THE OFFICIAL PUBLICATION OF THE OKLAHOMA NURSES ASSOCIATION Circulation 56,000 to All Registered Nurses, LPNs, and Student Nurses in Oklahoma

Volume 55 • Issue No. 2 Oklahoma Nurses Association—Est. 1908 June, July, August 2010

More inside... PRESIDENT’S MESSAGE

Chris Weigel, RN, BN, MBA, President use of social networking during working hours? Do employers have any right to know what employees “To blog or not to blog” is are doing in their private lives regarding social the current question facing media? the healthcare community. Employees need to become familiar with their The world of social media is employer policies regarding networking and guard a driving force for patients, themselves from inadvertent HIPPA violations, physicians, employees and possible discrimination, harassment or wrongful The ABC’s for Eliminating employers in the healthcare termination. At the same time employers need setting. A demand to create to be mindful of defining network boundaries by Clostridium Diffi cile and disseminate patient policy of acceptable and unacceptable behavior, education, health information, defining levels of access to social networking sites, Page 15 data, and experiences in a set limits regarding “friending” among superiors quick and expeditious manner and subordinates as well as developing practical is upon us. Currently, 540 guidelines to prevent unthinking, harmful employee hospitals in the United States Christine Weigel actions. utilize social media tools: According to AVG, here are just a few known Hospitals account for 247 YouTube channels, 316 facts about social networking: 21 percent of social Facebook pages, 419 accounts and 67 blogs reported networkers accept contact from members they don’t in the article, “Risky Business: Treating Tweeting the recognize, while 26 percent share files within a social Symptoms of Social Media.” network and 64 percent said they click on links From the patients’ perspective, they are seeking sent by other members. As a result of poor security the connection to investigate on line guidance to practices, 20 percent of web users that belong to a care, consumer details and services as well as social network have been the victim of identity theft. healthcare results. Patients and physicians are even In this world of social networking everyone needs tweeting about their experiences during surgery. to learn to protect themselves so limit information The patient does so to describe the experience and on your profile, consider creating false profiles, relieve nervousness by providing a distraction during monitor your privacy settings and update your Web surgery. While physicians use social media as a browser. Blog safely….. and be sure to Friend ONA on Tribute to Florence way to provide education to consumers, keep family Facebook and follow ONA on Twitter! members informed during surgeries, and encourage Makandi Mubichi transparency in healthcare. Social media is now a fact of life, and millions Page 21 of employees are actively engaged in networks. So, the question becomes how do employers guide the Executive Director’s Report

On Nurses Day, I had at the Capitol. ONA represents nursing at the Nurses Set the Pace the opportunity to attend Legislature to ensure nursing’s voice is heard. We Comanche County Memorial support funding for programs that affect patients, Jane Nelson, CAE Hospital’s Nurses Day work to advance nursing practice, provide guidance ONA Executive Director celebration. It was a great on new laws affecting nursing and healthcare, and day. The nurses at Comanche educate lawmakers and other policy makers about Every day I look around, and I see evidence had the opportunity to learn nursing priorities. of nurses working together to set the pace for a about Magnet Recognition I know that there are wonderful examples all healthier Oklahoma. It doesn’t matter the size of the from the Journey they were across this state. As you are reading this, you are group or community if you will, or if the setting is on as well as hear experiences also thinking about how nurses you know Set the an ONA committee, a hospital or another nursing from the three Oklahoma Pace! I am specifically inviting you to share your organization. Nurses set the pace! Magnet hospitals. It was “Strategies for Action” at the 2010 Annual Convention really inspiring to hear as a presenter. Details on how to submit a what it meant to the Jane Nelson presentation proposal are in this issue. If are looking Presort Standard hospitals that had for programs that work, then consider coming to the US Postage achieved Magnet and the difference it made 2010 ONA Convention. PAID not only for the nurses but for patients. It was “Nurses Set the Pace for a Healthier Oklahoma: Permit #14 evident that Nurses set the Pace! Princeton, MN Strategies for Action” is our theme and focus of the current resident or 55371 In March, the ONA Professional Practice 2010 Convention. I know that there will be proof Committee determined that they wanted to positive presentations. I hope you will join us. Once move forward with developing and expanding you see the initiative and brilliance for which ONA opportunities for newly licensed nurses to members are known, then we are confident you transition into the workplace as well as look will become a member, too. Convention is just one at staffing issues. This will be done as a of many ways to get involved with the resourceful community with other nursing organizations. nurses of this state. For more ways to become Nurses set the Pace! involved, please visit www.oklahomanurses.org. Hope ONA works with nurses to Set the Pace to see you in Tulsa this October! Page 2 • The oklahoma Nurse June, July, August 2010

THE OKLAHOMA NURSE (0030-1787), is Oklahoma Nurse Editorial published quarterly by the Oklahoma Nurses Oklahoma Nurses Association Association and Arthur L. Davis Publishing Agency, Guidelines and Due Dates Editor: Inc. All rights reserved by copyright. Views expressed [email protected] herein are not necessarily those of Oklahoma Submittal Information ONA 2009-2010 Board of Directors: Nurses Association. President Christine Weigel

Materials Due Oklahoma Nurse President-Elect Linda Fanning INDEXED BY Date to Editor: Issue Date: Vice President Connie Davis International Nursing Index and Cumulative Index Secretary/Treasurer Cynthia Foust to Nursing and Allied Health Literature. Education Director Marsha Green Copies of articles from this publication are available July 16, 2010 September 2010 Issue Disaster Preparedness and Response Director from the UMI Article Clearinghouse. Mail requests to: Janet Gallegly University Microfilms International, 300 N. Zeeb Road, 1. Manuscripts should be word processed and Practice Director Teri Round Ann Arbor, MI 48106. double-spaced on one side of 8 1/2 x 11 inch white Political Activities Director Peggy Hart Miller paper. Manuscripts should be emailed to Editor at Lucille Cox Region 1 Representative ADVERTISING [email protected]. 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Manuscripts must be accompanied by a statement signed by each author indicating 1) the manuscript is NOT being considered for publication in any other journal; 2) the manuscript WILL NOT be submitted to another journal until notification of acceptance or rejection is received from the Oklahoma Nurses Association; and 3) willingness to sign a copyright release form upon publication of the manuscript in The Oklahoma Nurse. Submit Manuscripts to the Oklahoma Nurses Association, 6414 N Santa Fe, Ste. A, Oklahoma City, OK 73119 or via email at [email protected]. June, July, August 2010 The Oklahoma Nurse • Page 3 Mercy Memorial Regional Presidents Leads the Way with Region 1: Region 5: President: Lucille Cox President: Flo Stuckert Joint “Camp” Email: [email protected] Email: [email protected] ONA Organizational Sponsor Region 2: Region 6: President: Joe Catalano Ardmore—Mercy Memorial Health Center recently President: Gerii Ellison hosted a party for some very special patients. What Email: [email protected] Email: [email protected] makes this group so special is they walked to the party with no pain in their knees or hips because Region 3: Region 7: they were patients at Mercy Memorial’s Joint President: Joyce Van Nostrand Vacant Replacement Center. Email: [email protected] In January 2009, the doors of the joint replacement center opened and since then more than Region 4: 300 patients have gone through the joint replacement President: LeAnn Nyce “camp.” Mercy Memorial’s commitment was to create Email: [email protected] a center where experienced orthopedic physicians, nurses, therapists and social workers carefully plan every step in the process. They guide no more than 10 patients at a time through the procedure of having their knee or hip replaced. Each week a small group of patients goes through surgery, recovery and rehab together. If you talk to joint replacement nurses, like Debra Wise, they’ll tell you replacing joints today is nothing like even a few years ago. Wise has been an orthopedic nurse for the past 15 years. “The best part of caring for our joint replacement patients is when they come back to visit us only 12 days after surgery and can walk the whole way,” said Wise. Mercy Memorial patients experience surgery on Monday and by Tuesday they are having fun in their rehab group. As Dr. Keith Troop, one of our joint replacement orthopedic surgeons, says, “The camaraderie of group rehab provides patients with motivation and they have a fun time, rather than a Oklahoma Regional difficult, lonely experience.” Nurses Association The Joint Replacement Center is an important piece of Mercy Memorial’s commitment to providing southern Oklahomans an option for quality health care, close to home. Quality includes how patients are served while at Mercy Memorial. Patients have ranked Mercy Memorial’s joint replacement center in the top two percent of hospitals nationally when it comes to total joint replacements. Page 4 • The oklahoma Nurse June, July, August 2010 Human Capital Theory: Another Way of Valuing RNs Knowledge Valinda Jones, BSN, RN, Director Clinical • Knowledge—acquired through formal education • Protocols contribute to improved patient Resources, St. John Medical Center-Tulsa or on the job training outcomes • Experience—comes with practice Studies show the nursing shortage negatively • Talent—a personal gift or skill Nursing human capital and patient outcomes— impacts patient care and inadequate staffing levels evidence indicates better patient outcomes are place heavy burdens on nursing staff and leads to Nursing human capital is operationally defined as realized when: burnout and increasing RN vacancy rates. Nursing the knowledge and skills obtained from: Administrators struggle to advocate for more • Nursing education is BSN or higher RNs in the current financial environment where • Academic preparation • Staff experience is >5 years. healthcare facilities are being pushed to decrease or • Participation in continuing education better manage human capital utilization. Nursing development According to research funded by the AHRQ, leaders must promote the clinical perspective in • Specialty certification hospitals with low RN staffing levels tend to have organizational decisions while remaining cognizant • Experience in clinical specialty higher rates of poor patient outcomes. Specifically, of the financial impact of those decisions. This • Unit tenure the research found: article suggests that considering staff RNs from • In hospitals with high RN staffing, medical the perspective of human capital theory might be Covell (2008) describes a relationship between patients had lower rates of UTIs, pneumonia, another strategy to assist Nursing Administrators. nursing knowledge, skills and experience and patient shock, upper GI bleeding and longer hospital The defining attributes of nursing human capital and organizational outcomes. She proposed that the stays are: theory of nursing intellectual capital (NIC) provides a • Major surgery patients in hospitals with high more comprehensive understanding of the conditions RN staffing had lower rates of UTI and failure • Skills/Competency—an individual’s actual that affect patient and organizational outcomes. She to rescue performance in a situation and includes conceptualized the relationships among variables as • Nurses are managing an increased workload cognitive, affective and psychomotor skills described below: due to higher acuity patients and added responsibilities Nurse staffing and nursing human capital: • Hiring more RNs does not decrease profit margins • A higher proportion of RN’s has been found to • Higher levels of staffing have a positive impact be inversely related to adverse patient events on both quality of care and nurse satisfaction (US Department of Human Services) Employer support for nurse continuous professional development (CPD) and nursing human capital: Nursing leaders face the daunting task of advocating for the needs of front line nurses, while • Educational support is necessary to ensure providing safe patient care and maintaining the high quality patient care financial stability of the organization. Using the principles of human capital should assist them in Nursing human capital and organizational advocating for improving the RN skill mix. outcomes—investment in CPD leads to: Valinda is a student in OUHSC CN Nursing Administration Pathway. • Higher retention rates • Lower vacancy rates References • Greater job satisfaction Covell, C. L. (2008). The middle-range theory of nursing intellectual capital. Journal of Advanced Nursing 94-103. Nursing structural capital and patient outcomes: US Department of Human Services, A. f. (n.d.). Hospital nurse staffing and quality of care. Retrieved November 10, 2008, from US Department of Labor web site: http://www. • Care maps ahrq.gov/research/nursestaffing/nursestaff.htm • Practice guidelines June, July, August 2010 The Oklahoma Nurse • Page 5 Job, Profession, or Passion: What is Nursing to You?

Nurse Practitioners Can be Shiela Derrevere MS, RN, CHPN a profession, and now it is truly my passion. More ONA Member, Region 2 explicitly, end-of-life nursing is my passion! It was Eligible for Medicare Funds to when I found my niche and really got involved that Use Electronic Health Records Twenty-seven years is a long time, a lifetime to nursing became the best thing in the world for me! If many reading this. I graduated with my ADN in 1983 you are not happy in nursing, perhaps you have not found your niche yet! ONA Affiliate Organization and worked on a geriatric unit. The transition from school to practice was shocking and unbearable. I So, how do you get from job to profession to cried driving home each night, wondering why I had passion? First of all, do not allow yourself to become The government is pumping out billions of dollars gone to nursing school in the first place. Change from stagnant. Commit to truly being a lifelong learner! to accelerate the use of electronic health records big hospital to smaller hospital was helpful but my The day I don’t learn anymore should be the day I (EHR) and help improve our health care system. big “break” (pun intended) came when an ER nurse don’t live anymore. Join and be active in nursing Some of this money will go to qualifying nurse in our small hospital broke her arm and had to be organizations. There is no substitution for this in practitioners who implement and use EHRs their off for 6-8 weeks. Working full time on the evening the invaluable networking and education resources practice. In fact, nurse practitioners can be eligible shift, I was asked if I would like to cross-train to the there. With the organizations come professional for more than $60,000 in incentives from The ER. Thank goodness, I accepted. journals, great websites and conference opportunities Centers for Medicare & Medicaid Services. In six weeks, I fell in love with ER, with doing as well. If money is an issue, then volunteer to serve The Oklahoma Foundation for Medical Quality something different, with the rapid comings and on the board of your nursing organization and many was recently named one of 60 Health Information goings of the shifts and especially with learning times you can get educational scholarships, grants, Technology Regional Extension Centers in the nation. again. I heard ER staff talking about being Advanced or even an educational stipend. There is no such In this role, OFMQ will provide technical assistance Cardiac Life Support (ACLS) certified and said I’d thing as a free lunch but I have earned my way by to over 1000 Oklahoma health care providers to use like to do that. One nurse, whose name shall go service to several national conferences and have EHRs to improve the quality, efficiency and value of unmentioned, said she didn’t think I had it in me. learned so much along the way. health care services patients receive. Providers who Like a dare, I was determined to rise above it. I not Really listen to your heart. Think about and pay start early, between now and 2011, can maximize only became ACLS certified, I became an ACLS attention to what it is you love. What part of nursing their reimbursement. instructor. I was then asked to cross-train to the or even back in nursing school was thrilling to you or “Implementing an EMR is an expensive, time Intensive Care Unit (ICU), went to a much larger most rewarding to you? Where did you fit in? Where consuming process,” said Dr. Dan Golder, chief hospital for a hemodynamic monitoring course, and did you feel the most at home and at ease? What area information officer for OFMQ. “Often it’s the was hired on to their ICU. of nursing has had a profound impact on your life nurse practitioners who are really hands on with The greatest miracle was that, after a few years on personally? What made you want to become a nurse the system in a family practice. This is a great weekends in ICU, I began to bloom as a nurse. I got in the first place? Think of those things and apply opportunity for these providers to get technical on some committees and started to study for national them to the wide world of nursing. One of my favorite expertise to help them make good decisions about certification in critical care. About that time, I things about nursing is that there are so many areas EHRs, use the technology to improve care and began to hear from some of my coworkers in ICU and so many options to work in. It is a career in a receive financial reimbursement for this effort,” he that I didn’t belong in the unit because I gravitated profession that grows with the individual nurse and said. toward the patients no one else wanted, the ones with age and experience we rather naturally are Nurse practitioners who see at least 30 percent stuck there on a ventilator, the ones who were dying. navigated to different aspects of nursing. Also, do Medicaid patients, primarily in small practice and I was constantly in trouble because I called doctors not be afraid to try new areas of nursing until you underserved settings, are eligible for the program. at midnight for DNR orders and kept the deceased find your niche. If you want to avoid “job hopping” For more information, contact Phillip Smith, patients in ICU rooms after exceptional post mortem ask about shadowing another nurse in the area you Community Development Manager at 405-302-3206. care for the family to view and grieve….while there are interested. A side job at an agency could get you Find more information on the Health Information was a line in the ER waiting for the bed. into some different areas to “try them on.” Technology Regional Extension Center at www.ofmq. Then, it happened. A former supervisor of mine So if you believe you are unhappy or unfulfilled com/hitrec. became the nurse manager of the health system’s as a nurse, I challenge you to reevaluate, participate, hospice. She asked me to fill in during some summer and rejuvenate your career. Along the way, you could ### weeks for her vacationing staff. I fell in love. I truly go from job to profession to passion. I dare you!

About Oklahoma Foundation for Medical Quality found my niche. Three long years later (there was a Oklahoma Foundation for Medical Quality (OFMQ) is a transfer freeze in effect) I became a full time hospice not-for-profit health care quality improvement organization nurse. Sixteen years later I am still flourishing there. (QIO) dedicated to improving health care and improving Over the course of those years, I became nationally lives. For over 35 years, OFMQ has played an integral role in certified, served four years on the RN Exam ensuring quality medical services for Oklahomans through Development Committee, and am now Treasurer health care review, quality improvement projects and public for the National Board for Certification of Hospice education. Working in partnership with physicians, hospitals, and Palliative Nurses (NBCHPN) and the Chair of nursing homes and other health organizations, we provide the LPN Exam Development Committee. I am an expert consulting for clinical and organizational quality improvement. Based in Oklahoma City, we serve providers and HPNA Approved Educator and an ELNEC Trainer. consumers throughout the state, and we contribute expertise Additionally, I have completed my BSN and a Masters and resources to advance health care quality improvement in Nursing Education and am planning to return through national quality initiatives. OFMQ holds contracts to school yet again for a PhD. I also enjoy teaching with the Centers for Medicare & Medicaid Services, an agency nursing part time for a local community college. of the U.S. Department of Health and Human Services. www. The point is, that nursing was a job first, later ofmq.com. Page 6 • The oklahoma Nurse June, July, August 2010 Mercy Saves Local Landfills and Big Bucks ONA Organizational Sponsor

Midwest—In just nine months, Mercy—a group of 30 hospitals in Arkansas, Kansas, Missouri and Oklahoma—has already saved almost $800,000 and diverted more than 20,000 pounds of waste from local landfills. And by all estimates, Mercy stands to save $2 million annually and some 30 tons from landfills once all facilities are at full speed with a new green initiative that involves reprocessing medical devices. “The health industry is second only to the food industry in contributing to our nation’s landfills,” said Lynn Britton, Mercy president and CEO. “Not only is Mercy impacting our environment by HCR 1060 “Rebecca’s reprocessing medical devices, we are putting the savings back into patient care. This is just one of Mercy’s strategies to reduce health care costs while Resolution” increasing the quality of patient care.” Following stringent guidelines set by the U.S. Eileen E. Kupper-Grubbs RN-BC Food and Drug Administration, hospitals across the Registered Nurse Deaconess Hospital country are beginning to revisit reprocessing devices Oklahoma City, Oklahoma such as surgical scissors, drills and many opened ONA Member, Region 1 but unused items. For years, U.S. hospitals have reprocessed devices in-house or through outside Another day to remember: April 19, 2010 vendors but over time, with a more disposable It has been 15 years since the bombing of the society, landfills are overflowing. Alfred P. Murrah Federal Building in Oklahoma According to a March 2010 study published in the City, Oklahoma. On this anniversary, House Association of American Medical Colleges journal, Concurrent Resolution 1060, which was authored by devices which are properly reprocessed “do not Representative Scott Martin and Senator Jonathan present an increased health risk when compared Nichols, was passed as written by the entire with new, non-reprocessed devices.” legislature. The process of making this resolution began on January 28, 2010 in the form of an email “Now, to ensure safety and efficiency, as well as Mercy registered nurse Paul Fuzy places a comply with FDA regulations, Mercy is partnering to the Executive Director of the Oklahoma Nurses with a leading single outside vendor which device used to hold scalpels during surgeries Association. The email described how there was disassembles, cleans, inspects, certifies, sterilizes into a reprocessing bin at St. John’s Hospital only one organ donor from the tragedy that was the and restores devices to manufacturer specifications in Springfield, Mo. Reprocessing of medical bombing of the Alfred P. Murrah Federal Building. and then returns items to Mercy facilities,” said devices has saved Mercy an estimated $800,000 The donor was Rebecca Anderson. She was born Stacy Howard, RN, MHA, MBA, director of Mercy’s and 20,000 tons of landfill space. in Arkansas, and was a nurse with an Oklahoman’s ROi operational support services. “They meticulously spirit. William Wilcoxson, a veteran from Duncan, track how many times each device has been • St. John’s Mercy Medical Center in St. Louis, Oklahoma, gratefully received her heart. Rebecca’s processed and recycle them when they need to be Missouri, will open a new patient tower this kidneys were given to recipients out of state. It is retired.” summer utilizing light harvesting. our hope that by remembering the positive moments Along with reprocessing, here are some other ways of humanity like this, we will continue to overcome Mercy is green: Many Mercy facilities are also switching to green the adversities presented by the tragedy of April 19, cleaning chemicals, reducing utility costs, doing away 1995. • Mercy Medical Center in Rogers, Arkansas, with water bottles and recycling everything from Many Oklahomans have no idea that Rebecca was is one of only 21 hospitals in the country cardboard to batteries. the only nurse who died that day, nor are they aware currently Energy Star certified, meaning it uses “No snowflake ever feels responsible for the that she was the only organ donor in the tragedy. less energy, is less expensive to operate and avalanche but we are all responsible for this planet,” This makes Rebecca Anderson’s contribution to the causes fewer greenhouse gas emissions than its said Sister Mary Roch Rocklage, RSM, Sisters of Mercy nursing profession of exceptional significance. Three peers, according to EPA standards. health ministry liaison. “Across Mercy, our 36,000 co- individuals recognized the importance: Oklahoma workers are impacting our communities by taking care Nurses Association’s Executive Director, Jane Nelson; • Mercy Data Center in Washington, Missouri, of the planet God gifted us.” the organization’s lobbyist, Victoria White Rankin, opening in summer of 2010, was designed to and myself as an Oklahoma Nurses Association be compliant with Leadership in Energy and Mercy—Sisters of Mercy Health member. We realized that this was an important Environmental Design—the standard for green System—is the eighth largest message for nurses as well as Oklahoman’s. Together, building design. Case in point: of the 255 tons Catholic health care system in the we encouraged legislators to create a resolution. of steel used, 100 percent came from recycled U.S. and includes 30 hospitals The resolution that passed essentially names sources. and more than 1,300 integrated physicians in Arkansas, April 19th as “Rebecca Anderson Nurse of the Day” Kansas, Missouri and Oklahoma. in perpetuity. This designation will be awarded to the ONA member selected from a competitive process to serve as the honorary Rebecca Anderson Nurse of the Day through the ONA Nurse of the Day program during legislative season at the State Capitol. An essay contest will be overseen by the Oklahoma Nurses Association and Life Share Oklahoma. Beyond remembering the moments of grace that arose from that senseless act of violence, ONA hopes to promote the importance of organ and tissue donation. As nurses, let us do our part to increase the understanding of what it means to be an organ and tissue donor while we continue the legacy of ultimate service exemplified by Nurse Rebecca Anderson. June, July, August 2010 The Oklahoma Nurse • Page 7 Update on Articulation Scarce Resource Situations Carole A. McKenzie, PhD, CNM, RN Loren N.M. Stein, RNC, MSN the resources. For instance, mechanical ventilation is Sub-Committee Co-Chair ONA Member, Region 1 a resource that many emergency/pandemic planning ONA Member, Region 4 teams have examined. New York State developed an Oklahoma consistently has a high number of Allocation of Ventilators in an Influenza Pandemic disasters each year (FEMA, 2010) and a small state Planning Document which resulted in a great deal of population. As a result, Oklahoma usually has the discussion and controversy. The Patient Care Strategies greatest disasters per capita and therefore Oklahoma for Scarce Resource Situations guidelines recommend nurses have the greatest probability of responding to several strategies for planning for the potential shortage a disaster. Many types of disasters may lead to scarce of mechanical ventilators during a catastrophic health resource situations; depending on the situation, the emergency: lack of resources could last for only a few hours or PREPARE Increase hospital stocks of it may stretch out over many days. ONA supports ventilators and ventilator circuits nurses involvement in the planning for scarce resource SUBSTITUTE Access alternative sources for situations at the state, county and institutional level. The Oklahoma Health Care Workforce Center’s ventilators Preplanning is necessary to develop guidelines for ADAPT Use alternative respiratory support Sub-Committee on Articulation has been meeting adapting standards of care during disasters that result quarterly for almost two years to assess progress on technologies in scarce resource situations. CONSERVE Decrease demand for ventilators allied health and nursing articulation and devise “As seen in catastrophic health emergencies like plans to improve the process. The committee is RE-USE Sterilize ventilator circuits after Hurricane Katrina, the same level of care may not cleaning comprised of representatives from allied health and be available due to limited resources and countless nursing education as well as service representatives. RE-ALLOCATE Assign limited ventilators to patients. Medical personnel working in these conditions patients most likely to benefit if The Institute for Oklahoma Nursing Education of course will use every means possible to provide the (IONE) is represented by the articulation sub- no other options are available. best level of care possible at the time, but realistically Facilities should not re-allocate committee chair from that group. they will not be able to follow everyday standards of The group has developed a position paper on ventilators unless this is a state and care (Oklahoma’s 2009 Catastrophic Health Emergency regionally agreed-upon necessity articulation related to nursing in collaboration with (CHE) Plan, Altered Standards of Care, p. 1).” Several IONE and will soon have developed a position paper in an overwhelming situation years ago, the CHE Task Force identified the possibility without potential to receive needed for allied health. A survey of articulation practices of changes in the standard of care during a disaster in allied health and also in nursing will soon be resources or evacuate patients to and organized a state Adapted Standards of Care (ASC) areas with necessary resources. distributed throughout the state and the allied committee to explore the issues related to planning health position paper will be informed by that data. for changes within our health delivery systems during A multi-strategy approach allows for adapting The nursing position paper will no doubt be revised a disaster. The Oklahoma Nurses Association has standards of care without implementing an all or once the data is received. Key points in the nursing been represented on that state committee since the nothing approach to disaster standards. position paper relate to current practices, funding, group first came together in 2005. This committee The ASC committee believes that in order to ensure and the nursing shortage. Guiding principles for has examined a wealth of literature about health care ethical and equitable decision making, as well as partnerships, collaboration and articulation in delivery in a disaster and networked with other state fair and consistent delivery of healthcare, during a nursing education have also been included. A great committees to share progress and developments. catastrophic health emergency, Oklahoma has an deal of discussion has also occurred with respect Recently the ASC committee proposed to the CHE obligation to the clinical practitioner, the healthcare to accreditation and regulatory challenges for both Task Force adopting guidelines developed in Minnesota community and the public to plan and develop nursing and allied health. Being a rural state creates entitled Patient Care Strategies for Scarce Resource guidelines for adapting standards of care during a difficulties in a program’s ability to meet criteria for Situations. In January, the Oklahoma Catastrophic disaster. The ASC committee continues to strive for faculty qualifications and the lack of flexibility in Health Emergency Task Force voted to continue to enhanced liability protection for healthcare workers accreditation standards makes the challenges even pursue the functionality of the guidelines offered in responding in a disaster that result in a scarce resource more acute. Patient Care Strategies for Scarce Resource Situations in environment. Nurse leaders will have an important role An exciting component of the work of this group Oklahoma. The purpose is to provide clinical guidelines in educating nurses, other healthcare professionals is the development of plans for an articulation for systems so that they may plan, prepare and respond and the public about strategies to cope with resource summit in Oklahoma City on Monday, November to a scarce resource environment. The guidelines constrained environments. 1, 2010. Stay tuned for more exciting information are intended to be a part of each healthcare facility’s ONA is interested in your opinions and ideas about about this education activity. Dr. Katherine Vestal, adaptable multi-tiered emergency response plan. A copy this the Patient Care Strategies for Scarce Resource FAAN, FACHE will be the keynote speaker but of the document can be found on the Oklahoma Nurses Situations guidelines. We would also like to hear the plans also include working groups to develop Association website: www.oklahomanurses.org. your thoughts on how to share this document with transformative strategies about articulation that The guidelines delineate a planning framework for health care professionals across the state. www. could provide exciting opportunities in our state as health care facilities to use when faced with scarce oklahomanurses.org. well as the potential for becoming a model for other resources for the following seven resources: oxygen, states to emulate. medication administration, hemodynamic support and References: Dr. Vestal is the President of Work Innovations, IV fluids, mechanical ventilation, nutrition and staffing. Declared Disasters by Year or State (2010). Retrieved on LLC and has an extensive background in allied Part of the appeal of the document is the variety of April 15, 2010 from http://www.fema.gov/news/disaster_ health and nursing, both in education and health common sense strategies that are suggested for each of totals_annual.fema care administration, as well as work redesign and transformation. She will be coming from Michigan to not only challenge us but to spur our work in new directions and jump start our articulation processes. Plan to be in Oklahoma City that day and mark your calendars now. The articulation sub-committee is anxious for feedback so please contact us at any time. You may send an e-mail to [email protected]. Also, please complete the articulation survey when it arrives in your in-box soon. It will assist us in cataloguing articulation efforts within the state as well as give us valuable information to plan priority actions for the group in the future. Page 8 • The oklahoma Nurse June, July, August 2010 2010 ONA Convention: Nurses Set the Pace for a Healthier Oklahoma: Strategies for Action New in 2010: Use one form for each submission, regardless of type.

200-500 words, addressing one of five concurrent session tracks: • Administrators/Managers • Burnout/Life Balance • Clinical (Practice or Process) Guidelines for Abstracts— • Educators Online Submissions • Staff Nurses Submissions must be made online • Students Submissions must be made online using the submission form and must include: and must be received by 5pm, • Point of Contact, Title, and Abstract, Author(s), credentials, and prior experience June 30, 2010 • Note: Authors may submit multiple proposals. For more information, visit the • Deadline: June 30, 2010: This will be a competitive selection process website,or call (405) 840-3476. If your proposal is accepted • You will be notified no later than August 3, 2010, and • Asked to present on Thursday, October 28, 2010, at the Convention Center in Tulsa, Oklahoma. • You will be required to complete and sign CNE credentialing forms, which are available online, before August 31, 2010. Failure to do so may cancel the offer to present, and the Committee may select another presenter. • Concurrent Session will be approximately 50 minutes in length, with 30-50 attendees. • Electronics versions of all handouts need to be submitted to the ONA office by October 1, 2010. • Posters will need to be in place before 9am on Thursday 10/28/2010. • You are required to staff your poster ONLY during the afternoon networking break. • Suggested maximum size of posters: 36” by 48” Compensation: Keynote Presenters will receive one complimentary registration • Concurrent Presenters: receive up to a 50% discount on two Convention registrations. • Poster Presenters receive up to a 25% discount on two Convention registrations.

Exhibitor Invitation to the 2010 ONA Convention Nurses Set the Pace for a Healthier Oklahoma: Strategies for Action October 27-28, 2010 at the Convention Center in Tulsa, OK

Full Booth (approximately 8’ wide by 10’ deep) Table Top (no backing, no floor-model pop-ups, no electricity available, lunch not included) Booth Prices: • Prior to August 27, 2010 $450.00 Table Top Prices: • Prior to September 30, 2010 $500.00 • Prior to August 27, 2010 $275.00 • After September 30, 2010 $550.00 • Prior to September 30, 2010 $300.00 • After September 30, 2010 $325.00 Exhibit Information: • Tulsa Convention Center, Tulsa, Oklahoma $50 coupons Exhibit Information: • Move in times: • Tulsa Convention Center, Tulsa, Oklahoma Wednesday, 5:00 p.m.-7:00 p.m.; for exhibitors • Move in times: Thursay 7:00 a.m.-9:00 a.m. that have Wednesday, 4:00 p.m.-7:00 p.m.; Exhibit Hours Thursday 7:00 a.m.-9:00 a.m. • Thursday 9:00 a.m.-4:30 p.m. exhibited with Exhibit Hours Rental Fee Includes: us before • Thursday 9:00 a.m.-4:30 p.m. • Back drape & booth dividers • 1 Skirted table, electricity available ($15 extra) Rental Fee Includes: • 2 Folding chairs • 1 Skirted table • 1 Vendor Identification sign with booth number • 1 Folding chair • Vendor packet • 1 Vendor Identification sign with booth number • 1 Lunch Ticket per booth, additional lunches available @$10 • Vendor packet • Other items and amenities available for additional fees

PLEASE NOTE THE FOLLOWING: ONA reserves the right to change these approximate values. Some Convention Sponsorship levels include an exhibit booth and/or discounts to be applied toward the fee. Loyalty Discounts will be given to returning vendors ($50 Off). Reservations may be made online. For more information visit the website, or call (405) 840-3476

Visit the website www.oklahomanurses.org June, July, August 2010 The Oklahoma Nurse • Page 9

2010 ONA Convention Special Events Nurses Set the Pace for a Healthier Oklahoma: House of Delegates, Wednesday, October 27, 2010 Strategies for Action Featuring a special welcoming address! October 27-28, 2010 at the Convention Center in This is why we call it a Convention: Using the Momentum Tulsa, Oklahoma of the last 100 years to build the future. ONA’s convention has been the designated annual meeting when regional nursing leaders “convene” in one place to determine the priorities of the Tentative Convention Schedule organization. Please join us and strengthen the direction of the Oklahoma Nurses Association. Whether you are an observer or Delegate, please plan on attending! Wednesday Afternoon Thursday Exhibit Hall Set-Up Registration House of Delegates Town Hall Breakfast Convention Registration Keynote Presentation Afternoon Educational Four Concurrent Sessions Rush Hour Reception: Thursday After Session Session Luncheon & Awards Let the traffic tough things out on its own, and join us for a EVENTS: Networking Breaks fun reception at the end of the day. In fact, the Convention Oklahoma Nurses Foundation Exhibit Hall Committee claims that it is worth staying over Thursday night Oklahoma League of Nursing Poster Presentations for all the excitement! Make a night of it! OU Alumni Rush Hour Reception Local Celebrities 50/50 Cash Rally for the ONA–PAC Concurrent Session Tracks Great Give-Aways and Raffles Administrators/Managers And more fun with your fellow nurses than you can imagine! Burnout/Life Balance Clinical (Practice or Process) It’s time you had a night out! Educators Staff Nurses Students

(Hint: To meet the poster presenters visit the poster area Town Hall Breakfast Awards Luncheon, during the afternoon break.) Please join us for Thursday breakfast and a newly This $35 value is included in the price of your registration! *Luncheon is included with registration fees formatted forum on hot topics in the nursing Please Join us as we celebrate some of our most profession! accomplished members. For more information visit the website at www.OklahomaNurses.org or call (405) 840-3476. Page 10 • The oklahoma Nurse June, July, August 2010 Fall Risk Assessment in the Outpatient Setting Suellen Meador, BSN, RN - Roberta Jones, MSN, The nurse inquires about RN., Administrative Support falls, marks the appropriate Marsha Heasley, RN, CAC, (retired) box in the screen as Computer Assistance ‘single’ or ‘recurrent’ falls, Jack C. Montgomery VA Medical Center, comments on recent fall circumstances, patient Muskogee, OK 74426 USA injury, and treatment for injury in a free text box. INTRODUCTION The screen also has Outpatient nurses at Jack C. Montgomery V.A. nursing screen check boxes Medical Center, Muskogee, OK, created a screening (per patient report). The tool for Fall Risk in Outpatient Clinics and Home nurse checks one or more Based Primary Care. The authors created an of the following boxes. Evidence-Based Research electronic tool that meets JACHO and VA requirements and includes the 1) assistive devices needed provider (Physician, Nurse Practitioner, Physician 2) difficulty walking when Assistant) in follow up. The VA population is male first gets up and female community-dwelling adults aged 20 to 3) medications possibly 90+. The VA system is completely computerized, so related to fall the main task was to make the tool user-friendly and 4) recent vision changes integrate research and technology into a Research- 5) shortness of breath on Based Screen. exertion 6) dizziness The Tool The tool, the Fall Risk Screen-Outpatient, was The research tool developed, tested and implemented at Jack C. chosen was Preventing Montgomery VA Medical Center. The goal is to Falls in Older Adults by Dr. improve veteran safety with fall and catastrophic Laurence Rubenstein (with injury prevention. The method comprised teaching permission). The provider nurses to report gait and balance problems uses ‘Evidence Based electronically with screens and reminders that Guideline for Fall Prevention’ include the Modified Get Up and Go Test. This Test and ‘Assessment and reports single and recurrent falls; circumstances of Management of Falls’ based the fall; if the patient was injured and needed to seek upon Rubenstein research. medical care after the fall; and if the patient would Management of falls includes benefit from assistive devices. This electronic tool is history, medication, vision, efficient, user-friendly, research-based and involves gait/balance, lower limb minimal expense. The information obtained goes joints, neurological and immediately electronically to the provider for any cardiovascular factors. changes in treatment. The provider has an The Fall Risk Screen-Outpatient toll also includes electronic plan/action com­ patient/family educational information, a handout ment box in the screen from the NCPS (National Center for Patient Safety). for medication review/ The process is based on Evidence-Based Research adjustment, environmental and can be divided into a three part algorithm: modifications/suggestions. They can electronically enter 1) education, (nurse), ancillary service consults, 2) gait/balance assessment, fall history, (nurse) gait/balance training, exercise, 3) research-based management (provider). and/or assistive devices.

The education handout chosen, ‘Fall Prevention RESULTS at Home,’ from the National Center for Patient The screen has been Safety Falls Toolkit is pleasant, easy-to-read and shared with other understand and is available as a paper copy or Department of Veterans computer link. Affairs Medical Facilities. The gait/balance assessment tool is the 10 Foot The tool exceeds JCAHO Safety Goal #9, reduce the ‘Get Up and Go Test’ (modified). The clinic nurses risk of patient harm resulting from falls. It meets the observe the patient get up out of their waiting room VA EPRP (External Peer Review Program) ACOVE chair and walk into the clinic. Any abnormal gait, Measures Basic Fall Evaluation (Assessing Care Of strength or balance or if the patient is in a wheel Vulnerable Elders, 75+). The Screen includes health chair is an Abnormal Get Up and Go Test. factors that electronically enable data tracking from The Get up and Go Test (modified) is defined as the VA’s Data Warehouse. follows: Patients sit in a straight-backed waiting room CONCLUSION chair, the nurse observe him/her: The focus of the tool, the Fall Risk Screen- Outpatient, is fall prevention with education, gait 1) Get up ( without use of arm rests, if possible) training and interventions including available 2) Stand momentarily assistive devices. Fall prevention and well-being 3) Walk into clinic promotion requires observing patients walk, asking 4) Sit down in clinic chair if they have fallen, and taking appropriate action. The people that can be helped the most with use of this Tool are those that have not yet started to fall. For more information please contact suellen. [email protected] or the hyperlink below. Primary Care Nurses Systematically Assess Fall Risk, Provide Real-Time, Easy-to-Use Alerts to Physicians to Facilitate Appropriate Interventions for Those at Risk June, July, August 2010 The Oklahoma Nurse • Page 11 Mental Gymnastics Crystal Jones-Gandy, RN ONA Member, Region 1

This time I would like to take a step back from all the mental gymnastics we do in our careers daily and encourage you to go back to basics. Before you reach for that PRN med for anxiety, pain, etc. I want to encourage you to listen to your patients. As I sit back and watch others doing the same thing as I am. I have experienced this already, in this short time that I have been an ICU nurse). I feel Crystal Jones- that I am so rushed. As nurses, Gandy we push against the clock to get our meds passed, get our paperwork done, do our daily routine, and then we really just overlook listening and talking with our patients. We hear “I have pain,” and we grab a med. We hear “I am scared,” and we say “You’re going to be okay.” We see all the signs and symptoms of fear or anxiety, and we reach for our MAR to see what we can do to quickly alleviate the problem and go on with all of our other work as we rush to beat the clock. Do you remember that part of school that you steered clear from as much as possible in nursing school? I’m thinking that right now is a good time to stop avoiding it. I am challenging myself and all the other nurses out there: let’s try some of that therapeutic communication. Saint Francis Hospital, part of the Saint It really does not take that long. I am already surprised to find how calming, relaxing, healing it is just to talk with your patient. (It’s also good for the patient!) I’m Francis Health System ~ Finding Its NICHE challenging myself to inform my patients. I don’t want to leave them out, but I get so busy. ONA Convention Platinum Sponsor acute medical needs. Saint Francis has improved It is easy to treat a sign and symptom, as RNs we Tyleen Smith, BSN, RN, Clinical Manager geriatric outcomes on the ACE unit, largely due can all do this. But, out here, away from the classroom to geriatric nursing education, daily patient care and clinical, the real challenge is to remember to care We hear it on the news and in the papers that rounds, nursing protocols and hourly rounding. for the person as well. Their feelings and emotions need healthcare is not ready for the baby boomers Outcomes such as a reduction in falls by 56%, a cared for as well. aging needs. Some predict that by 2020, 1 in 6 decrease in restraint rate by 42%, a decrease of Finally, (the mental gymnastics part) I ask you to Oklahomans will be 65 and older with that group 63% for pressure ulcer prevalence and no catheter join me in this challenge. Please evaluate yourself. Ask doubling by 2030. Only a few hospitals in Oklahoma associated urinary tract infections for a year. yourself, “Would you want you to be your own nurse if are prepared for the geriatric tsunami that is about Saint Francis is now infusing NICHE into all adult you needed one?” Then ask, “Are you the type of nurse to hit. It is widely known that currently 60% of inpatient nursing units with Geriatric Resource that you would want if you were the patient?” Challenge hospitalized patients are 65 and older with that Nurses (another NICHE model), a NICHE page on the yourselves to listen and to share information with each percentage only increasing in the coming years. We Saint Francis nursing website, and taking NICHE patient, and you may just remember why you began also know that nurses are the ones caring for this based protocols housewide—with the goal of making your nursing career. large geriatric population. So then the question…how sure that every nurse has the tools and resources do we prepare the nurses? to take care of geriatric patients. The most recent At Saint Francis Hospital in Tulsa “NICHE” is tools are a poster series called the NICHE TOP 10 for the new buzzword. Nursing Improving the Care of dealing with patients with delirium or confusion and Health system Elders is a program of the Hartford a Patient Activity Cart on every adult inpatient unit. Institute for Geriatric Nursing at New York University These Patient Activity Carts, made from recycled College of Nursing. The goal of NICHE is to achieve crash carts, are now filled with puzzles, activity systematic nursing change that will benefit aprons, colors, coloring books, stuffed animals, hospitalized older patients. The vision of NICHE is Slinkys and baby dolls to help nurses deal with for all patients 65 and over to be given sensitive and confused or delirious patients. Saint Francis has exemplary care. The mission of NICHE is to import been selected twice to present their geriatric best principles and tools to stimulate a change in the practices at the national NICHE conference, the most culture of healthcare facilities to achieve patient- recent being for the Patient Activity Carts. centered care for older adults. The focus of NICHE NICHE not only benefits the patients but it also is on programs and protocols that are dominantly has a large benefit to the hospital. With decreased under the control of nursing practice; in other words, length of stay and improved nursing satisfaction and areas where nursing interventions have a positive a decrease in nursing turnover, NICHE is a win for impact on patient care. everyone. Saint Francis joined NICHE in 2006 with the first Saint Francis has found its NICHE and is ready Acute Care Elderly unit (ACE) in the state. This 36 for the aging baby boomers. Has your organization bed unit is dedicated to patients 65 and older with found theirs? Page 12 • The oklahoma Nurse June, July, August 2010 Faith Community Nursing Is There a Role for ‘Wisdom Workers’ in Basic Preparation Course Planned Professional Nursing? Mary Diane Steltenkamp Patti Muller-Smith, RN, EdD licensed nurse. Proposed solutions have been offered ONA Member, Region 1 ONA Member, Region 2 time and time again and yet the statistics continue to range anywhere from 20 to 60% turnover in the first 12 to 14 months in most work settings. Involved in Faith Community Nursing is a recognized specialty Among the huge cohort of baby boomers reaching these statistics are issues of competency and creating practice for registered nurses combining professional retirement age, there are many registered nurses. a positive work setting where there is sufficient nursing and health ministry. Faith Community Nurses Many of these retired or soon to be retired nurses are support systems to make the transition from are often called “parish nurses,” “congregational health practitioners, educators, and managers who will take student to practitioner and creating a culture that is nurses,” or “church nurses,” and emphasizes health with them an enormous reservoir of information, professionally satisfying and provides for continuing and healing within a faith community. skill and knowledge. They are experts in both the growth and personal well-being. Preceptors, mentors This is an independent nursing practice which does art and science of professional nursing. They have and on unit clinical instructors have all been used not involve ‘hands-on’ health care. Instead the nurse reached a stage in their lives where they recognize to reduce the very costly rates of turnover, but the performs roles of educator, referral agent, advocate, that they are no longer able, or choose not to work statistics have not changed. Retention continues to personal health counselor, developer of support in the physically demanding or emotionally draining be a major issue and nurses leave because of the groups, coordinator of volunteers, and integrator of roles that exist in most health care work settings. discord that exists in the workplace. Nurse managers faith and health. The nurse performs all duties with a Many are in search of a greater work-life balance are plagued with the management of relationship special emphasis on the intentional care of the spirit. than existing roles can offer. Although the choice problems of the staff that are time consuming and The spiritual aspect is key to this nursing. The Faith to separate from the nursing profession is a viable emotionally draining. Managers are charged with Community Nurses Association of Oklahoma (FCNAOK) option for large numbers of nurses, there are still creating a positive work culture in addition to their is an organizational affiliate with ONA. those who find themselves searching for a way to many other tasks. They are responsible for the The Basic Preparation Course for Faith Community remain active and involved in their chosen vocation. clinical competency of the staff, the quality of patient Nursing has been offered in the State of Oklahoma In the past, mature individuals in their 60s or care, the financial aspects of managing a unit, and since 1999 and has had over 170 nurses completing the older were truly unable to continue in the work force. solving both physician and patient/family problems. program. The next course is scheduled the weekends Today, however, with the tremendous advances in our Rather then continuing to rename and use of September 30, October 1 and 2 and October 14-16, society, there is strong data to support that rather proposed solutions that have had limited success 2010. The weekend course will be held at Our Lady of than viewing 60 as the beginning of a declining in the past, would it not make sense to look at a the Lake Lodge in Guthrie, Oklahoma. Participants quality of life, it may really be just the beginning of new and different role that doesn’t draw from the must attend both weekends. The course, revised in the most transformative and generative time in our existing pool of practitioners but draws from the 2009, includes local faith community nurses and life cycle. Life expectancy is at an all time high and pool of mature nurses who are still committed to community leaders with expertise in theology, ethics, living well and active for 10, 20, or 30 years post their profession and have much to offer in the way of counseling, community resources and education. retirement is not an unrealistic expectation. competence, experience and skill in maintaining the This program is approved for 34 contact hours by the In the Twentieth Century, there was an obsession caring aspects of nursing? Kansas State Board of Nursing. with all things young. For the first time, adolescence This role would be one where responsibility for The course is open to registered nurses of all faith was identified as a distinct developmental period the orientation, on going competency, providing traditions. Registration is limited to 15 persons. Cost between childhood and adulthood. It was a time of support to the staff, and maintaining a collaborative is $675 which includes tuition, materials, CEU’s, enormous change both physically and emotionally. work environment is their primary job. The mature meals, lodging and first year membership with It was marked by drama and strained relationships nurse comes equipped to fill this role and would FCNAOK. Registration closes September, 2010. For between parents and teens. To some extent this need minimal orientation. They are clinically skilled more information contact Mary Diane Steltenkamp, has carried over into the twenty first century and with developed interpersonal skills; are committed to Director of Faith Community Nursing at Catholic has remained in our approach to many life and advancing the profession; and want to see patients Charities, 405-523-3000, or e-mail mdsteltenkamp@ professional challenges. As the baby boomers age receive the best quality care possible. They are catholiccharitiesok.org. we are facing the task of identifying those mature individuals who are neither young nor old, who neither practitioner, nor manager. They serve as a want to embrace new challenges and are searching resource to both. They may, for lack of a better term, for greater meaning in life. They bring with them be seen as the ‘unit culture specialist.’ They work wealth, resources, social capital and a sense of with newly licensed nurses to develop competence authority. These are in fact, the ‘wisdom workers’ of and confidence. They intervene in staff disputes and this century. Rather than seeing this mature adult solving some of the day to-day physician and patient/ over 60 as in a state of decline, losing both physical family problems. Their role is to create the positive and mental capacity leading to dependency, they work environment where positive patient outcomes should be seen as healthy, vibrant, wise, creative is the norm and individual practitioners find work and independent! The boomers are moving into the rewarding and satisfying. Managers can manage; third phase of their life cycle and still have much to practitioners can practice; and patients have a caring contribute to society and professional nursing. advocate. In many ways this role, well suited to the If we apply this change in thinking to our mature mature nurse, provides the link between the science nurse, and look at them as merely moving into the and art of nursing. next phase of their professional practice career, the This may seem like a simplistic solution to a question becomes: ‘How can professional nursing problem that has long plagued nursing practice and capture this valuable resource pool and use them to there is always the question of cost. The mature address some of the problems that have long been nurse in this role might well be the cost efficient way plaguing our work settings?’ to solve the problem. Reduce turnover by 10% and Nursing literature has constantly addressed the you have covered salary costs. If they are of medicare issue of retention and turnover of the young, newly age, they don’t require health benefits. Considering this new role may be a win-win for all concerned. Mature nurses can continue to contribute, staff has a support system to rely on, unit culture built on caring collaboration and competence is maintained and patients have the benefit of caring quality outcomes. Something to consider!!!! June, July, August 2010 The Oklahoma Nurse • Page 13 How is CTE an Investment in Your Future?

A Response by Deanna M. Prufert and knows standardized procedures and medically placement in today’s job market, the majority of nurses delegated techniques” (“Nurse” def. 1). This professional are able to find work. Our society is “in the midst of “Investing” alludes to images of the continuously definition is an excellent description of what is included a nursing shortage that is expected to intensify as rolling stock market ticker or the latest online trading in my program of study. baby boomers age and the need for health care grows” company commercial featuring a random “Law & The individualized instruction of my program is (Rosseter). The aging population will need care, and Order” star. While a successful stock market venture organized by learning contracts that detail the blend I, as a Licensed Practical Nurse, plan to be there to could certainly enhance one’s future, the risk of losing of textbook reading, interactive software, educational help fill the need. Empowered by an education that everything is always looming nearby. Broadly defined, media, and learning activity packets. The hands-on forced me to take control of my own learning, I will be to invest is “to expend for future benefits or advantages” training begins in the school laboratory and extends a critically thinking, confident, well educated member (“Invest” def. 2). When making an investment in the into the community at local hospitals. Our Health of the nursing profession. The variety of practical future, there is only one option that comes to mind Occupations Students Association (HOSA) also serves skill application opportunities and individualized which defies risk, commands respect, and ensures to fortify my expertise, with training and preparation instruction provided by a CTE program has provided a enrichment. This is education. An investment in for job readiness competitive events. The opportunity well rounded education in nursing. This education has education requires an expenditure of time, development to serve as HOSA President has offered a unique provided me with the confidence that I need to become of organizational skills, and hard work. Investment perspective into the leadership roles of nursing. Without an active member of the workforce in a job that I love. in an education is guaranteed to enhance knowledge, the personalized study planning of a CTE program, CTE has defined my future as a nurse. skills, employability, lifetime earning potential, and I would not have been able to seek out education as a quality of life. To actively seek out education is, returning adult student. The self-paced orientation Works Cited inherently, an investment in the future. of the program demands responsibility and a sense Career and Technical Education (CTE) is based on of accountability that is unrivaled by lecture based “CareerTech Glossary.” Oklahoma Department of Career and Technology Education. 16 January 2010 http://cms. preparing students to enter a competitive workforce educational programs. I have to study, read, perform skills, and write about my progress, or I will fail. okcareertech.org/glossary. through education that provides a solid knowledge base, “Invest.” Def. 2. The Merriam-Webster Dictionary. practical skill training, and the adaptability to survive The camaraderie of small classes and professional Springfield, MA: Merriam-Webster, Inc. Publishers, 1998. and thrive. At Moore Norman Technology Center, I am instructors only strengthens my desire to do well, for I “Nurse” Def. 1. Taber’s Cyclopedic Medical Dictionary preparing for a career in nursing as a student in the want us all to succeed as a team. My success in this Edition 19. Philadelphia, PA: F.A. Davis Company, 2001. Evening Licensed Practical Nursing (LPN) Program. An program will lead to steadfast employability skills in Rosseter, Robert. “Nursing Shortage.” American Association LPN is a technical nurse, “who is technique-oriented, nursing. of Colleges of Nursing. 15 January 2010 http://www.aacn. deals with commonly recurring nursing problems, While many college graduates are searching for nche.edu/Media/FactSheets/NursingShortage.htm. Page 14 • The oklahoma Nurse June, July, August 2010 Healing Hands in Haiti Tobi Bratten, RN dimly lit in this building. After claiming our baggage us. We were so blessed by this and she was truly a and going through Haitian customs, we walked godsend. I will likely never forget the moment I saw the through a gauntlet of 300 or more Haitians shouting All of our patients had walked miles down dusty tragic images roll across the television screen. in Creole, trying to wrestle our bags from us, and roads, some as many as seven miles to come to our My husband and I were vacationing in Cozumel, pulling at our clothes, begging for money. Once clinic. We began by check vital signs and triaging Mexico, on the evening of January 12, 2010. As outside, we boarded the bus which would take us patients. No one wanted to leave without medicine he flipped through the channels in our room, to the Nazarene Seminary, Eglese du Nazareen, in or a bandage—tangible proof that they had been to he paused when he came to CNN, and I heard the Petionville­—our home for part of the week. I smelled the doctor. Many patients presented with malarial words “7.0-magnitude quake hit Haiti earlier this a smell on our ride to Petionville which could best symptoms of fever, dizziness, and headaches. We had afternoon... serious loss of life expected” (Watson, be described as burnt plastic. We learned it was the a limited supply of doxycycline, so the people were 2010). As we watched news coverage of the damage, smell of Haitians making charcoal, their cash crop. instructed to walk to the hospital in town on Monday, I was stunned by the pictures. I had read and heard We nurses found out later that night that we would where they could get free anti-malarial medication. stories about the poverty and sickness that already not be going with the large medical group as we had The air in the tiny makeshift clinic was sweltering afflicted the country of Haiti, the poorest country been told, but would be hosting our own clinic. Since and hot. As the day dragged on, the people became in the Western Hemisphere. A desire to help Haiti we had so few medical supplies with us, we were restless from standing outside in the blistering sun. arose from within me. I knew there were going to be able to get some more supplies and medicine from The desperation in their faces was evident. Crying many who gave money or sent supplies to the Haitian a physician’s assistant on campus. Our clinic was babies were handed over the crowd and passed over people, but I realized then that I was not going to be scheduled for Saturday, and we were told to expect the door of the hut, because every parent wanted one who gave from back home. I did not know when, the entire community to show up. their children to be seen. One boy sat alone on the or how, but I knew I would be going to Haiti. Our first full day in Haiti was spent riding in a bench in the area that served as the waiting room, I am a registered nurse by profession. I received truck from Port-au-Prince in southwestern Haiti to crying softly. I guessed him to be less than two years my ADN from OSU-Oklahoma City in December Desroulin, a rural community in the mountains near old. His left axilla, chest, and bottom lip were covered 2008, and have spent most of my career working in the northern coast, where our construction team with round, yellow crust-covered lesions. I pointed to Intensive Care. There is something about caring for would build a church and we would have a clinic. We the boy and said, “Mom?” in English to the Haitian the sickest of the sick that first attracted me to ICU, left before sunup to avoid the morning “rush hour” standing nearest the entrance. A few moments later, and this also attracted me to Haiti. On March 17, of Port-au-Prince traffic. As we traveled further away the boy’s mom emerged from the crowd and came our group of 25 boarded a flight to Port-au-Prince. from Port-au-Prince, we saw less damage from the into the clinic to sit with her son. He stopped crying We were a mixed bag of mostly male construction earthquake and more of everyday Haitian life. I was at once, and sat on his mother’s lap until it was their workers and pastors. The medical personnel included taken aback by the beauty I saw there. Strong, sun- turn to see the doctor. me and one other RN from Oklahoma with over 20 tanned bodies labored in fields and rice paddies. Although we lost count during the day, our years nursing experience, my husband who is a first Chattering children walked to school, and women best estimate is that we saw 250-300 patients responder, and another EMT. Our small medical balanced goods on their heads to carry to market. on Saturday. Sadly, there were still 40-50 people team had planned on partnering with a larger Banana and palm trees dotted the countryside, and lined up outside when we had to close the clinic medical organization when we arrived in Haiti. We mountains rose up from the sea in every direction. that evening. It was a long and tiring day, but we were unsure of the accommodations we would find We arrived in Desroulin around 2:00 p.m. on felt productive. We had given out cases of Tylenol when we arrived there, but were told there were Thursday, March 18. Our construction team went and Ibuprofen, multivitamins, and Neosporin. plenty of medical supplies already in country due to work right away and was joined by Haitian men Dermatologic infections were found on almost to the disaster response from around the world. We and women who worked alongside us for the week. everyone. We sent many supplies with the doctor for brought a first-aid kit for our group with wound I was humbled by how hardworking these people her use and took up a collection of money. She had care supplies and a few bottles of over-the-counter are. Nothing comes easily in Haiti. Most of the worked all day with us, never turning anyone away, analgesics and vitamins. people we encountered in the mountains live in patiently seeing every man, woman, and child. My personal preparations for the trip included thatched-roof huts with dirt floors. They have no Our second clinic day was spent working in a tent brushing up on my first-aid skills, packing electricity, and they walk many miles to the river to city outside of Port-au-Prince. Here, the earthquake Lippincott’s Nursing Drug Guide in my carry-on, and get water. Children are taught in one-room, open-air damage was evident everywhere. The earthquake practicing the few words I know in French, hoping schoolhouses without windows or doors. When the refugees live in cities of tents which stretch for they were similar in Haitian Creole. During the two sun sets, the people walk through the hills with no miles. We joined another small medical group from months between the quake and the day we left for flashlight to light their path. The people of Haiti are the Nashville, TN area that consisted of a PA, CRNA, Haiti, my imagination had created many ideas of quiet and strong, gentle and proud. and EMT and set up our clinic underneath a tarp. what Haiti would look like, feel like, and smell like. We were awakened early on Saturday morning by These patients had different medical needs than My expectations of Haiti could be best summed up roosters crowing and donkeys braying. There were we had seen in the mountains, where we treated in one word—ugly. I had read about outbreaks of 50 or more Haitians waiting outside of our “clinic” mostly chronic illnesses. Here in the urban area, cholera in Haiti. I imagined ugly, desolate landscape, at dawn—a thatched-roof hut with a dirt floor. We we saw injuries from the earthquake—mostly open ugly streets filled with rubble, ugly smells of dirt and had hung tarps to create partitions to divide the leg wounds and broken bones, which we cleaned death, ugly, filthy water to drink, and frail bodies clinic into rooms—one for our supplies, one for the and bandaged to the best of our ability. We were not ridden with ugly wounds and diseases. waiting room, and one for seeing the doctor. We had equipped to set broken bones, so these patients were My first impression of Haiti was true to my a large case of medicines and another of supplies. told to go to the hospital. One thing that amazed me expectations. We circled the airport for about 45 One of the men on our construction team had been was that most of these people had been living with minutes before landing. I saw tent cities and piles injured while roofing. He was taken into the nearest these injuries since the earthquake over two months of rubble from destroyed buildings. After landing, town, where there was a Haitian doctor who stitched prior. We saw one gentleman with a large abdominal we were re-routed into a warehouse which had been his lacerations. She had heard that we were going abscess. Our team was hesitant to lance the abscess, converted into a terminal, because the original one to have a clinic on Saturday, and had come to join unsure of what we would find underneath or of the was damaged in the earthquake. It was hot and depth of the wound into his abdomen. We gave him a shot of Rocephin and sent him with some Ultram and instructions to go to the hospital immediately. This day, we saw somewhere around 150 patients in four hours. As always, there were people waiting to be seen when we left whom we had to turn away. We spent a week in Haiti, working with and staying among the people. I had gone with the intent to help them, but never expected them to help me. During my time in Haiti, I gained an honest and true perspective of life there. Nursing is never an easy job, in the U.S. or in a third-world country. I went expecting to find despair, but found beauty—in the land, and in the spirit of the people. The nursing work I did in Haiti is what nursing is really about, I believe. It is about helping the sickest of the sick, where medicine is limited, water is scarce, and critical thinking skills must be used at all times. In Haiti, there is no such thing as a supply room or pyxis, and the pharmacy consists of the medicine you brought, most of which needs to be mixed. Extra supplies that would be wasted in the U.S. because they had been taken into a patient’s room, although unused, would never go to waste in Haiti. The Haitians improvise and make due with what they have. I hope someday to be able to go back to Haiti and practice nursing in the way I did on this trip. My experiences in Haiti have made me want to know more, and to be more prepared and competent the next time that I go. I will obtain my BSN this May from Oklahoma Panhandle State University. I am not certain yet of my next step, but I plan on applying to either an ARNP or CRNA program. I want to increase my nursing knowledge and skills and use them to help those in need, both in the U.S. and in disaster- stricken lands such as Haiti.

References Watson, I., et. al. (13 January 2010). Haiti Appeals for Aid. Retrieved April 9, 2010, from www.cnn.com June, July, August 2010 The Oklahoma Nurse • Page 15 The ABC’s for Eliminating Clostridium Difficile Author: Toby Butler, MSN, RN, CCRN, and orally). After treatment, repeat Clostridium difficile absolutely no chance for a faster result. However, the Cynthia Zips SM(ASCP), CIC testing is not recommended if the patients’ symptoms bacterial culture may be the most accurate method have resolved as patients may remain colonized.” for the detection of the B1/NAP1/027 strain (APIC, Affiliation: HAI Quality Improvement Specialist (CDC FAQ, 1/13/2010). 2008). Oklahoma Foundation for Medical Quality B—Barrier Protection. When a patient has diarrhea, early “PRESUMPTIVE” isolation is best. Conclusion It is part of a nurse’s advocacy role to discuss While community-acquired CDI is possible, we ONA Member, Region 1 early contact isolation until the causative agent must concentrate our efforts to prevent the spread of for diarrhea can be identified. Personal protective Clostridium difficile in healthcare facilities. Utilizing equipment including gown and gloves should be the ABC’s, nurses should advocate for antibiotic used until 48 hours after diarrhea ceases (CDC stewardship, early barrier protection, and clean FAQ, 1/13/2010). Nurses should advocate having hands/clean environment. Antibiotic stewardship CDI patients placed in isolation rooms and also is important to prevent the elimination of the consider barrier protection of the skin by utilizing patient’s intestinal flora, reducing the likelihood of a fecal management system for active liquid stools. a Clostridium difficile infection (APIC, 2008). Hand Fecal management systems (FMS) contain infectious washing, with soap and water, with each contact diarrhea and provide relief to patients from with a Clostridium Difficile patient before leaving continuously oozing stool. the room prevents the bacteria and the spores from C—Clean Hands and Clean Environment. The leaving the patient’s room. Concentration on the use of soap and water is critical to prevent CDI proper antibiotic, proper treatment, proper dose, and transmission. Alcohol based gels and foams are the proper duration will lead to a more harmonious Background not effective against Clostridium difficile spores, healthcare environment with increased patient Clostridium difficile is a pervasive bacteria with and do not remove the spores from the hands. Old satisfaction and decreased healthcare cost. new virulence that has ravaged our patients and fashioned hand washing with soap and water will our healthcare institutions. Clostridium difficile remove the bacterial surface from the hands. A References: is an anaerobic, gram-positive, spore-forming sodium hypochlorite (bleach) solution of 10% is (2008). C. DIFF PACKS A HEFTY BILL FOR HOSPITALS. bacillus. It can cause a host of Clostridium difficile recommended for any surface in which the patient Health Facilities Management, 21(3), 6. Retrieved from associated diseases (CDAD) such as diarrhea, colitis, MasterFILE Premier database. Chicago/Turabian: Author- might come in contact with. Clean the surface well, Date pseudomembranous colitis, and toxic mega colon noting that disinfectants require 10 minutes kill which can lead to sepsis and potentially death. This APIC Elimination Guide; Guide to the Elimination of time. Then let the surfaces air dry. Surfaces that are Clostridium difficile in Healthcare Settings, 2008. infection, according to a 2008 study, may impact wiped dry generally have not had the disinfectant Bobulsky, GS, Al-Nassir, WN, Riggs, MM, Sethi, AK, health care with an additional 3.2 billion dollars in place long enough kill bacteria. As noted with Donskey CJ (February 2008). Clostridium difficile skin annually (Health Facilities Management, 2008). hand hygiene, alcohol based products for cleaning in contamination in patients with C. difficile-associated CDI can increase the length of stay for patients on patients with CDI rooms are not appropriate. disease. Research Service, Louis Stokes Cleveland Veterans average by 2.6-4.5 days in the hospital and increase Affairs Medical Center, 10701 East Blvd, Cleveland, OH each individual episode of care $2500-$3500 dollars. Testing for Clostridium Difficile 44106, USA. Clin Infect Dis. 2008 Feb 1:46(3):447-50. More alarming is the mortality rate increase after a CDC Frequently Asked Questions Information for Loose or watery stools should be submitted in a Health Care Providers (July 2005): Healthcare-Associated CDI incident. At thirty days the patient has a known clean, leak proof container. Specimens should be attributable increase of 6.9% and at one year 16.9% Infections: Infections: General: Resources. (Retrieved transported to the laboratory as soon as possible and 1/13/2010). http://www.cdc.gov/ncidod/dhqp/id_CdiffFAQ_ toward mortality (APIC, 2008). be refrigerated while waiting for transport. Storage HCP.ht ml Overuse of antibiotics leads to the decrease in at room temperature could possibly lead to toxin CDC. Guidelines for environmental infection control in the patient’s intestinal normal flora, allowing the deactivation which could lead to a false negative health-care facilities. MMWR 2003;52 (RR10):1-42. Also already present Clostridium difficile to adhere to result (APIC, 2008). Most laboratories only accept available at: http://www.cdc.gov/ncidod/hip/enviro/guide. the mucosa of the patient’s intestine. The key to one specimen per day because studies have shown htm prevention of CDAD is to first prevent the acquisition that more than one stool per day will yield the same Department of Health and Human Services (6/2009). of Clostridium difficile and its spore, and secondly, to Action Plan to Prevent Health Care Associated Infections. result. Likewise, most pathogens in the stool are Report 06222009. prevent the over use of antibiotics, thereby protecting shed intermittently, and therefore, a negative result the patient’s intestinal normal flora. Dubberke, E; Gerding, D; Classen,D,; Arias,K.;Podgorny, should be verified by retesting. K; Anderson,D; Burstin, H; et al. (October 2008). Shea/ While Clostridium difficile and its spores are spread Since CDI is a toxin mediated disease, most of Isda HAI Compendium. Strategies to Prevent Clostridium by contact, the route of transmission is usually fecal- the diagnostic tests involve detection of the toxin. difficile Infections in Acute Care Hospitals. Infection control oral. Once the bacteria or its spores are ingested, it Enzyme immunoassays (EIA) for toxin A and/or and hospital epidemiology. 29:1. survives the journey through the digestive system toxin B are the most widely used. These tests are Quintiliani M.D. (2007)., Pharmacodynamics of and finally makes residence in the intestinal tract. more cost-effective. They have a quick turnaround Antimicrobial Agents: Time-Dependent vs. Concentration- Once this has occurred, the patient is now colonized. time, yielding results the same day if the specimen Dependent Killing Colonization means that the organism is present Zilberberg, M. (2009). Clostridium difficile--related arrives to the lab in time, and with test results the Hospitalizations among US Adults, 2006. Emerging but not causing disease. The spores that exist, next day in most cases. However EIA assay are not even after the death of the bacteria itself, are viable Infectious Diseases, 15(1), 122. Retrieved from MasterFILE recommended for testing the stools of patients less Premier database. and germinate into vegetative bacteria while in the than one year of age, because the testing lacks intestine (Bobulusky et al., 2008). A patient with specificity for that age group. Cell cytotoxicity assays Disclaimer: This material is provided by the Oklahoma Clostridium difficile infection has skin contamination are more sensitive, being referred to as the gold Foundation for Medical Quality, the Medicare Quality with the bacterial spores over the surface of the standard, however, the test requires the maintenance Improvement Organization for Oklahoma, under contract body and not just in the stool. Once the patient has of live cells for testing, is more costly, and tests with The Centers for Medicare & Medicaid Services, an recovered from CDI, the patient remains colonized require 48-72 hours to yield a final result. It is also agency of the U.S. Department of Health and Human (Quintiliani, 2007). Services. The contents do not necessarily reflect CMS possible to culture the stool specimen for Clostridium policy. HAI-1015-OK-0310 When the patient has an illness requiring difficile, but a culture requires 72 hours, with antibiotics, the goal is to achieve the appropriate antimicrobial killing concentration for the appropriate period of time required to kill the pathogen without killing the other organisms in the patient’s body, which make up the patient’s normal flora. All antimicrobials have the potential to cause CDI and CDAD, however, increased risk have been noted with the use of certain antimicrobial classes, such as cephalosporin’s, clindamycin, and fluoroquinolones. Another alarming concern is the emergence of the B1/NAP1/027, a strain of Clostridium difficile associated with severe disease in adult and pediatric populations. B1/NAP1/027 has been identified as the causative organism of disease in populations that had no exposure to healthcare facilities and had no recent antibiotic use (APIC, 2008).

Surveillance, Tests to Identify CDI, and Interventions Nurses and other health care workers can quickly stop the spread of this infectious disease by using a few simple steps. It’s easy as 123 and ABC. The ABC’s of preventing the spread of CDI can be noted with the following acronym: A—Antibiotic Stewardship. Nurses are patient advocates. They must use nursing expertise to identify when an antibiotic may not be appropriate or be ready for discontinuation. Prompting licensed providers to consider discontinuation of unnecessary antibiotics is one of the first steps to stop the symptoms of infectious diarrhea. According to the Centers for Disease Control (CDC), “In 23% of patients, Clostridium difficile-associated disease will resolve within 2-3 days of discontinuing the antibiotic to which the patient was previously exposed. The infection can usually be treated with an appropriate course (about 10 days) of antibiotics including metronidazole or vancomycin (administered Page 16 • The oklahoma Nurse June, July, August 2010 Team Building: A Continuous Challenge for Today’s Nurse Leaders Susan Dellegar, BS, RN, Clinical Manager that nurse leaders must set clear and achievable goals not held accountable to the team’s interests and goals, St. John Hospital-Tulsa for self and staff. The “U” represents the skill sets nurse the tendency is to look out for their own interests. This leaders must utilize to create healthy teams. Strong is the ultimate dysfunction: The tendency of team It is difficult to pick up a health-care or nursing skills will create confidence and strengthen the patient members is to seek out individual recognition and journal today without seeing an article chastising care team. Team power, “C” is acquired by creating attention at expense of team results. healthcare teams for their lack of teamwork. There a clear, purpose-driven patient-care team. The “K” 5). Inattention to Results—To focus team members are many teambuilding models available addressing keeping a positive account represents the responsibility on building a functional team, it is essential teambuilding principles and competencies. This article to reward behaviors that reflect the team’s purpose that: concisely presents an overview of two prominent and value. Such rewards aim at achieving positive • Leaders and team members make the models, the PUCK model (Blanchard, 2001) and patient outcomes and effective team work. As this collective ego greater than individual egos. Lencioni’s Functional Team model (Lencioni, 2002). example shows, the PUCK model can be easily applied • Leaders don’t leave any room for Both of these models are presented as fables in short, in nursing. As a Nurse Leader utilizes this model, the interpretation when it comes to defining informative and enjoyable books. The PUCK model is results will be effective teambuilding and better patient results. summarized first followed by Lencioni’s model. care. • Expected results must be stated simply and Ken Blanchard and colleagues’ (2001) write about Lencioni’s (2002) “Five Dysfunctions of a Team” is a specific enough to be actionable. a man who, after being fired from his job for not being leadership fable about a technology company struggling • Team performance must be measured a team player, learns the skills of team building and to attract and keep customers. The new CEO recognized regularly so the team can react more team participation by coaching his son’s hockey team. the company’s innovative products and great talent was quickly on needed changes. The acronym PUCK is used to illustrate how repeated negated because the executives were not a team: They • The focus must be on creating the best reward and recognition focused on aligned behavior is were struggling but unable to agree on an appropriate team possible, not shepherding careers of the key to forming successful teams. The PUCK model, solution to their problems. The team eroded into individual athletes. discussed below, stands for providing, unleashing, naming, blaming and shaming. No one was accepting • Goals are reviewed regularly and addressed creating and keeping. responsibility nor making important decisions, quickly when unmet. P = Providing: Clear Purpose and Values—A deadlines were being missed, morale was declining, and • Resources are re-directed as indicated to Compelling Reason for Being the company was losing the battle for market share. achieve results. • Create a challenge, a reason for being, and a “holy Lencioni (2002) illustrates team dynamics and team Lencioni (2002) asserts that addressing these five grail” that commits and motivates people to work work by showing what teamwork is not, termed the five dysfunctions results in cohesive teams that trust one together. dysfunctions of a team. Then he provides a clear picture another; address conflict; commit to decisions and • Set clear and compelling goals and strategies, both of how a healthy team interacts and what it feels like plans; hold one another accountable; and focus on the for the individual and the team. to be part of a successful team. To achieve this goal achievement of collective goals. • Be clear about your values. requires that leaders address the team’s dysfunctions In nursing, the dysfunctions identified by Lencioni • Create a team charter that formalizes head on: Ambiguity is the enemy of results. The five can adversely affect a nursing team. The absence of commitments to each other and clearly states dysfunctions are discussed below accompanied by trust occurs when nurses do not address concerns what the team wants to accomplish, why it is strategies to move dysfunctional teams to healthy with physician or co-workers. Lack of commitment important, and how the team will work together to teams (Lencioni, 2002). may occur when a lack of direction and commitment achieve results. to patient care results in nurses’ lack joy in their work. U = Unleashing: Developing Skills—Developing Your 1.) Absence of Trust—Team members must: The fourth dysfunction, avoidance of accountability, is Bench Strength • Open up to each other. seen when the nurse leader does not give staff clear sets • Start with the basics: Build individual skills that • Operate without fear of reprisal. of expectations. In these cases, staff may choose silence will bolster team skills. • Overcome the need for invulnerability. rather than confront behaviors not conducive to team- • Provide feedback to build skills, confidence, and 2.) Fear of Conflict—Failure to productively building. The fifth dysfunction, inattention to results, accountability. address conflict: is known in nursing as “eating their young.” They • Learn each other’s roles. • Leads to preservation of a sense of artificial put their own personal needs and egos ahead of their • Build a sense of personal and collective power by harmony. colleagues; ultimately the team and patient care suffers. using individual and collective skills to achieve • Results in the ability to accept some conflict, Nurse leaders must quickly address these dysfunctions extraordinary results. acknowledging that no one gets use to and redirect team member behaviors to achieve positive C = Creating: Team Power—None of us is as smart conflict. actions and outcomes. as all of us: Synergistic harmony. 3). Lack of Commitment—Arises from failure to Research has shown that positive teamwork • Build a game plan for the team and stick to it. hear all the teams concerns before making a results in collaboration, improved problem-solving • Share leadership. decision: and communication, increased morale, and, • Reward team work. • Is evidenced by ambiguity. ultimately, improved patient care outcomes. The key • Rotate positions to build flexibility, introduce • Thus, if people don’t feel like they’ve been to teambuilding is creating a framework with clear change, and build mental and physical skills. listened to, they won’t really get on board expectations and open communication. As nurse • Turn individual skills into team skills. (committed). leaders, we must develop and encourage others to apply K = Keeping: The account on the Positive—Repeated 4). Avoidance of Accountability—All team members team-building strategies that can improve teamwork Reward and Recognition are not on the same page results in: and patient care. • Look for behaviors that reflect the team’s purpose • Organizational leaders won’t hold each other and values and reward, reward, reward! accountable because they want to avoid References • Catch people doing things right or approximately interpersonal discomfort. Blanchard, K., Bowles, S., Carew, D., & Parisi-Carew, E. • Lowered standards. (2001). High five! The magic of working together. New York: right. Harper Collins. • Redirect toward the goal; do not punish. Lencioni, P. (2002). The five dysfunctions of a team: A Lencioni (2002) points out that some employees are • Link all recognition and reward back to the leadership fable. San Francisco: Jossey-Bass. purpose and goals (Blanchard, 2001, p. 189-190). hard to hold accountable. They may appear to be helpful or become very defensive and intimidating. These team Susan is an OUHSC Graduate Student in the Nursing members must be ‘pushed respectfully’ for the team to This model can be used by the nurse leader in staff Administration Pathway. interactions. The “P,” clear purpose and value, means become a functional team. When team members are June, July, August 2010 The Oklahoma Nurse • Page 17 Cultures of Candor Betty R.Kupperschmidt, EdD, RN,NEA-BC. provisions for nurses to nap. However, the authors Associate Professor, Director, Nursing danced around the suggestion of changing from Administration Pathway. OUHSC-Nursing 12-hours shifts that reportedly increase nurses’ ONA Member, Region 2 fatigue and error potential. Virtuous Truth The act must meet the criteria Cultures of candor have listed in Box 1. When these criteria are satisfied, acquired new implications employees have a moral obligation to speak the truth in today’s health care to power if the actions of leaders might be harmful to any of the stakeholders. An organization in which environment; thus, candor Conclusion employees are empowered to know (verify) and speak is a central, urgent issue for Digital technology has changed the rules of the the truth is an integral part of a culture of candor. Nurse Leaders. This article game: Cultures of candor are no longer a choice Speak the Truth to Power Nurse Leaders foster presents selected thoughts but a business reality. Nurse Leaders who nurture speaking the truth to power as they treat employees from Bennis and colleagues’ cultures of candor are better positioned to maintain with respect, share relevant information, and include book Transparency (2008). employees’ and customers’ trust and respect even in them in decision making. This results in employees the face of disappointing outcomes. Essential Elements of cultures who are more willing and better able to provide key of candor information to the leader. Selected impediments to achieving cultures of Candor is an interpersonal Box 1. Criteria Required for Virtuous Truth candor are briefly discussed. process that promotes the Betty 1. Communication must be truthful; do no authentic expression of Kupperschmidt harm to innocents; and not out of spite or Employee Impediments different points of view in anger. Vital Lies Employees learn how to keep secrets search of actionable wisdom. A culture of candor 2. Communication must not be self-interested: (vital lies) at home and they bring this learned exists when there is a free flow of information and the benefits must go to others, or to the behavior to work with them. They learn the things critical information gets to the right person at the organization. to notice, what to say about what they notice, and right time for the right reason. This free flow of 3. Communication must be the product of the things not to notice, and they learn to never say information happens in environments where there moral reflection on right versus wrong and a anything to outsiders about the things they ‘don’t’ is sufficient trust for people to be authentically open messenger who is willing to pay the price. notice. and candid. Cultures of candor are comprised of 4. Communication must have at least a chance Candor-based Fear Candor-based fear is fear of integrity, trust, speaking the truth to power, and of bringing about positive changes. virtuous truth that allow leaders and employees to job retribution (risk losing influence and support); deal fairly with each other. social retribution (risk damaging social network); Integrity Nurse Leaders acting with integrity hurting others’ feelings (risk being perceived as References practice what they preach. When a mistake is disagreeable); losing face (risk looking bad); and fear Transparency: Bennis, W & Goleman,D & O’Toole,J & made, leaders call for an intensive postmortem as a of change. Biederman, P. (2008) San Francisco: Jossey-bass learning opportunity. When leaders are consistent in their approach to errors, employees know the rules Organizational Impediments Dr. Kupperschmidt (AKA Dr. K) has been assisting of the game won’t change and they are more willing Organizational Design Organizations with with editing papers sent to ONA for potential to tell the truth. many levels and checkpoints stifle information flow. publication. Our intent has not been to hide her but Trust Cultures of candor and trust are always The need for speed, hidden ground rules, such as just take advantage of her commitment to ONA and linked. Trust is an outcome of the Nurse Leaders’ employees’ perceptions about what can and cannot The Oklahoma Nurse. It seems that we should let accumulated actions and behaviors. Trust is hard to be said during meetings, may mitigate against readers know of her service. We felt that potential earn, easy to lose, and once lost, nearly impossible to cultures of candor. authors might have wondered why they were getting regain. Trust is a hard-edged economic driver, and a correspondence from Dr. K when they had submitted learnable and measurable skill. Nurse Leader Impediments something to ONA. In addition, Dr. K is available to There are 4 practical actions Nurse Leaders Shimmer Effect The best antidote to this assist those of you who have an idea you would like can take to foster trust: 1. provide equal access to effect, the belief that the leader’s motives cannot to discuss with someone or you may want to send information for everyone; 2. refrain from punishing be questioned, comprise seeking information from information to someone for critique and editing. She staff that constructively call attention to flawed employees at every level of the organization. is available and willing to work with you. assumptions or decisions; 3. refrain from rewarding Hubris Nurse Leaders may believe they are Dr. Kupperschmidt is Associate Professor and staff who echo only what they think the Nurse ‘wiser’ and thus fail to listen to, receive, and act Director, Nursing Administration Pathway, OUHSC Leader wants to hear; and 4. empower and reward upon others’ input. Sharing and supporting this College of Nursing. She has a rich history of principled contrarians, staff who speak virtuous hubris can lead to groupthink, a state of collective professional leadership in ONA, in education, and truth. denial supported by efforts to protect shared views service. We encourage you to take advantage of her In cultures of candor, Nurse Leaders challenge and assumptions. When the glue that binds groups willingness to work with you. She can be reached at assumptions, rethink basic premises, and question, is toxic, it can be an impediment to candor. [email protected] revise, and unlearn outmoded truths. The more Leadership Style Bennis et al. assert that great basic the assumptions, the less likely they are to be leaders possess the feminine virtues of humility, questioned (2008,p. 45). Twelve-hours shifts come inclusion, vulnerability, service to others, and to mind here. The Washington Nurses Association respect for people. Leadership candor mandates shared a white paper containing invaluable a leader to dare to listen, make it safe for others to information related to nurse fatigue, especially after express their perceptions, and provide feedback in a working 12.5 hours. Strategies included making way that allows employees to save face. These virtues are essential for nurturing cultures of candor. Page 18 • The oklahoma Nurse June, July, August 2010 Service Learning: Creating Lasting Bonds Authors LeeAnn Sipes, BSN, RN & Nurse educators across the world have recognized essential to gain maximum benefit from all the Helen Farrar, MS, RN, B-C that inclusion of service learning into nursing parties involved. curriculum promotes this behavior post-graduation. Incorporation of service learning into the associate Affiliation: Rogers State University Literature supports the inclusion of a service degree program in nursing at Rogers State University learning component into educational programs to (RSU) began with identification of those core promote civic engagement and expand the learning competencies that service learning and the program Helen Farrar, ONA Member, Region 2 environment for students and faculty. Potential as a whole shared. Participation in service learning benefits to nursing students include personal and reflects course objectives of caring interventions, Nursing is a service oriented profession full of professional development, increase in self directed collaboration and communication. Reflection of these caring, compassionate individuals who are able to learning and an increased connection between course objectives in the service learning activities earn a livelihood caring for clients in need of their theory and practice. The institution has the potential provided an additional opportunity for the students nursing expertise. Many nurses donate their time to benefit from increased institutional visibility, to incorporate these ideals into their personal and skill set in the community for both personal student and faculty engagement in college life and nursing identity. Students were self-directed in the and professional reasons. Nurses often report student retention. Nursing student service learning choice of their service learning and as recommended that these activities provide a level of personal activities of a health promotion nature have the by the literature; were required to complete a journal satisfaction and well-being beyond what they receive potential to benefit the health and wellness of the reflection exercise by the conclusion of the semester. in their workplace. Community service; also called community at large. Reflection was defined as an active, persistent, service learning is identified as a key competency Although research is present to support the thoughtful consideration of the experience. Faculty for programs educating health professionals. Many benefits of service learning in higher education, team members facilitated the refection process by healthcare institutions promote service learning in there are little formal guidelines for its incorporation asking questions for the students to reflect on such their framework and use these activities as part of into nursing programs, especially at the associate as “Why am I doing it?” “What am I learning?” a career ladder. Whether driven by a personal desire degree level. The majority of institutions are directed Faculty team members then engaged students in to help others or a professional expectation, working to incorporate these elements in ways that are discussion using a computer based discussion board in a volunteer capacity is a natural extension appropriate, convenient and reasonable for the format. of fundamental nursing principles of assisting organization to achieve. At the associate degree level, After the incorporation of the service learning ourselves and others to achieve the highest possible this inclusion of additional program requirements component into the associate degree in nursing level of wellness. has the potential to further strain a crowded program RSU faculty, institution and the local Nursing education is the primary means for curriculum. The immersion of service learning community voiced overwhelmingly positive the instillation of service learning concepts. as part of the curriculum rather than additive is comments. A student participant voiced that “prior to volunteering I experienced reservations about whether this, nursing is what I am supposed to be doing but after volunteering….I am confident that I am headed to the career that is right for me and I do have enough compassion” (volunteer at local free clinic). June, July, August 2010 The Oklahoma Nurse • Page 19 Signs of Humor

Corny Passalongs some influence, try orderin’ somebody else’s dog Digging in the Dirt Humor Why do potatoes make good detectives? Because around. Don’t pick a fight with an old man. If he is they keep their eyes peeled. too old to fight, he’ll just kill you. (e-mail 2002) Diane Sears, RN, MS, ONC My wife’s a water sign. I’m a earth sign. Together ONA Member, Region 2 we make mud. (Rodney Dangerfield) Mother Nature’s Gardening Humor God made rainy days, so gardeners could get the Finding a coiled two foot snake under a trashcan, The Tomato Garden housework done. while sweeping the patio An old Italian lived alone in New Jersey. He Gardening is a sport. Hoe for it. Being dive bombed by martins, while hoeing corn wanted to plant his annual tomato garden, but it was What did the bananas do when it saw the Getting stuck in mud up to your knees very difficult work, as the ground was hard. His only monkeys? Split. Walking into a sticky spider’s nest strategically built son, Vincent, who used to help him, was in prison. What do you get if you divide the circumference of the night before, not knowing where the spider is The old man wrote a letter to his son and described a pumpkin by its diameter? Pumpkin pi. Oklahoma sheer force winds leveling your plants, his predicament. Dear Vincent: I am feeling pretty What do you call a stolen yam? A hot potato. flat sad, because it looks like I won’t be able to plant my Knee: a device for finding rocks in your garden. “Will Sing for Worms” robins tomato garden this year. I’m just getting too old to be Bulb: potential flower buried in Autumn, never to Praying mantis impersonating a flower bud digging up a garden plot. I know if you were here my be seen again. (Henry Beard) Cat Gardeners troubles would be over. I know you would be happy to When did my wild oats turn to prunes and all dig the plot for me, like in the old days. Love, Papa. bran? (Lucy Parker) You might be a Redneck Gardener if: A few days later he received a postcard from his son. What lives in winter, dies in summer and grows You think a chain saw is a musical instrument. A Dear Pop: Don’t dig up that garden. That’s where the with its root upward? An icicle. half moon reminds you of your spouse pulling weeds. bodies are buried. Love, Vinnie. At 4 AM the next Just wanted you to know I have entered the Kudzu covers your arbor. You’ve ever cleaned your morning, FBI agents and local police arrived and snapdragon part of my life. Part of me has snapped... house with a leaf blower. You empty the trash when dug up the entire area without finding any bodies. and the rest of me is draggin. (e-mail 2008) you have enough to fill the pickup. You can amuse They apologized to the old man and left. That same yourself for more than an hour with a hose. You’ve day the old man received another letter from his son. Old Farmer’s Advice been cited for reckless driving on a lawnmower. Dear Pop: Go ahead and plant the tomatoes now. Your fences need to be horse-high, pig-tight and (Mike Garofalo) That’s the best I could do under the circumstances. bull-strong. Keep skunks and bankers at a distance. Love you, Vinnie. (email, 2002) Life is simpler when you plow around the stump. I have no plants in my house. They won’t live for A bumble bee is considerably faster than a John me. Some of them don’t even wait to die, they commit The top three hobbies of nurses I’ve known have Deere tractor. Forgive your enemies; it messes up suicide. (Jerry Seinfeld). For nurses with this level of been reading, cooking and gardening. Maybe our their heads. Do not corner something that you know green thumb talent, I have two words for you, “silk innate gardening interests arise from the healing is meaner than you. When you wallow with pigs, plants.” pharmaceuticals found in so many plants. I’m one expect to get dirty. The best sermons are lived, not of those nurses who loves to garden with flowers, preached. Most of the stuff people worry about ain’t For Oklahoma summers, try at least one patio vegetables, landscaping, people. I even gardened at never gonna happen anyway. Don’t judge folks by cherry tomato plant and some zinnias. They’re work. My office feels naked without something green their relatives. Don’t interfere with somethin’ that guaranteed to improve your humor. Remember that and growing in it. I had a huge airplane plant with a ain’t bothering you none. Good judgment comes each year gardening is an experiment and “Bloom profusion of babies that provided many smiles and from experience, and a lotta that comes from bad where you are planted.” (Mary Engelbreit) conversations through passalong plants given to a judgment. If you get to thinkin’ you’re a person of patient, their family member, visitor or co-worker. Page 20 • The oklahoma Nurse June, July, August 2010 To Build our Future Engaging Students in a Creative Clinical Experience We Have to Remember our Past… Authors: Carla Lynch, MS, RN associate program. Helen Farrar, MS, RN, B-C Collaboration and inter-level association LeAnne McWhirt RN, BSN, CWCA was promoted through the formal presentation MRMC Wound Management & Hyperbaric Center Authors Affiliation: Rogers State University Helen Farrar, ONA Member, Region 2 format of this project. Level one nursing students ONA Member, Region 3 were required to attend the level two student Maintaining nursing student enthusiasm for presentations, which served as an introduction to When I hear the name “Florence Nightingale” the content has always been a challenge for nurse mental health nursing. As audience members, level words that pop into my mind are: seeker, rebel, founder, educators. This challenge seems to increase in the one nursing students saw professionalism and the servant, and visionary. Other immediate responses final semester of nursing programs as students use of evidence-based nursing actively role-modeled are: war hero, Lady with the Lamp, evidence based switch their focus from the student role to the by the presenting students. To evaluate student practice, and first wound care nurse. Ms. Nightingale is professional role. For many programs, the mental perception of this curriculum alternative, a mental our founder who set forth a chain of events that have health component of nursing education is situated health project survey was developed and feedback brought us to where we are now. in the final semester at a time when engagement was solicited from students and clinical faculty The philosopher Nietzsche once said, “He who has a may be waning. The mental health clinical rotation following IRB protocol at RSU. Ninety-six percent why to live can bear almost any how.” I identify Florence is typically less hands-on than a traditional medical of surveyed students rated the project as a more as a seeker because she knew she had a calling in life surgical clinical experience thus further decreasing engaging alternative to the traditional case study. and she dedicated her life to seeking and fulfilling that student engagement. Student feedback included, “I would highly purpose. She was initially a student of God’s word and To combat waning student engagement, Rogers recommend keeping this in the curriculum,” “this later a teacher of the nursing profession and theory. State University (RSU) associate program nursing project was fun but difficult, it was hard to find She was born in a time when nursing was not a noble faculty piloted a capstone project in the mental time for the group to all meet,” “group work can be profession and to her parents dismay chose to fulfill a health clinical rotation. The associate level nursing difficult at times…I felt I learned a lot more about path and so I also identify her as a rebel. She chose her curriculum is packed full of content, so creativity is mental health than if I would have done a case path based on her own belief and broke the “mold” of often stifled by the need to teach key content. In an study.” Clinical faculty survey comments included, that era. effort to increase student desire to learn, creativity “I was impressed by the creativity displayed…they Florence Nightingale was also a great founder in and inter-student collaboration, the project asked asked a lot more questions in the clinical area about our history. During the Crimean War she cared for the students to demonstate the ability to meet clinical the care of their patients,” “it was harder to evaluate wounded and the sick. And during that time she also objectives through a group presentation versus the individual contribution to the project until the was the first to bring forth evidence based practice. the traditional written case study. In contrast day of the presentations,” “students were excited to Ms. Nightingale’s research determined that prior to to traditional, individually written clinical care show off what they had learned.” nurses providing care in the war the mortality rate of plans, students were divided into small groups RSU faculty continues to pilot this alternative those sick and wounded was an astounding 60% and that collaboratively researched and presented clinical component during the spring 2010 semester six months after nursing care was incorporated the information on a mental health topic of interest to mental health clinical rotations. Data collected mortality dropped to 2%!!!! In my eyes this was a HUGE them. Clinical faculty (both adjunct and full-time) thus far indicates overwhelming preference for the step for nursing! This was the first evidence to prove served as a resource for students during the project mental health group project as stimulating creative that nursing care definitively changed the outcomes of from the time of conception to presentation. The clinical learning in the mental health clinical our patients. She had a vision for nursing and took that project incorporated evidence-based nursing, clinical rotations. Further evaluation of this type of clinical vision to the next level in setting precedence for nursing experiences, and met clinical learning objectives. requirement may lead to the incorporation of other in the future. This strategy may be commonplace in a bacclaureate creative clinical assignments throughout the I believe we have to look at our past to truly see our nursing program but is not typical of a five semester associate level nursing curriculum. future and what an outstanding past we have. Florence Nightingale was a servant and her faith in God led her down the path of nursing. We cannot move to the future without truly looking at our past. This Nurses Day and everyday I hope that we honor our past and truly be servants, seekers, rebels, founders, and visionaries!!! Dentistry and Nursing: Bridging the Gap We have the history and we have the ability to use our past to expand and ever improve our future as nurses. Denise Senger, BSN, MPH and area, oral hygiene, restoration, hygiene and a Together we all share our great history and our vision Lisa Lee, MS, RN, Faculty pediatric station. Once the designated procedure was for the future. We have and do make a difference in OUHSC College of Nursing completed, clients were directed to the pharmacy the life of all we touch and what a great profession to ONA Members, Region 2 station, where the OU College of Pharmacy students choose! dispensed medications. ‘Leave your Ego at the door.’ This is the sign that The pressing question on the nursing students’ greeted us upon arrival at the Tulsa Civic Center, minds before they began this mission of mercy was: where the Oklahoma Mission of Mercy Dental How does nursing and dental caries go together? Clinic was held February 5th and 6th (in below Following the experience, students submitted freezing temperatures). The Mission: To provide journals reflecting on their experience. Faculty were much needed dental care. Our mission: To be part not surprised by their answers, but maybe you will of a “MASH—style free dental clinic designed to be! treat the most pressing needs of approximately 1600 …this has to be the most memorable community patients that are either uninsured, underinsured, assignment I will ever have. or would normally not have access to dental care.” …I try not to be hung up on feel-good things, but (“Volunteers,” 2010). on this day it is not hard to be proud to be a nurse The goal was to treat as many people as possible in-training helping people out. in two days for dental troubles ranging from …teamwork was a major part of today. Everyone cleaning, extractions, and even root canals. What an was doing what needed to be done no matter their exceptional opportunity for nursing students to be title a part of this service learning activity in their own ...the most interesting part is it wasn’t geared just community! toward homeless people, so many had good income The variety of the volunteers was staggering, but just did not have dental insurance. including a large number of dentists, dental …no one was more important than anyone else hygienists, pharmacists, pharmacy students, …I was so empowered after leaving, I am proud physicians, and 32 University of Oklahoma Nursing and honored to be a part of something that helped students. so many Beginning at 0430 Friday, the nursing students …I liked that no matter what your professional found their assignments at the 16 tables set up for role was, you did whatever needed to be done. intake and triage on the upper part of the Arena. …we weren’t just providing dental services at this This was an essential station because it was the event; we were providing a touch and a smile. first encounter with clients. The nursing students …I quickly learned how greatly oral care impacts obtained vital signs and performed finger stick blood a person’s entire well-being. sugars on all the clients under the supervision of the Reference nursing faculty. Volunteers. (2010). Retrieved March 28, 2010 from The real action began on the Convention Center http://www.okmom.org/volunteers main arena. There was a numbing station, surgical June, July, August 2010 The Oklahoma Nurse • Page 21 American Nurses Association/Oklahoma Nurses Association Membership—It’s Your Privilege! Tribute to Florence Makandi Mubichi Online Registration is available at Nov. 21, 1953-Mar. 16, 2010 www.OklahomaNurses.org Evelyn Acheson, PhD, RN The University of Oklahoma, College of Nursing 6414 North Santa Fe, Suite A • Oklahoma City, OK 73116-9114 • Phone: 405-840-3476 • 1-800-580-3476 • Fax: 405-840-3013 ONA Member, Region 2 Please type or print clearly. Please mail your completed application with payment to: ONA. Florence Mubichi was a Last Name______First Name______Middle Initial ______student, then a peer and most of all a friend. On the long Street or PO Box Number______journey to return to her home in Meru, Kenya in February City______State______Zip______County______when she realized the end was near, we had opportunity to Last Four Digits of Social Security Number______Email______reflect on her life and career that spanned 27 years. I share Home Phone______Work Phone______Cell Phone ______the following tribute: She began her nursing Home Fax______Work Fax______Pager ______career as an Enrolled Nurse (equivalent to LPN in the Employed at______as______US) in 1973 in a Methodist Florence Mubichi mission hospital and school Employer’s Address______of nursing in Maua, which at that time was one of the few opportunities for her to continue her education. She Academic Degree(s)______Certification(s)______married her high school sweetheart, Stephen Mubichi Paul after completing the EN program. She excelled Graduation from basic nursing program (Month/Year)______/______RN License # State______Date of Birth______/______/______in that program as she had done in secondary school (high school) before that. As a result of her outstanding abilities she received a scholarship at Aga Khan Membership Categories (please choose one category) Hospital Nursing School in Nairobi to pursue a diploma ❏ ANA/ONA Full Membership Dues in Registered Community Health Nursing, completing Employed full or part-time $22.00 per month or $258.00 annually. Includes membership in and benefits of the American Nurses that program in 1976. Association, Oklahoma Nurses Association and the ONA District Association. Between 1979 and 1987 she completed Midwifery training, served as acting Matron (Director of Nursing), ❏ ANA/ONA Reduced Membership Dues clinical instructor in the mission nursing school in Not employed RNs who are full-time students, newly-licensed graduates, or age 62+ and not earning more than Social Security allows Maua, and BSN in the US at Oklahoma City University. $11.25 per month or $129 annually. Includes membership in and benefits of the American Nurses Association, Oklahoma Nurses After completing the BSN she returned to Kenya serving Association and the ONA District Association. as Principal Tutor (Dean or Director) of the mission nursing program where she had studied in Maua. ❏ ANA/ONA Special Membership Dues Under her leadership, the school and their graduates 62+ and not employed, or totally disabled $5.88 per month or $64.50 annually. Includes membership in and benefits of the American were top performers in all of Kenya. Nurses Association, Oklahoma Nurses Association and the ONA District Association. As a life-long learner, she continued her education ❏ ONA Individual Membership Dues again in the US, at Benedictine University in Chicago Any licensed registered nurse living and/or working in Oklahoma $10.92 per month or $125.00 annually. Includes membership in and earning a Masters’ in Pubic Health degree, and later a benefits of the Oklahoma Nurses Association and the ONA District Association. second masters’ in Nursing Education at the University American Nurses Association Direct Membership is also available. For more information, visit www.nursingworld.org. of Oklahoma. When she enrolled in my course at OU, she made an appointment before the class started to see what she could begin working on. When I told her Communications Consent I had worked in Africa for several years, she said, “Oh, I understand that by providing my mailing address, email address, telephone number and/or fax numbers, I consent to receive communications I am so lucky to have you as a teacher.” I don’t believe sent by or on behalf of the Oklahoma Nurses Association (and its subsidiaries and affiliates, including its Foundation, District and Political I have ever had a student say that before or since. She Action Committee) via regular mail, email, telephone, and/or fax. had recently completed all requirements and was ready for her dissertation at Walden University at the time of Signature______Date______her death. Florence and I discussed her contribution to nursing Dues Payment Options (please choose one) in both the US and Kenya and she estimated that she SIGNATURE REQUIRED BELOW ❏ Annual Payment Charge to My Credit/Debit Card had taught well over 3,000 nurses in her career. At a ❏ Automatic Monthly Payment Options Make check payable to ONA or fill out ❏ VISA (Available for Annual or Monthly Draft Payments) time when Kenya had few nursing programs, 3,000 This is to authorize monthly electronic credit card information below. ❏ MasterCard (Available for Annual or Monthly Draft nurses constitutes a tremendous impact on both payments to American Nurses Payments) nursing and health care in this East African country. Association, Inc. (ANA). By signing SIGNATURE REQUIRED BELOW She would probably not have been a nurse at all if it on the line, I authorize ONA/ANA to ❏ Automatic Annual Credit/Debit Card Number______weren’t for the notice of her exceptional personality, withdraw 1/12 of my annual dues and any Payment Exp. Date______capabilities, persistence and intellect by the Methodist additional service fees from my account. This is to authorize annual credit Verification Code______Missionaries who then assisted her to earn nursing *SEE AT RIGHT card payments to American Nurses Signature______credentials, first as an Enrolled Nurse (LPN), then Association, Inc. (ANA). By signing below to a diploma program, and later BSN. Florence then ______I authorize ONA/ANA to charge the credit * By signing the Automatic Monthly continued her academic career to earn two masters’ Automatic Monthly Payment Authorization Signature card listed below for the annual dues on Payment Authorization or the degrees and was all but dissertation (ABD) for her the 1st day of the month when the annual Automatic Annual Credit Card Payment doctorate in Community Health Education when she ❏ CHECKING ACCOUNT: Please renewal is due. Authorization, you are authorizing ANA died. enclose a check for the first month’s *SEE AT RIGHT to change the amount by giving the The world is a better place because of Florence payment, which will be drafted on or undersigned thirty (30) days advance Mubichi, and I am a better person for having known after the 15th day of each month using ______written notice. Undersigned may cancel her. the account designated by the enclosed Automatic Annual Payment Authorization Signature this authorization upon receipt by ANA check. of written notification of termination twenty (20) days prior to deduction ❏ CREDIT/DEBIT CARD: Please date designated above. Membership complete the credit card information at will continue unless this notification is right and this credit card will be debited received. ANA will charge a $5.00 fee for on or after the 1st of each month (VISA any returned drafts or chargebacks. and MasterCard Only). Page 22 • The oklahoma Nurse June, July, August 2010 Specialty Nurses Association What is CMSA-OK and What Nurses Do can be an Organizational What Can It Do For You? By Peggy S. Hart Miller, PhD., RN Affiliate of ONA Political Activities Director, ONA by Micki Johnson ONA Member, Region 6 The Oklahoma Nurses Association encourages ONA Organizational Affiliate nursing and health-related organizations to become Legislative Day has come and gone but the organizational affiliates of ONA. They must first The Case Management Society of America- legislators are still in their appointed places busy meet the basic requirements set by the ONA Board Oklahoma Chapter is a professional organization about their appointed tasks. Nurses know the of Directors. These requirements include that the dedicated to the support and development of Case/ importance of sharing with their elected officials organization has a governing body comprised Care Management. CMSA-OK was formed in 1992. those issues that impact nurses and the public of a majority of registered nurses. In addition We serve local Case Managers and those who that is served. In fact, legislators most who are the organizational affiliate must pay an annual support Case Management in all practice settings not nurses, depend on nurses to share and direct fee of $500 and be approved by the ONA Board and areas of care coordination, including Workers decisions of public health concern. Nurses are a of Directors. Organizational Affiliates are also Compensation, Hospital, Social Services, and Home valuable resource. responsible for maintaining a mission and purpose Care. Our Chapter is part of a national organization Health Care Reform has passed at the federal level harmonious with the purpose and functions of ONA. 11,000 members strong with approximately 70 and now the states must decide how to implement Benefits to these organizations include: a Chapters. Some of the upcoming activities CMSA-OK the reform. Nurses can and should be major players voting seat in the ONA House of Delegates and will be sponsoring include: in the delivery of quality cost effective health care. the opportunity to make informational reports or • Educational Meetings providing CE and Nurses must be present at each level of planning presentations to the ONA House of Delegates within networking opportunities. Our next meeting and implementation of the reform. The nurses that the organizations area of expertise; a column in the is May 20th, on the topic of Social Security are involved include each one of you. Every nurse Oklahoma Nurse; a seat on ONA’s Governmental Disability. Check in is 5:30pm. Go to www. in Oklahoma has a story to tell with numerous Activities Committee, which works closely with ONA cmsa-ok.org for details. examples that validate what does and does not work. lobbyists to support nursing issues in the State • Local yearly Educational Conference in the fall Nurses must tell these stories. Nurses must step up Legislature; a reduced Exhibitor rate at ONA/ONSA with more CE credits, networking, and FUN. to the plate and be actively involved in determining Convention for the organization; and many more. This year’s theme is “Going the Distance with solutions that really make a difference and that When a specialty nurse organization joins ONA as Case Management” the Triple Crown: Educate- work. an organization affiliate the individual members also Advocate-Collaborate. It will take place on Nurses must be involved in innovative and creative have individual benefits that include participation October 6th and 7th at UCO Campus. efforts that develop new and diverse positions. in the Nurse of Day program at the Capitol during • Case Management Week festivities Oct 10- “Think tanks” where nurses can brainstorm to solve Legislative Session and reduced registration for 16th including a reception honoring our Case problems that meet health care needs will be exciting convention and conferences which is less than the Manager of the Year and Award of Service and challenging events. Imagine being in attendance non-member fee. Excellence winners as well as our profession. at one of these meetings! My own imagine runs wild. ONA currently has three organizational affiliates: • Golf Tournament at River Oaks Country Club, I shared a vision with the legislative day attendees Clinical Nurse Specialists (CNS), Oklahoma Section July 26th that nurses can and should be the first line care of the Association of Women’s Health Obstetrical and • Political presence representing our members’ providers in the provision of health care. Imagine Neonatal Nurses (AWHONN) and the School Nurses interests on issues affecting Case Management that an advanced practice nurse is employed by Organization of Oklahoma (SNOO). We look forward Professionals and client/patient well-being a large industry and has professional registered to their participation in our events. ONA’s website such as Multi-State Nurse Licensure and the nurses working under her. The registered nurse is www.oknurses.com and is a great resource for Case Management Model Act. performs routine assessments on each employee and information that pertains to ONA and ANA. each member of their family. This nurse provides all If you are interested in finding out more teaching, health prevention and health maintenance information about CMSA-OK, visit our website at for the whole family. Think of the implications. www.cmsa-ok.org. Or contact Micki Johnson at Immunizations are given, emergency room visits 1-800-398-2059 or [email protected]. are decreased, physician visits are decreased, and conditions/medications are monitored. I could go on and on. Situations that cannot be dealt with by the professional nurse are referred to the nurse practitioner. The client situations requiring medical attention would be referred by the nurse practitioner to the appropriate medical care giver. The salaries of the nurses would be provided by the industry. Insurance would be provided for situations requiring hospitalization and/or surgery needs. Expected outcomes of this system would be fewer hospitalizations, fewer clinic visits, healthier employees and their families, less expense for health care for the industry. This is just one example of how nurses might help resolve the health care crisis. What solutions can you think of that apply to your particular situation? Nurses should not be at the table to receive but to give by providing solutions. We are the experts for prevention and health maintenance. That is what nurses do.