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THE
Volume 66, Issue 3 June/July 2015
The Official Publication of the Alaska Nurses Association. Circulation 9,000. Distributed to every Registered Nurse and Licensed Practical Nurse in Alaska.
THE official publication of
THE Alaska Nurses Association
President’s Letter
3701 E Tudor Rd., Ste. 208 • Anchorage, AK 99507
907.274.0827 • www.aknurse.org
Jane Erickson, ADN, RN, CCRN
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: salesaknursepub@gmail.com • 907.223.2801
AaNA Board of Directors • President:
Jane Erickson, ADN, RN, CCRN • Vice President:
Arlene Briscoe, RN-BC • Secretary:
Phi Tran, MSHS, BSN, RN • Treasurer:
Jennifer Hazen, BSN, RN • Staff Nurse Director:
Danielle Heyl, BSN, RN • Rural Director:
Nelly Ayala, MSN, RN • Greater Alaska Director:
Juanita Reese, BA, BSN, RN, CEN • Labor Council Chair (Designee):
Donna Phillips, BSN, RN • Directors At Large:
Shelley Burlison, RN-BC Janet Pasternak, BA, BSN, RN Paul Mordini, MS, BSN, RN-BC Kimberly Kluckman, RN Lila Elliott, BSN, RN
• Student Nurse Liaisons:
Leanne Pizzi – UAA Teresa Beitel – Charter College AaNA Labor Council • ChaiR:
Donna Phillips, BSN, RN • Vice-Chair:
Jana Shockman, RN, CCRN-CSC • SECRETARY:
Danielle Heyl, BSN, RN • Treasurer:
Jennifer Hazen, BSN, RN • Directors:
Arlene Briscoe, RN Lila Elliott, BSN, RN Jane Erickson, ADN, RN, CCRN Kimberly Kluckman, RN
Alaska Nurses Association President • Anchorage, AK Greetings! I am the new President of the Board of Directors for the Alaska Nurses Association. Wow! Until very recently, I had never imagined myself as being in this type of a leadership role. However, I am enthusiastic about this opportunity to serve and to lead. I promise to do the best I can to maintain the dignity and honor of representing all the nurses in state of Alaska. Since this is my first President’s Letter, I’d like to share a little bit about who I am and how I came to arrive at the place I am today. I graduated from nursing school in 1982 from a small community college. I came up through the ranks first as a nurse aide and then as a unit secretary, until I finally graduated from that small community college and became a registered nurse. Following graduation, I worked two years on a medical surgical floor and then two years in a progressive care unit. I came up to Alaska in 1986 to work in the intensive care unit at Providence Alaska Medical Center. I had a one-month orientation to learn the ropes and then immediately began working 12-hour night shifts, three nights per week. I still work in the same unit at the same hospital today (fortunately, I now work days!). Over the past three decades, the changes that I have seen in nursing have
been enormous. Through my President’s Letters, I would like to share some of these experiences and changes that I have seen throughout my career. I would also like all of the “seasoned” nurses who have 20 years or more experience as a nurse to share their stories with me. My aim is to share these insights with the rest of Alaska’s nurses through this column. I would also like to ask all the younger and newer nurses (with five years or less experience, including nursing students and the newly graduated) to seek out a seasoned nurse and ask them what it was like to be a nurse in the 1960s, 70s, 80s, and even 90s. Boy, do we have some stories to share. As rapidly as our profession is changing, I believe it is essential to share the stories of the past in order to be fully prepared for the future. Nurses, please tell your tales by emailing me at jane@aknurse.org. I also want to take this opportunity to congratulate all the newly graduated nurses from UAA and from Charter College. The taxing work of studying is over and now the fun starts as you enter the working field of being a registered nurse. Congratulations! Do not hesitate to seek out advice from your friends and colleagues as you embark on the exciting journey of nursing. Stay tuned for some interesting experiences, stories, and lessons.
• PAMC BU Rep:
Jennifer Hazen, BSN, RN • soldotna BU Rep: Shelley Burlison, RN-BC • KETCHIKAN BU Rep: Susan Walsh, RN • Affiliate Organizations:
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
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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8 14 Inside This Issue President’s Letter Nurses Week Celebrated in Alaska AaNA’s 2015 Nurses Week Banquet Heroes in Nursing Award Winners Children’s Art Contest Winners Student Nurse Appreciation The American Nurse @ Bear Tooth 2015 Heart Run & Mini Run Patient Series Part I Patient Series Part II
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Patient Series Part III Patient Series Part IV Union Affiliates with AFT PRN Negotiations Update Medicaid Expansion Congratulations UAA Graduates Charter College Graduates Board of Nursing Report Student Nurses Volunteer Calendar of Events
Cover Photo: This issue’s cover features the artwork of Kisun K., age 9. Kisun was the Grand Prize winner of our first-ever Nurses Week Kids’ Art Contest. (More winners, page 6)
T h e o f f i c i a l P u b l i c at i o n o f t h e A l as k a N u r s e s A s s o c i at i o n
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Nurses Week Celebrated in Alaska by Andrea Nutty National Nurses Week was celebrated May 6th through 12th. Nurses Week got its start in 1954, when it was observed from October 11-16. A bill creating a National Nurse Week was introduced in Congress the following year, but was never passed. In 1965, the International Council of Nurses began celebrating International Nurse Day on May 12th, which was Florence Nightingale’s birthday. In 1974, the White House designated a week in February as National Nurse Week and a proclamation was issued by President Nixon. Various versions of “National Nurses Week”, “National Nurses Day”, and “National Recognition Day for Nurses” existed across the country in years following until 1991, when the American Nurses Association created National Nurses Week as we know it today. National Nurses Week is now held annually each May 6th through 12th in order to honor and celebrate the dedication of nurses across the country. Nurses Week now serves as both a time of celebration and a vehicle for nursing advocacy, to inform and educate the public, and to raise awareness of the value and purpose of nurses. Each year, the Alaska Nurses Association hosts a variety of events and activities aimed at honoring the tireless devotion of nurses across our great state. For Nurses Week 2015, AaNA celebrated by holding an appreciation event for student nurses, hosting our annual Nurses Week Banquet which featured the inaugural Heroes in Nursing Awards Ceremony, having our first-ever Kids Art Contest, and partnering with the Bear Tooth Theatrepub to hold two special screenings of the documentary The American Nurse.
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.
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AaNA’s 2015 Nurses Week Banquet by Andrea Nutty The Alaska Nurses Association’s annual Nurses Week Banquet was hosted at the Millennium Alaskan Hotel on Saturday, May 9th. Young nurses, seasoned nurses, and nursing students gatherCed in the Redington Ballroom during the week’s highlight celebration for entertainment, networking, and learning throughout the evening. Dr. Shelly Burdette-Taylor, PhD, MSN, RNBC, CWCN, CFCN, a new assistant professor at UAA’s nursing program and wound and foot care expert, delivered the keynote speech and educational session to attendees. Speaking on nurse leadership, Dr. Burdette-Taylor presented “Accountability and Leadership According to
Nightingale: What Would Florence Do?” as a culmination of her extensive research on the lasting principles and advice from Florence Nightingale that are still applicable today in the nursing profession. “We can look to Florence to address health care reform using the modern version of Nightingale’s Notes on Nursing and Notes on Hospitals,” Dr. Shelly Burdette-Taylor stressed. A rousing applause accompanied the finale of Dr. Burdette-Taylor’s presentation and nurses received 1.5 nursing contact hours from the Alaska Nurses Association for attending the educational presentation. The banquet also featured a colorful
display of artwork from AaNA’s first-ever Nurses
Week Kids’ Art Contest. Nurses enjoyed viewing the artwork during the dinner and submitted votes for their favorites in each age category as
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well as an overall favorite. The votes were tallied after the banquet, with winners from each age group receiving art- and healththemed prizes and the grand prize overall winner being featured on the cover of this issue of The Alaska Nurse. Check out pages 6 and 7 to view some of our favorite entries. The inaugural Heroes in Nursing Awards were also presented during the Nurses Week Banquet, with award recipients receiving a beautiful engraved plaque and gift certificates for a lunch and spa facial. Find out more about the amazing award recipients below. Nurses in attendance also stood a good chance of winning a door prize, as the Alaska Nurses Association received a record-breaking amount of donations from local Alaskan
businesses for Nurses Week 2015. AaNA thanks the following businesses for their generosity: Kaladi Brothers Coffee Company, Oil & Vinegar, Yes! Bistro, Skinny Raven, Alaska Mill & Feed, The Bagel Factory Café, Alaska Bagel Restaurant, Yoder Photography LLC, Photography by Zack Henderson, Shuzy Q, Simon and Seafort’s, First National Bank Alaska, Lush, Anchorage Yoga, Great Harvest Bread Company, Airmed Career Apparel, and MetrOasis. AaNA also appreciates the hard work of our Nurses Week Task Force members: Jane Erickson, Phi Tran, Jennifer Hazen, Kathy Bell, Caitlin Kovacevich, Kim Lomen, Kim Kluckman, Donna Phillips, Angelia Trujillo, Arlene Briscoe, and Andrea Nutty.
Award Recipients: Inaugural Heroes in Nursing Awards by Andrea Nutty The Alaska Nurses Association’s inaugural Heroes in Nursing Awards ceremony was held during the 2015 Nurses Week Banquet. Nominations from the around the state were received and ultimately four nurses were honored during the ceremony and received awards in four categories: Best Preceptor, Future Nurse Leader, Outstanding Community Nurse, and Everyday Hero.
Best Preceptor Award Recipient – Cindy Kumle, Anchorage, AK Cindy Kumle, RN received the Best Preceptor Award for her continuous dedication in precepting and mentoring new NICU nurses at Providence Alaska Medical Center in Anchorage for the past seven years. Cindy was nominated by a colleague who wrote that “the responsibility of the preceptor falls in between teaching and mentoring. Cindy is the best of both.” Cindy received the award for going above and beyond her preceptor duties and “stepping up to the plate again, and again, and again.”
Future Nurse Leader Award Recipient – Leanne Pizzi, Anchorage, AK Leanne Pizzi, a recent nursing graduate from UAA, received the Future Nurse Leader Award after she was nominated by a professor. Leanne was recognized for her outstanding academic leadership, community service, and work on interpersonal violence prevention. Leanne’s professor commended her “natural inclusive leadership style” and dedication to making “positive changes in the process of their education” for her cohort of nursing students.
Outstanding Community Nurse Award Recipient – Michelle Harrington, Barrow, AK Michelle Harrington, RN, PHN was honored for her exemplary work as a public health nurse in the North Slope Borough and received the Outstanding Community Nurse Award.
Michelle was recognized for her dedication to her two nursing passions: avoiding vaccine-preventable diseases and assisting clients and families with neurological developmental disorders. Michelle was nominated by a supervisor, who praised Michelle’s work in “ensuring children with neurodevelopmental delays receive early intervention for better outcomes in life” and stressed that “Michelle Harrington’s diligent efforts are a major contributing factor to North Slope Borough’s high immunization rates.”
Everyday Hero Award Recipient – Jan Ford, Anchorage, AK Jan Ford, RN, a long-time nurse at Providence Alaska Medical Center, received the Everyday Hero Award for her exceptional and dedicated service to the nursing profession. Jan was recently honored for her 40 years of service at PAMC and has spent over 75,000 hours working as a nurse and has cared for over 250,000 patients during her career. Jan was nominated by a colleague, who wrote that Jan “has consistently contributed her time and experience in order to make positive changes for the best patient care possible” and has been a tireless mentor to countless nurses over the years. Jan Ford is presented with the Everyday Hero Award by AaNA Treasurer Jennifer Hazen during the Heroes in Nursing Awards Ceremony
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Nurses Week Children’s Art Contest Winners
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Student Nurse Appreciation by Andrea Nutty On Tuesday, May 5th, the Alaska Nurses Association held our Nurses Week Kick-off event for student nurses at the University of Alaska Anchorage
and Charter College Anchorage. A Kaladi Brothers Coffee truck served students, faculty, and staff at UAA, while coffee carafes and bagels were put out for students to munch on at Charter College. Students had
fun walking down a “red carpet” and posing for photos with life-size cardboard cutouts of celebrities. Students at both UAA and Charter College were able to learn about the Alaska Nurses Association and enter drawings for free tickets to the Nurses Week Banquet and The American Nurse at the Bear Tooth Theatrepub.
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PRE-K 1) First Place: Min Sun K., Age 4 2) Second Place: Cordelia M., Age 5 GRADES K-2 3) First Place: Kaila M., Age 7 4) Second Place: Linnell H., Age 8 5
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GRADES 3-5 5) First Place & Grand Prize Winner: Kisun K., Age 9 6) Second Place: Marielle C., Age 9 GRADES 6-8 7) First Place: Marilynn N., Age 13 8) Second Place: Nika H., Age 12
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The American Nurse at the Bear Tooth Theatre
by Andrea Nutty On Monday, May 11th, hordes of nurses and the public packed the Bear Tooth Theatrepub for two special screenings of The American Nurse, a documentary film that follows five
nurses in five very different settings and areas of the country as they care for patients and give back to their communities. The Bear Tooth Theatrepub made the event possible by recognizing the importance of National Nurses Week and partnering with the Alaska Nurses Association to show the film. The documentary explored some of the biggest issues facing our country today – aging, war, poverty, addiction, and prisons – through the work and lives of five nurses. Nurses in attendance were able to receive 1.5 nursing contact hours after viewing the film through nurse.com. The film is also available to purchase and view online at www.americannurseproject.com.
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Mini Heart Run On Friday, April 17th, the American Heart Association and Providence Center for Child Development held their annual “Mini Heart Run” for young children at the childcare center. Toddlers and preschoolers sprinted, waddled, galloped, and moseyed along the short course, excited to be taking part in such a big event. The children received lessons on the importance of active play for healthy hearts and got to take home Healthy Habits coloring books from the Alaska Nurses Association.
2015 Heart Run On Saturday, April 25th, volunteers from the Alaska Nurses Association showed up at the Alaska Heart Run ready to provide healthy snacks, lots of water, and blood pressure checks and education to participants at the run. The annual event benefits the American Heart Association and serves to educate the public to combat high rates of and high risk for heart disease. Students from both Charter College and University of Alaska Anchorage’s nursing programs received plenty of hands on experience; performing tons of blood pressure checks throughout the event and brushing up on their patient education skills. The Alaska Nurses Association also saw one of its largest teams ever participate in the 5k run as members of “Team Alaska Nurses” dashed across the finish line. Make sure to join AaNA for the annual Anchorage Heart Walk, a fun filled family event, on September 26th at the Delaney Park Strip.
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Patient Safety Series Part I:
It’s Personal: 491 Days without a Father, the Devastation of Medical Errors pathology slides were sent to Boston for a second opinion. The benign tumor was not benign; it was a treatable cancer. Twelve important months of treatment time had passed. The invisible and veracious cells leftover from the surgery were allowed to uncontrollably proliferate. The miracles of modern medicine sat on a shelf presumably unneeded for a year. Two years of more surgeries, aggressive chemotherapy, and radiation treatments weakened the once strong man. An Avid Patient Safety Advocate:
by Carlie Holmberg, BSN, RN, CPHQ and Lynette Savage, PhD, RN Difficult Story to Tell: On a cold January morning, in a small town in Massachusetts, my father succumbed to the evils of cancer. I lost my mentor, my rock-solid support, and my Daddy. The deep painful ache in my chest is indescribable. The swirling feelings of sadness, anger, and helplessness make it difficult to concentrate. The waves of despair wash over me, making me feel cold and vulnerable. At times the waves drown me making me feel breathless and paralyzed. An Important Story to Tell: Four years ago, an inattentive pathologist made a horrible assumption about what he saw under the microscope. Later, he would unapologetically admit his mistake. He had assured my father and my father’s physicians that the small kidney tumor was benign. He recommended surgical removal of the tumor. No further treatment was necessary because these tumors never return. At the time, it was glorious news to my father and our family. We could breathe again. Twelve months after surgery, three new tumors – each larger than the original – were discovered. The original set of
Before the cancer, my father had become a huge supporter of patient safety initiatives. He scoured the internet and was an unrelenting patient self-advocate. Ten years ago, through his own research and some pressure on his physician to test him, he had discovered his own hemochromatosis. This easily-treated blood condition, if left unattended has injurious and sometimes fatal results. My father and I were a dynamic duo. We were like patient safety cheerleaders (minus the cute skirts and pom-poms). Dad could have easily written all of the entries in my blog, Airborne Patient Safety (airbornepatientsafety.wordpress.com). He fed me volumes of information about patient safety that fueled the flames of my patient safety passion. He was an incredible man. He understood the connection between aviation and patient safety. He had signed copies of Atul Gawande’s The Checklist Manifesto, as well as John Nance’s Why Hospitals Should Fly and Charting the Course. What would my father want you to know? What would my father want you to do? As a patient, my father would want you to talk about the importance of self-advocacy, researching your own situation, and paying attention to the fact that all healthcare workers are human. Humans are not perfect,
they cannot be perfect. He would want you to keep questioning your doctors and healthcare providers until you truly understand. He would want you to tell a healthcare worker to wash their hands before touching you. He would want you to understand your medications. He would want you to teach your loved ones about the dangerous realities in healthcare. He would want you to ask questions and speak-up. As a healthcare provider, my father would tell you that you are the first line of defense in keeping patients, clients, or residents safe. He would want you to follow the National Patient Safety Goals set forth by The Joint Commission (2014). He would encourage you to read the literature through websites such as the Agency for Healthcare Research and Quality [AHRQ] or the National Patient Safety Foundation (AHRQ, 2014; McTiernan, 2014). He would want you to ask questions and speak-up. Saying Good-Bye: The last conversation with my father was over the phone. He was very ill and in pain. At the end of the very brief call he said, “I love ya kid, I’m gonna miss you for a long, long, long time.” He then quickly passed the phone to my mother. Those words echo in my soul. It’s been 491 days without my father. That is a long, long, long time.
References: Agency for Healthcare Research and Quality [AHRQ] (2014). Research summaries for consumers, clinicians, and policymakers. Retrieved from http://www.effectivehealthcare.ahrq.gov/index.cfm/research-summaries-for-consumers-clinicians-and-policymakers/ Gawande, A. (2011). The checklist manifesto: How to get things right. London: Picador Publishing. Nance, J. (2008). Why hospitals should fly: The ultimate flight plan to patient safety and quality care. Bozeman, MT: Second River Healthcare Press. Nance, J. (2012). Charting the course: Launching patient-centric healthcare. Bozeman, MT: Second River Healthcare Press. McTiernan, P. (2014). Keeping quality and safety front and center. National Patient Safety Foundation. Retrieved from http://www.npsf.org/updates-news-press/updates/keeping-quality-and-safety-front-and-center-2/ The Joint Commission (2014). National patient safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx
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Patient Safety Series Part II:
Patient Safety is Not the Flavor of the Month
Stories illustrate that patient safety issues are not new and not going away: by Carlie Holmberg, BSN, RN, CPHQ and Lynette Savage, PhD, RN In 1994, at Harvard’s Dana Farber Cancer Center, an accidental chemotherapy overdose killed Boston Globe healthcare reporter Betsy Lehman. As the fatal dose of chemotherapy was being prepared and administered to the patient, the work passed through multiple checkpoints that could have prevented the patient from receiving the wrong dose (Commonwealth of Massachusetts, 2014). In 1995, at a Tampa, Florida hospital, 52-year-old Willie King, after a series of errors, had the incorrect leg surgically amputated. There were insufficient processes in place to prevent this type of error (New York Times, 1995). In 1999, in Washington, D.C., the Institute of Medicine reported that 44,000 to 98,000 Americans die each year as a result of medical errors. At the time this information was published, many in healthcare felt this was a conservative estimation (Kohn & Corrigan, 2002). In 2001, at Johns Hopkins hospital, Josie King, a healthy eighteen-month-old girl was recovering well from a burn. Unidentified dehydration, faulty communication between physicians and nurses, dismissal of a mother’s concerns, and a fatal dose of methadone killed this child (King, 2010). By the fall of 2002, Josie’s mother, Sorrel King, shared her story publically for the first time with healthcare providers and leaders with a plea to work on preventing medical errors in order to save lives. In 2002, in a central Texas hospital, John Alexander James, a healthy 19 yearold college student and son of a physician, died as a result of uninformed providers. His father struggled to piece together the events leading up to the untimely and seemingly avoidable death of his son (James, 2007) In 2007, at Cedars-Sinai hospital in Los Angeles, actor Dennis Quaid’s newborn twins came close to death after mistakenly receiving a Heparin dose 1,000 times larger than intended. Since that time Quaid has challenged healthcare leaders to invest more time and money into patient safety (SafetyLeaders, 2010). He co-authored an article on storytelling as a means to begin talking about patient safety (Quaid, Thao, & Denham, 2010).
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In 2013, the Journal of Patient Safety referred to medical errors as quiet, unseen tragedies that kill 210,000 to 440,000 Americans annually. Many of these are considered to be errors that could have been prevented (James, 2013). In July 2014, the United States Senate Subcommittee on Primary Health and Aging conducted a hearing to elevate the conversation about improving patient safety. The members of the subcommittee proposed the formation of a National Patient Safety Board similar to the current National Transportation Safety Board (United States Committee on Health, Education, Labor and Pensions, 2014, July 17). The entire hearing is available online at http://www.help.senate. gov/hearings/hearing/?id=478e8a35-5056a032-52f8-a65f8bd0e5ef. Nurses can improve the culture of patient safety; there are many flavors of ice cream: Nurses in today’s healthcare are faced with increasingly complex systems, technology, and patients. They know they are one of the last lines of defense to keep their patients safe. Patient safety is not the new vanilla chocolate chip ice cream of 2014. It is not the plain vanilla from 1994, the strawberry swirl from 1999, or the blueberrypistachio from 2007. Patient safety is a multifaceted combination of all possible flavors, current and yet to be discovered. Kathleen Bartholomew, RN, MN, an international speaker and consultant, who
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uses the power of stories and her nursing experience to raise awareness about the important connections between clinical teamwork, communication, and frontline nurses with patient safety. In her keynote speech to the 2014 Nebraska Hospital Association, she reviewed the need for nurses and nurse leaders to move away from the old healthcare hierarchical structures and begin focusing on the critical elements or flavors to improve the culture of safety. • Flatten the hierarchy • Sustain trust-same rules for all • Staff are accountable • Staff are problem solvers • Nursing peer evaluations • Develop strong relationships across healthcare disciplines • Leaders are part of the team, “we” mentality • Open honest discussions, learning from mistakes • Have the crucial conversations • Invest in education and training (Bartholomew, 2014) Nurses and nursing leaders can impact the culture of patient safety. Bartholomew described the need to support major trends from: • Reactive to Proactive • Preventive to Predictive • Parent to Partner • Trust to Transparency • Satisfaction to Outcomes
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Patient Safety is not the flavor of the month It is imperative for nurses to realize that patient safety is not just a new ‘catch-phrase’ or flavor of the month initiative. It is a growing problem that requires all nurses to incorporate all the ice cream flavors into one large batch of blended possibilities that saves lives. It is not enough to merely look at some factors involving patient safety or to endorse that we will get around to patient safety soon, when we have more time. We must continue to actively pursue changing the culture of safety in every healthcare environment, whether it is a hospital setting, a clinic, skilled nursing facility, or home health agency. The challenge Don Berwick (2006, para.1) gave to healthcare leaders and providers in his opening remarks introducing the Institute of Healthcare Improvement’s 100,000 Lives Campaign still rings true today, “The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been…” …some is not a number, soon is not a time.”
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References: Bartholomew, K. (2014). Leading a patient safety culture: Successful strategies for sustained change (Keynote address). Nebraska Hospital Association Mid-Year Conference. Retrieved from http://www.nebraskahospitals.org/file_download/183406058fbc-46b0-91e5-c8a98e98af78 Berwick, D. (2006). Overview of the 100,000 lives campaign. Retrieved from http://www.ihi.org/Engage/Initiatives/ Completed/5MillionLivesCampaign/Documents/Overview%20 of%20the%20100K%20Campaign.pdf Commonwealth of Massachusetts (2014). Betsy Lehman center for patient safety and medical error reduction. Retrieved from http:// www.mass.gov/chia/consumer/betsy-lehman-center-for-patientsafety-and-medical-error-reduction/ James, J.T. (2007). A sea of broken hearts: Patient rights in a dangerous, profit-driven healthcare system. Bloomington, IN: AuthorHouse. James, J.T. (2013). A new, evidenced-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122-128. DOI: 10.1097/PTS.0b013e3182948a69. King, S. (2010). Josie’s story: A mother’s inspiring crusade to make medical care safe. New York City, NY: Grove Press.
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Kohn, L.T. & Corrigan, J. M. (2002). To err is human: Building a safer health system. Washington, D.C.: National Academy Press New York Times (1995, September 17). Doctor who cut off wrong leg is defended by colleagues. Retrieved from http://www.nytimes. com/1995/09/17/us/doctor-who-cut-off-wrong-leg-is-defendedby-colleagues.html Quaid, D., Thao, J., & Denham, C. (2010). Story power: The secret weapon. Journal of Patient Safety, 6(1), 5-14. Retrieved from http:// www.safetyleaders.org/Quaid/content/Quaid-Thao-Denham__ Story_Power_Secret_Weapon__JPS_Vol6_No1_March_2010.pdf SafetyLeaders (2010). Dennis Quaid: Our new safety leaders TMIT teammate. Retrieved from http://www.safetyleaders.org/quaid/ United States Committee on Health, Education, Labor and Pensions (2014, July 17). More than 1,000 preventable deaths a day is too many: The need to improve patient safety. Retrieved from http://www.help.senate.gov/hearings/hearing/?id=478e8a355056-a032-52f8-a65f8bd0e5ef
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Patient Safety Series Part III:
For the Love of Nursing by Carlie Holmberg, BSN, RN, CPHQ and Lynette Savage, PhD, RN Airplanes and Patients: What is the Connection?
For more than 20 years, experts have compared aviation and healthcare. Why? The reason is simple, airplane crashes kill people and healthcare kills people. Still not seeing the connection? Human factors cause planes crashes and deaths; human factors cause medical mistakes and deaths. The connection is a call-to-action. The aviation industry assessed their weak processes meant to minimize human-err factors and adopted a strong culture of safety. The number of plane crashes fell while healthcare related injuries and deaths increased. Need more? As soon as the aviation industry identified the relationship between human errors and airplane crashes, it launched a huge culture shift to standardize processes, improve crewmember communication, and save lives. Airplane Captain Chesley B. “Sully” Sullenberger, the Hero-on-theHudson noted in a speech fourteen months after his ‘successful’ plane crash, “The risk of accidental death in a jet aircraft from 1967 to 1976 was 1 in 2 million. Today, it is 1 in 10 million. After 75 years, we in aviation have benefited from lessons learned at great cost, literally bought in blood, lessons we now offer up to the medical field for the taking” (O’Reilly, 2010, para. 5). Nurses know that patients are not airplanes, yet the dramatic shift in the aviation safety culture shows us that it is possible to save lives. Health care has not uniformly adopted the seemingly simple safety culture elements and standardized practices required to cease medical mistakes and save lives. Nance (2009) believes that “medical mistakes are merely human mistakes committed within
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a human system inadequately designed to catch and neutralize those mistakes in time” (p. 29). The Joint Commission (2014) reports that the single most significant trend found from sentinel events continues to be a lack of communication between team members. “It is thought that half of adverse events in surgery are avoidable and ‘the majority’ are due to poor communication, decision making and teamwork” (Smith, 2014, para. 2). No longer do aviation employees assume their leaders are omnipotent and infallible. Prior to the aviation culture shift, senior pilots were not questioned. The Tenerife Disaster, which killed over 500 people, is a primary example of this. The accident was linked to communication failures and a pre-existing hierarchy amongst the crew (Kilroy, 2013). Jacob Van Zanten, a well-respected and senior pilot, without question from the crew, attempted to take off. The plane crashed into another plane still on the runway. The final conclusion from the investigation found that Van Zanten was solely responsible for the accident. Human error. That incident forced aviation safety experts to focus on human error and communication as a systemic problem rather than as an individual problem. The causes of airplane crashes are often linked to human error. Yes, in fact, to err is human. The horrifying realities for healthcare Leapfrog Group’s Hospital Safety Score Website reports: • As many as 440,000 people die every year from hospital errors, injuries, accidents, and infections • Every year, 1 out of every 25 patients develops an infection while in the hospital, an infection that does not have to happen • A Medicare patient has a 1 in 4 chance of
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experiencing injury, harm, or death when admitted to a hospital • Today alone, more than 1,000 people will die because of a preventable hospital error It is important to remember that most hospital errors can be prevented. Nurses and other healthcare professionals work hard every day to protect their patients from errors, injuries, accidents, and infections, yet errors continue to occur at alarming rates (Leapfrog Group, 2014). A large part of making healthcare safer comes from changing the existing culture. Nursing students dig deeper into the connections An Anchorage cohort of five University of Great Falls RN-BSN students collaborated on a leadership project during the summer of 2014. These nurses studied the concepts surrounding aviation and healthcare safety. They looked to John Nance as a leader in patient safety. John Nance is a captivating international speaker on healthcare safety. He is also a commercial pilot. As a founding board member of the National Patient Safety Foundation, he is also touted as a pioneer and advocate for the aviation safety revolution. Nance was pivotal in developing Crew Resource Management principles and Air Force human factors flight safety education. He is the author of many books, journal articles, and newspaper articles. His well-known book Why Hospitals Should Fly is published in 32 countries and 18 languages. Mr. Nance and his wife, Kathleen Bartholomew, MN, RN, also a recognized author and leader in patient safety, are an inspirational duo focused on improving healthcare. On July 7, 2014 the Anchorage BSN students had a unique opportunity to speak with the couple on the telephone. These leaders offered to speak with the students
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while they were traveling. From an airport in Idaho they answered questions and shared their views about healthcare, leadership, and safety culture. It was sixty exciting minutes of captivating and inspirational discovery John Nance and Kathleen Bartholomew leave a lasting impression From that interview with Nance and Bartholomew several themes emerged: and infections • In patient centered care, the patient is the subject of care, not the object and infections • Human-designed systems are inadequately designed to catch and neutralize errors and infections • Perpetual perfection is fraud, we (healthcare) must build resilient processes and infections • Leadership must create the conditions that extract, orchestrate, and inspire human talent and infections • Hospital C-Suites (referencing administration, e.g. Chief Operating Officer, Chief Nursing Officer, and Chief Medical Officer) must be willing to dismiss those individuals threatening safety with their hierarchical attitudes and infections • Another must: reducing variation, increasing standardization, allowing for communication as equals, and an opportunity to speak up to the “captain of the plane” and infections • Nursing leadership is where the rubber and the road come together, a human interface with the patient with pathos and emotion The epilogue in Bartholomew’s book (2014) captures the ‘call-to-action’ for nurses. Bartholomew – always an educator – has provided four nursing contact hours with the book. She writes about a metaphor that holds
the essence of nursing’s collective dilemma. “One day a nurse was walking by a river and she saw a person calling for help in the water. Immediately she waded in and pulled her out and bandaged the leg of the bleeding woman. But no sooner had she finished attending to her needs than she heard another person calling for help, then another. She called for her friends and more nurses came to the rescue, frantically pulling injured people out of the turbulent waters. Not only did the numbers of victims increase, but the severity of their wounds did as well; so she called for the doctors. Day in and out for weeks the nurses and physicians kept saving the lives of the river wounded. Weeks turned into months; years turned into decades and everyone was utterly exhausted. And then one day without any warning, a single nurse stood up and started walking away from the river. Suddenly, like a swarm of swallows, thousands of nurses stood up and followed her as she walked away from the river of illness and disease. ‘Where are you going? You can’t leave!’ shouted a doctor, desperate and panicked. Just then, the very last nurse turned back to him and shouted, ‘We’re going to see who’s throwing these people down the river.’ It is time to leave the river; time to stop protecting our individual fiefdoms of professionalism and gather like moths to the flame around the value that nursing brings to our society. This coming together of like minds begins by supporting and nurturing the people we work with every day. Healing our world begins by caring for ourselves and each other with the same loving devotion that we administer to our patients. This is our Crimean War. But because the battlefield is all around us, it is difficult to perceive exactly what we are fighting, and so, many of us are constantly drawn down to the
river. If three million nurses stopped drinking bottled water or eating fast food; or demanded nurses in every school; or that the FDA address the use of hormones, antibiotics and pesticides in our food supply, the number of sick people in our river of illness would decrease exponentially. This is how we can leave the paradigm of disease – and take our patients with us. We have both an opportunity and an ethical obligation to come together in an unprecedented way to restore the health of our nation. Every individual action will either bring us closer, or farther, from this goal. To that end, I hope this book has served you well. For the love of nursing, Kathleen” If you were to ask one of the students today, they would tell you that there is a lot of work still left to be done. They would tell you that frontline nurses need to speak up about hostile environments created by those few rotten apples. They would comment on the critical role that nursing leadership plays in establishing care processes aimed to prevent harm. They would say that patient safety is similar to an incredible collaborative dance of many. Like a precision-line, one misstep off the choreographed plan can cause disaster. The students quickly realized their concept of patient safety would permanently change. A flattened hierarchy now made perfect sense, yet none of them had experienced it. Listening to these passionate leaders discuss healthcare transparency, authenticity, accountability, and culture sparked a fire within them that continues to burn. For the love of nursing, let us come together and begin to change our culture.
References: Alamy (2014). Photograph from Surgeons are to be tested on ‘people skills’. The Telegraph. Retrieved from http://www. telegraph.co.uk/health/healthnews/11048950/Surgeons-are-tobe-tested-on-people-skills.html Bartholomew, K. (2014). Ending Nurse-to-Nurse Hostility: Why Nurses eat their young and each other. (2nd ed.). Danvers, MA: HCPro. Flacy, M. (2012). Photograph from Airline pilot distracted by new text messages botches landing attempt. Retrieved from http:// www.digitaltrends.com/mobile/airline-pilot-distracted-by-newtext-messages-botches-landing-attempt/#ixzz3TSNtmOAO Kilroy, C. (2013). Special report: Tenerife. Retrieved from http:// www.airdisaster.com/special/special-pa1736.shtml Leape LL. (1994). Error in medicine. JAMA. 272(23):1851-7. Leapfrog Group (2014). Errors, injuries, accidents, infections. Retrieved from http://www.hospitalsafetyscore.org/what-ispatient-safety/errors-injuries-accidents-infections Nance, J. J. (2009). Why hospitals should fly. Bozeman, MT: Second River Healthcare Press. O’Reilly, K. (2010). Patient safety: What can medicine learn from aviation? Retrieved from http://www.amednews.com/ article/20100614/profession/306149945/4/%29 Smith, R. (2014). Surgeons are to be tested on ‘people skills’. The Telegraph. Retrieved from http://www.telegraph.co.uk/news/ health/news/11048950/Surgeons-are-to-be-tested-on-peopleskills.html The Joint Commission [TJC] (2014). Advancing effective communication, cultural competence, and patient-and-familycentered care. Retrieved from http://www.jointcommission.org/ Advancing_Effective_Communication/
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Patient Safety Series Part IV:
Human Fallibility, Nurses, and Patient Safety by Carlie Holmberg, BSN, RN, CPHQ and Lynette Savage, PhD, RN It has been over 500 days since my ‘patient-safety-advocate-father’ left me to battle the realities of healthcare. The thumping bass of national patient safety efforts is becoming more audible yet some health care professionals are either wearing earmuffs or not listening. Collectively as nurses, in order to address patient safety issues head-on we must admit and understand that human fallibility exists. We must embrace the notion that none of us, not one of us, are perfect. As intelligent as we are, as much fatigue we believe we can overcome, and as many crafty, pretentious work-a-rounds we create, we are not perfect. Fallibility is the human tendency to be wrong, to be in error, or to make a mistake. Kathryn Schulz (2011), has persevered to disseminate, in lectures and books, the fact that we [humans] are hardwired for imperfection. In her presentation themed “On being wrong”, she said:
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“Over 1,200 years before Descartes said his famous thing about “I think therefore I am,” this guy, St. Augustine, sat down and wrote “Fallor ergo sum” -- “I err therefore I am.” Augustine understood that our capacity to screw up, it’s not some kind of embarrassing defect in the human system, something we can eradicate or overcome. It’s totally fundamental to who we are.” (Schulz, 2011). Schulz continues by arguing that accepting the concepts of human fallibility is basic to dealing with it. Envision if all nurses and doctors considered themselves correct, all the time. Now, imagine my father’s pathologist admitting that on his inspection of the tumor tissue he was 100% sure it was benign. Eighteen months later, as I sat thousands of miles away via conference call, I remember the pathologist’s stinging words of truth. He said, I was sure I knew what it was and I performed the stains and tests to prove it but I did not look any further. Cognitive biases play a large role in our fallibility. In my father’s case, ‘confirmation bias’, the human tendency to search, interpret, and locate information to validate one’s beliefs is what caused his untimely death (Nickerson, 1998). The pathologist was wrong; he made a mistake, and he created a 12-month delay of curative treatments. Pathologists are human and humans blunder. In 2007, three wrong side brain surgeries were performed in a Rhode Island hospital (Crausman & McIntrye, 2008). A mixture of physician ego, overconfidence, and timid nurses multiplied by the human tendency to err caused these events. Nurses are familiar with the array of systems, structures and processes in healthcare that help counteract the risks associated with our humanness. For example, the Universal Protocol helps remove some of those risks in the operating room (The Joint Commission [TJC], 2015). Marking the surgical site prior to the patient going to the operating room is a rule, a standard, and a regulation that eliminates some human fallibility. Surgical teams are comprised of humans and human are fallible.
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In 1999, the Institute of Medicine (IOM) published its first report to Congress. This pivotal report discussed the human factors relating to patient safety (Corrigan, Donaldson, Kohn, McKay, & Pike, 1999). It addressed human fallibility and the dire need to develop preventive processes. It reviewed that most healthcare providers are not malicious or incompetent. “Most commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them” (Corrigan et al., 1999, p.2). Nurses are the last line of defense in keeping patients safe yet as a profession, we have a weak understanding of cognitive psychology. We need to ‘think about our thinking’ to advance patient safety. The evolution of our clinical critical thinking must include the purposeful, mindful, selfreflective, and self-regulatory judgment skills to override our cognitive biases and fallibility (Croskerry, 2013.) This is the big next step to keeping patients safe. Father’s Day is just around the corner. I cannot believe this will be my second one without him. Five years ago, my father
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introduced me to Schulz’s views on fallibility. He sent me her powerful Boston Globe editorial. It concluded with the following: “Embracing fallibility to prevent catastrophic error, embracing fallibility to prevent conflict: These are two hugely worthy goals. But learning to do either one consistently is close to impossible as long as we insist that mistakes are made by morons, and thatan intelligent, principled, hardworking mind is the only backup we need. This is the deep meaning behind the pat cliché ‘to err is human’. Take away the ability of an intelligent, principled, hardworking mind to get it wrong, and you take away the whole thing” (Schulz, 2010). I have a small satchel of my father’s ashes that rest in one of his treasures, a very special box from his Grandfather’s general store. The box is within view from my desk and always has an accompanying small candle lite while I work. I am not alone on this patient safety journey. I have co-workers, comrades, celebrities, senators, educators and more traveling along this bumpy scary heartbreaking road. As a profession nurses must kept the patient safety flame lite, maintain the burning passion to engage in improvements, and never give up on the quest to eliminate preventable healthcare associated harm and death. Happy Father’s Day Dad, I miss you.
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References: Corrigan, J., Donaldson, M., Kohn, L., McKay, T., & Pike, K. (1999). Institute of Medicine. To err is human: Building a safer health system. Washington, DC: National Academy Press. Crausman, R. & McIntrye, B. (2008). A history of wrong site surgery in Rhode Island. Journal of Medical Licensure and Discipline, 94(4), 6-10. Retrieved from http://www.decof.com/ decof/wp-content/uploads/2014/01/history-of-wrong-sitesurgery-in-ri.pdf Croskerry, P. (2013). From mindless to mindful practice: Cognitive bias and clinical decision-making, New England Journal of Medicine, 368, 2445-2448. Hughes, R. G. (2004). First, do no harm: Avoiding the near misses. Taking into account one ever-present factor: human fallibility. American Journal of Nursing 104(5) 81-84. Retrieved from http:// www.nursingcenter.com/lnc/journalarticle?Article_ID=503368 Nickerson, R. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Review of General Psychology, 2(2), 175-220. Retrieved from http://psy2.ucsd.edu/~mckenzie/ nickersonConfirmationBias.pdf Schulz, K. (2010, June 13). The bright side of wrong. Boston Globe. Retrieved from http://www.boston.com/bostonglobe/ ideas/articles/2010/06/13/the_bright_side_of_wrong/ Schulz, K. (2011). On being wrong. Retrieved from http://www. ted.com/talks/kathryn_schulz_on_being_wrong?language=en St. Andrew’s Presbyterian Church (2012). Do no harm. Retrieved from http://standrewsduncan.org/2012/02/28/do-no-harm/ The Joint Commission (2015). The universal protocol for preventing wrong site, wrong procedure, and wrong person surgery. Retrieved from http://www.jointcommission.org/ assets/1/18/UP_Poster1.PDF
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Labor Lines
AaNA Labor Program Affiliates with AFT by Andrea Nutty In early April, following a member vote, the Alaska Nurses Association (AaNA) Labor Program formally affiliated with the American Federation of Teachers (AFT) Nurses and Health Professionals. In a mail ballot vote that was counted on April 6th, registered nurses in bargaining units represented by the Labor Program overwhelmingly affirmed the recommendation of the AaNA Labor Council to seek affiliation with the AFT. The affiliation was also approved by the AFT executive council in a special meeting the same day. “We are excited and honored that Alaska’s nurses have put their confidence in the AFT, as a voice and fighter for nurses and for quality health care,” AFT President Randi Weingarten said. “Alaska’s nurses will be joining our union of professionals, 1.6 million members strong, including 113,000 members working in the health care industry across the nation, as we continue to fight for quality care, safe staffing levels and high professional standards — and demand that hospitals and health care facilities put patients before profits. We look forward to working with our new Alaska members to ensure they have the tools and conditions they need to care and advocate for the people they serve.” AaNA Labor Council Chair Donna Phillips said the announcement concludes a process that began 18 months ago when the AaNA Labor Program launched an initiative to investigate possible affiliation with a national union and to identify and review possible partners. “We sought a national union with a record of representing registered nurses, one that is active in the AFL-CIO and a partner that will
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give AaNA members a voice in the national policies that affect their work every day,” Phillips said. “We are professionals — and the AFT is the preeminent union of professionals in American labor today.” The AFT Nurses and Health Professionals division members include 85,000 registered nurses in 19 states. The Alaska affiliation will add more than 1,300 nurses in three bargaining units to that membership. “An affiliation with the national union will provide AaNA with training and mentoring opportunities for new and existing leaders, professional development for our members, assistance with new organizing efforts and support for AaNA’s existing bargaining units,” Phillips said. The partnership with the AFT ultimately will give AaNA Labor Program members a role in the national union’s policies and programs for registered nurses and other health care professionals. Changes in the health care industry, particularly recent trends toward mergers and acquisitions that have produced several large multistate and nationwide care-provider
T h e o f f i c i a l P u b l i c at i o n o f t h e A l as k a N u r s e s A s s o c i at i o n
systems, led the AaNA General Assembly to adopt a resolution in 2013 to investigate affiliating with a national union. Two large provider systems operating in Alaska employ many AaNA members. The two systems are Providence Health & Services Alaska, which is part of the third-largest not-forprofit health system in the United States, as well as PeaceHealth Medical System, which operates the Ketchikan Medical Center, as well as other facilities in Alaska, Oregon and Washington. AaNA’s third bargaining unit represents nurses at Central Peninsula General Hospital in Soldotna. Phillips said the new partnership with the AFT will help strengthen the voices of nurses currently in contract talks with Providence Alaska Medical Center in Anchorage. Phillips also emphasized the shared values and experience that led to the choice of the AFT. “The AaNA Labor Council sought to learn what a national union organization could provide to the Alaska Nurses Association Labor Program,” Phillips said. “Ultimately, the Labor Council team concluded that the AFT was the best fit for AaNA’s Labor Program membership, our history, and our vision for the future.”
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PRN Contract Negotiations Update By Donna Phillips The Providence Registered Nurses (PRN) Bargaining Unit of the Alaska Nurses Association is currently in the process of working towards a new collective bargaining agreement. Negotiations between AaNA (for Providence Registered Nurses) and Providence Alaska Medical Center are ongoing at this time. Over the past few months, the PRN Negotiations Team has been hard at work researching, strategizing, and bargaining on behalf of all PRN members. Multiple bargaining sessions between AaNA and Providence Alaska Medical Center have been held, and multiple tentative agreements have been reached. This means there is contract language that the PRN Negotiations Team believes is acceptable, but is still subject to ratification by the members once the entire contract is agreed upon. In order to prepare for negotiations, the PRN Contract Action Team surveyed nurses working at Providence Alaska Medical Center earlier this year to find out what was important to them. Upon reviewing survey results, the Negotiations Team built their plan based on the issues that PRN members indicated were most important: • Registry scheduling • Preceptor and orientor pay • Wages and differentials • Clarified language regarding frequency of absences and tardiness and the related discipline • Parental leave for those not eligible for FMLA • Private, clean areas for breastfeeding or pumping and adequate time to do so • Rewarding long term employment at PAMC • Having a strong say in staffing and safety issues, including environmental issues and increased availability of safe lifting equipment The PRN Negotiations Team continues to work diligently towards a fair and comprehensive contract between the Alaska Nurses Association and Providence Alaska Medical Center. The best way to stay in the loop regarding bargaining progress made and the most current status of negotiations is to attend PRN membership meetings and follow the PRN facebook page. PRN meetings are held on the third Thursday of each month from 4-6 PM at the AaNA office. The PRN facebook page can be found online at https://www. facebook.com/Providence RegisteredNursesAK.
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The Research Behind Medicaid Expansion in Alaska By Sarah Sjostedt Medicaid expansion is a provision of the Affordable Care Act (ACA) that has been left up to the individual states after a Supreme Court ruling. The federal government would cover the costs for the majority Medicaid expansion in it’s first year if approved, but then the state would be required to pay for 10 percent of it by 2020. Governor Walker has been outspoken in his support of Medicaid expansion, and it is under debate in the current legislative session. The decision to expand Medicaid represents one of the most polarizing and important issues presently affecting our state. Expansion of Medicaid in the State of Alaska could mean 40,000 of the most vulnerable of it’s citizens would now have access to affordable health care (Beltrami, 2015). Medicaid represents the one of the largest payees of insurance and provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities (“Medicaid Overview,” 2015). Medicaid is a program funded jointly by states and the federal government, meaning that the state administers the program with assistance from federal funds. Under the ACA each state has the option to “expand” Medicaid, increasing funding and enrollment. If Alaska chooses to do so, it will follow 23 30 other states that have elected to expand coverage. Six other states have expanded Medicaid but have used alternative methods to the traditional expansion (“Map: Medicaid expansion,” 2015). Supporters of Medicaid expansion are partially motivated by a moral imperative to take care of the less fortunate citizens of the state. Citing the importance of access to basic and preventative health care. Not only will expanding health care help upwards of 40,00 Alaskans but also create up to 4,000 jobs in the process. It has little financial risk to the state, the Federal Government will pay all of the costs for the first year and a large portion up to the year 2021 (Beltrami, 2015). Individuals who are not covered by Medicaid are forced to rely on emergency rooms for both primary and acute care, which has often been cited in driving up health care costs. Emergency departments are the only health care entities that have a legal mandate to provide care as a result of the Emergency Medical Treatment and Labor act (ETMALA). Enacted in 1986 EMTALA ensures medical access to care regardless of one’s ability to pay (“EMTALA,” 2012). With emergency rooms acting as a safety net for the 18
Over half of the states have adopted the medicaid expansion
uninsured or underinsured, there is an increase in uncompensated care or services for which providers or hospitals are not reimbursed (“Uncompensated care,” n.d). Uncompensated care is often absorbed by the individual provider or institution or partially paid by Hospital funds or charities or community funded care programs. This leads to increased costs by the institution in effort to recover costs, which can directly increase costs of services. By expanding Medicaid coverage, especially for the other wise ineligible “unworthy” poor, there is an inborn cost control. Increased insurance coverage means reducing the financial burden to individual providers, clinics, emergency rooms, and the health care system on a whole. The middle class is no longer responsible to pick up the bill of uncompensated care (Randolph, 2012). The ACA also provides federal assistance for unpaid bills, if a State’s governor refuses Medicaid’s expansion they will be missing out on these funds (Rome, 2012). Medicaid is already on of Alaska’s biggest budgetary expenditures spending $1,356,288,090 on the program. By expanding Medicaid the state has the opportunity to receive assistance with up 100% of these costs, with the current financial climate, supporters would argue this is a smart decision.
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Opponents of Medicaid expansion correctly cite profound budgetary issues currently affecting the state of Alaska, especially with a recent 4.4 billion loss in the fourth quarter for BP (“AaNA capitol currents,” 2015). With falling oil prices Alaska faces decreased revenue, although there is federal assistance further dependence on the federal government may not be the right choice for Alaska. Although Medicaid expansion costs are covered for the first year, there are no guarantees for subsequent years. Medicaid has long been one of the largest payers of insurance, but it remains a large federal program with a long history of budgeting and financial pitfalls. With the state’s current budget crisis, depending on a promise of federal funding for acostly program is an unwise decision. Government controlled programs such as Medicaid is flawed by design; comparatively privatized options for health care funding provide a more sustainable solution. Working towards reversing the ACA, and implementing high deductible insurance plans in combination with a health savings account provides a more solution to ever increasing health care costs. Further expansion of programs like Medicaid represent insolvent financial decisions that could further indebt our fragile state. Individuals have a right to choose their own health care
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coverage, and the government mandate for insurance coverage as well as distribution of, is a violation of the constitution some argue. Furthermore, further reliance on unguaranteed federal funds is not the answer. Not only does Medicaid further stress fragile state benefits, it has been demonstrated to deliver substandard care. Medicaid was originally designed for children and disabled adults (“Medicaid Overview,” 2015) the expansion would increase coverage for childless adults previously not covered by Medicaid. A recent academic paper suggests that expansion of programs such as Obamacare or Medicaid creates disincentives to work (Chen, 2014). Chapin White’s recent paper A Comparison of Two Approaches to Increasing Access to Care: Expanding Coverage versus Increasing Physician Fees published in the Health Services Research journal demonstrates how Medicaid provides substandard care in three ways. Medicaid underpays doctors for their services, Overall Medicaid expansions do not increase the number of doctor’s visits, and expansion of Medicaid could worsen physician access (Roy, 2012). Expanding Medicaid means a great increase in the number of individuals who are insured, estimates are 41,000 in Alaska.
There has long been a physician shortage in Alaska, especially in primary care. How will the rural communities of our state, already facing extreme physician shortages meet this demand? The current operating budget that was passed by the Alaska House of Representatives calls to the eventual elimination of Medical training program, WAMMI (Hanlon, 2015). How can the financially strapped state meet the absences in primary care, and maintain access? Furthermore, Medicaid’s absurdly low reimbursement rate further disincentives physicians to participate in the program (Roy, 2011). Why expand a program that providers are electing not to participate in? There are many arguments for and against the expansion of Medicaid, it is currently one of the top priorities for the Governor as well as the current legislative session. Health care workers, especially nurses are needed to take roles of leadership and action related to the policy decisions affecting practice. Increased education and awareness of the issues affecting our state, and all of their complexities will allow for further political action. I encourage you to read further on this topic, make up your own mind on the issue, and contact your local legislator.
References: 2015 Capital Currents Week four. (2015). Retrieved from http:// www.aknurse.org/index.cfm/Legislation/Current-Legislation/132 Beltrami, V. (2015, March 23). You are here Commentary Medicaid expansion: A low-risk boost to Alaska’s prosperity. Alaska Dispatch News. Retrieved from https://www.adn.com/article/20150323/ medicaid-expansion-low-risk-boost-alaskas-prosperity Chen, L. (2014, May 15). Best Argument Yet Against Medicaid Expansion. Bloomberg View. Retrieved from http://www. bloombergview.com/articles/2014-05-15/best-argument-yetagainst-medicaid-expansion Emergency Medical Treatment & Labor Act (EMTALA). (2012). Retrieved from https://www.cms.gov/Regulations-and-Guidance/ Legislation/EMTALA/index.html?redirect=/emtala/ Hanlon, T. (2015). Future of Alaska medical school program in hands of state Senate. Retrieved from http://www.adn.com/article/20150318/ future-alaska-medical-school-program-hands-state-senate Map: Where states stand on Medicaid expansion decision. (2015). Retrieved from https://www.statereforum.org/Medicaid-ExpansionDecisions-Map?gclid=CjwKEAjwlsSoBRDoid2ihqnjjlISJABZoG9yQ3xdFXcoDFt_Idt8Tzwv1Rzf2lYBsvz5kvrfahE2BoCaVbw_wcB Medicaid Overview. (2015). Retrieved from http://medicaid.gov/ medicaid-chip-program-information/medicaid-and-chip-programinformation.html Randolph, S. (2012). Giving Healthcare to the Poor Lowers Health Costs for Everyone. Retrieved from http://www.usnews.com/ debate-club/is-medicaid-expansion-good-for-the-states/givinghealthcare-to-the-poor-lowers-health-costs-for-everyone Rome, E. (2012). Expanding Medicaid Is a Moral and Fiscal Imperative. Retrieved from http://www.usnews.com/debate-club/ is-medicaid-expansion-good-for-the-states/expanding-medicaidis-a-moral-and-fiscal-imperative Roy, A. (2011, March 17). New Study: Obamacare’s Medicaid Expansion Will Exacerbate Doctor Shortages. Forbes. Retrieved from http://www.forbes.com/sites/aroy/2011/03/17/new-studyobamacares-medicaid-expansion-will-exacerbate-doctor-shortages/ Roy, A. S. (2012, March 9). Why Obamacare’s Medicaid Expansion Will Reduce Health Care Access. The Atlantic. Retrieved from http:// www.theatlantic.com/business/archive/2012/03/why-obamacaresmedicaid-expansion-will-reduce-health-care-access/254275/ Uncompensated care. (n.d). Retrieved from https://www.healthcare. gov/glossary/uncompensated-care/
What’s in the cloud? Nicotine — Addictive Acetone — Nail polish remover
Ultra-fine particles — Asthma Lead — Brain damage
Formaldehyde — Embalming fluid
E-cigs. Not harmless. Not healthy. Sources: 1. Schripp, T., Markewitz, D., Uhde, E. and Salthammer, T. (2013), “Does e-cigarette consumption cause passive vaping?” Indoor Air, 23: 25–31
2. Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P (2013) “Metal and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol” PLoS ONE 8(3): e57987
alaskaquitline.com
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NURSING GRADUATES
Congratulations University of Alaska Graduates May 2015 Graduates
Master’s Degree Program Graduates Jordin A. Thompson Dara M. Fields Kelly Cerutti Margaret K. Lindley Lindsey N. Leder Jessica C. Heafner Christine O. Bailes Margaret Maixner
Baccalaureate Degree Program Graduates Shannon F Agne Tessa M Beedle Denali E Blackmore Samantha R Brown Kristen L Burns Deidra M Burns Edward W Carman III Lindsey M Dunlap Ingrid A Elvira Cami N Fuller Rachel L Furman Annalyn H Gozun Timothy A Graham Kaylee B Grant Andre P Koehrer Kami N Kramer Kelsey L Marre Jordan M Mattingley Amber L Michael Jennifer M Minsch Nicole G Moore Kayla J Murphy Keith J Nadon Claire E Palmatier
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Spirit of Nursing Award –
Leanne R Pizzi Molly C Quinlan Morgan E Ramseth Amber L Reichardt Julia L Riopelle Maureen Rose Katherine G Rulapaugh Kalee M Rusenstrom Sarah E Sullivan Tandia V Turner Tamara R Van Diest Jacqueline A Van Driessche
Awarded by faculty vote for the student they feel best demonstrates the spirit of caring, science, love of learning, and compassion. Baccalaureate – Amber L. Reichardt Associate – Lori L. Bennett & Jessica L. Countryman
Peer Award –
RN to BS Degree Program Graduates Theodore W. Eyraud, RN Brenda S. Murphy, RN
Associate Degree Program Graduates – Anchorage Marsha A Bailey Taylor R Barnes Katie L Baumgartner Lori L Bennett Laura A Bleicher Erica Dittmar Nichole R Dojka Tabatha A Durand, LPN Jessica C Grinnell, LPN James B Hampton Jessica A Harmon Tara L Hopkins Dylan Y Kelley Hayley B Liston Travis J Marsh, LPN Britney A Murphy
Kayla M Olson, LPN Jordan L Otto Amanda L Rothbarth Abigail Rusak Robert J Schaefer Evinette R Sexton Camlynn J Shearer Kristen R Smith, LPN Aaron P Streeter, LPN Jonathan H Thomas Amber R Van Ness Desiree Velez Norma Zepeda-Navarro
Associate Degree Program Graduates – Juneau Elli R Braaten Kirsten A Elstad Jenny M Farley Wynette Hanna Allison T Kane Lena S Logan
T h e o f f i c i a l P u b l i c at i o n o f t h e A l as k a N u r s e s A s s o c i at i o n
Elizabeth D McKay Anne E Nelson Troy C Sharp
Associate Degree Program Graduates – Kenai Shannon D Biamonte Jessica L Countryman Madison M Dolifka Kathryn A Epperheimer Kadie E Hansen Heather M Hays Jessica L Mahurin Phillip J Wisnewski
Associate Degree Program Graduates – Fairbanks Cameron R Baird Erin R Burnette Lauren A Cordova Alina S Cushing
Rachel J Farris Stephanie V Fitzpatrick Faith A Freel Crystal C Hartman Lindsey A Jacobsen Emily M Lanni Alison C Slay Ariana L Smith Tina Son, LPN Allyson J Squires Melisa M Sturdevant Amy E Warren
Director’s Award – Awarded to the student with the highest GPA. Baccalaureate – Amber L. Reichardt Associate – Taylor R. Barnes, Tabatha A. Durand, Travis J. Marsh & Evinette R. Sexton
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. Baccalaureate – Amber L. Michael Associate – Jessica C. Grinnell Evidence-Based Practice Award – Master – Lindsey N. Leder Baccalaureate – Amber L. Michael Associate – Marsha A. Bailey & Faith A. Freel
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Congratulations Charter College Graduates May 2015 Graduates 1st Nursing Class of Charter College
Associate of Science in Nursing Graduates Cameron Benoit Teresa Bietel Benjamin Carlson Hye Suk Cho Caitlin Eisen Kayla Guzman Tomas Hansen Corin Jensen
Tara Brooke LaFramboise Kristi Naval Michelle O’Brien Jason Ocampo Shannon Robinette Marisela SanchezRamos Brett Schlieve Meleanna ShiuluaButler
Director’s Award – Awarded to the student with the highest GPA. Jason Ocampo
Peer Award – Sponsored by AaNA and awarded by the cohort to a fellow classmate who: maintained good attendance, consistently
demonstrated compassion toward peers, was a leader in the class, was a knowledgeable student, was a good time manager, was always willing to offer help in the clinical area, and showed exemplary compassion and safety to patients. Jason Ocampo
Daisy Award – Awarded to a student who demonstrates exceptional skill and innovative approach to patient care and quality outcomes, advocates for patients through application of knowledge and evidence-based practices, and makes a connection with patients and peers
by building trust and respect through their integrity and professionalism. Hye Suk Cho
Apply your heart and spirit to a nursing career in Ketchikan Nursing and Nurse Leadership opportunities are available at PeaceHealth Ketchikan Medical Center. We’d love to speak with you personally! Call our friendly nurse recruiter: 360-729-2256. Email our nurse recruitment team: Recruitment@peacehealth.org. Visit our website: jobs.peacehealth.org PeaceHealth is a not-for-profit, faith-based health care system. Grow your career in the specialty you’re passionate about! .
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T H E A L AS K A N U R S E • J U N E /J U LY 201 5
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April 2015 BON report to AaNA sent to the Board for review prior to final adoption of the Governance: Dr. Nancy new draft regulations. Sanders is retiring from the The Board held their Executive Administrator annual elections. Denise position this summer. Nancy Valentine, ANP, was re-elected has been the executive for chair and Julie Gillette, public approximately 10 years. member, was elected secretary. Qualifications for being the Senator Cathy Giessel executive are found in the has sponsored SB 53 which Alaska Nursing Statutes. is the Bill that renames ANPs The qualification for the Sharyl Toscano, PhD, MS, to APRNs, Advance Practice executive administrator BSN, RNÂCPN is the newest Registered Nurses. This title is a nurse who must have member of the Alaska change is in compliance with a Masters in Nursing or Board of Nursing. the National Council of State health related field. The Board of Nursing Consensus Model which executive administrator job posting will be aligns all advanced practice registered on Workplace Alaska. nurses in educational requirements Erin Evans, RN board member is and title recognition of the advanced resigning as of June lst. Governor Walker will educated nurse. The APRN Alliance has appoint a new member to fill the remaining worked for over 4 years with the Board of term that will end on March 1, 2018. An Nursing to develop this bill. Please keep RN applicant will be selected through the track of Senate Bill 53 and encourage Boards and Commissions Office. your legislators to pass this bill without The newest RN member of the Board amendments. The Bill passed the Senate is Sharyl Toscano from Anchorage. She and is now in the House Labor and received her Family Nurse Practitioner from Commerce Committee. the University of Massachusetts, Lowell and The Board continues to discuss the has a PhD from Boston College School of Nurse Compact Licensure option. After Nursing. Sharyl has over 20 years of nursing obtaining further information provided at experience. Sharyl has been an instructor the March 2015 NCSBN meeting, Alaska at the bachelor and masters level for 15 BON is not ready to commit. At this time years and is presently a professor at UAA. In there is no advantage for Alaska to join. addition to her job at UAA, she works part There will be a new compact by 2018. time as a certified pediatric nurse at Alaska There is work being done by the National Native Medical Center in Anchorage. Ms Council State Boards of Nursing to begin Toscano is published, has presented for the an APRN compact. To join a compact, the Robert Wood Johnson Foundation and is State of Alaska would have to give up their a frequent presenter at the International sovereign rights which makes this an even Qualitative Health Conference. Sharyl has more complicated option. RNs think it is also presented at other venues include just so they can practice with one state RN the Nurses Network Against Violence license but it is more complicated from the International and the Eastern Nurses Boards view. The Board is open to learning Research Conference. new information and will continue to The Board has drafted new regulations attend NCSBN compact offerings. on a variety of nursing topics. The draft There was a discussion about regulations will be put forth for public telehealth issues and definitions as to comment. Regulations are usually out for where practitioners are licensed versus public comment for 30 days. The best where the clients are. There is a need to way to be informed of regulations that mesh with other agencies and practitioners are out for public comment is to sign up to develop uniform definitions. The groups for the list serve on the BON website. This that are most affected by telehealth public comment time is when anyone decisions are the case management and may make positive or negative comments telehealth RNs. and suggestions about the proposed The next Board of Nursing meeting regulations. All comments received are will be in Anchorage July 8-10, 2015
Student Nurses
by Beth Farnstrom, BSN, RN
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T h e o f f i c i a l P u b l i c at i o n o f t h e A l as k a N u r s e s A s s o c i at i o n
By Teresa Beitel, ADN On April 25, 2015 students from Charter College and UAA volunteered at the blood pressure booth at the Alaska Heart Run. The Heart run is one of the biggest community events in Anchorage that helps raise money to help fight cardiovascular disease and stroke. Students during the health screenings took blood pressures and talked to race participants about the risks associated with heart disease. Also they educated the public on what it is to be heart healthy and taught various lifestyle modifications. It was a great day for a student to engage with the community and practice what they know. Between the readings, clinicals, homework, and examinations nursing school is tough and busy is the perfect word to sum up the life of a student. Sometimes it’s hard to see past these temporary obstacles but moments like this are very rewarding and remind you as students why you work so hard. That day I saw a group of student nurses come alive; confident in their ability to properly educate the public and demonstrate multiple skills they have worked diligently on. What I saw was the future
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on the Rise
Calendar of Events Save the Dates!
AaNA Board of Directors Meeting 4th Wednesday each month 4:30 to 6:00 pm
AaNA Labor Council Meeting 4th Wednesday each month 6:00 to 7:30 pm Contact andrea@aknurse.org for times
of nursing; kind, caring, and compassionate individuals that took the time to individualize each participants experience and make them feel comfortable. One runner (pictured above) approached me and shared that the UAA student nurse he is pictured with forever changed his life. He remembered her from a former event and was so happy that she took the time to sit, listen, and suggest modifications to improve his overall health and he couldn’t be more appreciative to the kindness she demonstrated towards him. Jeanine, the student nurse liaison for Charter College said “we loved being out in the community and meeting people. Especially nurses. It was nice to get out from our pile of books. And by working the booth it helped apply the fundamentals skills we have learned in the classroom setting. At school, the area is quiet and set up for the perfect scenario. Wherever we choose to work it is not always going to be quiet, so it was nice to be able to practice in a different environment.” I agree and volunteering opens up doors and new experiences. Students ,now is the time to get involved with the community and volunteer.
• AaNA Professional Practice Committee • AaNA Health and Safety Committee • AaNA Editorial Committee • AaNA Continuing Education Committee • AaNA Special Events Committee • AaNA Legislative Committee
FREE Webinar Offering from AaNA! You are invited to a free continuing nursing education webinar provided by the Alaska Nurses Association: Child’s Play… Or Not? A webinar introducing an evidencebased practice tool for identifying child maltreatment. Available 24/7, online. Earn 2.0 contact hours. aknurse.telspanexam.com
2015 Asthma & Allergy Conference September 11-12, 2015 conference.aafaalaska.com
Remember to visit: www.aknurse.org/index.cfm/education for frequent updates and information on local nursing contact hour opportunities and conferences!
Providence Registered Nurses 3rd Thursday of each month 4:00 to 6:00 pm
RN’s United of Central Peninsula Hospital Contact for times: 907-252-5276
KTN Ketchikan General Hospital Contact for times: 907-247-3828
Alaska State Board of Nursing Meeting Upcoming Meetings: July 8-10, 2015 - Anchorage agenda deadline June 17, 2015
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October 21-23, 2015 - Fairbanks agenda deadline September 30, 2015 The Alaska Board of Nursing has a listserv that is used to send out the latest information about upcoming meetings, agenda items, regulations being considered, and other topics of interest to nurses, employers, and the public. To sign up for this free service, visit www.nursing. alaska.gov Inquiries regarding meetings and appearing on the agenda can be directed to: Nancy Sanders, PhD RN, Executive Administrator, Alaska State Board of Nursing 550 West 7th Ave, Ste 1500, Anchorage, AK 99501 • Ph: 907-269-8160 • Fax: 907-269-8156 Email: nancy.sanders@alaska.gov
To Advertise in The Alaska Nurse contact Teresa Bracale 907.223.2801 T H E A L AS K A N U R S E • J U N E /J U LY 201 5
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T h e o f f i c i a l P u b l i c at i o n o f t h e A l as k a N u r s e s A s s o c i at i o n 1/30/14 11:34 AM