New Hampshire Nursing News YearYear ofof thethe NurseNurse 20202020

Official Newsletter of New Hampshire Nurses Association Quarterly publication direct mailed to approximately 1,250 Registered Nurses and LPNs and delivered electronically via email to 16,500 Registered Nurses and LPNs in New Hampshire.

March 2020 | Vol. 44 No. 2 www.NHNurses.org Florence Nightingale (1820-1910)

Please be sure to notify us with address changes/corrections. We have a very large list LEGISLATIVE TOWN HALL FORUM to keep updated. If the nurse listed no longer lives at this address – please notify us to Top Ten Bills Presented for 2020 discontinue delivery. Thank You! Please call 877-810-5972, extension 701 or Bill Description CGA Presenter NHNA Position email to [email protected] with Allowing RN’s to certify walking disability plate eligibility. Fixes a problem Nursing News in the subject line. HB 1489 with prior legislation by adding the RN to the list of health care providers that Linda Compton In Support currently certify eligibility for walking disability plates and placards. Establishing a NH health policy commission. Aims to establish a NH Index Health Policy Commission with the purpose of monitoring health care HB 1520 Katie Lajoie In Support Spotlight on a Specialty...... 2 delivery and spending. NHNA proposed adding a nurse to the Commission, and this amendment is supported by the bill’s prime sponsor. President’s Message...... 3 From the ED’s Desk...... 3 Relative to pharmacist-in-charge. This bill modifies the duties and responsibilities of a pharmacist-in-charge, clarifies the inspection Legislative Town Hall Forum...... 4 HB 1536 Karen Perry Watching services provided by the board of pharmacy, and repeals a provision on Membership Matters!...... 5 requirements for written orders for schedule II-controlled drugs. Bylaws ...... 6 Relative to purchase, use & possession of tobacco products. Raises the age Pam DiNapoli/ The 2020 Census Will Impact HB 1662 In Support for purchase, use and possession of tobacco products from 19 to 21 years. Carla Smith New Hampshire’s Healthcare Dollars...... 6 NHNA Ballots Are Counted, 2020 Officers Are ...... 7 Establishing a nursing review subcommittee. The purpose of this bill is to establish a nursing review subcommittee to the NH Board of Nursing Perinatal Nurses are Going PURPLE in New Hampshire . . . . . 8-9 SB 502 Joan Widmer In Support to review and investigate disciplinary complaints and then propose Be on the Lookout!...... 9 recommendations for handling the complaint to the BON. NH Nursing News Needs YOU...... 10 Establishing commission to study workplace safety. This bill creates an 2019 NHNA Awards Bestowed...... 10 Cynthia Cohen/ opportunity for an in-depth study to examine the issues surrounding Also in the News…...... 10 SB 506 Marsha In Support workplace violence in health care, as well as an exploration of policies Nurses Night at the Museum ...... 11 Davidson structures that will protect healthcare workers. Welcome New and Returning NHNA Members! ...... 12 Relative to policies for students with head injuries. This bill requires the Kudos...... 13 Department of Education to collaborate with the Brain Injury Association SB 584 Traci Fairbanks In Support From the Bookshelf...... 14 of New Hampshire to develop a return to learning policy and plan for NCLEX Reconsidered ...... 15 students with concussions and brain injuries. School Nurse Connections...... 15 Relative to hearings of NH BON. This bill allows the public member on School of Nursing News...... 16 the New Hampshire Board of Nursing to preside at hearings of the board. SB 596 Judy Odom Oppose Nursing Workforce Findings...... 17 NHNA has proposed making the public member of the BON ineligible to Humor Me...... 17 be Chair or Vice Chair, eliminating need for this legislation. In My Opinion ...... 18 Relative to passenger restraints. This bill aims to establish secondary seat Pam DiNapoli/ SB 609 In Support Management Minute...... 19 belts requirements for all ages in the State of NH Carla Smith Nurses on the Move...... 19 Relative to controls in long term care. The purpose of this bill is to allow Non-Verbal Communication: The Silent Giveaway. . . . . 20-21 SB 715 for more options and less restriction in long-term care for Medicaid Kim Pang In Support Nurses Host Breakfast with New Hampshire Legislators. . . . . 21 eligible elderly and chronically ill adults. In Memory of Our Colleagues...... 22 Legislative Town Hall Forum continued on page 4 Florence Nightingale – The Rebellious Years ...... 23

NH Nurse Appointed DHHS Head SAVE Lori Shibinette, RN, BSN, MBA has been unanimously Shibinette to lead DHHS confirmed by the New Hampshire Executive Council because of what he called to lead the Department of Health and Human Services her “unmatched operational (DHHS). As commissioner of DHHS, Shibinette will experience.” She will be THE DATE oversee programs and budgets of the largest state able to “hit the ground agency that accounts for nearly half of total state running,” Sununu said spending. Governor Chris Sununu says he picked during his nomination. “Our National Nurses Week strong economy May 6-12 Presort Standard has provided New th US Postage Hampshire with the Florence Nightingale’s 200 birthday! PAID opportunity to create Permit #14 robust programs May 12 Princeton, MN that need Lori’s Lori Shibinette, Excellence in Nursing Awards Night current resident or 55371 expertise to ensure better outcomes for RN, BSN, MBA May 19 individuals. Lori is a manager and has the ability to effectively oversee Red Sox Nurse Appreciation Night these programs to get the job done.” May 20 NHNA Spotlight on Nursing Program NH Nurse Appointed DHHS Head continued on page 3 June 11 Page 2 • New Hampshire Nursing News March, April, May 2020 Guidelines for Submissions to NH Nursing News

NH Nursing News (NHNN) is the official publication commercial affiliation. Email as New Hampshire of the NH Nurses’ Association (NHNA), published attachments to office@nhnurses. quarterly – and available in PDF format at our website: org with NN Submission in the NURSING NEWS www.nhnurses.org. Views expressed are solely those subject line. of the guest authors or persons quoted and do not necessarily reflect NHNA views or those of the publisher, Publication Selection and Arthur L. Davis Publishing Agency, Inc. NHNA welcomes Rights: Vol. 44 No. 2 submission of nursing and health related news items, Articles will be selected for Official publication of the New Hampshire Nurses’ original articles, research abstracts, and other pertinent publication based on the Association (NHNA), a constituent member of the contributions. We encourage short summaries and brief topic of interest, adherence to American Nurses Association. Published quarterly abstracts as well as lengthier reports and original works. publication deadlines, quality every December, March, June, and September. Library An “article for reprint” may be considered if accompanied of writing and peer review. subscription rate is $30. ISSN 0029-6538 by written permission from the author or publisher. *When there is space for Authors do not need to be NHNA members.* one article and two of equal interest Editorial Offices are under review, preference will be given to NHNA New Hampshire Nurses Association, 25 Hall St., Unit Manuscript Format and Submission: members. NHNA reserves the right to edit articles to 1E, Concord, NH 03301. Ph (877) 810-5972, E-mail Articles should be submitted as double spaced WORD meet style and space limitations. Publication and reprint [email protected] documents (.doc format vs. .docx, please) in 12 pt. font rights are also reserved by NHNA. Feel free to call us any without embedded photos. Photos should be attached additional questions at 877-810-5972. Editor: Susan Fetzer, RN, PhD separately in JPG format and include captions. Advertising: NHNA Staff Submissions should include the article’s title plus author’s Product, program, promotional or service Joan Widmer, RN, Nurse Executive Director name, credentials, organization / employer represented, announcements are usually considered advertisements Paula MacKinnon RN, Executive Assistant/ and contact information. Authors should state any vs. news. To place an ad, contact: Arthur L. Davis Communications Specialist potential conflict of interest and identify any applicable Publishing Agency, Inc. Email [email protected] or call Beth Dow RN, Event Coordinator 800-626-4081. Ad sales fund publication and mailing of NH Nursing News and are not paid to NHNA. NURSING NEWS is indexed in the Cumulative Nursing Index to Nursing and Allied Health Literature (CINAHL) and International Nursing Index.

For advertising rates and information, please SPOTLIGHT ON A SPECIALTY contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. Orthopedic Nursing in New Hampshire NHNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to Michelle Ferry, BSN, RN, ONC has been an corrections in the next issue or refund of price of orthopaedic nurse for 10 years at the Orthopaedic advertisement. Institute at Concord Hospital. Michelle is a charge nurse, a preceptor for new orthopaedic staff, and she Acceptance of advertising does not imply co-chairs the Orthopaedic Unit Practice Council. endorsement or approval by the New Hampshire Michelle is working towards her Master’s Degree Nurses Association of products advertised, the in Nursing and feels that furthering her knowledge advertisers, or the claims made. Rejection of an through research and studies is an important tool to advertisement does not imply a product offered for improve nursing care. The Orthopaedic Unit Practice advertising is without merit, or that the manufacturer council uses a shared governance model to improve lacks integrity, or that this association disapproves and incorporate evidence based practice for patient of the product or its use. NHNA and the Arthur L. Victoria Ribsam Emily Marsh care. Michelle was asked why she enjoys her career Davis Publishing Agency, Inc. shall not be held liable as an orthopaedic nurse. She replied, “I feel that I am for any consequences resulting from purchase or use Orthopaedic nursing involves the practice of caring improving the quality of my patients’ lives. Caring for of an advertiser’s product. Articles appearing in this for populations with musculoskeletal injury and them, aiding in increasing their mobility and enhancing publication express the opinions of the authors; they recovery is very rewarding.” Michelle is an active prevention of musculoskeletal injury or disease. do not necessarily reflect views of the staff, board, member of the National Association for Orthopaedic Musculoskeletal disease can affect people at all stages or membership of NHNA or those of the national or Nurses (NAON) and is certified as an Orthopaedic of life and can involve many different body parts local associations. and treatments. Orthopaedic nursing is a specialty Nurse. She stays current on best practice through that involves treatment, prevention, research and articles and webinars that NAON offers. education. Orthopaedic nurses have a variety of job opportunities available to them. They can be found The National Association of Orthopaedic Nurses VISION STATEMENT in a variety of practice settings that include physician represents nurses who are engaged in sharing offices, ambulatory surgery centers, hospitals, home knowledge about practice to improve patient care and Empower New Hampshire nurses as leaders in care, and inpatient rehab centers. Orthopaedic further the study of orthopaedic nursing. Orthopaedic advancing the profession of nursing and the health of nurses may be providing direct care to patients, nurses are Registered Nurses or Advanced Practice New Hampshire. teaching healthcare providers or patients, or providing Nurses that often have obtained a certification from leadership and program development. Delivering the Orthopaedic Nursing Certification Board. A professional musculoskeletal care across a continuum certification in Orthopaedic Nursing can be obtained is a role that requires specific skill and competency after 1000-1500 hours of practice in the field, as well MISSION STATEMENT for the orthopaedic specialty (National Association of as successful completion of an exam. Certified nurses NHNA, as a constituent member of the American Orthopaedic Nurses, n.d.). must maintain continuing education credits to expand their practice knowledge. Certification and membership Nurses Association, exists to promote the practice, to the NAON facilitate a high level of quality care development and well being of NH nurses through provided to orthopaedic patients (National Association education, empowerment and healthcare advocacy. Nominate a Nurse for the of Orthopaedic Nurses, n.d.). Adopted 10-20-2010. 2020 Clint Jones Nursing Award! There are more than 300 New Hampshire nurses who are members of National Association of Orthopaedic Do you know a registered nurse practicing Nurses practicing across the state. New Hampshire in New Hampshire who exemplifies is a unique environment to practice nursing. New Victoria Ribsam MSN, RN, ONC is the Clinical Director the practice of compassionate, quality Hampshire has a population of more than 1.3 million at and Emily Marsh MSN, RN, ONC is the Nurse nursing care and demonstrates a career people. It has some densely populated areas in the Educator of the Orthopaedic Institute at Concord Hospital. commitment to the nursing profession? south but is very rural in the north with 13 critical access hospitals (New Hampshire Department of Nominate them today! Health and Human Services, 2016). New Hampshire References National Association of Orthopaedic Nurses. (n.d.). http:// Visit www.healthynh.org to learn more. is a greying state with more than 18% of its population over the age of 65 (United States Census Bureau, 2018). www.orthonurse.org/page/what-is-orthopaedic-nursing New Hampshire Department of Health and Human Services. New Hampshire is known for its outdoor activities like (2016). https://www.dhhs.nh.gov/dphs/bchs/rhpc/critical- skiing, hiking mountain climbing, kayaking, camping, access-hospitals.htm biking, 4-wheeling, and hunting (Visit New Hampshire, United States Census Bureau. (2018). https://www.census.gov/ 2020). Orthopaedic nurses in New Hampshire have quickfacts/geo/chart/NH/AGE775218 unique skillset to provide care to this population. March, April, May 2020 New Hampshire Nursing News • Page 3 PRESIDENT’S MESSAGE

I would like to start with this, my inaugural message, by • To hold all confidences conveying a heartfelt “thank you” to all of you. It is an honor • To devote to the welfare of those committed under our care and a privilege to serve as the President of the NHNA’s Board of Directors. My promise to you is to serve with honor, dignity We have advanced our profession while remaining true to our pledge. We have used and integrity. the power of “us” to advocate for our patients and communities. We have advanced our practice through higher education, certification, and expansion of scopes of practice. We In their most recent poll, Gallup reported that nurses have refuse to remain idle while others suffer. We see the larger picture and are not afraid to been rated the most honest and ethical professionals, the 18th describe it. We treat all as equal and worthy of human dignity. The Year of the Nurse is year in a row that we have been so honored by the public! upon us and as you have just read, there is much to celebrate. As Dr. Ernest Grant, President of the ANA, stated in a recent message, this honor is a great way to start off the Year of the The ANA has a year of activities planned for us starting with the “See You Now” podcast Nurse. It also represents the fact that we, as a unified body, series, a joint venture between the ANA and Johnson & Johnson, a consistent supporter of continue to uphold the Nurses’ Pledge. Although I would Janice Deziel nursing. The podcasts are designed to highlight nursing’s work at the forefront of healthcare be challenged today to recite that pledge that I took so and innovation, and of our history on affecting change around the globe. The podcasts many years ago, the essence of what it meant has stayed with me and underscores why can be accessed at SeeYouNowPodcast.com and are also available on Apple Podcasts, the public has so much trust in us. Here are some of the core elements of the Florence Stitcher, Spotify and wherever else you listen to podcasts. Let us start off this Year of Nurse Nightingale Pledge that we, to this day, consistently exhibit: by energizing ourselves through these podcasts! You will walk away from them feeling • To practice the profession faithfully honored, valued, and empowered. And that is how it should be! • To abstain from anything that is deleterious or mischievous • To not take or knowingly administer a harmful drug Respectfully, • To maintain and elevate the standard of nursing Jan Deziel FROM THE ED’S DESK

The New Hampshire Nurses Association wants to better serve In addition, the New Hampshire Nurses Association is planning a year-long outreach to the nurses of New Hampshire. As part of this overarching 2020 the nursing leadership in the state’s other healthcare organizations to see how NHNA goal for the Year of the Nurse, NHNA is engaging in several can better serve their needs and those of their nurses. We have established a goal of new initiatives to better understand the needs of our members visiting at least half of the state hospitals, larger ambulatory practices and long-term care and the nurses of the state. organizations by the end of 2020. We look forward to seeing many of you during this exciting Year of the Nurse!! The first of these initiatives is NHNA’s participation on the HIVE Program through the New Hampshire Center for Non- Profits. The High Impact Volunteer Engagement Program offers staff and volunteer leaders the opportunity to explore the latest trends and best practices in volunteer engagement, along with support to pilot one strategic innovation in volunteer engagement that will measurably build the capacity Joan Widmer of the organization. NHNA was one of nine organizations selected through a competitive process to participate in this year’s HIVE program. A five member team of volunteers and staff will be spending the next ten months implementing a project to improve volunteer recruitment and engagement in the Association. I will be CEUs: Nurses 16.8 joining team members Cheryl Abbott, Julie Taylor, Pat Lazarre, and Paula MacKinnon. The team’s project is to create and implement an Engagement Task Force. The primary project deliverables include: • Develop a position description for the Engagement Task Force Champion (Chair) and team members • Recruit and screen for the Champion of the Engagement Task Force • Work with Champion to recruit and screen Task Force members • Design, implement and analyze a member needs assessment Marie Romagnano, Fr. Seraphim Brian B. Burkey, KEYNOTE SPEAKER: • Create a Member Tool Kit/Onboarding information for Task Force members MSN, RN, CCM Michalenko, MIC MD, MEd, FACS Bishop Robert McManus, MA, STD In late January, NHNA issued a call for nominations for a member to serve as the Champion of the Engagement Task Force. The HIVE Project team was tasked with the Information and to register: TheDivineMercy.org/worcester or call 1-800-462-7426 x 1 responsibility of reviewing the applicants and making a recommendation to the NHNA Board of Directors for appointment. As you read this message, NHNA will have appointed the Champion and the real work of the Engagement Task Force will have begun. The Champion and an additional team of five to six volunteers will work to develop a survey of our members and as many New Hampshire Nurses as we can reach via email and social media.

The purpose of this survey will be to identify how NHNA can better serve the needs of New Hampshire nurses. Questions will seek to find out: Why does a nurse join NHNA? What do members value in the organization? What can NHNA do to make their membership more relevant and meaningful? What can NHNA do to make you want to become more involved? Please let us know what you think when the survey link is published. We want and need to hear from each and every New Hampshire nurse. Once the data is collected and analyzed, the Engagement Task Force will work with the NHNA Board of Directors and staff to develop programs and events that address the needs identified though this survey. WeWe provideprovide medicalmedical andand non-medicalnon-medical homehome carecare servicesservices forfor thethe seacoastseacoast ofof NH,NH, andand NH Nurse Appointed DHHS Head continued from page 1 borderborder townstowns inin southernsouthern Maine.Maine. Shibinette earned a nursing diploma from her native Nova Scotia and the Cape Breton Regional Hospital School of Nursing. Relocating to New Hampshire in 1995 she practiced as a nurse at New Hampshire Hospital for two years, and then became director of nursing HiringHiring RNs,RNs, services at St. Francis Nursing Home in Laconia, N.H. While obtaining her BSN from the University of New Hampshire in 2005 she served as the CEO of the Merrimack County Nursing Home, a position she held until 2015. She obtained her MBA from Franklin Pierce University in 2013. In November 2016, she was named deputy commissioner LPNsLPNs andand LNAsLNAs at the Department of Health and Human Services (DHHS), where she was part of the department’s executive management team. Among her duties was overseeing New Contact Jeffrey Berk today! Hampshire Hospital and Glencliff Home, a state-run, long-term care facility, as well as Atlantic Homelife Senior Care, LLC implementing several recommendations from an independent sentinel review panel. In October 2017 DHHS commissioner Jeffrey Meyers appointed Shibinette as Chief 603-343-4434 Executive Officer of the New Hampshire Hospital after the sudden departure of the previous chief executive officer. Recently Shibinette obtained a Doctorate of Educational Leadership (EdD) from Rivier University. www.atlantichomelifeseniorcare.com Page 4 • New Hampshire Nursing News March, April, May 2020 LEGISLATIVE TOWN HALL FORUM Nurses Determine Legislative Priorities

On January 7, 2020 approximately 90 nurses participated in the New Hampshire NHNA appreciates the site coordinators for all their assistance in making the Town Nurses Association’s 2020 Legislative Town Hall Forum, hosted electronically at Hall Forum possible, in promoting the event at their location, preparing handouts and Granite State College, the site of the NHNA office. In addition to the Concord serving as discussion lead for their location. This year’s site coordinators included: location, host sites were located at Catholic Medical Center (Manchester), Dartmouth- Cheryl Abbott (Dartmouth-Hitchcock Medical Center), PattyAnn Labrie (Catholic Hitchcock (Lebanon), Cheshire Medical Center (Keene), Exeter Hospital (Exeter) and Medical Center), Paula Hudon (Cheshire Medical Center), Holly McCormack (Cottage Cottage Hospital (Woodsville). Thirty-six attendees participated from their own homes. Hospital), and Liz McFaddon (Exeter Hospital). Catherine McNamara (Saint Joseph This year’s event was hosted earlier than prior years because the legislative calendar Hospital) was also prepared to host, but this site was cancelled. The event sponsor began earlier in January. The earlier date presented challenges considering that the was Granite State College (GSC) and James Johnson provided his technical expertise in language for most of the bills was late in being made public. The Commission on running the Zoom conference. Government Affairs and the Legislative Advocacy Councils prepared the bill write-ups on a very tight schedule.

The program was opened by moderator Pamela DiNapoli, Chair of the Commission on Government Affairs (CGA). Dr. DiNapoli delivered introductory remarks and spoke Panelists (L-R) CGA Chair about the role the members of the Commission on Government Affairs and the four Pam DiNapoli, Rep. Polly Legislative Advocacy Councils play in advocating on the bills of interest throughout the Campion, NHNA lobbyist legislative session. The program continued with NHNA’s lobbyist, Teresa Rosenberger, Teresa Rosenberger and who presented a State of the State address, sharing with the audience her thoughts NHNA President Jan Deziel on the New Hampshire legislative environment. Ms. Rosenberger was then joined by a panel of experts, who provided brief remarks on their role in advocacy or the legislative process. Members of this year’s panel were, Jan Deziel, NHNA President, Polly Campion, State Representative from Grafton and ad hoc member of the CGA and Bonnie Crumley Aybar, Administrator, NH Board of Nursing.

The purpose of the Forum is to present pending legislation from this current legislation session to the NHNA members and attendees. Dr. DiNapoli shared information regarding the process by which the members of the CGA reviewed the legislative bills and how bills were selected for presentation at the Forum. Ten bills (see page 1), Legislative Town Hall selected by the CGA from a slate of 2020 bills, were presented. NHNA’s position on Forum participants at each bill was presented by members of the CGA. The CGA provides weekly updates the Granite State College on the 10 bills and others that come to their attention. Updates are provided on the location NHNA website: www.nhnurse.org, under the 2020 Legislative Activity tab.

At the conclusion of the bill presentations, each host site host was asked to engage participants in discussion about the bills presented. Each participant was given the opportunity to vote on their top three priority pieces of legislation. Participants at home were able to vote via an online ballot survey. The CGA will focus advocacy efforts on three bills earning the most votes. Legislation Followed by NHNA and Association Partners Priority 1 SB 609 Seat belts for all passengers over 18 years Requiring parity in the spend-down requirement for mental health and Priority 2 HB 1520 Establishing a NH Health Policy Commission HB 739 Priority 3 LSR 2799 A bill related to costs of long term care medical services. HB 1106 Relative to non-compete agreements for certain mental health professionals. In addition to voting on the top three bills, participants were also asked to share their opinions regarding the position that the CGA should take relative to SB 596, the bill Relative to membership on the board of psychologists and the board of that would allow the public member of the NH Board of Nursing to preside over licensing for drug and alcohol and other drug use professionals and relative HB 1140 hearings. The overwhelming response was to oppose this bill. We received feedback to insurance credentialing of out of state applicants for licensure as alcohol such as: “oppose [SB 596] and reconsider whether Chair/Vice Chair should only and drug counselors. be a nurse,” and "I oppose the approval of SB 596. I believe that a nurse should be presiding hearings at the NHBON regarding disciplinary actions for the licensees.” HB 1233 Related to coverage for children’s early intervention services. Only one nurse voiced support for SB 596. In response to the discussion of SB 596, the Commission on Government Affairs has endorsed the position of membership to HB 1410 Relative to Vaping Products (LSR 2208). oppose this bill. HB 1436 Related to autism insurance coverage.

HB 1521 Adding peer support specialist to the board of mental health practice. Medical, dental, vision, Healthcare FSA, Dependent HB 1576 Establishing a workforce development program. care FSA, Short and long- term disability, Continuing HB 1591 Relative to Cannabis use during pregnancy. education, Tuition assistance HB 1623 Relative to telemedicine and substance use disorder. program, Paid time off (PTO), WE’RE HIRING! 401(k)/retirement savings HB 1628 Relative to Vaping Products (LSR 2053). At Fresenius, the global leader in HB 1639 Relative to “In and Out Medical Assistance.” dialysis healthcare, we are always We are an equal opportunity Expanding family-centered early supports and services (FCESS) program to employer offering a generous HB 1707 looking for ways to make the world benefits package with children under the age of three who are born substance-exposed. a better place for everyone. room to grow. SB 555 Relative to Telemedicine Coverage and Reimbursement (LSR 3043) Relative to the Commission on Interdisciplinary Primary Care Workforce (LSR SB 567 2958). Here, you will be empowered Establishing an oversight committee on the office of professional licensure SB 568 to positively impact the lives of and certification (LSR 2975). patients and families affected SB 634 Relative to establishing a Peer Support Program in DHHS (LSR 2827). by kidney disease while you work alongside some of the best SB 671 Relative to Nursing Home Standards (LSR 2745). professionals in our industry. SB 685 Establishes a wholesale importation program for prescription drugs from Canada. Establishes a prescription drug affordability board to determine annual public payor spending targets for prescription drugs, develop and implement Visit our website at jobs.fmcna.com or SB 687 policies and procedures for the collection of prescription drug price data, implement a register of drug manufacturers for drug pricing data, and contact one of our 14 New Hampshire establish funding for the board by reasonable user fees and assessments. facilities to set up a visit to see what we Prohibits prescription drug formulary changes during a contract year under SB 690 do and apply at the same time. the managed care law. March, April, May 2020 New Hampshire Nursing News • Page 5 Membership Matters!

Membership and involvement in state and national professional organizations is considered “an ethical expectation” (Goolsby, 2017). Recently, the collective voice of NHNPA has been influential in several legislative Jennifer Thompson, MS, APRN initiatives, including: • Primary Care Workforce Coalition It is generally well accepted that participation in your • State budget – advocating for increased Medicaid professional organization is a good thing. However, many reimbursement rates factors compete with actually renewing professional • Tobacco 21 initiative memberships every year. Whether the reminder email • Climate change and health initiative is now buried among hundreds of other emails, or you • Elimination of non-compete language in employment would rather participate in your professional specialty contracts organization, or you just forgot – renewing annual • Assistant physician role defeated memberships is a drag. It is one more thing to do in the day, • Alternative therapy program for nurses one more item to add to the check list, or one more item to • Defeated 5.5% income tax on NP revenue (L-R) Kerry Nolte, Jennifer Thompson, Linda Reed, carry over to tomorrow’s list. Does it ever cause you to ask • Mental Health Procedures for Involuntary Christina Ferreri, Susan Feeney, Kara Doberstein, “what does this organization do for me anyway?” Commitment Jillian Belmont, Victoria Kendziora, Sue Corliss • Oral Contraceptive Dispensing In New Hampshire, there are approximately 2,600 licensed • Environmental Causes of Disease Yes, renewing annual memberships is a chore. But, in the Nurse Practitioners (K. Kidder, personal communication, • Governor’s Commission on Drugs and Alcohol big picture, it is vitally important to protect full practice April 1, 2019). The state professional organization for • Therapeutic Cannabis Advisory Council authority, to advocate for NP practice, and to support the Nurse Practitioners (NPs) is the New Hampshire Nurse • NH Oral Health Coalition health of a state. If you are already a member of NHNPA Practitioner Association (NHNPA). At the time of this • Commission to Study Environmentally-Triggered – thank you! If you are considering membership – here is writing, 416 NPs are members of NHNPA. This represents Chronic Illness your call-to-action. Join now at NHNPA.org! We need you a state membership rate of 16%, lower than the national • PDMP Advisory Council on our team! Oh, and, by the way, you can always select AANP membership rate of 25% (Goolsby & DuBois, 2017). Auto-Renew! Why are these numbers important? Nurse Practitioners that Another benefit of participation in professional actively participate “in professional organizations … have organizations is the ability to network and learn. NHNPA Reference voice in the identification and development of health policy will be doing this in a big way on April 9th and 10 th at the Goolsby, M. J., & DuBois, J. C. (2017). Professional organization initiatives” (Goolsby & DuBois, 2017, p. 437). It is through Northern New England Nurse Practitioner Conference membership: Advancing the nurse practitioner role. Journal of this collective voice of the professional organization of in Nashua. Last year over 300 healthcare professionals the American Association of Nurse Practitioners, 29, 434-440. NHNPA that NPs have and can influence health policy. In gathered for informative discussion and education on fact, this was exactly how full practice authority in New various clinical, policy and leadership topics. This year Jennifer Thompson MS, APRN is the Executive Director of Hampshire became a reality – Nurse Practitioners working is shaping up to be even better. If you have not already the New Hampshire Nurse Practitioner Association. together, a collective voice, to change a law. registered, please visit NHNPA.org. Page 6 • New Hampshire Nursing News March, April, May 2020 BYLAWS

NHNA Bylaws 2019: Impact on NHNA and on NHNA Members

Carmen J. Petrin, MS, APRN for review and feedback. At the NHNA Annual secure online teleconferencing platform rather than Chairperson, NHNA Bylaws Task Force Business Meeting held on November 20, 2019, a requiring in-person attendance at meetings. quorum was achieved and the 2019 NHNA Bylaws A Bylaws Task Force were approved. Article XI became Article X: Quorum. Section 1: was appointed by the NHNA Membership Business Meetings continue New Hampshire Nurses Bylaws direct the actions of the membership and to require a quorum of 5% of NHNA membership Association in the spring the association. The most significant revisions in verified in attendance. However attendance may be of 2019 for the purpose 2019 were in three articles: Articles V, X and XIII. in-person or by virtual attendance via secure online of revising and updating teleconferencing as specified in Article V. A quorum the NHNA Bylaws, last Article VI (2017) became Article V (2019): Timing is more likely by allowing members from all areas of approved in October of Meetings. The revision no longer restricts NHNA the state to participate without having to travel. 2017. Task Force members to one annual membership business meeting in the worked diligently over fall. It prescribes at least one membership business Article XIV became Article XIII: Bylaws several months to meeting annually between August 1st and December Amendments. Membership approval of bylaws at a accomplish their charge. 1st, but also allows for additional business meetings membership business meeting continues to require The proposed bylaws Carmen J. Petrin if approved by 2/3 of the Board of Directors. The 2/3 membership vote with at least one month were reviewed and further change provides greater flexibility to deal with notice to NHNA members and 99% membership revised by the NHNA Board of Directors and matters requiring membership approval. This vote without one month notice to NHNA members. then were sent to the ANA Committee on Bylaws article deleted the previous section on the New However, voting may be in-person at a business (COB) in July 2019 for their review and to ensure Hampshire Student Nurses’ Association and the meeting or by virtual attendance at the meeting via harmony with ANA Bylaws. The COB made a few section on Special Meetings. The second major a secure online teleconferencing platform. recommendations which were incorporated and impact of the article revision regards the voting posted to the NHNA website. An email with link body at membership business meetings, allowing The following changes will also have a positive was sent to the NHNA membership in September for virtual attendance and voting at meetings via a impact on membership and the association.

In Article I, the purposes and functions of NHNA were revised with updated language to reflect current nursing scholarship and practice and the The 2020 Census will Impact management of nonprofit organizations. Article III: Membership and Article IV: New Hampshire’s Healthcare Dollars Organizational Affiliate Membership were Reprinted with permission from RN Idaho. combined into one article with two sections, the first for Membership and the second for Organizational Affiliate Membership. The change Juanita Risch effectively aligns NHNA’s bylaws on membership Partnership Specialist, and affiliations with those of ANA’s. Los Angeles Regional Census Center In Article III, Section 1, at the recommendation of ANA, membership was amended to include retired The 2020 Census is right nurses, nurses no longer practicing nursing, and around the corner. By April 1, nurses in recovery who have temporarily restricted 2020, every home will receive licenses. An amendment to membership dues an invitation to participate reflects NHNA’s participation in the ANA Value in the 2020 Census. You Pricing Program which requires joint ANA/NHNA will have three options membership. NHNA has fewer than ten legacy for responding, online, by NHNA-Only members and cannot add any new phone, and by mail. The 2020 NHNA-Only members. The section also allows Census is the first time you NHNA to raise membership dues without requiring can respond online. You can NHNA membership approval providing the increase even respond on your mobile is enacted by ANA. However, raising the NHNA device. portion of the dues will still require approval by 2/3 of NHNA members voting at a membership The decennial census was first business meeting. The section also clarified the taken in 1790, as mandated by rights of ANA/NHNA members versus the rights of the Constitution. It counts our NHNA-Only members. population and households, providing the basis for In Article III, Section 2, membership of reapportioning congressional Organizational Affiliates was changed from seats, redistricting, and Registered Nurses to licensed nurses to allow distributing more than $675 affiliation with the National Association of Licensed billion in federal funds annually Practical Nurses or other LPN organizations. The to support states, counties and section also clarifies that Organizational Affiliate communities’ vital programs Help your community members are only entitled to benefits from NHNA that impact housing, education, and not benefits from ANA with updated benefits transportation, employment, for Organizational Affiliates. health care and public policy. stay healthy. Responses to the 2020 Census inform how over Article VII became Article VI: Board of Directors. For the 2020 Census, the U.S. $675 billion is distributed to communities nationwide The language regarding the functions of the Board Census Bureau plans to provide each year, meaning more hospitals and clinics in of Directors was updated to reflect current practice. the Internet Self-Response and places that need them most. Census Questionnaire Assistance For more information, visit: Article VIII became Article VII: Commissions. in 12 non-English languages; The language regarding the responsibilities of enumerator instrument, bilingual 2020CENSUS.GOV Commissions and Commission Members was paper questionnaire, bilingual D-PO-HC-EN-028 updated to reflect current practice. mailing, and field enumeration materials in Spanish; and It is hoped that the 2019 bylaws revisions will allow single, and by assisting with data collection for language guides, language glossaries, and language for more active participation and engagement patients who live in facilities where they work. identification card in 59 non-English languages. of members throughout the entire state, will promote membership growth, and will ensure that New Hampshire received 6.5 billion in federal Reference The George Washington Institute for Public Policy. (2019). NHNA remains a vibrant, relevant organization funding, based on data derived from the 2010 representing NH nurses now and in the future. Census (The George Washington Institute, 2019). Counting for dollars 2020: The role of the decennial census in the geographic distribution of federal funds. Nurses can impact the census by making certain Ed Note: The full text of the 2019 approved bylaws that their family information is collected, that they Retrieved from https://gwipp.gwu.edu/counting-dollars- 2020-role-decennial-census-geographic-distribution- is available at https://nhnurses.nursingnetwork.com/ individually complete their own forms if they are federal-funds page/64541-by-laws March, April, May 2020 New Hampshire Nursing News • Page 7 NHNA BALLOTS ARE COUNTED, 2020 OFFICERS ARE...

The votes have been counted and the election results Katherine “Katie” Lajoie, BSN, BA, RN. intimate role in the patients we serve and I would love the certified by Association Voting, the service the New Katie is a retired RN with 43 years of ability to play a role in nurses growing their practice to Hampshire Nurses Association (NHNA) uses to manage service as a nurse in public and support our patients best.” its elections. A total of 103 votes were cast, including community health. Katie writes, “I am one paper ballot. A quorum was established with the an environmental activist working Michelle Lincoln, MS, FNP works as a first 63 votes cast. NHNA is pleased to announce the locally and statewide to promote critical care nurse at Saint Joseph following talented nurses will be filling vital Board of maximum conservation, reuse, and Hospital. Michele writes, “I have a Director positions. recycling of valuable resources. I testify special interest in critical care and before state legislative committees pulmonary medicine [and a] Personal Treasurer regarding environmental policies, and I am familiar with Special interest in Mission work and Amy W. Matthews, DNP, MS, RN, accessing bills and monitoring their status as they go solutions for poverty, homelessness CENP. Amy recently earned her DNP through the legislative process.” and the environment. I am a great and has a Certification in Executive listener; I have a wealth of both life Nursing Practice. She has been a Judith Odom, MSN, RN, CCRN is a and work experience.” nurse for 34 years, and is currently staff nurse at Concord’s Ambulatory the Chief Nursing Officer and VP of Care Center and has been in nursing Finance, Investment & Audit Task Force: Two nurses were Patient Services at Cheshire Medical practice for 34 years. Judith notes, “I elected to NHNA’s newest Task Force to ensure the future Center. Amy writes in her intent to am interested in influencing the future of the organization. serve: “I am motivated to serve/"give of nursing as well as insuring a healthy, back" to advance nursing as a profession. I completed adequate workforce. Increasing Shauna DAlleva-McMahon, MSN, my doctoral education last spring and am now more regulations make our work more MBA, RN is currently the PTE able to commit time outside of work/study. With more cumbersome without necessarily Coordinator/EBP Coordinator at the than 20 years as a point of care RN, educational roles adding value.” Manchester VNA. Shauna notes, “given and now executive practice I believe that I have my educational preparation and skill knowledge and skills to serve. I have previous board Davida Rubin-Baker, RN, BA, JD a set, I believe that I would be a solid experience.” recent nursing graduate, works as the auditor for the task group that has been Infirmary Director for Camp Young formed. I also have experience in Director at Large Judaea and as a substitute school nurse. investing which would be an asset to Pamela Levesque, DNP, APRN, FNP- Davida has worked with NHNA in the NHNA.” BC, CNE. Pam brings 40 years of past, testifying at legislative hearings. nursing expertise to the board and is Barbarajo (BJ) Bockenhauer, MSN, currently a nursing professor with APRN, PMHCNS-BCBJ, a retired APRN Chamberlain College of Nursing. She with clinical experience in psychiatric also was a valuable contributor to the Commission on Continuing Education nursing, brings a wealth of financial and recent NHNA’s Bylaws Task Force. Jeanne Hayes, EdD, RN. Jeanne is an accounting knowledge regarding Pam writes: "My commitment to Adjunct Professor at Rivier University NHNA to this team. BJ most recently serve is driven by multiple factors, and has been in nursing practice for 43 served as NHNA’s Treasurer (for four beginning with being at a place in my life where I am years. Jeanne writes in her intent to years) and is a NHNA Past President. able to dedicate the necessary time. I believe that my serve, “my experience includes 37 years experiences as a clinician and as an educator will offer in nursing education, with expertise in a unique perspective to the Organization. My curriculum development, evaluation, ANA Alternative Rep background of professional volunteerism includes work and meeting professional standards for Judith Joy, MSN, PhD was elected as on NH State level commissions through the NHNPA. accreditation. Nursing practice and NHNA’s Alternative Representative to This work of advocacy and of inter-professional education are evolving rapidly, and it is essential that they the American Nurses Association’s collaboration adds another dimension of what I would are supported with peer-reviewed continuing education Membership Assembly held in June. be able to offer the NHNA. In closing, I would add that that meets professional standards. I believe my education Judy is a retired professor of Nursing for being driven by a moral compass that seeks to enhance and experience have prepared me well to assist NHNA in Colby-Sawyer College, and currently the lives of the citizens of New Hampshire as well as to this effort.” enjoys globe-trotting at every advocate for the profession of nursing is central to my opportunity. Judy writes, “My long desire to serve in the role of Director at Large." Commission on Nursing Practice: Four nurse members history with the Association and were elected to participate on the Commission which experience in its various roles affords me a unique Director at Large promotes clinical practice and recognition of nurses. perspective. My continued involvement in the Multistate Lindsey Randlett, RN, SANE- Division provides insight into current issues of concern to Prepared. Lindsey will serve in the Holly McCormack, MSN, RN is the the profession.” Board seat reserved for a nurse in Chief Nursing Officer for Cottage practice less than five years. Lindsey is Hospital. She writes, “I am interested in a SANE-Prepared Emergency nurse at becoming more involved in my state The Partnership for Successful Living affiliates Southern New Hampshire Health. She nursing association. As a CNO, I think graduated in 2016 from Rivier this would be an excellent example for change the lives of thousands of New Hampshire University. Lindsey writes, “Since the nurses that I lead. This particular community members each year. We couldn’t graduating from Rivier University's RN commission is looking at issues that are licensure program in 2016 I have been passionate about so vital such as work force (nursing do this without a dedicated, amazing team of staff clinical excellence and actively involved in creating a shortage). I also think that I can bring some great members and volunteers. If you are looking for a better work environment for myself, my colleagues and perspective as a representative of a critical access hospital fast-paced, challenging position in the nonprofit sector, fellow nurses. In addition to committing to 36 hours a in a rural location.” week in the Southern New Hampshire Medical Center you have come to the right place! We offer excellent Emergency Department (SNHMC ED), I have been able Shelley Friedman, MBA, MSN, RN is a benefit packages, generous paid time off, and plenty of to help improve patient outcomes and expand my Clinical Manager for Alice Day Peck opportunity for advancement. The ideal candidates are knowledge in ways that I believe will translate well to Hospital. She writes, “I believe this role the Director at Large, Recent Graduate position. Since will allow me the opportunity to committed and passionate to serving others, changing the very beginning of my nursing career, I have become collaborate with other nurses to lives, and creating a better community. a Sexual Assault Nurse Examiner (SANE) providing care continue to improve nursing processes to patients who are survivors of sexual assault or in NH.” She describes herself as a Competitive salary with a generous benefits package domestic violence in addition to caring for other “strong communicator, positive vulnerable populations who are victims of abuse.” “I motivator, open to new ideas, am also an active member of SNHMC ED's Unit Based empathetic, works well in teams, advocate for nurses and For information about all of our openings or to apply: Practice Committee. I recently did extensive research patients, and lifelong learner. on Nitrous Oxide for procedures that require sedation, www.harborhomes.org, click on Careers particularly in the pediatric population. She is currently Jayme Cutter, BSN, RN is a Maternal An equal opportunity employer, encouraging those with disabilities, enrolled in a Master’s of Science in Nursing with a Child Case Manager with Concord minorities, women, veterans, clients, and alumni to apply. concentration in Leadership in Health Systems Regional VNA. She describes herself as Management. “passionate about the care provided to women and children in the community. Commission on Government Affairs: Three nurse While this still remains a priority in my members were elected to participate on the career, I have started to become more commission that spearheads NHNA’s advocacy work. interested in supporting fellow nurses and our practice. Nurses play an Page 8 • New Hampshire Nursing News March, April, May 2020

Perinatal Nurses are Going PURPLE in New Hampshire

Alyssa J. O’Brien and Ashley S. Holtan the state, nurses are using family-centered care behaviors and the negative and potentially fatal practices to prepare parents to care for themselves ramifications of shaking a baby. Developed by Dr. The postpartum period, or what many are now and their newborns. A key aspect of this education Ronald G. Barr, a developmental pediatrician who calling the “fourth trimester,” is a time of adaptation is the anticipation of concerns or questions that may specializes in infant crying behaviors, and supported to new roles and family bonding. New parents arise after parents go home. Anticipatory guidance by the National Center on Shaken Baby Syndrome are often uncertain about their new role and are helps parents have the evidence-based foundational (NCSBS), the Period of PURPLE Crying educates in need of additional education and support. knowledge they need to make informed decisions parents and other infant care providers about the They have questions about how to care for their throughout the first postpartum year and beyond. normal phase of increased fussiness or crying that newborn, how to recognize emergencies, or even all newborns experience between the ages of two how their relationship with their partner might Many New Hampshire families with newborns are weeks and three to four months of age. The phase change. Postpartum nurses play an important role receiving a nurse-led educational intervention from is difficult for families because the crying seems to during this transition period by providing much- their postpartum nurse meant to reduce “shaken resist any attempts at calming and can last for hours. needed support and education to new parents. baby syndrome,” or acute head trauma (AHT). It is the time that many have come to joke about as Nearly 12,000 babies are born each year in New The Period of PURPLE Crying© is a program to the “witching hour” for babies. However, parents Hampshire; in inpatient obstetrical care units across inform parents about normal infant developmental can become concerned that there is something physically wrong with their baby or perceive their infant as having a difficult temperament. The phase can also put infants at risk for AHT because parents can become frustrated and react to inconsolable crying by shaking their babies. Although a seemingly simple intervention, when the Period of PURPLE Crying program was implemented as recommended, researchers found a 35% reduction in AHT admissions in children under 24 months of age (Barr et al., 2018).

The Period of PURPLE Crying consists of six elements, corresponding with each of the letters in PURPLE that are commonly seen in typically- developing infants. The letters in PURPLE stand for Peak of Crying, Unexpected, Resists Soothing, Pain- like Face, Long-Lasting, and Evening. The Peak of Crying implies that crying is expected to increase week-to-week from about two weeks of age, peak around two months, and then taper off sometime by five months of age. Unexpected represents that there is no predicting when the crying will begin or why. Resists Soothing indicates that a baby’s cries may not be quelled with soothing techniques that may have been effective at one time. Pain-Like Face, Long- Lasting, and Evening denote that a baby may appear to be reacting to a painful stimulus though they are not in pain, their cries may last up to or beyond five hours daily, and they may cry more during the afternoon and evening hours. The entire program is designed to reassure parents that this behavior is normal and to help them determine in advance techniques that may work for them to reduce their • Emergency Room • Inpatient Medical Surgical Unit stress related to their infant’s behavior.

• Maternal Child Health • Office RN In the hospital setting NH nurses are introducing the first “dose” of the Period of PURPLE Crying program by talking to parents about normal infant behaviors, ways to try to soothe their babies, and strategies to reduce their own frustrations when soothing is not effective. Nurses also provide parents with an educational booklet and access to a video that they can bring home and share with others, either as a DVD or as a code for a smartphone app download. University of New Hampshire assistant professor and AWHONN steering committee member Dr. Alyssa O’Brien RN, working with Maria Doyle of the NH Children’s Trust, Debra Samaha, Program Director of the Dartmouth Injury Prevention Center, graduate and undergraduate students from the UNH Department of Nursing recently collaborated to conduct a quality improvement (QI) project aimed at determining the fidelity of the Period of PURPLE Crying intervention at the bedside. The project

Rose Meadow Group (RMG) is celebrating its 25th anniversary and is looking for LPN’s to join our experienced care team! Beyond holding the applicable licensure, our ideal candidates will possess a strong caregiver instinct, a desire to provide care in a smaller setting where they can truly get to know and understand the needs of our residents, and a sincere willingness to support the needs of our program. Positions can be filled on either a part-time (24 hours/week) or full-time (32 hours/week) basis Greatest need is for 2nd shift (3-11) and 3rd shift (11-7) nurses RMG will consider alternate, 12-hour shift option (7pm to 7am) for interested applicants Signing Bonuses Available Submit a resume to [email protected], or call Rose Meadow's HR Department at 603-487-3590, extension 21. March, April, May 2020 New Hampshire Nursing News • Page 9

THE LETTERS IN PURPLE STAND FOR

P U PAIN-LIKE L E PEAK OF R P LONG EVENING UNEXPECTED RESISTS CRYING SOOTHING FACE LASTING

Your baby Crying can Your baby A crying Crying can Your baby may cry more come and may not stop baby may last as much may cry each week, go and you crying no look like they as 5 hours a more in the the most in don’t know matter what are in pain, day or more. late afternoon month 2, why. you try. even when and evening. then less in they are not. months 3-5 THE WORD PERIOD MEANS THAT THE CRYING HAS A BEGINNING AND AN END demonstrated that the hospitals who had program agreements with the NCSBS important, but also acknowledged that they are tasked with teaching a lot of had fidelity to the program and that NH nurses working in perinatal inpatient new information in a short period of time. Nurses felt that parents would benefit units felt that the program was valuable, memorable, and meaningful to both from hearing about normal infant behaviors and techniques to reduce parental nurses and the families they were educating. frustration about crying in a variety of settings, including prenatal classes, pediatric provider office visits, and nurse home visits. Respondents noted that parents were overwhelmed by the amount of new information they are asked to process while sleep deprived in the inpatient setting. Repeated teaching Curves of Early Infant Crying was suggested as a way to increase retention of new information and to allow 2 Weeks to 4-5 Months parents more opportunities to ask questions. This recommendation from nurses is in alignment with the American College of Obstetricians and Gynecologists 2018 recommendations to optimize postpartum care, which suggested that education should be a continuum over time and not a one-time interaction 5-6 Hours High Crier event. Developers of the Period of PURPLE Crying program also suggested that Average Crier multiple “doses” are important. In response to these suggestions, undergraduate and graduate nursing students from UNH are developing educational materials Low Crier aimed at training pediatric care providers, visiting nurses, and obstetrical care providers about how to introduce or reinforce the teachings of the Period of PURPLE Crying program with families outside of the obstetrical inpatient care setting.

Reference Barr, R. G., Barr, M., Rajabali, F., Humphreys, C., Pike, I., Brant, R., Hlady, J., Colbourne, M., Fujiwara, T., & Singhal, A. (2018). Eight-year outcome of implementation of abusive 20-30 Minutes head trauma prevention. Child Abuse & Neglect, 84, 106 –114. Alyssa J. O’Brien, RN, PhD is an Assistant Professor at the University of New Hampshire and Ashley Holtan RN, BSN is the Quality Improvement Nurse at Length of Time Crying in 24 Hours Crying Time of 24 in Length Lamprey Health Care. 2 weeks 2 months 4-5 months

One of the questions in the QI survey asked how nurses would make improvements to the way parents are taught the new information. The perinatal nurses felt that their role as educators for postpartum parents was White River Junction, VT VA Medical Center is seeking experienced Registered Nurses for the following clinical areas: ED • Med/Surg • OR • Mental Health Nursing Assistants • LPN (Residential Recovery) BE ON THE LPN (Telehealth) Burlington • LPN Littleton • PA/NP Littleton LOOKOUT! To learn more contact [email protected] OR look on USAJOBS.GOV RNs who join our team receive excellent benefits including: • 26 annual and accruable paid vacation days The goal of the New Hampshire Nurses • Association newly formed Membership 13 annual and accruable sick days • 10 paid Federal holidays Engagement Task Force is to create a • Retirement thrift savings plan with matching dollars membership experience that supports • Tuition reimbursement after one year of and advocates for the unique needs of its employment for qualified employees New Hampshire nurses. The task force has grown out of the participation of NHNA I'm not just a nurse. in the High Impact Volunteer Engagement (H.I.V.E) Project, funded by a grant from the I'm inventing a new NH Center of Non-Profits. The purpose is to identify and put into place the components model of health care. of membership that provide the most value to your professional careers.

A survey of members will be emailed, posted on our website and distributed through social media. Be on the lookout, don’t delete, and help us take your membership in NHNA to the next level in 2020! We need your input!

Paula MacKinnon, RN NHNA Membership and Communications Coordinator Page 10 • New Hampshire Nursing News March, April, May 2020 NH 2019 NHNA Awards Bestowed The 2019 NHNA’s Awards were presented at the annual Cheshire Medical Center. Maggie advocates for patients Nursing meeting, “Nurses Night at the Museum” on November as individuals and also identifies and resolves concerns 20, 2019 and included the Rising Star Award, the for populations. She has worked to implement changes Champion of Nursing Award, the Distinguished Member in order sets to improve the care of patients at the end of News Award, and President’s Award. life. Maggie is described as having a joyful and “can-do” attitude, being energetic, reliable and supportive. Needs The Rising Star Award honors a nurse who has been in the field less than five years and has both contributed to The second recipient is Rivier University Department of YOU the profession and has demonstrated significant potential Nursing and Health Professions. The Department offers a as a leader and nursing advocate. This year there were wide variety of nursing programs, from Associate Degree Guest Editor Opportunity nine nominations including: through Doctoral. Rivier has excellent staff and faculty • Scott Aldrich from Cheshire Medical Center that have worked diligently to achieve their mission Do you read the NH Nursing News and wonder how • Amanda Boyd from Littleton Regional Healthcare of transforming hearts and minds to serve the world it is put together? Do you like to write and organize? • Laura Galloway from Dartmouth Hitchcock Medical through nursing and other health professions programs. Did you ever wonder why the NH Nursing News Center The Department engages in experiential learning doesn’t include ______? Then you should • Gabriella Goddette from Southern New Hampshire opportunities that afford students real work experience give being a Guest Editor a try. The August 2020 Medical Center with professionals in the practice field. They have been Issue needs you! You will be mentored and have the • Natalie Hansel from Dartmouth Hitchcock Medical a strong support of nursing advocacy and have served resources of NHNA available to you. The guest editor Center as host site for the NHNA’s Legislative Town Hall forum is primarily responsible for the intellectual content of • Brianan Karasinski from Cheshire Medical Center for the past three years. Congratulations to both 2019 the issue itself and the content that comprise it. This • Lindsey Randlett from Southern New Hampshire Champions! includes not only securing articles from authors, but Medical Center also reviewing them and working with authors to • Alaina Slocomb from Cheshire Medical Center A new award presented in 2019 was the Distinguished make necessary revisions. You will offer an editorial • Stephanie Stickney from Southern New Hampshire Member Award. This award honors a nurse with opinion, create the Medical Center substantive service to the NHNA, through work on the table of contents commissions, work in nursing advocacy, or work on and review the Each nominee should be honored and proud to be NHNA task forces. The runner-up this year was Sandra final copy from included as a rising star. The nurses were nominated by Pascucci. Sandra has been providing nurses services for the publisher. administrators, unit educators, managers, and peers. The a long-term. She facilitated peer nurse support groups for Interested? Contact recipient of this year’s Rising Star Award was Stephanie nurses in recovery for 25 years and continues to do so. Joan Widmer at Stickney who practices on the medical-surgical One of her recent accomplishments include working on nhna.ned@gmail. oncology floor at Southern New Hampshire Medical a bill to implement an alternative recovery monitoring com and attach Center. Stephanie has demonstrated professionalism program for nurses in NH, which was passed in the 2019 your resume or through being kind, respectful and supportive of her legislative session. vitae. co-workers. She has demonstrated patient advocacy through characteristics such as integrity, responsibility, The recipient of the 2019 Distinguished Member Award and looking at the patients’ best interests. She has was Dr. Judy Joy. Dr. Joy is an advocate for the NHNA displayed leadership as the Unit Chairperson of the at the local, state, and national levels. Her commitment Nurse Practice Committee and is also very active in to NHNA is demonstrated through her current roles as the hospital-based Nurse Practice Council. Within the NHNA Delegate to the ANA Membership Assembly, hospital community, Stephanie participates in planning and serving as NHNA’s representative to the Northeast ALSO IN activities for retention and recruitment of nurses. Within Multistate Division, and is currently the President of the the patient community, she participates in activities NEMSD. Judy’s past service includes the role of Interim to support and raise money for patients undergoing Executive Director, President of NHNA and Chair of the treatment during the holiday season. She is also devoted Commission on Government Affairs. Congratulations THE NEWS… to the next generation of nurses and was involved in Judy! bringing two mentoring programs to the Student Nurse On October 23, 2019, Frisbie Memorial Hospital Associate Program and Dedicated Education Unit, where The President’s award is given at the exclusive discretion filed a notice of proposed acquisition transaction Stephanie has mentored student nurses. Congratulations of the President of the NHNA to someone who with FMH Health Services, LLC, an affiliate of HCA Stephanie! exemplifies the NHNA’s Core Values. President Carlene Healthcare, Inc., whereby FMH would purchase Ferrier presented the 2019 award to Dr. Pam DiNapoli. substantially all of the assets of Frisbie. Upon The Champion of Nursing Award honors an employer/ Dr. Pam DiNapoli has served in numerous leadership successful completion of the regulatory process, institution or individual who has had a positive roles at NHNA as a delegate to Membership Assembly, Frisbie Memorial Hospital will join Parkland impact on the profession of nursing. The Champion Chair of the Commission on Continuing Education, and Medical Center and Portsmouth Regional Hospital has contributed by demonstrating characteristics and currently as the Chair of the Commission Government as part of the HCA Healthcare family in New practices that support individual nurses or the nursing Affairs. She has been the go to person for meeting with Hampshire. profession. Two awards were bestowed in 2019. The congressional members on important nursing issues first recipient is Maggie Bard who practices in the float and has mentored many volunteers in successfully pool and chairs the acute nurse practice council at advocating for key legislation.

Champion of Nursing, Maggie Bard with Carlene Ferrier

100 Saint Anselm Drive Rising Star Award, Stephanie Stickney, with Joan Manchester, NH 03102 Widmer (L) and Carlene Ferrier (R) (603) 641-7086 www.anselm.edu/cne

Committed to Promoting Excellence in the Practice of Nursing Distinguished Member Award, Judy Joy

Saint Anselm College is approved as a provider of nursing Champion of Nursing, Rivier University continuing professional development by the Northeast Department of Nursing & Health Professions Multistate Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation Left to right: Sister Paula Marie Buley IHM, EdD, Dr. Denise Baxter, Dr. Paula Williams, Gail LaBrecque, Dr. Judi O’Hara, Dr. Jeanne Hayes March, April, May 2020 New Hampshire Nursing News • Page 11 Nurses Night at the Museum

On November 20, 2019, the New Hampshire Nurses Association (NHNA) stick injury and the contraction of HIV and Hep C, to advocating for the passage coupled its Annual Membership Business Meeting with a celebration of nursing of state legislation to ensure the use of safety needles in all Massachusetts based at the Currier Museum of Art in Manchester, New Hampshire. The Business healthcare facilities. It was an inspiring and moving story. A few the participant Meeting kicked off at 5:00 pm in the Currier Auditorium. After a brief welcome comments included: “Karen was an engaging speaker,” and “Karen was awesome.” by Board President, Carlene Ferrier, members gathered and had an opportunity to ask questions relative to the NHNA Annual Report previously posted on the Lyndsay Goss, Chair and Carol Allen, Vice Chair of the Commission on Nursing Association’s website. President Ferrier announced the winners of the 2019 Practice, presented NHNA’s Annual Nursing Awards. The awards presented elections. Weather and parking challenges resulted in a slight delay in member included the Rising Star Award, the Distinguished Member Award and the arrivals, so a quorum for the conduct of business was not established until 5:20 Champion of Nursing Award. Carlene Ferrier presented the President’s Award to pm, as certified by Pamela Kallmerten, Secretary of the NHNA Board of Directors. Pamela DiNapoli, Chair of the Commission on Government Affairs, in recognition Carmen Petrin, Director at Large, described the proposed bylaws changes, of her many years of service to NHNA and her on going nursing advocacy efforts. discussing changes one Article at a time. Votes were taken after the discussion of And last, but definitely not least, NHNA recognized over fifty members that the article and all proposed changes were passed based on the raising of member had been members of NHNA for 25 years or more. Fourteen of these members hands; all but one article passed unanimously. were present to receive this recognition and accept a specially designed 25-year membership pin. After the business meeting was adjourned at 6:15 pm members moved to the main floor of the Currier Museum to enjoy the hors d’oeuvres prepared by the Currier The conference evaluations revealed that all enjoyed the event. “Excellent idea of chef, including scallops wrapped in prosciutto, spanakopita bites, chicken satay having meeting at Currier Museum, loved the change,” “Setting of meeting was skewers and a sample of Italian entrees from the pasta station. Many enjoyed a beyond expectation,” and “Well done – loved the venue,” were just some of the glass of wine or beer while chatting with nursing colleagues. For the next hour, comments made by members on their evaluation forms. members and other guests toured the Museum exhibits and visited the exhibitor tables of the event sponsors. The ambiance of the Currier Museum led to a relaxing evening of celebration and rejuvenation of nursing.

Carlene Ferrier provided members with a retrospective of the past year, sharing highlights of activities and events (see “A year in Review” from the December 2019 issue of New Hampshire Nursing News). One participant commented, “Congratulations on many achievements over a year of hard work by many!”

American Nurses Association Past President, Karen Daley was the keynote speaker. Daley shared her personal journey in nursing advocacy: from needle

Amy Dooly, Karen Daley Bob Dunn, former NHNA Lobbyist, and Judy Joy (L-R) Aden Henry and Representative Gold Sponsors Polly Campion (L-R)

Virginia Blackmer of Roslyn Lawrence of Several Bylaw changes Sanbornton and Jeanne Concord received were approved at the Hayes of Milford both recognition as a Annual Membership received recognition as a member of NHNA Business Meeting. member of NHNA for 28 for 28 years. years. Silver Sponsors

Join a dynamic, caring organization and grow your career while making a difference in the lives of our residents.

n Resident focused with higher than average staff-to-resident ratios n Tuition reimbursement n Growth opportunities for RNs, LPNs, MNAs and LNAs Call RiverWoods Exeter at 603.658.1541 or visit RiverWoodsExeter.org/careers Page 12 • New Hampshire Nursing News March, April, May 2020 WELCOME NEW and RETURNING NHNA MEMBERS! NHNA welcomes these new and returning members. Thank you!!! NHNA welcomes these new and returning members. Thank you!!! What do these 52 nurses and over 1,100 NHNA members know that you don’t? If you are not a member ask your neighbor on this list why they joined! Go to nhnurses.org where joining is easy and one of the best professional values for your money! We want to see your name here in the next issue of the NH Nursing NEWS!

Alton Bay, NH Candia, NH Epsom, NH Manchester, NH Northfield, NH Salisbury, NH Melanie Tidd Deborah L. Osborn Christine L. Heichlinger Andrew Robertson Christina Capachietti Devan Rooney Dunlop Auburn, NH Charlestown, NH Franconia, NH Meriden, NH Sanbornton, NH Julie Crete Matthew Dejackome Julie Cote Susan B. Reetz Pelham, NH Mary Elizabeth O’Leary Stephen P. Callery Barrington, NH Concord, NH Goffstown, NH Merrimack, NH Stoddard, NH Ingrid Hagberg Mary Ann Aldrich Annalisa Ruth Jennifer Lynn Gould Piermont, NH Susan Hayes Melanie Leathers Macarthur Amy C. Hollenberg Michele F. Thayer Bedford, NH Michele Moreau Weare, NH Lauri Tebbetts De Witt Elizabeth A. Schock Grantham, NH Milford, NH Plainfield, NH Angela Roberge Rachel A. Ritter Diana Zoltko Teresa S. Didehbani Berlin, NH Deerfield, NH Westmoreland, NH Kevin Larochelle Bethany L. Hills Hollis, NH Nashua, NH Rindge, NH Kisha Thompson Corey Turner Heather D. Ditrolio Janet Baidoo Jennifer Lee Whitehead Derry, NH Jeannie Gonyer Windham, NH Bradford, NH Jaime Lynn Farrington Keene, NH Ellen M. Rearick Rochester, NH Robyn Clark Kathleen Croll Kathleen Scheidel Jennifer Sironen Nicole E. Wentworth Jenny Stillman Dover, NH Courtney Whitten Cherilynn Marshall Laconia, NH New Boston, NH Brentwood, NH Lynn A. Sutelman Magen Elaine Jenkins Rollinsford, NH Julie McLaughlin Eaton Center, NH Maura S. Carriel Linda Barton Lebanon, NH North Sutton, NH Aden Henry Beverly Marie Gagnon March, April, May 2020 New Hampshire Nursing News • Page 13

Kudos to Jean Coffey, PhD, APRN, a dying person at the end of his life. She really took care beyond that required for initial certification of nurse CPNP, director of the Plymouth State of everyone that was present during Ron’s final hours.” anesthetists. This credential has been earned by fewer than University nursing program, who was Peterson-Henry has been a nurse for 14 years, and at 80 certified nurse anesthetists nationwide inducted as a fellow in the Class of Concord Hospital for 11, starting in the ICU and now 2019 by the American Academy of working there as a per diem nurse in addition to her Kudos to Dr. Bernadette Y. Jao, RN Nursing. nursing supervisor/educator duties. The DAISY Award was of the Manchester VA Medical Center established in 1999 by Mark and Bonnie Barnes after their who received top honors from the son, Patrick, died in Seattle from complications from an Secretary of Veterans Affairs in the auto-immune disease. annual VA Excellence in Nursing and for the Advancement of Nursing Kudos to the outstanding team of certified perioperative award program. The awards were During the Annual Alumni registered nurses at Littleton Regional Healthcare who announced December 4, 2020. Jao Weekend at Rivier University Joan have earned the Certified Nurse Operating Room (CNOR) was honored in the Nurse Executive Widmer, RN MSN, Class of 2005 Strong designation for 2020. The CNOR Strong designation category. Jao’s efforts in improving was bestowed the Outstanding demonstrates continued dedication to perioperative nursing, provider and Veteran family satisfaction ratings Nursing Professional Award for her excellence, through achievement of a high percentage of were noted in her award. Since joining Manchester VA in commitment to excellence and certified perioperative nurses. In order to receive CNOR January 2018, Manchester VA’s Community Living Center service to patients, nurses, and Strong designation, at least 50% of eligible perioperative received a “5 Star Sail Rating” as best in its category for nursing education. Widmer earned nursing staff must be CNOR certified and the facility must exceptional long-term care for Veterans. A doctor of nurse her Associate of Science in nursing consistently recognize and reward nurses who become practice, her leadership also resulted in Manchester VA’s degree from Rivier and serves as CNOR certified or complete recertification. Sterile Processing Service receiving the most compliant the Nurse Executive Director of the New Hampshire review of any VA SPS department in the nation. Nursing Nurses Association. After a successful career in corporate at Manchester VA was also recognized as having five best accounting and finance, Widmer elected to pursue a practices and achieved zero Joint Commission findings in second career in nursing. Kudos! a 2018 survey. Each year, the U.S. Department of Veterans Affairs recognizes VA professionals for quality patient care, innovations, excellence and leadership in advancing nursing and with transforming VA health care.

Kudos to Nicki Schmarr RN of the Christina Morancie, MSN, RN, CNOR; Sharon Ambulatory Surgery Departement at Larsen, RN, CNOR, CGRN; Colette Haywood, RN, Weeks Hospital. Schmarr was a 2019 CNOR; Katherine LeHouskey, RN, BSN, CNOR, Blue Ribbon Award recipient. Nikki Director of Perioperative Services; Lorelee was recognized with the following Wetherbee, RN, CNOR Missing from Photo: patient comments: Sonya Morse, ARNP, RNFA, CNOR • She made me feel very KUDOs to the staff of Catholic Medical Center’s Heart comfortable before and after my and Vascular Interventional Unit for receiving a Silver Kudos to Francis Valenti, MS, CRNA procedure. Beacon Award. The Unit was informed in December, who has successfully achieved • Very professional and made me 2019, of the award bestowed by the American Association the distinction of certification in feel like family. of Critical-Care Nurses' Beacon Award recognizing units Non-Surgical Pain Management • Explained everything and made sure I was comfortable. with an excellence in professional practice, patient care and (NSPM-C) by the National Board of • Very professional, courteous, and treated me with outcomes. Certification and Recertification of respect. Nurse Anesthetists. The NSPM-C • I felt comfortable in her care and was not worried for my procedure. Kudos to Carolyn Peterson-Henry credential is a voluntary subspecialty certification for nurse anesthetists. • I loved Nicki in same day surgery. She gets patient care. RN, Concord Hospital nursing • Excellent! Nurse Nicki was exceptional. supervisor and Intensive Care Unit The NSPM-C program measures the knowledge, skills, and abilities of certified registered nurse • My experience was so good and we had so much fun. (ICU) nurse, who was a recent anesthetists for practice in the field of pain management. It If I had a week or two with nothing to do, I would recipient of a DAISY Award, which requires advanced, subspecialty knowledge and training come back for another surgery. recognizes excellence in nursing. The award is presented to nurses around the world who are nominated by patients, patient’s families or hospital colleagues. “I was extremely shocked,” said Peterson-Henry, who was nominated by the grateful widow of a patient she helped care for last spring. In a letter to Concord Hospital, Crystal Proulx of Bow said Peterson-Henry was “like an earth angel” caring for her husband, Ron, and his family.

“All day long, she treated Ron with respect and dignity,” Northern Human Services is seeking talented Proulx wrote. “She showed such great compassion for nurses to provide care to a diverse outpatient population at White Mountain Mental Health, a vibrant and growing Community Mental Health Center in the beautiful White Mountains of Whose team are you on? Northern New Hampshire. We want you to join our team!

Part Time Psychiatric APRN We have many opportunities available at Memorial Hospital: - approximately two days/14 hours per week • RNs in Med Surg, Family Birthing Center, Long Term Care, - eligible for student loan forgiveness through the General Surgery and Emergency Department National Health Service Corps and State of NH Loan - $1000 sign on bonus Repayment Program • LPN in Long Term Care - $1000 sign on bonus • LNAs in Med Surg and Long Term Care Interested candidates, please send CV and cover letter with salary - $500 sign on bonus requirements to: Bobbi Lyndes-Langtange, Office Manager • Per Diem opportunities for RNs with 2 years’ critical care PO Box 599, Littleton, NH 03561 We offer excellent pay, wonderful benefits, paid vacation, 603-444-5358, [email protected] tuition reimbursement, retirement and all in a warm, exciting and compassionate team setting! Positions require a valid driver’s license, proof of adequate auto insurance and the www.memorialhospitalnh.org completion of driving, criminal and background records checks. This Agency is an Equal Apply online at Opportunity Employer and Provider. or stop by and see for yourself! An Equal Opportunity Employer Page 14 • New Hampshire Nursing News March, April, May 2020

From the Bookshelf

OSCAR NOMINATED SHORTS

Reviewed by Anita Pavlidis, RN, MSN Daughter depicts a hospital room with a dying father Memorable is a heartwarming and distanced daughter, as the child recalls a childhood and heart breaking tale of how It’s that time of year again when the Academy Awards memory when she tried to share an injured bird with her the world changes for a painter and his wife as all sorts of preview the Oscar shorts in animated, live action, or father. A moment of misunderstanding and a lost embrace strange things have been happening to them. It is tragic and documentary form. These 15 short films nominated in these has stretched into many years all the way to this hospital lovely. three categories are mainly serious and grim. room. The shorts are funny and sad, profound and frustrating but The animated shorts had five films in the category, each Kitbull reveals an unlikely connection that sparks between provide a deeper connection to the soul. Well worth the from seven to fifteen minutes long. The themes were two creatures, a fiercely independent stray kitten and time to see them!! quite heavy – the death of a parent, Alzheimer’s, China’s a pitbull trained by an abusive master. Together they one-child policy, and more. The overall mood is rather experience friendship for the first time. https://shorts.tv/theoscarshorts/ melancholy. Sister relates how a man thinks back to his childhood Anita Pavlidis, RN, MSN, was the former Director of Hair Love has a lot of compassion and charm in the story memories of growing up with an annoying little sister in Nursing at the NHTI, Concord’s Community College and about a Daddy who must give his daughter an extra special China in the 1990s. What would his life have been like if Program Specialist at the New Hampshire Board of Nursing. hairstyle in this story of self-confidence and love between things had gone differently? fathers and daughters. It concludes upbeat and bittersweet. March, April, May 2020 New Hampshire Nursing News • Page 15 NCLEX Reconsidered Focus on Delegation

Ed Note: Where it has been a year or years since you took the NCLEX (AKA “Boards”), how well would you do now?

1. An emergency department nurse on the evening shift triages four patients. Which Testifying for Kids patient should the nurse assign priority to? School Nurses are back in Concord testifying at hearings assess a concussion at some point during the year including to advocate for bills that impact New Hampshire children emergency room nurses, inpatient nurses, and clinic A. Patient with a history of seizures and school communities. The New Hampshire School nurses. In schools, understanding the potential effects of complaining of headache Nurses Association (NHSNA) successfully lobbied in 2019 concussions on student learning and establishing appropriate B. Patient complaining of ankle for a School Nurse Coordinator to serve as a resource to all management of the return-to-learn process is critical in pain who fell during roller- school nurses in New Hampshire. The position is currently supporting students in their recovery. Many issues can arise blading requesting pain medication posted by the Department of Education. We look forward to during the medical office-to-school transition; oftentimes C. Patient with a minor laceration on welcoming a new school nurse coordinator into the school provider-school communication is not established, and index finger sustaining while chopping wood nurse community in 2020. the education expectations for the student are unrealistic. D. Patient who ate spicy pizza within the past hour HB584 expands school-based concussion and brain injury complaining of indigestion NHSNA Board Members Traci Fairbanks and Nancy Wells in-service training as well as requires school districts to adopt have been actively participating in the Medicaid to Schools return-to-learn programs similar to the return-to-play policies 2. In planning assignments for the day shift, which rule writing, which will impact funding for schools as that already exist for student athletes. By supporting SB584, patient should be delegated to an unlicensed assistive reimbursement for care administered during the school day. NHSNA is asking for protection for all New Hampshire personnel? NHSNA is also participating in discussions regarding a food students, not just student athletes in grades 4-12 who have a allergy bill HB1682, which would require a food allergy concussion. HB 584 extends the goal of returning to play on A. Patient requiring colostomy irrigation protocol with appropriate training for school staff in all a team roster, to returning to a full academic program. B. Patient started on continuous tube feedings schools, including Charter and Private Schools. School nurses C. Patient needing a urine specimen collection are excellent advocates for New Hampshire students and we One thing we have learned at NHSNA is if you advocate D. Patient with difficult swallowing after a bronchoscopy need to make sure that all food allergic students have access confidently for legislative action by sending a letter, by to a school nurse, and that this care is consistent through showing up in numbers and testifying in the House of 3. The charge nurse is preparing the shift assignment. every school across the state. Representatives or in the Senate, your voice will make a What factors should be considered in determining difference. We encourage you to advocate for your role as care? (Select all that apply) Concussions, or traumatic brain injuries (TBI) impact people a nurse and to speak up to protect your patients through of all ages. A concussion can be caused by incidents such change in New Hampshire laws. A. Acuity level of the patients as athletic injuries, falls from skateboards, motor vehicle B. Specific requests from staff accidents, or any blow to the head that results in mild to Kathy Barth, BSN, RN, NCSN is the President of the New C. Clustering of rooms on unit severe injury with resulting symptoms. Every nurse will likely Hampshire School Nurses’ Association. D. Number of anticipating patient discharges E. Personnel abilities and competencies

4. A nurse in a long term care facility has three UAPs and one LPN on the care team. Which patient(s) should be assigned to the LPN? (Select all that apply)

A. Patient requiring abdominal dressing wound change every three hours B. Older client requiring frequent toileting C. Patient on hourly vital sign measurements x four D. Patient requiring a compete bed bath E. Patient with COPD who has a new onset temperature Advance your of 37.5 C

5. The new nurse has received her assignments for the day shift. Place the patients in order that the nurse nursing career at should plan care for first?

A. Patient who is post-total knee replacement and using a walker the state’s flagship B. Patient four hour post-op hip replacement who received morphine two mg IV by the off going nurse C. Patient who is scheduled for physical therapy to learn crutch walking with a long-leg cast university D. Patient with a PCA after ORIF of left femur who is complaining of 6/10 pain

Answers on page 23 MASTER OF ADVANCED NURSING POST- SCIENCE IN EDUCATION MASTER’S NURSING WORKFORCE (ANEW) CERTIFICATE

Primary Care Family Nurse Practitioner Primary Care Family Nurse traineeships and funding Family Nurse Practitioner (FNP) for students in rural and Practitioner (FNP) underserved areas

For more information contact: [email protected] chhs.unh.edu/graduate-nursing Page 16 • New Hampshire Nursing News March, April, May 2020

Dr. Kevin Finn has been named Dean of the School of Nursing & Health Sciences and director of clinical will be the first of the partnerships at Colby-Sawyer College. Finn, who River Valley Community College brings over a decade of administrative, teaching and state’s community colleges to offer practical nurse education research experience, was most recently the associate leading to an LPN. The practical nurse program was dean for the School of Health Sciences at Merrimack made possible through funding in the last state budget, a College. Finn first served Merrimack College as an multimillion-dollar investment called the "Next Generation assistant athletic trainer and lecturer and then moved Workforce Initiative," which Gov. Chris Sununu says will into the role of professor and department chair. address a critical element of the health care workforce. Finn holds an Ed.D. in Curriculum and Teaching The program in Claremont will eventually move to River from Boston University, an M.A. in Teaching and Valley's Lebanon campus and other colleges in the state Curriculum from Fairfield University and B.S. in system. The first cohort of 16 students began on January Sports Medicine from Merrimack College. 21, 2020. Requirements for admission include passing all four sections of the nursing entrance exam (ATI-TEAS), high school college chemistry, and high school transcript, GED or HiSET. Prospective students must also be a licensed nursing assistant to apply.

Plymouth State University acknowledged the contributions of Anne-Marie Cote, recently retired, in laying the groundwork for the Thirty St. Anselm nursing students University’s nursing program. Before joining were inducted into the Sigma Theta the newly formed Nursing Department in 2011, Tau International Epsilon Tau-at- Cote worked in the emergency room at Speare Large Chapter of the Honor Society Memorial Hospital. Cote became one the first of Nursing on October 30, 2019. faculty members in the department and jumped Friends and family were welcomed headfirst into the complex process of building to the induction by Dr. Maureen courses and curriculum. “Annie is an authentic O’Reilly, Executive Director of nurse with knowledge and skills unparalleled the Department of Nursing. The by her peers,” said Jean Coffey, PSU director of ceremony was conducted by Epsilon nursing. “Her contributions, from the bedside to Tau-at-Large President Hilary Gorgol ‘14 the classroom, are truly lasting and we are so grateful for the wisdom she Vice President, clinical nursing faculty Susan Kinney, Faculty has instilled in our faculty and students.” Cote remains involved as a member Counselor, clinical nursing faculty Alicia Law, and Assistant of the PSU Nursing Department Advisory Council, which explores ways to Professor Carrie R. MacLeod. Secretary and alumna Mallory improve and complement nursing education in the North Country. Schell, BSN, RN ’19 was the guest speaker at the ceremony.

White Mountain Community College has been granted ED Note: News from nursing schools, faculty, initial accreditation for the Associate Degree Nursing students or alumni are welcome. Please direct Program through spring 2024 by the Accreditation submissions to [email protected] with NHNN Commission for Education in Nursing (ACEN). in the subject line. March, April, May 2020 New Hampshire Nursing News • Page 17 Nursing Workforce Findings HUMOR ME

Regularly exercising our sense of humor improves resiliency, positivity and balances anti-negatively. Laughter may not solve problems but can change your chemistry allowing you to face them anew. In this issue we present experiences with computers, with apologies to our IT colleagues. Submissions are welcome.

* I was going to change my password to MilkyTea but apparently that’s too weak. Then I changed my password to BeefStew but the computer told me it wasn’t Stroganoff. The computer said my password needed at least eight characters and at least one number, so I changed it to Snow White and the Seven Dwarfs. Apparently now my password needs to be capitals only so I’ve changed it to LONDONMADRIDROME

Findings reported in January, 2020 from the 2018 National Sample Survey of * Asked the librarian rather loudly for the wifi password. He said “Sshhhhhh!” I asked Registered Nurses (NSSRN), the longest running survey of registered nurses in “is that all lower case?” the U.S., shows nursing is more diverse and better educated than a decade ago.

Conducted by the Health Services Resources and Services Administration (HRSA), * Q. What is the biggest computer lie in the entire universe? the NSSRN is considered the “gold standard” for nursing workforce data. The Survey A. “I have read and agree to the Terms and Conditions.” was last conducted in 2008.

* The first computer dates back to Adam and Eve. It was an Apple with limited The findings show nurses are more diverse today in ethnicity and gender than in memory, just one byte. And then everything crashed. 2008. The percentage of the RN workforce that is Hispanic has almost tripled, from 3.6 percent to 10.2 percent. Male nurses now represent 9.6% of the nursing * A blonde texts her husband on a cold winter’s morning: “Windows frozen, won’t population up from 7.1% in 2008. RNs who have bachelor and higher degrees open.” Husband texts back: “Gently pour some lukewarm water over it and gently has increased from 50 percent in 2008 to 64 percent in 2018. It is unlikely that 80 tap edges with hammer.” Wife texts back five minutes later: “Computer really percent of RNs will have bachelor and higher degrees by 2020 as suggested by the messed up now.” Institute of Medicine Report. * Some people are like a software update. When I An estimated 3,957,661 licensed registered nurses live in the U.S., up nearly 30 see them I think, “Not now.” percent from 2008. About 83 percent of those nurses held a nursing-related job in

2017. The average age of a RN was 50 years old, but most nurses (53 percent) were * Whoever said that the definition of insanity is under 50. Median earnings for full-time RNs were $73,929, while part-time RNs doing the same thing over and over again and earned a median amount of $39,985. expecting different results has obviously never had to reboot a computer. Advanced practice registered nurses account for about 11.5 percent of the nursing workforce. The number of nurse practitioners in the US grew from around 91,000 in * Before you marry a person you should first make 2010 to 190,000 in 2017. The greatest NP growth was seen in the outpatient setting, them use a slow internet to find out who they the report found, and the number of registered nurses who were not advanced really are. practice RNs grew 22% from 2.5 million to 3 million.

Telehealth capabilities were reported in nearly 33 percent of nurses’ workplaces. Among them, 50.3 percent of nurses used telehealth in their practice.

For more details go to: https://bhw.hrsa.gov/health-workforce-analysis/data/national- sample-survey-registered-nurses Page 18 • New Hampshire Nursing News March, April, May 2020 IN MY OPINION Profession Under Siege In 1910, an educator by the by Flexner and supported over 100 years by many experts Senate Bill 596, sponsored by nine Senators and one name of Abraham Flexner is the requirement for self-regulation of a profession. House member would allow a non-public member of was tasked with a review of A profession, by virtue of its specialized knowledge, the Board of Nursing to preside over disciplinary hearings medical education and to must have autonomy to self-regulate its practice and its of the Board. Two individuals are allowed by rules to offer recommendations. His members. preside over disciplinary hearings, the Chair and Vice- report was groundbreaking. Chair. The presiding officer assures that the legal process He defined the characteristics The public is first to acknowledge that nursing is a is adhered to, allows the introduction of evidence, calls of a profession and noted that profession, in fact, the most trusted profession with and runs participation in meetings and calls for votes. medical education at the time, a unique body of knowledge. Yet, New Hampshire The current Vice Chair on the Board of Nursing, elected an apprenticeship without legislators seem to be uninformed. Two Senate bills in by the Board members, is a public member. At present, a quality assurance oversight, the 2020 legislature have the potential to diminish and public member cannot serve as a presiding officer during was woefully inadequate. One depreciate every New Hampshire nurses’ professionhood. a disciplinary hearing of licensees. SB 596 originated of the key characteristics noted Susan Fetzer We are a profession under siege. from the Board of Nursing. Evidently, the Board felt, due to the burden placed on the Board of Nursing Chair to preside at all hearings, the Vice-Chair, a public member should be satisfactory. In my opinion, such a solution is unacceptable. While members of the Board of Nursing are appointed and not paid, they apply for the position knowing the time constraints and activities that are required. They willingly request to be chosen. Once on the Board, members vote for a Chair and a Vice-Chair. The Board of Nursing rules are quite clear that a public member cannot preside at hearings; thus the Board and the Chair must have known and agreed, prior to the vote for Vice-Chair, that only the Chair would be presiding. Or were they not aware of the rules at the time of the vote for Vice-Chair?

The Board and the legislators opine that the role of the presiding officer during a disciplinary hearing is simply an individual that assures that due process is adhered, like the Chairperson of a Committee. However, a disciplinary hearing can be swayed by the presiding officer, just ask anyone who visited the House of Representatives in Washington, DC a few months ago. Disciplinary hearings are a form of peer review. There is a good reason why the Board has more nurses voting than public members. A disciplinary hearing should be presided over by a peer, a nurse. Nurses must trust in the process, and it was clear at the NHNA Legislative Forum in January, that nurses believed that a nurse should be presiding.

Senate Bill 568 seeks to create a Committee of two Senators and three House members of the general court to oversee the 52 licensing boards and the Office of Professional Licensure and Certification (OPLC). The OPLC was created in the 2016/2017 budget and consolidated the licensing boards under the umbrella of the newly established OPLC. According to their website:

“This consolidation was established to create efficiencies and eliminate redundancies, resulting in enhanced customer service and providing a consistent organizational structure for programs and licensees. Centralization of New Rates • Enhanced Benefits • Shared Governance administrative functions will enable program staff and Board members to more efficiently utilize their time and Free Healthcare Option for you and your family expertise regulating their programs.” The Board of Nursing suffered under the consolidation, Professional Growth and Development opportunities fewer staff resulted in less communication and information. However, now SB 568 justifies a legislative committee to duplicate the efforts of the OPLC:

“…provide legislative oversight of the office to support a cost effective, comprehensive, coordinated system of licensure that serves New Hampshire's workforce needs for professional and licensed services. The committee shall promote greater efficiencies by consolidating https://bmcnursingcareers.org/ and centralizing reporting requirements and other responsibilities of the office to avoid duplication of efforts involving other non-regulatory boards, commissions, councils, advisory committees, and task forces.”

In my opinion, both of the bills solve problems that are not apparent or justified. Worse, they threaten the professional status of nurses in New Hampshire. NHNA is spot-on to oppose SB 568 and SB 596. All nurses in NH must use their voice and visibility to make sure that these bills fail when then are introduced in the House of Representatives, the ‘peoples’ house. Representatives need to know that one in forty New Hampshire citizens are nurses and people who consider themselves professionals!

[Ed Note: Both bills voted as ITL (inexpedient to legislate) or killed at the time NHNN went to print!] March, April, May 2020 New Hampshire Nursing News • Page 19 MANAGEMENT NURSES ON THE MOVE MINUTE

Q: What do Chief Nursing Officers Kris Dascoulias BSN RN has Our goal is to work on programs like residencies for new (CNOs) and new graduate nurses been appointed as the Chief nurses to get them more engaged sooner.” Dascoulias, a have in common? Nursing Officer at Memorial Conway native, obtained her BSN from Colby Saywer A: A reluctance to ask for help. Hospital in Conway, New College in 1994 and is working towards a Master’s degree in Hampshire. Dascoulias has Nursing. CNOs and senior executives want to demonstrate that practiced at MH for over 25 they are in control. To ask for help, some think, may years, most recently as the make them look weak. New grads don’t want to appear Clinical Manager for the Family Heather Moquin has been “stupid,” so they stay still. The inability to ask for help has Birthing Center. Dascoulias appointed Chief Executive dire consequences. Failure to ask for assistance can derail noted “It’s challenging being a Officer of the New Hampshire a project, perhaps fatally. For a new grad, reluctance to ask nurse at the bedside. We are Hospital, replacing Lori for guidance can impact patient care or result in an error. always trying to balance Shibinette. Moquin has staffing with the needs of served as the Chief Operating In his new book "All You Have to Do Is Ask" author Wayne patient care. This is how I led the Family Birthing Center. If I Officer at the Hospital for Baker lists the reasons people are reluctant to ask for help. have to jump in, I jump in - the priority is taking care of the the past two years. Moquin • Underestimating other people’s willingness to help patient. Our nursing managers are helping out clinically. They has 25 years of clinical and • Overreliance on self-reliance come to work in scrubs so they are ready if need be. We operational experience in • Perception of social cost want to provide the highest level of nursing care every day.” New Hampshire. She began • Lack of psychological safety With 120 nurses currently practicing at MH, Dascoulias her career as a Registered • Systems and bureaucracy get in the way explained “We are focusing on recruitment. We recently did Nurse with the Merrimack • Lack of knowing how to ask for help or the “privilege” an open house and made a few successful hires. We have a County Nursing Home and was the Assistant Director of of asking for help great new recruiter in place, doing job fairs, getting our name Nursing from 2008 to 2009. From 2004 to 2017 she was the • Fear of appearing selfish out there, promoting us.” “We are also working with local Director of Nursing at Genesis Healthcare in Franklin, New colleges. We do internships and clinical rotations so we can Hampshire. Moquin earned a Bachelor’s degree in Health Asking for help can be similar to preparing for an interview get them not just in their senior year, but sooner. We want to Care Administration from Granite State College in 2010. She or a presentation- it requires preparation. Baker suggests give them more clinical experience, more exposure to what is currently enrolled in the MBA program at Plymouth State being SMART when making requests for help. SMART it’s about. We can help them see what the job really means. University. refers to Specific, Measurable, Assignable, Realistic and Time-related. "When you make SMART requests, you are likely to get positive responses. When you are generous and give help, others will want to help you.”

For a person in power, asking for help indicates vulnerability, e.g., I don't know all the answers. In addition asking for help demonstrates courage, e.g., I am not afraid to ask for help. Good leaders surround themselves with people smarter than themselves, and in doing so, these people become the go-to sources for information and assistance.

Be a Camp Nurse for a week RNs & LPNs Spend a week in the heart of the White Mountains! Horton Center, on top of Pine Mountain, is nestled north of Mt. Madison in Gorham, NH, and offers breath-taking views. We are seeking qualified professionals who hold a NH RN or LPN license & current CPR and First Aid certification. The Camp Nurse may bring her/his children, as worked out on an individual basis with the Camp Director. For more information about being a camp nurse this summer contact Tim Hughes at [email protected] - 603-545-9660

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Free to Nurses CALLING ALL Nurses! Privacy Assured Looking for a change? How about sharing your knowledge and skill by teaching LNA classes! Easy to Use We are currently hiring Nurses to teach per diem, who meet the following criteria: • Min . 2 years experience 1 year in LTC and 1 year as a nurse supervising LNA’s E-mailed Job Leads • Strong ability to multi-task• Positive and enthusiastic attitude! • Team player • Desire to help others learn and grow You can learn more about us and what we offer, online at www.LNAHealthCareers.com Interested candidates should submit a resume to [email protected] or fax 603-647-2175. Page 20 • New Hampshire Nursing News March, April, May 2020 Non-Verbal Communication: The Silent Giveaway

Carolyn Taylor, Ed.D. M.N. R.N. Remember when you were in a crowded room in comparison, does not face another person, ([email protected]) and someone keeps staring at you? If you were thereby, decreasing verbal and nonverbal President, leadershippoweronline.com led to believe that the person doing the staring communication. is a “difficult person” the invasion becomes a 3. The location of the leader: The “leader” (or Reprinted with permission from The Montana Pulse. “Psychological Territorial Threat” that causes stress someone in charge) is usually at the head of the – therefore, this nonverbal threat causes stress table – and is the person more likely to be in Of all the communication and an increase in blood cortisol excreted by the charge. If this person is not at the head of the that a person witnesses adrenal glands. Our body, in that type of situation, table, he/she is located somewhere in a central (verbal or non-verbal) can become stiff, we pull in our elbows, and turn location of the involved persons. (Remember the non-verbal silence our bodies so that our back faces the threat in an that leadership means the encouragement and is the most interesting attempt to reestablish our territory. active involvement of others; so, where do you and informative, by far. currently sit, as the leader, to encourage the Albert Mehrabian (1960) Determine another’s comfortable space by watching nonverbal participation and involvement of researched silent/non- their behavior (e.g. a hand shake or a hug) and others?) verbal communication allow that person to nonverbally tell you their and found it to be more personal acceptable closeness. The amount of Colors – believable than verbal extension of the arm to your extended hand for a All colors have meaning and cause an influence a communication. It is an hand shake, the closeness (or not) of a hug, or even person’s impressions and behaviors. When different independent messaging the desire for a private desk or cubicle are a few of colors are studied, some colors have consistencies system that is used Carolyn Taylor the “little things” that tell “big stories.” in their interpretations, and some do not. Even color differently by every person. Ed.D, MN, RN brightness has significant meaning. How good are you at As a leader in a work setting, it is best to reading people? We are all constantly sending encourage, when you can, the flow of group The color of white seems to impart a feeling of messages, whether we realize it or not! conversation between people in an open non- goodness; whereas, black seems to give a negative curtailing environment rather than in a cubicle or feeling. Bright colors give a feeling of intenseness. The content of this article is to encourage confined work space. Whereas, passive feelings can be related to black, thoughtful and accurate consideration of unspoken white, blue, and pink. In the sports world, research attributes of mankind. By increasing our personal Proxemics is the study of personal space, as a part tends to show that white uniforms or uniforms with and researched knowledge about unspoken body of territoriality. It determines what we do, think, and white seem to be more positively responded to by language, we increase our potential understanding how we react. Such as – referees than totally black uniforms. According to and appreciation of human physical and behavioral some studies, more penalties for teams wearing attributes. INTIMATE ZONE is for our family, close friends, and all black were reported to have occurred. Physical spouse. It is about 18 inches from us. aggressiveness was reported to increase by merely Not intentionally learned, but so very revealing wearing black. is blushing, shaking, sweating, smiling, laughing, CASUAL-PERSONAL ZONE is for normal crying, and similar behaviors that show conversation. It is about 18 inches to 4 feet from us. (The question for you is related to how do people nervousness. Think of “The Look!” (whatever that see you if you wear black? Do you see yourself as is!), a pat on the back, a pat on the “rear,” and CIVIL INATTENTION is for the person with whom more aggressive – or not? In this case, more likely, even a drop (or no drop or elevation) in the voice you have eye contact for a fraction of a second, the way YOU FEEL when you wear a certain color at the end of a sentence. Add to these examples then avert your eyes/gaze away from that person. usually results in you acting the way you feel. just a very few of the many non-verbal behaviors Your behavior related to how you feel most often – voice tone while moving the hands, shrugging SOCIAL CONSULTATIVE is for most day-to-day identifies your degree of aggressiveness, or lack the shoulders, wearing a certain color, decorating activities while recognizing personal autonomy and thereof.) a home in a certain color, listening to a specific privacy while conducting discussion. This ranges type of music, or even having a scented candle in from 4 to 12 feet from us – known as an area of The color of black is not always associated with the room. Our unspoken silence makes up our non- formal discussion. death in some cultures. Blue and white in Asia are verbal communication. often the colors of a funeral. In Ghana, red is often PUBLIC is from about 12 feet from us to what you combined with black for this occasion. Non-verbal (silent) communication has been, also, can see or hear. This includes observable activities. called the “transparency effect.” This says that we are Red is a lucky color in Asia. International research all more transparent than we realize! However, the key Differences in Cultures and Subcultures has found that ovulating women will unpredictably in recognizing the “transparency effect” in others is to Some cultures require distancing the person from often wear red. Red, being a bright color, is an correctly interpret the non-verbal communication we strangers; whereas, other cultures value closeness. attention seeking color. The color has been found to witness. For example, in Tanzania being too far away from attract a male’s attention toward females. Research another person as a matter of personal choice has determined that men have the same effect on Territoriality (Primary, Secondary, Public) means the given message is that you reject that women if they (males) wear red – and women found Humans have a sense of territoriality. This enables person; therefore, it is best to sit close to another that men wearing red were more sexually desirable us to invite or disinvite social interaction. We have person. Other cultures, such as the Arab culture, and of higher social status. all sorts of signs, signals, and effects to establish our desire to be as close as possible when conversing territory without saying a word. This comes from – close enough to feel a person’s breath (bad breath Mood – two types of learning – biological and social. For or otherwise). A nice warm cup of “something” or a hand warmer instance, in regard to biology, male animals often helps to promote a personal feeling of warmth fight off other males to defend females. Socially, Space, Colors, and Mood and trust toward another person. If you provide a humans declare possessions and spaces of their own Research shows that we shape our own environment cold drink or cold pack to another person, there and set boundaries on possessions and spaces within through determining our space, color, and mood. is reported to be an increase in the recipient’s the environment. Our social spaces and possessions The physical management of these factors in our loneliness. might include our side of the bed, our desk, our environment help to determine our personal behavior wallet, our closet space, our car, etc. and the behavior of other people. The environment, (Perhaps this knowledge can be used by safe houses in general, also triggers conscious and unconscious and disaster shelters in times of community stress The expression of PRIMARY territoriality can be perceptions. Our personal perceptions, in turn, and should be an example of the fact that, “all represented as non-verbal and verbal. We use non- determine our behavior. behavior has meaning” as a universal concept!! verbal “markers” to remind others as to what is “ours.” For instance, we place a sign of our name Space – Body Types – on the desk, put numbers on our house, and we There are three factors that determine the non- Body and faces can send many different messages. often put our initials on items. Oh yes, we all say, verbal spaces created by people. They are – In regard to the static features of the body and face, “This is MINE!” 1. The flow of traffic: The requirements of research tells us that: personal movement within buildings are SECONDARY territoriality involves belongings we an example. Studies have shown that in an Body Shapes (Identified by William Sheldon) – have for a limited time. We borrow books, have apartment house, the people living near 1. Endomorph is a heavier (fat) body type. He special food items for a snack, put your name on the stairwells are more likely to boost the claimed that the digestive system probably a pencil, etc. They are actually or figuratively interpersonal interactions with others. (MIT works slowly. This person, usually, is known to borrowed or soon to be used up. They usually 1950 study) Another example are the exits be relaxed and sociable. require a marker of some kind that allows for a within certain buildings that are somewhat 2. Ectomorph is a skinny body type. He claimed temporary access to the item. hidden – take as an example, the casinos that that the nervous system of this person probably are laid out in a manner that often discourages dominates. PUBLIC territoriality involves items that are shared finding your way out until you become aware of 3. Mesomorph is a more muscular body type. He by the public. That is, buses, roads, park benches, the layout. claimed that the muscular system probably is grass and trees in the park, etc. 2. The direction people face: Obviously when predominate. people face each other there is an increase in “Territorial Invasion” is when someone else takes the possibility of social interaction. The family Body Height – over a part or all of our territory. “Contamination” table usually requires people to face each other, 1. The world-wide income for males is two occurs when someone destructively takes over your which increases the opportunity for verbal percent more per one inch of height than territory – and that often becomes a legal matter. and nonverbal communication. The bar stool, March, April, May 2020 New Hampshire Nursing News • Page 21

females. Females over 5’ 8” earn about 15% who wore glasses were seen as smarter because It has been widely reported that nurses often do more than shorter females. it suggests, to some, that a person reads a lot. not assess non-verbal evidence of pain correctly. 2. In romantic relationships, women seem to prefer Broad-set eyes became a metaphor for broad We need to remember that every person/patient is taller men – especially if the female lives in a mindedness. Conversely, narrow set eyes different and their diagnosis (medical or psychiatric) dangerous neighborhood. became a metaphor for narrow-mindedness. can cloud the accurate recognition of pain. Some 3. Men often lie about their height on dating If the corners of your mouth turn up, it was patients think they “deserve pain” as if it were a profiles – a tendency to exaggerate. Females thought that you must be a happy person. redemption quality for their stated personal sins. frequently minimize (lie) about their weight on dating profiles. Where some of the neutral face research findings The message, here, is to increase awareness of the appear, sometimes to be true, it is also true that many unspoken behaviors that require an astute Why has height become important? It has been health conditions could be the reason for what is nurse to pay attention to the suffering patient. Do speculated that, maybe, it is because in the animal seen. not ignore the symptoms. Narcotics are not known kingdom height is a dominant factor and they tend to addict when a person needs true pain relief. How to be bigger and stronger. The dominant animals Personality Traits – many times have many of us ignored the silent signs lead the pack, the herd, or the group. Social scientists assume that we all have varying of obvious pain and reported that the patient is amounts of five personality traits. These are resting without pain? Waist-To-Hip Ratio in Women – conscientiousness, agreeableness, neuroticism, 1. Men appear to be more attracted to women that openness to experience, and extroversion. Your challenge – watch for the numerous and have a waist to hip ratio of 0.70. Fertility seems Assessments of photos show a significant correlation individual signs of non-verbal pain, treat that pain to be increased with, at least, this ratio. between the person’s photo personality assessment in an appropriate manner, evaluate the intervention, 2. If the waist to hip ratio gets to 0.85 or higher, and the person’s formal/actual personality and teach other nurses the individualized reaction health issues are more likely to occur – diabetes assessment. to the patient’s existing pain. Treat it as such, and heart disease. These diseases often cause because you are the nurse! And – we know that women to be less fertile. Romantic Relationships – no one deserves (and need not be) in unspeakable 3. It appears that men are more attracted to John Gottman, a psychologist, noted a pattern pain. women who have a hip-ratio that signals fertility of behavior in couples. He called them the four – and maybe the fact that they are, also, more horsemen of the apocalypse: criticism, contempt, Suggested Reading: attractive. defensiveness, and withdrawal. Criticism and “UNDERSTANDING NONVERBAL defensiveness are verbal signs that relate to sarcasm. COMMUNICATION” (Great Courses Course Weight – Contempt is a nonverbal sign expressed in the face. Guidebook) 1. The shift to an approval of increased weight Withdrawal occurs when the couple no longer talks By Mark G. Frank, Ph.D. has increased in the past 125 years in the U.S. to each other – and that is extremely toxic. Staying Professor and Department Chair, There could be a connotation that heavier happy in a marriage requires a couple to do the Department of Communication; means more wealth and the availability to food. little non-verbal “things.” They include, gentle Director, Communication Science Center 2. In some Arabic cultures the fathers like to boast squeezes, smiles, showing attentiveness – OFTEN! University of Buffalo, about their “heavier” daughters as evidence of The State University of New York the father’s ability to provide food. Silent Signs of Pain – One of the many responsibilities of a nurse is www.mdcalc.com/nonverbal--pain--scale--nvps- Faces – the recognition of pain. Nurses are expected to nonverbal-patients 1. The neutral face (without expression) is recognize pain just by looking at a patient. The Behavioral Pain Scale (/behavioral-pain-scale-bps- determined by others to identify the personality grimace, tenseness, moaning, being combative, and pain-assessment-intubated-patients) of the person. many other non-verbal symptoms and vital sign CPOT Pain Scale (/critical-care-pain-observation- 2. In 1950, there was an agreement that a changes can reveal pain intensity. Some patients tool-cpot) personality can be identified by the neutral will deny pain while their non-verbal says, without face. Research findings indicated that people doubt, they are in pain.

Nurses Host Breakfast with New Hampshire Legislators

On a snowy February 13, 2020 members of the New the Commission on Government Affairs (CGA) and Key pieces of legislation discussed included the Hampshire Nurses Association (NHNA) and the New Representative Polly Campion, Ad hoc member of the passenger restraint legislation (SB 609), workplace Hampshire School Nurses Association (NHSNA) jointly CGA, as well as NHNA members Kim Danis, Heather safety legislation (SB 506), establishing a New hosted a breakfast for New Hampshire legislators Grondin and Carol Townsend. Joan Widmer, NHNA Hampshire Health Policy Commission (HB 1520), in the Capitol dining room in Concord. Nearly 75 Nurse Executive Director and Teresa Rosenberger, of several of the bills that will impact the New Hampshire legislators came through to enjoy the continental Devine & Millimet, NHNA’s lobbyist, was also present. Board of Nursing (SB 502, SB 596 and HB 1536), a bill breakfast offering, taking the time to sit down and Members of the NHSNA participating included Paula regarding pediatric head injuries and return to learn discuss various legislative issues of interest to nurses. MacKinnon, President Elect, Meg Jenkins and Renee status (SB 584), and a bill impacting costs relative to NHNA members included Katie Lajoie, member of D’Allesandro. long term care (SB 715).

Seated: Senator Lou D’Allesandro and Renee D’Allesandro, Standing: Rep. Meg Jenkins, Kim Danis and Polly Campion, Kim Danis, Joan Widmer, Carol Townsend and Heather Grondin. Renee D’Allesandro speaking with Representatives.

Foreground: Rep Mary Freitas (red), Rep Joyce Weston, Rep Jeffrey Salloway and Joan Widmer (L-R). In background (L-R) Rep Polly Campion, Renee D’Allesandro, Rep ?, Meg Jenkins, Heather Grondin, Kim Danis and Carol Townsend. Page 22 • New Hampshire Nursing News March, April, May 2020 IN MEMORY OF OUR COLLEAGUES

The New Hampshire Nurses Association honors the Concord Hospital, Concord, NH. Her positions also Nurse Practitioner Association. Pat concluded her memory of and acknowledges the work of deceased included Chief Nurse at Project Hope serving in illustrious Nurse Practitioner career while practicing nurses who have graduated from New Hampshire Indonesia and Vietnam, Director of Inpatient Nursing at Whole Life Healthcare in Newington, N.H., while nursing schools or who have actively practiced in at Yale New Haven Hospital, Asst. Hospital Director simultaneously modernizing and managing the first aid New Hampshire during their career. Sharing the for Nursing for the UCONN Health Center, station on Star Island for the Star Island Corp. names and information about these nurses is one way Farmington, CT. She was active in professional we honor their contribution to the profession. Brief associations including serving as President of the DHMC Nurse submissions are welcome. NHNA. She retired in 1983. April (Amaral) Hoisington, 74, passed away on December 16, 2019 after a St. A’s Grad CMC Nurse long battle with renal failure. She Pauline J. (Duhamel) Broberg, 81, died Gloria M. (Lawrence) Dionne, 71, graduated from the Moore School of October 23, 2019, in Raleigh, North passed away on November 8, 2019. A Nursing on Goffstown in 1966. She Carolina. Born in Manchester, she lifelong Manchester resident she retired from DHMC in 2011 where she attended St. Anselm College, becoming graduated from the Sacred Heart worked as a nurse for many years. one of the first women to graduate from School of Nursing, and later earned her the college's nursing program in 1960. master's degree as a nurse practitioner LTC Nurse She practiced in Boston for 40 years. from Rivier University. She had a 50 Ann (Batchelder) Thibeault, 74, died year career and spent nearly 20 years at Catholic December 29, 2019, from heart disease. Keene Grad Medical Center. She practiced as a RN for many nursing Lorraine Chabott Johnson, 87, p a s s e d home residents in the Seacoast and away on October 26, 2019. A resident White Mountains areas. of Keene, she graduated from the Elliott Crotched Mt Nurse Community Hospital School of Nursing Nancy C. "Lynn" (Hancock) Frank, 88, with a nursing diploma in 1953. died on November 12, 2019. She obtained her nursing diploma in New Elliot Nurse York and had a nursing career at Esther Welch Adams, 87, die d Sacred Heart Grad Crotched Mountain for over 35 years. December 30, 2019. She was a 1954 Andrea M. (Girard) Morin, 97, die d graduate of the Elliot Community October 31, 2019. A Manchester native Hospital School of Nursing. she was a diploma graduate of the Elliot Nurse Sacred Heart School of Nursing and Norma Jane (Laro) Burroughs, 72, died practiced nursing in various doctors’ November 22, 2019 after a sudden offices. illness. Born in Laconia she practiced as Notre Dame Grad a RN for many years at the Elliot Yolande Noella (Lamontagne) Caron, Hospital in Manchester and the 88, died January 1, 2020. A Manchester American Red Cross. native she was a diploma graduate of SNHU Grad the Notre Dame Hospital School of Marie H. (Kelly) Coll, 86, died October Nursing, graduating as president of her 31, 2019. She obtained her nursing class. degree in Massachusetts and a Master’s NHTI Grad Degree in Human Services from Karen M. (Roberts) LeBlanc, 47, die d Southern NH University. She blended unexpectedly on November 28, 2019. her nursing skills with her compassion She was born in Berlin, NH, graduated Pedi Nurse for community social work by working from Keene State College with a degree Geraldine L. (Cross) Goodhue, 72, at Hampstead Hospital, Derry/Londonderry Family in Health Education, followed by a passed away January 2, 2020. She was a Mediation and the Lawrence Pregnancy Prevention degree in Nursing from NHTI. pediatric nurse at Mary Hitchcock Team. Memorial Hospital for many years.

Director of Nursing NHTI Grad Claire E. O'Neil, 98, passed away Susan A. (Foye) Conroy, 64, passed November 6, 2019. Born in Concord, away November 30, 2019 after a battle President DHMC NH she received a BS from Simmons with brain cancer. After obtaining a Nancy Ann (Mansheim) Formella, 66, College in Boston and a MS from nursing diploma in Massachusetts she of East Kingston, NH, passed away Syracuse University. She was a staff continued her education at the New January 16, 2020 after a courageous nurse in hospitals in MA, CA, and NH Hampshire Technical College in battle with brain cancer. Born in Iowa and was Director of Nursing Service at Concord. she obtained a bachelor's degree in nursing and then attended Marquette University in Milwaukee, Wisconsin, First Independent NH ARNP earning her Master of Science in Nursing. Nancy Patricia M. Ford-Gibbons, 74, passed began her career as a Clinical Nurse Specialist at St. away on December 11, 2019 after a Michael Hospital in Milwaukee and then moved to lengthy battle with metastatic lung Rochester, MN to accept an administrative position at cancer. Pat Ford, as everyone knew her, the Mayo Clinic. She then accepted an opportunity to graduated Boston City Hospital Nursing help develop the Mayo Clinic's new campus being School obtained a bachelor's degree at opened in Jacksonville, FL. She later became a The Center for Nursing Excellence (CfNE), in partnership with the Center the University of Vermont, completed a consultant for APM, helping to improve operations and for Learning and Professional Development (CLPD) at Dartmouth-Hitchcock, Nurse practitioner Certificate program and acquired a systems of hospitals all over the country. While invites you to join us for one or more of our continuing education Master's Degree at the University of Connecticut. consulting, Nancy was recruited by Dartmouth programs and interprofessional learning opportunities held in Lebanon, New Hampshire and in other convenient locations throughout the state. Hitchcock Medical Center in Lebanon, NH to be their Pat was part of a small coalition of sister Nurse Chief Nursing Officer. She rose to the position of Please visit our website at http://med.dartmouth-hitchcock.org/ce for more information and to register on line. For questions, please email Practitioners who successfully lobbied the President of DHMC, which role she held for five years [email protected] or Amanda E. Sanchez, Center for Nursing New Hampshire Legislature to provide rights of before retiring in 2012. Shortly thereafter, Nancy was Excellence, [email protected]. independent practice and additionally the rights recruited by Beth Israel Deaconess Medical Center in Dartmouth-Hitchcock Nursing Continuing Education Council is accredited of prescriptive practice to help New Hampshire Boston, Massachusetts to be their Chief Operating as a provider of nursing continuing professional development by the patients attain the quality and affordable healthcare Officer, a position she held for four years before American Nurses Credentialing Center's Commission on Accreditation. that has become the standard for healthcare in New retiring in 2017. In retirement she pursued her Hampshire. Pat was the first Nurse Practitioner Doctorate in Nursing Practice, while also starting an in New Hampshire to serve as an independent executive and leadership coaching business. She practitioner. She owned and operated her own graduated with her DNP in October, 2019. practice named Healthy Generations in Franklin, N.H. and built the practice to nearly 4000 patients over 20 CMC Nurse years. Betty E. (Daniels) Dufoe, 86, died February 1, 2020. A Manchester native Pat earned the Nurse Practitioner of the Year Award she was a 1954 graduate of the Nashua in 1991 due to her accomplishments in providing Memorial Hospital School of Nursing. leadership in the New Hampshire Nurse Practitioner She practice private duty nursing for 10 Association. Pat was also presented the Lifetime years then joined Sacred Heart Hospital Achievement Award by the New Hampshire and Catholic Medical Center for 30 years. March, April, May 2020 New Hampshire Nursing News • Page 23 Florence Nightingale – The Rebellious Years

Sue Fetzer Dr. Richard Fowler. She wanted practical experience to be Upon her return to England in August 1853, she assumed a better nurse for the townspeople around Embley. Like an administrative role as the superintendent of the Ed Note: This is the second in a four part series other Victorians of the time, her parents were vehement Establishment for Gentlewomen During Illness, a position celebrating the 200th birthday of Florence Nightingale and voiced their dissent that no nice girl would ever think she would hold for only one year. The three-floor private and the Year of the Nurse about such an activity. A year previous, Charles Dickens home on Harley Street in London housed 27 women. had written descriptions of Sairy Gump and Betsey Prig, Her quarterly reports to the governing committee of In the summer of 1837, W.E.N and Fanny Nightingale two ‘nurses’ in the alms houses. “She was a fat old woman, the institution and many letters and lists she wrote as were preparing to go abroad with their daughters, Parthe this Mrs. Gump, with a husky voice and a moist eye.” superintendent illustrated her ideas about sickness, health and Florence for an extensive European trip. They would They were untrained, coarse and ignorant drunkards with and healing. She referred to these concepts as the ‘art and travel to France, Spain, Italy, Switzerland and then back immoral conduct. science of nursing’. She implemented numerous changes at to Paris during the next 18 months. The extended stays the Establishment, primarily in the physical environment of in each location allow the girls to study the language, Crushed by her parent’s refusal, Florence withdrew; “Oh the facility and personnel. the arts and the culture of their surroundings. In Paris the for some strong thing to sweep this loathsome life into Nightingales met Miss Mary Clarke, or Clarkey as they the past.” In the fall of 1847, childless family friends, the Accepting that Florence would not marry, her father would later refer to her. Clarkey was one of the most Bracebridges, invited Florence on a six month trip to Rome. provided her an allowance of 500 pounds per year independent and forward thinking woman in Europe. In Rome Florence met many new friends, including Sidney (approximately $50,000 today), enabling her to work The 45 year old was a progressive and found English Herbert, only 10 years older, but already a force in the for the Establishment on a voluntary basis. For the first gentlewoman boorish. Yet, Parthe and sister Florence English political scene. He was concerned, like Florence, time in her life she was independent of her family and in become her special ‘pets’ with reform and philanthropy. In Rome he was on a charge of real patients in a real hospital. However, she taking them everywhere and honeymoon with his wife Elizabeth. The Herbert’s would was disappointed at being able to train new nurses based introducing them to everyone prove later to be lifelong friends and allies of Florence. on her own Kaiserswerth experience. Within a short time who was anyone. In Clarkey, she was asked to become superintendent of nurses at Kings Florence found much in After seven years, Richard Monckton Milnes proposed College Hospital. She began to plan her work there when common, they would be close marriage in 1849. After much deliberation, Florence the Crimean War broke out. friends for the next 40 years. rejected the proposal which exacerbated the family Both were intelligent, energetic, tensions. Shortly thereafter, Milnes married, though his In 1854 war was declared as Russia desired Turkey’s and impatient with convention. platonic relationship with Florence did not end. Florence Constantinople port. Allies England and France came to the They shared a love of literature, was the godmother to Milne’s daughter, Florence. aid of Turkey in March 1854. France sent troops and the arts, music and animals. They Catholic sisters with expertise in caring for the wounded. distained dressing up and fancy After turning down Milnes, England sent troops and a few surgeons. However, for hairstyles. They rebelled against Flo was again invited by the the first time in modern day warfare a war correspondent A drawing of Florence, women’s traditional roles and Bracebridges to accompany provided news coverage from the front and reported on c 1840, Artist had a love-hate relationship them on a trip to Egypt the appalling conditions of the British solider. High death Unknown with their mothers. and Greece. Knowing Flo’s rates from wounds and infections were multiplied by desires and dreams, at the the outbreak of cholera. The news reached London on When the Nightingales end of the trip they arranged September 30 that in the battle of Alma there were 2,860 return to England in April a secret trip to Germany wounded and 619 dead. 1839, the Embley house to visit Kaiserswerth. was being remodeled and Florence’s two week visit “The manner in which the sick and wounded are treated is they were forced to live to Kaiserswerth on July 31, worthy only of savages…here the French are greatly in London. Florence was 1850 molded the course superior…they have the help of the sisters of charity. These 18 and ready to make her Florence Nightingale of her life. Upon her return devoted women make excellent nurses.” – William Russell, formal entrance into society. with her pet owl, to London she published a London Times, October 12, 1854 In May, 1839 Florence was sketched by her sister 32 page pamphlet on her presented to the young Parthe Nightingale, experience “The institution The English responded. Sir Sidney Hebert, Florence’s good Queen Victoria, only a year c. 1850 of Kaiserswerth on the Rhine: friend from her trip to Rome was the Secretary of State for older than Florence. The For the practical training War. Herbert wrote a plea to Nightingale to organize and ‘coming out’ was one of the Portrait of Florence of deaconesses, under the direction of the Rev. Pastor superintend female nurses in Turkey. first steps that Fanny hoped (l) and Parthe (r) Fliedner.” She discussed the support and care of a hospital, would result in an excellent Nightingale by William infant and industrial schools, and a female penitentiary. She ‘There is but one person in England that I know of who marriage for Florence. Parthe White commissioned by did so anonymously so as not to raise the ire of W.E.N. and would be capable of organizing and superintending such had been ‘presented’ before the Nightingales Fanny. In the treatise she traces the roots of nursing and a scheme: and I have been several times on the point of the family’s trip to Europe. deaconesses “free from vows or cloistered cells’. asking you hypothetically if you would undertake to direct Parthe and Florence, close in age, were far apart in their it.” – Sidney Herbert to FN, October 15, 1854 education, views, desires in life and physical appearance. Returning home, Florence was even more convinced of Florence was taller and slender and thought by many, very her ‘calling.’ She finally persuaded her parents to allow At the same time, Florence wrote to Mrs. Herbert, offering attractive with her dark hair, grey eyes, beautiful white teeth her to ‘train’ at Kaiserswerth, providing she told no one her services in any capacity. Florence excitedly accepted and complexion. By comparison Parthe was plain and about the experience. From July 6, 1851 to October 7, the position and even Fanny was excited about Florence’s most thought sickly looking. A watercolor of the girls was 1851 she enrolled as a voluntary nurse at the Deaconess newfound fame. She was given less than a week before commissioned by Fanny. Intentionally, the girls look almost Institution at Kaiserswerth on the Rhine. At Kaiserswerth boarding a ship to the Crimea to obtain supplies, recruit like twins with Parthe the dominant figure. In reality, Parthe she combined hospital routine with beneficent work among nurses and pack her bag. was more likely to be doing needlework, while Florence the poor and outcast. During her three months of training, was reading. Florence wrote over 100 pages of detailed notes detailing the hospital management system. She returned to Embley In the summer of 1842 Fanny more determined than ever to follow her dream. About arranged for Florence to meet Kaiserswerth Florence wrote “This is Life! I wish for no Richard Monckton Milnes, other earth, no other world but this.” Next Issue: Florence Nightingale – Lamp of Scutari a 33 year old politician, poet, philanthropist, and Kaiserswerth, an old town near Dusseldorf, was started a charming fixture in in 1836 by the Lutheran Pastor Theodor Fliedner. It was Answers to NCLEX Reconsidered from page 15 London society. Richard a training school for Deaconesses. Fliedner encouraged 1. D 2. C 3. A, C, E 4. A 5. B, D, C, A and Florence courted for help and self-help and believed in the emancipation over seven years. Their of women. Starting with a small shed and room for relationship was unusual as two women, by 1850 the site had grown to 100 beds Florence was looking for and 116 trained deaconesses. The smoothly managed intellectual stimulation and institutions with goals, rules, and organizational Richard Monkton could not visualize life as a structure ensured quality care for very sick patients as Milnes (1809-1885) proper Victorian wife and well as rehab for orphans, prostitutes and less fortunate, mother with all of the hollow teaching them the skills needed to lead a useful life. L responsibilities and limitations. The model resulted in Deaconess Motherhouses NA’s FTS! founded around the world. WANTED ALL SHI Visitors to Embley in the summer of 1844 included Dr. Samuel Gridley Howe, a physician, and his wife Julia War Florence spent much of 1852 caring for her sick father and Full & part-time positions available. Great starting pay Howe, a writer and suffragette. One morning Florence in 1853 She then went to Dublin, then to Paris to study and with raise in 90 days! Excellent benefit package for those queried Dr. Howe: “Do you think it would be unsuitable learn in the historic hospital institutions under the guidance who qualify including health, dental, life, 401k with and unbecoming for a young Englishwoman to devote of the sisters of Charity St. Vincent De Paul but never got to employer match, disability, prepaid legal, weekend & shift differentials, referral & longevity incentives, generous herself to works of charity in hospitals and elsewhere as actually visit. In February her grandmother became ill and PTO plan, professional development reimbursements and Catholic sisters do?” Howe’s reply affirmed Florence’s in June Florence developed the measles. more! Must have valid NH LNA license. dream “Choose, go on with it wherever it may lead you.” But the first idea I can recollect when I was a child At age 25 in 1845, Florence proposed that she should go to was a desire to nurse the sick. My day dreams were of Please apply online at Salisbury Infirmary for training under a friend of the family hospitals and I visited them whenever I could. –F.N. www.websteratrye.com