2017 Clint Jones Award Bestowed

20 Pages·2017·8.96 MB·English

Official Newsletter of New Hampshire Nurses Association
Quarterly publication direct mailed to approximately 17,000 Registered Nurses, LPNs, and LNAs in New Hampshire.
www.NHNurses.org
October 2017 | Vol. 41 No. 4
2017 Clint Jones Award Bestowed
Please be sure to notify us with address
changes/corrections. We have a very large list
to keep updated. If the nurse listed no longer
Ashley Brandes, RN, BSN, is the hospital’s Pediatrics Unit working lives at this address–please notify us to
2017 recipient of the Clint with pediatric patients and
discontinue delivery. Thank You!
M. Jones New Hampshire their families, and serves as
Nursing Award. Brandes, Chair of the Unit Practice
a graduate of St. Joseph Council focusing on Please call [phone] or email
College, received the improving the quality
to [email protected] with
annual award in front and delivery of patient
Nursing News in the subject line.
of her peers during care. In nominating
a special Nurses Brandes for the
Week celebration award, Rebecca
held Wednesday, May Marden RN, MSN, Index
10th, 2017. The Clint CNML, Pediatrics
Jones Nursing Award Clinical Nurse Manager,
was created in 2006 by cited both her support President’s Message . . . . . . . . . . . . . . . . . . . . . . 2
the Foundation for Healthy of her fellow colleagues,
From the ED’s Desk . . . . . . . . . . . . . . . . . . . . . . . 3
Communities to honor the as well as her enthusiasm and
memory of the former director of the commitment to her patients and Nursing Quest Camp 2017
Foundation’s N.H. Nursing their families. “Ashley’s
L-R: Wife and son of the late Clint Jones, Leslie The Future Workforce . . . . . . . . . . . . . . . . . . . . 4
Workforce Partnership. passion for nursing is
and Matthew Jones, Ashley Brandes, RN, BSN
The award recognizes a evident in everything she Welcome New and Returning NHNA Members . . . . 5
registered nurse practicing does. She’s an exceptional
Board of Nursing News . . . . . . . . . . . . . . . . . . . . . 6
in New Hampshire for at least one year but not more family advocate, and has come in on her days off to
than six years, who exemplifies quality, compassionate support her patients during team meetings,” stated In My Opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
nursing care and demonstrates a commitment Marden. “Her level of commitment and engagement
School of Nursing News . . . . . . . . . . . . . . . . . . . . 8
to a career in nursing. Brandes joined the staff at to her patients and her peers directly impact the
Elliot Hospital in 2011 and currently serves on the quality of care we deliver.” Lean Thinking and Doing at Elliot Pediatrics . . . . . . 9
Annual Education Program Highlights
Current Trends . . . . . . . . . . . . . . . . . . . . . . . . 10
Kudos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Taking the Lead
NCLEX Reconsidered . . . . . . . . . . . . . . . . . . . . . 12
NHNA Annual Meeting & Banquet Nurse Lead Initiatives: BERT . . . . . . . . . . . . . . . . 13
From the Bookshelf . . . . . . . . . . . . . . . . . . . . . . 14
Save the date! The New Hampshire Nurses Association At the conclusion of the business meeting, participants Eta Iota Chapter Holds Annual Meeting . . . . . . . . 15
(NHNA) announces the Annual Meeting and Banquet will be free to tour the Discovery Center as all exhibits
In Memory of Our Colleagues . . . . . . . . . . . . . 16-17
will be held at 6:00 p.m. on Wednesday, October 25th will be open to attendees. The Discovery Center has an
at the McAuliffe-Shepard Discovery Center (2 Institute amazing collection of innovative, interactive exhibits to NHNA – The Beginning – Part V . . . . . . . . . . . . . 18
Drive, Concord, NH). This year’s theme is “Taking the explore. Delve into the worlds of astronomy, aviation, Nurses on the Move . . . . . . . . . . . . . . . . . . . . . . 19
Lead!” To start off the business meeting, the NHNA Earth and space sciences and become immersed in this
leadership will review the annual reports from the entertaining learning environment.
President, Treasurer and Chairs of each of the NHNA
Commissions (Commission on Government Affairs, There are programs at the Discovery Center for all To support the theme of “Taking the Lead”, the keynote
Commission on Nursing Practice and Commission ages! From the planetarium theater to the high-tech speaker, Carrie Bosela, BA, RN, CPC, CPC-I and
on Continuing Education). In addition, the results of observatory to workshops for educators…there is Administrative Director of Society for Vascular Surgery
the annual election will be announced. Key this year something for everyone at the Discovery Center. Patient Safety Organization (SVS PSO) will share with
will be the discussion of the proposed NHNA Bylaw the audience how she took the lead in her career and
changes, including the proposed name change to ANA Come hungry! An array of mixed hot hor d’ouvres and how you too can take charge of and take the lead in
New Hampshire. This meeting will provide members stationary tapas trays will be set up through-out the today’s growing healthcare market.
with an opportunity to ask questions, discuss concerns, event area to allow for easy networking, viewing of
or provide comments about the presented reports and the exhibits and poster presentations. For those of you Bosela has over thirty years’ experience in nursing and
the activity of the past year, as well as to discuss future who would like libations there will be a cash bar open health care. She has diverse experience in patient care
directions for the organization. throughout the event.
Taking the Lead continued on page 3
Presort Standard
SAVE THE DATE
US Postage
PAID
Permit #14
NHNA Annual Meeting
Princeton, MN
current resident or 55371
October 25, 2017
Concord
Page 2 • New Hampshire Nursing News October, November, December 2017
Guidelines for Submissions to NH Nursing News
New Hampshire
NH Nursing News (NHNN) is the official publication to [email protected] with NN
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Vol. 41 No. 4
publisher, Arthur L. Davis Publishing Agency, Inc. publication based on the
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NHNA welcomes submission of nursing and health topic of interest, adherence
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Joan Widmer, Nurse Executive Director
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PRESIDENT’S MESSAGE NHNA and the Arthur L. Davis Publishing Agency,
Inc. reserve the right to reject any advertisement.
Responsibility for errors in advertising is limited to
corrections in the next issue or refund of price of
advertisement.
Taking the Lead, Making Change Happen,
Acceptance of advertising does not imply
Saving Lives! endorsement or approval by the New Hampshire
Nurses Association of products advertised, the
advertisers, or the claims made. Rejection of an
advertisement does not imply a product offered for
This will be my last newsletter
advertising is without merit, or that the manufacturer
article submitted as the
lacks integrity, or that this association disapproves
President of the NHNA. My
of the product or its use. NHNA and the Arthur L.
term has been complete
Davis Publishing Agency, Inc. shall not be held liable
with successful transitions. I
want to thank Joan Widmer, for any consequences resulting from purchase or use
Nurse Executive Director of an advertiser’s product. Articles appearing in this
for being such a huge asset publication express the opinions of the authors; they
to the NHNA. She has do not necessarily reflect views of the staff, board,
demonstrated complete or membership of NHNA or those of the national or
commitment to the success local associations.
of the association and to
the Board of Directors and
Bobbie D. Bagley
Commission Chairs. It has
been a pleasure to work alongside of her and all of the
VISION STATEMENT
Board Members of the NHNA over the past year. L-R: Judith Joy, Carlene Ferrier, Joan Widmer,
Bobbie Bagley
In my reflections of the my final term year, I think Empower New Hampshire nurses as leaders in
back to the annual meeting of 2016 and the goal that advancing the profession of nursing and the health of
Specialty Nursing groups in events and activities and will
was set to increase the NHNA membership by 10%, New Hampshire.
continue to support their efforts.
enhance our visibility and increase our reach to the
nursing community to engage more members. This was
My involvement as a Board Member of the Northeast MISSION STATEMENT
accomplished in the events and activities planned during
Multistate Division (NEMSD) with Judy Joy, who served
the year. Three-quarters into the year, membership
as the Vice Chair, confirmed our commitment to our
was up by 7.6%. Events and activities have more than
sister states that NH would work together strategically, NHNA, as a constituent member of the American Nurses
doubled during year! We’ve had the opportunity to
as a participating member of the NEMSD, to develop Association, exists to promote the practice, development
engage our Student Nurses Association and Affiliate
a mission and vision that focuses on strengthening our and well being of NH nurses through education,
state associations in a shared business model designed to empowerment and healthcare advocacy.
maximize resources for efficiencies and sustainability.
Adopted 10-20-2010.
With regards to addressing pertinent issues over the
past year, the opioid epidemic in our state has brought
nurses to the forefront to advocate for policy changes we would be both seen and heard while taking a stance
and take the lead in initiating a comprehensive on critical issues such as rejecting the Trump health care
response to treatment and recovery. Nurses in NH have plan and speaking against the loss of insurance coverage
supported the call to action by participating in train-the for thousands in the state of NH.
-trainer initiatives for Narcan use and distribution in the
community, partnered with health care teams to make It has been a year of making change happen, taking the
the necessary changes in adhering to prescribing rule lead and working harder to save lives! Each President
changes and educating patients on the effects of opioid sets goal priorities during their term that they work
use, misuse and abuse. hard to see realized. I am very pleased that the goals
that I put forth for the association during my term have
I have participated in policy setting hearings, watched been accomplished. I look forward to my continued
and testified for and against legislation that supported participation on the NHNA and supporting the new
or would threaten the health, safety and well being of President Carlene Ferrier.
our communities and citizens in NH. I’ve made calls to
our legislators, submitted letters and went to congress Respectfully Submitted
on the hill so that our voices would be heard. Together, Bobbie D. Bagley
we’ve strategically placed ourselves in positions where NHNA Board President
October, November, December 2017 New Hampshire Nursing News • Page 3
FROM THE ED’S DESK
June 2017 saw NHNA’s first Medical Center and Northeast Delta Dental stepping that contains the minutes from the Board of Director’s
venture into offering an online up to be sponsors for this event. Early Health Fair meetings since the start of 2017. Another page contains
CNE program to its members. participants include AMR Ambulance Service, New the March and June Quarterly Financial Reports; these
Each year the Commission Hampshire Public Health Association, Association of reports demonstrate the financial health of NHNA.
on Nursing Practice prepares Women’s Health, Obstetrics and Neonatal Nurses, We have also added a page under the “Advocacy”
an educational program the Holistic Nurses Association, Banyan Tree Yoga and “Nursing Practice” tabs that host the minutes
on current nursing topics and our sponsoring organizations. The members of the meetings of these Commissions since the first of
through its Spotlight on the Commission on Nursing Practice (CNP) are busy the year. All minutes and the financial reports will be
Nursing Today. This year’s recruiting additional Health Fair participants. posted on the website for a period of six months from
program addressed the the date of posting. We also added another page under
topics of recognizing the The Commission on Nursing Practice members and I the “Continuing Education tab” to host upcoming CNE
stigma applied to individuals have also been busy planning the Annual Meeting and events that are free to participants. From time to time
coping with substance use Awards Banquet. This year’s event will be held at the NHNA will also share CNE events that have a fee for
Joan Widmer
disorder; the role nurses McAuliffe-Shepard Discovery Center in Concord. The participation, but any fees will be clearly noted for
need to play in screening patients for the risk of trauma event is scheduled for October 25th starting at 6:00 website viewers.
injuries related to guns in the home and what nurses pm. See the companion article for more details on this
need to know about therapeutic cannabis. In addition upcoming event. We hope you all will plan to attend. NHNA is now on Twitter. If you are on Twitter follow
to the nurses gathered for these informative discussions us at NHNA@Nhna_nurses. In addition to our tweets,
at our Concord office, we had nurses join us from On September 21st we hosted a meeting of the NEMSD we are following other nursing organizations so our
home through an online conference service. While the Board of Directors at our office in Concord. The NEMSD Twitter feed will have lots of useful information for our
program was not without a few technical glitches, we Board has been investigating non-dues sources of members.
did receive generally favorable feedback on this online revenue for the five member states, as well as looking
offering. We are hoping to be able to provide future for ways to facilitate member growth. The Board also Finally, in May I started calling each of our new
programs via electronic media. So stay tuned… discussed various operational issues regarding the members each month. It has been a great pleasure to
NEMSD. speak with many of you and to welcome you to NHNA.
I have spent much of the summer working on the We are currently developing a new membership video
inaugural NH Healthy Nurse Scholarship 5K Run and If you have not done so already, check out the NHNA to share the many benefits of membership. We will post
Health Fair. We are thrilled to have important NH website, www.nhnurses.org. We have been busy this to our website once it is complete, so log-in and be
healthcare organizations such as St Joseph Hospital, updating the information on the site. For instance, on the lookout.
Elliot Health System, Southern New Hampshire under the “About Us” tab you will now find a page
Taking the Lead continued from page 1 Finally, the winners of the annual
NHNA nursing awards will be
including critical, emergency and home health care intensive care, emergency room announced. These awards include:
care and home health care; spending most of her career in cardiac rehabilitation • Direct Care Nurse of the Year
and physician practice management. Bosela has also served as a professional claims • Professional Advancement
auditor and engaged in process improvement work in hospitals and physician • Champion of Nursing (non-
practices using Institute for Healthcare Improvement (IHI) techniques. For the past six nurse recipient, individual,
years, she has served as the Administrative Director of SVS PSO which governs the group or organization)
Vascular Quality Initiative (VQI). The VQI is the largest clinical registry focused only on • Nurse Leader of the Year
vascular procedures in the United States and Bosela has been instrumental in helping • President’s Award
this organization grow to over 450 member hospitals from 46 states and Canada. She
supports 18 regional quality groups using the registry data for quality improvement All in all, this will be a fun night for
initiatives including process and patient outcomes. all who attend. The goal is to provide
members with a chance to network
In recognition of the theme, “Taking the Lead” in your nursing career, this year NHNA with their peers, learn how to take
will open the event to all members of the nursing team, including LPN’s, and LNA’s. So the lead in their nursing career, learn
invite a coworker to attend the event as well. what NHNA has be doing over the
past year and provide members with an opportunity to voice their opinions on how
Have you been working on an evidenced-based healthcare focused research project NHNA can better serve the constituents.
or quality improvement initiative that that you would like to share? Now is the time to
“take the lead” and share all of the wonderful projects! The NHNA will be hosting a Watch the NHNA website for registration information – nhna.org.
poster presentation opportunity during the banquet. A call for abstracts for the poster
presentations will be issued to nursing leadership at the major healthcare organizations
around the state, as well as the deans of the state’s nursing schools. Posters will be
displayed around the museum.
A study that looked at how often college students check
their smartphones found participants opened their
devices 60 times a day for 220 minutes in the spring of
2015. In a separate study was reported that students
opened their device 50 times a day for 262 minutes in 2016.
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Catholic Medical Center is an equal opportunity employer
RiverMead is an equal opportunity employer. and we embrace diversity. EOE/M/F/D/V
Page 4 • New Hampshire Nursing News October, November, December 2017
Nursing Quest Camp 2017 –
HUMOR ME
The Future Workforce
Ed Note: Regularly exercising our sense of humor
improves resiliency, positivity and balances anti
negatively. Laughter may not solve problems but
can change your chemistry allowing you to face
them anew. In this issue “Humor Me” shares a story
with a different view of the world. Submissions are
welcome.
A poster featuring a young, thin and tanned woman
appeared in the window of a gym.
It said: “THIS SUMMER DO YOU WANT TO BE A
NHNA President Bobbie D. Bagley (L)
MERMAID OR A WHALE?”
pictured with 14 of the 17 NQC campers.
A middle aged woman, whose physical
This is the 9th year that Southern NH Area Health Extension, Southern NH Health Systems and AMR. The characteristics did not match those of the woman
Education Center has sponsored a group of 7-9th graders Executive Director, Paula Smith of AHEC, Bobbie D. on the poster, responded publicly to the question
at the Nashua Nursing Quest Camp. The camp is staffed Bagley, Director of the City of Nashua Public Health posed by the gym.
by nursing professionals with support from counselors Department and President of the NHNA, along with
from high school and college. During the week long camp counselors Brianna and Khaira, congratulated the To Whom It May Concern:
camp, the campers were given the opportunity to campers after they completed the camp in celebratory
learn about different professionals that make up the fashion with certificates of completion. Parents of the Whales are always surrounded by friends
health care team. The campers learned about the campers also attended the ceremony. (dolphins, sea lions, curious humans). They have
nursing profession, became CPR certified, practiced on an active sex life, they get pregnant and have
simulators and visited health care facilities such as the “This camp is so important because of the exposure adorable baby whales. They have a wonderful
hospital, an assisted living facility and the city health given to the youth in the community. It was such an time with dolphins, stuffing themselves with
department. honor once again to work with young people interested shrimp. They play and swim in the seas, seeing
in pursuing careers in the nursing and health care
wonderful places like Patagonia, the Barren Sea
The success of the camp is based on the collaborative professions” – Bobbie D. Bagley and the coral reefs of Polynesia. Whales are
efforts of many organizations that support youth wonderful singers and have even recorded CDs.
resiliency including the Boys and Girls Club of Nashua, Southern NH AHEC also sponsors a camp in Manchester They are incredible creatures and virtually have
City of Nashua Health Department, NAMI, Nashua for 7-9th graders and a camp at Dartmouth College for no predators other than humans. They are loved,
Community College School of Nursing, NH Cooperative 9-10th graders. protected and admired by almost everyone in the
world.
Mermaids don’t exist. If they did exist, they would
be lining up outside the offices of psychoanalysts
Harvest Hill & The Woodlands
35 Tilton Road • Tilton, NH 03276 Mark Mallahan due to identity crisis. Fish or human? They don’t
www.belknapsubaru.com General Sales Manager Harvest Hill is an Independent/Assisted Living community nestled have a sex life because they kill men who get
[email protected] on the campus of Alice Peck Day Hospital an affiliate of Dartmouth close to them, not to mention how could they
[phone] Hitchcock Health, in Lebanon, NH. Seeking staff who are creative, have sex? Therefore they don’t have kids either.
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Not to mention who wants to get close to a girl
[phone]
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LPN – Part Time every other weekend 7:00a-3:30p
LNA – Part Time 7:00a-1:00p
The choice is perfectly clear to me; I want to be
Per Diem LPN/LNA
a whale.
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October, November, December 2017 New Hampshire Nursing News • Page 5
WELCOME NEW and RETURNING NHNA MEMBERS!
NHNA welcomes these new and returning members. Thank you!!!
What do these 89 nurses know that you don’t? If you are not a member ask someone on this list why they joined! Go to nhnurses.org where joining is easy and one of
the best professional values for your money! We want to see your name here in the next issue of the NH Nursing NEWS!
Michelle Andrejak Manchester Meghan Gadapee Littleton Tracia Oshana North Haverhill
Katie Andreoli Manchester Amanda Garnham Concord Chelsea Ouellette Fremont
Katherine Baker Acworth Amy Gensale Pelham Judith Pare Windham
Denise Baxter Merrimack Scott Gladu Goffstown Colleen Pepin Bedford
Yolaine Beaulieu Derry Jennifer Gniazdowski Pittsfield Cheryl Perlo Littleton
Courtney Bergeron Bedford Debra Gottel Durham Cheryl Pineo New Ipswich
Elizabeth Berry Fremont Kate Goyette Manchester Erica Prince Hudson
Amanda Berwick Laconia Cindy Harris Exeter Jill Reid Bow
Crystal Bonias Epping Shay Heath Manchester Rosemary Ridge Manchester
Mary Boyer Merrimack Jennifer Hill Brookline Michael Rockwell Candia
Stasia Cardillo Nottingham Kaitlin Kerrigan Nashua Kati Roe Manchester
Wendy Carmichael Epping Jamie Koch Amherst Beth Rostron Hanover
Kathryn Cate Concord Rick Lapage Hampton Aaron Roudabush Nashua
Marilee Clark Portsmouth Nadine Larochelle Londonderry Patricia Savo Mont Vernon
Marian Conroy Grantham Hannah Lavery Candia Marilyn Scala Henniker
Debra Cook Hopkinton Brooke Lawler Rochester Chelsea Simard Derry
Deborah Cross North Conway Julie Leonard Chester Paige Smigiel tratham
Amanda Currier Rochester Jeanamarie Lopez-Carrasco Litchfield Sarah Smith East Hampstead
Denis Demirovic Manchester Melissa Macarthur Manchester Michelle Solis Candia
Kari Whitehouse Demirovic Manchester Natalie Mayo Portsmouth Jean Sousa New Boston
Morgan Diehm Waterville Valley Catherine McNamara Hudson Corie St Germain Allenstown
Jessica Donigian Newfields Carol Mitchell-Boudreau Stoddard Lauren Stacy Hancock
Jessica Duchano-Ader Merrimack Debra Modugno Merrimack Kristina Stalnaker Holderness
Meghan Duffy Hollis Michelle Moses Merrimack Diane Sweeney Weare
Julio Dutra New Hampton Charity Murray Salem Samantha Warren Lebanon
Hannah Estes Etna Katherine Murray Hudson Susan Weiss Merrimack
Kathleen Fantozzi Manchester Kendra Newton Warren Jenny Wells Stoddard
Emily Finn Portsmouth Lauren Noury Lebanon David Wendel Manchester
Danielle Floyd Manchester Melissa Oconnell Canaan Lisa Young Goffstown
Dorothy Freer Meredith Jennifer Andrade Orbeso Lebanon
MONEY CPR
HELP, It’s an Emergency!
Shawn Harrell, MS, RN expenses. Remember, you are looking for monthly food shopping more efficient and meal planning
necessities. If you lost your job you wouldn’t be taking and preparation more fun with less expensive,
Reprinted from Arizona Nurse a vacation, buying new clothes, or spending money healthier meals for yourself and your family.
May, June, July 2017 Issue on entertainment. You’re looking at rent/mortgage, Make eating out a planned treat.
insurance, car expenses, utilities, food, healthcare
A 2016 report from www.
expenses, and consumer credit bills. You may be able to Whatever strategy you decide to use, be sure to start that
Bankrate.com stated that over
negotiate consumer credit or school loan bills for lower emergency fund on the best day possible, today!
66 million Americans have
monthly payments, but for planning, consider them a
no emergency savings. None,
bill due. Take the monthly total of these expenses and
zip, nada. An emergency
multiple by 3. Remember, 3 months is the absolute
fund is defined as enough
minimum you need.
liquid cash to cover routine
living expenses. Most financial
How are you doing? Are you average, above average,
advisors recommend a
or in trouble? Is the amount you calculated for an
minimum 3 month fund. Some
emergency fund too darn big to contemplate? Start with
advise at least a 7 month fund.
a $1,000 goal. If you need to start or pad that emergency We Improve People’s Lives!
According to the Bureau of
fund, here are some tried and true ideas to help.
Labor Statistics, www.bls.gov,
• Treat the building of an emergency fund like a
the average annual hourly Shawn Harrell Seeking compassionate RNs, LPNs and LNAs for:
bill. Contribute to it every month.
rate for an RN in Arizona • Use a budget. If you don’t have a budget, get on line • Private Duty
was $34.51 in 2015, the last year of complete data.
and find the many helps there are to create a budget. • Pediatric Care
With the help of easily available websites and my crude
• Save money on food by using the store’s loyalty
calculations, I figured the average Arizona nurse, single • Skilled Care
card. If you don’t like carrying around a card,
and not a home owner, brings home about $50,790 after most stores allow you to use a phone number. • Supplemental Staffing
taxes a year. That hypothetical nurse should have around
Several stores also offer discounts on gas for
$12,500 saved in an emergency fund, very liquid and able
using their loyalty cards. Look at unit price to Interim HealthCare offers:
to be accessed any time without penalties.
determine which packaging or sale price is
• Competitive Salary and Benefits
better. Sometimes the results will surprise you.
To determine your after tax monthly income, your pay • Employee Referral Bonus Program
Take your lunch to work. Just that alone could
stub is the best place to start. Remember, in case of an
start an emergency fund. Trent Hamm of The • Free Continuing Education Courses
emergency, you would not be making contributions
Simple Dollar, www.thesimpledollar.com, did
to 401K plans or other automatic routine savings plans. • Per Diem and Full Time Opportunities
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and concluded that while lunch costs something • Six Convenient Locations Throughout NH
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Page 6 • New Hampshire Nursing News October, November, December 2017
NH Public Health Association’s
Holds Annual Meeting
Attended by over 25 nurses, the New Hampshire Public Health Association held its
inaugural Annual Educational Meeting at the Manchester Public Health Office on June
5, 2017. Darlene Morse, NHPHA Co-chair, and Bobbie Bagley, NHPHA Co-chair and
NHNA’s President, welcomed nurses from public health departments, public schools,
behavioral health and the NH correctional system. They shared NHPHA’s mission
and vision statement. The guest speaker for the evening was Dr. Rosemary Taylor,
RN, CNL, a faculty member in the Department of Nursing from the University of New
Hampshire. Dr. Taylor’s spoke on workplace incivility and bullying: “Any One of Us
on a Bad Day: Making Sense of Nurse Bullying, Tough-love, Hoarding and Other
Unprofessional Behaviors.” She described a continuum of incivility, ranging from
distracting behaviors to threatening behaviors, and ultimately physical violence. She
provided statistical data, including incidence and prevalence information. Taylor then
provided information to address the problem of incivility both on an individual basis,
as well as at the organizational level. The topic effectively engaged the audience.
New Hampshire Public Health Association
Vision: Elevating the practice and presence of public health nurses to ensure the
health and wellness of the clinics and communities of New Hampshire.
Mission: The mission of the New Hampshire Public Health Association is to help
strengthen the state’s public health system to improve health, prevent disease,
and reduce costs for all. The NHPHA advocates for the role nurses play as liaison
between primary care, acute care, long-term care and the greater community:
• Focusing on prevention of public health problems
• Developing and coordinating public health best practice to align with all
health systems.
The Board of Nursing responded to four
practice questions during the May and
June 2017 meetings.
Question: Is it within the scope of
practice for a nurse or LNA to reduce
hernias? News
BON: No
Question: Is it within the scope of
practice for a nurse to flush a chest tube
with normal saline?
BON: Yes. An RN can instill normal saline into and irrigate a chest tube
for open drainage only provided there is no danger of spontaneous
pneumothorax with atmospheric pressure entering the pleural space. The
RN should have specialized training and a hospital policy that speaks to
this task. The task should be performed in an area where there is sufficient
staff in possession of specialized knowledge and skills as well as emergency
equipment and monitoring equipment to provide for immediate intervention
if faced with a client adverse event.
Question: Is it within scope of practice for nurses or LNA’s to perform dry
needling under delegation of a provider?
BON: No. This task is not within scope of an RN to perform in a facility or
the community and cannot be delegated as a task via provider. Training for
this skill is directed at MD, DO and DPT professionals.
Question: Is it within an experienced, IV certified, LPN’s scope of practice to
remove a PICC line?
BON: Yes, it is within the scope of an LPN who has completed an approved
IV therapy course and has a facility policy in place may discontinue a PICC
or Midline on a stable client.
_ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
The Board of Nursing met with representatives of the Glencliff Home which
is in the process of an application to offer an entry level LPN program on
their premises. Glencliff is a 130 bed facility located in the White Mountains
which provides services for “New Hampshire’s developmentally disabled,
and/or mentally ill population in a home-like atmosphere with an emphasis
on independence, dignity, and acceptance.” Owned by the State of New
Hampshire and operated by the Department of Health and Human Services it
runs 85-95% occupancy. Currently, the Board recognizes two LPN programs in
New Hampshire: Salter School in Manchester has full approval while Harmony
Health in Merrimack is on probation.
October, November, December 2017 New Hampshire Nursing News • Page 7
IN MY OPINION
Time to Close the Barn Door
Susan Fetzer, PhD, RN father who was administered Narcan while the mother of screen students at least once during their curriculum.
Editor, NH Nursing News his child was in labor. Another colleague shared that the At UNH, screening is done before the first clinical
incidence of sexually transmitted diseases is on the rise rotation, at the beginning of the senior year, and at least
You can’t open the news, as prophylaxis is not a priority in a drug induced state. 5 students are selected at random every 3 months. The
whether a newspaper, Unfortunately, nurses are not immune in an epidemic. screening is mandated by most agencies where clinical
television or a website, rotations are held.
without hearing about Board of Nursing actions against licensees are available
the opioid epidemic. The on their website. A brief scan of actions in the past The National Institute on Drug Abuse estimates that 38%
President declares it a four months found that 11 RN and LPN licenses were of American adults, including nurses, were prescribed
national emergency, and the revoked. Of concern is that 4 revocations (36.6%) an opioid painkiller in 2015. It is time to be proactive
Center for Disease Control were nurses with compact licenses. While the Board of before more patients suffer. The NH Board of Nursing
(CDC) issues the statistics. Nursing has no record of nurses from compact states requires continuing education every 2 years at licensure.
The statistics are staggering: practicing in New Hampshire, it is unlikely that 36.6% In my opinion every licensee should also undergo a drug
• 9.5 million American of the nurses practicing in NH are from compact states. screen as a requirement for re-licensure. In addition, any
adults abused heroin Many of the revocations were emergency suspensions positive drug screen reported on a health care licensee,
or opioids in 2013 related to drug diversions. A review of the minutes whether employed or considered, must be reported to
Susan Fetzerr
• Overdose death rate revealed that there were 6 emergency meetings of this the Board of Nursing. Such an action could decrease the
reaches 19.9 cases for all-volunteer Board in the first 8 months of 2017, equaling number of compact nurses who may be job-hopping to
every 10,000 people in 2016, an increase of 3 that of the entire year in 2016. avoid drug abuse detection. The Board of Nursing has
cases over 2015 the responsibility to protect the public; it is time to close
Removing a license after an addiction is, what my dear the door before the horse is out of the barn forever.
The introduction of Narcan as a “citizen drug,” while departed father used to say, like closing the barn door
rescuing users from the immediate effects of opioids after the horse got out. It is too late. As a result many
has resulted in producing a significant burden on acute employers are requiring drug screenings as a condition
care services. Researchers at Beth Israel reviewed data of employment. Yet, a colleague recently disclosed that
from 23 million hospital admissions in 44 states from 3 potential new hires had been disqualified as a result of
2009-2015. Over 22,000 patients were admitted to positive results. But what happens to the applicant after
ICUs due to opioid overdoses. Once recovered from disqualification? There is no requirement to report the
the immediate insult, many of these patients become licensee to the Board of Nursing, as they have not been
abusive and demanding. “Administrative discharges,” employed. The licensee can find another agency, where Department of Health and Human Services
discharging a patient when they are non-compliant and drug testing is not required. Division of Public Health Services
abusive, have become more common. I have heard
1-800-852-3345 ext. 4931
several stories from colleagues about patients obtaining Several years ago I had the responsibility of telling
drugs from visitors and needing Narcan two to three a sophomore nursing student to find a new major www.getscreenednh.com
days after admission. A patient bragged to a health care when she tested positive for drugs in a routine student
worker, that this was her 6th “Narcan” admission. A screening. All nursing schools in New Hampshire drug
Page 8 • New Hampshire Nursing News October, November, December 2017
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Joan Loftus, RN, has assumed the operational
leadership and oversight of the undergraduate
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ED Note: News from nursing schools, faculty, students or alumni are welcome.
Please direct submissions to [email protected] with NHNN in the subject line.
AMERICAN NURSES ASSOCIATION
Questions to Ask in Making the Decision to Accept a Staffing
Assignment for Nurses
Reprinted with permission of the If the answer to the question is “no,” you have an may result in a request for “safe harbor” and/or peer
American Nurses Association obligation to articulate limitations. Limitations review.
in experience and knowledge may not require 8. Can I take the assignment in good faith?
1. What is the assignment? refusal of the assignment but rather an agreement If not you will need to get the assignment modified
Clarify the assignment. Do not assume. Be certain - regarding supervision or a modification of or refuse the assignment. Consult your individual
that what you believe is the assignment is indeed the assignment to ensure patient safety. If no state’s nursing practice act regarding clarification
correct. accommodation for limitations is considered, the of accepting an assignment in good faith. In
2. What are the characteristics of the patients being nurse has an obligation to refuse an assignment for understanding good faith, it is sometimes easier
assigned? which she or he lacks education or experience. to identify what would constitute bad faith. For
Do not just respond to the number of patients; 5. What is the geography of the assignment? example, if you had not taken care of pediatric
make a critical assessment of the needs of each Am I being asked to care for patients who are in patients since nursing school and you were asked
patient, his or her age, condition, other factors close proximity for efficient management, or are the to take charge of a pediatric unit, unless this were
that contribute to special needs, and the resources patients at opposite ends of the hall or on different an extreme emergency, such as a disaster (in which
available to meet those needs. Who else is on the units? If there are geographic difficulties, what case you would need to let people know your
unit or within the facility that might be a resource for resources are available to manage the situation? If limitations, but you might still be the best person,
the assignment? Do nurses on the unit have access my patients are on more than one unit and I must given all factors for the assignment), it would
to those resources? How stable are the patients, and go to another unit to provide care, who will monitor be bad faith to take the assignment. It is always
for what period of time have they been stable? Do patients out of my immediate attention? your responsibility to articulate your limitations
any patients have communication and/or physical 6. Is this a temporary assignment? and to get an adjustment to the assignment that
limitations that will require accommodation and When other staff are located to assist, will I be acknowledges the limitations you have articulated.
extra supervision during the shift? Will there be relieved? If the assignment is temporary, it may Good faith acceptance of the assignment means
discharges to offset the load? If there are discharges, be possible to accept a difficult assignment, that you are concerned about the situation and
will there be admissions, which require extra time knowing that there will soon be reinforcements. Is believe that a different pattern of care or -policy
and energy? there a pattern of short staffing, or is this truly an should be considered. However, you acknowledge
3. Do I have the expertise to care for the patients? emergency? the difference of opinion on the subject between
Am I familiar with caring for the types of patients 7. Is this a crisis or an ongoing staffing pattern? you and your supervisor and are willing to take the
assigned? If this is a “float assignment,” am I crossed- If the assignment is being made because of an assignment and await the judgment of other peers
trained to care for these patients? Is there a “buddy immediate need on the unit, a crisis, the decision and supervisors.
system” in place with staff who are familiar with the to accept the assignment may be based on that
unit? If there is no cross-training or “buddy system,” immediate need. However, if the staffing pattern is Retrieved from American Nurses Association: http://
has the patient load been modified accordingly? an ongoing problem, the nurse has the obligation to www.nursingworld.org/mainmenucategories/
4. Do I have the experience and knowledge to manage identify unmet standards of care that are occurring thepracticeofprofessionalnursing/workforce/workforce-
the patients for whom I am being assigned care? as a result of ongoing staffing inadequacies. This advocacy/questions-in-decision-to-accept-staffing-
assignment.html
October, November, December 2017 New Hampshire Nursing News • Page 9
Lean Thinking and Doing at Elliot Pediatrics
MaryEllen King, RN Falls are identified as a problem in the morning Huddle, meaning there was a
a daily meeting in which the entire multidisciplinary fall. These visuals are
Health care is being done differently in the Elliot Health team on Pediatrics participates. The A3 status sheet important and effective
System with the implementation of Lean. Lean is not (named for the size paper it is printed on) questions are in keeping everyone on
an acronym. It is a whole new concept of leadership asked: Why is this a problem? How big of a problem the unit aware of progress
and management that stands is it? How much does it and alert to ongoing evaluation. Falls are also discussed
upon the pillars of respect impact patient safety? These with visitors to the unit, from patient family members to
for people and continuous were questions that the hospital senior management.
improvement. Created and Unit Practice Council and
instituted by the Toyota leadership were thinking Falls are discussed again at future daily huddles to
Production System, Lean is about, but now everyone make sure there is continuous improvement. It’s not
finding its way into healthcare including Child Life and considered a task that has been completed. The idea is
facilities across the country even the housekeeping staff to keep falls and all other issues that affect patient care
with some amazing results. is involved. During the Unit at the forefront of everyone’s awareness. In December
“Lean is not a program, it’s not Practice Council meeting of 2016, the pediatric unit celebrated 170 days without
a set of quality improvement the root causes of falls are a fall! This accomplishment was recognized on the
tools, it’s not a quick fix or determined using a fishbone internal hospital wide website, the hospital newsletter,
a responsibility that can be diagram of cause and effect. and written up in the nursing annual report. As of July
delegated; rather Lean is a This method of investigating a 14, 2017 the unit had already gone another 168 days
cultural transformation that changes how an organization problem uses the WHYS: without a fall and they are hoping to beat their previous
works” (Toussaint & Berry, 2013, p.74) • Why did this fall occur? Because of this situation. record. What a change from one way, informational
• Why did the situation occur? Because of this staff meetings with frustrated nurse leaders, disinterested
Lean has certainly transformed the Pediatric Adolescent circumstance. and unmotivated staff and falls occurring at one per
Care Unit of the Elliot Hospital. Becky Marden, the • Why did this circumstance occur? Because of this month to productive and engaging huddles, everyone
Clinical Nurse Manager, and Pam Bedford, the Clinical misunderstanding. feeling fulfilled in their respective roles, and safe, happy
Nurse Leader, can’t say enough about it. The nursing • Why did the misunderstanding occur? Because of patients.
staff are engaged and involved in problem solving on the lack of experience and training.
unit. There is no clutter or disorganization, everything Lean is innovation at its best. It is the reason Toyota is
is clean and bright. Equipment and supplies are orderly The root causes of falls on the Pediatric Unit included the most successful automobile manufacturer with
and easily located. The ‘hustle and bustle’ present on everything from a particular psychiatric patient needing the highest quality product in the world. Nursing and
many inpatient units, is absent here. The atmosphere attention, to poorly fitting healthcare in general, can
is peaceful and productive. Even the patients appear hospital clothing that patients only benefit from changing the
happy. were tripping on, to weakness culture we work in to one that
and instability in postop respects people and strives
The focus is not how an organization implements Lean patients, to children who were for continuous improvement.
but rather how the Lean approach is used every day, feeling better running in the At Elliot, the plan is to change
and specifically how problems are addressed. A prime halls. the culture of the entire
example is the “Old Way” of addressing falls and the system using Lean strategies.
“Lean way” of addressing the problem of falls. Once the root causes have Becky Marden and Pam
been identified, ongoing Bedford both expressed their
Hospital falls and subsequent injury are a big problem discussion with all of the staff commitment this way. When
in health care. According to the Joint Commission “every reveals solid countermeasures asked by senior management
year hundreds of thousands of patients fall in hospitals, to prevent falls. Counter “what would you do if we
with 30-50% resulting in injury.” Injured patients require measures included took Lean away?” Their
additional treatment which prolongs the hospital stay communication with staff on answer was “You can’t take
resulting in additional costs, to say nothing of increased certain patient conditions, it away. We would still do it.
pain and suffering for patients. Fall prevention has training for other ‘float’ staff It has changed the way we
become one of the Joint Commission’s major concerns who might not be familiar think, the way we act, the very
and is one of the National Patient Safety Goals. with pediatric needs, teaching foundation of how we do our
on limit setting for parents, jobs. We are better leaders
On the inpatient pediatric unit at Elliot, there were 12 making sure unit scrubs fit the because we have learned to
falls in 2015 and 9 falls by July of 2016, nearly one fall patient and they are using the manage with new strategies,
per month. These falls do not include developmental safety socks, getting physical focused on continuous
falls without injury. (According to NDNQI, a therapy involved sooner in improvement and respect for
developmental fall is a fall in which an infant, toddler postop situations, identifying our people.” If we just use unit
or preschooler who is learning to stand, walk, run, or ways for safe release of energy. These were definitive, falls as one tiny measure of Lean’s success, the numbers
pivot falls as a part of the developmental process.) The almost “common sense” methods of preventing falls that speak for themselves.
old way of addressing falls would go something like the go way beyond mandates for closer patient supervision.
following. References
The next step was to discuss ways to put these Toussaint, J. & Berry, L. (2013). The Promise of Lean in Health
First, the Clinical Nurse Leader (CNL) and the Clinical countermeasures in place, once again involving staff, Care Mayo Clin Proc. 88(1):74-82. Available at http://dx.doi.
org/10.1016/j.mayocp.2012.07.025
Nurse Manager (CNM) receive data on patient falls. each person who is interested taking on a task. Visual
They decide there are too many falls occurring on the tools are made to track progress, a graph showing the
MaryEllen King, RN, BSN, CPN, is a member of NHNA
unit and something needs to be done. A monthly staff falls, a “falls safety cross,” a daily progress visual set up
Commission on Nursing Practice and practices as a
meeting is held. The CNL and CNM run the meeting like a cross-shaped calendar, with green colored date
triage nurse at Doctor’s Park Pediatrics of the Elliot
and the number one agenda item is patient falls. They boxes meaning no falls that day and red colored boxes
Hospital Physician Network.
tell the staff they need to be more observant; they need
to provide more patient supervision, parent education
and prevent the falls. The staff members all agree
publicly. They all go back to their assignments privately
grumbling to each other that kids fall and nothing can
be done about it. They don’t have time to provide more
supervision and it’s unreasonable to expect. Next month
the fall data is reviewed and nothing has changed. The
CNL and CNM are frustrated. They try a ‘falls campaign’
through the Unit Practice Council and a new fall risk
Come join our “Summerhill Family”
assessment tool is put in place. They also try to figure
out what strategies are and are not working. More falls We currently have openings for
are being reported, but preventing falls from occurring
in the first place is not happening. The managers are 3-11 Shift Nurses
overwhelmed and frustrated because nothing is working. Per Diem All Shifts Nurses
The staff has no input, and they feel like their efforts are
not appreciated.
Competitive Benefits Package includes, shift and weekend
Enter the Lean way. A whole new way of thinking about,
differentials, Health, Dental, Life Insurance, Disability-
looking at, and doing things. Everyone has input and
Accident-Critical Illness Insurance, 401 K as well as Flexible
everyone has a role. The system is aimed at empowering Spending Accounts for both Medical Care and Day Care.
staff to fix problems and make them successful in their
care delivery and profession.
Please stop by 183 Old Dublin Road, Peterborough
to fill out an application.
Page 10 • New Hampshire Nursing News October, November, December 2017
Annual Education Program Highlights Current Trends
Ms. Laurie Nolan-Kelley, a Clinical Nurse Leader in the Emergency
Department at Dartmouth Hitchcock Medical Center, shared her
research on firearms injury prevention. Her focus was on, “Taking
Aim: Educating Health Professionals in Firearms Injury.” The
evidence of injury or death associated with firearm use in the
United States is staggering, with 72,000 annual injuries and
32,000 annual deaths, costing $229 billion in 2014. Ms. Kelley
argued that this data supports classifying firearm
injury a public and population health problem, and
consequently it should be incorporated into the
social demographic screening done by healthcare
professionals. Just as clients are routinely screened for
tobacco, alcohol and drug use, clients should also be
routinely screened for the presence of guns in the home
and whether those guns are secured. Ms. Kelley also
supports posting “weapons free” signs along with “smoke
Each year the Commission on Nursing Practice hosts an annual educational program free” signs at all healthcare offices and institutions.
that focuses on current New Hampshire (NH) nursing topics. On June 15, 2017
nearly sixty nurses attended (online and in person) the Spotlight on Nursing Today’s Lisa Withrow was the final speaker for this educational evening. Ms. Withrow, a
educational session. This year’s program was timely and addressed three significant Nurse Practitioner and principal at Palliativity Medical Group, LLC spoke about
nursing topics that influence NH nursing practice. “Therapeutic Cannabis.” Her presentation began with a brief history of the New
Hampshire therapeutic cannabis law (HB 573, 2013), followed by a discussion of the
The first guest speakers, Aita Vonceil Romain, the Upper Valley Regional Substance client certification process, required treatment follow-ups, and how the local NH
Misuse Continuum of Care Facilitator at Dartmouth Hitchcock Medical Center and dispensaries operate. Ms. Withrow described the complexities of the different strains
Karry LaHaye, a Community Health worker at Dartmouth Hitchcock, spoke on of therapeutic cannabis and various cannabinoid compounds that are available in
“Challenging the Stigma of Substance Use Disorder” (SUD). Ms. Romain discussed the NH. She also discussed the specifics of administration, effects and medical benefits of
history of drug and alcohol misuse and how ethnic origins played a role in labeling therapeutic cannabis.
and the stigma associated with these disorders. She further elaborated on how the
vocabulary used to discuss SUD can further potentiate the stigma. Nurses should Light snacks and assorted beverages were provided by the members of the
avoid using words like addict, drunk and user. To minimize labeling and stigmatizing Commission on Nursing Practice. The post conference survey supported favorable
these disorders should be thought as chronic conditions; one in which there may be evaluations of the speakers and the content. The average knowledgeability scores
periods of setbacks with treatment. She suggested nurses use “abstinent” instead of were between 4.79 and 4.97 (on a 5-point scale) and the average content delivery
“clean” or “sober;” or use “recurrence” “setback” or “flair up” instead of “relapse.” effectiveness scores were between 4.53 and 4.97. Evaluations comments included:
Through the use of case studies, Ms. LaHaye reinforced the need to not judge a “very informative,” “great topics,” “very relevant to current health care issues.”
book by its cover, to remove stigma when working with clients. She shared stories of Attendee’s reported that these programs might change their practice by changing
misdiagnosed clients who were assumed to be “drug seeking.” In closing, several tools “terminology used when referring to situations with abuse,” asking “depressed patients
for reducing the stigma around behavioral health was shared with the audience. These if they have firearms in their home” and “assessing for firearms safety.”
tools included the; Developing a Stigma Reduction Initiative developed by the Center
for Mental Health Service (Pub No. SMA-4176), and the Anti-Stigma Toolkit prepared The NHNA would like to extend a special thank you to the event sponsors and
by The Center East Addition Technology Transfer and The Danya Institute (2012). exhibitors: ALD, Granite State College and Saint Anselm College.