Official Newsletter of New Hampshire Nurses Association Quarterly publication direct mailed to approximately 23,000 Registered Nurses, LPNs, and LNAs in New Hampshire.
July 2016 www.NHNurses.org Vol. 40 No. 3
Please be sure to notify us with address Navy Nurse Honored with Vietnam Vets changes/corrections. We have a very large list to keep updated. If the nurse listed no Ann Darby Reynolds of Exeter, French door when a 200-pound bomb in a panel truck longer lives at this address–please notify us to one of the first women in the went off in the Brink’s garage. The door blew into the Navy to receive a Purple Heart discontinue delivery. Thank You! room and glass broke on top of Reynolds, cutting her in the Vietnam War, was among in the leg. Since she was on call that evening, her first dozens of Vietnam veterans thought was, “Oh boy. Hospital OR [operating room] Please call (603) 225-3783 or email honored at a breakfast April 25, call. Here we go!” Dazed, Reynolds tried to go to her to [email protected] with 2016, commemorating the 50th bedroom to retrieve her sneakers but was ordered to anniversary of the war held at the Nursing News in the subject line. evacuate by another officer. She noticed fire and smoke Veterans Administration Medical as she made her way to the building’s courtyard, and Center. The commemoration then tried to assist the victims. When the ambulances extends from Memorial Day arrived, she got into the first one and took some patients 2012 through Veterans Day 2025. to the hospital six miles away. Reynolds had no idea One of its objectives is to thank she was bleeding until a corpsman said, “You need to Vietnam veterans, including Ann Darby Reynolds be sutured so I am putting a suture set aside for you.” prisoners of war and those listed Reynolds worked on patients until everyone was taken as missing in action, for their service and sacrifice on behalf of Index care of before requesting that her leg be examined. Navy Nurse Honored...... 1 the United States. Report from Governor’s Commission. . . . .2 Reynolds graduated in 1961 from St. Anselm College and Reynolds continued when interviewed by The Union Leader President’s Message...... 3 arrived in Vietnam in February 1964. She was the youngest noted “I was going on adrenaline. I was focused and went Navy Nurse at the Station Hospital Saigon. Her story has been right down to the operating room with those two patients,” she Save the Date! ...... 3 chronicled on the Naval History blog (www.navalhistory.org); said. The rest of the hospital staff came in behind her and all PPI and Clostridium Difficile Infection. . . 4-5 and featured in the Navy Magazine “All Hands” in March went to work. As she was being treated, another patient, who In My Opinion...... 6 2011 (http://www.moaa-nh.org/All_Hands_Mar_11.pdf) she knew from mealtimes in the cafeteria, was put beside her. “He didn’t survive,” she said, her eyes tearing up. “I This Month in Nursing History...... 7 still remember his last words – ‘Don’t let me die.’ That was From the Bookshelf...... 7 Lieutenant (junior grade) Ann Darby spent much of her Christmas morning. That was not a good Christmas.” time in Saigon working late night shifts in the surgical In Memory of Our Colleagues...... 8-9 ward or the intensive care unit. When she wasn’t treating The Brink BOQ bombing destroyed three floors of the KUDOS...... 10 the wounded, she was marching up and down the hotel’s building, killing two U.S. servicemen and injuring 63 five flights of stairs delivering food to patients. Even on Americans, an Australian Army officer, and 43 Vietnamese Eta Iota Sigma Theta Tau Chapter News. . .10 her days off, Darby devoted precious time hunting down civilians. Four Navy nurses in the building, including Humor Me...... 11 scarce hospital supplies at various Saigon apothecaries, Reynolds, were wounded in the attack and each one insisted often paying for items with her own money. on treating victims at the scene and helping with disaster Welcome New and Returning Members. . . 11 Reynolds shared an apartment with three other nurses response before tending to their own injuries. In recognition of School News...... 12 being injured during war and for her courageous service to our in the Brink Bachelor Officers Quarters (BOQ) – a NCLEX Reconsidered ...... 13 drab seven story hotel leased by the Navy to provide country, Reynolds was one of four Navy nurses who received housing for American officers in Saigon. Commander the Purple Heart during the Vietnam War. Student Nurse Conference 2016...... 14 Ann Richman, the head nurse, instructed Navy nurses Letters to the Editor ...... 15 to always travel in pairs and never leave their quarters Reynolds remained in Vietnam until March 1965. She after dark. “We heard that they had a price on the continued her Navy career earning the senior rank of Captain Board of Nursing News...... 17 heads of the medical personnel,” Reynolds later told and serving as the Chief Nurse at several Naval Hospitals. She What Does 72 Cents Buy in 2016. . . . . 19 retired in 1988 serving for over 26 years. In 2013 St. Anselm’s an historian, “A nurse was worth $25 dollars and a Membership Application...... 19 physician was worth $50.” awarded Reynolds the Alumni Award of Merit for her life- long devotion to the nursing profession and for providing On Christmas Eve, 1964, Reynolds stood in her living quality health care. room and gazed across the street hoping to see Bob Hope, who had just arrived in town for his annual Christmas tour. She had her face pressed against a
On May 13, 1908, President Theodore Roosevelt signed the Naval Appropriations Bill, establishing Presort Standard the Nurse Corps as an essential component of the Navy. Since then, the men and women of the Nurse US Postage Corps have served in times of peace and war, at home, overseas and on the front lines. From the first PAID Navy nurses in 1908, to 4,200 Navy nurses serving today, the Nurse Corps has answered the call, Permit #14 often at great sacrifice, to care for those entrusted to us when they need us most. In 1921, 11 Navy Princeton, MN Nurses became the first military women to serve aboard a hospital ship, the USS Relief. In 1972, a current resident or 55371 Navy nurse, Alene Duerk, was the first woman in the Navy to achieve flag rank. An integral part of the Navy Medicine team, Navy nurses fly with wounded; provide care for the fleet and aboard hospital ships; establish nursing schools, clinics, and small hospitals in remote locations; and serve in military treatment facilities worldwide. Navy nurses are scientists, teachers, researchers, providers and clinicians and are essential to force health protection and readiness.
– Taken from a 108th Birthday Salute from Vice Admiral Forrest Faison, Surgeon General Page 2 • New Hampshire Nursing News July, August, September 2016 Guidelines for Submissions to NH Nursing News NURSING NEWS NH Nursing News (NHNN) is the official publication of as attachments to [email protected] the NH Nurses’ Association (NHNA), published quarterly – with NN Submission in the subject Vol. 40 No. 3 and available in PDF format at our website: www.nhnurses. line. Official publication of the New Hampshire Nurses’ org Views expressed are solely those of the guest authors or Association (NHNA), a constituent member of the persons quoted and do not necessarily reflect NHNA views or Publication Selection and Rights: American Nurses Association. Published quarterly those of the publisher, Arthur L. Davis Publishing Agency, Inc. Articles will be selected for every January, April, July and October. 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Ad sales fund publication and For advertising rates and information, please interest and identify any applicable commercial affiliation. Email mailing of NH Nursing News and are not paid to NHNA. contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. NHNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. MISSION STATEMENT VISION STATEMENT Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement. NHNA, as a constituent member of the American Nurses Cultivate the transformative power of nursing. Association, exists to promote the practice, development Adopted 10-20-2010. Acceptance of advertising does not imply and well being of NH nurses through education, endorsement or approval by the New Hampshire empowerment and healthcare advocacy. Nurses Association of products advertised, the Adopted 10-20-2010. advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves Report from Governor’s Commission of the product or its use. NHNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use Ed Note: Todd Gardner is the NHNA Representative and addiction need readily available, highly trained, of an advertiser’s product. Articles appearing in this to the Governor’s Commission on Alcohol and Drug trauma-informed clinicians to guide their recovery publication express the opinions of the authors; they Abuse Prevention, Intervention, and Treatment. He and that the lack of support, incentives, or adequate do not necessarily reflect views of the staff, board, submitted this report to the Board of Directors during compensation for social workers and mental health or membership of NHNA or those of the national or the April, 2016 meeting. counselors in this state is concerning. local associations. The April 22, 2016 session began with the The Department of Health and Human Services gave introduction of James Vara of New London, Governor a status report on New Hampshire’s Medicare and Hassan’s newly appointed Advisor on Addiction Medicaid Section 1115 Research and Demonstration and Behavioral Health. As the newest member of Transformation Waiver. will enable health care providers and community the Commission, Vara plans to meet with each partners within a region to form relationships focused Commission member individually in the coming On January 5, 2016 the Centers for Medicare and on transforming care. This funding will also provide weeks to better understand our work. Medicaid Services (CMS) approved New Hampshire’s prompt resources for combatting the opioid crisis Section 1115 Research and Demonstration and strengthening the state’s strained mental health The NH Human Trafficking Work Group presented Transformation Waiver, #11-W-00301/1 to access new delivery system. For more information on Waiver a report on their ongoing work. The group’s mission federal funding to help transform its behavioral health 1115: http://www.dhhs.nh.gov/section-1115-waiver/ is to develop and implement a coordinated and delivery system. index.htm collaborative, victim-centered, trauma-informed, multidisciplinary response to human trafficking The Transformation Waiver has four main targets: There was a brief legislative update. The status of in New Hampshire. The group’s main goals are • Deliver integrated physical and behavioral the following current opioid related legislation can identifying trafficking victims, investigating and health care that better addresses the full range of be searched at: http://www.gencourt.state.nh.us/bill_ prosecuting, and providing comprehensive, victim- individuals’ needs status/quick_search.html centered, trauma-informed services to support all • Expand capacity to address emerging and ongoing survivors. It is recognized that human trafficking behavioral health needs in an appropriate setting SB 485 SB 369 SB 576 HB 1423 is often perpetrated by a person coercing the victim • Reduce gaps in care during transitions across into performing sexual acts in exchange for drugs. care settings by improving coordination across HB 1681 SB 523 SB 522 SB 430 The victims suffer from sexual trauma and the providers and linking patients with community HB 1619 SB 447 SB 532 HB 270 resulting drug addiction and the perpetrator controls supports. both. I offered that survivors of human trafficking • Move fifty percent of Medicaid reimbursement HB 1210 SB 533 HB 271 SB 464 to alternative payment models by the end of the demonstration period The session closed with brief Task Force reports and public comments. By providing funding to support delivery system transformation—rather than to cover the costs of The Health Care Task Force presented some ongoing specific services rendered by providers—the waiver development of strategies to reduce substance related harm including; opioid prescribing best practice education and online clinical tools, Screening, CALLING ALL RNs & LPNs! promotion and standardization of Brief Intervention, Looking for a change? How about sharing your and Referral to Treatment (SBIRT) substance use knowledge and skill by teaching LNA classes! intervention model, and promoting nhtreatment.org awareness. The need for embedded mental health We are currently hiring Nurses to teach per diem, who meet the following criteria: counselors in health care clinics is an identified need. • Min. 2 years experience in long term care Is an MPH degree in your future? The MPH program • Positive and enthusiastic attitude! at UNH strives to meet the needs of working health I am pleased to report that several commission • Desire to help others learn and grow care professionals by offering a high quality, face-to-face members have read, or are currently reading, Chasing • Strong ability to multi-task classroom experience centrally located at UNH Manchester. the Scream: The First and Last Days of the War on • Team player Drugs by Johann Hari – including Governor Hassan! You can learn more about us and what we offer, online at www.LNAHealthCareers.com/Careers Todd S. Gardner BSN, RN is a Behavioral Health Interested candidates should submit a resume Please visit our website at: chhs.unh.edu/hmp/hmp-masters-public-health-program Coordinator on the Behavioral Intervention Team at to [email protected] or fax 603-647-2175. Dartmouth Hitchcock Medical Center July, August, September 2016 New Hampshire Nursing News • Page 3 President’s Message
Peggy Lambert, NHNA President Intervention, and Treatment. Dr. Judy Joy was appointed to such as endocarditis, abscesses that might affect the skin serve on a Governor’s Commission to study shortages in or deep tissue structure or the spine. Nurses must be What an honor it has been NH of healthcare workers. vocal in this fight as we cannot arrest our way out of this to serve the nurses of New epidemic but need to work with the state to develop paths Hampshire as NHNA Of significant importance to NHNA is shaping the to recovery and mental health services that all can access President. On July 1st, 2016, structure of the Northeast Multi-State Division of ANA no matter what an individual’s socioeconomic status. I will transition from NHNA (NE-MSD). You will recall over the past three years ANA Drug courts need to be present in all of our communities President to Past President, and has supported us as we work to define what a regional not just a few. Bobbie Bagley will succeed collaborative would look like. The purpose of the regional me as NHNA President. This collaborative is to strengthen state organizations through Each year over 30,000 people die from gun related deaths is part of a transition plan sharing of various functions that we might not be able to in the US and another 70,000 injured (ceasefireusa.org/ to align our election process support as a single small state, while retaining our state take-action). The BBC reported that 372 mass shootings with NHNA’s change in By- organizational identity. At this juncture in time ANA is occurred in our country in 2015. The Brady Campaign Laws which changes the term asking the three different MSDs to develop a long term stated every day 89 people die from guns of 297 people of president from 1 to 2 years. structure that would be governed and supported by the shot in the US. They also stated that every day 7 children This fall when we vote on officers for NHNA we will be state members involved. Currently, we have been working and teens die in the US. Gun violence continues to threaten voting on a candidate for a 1-year position as President on defining articles of incorporation that would allow the the lives of American citizens at a rate seen by no other Elect to be followed by a 2-year term as President. The NE-MSD to enter into contracts on behalf of all states civilized country. Common sense gun laws do not mean change in term, will allow the President the time in office in the NE-MSD. Concurrently being worked on are by- that peoples’ guns will be taken from them. What they to be able to see initiatives through and help put effective laws that will define the governing structure of the NE- would mean is a safer America. It is frightening that we plans in place to meet our strategic goals. That will be MSD. The work on the structure is expected to take the are becoming immune to the mass killings, the number very beneficial as we continue to work on a number of remainder of the year. of guns used against victims of domestic violence, the important initiatives that are important to the nurses in the killings when toddlers and children find guns that have state and our organization structure. We held a very successful student conference and our been stored improperly. I encourage you to educate June Spot Light on Nursing. In April various specialty yourself on the issue of gun violence because if it hasn’t At NHNA we continue to work to strengthen our organizations of nurses convened for an evening of affected you or someone close to you it will. If you own commissions. Our goal is to provide volunteer opportunities discussion that was beneficial to all who attended. guns keep them in a gun safe, use trigger locks to prevent that could be either short (a project or event) or longer (serve accidental shootings and vote to improve gun safety in as a traditional member of a commission) term commitment. But there is so much more for us to do as nurses to America. It is important that nurses stay involved with charting our own improve the health of our communities. destiny because if we do not, others who are not nurses will. In closing, I wanted to thank you all for the honor of The war on drugs has far to go, NH is continuing to serving you and encourage all of you to be active in The Office of the Governor continues to reach out to see its citizens die at an alarming rate; the last statistic NHNA or your specialty organization. The rewards are far NHNA to identify nurses to serve on state commissions. I am aware of is that NH will see 550 overdose deaths more than you can imagine. Todd Gardner answered a call to action that NHNA by the end of 2016 based on the current the death rate. published and was appointed to serve on the Governor’s Much less talked about are the debilitating co-morbid Respectfully, Commission on Alcohol and Drug Abuse Prevention, conditions associated with opioid addiction, infections Peggy Lambert, MS, MBA, RN, CCRN-K SimpleWreath SimpleWreath specializes in handmade, natural looking wreaths that enhance October 12, the beauty of your home, both inside and out. 2016 Etsy: http://www.etsy.com/shop/simplewreath Facebook: https://www.facebook.com/simplewreath E-mail: [email protected]
NHNA Annual Meeting and Awards Banquet Please enjoy 10% off with coupon code: Invited Keynote Speaker: Pam Cipriano, NURSE10 President of the American Nurses Association
I would love to have you visit my shop! If you have questions or would like to request a custom order, please do not hesitate to contact me. Page 4 • New Hampshire Nursing News July, August, September 2016 The Relationship Between PPI and Clostridium Difficile Infection Kimberlee Delaney of hospital stay was also not explored, which would be particularly helpful in exploring the length of time clostridium difficile takes to cause symptoms and damage. Healthcare protocols continue to develop with the ever changing needs of today’s population including the use of prophylactic medications during acute care A retrospective cohort study by McDonald and others (2015) included patients of hospitalization. The occurrence of upper gastrointestinal disorders in healthcare two university associated hospitals in Canada. Risk factors identified included age populations has seen an increase in the prophylactic use of proton pump inhibitors (PPI). greater than 75, continuous proton pump inhibitor use, length of stay, and antibiotic While PPIs provide an effective and appropriate treatment for those affected by erosive re-exposure. Results overwhelmingly concluded that continued use of proton pump disorders of the gastrointestinal tract, the drug may not be appropriate for prophylactic inhibitors in patients with a history of clostridium difficile infection places patients at use (Heidelbaugh, 2012). Ancedotal evidence suggests that the risk of clostridium an elevated risk for reoccurrence. Interestingly, the study also revealed that less than difficile infection (C. Diff) may be related to PPI use. half (47%) of patients had an evidence-based indication for proton pump inhibitor use. However weaknesses in the study were a relatively small sample, differing length of Clostridium difficile is an aggressive infection which is both difficult to treat and causes the treatment amongst participants, and the potential for a lack of similarity between extremely unpleasant symptoms. The most notorious symptom is the associated diarrhea treatment protocols in Canadian and U.S. hospitals. The selection criteria for this study caused by an inflammation of the colon (Mayo Clinic Staff, 2016). As the bacterium was not well defined and the reason for previous exposure to clostridium difficile was not continues to evolve and gain strength against common antibiotics, its prevalence will mentioned. Despite the limitations the researcher ultimately suggested with confidence continue to rise in at-risk populations. In severe enough cases, infection caused by (CI 95%) that the use of proton pump inhibitors in patients previously exposed to CDI clostridium difficile can only be treated by removing the affected portion of the colon. In increases the risk for reoccurrence of infection (McDonald et al., 2015). 2011 alone, clostridium difficile was responsible for roughly a half a million infections; 29,000 people died within 30 days of diagnosis (CDC, 2015). A retrospective chart review at a large tertiary care hospital in the United States evaluated appropriate versus inappropriate prescribing of proton pump inhibitors using In order to identify best practice for prophylactic use of PPI’s a literature search was the American Society of Health-System Pharmacists and nonsteroidal anti-inflammatory conducted using the search terms “proton pump inhibitors” and “clostridium.” By ulcer prophylaxis guidelines (Redfern et al., 2015). Of the 303 medical records reviewed, excluding research prior to 2014, English only, and full text, 22 abstracts were read and only 119 (39.4%) patients met the guidelines for PPIs. Patients receiving prescriptions narrowed to 6 published articles that were applicable. The PICO question to be answered: for proton pump inhibitors post discharge were noted to be older, had higher scores How does the prophylactic use of proton pump inhibitors relate to the occurrence of on the Charlson Comorbidity Index, and had longer ICU and hospital length of stays. clostridium difficile infection? Further, do the risks of prophylactic use outweigh the Ultimately, results again concluded that patients are being inappropriately prescribed benefits? proton pump inhibitors. Not only are patients being given unnecessary pharmacological therapy, but in doing so they are being placed at greater risk for serious gastrointestinal Critical Appraisal of the Evidence compromise. Deshpande and colleagues (2014) conducted a systematic review and meta-analysis including a total of 33 studies with 18,530 participants. Two investigators were chosen Pappas and others (2016) aimed to determine the effects of proton pump inhibitors, to search the evidence regarding risk factors for clostridium difficile; inclusion criteria and if their benefits outweighed their risks. Interestingly, the study’s design applied included both randomized and non-randomized studies. The findings determined that a microsimulation model which used literature derived estimates of the risks of C. diff the three most frequent and evidenced risk factors associated with clostridium difficile infection in relation to PPI use. Participants were simulated general medical surgical infection included advanced age, additional antimicrobial use during follow up care, and patients outside of the intensive care unit. Infection risk was calculated for each proton pump inhibitor use. It is important to note that the population was not well defined simulated patient. The results of this study predicted an increased patient mortality in this meta-analysis of 33 research studies. The age range, gender distribution, and risk in 90% of the simulated cases. As with other studies, there are some weaknesses comorbidities were not specifically mentioned in the data selection criteria, which could which may have affected such drastic study results. The link between PPI use and these have greatly impacted patient’s susceptibility to clostridium difficile infection. The length hospital acquired infections was assumed and other factors which could have influenced the occurrence of a C. diff infection were not explored. Arguably the greatest weakness, or potential advantage to this study, was that it was designed using a microsimulation model. Further description of how the microsimulation program works could have strengthened the argument proposed by the results of this study. A particular benefit which does strengthen the study is the fact that the microsimulation’s data is literature devised.
Croft et al. (2016) explored inappropriate gastric acid suppression preceding clostridium difficile infection. The study was conducted within the Veteran Affairs facility, a 727 inpatient bed hospital. Eligible participants were greater than 18 years of age and had either a primary, recurrent, or reinfection of C. diff. Patients were identified using clostridium difficile toxin gene polymerase chain reaction assays and chart review. Gastric acid suppressant medications prescribed within 8 weeks preceding their diagnosis of clostridium difficile infection were assessed for appropriateness of therapy using AGA guidelines. Of the 71 episodes of infection recorded during the study period, it was found that 38% were preceded by inappropriate administration of gastric July, August, September 2016 New Hampshire Nursing News • Page 5 acid suppressant medications. For those who had been which the nurse responded by saying, “It is just a common prescribed gastric acid suppressant medications prior thing we do with all of our patients. It prevents stomach to their diagnoses, 67% were determined to have been complications.” The evidence indicates that this response prescribed such treatment inappropriately. The greatest is not appropriate. It is not a standard of care to prescribe Nurses Week limitation to this study was that the specific gastric and administer gastric suppressants to every patient suppressant medications taken by participants were not admitted to the hospital. In conclusion, determining clarified within the research. However, given the evidence which patients would benefit from prophylactic PPI provided by this study, the relationship of inappropriate administration is critical to ensure that the benefits of its prescribing of gastric acid suppressants to CDI was again use outweigh the risk or actual harm. reinforced and suggested as a possible cause of infection. Kimberlee Delaney was a junior nursing student at the An analysis of fecal samples done both prior to and University of New Hampshire at the time this article was following the use of proton pump inhibitors suggests written. She lives in Moultonborough, New Hampshire. that bacterial strains are increased with PPI use. Schuyler, (2015) evaluated fecal samples prior to PPI use References CDC (2015). About Clostridium Difficile. Retrieved from and again at 4 weeks, 8 weeks, and 12 weeks of PPI use. National Nurses Week begins Streptococcaceae, Enterococcaceae, Micrococcaceae, and http://www.cdc.gov/HAI/pdfs/cdiff/Cdiff_tagged.pdf Croft, L., Ladd, J., Doll, M., & Morgan, D. J. (2016). Inappropriate every year on May 6th and Staphylococcaceae bacterial strains following 12 weeks ends on May 12th, the birthday of proton pump inhibitor use increased. These strains are Antibiotic Use and Gastric Acid Suppression Preceding Clostridium difficile Infection. Infection Control & Hospital of Florence Nightingale. However, evidence of gastrointestinal bacterial overgrowth, therefore Epidemiology, 37(4), 494-495 2p. doi:10.1017/ice.2016.2 these permanent dates were not always increasing the risk for CDI. Though this research study had Deshpande, A., Pasupuleti, V., Thota, P., Pant, C., Rolston, D. D., etched on the calendar. In 1953 a proposal was limitations it demonstrated how proton pump inhibitors Hernandez, A. V., & ... Fraser, T. G. (2015). Risk Factors sent to then President Eisenhower to proclaim alter the microbiota composition of patients. for Recurrent Clostridium difficile Infection: A Systematic a Nurses Day in October of 1954, it was never Review and Meta-Analysis. Infection Control & Hospital proclaimed. Nurses still celebrated from Recommendations Epidemiology, 36(4), 452-460 9p. doi:10.1017/ice.2014.88 Heidelbaugh, J. (2012). Overutilization of Proton Pump Inhibitors: October 11-16 the 100th anniversary of Flo’s Evidence of the risks associated with prophylactic use mission to the Crimea. A bill was sponsored of proton pump inhibitors is clear and well established. What the Clinicians Need to Know. Therapeutic Adv Gastroenteral 5(4), 219-232. doi: 10.1177/1756283X12437358 to commemorate Nurses Week in the 1955 Though proton pump inhibitor use is important in at risk Congress, but no action was taken. Nearly 20 populations, it is clear that providers are over prescribing. Mayo Clinic Staff (2016). C. Difficile Infection. Retrieved from http://www.mayoclinic.org/diseases-conditions/c-difficile/ years later a similar bill to proclaim a “National As we emerge into the age of polypharmacy, it is important basics/definition/con-20029664 Registered Nurse Day” met a similar fate. to evaluate the use of each medication that is given and McDonald, E. G., Milligan, J., Frenette, C., & Lee, T. C. (2015). In 1974, the International Council of Nurses assess for unnecessary medication administration. Given Continuous Proton Pump Inhibitor Therapy and the proclaimed May 12 to be International Nurse the uniqueness of each patient situation it is imperative that Associated Risk of Recurrent Clostridium difficile Infection. Day; President Nixon followed in February of healthcare providers and nurses assess the administration of JAMA Internal Medicine, 175(5), 784-791 8p. doi:10.1001/ 1974 and proclaimed a National Nurse Week. medications and their appropriateness for each patient. The jamainternmed.2015.42 Pappas, M., Jolly, S., & Vijan, S. (2016). Defining Appropriate The next presidential proclamation was not until evidence surrounding the negative impacts of inappropriate 1982 when President Reagan proclaimed May use of gastric suppressants overwhelming concludes that Use of Proton-Pump Inhibitors Among Medical Inpatients. JGIM: Journal Of General Internal Medicine, 31(4), 364- 6 to be “National Recognition Day for Nurses.” in doing so, we are putting patients at greater risk for poor In 1990, the ANA expanded the recognition of outcomes and ultimately, death. 371 8p. doi:10.1007/s11606-015-3536-7 Redfern, R. E., Brown, M., Karhoff, K. L., & Middleton, J. L. nurses to the full week, from May 6 to May 12, (2015). Overuse of Acid-Suppression Therapy at an Urban and in 1993 established these permanent dates. As as student nurse is not uncommon for me to hear Tertiary Hospital. Southern Medical Journal, 108(12), 732- May 8 was designated by ANA as National patients questioning why they are receiving each 738 7p. doi:10.14423/SMJ.0000000000000383 Student Nurses Day, and Wednesday of the week medication they are given in the hospital. One clinical Schuyler, D. (2015). Proton Pump Inhibitors Alter Gut is celebrated as National School Nurse Day. moment which particularly stands out in my mind is when Microbiota Composition. Gastroenterology & Hepatology, a patient asked why they were being given protonix, to 11(11), 739-739 1/3p. Page 6 • New Hampshire Nursing News July, August, September 2016 In My Opinion What’s in your bag?
Susan Fetzer, PhD, RN have been ranked as the most honest and ethical profession for 14 straight years, 17 Editor, NH Nursing News percentage points greater than any other profession. It seems that among college students, nursing students are similarly ranked. Students would rather connect with Educators are very aware that we learn from our students peers than others in positions of authority. almost as much as they, hopefully, learn from us. It is less likely that a student can change our opinion on a health care The story has changed my perspective. I have requested that all nursing students issue. This past month, one did, not by anything she said, but on our campus be required to attend Narcan training at the beginning of their something she did. sophomore year. What about you? It is likely that you carry a pair of surgical or clean gloves in your car, in case of an emergency. Many of us carry an Epi-pen; some It is the whole naloxone (Narcan) issue. I believe, and still have their own bag-valve mask for a just-in-case situation. It seems only appropriate do, that Narcan is simply a Band-Aid approach to the opioid for all nurses in New Hampshire abuse epidemic. It is a quick fix for legislators to pass a bill to consider adding Narcan to their to allow anyone to administer the drug. They feel like they must-have stock of supplies. have done something for the problem, not realizing that it is just that, a quick fix. Narcan lasts 30-90 minutes, opioids are It is still a Band-Aid. We need to longer lasting. After administering Narcan the patient in pain work on making sure legislators once more becomes belligerent and is transported to the local emergency department. know that addiction programs are The quick fix becomes an emergency nursing problem. The angry patient can now sign sorely needed. In my opinion, if out AMA, and the cycle begins. A nurse related a situation to me that a patient was every nurse in New Hampshire bragging that she had received Narcan on six different occasions. Where is the fix? carried Narcan that would be a good start to broadcast our concern and A junior student stayed after class one day to tell me her story; she agreed that I could pleas for a real treatment. share it.
“I got a call from a friend on Saturday afternoon. She asked me on the phone if I knew CPR. I thought this was a strange question as she is not one to ask for help. I asked her what was going on and she said a friend of a friend was in trouble and they did not want to call 911. I grabbed my nursing bag, and drove Instructions for Administering Nasal Narcan over to their place. When I arrived, the friend was sitting on the couch. He was not moving and was not responding. He was breathing and I checked his pulse 1. Initiate CPR, call 911 if needed. and it was fine, though a bit high. I took out my pen light and checked his pupils and they were pinpoint. The way the others were acting, I knew there were drugs 2. Affix the nasal atomizer (applicator) to the needleless syringe and then in the house. I had just taken the presentation on administering nasal Narcan, assemble the glass cartridge of naloxone (see diagram). and we were given a Narcan dose after the presentation, I had put it in my bag. I took out the Narcan and gave it to him. Then I told his friends they had to call 3. Tilt the head back and spray half of the naloxone up one side of the nose (1cc) 911. They didn’t want to and told me they didn’t know what to say; but it would and half up the other side of the nose (1cc). be OK if I called 911. I did. We moved the patient to the floor, putting him on his side as I was afraid he would aspirate if he was on his back. By the time the 4. If there is no breathing or breathing continues to be shallow, continue to perform ambulance arrived, he had woken up, sat up, but was still slurring his words. He rescue breathing for them while waiting for the naloxone to take effect. spoke clear enough to tell everyone that he was angry they didn’t let him die. He said dying was better than going to jail.” 5. If there is no change in 3-5 minutes, administer another dose of naloxone and continue to breathe for them. If the second dose of naloxone does not revive them,—either it has been too long, there are no opioids in their system, or the My first response upon hearing the story was pride that the student had followed the opioids are unusually strong and require more naloxone. nursing process-assess-plan-intervene-evaluate; all educators desire to see critical thinking applied. My second response was a realization of the student being in 6. Continue monitoring and CPR if needed until rescue personnel arrive. the right place at the right time with the right information and the right drug. The optional Narcan presentation had paid off, nearly immediately. My third response was to wonder why her friends felt the need to call a nursing student instead of 911. The answer to this question is quite obvious. Among the general public, nurses
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Four easy ways to apply: Visit us at kah.kendal.org, e-mail resume to [email protected], drop off your resume or complete an application at 80 Lyme Road, Hanover, NH 03755. Kendal at Hanover is an equal opportunity employer, a drug-free workplace and a tobacco-free community. July, August, September 2016 New Hampshire Nursing News • Page 7 This Month in From the Bookshelf Nursing History Essential Procedures for Emergency, Care of Catheters: 1876 Urgent, and Primary Care Settings Holly Clayton RN, MSN, ACNP-BC Theresa M. Campo and Keith A. Lafferty The ANA Initiative to prevent CAUTI (catheter-associated Springer Publishing Company, Second Edition (2016) | Paperback, 490 pages urinary tract infections) offers three evidence-based approaches to improve care. The goal is to reduce the rate of CAUTI as follows: (1) prevention of inappropriate Reviewed by Alex Armitage, MS, APRN-BC, CNL foreign body in the eye or from soft body tissues. In addition, short-term catheter use, (2) nurse-driven timely removal the second edition includes evidence-based guidelines for of urinary catheters, and (3) urinary catheter care during Essential Procedures for performing ten new procedures, new photographs, the latest placement (nursingworld.org). Emergency, Urgent, and guidelines and evidence-based practice, as well as links to Primary Care Settings is videos of surgical procedures. Going back to 1876, consider what the book entitled a concise and practice- “Lectures on Nursing” offered regarding the cleaning oriented guide. This well It is refreshing to see a seamless blend of talent drawn from of urinary catheters. These lectures were delivered by illustrated clinical companion both experienced nurse practitioners as well as emergency William Robert Smith, Resident and Surgeon at the is hands-on for the busy medicine physicians. This lends a very comfortable tone to Royal Hants County Hospital, England (now known as practitioner. The format is the book. This is a solid, well thought out text, and will prove Royal Hampshire County Hospital or Winchester County concise, with well illustrated to be a valuable addition to any library. Overall, the text has a Hospital). The hospital opened in 1736 and Florence procedures, bullet-pointed clarity and focus which enhances understanding of the topics Nightingale was involved with the move of the hospital to easy to read information, presented. It is particularly notable for crisp reading and higher ground in the 1860’s, due to drainage problems. pearls and pitfalls for each uncomplicated, meaningful illustrations. Kudos to the authors situation. In addition to for presenting such a medically solid book without losing the Per nursing lecturer, 1876: Catheters were to be washed the printed text, purchase art of nursing care or the vision of a well tended patient. with water, before using, especially smaller size catheters. of the book allows access to an ebook and online videos for After soaking the catheter in water, it was to be held up to each section which round out the text quite nicely. Alexandra Armitage is a Nurse Practitioner and a certified drain it. “After this has been repeated twice, the nurse may Clinical Nurse Leader, specializing in neurology and blow through the instrument in the water, so as to make The book is divided into fifteen basic units which group neurosurgery; bringing evidence-based practice to the sure the eyes are clear. Now dry the catheter with a towel, related procedures together. Examples of these units include bedside to improve patient care, patient outcomes and again blow through it to dry the interior” (Clark, p. 66). sonography, airway management, incision and drainage institutional viability. Catheter placement was done with the patient covered and procedures, orthopaedic injuries, and miscellaneous the nurse standing on the right side locating landmarks. techniques such as lumbar punctures, as well as many more. It was noted a certain surgical patient population The format is simple and straightforward starting with a basic Warde Rehabilitation and Nursing Center is seeking (ovariotomy patients) would require catheter placement description of the problem at hand, and patient presentation RNs, LPNs and LNAs for FT, PT and Per Diem. and drainage every 6 hours. Another lecture in this book in bulleted format. Treatment for the problem is reviewed as noted nearly every surgical patient had a postoperative well as contraindications to treatment. The procedure is then Come join our staff and experience what wound infection. outlined in bulleted format with sufficient detail to allow the makes Warde special and how we make a reader to follow through step-by-step to completion. Post- difference in the lives of our residents. We offer sign on bonuses up to $2,000. References: procedure considerations are described, and (once again ANA CAUTI Prevention Tool. Retrieved from www. in bulleted format) educational points, complications and We are proud to be part of New Hampshire Catholic Charities continuum of care. nursingworld.org practice pearls are clearly laid out for quick reference. Finally there are extensive resources listed at the end of the unit for Please apply by the following: Online at www.nh-cc.org further study should the reader so wish. The format for Email: [email protected] | Fax: 603-890-1293 or in person at each procedure in the book is pleasingly standardized with 21 Searles Road, Windham, NH 03087 meticulous detail, ensuring that all the expected information is present and accessible. Included in this second edition, are the newest trends in nd rd sonography-guided procedures in emergent, urgent and 2 & 3 primary care settings. It includes two new chapters completely devoted to how sonography is used to enhance the accuracy Shift LNA’s! of numerous procedures, such as locating and removing a We want you!!
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Granite State College / Full-Time Program Director and Faculty (Non-Tenure Track) RN-BSN Program Granite State College (GSC) is currently seeking a Full-time faculty member to serve as the Program Director for the RN-BSN program. The program is offered in both online and Benchmark Senior Living blended formats to meet the needs of busy working nurses. Whose team are you on? is a leading provider of The Program Director of Nursing will serve as the academic leader of the senior living services in the program. The ideal candidate will have a strong academic background, a We want you to join our team! Northeast. sound professional reputation, commitment to excellence in education and teaching and possess strong, collaborative decision-making skills. We offer excellent pay, wonderful benefits, paid In New Hampshire This is a 12-month full-time non-tenure-track appointment and rank vacation, tuition reimbursement, retirement and all in will be negotiable at Lecturer or Senior Lecturer based upon academic a warm, exciting and compassionate team setting! • Concord RN & LPN • Salem credentials and experience. This is a benefits eligible position. We have many opportunities available and OPPORTUNITIES AVAILABLE • Nashua Interested applicants please go to https://jobs.usnh.edu/ our spotlight job is: DIRECTOR OF NURSING - NASHUA • Bedford and click on the Granite State College globe for full job description Registered Nurses Full Time & Per Diem The University System of New Hampshire is an Equal Opportunity/Equal Access/Affirmative Action Contact employer. The University System is committed to creating an environment that values and supports Apply online at www.memorialhospitalnh.org diversity and inclusiveness across our campus communities and encourages applications from qualified [email protected] individuals who will help us achieve this mission. The University System prohibits discrimination on the or stop by and see for yourself! basis of race, color, religion, sex, age, national origin, sexual orientation, gender identity or expression, An Equal Opportunity Employer www.benchmarkseniorliving.com/careers disability, veteran status, or marital status. Application by members of all underrepresented groups is encouraged. Hiring is contingent upon eligibility to work in the U.S. Page 8 • New Hampshire Nursing News July, August, September 2016
In Memory of Our Colleagues
The New Hampshire Nurses Association honors the NHTI Grad Hospice Nurse memory of and acknowledges the work of deceased Robin Kenney Charnley, 60, Sharon (Clement) Nowell, 66, of nurses who have graduated from New Hampshire nursing passed away from complications Rochester, died February 28, 2016. schools or who have actively practiced in New Hampshire of pancreatic cancer on February She graduated from New Hampshire during their career. Sharing the names and information 16, 2016. She graduated from the Vocational Technical College (Great about these nurses is one way we honor their contribution Waltham Vocational School of Bay CC) and practiced as a Registered to the profession. Brief submissions are welcome. Nursing in 1977, and earned an A.S. Nurse at Wentworth-Douglass Hospital as a registered nurse from the New in Dover for more than 30 years. Her Cheshire Nurse Hampshire Technical Institute in passions in nursing were pediatrics and Dorothy Elizabeth “Dot” (Autio) Concord in 1993. She was employed hospice. Graham, 92, of Troy, NH, died as a RN case manager with St. Joseph Hospital in February 3, 2016. She received her Nashua for the past four years and had previously been Geriatric Nurse nursing diploma from the Elliot employed with Health Dialogue of Manchester, as Jovana Celestine “Joanne C. Trombley” Community Hospital (now Cheshire Medical Center) well as other medical practices throughout her nursing Iorio, 78, of Keene, died March 1, School of Nursing Keene. After gaining her nursing career. Since being diagnosed with pancreatic cancer 2016. In a 35 year nursing career she license, she enlisted in the United States Army and served she became involved in fundraising for pancreatic practiced at the Keene Manor as well 5 years including the Brook General Hospital in Ft. Sam, cancer awareness and was determined to bring attention as for Elliot Community Hospital and in Houston, Texas. She was discharged with Honors as a to this form of cancer by being a survivor as well as an later Cheshire Medical Center. She also Second Lieutenant. Returning to New Hampshire she educator. worked for a while at Spofford Hall in practiced as a nurse for the Troy Schools and the town, Spofford. In the later years of her career as well as at Elliot Community Hospital, and later for the Elliot Hospital Nurse she worked locally for many of the Cheshire Medical Center, from where she retired in 1985, local nursing homes including Harborside, Westwood. as a Nurse Supervisor, after over 35 years. Martha Jane (Hutchins) Dollen, 79, died February 22, 2016 in Florida. Cadet Nurse Grad Surgical Nurse Prior to her retirement she practiced at Dorothy Miron Thorp, 88, died March 3, 2016. A cadet Elliot Hospital in Manchester, and the nurse graduate of the New England Baptist Nursing School Dorothy Gorham “Dottie” Chase, 90, Hillsborough County Nursing Home in in Boston she received her master’s degree in Health of Keene, passed away, February 14, Goffstown. and Human Services from New England College. She 2016. She was a 1947 diploma graduate practiced as a nurse at Phillips Exeter Academy for 25 from Massachusetts Memorial Hospital years. and practiced as a surgical nurse at Mary Hitchcock Hospital (DHMC). Employee Health Nurse St. Joe’s Grad Madeleine (Poissant) “Maddie” Hanlon, 80, of Keene Kareen T. (Carelli) Hamilton, 69, passed away March passed away February 22, 2016. She obtained her 5, 2016. A 1966 graduate of St. Joseph School of Practical nursing diploma in 1956 and practiced as an employee Nursing, she then continued studies at NH Technical Laconia Grad health nurse from 1975 to 1991 at Cheshire Medical Institute to complete her AS Degree. She was employed Center. as an RN for 35 years at various hospitals, nursing homes, Pauline May (Meader) Towle, 74, died and also rode with Milford Ambulance as an EMT. February 15, 2016. She was a graduate Pedi Nurse of the Laconia School of Nursing and Joyce Scofield Pleatsikas, 93, WDH Nurse practiced at the Lakes Region General passed away February 26, 2016. Hospital, retiring after 45 years of After graduating from the Elliot Mary Johnson Winchell, 92, died service. Hospital School of Nursing in March 11, 2016. She attended Concord Manchester, she interned at hospitals Hospital School of Nursing and the in Gloucester and Boston MA, before Wentworth Nursing Institute in Dover, returning to the Elliot Hospital as a N.H., graduating in 1945. She nursed pediatric RN. Joyce later earned her at the Wentworth Douglass Hospital for Bachelor of Science Degree from 27 years. New England College. She practiced for 4 decades as a nurse, first at Elliot Hospital and then the Bartlett Elementary School in Goffstown, prior to retirement. Concord Hospital Nurse
Cynthia A. Wessen, 86, died March 13, 2016. She earned her nursing diploma from the Elliot Hospital School of Nursing in Manchester in 1952. She practiced at Concord Hospital from 1974 until her retirement in 1990.
Registered Nurses Elliot Nurse Full and Part Time - All Shifts Olwen “Ollie” D. (Favor) Goumas, 78, died March 14, 2016. She obtained Psychiatric Specialty Areas: her nursing diploma from the Laconia Adult, Child/Adolescent, Geriatric & School of Nursing in 1958 and until her retirement in 1998, practiced as a Crisis Stabilization registered nurse with Elliot Hospital for Glencliff Home is seeking applications for thirty-nine years. Registered Nurses I-III Licensed Practical Nurses I-II Salary Range: $48,339.20 - $67,600.00 Salary Range: $42,952.00 - $54,600.00 New Enhanced Pay Scale To provide professional nursing care to residents Extensive Paid Orientation & CMC Nurse within an assigned unit and provide and support • 40 hours/week – Competitive Benefits Anne M. Lamere, 84, died April 2, 2016. She obtained medical care as directed by medical staff and Part-time Available her nursing diploma from the Mount Saint Mary - Sacred pursuant to objectives and policies of the nursing • ($2.00/hr 2nd shift diff.) Recent Graduates Welcome! Heart Hospital School of Nursing, in Manchester, NH in department and Glencliff Home. Must possess and • 1st and 2nd Shift Available 1952. She then practiced as a registered nurse at Sacred maintain a current license as a RN/LPN in NH. Salary Heart Hospital which later merged with Notre Dame and Position determined by years of experience and • Direct Care $.50/hr certifications. Hospital and became Catholic Medical Center where she View Job Specifications and How to Apply: worked until her retirement. State of New Hampshire Benefit Package! http://das.nh.gov/jobsearch/Employment.aspx Rebekah Young, Director of Nursing PRH Nurse 393 High Street, PO Box 76, (603) 989-3111 Ext. 1253 New Hampshire Hospital Barbara (Beal) Toomire, 91, of Portsmouth passed Glencliff, NH 03238 [email protected] NH Department of Health and Human Services away April 16, 2016. After obtaining her nursing diploma
Applications can be completed online at www.admin.state.nh.us/hr 36 Clinton Street Concord, NH 03301 in 1942 from Boston Children’s Hospital, she practiced or you can pick one up in the Human Resource Office Human Resources 603-271-5855 for the remainder of her career at Portsmouth Hospital. Equal Opportunity Employer Before becoming a nurse anesthetist she worked in several July, August, September 2016 New Hampshire Nursing News • Page 9 Nurses and In Memory of Our Colleagues Alphabet Soup Graduation 2016 for many nurses and nursing students is when they add educational credentials to their signature. If you have ever obtained a certification in a specialty you have added credentials. Credentials are a part of every journal article or departments. After retiring from that position she was book chapter. The American Nurses Association recognizes made the Employee Health Nurse, and was chosen to Nurse Centenarian that the listing of credentials helps to identify the nurse as receive the Dr. Frist Humanitarian Award. Upon retirement knowledgeable and credible to consumers of nursing care. In she volunteered at the hospital. Pauline (Polly) Fifield Kenick, 2009, the ANA published a position statement on “alphabet died peacefully May 2, 2016, at soup” credentials establishing a standard order of presentation. NHVT Grad the age of 106. Born in Hudson, she a graduate of the 1933 class of In order, after your name: Exeter Hospital Training School Susan Norcross (Hennick) Provost, for Nurses. Her student nursing 1. Highest degree earned in nursing such as AD, BSN, MSN, 69, passed away April 14, 2016. She experience is memorialized on PhD or DNP. It is not necessary to put all of your nursing was a graduate of the New Hampshire the “Wall of History” at the degrees! This credential is permanent, you earned it, it is Vocational and Technical College and present Exeter Hospital; her yours for life. If you have non-nursing degrees you may practiced for 30 years before retiring in student uniform and memorabilia choose to list them, but place them before the nursing 2014. are included in the Exeter degree. When you obtain a higher degree in the same field Historical Society’s collections. of study, the lower degree is no longer used. A lifelong career as a registered St. Paul’s Nurse nurse ended with retirement from 2. Licensure such as LPN, RN. When you retire you won’t the Lamont Infirmary of Phillips be licensed anymore, so it comes after your education. Barbara (Byrne) Wood, 84, died April Exeter Academy, after service 18, 2016 in Florida. After obtaining her at Exeter Hospital, Rockingham 3. State designation which recognizes authority to practice at nursing diplomas she practice hospital County Home, and the Exeter an advanced level such as APRN. nursing in New Hampshire, Arizona Red Cross. As a Red Cross District Nurse, Polly and Florida, finishing up her career at taught community health classes and provided 4. National certification recognized by a nationally St. Paul’s school in Concord. home nursing services, including home-delivery of recognized credentialing body such as CNOR, CCRN, babies! She was the holder of the Boston Post cane CRNI, or BC. It is not appropriate to use BCLS, TNCC, as Wilton’s oldest resident. She was a member of the IVC. Certification is voluntary. Nurse’s Alumnae Association, serving as secretary. LPN 5. Awards and honors of outstanding service or Carol Joyce (Dupuis) Snow, 73, died April 30, 2016. She accomplishments such as FAAN (Fellow in the American was an LPN at various nursing homes and hospitals in the Academy of Nursing) Monadnock region of New Hampshire. WHD Grad The letters should be all capitalized, with no comma after Concord Hospital Director Katherine J. “Kay” (Hughes) the name, but between each designation. The designation Laura Virginia Althoff, 84, died April 27. 2016. She Martel, 84, died May 7, 2016. She (c) is only used for doctoral students who have completed earned her BSN from Case Western Reserve University was a member of the last graduating all coursework AND been successful at a comprehensive Florence Payne Bolton School of Nursing, Cleveland, class of the Wentworth Hospital examination of knowledge required by the degree granting Ohio, and Master of Science in Human Services, from School of Nursing in 1953. She institution. The (c) indicates the student is a candidate for the New England College in Henniker. After moving to practiced nursing for 13 years at degree but has not yet completed a dissertation. New Hampshire she practiced at Concord Hospital as Wentworth-Douglass Hospital and the Assistant Director of Nursing and was promoted to Riverside Rest Home. Clinical Director. She was faculty at Concord Hospital Seeking RNs, LPNs and LNAs School of Nursing prior to its closure. She also served as Please apply by email to: the State Licensing and Federal Certification Coordinator, Office Nurse [email protected] NH Department of Public Health, Bureau of Health Facilities Administration; a Protective Services Advocate, Leslie Fabian, Director of Nursing NH Office of Long Term Care Ombudsman and was Jeanne E. (Levesque) Jalbert, 71, 117 North Road | Brentwood, NH 03833 licensed as a Nursing Home Administrator, State of NH. of Amherst, passed away on May 7, Visit www.co.rockingham.nh.us 2016. She attended the Concord School Great Bay Grad of Nursing and was a registered nurse throughout her career. She retired from Amherst Family Practice in 2010. Sandra Jean (Dunlap) Clough, 75, Phone: 603-679-9391 | Fax: 603-679-9456 died April 30, 2016. She earned her degree in nursing from Great Bay Keene Nurse CC and practiced for 35 years at Kathleen Patrice Garner, 67, of Keene, died May 7, Wentworth-Douglass Hospital in Dover. 2016. She received her nursing diploma in 1969 and practiced at Cheshire Medical Center for over 40 years. Page 10 • New Hampshire Nursing News July, August, September 2016 Strategies for Nurses Encountering Patients at Risk for Addiction or Substance Use Disorder
by Deborah A. Thomas, M.Ed., LPC, CADC, As the first step in helping a person at risk for an addiction of these individuals and assist them toward sobriety and Chief Executive Officer or with a substance use disorder (SUD), the nurse must ultimately to become a productive, motivated contributor to The Walker Center, Gooding, Idaho recognize that there is an addiction problem. When society. Residential facilities such as The Walker Center in Email: [email protected] encountering these adolescents and/or adults, a nurse may Gooding, Idaho, can help treat adults over 18 who are at feel manipulated and experience an active addict’s playing risk for addiction and/or who abuse drugs and alcohol. The Reprinted with permission from the February 2016 RN Idaho on the nurse’s emotions with lies, complaints, or even underlying emotional or behavioral issues are addressed appealing to the nurse’s sympathies in order to continue through gender-specific and gender-separate treatment Addiction is a chronic, progressive, primary disease that if to obtain the reward the addict may be actively seeking. such as cognitive behavioral group therapy. left untreated will lead to an early death. According to the Oftentimes a nurse will not know how to interact with American Society of Addiction Medicine [ASAM] (2011, these patients. Even worse is that those persons at risk for If you are concerned about someone who has a substance Definition of Addiction, para 1), addiction “is characterized addiction or with a SUD will not know what to do with abuse problem, facilitate the addiction specialist consult. by an inability to consistently abstain, impairment in themselves. It’s a frustrating situation. It can seem hopeless behavioral control, craving, diminished recognition of at times for the patient, the patient’s family, and the nurse. References significant problems with one’s behaviors and interpersonal American Society of Addiction Medicine. (2011). ASAM criteria. How Nurses Can Intervene Retrieved from http://www.asam.org/publications/the-asam- relationships, and a dysfunctional emotional response.” criteria In interactions with persons at risk for addiction or SUD, nurses may not know the words that will help these individuals or their family. From a nurse’s perspective, it may be challenging to determine whether a patient at risk for addiction or with SUD needs inpatient or outpatient treatment. The expectation is not that the nurse would assess KUDOS or treat these patients, but instead should make a referral to an addiction treatment center. Nurses should be aware however that this might lead to upset patients and/or family members. The person at risk for addiction or with SUD Congratulations to Karen Donoghue BS, RN, of the needs to hear that there is hope, that there is someone that NH Immunization Program who was awarded for can provide options, and that life can get better. Excellence in Adult Vaccination Leadership. Cindy Foley BSN, RN, of the Spaulding Youth Center, At the addiction treatment center, the addiction specialist Northfield, NH and Linda Culver, RN, of Littleton will conduct a multidimensional assessment of the Regional Hospital were awarded the Excellence in individual using the American Society of Addiction Childhood & Adolescent Immunization. The nurses Medicine Criteria (see Figure 1). According to ASAM were recognized for their achievements at the NH (2011. ASAM Criteria, para 1), these criteria are a Immunization Conference in April 2016 sponsored “comprehensive set of guidelines for placement, continued by the Department of Health and Human Services. stay and transfer/discharge of patients with addiction and co-occurring conditions.” Nancy Wells, MS RN NCSN was appointed to the new School Nurses play a pivotal role in ensuring the patient receives Nursing Coordinator position with the best treatment. By facilitating the referral, nurses plant the New Hampshire Department the seed to initiate change, which may turn around the life Figure 1. ASAM’s Six Dimensions of of Education. Wells, a nationally Multidimensional Assessment certified school nurse, and Past- President of NHSNA will be providing technical support, resources and trainings to all of New Hampshire’s school nurses, as well as monitoring the legislation that impacts school health Eta Iota Sigma Theta Tau Chapter News and school nursing practice. The position is part of the Office of Student Wellness in the Bureau of Special Education. Eta Iota Bobbie Bagley RN MSN has been appointed the Director of Public Health and Community Services Inducts New Members in Nashua, New Hampshire. The New Jersey native, who has lived The Eta Iota Chapter of Sigma Theta Tau welcomed criteria) and complete the printable Nurse Leader in New Hampshire since 1992 56 new members into the organization at our induction application (http://www.nursingsociety.org/docs/default- and Londonderry since 2002, was ceremony held on April 9th. This year’s keynote speaker source/Members/nl_application.pdf?sfvrsn=0). Completed confirmed to the new Nashua role was Maribeth Quinn, RN, CNM, MS. In her role with applications and supporting materials should be sent to in February 2016. Midwives for Haiti, Maribeth trains Haitian nurses to Chapter President Joyce Cappiello at joyce.cappiello@unh. become skilled birth attendants. She shared stories of her edu before September 15th. We will induct Nurse Leaders Carol Shanahan RN was the recipient of the 2016 important work with our inductees and friends and family into the Chapter during our fall event. St. Martin de Porres Award, given annually to a members at the ceremony held in Hampshire Hall at the professional who exemplifies the virtues of Catholic University of New Hampshire. Maribeth will be inducted On May 10, 2016 member Joan Widmer presented her healthcare. A graduate of St. Joseph’s Hospital as a Nurse Leader into the Chapter this fall. research at the Ann Manchester Kelly Nursing Inquiry School of Nursing the majority of her career was Day. Her study “Improving the Quality of Nasal Specimen focused on critical care. Recently she has worked in Nursing professionals not previously inducted as Collection for Influenza A + B Screening” was partially home care infusion services. students can join STTI as Nurse Leaders. If you have funded by the chapter. Widmer will be presenting her not been inducted previously, please consider applying work at a Global Conference in the fall. The Eta Iota for membership and encourage friends and colleagues Chapter continues to offer funding to members to present who you recognize as leaders to join. Those interested in their research at conferences and other venues, and is applying for membership should review the Nurse Leader accepting applications to support on-going research MAKING A Membership Criteria (http://www.nursingsociety.org/why- by active members. Please email Rosemary Taylor at DIFFERENCE stti/stti-membership/apply-now/nurse-leader-membership- [email protected] for further information. Join our team of dedicated nursing staff located in the Lakes & Three Rivers Region. Carroll County Mountain View Community IS HIRING! Healthy at Home Nursing positions Come work in a dynamic environment that provides 12 Amherst St competitive compensation and benefits! currently available in a Nashua, NH 03064 variety of departments. RN’s and LPN’s – P/T, Per Diem, all shifts 603-595-4243 We are easy to find near the junction Come be part of an Fax (603) 880-3171 of RT 16 and 28 in Ossipee. Stop by for organization where you can an application or visit our website at: really make a difference in Looking for skilled RNs and LNAs to work in the home setting. www.carrollcountynh.net. the health and wellness of the Previous experience preferred but will train the right candidate. Please submit completed application to: community. Psych experience and bilingual candidates a plus. Wynette DeGroot, HR Director PO Box 152, Ossipee, NH 03864 Please apply online at Please send resume to Diane Radziewicz, RN, Clinical Director, (phone) 603-539-1721 (fax) 539-1804 www.lrgh.org [email protected] [email protected] Carroll County takes pride in being an Equal Opportunity Employer July, August, September 2016 New Hampshire Nursing News • Page 11 Humor Me Welcome New and Returning NHNA Members Ed Note: Regularly exercising our sense of humor improves resiliency, positivity and balances Thanks for Your Support of Nursing in New Hampshire! anti-negatively. Laughter may not solve problems but can change your chemistry allowing you to NHNA welcomes these new and returning members. If you are not a member ask someone on this list why they joined! face them anew. “Humor Me” Go to nhnurses.org where joining is easy and one of the best professional values for your money! offers quips and stories to help you see things differently. We want to see your name here in the next issue of the NH Nursing NEWS! Submissions are welcome. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Penedum Adumene Manchester Ellen Hubbell Lebanon During the course of a day, we read a lot of signs Lindsay Andronaco Milford Tammy Hynds Penacook telling us where to go, what to see, what is on sale Cynthia Arcieri Hollis Kathryn Ippolito Grantham and how we should behave. These signs might say Eva Barger Manchester Kimberly Jacobson Hudson something else! Nathalie Beaudoin Manchester J. Dean Jarvis Grantham Lisa Bedard Nashua Marawiya Julkiply Lebanon A SIGN IN A SHOE REPAIR STORE: Laurie Bergeron Salem Holley Kazakis Hampton Catherine Bernard Manchester Joanne Kelly Marlow We will heel you Deann Berthiaume Milford Jennifer Knights Londonderry We will save your sole Melinda Bicknell Andover Elizabeth Kotrady Lebanon We will even dye for you. Arianah Blanchard Bennington Carol Krasin Amherst Tara Bolduc Grafton Katherine Krawczyk Manchester Lauren Boulton Pittsfield Debra Krison-Dowd Hampton A SIGN IN A GYNECOLOGIST OFFICE: Chelsea Brennan Henniker Chelsea Laughton Dover Melissa Canarelli Hudson Joseph Lavallee Manchester Dr. Jones, at your cervix. Peter Chemei Farmington Melissa Lopez Manchester Angela Clark Webster Mary Matthews Concord A SIGN IN A PODIATRIST OFFICE: Sharon Coronado Hudson Robin Mose Hancock Jacklyn Crosby Glencliff Brittany Nyman New Boston Time wounds all heels. Casee Cullen Londonderry Karen Parr-Day Warner Shauna Dalleva Nashua Kelsey Pearl Newfields A SIGN AT A OPTOMETRIST OFFICE: Kaitlynn Daneau Londonderry Amanda Porter Rollinsford Judith Darnell-Brozovic Manchester Julia Puglisi Manchester If you don’t see what you’re looking for, Dana Deboard Chester Cynthia Quigley Milford You’ve come to the right place. Hillary Deguire Hanover Jennifer Roy Manchester Thandiwe Dhliwayo Goffstown Amanda Sargent Derry Lynda Doherty Concord Patricia Scala Salem A SIGN ON THE PLUMBER’S TRUCK: Deirdre Donovan North Swanzey Jessica Schwartz Manchester We repair what your husband fixed. Amy Eilertsen Hanover Cynthia Smiddy Merrimack Ann Elder Auburn Heather Smith Concord Jeannie England Bristol Julia Sterner` Lee A SIGN AT A TIRE STORE: Colleen Falardeau Litchfield Timothy Tarner Enfield Melissa Fernandez Manchester Kelley Taylor Rochester Invite us to your next blowout. Sharon Fredette Amherst Frances Todd North Haverhill Susan Frieda Hudson Cynthia Tubman-Woodman Hanover A SIGN ON AN ELECTRICIAN’S TRUCK: Megan Gauvin Canaan Felicia Uzuyem Pelham Maureen Gaynor Grantham Penny Van Alstyne Keene Let us remove your shorts. Ann Marie Gelsomini Newton Karen Van Houten Jaffrey Emily Glaner West Lebanon Constance Vincent West Chesterfield A SIGN IN A NON-SMOKING AREA: Donna Grant Deering Leila Volinsky Hampton Laura Harwood Seabrook Diane Walker Manchester If we see smoke, we will assume you are on fire Toria Haungs Holderness Courtney White Portsmouth and will take appropriate action. Sheila Howley Litchfield
A SIGN ON THE MATERNITY ROOM DOOR: Push. Push. Push.
A SIGN AT A CAR DEALERSHIP: The best way to get back on your feet – miss a car payment. RN Manager IN THE LYME, NH AREA A SIGN AT THE MUFFLER SHOP: Work as part of our team, providing care for up to 12 No appointment necessary. We hear you coming. individuals at our Total Care and TBI residence. The RN Manager conducts nursing assessments and care A SIGN AT THE VETERINARIAN’S OFFICE: plans, serves as liaison with health care practitioners, and Be back in 5 minutes. Sit! Stay! ensures a safe medical environment for consumers and staff. Degreed and NH-licensed RN with supervisory and leadership experience and professional level communications skills A SIGN AT THE ELECTRIC COMPANY: essential. Must have 2 years licensed nursing experience within We would be delighted if you send in your payment on the last five years, with at least one year as an RN. time. However, if you don’t, YOU will be de-lighted. $1,000 Hiring Bonus A SIGN IN THE WINDOW *previous employees are not eligible for bonus. AT THE LOCAL DINER: Applications are found on line at www.pathwaysnh.org or Don’t stand there and be hungry; send resume to [email protected]. come on in and get fed up. Criminal background check, dependable vehicle and vehicle insurance required. Experience in the Human Services field preferred. A SIGN IN THE FRONT YARD OF A FUNERAL HOME: We are dedicated to expanding opportunities that enrich the lives of people with disabilities, and our services are provided in Drive carefully. We’ll wait. a spirit of partnership and respect.
An Equal Opportunity Employer Page 12 • New Hampshire Nursing News July, August, September 2016 BSN Programs on Probation
Two nursing programs were placed on probationary sophomore year. Plymouth State has also adjusted their admits students to the major at the end of the status during the February meeting of the New curriculum with nursing courses beginning in the first sophomore year. Hampshire Board of Nursing. The programs had semester of the sophomore year. With changes taking received conditional status by the BON up until place in the fall, freshmen and incoming Keene State Board of Nursing requirements included offering February. Plymouth State College director Dr. students will take the entire new curriculum, while nursing students additional resources to improve their Kathleen Patenaude and Keene State College director current sophomores and juniors will see a modified performances academically and on the NCLEX-RN. In Dr. Thomas Connelly were informed that they had 12 version. Because some sophomore nursing students response, Keene State’s actions include the hiring of a months, according to the Board of Nursing, to make will get caught in the middle, Keene State is looking to lab coordinator to host open lab hours to allow students changes to improve the first time NCLEX pass results offer online courses over the summer with free tuition. to practice their skills, and providing two NCLEX of their graduates. Yearly pass rates at Plymouth tutors at no additional cost to students State since 2013 were 72%, 65% and 56%; pass rates Keene State also increased academic standards for at Keene State since 2013 were 78%, 48% and 62%. nursing students. Students were required to maintain Both programs began in 2012 with 3 years to obtain In contrast the rates for all New Hampshire programs a 3.0 overall GPA, as well as a 3.0 GPA in science full approval by the Board of Nursing. During this were 83%, 86% and 87% which exceeded the national classes, according to Keene State’s nursing student time the Board provides conditional approval. When average each year. During probation, the nursing handbook. The new requirements are a 3.4 overall GPA the three year period is up and full approval is not programs have 12 months to identify deficiencies, and a 3.25 GPA in science classes. According to the met, programs are placed on probation. The Board write a plan to correct them and enact changes to meet Plymouth State web site, a minimum GPA of 2.67 is of Nursing can extend the probationary period by six the standards for full approval, according to the BON required. months if a program shows its efforts at compliance Rules and the NH Nurse Practice Act. demonstrate good faith and its plan of action is realistic The Board of Nursing also restricted class size and complete, according to the rules. If not, the nursing The Board of Nursing included specific requirements at Keene to 32 students. Currently there are 57 program faces the withdrawal of its status by the state under the probationary status. The specific sophomores and 43 freshmen. Keene State officially nursing board and closure of the program. requirements included limiting incoming class size and curriculum revisions. In March, the Senate of Keene State College which oversees policymaking, voted to change the curriculum proposed by the nursing department, upping its standards. One of the major changes is the beginning of nursing courses in the fall of the junior year. All 4 year New Hampshire BSN programs including Colby-Sawyer, St. Anselm and UNH begin nursing courses in the freshman or School News NH Nursing By the Numbers 709: NCLEX Applications for NH License in 2015 River Valley Community College was 87: Percent pass rate for NCLEX in 2015 New Hampshire Technical Institute in Concord granted full initial 5 year accreditation received continued 8 year accreditation by the by the Board of Nursing during the 1,741: APRNs in New Hampshire Board of Nursing during the February 2016 February 2016 meeting. meeting. 112: Nurse Midwives
342: Certified Nurse Anesthetists
26,000: Licensed nurses
Average age of NH nursing faculty 52: Rivier University is accepting applications for September enrollment for an online DNP –Source: American Association of Colleges of Nursing program. The program requires 39 credits Saturday, April 23 was a and is expected to take 2 ½ years. One on- memorable day for the 67 senior campus day per session is required. nursing majors who received their Saint Anselm College nurse’s pin in a ceremony at the Abbey Church. Commencement exercises were held on the lawn in front of Alumni Hall May 21, 2016.
RN Supervisor Southern New Hampshire University Clinical Lead celebrated Nurses Week with students and nurses when Bonnie Fecowicz, a full-time Lamprey Health Care, one of NH’s oldest Community working nurse and student in SNHU’s online Health Centers, is currently looking for a full time RN Clini- Master of Science in Nursing program, cal Lead to be part of our dynamic management team. pulled on a purple latex glove and took to the The primary role of this position is to oversee the supervi- The Doctor of Nursing Practice field to throw out the ceremonial first pitch sion of the Medical Assistants as well as working with our at the Fisher’ Cats May 9, 2016 ball game. providers and interdisciplinary staff on the floor to care Program at UNH has been moved directly for our patients, which includes a diverse popula- to an online program with 8 weeks tion. We are looking for someone that has strong clini- courses as of Spring, 2016. cal and assessment skills, is organized, and is a proven hands-on leader that enjoys helping people while making a difference with our vision, which supports the Patient Centered Medical Home model. This role also participates in office based nursing, triage, community outreach and follows standard evidenced based protocols and policies. RN license is required. Min of 2 years of recent experience in an office setting ED Note: News from nursing schools, faculty, students or alumni are or acute care environment is strongly preferred. Bilingual welcome. Please direct submissions to [email protected] in English/Spanish also preferred. Previous supervisory with NHNN in the subject line. experience is also preferred. Patient Care and Equal Op- portunity Employer. Interested applicants may apply online at: http://www.lampreyhealth.org/ Phone: 603.292.7777 July, August, September 2016 New Hampshire Nursing News • Page 13 NCLEX Reconsidered UNH Celebrates Ed Note: If it has been a year or years since you took the NCLEX (AKA “Boards”), how well would you do now?
1. A patient is seen in the outpatient clinic and the provider suspects lupus (SLE). What diagnostic tests do you anticipate to be ordered? a. Metabolic panel and LFTs b. CBC and ANA titer c. Cr/BUN and serum amylase d. Chest Xray and Mantoux UNH Nursing Chairs: (L-R) Front: 2. A patient is seen for a follow-up office visit following Anne Kelley, Raelene Shippee-Rice; surgery to remove a suspicious breast lump. The Back: Gene Harkless, Karen Johnson Recent UNH Grads reunite pathologist reports the tissue stage as T1, N3 and M1. This stage indicates: The University of New Hampshire Department of Nursing celebrated 50 years of nursing education a. a large tumor, confined to the breast tissue excellence in grand style with a gala dinner-dancing alumni event held April 29, 2016 at the Grappone b. a small tumor with cells also found in a single node Center. Alums from the first graduating class of 1969 to 2015 were treated to an evening of celebration. The c. three small tumors found in one breast UNH program admitted the first class of 13 students in the Fall of 1965 under the Chair of Louise Fernald. d. breast cancer that has metastasized Five of the eleven first graduates still living of the class of 1969 were in attendance. Three past nursing department chair persons, including Anne Kelley, Karen and Raelene Shippee Rice were also present in 3. What effect does a tetanus booster provide? addition to former and current faculty. Professor Emeritus Anne Kelley was recognized with a standing a. Active immunity ovation as being a member of the original faculty in 1969. Alums from each decade were recognized, as b. Passive immunity well as graduates of the undergraduate, RN to BSN, graduate and DNP programs. Patti Pucilli was noted as c. Cell-mediated immunity the only three-time graduate of UNH, an alum of the RN to BSN, MSN and DNP programs. d. IgE immunity
4. Gas tamponade was used to flatten the retina of a patient during retinal detachment surgery. Postoperatively, what action should you implement first? a. check pupil responses in both eyes b. confirm the patient is in the ordered position c. medicate for a dull headache d. obtain vital signs
5. A patient with suspected RLL pneumonia arrives in the ED and presents with the following arterial blood gas: pH 7.28, PaCO2 of 74, HCO3 of 28 mEq/L, and PO2 of 45, which of the following is an appropriate nursing intervention? (Select all that apply) a. Administer morphine sulfate 2 mg IV for restlessness b. Place the patient in a left lateral position to increase drainage c. Assist the patient to breathe slowly into a paper bag d. Place the patient in a high-Fowler’s position e. Apply non-rebreather oxygen mask at 10 L Enjoying the celebration Answers on page 16 Page 14 • New Hampshire Nursing News July, August, September 2016 Student Nurse Conference 2016 “Creating Your Nursing Futures 2016”
Holly Clayton RN, MSN, ACNP-BC Special Guests Chair, NHNA Commission on Nursing Practice Special visitors at this conference included U.S. Representative, the Honorable Frank Guinta, and a very good friend of nursing in the State, the Honorable Senator Lou D’Allessandro. Both of Many members of the graduating nursing class of 2016 were in attendance at the recent these special guests addressed the students, expressing how much they value the work of nursing. NHNA Student Nurse Conference, held on March 11th, 2016. This annual event was well attended, with 165 participants including student nurses, faculty members and members Awards Ceremony of the NHNA board. Students from schools across the state of NH travelled to the Each year, a student nurse is selected by the NHNA Commission on Nursing Practice campus of Southern NH University (SNHU), who sponsored the conference, supplying to receive the Student Nurse of the Year Award at this event. The recipient of this year’s the venue and meals for the attendees. prestigious award was Dana Mott, a junior student in the Rivier University Nursing Program. Her nursing instructor Diane Droutman, PhD(c), MSN, RN, CNE was present for the NHNA President’s Welcome Address conferring of the award. Following a continental breakfast, NHNA President Peggy Lambert, RN, MS, MBA, CCRN welcomed the attendees and introduced SNHU’s Provost Dr. Patricia Lynotte, Two other accomplished graduating nursing students were honored by the Commission on who represented the university and offered a welcome and remarks. SNHU’s Executive Nursing Practice with certificates: Beth Ann Westgate, senior nursing student at Saint Anselm Director for Nursing and Professions Dr. Sherrie Palmieri was a member of the planning College and Paige Kennedy, senior nursing student at Colby-Sawyer College. committee for the conference.
This year’s theme of “Creating Your Nursing Futures 2016” provided a wealth of information for nursing students, as they start to create their own nursing futures.
Educational Sessions Offered A variety of educational sessions were offered throughout the day. Students enjoyed a panel discussion entitled “How to Survive Your First Year – New Grad Wisdom.” Another panel Com provided information on the various career paths available to nurses. Breakout sessions e s addressed such timely subjects as getting the job you want and managing shift work. This hop with us! event offered valuable tips and networking opportunities to help students transition from school to the workplace. Participants visited the exhibitor tables during breaks.
Presentations included: • Hot Topic Discussion: “How to Get the Job You Want” by Peggy Lambert, RN, MS, Scrubs, lab coats, stethoscopes, MBA, CCRN shoes, medical supplies, & accessories– • “Making Your Future with Pharmacology Bright” by John Foley, Pharm.D. • “Creating Moments for Self Care” by Ann Fournier, PhD( c), RN, MS, MSN, ACNP- from all your favorite brands! BC, AHN-BC, CNE • “Shifts Happen” by Susan Fetzer, PhD, RN • f “Scope o Practice and Delegation” by Denise Nies, MSN, RN, BC, Executive Director Enter code GOG10 to save 10% on all orders! NH Board of Nursing Closing Remarks The day ended with parting thoughts from NHNA President Lambert and newly appointed Interim Executive Director Dr. Judith Joy. A raffle followed, where prizes were provided by the NHNA Board of Directors. Students then parted, and headed off into their bright nursing futures, having learned many valuable strategies for success and gained new knowledge.
Well Received The success of the event was reflected in feedback from the participants. Students from Great Bay Community College were overheard saying “what an awesome session.” A student said, “I loved hearing from the new grads.” Another student commented, “I am so impressed that [Representative Guinta and Senator D’Allessandro] came. They really seem interested in nursing.”
Sincere Thanks NHNA extends their appreciation to all of the session presenters who shared their time and expertise in making the conference such a success! NHNA again wishes to thank our sponsor and host, SNHU, who provided the venue, meals and overall support.
Visit ShopNurse.com today! July, August, September 2016 New Hampshire Nursing News • Page 15
Dear Editor, Dear Editor,
I wish to respond to two items in the column I had some concerns reading the short article and “NCLEX Reconsidered” in NHNursing News, April sample questions of the new NCLEX exams. (NH 2016. The column begins with “Ed. Note: If it has Nursing News April 2016). I had concerns about some been a year or years since you took the NCLEX of the answers that were given and wondered what the (AKA “Boards”), how well would you do now?” examiner’s intent was. The answers given to question The questions I wish to discuss are #3 and #5. In my #3, about the hemodialysis patient, and #5 about the opinion, Question #3 should have included notifying decision making process based on vital signs did not Question 3 the provider of serum potassium = 3.3, as this value seem right. Are these questions truly representative A patient admitted for a peripheral vascular disease falls below the normal range and is defined as of the exam questions? Or are they samples written of the left foot has just returned from a 4 hour dialysis hypokalemia. by someone else? Is the intent of the examiner to help treatment. What actions by the nurse are appropriate? more people pass? Or to test critical thinking in nurses? (Select all that apply) Question #5 asks the nurse to determine which patient would require his/her immediate attention In question #3, all the nursing actions one would a. Monitor blood pressure and additional assessment. We are given four employ in taking care of a post dialysis patient b. Notify provider of potassium of 3.3 choices, each patient having an abnormal vital are listed as possible choices. The question asks c. NPO for 4 hours after completion of treatment sign and a diagnosis. The answer printed was: which nursing actions would be carried out. Well, d. Instruct LNA to obtain dry weight The patient with COPD and a respiratory rate all of them really but if the intent of the question is e. Maintain bed rest for 4 hours after treatment of 24/minutes required immediate attention and “which ones are the most important?” the answer assessment. given (choices A and D, monitor BP and get a dry weight) leaves out one of the more important things I Question 5 I would like to thank the editor for the opportunity would have done. Choice B reads ‘notify provider of You are assigned the following patients to care for to consider this “triage” situation further, with potassium level 3.3” A potassium of 3.3 is a critical during your shift. The LNA reports the patients’ vital consideration for critical thinking. With the lab value and as such needs to be reported ASAP. signs. Which would require your immediate attention information given, a single diagnosis, we are Why wasn’t this included in the answer? Yes, you and additional assessment? not provided with the admitting diagnosis and would monitor the blood pressure and get a dry comorbidities, so we anticipate that each of the weight but you would also call the provider and notify a. A 58 yo with hypothyroidism and regular heart patients may have more complexity leading to him (or her) of the labs. Are we assuming the lab has rate of 52 bpm. their hospital admission. In my opinion, the already done so? Your question doesn’t say anything b. A 38 yo patient with Graves disease and heart rate absence of admission diagnosis, assessment about which you would do first. I would have gotten a of 112 bpm. information, clinical history, vital signs trends, blood pressure, gotten the weight and then called the c. A 63 yo patient with r/o adrenal tumor and blood labs and other pertinent data makes it difficult provider with all 3 pieces of info. pressure of 140/100. to truly “triage” these patients. If one thinks of d. A 49 yo patient with end stage COPD and “ABC’s,” the patient with COPD and elevated In Question #5 the examiner is asking the nurse to respiratory rate of 24. respiratory rate might be most at risk. However, base a triage decision on abnormal vital signs and a tachycardia could actually be atrial fibrillation, and diagnosis. Which patient should she see first? The tachycardia or bradycardia can be symptomatic. whole picture is not given. The info provided is the The blood pressure trend is not provided. As well, age of the patient, the diagnosis and one vital sign Ed Response: Question #5 did not include the nurse requesting that falls out of normal parameters. I say in order any additional resources for assessing the other to promote critical thinking the nurse needs more Thank you for enjoying our NCLEX review feature. patients. The nurse could request help from the information. Wouldn’t the first step be to get a little The questions are NOT obtained from the NCLEX charge nurse or colleagues as resources, to assess more? Being a triage nurse I get as much information exam as such questions are not released by the the other patients, while she went in to see the as I can before making a disposition recommendation. National State Boards of Nursing. NCLEX type patient with COPD first. I would do the same thing in the hospital. Perhaps questions are published in many books and by many get an O2 sat on the COPD patient? Check shift vendors of NCLEX review programs. Best practices Such questions are being thought about on a global report to see if the patient with the heart rate of 52 in preparing NCLEX questions are provided during level. An abstract from the International Nursing had any cardiac disease? Or determine the reason for faculty development programs and are developed to 25th International Nursing Research Congress in hospitalizing the person with the Grave’s disease? measure basic competencies of beginning practitioners. 2014, hosted by Sigma Theta Tau International, How about checking blood pressure trends on the Information provided in the question should be the was entitled “More Than Vital Signs: Reframing person with the adrenal tumor? If you were rushing only information that is considered when answering the Nurses’ Recognition and Response to Clinical in to see the COPD patient with the respiratory rate question. Deterioration.” The abstract discusses early signs of of 24 and got tied up in there, one of the others might clinical deterioration and the need for nurses’ timely get in to trouble. As nurses, we have to think outside In Question 3, an inpatient is returning to the medical- recognition of these and provision of the necessary the box. I think my first step would have been to surgical floor from a dialysis unit. The student is assessment to ensure optimal patient outcomes. get a little more information, as quickly as I could, taught that dialysis nurses monitor post-dialysis lab These are the challenges facing nurses in today’s and then determine who I should visit first on my values and that for some patients hypokalemia may complex patient care environments. Once again, assessment rounds. I would probably check on the occur. In a post-dialysis patient, it is unlikely that a I wish to thank our insightful editor for providing COPD patient first, since a respiratory problem will serum potassium level of 3.3 would treated. Symptoms the opportunity to discuss these current issues in get you into trouble more quickly than any of the of hypokalemia can be reflected in the blood pressure. nursing. others. But, if he were stable and one of the others The effects of dialysis, including hypovolemia, would was not, my decision would change. be monitored by blood pressure (a) and obtaining Sincerely, a post-dialysis or dry weight (d). There are no I don’t know if this is nitpicking, but I have taken a requirements for NPO or bed rest related to a dialysis Holly Clayton, RN, MSN, ACNP-BC few of these types of tests now and it often seems to treatment. The reference provide is a good review of me there is no right answer. I applaud the NCLEX potassium replacement for non-dialysis patients. writers for encouraging critical thinking but I believe References: in order to do that, a nurse needs to know that in The answer to Question 5 was printed in error and Cohn, J., Kowey, P., Whelton, P. & Prisant, M. (2000). New practice, she must have all the information she get should be Answer C. In Question 5 the scenarios asks Guidelines for Potassium Replacement in Clinical can get in a short amount of time, and not only make the student to relate the findings of a diagnosis which Practice - A Contemporary Review by the National decisions about her own actions but see to whom she are expected or not-expected. Bradycardia is a frequent Council on Potassium in Clinical Practice. Archives of could delegate tasks if needed. I thought it might be and expected finding in a patient with hypothyroidism Internal Medicine, 160 (16), 2429-36. helpful for people reading this article to think about (a). Likewise in a patient with Graves disease doi:10.1001/archinte.160.16.2429. (hyperthyroidism), the heart rate is elevated (b). A Osborne, S. (2014), More Than Vital Signs: Reframing these things. nurses’ Recognition and Response to Clinical patient with end stage COPD is likely to be tachypneic Deterioration. 25th International Nursing Research Thanks so much for your time (d). However, in a patient in which an adrenal tumor Congress. Wanchai, Hong Kong. is expected, a blood pressure of 140/100 may be a http://hdl.handle.net/10755/335692 MaryEllen King, BSN, RN, CPN precursor to a hypertensive crisis and requires further assessment (c). Page 16 • New Hampshire Nursing News July, August, September 2016 If You See Something, Say Something
Jennifer Flynn, BA patient concerns, response to treatment, and patient is declining rapidly. However, that documentation is Manager, Healthcare Risk Management safety. what will protect you should a claim occur. Date and Nurses Service Organization (NSO) time each entry and include detailed information about Make the patient your ally. Tell him or her to report the patient’s condition based on your assessment, who On a busy day with short staff and high-acuity any problem promptly. Keeping patients and families you notified, and actions taken. If you need to follow patients, a nurse fails to notify the physician of an informed will make it more likely they will speak up with someone higher in the chain of command, note abnormal clotting time for her patient. Not knowing up promptly. If there is a change in your patient’s that as well. Other areas to document include reporting the result, the physician orders the patient’s heparin condition, you’ll need to communicate it quickly. abnormal lab values and diagnostic tests. to be restarted. The nurse mistakenly overlooks the abnormal lab tests and implements the order. Communicate effectively Remember documentation basics: Follow your Subsequently, the patient suffers significant brain Think before you speak with the practitioner so you organization’s protocols and guidelines from your hemorrhage and permanent disability. can provide the information in a way that will get professional association. Don’t alter the medical record results. A commonly used tool is SBAR, which staff and comply with the policy for correcting errors. In this situation, you might think it was the physician’s, at Kaiser Permanente created based on a tool from the not the nurse’s, responsibility to check the clotting time U.S. Navy. Here is an example adapted from material Notifying practitioners before restarting the heparin. But in a similar case, a from Kaiser: These actions will help ensure you properly notify nurse was held liable for failing to notify the physician. • Situation. Give a concise statement of the problem. practitioner of a change in a patient’s condition: The case illustrates the important responsibility of “Dr. Jones, I’m calling about Jack Wilson, a • Frequently monitor the clinical situation of your nurses to notify others of a significant change in 55-year-old man who is pale, diaphoretic, and patients so you detect problems early. Follow a patient’s condition, including results of lab tests. complaining of chest pressure.” practitioner orders, but also use your judgment Failure to do so can leave you open to legal action by • Background. Give pertinent, but brief, information about when to conduct additional assessments. patients or families. Here is what you need to know related to the situation. “He has a history of • Listen to what the patient says. It can be tempting to ensure you are following correct procedures for hypertension and was admitted yesterday for GI to dismiss another complaint from a “difficult” notification. bleeding. He received two units of RBCs yesterday, patient. Don’t. and his hematocrit 2 hours ago was 32. His blood • Assess and document, at a minimum, the following A common problem pressure is 90/50 and pulse 120.” when there is a change in the patient’s condition: Allegations related to patient assessment monitoring, • Assessment. Provide what you found and what you presenting problem(s), comorbidities affecting treatment, and care—three main areas where think about the situation. “I think he is bleeding the patient’s status, mobility status, medications, notification plays an important role—are relatively again, and we can’t rule out an MI, but we don’t behaviors, cognition, vital signs, and lab values. common and can be quite costly, according to the have a recent H&H or troponin.” • Notify appropriate practitioners of your assessment CNA/NSO claim study Understanding Nurse Liability, • Recommendation. Request or recommend an results. 2006–2010: A Three-part Approach. From January action. “I’d like to get an ECG and labs, and have • Document the results of specific patient- 2006 through December 2010, assessment allegations you evaluate him right away.” monitoring activities according to the practitioner’s accounted for 12.6 percent of closed claims with a paid orders and as indicated by the patient’s condition, indemnity greater than $10,000, monitoring accounted To make your communication more effective, use the including vital signs and other relevant for 6.8 percent, and treatment and care accounted for practitioner’s name to get his or her attention and state information. 58.5 percent. The average paid indemnity was $228,737 the problem clearly and concisely. If you are talking in • Document all patient treatment and care, for assessment, $223,282 for monitoring, and $156,857 person, make eye contact. Minimize background noise, including timely implementation of practitioner for treatment and care. So how can you lower your particularly when you are on the phone, and avoid orders, patient/family education, supervision of risks for being named in a lawsuit as a result of not multitasking. Some hospitals have Rapid Response nonprofessional caregivers, tracking of test results/ notifying practitioners? Teams that you can call if you feel the situation consultation reports, follow-up of delays and issues warrants more immediate attention. Use them if you in obtaining tests or test results, and reporting of Monitor the patient need them. any patient incident (injury or adverse outcome and It seems self-evident that you should monitor your subsequent treatment/response). patients, but claim studies show that this doesn’t always Overcoming resistance • Document the actions you took to notify the happen. Base your monitoring on practitioner orders What if you feel the practitioner isn’t listening practitioner and the response. and your professional judgment. For example, if your to you or doesn’t plan to take appropriate action? • If you do not receive a response in a reasonable patient is having neurologic checks every 2 hours According to TeamSTEPPS, a tool for enhancing time frame, seek assistance elsewhere and and develops altered cognition, perform a complete patient safety that you can obtain at no cost from the document your actions. neurologic assessment. Agency for Healthcare Research and Quality, it’s your responsibility to assertively voice your concern The bottom line Common areas to assess include vital signs, blood at least two times to ensure it has been heard. If the As a nurse, you are responsible to promptly notify glucose, lab and diagnostic test results, clinical signs outcome is still not acceptable, you’ll need to contact practitioners of a change in a patient’s condition. of bleeding, effectiveness of pain management, signs of your supervisor or go up the practitioner’s chain of The bottom line is that if you see something, say infection or inflammation, nutritional intake, oral and command. something—and document it. I.V. fluid intake and output, outputs (e.g., urine, stool, wound drainage), wound status, behaviors, cognition, Remember that your goal is not just to notify RESOURCES someone—you want to ensure proper action is Agency for Healthcare Research and Quality. Pocket Guide: taken. Following the chain of command is important TeamSTEPPS. Publication number #06-0020-2. http:// from a liability perspective, too. According to the www.ahrq.gov/professionals/education/curriculum-tools/ Understanding Nurse Liability claims study, claims teamstepps/instructor/essentials/pocketguide.html. CNA, NSO. Understanding Nurse Liability, 2006- involving the failure to invoke the chain of command 2010: A Three-part Approach. www.nso.com/ represented 5.6 percent of the treatment and care nurseclaimreport2011. closed claims and had one of the highest average paid Kaiser Permanente. SBAR toolkit. http://www.ihi.org/ indemnities ($350,558). resources/Pages/ Tools/SBARToolkit.aspx.
Don’t forget to document This risk management information was provided by It’s easy to forget to document your efforts to contact Nurses Service Organization (NSO), the nation’s the practitioner, particularly if the patient’s condition largest provider of nurses’ professional liability insurance coverage for over 650,000 nurses since 1976. The individual professional liability insurance 100 Saint Anselm Drive policy is administered through NSO and underwritten SAVE THE DATE! by American Casualty Company of Reading, Manchester, NH 03102 12th Annual Wound Healing Symposium Pennsylvania, a CNA company. Reproduction (603) 641-7086 by Wentworth-Douglass Hospital Wound Healing Institute without permission of the publisher is prohibited. For At Wentworth-Douglass Hospital Garrison Conference Center questions, send an e-mail to [email protected] or call www.anselm.edu/cne 789 Central Avenue, Dover, NH 03820 1-800-247-1500. www.nso.com. November 10, 2016 $ 150- Pending contact hours (7) Committed to Promoting Excellence Register before October 14, 2016 - fee discounted to $125 Speakers this year are: in the Practice of Nursing • Stephen Gemmett, M.D. • Mary Liz Bilodeau, MS, ACNP-BC • Joyce Black, PhD, CWCN, FAAN • Vicki Haugen, RN, MPH, CWOCN Answers to NCLEX Reconsidered • Heather Hetterick, PT, PhD, CWS, CLWT from page 13 For more information or questions, please email: Online programs now available. Heather Sevigny, APRN, CWS 1. B at [email protected] 2. D or Stephanie Estrada, APRN, CWCN 3. B at [email protected] 4. B 5. D, E July, August, September 2016 New Hampshire Nursing News • Page 17 NHNA Commission on Nursing Practice
Holly Clayton RN, MSN, ACNP-BC Pam Cipriano made reference to this study in her “Inside ANA: From Your ANA President” column in American Nurse Today (2016, January). She noted, “The Healthy Work Environments Presentation at Monthly Meeting lower end of that range approximates 10 jumbo jet crashes per week.” Cipriano then On the evening of Thursday, April 14, 2016, the NHNA Commission on Nursing discussed the negative impact of harmful workplace cultures on the provision of Practice (CNP) held its monthly meeting at MCPHS University in Manchester, safe care to patients and the public. According to Cipriano, “changing the workplace NH. The first part of the evening featured a guest speaker, Meghan Baston, MSN, culture for the better… is a slow process. But it can be done, particularly with RN-BC, Director of Behavioral Health Services, at nearby Elliot Hospital. Her the strength, advocacy and leadership of nurses willing to take on the challenge” power point presentation, which included handouts, was entitled “How to Promote (Cipriano, 2016, p. 16). Healthy Work Environments.” Judith Joy, PhD, RN, NHNA Interim Nurse Executive Director attended, and nursing students were invited. This timely topic was selected Presentation on Healthy Workplaces by the NHNA Commission on Nursing Practice (CNP), as it strives to recognize Meghan Baston’s presentation on promoting healthy workplaces provided an and evaluate issues that affect nurses and nursing. Promoting healthy work opportunity to consider the evidence, learn about overcoming challenges of harmful environments, in which nurses can provide safe care, is in alignment with ANAs workplace cultures and embrace changes leading to positive practice environments. 2016 campaign for creating a “Culture of Safety” throughout health care. Baton opened her presentation with defining bullying and incivility. She went on to differentiate civility from incivility, with examples of what incivility actually looks Evidence-Based Practice like and how it can be quantified. Baston then examined the effects of this behavior The CNP seeks to promote evidence-based practice through education and on organizations, nurses’ wellbeing and the delivery of safe patient care. The ANA dissemination of information. What does the evidence show? The Journal of Code of Ethics was discussed, with respect to professional nursing. Baston offered Patient Safety published a study entitled, “A new, evidence-based estimate of solutions focusing on leaders, both informal and formal. Strategies and scripts patient harms associated with hospital care” (James, 2013). The findings revealed using cognitive rehearsal and restructuring were provided and discussed. As she that our healthcare system is not error-free, as 210,000 to more than 400,000 deaths concluded her informative presentation, Baston encouraged nurses to always speak of hospital patients occur each year related to preventable harm. ANA President up. The CNP expresses gratitude to Baston for this enlightening and informative presentation.
Culture of Safety The NPC has considered means of disseminating this information to our colleagues, as leaders or future leaders and advocates for safety. As readers may be aware, the ANA launched its “2016 Culture of Safety” campaign earlier this year, with the overall theme, “Safety 360 Taking Responsibility Together.” A June 2016 educational offering is being planned to include a focus on the ANA Code of Ethics and culture of safety. The CNP has invited Dr. Pam Cipriano, ANA President, to NEWS NH in October to meet with key leaders and attend the NHNA annual meeting and banquet. Dr. Cipriano has accepted our invitation and plans to present on “Culture Kevin Walsh was appointed by Governor Maggie Hassan as a public member to of Safety” that evening. the Board of Nursing. Walsh has been in law enforcement for the past 19 years and serves as the Chief of Police for Rye, New Hampshire. References Inside ANA: From Your ANA President. ANA calls for creating a culture of safety throughout health care. American Nurse Today, 11 (1), 16. The Practice and Education Committee of the Board of Nursing has responded to James, J. (2013). A new, evidence-based estimate of patient harms associated with hospital the following practice questions. care. Journal of Patient Safety, 9 (3), 122–8. doi: 10.1097/PTS.0b013e3182948a69
Question: Is it within scope of LPN/RN to do a skin scraping for scabies? Response: With the appropriate training and competency it is within a RNs scope of practice.
Question: Can a RN monitor and titrate ketamine infusions under a sedation protocol to manage chronic pain patients? Response: Yes, it is within the scope of practice of an RN to monitor and titrate Ketamine infusions in critical care settings for those clients who have a secured airway.
Question: Can lidocaine, sodium bicarb, and 0.9% NaCL solution intradermal and/orsubcutaneously be administered by RNs for minor excision procedures, in an office setting. Response: Yes, it is within the scope of the RN with education and competency.
Littleton Regional Healthcare, located in the White Mountains of New Hampshire is a desired vacation setting which offers year round recreation including hiking, fishing, golfing, skiing, snowmobiling, has great schools, and is conveniently located between Boston and Montreal. It’s a place to build a life and a future for yourself and your family.
Our healthcare facility has the following RN opportunities: • RN Surgical Services: Minimum of one year recent OR experience in a hospital or ASC setting. Candidates with less than one year will be considered for our Perioperative Nurse Intern program. BCLS required, ACLA and PALS within one year. CNOR or completion within one year of hire. Call commitment – must be within 30 minutes of hospital when on call. Current call requirements are one day per week and one weekend every 4-6 weeks. • RN Intensive Care Unit: Intensive Care Unit Registered Nurses are responsible for meeting the total nursing needs of the critically ill patient and their family consistent with the policies and procedures of the Department of Nursing and the New Hampshire Nurse Practice Act. Requires a minimum of six months on the job training, if no prior critical care experience with an on-call or in-house backup dependent on patient acuity. ACLS and Cardiac Rhythm Recognition course required before accepting ICU assignment. Critical Care Course within six months. CCRN preferred.
Littleton Regional Healthcare offers competitive compensation, a generous benefits package and ample opportunity for professional growth and development. Qualified candidates are invited to apply at our website www.lrhcares.org. Littleton Regional Healthcare Human Resources Department • 600 St. Johnsbury Road, Littleton, NH 03561 Phone: 800-464-7731 or 603-444-9331 • Fax: 603-444-9087 EOE Page 18 • New Hampshire Nursing News July, August, September 2016 Southern New Hampshire Medical Center NHNA Wants to Celebrates Nurses Week See You…. With a Nurses Day theme of “Seis de Mayo” (Translated: sickest patients and encourages other staff to make sure they Sixth of May) breakfast burritos were served and there get their patients up early. Recently, she coordinated the effort were ice cream sundaes in the afternoon. Two nurses were to bring one of her long term ventilated patients outside to IN THE NEWS celebrated as Nurse of the Year and Nurse Leader of the Year. experience the fresh air with family members. From where I In addition 5 nurses were recognized for their contributions stand, if you look into the eyes of this person, what you will Do you have some news that you want to share with to the mission and vision of the organization including: see is a passionate, committed and skilled nurse with a gift the nurses of New Hampshire? The NH Nursing News Leslie Bowen, RN Emergency Services (Transformational and a talent for spreading joy and hopefulness in a work accepts short press releases or announcements of your Leadership), Renee Glennon, RN 3 West (Structural environment where the nature of the illnesses treated can accomplishments. Empowerment), Angela Chapman, RN 4 East (Exemplary make it seem that both are in short supply.” Professional Practice), Sharon Paradis, RN Operating Room Did you present at a regional or national conference? (New Knowledge Innovations and Improvements) and Nurse Leader of the Year Heather Merrill, RN Patient and Family Services (Empirical Did you publish in a newsletter or journal? Outcomes). Ten nurses who had achieved BSN degrees Ashley Clement MSN RN BC, Clinical Teacher was awarded Did you get promoted? and 8 nurses who had achieved MSN degrees were also the Nurse Leader of the Year. Excepts from her nomination Did you get certified? acknowledged. letter included: Did you graduate with an advanced degree? Nurse of the Year “She is a high-energy person who is never satisfied with Did you get an award for the best nurse? the status quo. She continuously strives to improve herself, Did you get elected to a position in a state, regional or Barbara Hugh BSN RN CCRN was awarded SNHMC Nurse her unit, and nursing practice at SNHMC. She is a “go- national professional organization? of the Year. Excerpts from her nomination letter included: to” person who will not disappoint you should you seek her Did you start a new program? Provide a new service? assistance. She eagerly mentors staff at all levels to learn “This nurse is a kind and compassionate person who is a new things, to take on informal leadership roles in process mentor of staff that leads her peers by example. She is a improvement, and to embrace unit based practice changes. Deadline for the next issue is August 15, 2016. pleasure to be around and she is always making people laugh. She has a way of making a bad day great for both patients She establishes a comfortable learning environment for the Please send details and a photo if appropriate to and staff. She is the nurse that, when you see she is on, you new graduates who are very comfortable going to her. She [email protected]. know everything will be OK. She regularly rounds on patients demonstrates patience in orienting them and encourages transferred from her area to other units and supports and them to develop critical thinking skills. The combination of assists nurses during these visits. She is masterful at inserting her leadership and educator skills has helped these nurses to IVs and is often called upon by other staff and supervisors complete orientation on time and practice independently as to assist with IV placement. Her answer is always a smiling beginning nurses. She is a wonderful and committed nurse. “sure.” She goes above and beyond for her patients, washing She is the reason I love working here. She motivates others and curling their hair, or applying their makeup to meet their to work hard, look things up and be committed to improving personal needs. She personalizes their care often identifying the workplace and patient outcomes... She is a great nurse their favorite musical styles and playing them in the room. I leader.” According to her director, “This nurse makes my remember walking on to the unit and hearing singing and I job as a director easier and more fulfilling. I am proud to say looked into a patient room and she was singing and dancing that she is a member of my leadership team, and I know that I for the patient. The joy on the patient’s face was priceless. can always count on her to do the right thing to keep the unit The patient then stated “that was the best medicine I ever functioning well on a daily basis, as well as leading the staff Maybe you don’t want to blow your own horn, had.” She is committed to early mobilization of even the in a positive direction.” but we do!!!
Their Stories Are Our Stories.
Achieve better outcomes for your patients and career by joining the HealthSouth Rehabilitation Hospital of Concord, where we combine superior resources and support to impact your career growth, and the lives of those we serve. We are a 50- bed facility specializing in comprehensive inpatient and outpatient rehabilitation.
Due to our continued growth, we are always on the lookout for exceptional individuals to join our nursing team. If you are just starting out, or are a current nurse interested in a career in rehab, we have opportunities for you.
At the HealthSouth Rehabilitation Hospital of Concord, we achieve better outcomes by providing our employees with what they need to grow and advance in their profession. Learn more about the difference you can make in your profession as a member of our collaborative team.
BETTER OUTCOMES AT WORKTM www.healthsouthconcord.com July, August, September 2016 New Hampshire Nursing News • Page 19
Dr. Pam Cipiriano, ANA President, What does 72 Cents Buy to visit New Hampshire in 2016 The NHNA Commission on Nursing Practice is pleased meeting and vote on key items impacting the to announce that ANA President Dr. Pam Cipriano organization. The meeting is followed by our gala For 72 cents, you can buy 5 gulps of an ice cold will visit New Hampshire in October, 2016. Her two event and banquet for members and guests of NHNA, Starbuck’s Frappuccino on your way to buy one- day visit will allow her meet with key leaders in the and includes viewings of poster presentations and third of a gallon of gas. Or you can use your smart state and learn about nursing initiatives. Plans are visiting sponsor tables. A social time of networking is phone for about 12 hours while you have half of a for Dr. Pam Cipriano to be the keynote speaker at the followed by a gala dinner. finger nail polished during a manicure. Or you can 2016 Annual Meeting and Awards Banquet, on the buy membership in the New Hampshire Nurses evening of October 12th. In alignment with ANA’s 2016 NHNA President Peggy Lambert will open the post- Association, the only New Hampshire affiliate of the campaign “Safety 360: Taking Responsibility Together,” dining festivities. Last year we were honored to American Nurses Association that advocates for all the organization extended the invitation for this special have keynote speaker, Dr. Susan Fetzer, address the nurses in the state of New Hampshire. visit by the ANA leader. NHNA believes that safety is a audience on the topic of excellence in nursing. This shared responsibility, and members are looking forward year, we look forward to Dr. Cipriano’s presentation But why would you join NHNA if you already are a to learning more about key elements, action steps and focusing on a culture of safety. An awards ceremony member of other nursing organizations? While other core values related to safety. As nurses work towards follows, honoring nurses in NH. Raffle prizes will nursing organizations provide a variety of services creating a culture of safety, individually and as a group, close the evening event. for their members, NHNA in affiliation with ANA we share in the ANA campaign and we wish to promote is the largest professional nursing organization, this for our membership. We plan to cover aspects of Dr. Cipriano’s visit with looking out for the interests of nurses in all specialties media and will feature her visit in NHNursing News. and roles, wherever and whenever they practice. The New Hampshire Nurses Association Annual Please see our NHNA website www.nhnurses.org Specialty organizations are not your PROFESSIONAL Meeting and Awards Banquet takes place every closer to the date, to register for the annual meeting organization. The professional association is active in Autumn in Concord, NH. It is open to our members and gala dinner event. We welcome you and look health policy initiatives, such as supporting legislation from all over the state. Members attend the annual forward to greeting you there. for safe patient handling to prevent injuries to nurses, advocating for legislation that will allow nurse practitioners and nurse anesthetists to practice to the full scope of their education and promoting legislation to have a nurse on the Health Policy Commission.
NHNA offers networking opportunities and helps to keep all nurses in the state aware of trends in nursing by sending out this newsletter, not just to members but to all nurses. Providing mentoring opportunities for new nurses and maintaining the accredited approver units for continuing education activities are just two of the many programs which NHNA provides to NH nurses. The Commission on Nursing Practice coordinates continuing education programs for student and experienced nurses at a low, low, low price for members.
For your 72 cents you are also a member of the ANA which includes a subscription to the American Nurse Today in addition to all the personal benefits including reduced malpractice rates, books and conferences.
So what will you do with your 72 cents a day? Add your voice to the over 1,000 NH nurses who truly care about their profession? Think about the benefits the next time you drive through the Starbucks window, fill up the gas tank, use your phone or have your nails done! To join go to http/www.nursingworld.org/ joinana.aspx
JOIN OUR TEAM
at Northeastern Vermont Regional Hospital, located in Vermont’s historic and rural Northeast Kingdom! NVRH is proud to offer a positive working community in which to grow, learn and excel in your profession.
Various Nursing and Nurse Practitioner positions are currently available in Med/Surg, Emergency Services, OR, Day Surgery and Physician Practices. New grads are welcome and encouraged to apply.
For a full listing of available positions and to complete the online application, visit the Employment Opportunities pages at www.NVRH.org. NVRH offers competitive wages, shift differentials, per diem premiums and a generous benefits package for PT and FT employees working 20 or more hours per week. Benefits include medical, dental, vision, 401K retirement plan, tuition reimbursement, paid vacation days, membership to local gyms and more.
NVRH is an Equal Opportunity Employer Page 20 • New Hampshire Nursing News July, August, September 2016
Let NH Responds connect you to the Volunteering in an organization that will best fit your interests. Emergency
ESAR-VHP WHY REGISTER TODAY Emergency System for Advance Registration of Following a major disaster, Volunteer Health Professionals communities often need help caring MRC for their residents. During such Medical Reserve Corps events, emergency services can be delayed and challenging to access for DBHRT you, your family, and many of your Disaster Behavioral Health Response Team neighbors and friends. MMRS Metropolitan Medical Response System By joining today, you will become a registered volunteer, whose credentials and identity are verified Emergencies and natural disasters in advance, making you a valuable can happen anywhere... resource for your community, state, at any time. and the nation. Connect with NH Responds to help. NH Responds You will also gain access to specialized NH Department of Health and Human Services training that will provide you with 129 Pleasant Street, Concord, NH 03301 the necessary knowledge and skills Phone (603) 271-9475 needed to safely help people in need. [email protected]
To find out more information and to register visit www.nhresponds.org