Nursing Matters November 2015

Nursingmatters November 2015 • Volume 26, Number 9

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INSIDE: What if

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Cooper Reflections

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Simulation

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THOMAS DELANY JR.

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Waukegan Firefighters and Flight For Life personnel load a victim in a helicopter at Vista West Hospital located on Washington Street.

PASSION: GIVING ALL FOR OTHERS CITY OF WAUKESHA, WI – A Wisconsin communication specialist was honored nationally in October.

Steph Wilson, Flight for Life communication specialist, was recognized as the 2015 National Association of Air Medical Communication Specialists Communication Specialist of the Year. She was honored during an Air Medical Transport Conference in Long Beach, California.

Wilson was recognized for going above and beyond the call of duty in her promotion of safety, both in the communications center and throughout the entire Flight for Life organization. All 15 association board members chose Wilson as the 2015 recipient. The award is presented yearly to a communication specialist who has demonstrated enthusiasm and excellence in his or her field.

Steph Wilson, center, part of the Waukesha Flight for Life Wilson has been a communication specialist with Flight for crew, is honored as 2015 National Association of Air Medical

See Passion, Page 2

Communication Specialists Communication Specialist of the Year.

November • 2015

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Nursingmatters is published monthly by Capital Newspapers. Editorial and business offices are located at 1901 Fish Hatchery Road, Madison, WI 53713 FAX 608-250-4155 Send change of address information to: Nursingmatters 1901 Fish Hatchery Rd. Madison, WI 53713 Editor........................................... Kaye Lillesand, MSN 608-222-4774 • kayelillesand@gmail.com Managing Editor................................... Julie Belschner 608-250-4320 • jbelschner@madison.com Advertising Representative...................Andrew Butzine 608-252-6263 • abutzine@madison.com Recruitment Sales Manager.......................Sheryl Barry 608-252-6379 • sbarry@madison.com Art Director...........................................Wendy McClure 608-252-6267 • wmcclure@madison.com Publications Division Manager.................. Matt Meyers 608-252-6235 • mmeyers@madison.com Nursingmatters is dedicated to supporting and fostering the growth of professional nursing. Your comments are encouraged and appreciated. Email editorial submissions to klillesand@sbcglobal.net.

Call 608-252-6264 for advertising rates.

Every precaution is taken to ensure accuracy, but the publisher cannot accept responsibility for the correctness or accuracy of information herein or for any opinion expressed. The publisher will return material submitted when requested; however, we cannot guarantee the safety of artwork, photographs or manuscripts while in transit or while in our possession.

EDITORIAL BOARD Vivien DeBack, RN, Ph.D., Emeritus Nurse Consultant Empowering Change, Greenfield, WI Bonnie Allbaugh, RN, MSN Madison, WI Cathy Andrews, Ph.D., RN Associate Professor (Retired) Edgewood College, Madison, WI Kristin Baird, RN, BSN, MSH President Baird Consulting, Inc., Fort Atkinson, WI Joyce Berning, BSN Mineral Point, WI Mary Greeneway, BSN, RN-BC Clinical Education Coordinator Aurora Medical Center, Manitowoc County Mary LaBelle, RN Staff Nurse Froedtert Memorial Lutheran Hospital Milwaukee, WI Cynthia Wheeler Retired NURSINGmatters Advertising Executive, Madison, WI Deanna Blanchard, MSN Nursing Education Specialist at UW Health Oregon, WI Claire Meisenheimer, RN, Ph.D. Professor, UW-Oshkosh College of Nursing Oshkosh, WI Steve Ohly, ANP Community Health Program Manager St. Lukes Madison Street Outreach Clinic Milwaukee, WI Joyce Smith, RN, CFNP Family Nurse Practitioner Marshfield Clinic, Riverview Center Eau Claire, WI Karen Witt, RN, MSN Associate Professor UW-Eau Claire School of Nursing, Eau Claire, WI © 2015 Capital Newspapers

Nursingmatters

More than “just a nurse” Kaye Lillesand Nursing Matters editor‌

There is an old adage, “If you want to be respected, you must behave respectfully.”

I believe that we could easily substitute the word value for Kaye Lillesand‌ respect. That thought led me to wonder what behaviors nurses exhibit that cause others to value their work. Kelley Johnson, Miss Colorado 2015, is an example

of such a behavior when she performed a monologue about being a nurse for the talent portion of the competition. Instead of a gown she wore scrubs and a stethoscope.

The uproar that Joy Behar, a host on The View, caused by questioning why a nurse was wearing a stethoscope has filled TV and social media with comments and thoughts about nurses and the value they bring to society.

Another example I experienced recently was when a friend had a family member in an ICU. She said to me with some surprise, “It is the nurses who do all the work. The doctor is only there for a few minutes.” The family needed to make the painful decision to discontinue life support. When she was telling another nurse and myself about the whole

experience she said, “I don’t know how you nurses do it. You are working feverishly with the patient, keeping us informed and caring for us at the same time.” There was huge respect and a reflection of the value of nursing in her voice.

When people experience the physical and intellectual work that nurses do, they can’t help but value it, but too often we are reluctant to explain our thought processes to patients – what we are assessing and why.

What decisions we are making and why we are doing what we are doing often go unexplained. The public often sees us as “following doctor’s orders.” Katharyn May, Dean of the University of Wisconsin-Madison School of Nursing states, “The intellectual work that

See Editorial, Page 3

Passion

continued from page 1 Life since 2011. She is licensed in the state of Wisconsin as an EMT-Intermediate and a National Association of Air Medical Communication Specialists Certified Flight Communicator. She is a single mother of a 5-year-old son, and has still on many occasions gone above and beyond to ensure there is adequate staff in the Flight for Life Communications Center, even though that means taking time away from her family life.

As a Flight for Life Communication Specialist, Wilson brings professionalism, compassion and dedication to the job every day. She places tremendous importance on the safety of the flight crews. This emphasis on safety was highlighted in the nomination letter, which detailed an occurrence this past year when one of the Flight for Life aircraft was struck by a bird during a flight. Wilson dealt with the stressful situation in a calm professional manner.

She immediately located an alternate landing site for the aircraft and flight crew, resulting in a safe, uneventful landing.

This incident earned her a Flight for Life Safety Award and was a major factor in the Board of Directors decision to select her for this award.

Wilson’s passion for and dedication to her job as communication specialist while always keeping the safety of the Flight Crews a priority has earned her the respect of her colleagues. She was nominated for this award by one of her co-workers, Cory Lund.

“If not for Steph’s compassion for the job as communication specialist and her dedication to safety, who knows where the Flight for Life’s Communication Center would be today,” Lund said.

Flight for Life responds to the scene of a two-vehicle crash in Winnebago County.

Flight for Life responds to a traffic wreck.

Flight for Life has flown more than 34,000 patients throughout Wisconsin and Northern Illinois. As a communications specialist, Wilson is a critical component of each emergency transport, working behind the scenes to ensure the safety of

the patient, first responders and the Flight for Life crew. Her co-workers say they could not be more proud of Wilson winning the award – a pinnacle of achievement that recognizes all that she gives to Flight for Life and the communities they serve.

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November • 2015

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WHAT IF ...

What if a diagnosis hides real issues? Consider functional medicine Brenda Zarth RN, BSN

“Functional Medicine is a personalized, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working Brenda Zarth‌ in collaboration to address the underlying causes of disease,� according to Dr. David Jones and Sheila Quinn from the Institute for Functional Medicine.

They go on to say, “Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental and lifestyle factors that can influence longterm health and complex, chronic disease.�

Functional medicine means looking at a whole person, putting together a timeline of events that may have affected overall health, and focusing on a treatment plan that treats current disease as well as working to prevent future health problems.

Functional medicine suggests there are many factors affecting health, including nutrition, sedentary lifestyle, chronic stress, poverty or being uninsured, environmental toxicity, indoor living and an aging population. Functional medicine aims to integrate the science of medicine with the art of

Editorial

continued from page 2 nurses do is invisible.� Only nurses can make it visible to the public.

We are not “Just a nurse.� We are

clinical practice. It works to restore balance in the complex adaptive system that is the human being.

What if, in conventional medicine, labeling symptoms with a diagnosis code sometimes prevents us from digging deeper to find the real issues? Once the disease is labeled we continue to treat symptoms according to algorithms and treatment plans. I think illness is more individualized than that, and spending time investigating the beginning can prevent wasted resources and time.

This is where Functional Medicine makes sense. For example, a woman goes to her doctor with high blood pressure. Labs and diagnostic tests are normal. She is given an antihypertensive medication to bring down her blood pressure. What if her blood pressure is elevated because her husband filed for divorce, her son is taking drugs, she is filing bankruptcy and she has a history of poor nutrition? She is losing her ability to cope.

The antihypertensive medication may lower her blood pressure but it really isn’t fixing the underlying causes of her high blood pressure.

Functional medicine also addresses the adaptability of the human body. Imagine that our brain prioritizes where calcium is utilized based on critical need. We know the body uses calcium to relax muscle and for bone strength, and we can use it as a buffer in digestion. If the body can pull calcium from many different sources to satisfy the body’s needs, it would make sense that a lack of calcium might affect muscle relaxation, our ability to buffer acid in our stomach and cause brittle bones. A long-term dietary deficiency of calcium might relate to muscle

intelligent and caring individuals who do everything in our power to improve the health of patients and families we work with.

When we value what we do, our behavior will demonstrate it and the public will recognize our value to society.

aches, indigestion and osteoporosis. Taking a drug for indigestion in this case might not be as beneficial as identifying dietary deficiencies, genetic history and assessing lifestyle.

To further complicate this example, if we need Vitamin D to absorb calcium and we don’t have enough in our environment, we might have enough calcium but a decreased ability to utilize it. The calcium deficiency may not be found in a lab test because the brain is regulating the supply of calcium and might find the calcium level of the blood to have a higher priority than calcium in the bone.

Looking at the whole picture might better identify a timeline of when the body demonstrated it was losing its ability to cope and what deficiencies led to the problem.

Identifying the cause and treating the true dysfunction might prevent a health problem from continuing to escalate, and prevent subsequent additional system failures.

Functional medicine can go into great depth investigating environmental exposures, lifestyle influences and genetic predispositions to determine an evolving plan of action as the body continues to adapt.

According to the Institute for Functional Medicine, functional medicine is shaped by seven core principles: 1. Acknowledging the biochemical individuality of each human being, based on concepts of genetic and environmental uniqueness; 2. Incorporating a patient-centered rather than disease-centered approach to treatment; 3. Seeking a dynamic balance among the internal and external factors in a patient’s body, mind and spirit; 4. Addressing the web-like interconnections of internal physiological factors; 5. Identifying health as a positive vitality – not merely the absence of disease – and emphasizing those factors that encourage a vigorous physiology; 6. Promoting organ reserve as a means of enhancing health span, not just the life span, of each patient; and 7. Functional Medicine is a science-using profession.

Email BrendaZarth@gmail.com or visit brendashealthplan.blogspot.com to give comments.

November • 2015

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Nursingmatters

Reprint in a series written by Signe Cooper and introduced by Laurie Glass in Nursingmatters

Sister Emma Lerch — 1878-1953 Sister Emma Lerch, a Lutheran deaconess and dedicated nurse, had an extensive career in nursing, all at the former Milwaukee Hospital, which is now part of Samaritan-Aurora Health Care. When she retired in 1949, she had directed the School of Nursing for 38 years.

Sister Emma was born Dec. 7, 1878, in Switzerland and came to America with her widowed mother when she was very young. They settled in the Swiss Community of Hollandale in Iowa County,

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Wisconsin. In 1897, she became a candidate in the Lutheran Motherhouse in Milwaukee. While studying to become a deaconess, she became interested in nursing. She then completed the nursing program at the Milwaukee Hospital Training School for Nurses.

Serving as a staff nurse, head nurse in the operating room and as chief anesthetist, in 1911 Sister Emma was appointed superintendent of nurses and director of the school of nursing. During her tenure, nearly 1,000 young women completed the nursing program.

In 1948, she was awarded an honorary Doctor of Laws degree from the Capitol University in Columbus, Ohio, in recognition of her 50 years of service to the Milwaukee Hospital. Two years later she was presented the annual award of merit by the Wisconsin Hospital Association.

Sister Emma was highly regarded in nursing circles. An item in the March 1934 bulletin of the Wisconsin State Nurses Association stated, “Sister Emma’s ability to maintain the highest ideals for the preparation of young women for the field of nursing and to maintain for the hospital a good nursing service has won her the respect of the medical and nursing

profession ...”

Sister Emma was noted for her devotion to duty, loyalty to her profession and zeal for work. Her unusual energy was credited in part to her ability to relax while absorbed in her hobby of nature study. Even during her busiest years, she found time – usually in the early morning hours – to go birding in a nearby park.

She would identify hundreds of species of birds and flowers.

After her retirement in 1949, she traveled to various parts of the country, returning to the motherhouse in Milwaukee at intervals. She volunteered at the hospital until ill health prevented her from doing so. She died of cancer July 23, 1953, survived by two sisters and three brothers.

Sister Emma’s philosophy of nursing was expressed in words written for one of the graduating classes of the Milwaukee Hospital School of Nursing.

“In giving of service you will learn the secret of true happiness. Believe in yourself, believe in humanity, believe in the success of your undertaking. Fear nothing and no one. Love your work. Work, hope, trust. Keep in touch with today. Teach yourself to be practical and up-to-date and sensible. You cannot fail.”

Sister Emma Lerch

The author thanks Joyce Nedset of the Milwaukee Hospital School of Nursing Alumni Association for information and Sister Rose Kroeger for the photo of Sister Emma.

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CALENDAR Nov. 13: Mindfulness Meditation from a Clinical Perspective University of Wisconsin-Madison Continuing Studies Visit continuingstudies.wisc.edu/ behavioralhealth or call 608-262-2451 for more information.

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November • 2015

Nurses, physician assistants move lawsuit forward WASHINGTON, D.C. – Advanced-practice registered nurses, physician assistants and other healthcare professionals employed by the U.S. Department of Veterans Affairs are one step closer to having their day in court through a lawsuit claiming they have been required to work off the clock for years.

Attorneys W. Michael Hamilton of Provost Umphrey Law Firm LLP in Nashville and David M. Cook of Cincinnati’s Cook & Logothetis LLC are leading the lawsuit on behalf of the VA healthcare workers. The U.S. Court of Federal Claims in Washington, D.C., has announced a Nov. 16 deadline for the plaintiffs’ amended complaint in Mercier, et al. v. The United States of America, No. 12-920C. “We’re looking forward to taking depositions of VA officials who have required thousands of nurses to work an untold number of hours for no pay at all,” Hamilton said. “We plan to prove that our clients were put in the horrible position of having to either work off the clock or face disciplinary measures.”

The lawsuit seeks overtime pay for eligible VA employees from 2006 to the present. The plaintiffs say the VA required them to perform extensive patient-related work for no pay using

their VA facility computers, home computers and/or VA-supplied laptop computers, which include instructions for logging in from home. Those who do not complete the extra work are subjected to additional scrutiny from VA management, including disciplinary measures such as being written up for poor time management, the lawsuit says.

“These nurses and physician assistants are working ridiculous hours trying to save veterans’ lives or simply make their lives better, and they’re being punished for it, which is shameful,” Cook said. “These crucial healthcare workers are the primary clinical contact for countless veterans, but they’re not being paid for all their work.”

Currently, the VA employs more than 80,000 nurses in more than 1,400 medical centers and outpatient clinics in all 50 states, making the VA the largest employer of nurses in the United States. The number of VA healthcare workers who may be covered by the ongoing lawsuit is unknown, but Hamilton and Cook estimate that as many 7,000 could be eligible if the lawsuit is certified as a class action.

Contact Bruce Vincent at 800-559-4534 or bruce@androvett.com for more information.

Assistant Professor of Nursing Predolin School School of of Nursing Nursing at at Edgewood Edgewood College College announces announces the theopening openingfor for The Henry Predolin two full-time full-time tenure tenuretrack trackfaculty facultypositions positionsbeginning beginningwith withthe theacademic academicyear year2015-2016.

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Page 5

Researcher to lead conference Jason Farley, a leading researcher and prevention of HIV infection.

It’s an exciting recognition and in HIV/AIDS at the Johns Hopkins privilege.”

School of Nursing, is beginning his Last year Farley led an initianew role as president of the Assotive at the Johns Hopkins School ciation of Nurses in AIDS Care at of Nursing through the organization’s annual a $1.5 million grant conference. Through his to launch a new HIV term as president-elect, curriculum that gave Farley – PhD, MPH, students more time in ANP-BC, FAAN, AACRN clinical placement and – has been preparing to sensitivity training to lead the organization in challenge preconcepits mission to enhance tions they might have nurse development in about patients living HIV care, improve the with or at risk for HIV. health of those living Jason Farley In the local commuwith HIV, and lead both nity, Farley works with nurse and public awarethe Baltimore City Health Departness. According to Farley, mentorship brought him to the association, ment to scale up HIV-prevention services. Nationally his annual and the same ideals of bringing in “Diagnosis, Care, and Management the next generation of HIV nurse of Persons with HIV/AIDS” course leaders will guide him as president. provides a full week of presenta“Because of my mentors, I tions, discussions and training that was introduced to (Association utilize evidence-based strategies of Nurses in AIDS Care) and the to enhance patient-centered outnetwork of like-minded clinicians, comes. As a global epidemiologist, researchers, and advocates,” he his work in South Africa addressing said. “One of my central roles as the high prevalence of HIV and president is to help lead other multi-drug-resistant tuberculosis nurses to the same ambition of co-infection is also changing the learning, researching, and advocatnursing role in its management. ing for better treatment outcomes

November • 2015

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Nursingmatters

Guidelines support use of simulation WASHINGTON, DC – Guidelines released in October from the National Council of State Boards of Nursing emphasize the use of simulation in nursing training, and recommend certification to demonstrate that lead faculty and simulation-lab personnel are qualified.

The guidelines specifically cite the Certified Healthcare Simulation Educator as a suggested resource for simulation educators. The Certified Healthcare Simulation Educator is one of several certifications offered by the Society for Simulation in Healthcare, the leading professional association that advances the art, science and practice of healthcare simulation. Additional certifications offered by Simulation in Healthcare include the Certified Healthcare Simulation Educator -Advanced, and Certified Healthcare Simulation Operations Specialist. “The guidelines issued underscore the effectiveness of simulation-based practices in healthcare education as they favorably compare with those that occur in the clinical setting,� said Dr. Pamela Andreatta, president of the Society for Simulation in Healthcare. “Importantly,

the guidelines also emphasize the need for certification in simulation-based instruction to assure the inclusion of evidence-based best practices in the application of simulation techniques for clinical training.�

Published in the Journal of Nursing Regulation, the guidelines cite a study demonstrating that high-quality simulation experiences could be substituted for up to 50 percent of traditional clinical hours across the prelicensure nursing curriculum. They also cite several additional studies supporting

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the use of simulation in nursing training, including one that found that simulation improved the critical thinking, performance of skills, knowledge of the subject matter and increased clinical reasoning in certain areas.

Members of the Society for Simulation in Healthcare served on an expert panel that developed the guidelines to assist boards of nursing in assessing whether a nursing education program is ready to adopt simulation into its curriculum and substitute it for traditional clinical experience, and to direct nursing programs on the appropriate method for establishing and using simulation in the undergraduate curriculum.

The Society for Simulation in Healthcare seeks to improve performance and reduce errors in patient care through the use of simulation. Established in 2004 by professionals using simulation for education, testing and research in

“The guidelines issued underscore the effectiveness of simulation-based practices in healthcare education as they favorably compare with those that occur in the clinical setting. Importantly, the guidelines also emphasize the need for certification in simulation-based instruction to assure the inclusion of evidence-based best practices in the application of simulation techniques for clinical training.�

Dr. Pamela Andreatta, president of the Society for Simulation in Healthcare

healthcare, society membership includes nearly 3,200 physicians, nurses, allied health and paramedical personnel, researchers, educators and developers from around the globe. The society fosters the improvement and application of simulation–based modalities such as human patient simulators, virtual reality, standardized patients and task trainers.

Nurses urged to be vaccinated SILVER SPRING, MD – The American Nurses Association urges all registered nurses to get a seasonal influenza vaccination and to advise their patients to be vaccinated.

Flu vaccination coverage rates have steadily increased, particularly over the past five years, according to the Centers for Disease Control and Prevention. During the 2013-14 and 2014-15 flu seasons, vaccination rates for RNs were 90.5 percent and 89 percent, respectively, an increase from 69.8 percent in 2010-11. “As the nation’s largest healthcare workforce, nurses must be true advocates, educators and role models of health and wellness,� said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “This

includes setting the standard for immunization to protect ourselves, our families, our patients and our communities.�

The association has adopted a new position on immunization that aligns with the CDC’s guidance, calling for all people age 6 months and older to be vaccinated every season, with certain exceptions based on a person’s health and other factors. The position allows for exemptions for medical reasons or religious beliefs. The position on immunization for healthcare personnel also aligns with the “Statements,� which states RNs have an ethical responsibility to “model the same health maintenance and health-promotion measures that they teach and research,� including immunization.

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November • 2015

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Nursingmatters

Honor Society open to applications INDIANAPOLIS — The Honor Society of Nursing, Sigma Theta Tau International is accepting applications through Jan. 3, 2016, for its Maternal-Child Health Nurse Leadership Academy. The society’s International Leadership Institute administers the academy mentoring program in partnership with Johnson & Johnson Corporate Contributions.

The Maternal-Child Health Nurse Leadership Academy is an outcomesfocused, highly selective 18-month leadership development experience that pairs maternal-child health nurses and nurse midwives with experienced Leadership Mentors. The academy prepares these nurses for effective inter-professional team leadership as they strive to improve the quality of healthcare for underserved childbearing women, along with children up to 5 years old. Since 2004, more than 90 mentor/ mentee pairs from more than 35 states and two provinces in North America have participated in the academy.

“We are proud to partner with (Sigma Theta Tau International) on this premier leadership development initiative,” said

Yezenia Ramos, manager, Corporate Contributions at Johnson & Johnson. “We look forward to working together to build and expand nurse leadership and management programs that will make a broader impact in healthcare delivery and improve health outcomes for more patients.”

For more than 90 years, Sigma Theta Tau International has honored the best and brightest women and men in nursing.

The honor society provides its members with exclusive programs, resources and opportunities such as those offered through the International Leadership Institute, including the Maternal-Child Health Nurse Leadership Academy.

“As a global organization that brings together top-performing nurses in all disciplines of the profession, (Sigma Theta Tau International) is dedicated to providing care to vulnerable populations,”

said society President Hester C. Klopper, PhD, MBA, RN, RM, FANSA, FAAN. “Fellows of the Maternal-Child Health Nurse Leadership Academy achieve significant professional growth during their academy participation. The impact that their work has on this population is outstanding.”

The 2016-2017 cohort will begin in April 2016. Visit www.nursingsociety.org/ mch for more information.

The Honor Society of Nursing, Sigma Theta Tau International is a nonprofit organization whose mission is advancing world health and celebrating nursing excellence in scholarship, leadership and service. Founded in 1922, it has more than 135,000 active members in more than 85 countries. Members include practicing nurses, instructors,

“We look forward to working together to build and expand nurse leadership and management programs that will make a broader impact in healthcare delivery and improve health outcomes for more patients.”

Yezenia Ramos, manager, Corporate Contributions at Johnson & Johnson

researchers, policymakers, entrepreneurs and others. About 500 chapters are located at about 695 institutions of higher education throughout Armenia, Australia, Botswana, Brazil, Canada, Colombia, England, Ghana, Hong Kong, Japan, Kenya, Lebanon, Malawi, Mexico, the Netherlands, Pakistan, Portugal, Singapore, South Africa, South Korea, Swaziland, Sweden, Taiwan, Tanzania, Thailand, the United States and Wales.

Visit www.nursingsociety.org for more information.

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