May 2016 • Vol. 53 • No. 2

THE OFFICIAL PUBLICATION OF THE MONTANA NURSES ASSOCIATION Quarterly publication direct mailed to approximately 17,000 RNs and LPNs in Montana. President’s Report

It’s hard to believe I’ve been voice. It gives us more conviction as a profession. The a Registered Nurse for 38 end result is, of course, quality patient care. Which is years. The time has gone by what we all strive for in our jobs. pretty quickly. I have been a We have a challenge ahead of us this year bringing Montana Nurses Association Your Nurses Wear Combat Boots to the Legislature. (MNA) member for 26 of those It will take all of us using our voices to stress the years. Looking back, some importance of felony legislation to address this of my memories seem like issue. We need to educate our nurses, healthcare yesterday and others seem workers and community to understand why this is so like a lifetime ago. I have important, not only for the healthcare workers, but for Labor Retreat 2016- Largest Ever! worked in Alaska, Oregon and their patients and their families. Montana. I was fortunate to Of course, there is a lot more going on besides Lorri Bennet, RN Page 3 work in places that challenged MNA President this. Many contracts are being challenged every day in me to grow and become our local bargaining units. Nurses and the MNA staff better at my profession. I feel the same way about are continually meeting with administrations to keep being a member of the Montana Nurses Association. the contracts and the language agreed upon intact. It By volunteering to be active in my professional takes a lot of work but it is well worth it in the end and association, I have had many opportunities to learn these working conditions directly affect our patient so much, not only about nursing or the profession care. but about me and what kind of person I am as a I am very excited to be the MNA President for the professional Nurse and a woman. next 2 years. I believe I am ready for this challenge I have not always had the courage to take a stand and hope to learn more, give more and end up being for myself or my fellow nurses but now I do. I believe a better person and Nurse for it. I’m hoping with the we need to be advocates not only our patients, but for work and input of the Board Members and all of you ourselves and co-workers as well. as MNA members, that we can have many successes. Being a member of MNA and additionally a part I hope to see many of you at the MNA State MNA Local #14 Ratifies First Contract of a Collective Bargaining Unit, gives me a voice and Convention October 5th through the 7th, 2016 in Page 6 us strength in numbers. Our voices are stronger and Helena. It is a great place to start being involved in more collective and heard more frequently as one your professional organization

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PULSE SUBMISSIONS PUBLISHER INFORMATION & AD RATES Circulation 17,000. Provided to every registered nurse, licensed practical nurse, nursing student and nurse-related employer in Montana. The Pulse We are gathering articles that are relevant and is published quarterly each February, May, August and November by Arthur appealing to YOU as a nurse. What is happening L. Davis Publishing Agency, Inc. for Montana Nurses Association, 20 Old in your world today? Is there information we can Montana State Highway, Montana City, MT 59634, a constituent member of the American Nurses Association. provide that would be helpful to you? The Pulse is YOUR publication, and we want to present you For advertising rates and information, please contact Arthur L. Davis with content that pertains to your interests. Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. MNA and the Arthur L. Please submit your ideas and suggestions Davis Publishing Agency, Inc. reserve the right to reject any advertisement. to Jennifer. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement. CONTACT MNA [email protected] Acceptance of advertising does not imply endorsement or approval by the Montana Nurses Association Montana Nurses Association of products advertised, the advertisers, or 20 Old Montana State Highway, Clancy, MT 59634 the claims made. Rejection of an advertisement does not imply a product • Phone (406) 442-6710 • Fax (406) 442-1841 offered for advertising is without merit, or that the manufacturer lacks • Email: [email protected] • Website: www.mtnurses.org integrity, or that this association disapproves of the product or its use. MNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable Office Hours: 7:30 a.m.-4:00 p.m. Monday through Friday for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of VOICE OF NURSES IN MONTANA the authors; they do not necessarily reflect views of the staff, board, or MNA is a non-profit, membership organization that advocates for membership of MNA or those of the national or local associations. nurse competency, scope of practice, patient safety, continuing education, and improved healthcare delivery and access. WRITER’S GUIDELINES: MNA members serve on the following Councils and MNA welcomes the submission of articles and editorials related to nursing or other committees to achieve our mission: about Montana nurses for publication in The PULSE. Please limit word size • Council on Practice & Government Affairs (CPGA) between 500--1000 words and provide resources and references. MNA has the • Council on Economic & General Welfare (E&GW) right to accept, edit or reject proposed material. Please send articles to: • Council on Continuing Education (CCE) [email protected]. • Council on Advanced Practice (CAP)

MISSION STATEMENT www.mtnurses.org Welcoming our newest The Montana Nurses Association promotes professional nursing practice, member to the team. standards and education; represents professional nurses; and provides nursing leadership in promoting high quality health care. Jennifer Hamilton is our new Administrative Assistant. CONTINUING EDUCATION She was born and raised in Montana Nurses Association is accredited as an approver of continuing Helena, Mt. She comes to nursing education by the American Nurses Credentialing Center’s Published by: us from St. Peters Cancer Commission on Accreditation. Treatment Center where Montana Nurses Association is accredited as a provider of continuing Arthur L. Davis nursing education by the American Nurses Credentialing Center’s she worked for over 8 years Commission on Accreditation. Publishing Agency, Inc. as the primary scheduler. She worked directly with MNA the physicians, nurses, Jennifer Hamilton Board of Directors administrative staff and Administrative Executive Committee: OUR EXPANSION IS COMPLETE Board of Directors President Lorri Bennet, RN patients. Her strengths are Assistant Now with 108 Psychiatric Residential her natural tendency to be Board of Directors Vice President Terry Dutro, APRN, MSN, Treatment beds, serving Montana children in need of treatment very organized, upfront with concerns and a direct AGPCNP-BC for behavioral, emotional, and psychiatric issues. Board of Directors Secretary Mary Ann Zeisler, MSN, RN, approach to whatever needs to be accomplished in BAN, BA NOW HIRING FOR THE FOLLOWING POSITIONS: the office. Board of Directors Treasurer • RN’s BSN, not required ($2000 Sign-on Bonus) Board of Directors Member at Large Delayne Gall, RN, OCN • LPN’s ($1000 Sign-on Bonus) Board of Directors CPGA Teresa Lehman, CMSRN • Therapists, In-Training, LCPC, or LCSW ($1000 Sign-on Bonus) Board of Directors CE Debby Lee, RN • Teachers EXTENDED CARE FACILITY – Conrad, MT Board of Directors CAP John Honsky, APRN Board of Directors EGW Daylyn Porter, RN, OCN NURSING positions offer new Competitive wages, afternoon Employment Opportunities Council on Practice & Government Joey Traywick, CMSRN shifts offer a shift differential of $1.00 per hour and graveyard Affairs Deanna Evans, BS, RN shifts offer a shift differential of $1.50 per hour. CPGA Eve Franlin, RN MSN Acadia offers a generous Benefit Package that includes: RN | LPN Extended Care Medical, Dental, Vision, 401k, Paid Time Off and Extended Sick Leave. Council on Continuing Education Jennifer Taylor, BSN, RN, CCRN New Graduates are welcome to apply CE Gwyn Palchak, BSN RN-BC, ACM Contact Tawnya L. Mock, Human Resource Department, If you would like more information about our Sara Leland, BAN, CMSRN Acadia Montana, 55 Basin Creek Road, Butte, MT 59701. EOE. Emily Michalski-Weber, BSN, RN facility go to: www.ponderamedical.com Bonnie Hash, BSN, RNC, PN Phone: (406)496-6311, Fax: (406)494-5869. Contact Human Resources at 406-271-2235 or Megan Hamilton, MSN, RN, Email: [email protected] Fax 406-271-3917 [email protected] CFRN, NR-P Margaret Johnson, RN Mickie Simonson, RN, BSN Teresa Menicucci, RN Tammy Wilhite, RN Sandy Sacry, MSN, RN Polly Troutman, MSN, RN-BC

Council on Advanced Practice Terry Dutro, APRN, MSN, CAP AGPCNP-BC Nanci Taylor, APRN Deborah Kern, MSN, FNP

Council on Economic & General Welfare EGW Jack Preston, RN Delayne Gall, RN, OCN Deanna Evans, BS, RN Orpha Montgomery, RNC

Join Our Team National Federation of Nurses Jennifer Taylor, BSN, RN, CCRN Up to $20,000 in sign Daylyn Porter, RN, OCN Glacier National Park, mountains, Lucy Ednie, RN-BC lakes, ski resorts, golf, fresh air, friendly on incentives, DOE: people, and excellent schools all Surgical Services Director accompany this rapidly progressing Pediatric RNs MNA Staff: 303-bed hospital. PICU RNs Vicky Byrd, BA, RN, OCN, Executive Director NICU RNs Pam Dickerson, PhD, RN-BC, FAAN, Director of Continuing Education Operating Room RNs Mary Thomas, BA, RN, OCN, RN Continuing Education Specialist Critical Care RNs Kathy Schaefer, BA, Continuing Education Specialist Long Term Care RNs Robin Haux, BS, Labor Program Director Transitional Care LPNs Amy Hauschild, BSN, RN, Labor Representative Medical Surgical RNs Caroline Baughman, BS, Labor Representative Behavioral Health RNs Sandy Luckey, Labor Representative RN Staff Development Jill Hindoien, BS, Membership & Finance Specialist Coordinator/SNF Jennifer Hamilton, Administrative Assistant

Contact Laurie O’Leary, Human Resources Questions about your nursing license? 310 Sunnyview Lane, Kalispell, MT 59901 • 406-752-1760 Contact the Montana Board of Nursing at: www.nurse.mt.gov [email protected] • www.kalispellregional.org Drug Free • EOE May, June, July 2016 Montana Nurses Association Pulse Page 3 Labor Retreat 2016- Largest Ever!

Randi Weingarten, AFT President “Solution Driven Union”

Thank you to all who participated in our best Labor Retreat yet and are looking forward to 2017 already! Here are comments from our members:

“I had no idea how much the union does for us. “I believe I have gained insight regarding how “This conference has solidified our Local’s need to I am so thankful for this organization and will be important it is to be involved. I now have the reach out to the community we live and work in.” sharing with my coworkers.” confidence to step up and be a leader.” “Working as a team to support each other.” “Great conference, loved the interactive activities. “Great learning each day!! So many nurses need to “Great Conference! Thank you Learned a lot from them. Thank You!” know MNA.” “Great learning each all so much, you all rock!!” “Thank you everyone who planned the retreat “Unionizing and bargaining can be “Fellow Nurses, and let us come. It was extremely overwhelming day! So many nurses need I never knew how much our very powerful to hear what “Great conference, loved and scary. Being able to know MNA.” union supports all of the nurses until your union can do. Being the interactive activities. to surround yourself recently. Besides the usual wages, a younger nurse from a Learned a lot from them. with fellow nurses who are dealing with retirement, and PTO negotiations, I’ve discovered our generation where we were Thank You!” similar issues is so important and uplifting. union does SO MUCH MORE. Reviewing policies that taught that unions protect Knowing you have support and others keep both patients and nurses safe in their practices. un-motivated older nurses from being disciplined or behind you in your journey is so important.” Supporting employees from unfair disciplines or job security. I learned that a union is my voice, my “I didn’t realize how prevalent workplace violence workplace situations. shoulder to lean on, my support, and my security. is and how important it is to get this law passed! The They really represent the voice of the nurses at our Thank You.” numbers Brenda provided were astounding!” hospital. You will love the support and comradery of the union.” Labor Reports and News A Word to the Wise- Beware of the Perils of Social Media Sometimes a seemingly about privacy, social media and what employees are not be shared with anyone else who does not have (at the time) innocuous tweet permitted to “talk” about are overly broad, meaning a “need to know.” If a nurse has, on their Facebook or Facebook post can create the policy prohibits lawful communication among profile, information about where they work, that a professional nightmare for co-workers. Please speak with your MNA staff may put them in more jeopardy. Even if a nurse is nurses. In recent years, the representative if you have any questions about your disciplined or terminated because of an overly broad National Labor Relations Employer’s policies in these regards, and we can help policy, it can take many months or years to correct the Board (NLRB) has ruled you better understand. action, and all the while, the nurse may not be getting that social media is one of Using sound professional judgement, I think we a paycheck. Please err on the side of caution. many means of employee can all get behind the notion that if a nurse were My very best advice is to remove the name of your communication. In other to post a patient’s name, a picture of the patient employer from your profile, keep track of who your words, social media is an or a room number, that would fall outside of what is “friends” are, and don’t talk about patients on Facebook extension of how employees appropriate. It gets real tricky, though, when nurses or even when it is in the context of your working conditions. may communicate together Amy Hauschild, RN other healthcare workers are “talking” on Facebook. about their working Labor Then we must take into account HIPAA rules and conditions. Representative regulations. There is a really wide net when it comes When I was a young nurse to what is confidential patient information that should and Union member, it seemed as though we operated under the assumption that talking about the Union or our working conditions at work or during work hours CHOOSE TO CHANGE LIVES was prohibited. To be honest, just recently I heard a Improving the way member of supervisory staff indicate the same. What Now hiring! clinicians diagnose, treat, we learned over the years, and as the NLRB has made Crossroads Correctional Facility Shelby, MT manage, and educate their patients. rulings about employee communication at work, was that the old assumption was INCORRECT. LPN – Full-time, Part-time, PRN The UW PTC provides An Employer may limit employee speech at RN – PRN, Certified Medical Assistant classes that increase work, though they cannot solely limit Union speech Benefits for full-time employees: the knowledge and skills (employees talking together about their working • Medical, dental, and vision coverage of healthcare providers conditions or the Union). If employees are permitted, • Life and disability insurance in the area of sexual • 401(k) retirement savings plan health. as long as it is not interfering with work duties, to chat • Up to 12 days paid time off about current events, sports events and the summer • 9 Paid Holidays Serving: picnic, then those same employees may chat about • Paid training AK, ID, MN, MT, ND, Union and workplace matters. OR, SD, WA In this day and age of electronic communication and New graduates welcome! social media, some of those same principles hold true. Contact Cyndy McClimate, Medical Recruiter, phone 615-263-3148 For more information and Employees ARE permitted under the National Labor to find training in your area Relations Act to communicate about their working contact us today! conditions with each other using social media. The Join our heroes at jobs.cca.com/Shelby • 206-685-9850 • uwptc.org NLRB has even found that some Employer policies Drug Free Workplace & EOE • [email protected] Page 4 Montana Nurses Association Pulse May, June, July 2016 Boots Campaign Update The Your Nurse Wears The committee has had numerous inquiries from now. We must be prepared to go into the legislative Combat Boots Campaign is community members as well as nurses across the year with a box full of testimonies and stories from rapidly building momentum. state of how to be involved. We are in the process Montana Nurses, MNA member or not. Your story We have had some very of evaluating educational training opportunities does not have to be elaborate or long. It may be a exciting opportunities in the specifically designed for nurses to identify and reduce personal experience you have had with ANY type of last few months. potential violence as well as protect oneself against an violence or assault in your workplace. Perhaps you MNA was recently awarded assault. We also will be providing education on what to know of a coworker that has an experience. a “Patients Before Profits” do if an assault does occur. What is the legal process The National Institute for Occupational Safety and $10,000 matching funds grant once an assault charge has been filed? We have found Health defines workplace violence as: from the American Federation that there is a lot of ambiguity surrounding what the Violent acts (including physical assaults and threats of Teachers Nurses and legal process is. We want nurses to be knowledgeable of assaults) directed towards persons at work or Health Professionals to be Brenda Donaldson, and informed in a process that is not familiar to us. on duty. Examples include expressions of intent to used in our campaign. This is a RN, Boots MNA has developed a continuing education cause harm including verbal threats, threatening significant boost to our budget Campaign Chair offering titled “Addressing Violence Against body language, written threats and physical actions to more effectively carry out Healthcare Workers.” This is being offered as a 1 hour ranging from slapping to use of a weapon. our campaign goal of improving workplace safety for complementary contact hour. If you would like to host healthcare workers. this event in your facility, District or Local Unit please As you can see by this definition, violence is more MNA’s violence campaign will also be featured in contact the MNA office to schedule. than just hands on physical assault. a national AFT publication called Healthwire. We are Legislatively, the violence taskforce is collaborating I would urge you to stop right now and briefly grateful for this national exposure. MNA Executive with the Council on Practice and Government Affairs share any stories you have. Don’t put this off until you Director Vicky Byrd and I will be speaking at the (CPGA) to drive a strong presence at the 2017 have more time, if you are like me that day will never Professional Issues Conference and Annual Labor Legislative session. We are sending monthly postcards come. Take some notecards to work with you and Academy in Washington DC April 21, 2016. This is a to our legislators and key players to raise awareness. A give them to your coworkers to write their experiences joint conference sponsored by AFT Nurses and Health couple examples have been included in this edition to down while on their break, then send those by snail Professionals and the National Federation of Nurses. give you a visual of this work. You can also use these mail to MNA. Make sure that they put their contact We will be sharing the work that MNA is undertaking stories to start having conversations with your local information on their submission. MNA also has a link to address workplace violence. legislators. on the website www.mtnurses.org to submit your As a member driven organization we MUST have stories. It is #2 on the Banner, just click to get the member engagement in this important campaign. campaign information and it will take you to the next I know that you may be thinking that there is nothing page. Click on the link and share your story. Qualified Caring that you can do to help, but you are mistaken. Here is Together we can make a difference to improve Staff a significant way you can help: workplace safety for ourselves and our coworkers, but SUBMIT YOUR STORIES! This action is probably it will take our collective action to make it happen. RNs • LPNs • CNAs the most important request we have of you right We are currently taking applications for traveling careers for licensed / certified nursing staff, for long term care, hospital, correctional, mental health, clinics and treatment facilities, throughout Montana. Excellent wages, flexible work assignments, and other opportunities For an application or more information contact us: 406-360-5199 • 406-360-5149 • Fax 406-363-5726 Email [email protected] www.angeltravelers.com Equal opportunity employer

EVIDENCE-BASED FOR BEHAVIOR CHANGE

Since 2008, The Montana Diabetes Prevention Program (DPP) has focused on reducing the prevalence of type 2 diabetes. The DPP is an evidence-based lifestyle intervention program, adapted from the National Institutes of Health.

Refer Patients at risk for Type 2 diabetes to the DPP. This program will educate and provide him/her with skills to adopt a healthy lifestyle!

For eligibility criteria and to find a DPP site using our interactive map, visit the website below. The Montana Diabetes Prevention Program

dphhs.mt.gov/publichealth/diabetes/DPP May, June, July 2016 Montana Nurses Association Pulse Page 5 Labor Reports and News Employee Use of The Pre-Bargaining Contract Campaign! Employer Email Each year many of our developing a written campaign plan, implementing Locals open their contracts and overseeing the campaign and working to Systems- Legal Update and begin to bargain new mobilize members in an effort to win a fair, positive, successor agreements. With and ratifiable contract. Your written plan does not The National Labor Relations Board (NLRB) made each of these contracts, the need to be large, but should contain your goals, key a determination in the “Purple Communications” case MNA Labor Department issues defined by members, key tasks to determine and affirmed that employees have the right to use assists with the research, concerted activities, and define who is responsible. Employer email systems to communicate with each preparation, and bargains • Your communication structure will include the types other about Union-related activities during non-work with your bargaining teams. of communications (one-on-one conversations, time. Email communications at work is now viewed Our department is always meetings, conference calls, emails, social media, as an extension of the old “Union Bulletin Board” or looking for better ways texting, flyers, etc.) and the plan for how and discussions that may take place in hallways or the to support our members Robin Haux when your local can accomplish each method of cafeteria which have historically been protected speech. during bargaining and we will Labor Program communication the committee chooses. Director Often, Employers have policies about use of support and assist all of you • To encourage member involvement, make this company email systems and have forbidden “non- with pre-bargaining contract campaigns. process interactive! Use the creative energy and work related” use. In review of actual practice, however, A good contract campaign involves and mobilizes knowledge of your members as a resource. Create many times employees use company email for a members (and potential members), takes advantage events and opportunities for your members to variety of non-work activities such as sports pools/ of their creativity and workplace knowledge, contribute ideas to your campaign and for potential brackets, Girl Scout cookie sales and announcements and provides them with the reassurance and proposals for your contract. Solicit ideas for events, about social events unrelated to work, though Union encouragement they need to STICK TOGETHER! surveys, slogans, buttons, or any other item that communications are forbidden. The NLRB has Bargaining can be a stressful and emotional process. encourages member involvement. determined this as unlawful. Member input and involvement is how your nurses’ • Public relations are always valuable, but it is hard With all this said, communications sent though a voice becomes powerful at the bargaining table. to generate support with a last minute campaign, company email system are without an expectation of so start long before the bargaining begins. Work privacy. The Employer may review any communications STRUCTURE OF A CONTRACT CAMPAIGN together to create an outreach agenda and plan sent through the company system. If your Local Unit A contract campaign will include a campaign ahead for an event. Elicit support from your members communicates using company email, be judicious committee, communications structure, member to create a positive image to benefit your community. about content and make sure the nurses are not on involvement, community outreach, and a tracking • Hold your members accountable and follow up with work time. If you have any questions about the new mechanism (accountability). those who have accepted a task. Completing the ruling or your Employer’s policies, please contact your • Your campaign committee has three major communication loop is really important! MNA staff representative. responsibilities: Gathering input from members and These contract campaigns don’t need to be large! Make your campaign manageable and utilize your MNA resources for support. Call 406-442-6710 for more information and reach out to your Labor Representative for support!

Starting at age 50, all Montanans should be tested for colorectal cancer.

Confused about what screening recommendations to make to patients? Both men and women age 50-75 should be screened for colorectal cancer by one of the following three regimens: • Annual high sensitivity fecal occult blood testing • Sigmoidoscopy every 5 years combined with high-sensitivity fecal occult blood testing every 3 years • Colonoscopy every 10 years

Screening can prevent colorectal cancer.

www.cancer.mt.gov Page 6 Montana Nurses Association Pulse May, June, July 2016 Labor Reports and News MNA Local #14 Critically Thinking for Profession! I’m going to say something these important details and bring them forward, since Ratifies First that is old news: most administrative teams aren’t working on the floor As front line nurses, RNs enough to be able to see those types of details. Contract are in the best position to A patient care facility has so many moving parts to advocate for patients. it and so many policies and procedures in place that Now I’m going to say one small change can make a big difference in the something that can be easier overall function and accountability of the organization. said, than done: Another nurse’s critical thinking at work was when As front line nurses, RNs she was discussing proper use of patient rooms with are in the best position to the CEO at her facility. In the small, critical-access advocate for patients. hospital, the ER is getting backed up with only one Nurses have always Caroline Baughman provider available to patients. Non-clinical managers been the superheroes of Labor who focus on the business aspect of the hospital want healthcare. They’re constantly Representative the waiting room, understandably, to look productive balancing technical skills with & appealing. There was a patient with a migraine in compassion, inflicting pain with providing comfort, the waiting room crying, and one of the non-clinical and encouraging positivity with remembering reality. managers asked that the patient be put into a room. With all of that going on every day, it’s easy to miss The nurses knew a few things were going on: triage, Local # 14 bargaining team members some simple ways to spearhead advocating for patient outpatient rooms vs. inpatient rooms, the provider’s Julie Capraro, Rhonda Gremaux and Bethany care and fostering responsibility within organizations. schedule, etc. Just like in the other example, the Eide are shown with MNA bargaining mascot, But RNs hold the power to make huge change in conversation didn’t really seem to hit home with the “The Negoatiator.” the cultures of their facilities by simply asking more administrative team until the nurse started talking questions and critically thinking about practices they’re about the cost of turning over a room between Nurses in MNA’s newest local unit, MNA #14, asked to do. patients. Yes, the migraine patient could have been overwhelmingly ratified their first collective bargaining I was sitting in a meeting recently and heard a put into a room for a few minutes until the provider agreement CBA with Montana Mental Health Nursing Registered Nurse tell the COO about a practice within got to him after the two chest pain patients. But Care Center in Lewistown on March 14, 2016. the hospital that she thought could be risky. Any time what would happen if a trauma came in? What would Negotiations were long and difficult which has not the hospital received a transport patient with a Foley happen if each of the other 4 patients in the waiting been our typical experience in bargaining with the catheter, the practice was to replace that Foley within a room need to be admitted? That room, those linens, Department of Public Health and Human Services certain number of hours. What was this practice based and those supplies would all need to be tended to by (DPHHS) and the State of Montana. The nurses were on? A study, of course! It has to be evidence-based. the housekeeping staff. Did you know that laundry steadfast and resolute in their endeavors and were Why did this nurse think it was risky? There are just can account for 3% of a facility’s expenses? In a place pleased with the outcome. as many studies out there that discuss the infection where every cent matters, needlessly turning over The bargaining team nurses worked long and hard risks that increase with the removal and reinsertion rooms due to the “impression” aspect of the waiting to bring stability in the workplace which comes with of catheters and the like. And then the nurse said the room is something a nurse can speak up about by working under a CBA. Congratulations to all the RNs detail that changed it all: the study they based this encouraging responsible use of resources at an in Local #14, job well done! practice on had been funded by the manufacturer of organizational level. the catheters. The manufacturer has a commercial Nurses may not be experts in hospital finance, interest in those catheters being changed often—are staffing, or the break-even points of services, but you questioning the risk of the practice, yet? nurses are most certainly experts in their patients and The nurse was exercising critical thinking skills their facility’s environment and needs. With critical on a daily basis and she was looking for procedures thinking and trusting your gut, you can dig deeper and that could be improved upon. Trusting your gut gives continue to improve on procedures your managers you the springboard to dig deeper and ask more would never even think to question. Stand up for Nursing Faculty Position Available questions about safety, efficiency, and responsible your patients, community, and your organization by Full-time, benefits eligible position starting Spring 2017 practices. Only direct-care RNs can notice most of advocating as a front line nurse. Join a Nursing Team that educates in a state of the art Sim Hospital! Online Application: https://jobs.gfcmsu.edu/hr Disabled/AA/EEO/Vet Preference Employer

Jackson Hole, Wyoming

State of Wyoming, Department of Health, Aging Division, Laurel Healthcare Licensing and Surveys is recruiting for Health & Rehabilitation Center Health Facility Surveyor Recruitment ID: HSHP09-04217 Conduct surveys and investigate complaints in accordance with Seeking RNs & LPNs Wyoming State Statutes and agreement with the Federal Centers for Contact us for current openings Medicare and Medicaid Services (CMS). Enjoy small town atmosphere only 100 miles from Denver, NO STATE INCOME TAX, an average of 300 days of sunshine and unlimited outdoor activities. 820 3rd Ave. For more information or to apply online go to: Laurel, MT 59044 e-mail: Phone: 406-628-8251 https://www.governmentjobs.com/careers/wyoming/ jobs/1381552/hshp09-04217-health-facility-surveyor-cheyenne [email protected] Fax: 406-628-8253 Open until filled. EEO/ADA Employer. May, June, July 2016 Montana Nurses Association Pulse Page 7 Continuing Education Would You Like To Be Certified in Nursing Professional Development? Do you work in a staff development or education office? Does your job involve teaching other nurses or other healthcare personnel? MNA is hosting a certification prep course for Nursing Professional Development on September 20 and 21, 2016. Certification is a benchmark of quality. Achieving certification in your professional practice area shows that you are competent in the field, have made a commitment to lifelong learning for your own professional growth, and have met standards established by the national certifying body. Many nurses think of certification in clinical practice areas, but nursing professional development is a specialty Pam Dickerson, area, too, with its own certification. The guiding document PhD, RN-BC, FAAN for this specialty is the 2016 Nursing Professional Director, Development Scope and Standards of Practice, published Continuing by the Association for Nursing Professional Development. Education The certification exam is a computer-based test, allowing 3.5 hours to answer 175 questions. Eligibility criteria include: • Holding a current, active RN license • Hold a baccalaureate or higher degree in nursing • Have practiced for the equivalent of at least 2 years full-time as a registered nurse • Have a minimum of 4,000 hours of clinical practice in nursing professional development within the last 5 years • Have completed 30 hours of continuing education in nursing professional development within the last 3 years. The test is offered, and certification is issued, by the American Nurses Credentialing Center’s Certification Program. Test sites are located in Helena and Billings. To help prepare candidates for sitting for the examination, MNA will host a certification prep course, taught by the Director of Nursing Professional Development at the Association for Nursing Professional Development, Dr. Mary Harper. The course is a two-day event that will be offered at the MNA office on September 20 and 21, from 8 am to 5 pm. The cost of the course is $325 for members of the Association for Nursing Professional Development and $430 for nonmembers, presuming registration is received prior to September 1, 2016. ANPD does reserve the right to cancel the course if there are not an adequate number of registrations received by August 20, 2016. If you have questions about the course, please contact the MNA Continuing Education Department or ANPD at www.anpd.org. Online registration is available at www.anpd.org/event/2016MontanaCertPrep. Montana Nurses Association Approved Providers

St. Vincent Healthcare Alaska Native Medical Center Billings, MT Anchorage, AK Kalispell Regional Medical Center Fairbanks Memorial Hospital Kalispell, MT Alaska Benefis Healthcare Systems Central Peninsula General Hospital Great Falls, MT Soldotna, AK St. Peter’s Hospital Wrangell Medical Center Helena, MT Wrangell, Alaska Community Medical Center Montana Health Network Missoula, MT Miles City, MT Bozeman Heath Livingston Healthcare Bozeman, MT Livingston, MT Providence St. Patrick Hospital Alaska Nurses Association Missoula, MT Anchorage, AK Billings Clinic North Valley Hospital Billings, MT Whitefish, MT MT Geriatric Education Center South Dakota Nurses Association Missoula, MT Pierre, SD St. James Healthcare Partnership Health Center Butte, MT Missoula, MT Providence Alaska Medical Center Mountain Pacific Quality Health Anchorage, AK Helena, MT South Peninsula Hospital Alzheimer’s Resource of Alaska Homer, AK Anchorage, AK Bartlett Regional Hospital Wisconsin Nurses Association Juneau, AK Madison, WI Alaska Division of Public Health Shands Healthcare Anchorage, AK Gainesville, FL Mat-Su Regional Medical Center Palmer, AK Page 8 Montana Nurses Association Pulse May, June, July 2016 Continuing Education APRN Corner Transitioning from Well, if you weren’t at the annual APRN spring New Graduate to Nurse conference, please mark your calendar for next year. MARCH 2-3 2017 in Helena Montana at the Great Northern Hotel. Over 90 NPs attended for a possible 14 CE and 11.5 Pharmacology CE. We were fortunate to have Cindy Cooke DNP, the AANP president Keven Comer as our keynote speaker. MN, APRN, FNP-BC Group Work for Identifying Problems We celebrated 35 years of in Practice and Solutions Advanced Practice Nurses’ in Montana. Barb Schaff DNP, gave a wonderful slide show about the history. Makes us all proud to carry on the legacy of prior NPs. Remember that you need to complete 24 hours of continuing education by the end of December to renew your license. And if you hold prescriptive authority, you need to have 12 of the 24 hours in pharmaco-therapeutics. Even a new grad NP that will be starting to practice, will have pro-rated hours for both pharm and CE if licensed between January 2014 and December 2016. Make sure you keep your Director of Helena College MSU Taking a break to documented CE and pharm CE if you happen to ever Sandy Sacry, MSN, RN and Students “Take Care of Yourself and Move” be audited. I keep mine for 10+ years because of my national recertification requirements. Amy Soape, Helena College career because as nurses, we can get extremely If you would like to explore the opportunity to overwhelmed and tend to take on a lot of issues. present at the 2017 Nurse Practitioner Conference, As future graduates, the workshop that the When we need help, advice, or someone to listen please contact Mary at [email protected]. Montana Nurses Association put on was very to us, we need to take full advantage of our village. The state legislature will convene next year –2017. beneficial for us to attend. It helped calm my nerves This will benefit us immensely, because as we know, And the national Senate and House are probably not and made me feel like it was all going to be okay bottling up our emotions is not healthy and can lead to going to get any work done until after the election. (eventually). It was also very relieving hearing that our a faster burn out. We have bills regarding nursing home admission, fears are perfectly normal to experience and that there Another topic from the workshop that will benefit home health referral and hospice referrals. Remember are ways for us to cope. me in the future is the aspect of proper self-care. It is you can always write your congressman to discuss While Sunday was nice to get introduced to important to acknowledge the physical, mental and NP issues. There should be NO issues regarding everyone, on Monday we got more into the details emotional, psychosocial, and professional aspects of DME (except diabetic shoes), so if you are having with each one of the speakers. One woman, Mandy self-care. This is something we have talked about in any problems please let me know ASAP. Also, don’t Pokorny, was my absolute favorite. One of the things class, but I think it is worth mentioning again. It seems hesitate to contact me with any specific questions or that I really admired about Mandy was the fact that she all too easy to forget to take time for ourselves once concerns: [email protected] was the youngest one there, has only been a nurse we get into this demanding, but wonderful, career. for five years, but yet she has accomplished so much Another point that was made that hit home for me already. She was an amazing public speaker and really is the use of positive self-talk. This is something that made us feel like she was understanding of all our I really need to work on, and I know if I can utilize feelings. She is somewhat who I now strive to be like. positive self-talk, it will change my whole attitude and Specifically, Mandy talked about something allow me to be a better person and nurse. that she calls “5 Rules to Thrive” and a few of these This workshop was so incredibly helpful in various really hit home for me and made me feel extremely ways. Ultimately, it was validating to hear that our motivated to be the best nurse possible. For time fears are recognized and that there are residency and Co sake, I will only discuss a few rules. The first rule was mentor programs available in some facilities to help. me s “go right at the Y”, which basically made us think of Learning what to look for in a workplace was very hop with us! a nurse or mentor that we admire and to always valuable, too. I recommend all senior nursing students remember to be like them. On the other hand, we or new graduates attend this workshop to gain tools to could “go left at the Y”, which is where we wrote better themselves professionally and personally. Scrubs, lab coats, stethoscopes, down a name of someone who we hope to never Student Comments: shoes, medical supplies, & accessories– be like. I will use this in my career as a professional • Overall, this conference was a great experience. from all your favorite brands! nurse because I aspire to be the name on the right All the tips and information I received will help of someone’s “Y” once I am more confident and me develop into a professional nurse. Enter code GOG10 to save 10% on all orders! knowledgeable in the field. • Applying these simple principles in my Another rule was to find our village. Essentially, professional career and home life will help me she told us to find a good support system or perform at the level expected to provide the “village” and take advantage of the people in it when best possible care to my patients… needed. I will absolutely take this into my professional • Attending this conference has lessened some of the stressors that I am currently trying to muddle my way through. • Using the knowledge I gained there, I think I’ll be able to be more successful in transitioning MDS Coordinator • Acute Care Registered Nurses from student to new nurse. • Skilled Nursing Facility - Charge Nurse MGGH is located in the small friendly, affordable community of Hawthorne, Nevada.

• Eligible for HRSA NurseCorps Loan Repayment • Great Benefits including Retirement! Licensed Full Service Adoption Agency • $5,000 Sign On Bonus! International ~ Domestic ~ Foster Adoption • New Grads Welcome! Pregnant Need Help?? Hague Accredited ~ Call Us ~ We Can Help Please visit www.mtgrantgenhospital.org to PO Box 445, Twin Bridges, MT 59754 Visit ShopNurse.com today! download an application and for more info. Fax Resumes to 775-945-0725 406-684-5312 ~ [email protected] May, June, July 2016 Montana Nurses Association Pulse Page 9 Continuing Education APRN 2016 35 Years of Advanced Practice Nurses in Montana

Cindy Cooke, DNP, FNP-C, FAANP President CAP Council Collaborating with APRNs at Conference AANP presenting at APRN Left to Right: Nanci Taylor, NP; Terry Dutro, APRN, MSN, AGPCNP-BC; John Honsky, APRN; Barb Schaff, DNP, MA, FNP, RN, C; Keven Comer, APRN, MN, FNP-BC; Deborah Kern, MSN, FNP; Deanna Babb, DNP, APRN, FNP, FAANP

This year’s conference celebrated 35 years of APRN practice in Montana and accomplished yet another successful continuing educational seminar for a record number of attendants. With our captivating keynote speaker Cindy Cooke, president of the AANP (American Association of Nurse Practitioners), to Barb Schaff, pioneer and true trail blazer for Montana Nurses, who detailed history of APRNs in Montana. Accomplished officers of the ANNP, an affiliate of the ANA/MNA, Cindy Cooke, president, Deanna Babb our region eight director and Keven Comer, Montana Terry Dutro MSN, APRN, AGPCNP-BC state representative, sparked an inspiring and informative legislative update. The two-day conference with its Joseph Schmidt, RN, DNP Student As a registered nurse for over 40 years, lifelong slate of skilled presenters and sessions proved to be a learning and academic growth has been an integral relevant and important education activity that provided part of my journey. When asked to share my thoughts opportunities of improvement and changes in the about the recent APRN Pharmacology Conference my participants’ knowledge or practice based on favorable first reaction was; a continuing education conference course evaluations. of this prominence has never been more relevant and The APRN 2016 Pharmacology Conference was timely to my every day practice! valuable to me when it comes to applying knowledge Two of the nine Standards of Practice for Nurse in clinical practice, an important link in the chain Practitioners specifically point to the immense of excellence that can signify quality care and can importance of continuing education. III. Care Priorities ultimately make a difference in patient outcomes. (D) Provision of Continually Competent Care and VII. Plan on attending next year knowing the planning Quality Assurance and Continued Competence committee is already working on their commitment for (B & C) Facilitate Nurse Practitioners in Recognizing another quality educational gathering that continually the Importance of Continued Learning Through: strives for quality improvement for its annual conference. maintenance of certification in compliance with current Cindy Cooke said it best “Always Strive To Know state law and maintenance of current knowledge by the New Things” Elize Cline, FNP-BC attending continuing education programs.

Full-time RN and LPN Positions in Kalispell, MT at the Flathead Community Health Center providing case management services in the SimpleWreath Medicaid Health Improvement Program. SimpleWreath specializes in handmade, natural looking wreaths that enhance the beauty of your home, both inside and out. Critical Access Hospital, Longterm Etsy: http://www.etsy.com/shop/simplewreath Excellent benefits - salary negotiable. Care Facility and Rural Health Clinic. Facebook: https://www.facebook.com/simplewreath 166 Montana Ave. East E-mail: [email protected] For more information call 406.751.8254 or P.O. Box 530 Phone: (406) 378-2188 email [email protected]. Big Sandy, MT 59520 Fax: (406) 378-2180

Join our high caliber staff of RN’s and live in the beautiful high desert of Eastern Oregon! 25-bed Critical Access Hospital seeks Please enjoy licensed RNs for full time. Broad training opportunities 10% off with to facilitate your growth as a quality RN. Small patient to coupon code: nurse ratio and great medical staff who complete our care NURSE10 team. Prefer experience in med/surg, ER or OB. Salary FT Hope is always within reach. $29.56-$45.13 DOE, $4.25 night differential. Suicide is never the only option. Call Denise Rose, Harney District Hospital 541-573-5184 or apply at harneydh.com If you or a loved one are in crisis, Call the Montana Suicide Prevention Lifeline at Harney District Hospital 557 W. WASHINGTON • BURNS, OR 97720 I would love to have you visit my shop! If you have questions or would 541-573-7281 • www.harneydh.com WWW.DPHHS.MT.GOV/AMDD/SUICIDE like to request a custom order, please do not hesitate to contact me. Page 10 Montana Nurses Association Pulse May, June, July 2016 Statewide Nursing News Montana Nursing History Elaine Hunter, M.S.N., R.N., CNOR, The Sisters of Leavenworth, Kansas continued to contribute to Montana’s need Nursing Dept., Montana Tech for qualified nurses, and in 1877 lent their services at the Big Hole Battlefield, assisting both natives and Henrietta Shirk, Ph.D., Technical wounded soldiers (Finn & Crain, Communication Dept., Montana Tech 2005). In order to assist the fallen, they were required to travel 90 The history of professional nursing in Montana began with the Sisters of Charity. miles on horseback. By 1943 the In 1858, the Sisters of Charity sent six nuns to Helena, to establish their Rocky Sisters of Charity of Leavenworth, Mountain Mission. This mission the sisters developed quickly branched out from Kansas, began to affiliate their Montana to reach other western states. three schools of nursing with The miners in Helena contributed fifty cents to one dollar from each of their Carroll College of Helena, and by paychecks to supply and rent a house in Helena for the sisters to use as a hospital. 1960 the Sisters completely moved By 1870 Father DeSmet of Helena instructed the Sisters of Leavenworth, Kansas, the St. James School of Nursing to to establish six additional hospitals throughout Montana’s other mining districts, Carroll College in Helena (Montana beginning with hospitals in Deer Lodge (1868) and Virginia City (1875). Mining grew Nurses Association, 1961). in these areas with additional claims “I don’t think it will take me throughout Southwest Montana. long to learn nursing,” the girl told The Sisters responded to the great the Mother Superior, “All a nurse need for medical care in several remote has to do is put damp cloths on mining communities of Montana. One the patient’s forehead and hold mining claim that has continued to his hand” (quoted in Nursing this day is that of the extensive copper in Montana, 1961). Nursing as mother lode in Butte, Montana. By a profession in Montana has 1881 the Sisters founded St. James developed enormously since the Hospital in Butte, where they opened a turn of the 20th Century. school of nursing in 1906, with the first The history of the profession graduating class in 1909. The miners Graduating Nurses at St. James of nursing in Montana is a collection of Butte made financial contributions Hospital, Butte, ca. 1916. Photo of fascinating stories of strong and which firmly established a sound Courtesy of Butte Silver-Bow determined women who reflected the healthcare presence in this rough and Archives, Photograph Archives, culture of their times and who had a tumble mining district (Sherrick, 1989). Butte, Montana vision of what nursing was to become Within six months of their arrival, the as a profession in our state. From the Sisters raised $8,000 and built St. early 20th Century and the Great Depression, through the two World Wars, and James Hospital (Finn & Crain, 2005). St. James Hospital Nurses Dormitory Today Photo Courtesy until the 1950s, nursing was a developing profession. During the following six decades, the of montanawomenshistory.org Montana nurses contributed to the development of their own professional St. James School of Nursing was well- growth through Montana Nursing Association archival historians such as Mary known for its well-trained graduates. Munger RN. Joanne Green, MSN, RN and Claire Homan are well-known nurse The St. James Hospital Nurses Dormitory still stands today at 300 West Mercury historians in the Butte community and provided essential data for this article. In in Butte, where it functions as a medical clinic and is attached to the unoccupied future issues of The Pulse, we will be writing about some of the personal stories as original hospital (see photo). told by Eileen Tourikis RN, LaVerne Taulbee RN and Shirley Fogarty RN.

References NO Shifts Finn, L.J. & Crain, E. (2005). Motherlode: Legacies of women’s lives and labors in NO Weekends Butte, Montana. Livingston, MT: Clark City Press. NO Kidding! Montana Nurses Association (1961). Nursing in Montana. Helena, MT: Montana LPN Nurses Association. Must have current LPN license in the state of Montana. Sherrick, A. P. (1989). Worldwide evens influencing nursing in Montana. Bozeman, Previous Case Management experience preferred, but not required. MT: Artcraft Printers. RN CASE MANAGER Must have a current RN License in the state of Montana. Three years clinical experience required; CCM Certification required after one year employment. Previous Case Management experience preferred. Must be detail oriented with proven computer, communication and organizational skills. RN Medical Review Nurse The role of the Medical Review Nurse is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization and pre-determination referral requests. The Medical Review Nurse ensures that prior BECOME A HOMETOWN HERO! LMC is currently hiring for RN & LPN Positions! authorization and pre-determination requests are completed in a timely fashion to meet contractual RECRUITMENT BONUSES *FULLTIME: up to $8000 *PARTTIME: up to $4000 requirements and that all reviews are conducted using nationally recognized and evidence based standards. Applies clinical knowledge to make determinations for pre-authorizations and pre- *Dependent on commitment, minimum of 2 years. determination of specific procedures and services to ensure adherence to contract benefits and Internal Loan Assistance Program also available! plan provisions. Join a GREAT TEAM with competitive salaries and benefits. We value hometown care values, where community-minded nurses can build relationships with patients and families. If you are interested in becoming part of our Healthcare Team and Full job description & application available at www.askallegiance.com. want the opportunity to truly make a difference in a small community, please contact Shirley Please contact HR with questions at 406.523.3158 Morkrid, CNO by phone at 406-759-5181 or by email at [email protected]

ACCREDITED ONLINE NURSING DEGREES - RN to BSN - RN to BSN to MSN - MSN – 5 High Demand Specializations - DNP – Specializations in Educational and Executive Leadership Wanted Education Partner of Montana Hospital Caring & Association Compassionate RNs and LPNs to join Valley View Openings are available for both day and night shifts. Home’s In addition to competitive wages, Valley View Home dedicated staff offers a generous benefit package and opportunities for advancement.

1225 Perry Lane Applications can be obtained at the Valley View Business Learn more about discounted tuition rates: 866-922-5690 Glasgow, MT Office or on line at www.valleyview1.net. www.americansentinel.edu/mha 406.228.2461 May, June, July 2016 Montana Nurses Association Pulse Page 11 Statewide Nursing News Plugging In: A discussion of social media and public health

social media tools that can manage and facilitate We hope you will join us for this session and the conversations. We encourage you to check out upcoming sessions in September and November. the information being shared and discussed. Staff Please visit immunizations.mt.gov for additional members of these organizations monitor discussions information. Previous recorded webinar sessions can to ensure conversations are respectful. These social also be viewed here. Together, public health agencies media accounts are great resources for patients, and workers can use social media as a resource to Montana Immunization Program parents, friends, and fellow colleagues. promote health. The conversation on social media and public health Facebook, Twitter, Instagram, Pinterest, YouTube, continues to develop. Join the Montana Immunization Resources: LinkedIn, Flickr, Tumblr. These words flood daily Program on May 25th at 12 pm for Dr. Wendy Sue CDC Health Communicator’s Social Media Toolkit: conversations, consuming the general population’s Swanson’s presentation on “Immunizations: Building http://www.google.com/url?sa=t&rct=j&q=&esrc eyes and changing the way individuals communicate. Trust During the Time of Twitter.” Dr. Swanson is a =s&source=web&cd=1&ved=0ahUKEwj2s-TQl8 As technology advances and new applications pediatrician at Seattle Children’s Hospital, author of HLAhVBVmMKHXqDC5gQFggcMAA&url=http% become popular, health organizations face the the Seattle Mama Doc blog, and avid social media 3A%2F%2Fwww.cdc.gov%2Fhealthcommunica challenge of understanding how to use social user. Dr. Swanson will present on the ways in which tion%2FToolsTemplates%2FSocialMediaToolkit_ media to increase health awareness and influence she incorporates social media into her daily work life BM.pdf&usg=AFQjCNGiMNb732z_zNr_5q7H2p2Ud health decision making. Social media tools, such as and how she uses social media tools to educate and phZzg&bvm=bv.116954456,d.cGc Facebook and Twitter, create opportunities for public build trust with her patients and the public. discussions. Among the many health topics, vaccines “Immunizations: Building Trust During the Time of CDC’s Guide to Writing Social Media and vaccine-preventable diseases are frequently Twitter” will be the third session of 2016 Immunization http://www.cdc.gov/socialmedia/tools/guidelines/ discussed on social media. Provider Education Webinar Series put on by the guideforwriting.html The online network that connects social media Montana Immunization Program and is accessible is a growing resource for health organizations. through WebEx. There will also be a hosted Voices for Vaccines Health messages using social media tools are easily recording of the presentation on May 26th at 12 pm. https://www.facebook.com/VoicesForVaccines/ accessible and make credible resources available The Montana Immunization Program submitted an to the public. At best, health communications deliver application to offer contact hours for this webinar Vaccinate Your Family a message to increase a user’s awareness, change session. https://www.facebook.com/VaccinateYourFamily/ attitudes, and influence behavior. Healthcare providers continue to have the biggest influence on their patients; however, the availability of social media has 2016 Immunization Provider Education Webinar Series become a significant source of health information in the U.S. Health organizations or programs can face izations: za & difficulty participating in social media. More health Immun Influen HPV Building Trust sk & organizations are recognizing the popularity of social me High-Ri Adolescent media; however, processes add challenges to levels During the Ti ients of engagement. Managing comments and creating of Twitter Pat Vaccines Wendy Sue Swanson, MD, MBE, FAAP Gregory A. Poland, MD Erin Stevens, MD an environment for healthy online discussion require the Mayo Clinic Rochester Seattle Children’s Hospital Billings Clinic more time and manpower than available. Additionally, at 12 pm the specialized jargon for different social media tools e Live presentation May 25th at 12pm Live presentation September 9th Live presentation November 2nd at 12 pm such as, “tweeting,” “liking,” and “posting,” can be Hosted recording May 26th at 12pm

intimidating and confusing. ates Fortunately, organizations like Voices for Vaccines a v

and Vaccinate Your Family have established credible S D MORE INFORMATION about these webinars CAN BE FOUND AT www.immunization.mt.gov social media presences on Facebook and other

Find your career today! Search job listings in all 50 states, and filter by location and credentials. www.montana.edu/nursing Browse our online database 406-994-3783 of articles and content. Find events for nursing professionals BUILD A CAREER - in your area. MAKE A DIFFERENCE Your always-on resource for nursing jobs, research, and events. Undergraduate Degree Options • Bachelor of Science in Nursing (BSN) degree www.nursingALD.com • Accelerated BSN degree for post-baccalaureate students

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Is it because we feel the “devil is in the details” to get going - SOMETHING. Anything. But it failed political. Political science and we just want to be DONE with the details so we miserably. is not my forte. In fact, I got can conquer the issue once and for all and be done In reality, what I should have been discussing was my B.S. in Exercise Science, with it? I don’t know but I would be interested in a REAL change and how to maintain it. That is what so, what do I know about study that looks into the ways that we will bypass the would stick with audiences long after I left town; the politics? Well, probably very rational methodology of what we KNOW will work for development of habits. No, it’s not sexy and no it little, actually. But I DO know the hopeful fantasy of the enormous and immovable won’t win many votes but the honest truth is that if we that people are drawn to “do or die” mentality that inevitably leads to burnout, are going to change our lives we have to change our large, immediate and simple disappointment and further dilapidation. behavior and if we are going to change our behavior, goals, like, building a “huge” You see, I have noticed that when people talk we must create better habits. wall to immediately and about changing their health, they tend to embrace the Here’s an example. Let’s say I want to have a better definitively solve a complex Joey Traywick, “building walls” mentality. They want to make a change flossing habit. The temptation might be to resolve to problem like immigration. CMSRN that is simple, comprehensive and eternal, all at once. just get MOTIVATED and floss every tooth in my head Building a wall is much more It’s getting later into 2016. How are you doing on your every day for the rest of my life! In reality, that is too appealing (especially if we don’t have to pay for it) than resolutions to improve your health? Did you say to big and never ending. Been there. Done that. Instead, diving into the minutia of day to day issues that need yourself “This year, I’m going to run three miles EVERY shrink the change and resolve to make a stated habit small and even boring maintenance and attention, like, DAY until I lose this weight!” Or, did you say, “I’m just that goes something like “Every day, after I put my providing economic incentives on the other side of the not going to eat Anything after 7pm until I lose this toothbrush away, I will floss one tooth.” That’s it. The border and simply ensuring our current border patrols weight!” habit has a trigger and the habit is tiny enough that it are well staffed and trained. But I digress. We have all been seduced by the simplicity and can be done without negative consequences. Finally, The point is, that we as humans are, for some the finality of the over-reaching, unilateral and never- the key to all this is to celebrate the behavior. Create a invisible reason, drawn to sweeping and immediate ending goal that leaves us more disillusioned and less positive feedback so that once you are done flossing change that will cure all of our problems MUCH willing to try to improve on any level, next year. Face the one tooth you would look yourself in the mirror and more than we are compelled by the TINY HABITS it, the solution, NOT the devil, is in the details or, as smile or say, “You’re awesome!” that make up the majority of our real lives. I wonder Dr. B.J. Fogg calls them, Tiny Habits. Tiny Habits is This method is not proprietary or revolutionary but really not complicated. It is simply the explanation of it is self-explanatory. It is so effective, the Billings Clinic the method by which, if we are honest, we all change, Diabetes Prevention Program allowed me to become Seeking Nurses to Join our Healthcare Team for better, or worse. certified as a TINY HABITS INSTRUCTOR! That’s It is tempting to think that demise can befall us in right! I now can help people at risk of developing Type Garfield County Health Center one fell swoop while self-improvement or success II Diabetes with developing better habits focused on , located in Jordan, MT, is a small rural Critical Access is truly a lifelong endeavor that is both elusive and being more active and eating better! If our patients can Hospital and Long Term Care facility. consuming. The truth is, most times, you don’t fall benefit from developing good habits, we can too! † Excellent area for hunting and fishing out of shape overnight and you won’t fall into shape UGH! I feel like I have so much I want to tell you, † Wage DOE † Excellent benefits overnight either! It will be the Tiny Habits or the fellow nurse. I have so much passion to see you not Please contact Sarah Nordlund at 406-557-2500 smallest changes that you embark on, that you turn give up your health and wellbeing simply because you or [email protected] into routine that will make the most impact on your life. chose a profession that focuses more on the needs of for more information. I stumbled on Dr. Fogg’s TED Talk late one night as others than your own. I hope you will be patient with I was pondering the question, “Can anyone change me and have a large measure of grace when I get on their behavior by listening to a speech?” You see, I my “soapbox” or “soapboxes.” I believe in you and I had become a bit frustrated thinking that no one had invite you to put my suggestions of 7 minute workouts Stay up-to-date and find your dream job! contacted me after a presentation to say, “Joey, you at work or ten day no sugar challenges to the test. changed my life! I mean, I am going to be different But most of all, I invite you to research the skill of Job Board: Search job listings forever because of what you shared tonight.” And I building better habits so that your LIFE is better and in all 50 states. began to consider the possibility that I was wasting more full. Don’t fall prey to the notion that there is a my time giving talks on motivation and self-care. Then, quick fix out there that if you could just find it or make Publications: New publications after reading the ideas behind the Tiny Habits concept, more time or get more motivated, you could have and articles added weekly! I realized I was exactly RIGHT! I HAD been wasting more satisfaction and fulfillment. Those things are my time thinking that one speech on one night could based in habits and you can do that. Hey, you already Events: Find events for nursing change people forever. Indeed, at best, I was HOPING are! professionals in your area. against all hope that I could at least motivate them Let’s make encouraging one another by meeting to try harder for just a bit longer or to not give up or here in this publication a habit, what do you say? www.nursingALD.com Boom! There’s another wall coming down. May, June, July 2016 Montana Nurses Association Pulse Page 13 Membership

Has your contact Save the Date information changed? Montana Nurses New name? New address? New phone number? Association New email address? To update your contact information, please email or call Montana Nurses Association: 104th [email protected] or 406-442-6710 Annual Convention MEMBERSHIP MATTERS! Montana Nurses Association would like to invite you to join us today! BENEFITS INCLUDE: • EMPOWERING RNs TO USE THEIR VOICES IN THE WORKPLACE Great Northern Hotel • IMPROVING PATIENT CARE • HAVING INPUT REGARDING WAGES & Helena, MT Veteran Centered Care BENEFITS in the • CONTINUING EDUCATION OPPORTUNITIES October Civilian • LEGISLATIVE REPRESENTATION Healthcare World 5, 6, 7, 2016 November 8, 2016 Call or email today [email protected] Jointly Provided by Montana Nurses Register Online Association & VA Montana (406) 442-6710 Health Care System. Applications also available on www.mtnurses.org Where: Helena Colonial Red Lion our website. 2301 Colonial Drive, Helena, MT Save the Date mtnurses.org

Central Montana

Everyone Deserves A Job They Love!! Great Nursing Let Us Help, Call 406.228.9541 Opportunities! Prairie Travelers is Recruiting Traveling Healthcare • Nurse Staff in Montana, North & South Dakota Practitioners Opportunities • Registered Nurses Hospital, ER, ICU, OB and LTC • Nursing Join our team at the Montana Mental Health • Licensed Practical Nurses Leadership Nursing Care Center and help provide quality • Certified Medication Aides long term care for our residents. We are a • Certified Nurse Aides • Experienced RNs residential institution for mental disease located • Full-Time and Part-Time in Lewistown, Montana. Work in this beautiful Prairie Traveler’s Commitment to Our Staff community setting and in your leisure time enjoy • Excellent Wages • Health Care Benefits the many outdoor and family oriented activities • Travel Reimbursement • Annual Bonus of the area. Small town living in the shadow • Paid Lodging • Zero Assignment of three mountain ranges and close to the • Flexible Work Schedules Cancellations opportunities of Montana’s largest cities. We are • Varied Work Settings • 24/7 Staff Support a State of Montana facility offering competitive wages and a great benefit package. The state APPLY TODAY 406.228.9541 pays $976 a month towards health insurance. Prairie Travelers Recruitment Department 130 3rd Street South, Suite 2 • Glasgow, MT 59230 For an application or more information, Montana Mental Health visit For more information and to apply, visit Nursing Care Center www.billingsclinic.com/careers 800 Casino Creek Drive, Lewistown, MT 59457 www.prairietravelers.com or call (406) 238-2638 Phone (406) 538-7451 • Fax (406) 535-2863 Page 14 Montana Nurses Association Pulse May, June, July 2016 National News NIOSH Training Congratulations to We would appreciate your improve your sleep, alertness, and health and help with letting nurses in reduce risks Megan Hamilton, Montana know about this new online training program The NIOSH training is interactive and includes video Continuing — NIOSH Training for Nurses testimonials from several nurses. Continuing education on Shift Work and Long Work certificates for registered nurses are available and Education Council Hours – a free, online course certificates of completion are available for others. The by CDC.gov will help nurses course is divided into two parts: with the demands of working Part 1) Health and safety risks to shift work and Member! in the evening, at night, or long work hours and why these occur (1.5 contact Congratulations to long work hours as well hours of continuing education is available for RNs who Megan Hamilton, Continuing as give them strategies to Sandi Luckey, complete Part 1 of the course) Education Council member! improve their sleep, energy, Labor Part 2) Strategies to reduce risks from shift work She will be speaking at the and health. Representative and long work hours (1.7 contact hours of continuing 2016 PNEG Conference in The training was developed education is available for RNs who complete Part 2 of Ohio: by the NIOSH in collaboration with nursing organizations the course). and nursing faculty as well as input from focus groups The course can be taken at any time that is Caring for Our Own and pilot tests of staff nurses and nurse managers. convenient and over a series of 15 or 20 minute time Stress, challenging cases, periods if desired. It is available for desktop and mobile critical incident, and human The training covers: devices on this CDC website: http://www.cdc.gov/ fallibility are all a part of • How shift work and long hours are linked niosh/docs/2015-115 working in health care. We Megan Hamilton, to a wide range of health and safety risks We have gotten a lot of positive comments from are all susceptible to the MSN RN CFRN NRP by disrupting sleep, circadian rhythms, and nurses who took the course, for example ­— Concise, stressors that occur as we personal life informative, easy to understand; excellent presentation; connect with and care for patients and their families. • Vital functions that occur during sleep and the Learned a lot regardless of my experience. This session will explore these topics along with the processes that determine the timing of sleep We have a blog on this new online training program: second victim phenomenon. An interactive format will and the development of fatigue A Hard Day’s Night: Training Provides Nurses with be used to identify strategies to support staff, manage • Work organization strategies for employers and Strategies for Shift Work and Long Work Hours on http:// stress and enhance resilience. nurses to reduce health and safety risks blogs.cdc.gov/niosh-science-blog/2015/05/18/nurse- • Good sleep practices and other coping shift-work-training/ I will greatly appreciate any help strategies to adopt in your personal life to help you could provide with letting nurses in Montana know about this new training program. Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses

Reprinted with permission of the Do any patients have communication and/or there a pattern of short staffing, or is this truly an American Nurses Association physical limitations that will require accommodation emergency? and extra supervision during the shift? Will there 1. What is the assignment? be discharges to offset the load? If there are 7. Is this a crisis or an ongoing staffing pattern? Clarify the assignment. Do not assume. Be certain discharges, will there be admissions, which require If the assignment is being made because of an that what you believe is the assignment is indeed extra time and energy? immediate need on the unit, a crisis, the decision correct. to accept the assignment may be based on that 3. Do I have the expertise to care for the immediate need. However, if the staffing pattern is 2. What are the characteristics of the patients patients? an ongoing problem, the nurse has the obligation to being assigned? Am I familiar with caring for the types of patients identify unmet standards of care that are occurring Do not just respond to the number of patients; assigned? If this is a “float assignment,” am I as a result of ongoing staffing inadequacies. This make a critical assessment of the needs of each crossed-trained to care for these patients? Is may result in a request for “safe harbor” and/or patient, his or her age, condition, other factors that there a “buddy system” in place with staff who are peer review. contribute to special needs, and the resources familiar with the unit? If there is no cross-training or available to meet those needs. Who else is on the “buddy system,” has the patient load been modified 8. Can I take the assignment in good faith? unit or within the facility that might be a resource for accordingly? If not you will need to get the assignment modified the assignment? Do nurses on the unit have access or refuse the assignment. Consult your individual to those resources? How stable are the patients, 4. Do I have the experience and knowledge to state’s nursing practice act regarding clarification and for what period of time have they been stable? manage the patients for whom I am being of accepting an assignment in good faith. In assigned care? understanding good faith, it is sometimes easier If the answer to the question is “no,” you have an to identify what would constitute bad faith. For MMC is seeking Full or Part Time Family Nurse Practitioners and obligation to articulate limitations. Limitations example, if you had not taken care of pediatric Registered Nurses for our farmworker in experience and knowledge may not require patients since nursing school and you were asked health clinics in Montana and Wyoming! refusal of the assignment but rather an agreement to take charge of a pediatric unit, unless this were New grads encouraged to apply. -regarding supervision or a modification of an extreme emergency, such as a disaster (in which NEW! Competitive Wage Scale the assignment to ensure patient safety. If no case you would need to let people know your Opportunity to provide primary health care accommodation for limitations is considered, the limitations, but you might still be the best person, services for agricultural families in clinics, mobile nurse has an obligation to refuse an assignment for given all factors for the assignment), it would clinics, homes, fields, schools and orchards. which she or he lacks education or experience. be bad faith to take the assignment. It is always Call 406-248-3149 or Email: your responsibility to articulate your limitations Vicki Thuesen • [email protected] 5. What is the geography of the assignment? and to get an adjustment to the assignment that Montana Migrant & Seasonal Farmworker Council Inc. 3318 3rd Ave. North, Suite 100 • Billings, MT 59101 Am I being asked to care for patients who are in acknowledges the limitations you have articulated. close proximity for efficient management, or are the Good faith acceptance of the assignment means patients at opposite ends of the hall or on different that you are concerned about the situation and units? If there are geographic difficulties, what believe that a different pattern of care or -policy resources are available to manage the situation? If should be considered. However, you acknowledge my patients are on more than one unit and I must the difference of opinion on the subject between go to another unit to provide care, who will monitor you and your supervisor and are willing to take the RN to BSN Online Program MSN Online Program patients out of my immediate attention? assignment and await the judgment of other peers • No Campus • Classes That Fit and supervisors. Visits Your Schedule 6. Is this a temporary assignment? • Nationally • Competitive When other staff are located to assist, will I be Retrieved from American Nurses Association: http:// Accredited Tuition relieved? If the assignment is temporary, it may www.nursingworld.org/mainmenucategories/ BSN-LINC: 1-877-656-1483 or bsn-linc.wisconsin.edu be possible to accept a difficult assignment, thepracticeofprofessionalnursing/workforce/ MSN-LINC: 1-888-674-8942 or uwgb.edu/nursing/msn knowing that there will soon be reinforcements. Is workforce-advocacy/questions-in-decision-to- accept-staffing-assignment.html May, June, July 2016 Montana Nurses Association Pulse Page 15 National News Optimal staffing New resource aims to help RNs implement evidence-based staffing plans

Susan Trossman, RN they are being followed, Dent said. The guidelines, for example, specify that nurses cannot work more When it comes to achieving quality care, better than 12.5 hours a day, no more than three 12-hour patient outcomes and financial stability, optimal shifts in a row and no more than 60 hours in any staffing should be viewed as a necessity and not a seven-day period. Nurses and administrators also nice, but impossible, dream — particularly as health routinely meet to address nursing retention and care reforms and new regulations take hold. turnover, as well as other staffing-related issues That is a key message reflected in a new, formally and informally. comprehensive document commissioned by the American Nurses Association and developed by Lessons learned in Arizona Avalere Health, LLC, in collaboration with nurse and Like other hospitals across the nation, the Mayo policy experts. Clinic Hospital in Arizona was expecting a greater shift Although the white paper, “Optimal Nurse Staffing from inpatient to outpatient care in 2012 based on the to Improve Quality of Care and Patient Outcomes,” implementation of ACA provisions. focuses more on acute care hospitals, nurses in all “But our census didn’t drop as we anticipated,” settings and at all levels can use this resource to said Kathleen Matson, MSN, MHA, RN, NE-BC, advocate for and implement sound, evidence-based nursing administrator of nursing resources at Mayo. staffing plans. It is the first in a series of papers aimed “So nurses and other employees were working more at addressing the value of nursing care and services. of the unit. It further addresses efforts by ANA and overtime. But it came at a cost — we had an uptick in “The evidence from hundreds of studies — and other organizations to promote federal regulation and injuries and nurses felt burnt out. We also noticed that the white paper — make it clear that there is a legislation promoting flexible staffing plans, as well some of the drivers affecting patient satisfaction — like relationship between staffing and patient outcomes,” as ANA activities to support transparency and public the length of time it took for someone to answer their said Matthew McHugh, PhD, JD, MPH, RN, FAAN, a reporting of staffing data. call light — were affected. nursing outcomes and policy researcher and associate “We realized we needed to right-size our workforce.” professor at the University of Pennsylvania School Making it work Mayo brought in temporary nurses to bridge the of Nursing. “If there are not enough nurses at the Flexible staffing models, forecasting technology and gap and then immediately hired staff for an additional bedside, bad things are likely to happen.” routine discussions about staffing levels are three key 20 FTEs, according to Matson. The white paper highlights published studies that factors that can bolster care at health care facilities. Mayo leaders also made improvements to their demonstrate how appropriate nurse staffing helps to Two hospitals that have engaged in these strategies, patient classification-acuity system to ensure it would achieve both clinical and economic improvements, and are featured in the white paper, are Midland more accurately forecast staffing needs based on from reducing medication and other errors to Memorial Hospital in Texas and Mayo Clinic Hospital in patient needs. The system has 21 indicators that shortening patients’ length of stay. Phoenix, AZ. determine patients’ level of care, including looking at Yet there continues to be significant variations in In 2008, Midland Memorial Hospital created a the number of medications they receive, their ability to staffing from one hospital to the next, because there are Nurse Staffing Advisory Council to help improve perform ADLs, and need for 1:1 monitoring. not enough budgeted positions, according to McHugh, staffing and address concerns that the hospital might “We have the ability to run our classification system a Pennsylvania State Nurses Association member who fall short of meeting its mission to provide quality and then flex our staffing by the hour,” said Matson, helped develop the paper. And members of the public care, according to Bob Dent, DNP, MBA, RN, NEA- an Arizona Nurses Association member. For example, generally are unaware of these variations. BC, CENP, FACHE, senior vice president and chief Mayo can bring in more staff mid-shift if a unit that “They wouldn’t expect that if they go to one hospital operating officer at Midland. was staffed for 30 patients suddenly admits four more they will get lots of attention, and then go to another [in The advisory council, made up of 60 percent patients. their community] and not get an equal level of care,” he frontline nurses, nursing leadership and executive staff Additionally, Mayo nurse managers, supervisors said. subsequently worked together to implement several and team leaders meet at least three times a day to To ensure optimal staffing and equitable, quality strategies to address staffing and positively influence address staffing concerns, and there is a built-in ability care throughout the nation, RNs must continue to build patient care. to share staff. the business case for optimal nurse staffing. One important change involved implementing “Every nurse must meet core competencies, and “It’s a good investment in terms of the bottom line a comprehensive, electronic patient-classification processes are standardized from unit to unit,” Matson that pays dividends with regard to positive patient acuity system that could more accurately forecast said. “We also have an inpatient float pool to help us outcomes, better overall care, and in avoiding staffing needs, said Dent, an ANA and Texas Nurses manage just-in-time and scheduled absences, and we penalties, such as those associated with preventable Association member. Previously, staffing decisions were engage in targeted recruiting for those areas of nursing readmissions,” McHugh said. being made with data that did not necessarily reflect — such as ICU and oncology — where we may have up-to-date changes in patients’ conditions, for example. ongoing needs.” A closer look So managers were constantly reacting to short-staffing “I, like many other nursing professionals, view safe situations. Parting words staffing like air and water; it has to be there,” said The new system further was validated by nurses Nurse experts understand that financial resources Kathy Baker, PhD, RN, NE-BC, the nursing director on the units to ensure that it did reflect staffing needs are not limitless, and that staffing mix and experience of patient care support and emergency services at based on the ability to meet patients’ needs on every are crucial considerations. Virginia Commonwealth University Medical Center shift. And nurses and leadership set the budgeted “At VCU Medical Center, we want all our nurses and Health System. “But because of the complex positions for nurse staffing at the 50th percentile of and allied health staff to safely and effectively care for environment in health care today, we need to be more the National Database of Nursing Quality Indicators® patients, and we want to allow them to practice at the sophisticated in how we look at staffing. In the ’90s, it benchmark. Using the 50th percentile in the all- top of their scope of practice,” Baker said. “To optimally was a matter of getting more bodies at the bedside. hospital database for nursing hours per patient day is staff, we need to look at patients’ needs over time on Now, it’s not just about the numbers, but rather only used to procure positions needed in the budget. a unit, and have the ability to have the right nurses in linking it to all the variables.” Those variables include These resources are then assigned to patients based the right places at the right times. And sometimes that patient acuity, experience of staff, staffing mix and the on their acuity level. means reorganizing, and not adding, staff.” changing needs of patients over time. Midland also decided to eliminate the use of outside Dent emphasized that having not only the Further, while she said every organization is nurse staffing agencies, and instead created a roughly appropriate number of nurses, but also well-rested interested in staffing and scheduling, no one really has 100-member resource team-float pool to fill in for staff nurses, is a moral and ethical responsibility shared by “owned” it. vacations, sick calls and when the patient census or all within health care. “The white paper fuels this dialogue and offers a acuity rises. The hospital still uses some travelers to “And we in nurse leadership have to be able to very positive staffing framework,” said Baker, a Virginia meet patient needs, and nurse managers can hire defend our budgets [for optimal staffing],” Dent said. Nurses Association member who lent her expertise ahead of the turnover curve. “We need to be able to tell our boards of trustees and to ANA’s 2014 Staffing Summit discussion and review Another vital factor in strengthening staffing and other administrators: “If we want to be able to deliver of the document. (The framework is built on ANA’s care is Midland’s shared governance system. quality care to our community, then here is the staffing Principles for Nurse Staffing.) “We have unit-based councils, and nurses can make we need and here is the evidence [that supports that The white paper, in part, examines the various forces decisions on staffing for what works for them, such as decision].” that have impacted discussions about staffing and bringing in a nurse who only handles admissions and To learn more or obtain the white paper, go to health care, from Affordable Care Act provisions and discharges, or staggering shifts in the ER so staffing http://www.nursingworld.org/Avalere-White-Paper-on- Institute of Medicine reports to changing demographics. is higher when more patients tend to come in for Nurse-Staffing. It specifically notes that existing staffing systems are emergency care,” Dent said. “That’s the power of unit- often antiquated and lack flexibility to adjust to factors, based councils.” — Susan Trossman is the senior reporter for The such as patient complexity, a rise in admissions, Midland also implemented fatigue management American Nurse. discharges and transfers, and the physical layout guidelines, and leaders conduct spot checks to ensure Page 16 Montana Nurses Association Pulse May, June, July 2016

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