskans with diabetes increased from 16,631 to 27,155, or 63%, between 2000-2002 and 2005-2007. Using the example of foot exams, we can demonstrate the impact of this increase in persons with diabetes. During this time the number of Alaskans with diabetes receiving a foot exam increased from about 11,284 to about 17,315, even though the percentage that reported receiving this care slipped from 70% to 67%.

Missed opportunities. Using the foot exam example again, although 71% of Alaskans with diabetes said they had been to a health care provider for their diabetes, only 67% said they had received a foot exam. The 4% gap between these two percentages represents about 1,000 Alaskans.

This gap represents missed opportunities because one would expect that a foot exam would have been provided. Some clinics have been able to increase the number of foot exams by hanging signs in the exam rooms requesting patients to remove their shoes and socks if they have diabetes.

Alaskans with diabetes in the 18-44 age group were least likely to report receiving recommended diabetes care services. Nearly one-fourth of them (24%) said they had not had a health care provider visit for their diabetes in the previous year.

Particularly worrisome is the increase from 9% in 2000-2002 to 22% in 2005-2007 of Alaskans with diabetes in this age group who said they had not had any A1c tests during the previous year.

Table 2: Percentages of Alaskans with diabetes that reported receiving three recommended diabetes care services (foot exam, dilated eye exam and ≥ 2 A1c tests) and 2 A1c tests alone from the 2000-2002 and 2005-2007 AK BRFSS 2000-2002 3 DM care services

%

2005-2007

Estimated number

%

Estimated number

Ages 18-44

43%

1,156

28%

1,191

Total (all ages)

33%

5,413

33%

8,527

Ages 18-44

69%

1,685

44%

1,847

Total (all ages)

67%

9,600

64%

15,158

≥ 2 A1cs

Continued on page 9

August 2008—Alaska Nurse—Page 9

State of Alaska 2008 Recommendations for the Management of Diabetes Type 2 Continued from page 9 In both 2000-2002 and 2005-2007, less than one-third of Alaskans with diabetes reported receiving three recommended services: a foot exam, a dilated eye exam and at least two A1c tests. Although the race-specific percentages of Whites and Alaska Native/American Indians both decreased about 6%, the estimated numbers of persons receiving these services increased by 1000% for Alaska Native/American Indians and 45% for Whites.

Table 3: Percentages of Alaskans by race with diabetes that reported receiving three recommended diabetes care services (foot exam, dilated eye exam and ≥ 2 A1c tests) from the 2000-2002 and 20052007 AK BRFSS 2000-2002 2005-2007 %

Estimated number

%

Estimated number

Alaska Natives American Indians

31%

83

30%

973

Whites

34%

4,256

32%

6,164

Teams of health care providers are essential for providing quality diabetes care, and registered and advance practice nurses are key members of these teams. A comparison of diabetes-related quality improvement strategies found that significantly improved A1c measures were associated with the composition of health provider teams (i.e., multidisciplinary teams or expanding/revising professional roles) and/or case management services provided by a nurse or pharmacist. Case management services were particularly effective when the case manager could make medication changes without prior approval from a physician.2

Another study found general agreement that nurses are important in diabetes health care because they have more time with patients than physicians, are better listeners and provide better education.3 In summary, the number of Alaskans with diabetes is increasing and is expected to increase substantially over the next several decades. This increase will intensify the demand for services and will put a significant strain on our health care budget. This increased burden also places greater responsibility of individuals to make health lifestyle choices and on health care providers to adhere to clinical guidelines to prevent and/

or control this disease. We encourage health care providers to provide diabetes care services and education at each visit to maximize the quality of healthcare and to maximize the capacity of individuals to self-manage their diabetes.

For further information about diabetes care: • National Diabetes Education Program’s Better Diabetes Care website: http:// betterdiabetescare.nih.gov/suggestedviewing. htm#primarycare • American Diabetes Association website for health care providers: http://professional. diabetes.org/ [Ms. Stillwater is with the Alaska Diabetes Prevention and Control Program, State of Alaska/ DHSS/DPH/CDPHP. She can be reached at barbara. stillwater@alaska.gov.

1. For a copy of the 2008 Recommendations, go to http://www.hss.state.ak.us/dph/chronic/diabetes/data/ 2008DiabetesRecommendations.pdf or contact Barbara Stillwater at barbara.stillwater@alaska.gov or 269-8035.

2. KG Shojania, SR Ranji, KM McDonald, et al. Effects of Quality Improvement Strategies for Type 2 Diabetes on Glycemic Control: A Meta-Regression Analysis, JAMA 7/26/06; 296(4); 427-440.

3. LM Siminerio, MM Funnell, M Peyrot, RR Rubin, US Nurses’ Perception of Their Role in Diabetes Care; Results of the Cross-national Diabetes Attitudes Wishes and Needs (DAWN) Study. The Diabetes Educator Jan/ Feb 2007; 33(1); 152-162.

Page 10—Alaska Nurse—August 2008

Thoughts at the AaNA Office

by Lynne Sangster Administrative Assistant I wonder if the average nurse who works many, many hours a day and gets very little down time knows what else is available outside of the workplace as far as support in his or her profession?

You know last week we spent sometime in a round table discussion at Providence Hospital with Tom Renkes, the AaNA Executive Director talking about nursing issues, and it was great. We worked on solutions not problems and we came away feeling united. Some of us have also met at the Alaska Nurses Association and talked in a round table discussions, (but around rectangular tables).

We again talked about issues from work and life with a focus toward solutions not the problems. It feels wonderful to be involved in reaching out to each other in such a positive frame of mind.

The Alaska Nurses Association is open to nurses Monday through Friday nine until five pm. There are computers available to assist you in looking up information that may be more specific to your needs. We have pamphlets and other reading material that you are welcome to that may assist you in your professional practice. There are meetings held here on a regular basis, including teleconferencing that you are welcome to sit in on. In the warmer months there is a fabulous deck that you are more than welcome to come and enjoy the sun on. If you have questions for either myself, Lynne Sangster as the Administrative Assistant or Tom Renkes, Executive Director feel free to call: 274-0827.

August 2008—Alaska Nurse—Page 11

District 1 May Banquet

by Lynn Hartz District 1 Alaska Nurses Association 2008 Spring Banquet was sold out to 183 enthusiastic attendees at the Millennium Hotel May seventh. Guest speaker was Geneva Craig PhD, RN from Johns Hopkins Healthcare, LLC. Dr. Craig spoke on “Nurses Making a Difference Every Day.” She described the challenges of multigenerations of nurse working together under one roof together with tips to help communication.

She reported that 53% of nurses in Alaska are over age 50 and the average age of nurses in Alaska is 47. Craig noted that what all nurses have in common is that each wants to be Geneva Craig PhD, RN, previously from Anchorage, now works at Johns valued and respected.

Hopkins in Washington D.C. June 1, 2008 “Thank you to Donna Zeznock, RN and Dr. Deborah, RN for their diligent pursuit to have me come to Anchorage to help Alaska nurses celebrate Nurses Week 2008 and for their work efforts to complete the requirements for the CE units associated to my presentation. I also thank Nancy CumberlandPeterson, RN for her significant contribution of a round-trip ticket, Seattle-Anchorage, in recognition of the Nurses Week celebration. To the team at the Nurses Association Office thank you for the wonderful environment and delicious menu selections at the Millennium Alaskan Hotel. My fellow nurses I leave you with this thought, it is your responsibility to make Nurses Week successful every year by celebrating your fellow nurses and yourselves, don’t wait on another to initiate what you know you are deserving of.” - Geneva Craig, PhD, RN

Judy Petersen, a retired nursing professor from UAA had the pleasure of presenting Megan Kemp, a third year nursing student with a $1,000 scholarship from the Alaska Nurses Association.

On the left is Megan Kemp, a UAA nursing student, and scholarship recipient on the right is Judy Petersen, MSN, RN UAA faculty Ret. The school nurses also presented an award at the banquet.

Karen Dale, the school nurse from Spring Hill Elementary was named School Nurse of the Year.

Karen Dale, BSN, RN Alaska School Nurse of the Year

Left to Right Patti Hong AaNA Professional Practices Chairperson, Kay Lahdenpera, MA, RN, AaNA Professional Practices Dir. and Linda Webb JD, RN having fun at the May Banquet.

Page 12—Alaska Nurse—August 2008

Notice to AaNA Members

Membership Application Advancing and Supporting the Profession of Nursing

If you have not been getting email updates and information from the Alaska Nurses Association, and you are a member, please contact Donna Phillips at donnaphill@ acsalaska.net.

Membership Categories

Go to aknurse.org

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

For online CE

Anchorage Monthly (*EDPP) & Fairbanks Yearly

Full $28.00 $330.00

Reduced $14.25 $165.00

Special $7.38 $82.50

All Other Locations

$322.50 $27.38

$161.25 $13.94

$80.62 $7.21

Nursing News Alaska nursing links And more!

Integrity Professionalism ~ Advocacy Empowerment~ Representation

Dues

Yearly Monthly (*EDPP)

______________________________________ Last Name/First Name/ Middle Initial

_________________________________________________ Social Security Number

______________________________________ Street or PO Box City/State /Zip

_________________________________________________ Home Phone

______________________________________ Employer Name Unit City/State/Zip

_________________________________________________ Work Phone

____________________________ RN License Number/State

__________________________ FAX Number

__________________________ E-mail Address

Payment Method—see above for categories and amounts Apply Online at www.nursingworld.org—Join Today! Alaska!

Check—Please make checks payable to the American Nurses Association MasterCard or Visa—(available for annual payment only) ________________________ Card Number

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

_____/_____ $_______ _______________________________ Expiration Amount Signature

Monthly Electronic Dues Payment Please (1) read and sign the below authorization form and (2) enclose a check for the first month.

1/12 of your yearly dues will be withdrawn from your checking account monthly along with a monthly service fee.

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

Return to: AaNA, 3701 E. Tudor, Suite 208, Anchorage, AK 99507 or fax (907) 272-0292 or e-mail aknurse@aknurse.org and tell us your selection.

Integrity ~ Advocacy Professionalism Empowerment Representation

Share your Expertise!

Get Informed! >>check off and return form to AaNA

A Benefit of Membership: AaNA Member Name: __________________ E-mail: ________________________________ Informational E-mail ❏ Various Nursing Information—If you would like National, State and Local nursing information e-mails from AaNA on a weekly basis. ❏ Action Alerts—If you would like political action alerts for National and State legislative issues involving nursing and health care issues.

Taskforce E-mail Pools Taskforce E-mail Pool members will receive requests to work on a variety of projects on nursing issues, and may choose to participate in only the projects that interest them. ❏ Professional Nursing Practice Issues— Taskforces will consider issues relating to AaNA’s policy on RN practice and other professional issues. ❏ Health and Safety Issues—Taskforces will consider safety and health issues of nurses and patients. ❏ AaNA Event Planning—Taskforces will plan events such as the AaNA Fall Retreat, open house events, AaNA General Assembly, or other events for AaNA members. ❏ Other interest? Let us know what you would like to work on:______________ AaNA Committees ❏ Legislative Committee—Actively involved in reviewing and coordinating strategy and testimony for legislative issues related to health and nursing. Works closely with the AaNA Lobbyist. Usually meets on the second Monday of the month. Current Chair is Pat Senner. ❏ Conference Planning Team—Participates help plan the Alaska Statewide Nurses Conference. Roles include working with program planning, marketing, vendor and sponsor recruitment and onsite assistance. ❏ Continuing Education Committee—Members individually review applications for continuing education approval based on the established guidelines of the American Nurses Credentialing Center and in coordination with the CE Director. Makes recommendations for improvements in the application process. The current CE Director is Norma Monsen. ❏ Alaska Nurse Newsletter Editorial Board— Members work with the editor to recruit articles and pictures for the quarterly newsletter. The current editor is Lynn Hartz.

August 2008—Alaska Nurse—Page 13

Welcome Nursing Graduates In May, the following students graduated from the University of Alaska, Anchorage School of Nursing. The Alaska Nurses Association gives our best wishes and sincere congratulations on your achievement.

Baccalaureate Program Graduates Whitney E. Anker Amanda M. Kolosovsky Jennifer L. Barclay Tiffany M. Lees Nichole M. Benedict Mei Huah Lim Larissia J. Billy Michael J. Lynch Colleen A. Clarke Amanda M. Martineau April J. Cook Emily A. McCrea Rochelle L. Davis, RN Eric B. Moulton Lorayne M. Embretson, RN Beatriz E. Muse Monica T. Garcia Brooke A. Nelson Leah D. Gillham Virginia L. Parker Andrea M. Grohall Danielle M. Reilly Michelle M. Hanson T.J. Rodgers Jennifer D. Hazen Ambria R. Saucier Lydia F. Hicks Dara J. Scott Jennie A. Hermann Sarah E. Taylor Rebecca A. John Megan M. Tenge Sigma Theta Tau Nursing Honor Society Associate Program Graduates Shanna R. Albrecht Heather A. Kniefel Sara A. Bailey Amanda K. Landes Kate E. Baker, LPN Sharon R. Liska Lyubov Berki Janell J. Losing-Miller Carrie A. Blough, LPN Ruth C. Olson Beth Bumgardner Amy S. Osborne Rick L. Crawford, LPN Brandy J. Proctor, LPN Tawnie C. Curtin Jacque J. Quantrille Courtney N. Dillingham Michelle C. Quinton Natalie D. Ebarb Rebecca L. Reihle Rachael A. Fogal Lisa L. Rico Christy D. Gilmer Lori A. Runkle Katie M. Grubaugh Shiree I. Seeds Dawn E. Hammons Erica R. Tibbits James H. Hasegawa Julie A. Tummonds Dee Dee Hinkley Adrian Vasek Autumn Promise Emilie R. Waldstein Hollingsworth Amanda Wilhelm, LPN Tammi J. Kernen Cari A. Wood Rachel A. Kincaid

Masters Program Graduates Jennifer E. Allred, MS

2nd MS for Psychiatric Mental Health Nurse Practitioner

Elaine A. Ponchione, MA 2nd MS for Psychiatric Mental Health Nurse Practitioner Erin M. Pringle, MS

2nd MS for Nursing Education

Cynthia A. Ebelacker, MS Post Master’s Certificate Psychiatric Mental Health Nurse Practitioner Nancy V. Felton, MS

Post Master’s Certificate Family Nurse Practitioner

Teri L. Kiss: MS in Nursing Science, Nursing Education, Maureen O’Malley, Ph.D. Project Chair; “Facilitation of Evidence Based Practice in a Community Hospital” Jennifer Miramontes: MS in Nursing Science, Family Nurse Practitioner, Elizabeth Predeger, Ph.D. Thesis Chair; ”The Experience of Military Wives Whose Spouses Have Been Deployed to a Combat Zone”

AaNA Accredited by ANCC for Four Years Congratulations to the Alaska Nurses Association. The Commission on Accreditation Action from the American Nurses Credentialing Center has renewed accreditation as approver of continuing education for four years through February of 2012. Thanks to Norma Monsen as Director of Continuing Education for her hard work and dedication to this arduous process.

Page 14—Alaska Nurse—August 2008

Resources ANA is proud to announce its new partnership with Global Volunteers. Work alongside local people on life-affirming international service projects for one, two or three weeks. Use your health care background, teach conversational English, care for at-risk children or help on a labor project. Health care professionals are needed to provide basic care to impoverished newborns, children and their parents. Global Volunteers offers year-round volunteer programs on six continents and 20 countries. Learn more and choose your volunteer opportunity! Visit http:// www.globalvolunteers.org/ana.htm or call 800487-1074 for more information.

Whether you're actively searching or just curious about opportunities available, ANA Nurse's Career Center, the official online job bank of the ANA, is the place to go. Opportunities are updated regularly and targeted specifically to

Nurses. Sign up for Job Alerts to receive instant e-mail notification each time an opening is posted to the geographic location you specify. Learn more today at www.nursescareercenter.com ANANurseSpace is the premier online professional social network for ANA members that want to reach out and connect with other ANA members. Visit ANANurseSpace and discuss current hot topics, blog about your nursing experiences, build professional relationships, and share comments and ideas with other colleagues.

Participation is key, take a few minutes out of your day to explore and contribute to this professional community designed for nurses like you! If you're a first-time user, there's a tutorial available just for you! Access ANANurseSpace in Members Only at www.NursingWorld.org.

MyMedSchedule.com is a great medication reminder and it is free! The personal medication chart clearly shows the times to take each medicine or supplement, and how much to take—

there are even images of the pills so there is no confusion. With MyMedSchedule.com, nurses will have an easy way to explain new regimens to their patients and for patients to have a more active role in their own health care. [Editors note: I tried this site and it does work. It is easy and the medication list prints in a handy wallet-size. Certainly useful for patients who are computer-savvy.]

Health care professionals need information on comprehensive diabetes care that is streamlined, clear, and ready to translate into action. The National Diabetes Education Program’s new 2008 Diabetes Numbers At-a-Glance, a pocket-sized reference card to diagnose and treat pre-diabetes and diabetes, can help.

NDEP has free resources for health care professionals that: • Have been distilled from evidence-based national guidelines for diagnosis and care • Provide the critical information your readers need—right at their fingertips • Are available to download or order by visiting www.YourDiabetesInfo.org or calling 1-888-693-NDEP

August 2008—Alaska Nurse—Page 15

Upcoming Events

Alaska Nurse Practitioner Association’s 25th Annual Conference September 25, 26, and 27th, 2008 Anchorage Downtown Marriott Did you know that this year marks the 25th anniversary of NPs independent practice in Alaska, as well as the 25th anniversary of the ANPA conference? Please join your colleagues for an event at the conference to commemorate this anniversary.

Again this year, three specialty tracks will be offered—psychiatry, pediatrics, and women's health.-primary care topics from national and local experts, and an excellent speaker from the DEA to update us on "hot " issues. Remember to sign up early, so you can receive the early rate and assure a place at the workshops.

For details: www.alaskaanp.org, or for additional information: Marty Herriott, Conference chair, mherriott@aol.com or 279-8111

Alaska Statewide Nurses Conference “Nurses Wild about Alaska” October 10-12 2008 Anchorage Captain Cook Hotel Sponsored by the Alaska Nurses Association Focus of this year’s conference will be on environmental and disaster issues. Subjects include Avian flu, disaster nursing, Meth labs, domestic violence, child abuse, environmental health and more. There will be a dinner Friday night and “Nurses Night Out” Saturday night.

For more information call the Alaska Nurses Association, at 907-274-0827, or www.signup4. com/NURSES08.

Save the date now for the 3rd Annual NDNQI® Conference which will be held in Dallas, TX at the Hyatt Regency Dallas at Reunion from Wednesday, January 21–Friday, January 23, 2009. The Preconference will be held on Wednesday, January 21, 2009.

Our previous two conferences have been a huge success! Registration will be open in August, 2008. Please visit ANA's Upcoming Events page for updates The National Association of Clinical Nurse Specialists (NACNS) announces the call for abstracts for their 2009 Conference, Clinical Nurse Specialists: Vision, Value, Voice on March 11– 14, 2009 at the Hyatt Regency St. Louis at Union Station in St. Louis, Missouri