November, 2014 • Volume 23 • Number 4 www.nvnurses.org Nevada RNFORMATION

THE OFFICIAL PUBLICATION OF THE NEVADA NURSES ASSOCIATION Free to All Registered Nurses, Licensed Practical Nurses, & Nursing Students in Nevada: Quarterly Circulation 32,000 The Nevada Nurses Association is a constituent member of the American Nurses Association In this issue NNA Goes to Washington focus 14 Report on 2014 Member Assembly 15 Membership Assembly Addresses Nursing Issues articles 3 NNA/NONL Convention 4 Nurse Tenure, Education Linked to Shorter Hospital Stays 5 Vote! 6 Nursing’s Dirty Little Secret: When the Schoolyard Bully Becomes a Nurse 6 Hurrah! NNF is a reality! 7 A Good Dying 8 Leading the Future of Nursing 10 Crusader for Tobacco Cessation 11 Las Vegas APRN Helps Rural Nevada Community 11 District 3 VP Hosts Gathering for Women 11 NNA District 1 Announces 2014 Scholarship Recipients 12 Human Trafficking As mandatory reporters, nurses are required 16 How the climate is changing in the to report sex trafficking of a minor. Would Great Basin? 18 Student Corner: UNR Orvis Student you recognize the telltale signs? Evidence-Based Poster Presentation Page 12 regular features 3 Message from President Scott Lamprecht After many years, NNA now has a foundation that will 7 Letters to the Editor allow philanthropic donations. 9 Check It Out: Unspeakable Crimes Please help jumpstart the 2014 fundraising campaign.

Presort Standard US Postage ~ Betty Razor PAID Permit #14 Princeton, MN current resident or 55371 NNA State Convention November 16-18, 2014, Tropicana Las Vegas, 3801 Las Vegas Boulevard South, Las Vegas, NV 89109

Nurses Day at the Legislature February 25, 2015. Space is limited. Register online at www.nvnurses.org

For more information, visit www.nvnurses.org Page 2 • nevada RNformation November, December, 2014, January 2015 NNA Mission Statement Editorial Board The Nevada Nurses Association promotes professional nursing practice through continuing education, community service, nursing leadership, and Editor: Margaret Curley, RN, BSN [email protected] legislative activities to advocate for improved health and high quality health care for citizens of Nevada. John Buehler Garcia, RN, BSN Betty Razor, RN, BSN, CWOCN Eliza J. Fountain, RN, BSN Denise Rowe, MSN, RN, FNP-C NNA State Board of Directors Wallace J. Henkelman, Ed.D, MSN, RN Kathy Ryan, MSN, RN-BC Mary Baker Mackenzie, MSN, RN Debra Toney, PhD, RN Scott Lamprecht, DNP, MSN, RN, [email protected] . . . . . President John Malek, PhD, MSN, FNP-C Christy Apple Johnson, RN Elizabeth Fildes, EdD, RN, CNE, CARN-AP, [email protected] . . Vice-President Kathy Mohn, MSEd, BSN, RN, PLNC Nicola Aaker, MSN, MPH, RN, CNOR, PHCNS-BC, [email protected] . Secretary Pat Alfonso, RN, BSN, MN, APN, [email protected] . . Treasurer Heidi Johnston, MSN, RN, CNE, [email protected] . . Director at Large Mary Brann, DNP, MSN, RN, [email protected] . . Director at Large Are you interested in submitting an article for publication Susan Growe, MSN/Ed, RN, OCN, [email protected]. . . Director at Large in RNFormation? Please send it in a Word document to us Jean Lyon, PhD, RN, [email protected]...... President, District 1 at [email protected]. Our Editorial Board will review Dave Tyrell, BSN, RN, [email protected] . . . . . President, District 3 the article and notify you whether it has been accepted for Teresa Serratt, PhD. RN, [email protected] . . .Northern Legislative Co-Chair publication. Articles for our next edition are due by March 1, 2014. Katherine Cylke, DNP, RN, [email protected]. . .Southern Legislative Co-Chair If you wish to contact the author of an article published in RNFormation, please email us and we will be happy to forward your comments.

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Nursing Issues and Social Change Scott Lamprecht, DNP, RN, APN President, Nevada Nurses Association

This issue contains much information on Human Trafficking and Sexual advancing nursing practice, Exploitation. This is a very tough topic to present and a major social issue will that not also impact in the United States and Nevada. As nurses we see the aftermath and the social change/policy? By toll to patients through physical and emotional scars that may never heal. working together to reduce Nurses see the trauma and need to be part of the solution. There are many nursing practice issues and social issues in the US; homelessness, substance abuse, domestic violence, improve patient care, nursing and the list continues endlessly. Nurses need to be part of the solutions will become stronger and be because we are involved by caring for the victims, however, I am torn able have a larger presence with the issues that nurses face in healthcare such as staffing, mandatory and impact on all issues. overtime, and poor work environments. Once again nurses are involved I know I have stated this in the problems and need to be involved in the solutions. So where do we before, but communication focus our energies? Should we all go in different directions to attack every and working together are the keys to advancing nursing practice, patient issue? Or should we focus our energy together to make the best impact we care, and so much more. can? Working together toward a common agenda can accomplish so much more, but how do we decide what is on the agenda? We need to remember If you would like to contact NNA or President Lamprecht, please that we are nurses and that should be our focus. I am not saying to ignore the social issues, on the contrary, if nurses improve patient care through call 775-747-2333 or email [email protected].

Who Should Attend? All registered nurses and registered nurse students are invited.

Nevada Nurses Association / Nevada Organization of Nurse Leaders 2014 Convention

“Leading Something Extraordinary” will be the theme of this year’s convention, which will be held November 16-18 at the Tropicana Las Vegas. We hope you can join us. Scheduled sessions include (subject to change):

• Hot topics • Lateral Violence in Nursing • You May Be That Someone • Achieving and Sustaining Excellence • Nevada’s Safe Staffing Law and What It Means to Nurses and Hospitals • Leading Environmental Health Initiatives in Your Workplace Rooms are available at the Tropicana Las • Motivational Interviewing: Leading to Extraordinary Results Vegas for rates starting at $85 per night. • Nevada Action Coalition on the future of nursing in Nevada

Tropicana Las Vegas A special session for pre-licensure nursing students will be: 3801 Las Vegas Blvd. South • Preparing for NCLEX Las Vegas, NV 89109 • How to have a successful job interview

To make reservations, go to There will also be a break out session for front line nurse leaders. https://resweb.passkey.com/go/NONLNNA14 Join us on Sunday evening for a reception hosted by the Nevada Action Contact Coalition and on Monday evening from 4:30-6:30 p.m. for the Presidents’ Margaret Curley Reception and Legislative Meet and Greet. Nevada Nurses Association 775-747-2333 Full registration includes course fees and handouts, receptions on Sunday and Monday, [email protected] continental breakfast Monday and Tuesday, lunch Monday, and refreshments at breaks.

NURSING CEU’S PENDING Visit www.nvnurses.org to register today! Page 4 • nevada RNformation November, December, 2014, January 2015 Nurse Tenure, Education Linked to Shorter Hospital Stays Janis C. Kelly Medscape Medical News Reviewed by Denise S. Rowe MSN, APRN, BC, FNP

Does staffing acute care hospital units with and whether the units used regular nurses or who may have little familiarity with their nursing registered nurses for a tenure of at least one year contracted agency nurses to cover absent staff. colleagues or have no previous expertise with unit result in shorter patient length of stay (LOS)? Hospital LOS was used as a substitute for cost and practices, procedures or equipment. The answer is a resounding “yes” according quality of care, and the measure for productivity. In summary, the results of this study provide a to Kelly’s review of a study published in the Controls for variation in severity of illness were the valuable incentive for hospitals to support stable American Economic Journal: Applied Economics. difference between actual LOS and expected LOS. RN staffing and tenure on hospital units. I strongly In April 2014, a study by Ann P. Bartell PhD, and The study found that nurse specific tenure agree with the researchers’ conclusion that colleagues estimated that for an average one year on units was significantly important to patient maintaining experienced RNs on units increases increase in RN unit tenure, the adjusted length of outcome on those units. Negative productivity productivity, while significantly decreasing stay was reduced by 1.33%. They suggest that was associated with experienced nurse leaving hospital length of stay. This is a valuable human human capital investment plays a very important units and also with adding new nurses to capital. Further, this approach reduces annual role in the productivity of registered nursing staff. units. The effect of nurses’ overall tenure to a RN labor costs associated with staffing turnover, The researchers’ reviewed data from the Veterans hospital had no significance outside of the units. and presents a paradigm shift when looking at Administration hospital system and found that an Reduction in LOS was associated with higher retaining experienced nursing staff, as value- average RN unit tenure of 6.55 years would save staffing educational levels but varied with skill added assets. This study suggests hospitals would $20,976 annually compared to RN unit tenure of level of staff: LOS for RNs was 3.4%; for LPNs have a long term benefit in investing in registered 2.25 years. it was 2.9%, and 1.5% for unlicensed assistive nursing staff, and nursing education which would The authors investigated how the composition personnel. LOS was also shorter when overtime improve productivity and add value to the quality of the nursing unit teams affected patient was covered by regular RNs instead of contract of care delivered to patients. outcomes. Nursing units including medical, nurses. Contract nurse staffing did not improve surgical, neurology, oncology, intensive care and patient outcomes in LOS compared to regular RN References: cardiac care units were reviewed. They looked staffing. The authors surmise this difference was Am Econ J Appl Econ. 2014;6:231-259. Abstract at factors such as: when new nurses joined due to the human capital investment made in Medscape Medical News © 2014 WebMD, LLC the units, when experienced nurse left units, regular staff nurses compared to contract nurses

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Click on the “CAREERS” tab to apply today! www.NNRHospital.com November, December, 2014, January 2015 Nevada RNformation • Page 5 VOTE! Wallace J. Henkelman, EdD, MSN, RN

Once again, we are facing the vital local, state, now. There are also some nonpartisan websites and national elections. It is important that all such as www.vote-smart.org and http://www.c- Americans exercise their constitutional right to span.org that provide valuable and unbiased vote. As Americans, we have a right to have our information for voters. opinions on issues heard, and voting is a powerful One error that voters frequently make is casting tool with which to do that. Voting does not ensure their vote based on only a single issue, abortion that your opinion on an issue will prevail, but not for example. Just because a candidate agrees voting neglects the key tool for making your voice with the voter on that one issue, does not mean heard. that the candidate is the best choice overall. With All of our elected officials will certainly face additional information, the voter might find that healthcare issues such as health insurance, there are disagreements with the candidate on smoking limits, traffic safety issues, funding for many other issues. health facilities, and many others. As nurses, we Please take your responsibility as a citizen are intimately familiar with the facts related to seriously; register and vote. these issues and we need to let our officials know how we view the issues. Nurses’ opinions are valued by our elected officials. Alpine Hematology-Oncology One of the excuses for not voting is that a We thank our Nurses for their dedicated service. single vote really does not matter, but that is not always true. Just a couple of examples will 236 West 6th St., Suite 400 Reno, Nevada 89503 demonstrate that. In the United States Senate Office (775) 329-0873 election in Nevada in 1964, the outcome was The only wasted vote Fax (775) 329-1026 decided by only 48 votes out of 134,624. In a www.alpinedoctors.com Montana House of Representatives vote in 2004, is one that isn’t used! Steven A. Schiff, M.D. John A. Shields, M.D. the outcome was decided by two votes out of Sowjanya Reganti, M.D. Margaret Van Meter, M.D. 4,224. should also by accessed. Network news sources Another excuse is confusion on who or what Julie Simeoni, MN, APN are also sometimes biased based on the particular to vote for. There are numerous sources of political leanings of their owners. If the candidate information on the candidates and issues available has been in office previously, their voting record in print and on the internet. Since candidate showing what they have actually done is probably statements on their websites are, by their very better than any promises that they are making nature, biased, other sources of information Maxim Nurses Stand Out in a Crowd

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Ginger E. Fidel, MSN, RN, OCN, CNL

Although not a “The American Nurses is being disseminated by those who Peggy trained. new topic of interest Association (ANA) In the Valley Health System, new hires now for many nurses, the upholds that all nursing receive an overview of lateral violence; inevitably phenomenon of lateral personnel have the right when this content is shared, there is an often an violence, horizontal to work in healthy work acknowledgement by many experienced nurses hostility, or bullying, environments free of that have been on the receiving-end of bullying or call it what you will, abusive behavior such as who have witnessed such negative behaviors in was something many bullying, hostility, lateral the workplace. Since the NNA training, one of the of us have faced abuse and violence, fundamental components of education taught to since first becoming sexual harassment, our new graduates (these individuals are at high a nurse, whether it intimidation, abuse of risk for becoming targeted) in our RN Residency was experienced as a authority and position Program includes a two hour module on lateral target or as a witness and reprisal for speaking violence along with methods to stop the behavior of another being bullied. Used by permission out against abuses” by the bully including a focus on holistic methods Clark defines incivility (ANA, 2014, para. 2). of self-care (American Holistic Nurses Association, as “rude or disruptive behaviors which often While there is no standard that requires workplace 2011). Nearly 200 new graduate nurses have been result in psychological or physiological distress violence protections, the Joint Commission (JC) trained since October, 2013, in VHS. for the people involved—and if left unaddressed, created a new standard in the “Leadership” may progress into threatening situations” (2012, chapter (LD.03.01.01) that addresses disruptive References American Holistic Nurses Association (2011). Holistic stress p. 1). While educating new nurses in academe, and inappropriate behaviors (Larson, 2011). There management for nurses. Retrieved October, 2011, from the work of Dr. Cynthia Clark caught my eye is no federal standard the requires protection http://www.ahna.org/Resources/StressManagement/ because my worst lived-experience with horizontal against workplace incivility; therefore, hospital tabid/1229/Default.aspx hostility was as a young nursing instructor in not policy must be written such that this type of American Nurses Association (2014). Bullying and workplace violence. Retrieved, May 2014, from one, but two different academic settings in two behavior can be recognized and addressed http://nursingworld.org/MainMenuCategories/ different states. According to Clark, it is this type by leadership with zero-tolerance for bullying WorkplaceSafety/bullyingworkplaceviolence of unprofessional behavior that leads many to behaviors amongst health care workers. Clark, C. (2012). Creating and sustaining civility in nursing leave the profession of nursing including academe Nearly a year ago several colleagues in Las education and practice. Retrieved January, 2013, from http://coadn.org/north/files/resource/65.pdf (personal communication, Cynthia Clark, January, Vegas came together for one of the first Nevada Dulaney, P. (2013, September 23). Lateral Violence in 2011). Bullying is not just at the bedside, it is all Nurses Association (NNA) trainings on Lateral Nursing: Let’s Get Rid of It. (G. Fidel, Interviewer) pervasive, and many researchers in this area were Violence presented by Peggy Delany. Along with Larson, J. (2013). Nurse bullying: An ongoing problem in the health care workplace. Retrieved July, 2013, also bullied (personal communication, Cynthia many others across the country, including Nevada, from http://www.workplacebullying.org/2013/06/17/ Clark, February, 2011). information on the phenomenon of lateral violence nursezone/#more-12831

Assistant Director of Nursing (ADON) Desert Parkway Behavioral Healthcare Hospital is an 83 bed licensed acute psychiatric hospital that provides high quality behavioral and addiction treatment. This position will be a working position assisting the CNO in maintaining nursing standards and evaluating all nursing service activities. The ADON has a 24 HURRAH! hour, 7 day a week responsibility to ensure adequate nursing coverage. • A Nevada State RN License and MSN required. • Five years of experience in a supervisory role in a behavioral healthcare facility. To apply or for more information, please contact The Nevada Nurses Foundation (NNF) is a Please help us by personally asking and Milissa, Human Resources Director, [email protected] reality –Nevada Nurses Foundation (NNF)! soliciting the right person. www.desertparkway.com After many years and the hard work of Be an advocate for nursing and find a Margaret Curley and Barbara Wardwell (NNA “friend of nursing.” A link to NNF is on the NNA accountant), NNA now has a foundation that will web site. Email NNF at [email protected]. allow philanthropic donation and fund raising campaigns. The ultimate goal of the foundation is Will you be a “friend” to the Foundation by to advocate for excellence in nursing and quality helping us get started? health care for Nevada citizens by supporting nursing activities through scholarships, educational Please ask every nurse you know to endeavors, and research grants. send the foundation $10 to jumpstart We provide loving & compassionate The foundation directors and advisory board the 2014 campaign! care for our patients & will be seeking your assistance in effectively their families. locating “friends” that will support nursing and Donations can be made online at the www. conduct fund raising campaigns/projects, program nvnurses.org/foundation/. If you prefer to send Our Services: planning, provide financial support and donations. a check, make it payable to Nevada Nurses We add to our superior clinical, As a non-profit, NNF realizes that fund-raising is bereavement and counseling services, Foundation and mail to: NNF, P O Box 34047, music, massage, relaxation, pet and not just raising money; it is raising friends—people Reno, CA 89533 healing touch therapies at no cost to the who know about our organization and will support patient or family. Physical comfort and it financially, even help raise money. psycho-social-spiritual wellbeing May God Bless and Thanks, through the end of life are our priorities. Prospective donors will give when they are Betty Razor convinced of the value and need for their gift. 775-827-2298 www.colhospice.com Reno, Nevada Foundation Board of Directors Sandra ‘Sandy’ Olguin, MSN, RN President Denise Ogletree McGuinn, APRN, D.Minn Vice President Susan Growe, DNP, RN Secretary Beatrice ‘Betty’ Razor, BSN, RN CWOCN Treasurer Elizabeth Fildes, EdD, RN, CNE, CARN-AP, APHN-BC, DACACD Nevada Nurses Association Liasion Michael & Deb Girard, Owners November, December, 2014, January 2015 Nevada RNformation • Page 7 Letters A Good Dying To The Editor Paula Schneider, MPH, BSN, RN

Dear Editor, Have you, as a professional in the field of health Understanding the Special Awareness, care, ever given much thought to what your own Needs, and Communications of the Dying by I am writing to express my concern about the death might look like? Oh sure, many of you Maggie Callanan and Patricia Kelley and Sacred proposed Nevada’s Margin Tax. In November, have seen people die—patients, family members, Dying: Creating Rituals for Embracing Question 3 on the ballot will ask Nevada voters to spouses, friends. But have you considered your the End of Life by Megory Anderson are two approve the Margin Tax. own dying process? I believe that as nurses we excellent resources to check out as you begin your For your readers that don’t know, if the Margin must begin to contemplate these things so that research. Also, some people tell me they have Tax is approved, Nevada businesses that earn we better serve those who see us as role models already written their obituary, which I think is an over one million dollars in revenue, will have and look to us for guidance. We must expand our excellent exercise. approximately 70% of their gross revenues taxed comfort zone with death, as patients will be able If you work in a hospital, skilled nursing facility, at a rate of 2%. For healthcare providers this would to sense in us our discomfort if we have not done or assisted living facility, or if you are a hospice increase the taxes they now pay five-fold. A tax some work on this issue in our private life. professional, it is especially important that you increase of this amount would have a significant End-of-life topics are talked about in societies begin to deepen your understanding of death and negative financial impact on our healthcare industry. through the world today. Everyone knows that dying. You will confront it often in your career and Normally, business taxes are based on profits. The a huge glut of baby boomers born all over the you want to make sure that fears and anxieties more money you make after expenses, the more you world in the 40’s and 50’s are now beginning to you may be harboring don’t pop up at inopportune pay in taxes. But the Margin Tax is based on total turn 70 and beyond. We will all (myself included) times. Begin to find some peace around these revenues. In other words, a business that makes five be saying good-bye to this life within the next 20 issues so that when you need to draw upon it, it million dollars a year in gross revenue but is losing to 40 years. Many of us will soon be in the “frail will be readily available to you. money would pay the exact same margins tax as a elderly” category. In discussing death and dying Five Wishes advance directives are available five million dollar business that makes one million in the Death Cafes I facilitate, I have learned online at www.agingwithdignity.org and can be dollars a year in profits. That is simply unfair. that many in our parents’ generation refused to purchased individually or in bulk. Paula may be Research done by leading Nevada economists and discuss such matters, causing much family friction contacted by email at [email protected]. think tanks have found that such an indiscriminate in many cases. However, there is no excuse for She is happy to answer questions as well as offer tax policy would add a significant tax liability on the present generation of soon-to-be elders to be a list of excellent resources, such as books and many small businesses, killing job growth and uneducated about end-of-life issues! movies, for exploring end-of-life issues. damaging Nevada’s fragile economy. Some of you may be familiar with the term, “a Paula is a veteran Regis- As a registered nurse and owner of a small good death.” I think the better terminology would tered Nurse of 37 years. She business that provides critical healthcare services, be, “a good dying.” Most of us, if we are honest, has a BSN and a Master’s of I was startled to learn about the negative impact do not think of death as a good thing. Public Health degree from the the margin tax would have on healthcare-related Biologically, we are all dying. This process University of Texas Health businesses like mine. As I researched this initiative, I accelerates as we age. If we choose to engage Sciences Center in Houston. realized that many of us – small businesses and large in unhealthy lifestyles and behaviors, the aging Her health care career has businesses alike – would be negatively impacted process will emerge much quicker and will be been diverse, and her true love by a tax that indiscriminately affects companies’ more obvious. Too, ill health causes people to age is end-of-life care. She was a regardless of their expenses, profits, or losses. differently. The part of the dying process I am hospice RN case manager for 10 years for three A similar tax in Texas exempts Medicaid, Medicare referring to is the last months to weeks of life. different hos- pices. For five years while working and other health programs, but no such exemptions Perhaps you have been diagnosed with a terminal in hospice she wrote weekly articles on death, exist in Nevada’s Margin Tax. Furthermore, Texas’s disease or maybe you are just living out your dying, and spirituality for the Nevada Appeal. She Margin Tax provides for a 50% exemption for days. At any rate, besides creating an advance is knowledgeable about end-of-life care and is healthcare institutions. Nevada’s Margin Tax does directive, which is almost a given in today’s passionate about helping people understand what not. society, what does a good dying look like for you? dying in America entails today. She strives to help Jeremy Aguero, a local expert in economic Additionally, will you come to the end of your life others live life to its fullest and to be less afraid of analysis, recently examined the Margin Tax initiative’s and feel at peace about it? death and dying. potential impact on the healthcare industry in I have learned from talking to hundreds of Nevada, and found that the healthcare industry patients, families, and others about death and would experience “a 203% state business tax dying that most people want to die free of pain increase in 2015, should the initiative pass.” Thus, and they want their symptoms managed. Many if passed, the initiative would inevitably force an want to die at home (though statistically they increase in the cost of healthcare services and will not), surrounded by family and friends. AdvAnce your PrActice And cAreer restrict access to affordable, quality healthcare Overwhelmingly, people tell me they wish to die services for thousands of Nevadans. As healthcare in their sleep. Many people are, quite frankly, providers, citizens and Nevadans, Question 3’s dreading this whole dying scenario! Margin Tax will greatly affect us all. A beautiful document, Five Wishes, outlines It is estimated that the tax will increase the costs for the person filling it out, some ways that of doing business in Nevada by comfort and peace can be introduced into the $750 million. Some businesses may attempt to process of dying. Five Wishes is a combination reduce costs, others may be forced to close their living will and advance directive that allows the doors as they venture from profitable to unprofitable person completing it to think about the many as a result of the Margin Tax, resulting in lost jobs. ways that comfort can be a part of dying. Hospice Other businesses may increase their product and services are a valuable part of a comfortable RN–BS | AGNP | DNP service costs in order to remain profitable, passing dying process, as opposed to staying in a hospital Boise State University is a leading center the financial responsibility of the tax on to the undergoing yet another test, scan, or other for nursing education. consumer. In effect, this Margin Tax will be a burden invasive procedure to see “how far the disease Contact us and experience our supportive to us all: consumers, employees, and employer. has spread.” Many are choosing peace and approach and flexible online options!* I encourage my colleagues in the healthcare comfort rather than aggressive and sometimes 208-426-4632 industry to educate themselves on this ballot futile diagnostic procedures and treatment. initiative. Please visit the website at www.NOon3. I recommend reading materials that can help [email protected] com or www.stopthemargintax.com. people take the first steps to considering what hs.boisestate.edu/nursing/na their good dying would look like. Final Gifts: * Program availability varies by state and program. Best Regards,

Donna G. Miller, RN, EMS-RN, CMTE President / CEO / Flight Nurse Life Guard International - Flying ICU Page 8 • nevada RNformation November, December, 2014, January 2015 Leading the Future of Nursing: Your Nevada Action Coalition Jennifer Richards, RN, PhD., CNRN, Kristin Gillen, RN, DNP, CNML

The mission statement for the Nevada Action was awarded a State Implementation Plan (SIP) on the key competencies necessary to serve on Coalition (NAC) is to champion, through strategic grant and has been working to put plans in place hospital and health system boards. According to collaboration, access to high quality health to meet the deliverables of the grant. There are Sue Hassmiller, PhD, RN, FAAN “Board service care for all Nevadans where nurses contribute several deliverables related to the grant, some of can be rewarding to nurses both personally as essential partners. NAC will accomplish this the key metrics are: and professionally. It not only requires them to mission by implementing and supporting the 1. Establishing champions for each of the 8 exercise leadership; it expands those skills and recommendations from the Future of Nursing Recommendations advances their capabilities and knowledge. It Campaign. The 8 recommendation are as follows: 2. Establishing Champions for each of the 5 gives nurses the chance to meet people and 1. Remove scope of practice barriers Regions within the state enhance their professional networks. And it can 2. Expand opportunities for nurses to lead and 3. Diversity Plan be inspirational and empowering.” diffuse collaborative improvement efforts 4. Leadership summit The leadership summit will help to identify 3. Implement nurse residency programs the key competencies a nurse in Nevada will 4. Increase the proportion of nurses with a NAC is proud to announce in partnership with need to be successful in serving on a board. The baccalaureate degree to 80% by 2020 NONL and NNA we will be hosting a leadership competencies will be presented by Joey Ridenour, 5. Double the number of nurses with a doctorate Summit in Las Vegas On Nov. 16th. The leadership RN, MN, FAAN and will focus on evidence based by 2020 summit will focus on the current activities the NAC strategies to empower nurses to be confident in 6. Ensure that nurses engage in lifelong learning is involved in, some future activities we would what they bring to the board room. Nurses are 7. Prepare and enable nurses to lead change to like to organize and execute, as well as some key members of a healthcare board due to their advance health additional details related to the SIP grant. ability to bring the voice of the direct care staff 8. Build an infrastructure for the collection The leadership recommendation states we to the table. Being a part of the decision making and analysis of inter-professional healthcare should expand the opportunities for nurses to process enables a more rounded approach that workforce data lead and diffuse collaborative improvement efforts includes not only fiduciary responsibilities but also through increasing the numbers of nurses on those of quality and patient safety. Through board The NAC has had a busy 2014, working hospital/health system, policy and organization leadership nurses have the potential to impact diligently to establish a leadership structure and boards. As stated in the 2010 IOM Future of a multitude of quality and patient safety issues illustrating our partnerships with our supporting Nursing Report, “strong leadership is required to including medical errors, readmission rates, and organizations Nevada Alliance for Nursing realize a vision of a transformed health system”. hospital acquired conditions which can and will Excellence (NANE) and Governor’s Workforce In order to further the leadership recommendation impact an organization’s bottom line as well as the Investment Board (GWIB). Additionally, the NAC we need to educate and train nursing leaders health of the community.

OFFERED BY THE AMERICAN NURSES ASSOCIATION COULD YOU MAKE THIS MISTAKE— We all make mistakes. But as a nurse, one mistake AND BE SUED? can lead to disaster. Consider this real-life example.

A 48-year-old woman with sleep apnea had surgery at a hospital for a detached retina. The surgery went well, and the patient was admitted overnight for observation. That evening, the nurse gave the patient Demerol for pain as prescribed. When the patient vomited shortly thereafter, the nurse assumed the medication had been expelled and gave the patient another dose. Later, the patient complained of inadequate pain control. The nurse alerted the physician, who ordered another pain medication. By 1:15 a.m., the patient coded. The team could not resuscitate her. The patient’s daughter filed a lawsuit. The case was settled for more than $1 million, split evenly among the nurse and two physicians.1

It’s because of cases like this that the American Nurses Association (ANA) offers the Nurses Professional Liability Program. It protects nurses from the potentially devastating impact of malpractice lawsuits. Get the protection you need—without paying more than you need. To take advantage of special rates for ANA members, visit proliability.com/65011 for an instant quote and to fill out an application.

MALPRACTICE INSURANCE OFFERED BY THE ANA ANNUAL PREMIUM AS LOW AS $982 Protect yourself now! Visit proliability.com/65011 or call 800-503-9230.

1 Source: Forum, May 2008 2 Please contact the program administrator for more information, or visit proliability.com for a free quote.

65011 (11/14) Copyright 2014 Mercer LLC. All rights reserved. Underwritten by Liberty Insurance Underwriters Inc., a member company of Liberty Mutual Insurance. 55 Water Street • New York, New York 10041 Administered by: Mercer Consumer, a service of Mercer Health & Benefits Administration LLC In CA d/b/a Mercer Health & Benefits Insurance Services LLC AR Ins. Lic. #303439 | CA Ins. Lic. #0G39709 November, December, 2014, January 2015 Nevada RNformation • Page 9 Check It Out!

Unspeakable Crimes

Once upon a time, those enslaved by politics and religion braved Please visit the Polaris Project at www.polarisproject.org and danger and privation to seek freedom in a new world - our world - the the National Human Trafficking Resource Center at www. United States. Generations later, the United States abolished slavery traffickingresourcecenter.org. forever - or did we? Human trafficking is slavery, and it is alive and well today. In 2000, the United States government passed the Trafficking Victims Protection Act. “Key provisions” include prevention, protection, - United States - and prosecution. The Department of Justice, the FBI, Immigration and “In and out of foster homes in Southern California, USA, 13 year old Customs Enforcement, and the State Department share responsibility for Denise craved the love and support of a parent figure. She found that the implementation of initiatives. Updates in 2003 and 2005 strengthened in an older boyfriend she met in her neighborhood. He slowly convinced victims’ rights and expanded support programs. her that she could earn a lot of money in prostitution and acted as her pimp. She was arrested multiple times and served time in jail. Law The Trafficking Victims Protection Act and its updates are enforcement did not identify her as a human trafficking victim so she available through the Library of Congress’s Thomas website at www. did not receive social services and, instead, entered the juvenile justice thomas.gov. system as an offender. She has never had her prostitution convictions expunged. Those convictions have made it nearly impossible for her In Nevada, Attorney General Catherine Cortez Masto is both to find work. She admits that most in her financial situation would concerned about human trafficking and determined to stand against have returned to prostitution by now.” - globalfreedomcenter.org/GFC/ it. Her website reports the recovery of 2229 sex trafficking victims and humantraffickingstories 107 child victims over time, and hundreds of hotline calls in Nevada. Her website also discusses Masto’s “work to address the problem” and Human trafficking is the capture, control, and/or transport of provides links for additional information and resources, including “warning individuals without regard to age, gender, or culture. Victims are coerced signs of human trafficking,” “help for victims,” and “how you can help or forced into activities against their will, and traded or sold to the highest fight human trafficking.” bidder. Children are often sexually exploited, adults are often trapped in sweat shops. In every case, they are slaves. Please visit Catherine Cortex Masto’s website at http://ag.nv.gov/ Human_Traffciking/HT_Home/. Human trafficking selected statistics (worldwide estimates): - 27 million - the number of slavery victims “As we work to dismantle trafficking networks and help survivors - 161 - the number of countries involved in human trafficking rebuild their lives, we must also address the underlying forces that push - 1 million - the number of children abused through commercial sex so many into bondage. We must…build a global sense of justice that says trades no child should ever be exploited, and empower our daughters and sons - 32 billion - human trafficking yearly profits (in American dollars) with the same chances to pursue their dreams.” - President Obama, 2013, in the 2014 Trafficking in Persons Report The Polaris Project is a national organization whose purpose is to “combat human trafficking and slavery.” Services at the individual and victim level include direct outreach and victim identification, transitional housing, and social services. Services at the national level include the National Human Trafficking Resource Center (crisis and tip hotlines), encouragement and support for grassroots efforts, and education and advocacy for legislation at state and national levels.

LPN/RN Located in Carson City, we have immediate openings for compassionate, dependable, energetic nurses to work with special needs population. Predominantly night shift (Graveyard) with some days, 30-40 hours. Generous benefits including, health, dental, vision, insurance for employee completely covered. Current NV license, 1 year experience in acute care, long term care or IDD facility. Competitive compensation. Contact: Donna Weidner – [email protected] or 775-882-1188 ext. 29 www.eaglevalleychildrenshome.org EOE Page 10 • nevada RNformation November, December, 2014, January 2015 nevada nurses making a difference here and abroad Crusader for Tobacco Cessation

Danielle Logacho

Affairs (VA), she said, “I saw veterans who, in their connect them with the process of quitting smoking. old age, were victimized by chronic diseases related Follow-up phone calls help provide additional to tobacco use. I thought, it’s right that we start support. something here.” In Nevada, helpline counselors address not only These experiences helped sharpen Dr. Fildes’ the physical and emotional components of nicotine focus on helping people overcome their addiction to addiction, but also the spiritual side. tobacco – a role that she feels is especially suited “Not a lot of quitlines would ask about spiritual to nurses. practices, but we do that,” Dr. Fildes explained. “I think it’s a great opportunity for nurses to “We say, if prayer is part of your life, meditation demonstrate our ability to prevent disasters in is part of your life, these are very important tools people’s lives – the disaster of chronic debilitating that you can use in your quitting plan.” disease. I think smoking cessation fits very well into the paradigm of nurses because we care for Exporting the helpline to the Philippines the whole person.” This holistic model is part of what Dr. Fildes has presented to health officials in the Philippines Elizabeth Fildes, EdD, RN, CNE, CARN-AP, APHN- The role of a tobacco users’ helpline as part of her efforts to help establish a national BC, DACACD, may be one nurse, but through her quitline. work, she’s helped improve the lives of thousands It’s come at a good time. According to a survey of people. by the Philippines Department of Health, some A professor in Chamberlain’s Master of Science in 17.3 million Filipinos smoke – a figure that includes Nursing (MSN) degree program, Dr. Fildes founded almost half of all men in the country. Among the Nevada Tobacco Users’ Helpline in 1997 – a smokers, some 60 percent have stated that they service that to date has served 40,000 people in are interested in quitting. their struggle to quit smoking. In a chance meeting in 2012, Dr. Fildes Now she’s bringing her expertise back to her happened to be seated at a dinner at the same native Philippines as a volunteer consultant for the table as the Philippines Secretary of Health, Dr. country’s new tobacco users’ quitline. Enrique Ona. He mentioned that the country was Dr. Fildes’s interest in tobacco cessation was enacting a tax on alcohol and tobacco. She shared born from both personal experience and a belief in Dr. Fildes and the team at the Lung Center of with him the idea of establishing a tobacco users’ the Philippines the potential of nurses to make a difference in the helpline, to be supported by revenue from the tax. lives of others. “I said, ‘If you’re taxing the Filipino people, you Tobacco helplines, such as the one Dr. “My grandfather died of a tobacco-related need to offer them services to help them quit. I Fildes helped establish in Nevada, provide free, disease in the Philippines when I graduated from can help,’” she said. accessible, phone-based support to people who are high school,” she said. “There were no resources In 2013, she formally presented the idea of trying to quit smoking. Specially trained addiction available to resuscitate a patient with myocardial establishing a national quitline to Dr. Ona and other counselors conduct a holistic assessment of the infarction in my rural town in the Philippines — health officials. She briefed them on the benefits caller, explain strategies that have worked for other [making it] all the more important that we help of helplines and began sharing protocols and people and work with the individual to determine patients prevent these consequences.” guidelines that had proven successful in Nevada. which techniques are right for him or her. Later, after she moved to the United States Counselors use motivational interviewing and began working at the Department of Veteran The idea is now techniques to highlight the caller’s strengths and coming to fruition. The budget for the Philippines Tobacco Users Helpline Carson Tahoe Health was approved in February provides a complete of this year, and the first continuum of care with: employee was hired in March. · Three Hospitals Nevada Substance Abuse Prevention and Treatment Agency (SAPTA) Hurdles still need to · Two Urgent Care facilities be overcome – including · Comprehensive provider network The mission of SAPTA is to reduce the impact of marketing the service · 22 locations covering Carson City substance abuse in Nevada. Dr. Elizabeth Fildes & surrounding areas SAPTA funds services with private non-profit treatment and translating materials organizations, community level prevention organizations in all from English into some We offer: 17 Nevada counties, and governmental agencies statewide. of the more prominent languages in the Philippines · Competitive Salaries · Medical Benefit Package Treatment Services Offered – but the new helpline is on its way. Once it’s fully · PTO · Sick Leave · Paid Holidays • Detoxification • Residential treatment services implemented, it has the potential to help an untold · Education Assistance · Generous 401(k) • Outpatient counseling • Opioid maintenance therapy number of Filipinos beat their addictions. • Comprehensive treatment • Non-pregnant injection Visit our website for current nursing opportunities priority admission or interim drug users It’s quite an achievement, but in this and all services to pregnant women: • All Other Substance Abusers of her tobacco-related work, Dr. Fildes takes a www.carsontahoe.com • Pregnant injection drug users • Co-occuring behavioral health philosophical view of her role. Recruiter: 775.445.8678 • Pregnant substance abusers disorders “I want to be a conduit of good that needs to Job hot line: 888.547.9357 Prevention Services Provided happen in our world.” • Provide Federal and State funding to local and regional coalitions who Carson City, Nevada fund community level direct service providers to provide evidence- (Located in Northern Nevada, based programs, practices, and policies, on identified substance - See more at: http://blog.chamberlain. near Lake Tahoe and Reno) abuse and related factors in communities edu/2014/06/23/crusader-tobacco- EOE • Provide Federal and State funding to local and regional coalitions to cessation/#sthash.GNs5mY1x.dpufF provide environmental strategies to change community norms • Provide training and technical assistance This article was reprinted with permission from For questions or resources contact SAPTA at: Chamberlain College of Nursing Carson City: 775-684-4190 Website: http://mhds.nv.gov November, December, 2014, January 2015 Nevada RNformation • Page 11 nevada nurses making a difference here and abroad

Las Vegas APRN Helps Rural Nevada Community

Wallace J. Henkelman, EdD, MSN, RN, Nevada Career Institute

John was born and raised in Albany, New York Center asking if he could provide coverage for and began his nursing career by completing vacations. In December of that year he received his Associate Degree from Maria College and an email from the hospital informing him that working in Ortho/Neuro at St. Francis Hospital three rural healthcare providers had given their Medical Center in Hartford, CT. He moved to notice of resignation for various reasons; two Nevada in 1978 and worked at Sunrise Medical were moving out of the area and one was retiring. Center in Neuro Critical Care before moving to John was offered a part-time position to help northern Nevada in 1980. With the exception two fill the gap while recruitment was under way to years working at a migrant clinic in Florida, the secure additional full-time providers. Since then majority of his career has been spent at Carson John has driven from Las Vegas to Yerington, Tahoe Hospital in Carson City and South Lyon about 370 miles each way, every other week Medical Center in Yerington, Nevada. While at to provide his services to the community. They Carson Tahoe, he worked primarily in critical care, have since hired a full time nurse practitioner and education, and behavioral health while pursuing physician assistant but John continues to work As an APRN, John states that his greatest further educational goals. In 1995 he received per-diem, and is prepared to cover for vacations, rewards and challenges have come from working a BSN from Graceland University and in 1999 unexpected illnesses, or in any other capacity in rural health, since the need for healthcare an MSN with a focus on family practice. Soon for which his knowledge, skills, and abilities have providers in rural settings is now more critical than thereafter he entered a PhD program at Kennedy qualified him. His dedication to providing health ever. After taking early retirement in 2012, he Western University in Thousand Oaks, California care for an underserved community is certainly to received a call to action from South Lyon Medical completing his doctoral studies in 2002. be commended.

District 3 VP Hosts Gathering for Women

Donna Miller, RN, Vice-President of NNA District 3, hosted a forum, “When Women Succeed, America Succeeds,” in the hangar of her air ambulance service, Flying ICU, on June 13. Featured speakers were House Minority Leader, Nancy Pelosi, and Congresswoman Dina Titus.

NNA District 1 Announces 2014 Scholarship Recipients

Congratulations to this year’s scholarship recipients, Christy Apple- Johnson and Megan Gates!

Megan Gates

Christy is an RN to BSN student and Megan is studying for her MSN. Christy Johnson Page 12 • nevada RNformation November, December, 2014, January 2015 human trafficking

Sex Trafficking Overview There are some red flags when a patient arrives in ER or the clinic that may indicate the patient is a trafficking victim. These are What is Human Trafficking? of girls walking the streets does not mean your described by Mary de Chesnay in Human Human trafficking is “defined by US Federal community is free from this problem (Chalmers, Trafficking, A Clinical Guide for Nurses as: Law as (A) sex trafficking in which a commercial 2014). • Older man or woman with a young sex act is induced by force, fraud, or coercion, patient or in which the person induced to perform such Who are the victims? • Accompanying person dominates act has not attained 18 years of age; or (B) the “These girls did not arrive in a storage • Patient seems to defer or cower before recruitment, harboring, transportation, provision, container from Thailand. These are OUR girls,” the accompanying person or obtaining of a person for labor or services, says Assistant U.S. Attorney Carla Higginbotham. • Patient seems withdrawn, frightened, or through the use of force, fraud, or coercion for Sixty percent of the girls recovered in Las Vegas conversely agitated with signs of high the purpose of subjection to involuntary servitude, (Masto, 2014) and slightly less than half of those anxiety such as nail biting or fidgeting. peonage, debt bondage, or slavery. (Nevada recovered in Reno (Chalmers, 2014) are local (De Chesnay, 2013) Attorney General, 2012)” This article will deal girls. The average age of the victims recovered primarily with sex trafficking. in Las Vegas is 18-24 (Hughes, 2014), and the De Chesnay also describes the following average age in Reno is 20 (Chalmers, 2014). It red flags when the nurse is actually with the “Sex Trafficking is now being treated as a happens everywhere, in all the schools. Victims patient: public health crisis, and has become a topic are frequently girls with low self esteem (Robison, • Accompanied by a companion who of research and debate across all sectors.” 2014). Many are runaways or foster children, who attempts to control the interview by (ASU ASU School of Social Work Office of Sex may have been physically &/or sexually abused at answering questions for the patient or Trafficking Intervention Research, 2013) home. They may never have been loved in their offering to translate lives, so the promise of love from a pimp is a • Eyes downcast—poor eye contact with How does it happen? powerful draw (Higginbotham, 2014). providers A girl or women can either be kidnapped by • Minimal conversation with providers and a “gorilla pimp” and held by force, or she may fearful affect; alternatively might appear As mandatory reporters, nurses are be, more commonly, seduced into “the life” by hostile or “tough” required to report trafficking of a a charming, manipulative exploiter, known as a • Vague story of how obtained injury might minor. If you suspect a patient is under “romeo pimp.” Typically, he forms a relationship change when told to different staff 18 and is being trafficked, call the with her, promising “love,” then manipulates her • Old injuries such as bruises, poorly police. If you believe she is in imminent into performing commercial sex acts. The pimp healed fractures, and abrasions danger, call 911. will likely take her money, her phone, and her • Evidence of self-mutilation (small cuts on ID, making it hard for her to leave or get help. arms or legs) The victims are commonly sold to multiple sex Teen years can be difficult at home. Girls are • Presence of tattoos of names—many partners every night. One exploiter may have approached by an attractive man who offers them pimps brand their victims with own several girls or women in his “stable.” These all kinds of things—love, flattery, gifts—and preys names victims may be branded, beaten, and starved. on their vulnerabilities. The teen thinks “I’ll finally • Bad teeth be an adult.” Then, when the demands happen, (De Chesnay,2013) Where does it occur? they don’t know how to get out (Robison, 2014). Sex trafficking can occur anywhere in Nevada that is located on a major highway and has What is the role of nursing? • Do you feel like you are in control of your internet access—in other words, almost anywhere. Because they live in a violent world, these life? It happens most frequently in Las Vegas and victims may at some point interact with the • Are you allowed to carry your own ID? May I Reno, but it can occur in rural counties, as well. health care system. The most likely locations to see your ID? (Higginbotham, 2014). Most buying and selling of encounter them are ER, urgent care, labor and girls takes place on the internet, so the absence delivery, Planned Parenthood, a health clinic, or a Remember, if the patient is under 18 or looks dental office. This may provide their only chance under 18, you are required by law to report to law at escaping their situation. enforcement or child protective services. Asst. US Attorney Carla Higginbotham stresses If the patient is over 18 “you have to go with the importance of treating these patients with what the patient wants. If she won’t admit, compassion and respect. Remember that they make sure she knows what resources are out have probably been branded, beaten, housed in there, such as the FBI, Committee to Aid Abused a “stable,” advertised on the internet, and sold Women. They frequently don’t know where to go to multiple sexual partners every night. They for help.” (Robison, 2014) sometimes doubt that society will take them back Registered Nurses Bibliography after what they’ve done. Health care workers ASU ASU School of Social Work Office of Sex Trafficking At Carson Valley Medical Center Hospital we are seeking may be their first contact with the system since Intervention Research. (2013). WHAT YOU NEED to expand our Nursing staff. Located in Gardnerville entering “the life.” Ms. Higginbotham urges nurses TO KNOW, SEX TRAFFICKING AND SEXUAL Nevada, 20 miles from beautiful South Lake Tahoe, CVMC to be sure that your behavior toward these victims EXPLOITATION: A Training Tool for Health Care Providers. Tempe: ASU School of Social Work Office of is a full service critical access hospital. CVMC supports shows them that you consider them of value and an ICU unit, med tele unit, outpatient infusion center, Sex Trafficking Intervention Research. ambulatory surgery center and 24 hour ER. worth saving. That can influence the progress they Chalmers, S. R. (2014, June 30). Reno Police Department make in their future contacts with the system. Street Enforcement Team. (M. a. Curley, Interviewer) One Year recent critical care experience required. De Chesnay, M. a. (2013). Sex Trafficking: A Clinical Guide for Nurses. In M. D.-B. De Chesnay, Sex Trafficking: Successful applicant will be scheduled a combination of What should you do if you suspect a patient shifts in the ICU and Med-Surg/Telemetry department. A Clinical Guide for Nurses (pp. 287-288). New York: is being trafficked? Springer Publishing Company. CVMC offers competitive wages and benefits, The girl will probably be accompanied by the Higginbotham, C. (2014, July 18). Assistant U.S. Attorney. plus a retention bonus of $5,000. (M. a. Curley, Interviewer) pimp or an older female. Do not try to question Hughes, L. K. (2014, July 25). Las Vegas Metropolitan her in their presence. Get her alone before asking Police Department--Vice Section. (M. Curley, Visit our website at questions. If you work in large facility, Mary de Interviewer) www.cvmchospital.org Chesnay recommends alerting security to be in Masto, C. C. (2014, July 30). Nevada Attorney General. (M. a. Curley, Interviewer) the area while the patient is there. (De Chesnay, Nevada Attorney General. (2012). What is human Interested applicants please apply online or fax 2013) trafficking? Retrieved July 26, 2014, from Nevada a resume to 775-783-3070 or Washoe County SANE nurse Debbie Robison Attorney General: http://ag.nv.gov/Human_Trafficking/ call 775-782-1506 recommends asking these questions: HT_What/ Robison, D. R. (2014, July 8). CARES/SART Coordinator, • Are you in control of your money? Washoe County. (M. a. Curley, Interviewer) November, December, 2014, January 2015 Nevada RNformation • Page 13

What Nevada is Doing Human Trafficking: The Telltale Signs Interview with Attorney General Alberto Hazan, MD Catherine Cortez Masto

Sandy Olguin, MSN, RN If you’ve ever worked in an emergency room, to multiple sexual partners. They may be fearful you’ve likely treated a victim of human trafficking. of being integrated back into mainstream society 2014 marks a year since We all have, often without knowing it. or hopeless about their future, and so may act out passage of Assembly Bill (AB) With nearly thirty million people in modern-day to express their frustration. Therefore, it is critical 67, “legislation that establishes slavery around the world, there are more slaves we treat these patients with compassion. the crime of sex trafficking today than at any point in history.1 As Mary De Chesnay relates in Sex Trafficking, of children and adults, allows Human trafficking is defined as “the it is imperative that providers voice their concerns victims to receive assistance recruitment, harboring, transportation, provision, to patients in an attempt to identify victims of and gives them the right to or obtaining a person for labor or services, human trafficking in the clinical setting. Asking sue their traffickers” (NV. through the use of force, fraud, or coercion”2 our patients direct questions can often lead to gov, 2013). Attorney General for the purpose of serving in the sex trade or an open and honest discussion. In her book, De Catherine Cortes Masto has in forced labor. It’s the third largest criminal Chasney relates an incident early in her nursing been involved throughout her career in protecting industry in the world, outranked only by arms career regarding an eleven-year-old girl with an vulnerable members of population, as well as and drug dealing.3 Human trafficking is most ectopic pregnancy. When asked about the baby’s women and children. For many years she worked commonly known for the severe forms of violence father, the girl responded: “It could be my father, with the county juvenile system in Las Vegas, and it entails—such as incarceration, rape, torture, and my four brothers, or the men who come to party witnessed countless girls involved in commercial sexual enslavement.4 Up to 95 percent of victims on the weekend.” sexual exploitation during that time. experience some form of sexual and/or physical An encounter in the emergency department Attorney General Cortes Masto explained abuse during trafficking.5 may be the only opportunity for these victims to “perpetrators prey on vulnerable victims and foster Human trafficking doesn’t just occur in rural be rescued from their oppressors. If you suspect children are common victims of trafficking.” A India or urban Thailand. It occurs right here at someone of being a victim of human trafficking, it challenge observed in sex trafficking is that minors home. There are approximately 100,000 children is critical to keep these points in mind: do not see themselves as victims. Children and involved in the sex trade every year in the United • Get the patient alone before asking adults become trapped in the world of sex trafficking States. In fact, according to the Huffington Post, questions about their situation. Do not try to with little to no hope of ever escaping. the Super Bowl is the occasion for the single question them in the presence of the person Just over a year ago the victims of sex trafficking largest incident of human trafficking in this accompanying the patient. had little hope to leave the world of sex trafficking. country. With thousands of people visiting the • Contact child protective services and the Now with the initiative to punish perpetrators and host city, this sporting event becomes a prime police if the patient is underage. give back life to the victims, hope is being restored. breeding ground for sexual exploitation; trafficking • If the patient refuses assistance, make sure Attorney General Cortes Masto was a catalyst for victims are often forced to have sex with up to they are aware that there are resources the passage of AB 67 to identify sex trafficking as a thirty visitors a day. available to them. crime with increased penalties for perpetrators and Given the prevalence of human trafficking, assistance to the victims. She described AB 67 as a there is no doubt that we come across victims of The Polaris Project (www.polarisproject.org) has law to “increase penalties to include no probation sexual exploitation or forced labor in our everyday a twenty-four hour National Human Trafficking if a minor victim is involved” and “severe jail time” practice. Emergency physicians, advanced practice Resource Center hotline (1-888-373-7888), or you for the perpetrators and “lifetime sentence with clinicians, and nurses are in a prime position to can text INFO or HELP to BeFree (233733). possible parole.” General Masto asserts that in the identify victims of human trafficking. According to In an era when hospital administrators demand past, perpetrators after being released on probation the Family Violence Prevention Fund, 28 percent of us to do more in less time, it is critical to take a “would get out, threaten to harm or harm victims or trafficking survivors had contact with a healthcare moment to stop and think, to listen to that feeling their families” preventing the victim from testifying. provider, but the abuse wasn’t recognized.6 It is in our guts indicating that something is wrong, The perpetrator was out on bail unscathed. If there therefore critical for us to maintain a high level to get more information, to delve into the case is “no victim, there is no case” describes Masto. AB of suspicion during our clinical shifts. Identifying further, and to seek help. 67 gives prosecutors additional tools to help victims these individuals can mean the difference between Unless the patient refuses assistance, the and prosecute offenders. Restitution from the pimp life and death. police, CPS, social services, or human trafficking goes to the victim, and the victim can sue the pimp. Here are some telltale signs to assist you in services should be notified. We should consult Additional background on AB 67 include the recognizing potential victims of human trafficking. them, just like we consult cardiology for acute following (NV.gov, 2013): The patient may: myocardial infarctions or gastroenterology for GI • Changes the current pandering statute to the sex • Be accompanied by someone who attempts bleeds. Human trafficking is common, prevalent, trafficking statute. to control the patient interview (e.g. by and real—and it is just as deadly as any other life- • The federal definition of sex trafficking will be answering questions for the patient) threatening medical emergency—with potentially used to increase penalties by one sentencing • Have downcast eyes or diminished eye much more dire consequences. level. contact with the medical provider • Creates law enforcement tools for racketeering, • Have a flat or fearful affect, and engage in — Alberto Hazan is an emergency physician conspiracy, and wiretapping. minimal conversation with provider in Las Vegas and an assistant attending at St. • Those convicted would have to register as a • Have multiple injuries in different stages of Luke’s-Roosevelt/Mt. Sinai in New York City. He is sex offender, and their assets will be seized, healing, or signs of self-mutilation the author of the medical thriller Dr. Vigilante. liquidated and provided as relief to the victims. • Offer vague or conflicting stories about how • Restitution will be mandatory with the ability to injuries were obtained References bring a civil cause of action. The prosecution will • Have poor hygiene 1 Goldberg, Eleanor. 10 Things You Didn’t Know About be allowed to preserve the victim’s testimony for Slavery, Human Trafficking (And What You Can Do trial. The victim is usually accompanied by someone About It). The Huffington Post. January 15, 2014. older who dominates the conversation. The patient 2 State and Federal Laws. The Polaris Project. www.polarisproject.org With the outrageous number of sex trafficking will appear to cower or defer to them. They 3 The Future Group, Human Trafficking: A Human crimes committed in Nevada, Attorney General will appear withdrawn, frightened, agitated, or Security Crisis of Global Proportions. Cortes Masto successfully advocated for the passage anxious.7 4 United Nations Regional Information Center (UNRIC). of AB 67. These atrocious acts being committed However, as we all know from working in the 5 United Nations Global Initiative to Fight Human Trafficking. against our women and children in Nevada need to emergency department, patients often don’t 6 Saver, Cynthia. Trading on Innocence. stop. Assembly Bill 67 holds the key to increasing present like textbook cases. At times, the victims http://blog.diversitynursing.com the penalties of the perpetrators of sex trafficking of human trafficking may be violent, either 7 Mary De Chesnay, editor. Sex Trafficking: A Clinical Guide for Nurses. Springer Publishing Company. and helps the victim receive restitution however the physically or verbally, and can be abusive to the December 2012. cost of one’s childhood lost forever is irreparable. staff. As stated earlier, many of the victims have been beaten, incarcerated, kidnapped, and/or sold Page 14 • nevada RNformation November, December, 2014, January 2015 ana member assembly 2014 Report on 2014 Member Assembly

Betty Razor, BSN, RN, CWOCN

The American Nurses The one day during capitol and walked us through the many halls in Associations (ANA) this assembly that is set the capitol. We recognized many of these halls, annual Lobby Day and aside as “lobby” day is for we had seen them on TV interviews. ANA was Member Assembly was when all delegates make thrilled to have access to Senator Reid, who made from June 12-June 14th, the trip to the “Hill” to time to see “his constituents”. By the way do wear 2014. Elizabeth Fildes, confer with their state comfortable shoes. This day requires many steps. NNA Vice-President, and legislators. Key to a On Friday I, Betty Razor, as NNA/ successful lobby day is to everyone gathered ANA delegates made contact your legislators at the Washington the trip to Washington, well in advance and Hilton, Jefferson DC for this Annual schedule appointments Room, for Assembly along with with them. ANA assists opening session. over four hundred nurses and student nurses from with this process. Our lobby day started with the ANA presented across the country. What an awesome honor and briefing and then on to our first appointment at 10 two awards – adventure! Arriving a day early (the 11th) allowed am. Elizabeth and I coordinated our appointments, Congressional me to be fresh for the many activities on the so that we could visit with our own congressman. Advocate of agenda. Prior to this date all delegates received We both met with Senator Reid later in the day; the Year and Nurse Advocate of the Year; plus numerous emails from ANA on travel arrangement since, as majority leader he has a great deal of honoring deserving advocates from the Hill and hotel reservation and information on pending influence, it was critical that we both attend this and from the field in appreciation for their legislative issues. A special note to future meeting. selfless efforts to advance nursing legislation: delegates: ANA was very helpful and provided With ANA Congressional Nurse Advocate awards went to a great deal of support and information; ANA assistance, this was Senator Susan Collins (R-ME), Senator Barbara paid for all costs (air, hotel, meals); plus an email a very successful Mikulski (D-MD), and a Nurse Advocate Award to address to access the “schedule” and a code (app) day. The handouts Justin Gill, BSN, RN. for communication; any additional cost NNA will that ANA provided Dialogue forums were held on various national pick up. on the key bills nursing issues: Full Practice Authority, Palliative The events for us, as delegates, started on for nursing were Care, and others. More information will be Thursday June 12 at 7:30 am with a breakfast extremely helpful, available in the next issue of ANA newsletter. briefing and a review of the important key issues and we left copies The remainder of the day consisted of: call for facing the nursing profession. This included with the office staff nominations of officers and adoptions of various an update on specific ANA legislation pending after each meeting. policy issues. Please check ANA website for more before Congress that we would be addressing The atmosphere details. We attended an additional meeting in the with our legislators during ‘Lobby Day.’ These was stimulating, traveling from one building afternoon that consisted of all the western states included: Safe Staffing, Safe Patient Handling, to another on the Hill; just walking into these (WEX). This group will continue to meet again and Home Health & Durable Medical Equipment. building was exciting, but trying to find a specific in Las Vegas in Feb 24/25 with over 11 states I appreciated the comprehensive briefing, office was often a challenge. We needed to allow represented to discuss issues that specifically key talking points and strategies for effective extra time; since we needed to walk from one affects the western states. The day ended with a communication with congressional representatives building to another and back again due to their fun evening of Karaoke! that we received in written format from ANA, time availability. For some of the congressman, we Saturday including copies to give the legislators... met with their office staff since they were called consisted of: in session. I was able to meet personally with voting, report from Senator Heller before he was called into session. treasurer, chief Meeting with Senator Reid was unusual and extra executive officer, special. Since he was tied up in session at the outgoing president capital his staff escorted us through the building, and an unusual fun down to the mini-subway that zips us over to the event. Professional Psychiatric Nurse Practitioner musicians played for us and every place at the tables had either a Las Vegas Paiute Tribe is seeking an experienced violin or a percussion instruments. We received Psychiatric Nurse Practitioner to provide care & instructions on how to use the instrument and treatment to mental or behavioral health patients. after instruction period we played a specific musical piece; we were actually quite good and Requirements: effectively showed that even old dogs can learn Master’s Degree in Advanced Practice Nursing, new things. current unrestricted license (APN) to practice In conclusion, I believe NNA had an effective as an Advance Nurse Practitioner in the State of lobby day and really now understand the phrase Nevada and certification as an ANP with National when nurses talk, Washington listens. I personally Certification from an ANP organization. The enjoyed it all with only one regret; that I could not Master’s Program must include psychiatric training stay an extra day or two to play tourist and see for psychiatric nurse practitioner or a specialized Happy Holidays Washington DC. program in mental or behavioral health. Thank you for your Business! I do advise the next NNA delegate to try and A minimum of 5 years of experience in a similar add this extra time if at all possible; plus to field. Nevada State Board of pharmacy and contact their legislators when they are in your DEA privileges. Lelia’s Scrubs town and introduce yourself as the ANA delegate representing 30 thousand nurses in Nevada. For application, please visit us at $10.00 Coupon One Paiute Drive, Off $50.00 purchase Thank you for the privilege of being your Las Vegas, NV 89106, or Expiration date: 12-31-14 representative- I had a ball! fax resume to 702-383-4019. Limit One Per Customer No cash value Respectfully submitted 8175 S. Virginia St., Suite 250, Reno, NV 89512 Betty Razor 775.825.2888 Open M-F 10am-6pm–Sat & Sun 10am-4pm Elizabeth Fildes November, December, 2014, January 2015 Nevada RNformation • Page 15

Membership Assembly Addresses Nursing Issues

Capitalizing on the theme of “Nurses Leading Marijo Letizia, PhD, RN, APN/ANP-BC, FAANP, has been talking about interprofessional education the Way,” some 350 representatives and observers professor and associate dean of masters and DNP and practice since 1970. She then suggested to the American Nurses Association’s (ANA) programs at Loyola University, Chicago, addressed several strategies to advance high-performing, Membership Assembly displayed their leadership the importance of improving the knowledge and interprofessional practice, including writing it skills by participating in dialogue forums to offer skills of basic and advanced care nurses in the into organizational policies and procedures and strategies on three key topics: nurses’ full practice area of palliative care. She noted that both formal performance indicators; breaking down the silos authority, access to palliative care and high- preparation and continuing education coursework that exist between academia and practice; and performing interprofessional teams. Assembly should be implemented -- for every nurse and developing and implementing new integrated representatives subsequently voted on specific specialty. models of care. recommendations for the ANA Board of Directors “We don’t have to reinvent the wheel,” said Rugen spoke specifically about the ongoing to consider. Letizia about creating palliative care content. She efforts at the Department of Veterans Affairs mentioned helpful educational resources created Centers of Excellence in Primary Care Education. Being able to practice fully by the Hospice and Palliative Nurses Association She noted that physician residents and NP The first forum addressed “Scope of Practice (HPNA), an organizational affiliate of ANA. trainees, along with core clinic members, “learn to – Full Practice Authority for All RNs,” a topic For example, HPNA and ANA have worked work in – and lead – team-based, patient-centered proposed by the South Carolina Nurses Association. collaboratively on many initiatives, including care that they can use in their future practice.” Participants engaged in table discussions around developing Palliative Nursing: Scope and Standards The centers also focus on developing and legislation mandating physician supervision of of Practice. testing innovative curriculum models, and curricula APRNs over a certain period of time before APRNs After sharing information, Assembly and learning activities are geared to promote could gain full practice authority; major practice representatives formally voted on recommendations shared decision-making, sustained relationships, barriers for RNs; and potential strategies to move asking ANA to promote and support payment interprofessional collaboration and performance past “turf” battles as new roles and categories of models to improve access to palliative and hospice improvement, according to Rugen. health care workers evolve. care, including nursing care provided by both RNs Forum participants then weighed in with their In discussing practice barriers for RNs, and APRNs; advocate for comprehensive integration comments. Representatives offered ways ANA can participants commented on a lack of role clarity of palliative and hospice care education at all levels support nurses to further engage and assume roles and no separate, visible reimbursement for of nursing educational programs and professional to advance high-performing interprofessional teams RN services. They also noted that promoting development programs; and support developing across care settings. For example, participants interprofessional, team-based care, valuing all and expanding models of nursing care that include suggested engaging hospice and mental health members of the health care team and clarifying advanced care planning for early identification and professionals, because they have been using this nurses’ roles could help diminish turf battles. support of patients’ preferences for palliative and model for 20- 30 years. They also suggested Representatives then voted to recommended hospice services. supporting multi-day training for faculty and that ANA support interprofessional education, developing innovative resources that incorporate practice and research to promote the full scope Looking at high-performing, interprofessional simulation and social interaction of RN practice; encourage nursing research to interprofessional teams opportunities for acculturation, among others. compare full practice authority states, transition to The final forum explored high-performing, Assembly representatives ultimately APRN practice states, and restricted APRN states; interprofessional teams, and featured presentations recommended asking ANA to consider educating educate the public, policy makers and other health by Kathryn Rugen, PhD, FNP-BC, from the VA nurses about the application and impact of professionals about emerging roles and overlapping Centers of Excellence in Primary Care Education, evolving patient-centered, team-based care responsibilities; and support eliminating practice and Tara Cortes, PhD, RN, FAAN, executive director models on patient outcomes, and identify metrics agreements between APRNs and physicians. of the Hartford Institute for Geriatric Nursing. that evaluate the impact of high-performing, Cortes first addressed the history of team- interdisciplinary health care teams on patient Integrating palliative care based care, noting that the Institute of Medicine outcomes. In the second forum, guest speakers addressed the “Integration of Palliative Care into Health Care Delivery Systems: Removing Barriers, Improving Access.” This topic was proposed by the Ohio Nurses Association (ONA), which voiced ONA members’ concerns about a lack of access to and Offering online payment for palliative and hospice care. continuing education Kathryn M. Lanz, DNP, ANP, GNP, ACHPN, to ensure quality director of geriatric services for the University health care for of Pittsburgh Medical Center’s Palliative and Supportive Institute, started her presentation Nevada. with some troubling statistics based on a national Consider a Career at survey of Americans. Sixty-five percent of Saint Alphonsus Health System Expand your responders reported having loved ones who died knowledge, advance in pain, half of older Americans visited an ED in Saint Alphonsus Health System is a four-hospital regional, your career, develop the last month of life, and 70 percent of the public faith-based Catholic ministry serving southwest Idaho and eastern Oregon. new skills and easily worries about end-of-life issues. maintain your That said, she noted that there are good Opportunities available in: palliative care models, which take a person- • Intensive Care • Med-Surg professional licensure directed approach to care and are value-based. • Coronary Care • Rehab and certification with She further reported that implementing those • Emergency • OB/NICU a flexible framework models improves patients’ symptoms, quality and Department • Main OR to maximize quality length of life, as well as family satisfaction and • Clinical Support Team • Nursing and best health care bereavement outcomes. (Float Pool) Professionals practices. Key characteristics of effective models include family and social support, goal setting in which To learn more and to apply, please visit patients’ desires match their treatment, and www.saintalphonsus.org/careers a flexible approach to “dosing” – that is, the Or call Roxanne Ohlund 208-367-3032 appropriate type of care is given at the right time as patients’ symptoms wax and wane, according to or Rick Diaz 208-367-3118 Lanz. www.highsierraahec.org Page 16 • nevada RNformation November, December, 2014, January 2015 nna environmental health committee

How is the climate changing in our Great Basin? Dr. Timothy J. Brown Dr. Bernadette M. Longo, RN Precipitation: The Great Basin is a naturally dry environment. All Director, Western Regional Chair, NNA Environmental precipitation evaporates, sinks underground or flows into rivers and lakes. Climate Center Health Committee The creeks, streams, or rivers of the Great Basin find no outlet to either Desert Research Institute, NV University of Nevada Reno the Gulf of Mexico or the Pacific Ocean. Winter is the primary wet season, though precipitation and lightning can occur during summer from the How the climate is changing in the Great Basin Southwest Monsoon. Variability in year-to-year precipitation can be high; see for example annual precipitation for Nevada from 1895-2013 in Figure Words like “unusual” and “extreme” are now everyday verbiage used 3. Even with the Great Basin’s already low annual precipitation amounts to describe our weather and climate. We may sense that our environment on average, the region can become even drier from protracted periods of is changing and wonder about the impact on health to Nevadans. Gaining drought (a common natural occurrence; Figure 4). There has not been an knowledge about climate change and our Great Basin’s climate is key to overall increasing or decreasing trend in Great Basin annual precipitation effective advocacy as nurses. over the last 100 years. However, extreme precipitation events such as daily amounts have slightly increased. What is occurring on a planetary scale? Climate models project that if the carbon emission trend continues upward During the last 600 million years, Earth has mostly been in a warmer as it has been, then the Great Basin could become annually much warmer “greenhouse” state when the poles had forests and polar seas were warm. and drier. Soil moisture is related to precipitation and temperature, and is But since hominoids appeared and throughout the previous 30 million years expected to overall become drier. Soil-related bacterial and fungal pathogens the planet has been in a cool “icehouse” state characterized by continental- could become an increasing problem in our future climate. More extreme based ice sheets at high latitudes. Scientific evidence shows that an precipitation events (both in the form of drought and flood) are expected as enhanced greenhouse effect is underway. Alarmingly, levels of atmospheric a result of climate change. CO2 are rapidly rising, and atmospheric/oceanic global temperatures are rising in response. It is anticipated that global temperatures will continue Figure 3. to rise throughout the 21st Century challenging the adaptive capacity of Precipitation for Nevada ecosystems and humans. Public health planning and preparations are already 12 month period ending in December underway for current and future climate-related impacts appearing in our 20 backyard (Figure 1 – note Southwest). 17.5 Figure 1. 15 Examples of Regional Effects of Climate Change 12.5

Precipitation (in) 10

7.5

5 1900 1920 1940 1960 1980 2000 Ending year of period

Precipitation (in) Highcharts.com Figure 4. U.S. Drought Monitor August 12, 2014 West (Released Thursday, Aug. 14, 2014) Valid 8 a.m. EDT Drought Conditions (Percent Area) None D0-D4 D1-D4 D2-D4 D3-D4 D4

Current 27.11 72.89 59.80 43.63 21.43 8.90

Last Week 27.71 72.29 60.17 43.74 21.35 8.94 8/5/2014 Source: United States Global Change Research Program. Climate Change Impacts. 2009 3 Months Ago 31.18 68.82 60.82 47.37 19.96 4.70 5/13/2014

What does this mean for human health? Start of Calendar 22.20 77.80 51.44 31.11 7.75 0.63 The climate is changing and our increasing population is living in 12/31/2013 Start of Water Year 25.25 74.75 58.96 34.18 5.57 0.63 vulnerable locations at risk for wildfires, floods, mudslides, insect vectors 10/1/2013

One Year Ago of disease, drought and dust storms. Nurses treat the human response 13.31 86.69 77.53 56.74 20.35 3.09 to actual or potential health problems. Hence, our changing climate is 8/13/2013 Intensity: challenging nursing to enhance environmental health promotion and D0 Abnormally Dry D3 Extreme Drought educational interventions in our practice. For example, since the large Rim D1 Moderate Drought D4 Exceptional Drought fire of 2013 northern Nevada school nurses have developed and instituted D2 Severe Drought protocols to protect their student populations from future wildfire smoke The Drought Monitor focuses on broad-scale conditions. Local conditions may exposures. We as nurses have the opportunity to develop new initiatives to vary. See accompanying text summary for forecast statements. Author: Richard Tinker CPC/NOAA/NWS/NCEP prevent disease and maintain health for chronic disease populations in the face of a changing climate and ecosystem. Furthermore, we can institute changes in our own lives and institutions to minimize greenhouse pollution. http://droughtmonitor.uni.edu/

Figure 2. Wildfires are a natural part of the Great Basin landscape and occur to varying extent every year (Figure 5). Fuels for fires are dependent on How Can Climate Change Harm the Public’s Health? climate conditions, whether moisture for seed germination and vegetation growth, or drying and curing that make the fuels readily available to burn. Lightning is a primary ignition source for Great Basin fires, but the increasing population has increased the human source for ignitions. Since wildfire is so closely related to temperature and precipitation, it is not surprising that the climate change projections for this Century (warmer and drier) means increased potential for more fires and larger burned areas. Wildfires pose public health risks both from fire and smoke because of expansion of the wildland-urban interface. Regional Weather Regional

Source: United States Global Change Research Program. Climate Change Impacts. 2009 November, December, 2014, January 2015 Nevada RNformation • Page 17 nna environmental health committee

Figure 5. Figure 7. Mean Temperature for Nevada Large Burned Areas 12 month period ending in December Since 1980 54

52

50

Temperature (F) Temperature 48

46 1900 1920 1940 1960 1980 2000 Ending year of period

Temperature (F) Highcharts.com

Exercise: Assess your current “carbon footprint” and see if there are improvements you can make to reduce greenhouse pollutants! • http://www.carbonfootprint.com/calculator.aspx • http://www.nature.org/greenliving/carboncalculator/

EPA’s Climate Change Terms Source: Bureau of Land Management Central Basin and Range Rapid Climate: is usually defined as the “average weather,” or more rigorously, Ecoregional Assessment Report. as the statistical description in terms of the mean and variability of relevant quantities over a period of time ranging from months to thousands of years. Snowpack: Much of the Great Basin relies on winter snow supply for the The classical period is 3 decades. summer water demand. Like rainfall, snowfall can be highly variable from Climate Change refers to any significant change in the measures of climate year-to-year (Figure 6). The snow depth throughout the winter can be more lasting for an extended period of time. important than the amount fallen. It is the snowpack that feeds the lakes, Weather: atmospheric condition at any given time or place. It is measured in rivers and reservoirs of the region, and provides soil moisture for vegetation. terms of such things as wind, temperature, humidity, atmospheric pressure, Climate change models project that the historical snowline will get higher cloudiness, and precipitation. In most places, weather can change from hour- in elevation as a result of regional warming. This means less snowpack, and to-hour, day-to-day, and season-to-season. elevations accustomed to snow will experience more rain events. With the Climate System: the five physical components (atmosphere, hydrosphere, potential increase in extreme rainfall, this could mean more rain-on-snow cryosphere, lithosphere, and biosphere) that are responsible for the climate events leading to further floods. and its variations. Figure 6. Adaptive Capacity: the ability of a system to adjust to climate change (including climate variability and extremes) to moderate potential damages, to University of California Berkeley DONNER SUMMIT SNOWFALL AND SNOWPACK Central Sierra Snow Laboratory take advantage of opportunities, or to cope with the consequences. P.O. Box 810, Soda Springs, CA 95728 WINTERS 1879 - 2010 70 (530) 426-0318 | http://research.chance.berkeley.edu 20 Carbon Footprint: the total amount of greenhouse gases that are emitted Total Snowfall (measured twice/day) into the atmosphere each year by a person, family, building, organization, or Maximum Snowpack Depth 60 company. 50 Carbon Sequestration: terrestrial, or biologic, carbon sequestration is the 15 process by which trees and plants absorb CO2, release the oxygen, and store 40 the carbon. FEET

METERS Desertification: land degradation in arid, semi-arid, and dry sub-humid 10 30 areas resulting from various factors, including climatic variations and human activities. 20 Enhanced Greenhouse Effect: the concept that the natural greenhouse 5 effect has been enhanced by increased atmospheric concentrations of 10 greenhouse gases (such as CO2 and methane) emitted as a result of human activities. 0 0 Forcing Mechanism: a process that alters the energy balance of the climate 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 WINTER system, i.e. changes the relative balance between incoming solar radiation and outgoing infrared radiation from Earth. Such mechanisms include changes Temperatures in the Great Basin vary greatly between winter and in solar irradiance, volcanic eruptions, and enhancement of the natural summer, with daily values historically ranging from below zero to above 100. greenhouse effect by emissions of greenhouse gases. The overall trend for annual mean temperatures has been increasing over Mitigation: a human intervention to reduce the human impact on the climate the years (see Nevada example in Figure 7). However, it is the nighttime system; it includes strategies to reduce greenhouse gas sources and emissions minimum temperatures that are mostly driving this trend – or to say another and enhancing greenhouse gas sinks. way, nights are much warmer than they used to be. Natural Variability: variations in the mean state and other statistics (such Climate models project increased overall warming for the Great Basin as standard deviations or statistics of extremes) of the climate on all time and during this Century largely driven by greenhouse gas increases. Warmer space scales beyond that of individual weather events. Natural variations in temperatures will enhance soil moisture drying and plant evapotranspiration. climate over time are caused by internal processes of the climate system, such This in turn can enhance drought conditions. But globally, increased warming as El Niño, as well as changes in external influences, such as volcanic activity also means increased moisture in the atmosphere, and this can lead to more and variations in the output of the sun. extreme precipitation events. Source: http://www.epa.gov/climatechange/glossary.html

References & Resources The National Academy of Science, 2011. Understanding Earth’s Deep Past: Lessons for our climate future. http://www.nap.edu/catalog.php?record_id=13111 National Science Foundation: Climate Change. http://www.nsf.gov/news/special_reports/climate/ The Western Regional Climate Center. http://www.wrcc.dri.edu/ Great Basin National Park. http://www.nps.gov/grba/planyourvisit/the-great-basin.htm American Nurses Association, 2008. Resolution on Global Climate Change. http://www. nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/ Environmental-Health/Issues/Climate/Resources/GlobalClimateChangeandHumanHealth.pdf Page 18 • nevada RNformation November, December, 2014, January 2015 student corner UNR Orvis Student Evidence – Based Poster Presentations

Novice Nurses, Night shifts, and Medication Errors

Lauren Soletti, Andrea Bailey, Mandy Smith, Maebritt Hirvela

Aim It is common practice for novice nurses to begin work on the nightshift. This research project explores evidence regarding novice nurses working the night shift and the relationship to the number of medication errors.

Background Is Hand Sanitizer or Hand Washing More How Does Intentional Rounding Each patient that is hospitalized is subject Effective in Preventing Healthcare- Impact Patient Outcomes? to at least one medication error a day. This Associated Infections? includes factors such as giving the medication at Maria Durazo BS, Amber Bedillion, the wrong time, or not carrying out the proper Laura Allen, Josi dos Santos, Eleni Monos BA, pre-monitoring before passing the medication. Victoria Mischel, Amanda Salmonsen, Brian Collins, Natalie Hoenig, There is also a need for nursing schools to and Juliee Tibbits produce an estimated 30,000 novices nurse Jacqueline Wicks per year. Finally, when comparing day shift nurses with night shift nurses, night shift nurses The assignment was to discover evidenced Purposes/Aims reported more negative working characteristics, based practice on the effectiveness of hand The purpose of this research is to examine including lower overall job satisfaction, sanitizer verses hand washing in decreasing and evaluate patient outcomes resulting from insufficient amounts of sleep to perform the rate of Healthcare-Associated Infection. implication of intentional rounding in a clinical adequately at work, and increased overall stress The research has shown that hand sanitizer setting. and hand washing are both effective. Hand and fatigue. sanitizer is effective because of the higher Rationale/Conceptual Basis/Background Methods rates of compliance. Some research discussed Patient outcomes are largely impacted To adequately research novice nurses and the amount and the concentration that should by the quality of the care provided. In an medication errors, articles were analyzed from be used. The amount of hand sanitizer used inpatient clinical setting, quality care includes CINHAL, PubMed, Ovid, and IGT Knowledge should cover the palm of the hand to provide acknowledging and attending to patient needs center. Key words such as: medication errors, an ample amount and should dry completely. for comfort in addition to management of health night shift, novice nurses, new graduate nurses, When using hand sanitizer, the thumbs and problems. Patients must also be assessed and adverse events, and day shift versus night shift the back of the hands were places that were checked on regularly to help prevent further were all searched. From this research, nine most often forgotten. The alcohol-based hand health complications. This can prove challenging relevant articles were selected that were used rubs that have a 50-70% concentration of in a busy and fast paced environment where throughout the project. alcohol were the fastest and most effective nurse to patient ratios push staff to their limits. in reducing bacterial counts on the skin. The Implementation of regular scheduled rounding Results highest compliance rate coincided with the has been presented as a solution to help Many factors may contribute to medication hand sanitizer that was 62% alcohol with a improve overall quality of patient care as well as errors, including, personal neglect, citrus smell. At higher concentrations, there are patient satisfaction. complaints of irritating the hands of the workers, miscommunication, and environmental factors. It was found that an estimated 75% of novice which decreases the rate of compliance. All Methods nurses commit medication errors, and as the forms of hand sanitizer such as gel, foam, The University of Nevada, Reno online hours of sleep decreased in nurses, the number and wipes have been proven to be effective catalog for research was used to search for of patient errors increased. Finally, working against Influenza A. Although hand sanitizer relevant articles to our topic. The databases night shifts, combined with working longer has a higher compliance rate, when it comes to accessed included CINHAL and PUBMED. Our hours caused issues and failures in the cognitive enteric bacteria and viruses such as C. difficile search was limited to peer reviewed nursing functions of staff. and Norovirus, hand washing was superior to journals and of the 166 relevant articles hand sanitizer. Hand washing is effective, but returned 14 were selected to be included in our Implications has a lower compliance rate due to time, skin evaluation of the topic. irritation, and inconvenient locations of the The conduction of more level one evidence is needed in order to further examine relationships sinks. The sinks should be located within 10 Results between novice nurses working the night shift feet of the patient care for a higher compliance. The articles reviewed and evaluated found who commit medication errors. For the present The research has shown that hand sanitizer and that implementation of hourly or intentional working environment, it appears that shifts hand washing are both effective, but it depends rounding has improved patient outcomes and adequately staffed with the appropriate mix of on the compliance rate and the type of the satisfaction. There was a noted reduction of experienced nurses to novice nurses, along with organism. ground level falls, call light use by the patient, adequate unlicensed staff, results in a more increase in the patients positive perception of positive working environment. Furthermore, care, and sooner discovery and intervention in hospitals should have high percentage health complications. Looking for a nursing job in Nevada? requirements of BSN prepared nurses, as it has Make great money? Determine your own schedule? been shown that they commit fewer medication Implications Advantage On Call can deliver! errors. Lastly, hospital facilities and protocol Implementation of hourly rounding in the should encourage a positive learning climate, nursing practice will greatly increase patients in which staff learn from their mistakes and quality of care, thus overall patient satisfaction facilitate the generation of new knowledge, to and health outcome. further decrease the chances of future errors of the same nature. (702)733-1599 [email protected] www.advantageoncall.com Local Staffing with Advantages! November, December, 2014, January 2015 Nevada RNformation • Page 19

UNR Orvis Student Evidence – Based Poster Presentations

Benefits of a Dirty Baby Does a patient have more phantom limb pain from an elective or a Araceli Jimenez-Ruiz, Janet Jimenez-Ruiz, Jeeyun Sohn, Misty McCracken, traumatic amputation? Yessica Soto Rebecca Gansberg, Michelle Moscove, Purpose/Aims: Results: Nicole Rinas, Shannon Roberson, The purpose of this research project is to When comparing infants who retained the Alisha Simpson review existing studies to validate the clinical vernix caseosa 24 hours after birth, to infants implications and benefits of vernix. who had it removed, evidence showed that the Phantom limb pain is a well-documented infants with the retention of the vernix contained phenomenon occurring in roughly 50-80% of Rationale/Conceptual Basis/Background: higher levels of free amino acids. These infants patients following an amputation. Traditionally Vernix caseosa is a white, waxy, cheesy also contained higher hydration in their skin and this neuropathic pain has been treated, although substance, produced by the baby’s sebaceous an increased initial and long-term recovery of not as successfully, with narcotic medication. glands while in utero, that begins to form and disrupted skin. Studies also showed an increase Treatment with opioids or other traditional cover the skin of the fetus around the last of desquamation, the shedding of the outermost pain interventions have only succeeded in trimester of a pregnancy. This natural coating layer of the skin (Monteagudo et al., 2011) and taking the edge off the pain without any effect substance provides several benefits for a newborn toxicum neonatorum, a rash seen in about half on the cause of the pain. Research has been during its transition from intra-uterine to extra- newborn infants (2011) in infants with the absence conducted that describes the effectiveness of uterine life, and continues to provide those of vernix. Furthermore, additional studies showed non-pharmacological measures in decreasing benefits throughout the first week of life, if not the prevention of infection after birth by the the cause of the pain. Alternative therapies such washed away. Vernix provides skin protection for vernix. The vernix provides surfactant protein D as: mirror therapy, EDMR, and biofeedback have the neonate by providing antimicrobial properties, and other antimicrobial particles which control proven to be effective at minimizing the pain temperature regulation, hydration, and several the direct skin colonization by commensal flora in through targeting the cause of the pain. other benefits. So how long should we wait before the immediate neonatal period, helping prevent The most current research on phantom limb washing vernix off in order to get all of these infection. pain has been analyzed to identify various great benefits? Evidence based practice states interventions, both pharmacological and non- that the vernix is most beneficial within the 24 Implications: pharmacological aids, for methods of best hours post-delivery up until one week. Since little is known about the vernix caseosa, practice in the hospital setting. Various studies, it is important to educate mothers about the including randomized controlled-trials and a Methods: benefits of it. The vernix that presents with meta-analysis, from the years 2005-present were Databases such as; CINAHL, PubMed, EBSCO the newborn, helps the newborn adapt to the analyzed. The concepts of reliability, validity, and Host, Google Scholar, and INH Gov were used extrauterine atmosphere. Not only does it provide statistical analyses were utilized to ensure the to research our topic. Keywords included: Vernix free amino acids and hydration for these infants, research examined reflects the best evidence- caseosa, newborn skin care, neonatal and but it also provides antimicrobial properties. based practice. maternal factors, prevalence, and newborn. Over Recommending not bathing the child in their first 600 results were generated and eight articles 24 hours of life and suggesting allowing the vernix were selected for inclusion. to shed on its own is important in order to get the full benefits of the vernix. Southern Nevada Adult Mental Health Services, a NV State Agency, is seeking Psychiatric Nurses for our hospital and community outpatient clinics. Req’s NV license. Psychiatric exp preferred. Training available for new RN’s. Variety schedules including set 8 & 12 hr shifts (no call-offs!), exclnt benes health/dental/vision, Public Employees Retirement System, 3 wks annual & sick leave, holidays, on-site CEU’s and no social security, state, county or city tax! Email CV to [email protected] Join Nevada Nurses Association Today!

www.nvnurses.org The Las Vegas Chapter of the Case Management Society of America offers Six educational opportunities annually. Certified Case Manager study group beginning in February. Visit our web site for detailed information www.cmalv.com or Email [email protected] Page 20 • nevada RNformation November, December, 2014, January 2015 UNIVERSITY OF NEVADA, RENO

Orvis School of Nursing www.unr.edu/nursing n B.S. in Nursing n RN to BSN n M.S. in Nursing o Clinical Nurse Leader o Nurse Educator o Adult Gerontology Acute Care Nurse Practitioner o Family Nurse Practitioner o Psychiatric Mental Health Nurse Practitioner (Opening Fall 2015) n DNP (Doctor of Nursing Practice)* University of Nevada, Reno Statewide • Worldwide

*The DNP program is a collaborative program with UNLV. Students admitted through UNR for this program have their DNP degree conferred by UNR.