THE
Volume 63, Issue 4 • October/November 2013
The Official Publication of the Alaska Nurses Association Circulation 8,500 including all 7,820 Registered Nurses and Licensed Practical Nurses.
THE official publication of
THE Alaska Nurses Association
3701 E Tudor Rd., Ste. 208 • Anchorage, AK 99507 907.274.0827 • www.aknurse.org
President’s Letter
Published bimonthly: Feb., April, June, Aug., Oct., Dec. Materials may not be reproduced without written permission from the Editorial committee: Contact editor@aknurse.org Advertising: Contact salesaknursepub@gmail.com • 907.223-2801
Alaska Nurses Association President • Ketchikan, AK
AaNA Board of Directors • President:
Susan Walsh, RN • Vice President:
Jane Erickson, RN, CCRN • Secretary:
Kristin Fahey, RN • Treasurer:
Jennifer Hazen, BSN, RN • Staff Nurse Director:
Laura Weekley, RN, BC-Orthopedic, BC-Psychiatric • Rural Director:
Julie Serstad, MSN, BSN, RN • Greater Alaska Director:
Colleen Bevans, RN
• Labor Council Chair (Designee):
Donna Phillips, BSN, RN • Directors At Large:
Shelley Burlison, RN, BC-Gerontological Janet Pasternak, BA, BSN, RN Paul Mordini, MS, BSN, RN, BC-Psychiatric Jan Ford, RN Alison Selvik, RN • Student Nurse Liaison:
Vanessa Glenn
• Past President:
Mary Stackhouse (resigned) AaNA Labor Council
Susan Walsh, RN
the wing and another goose takes its place to fly at the head of the formation. The same principle applies to the members and leaders of the Alaska Nurses Association: we can achieve great goals more quickly and easily because we are traveling on the thrust of one another. As you are reading this, our elections have taken place and another is now flying at the head of the formation. I would like to thank all those whom have made my time much easier and enjoyable while serving many years on both the Board of Directors and Labor Council. As it is time for the snows to fly and a new season to be ushered in, please join me in welcoming our new board members and wish them well. I will be “honking” from behind, encouraging those up front in the lead. Take care and enjoy the season – stay warm and dry!
Whew, what a summer! We are so fortunate in Alaska to live where a subsistence lifestyle still is possible and our ties to the land and the seasons ingrained. I was on the beach last week gathering seaweed for my garden when my attention was directed to a loud honking overhead. Above, the first flock of geese filled the sky, flying south in their distinctive V-formation. This reminded me of the now famous “Goose Story” by Dr. Harry Clarke Noyes. According to Dr. Noyes, the V-formation allows the whole flock at least 71% greater flying range than if each bird were to fly on its own. When a goose falls out of formation, it suddenly feels the drag and resistance of trying to go it alone and quickly gets back into formation to take advantage of the lifting power of the bird in front. When the lead goose gets tired, it rotates back in
• ChaiR:
Donna Phillips, BSN, RN Jana Shockman, RN, CCRN
Do you know the symptoms of Anaphylaxis?
• Directors:
Lila Elliott, BSN, RN
Arlene Briscoe, RN, BC-Psychiatric Jane Erickson, RN, CCRN Deni Callahan, BSN, RN
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 AaNa. 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. Photos are encouraged and may be sent as a .jpg file, as an email attachment or on disc. Photographs send 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 double check the spelling, grammar, and content of your article. It is highly recommended that you have a colleague review your article before submission. Prepare the article as a Word document and attach it to an email to andrea@aknurse.org. You may also mail the article on disc to: The Alaska Nurse, AaNA, 3701 E Tudor Road, Suite 208, Anchorage, AK 99507. If you have any questions, please email andrea@aknurse.org.
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Lungs Shortness of breath, wheezing, coughing
Gut Nausea, vomiting, cramps, diarrhea
Skin / Extremities Hives / rash, swelling face and extremities
Get more information at:
Jennifer Hazen, BSN, RN
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Itching or tingling; swelling lips or tongue
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www.aafaalaska.com
• PAMC BU Rep:
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Jennifer Hazen, BSN, RN
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• Treasurer:
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Epinephrine is the treatment for severe allergic (anaphylactic) reactions. Don’t be afraid to inject!
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Janet Pasternak, BA, BSN
Alaska Affiliate of the American College of Nurse-Midwives Alaska Home Care & Hospice Association Alaska Association of Nurse Anesthetists Alaska Nurse Practitioner Association Alaska School Nurses Association Alaska Clinical Nurse Specialist Association Author Guidelines for the Alaska Nurse
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• Secretary:
• soldotna BU Rep: Shelley Burlison, RN, BC-Gerontological • KETCHIKAN BU Rep: Susan Walsh, RN • Affiliate Organizations:
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• Vice-Chair:
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Inside This Issue
2 President’s Letter
10 Nurses: Always on Call
3 Happy 60th, AaNA!
12 What is a “SART?”
4 Make the Injection Connection!
12 Call Block Implemented
5 “I Do” at the Bedside
13 Congratulations Graduates
6 ICU Receives Beacon Award
14 Calendar of Events
7 Flu Shots: Patient Education
15 Funds Raised for SART Training
8 Got Coverage? Marketplace Opens Cover Photo: Lauren Walker, RN, receives her free influenza vaccination at the Providence Alaska Medical Center mass vaccination exercise on Friday, Sept. 13. During the exercise 726 health care professionals received their free flu vaccines between 10:30 a.m. and 8 p.m. Lauren is a traveler who works in the Adult Critical Care Unit at Providence Alaska Medical Center.
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Editor’s Letter Happy 60th, AaNA! As autumn leaves fall and Alaska edges closer to winter, we at AaNA are reminded of a special event that takes place each year during this time: the anniversary of the Alaska Nurses Association. Certainly a wonderful occasion every year, to be reminded of the determination and diligence of hundreds of Alaskans throughout the history of this organization; representing fellow nurses across the state, advocating for and guiding our profession, and celebrating the devoted choice to be a nurse in everything we do. October 5th, 1953. On this day, the Alaska Nurses Association signed our official Articles of Incorporation with the Territory of Alaska. Yes, you read that correctly: AaNA is older than our state! If you’re the mathematically-inclined type, you may have noticed that 2013 marks an especially sweet year for the Alaska Nurses Association: our 60th Anniversary. This month marks 60 years of representing nurses in Alaska. 60 years of advocating for professional practice issues, nursing and health care legislation. 60 years of ensuring that nurses have safe environments to work in and ensuring fair employment practices and fair living wages for nurses across Alaska. 60 years educating nurses, providing contact hours through continuing education events and conferences. 60 years of mentoring the next generation of nurses. 60 years of shaping the way for Alaskan nurses now and for many years to come. We have come a long way in these 60 years, and represented thousands of nurses and our profession. We will be celebrating the anniversary in a number of ways throughout the year until next October, kicking events off with a Fall Retreat Conference, Nurses Night Out, General Assembly, and Legislative continuing education event on October 11-12. If you are a member of AaNA, we hope that you find the 60th anniversary of our organization as momentous as we do. And if you are not yet a member, we invite you to view this occasion as the perfect opportunity to join the strongest, largest, and longestserving nursing organization in the state. Cheers to another 60 years of AaNA!
— DENALI CENTER —
A GOLDEN OPPORTUNITY The Denali Center is hiring for heart. We seek CNAs, LPNs, and RNs toThe provide nursingCenter care in our loving, compassionate environment where Denali is hiring for heart. We seek CNAs, both residents and staff are encouraged to live fully and to learn and grow. LPNs, and RNs home-like to provide nursingpromotes care inhappiness our loving, Our award winning environment by fostering relationships amongst residents, andresidents volunteers. and compassionate environment wherestaff both If thisare is an environment where youfully wouldand feel to at home, visit staff encouraged to live learnplease and grow. our website for a complete list of current openings. Our award winning home-like environment promotes Administrative Assistant Sr. happiness by fostering relationships amongst Supports the Chief Nursing Officer (CNO), Administrators, or members of facility residents, staff and senior leadership teams by providing clerical andvolunteers. administrative services and assistance, requiring the use of judgement and discretion on a periodic basis.
If this is an environment where you would feel at home, Administrative Assistant Sr. please visit our website for or members of facility Supports the Chief Nursing Officer (CNO), Administrators, a complete listclerical of current openings. services and senior leadership teams by providing and administrative assistance, requiring the use of judgement and discretion on a periodic basis.
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Make the Injection Connection! Wheezin’, Sneezin’ & Itchin’ in Alaska
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Epinephrine is the treatment for severe allergic (anaphylactic) reactions. Don’t be afraid to inject!
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Throat Tight, hoarse
Get more information at:
www.aafaalaska.com
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Thready pulse, low blood pressure, fainting, pale or blue skin
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Do you know the symptoms of Anaphylaxis?
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Common triggers of anaphylactic responses are antibiotics such as penicillin, radio contrast agents, latex, insect stings, and foods such as peanuts, tree nuts, and shellfish. Many of us who have been nurses for a long time were taught to administer antihistamines, such as Benadryl, when allergic reaction first occurs. This is very dangerous. At the first sign of a severe allergic reaction, the patient should be given IM epinephrine immediately. There are tragic stories of young people being given Benadryl for anaphylaxis who initially appeared to be getting better but later experience respiratory arrest and death. An article in the New England Journal Medicine evaluated severe anaphylactic reactions to food in children. In six fatal cases, the children displayed anaphylactic symptoms three to
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Over 200 nurses, doctors, respiratory therapists, and other medical professionals attended “Wheezin’, Sneezin’ & Itchin’ in Alaska,” the 8th Annual Asthma and Allergy Conference hosted by the Alaska Chapter of the Asthma and Allergy Foundation of America on September 7th and 8th in Girdwood. The Alaska Nurses Association co-sponsored the continuing education event and Kathy Bell, a school nurse, served as AaNA’s nurse planner on the conference planning committee. The two-day conference covered a wide variety of topics including food allergies, chronic urticaria, hereditary immune deficiencies, chronic itching, and severe asthma. The strongest message conveyed was the importance of promptly using epinephrine when an individual is suspected of experiencing anaphylaxis. Anaphylaxis is an immediate systemic reaction caused by rapid IgE mediated immune release of potent mediators from immune mast cells and peripheral blood basophils. This rapid release causes the classic signs of anaphylaxis which include fear of impending doom, flushing, sweating, urticaria, pruritus, nasal congestion and angioedema of the lips or tongue. Due to swelling, the affected individual may experience coughing, itching, lightheadedness, stridor, hoarseness, or laryngeal edema, which can lead to death. While we often think of the above symptoms, GI and GU tract symptoms also may be present such as nausea, vomiting, diarrhea, and uterine cramping. The affected individual may become very confused. The order of progression in anaphylaxis is flushing, respiratory arrest, syncope, cyanosis, convulsions, and ultimately, death.
Shortness of breath, wheezing, coughing
Gut Nausea, vomiting, cramps, diarrhea
Skin / Extremities Hives / rash, swelling face and extremities
30 minutes following ingestion. Only two children received epinephrine in the first hour and not until 25 and 60 minutes following symptom onset. In comparison, there were seven non-fatal cases in which children exhibited symptoms within 5 minutes following symptom onset. All 7 received epinephrine within 30 minutes. The best method of injection of epinephrine is IM in the lateral thigh. This injection may be given through clothes. If the only available epinephrine injection device available is out of date, use it. There is less medication in outdated injectors, but there is still medication. Likewise if the injection is inadvertently given sq due to adipose tissue or clothes, it will also be helpful, just absorbed less quickly. If patient doesn’t improve quickly a second injection may be given 5 to 10 minutes after the first. There is no absolute contraindication for epinephrine, though the people who experience difficulties usually having underlying cardiac disease. Honored at this year’s conference for her volunteer service was Elizabeth Collins, a respiratory therapist at Central Peninsula Hospital. Collins was honored for her outstanding work at the Peninsula Puffers Asthma Camp in Kenai. Next year’s Asthma and Allergy conference will be held September 5th and 6th in Girdwood. If there is a topic you would like to have addressed at the conference, please contact the AaNA office and we will pass it on to the conference planners. Make the injection connection: don’t delay, give the epi! Posters, postcards and slide sets are available for free through the AAFA Office at aafaalaska@gci.net
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“I Do” at the Bedside Nurses at Providence Alaska Medical Center recently had the rare privilege to arrange for and participate in a wedding ceremony. In late August, Stephanie Nolte and Jody Thoms exchanged vows and said “I Do” inside a hospital room. A large crowd of supportive family members, friends, nurses, and hospital staff gathered to witness the bittersweet wedding of Stephanie, a radiant bride in spite of her terminal cancer diagnosis, and Jody, the eager groom. The ceremony was officiated by Reverend Susan M. Halvor, Senior Chaplain at Providence Alaska Medical Center. The ceremony centered around Stephanie, who lay in her hospital bed adorned in a beautiful pink scarf and head piece, her make-up gorgeously applied by sisters and friends. Following the ceremony, family celebrated with food, sparkling cider, and cupcakes in the atrium. Stephanie had a very exciting and taxing day but was thrilled to have “tied the knot.” Her illness had been prolonged and her energy in short supply, but with a solidified bond with new husband and her family and children’s support made official, Stephanie said she can “rest easy.” Stephanie Lynn Nolte-Thoms passed away Saturday, September 1, 2013 following a yearlong battle with cancer. “All of us in Stephanie’s family would like to thank all of those at Providence Alaska Medical Center: the nurses, doctors, case managers, chaplains, Hospice and everyone at Horizon House for your considerate and loving care of Stephanie. May God Bless.” The nurses at Providence Alaska Medical Center want to express their sincere thanks and well wishes to the Nolte-Thoms family for allowing us the sincere privilege and honor to participate and share in Stephanie’s life, wedding, and care.
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Fairbanks Memorial Hospital ICU Awarded
AACN Silver-level Beacon Award for Excellence Recipient The American Association of CriticalCare Nurses (AACN) recently conferred a silver-level Beacon Award for Excellence on the Intensive Care Unit (ICU) at Fairbanks Memorial Hospital, the first ICU in the state of Alaska to be recognized with the prestigious award. Only 98 hospital units throughout the U.S. were recognized with a Beacon Award in 2012. The Beacon Award for Excellence — a significant milestone on the path to exceptional patient care and a healthy work environment — recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six standards for a healthy work environment. Units that achieve this three-year, three-level award with gold, silver and bronze designations meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.
AACN President Kathryn E. Roberts, RN, MSN, CNS, CCRN, CCNS, applauds the commitment of the caregivers in the ICU at Fairbanks Memorial Hospital for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence. These dedicated healthcare professionals join other members of the exceptional community of nurses who set the standard for optimal patient care. “The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to
Back row, from left to right: Erika Grant, Shasta Stephens, Cindy Yocum, Dawn Brefczynski, Kathleen Baker, Sarah Martin. Front row, from left to right: Christina Sparks, Brenda Franz, Edie Forest.
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evidence-based care optimizes patient outcomes. Units that receive this national recognition serve as a role model to others on their journey to excellent patient and family care,” she explained. The silver-level Beacon Award for Excellence signifies continuous learning and effective systems to achieve optimal patient care. The ICU at Fairbanks Memorial Hospital earned its silver award by meeting the following evidence-based Beacon Award for Excellence criteria: • Leadership Structures and Systems • Appropriate Staffing and Staff Engagement • Effective Communication, Knowledge Management, Learning and Development, Best Practices • Evidence-Based Practice and Processes • Patient Outcomes Brenda Franz, RN, Director of ICU, Emergency Department and Procedures at FMH, described the award application process as very rigorous and comprehensive. “This accomplishment represents one of many significant milestones on our unit’s journey to optimal outcomes and exceptional patient care. We are incredibly proud of this award. This acknowledgement is just one more way to assure our community that they can get excellent patient care right here at home.” About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, Calif., the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more than 500,000 acute and critical care nurses and claims more than 240 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. To learn more about AACN, visit www.aacn.org, connect with the organization on Facebook at www.facebook. com/aacnface or follow AACN on Twitter at www.twitter.com/aacnme. Richard Howell, AACN Communications, (949) 268-7573, richard.howell@aacn.org
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Flu Vaccines: Patient Education
As termination dust settles in on Alaska, we know it is time to think about influenza season and the screening required for our patients. The Centers for Medicare & Medicaid Services (CMS) recommends that health care providers vaccinate while patients are at a routine health care visit or during hospitalization. Over 1 million people are covered through Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and soon, through the Health Insurance Marketplace. But coverage isn’t the only goal of CMS. To achieve a high quality health care system, it also aims for better care at lower costs and improved health. CMS guidelines and payment for the screening and vaccinations for seasonal flu help to lower costs by prevention of serious illness and potentially preventable deaths among Americans. Through Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices (ACIP) develops written recommendations for the routine administration of vaccines to the pediatric and adult populations, along with schedules regarding the appropriate periodicity, dosage, and contraindications applicable to the vaccines. ACIP is the only entity in the federal government that makes such recommendations. Clinicians should refer to published guidelines for current recommendations related to immunization. A brief summary of the 2013-2014 recommendations for the use of influenza vaccines follows.
ALASKA NURSES ROCK! Join our ADVENTUROUS and COMPASSIONATE team delivering health and social services to communities above the Arctic Circle!
Maniilaq Association in Kotzebue, Alaska is Now Hiring: Inpatient/ER RNs Long Term Care DON Long Term Care RN Public Health Nurse (RN) Nurse Practitioners Health Aid Instructor- NP/PA EXCELLENT BENEFITS, AMAZING CULTURE & COMMUNITY! Apply Now: https://www.vscyberhosting.com/maniilaq tiffany.west@maniilaq.org ?s Contact tiffany. tiffany west@maniilaq.org (206) 304-4552
this year More than 400 Alaskan women will be diagnosed with breast cancer ENCOREplus of the Anchorage YWCA helps make sure the diagnosis is done in time to save lives. You can help by purchasing a Together for Hope 2014 calendar. Proceeds go to ENCOREplus in Anchorage. Contact: Gutierrez Photography 907.727.1284 gutierrez@gci.net | gutierrezphotography.com | facebook: SupportEncoreplus
(See Vaccines page 9)
Please join Forget Me Not Mission in their efforts to reduce impaired and distracted driving fatalities and injuries through education and awareness.
Keep Alaska’s Highways Safe www.forgetmenotmission.com T H E A L AS K A N U R S E • O c to b er / N ov e m b er 201 3
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“Got Coverage?”...the New “Got Milk”
Helping Alaskans Learn About Health Insurance Marketplace The Health Insurance Marketplace for Alaskans opened for business on October 1, 2013. The marketplace or “exchange,” as it is also called, is the new way to shop for and buy quality, affordable health insurance in Alaska. It’s open to ALL Alaskans: the uninsured, the underinsured, and even currently insured Alaskans can see what types of coverage is available in the marketplace. The newly created Health Insurance Marketplace is a key component of the Affordable Care Act (ACA). Alaska is one of 34 states that did not elect to open a stateoperated exchange and instead is maintained by a Federally Facilitated Marketplace. Getting the Word Out To help get the word out to Alaskans about the marketplace and how to apply for coverage, the US Department of Health and Human Services recently awarded Navigator grants to two local organizations: United Way of Anchorage and the Alaska Native Tribal Health Consortium (ANTHC). United Way will
Given the task at hand, we can expect the road ahead to be typically Alaskan: a few bumps here, and a few small potholes there. By working together, we can make sure that our families and our neighbors receive necessary coverage.
focus its efforts in urban centers – Fairbanks, Juneau and Anchorage – while ANTHC will use the Navigator grant to focus on rural Alaska. In addition, 24 community health centers across Alaska were awarded Federal Outreach and Enrollment funding to help Alaskans both understand health insurance options and enroll in affordable coverage made available by the ACA. The grants made possible the hiring and comprehensive training of five “navigators” to provide Alaskan consumers with unbiased information about health insurance, the new Health Insurance Marketplaces, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program (CHIP), as well as the hiring and training of enrollment assisters. Informing and connecting nearly 140,000 uninsured Alaskans to the marketplace is a complex undertaking, but one that United Way, ANTHC, community health centers, and many partners throughout Alaska – including healthcare providers, business leaders, faith leaders, community groups, advocates and local elected officials – are ready to take on.
How You Can Help Be proactive. You don’t have to wait to be asked a question about the Health Insurance Marketplace; let people know the marketplace is open for business. Direct people to HealthCare.gov. For many Alaskans, applying, choosing a plan that meets their needs, and enrolling can be done online, without additional assistance. Direct people to call Alaska 2-1-1. 2-1-1 is an easy-to-remember telephone number that connects callers to free and confidential information about a broad range of community, health, and human services within their communities. For Alaskans who have never had insurance, or who may benefit from a more personalized approach to getting started in the marketplace, Alaska 2-1-1 is a great resource. Here, callers connect with Information and Referral Specialists who will guide them to the resources that best fit their needs, from HealthCare.gov to certified assisters to personal navigators and more. Alaskans can speak directly with Alaska 2-1-1 trained Information and Referral Specialists by dialing 2-1-1 or 1-800-4782221 from 8:30 am to 5 pm. Monday through Friday. Alaska 2-1-1’s website is available 24/7 at www.alaska211.org. Learn what resources are in place in your community. Check with your enrollment and benefits advisor or financial counselor to learn about the specific actions being taken to educate and enroll Alaskans. The Road Ahead We fully expect that once our navigators and other assisters have more time in guiding Alaskans through the enrollment process, new issues and challenges will come to light. You can count on United Way, ANTHC, and our many partners to find the solutions necessary to meet the needs of our fellow Alaskans. Submitted by United Way of Anchorage
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Vaccines (continued from page 7) Groups Recommended for Seasonal Influenza Vaccination Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Recommendations pertaining to the use of specific vaccines and populations are summarized below. People who are at high risk of developing serious complications (like pneumonia) if they get sick with the flu. • People who have certain medical conditions including asthma, diabetes, and chronic lung disease. • Pregnant women. • People younger than 5 years (and especially those younger than 2), and people 65 years and older. People who live with or care for others who are at high risk of developing serious complications. • Household contacts and caregivers of people with certain medical conditions including asthma, diabetes, and chronic lung disease. • Household contacts and caregivers of infants less than 6 months old. • Health care personnel. • A complete list is available at http://www. cdc.gov/flu/about/disease/high_risk.htm Who Should Not Get the Seasonal Influenza Virus Vaccine According to the CDC, individuals in the following groups should not receive the seasonal influenza virus vaccine without consulting a physician: • Individuals with a severe allergy to chicken eggs, • Individuals who have had a severe reaction to a seasonal influenza virus vaccination in the past, • Individuals who previously had onset of Guillain-Barre syndrome during the six weeks after receiving the seasonal influenza virus vaccine, • Children aged younger than six months, and • Individuals who have a moderate to severe illness with a fever (these individuals should wait until their symptoms improve) Timing of Vaccination In general, health-care providers should begin offering vaccination soon after the
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SCF is seeking dynamic Registered Nurses to act as Case Managers in our OB/GYN, Pediatrics and Primary Care Clinics in the Anchorage Native Primary Care Center. Experience the opportunity to practice population based case management in our award-winning Nuka System of Care, a designated medical home model. SCF offers competitive salaries, an excellent benefits package, and a 401K retirement plan. Please visit our website and apply at www.southcentralfoundation.com or call Tess Johnson at (907) 729-5011 or email at tjohnson@southcentralfoundation.com.
EMPLOYMENT OPPORTUNITY Bristol Bay Area Health Corporation www.bbahc.org
Located in beautiful Southwest Alaska, in the town of Dillingham, BBAHC has many employment opportunites. Come and enjoy the Alaska Native Cultures of the Aleut, Eskimo and Indian. Our town is 2,460 strong and we serve a 44,000 square mile region of 34 villages with a total population of 8000. Please contact Human Resources at (907)842-5201 or by email at personnel@bbahc.org or refer to our website at www.bbahc.org for more information BBAHC is an equal opportunity employer operating under the Alaska Native and American Indian Preference in Hiring provisions of PL93-638. Pre-employment drug screening and a completed background investigation and determination that the applicant meets the eligibility criteria of the Alaska Barrier Crimes Act and, where applicable, the Indian Child Protection Act, are prerequisites to hiring.
(See Vaccines page 11)
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Nurses: Always on Call You are a Registered Nurse even when you are not at the workplace. One year while attending the annual Alaska Nurses Association Legislative Fly-In, a group of nurses was walking along the Juneau waterfront when the nurses came across a group of teenagers jumping off the dock into ocean waters at least 15 feet below. Mind you, this was March and water temperatures were frigid. The group of nurses watched nervously and started a conversation among themselves as to what their professional responsibility was should one of the teens develop problems during a dive into the freezing salt water. One member of the group remarked that even when taking an evening stroll, professional obligations mandated that nurses had a duty to help if the need arose. The nurses were always on call. A recent article in the Journal of Nursing Regulation, “Professionalism Extends beyond the Workplace,” highlights the legal side of the concept of being “always on call” (Russell, K.A. & Beaver, L.K., 2013). After imbibing several alcoholic drinks, a nurse in California collided with the center divider on a highway. The nurse’s blood alcohol content was found to be 0.16%, twice the legal limit to drive. The nurse pled no contest to a DUI charge. The California Board of Nursing determined that the nurse’s behavior outside working hours was evidence of unprofessional conduct and the nurse was placed on three years of probation – even though there was no evidence of the nurse having addiction issues. The nurse then challenged the Board of Nursing’s ruling on the grounds that a criminal conviction could not provide grounds for Board discipline unless the misconduct substantially related to the qualifications, functions, and duties of the profession (Sulla v. Board of Registered Nursing, 2010, p.4). The nurse challenged the Board’s ruling and the case was brought before the
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California Appellate Court, where the court ruled that there is a relationship between the professional fitness of a registered nurse and the alcohol-related misconduct because the California Nursing Practice Act refers to misuse of alcohol as being unprofessional. In their discussion of this case, Russell & Beaver emphasize that nursing is a profession, not a job. “As such, nurses are professionals and can be defined as individuals expected to display competent and skillful behaviors in alignment with their profession. Therefore, the values of the profession must drive the professional’s beliefs and behavior…” (p. 15). The American Nurses Association Code of Ethics also states in Provision 5, “The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth…” (ANA, 2011, p. 10). But when do the expectations that apply to the profession, apply outside of work? At recent Alaska Board of Nursing meetings, several cases have been brought before the Board regarding the use of the title RN and nurses’ activities in non-healthcare settings. In one situation, a student brought before the Board a complaint against an instructor, who happened to be a registered nurse. The issue: whether the complaints against the
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nurse fell under the jurisdiction of the board. After a lengthy discussion, it was concluded that the Board did have proper jurisdiction. Other nurses have come before the Board to ask whether they can use their RN title when they are engaging in non-nursing commercial activities. The Board had a long discussion about whether this creates an extra level of expectations by the public, even though the nurse was involved in non-nursing activities. The Board came to the conclusion that the nurse could use their RN title in these situations. Most recently, the Board debated the dilemma of an RN acting as a life coach. Certainly one’s experience as a RN influences one’s approach to being a life coach, but life coaching is a completely separate occupation from nursing. The question raised is where does one role end and the other begin? We are nurses in everything we do. “Nurses also have the duty to recognize that as part of the license to practice in the nursing profession, one is considered a professional at all times,” Russell and Beaver conclude (p. 18). You are always on call. American Nurses Association (2011). Code of Ethics for Nurses with Interpretive Statements. Retrieved from: http://www. nursingworld.org/codeofethics. Russell, K.A. & Beaver, L.K. (2013). Professionalism extends beyond the workplace. Journal of Nursing Regulation, 3 (4), 15-18. Sulla v. Board of Registered Nursing. (2010, November 17).OAH No. 2010060913.
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Vaccines (continued from page 9) vaccine becomes available and, if possible, by October. All children aged 6 months through 8 years who are recommended for 2 doses should receive their first dose as soon as possible after vaccine becomes available; these children should receive the second dose ≥4 weeks later. This practice increases the opportunity for both doses to be administered before or shortly after the onset of influenza activity. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health-care visits or during hospitalizations whenever vaccine is available. Vaccination efforts should be structured to ensure the vaccination of as many persons as possible before influenza activity in the community begins. In any given year, the optimal time to vaccinate cannot be determined precisely because influenza seasons vary in their timing and duration, and more than one outbreak might occur in a single community in a single year. In the United States, localized outbreaks that indicate the start of seasonal influenza activity can occur as early as October. However, in >80% of influenza seasons since 1976, peak influenza activity (which often is close to the midpoint of influenza activity for the season) has not occurred until January or later, and in >60% of seasons, the peak was in February or later. For the first time, during the 2013–2014 influenza season, both trivalent (IIV3) and quadrivalent (IIV4) IIVs will be available. The relative quantity of doses of IIV4 that will be available is not certain; however, it is expected that the supply of IIV4 might be limited. Quadrivalent vaccines are designed to provide broader protection against circulating influenza B viruses in seasons during which the B virus contained in trivalent vaccines is not an optimal match to the predominant circulating B viruses. However, vaccination should not be delayed if only IIV3 is available. No preference is expressed for IIV4 over IIV3. For persons aged ≥65 years, either an age-appropriate standard-dose IIV (IIV3 or IIV4) or high-dose IIV3 are acceptable options. This year a vaccine is now available for those who have a severe egg allergy.
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T H E A L AS K A N U R S E • O c to b er / N ov e m b er 201 3
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Labor Lines Collective Bargaining Unit Nurses of AaNa
Call Block Trial
Hospital contract language makes changes toward an improved work-life balance for nurses who take mandatory call for units that are not open 24 hours a day, 7 days a week. As demands for nurses with specialized skills continues to rise and family demands continue to put pressure on time commitments, hospital units like operating rooms, endoscopy, and post-anesthesia care have found it increasingly difficult to recruit nurses to cover these units after hours. Not only do these jobs generally require working 5 days a week, the positions also include evening, night, and weekend call. Many nurses continue to prefer working three 12-hour shifts per week in order to have larger blocks of time off work to be with their families, pursue hobbies, and balance the demands of everyday life. Through the passage of a state law that prohibits nurses from working longer than 14 consecutive
hours with 10 hours of rest required between shifts, AaNA has found an increasing willingness of employers to look at innovative ways to cover positions and shifts that are normally difficult to recruit to. In August, the Labor Management Committee at Central Peninsula Hospital in Soldotna met to craft a Memorandum of Agreement that would allow the PostAnesthesia Care Unit nurses a trial working a “call block.” The nurses will now work their usual work week – four 10-hour shifts or five 8-hour shifts – without having to take evening or night call. The weekend call remains unchanged, beginning at 6 pm Friday until Sunday at 6 pm. The call block runs from Sunday evening at 6 pm until Friday morning at 8 am. The nurses will be on call from 7 pm until 8 am the following morning. They are responsible for 65 hours of call and paid for 40 hours. The only overtime is after 10 hours of consecutive work in one shift or after 40 hours in the call block week.
The nurses already notice a difference in energy levels, particularly on busy days, because their sleep is not being interrupted to cover a case in the middle of the night to return the next day with minimal sleep. This trial will last 4 months with a review at the end of the trial period. Central Peninsula Hospital Administrator Rick Davis and Human Resources Director John Dodd are hopeful that by implementing this new work rotation, they will be able to recruit and retain nurses for the PACU. Thank you to Andie Posey, Chief Nursing Officer and Mona Sanders for their work with nurses to assure the details of the Memorandum of Agreement came together so altered contract language was addressed for this new scheduling tool. Special thanks go to Heather Sumner and Tom Wilkenson, who did not give up on the vision of a call block schedule. The Alaska Nurses Association would like to thank Tom for his many years of service to the Kenai Peninsula community, CPGH, and fellow nurses by serving on past negotiating teams. We wish him well in his retirement. We would also like to recognize Heather Sumner for all her work on behalf of patient safety, as a member of the nurse negotiating team, and wish her safe travels as she and her family move out of state.
What is a “SART?” Lauree Morton, Executive Director of the Council on Domestic Violence & Sexual Assault
A SART, or Sexual Assault Response Team, is usually comprised of victim advocates, health care providers, and law enforcement officers. These team members provide a coordinated and supportive response to persons who have been sexually assaulted. A SART is designed to reduce the trauma of a sexual assault by providing victim-centered advocacy, care, and services as well as increasing the likelihood that assaults can be successfully prosecuted. Each member of the team has a specific role to play in assisting a victim through the forensic exam process. Health care providers generally assess, diagnose, and treat injuries and conditions related to the assault; offer health care information and referrals as needed; and identify, document, collect, and preserve
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forensic evidence during the medicalforensic exam; as well as testify in court when needed. Victim advocates generally provide immediate and ongoing support such as informing the victim of her or his rights, answering questions about the SART process, assisting with safety planning, and identifying resources and options for immediate needs and long-term support. Law enforcement officers are generally responsible for the immediate safety needs of the victim; interviewing the victim; investigating the crime; identifying, arresting and/or referring charges on the suspect; conducting or arranging for a forensic exam of the suspect when necessary; and participating in court proceedings. Each team member is expected to have training in their respective fields. It is also recommended that each team
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member receive general team training, specialized instruction and practical experience responding to sexual assault. Nurses who are interested in participating on a team should have a minimum of 40 hours sexual assault nurse examiner (SANE)/sexual assault forensic examiner (SAFE) training and familiarity with standards of practice. Generally, the SART process is activated when a law enforcement officer authorizes a medical-forensic exam. All three components of the team are to be notified of the “call-out.” Each SART must create procedures to ensure an immediate and coordinated call-out response. The procedures are to clearly identify: contact information for each on-call team member, an appropriate response time for call-out, and special procedures for when all of the team members are not able to respond. (See SART page 14)
August Graduates
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Jennifer Hazen, AaNA treasurer, with award winners Jennine Redick (left) and Ralph Pasana (right).
Congratulations UAA Nursing Program Graduates August 2013
Baccalaureate Degree Program Graduates Delora L. Alonso Marisa I. Ayala Cardenas Jacqueline M. Bowser Justin J. Bridendolph Crystal Cecil Hannah L. Chung Anne E. Clark Danielle E. Cross Hayley C. Crow Camilla V. Dahlstrom Jennifer J. Dieken Bree A. Dudley Laura A. Ellis Kali M. Ferrin Larinda M. Green Tiffany K. Khotprathoum Irene H. Kim Sonja M. Mack Ederlee K. Mojica Ralph M. Pasana Samantha M. Pasiewicz Jennine K. Redick Margaret A. Sage
Isabel Sanchez Chelsea M. Skelton April P. Smith Megan M. Starr Joy D. Stouffer Kyle A. Sullivan Caitlin M. Ulrich Janelle M. VanBuskirk Karl B. Wade Kristel G. Walsh
RN to BS Degree Program Graduates
Angela M. Santiago, FNP track Chair, Dr. Mary Logan – Title Project: Health Literacy of Immigrants to Alaska Amber L. Orellana, FNP track Chair, Dr. Thomas Hendrix – Title Thesis: Acceptance, Distress, and Implantable Cardiac Defibrillators
Spirit of Nursing Award – Ralph M. Pasana
Heath Christianson Sandra K. Frey Donald J. Vogel
Awarded by faculty vote for the student they feel best demonstrates the spirit of caring, science, love of learning, and compassion.
Master Degree Program Graduates
Peer Award – Jennine K. Redick
Kirsten D. Larson, FNP track Chair, Dr. Elizabeth Predeger – Title Project: Assessing Parents’ Knowledge & Attitudes toward Concussions: Issues for School Nursing Practice
Awarded by the senior class to a fellow classmate who has completed their nursing studies while balancing the daily demands of life. Sponsored by AaNA.
ASKKAA NNUURRSSEE •• OAU G UbSer T/ S PTE R 201 3 TTHHEE AALLAS c to / NEov e MB mbE er
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Calendar of Events Save the Dates! .............................................................................
Ongoing ............................................................................. AaNA Board of Directors Meeting Fourth Wednesday of each month
4:00 to 5:30 pm
............................................................................. AaNA Labor Council Meeting Fourth Wednesday of each month 5:30 to 6:30 pm
............................................................................. AaNA Professional Practice Committee Contact for times: andrea@aknurse.org
or 907-274-0827
............................................................................. AaNA Legislative Committee Contact for times: andrea@aknurse.org
or 907-274-0827
............................................................................. Providence Registered Nurses Third Thursday of each month 4:00 to 6:00 pm
............................................................................. RN’s United of Central Peninsula Hospital Contact for times: 907-252-5276
............................................................................. KTN Ketchikan General Hospital Contact for times: 907-247-3828
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............................................................................. American Association of Colleges of Nursing Fall Semiannual Meeting October 26-29, 2013 JW Marriott, Washington, DC www.aacn.nche.edu/conferences
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November .............................................................................. The 2013 All Alaska Pediatric Symposium November 1-2, 2013 Alyeska Resort, Girdwood, Alaska New this year: Pediatric Nurse Breakout Sessions! Registration opens August 15 Contact Stephanie Monahan, Executive Director, All Alaska Pediatric Partnership: stephanie@a2p2.com www.a2p2.com
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Alaska Kidney Patients Association
October ................................................................................
“Empowerment through Knowledge”
Alaska State Board of Nursing – Meeting October 23-25, 2013 • Agenda deadline
Renal Focused Professional Education Millennium Alaska Hotel, Anchorage, Alaska www.alaskakidney.org/profed
Oct. 3, 2013
January 22-24, 2014 • Agenda deadline
Dec. 30, 2013
The Alaska Board of Nursing has a listserv that is used to send out the latest information about upcoming meetings, agenda items, regulations being considered, and other topics of interest to nurses, employers, and the public. To sign up for this free service, visit www. nursing.alaska.gov Inquiries regarding meetings and appearing on the agenda can be directed to: Nancy Sanders, PhD RN, Executive Administrator Alaska State Board of Nursing 550 W 7th Avenue, Suite 1500, Anchorage, AK 99501 Phone: 907-269-8161, Fax: 907-269-8196 Email: nancy.sanders@alaska.gov
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November 20-21, 2013
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March of Dimes Nurse of the Year Awards November 22, 2013 Egan Center, Anchorage, Alaska www.marchofdimes.com/alaska/ events/ Sponsored by AaNA!
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Contact Hours www.aknurse.org/ Remember to visit:
index.cfm/education for frequent
updates and information on local nursing contact hour opportunities and conferences!
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SART (continued from page 12) Prior to the start of the interview, the victim is given an opportunity to speak with an advocate. The advocate will answer questions and ensure the victim understands her or his rights regarding the interview and exam, the process and structure of the interview and exam, and the use of digital recordings and photography. The interview consists of two parts: a forensic history taken by a law enforcement officer and a medical history taken by a health care provider. All team members are present for the forensic history. The victim chooses who may be present for the medical history. Next is the exam. It is recommended that health care providers have specific guidelines outlining the steps for the medical-forensic exam and guidelines for follow-up care and referral. Sexual Assault Evidence Collection Kits are provided by the State of Alaska through the Crime Lab. Before the victim leaves, each member of the team has the following responsibilities: Advocates ensure the victim has the contact information for call-out members and offers safety planning options and resources for advocacy follow-up; law enforcement officers provide the victim with a case number and other investigative information; and health care providers provide discharge instructions, schedule follow-up medical-forensic exams, and provide health care referrals as needed. I would like to thank the Alaska Nurses Association and Alaska Nurse Practitioner Association for sponsoring webinars and teleconferences of the Forensic Professionals Network: a support network to aid nurses and nurse practitioners through discussion of training opportunities, mentorships, and programming issues. If you are interested in participating in this network, please contact Angelia Trujillo at angelia.trujillo@gmail.com for more information. Thank you to each health care provider who chooses to step-up and perform this service. It is not easy. It helps to have several colleagues involved. A great example of peer support is the work being done at Bartlett Regional Hospital. The Bartlett Regional Hospital Foundation recently raised over $45,000 to train fifteen nurses and nurse practitioners to be able to respond to a SART call-out. Juneau will also be the community hosting week-long team training in March 2014. For more information please call the Council on Domestic Violence and Sexual Assault, (907) 465-4356.
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Sexual Assault Response Training Seafood Gala Raises Funds for Bartlett Nurses On Saturday, September 7th, the Bartlett Regional Hospital Foundation held a Seafood Gala and Fundraiser atop Mount Roberts Tram at the Timberline. The Gala featured an Alaskan seafood dinner, auction, and live music by local doctor and former Broadway singer Mimi Benjamin accompanied by Robert Cohen, which raised funds to help support sexual assault training and certification for Bartlett Regional Hospital nurses in Juneau.  “We raised more than $45,000 to provide training and certification for Bartlett’s nurses in conducting sexual assault exams,� said Foundation board president Holly Cerne. “They’ve been without this important certification for far too long, and it’s time to change that.� At the event, former Representative state Caren Robinson was honored at the Gala for her many years of work on behalf of domestic
violence and sexual assault victims. Currently a lobbyist for the Alaska Nurses Association, Robinson is the founder of Juneau’s AWARE shelter, which stands for “Aiding Women in Abuse and Rape Emergencies� and provides comprehensive intervention and prevention, outreach and education regarding domestic violence, sexual assault, and child abuse.  Cecelia Brenner, Bartlett Regional Hospital ER Nurse, also spoke on behalf of nurses, thanking the Foundation Trustees for selecting sexual assault nurse examiner (SANE) training as the 2013 gift to Bartlett Regional Hospital. All proceeds from the Fundraiser are dedicated to providing SANE (Sexual Assault Nurse Examiner) training and certification to any interested Bartlett nurses. The seafood gala featured a menu put together by celebrity chef Jesse Ziff Cool of CoolEatz restaurants and Timberline Catering Manager Mark Collier.
Professional auctioneer Charles Crochet from Louisiana, who is the father of ER nurse Jeanne Crochet, was the auctioneer, Cerne said, adding that the foundation is grateful to Juneau community members and businesses for their donations and sponsorship. “Juneauites should be proud of how generously this community has given to help us reach our goal,� she said.
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